National Health Service

HC Deb 24 January 1996 vol 270 cc374-452

Mr. Deputy Speaker (Mr. Michael Morris)

I have to announce that Madam Speaker has selected the amendment in the name of the Prime Minister.

4.47 pm

Ms Harriet Harman (Peckham)

I beg to move, That this House views with alarm the mounting evidence of inadequate patient care and of overstretched staff and facilities in the NHS; deplores the relentless cuts in NHS beds; condemns the increased amount of money spent on internal market bureaucracy rather than on front line services and staff; and calls on the Government to announce an immediate moratorium on bed closures; nominate someone in each health authority to identify bed shortages and take appropriate action locally; monitor and publish a weekly report on the number of beds and staff available; and issue clear national guidelines to end the uncertainty about who pays for continuing care. The debate is about the crisis in our national health service. It is about the hundreds of patients who wait on trolleys for emergency treatment. It is about the thousands who are denied the treatment that they need. It is about the millions of people throughout the country who no longer feel that they and their families can rely on our NHS.

The people of Britain want to know the answer to some very simple questions. Why is our great national health service being torn limb from limb by the Tory Government? Why is the NHS, which the Conservatives claimed would be safe in their hands, being savaged in their hands? Why have one in six NHS acute hospital beds been cut since 1990? Why are there 20,000 more managers and accountants in the NHS, but 50,000 fewer front-line staff on the wards?

The British people have a clear decision to make and that is what today's debate is about. It is a decision between a unified national health service with Labour and an NHS that is simply being frittered away under the Tories; a decision between more money on doctors and nurses with Labour and wasted money on accountants, form filling and bureaucracy under the Tories; and a decision between a strong public service for the next century with Labour and an NHS that is privatised, broken up and sold off to the highest bidder under the Tories.

Mr. Robert Atkins (South Ribble)

I would just like to ask the hon. Lady one question. Is it still Labour party policy to abolish fundholding?

Ms Harman

We have said that we are absolutely concerned that access to hospitals should be on the basis of clinical need, that everyone in primary care should work towards a local health strategy, agreed locally, and that there should be the minimum of duplication and bureaucracy. The right hon. Gentleman will understand from that that there are many problems with GP fundholding. We are concerned to ensure that there is fair treatment for every patient and a fair say for every GP in our renewed national health service.

Mr. John Sykes (Scarborough)

How much extra money would the hon. Lady pour into the hospitals? Is not it a good thing that there is no such thing as a grant-maintained hospital, otherwise would not she have been in more trouble?

Ms Harman

I am surprised that the hon. Gentleman did not rise to complain to the Secretary of State about the fact that, in his health region, 7,546 hospital beds have been closed. That is what his constituents want him to be speaking up about in the House rather than making cheap points. [Interruption.]

Today's debate is important because the NHS is at a crossroads. The importance of the NHS cannot be overstated. [Interruption.]

Mr. Deputy Speaker

Order.

Ms Harman

The NHS is the public institution that the British people cherish more than any other. It remains, despite the Tories, one of the few public services that bind the nation together. People want to have the confidence that the NHS will be there for them and their families. But today, under the Tories, they cannot have that confidence.

Dame Elaine Kellett-Bowman (Lancaster)

rose—

Mr. Quentin Davies (Stamford and Spalding)

rose—

Ms Harman

I give way to the hon. Gentleman.

Dame Elaine Kellett-Bowman

Sexist.

Mr. Davies

Is not it extraordinary that a party that has the pretension to be an alternative Government simply does not know the answer to the question whether it wants to abolish GP fundholding?

Ms Harman

Perhaps the hon. Gentleman was not listening or he cannot understand. We have set out our concerns and how we shall address them.

Whatever the Secretary of State says, people know what is really happening. They know that each and every day seriously ill people are being turned away from casualty. They know that treatments that used to be available on the NHS are simply no longer available in some areas. They can see from their own daily lives the growing reality of privatisation of our health services.

The Tories' strategy for the NHS is clear. They are allowing the NHS to fail and that is privatisation by the back door. Up and down the country, they are withdrawing many services so that people have to go to the private sector for treatment. They are changing what is left of the NHS so that it becomes less and less a public service and more and more a private business run on the basis of cost, not on the basis of need.

Mr. David Tredinnick (Bosworth)

Given the hon. Lady's commitment to the Conservative principle of choice in education—[Interruption]

Mr. Deputy Speaker

Order.

Mr. Tredinnick

rose—

Mr. Deputy Speaker

Order.

Mr. Tredinnick

rose—

Mr. Deputy Speaker

Order. Is the hon. Gentleman deaf? [Interruption.] Order. There will be freedom of speech on both sides of the House.

Mr. Tredinnick

Has the hon. Lady ever taken advantage of private health care?

Ms Harman

No. But let me make something clear to the hon. Gentleman, who has spoken of choice in relation to private health care. For many people, it is no longer a question of choice; they feel that they are refugees, driven out of the national health service because it is no longer available to them. We want the national health service to be available, so that people do not feel that they must pay again to obtain private treatment.

Nowhere is the rundown more devastatingly clear than in casualty departments. A fundamental principle of the NHS is that it will always be there for people in an emergency; at least, that used to be a fundamental principle, but it does not apply any more. Casualty departments have been closed, and critically ill patients are being turned away. It is happening throughout the country, as every hon. Member will know.

In London, at the St. Helier hospital, Carshalton, the casualty department was closed for 22 hours on 27 November. All ambulances were turned away. On another occasion, in the same hospital, patients had to be treated in the ambulances outside the casualty department because there were not even enough trolleys in the department; they were all full. On 14 January, at the Royal Hallamshire hospital in Sheffield, patients waited for 19 hours on trolleys in casualty. Many personal tragedies are occurring throughout the country.

Nine-year-old Nicholas Geldard was playing at his Stockport home just before Christmas when he fell ill. The emergency services searched hospital after hospital for an intensive care bed, but none could be found. Eventually, an ambulance had to take him across the Pennines in the small hours of the morning, in freezing fog, with his parents following by car. When they finally arrived at Leeds general hospital, they were told that their son had died on the way. No one can say whether he would have lived, but we know that he never had the chance of life that an intensive care bed in the NHS could have given him.

Consultant physician Professor J. D. Ward of the Royal Hallamshire hospital in Sheffield warns: For God's sake, do not get ill…to be taken as an ill patient into an acute casualty or admissions ward is now a major danger in life. It is not that the Government have not been warned; they will not listen. They have ignored the advice of the British Medical Association, which has told them that hospital emergency services are at breaking point because of a severe and prolonged crisis in the acute sector". They have ignored the Royal College of Nursing, which has warned that nurses' morale is now so low that 37 per cent. say that they would leave nursing if they could.

The reason for the crisis in our hospitals and for the plummeting morale of doctors and nurses is obvious: more than one in six NHS hospital beds have been closed. When sick patients are turned away from hospitals, the Government are betraying the basic principles on which the NHS was founded.

Mr. Anthony Coombs (Wyre Forest)

The hon. Lady cannot get away with being so evasive about GP fundholders. As of next year, 100 per cent. of the people in my constituency will be treated by GP fundholders and, as a result, they will receive a far better standard of primary health care than ever before. They will want to know, just as we do, whether the Labour party would abolish GP fundholding for those who are gaining so many benefits from it. Is the answer yes or no?

Ms Harman

I am glad that the hon. Gentleman is so interested in the policies that will be pursued under a Labour Government, and he will certainly hear of the discussions that we are having with GPs, both fundholders and non-fundholders, to sort out the mess that the Tory Government have created. I am surprised that he has not risen to his feet today to complain about the problems caused to his constituents in the west midlands because, in that region, one in five hospital beds have been closed in the past five years, the number of nurses has been cut by 12 per cent. and the number of managers has gone up by 310 per cent.

Mr. Coombs

What is the answer? [Interruption.]

Mr. Deputy Speaker

Order. It is no good the hon. Member for Wyre Forest (Mr. Coombs) saying, "What is the answer?" when the hon. Lady is giving her answer. He may not like the answer, but that is not my responsibility.

Ms Harman

It used to be a fundamental principle that NHS patients would be entitled to the best medical treatment, irrespective of where they lived, but now managers in each region are deciding on the ground of cost what will and will not be available on the NHS.

Two years ago, only four health authorities were excluding treatment from the NHS. Now 40 health authorities, one third of all the authorities in the country, are rationing, so people have to be careful where they become ill. Do not get brittle bones in Dorset, because the health authority is stopping screening for osteoporosis there. Do not get infected wisdom teeth in Hertfordshire or Kingston and Richmond, because the health authority will not take them out there. Health care has become a lottery, depending on where people live.

Dame Elaine Kellett-Bowman

On a point of order, Mr. Deputy Speaker. Is it in order for the hon. Member for Peckham (Ms Harman), the Labour Front-Bench spokeswoman, to practise sex discrimination—in the debate, she has given way only to men and not to women?

Mr. Deputy Speaker

That is not a matter for the occupant of the Chair, but I am sure that the hon. Lady's point of order will have been noted by Madam Speaker.

Ms Harman

It was not sex discrimination that made me not respond to the hon. Lady's intervention: it was kindness.

The problem is that, when people cannot get the treatment that they need on the NHS, they have to go private or go without. Again, we see the Government strategy of creeping privatisation at work. Again, it used to be a fundamental principle that the NHS provided not just for illness, but for a wide range of health care needs, but now services are being pushed one by one into the private sector.

Take dentistry. When people go to an NHS dentist, they pay so much, now that the charges have gone up, that they think they have gone private anyway. First, charges are pushed up so high that people can hardly tell the difference between the public and the private sector; then fewer and fewer dentists do NHS work, so more and more people end up having to go private.

Take long-term nursing care. The Government close long-stay wards and force people into the private sector. People used to receive treatment free and now they have to pay. It is no wonder that private health care is growing. These are the facts. There are now 28 per cent. fewer NHS hospital beds than there were 15 years ago, but there are 66 per cent. more private hospital beds than there were 15 years ago.

That, however, is just the start. The Government want to go further. They are handing public health services over to private organisations through market testing, the private finance initiative and making the NHS buy services in the private sector. Their privatisation strategy is about not just putting out services to the private sector, but changing the basic ethos of what is left of the NHS, so it is no longer doctors and nurses who decide how people are treated: it is accountants and bureaucrats put in by the Tories.

If people want to know where so much NHS money has gone in the past five years, I shall tell them. It has gone on accountants, on senior managers, on their company cars and on their form filling. The number of managers has increased from 5,000 five years ago to 23,000 today. At the same time, 50,000 staff have been cut from our wards. These are the Tory priorities for our health services: more people to count the cost of care, fewer people to provide that care. They are not, however, the priorities of the British people, who are totally opposed to the privatisation of the NHS.

The Secretary of State for Health, for all he protests—as he will, no doubt, today—that he is the friend of the NHS, is nothing more than the presentable face of privatisation. I should like to ask him some simple questions about where he stands. First, on the casualty crisis, does he agree with this statement: I believe that it is unacceptable that people entering the hospital through the accident and emergency unit should be kept waiting for hour after hour on a trolley"? Does he believe that that is unacceptable? That statement was made by the former Secretary of State for Health, the right hon. Member for Sutton Coldfield (Sir N. Fowler). If the Secretary of State agrees with that statement, which he says he does, and I welcome that, why does he not implement—

Sir Norman Fowler (Sutton Coldfield)

The hon. Lady has just quoted my words, so I think that I am entitled to ask her the further question: does she welcome the steps that the Government have taken to create new emergency wards at Good Hope hospital, to provide new nurses and to modernise the accident and emergency unit?

Ms Harman

No, I do not—[HON. MEMBERS: "Oh."] Will hon. Members listen? I do not welcome those steps because they are a sham. If hon. Members will listen, I received a letter from the chief executive of Good Hope hospital today, who said: I can tell you there are no new beds being opened. We are simply re-opening beds that have been closed through lack of staff resources.

Mr. Robin Corbett (Birmingham, Erdington)

I thank my hon. Friend for coming to Good Hope hospital in north Birmingham. May I confirm that none of the so-called beds opened when the Secretary of State for Health was walking down the corridor is new—they are reopened beds? There is no money available for an admissions ward alongside the accident and emergency unit. It will be a year before building on that ward can be started, even if it can be funded. May I confirm that the money that is now being spent on refurbishing the accident and emergency unit is not new or extra money, but money that the regional health authority already had and had allocated for that purpose?

Ms Harman

My hon. Friend's points demonstrate that the Government's response to the crisis facing patients is to produce bogus statistics and false solutions. Why does not the Secretary of State produce a real solution to the casualty crisis and act now?

There are many ways in which the NHS could improve the service that it provides. New technology offers unprecedented opportunities so that, for example, a doctor in Sheffield can examine a patient in London. New drugs and treatment, such as hormone replacement therapy for brittle bones, offer new hope to many women. New screening techniques can prevent and detect serious diseases, such as cystic fibrosis, and new ways of delivering care to people in their own homes can revolutionise medical treatment.

Rebuilding the NHS after the Tories will be a challenge, but its staff—the doctors, nurses and all the other staff—have repeatedly shown their commitment to the NHS as a public service. They have shown their ability to deliver high-quality care, despite the Tories. Labour will bring together staff, patients and the community to draw on their views, to create not division but consensus and to plan for the future of health care.

We will transfer the £1.5 billion that the Government waste on bureaucracy to front-line services—to doctors and nurses and not to accountants and managers. We will end the unfair system whereby treatment is dependent on which GP is purchasing the health care rather than on the clinical needs of the patient. We will end the lottery of long-term nursing care, which means that the care received and the price paid depend on where one lives. Our NHS will concentrate on the patient, not on the costs.

The NHS has great potential, which Labour in government will unlock. The next general election will decide the future of our health service. Already we have an NHS in which there are hospitals without trolleys, patients without beds and wards without nurses. The Tories have a hidden agenda for a fifth term that will destroy our NHS for good. The Secretary of State's friends give the game away. Roy Lilley, Tory health expert, called the NHS the rump of the remaining nationalised industries and an overburdened bureaucracy". David Green, of the Institute for Economic Affairs, said that the NHS breeds a childlike reliance. It has to go. The NHS is simply not safe under the Tories.

In their hearts, members of the Tory party hate the NHS. Its only safeguard is the party that created it—the Labour party.

5.13 pm

The Secretary of State for Health (Mr. Stephen Dorrell)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: believes that the NHS is a great British success story which delivers health care of international quality, which is and will remain available free at the point of use on the basis of medical need and provides excellent value for money for taxpayers; congratulates all NHS staff for their hard work and dedication, particularly during the exceptional period of increased demand for NHS services over recent weeks; welcomes the increasing number of qualified nurses and midwives over the last seventeen years and looks forward to the NHS continuing to flourish under the policies of a Government which has backed its commitment to the service with year-on-year increases in real resources.". This week, we have seen a completely new political principle being put into action by the Labour party. It used to be true—there was general recognition of its effectiveness—that the best way to express support for a political colleague was to go on to the media, write an article, give an interview and offer a public endorsement for the sort of policies that we have heard espoused from the Labour Benches. That is, of course, the old-fashioned method.

This week, the Labour party has found a completely new way to express the warm fraternal solidarity for which it is famous. The hon. Member for Hartlepool (Mr. Mandelson) has told us that the Labour party has expressed its support this week for the hon. Member for Peckham (Ms Harman) by remaining silent. The right hon. Member for Kingston upon Hull, East (Mr. Prescott)—that not normally taciturn individual—has not been anywhere near a studio this week. There has been no sign of the hon. Member for Holborn and St. Pancras (Mr. Dobson) or the hon. Member for Oldham, West (Mr. Meacher). They are all biting their tongues, restraining their natural urge and containing their generous instincts to support the hon. Lady. It has been the chorus of the Hebrew slaves in mime.

Conservative Members say that the hon. Lady's friends should have supported her. This week, we have seen the irresistible force of parental obligation meeting the immovable object—

Ms Hilary Armstrong (North-West Durham)

On a point of order, Mr. Deputy Speaker. I wonder what you can do to help the House. The Government have clearly sent in the wrong Secretary of State. This is meant to be a health debate, but the Secretary of State does not seem to know that.

Mr. Deputy Speaker

The Secretary of State's speech has been entirely in order so far.

Mr. Dorrell

This week, we have seen the irresistible force of parental obligation meeting the immovable object of political correctness. The reason why the hon. Lady is right, and virtually all of her Back-Bench colleagues are wrong, is that she has shown by her actions that she endorses the principles and values of a free and open society. That is important in education, and it is equally important in health care.

Mr. Deputy Speaker

Order. I have yet to hear the word "health", but I have every confidence that it is coming.

Mr. Dorrell

I fear that noise from Labour Members might have drowned out my point. I said that the principles for which the hon. Lady is standing are just as important in the management and development of the national health service as they are in education and much more broadly in our society. She is standing for the principles of choice and diversity. The sadness in the House this afternoon is that her rhetoric on the health service does not reflect her actions in the education sector.

We have argued that we need the NHS to deliver a service which empowers local people and allows them to make choices, and which allows the managers who are in charge of trusts to manage the trusts for which they are responsible.

Several hon. Members

rose—

Mr. Dorrell

As many of my hon. Friends have pointed out in interventions, we need a national health service that allows fundholding doctors to make decisions in the interests of their patients and, by so doing, to raise the quality of care throughout the NHS. Those are the principles on which our health policy is built. The hypocrisy of Labour Members—

Several hon. Members

rose—

Mr. Deputy Speaker

Order. It is clear that the Secretary of State does not intend to give way now.

Mr. Dorrell

The hypocrisy of Labour Members is demonstrated by the gap that has opened up this week between their rhetoric and their actions. That is what makes my hon. Friends angry.

Several hon. Members

rose—

Mr. Dorrell

I am spoiled for choice. I shall give way to the hon. Member for Liverpool, Walton (Mr. Kilfoyle), who I believe is an education spokesman.

Mr. Peter Kilfoyle (Liverpool, Walton)

I am indebted to the Secretary of State. He has said a great deal about principles. Will he explain how his Government's principles helped the 38 people who, two weeks ago, were kept overnight on trolleys in Fazakerley hospital in Liverpool, which led to surgical and medical cases being kept in beds in the maternity unit? Is that a reflection of his principles? Where was their choice?

Mr. Dorrell

I started my speech by pointing out the Government's commitment to the principle of local management in the health service to ensure that the health service responds to patients' needs as they arise. I shall now demonstrate how those principles in action have delivered the emergency service, which all national health service patients are entitled to expect.

The problem for the hon. Member for Peckham is that she is willing to endorse the principles by her actions but not to endorse those principles being put into effect within the national health service.

Mr. George Howarth (Knowsley, North)

On the Secretary of State's principles on the national health service, will he explain why Fazakerley hospital, to which my hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle) has already referred, is generating so many problems that two or sometimes three people contact me every day to complain about the service there? When I wrote to the Secretary of State and asked him to investigate what was going on there, he refused to conduct an investigation. If he has nothing to hide and there are no problems, why will he not hold an investigation? Is he more content to play politics than to sort out the health service?

Mr. Dorrell

I am content with a system that vests in local managers and clinicians the power to make decisions in the interests of patients in their area.

Several hon. Members

rose—

Mr. Dorrell

Before I deal with the background to the two points raised about Liverpool, I shall give way to my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman).

Dame Elaine Kellett-Bowman

I tried to make this point to the hon. Member for Peckham (Ms Harman), who would not listen. Does my right hon. Friend accept that all patients in my constituency will shortly be in fundholding practices and that the GPs in charge of those practices will be able to send their patients to the most up-to-date hospital north of Watford, with all the latest facilities, including a good day hospital that carries out cataract and varicose vein operations? Fewer hospital beds will be needed because the hospital has all the latest equipment, which is as good as anywhere in Europe.

Mr. Dorrell

My hon. Friend is right. The fundholding system benefiting her constituents would be under threat if the hon. Member for Peckham put into effect her rhetoric on the national health service, which is in sharp distinction from her actions in her own family.

Mr. Graham Riddick (Colne Valley)

Will my right hon. Friend confirm that all doctors must take the Hippocratic oath? Is it not clear that the hon. Member for Peckham (Ms Harman) has taken that to heart, but misunderstood it?

Mr. Dorrell

My hon. Friend makes his point compellingly. What makes Conservative Members angry is the distinction between what Labour Members say and what they do.

I shall outline the background to the stress and pressure on the emergency services, which we have seen over the past few weeks.

Several hon. Members

rose—

Mr. Dorrell

What I am about to say lies behind all the questions that Opposition Members have asked me. If it does not answer their questions, I shall give way further.

Over the past two months, there has been an unprecedented peak in the emergency work load placed on the NHS emergency services. I can illustrate that simply by a few facts: in the week commencing 8 January, emergency admissions in the city of Birmingham rose by 35 per cent. on the normal seasonal average; in Shrewsbury, they were 29 per cent. above the normal seasonal level; and in Winchester they were 50 per cent. above the normal seasonal level. So, throughout the health service, since the middle of November, there have been examples of unprecedented peaks in the emergency work load. The best overall measure was that, in the whole of London in December 1995, emergency calls increased by 11 per cent. compared with December 1994.

The background against which this debate takes place is of an unprecedented increase in the NHS's emergency work load. The fact that the hon. Member for Peckham does not like to face is that the more flexible local management in the health service that she likes to denigrate has responded to that increase and ensured that, in the overwhelming Majority of cases, it has been met. That has been done by increasing the bed space available to the emergency services. She decries that and says that a hospital that is not using all its beds should leave beds closed rather than reopen them to absorb the emergency work load. New bed space has been opened throughout the health service and existing bed space has been redesignated to ensure that the emergency work load is met.

The position is clear throughout the country: in Consett, 26 beds; in Sunderland, 26 beds; in Grimsby, a whole ward; in the Good Hope hospital, 39 beds; in the West Middlesex hospital, 12 beds; in Newham general hospital, two wards creating 32 beds. Furthermore, not just new bed space is being created but existing bed space is being redesignated to ensure that the emergency work load is met. The Birmingham Heartlands hospital has 60 extra beds from that source and in the North Staffordshire trust, 70 surgical beds have been redesignated as medical to meet the emergency demand.

The hon. Member for Peckham is therefore right to identify an increase in the health service's emergency work load, but she is profoundly wrong to denigrate the management system that has ensured that the health service has responded to that increase in emergency work load and, in the overwhelming majority of cases, delivered the emergency service that NHS patients need.

Ms Glenda Jackson (Hampstead and Highgate)

The local flexibility to which the Secretary of State referred operates at the Royal Free hospital trust in my constituency. One of my constituents, a cancer patient, was given a day for admittance to the hospital but his admittance was cancelled at 5 o'clock on the day that he was due to go in. He went in one day later and went through the entire pre-operation medical procedures, only to be told that the operation had been cancelled. At that time, the hospital could not give him an alternative date. Instead, it has allowed him to go home every day but he must return to the hospital at 6 o'clock in the evening. He believes, and I have had that belief confirmed by others, that during his absence his bed is used. That is not redesignation of beds but hot bedding.

Mr. Dorrell

It is well known that, if an hon. Member wants a Minister to examine a specific case, he or she will do so. I shall not seek to respond off the cuff to a specific case. I remind the House that, over the past two months, the national health service has done what it is there to do: treat priority cases first. In the overwhelming majority of cases, it has delivered the emergency service that we want to see.

Sir John Gorst (Hendon, North)

How does my right hon. Friend reconcile all that he has said and the principles that he correctly outlined at the beginning of his speech with the intention to close the accident and emergency unit in my constituency and replace it with a miserable alternative that is of no consequence when compared to the original?

Mr. Dorrell

My hon. Friend knows that we are currently engaged in consultation on the shape of services to be delivered at Edgware hospital in the future, and part of a state-of-the-art accident and emergency service for his constituents will be delivered through Edgware hospital. The precise nature of the total service to be delivered at Edgware is the subject of current consultation.

Mr. Hugh Dykes (Harrow, East)

Will my right hon. Friend give way?

Mr. John Marshall (Hendon, South)

Will my right hon. Friend give way?

Mr. Dorrell

I shall give way to one of my hon. Friends—my hon. Friend the Member for Harrow, East (Mr. Dykes).

Mr. Dykes

I am grateful to my right hon. Friend. Does he agree that a perfect example of his point about the increase in treatment figures and in the accident and emergency figures is Northwick Park hospital—a big district general hospital shared by my constituency and that of my hon. Friend the Member for Harrow, West (Mr. Hughes)—where the figures have risen enormously recently, but where treatment has improved, as all of its patients say, without any reasoned exception?

Mr. Dorrell

My hon. Friend is exactly right, and that has been the overwhelming experience of patients of the emergency services of the NHS. I must move on, because the hon. Member for Peckham said in response to my arguments—

Mr. Simon Hughes (Southwark and Bermondsey)

Will the Secretary of State give way?

Mr. Dorrell

Later. The hon. Lady said that the shift to meet the emergency work load has led to a reduced service for those on elective waiting lists, with the result—she claims—that there has been an increase in the proportion of elective surgery done by the private sector. I have heard her make that claim several times since I took up my present responsibilities, so I have had it examined. I have looked at the evidence to see whether it is true that there has been a dramatic increase in the share of elective surgery conducted in the private sector.

The fact is that, in the past 14 years, the share of elective surgery done in this country on people resident in this country by the private sector has risen from 14 per cent. of the total to 15.3 per cent. of the total—an increase of 1.3 percentage points. The House will not recognise from that statistic the rhetoric of the hon. Lady.

That brings me to another element of the choice and diversity for which the hon. Lady has made herself famous this week—the application of that principle within the NHS. Many of my hon. Friends have raised the issue of GP fundholding, and they are right to do so. The Government have made it clear that we are determined to develop the primary health care service of the NHS because—[Interruption.] Opposition Members appear to have lost interest in the NHS. So much for their passionate interest in the development of primary care in the health service. They seem to be more interested in their private internal bickering. No doubt they are all discussing the performance of the hon. Member for Peckham. We know from the lunchtime news what Labour Members think of her performance, and we can see them all plotting their next move in the battles that are going on within the Labour party.

When Opposition Members have concluded their private discussions, perhaps they would like to turn their attention for a moment to the future of the NHS and the delivery of high-quality primary health care. The fundholding system has been described by the chairman of the Socialist Health Association, Julian LeGrand, as the biggest success story of the health service reforms. Perhaps more tellingly, the hon. Member for Peckham's predecessor as Opposition health spokesman, the right hon. Member for Derby, South (Mrs. Beckett), went to the National Association of Fund Holding Practices—

Mr. Henry McLeish (Fife, Central)

This is old hat.

Mr. Dorrell

Old hat? This happened last October. How long does a policy last in the Labour party? Last October, the right hon. Member for Derby, South went to the National Association of Fund Holding Practices conference, and thought that she had better curry favour from the audience. She said that Labour understood and welcomed the advances fundholding has brought to many patients. The hon. Member for Peckham has shown us this week that she thinks services should be determined by—in her case—the interests of the son. I would argue that the same principle should apply to the patient.

There is, in the words of the right hon. Member for Derby, South, clear evidence that fundholding brings benefits to patients. I look forward to hearing from the hon. Member for Peckham how she justifies her policy of replacing fundholding. How can a party which espouses the true interests of patients be committed to sweeping away a system that its own previous health spokesman has recognised serves the interests of patients?

Mr. Jerry Hayes (Harlow)

Does my right hon. Friend recall that the right hon. Member for Derby, South (Mrs. Beckett) went on to say that she hoped that fundholding would be abolished in the first year of a Labour Government? Does that still stand?

Mr. Dorrell

The right hon. Member for Derby, South's line on fundholding was reminiscent of the line taken by Anthony Crosland on selective schools. Her line was, "We shall get rid of fundholding." The hon. Member for Peckham's words, however, are slightly more honeyed. She says, "We shall replace fundholding." What does that mean? The patients of fundholding practices—they will make up more than half of the patients in the NHS this April—want to know what the hon. Lady would do, were they ever misguided enough to put her in charge of the NHS.

Mr. Nicholas Winterton (Macclesfield)

Fundholding has brought immense benefits to the patients in the large village of Poynton in the north of my constituency. I had the privilege to open a new medical centre there that provides, on the doorstep of patients, facilities that hitherto would not have been available and for which local people would have to have gone to the district general hospital. The fundholding practice is working closely with the district general hospital and is providing additional, technologically advanced services right on the doorstep of patients.

Mr. Dorrell

My hon. Friend is precisely right. He quotes a good example where service has been enhanced, and that has happened not just in the practice in the constituency of my hon. Friend, but across the NHS. When one fundholding practice makes such a breakthrough, others—fundholders and non-fundholders—want to apply the same principles.

I said that I applaud the hon. Member for Peckham's endorsement of the principles of choice and diversity, and so I do. What I deplore is double standards and two-facedness. This week, the hypocrisy of the Opposition has been exposed. The hypocrisy of choosing selection for themselves while denying that right to others is just the tip of the iceberg. The hon. Lady can be excused for that, but not for the other hypocrisies for which she is personally responsible—the hypocrisy of talking about underfunding, while promising no more money; the hypocrisy of paying tribute to fundholders, while maintaining a commitment to abolish them; the hypocrisy of bewailing management costs, while voting against the abolition of regional health authorities; the hypocrisy of supporting a health authority's right to choose where to commission health care, while arguing that the internal market is wrong; the hypocrisy of arguing that the private finance initiative is right in principle, while arguing that it represents the privatisation of the health service.

Mr. Stephen Byers (Wallsend)

On the question of hypocrisy, the Secretary of State says that he is to launch an attack on bureaucracy in the health service. Can he tell the House why, compared with five years ago, there are 50,000 fewer nurses and 18,000 more administrators?

Mr. Dorrell

I am getting rather fed up with people taking statistics that they know to be dishonest and misrepresenting them—

Mr. Byers

Answer the question!

Mr. Deputy Speaker

Order. The hon. Member for Wallsend (Mr. Byers) asked a question—he should stay silent and wait for the answer. That is a courtesy of the House. We need ordinary and decent manners, and I would be grateful if the hon. Gentleman kept quiet.

Mr. Dorrell

The hon. Gentleman knows very well that the figures that he quotes rely for their effect on, first, ignoring the build-up of practice nurses in general practices, and secondly, pretending that nurses in Project 2000 are not in training and therefore do not count. As the hon. Gentleman knows very well, like-for-like comparison shows not a cut, but an increase in the nursing work force.

It has not escaped notice that the loudest cheer this week was that for the hon. Member for City of Durham (Mr. Steinberg) in the Members' Dining Room on Monday night. The simple reason for that is that he spoke for the majority of Labour Members. Those Members are now discovering what stakeholding means for them. It means what the hon. Member for Warrington, North (Mr. Hoyle) said on the lunchtime news about the parliamentary Labour party meeting this morning: We called the meeting. Let us hear the opinion of the parliamentary Labour party. "He might have added, "and then ignore it." Labour Members are discovering precisely what stakeholding means for them. It means do what Tony says. "Get up," says Tony, and they get up; when Tony says, "Sit down," they sit down; when Tony says, "Turn right," they turn right and when Tony says, "Turn left," they turn left. Where once there was commitment and passion there is now simply the grin on the face of the leader—a leader who likes to talk about standards in public life.

Mr. Ronnie Campbell (Blyth Valley)

On a point of order, Mr. Deputy Speaker. Are we debating the health service or the Leader of the Opposition?

Mr. Deputy Speaker

Order.

Mr. Dorrell

rose—

Mr. Deputy Speaker

Order. We are debating the health service.

Mr. Dorrell

We are indeed debating the health service.

I made the mistake of assuming that the leader of the Labour party was interested in the future of the national health service. It is to him that the difficult questions must how be addressed. He cannot hide behind the hon. Member for Peckham. What we need to know from the leader of the Labour party is whether he will authorise more money for the NHS. Will he support choice and diversity in general practice? Will he wind up fundholding in general practice?

Mr. David Shaw (Dover)

Hypocrite.

Mr. Dorrell

Will he support local managers—

Mr. Deputy Speaker

Order. Did I hear the hon. Member for Dover (Mr. Shaw) suggest that an hon. Member was a hypocrite?

Mr. Shaw

I would not want to suggest that at all; it must have been a mistake.

Mr. Deputy Speaker

The hon. Member did say that. Is the hon. Member withdrawing that remark here and now?

Mr. Shaw

I certainly would withdraw it if you thought I said it, Mr. Deputy Speaker.

Mr. Deputy Speaker

Order. I heard the hon. Member say it. Does the hon. Member withdraw it or not?

Mr. Shaw

I certainly shall withdraw anything that you are not happy with, Mr. Deputy Speaker.

Mr. Deputy Speaker

Order. Does the hon. Member withdraw the word I heard him say—that the Leader of the Opposition—

Mr. Shaw

I do—

Mr. Deputy Speaker

Order. Does the hon. Member withdraw his comment that the Leader of the Opposition was a hypocrite? Does the hon. Member withdraw that?

Mr. Shaw

I withdraw it.

Mr. Deputy Speaker

I am most grateful.

Mr. Dorrell

The questions remain for those on the Opposition Front Bench and most importantly for the leader of the Labour party. Those questions require him to face one way. They require him to convert soft-focus rhetoric into hard commitments. If he fails to do so, we must draw the conclusion that warm words are simply hot air. Today, another opportunity to do that has passed. Yet again, Labour has failed the test.

5.42 pm

Mr. Sam Galbraith (Strathkelvin and Bearsden)

I was somewhat disappointed that the Secretary of State spent so little time talking about the health service. I now realise why it is that more and more people within the NHS—

Mr. Deputy Speaker

Order. I hope that the hon. Gentleman is not criticising the Chair. The whole of the Secretary of State's speech was about the health service.

Mr. Galbraith

Thank you, Mr. Deputy Speaker.

I now realise why fewer and fewer people in the NHS listen to the Secretary of State. I was also disappointed that once again he raised the issue of choice under the Government as a result of their changes. The right hon. Gentleman should be aware that, before the Government changes, any doctor, be it a general practitioner or a hospital consultant, working anywhere in the health service, could send any patient anywhere in the United Kingdom at any time.

The Minister for Health (Mr. Gerald Malone)

That was the theory.

Mr. Galbraith

That was the practical reality. That fact is so. That is no longer the reality and I wish that the Secretary of State would stop going on and on about choice within the NHS.

Dr. Keith Hampson (Leeds, North-West)

What the hon. Gentleman suggests is simply not what happened in fact. For years and years, all hon. Members who represented Leeds, including Opposition Members, complained bitterly about how Leeds general infirmary was swamped by patients. They were sent to it from all over the area, to the point where our constituents in Leeds could not get treatment at our hospital. The hospital received no financial recompense for that. That is not the case now. One thing is for certain; the Labour party will not do any better than the Conservative Government, who, in the past three years, have raised the capital spending of LGI from £8 million to £20 million.

Mr. Galbraith

The hon. Gentleman reinforced my point by saying that people came from all over to his hospital. That reinforces my argument that choice always existed. Nowadays choice does not exist; one goes to where the contract is made. That is the reality.

Being a good Presbyterian, I want to start my speech today with a text from the Secretary of State. In The Guardian on 11 January he was reported as saying: It is no good continuing to provide treatment which is out of date, nor rushing to carry out new procedures before they have been clinically evaluated. That is an appropriate text, to which I shall return partly in relation to the changes within the NHS. I should like to start by relating it to beta interferon, once again. That drug is at the heart of much of the controversy in the NHS—the controversy does not specifically relate to the drug but concerns treatment rationing and effective treatment.

When the right hon. Gentleman has considered the subject before, he has sought to make a distinction between rationing and non-use of ineffective treatments. I am extremely happy that he has done so, because he has probably read some of my speeches on the matter.

In The Herald of Glasgow, of 5 October, I discussed the rationing of health care. I said that the definition of rationing was important and that rationing meant the denial to a patient of treatment that would benefit their physical or mental health, treatment the patient wishes to have and which, in the doctor's judgment, is considered to be medically appropriate. Unnecessary treatment, by which I mean treatment that is of no benefit to the patient, is not included within this definition. It is therefore not indicated—that means, to requote the Secretary of State, one should not rush to carry out new procedures before they have been clinically evaluated. In that respect, and given the Minister's view, I am really surprised that he is not taking a harder line on the handling of the drug beta interferon.

Let me explain briefly that beta interferon has been put forward as a treatment for multiple sclerosis—a debilitating disorder for which there are really no effective treatments. It is a disease that in part is considered possibly related to the immune system and slow viruses. One of the possible treatments put forward recently has been beta interferon.

The drug has been extensively evaluated, and as a result two studies were reported. The first of those appeared in an expedited publication in Neurology in 1993, volume 43, 655–81. A follow-up study was published in Neurology in 1995, volume 45, 1277–85. Those studies have been used as justification for the prescription of beta interferon—an extremely expensive drug. Those studies are what are known as phase 2 trials—a term that I am sure the Minister understands. Those trials do not use definitive end points but are studies used for looking at dose regimes and possible efficacy. They do not prove the worth or value of any treatment. They use surrogate end points such as remission rates and nuclear magnetic resonance scanning and different types of imaging of the brain.

Those phase 2 trials showed that, as a result of the drug, there may be an improvement, initially, in the remission rate, or at least a reduction in the exacerbation rate, but that it has no effect on disability at any stage. It is also a stage 2 trial and it is therefore not surprising that the authors, in their 1995 paper, conclude that their results do not establish an effect…in limiting progression of disability. This study was not originally powered to demonstrate a treatment effect on disease progression. At these levels of disability, more patients or longer follow-up, or both, would be required. Accordingly, additional clinical trials will be necessary to evaluate the role of IFNB in preventing disability. It is a drug of unproven value.

I return to the Minister's comment that we should not rush to carry out new procedures before they have been clinically evaluated. This is an expensive drug that has not been clinically evaluated. We should not rush into allowing its general use in the national health service.

I have raised that point before with the Secretary of State. He says, as do Scottish Office Ministers, that such matters should be decided locally. That is their first line, but it is a dangerous road to go down. The Secretary of State himself recognises that fact; The Independent on 9 January reported his speech to the Manchester business school in which he made the point that there should not be variations in treatment and practice in different areas. He said: We must recognise, in the first instance, that this is a national health service and prevent variations. I agree. Guidance on the matter must come from the centre. That principle should apply to all treatments in the national health service.

It is not appropriate for separate authorities to make differing decisions about treatment or its allocation. It is not appropriate that people who live on one side of a street are deemed to need treatment but that people who live on the other side are not. The system to decide whether treatment is necessary must be national.

The Secretary of State will say that different areas must decide on their own priorities. If an area requires increased resources for some disease such as, in my area, carcinoma bronchus ischaemic heart disease, it requires additional resources and not to start cutting back on other necessary treatments. I implore the Minister to consider the matter and give national guidelines.

The Secretary of State will also say that doctors must be left to make their clinical judgments. I accept that. On a day-to-day, face-to-face, eyeball-to-eyeball basis, doctors should make clinical judgments. However, we do not give doctors total freedom in their clinical judgment. That has never been appropriate and has never been the case. When cardiac surgery came in, we did not make it universally available to anyone who wanted it. It was evaluated nationally and properly. When it became clear that it was of use, we set up, using national guidelines, units throughout the country. That is the way forward.

Beta interferon is a test of the way in which the NHS works at its best. In other words, we respond to need; we evaluate that need; consider the methods of dealing with it; and, if a treatment is shown to have an effect on that need, we provide it. We must not get into the situation that exists in the United States, where the system is demand led. There, a drug, merely because it has become available and is being pushed by a drug company, suddenly acquires a demand and is prescribed all over the place. The NHS faces a test with beta interferon to ensure that it is prescribed only if it is shown to be effective. We should not duck that through doctor's choice or local choice. It is a decision that only the Government can make.

Mr. Norman Hogg (Cumbernauld and Kilsyth)

I am grateful to my hon. and technically qualified Friend. How can we deal with people who suffer from dreadful illnesses such as multiple sclerosis who are hoping for some remedy? I have seen a great deal of written information that seemed to make claims for beta interferon, but he says that they have not been substantiated by tests. How can we get over the problem of information being published in what seems to be a learned way when it is not true?

Mr. Galbraith

In this case, we can get over it by allowing it to be prescribed only in the context of a clinical trial. The authors of the Neurology study said that the drug required further study. That would mean a phase 3 study which would be a proper double-blind, crossover controlled trial with proper end-point evaluations. If it were done in that way, we would discover whether the drug was effective. That is the way forward.

The Secretary of State realises that that is part of what is known in the current phrase as evidence-based medicine. Most people thought that we have always had evidence-based medicine and that it was good medicine. Not everyone practised it; some people practised bad medicine. Evidence-based medicine is not new. If we are to use evidence-based medicine in clinical practice, we must use it in managerial practice in the national health service. We have singularly failed to do that, and it has led, in large measure, to the beds crisis that has occurred this winter.

The Minister pretends that somehow the beds problem is different. Every year, from time to time, there are beds crises in the NHS. The Minister maintains that it is worse this year than it has been in others. I am not sure about that. I am always wary of figures. Patients get redesignated and reclassified. I have been around several hospitals and I have seen no greater crisis than usual. There simply were not enough beds available.

That is not a problem by which we should have been surprised. Everyone predicted it because, in making managerial decisions, we had not considered the evidence properly and had made too many snap judgments. We should not have had a winter crisis, because hospitals are usually especially quiet at that time. Patients are decanted from beds over the holiday period and are not taken in for elective procedures. There ought to have been plenty of beds, yet we failed patients. We should examine the reasons behind that. We have closed far too many beds—a decision that was based on a model of bed numbers that was flawed and never subject to decent analysis but propagated on the one principle that we must close beds. Anything that challenged that assumption was ignored.

It is proper to consider how we can improve the model. That is happening in the Scottish Office and I hope that the Secretary of State will undertake to consider it for the whole United Kingdom. Let me suggest some of the things that went wrong. We have reached the stage where there are not enough beds. It is no good talking about redesignation and having bed managers.

Please save us from Philip Hunt of the National Association of Health Authorities and Trusts who came on radio to say that the way to solve the problem of the lack of beds was to appoint another manager. That is the last thing that we need. We need another manager like we need a hole in the head. We need someone to examine the problem. Does the Secretary of State realise what redesignation of beds means? It involves moving patients around the hospital over two or three days. They are often taken out of the ward in the middle of night and placed elsewhere. That is bad medicine for patients and doctors.

Let us return to the possible causes of the mistake with the beds. First, we did not properly take account of the demographic shift and the fact that older patients suffer more disease. Those diseases add to the number of emergencies.

Secondly, we did not take account of the effect that community care would have on emergency admissions. The principle of community care is right; I am not going to challenge that. However, many people in care in the community fall sick who would previously have fallen sick in hospital beds, where they were attended by surgeons and physicians in their hospitals and managed in their beds. Now, however, those people present at hospitals as emergencies, which is another factor that was not taken into consideration in the bed model.

The third factor that was not taken into consideration was early discharge from hospitals. The re-admission rate was simply not included in the calculation.

Mr. Malone

There is no evidence for that.

Mr. Galbraith

I hear the Minister of State saying that there is no evidence for that, but I should like him to present me with the facts.

I am not opposed to early discharge from hospital, which is correct and proper, but we must consider the re-admission rate that is associated with it.

The fourth factor that was not taken into account was the changing nature of the practice of medicine. In the past, myocardial infarctions and strokes could be managed at home; now they are not and, instead, the patient is taken to hospital. We should have taken all those factors into account.

The current crisis has come about not because of a lack of emergency beds but because of a lack of beds generally. In our acute strategies, we forgot to take into account all the necessary procedures. There is a similar shortage of intensive care beds. That shortage is not simply due to the fact that there are too few intensive care beds; there are too few acute beds. The way to free an intensive care bed is to move its occupier into a second-line bed. If there are no second-line beds, the patient cannot be transferred from the intensive care unit to a second-line bed. We must reappraise the number of beds; we cannot continue to close them.

The Government should have a moratorium on all bed closures until we reconsider the bed model and decide on the number of beds in the national health service. In that period, we should undertake a proper study in which we listen to everyone involved and base our decisions on evidence, and only evidence. We shall not base our decision on any prejudice, on managerial diktat or simply on financial grounds. We shall make our decision on the evidence. If evidence is good for clinical practice, it is good for every practice in the NHS and we should follow it through to its limit.

6.1 pm

Sir Norman Fowler (Sutton Coldfield)

I have been taking part in health debates for the past 20 years or so. The speech of the hon. Member for Peckham (Ms Harman) was one of the nastiest speeches on health that I have heard during those 20 years. When the hon. Lady says that the national health service is being "torn limb from limb" by this Government, she is talking the most contemptible nonsense—what is more, she knows it. The hon. Lady's allegation that the health service is being "privatised" and sold off to the private sector is ludicrous, and known to be ludicrous.

The hon. Lady has succeeded in showing us something else entirely: that the words of the Labour party do not match up to its action—its present action, its action when it was in power or future action that it might take if it were in power. I talk specifically about health, as I believe strongly that the sort of attack the hon. Lady pursued on the Government this afternoon was not only inaccurate, but hypocritical.

When we debate health, the public are not impressed when the political words do not meet the needs. The pubic want frankness about health care, and a recognition of the problems encountered in any health service system. The public want an explanation of constructive policies. The public wanted more this afternoon than the same depressing mixture of scare and stridency that we received. All we were given was the unappetising sight of the hon. Lady trying to work her passage back into her own political party.

The hon. Lady was trying, once more, to exploit the health issue. Despite the denials over the past 15 years by successive Secretaries of State for Health, the hon. Lady attempted to suggest that the Conservative party wants to privatise the health service. Attacked for her own double standards, she ascribes double standards to others. I reject that claim, and I return to the division between the Labour party's words and its actions. Let us compare the words that the Labour party now uses on health with the action that it took when it was in power.

Mr. Michael Connarty (Falkirk, East)

Will the right hon. Gentleman give way?

Sir Norman Fowler

I am glad that the hon. Gentleman has strolled in. I shall not give way to him, as he has not listened to the argument—I doubt whether it will affect his argument much, but it affects the House.

I accept that today there are problems involving the accident and emergency units and the demand they face. As my right hon. Friend the Secretary of State and my hon. Friend the Minister of State know, I have raised that issue in the House, as well as the subject of the Good Hope hospital in Sutton Coldfield, to which I shall turn in a moment, as it was raised by the hon. Member for Peckham. I have made criticisms of the current position, and I have welcomed the action that has been taken—including the creation of new operating theatres and the modernisation of the unit. I hope that, in due course, there will be a new admissions unit, provided by the Government.

When I intervened in the speech of the hon. Lady, she appeared to cast doubt on the importance being set on that issue at the Good Hope hospital. She quoted a few words from what Tom Dean, the chief executive at Good Hope, had said. As it happens, I have with me the press statement that Tom Dean issued on 12 January, when the Secretary of State and I were at the hospital. The Secretary of State will confirm that his words were not part of our press release, but his own.

The headline in the press release is "More beds opening at Good Hope". It continues: Tom Dean…said: 'We are continuing to take positive steps to deal with the rise in emergency medical admissions by opening more beds on various wards at Good Hope. 'Thanks to our recruitment drive for more nurses, we have been able to open another 18 medical beds and six surgical beds this week. 'Building on the recruitment drive, we expect to open a further 39 beds next month to assist with meeting the emergency needs and to help us catch up on non-urgent surgery. 'We are looking at ways of increasing yet further our operating lists, particularly for those patients for whom day case surgery is appropriate. That press release gives the flavour of what Good Hope hospital and its chief executive seek to do much more than the selective couple of words used by the shadow Secretary of State for Health. We shall want to see the full letter, from which she took just three or four words.

I hope that hon. Members on both sides of the House will accept that I find it difficult to take the implication or charge that came through in the hon. Lady's speech this afternoon—that the problems of the health service and of the Good Hope hospital have all emerged during the lifetime of the Conservative Government. Anyone who knows the position knows that that is not true.

In the 21 years that I have been Member of Parliament for Sutton Coldfield, the most agonising health meeting that I have attended—and that I ever hope to attend—was when a consultant at the hospital gathered together his entire waiting list in a local hall to confront the authorities. The authorities that he confronted to protest about waiting lists were not the Conservative Government, but the last Labour Government.

The biggest problem we have faced in the past 21 years in Sutton Coldfield has been what happened over the much-needed hospital buildings. Those buildings were cancelled because of the capital cuts made by the last Labour Government, which were brought about by the economic crisis. It is all very well to call—as the motion does—for new beds to be opened, but if the Labour party's practice had prevailed, there would have been no question of bringing back beds, because those beds would never have existed. The wards would not have been built. The Conservative Government built the wards in Good Hope hospital.

That is only one local hospital, but it illustrates the general position. Those of us who remember the health policies of the last Labour Government remember perfectly well that their actions did not remotely match the words that Labour Members use today.

What about future action? I listened to what the hon. Member for Peckham said this afternoon, and I listened to her in Birmingham town hall in a debate with my right hon. Friend the Secretary of State—and many other people, as it happened—and an audience of about 1,000 people. Naturally, the hon. Lady was asked about resources. The only answer she gave was one similar to that which she gave this afternoon—an assault on managers in the health service.

I am the last person to defend bureaucracy. Indeed, I believe that removing the regional health layer, which my right hon. Friend the Secretary of State is doing, is probably the best way of tackling bureaucracy. Although I oppose bureaucracy, I am emphatically in favour of strong management.

The general managers that I introduced in the 1980s, following the report of the late Roy Griffiths, were the real start of the health reforms of the present Government. I shall tell the House why those reforms were important.

In the summer of 1984, there was an outbreak of food poisoning at the Stanley Royd hospital near Wakefield. Perhaps one or two hon. Members remember it. It affected more than 800 elderly patients, and caused 19 deaths. I appointed a public inquiry into the outbreak, and the crucial message that came back was that we needed more hands-on management.

There was a gulf between those who were meant to be in charge and those who were carrying out the work. According to the report, the so-called managers at the time passed through rather than spent time in the kitchen". In other words, what were needed were managers who took responsibility for securing the best service for the patients and who could be held to account if there was failure. That was the overwhelming logic of the Griffiths report.

At the time, we were opposed all the way by the Labour party on that proposal. We were told that the health service was different from business, and therefore did not need the benefits of management techniques that had been developed in business and in industry.

Of course the delivery of health care is different from producing cars or selling food, but there are very many common problems that any manager shares. He must be concerned with the quality of service and productivity. He must motivate and involve all his staff, and he must live within his budget. The health service should not be run in any way on a commercial basis, but it certainly must be run in a businesslike way, because that is the sensible way to manage a service of that size.

Mr. Simon Hughes

I wonder whether the right hon. Gentleman's experience leads him to the conclusion that, however much one might devolve management, the only person publicly accountable by election for the health service in this country is the Secretary of State, so it is the Secretary of State who ultimately must ensure that, when the health service is needed, for example to respond to emergencies, the services are provided—the buck stops there, not with the local management.

Sir Norman Fowler

The buck ultimately does stop with the Secretary of State. As someone who was Secretary of State for six years, which I believe is longer than most, I bear the scars of the buck stopping with the Secretary of State.

Mr. Ronnie Campbell

You can see them.

Sir Norman Fowler

Indeed you can.

I agree with the hon. Member for Southwark and Bermondsey (Mr. Hughes) that the buck stops with the Secretary of State, but, before general managers were introduced, we had the totally unsatisfactory position in which, all too often, no one was in charge at the health authority level or the hospital level. That is not the way to run anything, let alone a health service as important as ours.

I predict with certainty that, if by some mischance there were a Labour Government, they would not abolish general managers. Labour Members have opposed them, but they would continue with them, because no serious figure inside or outside the health service wants us to return to the old system.

It is not only in the past or the future that the words of members of the Labour party do not match their actions. The Secretary of State was at the Good Hope hospital when it was announced that more beds were being made available. However—this really is an argument for the hon. Member for Peckham—a couple of miles away, in another part of Sutton Coldfield, the Labour-controlled Birmingham city council is closing altogether a 40-bedded, purpose-built residential home for old people, the Frances Withers home. It is transferring to other accommodation, if it can, residents aged, on average, in their late 80s and 90s.

The read-across from that is quite clear. Elderly people account for more than 40 per cent. of the cost of the national health service. If the council takes such facilities out of operation, we all know what will happen—sooner or later, the strain will be taken by the national health service.

I am not the only one who opposes that policy. It is opposed by the residents, it is opposed by the relations of the residents, and, perhaps most vociferously of all, it is opposed by the trade union Unison on behalf of the staff.

Why is the home being closed? Birmingham city council has a budget of about £1.2 billion. It spends almost £190 million on social services, yet it cannot find a small cost to keep that home open. It has wasted millions of pounds—there is no doubt about that—on maladministration in the housing benefit system. It is unable to find the modest resources necessary to keep open a purpose-built home, built only 20 years ago, with good single rooms for residents, an exceptionally quiet and safe position, and an excellent sheltered garden, which is in every respect an excellent place for elderly people.

I find the arguments for that policy extraordinary. The council says that, together, Sutton Coldfield and Erdington constituencies have the second greatest provision of residential accommodation in the city of Birmingham, and that has become an argument for closing down the home. The council cites the cost of refurbishing the home, yet—I toured the home myself again last Friday—there is considerable doubt whether any refurbishment is required.

The television cameras and the media have camped outside Good Hope hospital, and I make no complaint of that. I have, as the Secretary of State knows, been outspoken on behalf of my local hospital. I hope that the same television cameras will portray what is happening in the Frances Withers home. I hope that they will portray a home being broken up. I hope—

Mr. Connarty

Will the right hon. Gentleman give way?

Sir Norman Fowler

I will not give way, as I am just ending.

I hope that the cameras will portray how old people are being transferred from one part of the city to another, often far from their relations. I hope that they will portray the way in which a purpose-built home is being vacated. Let no one ever forget that that policy is being instituted and carried out by a Labour-controlled council.

So the hon. Member for Peckham—

Mr. Connarty

rose—

Sir Norman Fowler

I will not give way.

If the hon. Member for Peckham wanted to interrupt me, she might have remained in the Chamber. I regret very much that she has not done so.

The hon. Member for Peckham has succeeded in opening a debate. It may not be the debate that she intended to open in the glad morn of last Wednesday, when the subject was decided for today's debate. The debate that she has opened is about the difference between the Labour party's words and its actions. Conservative Members look forward with enthusiasm to joining that debate.

6.19 pm

Mr. Simon Hughes (Southwark and Bermondsey)

The first two speeches in the debate today have shed much heat but very little light on the subject. The hon. Member for Peckham (Ms Harman) moved the Opposition motion on the national health service. It contains some good ideas, including the suggestion that each health authority should nominate a person to identify bed shortages, that there should be a regular report on bed numbers, and that national guidelines should be introduced to clarify who pays for continuing care. The motion is strong, according to the hon. Lady's own diagnosis, but we know that we seek a diagnosis only in the hope that we shall receive a prescription, and the hon. Lady certainly offered very little in that regard.

The Opposition have many questions to answer. For example, the hon. Lady referred to the difficulty that people have securing dental treatment, but she did not tell us whether Labour is committed to restoring free dental checks. The hon. Lady and her colleagues regularly refer to the difficulties facing opticians, but she did not announce that the Labour party is committed to providing free eye tests. The Opposition complain every year when prescription charges increase, but they never confirm that they would freeze or reduce those charges.

The Secretary of State is correct when he says that we do not know whether the Opposition are for or against fundholding, the private finance initiative or increased money for the health service. Until Labour Members answer those questions, there will be no prescription—which is always more difficult to provide than a diagnosis.

The Secretary of State conceded that the health service has experienced some problems recently. He conceded that the demands on the health service have increased during the winter months, but he did not tell us whether the health service is coping with that demand, and he certainly did not tell us how he will ensure that it copes in the future. The Government amendment congratulates NHS staff on their hard work and dedication. The staff are certainly working hard, but I intend to cite some facts which show that they are not very happy about their status or about the work they are asked to perform.

The number of practitioners has increased in some areas, but decreased in others. In some areas, there is a dearth of people who are ready and willing to do the necessary work. The Government's figures show that their commitment to a year-on-year increase in real resources—we have debated the subject twice in this place in the past few months—will be barely attainable in future years.

The health service needs to develop three fundamentals in order to secure its future. It needs a working structure which will hold the health service together; it needs adequate funding to do the job; and it must be run effectively in order to improve staff morale. Although we do not need many further significant administrative changes within the health service, many areas that are clearly unsatisfactory could be vastly improved without uprooting or disrupting the service as a whole.

For example, from April we shall have regional outposts and regional civil servants, but no regional health authorities. The Liberal Democrats have long argued against separate regional health authorities. We believe that elected regional representatives should operate the strategy that determines the health service at a regional level. At a local level, the health authorities are appointed by the Secretary of State. That is not a democratic process, and my party has now agreed that health commissioning should be carried out by local government, in the same way as it carries out the commissioning and practice of social services.

Change is necessary in order to democratise the health service. I make it clear to the Minister that that does not mean any alteration in the purchaser-provider split; nor does it signal an end to fundholding. We believe that everyone should be a stakeholder in the fundholding and a partner who is able to buy the service—

Mr. Charles Hendry (High Peak)

Barmy.

Mr. Hughes

It is not barmy, and it is not a new idea. It has been advocated for a long time by eminent people on both sides of the House, and by others such as J. K. Galbraith.

Having improved the structure of the NHS, we must then address the question of funding. Whatever the complex causes may be, the perception on the ground is that the funding and resource needs of the health service cannot be met only by the redistribution of resources within the service. It is not sufficient to cut the high salaries and the perks of managers, although that should be done. It is not sufficient simply to reduce the number of managers and put more staff on the front line, although that must occur also. The health service has a more fundamental need, as has been evidenced in the past few weeks by a shortage of doctors, nurses and support staff.

Elements of the recent crisis have been publicised in the newspapers, which carried stories about people being flown around the country in search of hospital beds—in one case, it involved an airman from the east coast. It was clear that emergency services were not available. I was told at the beginning of the week that Guy's hospital in my constituency needs 40 intensive care nurses. In practices all over the country, people are being told that the resources are simply not available, and that they cannot be recruited.

Mr. Hayes

I accept that the hon. Gentleman is totally sincere. However, I refer him to his suggestion that persons elected from local authorities should serve on health authorities and trust boards. That idea was declared unworkable by Nye Bevan, and the leaked document describes it as "barmy". I suspect that it was declared unworkable and barmy because, under the present system of appointment—there are many Labour and Liberal Democrat as well as Conservative appointees—party politics is buried once the parties are around the table taking decisions. That is good for health care.

Mr. Hughes

I know that the argument is not cut and dried. No one wants to see health authority policy hijacked for party political aims. I shall conclude my speech by suggesting how we can behave slightly more intelligently in that area than we have of late. We should not shout at each other across the Floor of the House. The people are not well served by party political appointees who seek to advance an imperfect manifesto. No one has the benefit of complete wisdom.

However, I do not accept that no one should be elected, and that all members should be appointed by the Government. Of course they will appoint people of different political persuasions in order to make it appear a balanced exercise, but at the same time they will continue to appoint their own people and those who are politically neutral. That gives the Secretary of State enormous power and leads to a lack of accountability to the patients, which is entirely inadequate in the case of a public service. The service is funded with taxpayers' money, and people expect to have some control over that expenditure.

Many problems remain in the family doctor service, including inadequate out-of-hours service and inadequate deputising services in many areas. Doctors cannot be recruited in many urban areas, and the quality of doctors is also an issue. People often find it difficult to register with a doctor, and they may be thrown off a doctor's list even though they have not found a replacement GP. We have not yet resolved the controversial issue of how often doctors should be allowed to dispense.

Doctors certainly believe that they are under increasing pressure. My colleagues have surveyed doctors around the country, and I shall refer to the views of doctors in three areas. My colleagues in Hazel Grove—an area south of Manchester, which I know well—conducted a survey of general practitioners in the autumn, and discovered that 70 per cent. of those who replied wanted to change profession or take early retirement. Eighty per cent. of GPs said that they were unhappy with the state of their profession.

Colleagues in Cornwall made a similar survey, and in Devon morale among GPs was so low that new jobs in Torbay are attracting only two out of three applications, compared with 40 out of 50 a few years ago. In Cornwall, the county of the hon. Member for Falmouth and Camborne (Mr. Coe), the local medical council chairman, Dr. Andy Stewart, said in response to a survey by the hon. Gentleman's prospective Liberal Democrat opponent, Terry Jones, that 20 out of 320 GPs surveyed were receiving psychiatric care because of the stress caused by long hours and other work-related problems.

My colleague in Liverpool, who is a prospective candidate, also undertook a survey.

Mr. Malone

Was it a similar survey?

Mr. Hughes

Of course, and it comprised straightforward questions. I shall willingly show the Minister the results. When all the results are collected, I will let him have those because the issue is hugely important. Thirty per cent. of Liverpool's doctors are thinking of earlier retirement. Morale among GPs at the front line of the health service is severely low; that bodes ill for the future unless immediate action is taken to remedy it.

Mr. Sebastian Coe (Falmouth and Camborne)

I hope that the survey by one of the hon. Gentleman's colleagues in my constituency had slightly more intellectual and numerate rigour than the Liberal Democrat survey in Devon and Cornwall. Under scrutiny in a debate in this Chamber only a few weeks ago, the Liberal Democrats had to accept that the response rate barely bordered on 25 per cent.

Mr. Hughes

I am perfectly happy to deal with the figures. I remember that debate, and I have read it. Various surveys have been undertaken in large areas, if not throughout the country. The response rate varied. In some places it was one quarter, and in others well over 50 per cent. There is no secret—I can give the hon. Gentleman the figures. I hope that he shares my concern that the trend, which is identical or similar throughout, is for large numbers of general practitioners to say that they are overworked, over-stressed and thinking of retiring early, and cannot recruit to their practices.

A practice just around the corner from my house is having great difficulty recruiting. I asked another practice in my constituency today, so that I could not be accused of giving outdated information. It stated that it is under huge pressure because of lack of resources. It was told that there would be adequate resources for care in the community, but there are not.

The practice informed me, for example, about a lack of bathing facilities and care assistants. It knew of more than one person who has been waiting three years for a bath seat. Standards of care are often considerably reduced because there are not the people to deliver them.

I do not rejoice in that situation, but state facts rather than speak rhetorically. Those facts suggest that something is substantially wrong. We all have a responsibility to respond.

Mr. Ray Whitney (Wycombe)

We all want facts, not rhetoric. Does the hon. Gentleman have any comparable statistics of that claimed low morale in the medical profession during the Lib-Lab pact, when morale was distinctly low? I do not have any such figures, but it would be interesting to compare them. Is the hon. Gentleman aware that, in the past 10 years, the average GP list has been reduced by 9 per cent, which is difficult to square with the high stress to which the hon. Gentleman referred.

Mr. Hughes

I was not here in the time of the Lib-Lab pact, but I remember the issues and debates. The former Secretary of State, the right hon. Member for Sutton Coldfield (Sir N. Fowler), said that the health service suffered significant cuts and waiting lists under the Labour Government at that time. That is a matter of record, and I remember it well. I do not doubt that the health service in the late 1970s was badly sapped of morale. We are debating the health service today, and I want to respond positively because we have an obligation, between us, to prepare the service for the next century, when there will be more demands than now.

There will be no bottomless pit, no matter which party is in government and who is Secretary of State, any more than there is now. The Secretary of State was right to point out that there will always need to be rationing of health care, and we would be fools to ignore that fact. Rationing has always happened—at some times by long waiting lists, at others by clinical choices. We owe a duty collectively to our citizens to resolve three questions—as the hon. Member for Broxbourne (Mrs. Roe), who chairs the Health Select Committee, knows.

First, what are the health service's boundaries of responsibility? The original legislation and current legislation do not accurately define them. The right hon. Member for Sutton Coldfield gave an example of care in the community, where free service at the point of delivery may no longer be available. We may enter the area of community care or social services. Redefinition is a difficult debate, but we must address it.

Secondly, we must address how we make choices among competing priorities for funds that will always be insufficient to meet the needs to which the NHS would like to respond. We may need to be rigorous about eliminating work that does not have proven clinical value. If I may be controversial, the famous case of Jennifer's ear was probably an example of work that did not have proven clinical value.

Thirdly, we should seek to agree the minimum public funding needed to guarantee a comprehensive health service in all four countries of the United Kingdom that is free at the point of delivery and accessible to all our citizens.

Those difficult-to-answer questions are ideally suited to the exercise of that which, from this week, I am required to call partnership politics. The people—patients, actual and prospective, professionals and politicians—should begin a dialogue to reach agreement. Just as there used to be bipartisan agreement on pensions policy, if we are to hold on to a national health service we will require a bipartisan or multi-partisan agreement on health service policy.

The best guarantee for the future of the health service in the next century, with more older people to be treated and more high-cost medicine, is renewed commitment to the service's principles and agreement on paying for its practice in a way that accommodates those greater demands. I hope that the Secretary of State and his colleagues, and those who speak on health matters for Labour, agree that they should have such a dialogue with me and my colleagues and others in the House. Otherwise, we shall have the same sort of shouting match as we have seen this afternoon, which does not advance the cause of patients one jot.

6.37 pm

Mrs. Marion Roe (Broxbourne)

I am pleased that the House has the opportunity to debate the state of the national health service because I want to draw attention to the work that the Select Committee on Health, which I have the honour to chair, is currently undertaking in respect of long-term care—an issue of enormous importance in future policy and direction and to the public.

How the disabled elderly are to be cared for and who is to pay for that care is a question that affects us all potentially. Last November, the Committee published the results of phase 1 of its inquiry, which considered the implications of Department of Health guidance on NHS responsibilities for meeting continuing health care needs. That report was unanimous, and I thank all my colleagues on the Committee for the constructive way in which that topic was discussed. It was a very good advertisement for the Select Committee system. We are now well into phase 2 of our inquiry, which is considering the potential demand for long-term care in the future and the possible consequences of funding arrangements.

I shall begin by outlining the main conclusions in our report and the main points of the Government's response, which was published yesterday. The Select Committee has not yet had an opportunity to discuss the response, so I shall give my own personal view. I will also touch on the main issues that we are considering in phase 2 of the inquiry.

The Select Committee was pleased that the Department of Health had recognised the need to clarify NHS responsibilities for continuing health care services. We commended the Department for the extent to which it was able to accept views expressed during its consultation period. Nevertheless, there were some areas where we thought that further clarification would be helpful for the NHS, for local authorities and also, of course, for the users of those services.

The guidance calls on health authorities to develop local policies for purchasing continuing health care services. All the members of the Select Committee were struck by the desire of witnesses that health authorities should not focus solely on the important question of defining eligibility criteria for NHS continuing health care, but should also ensure that the full range of high-quality continuing health care services is available to support people in their own homes for as long as possible. I am pleased to note that the Government strongly agree with our sentiments.

The Select Committee shared the concerns of many witnesses who argued that locally set eligibility criteria might create unacceptably wide variations in the provision of NHS services. We recognised that the Department of Health's guidance provided a framework which went some way towards meeting those concerns, but on the grounds of equity we recommended that the nationally set framework should include eligibility criteria for long-term care so that it is absolutely clear what the NHS, as a national service, will always provide.

I am also pleased that the Government, in their response to our report, agreed that the current variation in continuing health care arrangements needs to be addressed. The Government have also committed the national health service executive board to reviewing, during the coming year, how eligibility criteria are operating in practice and to issuing further guidance on priority issues relating to eligibility criteria, which may, in effect, lead to the national criteria that we called for in our report.

The Select Committee felt that it was important that patients, together with their families and carers, should be left in no doubt as to the circumstances in which health authorities rather than local authorities will be responsible for purchasing continuing care services, especially nursing home care which, as the House will be aware, can be purchased both by health authorities and by local authority social services departments. We were not convinced that the Department of Health's refusal to provide information on the types of cases that might be expected to come within the eligibility criteria was justifiable. We therefore recommended that the Department of Health should prepare illustrative case studies and widely disseminate them.

I am pleased that the Government have recognised the strength of our case by accepting in their response that there is value in health authorities testing their eligibility criteria against case studies. I fear, however, that the members of the Select Committee will be disappointed that the Department of Health is still only considering whether it would be helpful to issue the kind of illustrative case studies that we call for. In our view, those are clearly necessary to help members of the public to understand their position.

Our report also recommended that the Department of Health should introduce a national long-term care charter, which would specify the minimum levels of provision that people could expect from health authorities, NHS trusts, GP fundholders and local authorities. It would also specify access to a named range of services, a minimum list of specialist equipment and home aids, time limits for assessment, and provision of services where need is identified.

The Government have told us that they have not reached a final decision on whether to issue such a charter, which would cover some of the ground already covered by the forthcoming local community charters, but that before April they will issue a national leaflet on long-term care. We look forward to seeing that.

The guidance issued by the Department of Health also deals with hospital discharge arrangements for patients who are assessed as not requiring further NHS-funded continuing health care. The Select Committee recommended that health authorities and NHS trusts should not discharge patients home without a package of care being prepared, which can be demonstrated to meet their assessed needs fully and, as far as possible, agreed in advance with them and their informal carers. We also called for NHS-funded patients entering a nursing home to have the right, subject to the necessary clinical and financial conditions, to choose their nursing home—a right which currently exists for local authority-funded patients in nursing homes.

The Select Committee welcomed the proposed establishment of independent panels to which patients being discharged from hospitals, who are not to be funded by the NHS, can appeal. Those panels will provide an extra safeguard for patients facing important and sensitive decisions about their future. We also urged the Department of Health to clarify the arrangements under which those panels would seek independent clinical advice. We also recommended that the right of appeal to the review panel should he extended to all patients assessed as requiring nursing home care, wherever they live, when that care is not to be funded by the NHS, and that the right of appeal should not be restricted to those being discharged from hospital.

I am pleased that the Department of Health's further guidance on the review procedure makes it clear that patients, families and their carers have the right to request a second clinical opinion, which should be offered routinely before their case reaches the independent review panel. However, it is disappointing that the Department of Health has not clarified our concerns about how the provision of independent clinical advice to the review panel can be conducted fairly from the patient's point of view, if an opinion is to be given only on whether the clinical judgments made match the health authority's eligibility criteria, rather than on the clinical diagnosis, management or prognosis of the patient.

The Select Committee warmly welcomed the decision that implementation of the new guidance should be one of the six national priorities set by the Department of Health for the NHS over the next three to five years. We called upon the Department of Health to set firm target dates for the completion of NHS reinvestment programmes by all those health authorities whose reviews indicated a need for such a programme. We also considered that to aid public confidence in the equity of access nationally to NHS-funded continuing health care, the Department of Health should publish the outcome of its review of individual health authorities' policies and eligibility criteria and outline the action that it would take against any authority which significantly departed from the national framework. I welcome the Government's assurance that health authorities will have to publish plans clearly setting out the target dates for completion of any necessary reinvestment programmes; and the Committee will look to the NHS executive to monitor health authorities closely to ensure that the policies are fully implemented.

I should like now briefly to outline how the Select Committee is taking forward its work on long-term care in phase 2 of the inquiry. Many of our witnesses have commented on the need for the Government, Parliament, providers and the public to participate in a far-reaching debate about the future of long-term care provision and funding. We hope that our Committee is currently stimulating that debate. We are considering what models of care exist for long-term care services, and we are further examining the differing models of care which can meet future demand for long-term care.

Some of our earlier witnesses stressed the potential impact that health promotion might have on reducing demand, while others drew attention to the potential offered by further investment in rehabilitation services. We are also considering who should manage long-term care.

An aging population is a widely recognised phenomenon throughout most of the developed world, including the United Kingdom. The state of health of older people is also a key determinant of the need for, and hence the cost of, long-term care. We shall therefore be considering the cost implications of long-term care, given projected demographic trends, and whether talk of a demographic time bomb is realistic or alarmist.

We have been exploring the question of whether longer life expectancy is likely to lead to longer periods of illness and disability, in addition to other factors which may impact on the demand for long-term care, such as changing social and demographic conditions.

Whatever the scale of the likely increase in demand for long-term care, one thing is clear: it will have to be financed from one source or another. Where the balance of responsibility for funding as between the individual and the state should lie is being debated in just about every western country, as well as in many Asian countries. It is probably true to say that this issue potentially eclipses in its future importance every other issue that we daily discuss in this House. I hope to be able to address the House on this subject again in the near future, when the Select Committee has produced its final recommendations.

6.52 pm

Mr. Joe Benton (Bootle)

I begin by thanking the shadow Secretary of State for Health for her excellent exposé of the state of the health services as they affect my constituents in Bootle and Merseyside. She particularly drew attention to the shortage of beds—a factor highly relevant to my part of the world.

I could not help pricking up my ears when I heard the hon. Member for Broxbourne (Mrs. Roe) refer to case studies. As she is Chair of the Select Committee on Health, I would like her to consider three case studies that I shall offer the House tonight, if the House will bear with me. I shall use them to illustrate and identify what is going on in hospital care in my part of the world. That is why I am asking the hon. Lady to take my case studies forward.

The first concerns Mrs. K. Larkin, who was diagnosed as having cancer and taken to Fazakerley hospital on 26 October. She was admitted at 2 pm and remained in the reception area until 8 pm without food or drink. Her daughter had to ask for a blanket to cover her up. Only after repeated requests from her family was she even given painkillers. She was later discharged and eventually died at home.

The second case relates to Mr. J. Molloy, another constituent of mine. On 16 January 1995 he was taken by ambulance to Fazakerley hospital, to which he was admitted at 1620 hours suffering from internal bleeding due to a duodenal ulcer. He was kept waiting in the reception area on a trolley for some seven hours and 10 minutes, before being transferred to a cubicle where he was later visited by a doctor, some eight and three-quarter hours after being admitted. He was then taken to a ward at 0320 hours the following morning.

The third case will take a little longer to deal with, but I should like the House to hear it. Mr. Barlow, now unfortunately deceased, was terminally ill with cancer. He was admitted to Fazakerley hospital, following a referral by Dr. Krasner, for the purpose of alleviating a restriction in his throat. He arrived at the hospital at 1.30 pm and proceeded to ward 12 as requested, where he waited for a doctor. After an hour, he asked the nurse when he would be seen and was advised that the doctor was on his way. Much later, because there was a bank holiday pending, he was advised that there was little point in his staying because he would not be seen until after the bank holiday.

Mr. Barlow arrived back after the bank holiday and was admitted to the ward at about 8 am, only to be told that no bed was available. A computer breakdown was blamed. He was given a trolley bed and placed in the store room of the hospital among boxes of syringes, dressing packs and other medical appliances and equipment. That afternoon he was taken to theatre and given a general anaesthetic. He was assured that he would be placed on a ward on his return from the theatre. Mr. Barlow came round from the anaesthetic somewhat disoriented and found himself back on a trolley bed in the same store room—aware that he still had a blockage in his throat. He could get no clear information about what had happened from nurses or ward doctors.

Those are three real cases: they actually happened. The situation in Liverpool's hospitals has been rightly described as critical. Indeed, so bad is it that my hon. Friends the Members for Liverpool, Walton (Mr. Kilfoyle) and for Knowsley, North (Mr. Howarth) went with me to meet the trust. Earlier, the Secretary of State talked about referring cases to Ministers individually. All Merseyside Members have referred individual cases to the Minister, but we have had no satisfactory response: we are always referred back to the trust.

This has caused a terrible crisis of confidence throughout Merseyside. The sad fact is that the older one gets, the less confidence one feels about going anywhere near a hospital. I should be grateful if the Minister would answer today the questions that I tried to put earlier in the debate. The Secretary of State today mentioned certain parts of the country where new beds have been created. Exactly what beds have replaced those lost by the closure of Walton hospital in Liverpool? Will he also say why, when we refer individual cases to the Department of Health—contrary to what the Secretary of State said earlier—he will not deal with them as a matter of urgency, but simply refers us back to the trust, which is self-defeating and gets us absolutely nowhere?

It is clear that there is a crisis in the health service. I am not a dinosaur. I am quite prepared to listen. I know of the problems of funding, and I am prepared to look at that and to have an open mind. What I and my colleagues insist upon, however, is that we have a national health service of which we can be proud. I remember its inception when I was a young boy, and I remember the great relief that it brought to families such as mine. Instead of having to pay for doctors and services, we had the national health service. It is one of the greatest treasures that this nation has and justifies our putting the adjective "Great" in front of Britain. That is what I think of the health service. I am prepared to look at all sorts of ideas so that we eventually come up with a national health service which provides the necessary service at the point of delivery and does not mean people being stuck on trolleys for nine hours at a time in hospitals up and down the country.

Before the hon. Member for Broxbourne leaves the Chamber, I ask her to take to the Select Committee the case studies that I have given. Let us see what the Committee has to say. If any Government fail to provide a proper national health service at the point of delivery, they will bring the country down. I believe in the framework of a Christian state, and that framework means a wholesome national health service that is available to everybody.

When the Minister replies, I very much hope that he will answer the questions that were posed by my hon. Friends earlier. We are dealing with a very serious matter, and we shall be failing many people if there is any further deterioration or exacerbation of the crisis that exists in the health service.

7.1 pm

Dame Jill Knight (Birmingham, Edgbaston)

The hon. Member for Bootle (Mr. Benton) is not the only one who seeks to have a Christian basis in life. Nor does any party, on either side of the House, have any right to suggest that it is the only party with a Christian base. It is extremely unfair to expect the Minister for Health, or, indeed, the Secretary of State, when he has had no warning whatever about Mr. Jones or Mrs. Brown having received this or that kind of treatment, to know instantly the circumstances surrounding the case, when there must be hundreds, if not thousands, of hospitals in this country. That would be totally absurd. I understand that the hon. Gentleman has not had the experience, but surely a little thought would have shown him that it is simply not reasonable to expect the Minister, who is in charge of the biggest business in the whole of Europe, to know every last detail about every patient in every hospital. He simply could not do that.

Mr. Benton

Of course, I do not expect the Minister to be able to reply in detail to every individual case, but it was the Secretary of State who said earlier that individual cases should be referred on an individual basis. I presume that by that he meant, referred to him. I—and my colleagues who represent constituencies in Merseyside—am tired of referring individual cases. I thought that I made that point clearly and lucidly. We are getting nowhere.

Dame Jill Knight

The hon. Gentleman is not being realistic at all. Obviously—I wish that he would listen to what I am saying—no Minister or Secretary of State for Health could possibly be expected to know all the details of all the patient cases in all the thousands of hospitals in this country. When a single case is referred to a Minister, he has no alternative but to make inquiries of the health authority that covers the hospital where the patient is having treatment. There is no other possible way to deal with the matter. I suggest that the hon. Gentleman is being a little unreasonable to suggest otherwise.

I did not, although many hon. Members did, seek to intervene during the opening speech of the hon. Member for Peckham (Ms Harman). It was not because I was not burning to do so—indeed I was—but because I did not know which point to pick her up on. A clear reply could have been given to every single one of her questions. I shall not prolong my speech by answering all the points that she raised, but I wish to raise a particular point.

The hon. Lady poured scorn on the Government's interest in involving the private sector and competition in the health service. Only last week—this is not old hat, either—I tabled a question, which, sadly, was not reached during oral questions, and how many of us have had to deal with that disappointment? My question read: To ask the Secretary of State what estimate he has made of the annual saving to the NHS arising from compulsory competitive tendering. The written reply was: As a result of market testing, it is estimated that since 1983 the national health service has been saved a total in excess of £1 billion".—[Official Report, 16 January 1996; Vol. 269, c. 548.] That saving is the result of competition being introduced and the private sector being utilised. What interests me about that is that every penny of that sum has gone to patient care. Had that action not been taken, there would have been £1 billion less for patient care. We can assume only that were, God forbid, a Labour Government to be elected and to take control of our health service, we would no longer have such savings. I have no doubt whatever that patients would suffer badly. It should be clearly on record that the Government's determination to save money and to use every sensible method of competitive tendering is a good idea.

Mrs. Anne Campbell (Cambridge)

Will the hon. Lady give way?

Dame Jill Knight

Other hon. Members want to speak, so if the hon. Lady will forgive me, I shall hurry along.

I am putting this on record, because it is true. Our health service has never been as good as it is today. For every one of the cases that the hon. Member for Bootle mentioned, I can tell him of 10, 20 or 30 patients who were very satisfied with the care that they received. Many of them have written to me about it. I have a file from people who wished to tell me how satisfied they were with the care that they received. Never in our history have so many doctors treated so many patients for so many ills with so few failures. Indeed, they are carrying out miracles, when I look at some of the cases of tiny babies being operated on today who would have died only a few years ago.

There are such cases not just in Birmingham, but throughout the country. Hip replacements are now carried out as a matter of common practice. Twenty years ago, transplant surgery was unheard of on its present scale, but it is now widespread. Consider how miraculous that is and the benefits that it gives. Nowadays people have not one heart bypass but triple or quadruple heart bypasses in one operation. Our clever doctors have never served the people so well. Our health service has never been as miraculous as it is today.

The second basic truth to which Opposition Members should listen carefully is that no Government of any political colour will ever be able to ensure that every single patient is treated for every single ill, in the hospital of his choice, by the consultant whom he prefers, the instant that the need arises. That may be a good goal for which to strive, but it ain't gonna happen because it is impossible. We can work towards it, but it is unlikely to be achieved, whoever is in power.

In Birmingham, we are grateful for the excellent health care available. However, Opposition Members have taken care to dwell on the few times when things do not go right rather than the thousands of times when they do. The newspapers are the same. I am aware that editors believe that only bad news sells papers, but I wish that they would not lie. A recent story in Birmingham referred to the huge loss of beds in Birmingham hospitals.

Incidentally, I was worried to deduce that the hon. Member for Peckham must have misled the House when she read a portion of a letter this afternoon. I know that my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) will have been disappointed that she was not present during his speech, because he also had information from the same official. The information that my right hon. Friend gave me was almost directly opposite to that given by the hon. Lady, so one of them must be wrong and we should be told which one. My right hon. Friend, who has been a Secretary of State, had the information in front of him and he read some of it.

I do not believe that the Birmingham health authorities are lying when they say: Claims in the local press and elsewhere, that there has been a huge loss of beds across Birmingham hospitals are not true. We should at least have the truth, and the authorities that are in charge say that such claims are not true.

It is right to recognise—nobody referred to this when talking about the lack of hospital beds—that many patients today are dealt with in day care facilities. Surely we do not need the same number of beds when thousands of patients are dealt with in the course of a day. I also welcome that advance, which medicine has given us.

The substantial investment in our Birmingham hospitals should be acknowledged. The Queen Elizabeth hospital has had a new neuro-science unit at a cost of £7.2 million, a cancer centre will open shortly at a cost of £8.5 million and there is a £30 million budget for improving theatres and wards. At Selly Oak hospital, £7.5 million has been spent on a new accident and emergency trauma unit and £2 million has been allocated for upgrading the outpatients' department. That was certainly needed, but £2 million is a lot of money. City hospital has had £7.2 million for a high-tech eye unit and £1.4 million for the upgrading of the accident and emergency unit, and it is also to have a new dermatology unit. Such figures are exceedingly encouraging.

Birmingham Heartlands, Good Hope and the Children's hospital have had £34.7 million between them. We also have a miraculous new women's hospital costing £17 million, for which we in Birmingham are grateful. All in all, Birmingham health authorities now have a budget of £600 million. That is one city—an important city, but one city.

Why will the Opposition never tell us whether they will put any more money into the health service, or even whether they will put as much money in? We just do not know. But those are the cold, hard facts and they are true. Of course, difficulties and problems can arise and they do, but there could not be a better sign of Government commitment to the health service than the fact that one city alone has had £600 million for the improvements that are needed.

I am rather tired of the unjustified criticisms made in the debate, which are constantly made, for reasons that can only be political. A favourite grumble is that too much is spent on management. My right hon. Friend the Member for Sutton Coldfield pointed out that inefficient management in the health service leads to bad patient care. However, I want to put on record the fact that Birmingham spends less than 3 per cent. of its resources on management—less than 3 per cent. That is not a waste of money on large cars and all the rest of it. In addition, there is no trace of self-congratulation when Birmingham says: We know there is further room for further improvement and we will go for it. I am sure that the Government feel the same.

Finally, I want to make two suggestions for the improvement of health care, particularly for the elderly. Too often in hospital, the elderly are robbed of their dignity. That occurs in two particular ways, which have been brought home to me, about which the previous Secretary of State tried to do something.

Many people hate being in a mixed ward. We understand that intensive care is a different matter because people are often unconscious. But men and women do not want to be mixed up in an ordinary hospital ward, and they should not be. It takes away their dignity and it is wrong.

There is also far too much taking away of elderly people's dignity by immediately referring to them as Betty, Jim or Bill. That may seem a small thing, but it is not. That surprises younger people, but I have known many elderly people—hon. Members know that there is validity in what I say—who feel a loss of dignity if they are addressed by their Christian name, often by nurses and doctors young enough to be their grandchildren, if they are not used to it. That is hurtful and there is no need for it. Surely to goodness we could recognise that every scrap of help that we can give our patients to preserve their dignity as well as their health should be made available.

With those two suggestions, I strongly support the amendment and I hope that it is carried.

7.18 pm

Mr. Ronnie Campbell (Blyth Valley)

Listening to some Conservative Members, one would think that the health service was safe in their hands, but the complaints that I have received and the troubles about which I have heard during a number of years under this Administration suggest otherwise. As a member of the Select Committee on the Parliamentary Commissioner for Administration, I know that there has been a large increase in the number of complaints about the health service.

I recognise that more operations are carried out now than ever before as a result of improved techniques. A person can go into hospital one day and come out the next, whereas a few years ago, he might have had to stay for a week. That, however, does not account for some of the horror stories that my hon. Friends have told. I have heard such stories myself, particularly in relation to a hospital in my area, the Cheviot and Wansbeck hospital.

Originally, a hospital was built in the constituency of my hon. Friend the Member for Wansbeck (Mr. Thompson), at considerable cost. Another hospital existed on another site, but, although still operational, it was run down and in a decaying state. The new hospital became a trust shortly after being opened, despite suggestions that it should not take that step too quickly. Lo and behold! In that first year of its existence, it was in debt to the tune of £2.5 million. That is when the problems started.

Two mothers are currently taking legal action against the hospital because they lost their children, which was undoubtedly due to neglect on the part of the hospital and, in particular, the maternity ward. I do not know what progress their cases are making, as legal action is a lengthy process. One of those patients is a constituent of mine; the other is a constituent of my hon. Friend the Member for Wansbeck. My constituent was left in the maternity ward. After her waters broke, she was left again. Although obviously in labour, she was left for hours with no one to tend her. Finally, someone came along and found that she was in labour—as she had been for some time. As it was her first child, she did not realise what was happening. The child was born, and taken from her; when she woke up, the doctors told her that it was very ill and that there was not much hope. The baby subsequently died.

The moral of that story is simple. As I said, the hospital had been advised not to become a trust yet, but it did so under pressure from the Government. It was £2.5 million in debt. It had cut the number of midwives on its staff to save a few bob: it had to save money in some way. Because of the cut, the midwife who was looking after my constituent was having to do 32 other things at the same time. She was under enormous pressure.

The chief executive, chairman and finance officer of that hospital have all left. I thank God for that, because it was they who made a mess of things. I must admit that those who took over are doing a pretty good job at present: at least they have clawed back £1 million, and patients to whom I have spoken seem fairly satisfied. I have not received many complaints.

I see that the hon. Member for Rugby and Kenilworth (Mr. Pawsey), who chairs the Select Committee on the Parliamentary Commissioner for Administration, is present. The Committee often investigates the health service, and we repeatedly find that trust managers and chief executives are not taking seriously their responsibility to deal with complaints. When serious complaints are made, they ignore them. The health service ombudsman is said to have renewed his attack on national health service managers' handling of complaints, and the way in which they ignore the necessary procedures. I wonder how many complaints are received by the Parliamentary Commissioner, and whether any of the complaints cited by my hon. Friend the Member for Bootle (Mr. Benton) have been investigated.

My local practice in Blyth Valley has 12,000 patients. The practice, which is one of the biggest in the area, refused to adopt fundholding, although other local practices have. I have heard stories and tried to gather evidence, and I questioned the Parliamentary Commissioner some time ago when he was giving evidence to the Committee. I had an inkling that fundholders were beginning to receive preferential treatment, although that has always been denied. I asked the Commissioner whether, if someone told me that a patient in a fundholding practice had been seen before them, that would constitute a legitimate complaint. The Commissioner said that he would investigate the matter.

I am examining the position carefully, and I have written to the executive at the Cheviot and Wansbeck hospital to that effect. Of course, those involved may have smartened themselves up because they know that I have my eye on them. I ask other hon. Members who obtain any relevant evidence to write to the Commissioner, and to inform my hon. Friend the Member for Rugby and Kenilworth and me. As I said, however, the hospital is getting back on its feet, and I hope that phase 3 will proceed successfully.

Only last year, Gallup conducted a survey among NHS workers. I doubt that the Minister has seen the results, but I shall provide him with a copy if he would like one. The survey found that nurses were leaving the NHS in droves, piling pressure on those who remained. I remind hon. Members that Gallup is entirely independent.

When workers were asked whether they would consider leaving the NHS if they could obtain another job, 62 per cent. said that they would—an increase of 48 per cent. since the last survey in 1993; 75 per cent. of ward sisters and charge nurses said that they would leave, and 74 per cent. of staff nurses, 70 per cent. of health visitors and 69 per cent. of midwives said the same. When asked for their reasons, they cited falling standards: 62 per cent. mentioned having to compromise in regard to standards of care, while 63 per cent. referred to acute staff shortages and 75 per cent. said that they felt undervalued. If that is the reaction from health service workers, no wonder my hon. Friend the Member for Bootle and others are receiving complaints. Sixty per cent. said that their reason was the treatment by management. Of course, management is hard on the heels of the poor unfortunate people working in the health service. The service is being cut and those people are under pressure, understaffed and under great stress, and they are doing more work now than before. Of course, they are sick of it, and managers are always on their back—that is what they are for.

Fifty-one per cent. of nurses said that their reason was level of pay. They were concerned about the Government's policy of breaking the national agreement and bringing in local pay. Many of them thought that that was just another way of devaluing their pay in different regions, so a nurse in one region would get less than a nurse in another region doing the same job. If nurses want to work in a rich region, they are "Okay, mate," but if they want to work in a poor one, they are not.

There was a good article on health in one of the national newspapers in the north-east. Newspapers are newspapers, but I have heard this before and it was not far from the mark. In the north, the number of nurses has fallen by 4,000 in five years. It was interesting to read that Scottish and Newcastle Breweries is luring nurses to pull pints. One of its executive members said: In our experience, trained nurses make superb pub managers". That is obviously because nurses are tolerant and understanding—that is all people want in a pub manager. Breweries are luring nurses and nurses are going to work for them.

This year, the Nursing Times and Nursing Mirror carried 1,000 job advertisements for nurses—there were five pages of them. More than 100 nursing posts are vacant in the north-east of England. There must be something wrong, unless all nurses go to a bank—as an agency is called. Apparently, nurses who use them get more money. A hospital or a trust can sack a nurse tomorrow and she can join a bank, come back to that hospital and cost the hospital more. I cannot fathom that out for my life, but it happens.

There are short-term contracts for nurses now. When a nurse is employed, she is put on only a one or two-month contract, so she has no job security. In the health service, hospital trusts can float people out and float them in at a whim. It is a pity that we cannot do the same with some of the executive members and chairmen of the trusts, although I must admit that I did pretty well in achieving that in the Cheviot and Wansbeck NHS trust, getting rid of three of them in almost one go.

Staff shortages and a growing work load cause great stress. At least 87 per cent. of nurses interviewed in the Gallup poll said that they were overworked and under great stress. That says a lot. I hope that the Minister will take note of the fact that people are under stress. We must ask why that is happening. It might be because they see all these people on trolleys. They might be seeing the things that my hon. Friend the Member for Bootle has made complaints about, and they cannot do anything about it because they are overworked and overstressed.

In the past few years, complaints about the health service have increased by 55,000. There is a serious fault somewhere. If we do not get to grips with it, and if we do not give nurses a decent wage and make the job worth their while, problems will pile up.

How many times have we heard a patient say how wonderful it was being in hospital, seeing nurses at work and seeing their dedication to the people whom they are there to serve? I have heard that many times in hospital, yet nurses' wages have fallen and, as the survey showed, many want to leave the health service. That counteracts all that. If those things are happening, big accidents will occur and complaints will be made.

In relation to the case involving my constituent—the mother who lost her child—it was not the midwife's fault. I do not blame her. It was the fault of the system. I forgot to mention before that the trust brought the nurses back after making them redundant, when it found that it could not do without them—I do not know for how long. That is the system that we have now. That is what causes deterioration in the health service.

The health service is a wonderful thing. There is no doubt in my mind that the Government's idea is to have a two-tier health service, whereby some people pay and some people wait in the corridor. That is the service which the Government want. I say to the Minister that, if the survey means anything, it means that people who are working in the health service are as sick as we are at the state of it.

7.34 pm

Mr. Ray Whitney (Wycombe)

What the hon. Member for Blyth Valley (Mr. Campbell) says about the health service in the north-east bears no relation to my experience in the health service in Buckinghamshire and in many other parts of the country. For example, he referred to nurses' pay declining. That is contrary to the facts. If my memory serves me well, since 1979 nurses' pay has increased in real terms by 45 per cent. Nurses' pay dropped only once in real terms and that was during the time of the Labour Government.

The hon. Gentleman seems to have trouble with the service he gets from his trust. He does not like fundholding. He suggests that nurses are leaving the health service in droves. The South Buckinghamshire NHS trust gives excellent service to my constituents. GP fundholders give excellent service too.

The hon. Gentleman seems to get no proper answers when investigating complaints about his chief executives. Again, that is contrary to my experience and, I suspect, to that of most hon. Members.

Mr. Ronnie Campbell

Will the hon. Gentleman give way?

Mr. Whitney

Very briefly. The hon. Gentleman had a pretty good innings.

Mr. Campbell

I did not say that I did not get proper answers; I said that the health service ombudsman said that he did not get proper notice from health executives.

Mr. Whitney

I can repeat only that that is certainly not my experience and I would be surprised if colleagues had a similar experience.

What the hon. Gentleman produced was on a par with that produced by his hon. Friend the Member for Peckham (Ms Harman). As someone who has been interested in the health service for many years, I have grown accustomed, over the years, to hearing a litany of complaints and—as the cliché has it—to seeing this shroud waving. We have had that this afternoon, particularly from the hon. Member for Peckham, who always—she, too, has been involved in the health service for a number of years—comes to the House and reads out her essay, which is one long dismal dirge quoting individual cases.

Invariably, Conservative Members become deeply angry about that misrepresentation of the health service and about the total farrago of misinformation. It is based sometimes on ignorance and sometimes, one is moved to believe, on malice. The standard attacks are normal. Sadly, part of the reason for that is that the national health service has become a political football—a lamentable feature of British politics. I may not have agreed with many of the things that the hon. Member for Southwark and Bermondsey (Mr. Hughes), the Liberal Democrat spokesman, said, but I join him in this: if only the Labour party grew up and stopped believing in the myths that it has created about what did or did not happen in 1948, we could have a genuinely adult approach to tackling the challenges of health care.

Everyone knows what those challenges are. With the discovery of new treatments, the aging of the population and the wonderful opportunities that are available, added to the inevitable and inescapable pressures of funding, there are and will always be challenges, but we shall get nowhere as a nation while we have the pettifogging, narrow-minded and idiotic approach that was personified by the performance of the hon. Member for Peckham. It is a matter of great regret that her participation in the debate and her presence in the Chamber seemed to be of such brief duration. We have seen little of her. She would have at least learnt something if she had stayed.

Mr. Alan Milburn (Darlington)

What about the Secretary of State for Health?

Mr. Whitney

My right hon. Friend was here a great deal longer than the hon. Member for Peckham. She is in much greater need of learning what is happening in the health service than is the Secretary of State.

The approach of the hon. Member for Peckham seemed to be based on one or two minimal propositions. The first was the usual litany of individual cases—we heard the same from every other Labour Member who has contributed—in which the NHS may or may not have failed. As up to 1 million patients a day are treated by the NHS in hospitals or GP surgeries, it is not surprising that there can be one or many more mistakes. Of course, that is not the story of what is really happening in the NHS. The lie is given to those statements by Labour Members—or would be if they thought, for only a moment—by the situation into which they plunged what they are so fond of calling their national health service.

In relation to other issues, such as what happened in 1979 and before, I am almost prepared to let bygones be bygones—but not about the NHS. The Labour Government's record was criminal, and Labour Members should never forget it or be allowed to forget it. They speak as if they are completely ignorant, which is the most charitable thing that I can say. They do not know how bad it was when they ran it. They seem to have no idea of the fact that we have increased spending on the NHS in real terms by 66 per cent.

The average spend has increased from £433 to £697 a head, which is a terrific achievement. Of course, any fool can spend money badly; the great challenge is to spend money sensibly. That is what is happening. It has not been universally successful, because that is not in the nature of life, or certainly not in an enterprise as big as the NHS. We heard no recognition of that fact from the hon. Member for Peckham.

We heard from the hon. Lady that fatuous attack on management. As my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) said, Conservative Members, far more than Labour Members, would lead the charge on bureaucracy. When one is dealing with £41 billion of taxpayers' money and when there are more than 8 million hospital treatments every year, one needs that money and that enterprise to be managed. To spend 3 per cent. on management charges strikes me as entirely reasonable.

The one concrete point—if it can be so dignified—made by the hon. Member for Peckham was that, in relation to resources, she had allegedly discovered £1.5 billion that was spent on management that she would transfer to front-line care. How will she manage that? What will she do? If 3 per cent. for management charges is too much, is 1.5 or 2 per cent. the right figure? We never hear anything like that from the Labour party, and least of all from the hon. Lady.

There was some suggestion that the NHS was being privatised, which of course is complete nonsense. It is true that we do not share the hon. Lady's opposition to private medical care. We believe in choice. I shall not go over the issue of choice, which has been so familiar over the past few days in relation to the hon. Member for Peckham, but it should be recognised that the private medicine sector is not in competition with, but is an adjunct and addition to, the health resources of the nation. I hope that the Labour party is clear about that.

The Member for Peckham seemed to object strongly to any increase—she greatly exaggerated what it has been—in private medical provision. I must tell Opposition Members that the final years of the previous Labour Government were one of the bonanza times for the private medical industry. They were the great recruiting sergeants for private medicine because the health service was in such a mess. The hon. Member for Blyth Valley would have had something to complain about then. That was when people, including the unions, flocked to sign up by the cartload for private medicine. Union leaders were working hard, and why not, to provide private medical services to their members in case it was needed.

We heard that great litany, which completely disregarded the achievements of the NHS which include the fact that 3 million more people receive treatments every year in NHS hospitals, and we have thousands more doctors and tens of thousands more nurses. It was the same old litany that we have heard so often.

I believe that a great disservice is constantly done to the 1 million people, or whatever it may be, who are now working in the health service and giving a first-class, international-quality service. The litany has completely devalued and debased that service. I hope that the Labour leadership will look at itself and try to adopt a more positive attitude and constructive approach. Perhaps then we will be able to conjure up some meaning out of the term "stakeholding". That would be better than a diatribe, of which the hon. Lady gave us the most classic example.

The hon. Lady said, for example, that some treatments were no longer available. Does she not know that there are vastly more treatments available now than were dreamt of in 1979, not because of the Conservative Government but because of medical advances? The Government have generated an economy that is successful and strong enough to bear the necessary increase in resources that are devoted to the NHS to bring those new treatments to the service of our constituents. The hon. Lady's statement that treatments are no longer available is a grotesque misrepresentation of reality.

The hon. Member for Peckham, finally, tried to attack the private finance initiative, and again she seemed to be at odds with her leader and protector, the Leader of the Opposition. In the Budget debate he said: The PFI is right in principle. We have supported it, and in many ways we have been advocating it."—[Official Report, 28 November 1995; Vol. 267, c. 1077.] Not so the hon. Lady.

The PFI has great benefits to bring to the NHS. I am delighted to say that Wycombe general hospital and Amersham hospital in my constituency and the constituency of my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) are benefiting as some of the first examples of funding from the PFI. They are benefiting to the tune of £35 million. Because of the PFI, a wonderful hospital development is coming to us much more quickly than it would have done. There is a great story to be told. A great record has been achieved. It is one more great British achievement that the Opposition concentrate on denigrating. They should stop.

7.47 pm

Ms Janet Anderson (Rossendale and Darwen)

The speech we have just heard from the hon. Member for Wycombe (Mr. Whitney) accused my hon. Friend the Member for Peckham (Ms Harman) of peddling misinformation about the NHS. I was present for both the opening speeches in the debate and was impressed by my hon. Friend's detailed knowledge of the problems facing the national health service, unlike the Secretary of State for Health, who devoted a great deal of his speech to matters that had nothing to do with the NHS. In fact, he seem to be much more concerned to find out what we were going to do in government rather than to tell us what he had done in his post.

The hon. Member for Wycombe talked about the number of patients being treated in the health service and I think that he said something like, "It is hardly surprising that there is a mistake a day when millions of patient are being treated." That is not much consolation to my constituent, Mr. Craig Yates of Darwen, who is fighting for his life in hospital because he was denied a brain scan at Blackburn royal infirmary.

I put it to the hon. Member for Wycombe that, if one out of 10 planes that land at Heathrow airport were to crash, we would not say that that was all right because nine out of 10 had landed safely; we would find out why one had crashed and do something about it. It is a great pity that Conservative Members do not apply the same test to the national health service.

I am grateful to you, Mr. Deputy Speaker, for calling me to speak in this debate. I shall concentrate on the future of the hospital in my constituency. I say "the" hospital because we have only one hospital, the Rossendale general. It is situated high on a hill, partly still housed in what was once a workhouse, with beautiful views over the Rossendale valley. It is dear to all our hearts, and is part and parcel of our valley community.

At times, Rossendale general has seemed to be under threat of closure and some of the services that we wanted retained have now gone. We have no accident and emergency facilities and no maternity unit. If people need accident and emergency facilities or want to have a baby, they must go to Bury, Burnley, Rochdale or Blackburn. We fought hard against those changes at the time, but when we lost the fight we consoled ourselves with the thought that at least we still had our hospital. We were further encouraged when antenatal facilities were restored and the Burnley Health Care NHS trust decided to invest £5 million in the hospital over the past four years.

Our satisfaction at having retained the hospital, however, may be short-lived. The bombshell was dropped last week by Mr. David Chew, chief executive of Burnley Health Care NHS trust. A week ago today, he met staff at the hospital and told them that 31 beds would be axed, a ward would be mothballed and 60 to 70 staff, mainly nurses, would go. He said: I hope that we can find jobs for everyone and that no staff will go". The local Unison representative, Susan Holmes, said: We are concerned about job losses. In spite of management assurances, there are a number of people on temporary contracts who are very worried about their position. Mr. Chew tried to assure us that this was the way forward". It may be the way forward for the trust, but it is not the way forward for the people of Rossendale, whom I am proud to represent in the House. Nor is it the way forward for the 60 to 70 staff who stand to lose their jobs, or for those patients who, according to nursing staff, have been sent packing because of insufficient beds.

The proposals also mean that elderly women will be forced to endure the indignity of mixed wards, to which the hon. Member for Birmingham, Edgbaston (Dame J. Knight) eloquently referred. She is right. Many patients, especially the elderly, do not want to be forced into mixed wards and I am deeply saddened that that will happen to my constituents to save money.

Anne Parkinson of the Royal College of Nursing said of those proposals: The beds we have been operating with have been full and we have been turning patients away recently. Goodness knows where they have gone. This seems a drastic step at a time when there is a national shortage of beds. I am sure the trust will handle redeployment sensitively but they cannot promise there will not be any job losses. Staff are worried about losing their jobs. Some who have not got any transport are also worried about where they will be redeployed. Fewer beds will also force more and more people to travel further afield for treatment. There has been a gradual decline in in-patient facilities here during the past 10 years and there is a real feeling among staff that the hospital is being run down. Patients are being turned away through lack of beds, yet the trust is axing 31 beds. Hospital staff whom I met last weekend told me that someone turned up at the hospital last week claiming that he had bought 18 beds from the hospital and was there to collect them.

If the proposals are not the way forward for my constituents, hospital staff and patients, why should it be the way forward for the trust? Mr. Chew made it plain last week that the decision was to do with cash, not patient care, and claimed that it would save the trust £200,000 a year. I wonder why the trust seeks to save that sum of money. Just over a year ago, my hon. Friend the Member for Burnley (Mr. Pike), who was present earlier in this debate, secured an Adjournment debate on the state of chaos in the Burnley Health Care NHS trust. He read out a headline from the Lancashire Evening Telegraph: Scapegoat: 'Health chairman asked me to resign to save his own neck'. The chairman and chief executive of the troubled Burnley Health Care Trust each called for the other's resignation today in an astonishing bust-up. We learned from the Minister's winding-up speech in that debate that, because the chief executive had fallen out with the chairman and wanted rid of her, the pay-off was no less than £245,000, which is the sum that the trust seeks to save today.

A moving article appeared in my excellent local newspaper, the Rossendale Free Press, which many of my constituents read. It sums up the position by saying: Desperately sick and dying people are shunted all over the country in search of hospital beds and Burnley Health Care NHS Trust's reaction is to close 31 beds at Rossendale General Hospital. How can it possibly make sense? They are not the right sort of beds, says Burnley Health Care Trust. There's no emergency intensive and coronary care back-up at Rossendale, which is to be turned into 'an important out-reach post for minor surgery', catering for short-stay and day cases. You'll get your ingrowing toenails, your hernia or your piles fixed at Rossendale and be home again in a jiffy. But who wants to be home again in a jiffy, walking wounded and thrown on the mercy of that well-known euphemism, Care in the Community? Try telling Rossendale's old people, stripped of their home-helps by financial cuts, what a marvellous service that is. A mixed-sex ward will replace the existing male and female general medical wards despite public inhibitions and sensibilities. When a woman is stripped of her dignity, in pain, and sitting behind a curtain on a bedpan, the last thing she wants is a bloke in the next bed. And vice versa. Letters heaping praise on Rossendale General and its superb nurses and doctors appear regularly on the Free Press Viewpoint page. The maternity unit was closed in the face of massive opposition. Ante-natal clinics were clawed back after public outcry. Trust chiefs are at pains to stress, yet again, the hospital is not in any danger of closing;… Yet they can hardly be surprised that Rossendale folk"— and their Member of Parliament— are unable to resist the doubts and now will be even more perplexed, agitated, defensive, protective. Must we now stand by while more excellent services are amputated like limbs, until the trunk is no longer a hospital, but becomes an 'out-reach post'? It is vital for the patients and staff of Rossendale general and the whole community of Rossendale that there are no further cuts. I hope that when the Minister responds to this debate he will tell us how the Burnley Health Care NHS trust's latest proposals will improve health care for my constituents.

7.58 pm

Mr. Jerry Hayes (Harlow)

I begin by declaring an interest. I am an adviser to the Western Provident Association, which, as the hon. Member for Fife, Central (Mr. McLeish) should know, is a non-profit-making organisation.

Mr. McLeish

indicated assent.

Mr. Hayes

I am glad to have the hon. Gentleman's nod of approval.

When I first saw the Leader of the Opposition sitting next to the hon. Member for Peckham (Ms Harman), I thought, "There is decency in the man after all. He is there to protect the hon. Member for Peckham. God bless him, what a brave man he is." Then I realised that I had got it wrong because she was there to protect him, and to act as his human shield. They are the Siamese twins of British politics, but I suspect that, even now, the hon. Member for Hartlepool (Mr. Mandelson) is working on a surgical separation. The hon. Member for Peckham should be very careful.

I was having a drink the other day with a member of the shadow Cabinet, who said, "We have a saying in the Labour party—beware of left-wing toffs." Looking at the Opposition motion today, one sees that he was right. It could have been cobbled together by guests at a Pinter soirée discussing their view of the health service while being served Nicaraguan coffee by Filipino maids.

The hon. Member for Fife, Central must, I am afraid, pick up the wreckage from the speech of the hon. Member for Peckham later tonight, and we expect some answers from him. The hon. Lady's speech was not so much a policy statement as a cry for help. The speech from the hon. Member for Blyth Valley (Mr. Campbell), however, was remarkably honest—although he did go off the rails towards the end. The hon. Gentleman admitted that we now have the lowest number of people waiting for treatment in the history of the health service. He also admitted that he had no evidence that there is a two-tier system, although he is investigating the matter. If the hon. Gentleman finds some evidence, I hope that he will report it to the House. I suspect, however, that he will find no such evidence.

I spent a little of this morning reading through all of the speeches that the hon. Member for Peckham has made on health. The hon. Member for Fife, Central saw me do it. It was not a happy task. One interesting thing that the hon. Lady did say was that in vitro fertilisation was a lottery and that, "It depends on where you live." Oh dear—that has a familiar ring.

One of the points that cropped up over and over again in the hon. Lady's speeches since 1987—I have listened to many of them in the House—was that the health service reforms that had been put into operation would have to be abolished. She has also said that GP fundholding was a wickedness that led to a two-tier system, and that, too, would have to go. NHS trust hospitals and the internal market would also have to go. It is all very different now, however.

We just do not know precisely what Labour's policy on health is, and there is tremendous confusion. About 41 per cent. of the population are now covered by GP fundholding, and more than 10,000 GPs have voted with their feet because they know that the scheme provides good service. [Interruption.] The hon. Member for Fife, Central is making a gesture with his fingers—a pleasant one, as one would expect from him—to indicate money. He is right. The fundholders are getting more money to spend on patient care, and that is quite apart from the money coming from the Government. I can give the hon. Gentleman an example—the £64 million made from efficiency savings has gone directly to the patient to provide services that have never been seen before.

Mr. McLeish

Would the hon. Gentleman like to extol the virtues of the 59 per cent. of fundholders throughout England that are commissioning groups?

Mr. Hayes

The hon. Gentleman refers to commissioning groups, but I understand that one of Labour's policies is that the internal market, or the split between purchaser and provider that has been denounced over the years at the Dispatch Box from which the hon. Gentleman will shortly address the House, will continue. Does the hon. Gentleman deny that? Of course not, because he knows that it works.

GP fundholders have been a great success, offering more services than ever before. There are now some 10,000 of them, covering 41 per cent. of the population, and it is expected that there will be an additional 660 by next year. If there is—heaven forbid—a Labour Government, the majority of people in the country will be covered by GP fundholders that work. According to GP fundholders in my constituency and elsewhere, it would be a grave mistake if they were not to continue.

That is why the fudges are beginning. I mentioned in an earlier intervention on my right hon. Friend the Secretary of State that the right hon. Member for Derby, South (Mrs. Beckett)—Labour's previous health spokesman—extolled some of the virtues of GP fundholding in October 1995, but had added that she hoped that they would be abolished in the first year of a Labour Government. I assumed that that would again be a Labour manifesto commitment as it was in 1992, but oh no. We now hear something totally different from the hon. Member for Peckham. The policy is now shrouded in secrecy, and I hope that the hon. Member for Fife, Central—as this is an Opposition Supply day—will tell us what that policy is.

What is a "comprehensive health care agreement", and how would it differ from the contract that we have at the moment? The hon. Gentleman knows that the contract system works because it gives incentives. Clive Wilkinson, chairman of the Wolverhampton NHS trust, said on BBC television: You do have to have in the final analysis, don't you, the ability to take the contract away. Otherwise, if you don't have that, then all the incentive to the provider to deliver what they are asked to deliver disappears. We know from past experience that just cajoling public servants to do better is not effective". I cannot see how the hon. Gentleman can possibly disagree with that.

There is total confusion among Opposition Members about the private finance initiative. On the day when the virtues of the PFI were extolled by the Opposition Treasury team—I can give the hon. Gentleman the quotations, although I am sure my hon. Friend the Minister of State will do so when he winds up—the hon. Member for Peckham was calling it "creeping privatisation". Yet the PFI was extolled by the hon. Member for Rother Valley (Mr. Barron), who said it was a Labour party invention. Again, there is confusion and division in the Labour ranks.

Hon. Members should cast their minds back to before the reforms, to the time when no one knew the price of anything at all. If one does not know the price of a treatment, a medicine or a bandage, how on earth can one plan for the future? We must spend the money wisely. My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) reminded the House that the Government were castigated when we introduced sensible management programmes.

I shall deal now with the Labour accusation of bureaucracy. The hon. Member for Fife, Central nods his head, and I suspect that he will later speak against bureaucracy with the eloquence of Satan denouncing sin. What does Labour want to do? It wants another tier of regional health authorities, which some of us have been trying to get rid of for years. That would cost £100 million, money that would be removed from patient care. The hon. Gentleman would have to get that £100 million from the Treasury if Labour were in government. The hon. Gentleman also wants a minimum wage— [Interruption.] Perhaps he does not want a minimum wage.

Mr. McLeish

I do want it.

Mr. Hayes

According to the hon. Member for Livingston (Mr. Cook), the minimum wage would cost the health service £500 million, and that money will all be taken away from patient care. The Opposition's policies are all about centralisation, whereas the Government's policies on health are very simple—we have decentralised, and brought better patient care to ordinary people. Since the introduction of the "wicked" reforms, 1 million more people have been treated, and the House will have heard my hon. Friend the Member for Wycombe (Mr. Whitney) give the figures. Some £4l billion is being spent—66 per cent. above the rate of inflation. We have the lowest waiting lists ever, and we have the citizens charter. Did one hear anything about a citizens charter under the previous Labour Government? It was derided by the Opposition as a rather sick joke—[Interruption.]—as a citizens anthem, I am grateful for the correction.

Mr. Edward O'Hara (Knowsley, South)

Is the hon. Gentleman aware that the citizens charter concept was invented by Labour local authorities long before the Prime Minister ever dreamt it up?

Mr. Hayes

I am grateful to the hon. Gentleman. I wish that he had told that to his hon. Friends on the Front Bench at the time, who were so vehemently opposed to the concept. That is yet another division in policy in the Labour party.

Under the patients charter, we set down clear times for operations and for when ambulances should arrive at the scene, and we introduced checks and further checks.

Mr. O'Hara

The Labour party criticised not the concept of the citizens charter, which it applauds and preceded the Government in thinking about, but the lack of resources to implement the set targets, which were utterly unrealistic.

Mr. Hayes

The hon. Gentleman has highlighted the exact problem I was about to consider. In the past, all the speeches from the Opposition, including those from the hon. Member for Peckham, which I read over again this morning, concentrated on the underfunding of the health service over the years. They claimed that hospitals had been starved, and promised £1 billion for them in their manifesto at the last election. Of course, the Treasury gave us an extra £1.3 billion just for 1996–97. Expenditure has greatly exceeded that manifesto pledge within just the first year of the present Parliament.

How much money will the hon. Member for Fife, Central pledge for the NHS? How much extra money will it take to get people off the trolleys? The Opposition have not pledged to the British people one single extra penny for the NHS. How do they intend to improve the health service, apart from the added bureaucracy of which we have heard, if they do not intend to spend any more money? Will they claim to be better managers of the NHS than the Conservative Government and NHS experts?

Let us destroy another little myth. We hear that the health service is overmanaged, but for every 26 front-line staff, there is one manager. Opposition Members should compare that with the relevant figures in France, Germany, the United States and the rest of Europe. They should check those figures and note that those managers account for just 4 per cent. of the NHS wages bill. We are very lucky to have such a management in the health service. Of course the Secretary of State is absolutely right to ensure that there is no waste and inefficiency.

Ms Janet Anderson

Is the hon. Gentleman aware that in North East Thames region, which covers his constituency, in the past five years, the number of managers has increased by no less than 260 per cent.? Does he think that that represents an efficient use of resources?

Mr. Hayes

If the hon. Lady looked at the figures, she would understand why that has happened. There has been an increase in managers all over the country because we happen to believe in a good role for women in management.

Mr. McLeish

Oh, come on!

Mr. Hayes

I thought that Labour was a politically correct party. Because we recognise the value of women and the value of nurses, we have re-registered many of them as business managers.

Ms Anderson

Is the hon. Gentleman talking about nurses or about managers? Is he saying that all the extra managers are women?

Mr. Hayes

There are nurses of both sexes. The hon. Lady can check the accepted facts in the Library, which show that many nurses have transferred to management posts. That is all that has happened. I note that the Minister of State, Scottish Office is nodding in agreement. The figures can be sorted out another time, but I promise the hon. Lady that what I say happens to be the truth.

If anyone wants to see decent health care, he should come to my constituency. I spent a long time fighting with respective Ministers because Harlow was genuinely underfunded under the RAWP—resource allocation working party—system. It was desperately unfair to my constituency because so much of our money was sucked into London and elsewhere. We had some of the longest waiting times in the country and the three accident and emergency departments did not operate terribly efficiently. The service was a catastrophe because we were constantly in debt.

I am not saying that health care in Harlow is perfect—it never will be anywhere because people's expectations are, rightly, so high. Errors will always be made. It is no use hon. Members shroud waving. [Interruption.] It is true. We all have dreadful cases that we all want to see investigated; they have arisen under every Government, and will continue to do so as long as the health service is run by human beings, not by robots. Mistakes are made, and all that we can do is institute various checks such as medical audits and clinical directorates to try to ensure that the minimum amount of errors are made in the future.

It is not particularly helpful to read out constituency cases in the House. The best thing to do is to deal with one's NHS trust chairman or chief executive. If one does not get satisfaction then, there is always the ombudsman and, if that fails, that is when one goes to see a Minister.

Mr. McLeish

What happens if people do not get satisfaction from anyone?

Mr. Hayes

Hon. Members who have constituency cases should deal with local managers first. If Members go to a Minister, all that happens is that the Minister asks for a report from the region, which then asks for that report from the local hospital. It is much quicker to go direct to the manager. Every time I have had a problem, I have always had a full and frank inquiry, and I have always been able to get the answer for my constituent.

I hope that the hon. Member for Fife, Central will come to Harlow in the run-up to the next general election, whenever that might be. He will see that in the last few years we have got a new computerised tomography—CT—scanner and a new MRI scanner. A new day surgery centre has just opened, along with a brand new £10 million accident and emergency centre. All that is good news for my constituents, but it is indicative of what is happening all over the country.

Mr. McLeish

I am grateful to the hon. Gentleman for his invitation and I will certainly take it up if I am successful and become a Minister, but the problem is whether the hon. Gentleman will still be in Harlow to see me.

Mr. Hayes

I look forward to welcoming the hon. Gentleman, when I hope he will be number two in the shadow health team as opposed to number three.

Health care has improved not just in Harlow but throughout the country. Every week, a multi-million pound capital project is announced for the health service. Compare that with the record of the Labour Government, who cut capital expenditure by one third. The hon. Member for Fife, Central should consider that.

8.16 pm

Mr. George Mudie (Leeds, East)

The hon. Member for Harlow (Mr. Hayes) spoke about money. I want to talk about the necessity of doubling the number of acute beds for youngsters in Leeds. Those beds are desperately needed, and they would cost £2 million to provide. They could mean the difference between life or death to youngsters in Leeds and West Yorkshire, but the hospitals cannot use those beds because they are in debt. They cannot find the necessary £2 million because of a £12 million debt between the two trusts. To the disgust of other doctors, fundholders in Leeds, at the end of the financial year, are sitting on £2.5 million. That surplus is lying in a bank, doing nothing but earning interest for those fundholders while seriously ill children are being bussed hundreds of miles by ambulance from Leeds to Newcastle for operations. That £2.5 million is sitting in the bank for dogmatic purposes and it is not being used in my city.

Let us talk about money for the health service. This seems to be a debate in which we are accused of waving shrouds, but Conservative Members wave capital receipts. We know where those receipts have come from as we go through Leeds and see hospital after hospital closed, asset stripped and beds closed.

Sir Ivan Lawrence (Burton)

That is not true.

Mr. Mudie

Not true! Let me tell the hon. and learned Gentleman about Killingbeck hospital and the actions of the Government and the regional health authority. Two years ago, it was decided that that much-loved hospital in my patch should be closed down. It was decided to transfer its facilities to the city centre at the multi-storey Leeds general infirmary. Once opposition from the public became apparent, the community health council decided to shift just the heart unit to LGI and to continue using Killingbeck for other NHS purposes. The people of Leeds still believe that Killingbeck is open. However, behind the scenes, the region—presumably with the Minister's knowledge, before the hospital has even shut and despite the pledge that it will continue to be used for national health service purposes—has sought planning permission for houses and industrial development for the whole 46 acres.

When the Government talk about fresh money and wave capital receipts at Labour Members, we know how they were got—by asset stripping other resources in the city. There is the evidence. The hon. and learned Member for Burton (Sir I. Lawrence) is not growling at me now because those are the facts from my own hack yard.

This is an intriguing and disappointing debate. It is intriguing because hon. Members seem to come from two different worlds. The hon. Member for Birmingham, Edgbaston (Dame J. Knight) made that point earlier when she said that the shadow Health Secretary was saying one thing and the right hon. Member for Sutton Coldfield (Sir N. Fowler) was saying the opposite. Someone is not telling the truth.

Our motion talks of "overstretched staff", "inadequate patient care" and the relentless cuts in NHS beds". It goes on to condemn the increased amount of money spent on internal market bureaucracy". In their amendment, the Government congratulate themselves on the "NHS continuing to flourish".

Dame Elaine Kellett-Bowman

It is.

Mr. Mudie

Before the hon. Lady gets over-excited, let me say that I do not for a minute think that Members such as the hon. Member for Wycombe (Mr. Whitney) do not see the health service in their patch. However, I wish that Conservative Members would not accuse us of shroud waving when we quietly, and in debates such as this, legitimately, explain the details.

Sir Ivan Lawrence

indicated dissent.

Mr. Mudie

I hope that the hon. and learned Gentleman will have the patience to hear my speech out. He will have the opportunity to respond.

Which flourishing health service are the Government talking about? It is intriguing that we seem to have two health services, but it is also disappointing. I was always disappointed when legitimate complaints about the health service were made and the previous Secretary of State used to go into her trance and recite all the statistics of buildings built, staff here and staff there, but pay no attention to the complaints. That that disappointment continues is clear both from the motion and from the performance of the Secretary of State today, when he took five minutes to mention the health service.

The Secretary of State is one of the most intelligent and caring Ministers in the Government, but if he cannot support the motion, thinks that he lives in a Britain with a flourishing health service, has little time for my hon. Friend the Member for Bootle (Mr. Benton) describing the ordinary human cases that happen day in, day out and accuses Opposition Members of shroud waving, it is a disappointing day.

Dame Elaine Kellett-Bowman

Will the hon. Gentleman give way?

Mr. Mudie

I shall give way in a moment. We are not all villains; when I look across the Table of the House, especially at those Conservative Members who are present, I have to say that they are not all villains.

Dame Elaine Kellett-Bowman

Will the hon. Gentleman give way?

Mr. Mudie

I shall give way when I finish my peroration. Conservative Members are not villains, but I wish that, for one minute, when we are discussing a sensitive and important matter—it is no exaggeration to say that it is a matter of life and death—we would listen to one another. I concede that there have been improvements in the health service under the Government, but I wish that some Ministers would listen to the case for some of the improvements that are needed to make it an even better health service.

Dame Elaine Kellett-Bowman

Nobody would suggest that Labour Members are villains. We merely suggest that some hospitals are more efficient than others. The hon. Gentleman may be right that there are two health services: those that are exceptionally well run and those that are not. In Lancashire as a whole, the expectation of life is a year below the national average. In my city, the expectation of life is a year above the national average. We are steeped in hospital care. We have the finest hospital in the country. It is funded in the same way as everybody else, but we run it extremely well. The nurses' mothers or fathers were probably nurses as well, male or female. Those families have been in the hospital service for the past 100 years and they care for it. Our services are exceptionally good and they make the best use of every penny that is given to them.

Mr. Mudie

I accept that. I live in a city with good hospitals, especially the two that I am going to discuss. I wish that the hon. Lady would listen to their problems. I do not say this of the hon. Lady, but the Secretary of State has been inclined to steamroller them. The previous Secretary of State made a habit of steamrollering genuine problems.

The Secretary of State pointed out that there was growing concern during the winter about intensive care beds. The problem is that he suggested that it was a seasonal difficulty and gave me the impression—in which I hope that I am mistaken—that the Government think that they are well on top of it.

I am delighted to see the hon. Member for Leeds, North-East (Mr. Kirkhope) here. As a colleague from my city, he will be able to confirm everything that I say. I am sure that he has come to the Chamber just to do that. This is an important matter. The Secretary of State accepted that, but blithely seems to suggest that the problem is under control. If he thinks that, I hope to give him some evidence to suggest that, at least in the city of Leeds, all is not well.

The Parliamentary Under-Secretary of State for the Home Department (Mr. Timothy Kirkhope)

I came hotfoot to the Chamber. I apologise for not having been here earlier, but I have been watching the hon. Gentleman on my television screen and heard some of what he has been saying about the wonderful health service in Leeds, a city which I am as proud to represent as he is. He has not been very fair to the people who work in the health service in Leeds or to the Government, who as he knows, are responsible for the wonderful new Leeds general infirmary which, even as we speak, is being built. Perhaps he would like to join me in going to see the 14 operating theatres being developed. The very latest technology in the world is being installed for the benefit of the people whom he and I represent.

Mr. Mudie

Before the hon. Gentleman came in, I was saying, as did the hon. Member for Lancaster (Dame E. Kellett-Bowman), that we had an excellent set of hospitals. Clearly, the hon. Gentleman had shifted channels. I had dealt with how the Leeds general infirmary was funded. If he wants to help me prevent what I described from happening, I hope that he will stay. The wonderful new LGI block is being funded by the sale of 46 acres of land in my constituency on which, at present, is a much-loved hospital.

The people of Leeds are under the impression that they have a pledge from the Government that that site will remain a hospital. Unknown to them, the Government and their agents have applied for planning permission before the hospital has even closed. There is no large LGI block funded by a benevolent Government; it is paid for by the rape and asset stripping of a much-loved east Leeds hospital.

If the Secretary of State, as the rational and intelligent man he is, thinks that the occupancy crisis is over, I hope that he will put in an order for the Yorkshire Evening Post, which carried the following headlines: A disgrace: How many must more die, Mr. Dorrell? and Tragic patient's eight hours on a trolley". In January, those who were not skiing abroad but working with their constituents will have noted the tragic death of a Bradford pensioner, a retired policeman who worked hard in his retirement for the British Heart Foundation. He was taken to, and turned away from, 12 Yorkshire hospitals. I can see some grins of amusement—I find the subject not amusing, but tragic. The man was flown 70 miles to a hospital in Scarborough where, sadly, he died shortly after arriving at the hospital. Incidents such as that prompt the Conservative newspaper in Leeds to run headlines such as the ones I have quoted for the second year running.

A week later, while some people were still skiing—

Dame Elaine Kellett-Bowman

Like the hon. Member for Rotherham (Mr. MacShane).

Mr. Mudie

The hon. Lady does get over-excited—she should be careful, as there is a shortage of emergency beds.

A week later, a pensioner—a 70-year-old stroke victim—spent six and a half hours on a trolley and died shortly after being found a bed in one of the Leeds hospitals. The trust is arguing that the pensioner waited on the trolley not for six and a half hours, but for five hours. The same week, another pensioner of 71 was one of 13 patients—one of whom was a lady of 96—who were left on trolleys for eight hours. That pensioner arrived at 1.30 pm and was found a bed at 10 pm.

The newspaper ran a series of articles on those incidents. In December, a 16-year-old lad suffering from a bacterial infection was taken to St. James's hospital and turned away. He was taken to hospital after hospital and died a week after. The same month, a young lad from Stockport was driven 45 miles to Leeds. I could describe case after case involving such incidents. The Secretary of State would say that I am talking about December and January, and describing seasonal matters. Every year, the LGI turns away a minimum of 118 severely ill patients who are looking for acute beds—there is nothing seasonal about that.

St. James's hospital, the biggest teaching hospital in Europe, turns away up to six people every day. Those people are severely ill and they are brought to the hospital to be given acute beds. When no intensive care beds can be found, those severely ill people who need urgent operations have to go from hospital to hospital.

I am not making a joke of that, but I want to make the point in the context of my speech. I am not trying to make political points, but simply saying that if ours is a flourishing health service, it should flourish a bit better. To the individuals or families involved, it is no joke, but a matter of life and death. In several cases, those involved have, tragically, died.

The LGI has five children's intensive care beds, and needs six. The extra bed is currently being run by doctors who work overtime simply to try to meet the demand. St. James's hospital has three such beds and needs six, which would cost £2 million. There is no likelihood of those severely ill children being found those beds.

When I said that I hoped that hon. Members would regard my speech as constructive criticism, there were groans and mutterings that it was a politician talking. Dr. Bodenham works at the LGI in Leeds. He says that the problems have occurred for years—they are not seasonal, as the Minister suggested. He states: We have been complaining about the lack of resources for years, even before I started here four years ago. Basically, nothing happens. They set up working parties then nothing happens. What the public expects is going up and up but resources are not there. A spokesperson for the Leeds general infirmary trust said: There is a national problem of rising admissions to hospitals, which has caused the problem here. There are more people coming into accident and emergency… It is simply that there are more patients than there are beds. The two doctors who run the intensive care units in both the hospitals undertook a report. It stated: Intensive care facilities in Leeds and in Yorkshire as a whole are inadequate. There are insufficient high dependency facilities in Leeds. Dr. Harris of Bradford said: But the big issue is not what we did at my surgery but the crisis with intensive care bed availability. I pay tribute to the local paper, the Yorkshire Evening Post, which has carried out a good campaign. If the Minister wants to smile, I hope that he will explain why he does so to the Yorkshire Evening Post. That newspaper has simply highlighted the fact that people are dying in our city because we do not have enough intensive care beds.

The Yorkshire Evening Post received a promise from the present Secretary of State that he would do something about the problem. He set up a review. The Yorkshire Evening Post and the people of Leeds are unconvinced by his promise and, in order to be fair to the present Secretary of State, I shall explain why. A year ago, the previous Secretary of State was confronted by a similar campaign after the death of a two-year-old child and an elderly pensioner. The previous Secretary of State said that she would take action; we believe that she did so, but no one can find out what action she took. This month, when she was in the city in her new ministerial capacity, the evening paper asked her where her report was. She refused to comment.

It was not a matter of someone making thoughtless or destructive criticisms; we have raised a genuine problem. The previous Secretary of State promised action, but that has not materialised and people have since died. We have now been given a similar promise by the present Secretary of State and I look for action and sympathy. Ministers must take off their rose-coloured spectacles and realise that, although they may have made achievements in the health service of which they are proud, there is still a long way to go.

8.37 pm

Mr. Richard Tracey (Surbiton)

I am pleased to be able to contribute to the debate at last. You, Mr. Deputy Speaker, may have noticed an anomaly in our proceedings: according to the Order Paper, today is supposed to be an Opposition day initiated by the Labour party, but for most of the past few hours the Opposition Benches have been almost empty and we have practically been debating with ourselves. I think that Opposition Members may have been drafted in from the Tea Room and the Labour Whips Office to address the House at some length in order to continue the debate from the Opposition Benches.

The hon. Member for Peckham (Ms Harman) and one or two other Opposition Members did not seem to be speaking of the health service that I know, and nor does the Opposition motion. The sort of language used by the hon. Member for Peckham, which was criticised by my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler), is exactly the sort of language that puts fear in the hearts of those who hear it. That is particularly true of the elderly people in this country who, on hearing soundbites on the radio and reading accounts in newspapers, seriously fear that the health service is falling apart. In fact, it most definitely is not.

We have a health service which, as various of my hon. Friends have said, is having £41 billion a year spent on it, is treating 3 million more people per year than it was in 1979—1 million more people per year than it was in 1991, when the reforms came in—and which accounts for 3,500 more people per day. That is not a health service which is in decline or falling apart limb from limb, as the hon. Member for Peckham claimed. It is a health service that is growing, and coping with the demands being placed on it. Those demands are considerably greater because there are more elderly people than there used to be. More intricate treatments are also being conducted, and people therefore expect far more to be done for them.

The Labour party criticises what apparently the Conservative Government are doing. Labour Members obviously did not read what one of their colleagues, the hon. Member for York (Mr. Bayley), wrote in The Times last week. He said: Labour's health policy will not look credible at the general election if we do not commit ourselves to matching the rate of growth delivered by the Conservatives in recent years". We need cite no more evidence to Labour Members than that. Those are the words of one of their colleagues, who recognises what the Government have been doing since 1979 and will continue to do, as may be appreciated by the pledges made by my right hon. Friend the Secretary of State for Health and by my right hon. and learned Friend the Chancellor of the Exchequer in the Budget.

Rather than telling a grim tale, such as those that we heard from one or two Labour Members, I wish to pay a great tribute to my local hospital—Kingston hospital—which delivers fine service to my constituents and to the people of Kingston. It does so despite the fact that we have many elderly people and some neighbouring councils are not taking elderly people out of hospital quickly enough back into care in the community. We have now put in place a discharge liaison nurse to facilitate the smoother running of those procedures.

Kingston hospital faced what was described by the chairman of the health trust and by the general manager as "an emergency situation"—a serious incident—during the new year period. Many hon. Members will recall that on 31 December 1995 there were extreme weather conditions, with icy rain falling on the pavements. As a result, there were many more emergency admissions to Kingston hospital than might remotely have been expected, and many more than had been catered for.

During the next three days, staff who in the normal way should have been having their bank holidays were drafted in. Operations took place, with double trauma operating lists in the operating theatres. The day surgery unit, which should have been off duty during the bank holiday, was called in and worked constantly. It was reported to me that staff worked solidly between 4 pm on Saturday 30 December 1995 and 5 pm on Monday 1 January 1996. Thirty-five full orthopaedic operations were completed in the main theatres, when usually only five such procedures would have been expected during that period.

I therefore wish to place on the record, here in the House of Commons, a tribute to the staff of Kingston hospital. The chairman of the health trust, Mr. Rowan Cole, wrote to me three days ago: The situation we faced over the New Year holiday was very unusual indeed. Our staff, in spite of great difficulties, coped with the situation magnificently, as indeed we would have to do in major incident conditions if there was a local disaster producing similar numbers of casualties. That is the type of health service that we have gradually begun to expect, and the type of health service to which our Government are committed.

I believe that we are doing a good job. We are producing the resources. Labour Members have read out in the House details of individual cases. As my hon. Friend the Member for Harlow (Mr. Hayes) said, they should take up such cases with their national health trusts instead of describing the details in the House to produce soundbites. By contrast, Conservative Members come to the Chamber to praise the work of the national health service in our localities, and rightly so.

8.45 pm

Mr. Mike Gapes (Ilford, South)

I shall not recite a litany of individual cases. In the past year, I have spent many weeks and months writing letters on behalf of many of my constituents, who have been on trolleys for hours or who have been on waiting lists or whose appointments have been cancelled and so on. The Minister knows that.

Last year, I also called for an inquiry into my local hospital following the press reports and the problems that we had but, in typical fashion, the then Secretary of State passed the buck to the North Thames region, which passed the buck to the health authority, which passed the buck back to the trust. That is typical of the way in which the health service is run today.

I shall draw attention to the wider problems of the north-east London area. The Secretary of State, in his opening remarks, referred to "unexpected problems" in admissions to accident and emergency departments in the last two months.

We are in January 1996. Since the end of September 1995, all local hospitals in north-east London have experienced extreme pressure and, to quote the words of a letter to me by the chief executive of the Redbridge Healthcare trust, throughout October and November, trolley waits, overnight in A and E have been commonplace at King George Hospital". As I understand it, almost every night since October 1995, patients have been waiting overnight on trolleys at my local hospital.

King George hospital is not alone. The local newspapers have referred to incidents there, but there have been others in all the other hospitals in our region. On 19 October 1995, the Ilford Recorder reported: Hospital crisis sparks bed plea. Ambulances were asked to avoid taking patients to King George Hospital again on Sunday because there were not enough Accident and Emergency beds. The call went out from the hospital in Goodmayes to the London Ambulance Service just after 9am asking crews to avoid King George if possible. Blue light cases, ie emergencies, were still allowed. The situation continued for about six hours. In November 1995, the local medical committee had a discussion about what had happened at the other hospital in the Redbridge and Waltham Forest health authority—Whipps Cross hospital, which is a very large hospital under the Forest Healthcare trust. As the Redbridge Guardian and West Essex Gazette of 16 November 1995 reported: We're full up, says hospital. Even some 999 patients are refused admission. Patients were turned away from Whipps Cross Hospital this week when management admitted hospital resources were stretched to their limits. The hospital was closed to admissions and victims of major accidents on Tuesday 'to ensure patient safety'"— [Interruption.] Conservative Members may think that that is funny, but I am sure that their constituents would not think so if they suffered the same problems.

When we discussed the situation with the local medical committee the following week, it reported that two extra wards had been opened at the hospital to try to cope with the problem. However, there were not enough staff to maintain them and the decision was taken to close the hospital on the ground that nursing practices had become unsafe. No other local hospitals could assist. King George hospital still had 17 patients on trolleys from the previous night. Three ambulances had waited at the door of the hospital, but there were no trolleys available.

The same situation was narrowly avoided in the week of 24 November. Discussions took place at that time between the chief executives of the trusts in Redbridge, Waltham Forest, Newham and Hackney in an attempt to adopt a co-ordinated approach to the problem. That was the situation in October and November last year.

In December, the Newham Recorder carried a front-page story on 13 December under the headline, "Hospital Crisis". The article stated: Resources at Newham General Hospital are being stretched to the limit according to the Director of Nursing, who admitted waiting times have tipped 14 hours". In a story entitled "Prescription for Disaster", the Ilford Recorder of 4 January stated: Health bosses in Redbridge have admitted the overnight closure of Oldchurch Hospital's"— in Romford— accident and emergency department to ambulance cases created chaos in casualty at King George". The newspaper also carries the story of a 65-year-old woman who waited 12 hours for a bed at the hospital after suffering a stroke and the case of a two-year-old toddler who had fallen and hit his head and did not receive treatment for 12 hours. They are examples of real suffering experienced by real people, many of whom are my constituents, but Ministers and Conservative Back Benchers do not care because they do not use the national health service.

We face a very serious problem in the North Thames region. I asked for an inquiry to be conducted last May, but the situation is now far worse. It is not the fault of the staff—the nurses, doctors and the hard-pressed administrators. It is the fault of the system that they have to try to administer and work with in order to treat patients.

I visited King George hospital's accident and emergency department at 10.30 on a Friday evening at the end of October. I was at the hospital for about six hours, during which I saw unbelievable pressure placed on the patients. People with broken limbs, head wounds and other conditions waited four or five hours to see doctors. There was massive overcrowding and the hospital had no real facilities to cope with families, especially children. That occurs day after day and night after night in the hospitals of north-east London. Families and staff are suffering along with the patients and, regrettably, the situation is worsening.

Conservative Members have wheeled out all kinds of platitudes and statistics, but let us consider what has happened so far in 1996. The hon. Member for Surbiton (Mr. Tracey) referred to the new year period. On Monday 1 January, which was a bank holiday, King George hospital was very busy and on 2 January I was told that it was swamped. More than 20 patients were waiting on trolleys at that hospital and 45 patients were waiting on trolleys at Whipps Cross hospital on 2 January. On the same day, the London ambulance service reported that every hospital in London was full. Nine hospitals were closed and all hospitals were turning away ambulances. Ambulances searched as far as North Middlesex hospital in one direction and Basildon in the other in a desperate attempt to find beds so that people could be admitted to hospital.

Whipps Cross hospital deals with those problems regularly. As it is an old hospital, it has some flexibility in that it can put old, disused wards into service temporarily in an attempt to cope with patient numbers. King George hospital, however, is a new hospital: it has no space and no flexibility, and it is already bursting at the seams. We are told that the winter has been particularly severe this year, but that is not really true: there has been no epidemic.

Sir Ivan Lawrence

Yes, there has.

Mr. Gapes

There may have been an epidemic of Conservative Members quitting their party, but it has not been a particularly bad winter in terms of the medical services. What will happen if there is another disaster on the scale of the King's Cross tragedy? How could our system cope with a disaster the like of which occurred on the Tokyo underground?

The Government, who know the price of everything and the value of nothing, have pared our health service and our accident and emergency departments to the bone. There is no flexibility in the system, which is crying out for space and the ability to deal with the unexpected. The Government's policy, which is based on accountancy rather than care, has led us to that situation. We cannot cope now, so how shall we be able to cope if there is a real crisis in the future?

I understand that there is a national shortage of D-grade nurses. We are told that the number of practice nurses assisting general practitioners has increased. That has taken the pressure off GPs, but it does nothing to solve the problem—in fact, it complicates it—of the nursing shortage in the hospital system.

Why are patient numbers increasing? The population is aging and people are becoming more dependent on the health service, but there is a wider and deeper problem: the failure of the Government's community care policy. Local authorities do not have enough occupational therapists, and local government resources have been cut to such an extent that they are unable to cope. People remain in hospital for weeks or months because there is no social support in the community. But the Government cannot use that as an excuse for hospital bed shortages, because ultimately they are responsible for that problem, too.

The problems in my area are reflected across the nation. However, the north-east Thames area faces some unique difficulties. The Redbridge trust is being asked to treat more patients while receiving 3 per cent. less funding. It currently operates on the target of the 12-month waiting list and it is trying to keep to that target, but the general crisis caused by accident and emergency department closures and hospital closures means that all hospitals in the area—they are in financial deficit from Tower Bridge to Basildon—are in danger of defaulting on that target and incurring financial penalties.

In a public relations stunt, the Government have said that the 12-month waiting list will come into force on 31 March and that trolley waits will be reduced to a two-hour maximum. Conservative Members should try telling that to my constituents who have waited for 30, 24 and 16 hours on trolleys in hospital corridors. If the hospitals have to meet that target, how will they cope with the other targets set for them?

The accident and emergency department at Oldchurch hospital is to be closed. The community health council in Redbridge estimates that the result will be 20,000 extra admissions per year for King George hospital. But that hospital does not have the space to take those patients. It is situated just two miles further along the A12, but it does not have the capacity to deal with extra admissions. So who will suffer as a result? It will be the patients—my constituents—who cannot receive treatment in their local constituency hospital. Financial penalties and the local trust's other difficulties will only compound the problem.

The National Association of Health Authorities and Trusts states that hospitals are faced with conflicting national priorities. On the one hand, they are expected to meet the Patient's Charter guarantee… At the same time, the Patient's Charter stipulates that nobody should wait for a bed in accident and emergency departments longer than four hours". That is to go down to two hours, but the association adds: A study of 20 hospitals in the Thames region found that only 18 per cent. of patients received a bed within two hours. The figure for the rest of the UK was 80 per cent., but how can north-east London possibly cope?

The situation is so serious that I fear for the future of many of my sick and elderly constituents. I am not shroud-waving—it is the responsibility of any elected representative to bring to public notice the serious problems that doctors, nurses, administrators, and constituents and their families, draw to our attention. If something is not done in terms of extra resourcing and more accident and emergency beds, and if priority is not given to analysing the problem, the situation will grow even worse for my constituents and people throughout north London. I fear for the future.

9 pm

Mr. David Tredinnick (Bosworth)

The description of doom and gloom by the hon. Member for Peckham (Ms Harman) to which I listened bore no resemblance to the health service in Leicestershire—the county that I represent. The hon. Member for Leeds, East (Mr. Mudie) pointed out a north-south divide in health services. Leicestershire has none of the problems that they mentioned, and I wonder whether we were listening to a severe distortion of the reality of today's health service.

The hon. Member for Ilford, South (Mr. Gapes) alluded to problems in his constituency, but the changes in Leicestershire and the midlands since the last Labour Government departed office have been substantial, and represent great improvements.

I want to talk a little about Leicestershire, but I also wear the hat of the long-standing treasurer of the parliamentary group for alternative and complementary medicine. In that capacity, I will refer to trends in Europe and the United States that my right hon. Friend the Secretary of State should be addressing as demand for alternative and complementary medicine in the UK increases at an exponential rate.

In 1979, the discharge rate at which patients left Leicestershire hospitals was running at 6,500 a year. By 1987, the figure was 12,500—nearly a 90 per cent. improvement during that Conservative period of office. In 1994, the latest year for which figures are available, 15,500 patients were discharged. That shows a threefold improvement in the number of patients being treated in the county.

The hon. Member for Peckham said that the health service was being torn limb from limb. She could not have noted the substantial capital investment in Leicestershire. Major developments at the Leicester royal infirmary include two new phases, the new children's hospital being just one of them. Currently, development work on an oncology unit is being undertaken. At the Glenfield general hospital, £50 million has been spent on development. That hospital specialises in cardiac and general acute services, and it has one of the most modern scanners in the world.

There have been improvements also in the Leicestershire mental health service trust. Approximately £25 million has been invested in new accommodation to replace the old institution, Carlton Hayes hospital. At Leicester general hospital, another £35 million has been spent.

At Hinckley, at the heart of my constituency, Fosse health trust has revealed plans for effectively a new £9 million hospital. Five years ago, the fate of that hospital hung in the balance. I remember meeting the chairman of Leicestershire health authority to discuss whether or not it should be closed and arguing that it was essential for the town, and that it was at an important location on the A5.

Since the reforms that my right hon. Friend and his predecessors have put in place, there has been a rapid development and expansion of improved facilities. It will be for Hinckley and Bosworth borough council to consider the planning application that is before that authority, but in principle that is an excellent proposal for the town.

The range of services offered at the district hospital in Hinckley has increased exponentially. It is now undertaking outpatient work and minor operations that could never be performed at the hospital before—principally because of referrals by GP fundholders, the number of whom is increasing all the time as doctors see the benefits of controlling their budgets and having the right to send patients to whichever hospital they choose. If GPs want to send patients to George Eliot hospital in Warwickshire or to hospitals in Leicestershire, they can do so. It will considerably encourage my constituents to know that a larger number of operations will be available at the enlarged Hinckley hospital.

Wearing now my alternative and complementary medicine hat, it may interest hon. Members to be reminded of the range of treatments available. They include osteopathy and chiropractic for back problems; herbal medicine and homeopathy; acupuncture, which originated in China; aromatherapy, which is the use of essential oils to help repair the body; allergy assessments; dietary improvements; and healing, which has been on the edge of alternative and complementary medicine but is now coming in from the cold to be considered as a serious treatment. The public have voted with their feet in respect of alternative medicine, and there is a huge demand for such services.

The growth has been phenomenal. It is not surprising that, on 10 January in another place, there was a three-hour debate on the subject, which was attended by no fewer than 80 peers. That well-attended debate is a reflection of people's interest in alternative medicine. However, out of a total annual health budget of approximately £37 billion, only £1 million is spent on supporting projects and research into alternative and complementary medicine.

I must tell my hon. Friend the Minister and my right hon. Friend the Secretary of State for Health that something is out of line, because demand for services has become very great. It is time that the Department of Health considered increasing the amount of money available for research.

In the United States since 1993, there has been an Office of Alternative Medicine, and well funded it is too. In Germany, the Government have been tasked by Parliament to help with scientific evaluations of alternative medicine. In Switzerland, since 1990, there has been a national research programme on alternative medicine.

In Europe, the report produced by Paul Lannoye for the European Parliament's Environment Committee proposed that 10 million ecu should be spent on research over a five-year period. My hon. Friend the Minister should accept the point that other countries are introducing proposals to increase funding, or they have already done so. I respectfully suggest that he should do the same.

According to my European colleague, Giles Chichester, a Member of the European Parliament who spoke to the all-party group recently, the United Kingdom is in many respects ahead on alternative treatments, because we are regulating them in a step-by-step approach. We have had the Chiropractors Act 1994 and the Osteopaths Act 1993, and other Acts will follow.

On behalf of the members of the all-party group, I wish to thank all the disparate practitioners who visit us to give us their views. I also wish to thank my right hon. Friend the Secretary of State and his colleagues for the sympathetic hearing that they have given to alternative and complementary medicine. My right hon. Friend the Secretary of State, when he was the Under-Secretary, agreed that alternative and complementary medicine could be made available on the NHS, providing that a doctor took clinical responsibility. That has had a significant impact on increasing the level of service available and the amount of money that has been spent by the health service on alternative medicine.

Earl Baldwin of Bewdley, in a recent speech in the other place, mentioned an organisation called Foresight, which has had great success targeting the health of couples to improve the probability of conception. It had spectacular results, but it was instructed to carry out a double-blind trial. Given the evidence of an 89 per cent. success rate, that seems unduly harsh.

Chinese medicine is growing in popularity, and has been successful in treating eczema. Tough restrictions and conditions have been imposed on practitioners who seek funding, despite the fact that there are 500,000 professionals practising in 1,500 hospitals throughout China. Surely that is evidence enough of the success of the treatment.

My message for the Secretary of State and the Minister is that demand for alternative and complementary medicine in all its many different hues has never before been so great, and it will increase. I suggest that it is not in the interests of the Department of Health to spend so little—£1 million out of £37 billion—on those important medical treatments.

9.13 pm

Mr. Edward O'Hara (Knowsley, South)

With all due respect to the hon. Member for Bosworth (Mr. Tredinnick), I must express my frustration after listening to such a lengthy excursion into alternative medicine. It has left me with very little time to discuss the ills of the national health service. They are what concern my constituents, for whom alternative medicine is not exactly an everyday option. In the few minutes I have at my disposal, I want to refer to the real experience of real people on Merseyside and in Knowsley, South, and to the accountability, or lack of it, of the NHS to my constituents.

Despite all the fine words about the magnificent resources being globally allocated to the NHS, inadequate resources have been allocated to Merseyside, given its demographic and medical needs. I shall base my remarks on one battle in the health service in our area—over the closure of the accident and emergency department of Broadgreen hospital.

By a quirk of a line on a map, the hospital is not in my constituency, but it could have been: it is on the other side of the road. It serves my constituency and is located on the junction of Liverpool's inner ring road and the M62, which leads to east Lancashire and joins the M57 and the M6, the main north-west route. One would have thought that an ideal location for an accident and emergency department, so I was deeply concerned about the loss of such a well-placed facility and the consequent impact on my constituents.

I was assured that magnificent new resources would be provided at the Royal Liverpool hospital, the trust that eventually merged with Broadgreen, and at Whiston hospital at the other end of my constituency. I did not want the closure to be effected until the new resources were available and on stream. I was assured that they would be, but as it happens, we lost the battle.

In the course of the battle to retain the Broadgreen A and E department, the public of Merseyside and my constituents lost all confidence in the people who were running the trusts. Even as a public representative, I found it difficult to get information and to make my voice heard. The closure was agreed by unaccountable NHS trust appointees. We suspected that the rationalisation would be accelerated—I had no illusions about that.

From my local government experience, at the delivery end and on the receiving end of rationalisations, I have learnt all the tricks; and when there were suggestions that the closure might have to be accelerated because staff could not be appointed to fill essential posts, I certainly had my suspicions. I asked why the staff were not appointed earlier and advertised for in good time.

Next, the closure took place, and I was assured of all the magnificent facilities that would be available at the Royal and Whiston hospitals. Instead, I found that patients were waiting as long as 12 hours for beds. There were no spaces for emergency cases. Ill and even terminally ill people were having to wait for hours in casualty. The surgical assessment unit had to be kept open all night so that people could lie there on beds. Emergency admissions had to be put in beds in the reopened but doomed Broadgreen hospital.

This information was given me in early November by a mole in the hospital trust, whose identity must be protected—a sad reflection on the system. The mole told me: The weather so far this autumn has been kind. I shudder to think what will happen if the weather turns cruel in the winter. So it turned out. Before Christmas, all the things that people were worried about in Merseyside happened.

Ten days before Christmas, there was an accident just around the corner from my house. A lady suffered multiple injuries and had to be transferred from Whiston hospital while connected up to drips and all sorts of life support systems. She was taken to Oldham, 40 miles away. Her condition was stable when she left, but deteriorated during the 40-mph journey through snow along the motorway. Ten days later, she died. I shall protect her identity, out of respect for her grieving family.

On Christmas eve, a heart attack patient presented herself at Whiston hospital and had to be transferred to Wythenshawe—another journey out of the area. I remind hon. Members that, if critically ill patients are transferred out of the area, the whole family is in crisis. My constituents in Knowsley, South should not have to travel 40 miles during their own crisis to visit sick friends and family.

The crisis in the NHS came to a head before Christmas, and I saw a system that had finally broken down. Emergency services on Merseyside could not cope. Beds were needed on Merseyside, but they could be provided only out of the area. Ambulances that were needed for emergencies on Merseyside had to travel large distances out of the area and were not available for emergencies on Merseyside.

I am describing the failure of a system and the lack of accountability to my constituents of the people who run it. The hon. Member for Harlow (Mr. Hayes) referred to returning the NHS to ordinary people. Is that what he means? Not ordinary people like Margaret Pritchard, my constituent, who provides me with information and keeps an eye on what is happening. She has been told that her requests for simple information about what is going on and what difficulties are being experienced in the hospitals on Merseyside will no longer be answered by the chairman's office. Delivery of the national health service to the people of Knowsley, South? Not on your life.

9.21 pm

Sir Ivan Lawrence (Burton)

I am delighted to see that the hon. Member for Peckham (Ms Harman) has returned from the school run. Perhaps she will hear something from me in the remaining two or three minutes about just how the national health service is "falling apart limb from limb" in Burton-upon-Trent.

The Queen has just opened the brand spanking new Burton district NHS hospital, costing £34 million. It is one of the best equipped in the country. It has 463 beds, which is 294 more than the old hospital had. It is modern, spacious and cheerful, and has integrated acute services. This is not a system that is falling apart limb from limb.

The hospital won the charter mark for excellence—the only acute hospital to do so in 1994—from the Prime Minister. It led the country in day surgery cases and has now increased the number of such cases by 10 per cent. We have slashed waiting lists, and nobody now has to wait for as long as nine months. The hospital leads the country in information technology. It has the first fully operational computerised information system, which is being spread to general practitioners, who can get their information from the same computer.

Ten per cent. more treatments take place there. Some 8,000 more of my constituents and those in neighbouring constituencies are able to access the new Burton hospital. This is not a system that is falling apart limb from limb.

There has been a magnificent reduction in waiting lists—down from 4,686 in December 1992 to 2,800 last December, which is a 40 per cent. reduction. I can go on, but, alas, I do not have the time. We have had two new nurse specialists from the Cancer Relief Macmillan Fund, who are doing magnificent work in helping cancer patients, in the finest traditions of those nurses. Last year, the Burton Hospitals NHS trust screened a higher proportion of women than anywhere else in the west midlands region.

The Burton trust has not been the only great NHS achievement in my part of the world. There is also the Premier Health NHS trust, which opened a £700,000 psychiatric unit only last year on the district hospital premises. There are 13 fundholder practices in nine funds, representing 85,000 patients and costing about £14.5 million.

Before all that was set up, I heard plenty of dread prophecies about what would happen, but I hear no complaints now about the concept of fundholding, either from GPs or from patients. They now receive better direct patient care, more quickly, efficiently and effectively and to a higher standard. My doctors and patients will be most interested to learn that Labour, if it ever got into power, would abolish fundholding practices and all the successes that went with them.

In my part of the world, the Staffordshire ambulance service is now better equipped, better organised and better performing—the fifth best in Britain. What on earth is the Labour party talking about when it speaks of the wreckage of Conservative policies, with the national health service falling apart limb from limb? It is preposterous that, in a debate such as this, so much time should be spent attacking what is clearly succeeding throughout Britain.

I know that, from place to place and from time to time, one can find things going wrong, but I am fed up with having to try to explain to people that what the Labour party says about the overall picture simply does not apply to my region. There are magnificent achievements there, and it is offensive to those who dedicate so much of their time—doctors, nurses and staff workers in the hospital—continually to have their achievements run down and rubbished by the Labour party.

I am pleased that I have managed—I thank everyone concerned—to say a few words which will perhaps correct the false impression. I hope that the hon. Member for Peckham, when she has finished delivering her children to their schools, will take a little drive around the country so that she can see what is really happening.

9.26 pm

Mr. Henry McLeish (Fife, Central)

There have been some excellent contributions in the debate. I want to single out two and, to show my impartiality, there will be one from each side of the House. My hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) demolished the Government's excuses for the crisis over Christmas in terms of bed numbers. It is useful to have an authoritative view on health care in the House and I congratulate my hon. Friend.

I also congratulate the hon. Member for Broxbourne (Mrs. Roe) on her contribution. She is Chairman of the Select Committee on Health, which has produced an excellent report on continuing care, and we await with interest its evaluation of the Government's response.

That said, the Government have a real problem. I recall the famous John Maples memorandum. [Interruption.] I hear the Secretary of State going on from a sedentary position, but I think that he will enjoy the next two or three comments. That memorandum suggested that the Tories should bury the NHS in any debate in any part of the country. Having listened to Conservative Members today, in particular the Secretary of State, I believe that that was probably the soundest piece of advice that they have been given in many years.

The Tories have a threefold crisis when it comes to their concept of a one-nation health service. We are now seeing the cumulative effect of the so-called reforms during the past three or four years and the Government's barely concealed incompetence. That rich mixture is fuelled by the obsession with privatisation.

The problem for the Government is that when the public perception of what is going on matches up with the reality facing patients, they have a crisis of credibility. As the Secretary of State undertakes his so-called charm offensive around the country, he would do well to face up to the fact that his problem is one of credibility, not charm.

The other part of the problem facing the Government is the inescapable conclusion about the future of the NHS. My hon. Friend the Member for Peckham (Ms Harman), in an excellent contribution to the debate, highlighted the fact that the Government were moving slowly but surely towards a privatised health service and, at best, a residual NHS. There has been fragmentation, contractualisation and commercialisation. If, for any reason, the Government won the next election, which is unlikely, the British public should be aware that those would be the building blocks for a privatised health service.

The other point that concerns us is the apparent tale of two health services. According to Conservative Members who have spoken up, there are no problems, and Opposition contributions have merely been encompassed by shroud-waving criticism. But if the Government think that everything in the garden is lovely, the public, patients, specialists within the health services, doctors, consultants, nurses and Labour are all marching together.

Mr. Whitney

If the hon. Gentleman had really listened to what was said by Conservative Members, he would know that no one suggested that everything in the garden was lovely. Everyone recognises the existence of a huge challenge, not only in Britain, but in every civilised and industrialised country in the world. Several of us enumerated the reasons for that. The hon. Gentleman and the Labour party ignore the challenge, because they have no solutions to offer; they try to pretend that there is no problem. There is a problem, however, and the Conservative party is contributing to the achievement of a magnificent solution following the mess that Labour left in 1979.

Mr. McLeish

I am pleased to find that we discussing semantics. Conservative Members call it a challenge; we call it a crisis.

In fact, I listened to all the speeches with great interest, noting the praise for the Chairman of the Health Select Committee. The fact remains, however, that Labour Members were accused of shroud waving and ambulance chasing. Conservative Members have been impertinent enough to suggest that we should not raise the cases that we have raised in the Chamber. That brings us back to the Maples memorandum: "If there is a problem, just bury it." We will not bury important NHS issues; we will raise them at every possible opportunity.

The Government tell us that they care for the national health service, but that is not the case if linage and word counts are anything to go by. At last year's Tory party conference, the party chairman, the right hon. Member for Peterborough (Dr. Mawhinney), devoted three lines of a 22-page speech to the national health service. The Deputy Prime Minister did not mention it once in a 19-page speech. Five lines of the Prime Minister's 31-page speech dealt with the subject. In those 72 pages of speeches, eight lines were devoted to the NHS.

Conservatives' attitude to the NHS is akin to Lady Thatcher's attitude to the Prime Minister: grudging, insincere and deeply damaging, with the suggestion that the object of criticism is not sufficiently right wing.

Mr. Hayes

Will the hon. Gentleman tell us how many lines of his speech the leader of his party devoted to the health service?

Mr. McLeish

What defines the difference between ourselves and the Conservative party is the fact that the leader of the Labour party is committed to a one-nation health service. The Conservatives are not committed to a one-nation anything.

We have been accused of shroud waving. We have heard of grim tales, and of people being scared by soundbites. The health service, however, touches everyone in the country; it is a precious asset. Meanwhile, we see headlines such as:s Children are dying and we can't offer a bed in the Evening Standard, Hole in the heart of the NHS in the Sunday Express—referring to children in intensive care—and Crisis for Britain's sick children in The Independent.

Are we making those stories up? It seems to us that the Government simply will not pay attention to the crisis that has engulfed the national health service. We could present a litany tonight, including ward closures, bed closures, staff morale, lack of trainees, accident and emergency problems, failure to meet "The Health of the Nation" indicators and poverty as a cause of malnutrition. There is also the way in which the Government have driven dentistry out of the NHS. Those are the issues that dominate the agenda of most ordinary people, and the Government ignore them at their peril. This is the NHS in 1996, Tory-style.

We should examine the case that we are making against the Government. The first issue, which arose recently, is poverty triggering malnutrition. It is happening not in 1896 but in 1996. An article in The Observer was headlined: Poverty triggers UK diet crisis". True to form, the Government commissioned a report, but saw the results and decided to shelve it. I challenge the Minister to comment on that damning report. More important, will he place a copy of it in the House of Commons Library?

The second issue is preventive health care. We thought that there was a consensus about the future of such care. Why is it then that the NHS is being pushed out of dentistry, which is vital as a preventive health measure, especially for children? A recent survey conducted by the British Dental Association shows that even 44 per cent. of Conservative Members believe that, in 10 years' time, the NHS will be outwith dentistry. That is a condemnation and a sad indictment of a so-called one-nation health service.

Mr. Tony Marlow (Northampton, North)

Will the hon. Gentleman give way?

Mr. McLeish

I am not giving way because I need to make some progress.

A one-nation health service can accommodate the cash to provide for dentistry.

The third issue is resources. We hear the Government say that funding always increases by more than inflation, but the Government must face real questions about waste. They are always lecturing people on their fiscal prudence, but they are happy to see £100 million in England tied up in GP fundholding balances held by health authorities. As some of my hon. Friends have said, that money should be spent immediately on the vital things that are missing from the NHS.

True to form, the Government have ensured that, in the most recent year for which figures are available, nearly £500 million has been spent on non-NHS providers. That is a leakage from the NHS. At the same time as children are touring the Pennines looking for a bed in a hospital, £500 million is being spent on non-NHS provision. That is a challenge to the Government. [Interruption.] Conservative Members are harping on from sedentary positions, but the harsh reality is that our NHS needs national investment, not the approach that is being taken by the Government.

I know that the Secretary of State for Health will not like this, but his so-called purge of bureaucrats comes too late. The Government have closed the door after the horse has bolted, which is typical. How laughable that, at the Conservative party conference, he should suggest that we tackle bureaucracy. The key issue for us on waste is that a large part of the finance is being spent on efficiency measures. We want an efficient NHS, but we cannot be bothered with more and more people policing an internal market where hospitals are competing with hospitals for patients' beds. That is ridiculous.

Over the next two or three months, we shall develop the issue of wasting taxpayers' money, but I want to return to the role of the Secretary of State for Health. Over Christmas, he decided to relax the drinks limit. That is nothing special in itself, but even the Conservative Medical Society, whose patron is the Prime Minister, said in its submission on the review: At a recent meeting of the Conservative Medical Society Executive there was unanimous opposition to any raising of the so called sensible limits for alcohol consumption. Any increase in recommended 'safe' limits is likely to encourage some or many individuals to consume nearer the levels to cause problems. It said that about 1 million people in Britain have alcohol-related problems. The question for the Secretary of State is this: if medical opinion was not moving him, and if the Conservative Medical Society was so opposed to the relaxation of the limits, why did he change the limits over Christmas and whose pockets were being lined by that development?

I also want the Secretary of State to respond to questions on bureaucracy. There is no point in shedding crocodile tears now, when during the past five years we have seen an increase of nearly 20,000 managers, while 50,000 front-line nurses have simply left the wards. It is important for the Secretary of State to come clean and explain that the Government have made historic mistakes. There has been burgeoning bureaucracy while, at the same time, they have sacrificed what patients and the public want—front-line care at the sharp end.

It is also crucial that we examine an experiment that is taking place in Scotland, in which the Secretary of State for Health does not seem to be interested. The experiment, in Stonehaven, is about clinical services and every other service being simply passed over to the private sector. In an interesting article in The Sunday Times about the Secretary of State for Health, unfortunately headed: Misfit with a mission against meddling", the Secretary of State said: What I'm not in favour of is privatising clinical care". We need to find out tonight—[Interruption.] I should be happy to send a copy of The Sunday Times interview to the Secretary of State. We did not bother with the other sources because one is damning enough.

The Secretary of State is quite happy for a poll tax-type experiment to take place again in northern Scotland, but is he willing to tell the House that he will not allow clinical services to go into the private sector in England? Double standards are being operated by the Secretary of State for Scotland and the Secretary of State for Health. The right hon. Gentleman should clear up that confusion as quickly as possible.

Labour Members want our Secretary of State for Health to be active on some of the issues that concern us. There has been much discussion recently about pregnant women being manacled by the Prison Service, but I did not hear the Secretary of State make much of an outburst about it. I should also like to reveal to the House that a Daily Mirror article of 12 January reveals that women prisoners who are being treated for cancer and pneumonia are also shackled. I expect the Secretary of State to give a lead and tell the Home Secretary that such barbaric behaviour is unacceptable. The Secretary of State for Health has been conspicuous by his absence on that issue.

We have raised with the Secretary of State the issue of intensive care beds for children. The tragedy about a hand-wringing, couldn't-care-less Government is that they say, "We don't know the answers to the questions you asked." On 16 January, my hon. Friend the Member for Sheffield, Hillsborough (Mrs. Jackson) asked the Secretary of State what is the present occupancy rate of intensive care paediatric beds?"—[Official Report, 16 January 1996; Vol. 269, c. 549] The Minister said that, because the information on bed occupancy was not available, the Department had asked the Sheffield Children's hospital to find out the bed occupancy rate from the 17 units. Is not that a damning indictment? People are concerned about serious issues, and this Secretary of State is not aware of the figures. The Department of Health instead asked the hospital to find the information that the health service executive should have had immediately available. Again, that speaks volumes for what is going on.

If there is one single issue on which morale reels in the health service, it is staffing. If one reads submissions from the Royal College of Nursing, the British Medical Association or GPs' committees, on every occasion, one finds a situation in which—[Interruption.] The Minister for Health can sit there and rant, saying "More, more," but I can tell him what the nation would like to see: more nurses, more trainee nurses and far fewer bureaucrats.

When are the Government going to stop pretending that the real world does not exist? When will Government Front-Bench Members acknowledge that, during the past five years—I shall repeat the figures for the Secretary of State; he got very excited when they were read to him earlier—50,000 front-line staff have disappeared from the wards? We have 19,000 fewer nurses in training, which is a scandal for investment in the new millennium. At the same time, the Government keep feeding through more and more money for an extra 20,000 managers.

How can the Secretary of State wonder why morale is low, when nurses give more than the hours they work suggest in terms of commitment, dedication and skill? How do they feel when they see a Government who deliberately ignore their needs and patients' needs and push the growth of a burgeoning bureaucracy on every possible occasion?

If the Government were serious about the national health service, they would stop acting on the basis of hearing no evil, seeing no evil and speaking no evil, and start to get to grips with the problems that surround them. [Interruption.] The Government Whips are suggesting that I sit down. They do not like hearing the truth about what is happening to the NHS throughout the country. It is crucial to tell the Government that, if they believe in a one-nation health service—in view of their recent behaviour, that is a laughable concept—they must stop shuffling structures and start to think about patients and the professionals who do an excellent job on our behalf.

Unfortunately, some time will elapse before we take over the national health service. Until then, the Government should try to make an effort. We want some urgency and understanding, and we want them to realise that, ultimately, the national health service is our most precious public resource. In 1952, Aneurin Bevan said: What emerges in the final count is the massive contribution that the national health service makes to the equipment of a civilised society. It has now become part of the texture of our national life. No political party would survive that tried to destroy it. We do not want the Tory party to survive, but the health service will certainly be safe in our hands.

9.45 pm

The Minister for Health (Mr. Gerald Malone)

The only interesting discovery to emerge from the contribution of the hon. Member for Fife, Central (Mr. McLeish) is that he reads party conference speeches after they have been delivered and analyses them. The only problem was that he had not read the Leader of the Opposition's party conference speech and could not even say how much he had addressed the subject of health, so it was not a compelling contribution.

I am grateful to my right hon. and hon. Friends who have spoken in and remained throughout the debate. Opposition Members pushed off following the solidarity photo opportunity, which was probably orchestrated by the hon. Member for Hartlepool (Mr. Mandelson), who pulls the puppets' strings from time to time. According to the Order Paper, this was an Opposition day, but on the Floor of the House it was an Opposition away day. If anyone in the House showed an interest in the health service, it was my right hon. and hon. Friends, who made excellent contributions to the debate.

As usual, the Labour party has alleged crisis. My right hon. Friend the Secretary of State referred to the pressures on the system, which I acknowledge. The hon. Member for Fife, Central suggested that Conservative Members had tried to say that there were no problems in the health service. We do not say that. We acknowledge the fact that pressures exist and that steps have been put in hand to deal with them. I take this opportunity to pay tribute to all those health service staff who do so well in difficult times to deliver service to the public. It can do them no good to hear Labour Members denigrate time and again the service that they deliver, basing their arguments on partial facts rather than the full story of what is happening. If anyone should be upset about the tale delivered by the Labour party, it is not the Conservative party but those who serve within the health service.

There is no doubt about the challenge that faces us, and a number of hon. Members dealt with it. I shall respond to the detail of the debate briefly because of the lack of time available to me.

The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) always makes an important contribution. He was on all fours with us about the difficulties of meeting the challenges of modern medicine and he referred to a number of matters on which we could agree. He mentioned emergency admissions and scoffed when I suggested that there was some doubt about why they were rising. Our research on whether premature discharges have caused the increase in emergency admissions comes from Scotland and shows that they are not necessarily a pressure.

My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) made yet another powerful Back-Bench contribution on behalf of his constituency, and he illustrated clearly the two sides of the coin. Opposition Members tried to say that the service was in crisis, but my right hon. Friend pointed quite properly to what was happening in Good Hope hospital in his constituency. He reminded the House about proper management arrangements, the need for which was rooted in the failure of the service in 1980s. The matter was addressed by my right hon. Friend, and the health service needs proper management.

Mr. McLeish

What about nursing?

Mr. Malone

I shall be pleased to refer to nursing in a minute. Proper management is right for the health service, and cutting away bureaucracy and cutting management—the policy of my right hon. Friend the Secretary of State—are also right. The two are quite compatible. The hon. Member for Southwark and Bermondsey (Mr. Hughes) talked about the structure of the health service, and about defining the boundaries of clinical effectiveness. I agreed with him on that, but he went on to say we that we should have local government participation.

I read with some interest a famous Liberal Democrat document, "Towards 1996", which said: Obviously this document will have a very limited circulation. I am not sure whether every one of my hon. Friends now has a copy of this document, but probably most do. The document referred to the work done by somebody called the Liberal Democrat party's political warfare officer—whoever that might be. The document dealt with health in some detail, and listed the Liberal Democrats' strengths and weaknesses on the issue. It managed to find one strength and four weaknesses, one of which was the policy enunciated by the hon. Gentleman, who talked of having councillors in control of health authorities. The document said: Lib-Dem policy of putting councillors in control of LHAs is a barmy idea. The hon. Gentleman would do well to listen to his advisers on that point.

My hon. Friend the Member for Broxbourne (Mrs. Roe), the Chairman of the Health Select Committee, made a powerful and thoughtful speech in which she set out an important future agenda for the Committee, with which we will work with great interest. The Government are keen to respond to the work of the Select Committee—as my hon. Friend pointed out—and we have just submitted an important memorandum on the subject of long-term care. I know that the Committee will consider that with great interest.

The hon. Member for Bootle (Mr. Benton) came out with the real tactic of the Opposition, which was to have a saga of cases to which Ministers might have been able to respond had they been given some notice. I say that because I made an offer to another hon. Member—he is not in his place—at our previous debate on the matter to investigate every single case that he raised. I must say that he was deficient in the facts when we looked at the cases. I make the same offer to the hon. Member for Bootle—I shall look at each of the cases that he raised and respond to him in detail.

The Government suggest that people go to the point of first resort, which is the trust. But if there is dissatisfaction, Ministers are happy to look at the case and take up matters on behalf of hon. Members. The hon. Member for Bootle mentioned specifically a reduction in beds, and the loss of a 59-bed unit at Walton hospital. There is to be a new bed block in an associated hospital, but the hon. Gentleman may be disappointed to hear—as it rather destroys his point—that it will contain not 59 but 72 beds.

The imbalance in the debate was that, although we heard tales such as that told by the hon. Member for Bootle, Opposition Members positively refused to talk about what was happening. The hon. Gentleman referred to Fazakerley hospital, but I was surprised that the hon. Gentleman—as an hon. Member who represents his constituents' interests—failed to mention the investment of £1 million in accident and emergency services in 1994–95. Although he illustrated his point with three cases, he failed to point out that 95 per cent. of patients are now admitted within one hour of the decision to admit. It would be helpful if he looked at the facts.

My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) paid tribute to what the NHS is achieving, but she raised concerns about mixed wards. We share those concerns, and we need to make progress towards eliminating such wards. She also suggested that NHS staff ought to have care when referring to patients by their Christian name, as that might be insulting. All I can say is that any staff member who referred to my hon. Friend as "Jill" should she ever be in hospital will probably get a thick ear. It is certainly not something that I would try.

I was pleased that the hon. Member for Blyth Valley (Mr. Campbell) acknowledged that there had been improvements in the service. He dealt specifically with nursing, to which I promised the hon. Member for Fife, Central I would return. I find fault with the Labour party because it always refuses to tell the full case. If one looks at the figures and notes that learners and Project 2000 students are now treated in a different way, and includes general medical services practice nurses, whom the Labour party always seems on purpose to exclude, one sees that there has been a 1.6 per cent. increase in qualified and unqualified nursing and midwifery staff between 1989 and 1994. The full picture shows a different story.

Mr. McLeish

There are not enough.

Mr. Malone

The hon. Gentleman says from a sedentary position that that is not enough, but that is not the point. His hon. Friends have said that nursing numbers have decreased, but that is simply not true.

Mr. McLeish

Will the Minister confirm that if one takes Project 2000 nurses and adds them to the learners who are still within the NHS, there are, based on the Minister's figures, 19,000 fewer nurses in training now than in the past?

Mr. Malone

The numbers of nurses in training at any given time, as of doctors and any other medical staff, are those sufficient to man the service. The hon. Gentleman forgets that when his party handed the health service to the Government, people were leaving it in droves. The NHS was not retaining its staff. More nurses are now being retained than in the past, and that explains why the figure is different.

My hon. Friend the Member for Wycombe (Mr. Whitney) challenged the Labour party to say what management levels are right. We did not hear anything about that from the Labour party. Judging from what the Opposition have said, however, one would expect them to say that no management was appropriate. That, of course, is absolute nonsense.

The hon. Member for Rossendale and Darwen (Ms Anderson) spoke about the plans for her hospital. The plans to which she referred were based on the recommendations of a working party composed of health care professionals and consultants. They have been discussed with the community health council and the staff. I am sad to say that the chief executive of the hospital has been trying, I understand unsuccessfully, to discuss the plans with the hon. Lady. Perhaps I will write to him tomorrow to tell him of the concerns that the hon. Lady has expressed in the House, and perhaps a meeting can now take place to illustrate what is going on.

Various other speakers contributed to the debate, and I would like to refer specifically to the hon. Member for Ilford, South (Mr. Gapes), who said that he was fed up with statistics. Too many statistics mask a story. What tell a false story are partial statistics, which the Labour party cites. It is all very well for the Opposition to say that they do not like statistics, but the truth of the matter is that the facts do not suit them. That is the problem with the health service—more people are being treated more effectively and there are more satisfied customers than ever before. The hon. Gentleman asked for more resources. I ask him to put that question to his hon. Friends on the Front Bench. The Government have been committed to putting more resources into the health service year on year, but it is his party that is silent on that.

My hon. and learned Friend the Member for Burton (Sir I. Lawrence) paid tribute to what has happened to the health service in his constituency. He is quite right to point out that it is a great achievement that day surgery is at record levels at his local trust hospital. That improvement is one reason why we have been able to make such progress.

I apologise to other hon. Members to whom I have not been able to respond directly, but my time is limited.

This has been an interesting debate in which the Labour party has not dealt with the current issues in the health service. We heard nothing from the Opposition about the primary care-led NHS and where it is going. They said nothing about how that service will shape the health service for the 21st century. Not a word did we hear.

We heard a mealy-mouthed answer to the question of fundholding. The hon. Member for Peckham (Ms Harman) will have to answer to a number of fundholding practices in her constituency, including Dr. Virji and partners, who offer clinical psychology, minor surgery and other services; Dr. Brownsdon and partners, one mile north of Herne Hill, who offer excellent services; and Doctor Hossain and partners, who provide outreach teaching clinics for dermatology and in-surgery clinics for antenatal treatment, asthma and hypertension. Those are the benefits that her party is, at bottom, committed to sweeping away. She is fudging the issue and refuses to tell the story.

Yesterday, we heard from the Leader of the Opposition that he was not buckling under pressure. The whole country could see that he was twisting. His party has been twisting on the health service today. Policy by staccato soundbite will not do. From what we have heard today, the hon. Member for Peckham is more credible when she acts on education than when she speaks on health.

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

The House divided: Ayes 262, Noes 285.

Division No. 35]	[9.59 pm
AYES
Abbott, Ms Diane	Byers, Stephen
Adams, Mrs Irene	Caborn, Richard
Ainsworth, Robert (Cov'try NE)	Callaghan, Jim
Allen, Graham	Campbell, Mrs Anne (C'bridge)
Alton, David	Campbell, Menzies (Fife NE)
Anderson, Donald (Swansea E)	Campbell, Ronnie (Blyth V)
Anderson, Ms Janet (Ros'dale)	Campbell-Savours, D N
Armstrong, Hilary	Canavan, Dennis
Ashdown, Rt Hon Paddy	Cann, Jamie
Ashton, Joe	Carlile, Alexander (Montgomery)
Austin-Walker, John	Chidgey, David
Barnes, Harry	Chisholm, Malcolm
Battle, John	Church, Judith
Beckett, Rt Hon Margaret	Clapham, Michael
Beggs, Roy	Clark, Dr David (South Shields)
Beith, Rt Hon A J	Clarke, Eric (Midlothian)
Bell, Stuart	Clwyd, Mrs Ann
Benn, Rt Hon Tony	Coffey, Ann
Bennett, Andrew F	Cohen, Harry
Benton, Joe	Connarty, Michael
Bermingham, Gerald	Cook, Frank (Stockton N)
Berry, Roger	Cook, Robin (Livingston)
Betts, Clive	Corbett, Robin
Boateng, Paul	Corbyn, Jeremy
Bradley, Keith	Corston, Jean
Bray, Dr Jeremy	Cousins, Jim
Brown, Gordon (Dunfermline E)	Cunningham, Jim (Covy SE)
Brown, N (N'c'tle upon Tyne E)	Cunningham, Rt Hon Dr John
Bruce, Malcolm (Gordon)	Cunningham, Roseanna
Burden, Richard	Dafis, Cynog

Dalyell, Tam	Keen, Alan
Darling, Alistair	Khabra, Piara S
Davidson, Ian	Kilfoyle, Peter
Davies, Bryan (Oldham C'tral)	Kirkwood, Archy
Davies, Chris (L'Boro & S'worth)	Lestor, Joan (Eccles)
Davies, Rt Hon Denzil (Llanelli)	Liddell, Mrs Helen
Davies, Ron (Caerphilly)	Litherland, Robert
Denham, John	Livingstone, Ken
Dewar, Donald	Llwyd, Elfyn
Dixon, Don	Loyden, Eddie
Dobson, Frank	Lynne, Ms Liz
Dowd, Jim	McAllion, John
Eagle, Ms Angela	McAvoy, Thomas
Eastham, Ken	McCartney, Ian
Etherington, Bill	McCartney, Robert
Evans, John (St Helens N)	McCrea, The Reverend William
Ewing, Mrs Margaret	Macdonald, Calum
Fatchett, Derek	McFall, John
Faulds, Andrew	McGrady, Eddie
Field, Frank (Birkenhead)	McKelvey, William
Fisher, Mark	McLeish, Henry
Flynn, Paul	Maclennan, Robert
Forsythe, Clifford (S Antrim)	MacShane, Denis
Foster, Rt Hon Derek	McWilliam, John
Foster, Don (Bath)	Madden, Max
Fyfe, Maria	Maddock, Diana
Galbraith, Sam	Maginnis, Ken
Galloway, George	Mahon, Alice
Gapes, Mike	Mandelson, Peter
Garrett, John	Marek, Dr John
George, Bruce	Marshall, David (Shettleston)
Gerrard, Neil	Martin, Michael J (Springburn)
Gilbert, Rt Hon Dr John	Martlew, Eric
Godman, Dr Norman A	Maxton, John
Godsiff, Roger	Meacher, Michael
Golding, Mrs Llin	Meale, Alan
Gordon, Mildred	Michael, Alun
Grant, Bernie (Tottenham)	Michie, Bill (Sheffield Heeley)
Griffiths, Nigel (Edinburgh S)	Milburn, Alan
Griffiths, Win (Bridgend)	Miller, Andrew
Grocott, Bruce	Mitchell, Austin (Gt Grimsby)
Gunnell, John	Molyneaux, Rt Hon Sir James
Hain, Peter	Moonie, Dr Lewis
Hall, Mike	Morgan, Rhodri
Hanson, David	Morris, Rt Hon Alfred (Wy'nshawe)
Harman, Ms Harriet	Morris, Estelle (B'ham Yardley)
Harvey, Nick	Morris, Rt Hon John (Aberavon)
Hattersley, Rt Hon Roy	Mowlam, Marjorie
Hendron, Dr Joe	Mudie, George
Heppell, John	Mullin, Chris
Hinchliffe, David	Murphy, Paul
Hodge, Margaret	Nicholson, Emma (Devon West)
Hoey, Kate	Oakes, Rt Hon Gordon
Hogg, Norman (Cumbernauld)	O'Brien, Mike (N W'kshire)
Home Robertson, John	O'Brien, William (Normanton)
Hood, Jimmy	O'Hara, Edward
Hoon, Geoffrey	Olner, Bill
Howarth, Alan (Strat'rd-on-A)	O'Neill, Martin
Howarth, George (Knowsley North)	Orme, Rt Hon Stanley
Howells, Dr Kim (Pontypridd)	Parry, Robert
Hoyle, Doug	Pearson, Ian
Hughes, Kevin (Doncaster N)	Pendry, Tom
Hughes, Robert (Aberdeen N)	Pickthall, Colin
Hughes, Simon (Southwark)	Pike, Peter L
Hutton, John	Pope, Greg
Illsley, Eric	Powell, Ray (Ogmore)
Jackson, Glenda (H'stead)	Prescott, Rt Hon John
Jackson, Helen (Shef'ld, H)	Primarolo, Dawn
Jamieson, David	Purchase, Ken
Jones, Barry (Alyn and D'side)	Quin, Ms Joyce
Jones, Ieuan Wyn (Ynys Môn)	Randall, Stuart
Jones, Jon Owen (Cardiff C)	Reid, Dr John
Jones, Lynne (B'ham S O)	Rendel, David
Jones, Martyn (Clwyd, SW)	Roche, Mrs Barbara
Jones, Nigel (Cheltenham)	Rooker, Jeff
Kaufman, Rt Hon Gerald	Ross, Ernie (Dundee W)

Ross, William (E Londonderry)	Taylor, Rt Hon John D (Strgfd)
Rowlands, Ted	Taylor, Matthew (Truro)
Ruddock, Joan	Timms, Stephen
Salmond, Alex	Tipping, Paddy
Sedgemore, Brian	Touhig, Don
Sheerman, Barry	Turner, Dennis
Sheldon, Rt Hon Robert	Tyler, Paul
Shore, Rt Hon Peter	Vaz, Keith
Short, Clare	Walker, Rt Hon Sir Harold
Simpson, Alan	Wallace, James
Skinner, Dennis	Walley, Joan
Smith, Andrew (Oxford E)	Wardell, Gareth (Gower)
Smith, Chris (Isl'ton S & F'sbury)	Wareing, Robert N
Smith, Llew (Blaenau Gwent)	Watson, Mike
Smyth, The Reverend Martin	Welsh, Andrew
Snape, Peter	Wicks, Malcolm
Soley, Clive	Wigley, Dafydd
Spearing, Nigel	Williams, Rt Hon Alan (Sw'n W)
Spellar, John	Williams, Alan W (Carmarthen)
Squire, Rachel (Dunfermline W)	Wilson, Brian
Steinberg, Gerry	Wise, Audrey
Stevenson, George	Worthington, Tony
Stott, Roger	Wright, Dr Tony
Strang, Dr. Gavin	Young, David (Bolton SE)
Straw, Jack
Sutcliffe, Gerry	Tellers for the Ayes:
Taylor, Mrs Ann (Dewsbury)	Mr. David Clelland and
	Mrs. Jane Kennedy.
NOES
Ainsworth, Peter (East Surrey)	Cash, William
Aitken, Rt Hon Jonathan	Chapman, Sir Sydney
Alison, Rt Hon Michael (Selby)	Churchill, Mr
Allason, Rupert (Torbay)	Clappison, James
Ancram, Michael	Clarke, Rt Hon Kenneth (Ru'clif)
Arbuthnot, James	Clifton-Brown, Geoffrey
Arnold, Jacques (Gravesham)	Coe, Sebastian
Arnold, Sir Thomas (Hazel Grv)	Colvin, Michael
Ashby, David	Congdon, David
Atkins, Rt Hon Robert	Conway, Derek
Atkinson, Peter (Hexham)	Coombs, Anthony (Wyre Forest)
Baker, Rt Hon Kenneth (Mole V)	Coombs, Simon (Swindon)
Baker, Nicholas (North Dorset)	Cormack, Sir Patrick
Baldry, Tony	Couchman, James
Banks, Robert (Harrogate)	Cran, James
Bates, Michael	Currie, Mrs Edwina (S D'by'ire)
Batiste, Spencer	Curry, David (Skipton & Ripon)
Bellingham, Henry	Davies, Quentin (Stamford)
Bendall, Vivian	Davies, David (Boothferry)
Beresford, Sir Paul	Day, Stephen
Biffen, Rt Hon John	Deva, Nirj Joseph
Body, Sir Richard	Devlin, Tim
Bonsor, Sir Nicholas	Dorrell, Rt Hon Stephen
Booth, Hartley	Douglas-Hamilton, Lord James
Boswell, Tim	Dover, Den
Bottomley, Peter (Eltham)	Duncan, Alan
Bottomley, Rt Hon Virginia	Duncan-Smith, Iain
Bowis, John	Dunn, Bob
Boyson, Rt Hon Sir Rhodes	Durant, Sir Anthony
Brandreth, Gyles	Dykes, Hugh
Brazier, Julian	Elletson, Harold
Bright, Sir Graham	Emery, Rt Hon Sir Peter
Brooke, Rt Hon Peter	Evans, David (Welwyn Hatfield)
Brown, M (Brigg & Cl'thorpes)	Evans, Jonathan (Brecon)
Browning, Mrs Angela	Evans, Nigel (Ribble Valley)
Bruce, Ian (Dorset)	Evans, Roger (Monmouth)
Budgen, Nicholas	Evennett, David
Burns, Simon	Faber, David
Burt, Alistair	Fabricant, Michael
Butcher, John	Field, Barry (Isle of Wight)
Butler, Peter	Fishburn, Dudley
Butterfill, John	Forman, Nigel
Carlisle, John (Luton North)	Forsyth, Rt Hon Michael (Stirling)
Carlisle, Sir Kenneth (Lincoln)	Forth, Eric
Carrington, Matthew	Fowler, Rt Hon Sir Norman
Carttiss, Michael	Fox, Dr Liam (Woodspring)

Fox, Sir Marcus (Shipley)	MacGregor, Rt Hon John
Freeman, Rt Hon Roger	MacKay, Andrew
French, Douglas	Maclean, Rt Hon David
Gale, Roger	McLoughlin, Patrick
Gardiner, Sir George	McNair-Wilson, Sir Patrick
Garnier, Edward	Madel, Sir David
Gill, Christopher	Maitland, Lady Olga
Gillan, Cheryl	Malone, Gerald
Goodlad, Rt Hon Alastair	Mans, Keith
Goodson-Wickes, Dr Charles	Marlow, Tony
Gorman, Mrs Teresa	Marshall, John (Hendon S)
Gorst, Sir John	Marshall, Sir Michael (Arundel)
Grant, Sir A (SW Cambs)	Martin, David (Portsmouth S)
Greenway, Harry (Ealing N)	Mates, Michael
Greenway, John (Ryedale)	Mawhinney, Rt Hon Dr Brian
Griffiths, Peter (Portsmouth, N)	Mayhew, Rt Hon Sir Patrick
Grylls, Sir Michael	Mellor, Rt Hon David
Gummer, Rt Hon John Selwyn	Merchant, Piers
Hague, Rt Hon William	Mills, Iain
Hamilton, Rt Hon Sir Archibald	Mitchell, Andrew (Gedling)
Hamilton, Neil (Tatton)	Mitchell, Sir David (NW Hants)
Hampson, Dr Keith	Moate, Sir Roger
Hanley, Rt Hon Jeremy	Monro, Rt Hon Sir Hector
Hannam, Sir John	Montgomery, Sir Fergus
Hargreaves, Andrew	Needham, Rt Hon Richard
Harris, David	Neubert, Sir Michael
Hawkins, Nick	Nicholls, Patrick
Hawksley, Warren	Nicholson, David (Taunton)
Hayes, Jerry	Norris, Steve
Heald, Oliver	Onslow, Rt Hon Sir Cranley
Heath, Rt Hon Sir Edward	Oppenheim, Phillip
Heathcoat-Amory, David	Page, Richard
Hendry, Charles	Paice, James
Hicks, Robert	Patten, Rt Hon John
Higgins, Rt Hon Sir Terence	Pattie, Rt Hon Sir Geoffrey
Hill, James (Southampton Test)	Pawsey, James
Hogg, Rt Hon Douglas (G'tham)	Peacock, Mrs Elizabeth
Horam, John	Porter, David (Waveney)
Hordern, Rt Hon Sir Peter	Portillo, Rt Hon Michael
Howard, Rt Hon Michael	Powell, William (Corby)
Hughes, Robert G (Harrow W)	Redwood, Rt Hon John
Hunt, Rt Hon David (Wirral W)	Richards, Rod
Hunter, Andrew	Riddick, Graham
Hurd, Rt Hon Douglas	Rifkind, Rt Hon Malcolm
Jack, Michael	Robathan, Andrew
Jackson, Robert (Wantage)	Roberts, Rt Hon Sir Wyn
Jenkin, Bernard	Robertson, Raymond (Ab'd'n S)
Jessel, Toby	Robinson, Mark (Somerton)
Johnson Smith, Sir Geoffrey	Roe, Mrs Marion (Broxbourne)
Jones, Gwilym (Cardiff N)	Rowe, Andrew (Mid Kent)
Jones, Robert B (W Hertfdshr)	Rumbold, Rt Hon Dame Angela
Jopling, Rt Hon Michael	Sackville, Tom
Kellett-Bowman, Dame Elaine	Sainsbury, Rt Hon Sir Timothy
Key, Robert	Scott, Rt Hon Sir Nicholas
King, Rt Hon Tom	Shaw, David (Dover)
Kirkhope, Timothy	Shaw, Sir Giles (Pudsey)
Knapman, Roger	Shephard, Rt Hon Gillian
Knight, Mrs Angela (Erewash)	Shepherd, Richard (Aldridge)
Knight, Rt Hon Greg (Derby N)	Shersby, Sir Michael
Knight, Dame Jill (Bir'm E'st'n)	Sims, Roger
Knox, Sir David	Skeet, Sir Trevor
Kynoch, George (Kincardine)	Smith, Tim (Beaconsfield)
Lait, Mrs Jacqui	Soames, Nicholas
Lamont, Rt Hon Norman	Spencer, Sir Derek
Lang, Rt Hon Ian	Spicer, Sir James (W Dorset)
Lawrence, Sir Ivan	Spicer, Sir Michael (S Worcs)
Legg, Barry	Spink, Dr Robert
Leigh, Edward	Spring, Richard
Lennox-Boyd, Sir Mark	Sproat, Iain
Lester, Sir James (Broxtowe)	Squire, Robin (Hornchurch)
Lidington, David	Stanley, Rt Hon Sir John
Lilley, Rt Hon Peter	Steen, Anthony
Lloyd, Rt Hon Sir Peter (Fareham)	Stephen, Michael
Lord, Michael	Stern, Michael
Luff, Peter	Stewart, Allan
Lyell, Rt Hon Sir Nicholas	Streeter, Gary

Sumberg, David	Walker, Bill (N Tayside)
Sweeney, Walter	Waller, Gary
Sykes, John	Ward, John
Tapsell, Sir Peter	Wardle, Charles (Bexhill)
Taylor, Ian (Esher)	Waterson, Nigel
Taylor, John M (Solihull)	Watts, John
Taylor, Sir Teddy (Southend, E)	Wells, Bowen
Temple-Morris, Peter	Whitney, Ray
Thomason, Roy	Whittingdale, John
Thompson, Sir Donald (C'er V)	Widdecombe, Ann
Thompson, Patrick (Norwich N)	Wiggin, Sir Jerry
Thornton, Sir Malcolm	Wilkinson, John
Thurnham, Peter	Willetts, David
Townsend, Cyril D (Bexl'yh'th)	Wilshire, David
Tracey, Richard	Winterton, Mrs Ann (Congleton)
Tredinnick, David	Winterton, Nicholas (Macc'fld)
Trend, Michael	Yeo, Tim
Trotter, Neville	Young, Rt Hon Sir George
Twinn, Dr Ian
Vaughan, Sir Gerard	Tellers for the Noes:
Viggers, Peter	Mr. Richard Ottaway and
Waldegrave, Rt Hon William	Mr. Timothy Wood.
Walden George

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 believes that the NHS is a great British success story which delivers health care of international quality, which is and will remain available free at the point of use on the basis of medical need and provides excellent value for money for taxpayers; congratulates all NHS staff for their hard work and dedication, particularly during the exceptional period of increased demand for NHS services over recent weeks; welcomes the increasing number of qualified nurses and midwives over the last seventeen years and looks forward to the NHS continuing to flourish under the policies of a Government which has backed its commitment to the service with year-on-year increases in real resources.