§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Boswell.]
§ 10 pm
§ Mr. Gwilym Jones (Cardiff, North)I am glad to have the opportunity to discuss the health service in Wales. I recently tabled a question on the health service to my hon. Friend the Under-Secretary, in which I asked what assessment he has made of the impact of new hospital technology on surgical procedures and treatments in Welsh hospitals. I received a fascinating reply. He told me of the opportunities for deinstitutionalising health care and said that before too long up to 60 per cent. of surgery will be performed on a day basis, with more than 80 per cent. being bloodless. Many lay people hearing that would be amazed to think that any operation, let alone 80 per cent. of day operations, would be bloodless.
My hon. Friend explained further developments, such as the use of endoscopy in gynaecology, orthopaedic and general surgery, whereby a flexible tube photographs body cavities and organs without the trauma of surgery. Lasers have superseded more traditional surgical approaches to treating skin, eye and gynaecological disorders.
My hon. Friend the Minister referred to keyhole surgery and laparoscopic cholecystectomies—no wonder the health service abbreviates that to lap-cholies—which are replacing open abdomen gallstone operations. Damaged knee cartilage can be removed without opening the knee. Balloon angiography passes a balloon into an artery in a catheter. Those, and similar developments, are having a profound effect on the size and nature of our hospitals.
My hon. Friend concludes:
What counts is not hospital bed numbers but providing people with the right services in the right settings."—[Official Report, 26 November 1991; Vol. 199, c. 457.]That made me want to look much deeper and I have tabled a series of questions to my hon. Friend on the health service in Wales. I regard this as an opportunity to put some facts on the record and further discuss the various arguments.It is fairly well known that we are living longer. Since 1979, the number of over-60s has increased by 10 per cent. Similarly, the number of over-75s has increased by 62 per cent. I sought to ask my hon. Friend the Minister about centenarians. It is not possible to be precise, but Department of Social Security records show that there were approximately 100 people over the age of 100 in 1979; that has increased to 210 according to latest figures.
It could be said that the national health service is a victim of its own success; it is getting better and better all the time. It is treating us so well that we are living longer and it must now look after other problems and burdens, whereas mother nature would have terminated our existence previously. NHS figures show that the number of patients over 60 has increased by more than 83 per cent. in the past decade, compared with a numerical increase in the age group of only 10 per cent. The number of NHS patients over 75 has increased by 119 per cent., compared with a numerical increase of 32.6 per cent. The small sample of treatment of centenarians shows that their requirement of the national health service in Wales increased by more than the numerical increase.
1163 Having considered the performance of the national health service in Wales, I believe that far too much time is usually spent examining incidental statistics which do not give the true picture—for example, the numbers of hospitals and hospital beds and waiting lists. There is an almost inevitable tendency for waiting lists to lengthen. As for hospital beds, there have been significant closures and new hospitals have been built to replace the old ones. That has often meant that more efficient new hospitals do not need the same number of beds as before.
If one were to dwell on, for example, the statistics for the number of hospital beds, the figures could be manipulated. The building of a brand new hospital in which the beds were kept empty would add to the total number of beds but would not add one jot to the number of patients being treated in Wales.
Similarly, waiting lists are the victims of the health service's success. I remember a while ago that one of my hon. Friends visited a hospital in Wales and was told that the waiting time for hip replacements was more than a year. He dared to ask what the position had been 12 months before and he was told that the hospital had not performed hip replacements 12 months earlier.
There are opportunities for people to queue for treatment that was not previously available. Hip replacements provide a perfect example. During the past decade there has been a 60 per cent. increase in the number of hip replacements. Similarly, there has been a 29 per cent. increase in hernia operations during that period. The increase in the number of varicose vein operations is even more marked at 184 per cent.
In considering bed use in national health service hospitals in Wales, it might be pertinent to take the example of maternity confinements. During the past decade, the length of obstetric stays for maternity purposes has decreased by 33 per cent. GP maternity has not decreased to the same extent—the decrease was about 21 per cent.—but both now represent a stay in hospital of usually 3.7 days. That is an example of a lesser demand for the health service and of a lesser need for hospital beds. Let us bear those figures in mind but think back a little further. In 1961—30 years ago—stays for obstetrics lasted 10.3 days and 9.2 days for the maternity category.
We have more sophisticated health care now, so there are many reasons why it is much more difficult to utilize hospital beds to the greatest advantage. One would imagine that the prevalence of highly technological treatments mean that they cannot easily be picked up and put down. They make planning far more difficult. One also imagines that if there is an interruption to the planning process an alternative cannot easily be substituted to make up for any gap. It must now be much more onerous to plan the use of resources in the health service.
There is a clear tendency with high-tech operations or maternity cases for stays in hospital to be shorter. There is also a marked swing in the amount of national health service work done as day treatment. I am very sympathetic to hospital managers in Wales because they face a much more complex task in trying to plan resources—the most obvious resource being hospital beds. However, I am glad that the Government have adopted a target of increasing the present bed use rate from 73.6 per cent. to 78 per cent. in three years. That is an effective and efficient use of health service resources.
In dealing with total spending on the health service in Wales, my right hon. Friend the Secretary of State for 1164 Wales this afternoon announced a magnificent increase —the figure for 1992–93 will be £1,877 million. What a sum that is when one reflects that in the last year of the previous Labour Government the figure was a mere £481 million. That should really be explained. These days we always have to ask for a definition not only in cash terms but in real terms. I am glad that this afternoon my right hon. Friend was able to translate the figures into terms that most of us could understand. My family of four—myself, my wife and two children—know, as every similar family in Wales does, that the health service will spend £2,600 on every family of four in 1992–93. That is quite a big deal and that is how it should be regarded. It is a better explanation than trotting out the response that there has been a 60 per cent. increase in real terms. The translation is that we are spending more than £50 a week for every family of four.
The obvious next question should be: where does the money go? Possibly the most important task that the Government had to take on was repairing the cuts that they inherited when they came into office in 1979. It must not be forgotten that the only Government in the history of the national health service ever to make cuts was the previous Labour Government. Repairing those cuts was the priority of our Government in 1979.
That was especially evident in capital spending on the health service. Over the five years of the Labour Government capital spending declined by 21 per cent., so it was important that in the following years the Government reversed that trend. The 21 per cent. cut was in real terms and in real terms spending has gone up by 62 per cent. since 1979.
The Labour Government's cuts were not all deliberate. One of the causes of the cut in capital expenditure was the burden of hyper-inflation. We shall never forget that nurses and doctors working for the health service in Wales were among those who suffered badly from hyper-inflation under the Labour Government. Their take-home pay was cut in real terms. Doctors lost 9.9 per cent.; nurses did far worse, suffering a cut of 21.1 per cent. Happily, the Government have now made up for that, too. Since 1979 doctors' and dentists' pay has increased by 28.7 per cent. in real terms and that of nurses, midwives and health visitors—they have had a better deal, but their increase was even more necessary because they suffered more under the Labour Government—has increased by 48.7 per cent. in real terms.
When considering the health service, the most important statistic is not how much has been spent—in real terms or otherwise—but how many more patients are being treated. That is the real proof of the pudding. I am pleased to see that creditable improvements have taken place under the Government. A total of 132,000 more in-patients are being treated—an increase of 38 per cent. since 1979. There are 122,000 more out-patients—a 28.6 per cent. increase. There has been a staggering increase —72,000—in the number of day patients, which represents a 232.9 per cent. increase.
The number of in-patients and day patients increased under the Labour Government, too, but another example of the cuts that they inflicted on the health service is the fact that the number of out-patients fell—not by much, only 3.4 per cent. That illustrates the way in which the health service suffered under Labour.
The improvements that have been made are an excellent tribute to the staff who work so hard in the national health service. However, we should not forget that the increase in 1165 the number of patients treated is not as large as the amount of extra funding. That is inevitable. The Government had to restore the cuts made by the Labour Government, including those suffered by doctors and nurses. They had to pay more for the more expensive, high-tech care and to meet the needs of the older patients that the health service now has to treat. But it entitles us to ask: can we do better with the health service? The overwhelming answer was that we had to reform it. It had gone on for such a long time in basically the same way that it had to be brought up to date to respond more realistically to the demands of the 1990s.
It was necessary to move forward and to consider whether we may have shed some important elements from the health service that should not have been taken away. If so, we could bring them back. The example that springs most readily to mind is the grade of matron. Matrons always seemed to run their hospitals in the best interests both of the hospitals and of the patients whom they served, so I welcome the announcement by my right hon. Friend the Secretary of State that there is to be a Pembrokeshire NHS trust.
So many wild claims have been made for electoral purposes—perhaps "deceptions" would be the right word to describe them—that hospitals would close and basic health facilities would be denied.
I notice that in the debate in Pembrokeshire those who seem to have really studied the matter—the community health council, the staff and the doctors—have come out in favour of the Pembrokeshire national health service trust. It means that a trust in Pembrokeshire will lead to local decisions being taken for the benefit of local people. We cannot turn the clock back, but it is the nearest that we can achieve to the desirable objective of putting matrons back into hospitals. They symbolise to me exactly what the national health service trust is all about.
In the campaign that has been waged against the NHS trust, it is a matter of great regret to me that politicians have also waged a campaign of denigration against the health service in Wales. One target has been the specialist treatment centres. I remember one allegation that was trumpeted loud—that the latest specialist treatment centre would employ only second-rate surgeons and that the presence of second-rate surgeons would lead to general practitioners not feeling that the centres were good enough for their patients. That was the most monstrous insult not only to the latest specialist treatment centre, but to the others which are already working hard and effectively on essentially the same basis to increase the number of operations. Do those who make those claims realise the damage that they are doing and the way in which they are denigrating a wonderful, fine and excellent health service? It may not be perfect, but at the very least we must defend it against political opportunists who make such claims.
We have a very good health service in Wales, although I cannot yet bring myself to describe it as an excellent one. There will probably always be, and there is now, room for improvement. I will give my hon. Friend examples. I have been in touch with him about hearing aids at the University hospital of Wales. There are other problems about ambulances and admissions to the University hospital of Wales. We shall always have such problems and I hope they will be as minor as possible.
1166 We shall have to continue to increase the funding of the national health service. I know that the Government are fully committed to that objective continuing. We must firmly reject those who denigrate the health service and those who make outrageous claims for electoral purposes. People who make outrageous claims will come to realise that they cannot fool all of the people all of the time.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Nicholas Bennett)I welcome this debate and I congratulate my hon. Friend the Member for Cardiff, North (Mr. Jones) on achieving this debate at short notice tonight. As a user of the national health service, I share the determination that we should continue to improve our national health service in Wales.
As my hon. Friend said, in the past 12 years we have transformed the NHS. When we hear Opposition criticisms about the national health service under this Government's control, it is interesting to look at the latest opinion poll, published just a few days ago. It shows that 93 per cent. of the people of Wales are happy with the national health service under this Government. Despite that, we are not complacent or smug. We want to ensure that the 7 per cent. who are not happy should in future have little or no cause for criticism. That is why we shall continue the reforming programme that we have introduced in the past year or so in the NHS in Wales. We shall not be deflected from it by the Opposition's ignorant criticism.
It is worth looking at the statement on spending made by my right hon. Friend the Secretary of State for Wales this afternoon. We often hear talk from the Labour party about cuts. As my hon. Friend said, the only cuts in the health service in Wales took place under the Labour Government between 1974 and 1979 after the then Chancellor of the Exchequer, the right hon. Member for Leeds, East (Mr. Healey), was asked by the International Monetary Fund to return from his visit to New York and to cut public spending.
Since 1979, spending on the NHS has risen from £8 billion to £32 billion. After taking account of price increases, the increase in the Welsh NHS spending between 1979–80 and 1991–92 is no less than 58 per cent. in real terms. My right hon. Friend's announcement today brings the increase up to more than 60 per cent. in real terms by 1992–93.
That rate of increase is twice that which occurred under the Labour party between 1974 and 1979. It has meant that the proportion of our national wealth that we spend on health has risen from less than 5 per cent. to 6 per cent. The total figure which was announced in the statement today brings spending in the Welsh NHS this year to £1,877 million. Planned expenditure will go up by a staggering £186 million. That will mean that national health service expenditure will be boosted in Wales to £651 this year for every man, woman and child in the Principality. Those are truly staggering figures. When one looks at the resources that are being put into the NHS, one can see dramatically the difference over the past 12 years compared with the period of the previous Labour Government.
My hon. Friend referred to cuts in the hospital building programme under the previous Labour Government—down in real terms by £11 million, but up, under this 1167 Government, by £27.5 million. He then spoke of the expectations of and demands on the Welsh health service. My hon. Friend was quite right to look in some detail at the changes that have taken place in what people expect—for example, a larger number of elderly people living to a greater age in Wales as a result of improved health care, and the new operations which have become available. My hon. Friend referred to increases in the number of hernia operations, varicose vein operations and hip replacements. It is no longer acceptable for people who have hernias to be told that they must wear a surgical truss. We do not expect women with varicose veins to be given surgical stockings and told to go away. People quite rightly now expect to have that treatment in the NHS, and the new NHS is providing it.
In 1961, the average maternity confinement was 9.2 days. Today it is 3.7 days. One can see clearly the information and the factors that are leading to a reduction in the number of beds. Opposition Members talk about bed reductions—reductions took place under the Labour Government as well—in a vacuum, without explaining the dramatic changes in the way in which people are treated today compared with many years ago.
My hon. Friend mentioned, for instance, that before long 60 per cent. of surgery will be performed on a day basis, with more than 80 per cent. of it being bloodless. He went into some detail—I will not attempt to pronounce some of the words that he found difficult to pronounce—of the new techniques which are being brought in, for example, with endoscopes, lasers and techniques known as keyhole surgery, all of which have reformed the way in which medical technology treats patients in the NHS and has made the need for so many beds and for a large number of old-fashioned hospitals now out of date.
I therefore make no apology whatever for the fact that both under this Government and under the previous Government we have reduced the number of crumbling Victorian hospitals and replaced them with new, modern district hospitals. Since 1979, we have opened major district general hospitals—for example, the Morriston phase 1 in Swansea, the Princess of Wales hospital at Bridgend, Ysbyty Wrexham Maelor, Ysbyty Glan Clwyd, Ysbyty Gwynedd, and the Prince Philip hospital in Llanelli—six brand new general hospitals. In the past year we have given approval for two more district hospitals to be prepared—at Neath and at Ynys-y-Plum in mid Glamorgan. We can see that progress is being made on all fronts under the Conservative party in control of the NHS in Wales.
In the 12 months I have been Minister, I have begun construction, attended or opened a new NHS facility in Wales every four weeks. More importantly, spending has led to dramatic improvements in the number of patients treated. As my hon. Friend mentioned, since 1979 the number of in-patients has risen by 38 per cent.—well over a third since we came to office—the number of out-patients has gone up by 29 per cent., and day case surgery has increased by almost 260 per cent. The results for the people of Wales have been dramatic. The number of men under 65 prematurely dying is down by 5 per cent. Premature deaths among women under 65 are down by 4 per cent. Perinatal mortality rates have been reduced by 40 per cent. The life expectancy at birth for someone living in Wales rose by two and a half years between 1979 and 1989. That is why we have been so determined to continue the reforms.
1168 We should pause for a minute to consider what is being done and why. We are carrying out our reforms not because we believe that we need to disrupt the NHS, not because we want to be unpopular, but because we believe strongly that our national health service can be reformed and needs to be improved still further and that is what we are determined to do. We cannot go on, as we have in the past, not knowing the cost of operations, not being able to compare different treatments, operations and techniques in different hospitals and not knowing whether one general practitioner is prescribing more drugs than he needs to compared with another GP. We had to get a grip on spending in the NHS—not because we wanted to save money for the sake of saving money because we were mean-minded and penny-pinching, but because we believe that a pound that is wasted in the NHS is a pound that is not available for direct patient health care. That is why we have introduced our reforms and why we have been prepared to take flak from the Opposition parties which are not interested in the NHS, but only in scoring party political points.
The reforms on which we have embarked are now being copied around the world with 18 out of the 24 countries of the Organisation for Economic Co-operation and Development either planning or implementing similar reforms. The Dekker reforms in Holland oblige purchasers to choose between providers. Germany is asking its sickness funds to cancel contracts with inefficient hospitals and is obliging its hospitals to publish details of their costs. Even in socialist Sweden, the health authorities have started awarding contracts to health centres and hospitals which provide the right service at the right price.
We are determined to ensure that our reforms continue. Only today we announced that an additional 19 GP fundholders had been approved to take control of their own budgets from next April. My right hon. Friend the Secretary of State for Wales also announced today the establishment of the first NHS trust in Wales. As the constituency Member of Parliament for Pembroke, I am delighted that Pembrokeshire is once again leading the way in Wales by pioneering new forms of NHS management.
I believe that trusts are, increasingly, the natural form of organisation for NHS units in Wales. The more I talk to managers as I visit hospitals throughout Wales, the more it becomes clear that they are enthusiastic about the new reforms and want to be able to go down the road of becoming NHS trusts. I hope that we shall shortly be able to announce that a substantial number of NHS hospitals and units in Wales have applied for NHS trust status. That shows that the Opposition's talk about our policy being unpopular is totally bogus because, of their own volition and without any pressure being applied, the staff and management of the NHS in Wales are applying to the Welsh Office with expressions of interest in becoming trusts. That shows that our policy is well understood by the professionals, who very much want the additional management control that trust status brings.
I find it strange that the Labour party is opposing the idea of NHS trusts because we are simply seeking to return to the system of hospital management boards which existed before 1974. Indeed, at that time the Labour party opposed the establishment of district health authorities and wanted to keep that old system. We have all recognised that big is not necessarily beautiful, and that there is much to be said for devolving management down 1169 to smaller units, but the Labour party is now in favour of large centralised bureaucracies. It opposes giving local people the opportunity to manage their own health services. I am delighted that we in Pembrokeshire have been able to lead the way.
The Government have also introduced the patients charter. I do not want to go into detail about that now because time is running short, but every home in Wales has already been sent a copy of the charter—or will be in the next few weeks—giving patients details of their rights. I believe that every person in Wales should know how their money is being spent and what services they can expect.
I turn finally and briefly to the Opposition's policy. It is interesting that no Opposition Members have stayed in the Chamber for this debate. Labour politicians throw up their hands in horror and make snide remarks about accountants in the NHS reforms, but they do not say that the opposite of achieving value for money through the reforms is to waste money. That is the most repugnant feature of Labour's dishonesty on health matters. 1170 Opposition Members try to pretend that they would spend more, but the hon. Member for Derby, South (Mrs. Beckett) and her right hon. and learned Friend the Member for Monklands, East (Mr. Smith) say that they cannot. When one looks at the Labour party's proposals, it becomes clear that the Opposition do not have any real policies for reforming the NHS. The only thing in which Opposition Members are interested is stopping reform or any change to the status quo. They would be the mouthpieces of the National Union of Public Employees and the Confederation of Health Service Employees. They would not in any way provide the service that the patients want.
That is why we must continue with the overriding objective set out in our agenda for action, which is to take the people of Wales into the 21st century with a level of health care that is on course to compare with the best in Europe. Our aim is nothing less than the regeneration and improvement of one of our most important public services for the benefit of all our countrymen. It is a challenge that we relish and accept. We shall not fail.
§ Question put and agreed to.
§ Adjourned accordingly at half past Ten o'clock.