Health Care

HC Deb 03 July 1995 vol 263 cc23-79 3.34 pm

Mrs. Margaret Beckett (Derby, South)

I beg to move, That this House shares with the public, with patients and with health care professionals, growing alarm at the incremental erosion of the public service ethos upon which the National Health Service was founded; rejects the drive to replace the cherished principles of public ownership, co-operation and fairness with private markets, excessive bureaucracy and inequity; calls for a slowing down of the passion for reorganisation; and urges that change in the NHS be based on health arguments, not financial considerations.

Madam Speaker

Order. I have selected the amendment standing in the name of the Prime Minister.

Mrs. Beckett

The debate is taking place at a time when Ministers have been squabbling among themselves, while in the country at large there is concern that the policies that the Government pursue are neither what the country needs nor what its people want. In no area of policy is that shown more clearly than in the health service, where there is growing alarm at the way in which co-operation and fairness in the delivery of health services are being displaced by competition and bureaucracy, and at the way in which the Government openly use the private finance initiative to privatise core clinical services.

There is little doubt that we shall again hear from the Secretary of State not only that the fears that we express are unfounded but that in holding them, the Labour party stands entirely alone. Unfortunately for the Secretary of State, our debate coincides with the annual conference of the British Medical Association. In a sermon on the eve of that meeting, the Bishop of Ripon attacked the Government's so-called reforms for fragmenting the health service and encouraging confrontation within it, and suggested that their dependence on the market and competition struck at the root of the principle of caring.

This morning, Dr. Macara, the chairman of the BMA council, addressed the conference and spoke of the dismantling of the NHS—and the creation of a grim game of winners and losers. Over the weekend yet another senior clinician, the orthopaedic surgeon Professor Colton—who, like all too many doctors these days, is taking early retirement, in his case at the age of 55—said that many of the reforms had more to do with politics than with patient care. He pointed out that he had received a £20,000 bonus for treating fewer patients—in fact, for having had a children's clinic closed for four months because that closure meant that all his patients were treated in times that met the citizens charter targets. He was paid for seeing fewer people. That puts into context the barrage of statistics with which the Secretary of State will no doubt again bombard the House.

Those are not the only voices raised in concern.

Mr. Jacques Arnold (Gravesham)

Will the right hon. Lady give way?

Mrs. Beckett

I shall give way in a moment. I am about to come to something very pertinent to the hon. Gentleman.

Some of the criticisms that we make, such as excessive bureaucracy, sweeping and sometimes ill-founded structural and organisational change, have been echoed in the ranks of the Government. The final words of our motion echo the words of the right hon. Member for Wokingham (Mr. Redwood)—and from before he left the Cabinet.

Mr. Arnold

Does the right hon. Lady really mean that she, in order to prove a point, would have been happy for patients' treatment to have been spread out through the year so that they would have had to wait longer? Surely it was in the interest of those patients to be seen early and well within the time scale that has been required by my right hon. Friend the Secretary of State for Health?

Mrs. Beckett

The hon. Gentleman has entirely missed the point. The professor was saying that his clinic was closed; he was not allowed to treat people. As a result of not treating people, the few people whom he did see were dealt with within the Secretary of State's target time. In consequence, he got a £20,000 bonus, which he thought was money misplaced. He saw fewer people than he could have seen had he been allowed to go on treating patients. That is what happens under the Government's reforms. It is not what is supposed to happen.

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

As the hon. Member for Gravesham (Mr. Arnold) contests the point, and as my right hon. Friend has raised an extremely interesting case, perhaps during the next four hours the Government could inquire about what happened and give us an explanation in the winding-up speech. We would all, including the hon. Member for Gravesham, like to know what happened.

Mrs. Beckett

I am confident that the Secretary of State will be able to explain it to us. It was announced at the weekend, so she will have had the opportunity to make her own inquiries.

I have no doubt, however, that the fundamental direction that the health service would take under the right hon. Member for Wokingham is exactly the policy followed by the Secretary of State. His policy is also privatisation, as he first made clear back in the 1970s when he spelt it out explicitly in a joint publication with Oliver Letwin, and it is a direction confirmed by his record in Wales.

To be fair, the right hon. Gentleman was approaching the medium to long-term project of privatising the health service with rather more political subtlety than the Secretary of State. As he made clear to the Welsh Select Committee, he seems genuinely able to see something that the Secretary of State apparently cannot—that the Government's plans for the health service are going visibly wrong, and he has enough wit to say so.

In the BMA News last August, the right hon. Member for Wokingham said—

Dame Elaine Kellett-Bowman (Lancaster)

Will the right hon. Lady give way?

Mrs. Beckett

In a moment; I am in the middle of a sentence. The right hon. Gentleman said that he was not mad keen to cut hospital beds. It's not politically popular". I now give way to the hon. Member for Lancaster (Dame E. Kellett-Bowman), who perhaps does not share that view.

Dame Elaine Kellett-Bowman

Is the right hon. Lady aware that the ex-Secretary of State for Wales reduced the number of bureaucrats in the health service in Wales by only 340, which is a smaller proportion than that by which my right hon. Friend the Secretary of State for Health has reduced the number of bureaucrats in the health service in England?

Mrs. Beckett

I am grateful to the hon. Lady. If she will allow me to continue, I am pointing out that there is some contradiction between what the right hon. Gentleman said and what he has done.

Dame Elaine Kellett-Bowman

Absolutely. Down with him.

Mrs. Beckett

I can without difficulty detect that the hon. Lady does not intend to offer her support to the right hon. Gentleman in the contest.

I was pointing out that the right hon. Gentleman has rather more sense than the Secretary of State for Health and knows when to keep quiet. Perhaps even more startling is his apparently unique perception among Cabinet Ministers that it would be important not to reduce the number of a beds to a point where there are not enough. That is an insight which has so far escaped the Secretary of State for Health.

The right hon. Gentleman can see that the Secretary of State's proposals for grand solutions and the closure of popular hospitals are deeply angering the public, something that she apparently cannot see. He is sharp enough to spot that the public are deeply disillusioned with Tory commitments that the NHS is safe in their hands.

The Welsh NHS has not adopted the Secretary of State's star rating system now in place in England because the right hon. Member for Wokingham said that quality is very important but it's harder to measure than factors such as numbers treated and cost. He also believes that tables are crude and simplistic.

As I said, the right hon. Gentleman knows when to keep quiet especially if, by not doing so, he would jeopardise his long-term project, which is also that of the Secretary of State—privatisation of the NHS. Therefore, when the private sector bid for a new cardiac centre at the Morriston hospital in Swansea proved uncompetitive and the bid went to the in-house team, the right hon. Gentleman said nothing, refraining even from reporting the outcome to the House.

In spring 1994, the then Secretary of State for Wales announced that the National Blood Transfusion Service would be market-tested and then, this year, he announced that, on the contrary, it would remain within the Welsh Health Common Services Authority. Sadly, the Secretary of State for Health does not know when she has gone too far. She knows neither when to keep quiet nor when to give way, gracefully or otherwise. Although the right hon. Gentleman can see when the Government are mishandling the NHS debate, there is no doubt that he shares the objective of privatisation, except that he would have undertaken it more quickly and more ruthlessly.

The right hon. Gentleman has railed against the growing number and cost of non-clinical staff in the health service but appointed an accountant to chair the WHCSA. He supports performance-related pay, which would demoralise staff and set one against another. In Wales, as in England, NHS services have already been market-tested, including clinical services such as blood culture management, dental services, pathology and pharmacy. In most parts of Wales, NHS dentistry has been allowed to wither away as it has elsewhere in England and, while the right hon. Member for Wokingham believes that the Secretary of State should keep popular hospitals open in England, he has refused to support the reprieve of what I am told is Wales' most popular hospital—Cardiff royal infirmary—whose services are being run down.

Since 1991, 6 per cent. of acute beds have been lost in Wales, the same percentage as have been lost in England. Since 1992 the number of managers in the Welsh health service has risen from 890 to 1,330. The right hon. Member for Wokingham claims that he would spend more on the NHS, but in 1993–94 the Welsh Office underspent on health to the tune of almost £30 million. In short the right hon. Member for Wokingham is a little less hamfisted in his public pronouncements than his colleagues at the Department of Health, but he is just as committed to the privatisation of the NHS—

Mr. Dennis Skinner (Bolsover)

The Secretary of State has said that she would work for him.

Mrs. Beckett

As my hon. Friend the Member for Bolsover (Mr. Skinner) says, no doubt that is why the Secretary of State has said that she would be happy to work with him.

The Minister for Health (Mr. Gerald Malone)

Will the right hon. Lady give way?

Mrs. Beckett

No, I will not give way to the Minister. He will have plenty of time to speak later.

The right hon. Member for Wokingham is just as committed to privatisation as he is to the long-term project of ensuring that the NHS no longer provides comprehensive health care for all our people but will instead becomes a small core means-tested service for those who cannot afford any private health care. The Secretary of State and the right hon. Member for Wokingham are clearly at one. It appears that the Tory party is faced with no choice at all.

Mr. Michael Fabricant (Mid-Staffordshire)

It is all very well for the right hon. Lady to carp about the health services that are being provided by the Government, but has she set any standards for the number of patients that she would treat if the reforms were carried out? To what extent would waiting lists be reduced? Can the right hon. Lady quantify the result of her intended reforms compared with those that we have already made?

Mrs. Beckett

I am not aware that the Government have ever tried to quantify in advance the results of their changes. I and most people in the health service believe that if the policies that we advocate were adopted as opposed to the ones that the hon. Gentleman and his party support, NHS staff morale would be far better, services would be far better delivered, and patients would benefit as a result. When a Labour Government assess the delivery of health care, we shall certainly not count finished consultant episodes but we shall count what actually happens in the treatment of patients.

While the Tory party is apparently not faced with any choice, the British people have a stark choice—privatisation under the Conservatives or modernisation of the health service under Labour. Under the Conservatives there have been disasters such as the one described last week by at least one newspaper as a "bloody shambles". That of course refers to the shambles that was caused when operations were cancelled after 15 per cent. of the country's blood supplies were recalled by the National Blood Authority because of a fault in a number of blood bags. As the authority's minutes show, it made a policy decision to buy a proportion of its bags from a new supplier, first and specifically to get them at lower cost and, secondly, to introduce competition to the supply, a policy that the Government are always urging.

The debacle that has followed is alarming in itself but it contains a number of striking ironies. For example, the fault was detected by staff at the centre in Oxford, which is threatened with closure in the reorganisation. Those donors who were called in to provide emergency supplies were called to centres such as that at Brentwood which are also threatened with closure because the National Blood Authority says it does not need them any more. Another irony, which I think is unintended, was contained in remarks by the authority's spokesperson, who said that the incident showed that the authority was right to bring in the new company because it was evidently dangerous to rely on one supplier. But the danger arose as a direct result of bringing in a new company, solely to lower costs and introduce competition.

Last week's problems are not isolated examples. Blood stocks were already low: they had been below the safe recommended level for four days. Stocks of O-negative had been below the safe recommended level for 11 consecutive days. That was a result of the worry and the low morale in the service and among donors following the National Blood Authority's recent proposals. All those problems arose before the most recent problem caused the fresh destruction of stocks.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

There is clear evidence that, before any decision is made in the House, this quango will proceed with the appointment of a vast number of administrators. Instead of using its existing centres to continue and expand its service, it is causing chaos.

Mrs. Beckett

I share my hon. Friend's view. No doubt she, like me, hopes that the Secretary of State will come to the House before the summer recess to tell us what decisions have been made about the National Blood Authority's proposals, and what progress there has been—and also hopes that the suspicion that has arisen in the service that the Government intend to postpone any announcement until the House has risen for the recess will prove ill founded.

Operations have been cancelled as a result of the problems that we have identified, but that too is not an isolated occurrence. The most recent figures show that the number of cancelled operations rose by 22 per cent. in the last quarter of 1994–95, and that the number of patients not readmitted within a month rose by nearly 50 per cent.

Those specific examples of more dramatic problems are only part of a general catalogue of difficulties in the service.

Nor are the moves towards privatisation occurring in isolation. I wonder how many hon. Members have seen brochures such as the one from SMI, which advertises a conference to be held in September this year.

The conference, entitled "Private Finance in Clinical Services", has been called to "assess" the moves towards private finance in core and clinical services". The brochure suggests that the private finance initiative involves a complete culture change, creating entirely new markets", and states that Health authorities … are about to look increasingly to the private sector … to manage pathology and core health services". I also have a copy of The Link, the staff newspaper for the Royal Hospitals NHS trust. It contains an article by the head of financial planning, one Mr. Sanford, who writes about the private finance initiative. He says: In all private finance deals the private sector partner will plan to earn enough income from the NHS to make a profit and cover the cost of its investment.

Mr. Malone

What a surprise.

Mrs. Beckett

It is not a surprise to us that the private sector will want to make a profit out of health care; that is why it exists. What we object to is that it should be making that profit, rather than our public and free national health service.

What may, or should, be of rather more interest to hon. Members who care about public finances is that Mr. Sanford also says: So often it may be difficult to demonstrate better value for money through the private sector's involvement. He goes on to suggest a number of ways in which the extra cost of borrowing from the private sector could be offset. His basic pitch is that, whether in laser surgery or pathology, the private sector will hope to cover the initial investment with income from the health service, and to make large profits out of the potential for private patient income. In the case of pathology, however, Mr. Sanford suggests that the private sector would gain through its profit on the sale of tests from a private sector service to NHS hospitals.

So there we have it: a finance director and specialist explains that it may not be possible to demonstrate better value for money from the private finance initiatives being used for clinical services, although they will certainly be used to generate profits. That may be the Conservative party's project, but it is not what the health service needs or what the country wants.

The Government try to pretend that their policies are right and successful, and that there is no alternative. None of those propositions is true. There is an alternative—in public health policy, for example. There appears at first to be some common ground between the Labour party and the Government, in our recognition of the importance of promoting good health rather than merely curing ill health; but, as always with this Government, the policy is flawed. Their first concentration is solely on the individual. It is up to him to eat sensibly, to keep warm in winter, and not to smoke, but the Government refuse to acknowledge their responsibility, the role of public policy, or the harmful effects on health—let alone on the ability of the individual to carry out those exhortations— of unemployment, bad housing, environmental pollution or poverty. Of course, when it comes to a choice between promoting good health by banning tobacco advertising, and the financial interests of the Conservative party, there is just no contest. A Labour Government would take action at national and local level to tackle such problems, insisting that Government Departments and local authorities alike assess and report on the impact of their policies on health.

We propose alternatives too for health care itself—nothing less than the renewal of health care, national in scope and run as a modern public service, not as a set of individual private businesses. With Labour, the national health service would be a single organisation, its assets owned and its staff employed by the nation. We would replace competition with co-operation, and we see all engaged in the service as partners. Doctors, nurses, professions allied to medicine, accountants, staff, managers, the patients, the public, their representatives—all are or should be health partners in a new health service.

The internal market depends on contracts and on competition. It is divisive, expensive and bureaucratic. We would replace it with a system in which funding came from the Department of Health to health authorities and, through them, to general practitioners and the organisations now known as trusts. That funding would flow to health authorities on the basis of weighted capitation.

The new health authorities will be required to assess the health needs of the population whom they serve, commission care and monitor overall service delivery through comprehensive and long-term health care agreements, covering the range of services required to specified quality and volume within a fixed budget.

Mr. Peter Bottomley (Eltham)

I may have misheard, but I think that I heard the right hon. Lady say that everyone in the national health service would be employed directly by the NHS. Does that mean that general practitioners would lose their self-employed status and become salaried family doctors?

Mrs. Beckett

No. What I am saying is that the staff who are employed in hospitals and other trusts would be employed within the NHS, not within individual businesses, as they are at present. I am sure that the hon. Gentleman understood that that was the proposal.

Mr. Keith Mans (Wyre)

That is not what the right hon. Lady said.

Mrs. Beckett

If I can correct the hon. Gentleman, who is interrupting from a sedentary position—I am sorry but I have forgotten his constituency—[Interruption.] No, I am not worried about it: the hon. Member for Wyre (Mr. Mans) may not be representing it for long. What I said was that all staff will work within the NHS, which they all do.

As these new authorities will have a greater range of responsibilities than the individual bodies that they replace, and as we believe that they should give greater attention to the area and to the policies of public health, we do not believe that it is right for those authorities, as was the case with those that they will replace, directly to manage the services that deliver health care. Although the trusts would cease to be separate businesses, and their assets would be owned by a national health service, with Labour, hospital and other trust services would have day-to-day financial and managerial independence, and would be free to make day-to-day decisions about how they delivered the care commissioned.

The authorities and services would have governing bodies reconstituted to reflect the interests of stakeholders, and within the guidelines of the Nolan committee. They would be reconstituted to include representatives of the health partners—staff, managers, the local community, service users and so on.

The hon. Member for Eltham (Mr. Bottomley) raised the question of GPs. Again, the House will know that we opposed the creation of GP fundholding on the grounds that it fragmented the health service, added to costs and could lead to a two-tier system. All those concerns, I am sorry to say, proved to be well founded in practice.

Fundholding is one end of a spectrum that we find unacceptable, but so is the extreme alternative: a system of health authority commissioning without any consultation or without the involvement of general practitioners or others in primary care. We find both of those extremes completely unacceptable, but between them there is a range of possibilities and models for GP commissioning that could be acceptable.

In the policy document that we published last week, we identified a number of examples of such models being developed at the grass roots by GPs working in concert with their health authorities. We would find many of those varieties acceptable, but there is one absolutely clear bottom line that must be present in every scheme or model, but which is not present in the model proposed by the Government—that what is good about the provision of primary care must be available to every GP and, through him, to every patient.

With Labour, GP fundholding will be replaced by a system aimed to benefit all patients, not just a few. Every GP will have the opportunity to take part in the commissioning of care. Every GP will have the freedom, at present exercised only by fundholders, to refer hispatient to whatever service and for whatever treatment he believes can best provide the necessary care. Those matters are essential to the provision of a renewed health service that will establish and stand by the principles that the British people expect.

In our proposals for health care, we do not seek to turn back the clock—as the Secretary of State, on automatic pilot, automatically assumed and asserted. However, nor do we suggest that the health service can stay as it is, and certainly not that it should continue to head in its current direction towards privatisation.

In our new document, we identify the stark choice before the British people. They can choose a truly national health service, available to all and based on need rather than ability to pay, or they can choose a fragmented collection of health businesses, increasingly dominated and driven by the interests of commerce. They can choose the competition of the marketplace or the co-operation of a single national health service. They can choose between a privatised health service under the Conservatives or a modernised health service with Labour.

This week, the Conservative party is making a choice which is no choice, between two people bound to the same policies. We believe that it is time for Britain to choose and that that choice should be for a new Government and for a new health service in a new century.

4.2 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: notes that since the introduction of the Government's health reforms, over one million more patients are treated in hospital every year and waiting times have fallen to the lowest on record; welcomes the Government's commitment to a strong and stable publicly-funded NHS where trusts and general practitioner fundholders are free to build further on these achievements; and condemns the inadequate, inconsistent and incoherent policies of Her Majesty's Opposition, which would destroy the key features of the new NHS, would undermine patients' interests and would throw into reverse the progress of recent years.". We have just heard a speech of incoherence and emptiness, which was soporific most of the time and which did not adequately answer the questions that the public and the Conservative party wanted the right hon. Member for Derby, South (Mrs. Beckett) to answer.

Dame Elaine Kellett-Bowman

My right hon. Friend is too generous.

Mrs. Bottomley

I apologise for being far too generous.

There was a moment when I wondered whether the right hon. Lady's speech had been drafted in Cowley street, but we moved on from that point. The underlying theme of her speech, apart from her clear and profound discomfort about the health policy that has been foisted on her, was a real loathing of the private sector and the profit motive. The Conservative party knows that only by having a wealth-creating nation can we adequately fund a national health service. The difficulty for the Labour party is that it has never really understood wealth creation and job creation, which provide the fundamental key to a flourishing health service.

Mrs. Dunwoody

rose—

Mrs. Bottomley

I hope that you, Madam Speaker, will not mind if I make a little progress before giving way.

Last week, the Health Authorities Act gained Royal Assent. That landmark legislation completes the structural reforms for the national health service. It abolishes the regional health authorities and creates fewer, better, all-purpose health authorities at local level to plan the entire range of health services. The Act is the culmination of a long path of health reforms.

The National Health Service and Community Care Act 1990 established the basic geography of the new health service—NHS trusts, general practitioner fundholders and the internal market, all aimed to achieve improvements in performance and efficiency. Underpinning the reforms is the principle that the decision should be taken as close as possible to patients. Underpinning the words of the right hon. Member for Derby, South is the principle of a command and control economy, with everything being decided in Whitehall. The regional health authorities had to go. They represented the last bastion of that old structure so favoured by the Labour party.

National health service trusts have freedom to run their own affairs. They can control their assets, their organisation, and—increasingly—their greatest item of cost: pay. The Labour party claims with every passing soundbite that it does not want to turn the clock back, yet it would strip trusts of those powers. Trust freedoms are not simply abstract concepts: they work for patients.

Since we liberated trusts from the straitjacket of central control, the number of patients treated every year has increased by well over 1 million. [Interruption.] It is very interesting that, whenever we talk about the numbers of patients treated, the Labour party loathes it. It dismisses fact and statistics. It simply likes to cobble together newspaper cuttings from the inevitable examples where, from time to time, things do not work as well as they should.

Mr. William O'Brien (Normanton)

I am grateful to the Secretary of State for allowing this intervention. Since she is referring to trusts and their work, will she address a situation on 7 June involving a constituent of mine? His doctor applied to admit him to Pinderfields general hospital in my constituency and was told that no beds were available. When a bed was arranged at Dewsbury district hospital, my constituent was told that no ambulances were available. How does the Secretary of State intend to deal with the situation under independent trusts? Will she hold an inquiry to find out why that incident was allowed to occur?

Mrs. Bottomley

If the hon. Gentleman had wanted a detailed answer, he would have given me notice of the question. I shall, of course, come back to him on the detail of that particular case.

There is no health service anywhere in the world where from time to time individual cases are not treated less well than one would have hoped. Nearly always, behind the headlines so sought by the Labour party—food and drink to its debates—there are far more complex and detailed aspects, very often involving confidential information about patients or clinical staff. [HON. MEMBERS: "That is rubbish."] If I may, I shall take, for example, the case of Professor Colton raised in the debate.

The House will have heard about Professor Colton and his decision to spend his time in the independent sector in Switzerland. It was the case that they decided at his clinic not to accept elective, non-urgent cases for a limited period. That was because, at that time, 242 out-patients were waiting a maximum of 56 weeks for treatment. At the end of that programme, 22 out-patients were waiting a maximum of four weeks, and they now offer an orthopaedic service for children, delivering a quality of care of which I, as Secretary of State, am happy to be an advocate. They were quite right to take that necessary short-term decision so that all patients could receive a standard of care.

Labour simply does not care—

Several hon. Members

rose—

Mrs. Bottomley

No, I will not give way.

Labour does not care about the detail. It simply wants mischievous interpretation. That is only too clear because it is quite unable in any way to undermine evidence that the people of this country now receive a better service than at any stage in the history of the health service.

Several hon. Members

rose—

Mrs. Bottomley

I am not giving way. I have a short amount of time. [Interruption.] The debate is limited, and I gave strict undertakings to my hon. Friends not to over-speak.

Apart from the 1 million more patients treated every year since the reforms, we have also put into the hands of doctors, nurses, managers and staff working in hospitals the ability to slash waiting times overall. The average waiting time is now—

Mr. Alex Carlile (Montgomery)

On a point of order, Madam Speaker. Is it the procedure of the House, and therefore in order, to refuse interventions on the ground of undertakings given only to Members of one's own party?

Madam Speaker

As the hon. and learned Gentleman knows, it is up to the hon. Member who has the Floor to decide whether to give way. It is certainly up to the Secretary of State to determine whether she will take interventions. She appears to want not to do so, but to make some progress for the moment.

Mrs. Bottomley

I have already taken interventions. I noticed that the right hon. Member for Derby, South refused to allow an intervention even from my hon. Friend the Minister for Health.

Mr. Carlile

Will the Secretary of State give way?

Madam Speaker

Order. The hon. and learned Gentleman must not insist; the Secretary of State has made her position quite clear. I shall do my best to call the hon. and learned Gentleman; he may like to make his point then.

Mr. Skinner

He is the only Liberal Democrat in the building.

Mrs. Bottomley

True. I want to proceed with my speech, but I shall try to find time to give way when I have made a little more headway.

Waiting times have been slashed to the lowest levels ever recorded. Clinics that were previously open on a strictly nine-to-five basis now open in the evenings or at weekends. Requests for help that previously met with the slamming of glass partitions are now handled with courtesy and speed. Where once 20 people were given a 9 o'clock appointment and then had to wait all morning, individual appointment times are now the rule.

I must make it clear to the House that survey after survey of the patients who use the NHS endorses their enthusiasm and appreciation of the service they have received, and shows that their confidence in the service is growing. I find it extraordinary that the Labour party, whenever the achievements of health service staff are pointed out, sneers at and denigrates that work.

Mr. Nigel Spearing (Newham, South)

Will the right hon. Lady give way?

Mrs. Bottomley

Even more achievements have been documented in the latest figures. In the year to March 1995, the number of patients waiting for more than a year for in-patient treatment fell by a half. That matters to patients. The new figures for out-patient waiting time show that 82 per cent. of patients were seen within 13 weeks, and that 95 per cent. were seen within 26 weeks. We are on course to meet the new patients charter target for out-patient waits that I announced earlier this year. That matters to patients and it is an achievement by the staff.

I can tell the right hon. Member for Derby, South that the league tables coming out later this month will again show that the NHS is becoming ever more efficient and responsive to patients. The Labour party sneers at and denigrates the remarkable document setting out the achievements throughout the country.

Mr. Spearing

Does the Secretary of State agree that what she has just said does not apply to the ambulance service, as is shown by the report from the Select Committee on Health? If, after nine debates:in the House, the ambulance service was not provided with what the Government eventually thought was necessary—they had given £5 million extra in 1991, and they gave £14 million extra last year—how can the Secretary of State say that the Government have calculated the real needs of the health service as a whole? If they got it wrong with the London ambulance service after nine debates in the House, how do we know that they will get it right for the country as a whole?

Mrs. Bottomley

Our Government are committed to making information public and available. There has been a transformation in the amount of information that people have on the performance of ambulance trusts and health services throughout the country. It is precisely by making such information available that we can lever up standards.

The hon. Gentleman is, however, right about the London ambulance service; he and I have spoken at great length about that service, and about its long-standing management and trade union problems. My hon. Friends are only too well aware that the London ambulance service is not an NHS trust. It is a sign of old-style health services and not of the way in which we want to manage health services for the future.

The Labour party claims that trusts would remain, but that they would be called local health services.

Mr. Nicholas Brown (Newcastle upon Tyne, East)

Will the Secretary of State give way?

Mrs. Bottomley

Is the Labour party really saying that all it has to show for five years of consultation, deliberation, effort and thought is simply a new name? Oh, no: the plan of the right hon. Member for Derby, South is much more sinister than that. She has already told the House that she thinks that trusts are an abomination. The truth behind her document is that NHS trusts would go. The right hon. Lady wants to take away their assets and freedoms. She aches to get back to the old regional health authorities with their web of committees, bureaucracy and grind. [Interruption.] The hon. Member for Bolsover (Mr. Skinner) agrees.

The Opposition voted against the Health Authorities Act at every stage, and they voted against the abolition of the regions that will save £150 million on administration to spend on patients. The difference between our parties is that the Labour party would pay the pen-pushers and bureaucrats, while we fund the front-line staff and the managers whom the Opposition never avoid denigrating.

The right hon. Lady should be aware that we know the offence she has caused to many in her party who are public servants working in the NHS as managers, and the work of the right hon. Lady and the leaders of her party in constantly denigrating the achievements of those managers is a subject that every Government Front-Bench spokesman has heard time and time again.

The right hon. Lady would have national pay, although someone—doubtless from the Leader of the Opposition's office—went over her head and inserted the meaningless words "with local flexibility". No wonder Bob Abberley, whose union Unison helps to pay the right hon. Lady's costs, welcomes her proposals. If the Labour party were ever in government again, it is clear that negotiations with the management side would be extremely difficult, as the management side would have one arm held behind its back by the very people for whose benefit it was negotiating.

Until the Labour party renounces the sponsorships of its Front-Bench spokesmen by the health unions, it will never have any credibility. As for the Labour party's acceptance of research costs being paid for by the health unions, I think that that is an absolute outrage, and the public will increasingly think that also.

One of the advantages of local pay is that it will take pay bargaining out of the national political arena and place it within trusts, closer to patients and focused on patient needs. Staff can and will benefit. Pay and conditions determined according to local circumstances can reinforce teams within trusts. Trusts can design packages for their staff to replace the bewildering array of national terms and conditions that currently exist.

I was pleased that the Royal College of Nursing and the Royal College of Midwives last week accepted the principle of local pay, and they have agreed to start negotiating locally this year. I hope that other unions will see sense and follow their good example, so that we can put this unnecessary dispute behind us.

I am tempted to speculate as to why we are having this debate. Is it the right hon. Lady's chance to put her spin on Labour policies? It must have been galling for the right hon. Lady on Thursday to see her policies being given the soft soap treatment by the Leader of the Opposition. Even as best supporting roles go, I think that the right hon. Lady will be pipped for an Oscar by my hon. and multi-coloured Friend the Member for Northampton, North (Mr. Marlow). Against a delicate pastel background, the Leader of the Opposition put his pastel spin on her policies, but green was closer to the colour with which I would associate the right hon. Lady.

The Labour party has assured us that it will keep the good elements of the Conservative health reforms. Is it turning the clock back? Heavens, no. The Labour party believes in continuity, progress and—above all—nicking good Conservative policies. The Labour party would renationalise the NHS—a meaningless piece of rhetoric. The spectre of privatisation was, as ever, waved about as the last bullet in the Labour party's threadbare locker.

The right hon. Lady made a performance on "Newsnight", where she snapped at the gentle Mr. Paxman that the market would definitely go, and that fundholding would not only go, but would be gone within the year. All day long, the Leader of the Opposition had been cuddling the NHS with his policies of continuity, but after he was tucked up with his Islington cocoa, the right hon. Lady was out of her cage to tear the whole thing apart.

Let us be clear—the right hon. Lady does not think that there is anything good about our reforms. She has been forced into a wholly unconvincing and inconsistent compromise by the Leader of the Opposition. The result is: Another fudge. These policies have not been properly thought through. They are spatchcock reactions, plundering what is newly popular while genuflecting to old vested interests".

Mr. Dennis Turner (Wolverhampton, South-East)

Redwoodism.

Mrs. Bottomley

The hon. Gentleman says Redwoodism, but those were not my words, or those of my right hon. Friend the Member for Wokingham (Mr. Redwood), but those of Melanie Phillips writing in syesterday's The Observer—neither noted for their unswerving support of Conservative causes. Dr. Vernon Coleman, in that other well-known propaganda newssheet for the Government, The People, said that the Labour party's proposals made him want to weep.

The right hon. Member for Derby, South is hopelessly trying to have it both ways. She says that she would keep the purchaser-provider system, but would abolish the internal market. Only Labour would try to ride a bicycle that had the right cogs in place, but no chain. What is the relationship between a health authority and a hospital, if it is not a managed and a market relationship? It is hard to find any precise answers in the document, because it promises armies of think tanks, consultation groups and even royal commissions for all the policies and details that the Opposition have been unable to clarify.

The right hon. Member for Derby, South says that Labour wants to give power to general practitioners, but makes it clear that it would abolish within a year the single most effective means of giving them that power— fundholding. She says that Labour would cut bureaucracy, but in place of local, direct management, she wants commissioning committees, a new tier of regional administration, and enhanced powers for the centre to second-guess local decisions. That is not just turning the clock back, but taking it off the wall and jumping up and down on it. Patients would be the losers.

Mr. Campbell-Savours

May I raise with the right hon. Lady a question that is causing me much anguish? Last Friday, I attended a meeting in my constituency of parents whose children are unable to speak properly because of the absence of speech therapy. The meeting was deeply worrying, because teachers said that as many as 20 per cent. of children in schools in my constituency are unable to speak properly because of a row between the health authority and the county education provider.

Those children have a medical condition. Can someone bang heads together and get the local health authority to recognise that it has responsibilities? Those children will probably be disabled all their lives because of an argument that is going on now. The right hon. Lady has it within her power to get the health authority to do something about it.

Mrs. Bottomley

I hope that the House will bear with me if I do not give way to Labour Members again. The hon. Gentleman has a good case, and I will be more than happy to provide him with a detailed examination of it, but the issue is the health authority assessing the need and commissioning care on behalf of the local community, and working with education and often social service authorities.

The point of the reforms and the significance of the distinction between purchasing and provision is that it is being done so that there can be assessment of need and a collaborative approach with other agencies to meet it. I am more than happy to go into further detail, but I will not rehearse the great increase in the number of speech therapists and the improved training and arrangements—I will spare the House those statistics.

The progress of the past few years has been formidable. The Opposition would throw it all into reverse. Fewer patients would be treated, and there would be longer waiting times as staff struggled—in a way that they have no wish to do—to come to terms with the ghastly new world of the right hon. Member for Derby, South, who has ignored the advice that she has received from many of her supporters. There is an obvious temptation for Labour to cash in on public concern and promise to undo every change the Tories have made … Such a gut reaction should be resisted. Those are not my words, but those of two health experts, one an adviser to the last Labour Government, writing in the June Fabian Review.

Professors Brian Abel-Smith and Howard Glennester went on:. There is now overwhelming evidence that fund-holders are able to get a better deal for their patients. They can pick those hospitals or departments of hospitals which give their patients a better and more convenient service … They can bully specialists about waiting times. They can insist that test results come back quickly … Fund-holding represents a major transfer of power from specialists to GPs".

[Interruption.]

Hon. Members

Disgrace. Apologise.

Mr. Deputy Speaker (Sir Geoffrey Lofthouse)

Order. I did not hear what the hon. Gentleman said.

Mr. Rhodri Morgan (Cardiff, West)

I apologise to the House for any discourtesy. If you, Mr. Deputy Speaker, did not hear my remark, that is all for the best.

My objection was to the idea that GPs can send contracts for all their out-patients to one hospital, as happens in Bath, while the X-rays are in another hospital. Is that in patients' interests?

Mrs. Bottomley

The point was about the leverage that GP fundholders have within the system to deliver better care for their patients. It is for GPs to make those decisions.

Those are precisely the dynamics of the new NHS which the right hon. Member for Derby, South finds distasteful, because they work and deliver improvements for patients, and patients throughout the country know that. The 10,000 GPs or GP fundholders will make their message only too clear to the Opposition.

Naturally, we are working to spread the benefits of fundholding to all GPs. We believe in levelling up, not levelling down, and have been listening to GPs' concerns. We shall make life easier for family doctors by cutting paperwork. We shall spell out the details of our plans shortly, but I can announce to the House today that an estimated 15 million forms a year will go.

On out-of-hours payments, I remind the House that, as a result of our offer, a typical GP would receive an extra £800 a year for an average of six night visits a month. There can be no excuse for family doctors taking action that damages patients. I am, however, sympathetic to their concerns. The criticism or concern that they have raised about the patients charter—not the cynical reaction of the Opposition—relates to the extent to which we need to remind the public of the importance of using the service responsibly rather than calling out GPs inappropriately, keeping appointments and supporting health staff in their work. That is an area in which we can work together and make good progress.

Our task is to realise the potential of the reforms. We must not turn the clock back and throw the whole system into upheaval. We believe in working with staff constructively and practically. We recently announced extra doctors and a 10 per cent. increase in new medical students. I set out many of those issues in a recent speech to the Royal Society of Medicine. I want to see the long-term perspective.

On contracting, we need to develop more sophisticated purchasing patterns. Contracts should be drawn up with imagination and an eye on the future, and not simply replicate the patterns of the past. They should take account of quality, outcomes and how services will improve, not simply cost.

The Opposition fail to understand that the information that we now have about health services, quality, cost and a number of other issues means that we can progressively fashion an innovative, pioneering and evidence-based service. Such a service will be developed on a research strategy, which is increasingly being acclaimed not only here but around the world, as is our "Health of the Nation" strategy.

In her grudging and mean-spirited way, the right hon. Member for Derby, South talked about the importance of improving health, but did not say that we are now marking the third anniversary of our "Health of the Nation" strategy, which the World Health Organisation is using as a model and which the French Government and many health advisers around the world commend. Today, we launched the next phase—a new phase—in the "Health of the Nation" strategy, to target young people. We have much more work to do in that area.

The Opposition simply wish to reorganise, turn the clock back and disrupt all that is taking place within the service.

Change is necessary in the national health service, but that is change that is driven by new medicine—by new science. Day surgery, laser surgery, bio-pharmaceuticals, genetics, information technology: all those and more are stamping their mark on the evolving pattern of health services. But what does the Labour party do? It resists every closure, every change of use, because Labour frequently supports the patterns of the past, not the patterns of the future.

The Opposition speak about the "public service ethos". Of course the national health service must remain publicly funded, but there is scope, as we see through the private finance initiative, to diversify and expand the range of provision without threatening that public service ethos.

Mr. Hugh Bayley (York)

The Secretary of State speaks about the Government's record on reducing waiting times, and says that it is important that services for young people should be improved. What would she say to the boy in my constituency whose mother wrote to me to complain that he had waited 20 months for a first out-patient appointment for orthodontic treatment, which he has now had, but that, if he is to receive treatment, he will have to wait a further 24 months before he receives the orthodontic treatment he needs, for which his general practitioner has referred him to the hospital?

When will the Secretary of State provide the improvement in services for all people—not just young people—that the patients charter promises?

Mrs. Bottomley

That is another individual incident, which I am more than happy to investigate.

The Labour party appears unable to see the wood for the trees. We have a health service that provides everyone with everything, almost without the use of charges. We have some of the best medical research anywhere in the world. We pioneer new services which are comparable with services anywhere in the world.

Our achievement on waiting times is formidable. We used to have 200,000 one-year waiters; we are now down to 32,000 one-year waiters. In the area of the hon. Member for York (Mr. Bayley), we used to have 7,000 two-year waiters when I first came to the Department, six years ago. Now, no one waits more than nine months in the west midlands.

I believe that the hon. Gentleman should commend the fact that the west midlands has gone from 7,000 two-year waiters to a guarantee of nine months, albeit that, with the complexity of delivering the service that we are entrusted to deliver, there will always be aspects where there is more to do. [Interruption.]

I apologise to the hon. Member with whom I momentarily confused the hon. Member for York. Be that as it may, I could offer him the figures—[Interruption.] Be that as it may, I shall spare him a similar comment about what is happening in York, except to say that the work taking place at the university on the dissemination of reviews—the service it provides and the interest that that is developing throughout the world—provides another example of the way in which we have made the service more fit to meet the future and to tackle the issues, not only of today, but of tomorrow.

One will be able to achieve that only by embracing change—not, like the Labour party, by turning the clock back.

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

There is no tomorrow for you.

Mrs. Bottomley

I profoundly reject the Opposition's misleading motion. The NHS is not a business; it is not for profit; it is not for sale. It will remain a service for all the people to use, regardless of their ability to pay. It must be a health service, not only an illness service; a service focused on the individual patient, responding to their needs and influenced by their choices. It must be an innovative service, evidence-based at every level, and an efficient service, providing value for the taxpayer's money. It must be a service with a long-term view, and a public service with strong ethical foundations.

That is precisely what we are achieving by means of the changes that we have set in hand. The Labour party is stuck in the past, and, although it furiously tries to deny it, the health policies that it proposes show that old Labour is far from dead and buried"./ I say to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) that those are not my words, but those of the Financial Times. The Labour party would tear up the key elements of the reforms; it would inflict upheaval and uncertainty on staff; it would rob patients of the benefits they receive under the Government's policies.

The choice is not between private markets and public health; it is between the Conservative party, which wants to modernise the national health service, and the Labour party, which wants to take it back to 1948.

4.34 pm

Mr. Richard Burden (Birmingham, Northfield)

I am sorry that the Secretary of State has already fired off one set of statistics about the west midlands in the wrong place. I can explain to her that the west midlands is in a different part of the country from York, although it is a city that I know well.

I should like, with your permission, Mr. Deputy Speaker, to give one illustration of the way in which the national health service internal market has worked. It is from my constituency in Birmingham. It shows graphically how a bureaucratic nightmare has developed in which the buck is passed from manager to manager, trust to trust and authority to authority. The end result is delay upon delay in the development of new NHS facilities. The much-vaunted private finance initiative, which the Secretary of State mentioned in her speech, has only made matters worse.

In my constituency there is a former psychiatric hospital campus called the Rubery-Hollymoor campus. It takes up about 200 acres of land. The hospitals have closed. The regional health authority, or NHS Executive West Midlands, as it will become, decided to sell off the land and develop it. There has been a great deal of controversy about to what extent local people would have a say in the development, and so on. I do not have time to go into that, but I recommend that hon. Members have a look at that story because it is fairly instructive in its own right.

From the beginning it was said that local people would be able to get out of the development a primary health care centre—something that they had demanded for years. They were told that when the land was sold off, money would come into the health service from the sale. Whatever else happened on that land, they would have a primary health care centre. There was a fair amount of discussion—this is going back to about 1990—between people in the area and the South Birmingham health authority about what the primary health care centre should deal with.

In 1994, the regional health authority published a new plan for health care in the west midlands. It had had some problems up to that point. It had become unpopular with its blueprint for health care in Birmingham. That even led to the resignation of the then chair of the regional health authority. In 1994 the authority published a new document called "Looking Forward". That document referred to a new preoccupation and emphasis in the west midlands on primary health care. It mentioned two flagship projects that would take place in Birmingham. One was a primary health care centre in a place called Quinton and another was a centre on the Rubery-Hollymoor site.

I have to tell the Secretary of State and the House that even though the project was talked about back in 1990, guaranteed at that time, and even though it was proposed in the document in 1994, not one stone has been laid to construct that new primary health care centre. For the first year or so, even though we in the area became frustrated, we thought that the delay was due to the various delays in the development in general.

Towards the end of last year I approached the regional health authority and asked what was happening about the development of the centre and why it appeared to be taking so long. The story that I got back was essentially that the main reason why no stone had been laid was that no one in the health service could decide whose responsibility it was to build the centre.

The original initiative had come from South Birmingham health authority. It could not be responsible for building the health centre. Why? Because all that it did these days was purchase health care. It could not be involved in developing a facility. The land was owned by the regional health authority so I asked why it was not taking the project forward. The answer was that the RHA did not really do anything these days but merely monitored what other people did. It was not the RHA's responsibility to build the primary health care centre. I was told that it was the responsibility of the local trusts and that the local mental health trust would develop the primary health care centre. When I asked why it had not got on with the job, I was told that that trust had been in negotiation with the other trusts to try to work out how it would fund the centre. After all, that primary health care centre was designed to offer a range of different services, including community services, general practitioner services and chiropody.

That was a great idea, so why had the mental health trust not got on with it? I was told that its negotiations with the other trusts had ground into the dust. It had asked the other trusts for the type of financial commitment that it felt it needed to develop the centre in the years to come, but they said that they could not make those financial commitments because, under the new NHS market, their financial regime operated just one year in advance. Those negotiations therefore produced no result and the project came to a halt. It was only when local councillors and I started to ask questions that the trusts decided that they had to get on with the centre.

Earlier this year we were assured that the project would go ahead. I asked the trusts what they intended to do and they said that they now had to prepare a business case. I asked for whom and I was told that the project had to be considered under the private finance initiative. The project had, effectively, to be put out to tender. I argued that the project had first been approved way back before PFI was ever contemplated, but I was told that that did not matter and that the project now had to be governed by the rules of the PFI. When I asked what that meant, I was told that the trusts were getting on with the project but the plain fact was that it would be another two years before the health care centre saw the light of day.

I was subsequently told by South Birmingham health authority that a notice for tender would be placed in the relevant journal in May 1995 and that pre-qualification submissions would be returned in early June. On 14 June pre-qualification tenders would be selected and an invitation to prepare an outline tender would be issued to between six and 10 companies. On 21 July, two preferred tenders would be short-listed and invited to prepare fully costed tenders. They are due to be returned on 8 September 1995 and on 3 October a finance committee, of the mental health trust I assume, will meet. The trust board will meet on 6 October and the full business case submission will be explored. That is what is due to happen in 1995—about five years after the health authorities agreed to the centre and almost one year after they had been chased up about why nothing had happened until then.

Once the private tenders have been returned and it is decided to work on the basis of the PFI, does that mean that the health care centre will then be built? No, it does not, because it is only at that stage that the trusts can start to submit their planning applications. It is only at that stage that the trusts will talk to local people about what they want at that health care centre.

Mr. Fabricant

The hon. Gentleman has offered us a long catalogue of tender procedures. Is he suggesting that such procedures should not be used and that the project should be given to one bidder only, who might just be the highest bidder? Would not that mean taking money away from patient care?

Mr. Burden

The project was given the go-ahead in early 1990s and had the support of local people. The health service then had a management structure that worked. The different parts of that service hung together and it would have been rather better if people had made the necessary decisions then. We would then never have reached the stage, as we did a year ago, where different trusts were unable to make a decision about who would fund the project, who would use it and who, indeed, would own it because it is always considered to be someone else's responsibility.

The hon. Member for Mid-Staffordshire (Mr. Fabricant) has implied that the PFI may offer better value for money to the health service. I am not too sure about that. I received a letter from South Birmingham health authority on 23 June, when I was updated on progress on the project. I was provided with the list of dates that I outlined a few moments ago. The health authority explained that taking the project through the PFI was a complicated exercise. It is so complicated that it appears that South Birmingham health authority, the trusts or even West Midlands regional health authority, cannot be expected to conduct it themselves. That is why I was told that, in order to pursue the PFI, the mental health trust had brought in outside help, Nexus Health Finance Ltd., to assist it to perform its task under the PFI regime. The trust, in order to obtain that finance, has had to commission and pay a private company to help it. That has happened on the back of the RHA's decision to call in Erdman Lewis company to help it market the land and another private firm to help it develop that land. Some questions must be asked about how much all that activity costs.

The primary health care centre in south Birmingham is just one example from a catalogue of disasters, and it says a great deal about the way in which the health service operates. Any individual manager or health practitioner will have the interests of the patient at heart. It is most unreasonable for Conservative Members to say that the Opposition have attacked people working in the health service. Goodness, we spend our days listening to them and taking up their grievances. We articulate for them because they are often not allowed to do that. That demonstrates what is wrong with the way in which the health service is operating.

It is clear that throughout the entire process in south Birmingham everyone has had the interests of the patient at heart, but when one puts the picture together and inserts the crucial mechanism of the market, the outcome is chaos. A decision was made that could never be carried through. The RHA wanted the health centre to be developed, but it never had the power to do that. In effect, the RHA took its eye off the ball. The trusts and provider units wanted the centre developed, but they could not reach the necessary agreement. That failure was not intentional, but they knew that the financial regime imposed upon them by the internal market forced them to expect of each other unrealistic financial demands. That led to delay and, finally, the much-vaunted PH. The only effect of that initiative on the proposed health centre in south Birmingham has been to create further delays and add to costs.

At the end of the day, who knows—public money may be used to build that health centre. We know, however, that it will not be built for another two years. Let us go back to the start. It all arose from the sale of hospital land. We were told that that would raise money that could be put back into the health service. The one obvious project arising from that development, however, cannot be financed out of health service money.

There is something radically wrong with the way in which the health service now operates. The market mechanism has not worked. It is because of that example in south Birmingham, and countless others throughout the country, that I welcome the new policy document issued by the Labour party. It is designed to bring to an end that disastrous market mechanism and, in a modern context, get back to the essential principles on which the health service is based. It will then serve the interests of people and patients, not bureaucrats and markets, and it will not be governed by an obsession with privatisation.

4.48 pm

Mrs. Marion Roe (Broxbourne)

There is no doubt in my mind that the health service reforms were radical and bold. They are now nearly five years old and they have matured into an understanding of the need for strategic long-term relationships between purchasers and providers and, where appropriate, between providers themselves.

I remind the right hon. Member for Derby, South (Mrs. Beckett) that NHS trusts are NHS funded and NHS managed. But, of course, they will tender for services from public or private suppliers where it is advantageous in terms of improved quality and efficiency—for example, for cleaning and catering, and for patient transport. But the objective always remains the same: to secure improved services that are balanced and non-ideological.

Competition stimulates innovation and improves efficiency; it also encourages new and better ways of providing health care. The NHS market is a public market, which is publicly accountable and publicly controlled. All purchasers, responding to the needs of the people they serve, seek to maintain good access to a comprehensive range of general hospital services. Those services will include all emergency treatment, which accounts for 35 to 40 per cent. of all expenditure.

However, in some other services, planning needs to be undertaken jointly between purchasers and two or more providers. The implementation of the chief medical officer's recent important report on cancer services could not effectively be undertaken without joint work between trusts to ensure the highest-quality surgery, chemotherapy and radiotherapy—that requires strong links between cancer centres and local cancer services.

In other services, the private sector may offer the best quality of care—but still funded by the NHS. Private psychiatric providers have specialist expertise for people with severe problems. Some purchasers are now obtaining much improved care at home for very dependent elderly people, such as quadriplegics, who need to receive customer-designed care, fitted to their needs, from specially and specifically trained carers. The private sector can often best provide such carers—funded and supervised by the NHS and social services together.

Mr. Alex Carlile

If it is right that the private sector provides facilities—as well it might—for some areas that are better and give better value than the NHS, can the hon. Lady explain why, in some areas of medicine, the NHS is obtaining services from neither the private nor the public sector? For example, why is it so difficult to obtain medical treatment for anorexic teenagers in the NHS in London, so that some of them suffer for years, while those whose parents can afford to pay can be in a psychiatrist's chair within minutes?

Mrs. Roe

I should draw the hon. and learned Gentleman's attention to the Select Committee's report on purchasing. If he reads the report in detail he will see that we considered those sorts of services that were not being provided in some areas, but found that such services were being provided in other areas and were certainly meeting the needs of the local population. I advise him to read that report in detail as he will see that his point is covered by it.

Mr. Fabricant

I am grateful to my hon. Friend for giving way because I wish to raise a point relating to the intervention by the hon. and learned Member for Montgomery (Mr. Carlile).

Is my hon. Friend aware that the family health services authority in Staffordshire produces a list of waiting times and availability of treatments for various types of disfunction? Is it not true that there is no reason why, if the fundholder is in London, the patient should necessarily have to be treated in London? If the treatment is not available, the patient could certainly easily be treated in areas surrounding London, where treatment is available.

Mrs. Roe

I take my hon. Friend's point but, again, the Committee's report shows that in some areas particular services are provided and are of a high quality.

The East Hertfordshire NHS trust, which covers my constituency, has established a deserved reputation as a prudent, well-operated organisation that has consistently met all its financial targets and contractual requirements, while placing key emphasis on developing new services for local people. In doing so, it has sought and benefited from private sector developments in just the sort of projects that provide benefits for patients first, for the trust second, and for the private sector third.

Most importantly, services for national health service patients have been extended and introduced when that would not otherwise have been possible. For example, new and improved equipment has been introduced where private finance has improved the cost-effectiveness of services in a wide range of areas. The use of leased equipment has enabled vital advances while relieving the NHS of the burden of risk and cost.

The East Hertfordshire NHS trust has been able to acquire more than £700,000 worth of essential equipment, ranging from image intensifiers, blood gas analysers and other critical medical equipment, as well as equipment that brings benefits to staff and patients, such as a new switchboard, new information systems and refurbished refreshment facilities within the main hospital. The trust has also developed improved diagnostic services through the provision of an on-site, state of the art, privately operated MRI scanner in a purpose-built unit.

The Chase Farm Hospital NHS trust, which also covers my constituency, has a partnership with the private sector; the trust and its patients have benefited, both financially and by means of direct clinical care, through their partnership with BMI. There is a partnership arrangement with the Kings Oak private hospital, which is on the Chase Farm hospital site and which was built by the private sector on Chase Farm hospital trust land. That yields an immediate income of a minimum of £380,000 a year, with additional benefits.

The benefits include: the sharing of expensive clinical equipment; training offered by the trust to the Kings Oak resident medical officer, with the trust in return receiving the funding for an additional doctor in its accident and emergency department; the ability to sell pharmacy, pathology and CTC scanning services to Kings Oak and generate income for the department involved; the opportunity for the doctors to undertake private practice on the Chase Farm site, thereby being easily accessible to the NHS when they are required; the ability jointly to develop new services such as mammography screening; and sports injury clinics. The Chase Farm trust has also worked closely with Broxbourne borough council, which was able to facilitate a land swap with the private sector, enabling the trust to re-provide Cheshunt community hospital with purpose-built premises in a central location in my constituency.

In my constituency we are concerned about the grass roots delivery of an excellent health service, not about ideological rhetoric, where the word "private" has developed into an abusive term.

Britain does not have to make a choice for the national health service between the public service or private markets. The key to maximising our resources and to providing the high-quality health care we need lies in creative and energetic partnerships between our national health service and the private sector. That is the way forward.

4.58 Pm

Mr. Alex Carlile (Mongomery)

It is now 16 years since the Government's political experiment with the national health service started. One would have thought that, by the end of 16 years, even by the standards of the right hon. Member for Wokingham (Mr. Redwood), the experiment would have come to fruition and would have achieved the panacea of the national health service that we had been promised. Listening to the hon. Member for Broxbourne (Mrs. Roe), one has the impression that the panacea has been delivered, at least in leafy Hertfordshire. If it applies in Broxbourne, it certainly does not apply all over the country.

The hon. Member for Mid-Staffordshire (Mr. Fabricant), who has temporarily left the Chamber, suggested in response to my earlier intervention that an anorexic teenager from London could be treated in Staffordshire. Are we really to believe that that is the recipe or prescription offered by the Government to people who are facing severe illness early in life? Where is the evidence that the national health service is meeting the acute needs of the great majority of the people?

The reality behind what the hon. Member for Broxbourne described is that there has been a tenfold increase in the number of NHS administrators. Senior managers are earning over £63,000 a year on average, and the best employment offers in the jobs pages of the heavier newspapers are not for doctors, but for national health service administrators. Of course the national health service needs good, well-paid managers who can administer it well; what it does not need is a management structure which has overwhelmed the medical ethos of the service.

It is all very well to talk about day surgery, laser surgery and technological changes; it is right that they should be embraced by the national health service. However, can we really be as satisfied—indeed, as self-satisfied and smug—as the Secretary of State and the hon. Member for Broxbourne when we hear, for example, the intervention by the hon. Member for Workington (Mr. Campbell-Savours) about speech therapy in Cumbria? It is not only in Cumbria that speech therapy is not available. There is a chronic shortage of speech therapists in rural Wales.

Why have the Government failed to meet the need for speech therapists? Why is there a shortage of physiotherapists? Why does the training that paramedics who attend accidents receive vary greatly from one part of the country to another in a way that may critically affect outcomes?

The Government ought to tell us what answer they have to the triple whammy which they have been given in the past two or three days by senior figures who have made comments about the national health service. The Secretary of State tried to rubbish the comments of Professor Colton, but she failed to deal with the comments of his chairman, Martin Suthers. He is the chairman of Queen's medical centre, Nottingham University Hospital NHS trust, and, one is told, a prominent Conservative. He said: I am sorry to see him go, but I understand his frustration. What frustration was that? Perhaps the Government would care to explain it.

I do not believe that Mr. Suthers is about to go to Switzerland to practise health in the private sector. He remains to try to pick up the pieces after the departure of Professor Colton, a leading paediatric surgeon, from Nottingham, and has been left to find somebody else to take over the children's clinic.

What about the Bishop of Ripon, the Right Reverend David Young? The Minister may laugh at the notion that bishops have any right to say anything about what is going on in our society, but the fact is that bishops see a lot of what goes on through their diocesan work. Why is it that the Bishop of Ripon, despite the Minister's smug and dismissive smile, said: The increasingly competitive nature of health care is damaging. He finds it difficult to see how competition can benefit patients.

Then, of course, we have Dr. Macara, the chairman of the council of the BMA. That name brought from the Minister not a smile but a double raise of his eyebrows, probably because he cannot do them one at a time. I see that he can. He raised one eyebrow in response to that.

Let us consider Dr. Macara for a moment. He is not a firebrand trade unionist; he has a long record of support for Conservative health policies. However, as chairman of the council of the BMA, this morning he described the regime under which the NHS now labours as "alien." He described the internal market as "an infernal bazaar". He has complained that there is neither equity nor integrity, and called the system whereby whistleblowers working in the NHS are under threat of losing their jobs "dedicated secrecy".

Can the Government really, in the style that the Minister of State carries so well off-the-shoulder, shirk such criticisms? Can the Government really be satisfied with having lost the support of the medical profession?

It simply will not do for the Secretary of State to say that general practitioners who are fundholders will fight to retain their fundholding status. She omitted to tell us that 60 per cent. of GPs have refused fundholding status. It is only the minority who are fundholders. There is some evidence that many of them regret it.

The Nottingham fundholding commissioning group has received a lot of praise, both from the Labour party and from my party. In Nottingham, a very successful alternative has been found to GP fundholding. Part of the evidence is that fundholders have declared that they wish to join the Nottingham group.

Why are the Government not prepared to give a fair run to fundholding groups such as that? Why do they insist on pressing the case for individual practice fundholding as their priority? Why are the Government not even prepared, as my party suggests, to test fundholders before they are given fundholding status, not on the basis of the size of the practice but by a strict system of accreditation, to ensure that they are fit to run the funds for their practices?

When the Minister replies, I would ask him to explain why it is that, mysteriously, only a few days ago, the extremely able chief executive of the new joint Nottingham health commission, who has given great administrative support to the Nottingham fundholding commissioning group, resigned his job. Did that involve interference by the Government? Have there been subtle words to lever him out because he is doing rather too well and the Nottingham experiment is beginning to show great success? We deserve an answer.

Mr. Malone

Will the hon. and learned Gentleman give way?

Mr. Carlile

I will gave way later, even though the Secretary of State refused to give way to me. I ask the Minister to find out the true explanation for the departure of the chief executive from his post. He should give an informed answer at the proper stage of the debate.

Mr. Spearing

Is the hon. and learned Gentleman telling us that in Nottingham, for which the Minister is responsible but in respect of which he may or may not reply, there is a group of GPs who wish to avail themselves of advantages through some large-scale co-operative organisation, thus benefiting local citizens, but who are being prevented from so doing? If so, the Government must say why.

Mr. Carlile

The Nottingham fundholders group is extremely well run, by some very good doctors. It is clear evidence that doctors can run important parts of the health service for themselves without large numbers of administrators. However, they have had a great deal of help from the chief executive of the Nottingham health commission, who sadly disappeared—I do not mean physically, but from his job, with very little notice, I understand, at the end of last week. If the Minister can give an informed explanation, I shall give way. I apprehended from his sedentary reaction that he was ready with one of his usual off-the-cuff ripostes rather than the true reasons.

Mr. Malone

The hon. and learned Gentleman asked two specific questions: had the Government engineered the chief executive's departure, and had the Government had any words? The answer to both is no, but I shall see whether there is any explanation that I can offer him. I cannot undertake to do so, but I shall certainly try. While I am on my feet, may I ask the hon. and learned Gentleman whether, as seems to be the case from what he said about fundholding, he shares the Labour party's view that it should be abolished?

Mr. Carlile

I look forward to the Minister of State's informed reply to my inquiry about the chief executive in Nottingham. The Liberal Democrat view on fundholding is absolutely clear. We would encourage the development of joint commissioning groups. One has to be realistic, and it is not realistic to abolish all fundholding at a stroke. I do not believe that the Labour party would regard that as realistic, either.

The development of joint commissioning groups, as Nottingham has shown, would ensure that fundholding would wither on the vine. Indeed, fundholding has always been a kamikaze policy. It was always in the end bound to set doctor against doctor and patient against patient, and it was quite illogical from the start. It is the doctors in Nottingham and elsewhere who are saving the Government from the consequences of that policy.

I welcome Labour's choice for a debate on the national health service. I hope that, as a result of the Labour party's measured approach to changing the NHS, we shall not return to the old phoney war of all public provision on the one side and possibly all private provision on the other. The NHS should cease to be a political and ideological battleground. It should rather be a service in which patients come first, and those who work in it come only slightly behind them.

Like the hon. Member for Newcastle upon Tyne, East (Mr. Brown), who is a member of Labour's Front Bench, I was present at the annual dinner of the National Association of General Practitioner Co-operatives at the weekend. That is another organisation which has shown that doctors can run important parts of the national health service. For a change, I should like to hear the Government say that they will introduce initiatives to ensure that not so much of the management and administration of the health service is taken up by an exponential increase in administrators of only the managerial kind, but is done by doctors as far as possible.

Although it provides a useful discipline, the internal market is desperately in need of reform. I accept the need to separate commissioners from providers, as it is a useful discipline which ensures that the best value and quality can be obtained. However, the creation of 400 to 500 separate hospital and community trusts, the fact that there are several trusts in some cities—there are four in Shrewsbury and three in Hereford—and that there is now a competitive market for nurses and auxiliaries, which means that continuity of care is not being provided in many areas, cannot be a sensible use of the internal market mechanism.

In addition, the fragmentation of the national health service under the Government has meant that networking is extremely poor. When the hon. Member for Mid-Staffordshire made his absurd suggestion that anorexic teenagers from London should be shunted up to Staffordshire for out-patient appointments—

Mr. Fabricant

rose—

Mr. Carlile

It is clear what the hon. Gentleman meant. He has had his opportunity—

Mr. Fabricant

On a point of order, Mr. Deputy Speaker. Is it in order for an hon. Member to misquote me deliberately in order to mislead the House?

Mr. Deputy Speaker

The hon. Gentleman will have the opportunity to make his point if he is fortunate enough to catch my eye.

Mr. Carlile

The hon. Gentleman's facility for expressing what he means may not always work in tandem with his mind. However, we understood that he made the absurd suggestion that young people should be shunted—[Interruption.] It has happened. Psychiatric patients in London are being shunted to the north-east of London, away from their families, because one NHS health trust is not able to tell a neighbouring trust what beds are available. That is the reality, and it is only one small example of the chaos that the Government have created in many spheres of medicine—if only they had the courage to realise it.

5.14 pm

Mr. Michael Fabricant (Mid-Staffordshire)

I am grateful to be called at this opportune moment, Mr. Deputy Speaker. If ever there was an example of the Liberal Democrats' woolly thinking and woolly hearing, the speech of the hon. and learned Member for Montgomery (Mr. Carlile) was it—as Hansard will clearly show.

The point that I was making, and which I shall make again later, is that the family health services authorities can provide lists of where people can receive treatment. To suggest for one moment that people from London would find it difficult to visit the surrounding counties is ridiculous. If the hon. and learned Member for Montgomery knew any geography, he would know that Staffordshire is nowhere near London. I was not saying that people from London should go to Staffordshire.

We heard woolly criticism from the Liberal Democrats, but earlier we were graced by the right hon. Member for Derby, South (Mrs. Beckett), who criticised the Government but came up with no tangible suggestions as to what she intended to do. She merely provided a series of models—I believe that that is what she calls them.

Mr. Patrick McLoughlin (West Derbyshire)

My hon. Friend was accused of supporting the idea that people should be moved from one part of the country to another, but is that not the reverse of our health reforms? More major operations now take place across the country so that people do not have to come to London. Yet we are criticised by the Opposition for tackling the problem.

Mr. Fabricant

As ever, my hon. Friend hits the nail on the head with great accuracy.

The right hon. Member for Derby, South talked about a number of different models for Labour party policy and alternative templates, but at the end of the day she came up with no tangible suggestions as to how the health service should be reformed. When I challenged her to say what her party's targets would be in terms of the number of treatments per year or by how much waiting lists should be reduced, she said that it was not her party's policy to set targets. All that we heard is that it is her party's policy to talk about centralism.

You will know, Mr. Deputy Speaker, that before I was a Member of Parliament I used to travel a great deal to the former Soviet Union where people were experts in centralism. The Soviet state committee for planning—or Gosplan—used to come up with wonderful five-year plans.

Mr. John Gunnell (Morley and Leeds, South)

Is the hon. Gentleman aware that the Health Authorities Act 1995 removes a regional tier, thus giving more power to the Department of Health? Does he not consider that a centralising measure?

Mr. Fabricant

The hon. Gentleman clearly misunderstands the point of the Act, which is to decentralise the health service. He may be old enough—possibly not—to remember the original series of Dr. Finlay's Casebook". Although it may have presented an idealised vision of the health service, it dealt with local treatment. But in those days, of course, the health service was not funded nationally.

The right hon. Member for Derby, South maintains the myth that we no longer have a national health service by saying that, somehow or other, the trusts and fundholders are some form of private medicine. That is not the case, as the health service is funded nationally. Efficiency and the ability to say what is required locally—with clinicians making such decisions rather than a bunch of central bureaucrats trying to plan the health service as Gosplan tried to do in the Soviet Union—has to be admired. Just as the Soviet Union was damned and doomed, so was the national health service as we knew it. But it is still very much a national health service, and that is how it ought to be.

I suspect that the only matter on which I agree with the right hon. Member for Derby, South and disagree with the Government relates to tobacco advertising. It is a strange anomaly that the Government rightly legislated in the Broadcasting Act 1990 to stop tobacco advertising on radio and television, but did not go the whole hog and ban it nationally in other media. That is a strange and inconsistent omission.

There is much of which the Government can be proud. The Department of Health has produced a statistical bulletin that was prepared by the Government's statistical service. It shows that on 31 March this year 1,440,051 patients were waiting for treatment. However, more than 75 per cent. of those patients had been waiting for less than six months at that time and more than half of all patients had been waiting for less than three months. Those are significant achievements, but did we hear any recognition for them from Labour or the Liberal Democrats, whose spokesman, the hon. and learned Member for Montgomery has not even had the courtesy to stay for my speech, which followed his? There has been no recognition at all.

When the Opposition were challenged to state what their targets would be, they came up with neither solutions nor targets. All they came up with were empty slogans and rhetoric. Of course, that is the authentic voice not of new Labour, but of socialism, and it speaks of central planning and slogans. The Opposition have no targets and no clear methodology as to how targets might be achieved.

The statistical bulletin shows that the number of patients who had been waiting more than a year had fallen by 50 per cent. since March 1994. Of course people will always be able to quote individual cases. A number of Opposition Members intervened during the speech by my right hon. Friend the Secretary of State and spoke about individual cases which they thought should have had better or quicker treatment. However, none of them seems to have had the energy to write to the Secretary of State or the Minister of State to raise those problem cases—if they truly exist.

The threat to scrap GP fundholders is worrying. Lichfield is witnessing the benefits of virtually all its doctors being fundholders. Fundholding is a clear example of how, for the first time since 1948, money is following the patients and not the other way round. That is an appropriate slogan because it summarises the position. The Victoria hospital in Lichfield has direct access surgery, evening radiology and physiotherapy services, additional orthopaedic, dermatological and gynaecological out-patient services and a new surgical wing, which I had the honour to open. All those services are being provided there for the first time and they are the direct result of the Government's strategy and policy. That hospital is ably run by Premier Health, whose managing director is a fully paid-up member of the Labour party. If he were here to speak to the right hon. Member for Derby, South he would probably have something to say about Labour's proposed reform of the trusts. If Labour's ideas were to be implemented not only would there be chaos, but there would be considerable delay in treating the people of Lichfield.

In 1993–94, the out-patients department treated 11,346 people, but it now treats more than 15,500. That is a significant increase, and it is the result of the trusts and fundholders in Lichfield being able to say, "We want our patients to be treated locally." As I say, that is money following the patient and not the other way round. The Opposition's broad proposals, about which they do not go into any detail, would restore the disastrous situation prior to the reforms when patients were shunted all round the country for quite ordinary treatment.

When I said that, for more complex treatments, people might have to travel a little distance, Opposition Members laughed. One of the great innovations by my FHSA in Staffordshire under the extremely able chairmanship of Mr. Philip Jones, who lives in Oulton Heath in Staffordshire, is a system by which all general practitioners, fundholders or not, receive every month a book which details against waiting lists the different types of treatment that are available in various parts of the country. Fundholders are able to say, "We can send our patients where treatment is most efficient, and to places with the shortest waiting lists." I hope that other counties will be able to emulate Staffordshire's flexibility.

Mr. Bayley

Will the hon. Gentleman give way?

Mr. Fabricant

I am happy to give way to the hon. Gentleman.

Mr. Bayley

Will the hon. Gentleman not acknowledge that before the Conservative health reforms every GP was free to refer patients to any NHS hospital? But under the reforms most GPs can refer their patients only to hospitals with which their health authority has a contract. The hon. Gentleman is right to say that a GP fundholder can refer patients to any hospital—if that GP wishes to set up a contract—but that just means that some doctors are getting back the freedom of referral that they had before the reforms were introduced. Patients who are not with fundholders do not have the freedom of referral that used to exist.

Mr. Fabricant

Perhaps the hon. Gentleman is looking back through rose-coloured spectacles. Many of the NHS hospitals to which he refers did not perform the operations for which people are now referred. If the hon. Gentleman cares to look at the data more carefully, he will discover that. The hon. Gentleman shakes his head in disagreement. He represents a major city but my constituency contains Lichfield, which is the second smallest city in the country. Lichfield did not have access to consultants and patients had to be sent to Wolverhampton, Birmingham or Sutton Coldfield. But since the reforms, consultants from hospitals in those places have to come to Lichfield away from their hospitals and, dare I say it, away from their golf courses, too.

Mrs. Beckett

Will the hon. Gentleman give way?

Mr. Fabricant

Perhaps the right hon. Lady would allow me to finish dealing with the intervention by the hon. Member for York (Mr. Bayley) who, I think, was getting at the two-tier system. I should like to see a one-tier system and all doctors being fundholders.

Mrs. Beckett

I have borne, I hope with some patience, the hon. Gentleman's remarks. He seems to be entirely unaware, so may I gently point out to him, that the kind of improvements to which he refers result from GPs being involved in commissioning care and not from people being fundholders. Indeed, similar improvements have been achieved in cases where health authorities and GPs have worked together in GP commissioning of one form or another.

Mr. Fabricant

I am glad that I allowed the right hon. Lady to intervene because she displays an inordinate lack of understanding of how not only fundholders but non-fundholders work. Waiting lists are being shortened not only because hospitals are now being run more efficiently, but because fundholders are able to perform the little operations that formerly had to be done in hospital. Simple operations such as the removal of moles which, of course, could lead to sarcomas, can now be undertaken swiftly and efficiently in fundholders' surgeries. That could not be done before the reforms, and the right hon. Lady should accept that. The fact that she refuses to accept this major change clearly demonstrates that she does not have a clear grasp of her brief.

In June 1995, my right hon. Friend the Secretary of State announced that the intake of medical students had increased by some 10 per cent., and that the number will have increased by 5,000 a year at the turn of the century. That is another demonstration of the improvements that have been made in the health service, nationally and locally.

The right hon. Member for Derby, South spoke of bureaucracy. Perhaps she would now care to tell me the actual number of people employed in NHS administration. She is constantly saying that the reforms have led to more bureaucracy; has she any idea of the percentage of health service employees who are administrators, and the cost involved? I shall be happy to give way to her.

Mrs. Beckett

And I should be happy to give the hon. Gentleman the answer to his question, if the Government would publish it. However, they refuse to reveal the figures. According to our most recent estimates—which depend on some information about the finance spend—perhaps as many as 30,000 people are now employed in administration. As far as I am aware, it is not denied that the administrative costs of the health service have doubled since the Government carried out what the hon. Gentleman is pleased to describe as their reforms.

Mr. Fabricant

Again, I cannot follow the right hon. Lady's logic. First she says that she cannot gain access to the data; then she says, with great assurance, that the number has doubled. She is clearly talking off the top of her head. I can inform her—she may wish to make a note of this, and no doubt her hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown) will refer to it in his winding-up speech—that just 2.6 per cent. of total NHS spend is devoted to administration. That gives the lie to the claim that it is additional—[Interruption.] The right hon. Lady and the hon. Member for Newcastle upon Tyne, East say "Rubbish", although they have said that they do not have access to the data. The right hon. Lady now has time to find out the precise figures or to make an estimate, and I look forward to hearing that information when the hon. Gentleman winds up the debate.

The point is that the NHS is the largest organisation in Europe. It spends £110 million of taxpayers' money every day. What would the right hon. Lady do? She says, "We will not get rid of fundholders overnight; we will allow a year before we slash them"—and, no doubt, slash local people's chances of being treated locally. I wonder whether, if there had not been a Conservative Government, the Labour party would be enduring the same old health service that was set up in 1948. Does Labour not accept that demands on the service have changed substantially since then?

Incidentally, Opposition Front Benchers keep coming up with the names of doctors who disapprove of the changes in the health service. Let me remind them that the British Medical Association—including consultants and other doctors—opposed the very changes that created the NHS. If we listened to every doctor who said, "We do not want change in the NHS; we want to exist in the same old way as before, although it will mean long waiting lists and will prevent us from treating people locally," no reforms would ever be made. We would never have had an NHS.

For Opposition Members simply to sit there and say, "We will not make these reforms: we do not accept that reform is necessary," is a negation of their duty. It is almost as if, in their heart of hearts, they did not expect to be a party of government. If they were a party of government, it would not be a case of talking about templates and models; they would have to provide tangible policies and targets, which they consistently refuse to do.

Even the Labour party admits that the situation cannot continue as it was. According to a Fabian Society report, Dismay was expressed at the myth that NHS managers were evil men in grey suits"— I know some evil men in grey suits, but they are not in the NHS— and there was a plea for the Labour Party not to perpetuate this image … Comparisons were made with the tad old days', when nobody knew who managed the NHS … It was claimed that more and more nurses are taking up management positions, and that 45 per cent. are women … There were some really good things happening in NHS management, it was argued, and the Labour Party would be foolish to dismiss them out of hand Those are not my words. At least the Fabian Society is the intellectual wing of the Labour party; at least it takes some pride in trying to evolve policy, rather than engaging in cheap point-scoring as Opposition Front Benchers do. They give us point-scoring and slogans, but no policy, no targets and, as ever, no clear idea of how they would resolve the problem of more patients needing more treatment.

The right hon. Member for Derby, South spoke of bureaucracy, although she did not know the number of bureaucrats involved. She called for the abolition of GP fundholders, although that would result in a more bureaucratic system than that which currently exists. Labour wants the return of regional health authorities, and makes similar demands in its proposed reforms of local government. Who wants regional seats of government in England? No one except the Labour party. Who wants regional health authorities? No one except the Labour party. It is the party of central planning—Gosplan. It is the party of bureaucracy. Indeed, following the Monklands affair, it could be said that it is the party of jobs for the boys. All that is typical of where Labour would stand if—God forbid—it ever gained power.

It is clear that Labour wants to turn back the clock. As Stephen Pollard of the Fabian Society has said, The whole issue of the future of the health service is, if you like, a classic test of old Labour against new Labour. Have we heard from new Labour today? No: we have heard the authentic voice of socialism.

Mr. Turner

Real Labour.

Mr. Fabricant

There we have it. The Opposition Whip himself—the silent one—says that real Labour is the authentic voice of socialism. I hope that that message gets across to the right hon. Member for Sedgefield (Mr. Blair). In his heart of hearts, the right hon. Gentleman knows that the majority of the Labour party is real Labour—old Labour. The old socialists have not been changed, and the oldest socialist of them all sits on the Opposition Front Bench.

According to Mr. Pollard, Old Labour … believed in sort of top-down state planning, the men in Whitehall know best about these things, which was typically characterised by the management of the National Health Service". As I have said, those are not my words but the words of Stephen Pollard of the Fabian Society, spoken in "On the Record".

Once again we have heard the authentic voice of socialism which, we are told, is the voice of real Labour, which is new Labour—it is the same thing. We have heard a criticism of the national health service as run by the present Government; yet we have heard nothing about how the Labour party would run the service if it ever formed a Government. When challenged by me and by others, Labour Members do not answer the question, "What targets would you set for patient care? What targets would you set for ensuring that patients are"—

Mr. Deputy Speaker

Order. The Chair has no views.

Mr. Fabricant

I was not referring to the Chair, Mr. Deputy Speaker, or indeed to the right hon. Member for Derby, South. I certainly would not point at the right hon. Lady.

Mr. Deputy Speaker

When the hon. Gentleman says "you", he is addressing the Chair.

Mr. Fabricant

As always, Mr. Deputy Speaker, you are right. I bow to your superior experience. I ask your forgiveness as merely a new boy and unaccustomed as I am to public speaking.

The fact remains that real Labour—old Labour, the old socialists, the Gosplans and central planners of this world—has no central plan. Its members simply carp, criticise and come up with slogans. When asked to come up with targets, they answer, "We have no targets. We can provide no targets."

The Government do provide a truly national health service in that the national health service should always be available free of charge to people who need it. Under this Government, it will always be nationally funded, but, whether it is the Soviet Union, which determined that central planning did not work, IBM, or any company in this country that knows that centralised planning never works—

Mr. Bayley

Will the hon. Gentleman give way?

Mr. Fabricant

I will give way to the hon. Gentleman. I was just about to conclude my speech and I know that he will be upsetting his Front-Bench team, but I am happy to give way to him.

Mr. Bayley

The hon. Gentleman says that he is against massive bureaucracies, but does he not agree that, as part of Conservative reforms, two further tiers of bureaucracy have been introduced between the Department of Health and the national health service—the NHS management executive and, beneath it, the regional offices of that executive—and that both tiers are accountable upwards to the Secretary of State for Health rather than outwards and downwards to the service, which was the case with the old regional health authorities? Two layers of bureaucracy have been introduced to replace one.

Mr. Fabricant

The hon. Gentleman has studied his brief, is well aware of the facts and has stated correctly that those tiers exist, but he has failed to observe that the number of staff in those bureaucracies has been reduced fivefold. There must always be some overall control of matters such as epidemiology, which, incidentally, no Labour Member has—

Mr. Bayley

Health planning.

Mr. Fabricant

Does the hon. Gentleman wish to intervene?

Mr. Deputy Speaker

Order. We should be getting on with the debate.

Mr. Fabricant

I thought that the hon. Member for York was trying to say something. The whole point of the reforms, as the hon. Gentleman obviously knows from his own experience in York, where I know there are many fundholders, is that local fundholders can direct where patients should go and, for the first time, perform operations that they were previously unable to perform.

I remind the House that every doctor gets two degrees, not one. Any doctor who graduates in England or Wales gets a degree in medicine and a degree in surgery—he becomes a Bachelor of Medicine and a Bachelor of Surgery. That enables him to perform minor surgery in his local trusts. The hon. Gentleman will know that the reforms in York and those that my right hon. Friend the Secretary of State has made in channelling money northwards away from London enable his patients to be directed to local hospitals, which are run now by local people. That is local accountability. That is not centralism. That is a framework in which the NHS has clearly demonstrated that it can reduce the number of people on waiting lists and that the number of patients treated can be increased considerably.

The hon. Member for York and his right hon. Friend the Member for Derby, South have come up with no proposals as to what they would do in office. All that they come up with is slogans. Here we have had it—the authentic voice of socialism: plus ça change, plus c'est la même chose.

5.43 pm

Mr. Kevin Hughes (Doncaster, North)

In the short time since my election to this Chamber—three years—I have heard some nauseating nonsense from Conservative Members, but that takes the biscuit.

It is appropriate that we are having this debate today, which has again been initiated by the Labour party. In my three years here, I do not believe that the Government have initiated one debate on the national health service. It was appropriate to hold the debate today because it allowed the Secretary of State for Health to give her swan song—and what a swashbuckling attempt it was. I am sure that by the end of the week she will be looking for a new post.

The debate is especially appropriate following the publication last week of Labour's policy document "Rebuilding the National Health Service", which was ably launched by my right hon. Friend the Member for Derby, South (Mrs. Beckett). The Secretary of State said that Labour would turn back the clock and return to a command-style national health service. Her criticisms were tongue in cheek and were levelled without foundation. Labour's plans will improve the service that the NHS can give patients, and secure the NHS as a public service for generations to come.

The founding principles of the NHS have been utterly undermined by the Government's policies. Their reforms have introduced competition into the NHS. They have sabotaged the principle of treatment on the basis of clinical need and instead have introduced finance as the main factor that determines whether people receive care.

The NHS was set up to ensure that payment would no longer be a condition of treatment, but the Government have reversed that. They have turned those principles upside down. The internal market has created a system of competing health businesses, each vying with each other for its own niche of the market. That has caused inflexibility, duplication and waste. It has also led to a secrecy and a lack of accountability that has been damaging the service overall, as well as the interests of patients.

The ideology that the Conservatives have imposed on the NHS is totally at odds with its purpose. A collective, co-operative approach is needed to maximise efficiency. What is needed now is a commonsense approach to the NHS to rid the system of the commercialisation, fragmentation and privatisation that the internal market has caused.

Labour will maintain managers' ability to manage at local and regional level to secure the most appropriate services for patients in their region. Services will be properly planned. Duplication and waste will not be tolerated under Labour. Patients must be treated, first and foremost, according to clinical need, but the Government's reforms have perverted that principle. Patients of fundholders may receive quicker treatment than some people whose care is paid for by the health authority, especially if its contract is nearing its end, as happens at the end of every financial year. We have heard stories—and we have checked them out and know them to be true—that, come the end of the financial year hospitals are told by general practitioner fundholders, as they are by different health authorities, not to carry out operations because they are running out of money.

Charges for eye and dental check-ups were introduced and charges for prescriptions have spiralled over the 16 years of this Government. We know that one result is that people have been discouraged from taking eye tests. The number of tests fell dramatically when charges were introduced. We also know that NHS dentistry has been sabotaged by the Government's policies. In May 1995, the General Dental Practitioners Association reported that, since 1990, the proportion of dentistry carried out in the NHS had fallen by one third. I know from experience in my constituency of Doncaster, North that dentists have written to patients, saying that they will not treat any more NHS patients and offering them private cover.

Patients are being told that they can wait months to see a consultant, or choose to pay £50 to see the same person privately the following week if they can stump up the money: for some people, that is some choice. With 1 million people on waiting lists, there is a real temptation for people to take that option, but, of course, not everyone can afford to, and the Government know that.

Time after time, Government policy has undermined equal access to treatment and treatment based on clinical need, with the least well-off in our society the worst affected. Today, the British Medical Association chairman asked a question: where stands equity when the cash lottery dictates priority to patients with lesser need? At the same time as the market is skewing equal access, lower-income groups continue to suffer more ill health than the rest of society. With economic inequality on the increase, inequalities in health have become more marked.

There is evidence that the service in deprived areas is lower than in other parts of the country, but the Government refuse to take account of deprivation through changes to the funding formula. As bureaucracy has spiralled, health care has suffered. Nationally, about 12 per cent. of the health budget is spent on administration. In Doncaster, administration costs increased by 48 per cent. following the introduction of the internal market, rising to £6 million. Management costs have spiralled even higher.

The Government deny any problems. It is clear that Health Ministers do not read the newspapers and do not listen to either their Back Benchers or Labour Members. Patients are being flown miles across the country to find beds. People are waiting for hours on trolleys because there is no proper space for them in local hospitals. In Doncaster, a number of patients have been farmed out to other hospitals because no beds have been available.

Those are real problems affecting real people, but the Government's response has been non-existent. Instead, they just get on with the job of upsetting health service staff by offering the nurses a pay award of just 1 per cent., by ending national pay, by lumbering them with more administration, by undervaluing their contribution and by failing to listen to their concerns. One trust in Doncaster has not paid the full 3 per cent. award—only 2.5 per cent., with a 0.5 per cent. top-up for this year. That means that in years to come nurses will be 0.5 per cent. worse off. With inflation currently at 3.4 per cent., that is little more than an insult to the people who run our NHS.

Labour recognises that patients and staff are people, not units on a production line. They must all be treated with respect and their views listened to. The Government are failing to do that. The long-running dispute with dentists, the imposition of local pay and the dispute over out-of-hours work by general practitioners proves that. Patients need a voice too, and Labour will tackle the secrecy that the internal market has created, ensuring that both patients and staff have a say in their NHS. Labour will bolster the community health councils as advocates for patients.

In "Rebuilding the National Health Service", Labour has comprehensively set out its vision for the national health service. It is a practical, effective recipe for improvement—a way of removing the worst excesses of the internal market and bringing some sanity back into the NHS—

Mr. Fabricant

Will the hon. Gentleman give way?

Mr. Hughes

No, many of my hon. Friends are waiting to speak and we are running out of time.

The Government say that the NHS is safe in their hands, but for those who have had to wait months for operations, for those whose operations have been cancelled—14,500 people in the first three months of this year alone—and for those denied services while others jump the queue, Labour has a more impressive agenda to offer. We will dispense with the policies that have left some unfortunate people with a second-rate service; we will introduce a system that can provide a service second to none, which is fair in its distribution of services and effective at meeting the demands of those in need.

We have our agenda for change. The Government will not accept the need for change. The Government must go—and given the current shambles on the Conservative Benches that will be sooner rather than later.

5.53 pm

Lady Olga Maitland (Sutton and Cheam)

The hon. Member for Doncaster, North (Mr. Hughes) made one true statement—that patients need a voice. How right he is, and that voice is coming from the Government. It has been passionately expressed by my right hon. Friend the Secretary of State for Health. I can think of no other person who has gone to greater lengths or shown greater commitment to giving patients a voice.

The Labour motion is a complete rag-bag of ideas. It focuses more on "growing alarm" than on any real care and concern, for the patient. Bearing in mind the fact that the Opposition tabled the motion, if they have so much care and concern, why are not their Benches full of Labour Members? Where are they? Their so-called concern for the patient is hypocrisy.

The Government have worked hard for years to get a good deal for patients. Indeed, the evidence of that is clear in the Government's amendment, which points out that over one million more patients are treated in hospital every year and waiting times have fallen to the lowest on record". Why was the right hon. Member for Derby, South (Mrs. Beckett) incapable of paying tribute to those remarkable achievements? Why is she blind to progress? It strikes me that the Labour party is attempting to politicise the health service, rather than focus on patients.

We kept hearing emotive words from the right hon. Lady, such as privatisation is an ogre and the private finance initiative is a dirty phrase. I can tell Labour Members that the PFI will give the NHS a boost and broaden its imagination in a way that has never happened before. I draw the attention of the House to an innovative programme that has been proposed in my constituency for a new Sutton medical campus, which will have the latest in technology and services for patients. How is that to be carried through successfully to the next century? It is by consulting and working with a private finance initiative. I have no doubt that patients throughout the south-west London area will benefit enormously.

Another thought occurred to me when I was listening to the right hon. Lady. Among all her incoherence, she gave me the feeling that she had to alter the NHS just for the sake of it. I maintain, "If it ain't broke, don't mend it." Indeed, what is remarkable is that the NHS is providing a better service than ever before. The greatest evidence of that is that people are now living healthier lives and for much longer because of preventive care—[Interruption.] That does not happen by accident; it is a result of excellent treatment.

Mr. Alex Carlile

Is the hon. Lady satisfied with a situation in which poor people live, on average, eight years less than affluent people?

Lady Olga Maitland

The whole point is that everybody has a different life style. If people choose an unhealthy life style, it is difficult to impose better habits on them.

Mr. Carlile

They are poor people.

Lady Olga Maitland

Yes, but does the hon. and learned Gentleman accept that the NHS helps everybody in the community, irrespective of income? With better preventive care than ever before, everyone in the community is leading a healthier life—[Interruption.] If people choose to smoke cigarettes, that is their choice—

Mr. Carlile

So it is down to fags and chips then.

Lady Olga Maitland

If people choose to eat an unhealthy diet, that is their choice. We can offer them the opportunity of a healthier life. There is no evidence that people on low incomes need necessarily live shorter lives. The hon. and learned Gentleman's comment was bogus.

Let us look at the broader picture in the health service today. It is remarkable that the health service is spending £110 million a day on patient care. Sadly, that message does not always get across. When talking to people in the street, I find that the responses are curiously paradoxical. I ask somebody, "How are you getting on?" They might say, "I am getting on very well, thank you." I ask, "Have you recently had any health treatment?" They say, "Oh, yes; I received wonderful service. My operation was carried out promptly, the doctors were dedicated, the nurses were marvellous and I am home, fit and well." I ask, "Why, therefore, are you and so many other people worried and fearful for the future of the health service?" The answer comes back over and over again, "It is what Labour says on television, what Labour says in the media, what Labour says through its politicians."

There has been a very dangerous and irresponsible misinformation campaign. The Labour party is playing on people's fears; it is playing on the fears of elderly people, of young people, of young mothers. That is utterly wrong. Instead, we need to consider their experiences.

In my constituency, the successful St. Helier NHS trust is treating more people every year. Operations are performed more promptly, waiting times are shorter and more out-patients are treated. The Royal Marsden hospital is also in our community. It has an excellent reputation throughout the world for the service that it provides and it is backed by the Institute of Cancer Research, whose research is second to none. More people are screened earlier for cancer, they are treated earlier and their survival rate has vastly improved. No longer do they suffer the fears that they had before.

With modern technology and medical science, GPs are finding that the whole picture has changed. The concept of day surgery has changed the face of modern medicine. We no longer need the same number of acute beds. Day surgery has meant that people recover more quickly at home. They are back on their feet and back to work more quickly. Modern medicine with modern management has made all that possible.

Waiting times have been a curse in the past, and it is interesting to note that, before our reforms, more than 200,000 people were waiting more than a year for hospital treatment. Today, the figure stands at only 31,600—the lowest since 1948. Indeed, over the past six years, the average waiting time has been cut in half. Half of all patients are seen right away—on the spot. The GP rings up, the appointment is made, the patient is seen; half the remainder are seen within five weeks. Nearly 75 per cent. are seen within three months and 98 per cent. are seen within a year. That leaves a tiny percentage of patients who have to wait for more than a year—the least urgent cases. Enormous progress is being made in our health service.

Those improvements have been noted. A British social attitudes survey published in November 1994 showed that more people were satisfied than not. A survey conducted for the National Association of Health Authorities and Trusts in 1994 showed that nine out of 10 patients who attended hospital in 1993 found the NHS very good, good or average and that three out of four found the service very good or good. That is a tremendous improvement on the past.

I shall turn briefly to the success of GP fundholding practices. I know that the Labour party is absolutely committed to sweeping away the independence of GP fundholders. Its deadly campaign against the independence of GP practices is very similar to what it tried to do to grant-maintained schools. It hates anybody or any authority having the ability to think and manage for themselves. It wants to drag people willy-nilly back under its centralised control and management—politicised management at that. Meddlesome Labour Members cannot let go and cannot stop interfering with other people's lives.

Even Labour party advisers have recognised the dangers of the interventionism that it advocates. Professor Julian Le Grand, founder of the Socialist Philosophy group, has described the health service as "the biggest success story" and noted that GP fundholding is now widely thought to be at the cutting edge of the reforms". Professor Brian Abel-Smith, vice-president of the Fabian Society, co-authored a recent article which said: There is now overwhelming evidence that fund-holders are able to get a better deal for their patients from hospitals … Fund-holding represents a major transfer of power from specialists to GPs". The success of fundholding has also been highlighted and praised by the Organisation for Economic Co-operation and Development, the National Audit Office, the King's Fund Research Institute and a four-year independent evaluation into GP fundholding in Scotland carried out by Professor John Howie and his team at Edinburgh university.

Why should the patient believe that the Labour party holds out any hope for progress or improvement? As an NHS patient, like anybody else in my constituency, I fear the Labour party's doctrinarian ideology. I fear the fact that Labour wants to bring politics into clinicians' decision making, undermining their work. I fear that patients will be faced with the gobbledegook of the Labour party. When the Labour party talks of comprehensive health care agreements, it means interference and meddling.

The Labour party will try to destroy incentives for hospitals to improve health care. I cannot see how that will benefit the patient.

Mr. Bayley

Will the hon. Lady give way?

Lady Olga Maitland

I am sorry, but I shall continue with my speech because I know that other hon. Members want to speak. At least one Labour Member wants to speak after me—at least I hope that he does; otherwise, it would show the paucity of Labour representation in this debate.

The Labour party is committed to abolishing compulsory competitive tendering, which will divert £100 million from patient care. I cannot see how that would benefit the individual. It is also going to persist with the minimum wage, which will cost the NHS £500 million. How will that help the patient? Surely we should concentrate all available resources on the patient himself.

The patient now faces a nightmare scenario. If this country ever decides to go down a socialist route, the patient will find that he comes second to confused, left-wing ideologies. I believe firmly that when patients look to their own interests, they will realise that there is only one way forward—the Conservative way.

6.9 pm

Mr. John Gunnell (Morley and Leeds, South)

It is always a pleasure to follow the hon. Member for Sutton and Cheam (Lady Olga Maitland). When she looks at the Conservative central office brief, she should study the articles from which she takes her selective quotations. If she looks at the article by Brian Abel-Smith, to which she referred, she will find that there are references to some of the shortcomings of the fundholding system. Indeed, the article concludes that the Labour party should consider putting substantial extra funds into services in poorer areas. The hon. Lady was asked earlier about the health of poorer people, but she completely ignored the question. There are grave inequities in health care in our present system and it is important that they are corrected.

The hon. Member for Sutton and Cheam was wrong in some of the factual points she made. A constituent wrote to me recently saying that following a first appointment, she was told that she would be on a 78-week waiting list. Her back condition meant that she could not carry on with her work, so she was forced to seek private assistance; she could not wait 78 weeks to get back to work. Another case concerns an 84-year-old lady who required an urgent bladder operation. Her sons were able to pay for her to have the operation and did so. They did not, however, take her off the waiting list because they were interested to find out just how long it would take for her to have the operation under the NHS. It was two years later that she was told that she could have the operation for which her sons had paid two years previously. That 84-year-old would have had an inordinate wait which she should not have had to suffer. There are real concerns which the hon. Member for Sutton and Cheam simply ignores because she sees the NHS through rose-coloured spectacles. Perhaps Sutton and Cheam is very different from the areas that other hon. Members on both sides represent.

The Secretary of State was a little petulant in her opening speech. I am sure that she has seen the Labour party paper, "Rebuilding the National Health Service", to which my hon. Friend the Member for Doncaster, North (Mr. Hughes) referred. She must have been able to see that it was a constructive paper. It was also obvious that the hon. Member for Mid-Staffordshire (Mr. Fabricant) had not read the paper because most of what he said about it was completely wrong.

The Secretary of State and the Minister of State no doubt expected a wrecking paper. They find, however, a paper that is constructive in its approach to the NHS. It makes it clear that the reforms already in place will evolve. Some practices will be jettisoned because they cannot conform to the principles that we espouse for the health service. On the whole, however, the reforms will evolve to meet our principles and without any worsening of patient care or of the service given by GPs. It is obvious that our proposals will be welcomed by patients, by health professionals and by health authorities. Under the present system, health authorities could find themselves in conflict. The reforms recently introduced would reduce the significance of the health authorities and reduce their health promotion and health purchasing roles. I am convinced that the reforms that we will put in place and the transformation that we will bring will benefit the health service and the British public.

It is clear that our first principle is that of a national health service. We do not believe in a service that is an oligarchy, as suggested by the hon. Member for Mid-Staffordshire, in which all power is centralised. We believe in a service in which regional power and local power exist. We clearly state that we intend to ensure that at the local level, the people who operate the health authorities have a degree of local accountability and that accountability becomes a much more important word. Through the changes that we shall make, we shall reduce the inequities in the service and restore the accountability of the service. We shall make our changes on the basis of the minimum disruption to patient care.

The hon. Member for Sutton and Cheam also suggested that the wording of the motion was inappropriate at almost every point. The motion is clearly worded to show that we have a choice between an increasingly privatised service and a service that returns to being a truly public service. It is important that we consider that point now, when the level of privatisation in the health service is about to increase considerably, if the Conservatives remain in power.

In the early years of the reforms of the health service, the Government did not find it easy to progress privatisation. The market that they set up was not a real but a bogus or quasi-market. Both purchasers and providers depended on public finance. Although in their roles as purchasers and providers they entered into contracts and although money was transferred on the basis of episodes of patient care, the money was almost always public money which was transferred from one body to another. The market was often self-consciously not a market in terms of the normal market mechanisms that the Conservative party espouses.

As members of Leeds Health Care—the Leeds health authority—we were given strict instructions when the authority was set up about the two major hospitals in Leeds. Whatever prices we arrived at through the contracting procedures—one of the hospitals appeared for most purposes to be more expensive than the other—it was regarded as important that each of the hospitals remained viable and in existence. I entirely supported that view. Leeds clearly needs both the Leeds general infirmary and St. James's University hospital. A current review of Leeds health services will, I hope, start from the basis that each hospital is needed. I understood, therefore, why the market mechanism was not a normal market mechanism, but one in which there were priorities other than simply accepting the lowest tender.

It has been difficult for the Conservatives to progress their privatisation proposals as they wish. There is abhorrence in this country at the idea of making money out of people's ailments. There are other societies where that is not the case. Having lived in the United States for eight years, I am well aware that one can enter a completely different system in which one can feel vulnerable. I felt vulnerable when I took children to the United States, as one child developed pneumonia—a condition not covered by insurance. He had experienced that condition in the year before going to America. In those circumstances, one recognises the great strength of the NHS.

Despite what the hon Member for Mid-Staffordshire asserted, the NHS is now not free at the point of delivery. There are charges to pay at many different points of delivery, as the hon. Gentleman and other hon. Members well know. Nevertheless, the NHS provides a level of support that is absent in what one might call the more traditional financial market in health care. The Government have been slow to develop the private market in health care in the NHS.

The debate comes at a critical point, because it is clear that a number of initiatives are progressing apace. One specific area that has been developing since the introduction of the Community Care (Residential Accommodation) Act 1992 is the provision of private nursing care. We are aware that many hospitals seem to have a mechanism whereby people move rapidly from hospital care to private care.

Highlighted in The Independent recently was the work of Michael Fallon, a former Member of the House who lost his seat to my hon. Friend the Member for Darlington (Mr. Milburn). Mr. Fallon, who made it clear that he was developing "Quality Care", a private nursing home group, was a member of the Government's deregulation task force and an adviser on the private finance initiative.

Mr. Fallon suggested that it was important to take the initiative forward, and he looked forward to a time when companies which are at present operating nursing care will be allowed to run entire hospitals, including the employment of doctors and nurses, on behalf of NHS trusts. The private finance initiative is currently concerned with the various ways in which money can be made through the NHS. I do not think that the NHS has yet created any individual millionaires through the initiative, but that is seen to be a possibility for the future.

The Opposition have never taken the view that there are no appropriate ways in which the public and private sectors could work together, but there remains a suspicion of the direct involvement of the private sector in making profits out of health care.

Two other aspects have been highlighted recently. One is the increasing use of NHS facilities—in particular hospital facilities—to assist private patients. An article in the same edition of The Independent referred to the Royal Surrey county hospital at Guildford, which will be well known to the Secretary of State, and talked about its provision of facilities for private patients. The article stated that those covered by private care—some 11 per cent. of the population—accounted for one in five of all those on the waiting lists for surgery. The facilities are being made available to the private sector because the income is extremely important to the trust, and the article made it clear just how important.

It is clear that there is preferential treatment as far as the receipt of surgery is concerned, which suggests that we have not a two-tier but a three-tier system. Those in the private sector have the best care, with those who are being treated by GP fundholders next on the list. The patients being treated by non-fundholders are at a lower stage.

Dr. John Yates has made a study of consultants and the incomes that they are receiving from private sector consultancies. He is concerned about the level of that private sector work in comparison with their public sector work. There will be a big increase in the level of privatisation in the service if the present Government remain in control, and that could well be to the loss of many people who rely on the health service in all circumstances.

It is important that people see that the Labour party's proposals in our recent document are constructive. In relation to GPs, we are proposing not to sweep away fundholding but to introduce a system of local commissioning on a wider scale so that the choice which is available currently to fundholders becomes available to non-fundholders too. I have seen examples in Leeds where operations were denied to non-fundholders because the contract was used up, and people wanting certain types of surgery have had to wait until the next financial year.

It is important that there is equality at GP level and that all GPs have similar access to hospitals and to hospital care. Far from being rigid, the pronouncements in our document make it clear that there will be many different forms of local commissioning and that we will encourage experimentation in that commissioning.

Our proposals are extremely constructive on trusts. The Secretary of State referred to trusts and their record of producing patient episodes, but what is not clear is the gain that trusts receive from being the owners of the hospital and from having a property management role. Our paper refers to hospitals, which makes a difference from most of the papers that we see nowadays. It is right that those hospitals are clearly publicly and communally owned, and not owned by individual trusts.

Lady Olga Maitland

Is the hon. Gentleman advocating political involvement in health trusts, and that councillors should take decisions over the heads of clinicians? All the evidence that the Labour party has given suggests exactly that. I cannot see how a patient would in any way benefit from such a system.

Mr. Gunnell

The hon. Lady ought to read the paper, and she will see that that is not the case. Of course, there may be a role for some members of a council. We have suggested, for example, that it may be constructive for the chair of a social services committee to be a member of the health authority. I was the chairman of a social services committee in Leeds and a member of the health authority, and it was possible to assist in getting those two bodies to work together. But we are not suggesting that all the people involved should be elected members. There should be a valid local reason for such a person to be a member of a health authority. We are not suggesting that they should all be elected members, but it is important to have some link with the local authority. Nor are we suggesting a lack of involvement on the part of professionals in the health service. Indeed, our proposals make it clear that there will be a wider role for them and that consultation with them will be an important factor in decision making.

The health service is at a crucial stage. A change of control is vital for the future of the service and, therefore, I very much look forward to the time when my right hon. Friend the Member for Derby, South (Mrs. Beckett) takes charge.

6.30 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East)

This debate has certainly drawn out the philosophical differences between the two political parties. The Opposition believe in a national health service based on the public service ethos, and the Conservatives believe in fragmented private markets.

As our motion makes clear, it is our fear that the public service ethos that underpins the NHS is being eroded. My hon. Friend the Member for Doncaster, North (Mr. Hughes) said that a doctor's first duty is to the patient—a point of view that is unexceptional on the Opposition side of the House. Mr. Roy Lilley, a leading Conservative thinker on such matters, and a man who is regarded as being in the vanguard of the Secretary of State's reforms, said recently that a doctor's first duty should be not to his patients, but to the employer. Every patient should carefully note that point of view, which comes from the Conservative side of the House.

The public service ethos of the national health service is undermined by the Conservative party's trusts. They are inserting gagging clauses in staff contracts, bringing a cult of Stalinism into the NHS, and preventing clinicians from speaking out. Recently, the Conservatives had the nerve to accuse us of wanting a command-and-control national health service, but it is they, not the Opposition, who have just renationalised functions that used to be carried out at the regional level of the NHS, but which are now being taken in-house, under the Secretary of State's direct control.

On the ground of commercial confidentiality, the Secretary of State is allowing national health service trusts—apparently still publicly owned—secrecy over their affairs. Commercial confidentiality in a public service—those two concepts do not sit happily together. The Nolan committee expressed concern at the appointment procedures used for the boards of NHS quangos. The chairman of the British Medical Association said today that the national health service is not so much an internal market as an infernal bazaar, in which considerations of cost reign supreme, whilst concerns for value and values are relegated to second place. Those concerns are echoed by the clergy. Last year, the Bishop of Birmingham described the reforms as distressing, unchristian and morally wrong. This year, the Bishop of Ripon denounced the internal market, and pointed out that it leads to a "lack of patient choice".

The Government defend what they have done on the ground that it has brought about efficiency savings that have benefited patients. We can see that they have brought about a substantial increase in NHS bureaucracy. It is harder to demonstrate that that has been to the benefit of patients. Until the reforms were introduced, administrative spending in Britain's health service was among the lowest in the world. At the moment, for every £10 spent in the health service, £1 is spent on administration. In 1989–90, it was £1 in every £20. That is a substantial increase.

The administrative costs of GP fundholding average £80,000 per practice, and trusts have spent around £117 million on conveyancing and image building. Every trust was given a one-off payment of £300,000 towards set-up costs.

Increasing bureaucracy has made patient admissions to hospital more complicated. It is a time-consuming paper-chase, and it was condemned in an article in the journal of the Institute of Economic Affairs, in June—a right-wing institute and not one associated with the Labour party. It described the red-tape nightmare in today's national health service thus: The very act of getting a patient on to a waiting list and then admitted has become a bureaucratic obstacle course for clinicians. The patient's postcode must be matched to their DHA. The GP must be identified in case they are fundholding. The procedure must be checked to see if it is chargeable to the GP or the DHA. The contract must be scrutinised to ensure it covers the proper operation … Sending the patient for admission requires many more hurdles to clear. An audit of one unit's admission process found 24 different steps were now required before the patient could be sent for. The institute concludes: It is difficult to reconcile this with the White Paper's assertion that the 'reforms will make it easier for consultants and their colleagues to get on with the job of treating patients'. That quotation is from a right-wing institute, not the Labour party.

Recently, the Select Committee on Health studied the London ambulance service to find out how well the Secretary of State's reforms were doing. I attempted to intervene on the Secretary of State, but she did not let me, and it will be pretty clear why when I read this passage from the report. That all-party Committee, which commands great authority in this place, had this to say about Ministers: We do not think that Ministers can be absolved of blame for the sorry record of the LAS. Ministers represent the final link in the chain of accountability. Had the political will existed at Ministerial level, the problems of the LAS might have been effectively addressed years ago. We are heartened by recent assurances that the political will does now exist. We will wait and see what that turns out to mean in practice.

The Government's reforms have been accompanied by cost cutting on patient care. The recent scandal over the National Blood Authority purchasing cheap blood bags, which have turned out to be defective, has caused widespread public concern, as well it might. Running parallel—this might almost stand as a vignette for the entire NHS—to that scandal, which has relied so much on public good will to help sort it out, there has been a change in the structure of the key management of the service.

Where previously one director and a small staff would do, there are now 23 key managers, including 11 regional chief executives, some of whom are paid more than £100,000 per year, as well as getting a nice new leased car. The public look at the bloated management and the failing service, and draw their own conclusions.

In debate after debate—all initiated by the Opposition, as my hon. Friend the Member for Doncaster, North rightly pointed out—we have heard of wards running at dangerously high capacity because of the relentless, management-led drive to get rid of beds. We have heard of casualty departments shutting their doors to new admissions—for almost 40 hours at the Homerton hospital, which is a case in point. We have heard of patients being driven and flown hundreds of miles to find an available specialist bed.

The situation is especially serious in intensive care, sometimes with fatal results. More and more patients are having their operations cancelled at the last minute before admission because of bed shortages. Psychiatric departments in inner London hospitals are regularly running at capacities of as much as 120 per cent., with the result that seriously mentally ill people, who are in need of treatment, are being turned away.

The Secretary of State must be proud that new wards are being named after her, even if they are only corridors with trolleys parked up in them.

Lady Olga Maitland

Cheap.

Mr. Brown

That is exactly the point—it is cheap. The hon. Lady is right. That is our criticism of what is being done. The money should be spent on patient care, rather than on a burgeoning bureaucracy.

The service is over-reliant on junior doctors. We have the worst patient-to-consultant ratio of many our European neighbours. We over-use bank and agency nurses to drive down the staff bill. The only area where NHS trusts are not attempting to keep the wages bill down is that of senior managers' pay. In 1993–94, the remuneration of trust chief executives rose by an average of 6.6 per cent., which is particularly remarkable given that there was a public sector pay limit of 1.5 per cent. for that year. Perhaps managers no longer regard themselves as part of the public sector.

Local pay is designed to push down wages and terms and conditions of employment. Apparently, it is now intended that it will apply to junior doctors as well as to nursing staff, with individual trusts instead of regional authorities holding their contracts. I presume that that is a prelude to local pay bargaining for junior doctors as well.

No wonder staff morale is at rock bottom. A survey in Doctor magazine found that 75 per cent. of doctors would leave the national health service if they could. The number of consultants taking early retirement has increased by 212 per cent. since 1988. The range of national health service employers are finding recruitment more and more difficult. The position is particularly bad for nurses and junior doctors, and it is difficult to get GPs to serve in deprived inner-city areas.

It is exactly that emphasis on primary care that is the Government's justification for removing secondary services, particularly hospital beds. The Government's amendment boasts that waiting times have fallen to the lowest on record". As a number of hon. Members have mentioned, Dr. Christopher Colton had something to tell us about that over the weekend. He says that the way in which he was ordered not to exceed his targets meant that he had to close his children's clinic for about four months and have no referrals. As he points out, it logically followed that he was seeing so few people that another target, that nobody should wait for more than 30 minutes, was 100 per cent. successful and he was rewarded with a £20,000 bonus. If a service is shut and the number of people who use it is thinned out, naturally one achieves that target, but it is a reprehensible way to run a public service.

We believe in a unified public service, as my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) pointed out. The Under-Secretary of State said recently that he sees no reason in principle why the private sector should not run entire hospitals on contract to the national health service. Expenditure on purchasing care from the private sector has increased by some 80 per cent. between 1992–93.

My hon. Friend the Member for Birmingham, Northfield (Mr. Burden) referred to the private finance initiative, which transfers risk to the public sector and profits to the private sector, and referred to its failings in his constituency.

Market testing in the national health service is progressing apace. Thirty clinical services have already been market-tested for privatisation and 1,100 private companies are on a Department of Health market testing database. The privatisation agenda is clear from a recent directive issued by the national health service executive, which expresses its concern that Collusion between providers and purchasers may prevent the entry of other organisations"— I presume that that means private health care firms.

The Labour party believes that there should be no entry of other organisations, and that both purchasers and providers should be publicly owned. It is interesting that the Government's motion does not refer to the public ownership of those who have the provider functions. It welcomes the Government's commitment to a strong and stable publicly-funded NHS but does not go on to say that the trusts and general practitioners will be in the public sector. The implication of the Government's amendment is that that will not be the case.

The Conservative party has been in government for a long time. Perhaps power brings a complacency of its own. Let me tell Conservative Members what a former leader of the Conservative party, Disraeli, had to say when the Conservatives had been in opposition for 19 years: A leader should not be afraid to dismiss his followers. The modern Conservative party, before its 19 years in opposition, clearly believes that the followers must not be afraid to dismiss the leader. The only thing that can be said with certainty about the last 10 days' events is that Mr. Hugh Grant has done his chances of getting elected leader of the Conservative party no good.

Today's BMA conference, perhaps anticipating the outcome of tomorrow's vote, has heard Dr. Sandy Macara say: We are labouring under an alien regime". The present Secretary of State is apparently willing to do so. Her statement that she is willing to serve in a Redwood Government—we have not been told that she has been asked to serve in such a Government—may say something about the likelihood of her services being retained by the present regime.

I do not understand how the Government can come before the House with a motion boasting of success, when the whole world knows that the architect of that success is about to be fired. I do not see how the Secretary of State for Health can offer to serve under Mr. Redwood when their views are so obviously at variance. She will no doubt double cross that bridge when she comes to it.

Mr. Redwood—

Madam Deputy Speaker (Dame Janet Fookes)

Order. I remind the hon. Gentleman of the convention that hon. Members do not refer to colleagues by name.

Mr. Brown

My problem is that it is difficult to keep up with the resignations, and I was not sure how far the right hon. Member for Wokingham (Mr. Redwood) had gone.

In his manifesto and recent speeches, the right hon. Member for Wokingham, as he is at the time of speaking, has offered to keep local hospitals—he describes them as "cherished institutions"—and to recruit more medical staff. He boasts that he will spend up to £114 million on the national health service in Wales next year. He also offers to cut taxes by £5 billion. Those policies are clearly the product of a great mind. He is right to want to breathe life back into the national health service, but combined with his tax cuts it will clearly be "life, John; but not as we know it."

While the Opposition deplore Mr. Redwood's drive towards the privatisation of public service—

Madam Deputy Speaker

Order. The hon. Gentleman has forgotten my previous admonition. He must refer to the right hon. Member for Wokingham (Mr. Redwood).

Mr. Brown

Yes, Madam Deputy Speaker. We deplore the drive towards privatisation of the hon. Member for Wokingham —

Dame Elaine Kellett-Bowman

Right honourable.

Mr. Brown

The hon. Lady is right.

Madam Deputy Speaker

Order. Those matters may safely be left to me.

Mr. Brown

I think so too, Madam Deputy Speaker. I was certain that the Prime Minister would not have deprived the right hon. Member for Wokingham of his membership of the Privy Council.

The right hon. Member for Wokingham has spoken of the shining principles of the national health service"; our motion speaks of "the cherished principles". The right hon. Gentleman has condemned excessive bureaucracy; our motion condemns excessive bureaucracy. Our motion calls for a slowing down of the passion for reorganisation". We lifted that phrase word for word from the right hon. Gentleman's speech.

Our motion calls for change in the national health service to be based on health arguments, not financial considerations. The right hon. Gentleman said that change in the national health service must be based on the health arguments, not financial considerations"— just as our motion says. Clearly, the right hon. Gentleman's advice to Conservative Members is, "Save your seats." I must tell them, "Vote for Labour's motion." May I add some helpful advice of my own to those Conservative Members who really want to save their seats at the next election: the very best chance they have is to stand as a Labour candidate.

6.48 pm

The Minister for Health (Mr. Gerald Malone)

I shall resist the temptation placed before me by the hon. Member for Newcastle upon Tyne, East (Mr. Brown) to follow him down his road of puns instead of discussing the substance of the debate. It has been an extraordinary debate, because it afforded an opportunity for the Labour party to set out with some clarity what lay behind its paper, so recently published, about the future of the health service.

Straining at the speeches of the right hon. Member for Derby, South (Mrs. Beckett) and her Opposition friends, it was obvious to me that what was certain about that document was that there was a change of philosophy. It is a centralist philosophy, concentrating power in an old-fashioned health service whose time has gone. It was a philosophy of replacing bureaucracy, recently abolished, and it was a philosophy of taking away from clinicians the discretion that they have been given by the Government—no more so than in GP fundholding.

The debate was typified, again and again, by the myths and scares that we so often hear from the Labour party. I felt the same frustration during the debate that I once felt when I was in the "Today" studios at Radio 4 in the morning, when, having set out the facts of the matter, I was greeted with the astonished and pathetic plea, "The facts are all very well, Minister, but?" That is the Labour party's approach throughout: the facts are all very well, but.

I turn to a matter that was mentioned by the right hon. Member for Derby, South specifically, when she spoke about facts. She constantly tells the House—

Mr. Andrew Miller (Ellesmere Port and Neston)

rose—

Mr. Malone

I will not give way; I have been given very little time.

The right hon. Lady constantly tells the House that we skew the figures. She and her hon. Friends always pray in aid the fact that we use finished consultant episodes to organise and describe the activity that takes place in the national health service.

Let me take the opportunity to tell the House the basis for those figures, and perhaps to surprise the right hon. Lady by reminding her that the figures had their genesis in the royal commission appointed by the last Labour Government in 1976, which, when it reported, said that there was no satisfactory basis of measuring activity in the NHS.

As a result, a group was eventually set up under the chairmanship of Edith Körner, who was then vice-chairman of the South-Western regional health authority. The aim of its investigations was to find a system that would accurately reflect the information needed by management to perform complex tasks of efficient administration, effective planning and genuine accountability.

That steering group's ultimate report said that, if the work done by individual consultants as specialty groups is to be accurately recorded, each consultant episode must be separately identified. That was the basis on which the change was made.

It is astonishing that, between 1979 and 1989, when the changes were made, not only did the Labour party make no criticism of that change, but it called for the more rapid introduction of the changes. I have consulted the Official Report, and there—lo and behold—over the years, and as recently as 1988, is the hon. Member for Holborn and St. Pancras (Mr. Dobson), urging the Government, in question after question, to get on with it. What were the Government afraid of? Were they afraid that those statistics would cause them a problem?

The simple truth—which the whole House should always remember when the Labour party makes those accusations in the way it does—is that the figures were a fine stick with which to beat the Government when the Labour party believed that it would suit its purpose, but, when it became clear that the activity in the national health service, as measured by those new and well-founded statistics, was not going to fit its arguments, it started to criticise them.

It is important that as those figures, described as "mere statistics" by the—

Mr. Miller

rose—

Mr. Malone

I have told the hon. Gentleman that I shall not give way.

The truth is that those are important facts, determined using the best methodology that is available. The House should know that, and I have pleasure in placing it firmly on the record.

I turn to several of the arguments that were made in the debate. The hon. Member for Birmingham, Northfield (Mr. Burden) expressed unease about the private finance initiative as it affected his constituency. The whole purpose of the PFI is to secure better care of patients and best value for money for the taxpayer. There is a transfer of risk, often away from the public sector to the private sector. That is the intention, and it benefits the national health service.

As far as the constituency of the hon. Member for Northfield is concerned, I would remind him that the reforms have served it well. No Birmingham in-patient or day case now waits longer than nine months for treatment. All Birmingham health authorities are signed up to a target of having no in-patient or day care patient case waiting more than six months by March 1996. If the hon. Member does not believe that that is good, and a vindication of the reforms in his constituents' eyes, I believe that they feel very differently.

My hon. Friend the Member for Broxbourne (Mrs. Roe), as always, made an important speech.

Mr. Burden

Will the hon. Gentleman give way?

Mr. Malone

I am not giving way to the hon. Gentleman.

My hon. Friend emphasised the benefits of partnership with the private sector. I agree with her entirely. It is important that we are not—as the Labour party is—purblind to the benefits that others can bring to the health service. Partnership brings in extra funds and extra activity. That is to be welcomed.

The hon. and learned Member for Montgomery (Mr. Carlile) made two specific inquiries. He queried why the chief executive of Nottingham Healthcare is leaving, and he suggested, rather strangely, that he did not want any "off-the-shoulder" remarks from me. I do not quite know what that means. I believe that he meant "shooting from the hip." He has been watching too many Versace dresses in the papers recently, and he is getting his analogies mixed up.

I can tell the hon. and learned Gentleman what the background is. I repeat what I said to him; there certainly has been no interference from Government. Dr. Reynolds is leaving on 10 October 1995 to take up a new post in the private hospital sector. I understand that Dr. Reynolds has a background in the pharmaceutical industry, and that he joined Nottingham Healthcare only on the understanding that at some time he would return to the private sector.

The hon. Member for Doncaster, North (Mr. Hughes) gave some general support to Labour party policy, but he was unable in any sense to say how much better health would be under those policies.

Something was markedly absent from the debate—very much the dog that did not bark. The Labour party has published a document, and I believed that the debate might give us an opportunity to hear the answer to the following question. How much money is the Labour party prepared to add to the national health service if it intends to bring about those great changes? What will its commitment be?

I say to the right hon. Member for Derby, South, if she is saying that there will be more commitment—every implication of what she says at that Dispatch Box and in the House is that more funding will be needed—what will the level of funding be? Will she tell the House tonight that she would at least do as well as the Government have done since they came into office and during the present Parliament, in increasing resources in real terms year on year? The right hon. Lady will not answer, and she is pretending that she does not hear what I am saying by being in deep conversation with her hon. Friends.

There we are, Madam Deputy Speaker. We hear that there is absolutely no commitment—no attempt to put us right on that issue.

We have had a typical debate from the Labour party, in which Labour Members have bad-mouthed a series of things that are happening in the NHS. They bad-mouthed management, as my right hon. Friend the Secretary of State says continually. It is a disgrace to bad-mouth management, who have delivered so much in the NHS.

In the NHS, fewer people are now involved in management, as compared with patient care, than 12 years ago. Sixty per cent. of people were involved in patient care about 12 years ago; now 66 per cent. are. That is an improvement, and it is a benchmark by which the Government are prepared to be judged.

Labour Members lose no opportunity, do they, to raise scares that are unfounded? I return to an argument that the right hon. Member for Derby, South made in the previous debate about health, when she made certain accusations about events that were going on in my constituency, concerning a patient who had not received proper treatment. It is a disgrace that, even when given the opportunity to retract, she has not done so.

The right hon. Lady has managed to get herself in the position in which not only am I pretty cross about her making unfounded accusations about a hospital in my constituency, but the chairman of the trade union group in that hospital has urged her to make a formal apology, and she has not. It takes quite something for me to forge an alliance in my constituency with that gentleman.

We have heard yet another debate in which Labour Members have made sterile arguments. We have heard the Labour party's philosophy of taking the health service back into central hands, abolishing GP fundholding and ruining the discretion of trusts—trusts that are developing unparalleled levels and quality of health care. The Labour party would destroy the health service that we have created. It has been in our hands for longer than it has been in the Labour party's hands. It will continue to improve in our hands. That is what its future will be.

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

The House divided: Ayes 218, Noes 288.

Division No. 189]	[7.00 pm
AYES
Abbott, Ms Diane	Dafis, Cynog
Adams, Mrs Irene	Dalyell, Tam
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)
Ashdown, Rt Hon Paddy	Davies, Ron (Caerphilly)
Ashton, Joe	Davis, Terry (B'ham, H'dge H'l)
Banks, Tony (Newham NW)	Dewar, Donald
Barnes, Harry	Dixon, Don
Barron, Kevin	Dobson, Frank
Battle, John	Donohoe, Brian H
Bayley, Hugh	Dowd, Jim
Beckett, Rt Hon Margaret	Dunnachie, Jimmy
Bell, Stuart	Dunwoody, Mrs Gwyneth
Benn, Rt Hon Tony	Eagle, Ms Angela
Benton, Joe	Eastham, Ken
Bermingham, Gerald	Etherington, Bill
Berry, Roger	Evans, John (St Helens N)
Betts, Clive	Fatchett, Derek
Blunkett, David	Faulds, Andrew
Bray, Dr Jeremy	Field, Frank (Birkenhead)
Brown, N (N'c'tle upon Tyne E)	Fisher, Mark
Burden, Richard	Flynn, Paul
Byers, Stephen	Foster, Rt Hon Derek
Caborn, Richard	Foster, Don (Bath)
Callaghan, Jim	Foulkes, George
Campbell, Mrs Anne (C'bridge)	Fraser, John
Campbell, Menzies (Fife NE)	Fyfe, Maria
Campbell, Ronnie (Blyth V)	Galloway, George
Campbell-Savours, D N	Garrett, John
Cann, Jamie	Godman, Dr Norman A
Carlile, Alexander (Montgomery)	Godsiff, Roger
Chisholm, Malcolm	Golding, Mrs Llin
Church, Judith	Gordon, Mildred
Clapham, Michael	Grant, Bernie (Tottenham)
Clark, Dr David (South Shields)	Griffiths, Win (Bridgend)
Clarke, Eric (Midlothian)	Grocott, Bruce
Clarke, Tom (Monklands W)	Gunnell, John
Clelland, David	Hain, Peter
Clwyd, Mrs Ann	Hall, Mike
Coffey, Ann	Hanson, David
Cohen, Harry	Hattersley, Rt Hon Roy
Corbett, Robin	Henderson, Doug
Corbyn, Jeremy	Hill, Keith (Streatham)
Corston, Jean	Hodge, Margaret
Cummings, John	Hoey, Kate
Cunningham, Jim (Covy SE)	Hogg, Norman (Cumbernauld)

Hood, Jimmy	Orme, Rt Hon Stanley
Hoon, Geoffrey	Pearson, Ian
Howarth, George (Knowsley North)	Pike, Peter L
Howells, Dr. Kim (Pontypridd)	Powell, Ray (Ogmore)
Hoyle, Doug	Prentice, Bridget (Lew'm E)
Hughes, Kevin (Doncaster N)	Prentice, Gordon (Pendle)
Hughes, Robert (Aberdeen N)	Prescott, Rt Hon John
Hughes, Roy (Newport E)	Primarolo, Dawn
Hughes, Simon (Southwark)	Purchase, Ken
Hutton, John	Quin, Ms Joyce
Illsley, Eric	Radice, Giles
Ingram, Adam	Randall, Stuart
Jackson, Glenda (H'stead)	Raynsford, Nick
Jamieson, David	Reid, Dr John
Janner, Greville	Rendel, David
Jones, Barry (Alyn and D'side)	Robertson, George (Hamilton)
Jones, Lynne (B'ham S O)	Robinson, Geoffrey (Co'try NW)
Jones, Marlyn (Clwyd, SW)	Rogers, Allan
Jowell, Tessa	Rooker, Jeff
Khabra, Piara S	Rooney, Terry
Kitfoyle, Peter	Ruddock, Joan
Lestor, Joan (Eccles)	Sedgemore, Brian
Lewis, Terry	Sheerman, Barry
Liddell, Mrs Helen	Sheldon, Rt Hon Robert
Litherland, Robert	Short, Clare
Livingstone, Ken	Skinner, Dennis
Lloyd, Tony (Stretford)	Smith, Andrew (Oxford E)
Loyden, Eddie	Smith, Chris (lsl'ton S & F'sbury)
Lynne, Ms Liz	Smith, Llew (Blaenau Gwent)
McAllion, John	Snape, Peter
McAvoy, Thomas	Soley, Clive
Macdonald, Calum	Spearing, Nigel
McFall, John	Spellar, John
McKelvey, William	Squire, Rachel (Dunfermline W)
McLeish, Henry	Steel, Rt Hon Sir David
McMaster, Gordon	Steinberg, Gerry
MacShane, Denis	Stevenson, George
McWilliam, John	Straw, Jack
Madden, Max	Sutcliffe, Gerry
Marshall, David (Shettleston)	Taylor, Mrs Ann (Dewsbury)
Marshall, Jim (Leicester, S)	Taylor, Matthew (Truro)
Martin, Michael J (Spingburn)	Timms, Stephen
Martlew, Eric	Tipping, Paddy
Maxton, John	Turner, Dennis
Meacher, Michael	Tyler, Paul
Meale, Alan	Vaz, Keith
Michie, Bill (Sheffield Heeley)	Walley, Joan
Michie, Mrs Ray (Argyll & Bute)	Wardell, Gareth (Gower)
Milburn, Alan	Wareing, Robert N
Miller, Andrew	Watson, Mike
Mitchell, Austin (Gt Grimsby)	Welsh, Andrew
Moonie, Dr Lewis	Wicks, Malcolm
Morgan, Rhodri	Williams, Rt Hon Alan (Sw'n W)
Morris, Estelle (B'ham Yardley)	Williams, Alan W (Carmarthen)
Morris, Rt Hon John (Aberavon)	Winnick, David
Mudie, George	Worthington, Tony
Mullin, Chris	Wray, Jimmy
Murphy, Paul	Wright, Dr Tony
Oakes, Rt Hon Gordon	Young, David (Bolton SE)
O'Brien, Mike (N W'kshire)
O'Brien, William (Normanton)	Tellers for the Ayes:
Olner, Bill	Mr. Jon Owen Jones and
O'Neill, Martin	Mrs. Barbara Roche.

NOES
Ainsworth, Peter (East Surrey)	Atkinson, David (Bour'mouth E)
Alexander, Richard	Atkinson, Peter (Hexham)
Alison, Rt Hon Michael (Selby)	Baker, Rt Hon Kenneth (Mole V)
Allason, Rupert (Torbay)	Baker, Nicholas (North Dorset)
Amess, David	Baldry, Tony
Ancram, Michael	Banks, Matthew (Southport)
Arbuthnot, James	Bates, Michael
Arnold, Jacques (Gravesham)	Batiste, Spencer
Arnold, Sir Thomas (Hazel Grv)	Bellingham, Henry
Ashby, David	Bendall, Vivian
Atkins, Rt Hon Robert	Beresford, Sir Paul

Biffen, Rt Hon John	Garnier, Edward
Bonsor, Sir Nicholas	Gill, Christopher
Booth, Hartley	Gillan, Cheryl
Boswell, Tim	Goodson-Wickes, Dr Charles
Bottomley, Peter (Eltham)	Gorman, Mrs Teresa
Bottomley, Rt Hon Virginia	Gorst, Sir John
Bowden, Sir Andrew	Grant, Sir A (SW Cambs)
Bowis, John	Greenway, Harry (Ealing N)
Boyson, Rt Hon Sir Rhodes	Greenway, John (Ryedale)
Brandreth, Gyles	Griffiths, Peter (Portsmouth, N)
Brazier, Julian	Grylls, Sir Michael
Bright, Sir Graham	Gummer, Rt Hon John Selwyn
Brooke, Rt Hon Peter	Hague, William
Brown, M (Brigg & Cl'thorpes)	Hamilton, Rt Hon Sir Archibald
Browning, Mrs Angela	Hamilton, Neil (Tatton)
Bruce, Ian (Dorset)	Hampson, Dr Keith
Budgen, Nicholas	Hannam, Sir John
Burns, Simon	Hargreaves, Andrew
Burt, Alistair	Haselhurst, Sir Alan
Butcher, John	Hawkins, Nick
Butler, Peter	Hawksley, Warren
Butterfill, John	Hayes, Jerry
Carlisle, John (Luton North)	Heald, Oliver
Carlisle, Sir Kenneth (Lincoln)	Heath, RI Hon Sir Edward
Carrington, Matthew	Hendry, Charles
Carttiss, Michael	Heseltine, RI Hon Michael
Cash, William	Hicks, Robert
Channon, RI Hon Paul	Higgins, Rt Hon Sir Terence
Churchill, Mr	Hogg, Rt Hon Douglas (G'tham)
Clappison, James	Horam, John
Clarke, Rt Hon Kenneth (Ru'clif)	Hordern, Rt Hon Sir Peter
Coe, Sebastian	Howard, Rt Hon Michael
Colvin, Michael	Howarth, Alan (Strat'rd-on-A)
Congdon, David	Howell, Sir Ralph (N Norfolk)
Conway, Derek	Hughes, Robert G (Harrow W)
Coombs, Anthony (Wyre Forst)	Hunt, Rt Hon David (Wirral W)
Cope, Rt Hon Sir John	Hunt, Sir John (Ravensbourne)
Cormack, Sir Patrick	Hunter, Andrew
Couchman, James	Hurd, Rt Hon Douglas
Cran, James	Jack, Michael
Curry, David (Skipton & Ripon)	Jackson, Robert (Wantage)
Davies, Quentin (Stamford)	Jenkin, Bernard
Davis, David (Booth ferry)	Jessel, Toby
Day, Stephen	Johnson Smith, Sir Geoffrey
Deva, Nirj Joseph	Jones, Gwityrn (Cardiff N)
Devlin, Tim	Jones, Robert B (W Hertfdshr)
Dicks, Terry	Kellett-Bowman, Dame Elaine
Dorrell, Rt Hon Stephen	Key, Robert
Douglas-Hamilton, Lord James	king, Rt Hon Tom
Duncan, Alan	Kirkhope, Timothy
Duncan-Smith, Iain	Knapman, Roger
Dunn, Bob	Knight, Mrs Angela (Erewash)
Durant, Sir Anthony	Knight, Greg (Derby N)
Dykes, Hugh	Knight, Dame Jill (Bir'm E'st'n)
Eggar, Rt Hon Tim	Knox, Sir David
Evans, David (Welwyn Hatfield)	Kynoch, George (Kincardine)
Evans, Jonathan (Brecon)	Lait, Mrs Jacqui
Evans, Nigel (Ribble Valley)	Lamont, Rt Hon Norman
Evans, Roger (Monmouth)	Lang, Rt Hon Ian
Evennett, David	Lawrence, Sir Ivan
Faber, David	Legg, Barry
Fabricant, Michael	Leigh, Edward
Fenner, Dame Peggy	Lennox-Boyd, Sir Mark
Held, Barry (Isle of Wight)	Lidington, David
Fishburn, Dudley	Lltley, RI Hon Peter
Forman, Nigel	Lloyd, Rt Hon Sir Peter (Fareham)
Forsyth, Rt Hon Michael (Stirling)	Lord, Michael
Forth, Eric	Luff, Peter
Fowler, Rt Hon Sir Norman	MacKay, Andrew
Fox, Dr Liam (Woodspring)	Maclean, Rt Hon David
Fox, Sir Marcus (Shipley)	McLoughlin, Patrick
Freeman, Rt Hon Roger	McNair-Wilson, Sir Patrick
French, Douglas	Madel, Sir David
Gale, Roger	Maitland, Lady Olga
Gardiner, Sir George	Major, Rt Hon John
Garel-Jones, RI Hon Tristan	Malone, Gerald

Mans, Keith	Rifkind, Rt Hon Malcolm
Marland, Paul	Robathan, Andrew
Marlow, Tony	Roberts, Rt Hon Sir Wyn
Marshall, John (Hendon S)	Robertson, Raymond(Ad'd'nS)
Martin, David (Portsmouth S)	Robinson, Mark(Somerton)
Mates, Michael	Roe, Mrs Marion (Broxbourne)
Mawhinney, Rt Hon Dr Brian	Rowe, Andrew (Mid Kent)
Mellor, Rt Hon David	Rumbold, Hon Dame Angela
Merchant, Piers	Ryder, Rt Hon Richard
Mills, Iain	Sackville, Tom
Mitchell, Andrew (Gedling)	Scott, Rt Hon Sir Nicholas
Moate, Sir Roger	Shaw, David (Dover)
Montgomery, Sir Fergus	Shaw Sir Giles (Pudsey)
Nelson, Anthony	Shaw Rt Hon Gillian
Neubert, Sir Michael	Shephard, Colin (Hereford)
Newton, Rt Hon Tony	Shepherd, Richard (Aldridge)
Nicholls, Patrick	Shersby, Sir Michael
Nicholson, David (Taunton)	Sims, Roger
Nicholson, Emma (Devon West)	Sims, Tim (Beaconsfield)
Norris, Steve	Soames, Nicholas
Onslow, Rt Hon Sir Cranley	Spencer, Sir Derek
Oppenheim, Phillip	Spicer, Sir James(W Dorset)
Ottaway, Richard	Spicer, Michael(S Worcs)
Page, Richard	Spink, Dr Robert
Paice, James	Spring, Richard
Patnick, Sir Irvine	Sproat, Iain
Pattie, Rt Hon Sir Geoffrey	Squire, Robin(Hornchurch)
Pawsey, James	Steen, Anthony
Peacock, Mrs Elizabeth	Stephen, Michael
Pickles, Eric	Stern, Micheal
Porter, Barry (Wirral S)	Stewart, Allan
Porter, David (Waveney)	Streeter, Gary
Portillo, Rt Hon Michael	Sumberg, David
Powell, William (Corby)	Sweeney, Walter
Rathbone, Tim	Sykes, John
Redwood, Rt Hon John	Tapsell, Sir peter
Renton, Rt Hon Tim	Taylor, Ian (Esher)
Richards, Rod	Taylor, John M (Solihull)
Riddick, Graham	Taylor, Sir Teddy(Southend, E)

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

Question accordingly negatived.

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

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

Resolved,

That this House notes that since the introduction of the Government's health reforms, over one million more patients are treated in hospital every year and waiting times have fallen to the lowest on record; welcomes the Government's commitment to a strong and stable publicly-funded NHS where trusts and general practitioner fundholders are free to build further on these achievements; and condemns the inadequate, inconsistent and incoherent policies of Her Majesty's Opposition, which would destroy the key features of the new NHS, would undermine patients' interests and would throw into reverse the progress of recent years.