Commons Sitting of 26 January 1993

Preamble
The House met at half-past Two o'clock
PRAYERS
[MADAM SPEAKER in the Chair]
PRAYERS

  NIMMO SMITH/FRIEL REPORT
  Resolved,
  That an humble Address be presented to Her Majesty, That she will be graciously pleased to give directions that there be laid before the House a Return of the Report of the Inquiry by Mr. W. A. Nimmo Smith QC and Mr. J. D. Friel, into an allegation of a conspiracy to pervert the course of justice in Scotland, instructed by the Lord Advocate.—[Mr. Lang.]

Oral Answers to Questions

  HEALTH
  Madam Speaker: Question 1.
  Mr. Dalyell: On a point of order, Madam Speaker. I object to the extraordinary and unusual procedure involving the notice of motion—
  Madam Speaker: Order. Let me help the hon. Gentleman. There is no Question for me to put to the House in regard to the motion. The return is unopposed by the Minister who will have to make it, and under our procedure no objection can be made. We must now move on to Question 1.

  Bronchitis
  Mr. Flynn: To ask the Secretary of State for Health what new proposals she intends to introduce to reduce the numbers of deaths caused by bronchitis.
  The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): It is estimated that 80 per cent. of deaths each year from bronchitis and chronic obstructive airways diseases are associated with smoking. The "Health of the Nation" White Paper commits us to ambitious targets to reduce smoking, and sets out a comprehensive strategy to achieve these targets, including action on price, health education, ensuring effective controls on advertising, and a great national health service role in reducing smoking.
  Mr. Flynn: Does the Minister recall giving a different figure when he told my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) that nine out of 10 deaths from bronchitis and emphysema—22,000 deaths per year—were caused by smoking? Does he also recall that during the general election campaign the marketing manager of Imperial Tobacco Limited said that his company had given the Conservative party 2,000 poster sites because it wanted the party to do its bidding when in
  856
  government? Why do the Conservatives always surrender to the tobacco lobby, ignoring all the weight of scientific evidence? Are they stupid, or are they corrupt?
  Mr. Sackville: If the hon. Gentleman seriously thinks that there is any improper connection between the Government and the tobacco industry, he may ask why we have operated a pricing policy which has increased the real price of cigarettes by 43 per cent. in the past 10 years.
  Mr. Sykes: Is my hon. Friend aware that, owing to the Government's policy on cigarette prices, the percentage of the adult population who smoke has fallen from 45 per cent. in 1974 to 30 per cent. today?
  Mr. Sackville: Indeed—and we intend to meet our target of 20 per cent. by the year 2000.
  Mr. McCartney: As usual, the Minister has completely missed the point. He has an opportunity today to do something about the 17,000 children who need hospital treatment each year because of passive smoking. He could also do something about the hundreds of children who take up smoking every day: he could announce a ban on tobacco advertising. The Government and the tobacco industry are alone in Britain, Europe and the world in opposing the banning of tobacco advertising. Is it not about time that the Government stood up for the interests of the 17,000 children who are affected by smoking, rather than standing up for the interests of the tobacco industry?
  Mr. Sackville: If the hon. Gentleman thinks that other countries in Europe have better policies on smoking than ours, he may wish to consider why it is possible to buy international brands of cigarettes and import them into this country at prices 20 per cent. lower than ours in Italy, 35 per cent. lower in France, 40 per cent. lower in Spain and 45 per cent. lower in Greece. He may also wish to ask the socialist brothers in Europe why they approve of a policy which subsidises tobacco growers to the tune of £1 billion per year.
  Mr. Rathbone: Does my hon. Friend accept that Great Britain, where there is viable and energetic marketing of cigarettes, has a higher incidence of low-tar cigarette consumption than almost any other country? Does he also accept that, contrary to the Select Committee report, there is no link whatever between advertising and the incidence of smoking among young people?
  Mr. Sackville: My hon. Friend is right to say that there is no proven link, but we shall continue our programme of education to deter young people from taking up smoking.

  Tomlinson Report
  Mr. Gerrard: To ask the Secretary of State for Health if she will make a statement on the capital sums required by London FHSAs for upgrading general practitioner facilities to implement Tomlinson report proposals.
  The Secretary of State for Health (Mrs. Virginia Bottomley): The Government are considering ways in which health care in London can be improved, especially primary health care. I shall make a full statement shortly.
  Mr. Gerrard: Does the Minister accept that substantial investment is needed to bring GP surgeries up to standard, especially in areas of London such as my constituency,

  857
  which has the highest proportion of single-practitioner GP practices in the country? Why will not she give the House the estimated cost per surgery? I assume that she must know the figures. Does she not understand that people in London want to know when their primary health care will be improved and what it will cost, and to be assured that the money will not come from cutting other health service facilities?
  Mrs. Bottomley: I accept that the people of London want to know what is going to happen and to bring the uncertainty to an end. They rightly want to be confident that changes will be based on improvements in primary health care. Significant further advances in primary health care have been made. Capital investment, for example, has doubled in the past two years, but very much more needs to be done. We are having detailed discussions before making announcements.
  Mr. Carrington: Does my right hon. Friend accept that Londoners are keen to see greater investment in primary health care, but that they also need investment in hospitals? Will she join me in welcoming the opening of the Chelsea and Westminster hospital, at a cost of £204 million, which is the most advanced, state-of-the-art hospital in Europe and will provide magnificent health care to west London? Does she agree that that represents a marvellous achievement for London's health service and is a testimony to the investment that the Government are making in health care in London? Will she also—
  Hon. Members: No.
  Madam, Speaker: Order. This is Question Time, not the time when Members make statements. The hon. Gentleman must have had three bites of the cherry already. I am sure that the Secretary of State is more than capable of answering.
  Mrs. Bottomley: I warmly congratulate my hon. Friend on his fluency in advocating the excellence of the new hospital. London will indeed remain a centre of excellence in hospital care, in research and in education. But we must look forward and make changes. The hon. Member for Walthamstow (Mr. Gerrard) is also right that that must be balanced with proper recognition of the role of primary care. These are difficult decisions, but they are decisions which we shall take.
  Ms. Primarolo: In reply to my hon. Friend the Member for Walthamstow (Mr. Gerrard), the Secretary of State referred to the improved investment in primary care. She must surely be aware that the Tomlinson report showed that 46 per cent. of GPs are performing below the national average, which is only 7 per cent. She is probably also aware that the Acheson report of 1981 stated that only 15 per cent. of GPs were performing under the national average in London. Since 1981, 5,000 beds have been closed to pay for improved primary care in London. There has been a threefold deterioration in the service. When will the Secretary of State take some action instead of lecturing us and offering platitudes?
  Mrs. Bottomley: The hon. Lady clearly fails to understand that significant improvements have been made in London, mainly as a result of the new GP contracts, which the Labour party voted against. The deprivation payments, the targets payments for immunisation and cancer screening have at last led to improvements in
  858
  inner-city areas, but more needs to be done. I welcome the hon. Lady's appreciation of many of the valuable points that are made in the Tomlinson report. She also referred to the Acheson report. Many of its recommendations have been implemented, the most important being the new GP contract which has set the tone for family doctor services across the country. The Labour party voted against that.

  Social Services
  Mr. Ottaway: To ask the Secretary of State for Health what plans she has to develop independent inspection of social services provision in line with the citizens charter.
  The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo): We shall build on the work of local authority inspection units and the Department's social services inspectorate by increasing independence, accountability and the involvement of lay people. Our plans are set out in the consultation document "Inspecting Social Services" published last October. These will be implemented once we have considered the responses now being received.
  Mr. Ottaway: Does my hon. Friend agree that anyone who needs a lesson on the need for independent inspection and regulation need only look across the river to the borough of Lambeth? If that is an example of Labour local government at work, is it not better that we introduce Conservative community care reforms as soon as possible?
  Mr. Yeo: My hon. Friend is right. The example of Lambeth borough council—a uniquely disastrous blend of socialist dogma and managerial incompetence—is a timely warning of the need for rigorous inspection, not so much of the independent providers, who are already accountable through the registration process and the market, but of the local authorities' own activities, which have only recently become subject to inspection as a result of our legislation and where our proposals will further tighten scrutiny.
  Mr. Robert Ainsworth: The Secretary of State will be aware that, as a result of the implementation of Government community care policy with Government funding, existing services for mentally handicapped people are to be closed in Coventry. How on earth will he inspect and ensure that people have their rights under the citizens charter when the facilities no longer exist?
  Mr. Yeo: By far the best safeguard of high standards is the mixed economy of care that we are using as the bedrock of our new community care policies. Coupled with the extraordinarily generous resourcing of the new policy, which next year makes available about 15 per cent. more money for personal social services expenditure throughout the country, it will mean that there is no reason for services to be reduced in Coventry or anywhere else. I hope, however, that the hon. Gentleman will urge his councillors to ensure that the council makes the fullest possible use of the independent sector. For some reason, some Labour authorities have been so reluctant even to consult the independent providers that we have today had to issue a direction requiring them to do so.
  Mr. Rowe: When talking about the inspection of social services, will my hon. Friend remember that one of the best and cheapest ways to ensure that standards are maintained

  859
  is to encourage a much wider use of volunteers in a variety of ways within the social services, not only to extend the reach of professionals but to bring into a range of what might have remained murky corners the bright light of public interest?
  Mr. Yeo: Again, my hon. Friend is absolutely right. We want all local authorities to make the fullest possible use of all types of independent provision, most notably the voluntary organisations which have a distinguished role not only in residential or nursing homes but in domiciliary and day care services. Organisations such as Age Concern are already making full use of volunteers, and local authorities that have adopted an outward-looking policy are contracting with voluntary organisations to improve the delivery of services, especially domiciliary services.

  Community Care
  Mr. Steinberg: To ask the Secretary of State for Health when she last met the Association of Directors of Social Services to discuss the implementation of the changes in community care.
  Mr. Yeo: I last met the president and secretary of the Association of Directors of Social Services on Monday 21 December.
  Mr. Steinberg: The Minister will be aware that Durham county council has already had to close eight old people's homes because of Government policies. Is he also aware that, due to those policies, it is now possible that it will have to close even more and that homes in the private sector might have to be closed? Bearing in mind the fact that the Government argue for choice for elderly people, will the Minister explain how the closure of all those homes will provide choice for elderly people in my constituency?
  Mr. Yeo: The hon. Gentleman could not be further from the mark. Frankly, I am astonished that he even raises the point. In his county of Durham, the personal social services standard spending assessment for next year is £54 million, which is more than 18 per cent. above what the county is spending this year. Unless the Labour council in Durham calls in Lambeth borough council for advice, there is no conceivable possibility of any cuts in Durham having anything to do with the resourcing of the policy or with the Government's attitude.
  The Government are giving all social services clients the right, backed by a statutory direction, to choose where they want to go. In the light of what the hon. Gentleman says, I am not surprised that people may not be choosing Durham county council homes. The fact is that Durham could spend a further £8 million and still be within its SSA. On top of that, it is getting a special transitional grant of £7.4 million to fund community care.
  Mrs. Roe: Does my hon. Friend agree that the Government have fully honoured their commitment to funding community care? Is it not now up to the local authorities, which will give the lead in these services, to establish their priorities, accept the challenge and make the decision to use those resources effectively and efficiently?
  Mr. Yeo: My hon. Friend is right. In many areas, local authorities already recognise the wisdom of the concept of the policy and the fact that they have been resourced most
  860
  generously to deliver it. I am confident that a high standard of community care will be available to people, especially in the areas in which there is good co-operation between the social services department and the health authority.
  Mr. Hinchliffe: Bearing in mind that we are now a mere nine weeks to the day from the April community care changes, is it not totally unacceptable that disabled people and local authorities still do not know how the successor to the independent living fund will operate? Is the Minister aware that within the past week I have received two totally contradictory parliamentary answers, one from him and one from the Department of Social Security, as to whether there will be a ceiling after April on the cost of help towards independent living? Will the Minister tell me straight whether there is to be a care cost cap?
  Mr. Yeo: The hon. Gentleman presumably knows that we have included in the ring-fenced money for community care a further £26 million to enable local authorities to make their contribution to the successor arrangements for the independent living fund. I am happy to make it clear that there will be no ceiling on the amount that local authorities can use to provide services for clients, whether they would formerly have been clients of the independent living fund or not. It will be for the local authority to decide how much local authority money is to be used to provide services.
  Sir John Hannam: Now that the independent living fund will no longer make cash payments in cases of severe handicap, will my hon. Friend adopt the Disabled Persons (Services) Bill, promoted by my hon. Friend the Member for Mid-Kent (Mr. Rowe), which is also called for by the Association of Directors of Social Services and by all the local authority associations, and which seeks to reintroduce the practice whereby local authorities could make direct cash payments in deserving cases to severely disabled people.
  Mr. Yeo: My hon. Friend raises an interesting point. I am aware that there is a lot of support in a number of quarters outside the House for giving local authorities the power to make cash payments which could then be used by individuals to purchase services on their own behalf. The Government are not ready at this stage to take that on board. We believe that it is the function of the social security system to make cash payments to individuals.
  The cornerstone of our community care reforms is the empowerment of the individual. Instead of the present arrangement whereby people automatically claim income support payments from the Department of Social Security, there will be individual assessment of people's needs, taking into account their wishes, the wishes of their families and of their carers—[Interruption.] The Opposition are not interested in the policy, but my hon. Friend the Member for Exeter (Sir J. Hannam) is interested, and he is a well-known authority on the subject —[HON. MEMBERS: "Address the Chair."] I believe—
  Madam Speaker: Order. I say to the entire House, Back-Bench Members as well as Ministers, that I want to have direct questions and very speedy answers to them so that we may move down the Order Paper and so that I may call other hon. Members who have substantive questions.
  Mr. Yeo: The policy that we shall implement in April will incorporate a number of features that will be of great advantage to individuals.

  Hospital Treatment
  Mr. Garrett: To ask the Secretary of State for Health what guidance she is issuing to provider units concerning preferential access to hospital treatment for patients from GP fund-holding practices.
  Mrs. Virginia Bottomley: Guidance agreed with the joint consultants committee was issued to hospital consultants in June 1991. It precluded contracts for general practitioner fund holder patients that disadvantaged other patients.
  Mr. Garrett: In Essex and Hertfordshire, and soon in Norfolk, patients of GP fund holders are being admitted to hospital while other patients will have to wait until April or beyond. What is that if not a two-tier health service?
  Mrs. Bottomley: I will make the position exactly clear. The GP fund holders are funded on the same basis per head as the district health authorities. It is for each of them to spend that money through the year as they think best. In some areas the districts have placed their contracts and the hospitals have more than met those contracts and are delivering fast, effective patient care. In some circumstances, the fund holders have not yet spent all their funds and can set priorities in a different way. Instead of begrudging it, the hon. Gentleman should see how fund holders have spent their resources to show how better the district could set its priorities for the year ahead.
  In the hon. Gentleman's constituency the trust hospital has treated 4,000 more patients than last year. His constituency also has a new renal unit, a new third orthopaedic theatre and a new £1 million accident and emergency department. If we are learning from the fund holders, we should welcome the example and innovation that they set.
  Mr. Hayes: Does my right hon. Friend agree that GP fund holding has been a tremendous success? It has improved patient care and choice for patients and it is popular with practitioners–14 per cent. of the population is now covered by GP fundholders. Does she also agree that clear guidelines have been issued by her Department against fast tracking and that they should be obeyed?
  Mrs. Bottomley: There are clear guidelines and it is important that we continue to observe them. GP fund holding has been a major source of innovation. For those who profess to support the patients, there is no better way of doing so than to give power to general practitioners. GP fund holding enhances the ability of the GP to act as an advocate on behalf of the patient. A recent survey in Doctor magazine showed yet again the way in which fund holders have been able to provide more efficient and effective care, integrating primary and secondary care in ways from which others can learn.
  Mr. Blunkett: Will the Secretary of State tell us, then, why GPs—including fund holders—throughout the country, consultants in the consultants and specialists committee of the British Medical Association, and all who work in and are aware of the health service are up in arms about a two-tier service, the existence of which the
  862
  Secretary of State refuses to accept? Is she aware of the case spelt out in The Guardian this morning by David Brindle? In view of her statement this afternoon, what action is she prepared to take to stop minor treatment taking precedence over major surgery and to prevent a two-tier health service in Britain?
  Mrs. Bottomley: The hon. Gentleman simply fails and refuses to understand the way in which the system works. At long last, we have a health service in which we can focus resources on the priorities set by the districts and GPs through the freedom that is given to GP fund holders. It is the job of the district to talk to local GPs about the priorities that they want set year on year as they place contracts. For 20 per cent. of the work, the GP fund holders have the freedom to allocate their priorities in a different way.
  The reason why I could never support the Labour party is that it believes—[Interruption.]
  Madam Speaker: Order. These interruptions are a complete waste of precious question time.
  Mrs. Bottomley: I could never support the Labour party because it believes in a system of levelling down, whereas we believe in a system of levelling up.
  Mr. Jacques Arnold: Are not the facts of the case as given by the hon. Member for Norwich, South (Mr. Garrett) further proof that the fund-holding practices in his area obtain better value for patients than the district health authority does? Is not that further proof that we should extend the fund-holding practices further for the benefit of patients?
  Mrs. Bottomley: My hon. Friend is exactly right. We want to extend the benefits of fund holding to all general practitioners, whether they apply, as do 20 per cent. of GPs, to become fund holders by this April, or find other ways of working more effectively with the district. The aim is to reverse the balance of power so that general practitioners, acting on behalf of patients, can have some leverage in the system.

  Elderly People (Deaths)
  Mr. Wicks: To ask the Secretary of State for Health what is her estimate of the relative number of deaths of those aged 75 years and over in (a) the summer and (b) the winter; what comparable figures she has for other European nations; and what assessment has been made of the causes of any difference in the figures.
  Mr. Yeo: Figures from 1988 to 1992 for England and Wales in respect of people aged 75 and over indicate that, on average, some 55 per cent. of all deaths have occurred in the winter period —October to March. There are no readily available comparable figures for other European nations. Evidence suggests, however, that there are significant variations in winter mortality across Europe, although the reasons for these discrepancies are not yet fully understood.
  Mr. Wicks: Is the Minister not aware that facts published in his Department's journal "Health Trends" provide European and international comparisons? Is it not the case that, sadly, these reveal that we are top of the

  863
  European winter deaths league? These facts are well known. Will the Minister take action to end the annual cold war on Britain's pensioners?
  Mr. Yeo: To the extent that the published figures mean anything at all—[HON. MEMBERS: "Oh!"]—they show that Portugal is at the top of the European league, substantially higher than Britain. Given his background, the hon. Gentleman ought to know that the pattern of a higher death rate in winter is a long-established trend. The excess of winter deaths over summer deaths was higher in the winter of 1978–79 than it was in the winter of 1991–92. Therefore, it is difficult to lay blame at the Government's door.
  Mr. John Greenway: Does my hon. Friend agree that one of the great advantages of being old in Britain is free access to our national health service? Does he further agree that a great many of the thousands of extra patients who have been treated since the Government's health reforms were implemented are elderly? That is why the vast majority of our pensioners support the NHS and think that it provides a wonderful service.
  Mr. Yeo: My hon. Friend is absolutely right. The results can be seen in the substantial fall in the number of deaths from hypothermia. Our older people benefit not only from the national health service but from advice under our "Keep warm, keep well" campaign which tells them about a wide range of matters, including benefits and insulation. A relevant factor in our success in helping old people in winter is that 67 per cent. of households containing older people have central heating. That is three times the percentage of 20 years ago.

  Hospital Admissions
  Dr. Wright: To ask the Secretary of State for Health if she will make a statement on the impact of budgetary restrictions on hospital admissions in the current financial year.
  The Minister for Health (Dr. Brian Mawhinney): The amount of money made available to the health service in England in 1992–93 was in real terms a massive 5.4 per cent. more than in 1991–92 which, together with the benefit of cash-releasing efficiency savings, has enabled over 200,000 more patients to be treated in the first six months of 1992–93 compared with the same period in 1991–92.
  Dr. Wright: Is the Minister aware that the Secretary of State's earlier denial of a crisis in the admission of patients to hospital is denied by the experience of patients up and down the country? What does the Secretary of State say to the general practitioner who wrote to me in the first week of January to tell me that he had just been told that, as a non-fund-holding general practitioner in south-east Staffordshire, he would not be able to admit patients to his major referral hospitals in Sutton Coldfield and Walsall until next April? What does the Minister and the Secretary of State say to my constituents who are now being denied hospital treatment? More importantly, what do they intend to do about it?
  Dr. Mawhinney: I shall tell the hon. Gentleman what he should say to his constituent. He should tell him that this year there was a 5.5 per cent. real-terms increase in the resources made available to the Mid-Staffordshire district
  864
  health authority and that next year there will be a 1 per cent. real-terms increase. He should tell him that there has been a 35 per cent. increase in the number of in-patients and a 100 per cent. increase in the number of out-patients treated by the Mid-Staffordshire DHA, and that there has been a 380 per cent. increase in the number of day cases. The GP should speak to the DHA about structuring the contracts next year so that those figures may be improved even more. I am sure that the hon. Gentleman's constituents will be sad that he is not pleased about the great improvement in health care that has been made available to them.
  Mr. Harry Greenway: Is my hon. Friend aware that the country is glad that so many more people are being treated in hospital? Will he confirm that when doctors say that cases are urgent it is rare for treatment not to be made available quickly?
  Dr. Mawhinney: My hon. Friend is absolutely right. It is worth pointing out that in this present year we are spending £629 per person on health care. In equivalent terms, the last figure under the Labour Government was £417. By next year, that will mean a massive 61 per cent. real-terms increase in resources.
  Ms. Lynne: Does the Minister accept that budgetary restrictions have led to a number of bed closures and is he aware that Rochdale health care trust has closed three wards? What does he suggest that I say to young patients, aged five and nine respectively, who now have to move to another hospital? It is traumatic enough for a child to be in hospital and they are very upset by a move.
  Dr. Mawhinney: I do not accept for one moment that there have been budgetary restrictions that have led to the results that the hon. Lady has just set forward. What I do accept is that the contracts, which have produced more resources this year and resulted in more patients being treated than ever before, need to be managed properly. They will be managed better if local managers involve local hospital doctors and consultants in the management process. They will be managed even better if GPs locally are brought into the process of determing how the contracting process should be carried forward. This is precisely the time of year when GPs who are not fund holders ought to be talking to the district health authorities about the shaping of contracts for next year.

  "Health of the Nation"
  Mr. Nigel Evans: To ask the Secretary of State for Health what plans the Government have formulated to carry out the strategy outlined in the White Paper "Health of the Nation".
  Mrs. Virginia Bottomley: The "Health of the Nation" strategy has been described by the World Health Organisation as a model for other countries to follow. There is a commitment to the strategy across government at the highest level, Action is now in hand to implement it in full. I have placed a summary of current action and initiatives in the Library.
  Mr. Evans: I am grateful to my right hon. Friend for her reply. Does she remember the speech she gave last year to the Conservative party conference? [Interruption.] Everyone appears to remember it. She referred then to

  865
  aspects and elements of "Health of the Nation" and to her personal commitment to mental illness and the strategy relating to it. Will she therefore accept the grateful thanks of many of my constituents who are extremely concerned about this issue? Would she also agree that, because of the surge of interest in mental illness recently, what she said then has been completely vindicated?
  Mrs. Bottomley: I thank my hon. Friend. Mental illness is three times as common as cancer and is a source of major disability and loss of time from work and must be a priority for us in the health service. It is a key area in the health of the nation and is vital in the implementation of community care. It is a question of resources. We are spending £1.7 billion on our mental health services, £43 million with the local authorities, but it is also a question of the delivery of those services. It is an area where I think that we must work together to secure better and more effective results.
  Mr. Wigley: May I question the Secretary of State further on the full utilisation of the capacity of hospitals to give treatment? Notwithstanding the increase to which her Minister referred for the first nine months of this year, does she accept what a consultant said on the radio last week—that he is unable, in the last quarter of this financial year, to undertake as much work as he could because of the shortage of resources? Surely this cannot be in line with her objectives for the health service. Can she try and get something done about it?
  Mrs. Bottomley: The House will well understand that it is a question of the way in which resources are used and the way in which we balance priorities. That will always be difficult, but much can be done from the centre and much has to be done locally. The key targets in the "Health of the Nation"—heart disease, cancer, accident, sexual health and mental illness—all have areas where we want to pioneer and innovate. All have areas where one has to balance between acute and community care. It is a question of taking people with us as we develop a strategy that the NHS reforms have made possible and which we have to deliver by the turn of the century.

  NHS (Efficiency Improvements)
  Mr. Riddick: To ask the Secretary of State for Health what estimates she has made of the total savings to the NHS from efficiency improvements.
  Dr. Mawhinney: Since 1978–79, hospital and community health services activity has grown by 29 per cent. compared with an increase in current spending—adjusted for hospital and community health services pay and prices —of 9 per cent. This means efficiency has grown by 19 per cent. over 12 years. This includes cash-releasing savings, now running at a cumulative £1.7 billion per annum, and also other efficiency gains from using resources more productively. Total efficiency gains of 2 per cent. are planned for both this year and next.
  Mr. Riddick: Are not those figures highly impressive? Will my hon. Friend give the House an assurance that the savings achieved through greater efficiency will not be squandered by retaining excess capacity for hospital provision in London? Does he agree that if the Tomlinson recommendations are not implemented, there will be fewer
  866
  resources for hospitals outside London and the losers will be NHS patients in the regions, in constituencies such as mine?
  Dr. Mawhinney: My hon. Friend is absolutely right; it is a very good record and it is to the credit of those who work in the NHS throughout the country that it has been achieved. I can confirm that the savings that have resulted have been used for other patient care. With regard to the latter point made by my hon. Friend, it is certainly one of the issues that are in the forefront of our minds as we contemplate the recommendations made by Sir Bernard Tomlinson.
  Mr. Enright: Is the Minister aware that it is the practice of several trusts, and I am thinking of Bassetlaw in particular, to buy expensive cars such as BMWs for their administrators, to take out car insurance for them all, and to spend NHS money in that way? Will he undertake to investigate that practice and find out how much it costs, because rip-offs such as those make Lambeth look like Snow White?
  Dr. Mawhinney: We on the Government side understand how embarrassed hon. Gentlemen are about Lambeth, but it will not go away and it will certainly not go away under the guise of pathetic—HON MEMBERS: "Answer".] I am trying to answer the question; the hon. Gentleman mentioned Lambeth. Secondly, I should have been more impressed by his question if he had bothered to take up the matter with me in a considered fashion by letter, but he has not done that. No doubt, if he does, we shall be able to respond. Trusts are treating more patients, using their resources more effectively and delivering better quality service, and I am surprised that the hon. Gentleman does not welcome that.
  Mr. Enright: On a point of order, Madam Speaker.
  Madam Speaker: Order. The hon. Gentleman is aware that I cannot take points of order in the middle of questions.
  Mr. Clifton-Brown: Does my hon. Friend agree that the Opposition seem to think that one can buy a better service simply by calling for more money, whereas we like to spend the money effectively? Compulsory competitive tendering has already saved £140 million. Does this not prove that our policies work?
  Dr. Mawhinney: My hon. Friend is absolutely right and puts the case very well.
  I just want to add with reference to the hon. Member for Hemsworth (Mr. Enright) that apparently he has written to me, but I have not seen the letter yet. If that is indeed the case, I should clarify that.

  Hospital Administration Costs
  Mr. Chisholm: To ask the Secretary of State for Health what were the total hospital administration costs in the financial years 1990–91 and 1991–92.
  Mr. Sackville: In 1990–91 expenditure on administration specifically in hospitals in England totalled £454 million. A strictly comparable figure for 1991–92 is not available, as information is now collected on a provider unit basis, which includes functions previously performed at district level. However, it is clear that the cost of

  867
  administration has increased: the national health service needs better management and administration to ensure the success of the NHS reforms for the ultimate benefit of patients.
  Mr. Chisholm: I am quite surprised at that answer, because comparable figures for Scotland were given a few weeks ago, and indicated a 75 per cent. increase in hospital administration costs. Is it not likely to be far worse in England, given the greater number of trusts? Is that not borne out by an answer in Hansard on 23 November, which indicated that the health reforms so far had cost £1.179 billion? Will it not get worse as we have more and more GP fund holders and more and more trusts, especially as so many senior managers in trusts are paying themselves grotesquely large salaries?
  Mr. Sackville: The success of the reforms is clear from the activity figures, which show more patients being treated quicker and better. That takes first-class management and investment in information technology. The hon. Gentleman should visit his local hospitals, talk to doctors and management and see how they are using that information technology for the benefit of patients.
  Mr. Nicholls: Does the Minister agree that those hospital administration charges are only part of a budget which makes it possible to spend £100 million a day on the national health service? Will he remind Labour Members of the promise they made at the last election to spend an extra £1 billion and the fact that that would have represented only 10 days' running costs? That puts the matter in perspective.
  Mr. Sackville: An organisation that seeks to spend £100 million a day on health care must be properly managed. We are moving from a system under which nothing was costed to a system under which everything is costed precisely, for the better management of health care for patients.

  PRIME MINISTER

    Engagements
    Mr. Battle: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    The Lord President of the Council and Leader of the House of Commons (Mr. Tony Newton): I have been asked to reply.
    My right hon. Friend the Prime Minister is making official visits to India and Oman.
    Mr. Battle: Is the Secretary of State for Employment telling the truth when she says that the President of the Board of Trade did not consult her about pit closures?
    Mr. Newton: If the hon. Gentleman thinks that my right hon. Friend was not consulted, would he like to tell me how it was possible for her to announce on the same day a wide-ranging package of measures directed at employment?
    Mr. Rowe: My right hon. Friend will be aware that as our trade with the European mainland constantly increases, a large proportion of it must pass through the county of Kent. Is he aware that the county of Kent and all the district councils in Kent are desperate to have a
    868
    considerable portion of that freight transferred to the railways? Will he ensure that when Ministers are considering the present proposals for the railways and the channel tunnel rail link, they do everything in their power to ensure that it is made possible for freight to be carried on the railway rather than on the cluttered roads of Kent?
    Mr. Newton: As my hon. Friend knows, it is precisely to improve the efficiency and attractiveness of rail freight that many of our proposals in the context of the future of the railways are directed.
    Mr. John Smith: Given that the crisis in the coal mining industry arises directly from the Government's rigging of the electricity market, why will the Government not accept that reform of the market to allow coal to compete fairly is the crucial and overriding issue?
    Mr. Newton: I do not accept for a moment the right hon. and learned Gentleman's suggestion. The problems in the coal industry arise from a long-term decline in the demand for coal which is being seen throughout the western world. The Government's policies are directed to addressing that and to securing the best possible future for the coal industry.
    Mr. John Smith: It is little short of astonishing that, even now, Ministers do not understand that the crisis arises from the botched privatisation of the electricity industry and not from any weakness in the British mining industry. Are the Government not aware that what the industry and the nation need is not some short-term fix to save the Government's face but a reform of the electricity market to allow British miners to compete fairly?
    Mr. Newton: My right hon. Friend the President of the Board of Trade will shortly bring forward proposals directed at the outcome of his review of the coal industry. Meanwhile, if I find anything astonishing, it is that on a day when interest rates have fallen to their lowest level for 15 years, the right hon. and learned Gentleman cannot even congratulate the Government.
    Mr. Raymond S. Robertson: Has my right hon. Friend had time to read the Confederation of British Industry's latest poll, which shows the biggest increase in business confidence for five years? Does he agree that low inflation, low interest rates and a very competitive exchange rate give British producers a real edge in world markets?
    Mr. Newton: I absolutely agree with my hon. Friend. We now have inflation at its lowest level for six years, interest rates, as I said, at their lowest level for 15 years, mortgage rates likely to be at their lowest level for nearly a quarter of a century and a marked increase in business confidence. We need Opposition Front-Bench Members to stop talking that confidence down.
    Rev. Martin Smyth: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer the hon. Member to the answer I gave some moments ago.
    Rev. Martin Smyth: In the light of press reports confirming the "Timewatch" programme and—as some of us have known for a long time—that the Dublin Government supported the growth of the provisional IRA

    869
    in 1970, will the Leader of the House join the defence correspondent of The Daily Telegraph this morning in urging the Foreign Office and the Northern Ireland Office to engage in a diplomatic offensive against the Dublin Government to defeat terrorism and thus release 10 batallions of the Army to engage in international peacekeeping?
    Mr. Newton: While I understand why the hon. Gentleman thought it right to raise that point, I have no intention of commenting on allegations relating to events nearly a quarter of a century ago. What matters now is the shared determination of the British and Irish Governments to resist terrorism from whatever quarter, and I know that we have the hon. Gentleman's support in that.
    Mr. Budgen: Will my right hon. Friend reflect that had we not so fortunately come out of the exchange rate mechanism on 16 September we might now have interest rates at something between 10 and 15 per cent. imposed upon us by the Bundesbank and against the interests of the British economy? Will my right hon. Friend be good enough to suggest to the Prime Minister that the best thing that he could do to revive confidence in the British economy would be to say that we shall never return to the ERM and that we want nothing whatever to do with a single currency in Europe?
    Mr. Newton: I do not think that, however enticing it is, I shall follow my hon. Friend into speculation about what would have happened if something that already has happened had not happened. He will know what my right hon. Friend the Prime Minister has said about the ERM and I do not propose to elaborate on it now.
    Dr. Berry: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer the hon. Member to the answer I gave some moments ago.
    Dr. Berry: Taking a more serious perspective on the economy than previous comments from Conservative Members, will the Leader of the House explain to the 4,637 unemployed people in my constituency of Kingswood and the 5,000 in his constituency of Braintree how it is that they are "a price worth paying" for the worst economic record of any post-war British Government?
    Mr. Newton: What I would say to those for whom concern is mutual on both sides of the House is that the policies that we have been pursuing and which have produced the results to which I adverted a few moments ago are providing the best basis for overcoming those concerns.
    Mr. Peter Bottomley: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer my hon. Friend to the answer I gave some moments ago.
    Mr. Bottomley: May I suggest to my right hon. Friend the point that he has made which will get the greatest echo from all political parties? The boost to jobs, the reduction in mortgage payments and the boost to capital investments
    870
    from low interest rates will make people ask whether it is possible for the Leader of the Opposition to join with the Government in helping to attract more foreign capital investment into this country—and more jobs—so that fewer people will be out of work.
    Mr. Newton: It would certainly be very welcome far beyond the confines of the House if the right hon. and learned Gentleman would give any sign whatsoever that he sees what would be required. Instead, he promises payroll taxes, excessive profit taxes, social chapters and the rest of it, which would keep foreign investment out for good.
    Mr. Tony Lloyd: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer the hon. Member to the answer I gave some moments ago.
    Mr. Lloyd: Continuing with the bipartisan interest in unemployment, may I tell the Leader of the House that in my constituency mass unemployment during the 14 years of Conservative government has resulted in high crime rates, the sale of drugs and its associated violence and individual family tragedies? My constituents are now incredibly angry at the inaction of the right hon. Gentleman and his colleagues. Rather than asking my right hon. and learned Friend to help them out, will the Leader of the House tell us what the Government plan to do about these problems, when will they do it and when can we see some results?
    Mr. Newton: I find that a strange question, especially against the background of our exchanges so far and on the very day that interest rates have fallen to their lowest level for 15 years. What is more, the hon. Gentleman might at least have acknowledged that unemployment in his constituency last month was 16 per cent. lower than in 1987.
    Mr. Butcher: Did my right hon. Friend notice the very welcome announcement by Jaguar in Coventry that it is to invest £700 million in developing three new models for the market? When our right hon. Friend the Prime Minister returns to the House, could he pass to him an invitation to visit Coventry so that he can show his support for the engineering profession and the engineering industry which will spearhead our recovery?
    Mr. Newton: I note my hon. Friend's request, which I shall draw to our right hon. Friend's attention when he returns. One of the encouraging signs in our economy during recent months has been the renewed strength of the car industry, in part as a result of the very overseas investment to which I referred earlier and which certainly would not have come here had the Opposition had their way.
    Mr. Gerrard: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer the hon. Member to the answer I gave some moments ago.
    Mr. Gerrard: Does the Leader of the House recall that in March 1991 the Government tried to buy their way out of their troubles with the poll tax by reducing it by £140 a head? They found the money to do that by raising VAT

    871
    from 15 to 17.5 per cent. Now that the poll tax is finally about to disappear, can we expect VAT to be cut by 2.5 per cent? If not, why not?
    Mr. Newton: The hon. Gentleman can expect the introduction of a system of council tax that will be a great deal better than what his right hon. and hon. Friends are offering with a return to the rates.
    Mr. Tracey: Is my right hon. Friend satisfied that the fullest possible investigation is being undertaken into the behaviour of Lambeth borough council, where one of the greatest frauds ever perpetrated in local government appears to have taken place?
    Mr. Newton: I think—I hope—that I can speak for both sides of the House in expressing concern about the allegations of a breakdown in financial control in the London borough of Lambeth. The proper authorities—the Audit Commission and the police—will be investigating the matter. As my hon. Friend says, if the allegations prove to be true, it will be a good illustration of some of the problems in Labour local authorities. I hope that the Opposition Front Bench will join us in condemning them.
    Mr. Hoyle: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I have been asked to reply.
    I refer the hon. Member to the answer I gave some moments ago.
    Mr. Hoyle: Does the Leader of the House agree that when considering energy policy, we should look not at short-term market forces but at long-term needs? That applies especially to collieries threatened with closure, such as Parkside. It has always been highly profitable and it has reserves for 70 years. Should not the future of such collieries be based on the future demand for coal, which will become increasingly competitive as other fuels become more expensive?
    Mr. Newton: By now, it must be clear to all in the House that the review is very thorough and is not looking simply at the short term. It is taking account of the reports by Committees of the House and a wide range of independent consultants. The results will be made known in due course, as appropriate.
    Mr. Milligan: My right hon. Friend has just explained the position in Lambeth, but is not Lambeth only one of many similar Labour local authorities throughout the country? For example, Monklands and Sheffield have been misusing taxpayers' funds, yet they have some of the poorest taxpayers in the country. Has not the time come to have a full public inquiry to discover whether there is a common thread?
    Mr. Newton: As I have already indicated, in the first instance inquiries into allegations of the sort that have been made against a number of authorities—by and large, Labour authorities, as my hon. Friend has said—are matters for the Audit Commission and the police. Were a common strand to emerge, I should expect the concern to be reflected on the Opposition Front Bench, and not just on the Government Front Bench.
    Mr. Mandelson: To ask the Prime Minister if he will list his official engagements for Tuesday 26 January.
    Mr. Newton: I refer the hon. Member to the answer I gave some moments ago.
    Mr. Mandelson: What does the right hon. Gentleman think the behaviour of British Airways towards Virgin Atlantic says about the business ethics of British Airways, and what does he think the failure of anyone at the top of British Airways to resign says about the integrity of that airline's management?
    Mr. Newton: The hon. Gentleman will be well aware that these matters have been the subject of legal action between Virgin and British Airways. That being the case, it would not be appropriate for me to comment further.

Nimmo Smith/Friel Report
3.30 pm
The Secretary of State for Scotland (Mr. Ian Lang): With permission, I should like to read to the House a statement being made today by my noble and learned Friend the Lord Advocate in another place. [Interruption.]
Madam Speaker: Order. The House must come to order, as the Secretary of State is about to make an important statement. Those hon. Members who are leaving the Chamber should do so quietly, and conversations should be conducted outside the Chamber so that we may make some progress. The House must settle down so that we may hear the Secretary of State.
Mr. Lang: My noble and learned Friend's statement reads as follows:
"In September of last year I asked Mr. William Nimmo Smith, QC and Mr. James Friel, Regional Procurator Fiscal of North Strathclyde, to inquire into certain allegations suggesting that there had been a conspiracy to pervert the course of justice in Scotland. The report of their inquiry has today been published as a Return to an Address of another place.
The inquiry was set up following the leaking to the Press of an internal police report about allegations that decisions in relation to five criminal cases had been taken for improper reasons, namely, to prevent disclosure of information said to identify certain individuals in the legal profession as homosexuals. The allegations relating to the decisions were therefore allegations of possible criminal conduct. Mr. Friel and Mr. Nimmo Smith were asked to report to me. When I received their report, it was my duty to consider whether there was any basis for criminal proceedings."
My noble and learned Friend's statement continues:
"I have now studied their full and detailed report. It concludes that the decisions in each of the five cases were taken on a proper basis. In particular, it finds that there is no evidence of a conspiracy to pervert the course of justice, or that the course of justice has been perverted or that the alleged motive for such a conspiracy has ever existed. On the basis of the report I have decided that no criminal proceedings fall to be instructed. Further, the report makes it clear that there is no evidence of irregularity in the conduct of business in the Crown office or procurator fiscal service.
On a wider front, in order to allay public anxiety it was my intention when I established the inquiry that, subject to any restriction necessary for the purposes of possible criminal proceedings, the report would be published in full. Since no question of criminal proceedings arises, the report has been published in full.
The allegations in the police report appear to have been more readily believed because of certain rumours which were circulating among police officers and others about members of the Scottish legal profession. Mr. Nimmo Smith and Mr. Friel have investigated these rumours and have concluded that they are without foundation.
To appreciate the force of its conclusions, the report requires to be read as a whole. Those who wish to form a considered view on the matters covered by the report will therefore wish to study and reflect upon the whole text."
My noble and learned Friend's statement concludes:
"The report contains criticisms of certain officers in the Lothian and Borders police force. These are matters for the chief constable and not for me. There are, however, two matters emerging from the report which relate to the police and which I wish to discuss. The first is the failure of certain officers to understand the role of the independent prosecution authorities in Scotland. The second is that officers may misunderstand the decisions properly taken by those prosecution authorities in particular cases. I intend therefore to pursue with the chief constable what can be done, having
874
regard to the principles which guide the relationship between the police and prosecution authorities in Scotland, to prevent such misunderstandings in future."
Mr. Tom Clarke: In view of the interest taken in these matters by a number of my hon. Friends, particularly by my Friend the Member for Linlithgow (Mr. Dalyell), who has pursued the subject diligently, will the Secretary of State, in the context of his statement, explain to the House why he felt it necessary to support the motion for an unopposed return? May I join the Secretary of State in thanking the Lord Advocate for agreeing to set up an inquiry, certainly on the suggestions of my hon. Friends the Members' for Edinburgh, Central (Mr. Darling) and for Linlithgow?
Does the right hon. Gentleman agree that, although many had called for a judicial inquiry, Mr. Nimmo Smith and Mr. Friel have conducted a thorough and exhaustive inquiry of unprecedented depth? Can he tell the House what precise action the chief constable of Lothian and Borders has taken in respect of the authors of the report and other matters within his remit and for which he is responsible to the Secretary of State? Is the right hon. Gentleman satisfied with the chief constable's response? Above all, what steps has the Lord Advocate taken to ensure that communication between the police and the Crown office is improved, to avoid what appears to have been a major breakdown of understanding of their separate and distinct roles?
Does the Secretary of State agree that, unless anyone has evidence to the contrary, the report should be accepted and that nothing is served by continued speculation in the absence of any such fresh evidence?
Mr. Lang: I am grateful to the hon. Gentleman for his comments. May I begin by welcoming him back to the House fully restored, we all hope, to health?
The hon. Gentleman referred to the statement that I made, but I should emphasise that it was my noble and learned Friend the Lord Advocate's statement which I have repeated in the House. It is important to establish that. It was my noble and learned Friend the Lord Advocate who set up the inquiry.
The hon. Gentleman asked me about the basis on which the report is laid before the House. It is published as a return to an address of the House and thus affords absolute privilege for those who publish it in accordance with the Parliamentary Papers Act 1840. This procedure is well precedented and has survived for 150 years; it is a sensible way to ensure that there is no need to contemplate any reduction of the content of the report as published.
I am grateful to the hon. Gentleman for his comments about Mr. Nimmo Smith and Mr. Friel, both of whom enjoy a high reputation in legal circles in Scotland for their ability, for their independence of mind and for their rigorous approach to the handling of evidence. It is, as the hon. Gentleman said, a thorough and exhaustive report, and I commend it to hon. Members to be read in great detail and thoroughly before firm views are reached about its conclusions.
The chief constable is responsible for actions in the police force, and he has taken a number of actions as a result of the consequences of this matter. He initiated a review of various areas of police operation, and an action plan was drawn up. There has been a redefinition of the responsibilities allocated to the three assistant chief constables, and a new chief of the CID has been appointed.

875
There have also been a number of reassignments of CID officers to uniformed duties. The aim is to ensure that officers do not remain overlong in specialist posts. The chief constable has demonstrated a firm resolve in dealing with the matter. He continues to enjoy the confidence of the police authority, as he does of myself.
The hon. Gentleman raised the question of the relationship between the police and the Crown office, and that is a matter, as my noble and learned Friend's statement said, to which attention is to be given. My noble and learned Friend intends to meet the chief constable shortly to discuss how both the relationship between the police force and the Crown office and the understanding among the police force of the Crown office's responsibilities can be improved.
I hope that that covers all the points raised by the hon. Gentleman.
Sir Nicholas Fairbairn: I thank my right hon. Friend for his welcome back to the hon. Member for Monklands, West (Mr. Clarke), the shadow Secretary of State for Scotland, whom we are delighted to see with us and well.
May I raise three matters that arise out of the report? The first is the wisdom of writing expensive reports on an inquiry into rumour. The second is the wisdom of appointing corporals to investigate whether the generals have been interfering with the privates. Should we not have had much more senior people, such as retired judges or people of significance, to pass judgment on the judiciary? The third matter is whether the report is sound when its principal author gave an interview to a crook who pretended to be a journalist and who told him what it was going to contain, having attempted to steal the evidence against himself being a known homosexual. That seems to me to raise matters of grave impropriety which taint the report. I ask for my right hon. Friend's views.
Mr. Lang: Before my hon. and learned Friend uses such words as "taint", I urge him to read the report.
Sir Nicholas Fairbairn: I have done so.
Mr. Lang: I think that he will be impressed, as I have been, by the thorough and rigorous approach brought to bear on these difficult matters by Mr. Nimmo Smith and Mr. Friel.
My hon. Friend raised three matters with me. First, he questioned the wisdom of carrying out a report into rumour. I think that the House will agree that the rumour and speculation had become so established and was so festering in the Scottish scene that it was becoming a matter of serious public concern and one that rightly had to be dealt with, and dealt with directly and thoroughly. That, I believe, and any reasonable person reading the report would believe, has been achieved by Mr. Nimmo Smith and Mr. Friel.
My hon. and learned Friend suggests that the matter should have been handled by someone more senior, suggesting perhaps a retired judge. As criminal charges might have been brought, it would have been inappropriate to have the inquiry carried out by a serving judge. I think that my hon. and learned Friend will agree that that would have been inappropriate.
876
The report, which, once studied, will confirm this, is so thorough and so detailed that the need to appoint two individuals of the rigorous and competent qualifications of Mr. Nimmo Smith and Mr. Friel is fully justified.
Thirdly, on the question of interviews, I draw my hon. and learned Friend's attention to paragraphs 1.9 and 1.10 where he will find listed the persons interviewed by Mr. Nimmo Smith and Mr. Friel. I think that the list runs to some 90 persons. Clearly, it was their purpose to obtain as much information as possible, to establish evidence and to seek corroboration of it, from some people of a rather unreliable nature whose evidence could not necessarily be taken on trust.
Mr. Nimmo Smith and Mr. Friel have carried out a difficult task thoroughly and effectively and the report's overall effect is to justify the clear conclusions that they reach.
Mr. Menzies Campbell: Was the report completed before the publication of an interview obtained from Mr. Nimmo Smith by someone masquerading as a journalist? Does the Secretary of State accept that, while it is right that we should consider the report as a whole, we must have regard to the fact that a number of other inquiries at the hand of the chief constable have not yet been completed? Will he undertake that the results of those inquiries will also be published so that we may have the opportunity to form a complete judgment?
Finally, if, notwithstanding the publication of the report, some people still believe that they have evidence to support the allegations, is it not their duty to present it to the proper authorities? If they are unwilling to do that, is it not about time that this speculation was brought to an end?
Mr. Lang: I understand that the report had been completed before the outcome of Mr. Nimmo Smiths interview with Mr. Donaldson was published. Indeed, Mr. Donaldson's report does not feature in the report of the inquiry. As for the question of other inquiries, internal matters affecting the police force are for the chief constable. I do not think that it would be appropriate to publish those decisions, but that is a matter for the chief constable. No doubt he will read of the hon. and learned Gentleman's concern.
The question of possible criminal charges arising from other inquiries is a matter for the procurator fiscal, not for me. As for the hon. and learned Gentleman's final point, certainly it is the duty of anyone who has further evidence that he considers relevant, or who wishes to make further allegations—notwithstanding the fact that the report has now been completed—to bring those matters to the attention of the authorities.
Mr. Alistair Darling: Does the Secretary of State accept that, notwithstanding what was said by the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn), there is no reason to doubt the integrity of this far-reaching and in-depth report? Does the right hon. Gentleman agree that anyone who believes that the report is anything other than a true and accurate account of what happened can do so for only one of two reasons: either such a person has a vested interest in undermining public confidence in the Scottish judicial system, or he insists on peddling his prejudices about gay people in society as a whole as well as gay people who may hold judicial office?

877
If there is no evidence to cast doubt on the report, is it not time that it was accepted at face value, and all unwarranted speculation ended?
Mr. Lang: I agree with the hon. Gentleman's views about the credibility and accuracy of the report; I certainly accept its conclusions. The House will have noted the hon. Gentleman's speculations on the motives of those responsible for spreading the rumours.
Mr. Tam Dalyell: Was this, in substance, a criminal inquiry?
Mr. Lang: I think that the hon. Gentleman should read the terms of reference, which are set out in detail in the report. The report could have given rise to criminal charges, because it examined the possibility that there might have been a conspiracy to pervert the course of justice in Scotland. I am sure that the hon. Gentleman agrees that that would be a very serious charge.
Mr. Jimmy Hood: Does the Secretary of State accept that all this has been going on for quite a few years? Hon. Members on both sides of the House will have been hearing the rumours for quite some time. Does it not come down to the fact that the police service mistrusts the judiciary to some extent, and will the publication of the report help to heal that? Will there be an investigation of what is influencing the suspicions within the police service and what is at the root of the problem?
Mr. Lang: The hon. Gentleman has identified a problem established and clarified by the report. Some members of the police force—a limited number, I suspect—misunderstand the precise role of the prosecuting authorities. There may also be a need for the prosecuting authorities, on some occasions, to explain more clearly their reasons for proceeding, or not proceeding, with charges.
Dr. Norman A. Godman: The Secretary of State mentioned transfers from the CID to uniformed branches. Will he give the House an assurance that officers who seem to suffer from a certain degree of misunderstanding have not been punished severely within the service?
Mr. Lang: The degree of punishment and the actions of the chief constable within Lothian and Borders are matters for the chief constable. Ultimately, any police officer who feels that he has been wrongfully treated in connection with a disciplinary matter has the right of appeal to me; but it is, in the first instance, a matter for the chief constable.
Mr. John McAllion: Mr. Nimmo Smith is a Queen's Counsel. He was educated at Eton, Balliol and Edinburgh university. He is very much a part of the legal establishment in Edinburgh. Indeed, he depends for his career advancement on that legal establishment. Does the Secretary of State accept that the report would have been strengthened if it had been conducted by someone outwith the legal establishment in Edinburgh?
Mr. Lang: The hon. Gentleman's view is very much a minority one. The appointments of Mr. Nimmo Smith and Mr. Friel were widely welcomed. When the hon.
878
Gentleman has read the report—I quite understand why he has not yet had a chance to do so—he will realise, from the quality and texture of its detailed analysis of the issues, that it could probably have been compiled only by people with close experience of legal matters and legal procedure.
Mr. Eric Clarke: Is the Secretary of State really saying that we must accept this carte blanche? He seems to have failed to convince Conservative Back Benchers, such as the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn). It seems that Mr. Nimmo Smith was hoodwinked, very naive, or both. I know that morale among the constabulary in Lothian and Borders is very low. They see scapegoats being so-called retired prematurely and demoted to the uniform branch. I can assure you that when one of them—
Madam Speaker: Order. Will the hon. Gentleman speak through the Chair, please?
Mr. Clarke: I can assure the Minister that when one of them had his retirement farewell it was a pack-out—a show of solidarity by his fellow officers that he was wrongfully retired.
Mr. Lang: I advise the hon. Gentleman to read the report, and once he has read it in its entirety he will probably find it persuasive overall, as I did. My noble and learned Friend the Lord Advocate has accepted the conclusions of the report, which are clear cut.
Mrs. Margaret Ewing: I welcome the publication of the report, but does the Secretary of State accept that the effective prosecution of justice in Scotland is an inalienable right to each and every citizen, must be beyond question and must have the confidence of the population? The Lord Advocate has asked that we read the report in full and reach a considered view. Does that mean that the Secretary of State is considering allocating parliamentary time to considering the legal system in Scotland, in which we could not only explore the results of this inquiry but consider other aspects that are causing concern such as legal aid, the amount of time that policemen must spend hanging around courts, the need to appoint further procurators fiscal and so on? Parliamentary time is desperately needed, and there is consensus on the need for such a discussion.
Mr. Lang: I share the hon. Lady's sentiment about the importance of maintaining confidence in our prosecution service, which is kept distinct and separate from the actions of the legislature. The allocation of parliamentary time to consider the legal matters that she described is not directly a matter for me but is for the usual channels. I am sure that her thoughts will have been noted.
Mr. Malcolm Chisholm: I should like to associate myself with the remarks of my hon. Friend the Member for Edinburgh, Central (Mr. Darling), but might not it be helpful in future if the Crown office were to give some indication of why charges are not being brought rather than using the catch-all phrase, "not in the interests of justice"? Might not it be illuminating in other cases where charges are not brought, such as in cases of domestic violence?
Mr. Lang: It is important that the Crown office should preserve its independence and should not be held to account for every decision that it takes, and thus have to

879
enter into the debate at all times. Having said that, and subject to that qualification, as a result of the report a need has been identified for the chief constable of Lothian and Borders to speak to my noble and learned Friend the Lord Advocate and to consider what can be done to improve the understanding of each other's positions between the police and prosecution authorities.
Dr. John Reid: I have no reason to believe that the report is anything other than thorough and was carried out objectively, but, having no legal expertise, it seems to me to leave us with a problem. As I understood what the Secretary of State said, the basis of the reports, which have persisted for a considerable number of years and with considerable strength, was apparently a figment of the imagination of a small number of unspecified policemen who are apparently not only prejudiced but do not understand the workings of the legal system in Scotland and have a terrible propensity to gossip. I find that extremely difficult to believe as an explanation for the continuation and strength of the rumours.
However, if it is true, is not the Secretary of State asking us to believe that something drifted on for all these years without a conspiracy by the same police officers? In apparently clearing up one accusation of conspiracy, has he not implied that there was a conspiracy to undermine the legal system but one which came from police officers?
Mr. Lang: No, I am not drawing that conclusion, nor do I think that the House should. I urge the hon. Gentleman to read the report in detail. It is severely critical of certain officers, and it is true that some saw a conspiracy; but I expect that they will also want to read the report thoroughly and may reach different conclusions as a result. Certainly the report reaches a clear verdict, and I urge the House to consider it carefully before commenting further on these issues.
Mr. John Home Robertson: Whether the smoke has been generated without fire, and following the point raised by my hon. Friend the Member for Motherwell, North (Dr. Reid), will the Secretary of State take it from me that people from the Lothian and Borders area have the highest regard for the leadership of their police force? Does he agree that we are lucky to have the services of a chief constable and deputy chief constable of such a high calibre in the Lothian and Borders police?
Mr. Lang: Yes.
Mr. David Trimble: It is clear from the comments that the rumours and this case generate a concern that goes beyond the cases mentioned. I hope that the report will allay that concern, but I am curious about what the Secretary of State said about the reasons for making the report in this form, as a return to an address. Am I right in thinking that it was made in that way because parts of the report require the protection of the privilege of the House and would give rise to legal proceedings if it were published in the usual way? Does that not imply that parts of the report are therefore a little dubious or uncertain, and point to the need for a full, thorough judicial inquiry perhaps, as has been suggested, by someone from outside, finally to put the matter to rest?
Mr. Lang: I do not think that there is a case for starting another inquiry and going over the same evidence and background again in the absence of any new evidence. As for the publication of the report as a return to an address, it is a well established procedure which has been in place for more than 150 years. Its use does not imply any value judgment as to liabilities that might arise on particular individuals from the report, but it protects against that possibility, sets aside any uncertainty and enables all aspects of the report to be laid fully and clearly before the House.

Points of Order
3.58 pm
Mr. George Howarth: On a point of order, Madam Speaker. You will recall that during the Second Reading of the National Lottery etc. Bill yesterday I raised with you a point of order, as reported in columns 716–17 of Hansard.
My point of order was about the GAH group, which was commissioned by the Government to produce a report on the establishment and operation of a lottery and its impact on other industries. At the time, you said that you would look into the matter. I was especially concerned about an exchange that took place between the hon. Member for Crosby (Sir M. Thornton) and the Secretary of State for National Heritage which seemed to confirm that the hon. Member for Crosby was quoting from an article in The Guardian, which itself quoted from the GAH report. In addition, in confirming that, the Secretary of State was in effect quoting from that report.
It is worth mentioning that the GAH group was apparently formed on 8 June 1992—
Madam Speaker: Order. That is not relevant to the point of order.
Mr. Howarth: The Parliamentary Under-Secretary of State for National Heritage, in replying to the debate, referred at column 803 to the GAH group report and gave some detail of what is in it. I feel strongly that, in effect, Ministers were quoting, if not directly—we do not know whether they were quoting directly without seeing the report—from the report.
Although I am sure that I do not need to, I draw your attention, Madam Speaker, to page 382 of "Erskine May". Under the heading:
"Citing documents not before the House",
it says:
"A Minister of the Crown may not read or quote from a despatch or other state paper not before the House, unless he is prepared to lay it upon the Table. Similarly, it has been accepted that a document which has been cited by a Minister ought to be laid upon the Table of the House, if it can be done without injury to the public interests."
The concealment of the report is in itself injurious to the public interest. It is now time that the Government were made to reveal the contents of the report which has clearly formed a great part of their thinking. I maintain that the report was quoted during the debate last night.
Madam Speaker: I am grateful to the hon. Gentleman for raising the matter and for giving me an opportunity to respond. I have taken the opportunity to examine yesterday's Official Report. The Secretary of State for National Heritage responded to an intervention from the hon. Member for Crosby (Sir M. Thornton).
I make it clear to the House that the rule that a document that has been referred to should be laid upon the Table in its entirety applies only when part of it has been read to the House or when quotations have been read from it. Summarising or confirming—the hon. Member for Knowsley, North (Mr. Howarth) made a point about confirming—the accuracy of other people's summaries does not bring the rule into operation. The Secretary of State did not give a direct quotation from the document in question, nor did any other Minister. There is no obligation to lay the document before the House.
Mr. D. N. Campbell-Savours: Further to that point of order, Madam Speaker. I accept your ruling unreservedly, but, I suggest that when you used the word "confirming" you opened the door to a Minister asking a sympathetic Back-Bench Member to quote from a document and then confirming it from the Dispatch Box as a means of partly introducing to our proceedings something that should be made totally available.
Madam Speaker: The words I used were
"Summarising or confirming … the accuracy of other people's summaries".
I do not want to go further than that. The hon. Member for Knowsley, North made the point that the intervention concerned a summary from The Guardian.
Dr. Norman A. Godman: On a point of order, Madam Speaker. I seek your advice. If a report is the subject of a ministerial statement, would it be possible for hon. Members to be given access to such a report some 30 minutes before the statement? Statements give ministerial interpretations of reports and their findings. It would be useful for hon. Members to be given access to such reports 30 minutes before statements are made.
Madam Speaker: I understand the hon. Gentleman's concern about the matter, although I do not necessarily support his point of view. He may wish to pursue the matter with the Leader of the House on another occasion.
Mr. Bruce Grocott: On a point of order, Madam Speaker. At Question Time, in response to a question from my hon. Friend the Member for Croydon, North-West (Mr. Wicks) in which he quoted Government statistics, the Parliamentary Under-Secretary of State for Health, the hon. Member for Suffolk, South (Mr. Yeo), referring to the statistics, said:
"To the extent that the … figures mean anything".
A Minister has thrown doubt on the accuracy of Government statistics. It is difficult for us to understand how we can have a sensible debate in the House if Ministers do not believe the figures they are giving. That is especially important in light of the fact that we are about to have a debate on health matters. Ministers should make it clear when they speak in which statistics they believe and in which they do not believe.
Madam Speaker: If the hon. Gentleman wants to make that point, he must do so directly to a Minister through the debate. Perhaps if he catches my eye during the debate he can make that point to a Minister then.
Mr. Edward O'Hara: Further to the point of order raised by my hon. Friend the Member for Knowsley, North (Mr. Howarth), Madam Speaker. May I seek your guidance? There is a philosophical question of what is a summary and what is a quotation. I have before me column 716 of the Hansard report for 25 January. The hon. Member for Crosby (Sir M. Thornton) quoted the statistics of 17–5 per cent. and 1,100. The Secretary of State referred to those statistics as quotations from the GAH report. Figures such as those which my hon. Friend the Member for Knowsley, North quoted were obviously quotations from the report. I seek your guidance on whether that might be regarded as a quotation and not a mere summary.
Madam Speaker: The answer is that it is not a direct quotation; it is a summary. I have gone as far into that matter as I am able. I have dealt with three points of order on the matter today. Indeed, I dealt with points of order on it yesterday evening. I have made it clear that summarising or confirming the accuracy of other people's summaries does not bring the rule into operation. I have tried to be as helpful as I can to the House on the matter.

STATUTORY INSTRUMENTS, &c
Motion made, and Question put forthwith pursuant to Standing Order No. 101(3) (Standing Committees on Statutory Instruments, &c.).
STATUTORY INSTRUMENTS, &c

  PUBLIC PATH ORDERS
  That the draft Local Authorities (Recovery of Costs for Public Path Orders) Regulations 1993 be referred to a Standing Committee on Statutory Instruments, &c.—[Mr. Nicholas Baker.]
  Question agreed to.

Newly Qualified Drivers
4.5 pm
Mr. Simon Burns: I beg to move,
That leave be given to bring in a Bill to make it compulsory for newly qualified drivers to display plates indicating that they are recently qualified; to limit the engine size of the vehicles that they may drive; and for connected purposes.
As clarification, may I explain that newly qualified drivers are not exclusively drivers under the age of 25. Although the vast majority of newly qualified drivers are under that age, other newly qualified drivers are aged from 25 upwards, in some cases even to over 60.
As I said when I moved a similar Bill almost three years ago to the day, in the past 25 years there has been a revolution in motoring. Improved living standards have ensured that there is far wider car ownership. Instead of a norm of one car per family, it is now often the case, and indeed likely, that members of the same family own two or even three cars.
Furthermore, advances in technology, design and engine power ensure that cars are more sophisticated and powerful than 25 years ago. More than 29 million people have licences to drive a motor car. In 1988, 1,039,000 people passed their driving test. Of those, 73 per cent. were aged between 17 and 25; 21 per cent. were aged between 26 and 40; 5 per cent. were aged between 41 and 60; and, perhaps surprisingly, 0.3 per cent. were aged over 60.
It is abundantly clear from those statistics that the vast majority of newly qualified drivers are young people aged between 17 and 25. The accident, injury and death rates among that age group are unacceptably high. I fully recognise that in the past few years the Department of Transport and successive Ministers have made strenuous efforts to reduce road accidents and injuries. Their efforts are highly commendable and successful, with death rates declining noticeably.
However, there is still a serious problem that needs to be tackled and I suspect that hon. Members from all parties recognise that. The casualty rates for 1991 highlight the case. In that year, drivers killed at ages between 16 and 19 represented 4.6 per 100,000 of the population. Drivers killed at ages between 20 and 29 represented 4.5 per 100,000. of the population—almost as unacceptably high. For age groups above that, the average falls dramatically to 2.2 per 100,000.
A recent study carried out by the Transport Research Laboratory for the Department of Transport on attitudes, opinions and development of skills in the first two years of novice drivers reinforced those statistics. It showed that 28 per cent. of respondents to the study's questionnaire had been involved in at least one accident as a driver since passing the test. Of those, 25 per cent. had been driving for only 12 months; 27 per cent. for only 18 months; and 35 per cent. for up to 24 months. It also showed that some 33 per cent. of those who had been in an accident had been in one that resulted in an injury. From their own statistics and estimations, 34 per cent. felt that it was likely that they would be at least partly to blame if they had an accident in their first 12 months of driving.
The report goes on to highlight the fact that those who had been driving for two years had higher scores on confidence in decision making than those who had been driving for a shorter period. This group also reported more frequently failing to notice someone waiting at a crossing, failing to use the mirrors when they should, making

885
misjudgments in driving, trying to beat others at getting away and doing things that they knew were dangerous. Interestingly, the report shows the proportion of new drivers who had been involved in an accident was greater between 18 and 24 months after passing the test than between 12 and 18 months. The report and the statistics clearly show that there is a serious problem regarding newly qualified drivers and road safety.
The Bill seeks to improve safety not only for newly qualified drivers, but for other drivers and innocent pedestrians. Part of the problem emanates from the fact that as soon as they pass the driving test inexperienced drivers are given the same privileges and rights as someone who passed the test more than 20 years ago and has gained experience and maturity for driving over that time. That is a mistake. My Bill would require all newly qualified drivers to display a P plate for up to 24 months after passing the test, indicating that they were probationers. The plate would be a constant reminder to such drivers that they are newly qualified and it would also advise other drivers of that fact.
It was interesting to see in the Transport Research Laboratory report that more than half the respondents felt that requiring newly qualified drivers to display a special plate to let others know that they were inexperienced would prevent many or a great many accidents. Some may say that such a proposal is unenforceable, but I do not share that view. I suspect that when L plates for learner drivers were introduced, people said that they were unenforceable, but experience since their introduction shows that the system seems to work well.
Secondly, I should like to see newly qualified drivers being restricted to driving cars of 1300 cc or less for 24 months after passing their tests. In theory at present, on his or her 17th birthday a person can pass the driving test, leave the test centre, and drive away in a Porsche, a series 7 BMW or any other high-performance car. If such a youth, who would clearly be inexperienced, got into difficulties he would not be able to handle the car properly. That is wrong and it is dangerous to allow it.
I am a realist and I appreciate that the Bill will not reach the statute book in this Session. However, the problems of newly qualified drivers and their safety are pressing matters which, I am sure, concern a great many people throughout the country. If the Bill draws further attention —especially the attention of the Department of Transport and its Ministers—to the problem, raises the level of discussion, improves the understanding of the problems and leads to a reduction in the number of tragic accidents and injuries on our roads, it will be worth while. I commend the measure to the House.
4.14 pm
Mr. Peter Bottomley: The whole House will join my hon. Friend in his concern to reduce the casualties among young drivers just as much as among other groups. He is right to draw attention to the increased risk associated with the early years of driving. I caution the House, and I shall ask the House to reject the motion on
886
the ground that there could be evidence about whether his proposal would work. He proposes that those who are recently qualified should have a plate that substitutes for the L for learner plate, when the driver has to be accompanied by a supervisor, a P plate for probationer or R for restricted. Many countries have these requirements. Within the United Kingdom, Northern Ireland has a similar requirement, but there is no evidence that I know of that it has much impact.
I join my hon. Friend the Member for Chelmsford in paying tribute to the Minister for Roads and Traffic who has done a great deal to push forward the continuing aim of reducing accidents set out in the "Health of the Nation" White Paper. In the age group to which my hon. Friend the Member for Chelmsford referred, road crashes are the primary cause of death for people recently qualified. I think that we need to ask for the evidence on whether his proposal would make a significant difference. I fear that we are facing what appears to be the common sense solution, similar to the one that we used to have with the calls for random breath testing for drink driving. Because something appears to have worked somewhere, it was obviously going to have great advantages here. In fact, in drink driving, which was the real problem, we have seen a continued reduction, especially among the groups to which my hon. Friend has referred.
I ask the House to reject the motion and to say that we look forward to hearing at some appropriate stage from the Minister whether research can be commissioned and to say to young drivers that they ought to follow the points that my hon. Friend is making and that it is unwise to drive in a way that involves extra risk, especially when there are others in the car. They should save their lives and those of others by following common sense driving solutions which I am sure most hon. Members follow, even though most of us are above the age of 19.
Madam Speaker: The Question is, That the hon. Member has leave to bring in his Bill. Those in favour say Aye, to the contrary No. The Ayes have it — [interruption.]—Order. When an hon. Gentleman or, for that matter, an hon. Member has opposed a ten-minute Bill, his voice simply has to follow his rejection and that has happened in this case. Now we can proceed.
Question put, pursuant to Standing Order No. 19 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.
Bill ordered to be brought in by Mr. Simon Burns, Mr. Keith Mans, Mr. Alan Duncan, Mr. David Porter, Mr. Michael Brown, Mr. Anthony Coombs, Mr. James Cran, Mr. John Whittingdale, and Mr. Bob Dunn.

Newly Qualified Drivers
  NEWLY QUALIFIED DRIVERS
  Mr. Simon Burns accordingly presented a Bill to make it compulsory for newly qualified drivers to display plates indicating that they are recently qualified; to limit the engine size of the vehicles that they drive; and for connected purposes: And the same was read the First time; and ordered to be read a Second time upon Friday 26 March, and to be printed. [Bill 120.]
Opposition Day
[9TH ALLOTTED DAY]
Opposition Day

  National Health Service
  4.17 pm
  Mr. David Blunkett: I beg to move,
  That this House regrets the growing crisis within the National Health Service; condemns the commercialisation of the health service and the development of two-tier health care; expresses concern at the total fragmentation of health care due to underfunding and the impact of the internal market, Trusts and GP fundholding; regrets the destruction of NHS dentistry and the uncertainty over the future of London's health care; deplores the lack of accountability now at the heart of the NHS; and calls on Her Majesty's Government to act immediately to tackle this crisis before the end of this current financial year and to begin a review of their so-called health reforms for 1993/94.
  Madam Speaker: I have had to limit speeches to 10 minutes between 6 pm and 8 pm because of the demand by Members to participate in this debate. I have selected the amendment in the name of the Prime Minister.
  Mr. Blunkett: There is a crisis at the heart of the national health service. That is why I and my right hon. and hon. Friends are moving this motion. The NHS is under-funded. It is being undermined. Unfortunately, it is under the direction of a weak and indecisive Secretary of State. A sophisticated sophistry of statistics is invented by the PR Department who present her, albeit wonderfully, in the guise of mother superior of the NHS.
  We have before us an amendment by Her Majesty's Government which has the cheek to welcome the NHS changes and to talk about the
  "record numbers of patients being treated",
  when waiting lists are increasing, operations are being cancelled and, as we all know, across the country there is a real crisis in our hospitals.
  The amendment also mentions
  "elimination of two-tier waiting lists in the regions".
  Well, instead of two-tier waiting lists in the regions, the Government have created a two-tier health service across Britain. The amendment goes on to claim
  "a substantial reduction in long waiting times generally".
  We all know that the time taken to undertake serious elective surgery is rising in proportion to the number of minor ailments being treated in this two-tier service.
  The NHS, far from being safe in the Government's hands, is gradually and regrettably beginning to fall apart. Instead of policies for caring, we have competition. Instead of service, we have commercialisation. The internal market and the two-tier service are undermining equal access, which is now being denied to patients throughout the country. Information sought by the Opposition and by Back Benchers of all parties is being denied increasingly by a Government frightened to tell the truth. In the words of the Parliamentary Under-Secretary of State for Health, statistics—what was the phrase?—if you can believe them, or for what they might mean.
  Hospitals are no longer called that; they are called provider units. Patients are now described as episodes. Instead of a health service of which all of us can be proud, we have something that has turned into a commercial
  888
  enterprise. Promises have been broken, and broken again, from small promises about drug and alcohol units being safeguarded and ring-fenced, to the promise that was made leading up to the general election that the Government would be spending billions of pounds more each year on our NHS. Instead, on 12 November, the Chancellor of the Exchequer announced that that promise, built into the public expenditure predictions on which the Conservatives fought a general election, has now been set aside, with a cut in England alone of £700 million in the projected budget for next year.
  A promise is not worth a thing when it is in the hands of Conservative Ministers, and that promise has been substantially broken for one very clear reason: because of the total incompetence of Government Ministers in handling our economy. We have had the fiasco of black Wednesday; the £2 billion plus gold and currency reserves that were squandered; the inability to manage the health service, with £300,000 per bed being spent on the Chelsea and Westminster hospital; and an audit service that is not allowed to publish its results, not allowed to tell the truth to the people of the west midlands, Wessex and elsewhere about the mismanagement of the service that is supposed to be operated in their name.
  Mr. Jerry Hayes: The hon. Gentleman spoke eloquently a moment ago about broken promises. Does he remember the promise that he made to the Blackpool Labour party conference on 30 September 1992, when he spoke about the Tories' own Frankenstein monster, meaning national health service trusts? He went on to say —I paraphrase—that the people of Britain had a right to know when, if ever, the Government would admit that their great trust experiment was not working and was in urgent need of reassessment. He has just broken that promise, has he not, because he has reversed his policy; he is not going to abolish trusts at all.
  Mr. Blunkett: I am sorry to disillusion the hon. Gentleman. I presume that he must read The Daily Telegraph, which misreported me. Having not sent a journalist to the briefing meeting and therefore not being aware of the facts, The Daily Telegraph then declined to publish my letter setting out the truth. The Secretary of State said on "Question Time" about 10 days ago that she supports the Bill of my hon. Friend the Member for Hammersmith (Mr. Soley), which is coming forward next Friday, but unfortunately will not be voting for it. She should have a word with the editor of The Daily Telegraph, because the right of reply is important if we are to have an honest and sensible debate.
  As we are dealing with trusts, let us get something straight. Even the Secretary of State admits that trusts are non-accountable, that they are not working and that she will have to bring them to heel. There is the well-funded federation that represents their views, not forgetting the £60,000 spent on the salary of the new chief executive, recruited from Tory party central office. It will all be wasted because the Secretary of State knows that she will have to make trusts accountable.
  Several hon. Members rose—
  Mr. Blunkett: I willingly give way.
  Madam Speaker: Order. To whom is the hon. Member giving way? Several hon. Members wish to intervene.
  Mr. Blunkett: I give way first to the hon. Member for Amber Valley (Mr. Oppenheim), on the ground that at least he knows in which direction he is going.
  Mr. Phillip Oppenheim: I am not sure what to read into that, but I thank the hon. Gentleman for his courtesy in giving way.
  In relation to NHS trusts, if the hon. Gentleman denies the report in The Daily Telegraph to which reference has been made, may I ask him to comment on the report in The Times on 14 January of this year, which quoted him as saying that he would not be in favour of abolishing NHS trusts, just
  "integrating them into some future coherent NHS strategy"?
  What did he mean by that?
  Mr. Blunkett: I do not have any difficulty in saying that non-accountable, completely undemocratic, self-governing trusts will not exist under a Labour Government, because we believe in democracy and accountability, with the involvement of local people, by which I mean not just business people and Conservative party friends. I am not talking about the sort of nepotism that is now being practised in a remarkable way throughout the country.
  The latter part of the Government amendment, which refers to the Opposition politicising the health service, takes the biscuit, considering what has been going on in Britain. South Glamorgan is only the tip of the iceberg —not so much a two-fingered handshake as the ability to shake hands with one's next door neighbour and promise that neighbour a job the following week. All have their snouts in the trough. That is happening in the health service in Britain.
  In that context, let us consider the health service and the integration of community services with hospitals that made such a difference to planning the service. Let us then question community care, which the Government have ill planned and under-funded.
  The Secretary of State for Health (Mrs. Virginia Bottomley): The hon. Gentleman talks about snouts in the trough. Is he referring to people such as Helen Hayman and Rabbi Julia Neuberger, who have agreed to become chairmen of NHS trusts?
  Mr. Blunkett: The Minister need only talk to her hon. Friend the Member for Macclesfield (Mr. Winterton) to get a picture of snouts in the trough and the facts about the transfer of the chairman of the Merseyside region, Sir Donald Wilson, to the west midlands, presumably to peddle the same nepotistic attitudes and policies. The fact that the Secretary of State can quote the names of Labour and Liberal Democrat members is indicative of how many people are being appointed—[Interruption.]—with Tory party cards in their pockets.
  Accountability is non-existent for trusts and general practitioner fund holders. To whom are they accountable? Is it to the region? Is the region accountable to the Secretary of State? Is the Secretary of State accountable to this House, remembering that every time we raise questions about detailed matters we are given the platitude that the statistics for which we ask are not collected or held centrally? The politicised management executive is not accountable; nor are health authorities and family health services authorities.
  It was the European Policy Forum, and not a left-wing think tank, which talked about the new, undemocratic,
  890
  paternalistic way in which Government agencies and the Department of Health are now being operated. It said that we have a new magisterial epoch in which people get jobs not because they are elected or accountable but because they have friends in high places.
  Mr. Patrick Nicholls: I am grateful to the hon. Gentleman for giving way yet again on the question of accountability. He complains that trusts are not accountable, yet his hon. Friend the Member for Livingston (Mr. Cook) said in the House less than two years ago that the simple test for judging the trusts was whether they did more or less work for NHS patients. Does the hon. Member for Sheffield, Brightside (Mr. Blunkett) confirm that test or does he repudiate it?
  Mr. Blunkett: I do not confirm the test, the results or that trusts are working. Doctors, consultants and patients across the country, reading their local newspapers, watching their regional television programmes and listening to regional radio, will know what is happening to their health service.
  Professor John Ward, director of medicine at the Royal Hallamshire hospital, said in the local paper last week:
  "The service has reached breaking point."
  Speaking about his meeting with Sir Duncan Nichol, the head of the management executive, two days later, he said:
  "I shall be putting the boot in."
  I do not think that we should blame the messenger; we should blame the Secretary of State and the Government who provide the message. The boot will go in from us and from the electorate up and down the country.
  In that one hospital alone, six emergency admissions in one afternoon were sitting in the corridor waiting for a bed, not in a general ward but in the admissions ward. In the words of Professor Ward, 850 emergency admissions were dumped in the hospital between September and the end of December. All three emergency hospitals in the city of Sheffield have been on red alert for virtually all of 1993. That situation is repeated up and down the country, from Cambridge to Birmingham, across the length and breadth of the land. If it is not a red alert, it is a yellow alert.
  Mr. Eric Pickles: Will the hon. Gentleman give way?
  Mr. Blunkett: No, I want to make a little progress. In the same report, Sister Milne said:
  "Waiting times on trolleys can be five, six or seven hours."
  The Secretary of State knows all about waiting times of five, six or seven hours, because that very reliable organ of Conservative party propaganda, edited by a minor public schoolboy, The Sun, reported that her mother had waited for seven hours in St. Mary's hospital before being seen to.
  I did not know whether to believe the Secretary of State's family or The Sun. My instincts told me to believe the family. I believe that the Secretary of State's brother and family are honourable people, but if she does not stand up and contradict them, I shall have to believe that the minor public schoolboy who has frightened Conservative Members so much in the past few days was telling the truth after all.
  Instead of taking action on behalf of patients, the Secretary of State bows to publicity stunts. We had one this morning; a new British Telecom health line. I do not know whether the health line will be available for people seeking emergency ambulance cover when they cannot get through on 999 or whether, BT style, the new health line

  891
  will simply say, "You are being held in a queue, this is normal for the NHS.". Whatever it is, I do not think that it is a particularly good gimmick.
  I do not think that the doctors thought it a particularly good gimmick when on new year's eve the Secretary of State took herself off to plague them at her local hospital. I should be careful about quoting correctly because I think it was The Daily Telegraph that reported her striding down a corridor at the stroke of midnight having talked to doctors and nurses who were too busy dealing with casualties on new year's eve to take seriously her eulogies about the new NHS reforrns.—[Interruption] The Secretary of State seems to be saying that no one was with her. It must have been a phantom reporter who put out the news that Virginia Nightingale was ministering to the sick and the wounded on new year's eve. I hope that the right hon. Lady has a very happy new year. I hope that next year she will be able to drink a toast to a health service that has improved rather than deteriorated.
  Perhaps the right hon. Lady will take notice of Dr. Ian Bogel, chairman of the general medical services committee of the British Medical Association. When describing the guidelines on access to the NHS, he said:
  "Equal access to secondary care has been flouted by hospitals which cancel operations but continue to treat GP fund holders' patients."
  That is repeated throughout the country.
  A letter from the Plymouth health authority states:
  "It is increasingly clear that GP fund-holding practices have the capability and are intent on encouraging the development of mini clinics in dermatology outside the hospital service. This has the effect of taking NHS money away from the acute unit to the detriment of that unit. We propose to set up a clinic with sessions at Greenbank hospital every Wednesday evening between 5 and 7 o'clock with the specific intention of seeking patients from GP fund-holding practices."
  The letter then lists seven reasons why GP fund-holding practices should take up the work. It continues:
  "While it is clear that this will create a two-tier system within the service, it will have no greater effect than that already commenced by several general practices employing their own dermatologists outside the hospital service."
  Dr. Liam Fox: For the sake of clarity, will the hon. gentleman tell us whether it is Labour party policy to abolish both NHS trusts and GP fund-holding practices?
  Mr. Blunkett: I think that I have comprehensively dealt with trusts, so I shall comprehensively deal with GP fund holdings. I have made it unequivocally clear—it is on the record of every occasion on which I have spoken—that the Labour party and I, as its spokesman, are against GP fund-holding practices and a two-tier service.
  The reason for our opposition is that given by Dr. Michael Jenner of Tonbridge. In a letter to me last week, he said:
  "I know of a case in my practice where a patient had been on the waiting list for two years for a minor complaint and had to be admitted before a patient with a potentially malignant diagnosis because of the patients charter saying no one should wait more than two years … The NHS is rapidly becoming split in two and morale is at the lowest I have experienced in the 25 years I have worked in the service. My only advice to patients now is for them not to vote for the present Government."
  Mr. Ken Eastham: Only this week I received a letter from a doctor in north Manchester about the Booth Hall children's hospital and a child aged
  892
  six who had been referred to it for an operation in January 1992. That child is still waiting and the earliest date for the operation is now May this year. He referred to the child's suffering and to the education that he had missed. It is a disgrace. If we were a third-world country, with a shortage of theatres and wards, we could understand the reason for long waiting lists—but that children's hospital has actually closed a theatre and a ward.
  Mr. Blunkett: My hon. Friend is quite right. In 1987, when we last had a crisis in the health service—not the worst for 30 years, as the British Medical Association described this one, but so serious that the last Prime Minister had to decide to demolish the whole NHS so that it could be dealt with—there were 100,000 fewer people on waiting lists, and children such as the one to whom my hon. Friend has referred were being admitted and dealt with before minor cases.
  The Government have simply devised a new, bizarre and irrational way of running out of money. The doctors are there, the nurses are there and the hospital wards are there, but the contracts have run out. Whatever increase there has been in productivity has been dissipated by the system that is currently being operated. A person with a serious but non-life-threatening ailment cannot get in to hospital, but when a person from a GP fund-holding practice has a minor illness, care can be bought.
  Mrs. Virginia Bottomley: Can the hon. Gentleman name any Labour Government who left office with waiting lists lower than when they came to power? In fact, every Labour Government left office with waiting lists higher than when they came to power, whereas all Conservative Governments have seen waiting lists fall.
  Mr. Blunkett: Had we managed to get rid of the Conservative Government on 9 April we should have had a startling and outstanding example of a Government leaving office with waiting lists much higher than those they had inherited. The Government have to hark back to 1978 for the lowest interest rates, and to 1968 for the lowest level of inflation. People ought to be reminded that many of the great records are held by Labour Governments. And we shall hold them again.
  The NHS reforms are making matters worse. Waiting lists have increased since 9 April, and they are continuing to increase. The money does not follow the patients; the patients follow the money—if they are lucky. That is the truth of the matter. But what do the Government do about it? They talk to doctors about slowing down, about pacing themselves, about spreading the money over 12 months instead of nine months, about preventing embarrassment for the Government when the NHS has run out of money after nine months of the financial year.
  The Government seek not to help hospitals to treat more people or to treat more serious cases, but to hide the truth from the British people—slow down, put down, perhaps lay off. That is the logic. If there are consultants who cannot work to full capacity, who cannot take on serious cases, are they to be laid off'? Are nurses to be laid off? Are more contract works simply to be taken on so that they can be laid off at the drop of a hat? Hospitals still have to be heated, the beds are still there, even if they are not made up, and the on-costs still have to be met. But the cosmetic surgery of the so-called waiting list initiative takes priority over the real needs of patients and of care in the health service.

  893
  Let us not have the fiddled figures paraded as though the Government were doing better. Waiting lists have lengthened, but there is a new technique—people are not put on waiting lists at all. People are now being told that they cannot be given a definite date for a hospital bed. Therefore, they do not appear in the statistics. This is gross distortion worthy of George Orwell, and the Government are getting away with it.
  What is more, as the patients charter and the waiting list initiative take effect, the Government deliberately skew the figures so that one can no longer find out nationally how long it takes to get a first appointment with a consultant. The first appointment is the most important of all, as it is at that point that an illness is diagnosed as being serious or minor. And that is critical to the saving of life. Yet, having tabled a parliamentary question a few weeks ago, I was told that the Department saw no need for national collection of statistics on waiting list times.
  Mr. Eddie Loyden: Is my hon. Friend aware that in the very recent past an epileptic young woman of 19 in my constituency was taken into hospital and discharged, was taken into hospital again, and discharged, and was taken in a third time and died? Surely that indicates the nature of the problem in the national health service.
  Mr. Blunkett: My hon. Friend, as ever, speaks from the heart about the truth that emerges from our postbags day in and day out, week in and week out. Consultants, other doctors and patients write to us about the stark reality that Conservative Members are unable to face.
  What about activity levels, about which the Secretary of State spoke at Question Time today? As John Chawner, the chairman of the committee of consultants and specialists, pointed out to the Secretary of State in a letter of 22 December, more day cases—minor cases—are being dealt with, while more serious cases are being made to wait. In addition, research shows that 28 per cent. of so-called episodes of activity levels turned out to be fraudulent. A patient was moved from one ward to another—and was counted as a new episode. The whole thing is a farce and a fiddle. One can no longer believe anything.
  What are these changes costing us? Longer waiting lists, more suffering, greater worry and £1,180 million. This is a scandalous waste of money that could have been spent on patient care, on improved quality and on equal access. And all this is happening during a winter when there has been no major epidemic. There has been no major outbreak of flu, except in my own case.
  Mr. Pickles: Given that 90 per cent. of doctors have now reached the immunisation target, why does the hon. Gentleman object to fund holders? Is not this an example of success?
  Mr. Blunkett: I have never criticised immunisation. The hon. Gentleman needs an injection of common sense, decency and care to stop his blithering—the blithering in which he used to engage when he was leader of Bradford city council.
  Instead of care and action, we have public relations offensives. In newspaper and television interviews the Secretary of State tells us how wonderful things are.
  894
  Journalists become star-struck the minute she smiles beguilingly and gives her enchanging, "mother superior" view of the world. But the record speaks for itself. In July we had her announcement about dentistry, which created such chaos that, since then, 250,000 people have been removed from the NHS dental lists. Of these, 13,000 live in Surrey, the county of the Secretary of State. And in the Prime Minister's constituency 99 per cent. of dentists are refusing to register adult patients.
  Mrs. Virginia Bottomley: I urge the hon. Gentleman to look again at his information. There are 1 million more people registered with dentists than there were last July, and there are 7 million more courses of adult treatment than there were in 1979. Finally, Bloomfield has said that dentists' earnings are now at a record high. The hon. Gentleman might like to consult the record to see what happened to dentists' earnings in real terms when his party was in power. They fell by more than £3,000.
  Mr. Blunkett: The Secretary of State, as I suggested at the beginning of my speech, is a sophistry of statistics, but the reality is different. The deregistration of patients, the refusal of dentists to take on patients, the increase in private dental practice encouraged by the Government, the steer given to the Bloomfield inquiry, which has all sorts of suggestions about a new, privatised service, cannot disguise the truth. The registrations were encouraged by the Government on the grounds that unless dentists found their records and registered those who had not been to visit them in the past two years, they would not "benefit" from the new system. When the Secretary of State eventually comes to the House, as she is so often reluctant to do, to make a statement on what she will do about dentistry in the national health service, we will deal with this matter comprehensively.
  In September the London ambulance service staggered, as it had done for months, from crisis to crisis. What action was there from the Secretary of State? None. There was a resistance to action, a resistance to getting rid of the people running the service, a resistance to doing anything to safeguard life and limb—until she was forced to come to the House when the whole system collapsed in October.
  Right through the summer and autumn, the West Midlands regional health authority was nothing less than a fiasco—millions of pounds wasted on privatisation and consultancies, audit reports, National Audit Office reports, but no action, a refusal to take any steps to deal with the chairman or with the authority's incompetence until the Secretary of State was forced to take action when Sir Roy Griffiths said that it could not carry on any longer. When the chairman went, whom did she appoint? Sir Donald Wilson, the 70–year-old chairman of the Merseyside region. She really has a sense of humour. The only thing I can say for her is that she is not ageist. If the Secretary of State listens to her hon. Friend the Member for Macclesfield, she will know just what the west midlands is in for in the months ahead.
  What else in October? The Secretary of State announced with a fanfare of trumpets that she would consult on the Tomlinson report. There was to he a major review of London's health care.
  Mr. James Clappison rose—
  Mr. Blunkett: I am not giving way, Mr. Deputy Speaker. I have given way more than most hon. Members on the Front Bench.
  The Tomlinson report, and the consultation on it, was to be the great step forward for London's health care. A major announcement was to be made after the Minister of State had toddled around the hospitals, not consulting the people of London or the local communities, the patients, the people who mattered. Then a message came round from Downing street to the Secretary of State. It said that she must forget about the frontal attack, about the comprehensive approach, because the Government were running scared. She was to announce that Bart's would be saved. We are all grateful for that; the campaign run by the Daily Mirror and the Evening Standard and by my right hon. and hon. Friends in London has done a superb job, and I am pleased about it.
  But what sort of a Secretary of State announces one week, at the beginning of January, that it is full steam ahead and no change, and the next week is called into No. 10, and it is all overturned? Or perhaps it is not quite all overturned, as we will hear if we can get the Secretary of State to make a statement to the House about what she intends to do—because what they were not prepared to do in a full frontal attack they are determined to do by stealth. That is the truth of the matter on Tomlinson.
  What about January? What about Ben Silcock being mauled by a lion at London zoo? I pay tribute to the Secretary of State's commitment to mental health issues. I even accept her sincerity in the media blitz that she launched in the aftermath of that accident. But what happened to her promise that action would be taken? The Daily Mail splashed it across the front page. She appeared on television, metaphorically with her arm around a number of her friends, telling everybody how much she cared and that steps would be taken immediately. What has happened? Precisely nothing. Once again, it is all wind and no action, and the same will be true for future announcements on what is to happen to the regions.
  The Secretary of State has not even made an announcement about what is happening to health authorities. Their number is being reduced from 190 to 85 without an announcement to the House and without giving us the opportunity to debate such issues sensibly on the Floor of the House. We have the withdrawal of information that I have spoken about, and the Touche Ross report which the Secretary of State will presumably leak out on Friday afternoon, telling us again that nothing will be done.
  We had tobacco and the Smee report: no action. The Secretary of State eventually chaired the first meeting on 13 November in that ill-fated six months when the Government had the presidency of the European Community. There was no action by way of banning tobacco advertising or joining forces with our colleagues in Europe to take decisive steps.
  What about prescription charges? We expect increases in them to be announced in the next few weeks. Will the new cost be £4 or £4.25?
  What about the Bloomfield report on dental services which the Secretary of State referred to? Will nursing mothers and pregnant women be denied free treatment, which is what the Bloomfield report threatens? Or will the Secretary of State take the advice of someone who once wrote about families cutting down on visits to the doctor because they could not afford the prescription charges,
  896
  who wrote about mothers who could not afford the then small prescription charge not visiting the doctor for a cure for minor ailments?
  The author wrote that people looked around for other cures. When they could not afford a cure for their toothache, some of them, said the author, used to bite on a clove. Adult members of these families would not go to the dentist because of the charges and consequent problems. They could not afford it with children to look after, or, as one family said, they would not go unless they were in absolute agony.
  Who was the caring, decent person who talked about frightful housing, who talked about being unable to afford prescription charges, who talked about the problem of access to the dentist? It was the Secretary of State for Health, in an earlier, caring period when she worked with the Child Poverty Action Group and wrote pamphlet No. 8.
  Is the right hon. Lady now the caring young woman who got down to the realities of what was happening in family life or is she the Secretary of State beholden to a Cabinet, to colleagues such as the right hon. and learned Member for Rushcliffe (Mr. Clarke) who appears still to run health policy from the back seat?
  Our health service is in a mess, and this expensive mess has been created by the Government. I pay tribute to those in the health service who have fought to keep it going over the years. I pay tribute to those who have been telling the truth about our health service despite the risks and problems that they face. I pay tribute to those who are working to improve the quality of patient care, and I pledge that we will continue to fight for a comprehensive health service, tackling prevention, investing in primary and community care, intent on early intervention and, above all, linking health with housing, unemployment, poverty and inequity, a health service that provides equal access for all, a health service that is accountable and a health service of which all of us can be proud.
  4.58 pm
  The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
  "congratulates Her Majesty's Government on its reforms to the National Health Service which have led to record numbers of patients being treated, the elimination of two year waiting lists in the regions, a substantial reduction in long waiting times generally and significant improvements in the quality of care; looks forward to more general practitioner fundholders and National Health Service trusts and the further improvements they will bring; and believes that in the modern health service the focus should be on patients and prevention and not on politicisation, which remains the dominant concern of Her Majesty's Opposition.".
  The Opposition motion refers to a crisis in the health service, but in reality the debate is more about a crisis in the Labour party and the particular crisis facing the hon. Member for Sheffield, Brightside (Mr. Blunkett). The dilemma for Labour health spokesmen is that they are condemned to pass as an unread chapter unless they cart generate a crisis. The hon. Gentleman has deepened his troubles today. His speech was wanting in substance, it was wide of the mark and none of my hon. Friends is any the wiser about Labour party policy on health than he was at the start. Labour party policy on health is a policy-free zone. Hundreds of thousands of staff and millions of

  897
  patients and their families and friends will have found it difficult to recognise their national health service from the hon. Gentleman's speech.
  Throughout the country, millions each year rely on the care that they receive from the health service. Time and again, the Opposition take individual cases, exploit them out of all recognition and paw upon personal detail to try to create a crisis in the service.
  I will tell the hon. Gentleman about one of the individuals that he mentioned in his speech. I do not want to intrude on the privacy of all the many other individual cases in which his party trades. I will tell him about my mother who, like many others, could not speak more highly of the care that she received not only at Queen Mary's but also at Guy's, where she had been extremely ill beforehand. My mother spoke, as so many others do, with respect, affection and admiration for all that is achieved by NHS staff, and she was not best pleased by the way in which her privacy was intruded upon at a moment of considerable illness.
  Ms. Jean Corston: Will the Secretary of State tell the House when any Labour Member has criticised an individual member of staff working in our NHS hospitals? They are the people who are coping with the mess that she has created.
  Mrs. Bottomley: Those with memories which go back as far as the general election will know that the Opposition trade in individual cases taken out of context.[Interruption.] One of my hon. Friends mentions the case of Jennifer's ear; I need say no more.
  This is the first time for nearly two years that the Labour party has chosen to debate health in its own time. For a party which is so arrogant about its supposed special claim to the NHS, it is remarkably reluctant to debate the matter in this place—and from the hon. Gentleman's speech, it is all too clear why.
  During the general election Labour turned our children's wards into a political battlefield. The voters rightly punished it for its repugnant tactics, but it is clear that it has learnt nothing from that. Scaremongering and shroud waving are still the base elements of its approach.
  We hoped for fresh thinking on health from the hon. Gentleman, but there was precious little sign of that in his speech today. He has dashed any hopes that a Labour Government would play a constructive role in improving people's health. Where was his admission that the health reforms are here to stay? When will the Labour party apologise for getting it so completely wrong? The hon. Gentleman's speech boiled down to the same old whine: more money for the NHS. His preoccupation, as always, is with inputs and not outputs. Yet in a recent press comment the hon. Gentleman said that the NHS had had a massive cash boost in the year of the election. It is hard to know which message he is trying to give. He cannot have it both ways. His mode of communication is not just waffle, but multi-directional waffle.
  Mr. Blunkett: As there was a cash boost for the general election and the Secretary of State has been parading it, and as I am not denying that, why is there such a crisis? Why is the money running out within three months of the
  898
  financial year ending in a year in which she says that the Government have an all-time record on spending on the NHS?
  Mrs. Bottomley: I shall be addressing the House on the situation in which we find ourselves, where hospital after hospital has exceeded all expectations in the amount of work that they have done. But NHS trusts and other hospitals also have to live within their budgets. If, two thirds of the way through the year, I were to break other parts of the NHS budget, I would be doing exactly the very thing for which I would expect the hon. Gentleman most to criticise me. The way in which I would do it would be to raid the community budget, or help myself to the budget for the mentally ill, community nurses, or all the other unfashionable areas of the health service.
  If we are to have a principled health service which delivers services according to a strategy which is right for the health of the nation, it is not right for a Secretary of State for Health three quarters of the way through the year suddenly to say, "No, you have all been providing more care of a higher quality: we will change all the priorities now and take money from the budgets of those least able to defend themselves."
  I am proud of our achievements. Hospitals have done well to achieve their high figures—some have treated 4,000, 3,000 or 2,000 more patients than they did a year ago—but they have to live within their budgets and manage the resource for the year.
  Mr. Richard Burden: If the Secretary of State feels that it is inappropriate to provide extra cash for hard-pressed hospitals, how does she explain the fact that the West Midlands regional health authority was prepared to make cash handouts to a privatised firm that it had set up?
  Mrs. Bottomley: That is far from the discussion about how hospitals can manage their budget through the year. There are serious questions about the West Midlands regional health authority. That is why I have appointed such a distinguished and eminent chairman as Sir Donald Wilson to take over in the short term. I deplore the ageist comments of the hon. Member for Brightside. This is the European year for older people and solidarity between the generations. Yesterday I launched the year with Sally Greengross. She talked of the problems of ageism; yet today the shadow health spokesman has shown the most shamelessly ageist approach to a most distinguished and eminent chairman. If the west midlands can achieve the results that Mersey has achieved, the hon. Gentleman's constituents will wonder what on earth he is talking about. They want similar reductions in waiting lists and waiting times and the delivery of health care in an effective, practical and sensitive manner.
  We now spend £100 million every day on the NHS, but the challenge—as always—will be to live within a budget. A budget has to be maintained for 12 months, not eight or nine months. Of course I share people's concern when they hear that hospitals are unexpectedly slowing down elective admissions or going on yellow or red alert in the face of exceptional seasonal pressures, but we must learn those lessons and ensure that in placing the contracts for next year we benefit from the experience of this year, pacing activity more effectively through the year and, above all,

  899
  ensuring that there are proper discussions with the district and the general practitioners and, within the hospitals, between the managers and the clinicians.
  Mr. Robert Ainsworth: On the issue of budgets and slowing things down, the Secretary of State talked about principles, but she now accepts that some people are waiting for serious operations while others, brought into local hospitals from fund-holding practices outside the area, are treated ahead of them. Where on earth are the principles in that? I shall not quote an individual case because the right hon. Lady goes on about shroud waving, but she knows that that is happening throughout the country.
  Mrs. Bottomley: I shall say a little more in a moment about general practitioners' fund holding. The Opposition still seem to have failed to appreciate that it is GP fund holding that offers the real lever for change if we want a service which is sensitive to patients' interests, because the advocate for the patients in the health service is the general practitioner.
  Only last week, the hon. Member for Brightside said that in the long term there would be a shift of resources from traditional hospital care. Yet today he argues the reverse—that money can only come from other services to go into the hospitals. He cannot have it both ways. The majority of services are not affected by the present end-of-term pressure on budgets.
  The British Medical Journal survey, which has been much quoted, also hides a number of other issues. In Calderdale, for example—
  Mrs. Alice Mahon rose—
  Mrs. Bottomley: Is the hon. Lady going to tell us that in Calderdale only 14 patients now wait for more than a year? That is a dramatic achievement. In Manchester., the number of patients waiting for one to two years has been halved. In Brighton, by March no one will wait longer than 18 months, and an extra 1,500 patients will have been treated. In Norwich and Norfolk, 4,000 more patients will have been treated, and 3,000 more will have been treated at Stoke Mandeville.
  Mrs. Mahon: The Secretary of State mentioned Calderdale. A close relative of mine has suffered under that practice. Will the right hon. Lady tell us how many people are waiting to see a consultant before going on to a waiting list? I have absolute proof of what is going on: it is going on in my family.
  Mrs. Bottomley: I shall say more later about waiting times, and about what we have achieved. I should very much like to move to a stage at which benchmarks operate for first out-patient appointments. I am sure that that is the next step—having brought down in-patient waiting times, to start setting benchmarks for out-patient waiting times. That is the way forward—to deliver change throughout the service, and to make clear, steady progress.
  I should make it clear that the amount of money currently involved is less than three quarters of 1 per cent. of total hospital and community budgets. The problem must be seen in perspective but, relatively small though it is, I do not think that we should ignore it. Doctors and managers do not always get together to work out how to plan activity through the year. General practitioners and district health authorities still have more to do in
  900
  discussing priorities for the year ahead. I want to encourage closer co-operation between managers and consultants, GPs and other professionals, in the drawing up of contracts for health care between purchasers and providers. That is where discussion should rightly take place. We also need careful co-operation in the monitoring of performance against contract through the year.
  I am pleased that the chief executive of the NHS and the chief medical officer have established a working party to examine those questions in detail with the professions, and to spread advice and assistance. The chief executive, Sir Duncan Nichol, will shortly issue further helpful guidance to the NHS. It is important for the lessons that we have learnt from this year to be acted on, and used further to improve the contract process for next year.
  Mrs. Barbara Roche: Will the Secretary of State give way?
  Mrs. Bottomley: I will, but only because the hon. Lady stood against me in my first by-election.
  Mrs. Roche: I am grateful to the Secretary of State. I remember that by-election with relish; I also remember that we discussed health on that occasion.
  The Secretary of State mentioned the yellow bed alert. She will recall that my region, North East Thames, had such an alert. How does she reconcile her policy with the damaging effect that it will have on the more than 130,000 people on the London waiting list? Does she not agree that it will cause them tremendous harm?
  Mrs. Bottomley: The hon. Lady will be aware that pressures in the winter are a traditional part of health care management. Yellow alerts, and other pressures caused by a variety of unforeseen circumstances, must be managed' better: we must be better prepared. I should make it clear, however, that all urgent and emergency cases are seen. Our emergency service is unrivalled anywhere in the world.
  Overall decisions about priorities must be made by the district authority, which acts as the champion of local GPs. It must form a strategy for health, deciding priorities between different areas of interest and concern. That coherent approach must be followed to deliver ever-rising standards of health care, which will achieve health gains for local communities.
  Dr. Lynne Jones: Will the Secretary of State give way?
  Mrs. Bottomley: I want to make a little more headway. I have already given way a huge amount. I want to talk about the achievements of the NHS reforms—[HON. MEMBERS: "Give way."] I have been enormously generous in giving way. I have given way almost entirely to Opposition Members; I fear that I have neglected my hon. Friends. I now wish to proceed with my speech.
  The NHS reforms have been a tremendous success. We see that success in the record number of patients being treated this year. The number of acute in-patients treated is up again—more than 4 per cent. higher than last year, and even higher than that in the trusts. The health service is on course to treat 7.6 million patients this year; an extra 600,000 a year are being treated only two years into the new health service.
  Those record increases have been accompanied by reductions in waiting times. We have now eliminated waits of more than two years in the regions; what for many years

  901
  was a dark feature of the NHS has gone. Since our reforms were introduced, there has been a fall of more than 50 per cent. in the number of patients waiting for more than a year. In line with our manifesto and patients charter commitments, we are on course to eliminate waits of more than 18 months for hip, knee, and cataract operations. A number of regions and areas are heading for an 18-month maximum wait across the board: Mersey, South Western, Northern—
  Mr. Andrew Rowe: My right hon. Friend has mentioned hips, knees—[HON. MEMBERS: "And boomps-a-daisy."] And, no doubt, boomps-a-daisy. The trouble is that the nature of what can be done in the health service is changing very fast, which creates an entirely different kind of debate about priorities. But for the Government's reforms, it would be impossible to have a sensible debate about priorities, because until now we have not had the faintest idea what any of the procedures in the health service cost.
  Mrs. Bottomley: My hon. Friend's welcome intervention has precisely identified one of the profound changes brought about by the NHS reforms. I hope that he will elaborate on his arguments if he catches your eye, Mr. Deputy Speaker.
  Reducing long waiting times is central to the patients charter. We have spent more than £200 million on the waiting time fund in the past six years, and today I am announcing an allocation of a further £2 million from the £39 million fund this year to pump-prime 30 innovative pacesetter projects to reduce waiting times further. Each project will harness innovation, spread good practice and set quality benchmarks in the service which others can aim to meet.
  We are determined—and we shall continue—to take the waiting time battle further.
  Mr. Rhodri Morgan: Waiting for what?
  Mrs. Bottomley: As the hon. Gentleman rightly implies—and as I have already said in the House—we want to set waiting time targets for out-patient as well as in-patient appointments. This is yet another example of the way in which the Government have won the argument. Labour Members want us to go further, faster, and I am the first to agree.
  NHS trusts are good for patients and staff, and they are here for good. It is far from clear whether the hon. Member for Brightside has yet been able to make up his mind about trusts, but I can tell him that patients have. They will have noticed, for example, the developments in the hon. Gentleman's own area. They will have noticed the £22 million Firth wing at the Northern General trust in Sheffield which opened last May, the two new children's and six new adults' surgery wards, and the state-of-the-art theatre suites and recovery rooms.
  The hon. Member for Brightside referred to accountability. I despair at the fact that, even at this stage, he is so unclear about the way in which accountability works. The trusts are accountable financially to their management executive, but they are accountable through their contracts to the district—to the purchaser, who acts on behalf of local people, securing quality improvements, having detailed discussions and championing the interests
  902
  of local people. That opportunity simply did not exist in the past. The district could not tell a hospital, "We like this aspect of your work, but are not happy with other areas; our GPs are unhappy about one development, but are pleased about your progress in another department." Under the contracts, which are open to the public, accountability is exercised more effectively than ever before.
  There has been a revolution in information—in the plans, the accounts, the annual meetings. As my hon. Friend the Member for Mid-Kent (Mr. Rowe) said, when the Labour party was in power no one had the faintest idea what anything cost in the health service, what a hospital's budget was, or how resources were used. That suited Labour Members—sponsored, to a man, by the National Union of Public Employees—because they did not want the public to know what they were doing and how they were spending money.
  Several hon. Members rose—
  Mrs. Bottomley: Many hon. Members will want to catch your eye later, Mr. Deputy Speaker, to make their own contributions, but my hon. Friends want me to put on record the tremendous achievements of the health service. I feel duty bound to do so, because my hon. Friends want to know what I am about to say. I am about to announce a record capital allocation to the national health service —nearly £2 billion. Taking internally generated capital into account, total NHS capital spending for next year is expected to break the £2 billion barrier for the first time. This £2 billion programme will allow trusts and health authorities to take the initiative in developing their services to meet the needs of the future. As my hon. Friends will be only too well aware, it will support the construction industry and support jobs at the same time. It is scarcely surprising that the Labour party is so embarrassed by my announcement of this £2 billion programme, because, as my hon. Friends are aching to say—
  Mr. Andrew Miller rose—
  Mr. Rhodri Morgan: Give way.
  Mr. Deputy Speaker (Mr. Michael Morris): Order. The Secretary of State will indicate when she is giving way to hon. Members, but it is clear that there are occasions when she is not. It is no good the hon. Member for Cardiff, West (Mr. Morgan) saying, "Give way".
  Mrs. Bottomley: As I feared, my hon. Friend the Member for Harlow (Mr. Hayes) took my punch line. As soon as I sat down, he rightly said this is why the Labour party was making so much noise—that the Labour party cut the capital programme by 28 per cent. That makes the £2 billion that I have announced really look quite something. The punch line is that when the Labour party was in power the capital programme was not a record £2 billion but was cut by 28 per cent.
  I very much want to deal with the question of GP fund holding—a voluntary scheme that we hope to extend more widely. We hope that the benefits of fund holding, even for GPs who do not become fund holders, will be taken for granted by all GPs. GP fund holders have helped to raise standards across the board and to integrate primary and secondary care. They have reduced waiting times and brought more health care into the community. The Labour

  903
  party, wallowing in the politics of envy—as ever—derides this as the success of a two-tier service. As ever, its policy is equal misery for all. We can never have levelling up; we must always have levelling down from the Labour party.
  Let me make it clear that we are going forward with fund holders and we shall make it easier for them to extend services for their patients. The regulations will be changed to ensure that budget holders can cover the cost of providing a wider range of services, covering a range of diagnostic testing and minor surgical procedures which are outside the scope of their existing contract. This will make it easier for them to provide extra services where they are qualified to do so and to bring specialists into their practices. As a result, fund holders will be able to provide those services for patients without having to go to the trouble of setting up limited companies.
  We are the party of change and of progress. We have set in place, with our health reforms, a health service fit for the next century. For more than 40 years, the NHS was driven by institutions and illness, not by patients and prevention. We are changing the focus to concentrate on the needs of patients today and tomorrow and on work for better health. We can look forward to achieving the aims of the National Health Service Act 1946:
  "a comprehensive health service designed to secure improvement in the physical and mental health of the people … and the prevention, diagnosis and treatment of illness."
  We have established the mechanisms to decide priorities on a national and local basis, and we are not prepared to leave the service to stumble from problem to problem with only the knee-jerk excuse of underfunding to fall back on like the Labour party. We are determined to use the potential of our greatest resource—our skilled and committed work force. In the face of the most negative opposition and the most scurrilous and distorted tactics that the Labour party could muster, the Government have accepted the challenge of reform and carried it through.
  Dr. Lynne Jones: The Secretary of State rightly referred to our skilled and dedicated work force. I received a letter this week from a consultant who says:
  "junior medical staff, nurses and therapists are on their last legs and morale is lower than ever before."
  When will the right hon. Lady get off the clouds, put her feet firmly on the ground and listen to the people who know what is really going on in the health service: the 29 consultants who say that she had said that she will only interfere in the west midlands—
  Mr. Deputy Speaker: Order. The purpose of an intervention is to raise a single poignant point, which the hon. Lady did.
  Mrs. Bottomley: I can tell the hon. Lady when morale was lower: when the Labour party was in power and it cut nurses' and doctors' pay and spending on the health service. Of course there is more for us to do, but we are reducing junior doctors' hours and giving people hope and confidence in the way forward.
  Let me speak about the great achievements of the new strategy for health, putting prevention right at the heart of the delivery of health care. I hope that I shall receive co-operation from the Labour party as we take forward that strategy, which is chaired at the highest level by the Lord President to ensure that all members of the Government play their part in achieving and taking forward health gain.
  904
  We are determined to see further shifts of power in the NHS—away from institutions and providers to patients. The patients charter has been very important in spelling out the rights and standards that patients should expect.
  It is interesting to see the sneering approach of the hon. Member for Brightside to the new telephone information line. Many members of the public, many of our constituents and many patients are not clear about what services or health advice is available and do not know where to go for help. Today I launched the national helpline, which was a commitment in the patients charter and in our manifesto. The number is 0800 66 55 44. That single freephone number, which is available to all, will better empower patients to make the best possible use of the health service. The sneering, patronising attitude of the Labour party shows that it fails to understand that the number will enable our constituents to make better use of the service.
  Mr. Den Dover: I applaud my right hon. Friend's superb speech, which accurately represents the situation in my constituency of Chorley. More in-patients and out-patients are now being treated in the community, and below budget. There is one major cause for concern, indeed, I will call it crisis: more than 6,000 of my constituents have been put out of the national health service dental system. I know that my right hon. Friend has already received a report of the dentists' pay review, and I hope that in the closing minutes of her speech she will be able to deal with that problem.
  Mrs. Bottomley: I am happy to deal with the matter for my hon. Friend the Member for Chorley (Mr. Dover). One million more adults are now registered for dental care than in July. Dentists' earnings are also at an historic high. Sir Kenneth Bloomfield's report, which I hope that my hon. Friend will refer to his dentists and patients, and also consider himself, offers a number of options for change.
  Opposition Members seem surprised that the Government do not have a knee-jerk response to every publication that we produce for consultation. We wish to talk to dentists, the health service and others about whether there are ways in which we can change the system of remuneration. My hon. Friend should be sure, however, that his constituents have access to an NHS dentist. The family health services authority should employ a salaried dentist. If there are any difficulties, I shall personally be more than happy to look into them.
  The hon. Member for Brightside spoke about information. Sometimes he tried to lambast the Government for not making available the information that he wants for his own purposes, and which we do not collect because it is not needed to help to run the service. In the next breath, he claimed that there were too many managers and accountants and too much bureaucracy, which is precisely what would be needed if we were to collect a huge amount of unnecessary data.
  The role of management in the health service is of great importance: something like two NHS staff out of every 100 are managers.
  Mr. Blunkett: I am grateful to the Secretary of State for giving way to me twice. Can she tell me why the Yorkshire regional health authority yesterday refused to provide me with figures on waiting lists which it has available at its headquarters in Yorkshire? Other regions have been prepared to do so, so why was Yorkshire regional health

  905
  authority not prepared to release those figures, even though it had had to collect them for its own internal purposes? Is the Secretary of State prepared to take action to stop the secret society taking hold of the NHS?
  Mrs. Bottomley: I do not know the content of the hon. Gentleman's discussion yesterday with the Yorkshire regional health authority, but I feel strongly about information being available, which is why I have today launched the national helpline. It is not only the hon. Gentleman who should have information—I believe that members of the public should also have it, and I shall certainly consider the matter for him.
  Mr. Jimmy Boyce: As the Secretary of State is so ready to go to Chorley to talk to dentists there, will she speak to the dentists who are complaining in Rotherham? We assure her of a riotous welcome.
  Mrs. Bottomley: I thank the hon. Gentleman for that warm invitation, but he should listen to what I am saying. I said that dentists' earnings were at an all-time high and that we now provide 7 million more adult treatments per year than in 1979. I was comparing that with what happened when the Opposition were in power—when dentists' real earnings fell by some £3,000 per year.
  The health service has an annual budget of £37 billion, it employs nearly 1 million people, and the money must be managed. I do not think that the Opposition understand that. They continue to promote a state of apartheid between managers and doctors. The Opposition also talk about accountability. My hon. Friends are deeply suspicious of what the hon. Member for Brightside means by accountability. We fear that he means that those who manage—
  Mr. Bernie Grant: On a point of order, Mr. Deputy Speaker. Is it in order for the Secretary of State to—
  Mr. Deputy Speaker: Order. I shall let the hon. Gentleman continue in a moment, but he must be clear that a point of order is a matter on which the Chair can rule, not a matter of the political content of speeches.
  Mr. Grant: I am surprised that you will not let me finish before you rule, Mr. Deputy Speaker.
  Mr. Deputy Speaker: Order. I shall let the hon. Gentleman finish, but I want to be sure that he is clear that it is something on which I can rule.
  Mr. Grant: I am sorry but, like other hon. Members, I raise a point of order and then you tell me whether it is true. Is it in order for the Secretary of State to make a promise to one of her hon. Friends but not to other hon. Members?
  Mr. Deputy Speaker: The hon. Gentleman knows that that has nothing to do with the Chair.
  Mrs. Bottomley: I do not think that I should make a promise to another hon. Friend that I would not also make to the hon. Member for Tottenham (Mr. Grant).
  My hon. Friends are deeply suspicious about what is in the mind of the hon. Member for Brightside when he talks of accountability. We know that he is really an
  906
  old-fashioned municipal socialist. I wonder whether he remembers telling the Association of Direct Labour Organisations last year that
  "municipal services were started because there was so much price-fixing and corruption when services were not in council control."
  That comment will cause a bitter laugh among the people of Lambeth today. I do not think that the people of Merseyside, with all their experience of Labour's chaos and the incompetence of the town hall, would swap the management of the health service for the form of accountability established by local government. I think that the hon. Gentleman's prescription for the health service would be Lambeth-style militancy, Lambeth-style madness and, I fear, Lambeth-style fraud.
  I now speak about a subject of great concern, I hope, to all hon. Members—the situation in London. There are inequalities of provision in the health service and they must be tackled. The issues that Sir Bernard Tomlinson has put on the agenda have long been recognised. Many hon. Members have long been worried about the extent to which they subsidised services in London. London spends 20 per cent. of the money on 15 per cent. of the people. Far more serious, however, is the fact that the health service for Londoners is not of the standard that I am determined that it should be. That is because of the great provision of institutions, many dating back hundreds of years, which are not appropriate to the health needs of today and tomorrow. In the past 100 years there have been 20 reports all urging change. At the end of the last century Florence Nightingale argued that St. Thomas's should move out to Blackheath.
  We must grasp this opportunity to ensure that there is change. It will not be easy. It means tough decisions, but we shall take them. I pay tribute to the work of the Minister of State, who has held thorough meetings with about 50 institutions and organisations so that we have the opportunity to listen to the views of the people most directly involved. We recognise the need to bring an end to uncertainty—nobody recognises that more than us—but we also have to make sensible, practical, clear decisions to make cost-effective improvements in health care which lead to improvements in treatment, research and teaching.
  We shall not transform the health service in London overnight, nor shall we impose change by central diktat. It will take time to correct the imbalances and distortions which have grown up over many decades. There will be different forces in play, not least the shifting pattern of referrals as health authorities inside and outside the capital exercise greater choice on behalf of their patients. The operation of the internal market must continue to play a part in determining the future pattern of services in London.
  Mr. Jeremy Corbyn: The Secretary of State says that she is aware of serious problems with the administration of the health service in London. If that is so, why does she still support a report which proposes the closure of seven hospitals while 130,000 people are on the hospital waiting list in London?
  Mrs. Bottomley: I regret having given way. The hon. Member for Brightside has a more enlightened view of these matters than the hon. Member for Islington, North (Mr. Corbyn) has. The hon. Member for Brightside has made it clear that the status quo cannot continue. I know that the hon. Member for Brightside got into trouble with

  907
  his hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) for daring to have such an enlightened view. The hon. Member for Hackney, South and Shoreditch, who normally saves his wrath for castigating Conservative Members, took his hon. Friend to task for having an enlightened view on the question of London. All reasonable and thoughtful hon. Members know that the change must happen—and it must happen on the basis of improved health services for London. All agree that the enhancement of primary care is a basic building block in that change.
  I was surprised that the hon. Member for Brightside spent so little time talking about care in the community. Care in the community is an enormously important policy which we are making a reality, not only in the policy, in the guidance and in the legislation, but in the resources. I am sorry that the hon. Gentleman misunderstood the issue of ring fencing for drug and alcohol support. When we debated the matter, we did not expect to have a ring-fenced sum for the whole of the transfer money. We have secured £565 million which will be ring-fenced for community care. That is 35 per cent. more than would have been spent through social security.
  There is an important opportunity here for local authorities. They are rightly proud that the Government have asked them to provide the lead in community care. That leadership means grasping challenges, establishing priorities, making decisions and shouldering responsibilities. It does not mean running back to the Government for more cash at every turn. Through the funds that we have made available, and through the consistent, practical support and guidance that we have given, we have honoured our commitments in full.
  Our community care reforms provide choice for individuals, choice for users and choice for carers. We are determined to protect the independent sector. We fear that Labour councils, left to their own devices, would distort the system as ever—in favour of their own services at the behest of their trade union masters. There would be the old temptation to ride roughshod over the interests of users in the interests of producers—[Interruption.] Before Opposition Members cry too loud, I should tell them that I worked in Southwark at the time of Nye Bevan house. I know many of the scandals with which the Parliamentary Under-Secretary of State for Health, my hon. Friend the hon. Member for Suffolk, South (Mr. Yeo), has to cope when local authority providers fail to serve those who are entrusted to their care. The Government want first-class —not Lambeth-class—services for the elderly and needy. That is why we have insisted that a high proportion of community care money must be spent in the independent sector, and that is why we have backed up the reforms with statutory direction which enshrines the right of individual choice.
  I leave the last word on community care to Mr. David Townsend, once a special adviser to Baroness Castle and now director of social services in the London borough of Croydon. Mr. Townsend works at the sharp end of social services and he disagrees with the hon. Member for Brightside. In a recent letter, Mr. Townsend said:
  "Having failed to alter the national political map, Blunkett … goes home and kicks the cat; in this case local councillors and directors of social services. Mature reflection on Blunkett's part would have led to the correct conclusion that he is the one who loses general elections, not us. Most of us directors … get on with the job—"[Interruption.]
  Mr. Martin Redmond rose—
  Mr. Deputy Speaker: I call Mr. Redmond.
  Mrs. Bottomley: I sat down because I could not get any quiet, Mr. Deputy Speaker. We are all aware that Opposition Members make a great deal of noise because they do not want my hon. Friends to hear what I am saying. I was hoping for your assistance to ensure that. I could complete the words of Mr. David Townsend. It would be discourteous to interrupt his remarks and I should like to get to the end of them. Mr. Townsend says:
  "Most of us directors … get on with the job, increasing the range of services year on year … and leave the more self-exciting 'grand political claims' to those like Blunkett who recline on the green leather benches for a living."
  While the hon. Member for Brightside is reclining on the leather Benches, he should reflect on the fact that spending on the NHS is at record levels. It has grown by 57 per cent. in real terms since 1979. We are treating more patients than ever before. Nurses and doctors are better paid than ever. They have seen a substantial real increase in their incomes since 1979. We have cut junior doctors' hours substantially and there are more reductions to come. The range and quality of services the NHS now offers has never been greater. Waiting times are tumbling and long waits are set to fall further.
  The hon. Member for Brightside referred to my work many years ago for the Child Poverty Action Group. Memories of that work have stayed with me over the years. The hon. Member for Brightside mentioned prescription charges. It is a source of pride to the Government that, whereas a charge was claimed on one item in three when Labour were in government, a charge is now claimed on only one item in five.
  It is an achievement for the Conservative party that more babies now survive the earliest months of their lives than at any time since records began. We have seen life expectancy grow by two to three years over the past decade. In the past decade, perinatal mortality has fallen across all regions and in all social classes. It has fallen substantially in London. The figures in London—[Interruption.] As I made clear earlier, many of the changes have been brought about because of the introduction of the GP contract, which the Labour party rejected and voted against. It is as a result of that change that we have seen the dramatic increases—which are still not high enough—in many of our inner-city areas in terms of immunisation and cancer screening figures. For the past two years—for the first time ever—no child has died from measles or from whooping cough.
  In "The Health of the Nation" we have established a health strategy that the World Health Organisation has described as a model for others to follow. Those are achievements of which we are proud. It is only those whose sole concern is politicising the health service who wish to deny those achievements. It is only those who are interested in politicising the health service who whine about underfunding rather than trying to get to grips with the complex issues. It is only those who are interested in politicising the health service who exploit individuals' misfortunes rather than examining the arguments. I am afraid that the hon. Member for Brightside and his hon. Friends have shown how out of touch their party is with the modern NHS.
  The health reforms were not designed to produce a quick fix or to gain temporary political advantage: they

  909
  have equipped the NHS to serve the people of this country for the next half century even better than it has done in the present half century. The NHS is going through a time of change and a time of great opportunity. It may be easier for hon. Members to duck change, as the hon. Member for Brightside has done, and to indulge in sloganising, but that would betray the people of this country. We have begun the work and we shall finish it.
  5.49 pm
  Mr. Martin Redmond: The Secretary of State has been speaking a load of drivel for more than an hour. Will she not go out into the world of reality where the facts speak for themselves? The facts are at variance with what she has said from the Dispatch Box today. There is a hidden agenda and a two-tier health service. The evidence for saying that exists, and my hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) has given it.
  The chairmen of the trusts—[Interruption.] If the Secretary of State would listen instead of opening her big gob, she might learn something. That is the trouble with Conservative Members. They are for ever opening their gobs. If they would listen—
  Mrs. Virginia Bottomley: Will the hon. Gentleman give way?
  Mr. Redmond: I will not give way. Shut up: the Minister has had well over an hour.
  We have had correspondence with the Department about the appointment of chairmen of trusts. Mr. Peter Horsburg was appointed as a chairman but was refused to be acknowledged by the Secretary of State. There was a misunderstanding about the facts surrounding that event. However, there are rewards for political obedience among officers in the health service. When trusts are created, the directors receive wage increases of 100 or 150 per cent. It galls me that the Secretary of State and Trent regional health authority, in my area, appoint political stooges—as the chairman of the health care trust in Doncaster has said. They are paid salaries approaching £20,000. Non-executive directors receive £5,000 each as well as free lunches, subsistence and travel.
  Few, if any, of the chairmen and non-executive directors even approach the time commitment that they should make in return for the political gift which they have been given. I challenge the Secretary of State to order the Audit Commission to investigate the time that directors put in for the monetary reward that they receive from the health service. The Tories have always attacked local councillors for working seven days a week for the pittance that they receive. The Government should examine the position of trust directors.
  Regretfully, the Government have proposed effectively to reduce the pay of those who keep the NHS alive. They have limited their pay increases to between 1 and 1.5 per cent. Perhaps the Government will reduce the ill-gotten gains of trust directors to the pay of nurses since 1989.
  The Secretary of State talks about the health service. She should go into a hospital for 24 hours, seven days a week for a few weeks. Then she would see whether the health service was growing as a result of all the money that
  910
  the Government are putting into trusts. I do not believe that the NHS is growing. Millions of pounds have been put into the NHS to create the trusts.
  The Secretary of State is now telling trusts to slow down. Does she not realise, as she laughs, that to tell trusts to slow down treatment could at worst result in patients dying? She is not interested in the deaths among NHS patients caused by her policies. At the least, the quality of life of patients is affected.
  It is no good saying that patients can obtain treatment if their case is an emergency. That depends on the clinical judgment of the GP. The Secretary of State referred to patients' rights. They are nothing but a con trick. Patients have no right to a first out-patients appointment. That fact, together with the placing of patients on review, falsifies the in-patient waiting lists. I wish that the Secretary of State would get the figures right. Millions of patients who are not on any list are waiting to see a consultant. The lists have been reduced simply by removing patients from them.
  The Conservative Government shout from the roofs about value for money. I am pleased that the Secretary of State does not live in my household. The reforms have cost money in increased administration costs. Far from reducing the bureaucracy, the reforms have added to it. Doncaster health authority had administration costs of approximately 4 per cent. Celia Wilson, the former chairman, was a Conservative, but she was committed to the health service and to the people of this country. That is a commitment which the Government do not have. [Interruption.] I will not give way to the hon. Member for Harlow (Mr. Hayes). If he will shut up and listen, he may learn something from Opposition Members.
  Celia Wilson, the chairman, Tony Dale, who was in charge of administration, and David Eves, the treasurer, did a marvellous job of ensuring that the health authority produced value for money. Doncaster now has four chairmen whereas previously it had one. It has 24 non-executive directors at an annual cost of more than £200,000. It has three chief executives, three directors of nursing, three directors of finance and four directors of medicine, all at vastly increased salaries. There is massive duplication of management. The bureaucracy of Conservatives in government is crazy. If the Secretary of State wants to make improvements, she should reduce the bureaucracy.
  I admire the working doctors, nurses and support staff for their complete commitment in return for little reward. They have to live with the greed of the people who seek to exploit them. I am extremely grateful to the doctors, surgeons and nurses of Doncaster Royal infirmary without whose skills I would not be here today. I am also grateful for the research done at Weston Park hospital in Sheffield. Marvellous work is going on there under Professor Hancock and his team. I am also grateful to my GP, who used his clinical judgment to put me into the accident and emergency department. It was his decision, not that of a consultant. That onus should not be placed on GPs.
  When one is on a ward for 24 hours, one can see the nurses and junior doctors working under pressure. The Secretary of State should spend a little time on a ward at 2 or 3 o'clock in the morning and see what the nurses have to do.
  Mrs. Virginia Bottomley: The hon. Gentleman asked me to spend a little time at 2 or 3 o'clock in the morning on a ward. That is exactly what I have been doing.
  Mr. Redmond: I am not sure whether it was as a patient or as a visitor. If she spent time on a ward day and night, she would know. If she opened her eyes, she would perhaps learn a little. Regretfully she does not appear to have done so.
  An early-day motion has been tabled requesting a public inquiry into the maternity wing at Doncaster Royal infirmary. It is important that a public inquiry should take place. The internal inquiry was purely and simply a statistical game. It compares Doncaster with Sweden and western Australia. Instead of looking at figures, it should investigate practices because that would be to the benefit of nurses and the people of Doncaster. I hope that the Secretary of State or the Minister will say whether a public inquiry is to take place. The policy of GP fund holders does not appear to be welcome, but apparently it is the only policy under which money can be obtained from the Department. I hope that even at this late stage the Government will abolish the trusts and let us get back to a true national health service.
  5.59 pm
  Dame Jill Knight: It is a mystery to me why the Labour party constantly contrives to turn a success into a failure, an achievement into a disaster and a cure into a calamity. About £100 million a day is spent on the health service, more patients are being treated with better operations and better drugs—
  Mr. Bob Cryer: It says here, "Issued by Conservative central office".
  Dame Jill Knight: I wrote my own speech, as I always do.
  There is also better equipment, and, even more important than all that, there are now cures for diseases which would have killed patients only a short time ago. Waiting lists are down and the pay of doctors and nurses is up. I could go on listing the improvements, but to listen to Labour Members one would think that all was doom, gloom and despondency. We fundamentally disagree with Labour's carping and belly-aching and we are proud of the record of the health service under this Government.
  In my well-known way of spreading light, sweetness and agreement, let me turn to a matter on which all hon. Members can agree. All the experts in the health service deserve our admiration and every help which we can give to them and they should not have to face dangers which we have the power to remove. Consider the scenario of a patient needing a transplant of some vital organ—perhaps a lung, heart or liver—being prepared for the operation. All sorts of tests are carried out. Blood cells are measured, haemoglobin and blood gases are checked and the functioning of his organs is carefully assessed by electro-cardiogram. Every test that doctors deem necessary for the safety of the patient is meticulously embarked upon.
  However, the one test that is essential for the safey and peace of mind of the medical team is left out—the test as to whether the patient has AIDS. Doctors can check for hepatitis and syphilis, but they cannot check for AIDS
  912
  unless two conditions are fulfilled. The first is that the patient must agree to the test, and the second is that counselling has to be available for the patient.
  I am told that in a recent case a young surgeon's razor-sharp scalpel slipped and cut his hand in the middle of an operation. No one knew whether the patient had AIDS, but when he came round and was fit to talk he was asked whether the doctors could conduct tests to make sure that he was all right. He said that they could not. That young surgeon will not know for many long and agonising months whether he has contracted AIDS. He will not be able to get on with his professional or private life because he can neither operate nor sleep with his wife. We should not put doctors in that position.
  Let us look at the case of a person who is brought unconscious into an operating theatre following an accident, an attack or seizure or perhaps an overdose. I am assured that, although he is unconscious, he may vomit blood and that instant care has to be made available to him. However, no AIDS tests can be carried out because he cannot be asked whether he agrees. I do not want to harass AIDS victims or hurt their feelings or multiply their agony, but I certainly want to protect nurses, doctors, surgeons and laboratory staff and all others who may put their own lives at risk by caring for someone who has AIDS.
  As I have said, doctors are allowed to test for venereal diseases such as syphilis and the patient does not usually know that the test has been carried out. I am told that if the patient does not have the disease there is no problem, but if he has he is advised about the best medical care that he can be given. Surely we should follow that rule for AIDS. Why not extend the practice? It is not right to sacrifice the life, health and peace of mind of medical staff and their ability to continue to operate, nurse or test because of fear of hurting the feelings of people who, although tragic, undoubtedly pose a serious threat to the lives of others.
  I have a second request on another matter to make in my short speech. I am trying to be constructive in asking my right hon. Friend the Secretary of State to take two actions that could be of immense help in two different fields. The second concerns a thoroughly responsible and respectable couple in my constituency who were asked by a social worker in March 1988 to take in a six-day-old Sikh girl who had been abandoned by her mother. They did so. They came to love the child and, although they had a boy and a girl of their own, they eventually asked Birmingham social services department whether they could adopt the little girl. Incredibly, the council not only flatly refused but spent a large sum of ratepayers' or poll tax payers' money, or whatever we want to call it—I am told that it amounted to tens of thousands of pounds—on court action to try to get the child away from her loving home, the only home that she knew and the one in which she wanted to stay. A social worker told those caring and excellent parents that white people were not good enough to bring up black children.
  Can we imagine the fuss, the headlines and the furore that would result if a black couple were told that they were not good enough to look after white children? And quite right too; I would similarly decry such an appalling statement. No one except the couple and a friend who tried to help them knew about that because for three years Birmingham city council gagged the couple with art injunction. They were not allowed to speak to anyone. I

  913
  am their MP, but they did not dare to write to me or anyone else about what had happened. They were afraid that, if they broke the injunction, they would not be allowed to adopt the little girl.
  It seems that not only the Race Relations Act 1976 but freedom of speech was flouted. At one stage the couple were told that a black adoptive family had been found for the little girl, but they discovered that it was not a Sikh but a Muslim family and the mother could speak no English, although the little girl had been brought up in a home in which English was the natural language. The proposal to send the child to the Muslim family was called off after the parents protested. A social worker visiting the family forbade the little child to call her parents—the only parents she knew—dad and mum.
  The child was then secretly introduced to another Asian family who agreed to take her as a foster child. All this when Joanne had lived for years with the family and loved them dearly, as they loved her. Then, when the couple were given 48 hours' notice that Joanne would be taken from them, they took court action. It was three years before the High Court, in November last year, ruled in their favour and they can adopt the child. There is no excuse for all this, especially for telling a loving couple that they are not good enough to adopt a child because of the colour of their skin.
  I make the direct appeal to my right hon. Friend the Secretary of State to look into both these totally different sets of circumstances and stop social workers from behaving in that way in one set of circumstances and to help surgeons and medical staff in the other circumstances.
  Mr. Deputy Speaker: Before I call the next hon. Member, may I remind hon. Members that Madam Speaker has ruled that we should now start on 10–minute speeches.
  6.10 pm
  Ms. Liz Lynne: We, too, regret the growing crisis in the NHS. The national health service, which is approaching its 50th anniversary, has served several generations very well. Whenever possible, it has cured us. At other times, it has at least healed us. Few would disagree that it has almost always cared for us. Against this background, it is tempting wholeheartedly to follow the Labour party argument. There can be little dispute that the system is underfunded and that the internal market is creating two tiers of care.
  However, if we are to alleviate the crisis in the NHS, we cannot just go back to the status quo before the reforms. Before the general election, I was opposed to GP fund holding and to hospital trusts and still am, but we have to accept that they are there and that there will be even more before the next election. We have to face that reality and try to find a solution. The Government are not going to change their minds.
  Although I do not embrace this Government's philosophy of change for change's sake, I do at least accept that some change is needed, but that change should have taken into account the needs of the patients and the fact that there was not enough money to meet everyone's needs and that more money should have been found for the health service. I know that some more money has been put in, but that is not enough to meet those needs.
  914
  The internal market has not been a great success in most instances. The market can be very cruel when applied to the vulnerable: the sick child who cannot be admitted to hospital until after 1 April will not understand that his GP is not a fund holder; nor do the caring health service staff appreciate having to close hospital wards when they know that there are people who need treatment. The Secretary of State responds by telling hospital staff to pace themselves; in other words, "don't cure people too fast". This is at a time when the Government's own target, a maximum of two years on the waiting list, has not yet been achieved in all areas. They have to acknowledge that fact.
  The internal market is also creating problems in a number of trusts. My local Rochdale trust has increased its patient activity, reduced its waiting lists and cut costs considerably, but having done that, it will not be awarded any further contracts by the health authority because of lack of funds. This is not because the health authority does not want to spend the money. It simply does not have enough.
  Dr. Liam Fox: Perhaps the Liberal spokesman will tell us how much extra money the Liberal party believes we have to put in to achieve the situation that she wants? Exactly how much?
  Ms. Lynne: I am grateful to the hon. Member: as we said before the general election, another £2 billion over the course of a Government. That was stated very clearly in our manifesto commitments.
  The hospital at Rochdale is now forced to close wards. Many hospitals may in future, because of this trend, have to throw people out on the dole. GP fund holding has also served only to promote a two-tier system.
  It is naive in the extreme for the Government to expect an even result when it has installed two budgetary structures, a more generous one for fund holders and a rather more stringent one for health authorities. At least they cannot say we did not warn them about the problems they were creating. All our calls for wider consultation on the internal market generally were ignored. That will be cold comfort for the thousands turned away from hospitals and told to come back after 1 April. It will be cold comfort to, for instance, the two children in Rochdale who have been in traction for some time and were just settling into their ward but will now be forced to move to another hospital.
  The question is how we can reverse the crisis in the health service. A two-tier system with care for some is not quite the way to celebrate the 50th anniversary of Beveridge's proposals. The way forward would have been through pilot projects, consultation, listening to both the users of the service and to those who make the very difficult decisions in it every day. But the Government did not do that. Even though they did not do it to start with, the least they can do is to conduct a full survey of the reforms, and, more important, to make the results public. We have a right to know the extent of the problem and why they did not consult fully to start with. We have a right to know how they propose to get out of this mess.
  I believe that a new idea of locality fund holding represents a positive way out of the present mess. I am not going to dictate the solution, but I want to talk to health professionals and see whether it is the appropriate solution. As I have already said, hospitals up and down the country are running out of money and closing wards while

  915
  some GP fund holders have excess cash. Locality fund holding could be a way round the problem. I hope that the Government will take this on board. Under locality fund holding, GPs in a particular area would band together and become fund holders, between themselves, thus avoiding the two-tier system that is being created at present. Community care services could also come under the locality fund-holding umbrella in order to stop people falling through the net between health authority and social services provision.
  I have deliberately not spelt out a definitive policy on locality fund holding, because, unlike the other two parties, I believe in genuine consultation before policies are fully formed and I do not want to limit the responses I receive.
  Another area on which the Government appear to have failed is Tomlinson. That also is due to lack of consultation. Why did they not ask the people who know, the professionals and users of the service? If they had, they would have been told that they could not think about closing hospitals before the primary and community health service was up and running. They would have been told that we need a single London health authority. They would have been told that the figures used by Tomlinson simply do not add up. Why did they not ask? Why did they not listen even though they did not ask?
  The Minister for Health (Dr. Brian Mawhinney): I was wondering whether the hon. Lady thought that when she and her colleagues came to see me to give me the benefit of their views, as part of the London consultation, I was not listening or taking account of what they were saying.
  Ms. Lynne: Yes. My colleagues and I were grateful for that. I feel that the Minister was listening, but he should have consulted more widely previously and should have consulted the health professionals earlier. I am talking about consultation, not with us, but with the people within the health service and with its users. I know that the hon. Gentleman has been round to all the hospitals, but I do not think that he has really been listening. I do not think the Government are going to consult this time. I do not think that they have learnt the lessons, because I do not think that they are listening properly.
  Are they going to listen to the dentists and their patients? They have already forced many dentists out of the NHS. Dental health is already at risk. Now the Government want to take away free dental treatment from pregnant women. How much further do they want to go?
  Dr. Mawhinney rose—
  Ms. Lynne: If the hon. Gentleman wants to intervene again, I will gladly give way.
  Dr. Mawhinney: Which Minister said that?
  Ms. Lynne: It was in all the reports, including the report that came out recently. Neither the hon. Gentleman nor the Secretary of State has come to the House to make a statement on that report. Perhaps the right hon. Lady would like to do so; then we can debate the report. I know that the Opposition spokesmen have asked for this, so perhaps the hon. Gentleman can give a commitment to it today.
  Dr. Mawhinney: But the hon. Lady wants us to consult.
  Ms. Lynne: I should like the Secretary of State to come to the House and make a statement on dentists. Now, if the hon. Gentleman will allow me to continue—
  Mr. Deputy Speaker: Order. Sadly, not this afternoon; the 10 minutes are up.
  6.20 pm
  Mrs. Marion Roe: Once again I have listened to my right hon. Friend the Secretary of State with admiration. It is not just the grasp of her subject that is impressive, but the clarity of her vision and her determination to do what is right. Conservatives should not let the mantle of compassion be taken from them. We need to put paid to the myth that management is outside the welfare arena. To manage well is to ensure fairness and the best possible service.
  The debate on the health service has certainly come a very long way in the last 15 years. Up to the early 1980s, the service's success tended to be measured by how big a budget could be wangled from the centre and how quickly it could be spent. Huge blanket sums were consumed without guidelines, and seemingly with few controls. The game was to spend, to look good and not to worry about the consequences for others either within the service or outside it. Peter was robbed to pay Paul and shroud waving—a new expression, I think, in the Chamber—was the main feature of the yearly expenditure round.
  Less than 20 years ago, the health service did not even know how many doctors it employed, let alone how much a certain course of treatment would cost. Morale was low, and the service was to suffer under the last Labour administration its biggest capital cut ever. The situation was critical, and those of us who believe in the principles enshrined in the NHS knew that there had to be a radical change if a comprehensive free service was to survive into the 1980s and 1990s.
  The first step was to restore confidence and to reverse those cuts. There is no disputing that the health service has benefited from massively increased funds under the Conservatives. The health service now has the second largest budget in Government expenditure. At £37 billion, it is second only to social security—and I believe that few here doubt that that is as it should be.
  The provision of money alone was not enough to reverse the games that were played before, and the Government deserve credit for moving the debate on. They are only too aware now that it is not how much is spent that matters, but how it is spent. By insisting on and providing the tools for better management, by improving the management structure and by introducing financial disciplines, the Government have given the NHS its own lifeline.
  It is less than two years since the biggest ever reforms of the national health service were introduced. The second year has not yet been completed. GPs—only those who could and wanted to—were given the ability to handle their own budgets in certain areas, and some hospitals became self-governing trusts. There is, and has been, no duress to become a trust. Application for trust status is entirely voluntary and open to any unit which satisfies the criteria. Less than two years on, 95 per cent. of hospitals and community health service provision have either moved to trust status or expressed an interest in doing so. Moreover, nearly 550 GPs have become fund holders, and

  917
  there is a likelihood that a further 700 will join them. That will mean that one quarter of the population will be served by fund holders.
  By any standards, that is an enthusiastic response to the reforms in the service—encouraged, no doubt, by the early signs of success. In a recent survey, more than 70 per cent. of GP fund-holding practices reported falling waiting times and improving efficiency. In their first year of operation, trusts treated 8 per cent. more patients than in their last year as directly managed hospitals.
  In my own constituency, the East Hertfordshire NHS trust has boosted out-patient attendances by 3 per cent. from last year, and in-patient cases have risen by 4·2 per cent. Also, waiting times are dropping. The East and North Hertfordshire district health authority is on target to achieve by 1993 the region's standard of no one waiting more than 18 months. The expectation is that waiting times will be dropped to 15 months in the coming year.
  I maintain that contracting has improved service delivery and will continue to do so. GPs handling their own affairs can understand the cost implications more easily and arrange their priorities according to their needs. Trusts can plan ahead freely without interference from the regional health authorities and the Peter robbing Paul mentality. Services can be delivered as promised and strategic plans made for the future with confidence. They know at the beginning of each financial year how much elective—that is, non-urgent—work they will be required to do, so they can plan staffing and other facilities accordingly. Better information also enables trusts to make accurate estimates of the amount of emergency and urgent work that they are likely to do and to plan their budgets accordingly.
  Inevitably, some of the shroud-waving mentality has survived and is finding its voice on the Opposition Benches today.
  Mr. Ian McCartney: Will the hon. Lady give way?
  Mrs. Roe: We have a 10-minute time limit, Mr. Deputy Speaker, and there is a great deal that I want to say. I shall give way when I have finished my speech.
  No reasonable person would expect radical change to be introduced without some teething problems. Equally, no reasonable person could expect to return to the old mentality which was so ruinous to the provision of services. It is unfair to other parts of the health service to raid their budgets to get some hospitals out of financial difficulties. It is also unfair to take a snapshot view of what is happening in the health service before the year is out. Doing so distorts the picture. The fact that there has apparently been over-performance on elective surgical contracts reflects the situation that more elective work is done in the first six months of the financial year—that is, in the summer—because more beds are required for emergency medical admissions in the winter months. Surely it could also be claimed that this is sensible planning —to plan the elective work when it can be done and leave the hospitals free to cope with the demands that winter brings.
  To counter some of the very negative stories that we have heard from the hon. Members for Sheffield, Brightside (Mr. Blunkett), for Don Valley (Mr. Redmond)
  918
  and for Rochdale (Ms. Lynne), I should inform the House that the East Hertfordshire NHS trust is working to contract and has no plans for bed closures. The elective and emergency services will be maintained to year end, and financially the trust will be broadly in balance. Its strategic plans have been published and over the next five years its programme of development includes completion of a 30-bed day care unit at the Queen Elizabeth II hospital in Welwyn Garden City, construction of a purpose-built orthopaedic unit in the grounds of that hospital, and construction of a 60-bed unit for continuing care of the elderly on a site in Hoddesdon in my constituency. There are also a further six projects. The result of such developments will be that services will be more convenient and supplied more quickly and efficiently and to a higher standard.
  I urge the Government to continue with their reforms. Recently, the Health Select Committee published its interim report on NHS trusts. One of its concerns was that there should be a strategic overview of the management of trusts. Within this question lies the future role of the regional health authorities. I believe that as the reforms take a firmer hold on the future provision of the services the present role of the regions will change. Their role will therefore have to be redefined as we continue to improve the standards and provision of patient care.
  Mr. McCartney: Perhaps the hon. Lady would like to comment on the statement of one of her local GPs, Dr. Laurence Buckman, that patients in his area have already died because of serious bed shortages—and one of his patients died in an ambulance because of a row as to who should pay for his treatment. That is not the Labour party but one of the hon. Lady's local GPs.
  Mrs. Roe: That local GP has certainly not written to me on the matter. He has not drawn it to my attention for me to bring it to the attention of the local authorities.
  6.30 pm
  Mrs. Alice Mahon: I shall not be congratulating the Secretary of State on her speech. Indeed, when she resumed her seat I thought, "Thank goodness we have got to the end of that self-righteous rant."
  This month's edition of GP News, referred to by my hon. Friend the Member for Makerfield (Mr. McCartney), contains a report under the headline:
  "Human toll mounts as reforms fail."
  It goes on to say:
  "Patients have already died waiting for beds."
  In that article Dr. Buckman, a member of the General Medical Services Committee, whom the hon. Member for Broxbourne (Mrs. Roe) claims has not written to her, reveals in tragic detail the case of a severely asthmatic girl who nearly died when Barnet general hospital sent her away because no beds were available.
  What I say may be dismissed as shroud waving by some Conservative Members. They would not dismiss things so lightly if members of their own families were affected. What would the Secretary of State say if her mother experienced the suffering of a patient cited by Dr. Buckman—an elderly person with a leaking aortic aneurism who died in the ambulance while a row ensued as to who would pay for the treatment? Conservative

  919
  Members would not want tragedies of that sort to affect their families. Labour Members do not want them to affect anybody at all—that is why we demanded today's debate.
  It is time the Conservatives admitted, before more tragedies occur, that the internal market has been an unmitigated disaster for health services in Britain. Dr. Buckman's examples highlight the human cost of the greatest crisis in the hospital service since the NHS was formed.
  I do not want to talk simply about headline tragedies. I am anxious to bring attention to bear in the debate on what is happening to the NHS throughout the country. The Secretary of State referred to Calderdale. Halifax is one of the two towns comprising that district. There has been a massive bed closure programme in Halifax. It has been going on for the past 13 years and it has led to many serious problems. Management there will hasten to deny it, but I know from talking to members of staff and patients, and from visits to hospitals, that serious problems exist in Calderdale. The Royal Halifax infirmary recently had no beds available for a two-week period. I understand that panic sets in regularly among managers and consultants who are desperate for beds. I also understand that they regularly discharge patients early.
  That brings one to the dreadful business of bedding out, which has not been referred to in the debate so far. Bedding out is the norm in most hospitals nowadays. Does the Secretary of State know what bedding out is all about? A woman who had been pregnant recently wrote to me saying that although she was in danger of losing her baby —she finally lost it—placed in the next bed to her was a psycho-geriatric patient. That happened on the gynaecological ward as she was going through the trauma of losing her baby, and it was distressing for both patients and for staff and relatives.
  The Secretary of State might feel differently if she had been moved from an acute medical ward to a surgical ward to make way for new admissions. Such transfers happen on a regular basis. Had she experienced it, she might understand just what a rotten practice bedding out is. Elderly people are regularly suffering dreadfully as they are admitted to casualty and have two or three moves as they are bedded out on to different wards to make way for other patients.
  It is widely known in Halifax that psycho-geriatric patients are often admitted to ordinary wards for the elderly because there are not enough specialist beds to cope with patients of that type. That, too, puts great stress on staff. Noisy, disturbed and perhaps doubly incontinent patients require special care. Would the Secretary of State describe such a situation as levelling up or levelling down? I assure her that that sort of thing did not happen when I worked in the service in the 1970s.
  For years, we in Halifax have not had any coronary care beds for males. Four beds are coming on stream and should have opened on 1 January. I believe that their opening has been delayed due to lack of cash, though the Tory-appointed administrators will no doubt say that the delay has occurred for other reasons. It is high time that those beds came on stream.
  Because of the shortage of beds, a practice known as mixing is taking place. I was recently visiting a friend in a ward for elderly females and noticed that there was one elderly male on the ward. I believe that he died during the following 24 hours. I did not regard it as respectable, dignified or comfortable for people of that age to have to
  920
  be on a mixed ward. I have spoken to many patients in that position and it is clear that they are not happy in that situation. I ask Conservative Members to ask themselves whether, if they were feeling low, they would like to be on a mixed ward. I would not. That is happening as a result of the Government's bed closure programme, and the Tories are proud of it.
  The response of the Secretary of State to the types of situation that I have described has been frankly insulting. She tells my hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) that he is scaremongering. The criticisms of the British Medical Association are dismissed, the BMA being told that it has said nothing apart from complaining about the NHS being underfunded. The right hon. Lady may say that my hon. Friends and I do not know how the system works, but I accuse her of not understanding what is happening in the NHS. Her highly paid political friends who are now running the service are issuing harsh penalties against anybody who dares to blow the whistle.
  We have been made aware of how serious a threat that is to the freedom of staff to speak out. Doctors and nurses are under great pressure not to express their views, as their evidence when trusts were looked into made clear. The Government have devised a special plan for dealing with what one might call the deviant doctor. It is called a rolling contract or a fixed term contract. Tory business managers are casualising the work of doctors. Indeed, they have the ultimate weapon over doctors. As Mr. Chawner of the joint consultative committee with the BMA said:
  "A doctor is bound to think … his job is coming to an end … unless he complies with some set objective which may not have been set by him or his peers. In fact, at times I have to say I think it may be set for political reasons in that it would be useful to cut a waiting list. That a doctor should be subject to that sort of influence is quite undesirable from the patient's point of view. Doctors should always decide on the basis of an individual patient, in front of him, and not according to whether he is going to please the manager or anyone else."
  I would go further than Mr. Chawner. I would call them not rolling or fixed contracts but blackmailing or gagging contracts. Clearly, the present contracts have been well thought out.
  Labour Members have time and again said that underfunding is the problem with the NHS. We warned that the Government's guidelines on equal access would be openly flouted. Fast-track patients from GP fund holdings are being canvassed openly and placed at the head of the queue for purely financial reasons. The Secretary of State's excuses on that have been disgraceful.
  Because of the 10–minute limit, I do not have time to quote from a letter dated 24 December from the managers of the Bradford trust. They were clearly canvassing GP fund holders in respect of consultants holding waiting lists. That must represent a two-tier system and it should be exposed, as should the waiting list cheating that goes on. Cheating is taking place on a massive scale. The report of the Select Committee and the evidence about trusts makes the position clear. Doctors said that the two-year waiting list was fatally flawed, that people with acute clinical conditions were sometimes unable to get treatment and that they often faced a life and death situation. The Royal College of Nursing says that nurse redundancies are occurring throughout the country, including 300 at Horton psychiatric hospital.
  That is happening at a time when political nepotism is the norm. What qualifications does Alan Titterington have

  921
  to make him a suitable chair for the West Yorkshire ambulance trust? His businesss background is fibre-optics in the music industry—his political background is the chair of a local Conservative association. Nor should we overlook Lord Hayhoe, who yesterday deliberately canvassed for the chair of St. Thomas's and Guy's.
  There is only one place for the Tomlinson report, and that is the dustbin. It is disgraceful. I hope that Londoners can get back the feeling of the blitz, recognise who the enemy is, defeat the Government and damn the report.
  6.39 pm
  Mr. Jerry Hayes: First, may I make a declaration of an interest? I advise the Western Providence Association, which is a non-profit-making organisation.
  I listened most carefully to the speech of the hon. Member for Halifax (Mrs. Mahon) whom I have known for years. We served together on the Select Committee. It was interesting to hear that she totally disagrees with her Front Bench on the Tomlinson report.
  We have heard on many occasions from the hon. Member for Sheffield, Brightside (Mr. Blunkett) that he believes that the status quo is no longer an option. I wish that the hon. Gentleman were in his place. Bring back the hon. Member for Livingstone (Mr. Cook); all is forgiven. I may not have agreed with him, but at least he understood and mastered his brief. Here we have a shadow Secretary of State who has hands on, but absolutely no grip whatsoever.
  I understand why Opposition Members feel rather twitchy about the motion. It is not so much a motion as a stream of consciousness in the image of Dave Spart. They talk about the growing crisis in the health service, the commercialisation of the health service, concern at the total fragmentation of care due to underfunding, the impact of internal market trusts and GP fund holders. It goes on and on. Worst of all, it contradicts Opposition Front-Bench policy—[Interruption.] Hon. Members should listen and then they would learn.
  Not so long ago we heard the hon. Member for Brightside at the Blackpool conference going on about
  "the Tories' own Frankenstein's monster"
  and saying that he was committed to getting rid of the trusts. The hon. Member for Bristol, South (Ms. Primarolo) said pretty well the same thing. On 21 August 1992 she told The Independent that trusts enjoyed "no public support". She told BBC television that she was committed to getting rid of them.
  Ms. Dawn Primarolo: Absolutely.
  Mr. Hayes: Let that be on the record.
  When I picked up my copy of Hospital Doctor which I recommend to the hon. Lady, I turned to the back page. This is not The Daily Telegraph or the Tory press, it is Hospital Doctor. It says:
  "Labour abandons vow to end trusts".
  It goes on:
  "Labour has officially reversed its general election pledge to abolish trust hospitals. Announcing the decision, Labour health spokesman David Blunkett said, 'you can't turn the clock back'."
  I hope that the hon. Lady totally agrees with the new policy.
  Ms. Primarolo: I am happy to say now, to avoid speculation until the end of the debate, that Labour party policy was confirmed by my hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) this afternoon. We do not accept trusts, GP fund holders or the internal market. The hon. Gentleman has heard that twice now and I hope that he is now clear.
  Mr. Hayes: I hope that the hon. Lady and the hon. Member for Brightside will be calling for an immediate apology from Hospital Doctor for publishing such a terrible travesty, accusing them of making a U-turn.
  Opposition Members attack GP fund holders. In The Times on 14 January 1993 the hon. Lady and the hon. Gentleman said that the system would be scrapped. But another medical publication, not the Tory press but BMA News Review in January 1993, published an interview with the hon. Member for Brightside saying:
  "he is aware, however, that all GPs have benefited from increased flexibility and influence in purchasing decisions".We watch this space for another dramatic U-turn.
  The wonderful Dave Spart motion also attacks underfunding. On 26 September 1992 The Times reported:
  "On funding, Mr. Blunkett made it clear that Labour was no longer tied to the general election commitment to restore underfunding within the NHS since 1979."
  Perhaps there should be another apology. I imagine that the hon. Lady would totally refute that as well.
  The Dave Spart motion goes even further, condemning the internal market. The hon. Member for Brightside was reported in The Times on 14 January 1993 as saying that Labour should not have any hang-ups about the market. I am delighted to hear that the hon. Gentleman has no hang-ups, which is more than many hon. Members, but perhaps he will demand an apology from The Times as in his motion he has condemned the internal market, as have his hon. Friends.
  The hon. Member for Halifax made a wonderful attack on Tomlinson. We know full well what the hon. Member for Brightside said about Tomlinson. The Guardian, which is not exactly the Tory press, said on 24 October 1992:
  "If Labour was in office it would be proceeding in exactly the same way."
  But what did the hon. Gentleman say about Tomlinson?
  "The status quo is no longer an option."
  He went even further in a Labour party press release on 15 October:
  "The evidence is now overwhelming that there is a need for the reorganisation and relocation of resources in London."
  That was another dramatic U-turn; it is absolutely remarkable.
  We have heard something about the BMA backing rationing and saying that we have the worst crisis for 30 years. It is written on the front page of Hospital Doctor. However, in the same column the National Association of Health Authorities dismissed the BMA's criticism and allegations. Its director, Phillip Hunt, said:
  "I am not disputing that there are problems, but we have to set them against the impressive results that we are achieving on waiting lists."
  Hon. Members on both sides of the House should appreciate that.
  I have no interest in Hospital Doctor, but the first two pages cover eight little stories. One is headed, "Praise for Combined Drug Cash"; another reports neo-natal services in Wales being given an extra £4.5 million boost; another reports nearly £2 million being made available to treat babies with severe combined immuno deficiency-related

  923
  disorders and another deals with the United Kingdom's first small intestinal transplant at Addenbrooke. That is all good news.
  I am not trying to say that everything is rosy in the national health service; of course it is not. I now refer again to The Times and I think that the Opposition may agree with this:
  "Imminent demise has been the prognosis on the Health Service almost since its inception, but in recent years complaints that it is falling apart from lack of money have become louder … Doctors complain that the service is chronically under-financed, that their incomes have not kept pace with inflation and that the 1974 reorganisation led to chaos in hospital services."
  That article was in The Times in 1978. Nothing whatsoever is new.
  Ms. Primarolo: Except that the money was spent.
  Mr. Hayes: The hon. Lady said that the money was spent and I expect that she is about to make an incredibly crass point about bureaucracy. Let me give her some help. For every £1 spent on bureaucracy, £47 is spent on doctors and nurses—
  Ms. Primarolo: So?
  Mr. Hayes: The hon. Lady says "So?" but it is incredibly important. We have increased financing of the health service in real terms by 57 per cent. and £100 million a day is being spent on the national health service.
  The hon. Member for Rochdale (Ms. Lynne) made an interesting speech. Although she did not tell us what the Liberal Democrats would do, she said that they would make a commitment to an extra £2 billion. She made that commitment at the general election, but that was the precise amount that my right hon. Friend the Secretary of State got for the health service in the last financial round.
  6.49 pm
  Ms. Jean Corston: This debate is well named. There is a crisis in the health service and it is necessary to go back to the founding principles to identify it. One of my most treasured possessions is a leaflet sent out to the population in 1948 by the Central Office of Information entitled "The New National Health Service."
  It said:
  "Your new National Health Service begins on 5th July. What is it? How do you get it?
  It will provide you with all medical, dental, and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a 'charity'. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness."
  Those were the founding principles of the NHS, but the Government's policy is a retreat from them. They spent £1.7 billion to change the service—and I emphasise the word "service"—into a market.
  Like the hon. Member for Birmingham, Edgbaston (Dame J. Knight), I make no apology for using anecdotes. Unlike the Secretary of State, I understand that health care is about personal experience rather than statistics, and anecdotes are all that can relate personal experience. I shall explain the consequences of the Government's policy on Bristol by using letters written to me by constituents. I consider that to be a reasonable way of dealing with the matter.
  There is now a 19–month wait for an orthopaedic out-patient appointment at Frenchay hospital. I discussed
  924
  that with trust officers, who confirmed that it was true and said that it was the norm. They said that it was due to underfunding. Are they whingers? Are they shroud wavers?
  A woman constituent wrote to me saying that her condition caused her such pain and distress that she is afraid that she will have to give up work. She cannot even get an out-patient appointment at a clinic in the directorate of surgery at the Bristol Royal infirmary. She cannot get on to the waiting lists that we are told are being reduced. Another example is of a frantic woman waiting half a Saturday afternoon for her collapsed husband to be taken to hospital by ambulance because the bed bureau could not find a bed.
  At the ambulance service, which is now a trust, the aim of the management is to cover 95 per cent. of shifts. Ambulance crews say that the cover should be 100 per cent.; that is their commitment. However, to provide that cover they have to work through their meal breaks and rest periods. Meanwhile, to make money the trust has produced a corporate brochure advertising servicing and maintenance of vehicles; sales of pagers, portable radios and telephones; and first aid and driver training courses. The logical conclusion for patients of all that is that money talks.
  Another constituent who needed a physiotherapy assessment after a serious accident telephoned the Bristol Royal infirmary to ask when he would get that appointment. He was told—he says somewhat irritably —that it would be at least a month. When he mentioned that membership of BUPA was a condition of his employment and asked whether that made any difference, he was told to come at 2.30 pm that day. That is what is happening. If the Secretary of State were to wander around our hospitals incognito and talk to staff and patients, she would see that for herself, rather than being shielded by officials and protected by a massive departmental public relations machine.
  The United States private health care system has admirers in the Conservative party, but one third of the population has no cover, one third has inadequate cover and one third has some overprovision. It is no accident that President Clinton won the election when he promised a proper health care system; the market has been shown to be wasteful and inefficient. One 200–bed hospital in Massachusetts employs 220 staff to send out bills to various insurance companies. I have spoken to consultants working in our hospitals who are overwhelmed by the paperwork in the new market system. Is the American experience to be our inheritance? The price of each General Motors car in the USA includes $1,050 for the cost of its employees' private health care. The company is now thinking of relocating to Canada where there is a health care system.
  The Government are always telling us that we cannot have the social chapter, wages councils or a decent minimum wage because of what they claim to be the burden on employers. Will they tell us what is the current cost to commerce and industry of providing health care insurance for employees? To cap it all, I understand that BUPA is in contact with the Dental Practice Board to consider the feasibility of a national private dental insurance scheme.
  I met members of the Avon dental committee yesterday. They described a system that is fast breaking down. The Department of Health concept of the "average"

  925
  dentist bears no reality to the true position in Avon; neither does the assumption that a dentist's pre-tax income after expenses is £35,805. Dentists in Bristol would need to increase their gross income by at least £20,000 a year to guarantee that level of income.
  Many of my constituents in Hengrove are being told that their dentist can no longer continue to provide NHS treatment and they are being invited to join a scheme called Denplan at a cost of £9.75 per month. To add the insult of bureaucratic red tape to the injury of a withering service, patients are now subject to automatic monthly deregistration from a dentist's register. Adults who have not contacted their dentists for two years—for children it is one year—are taken off the list by the Dental Practice Board. They then have to shop around for NHS treatment.
  Dr. Mawhinney indicated dissent.
  Ms. Corston: It is no use the Minister shaking his head —that is the experience of dentists who spoke to me yesterday. The Minister should try telling them that that is not the case.
  To safeguard their patients' position, dentists now send out reminders telling patients to make an appointment so that they do not risk deregistration. However, the dentists have to bear the added costs of the administration, printing and postage. Most dentists in Avon are keeping open their current lists, but they are not adding patients. The Medical Sickness Society will no longer cover dental practitioners beyond the age of 55 because of its experience of claims resulting from the stress of trying to work harder to keep up. I was told of a dental technician who worked from 2 am to 6 pm to make a living.
  The Bloomfield report will not lead to initiatives until 1993–94. Avon dentists told me yesterday that that would be too late. They asked me to draw the attention of the Secretary of State to paragraph 2.6 on page 3 of the report, which states:
  "I have been asked to identify options"—
  and the word "options" is emphasised—
  "for change rather than a single recommended course. I welcomed this opportunity to examine alternative possibilities. The sums made available for the remuneration of General Dental Practitioners are not simply for the purpose of paying dentists but for the wider purpose of securing dental health. Much will depend upon the direction in which Government—no doubt after full discussion with the relevant interests—wishes NHS dentistry to go."
  The dentists ask, "Which way do the Government want NHS dentistry to go?" They say that it is fast going down the drain.
  6.58 pm
  Mr. Roger Sims: I have some sympathy with the Opposition today because when I was first elected to the House in 1974 I spent my first few years on the Opposition Benches. From time to time, Opposition Supply days are available and the Opposition have to find a subject for debate. It has to be one on which they can try to prove that the Government are not doing a good job and they could do better. That is the Opposition's position today. After an interval of two years, they have settled upon the NHS. I suppose the feeling was that the health service is always a good subject for the purposes of finding something somewhere that has gone wrong. But the Opposition may well be having second thoughts about
  926
  their wisdom in choosing this topic for debate, having been so effectively dealt with by my right hon. Friend the Secretary of State in a very robust speech. In my view, she won game, set and match, as she did at Question Time today.
  Inevitably the cry is for more money—hardly a new or original slogan. But we all know that more money than ever is being spent on the national health service, and we heard from my right hon. Friend today of a further £2 billion. The argument is not simply about how much money is spent but also about how it is spent. That is the important issue that we are discussing today.
  The other theme that has been coming through revolves around the in-word "crisis". How very original. When has the national health service not been in crisis? I made a point of looking up the definition of "crisis". Presumably the Opposition are using it in the sense of an emergency or a time of distress—as they allege. But a crisis, by definition, is also a crucial or decisive moment or a turning-point. That is where the national health service is. We all remember the 1980s, when although more and more resources were being devoted to the health service, there were still lengthening waiting lists and variations in the quality and efficiency of service up and down the country. This led to the Prime Minister's instigation of the review that resulted in the White Paper from which flowed the National Health Service and Community Care Act 1990. I have vivid memories of serving on the Standing Committee that dealt with that Bill.
  A review of health services is hardly unique to this country. Such exercises are taking place in countries all over the world. It is well that, following the general election, there was a change in the health affairs personnel on the Opposition Front Bench. If the dire predictions of the hon. Members for Livingstone (Mr. Cook) and for Peckham (Ms. Harman) were quoted to their faces, they would at least blush, if not hang their heads in shame.
  The truth is that the reforms are working and that the beneficiaries are the patients. I am not saying that the reforms are working smoothly. There are bound to be problems in a new climate and with a new way of working. Hospitals must learn that when they know the contracted work for elective activity the work load must be phased. They must involve the clinicians in the management process, and the clinicians must be willing to he so involved. The situation is not easy. There are bound to be teething problems, but what is intended can be done and, indeed, is being done up and down the country. Only here and there have problems arisen. Everybody can learn from the experience of the early days of these reforms, just as we are learning from the experience of the role of the GP fund holders, who can themselves negotiate contracts. There are bound to be circumstances in which health authorities have exhausted their budgets and where hospitals have capacity that the fund holders can use. Why not, if priorities and emergencies are not overridden? Consultants are now going to surgeries to do work on the spot for fund holders—a new concept for surgeons, but surely a good one. This too is working for the benefit of patients.
  Some problems have certainly arisen with regard to extra-contractual referrals. Perhaps that too was inevitable, as this was unknown territory. Again we are learning from experience, and health authorities may need

  927
  to earmark a larger proportion of their budgets for extra contractual referrals. But the fact is that the reforms are working.
  As soon as the White Paper proposals came out, it was obvious that they would have a particular effect on London. I recall discussing this matter with a previous Secretary of State—not the last one but the one before that, I think. Up to now general practitioners in outer London and the home counties have tended to refer cases to their friends in the inner London hospitals. Now, because of costs, they refer far more on a local basis. It would have been easy to let matters take their course, to have a gradual falling-off of activity in the London hospitals, some of which would eventually have withered on the vine. But this would have been messy, it would not have been in the interests of patients, and it would have been costly.
  I congratulate my right hon. Friend on the fact that she grasped this nettle by asking Professor Tomlinson to look at the matter and make recommendations. Clearly there must be managed change. I admire the way in which the Tomlinson report is now being considered in detail, and I admire especially the diligent manner in which my hon. Friend the Minister for Health is visiting every hospital and—contrary to the impression given by the hon. Member for Rochdale (Ms. Lynne)—listening to representations about the proposals in the report.
  It is interesting to note the similarities between the Tomlinson report and the King's Fund report and to note the number of hospitals—such as Guy's and St. Thomas's, Brompton and Marsden—which, by discussing possible ways forward, were anticipating Tomlinson before he even started his work. I eagerly await my right hon. Friend's decision, but should like to make two comments.
  First, we must not lose sight of the fact that Tomlinson is not only about the number of hospital beds—at present there are four acute beds per 1,000 people in London, as against 2.5 nationally—but also about primary and community care in inner London, which is well below the national average and, clearly, under-resourced. Secondly, Tomlinson looked at medical need but, on his own admission, did not quantify costs, on the rather curious ground that it would be too difficult to do so. I do not need to tell my right hon. Friend or the House that costs cannot be ignored, that they are an essential element of any political decision. We have to consider not only the loss of capital investment that the closure of hospitals entails but also the cost of effecting some of the moves that are proposed.
  It is obviously important that some of the centres of excellence in London be retained. But, whereas some are simply teams of highly qualified people—and it is immaterial where they work from—others involve specially constructed units and complex equipment. For example, one needs only to visit the cardiac unit at Brompton hospital to see that its removal to purpose-built premises at Charing Cross hospital might be possible but would be enormously expensive. Then there is the unique asthma/allergy centre that is under construction at Guy's. Incidentally, that centre was financed largely by funds raised voluntarily.
  There are two other matters that I wish to raise briefly. First, I pay tribute to the work of the voluntary hospices, which perform such a valuable role in relieving the national health service by providing high-quality care to people nearing the end of their days. From modest
  928
  beginnings—pioneered by Dame Cicely Saunders—they have become a national movement. I welcome the fact that the Department gives them some support, but more would certainly be welcome.
  Secondly, my right hon. Friend will not be surprised if I mention the question of nurse prescribing. In view of my personal involvement, I was naturally deeply disappointed at the decision—one of the autumn statement measures —to defer implementation. But, more to the point, it was a very deep disappointment to the thousands of nurses who were looking forward to such a step—
  Madam Deputy Speaker (Dame Janet Fookes): Order.
  7.9 pm
  Mr. Brian Sedgemore: I wish to speak about the future of St. Bartholomew's hospital. Last Wednesday a candlelit procession moved from Bart's to St. Paul's cathedral. This was followed by a service as part of the campaign to save Bart's. Sixteen hundred people prayed to God that Bart's would survive. Afterwards the Dean of St. Paul's said to me, "If Bart's does survive, perhaps we should have a thanksgiving service." I pointed out to him that, because of the personal determination of the Secretary of State to close it, Bart's might not survive. We may have to rely on the Prime Minister's political antennae which tell him that there will be an enormous eruption if the hospital is closed.
  People are puzzled at the attitude of the Secretary of State. They ask why she seems determined to do what the Black Death, Henry VIII and Hitler's bombers could not do. They ask why she desires to destroy St. Bartholomew's hospital. The answer is simple. It lies in the fact that she wants to get rid of the impediment which has blocked her political career—the fact that she has less political clout than the proverbial feather falling on a blancmange. She wants to be able to say that she took on the finest doctors in Britain and beat them. She wants to be able to say that she closed down the best hospital in the world, and it shows how strong she it. Closing down the best hospital in the world, however, is a sign not of strength but of weakness.
  The House will be interested to know that shortly before Christmas, St. Bartholomew's hospital received a telephone call from one of the best-known journalists in the country who said that he had dined with the Secretary of State and that she had told him she was going to close Bart's. We have recorded a number of occasions, mainly Conservative functions, when she has told people that she will close Bart's. Bearing in kind that one is not supposed to prejudge a consultation, this is a contempt of Parliament and an insult to democracy.
  To show that I am even-handed, I should like to say of the Minister for Health, with whom I have had many talks since the consultation began, that I have found him to be courteous, charming and propriety itself. When the decision to keep Bart's open is finally made, I imagine that the Secretary of State will resign and that he will take her job. Congratulations, doctor.
  There is something special about a hospital that can persuade one of our greatest cathedrals to hold a service for it. There is something special about a hospital that has persuaded no fewer than 750,000 Londoners, an enormous number, to sign petitions in its favour. Looking back over the past 50 years, I cannot remember an occasion when one single, small institution facing political survival has

  929
  had such support. I dare say that no institution this century facing political survival on its own has had the same amount of political support.
  There is something special about a hospital that has support from every part of the globe. I have here a publication which contains 53 letters from all parts of the world to the Prime Minister. We also know that the Prime Minister has received a large number of letters of which St. Bartholomew's hospital does not have a copy. In addition to that, Professor Leslie Rees, the dean of the medical school, has received 406 letters from 46 countries round the world. They are from doctors and specialists, all of whom are pre-eminent in their field. So, in total, 500 top doctors and medical scientists around the globe have pleaded for St. Bartholomew's hospital to stay open.
  I will give a few brief quotations. Herbert Pardes, dean of the faculty of medicine of the College of Physicians and Surgeons of Columbia University, writes to the Prime Minister:
  "The adverse effects of closing St. Bartholomew's Hospital will be felt not only in the United Kingdom, but the medical community throughout the world. What's more, it may raise justifiable doubts about the future viability of the British biomedical research establishment which is already under attack by recent extensive budget cuts."
  Joe Leigh Simpson, faculty professor at the University of Tennessee, Memphis, writes about the proposed closure of Bart's:
  "I hope this is mere rumor as I personally have ongoing experience with two groups of valued collaborators—Professor Nicholas Wald (Epidemiology) and Professors Gedis Grudzinskas and Timothy Chard (Reproductive Endocrinology/Biology). I can personally attest that both these groups are not merely national (U.K. treasures) but rather worldwide resources."
  Professor Jorn Nerup from the Steno Diabetes Center in Denmark writes to our Prime Minister:
  "Seen from abroad, closing this excellent institution and dispersing its facilities and specialists to other locations will be a major loss for British as well as for international medical science."
  Lastly, Professor Jenkin from the Toronto-Bayview Regional Cancer Centre writes to our Prime Minister:
  "I have recently heard, to my distress, that there is an official proposal to close and disperse St. Bartholomew's Hospital. I cannot understand the thinking that must have gone into such a decision … [it] is quite unbelievable and surely unprecedented."
  The Secretary of State, in attempting to take on the whole of the world's medical establishment, is surely behaving like some female version of Doctor Strangelove.
  I have spoken in an Adjournment debate, but I want to make two further brief points. Tomlinson measures bed efficiency by the number of beds that a hospital uses to treat 1,000 patients. He uses this analysis to say that there is a great deal of scope for efficiency improvements in London as a whole, and that this factor, rather than changes in patient flows, will be crucial in determining loss of beds. Yet, amazingly, in his analysis of individual hospitals' vulnerability, Tomlinson includes potential loss of patient flows, but makes absolutely no reference to performance on efficiency.
  The North East Thames regional health authority submitted figures to the Tomlinson inquiry in July. The figures were not published, but I have them here. On bed efficiency, they show that Bart's is more efficient than the Royal London, the Royal Free, University College
  930
  Hospital/Middlesex and the Whittington/Royal Northern. Further figures show that, taking the combined effect of efficiency improvements and loss of distant patient referrals, Bart's is less vulnerable to bed loss than any other inner London provider in the North East Thames region—that is, less vulnerable than the Royal London, which it is proposed to keep open, the Royal Free, UCH/Middlesex and the Whittington/Royal Northern.
  The region also submitted to Tomlinson an analysis of day cases as a measure of efficiency and progressive clinical practice. It shows that Bart's fared better than the Royal London, the Royal Free, UCH/Middlesex and the Whittington/Royal Northern.
  There is, therefore, a gigantic inconsistency in the Tomlinson report. Tomlinson says that efficiency is the key to bed loss in London. He says that the survival of many hospitals will depend on it. Yet he recommends the closure of the hospital in north-east London with the best record of efficiency.
  My last point concerns the financial deficit of Bart's. Tomlinson wrote that the unit was in severe recurrent financial difficulties. The Minister of Health, quite rightly, has bullied and cajoled Bart's into bringing its deficit down. In June this year, its total projected deficit was £11.45 million, made up of £6.74 million recurring deficit and £4.71 million non-recurring deficit. As a result of the extraordinary efforts of the new chief executive, Professor Besser, two days ago the total deficit had come down from £11.45 million to £5.5 million, made up of £2.45 million recurring deficit and OA million non-recurring deficit. That is an extraordinary example of bringing finances under control. The news that I have for the House, however, will excite the Minister and make him ecstatic, because early this morning I was lying—
  Madam Deputy Speaker (Dame Janet Fookes): Order. I am sorry to cut the hon. Member's peroration short. Mr. James Cran.
  7.19 pm
  Mr. James Cran: This is one of those occasions that generates a great deal more heat than light. I am bound to say that, on the basis of the evidence before me, most of the light in today's debate has been shed by my right hon. Friend the Secretary of State in what was a superb speech.
  I say that against the background of the Opposition's motion which is peppered with exaggerations—"growing crisis", "total fragmentation", "destruction of NHS dentistry". That is simply not reflected in my constituency in east Yorkshire. From correspondence with my constituents, I know that they take the view that the internal market is beneficial to their interests and is delivering, as the Americans would say, the bacon to the people of east Yorkshire.
  I freely admit—it is only prudent to do so—that general practitioners were unhappy in the run-up to becoming fund holders. They distributed leaflets to my constituents describing the dire consequences of fund holding. I would not say all of them, but many are now beginning to see the benefits to which they have signed up.
  The same applies to the staff in the trusts in my constituency. Before the event, staff could not relate to this thing called the national health service because it was too

  931
  big. They had few means of communicating with anyone. Now the NHS has been broken down into units to which they can relate.
  I was surprised to hear the hon. Member for Sheffield, Brightside (Mr. Blunkett) say in an intervention in the speech of my right hon. Friend the Secretary of State that he had unsuccessfully requested statistics relating to the health service in Yorkshire. I have found it exceedingly easy to obtain statistics on health provision in Yorkshire. All I had to do was to ask for them, and I got them.
  I could spend much time outlining those beneficial statistics, but I shall not do so because I do not have the time. Suffice it to say that statistics resulting from a survey of health users in the Yorkshire region, which was published in November last year by the National Association of Health Authorities, show a satisfaction rate of 89 to 90 per cent. Such a level of satisfaction would not be achieved if the Opposition's motion, to which I am having to address myself, was the case. It simply would not be so.
  The Opposition could and perhaps should say that the level of satisfaction should be higher. If so, I would agree. That would be a reasonable statement to make. But, on the basis of a 90 per cent. satisfaction rate, it is not reasonable to say that the NHS in my neck of the woods is in crisis.

  My constituency has a first-class general hospital, the Castle Hill hospital, built mainly out of own resources. I receive few complaints from my constituents about health care and health delivery at that hospital. Out-patient cover there has increased by about 54 per cent.
  Opposition Members have spent much time talking about long waiting lists, but open heart surgery in my constituency has one of the shortest waiting lists in the country. The same is true of cardiology. Patients are attracted from all around the country to my constituency and the Castle Hill hospital.
  There is clear evidence that people prefer day care and Castle Hill hospital and my authority are responding to that. I repeat that my constituents are not complaining in the way that Opposition Members are. In addition, the radiological unit at Castle Hill hospital is acquiring a new digital X-ray machine and a whole body scanner.
  I could go on and on outlining—[Interruption.] I know that Opposition Members would really like me to go on, and if I had the time I would. I shall simply say that the evidence does not seem to show a service in retreat.
  However, naturally, all is not completely well. It would be silly for me to say that everything is well. Of course, it is not. My constituents' access to orthopaedic surgery is not as it should be. One of my constituents had to wait 96 weeks for an appointment with the relevant consultant. That is simply not good enough, as we all know. However, I can report that my health authority and the hospital trusts are moving like greased lightning to reduce that waiting list. If it does not reduce to the level to which I think that it should, I shall make vigorous representations to my hon. Friend the Minister for Health and my health authority. But I am confident that improvement is on the way.
  I have no worries that my right hon. Friend the Secretary of State will not respond in the way that I would wish to the Bloomfield report on dentistry in the NHS. I simply want to register the fact that my constituents wish to be able to obtain dental care within the NHS. They do not want, as is reported to me to be the case in other parts of the country, only private dental care to be available.
  932
  That is not acceptable to my constituents. It is in that light that I would expect my right hon. Friend to respond to the Bloomfield report.
  The Department of Health has looked in some detail at no fault compensation. In one case at the Beverley Westwood hospital, not involving one of my constituents, a child was starved of oxygen at birth with the result that she sustained severe mental injury. Eight years later the health authority has decided upon a settlement of £l million. The delay is just not good enough. All hon. Members will appreciate that the family in question has gone through eight years of sheer hell. I hope that it is not beyond the wit of man to devise a compensation system whereby such families would not have such an agonising wait and I await the comments of the Secretary of State.
  In summary, the NHS in my constituency is in good order. We deeply resent people, particularly politicians, running down the NHS. Thus, Opposition Members who would like to see how the NHS should be run should come to my constituency. I should be delighted to welcome them and show them around.
  7.27 pm
  Ms. Mildred Gordon: I listened carefully to the Secretary of State and some of what she said surprised me greatly. She expressed great respect and admiration for workers in the NHS, but went on to denounce members of the National Union of Public Employees and other trade unions. Apparently, she respects only those NHS workers who are not members of a trade union.
  The right hon. Lady talked about the hot line, or the information line, that she is opening today. That will not be much use to the gentleman in my constituency who wrote to me recently to say that his urological operation had been cancelled three times and to ask whether I could find out when he was likely to have it. In reply to my inquiry, the Royal London hospital trust said that the district health authority was low on funds and could afford only emergency and urgent operations and my constituent would be considered in April in the new financial year.
  The Secretary of State said that people often do not know to what services they are entitled. In the old days, my constituents knew very well how to get their services. They used to go to their GP, wait a few weeeks and get an appointment with a consultant who would then put them on his list and they would have an operation within a fairly short time. Now they do not know how to obtain the services that they need, because those services are not there. Such services are not free; people have paid national insurance contributions throughout their working lives to receive them. Some of those people have hardly used the national health service in the past, but, when they are older and need an operation, they find that the service is no longer there for them.
  I am sure that the Royal London hospital has not given up all elective surgery; but for whom is it performing that surgery? Is it performing surgery for people who live outside London and whose GPs are budget holders? That is very likely.
  An old friend of mine, whom I have not seen for years, telephoned me today: he said that he had had four heart attacks, and was waiting for a bypass operation. He went to Kings College hospital in south London, and was told that he would have to wait for at least 15 months. He said

  933
  to me, rather naively, "Strangely enough, the only three people who were admitted came from quite far away: one of them lived in Ramsgate. I could not understand it. All of us local people were sent home. Perhaps they were emergency cases." I thought, "Perhaps their GPs were budget holders, or their district health authorities had not run out of funds."
  The system is becoming totally unfair. As many hon. Members have pointed out, it is turning into a two-tier system. This callous, inefficient, doctrinaire, bungling Government are destroying the benefits of a service that people have enjoyed for four decades.
  The Royal London hospital trust—the very organisation that wrote to tell me how sorry it was that my constituent's operation had been cancelled three times; that the trust understood how awful that must be, but he still could not have the operation—is in favour of the Tomlinson report. It is closing one of its two accident and emergency departments in February, but says that it can deal with some of the specialty work currently handled by Bart's, along with paediatric work currently handled by the Queen Elizabeth children's hospital: a merger is proposed between that hospital and the Homerton hospital. The trust also says that it can take on the work of the London chest hospital and sell its site. It can do all that—it is into empire building—but it cannot operate on a man whose operation has already been cancelled three times.
  I recently visited the Queen Elizabeth children's hospital and the London chest hospital, and met the general managers of both hospitals. The London chest hospital is in a rather salubrious, unusually green part of the borough of Tower Hamlets, near Victoria park. It has a wonderful reputation: many people have written to me saying how awful it would be if it closed and how it saved their lives, or their mothers' lives. If it becomes part of the Royal London hospital—separated from the Brompton chest hospital—the building will be sold in the medium term: that is the plan. Patients with severe respiratory problems will be treated in the Whitechapel area, in the midst of filth and dust, rather than in the green area that contains the London chest hospital, with all its marvellous facilities. That will not benefit the people of London, no matter how the Secretary of State twists the truth and tries to pull the wool over our eyes. It will damage their chances of good treatment, and will prevent lives from being saved and improved.
  Although Tomlinson treats it as a general hospital, the Queen Elizabeth children's hospital is more than that. It is a specialist hospital. If it is merged with Homerton, Great Ormond Street hospital will be affected very badly. I was told by officials at Queens that, without the Queen Elizabeth children's hospital, Great Ormond Street would be unable to provide the full range of paediatric care for which it is universally renowned. The research in pathology, radiology and anaesthetics which, for babies and children, represents a very special sphere of practice is done at the Queen Elizabeth children's hospital. If the Tomlinson proposals are implemented, the Great Ormond Street hospital will have to compete in the market, and is unlikely to be able to do so successfully: a comparatively
  934
  small volume of the population uses its services, and the highly specialised procedures for small children are expensive.
  The Carshalton and Westminster children's hospitals are closing, so that London will be the only capital city without a specialist children's hospital. Hospitals in Toronto, Boston and Melbourne, for instance, all work on the system used by the Queen Elizabeth and Great Ormond Street hospitals. We should view the matter in context: 30 per cent. of babies in London attend an accident and emergency department in the first six months of their lives, and 15 per cent. are kept in—mostly with respiratory and gastroenterinal problems. The child population in Tower Hamlets, on the borders of which the Queen Elizabeth hospital is situated, will grow by up to 19 per cent. in the next few years, and the area has twice the average number of premature births. These recommendations can only lead to the death of babies and children through lack of facilities. In these circumstances, do hon. Members think it is worthwhile to implement a doctrinaire policy about market forces in order to save money? I certainly do not; nor do my constituents, and nor would any right-minded person.
  The Tomlinson proposals will affect Londoners severely. We want better primary health care in Tower Hamlets; there are many single-person practices there, and, although the position has improved, it could improve further. We want better care in the community—and we want the funding for it: in the past, care in the community has meant increased burdens on carers of both sexes, but especially women, and, often, on the whole family. "Care in the Community" has meant no real care, but the imposition of more burdens on people who are already doing more than their fair share—picking up the pieces of the welfare state that the Government are destroying. As my hon. Friends have pointed out, 13,000 Londoners are on waiting lists. The Americans are currently demanding, and moving towards, better health care provision; meanwhile, our Government are moving us towards the bad arrangements that have existed in that country hitherto.
  A number of hon. Members on both sides of the House have mentioned dentistry. The Government have offered early retirement to all dentists over the age of 55. My dentist has taken it; he would have been stupid not to. But it is a way of encouraging large numbers of dentists to leave the health service. The other day, my husband had a small filling and his teeth cleaned: it cost £12.60. He was told, "This is the last time; at the end of January, the dentist will retire and do only private practice. He will not work in the health service any more." That dentist had spent 20 years in the health service. I said, "What will the same cost privately?" I was told, "Between £45 and £50."
  I remember the days before the health service. I remember when many people in my constituency—not necessarily old people; some were not much more than 20 —had no teeth. Their teeth had been pulled out, they could not afford false teeth, their gums had hardened and they had had to eat sops. I recall clearly their gummy faces. Do we want a repetition of that? I fear that, with prices such as this, many people will be unable to afford dental treatment. Meanwhile, competition to get on to the list of a national health service dentist is becoming increasingly fierce.
  Opposition Members are proud of the health service. Labour created it, and is justly proud of its creation.

  935
  Londoners are proud of their hospitals, and do not want them to close. I have had an enormous postbag about Bart's, although it is in an adjacent constituency. We want to modernise and improve the health service, but on the basis of the fundamental principles—
  Madam Deputy Speaker: Order.
  Ms. Gordon: May I finish my sentence?
  Madam Deputy Speaker: No; I am sorry.
  7.37 pm
  Mr. Gerald Malone: I am sorry to have to disagree with one of the points made by my hon. Friend the Member for Harlow (Mr. Hayes), but I feel safe in doing so because he is not in the Chamber. He suggested that the hon. Member for Sheffield, Brightside (Mr. Blunkett) was not nearly so welcome as his predecessor. I profoundly disagree: I believe that in this debate we can put in context some of the remarks made by Opposition Members before the general election, and some of their predictions about the health service which would result from the re-election of a Conservative Government. One of my hon. Friends mentioned that earlier, but chose not to return to the assertions made then. It may be worth detaining the House for long enough to quote some of those predictions, so that we can see whether they would be endorsed yet again by Opposition Members.
  We were told by the hon. Member for Livingston (Mr. Cook) that we were moving quickly towards a system in which patients would die in casualty rooms while the accountant was finding out who would pay for them. My hon. Friend the Member for Broxbourne (Mrs. Roe) said that she had never heard of waving the shroud before: I commend that totally unsupported assertion as just one example of what was happening on the Opposition Benches during the last Parliament. We also heard from the Labour party that the Government were planning to embark on the final stage of selling off those hospitals that they had prepared for privatisation, that we were proposing to return health care to the free market of the 1930s and that we were creating trusts which would not be part of the NHS. That was one of the five great scare stories, which ran for some months without any foundation, none of which came to pass and none of which will come to pass.
  I welcome the transition of the hon. Member for Livingston to another post and the arrival of the hon. Member for Brightside, from whom we heard not scare stories but nothing at all. We certainly heard little to support the contention in the Opposition motion that the health service is in crisis, and we heard nothing about the second part of the motion, which calls for reform. What reform? I doubt that we shall hear more detail from the hon. Member for Bristol, South (Ms. Primarolo) because the truth of the matter, whether she or other Opposition Members like it or not, is that Labour has conceded that our reforms will remain broadly in place—and quite right, too.
  I wish to deal with the free market in health, which has not been mentioned so far. It is not a free market at all. Opposition Members suggest that the unseen, hidden hand of the market is directing reforms in patient care. That is sheer balderdash. There is a seen hand in the internal marketplace which has been created by national health service trusts—the seen hand of primary care. We must not
  936
  forget that what underpins the reforms is the fact that, for the first time in the health service, provision will be dictated by primary carers. It is not the unseen hand of accountants that will dictate what happens, but the seen hand of need as determined by general practitioners who will be able to place contracts and have them fulfilled.
  Many eloquent speeches have been made on the Tomlinson report by Opposition Members who have constituency interests, I too, have a constituency interest, but it is somewhat different. It lies at the heart of what Tomlinson is trying to do—to reallocate resources within the health service to areas of population expansion and away from areas of population decline. That is what drives the report. Wessex region has, historically, received one of the lowest allocations of resources in the country, principally because a tremendous amount of resources have been siphoned off to nearby London. I am delighted to tell my hon. Friend the Minister that Wessex's 1.5 per cent. increase in real terms for 1993–94 is extremely welcome, taking Wessex's budget to over £1 billion for the first time, but still leaving it as one of the lowest areas of expenditure per head of population. However, Wessex has experienced the highest growth in population of any area in the south in the past 10 or 15 years. I welcome the Tomlinson report because it will mean that resources follow population in a more sensible pattern than hitherto, which will be to the long-term good of health care not only in the Wessex region but throughout the country.
  My right hon. Friend the Secretary of State made a tremendous speech in opening the debate. She and other health Ministers have made remarkable efforts to visit all the hospitals affected by and mentioned in the Tomlinson report and to listen to what is said. I hope that she will decide that some of the decisions about hospitals will be determined by those in the primary care sector, who by the contracts that they provide will show what the health service pattern should be in London. I hope that that will determine the process.
  An application made last year for the Winchester integrated health care trust was rejected because it was deemed not to be in the interests of the Government's policy for it to be an integrated trust. The application has been resubmitted with some changes, and I commend it to my right hon. Friend the Secretary of State. It is important that Winchester should be carried along in the fourth tranche of health care trusts. Some changes have been made since the previous application was submitted. Some fear was expressed that the extent of current clinical and management integration in the health service in Winchester would not enable a self-standing trust to operate. I have taken considerable care to speak to all those who provide the service. Management changes have been effected and are being implemented. I believe that it will be well worth while giving the application close consideration again. I do not want to go through all the details in this short debate, but I shall write to my hon. Friend the Minister soon to back up the arguments advanced by those who provide health care in my constituency.
  I join other hon. Members in paying tribute to those who provide health care in our constituencies. We owe them a tremendous debt. They do a tremendous job, but they do a better job under the reforms that the Government have put in place than they were able to do before. A record number of patients have been treated in Winchester this year. Like many other hospitals, we are

  937
  now experiencing problems with pressure, but they do not disguise the fact that 28,000 patients have been treated. That was the target, but it has been exceeded by 400 already and there is still some time to go. It is a bit rich to suggest that such success, where budgets are being used by enthusiastic medical personnel and where more patients are being treated than before, is not an improvement on the previous situation.
  The debate has exposed clearly the paucity of Labour policies for the health service. They criticised the health service in the run-up to the last election and exaggerated its position, saying things which were not going to happen and, what is worse, which they knew were not going to happen and formed no part of the Government's policy. We have now seen a collapse into inactivity. Labour Members do not know what their policy is. They have fumbled and mumbled about what they would do, but they will not come out—I shall be interested to see whether we hear more about this in the winding up speeches—with a detailed policy about why we are wrong and what they would do about it.
  7.47 pm
  Dr. Joe Hendron: The World Health Organisation has defined health as
  "a state of complete physical and mental well-being and not merely the absence of disease."
  Health economists inevitably place themselves in an uneasy position if the economy being promoted by them undermines that well-being, which should be central to their endeavour. In short, what has gone wrong with the national health service?
  Rationalisation really means centralisation, whereby the central, powerful and big are allowed to colonise the weak, small and peripheral. In other words, central institutions are dictating people's need, rather than responding to needs of the people. We have the technology to put men on the moon, yet there is much debate about whether women can have their babies in the local hospital.
  Since the Westminster election of 1987, the Conservative Government have embarked on a reorganisation of the health service that owes more to the ideology of the marketplace than to real concern for the health and well-being of people. Northern Ireland has adopted a copy of those proposals, regardless of the different circumstances of small size, high levels of deprivation and the fact that regional specialist services are provided in a single location.
  The Government's changes are not intended to reform the national health service as a public service but to deform it into a commercial business. Hospitals are being forced to compete against each other for business rather than to co-operate with each other for the benefit of the patient. The national health service is not and should not be treated as a marketplace. There is no proper democratic accountability.
  The Royal group of hospitals in Belfast, which includes the Royal Victoria, the Royal Maternity and the Royal Belfast Hospital for Sick Children, and which is in the heart of my constituency, is among the finest in Western Europe. It is not only in the front line of medicine but has been in the front line of civil unrest and conflict in Northern Ireland for more than 20 years. It serves the people of Belfast and, through its regional services, the
  938
  people of Northern Ireland. I pay tribute to the nurses, doctors and other professionals who, with the nonprofessional staff, have given so much to the health and welfare of the people.
  It takes much more than manpower to run a health service. Under the so-called rationalisation of services, many peripheral hospitals in Northern Ireland have been closed and there has been a serious reduction in the number of beds in the larger ones, including the Royal group of which I spoke.
  The incidence of coronary artery disease in Northern Ireland is one of the highest in the world. Through its research, the Northern Ireland Chest, Heart and Stroke Association has shown that 1,200 bypass operations are needed each year, but only half that number was being carried out because of a lack of staff and resources. However, I accept that the chief medical officer in Northern Ireland is doing something about that at present.
  The Royal group of hospitals has applied for trust status and will become self-governing on 1 April. While I wish the chief executive and his staff well, I believe that the road ahead is fraught with great difficulties. Only in the past few days we have been informed that the Eastern health board had a secret meeting last week. It is to hold a public meeting on, I think, Thursday and will put forward proposals that will decimate those great hospitals. Even those seeking trust status have been taken by surprise.
  Like other hon. Members who have spoken in the debate, I read last week's British Medical Journal which said that many hospitals around Britain are working at less than full capacity because health authorities do not have enough money to buy their services. Apparently, some of those hospitals will have to scale down admissions and operations unless they can obtain more funds from the health authorities and fund-holding general practices that buy their services.
  The Government have ignored the wishes and needs of the people. Perhaps they will listen to the British Medical Association which said that the breakdown of many hospital services, which will lead to a two-tier provision to patients in many parts of the country, is wholly unacceptable. The current cash-limited funding is inadequate to deliver fully comprehensive patient care. Also like other hon. Members, I read the letter that the Consultants Specialist Committee recently published which speaks of the difficulties of most of the hospitals in Great Britain.
  In the Government's strategy for community care, it is right to place great emphasis on keeping the elderly, the mentally and physically handicapped and the chronically sick in the community if at all possible. However, proper resources and care for the carers are extremely important. There are an estimated 210,000 carers in Northern Ireland according to the Carers National Association and without them current Government policy would be a nonsense. They are unpaid and largely uncomplaining. Much greater emphasis must be put on respite care which can be of such tremendous benefit to the carer.
  Earlier, reference was made to the young man who went into the lion's den. One of the greatest problems in primary health care is with the young psychotic or schizophrenic who refuses treatment. I know that the Secretary of State for Health expressed her concern at the time and I shall certainly wait with great interest for any realistic proposals to resolve that burning issue.

  939
  Insufficient attention has been paid to the implications for health of social inequalities, including unemployment and poor housing, which were identified in the 1980 Black report, "Inequalities in Health", and in "The Health Divide" published in 1987.
  Rev. Martin Smyth: I share the burden that the hon. Gentleman is bringing before the House. Does he agree that where there is a need for cardiac surgery in Northern Ireland, there could also be room for co-operation? The City hospital had the theatre space and nursing staff, if only surgeons had been prepared to use them instead of saying that there was not sufficient surgery space in the Royal Victoria, as a result of which many people are still waiting for surgery.
  Dr. Hendron: The hon. Member for Belfast, South (Rev. Martin Smyth) makes a point, but I understand that it would be difficult to have the extremely expensive technology for cardiac surgery in two hospitals that are literally only a mile apart. However, I understand that there are plans to increase the number of operations in the Royal Victoria.
  The health service in Northern Ireland is in a state of chaos. Senior executives are attempting to defend the indefensible while people in need of urgent care are being neglected or ignored. The Government have unashamedly helped to secure the acquiescence of a significant number of senior staff by enhancing their terms of employment.
  The national health service is in a state of crisis, and I seriously believe that the Government should take heed of that message which is ringing out across the land.
  7.56 pm
  Mr. Michael Trend: From listening to the Opposition, one would think that a £37 billion national health service was the end of the world, instead of the envy of the world which indeed it is. We have witnessed the political football marked "underfunding" being kicked about wildly and heard the national health service being talked down. Overall, I believe that the national health service is in good shape and improving all the time, but there are aspects still to be considered. That is the work of the Select Committee on Health, of which I have the honour to be a member.
  One particular issue which recently came before the Select Committee was tobacco advertising, which I shall deal with in the context of the prevention policies mentioned in the Government's amendment and of the unjustified criticism of the Government by the Opposition spokesman. The Select Committee considered tobacco advertising and took evidence from a number of witnesses. There was general agreement on most of the analysis which resulted from our inquiry—that it was a laudable aim that smoking should be reduced, and that the means to achieve that should be considered. There was a great deal of agreement, but there was also an important dissenting voice on the final recommendations in our report last week which, in a magnificent week for Select Committee reports, was slightly overlooked by the press.
  Of the eight members voting, three did not agree with a total ban. As background to what I shall say later, I should like to explain the two main reasons why I and two others did not agree with such a ban. First, in the context of the European dimension, we were being asked to subscribe to a European directive which we did not think
  940
  was an appropriate vehicle. We did not think that it was necessary for the completion of the single market. It was not a matter of competence for trade but a matter of health —and health is not and should not be a matter for majority voting.
  There was also much bogus talk about what happens in the rest of Europe. Is it not odd that all countries with nationalised tobacco industries support a ban? Some may say that that is to discourage imports. Is it not odd that the vast majority of those countries which grow tobacco and support a ban receive more than £1 billion in European Community subsidies? Is not our record on curbing smoking second only to that of the Netherlands where, as here, there is no statutory ban? Yet there are countries in Europe where tobacco consumption is still rising, and the highest rises in consumption coincide with the lowest prices.
  The second reason why we objected to the final recommendations of the Select Committee report was the important matter of commercial freedom of speech. Tobacco is a legal product. A ban on its advertisement would be a serious step in a free country. Commercial freedom of speech is part of freedom of speech itself. I can think of no other example of the makers and vendors of a legal product not being allowed to advertise that product, but I can think of many areas to which some people might want to extend an advertising ban if the proposed tobacco advertising ban set a precedent. There could be a knock-on effect in many areas, such as alcohol, some fatty foods, fast cars, fireworks, gambling and guns.
  There may be an argument for banning tobacco, but I should like to see someone brave enough to put that argument forward in this context. Unless tobacco is made illegal, commercial freedom of speech should not be sacrificed in terms of banning tobacco advertising. A statutory ban on the advertisement would turn a hard case into bad law. If we need to consider the whole idea of restricting commercial freedom of speech, we should do so openly and honestly. We should not do it in this way. We should start with the basics and establish new ground rules from which to judge particular cases. One generation's unique evil will soon be overtaken by another's. If we changed the general rule on commercial freedom of speech, bans would be extended.
  I support the Government's present position —a basket of measures which have been notably successful. Effective prevention, as mentioned in our amendment, has been the heart of our policy. The Government have done much in terms of price. The price of cigarettes has gone up by 43 per cent. in real terms in the past 12 years. It is calculated that each 10 per cent. increase in price leads to a 3 per cent. to 6 per cent. fall in consumption. It is a serious mechanism.
  The Government have insisted that warnings are put on tobacco packets. The tobacco industry is often accused of being a friend of our party, yet it has taken the Government to court over what it regards as the over-zealous size of the warnings that it is required to put on packets. Some people have said that the only way to spot a cigarette advertisement nowadays is by the large Government health warning on it.
  The Government have made much progress in education, through the health education authority and through the inclusion of aspects of smoking in the national curriculum. The GP contracts include a remit for health promotion clinics which deal with smoking. There is also

  941
  the general determination of the Government and especially of the present Secretary of State as shown in the White Paper, "The Health of the Nation". There is no doubt that the Government intend to bear down strongly on smoking.
  Social pressure is even stronger. In the past 10 or 15 years, people have made their own decision in companies, in factories and elsewhere. In restaurants and in trains, smoking has become socially more unacceptable as the years have gone by. The climate of opinion has been a strong mechanism. Against that background, I support the Government's package of measures. I should like to see the continuation of the voluntary agreement— indeed, I should like to see it strengthened, especially for children and young people.
  1 am suspicious of conceding a false point to the European Community over the directive, especially when I consider the bogus practices which I have described. I have said that I am suspicious of making new case law for commercial freedom of speech without first looking long and hard at the deeper implications of such a move. I am also suspicious of the idea that there is a quick fix to be had by banning tobacco advertising. Although I do not deny the obvious link in general terms between the advertising and consumption of all products, I did not find any convincing evidence in the recent Smee report that a ban now would lead to a major drop in the smoking of cigarettes in the United Kingdom. His own evidence was decidedly ambiguous on that point.
  I am against the quick-fix school of politics in general. Those who advocate quick-fix policies seem to be permanently fixed on the Opposition Benches. They use the NHS as a political football, but, as the past four general elections have shown, all that they have done by kicking the ball around in their characteristically volatile and hare-brained manner is to score an impressive series of own goals. To continue the football metaphor, that is why Labour Members are sitting on the Opposition terraces looking as sick as parrots.
  8.4 pm
  Mr. Malcolm Chisholm: The one benefit of the recent economic chaos from the Conservative party's point of view is that it has masked the health chaos developing in the wake of the NHS reforms. The two problems are connected because, just as an ideological obsession with the market has damaged the economy, so an ideological obsession with the market will destroy the national health service unless action is taken to check it.
  We in Scotland are protected at the moment from the worst excesses of the market. There are only two GP fund holders and no trusts yet in Edinburgh, but it is with alarm and dismay that we have looked on as events have unfolded in England. We hear from the British Medical Association that we face the worst crisis for 30 years. We see hospitals under red and yellow alerts, patients turned away and admitted only when they become emergencies and an all-round preference being given to GP fund holders as a two-tier system develops.
  We also read about plans to axe hospitals in London when waiting lists there clearly show that the problem is
  942
  not that there are too many beds for the patients, but that there is simply not enough money to cover the necessary treatments.
  The Government know that the market system, with its purchaser-provider split, is the most effective method by which to cash-limit hospital services. While cynically claiming that choice has been increased, as the Secretary of State said today, the Government know full well that the reverse is true.
  The most extreme manifestation of the market system on the provider side is the trusts, which are now about to be imposed on Lothian region and on Scotland as a whole. The phoney consultation for the West Lothian trust has just been completed, and the phoney consultations for all the hospitals in Edinburgh are about to begin.
  The dates for all the opt-outs were pencilled in in a document in the Scottish Office at the time of the general election and no serious consideration has been given to the alternative, which is directly managed units. Even the Select Committee on Health, with its Conservative majority, suggested that the Government should proceed with caution with trusts. The Committee referred to problems of accountability, of strategic planning and of conditions for staff, yet within two years Scotland will be covered with trusts in the way that England is at present. That is undemocratic from several points of view, not least because the vast majority of people in Scotland are totally opposed to the imposition of opt-out hospitals. It is also irrelevant to the real problems of the health service in Scotland and will make them far worse.
  The real problems in Scotland, as in England, are to do with underfunding, with lack of health service democracy and with the social conditions in which people live. The Government may ignore the connection between poor health and poverty, but Dr. Helen Zealley, the director of public health for Lothian health board, recently asked the health board to take seriously the greater rates of death and of illness among people living in deprived areas of Lothian. The figure for such people was 29 per cent., and many of them live in my constituency. It is scandalous that that link was not highlighted in the recent White Paper "The Health of the Nation".
  The effects of underfunding in Lothian can be seen in waiting lists, accident and emergency services, continuing care of the elderly and community care. More than 25 per cent. of people wait more than one year for general surgery in Lothian. There is no way of reducing that list without spending more money.
  Accident and emergency services in Edinburgh were centralised in the Royal infirmary following the cash crisis in 1990. I and three of my hon. Friends visited that hospital on Friday and saw the consequences of that centralisation of services. We were told that 80 per cent. of beds were tied up in emergency admissions. Of course, that is one reason why it is difficult to reduce the waiting lists. We were told that there were not enough beds in the coronary care unit but that every 999 heart attack call had to go to that hospital because it was the only one in Edinburgh with an accident and emergency department. We were also told, as I knew full well, that people from all over Edinburgh had to go to that hospital with even the most minor injuries. That has been the result of the centralisation.
  Care of the elderly is another issue which is being hotly debated in Edinburgh. Following the English example, Lothian health board proposes to cut the number of NHS

  943
  continuing care beds from 1,800 to 500. That means that 1,300 beds will be privatised. The reason is simply that the hoard does not have a sufficiently large capital allocation to build the necessary new buildings. That means that we cannot have the continuing care hospital in my constituency of Leith for which many people have been planning in the past few years.
  Another cause of anxiety to which my attention was drawn at a recent surgery is the drugs which the Government will allow on prescription. A newspaper article was brought to me which said that many drugs would no longer be available on prescription. When I sent it to the Secretary of State, she did not deny that that was the case. Examples of such drugs were the contraceptives Femodene and Minulet. They are more expensive than others and may be taken out of the list for that reason, even though they have no side effects and may help to protect against breast cancer.
  The Government claim that they are putting a great deal of money into the health service in Scotland. However, detailed analysis of the figures shows that the outturn health expenditure this year for Scotland is £3.64 billion. The planned health expenditure for next year is £3.75 billion. That is an increase of slightly more than 3 per cent.
  Mr. George Kynoch: Does the hon. Gentleman recognise that health expenditure in Scotland is some 50 per cent. higher in real terms than when his party was in office? Does he accept that a record number of patients are being treated in Scotland and that there has been a great deal of major hospital development in Scotland since his party was last in office? We now have more hospital beds and more doctors and nurses. Far from being in crisis, the health service in Scotland is faring well under the Conservative Government.
  Mr. Chisholm: I cannot reply to all of those points, but the number of nurses has declined recently. I ask the hon. Gentleman to use all his influence to ensure that his Government approve a new hospital for Edinburgh. The proposal has been with the Treasury for a long time and many people in Edinburgh want an answer soon.
  The 3 per cent. increase in health expenditure in Scotland covers normal inflation, but everyone knows that health service inflation runs at 2 per cent. beyond that. That is not covered. Everyone knows that an extra 1 per cent. is needed to cover the needs of the increasing elderly population. That is not covered. Everyone knows that at least an extra 0.5 per cent. is needed to cover developments in medical technology. That is not covered either. So the much-trumpeted deal on health expenditure for Scotland is not acceptable and is not enough.
  The example of the accident and emergency services which I gave a moment ago also raises the important issue of health service democracy. When the Public Accounts Committee recently investigated accident and emergency services in Scotland, my right hon. Friend the Member for Swansea, West (Mr. Williams) asked the chief executive of the national health service in Scotland whether local people had been consulted about removing the accident and emergency service from the Western General hospital. The chief executive was reluctant to answer for the simple reason that no consultation had been carried out.
  944
  In my constituency people from Granton, Pilton and Muirhouse opposed vigorously and vociferously the closure of the accident and emergency department. Yet their views were ignored.
  The rhetoric on trusts is all about taking account of local needs and paying attention to local people. But the reality is the opposite. Reference has been made in the debate today to new appointees to the health boards. There is no democracy about that. The political affiliations of new appointees have been referred to by several hon. Members. I would point out that few women and few representatives of the ethnic minorities sit on the new trust boards. The proportion is even lower than in the House. That shows how bad the position is.
  The new agenda for the national health service must involve emphasising the connection between poverty and poor health. It must involve developing health service democracy and replacing the market. That is not going back but going forward. The Conservative party lives in the past with its market obsessions. It has taken 14 years for many people to see the Conservative party's failures in economic policy, but its health policies are imploding after only two years. It is time for another U-turn. Let the Government start by saving all the hospitals in London and not proceeding with any more trusts in either Scotland or England.
  8.16 pm
  Dr. Liam Fox: It is a shame that the debate, which could have been an opportunity for rational and mature discussion about the future of the national health service, has been turned into something of a circus by the Opposition. The hon. Member for Sheffield, Brightside (Mr. Blunkett) made a supposedly keynote but ultimately sournote opening speech. He made personal attacks on the Secretary of State. I am sure that she is flattered that the Opposition feel that they have to attack her personally on so many occasions.
  The hon. Member for Brightside failed to grasp the main issues. Startlingly enough, he did not come up with a single suggestion about how to move ahead in the national health service. Instead, he carped on about this and that problem and threw up individual cases, as we have heard Opposition Members do in every debate in the House since the election. Not one constructive idea has been given. For a party that believed that it would form a Government last April, it is amazing that, after all this time, it cannot come up with one constructive idea about the way forward.
  However, Conservative Members like to listen. I am sorry that the hon. Member for Rochdale (Ms. Lynne), the Liberal spokesman, is not in her place. Conservative Members like to consult. We do not take lightly the views of any who work in the NHS, not least the British Medical Association. Therefore, we must take the BMA chairman seriously when he says:
  "The low morale in all areas of the service is largely due to the poor state of so many of our hospitals, lack of equipment to improve and, in some cases, save the lives of patients, shortage of staff, and the proper rewards to which all health workers are entitled."
  I am sure that Opposition Members support those words. Unfortunately, that was the BMA chairman in 1978, when the Labour party was in government.
  That was the year when I went to medical school. My first experience of the national health service was of a

  945
  service falling round our ears—that was when we could get into the hospitals, when they were not being blockaded by the unions and when the health workers were not on some sort of strike.
  My first experience of the national health service was of staff having to push patients into the wards because porters were on strike, supported, needless to say, by the National Union of Public Employees and the Confederation of Health Service Employees, which have gone all white and caring in recent years.
  Of course, 1978 was one of Labour's years of record. The hon. Member for Brightside talked about Labour records. One of the records of which I am sure that the Labour party does not want to be reminded is that it is the only party to have cut spending on the NHS; 1978 was the only year in the history of the NHS in which spending was cut. The Opposition cannot get away from that, but I do not intend to dwell on their record in office compared with ours, as it is becoming statistically insignificant.
  We must look at the health service in 1993 and its problems and compare it with my early experience. In the first six months of this financial year we treated 200,000 more patients than last year. National health spending has reached £100 million per day and capital spending has gone up by 76 per cent. from when I entered the medical profession. Those are all achievements.
  We are looking at ways to make the service more efficient and to bring doctors and others with medical expertise into management. That is one of the great benefits of trust hospitals.
  We have heard much from the Opposition about how encumbered we are by management, but those in management at all levels in the NHS constitute only 2 per cent. of its work force. Total spending on management in the NHS is only 3 per cent. of total health service spending, and that makes the NHS one of the most efficient health services—if not the most efficient—in the world. Compare that with the United States where current management expenditure is 19.5 per cent. of total health care funding. That shows the efficiency of our NHS.
  There are 17,000 more doctors in the NHS than there were when I went to medical school in 1978. General practitioners' lists are 18 per cent. lower than when we came to office in 1979. Preventive medicine is now at the heart of medical policy making and that was unheard of, even unthinkable, in 1978–79. Those are all major achievements and the House would be held in higher esteem if, from time to time, the Opposition accepted such achievements. Problems may still exist and may always be there for us to tackle, but for the Opposition to pretend that everything in the health service is rotten makes a mockery of rational debate.
  The hon. Member for Bow and Poplar (Ms. Gordon), who is not in her place, said that the Labour party created the NHS and that it was proud of its creation. When were the Opposition last proud of the NHS? Was it when they left office, which they occupied from 1974 to 1979, when the NHS was falling apart? At no time that I can remember since 1979 have the Opposition said that they are proud of the NHS. When advances are made, why can they not say that they agree with the Government, congratulate them and then move on to rational debate? The answer is that
  946
  they simply cannot bear Conservative success. Even when it is staring them in the face, they refuse to accept that what we have done has benefited the health service.
  Over the past few years, we have been subjected to all sorts of predictions about what would happen under the Conservative reforms. Listening to some Opposition Members, one would think that the health service was absolutely perfect before we instituted our reforms. We introduced those reforms simply because the NHS was such an inefficient system and was failing to deliver what we regarded as modern standards of health care. Standards have improved as a result of the reforms, not least of which is the GP contract.
  The hon. Member for Bristol, South (Ms. Primarolo) shakes her head. The Opposition told us that we would never reach our targets for immunisation or cervical smears. We surpassed them, and that is another major achievement. In view of those rising levels of immunisation it beats me why for once the Opposition cannot say, "You have done well."
  The hon. Member for Peckham (Ms. Harman) said that there was no support among GPs for the concept of fund holding. How is it that already we have 3,000 GP fund holders and by April there will be 5,000. When the Secretary of State relaxes some of the conditions governing GP fund holders, as she told us she will, there will be even more. I welcome the fact that GP fund holders will be able to come in with a list of 7,000. Many Opposition Members and Liberal Democrat Members—when they decide to come to the House—are keen to speak about consultation and pilot schemes. We said that we would limit GP fund holding to those with a practice size of 9,000 and later said that we might extend it. Did we get credit for that pilot scheme? No, we did not, but it has been an undoubted success and now we shall extend it because that is the prudent way to go forward and it has always been the Government's policy.
  The magazine Doctor, hardly a mouthpiece of the right, this month conducted a survey of GP fund holders. The survey showed that over 70 per cent. reported cuts in waiting times and improved efficiency for their patients. Over 60 per cent. reported improved services for follow-up appointments, over 50 per cent. reported improved dealings with consultants and were providing extra services such as chiropody. Over 40 per cent. reported better pathology services and improvements in the prescribing service and almost 40 per cent. of practices now have consultants visiting their practices. Those are all good for patients. We must get away from the idea that the health service is for those who provide it. We run it for those who use it, and that is one of the biggest differences between the Conservative party and the Labour party. It is one of the reasons why we are in government. [Interruption.] I shall give way to any Opposition Member who wishes to intervene.
  We are concerned philosophically to move in the health service in a direction that allows decisions to be made closer to the patient. That is why it is correct to concentrate more power in the hands of general practitioners. There has always been rationing of one form or another in the provision of health services. There was hidden rationing for a long time and it worked in the following way. If I wanted to refer a patient for consultation I ticked one of four boxes at the top of the letter. The boxes are labelled "emergency", "urgent", "soon" or "routine". That was how GPs always rationed

  947
  care in the health service, but in many cases it was not explicit. However, GP fund holders can decide which groups of their patients can be seen more quickly than others, and surely GPs are better placed than bureaucrats in health boards to decide whether a group of patients in a specialty should take precedence over another group. That is why we must continue to extend the fund-holding practices.
  Not all services are covered by GP fund holders. The Opposition seem to think that GP fund holders are keen to involve themselves in coronary care and every other acute service. They cover "cold" services for which GPs can make a rational decision—one that does not involve acute patients. The Opposition say that a two-tier system is being created. If they believe that GP fund holders can offer a better service to patients than GPs who are not fund holders, surely the logic of the argument is to extend the fund-holding scheme to more and more GPs. However, the Opposition are intent on destroying our improvements and returning to the lowest common denominator, which is the base line for all their policies.
  Of course, there will be problems during the transition. We are some way from knowing how GP fund holders use their contracts and how they will pan out. It is not entirely unexpected to encounter problems nine months into the financial year. No matter how we decide to use the funding, problems will remain throughout the decade. Medical science is advancing at a far greater pace than we can ever fund by public money. The gap between what can be provided by medicine and what we can afford to purchase will increase. Within whatever finite budget is in place there will have to be choices between acute and chronic care, between centralised hospitals and community hospitals, an issue raised by the hon. Member for Edinburgh, Leith (Mr. Chisholm).
  There is a conflict of interest in my constituency about whether funding should go to Bath or to one of my local hospitals in Paulton. It is a matter of trying to decide at the lowest possible level to respond to what local people want. We must take a fresh look at the advantages of community hospitals as opposed to centralised care. There will be a limit to the level of increase in funding that can be internally generated by efficiency. Sooner or later, we shall have to make explicit judgments about the rationing of health care.
  I asked in a previous debate whether it was acceptable, when there is a shortage of money in certain sectors, to pay for tattoo removal and so on. We shall have to look explicitly at whether we make these things freely available on the NHS. We have to use the personnel who work in the NHS in the most efficient way, and that is especially true of general practitioners. They are at the forefront of all the advances that we are making. As GP fund holding is extended, they will be asked to make more and more specific rational decisions, but their time must be used appropriately and, while many benefits have come from fund holding, not least the ones I have mentioned about cancer screening and immunisation, we must make sure that GPs are not overburdened with regulation.
  It is prudent now, a couple of years into GP fund holding, for the Government to look at which areas are being productive and which may be unnecessarily overregulated. As we have asked for unnecessary regulation to be swept away in other areas of government, the Department of Health should also look at whether it is using GPs' time most efficiently.
  948
  We also have to look at whether we must have the regional tier because, while we are waiting for the internal market and its working to become clearer, as it will over time, there is still some need to keep the regional tier but there will come a point in the not-too-distant future when the regional tier will become over-bureaucratic and interfering and we may no longer require it. I hope that the Government will seriously look ahead to that time.
  I want to make a final point, about the mental health changes, following the comments made by the hon. Member for Belfast, West (Dr. Hendron). I also feel strongly about this subject. It is dangerous to try to oblige any one fashionable medical idea across an entire spectrum and that is what has happened with mental health.
  I do not believe that it makes any more sense to say that all the mentally ill should be institutionalised than it does to say that they should all be in the community. There has to be a balance, and I very much welcome the commitment by the Secretary of State a few weeks ago when she said that the Government would be reviewing all those guidelines. Surely we must have a balance in that system so that those who can integrate will be integrated and those who require institutional care can get that institutional care.
  I hope that we shall turn back a little of the medical fashion which is putting everybody into the community which, as one can see on the streets of any city, is proving to be something of a mistake, especially for patients suffering from schizophrenia.
  The Government have been brave in recent years in carrying forward their proposals. They have always done so against the wishes of the Opposition, who cannot tolerate anything that smacks of change and movement away from bureaucracy, and often in the face of criticism from the medical profession.
  It has taken seven years for the Labour party to change their mind about council housing policy; five years for them to change their mind about British Telecom. I wonder how long it will take them to change their mind about NHS trusts and fund-holding practices.
  I am sure that the real world will catch up with them in this, as in all the other policies which they have foolishly turned their faces against. I hope that it will be sooner rather than later, but for the electorate it will not make any difference because the Opposition will not get the chance to put their policies into practice.
  8.34 pm
  Mr. Alan Milburn: The hon. Gentleman's belief that everything in the NHS garden is lovely is not a view shared by NHS professionals or NHS patients. He will know that the BMA recently condemned the breakdown of many hospital services leading to a two-tier provision of service. The BMA has also condemned underfunding and flaws in the reforms and has called for radical reforms of the Government's changes immediately.
  They know, and we in the Opposition know, that two years into the market all the impact that we predicted would occur with the introduction of the market into the NHS is now coming to fruition. The chickens are coming home to roost. Hon. Members on both sides know in their heart of hearts that the Government have created a system in which hospital services in many parts of the country lie idle for three months of the year because there is not

  949
  sufficient money. It is unfortunate that NHS patients refuse to become ill for just nine months of the year. They become ill for 12 months and many are having to wait longer and longer for treatment.
  The lack of resources for clinical care contrasts markedly with the booming resources that seem to be made available for bureaucracy within the NHS. The hon. Member for Woodspring (Dr. Fox) and some of his colleagues have spoken of the relatively small ratio of bureaucrats to clinical staff in our national health service. That was something to be proud of. I speak in the past tense because the figures from the Department of Health, as the Minister knows full well, point in a startling new direction.
  Mr. Malone: So that we can get something positive from the Opposition, with what structure would the hon. Gentleman replace the management structure?
  Mr. Milburn: I will deal first with the point that I was attempting to highlight and come to that later. We have more and more red tape in the NHS. Arguably, it is strangling the service. We have had a boom in bureaucracy in the past few years. The figures that I have received from Ministers indicate that during the period when the market was introduced into the NHS, between 1989 and 1991, the number of managers tripled while the number of nurses and midwives available on our hospital wards and in our communities fell by some 8,500. That has to be coupled with the enormous growth in administration generally. We now have 9 per cent. more clerical staff and more administrative staff as a result of the Frankenstein that the Government have created. Once one has the market, one has the purchasers and providers, opted-out units, more accountants, more financial directors and more of the institutions of the market.
  In my region in the north, during that three-year period we saw a 500 per cent. increase in the number of managers. I would happily have lived with that, and many of my hon. Friends would happily have lived with that, if it had been complemented by a 500 per cent. increase in the number of nurses and midwives, but it was not—it was accompanied by a real decline in their number. There are fewer nurses on our wards. Many nurses are losing their jobs altogether and almost 5,000 health workers were made redundant between 1989 and 1992 because of the closure of their hospital units. Those are not my figures. They are not NUPE's figures. They are not the BMA's figures. They are the figures of Ministers from the Department of Health. They know in their heart of hearts exactly what is happening. Job losses were up by 50 per cent. in the first year of the market. It will not surprise my hon. Friends to learn that the biggest wave of redundancies took place in NHS trusts because there the ethics of the market are running amok. We are seeing more redundancies and sackings and fewer nurses and midwives at the sharp end of health care.
  I go back to the introduction of the market and the Government's White Paper promising all these changes. I vividly remember as a humble parliamentary candidate that we were promised a leaner and fitter national health service. We were promised that it would be more efficient and less bureaucratised and that there would be a freeing of resources to enable the health service to treat patients at
  950
  the sharp end. But it is not leaner: it is fatter—fatter with bureaucracy. It is bureaucracy gone mad. I understand that the Secretary of State enjoys being well briefed and therefore might want extra staff to monitor the effects of her policies, but do we need thousands of extra bureaucrats, accountants and administrators at the expense of qualified nurses? That is what we have got. That is a national scandal because it has done precisely nothing to improve patient care in this country.
  I will allude briefly to some of the problems in my own area. Darlington's NHS is suffering a three-fold crisis because of underfunding, continuous administrative upheaval and the emergence of a two-tier health service. Darlington health authority is being denied any growth funding until 1995, despite having a greater than average elderly population. The local hospital is in dire financial crisis. In the current financial year, it is rumoured to be facing a £2 million deficit, and that is having a real impact on patient services. Hon. Members have spoken about looking after, listening to and ensuring that the concerns of NHS staff are taken fully on board, but in Darlington there is a vacancy freeze on new NHS staff.
  In the past six years the hospital's cost improvement programme has taken £3.25 million away from hospital services. As a result, we have seen acute medical and surgery wards closed, children's wards being merged and, finally, desperate underfunding of our accident and emergency provision. The accident and emergency department treats some 10,000 patients every year. In the event of a major crisis on the east coast mainline railway, at Teesside airport, just two miles from Darlington, or on the AIM, just one mile from Darlington, that accident and emergency department would have to deal with a catastrophe without having any specialist accident and emergency consultant because the hospital cannot afford to appont one in this financial year. That is courting disaster and gambling with local people's lives.
  Mrs. Audrey Wise: Before my hon. Friend leaves the point about the lack of jobs for nurses, he may be interested to know that a student nurse recently described to me graphically how, as an official part of the course in the final year, students are being lectured on how to find opportunities to work overseas when they qualify.
  Mr. Milburn: I am grateful to my hon. Friend. I believe that we face a major brain drain from the health service precisely because opportunities are lacking for qualified nursing staff.
  Money can always be found for managers, of course. I understand that Darlington health authority is about to appoint a new project manager to lead the opt-out of acute services, on a salary of up to £53,000 per annum. That appointment is quite unnecessary. It is a direct product of the interference from Whitehall in local decision making about the future make-up of local health services in Darlington.
  Dr. Liam Fox rose—
  Mr. Milburn: I have given way on a number of occasions and I should like to begin to wind up my remarks.
  One of the final issues that I want to address is the decision which has just been taken today about the future make-up of health services in my constituency. We are sick and tired of governmental interference with our local

  951
  health service. Just today, the regional health authority agreed a merger between Darlington and South West Durham health authorities, in the teeth of opposition from patients, staff, the two community health councils, the four Members of Parliament, the local authorities and local people. It is claimed that the Government are prepared to listen, but where is the listening there? They have not listened; they have ridden roughshod over the wishes of local people in my town. There will be no choice for patients as a result of that merger, because increasingly patients will have to travel for treatment to Bishop Auckland and out of the town altogether.
  Some patients, of course, will not need to travel at all. They can take advantage, if they are lucky, of the top tier of health care in a two-tier service. Fund-holding GPs in my constituency have the benefit of referring patients directly to fast-track treatment. They do not do so through the NHS; they refer patients directly to the local private hospital. Hon. Members have attempted to mock some of the statements made by my hon. Friend the Member for Livingston (Mr. Cook) prior to the general election. He warned about creeping privatisation. That is not creeping privatisation; it is full steam ahead privatisation. Hon. Members should be ashamed that we have seen the development of a two-tier health service in this country.
  I do not blame the GPs or the patients; they are playing by market rules, but the market means winners as well as losers and I am afraid that the NHS has become a national lottery. Lucky patients hit the jackpot, but this is not the sort of NHS that the British people want. They want an NHS which is free at the point of use, guaranteeing equal access to expert medical help when it is needed. That is the sort of NHS that we had in 1948 and the sort of NHS that we had in 1979. Unfortunately, it is not the sort of NHS that we have today.
  8.45 pm
  Mr. David Willetts: I am grateful to you, Mr. Deputy Speaker, for calling me to speak in this debate because the motion put forward by the Labour party reveals that it fails to understand the basic objective of the Government's health reforms and how they work for the benefit of patients. Hon. Members talk about commercialisation of the health service and fragmentation of health care, but what the Labour party calls commercialisation and fragmentation is freedom for the providers of health care to serve the best interests of patients for whom they have responsibility.
  A piece of doggerel that was circulating in the NHS many years ago summarises the purpose of the Government's health service reforms. It was said of doctors:
  "Masters of their patients when servants of the state,
  Servants of their patients when masters of their fate."
  It is the purpose of the Government's health reforms to make GPs and self-governing hospitals masters of their fate, no longer tied up in elaborate bureaucracy, and in doing so to ensure that they can properly serve the interests of their patients.
  I will look first at primary care and the role of GPs now that they have the opportunity to be budget holders. Here I draw on my experience of serving for several years as a member of a family practitioner committee. Although many advocates of the old-style NHS have said that one of its strengths was the so-called gatekeeper function carried
  952
  out by GPs, in practice the division of responsibility between primary and secondary care was one of the great weaknesses of the old NHS. It was a weakness that went back to Bevan's original design. On the one hand, GPs had the freedom to refer wherever they wished; on the other hand, they had no power to send resources to the places to which they were referring patients. The allocation of resources was determined by the Department of Health —determined, as Nye Bevan famously observed, by a department where, if a bedpan was dropped in any hospital in the NHS, the sound could be heard in Whitehall. That was no way to run the NHS.
  If GPs are to be given proper freedom to refer, that freedom must be backed by the power to send the money to the places to which they are referring. That, of course, is the crucial significance of the option for GPs to become budget holders. It is an innovation which resolves one of the contradictions in the old-style Nye Bevan NHS. It not only solves the problem of that tension with which the NHS had wrestled for a long time, but also goes with the grain of technological development. The old-style view of the NHS as a service which required larger and larger hospitals, with more and more functions centralised in enormous hospitals, is not what the patients want, it is not what communities want, and it is no longer what medical technology requires. The power of miniaturisation and medical advance makes it possible for many treatments to be carried out in the GP's surgery or in the local clinic. Only 10 years ago, such procedures would have been thought to require hospital treatment. GPs are now properly reimbursed for minor ops—lumps and bumps. In future they will be able to carry out in their surgeries pathology tests with the use of small sensors, enabling patients to have immediate results. In the past, patients would have had to go to hospital, lie on a bed, have a blood test, return home, and be called to see the GP or hospital a week later for the result. Many enormous simplifications will be made possible by technology.
  The old style NHS stood in the way of such advance. It had no interest in services becoming available at the primary care level because there was no financial system by which the pattern of funding the NHS could keep up with the pattern of technological change. Freedom to spend the money that they are allocated in the way they know to be in the best interest of their patients will result in GPs saying, "I need not send my patients to the big district general hospital 10 miles away for some tests; I can invest in the technology which will enable me to do those tests in my surgery."
  The strengthening of the GP has been one of the great success stories of recent reforms, going beyond the wildest hopes of Ministers when they originally planned those reforms. In the old days, the contempt with which many hospitals and district health authorities treated GPs had to be seen to be believed. I recall the way in which the local district health authorities, as they saw the review of the NHS coming into effect, for the first time realised that if they really wanted to make sure that money was properly allocated, they had to conduct research into what GPs thought about the current pattern and quality of hospital services. They were horrified when, for example, they came across GPs who could say, "We are not satisfied with the quality of treatment from this or that hospital or department."
  When writing contracts and deciding the services that they wanted to buy on behalf of patients, DHAs for the

  953
  first time seriously consulted GPs to find out what they wanted. They now know that if they ignore GPs' views, many more GPs will become budget holders. The threat of becoming a budget holder has improved the quality of care for GPs who are not budget holders as much as it has improved the quality of care for those who are. That is why the reference in the Opposition motion to a two-tier health service goes against the reality of developments in recent years.
  Dr. Liam Fox: Does my hon. Friend agree that what is important in cases of referral is not where patients go—whether to a private sector or a NHS hospital—but how quickly they are treated? The Labour party is tied to dogma, whatever Opposition Members say about Conservatives being dogmatic on the issue.
  Mr. Willetts: I agree with my hon. Friend. He reveals the cynicism with which Labour Members speak of privatisation. They use it in the sense of people having to pay for their health care. That is not, and never has been, Conservative party policy and what we are discussing is not in any way privatisation in that sense.
  Completely different is the concept of a patient enjoying health care free at the point of use—that care perhaps being delivered most expeditiously by a private hospital with which a DHA has a contract so as to reduce its waiting list. That is not privatisation, but delivering publicly financed health care free at the point of use in the most cost-effective and efficient manner. Only blinkered ideology could lead anyone to oppose such an approach to health care. The patient gains by getting the best possible health care without having to pay for that care at the point of use.
  I move from primary to secondary care—the hospital service. An irony of the hostility of Labour Members to self-governing hospitals is that they oppose a measure which was modelled in many ways on a feature of Nye Bevan's health service which deserved approbation. When he was establishing his health boards, he deliberately decided, after consulting the leading representatives of the hospitals, that the leading teaching hospitals, with their medical schools, should not be brought under the direct control of medical boards. The old teaching hospitals were to remain self-governing.
  Bevan envisaged that they would be self-governing, and so they remained until—the irony of what occurred will not escape my hon. Friends—Lord Joseph's reforms of the health service in 1970 to 1974, which brought those teaching hospitals under the direct control of health authorities. It was not a fundamental feature of the post-war NHS, but a relatively recent development. Indeed, in Guy's hospital there is a notice on the wall with a rather melancholy inscription saying that the board of governors met there for their final meeting, in the 250th year of their existence, in February 1974.
  An idea behind the reforms which has proved enormously popular is now to give every NHS hospital the opportunity to enjoy self-governing status, the sort of freedom which Nye Bevan envisaged should be enjoyed by our great teaching hospitals. It is in no sense a dismantling of the NHS, but an attempt to ensure that all hospitals can enjoy the freedom which teaching hospitals had up to 1974. It is ironic that Labour Members should be
  954
  committed to a stout defence of an over-bureaucratic, over-managed structure of the NHS introduced in the 1970 to 1974 period. There is no reason why that should be regarded as a fundamental feature of the NHS. As we see with several waves of applications for trust status, doctors, nurses and managers at those hospitals greatly relish the opportunity to employ staff more flexibly so as to serve patients in the ways that they know best.
  Much has been said by Labour Members about the management of the NHS. If one wanted an indication of the inability of the Labour party to take seriously concepts such as efficiency, effectiveness and high quality care, it is their manifest opposition to anything regarded as management in the NHS. They do not like the idea of managers or accountancy or the efficient use of money. The NHS is one of the largest organisations in western Europe. The idea that it can survive simply by the endeavours of doctors and nurses, crucial though they are, without a professional cadre of people committed to the efficient use of resources, the proper control of money and the proper management of large and expensive hospitals is at best naive and at worst shows an extraordinary disregard for what is in the real interests of patients. I hope that we shall hear no more attacks on the essential work that managers do in the NHS. We do not say that the only staff doing a real job in ICI are chemists or that the only people doing a worthwhile job in Shell are those who work on oil rigs. We accept that large, complicated organisations have management functions which need to be carried out by experts.
  Mr. John Gunnell: The hon. Gentleman has philosophically explained his case for fund holders and has made a similar case for trust hospitals. Now he is moving on to management. He has left out the purchasing authority. He obviously envisages an increase in the number of fund holders and presumably he wishes all GPs to become fund holders. What role does that leave for the purchasing authority? Or is the purchasing function to be entirely in the hands of individuals?
  Mr. Willetts: The hon. Gentleman has raised an important question. The reply is twofold. First, the Government have always made it clear that becoming a GP fund holder is a voluntary option. Nobody is being dragooned into becoming a fund holder. I welcome the enormous number of GPs who have already exercised that option and I expect that many more will do so in future, but it is not compulsory.
  Secondly, as my hon. Friend the Member for Woodspring (Dr. Fox) has already pointed out, the GP budget does not cover all services that the NHS provides. It covers the services which are frequently used at relatively low cost, but it was not thought feasible or sensible to include expensive and relatively rare treatments because they are randomly distributed. A relatively small number of cases would risk overturning a GP's ability properly to plan his budget, so such treatments remain financed through DHAs as purchasers. We may hope that some of the services currently bought by district health authorities will in future be bought by GP budget holders, but I expect that there will always be a wide range of services to be purchased by DHAs and not by GP budget holders.
  I return to the point about management with which I was concluding, and to the record and the figures that we

  955
  heard from my right hon. Friend the Secretary of State for Health today in a speech that I thought was so effective and persuasive.
  Mr. Trend: It was brilliant.
  Mr. Willetts: My hon. Friend describes it as a brilliant speech—[Interruption.] Opposition Front—Bench Members say that they were deeply impressed. I am pleased to have such confirmation of its quality. That speech included figures on the record number of patients treated and the record activity in the new style NHS which have been achieved by a combination of high-grade management and the freedom at last for people working in hospitals and for GP budget holders to act without the crippling control of the state. I therefore strongly oppose the Opposition motion.
  9.2 pm
  Mr. Richard Burden: The Opposition, and indeed the country, are getting quite used to the bland assurances of Conservative Members that there is no crisis in the NHS.
  The picture of fund-holding GPs, hospitals and health authorities all competing in perfect harmony and patients armed with their own personal copies of the patients charter waiting only a short time for treatment is about as believeable as the adverts for private health care which show healthy people sitting up in hospital and smiling, being treated by nurses who never look tired while the patients never look sick. I cannot comment on whether that is an accurate picture of a private hospital because, unlike some Conservative Members, I do not use them. However, I do know that that is not a picture of care in the national health service in my region, the west midlands. In that region, the Government's health reforms are creating a kind of Trotter's Independent Traders, without the same social conscience but with the same financial acumen.
  Qa Business Services, the computer division of the regional health authority, was sold off and went bust within 18 months. Millions of pounds have been spent on a value-for-money exercise that saves no money. We see HealthTrac, a new all-singing, all-dancing supply system that has to be investigated by the Audit Commission. That is what is happening under the new-look national health service.
  It would not be so bad if the effects were simply financial. But it is not simply money; it affects real people such as those who worked for Qa Business Services—pensioners who stand to lose two thirds of their pension entitlement because of that mismanagement.
  In my area of south Birmingham a merger was forced through against the wishes of local people and community health councils. It resulted in a deficit of about £25 million. That is leading to the closure of hospitals. It has already led to the loss of beds, and it means that the Royal Orthopaedic hospital in my constituency is to close, as is the accident hospital which has one of the best burns unit in the country. Services are also to be transferred from the general hospital in the city centre. Consultants opposed it and the local community opposed it. Consultants have warned of the danger of cross-infection—but because the market dictates, the policy must be pushed through.
  Even before that happens, the Royal Orthopaedic hospital has to offer bargain basement prices to get contracts from other health authorities, but it cannot get
  956
  them because those authorities do not have the money. A constituent of mine has been told that he must wait 92 weeks even to see a consultant. He needs the services of that hospital. The services exist, but he cannot use them because the market dictates that he cannot do so.
  Another constituent of mine, a young boy aged nine called Thomas Leavy, has cerebral palsy. The health authority has told him that, because it does not have the resources as a result of the financial crisis caused by the health reforms, he cannot get adequate physiotherapy treatment and he must wait six months just to see somebody about the possibility of occupational therapy.
  That is the reality of the Government's health reforms. It has been summed up much more eloquently than I could put it by a Birmingham consultant, who wrote to general practitioners in the north Birmingham and Bromsgrove areas—copying the letter to the Secretary of State, among others saying that it was not possible to place patients from their authority in his hospital. He said:
  "My medical colleagues and I believe that this is a totally unsatisfactory state of affairs. The NHS reforms are not working. Money is not following the patients. The choice of patients and General Practitioners is being restricted not preserved as promised. We are into the realms of a two-tier health service depending on who has got the money and where patients live."
  Those are not my words, nor the words of the Labour party, nor even the words of NUPE—which Conservative Members like to quote—but the words of a consultant. That is the reality of the health service as it operates today.
  Everything happens behind closed doors; secrecy surrounds the health authority. I and other Birmingham Members have tried to get answers time and again. We have asked the Secretary of State, Ministers and the regional health authority to provide us with the reports of the investigations into the financial crisis facing the South Birmingham authority. We have asked for copies of audit reports on the financial scandals in the West Midlandls authority.
  Time and again, the Government insist that they listen and consult, but they have fobbed us off. Time and again, the Secretary of State has refused to meet Members of Parliament from the south Birmingham area to discuss the plans to close hospitals such as the Royal Orthopaedic. Of course, they say that it is a matter for management. We know what management means in the west midlands—financial scandals. It has meant Sir James Ackers running the flagship of the authority's internal reforms. We called for his resignation for months and months. Finally, after ignoring those requests, the Secretary of State was forced to accept his resignation a month or so ago, under circumstances not yet revealed.
  There is now new management in the authority—Sir Donald Wilson, formerly of the Merseyside authority, which is itself the subject of calls for a public inquiry. He has been foisted on us. We are told that there is a new regime with a new open-door policy. That sounds great, but still all the hon. Members who have been asking for those reports have not been given them. That new management has not said that it will save one hospital or one hospital bed.
  The new management is not much change on the old. When we discovered that, we asked the Secretary of State to direct the new management to ensure that the reports were made available to us, the local democratically elected representatives. Although she said in the debate today that she was in favour of all information being made available,

  957
  her hon. Friend the Minister for Health replied to our requests, "No, it is a matter for management whether those reports are released."
  A stop must be put to the situation in which the health service is run as if it were some kind of glorified supermarket. When we say that privatisation is creeping into the NHS, we are not exaggerating. We shall have in the health service what has happened in a number of other industries. First, the financial structure is changed and financial shackles are applied. Then there is the pretence that there is some kind of decentralised decision-making, whereas the only thing that is being decentralised is responsibility. When that system breaks down, Ministers say, "Wouldn't it be much easier if you went independent, if you freed yourselves from the shackles of Government control?"—the Government that put the shackles on in the first place. That is what Conservative Members intend for the national health service, although they do not have the guts to say so, and it is what Opposition Members will oppose and oppose and continue to oppose because we support and defend the health service that we created.
  Conservative Members have asked us what our alternative is. Let me make three points for a start. First, the market mechanism, which is alien to the concept of health care and proper health planning, should be abandoned. Secondly, the health service should be given the funding that it needs. No amount of jiggery-pokery, with purchasers, providers and contracts, can make good the underfunding. Thirdly—and equally important—people who believe in the national health service, who use it and who live locally should be put in to run the service in a way that does not suggest that it is some kind of glorified supermarket.
  9.10 pm
  Mr. Jeremy Corbyn: I should like to put on the record my thanks to my hon. Friend the Member for Bristol, South (Ms. Primarolo) for giving me five minutes of her time.
  I want to put on the record too—so that it will not be possible for anyone to claim otherwise—the fact that, as a Member of Parliament, I am sponsored by NUPE. I am not ashamed of that connection; indeed, I am rather proud of it. Members of my union and, indeed, of the unions with which we are about to merge do very valuable work in the health service and are dedicated to the principle of a health service free at the point of use. They will remain dedicated to that principle, as has been demonstrated by their many years of service.
  I wonder how those people are expected to continue their dedication when they are told that their pay rise in April will be limited to 1.5 per cent. despite the fact that the rate of inflation is far higher than that. Conservative Members may find this extremely amusing, but they are quite concerned about the future of their own jobs—especially the London Members, to whom I wish to address my comments tonight.
  The Government's treatment of the health service in London is nothing short of appalling. We have seen 5,100 beds lost since 1982; during the same period there has been an increase of 18 per cent. in demand for hospital places; and regional health authority decisions have been imposed on London health districts, with no democracy whatsoever
  958
  in the decision-making process. With the growth and merging of health authorities, we now have bigger, more impersonal and less accountable bodies in London and a continual drift of resources out of London and into the home counties.
  I do not intend to be dragged into a false argument about the needs of inner London as opposed to those of Essex, Hertfordshire, Surrey and Kent. What we require is recognition by the Government of the needs in inner city areas. In London there are 60,000 people living in temporary housing accommodation, a considerable number sleeping on the streets, 1 million people living in poverty, above-average levels of deprivation and a high incidence of suicide, AIDS and many related diseases and illnesses. If the Secretary of State were to look at statistics produced by any family health service authority in inner London, she would recognise the degree of deprivation.
  But what did the Government offer? The Tomlinson inquiry. It is proposed that a considerable number of hospitals, including Bart's, about which my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) spoke so eloquently, should be closed, with the loss of a very large number of beds. It is claimed that, somehow, this will solve the problem of a London waiting list of 130,000 people. The implication is that the problem will be solved by transferring resources from the hospital sector to the primary care sector. That is not the alternative for which we are looking. What we want is recognition of the fact that the people of London need and deserve a proper health service. That means increased resources for the primary sector, increased resources for general practitioners, and better general practitioner services. But that will not be achieved if much of the general practitioners' time is taken up as a result of premature discharges from hospitals and inadequate hospital services in the first place. The Secretary of State and the Government must recognise that Tomlinson has got it fundamentally wrong. What Tomlinson is talking about is mass closures, with loss of beds, in order to solve the problem of underfunding of primary care in the first place when what we require is a recognition of those needs.
  There is at last an inquiry into the activities of the London ambulance service, after years of providing an inadequate service because of an incompetent management and a particularly incompetent board. What we need at the same time is the recognition that the health needs of London will be met not by things like the Tomlinson inquiry but only by an increase of resources as a whole to the people of London. It is not right that people living in inner London suffer a higher level of infant mortality, a shorter life expectancy and a higher level of notifiable diseases than those living in the rest of the country. These problems must be addressed by an adequate provision of resources by Government to meet the need.
  9.15 pm
  Ms. Dawn Primarolo rose—
  Hon. Members: Hear, hear.
  Ms. Primarolo: Perhaps I should sit down now and quit while I am ahead, with the support from my hon. Friends.
  The debate has been about the realities of the national health service and the experience of people using and working in the service. My hon. Friends who have taken part in the debate have adequately described that

  959
  experience. My hon. Friend the Member for Don Valley (Mr. Redmond) pointed out the political nature of the appointments, the placemen who are put on to trusts and rewarded generously while poor pay continues in the national health service and there is a pay freeze of 1.5 per cent.
  My hon. Friend the Member for Halifax (Mrs. Mahon) spoke about the human cost of the national health service reforms, the bed closure programme and the desperate situation in her constituency because of bed shortages.
  My hon. Friend the Member for Bristol, East (Ms. Corston), speaking about her constituency in particular, concentrated on what the national health service was created to do and what it does now in our communities. She spoke particularly from the personal experience of her constituents waiting 19 months not to be treated but merely to receive an appointment to see a consultant. She also mentioned the problems with dental services in Bristol, the ambulance cover, which is only 90 per cent., and the two-tier system whereby the patients of general practitioner fund holders are treated in advance of those on the waiting list.
  My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) was cut off in his prime. He had enthusiastically defended Bart's hospital, and I am sure that the Minister on his frequent visits to Bart's will likewise defend that excellent institution, but my hon. Friend was cut off before he could tell us that Bart's has now eradicated its deficit. It is, I hope, about to tell the rest of the London hospitals how it managed it, and then the closure programme proposed by Tomlinson can be abandoned as irrelevant.
  My hon. Friend the Member for Bow and Poplar (Ms. Gordon) spoke about the importance of access to care on the basis of need, the cornerstone of the national health service, and went on to describe why the basic facts and data used in the Tomlinson report were incorrect.
  My hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm) spoke about the experience in Scotland and drew comparisons with England; he rightly said that the British Medical Association describes the crisis now being experienced in the national health service as the worst for 30 years. That is nothing for hon. Members on either side of the House to be proud of, and it is something which we should address.
  My hon. Friend the Member for Darlington (Mr. Milburn) spoke with great authority and accuracy, cutting through the assertions made by Conservative Members about our now having a leaner, more efficient national health service in which the bureaucracy has been reduced. Using Department of Health figures, he put paid accurately to that misrepresentation. As he pointed out, there has been no freeing of resources for patient care.
  My hon. Friend the Member for Birmingham, Northfield (Mr. Burden) talked eloquently about Trotter's independent trading company, as he called it, in the west midlands, and the secrecy that persists about the misuse of money in the NHS. He pointed out that one of his constituents had a 92–week wait to see a consultant. That is disgraceful.
  My hon. Friend the Member for Islington, North (Mr. Corbyn) pointed out further shortfalls in the Tomlinson proposals. Most important, he showed that at no point had there been any assessment of London's health needs or any assessment of the tremendous problems that London faces, as do many of our other inner cities.
  960
  The Secretary of State told us that she had launched a new health help line to which she had made the first phone call—presumably to try to find out what is going on in the service. However, she failed to tell us that the help line closes at 5 o'clock. We have tried several times to get through, in the hope of obtaining some of the information that we cannot obtain from the Government, only to be held in a queue or requested to leave a recorded message which would be dealt with in due course. I hope that we do not have to wait until April when the new contracts start.
  The Secretary of State said that a health service should be based on principles, but she went on to qualify that, saying as long as those principles stick to the budget. That is the politics of the balance sheet, not clinical priority.
  The Secretary of State announced that £2 million would be given to pump prime pacesetter projects. I wondered whether that had anything to do with heart surgery; then I realised that it did not. She said that the object was to reduce waiting list times by setting new benchmarks. Perhaps she will explain to the House how pacing treatment, spreading it over a longer time, will lead to a reduction in the waiting lists. Presumably people will have to wait longer before they are reached.
  The Secretary of State then announced something that she has already told us about.
  Mrs. Virginia Bottomley: The sort of schemes to be funded are those at Walsall and Horsham which ensure that people can have their cataracts treated more swiftly and that people coming forward for breast cancer checks will be seen within 48 hours—innovative schemes, different ways of doing things, which others across the health service can emulate.
  Ms. Primarolo: It is a shame that the Secretary of State could not have told us that in her speech and that she did not make it clear that the scheme was not about pacing treatment but about access.
  The Secretary of State also announced for the second time the £2 billion to be used for capital projects within the NHS. She went on to say that that was to be provided by the sale of land and property. First, that is not new money, because it was in the autumn statement and, secondly, it is money which is funded by closure programmes, and the right hon. Lady cannot be sure that it will be available.
  The Secretary of State referred to the huge investment that has been undertaken by the Government, and derided Opposition Members for the performance of past Labour Governments. She went on to talk about primary care. In 1981, the Acheson report identified the fact that 15 per cent. of GP premises in London were below the national average in that respect. Extensive and good proposals were made for the expansion of primary care. Hardly any of those were implemented, but linked to that was a bed closure programme. That, no doubt, sounds familiar to my hon. Friends.
  A total of 5,000 beds were closed to pay for the increased primary care, but, by 1992, when we received the Tomlinson report, we found that the situation in London had deteriorated rather than improving: now 46 per cent. of GP premises are below the national standard. That decline in primary care has been presided over by a Government who claimed that they were providing more money.
  Mr. Willetts: Will the hon. Lady give way?
  Ms. Primarolo: I hope that the hon. Gentleman will appreciate that Conservative Members have spoken at length, and that I have given up some of my time to ensure that my hon. Friends could speak and to allow time for the Minister. Every time hon. Members interrupt me, thus reducing my time, I shorten the Minister's time. Does the hon. Gentleman want to incur the Minister's wrath?
  I hope that the Minister will take the opportunity to repudiate paragraph 12.25 of the Bloomfield report on dentistry, which states:
  "In considering priorities for exemption from payment, there must be doubts about the category of pregnant women/nursing mothers."
  Will the Minister state categorically that there will be no reduction in that exemption? Will he also refer to the new blacklist that is to be introduced, and give the House a categorical undertaking that no contraceptives will be removed from the list?
  The Government told us that the national health service stumbled from crisis to crisis, and that we needed to accept the implementation of their reforms; the crises would then disappear.
  Mr. Miller: We have heard a good deal about choice from Conservative Members. Would my hon. Friend like to comment on the board of the Countess of Chester hospital, in the Mersey region? There are four Conservative activists on the board—including Lord Wade of Chorlton—a failed Tory party treasurer and cheese maker. Would my hon. Friend care to contrast them with my constituent, a YTS trainee who suffers from a life-threatening disease and who—because of the "choice" offered by the Government—cannot get free prescriptions on the national health service?
  Ms. Primarolo: My hon. Friend has summed up what is happening in the national health service. There are jobs for the boys; jobs in return for past work; jobs as a reward. But there are no prescriptions for those who need them.
  The market, we were told, would eradicate the crisis. We would have a lean, finely tuned, responsive national health service. Let me give the House an example by describing a day in Bristol's health service. Bristol has three large teaching hospitals and a number of other hospitals.
  This is what happened on 7 January. All through the night, Manor Park hospital had no female beds available. Before 8 am, the Bristol Royal infirmary and the Frenchay hospital had no coronary care beds available. The Southmead had one. The Frenchay refused to take patients from outside its catchment area. The BRI started at 9 am with no medical beds, and, by 2 pm, was completely closed; it had no beds. By 12 o'clock, the Southmead had no available beds, and Western General was closed to all admissions. Shortly after lunch, the Bristol general hospital had no beds. By 8 pm, the Frenchay, the BRI and the Southmead all had no medical beds available. Some time after 9 pm, the Southmead decided to accept medical admissions, but only from within the Southmead area.
  The crisis in the NHS has been documented by everyone except the Government and their Department of Health. It has been demonstrated that patients wait in casualty for hours on end, and hospitals go on and off red and yellow alert.
  Job losses among health workers rose by more than 50 per cent. in the first year of the Government's market-style
  962
  changes to the NHS. Junior doctors are reportedly working more than the legal number of hours, despite the Government's pledge that the NHS would meet its first major deadline. Hospitals run out of beds and emergency admissions are not allowed as the money dries up. The BMA says that hospitals are facing financial collapse because of the ravages of the internal market. The mechanism that the Government told us would save the health service is destroying it.
  We are seeing queue jumping; patients are refused treatment; people's working conditions deteriorate further; yet the Government do nothing except peer at the world through the rose-tinted glasses of Richmond house. An editorial in the Doctor, in absolute desperation, advised doctors to
  "Bend Virginia's ear with proof of the crisis. The Secretary of State's underlings do not tell her the extent of the bad news."
  What can doctors do to persuade her that the present crisis is the most catastrophic but can be avoided?
  One day the Secretary of State is full of praise for those who work in the national health service and is proud of their professionalism and commitment—rightly so—but the next she shifts the blame for the chaos on inept managers, greedy consultants or whingeing GPs. She should make up her mind about who is to blame, what is going wrong and how it should be put right. It is her fault and her Government's fault. Her reforms have demonstrated the persistent underfunding of the national health service: the very thing that the Government wished to disguise has been exposed by their own reforms.
  The Secretary of State tells us that pacing work in hospitals is important. Hospital resources stay underused for three or four months of the year. How do doctors pace themselves when they are faced with seriously ill patients? I shall give an example of how they pace themselves from the intensive care unit admission policy of Gloucester health authority. This is what the reforms mean:
  "Any surgical patients who are expected to require post operative intensive care will be deferred or transferred to another hospital pre operatively … In addition the following … patients will not be admitted. Patients with acute … chronic lung disease … Patients with chronic poor quality of life"—
  goodness knows what that means—
  "Patients 70 years or over with: Acute Renal failure … Respiratory failure due to pneumonia".
  That is what pacing is. Those are the priorities of the budget sheet.
  Waiting lists, perversely, allow people to be treated not according to clinical need but on the period of time and political priorities of the Government. People are called finished consultative episodes instead of people. Refurbishment means closure: in the Secretary of State's national health service, any word can be used. Prevention is distorted. Breast cancer services are a clear example. There are 1,400 victims in the United Kingdom every year —the highest number of deaths in Europe. We have the fewest cancer specialists in Europe, yet the Secretary of State tells us that prevention is better than addressing the need for such facilities. Prevention is a good strategy, but 4 million women in this country, 2 million of whom live in London, have not had a cervical smear in the past five and a half years. It is about time that that was addressed. Patients' choice has been eradicated; patients cannot choose their hospitals. Money does not follow them—they follow the money.

  963
  In Bristol we are about to have catchment areas for hospitals—if one does not live in the catchment area, one cannot go to the hospital. It is interesting that we are not allowed to have catchment areas in education, but we are allowed them in health. Frenchay health authority is already proposing to administer such a scheme. We are in the ridiculous position where the hospital in TruroTreliske—faces financial difficulty because tourism has dropped in the west country as a result of the Government's failure with the economy. That shows the state of the national health service under the Government's reforms.
  We have tried today to show the perverse incentives that the Government have introduced into the national health service. The reforms have not worked, but are making the situation worse. It is about time that the crises were dealt with. I urge my hon. Friends to support our motion, as I know they will. If the Government continue to preside over this crisis, they will carry the shame in years to come.
  9.35 pm
  The Minister for Health (Dr. Brian Mawhinney): In view of the self-proclaimed importance that the Opposition attach to the health service, some of us have wondered why they have not called such a debate for so long into this Parliament. Now we understand: they have not had such a debate because they had nothing to say. Indeed, some of us are driven to conclude that today's debate has more to do with the standing of the hon. Member for Sheffield, Brightside (Mr. Blunkett) in the shadow Cabinet than with the health service. I am sorry that the hon. Gentleman had the flu, and I hope that he will soon be feeling better. I shall not go into his speech in great detail. However, he talked about records of which Labour and Labour Governments were proud.
  I need to remind the hon. Gentleman, as did my hon. Friend the Member for Woodspring (Dr. Fox), that he forgot to mention the record of a real cut in NHS spending under the previous Labour Government. He also forgot another record which will have great relevance against his hon. Friends' rhetoric during the debate: in four of the five years of the previous Labour Government, nurses' pay was cut in real terms. I hope that the hon. Member for Darlington (Mr. Milburn) will take careful note of that point.
  Another of the hon. Gentleman's points that interested me involved accountability. My right hon. Friend the Secretary of State dealt with that in political terms, but I am genuinely surprised that the hon. Gentleman and the hon. Member for Bristol, South (Ms. Primarolo) have taken such a jaundiced view of the Government's attempts to empower patients by giving them as much information as they possibly can to enable them, in turn, to have informed conversations with their general practitioners, the better to get the type of care in the location and in the time frame most suitable for them.
  Not only is the help line being launched today but regional health authorities have had a number of similar schemes available for some time. Indeed, some have been publishing waiting list times in local newspapers. I believe that The Citizen in Peterborough was the first in the country to do so, and I applaud it. We believe that patients
  964
  should have as much information as possible because, after all, the service is designed to benefit them and to deal with their needs.
  The hon. Member for Bristol, South invited me to comment on the Bloomfield report and on selective lists. When the Government said that they would listen to the views of people in the NHS, of dentists and patients before reaching a conclusion on the report, they meant what they said. On the whole, the hon. Lady is encouraging us to consult and listen and to try to find common ground, so she will not take it amiss if I do not accept her generous invitation but stick to the consistency which, as she is learning to appreciate, is shown by the Government.
  I sum up the speeches of Opposition Front-Bench Members as follows: nothing should change in our thinking in a world that is changing. To paraphrase more neatly, they seemed to say, "Stop the world, I want to get off."
  My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) raised two important points. First, she asked about AIDS testing. I can confirm that the arrangements that she set out are those contained in the General Medical Council guidance. I listened carefully to her speech, and I and my right hon. Friend the Secretary of State will reflect on it.
  Secondly, my hon. Friend the Member for Edgbaston spoke about an adoption story. I am sure that I am not alone in the House in being shocked by the details she gave. We have a strong commitment to and a strong appreciation of the work of social workers, but we draw definite lines beyond which they should not go. From what my hon. Friend has said, it seems that she knows of a case in which those lines were transgressed. If she would be kind enough to let me have the details of the case, I will ask my hon. Friend the Parliamentary Under-Secretary, the hon. Member for Suffolk, South (Mr. Yeo), who has responsibility for these matters, to investigate the case in depth.
  Mr. John Marshall: Will my hon. Friend give way?
  Dr. Mawhinney: No, because I should like to make a little progress.
  The hon. Member for Rochdale (Ms. Lynne) encouraged us to consult. She was, if she will forgive me for saying so, rather churlish about the efforts that the Government are making legitimately, sensibly and sensitively to do exactly what she wants us to do. I am pleased that she was gracious enough to recognise that, when she and her colleagues came to see me, I was genuinely consulting and genuinely listening. I assure her that I took note of the points they made.
  My hon. Friend the Member for Broxbourne (Mrs. Roe) made an important point. She said that management cannot be taken out of the context of care, and she was right. Some peddle the false argument that we have to choose between care, and the efficient and effective use of resources. That is a spurious dichotomy. As we use resources efficiently and effectively, we enable more patients to be treated. There is nothing from which to resile in wanting to see the £100 million a day we spend on the health service used to best effect.
  My hon. Friend the Member for Chislehurst (Mr. Sims) raised a number of questions about London to which I shall return in a few moments. He also expressed his

  965
  concern and regret about our decision on nurse prescribing. I pay tribute to my hon. Friend, who has been one of the strongest advocates in the House of nurse prescribing. The genesis of the policy, to which we are still committed and about which we are still enthusiastic, owes much to his advocacy.
  We are concerned to ensure that nurse prescribing is launched in an environment that is as conducive as possible to its success. We are not at all certain that the present climate, in which there is to be an extended discussion about the drugs bill and about prescribing generally, is the best in which to move forward that policy.
  My hon. Friend the Member for Chislehurst paid an appropriate tribute to the hospice movement and to its work. I am sure that that is a matter for appreciation across the House. There is nothing partisan in our appreciation of the work done by hospices. I am pleased to announce to the House a £43 million extra payment to charitable hospices through health authorities in the coming year to help them to provide support for voluntary hospices. The Department will provide £32·3 million for voluntary hospices. A further £5 million is to be given to health authorities to help them to pay for hospice care for terminally ill people as part of the community care changes, and £5·6 million is to give voluntary hospices access to drugs supplied by health authorities. That means that the total Government funding to voluntary hospices since 1991 is £l05·3 million.
  Mr. Blunkett: As we are not having an evening of churlishness, I should like to put it on record that the Opposition welcome that statement and wholeheartedly give their backing to the allocation of those resources to hospices, which do such good work.
  Dr. Mawhinney: I am grateful to the hon. Gentleman. I appreciate the generosity of his statement and of his gesture in making it.
  I pay tribute to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) for the assiduous way in which he has represented his constituents' views on the future of St. Bartholomew's hospital. Indeed, outside my family, I have probably written more letters to him than to anyone else in the whole world in the whole of my life.
  The hon. Gentleman is in danger of going down in this debate as a tease because he raised my expectations to fever pitch and was cut off in his prime. So exceptionally —I hope that you will not feel that I am transgressing your 10–minute rule, Madam Deputy Speaker—I am happy to give way to the hon. Gentleman to let him have his expectation.
  Mr. Sedgemore: I am grateful to the Minister for allowing me to intervene. I received a telephone call from Professor Besser, the chief executive of Bart's, this morning. He said that Bart's should be making an announcement in the next few days that it can finance the whole of its non-recurring deficit and that its recurring deficit should so be slashed that it will be close to having a balanced budget.
  Dr. Mawhinney: The hon. Gentleman will understand, given the discussions that we have had in the past few months, if I hang on to my ecstasy for a little longer until I see the small print.
  966
  While the hon. Gentleman was personally generous, I deplored the attack that he launched on my right hon. Friend the Secretary of State. It was without justification or foundation. I hope that he will find it possible to withdraw it on a suitable occasion.
  My hon. Friend the Member for Beverley (Mr. Cran) was entirely right to draw attention to the importance of day care surgery and the effect that it is having on the ability of the NHS to treat patients.
  I intended to dissect the Opposition motion this evening, but my hon. Friend the Member for Harlow (Mr. Hayes) did it for me and probably did it better than I could. He pointed out that for every claim in a newspaper there was a counter-claim in another newspaper and that mutually exclusive statements were made elsewhere. He said that, while the Opposition Front-Bench team had been busy, it did not have an idea what it had been busy about.
  Only a fraction of hospitals are affected by the crisis that Opposition Members have unsuccessfully tried to sell to the House this evening. We spend £100 million a day on the NHS. It has treated 600,000 more patients on average every year since the reforms were introduced. The number of people who wait between one and two years is down by more than 50 per cent. since the reforms were introduced. According to a recent survey in Doctor magazine, 70 per cent. of GP fund holders recorded reduced waits and improvements in efficiency.
  The NHS trusts treated 8·2 per cent. more patients in the first year of operation, compared with 7·2 per cent. for the directly managed units. In other words, no matter how we approach the reforms—whether it is trusts, GP fund holders, quality, waiting lists or convenience to patients —they are delivering better services for patients.
  Mr. David Trimble: Not only the Opposition Front-Bench team is in two minds. As the Minister knows, in Northern Ireland the boards of both the local health authorities and the hospital trusts are composed of Government appointees. He may also be aware that a trust will come into operation in my constituency in a couple of months. However, the health board is rushing through a review which threatens to close two hospitals, thus pre-empting what the trust might do. We have good reason to believe that the trust will keep at least one and perhaps both hospitals open. Is not that an example of bad co-ordination and management?
  Dr. Mawhinney: The hon. Gentleman's constituents are fortunate if they are to have a trust in a couple of months because they can look forward to better patient care and more treatments. I was in the Province for six and a quarter years and it may have appeared to the hon. Gentleman that I was a permanent fixture. However I was not, and he will have to raise those issues with my right hon. and learned Friend the Secretary of State for Northern Ireland.
  Mr. John Marshall: My hon. Friend will be aware that the London gender clinic is in my constituency and that its activity has caused great concern. Will he ensure that it operates within the law and look at any lacuna by which it may have breached the law?
  Dr. Mawhinney: As my hon. Friend may be aware, the British Medical Association has expressed some views

  967
  about the clinic and the HEFEA committee has published a paper on the issue. We are looking carefully at the matter.
  The characteristic feature of the debate is that, while we have been speaking about patient treatment and care and numbers of patients, the Opposition have spoken about beds and buildings. I suppose that that represents the division on thinking between us. For more than 40 years the health service was provider driven. As a result of the reforms, it should become purchaser driven, with the needs of the patient at the centre.
  I accept without embarrassment or difficulty that a service that has been running for more than 40 years on provider lines and has to start running on purchaser lines will find that that line is not unlikely to be as strong as the previous one. There are obvious reasons for that and it takes time to build expertise. It would be absurd to suggest that there is not a single case among the 45 million people whose lives are touched by the NHS in any one year in which the system has not worked to maximum advantage. We are debating 1 million employees, 45 million patients and an organisation with a budget in England of £30 billion.
  However, I am perfectly prepared to defend the reforms, to laud the advantages that they are bringing to patients, to confirm the strengthening of the purchasing line year by year and to recognise that the contracting process needs to be properly managed. It is more likely to be properly managed if hospitals, doctors and consultants are included at an early stage in management discussions. It is likely to be even better managed if GPs who are not fund holders enter into early discussions with purchasers, with the district health authorities, so that when those authorities are putting contracts to providers they will do so in a way that satisfies the GPs in the area.
  We have heard much about GPs. It is quite wrong to assume that GPs who are not fund holders are unable to influence the standard of care that is available to their patients. I should like to see more influence exercised by GPs on the district health authorities as they prepare contracts for hospitals. I hope that those with management responsibilities in the trusts will recognise that their ability to deliver consistent health care throughout the year will be improved if doctors are involved in the process from the beginning.
  My hon. Friend the Member for Havant (Mr. Willetts) made an excellent speech, as one would expect because he clearly understands the importance of the freedoms—[interruption.]
  Madam Speaker: Order. I should be obliged if hon. Members on both front Benches below the Gangway ceased their conversations so that I might hear the Minister.
  Dr. Mawhinney: My hon. Friend clearly understands the importance of the freedoms that we have given to GPs and the importance that we attach to their fundamental role. If the service is to be as sensitive as possible to the needs of the patient, the GP must be involved in the system as much as possible.
  My hon. Friend was right. The proof of the pudding is in the eating. We are not coercing, forcing or cajoling GPs to become fund holders. The debate on trusts is over. By April 1994, something like 95 per cent. of all the provider units in the country will be trusts, and if the Opposition
  968
  ever come up with a policy they will not be able to put it into effect if that policy in any way involves dismantling trusts. Of course they will not get into office, so it is a bit of a hypothetical point.
  At the heart of the reforms is the role of the GP and of the GP fund holder, and GP fund holders are increasing in number precisely because they recognise that they can provide more, better and more sensitive services to their patients.
  It is worth reminding Opposition Members that we have made it easier for patients to move from their GPs if they are dissatisfied. What is happening to GP fund holders? Their lists are not going down but up. To talk about a two-tier system is totally to misunderstand the heart of the Government's reforms. It is not a two-tier system but a shared purchasing system. I am very clear, particularly given the record of Opposition Members in this debate, that we shall have to keep on saying that to them regularly month by month for a long time until finally the penny drops. The penny will need to drop because GP fund holders are at the heart of the reforms and will drive forward the improvements we are all committed to making.
  Turning to the question of London, I wish to pay tribute to Sir Bernard Tomlinson, a distinguished academic and public servant who has produced an excellent report. He does not deserve some of the personal abuse which has been heaped on him over the past three months. It is important to understand that the Tomlinson report, which remains, until my right hon. Friend makes her decisions, advice to Government, is not about whether one closes a hospital here or merges a couple of hospitals there but rather about the re-configuring of health care in London. The fact is that change is taking place and even the hon. Member for Brightside once recognised that London's status quo could not be maintained. He has wobbled a bit and waffled a bit since, but he did at least recognise that.
  Part of the change is reflected in increased standards of health care provision in hospitals outside London so that those who used to send their patients to London no longer have to do so, because the patients do not want to travel if they do not have to and they can get treatment at home.
  We have been consulting. I have been listening to representatives of the users, of the providers and of the purchasers as well as to the politicians, and I recognise the importance of primary care. Tomlinson does and so do we. In addressing primary and community care, we recognise that we have to address the problems of bed blocking in hospitals. All of my conversations have been confidential. but I will give the House one piece of information from a medium sized teaching hospital in London, which told me that on every day of the year between 60 and 100 of its beds are blocked by people who are clinically discharged but cannot go home because of inadequacies in primary care. We recognise the importance of addressing that issue.
  It is easy to sum up this debate. There is a crisis. It is a crisis in the Labour party; and those who do not believe it should have been watching the face of the Leader of the Opposition when the hon. Member for Brightside was speaking. The Labour party policy on the NHS was rejected by the public in April. Now there is not even a policy, not a whiff of a policy. The Opposition have elevated the whinge to an art form.
  Labour Members have a concern for individuals, as do all of us. The difference between us is that we are

  969
  developing systems that ensure that more patients are treated to higher standards and with more regard to their wishes than ever before. GP fund holding is at the heart of those reforms.
  The public's appreciation of the NHS is far greater than the Opposition's. Its appreciation of what we have done to improve the NHS is far greater than the Opposition's. Our commitment to the NHS is clearly far greater than the Opposition's. For those reasons, our vote tonight will be far greater than the Opposition's.
  Question put, That the original words stand part of the Question:
  The House divided: Ayes 281, Noes 316.

  Division No. 125]

  [9.59 pm

  AYES

  Abbott, Ms Diane

  Corston, Ms Jean

  Adams, Mrs Irene

  Cousins, Jim

  Ainger, Nick

  Cox, Tom

  Ainsworth, Robert (Cov'try NE)

  Cryer, Bob

  Allen, Graham

  Cummings, John

  Alton, David

  Cunliffe, Lawrence

  Anderson, Donald (Swansea E)

  Cunningham, Dr John (C'p'l'nd)

  Anderson, Ms Janet (Ros'dale)

  Dafis, Cynog

  Armstrong, Hilary

  Dalyell, Tam

  Ashton, Joe

  Darling, Alistair

  Austin-Walker, John

  Davidson, Ian

  Banks, Tony (Newham NW)

  Davies, Bryan (Oldham C'tral)

  Barnes, Harry

  Davies, Rt Hon Denzil (Llanelli)

  Battle, John

  Davies, Ron (Caerphilly)

  Bayley, Hugh

  Davis, Terry (B'ham, H'dge H'l)

  Beckett, Margaret

  Denham, John

  Beggs, Roy

  Dewar, Donald

  Beith, Rt Hon A. J.

  Dixon, Don

  Bell, Stuart

  Dobson, Frank

  Benn, Rt Hon Tony

  Donohoe, Brian H.

  Bennett, Andrew F.

  Dowd, Jim

  Benton, Joe

  Dunnachie, Jimmy

  Bermingham, Gerald

  Dunwoody, Mrs Gwyneth

  Berry, Dr. Roger

  Eagle, Ms Angela

  Betts, Clive

  Eastham, Ken

  Blair, Tony

  Enright, Derek

  Blunkett, David

  Etherington, Bill

  Boateng, Paul

  Evans, John (St Helens N)

  Boyce, Jimmy

  Ewing, Mrs Margaret

  Boyes, Roland

  Fatchett, Derek

  Bradley, Keith

  Faulds, Andrew

  Bray, Dr Jeremy

  Field, Frank (Birkenhead)

  Brown, Gordon (Dunfermline E)

  Fisher, Mark

  Brown, N. (N'c'tle upon Tyne E)

  Flynn, Paul

  Bruce, Malcolm (Gordon)

  Foster, Derek (B'p Auckland)

  Burden, Richard

  Foster, Don (Bath)

  Byers, Stephen

  Foulkes, George

  Caborn, Richard

  Fraser, John

  Callaghan, Jim

  Fyfe, Maria

  Campbell, Mrs Anne (C'bridge)

  Galbraith, Sam

  Campbell, Menzies (Fife NE)

  Galloway, George

  Campbell, Ronnie (Blyth V)

  Gapes, Mike

  Campbell-Savours, D. N.

  Garrett, John

  Canavan, Dennis

  George, Bruce

  Cann, Jamie

  Gerrard, Neil

  Carlile, Alexander (Montgomry)

  Gilbert, Rt Hon Dr John

  Chisholm, Malcolm

  Godman, Dr Norman A.

  Clapham, Michael

  Godsiff, Roger

  Clarke, Eric (Midlothian)

  Golding, Mrs Llin

  Clarke, Tom (Monklands W)

  Gordon, Mildred

  Clelland, David

  Gould, Bryan

  Clwyd, Mrs Ann

  Graham, Thomas

  Coffey, Ann

  Grant, Bernie (Tottenham)

  Cohen, Harry

  Griffiths, Win (Bridgend)

  Connarty, Michael

  Grocott, Bruce

  Cook, Robin (Livingston)

  Gunnell, John

  Corbett, Robin

  Hain, Peter

  Corbyn, Jeremy

  Hall, Mike

  970

  Hanson, David

  Morris, Estelle (B'ham Yardley)

  Hardy, Peter

  Morris, Rt Hon J. (Aberavon)

  Harman, Ms Harriet

  Mudie, George

  Harvey, Nick

  Mullin, Chris

  Hattersley, Rt Hon Roy

  Murphy, Paul

  Hendron, Dr Joe

  Oakes, Rt Hon Gordon

  Heppell, John

  O'Brien, Michael (N W'kshire)

  Hill, Keith (Streatham)

  O'Brien, William (Normanton)

  Hinchliffe, David

  O'Hara, Edward

  Hoey, Kate

  Olner, William

  Home Robertson, John

  O'Neill, Martin

  Hood, Jimmy

  Orme, Rt Hon Stanley

  Hoon, Geoffrey

  Parry, Robert

  Howarth, George (Knowsley N)

  Patchett, Terry

  Hoyle, Doug

  Pendry, Tom

  Hughes, Kevin (Doncaster N)

  Pickthall, Colin

  Hughes, Robert (Aberdeen N)

  Pike, Peter L.

  Hughes, Roy (Newport E)

  Pope, Greg

  Hughes, Simon (Southwark)

  Powell, Ray (Ogmore)

  Hutton, John

  Prentice, Ms Bridget (Lew'm E)

  Ingram, Adam

  Prentice, Gordon (Pendle)

  Jackson, Glenda (H'stead)

  Prescott, John

  Jackson, Helen (Shef'ld, H)

  Primarolo, Dawn

  Jamieson, David

  Purchase, Ken

  Janner, Greville

  Quin, Ms Joyce

  Jones, Barry (Alyn and D'side)

  Radice, Giles

  Jones, Ieuan Wyn (Ynys Môn)

  Randall, Stuart

  Jones, Jon Owen (Cardiff C)

  Raynsford, Nick

  Jones, Lynne (B'ham S O)

  Redmond, Martin

  Jones, Martyn (Clwyd, SW)

  Reid, Dr John

  Jones, Nigel (Cheltenham)

  Robertson, George (Hamilton)

  Kaufman, Rt Hon Gerald

  Robinson, Geoffrey (Co'try NW)

  Keen, Alan

  Roche, Mrs. Barbara

  Kennedy, Charles (Ross,C&S)

  Rogers, Allan

  Kennedy, Jane (Lpool Brdgn)

  Rooker, Jeff

  Khabra, Piara S.

  Rooney, Terry

  Kilfoyle, Peter

  Ross, Ernie (Dundee W)

  Kirkwood, Archy

  Rowlands, Ted

  Leighton, Ron

  Ruddock, Joan

  Lestor, Joan (Eccles)

  Salmond, Alex

  Lewis, Terry

  Sedgemore, Brian

  Litherland, Robert

  Sheerman, Barry

  Livingstone, Ken

  Sheldon, Rt Hon Robert

  Lloyd, Tony (Stretford)

  Shore, Rt Hon Peter

  Llwyd, Elfyn

  Short, Clare

  Loyden, Eddie

  Simpson, Alan

  Lynne, Ms Liz

  Skinner, Dennis

  McAllion, John

  Smith, C. (Isl'ton S & F'sbury)

  McAvoy, Thomas

  Smith, Rt Hon John (M'kl'ds E)

  McCartney, Ian

  Smith, Llew (Blaenau Gwent)

  McCrea, Rev William

  Soley, Clive

  Macdonald, Calum

  Spearing, Nigel

  McFall, John

  Spellar, John

  McKelvey, William

  Squire, Rachel (Dunfermline W)

  McLeish, Henry

  Steel, Rt Hon Sir David

  Maclennan, Robert

  Steinberg, Gerry

  McMaster, Gordon

  Stevenson, George

  McNamara, Kevin

  Stott, Roger

  McWilliam, John

  Strang, Dr. Gavin

  Madden, Max

  Straw, Jack

  Mahon, Alice

  Taylor, Mrs Ann (Dewsbury)

  Mandelson, Peter

  Taylor, Matthew (Truro)

  Marek, Dr John

  Thompson, Jack (Wansbeck)

  Marshall, David (Shettleston)

  Tipping, Paddy

  Marshall, Jim (Leicester, S)

  Trimble, David

  Martin, Michael J. (Springburn)

  Turner, Dennis

  Martlew, Eric

  Tyler, Paul

  Maxton, John

  Vaz, Keith

  Meacher, Michael

  Walker, Rt Hon Sir Harold

  Meale, Alan

  Wallace, James

  Michael, Alun

  Walley, Joan

  Michie, Bill (Sheffield Heeley)

  Wardell, Gareth (Gower)

  Michie, Mrs Ray (Argyll Bute)

  Wareing, Robert N

  Milburn, Alan

  Watson, Mike

  Miller, Andrew

  Welsh, Andrew

  Mitchell, Austin (Gt Grimsby)

  Wicks, Malcolm

  Moonie, Dr Lewis

  Wigley, Dafydd

  Morgan, Rhodri

  Williams, Rt Hon Alan (Sw'n W)

  Morley, Elliot

  Williams, Alan W (Carmarthen)

  Morris, Rt Hon A. (Wy'nshawe)

  Wilson, Brian

  971

  Winnick, David

  Wise, Audrey

  Tellers for the Ayes:

  Worthington, Tony

  Mr. Andrew Mackinlay and

  Wright, Dr Tony

  Mr. Eric Illsley.

  Young, David (Bolton SE)

  NOES

  Adley, Robert

  Davis, David (Boothferry)

  Ainsworth, Peter (East Surrey)

  Day, Stephen

  Aitken, Jonathan

  Deva, Nirj Joseph

  Alexander, Richard

  Devlin, Tim

  Alison, Rt Hon Michael (Selby)

  Dickens, Geoffrey

  Allason, Rupert (Torbay)

  Dicks, Terry

  Amess, David

  Dorrell, Stephen

  Ancram, Michael

  Douglas-Hamilton, Lord James

  Arbuthnot, James

  Dover, Den

  Arnold, Jacques (Gravesham)

  Duncan, Alan

  Arnold, Sir Thomas (Hazel Grv)

  Duncan-Smith, Iain

  Ashby, David

  Dunn, Bob

  Aspinwall, Jack

  Durant, Sir Anthony

  Atkinson, David (Bour'mouth E)

  Dykes, Hugh

  Atkinson, Peter (Hexham)

  Eggar, Tim

  Baker, Rt Hon K. (Mole Valley)

  Elletson, Harold

  Baker, Nicholas (Dorset North)

  Emery, Rt Hon Sir Peter

  Baldry, Tony

  Evans, David (Welwyn Hatfield)

  Banks, Matthew (Southport)

  Evans, Jonathan (Brecon)

  Banks, Robert (Harrogate)

  Evans, Nigel (Ribble Valley)

  Bates, Michael

  Evans, Roger (Monmouth)

  Batiste, Spencer

  Evennett, David

  Bellingham, Henry

  Faber, David

  Bendall, Vivian

  Fabricant, Michael

  Beresford, Sir Paul

  Fairbairn, Sir Nicholas

  Biffen, Rt Hon John

  Fenner, Dame Peggy

  Blackburn, Dr John G.

  Field, Barry (Isle of Wight)

  Body, Sir Richard

  Fishburn, Dudley

  Bonsor, Sir Nicholas

  Forman, Nigel

  Booth, Hartley

  Forsyth, Michael (Stirling)

  Boswell, Tim

  Forth, Eric

  Bottomley, Peter (Eltham)

  Fowler, Rt Hon Sir Norman

  Bottomley, Rt Hon Virginia

  Fox, Dr Liam (Woodspring)

  Bowden, Andrew

  Fox, Sir Marcus (Shipley)

  Bowis, John

  Freeman, Roger

  Boyson, Rt Hon Sir Rhodes

  French, Douglas

  Brandreth, Gyles

  Fry, Peter

  Brazier, Julian

  Gale, Roger

  Brooke, Rt Hon Peter

  Gallie, Phil

  Brown, M. (Brigg & Cl'thorpes)

  Gardiner, Sir George

  Browning, Mrs. Angela

  Garel-Jones, Rt Hon Tristan

  Bruce, Ian (S Dorset)

  Garnier, Edward

  Budgen, Nicholas

  Gill, Christopher

  Burns, Simon

  Gillan, Cheryl

  Burt, Alistair

  Goodlad, Rt Hon Alastair

  Butcher, John

  Goodson-Wickes, Dr Charles

  Butler, Peter

  Gorman, Mrs Teresa

  Butterfill, John

  Gorst, John

  Carlisle, John (Luton North)

  Grant, Sir Anthony (Cambs SW)

  Carlisle, Kenneth (Lincoln)

  Greenway, Harry (Ealing N)

  Carrington, Matthew

  Greenway, John (Ryedale)

  Carttiss, Michael

  Griffiths, Peter (Portsmouth, N)

  Cash, William

  Grylls, Sir Michael

  Channon, Rt Hon Paul

  Hague, William

  Chaplin, Mrs Judith

  Hamilton, Rt Hon Archie (Epsom)

  Churchill, Mr

  Hamilton, Neil (Tatton)

  Clappison, James

  Hampson, Dr Keith

  Clark, Dr Michael (Rochford)

  Hannam, Sir John

  Clarke, Rt Hon Kenneth (Ruclif)

  Hargreaves, Andrew

  Clifton-Brown, Geoffrey

  Harris, David

  Coe, Sebastian

  Haselhurst, Alan

  Colvin, Michael

  Hawkins, Nick

  Congdon, David

  Hawksley, Warren

  Conway, Derek

  Hayes, Jerry

  Coombs, Anthony (Wyre For'st)

  Heald, Oliver

  Coombs, Simon (Swindon)

  Heath, Rt Hon Sir Edward

  Cope, Rt Hon Sir John

  Heathcoat-Amory, David

  Cormack, Patrick

  Hendry, Charles

  Couchman, James

  Heseltine, Rt Hon Michael

  Cran, James

  Hicks, Robert

  Currie, Mrs Edwina (S D'by'ire)

  Higgins, Rt Hon Sir Terence L.

  Curry, David (Skipton & Ripon)

  Hill, James (Southampton Test)

  Davies, Quentin (Stamford)

  Hogg, Rt Hon Douglas (G'tham)

  972

  Horam, John

  Pickles, Eric

  Hordern, Rt Hon Sir Peter

  Porter, Barry (Wirral S)

  Howard, Rt Hon Michael

  Porter, David (Waveney)

  Howarth, Alan (Strat'rd-on-A)

  Portillo, Rt Hon Michael

  Howell, Rt Hon David (G'dford)

  Powell, William (Corby)

  Hughes Robert G. (Harrow W)

  Rathbone, Tim

  Hunt, Rt Hon David (Wirral W)

  Redwood, John

  Hunt, Sir John (Ravensbourne)

  Renton, Rt Hon Tim

  Hunter, Andrew

  Richards, Rod

  Hurd, Rt Hon Douglas

  Riddick, Graham

  Jack, Michael

  Rifkind, Rt Hon. Malcolm

  Jackson, Robert (Wantage)

  Robathan, Andrew

  Jenkin, Bernard

  Roberts, Rt Hon Sir Wyn

  Jessel, Toby

  Robertson, Raymond (Ab'd'n S)

  Jones, Gwilym (Cardiff N)

  Robinson, Mark (Somerton)

  Jones, Robert B. (W Hertfdshr)

  Roe, Mrs Marion (Broxbourne)

  Kellett-Bowman, Dame Elaine

  Rowe, Andrew (Mid Kent)

  Key, Robert

  Rumbold, Rt Hon Dame Angela

  Kilfedder, Sir James

  Ryder, Rt Hon Richard

  Kirkhope, Timothy

  Sackville, Tom

  Knapman, Roger

  Sainsbury, Rt Hon Tim

  Knight, Mrs Angela (Erewash)

  Scott, Rt Hon Nicholas

  Knight, Greg (Derby N)

  Shaw, David (Dover)

  Knight, Dame Jill (Bir'm E'st'n)

  Shaw, Sir Giles (Pudsey)

  Knox, David

  Shephard, Rt Hon Gillian

  Kynoch, George (Kincardine)

  Shepherd, Colin (Hereford)

  Lait, Mrs Jacqui

  Shersby, Michael

  Lamont, Rt Hon Norman

  Sims, Roger

  Lang, Rt Hon Ian

  Skeet, Sir Trevor

  Lawrence, Sir Ivan

  Smith, Sir Dudley (Warwick)

  Legg, Barry

  Smith, Tim (Beaconsfield)

  Leigh, Edward

  Soames, Nicholas

  Lester, Jim (Broxtowe)

  Speed, Sir Keith

  Lidington, David

  Spencer, Sir Derek

  Lilley, Rt Hon Peter

  Spicer, Sir James (W Dorset)

  Lloyd, Peter (Fareham)

  Spicer, Michael (S Worcs)

  Lord, Michael

  Spink, Dr Robert

  Luff, Peter

  Spring, Richard

  Lyell, Rt Hon Sir Nicholas

  Sproat, Iain

  MacGregor, Rt Hon John

  Squire, Robin (Hornchurch)

  MacKay, Andrew

  Stanley, Rt Hon Sir John

  Maclean, David

  Steen, Anthony

  McLoughlin, Patrick

  Stephen, Michael

  McNair-Wilson, Sir Patrick

  Stern, Michael

  Madel, David

  Streeter, Gary

  Maitland, Lady Olga

  Sumberg, David

  Malone, Gerald

  Sweeney, Walter

  Mans, Keith

  Sykes, John

  Marlow, Tony

  Tapsell, Sir Peter

  Marshall, John (Hendon S)

  Taylor, Ian (Esher)

  Marshall, Sir Michael (Arundel)

  Taylor, John M. (Solihull)

  Martin, David (Portsmouth S)

  Taylor, Sir Teddy (Southend, E)

  Mawhinney, Dr Brian

  Temple-Morris, Peter

  Mayhew, Rt Hon Sir Patrick

  Thomason, Roy

  Mellor, Rt Hon David

  Thompson, Sir Donald (C'er V)

  Merchant, Piers

  Thompson, Patrick (Norwich N)

  Milligan, Stephen

  Thornton, Sir Malcolm

  Mills, Iain

  Thurnham, Peter

  Mitchell, Andrew (Gedling)

  Townend, John (Bridlington)

  Mitchell, Sir David (Hants NW)

  Townsend, Cyril D. (Bexl'yh'th)

  Moate, Sir Roger

  Tracey, Richard

  Monro, Sir Hector

  Tredinnick, David

  Montgomery, Sir Fergus

  Trend, Michael

  Moss, Malcolm

  Trotter, Neville

  Nelson, Anthony

  Twinn, Dr Ian

  Neubert, Sir Michael

  Vaughan, Sir Gerard

  Nicholls, Patrick

  Viggers, Peter

  Nicholson, David (Taunton)

  Waldegrave, Rt Hon William

  Nicholson, Emma (Devon West)

  Walden, George

  Norris, Steve

  Walker, Bill (N Tayside)

  Onslow, Rt Hon Sir Cranley

  Waller, Gary

  Oppenheim, Phillip

  Ward, John

  Ottaway, Richard

  Wardle, Charles (Bexhill)

  Page, Richard

  Waterson, Nigel

  Paice, James

  Watts, John

  Patnick, Irvine

  Wells, Bowen

  Patten, Rt Hon John

  Wheeler, Rt Hon Sir John

  Pattie, Rt Hon Sir Geoffrey

  Whitney, Ray

  Pawsey, James

  Whittingdale, John

  Peacock, Mrs Elizabeth

  Widdecombe, Ann

  973

  Wiggin, Sir Jerry

  Wood, Timothy

  Wilkinson, John

  Yeo, Tim

  Willetts, David

  Young, Sir George (Acton)

  Wilshire, David

  Winterton, Mrs Ann (Congleton)

  Tellers for the Noes:

  Winterton, Nicholas (Macc'f'ld)

  Mr. Sydney Chapman and

  Wolfson, Mark

  Mr. David Lightbown.

  Question accordingly negatived.
  Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.
  Madam Speaker forthwith declared the main Question, as amended, to be agreed to.
  Resolved,
  That this House congratulates Her Majesty's Government on its reforms to the National Health Service which have led to record numbers of patients being treated, the elimination of two year waiting lists in the regions, a substantial reduction in long waiting times generally and significant improvements in the quality of care; looks forward to more general practitioner fundholders and National Health Service trusts and the futher improvements they will bring; and believes that in the modern health service the focus should be on patients and prevention and not on politicisation, which remains the dominant concern of Her Majesty's Opposition.

  SCA Aylesford Ltd
  10.14 pm
  The Minister for Industry (Mr. Tim Sainsbury): I beg to move,
  That this House authorises the Secretary of State to pay, or undertake to pay, by way of financial assistance under section 8 of the Industrial Development Act 1982, in respect of the installation of new and the refurbishment of existing machinery to manufacture newsprint from recycled fibre at Aylesford, Kent by SCA Aylesford Ltd, sums exceeding £ l0,000,000 but not exceeding £20,000,000.
  As the House knows, last March my right hon. Friend the then Secretary of State announced our intention to provide a grant of not more than £20 million to SCA Aylesford Ltd towards the cost of an investment in a project to manufacture newsprint from recycled fibre at Aylesford, near Maidstone in Kent. The project is estimated to cost no less than £260 million.
  We propose to provide the financial support through the Department's assistance-for-exceptional-projects facility. That is funded under section 8 of the Industrial Development Act 1982, under which the approval of the House is required before assistance of more than £10 million can be granted to any single project.
  The purpose of the AEP facility is to assist a small number of investment projects and research and development projects that are likely to yield exceptional national benefits. Applicants must also show that the project is commercially viable and that, despite its exceptional merits, assistance is necessary to enable the project to go ahead as planned. Assistance is provided on a selective basis, usually as a grant. The amount is negotiated as the minimum necessary for the project to go ahead and is subject to a maximum of 25 per cent. of eligible costs. In SCA's case, the exceptional national benefits are environmental and the project has the strong support of my right hon. and learned Friend the Secretary of State for the Environment.
  SCA currently operates a single newsprint machine at Aylesford, which manufactures 80,000 tonnes of newsprint annually from 100 per cent. recycled fibre. Indeed, it is the only company in Europe presently manufacturing newsprint wholly from that source of raw material.
  The project is to install an additional machine, together with the associated de-inking, water treatment and other facilities required to manufacture a further 250,000 tonnes of newsprint a year wholly from recycled fibre. The existing 80,000-tonne machine will also be refurbished to improve the quality of its output and increase it by 26,000 tonnes a year.
  In all, the plant will consume some 430,000 tonnes of waste paper a year, much of it from household waste. The developments will enable the feedstock to consist of 80 per cent. post-consumer waste—that is, old newspapers and magazines—and only 20 per cent. pre-consumer waste. That would reverse the proportions used by the present machine.
  The project will thus make a major contribution to our target for recycling 25 per cent. of domestic waste by the end of the century. To help to meet that target, British newspaper publishers have also agreed that they will use 40 per cent. of recycled fibre in their publications by the year 2000. A new accessible source of wastepaper-based newsprint is vital if publishers are to fulfil the undertaking from United Kingdom sources.

  975

  In due course, the project will create an additional 100 permanent jobs. It would be uneconomic simply to refurbish the current machine unless the new machine is installed. The project will therefore also safeguard almost 300 existing jobs at the Aylesford site. Construction work will give rise at a peak to about 1,000 additional temporary jobs.
  A detailed assessment of the project has been carried out by my Department in conjunction with the Department of the Environment. That has established that all the criteria of the AEP facility have been satisfied and that an offer of £20 million would be justified. The independent Industrial Development Advisory Board, which advises the Department on the provision of selective financial assistance, has also recommended that support of £20 million should be offered.
  We have also notified the European Commission of our intention to assist SCA Aylesford. It has recently informed us that it considers that the project is of demonstrable environmental interest to the European Community, that the aid is necessary for the project to take place, and that the level of aid is sufficiently modest to make it unlikely that it will distort trading conditions between member states.
  I should like to pay tribute to my right hon. Friend the Member for Tonbridge and Mailing (Sir J. Stanley), who first brought this environmentally significant project to the Government's attention in 1991, and whose support has been invaluable. We have greatly valued his continuing and energetic support, particularly during our discussions with the European Commission.
  I believe that SCA's project will make a valuable contribution to the infrastructure for recycling household waste in this country. In asking the House to approve the proposed assistance, I therefore particularly commend the project's potential for recycling waste material and for raising awareness of the commercial benefits of recycling.
  As I have said, this scheme was devised for very exceptional cases. That is why the criteria are deliberately very tightly drawn and difficult to satisfy. Of the many inquiries received by my Department during the five years the scheme has been in existence, only 55 projects justified further consideration. We accepted fewer than 10 for a time-consuming full appraisal process. Of these, only two have succeeded in meeting the criteria and have been offered grant.
  I have therefore concluded that we should suspend this scheme for the present. The extreme difficulty of qualifying for grant means delay and uncertainty for companies. This complicates the often difficult decisions that they have to make on potentially eligible projects. The lengthy grant approval process involves an investment of resources by both the company and my Department.
  Mr. Rhodri Morgan: Would the Minister take time to explain this matter in the context of the motion before the House? My understanding was that we should be discussing simply a grant to SCA Aylesford, but the Minister has announced the suspension of the scheme, shutting the stable door after the horse—the grant to SCA Aylesford—has bolted. Is it not a matter requiring a separate statement if the Minister thinks that there should be no more grants of this type? Surely, out of courtesy, he should make a separate announcement.
  Mr. Sainsbury: My feeling was that the House would like to be told of the suspension of the scheme at the time of the announcement of this grant as the two matters are very closely related. Obviously this is a very substantial grant.
  Mr. Morgan: Will the right hon. Gentleman give way?
  Mr. Sainsbury: Perhaps the hon. Gentleman will allow me to give an explanation that should meet his point.
  As I have already pointed out, in the case of most applicants, this investment does not produce a return by way of grant. In addition, the scheme requires that Government funds be earmarked for possible successful applicants. I am sure that the hon. Gentleman will understand that. Often these funds have not been spent, as there have not been any successful applicants. It is clear that the funds might more effectively have been used for other schemes. That is inefficiency that we cannot afford, particularly with the very heavy current pressure on public expenditure, of which the House is aware.
  Relaxing the criteria and making more grant offers is not a practical possibility, as we—like Opposition Members, I hope—attach great importance to the existence of a level playing field in Europe. The Commission has required member states to phase out general investment support schemes outside assisted areas. We strongly support its efforts to limit such schemes as they can so easily distort competition. We should not want to detract from the Commission's efforts, and thus undermine the achievement of the objective of a level playing field throughout the Community, by operating our scheme less rigorously than at present. I should, however, emphasise most strongly that regional assistance will continue to be available in the assisted areas.
  In those circumstances, and in the light of the substantial grant that I am asking the House to approve and of the demand on funds that that represents, I intend to suspend the operation of the assistance-for-exceptional-projects facility with effect from the end of February for the next financial year. No further applications will therefore be accepted from the end of February, and the scheme will be suspended until April 1994.
  I stress that I shall keep the position under review and make a further announcement in due course. Applications which have already been received, or which are received by the end of February and which are adequately prepared and sufficiently developed to enable appraisal to go forward, will be fully considered against the criteria of the scheme. I can confirm that we shall consider against those criteria the application currently being pursued by North British Newsprint in respect of the Gartcosh project.
  I repeat my thanks to my right hon. Friend the Member for Tonbridge and Mailing for bringing SCA Aylesford's project to the attention of the Government. I emphasise the exceptional environmental advantage of the project that we are considering today and I ask the House to agree the motion.
  10.24 pm
  Mr. Derek Fatchett: I had thought that we would have a broadly consensual debate on the application for money and the agreement by Government to make money available to SCA, but I must say that the Minister's announcement at the end of his speech was, in

  977
  my view, a discourtesy to the House. It is, Madam Speaker, as you fully realise, a very tight motion which relates to the Industrial Development Act 1982, to section 8 of that Act and to a particular project. For the Minister to come to the House and announce the suspension of the scheme in this way is discourteous. It should have been announced in a different way. There should have been a statement in prime time to give other hon. Members the opportunity of asking questions of the Minister.
  The Government did not even have the courtesy or the courage to put this on the Order Paper. It is a substantial change in policy dictated by one of two reasons. Either it has been dictated by financial concerns, which is a further indication that the Government are in difficulty with their trade and industry budget—perhaps the Minister will confirm that—or it has been dictated to the Government by the European Commission. The Minister talked about a level playing field. Perhaps he could make it clear to us whether this is a result of the intervention of the European Commission. If so, the House has a right to know.
  The Minister's statement is cursory and unreasonable, having regard to hon. Members' right to know about important statements of this sort. I am sure that, as a courtesy to yourself, Madam Speaker, and to the House it would have made some sense if the Government had put down a motion related not just to SCA but to the broader issue. I realise, Madam Speaker, that in many respects I am out of order in making these general comments, but I think that it is appropriate in the circumstances when the Minister has taken the opportunity to make a wider statement.
  Madam Speaker: May I make the point that the Minister of State has opened it up, and the hon. Gentleman is perfectly in order, once the Minister has done so.
  Mr. Fatchett: I realise that, Madam Speaker. I meant that it may have been discourteous to you and the House for the Minister to make the statement in this way.
  The statement raises a number of points which also relate to the more general issues. Why this particular scheme? The criteria are set out in the Government's documentation under the Industrial Development Act 1982—the annual report for the year ending 31 March 1992. We welcome this scheme. We believe that it has environmental advantages. We are also delighted to hear that the Department of the Environment agrees with the Department of Trade and Industry on this project. It may be almost unique at the moment for the Secretary of State for the Environment to agree with the President of the Board of Trade, so the SCA scheme has brought together two members of a warring Cabinet and it may reflect further credit on the right hon. Member for Tonbridge and Mailing (Sir J. Stanley). He must have healing tendencies.
  The Minister said that the scheme may need to be looked at because of the number of projects that have been approved, but, as my hon. Friend the Member for Cardiff, West (Mr. Morgan) said, it is not because of the lack of projects. It is interesting to look through the number of applications received in the year to 31 March 1992. All but two of the 44 applications were turned down. All the way across the country, project after project was turned down because, according to the Department of Trade and
  978
  Industry, it did not meet the requirements set out. Two projects for Wales gained approval and expenditure of £4·2 million.
  Mr. Sainsbury: One project.
  Mr. Fatchett: I only read the documents that the Department of Trade and Industry pushes out. It is difficult to conclude other than that two projects received offers. Perhaps the Minister is suggesting that only one of those offers was taken up.
  Mr. Sainsbury: It may be a little confusing. Perhaps I can help. Two separate companies were involved, each receiving a grant in respect of the same project. Therefore, it was effectively one project.
  Mr. Fatchett: We seem to have resolved that small matter. Two companies, one project, 44 applications, only two approved.
  The Minister says that it would be unreasonable to change the criteria, so the scheme is stopped altogether. If various companies have expressed an interest in relation to 44 projects, would it not also have been sensible, instead of announcing the suspension of the scheme without consultation, for the Government to have consulted so that people could comment on the nature of the scheme, its success, whether the criteria need to be changed or whether schemes could fall within the criteria? But the Government do not even bother to consider consultation on that basis.
  The Minister has given reasons for this particular scheme. He also commented on the Gartcosh scheme, which has many similarities to the SCA scheme. Will the Gartcosh scheme now gain Government approval? I understand that if section 8 money had been made available to that scheme in 1991, when it was short of only £15 million out of £250 million, it would now be on stream. Perhaps the Minister will give us the details of the Gartcosh scheme, and where it now stands. When there is such difficulty in finding successful applicants for the scheme, will he explain why, in 1991, when Gartcosh was so close to achieving all the criteria, the Government did not make the necessary money available?
  As with any scheme of this sort, a number of issues are raised. We are told that the scheme qualifies only if the capital investment is guaranteed by the scheme and will not be available in any other form. The Minister provided no evidence that that condition has been met in relation to this scheme. Why has the Minister come to the conclusion that this scheme, and this scheme alone, will be in a difficult position and not attract the capital investment other than by means of the grant?
  The Minister skated over the job implications of the scheme. As I understand it, he said that the SCA scheme would protect an existing 300 jobs. We welcome that. He also said that there would be 1,000 temporary construction jobs. But in the long term the scheme will not create one new job. It will simply protect existing jobs. I hope that the Minister will confirm that that is the case.
  The National Audit Office report in relation to Wales, not necessarily the Department of Trade and Industry, entitled "Creating and safeguarding jobs in Wales", published in October 1991, criticised the Government for not always having effective forecasts and estimates of the job creation implications of particular schemes. It said:
  "From the point of view of jobs alone, the National Audit Office believe that the bodies have been slow to make forecasts

  979
  for and assess the achievements of the initiatives by measuring and verifying actual jobs achieved and by undertaking more regular and communally devised evaluation studies."
  That may apply to this scheme as well.
  The Minister will be aware that SCA has not just had an interest in the constituency of the right hon. Member for Tonbridge and Mailing in Aylesford in Kent, but also has or had an interest in Blackburn. SCA bought out the Reed paper organisation, and, on that basis, inherited the Sun paper mill in Blackburn, which employed 180 people and was closed last July. Other buyers were interested, but the impression given is that SCA was not concerned about the possibility of selling the land to any buyer; it was keen to close the mill, and to concentrate its activities on Aylesford.
  In the Minister's calculation of jobs and his discussions with the company, has he taken any account of the 180 jobs that have been lost in Blackburn as a result of SCA's decision to close the Sun paper mill? If he has not, the equation changes dramatically.
  Finally, I should like the Minister to say more about the details of the scheme. I am relying solely on what the Financial Times said on 12 January about the construction contracts. The Minister may well have more information; if so, I defer to his greater knowledge.
  According to the Financial Times,
  "John Brown, a member of the engineering division of Trafalgar House, is to construct a … gas turbine based heat and power … plant at … SCA … papermaking site in Kent.
  The company was awarded the Aylesford contract by National Power who will own the plant and supply the electrical power and heat to meet SCA's current energy and process needs on site."
  Will the Minister tell us whether that gas-driven scheme, however small it may be, was taken into account in some of the broader energy discussions? Were the energy implications noted?
  I welcome the grant, and the support for the plant. I have raised a number of detailed questions. We are keen to know about the future of Gartcosh, the implications of the job losses for Blackburn and the evidence that capital investment would not be made available by other means; but the most disappointing feature of the Minister's statement is the decision to suspend the scheme. That, I think, will disappoint British industry. It will certainly disappoint the House that the Minister has sneaked out the statement so late at night.
  If the Government want industrial partnership with British industry, they should recognise that making such an announcement at this time of night is not a good way of setting up the new relationship. The Opposition will support the measure, but we shall want to return to the broader issues at a later stage.
  10.37 pm
  Sir John Stanley: I am glad that we have the support of the Opposition Front Bench. Obviously it is for my right hon. Friend the Minister to respond to the questions raised by the hon. Member for Leeds, Central (Mr. Fatchett), but it may assist the House if I briefly sketch the history of paper making at the Aylesford site as it bears directly on the rationale for the grant.
  Paper making began in the 1920s at Aylesford, which was a perfect site for the purpose. The River Medway runs through the site, providing the all-important water supply,
  980
  and also river access from the Thames estuary for the key raw materials pulp, china clay and, at that time, coal. The site prospered until the second world war, and after 1945. Paper making continued to expand on the site until the end of the 1950s. At that point, there were no fewer than 13 paper-making machines on the site, which was the largest single paper-making complex in Europe. Since then, the story of the site has been one of sedate but remorseless contraction. In 1959, there were 13 paper-making machines, but now there are three.
  Sadly, under the management of successive British companies, it has not proved possible to find the finance for the major investment necessary to render the site competitive in the long term. An opportunity to change that occurred in 1990 when the Swedish SCA group took over the site. SCA's strategic plan was to establish within the confines of the EC area a major newsprint manufacturing operation using only recycled paper. It was far from certain that SCA would locate the new £260 million investment in this country at Aylesford, and it reflects credit on the Government that we are holding this debate today and that this important strategic national investment has been secured for this country.
  I should like to pay a personal tribute to two members of the Cabinet and one former member of the Cabinet who were instrumental in retaining this investment in the United Kingdom. I first took the chairman of SCA to my right hon. Friend the Member for St. Albans (Mr. Lilley), then Secretary of State for Trade and Industry, in August 1991. The chairman eloquently and persuasively set out the case for the major investment at Aylesford. He developed the environmental case, the significant balance of payments case and the employment case. He pointed out, very reasonably, that other countries were anxious to secure SCA's investment, in particular Germany and the Netherlands, both of which were offering substantial capital grants running to tens of millions of pounds to attract investment. He told my right hon. Friend that, unless the British Government were able to match to some degree the financial assistance being offered by other countries, SCA would inevitably have to locate the investment elsewhere. The hon. Member for Leeds, Central may wish to note that because it directly addresses one of the points that he made.
  Against that background, it was clear that unless a degree of financial assistance was offered by the Government the project would be lost to this country. The initial response of my right hon. Friend the Member for St. Albans was not particularly encouraging. He told us that it was not Government policy to subsidise private companies, that private companies were expected to stand on their own feet and that the Government were not sympathetic to the suggestion that they should intervene in industry.
  The meeting ended cordially and, to his credit, my right hon. Friend reflected closely on the detailed case for the project submitted to the Department and moved from a position of scepticism to one of support and strong backing. He was Secretary of State for Trade and Industry when the £20 million grant was announced at the end of the last Parliament.
  Secondly, I pay tribute to my right hon. and learned Friend the Member for Putney (Mr. Mellor). I well remember that on the key day—Monday 16 March, the last day of the last Parliament—the Department of Trade and Industry was ready to go ahead with the

  981
  announcement of the grant. All that was necessary was Treasury approval in the form of the agreement of the Chief Secretary. I went in search of him and found him discharging his duties in the House. I was able to have a discussion with him behind the Speaker's Chair. With his usual energy, my right hon. and learned Friend managed to produce Treasury approval in a matter of hours. It is wondrous what can happen on the last working day of a Parliament when Ministers and officials are desperate to clear ministerial desks for whatever may lie ahead.
  Thirdly, I pay tribute to my right hon. Friend the Member for Henley (Mr. Heseltine), who was Secretary of State for the Environment in the previous Parliament. Since he has become President of the Board of Trade he has played a crucial role in ensuring that the Government's intention to give the go-ahead to the project with the assistance of the £20 million grant was not torpedoed by the European Community. The House may want to know that that was a real possibility at one point, and we are indebted to the determination, skill and persuasiveness of the President of the Board of Trade and his extremely diligent officials in ensuring that the EC did not manage to wreck the project in the United Kingdom. I am grateful to my three right hon. and right hon. and learned Friends.
  I mention one policy point which is important to me as I have lived with the project for some two and a half years. I know that what I am going to say will not please hon. Members with constituencies in assisted areas. My experience of the project is that it has now become almost impossible to gain major manufacturing investment in a non-assisted area in the United Kingdom because of a double handicap faced by such areas. The geographical extent of non-assisted areas in the United Kingdom covers the greater part of England.
  The double handicap applies, first, in the United Kingdom itself. In the non-assisted areas, there is no help with development grants for new manufacturing investment. That is in contrast with the substantial assistance available to assisted areas and it can have some grotesque effects. The hon. Member for Leeds, Central referred to the SCA closure in Blackburn. I do not know the background to that, but I offer an illustration of what has happened as a result of a major discrimination against non-assisted areas in the United Kingdom.
  On the Aylesford site, alongside SCA, there is another paper-making company called Kimberly-Clark. If hon. Members have not heard of that company, they will at least have heard of its major product—the excellent Kleenex tissue range. A few years ago, Kimberly-Clark managed to secure a major new plant investment in Wales —I know that the hon. Member for Cardiff, West (Mr. Morgan) will be glad to hear that—with development grant assistance. As a result, in October last year Kimberly-Clark at Aylesford announced 300 redundancies. The new plant that it had established in Wales with Government assistance meant that it was transferring products from Kent. It does not seem to make sense to use taxpayers' money to create notional employment in one part of the United Kingdom while producing redundancies in another. That is a serious issue which the Government need to address.
  The second handicap relates to the EC's competition policy. My right hon. Friend the Minister sought to justify
  982
  his suspension announcement today in terms of helping the EC to maintain a level playing field. Although the EC notionally seeks to establish a level playing field for manufacturing industry, there is no level playing field in practice—for the simple reason that any assisted area in the EC can obtain any amount of subsidy that the national Government can produce and not run any risk of having that investment torpedoed by the EC. Inside a non-assisted area, such as Kent generally and Aylesford in particular, the moment any form of Government subsidy is used one runs the gauntlet of the EC and is likely to have one's investment torpedoed
  There is no level playing field. The real issue is whether it is possible to have genuine and fair competition when one geographical section of the EC—the assisted areas —has limitless amounts of Government subsidy open to it while the rest of the EC has no such access to subsidy and faces the possibility of its manufacturing investment being torpedoed by the EC if any Government subsidy is used. There is no such thing as a level playing field at present, and until the issue is addressed there will be no fair competition. I ask my right hon. and hon. Friends on the Treasury Bench to take my point seriously and to look for some sensible answers to it so that we can have genuine and fair competition in manufacturing investment in the EC.
  Mr. Fatchett: The right hon. Gentleman is making an important point. May I push him a stage further? He said at the beginning of his speech that what was important to the company was the assistance, which is supported in the motion, under section 8 of the Industrial Development Act 1982. Is it not the case, in terms of the right hon. Gentleman's argument about the level playing field, that Governments in other countries, regardless of regional policy, find ways to support such projects? The danger with SCA and other similar companies is that if the money had not been forthcoming from the United Kingdom they would have taken the jobs and the investment elsewhere.
  Sir John Stanley: The hon. Gentleman is correct and precisely describes the position. He has explained the central rationale for the grant, as I see it. If the Government had not made the grant available, the £260 million project, with the environmental and employment benefits to which hon. Members have referred, would have gone either to Germany or to the Netherlands. Other countries understand that the wider they draw the boundaries of the assisted areas, the greater the ability they have to play the subsidy system free from EC interference. That is a lesson that other countries understand. Ministers should reflect on that point.
  Mr. Roy Beggs: Does the right hon. Gentleman agree that there is no possibility of other EC countries diminishing the level of state aid that they provide until we provide the same level of aid? We should then be able, as one sovereign country with another, to negotiate within the EC for overall reductions in state aid, thus providing a genuine level playing field.
  Sir John Stanley: I do not see the position as the hon. Gentleman describes it. My experience, deriving essentially from this project, is that each Government will try to work the existing EC rules to their own national

  983
  advantage. That does not affect the aggregate amount of subsidy. Each Government will try to work the system to help their own national interest.
  I suggest that the Aylesford paper-making site has been a microcosm of British manufacturing industry and the way in which it has ebbed and flowed in the post-war period. It prospered through to the end of the 1950s and since then has experienced a slow but steady contraction, although the site is still effective and has done pretty well through the severe recession that we have recently experienced.
  984
  With the assistance of the grant—if the House approves it today—we shall see ushered in at Aylesford another significant period of manufacturing investment and benefit to manufacturing industry at Aylesford. Although the debate has inevitably focused narrowly on my constituency—I am grateful to the House for its time—it is my fervent wish that the strengthening of manufacturing in Aylesford in the 1990s will be accompanied through the 1990s by a general widening and strengthening of manufacturing investment in Britain as a whole.
  10.55 pm
  Mr. Bob Cryer: I am grateful for the opportunity to make a few comments on the remarkable statement that the Minister made. He is bound to make a statement to the House under the Industrial Development Act 1982 when a grant of more than £10 million is made. It is a matter of great regret that the Minister slipped in a significant change of policy while he was making a statement about an individual grant. He was bound to make such a statement under the terms of the legislation.
  The Minister's change of policy means that all the claims of advantage made by the right hon. Member for Tonbridge and Mailing (Sir J. Stanley), that industry would be secured in his constituency which would have gone to either Germany or Holland without that inducement, are now scattered to the winds. Any Member of Parliament who makes a similar approach to a Department of Trade and Industry Minister will get naught for his or her pains. Investment of a major nature for special projects cannot now be induced to come to the United Kingdom in spite of the Government's proud boasts that they attract inward investment.
  Assistance cannot be sought for a similar project which, on the admission of the constituency Member of Parliament, required a £20 million inducement—the same as the amount of grant in the motion before the House. We can no longer encourage investment in manufacturing industry in that way. That is a major change of policy. It is a matter of great regret that the Minister chose this underhand method. It is a way of withholding information from Parliament.
  There is a great difference between tabling a motion about a single payment to a factory at Aylesford in Kent and announcing at just before 1 pm on the annunciator throughout the Palace of Westminster that a Minister will make a statement. A statement would have given everyone the opportunity to come to the Chamber. Members could not possibly anticipate from the narrow motion on the Order Paper that it contained a major change of policy.
  Everyone would agree with the criteria in section 8. They are that any grant must benefit the economy; it must be in the national interest; and there must be no alternatives available to the Secretary of State than to pay grant assistance. Those three criteria are reasonable and straightforward. It is madness for the Government to say that they will no longer apply those criteria. Even if a project is in the national interest and will benefit the economy and even if there are no alternative ways of financing it, such a project will go out of the window for the United Kingdom by virtue of what the Minister has announced tonight. That is a matter of great regret.
  The Minister said that the project will have environmental benefits. His statement confirmed that, and it supports the investment to recycle used paper to provide fresh paper. Other industries can provide environmental benefits in exactly the same way. As the Minister knows, the textile industry has had many concerns about the use of water, of which the paper industry is also a major user. If the textile industry had a plan to introduce carbonising and scouring, which involved significant capital expenditure—which I assure the Minister the textile industry could not reasonably afford—it would require grant assistance. However, it would be denied such assistance. That is extremely unfair.
  Madam Deputy Speaker (Dame Janet Fookes): Order. I understand the hon. Gentleman's line, but it is going rather wide of the motion. It is one thing to make a passing reference, but the hon. Gentleman is beginning to develop a theme that falls outside the scope of the order.
  Mr. Cryer: You were not in the Chair, Madam Deputy Speaker, when that very point was raised with Madam Speaker. Because the Minister had referred to the suspension of the scheme, Madam Speaker agreed that it was no longer simply a debate on the narrow issue of this grant to SCA Aylesford but could go wider. I am speaking about the suspension of the scheme.
  Madam Deputy Speaker: It is a matter of degree. What I have described as a passing reference is one thing, but we cannot widen the debate so that the original issue becomes lost in the other issues of whether the scheme continues. I must draw the line there and I hope that the hon. Gentleman will understand that. He has made his point cogently but should not continue with it.
  Mr. Fatchett: On a point of order, Madam Deputy Speaker. When I responded to the Minister I was conscious of the fact that the motion referred only to SCA Aylesford. I asked Madam Speaker for guidance and she made it clear that we could comment on the Minister's announcement and its implications. [Interruption.] Despite the laboured French from the Conservative Benches, it was not en passant. Madam Speaker was clear that we could draw substantial attention to the Minister's announcement, and in his speech the right hon. Member for Tonbridge and Mailing (Sir J. Stanley) said that the scheme relates to projects that are of national importance. I think that Madam Speaker intended to allow a much more general debate.
  Madam Deputy Speaker: That is not my understanding.
  Mr. Cryer: Perhaps I could extend the debate to consider the question of jobs. The Minister made it clear that 300 jobs would be safeguarded and that there would be 100 additional jobs, plus construction jobs on the project to which the grant relates. By virtue of the avoidance of payment of unemployment benefit and the tax revenue that the jobs will yield, surely the cost of the grant will be recouped over time. Has the Minister calculated over how many years the tax revenue and the unemployment benefit would be equivalent to the £20 million grant?
  The right hon. Member for Tonbridge and Mailing said that if the grant were not available the paper-making capacity at Aylesford would be extinguished. Therefore, there is a possibility that jobs will be lost if the grant is not forthcoming. My question is therefore valid. The Minister's announcement of the suspension of the scheme means that the Government will pay more money than grant aid through the payment of unemployment benefit and the loss of tax revenue. That potential loss can be set against the amount of grant which would preserve jobs.
  The Minister also mentioned suspension of the scheme, due to a desire to conform to the EC's much-vaunted but highly inaccurate claim of providing what is generally termed a level playing field, because state aids, he said, distort competition.
  I find the statement from the Minister extraordinary, because the reality is that competition inside the EEC is distorted and until the EEC Commission makes it clear

  987
  beyond peradventure that other state aids in other countries are also to be completely removed, we are tying an economic hand behind our back without any economic advantage being provided.
  It does not make sense. What, for example, has the Minister done in the textile industry? This is said by way of example and explanation, Madam Deputy Speaker.
  Madam Deputy Speaker: Order. The explanation is getting very full and lengthy so I remind the hon. Member again of the point I made earlier.
  Mr. Cryer: The explanation is one that the Minister made in his statement, when he said that the scheme was suspended because, in his view, it helped to distort competition. I am commenting on the Minister's statement.
  I am saying that, in the EEC, nothing was done about the Lana Rossi scandal in which £4 million was given to a private company, in the Prato region of Italy. There was a 10 per cent. competitive advantage because there were no insurance payments.
  That is what I am saying in comparison and explanation. The Minister is giving away, by suspending it, a scheme which could have been of benefit to British manufacturing industry. It is being scattered to the winds for no advantage.
  Why did the right hon. Gentleman not go to the Common Market and say that if they made certain concessions about schemes which are giving advantage to other EEC countries he would suspend this scheme? Nothing like that happened. He came simply to the House and made this announcement without so much as a by-your-leave statement or anything of that nature. He tried to creep it past Parliament without any concentration on it.
  This scheme is administered under section 8 of the Act and there is provision for advice and guidance from the Industrial Development Advisory Board. Has that board approved suspension of the scheme? Did the board consider all the 44 or so applications before the Minister, which, he said, were not successful? Did the Industrial Development Advisory Board reject them, or did they never reach the position of the board providing advice and guidance?
  Lastly, because the board involves manufacturers, industrialists, merchant bankers, and so on, did any of the board members dealing with this scheme have any financial interest involved, and did any withdraw when the matter was under consideration?
  I can recall, as a former Minister at the Department of Industry, that that policy was scrupulously followed: when members of the Industrial Development Advisory Board had financial investment, it was important that they should withdraw so that independent advice was seen to be continuous and clear for all.
  I hope that, although the Minister was not listening, he will make some acknowledgement of the questions that I raised.
  I conclude by saying that it has been very confusing for you, Madam Deputy Speaker. You came into the House and went into the Chair with a straightforward motion, not realising that the Minister had slipped through a much wider announcement. The confusion for you, Madam Deputy Speaker, is confusion for hon. Members on both sides of the House. We are faced with a typical example of
  988
  the underhand way in which the Government treat Parliament. They tried to slip through a change of policy late at night when hardly anyone would be in the Chamber.
  11.11pm
  Mr. Michael Ancram: My right hon. Friend the Minister for Industry knows of my interest in the Gartcosh plant, but I do not intend to talk about that plant this evening. Instead, I want to ask some questions about the recycling of paper. Earlier, I asked my hon. Friend the Minister for the Environment and Countryside, who is sitting next to my right hon. Friend on the Government Front Bench, about the Government's target of ensuring that 40 per cent. of waste paper is recycled by the year 2000. I asked also what the Government were doing to encourage outlets to ensure that the target is met. I was told that SCA Aylesford Ltd's plant was an example of the encouragement that was being given to the recycling of paper. I am sure that the Government will accept that if the target of 40 per cent. is to be met, SCA will not be able to produce a sufficient market to ensure that the necessary uptake will be achieved.
  I was glad to hear what my hon. Friend the Minister said about Gartcosh this evening, but what further encouragement will the Government give to ensure that in the south of England, the north and in Scotland there is a sufficient uptake of waste paper and a proper manufacturing outlet so that we can be sure that the Government's sound environmental target is achieved?
  11.12pm
  Mr. Rhodri Morgan: We are here because we want to extend our congratulations to SCA Aylesford and to the right hon. Member for Tonbridge and Mailing (Sir J. Stanley), who has fought hard to get the project grant-aided. Our congratulations and our acceptance of the part that the right hon. Gentleman has played are tinged with regret and annoyance because the Minister has chosen to abuse and confuse the House and do untold damage to relationships with industry. The motion refers to SCA Aylesford and nothing but SCA Aylesford, but it has been announced that section 8 of the Industrial Development Act 1982 is being scrapped. That section has been on the statute book for 20 years. It is not some fly-by-night, temporary provision. It is—[Interruption.] If the Minister is telling me that it is only part of section 8 that is being scrapped, perhaps he will elucidate now. Is that why he is shaking his head?
  Mr. Sainsbury: It may be of assistance to the hon. Gentleman and to the House generally if I explain that what I announced was the temporary suspension of a scheme that is operated under the provisions of section 8. That has no effect on section 8 itself.
  Mr. Morgan: I hope that the Minister will be able to say more about that.
  What proportion of total section 8 money is being removed by the suspension of this particular AEP—assistance for exceptional projects to the national economy? Hon. Members on both sides of the House are confused—no doubt industry is similarly confused—in the absence of a proper democratic procedure. There is nothing before us save the motion, and we have not been given proper notice. The Government wish sneakily to slip

  989
  the motion through the House. If the Minister's family grocery store, of which he is a proud scion, tried to sell an SCA Aylesford order while suspending part of section 8, the local trading standards department would be down on it like a ton of bricks. Such behaviour is not acceptable in an advanced and civilised western democracy.
  I am pleased that some of us have been in the Chamber this evening to see what the Government are up to. If their behaviour is any indication of the chiselling that they intend to do to regional aid when section 7 is finally reviewed—several months late—by the President of the Board of Trade, there is a pretty poor outlook for those of us who represent constituencies in the assisted areas.
  The Minister's excuse is extremely thin. The scheme was being suspended, he said, because it did not get sufficient use and there was always money left over at the end of the year. He is forgetting that those of us who have worked in the field and have tried to obtain section 7 and section 8 assistance for projects in our areas—in my case, before and since coming to this place—know that section 7 and section 8 budgeting is almost impossible. It is the most difficult area of prediction for any Government to say how much industrial demand there will be in the next budget year for section 7 assistance, if it is under the regional aid budget, or for section 8 assistance, if it is under the non-regional aspects of industrial assistance.
  It is always pitched high because of the problems that can arise if one needs to return to the House three quarters of the way through the financial year. So an over-estimate is nearly always done because it is demand-led from industry. If there is a great deal of industrial investment, there tends to be a high level of demand, and one tries to allow for that when setting the budget for the following year. In my experience, section 7 is always wildly over-estimated in the Department of Trade and Industry budget and is rarely used. The same probably applies to section 8.
  But that is no reason for suspending—I call it scrubbing —the scheme because the chances of it being revived are slim in the light of the £44 billion public sector borrowing requirement and the Government's attempts to save money here, there and everywhere. We regret that it is happening without proper discussion. Almost by accident—simply because some of us take an interest in the paper industry, since we have paper mills in our constituencies —the matter is being raised. We regret that the Government should be making such an important announcement in a behind-the-hand manner. In his reply, the Minister should apologise to the House and explain the matter in more detail.
  In relation to section 7, particularly during a recession when there is less industrial investment, it is inevitable that the target of the previous year will be undershot. After all, the budget of the year before, particularly in an election year, will have been set in the hope that industrial investment will pick up. In the event, it has not, so there is less call for grant. The same is true of many other industrial aid schemes, but that is no reason for closing them down.
  The Minister's behaviour tonight has been appalling and discourteous to the Chair, to hon. Members and to industry as a whole. If this is part of a new spirit of partnership, I fear that, until the Government are
  990
  removed, we shall continue to have the problem of Ministers announcing unpopular news late at night without making proper provision for the matter to be discussed. It represents an abuse of the House. It may be on a small matter, but in terms of the grossness of the abuse, it is the worst that I have witnessed in my five and a half years' membership of the House. I appeal to the Chair to protect our rights in the future.
  11.18pm
  Mr. Michael Connarty: I echo the remarks of the hon. Member for Devizes (Mr. Ancram) and the concerns that have been expressed about Gartcosh. I took part in the vigil when the rolling mill at Gartcosh was closed. I know well the people—I come from there—I lived within a mile of that plant. They have been looking forward to some activity in the paper recycling business.
  I regret that I was not in my place for the Minister's opening remarks. I gather that he announced the suspension of the scheme but that the scheme will still be in existence and could be applied to Gartcosh. That is a non sequitur, in terms of grant availability, if ever I heard one. Is it not a fact that if a scheme is suspended, nothing can be available under it? How can a scheme that is being suspended temporarily still be available for one project? The people of Scotland will be confused when they read about it in tomorrow's newspapers.
  It would have been better if the Minister had made a special announcement about the decision to suspend the scheme, explaining precisely which applications would be processed, how the procedure would apply and when the suspension would come into being. The people of Scotland will not be satisfied about what is proposed until a full explanation is given.
  11.19pm
  Mr. Sainsbury: First, may I thank my right hon. Friend the Member for Tonbridge and Mailing (Sir J. Stanley) for his kind remarks. He was modest about his own contribution to the success of SCA Aylesford. Some of his remarks about major manufacturing investment in non-assisted areas were perhaps a little wide of the mark. Two projects currently coming on stream and greatly to the benefit of the areas involved and the country are the Toyota factory in Derbyshire and the Honda factory in Swindon—[Interruption.] Perhaps the hon. Member for Cardiff, West (Mr. Morgan) will contain his sedentary remarks for a moment and allow me to develop my point.
  My right hon. Friend was suggesting that it was not possible to get major manufacturing investment outside a non-assisted area and I was pointing out that there are a number of major investments.
  The hon. Member for Bradford, South (Mr. Cryer) was decrying our ability to get inward investment and suggesting that somehow a modest change to one scheme which has assisted only two projects in five years would mean that any prospect of attracting inward investment was for ever destroyed. As we might expect from the hon. Gentleman, that is a gross exaggeration, because, after all, Britain gets a larger share of investment from the United States of America and from Japan than any other country in the European Community—something like 40 per cent. of that investment.
  Mr. Cryer: Will the Minister give way?
  Mr. Sainsbury: I shall just finish one point arising from the remarks of my right hon. Friend.
  We support the European Community in its efforts to create a level playing field; those efforts include monitoring the schemes that are available in assisted areas. My right hon. Friend made some valid points about what occurs, but we are hopeful that the situation is being improved. His rather splendid suggestion that any amount of grants were available in some countries is not precisely the position and I think that matters are improving.
  Mr. Cryer: The Minister, in turn, is exaggerating my remarks about inward investment procedures. Will he confirm that no other SCA Aylesford-type investment projects will be induced to come to Britain because of the suspension of the current scheme?
  Mr. Sainsbury: That scheme has helped only two projects—this being the second one—in five years. A great deal of money has been made available over the years. Since 1972, more than £1.7 billion has been paid out under section 8 and, including the £20 million that we hope the House will approve this evening, only £30 million has been paid out under the AEP scheme. I hope that puts matters in perspective.
  Mr. Peter Thurnham: Is my right hon. Friend aware of how important the project is to two companies in an assisted area in my constituency? The first is Davidson Ratcliffe Ltd., a leading waste paper collector and merchant, and the second is Beloit Walmsley Ltd., a very large manufacturer of paper-making machinery, which I understand is in contention to win orders under this project. I welcome the motion.
  Mr. Sainsbury: I am not familiar with the firms to which my hon. Friend refers, but I know how energetically he pursues the interests of his constituent companies and we hope that one, if not both, of them will be successful in gaining work from this project.
  I began to regret what I had hoped was a courtesy to the House. Let us be realistic and recognise that the normal arrangement for announcing the suspension for one year of a scheme which has produced two grants in five years would have been for a written answer to appear on the Order Paper. If Opposition Front-Bench Members were honest with themselves, they would recognise that. I thought that it was a courtesy to the House, given that we had the opportunity to debate the grant, to announce its temporary suspension in a debate rather than a written question so that right hon. and hon. Members would have the opportunity to comment on it. The Opposition's reaction is more than a little unrealistic.
  Mr. Fatchett: Does not the Minister realise that that is a specious argument? If the response had been through an answer to a written question, it would have been on the Order Paper. My right hon. and hon. Friends would have had the opportunity to study it and to make whatever comments they wished about local schemes. The simple fact is that the announcement was not on the Order Paper —and in that sense it is a gross discourtesy to the House and to the Chair.
  The Minister has taken the opportunity of this debate to sneak through an announcement without having a word with the Chair and getting its support and permission. Out of courtesy to every Member of the House, the right hon.
  992
  Gentleman should have made his announcemenmt at some other time. He should apologise rather than make a specious argument.
  Mr. Sainsbury: I refute the hon. Gentleman's suggestion. All that he has succeeded in doing is to encourage the Government to proceed on such matters by means of a written answer. If the next time that happens we get protests from the Opposition, I shall know to what to draw attention.
  Mr. Mark Robinson: Does my right hon. Friend agree that if he had made his announcement by written answer, the Opposition would have complained equally vociferously?
  Mr. Sainsbury: I am not too sure about that. The comments of Labour Members this evening suggest that they would rather have such matters dealt with by means of a written answer—[Interruption.] Their suggestion that this matter merits a statement is, as I said earlier, quite absurd. Labour Members—[Interruption]
  Madam Deputy Speaker: Order. Many allegations of discourtesy are flying about. I remind hon. Members that it is an elementary courtesy that when someone is speaking he should not have to do so with a chorus of seated interventions.
  Mr. Sainsbury: Thank you, Madam Deputy Speaker. I shall move on to one or two of the more important observations that were made.
  The point about the AEP scheme is that it is for projects that carry exceptional national benefits. As I emphasised in my opening remarks, there are exceptional national benefits relating to this scheme relating to environmental policy objectives. I stress that it is not like the regional selective assistance scheme, which is job related. That point was made by several Opposition Members. The number of jobs actually created or safeguarded, or those created during the construction process, is not in itself one of the objectives of the scheme. The exceptional national benefits have to be something beyond merely job creation. In this case, it is the use of a new technology in de-inking that meets those important environmental policy objectives.
  A point was made about energy consumption. The energy generation on the site is small compared with national energy consumption. The existing mill takes its electricity from the national grid and is derived from coal and oil. One could say that moving to a combined heat and power gas-fired plant would result in lower CO2 emissions, which would meet another environmental objective.
  My hon. Friend the Member for Devizes (Mr. Ancram) referred to the further encouragement of the collection of waste paper. We certainly intend to meet the targets and we will consider all measures that ensure that market mechanisms achieve that work.
  Points were raised about the Gartcosh scheme. The hon. Member for Falkirk, East (Mr. Connarty) was not in the Chamber when I made my opening remarks. For his benefit and that of others who may not have been listening as closely as they might have done, I shall repeat what I said. I said:
  "I can confirm that we shall consider against those criteria the application currently being pursued by North British Newsprint in respect of the Gartcosh project."

  993
  Now that I have announced that AEP is to be suspended, the company will need to develop its application by the end of February so that the appraisal may go forward.
  Mr. Fatchett: The Minister has omitted an important point. Several hon. Members asked whether the European Commission had indicated its objection to this scheme and whether that was why the Government were suspending it. Can the Minister clarify the position in respect of that matter?
  Mr. Sainsbury: We did not discuss the scheme as a whole with the European Commission. We share the Commission's desire to keep firm control of all schemes that can distort competition in the Community. Such schemes can, of course, be outside or inside assisted areas. In referring to this matter, my right hon. Friend the Member for Tonbridge and Mailing talked about any amount of money being available. Schemes within assisted areas are also subject to the scrutiny of the European Commission. That is something which we welcome, as we believe that distortion of competition does not benefit either this country or any other part of the Community.
  Mr. Fatchett: Am I right in construing the Minister as saying that he thinks that this scheme distorts competition and that its suspension has, therefore, been volunteered to the European Commission?
  Mr. Sainsbury: I believe that in my remarks there was a reference to relaxation of the criteria for this scheme. Such relaxation might result in success for more applicants. As I pointed out, in five years only two applicants have been successful. This would be a move towards more overtly flexible schemes—schemes of just the sort that can be used by others to distort competition and might, therefore, understandably, find disfavour in the Commission. There have been several alleged instances of aid in other countries giving rise to complaints from British industry.
  Mr. Alex Salmond: The Minister has said that the scheme at Gartcosh will now have to be developed before the end of February if it is to go forward. Why the end of February? Does the Minister know that that will give the company sufficient time to develop its application? Or is it a purely arbitrary date that the Minister has conjured up out of thin air?
  Mr. Sainsbury: The hon. Gentleman may not have been in the House when I made my introductory remarks and, therefore, may not have heard my reference to the suspension of the scheme from the end of February until April 1994. I said that North British Newsprint ought to get its scheme registered before the end of February so that it might be subjected to the appraisal process.
  Mr. Connarty: This matter continues to worry me. What notice of the Minister's announcement was the company given? Is it to get its information from tomorrow's papers?
  Mr. Sainsbury: The company has been in contact with the Department for a considerable time. Since July we
  994
  have been waiting to hear from it. We do not know whether it will come back to us. [Interruption.] The hon. Gentleman was not in the House when I dealt with this point. We have discussed it at length.
  This scheme will bring considerable benefits.
  Mr. James Wallace: Will the Minister give way?
  Mr. Sainsbury: As the hon. Gentleman, unlike some hon. Members, has been in the House for the debate, I shall give way to him.
  Mr. Wallace: Can the Minister be more explicit? When is it intended that those putting in the application for Gartcosh will be told about the suspension and informed that the application will have to be received by the end of February? Have they been informed already, or will this come as news to them? Has the Minister any indication that what he is asking of them is feasible?
  Mr. Sainsbury: To the best of my knowledge, it is entirely feasible. Whether they will actually do so, I do not know. We will, of course, communicate with the company.
  It is occasionally suggested—not infrequently, I suggest, by hon. Members on the Opposition Benches—that it is a courtesy to come and tell Parliament things first, and that I have done. I have provided an opportunity for debate, and all I have received in exchange is brickbats. Perhaps we can draw a conclusion from that.
  Mr. Salmond: On a point of order, Madam Speaker. There is considerable noise in the House. As you will recollect, a few seconds ago the Minister started a sentence about the company being unable to bring the scheme forward by the end of February; in the noise I lost the second half of that sentence. Perhaps the Minister could complete it for us now.
  Mr. Sainsbury: I may have to read Hansard, which is not immediately available, to find out what I said. Perhaps I could recommend that the hon. Gentleman read Hansard himself. It may be that the sentence to which he referred was when I said that the company would need to develop its application by the end of February so that the appraisal could go forward. Perhaps it was those words that he did not hear clearly; I hope that it was and that we will have it doubly on the record.
  The motion is to approve a grant to a project which I think has exceptional national benefits. It enables environmental policy objectives to be met. It maintains and improves the operation of a company which, as my right hon. Friend the Member for Tonbridge and Malling has said, has operated with distinction in his constituency for a long time. I hope that the House will approve the motion.
  Question put and agreed to.
  Resolved,
  That this House authorises the Secretary of State to pay, or undertake to pay, by way of financial assistance under section 8 of the Industrial Development Act 1982, in respect of the installation of new and the refurbishment of existing machinery to manufacture newsprint from recycled fibre at Aylesford, Kent by SCA Aylesford Ltd., sums exceeding £10,000,000 but not exceeding£20,000,000.

  Public Health
  11.36 pm
  The Parliamentary Under-Secretary of State for Scotland (Sir Hector Monro): I beg to move,
  That the Food Protection (Emergency Prohibitions) (Oil and Chemical Pollution of Fish) Order 1993 (S.I., 1993, No. 17) dated 8th January 1993, a copy of which was laid before this House on 11th January, be approved.
  In the statement that my right hon. Friend the Secretary of State for Scotland made on 11 January about the Shetland tanker incident, he told the House that an exclusion zone had been declared under the Food and Environment Protection Act 1985, within which fishing and harvesting of farmed fish is prohibited. The emergency order which set up the exclusion zone requires the approval of Parliament if it is to continue in force, and that is the purpose of tonight's motion. Copies of the map of the area are available in the Vote Office.
  The purpose of the order was to ensure that, in the light of the Braer incident, there was no danger of fish or fish products reaching the market if they could be hazardous to human health. No sensible fishermen would have fished in the area after the incident—in the light of the weather conditions, I do not think that they would have tried—and fish farmers affected by the spread of oil could similarly have been relied upon voluntarily to keep their product from the market. The fishermen imposed a voluntary ban before the order was made. I pay tribute to the Shetland Fishermen's Association and the Shetland Salmon Farmers Association, and particularly to their respective chief executives, John Goodlad and Jimmy Moncrieff, for their excellent and impressive response to all these difficulties. I pay tribute also to the hon. Member for Orkney and Shetland (Mr. Wallace) who, in his capacity as constituency Member, has been very helpful and constructive throughout.
  Nevertheless, my right hon. Friend and I thought it right to use the power that was available to give legal force to a ban on taking fish from the area. We did this after full consultation with, and with the agreement of, both the Shetland fishermen and the fish farmers. The imposition of the order was part of a three-pronged strategy which also included the establishment of arrangements to sample and test fish being landed on Shetland markets, and the setting up of longer-term monitoring arrangements covering both fish and water quality.
  That background to the order is important. In setting up the arrangements, we had in mind the vital importance to the Shetland economy of both the fishing and the fish farming industries. They faced an obvious and immediate threat to their businesses. There was also the danger of much longer term damage if those industries should lose market and consumer confidence.
  Therefore, the order, and the other arrangements that I have mentioned, seemed to me of the greatest importance in assuring commercial buyers and consumers that special care was being taken over the quality of Shetland fish products and, correspondingly, that the public should have every confidence in the products when they reach the shops. I know that that approach has the full confidence and support of the industries in Shetland, and with regard to salmon it is reassuring that a number of supermarket chains which have now visited the islands are remarketing Shetland products. I have emphasised the consultation because some newspapers implied that the Government
  996
  had slapped on an order without considering the interests of the Shetland fishermen when, in fact, the reverse was the position.
  Against that background, we must proceed cautiously in considering the future of the ban. It may be helpful to say a little more about the arrangements which underpin the ban. Those are based on a continuous programme of water and fish sampling. The first test is the state of hydrocarbons in the water. If the water is polluted, the pollution will get into the fish. The critical test, from the point of view of food safety, is the fish itself and the accumulation of hydrocarbons in their edible tissue.
  The sampling programme has been hampered by extreme weather conditions, but a clear enough picture has emerged which requires a continuing exclusion of fishing and fish harvesting activity in the zone as presently defined. I confess that I had hoped to be able to inform the House this evening that it would be possible to remove the ban on the east side of the mainland. My feeling is that this may be possible soon, but the latest results indicate not yet.
  On the west side of the zone, readings remain high, and the unhappy news is that I have had to decide to extend the western boundary of the zone by 5 nautical miles, from 1 deg 30 west to 1 deg 40 west. This is in response to most recent results of tests on water quality, and on sea fish caught in the new area. The new area will not extend the present zone any further north or south. Thus it will not bring the salmon farms at Vaila Sound and Gruting Voe into the exclusion zone.
  I recognise that that is not encouraging news for those concerned. However, I thought it right to tell the House at the earliest opportunity. I also emphasise that, while the news in itself is regrettable, it should nevertheless reassure both consumers and the local fishing and fish farming industries that the monitoring arrangements are working effectively, and that fish and fish products reaching the market are safe and are of good quality.
  Nevertheless, I am keenly aware of the problems that the situation creates for the salmon farming businesses. I am anxious that, as soon as the evidence warrants it, we should move to more flexible arrangements which will allow fish to be harvested from within the current exclusion zone when it can be demonstrated that they are free of taint and hydrocarbon contamination. We shall be in continuous touch with those concerned to see what progress can be made as further test results come in.
  Meantime, only one claim from a salmon farmer has so far been received by the claims office in Lerwick. I understand that the insurers and the international oil pollution compensation fund have today agreed a substantial advance payment in this case to mitigate economic hardship. That will be paid to the producer by the insurers direct. The speedy reaction of the insurers and the IOPC fund to a claim submitted only at the end of last week should encourage other salmon producers to bring forward their claims. I am sure that the hon. Member for Orkney and Shetland will have something to say on that.
  Additionally, the Government have made available to producers a bridging fund which will be operated for the Government by the Shetland Islands council. Details of the fund's operation were announced in the House on 21 January by my right hon. Friend the Secretary of State for Scotland. The purpose of the bridging fund is also to prevent economic hardship to fish farmers and other primary producers facing temporary cash flow difficulties

  997
  pending settlement of compensation claims. The first payment of £1 million to set up the fund will be made to Shetland Islands council this week.
  It is also important for us to assess the ecological effects of the incident. My right hon. Friend has announced his intention of setting up an ecological steering group to consider strategies, in both the short and the longer terms, to deal with the impact of the incident on the local environment.
  Dr. Norman A. Godman: Is the Minister satisfied that there is no danger that oil from the tanker will drift into areas fished by fishermen from other ports in the European Community?
  Sir Hector Monro: As I have said, we are monitoring every development extremely carefully, and taking all possible steps to establish where the oil is now. We feel that the only area where it is unsafe to fish is the current exclusion zone, along with the small extension that I have announced today. I think it important for us to continue the detailed monitoring now being carried out so that we can keep a close check on what is happening.
  As the hon. Member for Orkney and Shetland knows, my right hon. Friend today announced the terms of reference of the steering group, and the appointment of Professor Ritchie as chairman. The group's initial purpose will be to take an overall view of the various ecological and environmental initiatives that are now getting under way, or are likely to be established on the group's initiative.
  I trust that hon. Members on both sides of the House will recognise that the order forms part of a pattern of effective Government action and is in the best interests of the fishing industry and the consumer.
  Mr. Brian Wilson: I welcome the appointment of the principal of Aberdeen university to conduct the local inquiry into the environmental ramifications. Is it not a little unfortunate, however, that the wider inquiry, under Lord Donaldson, will not take place in the area in which the incident occurred? Will the Minister give an assurance, on behalf of the Scottish Office, that any witness—or anyone who feels that he can contribute to the wider inquiry—will not be inhibited from doing so on grounds of cost or inconvenience, wherever that inquiry is held?
  Sir Hector Monro: Lord Donaldson's inquiry is rather outwith the terms of the order. However, I am certain not only that it will be peripatetic and will take place in various centres but that everyone with important evidence to give will have the opportunity to give it. I hope that people will do just that: we want to ensure that the problems that we have faced in the past few weeks can, if possible, be prevented from recurring.
  I hope that I have made clear how seriously the Government are taking the monitoring of the sea around the Shetlands—and, indeed, further afield if that becomes necessary. We are determined that the exceptionally good reputation of fish from the Shetlands—whether they come from the sea or from the salmon farms—is maintained, and I believe that the stringent measures that we have adopted provide the best way of doing that.
  11.48 pm
  Mr. James Wallace: I thank the Minister for the further information that he has given us. We do not necessarily thank him for finding it necessary to extend the area concerned, but we recognise that there is no point in trying to take short cuts, or in trying to pretend that something does not exist when it plainly does. I also welcome what the Minister said—and the written answer that I received from the Secretary of State earlier today —about the monitoring committee. It is recognised that the committee will have work to do for a considerable time.
  Some may find it appropriate for us to debate the Shetland area on the last Tuesday in January. Traditionally, this is the evening on which my constituents celebrate Up-Helly-a'. For my own part, I confess that I would much rather be in Lerwick; even at this hour the evening is still young, and there is much dancing and singing ahead. I was in Lerwick this morning at the outset of the day's celebrations, where the strong community spirit that has served Shetland well in recent days was clearly evident.
  I take this opportunity to acknowledge the valuable work and co-operation of the salmon farmers' association, the Shetland Fishermen's Association, crofters in the National Farmers Union and officials of the Shetland Islands council, who have conducted themselves with exemplary professionalism.
  Perhaps the local mood might best be judged by the proclamation that was published this morning by the Guizer Jarl in Lerwick. Under the heading "Stop Press" —I think that the pun is probably intended—there is the following notice:
  "Contrary to some immediate predictions our outlook is less BLACK as various expressions would have it to be. Crude and slick exaggerations do us no favours and are unfounded, thanks to the 'rolling sea' and the 'foaming tide'. we are sure that raising the 'flaming brand' will help brighten our outlook once more."
  Although that is humorously intended, it emphasises a clear need for balance in our approach to events since the grounding of the Braer on 5 January. It has been necessary to be alert to possible health risks but, equally important, not to overstate them and cause undue alarm. This order is necessary because there has been some contamination, but it is important to stress the determination of Shetlands' food industries, which the Minister has acknowledged, to maintain their reputation for high quality produce, which over many years they have justly earned.
  In a way, the order reinforces that commitment because, as the Minister has acknowledged, fishermen and fish farmers imposed a voluntary closure before the statutory order was promulgated. The Minister mentioned the industries' co-operation with the closure orders.
  It is in no one's interest that produce that fails to meet stringent quality tests should be marketed. The order is a safeguard, which I hope will reassure potential customers. The Minister referred to the monitoring conducted by some of the industries, including the salmon farmers' programme. Samples taken from fish harvested outwith the closed area have shown no traces of contamination. After inspecting that monitoring programme and visiting salmon farms last week, food technologists from Marks and Spencer expressed their satisfaction with what they found and lifted the temporary suspension on Shetland salmon.

  999
  The House should be in no doubt that in protecting the longer-term market integrity of our natural products there will inevitably be some short-term and perhaps medium-term pain, depending on how long it is necessary to keep the closure orders in force. I am told that, at this time of year, but for the ban, most Shetland fishermen would fish in the closed area. Most of the vessels involved are capable of going further afield, but that inevitably involves additional costs. They may have less knowledge of where stocks are likely to be, and for a number of smaller vessels, principally white fish or shellfish vessels operating out of Scalloway or Burra, there is no alternative but to tie up.
  For a number of salmon farmers, crisis is imminent. It has not been possible to harvest because of the closure order, and cash flow problems quickly loom. Others may be missing a key window for bringing in smolts, and that problem will increase if the ban is maintained for some time. All in all, economic hardship mounts up, particularly on certain individuals.
  It was against that background that the case for immediate Government assistance to tide over businesses and individuals pending settlement of claims was made.
  I welcome the fact that in his statement on 11 January the Secretary of State for Scotland said that a bridging fund would be made available. Some might have quibbled about the timing, but the most important thing is that it was established. Some expressed disappointment that a figure was not mentioned, but I took some reassurance from that because I should have been rather alarmed if a cash-limited figure had appeared when no one could have been entirely sure—and still cannot be—how much would be needed.
  On 11 January the Secretary of State also said:
  "There is … understandable concern in Shetland about the cash flow problems which may face businesses, particularly the farming, fishing and fish-farming industries, in the period before claims are settled in full. In view of the significance of these industries to the Shetland economy, my Department is proposing to make resources available through a special bridging fund to help them with particular economic hardship pending the settlement of compensation claims."—[Official Report, 11 January 1993; Vol. 216, c. 626–27.]
  That was followed last week by a written answer from the Secretary of State in which he again referred to the bridging fund and said that it was designed
  "to help in particular the farming, fishing and fish-farming industries in Shetland, and prevent economic hardship to primary producers facing temporary cash-flow difficulties pending the settlement of compensation claims."
  My concern is that there may have been some initial difficulties in activating the bridging fund. The Minister said that, to date, there had been one claim. I understand that one of the reasons why claims have not been made more quickly is that the original form issued by the international oil pollution compensation fund contained a requirement for the claimant to state that it was a "complete and accurate account of the loss suffered and costs incurred".
  At this stage, no one—especially a salmon farmer—is in a position to say that he can offer a complete account. To be fair, the matter having being raised with IOPC representatives in Lerwick, there is some movement in the nature of the form to be submitted.
  It is also a matter of concern that there were signs, certainly at the meeting I had this morning with regard to meeting the cash flow problems, that IPOC representatives were showing a certain unwillingness to act as bankers, as
  1000
  it were. As recently as yesterday, it was said that they claimed to know nothing about the bridging fund. Objectively, the idea is that claims should go through the claims office opened in Lerwick. The Minister said that a payment had been made today. As that relates to a cash flow problem, I hope that it means that that difficulty has been overcome.
  I appreciate the fact that matters are developing from day to day, but in view of the fact that the purpose of the bridging fund was to meet cash flow difficulties, there was concern that that particular difficulty seemed to be causing a blockage. I shall certainly want to monitor what happens during the rest of this week because, although I do not want to overdramatise, we are talking of days rather than weeks before difficulties arise for some companies.
  I know that the Minister has taken a close interest in events in Shetland as they have unfolded. Will he therefore satisfy himself that the bridging fund which the Government have set up and which they have said will pay £1 million to Shetland Islands council this week is operating as the Government intended. If it appears at some stage that there are inadequacies in the fund and that it is not meeting the need, will he assure us that there will be a willingness to show flexibility so that individual hardships can be dealt with?
  Initial claims are to be channelled through the IOPC office. In the written answer to which I referred it was stated that claims
  "from businesses which qualify under this scheme and which are, in the view of the club and the IPOC fund, likely to receive compensation in due course will be passed to the islands council".—[Official Report, 21 January 1993; Vol. 217, c. 411.]
  Will the Minister therefore confirm that persons submitting claims for assistance under the bridging fund are in no way excluding the possibility of taking other courses of action? I do not believe that it is for politicians, either as members of the Government or as constituency Members of Parliament, to give legal advice on whether people should pursue their claims through compensation funds set up under international convention or through United States attorneys. That must be a matter for legal advisers with the full range of knowledge about what the options are. However, I should like the Minister to confirm that options are not being foreclosed by those who wish to take advantage of the Government's bridging fund.
  The reason why the order is before us tonight is the grounding of the Braer. I was grateful and interested when the Minister said in response to the hon. Member for Cunninghame, North (Mr. Wilson) that the Donaldson inquiry may be peripatetic.
  What is causing concern is that the inquiry into the circumstances of the grounding is being undertaken presently by the marine accident investigation branch. As a result of the way in which the branch works, the inquiry is being carried out in confidence and in secret. People want openness about how the vessel ran aground in Shetland. I have looked through the statutes, and I find that it is open to the Secretary of State for Transport to order a formal investigation by a sheriff under section 56(1) of the Merchant Shipping Act 1970. I hope that he will take the opportunity to do so.
  On the economic impact that will flow from the order and from what has happened in Shetland, I was also, interested by a comment by the Secretary of State for Scotland in his statement on 11 January. He said:

  1001
  "Once the extent of the damage is more fully known, Shetland Enterprise and Highlands and Islands Enterprise will work with Shetland Islands council to assess the impact on the island's economy. I shall consider carefully any recommendations made to me as a result of this assessment.—[Official Report, 11 January 1993; Vol. 216, c. 627.]
  We should like to hear more commitment than just a reference to a consideration of any recommendations. It will be necessary to have a longer-term economic impact assessment of what the effects will be. A closure order, such as this one, could apply for some time. It could have implications for the economy in terms of having to regain markets. That will not necessarily be easy and may not be covered by any compensation fund supplied by the insurers.
  We want to be satisfied that Shetland businesses and Shetland individuals will not be out of pocket at that stage. Shetlanders are well aware of the importance of the marine environment to their economy. The Select Committee on Agriculture, when examining fish farming, commended Shetland salmon farmers on the environmental controls they had introduced. The Minister knows from his own experience that Shetland fishermen tend to be at the forefront when it comes to promoting technical conservation measures in the fishing industry.
  The Government have recently announced environmentally sensitive area status for Shetland, which shows that, after a difficult start, harmony has been built up between crofting and farming interests and environmental interests. We in the isles understand the importance of a clean environment for our economic prospects.
  People have felt badly let down for a number of years. Shipping safety measures were not taken at national or international level to protect the environment. Shetlanders must not have to pay for what has happened. A Government commitment in the longer term to the economic well-being of the islands, apart from the announcements already made, would be very welcome.
  12.2 am
  Mr. John McFall: I concur with the comments of the hon. Member for Orkney and Shetland (Mr. Wallace) and I commend him on his industry and his work since the unfortunate accident.
  The Opposition will support the order, for a number of reasons. The Minister has mentioned that the exclusion zone will be extended westwards. We support that because the Shetland people themselves wish the zone to be extended, despite the hardships they will face.
  The Minister mentioned John Goodlad and Jimmy Moncrieff. I spoke to both of them today on the telephone. The Shetland Fishermen's Association said that, although it recognised that the introduction of the zone was causing serious problems to fishing and farming in Shetland, the industry remained of the view that the objective must remain the protection of its quality reputation for producing some of the best fish and fish products in the world. With that and the maintenance of quality and consumer safety in mind, the industry fully supports the continuation of the ban. We concur with it on those points.
  The economic problems caused by the incident must, of course, be addressed. The hon. Member for Orkney and Shetland mentioned that. My comments will focus on compensation and monitoring. The fishermen and the
  1002
  salmon farmers have mentioned to me that the marine laboratory in Aberdeen has done excellent work in sending 25 individuals to Shetland to work alongside those in the islands. Scottish Office personnel have also done excellent work. I pay tribute to them.
  I was in Shetland last week with my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), who has the shadow environment portfolio. We were impressed by the good work that was being done by Scottish Office and marine laboratory representatives and environmental personnel in the Shetland islands. I pay tribute to Shetland Islands council. We are all aware that Members of Parliament are often criticised. But district and regional councils are also criticised. There was not one criticism of Shetland Islands council among all the comments made to me by people on the island that day, including farmers, crofters and fishermen. Shetland Islands council has stepped in and written an open cheque for the farmers and fishermen to go ahead and do what they think is necessary.
  While good work has been done on monitoring from scratch and in terrible conditions, there is anxiety about the Government's commitment to long-term monitoring. The headline in the Shetland Times last week when I was there was "The cruel sea cleans it up." The fact that the water is clear does not mean that the problem is removed. The latest press reports say that oil has been found in the flesh of some farmed salmon in the south of the Shetland islands. Volunteers from British Divers Marine Life Rescue have discovered what they term as an ecological disaster in Spiggie bay four miles north of Quendale bay. Those reports show that both short-term and long-term monitoring is essential.
  I visited the wildlife co-ordinating rescue centre in the south part of the island on the day of my visit. It did a tremendous job. It was up and running within 48 hours, not because a Government scheme was in operation or the Scottish Office moved fast but because of the existence of Sullom Voe. Monitoring arrangements were already in place. Indeed, Sullom Voe has a budget of £200,000 per year for monitoring. The existence of that body meant that the response to the incident was instant and something could be done.
  I suggest that if Sullom Voe had not been in existence, the position could have been entirely different and more detrimental to the interests of people on the islands. While we are glad that the wildlife co-ordinating committee responded so quickly, we have to recognise that the Government had no system in place. If, God forbid, another accident happened, perhaps we should not be so fortunate in the location of that accident close to facilities such as those at Sullom Voe. That is worth remembering.
  The fishermen and others agree with the Secretary of State that the polluter should pay. I do not think that anyone would disagree with that. But the problem is that a time scale is associated with it. If a benign view is taken of the polluter—pays principle, we could be talking about a time scale of five to 10 years. That is far too long for salmon farmers, because the problem for them is immediate. I said that they had imposed a voluntary ban. They imposed it 12 hours before the Government did so, simply because of their recognition that their worldwide reputation had to be maintained. They have also monitored outwith the exclusion zone and taken flesh samples of salmon harvested in that zone. The industry is paying for that itself to reassure the trade—firms such as

  1003
  Marks and Spencer, Asda, and Tesco, which have sent their food technologists to the area. They are satisfied with what is being done. The exercise is being paid for by the industry. The Minister should direct his attention to that, so that the fishermen's expenditure can be recognised and the Scottish Office will act quickly.
  In a statement earlier this month, the Secretary of State for Scotland said:
  "the Government strongly uphold the polluter-pays principle.
  There is every reason to believe that the resources available for compensation from the international fund will be sufficient to meet all eligible claims."—[Official Report, 11 January 1993; Vol. 216, c. 626.]
  Not one person to whom I or my hon. Friend the Member for Islington, South and Finsbury spoke believes that resources will be available from that fund. As we all know, the fund has a limit of £50 million. Jimmy Moncrieff said to me today that the compensation for the salmon farmers could run into tens of millions. That could be mirrored by the comments of the farmers themselves. Therefore, the £50 million limit is insufficient, and recognition of that fact by the Minister would reassure people in the islands that the Government will not rely solely on the £50 million.
  I know that the Government will have claims on the fund. In order to reassure farmers and others, will they consider being last in the queue to claim from it? Such a commitment would be some comfort to the salmon farmers and others. The Secretary of State spoke about the special bridging fund, but no mechanism has yet been established, despite what the Minister said, for payments from that fund. I was assured today in my discussions with the salmon farmers and fishermen that, despite the Secretary of State's announcement on 11 January, not one penny has been paid to any of the farmers. I shall give an illustration of the effect of that on the salmon farmers.
  Salmon farms range from those with 500,000 fish and a value of £8 million to those with running costs of, say, £40,000.1 was told today that such a small firm could take out an overdraft of £90,000 to £100,000. That firm's exposure to the banks will already be at a maximum, with personal guarantees and mortgaged houses. As of today, some of the banks are telling the smaller salmon farmers that they cannot issue any more cheques. That means that those farmers are currently experiencing a cash flow problem. Because it is an intensive cash flow industry, farmers need to harvest or they will go bust. Farmers, such as the hypothetical one with running costs of £40,000, are only days away from the bank pulling the plug on them, so the need for that money to get to the islands is urgent. It has to be addressed now. The Minister has to take away from this debate the feeling that these farmers have to be assisted almost immediately.
  I agree with the Minister about the testing taking place in salmon farming areas, and salmon farmers and fishermen are content for the tests to take place.
  I also realise that the test for hydrocarbons, as the Minister mentioned, is an elaborate one, taking about two days, but there is concern about the future for sand eels, which spawn at this time of the year, and it is unclear at present whether they will be affected. Some reassurance about that should be given to farmers and fishermen. I am also aware that the herring will come down for spawning in two or three months' time. Those concerns have to be kept in mind.
  On the extension of the exclusion zone on the west coast, may I ask the Minister to comment further on the
  1004
  east of the Shetlands? It has been mentioned that very little oil has reached there and it might be possible to relax the restrictions if the scientific tests are favourable.
  Lastly, I mention the comments that have been made about the public inquiry. We welcome the inquiry which Lord Donaldson will conduct.
  We stand here tonight in sorrow because there was no mechanism about tanker transportation in place. There is still no mechanism, and I note from the papers today that the European Community had a meeting yesterday in which systems such as the obligatory routeing of ships were put forward, with stiff penalties for transgressors. I am dismayed that it says that the Netherlands, Denmark, Greece and Britain are among the countries that are slow to support tougher legislation, and that the Secretary of State said in the paper today that, while a tightening of safety standards would help, "we have to realise we cannot prevent everything".
  Those who live on the Shetland islands know that the Braer disaster is not preventable now. It is in the past, but they are looking for reassurances for the future. They are looking for reassurances about tanker transportation in Fair Isles and The Minch. It has got to stop.
  While that is not totally germane to this debate, we shall be back to debate it at another time if the Government and the Scottish Office do not make their views known to the Department of Transport. That is the message we want to get across. Do not let us come back in a few months' time because there is a disaster waiting to happen now. Let the Minister tell us exactly what the Government are going to do, so that we are not back here again, debating in sorrow. Let us have legislation in place so that we do not have anything like this catastrophe occurring again.
  12.18 am
  Mr. Alex Salmond: I intend to speak very briefly because I certainly endorse in full many of the points that have already been made. The Minister will understand that right across the House there will be substantial cross-party feeling that we want to see the concerns which the local Member, the hon. Member for Orkney and Shetland (Mr. Wallace), expressed tonight fully met in the ministerial reply, if that is at all possible.
  I would also mention in particular the points made from the Labour Front Bench on the long-term environmental assessment because I suspect that no one knows what the knock-on effects of the disaster will be on the environment. Some assurance tonight that there is to be effective monitoring over the medium term will be very welcome.
  I want to restrict the burden of my remarks to two features which perhaps require some amplification. First, what will be the Government's approach to the medium and long-term economic damage that the accident may cause? Perhaps the Minister will be able to give me an interim answer. Billions of pounds have been spent internationally on media exposure that has given negative publicity to the Shetland islands. The islands have been associated internationally with a major environmental disaster. As the hon. Member for Orkney and Shetland rightly said, we are talking about a community that prides itself on the quality of its produce—sea fish—and the products of its fish farming. The economic damage over the medium term is potentially seriously damaging.

  1005
  The Government may be able to reintroduce confidence —restrictions are to be extended—that produce from the Shetlands is 100 per cent. all right in environmental terms and that quality is being secured. The vigour of the environmental assessment is important. We hope that Government action will contribute to mitigating the economic consequences. There is bound to be an economic impact on the Shetlands—at what level we cannot say—because of international exposure that associates Shetland with a major environmental disaster. Images are still fresh in our minds of the disaster, but less publicity will be given to the measures that are being taken to ensure that Shetland produce meets the highest health regime standards.
  Will an assessment be undertaken and a judgment made? The problem could be tacked by a reinforcement of the Shetland marketing effort internationally. Would that come within the context of the assistance that the Government might be prepared to make available to the islands in future? I accept that it would be difficult to make such an assessment. It would be difficult also for the Minister to give us a guarantee this evening. I hope to hear, however, that an assessment will be considered. If it were found that an intensive marketing effort from the Shetland islands was necessary to secure the position in the markets that their produce held, I hope that the Government would be forthcoming with assistance. I hope that the Minister will comment on how often these measures will be implemented or called into question.
  Early-day motion 1177 was tabled by the hon. Member for Southwark and Bermondsey (Mr. Hughes). It reflects the great concern of Greenpeace and other organisations that at least one major international oil company appears through its internal documents to be extremely reluctant, to say the least, to discuss the safety of tanker transportation. I would like the Minister to indicate that he shares the concern that is felt widely throughout the parties, which is reflected in support for the early-day motion. As I have said, the internal documents of a reputable company suggest that it wants to avoid a public debate on tanker-route safety. I hope that the Minister will respond.
  The motion states that there is a great deal of support for routeing and for some interim action—
  Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. Tanker routeing is pretty wide of food and fisheries.
  Mr. Salmond: I appreciate that, Mr. Deputy Speaker. I am bringing my remarks to a close.
  We are all concerned that we might regularly be faced with measures such as the order in the absence of an assurance from the Minister that interim action will be taken while we await the results of the inquiry.
  12.25 am
  Mr. Elliot Morley: I wish at the outset to add my praise for the attitude of the Shetland Fishermen's Association and the Shetland Salmon Farmers' Association and to congratulate them on the professional and thorough way in which they acted in dealing with the disaster.
  It should be remembered that the Shetland Islands council has for a long time had a contingency plan to deal
  1006
  with disasters of this kind. It is clear that that plan was put into operation effectively, professionally and quickly. That is a tribute to the council and, in particular, to its environmental health department, which is closely involved in the monitoring exercise.
  It is right that we should have the order, not only to protect the health of consumers but to guarantee the quality of produce from the Shetland isles. That aspect has been emphasised in the debate. Some major retailers, such as Marks and Spencer, have begun to buy again from the areas which have not been affected by the disaster. It is clear that there are parts of Shetland from which quality produce can still be marketed, even though the order applies to the affected area.
  I draw the attention of the Minister to the state of the fishing industry and the fact that although it has backed the closure order—and has brought forward its own voluntary ban—the industry faces a series of problems. The ban is yet another problem that it must bear, in addition to the restrictions imposed by the Sea Fish (Conservation) Act 1992, fish quotas, and so on. Knowing that the Minister is aware of those problems, I hope that he will take them into account when considering the strains on the industry and that he will listen carefully to the industry's representations. They will include an appeal for support in the coming months.
  There is the question of salmon stocks now in the cages. Will the Minister consider consulting the industry about whether those stocks, having been contaminated, may be difficult to sell? Bearing in mind the points that have been made today about the quality of Shetland produce, it may be necessary to consider whether those contaminated stocks might compromise that quality. Accordingly, they may have to be destroyed and the farmers compensated.
  The Minister should also consider the effect of the disaster on shore-based industries which rely on the salmon breeding industry. They have been greatly affected by the lack of trade and supplies. Although some industries are not directly involved in salmon farming, the knock-on effect on them has resulted in financial hardship. Are they eligible to submit claims for compensation?
  The long-term monitoring aspects of the disaster must be borne in mind. It was a unique disaster in that it was a very light crude; never before had there been a spill on that scale in the weather conditions which prevailed and the crude mixed in with the water and penetrated the water column.
  Perhaps the Minister will also comment on the effects of the dispersants. After all, the fact that dispersants were used is one reason for the closure order. May we be assured that the dispersants currently being held in this country for use in such disasters are modern and not old stocks which have been stored for years waiting for disasters to occur? Are they internationally approved chemicals, including those approved by the Ministry for licensing purposes?
  Long-term monitoring may be necessary for perhaps 10 years. Who will pay for it? The cost should not become a burden on Shetland Islands council or the local communities. The oil industry should make a contribution on the principle that the polluter pays.
  The Minister will be aware of the three-year project, now reaching its conclusion, being carried out by Glasgow university and the Natural Environment Research Council. He will be aware that I have asked him some written questions about whether the project could be

  1007
  extended to study the relationship between the biology of sea birds and sand eels. If he cannot reply tonight, will he give the matter serious consideration, given the commercial effects of the spill and the fact that the Shetland islands are of international importance in terms of the ecology they support?
  Can the Minister confirm that the Shetland consortium of conservation groups has now been disbanded and, if it has, whether it is being replaced by the ecological steering group? What time scale does he envisage for monitoring?
  The Minister will be aware that there has been a ban on the industrial catching of sand eels in Shetland waters. When will he be able to give us a statement on whether the ban will continue in relation to the disaster and its effect on the long-term ecology of sand eels in terms of the fish which prey on them and the local wildlife?
  The oil spill is a tragedy which could have been avoided. It is right that we should implement the order to guarantee consumer confidence and safety. I know that it has the full support of the fish producers in the Shetlands who have acted in a responsible and professional way. However, the disaster raises issues which go beyond the scope of the order, such as the tragic decline of our merchant fleet, flagging out, tanker routes and coastal policy. I hope that those issues will be thoroughly addressed in the forthcoming inquiry.
  I hope that the Shetland Islands council and its community get the help and support that they have every right to expect to overcome this disaster. Above all, I hope that the lessons learnt in this tragedy will be applied so that we do not have another one in British waters.
  12.31 am
  Mr. Michael Connarty: Although I have no knowledge of or expertise in the salmon fishing industry, as a former member of the Salmon Fisheries Board I know a little about wild salmon.
  I am pleased that we are supporting the order as it is obviously necessary. My hon. Friend the Member for Glanford and Scunthorpe (Mr. Morley) touched on one of the concerns I wish to express. The contamination from the oil will take a long time to disappear, but the contamination caused by the chemicals was a cause of concern when they were being used. It will be much longer before we know whether it will have affected the salmon stocks and the other fisheries.
  It is a great tragedy and I pay tribute to the stalwart way in which the people of the Shetlands and their representatives have shown determination to win back markets and not to have their lifestyles and the quality of their lives destroyed. It is a pity that the order provides only for public health and food issues as it is quite clear that the matters of tanker routes that are not for discussion tonight will hang as a cloud over the Government who will be criticised for not laying an order to deal with those matters.
  I also wish to ask a naive question that other mainlanders and people in the industrial sector who have watched the tragedy with amazement will be asking. Where is the rest of the oil going now? The monitoring that we have discussed seems to be taking place in a small area close to the Shetlands, but 80,000 tonnes of oil do not disperse without landing somewhere and causing more
  1008
  pollution. The Minister mentioned monitoring far and wide and I hope that he will say something about how it will be carried out.
  The amendment of the designated area for the order five miles further west makes it clear that there was some miscalculation or lax monitoring when the original order was placed. It must be a matter of concern that the original order was insufficient to cover the area that now seems to be affected.
  I was one of those who asked about compensation. The hon. Member for Orkney and Shetland (Mr. Wallace) thought it better to leave the figure unstated, in the hope that it will increase in line with needs. Those in the Shetlands who are probably reaching the bottom line in their calculations are beginning to worry whether it will be sufficient.
  The ecological steering group, which will deal with the local area, will be welcomed. However, the people on the mainland are wondering whether the monitoring will be sufficiently rigorous and whether the ecological damage that may occur further afield will be properly monitored and made public. People still have in mind the long-term effects of a much larger disaster, Chernobyl, where the emissions continued to leak out. Indeed, I believe that leakage has not yet stopped. People are worried that the Government might not want to talk about ecological damage because they would, first, have to admit to it and, secondly, have to deal with it.
  I hope that the Government will take account of the fact that five million people in Scotland are concerned about the long-term damage that may be caused outwith the Shetlands. I ask the Minister to do me the courtesy of explaining the technical detail of the monitoring operation. We need to ensure that a lack of proper monitoring does not lead to long-term and long-distance effects on other fishing stocks which, perhaps, have just been fed into the food cycle of the people of Scotland and elsewhere. I should be grateful for reassurance on that point.
  The hon. Gentleman must realise that there are many people on the mainland who do not have the special knowledge of the Shetlanders and of my hon. Friends on the Front Bench. Those people are looking for answers, but they are not getting them from the Government. We need to know where all that oil has gone and which other fishing areas we need to be concerned about. Although the order covers only the Shetlands, the concern stretches much further afield. No one believes that 80,000 tonnes of oil can be dispersed without damage to some other parts of Scotland's ecology, not just that of the Shetlands.
  12.36 am
  Sir Hector Monro: With the leave of the House, Mr. Deputy Speaker, I am glad to reply to the debate, which in general has been welcomed by all hon. Members who have spoken. However, I was a bit disappointed with the hon. Member for Falkirk, East (Mr. Connarty).
  Everything that I said tonight demonstrated that our maximum effort was on monitoring, in particular on what we have been doing in difficult circumstances during recent weeks and what we will continue to do. It has been difficult to get boats out to sea west of the Shetlands, but we managed to do it and they caught fish. We are grateful to the Shetland fishermen for catching fish for us to monitor. It is because we have been monitoring effectively that we

  1009
  have to extend the exclusion zone. That shows that we are taking the correct action, which will continue for as long as is necessary.
  The hon. Member for Orkney and Shetland (Mr. Wallace) gave a warm welcome to the order. I want to express my appreciation for all that he has done regarding his constituency since the wreck. The hon. Members for Dumbarton (Mr. McFall) and for Glanford and Scunthorpe (Mr. Morley) referred to the economic problems of the salmon farmers. I, too, recognise the problems, which is why we have introduced the facility of a bridging loan, to be paid this week. The Shetland Islands council, which is responsible for the administration of the claims, today paid out a large sum to the first salmon farmer who put in a claim. I hope that that will encourage others to apply if their cash flow requires that. I am sure that a significant number of farmers are affected.
  It is good news that the vast majority of the salmon farms are not in the exclusion zone. We are dealing with a small number of farmers, but the scheme is important for their cash flows. We hope that, in the end, the situation will be brighter—that the damage will not be quite so long term as some hon. Members have implied. In the meantime, monitoring will continue. There is virtually continuous contact between the Scottish Office and the salmon farmers. We welcome that contact, and we shall continue to provide all possible assistance until the whole situation has been sorted out. I do not know whether that will take weeks or months, or even years, but general monitoring will continue, as will monitoring of the long-term ecological implications.
  There is no firm knowledge about how long the oil will linger in the area. We do not know what will happen. However, the Government give a categorical assurance that there will be monitoring in all directions, where it is thought to be necessary, to allay the fears of anyone in the United Kingdom. There may have been much more evaporation than some people believe. In any case, there will not be any complacency. We shall be working full time and as hard and fast as possible to make certain that the situation is fully dealt with.
  Several hon. Members, including the hon. Member for Orkney and Shetland, talked about the longer-term economic problems. Most hon. Members will agree that that matter is a little wide of the subject of this debate. However, I assure the hon. Member for Orkney and Shetland that we are considering it. Indeed, my hon. Friend the Member for Edinburgh, West (Lord James Douglas-Hamilton), the Parliamentary Under-Secretary of State, hopes to go to the islands at an appropriate time in the not-too-distant future—a time when it is felt that the islands council would like to meet him and have a discussion involving Highlands and Islands Enterprise and everyone else concerned.
  Mr. Salmond: May I take it from the Minister's reply that he is not ruling out the possibility of longer-term economic aid in such areas as reinforcement of the Shetlands marketing effort internationally if that should be judged to be necessary?
  Sir Hector Monro: The hon. Gentleman is a great man for trying to widen issues and get Ministers on the hop. We shall do all we can to help the economy of the Shetlands.
  1010
  It has been amazingly robust and effective over the years, and we want that to continue. Help will be provided. My hon. Friend the Parliamentary Under-Secretary of State will be able to talk to the Shetland Islands council about the economic aspects.
  But all hon. Members must realise that we are in a somewhat grey area. Nobody knows quite what the future holds. The situation may resolve itself in the medium term, but no one can be certain about the long term. However, I hope that we can be optimistic about the economy of the Shetlands—whether fishing, agriculture or other pursuits. I do not want in any way to run down the opportunities of the Shetlands. They have rightly emphasised the importance of regaining the quality reputation of their products, and I am optimistic about their ability to do just that.
  The hon. Member for Dumbarton implicitly criticised us on the ground that we were unprepared for a major shipwreck. The hon. Gentleman must give credit for the fact that the marine pollution control unit was present on the day of the accident and that on the following day aircraft were spraying dispersant. Because of Sullom Voe, the Shetland Islands council had outstanding preparations. The operations room was put in place extremely quickly. It was a highly commendable effort by all concerned.
  Mr. McFall: Just to correct a point that the Minister made, I paid fulsome tribute to the fact that the wildlife rescue co-ordinating committee was in place because of Sullom Voe and because it already existed in the Shetland Islands council. What I am saying is that perhaps on another occasion—which God forbid—the Government will not be so well prepared. It was quite fortuitous that we had that organisation there on the ground and up and running immediately. That is my point.
  Sir Hector Monro: The hon. Gentleman went on to talk about compensation. I give him the assurance that the Government are last in line for the payment by the polluter.
  The hon. Gentleman then raised the issue of the ban that was put in place voluntarily by the fishermen. The only reason why we were not ready at exactly the same time is that it takes a certain amount of time to lay an official order, but discussions were going on at the same time and we were in entire agreement—and I am glad about that.
  The hon. Gentleman asked about the waters to the east of the islands and about monitoring. We are monitoring that area as well as the west and the south. It is encouraging, but it is too soon at this stage to reduce the exclusion zone to the east of the island. I should think that it will, however, come earlier than in the west.
  I cannot go into too much detail about the Donaldson inquiry because that is where the future of oil transport and routeing of tankers will be discussed. Recommendations from that in line, I hope, with what took place in Brussels yesterday will produce legislation which may well have to be international to make certain that tankers do not sail in vulnerable waters such as those in the Shetlands. We are also most concerned about the Minch.
  The hon. Member for Banff and Buchan (Mr. Salmond) talked about the economic damage. Again, we are watching the situation as closely as we can, but it is more

  1011
  a medium and long-term problem rather than getting over the immediate problems that we are dealing with at present. Scottish National Heritage is co-ordinating what may be required in the longer term for ecological monitoring, and the steering group is in place and will give wise and helpful advice on how we should proceed, so there is no question but that the Government have acted very quickly in setting up these organisations to look after the future of the ecology of the whole area. It is absolutely vital, and we will not let up on it.
  I welcome what the hon. Member for Glanford and Scunthorpe said about the Shetland Islands council and everyone involved. I said that we are having continuous consultations with the salmon farmers. The hon. Member asked about the dispersant. It was approved for use at sea. Through an unfortunate accident, a certain amount was sprayed on the rocks—not an approved use, but on this sort of occasion one must accept that accidents happen. I do not think that it will have caused lasting damage to any person, and again it is being monitored by the health officers on the island.
  All in all, I am very pleased at the tremendous efforts that have been put in by the Shetland Islands council, by the fishermen and by everyone concerned. We hope that the order will not have to be in place for too long, but it must be there while there is any doubt about the quality of the fish landed in the area concerned.
  Mr. Morley: Before the Minister reaches his conclusion, I wonder if he would deal with the point about the fish that have been contaminated in the cages. He quite rightly said that it is difficult to know how long the order will apply because of unknown factors, and people accept that; but he must also accept that if the fully grown fish are held in cages, the whole cycle of salmon farming as regards replacement of the smolts is disrupted, and the disruption will go right down the line of production. Will the Minister consider talking to the industry about the present situation of the fully grown fish?
  Sir Hector Monro: I cannot say tonight whether any of the salmon in the cages have been contaminated. There was talk about a light sheen over one or two of the cages. Some are in the exclusion zone, so the fish cannot be sold. I am well aware that the fish farming cycle is crucial, and that must now be discussed with the Shetland Islands council and the insurers.
  The insurers' initial payment shows that they are willing to accept their responsibility and I hope that no salmon farmer will be out of pocket as a result of this serious incident, which to them will be catastrophic if they cannot sell their fish. I hope that they will be able to do so in the future and that the order will be lifted as soon as the water is clear and the fish are uncontaminated. I commend the order to the House.
  Question put and agreed to.
  Resolved,
  That the Food Protection (Emergency Prohibitions) (Oil and Chemical Pollution of Fish) Order 1993 (S.I., 1993, No. 17), dated 8th January 1993, a copy of which was laid before this House on 11th January, be approved.

  Postal Services (Valley and Rural Areas)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Andrew Mitchell.]
  12.50 am
  Mr. Peter Hain: I am grateful for this opportunity to draw the attention of the House to the Government's misguided and doctrinaire policies which mean that a sword of Damocles now hangs over the Post Office, threatening the future of services in rural and valley areas.
  For example, the Government's policy of blocking Post Office Counters' desire to offer new business and services has resulted in the closure since 1979 of 2,072 sub-post offices and 561 Crown post offices, making a total of 2,633 local post offices.
  Desperately at risk because of the Government's privatisation threat are 10,000 rural offices which form half the Post Office Counters network but provide just 4 per cent. of its volume and are subsidised by nearly £30 million, so they are extremely vulnerable.
  In addition, the Government have forced huge negative external finance limit payments from the Post Office of more than £1 billion at constant prices since 1979, and that extra penalty tax has stopped investment to improve quality in postal services, especially in rural and isolated areas.
  Because the Government are refusing to allow the Post Office, which is entirely self-financing, to raise finance for its investment and modernisation, that, too, is delaying improvements in quality of service.
  In short, the Government's cost-cutting and privatising mania ignores a series of critical questions. For example, if they proceed with their privatisation objectives, who will fund the £200 million rural letters subsidy? The profitable inter-city parts of the Post Office Royal Mail network subsidise the outlying rural deliveries and collection boxes.
  Do the Government plan to restrict deliveries in outlying areas to boxes at the bottom of gardens or drives, or do they propose to ensure that residents will have to go to collection points at the centre of villages or outlying areas to collect their mail, rather than have it delivered to their homes?
  Mr. Elliot Morley: Is my hon. Friend aware that what he has outlined so well is already happening in my rural areas? The village post ladies are being taken to the nearest town and are being replaced by a service from out of the village, coming in by van. Parcels will no longer be left at the village post office but will have to be collected from the nearest town or alternative arrangements will have to be made. That seems to be part of the rationalisation which is linked to the privatisation proposals that my hon. Friend outlines.
  Mr. Hain: I agree with my hon. Friend. The point that he makes should be answered by the Minister who is directly responsible.
  For example, in Wales, the Post Office is rapidly losing its distinctive relationship with the Welsh people. We have seen substantial cuts in services and jobs. For example, 100 small post office closures have occurred in the past five years, often depriving valley villagers of the last remaining service. In addition, 22 urban and Crown offices have closed—and, more recently, about 600 of the 1,200

  1013
  remaining rural post offices' opening times have been cut substantially: instead of being open throughout the week, they are to be open several hours weekly.
  Moreover, the closure of Post Office Counters headquarters in Bangor and Bridgend will take effect by the summer. Those headquarters will be shifted—to Bristol and Manchester. The move will involve the loss of 120 jobs in Wales; in addition, about 500 postmen's and sorters' jobs will be lost over the next five years as part of Royal Mail's reorganisation and introduction of new technology in Wales.
  Parcel depots are being merged as a prelude to privatisation, and 50 jobs in Wales will be lost as a result. Depots in Swansea, Newport and Cardiff are being merged, and some jobs are being transferred to Bristol —again, out of Wales into England. Those 50 job losses exclude future job losses that will occur as a result of the privatisation of Parcelforce. A total of 670 Post Office jobs will be lost over the next five years as a result of the Government's policies, and that excludes the consequences of privatisation.
  A monument to the Government's folly is their proposal to privatise Parcelforce. It has been sloppily planned. Characteristically, the President of the Board of Trade was shooting from the hip when he announced the privatisation in July. If I were charitable, I would suggest that he had been set up by his Svengali, the Parliamentary Under-Secretary of State—a Minister who is obsessed with privatisation, regardless of the consequences to the public.
  I ask the Parliamentary Under-Secretary to deal with the central issue. Services to rural areas will undoubtedly be threatened by privatisation: 20 per cent. of parcels traffic, worth £50 million, is now handled by Royal Mail Letters on behalf of Parcelforce. That is unprofitable and extremely costly, and the aim of the Government's privatisation proposals seems to be to dump it back on to the public sector.
  I hope that we shall receive some straight answers from the Under-Secretary of State about the issue with which the Government are now grappling—the question of VAT. Under schedule 6(3) to the Value Added Tax Act 1983, which implements article 13 of the European Community's sixth directive, the postal services are exempt from VAT, but, as a result of the privatisation of Parcelforce, there will be an immediate price increase of 17.5 per cent.—nearly a fifth—because VAT will be levied.
  Businesses registered for VAT will be able to reclaim the money, but that does not apply to the estimated 1·3 million small businesses that are not VAT-registered. Even more important, it will not apply to the ordinary citizens who posted 11 million parcels to one another last year, worth £40 million.
  In valley and rural areas, there are effectively no competitors. TNT, Securicor, United Parcel Service and all the other predators waiting in the wings for a privatised parcel service are not interested in delivering to a remote Welsh mountainside, or to a remote village—in the valleys or anywhere else in Britain. Residents will be faced with a price increase of 17·5 per cent., because they will attract VAT. That means that a typical 1 kg parcel charge of £2·50 will jump by 42p to £2·92, while the charge for a large parcel costing £7·80 will jump by £1·36, to £9·16.
  1014
  On 2 December, at column 282 of the Official Report, the Minister told me that he intended to maintain a uniform tariff for parcels. He dodged the issue on 15 December, when— as can be found in column 147–I asked about the impact on VAT. There will no longer be a uniform tariff, because the businesses that are able to reclaim VAT will be charged 17·5 per cent. less than ordinary individuals who have to pay VAT alongside small businesses. The uniform tariff will no longer exist.
  How will charities be affected by this proposal? What about the small businesses that purchased expensive metering and franking machines, because they will not be able to use stamps once Parcelforce has been privatised?
  I understand that, because of the intractable problems raised by the VAT issue, the Minister has canvassed the idea of ring fencing parcels posted by individuals across Post Office counters and somehow making them VAT exempt. I do not know whether it can be done without a change in the law. Is the Minister planning to introduce such a change in the Finance Bill after the Budget on 16 March? If he does so, no doubt competitors will protest about unfair treatment. Alternatively, is the Minister's real agenda to privatise the whole of the Post Office, including Parcelforce?
  I have seen advice to the Post Office that the £1·4 billion surplus in its pension funds cannot be transferred. Parcelforce's share is worth about £84 million. Parcelforce's employees are entitled to that money because they contributed to the surplus. Will the Minister confirm that it is not possible to transfer that surplus if he privatises Parcelforce?
  Will the Minister confirm that the Queen and royal family currently send parcels free—what one might call the royal mail prerogative—that the Government will require a privatised successor to provide those services free and, if so, who will pay for it?
  Will the Minister address the question of customs clearance? These matters are central to services in outlying areas and the viability of a future parcels service. Will he confirm that, after privatisation, Parcelforce will operate on the same level as private operators? Its operations may be speeded up as a result, but it will have to be charged extra costs, as the Post Office is currently not charged for customs clearance.
  Then there is the perhaps small matter of yellow lines. I am told that guidance is given to parking wardens not to book Royal Mail vans that are parked on single or double yellow lines. Will the Minister confirm that that special privilege will apply after privatisation?
  What about the employees, whose legally contracted employer is the Post Office? In 1989, when Parcelforce was separated from the Royal Mail, staff were given the option of transferring to Parcelforce. Many did so on the clear and written understanding that they would remain Post Office employees. The Government propose to break that pledge—to dishonour it or to rat on it. Will the Minister confirm that?
  Another example of the overall effect of privatisation on outlying areas is the Government's investment freeze as part of their privatisation of Parcelforce. They have frozen £200 million of Parcelforce's planned £250 million investment in a modernisation programme. As a result, the Coventry hub, a new regional centre linking air to network services, has been postponed. I understand that the

  1015
  £2.5 million needed to purchase the site—a critical part of Parcelforce's new planned network—has been disallowed and that therefore the programme will not go ahead.
  The biggest scandal is perhaps the public subsidising the privatisation of Parcelforce. Parcelforce lost £155 million pounds in the years 1990–92. That amount was absorbed by the Post Office—principally by the highly profitable Royal Mail service—but that was our money, which we have paid into the Post Office as a result of using its services. It is public money. In addition, a further £80 million was spent establishing Parcelforce as an entirely separate business, ripe and ready for privatisation. It is outrageous that a total of £235 million has been spent to set up Parcelforce for privatisation. Are the Government suggesting that any new private operator taking on the business will pay that money back to the public? Incidentally, what will happen to the £187 million of outstanding loans that Parcelforce owes the Royal Mail? Will a privatised company pay back that money? The public are subsidising Parcelforce with a total of £422 million in setting it up for privatisation. It should be remembered that the business is worth only half that amount.
  Mr. Michael Connarty: Will my hon. Friend raise with the Minister the fact that current Post Office Counters legislation restricts what it can sell and does not allow it the full freedom of any other shop in a rural environment or town?
  Mr. Hain: That is an important point. The Government have not allowed Post Office Counters to compete on a level playing field with other businesses. It would very much like to extend its services by operating ticketing, travel and financial services and to undertake the national lottery if that is established. All those initiatives are being blocked by the Government, which puts local post offices under enormous pressure because they are not economically viable.
  What guarantee can the Government give that a privatised successor to Parcelforce will always be able to fulfill its duty under the law to maintain a universal service? They can give no such guarantee. What would happen to services in valley and rural areas if the company went bankrupt? Someone will undoubtedly be willing to pick up the profitable but not the unprofitable parts.
  It is crystal clear that the proposal to privatise Parcelforce is a dog's breakfast. I urge the Government and ask the Minister specifically to invite the Select Committee on Trade and Industry to investigate it before he and the President of the Board of Trade finalise it and make an announcement to the House.
  1.6 am
  The Parliamentary Under-Secretary of State for Technology (Mr. Edward Leigh): I am grateful to the hon. Member for Neath (Mr. Hain) for raising the important issue of the future of postal services in valley and rural areas. I am especially grateful to him for having given me a preview of his speech in The Observer last Sunday. It proved most useful in informing me that various demands would be made of me. I apologise in advance if I am not able to answer all his questions, but I shall try to cover as much ground as I can in the time available.
  The House respects the hon. Gentleman's great knowledge of postal matters, which is based on his 15
  1016
  years as director of research for the Union of Communication Workers. However, I must say that he approaches these issues with a particular political bias, but I forgive him for that.
  My right hon. Friend the President of the Board of Trade announced on 29 July 1992 that there was to be a review of the structure and organisation of the Post Office. We are considering a wide range of options, including private sector options, for the Royal Mail and Post Office Counters. We must recognise that the Post Office is first and foremost a commercial business and that our first duty in this matter is to consider what is best for customers of the business, and that is what we shall do.
  My right hon. Friend has emphasised that the Government remain committed to a nationwide letter service with delivery to every address in the United Kingdom, within a uniform and affordable structure of prices, and with a nationwide network of post offices. He said when he announced the review, and I repeat now, that these commitments are not negotiable and will remain at the heart of public policy towards the Post Office. All the alternative ownership and structural options are being examined with this in the forefront of our minds. Any reform must satisfy these non-negotiable commitments.
  The Post Office is made up of three separate businesses —Royal Mail, Parcelforce and Post Office Counters. I shall speak about each in turn, starting with Parcelforce.
  As my right hon. Friend the President of the Board of Trade said in his announcement last July, Parcelforce operates in a fully competitive parcels market. The majority of its traffic is business traffic. For that reason, my right hon. Friend announced his intention to privatise Parcelforce. I believe that Parcelforce can flourish in the private sector. It has a distinctive brand image and a large customer base which are strengths on which it can build.
  Energetic commitment and support from the work force have already contributed to Parcelforce's improved financial performance. Such attitudes are vital to the future of the business. Parcelforce needs its employees as much as it needs its depots, its sorting offices and its vehicles.
  My right hon. Friend said that he would take advice on the best way to privatise Parcelforce and that he would involve the Post Office board. I am not able to say anything more at the moment about the results of the studies. We are considering the many issues involved.
  Mr. Hain: Will the Minister confirm that the Post Office board has made representations to him, and has said that it does not want Parcelforce privatised separately but wishes to keep the whole Post Office together, either as a fully privatised operation or in the public sector with the commercial freedom that he now denies it?
  Mr. Leigh: The hon. Gentleman will appreciate that I have had a series of meetings with all interested parties, not only with the Post Office board on a number of occasions, but with the trade unions involved, with interested parties in the public sector and with the Post Office Users National Council. They have given me their advice in the review on the basis of confidentiality. The hon. Gentleman would not expect me at this stage to reveal what the various parties have said to me, but I note the hon. Gentleman's question. We are considering the many issues,

  1017
  involved, some of which the hon. Gentleman has touched on, including the best way to secure the universal parcel service. That is not a process that can be rushed.
  The hon. Gentleman has questioned the future of rural parcel services once Parcelforce is privatised. He made some personal comments about me in his speech, but I forgive him for that. However, this is a debate about rural services. He will appreciate that I have one of the most rural constituencies in the country, covering about 750 sq miles. As I am charged with looking after the Post Office, not in terms of operational matters, to which the hon. Gentleman referred in his intervention, but in terms of overall policy, I assure him and give him the commitment from the Dispatch Box that whenever I am considering matters appertaining to the Post Office, it is rural areas, and the needs of rural consumers, of those who live in villages and of those who attach great importance to the village post office, which are uppermost in my mind. The other point that is uppermost in my mind is ensuring that the Post Office has a bright, competitive future.
  Mr. Morley: My point concerns the village of Winterton where I live. The jobs of the three village post ladies are under threat in the reorganisation. The service is deteriorating in the sense that people can no longer collect bulky items from the local sub-post office. Having raised the matter with the Minister, will he use his influence to make representations to the Post Office board to reconsider the matter?
  Mr. Leigh: I know the village of Winterton. The hon. Gentleman is quite entitled to raise the matter. It is an operational matter, but following the debate I will contact Mr. Mike Heron, the new chairman of the Post Office, and convey to him the deep concern of the hon. Gentleman and his constituents in the matter.
  I can assure the hon. Member for Neath that the service to rural communities is not in doubt. My right hon. Friend said clearly in his announcement to the House on 15 July that the continuation of a universal parcel service at a uniform and affordable tariff—I emphasise the word "uniform"—was not negotiable. That means that users of the standard parcel service can still expect to have parcels delivered anywhere in the country within a few working days. The general public use Post Office Counters to send parcels. They can leave parcels to be collected at any of the 20,000 post offices in the country, however remotely located. Charges are based on a simple weight-related tariff so that it costs no more to send a parcel 300 miles than 10 miles. It makes good sense for each aspect of the service to continue, because that is what the public are familiar with and find convenient. Of course, it has been a traditional part of our Post Office.
  Mr. Hain: What about VAT?
  Mr. Leigh: In the time available to me I shall reach that point.
  We are still looking at how the Parcelforce pension surplus should be dealt with. It is a complex and highly technical issue. The options need to be identified and clarified. I cannot say what the conclusions will be.
  Another issue that we are considering is the value added tax position of a privatised Parcelforce. The hon. Member for Neath has been speculating that a privatised
  1018
  Parcelforce will be obliged to charge VAT. He has made that point several times before. He has said that that would put up the price by 17·5 per cent. Such speculation is idle. We have not yet decided on the appropriate VAT treatment for Parcelforce in the private sector. There are many issues to be addressed and we are looking closely at them all in consultation with the European Commission, which obviously has an interest in the matter. It is foolish to wring our hands and speculate about price rises when no decision on the matter has yet been made.
  Mr. Jim Cousins: The Minister has said several times that the matter is complicated in the context of VAT and a chain of other issues and that it must not be rushed. When the President of the Board of Trade announced the possible privatisation of Parcelforce in July, he promised a statement in December. Can the Minister give us some idea when the matters which at the end of January still cannot be rushed may be brought to a conclusion?
  Mr. Leigh: We have had a Post Office for some three and a half centuries. I assure the hon. Gentleman that we will not take three and a half centuries over the review, but I cannot give him any more information than that. This is a serious and complex issue. Both my right hon. Friend the President of the Board of Trade and I are determined to ensure that we get it right and that we consider all the options. In good time, my right hon. Friend will come to Parliament when he and his senior Cabinet colleagues have made a decision. The process will not be rushed, so I cannot give the hon. Gentleman a firm date when a statement will be made. It will be made at the right time. It will be made at a time which will allow us to introduce legislation at a suitable point, if that is what we have to do.
  Mr. Cousins: Is the Minister saying that the privatisation of Parcelforce alone—separate from the rest of the Post Office—is a matter that will require legislation?
  Mr. Leigh: I did not say that. Our advice is that if we decided to privatise Parcelforce alone, it would not require legislation. I think that the hon. Gentleman knows that already.
  Royal Mail provides the fastest and best value—for —money postal service in Europe, and it is not resting on its laurels. In each of the last four years the Post Office has recorded a significant improvement in its delivery performance, as measured by independent researchers. In the first six months of the financial year, Royal Mail's quality of service climbed to record levels, with 91.5 per cent. of all first class mail reaching its destination the following day after posting. This compares favourably with other EC countries. Since 1990, the British Post Office has led Europe for quality of service and value for money in terms of speed of delivery. Royal Mail is, indeed, the only postal administration in the world to conduct independent end-to-end monitoring of service quality.
  In the Swansea postal district, which covers the constituency of Neath, 93 per cent. of all first class letters are now delivered by the next working day. Indeed, Wales as a whole, even in the most rural and remote of areas, has a service which is better than the national average. My own constituency is in the Lincoln postal district, where 95 per cent. of first class letters are delivered the next working day. I am sure that the hon. Gentleman will agree that those are excellent performance figures.

  1019
  The figures show Royal Mail's commitment to service in rural areas and there is no reason to believe that this will change. However, the Royal Mail faces change in many other respects. It no longer has a monopoly over express products and unaddressed mail, its direct mail services face competition from other forms of advertising, and competition from the telecommunications sector is ever growing. Now is the time to consider the potential impact of these changes on Royal Mail.
  The reason for the review is to explore ways in which the organisation and structure may need to adapt to enable Royal Mail to face new challenges and benefit the consumer. I stress that no decisions have yet been taken, but in terms of Parcelforce, the hon. Member may be assured that the manifesto commitments to a universal letter service and a uniform tariff structure are non-negotiable and will be maintained.
  With regard to Post Office Counters and the network of post offices, I remind the hon. Member of the clear, unfettered commitment in our manifesto to a nationwide network of post offices. I do not recall seeing any such
  1020
  commitment in the honourable Member's party manifesto. Post offices and their customers throughout the country can therefore rest assured that whatever solution we adopt for the Post Office and its constituent parts, whether in the public sector or in the private sector, our manifesto commitment will not be compromised.
  That does not, of course, mean a guarantee that no post office will ever close. That would be an absurdity. The precise number and location of offices has to adjust to shifts in population, and to changes in the requirements of clients and customers. Our commitment is to maintain a readily accessible network which fully satisfies the social, industrial and commercial needs of the United Kingdom.
  I echo the hon. Member's sentiments about the importance of the rural sub-post office network. These small post offices play a vital role—
  The motion having been made after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
  Adjourned at twenty minutes past One c'clock.