National Health Service

HC Deb 20 January 1994 vol 235 cc1051-144

Madam Speaker

I must inform the House that I have selected the amendment in the name of the Prime Minister. Because of hon. Members' great interest in the debate, I have had to limit speeches between 7 pm and 9 pm to 10 minutes. I make the strongest plea to those who speak outside those hours to limit their speeches voluntarily so that I may call as many hon. Members as possible.

4.5 pm

Mr. David Blunkett (Sheffield, Brightside)

I beg to move, That this House deplores the lack of accountability, the growth in bureaucracy and waste of resources which have occurred at the expense of patient care arising from the implementation of the National Health Service and Community Care Act 1990. Before I begin my speech, may I appeal to the Secretary of State to make Government time available for an open and non-party debate in the House about infertility and embryology research. During the Christmas recess, great concern was expressed about that issue and the House should have the opportunity to debate it in Government time.

I mention Government time because it is two and a half years—it was 1991—since the Government last came to the House, voluntarily, to debate the national health service. It is exactly a year to the week since we had a debate on the NHS and, just like today, it was held in time allocated to the Labour party. That was not surprising, because the Government have a great deal to answer for.

The Government have created chaos in the greatest health service in the world; they have undermined the confidence of those who work in the service at every level; they have created a situation where instead of money being spent on patient care, it is spent towards servicing the system; they have created a situation in which 100,000 more people are on waiting lists than at the time of the general election. In the first half of this financial year, there was a jump of 25 per cent. in those waiting for more than a year. Last year, there was an increase of 37 per cent. in the number of complaints made.

The Government have deliberately created two-tier access to services with the creation and encouragement of general practitioner fundholding. Their record is a disgrace. In the past year, one in five accident and emergency units were closed. Since the Government came to office, one third of all beds have been lost and one quarter of all hospitals have been closed. That has happened without commensurate investment in care in the community and localised community care facilities. That is a sorry record, but the Government try to blame it on those who work in the health service.

The Secretary of State for Wales said that it was all the fault of the men in the grey suits. It is not their fault, but the fault of the Secretary of State for Health. She is responsible for what has happened to the health service and its work force. We are defending, promoting and encouraging the NHS as we know it—and we created it.

We are fighting against corruption, commercialisation, privatisation, waste and the politicisation of the service at every level.

We must do that because the Government, during 15 years in office, have forgotten the definition of the proper conduct of public business. From Westminster and Wandsworth borough councils to the hon. Members for Rutland and Melton (Mr. Duncan) and for City of Chester (Mr. Brandreth), to quangos and trusts up and down the country, every inch of public life is being packed by the Conservative party supporters.

Mr. Michael Bates (Langbaurgh)

Does the hon. Gentleman include in the trusts that he accuses of being packed with Conservative party supporters the new chairman of the Priority Health Care Wearside trust, Mr. Joe Mills, former chairman of the regional Labour party in north-east England?

Mr. Blunkett

The exception proves the rule. A recent survey showed that 70 per cent. of those prepared to declare a political conviction were Conservatives. Figures placed in the Library by the Government on Tuesday reveal that 60 per cent. of all chairs of trusts in England have a business or financial background; 50 per cent. of non-executive members have a business or financial background; and only 4 and 6 per cent. respectively have any connection whatever with the national health service.

The Secretary of State for Health (Mrs. Virginia Bottomley)

Does the hon. Gentleman also include Helene Hayman, chairman of the Whittington trust? Does he include his own spokesman in the House of Lords, Baroness Jay, who is a member of the health authority?

Mr. Blunkett

Yes, I include them in the 4 per cent. who have an interest in the health service.

I draw attention to the position in south Wales, Scarborough, Glasgow and Gravesham. Let us take a little look at Gravesham. The five non-executive members of the Dartford and Gravesham trust were announced just a few weeks ago: Professor Kelly is a neutral; Kenneth Shaw, a banker, is a Tory councillor; Malcolm Nothard, who is in insurance, is a Tory councillor; Eileen Tuff is a chair of the local Tory association; and Janet Dunn happens to be the wife of the local Tory MP.

May I mention the names of a few other spouses? Mr. T. Shephard of King's Lynn; Mrs. S. Taylor of Southend; Mrs. S. Biffen of Shropshire; and Mrs. Gardiner of Surrey ambulance service—who are they married to? [Interruption.] The hon. Member for Lancaster (Dame E. Kellett-Bowman) shouted,"Sexist.." [HON. MEMBERS: "She is not here."] There is nothing sexist about mentioning both sexes.

Several hon. Members

rose—

Mr. Blunkett

I shall give way in a moment.

What about ex-Members of the House, from before the last election? Mr. T. Flavell, Lord Jenkins, Lord Hayhoe and Sir Timothy Raison were all appointed to trusts. Trusts are a bit like Woody Allen films. We start out with husbands and wives and end up seeing crimes and misdemeanours.

Mr. Jon Owen Jones (Cardiff, Central)

My hon. Friend neglected mentioning the former Member for my constituency, Mr. Ian Grist, who lost his seat at the last election. He is now chairman of the health authority in South Glamorgan and today he announced the closure of the acute unit of the district hospital in my constituency—formerly his constituency. He should have been here to protect it and was then appointed chairman of the health authority to close it.

Mr. Blunkett

I am sorry that I must miss certain former Members, spouses or Tory party Members, because the service is riddled with them. Other hon. Members will no doubt make similar points.

Mr. Andrew Rowe (Mid-Kent)

I should be sorry if the hon. Gentleman omitted to mention my wife. His comments raise an interesting question in relation to Labour party policy. Is the hon. Gentleman saying that a woman who has worked for more than 20 years in the national health service and allied jobs, and who, long before she married a Member of Parliament, had built up a considerable reputation for expertise in the subject, should automatically be denied a presence on a trust simply because she is married to a Conservative Member of Parliament?

Mr. Blunkett

Certainly not. I make no such presumption. merely know that the people who are declared as, or declare themselves as, Tory councillors or Tory Members, or who are married to, or have been married to, Tory Members, are committed to the Tory cause.

When, last week, the Secretary of State rushed out a response to the working party investigation on corporate governance, she expected us to take seriously the message that major changes would be made to bring about accountability in the service. She spoke of staggering changes, such as the fact that, for the first time, health authorities would have to publish annual reports and, for the first time, non-executive and executive members would have to declare any interests in relation to the health service and in relation to their own trusts.

Mr. Edward Garnier (Harborough)

rose—

Mr. Jerry Hayes (Harlow)

rose—

Mr. Blunkett

I shall not give way, as I have given way sufficiently for the moment.

In the Health Service Journal last week, the Secretary of State said: Accountability is one of the key ideas and issues that will be concerning the health service in 1994". It certainly will. We shall want to hold to account those who are making decisions and need to answer to the public about what they are doing. When we table questions in the House, we are met with the blocking response that the information is not collected centrally. We are referred to local trust chairmen and chief executives who are appointed by the Secretary of State, whose remit and survival depend on the Secretary of State and who have no direction to give us the answers.

The pay of those chief executives, chairmen and non-executive members will not be directed by the decision made by the Secretary of State last week on corporate governance, despite the fact that over Christmas the Secretary of State, in the numerous interviews that she gave to the press, gave the impression that it would.

There will be no change; there is no intention to open up the health service. The Secretary of State's proposals on regions make the opposite presumption—instead of regional board members there will be a "respected local figure". The respected local figures for the eight new zones will, even now, appear on the Conservative central office computer.

Ms Joan Walley (Stoke-on-Trent, North)

Is my hon. Friend aware that we in Staffordshire face the prospect of losing our ambulance trust, directly as a result of the Secretary of State's failure to be accountable for what is going on? That is simply because there are so many players who are trying to get rid of a good public service and are concerned only about money. Where does accountability lie for the reduction in the rates of pay of my constituents, who are sitting in the Gallery, from £4.85 to £3.26 an hour?

Mr. Blunkett

My hon. Friend is absolutely right. There is no accountability; there is a concentration not on improving the quality and standard of service, but on cost cutting and demoralisation.

Just before Christmas, I was sorry to hear that the Secretary of State had had her handbag stolen. It was stolen from the back of the official car at 11.30 pm, while it was waiting for her outside Annabel's night club after a Tory party Christmas bash. I mention that not merely to draw attention to the fact that the Conservatives have lost any understanding of the line to be drawn between what is right in terms of political responsibilities and what is expedient in terms of personal and political interests, but to show that the Secretary of State should set an example.

When expense on hospitality in the Department of Health goes up by 46 per cent., it is not surprising that people fail to take seriously calls to cut down on waste. The Secretary of State spent £45,000 on overseas visits—the most of any domestic Government Department, and nearly as much as the Secretaries of State for Foreign Affairs and for Defence. She spent £1 million on the good news unit, using our money to promote her propaganda.

Mrs. Virginia Bottomley

Is the hon. Gentleman aware that all the Ministers in the Department of Health underspent their hospitality budget last year?

Mr. Blunkett

The estimates by the Department of Health equate entirely with the incompetence with which it runs the rest of its budget. If Ministers underspent and still had a 46 per cent. increase, Lord help us if they had really been trying.

At Quarry house in Leeds, home of the NHS Management Executive, the Department spent £55 million and provided hand-woven carpets. It cost £30,000 for just three people to travel between Leeds and London. The A to Z sent out from the health service cost £368,000 and contained a wonderful definition of a bed. People up and down the country know all too well that a bed is not a trolley.

Circulars have increased by 100 per cent. in one year and pamphlets cost £800,000 last year. The Secretary of State for Health has become the task force queen of the Government. A task force has been set up for every single month that the right hon. Lady has been Secretary of State for Health.

Mr. Stephen Day (Cheadle)

When the hon. Gentleman has finished his long list of personal attacks, smears and innuendo, perhaps he will take some time out to explain the Labour party policy on NHS trusts. He has made contradictory statements in the past and I hope that he will allow us to have a proper debate by clarifying where Labour stands on that matter.

Mr. Blunkett

I will clarify our policy in my own good time. However, our policies will have something to do with treating patients, quality of care and what goes on in the service. I raised issues relating to the Secretary of State because she is in charge and what she does and says matter. Her attitudes pervade the entire service.

It is worth drawing attention to a 19-year-old boy called Dominic who wrote to every member of the Cabinet just before Christmas asking for a donation towards a £1 million appeal to charity.

Dame Jill Knight (Birmingham, Edgbaston)

That has nothing to do with the motion on the Order Paper.

Mr. Blunkett

It has absolutely everything to do with what we do and how much we care. The Chancellor of the Exchequer gave a tenner, the Chief Secretary gave a fiver. It is relevant, because the Secretary of State for Health sent him a photograph of herself. Sincerity ratings and opinion poll ratings reflect that.

Dame Jill Knight

On a point of order, Mr. Deputy Speaker. Is it in order for hon. Members to make gross personal attacks, nothing whatsoever to do with the motion on the Order Paper?

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)

If there had been anything out of order the Chair would have ruled on it. It is a matter for the hon. Member, who is responsible for his own speech.

Mr. Blunkett

I drew attention to what is said and done. We are talking about £1.2 billion being spent on introducing the new system; we are talking about waste and the use of the new market system to increase profits in the private sector by 19 per cent. in the past year; we are talking about he misuse of money merely to manipulate and service the system rather than to provide care.

We are also talking about the ridiculous position of London with the specialty reviews, the Tomlinson review and the Peckham reviews. University College hospital is not threatened by any of those reviews but by the market itself, and the Secretary of State has had to intervene to save that great hospital and its facilities from herself.

Those things matter greatly to every single person. They matter to those who have been waiting 14, 18, 19 or 22 hours on trolleys. They matter to those who have been waiting for operations that have been cancelled again and again. They matter to people who have been told that they could have their operation done if only their GP belonged to a fundholding practice. They matter to people who have seen waste in every area of the service. For example, salaries have risen for senior managers, people have undertaken trips abroad, conferences on waste have cost thousands of pounds.

Nadene Ghouri rightly said in the Evening Standard a day or so ago that one waits for hours and is then told that, if only one would pay, one could have a bed—which was already there and available—for £270 at King's, and that one could be taken off a trolley and given the care that one deserves if one were prepared to pay the money.

We know why people believe that the health service is not safe in the hands of the Secretary of State. We know why people are so angry and frustrated. We know why people wish us to raise the issue of waste at every opportunity. We know why people are asking us, day in and day out, to raise their concerns, which they express at every surgery: why waiting lists and waiting times have gone up; why there are hidden waiting lists; and why they must wait to see a consultant—the crucial time—so that it can be assessed whether there is an urgent case to be dealt with and urgent treatment to be undertaken.

Those things matter to everybody, but no statistics on those matters are kept nationally. They are not added to the waiting times. The Secretary of State will shortly give instructions for getting waiting lists down for those waiting more than a year. Nobody takes the statistics of those who have never been put on a waiting list, because they have been told that they cannot be given a time and therefore that there is a pending list on which they have to be kept. Nobody would forgive us if we did not raise again and again the need for every pound of our money not to be spent on peripheries, not to be wasted on incompetence, but to be spent on patient care.

Mr. Gyles Brandreth (City of Chester)

Given that the hon. Gentleman wants to see more money spent on patient care, why did he oppose compulsory competitive tendering, which is producing some £130 million extra for patient care? That is what the debate is about.

Mr. Blunkett

I think that the term "brass neck" would be an understatement.

Mr. Brandreth

Answer the point.

Mr. Blunkett

I am interested not in cutting the wages of the lowest paid, but in improving the quality of care to the patient and getting people off trolleys and into beds. Today, in its campaign to improve our health service, has provided excellent information, as has the Evening Standard on what is happening in London, the Manchester Evening News in Manchester and the Sheffield Star in my area, and newspapers throughout the country, and the exposure of waste by the Daily Mirror.

All that information is available for people to see. What is more, people also know who benefits from spending and from the health service, not merely those who are placed in positions with which I have already dealt this afternoon. Of the top five beneficiaries who benefit from health service spending, two of them give money to the Tory party: A. A. H. Holdings plc and Glaxo. They will benefit from our money. The hon. Member for City of Chester should not start lecturing about where the money goes or who benefits from it, because some of us could give chapter and verse about how some people have been benefiting greatly from the thrust towards privatisation in the health service.

Mr. Nigel Evans (Ribble Valley)

Will the hon. Gentleman give way?

Mr. Blunkett

I shall not give way.

We know what is happening. The Secretary of State for Wales revealed it all. There is jargon where previously there was common sense, and over-management where previously people committed themselves to service. Episodes of care have replaced counting patients. Activity levels are fiddled by counting those who come back from theatre not only to a different ward but to a different bed, and by double-counting people who have been discharged too quickly and are readmitted for the care that they should have had in the first place. Provider units have replaced hospitals and community services.

I was asked what we would do. We would repay the confidence of the British electorate by treating them with respect and dignity, to restore common sense to our health service. We would not adopt the "Yes, Minister" approach in which the Secretary of State has been engaged, with private gain at public expense, which is what we have had during the past 15 years. Each year, £85 million goes in tax relief alone for those who are retired and cannot obtain services in the NHS. Insurers provide the facilities that the NHS should provide as a matter of right. That is the truth of the matter.

Again and again, we have raised the incompetence, corruption and nepotism in the Wessex and the West Midlands regional health authorities, or the sell-off of the estates facilities in the South West Thames regional health authority, which reaped one man alone a profit of £900,000. It is no wonder that the British people rally to our support in our fight to cut bureaucracy and to increase investment in the care of patients.

In the year ahead, the British people will see the Secretary of State's capital budget cut by £73 million and there has been a 4 per cent. reduction in the proportion of the health service budget spent on the mental health service, despite the declared commitment to that service, and they will hear the Secretary of State repeating platitudes. No wonder the word "ecology" springs to mind. Recycling the same statistics and verbiage is no substitute for a policy.

Our principles are clear. We want a comprehensive NHS, not a fragmented, destroyed and undermined service, and equal access for everyone at time of need, not GP fundholding undermining that key principle on which we stand. We want a health service that is publicly funded and publicly provided, not an easy killing for the private sector—what Aneurin Bevan described rather graphically as sucking at the teats of the state. We want public accountability where we currently have nepotism, and a free service at the time of need, not charges and private insurance.

That is why I was so interested in the interview—

The Minister for Health (Dr. Brian Mawhinney)

For the purpose of clarification, has the hon. Gentleman just announced that the Labour party will abolish charges if it is ever re-elected to government?

Mr. Blunkett

I did not know that the Government were committed to charges for treatment at the time of need. Last year, the Secretary of State went out of her way to say that she was against charging people at the time of need. The Chief Secretary did not. He made it clear that he was in favour of extending all charges—charges for what he calls hotels in the hospital service; charges for meals; charges for what is now known as recuperation, for nursing when one comes out of theatre—which will soon be known as convalescence and charged for. The Secretary of State boldly stepped in to contradict her right hon. Friend, saying that, for the time being, there would be no charges for treatment. And Conservative Members have the cheek to ask me whether we would charge patients for treatment!?

I can think of no better way in which to sum up the Secretary of State's dilemma than quoting from a recent interview that she gave The Spectator.

Mr. Garnier

Will the hon. Gentleman give way?

Mr. Blunkett

No, I will not. I have already given way a number of times, to the detriment of the flow of my attack on the incompetent handling of the health service.

In that interview, the Secretary of State said: We are like ducks going round in a fairground, and people shoot at you all the time as you go round. In the end, they get you, and the great thing is to know what you will be doing the next weekend. I know where the Secretary of State will be going. I know where she will find herself when the people of Britain have the opportunity to make a judgment on the Government's stewardship of the NHS—on the way in which they have used resources, the way in which they have undermined the heritage that they received, the way in which they have increased the amount of waste and bureaucracy in the service and the way in which they have undermined accountability. That is why we have moved the motion, and why we have every confidence that people of good will, who are committed to the NHS, will reject the Government amendment.

4.36 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: 'welcomes the improvement in the efficiency of the National Health Service which has resulted in a substantial increase in the number of patients treated, a reduction in long waiting times for hospital treatment and improvements in the quality of patient care; considers that these improvements show that the health reforms are working and that accountability has been strengthened by the clarification of responsibilities under those reforms; and looks forward to further benefits for patients resulting from proposals announced by the Secretary of State for Health to minimise the costs of administration through the proposed abolition of regional health authorities and streamlining of management.'. We have just heard a catalogue of vituperation, personal abuse, innuendo and unsubstantiated smears. Once again, the one thing that we have not heard is a policy: this is a policy-free zone, as it has been before.

Mrs. Jacqui Lait (Hastings and Rye)

I listened carefully to what was said by the hon. Member for Sheffield, Brightside (Mr. Blunkett). I fear that I must disagree with my right hon. Friend according to her, the hon. Gentleman said nothing about policy, but I picked up two ideas—albeit meager—from what he said. The first is that, if Labour ran the health service, there would be centralised control of information; the second is that there would be public accountability. Does my right hon. Friend agree that that public accountability would lead to a trebling of a number of committees in the health service? That is what happened in Sheffield when the hon. Gentleman led the council.

Mrs. Bottomley

Yes, indeed. My hon. Friend is entirely right.

As I was saying, we have again been confronted with a policy-free zone, empty of substance. As always, the hon. Member for Sheffield, Brightside (Mr. Blunkett) condemned and talked down the national health service, rather than pay tribute to the dedicated staff who work in it, providing ever higher quality care.

Ministers give an account of their stewardship of the health service every month at Question Time, and in Adjournment debates and statements. Even when they give their account of developments to the press, the hon. Member for Brightside complains that there are too many press interviews and press notices—simply because, yet again, they highlight the bankruptcy of his own position. He asks a good many questions. During a recent period, Opposition spokesmen asked 1,400 questions, at a cost of £144,000: they cost £97 a go. However, I am grateful to the hon. Gentleman.

Mr. Andrew Faulds (Warley, East)

On a point of order, Mr. Deputy Speaker. Is it not rather inadvisable of this young woman—she supposedly is a Minister—to question the right of hon. Members to table questions, regardless of cost, when she is the most incompetent Minister in an incompetent Government?

Mrs. Bottomley

I was going to suggest to the hon. Member for Brightside that requests for me to list NHS expenditure, in the latest year for which figures are available, on surgical dressings and bandages, broken down into the country of manufacture, were not particularly necessary to the careful stewardship of the national health service, bearing in mind the fact that each question happens to cost £97.

A year ago, we charged the hon. Member for Brightside to explain his policies but we are still waiting. Would he abolish NHS trusts? We heard an interesting intervention from the hon. Member for Stoke-on-Trent, North (Ms Walley) who seemed particularly distressed at the prospect of her trust being dismantled. Would the Labour party dismantle the health reforms or does it accept that they are here to stay? We have waited a year but printing machines have failed to roll. The questions are still unanswered; the policy zone is still deserted.

The answer to the question, "What is Labour's health policy?" is that Labour's health policy is due out next month. As far as I can tell, that has been the position since the general election and it was certainly the position when last month the hon. Member for Brightside gave a short interview about his policies. However, next month has arrived and the hon. Gentleman is still silent. He is the mafiana man, always putting off until tomorrow what he should be doing today.

Mr. George Stevenson (Stoke-on-Trent, South)

On the subject of NHS trusts, does the Secretary of State understand that the split between purchaser and provider is widening and that patients are falling into the gap that is being created? For example, a 90-year-old constituent of mine, who was taken to a trust hospital for a head injury, complained of rib pains, was sent home without an examination and was later found to have broken ribs. That occurred because the hospital needed more beds. Is that the sort of policy that the right hon. Lady promotes? Is that the sort of service that people deserve?

Mrs. Bottomley

There are few thinkers who do not believe that the distinction between the task of assessing health need and purchasing health care and the task of providing for patients is better separated. They are different jobs and separation provides the opportunity to develop a strategic framework to improve the health of the nation. The health reforms, which will ensure that money is not used merely to prop up institutions but has a strategic purpose, are of profound importance.

It is a source of great regret that the Opposition are not interested in debating or willing to debate in detail the complexities of making the system even better. Had they been interested, I should have referred the hon. Gentleman to, for example, the speech by Sir Duncan Nichol, the chief executive of the NHS, in which he talks about the importance of purchasers and providers working together and to repeated statements by Ministers to the effect that it is important that there is a spirit of trust and co-operation between the districts and the general practitioners and between the hospitals and the clinicians who work in them. Out of that new system comes an opportunity to develop a health service that meets the health care needs of his and all of our constituents much more effectively.

The sadness of the Opposition, who are dominated by the trade union movement, is that they talk constantly of the reactionary, the fossilised and vested interest but they have no interest in patients or in progress.

Mr. Rowe

Is not it true that in the mafiana republic that the hon. Member for Sheffield, Brightside (Mr. Blunkett) wishes to establish we would return to a provider-driven service? Is it not perfectly clear that one of the enormous advantages of the purchaser-provider split is that it has rendered the accounting transparent? That, in turn, has made it much harder for people to get away with a range of little abuses that have crept in, such as the use of NHS equipment in private practice. Is not that a clear example of value for money?

Mr. Deputy Speaker

Order. Interventions are supposed to be short but the two that we have just heard have been rather lengthy. If that continues, the many hon. Members who want to catch my eye will be disappointed.

Mrs. Bottomley

I shall try to resist inteventions for a while but, Mr. Deputy Speaker, you will appreciate that I have a great commitment to the changes that we are setting in hand and my hon. Friend the Member for Mid-Kent (Mr. Rowe) raised precisely the sort of point which proves that we are becoming ever more effective in improving the quality and quantity of care that we are able to deliver.

Mr. Thomas Graham (Renfrew, West and Inverclyde)

rose—

Mr. D. N. Campbell-Savours (Workington)

rose—

Mrs. Bottomley

I hope that the hon. Gentlemen will bear with me. It is my way to give way but I fear—

Mr. Campbell-Savours

rose—

Mr. Deputy Speaker

Order. It is fairly obvious that the Secretary of State is not giving way.

Mrs. Bottomley

Of course there are times when things do not go as they are intended. There are times when patients are treated unacceptably but, of the 8 million in-patients treated, the vast majority express great satisfaction with the care that they receive. When things do go wrong, it is right for us to take action.

One such example is the case of the lady mentioned by the hon. Member for Stoke-on-Trent, South (Mr. Stevenson) who had to wait an unacceptable length of time on a trolley in an accident and emergency department where an £8 million investment programme is under way to extend it. It was, nevertheless, an unacceptable state of affairs which is why I have today written to health authorities to ensure that they have the proper A and E arrangements in place, that they have provision for a service that is subject to unpredictability, that they have the spare capacity and that patients are always treated with dignity and courtesy.

Mr. Campbell-Savours

rose—

Mrs. Bottomley

I cannot give way as I need to make further progress.

The hon. Member for Brightside refers with scorn and abuse to all those who spend their time working in the health service. He speaks vindictively of those he describes as non-caring, non-patient—orientated"—[Official Report, 21 October 1993; Vol. 230, c. 400.] meaning the white collar workers in the NHS. It is not good enough for him then to say that he has in his sights only the senior executives or some group that he associates with the reforms. It is important to make it clear that general and senior managers account for only 3 per cent. of the NHS wage bill and 2 per cent. of the work force. They are tiny figures.

The figures that the hon. Member for Brightside frequently quotes as a damning indictment of NHS bureaucracy include, for example, the medical secretaries who provide the invaluable back-up to doctors, freeing them to spend more time with patients. Is the hon. Gentleman, in his abuse of managers in the service, saying that medical records should not be filed or patients' notes typed? Is he saying that such people are "non-caring, non-patient orientated?" He should apologise for his remarks which belittle and insult the hard-working members of the NHS. As ever, his comments show the bankruptcy of his arguments.

Mr. Blunkett

Statistics provided by the right hon. Lady's Department show that senior management costs have risen from £25 million to £494 million and that last year trusts spent £24 million on cars compared with £5 million the year before. Where do medical secretaries feature in those statistics?

Mrs. Bottomley

The hon. Gentleman is adding apples and pears; he is not comparing like with like. There has been an increase in the number of managers, in large measure because of the reclassification of a great number of senior nurses. The fact remains that whereas, 10 years ago, 60 per cent. of our staff were involved in direct patient care, the figure has increased to 65 per cent.

Our record is commended around the world. We concentrate on meeting patients' needs and we do so effectively. The question that the hon. Gentleman should ask is, what is the added value from the management input in the health service? The answer is the delivery of extra patient care, falling waiting times and improved quality, which is so important.

Mr. Graham

Will the right hon. Lady give way?

Mrs. Bottomley

I shall give way for the last time and then I must make headway.

Mr. Graham

I am delighted that the Minister has agreed to give way.

The citizens charter, which promised our constituents that they would be treated or get an appointment in a certain period, is absolutely horrifically not working in my constituency. One of my constituents has been waiting five months for an appointment with a urologist. I have been told by a local doctor that it will be more than 19 weeks before they can get an appointment to meet a urology consultant. Is that the type of health service that we are running for our constituents?

Mrs. Bottomley

The House must be aware that before the health reforms more than 200,000 people were waiting for more than a year and many people were waiting for more than two years. We have seen a plummeting in the long waiters and a substantial reduction, in the year, of more than one year waiters. There has been progress in the health service and transparency for patients because the patients charter explains to patients precisely to what they are entitled. That is because of the greater transparency, the better organisation and the commitment by the Government to the NHS.

My hon. Friends on the Conservative Benches will remember the Cook test, named after the hon. Member for Livingston (Mr. Cook), who radically challenged us to measure the success of trusts by the simple test of whether they do more or less work for patients. Now that those trusts are indisputably doing more work for patients, the hon. Member for Livingston conveniently finds himself with new duties, but the hon. Member for Brightside is left to wriggle and squirm his way out of that hole. That is why he will count the number of beds, bandages or of press notices—anything but patients. The hon. Member will not recognise that it is the patients who count.

The hon. Member for Brightside forgot to mention in his speech that the NHS hospitals are on course to treat 8 million patients this year. That is 1 million more than in the year before the reforms, but it is 3 million more than it was when the Labour party was in power. [Interruption.]

Mr. Deputy Speaker

Order. The Secretary of State has made it very clear that she will not give way.

Mrs. Bottomley

The hon. Gentleman forgot to mention that trusts have increased their patient activity even faster than other hospitals. He forgot to mention that for every 100 patients treated in hospital before the reforms 116 are treated today, and next year it will be 120. He forgot to mention the rapid increase in day surgery and childhood immunisation and in the quality of care.

The hon. Member for Brightside spoke about waiting lists. He forgot to mention the 51,000 patients who, before the reforms, were waiting more than two years; there are none today. He never gives credit. He certainly did not mention that before the reforms the average wait was nine months; that has now decreased to five months. Ten years ago, only one in eight patients were able to have a hospital operation and go home the same day. That is now one in four.

That is what our-policies are achieving. The Labour party cannot bear to hear the accurate statistics of the achievements of the national health service because the figures highlight even more clearly its abject failure to come up with a policy. [Interruption.]

Mr. Deputy Speaker

Order. It is fairly obvious that the Secretary of State is not giving way at this stage.

Mr. Graham

On a point of order. Mr. Deputy Speaker. I thought that debates were an opportunity to give Back Benchers a chance to question the Minister. It is difficult for us to do a good job if we cannot get a chance to do so.

Mr. Deputy Speaker

The Secretary of State is responsible for her own speech and whether she gives way.

Mrs. Bottomley

I think that I have given way as much as, or probably more than, the hon. Member for Brightside. Opposition Members do not wish to have an informed debate. They seem to wish to make a great noise because they want to obscure the achievements of the national health service.

Mr. Mark Wolfson (Sevenoaks)

I am most grateful to my right hon. Friend. She is making a robust defence of the strategic changes in the health service and I commend her fully for that. May I say, however, that there is concern among many general practitioners in my part of the country about the quantity of statistics—which she recently mentioned—which they have to provide. At this stage they do not receive enough information about the usefulness of those figures. I hope that she will regard that as a constructive contribution to the debate, in contrast to the attacks that she has received from Opposition Members.

Mrs. Bottomley

That is an extremely constructive contribution because it highlights one of the dilemmas or complexities that confront us. We have to be accountable for the work that is undertaken by general practitioners; we have to ensure that there is a comprehensive health service; we have to have control, not only of the financial aspects, but of the quality of clinical care. Every time that a form is filled in, however, there is a distraction. That is time that general practitioners would rather spend with their patients. I hope that we shall find more simplified ways of satisfying the proper interests of general practitioners as well as, rightly and properly, the need for accountability and the stewardship of the national health service.

Mr. Campbell-Savours

rose—

Mrs. Bottomley

I think it would be fair to say that I have given way to Labour Members twice as many times as I have to Conservative Members. I do not wish to fall out with my hon. Friends and, therefore, for fear of getting into difficulty with them, I must demonstrate some sense of balance and order in the number of occasions on which I give way. When I have given way to an equal number of Conservative Members I will try to give way to Opposition Members once again.

You will appreciate, Mr. Deputy Speaker, with the substantial advances that I have identified, that the Labour party—

Mr. Home Robertson

On a point of order, Mr. Deputy Speaker. Will you start a waiting list for Members who want to intervene in the debate?

Mrs. Bottomley

I suggest that Labour Members put their name down on the waiting list for a Labour party policy on health because if ever there was a case of, "If in doubt, shout", it is the Labour party: It has no policy. The nerve of asking for a debate which simply gives my hon. Friends the opportunity to expose the Labour party's policy-free zone defies all description. We had thought last week that the antics of Labour Members were a result of their deciding at the last possible moment that they could not brave a debate, and were a way for them to pull the plug on it. Be that as it may, all day today the hon. Gentleman will have to put up with my hon. Friends asking time and again, "Where is the policy?" That will not deflect me from continuing to give an account and an explanation of those important changes.

We take the view that the way in which resources are managed is of crucial importance to delivering quality and cost-effective patient care, but we also accept that the resources are important. That is why, this year, we have more than met our manifesto commitment. NHS spending is already at record levels and it will increase next year by a further £1.6 billion—equivalent to an extra £83 for every household.

I notice that last week in the British Medical Journal the hon. Member for Brightside said that he hoped that the Labour party would make a specific commitment on NHS funding. I hope so too, after the consultation. We are sick and tired of being told that the health service is underfunded, by a party which refuses time and again to say by how much health spending should increase.

Last month, however—Labour Members may wish to listen to this—the hon. Gentleman said that a Labour Government would aim to take Britain into something called "the 7 per cent. club", by which he meant the group of nations who spend at least 7 per cent. of gross domestic product on health services. Is he aware that the policy would cost the British taxpayer an extra £6 billion? Will he confirm whether that is now Labour's firm commitment? Will he confirm whether he has the express permission of the shadow Chancellor to make that commitment?

While the hon. Member for Dumfermline, East (Mr. Brown) is telling the British taxpayers, "Honest, guy, we've gone straight," the hon. Member for Brightside wants to pick £6 billion out of their pockets. Perhaps the hon. Gentleman wishes to confirm the status of his commitment to spending an extra £6 billion on health. Would he like to intervene?

Mr. Campbell-Savours

rose—

Mrs. Maria Fyfe (Glasgow, Maryhill)

rose—

Mrs. Bottomley

It seems that the hon. Member for Brightside does not wish to substantiate the claim that he made last month. No doubt my hon. Friends, and their constituents, will be extremely worried about that aspect of Labour party policy.

The truth is that in government Labour cuts spending and in opposition it cuts commitments. The Government have done neither. We have cut out waste and improved efficiency. Since we came into office the number of patients treated in hospitals has increased nearly three times as fast as spending, even when that is adjusted for inflation. In the 1980s the number of patients treated in hospital grew on average by 2.5 per cent. a year.

Mr. Graham

The health of the nation is deteriorating.

Mrs. Bottomley

I must respond to that off-side intervention. The hon. Gentleman says that the health of the nation is deteriorating, but he may like to know that over the past 10 years the number of people who die below the age of 65 has fallen by one fifth, the number of babies who die in their first year has fallen by two fifths, and average life expectancy has increased by two years. I regard that as a substantial improvement in the health of the nation.

Mr. Campbell-Savours

rose—

Mrs. Bottomley

I am seeking—

Mr. Home Robertson

rose—

Mr. Deputy Speaker

It is fairly obvious that the Secretary of State is not giving way.

Mrs. Bottomley

Labour Members may wish even less to hear what I have to say next. In the 1980s the number of patients treated in hospitals grew on average by 2.5 per cent. a year; in the 1990s, since the reforms, that number has been growing by 5 per cent. a year, and even faster in the trusts. Under the Labour Government activity grew by little more than 1 per cent. a year. The improvements are essential if the health service is to keep pace with the demands on it. That is why, as well as maintaining our spending commitments, we shall continue to demand tough efficiency improvements from the health service.

Mr. Hughes (Doncaster, North)

rose—

Mrs. Bottomley

It is not how much one spends, but what one does with it.

Mr. Hughes

Will the Secretary of State give way, on spending commitments?

Mrs. Bottomley

I have no need to give way on spending commitments. A Government who have given an extra £1.6 billion this year do not need to give further explanations of spending commitments.

For the coming year we have set a target of 2.25 per cent. for efficiency gains, which will release an extra £450 million to spend on patient care. It is no coincidence that those dramatic improvements in the number of patients treated have taken place as the Government deliberately strengthened NHS managers. Leaders of the profession agree.

Christine Hancock, for example, recognises that that process was needed, and indeed overdue. Sir Roy Griffiths, whose management reports in the mid-1980s were so important, said that if Florence Nightingale were carrying her lamp through the corridors of the NHS then, she would almost certainly be searching for the people in charge. In the unmanaged shambles that we inherited from the Labour party it was impossible to reduce costs because nobody knew what costs were. Better management has meant that we have been able to cut waste by improving services and service delivery.

Take, for example, the supplies authority—

Mr. Campbell-Savours

rose—

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

Give way, give way.

Mrs. Bottomley

Last year and this year the NHS supplies authority has saved £84 million. In addition it has just negotiated a deal with British Telecom to save several million pounds through its contracts. Better management has cut energy consumption. The hon. Member for Brightside pours scorn on the "A to Z of Quality", but the idea has brought forward practical initiatives throughout the health service, and people are taking those achievements forward. The hon. Gentleman is pouring scorn on the efforts of nearly 3,000 NHS staff who have submitted their ideas for individual cases to be selected.

Mr. Campbell-Savours

rose—

Mrs. Bottomley

In just one example, in the constituency of the hon. Member for Wakefield (Mr. Hinchcliffe), energy management—

Mr. Sedgemore

Give way, give way.

Mr. Deputy Speaker

Order. It is a matter for the Secretary of State whether she gives way or not.

Mr. Sedgemore

Why does she not give way? There is something wrong with her.

Mrs. Bottomley

One of the examples—[interruption] Once again, Labour Members do not want to hear the facts of the situation. One of the examples in the "A to Z of Quality" concerns the constituency of the hon. Member for Wakefield, where the energy management project is saving £370,000 a year. That more than covers the costs of the "A to Z of Quality", and the money is all being spent on patient care.

We have cut waste by contracting out services. Competitive tendering across an ever widening range of services has led to savings of at least £130 million a year. The Labour party fought those changes and it fights them still. That says more about its real commitment to rooting out waste in the health service than all the spurious facts and figures cited by the hon. Member for Brightside.

Mr. Campbell-Savours

Will the Secretary of State give way?

Mrs. Bottomley

The hon. Gentleman has ground me down, Mr. Deputy Speaker.

Mr. Campbell-Savours

Contrary to what the right hon. Lady has been saying, some Labour Members are very happy with the treatment that we have had in the national health service, and we are prepared to say so publicly.

Mr. Sedgemore

Where was the treatment? St. Bartholomew's.

Mr. Campbell-Savours

However—

Mr. Sedgemore

The Secretary of State is closing down the hospital that saved my hon. Friend's life.

Mr. Deputy Speaker

Order. The hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) must control himself.

Mr. Campbell-Savours

When one is in hospital one hears when things go wrong. I can tell the Secretary of State about an incident one evening in Bart's when the accident and emergency department was 33 beds short. The chap responsible for running the whole hospital decided that the staff had to put beds on the floor—

Mr. Sedgemore

Mattresses.

Mr. Campbell-Savours

I am sorry, it was mattresses. They had to put mattresses on the floor to take in the extra patients in accident and emergency. Someone then telephoned throughout London to find out whether there were additional beds available in any other accident and emergency department, or in any other ward in any other hospital. Bart's telephoned 17 hospitals, and could not find a bed. So we cannot understand why, at the same time—

Mr. Sedgemore

She is shutting the A and E unit.

Mr. Campbell-Savours

We cannot understand why the right hon. Lady is deciding to shut the accident and emergency unit in the hospital where I was. Where is the sanity in that policy?

Mrs. Bottomley

Again, I ask Labour members to read the informed and sensible debate on change in London that was led by their spokesman in the House of Lords. She said, as the hon. Gentleman must also say in his more rational moments, that no change is no option in London. Of course having first-rate A and E services is essential for the change. That is why we are putting nearly £15 million more into the London ambulance service.

Meanwhile, there is a major development programme at the Homerton, increases at the Royal London, improvements in the A and E at St. Thomas's and £8 million being spent at King's. Those who take a more serious interest in the health service will know that one of the dilemmas in London is caused by the fact that people frequently use A and E services where elsewhere they would use primary care. If the hon. Gentleman cared to consult Professor Lesley Southgate, professor of general practice at St. Bartholomew's hospital, he could have an informed discussion about the importance of change in London and of developing primary care, and about the phenomenal unprecedented investment that is under way, taking forward 100 primary care schemes across London this year. That is a necessary programme of change.

I understand the concerns of those most directly involved. I also know that it would be unforgivable, in the light of all the changes, and all the medical advances, to fail to grasp the nettle. I admire Labour Members who constructively and responsibly seek the right outcome rather than simply holding on to the latest fashion and resisting change. It is that approach which makes them unfit ever for government and ever again for stewardship of the national health service.

This debate is of great importance and there are further matters which I wish to raise. We have announced recently that we wish to streamline the management of the NHS. Every change requires review and further development. We have had a successful drive towards decentralisation. We want patients closely involved and we want decisions to be made as close to patients as possible. Now is the time to sweep away a layer of administration. That is why I have announced proposals to abolish the 14 regional health authorities, to reduce further the number of health authorities by allowing district and family health service authority mergers and by streamlining the management executive. Those proposals received a broad welcome, both inside and outside the health service.

Of course, as ever, the hon. Member for Brightside could not bring himself to share that welcome. Once again, he talked about cutting out waste and when we take action to do so, he is lost for words. The proposals will mean that the management of a decentralised health service is even more effective and they will save money on administration to be spent on patients. That process is already well under way. Take, for example, the Northern regional health authority.

Mrs. Fyfe

On a point of order, Mr. Deputy Speaker. Do you agree that it is a disgrace that there is no Minister from the Scottish Office present so that we have some idea of whether the Secretary of State's proposals will also apply to Scotland?

Mr. Deputy Speaker

That is not a matter for the Chair and the hon. Lady knows it.

Mrs. Bottomley

I was referring to the Northern regional health authority, which plans to save more than £3 million on administration over the next two years to be spent on patients—including reducing waiting times. East Anglia health authority expects to save £1.6 million and to use that extra money to deliver 4,000 patients treatment.

The hon. Member for Brightside referred to accountability, which is an enormously important subject in a service as sensitive and as complex as the NHS. We will uphold and strengthen the accountability of the NHS to Ministers and to Parliament. The public must continue to have confidence in the stewardship of the taxpayers' money spent by the health service. Citizens and taxpayers have a right to expect those who use their money to provide services to carry out their jobs with responsibility, with honesty and to the highest possible standards. No one can give a guarantee that nothing will ever go wrong, however the health service is managed. What matters is to throw the spotlight on such matters and to take the necessary action.

I remind hon. Members that it was this Government who opened the doors of the health service to the independent external scrutiny through the Audit Commission. The Labour party was quite content with the cosy, secret world of closed books behind closed doors. We are determined that there should be a rigorous system of accountability with external audit and that lessons should be learned when things go wrong. The vast majority of NHS work is characterised by dedication, responsibility and honesty. This year, the Audit Commission reported that the overall financial management of all NHS activities has shown a significant and welcome improvement. It is disgraceful that the Labour party should use isolated examples to cast a slur on the integrity of the majority of men and women who work in the health service.

It is right that in the light of the important Cadbury report on corporate governance, and in the light of recent, justified criticism from the Audit Commission and the Public Accounts Select Committee, we have been working to look again to develop codes of conduct and accountability in the NHS. Once again, the hon. Gentleman poured scorn on the use of task forces in the NHS. In a service as complex as ours, the involvement of people working, rather than the loudmouths of the Opposition, is a better way in which to deliver policies which will work in practice. I pay tribute to all those who have helped the task forces on corporate governance, on accountability and on the code of conduct.

Those codes will play a key role in strengthening accountability, probity and financial control. They re-affirm long-standing good practice in the NHS and state unambiguously that NHS boards are responsible for ensuring effective financial stewardship through value for money, financial control and financial planning strategy. The codes include new measures which will require the directors of boards to declare private interests, require boards to establish audit and remuneration and terms of service committees, to keep proper control over the pay of chief and senior executives, and will require pay and remuneration packages of both executive and non-executive board members to be published in annual reports.

The information revolution is already under way. In the past, no one knew who was in charge of a hospital. The establishment of trusts, the requirement to produce annual reports, to produce accounts, to have a public meeting of the trusts, apart from the work of the health authority means that the amount of information that is now available is unprecedented. I look to chairmen personally, with the full support of non-executive members and chief executives, to take a lead in implementing those codes. They must lead by example.

Labour Members delivered their usual catalogue of abuse against those who serve as non-executives on the NHS trusts and authorities. I find that unbelievable because I believe that there is a tradition in this country of public service and service for the NHS which transcends political parties. I remember Lady Callaghan only too well when she was chairman of Great Ormond Street hospital. I remember any number of spouses of Labour Members taking a key and influential role and that there are any number of individuals throughout the service of all political parties who are serving the NHS trusts.

I am pleased, from what I gather, that the Opposition are no longer actively discouraging their members to serve on trusts and authorities. Too often in the past, it was reported that there was pressure put on members of the Labour party not to serve on trusts and authorities.

The way in which chairmen of health authorities have been appointed has varied little over the years since 1948. I suggest that the Labour party puts forward its own good names and support people who are doing an extremely good job and recognise the great quality of the contribution of the non-executive members. For example, Dame Margaret Turner-Warwick, the previous president of the Royal College of Physicians, is now the chairman of the Exeter NHS trust. There are any number of examples of people from all ranges of activities who are contributing to the national health service.

The hon. Member for Brightside knows that whatever accusations he has made against the health reforms, they have been widely accepted in and beyond the NHS. His dilemma, and it is a real dilemma as my hon. Friends will know, was summed up by the founder of the Socialist Philosophy group, Professor Julian Le Grand, when he said of the Labour party in an article in the New Statesman: If they refuse to believe that there are positive features of the reforms, they can call for their complete withdrawal. But then they have to offer something else that would do better. It is far from clear what that would be. Certainly few who work in the NHS would want to go back to the old pre-reform system. And even fewer would relish the prospect of yet another dramatic upheaval regardless of what form it took. Elsewhere in the article, the professor states wisely: central planning was not a conspicuous success in the old health service and he describes GP fundholding, which is always denigrated by the Labour party, as "perhaps the biggest success story" of the NHS reforms. If that is what constitutes socialist philosophy in revisionist times, I. have a great deal more time for it than the half-baked denigrating variety served up by the hon. Member for Brightside.

The hon. Member for Brightside has no answer to the increasing success of the health reforms, he has no answer to the improved efficiency of the health service, he has no answer to the extra spending, and he has no answer to the millions more patients who are treated. The hon. Gentleman has no answer to the dramatic falls in long waiting times, and no answer to the improvements in patient care which are taking place in every hospital, every clinic and every GP's surgery. His sole response is to spread scares, smears and innuendos against people in the NHS. His mean-spirited attacks lack recognition of all that the staff have achieved in the past three years. They have taken change on board and they have made it work for the benefit of patients.

We have begun a great journey with our health reforms, and that journey must and will go on. We will make the health service even more responsive to the ever-changing needs of the population and the ever-widening capabilities of science. The hon. Gentleman, in one of the rare sane moments in his speech, referred to the important but deeply concerning matter of human fertilisation and embryology. I will certainly talk with others about a possible debate on it. This country was indeed ahead of others in setting in place legislation to control those new techniques. That was a forward-thinking and enlightened piece of legislation, and so also are the health reforms a forward-thinking, enlightened piece of legislation, which will encourage diversity of care, not just in hospital but across the range of settings.

We will harness the health service single-mindedly to the goal of improving the nation's health. We will keep the health service at the leading edge of modern medicine. In practice, it must always be informed by the best and the latest medical knowledge. It must be clinically effective as well as cost-effective. Above all, we shall ensure that patients are treated with the courtesy and dignity that they deserve. Their needs, their choices and their well-being come before all else. Our health reforms are the means to those ends. They will uphold and strengthen the integrity and dynamism and the value of our NHS now and into the next century.

5.21 pm

Mr. Martin Redmond (Don Valley)

I shall be brief. The Secretary of State and her mouthpiece, the right hon. Member for Peterborough (Dr. Mawhinney), should be congratulated on their skilful misuse of NHS statistics and accounts which could lead one to believe that they were the grandchildren of Goebbels, for they regularly use his propaganda skills. Two and a half decades ago, when he was a Health Minister, Enoch Powell referred to NHS statistics as a pack of lies. He would not be so complimentary now.

The Secretary of State continually claims that never before has the NHS been so well run. NHS trust chairmen and chief executives tell her that, but that is no surprise. She says that never before has so much been spent and so many patients treated. Those comments are the deliberate, cynical misuse and falsification of facts and statistics. The Secretary of State should know that the form of NHS accounts and statistics was so substantially changed on 1 April 1990 that comparisons before and after that date are virtually impossible. I am aware of an in-patient case which involved at least four consultants by the time surgery took place.

In recent days, the Secretary of State has thrust herself forward as an exponent and promoter of "back to basics''. Although that was clearly designed to camouflage Government incompetence, she should at least present facts to the public without criminal distortion. Let us hear of a few basics which the Secretary of State has not seen fit to publicise.

First, no chairman or non-executive director of an NHS health authority or trust is democratically elected, yet we hear much criticism from Conservative Members about trade unions. Conservative NHS appointments are more akin to the Nazi gauleiter system. Secondly, in 1993–94, NHS chairmen and non-executive directors will receive about £50 million in salaries and expenses. That sum would pay for 40,000 in-patient cases. Some non-executive directors have received more than £500 per meeting attended.

Thirdly, since 1990, chief executives and immediate managers have doubled or trebled their pay. During the same period, caring staff received little more than a 10 per cent. increase. Fourthly, extravagance is rife. It is only in the past few years that a manager would have had the affront to travel by Concorde at public expense, without a word of criticism by the Secretary of State.

Fifthly, vastly increased expenditure on managers' cars has been incurred, despite their having little need for them. However, district nurses need cars. Sixthly, over the past three years, the cost of managers and management has increased by about 1,500 per cent.

Seventhly, contractual mismanagement on a scale unheard of in the public service has occurred in two regions, costing tens of millions of pounds and, sadly, depriving tens of thousands of patients of treatment. What has been the Secretary of State's reaction? She rewarded the chairman of one regional health authority with the chairmanship of the national supply committee, and, on his resignation, she made Sir James Ackers the unique gift of £10,000 from public funds, thereby happily compounding the regional health authority's action in making illegal payments to senior officers rather than dismissing them. The Secretary of State would learn something if she listened rather than rabbited.

Eighthly, nurses who were still waiting for grading settlements five years after their 1988 grading restructuring were refused interest on moneys outstanding. That is the meanness of the Secretary of State. Ninthly, in-patient waiting lists remain immense, despite dodges such as putting patients on 12-month out-patient review or delaying out-patient appointments falsely to understate the waiting list.

Tenthly, there has been the highest ever reduction in the number of posts for caring staff, to fund the highest ever costs and staffing levels of administration and management. Eleventhly, the sum of nearly £1 billion, which was spent on computers, management and accounting systems to support the market style of management, would have paid for the treatment of the greater part of the in-patient waiting list, as declared by the Secretary of State.

Twelfthly, the Secretary of State has consistently refused to order public inquiries into the deaths or permanent damage of children in hospital—no doubt, to suppress the truth—and, at the same time, delayed the payment of damages which could have improved the life styles of some unfortunate children. The Secretary of State should be ashamed of herself.

Last week, Public Finance and Accountancy quoted the Secretary of State as saying: Review bodies must look at pay in the context of what is affordable. I have yet to hear her say that regional health authority corruption and incompetence are unaffordable. As stated earlier, they are well rewarded in the West Midlands regional health authority. It has also been feared that the 1,500 per cent. increase in managers' pay is not affordable. The statement of the junior Minister— we make no apology for the small real increase in senior managers— is pathetic and shows not only the Government's ignorance but their indifference to the sick. I call on that Government to order a 10 per cent. per annum reduction in the number of all health authority and trust managers and their pay over each of the next five years as a start to restoring the balance between those who care and those who live on their backs.

"Back to basics" in the health service creates unemployment among nurses and the lowest possible pay, with the exception of top management who are rewarded with massive pay and rewards for mindless loyalty. Back to basics—so much for sound economic management. Anything is affordable to avoid publicity. Back to basics—justice and fairness are not applicable to nurses, only to those who promote Tory policies. Back to basics—never let the public know the truth.

I could go on, but time is limited. In the past five years, we have seen a massive growth in corruption and gross management incompetence throughout the national health service at the same time as the last elements of accountability of chairmen and directors have been removed. The Secretary of State can take notice of whichever of the Prime Minister's back to basic principles she chooses. But she and her team should resign and let us get back to running the national health service.

5.31 pm

Mrs. Marion Roe (Broxbourne)

I am grateful to have the opportunity to speak in the debate. Unlike Labour Members, I see the latest management changes introduced by the Secretary of State as another constructive step towards the Government's goal of achieving an appropriate and accountable management structure in the national health service.

I remember that, not long ago, the national health service had no management structure of which to speak. Those were the days when no one could provide even the most basic information such as the number of doctors employed in the NHS, the bed occupancy rate or even treatment costs. As Sir Roy Griffiths said in 1984, there was no one "in charge" and no one could be held to account for the billions of pounds of public money that were being poured into the service. What was needed was nothing less than a management revolution to give the health services the sort of management that was capable of handling its huge resources.

I am proud that the Conservative Government grasped the nettle in the early 1980s and have continued to pursue their aim of improving management performance. I remain convinced that only through good management can the health service continue to deliver the range and high standard of services that are demanded by rising public expectations and increasing medical capability.

Anyone who is acquainted with the reforms introduced in the past 15 years will understand that changes on the scale that have been achieved could not be introduced overnight. There had to be a clear strategy with every stage building on the previous one. The introduction of general management and the various management initiatives of the 1980s strengthened and increased the role of management.

The breadth of the reforms introduced by the National Health Service and Community Care Act 1990 added new dimensions and new responsibilities as the internal market developed. I want to take this opportunity to congratulate the scores of managers who have worked stoically to improve services for patients as well as implement the many changes that are expected of them.

One year ago, the Select Committee of Health, which I am privileged to chair, published its interim report on the NHS trusts. The Committee recognised the long-term contribution that trusts are making, and will increasingly make, to the health service. However, we expressed the view that the rapid expansion of trusts was in danger of causing a potential loss of strategic planning, especially at the regional level. We asked that consideration be given to the way in which the roles of the regions and the NHS management executive outposts could be accommodated with the freedom of the trusts. It seemed to us that there was a proliferation of management as a result of the new system growing up alongside the old, largely centralised management structure.

I am satisfied that the Secretary of State has responded to that concern. Her latest announcement on the structure of NHS management will ensure that the best parts of the old system are fully integrated with the new. The reduction in number and slimming down of regions, the merger of the outposts with regions, the review of staffing in purchasing authorities and the merger of districts will all contribute to slimlining the management structure. In addition to that top-down rationalisation, as the structure settles down and individual managers gain confidence, they are achieving their own improvements.

In my constituency, the East Hertfordshire NHS trust, which covers patients living in my constituency, has reduced the number of its full-time managers by nearly one third, from 50 to 35, since trust status was achieved. Management costs are also down to less than 2 per cent. of the total budget. Yet all contracts in 1992–93 were delivered within budget, and it is expected that they will be again in 1993–94.

In any large organisation, integrity is an absolute prerequisite, especially when large public funds are at stake. I welcome the positive steps taken by the Secretary of State to strengthen accountability, probity and financial control in the NHS. The codes of conduct and accountability that she proposes to introduce will reaffirm the long-standing good practice in the NHS and set out clearly the corporate standards that people can expect from the NHS boards.

Mr. Nicholas Winterton (Macclesfield)

Will my hon. Friend give way?

Mrs. Roe

I will not give way at the moment. Mr. Deputy Speaker has already said that many hon. Members wish to speak. I know that my hon. Friend will be speaking later, and he can make his points then.

With an organisation as vast as the NHS, good management is essential for higher productivity and better efficiency. Good management pays, as the performance of my local NHS trust has shown. I am proud to be able to tell the House that, without any subsidy, the trust complied with its financial duties in the first year and broke even. This year, it is on target to achieve a similar result.

All that was achieved while there was an overall increase of 4 to 5 per cent. in patient care. Improvements in waiting times have been made—over 85 per cent. of patients are seen by a consultant within 30 minutes of the time of the original appointment; improvements in support services have been made—for example,. 95 per cent. of patients attending the East Hertfordshire trust accident and emergency department are seen immediately by a senior triage nurse; the trust has efficiently managed a 10 per cent. increase in attendees in the accident and emergency department in 1993–1994; and day surgery output increased by more than 20 per cent. in 1993. Those are facts. East Hertfordshire trust has been reported as the top provider in the North West Thames region on the patients charter monitoring. None of that suggests to me that this is a service in decline—far from it.

5.40 pm

Ms Liz Lynne (Rochdale)

I welcome the opportunity afforded by the debate to discuss the national health service. I know from my postbag that the state of the NHS continues to be one of the key issues for the public. People have written to me from all parts of the country—no doubt they have done to other hon. and right hon. Members—expressing their concern at the closure of beds, wards and hospitals.

One of the reasons for that state of affairs is surely the NHS's increasing bureaucracy and the seemingly endless stories of waste. I do not say that that is the only cause, but it is one. The Government claim to be opposed to a vast and bloated bureaucracy, but the whole nature of the changes that the Government have introduced meant that an increase in bureaucrats and managers was inevitable.

If one separates purchaser and provider functions, each with their own management structures, one inevitably creates more management posts. If one establishes a contractual relationship between purchasers and providers, one inevitably creates a new layer of bureaucrats dealing with negotiations and contracts.

The Government make great claims for their reforms, trumpteting the fact that many more patients are now being treated. However, there is considerable doubt about how meaningful those figures are. The figures that the Government provide are for "finished consultant episodes", but it has been shown that the treatment of an individual patient for a single illness can lead to several "finished consultant episodes".

A leading health economist, Professor Alan Maynard, stated in a recent article in the Health Service Journal: effects of the reforms are unknown due to the Government's decision not to evaluate them. That is presumably on the ground that the Government cannot possibly be wrong. There are, however, numerous examples showing that they do appear to be wrong when it comes to running the NHS. Millions of pounds have been spent by health authorities in hiring head-hunting firms for senior managers—£10 million was wasted on business consultants by the West Midlands regional health authority, as has been mentioned in the debate; £40 million was spent by the Department in setting up the NHS trusts, with no independent means of checking where the money has gone.

We have all heard of the loss of up to £63 million by Wessex regional health authority in its mismanaged computer scheme. Another example is the £100 million wasted by the NHS Supplies Authority through inefficient management techniques and muddled contracts. The catalogue goes on and on and on. It is no wonder that a "good news unit" has been set up by the NHS Management Executive in Leeds—it is more correctly titled the corporate affairs intelligence unit. Surely that is another example of waste and pointless bureaucracy.

It would be wrong to say that the Government have not responded in a more concrete way to the reports of waste and failure in the NHS. Following the Public Accounts Committee report on West Midlands health authority, the Minister made it clear that Sir Duncan Nichol was developing guidance addressing the need to reinforce core public service values in the NHS. That is quite laudable, one might think, but why does a task force have to be set up to reinforce public service values in what is supposed to be our greatest public service? My party would put the concept of public service at the heart of the NHS.

Our local hospitals should be accountable to the local people whom they are supposed to serve. The Government claim that they want to encourage the involvement of local people in decisions about health care provision for their area, but surely the creation of trust hospitals in their present form makes that more difficult. There is no effective local representation, with no real local accountability. Mind you, district health authorities are not really accountable, either. We need direct elections; only then will we get proper accountability.

At the regional tier, while no one wants to see a bloated bureaucracy, an open form of regional planning and supervision would be far preferable to the closed and secretive system that the Government propose.

In the long term, we should also like to see merged district health authorities and social services departments, to reduce unnecessary bureaucracy, to ensure a seamless provision of care and to reinforce local accountability. The Government have failed to set up ways of evaluating the effectiveness of their changes and thereby establish mechanisms to put a check on wasteful expenditure and growing bureaucracy. However, others have been doing it for them.

A recent key report from the British Medical Association underlined the fact that one of the damaging effects of the Government's changes has been to create a two-tier NHS. As a result of the so-called fast tracking procedure, patients of GP fundholders are receiving treatment ahead of patients whose services are purchased by the district health authority.

Such queue-jumping is happening even when district health authority contracts have not been fulfilled. That process is clearly undermining one of the fundamental principles of the NHS—that patients should be treated on the basis of need. Just because they happen to be patients of a particular doctor, people who are less seriously ill should not be able to jump ahead of people who are in greater need of treatment.

Much has been made recently of the increase in NHS bureaucracy, and the ever-increasing burden that pay and perks are loading on NHS finances. While nurses have to stick to 1.5 per cent. on average, trust chief executives are getting huge increases of 9 per cent. That is hardly fair.

What, therefore, is the future for the key workers in the NHS—the doctors and nurses who provide the care, and the many support workers? The Government have come out in favour of the Calman report on specialist medical training, and I am pleased about that. Where, however, are the resources to enable an increase to be made in the number of consultants? I shall be grateful if the Minister will answer when he replies.

The Government are committed to action to reduce junior doctors' hours, which is another thing for which I am grateful, but another report from the BMA recently pointed out that that is being patchily implemented.

The position of nursing in the NHS looks even worse. The number to be trained will fall by 16 per cent. In England between 1993–94 and 1994–95. That is despite research by the NHS management executive that shows that better qualified and trained nurses are more cost-effective and provide higher quality care. Clearly, the decline in the number of trainee nurses will have a dramatic impact on the future quality of patient care.

Surely the purpose of the Government's changes, although I do not know what was in their minds, was to try to use the money in the NHS as effectively as possible, but the reverse seems to be the case. Or is it that, by some unfortunate chance, the changes have highlighted the one problem that the Government have tried to mask—underfunding?

Of course, the Minister will try to blind us with statistics, and it is difficult to believe that over £20 billion is not enough. I agree with that, but we should remember that we spend less money on our health care as a percentage of GDP than almost every other major western country. In the light of that statistic, it is amazing that the NHS is as good as it is. For that, we must thank the dedicated people who staff the NHS at every level.

Mr. Day

The hon. Lady mentioned the total amount spent in this country. Is she aware that, in terms of public expenditure, this country leads Europe? In the rest of Europe, the figures for total spending as a percentage of GDP are different, because there is more personal input on health in other countries. That is not an argument for or against private health, but the hon. Lady must recognise that fact.

Ms Lynne

I recognise that more money has been spent on the health service, but it needs even more. Inflation in the health service is running at 3.9 per cent., so the money currently invested in it is not enough. The hon. Gentleman will be pleased to know that I am just about to discuss funding possibilities.

The Government should give careful consideration to the possible advantages to be gained from hypothecated taxation. It is often said that the British public want better public services, but are not prepared to pay for them. Perhaps that is because they do not trust us, the politicians, enough to handle their money. The catalogue of waste outlined today certainly gives them good cause to believe that.

We want a health service that is not plagued by ever-lengthening waiting lists. It is possible to manage other European health services to avoid such delays, so why not here? Perhaps if we politicians gave a commitment to spend resources and source revenue on specific health services, we might be able to convince the British people that we are committed to improving the services that they cherish. They might then believe that we can be trusted not to waste their money elsewhere.

Dr. Mawhinney

I want to be quite sure about what the hon. Lady is telling the House, because hypothecation would not, of itself, offer more money to the health service. Is she suggesting that the Liberal Democrats want to take more public expenditure from some other programme—and if so, which one—to give to health? Or is she announcing to the House and the country that after the Liberal Democrats have increased taxation to fund education, they will increase taxation even further to pay for greater spending on the health service?

Ms Lynne

I am glad to answer that question.

The Liberal Democrats have begun to study hypothecation in detail and I sincerely hope that the Government will do the same. We could explicitly earmark the money raised from tobacco and alcohol exise duties for spending on the health service. We could raise considerable amounts through those duties from hon. Members alone.

It is not for politicians alone to decide on the appropriate way forward. We must open up the debate on how to fund our health services.

Dr. Mawhinney

I am grateful to the hon. Lady for giving way once again, because I am genuinely trying to understand what it is she has suggested. She answered my question by telling us a little bit about hypothecation. That was fascinating, but it did not answer my question.

Is the hon. Lady suggesting that money should be taken from other spending programmes to pay for the health service? The money raised through taxation on alcohol and tobacco is already spent. She cannot spend it twice. Is she announcing to the country that after increasing tax to fund education, she would increase it still further to fund the health service?

Ms Lynne

I am grateful for that further intervention. My party is looking at hypothecation. I am not making a commitment that the Liberal Democrats would raise taxes after the next general election. I want the merits of hypothecation of taxes to be. subject to public consultation. I want to go out and talk to the public about whether that is the best way forward. Our policy is markedly different from that of the Government, who brought in their reforms without consulting enough. Hypothecation could be the way forward and it is up to the Minister to examine all its implications carefully instead of trying to make a party political issue.

The British public must be given the opportunity to participate in the key decisions about the future, as well as being given the chance to hold to account those who made mistakes in the past.

I welcome the Secretary of State's announcement to consider having a debate in the House, for which I asked, on the new and possible treatment and use of eggs from dead foetuses for in vitro fertilisation. I am grateful to the right hon. Lady and I hope that she will honour that commitment.

5.53 pm

Mr. Ray Whitney (Wycombe)

I am afraid that the hon. Member for Rochdale (Ms Lynne) followed Opposition Members, as the Liberals usually do, by offering the usual carping, negative criticism of the health service. I congratulate her, however, because, in clear distinction from the Labour party, she at least provided one or two elements of possible Liberal Democratic policy. I do not believe that they bear too much scrutiny. The hon. Lady said, "We are looking at hypothecation," which is a pretty good example of how the Liberals approach policy making. I wish that she had offered a more concrete definition of her party's policy.

Everyone should join Conservative Members in applauding the idea that decisions on health should be taken locally. That was the thrust of the health reforms and it is one reason why they are working so well. The Liberal Democrats' proposition that such decisions should be made on the basis of elected local agencies, which would, however, be funded centrally, fills me with the deepest misgiving.

The problems faced by all central Governments over the funding of local authorities would be a picnic compared with the battles and feuding that would arise over health authorities being elected locally but funded centrally, whether that funding was derived from hypothecated additional taxation or additional income tax.

I hope that the Liberal Democrats will continue to explore such ideas, but will offer the nation a more informed analysis of their potential, because I genuinely believe that it is right that such ideas should be considered. That is why it was so sad to witness the performance of the hon. Member for Sheffield, Brightside (Mr. Blunkett) and that of other Opposition Members, because, as usual, they offered no positive thinking on policy.

One of the great tragedies of the Opposition is that they fail to understand that the provision of truly adequate health services for the 1990s is an international challenge facing all modern societies. These days, the aspirations of people, the challenges and costs of modern developments in medicine require the solution of terrifically difficult problems. Germany, France, the United States and other countries face that difficulty and they have all produced different solutions.

I believe that the British solution, as it is developing, is one of which we should be proud. Our solution is not perfect, but we will make no progress as a nation if the continued examination of this crucial subject is bedevilled by the mean-minded, ill-informed, pettifogging attitude adopted by the Labour party.

When the hon. Member for Brightside, the Labour party spokesman on health, can offer as the subject of his major speech nothing but a reference to the restaurant at which my right hon. Friend the Secretary of State for Health dines, it is a pure and appalling reflection on the paucity and poverty of what passes for thinking on the Opposition Benches. Such behaviour by the Labour party is traditional and it makes me somewhat hot under the collar.

The hon. Member for Brightside talked about the NHS and said, "We created it." Is the hon. Gentleman suggesting that "we", the Labour party, created the NHS? Does he know nothing about history? Has he any idea of the thought and work undertaken by others towards the creation of the NHS during the 1920s, 1930s and 1940s? He is totally ignorant. He obviously has no idea of the efforts made by all parties towards its creation. It started with the Liberal party and Lloyd George, and the idea was carried forward by Neville Chamberlain. The White Paper that provided the fundamental basis for the NHS was introduced by Henry Willink, the Conservative Minister for health in the wartime coalition Government. The irony is that the only significant change made by Mr. Aneurin Bevan was to go against the declared policy of the Labour party for locally based and controlled health units and opt for a nationalised hospital service. It is the nationalised hospital service which has caused so many problems over the 40 years. [Laughter]

What is the hon. Member for Bristol, South (Ms Primarolo) laughing about? Does she think that there were no problems when Baroness Castle was Secretary of State and Lord Owen was Minister responsible for Health? There were huge problems, which is why we have had to find a way forward and why the health service reforms are providing an excellent solution to that challenge.

Ms Dawn Primarolo (Bristol, South)

indicated dissent.

Mr. Whitney

The hon. Lady shakes her head. She probably was not born at the time, but Herbert Morrison pointed that out to Aneurin Bevan, who won the argument in Cabinet but lost it in the succeeding 40 years.

Mr. Dennis Turner (Wolverhampton, South-East)

Although that is interesting and I am grateful for the history lesson, I am not sure whether I accept the hon. Gentleman's interpretation of the historic events that led to the creation of the national health service.

We are all concerned about the national health service and should be thankful for every person who is treated in our hospitals. Last week, the Wolverhampton Express and Star announced: Hospital Waiting Lists Are Soaring". It said that 1,800 extra people were on the waiting list and that more than 6,000 were waiting. In the west midlands, more than 100,000 people were waiting for treatment. Is that success in the health service?

Mr. Deputy Speaker

Order. That was a very lengthy intervention.

Mr. Whitney

I clearly made a mistake. I could give the hon. Gentleman several answers, but shall give him a brief one. Since 1988, the average waiting time for treatment has fallen from nine to five months. I invite the hon. Gentleman to write to me and tell me what waiting times were in Wolverhampton in 1977 or 1978 during the last Labour Government, when the national health service was plagued by strikes.

I am glad that the hon. Gentleman accepts the history lecture and I hope that he passes it on to his colleagues in the Labour party. I hope that next time they have a debate on the national health service, they will not just say, as the hon. Member for Sheffield, Brightside said, "We shall clarify our own policies in our own good time." That good time is up. The nation demands to know what the Labour party has to offer.

The Conservative party knows that it has to offer the huge improvements which my right hon. Friend the Secretary of State for Health has outlined. The nation knows that we are now treating a million more patients than last year, and 3 million more than when we came into office. The nation knows that waiting times are reduced, there are tens of thousands more nurses and thousands more doctors, and their pay has risen by some 40 per cent. in real terms. We are proud of that record. The nation cannot be proud of a political party that claims, on bogus grounds, that it is its health service, but has no contribution to make to its continued development.

6.3 pm

Mr. Terry Davis (Birmingham, Hodge Hill)

The hon. Member for Wycombe (Mr. Whitney) tried to suggest that the Labour party had claimed that there were no problems before the Conservative Government were elected. That is nonsense.

Mr. Whitney

I said nothing of the sort.

Mr. Davis

Oh yes, he did. Of course, there were problems before the Conservative Government were elected and problems still exist in the national health service. The charge against this Government is that they have made the problems worse.

That charge is contained in the motion. I was interested to note that, in his peroration, the hon. Member for Wycombe never referred to the motion. I sha!1 debate the motion before the House. As I was coming to the House today I wondered how the Secretary of State for Health could oppose a motion that deplores the lack of accountability, growth in bureaucracy, and waste of resources in the national health service, all at the expense of patient care. After all, in the past year the Public Accounts Committee has produced two major reports on how resources have been wasted in the national health service. Both reports drew attention to the lack of accountability in the health service and pointed out that bureaucracy in the health service has failed the people of this country.The Committee says that all that has been done at the expense of patient care.

The West Midlands regional health authority has wasted millions of pounds. The regional health authority admits that it wasted at least £10 million. We have had a report on the Wessex regional health authority, which wasted tens of millions of pounds. The regional health authority and national health service management executive admit that it wasted at least £20 million. Today, the Secretary of State for Health said that the books were no longer closed and no longer examined behind closed doors. That is simply untrue. The books are examined behind closed doors by the district audit service, whose reports are kept secret.

If someone writes to the district auditor and asks about the reports, he or she is referred to,the regional health authority. If one then asks, "But how can I ask the regional health authority for the report if I do not know what was reported on?", he simply says that that is a good question. One cannot ask for a report unless one knows that it exists. If one knows that it exists and asks the regional health authority about it, one is most unlikely to get a copy of it because the books are examined behind closed doors and kept secret.

The internal report on the West Midlands regional health authority, known as the Carver report, explained how procedures had been flouted and regulations ignored and how people had wasted money. It was kept secret until someone in the regional health authority leaked it to a journalist on the Wolverhampton Express and Star. Only once it had been leaked and had come into the possession of hon. Members and referred to the Comptroller and Auditor General could the National Audit Office mount an investigation.

We should not depend on leaks. Reports should be put before us so that we can make up our minds on the basis of facts. I am not surprised that the Secretary of State has left the Chamber, having refused to allow me to intervene in her speech. She knows that what she said was totally misleading—I choose my words carefully to stay in order.

The West Midlands regional health authority was described by the chief executive of the National Health Service Management Executive as "a shambles". That is the truth about the national health service 15 years after the Government were first elected. The Public Accounts Committee said that officers' behaviour fell well short of the standards of conduct expected from public officials". It said that not only were there serious failings at all levels of management in the West Midlands regional health authority, but a serious failure by Members of the regional health authority and in particular the chairman, in their duty to ensure the accountability of regional management". The report on Wessex said, most revealingly, that the auditors had sent their reports to the national health service management executive before the issue ever came to the Public Accounts Committee and before the National Audit Office was put on to it by people like my hon. Friend the Member for Southampton, Itchen (Mr. Denham). The auditors did not stop there, but sent the reports to the Secretary of State—not once but over several years. And nothing happened. That is where we come to the whole point of accountability.

When Sir Duncan Nichol, chief executive of the national health service management executive, came before the Public Accounts Committee, he had to say that he had no authority. I am not sure what he was the executive of, but he was called the chief executive and he had to say that he had no authority—it was a matter for the Secretary of State.

We are entitled to ask what the Secretary of State did. The answer can be given in one word—nothing. She did nothing about the fact that those appointed, particularly the chairman of the Wessex regional health authority, Sir Robin Buchanan, were personally responsible for that region's failures. Tens of millions of pounds were wasted at the expense of the care of those living in the region.

Mr. Nicholas Winterton

As the hon. Gentleman will know, I have taken a great interest in the health service over many years. Did the hon. Gentleman tell the House the truth when he said that Sir Duncan Nichol said that he had no authority over that matter? My understanding of the National Health Service Management Executive was that it administered the service on behalf of the Department of Health. If Sir Duncan Nichol has no authority, what is the point of the executive?

Mr. Davis

The hon. Gentleman might well ask. I can assure him that I have given an accurate summary of the statements of Sir Duncan and his predecessor. If the hon. Gentleman wishes to come with me after the debate, we can sit in the Library together and go through, not one or two, but several sittings of the Public Accounts Committee. He will then see that such statements were made, not only by one but by a succession of accounting officers from the health service management executive.

When the chairman of the West Midlands regional health authority eventually resigned, he received a letter of praise from the Secretary of State for Health and a golden handshake worth several thousands of pounds. I suppose that we should consider ourselves lucky because the chairman of Wessex regional health authority was promoted. If someone wastes more—tens of millions of pounds—he is promoted to a better job. That is the truth about accountability and the lack of accountability in the health service under this Government.

All this waste is at the expense of patient care. I shall give an example from the west midlands. A hospital in Birmingham that serves my constituency used to be called the East Birmingham hospital. When it opted out and became a trust it changed its name to Birmingham Heartlands hospital—it is known locally by my constituents as the "Heartless" hospital. In October there was a series of newspaper reports about people attending the accident and emergency unit and having to lie on trolleys all night. Another group of people had to wait on trolleys the following night, and the same thing happened the night after that. Patients had to be resuscitated in corridors because there were trolleys in the resuscitation room. Patients had to urinate into bottles in front of other people in corridors.

Staff were almost driven to breakdowns in the accident and emergency unit because there were not enough beds for patients to be admitted. Those who could not be admitted were not attending the unit unnecessarily. They had been taken there by ambulance and examined by doctors who had decided that they should be admitted. But there were not enough beds.

My hon. Friends and I went to see the chairman of the district health authority to discover what he was doing as a purchaser. I did not agree with the Government's changes and voted against them, but the system was implemented. When we met the so-called purchaser to discover what he was doing to purchase an adequate accident and emergency service on our behalf, he told us that he could not obtain answers to his questions.

The chairman said that inherent in the Government's organisation was an adversarial—his word—relationship between his health authority and the trust hospital. That was said by a man appointed chairman of a district health authority by the Government. He has since been appointed as a chairman of a trust elsewhere. He also said that the position was aggravated by personality, but I do not want to become involved in personalities in the House. The adversarial relationship between hospitals and health authorities lies at the root of the problem.

Dr. Tony Wright (Cannock and Burntwood)

Does not my hon. Friend's illustration reveal the heart of the problem—that nobody is responsible for anything any more? We write to purchasers, providers and Ministers, but they all say, "It's not us, guy, it's somebody else." I have a letter from a Minister to back up my hon. Friend's argument. Mid-Staffordshire health authority lost £3 million in the market system last year. I asked the Minister to assure me that there would be no impact on patient care. I received a letter from him assuring me that patient care would not be affected, but this week the authority has closed four wards. It seems that nobody is responsible for that.

Mr. Davis

My hon. Friend is right: nobody accepts responsibility—it is always the fault of someone else in the national health service, particularly those who sit on the boards of health authorities.

One would have expected something to have been done about the lack of beds in Heartlands hospital last October. In the intervening three months there have been several circulars, meetings and discussions with Ministers, and the Secretary of State for Health has popped in and out of Birmingham. However, after she had made her visit, the problem recurred.

A fortnight ago the Birmingham Evening Mail featured a patient who had lain on a trolley for 21 hours. He was admitted at 5 o'clock and was not found a bed until 2 pm the next day.

My hon. Friends and I had a meeting with a junior Minister in the Department of Health. He seemed to know all about it and to be well briefed until we asked how many people had suffered the same experience and whether it was a lone incident. We asked whether that man was the only victim of what the Minister described as a sudden surge in emergency admissions. The Minister said no. He said that the man was one of 22 patients who had spent all night on trolleys at the same hospital where, three months earlier, patients had had to suffer the same experience for three nights in succession.

Let us examine the figures of the so-called sudden surge. We were unable to obtain good figures. The junior Minister gave one set of figures and the chairman of the hospital trust gave a different one—the two sets could not be reconciled. The junior Minister said that he would reconcile the figures, but we are still waiting for clarification. After we had talked to doctors, it was clear to us that there has been a steady upward trend in emergency admissions, not merely for one year on year, but year after year. That was true, not only in east Birmingham, but throughout Birmingham.

Those running the health service failed to predict what was an obvious trend. They actually thought that there might be fewer admissions this year than last. They had no explanation for reaching that bizarre conclusion, impossible hypothesis and incredible assumption—they failed and simply did not provide enough beds. That lack of beds existed even without the closure of the Birmingham General hospital, which has led to many more patients being admitted to the Heartlands hospital. Those running the health service did not even take that fact properly into account.

The problem does not stop with patients lying on trolleys instead of beds. Patients are taken out of bed and sent to other hospitals. They are discharged too early. Doctors making their rounds during the night may have to decide that, even though the consultant responsible for the patient stated that he was not ready to be discharged, the patient must be discharged because a patient who is in a worse condition is lying on a trolley.

Other patients do not receive operations as a result of the Secretary of State's gimmicks and gestures. Every hon. Member could recite from letters, cite examples and talk about families at their advice bureaux who have been unable to get the operations that they need. For me, the problem was crystallised in a letter written by a consultant at the Heartlands hospital in reply to a protest about the delay in an operation. The consultant wrote back stating: There is no doubt in my mind that he requires the operation to correct his nose … Unfortunately I am only too well aware of the non-medical urgent priorities of many of our cases on our far too long waiting list. Nevertheless at this time the major incentive for surgery appears to be a management decision"— not a medical decision, appraisal or assessment— to remove all those who have been waiting more than one year for their operation regardless of priority and this has upset our general ability to bring forward cases". That policy is being implemented in hospitals in order to achieve the Secretary of State's target whereby nobody has to wait for more than a year. It means that people who need urgent operations are not having them. It is a scandal that people who should have operations—people whose noses bleed every night—cannot get an operation. The priority is decided by management, so that even those who are not so seriously ill will not have to wait for more than 12 months. Of course, we do not want people to wait for more than 12 months, which is a scandalously long time, but the waiting time should be reduced for everyone, not at the expense of the most urgent cases.

One might think that after what I have described—my hon. Friends from Birmingham could give similar accounts—everybody would realise that the fact that there are not enough beds lies at the root of the problem. It is not the staff or the doctors; it is the beds that people who should go into hospital, or must stay in hospital, cannot have because so many beds and wards have been closed.

We are told that things take less time now and that people do not spend so long in hospital. So putting to one side the mistakes that have occurred in the past 15 years, against the background of a crisis, what does the West Midlands regional health authority want to do in Birmingham? It wants to reduce the number of beds not by 10, 20 or 100, but by 1,500. It proposes 300 fewer beds in the very hospital where people have been left on trolleys all night. The fact is that the regional health authority does not know how many beds are needed.

Today I have managed to get hold of another report by the district audit service. Perhaps my hon. Friends have not yet seen it. The district auditor wrote: hospital management in the west midlands have not determined the numbers of acute medical beds required for their contractual work load": So much for all that business about purchasers and providers. The purchasers place contracts, but the providers do not work out how many beds they need, so people are lying on trolleys.

The Secretary of State praised the efforts of the staff in the national health service. At least we can agree on that, but the staff working in the national health service deserve our credit and our sympathy as they combat and struggle with the consequences of Government policies and the incompetence and waste of resources by Government appointees. It is not surprising that almost every day staff from local hospitals phone my local office to tell us what is happening there. They will not come forward; they are frightened because they know what will happen—they will lose their jobs; and, as 15 to 18 per cent. of the local people are already unemployed, they cannot stand up for themselves and we have to explain it for them.

The Secretary of State ignored the terms of the motion because she ignores the facts and does not live in the real world. She has lost the respect of the staff in the national health service and the confidence of all the patients.

6.21 pm

Dame Jill Knight (Birmingham, Edgbaston)

That was good knockabout stuff, but now we come to some facts instead of flying off on extraordinary tacks. Listening to the speech of the hon. Member for Birmingham, Hodge Hill (Mr. Davies), one would think that nobody was ever treated in the health service or went on anything else but trolleys and never went into beds.

Whether the hon. Gentleman likes it nor not, and I suspect he does not, there has never been so much careful treatment of sick people in the west midlands and the rest of the country as there is today. People are being operated on with infinitely more complicated techniques and treated with very much newer and cleverer treatments than ever before. They are being treated with drugs which were invented only a few years ago.

The hon. Gentleman and the Opposition should recognise that there is a great deal for which to be thankful in the way in which our health service is treating and curing people who, only a few years ago, would have died.

My right hon. Friend the Secretary of State made it absolutely clear that she deplored people lying on trolleys and was anxious to deal with the shortages as soon as she possibly could.

Never before has so much money been spent on the health service—more than £100 million a day. It is interesting that while Opposition Members are happy to object, to fulminate and frighten people into fits, they will never say how much more money they want spent on the health service, nor where they would get it.

No one has done more to tackle waste in the health service than my right hon. Friend and one of her predecessors, my right hon. and learned Friend the Chancellor of the Exchequer.

Previously, money was shovelled in increasing amounts into the ever-open maw of the NHS. No one knew how much was wasted because no one knew what anything cost. No one was ever able to assess one hospital's running costs against another's, or one doctor's practice against the one up the road to see if one was managed more sensibly and cutting out waste rather better than the other. No one ever questioned whether any drug costing less might be just as effective as one costing more, or whether wards, operating theatres or kitchens could be run better.

Mainly because it is essential that all the billions of pounds of taxpayers' money spent on the health service should go to patient care and not be wasted, the Government set about changing all that. However, the Opposition fought us long and hard on every single reform that we tried to make to ensure that waste was stopped. That is why they have a brass neck, a bare-faced cheek and a confounded nerve to table the motion on the Order Paper today. A great deal has been done which Labour would never have had the guts to do.

My right hon. Friend would probably be the first to agree that there is still some way to go. In fairness, eliminating all the faults in the biggest business in Europe takes a bit of doing.

May I suggest to my right hon. Friend that the first essential is accurate information. On that narrow point, I agree with the hon. Member for Hodge Hill. The proposed closure of the Royal Orthopaedic hospital in Birmingham, known locally as the Woodlands, is a case in point. I and others were given wrong and misleading information to support the closure decision. We were told that the hospital was losing £250,000 a year. Now there has been a Peat Marwick report. I am surprised that the hon. Gentleman, who said that he could never get any official reports from the auditors, had not heard of it.

Mr. Terry Davis

I made it very clear, as the hon. lady will see when she reads my speech in Hansard tomorrow, that I was referring to the district auditor's report. Peat Marwick is not the district auditor.

Dame Jill Knight

The hon. Gentleman, in dealing with audits and costs, never mentioned the most important audit report that Peat Marwick produced as a respected and independent auditor.

Mr. Richard Burden (Birmingham, Northfield)

Will the hon. Lady give way?

Dame Jill Knight

The hon. Gentleman must make his own speech. I am trying to be quick for the sake of other hon. Members.

I am anxious to inform the House and to say in front of my right hon. Friend that it was a very great shock to some of us that the information that we were given about the amount of money that the hospital was losing was not correct. Far from losing £250,000 pounds per annum, Peat Marwick says that it is making a profit of £680,000 per annum.

We were told that the supply of patients was drying up. Now we learn that there are waiting lists for that hospital. We were told that the layout of the Woodlands was too old fashioned and difficult to run. If that is so, why are so many doctors and surgeons virtually unanimous that the Woodlands should stay open and are campaigning hard to that end? We were told that the doctors and consultants did not object to a move. They most certainly did.

It is crucial that the information on which we make our decisions should be accurate and right; if it is not, we shall not reach the right decision.

I believe that the hospital should stay open and that is certainly the overwhelming view of the people of Birmingham right across the political spectrum. There is unanimous agreement in the council.

We now have a reprieve while the matter is considered again. I shall make two points to my right hon. Friend on it. First, please give us accurate and unbiased information. If there is a cost in the continuation of that hospital—it has been suggested that there is—please tell us what it is and what the option is. We can then decide whether we should pay that cost, whether it be with greater waiting lists elsewhere or with pure money.

Secondly, please can we reach a decision quickly? The Woodlands is peopled with highly expert staff. It has an international reputation. It is not surprising that all those people are under strong pressure to go elsewhere. They are saying to themselves, "Well, if the hospital is not going to be there, perhaps I should accept the request to go elsewhere." It is important not only that a right decision is made but that it is made soon, because we are losing staff through uncertainty.

The motion mentions bureaucracy. I know how open my right hon. Friend is to argument and persuasion, but there is some truth in the fact that bureaucracy exists. Some of it could be struck off. A doctor constituent of mine wrote to complain about a communication from the family health services authority. He says: We have just received the enclosed communication from the Birmingham FHSA. The amount of work it will entail for our staff if one follows it to its logical conclusion which includes half-day absences for courses etc. is really quite pathetic and I wonder whether there is anything you can do to try and help us reduce this flood of bureaucratic waste". I have the form here and it is indeed complicated. It would undoubtedly take a busy doctor a long time to fill it out. I gather from my constituent that it is new. Will my right hon. Friend be kind enough to investigate the complaint, because doctors do not have time to fill out forms that are not necessary?

I shall now deal with a concern that Birmingham FHSA has with the medical practices committee, which controls the distribution of general practitioners. The FHSAs are responsible for the smooth running 'of GP services in their area. The MPC is supposed to take the advice of the FHSAs, but it does not. I tell my right hon. Friend, with no pleasure, that there are too many running battles going on between the FHSAs and MPCs. Those battles waste time, impair efficiency and affect patient care.

Last summer, a GP in Birmingham, after two years of consistent inefficiencies, was disallowed from practising. That followed his suspension by the General Medical Council. On four occasions over two years, his conduct was officially deplored. On one occasion he was warned; on two others, £500 was withheld from his pay and he was suspended. On the last occasion, he was fined £1,000 and suspended again.

The FHSA wanted the GP out. Who can be surprised at that? It explained its need and responsibility to get proper care for the patients on its list. But the MPC did not agree. Oh dear me, no. It said that there would be eight months' suspension and told him that he would automatically be returned to the medical list after suspension, although the FHSA gave strong and unequivocal advice that the doctor could not or would not provide proper patient care and that it could not carry out its duty to give patients that proper care with that doctor still in place. For eight long months, there were no proper services, except temporary, for all the patients on his list. That matter is now resolved, but I have details of no fewer than five other cases where the advice of the FHSA has been ignored and overridden by the MPC. Will my right hon. Friend kindly look at that, because it needs to be checked?

Finally, I wish to voice my concern yet again about a system that keeps a consultant or hospital doctor in suspended animation for months, or even years, on full pay if he is under accusation of improper or negligent conduct. I would like to know what has been done to speed up the business of resolving that matter. I know of one case where a consultant was sent home. He did nothing for two and a half years, but was paid his full salary throughout that time. At the end he was found to be innocent, but it was a great waste of money. Of course I am not saying that he should be cut off from all his money when the case is not proven, but we need to speed up the arrangements formally made because it is a great cost to the country and a great strain on the doctor concerned.

My right hon. Friend has done much to improve the health service. She has fought successfully to get record sums from the Treasury. Even now, we hear that more will be allocated. She has tackled waste and inefficiency. She has stood up with courage and grace to the despicable attacks made by the Opposition and she has never shirked awkward decisions. How the Opposition would love to have a Virginia Bottomley on their side. It is not because she has done little, but that she has done so much and proved time and again that she is dedicated to constant improvement of the health services that I draw those matters to her attention and ask her to bring her considerable talents to bear on solving those problems.

6.36 pm

Mrs. Alice Mahon (Halifax)

I welcome the debate on accountability, because somebody should certainly be held accountable for what is happening to the national health service. In spite of some of the rhetoric from the Government Benches, every day, in every part of the country, there is an acute bed crisis. Every day, people in pain, anxious, worried and afraid telephone some hospital early in the morning to find out whether there is a bed available. Increasingly, there is not, because one in three beds has been lost since 1979. Every day we read of sick people spending hours on hospital trolleys and mattresses, as my hon. Friend the Member for Islington, North (Mr. Corbyn) outlined earlier this week. We heard also from my hon. Friend the Member for Workington (Mr. Campbell-Savours), who has experience as a patient at Bart's hospital.

The Secretary of State says that she deplores the situation and wants to do something about it. She should be thoroughly ashamed of herself, because her so-called reforms have helped to bring it about. Every day we are bombarded with slick propaganda from the Department of health and the Government telling us that closing wards and hospitals will make the NHS deliver a better service. Fewer beds, but more patients treated, they claim.

A closer inspection suggests that the apparent increase in the treatment of patients has far more to do with the,introduction of the internal market and the increasing numbers of managers and administrators, who have the duty and the time to fiddle the figures and ensure that the statistics match what the Government want them to match. Before the internal market, putting a price on everybody's head was not a priority; treating the patients was.

We should keep saying again and again and outlining one or two of the tricks that the Government get up to, because finished consultant episodes mean that the same people can be counted if they change consultants two or three times. It is only one person, but he or she has been counted three times. The revolving door policy introduced in the 1980s, whereby elderly patients enter hospital for a fortnight and go out for a fortnight, means that the same people are counted over and over again on admission. I do not argue for elderly people to be kept in hospital any longer than is necessary.

The position regarding Government-appointed heads of trusts becomes worse the more that we read. A recent survey conducted by Incomes Data Services, a respectable industrial research body, said that the pay of trust chief executives had escalated sharply. It also found that, in stark contrast to the openness of the trusts, information on that was limited in detail and difficult to acquire. If such people are still working for the NHS, why cannot we be told what they are paying themselves? IDS concludes that public sector accountability appears to be diminishing. That is an understatement.

The Government refuse to keep statistics on the number of nurses and health workers who are disappearing as the army of administrators grows.

Mr. Garnier

Will the hon. Lady give way?

Mrs. Mahon

No, I will not. I am aware that many hon. Members want to speak, so I shall try to be brief.

Matters get worse. This morning, the Select Committee on Health, in its examination of the drugs budget, heard from witnesses, not for the first time, about the advisory committee on national health service drugs—yet another Government quango. That particular quango is overseeing and advising on the limited list. We do not know its terms of reference; nor, it seems, does anyone else. Witnesses tell us that its terms of reference have changed from a scientific to a cost basis.

It was put to us that the committee is high-handed and secretive. It is obviously not transparent. We do not know whether the committee holds a statutory position, nor from where its advice comes or to whom it is accountable. The limited list system and the committee are so unaccountable that no one on the Select Committee or giving evidence to it knows how it works. This morning, a representative of the National Association of Health Authorities and Trusts claimed complete ignorance, so we are entitled to ask a question or two about that.

Our national health service, based upon equity and being free at the point of use, is disintegrating before our eyes.

Mr. Garnier

Will the hon. Lady give way on that point?

Mrs. Mahon

I am sorry, no. The hon. Gentleman can make his own speech.

According to a survey by the BMA, 42 per cent. of acute units in England give priority to the GP fundholding practices. Hospital waiting lists stand at over 1 million. We daily read of cuts, closures, queue jumping and sometimes, tragically, avoidable deaths. All the time, the huge unaccountable monster of a market-led NHS gobbles up precious resources.

My hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) gave an excellent exposé of what has been happening in the West Midlands and Wessex health authorities and the Government-appointed business men who have made such a mess and wasted so much money. The sleaze encouraged and permitted by the Government is a disgrace.

My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) referred to the increase in administrative costs. I wish that the Secretary of State had attempted to reply to some of the serious points that he made. When so much money is going on administration and being taken away from nurses, most people would accept that it is the patients, nurses and health workers who lose. In this brave new world of markets and managers, nursing and midwifery staff have decreased by 5.4 per cent.

Our ambulance service, once the pride and envy of the world, has also suffered. Since 1987, there has been a massive cut in staffing levels and the funding of the service has fallen by 10 per cent. in real terms. The Minister likes to talk in real terms. In 1992–93, 30 per cent. of England's ambulance services failed to meet minimum response times. In west Yorkshire, only 55 per cent. of responses were within eight minutes. In Halifax recently a young man tragically died. Because of cuts in the number of crews, a crew from another town had to come and the time that that took was unacceptable.

The new NHS executive management headquarters in Leeds cost £55 million, about the same amount that it would have cost to build the new hospital for which Halifax has been waiting since 1978. Last year, our trust submitted a plan for a new hospital at a cost of £50 million which was turned down by the Government. After meeting in secret, it has now submitted another plan costing £35 million, thus hoping to save the Government £15 million in capital expenditure. That will mean the closure of two hospitals—the Royal Halifax infirmary and the Northowram hospital which caters for elderly and mentally ill patients. If that plan is accepted, the service to my constituents will be drastically reduced.

Calderdale has already seen its service much reduced. Due to overspending, infertility and cosmetic surgery are to be curtailed. Mixed wards have been introduced. I receive many letters of complaint about that, mainly from women who do not want to be on a mixed ward. Mixed wards have been introduced simply because managements have closed other wards. Women tell me that they feel at their lowest in hospital and are embarrassed to be on a mixed ward. They do not want them. But all the Government-appointed trust management says is that no one complains to it. They certainly complain to me and I would not want it.

The referral of non-GP fundholding patients from outside hospitals in Calderdale has been stopped and there has been an increasing use of short-term contracts. Staff have experienced insecurity, some of them working in casualty on short-term contracts. How does that relate to a Government who profess to care for nurses? In addition, we have seen the closure of one of our intensive care beds because of a £55,000 overspend. If the hon. Member for City of Chester (Mr. Brandreth) would donate just one quarter of the public money that he has had, we could reopen that bed and perhaps save someone's life.

The management of the trust is Government appointed and it is difficult to obtain any real information from it. The chief executive of the Calderdale health care trust wrote to me on 3 December in reply to a letter from me about the closure of the Arthur and Ada children's ward saying that the trust had no plans to close it. Such a statement was a disgrace from a public figure because a few weeks later she announced the closure of the whole hospital, not just the children's ward.

The new development plan for Calderdale is shortly to be put out for so-called consultation. The last consultations concerned whether we wanted trust status and just about everybody in the town said no. But a handful of people, appointed by the Government, decided to go ahead. Therefore, consultations in Calderdale and, I think, everywhere else, should be taken with a pinch of salt.

This week I received a letter from Calderdale and Kirklees local dental committee showing the cuts and how the figures are fiddled. Cuts in services are going on apace. The letter complains that the new purchasing authority, the West Yorkshire health authority, proposes to treat only the most severe orthodontic cases in hospital and to send the rest back to general practitioners. The health authority exists to provide services to my constituents, but in this case it is clear that it is under pressure from the NHS Management Executive to cut waiting lists. It accepts that it is under that pressure.

There is a shortage of orthodontists: the Select Committee was recently told in a report on dental services that the service in the United Kingdom was inadequate. That need will not go away. A group of patients in Calderdale are to be disfranchised just so that waiting lists can be shortened. Sadly, most of the patients involved will be children.

The letter states: As in any medical or dental treatment, the most severe cases are the rarest and those children that fall into Grade 3 (moderate) will be that group most referred for consultant treatment. The majority of these patients are children and it is probably that the treatment of these children is beyond the skill of most dentists. The children concerned will disappear from the waiting list; they will go into the black hole into which the Government pour any statistics that cause them difficulty. Another service will be lost—but the waiting list will be shortened. It is all done by fiddling the figures.

The hon. Member for Birmingham, Edgbaston (Dame J. Knight) threw out the taunt that we wanted a Virginia Bottomley in our party. That is the last thing that we want—and, moreover, the last thing that the country wants is another Virginia Bottomley, or any more of the current one. I say that in the name of patients who, tomorrow morning, will be telephoning to ask for beds that are not there, or on a waiting list that is there.

6.51 pm

Mr. John Whittingdale (Colchester, South and Maldon)

Although I agree with nothing else that the hon. Member for Halifax (Mrs. Mahon) said in her speech, I join her in welcoming the debate. I believe that the issue of how to obtain the best possible management in the national health service is very important, and I am glad that the Opposition have given us the chance to discuss it. I regret, however, that Opposition Members who have spoken so far have chosen not to focus on that issue, or to set out any alternative policies.

Instead, the hon. Member for Sheffield, Brightside (Mr. Blunkett) treated us to a tirade of personal abuse, smear and innuendo, directed at those who work in the management of the health service and, in particular, at my right hon. Friend the Secretary of State. Although I have not been in the House for very long, I suspect that I shall have to wait some time before I hear such an outrageous speech again.

In contrast, I want to concentrate on the issue of NHS management. The NHS is one of the biggest employers in the world. About 800,000 people work for it—more than the total number working in the armed services, the police, the Post Office and British Telecom combined. This year, the NHS will spend £37 billion of taxpayers' money. Let me put that into proportion: the NHS budget is larger than the gross domestic product of New Zealand, Ireland, Egypt or Portugal. If we are to obtain the maximum value from that enormous sum, an organisation of such size, complexity and scope must clearly have good management.

The Opposition have given the impression today that NHS managers are simply unnecessary bureaucrats—that anyone who is not a doctor, a nurse or an ancillary is a worthless drain on resources. They seem to think that the sole concern of NHS managers is to obtain new offices and limousines: throughout the debate, they have delighted in denigrating the efforts of administrators.

It must be said that the Opposition are not alone in that regard. Every Saturday evening, those who watch "Casualty"—I do, regularly ; it is my wife's favourite programme—will note that the villain is the hospital manager. In every episode, he tells the medical team that they cannot afford to employ any more nurses, that they must close a few more beds or that they must lose a couple more wards. The latest development is that the manager is to leave the hospital to work for the ultimate horror, a tobacco company.

Mr. Garnier

May I bring my hon. Friend back to the realms of real life, rather than the fiction presented by television? If he visits Leicestershire, he will see NHS trusts working side by side with non-trust systems. The three major acute NHS trust hospitals in Leicester are the Glenfield, the Leiester Royal infirmary and the Leicester general hospital. In those hospitals, and in the Fosse trust, my hon. Friend will see more patients being treated, shorter waiting lists, more medical staff doing more medical work, greater efficiency and better use of public money to provide the best possible service for NHS patients. Notwithstanding the picture painted by Opposition Members, the Leicestershire system deserves much praise.

Mr. Whittingdale

I entirely agree with my hon. Friend: the reality is very different. The position that he has described is duplicated throughout the country.

The truth is that NHS managers are as essential to the provision of health care as consultant surgeons. The introduction of proper management has not wasted money; it has saved money. According to one estimate, about £1.5 billion has been secured in efficiency savings since the reforms have installed proper management.

The Government's record in providing more resources for the NHS is second to none. Every year the increase in expenditure on the service has risen by more than that in almost every other area of Government spending. That record has allowed us to treat more patients each year, and to ensure that our standard of health care is among the best in the world.

However, it is no good simply increasing the budget every year if the way in which the money is spent is not properly controlled. The search for greater efficiency and value for money is also essential if we are to obtain the maximum amount of patient care. That requires first-class, experienced managers—and securing them means paying the proper rate for the job.

It also requires a clear, streamlined management structure. The original structure of the NHS was a recipe for chaos. Area health authorities, regional health authorities and health districts all competed with each other; the result was confusion, bureaucracy and a lack of accountability. In 1980, area health authorities were abolished, which removed one unnecessary tier of bureaucracy. The abolition of regional health authorities will remove another: it will give more power to the districts, which are closer to the people whom they serve, and it should also result in savings in administrative costs which can be ploughed back into patient care.

I hope that that will also mean that NHS resources can in future be distributed on a fairer and more equitable basis. I know that my right hon. Friend the Secretary of State is familiar with Essex Members' complaints about the way in which we have been penalised, year after year, by the weighted capitation formula used by North East Thames regional health authority. Indeed, we have suffered a double penalty.

The formula for allocating resources between regions works on the basis of capitation weighted on the basis of age and relative mortality; it does not take account of socio-economic factors such as housing conditions. The formula used within the North East Thames region to distribute resources between districts has an additional weighting to benefit poorer areas. As a result, the region receives no more money because it covers some of the poorest London boroughs; but districts outside London lose as the regional distribution is skewed away from them.

North Essex—which covers my constituency—consistently receives less than its fair share. In 1991–92, for instance, revenue expenditure per head in North East Essex and Mid Essex was £317, compared with £345 in East Suffolk, a district which is identical to North Essex in almost every respect but which has the good fortune to fall within the East Anglia region. In view of the abolition of the regional health authorities, perhaps my right hon. Friend could introduce a single national formula for the allocation of resources to remove the unfairness.

When the regional health authorities are abolished, power and responsibility will rest with the districts. My constituency was previously covered by two district health authorities—the North-East Essex and the Mid-Essex health authorities. They have recently merged with a third authority to form a new single authority—the North Essex district authority. It has a budget of £277 million of which management costs are £3.4 million, or only 1.2 per cent. That is an extremely good record and one which compares well with private sector organisations.

The merger of the three authorities has not only strengthened the district's ability to obtain value for money in its purchasing but has produced a recurrent saving of £100,000. As a result of my right hon. Friend's recent announcement, it will have a further opportunity to merge with the family health service authority. It must make sense to have a single body locally which is responsible for the provision of every element of patient care. I welcome the discussions now taking place between the district health authority and the FHSA on the establishment of a single authority.

Strong and clear management is needed not only at district level and in the purchasing of health care; it is equally important in provision in hospitals. One of the great benefits of the NHS reforms has been that they have revealed the degree of inefficiency and waste which was endemic throughout the NHS. Prior to the reforms, it was often considered wrong even to think about the cost of treatments or, indeed, the cost of any element of the NHS. As a result, no effort was made to identify possible savings. Staff who faced the choice of using different procedures usually had no idea which might be the more expensive and which might be cheaper but just as effective. That has changed since the reforms.

Cost awareness is now widespread and practitioners have the information that allows them to take account of cost, not as the determing factor in deciding on a treatment but as a relevant consideration. At the same time, the requirement to assign costs to different procedures in different hospitals has shown enormous differentials in costs and, as a result, purchasers are now able to shop around and managers can compare costs and identify best practice. They are now able to obtain more value for money, which means that more resources are releaased and returned to patient care.

Strong management will keep down costs and ensure that more resources are devoted to patient care, but strong management is not enough to maximise efficiency. If anything has been proven in the past 14 years, it is that the greatest spur to efficiency is competition. Compulsory competitive tendering has already led to enormous savings in the delivery of health care. Competitive tendering of laundry and portering services has already resulted in an estimated saving of £136 million. Other non-core activities could also benefit from private sector disciplines or CCT.

I cite just one example. Since the NHS Supplies Authority was established in 1991, it has brought together more than 70 separate local supply organisations. As a result, more than £60 million in purchasing costs has already been saved, but the scope for larger savings is considerable.

If the authority were able to take advantage of information technology, it could service every hospital in the country from a single warehouse connected to the hospitals by electronic data interchange. Companies such as Sainsbury, Unipart and National Freight operate complex delivery systems every day. The transfer of the Supplies Authority to the private sector would allow it access to necessary investment capital that it needs to set up such a system and the savings would allow more money to be put back into patient care.

It is not only in non-health activities that competition is providing greater efficiency and value for money. The NHS reforms have created an internal market that allows health purchasers a proper choice for the first time. General practitioners and district health authorities—

Mr. Turner

The hon. Gentleman believes that the health service reforms are wonderful, but my hon. Friend the Member for Wolverhampton, North-East (Mr. Purchase), who is sitting below the Gangway, has informed me that in Wolverhampton tonight dead people are lying in hospital beds because of the disappearance of the night portering service. Is that the image of the national health service in Britain in 1994? Dead people are not being taken from their beds until the following morning because of the failure to provide a portering service.

Mr. Whittingdale

I cannot answer for the service in Wolverhampton, but I accept that the NHS is not perfect and that we still need to make improvements. The Opposition, however, will not accept that more patients are being treated every year and that things are getting better. If the Opposition would recognise that, we might have a more constructive debate.

As I was saying, general practitioners and district health authorities are now able to seek competition between providers and are therefore able to obtain faster and cheaper treatment for their patients. The line between public and private care is now being blurred and NHS trust hospitals are trying to attract extra resources by providing private treatment. Purchasers are turning to private hospitals as well as to NHS hospitals.

Mr. Rhodri Morgan (Cardiff, West)

Wonderful.

Mr. Whittingdale

It is wonderful, and I shall explain why. GP fundholders have been quick to take advantage of the freedom that they have as budget holders. One GP fundholder in my constituency has contracted with the local private hospital rather than the NHS trust hospital. with the result that 90 per cent. of his surgical referrals are: carried out by the private sector. In so doing, he has largely eliminated waiting lists, his patients are now treated in single rooms in comfortable surroundings and the cost to his budget and, therefore, to the NHS is less than if he had contracted with the local trust hospital.

The NHS reforms have not—

Sir Harold Walker (Doncaster, North)

I have listened carefully to the hon. Gentleman. Will he give me a little advice on how to reply to a constituent who wrote to me yesterday? An elderly lady who is going progressively blind because of cataracts has been told that she will have to wait 62 weeks for an appointment for the consultant even to examine her. Will the hon. Gentleman tell me how I might best advise my constituent?

Mr. Whittingdale

I would advise the right hon. Gentleman to tell his constituent that waiting lists are declining and that the number of cataract operations being performed is increasing.

Mr. Hayes

Perhaps I might suggest that the constituent of the right hon. Member for Doncaster, Central (Sir H. Walker) uses the national health service hotline, which is a very effective means of dealing with the problem.

Mr. Whittingdale

I am grateful to my hon. Friend, and I am sure that the right hon. Gentleman will pass on that advice to his constituent.

The NHS reforms have not led to increased bureaucracy and waste as the Opposition motion claims. They have, in fact, done precisely the reverse. They have improved efficiency and they are enabling more patients to be treated. I hope that my right hon. Friend the Secretary of State will build on the reforms by encouraging more competition in the provision of health care and thus allow us to treat even more patients in future.

Mr. Deputy Speaker (Mr. Michael Morris)

Madam Speaker has stated that between 7 pm and 9 pm speeches shall be restricted to 10 minutes.

7.9 pm

Ms Tessa Jowell (Dulwich)

There are two views of the condition of the national health service—the Secretary of State's and everyone else's. The Secretary of State seeks to assure us that all is well and, indeed, improving. Another reality is played out day and night in the casualty units of London's hospitals. Since before Christmas, I have made regular evening visits to a number of casualty departments in London to see at first hand the impact of bed closures and the internal market on Londoners' health service.

I shall at this point make a special mention of King's, which is the hospital that achieved notoriety this week and on a number of previous occasions because of the long waits on trolleys that patients have to endure before being admitted to the hospital. It is not unusual, but it is probably worse at King's than anywhere else in London. The reasons are obvious.

King's has closed 120 beds in the past two years. Is it, therefore, surprising that the hospital finds itself, night after night, without beds to which to admit sick patients? The only alternative is to leave them lined up on trolleys that touch one another, in the casualty department.

Mr. Ian McCartney (Makerfield)

I hope that my hon. Friend will mention the Higgins inquiry report, which the Secretary of State promised to implement in full as a matter of urgency, into the accident and emergency service at King's, where people were lying for up to 24 hours and some people died before treatment was given to them. If the Higgins inquiry report was to be implemented it meant that an absolute commitment, and a fast track commitment, had been made to providing new resources. Is my hon. Friend saying that that promise is not being kept?

Ms Jowell

As the Secretary of State said earlier, building work is under way for a new accident and emergency department. Indeed, late last night I saw the new X-ray facilities at the hospital. However, it is pointless to tell sick people tonight that in two years' time there will be an accident and emergency department, which will mean that they do not have to wait on trolleys. The Conservative party patently refuses to understand that sense of desperate urgency.

The crisis in our hospitals in London has been brought about by two factors. The first factor is the steady closure of beds during the past five years—inner London has lost about 14,000 beds—and the second is the impact of the internal market. The market now means that hospitals have to live by the rules of competition. "Contractual viability", in new NHS-speak, means 100 per cent. bed occupancy. Anything less will put prices up and therefore threaten the market competitiveness of the hospital.

That also means that there is no slack to deal with the inevitable peaks and troughs in demand that are part of being a national health service hospital. While hospitals may be operating at the limits of the capacity that the contracts that their purchasers have paid for, they are all operating with closed beds, so they are in fact operating at below real capacity and only at the capacity which is specified by the market, not by the needs of patients on the waiting lists.

It is interesting to note the way in which the private sector, which the Government constantly hold up as a desirable role model for our national health service, has such a remarkable and unfair advantage over the national health service. There are important differences.

First, the private sector does not have to deal with emergencies, so all admissions are planned admissions. In contrast, almost every national health service hospital in London admits about 60 per cent. of patients through the accident and emergency department. They are unplanned, unpredictable, unquantifiable admissions—quite unlike the situation in the private sector.

The second difference between the national health service and the private sector is that the private sector responds only to demand. Therefore, if patient demand requires that operating theatres be fully used and consultants kept fully occupied operating, that is what they do. They are not bound by the absurdities of the internal market, which mean that a national health service which is desperately needed to operate at full capacity is prevented from doing so by Government edict through the internal market.

As one health manager said to me recently, it is now dog eat dog in the national health service". Consultants admit their elective patients needlessly early, simply to stop anyone else getting into the bed. As a result, patients who need to be admitted through the casualty department have to wait on trolleys because there are no beds available for them.

Some hospitals manage somehow. They put up camp beds. When a bed becomes free during the night it is only because another patient has died. The staff then work to "get the bed cold" in order to take a trolley patient up from the casualty department. However, the patient who is being admitted has to be admitted to the ward wherever the vacancy is. That is why elderly men are admitted to gynae wards and women with gynae complaints are admitted to wards where all the other patients are elderly men. As one member of staff said to me, when one has to operate under that type of pressure the quality of care goes out of the window.

Let us dwell for a moment on the fact that the patients charter says that only after someone's operation has been cancelled twice is guaranteed admission within a month. The mayhem that the market has created in our hospitals means that that is regarded now as an acceptable standard.

We heard a lot from the Secretary of State about the way in which waiting times have decreased. What has happened, however, is that people are now treated on the basis of the length of time that they have been on the waiting list only, not on the basis of clinical need.

As a doctor told me a couple of days ago, if someone with an ingrowing toenail has been on the waiting list for 18 months, he will be taken into hospital because the patients charter requires it. However, a woman who needs a hysterectomy, who has been bleeding and in discomfort for many months, and has been on the waiting list for five months, is likely to have to wait 18 months before she is admitted. That type of perversity, that absurdity, is played out day by day in our national health service hospitals.

Is the Minister aware of the Norton scale? If he is not aware of the Norton scale, which was posted up in an accident and emergency department that I visited last night, let me tell him the way in which the administration of that new nursing protocol is described: Due to increased waiting times in accident and emergency, it is essential that we assess our patients' risks of developing pressure sores. That is a nursing protocol to ensure that people—often elderly people—who wait for hours on trolleys are monitored, because of the likelihood of their developing pressure sores and dehydration. It is now a fact of life that elderly people who are kept waiting in casualty departments arrive on the wards, when they are eventually admitted, in a worse state than when they arrived at the hospital.

There has also been a sharp increase in the numbers of people attending accident and emergency departments and, more disturbingly, in the numbers of people who are not registered with a general practitioner.

7.19 pm

Dr. Charles Goodson-Wickes (Wimbledon)

It will be 50 years ago next month that a Conservative Minister in the wartime coalition published the first Bill promoting the national health service. My hon. Friend the Member for Wycombe (Mr. Whitney) rightly gave credit to Liberals such as Lloyd George and Beveridge, and to the Labour party for actually enacting the legislation, but every party in the House can take credit for the basis of the NHS.

Having listened to some of the Opposition's arguments tonight, I feel that they still fit the descriptions such as "the halt, the sick and the maimed" that we find in the Third Reading debate on the Act that established the national health service. I sometimes wonder whether the Opposition parties can really cope with the advances of the past 50 years.

The strength of the national health service has been much trumpeted over the years, but, not surprisingly, the weaknesses became ever more obvious. By the early 1980s, it was obvious to everybody that its management was inadequate. The Griffiths report began to tackle those problems. However, it was not until the Government under Lady Thatcher published the White Paper, "Working for Patients", that the most radical changes were proposed. What a culture shock they were, and what emotions they aroused.

According to the Labour party, hospitals would opt out of the national health service, general practitioners would collapse under the administrative burdens of running their practices, and patients would suffer further as the whole system ground to a halt. Now, three years on, we can see the great success story of those Conservative reforms. The internal market works, based on the logical concept of separating health needs from the delivery of health care. Nobody pretends that there were no teething problems—you, Mr. Deputy Speaker, are in an especially good position to judge that. We all remember the irate meetings and the clamour riding on the back of the threat of change.

Having been trained in the national health service and having worked in it for much of my life, I have some insight into the fears. How were doctors expected to manage budgets when they had spent their entire professional lives ordering investigations and prescribing drugs with no knowledge of the costs involved, let alone any concept of accountability? Yet, surprisingly quickly, the first tentative steps towards fundholding became a rush. Now about 25 per cent. of the population are covered by fundholding GPs.

The story of national health service trusts is similar. The various waves almost had to be held back, as hospitals—their number is now almost 400—clamoured to regain some of the independence that they had lost over the years When they were kept down by arrogant and stifling bureaucracies. Doctors, nurses, ancillary staff and administrators have risen to the challenge. Suddenly, the national health service was competing with the independent hospital sector for contracts.

I declare an interest as a director of two private health care companies operating in this country, one British and one German. They cannot relish the process of NHS reform, but they now have an added stimulus to give choice and value for money.

I welcome the competition. The private sector will survive only if it offers a better service than the reinvigorated national health service. That is what Conservative competition is all about. I can live with that. It gives better treatment for patients, and that is the most satisfactory outcome of all. It so happens that neither I nor my family have private health insurance. We have all been in-patients in the NHS over the past few years and we all have a vested interest in it—and we have all had the most excellent treatment.

We see a great success story, but all we hear from the Opposition parties is negative vilification, with no acknowledgement of the progress that the Government have made. Even if the Labour party does not recognise the achievements of my right hon. Friend the Secretary of State, perhaps Labour Members should listen to Professor Le Grand of the Socialist Philosophy Group, who said that fundholding was perhaps the biggest success story". As my right hon. Friend told the House earlier, Professor Le Grand emphasised that few who work in the NHS would want to go back to the old pre-reform system. The Labour party sees efficiency as some sort of inhumane capitalist mechanism rather than as a means to deliver the best possible resources for the care of the only person who matters in the exercise, the patient.

I am ashamed to say that only two weeks ago my own trade union, the British Medical Association, published pleas for pilot projects. We have heard that expression before. "Pilot projects" were among the concepts advanced by the Labour party at the general election, and it said that the election would be the test of health care delivery in this country. We know the result of that election, and we know that pilot schemes have been translated into the real thing over the past three years, and that patients have benefited thereby.

In anticipation of today's debate, the hon. Member for Sheffield, Brightside (Mr. Blunkett) announced that 10,000 beds had been lost in one year. That statement is an index of the hon. Gentleman's crass ignorance as a health spokesman. Has he never heard of day surgery? Does he not realise that day surgery does not require beds, and that stays in national health service beds are getting shorter and shorter? Does he not realise that more and more patients are being treated in out-patient departments, and that fundholders now treat more patients in their own surgeries, so we need fewer beds?

The Opposition keep pushing the argument about people being left in corridors, and so on. That is not a medical problem; it is a management problem. We accept it as such and it will be sorted out as such.

Dame Jill Knight

Will my hon. Friend give way?

Dr. Goodson-Wickes

No, I regret that my speech is time-limited.

Let me educate the Labour party. In 1991–92, 36 per cent. of elective surgery was done on a day basis. That percentage has now risen to 45 per cent., and the Royal College of Surgeons has a target of 50 per cent. for the near future. Sadly, the hon. Member for Brightside seems to have no idea of the effects of community care on the need for beds.

Dr. Joe Hendron (Belfast, West)

Will the hon. Gentleman give way?

Dr. Goodson-Wickes

I cannot, I fear.

Community care has introduced a whole new and humane system that gives the lie to the accusation that the Government are centralist. It has produced the most major change in influence from central to local government, and the greatest increase in local responsiveness that we have seen for many years. That is another reason why fewer beds are needed in our hospitals.

My constituency is served by three excellent national health service trust hospitals, and I have reports from regular visits there. One of them, St. George's Healthcare, has reduced its running costs by almost £10 million, through a combination of removing overheads including direct management costs, improving clinical efficiency and income generation. There has been a vigorous competitive tendering programme, and the trust even generates its own electricity—I welcome that. At night, it sells electricity to the London electricity board, thus generating savings of about £900,000 per year. Who would have thought that that would be an outcome of Conservative policies? And how agreeable it is.

The St. Helier national health service trust has treated more patients every year within the patients charter guidelines, within its financial budget and within the Department of Health programme for total quality management. The Kingston NHS trust has reduced its staff by 7 per cent. while productivity has increased by 23 per cent. There is multi-skilling of staff, and clinical staff are now released from administrative duties to do the job for which they were trained.

In summary, there is solid evidence that Conservative policies work. In 1948, Nye Bevan said: The House of Commons only produces Bills, but it is the men and women outside who can make the living realities. How ashamed he would have been if he had heard the Labour speeches today. They contain no policies whatever. I have the greatest confidence in my right hon. Friend the Secretary of State, and she is running the largest organisation in Europe—for the benefit of patients.

7.29 pm

Mr. Richard Burden (Birmingham, Northfield)

On 8 January last year, Sir James Ackers resigned as chair of the West Midlands regional health authority. His resignation was greeted by a letter from the Secretary of State, who said today that, occasionally, things go wrong in the national health service. The letter she wrote to Sir James Ackers included the words: You have strongly supported the reforms of the NHS and have overseen their successful implementation in the region. In addition you recently initiated some important improvements in the managerial structure of the region. Underpinning all this has been your personal commitment to the health service and its patients. Clearly, the Secretary of State thought that he had done a rather good job. One or two people disagree with her on that. The Public Accounts Select Committee disagrees with her, because its report into goings on inside the West Midlands regional health authority during Sir James's stewardship began with the following words: The use of National Health Service funds by the West Midlands Regional Health Authority has been characterised by serious shortcomings in the management, control and accountability of the Authority's Regionally Managed Services Organisation. These shortcomings have led to the waste of at least £10 million. The Committee looked at the engagement of a consultancy firm to consider the supplies organisation, which promised to save £50 million. It ended up costing the West Midlands regional health authority, and ultimately the patients in the west midlands, between £2.5 million and £4 million. There were no terms of reference or financial conditions in the arrangements established and the report of the Comptroller and Auditor General noted that the consultants' expenses amounted over one year to some £350,000, and included such items as leased houses, aircraft hire and lavish entertainment. Clearly, that was the kind of good job being done at the time.

Of course, many such projects were the brainchild of the former director of the regionally managed services department—a man who had a penchant for privatisation. Privatisation has been something of a theme of West Midlands regional health authority. One instance was the privatisation of the management services division, which was turned into a company called Qa Business Services, for £750,000. It went bust in 18 months and the consequences have so far cost the West Midlands regional health service £928,000.

The staff did not do too well from that privatisation. I find it interesting that Conservative Members have said that Opposition Members do not care about white-collar staff. I would like to know what they would say to former employees of Qa Business Services, who lost their jobs. Many did not get redundancy payments and some lost up to two thirds of their pension entitlement because the pension fund that was set up could not cover its liabilities.

When I and other hon. Members have tried to raise the issue of the pensioners of Qa Business Services, we have been fobbed off time and again and after all the reports, the answer given was that the national health service had no moral or legal responsibility to those people. What a travesty and an insult. Even after that, Conservative Members have the gall to say that we do not care about white collar staff in the national health service.

Of course, others did rather better. Sir James Ackers, the man who was praised in the letter from the Secretary of State, received a pay-off of £10,000. That pay-off was not in his contract, but was a discretionary payment. The man who oversaw the consultancy to which I referred received a pay-off in excess of £80,000. There is a small problem with that, because it was subsequently discovered that he was overpaid by about £41,000. Attempts to recover that money are still going on.

The gentleman who authorised that overpayment was Mr. Mel Nock, who was in charge of the personnel function and has since left the regional authority. He has recently been appointed as the consultant to advise on personnel matters for the new North Birmingham health consortium by Malcolm Skilliorn, a colleague from the regional health authority and other places before.

That is the reality of the serial sleaze of the national health service today and the Secretary of State has the gall to say that things go wrong from time to time. Such things are endemic in the mentality that the Government have introduced into the NHS; a mentality of bureaucracy and unaccountability and an obsession with the market.

In my own district, South Birmingham, we have experienced the operation of that market. We were told that, under the market, money would follow the patients. I can tell the Minister that we have plenty of patients in South Birmingham, but we have a little difficulty getting hold of the money to treat them. The Royal Orthopaedic hospital, adjacent to my constituency of Northfield and internationally renowned for orthopaedic services, is currently under threat of closure because of the way in which the market is operating. The hospital runs at a surplus, yet it is still under threat of closure. It has been reprieved for a short time for consultation.

That is not all that is happening. One thousand five hundred acute hospital beds in Birmingham are under threat. Birmingham also has examples of patients waiting for up to 22 hours on trolleys. Elective work has virtually dried up in many hospitals because emergency patients are taking all the beds. The future of Selly Oak district general hospital is also under threat.

Perhaps Ministers will have an answer for that great beds crisis. They may suggest sharing beds. That always saves a little money. However, that is not much of an answer to patients in the south of Birmingham. That area is short of between £12 million and £16 million every year.

The massive organisational changes that have been brought about by the Government and the effects of their reforms were blamed in a report as contributory factors to a well publicised case over the summer of maldiagnosis of bone tumours, which meant that large numbers of patients may have been wrongly diagnosed.

One of the most insidious effects of the market is the way in which it sets hospital against hospital; purchaser against so-called provider. For instance, the Royal Orthopaedic hospital, to which I referred earlier, is in surplus but under threat of closure. Let us imagine that the health authority sees sense and reprieves that hospital, not in the short term, but in the longer term. The health authority would still be short of money. It would still have to close something, so it would perhaps consider the number of beds and would take some beds from Selly Oak district general hospital.

The health authority could decide that it should not cut beds, because the emergency beds were already overflowing. What could it do as a result? It would have to cut what is called its purchasing allocation and cut the services that could be provided by the very hospital that it had decided to keep open.

What would happen then? Local people would not be able to receive treatment at their local hospital, because the local health authority would not have the money to purchase the service. The hospital would have to raise income to pay for that service. How? An interesting scheme in Birmingham Heartlands hospital in east Birmingham over the summer determined that a sophisticated scanner, intended to treat patients, was used to treat pigs and sheep. It was hired to the Meat and Livestock Commission because it was described by the West Midlands regional health authority as a "form of income generation". That was one rather interesting scam.

A more likely outcome is that the hospital under threat would end up only treating patients from doctors who are GP fundholders or those who were able to pay for themselves through the private sector. It is a ridiculous merry-go-round on which a hospital is reprieved, but the health authority cannot buy services from that very hospital. That is the real effect of the market. That is what is happening in Birmingham and in other parts of the country.

In June, during health questions, I raised an incident in my constituency with the Secretary of State, which applied to that same orthopaedic hospital. A patient was told that he would have to wait six months for a knee operation, but that it would be only six weeks if he came from a GP fundholder. That is a distortion of the principles on which the national health service was founded. The sooner we get rid of the market mechanism, the better.

7.39 pm

Mr. Jerry Hayes (Harlow)

I declare an interest. I advise the Western Provident Association, which, as most people know, is involved in health and is non-profit making.

This has been a particularly depressing debate. We heard from the hon. Member for Sheffield, Brightside (Mr. Blunkett) one of the most disgraceful speeches that I have ever heard from an Opposition spokesman in my 10 years in the House of Commons.

Mr. Jim Dowd (Lewisham, West)

The hon. Gentleman always says that.

Mr. Hayes

I say that only when the hon. Member for Brightside speaks. He accused the Government of sleaze, yet he had the nerve to attack the Conservative Members' wives who served on health authorities. He criticised the number of appointments of Conservatives. He should mug up on his history of the health service. There are slightly more Conservatives on health authorities because the hon. Gentleman's predecessor, the hon. Member for Livingston (Mr. Cook), forbade members of the Labour party to take such appointments. The hon. Member for Brightside cannot have it both ways. If air miles were given for sleaze, the hon. Member for Brightside would be the first man on Mars.

Talking of interplanetary activities, it is remarkable that no Opposition Member has had the grace to mention that far more people than ever before are being treated every year—more than 1 million people since the health service reforms came into operation.

Ms Jowell

Will the hon. Gentleman give way?

Mr. Hayes

We are constrained by time. I would be delighted to give way to the hon. Lady, but I am unable to do so.

We are now spending more than ever before—£100 million a day. Efficiency savings are being made. We are talking about 2 per cent. this year and, perhaps, 2.5 per cent. next year. An extra £450 million will be spent directly on patients. It will not go to the Treasury.

The other amazing thing that I could not believe was that the hon. Member for Brightside could not tell us what his policy is. That is one matter on which I profoundly disagree with my right hon. Friend the Secretary of State. She called the hon. Gentleman the mañana man because he was so slow. The word "mañana" in connection with the hon. Gentleman implies far too much urgency. However, he gave us a little clue. He said, "I will tell the House what the policy will be about. It has something to do with treating patients." Wow! I can imagine the great slogan when that policy document is produced in perhaps two or three years, after the next general election—"Something to do with treating patients."

The one thing that the hon. Gentleman did right was to introduce the debate on wasting resources and on bureaucracy. If anyone knows all about wasting resources and all about bureacuracy, it is the hon. Gentleman. Just a little clue about what would happen if he became Secretary of State for Health is what happened when he was the leader of Sheffield council. Under his leadership, the number of committees increased from 97 to 247. No Opposition Member had the grace to tell the House that, for every 100 patients treated before the reforms, there are 116 now.

Ms Primarolo

They are patient episodes.

Mr. Hayes

They are not patient episodes. With the greatest respect, the hon. Lady does not know what she is talking about. We are talking about the number of people being treated, and that is just in the short period since the reforms. Opposition Members should be proud of that. Anyone who works for the health service would feel nothing but despondency and misery at the dangerous nonsense that comes from the Labour party.

By April, national health service trusts will provide 90 per cent. of health and community care. Have they been a disaster? Opposition Members will say, "Of course they have." They have not, because trust activity has grown by 5.3 per cent. compared with an average of 4.3 per cent. in the other sector, and that growth is continuing.

When we have the great policy document from Opposition Members, what will they do? Will they abolish trusts, as they promised to do? The hon. Member for Bristol, South (Ms Primarolo), who will delight us with a speech a little later, is nodding her head. I can only assume that we now have a policy.

Let us have a few more. What about GP fundholding? Six thousand GPs have become fundholders. One in four of the population are covered by them and by April it will be one in three. What will the Labour party do about fundholders? They have been a manifest success. The British Medical Association is in favour of them, GPs are in favour of them and, clearly, patients are in favour of them. I am looking for an inclination of the hon. Lady's head—just a little clue, perhaps.

Ms Primarolo

rose—

Mr. Hayes

I will happily give way to the hon. Lady.

Ms Primarolo

The hon. Gentleman knows that the BMA has denounced the Government's two-tier health system, which was created by fundholders who allow patients to jump the queue, ahead of other people in greater need. The hon. Gentleman also knows—[Interruption.] The hon. Gentleman asked me a question: shall I sit down, or would he like me to answer it? He asked whether we are in favour of a two-tier system and GP fundholders. We have said before that we do not support GP fundholders. We believe that they are wrecking the national health service, as the Government intend, and they will not exist in this form.

Mr. Hayes

"In this form"—if ever there was the small print, that was it. Why does the hon. Lady not tell the House that, for every manager—[Interruption.] The hon. Lady is having a fascinating conversation with my hon. Friend the Member for Wyre (Mr. Mans), but perhaps she would like to listen to me, because she will hear even more exciting information.

For every manager in the national health service there are 26 doctors and nurses. Why do Opposition Members not say that? National health service managers in the over-bloated service that we are told about account for 2 per cent. of the national health service work force and 3 per cent. of the wages bill, and administrative and clerical managers account for 11 per cent. of the wages bill. The hon. Lady should be telling the country about those facts and figures. The proportion of national health service staff who provide care directly to patients increased from 60 per cent. in 1981 to 65 per cent. now. That trend will continue.

I will tell the House what the Government are doing about waste. There is bound to be waste in an organisation the size of the national health service. What are we doing to cut bureaucracy? We are allowing health authorities to merge—a perfectly sensible reform.

Mr. David Hinchliffe (Wakefield)

Labour proposed it.

Mr. Hayes

The hon. Member for Wakefield (Mr. Hinchliffe) says that Labour proposed it. He should welcome what we are doing rather than attack the Government.

Some years ago we abolished area health authorities, and now, thank heaven, we are abolishing regional health authorities. Why do Opposition Members not give us some good news? There is a lot of good news? Opposition Front-Bench Members should read the King's Fund Institute report, and they should read about health care in London. The hon. Member for Dulwich (Ms Jowell) in particular should listen to what is happening in London.

Ms Jowell

I know what is happening in London.

Mr. Hayes

She says that she knows, but if the hon. Lady reads the latest issue of "London Monitor" she will see that it states: For the first time in history, primary care will be tailored to meet the needs of all London's population, regardless of age, gender, socio-economic status and community origin. That is good news. Opposition Members should read the views of Rosalind Wilkinson and Hilary Scott, who said that the City and East London family community health service organisation will be discussing exciting new developments in the provision of health services in the east end of London.

There is a lot of good news on the health service, and Conservative Members are sick to death of it being ignored.

7.49 pm

Dr. Joe Hendron (Belfast, West)

Thank you, Mr. Deputy Speaker, for calling me.

I have listened carefully to the debate and to the speech of the hon. Member for Wimbledon (Dr. Goodson-Wickes). I have been involved in primary health care for 30 years in west Belfast, but I must be living in a different world from the hon. Member. The fact that most of the population in my constituency are from social class groups 4 and 5 may have something to do with it.

I find the attitude of Conservative Members incomprehensible. This is the 20th century and we are about to move into the 21st. We should expect health services to improve: they are improving in every western European country. Why have Conservative Members been crowing? One after another has shouted about all the fantastic things that are happening. Of course, improvements have been made. Perinatal mortality rates, which were higher in Northern Ireland than elsewhere, have come down. We expect better maternity and geriatric services and better care for handicapped children.

Why cannot Conservative Members accept objective criticism from the Opposition? Why is a debate like a boy scout game, with hon. Members trying to catch each other out on point after point? Genuine criticism has been made but does not seem to have been accepted. If Conservative Members were to point out that they had achieved A, B, C and D but were having problems in other sectors, they might have some credibility.

My experience of these matters has been in Northern Ireland and I make no apology for referring to it. I pay tribute to the outstanding hospital staff of Northern Ireland, especially those in Belfast, where there is the violence factor, which I need not touch on now. Staff at the Royal group of hospitals—not just doctors and nurses but right across the board—deserve our appreciation. I should especially like to mention ambulance drivers. Throughout the trouble, I have never known one to refuse or to object to going into any situation, despite there being destruction all around them.

There have been achievements in cardiac surgery. The number of cardiac units at the Royal Victoria hospital has increased from three to five. Belfast and, I think, Glasgow have the highest incidence of coronary-artery disease in the world. I do not have the figures to hand, but I know that they are very high.

I accept that improvements have been made in Belfast, which serves the whole of the north of Ireland, yet patients are still being transferred to London and elsewhere for cardiac surgery. More people in their late twenties and thirties are suffering from ischaemic heart disease. They are mostly in social class groups 4 and 5—unemployed people, who cannot afford to look after their health by eating nutritional food. I pay tribute to the health promotion unit of the Eastern health and social services board, which has done a good job in trying to convey that message to people.

I should like to give an outstanding example of the deficiency of hospital trusts. The Royal group of hospitals was the first such group to have trust status in Northern Ireland. That caused great celebration among those who had sought it. Despite the objections of Belfast city council, trade unions, medical and nursing staff and local people, the group gained trust status. Once that had happened, I said that they should accept it.

Within months of the trust being set up, the Eastern health board offered Royal Victoria hospital a contract for 3,000 general surgical and ear nose and throat operations, which was less than it had had in the previous year. If that contract had gone through, it would have been the beginning of the end of the Royal Victoria as a general hospital. It would have continued as a regional hospital.

How was that contract stopped? It was done by a massive campaign in which, thankfully, Catholic nationalists from the Falls road and Unionists and Protestants from the Shankhill road came together to join trade unions in opposing the contract. An Adjournment debate was held on the matter. We spoke to the Secretary of State about it. The result was that Lord Arran, the former health spokesman, would not allow the contract to proceed.

That happened only a short while ago. The next proposal is for the Royal group of hospitals trust to merge with the City hospital, which was made a trust. Where will it all end? The Eastern health board, which offered the contract in the first place, did not even keep to the criteria that were laid down by the management executive of the Department of Health and Social Security in Northern Ireland. I read the criteria carefully, and I assure hon. Members that the contract did not keep to them. If I had more than 10 minutes, I would go into that matter.

Obstetric services are being closed. Lagan Valley, Mater, and Down hospitals are under threat. We are told that, for a service to be viable, 2,000 deliveries are needed. At the same time, a maternity committee has been set up to consider midwifery-led and GP-led childbirth, which I support. How can a committee consider such a proposal when a major maternity hospital is being closed and three others are under threat? It does not make sense.

Fundholding seems to work on Humberside, but I do not see it working in Belfast. It is early days, however, and there are few fundholders at present. I understand that if a fundholder can save money and use it to care for patients, his allocation for the following year is reduced.

Musgrave Park hospital is the main orthopaedic centre for Northern Ireland. It is a fantastic hospital. If any hon. Members need a new hip, I recommend that hospital, which will measure them up as if they were being fitted with a suit. Threats hang over that hospital as well.

Belvoir Park hospital, the main unit for oncology and cancer services, is also under threat. It is located in beautiful green territory and the proposal is to move services to one of the main Belfast hospitals, which would be a disaster. Orthopaedic waiting lists are massive. People on the cardiac waiting list die as they wait for surgery.

There are no problems with acute services and admissions, but people who may have cancer have to wait for proper investigations to be conducted. If the cancer is at an advanced stage, they may be treated too late.

The idea of community care and of elderly and handicapped people being kept in the community, which all hon. Members would support, is not new. Assessment of such people is important. Everybody wants to keep their grandmother or friend with a failing mind in the community for as long as possible, but somewhere along the line, if it is unavoidable, those elderly people have to go into an institution. Elderly people's homes are being closed, so something is wrong with social policy.

The issue of accountability appears in Labour's motion. Where is the accountability? I have not heard Conservative Members talking about accountability. They do not accept that the health service has any faults, yet there is no accountability.

Legislation on child care in Northern Ireland, where it is a major problem, has to be considered.

The Huston report, which deals with Northern Ireland, will come out either tonight or tomorrow morning. It investigated major cases of sexual abuse in Belfast. It contains 52 recommendations and is about the breakdown of information between statutory and voluntary bodies and it should be sent to every hon. Member.

7.59 pm

Mr. Sebastian Coe (Falmouth and Camborne)

My immediate remarks are directed at the hon. Member for Belfast, West (Dr. Hendron). I do not wish to question his knowledge of community care in that area, but Tory Members have not been crowing. Nor do we wear rose-tinted spectacles. We are rightly proud of the changes in health care in this country recently. That must be set alongside the system that was changed.

It must be remembered that, for every pound that was designated for patient care before the reforms, significantly more was being spent on a system that was simply waiting for reform to happen. Money was spent on funding a creaking management structure which was allowing it to happen. By most assessments, the organisation lacked sense, magnitude and direction. That was rationale enough for our recent reforms. The concern of Tory Members for a considered evolution to an institution that has at its core a focus for the needs of patients and its users is laudable and undiminished.

There was no overt conspiracy in the past to subvert the national health service from considerations of good management, effective resource allocation and monitoring. It did not happen because no culture or environment expected it, or even demanded it. It was a culture where costs were never properly assessed, altered demographics were not taken into consideration and advances in technology were discounted. Such advances have provided a raft of new techniques and disciplines which were the stuff of fertile imaginations and daydreams only a few years ago. Of course, they are now the everyday reality for many people, freeing them from pain and discomfort, and badly curtailed life styles.

One of the inevitable results is that people live longer. The Secretary of State was right to point out that, in living longer, people may also need more expensive and technical treatment. All of that adds up to the overall resource implications and cost of patient care which should lie at the heart of this debate. It goes without saying—and here lies some criticism—that those who conceived the idea of a national health service did not anticipate the rapidly rising costs with which it was presented almost from the word go.

Confronting the issue of resources and their effective allocation is one that Opposition parties have simply failed to confront in any systematic way—certainly, so far in this debate. But that is hardly surprising. To imply that the path to salvation lies only in a greater level of funding is certainly not surprising. But to pass off that rhetoric as a coherent strategy—even if they believe it—poses the greatest threat to the national health service and patient care in this country.

Equal in that danger is the elevation of the national health service to the point at which it remains untouched by the realities of greater demand and the ever-increasing public expectation of improved conditions, care and service. It sets deliberately false trails. It is misleading and makes no serious contribution whatever to the debate about how the national health service should be judged.

There can be only two indices of assessment. Efficiency and effectiveness can be measured only by the quality and quantity of patient care that it delivers. On both counts, the reforms have produced quantitative improvement. My hon. Friend the Member for Harlow (Mr. Hayes) was right to mention that, and I am not ashamed to repeat it. More patients are being treated than ever before. The length of time that patients wait for treatment has fallen sharply.

There have been increases in spending each and every year. The proportion of our national income which is devoted to the national health service will rise this year to an estimated 6 per cent—1.5 percentage points higher than when the Government came to power. Those realities are neither the politics nor the statistics of neglect. To suggest otherwise is disingenuous. In fact, it is downright dishonest.

The national health service is the largest employer in Europe. One could be forgiven for thinking that for some, that is the only indicator which will be considered. The proper use of the public purse, the efficient use of scarce resources and the better care of patients are not a happy accident. This is not the managerial version of "It'll be all right on the night". It comes about by one thing, and one thing alone—good, effective and sensitive management, and committed medical professionals.

To push through operational changes without necessary management changes would be ridiculous. That is why, since the mid-1980s, the Government have progressively—strengthened national health service management. The populist view that an under-managed service and weak management—and worse, under-valued management—are compatible with the pursuit of an ever-improved service is a dangerous myth.

It is interesting that most debates in the House dealing with the provision of public services are spiced with spurious Opposition claims of rock-bottom staff morale, whether they be teachers, local authority workers or the police. Yet I have heard only the most demotivating barrage of abuse about dedicated professionals. I am sure that Unison was listening with great interest to the support from its comrades in arms and the comments about many of its members. Does the morale of management not count when it comes to fraternal concern? Apparently not.

Managing the new NHS cannot be done on the cheap. It certainly will not be done by abusing managers and staff. Of course, we must be alert to the need at all times to keep management cost effective and streamlined, and keep waste to a minimum. It was right that my hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale) put this into perspective. General and senior managers in the national health service still account for little over 2 per cent. of the NHS work force and about 3 per cent. of the annual wage bill. I should, add that, in any management model, those are not unacceptable statistics. Administrative and clerical staff, many of whom directly support nurses and doctors, account for 11 per cent. of the wage bill. The overwhelming draw on the budget remains those staff who provide care to patients directly; they account for some 65 per cent. of the wage bill.

The reforms of the late 1980s paved the way for the recent changes in management structure which were aimed at reducing bureaucracy, minimising administrative costs and aligning the structure of the NHS more closely with the purpose of the reforms. The merger of district health authorities with family health service authorities will simplify and clarify managerial roles and responsibilities. Regional health authorities were part of that outdated culture. Their abolition was rightly welcomed by health professionals across the board. The streamlining of NHS management executive supports those changes taking place lower down the management dynamic.

Taken as a group of measures, there is much to be welcomed in the Government's plans. As with previous reforms, their success will depend on the careful monitoring and constant control of management costs—both set against explicit targets. But we must never forget that these controls should not become so restrictive that they prevent managers from carrying out their duties effectively. The national health service must be run by managers on the ground with doctors and nurses contributing to the decision-making process in the wards and in surgery. The most fundamental aim must be to improve health care.

The majority of people who use the national health service are satisfied users. Poll after poll has identifield that. People are not scared of the changes. Improved management touches large parts of their lives, whether in the public sector or in the private sector. They are right to demand it—they want to embrace it.

8.8 pm

Mr. Jim Dowd (Lewisham, West)

Earlier, a Tory Member put up what is a fairly usual smokescreen for the Tories by saying that they have a right to claim that all the parties in the House can take credit for the national health service. It is certainly true that all the parties would like to take credit for the NHS. However, the Tories have the greatest difficultly because, of course, about 40 years ago they voted against the establishment of the national health service. That has proved a great difficulty for them ever since. It is the one issue which cuts most directly against the free-booting rhetoric of the market that is so beloved by the simple-minded ideologues who seem to have taken the Conservative party hostage for the moment.

They have the greatest difficulty with the NHS—it is the rock upon which they founder—because the NHS accords with the highest ideals and the fundamental needs of the British people. The Government's approach to the NHS must be set against that. The NHS will not stand the full frontal assault which they have exhorted in other areas, so their approach needs to be far more subtle.

The motion tonight relates to waste and bureaucracy in the NHS. I want to go back over a few Tory reforms, not just the most recent reforms but those which immediately preceded them. Every Conservative Government have seen it as their role to reconcile their initial, fundamental and innate hostility to the principles of the NHS with the fact that they have to run it.

In 1974, for example, there was a reorganisation under Sir Keith Joseph, as he then was, which established the area health authorities. I was appointed to the area health authority, then called Lambeth, Lewisham and Southwark, that was formed as a result of the reorganisation in 1974. In 1984, we had the district health authorities. I went on to serve on Lewisham and North Southwark district health authority, which principally embraced Guy's hospital, Lewisham and a few others.

There was then the cash crisis of the winter of 1987–88, when the previous Prime Minister was forced on one of the few occasions during her premiership to back down in the face of public pressure. Rather paralleling her similar experience in 1981 with the miners, she did not take the matter lying down and set in train a series of events which was designed to reorganise the NHS and, more particularly, to wreak her revenge upon it. The consequence of that came to fruition in 1990, when we got the regime under which the NHS currently operates, with the emergence of self-governing trusts.

What are those trusts? They are collections of self-appointed individuals, who asked nobody whether they wanted them to take over the health service. They have consulted no one who would be a beneficiary of those services. They just selected themselves and decided that they would provide the health services in an area because they knew best. We have particular experience of that in Lewisham and North Southwark, because we had the flagship trust of Guy's and Lewisham launched upon us.

Those of us at the Lewisham end of that were particularly concerned. We were told that Lewisham hospital, as a relatively insignificant district general hospital in the shadow of a major international institution like Guy's, had no conceivable future away from Guy 's hospital. We were told that there was an umbilical and incontrovertible link between Lewisham and Guy's. To coin a phrase, what was needed to improve the health services in our part of south-east London was an ever-growing union.

Then came the Tomlinson report. More than anything, that report was a substitute for the fact that there is no single regional health authority in London. Many of the problems in London's health services will not be solved until such a time as there is a region-wide London health authority. The other reason for the emergence of Tomlinson was the immense distortion which the internal market was creating, not just across the country, but in London in particular.

The Tomlinson report has brought in its train serious threats to some of the finest centres of medical excellence in the world. People from overseas look aghast that we should even be considering closing centres like Bart's or University College hospital or Guy's or St. Thomas's. They think that we must be several light years out of our skulls, or at least that the Government are.

What else were we told by Tomlinson? We were told that the link between Guy's and Lewisham was now no longer necessary, because Guy's would be linked with St. Thomas's. We were assured by the self-same people who, a couple of years ago, told us that Lewisham had no future other than being linked with Guy's that Lewisham could stand happily on its own and would, in fact, benefit from being a separate trust. I can only suggest that there were either lies three years ago or there are lies now, because both cannot be true.

More embarrassing for those who are currently running the trusts is that the same people were telling us that those two conflicting stories were both true. So now we have a trust in Lewisham and a separate trust at Guy's and St. Thomas's. What Tomlinson came up with for Guy's and St. Thomas's was a merger on a single site. Anybody with any intelligence could see what that means. Either Guy's or St. Thomas's will close, and either over the river or further down at London bridge there will be a single sign saying "Guy's and St. Thomas's hospital". The entire nation is to be asked to believe that that is the continuation of Guy's and St. Thomas's, but it is a mask for closure.

The health authority has been through a metamorphosis. While the trusts were being set up, there was an imbalance—particularly as the flagship was moored so close by. Incidentally, it is now obvious that the flagship trust was sailing under a flag of convenience, which was that of expediency. The authority had to look at another way of matching the producer-provider split. That idea has not just dropped from the heavens. It is not a revolutionary idea—the producer-provider split in the public services is as old as public service itself.

We are arguing about the way in which it operates and the system under which it operates. The district health authority at Lewisham and North Southwark got together with what was then the authority for Camberwell and West Lambeth and created what was informally known as the south-east London commissioning authority. After due consultation, they decided to formalise a split with the commissioning authority, and we had something called the South East London health authority. That was formed, amazingly, out of the London boroughs of Lambeth, Lewisham and Southwark. Those hon. Members who are still awake will recall that I mentioned the area health authority which was formed in 1978 out of Lambeth, Lewisham and Southwark.

I was just getting used to the South East London health authority, when I got a letter at the end of 1993 from an organisation called the Lambeth, Southwark and Lewisham health commission. This has all happened within a space of a few months. The only people who have benefited from the upheaval in south-east London are public relations consultants who have designed logos and printers who have designed letter headings.

The Lewisham trust, meanwhile, has announced for the fifth time to my certain knowledge phase 2 of the development of Lewisham general hospital. This is the fifth time since 1984 that that major step forward has been announced. On the other four occasions, it came to nothing. Let us hope that it is more successful on this occasion.

The chairman of the Lewisham trust resigned after I placed questions on the Order Paper asking what the hell he was doing launching a £100 million carpet company at the same time as he was supposed to be running a hospital. I accept immediately that carpets are important in hospitals, but I would much rather have somebody in charge who knows about health rather than about carpets. I asked questions about what he was doing and he resigned a few months later, I am pleased to say. However, we are left with his legacy.

It is clear that the NHS is not safe in the hands of the Government, and not safe in the hands of the Conservative party. The British people know to their cost that it is not the protection of the Tories that the NHS needs, but protection from them.

8.18 pm

Mr. Nicholas Winterton (Macclesfield)

I congratulate the hon. Member for Belfast, West (Dr. Hendron) on his rational speech. He showed that he has a refreshing knowledge of the health service in Northern Ireland. The hon. Gentleman is now accompanied by the hon. Member for Belfast, South (Rev. Martin Smyth), whom I know well. He has served on the Health Committee and its predecessor Committee for many years, and there is no doubt that Northern Ireland is well represented in the debate.

I also congratulate the hon. Member for Belfast, West on what I consider to be a sensible remark. He said that the Government have done a lot of good for the health service and indeed they have. Some of the reforms have been beneficial and should be carried forward. The hon. Gentleman added that the Government are not prepared to listen to criticism. They are not prepared to listen to people who have a point to make. He said that the Government appear to think that any criticism comes from people who do not want to know anything about the reforms that the Government have introduced. He believes that the Government consider that those people are foolish, that they believe in a different philosophy and that therefore they need not be listened to. I think that people should be listened to.

Although I warmly welcome a number of the reforms that the Government have introduced, certain problems have arisen. Unlike the Opposition, I would not abolish fundholding practices, but I would ensure that every practice was a fundholder. That would put all practices on the same footing.

The hon. Member for Bristol, South (Ms Primarolo) will respond for the Opposition and I say to her, as a Conservative and a member of the Government, that I accept that there is a two-tier system. I have had many instances in my own constituency of such a system operating. Patients in a fundholding practice are offered immediate treatment, whereas those in a non-fundholding one are made to wait because the district health authority or the regional health authority has run out of money. The hon. Lady and every other hon. Member could cite similar examples. It is interesting that fundholding practices do not appear to run out of money, just district health authorities. I do not have time, unfortunately, to talk about the allocation of resources.

I respect my right hon. Friend the Minister immensely, despite our many differences since his appointment to the Department of Health. Many of the Government reforms are good and should be supported, but my right hon. Friend and his ministerial colleagues, particularly the Secretary of State, should listen to constructive criticism, because everything in the health service is not rosy.

I accept that there is a lack of morale and a sense of uncertainty within the NHS. I say that as a Conservative, so my comments will not be welcome, bearing in mind the theatrical performance from my hon. Friend the Member for Harlow (Mr. Hayes). People wonder whether the Government are committed to the health service, as we know it and as I believe it should be. People are concerned about whether functions are being gradually weaned away to the private, independent sector or charitable sector of the hospital service.

That process has already affected community care and the care of the mentally ill, the mentally handicapped and those who are suffering from aging illnesses. They are no longer looked after in the NHS, but in private nursing homes, private residential homes or charitable, non-profit-making institutions. That is dangerous, because the health service is now dominated by its concern for treatment. It is gradually squeezing out care, but to my mind the provision of such care is a vital part of our NHS. People who work within the service, especially nurses, express that concern to me over and over again.

Macclesfield has a superb district general hospital. I congratulate the regional health authority chairman, Sir Donald Wilson, on the resources that he has allocated to that hospital and the extensions that have been made to it. I also congratulate him on the additional facilities that we have bought, because, I am glad to say, a private hospital went into liquidation. It had been built on health authority property next to the district general hospital and, as a result of its failure, we now have a superb orthopaedic department, at a third of the cost of providing one from scratch.

Nurses are overworked and are under immense pressure. They tell me that they were taught to care, but that they do not have time to care, even for people who are dying. My right hon. Friend has an immense experience of the medical profession and surely he would agree that a person should die with dignity and be offered care, compassion and love. The people who can give them that do not have the time to do so.

The debate is about bureaucracy and administration. Whatever my hon. Friends may say, there is no doubt that the system has created a huge bureaucracy and a huge additional administration. Senior management have increased from 1,000 to 10,000. It is not as though those people are still paid between £35,000 and £40,000 per annum. They now earn between £80,000 and £100,000 and receive big bonuses, cars, perks and various other benefits. They are extremely costly to the health service. Administrative and management personnel have increased from 10,000 to 35,000. My right hon. Friend may justify expenditure on those functions and claim that it is worth while, but a lot of that money should be going to patient care.

It is difficult to cost care. It is quite easy to cost treatment, but my right hon. Friend does not know how much care a particular patient will need. If commercialisation is to dominate our hospital service, one of the most valuable assets of our service, the care that is offered to sick people will disappear. That would be extremely sad.

I recently wrote to Sir Donald Wilson, because, although I pay tribute to him for reducing waiting lists and, perhaps, for running the most efficient region in the country—as he, or should I say his public relations department, is wont to say—I can only say that Macclesfield looks rather like a war memorial. Although I have a first-class trust chairman in Mr. Peter Hayes, a first-class board, both non-executive and executive, and first-class staff at the district hospital, what has happened to health facilities in Macclesfield?

The Mary Dendy hospital and the Alderley Edge community cottage hospital have been closed. The Soss Moss hospital is to close. Parkside hospital, one of the finest mental health hospitals in the country, is to close, despite my opposition, which I have voiced throughout the time, nearly 23 years, in which I have represented Macclesfield.

The young persons unit, which treats young people with behavioural problems, has the most outstanding reputation of any such unit. It, too, will be closed because it has a low profile in terms of the service that it provides and therefore it is a low priority on any purchaser's list. At the same time, the district hospital will provide an after-school sex clinic. The authority has got its priorities slightly wrong, because to abolish a unit that is a success story and to duplicate existing facilities in my community is a mistake.

The health authority has also decided to close the Priory unit, which treats those who suffer from alcohol dependence. The carers, the staff and those who use that unit want it to survive, but, oh no, the health authority wants it to close. The authority has informed my trust that it will not purchase any places at the unit and that its patients should be treated in the community.

I have received pleading letters from my constituents whose lives have been saved by the unit, but where is the consultation about which we hear so much? My hon. Friend the Member for Broxbourne (Mrs. Roe), who now chairs the Select Committee on Health, talked about accountability, but where is it? There may be accountability to Ministers and Sir Duncan Nichol, but there is none to the local community which is served by the health service.

The decisions in my area are not even made by the chairman of the district health authority, County Councillor Simon Cussons, but by Sir Donald Wilson, and I give him full credit for his experience. That health authority was merged against the wishes of my local authority, my wishes and those of the community health council. Now, it is not even located in the area that it serves, so how can it offer an acceptable level of accountability?

I urge my right hon. Friend to use the good reforms that we have introduced, but we should implement them in a way that is acceptable to the people of this country, the people who serve in the NHS, and particularly the patient.

8.28 pm

Rev. Martin Smyth (Belfast, South)

I am glad to follow my parliamentary friend and erstwhile colleague on the Select Committee, the hon. Member for Macclesfield (Mr. Winterton), because of his concern in health.

The hon. Member for Falmouth and Camborne (Mr. Coe) gently chided the hon. Member for Belfast, West (Dr. Hendron) for overdrawing the picture. Unless my knowledge of quotations is completely wrong, he was quoting the director of Booz Allen and Hamilton, speaking in December, when he compared spending £1 directly on patient care and £4 on aspects of indirect care. I had the impression that that had been changing as a result of the Government's reforms, whereas the director was implying that that was still going on. He said: For every pound spent directly on caring for the patient, £3-£4 is spent on writing things down, scheduling work, and waiting for work to be required. We must face some of the issues that remain with us. I pay tribute without reserve to the work that has been done over the years through the national health service. I have campaigned for it, but I do not believe that it has been perfect. Indeed, I do not believe that anything that a human puts his hand to is necessarily perfect. We should therefore always strive to improve.

In that context, I pay tribute to the recent honour that the Minister for Health has received. When I raised a question during the paediatric statement, he missed the point that I was making and said that he would refer the matter to the Earl of Arran. I received an acknowledgement that he had done so and, amazingly, I am still waiting for a definitive reply.

Paediatric orthopaedics is an example of the weakness in the national health service. It has a tremendous need to deal with youngsters, and one of the finest provisions in the United Kingdom is provided by Musgrave Park hospital. I knew that the Minister had personal experience of it. I acknowledge that the North British Tours organisation has given another generous donation from private enterprise to fund the work carried out at the hospital's Gait unit. I was amused to receive an oblique reply referring to the orthopaedic surgeon handling the work at the children's hospital.

I cannot understand why the Department continues to write to Members who raise issues detailing facts that the Members already know rather than dealing with the problems that they raise. He told me that Kerr Graham was the surgeon, but he had already written to me to thank me for the interest that I had shown.

I am not knocking at the health service but pleading for continued improvement in it. I understand the views of the hon. Member for Falmouth and Camborne on care because, on Tuesday this week, I was travelling from Belfast with one of Northern Ireland's finest comedians, Frank Carson, who paid tribute to the hon. Gentleman's concern for social care.

The earlier part of this debate seemed, with sound and fury, to signify nothing. We must get beyond a partisan approach so that we can come together to help and improve. Some people constantly seek to defend their own patch. It is interesting to discover that the pharmaceutical industry is adamant that we should not curb drug production because only 10 per cent. of the national health budget is spent on drugs. Yet there is 10 per cent. wastage in the health service, so why take it out on drug manufacturers when what they supply equals the waste? Nobody will suggest that the waste occurs only in the drugs budget.

Hon. Members complain that we knock the managers. As I said in Committee earlier today, I put on a blue suit because I was not knocking the men in grey suits. None the less, we need to examine the growth of the managerial approach. Figures that were given to another hon. Member suggest that 36,000 more managers and 27,000 fewer nurses are employed than before the reforms. I appreciate that statistics can be confusing, because those figures refer to the whole United Kingdom from 1989–90 onwards and include nursing auxiliaries and pre-Project 2300 nursing students, whereas the Department of Health figures in the statistical bulletin exclude Northern Ireland and apply only to qualified nurses.

It is, therefore, difficult for hon. Members asking questions in this place if they do not get clear answers. Perhaps some of us are still living in our school days, when we gave a vague answer to try to gain something from the examiner because we did not have the full answer. I suspect that there are still more nurses in patient care, because one must add to the number of nurses involved in the health service those now involved in private residential and nursing home provision.

The fashion of provision on acute sites is one of the issues raised in the London review. It is argued that we should not have specialised, free-standing units, but that they should be on acute hospital sites. I share the concern of the hon. Member for Belfast, West about the suggestion that one of the finest cancer units in the United Kingdom, at Belvoir park on the outskirts of Belfast, serving the whole region, should be on an acute site, whether the City or Royal site. The Minister will agree that the City or Royal sites could not even cope with the parking facilities now available at Belvoir Park. To destroy that wonderful provision because a fad in medicine says that it must be on an acute site would be lunacy.

We must challenge some of the thinking in the medical profession for which politicians get the blame when, in fact, the changes have been driven on by advances in medical care and technology. The poor politician must then provide the money and carry the can for those decisions. The public must realise that medical folk have their own agenda.

The hon. Member for Macclesfield referred to community care and the move to private provision. The tragedy is that now, with the new programme—in time, the Government want to try to extend community trusts to the rest of Britain—we are discovering that private residential facilities in Northern Ireland are closing. People are afraid that there will be no provision for the elderly, the mentally infirm and others. We are decanting them and relying on their families, without proper respite provision or back-up in community care.

We must constantly keep alert to those issues, so that we maintain the best health service that the world knows.

8.38 pm

Mr. Stephen Day (Cheadle)

First, I declare an interest. I am the parliamentary consultant to the National and Local Government Officers' Association section of Unison, and I am proud so to be. Some of the comments in the debate may be construed by members of that union to be an attack on them. That is unfortunate, because many members of Unison work in the NHS and many members of NALGO work in the administration of that great service.

It has been said today that, as a Government and as a party, the Conservatives should listen to criticism about the present workings of the national health service. That is right, and that is what the Government do. Only recently, the Secretary of State responded by announcing an initiative issuing new NHS codes for accountability, probity and financial control, for which I applaud her.

The NHS is a vast service, which employs many people, and it would be surprising if there were no instances of genuine distress involving individual patients at specific hospitals. When such stories are related by Opposition Members, they are valid and particularly pertinent to the patients who suffer. But such tales do not tell the other side of the story—the vast number of patients who are treated by the NHS and are well satisfied. I am constantly amazed by the number of people who come to me, either in my surgeries or as I am wandering around the constituency, and say that they have received wonderful service from the NHS. They are often elderly people.

Opposition Members often cite examples of patients who have been kept waiting for what everyone agrees are unacceptably long periods. It is fine if Opposition Members do so to try to improve the service, but they do not. They do so in an attempt to attack the integrity of the Government and the NHS by continually alleging that that is the true picture.

That is why I had some sympathy with the hon. Member for Belfast, South (Rev. Martin Smyth) when he said that in order to deal with the problems we need a consensus. That is necessary if we are genuinely interested in saving the NHS for the future—the task before us. All hon. Members know the pressures on the service. They are shown not just by the individual difficult circumstances already mentioned, but by the massive number of patients successfully treated by the NHS. Success identifies the problems faced by the service, but that aspect has hardly been mentioned in today's debate.

The idea that a service designed to meet the needs of the 1950s could be retained in a fossilised form without change is bizarre. The NHS could not possibly have met the needs of the 1990s in its original form. Even now, the NHS is not perfect. Given the pressures that it is under, I suspect that it never will be. Nobody in the House can deny that the NHS has never been perfect. The problem of patients having to wait too long did not suddenly occur when the reforms were introduced. Indeed, the reforms were an attempt to deal with that problem.

Nobody can promise to eliminate that difficulty, but it does not serve the interests of the House or the subject when hon. Members constantly and only relate the downside of the equation. Even with the shortest of waiting lists, someone will always have to be last on the list. Hon. Members who are constantly on the attack by reminding us of the person who comes last are not helpful. According to them, the NHS cannot win, but it is not good enough merely to say that.

The NHS is a great institution. I am proud to say that I rely totally on the NHS for my health provision. I thank God that I have been lucky enough not to have use the services of the NHS except for specific injuries. The NHS has been successful, and more people are living to a greater age. We all welcome that and hope to be part of the problem. In the light of the temperature in here sometimes, I am not sure whether it is the best place to be to become part of that problem for the NHS, but I shall try.

Parliament and politicians must recognise that to provide for people in old age requires changes. We must constantly fine-tune the system and the changes. If the Opposition criticisms are designed to help that fine tuning, they are valid, but I do not recognise such criticisms in what they have to say.

I cannot remember who it was but, during the debate, an hon. Member related the problems that one of his constituents faced waiting for a cataract operation, and his story proves my point. The number of people waiting for cataract operations originally began to grow—despite the Government's partial success in that sphere—because the NHS was so successful that more people began to live to an age when they suffered cataracts. We must recognise that problem if we want to save the NHS. As someone who uses the NHS, I have faith that the reforms are not a threat to the principles of the NHS, but its salvation.

8.45 pm

Mr. Alan Milburn (Darlington)

I pay tribute to the brave and forthright speech of the hon. Member for Macclesfield (Mr. Winterton). He highlighted what happens when a Government become so obsessed with ideological ends that they put their obsession ahead of a commitment to the most popular of all public services in this country, the national health service. The Government have taken no account of the costs of their policies.

We have heard today that the NHS is in a state of perpetual crisis in all parts of this country. I do not need to repeat the litany of problems already mentioned by my hon. Friends—suffice it to say that the NHS cannot cope with demand because it is so short of supplies. I should have thought that a Government so committed to the ethics of the marketplace would have understood that—the first principles of economics. For any enterprise to succeed, it must be able to meet demand with adequate supply. If one closes one fifth of one's capital assets—hospitals and acute wards—and fails to protect investment—the NHS budget—from the ravages of inflationary costs, one's enterprise will inevitably fail to keep pace with demand. Is that not the homily that we have heard from successive Chancellors of the Exchequer, Prime Ministers and Health Ministers?

Such a scenario is bad enough when it afflicts an individual firm, but when it comes to pass in an institution' as vital to the health of our nation as the NHS, the country's alarm bells should start to ring. What is at stake is the health and future of our nation. The NHS is in danger of imploding as a consequence of the combination of underfunding, rock-bottom staff morale, public disquiet and the Conservatives' market changes. The straw that: may finally break the camel's back is the boom in bureaucracy of recent years.

We all know that times are hard, that precious resources have to be husbanded and that we cannot do everything that we would wish to do immediately. If we ask members of the public where they want their hard-earned tax revenues to be spent in the NHS, they say that they want more doctors, nurses and midwives and more expenditure on medical equipment. I bet that no one would say that they want more bureaucrats or managers, but that is precisely what we have. In the midst of famine, there is a feast of bureaucracy.

There is the starkest contrast between the problems that my constituents face as health care providers and people requiring health care and the boom in bureaucracy over recent years.

The NHS is becoming more secretive, centralised and top heavy. It is in danger of becoming a service where the daily growth in the number of chiefs is matched only by a fall in the number of indians.

The position is now sufficiently clear. The Department of Health's own figures paint the starkest picture. There were 14,000 more managers, 22,000 more administrators and 27,000 fewer nurses in the United Kingdom's national health service between 1989 and 1992. The introduction of the Conservatives' market changes saw a 236 per cent. increase in managers and a 5 per cent reduction in nurses.

Ministers have formed an army of bureaucrats which is strangling the NHS with more and more red tape. The internal market is sapping the health of the nation with a booming bureaucratic burden in contrast to Ministers' promises. We were promised a leaner and a fitter national health service where resources would be freed for better patient care. It is not leaner or fitter; it is fatter with bureaucracy.

Ministers say they are determined to hold down administrative costs. The Secretary of State claimed in her statement to the House last October that the abolition of the regional health authorities will slim down NHS management".—[Official Report, 21 October 1993; Vol. 230, c. 400.] She repeated that claim earlier today, but, as the right hon. Lady must know, axing the regional health authorities will do no such thing. They have been sacrificed, not in an effort to cut down bureaucracy, but to stamp out the last vestiges of proper planning in the NHS.

If the proposals go ahead, the distinctive health needs of my region, the north, will be swamped in a larger, less accountable organisation run from the centre by the hand-picked appointees of the Secretary of State for Health.

As for the claim that it will mean fewer managers, who on earth do Ministers think they are kidding? In 1992, out of a total of 710 managerial staff in the national health service of the north, just 88 were directly employed by the regional health authority. The Secretary of State quite simply has the wrong target in her sights if she is serious about reducing NHS bureaucracy. Its growth owes nothing to the planning work of regional health authorities and even less to the redesignation of nurses as managers; it owes everything to the introduction of a new contract culture at hospital level.

That culture has brought with it the paraphernalia and institutional bureaucracy of the marketplace. We have more financial directors, more pieces of paper, more trading in health care, and more PR specialists and management consultants, and they are all looking to make a killing in the new environment. If the Government really want to cut down on bureaucracy, stamp out waste and end the growth in grey suits, they have to end the market experiment in the national health service.

The responsibility for waste and unnecessary red tape lies with Ministers. They have abused public spending. The annual pay bill for managerial staff in the United Kingdom has trebled—an increase of more than £350 million. In the past year in England alone it has risen by £110 million—an increase of 29 per cent.—while the overall nurses' salary bill has increased by just 5 per cent.

Ministers say that it takes a special person to be a hospital manager and that therefore hospital managers deserve a special reward, but it also takes a special person to be a nurse, a doctor, a porter or somebody working in NHS labs saving lives in our hospitals and communities every day. But what is their reward? A pay squeeze, which damages morale further. It is an insult to NHS staff at the sharp end of health care and it is precisely the double standards we have come to expect from the Government.

That is just the beginning of the story. My hon. Friends have alluded to the growth in corruption within the national health service. I never thought that we would see the day when corruption would become synonymous with the NHS.

In my region we have the Northumbria ambulance service, the jewel in the crown of the NHS trust success story run by a man who happens to be the president of the Tynemouth Conservative association and, I understand, of the Tynemouth boy scouts as well. Mr. Stewart and his friend Mr. Caple have very good track records. There are personalised number plates for NHS ambulances. They pop over to America and buy a new fleet of ambulances—

Madam Deputy Speaker (Dame Janet Porter)

Order.

8.56 pm

Mr. Roger Sims (Chislehurst)

The motion alleges lack of accountability within the health service, and I would dispute that. Health authorities and trusts are answerable to local people, including local Members of Parliament. They are answerable to the NHS executive and to Ministers who, in turn, are answerable to us in the House by way of letters, parliamentary questions and debates such as we are having today.

I do not consider the first leg of the motion to be particularly strong. When Opposition Members talk about accountability, what they mean is that they would like to see health authorities elected and turned into party political bodies, to which my response is, God forbid.

The second leg of the motion alleges a growth in bureaucracy. In the sense that there are now people with management responsibilities that did not exist before, that is correct. It is exactly what was needed in the health service—a clear line in management responsibility.

The third leg alleges waste of resources. That is certainly true. There is some waste of resources, but, thanks to the reforms in the health service, we can now identify and deal with them. At least there is now a mechanism in place whereby they can be handled, which was not the case in the past.

I am not going to quote an over-quoted slogan, so I think that we should go back to why and how the structure of the NHS was changed. The House will recall that, in the early 1980s, we were faced with ever-increasing expenditure in the health service without apparent corresponding improvements in the service, and with lengthening waiting lists. As a result, the then prime Minister set up her inquiry and Sir Roy Griffiths was asked to initiate an inquiry into the management of the health service which he concluded was poor.

There was waste then, but it could not be identified, because we did not know how much things cost. In those days, if one asked at the local hospital or health authority what was the average cost of a gall-bladder operation or a hysterectomy, they literally did not know. How can waste be prevented if one does not know what the costs are? Not were there clear lines of responsibility. Obviously, resources of cash and staff were not being used as effectively as they could have been, but no mechanism existed to identify where the weakness lay. That was why the reforms were introduced.

The front line of the NHS are the doctors and nurses, who heal and care for patients. Every one of us has benefited from the work they do, but they do not work in isolation. It is easy to scoff at managers and administrators, but without them doctors and nurses simply could not do their work. Any successful industrial or commercial organisation depends on the skills, not only of those who fashion the final product, but of those responsible for managing the premises, for the purchase and supply of materials, and for programming the production process to make the maximum use of facilities within the organisation.

I do not suggest that the NHS is either an industrial or commercial concern, but, in staff employed and the money spent, it is big business. It must be sensible to apply business methods to its administration. Behind those front-line doctors and nurses there are now managers responsible for the premises, for record keeping, for ensuring that drugs and equipment are available when needed, and for effecting a match between operating theatre time, bed occupancy, treatments and patients' needs, thus reducing and, I hope, eliminating, waste.

We now have managers at purchaser level in the health authorities who know the cost of treatments and can allocate resources in the best interests of the local population. By contracts, they can get the best value for the funds that they have available, which are always going to be limited, whatever the ultimate figure. The fact is that the system is working. We are getting more and better treatment for the money spent.

In her opening speech, my right hon. Friend the Secretary of State quoted some national figures. They are reflected locally. In my area, in 1992–93, Bromley health authority purchased homeopathic treatment for 232 out-patients, two day cases and nine in-patients, at a cost of £50,000. In 1993–94, it purchased 320 out-patient appointments, nearly 100 more, for £14,400 as against £50,000 the year before, thus releasing more money for other treatments.

There is a new administrative structure, or, as Opposition Members might like to call it, bureaucracy. But it is working. It is having the effect that it was intended to have. That is not to say that there is not scope for further improvement—of course there is.

We look forward to legislation to reduce the number of regional health authorities. It will also enable the merging of health authorities and family health services authorities. That is already happening in Bromley, in all but name, with advantages all round. It means that referral and discharge protocols have been developed to ensure the maximum benefits for patients, and the most effective use of resources. It has enabled the managing of joint budgets to ensure that authorities are able to make the most appropriate and cost-effective arrangements for the treatment of those for whom they are responsible.

Inevitably, there are problems as new systems are implemented. Hospitals may well complete their contracts before the end of the financial year, but that demonstrates the need for them to pace themselves and/or to consider whether there are ways of attracting new contracts. All the players are learning by experience in negotiating contracts and in assessing extra contractual referrals that are likely to be needed.

Of course mistakes will be and have been made, arid where they are gross—some examples have been quoted today—that may well be due to sheer incompetence, and appropriate action should be taken against managers who are simply not up to the job.

The organisation and administration of the NHS is not perfect, but at least the Government have had the courage to implement revolutionary changes and have not been afraid to make adjustments and improvements where they are needed. All the Opposition seem able to do is to criticise in a manner that cannot help the morale of those who work in the service, whether as nurses or at management level.

It is not as if the Opposition's criticism is constructive, even though members of the Labour party are actively involved in working in the NHS at many levels. We simply do not know what the Opposition's policies are. Are they in favour of trusts? Would they put the clock back? Are they in favour of fundholding GPs? Yes or no?

Today was the opportunity for the Opposition to tell us what Labour party health policy is, especially since they initiated this debate. Once again they have fluffed it. There has been plenty of criticism but nothing constructive. It is just possible that when the hon. Member for Bristol, South (Ms Primarolo) replies to the debate she will tell us what Labour party policy on health is, but I would not put my money on it.

People will make their own judgments on which party believes that the NHS is a subject for party political point scoring but has no new ideas and which party is wholly committed to the NHS and is constantly working to improve it.

9.6 pm

Dr. Lynne Jones (Birmingham, Selly Oak)

Earlier today we heard a great deal about the large quantities of propaganda material being churned out of the Department of Health. My attention was drawn to a press release dated 6 January with the headline: NHS must learn to listen and respond to local voices says Mawhinney". About the same date, a letter signed by 124 consultants—yes 124 consultants, more than 60 per cent. of the consultants in the south Birmingham acute unit—wrote a letter to the Secretary of State which was a cry for help. They are the local voices. They referred to the problems that they experience day to day and to what was going on in our health authority in south Birmingham—a series of reorganisations, relocations and administrative schemes that have consumed funds and countless working hours and have led to confusion, demoralisation and reduced efficiency. That is what 124 consultants working in south Birmingham said about what was going on in our health service.

If they are confused, the people are even more confused. The merger of south and central Birmingham health authorities had been forced through with inadequate preparation by the discredited former chair of the regional health authority, Sir James Ackers, who was appointed by the Government. A new accident hospital was originally planned for Birmingham as part of plans for major capital investment. Sir James Ackers said that Birmingham had been starved of investment and he put forward grandiose plans, most of which local people.did not want because they concentrated everything on the site of one mega-hospital. That plan was to go ahead and lots of money was to be spent, but, all of a sudden, that money dried up and the plan was shelved.

In the confusion, there were plans to close hospitals to try to save money. The accident hospital was relocated to the general hospital. Now, because we need a new hospital the accident hospital has to move out of the general hospital so that the children's hospital can move into the general hospital. The Royal Orthopaedic hospital that was to move to the general hospital will not now do so, and there are plans to move it to Selly Oak hospital. No wonder people are confused. They wonder what on earth is going on when decisions seem to change from day to day and money which at one time was readily available suddenly dries up.

We know what is happening. Because everyone is moving towards the idea of hospital trusts, new trusts can no longer guarantee that they will have contracts: that means that they cannot plan for the future and cannot make long-term capital investment. That is why Birmingham cannot have a new children's hospital and that is why we cannot have a new trauma unit.

The people of Birmingham have little confidence in the present arrangements. First, they were told that the number of beds in the Queen Elizabeth hospital must be doubled; then, only a year ago, the chief executive of the acute unit—who has now resigned—said that there was a greater demand for beds in that hospital and in the Selly Oak hospital. Last October, however, the new purchasing plans were published: they envisaged a loss of 236 beds. Only two months later, the regional health authority's plans appeared, stating that nearly 500 beds must go.

When I queried the discrepancies, the regional health authority told me that there was one year's difference in its figures; a steep decline in numbers was taking place. Now, the people of Birmingham are wondering whether they will have any hospitals left. The Minister talks about listening to local people, but he does not really want to listen to the voices of people in Birmingham, or to the views of those 124 consultants. I note that the Secretary of State did not mention the letter from those consultants when she referred to the various comments that she had received.

In its propaganda newspaper, "Heartbeat", the regional health authority proudly announced last September that beds, wards and even whole hospitals could be closing across the west midlands as patients and general practitioners exercised their new power to withhold custom from unsatisfactory hospitals. Beds, wards and hospitals are closing; but they are not closing because customers do not want to use them. Waiting lists have lengthened, and every week I hear from my constituents about their difficulties in securing the operations they need.

One consultant recently told a patient, "You are No. 144 on my waiting list of 238. Only very urgent cases—patients with cancer—can get treatment." A group of gynaecologists, frustrated by their inability to take patients from GPs unless they were fundholders, wrote a circular letter to all GPs, letting them know what was going on.

Mr. Whitney

The hon. Lady has made frequent mention of the number of consultants who are complaining about the health service. Can she name a year since 1948 in which consultants have not complained about the state of the NHS?

Dr. Jones

Consultants have never spoken out as they are speaking out nowadays. That is my experience in Birmingham: they have never been willing to speak out in that way.

A lady who came to my surgery on Friday had been in daily pain, needing an operation. The consultant said that she could have the operation in January; there is no waiting list. She has been told, however, that because she lives in south Birmingham she cannot have the operation, because there is no money. A patient about to be discharged from a mental hospital in south Birmingham was told that she would be given counselling sessions and would be able to come in once a week for day care. When it was realised that she lived in south Birmingham, however, she was told that she could not receive that service.

Surgeons tell me that elective surgery is virtually being cancelled in Birmingham. Because of the closure of one of our local maternity hospitals, women are being forced to go out of the district, because the remaining maternity hospital cannot cope with the demand. The situation is ridiculous: patients cannot be given the treatment they need, although there are consultants willing to undertake the work.

I heard last week that, in the Birmingham maternity hospital—which has an intensive care unit for babies—demand is so great that nurses are rushed off their feet, because they are admitting more premature babies in need of intensive care than can be dealt with by their facilities. They are packing them in because they want to make a profit. That is a consequence of the market: we are measuring the success of hospital units according to whether they make a profit rather than the quality of service that they provide.

The internal market is not working in south Birmingham. I urge the Minister of State and the Secretary of State to take their own medicine and listen to the people who experience what is happening every day. Will they please accept our invitation to talk to local Members of Parliament, local consultants, local nurses and the local people?

I am confident that, with proper planning to get us over our current problems which are due to inadequate planning in the past and a lack of capital investment, south Birmingham could have good and efficient services on a reasonable budget. At the moment, however, the health authority is being asked to make impossible savings which are decimating patient care in my constituency and in other parts of the South Birmingham health authority area.

9.15 pm

Mr. David Congdon (Croydon, North-East)

A few moments ago, a Labour Member accused the Conservatives of being obsessed with an ideology for the national health service—wanting to make it a commercial market and eventually privatising it. I utterly reject that charge, but I plead guilty to being obsessed with ensuring that the NHS provides the most efficient and cost-effective patient care possible. I also plead guilty to being obsessed with wanting to root out waste in the NHS. It was interesting that virtually all Labour Members criticised the NHS for this and that, but they did not offer one constructive proposal to root out waste.

Listening to Labour Members, one would have thought that they had a magic method of improving efficiency in the NHS and that the experiences of other large organisations could be dismissed. Many large public sector organisations have a record of inefficiency. One need only remember the old nationalised industries—thank God there are very few left—or consider many sectors of local government, especially Labour-controlled authorities, to know the meaning of inefficiency. It is difficult for a large organisation which is spending £100 million a day to ensure that it gets the maximum value for each £1 spent and to remember that every £1 spent badly is £1 less for patient care.

The key test is whether we have now organised the national health service in such a way as to provide greater efficiency and improved patient care. It has been announced—rightly so—that the size and scale of the regional health authorities is to be reduced, and that is to be welcomed. The changes have inevitably led to a reduction in the number of staff employed by the district health authorities because many of their functions have been taken over by the trusts. It is true that the DHAs are spending very little in carrying out the purchasing function, but it is a key function.

There is a split between the purchaser and the provider, ensuring that there is an important distinction between those who decide what the health care needs are and those who meet them. That is also leading to improved efficiency. I believe that fundholding GPs are the key to the future. They are able to determine what they wish to buy without an intervening layer of bureaucracy, but we heard little about that from Labour Members. It is also clear that the way in which the purchasing authorities place their contracts is also leading to better value for money.

Perhaps most important of all are the measures that lead to efficiency. I do not have time to list them all, but we know that more patients are being treated than ever before. That cannot be ducked by Opposition Members.

We know that the measures in terms of indices of efficiency are improving in the national health service. There have been productivity gains of about 32 per cent. during approximately the past 10 years. There have been productivity gains of 1.9 per cent. last year and 2 per cent. this year. The NHS is a success story and we are determined to ensure that it continues.

To listen to Opposition Members, one would have thought that there was no need to have managers in the health service who monitor what happens. We know that the performance of individual hospitals varies greatly; length of patient stay varies considerably ; the amount of use of operating theatres varies widely up and down the country. The challenges for the health authorities—it has not changed for many years—is to ensure that the standards of performance of the worst areas come up to the standards of the best, because there are such wide differences. We must aim for that.

The health service in London was also mentioned. Some difficult problems need to be resolved. We know that the number of beds in London needs to be reduced. My plea to Ministers is to control the pace of change in London, because we cannot afford to reduce the number of beds too quickly. We have to ensure that the number is reduced in line with other changes, especially in primary care, in London.

The motion that we are debating is a sham. The Opposition are not interested in the efficiency of the health service. We have heard little about what they would do to improve it. They wish to have a large, monolithic organisation, with the producer interests put first. We wish to ensure that the interests of the patients are paramount. That is why it is important to continue with the reforms that are leading to improved efficiency and—perhaps more important—improved patient care.

9.21 pm

Mrs. Jane Kennedy (Liverpool, Broadgreen)

Like the hon. Member for Cheadle (Mr. Day), I am associated with Unison as a sponsored Member and I have been a member of the National Union of Public Employees since 1979. I will not accept instruction from the hon. Member for Falmouth and Camborne (Mr. Coe) on how to represent Unison members. I fought the proponents of permanent revolution in my party and I will fight the idea of permanent revolution in the NHS with every breath left in my body.

I wish, however, to give the Minister the opportunity to take action that will halt the waste of £9 million of capital investment and at least £4 million of revenue costs per year—a waste of resources which, I believe, will have a direct and detrimental effect on the care of cancer patients in my constituency and which has not yet happened. There is an opportunity for the Minister to do something specific that will halt waste in the health service.

The Secretary of State said that it was crucial that the management of resources for the NHS should be effective. I agree with her, but a proposal is being considered by the NHS directorate of the Welsh Office to develop a cancer treatment centre at Glan Clwyd hospital in Bodelwyddan, north Wales.

The Welsh Office believes that Wales should be self-sufficient in the provision of services to its people. That has reached the point where services that are provided to Wales from England are to be substituted by provision in the Principality, irrespective of the financial illogicality of it or of the impact on the quality of service that will be offered in return.

The north-west of England and north Wales are well served by the two cancer treatment centres at Christie's in Manchester and Clatterbridge on the Wirral in Merseyside. Christie's, marginally larger than Clatterbridge, draws its patients from east Cheshire, Greater Manchester and Lancashire. Clatterbridge patients come from Merseyside, west Cheshire and north Wales—specifically Gwynecld and Clwyd.

The patients travelling from north Wales for diagnosis and radiotherapy have long distances to travel and usually stay overnight or are admitted as in-patients to Clatterbridge. I can understand how that must add anxiety to an already stressful and worrying time for patients and their families. However, the current proposal from the Welsh Office to develop an independent radiotherapy service at Bodelwyddan does not make financial sense, will not improve the quality of service provided and flies in the face of recent concerns about the non-uniformity of the quality of cancer treatment throughout the United Kingdom as a whole.

According to a Touche Ross report for the Welsh Office, estimates of the capital costs involved vary from £11.7 million to £12.9 million, depending on which site is chosen. Revenue costs would add a further £4 million per annum. The maximum number of patients forecast for the unit is 1,700 per year, and the expected number is 1,400 per year. That could never be enough to allow a centre of excellence to develop, and even those numbers could be achieved only if the health authorities of Gwynedd and Clywd committed the vast majority of their patients to the new centre, which would remove all choice from patients and their GPs.

Furthermore, I understand that Glan Clwyd hospital, the most likely site, has asked that the cancer centre's funding should be ring-fenced and underwritten by the Welsh Office. Otherwise, failure of the proposed unit could wreck the financial viability of the Glan Clwyd trust and damage the services on offer there. Such an open-ended financial commitment to the north Wales centre would inevitably be a drain on funds for the treatment of patients in England, and my constituents in Broadgreen would suffer because of the limitations that would be placed on the development of new treatment at Clatterbridge.

The Clatterbridge centre for oncology cares for about 6,000 patients a year, nearly 900 of whom come from north Wales. Its size has allowed it to develop a unique combination of people and equipment. Its neutron accelerator is used in the treatment of eye tumours, and that requires the support of specialist staff, who produce facial masks to hold the patients still while the treatment takes place. It is inconceivable that such treatment would be available at Bodelwyddan, so some patients would still have to travel to the larger centres of Clatterbridge and Christie' s.

However, if Clatterbridge lost the 900 patients from north Wales, how would its own financial viability be affected? Obviously unit costs would increase. How long would it be before the case was made by the people whom we have come to know as "the purchasers" that we could not afford three cancer treatment centres in such close proximity? As the Welsh Office would be so financially committed to the unit in north Wales, the future of Clatterbridge would inevitably be called into question.

The Clatterbridge centre for oncology has submitted its own proposals to the Welsh Office. I know that the Minister has been involved in that process, and I hope that he will respond at the end of the debate to what I have said.

The Clatterbridge proposals would improve the treatment of patients throughout the region. The centre would like to develop network cancer treatment facilities throughout its present catchment area, including north Wales. That could involve potential for the installation of linear accelerators at Bodelwyddan. Alternatively, it could involve developing facilities at each of the three general hospitals that serve the area. Being part of the Clatterbridge management unit would allow for provision of the high-quality skills and treatment that we need to standardise throughout cancer care.

The capital cost involved would be as little as £2.4 million, depending on which option was adopted. Clatterbridge is developing for all its patients a system of delivering chemotherapy through local clinics, bringing the treatment to the patients in Southport, St. Helens, Walton and Warrington. North Wales should be allowed to benefit from that system, too.

At a time when the Government's chief medical officer is leading an initiative to improve cancer treatment across Britain through the standardisation of excellence, it seems a great shame that the Welsh Office should be poised to spend millions of pounds on a venture that will not only almost certainly fail to deliver quality in north Wales, but may also wreck the centre of excellence at Clatterbridge. I should be grateful if the Minister could find time to respond to that specific example of bureaucratic nonsense. However, if he cannot manage to do so in the short time that I know he has available, will he respond more fully later?

In the last minute of my speech, I shall deal with some of the nonsense being perpetrated by Conservative Members. When Unison-sponsored Opposition Members speak up and describe the chaos that they see around them in the health service, which has been caused by the introduction of the internal market, Conservative Members say that we are attacking the Unison members working in hospitals throughout the country. But it is nurses who are Unison members who have told me that, in Alder Hey hospital, they can no longer perform the role of key nurse, because they never know from one day to the next which ward they will be working on. They are redirected, as soon as they enter the hospital, to the ward with the fewest staff on duty that day.

Unison members are unable to carry out the professional role that they came into the service to provide. They feel bitter and tell me so. I wonder what they say to Conservative Members. I wonder whether Conservative Members have held surgeries or have opened their mail bags, because after the messages that I have received, not only from those who work in the health service and Unison members, but from members of the public who have written to tell me about operation cancellations, Conservative Members must have been living in a different world.

9.29 pm

Ms Dawn Primarolo (Bristol, South)

Again, the debate on health has been in Opposition time. The Government claim to have had such wonderful sucess in the service, but they reflect and decide not to debate health in their own time.

In the debate, we have considered accountability, efficiency, bureaucracy, waste and the fundamental difficulties with the reforms. The Labour party is trying to make it clear to the Government that a system that is driven by cost, in which everybody knows the price of everything, affects the quality of care. It is true that staff nurses now know the cost of everything, and that perhaps they did not know before. We all know that canisters to warm blood before transfusions cost £60. However, what happens as a result is that they do not use those facilities.

We know that purchasing authorities use different specifications, which means different services are being purchased across the country, with the inevitable consequence of the undermining of the national health service. We know that commercialisation and privatisation mean a defensive, closed, secret system in which trusts, in order to compete, spend more time worrying about their balance sheets and what their neighbours are doing than about the care of their patients. We know that competition is leading to duplication, where every authority thinks that it should have all the equipment and where planning is diminishing.

Opposition Members have detailed at length the waste, the bureaucracy, the waiting lists, the problems with GP fundholding and the two-tier system, and they have demonstrated how private gain is at public expense.

Mr. Day

Will the hon. Lady give way?

Ms Primarolo

Conservative Members know that I have 15 minutes only. The Secretary of State took 50 minutes. I shall try to make some progress through my speech if Conservative Members will allow and I shall give way if time permits.

My hon. Friend the Member for Don Valley (Mr. Redmond) said that we ought to go "back to basics"—back to the basics of justness and fairness. Conservative Members spent their time saying how wonderful the reforms were everywhere, except in their constituencies, where their hospitals were having problems and they thought that perhaps it was a hiccup in the system. We have heard about bed crises, cheating on figures, and ways in which to squeeze treatment out of the system.

My hon. Friend the Member for Lewisham, West (Mr. Dowd) rightly pointed out that Tories claimed that they supported the NHS, have always supported it and were joint partners with the Labour party. I refer them to the vote in the House of Commons on 30 April 1946, when their Government voted against the creation of the national health service by 359 votes to 142.

As the hon. Member for Macclesfield (Mr. Winterton) pointed out, fundholding means that GPs have independence. That is one of the fundamental difficulties with the system. There is a conflict between the district health authorities and the GP fundholder. GP fundholders are not monitored or directed, do not have to ensure that they are buying the services correctly and are pulling in the opposite direction to the district health authority's purchasing strategy. In the middle, the hospitals, the patients and the workers are suffering. That is the problem with the system.

In January 1990, the then Secretary of State for Health said: Next year… we propose to reform the NHS: the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services".—[Official Report, 11 January 1990; Vol. 164, c. 1124.] Where is the truth in that statement? It appears at column 1124 of the Official Report, for those who are interested in the facts.

For three years, we have constantly pointed out that the internal market reforms would mean the destruction of the national health service based on the principles of equity, universal access and comprehensiveness of service. 'Three years later, we have the cancelled operations, closed wards and cuts in services that the reforms have introduced. We have a two-tier health service, which is nothing to be proud of. A health service is emerging in which, if one chooses private care or one's GP is a fundholder, one is treated quicker than someone who goes to a non-fundholder—and massive waste, bureaucracy and a lack of planning pervade.

By contrast, the Government continually mislead the public about the crisis in the national health service. For example, a letter that was circulated in one of our hospitals states: Theatre cancellation programme. I am writing to inform you that the cancellation programme for January and February of 1994 has been delayed. The reason is the expected reduction in the workload to counteract the overachievement of contracts in some specialities. I apologise for the delay in implementing the cancellation programme

and hope we will be able to finalise the programme shortly. That is the stupidity and chaos of the present system.

The Government and their flagship authorities tell us that they are getting waiting lists down. An article in The Independent of 5 January 1994 states: Mersey has become the first regional health authority in England to have no patient on the NHS waiting lists for more than a year. We telephoned some GPs in Merseyside to find out what is going on. A letter circulated in January states: The waiting lists for out-patient appointments for the spine clinic is now in excess of 18 months."— wait for it— The total appointment booking facility on the hospital computer system is only 18 months, therefore the computer facility is exhausted. All appointments will be allocated when appointments are available. Yet the Government, through their good news unit, are encouraging the idea that there are no waiting lists of more than one year. That is not true.

Another patient received a letter in October 1993, advising the date of the first appointment—Thursday 5 January 1995. That is what is going on in the national health service under the Government.

The Government say that the health service needs more competition, but what has competition meant so far? We are now three years into the internal market and what do we have? We have a system in which money talks. If one's doctor happens to be a fundholder, one has more chance of being treated quickly.

It used to be that hospitals ran out of money and took only emergencies towards the end of the financial year. That is now happening at the start of the financial year. I have been told that some cash-strapped hospitals a:re desperate and are asking their consultants to seek out friends who might be fundholders. What does the Secretary of State have to say about that? She says that they are discovering more quickly that they cannot meet their commitments because they are more vigilant. They discover at the end of the year instead of at the beginning. Presumably that is what all the bureaucrats are doing.

Mr. Day

Will the hon. Lady give way?

Ms Primarolo

I have only 15 minutes.

The reforms have been about bringing the health service to the brink of privatisation. The interplay of the internal market, recent national policy changes and the activities of the private sector mean that the boundary between public and private health care is being blurred, so that soon—the Government hope—we will not be able to identify the boundary at all.

The number of people in Britain with private health care has grown. One out of nine people are now covered by private insurance, and GP fundholders have a financial incentive to encourage their patients to take insurance.

Mr. Day

Will the hon. Lady give way?

Ms Primarolo

No.

National health service income from private patients has soared by more than 30 per cent. in the first year of the reforms. Almost a quarter of the charges were accounted for by the first 57 hospitals. Of course, such hospitals are not taking private patients because they have exhausted their waiting lists. When they have no one to treat, they sit round idly waiting for the next patient to walk through the door. They turn to the private sector for work because the public sector cannot afford to pay for more patients to be treated. Waiting lists grow while the Government starve the NHS of money.

The National Health Service Management Executive actively encourages the investment of private capital in joint ventures in the NHS. In April this year, the Government relaxed the rules authorising capital spending, and the NHS Management executive is holding up schemes such as kidney dialysis, magnetic resonance imaging, staff accommodation, clinical waste incineration and patient hotels as examples of successful private investment. Naturally, the trusts and the private sector are delighted and are developing more joint ventures with enthusiasm.

Mrs. Bottomley

Excellent.

Ms Primarolo

The Secretary of State says "excellent". I am glad that she agrees with our analysis of the Government's interest in privatisation.

Mrs. Bottomley

Will the hon. Lady give way?

Ms Primarolo

Madam Deputy Speaker—[Interruption.]

Madam Deputy Speaker (Dame Janet Fookes)

The House knows that if the speaker who has the floor does not choose to give way, other hon. Members must resume their seats.

Ms. Primarolo

The Secretary of State had 50 minutes.

I do not have all that time and I am required to sum up the debate.

The Government say that they are treating more patients. When I asked them how many patients were being treated in 1991 and 1992 by trusts, shadow trusts and directly held units, I was told in a written answer on 8 February 1993 that they did not collect the information and did not know. Dr. Ian Bogle, the chairman of the general medical services committee, describes the Government as undertaking a national cover-up, having a lack of honesty and living in Alice in Wonderland's world. I could not agree with him more.

We want to develop a national health service on the basis on which it was established and which the people of this country demand to see maintained—a high-quality public service that is paid for from central taxation and free at the point of delivery for all who need treatment. There will be no self-governing trusts or GP fundholders operating as private businesses in our national health service. There will be no need for gagging clauses restricting health workers from speaking out on the ground of commercial confidentiality.

We will provide a public health service, rather than an ill health service. Instead of creating poverty, unemployment and a health crisis, and then leaving the NHS to pick up the tab for poor health, we will promote health through co-ordinated action against poverty and inequality. We will consult on the way to shape a national health service around those principles, and about how a Labour Government will fund that underfunding.

The British Medical Association said: The council endorses the view that prioritising treatment on the basis of a purchaser's ability to fund that treatment, rather than on the basis of an objective assessment of relative clinical needs, infringes the ethical principle of equity and should be vigorously opposed. We oppose the Government's privatisation of the NHS. We oppose their reforms, but not because we do not believe that the NHS needs improving and needs changing. It is a dynamic service which deals with people and needs to respond to people's needs. We believe that the Government's vision of the health service will not provide for the NHS. Therefore, we will continue to oppose their attempts—they have tried to do it since 1946—to destroy our NHS.

9.45 pm

The Minister for Health (Dr. Brian Mawhinney)

The hon. Member for Bristol, South (Ms Primarolo) pointed out that neither she nor I had much time to respond to today's debate, so I will take my lead from her.

I cannot ignore the speech by the hon. Member for Sheffield, Brightside (Mr. Blunkett). He pointed out that this was the first debate on the subject for a year, and that the Opposition had called it. After today's experience, I suspect that it will be a long time before the Opposition call another such debate. Indeed, so riveting was it for the Labour party that all of 34 Labour Members sat behind him as he delivered his scathing, vulgar and abusive attack on the Secretary of State.

The hon. Gentleman was unable to give, or to respond to questions and enunciate, any scintilla of Labour party policy. I thought for one moment that the hon. Member for Bristol, South had broken from cover and said something to do with policy. However, it was so ringed around with conditional clauses that I could see that she was entirely on a par with the hon. Member for Brightside.

He did say something, however, and I was interested that my hon. Friend the Member for Harlow (Mr. Hayes) picked up on it, as I did. This was the only policy that we have had from the Labour party tonight, and I want my hon. Friends to listen carefully. The hon. Gentleman said, "Our policies will have something to do with treating patients." I see that as being a big vote-getter around the country. My right hon. Friend the Secretary of State pointed out that that will be next month, or the month after, or the month after that.

I want to pick up on the comments of two hon. Gentleman who contributed to the debate. My hon. Friend the Member for Macclesfield (Mr. Winterton) encouraged us to listen to constructive criticism. We do that, but we are not interested in the mindless and ideologically based criticism that we have heard from the Opposition tonight. We are interested in constructive criticism. We recognise that, in a venture as large as the national health service, there are always ways to produce improvements, and we are always open to listen to constructive comments.

I heard what my hon. Friend said about community care. That it is a successful policy and helps frail elderly people enormously is agreed. It also helps people with mental illness, and I know that my hon. Friend is committed to them. I heard what he said about nurses and, while I have always resisted the temptation to encourage colleagues to read speeches which I have made in the past, perhaps he will take the time to look at a speech I gave at the Royal College of Nursing congress in May 1993. He will find that I reflected exactly and in some greater detail the very point that he made earlier about the importance of creating space for nurses to care as a part of the professional discharge of their duties.

I would like to thank the hon. Member for Belfast, South (Rev. Martin Smyth) for his kind personal comments. My hon. Friend the Member for Broxbourne (Mrs. Roe) and my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) both recognised that it was important to increase funds to the NHS year on year, as we have done. My right hon. Friend pointed out that another £1.6 billion will go into the NHS during the next financial year. My hon. Friends pointed out that the way to maximise patient benefit from those resources was to improve management.

I was reminded of a comment made to me by a health authority chairman some time ago. He said that, when he was appointed four years ago, he inquired in his first week in office what the cost was for a hip replacement operation. Today, he says that he knows not only the cost of that operation, but the cost and quality of it in every single hospital in the area. He now knows that there is a sixfold difference in those costs. He is now able to manage the system in a manner that enables a better service to be presented to patients. My hon. Friend the Member for Chislehurst (Mr. Sims) also referred to that point.

The Labour motion expresses some concern about patient care. I know that the hon. Member for Brightside is extremely interested in beds. He issued a press statement—I read them all—on that matter on 10 January. I must admit that his press officer did not do an awfully good job, but, with reference to beds, that statement read: The NHS is slowly being whittled away I looked up the figures on the percentage reduction in the number of in-patient beds between 1979 to 1989. I discovered that, in this country, there has been a reduction of just more than 20 per cent. Spain, Greece, Portugal and the United States were in the 15 to 25 per cent. reduction band. The hon. Gentleman wiil be interested to know that even bigger reductions were made in Italy, Denmark and Ireland. Reductions were also made in Germany, France and the Netherlands.

The hon. Member for Brightside is probably incapable of getting his mind around those figures, but people outside the House will want to know why the number of beds available for health care is being reduced not only in this country but in every developed country in the world, except Belgium—I do not know why that is so. Let me give the hon. Gentleman the answer.

During the 1980s, the average length of stay in hospital was reduced from 10 days to six and a half days. In 1982, the average stay in hospital for someone receiving treatment for cataracts was eight days; today it is under three days, and many are treated as day patients. In the late 1970s, a person with a peptic ulcer would spend at least a week in hospital. Today, many patients do not go to hospital, because they are simply treated with drugs. The hon. Member for Brightside does not understand, will not understand and is incapable of understanding that, if the health system becomes more efficient, two things happen: more patients get treated and there is less demand for the hospital beds in which to treat them.

The hon. Gentleman will be interested to know that I visited the Enfield Community Care NHS trust on Monday. Members of the trust told me—I did not ask for or know the facts they simply gave them to me—that it is now treating nearly 20 per cent. more acute elderly in-patients, and that treatment costs have been reduced by 40 per cent. in the past three years. The average length of stay in the hospital has been halved. It has fewer acute beds and more doctors and nurses per acute patient. Those facts reflect what is happening in the health service throughout the country.

Instead of thanking the senior managers or the administrative staff of that trust for the job that they are doing, perhaps I should have said something in keeping with the speech by the hon. Member for Darlington (Mr. Milburn). Perhaps I should have said, "Ward clerks, the Labour party thinks that you are a waste of space. Medical secretaries, the Labour party wants you out. Wage clerks, the Labour party wants you on the dole. District nurses, no cars, the Labour party wants you on your bikes GPs on night calls, walk."

That is the sort of nonsense that flows from the ill-informed attacks by the Labour party on the management of the NHS, month in and month out. Do members of Unison think that they are being denigrated by Opposition spokesmen? Of course they do, because that is precisely what the Opposition have done in the debate.

I should like to draw the attention of the.hon. Member for Brightside to the North West Anglia hospital trust in Peterborough. It runs the best hospital-at-home scheme in the country. I am told that this year it will treat 635 patients, 435 of whom will be discharged early from hospital as a consequence of the scheme and another 160 who would otherwise have gone into hospital but can be treated at home.

May I give another example for the edification of the hon. Member for Brightside? Based on the national average, the length of stay in an acute hospital for hip replacement surgery is 15 days. In Peterborough it is six days in hospital and six days at home. The hospital-at-home scheme has reduced costs per case by 20 per cent., the length of stay in acute hospitals by 60 per cent., and the total length of the care episode by 20 per cent. We on this side of the House welcome that. It is good patient care and more patient care, but it makes no difference to the Opposition.

Under the last Labour Government, the number of patients treated increased by 1 per cent. a year. During the 1980s under this Government, the number increased by more than 2 per cent. a year. Since reforms were introduced in 1990, the number has increased by more than 5 per cent. a year—[interruption.] I understand that Labour Members do not like that.

Let me help the Opposition to understand it in a different way. That 1 per cent. a year under Labour represented 57,000 extra patients a year, whereas the 5 per cent. increase in the number of patients treated since the reforms represents 417,000 extra patients treated every year.

Let me put it another way for the Labour party. If I were to fill Wembley stadium on Monday night, Tuesday night, Wednesday night and Thursday night, and put more people in it on Friday night than ever watch Sheffield Wednesday or Sheffield United, all of them together would represent the increase in the number of patients treated under this Government each year compared with the annual increase in the number treated under the last Labour Government.

Let me put it another way. Had we not changed the system that we inherited from the Labour party in 1979, more than 2,600,000 patients who received treatment would not have been treated. That number would fill Wembley stadium every night for a month. Those facts give a new meaning to that well known song, "We're on our way to Wembley."

This debate has illustrated, like no amount of Labour press releases could, the difference between each side of the House. The Labour party has no policies, whereas we have a co-ordinated patient-focused policy that is producing more patient care. They have a fixation with beds; we have a fixation with patients. They have a fixation with hospitals; we have a fixation with patient care.

I call on my hon. Friends to recognise that, in every football ground in the country, people are singing our praises because they realise that we are on our way to Wembley in terms of the number of patients that we have treated. I urge my hon. Friends to throw out the Opposition motion and support the Government's policy.

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

The House divided: Ayes 265, Noes 311.

Division No. 85]	[10 pm
AYES
Abbott, Ms Diane	Chisholm, Malcolm
Adams, Mrs Irene	Clapham, Michael
Ainger, Nick	Clarke, Eric (Midlothian)
Ainsworth, Robert (Cov'try NE)	Clarke, Tom (Monklands W)
Allen, Graham	Clelland, David
Alton, David	Clwyd, Mrs Ann
Anderson, Donald (Swansea E)	Coffey, Ann
Anderson, Ms Janet (Ros'dale)	Cohen, Harry
Armstrong, Hilary	Connarty, Michael
Ashton, Joe	Cook, Frank (Stockton N)
Austin-Walker, John	Corbett, Robin
Banks, Tony (Newham NW)	Corbyn, Jeremy
Barnes, Harry	Cousins, Jim
Battle, John	Cox, Tom
Bayley, Hugh	Cryer, Bob
Beckett, Rt Hon Margaret	Cummings, John
Bell, Stuart	Cunliffe, Lawrence
Benn, Rt Hon Tony	Cunningham, Jim (Covy SE)
Bennett, Andrew F.	Cunningham, Rt Hon Dr John
Benton, Joe	Darling, Alistair
Bermingham, Gerald	Davidson, Ian
Berry, Dr. Roger	Davies, Bryan (Oldham C'tral)
Betts, Clive	Davies, Rt Hon Denzil (Llanelli)
Blair, Tony	Davies, Ron (Caerphilly)
Blunkett, David	Davis, Terry (B'ham, H'dge H'l)
Boateng, Paul	Denham, John
Boyes, Roland	Dewar, Donald
Bradley, Keith	Dixon, Don
Bray, Dr Jeremy	Dobson, Frank
Brown, Gordon (Dunfermline E)	Donohoe, Brian H.
Brown, N. (N'c'tle upon Tyne E)	Dowd, Jim
Bruce, Malcolm (Gordon)	Dunnachie, Jimmy
Burden, Richard	Dunwoody, Mrs Gwyneth
Byers, Stephen	Eagle, Ms Angela
Caborn, Richard	Eastham, Ken
Callaghan, Jim	Enright, Derek
Campbell, Mrs Anne (C'bridge)	Etherington, Bill
Campbell, Menzies (Fife NE)	Evans, John (St Helens N)
Campbell, Ronnie (Blyth V)	Ewing, Mrs Margaret
Campbell-Savours, D. N.	Fatchett, Derek
Canavan, Dennis	Faulds, Andrew
Cann, Jamie	Field, Frank (Birkenhead)

Fisher, Mark	McNamara, Kevin
Flynn, Paul	McWilliam, John
Foster, Rt Hon Derek	Madden, Max
Foulkes, George	Mahon, Alice
Fraser, John	Mandelson, Peter
Fyfe, Maria	Marek, Dr John
Galloway, George	Marshall, David (Shettleston)
Gapes, Mike	Marshall, Jim (Leicester, S)
Garrett, John	Martin, Michael J. (Springburn)
George, Bruce	Martlew, Eric
Gerrard, Neil	Maxton, John
Gilbert, Rt Hon Dr John	Meacher, Michael
Godman, Dr Norman A.	Meale, Alan
Godsiff, Roger	Michael, Alun
Golding, Mrs Llin	Michie, Bill (Sheffield Heeley)
Gordon, Mildred	Milburn, Alan
Gould, Bryan	Miller, Andrew
Graham, Thomas	Mitchell, Austin (Gt Grimsby)
Grant, Bernie (Tottenham)	Moonie, Dr Lewis
Griffiths, Nigel (Edinburgh S)	Morgan, Rhodri
Griffiths, Win (Bridgend)	Moriey, Elliot
Grocott, Bruce	Morris, Rt Hon A. (Wy'nshawe)
Gunnell, John	Morris, Rt Hon J. (Aberavon)
Hain, Peter	Mowlam, Marjorie
Hall, Mike	Mudie, George
Hanson, David	Mullin, Chris
Hardy, Peter	Murphy, Paul
Harman, Ms Harriet	O'Brien, Michael (N W'kshire)
Hattersley, Rt Hon Roy	O'Brien, William (Normanton)
Henderson, Doug	O'Hara, Edward
Hendron, Dr Joe	Olner, William
Heppell, John	O'Neill, Martin
Hill, Keith (Streatham)	Orme, Rt Hon Stanley
Hinchliffe, David	Paisley, Rev Ian
Hoey, Kate	Parry, Robert
Hogg, Norman (Cumbernauld)	Patchett, Terry
Home Robertson, John	Pendry, Tom
Hood, Jimmy	Pickthall, Colin
Hoon, Geoffrey	Pike, Peter L.
Howarth, George (Knowsley N)	Pope, Greg
Howells, Dr. Kim (Pontypridd)	Powell, Ray (Ogmore)
Hoyle, Doug	Prentice, Ms Bridget (Lew'm E)
Hughes, Kevin (Doncaster N)	Prentice, Gordon (Pendle)
Hughes, Roy (Newport E)	Prescott, John
Hughes, Simon (Southwark)	Primarolo, Dawn
Hume, John	Purchase, Ken
Hutton, John	Quin, Ms Joyce
Illsley, Eric	Radice, Giles
Ingram, Adam	Randall, Stuart
Jackson, Glenda (H'stead)	Raynsford, Nick
Jackson, Helen (Shef'ld, H)	Redmond, Martin
Jamieson, David	Reid, Dr John
Janner, Greville	Rendel, David
Jones, Barry (Alyn and D'side)	Richardson, Jo
Jones, Jon Owen (Cardiff C)	Robertson, George (Hamilton)
Jones, Lynne (B'ham S O)	Robinson, Geoffrey (Co'tryNW)
Jones, Martyn (Clwyd, SW)	Roche, Mrs. Barbara
Jowell, Tessa	Rogers, Allan
Keen, Alan	Rooker, Jeff
Kennedy, Jane (Lpool Brdgn)	Rooney, Terry
Khabra, Piara S.	Ross, Ernie (Dundee W)
Kilfedder, Sir James	Rowlands, Ted
Kinnock, Rt Hon Neil (Islwyn)	Ruddock, Joan
Leighton, Ron	Sedgemore, Brian
Lewis, Terry	Sheldon, Rt Hon Robert
Litheriand, Robert	Shore, Rt Hon Peter
Livingstone, Ken	Short, Clare
Lloyd, Tony (Stretford)	Simpson, Alan
Llwyd, Elfyn	Skinner, Dennis
Lynne, Ms Liz	Smith, Andrew (Oxford E)
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)
Macdonald, Calum	Soley, Clive
McFall, John	Spearing, Nigel
McKelvey, William	Spellar, John
Mackinlay, Andrew	Squire, Rachel (Dunfermline W)
McLeish, Henry	Steinberg, Gerry
Maclennan, Robert	Stevenson, George
McMaster, Gordon	Stott, Roger

Straw, Jack	Williams, Alan W (Carmarthen)
Taylor, Mrs Ann (Dewsbury)	Wilson, Brian
Tipping, Paddy	Winnick, David
Turner, Dennis	Wise, Audrey
Vaz, Keith	Worthington, Tony
Walker, Rt Hon Sir Harold	Wray, Jimmy
Walley, Joan	Wright, Dr Tony
Wardell, Gareth (Gower)	Young, David (Bolton SE)
Wareing, Robert N
Watson, Mike	Tellers for the Ayes:
Welsh, Andrew	Mr. Peter Kilfoyle, and Mr. Jack Thompson.
Wicks, Malcolm
Williams, Rt Hon Alan (Sw'n W)

NOES
Ainsworth, Peter (East Surrey)	Davies, Quentin (Stamford)
Aitken, Jonathan	Davis, David (Boothferry)
Alexander, Richard	Day, Stephen
Alison, Rt Hon Michael (Selby)	Deva, Nirj Joseph
Allason, Rupert (Torbay)	Devlin, Tim
Amess, David	Dickens, Geoffrey
Ancram, Michael	Dicks, Terry
Arbuthnot, James	Dorrell, Stephen
Arnold, Jacques (Gravesham)	Douglas-Hamilton, Lord James
Aspinwall, Jack	Dover, Den
Atkins, Robert	Duncan, Alan
Atkinson, David (Bour'mouth E)	Duncan-Smith, Iain
Atkinson, Peter (Hexham)	Dunn, Bob
Baker, Nicholas (Dorset North)	Durant, Sir Anthony
Baldry, Tony	Dykes, Hugh
Banks, Matthew (Southport)	Eggar, Tim
Banks, Robert (Harrogate)	Elletson, Harold
Bates, Michael	Emery, Rt Hon Sir Peter
Batiste, Spencer	Evans, David (Welwyn Hatfield)
Bellingham, Henry	Evans, Jonathan (Brecon)
Bendall, Vivian	Evans, Nigel (Ribble Valley)
Beresford, Sir Paul	Evans, Roger (Monmouth)
Biffen, Rt Hon John	Evennett, David
Blackburn, Dr John G.	Faber, David
Body, Sir Richard	Fabricant, Michael
Bonsor, Sir Nicholas	Fairbairn, Sir Nicholas
Booth, Hartley	Fenner, Dame Peggy
Boswell, Tim	Field, Barry (Isle of Wight)
Bottomley, Rt Hon Virginia	Fishburn, Dudley
Bowden, Andrew	Forman, Nigel
Bowis, John	Forsyth, Michael (Stirling)
Boyson, Rt Hon Sir Rhodes	Forth, Eric
Brandreth, Gyles	Fox, Dr Liam (Woodspring)
Brazier, Julian	Fox, Sir Marcus (Shipley)
Bright, Graham	Freeman, Rt Hon Roger
Brooke, Rt Hon Peter	French, Douglas
Brown, M. (Brigg & Cl'thorpes)	Fry, Sir Peter
Browning, Mrs. Angela	Gale, Roger
Bruce, Ian (S Dorset)	Gallie, Phil
Budgen, Nicholas	Gardiner, Sir George
Burns, Simon	Garel-Jones, Rt Hon Tristan
Burl, Alistair	Garnier, Edward
Butler, Peter	Gill, Christopher
Butterfill, John	Gillan, Cheryl
Carlisle, John (Luton North)	Goodlad, Rt Hon Alastair
Carlisle, Kenneth (Lincoln)	Goodson-Wickes, Dr Charles
Carrington, Matthew	Gorman, Mrs Teresa
Cash, William	Gorst, John
Channon, Rt Hon Paul	Grant, Sir A. (Cambs SW)
Churchill, Mr	Greenway, Harry (Ealing N)
Clappison, James	Greenway, John (Ryedale)
Clark, Dr Michael (Rochford)	Griffiths, Peter (Portsmouth, N)
Clarke, Rt Hon Kenneth (Ruclif)	Grylls, Sir Michael
Clifton-Brown, Geoffrey	Gummer, Rt Hon John Selwyn
Coe, Sebastian	Hague, William
Colvin, Michael	Hamilton, Rt Hon Sir Archie
Congdon, David	Hamilton, Neil (Tatton)
Conway, Derek	Hampson, Dr Keith
Coombs, Anthony (Wyre For'st)	Hanley, Jeremy
Coombs, Simon (Swindon)	Hannam, Sir John
Cope, Rt Hon Sir John	Hargreaves, Andrew
Couchman, James	Harris, David
Cran, James	Haselhurst, Alan
Currie, Mrs Edwina (S D'by'ire)	Hawkins, Nick
Curry, David (Skipton & Ripon)	Hawksley, Warren

Hayes, Jerry	Nicholls, Patrick
Heald, Oliver	Nicholson, David (Taunton)
Heath, Rt Hon Sir Edward	Nicholson, Emma (Devon West)
Heathcoat-Amory, David	Norris, Steve
Hendry, Charles	Onslow, Rt Hon Sir Cranley
Heseltine, Rt Hon Michael	Oppenheim, Phillip
Hicks, Robert	Ottaway, Richard
Higgins, Rt Hon Sir Terence L.	Page, Richard
Hill, James (Southampton Test)	Paice, James
Hogg, Rt Hon Douglas (G'tham)	Patnick, Irvine
Horam, John	Patten, Rt Hon John
Hordern, Rt Hon Sir Peter	Pattie, Rt Hon Sir Geoffrey
Howard, Rt Hon Michael	Pawsey, James
Howarth, Alan (Strafrd-on-A)	Peacock, Mrs Elizabeth
Howell, Rt Hon David (G'dford)	Pickles, Eric
Howell, Sir Ralph (N Norfolk)	Porter, Barry (Wirral S)
Hughes Robert G. (Harrow W)	Portillo, Rt Hon Michael
Hunt, Rt Hon David (Wirral W)	Powell, William (Corby)
Hunt, Sir John (Ravensbourne)	Rathbone, Tim
Hunter, Andrew	Redwood, Rt Hon John
Jack, Michael	Renton, Rt Hon Tim
Jackson, Robert (Wantage)	Richards, Rod
Jenkin, Bernard	Riddick, Graham
Jessel, Toby	Robathan, Andrew
Johnson Smith, Sir Geoffrey	Roberts, Rt Hon Sir Wyn
Jones, Robert B. (W Hertfdshr)	Robertson, Raymond (Ab'd'n S)
Jopling, Rt Hon Michael	Robinson, Mark (Somerton)
Kellett-Bowman, Dame Elaine	Roe, Mrs Marion (Broxbourne)
Key, Robert	Rowe, Andrew (Mid Kent)
King, Rt Hon Tom	Rumbold, Rt Hon Dame Angela
Kirkhope, Timothy	Ryder, Rt Hon Richard
Knapman, Roger	Sackville, Tom
Knight, Mrs Angela (Erewash)	Sainsbury, Rt Hon Tim
Knight, Greg (Derby N)	Scott, Rt Hon Nicholas
Knight, Dame Jill (Bir'm E'st'n)	Shaw, David (Dover)
Knox, Sir David	Shaw, Sir Giles (Pudsey)
Kynoch, George (Kincardine)	Shephard, Rt Hon Gillian
Lait, Mrs Jacqui	Shepherd, Richard (Aldridge)
Lamont, Rt Hon Norman	Shersby, Michael
Lang, Rt Hon Ian	Sims, Roger
Lawrence, Sir Ivan	Skeet, Sir Trevor
Legg, Barry	Smith, Sir Dudley (Warwick)
Leigh, Edward	Smith, Tim (Beaconsfield)
Lennox-Boyd, Mark	Soames, Nicholas
Lester, Jim (Broxtowe)	Speed, Sir Keith
Lidington, David	Spencer, Sir Derek
Lilley, Rt Hon Peter	Spicer, Sir James (W Dorset)
Lloyd, Rt Hon Peter (Fareham)	Spicer, Michael (S Worcs)
Luff, Peter	Spink, Dr Robert
MacGregor, Rt Hon John	Spring, Richard
MacKay, Andrew	Sproat, Iain
Maclean, David	Squire, Robin (Hornchurch)
McLoughlin, Patrick	Stanley, Rt Hon Sir John
McNair-Wilson, Sir Patrick	Steen, Anthony
Madel, Sir David	Stephen, Michael
Maitland, Lady Olga	Stern, Michael
Malone, Gerald	Stewart, Allan
Mans, Keith	Streeter, Gary
Marland, Paul	Sumberg, David
Marlow, Tony	Sweeney, Walter
Marshall, John (Hendon S)	Sykes, John
Marshall, Sir Michael (Arundel)	Tapsell, Sir Peter
Martin, David (Portsmouth S)	Taylor, Ian (Esher)
Mates, Michael	Taylor, John M. (Solihull)
Mawhinney, Rt Hon Dr Brian	Taylor, Sir Teddy (Southend, E)
Mayhew, Rt Hon Sir Patrick	Temple-Morris, Peter
Mellor, Rt Hon David	Thomason, Roy
Merchant, Piers	Thompson, Sir Donald (C'er V)
Milligan, Stephen	Thompson, Patrick (Norwich N)
Mills, Iain	Thumham, 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
Needham, Richard	Twinn, Dr Ian
Nelson, Anthony	Vaughan, Sir Gerard
Neubert, Sir Michael	Viggers, Peter
Newton, Rt Hon Tony	Waldegrave, Rt Hon William

Walden, George	Willetts, David
Waller, Gary	Wilshire, David
Ward, John	Winterton, Mrs Ann (Congleton)
Wardle, Charles (Bexhill)	Winterton, Nicholas (Macc'f'ld)
Waterson, Nigel	Wolfson, Mark
Watts, John	Wood, Timothy
Wells, Bowen	Yeo, Tim
Wheeler, Rt Hon Sir John	Young, Rt Hon Sir George
Whitney, Ray
Whittingdale, John	Tellers for the Noes:
Widdecombe, Ann	Mr. David Lightbown and Mr. Sydney Chapman.
Wiggin, Sir Jerry
Wilkinson, John

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments):—

The House divided: Ayes 309, Noes 264.

Division No. 86]	[10.15 pm
AYES
Ainsworth, Peter (East Surrey)	Coombs, Simon (Swindon)
Aitken, Jonathan	Cope, Rt Hon Sir John
Alexander, Richard	Couchman, James
Alison, Rt Hon Michael (Selby)	Cran, James
Allason, Rupert (Torbay)	Currie, Mrs Edwina (S D'by'ire)
Amess, David	Curry, David (Skipton & Ripon)
Ancram, Michael	Davies, Quentin (Stamford)
Arbuthnot, James	Davis, David (Boothferry)
Arnold, Jacques (Gravesham)	Day, Stephen
Aspinwall, Jack	Deva, Nirj Joseph
Atkins, Robert	Devlin, Tim
Atkinson, David (Bour'mouth E)	Dickens, Geoffrey
Atkinson, Peter (Hexham)	Dicks, Terry
Baker, Nicholas (Dorset North)	Dorrell, Stephen
Baldry, Tony	Douglas-Hamilton, Lord James
Banks, Matthew (Southport)	Dover, Den
Banks, Robert (Harrogate)	Duncan, Alan
Bates, Michael	Duncan-Smith, Iain
Batiste, Spencer	Dunn, Bob
Bellingham, Henry	Durant, Sir Anthony
Bendall, Vivian	Dykes, Hugh
Beresford, Sir Paul	Eggar, Tim
Biffen, Rt Hon John	Elletson, Harold
Blackburn, Dr John G.	Emery, Rt Hon Sir Peter
Body, Sir Richard	Evans, David (Welwyn Hatfield)
Bonsor, Sir Nicholas	Evans, Jonathan (Brecon)
Booth, Hartley	Evans, Nigel (Ribble Valley)
Boswell, Tim	Evans, Roger (Monmouth)
Bottomley, Rt Hon Virginia	Evennett, David
Bowden, Andrew	Faber, David
Bowis, John	Fabricant, Michael
Boyson, Rt Hon Sir Rhodes	Fairbairn, Sir Nicholas
Brandreth, Gyles	Fenner, Dame Peggy
Brazier, Julian	Field, Barry (Isle of Wight)
Bright, Graham	Fishburn, Dudley
Brooke, Rt Hon Peter	Forman, Nigel
Brown, M. (Brigg & Cl'thorpes)	Forsyth, Michael (Stirling)
Browning, Mrs. Angela	Forth, Eric
Bruce, Ian (S Dorset)	Fox, Dr Liam (Woodspring)
Budgen, Nicholas	Fox, Sir Marcus (Shipley)
Burns, Simon	Freeman, Rt Hon Roger
Burt, Alistair	French, Douglas
Butler, Peter	Fry, Sir Peter
Butterfill, John	Gale, Roger
Carlisle, John (Luton North)	Gallie, Phil
Carlisle, Kenneth (Lincoln)	Gardiner, Sir George
Carrington, Matthew	Garel-Jones, Rt Hon Tristan
Cash, William	Garnier, Edward
Channon, Rt Hon Paul	Gill, Christopher
Churchill, Mr	Gillan, Cheryl
Clappison, James	Goodlad, Rt Hon Alastair
Clark, Dr Michael (Rochford)	Goodson-Wickes, Dr Charles
Clarke, Rt Hon Kenneth (Ruclif)	Gorman, Mrs Teresa
Clifton-Brown, Geoffrey	Gorst, John
Coe, Sebastian	Grant, Sir A. (Cambs SW)
Congdon, David	Greenway, Harry (Ealing N)
Conway, Derek	Greenway, John (Ryedale)
Coombs, Anthony (Wyre For'st)	Griffiths, Peter (Portsmouth, N)

Grytls, Sir Michael	Mellor, Rt Hon David
Gummer, Rt Hon John Selwyn	Merchant, Piers
Hague, William	Milligan, Stephen
Hamilton, Rt Hon Sir Archie	Mills, Iain
Hamilton, Neil (Tatton)	Mitchell, Andrew (Gedling)
Hampson, Dr Keith	Mitchell, Sir David (Hants NW)
Hanley, Jeremy	Moate, Sir Roger
Hannam, Sir John	Monro, Sir Hector
Hargreaves, Andrew	Montgomery, Sir Fergus
Harris, David	Moss, Malcolm
Haselhurst, Alan	Needham, Richard
Hawkins, Nick	Nelson, Anthony
Hawksley, Warren	Neubert, Sir Michael
Hayes, Jerry	Newton, Rt Hon Tony
Heald, Oliver	Nicholls, Patrick
Heath, Rt Hon Sir Edward	Nicholson, David (Taunton)
Heathcoat-Amory, David	Nicholson, Emma (Devon West)
Hendry, Charles	Norris, Steve
Heseltine, Rt Hon Michael	Onslow, Rt Hon Sir Cranley
Hicks, Robert	Oppenheim, Phillip
Higgins, Rt Hon Sir Terence L.	Ottaway, Richard
Hill, James (Southampton Test)	Page, Richard
Hogg, Rt Hon Douglas (G'tham)	Paice, James
Horam, John	Patten, Rt Hon John
Hordem, Rt Hon Sir Peter	Pattie, Rt Hon Sir Geoffrey
Howard, Rt Hon Michael	Pawsey, James
Howarth, Alan (Strat'rd-on-A)	Peacock, Mrs Elizabeth
Howell, Rt Hon David (G'dford)	Pickles, Eric
Howell, Sir Ralph (N Norfolk)	Porter, Barry (Wirral S)
Hughes Robert G. (Harrow W)	Portillo, Rt Hon Michael
Hunt, Rt Hon David (Wirral W)	Powell, William (Corby)
Hunt, Sir John (Ravensbourne)	Rathbone, Tim
Hunter, Andrew	Redwood, Rt Hon John
Jack, Michael	Renton, Rt Hon Tim
Jackson, Robert (Wantage)	Richards, Rod
Jenkin, Bernard	Riddick, Graham
Jessel, Toby	Robathan, Andrew
Johnson Smith, Sir Geoffrey	Roberts, Rt Hon Sir Wyn
Jones, Robert B. (W Hertfdshr)	Robertson, Raymond (Ab'd'n S)
Jopling, Rt Hon Michael	Robinson, Mark (Somerton)
Kellett-Bowman, Dame Elaine	Roe, Mrs Marion (Broxbourne)
Key, Robert	Rowe, Andrew (Mid Kent)
King, Rt Hon Tom	Rumbold, Rt Hon Dame Angela
Kirkhope, Timothy	Ryder, Rt Hon Richard
Knapman, Roger	Sackville, Tom
Knight, Mrs Angela (Erewash)	Sainsbury, Rt Hon Tim
Knight, Greg (Derby N)	Scott, Rt Hon Nicholas
Knight, Dame Jill (Bir'm E'sfn)	Shaw, David (Dover)
Knox, Sir David	Shaw, Sir Giles (Pudsey)
Kynoch, George (Kincardine)	Shephard, Rt Hon Gillian
Lait, Mrs Jacqui	Shepherd, Richard (Aldridge)
Lamont, Rt Hon Norman	Shersby, Michael
Lang, Rt Hon Ian	Sims, Roger
Lawrence, Sir Ivan	Skeet, Sir Trevor
Legg, Barry	Smith, Sir Dudley (Warwick)
Leigh, Edward	Smith, Tim (Beaconsfield)
Lennox-Boyd, Mark	Soames, Nicholas
Lester, Jim (Broxtowe)	Speed, Sir Keith
Lidington, David	Spencer, Sir Derek
Lightbown, David	Spicer, Sir James (W Dorset)
Lilley, Rt Hon Peter	Spicer, Michael (S Worcs)
Lloyd, Rt Hon Peter (Fareham)	Spink, Dr Robert
Luff, Peter	Spring, Richard
MacGregor, Rt Hon John	Sproat, Iain
MacKay, Andrew	Squire, Robin (Hornchurch)
Maclean, David	Stanley, Rt Hon Sir John
McLoughlin, Patrick	Steen, Anthony
McNair-Wilson, Sir Patrick	Stephen, Michael
Madel, Sir David	Stern, Michael
Maitland, Lady Olga	Stewart, Allan
Malone, Gerald	Streeter, Gary
Mans, Keith	Sumberg, David
Marland, Paul	Sweeney, Walter
Marlow, Tony	Sykes, John
Marshall, John (Hendon S)	Tapsell, Sir Peter
Marshall, Sir Michael (Arundel)	Taylor, Ian (Esher)
Martin, David (Portsmouth S)	Taylor, John M. (Solihull)
Mates, Michael	Taylor, Sir Teddy (Southend, E)
Mawhinney, Rt Hon Dr Brian	Temple-Morris, Peter
Mayhew, Rt Hon Sir Patrick	Thomason, Roy

Thompson, Sir Donald (C'er V)	Wheeler, Rt Hon Sir John
Thompson, Patrick (Norwich N)	Whitney, Ray
Thurnham, Peter	Whittingdale, John
Townsend, Cyril D. (Bexl'yh'th)	Widdecombe, Ann
Tracey, Richard	Wiggin, Sir Jerry
Tredinnick, David	Wilkinson, John
Trend, Michael	Willetts, David
Trotter, Neville	Wilshire, David
Twinn, Dr Ian	Winterton, Mrs Ann (Congleton)
Vaughan, Sir Gerard	Winterton, Nicholas (Macc'f'ld)
Viggers, Peter	Wolfson, Mark
Waldegrave, Rt Hon William	Wood, Timothy
Walden, George	Yeo, Tim
Waller, Gary	Young, Rt Hon Sir George
Ward, John
Wardle, Charles (Bexhill)	Tellers for the Ayes:
Waterson, Nigel	Mr. Sydney Chapman and Mr. Irvine Patnick.
Watts, John
Wells, Bowen

NOES
Abbott, Ms Diane	Cunningham, Jim (Covy SE)
Adams, Mrs Irene	Cunningham, Rt Hon Dr John
Ainger, Nick	Darling, Alistair
Ainsworth, Robert (Cov'try NE)	Davidson, Ian
Allen, Graham	Davies, Bryan (Oldham C'tral)
Alton, David	Davies, Rt Hon Denzil (Llanelli)
Anderson, Donald (Swansea E)	Davies, Ron (Caerphilly)
Anderson, Ms Janet (Ros'dale)	Davis, Terry (B'ham, H'dge H'l)
Armstrong, Hilary	Denham, John
Ashton, Joe	Dewar, Donald
Austin-Walker, John	Dixon, Don
Banks, Tony (Newham NW)	Dobson, Frank
Barnes, Harry	Donohoe, Brian H.
Battle, John	Dowd, Jim
Bayley, Hugh	Dunnachie, Jimmy
Beckett, Rt Hon Margaret	Dunwoody, Mrs Gwyneth
Bell, Stuart	Eagle, Ms Angela
Benn, Rt Hon Tony	Eastham, Ken
Bennett, Andrew F.	Enright, Derek
Benton, Joe	Etherington, Bill
Bermingham, Gerald	Evans, John (St Helens N)
Berry, Dr. Roger	Ewing, Mrs Margaret
Betts, Clive	Fatchett, Derek
Blair, Tony	Faulds, Andrew
Blunkett, David	Field, Frank (Birkenhead)
Boateng, Paul	Fisher, Mark
Boyes, Roland	Flynn, Paul
Bradley, Keith	Foster, Rt Hon Derek
Bray, Dr Jeremy	Foulkes, George
Brown, Gordon (Dunfermline E)	Fraser, John
Brown, N. (N'c'tle upon Tyne E)	Fyfe, Maria
Bruce, Malcolm (Gordon)	Galloway, George
Burden, Richard	Gapes, Mike
Byers, Stephen	Garrett, John
Caborn, Richard	George, Bruce
Callaghan, Jim	Gerrard, Neil
Campbell, Mrs Anne (C'bridge)	Gilbert, Rt Hon Dr John
Campbell, Menzies (Fife NE)	Godman, Dr Norman A.
Campbell, Ronnie (Blyth V)	Godsiff, Roger
Campbell-Savours, D. N.	Golding, Mrs Llin
Canavan, Dennis	Gordon, Mildred
Cann, Jamie	Gould, Bryan
Chisholm, Malcolm	Graham, Thomas
Clapham, Michael	Grant, Bernie (Tottenham)
Clarke, Eric (Midlothian)	Griffiths, Nigel (Edinburgh S)
Clarke, Tom (Monklands W)	Griffiths, Win (Bridgend)
Clelland, David	Grocott, Bruce
Clwyd, Mrs Ann	Gunnell, John
Coffey, Ann	Hain, Peter
Cohen, Harry	Hall, Mike
Connarty, Michael	Hanson, David
Cook, Frank (Stockton N)	Hardy, Peter
Corbett, Robin	Harman, Ms Harriet
Corbyn, Jeremy	Hattersley, Rt Hon Roy
Cousins, Jim	Henderson, Doug
Cox, Tom	Hendron, Dr Joe
Cryer, Bob	Heppell, John
Cummings, John	Hill, Keith (Streatham)
Cunliffe, Lawrence	Hinchliffe, David

Hoey, Kate	O'Hara, Edward
Hogg, Norman (Cumbernauld)	Olner, William
Home Robertson, John	O'Neill, Martin
Hood, Jimmy	Orme, Rt Hon Stanley
Hoon, Geoffrey	Paisley, Rev Ian
Howarth, George (Knowsley N)	Parry, Robert
Howells, Dr. Kim (Pontypridd)	Patchett, Terry
Hoyle, Doug	Pendry, Tom
Hughes, Kevin (Doncaster N)	Pickthall, Colin
Hughes, Roy (Newport E)	Pike, Peter L.
Hughes, Simon (Southwark)	Pope, Greg
Hume, John	Powell, Ray (Ogmore)
Hutton, John	Prentice, Ms Bridget (Lew'm E)
Illsley, Eric	Prentice, Gordon (Pendle)
Ingram, Adam	Prescott, John
Jackson, Glenda (H'stead)	Primarolo, Dawn
Jackson, Helen (Shef'ld, H)	Purchase, Ken
Jamieson, David	Quin, Ms Joyce
Janner, Greville	Radice, Giles
Jones, Barry (Alyn and D'side)	Randall, Stuart
Jones, Jon Owen (Cardiff C)	Raynsford, Nick
Jones, Lynne (B'ham S O)	Redmond, Martin
Jones, Martyn (Clwyd, SW)	Reid, Dr John
Jowell, Tessa	Rendel, David
Keen, Alan	Richardson, Jo
Kennedy, Jane (Lpool Brdgn)	Robertson, George (Hamilton)
Khabra, Piara S.	Robinson, Geoffrey (Co'try NW)
Kilfedder, Sir James	Roche, Mrs. Barbara
Kinnock, Rt Hon Neil (Islwyn)	Rogers, Allan
Leighton, Ron	Rooker, Jeff
Lewis, Terry	Rooney, Terry
Litherland, Robert	Ross, Ernie (Dundee W)
Livingstone, Ken	Rowlands, Ted
Lloyd, Tony (Stretford)	Ruddock, Joan
Llwyd, Elfyn	Sedgemore, Brian
Lynne, Ms Liz	Sheldon, Rt Hon Robert
McAllion, John	Short, Clare
McAvoy, Thomas	Simpson, Alan
McCartney, Ian	Skinner, Dennis
Macdonald, Calum	Smith, Andrew (Oxford E)
McFall, John	Smith, C. (Isl'ton S & F'sbury)
McKelvey, William	Smith, Rt Hon John (M'kl'ds E)
Mackinlay, Andrew	Smith, Llew (Blaenau Gwent)
McLeish, Henry	Soley, Clive
Maclennan, Robert	Spearing, Nigel
McMaster, Gordon	Spellar, John
McNamara, Kevin	Squire, Rachel (Dunfermline W)
McWilliam, John	Steinberg, Gerry
Madden, Max	Stevenson, George
Mahon, Alice	Stott, Roger
Mandelson, Peter	Straw, Jack
Marek, Dr John	Taylor, Mrs Ann (Dewsbury)
Marshall, David (Shettleston)	Tipping, Paddy
Marshall, Jim (Leicester, S)	Turner, Dennis
Martin, Michael J. (Springburn)	Vaz, Keith
Martlew, Eric	Walker, Rt Hon Sir Harold
Maxton, John	Walley, Joan
Meacher, Michael	Wardell, Gareth (Gower)
Meale, Alan	Wareing, Robert N
Michael, Alun	Watson, Mike
Michie, Bill (Sheffield Heeley)	Welsh, Andrew
Milburn, Alan	Wicks, Malcolm
Miller, Andrew	Williams, Rt Hon Alan (Sw'n W)
Mitchell, Austin (Gt GrimsBy)	Williams, Alan W (Carmarthen)
Moonie, Dr Lewis	Wilson, Brian
Morgan, Rhodri	Winnick, David
Morley, Elliot	Wise, Audrey
Morris, Rt Hon A. (Wy'nshawe)	Worthington, Tony
Morris, Rt Hon J. (Aberavon)	Wray, Jimmy
Mowlam, Marjorie	Wright, Dr Tony
Mudie, George	Young, David (Bolton SE)
Mullin, Chris
Murphy, Paul	Tellers for the Noes:
O'Brien, Michael (N W'kshire)	Mr. Peter Kilfoyle and Mr. Jack Thompson.
O'Brien, William (Normanton)

Question accordingly agreed to.

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

Resolved, That this House welcomes the improvement in the efficiency of the National Health Service which has resulted in a substantial increase in the number of patients treated, a reduction in long waiting times for hospital treatment and improvements in the quality of patient care; considers that these improvements show that the health reforms are working and that accountability has been strengthened by the clarification of responsibilities under those reforms; and looks forward to further benefits for patients resulting from proposals announced by the Secretary of State for Health to minimise the costs of administration through the proposed abolition of regional health authorities and streamlining of management.