HC Deb 16 January 1991 vol 183 cc866-908 4.23 pm
Mr. Speaker

I must announce to the House that I have selected the amendment in the name of the Prime Minister.

Mr. Robin Cook (Livingston)


Mr. Harry Ewing (Falkirk, East)

Move it formally.

Mr. Cook

I am afraid that 1 must decline my hon. Friend's invitation to move the motion formally.

I beg to move, That this House expresses concern at the effect on patient care of the closure of 4,000 hospital beds since the start of the financial year; records its alarm at the growing number of hospitals that have been forced by financial pressures to cancel admissions from their waiting lists for the remainder of the financial year; notes that health authorities have been compelled to take this unprecedented step because of Her Majesty's Government's damaging changes to the National Health Service which prevent them carrying forward a deficit; regrets the decision of the Government to impose self-governing trusts on 56 hospitals and other units despite the evidence provided by the consultation period of overwhelming opposition by public and by health staff, and deplores their decision not to submit this decision to debate in the House; and calls upon the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public. It is almost exactly a year since the House debated the national health service in the first Opposition day debate following the Christmas and new year break. In that debate, the then Secretary of State for Health gave the following ringing promise to the House: The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services".— [Official Report, 11 January 1990; Vol. 164, c. 1123.] At the time, I did not believe the right hon. and learned Gentleman and now I know I was right not to believe him. We meet this January in a winter during which more wards have been closed and more operations cancelled than last year or in any previous year.

Of course, we now have a new Secretary of State for Health and he comes to the job with clean hands. He is free, if he wishes, to criticise the mess that he has inherited from his predecessor, although he might be unwise to do that in this forum.

In trying to establish common ground on which we can build in the debate, I hope that the new Secretary of State will at least acknowledge that the position is now unique. Never before have dozens of hospitals in the health service been obliged to close their doors to patients on their waiting lists because the money has run out. That situation is without precedent in the 40 years of the NHS.

The nearest hospital to this place is Westminster hospital. In the second week of October, it closed its doors to all patients on its waiting list. Even now it is admitting fewer than half the patients for routine surgery that it would normally admit.

Westminster hospital is a teaching hospital and we depend on it to train and teach the next generation of doctors. In December 1 sat down with some of the medical students attached to Westminster hospital for six months and they told me that they were spending their six months without the experience of the routine surgery for which they had come there.

The financial crisis does not just affect the teaching hospitals or London. Morpeth cottage hospital occupies a different position in the spectrum of NHS provision. I do not want to offend my hon. Friends from the north-east by suggesting that that cottage hospital occupies the opposite end of the spectrum of provision in relation to Westminster hospital, but it occupies a different part.

Morpeth cottage hospital and Westminster hospital are linked by a common financial crisis. On 21 December, Morpeth cottage hospital closed a surgical ward and an operating theatre for the Christmas break. What makes the Christmas break unusual is that on this occasion neither the ward nor the operating theatre will open again until 1 April when we reach the new financial year.

Last summer the No Turning Back group created something of a political stand by producing its manifesto for a fourth term of Conservative Government. Part of the electrifying notions in that manifesto related to the proposal that the NHS should be an emergency service only and that there should be compulsory private insurance for other routine, non-emergency operations. Right hon. and hon. Members on the Treasury Bench, with the exception of the Minister of State, Scottish Office, the hon. Member for Stirling (Mr. Forsyth), who is sitting there, ran to distance themselves from those proposals. I recall the former Secretary of State for Health stating clearly that he did not accept that as a vision for the health service. Only six months later the new Secretary of State presides over a health service which in many parts of England is an emergency service only and in which no routine operations are available.

Mr. Max Madden (Bradford, West)

Will my hon. Friend give way?

Mr. Cook

I will give way now, but I am conscious that this is a half-day debate which is in danger of becoming a quarter-day debate. If the House will forgive me, I will not give way on every occasion.

Mr. Madden

I am most grateful to my hon. Friend.

My hon. Friend knows that wards are being closed in Bradford as a direct result of deficits and the same is true in many other health authorities. What is my hon. Friend's estimate of the amount of money required to make good that deficit to ensure that beds and wards are kept open, particularly when health authorities are being asked to be ready to admit 7,500 casualties who are likely to come from the Gulf within a matter of days, if not weeks?

Mr. Cook

I will refer to the Gulf later. However, with regard to my hon. Friend's question about the current deficit, the Government provided their estimate of the deficit in a written answer just before the House rose for the Christmas recess. The Under-Secretary of State for Health gave a figure of £40.5 million for the combined deficits across England. I rather suspect that that is on the low side, but even if it is doubled, we are still talking about a figure less than £100 million.

One of the ironies—a grotesque feature—of the present crisis is that hospitals are obliged to make deep cuts in the service that they provide to save relatively modest sums of their total budgets. We are inflicting cuts out of all proportion to the money involved. Of course, in many cases those cuts occur in hospitals that are particularly efficient. In his written answer the Under-Secretary of State explained those deficits as the result of "bad financial management". In his absence, I advise his colleagues in the Department of Health that I regard that approach as contemptible buck-passing. Many hospitals that have had to close their doors are among the most efficient in Britain.

Watford general hospital is recognised by Conservative Members for its waiting list initiative. In five months last year, one ward of 19 beds in that hospital treated 1,000 patients. It must have been one of the most efficient wards in any NHS hospital. That same ward was closed in November and will not reopen until April because of the lack of money to keep it going. What sort of signal does the Secretary of State think that that closure is sending to the staff who work in the wards of our hospitals? It is impossible to understate how much it demoralises the staff who deal with patients in our wards to be told that they must reduce the number of patients with whom they deal.

I have seen reports from Wrexham Park hospital in Slough which show that, in the past 18 months, it has cut its list by one third. Now, with appalling symmetry, that same hospital has been told to cut its operations by a third. The anaesthetist who worked on many cases when the hospital was clearing the waiting list said: After working after-hours and at weekends … to get the lists down, we now have to sit and watch them climbing back up. What about the signal that we are sending to patients from those closures? There is one unavoidable result of the closed wards and cancelled operations of this winter: more patients will wait for their operations and more of them will wait longer. That is not a matter of speculation by me. Several health authorities have made precise calculations about what closure will mean for their areas. South Bedfordshire health authority has closed 126 beds at its general hospital. Those beds will not reopen before April. The same health authority has prepared its own estimate of what will happen to the waiting list by next April: it is that, by April, the number of patients waiting for operations for general surgery, for urology and for orthopaedics will double. The waiting time for hernia operations will increase from 13 weeks to 36 weeks. The waiting time for hip operations will increase from 24 weeks to 66 weeks. Clearly, doctors are requested to take impossible decisions on who gets treatment and who does not.

Another hospital near to this place is St. Thomas's. In November, St. Thomas's imposed a ceiling on the number of abortions that it would carry out. That ceiling rests at nine cases per week. One local GP has been quoted as saying: It seems to be a lottery each Monday morning. Once the nine places are full, people are turned away. How can any consultant decide which nine women get the treatment for which they have been referred and which nine—or 19—women are turned away? It is wholly unacceptable that a woman's chance of the treatment for which her GP has referred her should depend on whether she comes to the front of the queue at the moment when there is a vacancy in that week's ration.

It is not only Opposition Members who are alarmed at the present situation. I do not imagine that Tory Members will speak up for what is happening in the hospitals in their constituencies—it is not in the nature of Supply day debates to do so. But many of them know that what is happening is unacceptable in their constituencies and to their constituents.

I am pleased to see the hon. Member for Harlow (Mr. Hayes) in his place, as he often is for health debates. He will know that I visited his constituency in December and the hospital that serves most of his constituents. It has one of the six longest waiting lists for general surgery anywhere in England. It would take one and a half years for the hospital to clear its waiting list, even at full working. While I was there, I saw a surgical ward being cleared of beds to be closed because the hospital will carry out only one third of the operations which it previously did. The hon. Member knows this well. Indeed, in the week after the Secretary of State was appointed, the hon. Member made a number of observations to the newspapers about the forthcoming crisis.

Mr. Nicholas Soames (Crawley)

He is very good at that.

Mr. Cook

I am glad to have the endorsement of the hon. Gentleman's colleague.

The hon. Member for Harlow struck on a happy phrase which was calculated to provide the maximum chill to the spine of a Conservative Secretary of State for Health. The hon. Member warned him that he faced another "John Moore winter", by which I presume that he was reminding us of the experience of 1987–88 when hospital cuts forced the national health service to the top of the agenda. Of course, that was the winter which pushed the Government into setting up the NHS review. The Government have spent the three years since dreaming up a dogmatic package to put health care into the market place and ramming that package through the NHS—deaf to the opposition of the public who use the service and blind to the informed criticism of the people who work in it.

Where are we after three years of near civil war in the health service? We are back exactly where we were when we started, with a winter of crisis in our hospitals. It is even worse than the crisis which began it all. The hon. Member for Harlow was, if anything, guilty of understatement.

Dame Elaine Kellett-Bowman (Lancaster)


Mr. Cook

I think that the hon. Member for Harlow can defend himself against that unworthy and unjustified criticism.

Dame Elaine Kellett-Bowman

I was making the point not against my hon. Friend but because my hospital runs its finances extremely well. It has all the latest technology. Its performance bears no relation to the picture that hon. Member for Livingston (Mr. Cook) has been giving over the past half hour.

Mr. Cook

No doubt the hon. Lady's constituents will be delighted that she is satisfied with the state of the health service that serves them. I have to say to her that the figures tell another story. In the whole year, including the winter, of 1987–88, a total of 3,500 beds were closed because of financial pressure. Already in the financial year 1991 over 4,000 beds have been closed because of financial pressure.

As the whole House will know, it is a cruel irony of history that during one of the deepest crises in the hospital service the national health service may be called upon to make the greatest effort to cope with the casualties of the crisis in the Gulf. The Secretary of State has given a guarantee, as have other Ministers, that the NHS will cope with all the casualties of the Gulf and with all emergency cases from the civilian population. Of course, it will not be the Secretary of State who will be called upon to honour that commitment. The people who will have to deliver on his guarantee will be the doctors and nurses who staff our accident and emergency units—the nurses who tend patients who may wait for hours on trolleys for beds and the registrars who spend those hours ringing round perhaps 20 hospitals looking for beds. I have no doubt that those nurses and doctors will move mountains to deliver the guarantee given by the Secretary of State.

But neither the Secretary of State nor the House has the right to require that effort of our health staff if we simply respond to the Gulf crisis by taking out of the present number of wards 7,000 beds which the military says that it might need. The Secretary of State must assure us—I hope that he will take the opportunity of this debate to do so —that as many as possible of those 7,000 beds will be provided by bringing back into service some of the 10,000 beds that have been taken out of service during the past three years.

Mr. Jerry Hayes (Harlow)

Will the hon. Gentleman be absolutely fair and straightforward about the 4,000 bed closures to which he referred? I am sure that he has read the report of the National Association of Health Authorities, which said that last year 3,500 beds were closed but most of those closures occurred for medical or health policy reasons such as new treatments which require shorter stays. That came from not the Department of Health but from a body as influential and authoritative as the National Association of Health Authorities.

Mr. Cook

I read that report with the greatest interest. I congratulate the National Association of Health Authorities on putting the best possible gloss on the data that it found. I was particularly struck with the paragraph in which it said that four out of 10 health authorities managed to get through the first six months of this year without closing beds because of financial pressures. Logically that leads one to the conclusion that six out of 10 health authorities have closed beds because of financial pressures.

Nor is that association the only witness. The survey carried out over several days by The Independent came to precisely the conclusion that I have quoted to the House. Over 4,000 beds have been taken out of service, either temporarily or permanently, at least partly as a result of financial pressures on health authorities.

There is another way in which the present crisis is more grim than that of 1987–88—the crisis which gave birth to the NHS review and led to the changes which are coming in April. We can be more dismal than we were three years ago because Ministers have dropped any pretence that the changes coming in April will solve the problem. In that, the Secretary of State is a sad declension from his predecessor. The right hon. and learned Member for Rushcliffe (Mr. Clarke) was always refreshing in his irrepressible optimism. He was a born-again reformer. He continually assured us that, once in place, the changes in the national health service would transform it and wipe away waiting lists. We may not have been convinced by his assurances, but at least we were entertained by him.

The right hon. Member for Bristol, West (Mr. Waldegrave) is much more cautious in his language. He will recall that he and I took part in a radio debate following the decision of Tunbridge Wells hospital that it, too, would close its doors to everyone but emergencies. When pressed by the interviewer on whether the new system in April would avoid such cuts, the Secretary of State was unable to overcome his natural honesty. His reply was that, under the new system, cuts would be smoothed over the year as a whole. In other words, in the new system we shall have service reductions every month of the year, not only the winter months.

Mr. John Marshall (Hendon, South)

Can the hon. Gentleman explain to the House how the abolition of prescription, eye test and dental charges and of competitive tendering which would cost the health service £500 million in total would do anything to solve the problems that he has described?

Mr. Cook

The hon. Gentleman asked three separate questions. I shall deal with two of the three. As he offered me a multiple choice question, that is not an unreasonable attempt. We have had ample evidence of what happens when competitive tendering is introduced. We get dirtier hospitals and patients are more poorly fed. We are not prepared to accept that in a public service.

I make a prediction to the hon. Gentleman—[Interruption.] If hon. Members will allow me to proceed with my speech, I shall make a prediction. All the companies that poured into the hospital sector three or five years ago thinking that they had found a honeypot are discovering that it is anything but. They are discovering time and again that they cannot provide the service required in the NHS and make a profit. I predict that if such companies continue providing services under tender for another three or five years prices will quickly be ratcheted up. That will wipe out the alleged savings, but we shall be left with a worse service.

The hon. Gentleman's other point was about the charge for eye tests. I make no apology to the House for repeating once again our clear commitment, as a matter of priority, to abolish the charge for eye tests and restore the free eye test. We shall do so because the charge is ruining an essential screening service. If only a fraction of the 3 million people who are not coming forward for eye tests develop serious and irreversible conditions of the eye and lose their sight, it will more than wipe out the alleged savings from that short-sighted measure.

Mr. Dennis Skinner (Bolsover)

The hon. Member for Birmingham, Edgbaston (Dame Jill Knight) will support us on that one.

Mr. Cook

The reference to short-sightedness is one which I should perhaps seek to change in Hansard when I have the opportunity to read my speech.

Before the hon. Gentleman interrupted, I was making the point that the changes in April will not rescue us from the present position. I hope that in the coming debate we shall be spared any Conservative Members telling us that we must have the changes in April to deal with the crisis in the national health service. The truth is the precise reversal of that. One of the reasons why we have the crisis this winter is the changes that are to take place in April.

The new system does not allow deficits. It was only because they could roll forward deficits from one year to another that many health authorities got through the past three years. Now even that freedom for manoeuvre has been removed. Conservative Members closed off the one turning space in which financial managers had some room for manoeuvre. Those financial managers are now exposing the underfunding of the service because they have lost the flexibility with which they used to conceal it.

Mr. Simon Burns (Chelmsford)

Will the hon. Gentleman give way?

Mr. Cook

I shall give way on this occasion, but it will be the last.

Mr. Burns

The hon. Gentleman is aware that the hon. Member for Derby, South (Mrs. Beckett) has said that the only spending priorities of a future Labour Government will be pensions and child benefit. The national health service would not be a priority. Does the hon. Gentleman agree with his hon. Friend, or can I tempt him to defy her in the House today and tell us what figure he would guarantee during the first year of a Labour Government for extra spending on the health service?

Mr. Cook

The decision which both I and my hon. Friend the Member for Derby, South (Mrs. Beckett) have taken is clearly spelt out in the record. It has been printed on several occasions, the most recent being last December. The spending commitments of the Labour party are perfectly clear. We shall fully fund pay awards in the health service. We shall make sure that year on year the health service is fully funded to meet demographic pressures, and during the lifetime of the next Government we shall restore the health service to the extent to which the Government have underfunded it. I shall be able to give the precise figure when the Government are willing to admit the degree to which they have underfunded the health service.

The present crisis and the troubles that are coming in April cannot be detected in the amendment tabled by the Secretary of State and his colleagues. The amendment before the House is of obtuse complacency. It recognises no problems and sees only successes. One series of statistics provides a measure of the health service in the 10 years of the Government's stewardship. They were not collected by the Government's statistical service. If they were, they would by now have been doctored.

The London emergency bed service has supplied figures on the number of times that it has had to go through the appeal mechanism to force hospitals to accept a patient for a bed. In 1980 and even in 1983 the emergency bed service had to trigger that procedure in only 7 per cent. of cases, but by 1988 it was triggering the appeal mechanism in 16 per cent. of cases and by last year in 29.5 per cent. of cases. In December last year the appeal mechanism was triggered in 41 per cent. of cases and in the first seven days of January the service was obliged to go through the appeal mechanism in 46 per cent. of all emergency cases with which it dealt. That is the reality behind the massive increases in resources to which the Government amendment refers. The reality is a fourfold increase in the number of emergency patients who must lie in pain and distress while an emergency service goes through an appeal system to squeeze an extra bed from the hospital sector.

Even when a patient gets into hospital, that does not guarantee him a bed. In the past financial year King's College hospital in Camberwell closed 120 beds. On 13 December the community health council counted 17 patients lying on trolleys in the accident and emergency department for whom there were no available beds. One patient who went through that procedure was Mrs. Julia Branch, who was admitted with kidney failure and who remained in acute pain for seven hours on a trolley in the accident and emergency department. At midnight she was transferred by ambulance to Dulwich hospital where a bed had been found. Her troubles did not end there. The bed that had been found for her was in a ward which was scheduled to be closed. Two days later she and the other patients in that ward were transferred to another ward at the other end of Dulwich hospital where she died the next day. She was 79. She belonged to a generation who voted for the national health service and who, through their working lives, paid to set it up. She deserved better from the NHS in her last three days than to be shuttled round in search of a bed that was not yet closed.

We are told that we now have a more human Government and that we have a gentler Secretary of State for Health. There is one obvious test of how much more caring and gentle they are. Three years ago the health service faced a similar crisis in our hospitals and that less caring, less gentle Government came up with extra money to stop the cuts. Will this new regime do the same, or is all the prattle about a more compassionate responsive Government so much cant?

There is another even more powerful precedent for financial help. The present crisis is provoked by the major restructuring of NHS finances in April. The cuts in our hospitals are a result of Ministers telling health authorities that it is for them to eliminate their deficit to make way for the financial restructuring. There is an obvious contrast with the entirely different way in which Ministers of the same Government have treated every public industry which they have privatised. Nearly every privatised industry has left the public sector with the generous parting gift of having its debts written off. British Steel had £4,500 million written off and the water industry £5,000 million. How is it that a Government can find more than £9,000 million to float two industries into the private sector, but cannot find £100 million to write off the deficit of the health authorities before the changes in April? Why is it sensible tactics to wipe the balance sheet clean because an industry is being privatised, but the wrong signal to management to give the same fresh start to a public service? Only this Government's double standards can explain why those questions are given different answers.

Tonight we shall give Ministers an opportunity to demonstrate their new caring credentials by putting to the vote our demand for the extra funds which the NHS plainly needs. We shall put it to the vote in the full knowledge that the Lobby will not demonstrate the new caring image. It will expose the same old double standards.

4.54 pm
The Secretary of State for Health (Mr. William Waldegrave)

I beg to move, to leave out from "House" to the end of the Question, and to add instead thereof, welcomes the substantial increase under this Government in the number of patients treated by the National Health Service and in the availability of new and better forms of treatment; notes that this has been made possible by massive extra resources provided by the Government, combined with more effective use of those resources; welcomes the further record increase in resources planned for the National Health Service in 1991–92; congratulates those hospitals and other units which have sought and obtained approval to manage their own affairs as self-governing National Health Service trusts; looks forward to the setting up of the new general practitioner fundholding practices; and supports the Government's reforms which will continue to put patients first by further improving the quality, quantity and cost-effectiveness of health services.". The background to this debate is sombre. We speak as a significant part of our armed forces is deployed ready for a battle which may be imminent. The admiration and pride of this House for them has been expressed eloquently from all sides. Let us today in this debate pay a special tribute to all the doctors and nurses out there with them who face many of the same dangers. Here at home our national health service, with all its immense capabilities, stands ready to provide the necessary support for the armed forces' medical teams.

Mr. Harry Cohen (Leyton)


Mr. Waldegrave

The House will forgive me if I use this opportunity to give an assurance that the management executive of the health service, in close co-ordination with the Minister of Defence, has made contingency plans which are well founded.

Mr. Cohen

What about private hospitals?

Mr. Waldegrave

I believe that there is little more that could be done and that the health service is ready.

It is right for the House to know how the Government intend to handle the financial impact on the NHS of what may happen. The situation is straightforward. We will provide the extra money to meet the full cost of any Gulf casualties. I have told the health authorities to let the hospitals know that they should spend what is necessary, and we are giving them guidance on how to account for and reclaim Gulf costs.

Mr. Cohen

What about private hospitals?

Mr. Waldegrave

If it is necessary for the resources of private hospitals to be bought with the money available, it is up to the regions to do so. I have told the health authorities—[Interruption.]

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The Secretary of State's opening remarks must be heard.

Mr. Waldegrave

Health authorities will be able to continue to use all the money in their normal allocations for patient care.

Mr. Cohen

What about private care?

Mr. Waldegrave

I have been assured that there will be no break in non-Gulf related emergency work, but people may have to wait a little longer in the short term for non-emergency treatment.

Mr. Cohen

Why should not private beds be available?

Mr. Waldegrave

People will understand that, even if the hon. Gentleman does not understand how NHS finances work.

Mr. Bob Cryer (Bradford, South)

It is profit before people.

Mr. Waldegrave

The hon. Gentleman's yah-boo behaviour is embarrassing the Opposition Front Bench as much as it is irritating the public.

With the extra money for casualties, the commitment to which I have announced today, health authorities should soon be able to catch up. At this stage, it is for me to pay tribute to the service and the management executive for the efficiency with which they have undertaken the task of putting the NHS on a war footing. If it comes to fighting, the House and the country will once again have reason to marvel at the resources or commitment and skill which the direst emergencies call forth from everyone in the NHS.

The ability of the NHS to respond to emergencies depends on there being a clear chain of command and a clear division of responsibility among the professionals who work in this enormous service.

Mrs. Alice Mahon (Halifax)

Jim Dyers of the Edinburgh Royal infirmary said that the 30 burns units in this country would be overwhelmed within days. What contingency plans does the Secretary of State have in mind for those victims?

Mr. Waldegrave

The hon. Lady is right that there will be great pressure on burns units if fighting occurs. I am assured by the NHS management executive that it can handle the situation. We have put contingency plans in place. [Interruption.] Perhaps I may be allowed to answer the hon. Lady, or perhaps she is not interested in the answer. I am advised that it is unlikely that we shall be unable to supply all that we need, but if that is the case, the resources of neighbouring European countries will be made available to us.

The ability of the NHS to respond depends on its management chain and management skills. This is not a matter simply of management theory. We need a service which knows where it is going, which is patient centred, which has clear targets to work towards and which is accountable. It is in that context that I want to place our health reforms.

Mr. Cryer

Will the Secretary of State give way?

Mr. Waldegrave

I do not know whether Back Benchers wish to speak in the debate. If not, the two Front Benches can fill the entire time with the hon. Gentleman's help. I shall give way to him and then perhaps I can proceed.

Mr. Cryer

Rather than seeking treatment in other European countries, would it not be simpler, better and more efficient to requisition beds in private hospitals rather than strain the NHS beyond endurance to deal with any casualties? Surely that would demonstrate that the Government are not putting profit before people.

Mr. Waldegrave

The hon. Gentleman displays less knowledge about the NHS than his Front Bench colleagues. The type of facilities that would be needed are simply not available in our private sector. The huge, skilled centres for burns units are to be found in the NHS only.

First, the philosophy behind our reforms is that there should be a separation of responsibility for the planning of health services from responsibility for the provision of health care—what we call the purchaser-provider split. This division is fundamental to our reforms. It is the key which makes it possible, for the first time, for us to have a national strategy for health that can actually be implemented. It enables us to define more clearly the proper responsibilities and functions of everyone who is involved in the health service. The distinct role of health authorities will be to assess the needs of their populations and decide how best they can be met. They will set local priorities and will contract with health providers to provide the best quality care at the best value for money.

Recently one general manager in the NHS described the new role of health authorities very well when he said: What the reforms will bring is a framework whereby what is being commissioned or purchased is an explicit statement of what we are doing to meet the health needs of the population. I must say that I have been heartened in recent weeks by indications that the Labour party agrees with this fundamental distinction, though I understand that its policy document prefers to talk of "performance agreements" rather than contracts. There seems to be an emerging consensus around the fundamental principles of how to manage the NHS which I welcome, whatever the difference in terminology.

Secondly, the clearer definition of needs and contracting to secure the right kind and quality of services will strengthen accountability. It will strengthen the accountability of the provider to its patients and it will strengthen the accountability of the purchaser upwards towards this Parliament. As the Secretary of State, I am responsible for developing health services that will lead to improvements in the health of the people. In the past, holders of my office of both parties—read the memoirs —have found that there were precious few levers available to them to secure the priorities upon which Parliament might decide.

The reforms initiated by my predecessor will give me, and my successors, a far better chance to develop policies and priorities that will secure improvements through the objectives set for the purchasers. That leads us on to the fact that in the arguments about organisational reform, as well as in the perennial argument about resources, we have had too little discussion of those true health policy issues in Parliament. I now want to place them firmly on the record.

Recent reports, for example, have shown the persistent existence of health inequalities in our country. That is a long-standing issue that has challenged and defeated previous Governments and continues to defeat Governments even in the smallest and richest countries that spend most on health.

I want to remind the House that the requirement in the reforms that health authorities assess the health needs of their populations will, for the first time, provide a mechanism for truly addressing those issues. If a future Government were to discard that mechanism, those who care about the public health would not thank them for it. We have therefore decided to work towards developing a national strategy for health with some hope at last that the health service's part in achieving that may be properly co-ordinated. The strategy will give the NHS a clear set of goals against which to measure success and to set its priorities. I recognise that that will not be an easy task. We will consult widely and I shall shortly be publishing a consultative document setting out our ideas. We shall use that to invite the views of all those concerned with a view to publishing a definitive strategy document towards the end of the year.

The third principle behind our reforms is that the new arrangements will ensure a closer dialogue between the hospital service and general practitioners. Under our proposals, hospitals must take fuller account of the wishes and contributions of GPs who are, in the normal run, the closest representatives of the medical interest of most patients. It is an inevitable concomitant of the contracting principle that consultations between GPs, districts and hospitals will have to become closer. I have already seen it happening. What is more, for the first time, GP fundholding will give GPs a route to direct financial empowerment if they feel that consultation is not enough to secure the services which they judge to be necessary for their patients. I regret sincerely that it is the present policy of the Labour party to throw away those aspects of the reforms and, in so doing, deny patients the benefits that will accrue. However, I have some hope that thoughtful Labour party sympathisers are questioning this present aspect of their party's policy.

Let me quote the views of Professor Le Grand, who, I am told, was a founder of the Socialist Philosophy Group no less, who said in a recent television interview: There is nothing in the new Labour proposals that will do anything about the power of patients or the power of GPs with respect to the power of consultants … Indeed, they are proposing actually to abolish the GP fundholding practice which is the one instrument that we have got"— so he says— at the moment for actually trying to control that power. I hope that we shall come together on this as, as far as I can see, that should not be in any way inimical to Labour's beliefs.

Fourthly, our reforms will return responsibility for managing hospitals to the hospitals themselves. Those who work in hospitals do so because they regard that as a way of providing help and support to other people. I want to give those employees the opportunity to manage for themselves the resources for which they are responsible and to be able to respond to need without constant referral to higher authorities.

Mr. William Cash (Stafford)

Trusts have been established in Stafford in advance of the arrangements that my right hon. Friend has described. The St. Christopher's trust works well and the hospice trust will work extremely well. I have visited the patients and it is clear that they and the employees benefit enormously from such trust arrangements. The existing practice in Stafford already shows that we are moving in the right direction with the current proposals.

Mr. Waldegrave

I agree with my hon. Friend. I have seen similar examples elsewhere.

If managements in hospitals are to be properly devolved, they need certain basic information about what things cost and the value of the assets that they are using. The reforms, with their emphasis on resource management and new technology, will ensure that that information becomes available. It will enable professionals and managers at all levels to make more informed decisions than have been possible in the past. Without it, talk of accountability, of setting priorities, of steering the service this way or that, is almost wholly empty. One cannot make rational choices if one does not know how much things cost.

Fifthly, the reforms will make available a more rational and explicit system for allocating scarce resources. The contracting system will introduce more flexibility and incentives for a more patient-centred service for hospitals and other units.

Hospitals will be funded according to the contracts they attract, which in turn will reflect the priorities set by DHAs and GPs when considering the health needs of their residents. This is far better than the present system of annual fixed-cash budgets for hospitals which so often seems to penalise efficient hospitals that treat more patients and indeed provide very little capacity to judge whether a hospital is efficient or not, leaving decisions to be made incremently just on the basis of what has happened before.

The Opposition motion refers to bed closures about which the hon. Member for Livingston (Mr. Cook) spoke justifiably. One aspect of this is surely now well understood. The number of hospital beds is not a good indicator of health service activity. The trend in bed numbers has been downward for very many years. Modern medicine is often less traumatic for the patient. Hospital stays are becoming shorter and for many conditions are being dispensed with altogether. The NHS is treating more patients than ever before. All the evidence supports that: in 1989–90 the NHS in England treated nearly 8.5 million in-patient or day-case episodes—an increase in activity of nearly 3.5 per cent. The number of day cases has doubled to 1 million during the past 10 years, so the NHS has been able to treat more patients using fewer hospital beds. I know that the hon. Member for Livingston is well aware of that trend. I have a quote from him recorded in Tribune, which I shall not bother to read out, which makes it clear that he shares the objective of getting people out of hospital beds if that is the right course of medical treatment.

I do not deny that there are cases when hospital budgets have not been properly controlled, usually in the first half of the year, leading to acute difficulties in the second half. No financial system whatever—this is the point I was seeking to make on the radio and which the hon. Member for Livingston did not accurately quote—is foolproof against that. The House should not expect us to reward bad management by diverting inevitably limited money from those who manage better. For that reason a motion that proposes so cavalierly that health authorities should simply go on carrying forward deficits is not one that the Government can support. I am well aware, however, that we will not eliminate all deficits this year.

I genuinely fear that the proposals in the Labour party document to give extra money to hospitals that exceed their "activity targets" would only increase the likelihood of mid-year crises and bed closures. Every hospital would race for the prize money in a system that—as Labour agrees on every page of the document—must be cash-limited. Not everyone can be a winner. It would be a recipe for year-end confusion and disappointment and much worse than the present system—bad though it is—from which we want to escape.

Next year, the health service will receive a real terms increase of more than 4.5 per cent. and a cash increase of £3 billion. We have increased National Health Service funding in real terms by more than 50 per cent. since 1979. That financial and political commitment has undoubtedly been a key factor in enabling the service to treat more patients and to make more widely available new advances in medicine. The world of 1978–79, when defence received more than health, seems a long time ago.

Mr. Robin Cook

Will the Minister allow me to intervene?

Mr. Waldegrave

I did not interrupt the hon. Gentleman, but I will allow him to interrupt me.

Mr. Cook

I intervene because I should not want that statement, which has been uttered by the Minister's predecessors on many occasions, to go on to the record unchallenged. In 1978–79, the health budget was higher than that for defence, as it was in every year since 1969 until 1980. It was the present Government who started spending more on defence than on health for the first time in 15 years, and they can hardly pride themselves on reversing the priority that they set.

Mr. Waldegrave

It is clear that Labour's spending priorities for the future do not give room for any confidence that it can do better than we are doing in the provision of resources. I shall justify that statement shortly.

I will make one more party point in the everlasting debate about who would do better in the provision of resources. Last year, the hon. Member for Livingston said that Labour would increase NHS funding by £3 billion over the life of a Parliament. We are doing that in one year. Wisely, the hon. Gentleman now refuses to put a figure on his commitment, partly because he has been silenced by the right hon. and learned Member for Monklands, East (Mr. Smith), and partly because he fears that we might achieve his new figure the year after. The hon. Gentleman's commitment has become subject, quite rightly, to the overriding qualification that he would be allowed to spend only what the economy could afford.

Speaking to Shearson Lehman, an American finance house, the right hon. and learned Gentleman went on record as saying that Labour would maintain a responsible fiscal policy, with prudent control over public finance, spending only as resources allow and as the economy can afford. That is all very sensible, but the unfortunate hon. Member for Livingston is consequently not only unwilling to say how much Labour would spend on the NHS but is unable to stipulate where health stands in Labour's set of priorities. According to the hon. Member for Copeland (Dr. Cunningham), education is Labour's top priority. I have heard that there are serveral other top priorities, which means that the spending pledges made by the hon. Member for Livinston will have to go in the queue with all the other topics that Labour Members have earmarked as so-called top priorities.

I apologise to the House for briefly delving into the past, but it is as well to remind ourselves that the one and only time in the whole history of the NHS when funding ceased to grow in real terms was in 1977–78, under Labour. It is true that Labour achieved a 1.5 per cent. real increase for health when in government, but we have doubled that figure. They were half as good as us, because we have achieved a 3 per cent. increase.

Mr. Robin Cook

Will the Minister give way?

Mr. Waldegrave

The hon. Gentleman might have an opportunity to make further points later but I shall give way to him for the last time.

Mr. Cook

The Minister's figures are totally incorrect, and are the same as those used by the Parliamentary Under-Secretary of State in last December's debate, which I checked at the time. Those figures left out of the reckoning the year 1974–75, and assumed that a Labour Government began in 1975–76. If one starts instead in 1973–74—as I got the Library to do for me—one finds that under the last Labour Government, health service expenditure increased by an average of 3.3 per cent., whereas under the present Government it has shown an increase of 2.9 per cent. Even that improvement is based on the massive rise during the Clegg years. If one takes the last 10 years, which is long enough to provide a proper comparison, the average increase under this Conservative Government has been 2.3 per cent. In the last five years of the previous Labour Government, the increase in health spending was 40 per cent. higher than during the last 10 years of the present Government.

Mr. Waldegrave

The hon. Gentleman would have done his reputation more good if he had not made that extra-long wriggle. I remember, because I was working in Downing street at the time, that there was a Conservative Government during all but the last month of 1973.

We have been given another example of Labour's increasing equivocation, and the hon. Gentleman's credibility in respect of resources is wearing pretty thin. That is being increasingly admitted by honest Labour supporters. I quote Professor Le Grand: The Conservative Government has promised an extra £3 billion for the next financial year … It's difficult to imagine that Labour could do much better given the other demands that Labour will undoubtedly face on taking office. I would substitute "would" for "will". Otherwise, every Labour Member knows—outside these knockabout Wednesday debates—that whatever party loyalty demands that he say, the professor is right.

At least there is now some consensus between us that resources will always be finite and that no system can absolutely guarantee that health authorities or hospitals will not spend more than their budgets, because Labour is committed to cash limits. That is one beneficial aspect of the support of Opposition Members for a party that agrees to cash limits. However, poor budget management means crisis management, which harms patient care—and that message is getting through.

In 1989–90, well over 100 districts showed a deficit. This year, 51 districts are currently predicting deficits, and all but a handful will have sorted themselves out by the end of the year.

Mr. Thomas Graham (Renfrew, West and Inverclyde)

Will the Minister give way?

Mr. Waldegrave

I have allowed several interventions, but in the interests of Back Benchers, I do not think that I ought to give way again. No doubt the hon. Gentleman will catch your eye, Madam Deputy Speaker, for he is a substantial figure.

Only a very few districts expect to have to take further action next year. The House will agree that that is an encouraging picture, but it has not been achieved without difficulty. In some places, it has contributed to waits for treatment which are too long. We are determined to continue the attack on that problem, and I am pleased to be able to tell the House that the Government are making available an extra £35 million to enable health authorities to tackle waiting lists in 1991–92. Of that, £25.5 million will be allocated direct to health authorities in quarterly instalments, linked to reductions in waiting times that have been agreed with the management executive.

For the first time, we are also asking regions to match those allocations pound for pound from their own resources. They have agreed, which means that, overall, a total of £51 million will be available in the next financial year for schemes to reduce long waits.

As I demonstrated, we invested record sums of money in the NHS during the 1980s, but that in itself is not enough. No system can afford to stand still and let the world change around it. The task for the 1990s is to build on and to better that record.

It is generally recognised that as wider ranges of treatment are developed, and patients' expectations are raised, the cost of providing health services goes on increasing. Some commentators have pointed out that by extrapolating trends in straight lines, we could theoretically end up using more than 90 per cent. of the national budget on health care. That cannot happen, and it will not happen, because we will all the time have to be taking difficult decisions about priorities and relentlessly addressing issues of efficiency.

Mr. Graham


Madam Deputy Speaker

Order. The Minister has made it abundantly clear that he will not give way again, and hon. Members should not persist in trying to intervene further.

Mr. Waldegrave

We need to examine more closely the right balance between prevention and treatment. We must make health the true indicator of the effectiveness of the NHS. The service has brought about steady improvements in the nation's health. Life expectancy for men and women has gradually increased, and, at the other end of the spectrum, infant and perinatal mortality rates are now the lowest ever recorded. However, there is still a long way to go—for example, in getting at heart disease by encouraging better diet and more healthy lifestyles.

We have already taken steps to bring about a better balance. The new contract for GPs, which emphasises their role in promoting the health of their patients, is bringing benefits. Many patients can now attend health promotion clinics to get practical help and advice on staying healthy. Helped by the introduction of payments to GPs for reaching immunisation targets, we achieved 90 per cent. uptake rates for diphtheria immunisations last year. We have had similar success with the new combined mumps, measles and rubella immunisation. Against this background, I hope that I am wrong in thinking that the Labour party is still committed to repealing the GPs' contract. Could it really wish for a falling-back in immunisation rates to the old level? Surely not.

Mr. Charles Kennedy (Ross, Cromarty and Skye)


Mr. Waldegrave

I have explained that I must press on and I am nearing the end of my speech.

These achievements by GPs are really remarkable, particularly in light of the fact that expert commentators had doubted whether the targets could be achieved. If I may quote one: The targets … are so heroic, so far beyond the present figures for most practices, … that many doctors will give up trying". As the hon. Member for Livingston knows, that was the hon. Member for Livingston's view in words that he used in the House in July 1989. I am happy to report, as I am sure he is, that GPs took not the slightest notice of him, and I am sure that he now joins with me in congratulating them on what they have done and welcoming the great benefits to patients arising from those higher targets.

Our policies for NHS hospitals—both trusts and directly-managed units—and for the NHS as a whole are, we believe, policies which deserve the support of those who work within the NHS and of this House.

Of course, within the huge resource increase of the last year and of next year, we will not, by some magic, be free of pressure on resources or arguments about resources. They are inherent in a politically accountable health service, which I believe had its first funding crisis two years after it was founded. But what we will have, at last, is a far more powerful system for securing even better value for the patients from those increased resources. Simply listing present problems—a technique of debate to which I could reply by listing all the problems that there were under Labour from the winter of discontent upwards or downwards—does not address the real issues. What the Labour party needs to do today is to convince the House that it has any ideas which merit our consideration about how better to manage the service so as to secure further improvements in our nation's health. I do not believe we have heard them, nor do I believe that we will hear them. Therefore, I wholeheartedly commend the amendment standing in the name of my right hon. Friends and myself to the House.

5.21 pm
Mr. David Hinchliffe (Wakefield)

I apologise to those on the Front Benches for the fact that I will be absent from the Chamber for the winding-up speeches. As some of my hon. Friends are aware, I hold an important post in this Palace as joint secretary of the all-party Rugby League group; we are to have an important meeting with the Minister for Sport at 6 o'clock, so I have to be present.

Having listened carefully to the Secretary of State for Health, what worries me is that the Government appear to view this crisis as purely and simply an academic book-keeping exercise. The Secretary of State made no mention of the implications for patients of the present cuts. I want to concentrate on the important human consequences of what is happening in the national health service, with the present beds crisis. Two cases in Wakefield, which I shall mention, typify many of the problems facing individuals who need health care because of the Government's policies.

I make no apology for being parochial, because the health authority in Wakefield has an excellent track record of being first in the field to make massive cuts, bed closures and even hospital closures. That was repeated in November, when there was an announcement of the closure of nearly 100 beds in two hospitals treating my constituents in Wakefield. At Pinderfields hospital, which serves most of my constituents, and is in the constituency of my hon. Friend the Member for Normanton (Mr. O'Brien), 22 beds were closed on S ward, a general surgery and neurology ward; 22 beds on H ward, an orthopaedic ward; five beds on ward 2, a neurology ward; 17 beds on ward 5, a general medical ward; and 16 beds on C ward, the plastic surgery and dental ward. At Clayton hospital, in my constituency, 13 beds were closed on Queen Victoria, the gynaecology ward.

In addition, short-term contracts for people employed by the health authority have been terminated, and there has been a freeze on all vacant posts, including nursing posts. Those policies, and the implications of the cuts, have an important bearing on the range of treatments available to my constituents, and there have been dire consequences. I am learning of these daily, as people approach me to tell me of their circumstances.

For example, I am aware that two sessions of ophthalmic operations per week have been lost, which directly affects large numbers of elderly people suffering from such worrying conditions as cataracts. In Wakefield, we are fortunate in having a good ophthalmic service. I know the consultant, who has effectively treated a member of my family, and has done a first-class job of trying to reduce waiting lists. His efforts are set back by this policy.

Patients are having to be admitted to wards in which they would not normally be placed. Nursing staff have expressed their anxiety to me about the fact that patients with special needs are in wards where the medical equipment required for their conditions is not available.

I pay sincere tribute to the medical, nursing and ancillary staff in the Wakefield hospitals for the way that they have been trying to continue to provide a service, despite the effects of the Government cuts. For example, I have been told that doctors on S ward at Pinderfields continued to admit patients after the bed closures decree was announced by management. To prevent them from admitting patients to that ward, the management locked the doors. It is worth pointing out that complaints have been made to the fire prevention officer and to the Health and Safety Executive, because padlocks have been fitted to fire doors on that ward to prevent the admission of patients.

Mr. John Battle (Leeds, West)


Mr. Hinchliffe

As my hon. Friend says, we have reached an incredible situation because of the Government's policies. One ward sister, Christine Robinson, whom I happen to know and who works at Pinderfields hospital, said to me yesterday: "You can lock ward doors but you can't stop strangulated hernias and acute appendicitis." That sums up the position within the NHS at the moment because of Government cuts.

The implications for constituents are clear. What saddens me about the Secretary of State's contribution to the debate is that he made no reference to the human consequences of Government policies.

I shall cite two cases in my constituency. The first concerns a lady whom I shall not name. I have a letter from her in my hand, and the Secretary of State and the Minister are welcome to see her comments. This lady, a pensioner, had physiotherapy and x-rays for a painful hip condition. In June last year, she was told that the only treatment that would help was a hip replacement operation. In her letter, she writes: My doctor got in touch with Pinderfields for an appointment, which after a long wait duly came for the 14th November nearly 6 months later. To overcome this I went to see the orthopaedic specialist privately at the end of August and paid £50, which is very much against my principles but for my own peace of mind I paid the consultant's fee. Quite a sum when you are on a pension, of £50.34. However, I felt it was money well spent and was anticipating having the operation in October/November. However, the day I thought I would be going into hospital they decided to close the female orthopaedic ward. The only consolation I have was that 25 other women were suffering from something similar to me. Obviously, apart from being disappointed, I am gradually getting worse. Now, it could be March before I hear anything. I am very fortunate in that I have caring and loving neighbours and friends from church who are willing to give me transport. I have virtually been a prisoner in my own home since July. That was one of a number of cases of constituents who have been affected by the cuts in the NHS—

Mr. Cryer

Will my hon. Friend give way?

Mr. Hinchliffe

With respect to my hon. Friend, I must leave the Chamber soon, so I have to make a hurried contribution.

My hon. Friend the Member for Livingston (Mr. Cook) mentioned a constituent who had unfortunately died, and my constituent, too, has contributed to the NHS since its inception—yet when she desperately needed help, when she was suffering discomfort and pain, she received this sort of response from the NHS under this Government.

My constituent's circumstances are a direct consequence of Government policy. That policy is deliberately designed to contract state health care. We have often heard hostility to it expressed by Conservative Members, a hostility that has existed among them since the NHS began in the 1940s. Government policy is actively to encourage charitable fund raising. One cannot move in certain supermarkets in my constituency these days for people rattling tins—decent people who care that others are suffering because of lack of investment in the NHS, and raising money for diabetic provision, for spinal injuries, for breast screening and for terminal care, all of which should be funded by the NHS. But we are down to rattling tins, as we were before the NHS came into being.

Government policy is also about forcing people into private health care, with the sort of dire consequences that befell a constituent of mine—a pensioner who had to pay her entire week's pension to get a private consultation which she should have been granted on the NHS, for which she has paid all her life. Her name was Mrs. Margaret Hardacre, a lady who has unfortunately succumbed to certain problems in the private health care sector. She told me almost a year ago about the difficulty that arose when she was given a bill for £6,665 for the removal of bunions at Methley Park private hospital near Leeds. She had used her husband's medical insurance policy, provided as a perk through his job, with an organisation known as Western Provident Association. Faced with this enormous bill, my constituent found that Western Provident Association was not prepared to meet it, because it claimed that her problem related to an arthritic condition that she had had before she applied to join the association's scheme.

Professor Wright, professor of rheumatology at Leeds general infirmary—one of Yorkshire's experts on this condition—and the surgeon who treated my constituent for her condition, a Dr. Ghali, who is based in Wakefield, both certified that the foot trouble for which she had claimed benefit was not caused by or related to osteoarthritis. So clear medical evidence presented to the company was rejected—

Mr. Hayes


Mr. Hinchliffe

I have already told my hon. Friends that I am not prepared to give way. Usually, as the hon. Gentleman knows, I would.

This lady suffered hell for two years, harassed by debt collectors and threatened, in a series of letters from debt collecting agencies, with court action because she had not paid the £6,665. Finally, it was only letters from me and, I suspect, the fear of Western Provident Association that I might raise the matter in the House which led the company to make an ex gratia payment to cover the costs of treatment. But now my constituent is faced with legal bills of £620 arising out of her need to defend herself against court action taken because of her alleged debt. Western Provident also refused to pay for the completion of the course of treatment on which she had started some time before. I believe that WPA is obliged not just to pay for the completion of the treatment but to meet the legal fees that this woman has incurred.

This is but one example of someone facing difficulties with private health care—the sort of system towards which the Government want to move. The logical outcome of what is proposed, with effect from 1 April, is that people will face this sort of appalling debt and the kind of hell through which my constituent went for more than two years.

I have heard it said that the Gulf war is taking the public eye off other Government domestic policies—on the NHS, education, community care and the economy—but I am sad to have to say that it will be the Gulf above all which will expose once and for all what the Government have done to the NHS.

5.35 pm
Dame Jill Knight (Birmingham, Edgbaston)

I often think that it is the small courtesies of this House which oil the wheels, and it is a courtesy, when a new Minister comes to the Dispatch Box for the first time, for his colleagues to wish him well. I am pleased but surprised that I should be the third speaker in the debate and yet be the first to welcome my right hon. Friend most warmly to his new job.

I assure the hon. Member for Wakefield (Mr. Hinchliffe), without the need for the slightest consultation with my colleagues or the Prime Minister, that the Conservative party did not encourage Saddam Hussein to invade Kuwait to get the Conservative Government off the hook.

What a shabby little motion the Opposition are having us debate tonight—heavy with emotion but light on facts, redolent with implication but divorced from reality. First, the motion mentions the closure of hospital beds. My hon. Friend the Member for Harlow (Mr. Haynes) rightly drew the attention of the House to the fact that, once again, the hon. Member for Livingston (Mr. Cook) had his facts wrong. The National Association of Health Authorities, in no way in the pocket of the Conservative party, says that 3,500 beds have been closed this year, not the 4,000 mentioned in the motion. The NAHA also draws attention to the fact that this therefore concerns 2 or 3 per cent. of all beds in the country. It drew the conclusion, moreover, that most of those closures occurred for medical or health policy reasons, such as new treatments requiring shorter stays.

The motion conveys, as it is intended to, an horrific picture of 4,000 sick people bodily thrown out of hospital beds or callously not put in them, but the important thing is not whether beds are closed but whether patients are treated. During many hospital visits, some to constituents, some to friends and some official, I have seen empty or near-empty wards while there has been plenty of capacity in the wards next door. If it is a matter of keeping such wards heated, lit, clean and staffed just for the look of it, I am against such a waste of health service resources. I cannot condone waste of resources, although I recognise that the Labour party can, and does.

Mr. Hayes

Will my hon. Friend give way?

Dame Jill Knight

I am trying to make a short speech, but I shall allow one intervention.

Mr. Hayes

I am grateful to my hon. Friend. She referred to the Labour party. However, the Opposition do not seem to care too much about health, because not a single Opposition Back Bencher is here for their own debate.

Dame Jill Knight

At least let us be thankful that the two Front-Bench spokesmen are still here and sticking to their posts.

Mr. Hayes

But chatting between themselves.

Dame Jill Knight


The motion does not claim that 4,000 people are desperate because they are not getting the care they need—even the Opposition know that such a claim is untrue—but that is the clear implication of the motion. It is important, therefore, to highlight the fact that more patients are being treated than ever before. About 25 per cent. more in-patients and about 50 per cent. more day or out-patients are being treated a year. One cannot complain about the closure of beds and imply that people are not being treated, while at the same time ignoring the fact that so many more people are being treated by means of far more complicated, and therefore much more expensive, operations and drugs than ever before.

The motion refers to the cancellation of hospital admissions from waiting lists. As new operations and better treatments come on stream, with the result that many people can be cured or can have their condition alleviated, which would have been impossible only a few years ago, the demand for treatment by these new means becomes heavier and heavier. As the capacity of the NHS to cure people increases, waiting lists also increase. A sum of money has been allocated for the specific purpose of reducing waiting lists; it amounts to £119 million over four years. It has enabled 500,000 additional patients to be treated, and waiting lists in many hospitals have been greatly reduced.

Dame Elaine Kellett-Bowman

And extra money is given to those hospitals.

Dame Jill Knight

Of course. It seems as though extra money is made available nearly every week.

Dame Elaine Kellett-Bowman

Yes, it is.

Dame Jill Knight

When it comes to bed closures, it is easy to over-simplify the waiting list issue. Many waiting lists are false. When hospital administrators want to get people into hospital for their operations, they often find either that those people had their operations some months ago in another hospital or that they no longer need the operation. The waiting lists in many hospitals are known to be false, because those who were waiting to go into hospital do not always let the hospital know that they no longer need the bed.

It is also easy to over-simplify in another way. A 70-year-old who is waiting for a hip operation cannot be put into a maternity hospital bed, and a person who is waiting for a kidney transplant cannot be treated in an ear, nose and throat ward. It is useless to tie waiting lists to the allegation that people are denied the treatment they need. All hon. Members know of people in their constituencies who need hospital care. I am sure that they all do, as I do. When I find that treatment is urgently required, I get on to the doctor and ask why that person has not been admitted to hospital. I have never yet failed to get someone into hospital when that person genuinely needed to be admitted as an urgent case.

The motion raises its grubby little hands in horror at the very idea that any cash deficit should be other than written off; then it has the colossal cheek to demand a cash increase. We were asked why deficits can be written off if a hospital intends to go private but cannot be written off if it intends to remain within the national health service. Nothing would more greatly ensure the continuation of deficits than continually writing them off. If any hospital goes private, debts incurred after privatisation will no longer be the responsibility of the national health service. To suggest that all deficits in NHS hospitals should be written off would be to ask for trouble.

The Opposition had a colossal cheek in tabling this motion. First, they want more money to be spent on the NHS. However, they consistently refuse, as the hon. Member for Livingston (Mr. Cook) has done again today, to say how much money they would make available to the NHS. We say that we must make X, Y or Z amounts of money available, but the Opposition will never say how much they would make available. Let them shut up until they can answer that question.

Secondly, the Opposition conveniently ignore the enormous amount of additional money that the Government have poured into the NHS. If the allegations made by some Opposition Members—that the Government want the NHS to wither away—were true, I do not believe that we should have poured money into the NHS, as we have done so magnificently, over so many years. We have done that every year since we came to power.

Opposition Members may not like it, but I must remind them that, when they left office, only about £8 billion each year was being spent on the NHS. That figure has risen to over £30 billion a year. How, in heaven's name, that can be described as a cut, I do not know. Even after taking inflation into account, NHS funding has increased by about 50 per cent. I do not know how the Opposition can have the brass neck to demand that the Government ought to provide more money for the NHS. The increase in NHS resources that has been provided by the Government has been described as peanuts. To my mind, £22 billion is a pretty hefty peanut.

Thirdly, it is a cheek for the Opposition to couch their motion in these words, because they spent infinitely less on the NHS when they were in office. I wonder what would have happened to those people whose cases have been described by Opposition Members if a Labour Government had been in power. For the first time, cuts were made under a Labour Administration. What about the lady whose sad case was described by the hon. Member for Livingston? We were all shocked to hear it, but how would she have got on? The case of another lady aged 79, suffering from kidney disease, was described to us and the implication was that it was this wicked Government who had caused her death. I am very sorry that the lady died, but I cannot think that the blame can all be placed at the Government's door when a 79-year-old lady with severe kidney problems dies. I believe that she would have had infinitely less chance of survival had she had the misfortune to be sick under a Labour Administration.

The fourth reason why it is a cheek to ask the Government to increase the amount of cash for the NHS is that the Opposition consistently oppose all our efforts to end waste of cash by the NHS. Time and again I have attended these debates and listened to the reasons why amendments and different arrangements are being introduced in order to stop the waste that everybody connected with the health service knows has gone on for years. We have tried to stop that waste and have been very successful. However, every time we have tried in any way, shape or form, the Labour party has fought us tooth and nail.

The motion refers to "imposing" self-governing trusts, but hospitals have to apply to become self-governing. How can one have something imposed on one if it has to be applied for and if certain stringent conditions have to be met? Again, the motion is inaccurate. There can be no imposition of self-governing trusts when the management have to demonstrate what skills they have, what benefits would accrue to patients, and other things. I can well understand that the Confederation of Health Service Employees does not like it, because it might curb the wings of the militants and, Lord knows, there are enough militants in COHSE.

To say in the motion that the public are against self-governing trusts is quite wrong. They are strongly in favour of hospitals becoming local entities again and they love the idea of hospitals choosing what they want to do and perhaps having a matron again if they so wish. That pleases many people, but the Labour party does not wish to know that. [Interruption.] If the hon. Member for Coventry, North-East (Mr. Hughes) does not know anything about hospitals, he should try to learn before attending a debate. As you are aware, Madam Deputy Speaker, one of the most successful hospitals in Birmingham has a matron. The public know that, approve of it and would like to see more matrons.

I want to refer to the new burdens that will be imposed on the health service as a result of the Gulf war. That is a more up-to-date topic than this tired old rubbishy motion, and it touches on the comments in our amendment about putting patients first, and on what my right hon. Friend the Secretary of State said in his speech. Some constituents are worried about the effect of the Gulf war on patient care in this country and possible casualties taking hospital beds. We made a decision in the House yesterday with an overwhelming majority—one of the largest majorities I can remember in recent years—to follow the United Nations line, and that may mean that casualties will have to come here. However, there are base hospitals in the Gulf and, as I understand it, there are six or eight service hospitals in this country ready and waiting to receive service personnel who may be injured.

Let us be frank: soldiers, airmen or service women who are injured in the Gulf have every right to expect to be treated in British hospitals. They have as much right as motorway accident victims or any other victim. We must recognise that. We do not know what will happen, but we must face the fact that if there were, heaven forfend, large numbers of casualties from the Gulf, there could be an effect on non-emergency cases here. I must stress that it will affect only non-emergency cases. I believe that my right hon. Friend said that it does not alter the position of emergency cases in this country, and he referred to the fact that extra money is being made available to cope with the problem.

No one on either side of the House is complacent or entirely satisfied with every aspect of the health service. We care just as much as Opposition Members when people need medical care and cannot immediately obtain it. Let us have that out of the way.

Let us also have out of the way the accusation that we are trying to get rid of the health service. Far from it. We are as dedicated to the principle as any Opposition Member. I believe that Britain has a health service second to none for its expertise, easy availability and effectiveness. The Opposition constantly seek to belittle or misrepresent it but their ill-judged attacks cannot overcome the solid experience of those who have sampled health service care. The hon. Member for Livingston has only condemnation, but patients have appreciation, gratitude and understanding. It is the motion that should be condemned, not the Government.

5.55 pm
Mr. Charles Kennedy (Ross, Cromarty and Skye)

I shall be brief, and I shall not pursue all the points raised by the hon. Member for Birmingham, Edgbaston (Dame J. Knight). She backed up some of her points with argument, and she justified some with facts, but by no means all. In opening the debate today, the new Secretary of State struck a different tone from his predecessor and seems, rather like the new Prime Minister, to be opting consciously for a quieter tone, if not a quieter approach. As far as it went, that is welcome to those of us who have been used to the at times dismissive attitude of his predecessor. However, essentially his song remains the same, albeit dressed up in rather more theoretical packaging than we have been used to from his more street-fighting predecessor when he was at the Dispatch Box.

The Secretary of State addressed the points raised by the hon. Member for Livingston (Mr. Cook) about bed closures. The hon. Member for Edgbaston went on to defend the Government's position as she saw it, and criticised the figures in the motion and the arguments behind them. The hon. Member for Edgbaston criticised the Labour party's motion, because it specified a figure of 4,000 beds lost. She told us that the true figure was 3,500, as if that was a vindication of the Government's position. —[Interruption.] I accept that that figure is from the report of the National Association of Health Authorities and Trusts. The House will understand that the hon. Member for Livingston does not consult me when he drafts his motions, but I think that the figure of 4,000 was from The Independent newspaper survey published in the same week as the report.

As the hon. Member for Edgbaston said, whether the number of beds lost is 3,000 or 4,000, it represents 2 per cent. or 3 per cent. of all acute beds in the country. How can any of us be sanguine about that when we all know of the waiting lists about which our constituents write to us and about the operations that they are waiting for and the countinuing physical discomfort, pain and sense of frustration that they feel when they encounter such a position? It is a pretty weak case for the hon. Member for Edgbaston to say that it represents "only" 2 per cent. or 3 per cent. of acute beds and that it is "only" 3,500 as opposed to 4,000.

It is worth putting that in the context of the Government's record since 1979. On that basis, over 70,000 beds have been lost from the 1979 United Kingdom total. That represents over 16 per cent. of all NHS beds, and it is an alarming figure. Upwards of one fifth of our NHS bed provision has gone during the lifetime of this Government.

As well as the facts themselves, there is an aspect of the interpretation of the facts with which I wish to take issue with the hon. Member for Edgbaston. She said that we must look at numbers treated. I agree with her to a large extent, and the hon. Member for Livingston acknowledged that too. However, we must not allow the numbers treated to disguise the fact that, all too often, other pressures or considerations are creating the larger numbers being treated, making it look as if there is an improvement when it might be something else.

I give the hon. Gentleman two examples. First, we must judge the quality of care that is being provided, not just its rapidity. At times, those two concepts cannot, by definition, work together. A rush to get people out of available post-operative beds so that other people in the queue can use them may mean elderly people having to return to homes that have less than satisfactory standards of care.

The quality of care is important, but, secondly, if that quality of care and post-hospital care is not sufficient, all too often it leads to the revolving-door syndrome, when the same person is readmitted for further treatment or because of additional complications or a recurrence of the original problem. The readmittance of that patient counts as a further treatment statistic, which is then trumpeted by the Minister as further evidence of the success of the Government's health policy. In many cases, the readmittance of that patient represents a failure of health care, hut he has clocked up a further treatment point for NHS statistics. Those two major caveats weaken the case of the hon. Member for Edgbaston.

The figures on underfunding provided by NAHA—there has been no question of trying to discredit that organisation in previous debates—are alarming. I shall not cite all the statistics for the cumulative period of the past decade, but it estimates underfunding of the health service at about £3.25 billion. That is a substantial amount of money, and I notice that the hon. Member for Macclesfield (Mr. Winterton) is nodding in agreement. He is a long-standing member of the Select Committee on Social Services. Some years ago, I served on that Committee with him, and we undertook an analysis of real-terms growth expenditure in health care, as set against perceived need. We arrived at a distressing shortfall in aspiration and in what was being delivered. That earlier experience, taken with the up-to-date figures, shows that there is far more of a problem than the hon. Member for Edgbaston was willing to acknowledge.

Hon. Members have mentioned the dreadful circumstances in the Gulf. I wish to raise an item that was not dealt with satisfactorily—off-stage noises were being made by several hon. Members who are no longer present—concerning the role of the private sector, about which I wrote to the Secretary of State last week. Tragically, we are now on a national war footing, and it appears that we shall be involved in military conflict sooner rather than later.

It is right—I voted with the majority last night—that the best provision should be made for service personnel who return home injured and in need of treatment. If any of our troops are injured in carrying out their instructions with courage and skill, the whole country, irrespective of the divisions on the rights or wrongs of them being sent to the Gulf, will want the best possible standards of care to be made available to them. There can be no serious debate or argument about that.

The Secretary of State said that he has taken steps to encourage the provision of national health service beds and that, contractually, it is for health authorities to take decisions on available private sector provision in their areas; but that is not good enough. I do not say that from an ideological standpoint of being anti-private sector, but if the Government are being consistent and are saying, as they do in so many cases, that there should be more mutual understanding, cross-exchange of information and co-operation between the private medical sector and the public sector, on an issue as fundamental as military conflict, with injured troops returning home, the private sector should subscribe to that aspect of Government policy and should co-operate.

If the Government can requisition boats, buildings and other private-sector installations, there is no logical reason why, similarly, ministerial action cannot be taken to requisition, where appropriate or relevant, private sector health facilities. The private sector in health care would do its public reputation some good if, rather than awaiting calls in Parliament for it to be seen to be involved or for the Minister to require it to be involved, it volunteered some of its facilities. However, we should leave the ideological sparring match between public and private health provision to one side and agree that all medical facilities should be regarded as legitimate for use in the war effort.

My understanding of the instructions that have been sent to general managers is that, as and when injured personnel return home from the Gulf, hospitals in London, in the major southern cities and military hospitals in the south will be used first and that provision will slowly spread north to Glasgow, Edinburgh and Inverness—I welcome Inverness's contribution in that respect. Given that geographical spread and the strain which the Secretary of State has acknowledged will be put on health service facilities, surely it would make sense to spread that burden as equally and fairly as possible.

Sir David Steel (Tweeddale, Ettrick and Lauderdale)

I understand that general practitioners who are called up for service in the Gulf receive simply their Army emoluments, and must provide a locum in their practice from their own pockets. It is wrong that medical practitioners who disrupt their careers to serve their country should be financially out of pocket. The Minister should comment on that.

Mr. Kennedy

I am grateful to my right hon. Friend. Hon. Members will have received direct representations or anecdotal evidence on that from their constituents. That follows the earlier points that I was making about some aspects of the dreadful problem in the Gulf. I hope that the Minister will take a few minutes to reply to that point, because the Secretary of State did not deal with it to a great extent. I share the sentiment that my right hon. Friend expressed.

There is no doubt that the treatment of casualties from the Gulf will place strain on the NHS. The Secretary of State has said that he will probably need to secure extra funding from the Treasury, and he will receive full all-party support for that. However, health authorities will have to take day-to-day decisions now without knowing what funding will be required, and the pressure on them will be greater because of that.

Will the Minister for Health comment on the suggestion that health authorities have been told to plan on the basis that, on average, Gulf casualties will need to be hospitalised for 12 days? I should be grateful if she would tell me whether the Department of Health has given those instructions and that advice to health managers. If so, it is widely optimistic, given the nature of some of the injuries that could be sustained, not least from burns. I hope that the Department of Health will keep that aspect closely under review.

I have concentrated on the Gulf in my remarks, apart from my opening comments on the general level of underfunding and the general problems caused by bed losses in the hospital service. Although we heard more of a theoretical framework from the Secretary of State, there is unambiguous evidence that we still need much more in terms of practical delivery so that the hospital sector can begin to come up to the standard which the country needs and which, according to every available test of public opinion, the country clearly wants but does not believe it is getting from the Conservative Administration.

6.10 pm
Mr. Nicholas Winterton (Macclesfield)

I congratulate the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) on his constructive and measured contribution. I hope that my hon. Friend the Minister for Health will respond as much as she can to his somewhat detailed but relevant questions to the House and to the Treasury Bench.

My right hon. Friend the Secretary of State referred to the sombre occasion of the debate, and we would all agree with him. As the Member for Macclesfield, I wish to pay tribute to those members of the Territorial Army division of the Royal Army Medical Corps in my constituency who volunteered to go to the Gulf and are serving there. I know from my regular contact with them that they are courageous, able and highly skilled and will do a wonderful job should casualties occur.

My district general hospital has been asked to accept a number of casualties. I know from my discussions with the local health authority chairman that they will be well looked after and will receive the best possible treatment. They will be welcomed to Macclesfield, where there is quite a military tradition.

This is a sombre debate. Whatever statistics and facts are bandied about by both sides of the House, problems face the national health service. It is incumbent on all hon. Members to reflect those problems as accurately as possible. My right hon. Friend the Secretary of State did not deal with the deficits for the current financial year faced by health authorities before the new system comes into operation on 1 April. I am sure that my hon. Friend the Minister is aware that many of those deficits arose because of the clawback of resources to meet the capital requirements resulting from the health authorities' failure to sell land which they had intended to sell prior to the capital contract beginning or because the price drop caused by the current economic situation meant that the money expected from the sale of land did not materialise. The Government must look at the deficits of some health authorities and take action so that they do not go forward from 1 April with millstones around their necks.

Some closures of hospital wards and beds have occurred because of improvements in medical techniques. For some operations people do not now have to stay overnight in hospital. There was some substance in the criticism by the hon. Member for Livingston (Mr. Cook) about the number of beds that have been closed. I wish to refer not to the statistics from the National Association of Health Authorities but to Macclesfield district general hospital, where 50 beds have been closed but there is a waiting list for urgent surgery. Because the beds have been closed, people cannot have the operations that would give them a more meaningful life or reduce their suffering and pain.

As I said during Health questions, it is a false economy to build a wonderful new district general hospital—I pay credit to the Government for providing the wherewithal —only to have to close beds because of its success and because of the skill and expertise of the consultants who carried out many more operations than was originally budgeted for. Success should be rewarded, as I am sure my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) agrees. It cannot be satisfactory, financially or medically, to have 50 empty beds in a hospital when people are waiting for operations, theatres are available and consultants are ready to carry them out. It is a false economy and a terrible waste of capital expenditure to provide those beds in the first place.

I do not often pay tribute to the chairman of the Mersey regional health authority, Sir Donald Wilson, but I must this time. He has achieved the greatest reduction in waiting lists in any region, and Macclesfield health authority has achieved the biggest reduction in waiting lists in the Mersey region. I pay tribute to the management, consultants, nurses, paramedics and other staff in Macclesfield who achieved that splendid result.

Parkside hospital, which is close to my heart, deals with mental illness. I have often pleaded in the House for a moratorium on the closure of beds or of mental illness hospitals until adequate resources, facilities and qualified personnel are available to deal with those discharged into the community from those and other hospitals.

The hon. Member for Ross, Cromarty and Skye mentioned my service on the then Social Services Select Committee which highlighted in several reports the ongoing underfunding of the national health service. I shall not go into the substantial underfunding that occurred under the last Labour Government, but I shall refer to underfunding between 1981 and 1985 under the present Government. I do not believe that it was intentional Government policy; it occurred because the Treasury and the then Department of Health and Social Services underestimated demographic changes and advances in medical techniques and medical science, which meant that much more expensive, sophisticated operations could take place, and did not budget for them. There was a huge advance in the use of magnetic resonance scanners and computerised tomography scanners, for example, which can do so much not only in tracing illness but in enabling surgeons and consultants to carry out successful surgery.

I should like to refer to self-governing trust status, about which much has been said by the Opposition and a little by Conservative Members. Nursing morale in my constituency is low and consultants are worried because of the problems facing the health service and bed closures and because they know that they could put people into beds and carry out operations but no money is available to do so because of the number of recent changes in the health service and the speed with which changes have occurred.

From the representations made to me by consultants, nurses, members of the public and general practitioners, I am led to believe that there is general support in my area for the principle of self-governing trust status. But those to whom I have spoken want self-governing status for the district as a whole.

The chairman of the regional health authority, Sir Donald Wilson, always appears to want to have his own way. We have various levels of health government—the Mersey region, and Macclesfield health authority—and I thought that the decision to go for trust status would lie with the management at district level, with the people served by the district general hospital and with the nurses, consultants, general practitioners and others involved with the provision of health care locally. Oh no; it appears that the region is demanding not only that there should be the acute unit seeking self-governing trust status but that the community and mental health services should form a second self-governing trust. I strongly oppose that. I am already in communication with the Secretary of State. I do not know whether my right hon. Friend or my hon. Friend the Minister for Health will be prepared to see me but I have formally asked my hon. Friends on the Front Bench to discuss the matter with me because a substantial majority of those involved in health care in my constituency believe that patient care and the best interests of those who want to use the health service in my area would benefit from a single self-governing trust covering the district health authority as a whole. I look forward to meeting the Minister or the Secretary of State.

I am advised that, in my area, there is some problem in dealing with nurses who have taken advantage of the new structure to upgrade themselves from state enrolled nurses to state registered nurses. In all the cases that have been drawn to my attention, nurses were promised that they would be given positions when they obtained the new qualifications. Unfortunately, no such positions are now being offered to them. Some have been offered redundancy but the redundancy payments for which they qualify do not take account of their new qualifications. Bearing in mind the promises that were made when the new system came into being—many hon. Members on both sides of the House warmly welcomed it—I hope that, in her winding-up speech, or perhaps by letter, my hon. Friend the Minister will be able to give me information and assurances that I can pass to my constituents, who are deeply concerned.

The health service is close and dear to the hearts of all the people of this country. The health service and health care must never become the preserve and privilege of the wealthy. They must be available for all the people of this country. I, as a Conservative Member, must express my concern about the implications and possible results of some of the changes that we are introducing. I believe that we are going towards the North American system at the very time when the Americans are turning away from their system and looking to us with some envy.

Miss Emma Nicholson (Torridge and Devon, West)


Mr. Winterton

My hon. Friend may say, "Rubbish." I shall not give way to her because she has not been present for the whole debate. I have served on the Select Committee on Social Services for 16 years without a break. I have met a great many people who take advantage of, and are interested in, health care. As a member of that Committee, I have had the privilege of travelling widely throughout the world. Having travelled throughout Europe and North America, I can only say that the United Kingdom national health service is the best and most comprehensive health care service in the world, and provides the very best value for money, despite the problems that it faces. It is in that spirit that I address my remarks to my right hon. and hon. Friends on the Front Bench.

6.24 pm
Mr. John Hughes (Coventry, North-East)

It is appropriate that this debate on the national health service —in particular, that part of the service known as the hospital and community health service—should take place now. The possibility of war in the Gulf should not be allowed to overshadow what is happening to the NHS. Hon. Members on both sides of the House, those in the media and members of the public at large would be well advised to take special note of what is said, because the hospital and community health service has never been less well prepared than it is now to cater for the additional demands that war will place on it. When I say that it is less well prepared, I do not mean that our doctors do not have the necessary ability, our nurses the necessary skills or our health workers the necessary compassion. I mean simply that the NHS does not have the money.

The Minister may be surprised at that remark. After all, he has not been the incumbent of his present post for very long, and, being less dependent on the NHS than many of my constituents, particularly many elderly people, he has not perhaps had time to realise the dreadful state to which the health service may have been reduced. Given the many distractions of the past few months—for example, the considerable Christmas cheer brought to many by the unseating of the previous Prime Minister, who was the jockey principally responsible for riding the NHS into the ground—it is not surprising that the right hon. Gentleman has not yet been able to discern what is happening to the service for which he is responsible. He has not perhaps discerned that the service is collapsing.

Even before Christmas, a newspaper reported that 4,500 beds—equal to 3 per cent. of acute beds—had been closed in an attempt to make ends meet. But that is only the tip of the iceberg. As the end of the year approached, more desperate measures were taken. Over the Christmas period, we heard of extensive ward closures, with hospitals reduced to emergency-only treatment. The closures were often described as extended breaks, but the truth is that every week during which a ward is closed represents a 2 per cent. cut in the annual service provided by that ward. For many hospitals, a three-week Christmas interval replaced a one-week interval. That meant a 4 per cent. reduction in non-urgent activity. That was still not enough.

A recent Audit Commission report highlighted the importance of day surgery work, arguing strongly that day surgery meant that more cases could be handled by the NHS at a lower unit cost. It is certainly true that medical developments have enabled certain types of patient to be treated in greater numbers. Contrary to the view that the Government have attempted to foster, the ability to treat people effectively on a day basis has been the result of scientific and medical advance and improvements in medical procedures. It has not come about through the intervention of accountants, much less politicians. The credit for the developments in day surgery—and the reductions in the average length of in-patient stays resulting from improvements to treatments—lies with the NHS staff and medical researchers. They have come about in spite of—not because of—the Government's policies.

No better illustration of that point exists than the fact that the day surgery unit at Coventry and Warwickshire hospital in my own city has had to be closed for the remaining three months of the year. The authority has run out of cash. As a result, it is expected to be able to complete only 990 operations this year—only slightly more than half of what was achieved in former years.

The cumulative effect of thousands of crises such as that—some of which reach the public eye and some of which are buried in the private part of the health authority agenda—is likely to take the NHS waiting list over the 1 million mark for the first time in the history of the service, and that is before we take account of the impact of war in the Gulf.

Like the Government, I have been guilty of concentrating on the acute side of the health service coin —the operations and waiting lists. We should not forget the far more devastating effect on the services for the less privileged in our society, including those whose health is in one way or another permanently impaired and whose dependence on the NHS is not intermittent. In that group, I include large numbers of chronically ill elderly patients, the mentally ill and the mentally handicapped and the physically disabled. The number of beds available to those patients has fallen dramatically over the past 10 years. According to the Government's only published figures, the number of non-acute beds has fallen from 213,000 in 1979 to 149,000 today, a fall of 64,000.

Ironically, a patient discharged from one of those beds—perhaps prematurely and possibly in need of constant care rather than intervention—could be readmitted later, as the condition may have deteriorated. That patient will duly increase the Government's figure of the number of in-patients treated.

The prospects for that kind of patient are now bleaker. April 1991 will see the establishment of the first trusts, and the prospects are clearly so horrendous that the Government have chosen to throw a cloak of secrecy over the whole business. Whole chunks of what the Government claim will still be part of the NHS are subject to the rules of commercial confidentiality. As a consequence, the elected representatives of constituents cannot see a report commissioned by the Government about the financial plans for the trusts.

We have to be content with rumours that the report suggested that the financial plans were, to say the least, inadequate. It is rumoured that some of the more sensible civil servants may have advised the Secretary of State that the majority of trust applicants were unfit to run a whelk stall. Sadly, we cannot undertake our own analysis of the financial plans, because the trust applicants were forbidden to publish them. That in turn means that the Government expressly sanctioned a consultation exercise in which not only were staff ballots forbidden and community views discounted, but the communities were even forbidden to know what they were being consulted over, and they are not to be told now of the outcome. Having learned nothing, the farce is being repeated for another wave of misguided applicants. There is no sign, as all hon. Members are aware, of how the system will work in reality.

There has been much talk in recent years about improving the management of the health service. It is clear that the people responsible for the NHS White Paper are not managers: they are solicitors skilled in drawing up that which no one can understand and which never does what it is supposed to do. Its strategy would be to the detriment of my constituents.

6.33 pm
Mr. Jerry Hayes (Harlow)

It is a poor day for the Labour party when we have a Supply day debate on a major aspect of Government policy—the health service —and at one stage only the shadow Secretary of State for Health, the hon. Member for Livingston (Mr. Cook), represented the Labour party in the Chamber. No Opposition Back-Benchers were present. The Labour Whips had to trawl round the streets, the bars and tearooms to drag in Opposition Members to say something and to show how desperately caring is the Labour party. That has been exposed—mercifully we have television and people outside will be able to see what happened.

I do not pretend for a moment that all is rosy in the national health service. Of course it is not. My right hon. and hon. Friends are aware of the terrible difficulties in my health authority in west Essex and I hope that those problems are being addressed at the moment.

However, this is a Supply day and as such we have a right to know what the Opposition are going to do. After all, the Opposition's health policy has been published for a year and a month, but we are none the wiser and we are not better informed.

Mr. Gerry Steinberg (City of Durham)

That is because the hon. Gentleman cannot read.

Mr. Hayes

I have read Labour's health policy, but we did not hear anything about it today. We have heard about cumulative underfunding and how the health service needs more money. Unfortunately, the hon. Member for Livingston did not tell us how much is needed, either because he does not know or because he is frightened of the hon. Member for Derby, South (Mrs. Beckett). I do not know what it is that ladies from Derbyshire do to hon. Members, but the hon. Member for Derby, South seems to frighten the hon. Member for Livingston. He would not tell us how much he was going to spend or where he was going to spend it.

However, the hon. Member for Livingston was marvellous when he referred to history. He did for the history of the funding of the health service what King Herod did for babysitting. The hon. Gentleman told us that the Conservative Government have a habit of spending more on defence than on the health service. The Library was kind enough to provide me with the figures. In 1970–71 and 1971–72, defence spending was higher than health spending. At that time a Conservative Government was taking over from a Labour Government. From 1972–73 to 1975–76 health spending was higher than defence spending. In 1976–77, 1977–78 and 1978–79, defence spending was higher. From 1986 onwards this Government have been spending more on health than on defence. The hon. Member for Livingston did not tell the House about the massive cuts made in health spending by the last Labour Government. They cut 3 per cent. from the budget in real terms.

The hon. Gentleman did not tell us about the unions. He was right to tell us that the debate is about money and I know where he would have to spend the money that the hon. Member for Derby, South might just give him. He would have to spend it on his friends in the Confederation of Health Service Employees and in the National Union of Public Employees.

The hon. Member for Livingston should read the debates on health that took place during the dying days of the previous Labour Government. Those debates were not about patient care; they were about the disasters that were occurring in the system when the dead were unburied and hospital waiting lists made our present problems look like a teddy bears' picnic. If the hon. Member for Livingston reads those debates, he will see that they referred to formulas and face-savers to help NUPE and COHSE in an attempt to get those people to see reason.

However, I was encouraged in some respects by the speech of the hon. Member for Livingston. There are signs of good sense in the Opposition's motion. The hon. Member for Livingston did not refer to opting out and that is very encouraging. I imagine that he now accepts that there is no such thing as an opting-out hospital. He referred to self-governing trusts and that is a step in the right direction. He did not talk about hidden agendas, which was very good, and he did not talk about privatisation. He did not talk about money either.

Mr. Robert N. Wareing (Liverpool, West Derby)

What is the hon. Gentleman talking about? [Laughter.]

Mr. Hayes

I will give that one to the hon. Gentleman on points.

There have been some exciting reforms which have been overwhelmingly—80 per cent.—accepted by the medical and caring professions. The NHS has been lurching from crisis to crisis since it began in the 1940s because of the antiquated and ridiculous methods of funding. This Government have the courage to change that.

The hon. Member for Livingston referred to the efficiency trap. The efficiency trap will stop when money travels with the patient. The present problem is to help the health authorities with particular difficulties to balance their budgets before April. That is a problem that my right hon. and hon. Friends must address.

We were all delighted and reassured to hear that money will be given to hospitals such as my own in west Essex and Harlow for beds to be allocated to Gulf casualties. However, several health authorities, including my own, will not be able to balance their budgets in April. There is a great danger that some of them might do things that would be quite unconscionable and wrong and add to waiting lists to balance their budgets. That matter must be discussed.

I am not asking for vast sums to be poured into the regions. Usually, a region messes up the money in the first place. The Government provide enormous resources—something for which the hon. Gentleman should have given my right hon. Friend the Secretary of State credit. The hon. Gentleman did not talk about the extra £3 billion. He did not talk about the real-terms increase of 5.3 per cent. across the board. That is a great deal of money. He will say that it is not enough, and so will some of my constituents. It will never be enough. It is a significant, sizeable chunk of taxpayers' money. He did not talk about the £1.9 billion—a 6 per cent. increase in the hospital budget.

Mr. Dennis Turner (Wolverhampton, South-East)

Will the hon. Gentleman give way?

Mr. Hayes

I should love to give way, but the winding-up speeches are a minute away. I am terribly sorry, but it would not be fair to those who are to wind up the debate.

There is much that I should like to say about my district, but I do not have time to do so. All that I am trying to put across to the House is that at least the Government have the courage to put forward policies which, in the long term, will make the future of the health service much more rosy. The Government will help with waiting lists. The hon. Member for Livingston and my right hon. Friend the Secretary of State must address a matter that my hon. Friend the Member for Macclesfield (Mr. Winterton) mentioned—the terrible problem of capital projects. For one reason or another, capital projects from land sales fell by about 50 per cent. in the past year. That will cause tremendous revenue problems, particularly in the Thames region and certain areas of the north. There is no reason whatever why the Treasury cannot appraise some of the schemes that have revenue consequences, and sort out some form of mortgage arrangement so that the taxpayer, the patient and the health authority do not lose out. That is a perfectly sensible financial arrangement, and it should be considered.

The debate has been about money—money that will be spent on NUPE and COHSE—and has had nothing to do with patient care. It is rather sad that the hon. Member for Livingston said much about the producer and people being paid. He said nothing about more patients being treated with the money that he wants to give the health service.

6.42 pm
Ms. Harriet Harman (Peckham)

The two most striking aspects of the debate have been, first, the extent of the pain and suffering that people must undergo because they cannot get the treatment they need because of the hospital crisis and, secondly, the absolute refusal of the Government and the new Secretary of State to acknowledge that pain and suffering. The message is clear—the Government are pretending that the hospital crisis does not exist, because they are not prepared to act to end the crisis on our hospitals. The pain, anxiety and suffering are only too real.

For example, baby Sarah Goodings needs a kidney operation, yet, for the third time last week, her operation at Guy's hospital was cancelled. Without an operation, she must constantly be on antibiotics or risk permanent damage to her kidneys. Her doctor has been told that he is able to operate only one afternoon a week, to help Guy's hospital save money.

Miss Emma Nicholson

Will the hon. Lady give way?

Ms. Harman

I shall not give way, because I must be brief. The hon. Lady has not been present during the debate to which I am trying to respond; she has only just arrived.

It is not only waiting lists that are being hit by the crisis. Even emergency patients are being hit by the crisis. Doctors are having to struggle to get even emergency patients into hospital, because ambulances are being diverted from hospital to hospital as more and more hospitals go on red alert.

The Secretary of State talked about bad management in the health service. Does he know what health service managers are doing? They are not managing the health service; they are managing a crisis. They are sitting at their desks with two piles of letters in their out-trays. One pile contains standard letters to patients saying, "Don't come in for your operation. Don't come in for your long-awaited out-patient visit. The operation is cancelled. The out-patient clinic is cancelled because of lack of funds." The other pile contains letters to GPs saying, "Don't send in any patients; we are short of funds. Cancel your out-patients' clinics and reduce your operating lists."

Tens of thousands of patients are receiving standard printed letters from district health authorities telling them that their out-patient appointments or their operations have been cancelled. Each time one of those letters arrives on the mat, there is more misery and disappointment for individuals and their families. It is extraordinary what fortitude and resilience some people show when waiting for their operations. Why should they have to suffer 24-hour pain and suffering? Why should there be stresses and strains on their families? Why should their jobs be threatened or put at risk when they need to be admitted to hospital to have an operation that could sort them out? Why should people have to lead their lives overshadowed by pain? It is because the Government are telling health authorities to balance their books so that they can operate like businesses.

Such cuts are not only cruel but stupid and a false economy. The longer a patient waits for a hip replacement —my hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred to just such a case—the bigger the operation is and the lower the chances of making a complete recovery. It does not make financial or medical sense to make patients wait. The longer a heart patient waits for an operation, the less likely he or she is to survive.

According to an article in The Daily Telegraph, Mr. Tony Lees Jones, aged 59, has a leaky aortic valve. The results are fluid build-up in the lungs, breathlessness and increasing strain on an enlarged heart, and the longer the condition continues without an operation the greater the risk of permanent damage. The longer someone has to wait, the lower the chances of success. We should be concerned about the outcome of health care, rather than simply act like accountants and look at the balance sheet in the short term.

The Secretary of State talked about a new agenda for a health care strategy. He mentioned preventive health care. The menopause clinic in Dulwich hospital treats menopausal women who suffer from osteoporosis. It treats them with hormone replacement therapy and therefore reduces the chances of broken bones. That clinic has been cut. As a result, more women will suffer from osteoporosis, break their bones and end up in an already overcrowded hospital as emergency patients.

What about the family planning service—an obvious preventive service? Family planning services are cut, and as a result there is an alarming rise in the number of unplanned teenage pregnancies. My hon. Friend the Member for Renfrew, West and Inverclyde (Mr. Graham) asked me to draw to the attention of the House the fact that, in his area, the school eye service—a preventive service if ever there was one—has been cut because of a shortage of money. Does the Secretary of State know that preventive services have been cut? Does he defend cuts in preventive services? Does he even know that cuts in preventive services are happening?

It is crisis management in the national health service, and it is making the national health service less efficient. Health service managers cannot plan from year to year —they cannot even plan from month to month. In some districts, they cannot even plan from day to day, as they try to manage the crisis, and that makes the health service less efficient.

The Secretary of State has said that there has been bad management, but does he know what his Department is asking managers to do? I have a copy of a circular from the district general manager of Bromley, David Milner, addressed to geriatricians about marketing geriatric services. It says that they must look to understanding and assessing the markets, determining pricing policies—that is what managers are doing—and understanding customers and their behaviour.

Of course, by "customers" he does not mean geriatric patients but the purchasing authorities who will be trying to beat the price down. He talks about communication with customers and advertising and promotion policies. That is what managers in the National Health Service are doing. They are not trying to improve preventive services or to reduce waiting lists; they are trying to cut the deficits and commercialise the national health service.

I am disappointed that the Secretary of State has been peddling the same old myth of his predecessor that somehow we agree with the Government about their attempts to dismantle the health service and to introduce an internal market. We do not agree with them. We do not want to see hospitals competing on cost. We do not want patients to be denied choice as they are sent to the hospital where the cheapest contract has been placed by the district health authority. We are against that. If he is an honest man, I hope that the Secretary of State will stop peddling that myth.

Yes, as the Secretary of State said, there is a consensus between the Labour party and the public, and the Government are outside it. Despite the fact that there has been a change of face on the Government Front Bench, it is a pity that there seems to have been no change of heart on the health service. People want to hear that the Government recognise the problem, that they accept their responsibility and that they are determined to solve the problem that is causing pain and suffering to so many people. We have not heard that from the Government.

6.51 pm
The Minister for Health (Mrs. Virginia Bottomley)

We have heard again tonight the traditional rant of doom and gloom from the Labour party—scaremongering, lowering morale and uttering irrelevance. Before the main part of my reply I refer the Opposition to a recent New Statesman article which said that it is time to realise that the real agenda for health policy … must be about making better, more informed decisions about what it is worth buying with the £30 billion we are already spending each year. So the absence of a really convincing means for moving resources out of their historical grooves amounts to a serious flaw in Labour's proposals … To continue with a system where service providers determine spending priorities is unacceptable. Until Labour can be more convincing about shifting the balance of power it will have failed to address the central challenge for health policy. We agree with the New Statesman.

Many of my hon. Friends have ably and articulately identified the reforms that we are trying to make in the health service. We are proud of the record investment of resources; £30 billion next year is a remarkable achievement. But we do not think that money is the only way to success. Better health for the nation is the outcome which we want to achieve.

My right hon. Friend the Secretary of State outlined his strategy for health, on which we should all agree. It is irrelevant and ridiculous of the Labour party to try to pursue old hares rather than co-operate and collaborate on the real challenges and opportunities which we face. The hon. Member for Wakefield (Mr. Hinchliffe) talked about cataracts. In 10 years, the number of cataract operations has increased from 40,000 to 92,000. There has been an increase in the number of hip replacement operations and in the number of coronary artery by-pass operations. Above all, we have seen an increase in the number of people who work for the health service. We have seen a dramatic increase in the number of hospital doctors and general practitioners, so that each GP's list has come down.

Dame Elaine Kellett-Bowman

And nurses.

Mrs. Bottomley

Yes. My hon. Friend, who always supports matron, will be pleased about the increase in nurses. Not only are there more but they are much better paid. Their basic pay has gone up by over 41 per cent. Hon. Members should compare that with what happened under the Labour Government when it fell by 5 per cent.

We want to invest in our staff, not only through pay but through training and qualifications. That is why I was so pleased last week to announce an extra £71 million for Project 2000, which will make it possible to start 14 new schemes for nurses. The total of approved colleges of nursing will be 44, and half of our new nurses will have Project 2000 qualifications.

Hon. Members should note not only the professional but the vocational qualifications that we are bringing in for people who work and serve in the health service. They should note, too, the progress we are making with junior hospital doctors. We want to be a good employer. We want to serve patients, and we want to work with and for our staff. Bringing down the unacceptable, onerous rotas that generations of doctors had to live with under the Labour Government will be a major breakthrough. An extra 200 consultants and 50 more staff grade posts will help urgently to tackle that problem.

We are investing in research because, in our great health service, research and development are fundamental. The recent appointment of Professor Michael Peckham as the director of research and development is a great step forward. Only this week, we announced an extra £5.8 million to increase postgraduate training and education. About £1.5 billion is spent each year on health research in the United Kingdom. We want to get the best benefit from that. We want to improve quality. That is why we are spending £30 million on clinical audit. That shows that we are not just looking for the turnover of beds. We want quality and better patient care. That is the way forward.

We have to accept the problem of waiting lists, to which many of my hon. Friends referred. We are pleased that the number waiting for more than a year has been reduced by 7 per cent. this year. That is important. My right hon. Friend the Secretary of State announced a £35 million initiative, building on the work that John Yates has done and that we have been doing to tackle the problem of people who have to wait an unnacceptable length of time.

There is an important distinction. Half the patients are admitted immediately. People are admitted on the basis of clinical priority. Of those who are taken off waiting lists, half wait five weeks. Some wait an unacceptable length of time. How pleased I am that Macclesfield is leading the way in coping with the problem. The chairman of Mersey region has shown an admirable example by deciding not to put up with long waiting lists. We fully endorse the move to deal with people who have to wait an unacceptable length of time.

I want also to address the subject of beds. Listening to the hon. Member for Livingston (Mr. Cook), one would think that he was trying to be a shadow Minister of beds and warehousing, because of his preoccupation with beds in the health service. We have over 200,000 non-psychiatric beds. We have recently been censured by the Audit Commission for not moving to more day work. The introduction of endoscopes, laproscopes and all sorts of diagnostic techniques, which mean that we do not have to admit patients, has doubled bed occupancy in recent years. We have to do more. Certainly, at times, beds have closed because of financial pressure, but it is naive to think that that is the only reason for bed closures. Health authorities which have treated bed closure as an easy option when under financial pressure need to plan more carefully to balance their activity and their resources. That is the secret of the reforms that we are establishing in the health service, so that we can be rid of the perverse form of funding where, although a good hospital attracts more patients, the funding does not come with them. The reforms which we are seeking will ensure that resources are used to the best possible effect.

Following my right hon. Friend the Secretary of State's comments about this being a sober occasion, several hon. Members referred to the plans for the NHS response to casualties from possible fighting in the Gulf. Very careful, detailed planning has been taking place. All the regions are prepared to receive casualties. Casualties will go to each region in turn, as suggested by hon. Members. We are confident that all possible steps have been taken. Although our plans are not predictions, much care and thought have gone into them. I know that hon. Members welcomed the statement by my right hon. Friend that we will receive additional funding for that purpose.

A great deal is achieved by our excellent health service. It is a service to be proud of. I did not realise that I could ever agree so strongly with my hon. Friend the Member for Macclesfield (Mr. Winterton): we have the best health service in the world, and we want to continue to improve and develop it. It is not in crisis. It is in change. This is a time of opportunity. We have a proud record, and we want to do more with the professionals and for the patients to develop, build and strengthen our national health service.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 238, Noes 309.

Division No. 38] [7.00 pm
Adams, Mrs. Irene (Paisley, N.) Dalyell, Tam
Allen, Graham Darling, Alistair
Alton, David Davies, Rt Hon Denzil (Llanelli)
Anderson, Donald Davies, Ron (Caerphilly)
Armstrong, Hilary Davis, Terry (B'ham Hodge H'I)
Ashdown, Rt Hon Paddy Dewar, Donald
Ashley, Rt Hon Jack Dixon, Don
Ashton, Joe Dobson, Frank
Barnes, Harry (Derbyshire NE) Doran, Frank
Barnes, Mrs Rosie (Greenwich) Douglas, Dick
Barron, Kevin Dunnachie, Jimmy
Battle, John Dunwoody, Hon Mrs Gwyneth
Beckett, Margaret Eadie, Alexander
Beggs, Roy Eastham, Ken
Beith, A. J. Evans, John (St Helens N)
Bell, Stuart Ewing, Harry (Falkirk E)
Bellotti, David Ewing, Mrs Margaret (Moray)
Benn, Rt Hon Tony Fatchett, Derek
Bennett, A. F. (D'nt'n & R'dish) Faulds, Andrew
Benton, Joseph Fearn, Ronald
Bermingham, Gerald Field, Frank (Birkenhead)
Bidwell, Sydney Fisher, Mark
Blair, Tony Flynn, Paul
Blunkett, David Foot, Rt Hon Michael
Boateng, Paul Forsythe, Clifford (Antrim S)
Boyes, Roland Foster, Derek
Bradley, Keith Foulkes, George
Bray, Dr Jeremy Fraser, John
Brown, Gordon (D'mline E) Fyfe, Maria
Brown, Nicholas (Newcastle E) Galloway, George
Brown, Ron (Edinburgh Leith) Garrett, John (Norwich South)
Bruce, Malcolm (Gordon) Garrett, Ted (Wallsend)
Buckley, George J. George, Bruce
Caborn, Richard Gilbert, Rt Hon Dr John
Callaghan, Jim Godman, Dr Norman A.
Campbell, Menzies (Fife NE) Golding, Mrs Llin
Campbell, Ron (Blyth Valley) Gordon, Mildred
Campbell-Savours, D. N. Gould, Bryan
Canavan, Dennis Graham, Thomas
Carlile, Alex (Mont'g) Grant, Bernie (Tottenham)
Cartwright, John Griffiths, Nigel (Edinburgh S)
Clarke, Tom (Monklands W) Griffiths, Win (Bridgend)
Clay, Bob Grocott, Bruce
Clelland, David Hardy, Peter
Clwyd, Mrs Ann Harman, Ms Harriet
Cohen, Harry Hattersley, Rt Hon Roy
Cook, Robin (Livingston) Heal, Mrs Sylvia
Corbett, Robin Healey, Rt Hon Denis
Corbyn, Jeremy Henderson, Doug
Cousins, Jim Hinchliffe, David
Cryer, Bob Hoey, Ms Kate (Vauxhall)
Cummings, John Hogg, N. (C'nauld & Kilsyth)
Cunliffe, Lawrence Home Robertson, John
Cunningham, Dr John Hood, Jimmy
Howarth, George (Knowsley N) Owen, Rt Hon Dr David
Howells, Geraint Paisley, Rev Ian
Howells, Dr. Kim (Pontypridd) Parry, Robert
Hoyle, Doug Patchett, Terry
Hughes, John (Coventry NE) Pike, Peter L.
Hughes, Robert (Aberdeen N) Powell, Ray (Ogmore)
Hughes, Roy (Newport E) Prescott, John
Hughes, Simon (Southwark) Primarolo, Dawn
Illsley, Eric Quin, Ms Joyce
Ingram, Adam Radice, Giles
Janner, Greville Randall, Stuart
Johnston, Sir Russell Redmond, Martin
Jones, Barry (Alyn & Deeside) Rees, Rt Hon Merlyn
Jones, leuan (Ynys Môn) Reid, Dr John
Kaufman, Rt Hon Gerald Richardson, Jo
Kennedy, Charles Robertson, George
Kilfedder, James Rogers, Allan
Kinnock, Rt Hon Neil Rooker, Jeff
Kirkwood, Archy Rooney, Terence
Lamond, James Ross, Ernie (Dundee W)
Leighton, Ron Rowlands, Ted
Lestor, Joan (Eccles) Ruddock, Joan
Lewis, Terry Salmond, Alex
Litherland, Robert Sedgemore, Brian
Livingstone, Ken Sheerman, Barry
Livsey, Richard Sheldon, Rt Hon Robert
Lloyd, Tony (Stretford) Shore, Rt Hon Peter
Lofthouse, Geoffrey Short, Clare
Loyden, Eddie Skinner, Dennis
McAllion, John Smith, Andrew (Oxford E)
McAvoy, Thomas Smith, C. (Isl'ton & F'bury)
McCartney, Ian Smith, Rt Hon J. (Monk'ds E)
Macdonald, Calum A. Smith, J. P. (Vale of Glam)
McFall, John Snape, Peter
McKay, Allen (Barnsley West) Soley, Clive
McKelvey, William Spearing, Nigel
McLeish, Henry Steel, Rt Hon Sir David
Maclennan, Robert Steinberg, Gerry
McMaster, Gordon Stott, Roger
McWilliam, John Strang, Gavin
Madden, Max Straw, Jack
Mahon, Mrs Alice Taylor, Mrs Ann (Dewsbury)
Marek, Dr John Taylor, Rt Hon J. D. (S'ford)
Marshall, David (Shettleston) Taylor, Matthew (Truro)
Marshall, Jim (Leicester S) Thomas, Dr Dafydd Elis
Martin, Michael J. (Springburn) Thompson, Jack (Wansbeck)
Martlew, Eric Turner, Dennis
Maxton, John Vaz, Keith
Meacher, Michael Wallace, James
Meale, Alan Walley, Joan
Michael, Alun Wardell, Gareth (Gower)
Michie, Bill (Sheffield Heeley) Wareing, Robert N.
Michie, Mrs Ray (Arg'l & Bute) Watson, Mike (Glasgow, C)
Moonie, Dr Lewis Welsh, Andrew (Angus E)
Morgan, Rhodri Welsh, Michael (Doncaster N)
Morley, Elliot Wigley, Dafydd
Morris, Rt Hon A. (W'shawe) Williams, Rt Hon Alan
Morris, Rt Hon J. (Aberavon) Williams, Alan W. (Carm'then)
Mowlam, Marjorie Winnick, David
Mullin, Chris Wise, Mrs Audrey
Murphy, Paul Worthington, Tony
Nellist, Dave Wray, Jimmy
Oakes, Rt Hon Gordon Young, David (Bolton SE)
O'Brien, William
O'Hara, Edward Tellers for the Ayes:
O'Neill, Martin Mr. Frank Haynes and
Orme, Rt Hon Stanley Mr. Martyn Jones.
Adley, Robert Ashby, David
Aitken, Jonathan Aspinwall, Jack
Alexander, Richard Atkins, Robert
Alison, Rt Hon Michael Baker, Rt Hon K. (Mole Valley)
Allason, Rupert Baldry, Tony
Amery, Rt Hon Julian Banks, Robert (Harrogate)
Amess, David Batiste, Spencer
Amos, Alan Beaumont-Dark, Anthony
Arbuthnot, James Bellingham, Henry
Arnold, Jacques (Gravesham) Bendall, Vivian
Arnold, Sir Thomas Bennett, Nicholas (Pembroke)
Benyon, W. Garel-Jones, Tristan
Bevan, David Gilroy Gill, Christopher
Biffen, Rt Hon John Gilmour, Rt Hon Sir Ian
Blackburn, Dr John G. Glyn, Dr Sir Alan
Blaker, Rt Hon Sir Peter Goodhart, Sir Philip
Body, Sir Richard Goodlad, Alastair
Bonsor, Sir Nicholas Gorman, Mrs Teresa
Boscawen, Hon Robert Grant, Sir Anthony (CambsSW)
Boswell, Tim Greenway, Harry (Ealing N)
Bottomley, Peter Greenway, John (Ryedale)
Bottomley, Mrs Virginia Gregory, Conal
Bowden, A (Brighton K'pto'n) Griffiths, Sir Eldon (Bury St E')
Bowden, Gerald (Dulwich) Griffiths, Peter (Portsmouth N)
Bowis, John Grist, Ian
Boyson, Rt Hon Dr Sir Rhodes Ground, Patrick
Braine, Rt Hon Sir Bernard Grylls, Michael
Brandon-Bravo, Martin Gummer, Rt Hon John Selwyn
Brazier, Julian Hague, William
Bright, Graham Hamilton, Hon Archie (Epsom)
Brooke, Rt Hon Peter Hamilton, Neil (Tatton)
Brown, Michael (Brigg & Cl't's) Hampson, Dr Keith
Browne, John (Winchester) Hanley, Jeremy
Bruce, Ian (Dorset South) Hannam, John
Buchanan-Smith, Rt Hon Alick Hargreaves, A. (B'ham H'll Gr')
Buck, Sir Antony Hargreaves, Ken (Hyndburn)
Budgen, Nicholas Harris, David
Burns, Simon Haselhurst, Alan
Burt, Alistair Hawkins, Christopher
Butler, Chris Hayes, Jerry
Butterfill, John Hayhoe, Rt Hon Sir Barney
Carlisle, John, (Luton N) Hayward, Robert
Carrington, Matthew Heathcoat-Amory, David
Carttiss, Michael Heseltine, Rt Hon Michael
Cash, William Hicks, Robert (Cornwall SE)
Chalker, Rt Hon Mrs Lynda Higgins, Rt Hon Terence L.
Channon, Rt Hon Paul Hill, James
Chapman, Sydney Hind, Kenneth
Chope, Christopher Hogg, Hon Douglas (Gr'th'm)
Churchill, Mr Hordern, Sir Peter
Clark, Rt Hon Alan (Plymouth) Howard, Rt Hon Michael
Clark, Dr Michael (Rochford) Howarth, Alan (Strat'd-on-A)
Clark, Rt Hon Sir W. (Croydn S) Howarth, G. (Cannock & B'wd)
Clarke, Rt Hon K. (Rushcliffe) Howell, Rt Hon David (G'dford)
Colvin, Michael Howell, Ralph (North Norfolk)
Conway, Derek Hughes, Robert G. (Harrow W)
Coombs, Anthony (Wyre F'rest) Hunt, Rt Hon David (Wirral W)
Coombs, Simon (Swindon) Hunt, Sir John (Ravensbourne)
Cope, Rt Hon John Irvine, Michael
Cormack, Patrick Irving, Sir Charles
Cran, James Jack, Michael
Critchley, Julian Jackson, Robert
Davies, Q. (Stamf'd & Spald'g) Janman, Tim
Davis, David (Boothferry) Jessel, Toby
Day, Stephen Johnson Smith, Sir Geoffrey
Devlin, Tim Jones, Gwilym (Cardiff N)
Dicks, Terry Jones, Robert B (Herts W)
Douglas-Hamilton, Lord James Jopling, Rt Hon Michael
Dover, Den Kellett-Bowman, Dame Elaine
Dunn, Bob Key, Robert
Durant, Sir Tony King, Roger (B'ham N'thfield)
Dykes, Hugh King, Rt Hon Tom (Bridgwater)
Eggar, Tim Kirkhope, Timothy
Emery, Sir Peter Knapman, Roger
Evans, David (Welwyn Hatf'd) Knight, Greg (Derby North)
Evennett, David Knight, Dame Jill (Edgbaston)
Fallon, Michael Knowles, Michael
Favell, Tony Knox, David
Fenner, Dame Peggy Latham, Michael
Field, Barry (Isle of Wight) Lawrence, Ivan
Finsberg, Sir Geoffrey Lee, John (Pendle)
Fishburn, John Dudley Lester, Jim (Broxtowe)
Fookes, Dame Janet Lloyd, Sir Ian (Havant)
Forman, Nigel Lloyd, Peter (Fareham)
Forsyth, Michael (Stirling) Lord, Michael
Forth, Eric McCrindle, Sir Robert
Fowler, Rt Hon Sir Norman MacGregor, Rt Hon John
Franks, Cecil MacKay, Andrew (E Berkshire)
French, Douglas McLoughlin, Patrick
Gale, Roger Madel, David
Gardiner, Sir George Mans, Keith
Marlow, Tony Ridley, Rt Hon Nicholas
Marshall, John (Hendon S) Ridsdale, Sir Julian
Martin, David (Portsmouth S) Roberts, Sir Wyn (Conwy)
Maude, Hon Francis Roe, Mrs Marion
Maxwell-Hyslop, Robin Rossi, Sir Hugh
Meyer, Sir Anthony Rost, Peter
Miller, Sir Hal Rumbold, Rt Hon Mrs Angela
Mills, Iain Ryder, Richard
Miscampbell, Norman Sackville, Hon Tom
Mitchell, Andrew (Gedling) Sayeed, Jonathan
Mitchell, Sir David Shaw, David (Dover)
Moate, Roger Shaw, Sir Giles (Pudsey)
Monro, Sir Hector Shaw, Sir Michael (Scarb')
Montgomery, Sir Fergus Shelton, Sir William
Morrison, Sir Charles Shephard, Mrs G. (Norfolk SW)
Morrison, Rt Hon Sir Peter Shepherd, Colin (Hereford)
Moss, Malcolm Shepherd, Richard (Aldridge)
Moynihan, Hon Colin Shersby, Michael
Mudd, David Sims, Roger
Neale, Sir Gerrard Smith, Sir Dudley (Warwick)
Nelson, Anthony Smith, Tim (Beaconsfield)
Neubert, Sir Michael Soames, Hon Nicholas
Newton, Rt Hon Tony Speed, Keith
Nicholls, Patrick Speller, Tony
Nicholson, David (Taunton) Spicer, Sir Jim (Dorset W)
Nicholson, Emma (Devon West) Spicer, Michael (S Worcs)
Onslow, Rt Hon Cranley Squire, Robin
Oppenheim, Phillip Stanbrook, Ivor
Page, Richard Stanley, Rt Hon Sir John
Paice, James Steen, Anthony
Patnick, Irvine Stern, Michael
Patten, Rt Hon Chris (Bath) Stevens, Lewis
Patten, Rt Hon John Stewart, Allan (Eastwood)
Pattie, Rt Hon Sir Geoffrey Stewart, Andy (Sherwood)
Pawsey, James Stewart, Rt Hon Ian (Herts N)
Peacock, Mrs Elizabeth Stokes, Sir John
Porter, Barry (Wirral S) Sumberg, David
Porter, David (Waveney) Summerson, Hugo
Portillo, Michael Tapsell, Sir Peter
Powell, William (Corby) Taylor, Ian (Esher)
Price, Sir David Taylor, John M (Solihull)
Raison, Rt Hon Sir Timothy Taylor, Teddy (S'end E)
Redwood, John Temple-Morris, Peter
Renton, Rt Hon Tim Thompson, D. (Calder Valley)
Rhodes James, Robert Thompson, Patrick (Norwich N)
Riddick, Graham Thorne, Neil
Thornton, Malcolm Watts, John
Thurnham, Peter Wells, Bowen
Townend, John (Bridlington) Wheeler, Sir John
Townsend, Cyril D. (B'heath) Whitney, Ray
Tracey, Richard Widdecombe, Ann
Tredinnick, David Wiggin, Jerry
Trippier, David Wilkinson, John
Trotter, Neville Wilshire, David
Twinn, Dr Ian Winterton, Mrs Ann
Vaughan, Sir Gerard Winterton, Nicholas
Viggers, Peter Wolfson, Mark
Wakeham, Rt Hon John Woodcock, Dr. Mike
Waldegrave, Rt Hon William Yeo, Tim
Walker, Bill (T'side North) Young, Sir George (Acton)
Walker, Rt Hon P. (W'cester) Younger, Rt Hon George
Waller, Gary
Walters, Sir Dennis Tellers for the Noes:
Ward, John Mr. Nicholas Baker and
Wardle, Charles (Bexhill) Mr. Timothy Wood.
Warren. Kenneth

Question accordingly negatived.

Mr. Speaker

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

Resolved, That this House welcomes the substantial increase under this Government in the number of patients treated by the National Health Service and in the availability of new and better forms of treatment; notes that this has been made possible by massive extra resources provided by the Government, combined with more effective use of those resources; welcomes the further record increase in resources planned for the National Health Service in 1991–92; congratulates those hospitals and other units which have sought and obtained approval to manage their own affairs as self-governing National Health Service trusts; looks forward to the setting up of the new general practitioner fundholding practices; and supports the Government's reforms which will continue to put patients first by further improving the quality, quantity and cost-effectiveness of health services.