Commons Sitting of 26 June 1996

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

  Right to Work
  [Relevant document: The Second Report from the Employment Committee of Session 1995–96 on The Right to Work/Workfare (House of Commons Paper No. 82). and the Second Special Report from the Education and Employment Committee containing the Government's Reply thereto (House of Commons Paper No. 585.]
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]
  9.35 am
  Mr. Greville Janner: I greatly welcome the opportunity to put before the House the recommendations of the Employment Select Committee concerning workfare. I do so with some trepidation because we have, as it were, risen from the grave. The Government having consigned us for ever to oblivion, we have emerged again to entertain the House a little. Still, this is a subject of great importance to the country, to the House and to every hon. Member in the House.
  I pay special tribute to all the members of the Select Committee on Employment for the work that they did on this report; and I thank the hon. Member for Crosby (Sir M. Thornton) in particular for all that he has done to enable this debate to take place, and for so kindly allowing me to open it. I am the departed Chairman of the old Committee; he is the newly installed Chairman of the new and reincarnated Committee, which incorporates the old one.
  The problem of unemployment is one of vast consequence. It is the greatest single cause of economic misery in this country. It is a disaster for millions of people and for their families, and the Employment Committee was united in seeking ways to deal with it.
  At this point I pay tribute also to a man whom I would wish to call my hon. Friend, because he is both honourable and my friend: the hon. Member for North Norfolk (Sir R. Howell). Thinking about tonight's football match, I wonder whether he would be more comfortable on the right wing, where he has been used to spending his time, or on the left wing, to which some of us feel he has moved. For he is the progenitor of ideas that are far from orthodox on the right. I note that he shakes his woolly, farmer's head—to no avail. He is a man of integrity and of ideas, and this one is his baby. Once I have outlined what the debate is about, I shall leave it to him to advance the united views of the Committee.
  We start from the premise that the need for jobs is huge. We start from the Government figure of just over 2 million unemployed people—nearly double the number when they came to office. It is, however, an unreal figure because it excludes 10 categories of people. They include
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  those who have left the register because they have simply given up and no longer feel that there is any hope of jobs for them. Another category is of people who work just one hour or more part time and who, like millions of others, leave the register when they get part-time jobs. People desperate for work will take part-time jobs because there are no full-time jobs. I would be astonished if there were fewer than between 3.5 million and 4 million people who want full-time jobs today but cannot find them.
  The Minister of State, Department for Education and Employment (Mr. Eric Forth): I thought the hon. and learned Gentleman might get on to this nonsense early in his speech—he is in typical form. If he approves of the International Labour Organisation—I do not but I suspect that he does—and if he agrees with the labour force survey method of counting the unemployed, which is the ILO-approved method—
  Mr. Frank Field: You do not.
  Mr. Forth: I do not, but I suspect that the hon. and learned Gentleman does. If he approves of either or both, how does he explain their figure of about 2.2 million or 2.3 million for unemployment in this country?
  Mr. Janner: The Government have no idea how many millions of people are unemployed, nor how much it costs—and they do not care, as they have said in their response to the Committee's report. The Government do not know how many people with part-time work want full-time work—they have never tried to find out and they do not want to know. They do not know how many full-time students would be at work if they could get a job—and they do not want to know. They have no idea how many people in a family wish to work but cannot find a job. What is more, the Minister and Government members laugh about it—that is a disgraceful attitude. The Government think that it is funny that people are unemployed.
  The Committee produced a unanimous report—Conservative and Labour members agreed—which outlined ways to look at the problem. But what was the Government's reply? I shall tell hon. Members my definition of unemployment: it is a "recession" when someone else is out of work, it is "depression" when you are out of work and it is "recovery" for the country when the Government are out of work. That is when we will have hope.
  The Committee—which was led by the hon. Member for North Norfolk—said that we need to know the cost of unemployment. The Secretary of State for Education and Employment—an expert in mathematics—started off by telling us that the cost was about £9,000 per head, but then she lowered the figure to about £3,000 per head because she decided to leave a few things out of the statistics.
  What was the Government's reply? They said that it is not necessary to produce the figures and that that will not help. I know that that view is not held by the hon. Member for North Norfolk, nor by any other member of the Committee. When one wants to cost something out, to find out how to remedy a wrong, and to know what steps to take—whether in business, in commerce or in government—one must know the present cost. The approach of the so-called Government in this regard has been amazing.

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  What is the cost of unemployment? We know that it costs misery for millions of people. Unemployment is at the heart of the insecurities of our constituents and the constituents of the laughing Minister, who would not find this at all funny—they either do not have jobs or, if they do have jobs, they feel insecure about their future. Our constituents know—even if the Minister does not—that the number of jobs, the number of people at work, in this country has dropped by 5 per cent. since the Government came to office. That is another indication that the Government's fiddle on figures is the Stradivarius of political life.
  We need to know the cost of unemployment—not just in misery, but in pounds and pence. We need to know the cost of people who are unemployed and receiving benefit, but who wish to work—that is not funny. We need to know the cost of people who wish to be at work and who would be paying tax if they were employed, but who are not—that is not funny. We need to know the cost of people who are unemployed and who would be paying national insurance if they were employed, but who are not—that is not funny. And, above all, we need to know the cost of the loss to the country of all the efforts of these people.
  The Committee made some modest suggestions, such as extending existing schemes and looking not at compulsion—because Labour Members on the Committee would not have accepted that—but at ways in which the community could help people to work. We should pay people to be at work, not pay them not to be at work. This must make sense, provided that we can do it without destroying real jobs. All we asked was that the Government look at this. The puny, nasty, inadequate, insubstantial and impertinent document that the Government have seen fit to put before us is unworthy of the Government—even though they thought that the Committee would never be able to answer back. This is our chance to answer back.
  If the hon. Member for North Norfolk catches your eye, Madam Speaker, he will give the House the answer—as will my hon. Friend the Member for Birkenhead (Mr. Field), whose depth of knowledge and understanding of these matters is unrivalled in the House. I shall leave it to them to answer the Government. I ask the Government not to laugh at the unemployment rates, at the figures, at their failure to cost out unemployment in financial and in human terms, and at the report of the distinguished, but now defunct, Committee. It is a report of substance, importance and intelligence—the Government should act on it, not laugh at it.
  9.45 am
  Sir Ralph Howell: I thank my friend the hon. and learned Member for Leicester, West (Mr. Janner) for his kind remarks about me and for allowing the debate to take place. I became a member of the Committee approximately two years ago. Soon after I joined the Committee, it decided to study workfare and the right to work. I believe that the Committee did a good job in looking into the matter and trying to find a way to solve the problem of unemployment. Everyone agrees that unemployment is wasteful, soul destroying, degrading, unnecessary and unaffordable.
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  The hon. and learned Member for Leicester, West referred to the cost of unemployment—the cost is all important. The welfare state is costing too much in this country, and everywhere else. Therefore, it is unrealistic to try to make reforms that will cost even more. The reforms that the Committee recommended—reforms that I have pursued for many years—would save a considerable amount of public expenditure. The hon. and learned Gentleman's point on cost is relevant.
  There should be an independent inquiry into the cost of the Right to Work Bill, which I have put forward with the support of the hon. Member for Birkenhead (Mr. Field), who is also a friend of long standing. The Bill was introduced with just one supporter last July.
  Ms Angela Eagle: Does the hon. Gentleman agree that the other part of the equation that we need to look at is the cost of the current level of unemployment and the cost of keeping those people doing nothing? Does he also agree that we tried very hard in our report to get the Government to give us an estimate of the cost? The cost ranged from a basic £10 billion a year—which is pure benefit payments—to as high as £24 billion.
  Sir Ralph Howell: I shall refer to the details of the cost a little later in my speech. I beg the Government to take this matter seriously and to have an independent inquiry into the overall cost of the proposals—only then will we know whether they are practical. The Committee believes that we could save at least £5 billion per year, and probably considerably more.
  It is obvious that the welfare state is out of control. In 1948, based on the Beveridge report, we set out on a welfare state system. However, the Beveridge report was never fully put into operation. If it had been, there would never have been any long-term unemployed. Beveridge said that after three months or six months—whichever was decided—benefit would cease and work would be offered. To be fair to the Attlee Government, they could not put the whole report into operation then because there were no unemployed. When unemployment did creep in, successive Governments should have done something about it.
  We are in a extraordinary situation with the Right to Work Bill. An early-day motion has been supported by 70 of my hon. Friends, by 40 Labour Members, six Liberals and eight others, so we have cross-party support. We are causing the Front Benchers to think about the matter seriously. All three main parties have their heads firmly in the sand and they hope that the problem will go away, but it will not go away. The problem will worsen for as long as the welfare state is operated and we must stop spending money and receiving nothing for it in return.
  Most people who are unemployed want to work. The cost of unemployment has already been mentioned and the Government admit that unemployment costs £13.5 billion a year. If we divide £13.5 billion by the number of unemployed—2.2 million-the cost is £6,000 a year each. If we also include the tax and national insurance of at least £1,000 that everyone would pay if they were earning £6,000 a year, the Treasury is losing at least £7,000 per person through unemployment. Society at large is getting nothing in return. Would not it be better for unemployed people to be doing something?

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  Unemployment carries further costs in stress, increased sickness, marriage break-up, crime and drug-taking and it is no good denying that there is a connection between crime and unemployment. Everybody should have an opportunity to work, everybody should have a right to work and everybody should have a right to the dignity of earning a living. We could deliver that and save at least £5 billion a year.
  I shall explain how the Right to Work Bill would operate. The main obstacle is that the Government are determined not to accept a situation in which the state is the employer of last resort, but the state is the provider of last resort. Would not it be more sensible from everybody's point of view if the unemployed could do caring work, environmental work or minor infrastructure work—a variety of jobs that could be offered—for the general good of the nation? Fresh thinking is needed immediately.
  The Bill states that the state should become the employer of last resort and should offer work to anybody who has no other work. That idea is not new. It was first introduced in the House in 1911 by Keir Hardie, who by that time was not top of the pops in the Labour party. A rehash of the Keir Hardie Bill was introduced again by a Member of Parliament named Enoch Edwards in 1912. My Right to Work Bill, 84 years later, comes from the opposite side of the House, although I am still as right-wing as I ever was. [HON. MEMBERS: "NO!"] We have formed a bridge across the House and it is time to accept that the state should be the employer of last resort.
  We would ease into the new approach through workstart. I wish to pay tribute to my right hon. Friend the Secretary of State for Education and Employment, because the pilot workstart scheme was set up when she was in charge of the old Department of Employment. It has been highly successful in every respect, but sadly there has been no financial evaluation of it. I ask my hon. Friend the Minister of State to insist on an evaluation of the savings that must have been made by the workstart scheme.
  Under workstart, the Government paid £60 to an employer who took somebody off the register for the first six months and £30 for the next six months. The average saving must have been about £75 a week on what the state paid someone to do nothing before. Workstart should be offered nationwide.
  We should also introduce a non-worker payment. Some people will refuse to work and it should be possible to sack people from the right-to-work scheme if they try to abuse the scheme. The non-worker payment should be 25 per cent. of what is offered under the right-to-work scheme. We should also pay a parents' grant of £60 for the lower-paid. Any couple with an income of less than £180 a week would be eligible for a £60 grant, if one of them remained at home to look after their children.
  Those are the provisions of the Right to Work Bill which has received support from both sides of the House. The Bill would not introduce American-style workfare. So often when this matter is discussed, the media talk of American-style workfare, but we would offer a real job to everybody who wishes to work so that everybody can have the opportunity to earn a living.
  I shall spell out the financial terms. Everybody would have the right to work for 40 hours at £3 an hour, giving a maximum of £120 a week. That would also mean that
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  every couple would have access to £240 a week, so virtually no social security payments would be necessary to maintain any couple, married or not. Everybody would have the opportunity to earn £120 and that would get rid of the stigma of social security payments. There would be no fraud and no need for fraud squads for the simple reason that, unless people reported to work, they would not be paid. People could put in whatever amount of time they wished, up to 40 hours a week. I ask my hon. Friend to consider that as a way forward in Europe. I believe that the Government are right to opt out of the social chapter which is causing immense problems.
  Mr. Ken Eastham: Is there not a slight contradiction in the hon. Gentleman's remarks? A few moments ago he argued the case for a minimum wage of £3 an hour, but the Government say consistently that they oppose the introduction of a minimum wage under the social chapter.
  Sir Ralph Howell: The figure of £3 an hour would not be a minimum wage in a statutory sense—anyone who wanted to could work for less—but it would probably develop into one. I have no hang-ups about that, although perhaps the Government do. I am glad of the hon. Gentleman's intervention as it allows me to admit that I have pitched the figure at a low level. I have been talking about £3 an hour for about three years and perhaps it should be a little higher now. However, for the sake of convenience and so as not to confuse the issue, it is advisable to continue talking about £3 an hour. That would be easy to phase in and it would be less likely to upset the Government. I cannot understand why the Government have a problem with the idea of a minimum wage. We spend more than £2 billion supporting the low-paid, so we are bringing wages up to a statutory minimum in any event.
  Returning to my earlier point, I think that the Government are correct to oppose the social chapter as it is now drawn. The Germans, the French and everyone else in Europe who is suffering as a result of the social chapter will find in time that they can no longer support it in that form. I ask the Government to take my proposals seriously. Would it not be better for Britain to rewrite the social chapter instead of sniping from the sidelines? This country has taken the lead many times before—I hope that we shall do so again today in the football—and it is time to rethink the question of the welfare state. Almost all countries copied our welfare system in the late 1940s, but it is no longer viable. It is unsupportable and it is time to rethink the whole system.
  I believe that the legislation would remove unemployment and the fear of unemployment—which is probably worse than the original problem. It would be a fresh start and it would give us something to hope for. I ask my hon. Friend the Minister to persuade the Secretary of State for Education and Employment to take the proposals seriously and see whether she can adopt them.
  10.3 am
  Mr. Frank Field: While listening to my hon. and learned Friend the Member for Leicester, West (Mr. Janner), who opened the debate, I recalled a comment by Jeremy Thorpe. Speaking about the other place, he said that here was evidence of life after death. The Government have wound up the Employment Select

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  Committee, but its former Chairman opened our debate today. Hon. Members and their constituents are grateful to him for carefully nurturing the Select Committee, for opening the agenda and for encouraging hon. Members to exchange ideas and to produce reports that are relevant rather than politically correct.
  My association with the hon. Member for North Norfolk (Sir R. Howell) goes back a long way. At one time I was in receipt of Cabinet papers about child benefit. The last Labour Government had slight difficulties introducing that benefit and, because I was worried that the special branch would raid my office and take those papers from me, I destroyed them. If I had not done so, I would have been able to look up the exact dates of two events.
  The first was when my hon. Friend—which is how I regard the hon. Member for North Norfolk—attended a breakfast with the Child Poverty Action Group at the Tory party conference. Sir Keith Joseph—as I learnt more about him, I became fonder of him—was hosting that breakfast. The hon. Member for North Norfolk was advancing ideas similar to those in the legislation that he and I promoted during the last parliamentary Session and suddenly Sir Keith Joseph leant across the table and said to the hon. Gentleman, "But, Ralph, you are promoting communist ideas." The hon. Gentleman, in a totally proper, English manner, gently reminded his shadow colleague that he was not particularly interested in labels but in practical proposals to combat an evil.
  At that meeting I first became aware of the hon. Gentleman's real feeling for those people who, for all intents and purposes, have been cast on the scrapheap. He was angry on their behalf that we should run our affairs so carelessly and forget about them because we think that we have done our bit by paying them dole money. I remember also the way in which he challenged Sir Keith Joseph at that meeting by reciting a list of jobs that needed doing in his constituency. He pushed his shadow spokesman on to the back foot by saying, "Is it not more sensible to put aside labels—whether we are communist or right-wing? Instead of spending large sums keeping people idle, should we not think of ways of spending some, if not all, of that money employing people in tasks which would give them dignity, which would add considerably to the well-being of the local community and which the Government could enter in the national income figures and would lead to an increase in national wealth?" That was my first encounter with the hon. Gentleman.
  Mr. Forth: I am provoked to rise to my feet by the hon. Gentleman's passing and ritualistic reference—it was not a casual reference, as nothing about the hon. Gentleman is casual—to scrapheaps and to people being cast aside. The hon. Gentleman must visit jobcentres, as I do, and talk to the very dedicated staff. He must know that everyone who has the misfortune of losing his or her job is treated as an individual by caring jobcentre officers and officials and offered a wide range of possibilities. How does he square that reality with his reference to scrapheaps and to people being cast aside?
  Mr. Field: I invite the Minister to join my hon. Friend the Member for Wallasey (Ms Eagle) and me on a visit to Birkenhead jobcentre. If the Minister looks at the jobs
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  advertised there, he will see that most employers are so ashamed of the wages that they can get away with offering that they do not state those wages—if there are wages attached to the job, as many of the positions are on a commission basis only. We must draw a distinction between the dedication of the jobcentre staff—to whom we pay proper tribute—and the Government who believe that they cannot do anything, beyond the measures that they currently employ, to expand the job base.
  The debate is about whether there is a set number of jobs and how those jobs are determined. It raises the big issues of our time. Does training by itself represent an adequate response to the problem and will it enable Britain to go up market and reach a position of full employment? Should we be more active in the labour market—given the fact that the market cannot adjust itself—in using people's skills and in matching them to the work that must be done? My hon. Friend the Member for North Norfolk has been raising that issue for the 30 years that I have known him, and it is what the Bill is about. He gently pressed the Government to recognise how their response to the measures that he proposed will appear to people outside: casual and lacking in concern.
  Mr. Ian McCartney: I was in Yorkshire last week and had passed on to me, anonymously, the concerns of staff members of the Employment Service about the jobs that they are forced to offer. From the list of jobs that I was shown, one was for a warehouse assistant, full-time—£10 plus benefits. Another was for a full-time agent working in the local community—commission only.
  Mr. Field: On the first job that my hon. Friend mentioned, it is probably illegal to offer work under those conditions, given the requirements for income support. We shall leave that aside. That is not a reflection on the dedication or the concern of the staff of the Employment Service. It just shows how the labour market will adjust to the circumstances. All of us have witnessed the rise in unemployment in our constituencies and the fall in real wages. Most employers, knowing what they can get away with, use the jobcentres and do not even say what the wage will be.
  My second meeting with my hon. Friend the Member for North Norfolk was when he wrote a pamphlet for the Low Pay Unit, an organisation that I worked for, on the unemployment trap. In the days before we were as dependent on means-tested benefits as we are today, he was a prophet calling attention to the way in which ordinary people have to make rational decisions about their well-being and that of their family, and how for a growing number of people then—now a huge number—the trade-off, if there is any, between working and not working is small.
  That is the background to my association with my hon. Friend and thus my willingness to sponsor with him the Right to Work Bill, not because we agreed on every proposal after we had discussed it, but because we both believed that it was an opportunity that the Government could seize to show that they were serious about dealing with the issue. We did not think that it would be the great panacea or that it would be achieved in the timetable that we had set in the Bill. We included the timetable because we were anxious to show our constituents that we had a sense of urgency about the issue, because many of them had been without work for many years.

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  I am here to support my hon. Friend in his request for two things: first, for the Government to get an independent and serious costing of the proposals. Given the way in which they have handed out contracts—I shall not say "to their friends"—the Government believe in job creation. They have handed out contracts to inquire into this and that, and to report on this and that, for which I am grateful, as that is, as my hon. Friend the Member for North Norfolk knows, what job creation is about. We now ask, as a sign of the Government's true faith, that they consider seriously every proposal given to them, as a means of tackling the evil of unemployment.
  The second request is for a real costing of unemployment. Let us leave aside whether the total is 2 million or 4 million. Let us leave aside the number of workers who will come into the labour market who are not registered as unemployed but who would be there if jobs were available. There are armies of workers who, because they do not receive benefit, do not register as unemployed, but that does not mean that they do not want work and would not work if it was available. The Minister turns his nose up at these proposals, but anybody who wanted to indulge in rational debate and was confident of his position would have commissioned both of these studies a long time ago. Not to do so would suggest to the House and, more importantly, our constituents, that the Government do not want to know the information, because it would make their position less tenable.
  I am pleased to be able to speak in the debate. It is a pleasure to follow my hon. and learned Friend the Member for Leicester, West. I pay tribute to the way in which he chaired the Select Committee on Employment and the way in which he encouraged a thousand ideas to blossom in it. He did not feel it necessary to take a Stalinist line on what the truth is, or to say that every report must come down on the small area of agreed truth. I think that the report will be considered as a landmark, because it will show that we have moved away from the heady days of the 1980s, when we believed that markets could solve everything. No one is saying that we do not believe in markets. The House is saying that we want markets to work where they can work. Where they cannot work, where millions of people want to work but cannot, we have a duty to try to find ways of extending work opportunities to them which are useful and beneficial, raise their status and add to the national well-being.
  I applaud my hon. Friend the Member for North Norfolk for the way in which—despite all the rebuffs that he has received, often from his own side—he has never lost sight of the anger and despair of a large number of our constituents. Even though they might put on brave faces for some public events and seem as if they do not care about work, as if they have managed to sort their lives out and are happily getting on with things, they feel real despair at having a label put on them as unemployed and therefore having no useful role to play in Great Britain today.
  10.17 am
  Ms Angela Eagle: I support many of the comments that have been made today. It is important that we have been given the chance to debate the extremely interesting and thoughtful report from my hon. and learned Friend the Member for Leicester, West (Mr. Janner), who chaired the Select Committee on Employment, on which I had the honour to serve.
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  The report contains certain recommendations, but the Committee considered in detail some of the things that we thought that the Government should consider given the persistence of mass unemployment in this country. When we considered mass unemployment, one thing of which we were well aware was that it includes an increasing number of the long-term unemployed. Many of the policy prescriptions that we considered were not aimed at people who go through a short period of unemployment and then move back into the labour market. They clearly do not need the same support and help as those who become long-term unemployed, in a labour market in which the pace of change accelerates ever more rapidly, when the skills that they may have had become obsolete when they have been away from the labour market for a long time and lost much of their confidence.
  The evidence that we took suggested that employers regard the long-term unemployed with suspicion, because they know that they have been away from the labour market. They are increasingly reluctant to hire such people, to whom our report paid particular attention. The Right to Work Bill—so ably supported by my hon. Friend the Member for Birkenhead (Mr. Field) and the hon. Member for North Norfolk (Sir R. Howell)—is one way of dealing with the problem, and many other ways are suggested in the report. One suggestion is the intermediate labour market—a halfway house mixing education with training in work experience. The Wise group in Edinburgh gave us some impressive evidence about that. It is a practical way of reattaching people who have become detached from the labour market, giving them back their confidence and reskilling them.
  As the report points out, there are no panaceas, certainly on the supply side. There is only so much that we can do to return our labour market to its full capacity. Training and work combinations of the kind suggested by the Wise group are not cheap, but we believe that in the end they are very effective in getting rid of persistent long-term mass unemployment.
  When taking evidence, we were struck by the Government's extraordinary reluctance to give us a basic statistic. We wanted to know the cost of keeping more than 2 million people—at some points in the past few years, the figure has risen to 3 million—permanently or semi-permanently on the dole. When we took evidence from the then Secretary of State for Employment, she told us that the cost was approximately £9,000 per head. Appendix 1 of the report gives our best estimate of the cost of mass unemployment—£8,400 per claimant—and we calculate that the total cost to the Exchequer is £24,000,315,000. That is a good deal of money, which is currently being wasted on passive support.
  We must be able to do something more active and innovative—something that is more likely to return people to the labour market. The Government should not simply condemn the thousands of long-term unemployed in Wallasey—some of those whom I have met have been unemployed for 15 years, and have little chance of returning to the labour market as things stand-to continuing unemployment. Nor should the Government blame them for their predicament. That has been the Government's other main response: they have made benefit more conditional, telling people that they must do more in order to qualify, such as sending out CVs for jobs that do not exist.

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  Of course it is important to teach people how to write CVs; of course it is right to try to motivate them to search for jobs. But it is also important to make them employable—to equip them so that they have a reasonable chance of finding work, rather than forcing them to send out endless streams of CVs with no hope of ever succeeding. Having to deal with that kind of rejection is even worse than simply being stuck on the dole.
  We want a much more innovative, caring and realistic approach to solving the problems of long-term unemployment than the Government have adopted. The report asks them to consider such an approach. We want them to pay special attention to the plight of the long-term unemployed, and consider how they can be reattached to the labour market. We have heard numerous arguments about the substitution and "deadweight" effects of job creation schemes, and I expect that we shall hear some from the Minister today, but such arguments do not apply nearly as much to the long-term unemployed as they might to someone who has only just lost a job and is still relatively close to the labour market.
  I hope that the Minister will devote particular attention to that group, and will tell us what the Government plan to do to return them to a labour market from which many have been absent for a decade.
  10.24 am
  Ms Roseanna Cunningham: The Scottish National party welcomes many elements of the report. We especially welcome its emphasis on the long-term unemployed, to which a number of hon. Members have referred. Most of us agree that that is where the biggest difficulty arises, in terms of the lives of such people and the need to return them to work.
  While I accept that the workstart programme has had some beneficial effects, I note that the Employment Committee was equally clear about the fact that it has not created many new jobs. Ultimately, it is the creation of new jobs that will solve the problem; workstart is only a partial solution. The Committee stresses the importance of training in employment, and the Scottish National party supports the idea of a national apprenticeship scheme, which would go some way towards achieving such a system.
  We also support the Committee's second main recommendation. It calls for a full financial report on the effects of workstart, and for a much wider assessment that would include figures relating to the number of people who have remained in employment after the one-year workstart period. That ought to be the measure of long-term success.
  We believe, however, that the key recommendation is the rather more controversial suggestion of a pilot scheme to try out the right to work-workfare principle, based on the Right to Work Bill. I shall say more about my party's views shortly, but let me say at once that the SNP is opposed to workfare in principle. We should need to look closely at any suggested pilot scheme. Words can be used to mean very different things, and I am concerned about some of the language in the report. There is talk of the pilot scheme being based on the 1995 Bill, but I am not sure what that will mean in practice.
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  For example, a crucial part of the Bill was the removal of any real choice. Those who refused a job would be entitled to only a quarter of the payments available to a person who was making himself available for work. I am not sure how that squares with the Committee's insistence that compulsion will not be necessary. It is, I think, agreed that most of the evidence suggests that compulsion is not a good idea.
  Sir Ralph Howell: Surely we have reached a point at which we must choose between the right to be unemployed and the right to work. The hon. Lady and her party will have to make up their minds about what they want. I believe that, while the right to work would constitute a big step forward, defending the right to be unemployed is unacceptable.
  Ms Cunningham: It is not a question of a right to unemployment. Of course everyone has a right to work, but the balance is changed considerably when an element of compulsion is introduced. In its evidence to the Committee, the National Council for Voluntary Organisations opposed any compulsive element in workfare, which it considered would ultimately have a detrimental effect on the whole attitude of the unemployed, especially their motivation and approach to learning and training. It might also have a detrimental effect on the labour market: employers might not be keen to take on reluctant workers, feeling that people were not there because they wanted to be there. Ultimately, it would encourage job substitution.
  The 1995 Bill defined useful employment, which could not be refused without severe financial penalty, as caring, environmental or minor infrastructure work. Will that definition be the basis of the pilot scheme? If so, what sort of jobs will be covered? If they are associated with work that ought to be done anyway, they should be available not just in connection with the pilot scheme. The 1995 Bill also sought to abolish the right to income support and unemployment benefit after an initial three-year period, with persons not in employment having to register at a work centre. That gives rise to the issue of payment at £3 per hour, which effectively becomes the minimum wage. My party supports the minimum wage but, unlike Labour, we are not prepared to duck how much it should be. We do not regard £3 per hour as civilised and would not support a measure based on that amount. We approve the figure proposed by the Scottish Trades Union Congress and the TUC for England and Wales, which is in the region of £4.10 per hour.
  The 1995 Bill made an inadequate attempt to provide for parents, as it covered only parents of children under five years of age and a gross income of no more than £120 a week—not conditions to which we should agree, as they would cause great hardship.
  Any success with workstart appears to be limited to the short term. Real employment must take the form of new, long-term jobs. The Wise group's intermediate labour market is welcome but will require sustained, consistent and prolonged Government investment—and that has not been forthcoming. A policy of full employment should not be discarded as being unattainable. If that objective is taken together with job creation, one could devise a

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  fundamentally different approach to unemployment that would contrast sharply with present Government policy—which, in many cases, merely creates unemployment.
  Mr. Forth: Will the hon. Lady tell the House what she means by full employment?
  Ms Cunningham: There will always be structural unemployment, when a person chooses to leave a job to go to another and may be unemployed for a few weeks in between. There is no reason for the high number of unemployed people and lengthy unemployment that exist today.
  As a first step, the transfer of housing capital debt to central Government and the release of funding for house building and renovation would immediately create work in the construction industry. Government policies that produce unemployment include privatisation, as with job losses in the gas industry, market testing and local government reorganisation. The abolition of wages councils should have led, by the Government's own logic, to employers taking on more workers, but that has not happened.
  The emotive language used when debating the right to work-workfare is misleading, with constant references to the unemployed being paid to remain idle and the underlying assumption that most of them do not want to work. That is not my experience. The majority of unemployed people want to work but there are no jobs for them. It is significant that the Government decided last year to scrap the separate Department of Employment and to merge it with the Department for Education. Nowhere in the right to work-workfare proposals is there an assessment of the short-term and long-term needs of commerce and industry in respect of employee skills.
  The Scottish National party supports as positive approaches the principle of lifelong learning and specific proposals such as an integrated training and employment scheme. We see no long-term solutions from the present Government.
  10.35 am
  Mr. Ernie Ross: As I know that my colleague on the Committee, my hon. Friend the Member for Manchester, Blackley (Mr. Eastham), wants to speak, I will be brief.
  I suppose that in the preamble to his speech on the constitution tonight, the Prime Minister will indicate changes to parliamentary procedures that may give right hon. and hon. Members more time to consider measures before they come before the House, which would be welcome. All members of the new Education and Employment Select Committee were shocked that we managed to convince the Government to debate workfare. Other Select Committees will be keen to ensure that the hard work that they put into their reports will be recognised by the Government as a useful part of the democratic process and will be the subject of debates in the Chamber.
  Although I do not know what will be the Minister's response to the debate, judging by his interventions we can guess that it will be negative. The Government reject not only the report's proposals but consistently criticise the performance of existing programmes that they initiated, such as workstart and the Wise project. The then
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  Employment Select Committee was denied information by the Government, who denigrate schemes but offer no analysis as evidence to support the claim that workfare would not work. I refer not only to answering the famous question, "Is the cost of an unemployed person £8,000 or £9,000?" At one stage, the Secretary of State argued that a price could not be put on keeping someone unemployed because one would have to know the value of the job to which the individual could go. The Government were saying, "Social security scroungers do not want work but just benefits. They are a burden on the nation. Not only are they responsible for being in that position because they are unskilled and untrained, but we do not even class them as people. We do not know whether there are jobs for them to go to, so we cannot estimate the cost in respect of the individual and his family." The Government would be more believable if the Minister could provide an analysis of the workstart and Wise projects, which we failed to elicit from the Government's evidence to the Committee.
  The hon. Member for Perth and Kinross (Ms Cunningham) said that the Scottish National party would view with concern any attempt to introduce workfare. Members of the Committee followed in the footsteps of the Secretary of State and went to the United States, which is the home of workfare. Despite the fact that the Committee split into small groups and scoured America, at least for the few days that we were there, we could find no evidence of workfare. Even the most Republican-minded right-wing states that tried to get people back to work discovered first, that people actually wanted to work, and secondly, that it cost money. Many of the unemployed in America, as in Britain, are women, so child care facilities were needed.
  The message that we brought back from America is that there is no financial short cut to getting people back into work and that if we want to encourage women back into work, we have to provide child care facilities. Given the Minister's most recent performance before the Employment Committee, I do not hold out much hope that he will announce plans for child care in his speech today.
  The report has been a worthwhile exercise, if only to bring to the attention of the wider population the fact that there are alternatives—Government-funded alternatives. I do not know just how many schemes the Government have started but then stopped before they have had a chance to make any impression. The Government will not convince the Opposition or, indeed, the hon. Member for North Norfolk (Sir R. Howell), that they are taking the right approach. Unless they are prepared to put their money where their mouth is and do an in-depth analysis of the success or otherwise of those schemes, the argument about the need for the Government to be pro-active in the labour market will continue.
  10.40 am
  Mr. Ken Eastham: When we embarked on our study, which lasted 14 months, many members of the Select Committee already understood many of the factors involved, so there are no shocks in many of our conclusions.
  I want to nail the folly that is evident in this Chamber almost every week, when members of the Government boast about low pay as though that is good for the workers and good for the nation. People know, in their heart of

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  hearts, that that is not true. If people do not have purchasing power, they do not buy clothes, furniture or houses; there is a general rundown as a result of those poverty payments.
  As was pointed out to me some years ago, when there was slavery in America at least the slaves were fed. Today, some working people in Britain receive such poor pay that they are denied a decent diet. Doctors talk about the malnutrition among the very poor in our society. [Interruption.] I wish that, on occasions, the Minister would be a little more serious when dealing with unemployment matters. He seems to think that it is a gala day and he just sits on the Bench laughing. He does not take seriously the misery of the unemployed. Oh, the hon. Gentleman suddenly looks up with great concern, but it is rare that he looks serious when we are discussing a serious matter.
  I want to raise a point about jobcentres. Perhaps the Minister would stop grinning for a moment. I want him to raise some of our concerns with the managers of jobcentres. I wish that this debate was televised so that 20 million people could see how the Minister is behaving; then he would get his ticket at the next general election.
  During the past fortnight, I heard of the case of a man who had been out of work for months and was desperate to find a job. He went to a jobcentre, took a card advertising a vacancy and went to see the firm involved. He worked for it for two weeks, but never received any pay. He went back to the jobcentre but was told, "We gave you a card and you got a job." He is now on crisis loans because he cannot even get back on to benefits. He is living hand to mouth. I wrote to the manager of the jobcentre, but was told that his job was only to put a card on the wall and that he was not responsible for what happened. Somebody must take some responsibility. I believe that both the Government and jobcentre managers have responsibility.
  Bogus jobs are being advertised. I can tell the Minister that I will be giving this case some publicity—[Interruption.] The Minister is a bit of a clown, sitting there puffing and blowing. It is an absolute disgrace that, although he is the Minister with responsibility for employment, he is scathing and casual about a serious matter that the House is debating for just an hour and a half.
  It is a great myth that people do not work. People have been saying that for years, but over that time it has been shown quite conclusively that people desperately want to work. Being unemployed causes great misery. The workstart project referred to by the hon. Member for North Norfolk (Sir R. Howell) has some merit and we have seen one or two such schemes. It has certainly led to new thinking about what the Government could do. It is interesting to note that even the Confederation of British Industry said that employers could help to improve the skills match through work experience. That is commendable. No one could say that the CBI is a supporter of the Labour party; basically, it supports the Conservative party. However, it is singing the same tune as the Labour party and the hon. Member for North Norfolk.
  I want to say a great deal more, but I realise that my time is up. I am grateful for the five minutes that I have had.
  10.45 am
  Mr. Ian McCartney: On behalf of the Opposition, I welcome the report "The Right to Work/Workfare". I give a commitment that if, after the next general election, I am the Minister responsible for employment, I will take the report out of the bucket, dust it down and give a rather more adequate response to its recommendations.
  Time does not allow us to deal appropriately with all the issues raised both in the report and by the hon. Member for North Norfolk (Sir R. Howell) in his Right to Work Bill. However, despite the inadequate time, it is important to set out clearly a range of issues on which the Labour party has given commitments. The nation's most important capital asset is its people—their knowledge, skills, endeavours and commitments. Under this Government, over a decade and more, a mass of talent has gone to waste. Since November 1990, when the Prime Minister took office, 11 million people have been unemployed at least once. Since the last general election, 8.7 million have been unemployed at least once. In my region, the north-west of England, 1 million people have been unemployed at least once since the last general election.
  The numbers of long-term unemployed do not move down consistently or dramatically. Once a male becomes unemployed, he usually becomes long-term unemployed. Under this Government's training packages, it is almost impossible for him to return to a meaningful job. Of those who do manage to return, 50 per cent. are out of work again within a year. Last year, more than 400,000 of our fellow citizens who became unemployed but found another job were unemployed again by January this year.
  It is not just a matter of losing a job; having lost it, it is almost impossible to find another one. When people do find jobs, they are usually short-term, insecure and part-time. Nine out of 10 new jobs created in the economy fall into that category. About 1 million full-time jobs have been lost since the start of the recession. Those jobs, in the main, have been replaced by part-time, insecure and low-paid work. It is no wonder that the country feels insecure when people have a one in three chance of losing their jobs. In the first quarter of this year, more than 50,000 jobs in manufacturing and in the key sectors of the construction industry were lost and there will be further losses between now and the end of the year. Yet despite those statistics, the Government say that the recession is over. The truth is that no one's job is secure; no one has the certainty of continuing employment.
  The Government's deregulation policies have failed dramatically. They have failed in respect of our European competitors as we lag behind them in investment, training and competitiveness. We lag behind them also in our ability to develop our economy. There is a lack of capital investment in key sectors of the economy.
  Let us take the construction industry as an example. It is incredible that, at a time of the highest level of homelessness for 30 years, more than 250,000 building workers are languishing on the dole. Capital assets worth £6 billion are locked in local authority bank accounts, yet the Government will not allow their phased release so that construction and infrastructure projects can go ahead, the construction industry can get back to work and public and private sector incentives to restructure the economy and our capital infrastructure can be provided. It is simple

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  common sense to bring together those capital assets with people who are unemployed to create the types of jobs that we need in the construction industry. That is just one practical example of the significant steps that could be taken.
  The Government have staggered from despair to counter-despair in trying to massage unemployment figures and the withdrawal of resources from training budgets. We are spending more than £1 billion less on training than we were at the start of the recession and 600,000 young people are in neither full-time education, nor training, nor employment. They are on the margins of society. Yet what do the Government offer? They offer pilot project work—not for 600,000 or 30,000 people, but for a mere 6,000. Eight weeks after the scheme was supposed to start, the Government still cannot tell us about contracts in relation to trainers: who is training, what type of work is it, and what access is there to pilot job opportunities?
  In setting the contracts for the scheme, it seems that the Government are reducing the resources. In doing so, they are refusing access to training as a component of the pilot projects. The Minister smiles, but I hope that he will jump up in a moment to give me the answer that he has been unable to supply for the past eight weeks. If he does, it would be better late than never and I would congratulate him on doing so. The pilot project is supposed to be at the heart of the Government's drive to give people access to the labour market. Yet, in the contracts, which are to be announced, there is no training element. That is a complete nonsense. The work provided is skivvy labour, and there is no intention of promoting and developing real jobs.
  We should consider the plight of young people. They are living in communities scarred by unemployment, where one in five non-pensioner households have no working member. Their self-esteem has been destroyed, they are living on the margins of society, and there is involvement in crime, drug and alcohol abuse and sexual exploitation. That should not be our young people's experience as we approach the millennium. They should be part of society, not forced to its margins. There should be community and peer support, a sense of belonging, access to social facilities, vocational guidance and support, training and jobsearch, meaningful links with responsible employers, work experience, job opportunities and the ability to move in the wider labour market to seek out better job prospects.
  My hon. Friends the Members for Dunfermline, East (Mr. Brown) and for Sheffield, Brightside (Mr. Blunkett) recently proposed a comprehensive set of fiscal incentives to help the long-term unemployed and young people, which I commend to the House. They are priorities for an incoming Labour Government.
  The Select Committee report is correct in its analysis about the failure in the United Kingdom labour market to provide access to long-term job opportunities. The Government have two choices: to continue to tax for failure to pay the huge benefits bill, or to begin investing in success. We need a Government who are committed to the latter, and to the provision of training and retraining opportunities, access to the labour market for the long-term unemployed and job security through training for young people entering the labour market for the first time.
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  The Government have a role to play with employers. They cannot stand idly by and allow the market to determine that we have a pool of long-term unemployed people of—depending on the cycle of the economy—between 2 million and 3 million. They are prepared to allow 500,000 people at any one time to live on the margins of society. The Government have a responsibility. If they will not take it, they should move over and let in a Government who will.
  10.53 am
  The Minister of State, Department for Education and Employment (Mr. Eric Forth): This debate has been light on Members and heavy on cant and nonsense, which I suppose is no surprise given its nature. I counted as many as six Labour Back Benchers crowding the Chamber for a debate to which they claim to attach such importance. I counted one hon. Member from the Scottish National party and one Liberal Democrat. I say that because—[Interruption.] I have touched a raw nerve with Opposition Members, and so I should. Anyone who takes the trouble to read Hansard might think that, given the amount of emotional claptrap that we have heard from Opposition Members, the debate concerns many of them. I want the record to stand: ix Labour Back Benchers were present.
  I experienced a brief moment of excitement when the hon. Member for Makerfield (Mr. McCartney) talked about Labour party commitments. He began with a rousing commitment and I made a note of his words. He said that, in contrast to the Government's response to the Select Committee report which we are discussing, his party, excitingly and dynamically, would
  "give a…more adequate response".
  That is new Labour with knobs on if ever I saw it.
  We are in exciting new territory in responding to all the problems that Labour Members have been ranting about this morning. The hon. Member for Makerfield said that he would list the Labour party's commitments in order to deal with all those problems. I am still waiting. I am being generous in saying that I counted one and a half commitments. The half that I identified was what I assume was a financial commitment—which I also assume the hon. Gentleman has agreed with the hon. Member for Dunfermline, East (Mr. Brown)—to increase training budgets. He did not put a figure on the commitment, so we shall have to hold our breath to see what will happen. We await a further episode to hear the commitments.
  By the way, the hon. Member for Makerfield does not read his post very closely, because I wrote to him yesterday giving him the answer to the question that he reasonably asked about the providers of contracts for project work. I will not delay the House or use up even more of the very short time that I have available except to refer him to my letter of yesterday that gives him the information that he wants.
  Uncharacteristically, the hon. Member for Birkenhead (Mr. Field) of all people made a rather infelicitous reference in which I am sure he said—we shall check the record—in passing that there had been an increase in unemployment in all our constituencies. That sparked me into looking at the movement of unemployment in the constituencies of this small but dedicated handful of Members who are present. I find that unemployment since

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  December 1992—[HON. MEMBERS: "1979."] I did not hear the hon. Gentleman say 1979, but I shall happily talk about that. We all know that unemployment across Europe is significantly higher than in 1979 and that this country is performing a lot better. If I had more time, I would go into that at some length. I want the record to show that unemployment has fallen in Birkenhead by 1,300, in Makerfield by 1,300, in Leicester, West by 1,300, in Wallasey by 1,200 and in North Norfolk by more than 1,000.
  The hon. Member for Wallasey (Ms Eagle) referred to increasing numbers of long-term unemployed people. That is also an inaccurate statement. I shall be charitable by referring to International Labour Organisation figures—hon. Members will not often hear me quoting them, but for this purpose I shall, since Labour Members find them more attractive—that show that long-term unemployment has fallen over the past year from 43 to 40 per cent. and the claimant count has fallen by more than 500,000 since the mid-1980s. The debate has regrettably been characterised by some inaccuracies from Opposition Members, on which I hope they want to reflect.
  The hon. Member for Perth and Kinross (Ms Cunningham) trotted out the glib phrase about the concept of full employment which is frequently heard in these debates and on which we should dwell. Opposition Members have implied that, somehow, everybody could have a job if only the Government of the day did something different. There is no evidence from around the world to support that. Even in Japan, unemployment is 3 or 4 per cent. and rising. In the United States, it is 5 per cent. and steady, and in France, Germany and Italy, the countries most admired by Opposition Members—our partners in Europe whose models they would adopt—the unemployment rate is 11 or 12 per cent.
  Mr. Ian McCartney: Will the Minister give way?
  Mr. Forth: I cannot give way, because I am running out of time.
  Opposition Members promote the idea of full employment without mentioning a number or a quantity. They should pursue that argument only if they are prepared to say exactly what they mean.
  Mr. Frank Field: What about the report?
  Mr. Forth: The hon. Gentleman should simmer down. I agreed to restrict my remarks to allow Opposition Members time to speak. That is what I have done. I am now replying to the points that were made in the debate. I know that is old-fashioned, but I thought that I would make an attempt.
  Mr. Deputy Speaker (Mr. Michael Morris): Order.

  Private Finance Initiative
  [Relevant documents: Sixth Report from the Treasury Committee of Session 1995–96 on The Private Finance Initiative (House of Commons Paper No. 146), and Fourth Special Report from the Committee containing the Government's Reply thereto (House of Commons Paper No. 513).]
  11 am
  Sir Thomas Arnold: I am grateful for the opportunity to debate the sixth report of the Treasury Committee on the private finance initiative. Let me begin by thanking my hon. Friend the Financial Secretary to the Treasury for his recently published response. I welcome the fact that he has taken a number of the points that we raised very much to heart.
  It may be for the convenience of the House if I briefly explain the background to our report. The private finance initiative was launched in 1992. Its early progress was slow and in our report on the 1994 Budget we noted that it had failed to encourage significant private investment and expressed concern that it was unclear whether it was intended to supplement or to replace public expenditure. When conducting our inquiry into the 1995 Budget we recognised that our concerns had not altered, which led us to decide to undertake a short inquiry into the PFI.
  The Committee identified six issues: additionality, the control of public spending, obtaining value for money, the bidding process, the transfer of risk and accountability. I shall deal with each in turn.
  It is clear that at the start of the PFI spending was regarded as additional not substitutional, but its substitutional character has increasingly come to the fore. That has raised a number of important questions. For example, if a scheme expected to be funded under the PFI failed to attract sufficient funds, would the deficit be met from the public purse? How would the priority of the projects be determined—by an assessment of need or by the availability of funding?
  A key feature of the PFI is that the public sector contracts to buy services rather than assets. That reduces capital expenditure in the short term, but increases current spending available to purchase services in the longer term. It raises a considerable worry over the control and monitoring of public expenditure in current and future years. There is no central control over the PFI commitments being entered into by a diversity of public bodies. That was a matter of considerable concern to the Committee.
  The Government's response shows that our concern has been taken seriously and I welcome that. As I understand it—the Minister may wish to comment further on this—the Treasury will publish in the Red Book the aggregate level of public expenditure implicit in PFI deals and will monitor and control commitments under the PFI as they develop.
  The Committee identified the need for greater clarity in exactly how perceived value for money benefits accrue. For instance, it identified the relative importance of different cost savings. The Government's response identifies particular areas where value for money benefits accrue.
  The process of competitive bidding is fundamental to the success of the PFI. There was, however, a series of criticisms—at times conflicting—from private sector

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  firms about the nature and cost of the process. Some contractors felt that the specifications for projects were insufficiently defined—although broad specifications were intended to encourage innovative bids—while others were concerned that the rigid definition of specifications prevented the scheme from operating effectively. A common concern was that tendering should be encouraged only for projects that had a high probability of materialising and should not be undertaken as a mechanical exercise, even when a PFI option is unlikely to be suitable. I am pleased to report that the Treasury has already acted to address these concerns.
  According to the Treasury, an important feature of the PFI is that it allows the proper allocation of risk so that those most able to manage the risk are responsible for it. Evidence presented to the Committee suggested that, in the past at least, that has not always been so. I invite my hon. Friend the Minister to comment on that.
  The House takes accountability very seriously. Although the PFI aims to encourage private investment in sectors previously funded by the public sector, the PFI does not eliminate public spending. On the contrary, the vast majority of PFI projects will involve some form of public expenditure. It is one of the important jobs of Parliament, through a range of mechanisms, to scrutinise that expenditure. During our inquiry, we were informed that details of PFI projects might be suitable to the constraints of commercial confidentiality. The Committee found that unacceptable, and commented:
  "We do not think that the House would or should sacrifice its rights to see any details of Government spending it sees fit."
  I conclude by referring in particular to the final paragraph of the report, where we make a series of proposals and recommendations, including the following: that a breakdown between PFI projects funded via user charges and those funded by leasing charges and future public expenditure should be published, and whether it remains appropriate for private finance options to be tested in all projects or whether some might be excluded from the outset. The Government's response outlines a series of circumstances in which the PFI might prove inappropriate.
  We propose that a demonstration of cost savings on specific projects should be provided to show how the higher cost of capital in the private sector was offset. The Government's response shows that, typically, operating savings of 14 per cent. and construction savings of 7 per cent. can be achieved compared with a publicly funded alternative.
  We recommend that full and transparent accounting be maintained, with a full statement of expenditure commitments implicit under PFI contracts, and that details of PFI projects should be published at departmental level.
  I should make it clear that, in principle, the Treasury Select Committee welcomes the private finance initiative and recognises that a huge amount of complicated detail will need to be mastered if the policy is to progress successfully. The Minister's response is a welcome start to the next stage of that process.
  11.8 am
  Mr. Clive Betts: I welcome the comments of the Chairman of the Treasury Select Committee, the hon. Member for Hazel Grove (Sir T. Arnold), who fairly reflected the areas of
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  consensus in the Committee's report and members' collective concerns about the PFI. I should like to express some more critical views of the issue, to which I hope the Minister will respond.
  I was previously a member of a local authority that was engaged in many partnerships with the private sector, so I have no philosophical or principled objection to them. I believe that partnership is appropriate where the private sector can work with the public sector to bring additional value to a project. Therefore, although my approach to the PFI is slightly sceptical, I am prepared to accept that it may have benefits if it attracts additional resources to important projects from which the public will benefit.
  Having considered the evidence and having further read the Government's response to the Committee's report, I am now cynical rather than sceptical. It is obvious mat what we have now is not additional expenditure on projects, but a replacement for what was initially planned public expenditure. There is now a substitution of funding to allow the Government to cut their public sector borrowing requirement commitments, perhaps to provide some leeway before the next election. In some respects, we are embarking on potentially the biggest deferred purchase scheme in British financial history, and it is being proposed by a Government who criticised local authorities—such as the one of which I was a member—for previous deferred purchase schemes.
  There has been an interesting shift in the Government's position in another respect. The manual on the way in which schemes are compared, which the Committee considered, states that the Government are neutral on whether the private or public sector route would be the most appropriate. In their latest response, the Government have made it clear that they believe the private finance route to be better, and that it will generally provide savings. That is a distinct shift in emphasis.
  The Government's main claim about the possibility of efficiency savings is that the private sector will produce, design, build and operate schemes and will carefully incorporate in them low maintenance costs for the future, as it will be responsible for operating those projects. If the Government are saying that the public sector is incapable of designing low-maintenance schemes, that says a lot for their procurement policies in the past 17 years. If that is the Government's complaint, it must be possible to improve the way in which they purchase in the public sector.
  One of the main reasons why maintenance problems emerge is that sufficient capital is not spent on designing better projects. All too often, that is a product of Britain's financial systems, which concentrate so much on controlling initial costs and not enough on downstream revenue implications. In that respect, the PFI is a step forward, as it enables us to look at the life costs of a project rather than its initial costs. My criticism is a reflection on the Government's financing policies of the past 17 years as much as on anything else.
  Mr. Nick Hawkins: Is the hon. Gentleman suggesting that the way in which the Treasury has dealt with the accounting of these matters in the past 17 years has differed from the method that it used under previous Labour Governments?
  Mr. Betts: I am suggesting that many people in local government will know that the regime has become an

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  awful lot tighter and more rigid in the past 17 years, which has often forced the making of wrong judgments at the beginning of projects. I welcome the Government's decision to look at resource accounting, which the Committee is considering in a separate report, and I hope that they will look further in that direction. That will be an interesting debate for the future; resource accounting may resolve some of the difficulties.
  The Government claim that savings will always be made, but the PFI is hardly cost free. The Committee heard a lot of evidence about the bureaucracy and delays in the procedure, including evidence on the Stonegrove annexe to the Royal Hallamshire hospital in Sheffield, which has been a committed priority for three years and has been in the PFI pipeline for approximately 12 months. Examples of delays were repeated in evidence given by representatives of the construction industry.
  The other day, I was reading The Mail on Sunday—a newspaper that is not normally sympathetic to the Labour party—which carried a report on the Walsgrave hospital in Coventry. The contract for the PFI scheme at that hospital ran to 17,000 pages and a cost of £500,000—just for the beginning of the project's documentation. Someone will presumably have to account for that cost, which probably will be borne by the public purse. Similar examples are repeated around the country.
  The report referred to difficulties with cost control in PFI schemes, and the Chairman of the Committee also referred to this matter. In a recent debate on the health service, we criticised the Minister for saying that the external financing limit was to be the control because it covers only the forthcoming three years. Many of the costs of PFI schemes, however, do not become apparent until at least three years after a project has been initiated. I am pleased that the Government are now setting up a proper monitoring system and that they will publish figures on the downstream commitments of PFI schemes. That is a step forward, although I would have been happier if more details had been provided.
  There is great difficulty in making accurate comparisons between PFI and publicly funded schemes. There is no up-front cost in a PFI scheme, the costs of which can be considered only on a year-by-year basis once it gets off the ground. Under current rules, a public sector scheme will always have that cost—it is a hurdle to get over. The chairman of the PFI panel, who was appointed by the Government, said in evidence to the Committee that this gave an in-built bias to PFI schemes, rather than to traditionally funded schemes. If they want to make fair comparisons, the Government must look at their approach to the control mechanisms of publicly funded schemes. I hope that resource accounting will increasingly be viewed as a better way of dealing with those issues.
  The Government responded to our concerns that we are handing decision-making powers over to private sector funding consortiums by saying that decisions on which projects go ahead remain with the Government. However, this year's Budget cut public capital expenditure by £2 billion. If a project has been identified as a priority—such as the annexe at the Royal Hallamshire hospital—but no PFI scheme is available to complete it, are the Government guaranteeing that public funding will be available to enable it to go ahead? The Royal Hallamshire
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  hospital has already worked with three firms for nearly a year, two of which pulled out at the last minute. If the Government are not prepared to give that guarantee, they are saying that schemes will go ahead only if a PFI funder is willing to complete the project. In other words, the responsibility for deciding which projects are completed will have passed to the private sector, and that is worrying. It is one of the fundamental criticisms of the scheme and the Government must reply to it.
  There are real problems with risk transfer, which is at the heart of the Government's message. They believe that as they are transferring the risk from the public to the private sector, they can stand back and any mistakes will be picked up by the private sector. Arthur Andersen's experience with the national insurance computer—and the Government's triumphant lauding of the fact that the £10 million losses will be borne by a private sector firm—will not encourage private firms to participate in similar projects. The Government should be worried about that.
  It is relatively easy to transfer risk where a private customer pays for goods or a service produced under a PFI scheme. I draw the attention of the House to the combined heat and power project in Sheffield, which is not a PFI scheme as such but a partnership scheme. Sheffield university, local shops and other private sector institutions can purchase a heat source from a partnership company. That is clear—the risk lies with a company selling its product in the marketplace. It is a lot more difficult to transfer risk when the Government are paying for that service, and they must make sure that a clear mechanism is established so that risk is really transferred to the private sector. If risk transfer takes place, there is a further problem with many such projects.
  Mr. Hawkins: Will the hon. Gentleman give way?
  Mr. Betts: If the hon. Gentleman will excuse me, I will not give way because my time is limited and other hon. Members want to speak.
  If risk is transferred, control is often transferred as well. That is a great worry and it has been raised in respect of hospital projects. It was clear from the evidence to the Committee that it is not possible to transfer non-clinical and clinical services as part of such schemes. The chief executive of Royal Hallamshire hospital at the Central Sheffield University Hospitals trust made that clear in his evidence. Further information has come from a hospital in Carlisle, where doctors have described a planned building as "more like a doss-house". That is because, to make the sums add up and ensure that, with the transfer of risk, the private sector can make its profit, more patients are being squeezed into wards. The hospital is trying to double up to make the project pay. That is a clear example of the PFI mechanism affecting the delivery of clinical services.
  Mr. Hawkins: Will the hon. Gentleman give way?
  Mr. Betts: I must continue because others want to speak.
  It is clear from the evidence that it is especially difficult to transfer risk at the end of a project, whether it be Northern line tube trains or hospital or school buildings. There is not a free market in which to have real risk transfer. At the end of the 20 or 30-year—or even

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  longer—contract all that exists is a school, hospital or tube train for which there is no other use. On the other hand, the public sector needs the hospital, school or tube trains. In such circumstances, it is almost impossible to transfer risk in any real way.
  If risk is transferred, we risk transferring control. If we start building schools through PFI schemes, and therefore transfer risk, and the operators are to be paid according to the number of pupils who attend the school, there will be a market in schoolchildren. The Government may be considering that scenario. The operators of the schools will advertise to get more children to get a bigger revenue stream. The next step would be that the operators would want to control curriculums so that they can have real control of the number of children whom they can attract. That is how elements of public policy, for which public representatives should be accountable, will pass to the control of the private sector. I am worried about that and want a response from the Government.
  I am worried about accountability, to which the hon. Member for Hazel Grove rightly drew attention. I am worried that we will be able to audit schemes only after they have happened and that we will not get proper information about them beforehand because of commercial confidentiality. I fear corruption, because of the difficult problem of intellectual property rights and the fact that the schemes that will be compared will not involve comparing like with like. I am concerned that savings will come not from efficiency but, as with compulsory competitive tendering in local government, from cuts in the pay and conditions of low-paid workers.
  The PFI and the Select Committee report raise many questions that have not been answered. If the schemes were progressing wholesale, I would be worried that the unanswered questions would cause difficulties in future. However, I am also worried because the evidence suggests that they are not progressing but are bogged down in bureaucracy and administration. The private sector is not rushing forward to put in bids for such projects. If that continues, because the PFI involves substitution not additionality, there will be many projects that the Government admit are priorities that will not go ahead. Public services will be the poorer for that. A complete rethink is needed.
  I believe in the principle of partnership: in the public and private sector working together, where appropriate and where the private sector can bring additional benefit to bear on projects. However, I fear that the PFI goes back to a problem that has existed throughout the Government's life: the belief that the private sector is good and the public sector is bad. That principle is wrong and will not deliver better public services. I hope that the Government will rethink it, and quickly, before fewer and worse public services result from their scheme.
  11.23 am
  Mr. Jacques Arnold: The speech of the hon. Member for Sheffield, Attercliffe (Mr. Betts) is a good example of how the Labour party, observing new Government policies, wants to criticise them bitterly but leaves the back door open so that when they succeed it can claim to have supported them all along and, no doubt, in a few years can tell us that they were its idea in the first place. I read the Treasury Select Committee report with interest and noticed its endorsement of the PFI as an
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  imaginative and laudable initiative. It is the latest of several detailed Government policies that the public have not generally noted amid the lurid headlines that we get in the press these days.
  The hon. Member for Attercliffe tried to make great play of projects not making progress. In the short time available, I shall draw attention to a massive project that is making remarkable progress: the £100 million Darenth Park hospital, which is proposed by the Dartford and Gravesham NHS trust. I have been the Member for Gravesham for nine years. Over that time, and for many years before, the people of Dartford and Gravesham have relied on three elderly hospitals—the Joyce Green, the West Hill in Dartford and the Gravesend and North Kent in my constituency. I became fed up with being told by the powers that be in the health service that my health district had the worst capital stock in the region while nothing was done to replace it with the modern district general hospital that we all wanted. The reason for that was simple.
  We have an excellent site at Darenth Park, cleared and ready for a hospital and owned by the NHS. The problem arose because of the old system, which is beloved of the Labour party. We had to go to my right hon. and learned Friend the Chancellor of the Exchequer with a project and say, "Please can we have a cheque for £100 million?" Inevitably, we were told time and again, "£100 million? Are you sure that you really need it? Have you done a thorough review?" Time and again, we had thorough reviews to ensure that the project was designed to use the latest medical technology and so on. The years passed by.
  We proved that we needed the hospital. We proved that the proposed technology was ideal for the future of the hospital service in north-west Kent. Then we were told that £100 million was too large a part of the capital allocation to be given in one go and were asked whether it could be done in phases. We said that we did not want three old hospitals but one new one. They were proposing three old ones and a bit of a new one. That would have involved four sites, which is impractical. We were asked why we could not build the phased project on the site of one of the old sites. Someone who suggested to one of my constituents that we should build a phased hospital over 30 years at Joyce Green, would be in physical danger of needing to go to hospital.
  The PFI is a magnificent opportunity to get the new district general hospital for north-west Kent. The Government have asked the basic question: do we need to own the hospital or do we merely need the use of a hospital with the latest state-of-the-art technology to provide hospital services to the people of the district? Clearly, the latter is the case. The NHS is not a property company, but, quite properly, is in the business of providing excellent health care to the population.
  The capital costs for hospital trusts such as that which serves my area amount to about a quarter of their running costs. If those costs could be put into the PFI, it could well provide the solution to the problem. In the middle of a major construction recession, we, quite properly, went to the market and asked it whether it could put together a proposal for a private finance initiative to build a hospital for north-west Kent, all in one, on a cleared site at Darenth Park including the disposal of the old Joyce Green and West Hill hospitals and the release of the Gravesend and North Kent for other uses in the health service.

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  Surprise, surprise, in the middle of a recession in the construction industry, we found five consortia which wanted to bid. Four of them were up to it and went on to bid. Two were excellent and they have now been invited to tender by early next month. Those two tenders will be considered carefully by the Dartford and Gravesham NHS trust, by the commissioners, the West Kent health authority, the Department of Health and the Treasury. We are looking to my hon. Friend the Financial Secretary to the Treasury and to Ministers in the Department of Health to analyse that thoroughly and rapidly in order to keep up with the programme.
  It will be of interest to the House to consider the consortia that bid for the Dartford and Gravesham hospital. They typically included a construction company, a catering and housekeeping company, an administration and co-ordination company and a financial company, working together within their consortium to put together management expertise and the critical mass to take forward such a hospital project.
  If all goes well, we hope, through the trust, the commissioning authority, the Department of Health and the Treasury, that a contract will be signed with one of the bidders by this autumn and that construction of the hospital will begin early next year. That is cracking good progress, but listening to Opposition Members one would think that nothing was going ahead. One might almost say that they hope that nothing is going ahead.
  The hon. Member for Peckham (Ms Harman), who is conspicuous by her absence in this debate, scoffed with great amusement and derision in the House at the fact that the Dartford and Gravesham proposal was in a list B, which she claimed some sneak from the Treasury had leaked to her. If a project making such good progress is in list B, the Labour party had better make its traditional conversion to Conservative policy even quicker in this case.
  I said earlier that the site of the third hospital, the Gravesend and North Kent hospital which is currently serving the local population, would be released. For my constituents, that would be icing on the cake of the brand new district general hospital at Darenth Park, because the Gravesend and North Kent site, which has been a hospital site ever since it was endowed by the Earls of Darnley in the last century, would become available for what we have long wanted in Gravesend, a community hospital, which would provide, through the Thameslink Healthcare Services NHS trust, a wide range of perhaps lower-tech services, but, above all, local services for the community. For instance, it would provide general practitioners' beds, beds for care of the elderly needing lower-tech hospital care, respite care and a wider range of out-patient departments, paramedical and diagnostic and other day care. The refurbishment and structuring for the 21st century of the community hospital in Gravesend at that site is costed at about £8 million, which the trust also hopes to advance in a PFI at that time.
  I welcome the Government's innovative PFI policy. Projects such as my own are rapidly coming to fruition. Notably, the Treasury Committee has positively and enthusiastically reviewed the details. It is encouraging that 16 or 17 years into a Conservative Government, massive new reforms and new ideas are coming forward with such
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  enthusiasm, which in this case will give reality to the dreams of my constituents—a brand new district general hospital, high tech, equipped for the 21st century to serve the people of north-west Kent.
  11.33 am
  Mr. Malcolm Bruce: I do not think that anyone is against the use of the PFI to bring forward projects in partnership with the private sector and add to the provision of public services. I do not know the circumstances of the project described by the hon. Member for Gravesham (Mr. Arnold). It may be as he describes it, but I am a little concerned that he does not believe that there are any questions about the need to ensure that we obtain the best value for money for the taxpayer, and that we are not driving the scheme simply as a means of substituting public money with private, but are trying to obtain a sum gain in terms of quality of service.
  Those should be the fundamental objective criteria by which the PFI is judged. By promoting the partnership between the private and public sectors there should be perceptible added value, either in terms of clear value for money or in terms of up-to-date technology and innovation, or, preferably, a combination of the two. Where those criteria are delivered, the PFI will have achieved its desirable objective and should be supported and endorsed. Those are the criteria that we should pursue.
  The Select Committee, of which I, too, am a member, has rightly said that it agrees with that. It believes that the PFI is innovative and that there are benefits to be accrued from it, but it has some concerns and reservations which need to be addressed. Some of us are not entirely convinced that the Government's reply is, in some cases, satisfactory, and, in one particular case, begins to address the point.
  One of the Committee's particular concerns was that the PFI was being driven by the financial constraints of the Treasury and the need to substitute committed public expenditure with PFI projects, and that that was what was driving it. As a consequence, projects might go ahead, or be forced to go ahead, for those reasons only, so not meeting the two criteria that I set out as desirable at the beginning. The Committee had some evidence that that was the case.
  It was a matter of concern to me that, in the first evidence that we took from Treasury officials only a few months ago, it was acknowledged that the criteria or the monitoring process on which the PFI was to be judged had not been worked out. That gave me the impression that it was being driven by financial considerations rather than innovation and value for money.
  I was disappointed, as was the Committee, which is why it instigated the inquiry, that the claims for the PFI, in terms of the number of projects and the value that could be delivered, were not being fulfilled, and clear problems were arising which had not been anticipated. Despite the fact that those problems were obviously arising, which is why the Treasury could not prove the schemes at the rate that the Government had forecast, the Government did not revise their forecast, or if they did they revised it upwards. Basically, 100 per cent. of the Government's new committed expenditure is to be found from a PFI scheme that has not been fully tested, evaluated or proved capable of delivering that volume.

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  I want to mention one or two projects of particular concern to me. Either we will stumble into projects which will subsequently prove to be bad value for money or, worse, may even lead to the project failing and public money being written off, or we will not achieve the committed public expenditure that the Government are claiming. The Government say that they want to build more hospitals and roads and, during the general election, they will tell everyone that that is what they will do. However, they will not be able to find the money within the normal budgetary procedure, so they will pluck it all out of the air as being delivered by the PFI, despite the fact that they know that there are not enough projects and not enough companies coming together to deliver that. Therefore, the Government know that what they are saying is essentially a lie and that they are putting a forecast that they know they cannot deliver. The Select Committee has some reason to suggest that that has some substance because the Government have to date failed to deliver their forecast promises.
  We all expect the PFI to accelerate and, if they are the right kind of projects, I shall certainly welcome them, and I believe that those of our constituents who can see benefit in them will also welcome them. But let me put from my own knowledge the sort of concerns that arise which I believe are legitimate. The hon. Member for Gravesham said that projects were going ahead out of the glare of the tabloid headlines. Perhaps they are, but yesterday, in The Herald a broadsheet, there was the headline
  "A tender moment of truth",
  referring to the announcement of the successful bids relating to Stonehaven hospital in Kincardine and Deeside. The Stonehaven hospital project is a small one, but in other ways it is similar to the project that the hon. Member for Gravesham has described—with one fundamental difference. There are two outdated community hospitals in Stonehaven, and there is wide agreement that they need replacing by one up-to-date community hospital. The difference between this project and all others is that, under pressure from the Scottish Office, the health board has been required to invite bids for the whole hospital, including the provision of clinical services. It will be the first hospital in Britain where the clinical services will be operated and managed by a private concern.
  People are right to say that this marks a significant development in the national health service. For many, it marks the beginning of the end of the NHS as we have known it. The Government have said—as a matter of agreed public policy—that when a hospital is to close and a new one is to be built there will be public consultation. The local authorities, trade unions and others with an interest have asked about the procedure for consulting on the closure of the hospital. The ministerial reply was that the Government had widely consulted among local GPs and the community about what will actually go into the hospital, so they considered the matter closed. That means that they are avoiding their statutory obligation; if they go ahead in this way they may find themselves subject to judicial review.
  In effect, the public were told that they could have the hospital on the terms proposed—with the clinical services put out to tender—or they could have no hospital. No other option was given. Indeed, the health board explored a different route with one of the local health trusts, to its
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  satisfaction, but was overruled by the health service administration in Scotland and told to issue a competitive tender.
  The private sector faces certain problems too. There were seven bidders for the hospital, three of which have progressed to the final stage. As the PFI gathers momentum, private bidders express concern at the cost of preparing bids many of which, by definition, will be unsuccessful. Companies of all sizes have expressed a clear reluctance to prepare endless numbers of tenders that will result only in lost money.
  This is not an argument against tendering: it is an argument for recognising that unless there are enough objective and competitive tenders around, companies may not be prepared to bid, as they find that costs are so high that they have no serious prospects of getting their money back.
  We shall know in a week or two who has successfully bid for the hospital. There is a widespread suspicion that the contract will go to the local NHS trust. I do not say "suspicion" to suggest that that is not what people want—it is exactly what they want—but there is a real suspicion that the whole tendering process has been a charade, with the result that the local trust finally gets the contract that it was awarded in the first place anyway; but with the waste of a year, at considerable cost, and following a diversion of a great deal of trust management time from other possible projects. They include a community hospital at Ellon in my constituency. The trust management simply did not have the resources to deal with both processes at once. When the management says that it has had to divert all resources to winning the tender for one project, it is clear that it has had to abandon work on the other. That is not accelerating such projects; it retards them.
  The Committee has also expressed its concern about the Skye bridge PFI project, which continues to cause considerable controversy in Scotland. The people of Skye believe that they are entitled to modern transportation links, of which the bridge is one part. But they were effectively told that, as a small and remote community, they had no chance of being given as much priority as a community closer to the centre would get. That is somewhat ironic; it is precisely because Skye is so far away that its people need improved transport links. The Committee report states:
  "Our specialist adviser drew attention to the fact that the Skye Bridge received the blessing of the Highland Regional Council only after the Scottish Affairs minister, Lord James Douglas-Hamilton, said that there was no possibility of a toll-free bridge for at least 20 years. This not only calls into question whether 'best value for money' was obtained but also highlights the concern that the decision to proceed with projects is determined by the funding mechanism rather than an evaluation of desirability."
  I contend that the same applies to Stonehaven, the decision on which will be announced shortly.
  My final example shows, as the hon. Member for Sheffield, Attercliffe (Mr. Betts) pointed out, that local authorities in my area are not at all averse to exploring private finance initiatives when they think that they will give rise to good projects offering value for money. They are in the early stages of exploring the possibility of building a new academy—the Garioch academy—in the heart of my constituency. In preliminary discussions, private companies are being asked whether they would be interested in bidding. They are also being asked what is

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  in it for them, what is in it for the local authority and what is in it for the people who would use the school. The only answer so far has been that the janitors would be paid less. A school does not employ a great many janitors, so the savings will not be huge. We are looking at the possibility of dual use—giving the community a recreational and sporting interest in the academy. If the local authority can use the PFI to get the school built, I have no doubt that it will do so.
  The problem is that this will take a good deal of time and there is no guarantee that the right kind of package will ultimately be found—or that anyone will want to bid. The fact remains that we desperately need the school, but we are told by the Government that there is no chance of the money being provided for it. Nor have we been given any guidance on how to find it.
  The PFI does offer innovation potential for unlocking funds and giving added value for taxpayers, and that is commendable. Our concern, however, is that the PFI may be driven by other motives—that it may be a substitute for public spending commitments that will serve only to delay projects. That will put public money at risk; or it may convert public capital projects into expensive hire purchase agreements, costing taxpayers more in the long run. The Government have responded to the Committee by saying that they intend to monitor the PFI so as to avoid this problem. I should like the Minister to spell out how the Government intend to publish evaluations of projects so that we can see where there has been success, or a lack of it. That in turn will inform those working on PFI projects, ensuring that the good ones go ahead and preventing too much waste of time and money in the case of projects that are bound to collapse.
  If we can achieve what I have outlined, in a few years' time the PFI will be seen to have made a large additional contribution to public services in this country.
  11.47 am
  Mr. Nick Hawkins: I am delighted to have the chance to speak in this short debate. I want to touch on one or two matters mentioned by the hon. Member for Gordon (Mr. Bruce)—and on some of the points raised by the hon. Member for Sheffield, Attercliffe (Mr. Betts).
  As the Minister knows, I have strongly supported the private finance initiative. I have had a number of meetings with him recently to try to help the Government's development of the PFI. I believe that using the private sector in such projects will provide the public services with better assets for the future.
  I should declare my background and my interest in this regard at the outset. For some time before coming here I was a corporate lawyer, spending some of my career in the construction sector. More recently I became the parliamentary adviser to the Building Employers Confederation.
  The construction industry, along with Her Majesty's Treasury, has played a big part in the development and the improvement of the PFI process. I shall refer to the points that the Construction Industry Employers Council—a big umbrella body—put to the Committee. The Committee's report is positive about the private finance initiative—it does not share the concerns of the
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  hon. Member for Attercliffe about the transfer of risk. He put forward his points in rather lurid terms, and I shall refer to them later.
  I hope that my hon. Friend the Minister—in addition to the Government's formal reply to the Committee—will be able to give hon. Members further reassurance today. People from the construction industry and from the legal profession who submitted evidence to the Committee believe that the bidding process should be more straightforward and simple. In particular, they believe that there should be much more use of standard clauses—not just on peripheral issues, but on major issues—to cut down the amount of documentation.
  The Committee heard evidence that the Government should, in future, seek to ensure that only those projects that are genuinely viable for the private finance initiative are put out to competition and ensure that the recently issued Treasury guidance that no more than three or four bidders be invited to produce a full tender is strictly adhered to by the public sector bodies.
  I draw the attention of hon. Members to the evidence given to the Committee by Sir Christopher Bland, the then chairman of the private finance panel. He talked about the importance of improving training for those in the public sector and about the intensive training that was provided. In answer to questions from the hon. Member for Attercliffe in the evidence session, Sir Christopher made the point that there is a need to train people in the public sector so that they understand how the private sector works—this will enable PFI projects to go forward. Throughout my career—both before and since becoming a Member of Parliament—I have always believed that it is important for the public sector to understand how the private sector works.
  A single preferred tenderer must be identified as early as possible. Everyone understands that the gestation period for most private finance deals is extremely long and involves considerable expense. Bidders are generally willing to make a significant investment if they have a reasonable chance of securing the project, but as the costs escalate they will be reluctant to continue to spend if they are still in a competitive situation—all the money may go to waste.
  Those on the public sector side, the Government side, of a possible PFI project must, at the outset, take a realistic attitude to those risks that can be transferred to the private sector. Contracts that contain unacceptably onerous conditions should not be offered—perhaps, as a corporate lawyer, I am arguing for less work for lawyers. It is important that these deals do not get snarled up in vast amounts of contract documentation and negotiations.
  Wherever possible, standard contract documents should be produced for PFI projects. This was stressed in evidence to the Committee by S. J. Berwin and Co. and by Beachcroft Stanleys, two leading firms of solicitors that have extensive experience of projects such as this.
  The hon. Member for Attercliffe mentioned two hospitals—and, as it happens, I know quite a bit about both of them. Both of my sons were born at Walsgrave, Coventry, and my father-in-law trained as a doctor and subsequently worked as a consultant at the Royal Hallamshire, which is in the hon. Gentleman's constituency. I am well aware of what is going on in those hospitals, and I understand some of the things that he talked about. In particular, I share his concern about hugely complex contractual documentation.

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  The hon. Gentleman talked about the transfer of risk and the need to try to keep things in the public sector. I refer to the unsuccessful world student games, the cost of which the hon. Gentleman—as the then leader of Sheffield city council—and his colleagues cast on to the council tax payers of Sheffield. I would have thought that he would understand that it is better if risk is transferred to the private sector and that the projects that need to be in the private sector benefit from the transfer of risk so that burdens are not cast on the taxpayer.
  I have emphasised some of the ways in which construction projects, in particular, can go forward with further help from the Government. This morning, for about an hour I met the director of a company that has been involved in PFI bids—in a totally different field, but one in which PFI projects are being considered. The one point that he emphasised was the importance of training public sector people who are involved in PFI negotiations to think like private sector people so that there can be a genuine meeting of minds. Only when that happens in every possible PFI project will we have more successes, such as the one in the constituency of my hon. Friend the Member for Gravesham (Mr. Arnold), which he highlighted this morning.
  11.55 am
  Mr. Stephen Timms: Two months ago, the Financial Secretary to the Treasury addressed a conference on the private finance initiative in the health service. Apparently, without a hint of irony, he stood before the delegates and said:
  "Many of the hospital managers here today can testify that PFI has meant that their own local scheme has finally been able to get off the ground."
  There were looks of blank incomprehension around the conference hall because the PFI has delivered precious little so far in the health service—in fact, it is in trouble. The big contracts that the Secretary of State for Health keeps announcing—he has been making announcements for more than a year—are a long way from being agreed. In March, the Treasury Select Committee established that not one of the contracts for the major schemes had been signed—and they still have not been signed at the end of June.
  Special legislation was rushed into law in an attempt to facilitate the contracts, but still nothing has happened. Only a fraction of the capital projected in the Budget last November to be spent in the health service through the PFI—as has been said, it was a justification for the substantial drop in the national health service budget—has been committed.
  The major investment projects for which the NHS is crying out are in limbo. The banks and institutions, whose money is needed, are deeply unhappy with the way in which the initiative is being handled. The handful of big projects that are said to have got off the ground are still firmly on the ground.
  I hope that the optimism expressed by the hon. Member for Gravesham (Mr. Arnold) proves to be well founded. At the moment, the bankers are not putting up the money. I caution the hon. Gentleman against putting the bunting out about the success of the project before the money is in place—the banks are currently saying no.
  I hope that the Financial Secretary will be able to explain to us exactly what the problem is with the banks. I hope that he will be able to explain why none of the
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  major health service projects has got to the contract signing stage. What steps are the Government taking to sort out the problems?
  Mr. Jacques Arnold: I believe that the Opposition's tactics in trying to oppose the National Health Service (Residual Liabilities) Bill had something to do with it. The passing of the Bill only emphasises to the lenders that the security for their lending will be protected, in terms of both the capital lending and the flow of repayment.
  Mr. Timms: I understand that that is not the reason. Perhaps the Minister will be able to give us more: information. I am interested to know why that is the case. At the moment, none of the projects is going forward.
  Before saying a little more about the PFI in the health service, I wish to make some general comments. The PFI is in trouble, and not only in the health service. It seems that no Sunday business section is complete these days without its PFI bad news story. Recently, The Mail on Sunday carried such a story, and there have been plenty of other such stories. The initiative is in trouble.
  We all welcome the use of private capital to improve public services, but the central problem is that the PFI is; being much too widely applied. It is being pressed into service when it is not appropriate and before the necessary procedures have been adopted. The PFI should be a way to lever in additional resources for public services, but it is being used to achieve short-term cost savings this side of the election. That is wrong. It is also depressing because, when the bills come in, the PFI will probably cost us more than procurement by the traditional route.
  I am pleased that the Government's response to the Select Committee report promises that data will be published on the long-term revenue commitments from PFI deals. That is progress, but the reason given for pressing the PFI into action is that private stewardship is more effective than public. Certainly, the cost of the finance is greater, because private borrowing costs more than public, so we have to believe that private management is more effective than public by a margin that exceeds the excess financing cost. To make sense of the Government's insistence that PFI should be used everywhere, one has to believe that private management of an asset is always more cost-effective than public management by a margin greater than the financing costs. The Government plainly believe that, but nobody offered any evidence to the Select Committee. The Government's response to the Select Committee contains assertions to that effect, but they are not substantiated. I am keen to see some evidence that would substantiate those claims, because they are at the heart of the case for the current version of the PFI.
  The Government have made the point that the PFI always contains a public sector, value-for-money comparator, but a false comparison has been made. The comparison is between a public sector solution and a different private sector solution. The latter may be the better solution, but nobody asks whether that solution would be more effectively procured with public sector finance and management. That is the real comparison that should be drawn, but it is not.
  Private finance can genuinely help when the creation of an asset generates a new, tangible stream of revenue which can be used to lever private capital into the project.

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  For example, the construction of a bridge, as we have heard, might bring a revenue stream in toll income and construction of a hospital may lead to revenue from car-parking charges. Those revenue streams may be used to lever an element of private sector capital into building the bridge or the hospital car park. If there is no such revenue stream, the case for private finance is much weaker. As one of the written submissions to the Select Committee suggested, there is no benefit to the economy in building a hospital with private finance rather than public if, in the end, the whole cost will be met from taxation.
  The problem is that we have lurched from one extreme to the other. Under the rules drawn up by Sir William Ryrie—who, I notice, re-emerged as a director of Barings bank, at the time of its crash, after his retirement from the Treasury—no private capital was involved at all. Under the present arrangements, private capital must be used except in what has been called the
  "relatively rare set of circumstances"
  set out in the Government's response to the Select Committee report. We need a middle course so that private finance can be used to supplement public, when appropriate.
  When the Treasury Select Committee took evidence on the use of PFI in the health service, it became clear that the initiative had run into more trouble in the health service than anywhere else. We found five major areas for concern. First, the initiative has so far had only a marginal effect on resources in the health service and capital spending has been cut in the false expectation that PFI money would replace it. Secondly, many witnesses spoke of the failure of Departments to provide clear objectives for bidders and of the excessively high cost of putting in bids that have little chance of success. Thirdly, there is clear evidence that in some cases PFI
  "has delayed rather than encouraged investment, by creating a need for testing and uncertainty over the level of public funding".
  It has also introduced huge additional bureaucracy to project initiation. Fourthly, the provision of services under a PFI contract may be liable to be dictated, not by need, but by the level of return available on a private investment lead, so leading to a health service without strategy or priorities. Finally, it is difficult to make a clear distinction between clinical and non-clinical services, but health managers have been forced to make it by the Government's express requirement that PFI should not be used for clinical operations. The omission of clinical services from the PFI is telling, because if the Government's dogma—that private sector management is always more effective—were true, clinical services should be included. They have been excluded because the Secretary of State for Health has recognised that the dogma is wrong in this case. It is wrong elsewhere, too.
  The most striking aspect of what has happened to PFI in past months is the extraordinary degree of disillusionment felt by the contracting companies about the scheme. Small companies felt excluded when the Select Committee took evidence, but one by one the big companies have now joined the attack. Mr. Martin Laing, the chairman of Laing and of the Building Employers Confederation, has said that it was frustrating how little work had emerged from the private finance initiative. In March, Mr. Laing said that the existing regime was
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  "farcical … leading to growing frustration among contract bidders about the appallingly slow rate of progress".
  In May, Bovis said that it would not tender for any more PFI road projects and refused to budge even when its representatives were summoned to 10 Downing street to explain. Taylor Woodrow said in May:
  "everything is slow, the bidding costs are high and we haven't had any tangible results yet. We are still to put a spade in the ground on a PFI project."
  This month, it has been revealed that W. S. Atkins is to stop bidding for PFI health care projects. With Trafalgar House, it has pulled out from the Central Sheffield University Hospitals NHS trust, leaving only one bidder in the frame.
  I am disappointed by the Government's flip and superficial response to our report. It is a good report, which the hon. Member for Hazel Grove (Sir T. Arnold) summarised well earlier in the debate, and it deserves a more considered response from the Government. Without one, the bad news from the PFI will continue.
  12.6 pm
  Ms Diane Abbott: I welcome the opportunity to speak in the debate. I wish to apologise because I was not here to hear the distinguished Chairman of the Treasury Select Committee introduce the debate, but I am sure that he did so with his normal distinction and aplomb.
  Everybody on the Treasury Select Committee, regardless of party, welcomes the use of private sector finance for public sector projects in principle, but we wish to flag up the problems. I shall deal with three issues this morning: first, whether PFI represents additional money or is simply a substitute for public expenditure; secondly, whether PFI is suitable for the full range of public sector projects; and, thirdly, the challenge PFI poses for the public's ability to monitor public finances and expenditure.
  On the first point, the Select Committee has noticed conflicting positions from Ministers. In his 1994 Budget speech, the Chancellor said:
  "The growing importance of private finance has helped us to find significant savings for the taxpayer in the transport programme."—[Official Report, 29 November 1994; Vol. 250, c. 1085.]
  But the Chief Secretary, in his evidence to the Select Committee, said:
  "Private finance is genuinely additional."
  Which is correct? Is PFI about savings for the taxpayer or is it about additional money?
  My second point is whether PFI is suitable for the full range of public sector projects. When the Select Committee began its inquiry, the standing instructions from the Treasury were that every public sector project had to be examined for its suitability for PFI. People in the public sector complained about that and the bidders and contractors said those rules were ridiculous because time was wasted considering unsuitable projects. It is clear from the Select Committee's inquiries that PFI is probably most suited to projects with a natural revenue stream and it is least suited to publicly sensitive projects such as the health service.
  We want private sector money to be used to solve existing public sector infrastructure problems. Decisions about the way in which we spend money and what is built

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  must not be distorted by the PFI. The House of Commons must take decisions about our public sector infrastructure priorities and then look to the PFI—the PFI should not drive our public sector building and infrastructure programme.
  It is clear to the Committee that future PFI commitments are being entered into across a range of Ministries without any central monitoring. In a sense, PFI embraces the "buy today, pay later" approach—it is a form of hire purchase. We are concerned about public finances and we believe that the Government are not paying enough attention to central monitoring and to keeping control of the taxpayers' long-term financial commitments.
  The Committee members support PFI in principle, but we believe that its applicability is much narrower than the Government claim. In fact, the PFI's applicability is probably restricted to those areas that my right hon. Friend the Member for Kingston upon Hull, East (Mr. Prescott)—who introduced the forerunner of the PFI—set out in his original ground-breaking speeches on the subject.
  12.10 pm
  Mr. Mike O'Brien: I congratulate the hon. Member for Hazel Grove (Sir T. Arnold) and the members of the Treasury Select Committee on a very good report about an issue of enormous importance. I assure my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) that the Chairman explained the report with his usual distinction and aplomb.
  The report contains many forceful criticisms of the private finance initiative that the Government must address. The Chairman set out the main concerns succinctly: additionality or substitution, the transfer of risk, accountability, the bidding process, value for money and public expenditure control. The Committee decided to undertake the inquiry after I ceased to be a member of it. However, I was a member of it for 18 months, and in our report on the November 1994 Budget we noted that the PFI had failed to attract significant private interest. We expressed concern about whether it was supposed to provide substitute or additional funding.
  In the present report, Committee members—apparently without controversy—say:
  "We continue to see PFI as an imaginative and very laudable initiative to attract private capital into areas into which it has not before previously been drawn."
  Labour shares the Committee's welcome for the PFI in principle, as did the hon. Member for Gordon (Mr. Bruce) on behalf of the Liberal Democrats. Indeed, that principle enjoys broad support. However, we share some of the Committee's concerns about the way in which PFI is operating and we agree that a number of important issues must be resolved.
  Before I respond directly to the report, I shall set out Labour's general view about public-private partnerships and the PFI. In politics, new ideas tend to meet with the same pattern of response: at first they are dismissed, then they are embraced with a zealotry that is out of all proportion to their worth and then they settle down to the recognition that they are much less valuable than the zealots thought but, none the less, are of considerable worth.
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  In the 1980s, the old Ryrie rules introduced phase 1. They restricted the ability to apply PFI and the whole idea was greeted with suspicion. The Government have now entered phase 2, with the Financial Secretary perhaps the zealot incarnate of PFI—a description that I suspect he would not deny. He has abandoned the reality of public finance and believes that the PFI is the answer to all the Tories' financial problems.
  It is partly ideology and partly desperation that drives the Treasury to reduce public spending. It thinks that the PFI is an all-purpose Tory life raft for public capital spending. When the Government sink, the Financial Secretary will realise that he was wrong. As befits the party of the future, Labour has already reached phase 3, but we appreciate that the PFI is not the answer for all public capital projects. It is an alternative, useful and often attractive source of finance in particular circumstances. It should be used where appropriate, but it cannot be a substitute for public spending on all capital projects.
  We support the principle of joint public and private sector investment; indeed, many Labour-controlled local authorities have pioneered such investment. Joint provision will become increasingly common in the future. It will be an important part of our policy and the driving forward of such ideas will be a key aim of a Labour Treasury. A partnership between the public and private sectors can enhance public provision by introducing new sources of finance and expertise. However, there are key distinctions between the way in which the Labour party and the Conservatives approach PFI.
  The Conservatives seem to be dawdling in the same old ideological rut—the mindset that private is always best. Labour has set aside the old ideological battle lines between the private and public sectors. We recognise that those sectors can complement each other: there are things that the private sector does best and areas where public sector finance is more appropriate. In some cases, a combination of public and private sector provision is necessary. Joint provision is often appropriate in areas such as savings provision, training and investment in infrastructure.
  Labour will adopt a practical approach to those issues. Our primary concern is to ensure that the public get the best possible provision of services and the best value for money. In many ways, we are moving beyond the old concept of the mixed economy. Public and private provision are increasingly interlinked. Under the classic mixed economy, a certain percentage of ownership was in public hands while another percentage was in private hands. We are developing beyond that point. In some cases, it is possible to harness the best of both worlds—the two sectors are being fused.
  Mr. Hawkins: Will the hon. Gentleman give way?
  Mr. O'Brien: No, I am afraid that I am short of time.
  Public-private partnerships can play a key role in that context. For years, Britain has suffered from under-investment in its economic and social infrastructure. The poor physical condition of the nation's public buildings, transport facilities and communications bear testimony to the need for investment. Jobs need to be done and there are people ready to do them. Businesses are keen to have new opportunities to ensure that the work will be completed and the profits gained. The Government

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  must set out their clear priorities and establish a framework within which that investment can be made. Only the Government can put that framework in place and set strategic priorities. The public and private sectors could work together in that way, but unfortunately the Government are failing in that task.
  Labour shares the concerns expressed by the Treasury Select Committee about the Government's general approach to the PFI. We are worried that the Government's projections regarding the value of PFI projects may be over-optimistic. The Government predict that the PFI will increase from £600 million in 1995–96 to £1.9 billion in 1996–97 and to £2.6 billion in 1997–98. We also agree with the Committee—and with my hon. Friend the Member for Sheffield, Attercliffe (Mr. Betts), who set out his concerns in an excellent speech this morning—that the Government are treating the PFI as primarily substitute funding. In paragraph 7 of its report, the Committee states:
  "It is enabling the Government to cut capital budgets in future plans."
  That may be valid in some circumstances, but it was hoped that the PFI would provide private capital that could be added to public money to widen and improve public sector services. In paragraph 6, the Committee correctly says:
  "If there is a serious shortfall in the PFI projections it will be difficult to provide money from public capital budgets to fill the gap."
  It remains to be seen whether the Government are being over-optimistic and whether there will be serious shortfalls. If that occurs, the Committee's warning will have been timely and it will serve as a useful reference point for assessing the Government's performance on PFI.
  The Government's attitude to the PFI has been criticised by Adair Turner, the director-general of the Confederation of British Industry, who said:
  "The pressure to achieve public expenditure cuts is ferocious, the capital expenditure budget looks an attractive target and the PFI is seen as a justification for major cuts."
  Last September, the Building Employers Confederation claimed in its Budget submission that the Government's decision not to approve capital projects until private finance options had been explored had led to a
  "serious hiatus in the placing of public sector construction orders."
  Those concerns have been reinforced in a number of sectors. The Government's "buy now, pay later" approach to the PFI raises serious concerns for Parliament. The Treasury Select Committee report presents an alarming array of evidence regarding the Government's cavalier approach to the PFI.
  Mr. Jacques Arnold: But you are in favour of it.
  Mr. O'Brien: Yes, we are in favour of the principle, but we dispute the Government's cavalier approach. That is a serious problem. [Interruption.]
  Madam Deputy Speaker (Dame Janet Fookes):Order. There is an unattractive chorus emanating from the Back Benches. I ask hon. Members on both sides of the House to keep quiet.
  Mr. O'Brien: I am grateful to you, Madam Deputy Speaker.
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  To some extent, the Treasury's response to the Select Committee must be welcomed, because it acknowledged the nature of the problem of monitoring and promised that it would seek to monitor commitments to
  "safeguard against an imprudent build up of liabilities in the future which might impair a future government's ability to change spending priorities, reduce spending in a given area or to deliver the relevant services in another way".
  Yes, and about time, too. The Treasury should have realised that an awful long time ago. However, it then goes on to say:
  "The precise details of the control regime would be individually negotiated between departments and the Treasury".
  It is unclear precisely what that means. It seems that the Treasury has changed its hands-off approach evidenced in earlier documents to the Committee, but it does not appear that it has any effective controls in place to ensure that the PFI is delivered within reasonable public expenditure controls. That is clearly inadequate, and the Financial Secretary's apparent response to the Committee—"It is better to travel in hope than not to travel at all"—borders on a bizarre approach to public finances.
  When the Committee's report considered value for money, the Treasury's position became a matter of even greater concern. Labour will adopt an entirely different approach. We believe that it is the Government's job to set out a policy framework, against which companies can be expected to plan. Having determined our priorities, the private sector can then make its proposals. The models that we shall adopt will be flexible and appropriate to the circumstances.
  We propose to set up a unit to ensure that projects get off the ground. We shall ensure that public bodies are equipped to deal with the projects. The primary duty of Government is to ensure that services are delivered for the benefit of the public. That means using the expertise and innovation that is available to this country, while keeping a rigorous control over the cost of the liabilities being entered into. Control of public spending is essential if we are to maintain economic stability.
  This partnership has tremendous potential. The tragedy of it is that the Government see the PFI as an opportunity to privatise policy making and decision taking and have abdicated their responsibility. That is one of the reasons why the PFI is in its current state. Labour has a new approach, which I believe will increasingly command the support and confidence of the public and the private sectors.
  12.21 pm
  The Financial Secretary to the Treasury (Mr. Michael Jack): In the few minutes remaining, I shall do my best to reply to the debate, which was so ably opened by my hon. Friend the Member for Hazel Grove (Sir T. Arnold), who, in balanced, careful and exacting terms, dealt with the Committee's extremely good report and the Government's response to it.
  Time may prevent me from replying in detail to every comment that was made by Opposition Members, but one thing that came shining through was the fundamental discomfort of many Opposition Members—on both the Front Bench and the Back Benches—about what the private sector can deliver; a fundamental distrust lingered beneath their comments.
  The hon. Member for North Warwickshire (Mr. O'Brien) said, in effect, "Labour will take back control. We don't really want the private sector to make progress in these particular areas."

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  Compare and contrast that entirely negative view with that of my hon. Friend the Member for Gravesham (Mr. Arnold), who eloquently pointed out the benefits of the PFI in rapidly making much needed health improvements for his constituents. My hon. Friend asked whether we could pour oil on the wheels that do the deals. The private finance panel executive plays a major part in helping these projects to come to fruition. I can assure him that I shall draw his remarks to its attention and ask it, where appropriate, to give every assistance.
  My hon. Friend the Member for Hazel Grove mentioned additionality, as did other hon. Members. He will recall that I gave evidence to the Committee. When the Government decide the amount that they will spend, the services that they purchase under the PFI fall within that financial envelope, so projects that are not straightforwardly financed from public moneys must by definition be additional.
  More important, when one compares and contrasts the benefits from private finance—value for money and risk transfer, and one has only to look at projects such as the British Library and the Limehouse link, referred to in our reply to the Select Committee's report, to realise the benefit of those—one sees that a great deal of public money was wasted in the past because there was no proper procurement and because risk factors had not been properly considered. Under the PFI, those risks are now borne by the private sector, not the public purse, so each pound that the public sector spends can be made to work harder to provide high-quality public services.
  My hon. Friend the Member for Hazel Grove mentioned control and monitoring, as did other hon. Members. I have never made a secret of the fact that, with an initiative that is only three years old, there will always be much to learn and that there will be an opportunity for constructive criticism and a chance to refine and improve. I very much welcome what the Select Committee said as a contribution to that debate.
  My hon. Friend mentioned the bidding process. We have, subsequent to the Select Committee's report, published a new set of procurement guidelines, which have been widely welcomed by many of the people who were quoted by Opposition Members as being critical or in some way against aspects of the PFI. [Interruption.] It is important that we continue to refine the bidding process to take cost out and continue our work on, for example, producing standard clauses for contracts, all of which will help to deal with some of the reasons why private sector companies have reprioritised.
  Some of the companies have said that they already have so many bids on their plate that they will not make any more because their resources or their manpower are limited. It is not, though—to answer the criticism of the hon. Member for Hackney, North and Stoke Newington (Ms Abbott)—because they have issued a vote of no confidence in the PFI. Far from it. When I saw the number of companies that attended the roadshows that I visited around the country; the number of companies that continue to bid for projects— [Interruption.] If the hon. Lady had listened, she would have heard that I answered her a moment ago. [Interruption.]
  Madam Deputy Speaker: Order. I wish that the hon. Member for Hackney, North and Stoke Newington (Ms Abbott) would refrain from making what is becoming a running commentary.
  Mr. Jack: Those companies maintain their interest in the PFI and certainly in the health service. To date, 34 PFI contracts, worth £82 million, have already been signed. Six major hospital schemes, with a capital value of some £386 million, have been improved in the past few months. Our new private finance panel chairman, Alastair Ross Goobey, and I share one thing in common: our top priority is to ensure that those deals are signed. They are complex deals. They are difficult to execute, and they are not helped by the noises from the hon. Member for Peckham (Ms Harman), who runs around saying, "This is all about privatising the health service," when nothing could be further from the truth.
  Mr. Betts indicated dissent.
  Mr. Jack: The hon. Gentleman shakes his head. He obviously has not read the relevant section of "Private Opportunity, Public Benefit", which shows quite clearly how the private sector's expertise in the provision of certain medical services under the direction of the NHS can be a tremendous boon and a blessing to patients.
  I listened with incredulity to the outburst of the British Medical Association. The PFI attracts resources that improve the delivery of health care. All we hear from the Opposition are noises questioning whether this is a good idea. My hon. Friend the Member for Gravesham clearly and positively proved that the way forward is to back the PFI. It brings new, innovative solutions, better value for money and, most important, NHS health care delivered under the current terms of the NHS in better facilities for patients. Surely that is something on which we can all agree.
  The hon. Member for Gordon (Mr. Bruce), who, sadly, is not in his place but who kindly wrote to me, made a thoughtful and helpful speech. He drew our attention to two fundamentals of the PFI: perceptible added value and the use of up-to-date technology and innovation. That is precisely how we achieve the better value for money that lies at the heart of the private finance initiative.
  Interestingly, perhaps the most knocking copy came from the hon. Member for Sheffield, Attercliffe (Mr. Betts), who led a council into near-financial disaster over the arrangements for the Sheffield games. He smiles, but he illustrates as no one else can how the lack of any business acumen among Opposition Members undermines their understanding of what the PFI is all about.
  The Government will monitor carefully the forward commitments entered into by Departments, but that is part of a controlled whole. At least this Government have a grip on public expenditure, unlike the hon. Member for North Warwickshire, who gave us no figures. That is typical of Labour's menu without prices. Whatever it has to say, on a menu without prices its diet will be utterly unaffordable.
  Madam Deputy Speaker: Order. We must move to the next topic.

  Dance and Drama Students
  12.30 pm
  Mr. Peter Luff: There are some things that this country is quite simply best at—and I am not just referring to football. Theatre is one of those things. Britain can be justifiably proud of its theatrical heritage. We have enormous artistic talent, but the worldwide reputation of British dance and drama has been built on the hard work, dedication and training that are required for success in those demanding professions. Some 93 per cent. of our dancers and 86 per cent. of our actors and actresses were trained professionally, and most of our finest performers began their careers at the small number of independent dance and drama schools that still promote professional standards and excellence in the performing arts.
  Together, those independent schools provide a system of training which, as Sir Anthony Hopkins said—a man, incidentally, whose personal contribution to the training of our young people is generous in the extreme—
  "is the envy of other countries; we produce actors who are respected and revered around the world and who can be fine ambassadors for the nation."
  Those fine actors and dancers enhance our cultural lives, but they also play a major part in attracting visitors to our country. London's theatre life is a magnet for tourists from overseas, and from elsewhere in the country. It is a huge factor in the economy of London and the nation. Around Britain, regional companies rely on, and themselves develop, the pool of well-trained actors and dancers produced by our specialist stage schools. From Sir Andrew Lloyd Webber's latest musical to the revivals of classic dramas, and from the Royal Ballet to the latest contemporary dance, one strand runs: dependence on British performing talent.
  Thanks to the national lottery, we are investing in the physical infrastructure of the arts on a massive scale, but we are ignoring human capital in a cavalier way. We also risk destroying the long-term training infrastructure of fine schools that may be forced to close or make invidious choices—schools such as the Birmingham school of speech and drama, the central school of ballet and the Doreen Bird college of performing arts, of which we have every right to be proud.
  Young talent must be trained in dance and drama schools, not just at higher education institutions and universities. After years of warning, we are now at the very edge of the precipice. Very soon—apart from the lucky few who live in the right place, or whose parents are prepared to make enormous sacrifices to ensure that they are trained: some constituents of mine have sold their home to fund their daughter's dance training—only the rich and the foreigner will be able to be trained at British schools of performing arts.
  Sir Andrew Lloyd Webber said 18 months ago—his office tells me that he stands by these remarks—
  "This country is famous for its talent in this field. The present policy could lead to a serious gap in training and ability, which, if allowed to continue, will be filled by others."
  He means, of course, foreigners in his own musicals.
  Vocational dance and drama training in the United Kingdom takes place at independent institutions that receive no funds from central Government. As a result, they must charge full economic fees for the courses they offer—typically, some £7,500 a year for dance, with maintenance costs on top of that.
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  With no central funding, and now no eligibility for mandatory awards, students must rely on discretionary awards from their local education authorities; but increasing numbers of LEAs are saying that they cannot afford to fund students. Some feel that they can use such large sums better by sharing them among more students, while others have a philosophical dislike of private education, which is how they wrongly view the independent stage schools. Others—such as Hereford and Worcester county council in my constituency—have given up discretionary grants altogether. The total cost of dance and drama training in those institutions is a little over £20 million a year, and only a small proportion of that is now being met by the LEAs.
  There have been two recent surveys, one of which received rather more publicity than the other. I had conducted my own survey before I realised that the Gulbenkian Foundation, along with a number of other charities and trusts, had commissioned one. I am glad to say that the two surveys produced broadly the same outcome. The Gulbenkian Foundation survey, published on 4 June, said:
  "The situation is at least as bad as had been feared. Twenty-eight per cent. of all LEAs have a declared policy of giving no support to students of dance and drama."
  Mr. Jacques Arnold: Is not a particularly tragic example that of Kent county council, which scrapped discretionary grants when Labour and the Liberal Democrats took control? A young girl living close to my constituency—a very talented dancer—was turned down for such a grant. What is particularly wicked is that, if and when parents appeal, the appeal is conceded, but the parents do not know that in advance. Parents who do not appeal have therefore lost the opportunity. Moreover, the Lib-Lab county council will not tell Members of Parliament about constituents whose applications have been refused, and whom we could inform of the possibilities of success at appeal.
  Mr. Luff: My hon. Friend points the finger in the right direction. I intend to return to that subject later.
  The Gulbenkian Foundation continued:
  "Between 1994–5 and 1995–6, the two years covered by this study, the number of students receiving such awards fell by 12 per cent. Of those LEAs which did make awards in this field, less than half met the full cost of college fees and of maintenance at the standard (i.e. mandatory award) level. There is evidence that potential students are being discouraged from applying for support both because they perceive that they have little chance of success, and because of their concern that if they are successful they themselves will have to bear the cost of a substantial part of their fees."
  Some believe that we can turn the clock back and encourage local education authorities such as that of my hon. Friend the Member for Gravesham (Mr. Arnold) to start making awards again, and increase the number of awards. I think that those hopes are ill founded.
  Mrs. Jacqui Lait: I apologise for arriving a few seconds late. My hon. Friend has made some very good points, with which I entirely agree. Can he confirm the experience of students in my constituency, that even the charities that have been able to help out in the past are now running out of money?
  Mr. Luff: My hon. Friend is right. I am glad to say that organisations such as the Foundation for Sport and the Arts are making awards, but they cannot be expected to make good the total shortfall.

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  Vocational performing arts training is pretty well the only first qualification for which Government funds are now not available. Music and visual arts students receive mandatory awards, as do academic dance and drama students who go on to teach, and students of Anglo-Saxon and sociology. For my party, which believes in equality of opportunity, the issue cries out to be addressed. The human results are very worrying.
  There is, for instance, the misery of those who cannot fulfil their talents. I find interviews on the subject in my constituency heartbreaking. It is almost impossible to look at the girls involved—the students in my constituency tend to be girls, because it contains a fine dance school, the Harlequin stage school in Worcester, run by the principal, Paula Dymock. That school has an extraordinary ability to bring on the inherent talents of girls, but we know that, because they live in Hereford and Worcester, they will not be able to go on to the colleges that they wish to attend in order to develop their talents. I cannot accept that such talents should be discarded.
  There is another problem. Some LEAs make partial funding available to students, but that too is a kind of trap, although it is better than nothing. Students try to make up the financial shortfall by working part time while they are on their courses, which means that they cannot deal with the physical requirements of those demanding courses, especially dance courses. There is abundant evidence of increased injuries to dance students through lapses in concentration and simple physical and psychological pressure. As a result, students withdraw from courses injured and in debt.
  Whom do I blame? I firmly blame the Labour and Liberal parties which, sadly, are in power at LEA level. They are turning their backs on the problem. They, not the Government, are to blame. The local authority for the Minister's constituency finds the money to spend—not surprising, because its budget increases in real terms each and every year. However, it will not find even modest sums for the most talented dance and drama students who want to go to college.
  Labour postures, but has nothing to offer. Labour floated an inadequate solution in 1994, but it seems to have sunk without trace. That party's document, "Lifelong Learning", which was published last month, alludes to the problem tangentially. Its introduction states:
  "whole categories of students have no mandatory entitlements".
  I searched in vain for any explanation of how that would be overcome. Even the inadequate solution that Labour was canvassing of a small number of accredited schools, not courses—many of which are already in the higher education sector—seems to have been dropped. No doubt Labour's shadow Arts Minister is afraid of the shadow Chancellor. So much for new Labour's commitment to the arts.
  We must first make sure that schools and courses are up to the mark, then provide direct public funding as for any other career or qualification. There must be accreditation, to make sure that schools deserve the public money that I want them to receive. Drama schools were the first to be accredited, followed by the Council for Dance Education and Training—whose procedures are exceptionally stringent and effective.
  The drama sector admits that dance education is in the lead in that respect. The National Council for Drama Education plans to catch up, using new accreditation
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  procedures. The CDET accredits courses, not institutions, and aims at raising standards throughout the country. Its system was devised after extensive consultation with Ofsted and experts. Visits are made by trained inspectors, including former members of Her Majesty's inspectorate of schools.
  That serious exercise began a year ago, and seems likely to result in a significant reduction in the number of accredited dance courses, which will in turn lower the number of students eligible for discretionary awards by two thirds. Dance schools have gone through a tough process, and deserve credit for their approach. My hon. Friend the Minister can be confident that the courses remaining will deserve the taxpayers' money. The accreditation procedures in place or being developed will have to be approved by the Department with a rubber stamp, but we do not need the new bureaucracy proposed by Labour.
  Public funding would end the system whereby LEAs make discretionary awards. They do not want that discretion, but are anxious to surrender it. Some voices in the Government say that we must not deny any discretion to LEAs or local authorities. In fact, that discretion creates more problems than it is worth.
  It is easier for the Government to solve the problem in drama training, because students are typically post-A-level, and it is effectively a higher education sector. Drama students could go straight for mandatory grants, with the schools funded centrally. Dance education is more complicated, because its pupils normally begin intensive vocational courses at a much earlier age, to develop muscle memory and so on, before taking their A-levels.
  The Government could adopt a range of possible solutions—I am not concerned which, provided that the outcome will be mandatory awards for dance students. The Government could expand the music and ballet scheme, make direct grants, develop a permanent role for the Arts Council or—my personal preference—establish an independent funding council for dance education. When my right hon. Friend the Member for Old Bexley and Sidcup (Sir E. Heath) was Prime Minister, he made music students eligible for mandatory awards. I hope that the present Government will do the same for other students.
  The Government are already doing a lot that is right. I welcome the expansion of the music and ballet scheme. Yesterday, my right hon. Friend the Secretary of State for Education and Employment announced an extension of the specialist schools programme to sport and the arts, including the performing arts. I am delighted that my right hon. Friend the Secretary of State for National Heritage has said that lottery money can be used to develop young talent. However, the fundamental injustice remains. I want the Government to develop a sticking plaster solution—a short-term remedy—while they work out the longer-term answer.
  I do not believe that the Arts Council represents the long-term solution. Given the huge contribution to our lives that the performing arts make, they should be treated like any other academic or vocational qualification and be funded by the same sort of institutions—although, in the short term, the Arts Council must be involved.
  On 1 April, my right hon. Friend the Secretary of State for National Heritage issued new guidance on lottery funds that instructs the Arts Council to take into account

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  the desirability of developing talents, skills and creative abilities—particularly among young people—while having regard, rightly, to the importance of not entering into long-term commitments or creating long-term expectations that might limit the money available for distribution in future. The mechanism exists for a stop-gap solution while my hon. Friend the Minister and his officials develop a longer-term answer.
  The Arts Council for England has established a small group led by Clive Priestley to analyse the current situation. It will report next month to the Government and its recommendations will be passed to Sir Ron Dealing. I am pinning my hopes on Sir Ron's higher education review, which is due in the middle of 1997. I hope that the Minister can confirm that dance, with its relatively young entry age, and drama could fall within Sir Ron's terms of reference. The report will not be implemented immediately for a year or two after publication, so for three years, dance and drama students will be in jeopardy. There is a risk of throwing away a whole generation of talent and of destroying the skills base of schools.
  My hon. Friend the Minister has a deep sense of justice and fair play, and I am sure that he will demonstrate those qualities in his reply. I hope that he will offer a short-term solution and guarantee that the longer-term remedy will lie in Sir Ron Dealing's remit. Who knows how many superstars of the future will be lost if we do not act? Who knows how many we have already lost? The chances are that many have been lost, and we must not lose any more. We must not let down the Darcy Bussells, Sarah Brightmans and Sir Anthony Hopkinses of the future.
  12.45 pm
  The Minister of State, Department for Education and Employment (Mr. Eric Forth): My hon. Friend the Member for Worcester (Mr. Luff) painted a gloomy picture of the situation facing students who are seeking discretionary awards in dance and drama from local education authorities. He mentioned the research by the National Foundation for Educational Research, which underlies much of his analysis, and the efforts of the Gulbenkian Foundation to get at the facts.
  I have no doubt that the findings of those two bodies and of my hon. Friend, which are based on a survey of LEAs, are broadly accurate. They reflect points made to the Department about LEA policies for some time, including those of my hon. Friends the Members for Gravesham (Mr. Arnold) and for Hastings and Rye (Mrs. Lait). There has been a significant decline in the number and level of LEA discretionary awards in the past two years, and it is clear that dance and drama students have been particularly affected.
  I take issue with my hon. Friend's suggestion that dance and drama students are uniquely disadvantaged. I am aware from representations by other hon. Friends and interested parties that osteopaths, chiropractors, horticulturists and certain private agriculturists feel similarly disadvantaged, which proves that it would not necessarily be inexpensive to correct the problems identified by my hon. Friend.
  Mr. Denzil Davies: One of my constituents will, after much competition, be attending a London
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  drama school. He does not want to enter one of the universities offering drama courses, because they are theoretical, and he wants to be an actor. Is not the problem that a mandatory grant would be available for theoretical university drama courses but not for the alternative?
  Mr. Forth: The right hon. Gentleman makes a clear point that goes to the heart of the debate—that everybody has to make a judgment as to the relative value to society and the individual of different kinds of vocational and other education and training, and the priorities that we award them. That consideration underpins my hon. Friend's case.
  I am aware of the views of students, teachers and others directly involved, and acknowledge the level of anxiety that has been expressed.
  Interestingly, in discretionary awards—which are so key to what we are considering—as a whole, the numbers rose between 1990–91 and 1993–94. Indeed, the number of awards even in 1994–95, when the sharp decline had started, was still some 66 per cent. higher than the number of further education awards a decade earlier. Spending on further education discretionary awards was almost 60 per cent. higher in real terms than it was a decade before. Again, that shows that we are talking about the ordering of priorities within an overall amount of expenditure, those priorities being determined largely by LEAs. Therefore, the position overall can conceal a much worse situation in individual subject areas. That is what we are talking about today.
  It is important—and it is another legitimate area of judgment and debate—that we acknowledge, as my hon. Friend did, that we are talking about discretionary awards, which are at the discretion of local and accountable LEAs. They have to consider applications on their merits, across the whole range of subject matters. The number and level of grants is a matter for those elected LEAs, taking account of their financial situation and their views on and judgment about local priorities.
  That is the way the system works. Unless and until there is a significant policy decision by this or any other Government to alter that, that is the context within which we must all operate. LEAs must listen to local views. It is up to everyone concerned—not least my hon. Friends in the Chamber today, individual students, their families and others—to influence LEAs to alter their judgments and priorities if people believe that there is something wrong with them. That is the way to do it.
  However, in doing that, a number of questions arise. We must acknowledge that all public bodies, central and local government are operating with tight resources, which means that the focus and the priorities must be ever sharper. It involves ever more difficult decisions being made.
  Those who seek additional money, as my hon. Friend has done openly today, ultimately have to say how they would alter the priorities to find that additional money. They also need to show that the number of places available currently, or if enhanced, is justified. They need to ensure that provision is not fragmented. It is essential that they show that the training is of an acceptable standard. In that respect, I am encouraged by the recent accreditation work of the Council for Dance Education and Training, to which my hon. Friend referred. They always need to show that costs are realistic. That is an

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  important point, especially as dance and drama courses are expensive. All those points must be addressed; indeed, many are being addressed already.
  The difference in emphasis between local authorities highlights my point. There is an enormous disparity between what different LEAs do. They have a voluntary code of practice, which we welcome. However, there is an issue about what some people call black hole provision. We shall continue to reflect further on the implications of that and on what changes may be necessary.
  I am aware that, in Scotland, responsibility for discretionary awards has been transferred to individual institutions from local government—something akin to my hon. Friend's suggestion. We are continuing to discuss the matter with our counterparts at the relevant Departments. The truth, as my hon. Friend recognised, is that, under the current system and current legislation, there is no scope for the Government to intervene. We cannot substitute our view for that of the LEAs.
  Another suggestion has been to ring-fence funding for discretionary awards. LEAs have to take decisions based on their full understanding of the position and the resources available to them. We should not constrain that freedom, as that would involve a major departure in the relationship between central and local government—and, indeed, the role we envisage for local government. Although many people may be tempted to seek such a change, it is more for the medium or longer term. We should pause before going down that route.
  My hon. Friend suggested that mandatory awards should be extended to dance and drama students. That is a solution, but perhaps for the medium term rather than for the immediate or short term. It would involve a change in both principle and practice in the approach taken up till now. It would mean either an increase in overall public expenditure or a reordering of priorities within the existing provision.
  That leads us to the point made by my hon. Friend about the committee of inquiry into higher education, and the input that the Arts Council intends to make. It is legitimate to consider whether the very wide terms of reference given to Sir Ron Dearing and his committee could encompass the matter that we are debating today— if only because, as the right hon. Member for Llanelli (Mr. Davies) said, certain elements of the provision are already covered by higher education. Therefore, it is legitimate to ask the committee to consider whether that should be broadened or changed in concept or in delivery.
  I do not want to pre-empt any of that. So far, we have taken the view that the current system of mandatory awards and loans is intended and designed for full-time undergraduates. It has, until now, been thought to be unsuited to the wide variety of vocational courses and the needs of their students. All that is legitimate territory for representations to Sir Ron Dealing and his committee. It is a once-in-a-generation opportunity to look at all these questions in the light of the changed circumstances since the Robbins review 30 or more years ago.
  I want to say a few words about the music and ballet scheme, to which my hon. Friend referred. It was designed to support school-age children of outstanding potential to train for a career in dance and music. At present, the scheme is limited to the Royal Ballet school and four independent specialist music schools. They were selected to participate in the scheme because they are both
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  pre-eminent in their specialist field, and offer high standards of teaching and learning across a broad and balanced curriculum, including a good range of A-levels.
  We are expanding the MBS from September this year, by allocating further aided places to existing schools and by bringing in two new schools—the arts educational school, Tring, Hertfordshire and the Elmhurst ballet school, Camberley, Surrey—both of which will offer ballet places.
  The scheme is means-tested. Parental income assessments are identical to the arrangements under the Government's assisted places scheme at independent schools, although the contribution scale is more generous under the MBS, to reflect the fact that it covers boarding costs and the best specialist music and dance tuition available. It is possible that some colleges might be candidates for incorporation as further education institutions, but the criteria are deliberately strict, and I would not wish to raise hopes unnecessarily high.
  My hon. Friend mentioned the role of the Arts Council. Lottery proceeds may be a possible solution to some of the problems we are debating. My right hon. Friend the Secretary of State for National Heritage announced on 1 April a new direction on the distribution of lottery proceeds. That requires the Arts Council to take account of the need to develop the skills, talents and creative abilities of young people.
  The council has not yet published details about how it intends to implement the direction. I understand that, before the details are finalised, there will be an opportunity to comment. That is another opportunity in the short term to try to influence the way in which things are moving in that area.
  Any suggestion that we should require the Arts Council to target lottery proceeds on dance and drama students should be treated with some caution. This House agreed that the distribution of lottery funds should be carried out at arm's length from Government, albeit in a framework set by Ministers from time to time. The House also decided that the decisions on allocating funds should be taken by the distributing bodies.
  These matters are rightly for the Arts Council. However, as my hon. Friend mentioned, it has been decided to establish a group chaired by Mr. Clive Priestley to look into the problems of dance and drama students. I understand that the remit of that group includes the possibility of using lottery money for that and related purposes. That is another avenue of approach open to those who share my hon. Friend's anxieties through which they can try to influence the course of events.
  I need no convincing that those involved with dance and drama consider that there is a need for more expenditure, as my hon. Friend has laid out, and I have no doubt about the genuineness of their enthusiasm and anxieties. As I have said, aspects of the student support system need to be looked at, and the higher education inquiry is the vehicle to enable that.
  At this stage, on the evidence provided—even in this debate—I am reluctant to contemplate the kind of increases in public expenditure that my hon. Friend suggested. We shall, however, keep an open mind, and continue to monitor the position. Opportunities to press

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  the case are available, and I hope that my hon. Friend and many others who I know share his view will take every one possible to—
  Madam Deputy Speaker (Dame Janet Fookes): Order.
  1 pm
  Sitting suspended.

  Osteoporosis
  On resuming—
  1.30 pm
  Mrs. Teresa Gorman: I am pleased to have this opportunity, 10 years after the launch of the National Osteoporosis Society and two days after the first World Osteoporosis Day, to tell the House about brittle bone disease, or osteoporosis, and how it relates to our lives.
  It is an old disease in two senses. Fossil skeletons show that Cro-Magnon woman suffered from it—if she survived being dragged off by some caveman to bear him umpteen children. Most such women would have been dead by 50, the age after which people become increasingly vulnerable to the disease. We can all look forward, if that is the right expression, not only to a ripe old age but to the risk of the disease.
  Today, the average longevity of women is 84; for men, it is 79. It is not surprising that the disease is becoming more and more common. The incidence has almost doubled in the past 30 years. In 1990, according to the World Health Organisation, 1.7 million osteoporotic hip fractures occurred in the western world. If we do nothing about it, the number is predicted to rise to 6.26 million by the year 2050. That is an awful lot of people and an awful lot of pain and cost. Osteoporosis is reckoned to cause around 200,000 fractures in Britain alone each year and it costs the national health service around £750 million to care for those people.
  Fairy tales are full of stories that feature old crones—women shrunken, bent double and hobbling along with a stick, or long in the tooth as we say. Those problems are all due to osteoporosis. The tooth problem is caused by shrinkage of the jaw. Today, we hide people in that condition in old people's homes and give them zimmer frames. It was in such homes that I first became of the aware of the extent of this crippling disease. Osteoporosis can affect all parts of the skeleton. We shrink as we get older. Two or 3 in is common, but 10 or 15 in is not unknown. Such cases involve great curvature of the spine, the head sinks into the chest, pressure is caused on the lungs, and the people afflicted often die from lung disease before the bone disease gets them.
  If the crones were young today, the National Osteoporosis Society would be there to tell them how to prevent distorted frames and save them from their suffering. It does a wonderful job with the money that it raises and it deserves as much as the Government can give it. Apart from anything else, it would be a terrific investment. About a third of our hospital beds are occupied by people being treated for osteoporotic fractures. Some never get out of their beds; they are crippled for life. We must thank the society and its campaigning for the fact that women, in particular, are much more aware of the risks that they run. However, it is still difficult to get women to do something about the problem sufficiently early. Not for nothing is it called the silent disease; it creeps up on people over the years. By the age of 60 to 70, people are at severe risk of fractures; by 70 to 80, there is a one in three chance of something serious happening to the skeleton.
  At first glance, bones look solid, but that is far from being the case. When they are young, they are hollow and the material of which they are made is full of tiny holes.

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  As we grow older, the holes get bigger, like in a piece Swiss cheese, and the bones become fragile. One can suddenly suffer a broken bone from a fit of coughing, lifting a grandchild or using a vacuum cleaner. One does not have to fall over to sustain a fracture in one's 60s or 70s. When such people fall over, they have a big chance of breaking their ankles, wrists or pelvic girdles. Such fractures can be lethal; 15 per cent. of women who fracture their pelvic girdles—which are not to be confused with hip joints—die of the condition, even though they are operated on. Patching up that part of the body is difficult, because the bones are naturally thin. There is a good chance that people who survive will need zimmer frames for the rest of their lives. The quality of life is greatly reduced.
  In the past, women over 50 were considered to be over the hill or on the shelf, partly because of the decline in their health. There are many things that such women can do with their talents, but good health is essential. The early treatment of osteoporosis can go a long way towards improving the chances for older women to continue to make an important contribution to our society.
  The good news is that osteoporosis is preventable and treatable. A healthy diet with lots of calcium, which means butter, cheese and milk, gives bones strength. Vitamins are important, especially vitamin D3, which is obtained from dairy products and sunlight. Exercise is important; during exercise, the muscles pull on the bones, which strengthens them. However, the most important ingredient in preventing bone loss in women is the replacement of the natural hormones, which begin to decline as women grow older.
  It is a well-known medical fact that, if hormone replacement therapy is taken by women of 50 and over for 10 years after the menopause, the risk of brittle bones is very much reduced. A study of 6,000 women in Hull between the ages of 50 and 54 showed that 37 per cent. of them were already experiencing bone loss. Most of them went on to hormone replacement therapy, and the bone loss stopped. Not all women want to take hormone replacement and the pharmaceutical industry is developing non-hormonal treatments to counter the disease.
  Baroness Cumberlege, the Under-Secretary of State for Health, has taken much interest in the subject. She is actively encouraging health authorities to provide a comprehensive service for osteoporosis sufferers. So far, 12 per cent. of health authorities have responded. The number is growing, but clearly we want to encourage them to do more. More hospitals have scanning facilities for measuring bone loss, although it is, of course, much better for people to take precautions when they are younger and not wait for the loss to begin.
  Fewer than 10 per cent. of the sufferers of osteoporosis receive adequate treatment, but if a woman's mother or other women in her close family display some of the crippling problems of old age, she should think seriously about requesting a bone scan. The more people ask for that, the more chance that facilities will be made available in Britain for women and, I might say, for men.
  Above all, professional and public education is needed. It would be, as I have said, a tremendous investment. We would be saving hundreds, possibly thousands, of millions of pounds in the future each year, because more and more
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  people would avoid this crippling disease which, in the past, has been taken for granted as part of the problems of old age.
  For myself, I certainly take this treatment. I am told that I have the skeleton of a 15-year-old and that my jaws and teeth are in equally good condition. Sometimes we forget that teeth are part of the skeleton and the fact that old people lose their teeth has as much to do with bone loss as it has to do with the condition of their teeth.
  I have talked a lot about osteoporosis as it affects women. It is true that most of the sufferers are women. On average, one in three women are likely to suffer a fracture as they get older. But, of course, men can suffer too. One in 12 experience bone loss during their lifetime, although the onset usually occurs much later.
  My observation is that medical problems receive much more attention when they are considered to affect men. That is certainly true for heart disease. Therefore, I have decided to ask the hon. Member for Woolwich (Mr. Austin-Walker), who also takes a great deal of interest in the subject, to put the case for his own sex, because then I know that our health authorities, many members of which are men, will take the problem much more seriously, and the problems of osteoporosis will become a top priority in the treatment for what is an avoidable disease.
  1.41 pm
  Mr. John Austin-Walker: I only hope that my voice will last long enough to allow me to make my points.
  First, I thank the hon. Member for Billericay (Mrs. Gorman) for giving me the opportunity to participate in the debate and for having requested it. I fully endorse all her remarks about the work done by the National Osteoporosis Society. I draw the Minister's attention to early-day motion 1037 in my name which was tabled on Monday to coincide with World Osteoporosis Day and which I understand has now been signed by more than 200 hon. Members on both sides of the House.
  The hon. Lady is correct to say that osteoporosis is a devastating illness for women. She is right to point out that it is not exclusively a women's disease. She has said that one in 12 men can expect to experience a fracture as a result of osteoporosis at some time during their life. Recent research has suggested that the figure may be as high as one in eight. What is worrying is that the figure is increasing. Therefore, we must address the early identification and treatment of the disease.
  The hon. Lady has mentioned that about 200,000 fractures a year are caused by osteoporosis. The National Osteoporosis Society estimates that there may well be 40 premature deaths every day as a result of this crippling disease; but, as the hon. Lady has said, it causes misery not only for those affected by this disabling disease but for their families and loved ones.
  The main thing that we have to say is that prevention is possible and early diagnosis can lead to effective treatment. The hon. Lady has referred to hormone replacement therapy. She is affectionately known as the queen of HRT. My secretary has asked it to be known that, if the hon. Lady is the queen, she claims the role of princess. But it is clear that HRT has been shown to reduce the risk of osteoporosis in menopausal and post-menopausal women. However, there is a need for a wide public education programme about other ways in which the disease can be reduced in both men and women.

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  First, smokers are more at risk of osteoporosis than non-smokers. As the hon. Lady has said, diet is also an important factor. Exercise has certainly been shown to be effective in building up bone density. Some drugs can be effective in treating osteoporosis, but much more research needs to be carried out into prevention through non-hormonal drug programmes. Further research, monitoring and prevention will ensure that future generations of men and women, but more particularly women, can lead full lives unhindered by the pain and disability of osteoporosis.
  The hon. Lady and I ask the Government to give a higher profile and priority to osteoporosis. As the hon. Lady has said, one third of orthopaedic beds in the NHS are occupied by patients with osteoporosis, and the estimated cost to the NHS of fractures caused by osteoporosis is around £750 million a year. But that is only part of the cost. One in five people sustaining a hip fracture die within six months, and more than half cannot walk independently afterwards, many becoming highly dependent. There are then the unseen costs of care in the community and the on-going costs of drugs, physiotherapy, occupational therapy and other support services provided by the NHS and local authorities. There is also the cost to an individual in terms of the quality of life and the quality of a carer's life. The chronic pain, the disability and the possible deformity which were outlined earlier cannot be overestimated.
  Diagnostic tools should be more widely available. The facilities in the United Kingdom for measuring bone density are scarce, although I recognise that they are increasing. But in my view and that of the National Osteoporosis Society, every health authority should have a designated lead clinician with a special interest who can update other professionals on the prevention and effective management of osteoporosis.
  The primary and the secondary services must work together to provide a seamless service, and funding for osteoporosis needs to be positively and definitely included in local contracts. Action is needed at local level. A local health commission could set up an effective osteoporosis service for about £50,000, which is less than the cost of treating two weeks' hip fractures. There needs to be action by Government. Osteoporosis should be given key area status in the Government's "The Health of the Nation" programme.
  The Minister will know that Baroness Gardner and I jointly chair the all-party osteoporosis group. Informally, we have had a sympathetic and encouraging response from Baroness Cumberlege, his ministerial colleague in the other place. I hope that we shall have a formal and positive response from the Minister today, and a commitment to recognise osteoporosis in "The Health of the Nation" targets.
  1.48 pm
  The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am grateful to my hon. Friend the Member for Billericay (Mrs. Gorman) for initiating a debate on osteoporosis in the middle of National Osteoporosis Week. She said during her speech that her jaws and teeth were in good condition; I can assure her that the House and, in particular, the
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  Government have never had any doubt about that. I believe that this is the second such week—the first World Osteoporosis Day was on Monday—the main initiative for which came from the National Osteoporosis Society.
  I should also like to take this opportunity to pay tribute to the society and its achievements during the past 10 years in giving osteoporosis sufferers everywhere a voice. The NOS has also organised this week the fifth annual conference on osteoporosis and bone mineral measurement, in Bath, bringing together the leading experts in the field.
  As my hon. Friend said, the debate can only help to raise the profile of a condition which has been described as the silent epidemic. Osteoporosis is undoubtedly a major public health problem. It has been estimated to affect as many as one woman in four in the United Kingdom. Each year in this country, there are about 60,000 hip, 50,000 wrist and 40,000 vertebral fractures which are due to osteoporosis. Most of these occur in older women, but about 20 per cent. of the hip fractures occur in men. I noted the comments about that by the hon. Member for Woolwich (Mr. Austin-Walker), the chairman of the all-party group. Almost half of all women will have experienced a fracture by the time they reach the age of 70.
  In March 1993, my colleague Julia Cumberlege—I acknowledge the tributes paid to her work—decided to look at what we were doing in the whole field of women's health, for which she has particular ministerial responsibility, and to examine the outstanding issues. She concluded that, at that time, osteoporosis was the single most important women's health issue yet to be addressed by the Department: it had not been given the attention that it deserved. She resolved to put this right by setting up the advisory group on osteoporosis, or AGO.
  The group's remit was
  "to establish what information about osteoporosis is available, what research is being conducted and what further work needs to be done, and to report to Ministers".
  AGO submitted its report in November 1994 and, having accepted its recommendations, Julia Cumberlege published it in January 1995. The AGO report was widely distributed both within and outside the NHS, and we have reprinted it three times since then—a pointer to its popularity among health professionals and the public.
  Since publication of the AGO report, progress has been made on a number of fronts in developing osteoporosis services. Two of the report's recommendations were directed at the NHS. Julia Cumberlege wrote to the chairmen of all NHS bodies about these on the day before the report was published, and has subsequently discussed them with regional chairmen.
  The first of AGO's recommendations specifically for the NHS was that health authorities should facilitate improved co-ordination and communication between the various groups of professionals and specialists—general practitioners, nurses, gynaecologists, rheumatologists, radiologists, orthopaedic surgeons and others—involved with different aspects of osteoporosis. That may sound like a statement of the obvious, but we have made it clear to NHS chairmen that we think that it is worth taking a bit further—looking at whether having a lead clinician for osteoporosis in each locality would be cost-effective and desirable. Osteoporosis should be tackled with a "shared care" approach among all sectors of the NHS.

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  The advisory group's second recommendation for the NHS was that bone densitometry should be made available to assist clinical decision making with certain groups of patients identified as being at high risk.
  The National Osteoporosis Society, the leading voluntary body, published in January the results of a survey it had carried out among health authorities of the services provided around the country for people with osteoporosis. My hon. Friend referred to this work. It is fair to say that the results of that survey clearly highlight the fact that the NHS has a lot of work to do before the recommendations of the advisory group can be considered to be successfully met. It is clear that some health authorities have a great deal of work to do in improving local osteoporosis services. I note the percentage of them that my hon. Friend mentioned. That said, it would be unrealistic to expect services to improve radically overnight, but there are many points that need to be improved on.
  A number of the recommendations of the advisory group on osteoporosis were directed at the centre, and a great deal of work towards implementing the recommendations has already been done. For example, a group led by the Royal College of Physicians is working on clinical guidelines for osteoporosis. I also understand that the Clinical Standards Advisory Group will take the AGO report into account in its own report on community health care for elderly people, which is expected to be submitted to the Department later this year. Osteoporosis is now also specifically referred to in "The Health of the Nation" fact sheet on accidents.
  There has been much debate about the role of bone density scans. In such debates, the findings of the "Effective Health Care Bulletin on Screening for Osteoporosis", produced by the York centre for reviews and dissemination, are often cited in defence of decisions not to increase the availability of bone scans, as recommended in the AGO report.
  The "Effective Health Care Bulletin" considers the evidence for establishing a population screening programme for osteoporosis and concludes that, on current evidence, it would not be advisable to do so. The AGO report reaches the same conclusion. However, the latter goes on to say that, once someone at high risk of developing osteoporosis has been identified—usually by the GP asking a few key questions in the surgery—there is an important role for bone density measurements to confirm the diagnosis where the patient is reluctant to agree to treatment and to monitor the treatment to encourage the patient to continue with it.
  This use of bone density measurement is not considered by the "Effective Health Care Bulletin"—which is why the AGO report recommended that it should be reviewed. AGO rightly concluded that the bulletin as it stands has misled health care purchasers into believing that there was no role for bone density measurement in local service provision. The NHS executive is in discussion with the York centre about updating this and other bulletins in the context of a new contract for further clinical effectiveness work.
  Of course, bone density scans are not the solution to osteoporosis; but I believe that their availability, in the circumstances set out in the advisory group's report, is an important element in a good local osteoporosis service.
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  The Department of Health has considered the contribution that nutrition can make to maintaining bone health on several occasions. In 1991, the Government published updated dietary reference values for assessing the adequacy of dietary intakes of nutrients. The nutrients generally regarded to be most important in bone health are calcium and vitamin D, but many other nutrients have been implicated, including copper, fluoride, phosphorous, vitamin C and protein. In addition, the risk of fracture in old age is related to body composition—for once it seems to help to be a little bit plump. I make no reference to my hon. Friend the Member for Billericay in this context, of course.
  I also noted with great interest what my hon. Friend said about HRT, and I know of her other concerns in that area. Much of what she said about it made great sense.
  The report of the advisory group on osteoporosis also recommended better public and professional awareness of the condition. It also made recommendations in respect of the nursing professions; indeed, a key quotation from the section on the role of nurses said:
  "with appropriate preparation this group is in a prime position to make a significant contribution to any programme for the prevention, early diagnosis and treatment of osteoporosis".
  Nurses can do this only if they have a full understanding of the disease and its implications. Therefore, the next logical step was to build on the existing literature by producing a comprehensive and detailed resource pack for nurses.
  I am therefore delighted that, on Monday, at the fifth annual conference on osteoporosis and bone mineral measurement in Bath, Julia Cumberlege launched just such a resource pack on osteoporosis for nurses, midwives and health visitors. I have one with me; it is an excellent document, hot off the presses, and I can recommend it to nurses and to hon. Members. The resource pack was produced jointly by the Royal College of Nursing and the National Osteoporosis Society, and my Department gave a grant of £5,000 towards its production costs.
  The resource pack takes the form of short fact sheets in an easy-to-use folder. The simplicity of its production belies the depth of the information which it contains. The subject matter is fully covered and I am sure that it will be an invaluable aid to the expansion of the nurse's role in this field. The pack is available, free of charge, to any nurse, midwife or health visitor and can be obtained from the NOS.
  I hope that I have revealed the importance that the Department of Health attaches to osteoporosis, which is also reflected in the financial support which we give to charities in this field—not only to the National Osteoporosis Society but to Women's Health Concern and the Amarant Trust, of which my hon. Friend was a founder. We shall continue to work with them and with other interested parties, with the NHS and health service professionals, to increase awareness of osteoporosis and to improve its treatment.
  It being two minutes to Two o 'clock, the motion for the Adjournment of the House lapsed, without Question put.
  Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.

Oral Answers to Questions
  EDUCATION AND EMPLOYMENT

    School Admissions
    Mr. Rendel: To ask the Secretary of State for Education and Employment what plans she has to issue guidance to grant-maintained schools on the question of admission of children permanently excluded from their previous school. [33195]
    The Parliamentary Under-Secretary of State for Education and Employment (Mr. Robin Squire): The Secretary of State has no plans to issue such guidance. However, she has stressed in a White Paper entitled "Self-Government for Schools" and in a new circular on school admissions that grant-maintained schools should have the maximum flexibility to shape their admission arrangements to reflect the wishes of local people.
    Mr. Rendel: Does the Minister accept the figures for Berkshire—which I sent to the Secretary of State at the beginning of June—which show that pupils excluded from local education authority schools are not being taken on by grant-maintained schools, but that pupils excluded from grant-maintained schools are being taken on by local education authority schools? Does the Minister accept that, whatever the Government might say about having a level playing field between different types of schools, in practice their policy is that all schools are equal but some are more equal than others?
    Mr. Squire: While I have no reason to dispute the figures that the hon. Gentleman has submitted, I dispute the conclusions that he draws from them. Instead of the conspiratorial thesis that the hon. Gentleman puts forward—which reflects the anti-grant-maintained view of the hon. Gentleman and his party—a more prosaic reason is that virtually all grant-maintained schools are over-subscribed and full, and it is logical that more LEA schools accept exclusions than GM schools. As the hon. Gentleman is aware, there is power within legislation for an LEA to direct a GM school in specific circumstances to accept a pupil who has no other place.
    Mr. Rowe: My hon. Friend is right to be concerned about children who have been excluded from schools that they might otherwise wish to attend. I refer to children who are kept in schools, under the force of law, but who are getting absolutely nothing out of their education. Would my hon. Friend consider the possibility that such children might be able to take the money that the local education authority is wasting on their education and spend it somewhere else?
    Mr. Squire: My hon. Friend makes an interesting suggestion. As he knows, since April the Government have been consulting on the way in which 14 to 16-year-olds are educated and the other opportunities that are being developed. Schools should be able to find the correct way to educate children, whatever their particular talents. I am happy to look at my hon. Friend's suggestion.

    Schools (Security Cameras)
    Mr. Michael Brown: To ask the Secretary of State for Education and Employment what contribution is planned from public funds to assist schools in the provision of security cameras. [33197]
    Mr. Robin Squire: Last week we announced extra funding for security cameras in 112 schools in England under the Home Office closed circuit television challenge scheme. The Department for Education and Employment contributed £2 million to the scheme. The Government also accept in full the recommendations of the working group on school security, including the provision of new money. That will support a further range of measures in schools, including security cameras where appropriate.
    Mr. Brown: I welcome the announcement that the Secretary of State made yesterday to make a larger proportion of budgets directly available to schools. Does my hon. Friend think that there is also a case for making the funds that he announced last week directly available to individual schools? For example, schools in constituencies such as mine face problems of vandalism and security, which have to be paid for directly out of the school budget.
    Mr. Squire: I am grateful to my hon. Friend for his welcome of last week's announcement. I am sure that all hon. Members welcome it because school security is important. I can confirm to my hon. Friend that all the winning schools in the announcement will receive the money directly, but money for the new security measures, for which we will make provision in the annual grant guidelines, will be paid via local education authorities, not least because they are best placed to judge the relative priorities of conflicting bids in their areas.

    Teacher Training
    Mrs. Lait: To ask the Secretary of State for Education and Employment what recent representations she has received regarding the reform of teacher training. [33198]
    The Secretary of State for Education and Employment (Mrs. Gillian Shephard): There has been a warm welcome for my recent announcement of my intention to define a national curriculum for teacher training, beginning with the teaching of primary literacy and numeracy.
    Mrs. Lait: May I offer my thanks and those of many of my constituents for the announcements that my right hon. Friend has made? Can she assure me that the national curriculum will include the difference between "its" and "it's", "their", "there" and "they're", and the plural and the apostrophe? Can she further assure me that 12-year-olds will be able to give a better definition of a verb than "a doing word" and that they will understand what a preposition is? Can she assure me that teachers will be instructed, whatever their subject, to correct basic mistakes in grammar, always assuming that they know what it is?
    Mrs. Shephard: We have introduced a number of reforms to ensure proper teaching of the basics, but an

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    Office for Standards in Education survey has shown that 46 per cent. of newly qualified teachers feel ill equipped with the practical skills that they need. They and the children deserve better. I shall announce in September the details of a curriculum for teacher training, which will start with the basic literacy skills about which my hon. Friend is rightly so concerned.
    Mr. Bryan Davies: How can the country have confidence in Ministers if, after 17 long years, they are only now waking up to the question of how teachers learn to teach?
    Mrs. Shephard: Perhaps I can remind the hon. Gentleman of what his party has done in the past 17 years. It has opposed every measure that we have introduced to improve standards, including the establishment of the Teacher Training Agency, so Opposition Members cannot now claim to be interested in high standards or in measures to improve them. If the Opposition are so concerned about higher standards, why do not they start putting matters right in the nine local education authorities that they control out of the 10 with the worst GCSE results?
    Mr. Evennett: Does my right hon. Friend agree that teacher training must be effective and relevant when it is taught in the colleges? My hon. Friend the Member for Hastings and Rye (Mrs. Lait) highlighted literacy skills, but does my right hon. Friend agree that it is also important to teach classroom skills, including discipline and how to manage a class? If teachers do not have those skills, they will not be effective however good their training is in their subjects.
    Mrs. Shephard: Clearly, every teacher must be trained, through initial teacher training and through in-service training, in whole-class teaching; to use phonics to help early reading; to engage in active instruction rather than passive supervision; and, of course and most importantly, to keep discipline.

    Deeside School
    Mr. Miller: To ask the Secretary of State for Education and Employment what plans she has to make provision for severely disabled children following the closure of Deeside school. [33199]
    The Parliamentary Under-Secretary of State for Education and Employment (Mr. James Paice): In considering Cheshire's proposal to close Deeside school, one of the factors that my right hon. Friend took into account was the availability of places at suitable alternative schools.
    Mr. Miller: Does the Minister agree that a civilised society is one that looks after those in greatest need? As he was a party to the barmy decision to close Deeside school, will he now condemn Cheshire county council, which is continuing to break the law by failing to provide full and up-to-date statements for children from that school?
    Mr. Paice: If the hon. Gentleman believes that any local education authority is breaking the law, he should draw his allegations properly to the attention of my right hon. Friend. There are a whole range of reasons why
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    Cheshire LEA proposed the school's closure and my right hon. Friend took them all into account—not least the fact that the cost per pupil place at the school is almost double the cost per pupil place at the average special needs school in the same LEA area.

    Standard Assessment Tasks
    Mr. Simon Hughes: To ask the Secretary of State for Education and Employment what representations she has received on her policy of requiring key stage 2 SAT results to be submitted to her for publication; and if she will make a statement. [33200]
    Mrs. Gillian Shephard: The key stage 2 tests have been a great success this year. The overwhelming majority of schools have taken the tests and sent them for marking.
    Mr. Hughes: What would the Secretary of State say to the governors, the head and the teachers of the Church of England primary school in Bermondsey, where I am the chair of governors, who met last week to consider the extremely good inspector's report that has been produced on the school, which has now been publicised, and who decided—I vacated the chair so I did not influence the decision—that sending SAT results for publication is a completely irresponsible and inaccurate method of comparing schools' performances? Will the Secretary of State consider the school's request that it not be obliged to provide that information and that it rest its case on the basis of the Office for Standards in Education report, which says it is a perfectly good school that has obtained good results in all subjects?
    Mrs. Shephard: I congratulate the hon. Gentleman on the quality of the Ofsted report on the school where he is the chairman of governors. However, I regret the decision by any governing body to break the law and to withhold from parents and the wider community information about a school's performance to which they are entitled. I hope that the hon. Gentleman will exercise his influence in a benign way in that regard.
    Performance tables contain hard facts. Obviously, value added is also important and the hon. Gentleman will know that we have asked the School Curriculum and Assessment Authority to take forward work in that area.
    Mr. Thomason: Can my right hon. Friend confirm that the publication of the figures has proved extremely popular with parents? Is it not surprising that Opposition Members should seek to ensure that that information is not freely available?
    Mrs. Shephard: I do find that surprising. I think that parents greatly value information about schools and their performance at both primary and secondary levels. It seems curious that any hon. Member would wish to deny them that information.

    UNESCO
    Mr. Mark Robinson: To ask the Secretary of State for Education and Employment what consultations she has had with regard to co-operation with UNESCO. [33201]
    The Minister of State, Department for Education and Employment (Mr. Eric Forth): None.
    Mr. Robinson: Can my hon. Friend confirm that Britain is making full use of its liaison arrangements with UNESCO? What steps has his Department taken to evaluate the educational benefits of rejoining?
    Mr. Forth: Yes, but I find it difficult to imagine circumstances in which we could identify a value added, in educational terms, in rejoining the present form of UNESCO—particularly in comparison with the undoubted value of our membership of bodies such as the Organisation for Economic Co-operation and Development.
    Mr. Dalyell: What is the particular form of UNESCO to which the Government object? Is it not humiliating that a party which included among its members David Eccles and Edward Boyle—who, as Education Secretaries, were great supporters of UNESCO—continues to adopt a stand-off attitude that brings shame to our country?
    Mr. Forth: No. Madam Speaker, if I were to attempt to list the defects that we still identify in UNESCO, it would try your patience and that of the House. For example, we believe that its work lacks a clear focus, there is a danger of its duplicating the activities of other organizations—not least the OECD—we wish to see further decentralisation from Paris into the field, it needs to reduce staff costs, and we have no evidence that if we were to inject £11 million per year into UNESCO we would get any value for money. I am not impressed by the hon. Gentleman's dropping historical names and I doubt that it will impress the House.

    Independent Schools
    Mr. Nicholas Winterton: To ask the Secretary of State for Education and Employment if she will make a statement on independent schools. [33202]
    The Parliamentary Under-Secretary of State for Education and Employment (Mrs. Cheryl Gillan): Independent schools are beacons of choice, diversity and excellence. We want them to flourish. Through the expanding assisted places scheme, we are making opportunities at top independent schools more widely available.
    Mr. Winterton: Quality and diversity of choice are what parents demand. Is my hon. Friend aware that the cost of a Government-assisted sixth form place in an independent school is, on average, less than the cost of a sixth form place in a state school when one takes into account the capital and administrative costs that are included in independent schools' fees but are not included in the standard spending assessment of local education authorities? Will my hon. Friend give me and the House an assurance that she will continue to promote the assisted places scheme and expand it so that as many children as
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    possible, from as wide a spectrum as possible, are able to take advantage of what independent schools can provide for this country?
    Mrs. Gillan: My hon. Friend makes an extremely valid point, and I am extremely happy to confirm to him and the House that we are committed to the assisted places scheme, which currently offers 34,000 children, more than 80 per cent. of whom come from families with incomes below the national average, an excellent education. We have announced a doubling of the scheme over time, and from September 9,700 places will be available in 355 schools. I hope that the thousands of parents of children who currently benefit from the scheme, or who may benefit from it in future, will notice the Opposition's clearly stated policy—one of their few clearly stated policies—to destroy this ladder of opportunity.
    Mr. Hanson: Does the Minister accept that many Opposition Members view with some scepticism the Government's continued commitment to the assisted places scheme while local authorities throughout England and Wales have to reduce expenditure on local education provision because of the Government's revenue support grant settlement? Will she say whether independent schools provide a model for the future, that is, selection and fee paying for schools in the public sector that are currently subject to the document that was produced yesterday?
    Mrs. Gillan: Independent schools provide choice and diversity for parents who wish to send their children to them. I accept that the Opposition wish to destroy the scheme. I also accept that they do so on the basis of a false premise. In fact, if one tried to educate all the pupils who are currently educated under the assisted places scheme back in the state system—for example, at the cost per pupil of a Hackney Downs education package—it would cost more than the current scheme costs the Government at the moment.
    Mr. John Marshall: Does my hon. Friend agree that the assisted places scheme widens choice and enables those schools to have a wider social spread in their pupils? Is she surprised that the opposition to this scheme comes from a party led by an old Fettesian and whose Chief Whip also went to an independent school?
    Mrs. Gillan: My hon. Friend again makes an extremely good point. It is just another example of the Labour party saying one thing and doing another.
    Mr. Jamieson: As £350 million of taxpayers' money is being spent in independent schools, can the Minister say why Ofsted has stopped inspecting them?
    Mrs. Gillan: Independent schools are currently subjected to a very rigorous regime. The Secretary of State has powers over independent schools, and the hon. Gentleman is simply pursuing a vendetta against a scheme that offers thousands of children from families who could not otherwise afford it the opportunity to get a good education in an independent school.

    Primary Schools (Staffordshire)
    Sir David Knox: To ask the Secretary of State for Education and Employment how much was spent per pupil at primary schools in Staffordshire in the most recent year for which figures are available; and what was the figure in 1978–79, at constant prices. [33205]
    Mrs. Gillan: Unit net institutional expenditure on primary and pre-primary pupils combined in LEA-maintained schools in Staffordshire was, at 1994–95 prices, £1,178 in 1978–79 and £1,565 in 1994–95, the latest year for which figures are available.
    Sir David Knox: Although the figures show that there has been a significant increase since the Government came to power, that increase falls short of the increase that has taken place in any number of other local authorities. Will my hon. Friend ensure that, when expenditure for the next financial year is determined, Staffordshire will be given an opportunity to make up the ground that it has lost in recent years?
    Mrs. Gillan: My hon. Friend has always been a great champion of Staffordshire's education system. No doubt he is aware that both my right hon. Friend the Secretary of State and I have discussed these matters with representatives from the county: we have had some very helpful meetings. I hope that he will bear it in mind that Staffordshire is set to benefit this year from an above-average increase in its education standard spending assessment—an increase of 5 per cent., or £17.324 million.
    Mr. Brian David Jenkins: I thank the hon. Member for Staffordshire, Moorlands (Sir D. Knox) for raising Staffordshire's concern about the SSA. Does the Minister agree with some figures that I have here? [HON. MEMBERS: "Reading."] The Library gave me the figures this morning, and I think that they are fairly accurate. In 1976–77, the SSA for primary schools in Staffordshire was £1,894, and the SSA for secondary schools was £2,520.[Interruption.]
    Madam Speaker: Order. Let me help the hon. Gentleman, who has not been in the House as long as some hon. Members and should be granted a little tolerance. At Question Time, hon. Members are not allowed to read or quote.
    Mr. Skinner: Except Ministers.
    Madam Speaker: Except Ministers. It will be difficult if the hon. Gentleman is going to go through a lot of figures, but will he do his best not to quote and just give the figures? We will help him through today.
    Mr. Jenkins: Thank you, Madam Speaker. Rather idealistically, I thought that I could put the figures on the record. I wanted to be accurate about the SSA, because accuracy is sometimes forgotten in the House.
    If I moved one of the 800-pupil secondary schools in my constituency into a much deprived area such as Hertfordshire, it would receive an extra £168,000 a year. If the school were moved into Tory Westminster, it would receive more than £600,000 a year extra to educate the
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    same 800 students. Can I tell my constituents, and other people in Staffordshire, that the SSA is accurate and based on a standard of educational attainment, and is not a Tory-funded fiddle?
    Mrs. Gillan: After that long question, I think that I had better send the hon. Gentleman back to the Library to do a little more research. Staffordshire's SSA is lower because the authority has falling pupil numbers, while numbers are rising nationally. It receives less for additional educational needs, for example, owing to the falling number of families in the county who are on income support. I would expect the hon. Gentleman to welcome that.
    Sir Patrick Cormack: Does my hon. Friend accept that, although the Staffordshire Members of Parliament who spoke to the Secretary of State last year greatly appreciate the sympathetic hearing that she gave and the action that followed, we see it as just the beginning of catching up on other areas? Is it not crucial for Staffordshire to have an even better settlement next year?
    Mrs. Gillan: I thank my hon. Friend for his kind remarks. As I told my hon. Friend the Member for Staffordshire, Moorlands (Sir D. Knox), we had an extremely good meeting about Staffordshire, and all that is said about its education SSA will be taken into account.

    Skills Training
    Mr. Robert Ainsworth: To ask the Secretary of State for Education and Employment what plans she has to improve skills training for small firms. [33206]
    Mr. Paice: During the last 18 months both skills for small businesses and the skills challenge have been targeted at small businesses. Two weeks ago, we announced further measures to simplify and improve our small business support.
    Mr. Ainsworth: The Minister should be aware that representatives of both the construction and the construction engineering industry have recently been quite scathing about the Government's inability to provide training for small businesses in those sectors. I hope that he will also know that the Select Committee on Trade and Industry recently said that the Government appeared to have no framework for training targeted at small businesses. Is that not disgraceful, given that the Government have lectured us for so long about the importance of small and medium enterprises? When will we hear a little less rhetoric, and see a little action to provide the training that is necessary if small enterprises are to succeed?
    Mr. Paice: I find it fascinating that the hon. Gentleman quotes the two industries that still retain statutory training boards, which I thought the Labour party always espoused. The statutory boards for the construction and engineering construction industries are responsible for designing policy. As to the future, I said in my first reply that the Government have helped thousands and thousands of small firms through the skills for small businesses support scheme. The skills challenge that we ran last year also enjoyed massive support, and the benefits will be

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    immediately available to the thousands of firms that were involved. The same information will be available to help other small businesses. I remind the hon. Gentleman that nearly one half of all the companies in this country that are committed to the Investors in People standard have fewer than 50 employees.
    Mr. Ainsworth indicated dissent.
    Mr. Paice: The hon. Gentleman shakes his head, but those are the facts and he should take them on board. The Government have a proud record of helping small businesses in training.
    Mr. Spring: Is my hon. Friend aware of the enormous increase in upgrading skills across the small business community in my constituency, as we know from the Small Business Bureau analysis? The total number of organisations involved in the Investors in People initiative is 22,000, of which nearly half employ fewer than 50 people.
    Mr. Paice: My hon. Friend is a champion in the House for small businesses not only in his constituency but throughout the country. He is right to emphasise the importance of the Investors in People standard, which is the most appropriate lever for promoting training in businesses of all sizes. In most cases, the problem is not funding but helping small businesses to make time available and acquire the motivation for training. The usual response from the small business man is, "I am too busy running my business." The Government's policies are aimed at addressing that situation.
    Mr. Byers: Can the Minister confirm that more than half the work force are in firms with fewer than 100 employees? Given the significance of that sector of the labour market, will the Minister explain why, under the Government's public expenditure plans, the small business budget is to be cut next year? Given also the real difficulties that small firms have in training employees, why do not the Government adopt Labour's proposals to target financial assistance on small firms, so that they can be part of the skills revolution that the country needs?
    Mr. Paice: The majority of people work for businesses with more than 50 employees, which is why our lifetime learning targets—as part of our national education and training targets—are aimed at that size of business and beyond. That is the way to connect with the large number of people working in sizeable businesses and helping the majority of employees. The hon. Gentleman suggests that the Government should copy Labour party policies. If he thinks that we are going to introduce compulsion, which is Labour's policy for small businesses, so that young people will be let off and sent to college—
    Mr. Blunkett: Yes, in the case of 16 and 17-year-olds.
    Mr. Paice: The hon. Gentleman says yes. Labour would require small firms—not encourage or persuade—under threat, to let young people go to college. That would destroy employment opportunities for tens of thousands, if not hundreds of thousands, of young people.

    State Schools
    Mr. Pawsey: To ask the Secretary of State for Education and Employment what actions her Department has taken since 1988 to improve the quality of education in state schools; and what further plans she has for improvement. [33207]
    Mrs. Gillian Shephard: The whole thrust of Government policy over the past 16 years has been to raise standards. I have recently announced plans to reform teacher training, improve discipline and promote school self-improvement. Yesterday, we published a White Paper to extend self-government for schools and to increase choice and diversity in our school system, which will also help to raise standards.
    Mr. Pawsey: My right hon. Friend's answer outlined the action taken so far by the Government and the action that they will take when they are re-elected in a few months' time. Will she confirm that the White Paper that she announced yesterday will ensure the transfer of more than £1 billion from local education authority administration to the classroom, give parents and schools much greater choice and allow the emergence of additional technical schools?
    Mrs. Shephard: I can indeed confirm that the White Paper will extend independence for schools, freedom for grant-maintained schools and choice for parents. An additional £1.3 billion will be delegated to schools, giving them more control over what they do. I confirm that the White Paper proposes a welcome expansion in the very successful programme for specialist schools and colleges.
    Mr. Don Foster: Does the Secretary of State agree that accurate methods of measuring performance will have to be in place before the Department for Education and Employment can claim that its measures have led to improvements in education? In that context, does she agree that standard assessment tasks would be an inappropriate measure, given the uncertainty about the definition of the various levels of SATs and the recent changes in the SATs marking system?
    Mrs. Shephard: The School Curriculum and Assessment Authority has been redefining levels with schools and teacher associations. It is very important that all such matters are taken seriously—the SCAA is certainly doing so—because test marking must be entirely consistent. That is in hand, there is no problem and the work is continuing.
    Mr. Dunn: Will my right hon. Friend confirm that we are now witnessing the final destruction of social engineering in education? Will she further confirm that we are about the elimination of Stalinism in local education? Finally, will she confirm that we are about maximising choice and exposing the hypocrisy of those who say one thing and do another?
    Mrs. Shephard: I certainly confirm that we are seeing the end of Stalinism, and very welcome that is, too. I remind my hon. Friend, although he needs no reminding, that the pathetic and backward-looking response of Opposition Members yesterday to our proposals to provide for the

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    aspirations and ambitions of parents and children—by increasing independence for schools and choice for parents—showed that their ideas are indeed stuck in the time warp so clearly defined by my hon. Friend.
    Ms Hodge: Will the Secretary of State confirm that when she was asked about selection procedures in secondary education at a meeting with the National Union of Teachers in Norfolk in 1994—after she had become Secretary of State—she said:
    "nothing would change while I'm in charge"?
    Yes or no?
    Mrs. Shephard: The hon. Lady has been most assiduous in her researches. She might be better advised to get on with what I understand to be her allotted task of preparing Labour's policy on nursery education, which is a long time appearing. I advise her to concentrate on her day job.
    Mr. Brazier: My right hon. Friend's recent proposals on discipline, designed to improve the quality of state schools, were especially welcome. Are not her proposed measures to return to teachers the power to discipline unruly pupils, with or without the consent of their parents, absolutely essential and welcome?
    Mrs. Shephard: They are indeed essential, and since being elected my hon. Friend has been most assiduous in pursuing that cause. He will therefore welcome our proposals, which we shall enact if parliamentary time allows, to support teachers in the classroom.
    Mr. Kilfoyle: Given the Secretary of State's newly found enthusiasm for secondary modern schools in every town, will she tell the House whether the Chancellor of the Exchequer has agreed the estimated £2 billion extra cost of the Prime Minister's pipe dreams, whether she has assessed their impact on surplus places in our schools and why she remains obsessed with structure when the country is crying out for the raising of standards in education? Are not the Government's education proposals about as much use as a chocolate fireguard?
    Mrs. Shephard: The hon. Gentleman is never short of a colourful phrase or two. I remind him that if structures increase the independence of schools and increase choice and diversity, they can contribute to the raising of standards.
    I made the position on costing absolutely clear yesterday. The hon. Gentleman and his hon. Friends cannot have it both ways. They are either in favour or more independence for schools and more choice for parents, in which case they should support our policies, and in particular yesterday's White Paper, or they are not, in which case they should condemn those members of their Front Bench who not only support our policies, but take advantage of them for their own children.

    Schools (Selection)
    Mr. French: To ask the Secretary of State for Education and Employment what representations she has received regarding selection in schools. [33208]
    Mrs. Gillan: My right hon. Friend receives frequent representations about all aspects of school admissions and organisation.
    Mr. French: Is my hon. Friend aware that Gloucestershire never abandoned selection or grammar
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    schools, despite the most vigorous and determined opposition to them and the absolute determination of the Labour and Liberal Democrat parties to bring about their abolition? Is she further aware that the result has been highly motivated pupils and a very high academic attainment, which applies to pupils who have been selected and those who have not?
    Mrs. Gillan: My hon. Friend is absolutely right. Where grammar schools have been retained, the standard of education is high. The Conservative party has clearly laid out its plans in the White Paper. The Conservative party is the party of choice. Of course, the Labour party has always had choice—the choice to support the national curriculum, the choice to support testing, the choice to support inspection and the choice to support the raising of standards, but it has chosen not to support those excellent changes.
    Mr. Barnes: Why has the Secretary of State changed her mind about selection since her statement in 1994?
    Mrs. Gillan: It is typical of Labour Members to keep harking back to something that occurred 20 years ago—[HON. MEMBERS: "Two years."] Their policies are 20 years old and their thinking on education is from Neanderthal times.

    Local Education Authorities
    Sir Michael Marshall: To ask the Secretary of State for Education and Employment if she will list the 10 worst-performing local education authorities on the basis of national examination results. [33209]
    Mr. Paice: The 10 local education authority areas with the lowest percentage of 15-year-old pupils achieving five or more A to C grades at GCSE were Islington, Knowsley, Tower Hamlets, Southwark, Manchester, Lambeth, Newham, Hackney, Liverpool and Sandwell.
    Sir Michael Marshall: In that sad picture—sad for the parents and sad for the children involved—what common feature does my hon. Friend detect? Would I be right to assume that none of those authorities is Conservative controlled?
    Mr. Paice: My hon. Friend is right. Of course none of those authorities is Conservative controlled—none of them has been for some considerable time. That is the common theme that he rightly identified. It is Labour, in reality, in control of education. Those authorities have been controlled by the Labour party—with a little help from the Liberal Democrats in a couple of cases—for many years. That is why they are consistently at or near the bottom of the table on education standards. That is the reality, not the pious words of the Labour party. If people want to see what Labour is really like in control of education, they need only look at those authorities.
    Mr. Eastham: Is it not extremely dishonest of the Minister to draw comparisons with inner-city authorities, which have a high incidence of immigrant children whose first language is not English, when the Government are cutting section 11 funding to assist such pupils?
    Mr. Paice: Most inner-city authorities are spending vastly more than the national average. Indeed, Lambeth is

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    at the top of the spending tree for primary schools and second from the top for secondary schools. The tables that we publish demonstrate that there is no correlation between pupils' achievements and the money being spent on them by wasteful authorities.
    Mr. Day: Am I right to believe that the Labour authorities that rank in the bottom 10 are wedded to the principles of so-called progressive education, which have led to the destruction of such vital assets in schools as competitive sport, and believe that schools cannot produce pupils who could be classified as winners? In many schools, entire classes of losers have therefore been produced, which is not in the pupils' best interests and destroys opportunities for pupils of all abilities.
    Mr. Paice: My hon. Friend is entirely right. The authorities that, sadly, have been controlled by Opposition parties for many years have consistently promoted forms of education that have now been proven to fail pupils. They adopt allegedly "progressive" methods—if ever there was an abuse of a term, that is it. Such methods have destroyed young people's opportunities. Nobody could take any pleasure or pride from the fact that only 17.4 per cent. of pupils in Islington and 19 per cent. in Knowsley are gaining five or more GCSEs, but, somehow, the Opposition try to do so.
    Ms Estelle Morris: Does the Minister share my concern that figures given to me in a written answer this morning show quite clearly that, last year, Tory-controlled Westminster increased its spending on bureaucracy so that it spends more than any other local authority in the country? Will he join me in congratulating Labour local authorities such as Sheffield and Birmingham, which last year further reduced the amount spent on bureaucracy and now spend less than half that spent by Tory-controlled Westminster?
    Mr. Paice: I am always glad to be asked a question by a former grammar school pupil, especially in the light of the allegations made yesterday about my right hon. Friend the Secretary of State's policies. Westminster achieves the best results of any inner-London borough, of which the Government and the Conservative party are very proud.
    Mr. Harry Greenway: Will my hon. Friend confirm that some lucky pupils in those very badly run authorities have assisted places at independent schools? Is it not a disgrace that the Labour party runs those authorities and many others so badly that it denies poor children proper opportunities, as it will by trying to abolish the assisted places scheme? That is typical of the Labour party.
    Mr. Paice: Given his knowledge of these matters, nothing should surprise my hon. Friend. It should not surprise him that Labour Members are intent on removing the ladder up which most of them climbed—the ladder of grammar or direct grant schools, which many attended. Indeed, earlier we listened to constant sedentary comments from a very prominent former grammar school pupil, the hon. Member for Bolsover (Mr. Skinner). [Interruption.] I do not like to be provocative. My hon. Friend should also take into account the fact that those authorities' failures extend not only to examination results; six of them are also among the 10 worst authorities for truancy.

    Grammar Schools
    Mr. Mudie: To ask the Secretary of State for Education and Employment when she estimates there will be a grammar school in every town. [33210]
    Mrs. Gillan: Grammar schools have a proud tradition of helping the most able children to achieve their full potential. We want to encourage the establishment of more of them, as part of a spectrum that allows parents to choose the schooling that best matches their children's abilities and needs. The measures in the White Paper, "Self-government for schools", that we published yesterday will make it easier for grammar schools to be set up wherever that is what parents and schools want.
    Mr. Mudie: The Minister will be aware that the public response to the White Paper was that it is a sham, designed to fool the policy unit at No. 10 rather than being relevant to the needs of the majority of schoolchildren in Britain. If the Minister disagrees, and we are to take seriously the Government's proposal that there should be a grammar school in every town, will she say how many she expects there will be—first, before the general election and, secondly, before the millennium? Finally, let me raise a matter that was significant by its omission from yesterday's White Paper: how much new money has the Department been promised to create those new grammar schools?
    Mrs. Gillan: The hon. Gentleman will have to read the White Paper again as he obviously does not understand it. The Government want to establish a range of schools to match children's varied talents, interests and needs. Grammar schools and other selective schools are an essential part of that range, but we are giving local communities the opportunity to decide whether they want a grammar school. I refer him to a recent survey commissioned by the Association of Teachers and Lecturers. It found that 54 per cent. of parents were in favour of a return to a fully selective education system. I would also draw his attention to headlines in newspapers such as, "Give us more grammar schools".
    Mr. Hawkins: My hon. Friend will know that I have campaigned for the expansion of grammar schools for the past 23 years, ever since direct grant grammar schools such as the one that I was lucky enough to attend were destroyed by doctrinaire, narrow-minded socialist ideology. Does she agree that Labour's hypocrisy is especially shown by Opposition Front Benchers, who have so little faith in Labour local authorities such as the one that the hon. Member for Barking (Ms Hodge) used to lead that they do not send their children to schools in those authorities but take advantage of Conservative policies of choice and diversity?
    Mrs. Gillan: I look no further than the Labour Front Bench to see the success of our education policies. The hon. Member for Peckham (Ms Harman) and the right hon. Member for Sedgefield (Mr. Blair) could give many other Labour Members a private tutorial.

    Head Teachers (Retirement)
    Mr. Spearing: To ask the Secretary of State for Education and Employment what study she has made of the reasons for early retirement of head teachers. [33211]
    Mr. Forth: My right hon. Friend has made no study of the reasons for early retirement of head teachers. She is, however, considering the issue of early retirement for all teachers following a recent report of the Public Accounts Committee.
    Mr. Spearing: Was it not the duty of the Secretary of State to have done that some time ago, bearing in mind the reports from professional associations of rapidly rising early retirement through stress? Is not the task of a head teacher to assemble the appropriate educational offering for all pupils in the school, for which he should be provided with the resources so to do? Have not the Government's changes turned head teachers virtually into business managers, dealing with a variety of issues that are extraneous to education? Does that not prejudice the quality of teaching and education and affect the standards that are attained and are constantly on the lips of Ministers and Conservative Members?
    Mr. Forth: The hon. Gentleman, rather uncharacteristically, has departed from the factual background to his question. He should consider the fact that only 2.3 per cent. of heads and 1.5 per cent. of deputies retired on ill-health grounds in 1994–95. That is hardly a torrent or a flood. He should also bear in mind the fact that the increasing rates of ill-health retirement in teaching are below those in the health service or even the civil service. That hardly suggests that head teachers are peculiarly stressed or are retiring earlier than anyone else. I repeat that the Secretary of State will examine the subject of early retirement from teaching. Presumably, that will encompass heads.
    Mr. Duncan Smith: When my hon. Friend looks in detail at the figures, will he bear in mind the fact that as we have now released schools from complete political control through local management of schools—and, ultimately, through the grant-maintained system—we are at last offering to those who aspire to be head teachers and to those who are head teachers the opportunity to run their schools for the benefit of the pupils? Essentially, that means that heads will be better off, will enjoy their job and will get greater job satisfaction. Are they not therefore more likely to stay for longer than those who wish to retire now?
    Mr. Forth: How typical of my hon. Friend to encapsulate the difference in attitude between the Government and the Opposition. He rightly identified the opportunities available to heads the better to run their schools, while Opposition Members saw it as a matter of stress and a disadvantage. There could not be a clearer difference.

    Nursery Voucher Scheme
    Mrs. Helen Jackson: To ask the Secretary of State for Education and Employment what plans she has to extend the nursery voucher pilot schemes to other areas. [33212]
    Mr. Robin Squire: Our plans for nursery education vouchers are transparently well known. We expect to extend the voucher scheme to all local education authority areas in England in April 1997.
    Mrs. Jackson: In consultations with parents of nursery children in my constituency, I have found not one who wants the system of nursery vouchers foisted upon my area. Will he accept the sensible amendment accepted in the other place two weeks ago, whereby the pilot schemes for young guinea pigs in Wandsworth, Westminster, Norfolk and Kensington would be properly evaluated by the House before being extended?
    Mr. Squire: We are, naturally, considering the matter in light of the vote in the other place, but we remain confident that the scheme has many attractions for parents. I hope that when the hon. Lady next meets parents she will point out to them the result of the survey of parents in phase 1 areas, which disclosed that 87 per cent. of Norfolk parents already rate the scheme as very good or quite good. The chief executive of the Pre-school Learning Alliance, which represents some 20,000 voluntary groups across the country, spoke the truth when he said that the House of Lords had got it wrong and that at least 200,000 young children would lose out as a result.
    Mr. Bellingham: Is my hon. Friend aware that the scheme has met with great approval in Norfolk and that, in my constituency, the figure of 87 per cent. is probably an underestimate? Is he further aware that parents are very pleased, in spite of the great reservations expressed by the Labour establishment in Norfolk and elsewhere? Will the Norfolk schools that would have liked a nursery school project this year be given every possibility of getting one next year?
    Mr. Squire: I congratulate my hon. Friend on his last question, but he will understand if I cannot give him that commitment this afternoon. The structure and sense of his comments is absolutely right, and his findings in Norfolk are reflected in each of the phase 1 authorities. The only danger is not the scheme itself but the distortions spread by Opposition Members.
    Mr. Blunkett: Will the junior Minister tell us why, in her letter to the Leader of the House, the Secretary of State for Education and Employment stated that she thought that she would experience greater difficulty overturning the amendment in the Commons?
    Mr. Squire: Much as the Government's commitment to open government becomes more apparent week by week, I hesitate to embrace these discussions on the Floor of the Chamber. Labour has no policy on nursery education, despite 17 years in opposition in which to plan for one. All Labour is prepared to do is to seek to frustrate the expansion of a scheme to provide quality nursery provision across the country. Labour should be ashamed

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    of itself. To use the vernacular that is appropriate today, even if there is extra time in this area, there are no golden goals for Labour—there are only penalties for parents across the country.
    Mr. Jacques Arnold: What does my hon. Friend think has been said to the parents of children who are on the waiting lists, without much hope, of the state nursery units in Sheffield? Why has not the hon. Member concerned met them?
    Mr. Squire: My hon. Friend is right. If only Opposition Members, including those representing Sheffield, would give the same consideration to spreading the range of choice of pre-school provision that the Government are delivering, matters would proceed more smoothly and parents would be the gainers.

    EU Social Affairs Council
    Ms Quin: To ask the Secretary of State for Education and Employment when she next expects to attend a meeting of the EU Social Affairs Council; and what matters relating to working conditions she expects to be discussed. [33213]
    Mr. Forth: The next meeting of the Social Affairs Council is scheduled for 24 September. No agenda has yet been agreed, but I shall seek to ensure that the focus is on providing the environment to reduce unemployment and not on agreeing unnecessary, new and damaging European legislation. In the European Union, we want to make sure that there is a level playing field in the single market, an impartial referee in the European Court of Justice and no own goals to handicap our global competitiveness.
    Ms Quin: Has the Minister noticed that the principal employment policy adviser of the Confederation of British Industry recommends that the British Government end their opt out from the social chapter? How does he explain to his European counterparts the fact that British industry is increasingly ignoring Government advice on the subject?
    Mr. Forth: I wonder whether that would be the same adviser who advised entering the exchange rate mechanism. If so, we can safely discard the advice.
    Lady Olga Maitland: Will my hon. Friend confirm that he has no intention of accepting the social chapter and the minimum wage? Does he agree that those factors above all else have caused high youth unemployment in other European countries, whereas our young people have far better life chances and a better chance of getting jobs?
    Mr. Forth: My hon. Friend is right. To keep faith with our young people—happily, our youth unemployment rate is significantly lower than that of most of our partners and competitors—we must ensure that we do not embrace policies that will prejudice youth employment. We find it hard to understand how Opposition Members claim to be concerned about youth unemployment when all the policies that they would adopt would force it up.
    Mr. Meacher: If European social market legislation is so damaging, will the Minister explain why 90 per cent.
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    of that legislation was passed into British law by his Government before the social chapter was heard of in 1993? How can the social chapter be so damaging when only one measure—the European works directive—has been passed under it since 1993? Even in that case, the 140 British companies affected by the opt-out all later decided voluntarily to opt in. As the evidence shows that the member states with the best social provision are also those with the most competitive and productive economies, is not all the claptrap about the social chapter merely a cheap Tory pre-election stunt?
    Mr. Forth: I was trying to find something of substance in the hon. Gentleman's question. I think that I stumbled on one thing that he accidentally said that illustrates clearly the difference between our parties. The fact that businesses agree to do something voluntarily is entirely a matter for them. The difference is that we would not unnecessarily force something on businesses whereas his philosophy—old Labour personified—is to force businesses to do what he thinks is good for them. We recognise their freedom of choice.
    Mr. Sykes: Will my hon. Friend the Minister tell the Council, the hon. Member for Oldham, West (Mr. Meacher) and Opposition Members that factories such as mine in north Yorkshire have to work when the work is there, not when some Greek Commissioner says that it is there? If we were saddled with the 48-hour week, we would lose orders and have to lay men off. What is he going to do about the 48-hour week? Will he compare the Government's approach with the spineless attitude of the Labour party to such matters?
    Mr. Forth: My hon. Friend, who knows about these things, is right to put his finger on the fact that measures that seek arbitrarily to limit the reasonable and realistic action of businesses are likely to prejudice the competitiveness of the European Union as a whole. As a member of that Union, that concerns us. We want Europe and Britain to be globally competitive; that is where jobs and wealth come from. Any measure that seeks arbitrarily and unthinkingly to trammel competitiveness is likely to prejudice our opportunities. The Government are examining carefully the directive that he mentioned and will respond in a proper way in due course.

    Jobseeker's Allowance
    Mr. Burden: To ask the Secretary of State for Education and Employment if she will make a statement on the future of the mechanisms in respect of the jobseeker's allowance administered by her Department. [33214]
    Mr. Forth: The mechanisms necessary for delivery of the jobseeker's allowance will be in place by 7 October 1996 and reviewed as necessary thereafter.
    Mr. Burden: The Minister is surely aware that in the first year of the jobseeker's allowance it is estimated that 90,000 people will lose all their entitlement to benefit and that about 150,000 will lose part of their entitlement. Is the Minister familiar with the term "social insurance" and, if so, what would he say about a private insurance company that collected contributions on one basis then, without asking the customer, cut the benefits? Would not

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    he urge that customer to seek the advice of a solicitor against that private insurance company operating under false pretences? Why does not he operate the same standards for his own Government?
    Mr. Forth: The hon. Gentleman must occupy a peculiar world if he believes that every entitlement and
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    every benefit that has ever existed could never be changed in one direction or another. If he looks back at the record of the previous Labour Government, however long ago it may be now, he will find that that Government felt quite free to change entitlements, usually for the worse, for a large number of people, so I do not even understand the basis of his question.

First Scottish Standing Committee
3.30 pm
Mr. Michael J. Martin: On a point of order, Madam Speaker, of which you have been given notice.
It is my unpleasant duty to inform the House that, at the meeting of the First Scottish Standing Committee yesterday afternoon, I drew attention to the presence of roseanna Cunningham, the Member for Perth and Kinross, Mrs. Margaret Ewing, the Member for Moray, and Mr. Alex Salmond, the Member for Banff and Buchan, not being members of the Committee, in the part of the Committee Room reserved for the members of the Committee; and the hon. Members having declined to withdraw, the Committee ordered
That the Chairman do report roseanna Cunningham, Mrs. Margaret Ewing and Mr. Alex Salmond to the House.
Madam Speaker: I understand that the Leader of the House intends to move a motion relating to privilege.
Motion made, and Question proposed,
That the Chairman of the First Scottish Standing Committee, appointed in respect of the Education (Scotland) Bill [Lords], shall have power to order any Member who is not a member of the Committee to withdraw immediately from the Committee Room and the Serjeant at Arms shall act on such orders as he may receive from the Chairman in pursuance of this order.—[Mr. Newton.]
3.32 pm
Mr. Alex Salmond: The motion before us is to give the Chairman of the Scottish Standing Committee powers. My argument is that the House should not give the hon. Gentleman such powers, certainly not until such time as the House has debated the issue of the conduct of Scottish business, which has been a running sore in the House for many years.
I intend to be brief, not just to stay within the rules of order, but also because I would not dream of depriving English Members of their right to watch the semi-final of the European championships later this evening.
I start by pointing out some of the precedents for motions such as this, some of which might surprise many hon. Members—because, from time to time during the past 20 years, every Opposition party has been involved in similar circumstances.
The first precedent I want to consider was in 1972 during consideration of the Local Government (Scotland) Bill, when three Liberal Members of Parliament and three Labour Members of Parliament, two of them still distinguished Members of the House, went on to the Committee although they were not members of it.
The Members concerned were the hon. Member for Inverness, Nairn and Lochaber (Sir R. Johnston), the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), the former leader of the Liberal Democrats, the late Jo Grimond, the late John Mackintosh, the late John Robertson and the late Tom Oswald.
In conversation with the hon. Member for Inverness, Nairn and Lochaber last evening, I reminded him of the precedent, and he remarked to me that that was something that he did as a younger Member of the House. I must take some comfort from the fact that perhaps that implies that I could still be classified as a younger Member.
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Those Members in 1972 challenged the fact that Members from Scottish constituencies were not given the facility of serving on a Committee examining an extremely important Bill.
During the first sitting of the Standing Committee scrutinising the Housing (Scotland) Bill in 1988, the hon. Member for Falkirk, West (Mr. Canavan), still a Member of this House, interrupted the proceedings; the hon. Member for Glasgow, Springburn (Mr. Martin) was also in the Chair on that occasion. Although the Committee was suspended twice, the hon. Member for Springburn did not seek leave on that occasion to bring a motion before the House, and there was no debate in the House.
The argument used at the time by the hon. Member for Falkirk, West was that he was affronted by the fact that Members less qualified than he, from English constituencies, were allowed to debate and decide on Scottish matters, whereas he, a Scottish Member with suitable qualifications, was excluded.
Several hon. Members rose—
Mr. Salmond: It seems that I have quite a choice.
Mr. Anthony Coombs: If the hon. Gentleman's objection is that English Members may vote on the Education (Scotland) Bill, was it inconsistency or hypocrisy that led him and his Scottish National party colleagues to see fit to vote on the Nursery Education and Grant-Maintained Schools Bill recently, even though it applied only to England and Wales?
Mr. Salmond: Before I answer that, I must correct the hon. Gentleman on one point. I am not objecting to English Members serving on Scottish Standing Committees. I object to Members from English constituencies serving on them—[Interruption.]—an important difference, which the hon. Gentleman does not seem to appreciate. Many Members who represent English constituencies are Scots, and some Scottish constituencies are represented by English Members.
Mr. Coombs: Answer the question.
Mr. Salmond: I am making the point that people who serve on Standing Committees should have a responsibility to their constituents. Members without a single affected constituent can, it seems, decide key areas of Scottish business.
Mr. Michael J.Martin rose—
Mr. Salmond: In a minute.
Mr. Coombs rose—
Mr. Salmond: I do not want to have to appeal to the Chair for protection, but Conservative Members should learn to conduct themselves in an orderly fashion. When I have finished answering the hon. Gentleman, I shall gladly give way to the Chairman of the Committee.
The former, an experienced Member of this House, should know that my colleagues and I make it our practice not to interfere in English business. The most recent example of that was the Family Law Bill. If the hon.

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Gentleman checks the record, he will find that none of us voted on that measure, because it concerned specifically English business. It was, however, quite clear that the nursery vouchers Bill for England was going to be used to pave the way for nursery vouchers in Scotland.
Mr. Michael J. Martin: I should point out for the record that, when the Committee was reconvened and my hon. Friend the Member for Falkirk, West (Mr. Canavan) was present again, I asked him to leave, and he left. So there was no need to come to the House to seek any powers. I say this just in case the hon. Gentleman is implying that he has received different treatment.
Mr. Salmond: The hon. Gentleman should check the record, which he may not have with him at the moment. I remind him that he twice suspended that Committee, and then suspended it until the following Thursday. The Committee did not sit on the day in question, because the hon. Member for Falkirk, West was still in his place. The date was 19 January 1988, so the hon. Gentleman should check the record—
Mr. Martin rose—
Mr. Salmond: Far be it from me—[Interruption.]
Several hon. Members rose—
Madam Speaker: Order. Mr. Salmond has the Floor.
Mr. Martin rose—
Madam Speaker: Order. The hon. Member for Banff and Buchan (Mr. Salmond) has the Floor, unless he gives way.
Mr. Salmond: I will not give way to the hon. Member for Springburn until I answer his question. The hon. Gentleman should note that, on 19 January 1988, the first sitting of the Scottish Standing Committee could not go ahead because the hon. Member for Falkirk, West did not leave the Committee. I understand that the Chairman of the Committee suspended the sitting until the following Thursday, but did not move a motion to report the hon. Member to the Floor of the House. Perhaps the hon. Gentleman has other information.
Mr. Martin: I shall put it on the record again: the hon. Gentleman turned up on the following Tuesday. I know that, because we shared an office at the time. I told him that I was going to chair the Committee, and he said that he was going to come and sit there. He turned up on the Tuesday, made a protest, left to go to another Committee meeting, and it was all over.
Mr. Salmond: I think the hon. Gentleman should check the record-he will find that the Committee had to be postponed until the following Thursday. Perhaps, if I shared an office with the hon. Gentleman, I would not be standing here debating these matters on the Floor of the House.
Mr. George Foulkes rose—
Mr. Salmond: I have already referred to two precedents, and before I give way to the hon. Gentleman, I shall refer to two more.
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The third precedent is the Self-Governing Schools Etc. (Scotland) Bill in 1989. Again, the Scottish Standing Committee was interrupted by me, by my hon. Friend the Member for Angus, East (Mr. Welsh) and by the then hon. Member for Glasgow, Govan. We advanced the same argument: Members less qualified than Scottish Members were able to sit and determine Scottish business.
Several hon. Members rose—
Mr. Salmond: Again, I am spoilt for choice, but I think I should finish referring to my precedents before I give way to hon. Members.
The fourth precedent is the Local Government Etc. (Scotland) Bill in 1994. Again, the Scottish Standing Committee underwent the exact same process, and yet again there was a debate on the Floor of the House.
My point is simple: these examples show that, concerning members across the Opposition parties, there is a running sore in the conduct of Scottish business. At various times and on various issues, Opposition Members have found it unacceptable that Members from English constituencies have been able to determine matters that they could not determine.
Mr. Foulkes: I understand the point that the hon. Gentleman is making. I am thinking back to when the House constituted the Scottish Standing Committee. I do not remember the hon. Gentleman or either of his two colleagues seeking to serve on the Committee. Did he ask to serve on the Standing Committee? In fact, will he remind the House whether he has ever served on a Standing Committee?
Mr. Salmond: As the record will show, I have volunteered to serve on Standing Committees on Scottish business on every major piece of legislation. My difficulty has been getting on to the Committees—even if sometimes I am ejected from them.
Mr. Foulkes: No, no.
Mr. Salmond: The hon. Gentleman says, "No, no." I remember a case when the hon. Member said that he was going to play Parnell with the House of Commons— that he would stand before the Mace. If the hon. Gentleman was still before the Mace, he would be kneeling, not standing.
Before we give powers to the Chairman of the Committee, there should be a substantive debate on the conduct of Scottish business, so that all these issues can be ventilated—so that we can decide whether it is appropriate for Scottish Members, who are responsible to their constituents, to effect these matters on Standing Committees.
Mr. Robert G. Hughes: Will the hon. Gentleman be specific in his answer to the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes)? Did the hon. Gentleman, the hon. Member for Moray (Mrs. Ewing) and the hon. Member for Perth and Kinross (Ms Cunningham) write to the Chairman of the Committee of Selection asking to be on this Committee? Yes or no?
Mr. Salmond: If the hon. Member can guarantee me that a letter to the Chairman of the Committee of Selection

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will result in me and my hon. Friends being offered an opportunity to serve on these Committees, I will gladly write such letters.
Mr. Andrew Welsh: I am sure that my hon. Friends have been happy to serve on Standing Committees. Does the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) speak for Labour Front Benchers in offering us places on the Standing Committees? As he knows, the places are carved up by the Front Benchers.
Mr. Salmond: In my attendance at the First Scottish Standing Committee yesterday morning, I noted the degree of co-operation between the Labour and Tory parties. I have not witnessed that degree of connivance in any other Committee—or across the Floor of the House, despite the usual channels.
My argument is that we should not give the Chairman powers until there has been a substantive debate on the conduct of Scottish business. Two important precedents should give us cause to consider that point seriously. The first is the question of Welsh business.
A Standing Order of the House allows every Welsh Member to sit on Welsh Standing Committees. I understand that that Standing Order was introduced in the early years of this century. Is not there a valid argument, even in the confines of the unitary Parliament in which so many hon. Members believe, to improve the conduct of Scottish business and grant the same facility as exists for Welsh business?
Mr. Dafydd Wigley: I am grateful to my hon. Friend. Since 1907, Standing Order No. 86 has allowed every Welsh Member to sit on the Standing Committee of a Bill that deals exclusively with Wales. But, as my hon. Friend will understand, the reality is that, as soon as that Standing Order comes into play—for example, during consideration of the Welsh Language Act 1993 and the Local Government (Wales) Act 1994—the Government move a motion to abolish its powers. In reality, a majority of English Tory Members told us what to do about the Welsh language and local government in Wales.
Mr. Salmond: The point made by the hon. Gentleman is well taken, and it shows that many hon. Members present, who say that the Standing Orders of the House should be observed, are prepared to reinterpret them flexibly, as the Welsh example shows, when they do not suit the objectives of the governing party.
I know, Madam Speaker, that you have often reminded hon. Members, during Question Time and at other times, that we must be conscious of how our debates look to our constituents and to people outside the House. My strong feeling is that people in Scotland do not understand why Members from English constituencies should determine issues such as Scottish education, nursery vouchers and the compulsory enforcement of testing, against the wishes of the Scottish people.
Under Standing Order No. 86(2), it is doubtful that the hon. Members for Colchester, North (Mr. Jenkin), for Brentford and Isleworth (Mr. Deva) and for Langbaurgh
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(Mr. Bates) should be considered as suitably qualified, not because they are English but because they do not have a single constituent who will be affected by the provisions that are being debated.
I offer one other reason why we should not pass this motion. Last autumn, a facility was introduced to the procedures of the House that we were told would make a substantive change in the way that Scottish business was debated and discussed. My hon. Friends and myself have spent much time, as have other hon. Members on the Grand Committee, visiting various airts and pairts of Scotland on Mondays in the past few months. Indeed, two of my hon. Friends have a 100 per cent. attendance record, a record of which few—probably one or two—Labour or Conservative Members can boast.
My point is that, while the Grand Committee goes on its visitations round Scotland and acts as a mobile press conference for the Secretary of State for Scotland, the real decisions are made in Scottish Standing Committees. They are made not in the Grand Committee by Scottish Members, but in the First Scottish Standing Committee, with a majority secured by the importation of three Members from English constituencies who are the silent majority.
When the Prime Minister speaks this evening about how Scotland gets a good deal in the House of Commons and how the House is sensitive to the conduct of Scottish business, he should answer the substantial charge of hypocrisy. While he makes those comments about sensitivity to Scottish business, he mobilises the majority of English Conservative Members to enforce on Scotland measures that are clearly unwanted by the Scottish people.
Mr. Michael Bates (Lord Commissioner to the Treasury)indicated dissent.
Mr. Salmond: I see that the hon. Member for Langbaurgh is not in full agreement with the points that I have made. I wonder how many times he has explained to his constituents why he spends so much of his valuable parliamentary time forcing unwanted measures on a range of policies on the Scottish people and our constituents. I think that the people of Langbaurgh are entitled to a full-time Member of Parliament, as opposed to one who spends so much time facilitating the conduct of Scottish business.
Several hon. Members rose—
Madam Speaker: Order. Is the hon. Gentleman giving way?
Mr. Salmond: No, Madam Speaker.
Madam Speaker: In that case, the hon. Members must resume their seats.
Mr. Salmond: Despite the precedents to which I have referred, and the fact that hon. Members from all Opposition parties have made similar points—often in the manner in which I have described there are those who would say that seeking to attend Standing Committee meetings against the wishes of the Chairman is not the way to deploy our grievances.

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I noticed that the leader of the Labour party in Scotland, the hon. Member for Hamilton (Mr. Robertson), claimed in today's press that such actions represent a challenge to the sovereignty of the House of Commons. It occurs to me that the hon. Gentleman and all his hon. Friends signed a document, "The Claim of Right", which was a challenge to the sovereignty of the House of Commons.
Mr. Tam Dalyell indicated dissent.
Mr. Salmond: The hon. Gentleman shakes his head, so I assume that he did not sign it.
I have no problem with challenges to the sovereignty of the House of Commons. However, I think that it is interesting that people who sign documents in Scotland are prepared to employ totally different arguments when they are in London.
Mr. Robert Key: The hon. Gentleman said that he would be brief. I am beginning to suspect collusion between the Scottish Nationalists and the Government Front Bench to prevent us from hearing the words of the hon. Member for Peckham (Ms Harman).
Mr. Salmond: I had intended to be brief, so as not to disrupt the hon. Gentleman's viewing of the football semi-final this evening. However, I have been diverted by his intervention and by those of his hon. Friends. My only sin has been to give way too generously to hon. Members, and to expect them to make more substantive points than they have been able to manage.
The conduct of Scottish business in the House would be deployed better if we had a serious debate on the Floor of the House about a specifically Scottish Bill. The legislation under consideration is no ordinary Bill—it is one of the few measures certified by the Chair as a specifically Scottish measure. Under those circumstances, and before we give draconian powers to the Committee Chairman, should we not debate whether such legislation could be facilitated by allowing Scottish Members of Parliament to decide the matter?
Mr. Andrew Faulds: I am grateful to the hon. Gentleman. As a Scot, I have a great deal of fellow feeling for his dissertation. I think that Scotland in these circumstances gets a rough deal, and I hope that that is rectified in future Parliaments. But I have to say, in making a positive and helpful contribution, that it is time the whole question of the composition of Committees was examined profoundly in this House of Commons.
I have been here for 30 years. I have detailed knowledge of a limited number of subjects, but if ever I have applied for a Committee on which I might have made a positive contribution, have I been accepted? I could name the Committees—but I do not want to bore the House. If one's face does not fit, if one is not a mate of the Chairman of the Committee of Selection—and I certainly was not—and if one did not have the right contacts with one's Whips Office—we have all had happy and less happy experiences in the past 30 years—one does not stand much chance of selection. This whole question needs to be profoundly re-examined.
Mr. Salmond: The hon. Gentleman tempts me to stray somewhat wider than the motion under consideration.
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I can understand why many Committees might be somewhat wary of the hon. Gentleman's formidable debating skills and his experience in the House of Commons over many years. He expresses his frustration, and reminds us that it is not only Scottish Members of Parliament who are frustrated in these matters. I am sure that he would be the first to recognise—as he said—that there is a specific matter—
Mr. Jacques Arnold: This is a filibuster.
Mr. Salmond: I have tried to be generous to the hon. Gentleman's colleagues. Every item of Scottish business is not only filibustered but gerrymandered in this place by his right hon. and hon. Friends, who dictate Scottish business against the wishes of the Scottish people.
The Parliamentary Under-Secretary of State for Scotland (Mr. Raymond S. Robertson): I am grateful to the hon. Gentleman for giving way, as I realise that he was about to conclude.
The hon. Gentleman said—and rightly so—that the Bill in question is a purely Scottish measure. Will he go back to the answer that he gave my hon. Friend the Member for Wyre Forest (Mr. Coombs), and say why he voted on an equivalent English Bill, which he said had implications for Scotland? If the Bill that we are debating upstairs in Committee is a purely Scottish measure, what were those implications that were so important that he and his hon. Friends voted?
Mr. Salmond: We received representations from many organisations in Scotland, including the teaching unions, saying that we should take a look at the measure, because, in so many ways, the Minister and the Secretary of State for Scotland were trying to take Scottish education in an anglicised direction. The measures that he supports today in England are exactly the same as the ones that will be introduced in Scotland tomorrow. On that basis, given the representations that were made by the teaching unions and others, we deemed it appropriate to vote against it.
Any examination of the record will show that my hon. Friends and I do not vote on specifically English matters as a matter of course. Indeed, I have been criticised in the House for not exercising a vote on specifically English matters. The Minister should note that, if he wants to anglicise Scottish education, he will have to accept that Scottish Members must take note of what his colleagues are doing south of the border, because what is being done to fragment and divide the education system south of the border is what will be done to fragment and divide it in Scotland later on.
My substantive point is to draw attention to the anomaly whereby specific Scottish business, certified by you, Madam Speaker, is not decided by Scottish Members who are responsible for their constituents. As I have pointed out, there have been many precedents in the past 20 years or so involving hon. Members of all Opposition parties in the House, which shows that we are debating not an isolated incident but a running sore in the way in which the House of Commons debates and takes decisions on Scottish business.
Before Labour Members go into the Government Lobby, they should reflect that, many times, their own constituency Members have made similar points. Surely

349
the House is generous enough, before proceeding with the motion, at least to concede a debate on the substantive concern that all Scottish Members should have about the conduct of Scottish business in this place.
3.57 pm
Mrs. Ann Taylor: I was minded to support the motion of the Leader of the House before I heard the hon. Member for Banff and Buchan (Mr. Salmond). Having heard him, however, I am even more convinced that the motion is absolutely necessary. His speech was extremely revealing, and gave us no good reason to vote against the motion.
I intend to be brief, unlike the hon. Gentleman, because I personally regret the fact that the House has to spend time debating this motion when we could be debating the motion on the health service, which applies to Scotland as well as England. If the hon. Gentleman had read his Order Paper, he would have realised that what he is doing today is ensuring that time is taken from a critical debate on health, which affects Scotland as much as England.
Mr. Salmond: The hon. Lady seems to be suffering from a misapprehension. My hon. Friends and I do not decide when these motions are brought to the Floor of the House. That is a matter for the Leader of the House, no doubt in concert, through the usual channels, with the hon. Lady.
Mrs. Taylor: The hon. Gentleman should have thought about that before he disrupted the Committee yesterday. If he does not know enough about procedure to realise that his actions yesterday would lead to this motion, he is obviously not very well informed on the procedures of the House. It struck me while he was speaking that he had one concern about today, and it was not the health service debate. There is a football match later this evening. If that is his priority, so be it, but I do not think that it is the priority of the people he represents.
Hon. Members take different opportunities to make their points in the House, and it is legitimate that they protest about the activities of the Government or other hon. Members. The House has many procedures and safety valves—points of order and other mechanisms—allowing hon. Members to raise issues, and disruption of a Committee of the kind that we saw yesterday is extremely juvenile behaviour. If hon. Members choose to protest in that way, they must take the consequences, and today's motion is a direct consequence of what happened yesterday.
The hon. Gentleman's argument was strangely convoluted. For instance, he did not say why he had chosen to disrupt that particular Committee at that particular time, rather than disrupting any other Committee dealing with Scottish affairs. If he were consistent, he would disrupt every Committee of which he is not a member—I gather that there are quite a lot of those.
Moreover, if the hon. Gentleman was so worried about the membership of the Committee, why did it take him six sittings to work out that it included three English Conservative Members? What was he doing during all that time? I have not followed the Committee's proceedings very carefully, but I do not imagine that the English Conservative Members were making a tremendous contribution. Nevertheless, I would have expected the hon. Gentleman to notice their presence before now.
350
As for the interest that the hon. Gentleman and his two hon. Friends have taken in the Bill, I note that, on Second Reading of the Bill, a succession of Labour Back Benchers spoke, one after the other. I do not think that you, Madam Speaker, would have called them if members of other parties had sought to catch your eye. I think we can be certain that this was no more than a simple device.
Mr. Salmond: My hon. Friend the Member for Angus, East (Mr. Welsh) spoke on Second Reading. But am I right in thinking that the Labour party did not vote against Second Reading, although both the Liberals and the SNP did so?
Mrs. Taylor: Again, the hon. Gentleman should do his homework. He should remember the reasoned amendment we tabled on that occasion. As for the fact that one member of the Scottish National party spoke, what a big deal! After all, the measure affected Scotland, and, as I have said, there was scope for other hon. Members to intervene. There was a succession of Labour speakers; had members of other parties wished to speak, they could have caught the Speaker's eye.
I am pleased to note that the hon. Gentleman has decided that in future he wishes to participate in Standing Committee sittings. It has been brought to my attention that, since he entered the House in the 1987–88 Session, there have been 51 Standing Committees on Bills affecting Scottish legislation, which have had 227 sittings. The hon. Gentleman is so keen on contributing to discussion of such affairs that he has managed to attend one sitting of one Committee.
I am afraid that the record of the hon. Gentleman's party is not always terribly good. No member of the SNP could find time to serve on the Committee considering the Deer Bill—enacted in 1991—the last for which membership was requested. The real problem is that my hon. Friends were doing far too well on the Standing Committee for the Scottish nationalists' liking. The Scottish nationalists were making no substantial contribution. Their tactics were wrong, and they had no real ideas about the legislation. In order to mask their ineffectiveness, they staged a silly juvenile prank. I do not believe that the House will, on this occasion, have any sympathy with the hon. Member for Banff and Buchan and his colleagues. They were foolish yesterday, and they must accept the consequences.
4.4 pm
Mr. Bill Walker: I rise to support my right hon. Friend's motion, and the House may well ask why—[HON. MEMBERS: "NO."]—a Scottish Member of Parliament, having listened to the tirade from the hon. Member for Banff and Buchan (Mr. Salmond), would do so. We must support the Chairs of Standing Committees. The Chair of a Standing Committee has the onerous task of ensuring that legislation proceeds in an orderly manner. The hon. Member for Banff and Buchan made a revealing speech, and the hon. Member for Dewsbury (Mrs. Taylor) added to the revelations.
It is interesting that some hon. Members do not serve on Standing Committees and give their service to the House, but not surprising, because they do everything they can to undermine the House and its workings. The

351
Scottish National party is all about doing that. The actions of SNP Members yesterday were designed to produce this debate, and for them to pretend otherwise is humbug.
Mr. John Home Robertson: I do not believe that the House wants to take lectures from the hon. Member for North Tayside (Mr. Walker) about humbug. Perhaps the hon. Gentleman will cast his mind back to the last Parliament, when he single-handedly prevented a Scottish Select Committee being established to monitor the work of the Scottish Office during the whole of that Parliament. If the hon. Gentleman is so loyal to the Chairs of Committees, why is he not backing the Chairman of the Select Committee on Scottish Affairs?
Mr. Walker: I would have preferred the hon. Gentleman not to bring up that matter, because it is embarrassing to his party, not to me.
You are well aware, Madam Speaker, of the matter about which you have written to me, concerning the chairmanship of the Scottish Affairs Select Committee. It was not my intention to mention that matter today—or the apology that had to be made by the shadow Secretary of State for Scotland in respect of matters affecting that Committee. The hon. Member for East Lothian (Mr. Home Robertson) has done his party a great disservice. Before the hon. Gentleman criticises me in relation to rules, procedure and behaviour, he should do his homework a bit more carefully.
We are seeing today a disagreement between the Scottish National party and the Labour party, dressed up—for that is what it is—as a pretence that principle is at stake. We all know that Standing Committees reflect the majority party, whichever it might be. We know that, if the Government of the day are to have their way, they must have a majority in Standing Committees—reflecting the composition of the House.
It is nonsense for the hon. Member for Banff and Buchan to pretend that his behaviour and that of his colleagues yesterday had anything to do with principle. He claimed to be making a point about the conduct of Scottish business and the composition of Standing Committees considering Scottish Bills.
The hon. Member for Dewsbury pointed out that the hon. Gentleman is in no position to make such a claim. As a Member of Parliament who has served all the hours on Standing Committees that the hon. Lady mentioned, I have noted the absence all his time in the House of the hon. Member for Banff and Buchan from Standing Committees. It is clear to me that hon. Gentleman is in no position to comment on the composition of Standing Committees.
Mr. Salmond: I remind the hon. Gentleman that he has voted three times over the past few years to eject me from Standing Committees considering Scottish business.
Mr. Walker: And I shall be doing so again today. The hon. Gentleman has clearly demonstrated to the House why it is right to do so.
What we saw yesterday and what we have seen today is a foretaste of what a Scottish Parliament would be like. I am delighted that this has been brought to the attention of the people of Scotland, because it clearly demonstrates
352
that the left-wing socialists of the SNP fell out in Committee with the socialists of the Labour party in Scotland.
Those of us who were in the Committee know that the hon. Member for Angus, East (Mr. Welsh)—to put it kindly—was miffed. He and Labour Committee members had words, which was partly due to the fact that the very able but inexperienced Labour Front Bencher leading for the Labour party—[Interruption.] Yes, the hon. Member for Monklands, East (Mrs. Liddell) is very capable, and she was very impressive in how she handled the matter. But she is not fully aware of the House's rules and conventions, which seems to be a common failing of hon. Members from the Scottish Labour party.
The hon. Member for Monklands, East upset the hon. Member for Angus, East because she publicly—I thought unwisely—drew attention to the fact that she disagreed with him, and suggested that he did not understand the rules. That is a paraphrase, but that is roughly what happened.
The hon. Member for Angus, East felt that he had to do something about that. Because of that, we are all suffering today. That is why I believe that it is right that the House should support the Chairman of the Committee. If we do not support the Chair, we will never conduct our business properly.
Mr. Jeff Rooker rose in his place and claimed to move, That the Question be now put.
Question, That the Question be now put, put and agreed to.
Question put accordingly:—
The House divided: Ayes 349, Noes 5.

Division No. 157]

[4.11 pm

AYES

Adams, Mrs Irene

Bottomley, Peter (Eltham)

Ainger, Nick

Bottomley, Rt Hon Virginia

Ainsworth, Peter (East Surrey)

Bowis, John

Ainsworth, Robert (Cov'try NE)

Boyson, Rt Hon Sir Rhodes

Aitken, Rt Hon Jonathan

Bradley, Keith

Alison, Rt Hon Michael (Selby)

Brandreth, Gyles

Allason, Rupert (Torbay)

Brazier, Julian

Alton, David

Bright, Sir Graham

Anderson, Donald (Swansea E)

Brown, M (Brigg & Cl'thorpes)

Anderson, Ms Janet (Ros'dale)

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

Arbuthnot, James

Bruce, Malcolm (Gordon)

Arnold, Jacques (Gravesham)

Budgen, Nicholas

Ashdown, Rt Hon Paddy

Burden, Richard

Atkinson, Peter (Hexham)

Burns, Simon

Austin-Walker, John

Byers, Stephen

Baker, Nicholas (North Dorset)

Callaghan, Jim

Baldry, Tony

Campbell, Mrs Anne (C'bridge)

Banks, Robert (Harrogate)

Campbell, Menzies (Fife NE)

Barnes, Harry

Carlisle, Sir Kenneth (Lincoln)

Barron, Kevin

Carrington, Matthew

Batiste, Spencer

Cash, William

Bayley, Hugh

Channon, Rt Hon Paul

Beggs, Roy

Chapman, Sir Sydney

Bellingham, Henry

Chidgey, David

Bendall, Vivian

Chisholm, Malcolm

Benton, Joe

Clapham, Michael

Beresford, Sir Paul

Clappison, James

Betts, Clive

Clark, Dr David (South Shields)

Biffen, Rt Hon John

Clark, Dr Michael (Rochford)

Body, Sir Richard

Clarke, Eric (Midlothian)

Booth, Hartley

Clarke, Rt Hon Kenneth (Ru'clif)

Boswell, Tim

Clarke, Tom (Monklands W)

353

Clifton-Brown, Geoffrey

Hannam, Sir John

Coffey, Ann

Hanson, David

Cohen, Harry

Hargreaves, Andrew

Colvin, Michael

Harman, Ms Harriet

Congdon, David

Haselhurst, Sir Alan

Conway, Derek

Hawkins, Nick

Cook, Robin (Livingston)

Hawksley, Warren

Coombs, Anthony (Wyre For'st)

Heald, Oliver

Cormack, Sir Patrick

Hill, Sir James (Southampton Test)

Corston, Jean

Hill, Keith (Streatham)

Couchman, James

Hinchliffe, David

Cousins, Jim

Hoey, Kate

Cunningham, Jim (Covy SE)

Hogg, Norman (Cumbernauld)

Curry, David (Skipton & Ripon)

Home Robertson, John

Dalyell, Tam

Hood, Jimmy

Darling, Alistair

Horam, John

Davidson, Ian

Howarth, George (Knowsley North)

Davies, Chris (L'Boro & S'worth)

Howell, Rt Hon David (G'dford)

Davies, Quentin (Stamford)

Howell, Sir Ralph (N Norfolk)

Davies, Ron (Caerphilly)

Hoyle, Doug

Day, Stephen

Hughes, Kevin (Doncaster N)

Deva, Nirj Joseph

Hughes, Robert G (Harrow W)

Devlin, Tim

Hunt, Rt Hon David (Wirral W)

Dewar, Donald

Hunter, Andrew

Donohoe, Brian H

Hutton, John

Dorrell, Rt Hon Stephen

Illsley, Eric

Douglas-Hamilton, Lord James

Ingram, Adam

Dowd, Jim

Jamieson, David

Duncan, Alan

Jenkin, Bernard

Duncan Smith, Iain

Jenkins, Brian (SE Staff)

Dunn, Bob

Jessel, Toby

Dunwoody, Mrs Gwyneth

Jones, Dr Lynne (B'ham S O)

Dykes, Hugh

Jones, Nigel (Cheltenham)

Eagle, Ms Angela

Jones, Robert B (W Hertfdshr)

Eastham, Ken

Kaufman, Rt Hon Gerald

Eggar, Rt Hon Tim

Kellett-Bowman, Dame Elaine

Emery, Rt Hon Sir Peter

Kennedy, Charles (Ross, C&S)

Evans, David (Welwyn Hatfield)

Kennedy, Jane (L'pool Br'dg'n)

Evans, Roger (Monmouth)

Key, Robert

Evennett, David

Khabra, Piara S

Faber, David

Kirkwood, Archy

Fabricant, Michael

Knight, Mrs Angela (Erewash)

Fatchett, Derek

Knight, Rt Hon Greg (Derby N)

Field, Barry (Isle of Wight)

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

Field, Frank (Birkenhead)

Knox, Sir David

Flynn, Paul

Kynoch, George (Kincardine)

Forman, Nigel

Lait, Mrs Jacqui

Forsythe, Clifford (S Antrim)

Lang, Rt Hon Ian

Foster, Rt Hon Derek

Lawrence, Sir Ivan

Foster, Don (Bath)

Leigh, Edward

Foulkes, George

Lennox-Boyd, Sir Mark

Fox, Dr Liam (Woodspring)

Lester, Sir James (Broxtowe)

Fox, Rt Hon Sir Marcus (Shipley)

Liddell, Mrs Helen

Freeman, Rt Hon Roger

Lidington, David

French, Douglas

Lilley, Rt Hon Peter

Fyfe, Maria

Lloyd, Rt Hon Sir Peter (Fareham)

Gale, Roger

Lloyd, Tony (Stretford)

Gallie, Phil

Lord, Michael

Gardiner, Sir George

Luff, Peter

Garnier, Edward

Lyell, Rt Hon Sir Nicholas

Gerrard, Neil

McAvoy, Thomas

Gill, Christopher

McCartney, Ian

Gillan, Cheryl

Macdonald, Calum

Godman, Dr Norman A

McFall, John

Golding, Mrs Llin

MacKay, Andrew

Goodlad, Rt Hon Alastair

McKelvey, William

Goodson-Wickes, Dr Charles

Mackinlay, Andrew

Grant Sir A (SW Cambs)

Maclean, Rt Hon David

Greenway, Harry (Ealing N)

McLeish, Henry

Greenway, John (Ryedale)

McLoughlin, Patrick

Griffiths, Win (Bridgend)

McNair-Wilson, Sir Patrick

Gunnell, John

Maddock, Diana

Hain, Peter

Madel, Sir David

Hall, Mike

Mahon, Alice

Hamilton, Neil (Tatton)

Maitland, Lady Olga

Hanley, Rt Hon Jeremy

Malone, Gerald

354

Mans, Keith

Shersby, Sir Michael

Marland, Paul

Short, Clare

Marlow, Tony

Skeet, Sir Trevor

Marshall, David (Shettleston)

Smith, Llew (Blaenau Gwent)

Marshall, Jim (Leicester, S)

Smith, Tim (Beaconsfield)

Marshall, John (Hendon S)

Smyth, The Reverend Martin

Marshall, Sir Michael (Arundel)

Soley, Clive

Martin, David (Portsmouth S)

Spearing, Nigel

Martin, Michael J (Springburn)

Spellar, John

Martlew, Eric

Spencer, Sir Derek

Merchant Piers

Spicer, Sir James (W Dorset)

Michael, Alun

Spink, Dr Robert

Michie, Bill (Sheffield Heeley)

Spring, Richard

Milburn, Alan

Sproat, Iain

Mills, Iain

Squire, Rachel (Dunfermline W)

Mitchell, Andrew (Gedling)

Stanley, Rt Hon Sir John

Monro, Rt Hon Sir Hector

Steel, Rt Hon Sir David

Montgomery, Sir Fergus

Stephen, Michael

Morgan, Rhodri

Stevenson, George

Mudie, George

Stott, Roger

Murphy, Paul

Strang, Dr. Gavin

Nelson, Anthony

Streeter, Gary

Neubert, Sir Michael

Sumberg, David

Newton, Rt Hon Tony

Sutcliffe, Gerry

Nicholls, Patrick

Sweeney, Walter

Norris, Steve

Tapsell, Sir Peter

O'Brien, William (Normanton)

Taylor, Mrs Ann (Dewsbury)

O'Hara, Edward

Taylor, Ian (Esher)

Olner, Bill

Thomason, Roy

O'Neill, Martin

Thompson, Sir Donald (C'er V)

Ottaway, Richard

Thompson, Patrick (Norwich N)

Page, Richard

Thornton, Sir Malcolm

Parry, Robert

Touhig, Don

Patten, Rt Hon John

Townsend, Cyril D (Bexl'yh'th)

Pawsey, James

Tredinnick, David

Peacock, Mrs Elizabeth

Trend, Michael

Pickles, Eric

Trickett, Jon

Pickthall, Colin

Twinn, Dr Ian

Pike, Peter L

Tyler, Paul

Pope, Greg

Viggers, Peter

Porter, David (Waveney)

Walker, Bill (N Tayside)

Portillo, Rt Hon Michael

Wallace, James

Powell, William (Corby)

Waller, Gary

Prentice, Bridget

Wardell, Gareth (Gower)

Wareing, Robert N

Purchase, Ken

Waterson, Nigel

Quin, Ms Joyce

Watson, Mike

Radice, Giles

Watts, John

Randall, Stuart

Wells, Bowen

Raynsford, Nick

Whitney, Ray

Reid, Dr John

Whittingdale, John

Rendel, David

Wilkinson, John

Richards, Rod

Willetts, David

Riddick, Graham

Williams, Rt Hon Alan (Sw'n W)

Robathan, Andrew

Wilshire, David

Robertson, George (Hamilton)

Wilson, Brian

Robertson, Raymond (Ab'd'n S)

Winnick, David

Robinson, Mark (Somerton)

Winterton, Mrs Ann (Congleton)

Roche, Mrs Barbara

Winterton, Nicholas (Macc'f'ld)

Roe, Mrs Marion (Broxbourne)

Wise, Audrey

Rooker, Jeff

Wood, Timothy

Ross, Ernie (Dundee W)

Wright, Dr Tony

Rowe, Andrew (Mid Kent)

Yeo, Tim

Sedgemore, Brian

Young, David (Bolton SE)

Shaw, Sir Giles (Pudsey)

Young, Rt Hon Sir George

Sheerman, Barry

Sheldon, Rt Hon Robert

Tellers for the Ayes:

Shepherd, Sir Colin (Hereford)

Mr. Michael Bates and

Shepherd, Richard (Aldridge)

Mr. Roger Knapman.

NOES

Cunningham, Roseanna

Wigley, Dafydd

Ewing, Mrs Margaret

Tellers for the Noes:

Salmond, Alex

Mr. Andrew Welsh and

Skinner, Dennis

Mr. Cynog Dafis.

Question accordingly agreed to.
Resolved,
That the Chairman of the First Scottish Standing Committee, appointed in respect of the Education (Scotland) Bill [Lords], shall have power to order any Member who is not a member of the Committee to withdraw immediately from the Committee Room and the Serjeant at Arms shall act on such orders as he may receive from the Chairman in pursuance of this order.

Point of Order
4.26 pm
Dr. Gavin Strang: On a point of order, Madam Speaker. Last Thursday, in reply to an oral question, the Minister of Agriculture, Fisheries and Food advised the House that measures associated with bovine spongiform encephalopathy would cost around £1.5 billion over the next three years. I assumed that he made an error in reading his brief as previous written answers and the Minister's own eradication plan had put the figure at around £2.5 billion.
Last night, however, in her reply to the debate the Parliamentary Secretary told the House that
"the cost over the next three years was quoted as being £1.5 billion."—[Official Report, 25 June 1996; Vol. 280, c. 250.]
She said that Ministers had looked at the consequences of all the schemes and that she could now tell the House that the cost would be around £2.5 billion. She then asked whether the House would accept that "updated figure".
The Parliamentary Secretary was seeking to give the House two messages: that the Minister was merely quoted as underestimating the amount and that she had a new, updated figure to give us.
I assume that the £2.5 billion does not include the cost of the selective slaughter programme agreed by the Prime Minister in Florence. I fully appreciate that the Minister is away and that the Parliamentary Secretary is not available, but I hope that in due course the Minister will give us a clear statement on those costs. They are large sums of money and it is only right that the House should be properly informed.
Madam Speaker: I noticed the updated figure that was given yesterday by the Parliamentary Secretary. The comments of the hon. Member for Edinburgh, East (Dr. Strang) will have been noted. Perhaps he will wish to take the further opportunities to put questions and to press the matter.

Energy Conservation (Provision of Information)
4.28 pm
Mr. Tim Yeo: I beg to move,
That leave be given to bring in a Bill to make provision in respect of information to be provided in connection with the energy efficiency of residential buildings.
I am delighted to have the chance, rather belatedly, of introducing a measure that will apply in England and Scotland. It will have three effects: first, it will cut the fuel bills paid by home buyers; secondly, it will save, energy and improve the environment; and, thirdly, it will create jobs in the construction industry. Each of these desirable aims will be achieved without using a single penny of taxpayers' money.
The Bill provides for all mortgage lenders—be they building societies, banks or other financial institutions— to require from house purchasers an energy rating survey of the property that they wish to purchase. That is not an onerous requirement. House buyers who require mortgage finance to enable them to purchase a property already normally have to undertake a survey of the condition of the property that they wish to buy. To include in such a survey an assessment of the energy rating of the property will involve little extra work—it is estimated that it will take perhaps an extra 15 or 20 minutes on the part of the surveyor. The additional cost, therefore, to the house purchaser will be of the order of £10, or £20 at the most.
The energy rating takes the form of a standard assessment procedure rating that will give a figure on a scale from one, for the most energy-inefficient properties, to 100, for those properties that are the most energy-efficient. I am glad to say that this system now has the support of the various groups that had previously backed rival and competing methods of analysing the energy efficiency of a property. That period of competition and disagreement has ended, and there is now general support for the SAP rating system.
New homes, for the most part, are built to a high-enough standard to achieve satisfactory levels of energy efficiency. The Bill is therefore targeted at the large stock of second-hand homes, the vast majority of which were built before considerations of energy efficiency were as important as they are today. Last year, about 680,000 second-hand properties changed hands, with three quarters of those transactions being completed with the help of a mortgage. Therefore, the effect of the Bill would be that, each year, about 500,000 second-hand properties would have the benefit of having an energy rating survey carried out.
The owners of those 500,000 properties would be made aware of the potential scope for cutting their fuel bills by a modest investment in energy-saving measures. In many cases, those owners may be made aware of that fact for the first time. Far too few people are aware of how much can be done by quite modest expenditure to save energy, and thus to cut fuel costs. The payback period can be rapid. For example, the cost of insulating a loft or a hot

357
water tank can be recovered in as little as two to three years. Insulating a cavity wall is a rather more expensive exercise, but here too the payback period can be five years or less. The same is true of the purchase costs of a gas condensing boiler.
In those various ways, house buyers can achieve substantial savings over a short period, but the Bill will not merely be of advantage to them. As more and more homes are subject to an energy survey, so the environmental gains will accumulate. Let us make a cautious assumption that perhaps three out of five home buyers—once they were aware of how much they could save by investing in energy-saving measures—will take the rational and self-interested decision to improve their homes in that way. If the number of house transactions remains at its current relatively low level, the reduction in carbon dioxide emissions could reach 270,000 tonnes annually within 10 years. By the middle of the next century, virtually the whole stock of second-hand homes would have received an energy rating. By then, we could expect savings in emissions to have reached 1.5 million tonnes of carbon a year. That would make a substantial contribution to meeting the national target to which Britain is publicly committed.
Finally, let me draw attention to the employment consequences of those measures. Much energy-saving expenditure results in highly labour-intensive work. The immediate and direct consequence of encouraging home buyers to spend money on energy saving would be to increase employment in the construction industry and related sectors.
I cannot imagine what objection there could be to the proposal. The only possible one arises from an entirely proper and understandable concern that Parliament should not impose additional statutory obligations on house buyers, who already face a cumbersome process. However, the measure would achieve benefits that would justify the modest additional legislative hurdle. Even that objection could be overcome if we built a time limit into the measure.
358
Let us suppose that the statutory requirement for an energy rating was to be imposed on lenders for a limited period of, say, five years. I am confident that, at the end of that period, the concept of having information about the energy efficiency of a home would become so widely accepted that it is inconceivable that lenders or borrowers would wish to proceed with a transaction without it. No one would think of buying a house without knowing what council tax band it was in. No estate agent would publish the particulars of a property that they were trying to sell without giving such information. Yet many households spend far more on heating and hot water fuel costs than on council tax. It should be a matter of routine for everyone involved in the transfer of a house, whether the vendor, the purchaser, the estate agent, the lender or the surveyor, to supply energy efficiency information.
I recognise that, under our procedures, the Bill will not pass on to the statute book this Session. I hope that after the ballot for private Members' Bills in the autumn another hon. Member will pick up the issue. Energy efficiency is not a glamorous or politically controversial subject. One of its problems is that it is not sufficiently exciting to attract the attention of many people. However, there are few issues where environmental and economic aims so harmoniously and completely coincide. Rarely are the interests of the individual directly affected and those of the community so entirely at one. It is against that background that I warmly commend the Bill to the House.
Question put and agreed to.
Bill ordered to be brought in by Mr. Tim Yeo, Sir John Hannam, Mr. Richard Needham, Mr. Nigel Forman, Mr. Peter Bottomley, Mr. Alan Simpson, Mr. Matthew Taylor, Dr. Michael Clark and Mr. Patrick Thompson.

ENERGY CONSERVATION (PROVISION OF INFORMATION)
Mr. Tim Yeo accordingly presented a Bill to make provision in respect of information to be provided in connection with the energy efficiency of residential buildings: And the same was read the First time; and ordered to be read a Second time upon Friday 12 July and to be printed. [Bill 162.]
Opposition Day
[17TH ALLOTTED DAY]
Opposition Day

  National Health Service
  Madam Deputy Speaker (Dame Janet Fookes): Madam Speaker has selected the amendment in the name of the Prime Minister.
  4.39 pm
  Ms Harriet Harman: I beg to move,
  That this House notes that patients are suffering as NHS services are overstretched, that there is a shortage of intensive care beds, that waiting lists are long and set to rise, that patients have to spend hours on trolleys in Accident and Emergency Departments because of the cuts in hospital beds and that community and mental health services are struggling to meet growing need; believes that the Government aims to reduce the NHS to a safety net service, that people should not be forced to pay to go private to get excellent and prompt care and that the NHS must meet patients' needs and expectations; regards it as a scandal that extra resources put into the NHS have been squandered by the Government on extra bureaucracy for the internal market; and calls on the Government to cut the red tape and put the money into patient care, scrap the internal market, replace GP fundholding with GP commissioning, and thereby renew the NHS as a one nation health service which is fairer and more efficient.
  For millions of people throughout Britain, the NHS means security and peace of mind. At a time of growing insecurity—insecurity at work and fear of crime—and uncertainty, the NHS means knowing that there is at least one area of our lives where we can be sure that we will get what we need when we need it, no ifs, no buts. That was the founding principle of the NHS that Labour created, and that remains its central principle today, or at least it should be.
  But the NHS is under threat. People are having to pay for more and more aspects of their health care. If the Conservatives were to be re-elected at the next election, they would strip the NHS down to all but the basic emergency services. We know that from what the Conservatives are doing and saying.
  Services are being pushed out of the NHS. Take dentistry. First, the Tories put up charges so high that the dentist's bill makes one think that one has gone private. Then it becomes harder and harder to find an NHS dentist, so people do end up paying to go private. NHS dental lists now have 2 million fewer people than two years ago.
  Take long-term care. The Tories promised care from the cradle to the grave. Then they closed the nursing beds in the NHS and people now have to pay to go private or go through a means test.
  More and more people are having to pay for their operations. The number of people covered by private medical insurance has more than doubled. Under the Tories it has risen by 124 per cent.
  As NHS hospital beds close, private hospital beds open. During the past 15 years, the number of private hospital beds has increased by 66 per cent., while the number of NHS hospital beds has been cut by 28 per cent.
  The Tories are beginning openly to admit that what they really want is for the NHS to be cut down to core services, as they describe them, so that it becomes a safety net service. The Secretary of State, in his recent statement to the House on long-term care for the elderly, said:
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  "The Government believe that the principal responsibility for making that provision must rest with the individual citizen … We shall continue to provide a safety net."—[Official Report, 7 May 1996; Vol. 277, c. 29–31.]
  On BBC's "Question Time" last month, the Chief Secretary to the Treasury said:
  "The real question is, 'What are the key core things we should be doing and what are the things that are further down the list of priorities that are less important for health services to be doing at the public expense?'"
  The Secretary of State for Health (Mr. Stephen Dorrell): The hon. Lady accurately quoted from a statement that I made on the subject of the social care of the elderly. As she knows, ever since 1948, social care has been a means-tested service within the welfare state. Is she committing the Labour party to making it a universal tax-funded service?
  Ms Harman: I am saying—[Interruption.]Might I be allowed to answer?
  I am saying that the Government are pushing services that used to be free under the NHS out of the NHS. People used to get long-term nursing care in the NHS. Then it was an NHS service and it was free. Now it has been pushed out of the NHS, redescribed as a social care service and is subject to a means test. It is no good the Secretary of State trying to fiddle around with definitions. A whole generation of elderly people in Britain know that the Government's promises have been broken.
  Mr. Dorrell: I am grateful to the hon. Lady for giving way again. She knows that we have closed 20,000 geriatric beds in the NHS over 17 years and we have seen a growth in the private sector of nursing and residential care of bed space of 250,000, 80 per cent. of which are supported from public funds. Is she committing the Labour party to providing that service on the taxpayer? The elderly people of this country are entitled to know the answer to that question. Is she committing Labour to paying out of tax revenues, or is she committing Labour to continuing the present policy?
  Ms Harman: I am saying that a whole load of services that used to be provided free in the NHS have now been pushed out of it, so that people have to pay for them or they have to be means-tested. The figures that the Secretary of State has just given the House have assisted my case.
  As the Tories cut services, patients suffer. In December last year, 10-year-old Nicholas Geldard collapsed at home, seriously ill. No intensive care bed could be found for him in the Greater Manchester area, so he had to travel 69 miles across the Pennines to Leeds, where he arrived 12 hours later, but he was dead on arrival. There are many other similar tragic cases. The survey that we carried out earlier this year of paediatric intensive care units showed that during the first four months of this year no fewer than 330 critically ill children were turned away from intensive care beds—in every region of the country.
  What was the Secretary of State's response to this tragic situation? He said, certainly, that there should be more intensive care beds, but he said nothing about where the extra money would come from—
  Mr. Dorrell: I announced the beds.
  Ms Harman: Yes, but not how they were to be funded. Up and down the country doctors are warning that patient

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  care is being put at risk and that the quality of care that they want to give their patients is suffering because the Government want hospitals to treat more and more patients, but without enough money. I should like to quote some of the doctors who have spoken up on the issue. Dr. Christopher Adams, consultant neurosurgeon at the John Radcliffe infirmary in Oxford, resigned his post, saying:
  "It got to a stage where we were churning out patients so fast it became dangerous."
  As hospital beds are cut—the Tories have cut one in five NHS hospital beds—patients are forced to wait for treatment on trolleys in casualty departments. In January this year, the British Medical Association warned of a severe and prolonged crisis in the acute sector. In the Good Hope hospital, people were having to wait for long periods on trolleys in accident and emergency. Ambulances brought in more patients, but they could not be taken out of the ambulances to the A and E department because the department was already full of patients lying on trolleys, unable to be admitted to the wards because the wards were full—because bed numbers had been cut. So the patients waited in the ambulances. Then, when the ambulances were called out again, they could not do their emergency runs because patients were still waiting inside them.
  In the Royal Hallamshire hospital in Sheffield, patients waited up to 19 hours on trolleys, and a consultant physician warned:
  "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."
  Patients are waiting too long on waiting lists for treatment. That means misery for them. Having to wait a long time for treatment is the criticism that patients most frequently make of the NHS. One million people are waiting for operations; 250,000 of them have been waiting for more than six months. Long waits matter a great deal to patients and to those working in the NHS, yet only last week the Secretary of State for Health gave hospitals the go-ahead to increase the times that they make patients wait before treatment. Patients are often in pain or discomfort, and waiting puts additional stress on them and on their families and jobs.
  No wonder so many people feel driven to pay to go private for the health care that they need. It is not just hospitals; community and mental health services are also struggling. But even after people have had to wait a long time for treatment, when they telephone the hospital on the day of an operation, they are often told that it has been cancelled. Last year 55,000 patients were told that at the very last minute. That number is increasing. It is unacceptable that patients have to wait months for treatment, only to have their operations cancelled on the day that they are due to go into hospital. Patients are being pushed into the private sector—pushed into paying— because of the fear and uncertainty of waiting and of operations being cancelled.
  Dr. Charles Goodson-Wickes: I take it from the hon. Lady's speech that she endorses the fact that
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  trade union members take advantage of the independent sector—the Manor House hospital, the Benenden hospital, et cetera—and jump the queue?
  Ms Harman: The hospital that the hon. Gentleman mentioned is a long-standing charity; it is not at all the same issue that we are dealing with today—we are dealing with the failure of the national health service to meet people's needs under the Conservative Government. People are having to pay, to go private, to get the treatment that they need.
  Dr. Goodson-Wickes: Will the hon. Lady give way?
  Ms Harman: No, I shall not give way again.
  I refer to 64-year-old David Miller, from Surrey, who had his operation cancelled no fewer than 10 times at the Hammersmith hospital. In May this year, he decided to go private, only to be told that his liver cancer had spread too far and that it was too late for surgery.
  The Government tell people, "Your child needs an intensive care bed, but they are all full—sorry." People are being taken into accident and emergency departments and told, "You will be admitted, but you will have to wait hours on a trolley because all the beds in the hospital are full—sorry." People who are told that they need a hip replacement want to have it done right away, but they are told, "You will have to wait months—sorry."
  While the Government are telling patients that they cannot get the care that they need, and while one in three health authorities is rationing, they are pouring money into the NHS bureaucracy. That is a scandal. The Government are saying, "We are putting more money into the NHS"—it is in their amendment, and no doubt the Secretary of State will talk about it. It is not how much money they are putting in; it is what they are spending it on. The doctors are right: the NHS needs more money for patient care, but every year the Government are siphoning off precious NHS resources. Hundreds of millions of pounds that should be going to patient care services are being put into the growing bureaucracy to run the internal market.
  Mr. Rod Richards: Is the hon. Lady aware that if we were to guarantee accident and emergency admissions in every single hospital in the country, we would have to keep approximately 20 per cent. of our hospital beds vacant and that the resources to service the beds would have to be made available? Is she in favour of that?
  Ms Harman: The hon. Member has referred to occupation levels. It is true that because so many patients are being crowded into so few beds, hospitals do not have the capacity to deal with sudden or temporary increases in emergency admissions. That is what happened this year— there was a temporary increase in emergency admissions. There were no safety margins—one in five hospital beds had been cut—and people had to wait for hours on trolleys.
  It now costs an extra £1.5 billion every year in administration just to run the Government's NHS internal market. Of course it is important to have good management of patient care services, but that is not the sort of management that we have seen growing under the Tories. The Tories have not appointed managers who are dedicated to running clinical services; they have appointed thousands

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  of extra accountants and bureaucrats to run the internal market. There are managers to draw up annual contracts, managers to consider and approve extra-contractual referrals, managers to negotiate with general practitioner fundholder practice managers, managers to send out invoices, managers to query invoices and managers to deal with the managers who are querying the invoices.
  Apparently, the NHS now needs no fewer than 70 different types of managers—not managers to run the patient services, not managers to get the best out of the people and the money in a large organisation, but managers to manage the market. There are sales managers, contract managers, business managers, marketing managers—the managers who manage the market have no connection with patient care, except that they are taking money away from patient care.
  The NHS is tied up with red tape and it is bogged down in paperwork. For example, last year, my local hospitals—Guy's and St. Thomas's—had to process and send out 57,000 invoices to health authorities and GP fundholders. My local health authority, Lambeth, Southwark and Lewisham, is one of the health authorities to which the hospitals send their invoices. The madness of the Tory internal market means not only that Guy's and St. Thomas's have to appoint the managers to draw up and process 57,000 invoices and send them out to GPs and health authorities, but the health authority has to appoint managers to approve and process 26,000 invoices to buy health care for its local population from local hospitals. That is madness.
  Extra-contractual referrals are just one of the costly, bureaucratic examples of the Tory market madness in the NHS. Patients can now be referred to hospitals only if the GP—if the GP is a fundholder—or the health authority, if the GP is a non-fundholder, has a contract. Otherwise patients have to get approval for an extra-contractual referral.
  I shall give the House details of the recent case of a woman with back pain who was being treated by her GP. She had been to the local hospital, but it could not sort her out, so she went back to her GP, who decided to send her to the Royal National Orthopaedic hospital because the problem was serious and had been troubling her for some time. The GP had to apply to the health authority for approval for an extra-contractual referral and it took five months for that to be approved.
  Five people were tied up in the red tape of processing the case, let us remember, of a woman being sent to a specialist by her GP because the local hospital could not help. The GP had to fill in forms and make telephone calls. The director of public health at the health authority had to fill in forms and make telephone calls. The administrators at the health authority and the administrators and the consultant at the Royal National Orthopaedic hospital had to waste their time and money, too.
  The result was that the woman was given approval to go to the Royal National Orthopaedic hospital for £120-worth of consultation. That was the value placed on her treatment, but we calculate that the bureaucratic cost of seeking the approval, after all the procedures that had to be followed, was no less than £360. The treatment was worth only £120, yet the bureaucracy spent £360 to authorise it. If the Government cut the red tape and put
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  the money into patient care, three patients could have been treated at the Royal National Orthopaedic hospital instead of lingering on waiting lists.
  Mr. Dorrell rose—
  Ms Harman: If the Secretary of State wishes to intervene, will he confirm that he will abolish the extra-contractual referral system, which we warned all along was wrong? Will he abolish it and put the £22 million that it costs every year into patient care? Will he admit that we were right and that the system was market madness?
  Mr. Dorrell: The hon. Lady has accurately described the process of the extra-contractual referral system as it now is, but she has omitted to mention that I announced a month ago that it will be simplified.
  Ms Harman: I know well the announcement that the Secretary of State made a month ago. I read the document, which has the catchy title "Seeing the wood, sparing the trees"—it emanates not from the Ministry of Agriculture, Fisheries and Food, but from the national health service executive. I have examined carefully what the Secretary of State plans to do with extra-contractual referrals. He seeks not extra-contractual referrals, but compliance with a protocol: it is the same market madness. Until the Secretary of State recognises that he cannot run the service through the market, he will continue to pour hundreds of millions of pounds into bureaucracy that should go into patient services.
  The Government are seeking protocol compliance instead of extra-contractual referral approvals. But it will make no difference: it will still tie up GPs, hospital consultants and those in the health authority. However, instead of ECRs, it will be protocol compliance. That is nonsense.
  Mr. Dorrell: You don't understand it.
  Ms Harman: We understood it when the White Paper was put before the House. We predicted what would happen, and it has.
  Mr. Dorrell: The hon. Lady responded to my challenge when I said that she did not understand it. She cannot understand it if she claims that the health authority will still be involved in the approval of ECRs. That is what we are abolishing.
  Ms Harman: Health authorities will be involved in drawing up the protocol and establishing compliance with it. They are specifically included in the protocol requirements with which GPs must conform. It is not me, but the Secretary of State, who does not understand how the system will work.
  It cannot be right that, while more managers are being appointed to run the internal market, the number of nurses on the wards is being cut. There are now 20,000 more managers in the NHS than there were five years ago. At the same time, there are 50,000 fewer nurses on the wards. That means that there are more people to count the cost of care and fewer people to provide it. The expenditure

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  of public money must command public support. The public do not want to see money drained from their front-line services into bureaucracy.
  There is no point in the Secretary of State saying that he will reduce the number of managers and that he is "bureau-sceptic". His Government created the internal market and that system demands bureaucracy. Until he scraps the market, the demands for red tape will grow and grow. The administrative costs of the NHS have soared from £2 billion to £4 billion in the past 10 years. But that is only the beginning, because the market is still in its infancy. Only half of GPs are fundholders. If the Government were to take forward their plans and all GPs were to become fundholders, administration costs would double.
  A hospital that is quoted in the Secretary of State's report complains that it must have 900 separate annual contracts with 900 different fundholders. If the Tories got into office again, that hospital would have 2,000 fundholders and 2,000 separate annual contracts. It would have to send out hundreds of thousands of invoices every year.
  As I predicted, the Secretary of State has said that his recent efficiency scrutiny report will reduce bureaucracy in the NHS. However, the savings that he purports to announce do not exist—they are wishful thinking. It is an inescapable fact that his system—the internal market—drains £1.5 billion a year from patient care into bureaucracy. The Government cannot scrap the bureaucracy because they will not scrap the internal market. They will not do what the people want: cut the red tape and put the money into patient care.
  The provision of public services must command public support. Public services must provide what people want and people's expectations will change over time. Labour will renew the NHS. We will strip out the market, strip away the bureaucracy and put the money into patient care. We will also recognise changes in people's lives and in their aspirations. People want services that fit in with their lives—they do not want to reorganise their lives around service provision. People do not want to have to wait and then receive an appointment card through the post—which probably arrives while they are on holiday—telling them when it is convenient for the NHS to treat them.
  Last year 5 million patients did not turn up for out-patient appointments—the technical term is "Do Not Attends". Those 5 million people received appointments without being asked whether they could make them and they were unable to cancel them. People receive appointment cards through the post—at last notifying them of the date of their appointment—but if they try to contact the service provider they may get an answerphone or they may be referred to someone else. Therefore, they are unable to cancel their appointments.
  People want to book a time for treatment that fits in with what is going on in their lives. It should not be a matter of waiting until a person is told when his or her hernia operation will be done. People should be able to choose the time so that an operation interferes with their work or family arrangements as little as possible. People want a say in where, when and how they are treated. They do not want to wait. The private sector knows that, which is why the newspapers and our letter boxes are full of invitations to go private.
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  The advertisements say, "The NHS makes you wait. You don't want to wait and you don't have to wait—go private". The system then becomes more unfair and more expensive. Those who can afford it, go private—many of them reluctantly. Those who cannot afford it are left using a service that inexorably becomes a poor service for the poor. Any service that is used exclusively by those who have no other choice is doomed to decline. A public service cannot thrive on a captive audience. While more and more people become refugees out of the NHS, those who cannot afford to pay to go private are left behind. They are not grateful, but resentful because they cannot get the care that they need promptly. People should not have to pay to go private: they should get what they need on the NHS. The Government should cut the waste and cut the waiting. They will not, but Labour will.
  The choice before the country is clear: a struggling NHS that is being stripped back to a safety net under the Tories or a one-nation NHS that is renewed as a public service under Labour. The British people want Labour's future for the NHS. That is one of the many reasons why Labour must become the Government after the next election.
  Madam Deputy Speaker: For the convenience of the House, I inform hon. Members that Madam Speaker has decided that there shall be a 10-minute limit on speeches between the hours of 7 pm and 9 pm.
  5.7 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:
  'congratulates the staff of the National Health Service for providing high quality care to a record number of patients, and notes that their achievements have been underpinned by the Government's unique commitment to increasing National Health Service funding, which has meant an extra £9.5 billion since 1992, and is dismayed that the Opposition proposals put ideology before patients, in particular by removing the option of fundholding from the 50 per cent. of general practitioners who have decided that this system offers the best prospect for their patients.'.
  This afternoon, the House has witnessed yet again a spectacle with which we have become depressingly familiar during health debates. The hon. Member for Peckham (Ms Harman) had time to set out clear answers to the questions that many people within and outside the national health service are asking about the Labour party's future policies for the NHS.
  What are the hon. Lady's answers to the questions about the future of primary care? What are her answers to the questions about the future of mental health care and cancer care? How would she organise training and research within the national health service? How would she address the questions of clinical effectiveness that are at the core of modern health care delivery?
  The most important question from the British Medical Association this week is how much money Labour would put into the national health service. Will Labour give a commitment to deliver more than an average of 3 per cent. growth in real terms over 17 years? That is what we have done since 1979. Will Labour commit itself to matching our funding record for the national health service?
  Ms Harman: When the Secretary of State mentions the increase in resources that he has taken from the public

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  purse and put into the NHS, will he say how much of that figure he has siphoned away into bureaucracy? Will he confirm that, in one year, 50 per cent. of the extra resources in the NHS were siphoned off and never went anywhere near patient care?
  Mr. Dorrell: The hon. Lady had better contain her patience, as I have quite a lot to say about the internal market and administrative costs. I shall come to that in the fullness of time.
  When I gave way to the hon. Lady, she dodged the question about how much money Labour in government would provide the NHS. The House and the country will understand that, in one speech, the hon. Lady cannot cover all those questions, but it is depressing that she did not touch on a single one of them. That is something that neither I nor the country will understand. No wonder the Leader of the Opposition is already returning to the charge of postponing the shadow Cabinet elections. We see in today's edition of The Daily Telegraph that the Labour Whips have told the Leader of the Opposition that the party's health spokesman faces a humiliating defeat and that she could receive as few as 40 votes. We know that the right hon. Gentleman is loyal to the hon. Lady. Nobody could accuse him of being anything other than very loyal—indeed, almost touchingly and sentimentally loyal—to the hon. Lady. He talks a lot about middle-class insecurity. He seems to see the hon. Lady as an important element in meeting the concerns about middle-class insecurity.
  My sympathies are with Opposition Back Benchers, because from their cradles they have been brought up to believe that the NHS is home ground for Labour. They are used to losing arguments on defence. Indeed, they do not remember winning an argument on defence. They are used to losing arguments on the economy. They are not very interested in wealth creation. They are used to losing arguments on law and order, because they know that they voted against all the effective measures. What they cannot forgive the hon. Lady is that they are now losing arguments on health within the NHS and the country as well.
  To my hon. Friends I say spare a thought for Labour Back Benchers in their predicament. Here we are in a pre-election year, and the Labour leader, last week, went to a major health service conference to deliver a much trumpeted speech, which was said to set out Labour's agenda for the future of the NHS. How was that speech received the following day? The Independent devoted its whole editorial to an assessment of the Labour leader's speech.
  Mr. Ken Purchase: It did not mention you.
  Mr. Dorrell: It did not mention me that day because I had not yet spoken.
  Under the heading "Labour on health: an acute case of evasion", the editorial said:
  "not a great deal was to be expected of Tony Blair's keynote speech on health yesterday. In the event, even less was offered."
  Mr. Henry McLeish: How was it received?
  Mr. Dorrell: It was received as a failure by The Independent. Let me quote further. [Interruption.]
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  The doctors were not there in huge numbers, either. It was primarily a conference of health authorities and trust managers. [Interruption.]
  Madam Deputy Speaker: Order. There are too many sedentary interventions, particularly from hon. Members on the Front Benches. I expect Front Benchers in particular to set a good example.
  Mr. Dorrell: The editorial continued:
  "professionally, organisationally and morally the health service is in remarkably fine fettle. To suggest otherwise, as Labour may well do, is to play into the hands of those merchants of social policy apocalypse who are willing us into a crisis that does not and need not exist".
  I do not agree with everything that The Independent writes, but I agree whole-heartedly with that.
  Mr. Robert Ainsworth: If the Secretary of State wants to know what is depressingly familiar, and if he is genuinely concerned about Opposition Back Benchers, he will be aware that our speeches will be limited to 10 minutes. He has spoken for seven minutes and has not said a word about the NHS or about his Government's record over the past 17 years. Will he please get on to the subject at some point?
  Mr. Dorrell: I can well understand the hon. Gentleman's sensitivity when his leader's speech on Labour's home subject is received as badly as that by The Independent.
  The person responsible for that policy failure is the hon. Member for Peckham. I shall go through some of the themes that she developed in her speech—they are familiar Harman themes—and analyse precisely what they mean. Let us begin with the slogan "Labour would abolish the internal market". I want to be clear about what the phrase "the internal market" means. We have a system under the reformed health service where we do not fund hospitals and health providers directly. We fund them through purchasers. We fund those purchasers in turn on the basis of need through a weighted capitation formula.
  Mr. McLeish: Massive bureaucracy.
  Mr. Dorrell: I remind the hon. Gentleman that his party is committed to maintaining precisely that structure.
  Health authorities are in turn free to commission care from individual trusts and other providers of health care in a way that reflects local need and the views of general practitioners, both fundholding and non-fundholding, including commissioning. The market, in so far as an internal market exists in the NHS—it is a phrase of which the hon. Lady is fond—exists because the purchasers control the money into the system and are free to decide which providers in the health service meet the needs that they identify.
  Mr. Richard Burden: Will the Secretary of State give way?
  Mr. Don Touhig: Will the Secretary of State give way?
  Mr. Dorrell: No. This is an important point. I want to develop it; then I shall give way.

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  That is the sense in which there is a market. Funded purchasers are free to decide where they commission care. The health service wants to know which elements of that system the Labour party would change if it were given the opportunity. The policy document that it issued last summer was absolutely clear on this matter: it would not change the separation between purchase and provision. It said clearly:
  "We want health authorities to commission care, but we do not want them to run hospitals on a day-to-day basis."
  So the Labour party maintains the distinction between purchaser and provider. Furthermore, the policy document was also clear that purchasers would be free to choose where they placed their commissioning arrangements.
  Mr. Touhig rose—
  Mr. Dorrell: I said that I shall give way in a moment. I want to develop this argument.
  Again I quote
  "Health authorities will have agreements with different local health services and will have choice as to where to place them to suit patient needs."
  Last summer, Labour was committed to maintaining both key elements of what the hon. Lady describes as the internal market.
  Not more than a fortnight ago, the hon. Lady went to the Institute of Health Services Management to deliver a speech. A passage of her speech was headed "Abolishing the Market", so I was interested to read it to understand precisely which of the two building blocks of the market she would strike away. Would it be the separation of purchase and provision, or would it be the freedom of purchasers to choose where they commissioned care? Her speech was clear in answer to the first question. She—no more than her predecessor—is not in favour of abolishing the distinction between purchase and provision. She said:
  "The planning of health services and the delivery of health care are distinct responsibilities. They will be kept separate."
  That could not be clearer. But what is very much less clear to me, and I suggest it should be to the hon. Member for Islwyn (Mr. Touhig) if he reads the six-paragraph section on abolishing the market, is how maintaining the purchase and provision system that we have established— [Interruption.] I am quite prepared to amend the terms to planning and commissioning, as the distinction between them is not very different. In what sense does that deliver abolition of the market?
  The question that the hon. Lady did not answer in her speech to the IHSM was whether she maintains the second commitment made by her predecessor, in regard to the planning of health authority functions. Would health authorities be free to choose, in the interests of local people, where they commissioned their health care? If the answer is yes, there would be no change in the present internal structure of the health service; if the answer is no, there is a fundamental change. In that event, the hon. Lady would indeed be abolishing the internal market. We are entitled to know whether that is the policy that Labour would pursue.
  The question to the hon. Lady is extremely simple: would Labour abolish health authorities' right to choose the commissioner that satisfied the needs that they have
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  identified, or not? I am happy to give way to the hon. Lady, so that she can clarify whether Labour would abolish that freedom to choose.
  Ms Harman: The Secretary of State has involved himself in an administrative confusion. In my speech, I gave the example of a woman with back pain. She had used the service of her local hospital, to which she would have been referred by her GP. If she cannot be dealt with in that hospital, her GP will refer her to the Royal National Orthopaedic hospital. She will either use her local services—if she and her GP decide that they should start her care—or be referred to a specialist hospital. The patient and her GP, not some bureaucracy, will decide.
  Yes, there are distinct and separate functions. That seemed to confuse the Secretary of State. He says that on the one hand there is responsibility for the day-to-day running of services in the hospital, and on the other hand there is responsibility for assessing the health needs of the local population and planning and shaping services to deliver longer-term improvements. Those are simple functions, but it might help the right hon. Gentleman to concentrate on our view—with which we have been consistent throughout—that the decision on where a patient should go is not a commissioning decision, but a decision to be made by the patient and his or her GP.
  Mr. Dorrell: That argument has two fundamental flaws. First, many aspects of health care are not the subject of GP referral. The hon. Lady has not told us who decides where provision is commissioned when there is no GP referral. Secondly, she has said that the health authority is responsible for planning the pattern of health care provision, but if the GP has absolute freedom of referral without any reference to the health authority's planning, there is no connection between the planning and the referral.
  The hon. Lady has not made clear the means by which health authorities discharge their obligation to ensure that health provision in a particular district meets the need that they have identified. That is the question that she must answer. Are health authorities free to choose the hospitals from which they commission, or not? The hon. Lady has avoided that question again.
  Mr. Touhig: I am very interested in what the Secretary of State has been saying about commissioning and the market. Would he care to comment on Gwent health commission's decision to market-test the care of the terminally ill? The main provider of that care is a local charity which spent £10,000 on its tender bid, only for the commission to abandon the whole procedure halfway through. Is that a sensible use of resources and planning?
  Mr. Dorrell: Any health commission that is deciding which services best meet the needs of its patients should be free to look at alternative providers, whether, in the case of terminal care, the provider is a charity-funded hospice or part of the NHS. The principle that a health authority should be free to choose where to commission care is a fundamental part of good management, and I do not resile from it.
  Mr. Burden: The Secretary of State said earlier that health purchasers should be free to purchase care for their local populations with resources given to them on the

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  basis of need. Last year, the right hon. Gentleman promised health authorities a 1.1 per cent. increase. Birmingham was given an increase of 0.5 per cent.; rather surprisingly, Huntingdon was given a 1.7 per cent. increase, despite being shown to have one of the highest levels of bureaucracy in the country. Is the right hon. Gentleman saying that Huntingdon's health care needs are greater than those of Birmingham?
  Mr. Dorrell: As the hon. Gentleman knows, I am simply saying that there is a formula determining the distribution of resources—a need-based formula, devised for us in the university of York. The hon. Member for York (Mr. Bayley) knows very well how that formula evolved. If the hon. Member for Birmingham, Northfield (Mr. Burden) knows of a better way of channelling resources to different health authorities, reflecting both population and need, we shall be happy to hear from him. As the House knows, we allow the system to evolve every year.
  Mr. Hugh Bayley: Will the Secretary of State give way?
  Mr. Dorrell: I will give way to the hon. Gentleman, but I must then make progress.
  Mr. Bayley: The Secretary of State did not acknowledge that the Government refused to implement the independently determined formula. Instead, they amended it in order to shift resources from the north to the south, and from inner cities to shire counties.
  As the right hon. Gentleman is having difficulty in understanding the difference between Labour and Conservative policy on the NHS internal market, may I give him a practical example? My constituency contains an extremely large fundholding practice with 20,000 patients. That practice decided to shift its contract for community health services from one trust to another, believing that that would improve services for its patients. Its action greatly weakened the services of the trust that it had formerly used, and the level of community health service support for all the other GPs in York declined as a result.
  The difference between Labour and Conservative policy is that the Conservative party's free market approach allows such dog-eat-dog developments, while the Labour approach of commissioning would make one general practice deal with another and reach agreement on the best pattern of local services.
  Mr. Dorrell: Not for the first time, the hon. Gentleman had better clear his line with his hon. Friend the Member for Peckham. Only a few minutes ago, the hon. Lady was saying that, under her system, GPs would have absolute freedom to decide where patients were referred. It is essential to focusing on the delivery of high-quality care for those responsible for fashioning the pattern of provision to do so in the way that is dictated by the interests of the patients for whom they are responsible. That is the merit of the fundholding system.
  Let me give the last word on the merits, or otherwise, of the system that we have introduced, which grants health authorities greater freedom to decide where to commission care. That last word should, perhaps, go to Lord Winston, a Labour spokesman in another place. According to him,
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  "The internal market has resulted in many hospitals improving outpatient facilities, improving comfort for patients, improving waiting times in clinics and in some cases improving waiting lists."—[Official Report, House of Lords, 26 February 1996; Vol. 569, c. 1460.]
  There is no doubt that that has happened. That is the case for the internal market, which the hon. Lady is committed to abolishing—or so she says; she cannot substantiate the commitment.
  Another issue which the hon. Lady is fond of discussing is that of administrative costs. We have heard more from her on that subject today. Both she and the Leader of the Opposition are fond of referring to what The Independent, in that same editorial, described as a "golden stream" of resources available from administrative savings.
  The hon. Lady's problem is the same as that of the Leader of the Opposition: no one believes them, for very good reasons. It is the original political mirage. The hon. Lady says that we do not need to provide extra resources; we can secure all the resources through administrative savings.
  Mr. Purchase: The Government have been saying that for years.
  Mr. Dorrell: We have not. We have delivered growing resources to the NHS and a more efficiently managed health service for more than 17 years, because benefits to patients are our driving consideration.
  The right hon. Member for Derby, South (Mrs. Beckett), who was the predecessor of the hon. Member for Peckham as Labour's health spokesperson, was clear about NHS management. On 19 February 1995, she said on "The World This Weekend":
  "I don't think it's really in question any more that the NHS has been undermanaged in the past."
  What would Labour do about ensuring that the NHS of the future is efficiently managed? The hon. Member for Peckham is fond of talking in general terms of saving £1.5 billion in administrative costs, and she did so again today, but that proposition is absurd.
  Ms Harman indicated dissent.
  Mr. Dorrell: The hon. Lady denies saying that. I will quote her verbatim from an interview which she gave on 20 June, not long ago:
  "As we have said, we think the overall figure is somewhere between £1.4 billion and £1.7 billion."
  The hon. Lady says that is the extent of the resources that will be available to expand provision. How would Labour deliver remotely that sum of money?
  Ms Harman: We have said, and we stick by this claim—the Government's figures and independent estimates support this—that it costs an extra £1.5 billion every year in administrative costs to run the market. If one abolishes the annual contracting round, all the people needed to negotiate contracts will no longer be required. If fundholding is replaced with GP commissioning, hundreds of thousands of invoices will not have to be processed by managers. When there is freedom of referral and patient choice instead of the bureaucracy of extra-contractual referral, there will be no need for all that paperwork. Chris Ham said on the "Today" programme:

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  "They can release hundreds of millions of pounds from the internal market and put it into patient care."
  Mr. Dorrell: The hon. Lady has been more precise than Chris Ham. She claimed that she will release £1.5 billion. The House must assess the plausibility of that claim, remembering that total NHS expenditure on general and senior managers, and on administrative and clerical staff in 1994–95, was £2.4 billion.
  Ms Harman: That is M2.
  Mr. Dorrell: No, that figure is a lot more than M2. It relates to all administrative and clerical salaries in the NHS. The hon. Lady claims that she can save almost exactly 60 per cent. of total spend. I invite the House to test that claim against basic plausibility. Does anyone believe that the hon. Lady, by taking over my job, can release 60 per cent. of the health service's administrative costs? In the interview that I quoted earlier, Nick Ross asked the hon. Member for Peckham to demonstrate how she would set about releasing 60 per cent. of NHS administrative costs. She started with an example involving £20 million. She may have identified one saving of £20 million, and I assume that was not the smallest that the hon. Lady could think of—it was probably one of the largest. The hon. Lady must find another 74 examples to get near her target of savings of £1.5 billion.
  Mr. Eric Martlew: In 1977, Cumbria had one health authority and the only salary paid was £2,000, to the chairman of that quango. Today, Cumbria has two health authorities and seven trusts at a cost of £332,000. Is that money not spent on bureaucracy?
  Mr. Dorrell: The hon. Gentleman is wrong in several respects. In 1977, every part of the country was covered by a general practitioner committee, health authority, area health authority and regional health authority. [HON. MEMBERS: "NO."] Labour Members may deny that that happened, but in 1977, every part of the country was within a health region, area and district—and was also covered by a family practitioner committee. Another problem for the hon. Member for Fife, Central (Mr. McLeish) is that Labour is committed to maintaining the distinction between health authorities and health providers.
  Two other factors make the Opposition's claim of £1.5 billion savings wholly absurd. One of the big administrative savings which we made in recent years was from the abolition of regional health authorities—which Labour voted against. Removing that unnecessary tier produced savings of £100 million. The £2.4 billion spent on administration accounts for 7.5 per cent. of the NHS total spend. How much does the hon. Lady intend to save from that sum? I have already committed the Government to a programme of administrative savings to reduce administrative costs by £300 million, which is 1 per cent. of the total. If the hon. Lady thinks that she can go beyond that, she owes it to the House and to the country to explain how.
  Mr. Simon Hughes: NHS consultants, the Royal College of Nursing, the British Medical Association and family doctors, apart from asserting that the money spent on administration is
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  a misuse of resources, complain about the impact of the paperwork and bureaucracy brought about by the 1990 Act. Does the Secretary of State say that they are wrong? Does he accept those complaints, and will he do something to meet those serious concerns—which are driving many people out of the profession?
  Mr. Dorrell: I have implemented the recommendations of two efficiency scrutinies which were designed to reduce unnecessary administrative processes. When the Leader of the Opposition addressed the National Association of Health Authorities and Trusts last week, he acknowledged that nowhere in the health service was there an appetite for further fundamental administrative reform, which is why I am confident that Labour would not deliver the pledge that it is fond of making, to abolish the internal market. I am confident, because when Labour Members are asked to demonstrate how they would do that, they never can.
  Another question for which we await an answer from Labour Front Benchers relates to fundholding, which has troubled them ever since fundholding was established. The policy background is clear. More than one half of GPs have opted into fundholding because they believe that it delivers the best prospect of care for their patients. [HON. MEMBERS: "NO."] Labour Members must ask GPs what other purpose they had. If GPs do not believe that fundholding offers the best prospects of improving patient care, one must inquire why they made that choice.
  Mr. Kevin Barron: What about the Audit Commission?
  Mr. Dorrell: The Audit Commission recently examined fundholding, and its director was asked about its report. He said on radio:
  "Most fundholders have…produced some benefits for patients and 10 per cent. of fundholders have done very well indeed."
  Given that 10 per cent. of fundholders have done well and all fundholders have produced some benefits, what is the proper response? We are clear that the right way forward is to level up. Where 10 per cent. of fundholders have led, we should encourage and ensure that others follow, to deliver the same benefits to their patients. Fundholding and the system that lies behind it are a ratchet to improve standards and efficiency. Labour takes a different approach. I want a precise answer to this question.
  Does the hon. Member for Fife, Central speak directly and with authority for Labour on the subject of fundholding? On 6 March, he went to Guildford—to the South Thames Fundholders Association—and, to that assembly, committed a Labour Government to abolish fundholding. His words were:
  "Fundholding will end on 31 March 1998",
  the year after an election, assuming that it would take place next spring. He went on to say:
  "The Audit Commission has shown that fundholding managers have not achieved anything worth saving. They will go."
  Is that true? The hon. Gentleman said that fundholding managers will go?
  Mr. McLeish indicated dissent.
  Mr. Dorrell: So it is not the Labour party's policy to abolish fundholding? We cannot run fundholding without

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  fundholding managers. Will they go or will they not? They are real people with real jobs. They are entitled to know whether the Labour party will sustain them in jobs. Will they go or will they not go? What is the answer to that question? We are entitled to know. I give way to the hon. Member for Peckham or to the hon. Member for Fife, Central.
  Ms Harman: I have said that we will replace GP fundholding with GP commissioning. We will do that not only because GP fundholding is unfair, part of a two-tier system, and because it makes it impossible to plan improvements across a locality, but because it costs hundreds of millions of pounds in bureaucracy and provides no extra benefit for patients.
  If there is a simple choice between employment of more practice managers or administrators to support practice managers and more health visitors or midwives—that is, in fact, the choice—we will choose to put cash into front-line patient services. We will not, as the Secretary of State is doing, champion mountain upon mountainous layer of extra bureaucracy. How on earth can he justify that?
  Mr. Dorrell: No one can say that I have not given the hon. Lady an opportunity to clarify the policy. The hon. Member for Fife, Central was clear: he said that fundholding would end. The hon. Lady has refused to endorse that policy. If the hon. Gentleman wishes to remove any doubt, I shall give way.
  Mr. McLeish: I am very happy to put the record straight. With his experience, the Secretary of State should be a bit wiser in the material that he uses. The simple fact is that, after addressing a group of south Thames fundholders at their invitation, three of the fundholders—whom I regard as enthusiastic fundholders—provided copy to the periodical to which he referred.
  All the comments which were made were complete and utter lies. I cannot say anything more to put the record straight. They were made deliberately to achieve that in which the Secretary of State is indulging. I regret that, but I hope that I have put him straight on the record. I tell him sincerely that those comments and ideas attributed to me were not simply wrong; they were untruths.
  Mr. Dorrell: I accept that the hon. Gentleman was not accurately reported in that meeting, which, in itself, is not the most important issue in the world. What is important is for those who work in the fundholding system to know whether Labour would end fundholding. We still do not have an answer.
  Ms Harman: Yes.
  Mr. Dorrell: In that case, why is the hon. Member for Fife, Central at such pains to deny that he defended Labour policy to the south Thames fundholders? It is true or is it not true?
  Mr. McLeish: I expect a great deal more from a struggling Secretary of State. We are replacing fundholding. Read my lips: we are replacing fundholding. I said that the comments to which he referred were simply
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  untruths passed on from a meeting. That is the important distinction which he must draw. I hope that the Secretary of State will control his worst excesses and apply himself to the facts. We will replace fundholding.
  Mr. Dorrell: I understand what happened at the Thames meeting. I am simply picking up on the question of the word "end". I asked whether the Labour party would end fundholding.
  Ms Harman: Yes.
  Mr. Dorrell: Again the hon. Member for Peckham says, "Yes." Why is it that the hon. Member for Fife, Central leaps to his feet to deny that he used the word "end" when he went to the south Thames meeting on 6 March? The truth is that Labour Front Benchers have not agreed among themselves—still less have they agreed with anyone else in their party—what their policy is, and that is true not only on the fundholding issue.
  The same problem exists on the private finance initiative, which is an absolutely key issue for the NHS. The PFI offers the health service the prospect of escape from a system of capital planning of which it has been a prisoner since the day it was established. The PFI offers escape from short-termism. The Leader of the Opposition understands that. He said:
  "The PFI is right in principle."
  That may be the only matter on which he agrees with the right hon. Member for Kingston upon Hull, East (Mr. Prescott), who claims paternity of the PFI.
  So the senior people in the Labour party are quite clear where they stand on the PFI—they are in favour of it. The hon. Member for Rother Valley (Mr. Barron) is also in favour of it; he is another member of this "team". He said:
  "We do not disagree with the PFI. How could we?…It was Labour who first thought of partnerships between the public and private sector."
  I am not sure that the idea of partnerships between the public and private sector did not antedate the foundation of the Labour party, if truth be told.
  The hon. Member for Rother Valley is keen to be on the record as supporting the PFI. He is a shrewd fellow and clearly thinks that it is more important to his career to be close to the Leader of the Opposition than to be close to his boss on the Front-Bench team—because the hon. Member for Peckham does not support the PFI. His boss on the Front-Bench team takes a distinctively different view of it. She said that the PFI was
  "a new trick to privatise the Health Service."
  She also said:
  "I don't call it the Private Finance Initiative, I call it a privatisation initiative."
  We are entitled to know which of these various stars among Labour Front Benchers speak for the Labour party on health. They speak with different voices on different days to different audiences.
  Mr. Barron: What does the right hon. Gentleman think?
  Mr. Dorrell: I will tell the hon. Gentleman exactly what I think about the PFI. I think that it is the best opportunity that the health service has to ensure that it

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  escapes from capital short-term planning and delivers the modern equipment and buildings that we need to ensure that the NHS meets the challenges of the next century.
  The hon. Member for Peckham has an opportunity to tell us her position. We do not ask her to take the opportunity today, but we ask her to take it tomorrow. I understand that she will go to talk to Unison tomorrow on the PFI. Unison's position on the PFI seems pretty clear from this advertisement, which states:
  "PFI: the biggest threat to your health since 1947."
  It has even designed a logo to encapsulate the message, which states:
  "Unison says no to private finance."
  The hon. Lady has to decide before the meeting—at 12.30 pm tomorrow, at the Cumberland hotel—whether she is on the Unison side of that argument or on the side of the Leader of the Opposition and the hon. Member for Rother Valley. The health service needs to know the answer to that.
  I conclude with a little advice to the hon. Member for Peckham. She would do well to back the Leader of the Opposition. In my humble opinion, the right hon. Member for Sedgefield (Mr. Blair) remains her best and only hope, because the fact is that Labour's health policy is a shambles. Labour Members have a slogan on the internal market, but they have absolutely no substance to back it up. They have no idea what they would do about fundholding. They have no idea what they will do about the PFI. Their policy on resources on health relies on a non-existent El Dorado.
  The hon. Member for Peckham survives by the indulgence of the right hon. Member for Sedgefield, who demeans himself and his party by his unwillingness to face even one of the real issues facing the NHS. Where there should be substance, there is a vacuum. His speech to NAHAT last week was as trivial as it was content-free. Even the high spots last week were not so much soundbites as soundnibbles.
  The right hon. Member for Sedgefield has done the hon. Member for Peckham a favour by organising this debate on the night of the biggest football match of the year so far, so that she can conduct it in decent obscurity. But he cannot protect her for very much longer. Sooner or later her failure will be exposed, as the voters realise that it is the Tories who deliver on the national health service.
  5.48 pm
  Mrs. Audrey Wise: I want to raise two major points in the time available to me. One relates to fragmentation and the lack of co-ordination and the other to the bureaucratic nonsense of so many of the so-called activity and efficiency measures introduced by the Government.
  I shall start with the latter, but before doing so I want to comment on the remark made by the hon. Member for Clwyd, North-West (Mr. Richards) about emergency admissions. He seemed surprised to find that we expect beds to be available for emergency admissions. I expect beds to be available and vacant, as needed, for emergency admissions, and I expect fire engines and ambulances to be standing waiting just in case I have a heart attack or
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  there is a fire at my home. I am obviously grossly extravagant in my expectations, but I can tell the hon. Gentleman that those expectations are shared by the overwhelming majority of the population.
  The problems with bureaucracy go back a long time. One of its major manifestations is compulsory competitive tendering. CCT does not necessarily lead to the best value being obtained, but rather to trouble and expense being incurred in obtaining normal services.
  Although I am on good terms with my local district general hospital and although I believe that those managing it are doing their level best in difficult circumstances, I want to give a small critical example of the sort of problem that arises. Cleaning is obviously basic in a hospital. A constituent drew my attention to a lack of cleanliness at the Royal Preston hospital at the turn of the year. I was very concerned about that. I had been a patient in the hospital, but before CCT was introduced. I can tell the Secretary of State that the hospital was sparkling then.
  I investigated the problem and it was confirmed that there were difficulties. The chief executive said:
  "The problem relating to the cleanliness of the wards relates to difficulties encountered by the contractors in maintaining sufficient staff on the wards."
  I wrote asking whether the contractors did not pay adequate wages. I was told that they paid the same wages as were usual and that any recruitment difficulties experienced from time to time were more to do with the local labour market.
  I know that many, many people in Preston are desperate for work. I do not believe that good employers cannot obtain staff for a job that is not unpopular. As cleaning jobs go, cleaning a hospital is regarded as very useful work that carries with it some sort of standing in the community. It is not a rubbish job—or it should not be. It is an essential job.
  I was told by the chief executive:
  "A meeting is to be held shortly with the director of the company with an expectation that the problems will be overcome."
  The problem with that is that the meeting was scheduled to take place three months after the identification of the problem of lack of cleanliness. Three months is a long time to have cleaning problems in a hospital. That sort of problem arises not because of any inefficiency by the chief executive, but because he no longer runs the show. Other people employ those who are performing that essential service in the hospital. That does not lead to good management.
  I can tell the Secretary of State that I know of cases—not in the Royal Preston, but elsewhere—of apparent savings in supplies contracting. The only problem has been that the search for and the delay while waiting to identify those minuscule savings have more than swallowed up several years' cumulative savings. Again, that is not such a good idea.
  Finished consultant episodes are now a measure of activity or efficiency in the NHS. I do not believe that they measure either of those—they certainly do not measure efficiency. Indeed, I have recently learnt that they do not even measure activity. Gimmicks or ruses are employed so that a hospital can show a massive increase in its activity through finished consultant episodes. It is very easy—the hospital simply discharges patients to whom previously it would have said, "Come back next

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  month." It now says, "Go to your general practitioner." The GP then refers the patient back to the hospital, but it counts as a new consultant episode. The hospital can then say that far more people are being treated. Finished consultant episodes do not equate to people being treated. That should be lesson No. 1 for any Secretary of State who wants to get real efficiency in the NHS. Some of the effort put into accountants chasing pieces of paper should be put into finding sensible measures of outcome in the NHS and treatment for patients.
  I want to refer to the lack of co-ordination, especially in relation to child health. A report was published 20 years ago, having been commissioned by the then Government. It was one of the rare excursions by the powers that be into children's health—a subject that has been grossly neglected by the House and by successive Governments. However, 20 years ago the then Labour Government published the Court report, the essential plank of which was that there needed to be more co-ordination in the provision of a children's health service. We still do not have a children's health service. In fact, if any hon. Member cares to consult any voluntary organisation, I can promise that the story that that hon. Member will be told will be one of fragmentation, competition, lack of communication and general chaos, which in my opinion is not too strong a word to use.
  It is deplorable that there should be quarrels between health services, social services and education services about who pays for what, while the children go without. A sensible Government would give more than a steer on who pays for speech therapy, for instance, instead of allowing it to be shunted between local education authorities and health authorities, while the children go without. I would not mind if the argument were being conducted on the side, at the same time as provision was being made, although I would still think that they should not put too much time and effort into the arguments. However, the children go without while the squabbles continue.
  I am sure that, in general, voluntary organisations would echo an organisation called Aid for Children with Tracheostomies. It complains bitterly about difficulties in obtaining essential equipment, disposable supplies and respite care. All those are needed for children who are being nursed in the community, which is a growing trend. Along with that growing trend should go a growing provision of essential equipment, disposable supplies and respite care; otherwise, the children are being short-changed. Indeed, I do believe that children and their parents are being short-changed.
  Respite care at home is a very good idea. Unfortunately, it is difficult to organise. It is hard to understand that because keeping a child in hospital for one night costs about £150, apart from any treatment costs. I am reliably informed that full respite nursing care for the equivalent period would cost £80—a saving of £70. One would think that all authorities would be queuing up to provide respite care at home, but no money for such care appears to have been built into the community nursing service budget. Therefore, a liaison nurse—assuming that there is one, which is quite a big assumption in some places—has to approach a GP and request that the GP puts in a bid for health authority funding.
  My hon. Friend the Member for Peckham (Ms Harman) cited examples of bids being made for extra-contractual referrals. I am not too happy about the fact that a
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  community nursing service may think that respite care is needed for a child at home, but can arrange it only through a GP, who must bid—which presumably means that it may or may not be granted—for something that is not only better but cheaper. Despite that, the Government tell us that they know how to run the national health service.
  There is a lack not only of respite care at home but of a community children's nursing service. Not only are children in hospital still as likely to be nursed in adult wards as they are in children's wards, but when they are discharged for continuing care at home, there is a 50:50 chance of there being no community children's nursing service in their area. That means that their care is not supervised by qualified children's nurses.
  For the benefit of Ministers' education—if they will spare time from their conversation and listen—I should point out that it is a prime tenet of children's medicine that children are not simply small adults. They require very specialist care, yet in 50 per cent. of the country there is no community children's nursing service and only 10 per cent. of the country has a 24-hour children's community nursing service.
  Children are increasingly being discharged to their homes when they still need quite elaborate care, which is undertaken by parents. Parents are entitled to proper back-up, supervision and, indeed, nursing services, but they are being exploited; gross advantage is being taken of their keenness to have their children at home. It is no part of a parent's duty to undertake, for example, procedures such as passing nasogastric tubes, yet in our constituencies a person may be expected to do that as the price for having their child at home instead of in hospital, which is entirely wrong.
  I am astonished at the complacency to which we have been treated by the Secretary of State, who thinks that the Conservatives deliver health care and protect the national health service. If he were a sick child or a parent of a sick child, he would be a good deal less complacent.
  Mr. Michael Fabricant: Does the hon. Lady recall that, when the Labour party was in power in 1977, it cut nurses' pay? Does she recall that in 1978 and 1979, sheets in hospitals—yes, including in children's hospitals—were not being cleaned because of the winter of discontent? Is that the legacy of which she is so proud?
  Mrs. Wise: If the hon. Gentleman chatted with any nurse in his area, he would find that a different comparison would be drawn. Nurses may not be going on strike collectively, but they are doing so individually by leaving the service. Has the hon. Gentleman ever chatted to a nurse and had that nurse tell him about the times when she has gone home and cried because of the inadequacy of the service that she was trying to provide? If he has not had that experience, he has not talked to many nurses.
  I congratulate my hon. Friends on the motion. I am quite sure that when we condemn the Government for their handling of the NHS, the bureaucracy, the lack of efficiency, the preference for competition over planning, the lack of any strategic thought and especially the lack of so many basic services, the people of this country are on our side of the argument and regard the Secretary of State's statements as simply incredible.
  6.4 pm
  Mrs. Marion Roe: I listened very carefully to the points made by the hon. Member for Peckham (Ms Harman), who, unfortunately, is just leaving the Chamber, but I totally disagree with her. Patient care in the national health service is most certainly not dominated by bureaucracy. To maintain that argument does a great disservice not only to the very good managers of the national health service but to the improvements in patient care that have been made since the advent of the national health service reforms.
  The taxpayer surely has every right to expect that public money is spent wisely and that it is committed to achieve the ends that Parliament considers most vital. It is simply common sense that, in an organisation the size of the NHS, that requires strong leadership and robust financial control. That is the role of NHS managers. I believe, along with many others, that the many recent achievements of the NHS would not have been possible without them. The achievements to which I refer have not in any sense been attained in an ivory tower; they are solid, demonstrable improvements in patient services. I shall give a few examples of such achievements by citing what has occurred in the two hospitals that serve my constituents.
  Over the past five years at the East Hertfordshire NHS trust, which operates at the Queen Elizabeth II hospital in Welwyn Garden City, there has been a 30 per cent. increase in the number of day cases and in-patients treated, including a 14 per cent. increase in emergency admissions. Over the same period, more than 33 per cent. more out-patients have been treated. Accident and emergency attendances have increased by more than 5 per cent. a year since 1991, but with the recent introduction of assessment units for children and GP-referred patients the trust has managed to control the number of unnecessary and, of course, costly emergency admissions.
  For patients awaiting routine surgery, there has been a huge reduction in overall waiting time. On 31 March 1993, almost 600 people had waited longer than 12 months for their operation, but on 31 March 1996 only one person had waited longer than 12 months. That patient was admitted in early April. The appointment of many new consultants enables the trust to provide a very wide range of services locally so that patients do not have to make the tiring and often stressful journey into London.
  Since 1991, a range of new units and services has been planned, built and put into service. They include a new day surgery unit that performs operations for more than 7,000 patients a year, the joint development of a magnetic resonance unit providing a state-of-the-art diagnostic imaging service, a new residential and respite care unit for younger physically disabled people, a pre-discharge unit for elderly patients awaiting assessment for longer-term care, a stroke rehabilitation unit, a complete new hospital ward for gynaecology patients and a high-dependency unit for coronary care and other serious medical conditions.
  That is typical of what has been achieved in east Hertfordshire since the introduction of the NHS reforms. Those who are familiar with the funding of health services in the shires will be well aware that it was certainly not the result of over-generous funding. While all those developments were taking place, the revenue funding available to east Hertfordshire rose by only 3 per cent. It is
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  a superb record of efficient management and it equates to an efficiency gain of 22 per cent. in total or 4 per cent. on average each year, which well exceeds the national target of 3 per cent.
  I am aware that those major advances in patient services are reflected throughout the country. They have been achieved not through bureaucracy but through skilled and effective management. Therefore, it must be clear that prudent investment in good managers pays dividends.
  Those achievements have been attained against a background of low management costs. In 1996, East Hertfordshire NHS trust recorded management and administration costs of 5.7 per cent. of its overall expenditure. That low total would be the envy of many organisations with far simpler remits. However, we must not forget that many doctors, nurses and technical and professional staff are involved in the management of the NHS, and that is exactly as the taxpayer would wish. Of the 5.7 per cent. that I have just quoted, 1.7 per cent. relates to staff with a clinical or technical function.
  Similar successes have also been achieved in the Chase Farm Hospitals NHS trust, which operates from Chase Farm hospital. Management of the trust is based around 12 practice management groups—the local version of clinical directorates, which were introduced in 1991—based on the major specialties. Each is headed by a PMG chairman who is a senior consultant in that specialty. PMGs are responsible for the quality of services, financial management, staff management and development and planning service developments through the annual business planning process. PMGs make budget and day-to-day decisions about services, so many important decisions are made at the chalk face rather than in the boardroom. About 50 per cent. of the full-time consultants are directly involved in management and there are excellent working relationships among medical, nursing, management and other professional staff.
  The past three years at Chase Farm have seen the development of new, innovative services and the appointment of 14 new consultants, with additional consultant posts in general surgery, oral and maxillofacial surgery, obstetrics and gynaecology, anaesthetics, paediatrics and accident and new consultant appointments in orthopaedics, ear nose and throat and medicine.
  The Chase Farm trust also places the highest priority on developing relationships and communications with GPs and various important initiatives have been developed. There is a GP forum, which is an open meeting for GPs that is held every Sunday morning. Farmfacts is a newsletter specifically for GPs and practice staff. Regular contact has been established with individual practices and doctors and managers visit GPs in their surgeries to focus on specific issues. There is a medical director helpline, which provides a regular time when the trust's medical director is available for GP queries, and there is also a GP adviser to the trust who attends all the board meetings.
  Through its relationships with GPs the trust has developed services much closer to patients' homes. For example, there is a consultant-led clinic in my constituency at the Cheshunt community hospital as well as numerous GP surgeries. Those initiatives are the result of discussions between consultants and GPs about the services that they require for their patients.

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  Another recent innovation is allowing a consortium of Cheshunt GPs to use the community hospital as a base for their out-of-hours service.
  Clearly, it is important to take account of every member of staff in the hospital who is involved in its management, but many managers retain significant clinical responsibilities. They include the chief pharmacist, the chief physiotherapist and other senior professional and technical staff. The medical director is a busy surgeon who fulfils his management role in four weekly sessions.
  It is an inescapable fact, however, that the NHS internal market, which has been in operation since 1991, has incurred some elements of bureaucracy that could be dispensed with by carefully targeted action. For example, we need to examine whether staff time should be taken up with issuing invoices and checking queries. There may be scope for simplifying the system—a task that my right hon. Friend the Secretary of State has well in hand through the major efficiency scrutiny that he has launched in the NHS.
  It would be particularly welcome for the recommendations of the scrutiny team to concentrate on those areas where staff have to check and confirm the details of patient care that have been provided in good faith by hospitals and community services. More straightforward administration of extra-contractual and tertiary referrals could be achieved at no cost to the effectiveness or control of patient care.
  Finally, after five years of enormously effective operation, we must acknowledge that some elements of the NHS reforms may require adjustment. As I have already said, that is now in hand. However, we must keep clearly in mind what the NHS reforms were meant to achieve. The purpose of the reforms, in addition to a much increased involvement of doctors in key decisions, was to ensure that taxpayers' money was spent on patient care and that that could be demonstrated clearly through a system of accountability between purchasers and providers. That those objectives have been achieved cannot be questioned.
  Mr. Bayley: I have listened with interest to the hon. Lady. She mentioned a considerable list of service improvements at the Queen Elizabeth II hospital over a five-year period and said that during that time the hospital's income had increased by only 3 per cent. in real terms. Earlier this afternoon, the Secretary of State said that the NHS had received a real terms increase of 3 per cent. in each of those years. Which figure is right? Is it 3 per cent. per year or 3 per cent. over five years?
  Mrs. Roe: I was absolutely clear, but I shall repeat what I said so that the hon. Gentleman does not misunderstand me. He will find that I said that while various developments were taking place, the revenue funding available to East Hertfordshire NHS trust rose by only 3 per cent. Those in Hertfordshire complained because they did not believe that they were being generously over-funded, and colleagues from Hertfordshire have brought that to the attention of the House on numerous occasions.
  The objectives of the reforms have been achieved—that cannot be questioned. The Government's emphasis on improving patient care guaranteed that the objectives would be achieved, and with their worthwhile and timely
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  efficiency scrutiny they have seized the opportunity to take stock of the system that they put in place and to support the vast improvements in patient care that have taken place. I hope that the scrutiny's detailed recommendations will enable us to put an end to the claims that are made—so often on an uniformed basis—of an over-bureaucratic structure in the NHS. I am glad to confirm that, from my constituents' point of view, the focus of the NHS remains clearly on the patients, whose care must always come first.
  6.20 pm
  Mr. Simon Hughes: This debate is rather like pass the parcel, with everyone hoping to get in before the match starts later on. For the information of the House, it is still nil-nil between France and the Czechs in the second half of extra time.
  The debate was started by a set of assertions in the Labour motion that I hope the Government—although they would generally be unhappy about agreeing to them—will accept. These include the statements that NHS services are overstretched, however many resources are put in; that there is a shortage of intensive care beds, certainly where they are needed; that waiting lists are over-long and people cannot get the service at the place or time they want; that there are still people waiting on trolleys in accident and emergency departments; and that there is great pressure on community health services. There can be no honest dispute about those matters.
  Whether or not it is the Government's policy, it is a fact—as the hon. Member for Peckham (Ms Harman) rightly said—that many people are driven to private health care, even though they would not choose to do so, simply because they cannot be treated in time. Although there will always be rationing in the health service, and the debate is not about "whether" but "how", the test of whether we have a national health service is whether it has the capacity to meet the clinical needs of people throughout the UK.
  The key debate tonight is about whether we are spending money on unnecessary bureaucracy at the expense of and to the detriment of patient care. All the evidence and submissions that I have seen for this and other debates make it clear that we are. Bureaucracy has been growing and, in the words of my party's amendment—which was not selected—
  "excessive, expensive and often unnecessary"
  bureaucracy has resulted from the 1990 reforms.
  I accept that the Government have always made additional capital investment in the NHS, and that there has been real terms growth throughout their period of office, but it is getting a bit thin. It is now down to an increase of 0.1 per cent. this year over the last, but the Government are just about making their manifesto commitment. The test that matters to people outside is whether that growth results in money being diverted to the patient.
  There are issues that the Government have not yet accepted and addressed. For example, many people have experience of a two-tier health service. It does make a difference whether one is the patient of a fundholder or not, and one often does get seen more quickly as a patient of a fundholder. The reason for that is that the trust will take the fundholding patient because it wants to keep the

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  fundholder's contract rather than that of the commission or local health authority, because the trust can be more secure about the future of the commission's contract.
  There is a real debate about making sure that money is properly spent and not wasted. The Government accept privately—although they may not do so publicly—that an unnecessary amount has been spent on bureaucracy as a result of the changes. We must all have constituency experiences—I certainly have—of local GPs and people working at, for example, Guy's hospital in my constituency who have given examples of bureaucracy gone mad in terms of the way in which people move from the moment their need is expressed to treatment. No one can be satisfied with that in the health service.
  I shall refer to, rather than elaborate on, the professions I cited in an earlier intervention on the Secretary of State, who say that the system is far too bureaucratic and add that they are suffering under it. They are suffering not just because it is costing money, but because it is diverting resources and time, and demotivating them from the service that they want to provide.
  First—the hon. Member for Peckham referred to this event also—a news conference was organised by the British Medical Association on 16 May, the report of which stated:
  "Flagship hospital trusts are reportedly seeing their once-efficient departments slowly destroyed by government requirements for trusts to make year-on-year efficiency savings of 3 per cent. But they are not allowed to use any surpluses to increase capital resources, such as beds, in the following financial year. Instead they have to use them to cut prices."
  The Royal College of Nursing has signalled certain specific concerns, and has made the point that it is a bad economy to cut out senior nursing posts—one of the consequences of the Government's reductions in certain budgets at a time of nursing shortages. If there are nursing shortages and less experienced groups of nurses, we need the senior nurses in post to be able to make sure that they manage less experienced staff and plug the gaps better.
  According to the RCN, the number of nurses fell by 2 per cent. in 1992–93 and by 1.27 per cent. in 1993–94. More worryingly—I hope that this concern is shared across the House, and I know that the Select Committee has declared its concern—the number of pre-registration students has gone down considerably, from 37,000 qualifying in 1983 to 14,000 in 1995. There is real concern about the future of people coming into the health service to train as GPs or nurses.
  The RCN suggested two matters of particular concern. First, the introduction of local pay bargaining is extremely time-wasting and debilitating. There are now 488 sets of local pay negotiations—what a waste of time and effort. There should be a minimum guaranteed pay scale for nurses across the NHS. If one wants to top up that scale as a result of extra bonuses for work done—rather than negotiated pay—then that can be done.
  It is noticeable that, as of a couple of weeks ago, out of the 488 employers in the NHS, only 111 had concluded negotiations four months after the pay review report. That is the first thing we could do to save an enormous amount of time and effort, and to stop distracting people.
  Secondly, every year now, the commissioner, which is the local health authority, and the trust, as the supplier, must negotiate the contract. Contract negotiations year in,
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  year out, are the most time-consuming and frustrating exercises. Nobody in the public service wants a one-year contract, and we should get away from the idea that that is the way to run the NHS. That is what takes all the time, and that is where all these extra people are employed.
  That is also what produces all the paperwork referred to by the hon. Member for Peckham. We must move very quickly, and I hope that the Government will introduce regulations so that we have much less frequent contract renegotiations.
  The BMA has made some additional points. It says that there has been a huge duplication of administrative effort and a large diversion of resources into administration. GPs around the country—the Minister will have heard this from GPs in Winchester—tell us that the thing that bugs them the most is the paperwork. The Minister knows that that is the case whether it is our survey or his, private or public.
  The Minister for Health (Mr. Gerald Malone): They are bogus surveys.
  Mr. Hughes: They are not bogus, but they are consistent in saying that what bugs GPs most is paperwork. GPs went into general practice to be doctors, not administrators. The most recent survey of GPs' work load, which was conducted by the British Medical Association, showed that the average weekly time spent on practice administration had risen 85 per cent. since 1985–86. Claim forms, recording data, commissioning, fundholding and the patients charter were regarded as bugbears.
  I accept that the Government have addressed some of those concerns, and that the NHS executive report "Patients not Paper" made 65 recommendations, which are being implemented. I hope that we go on down that road, because we have to reduce the administrative burden on our doctors.
  I hope that the Minister will reply to the representation of the National Health Service Consultants Association. Its executive committee met the Secretary of State in March. It was asked what it would recommend, given that the Secretary of State would not concede that the 1990 reforms should be torn up. It wrote to him in May, but had had no reply to its propositions by 20 June. It is clear about the problem. I shall quote its view, because it is up to date and on the ball.
  The association states:
  "the great weight of evidence presented to us indicates that features of the Act and what has developed from it are the prime causes of the current low morale in all branches of the medical profession and indeed throughout the NHS."
  The association is frustrated because the service is fragmented. Loyalty to the concept of the NHS is being replaced by corporate loyalty to the local individual unit, which encourages destructive rivalries and antagonisms, lack of openness and interference with rational strategic planning. A major source of dissatisfaction is that the pricing system is patently arbitrary, is at the mercy of creative accounting, and produces clinical absurdities that bring the system into disrepute.
  The association says that there is no justification for the explosion in the use of external management consultants to report on every problem that occurs. The investment in newsletters and public relations departments to present

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  policies in the most favourable light is a bad use of money. The Minister has received 12 recommendations from the association to reduce bureaucracy and divert resources. I ask that the Government reply as soon as possible and accept, as far as possible, its proposals, which are based on experience and put reasonably, and which include many good ideas.
  A constituent of mine, in discussing the local council and its services, told me in a letter last week that he was busy fighting cancer and did not have time to fight bureaucrats. That is what people in the health service want to do. I shall put the central allegation to the Government and then make suggestions for progress. I shall do so quickly, for the twin purposes of letting other hon. Members speak and releasing myself.
  I hope that the Government accept that it is unarguable that administration costs have risen from 6 to 11 per cent. of spending since the 1990 reforms were introduced. We have gone from 500 general managers—I know that there has been some redefinition—to some 20,000. Redundancy payments have risen from £12 million to £114 million a year. That shows the extent of managerial upheaval.
  My first proposal for change is that the contract period be extended from one to three years. That is no good unless the people involved know how much money is coming down the tracks. It is no good if the budget is given, whether in west Hertfordshire or elsewhere, on a year-by-year basis. The same complaint applies to local government.
  A clear idea is needed of the money that will be available over the next few years. Of course circumstances change and there has to be flexibility, but it would be possible to have a financial framework within which one could know the parameters of the money that was to be given. Within that, there could be adjustments, but it would allow people to plan. Will the Government consider extending the one-year contract period to three years?
  Can we avoid having to price everything? It is quite possible to give a round figure price for the day cost of conventional care in a hospital. We should not have to cost separately the bedpan, the sheets, use of the fan and breakfast. There must be a day rate, as with paying hospital beds or private hotels. It is nonsense to go down to such particulars. We could avoid much costing by having a more generalised process.
  There must be a return to a sense of the public service ethos. One problem is that many managers have not come up from the national health service. Many people in the health service feel that managers do not understand what they have to manage. Let us train people from inside the health service—people who know about managing the service. When we need efficiency cuts, let us not imagine that cutting senior managers is necessarily the best way to achieve cuts.
  Thirdly, can we have longer staff contracts? Short-term staff contracts are demoralising and demotivating. It is not good employment practice, but it is more bureaucratic. It means that many agency staff are employed. It is possible to move efficiently and quickly to longer-term contracts that give everyone a sense of security and the institution a sense of coherence.
  Fourthly, staff planning needs must be better met. That used to be the responsibility of regional health authorities, but they have gone. We have regional health chairmen
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  with nothing to chair; that is nonsense. Local trusts or health authorities cannot plan staff levels because they are too small. They are having to form consortia. We need to return to regional planning of health service staff needs.
  Fifthly, can we end the nonsense of local pay negotiations? Sixthly, can we end the system that requires the health service negotiating process to be rather like the United Nations Security Council? When health authorities, trusts and other players must all agree something, it takes only one agency to say no to veto the whole thing. Perhaps a regional tier or national inspectorate could cut through that. Whichever is needed, we must avoid having to get everyone to sign up to everything before anything can go ahead.
  Penultimately, it is not right to attack management. I agree with the hon. Member for Broxbourne (Mrs. Roe), who chairs the Select Committee, that many managers do a good job. I was in Harrogate hospital at a conference recently. They are doing an excellent job in managing that trust. It is not the managers who are the problem, but the systems that we have imposed. I agree with her and the hon. Member for Peckham that it is the bureaucracy that we have introduced that is debilitating all the players.
  Lastly, the NHS performance indicators will be published next week. There will no doubt be great trumpeting from the Government that they all show that the NHS is performing better. However, the indicators are all related to time; none is related to the quality of care.
  The test of the NHS is not how many people are put through a certain number of beds in a certain number of days: it is the quality of care people have, whether they are in-patients or out-patients. All the statistics in the world showing that we are treating more people more quickly are of no use to anyone if the care is not of an ever higher quality. I hope that the Government understand that it is not the politicians who have the biggest cause to complain about the bureaucracy, but the patients and the people working for the NHS, and they do so because they want the money to go on patient care.
  6.39 pm
  Dr. Charles Goodson-Wickes: As the general election approaches, debates on health care become ever more bemusing and intriguing. Opposition Members' speeches today have demonstrated all too well the increasing contradictions and anomalies in the Opposition's policies, which have been so well exploited by my right hon. Friend the Secretary of State. I have no doubt that my hon. Friend the Minister for Health will probe further when he replies.
  I begin by deploring the fact that, at this time of year, the chairman of council of the British Medical Association seeks to provide emotive headlines at the BMA's annual conference. I had better declare an interest straight away, as the BMA is my trade union. The sort of language he has used, which is translated into the headlines we read, is reminiscent of the worst days of the old TUC conferences: "Health service heading for disaster"; "NHS sinking like the Titanic". Such headlines are not only singularly unhelpful—indeed, untrue—but totally out of keeping with the medical profession and all it stands for.
  The ethos of the medical profession is surely to reassure and to act in the best interests of patients. It must adapt to changing times, but in that adaptation and change, must assist, with the prime object always in view—the welfare of the patients it is looking after.

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  When on earth were there not politicians bemoaning chaos and crisis in the NHS, combined with limited resources? "Underfunding" is an emotive left-wing word which has got into the Opposition's vocabulary as a cover-all description which completely fudges everything that we are in politics for—to make decisions about priorities, within limited resources. It is nonsense to talk about underfunding.
  Our job here, on whichever side of the House we sit, is to decide where best we can use the taxpayers' money. It is a fundamental naivety for the Opposition always to go on about underfunding, when we should be talking about efficiency and patient care.
  Mr. Martlew: Does the hon. Gentleman think that the NHS is underfunded?
  Dr. Goodson-Wickes: I certainly do not. The hon. Gentleman has not been following my train of thought. In an ideal world, every Secretary of State would have an unlimited budget, and the world would be a lot better for that. But that is not the sort of Utopia in which we live. I am sure that the hon. Gentleman recognises that. I welcome the fact that his right hon. Friends on the Opposition Front Bench increasingly recognise that, and are beginning to see the realities of life. I look forward to the hon. Gentleman joining that club in due course.
  After all, Nye Bevan himself wholly failed, in all his admirable work in setting up the NHS, with all-party backing—the Conservative and Liberal parties, Beveridge, all worked together in the all-party tradition to set up the NHS—[Interruption.] If anyone disagrees, they have only to read the history books. I will send them the bumf whenever they like.
  But in setting up the NHS, Nye Bevan himself wholly failed to recognise the infinite demand which would result thereafter. He thought that ill health would, to coin a phrase, at a stroke be eradicable, that everyone would be cured instantly, and that people thereafter would not become ill. I forgive him for that. He could not possibly have foretold the developments in medical technology and so on, which have now opened unforeseen areas of expertise for the benefit of patients and populations.
  Mr. Simon Hughes: Without getting into a debate about Nye Bevan, I have one factual point to make. I hope that the hon. Gentleman will not deny that, in the 1945–50 Parliament, the Labour and Liberal parties voted for the NHS legislation, and the Tory party voted against it.
  Dr. Goodson-Wickes: I said that I was perfectly prepared to send hon. Members the exact basis on which the Conservative party did that. But the hon. Gentleman, being a fair-minded man, will acknowledge that the Conservative party had a considerable input in the setting up of the NHS. We go back to 1911 and Lloyd George. I hope that the hon. Gentleman will be happier now that I have mentioned Lloyd George.
  The hon. Gentleman knows perfectly well that the workings of this place are such that, for bizarre reasons, particular parties go into particular Lobbies, and then the reasons are dissected. We all know the truth. I am sure that the hon. Gentleman and Opposition Members will
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  acknowledge the Conservative party's input. However, I give Nye Bevan the credit for getting the NHS legislation on to the statute book.
  The perfect must never be the enemy of the good. One of the uncomfortable messages we must all address on a non-party political basis is well set out in a leading article in this week's British Medical Journal. I was critical about that publication earlier this week, so I had better be polite about it today. The article, headed "Rationing health care: moving the debate forward", says:
  "In Britain neither the Government nor the main opposition party will openly acknowledge the inevitability of rationing health care."
  That is at the nub of every debate that we have about health care. Commentators believe that the Government should lead a debate on how best to ration health care. We are talking not about whether one should or should not ration health care, but about how best to do it. Anyone who says otherwise is living in the Utopian world to which I referred earlier in reply to the hon. Member for Carlisle (Mr. Martlew).
  The article continues:
  "Many people in the health service think that more funds should be available for health care, and many members of the public support such a proposal. But these are separate debates. More effectiveness and more money will not"—
  I repeat, not—
  "remove the need to deny effective treatments."
  In other words, to go back to the hon. Gentleman's intervention, however much money one has, the resources will never be available to give effective treatment to all patients regardless of need. That is an entirely non-political argument.
  Five years on from the NHS reforms, it is an appropriate time to take stock. Having spent most of my career in the NHS, I have had ample opportunity to see bureaucray at first hand, and bureacracy is the subject of the motion today. I have seen the appallingly long waiting lists for admission, the inadequate administration of case notes, the lack of a proper appointment system in out-patient departments with either no appointment system at all or multiple bookings, and the lack of liaison with investigation results coming back after patients have been seen.
  On top of all that—I say this with humility about my profession—all too often in the past, superimposed upon all those inadequacies has been an air of condescension and old-fashioned paternalism which suits this day and age particularly badly. Any reform which helps to remedy some of those problems, and which the Government have been so conspicuously successful in achieving, is warmly to be welcomed—I imagine, on both sides of the House.
  Where do we go from here? I believe that the Government's record stands up to the closest scrutiny. I welcome the shift from secondary care to primary care, with all that that involves for GPs and their close involvement with patients. I want to quote a letter sent to all Members of this House from the BMA, dated 2 November of last year:
  "The Government's reforms offer improved services to patients, both in quality and range".
  Of course, resources must mirror these changes-although they are not infinite. I certainly hope that GPs' careers will be further enhanced; likewise their job and clinical satisfaction.

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  There is no district general hospital in my constituency, but the borough of Merton's is arguably the best served population in the country, in that it contains three superb district general hospitals which serve my constituency: St. George's Hospital NHS trust, Kingston Hospital NHS trust and St. Helier Hospital NHS trust. I keep in close touch with all of them to find out how they are dealing with the Government's reforms, particularly in respect of bureaucracy.
  The St. George's Hospital trust warmly welcomes the efficiency scrutiny exercise now under way, and believes that it will offer scope to allow the hospital to reduce administrative effort—for instance, in invoicing each month, as mentioned by the Chairman of the Select Committee. The hospital will also be able to simplify contract payments with purchasers and to reduce the need for pre-authorisation from purchasers. That will lead to reduced bureaucracy in the internal market.
  My hon. Friend the Member for Broxbourne (Mrs. Roe) and I would do anything to reduce the bureaucracy that inevitably arises during any administrative change. The fact that St. George's is reacting so positively to the initiative is a good omen for the future.
  The hospital has already speeded up communications within the trust by using e-mail technology. It has developed an integrated information support scheme that speeds up patient results to doctors, reduces the time spent chasing medical records and generally reduces bureaucracy and paper chasing, thereby allowing more time for hands-on patient care. It is important to eliminate the sort of problems which I said at the beginning I had seen at first hand.
  Information links to GP practices have been greatly enhanced, allowing laboratory and radiology results to be passed on quickly and permitting GPs' letters and discharge statements to be electronically mailed. This, too, will alleviate the old problem of time spent chasing paper. I believe that all hon. Members would endorse such an objective.
  I tried earlier to intervene on the hon. Member for Peckham (Ms Harman) while she was waxing lyrical about the bureaucracy surrounding fundholding practices. The House will have noted that she declined to give way, despite my trying to intervene several times. I have specific examples that rebut what she alleged is happening to increasing numbers of GP fundholders.
  The Kingston Hospital trust document explains exactly what I mean. It has set up a so-called GP multi-fund, which, although it consists of about 40 practices, enables the hospital to deal with a single management group. I do not know whether that pattern is followed around the country; if not, it should be, because it is eminently sensible. I hope that the hon. Member for Peckham will visit Kingston hospital and find out at first hand how well the system is working—instead of waffling on about thousands of GP fundholding practices and the bumf that she says they generate. It simply does not work like that.
  Kingston is also talking to the district health authority and to the multi-fund group about providing electronic data transfer between GPs and the hospital, thereby reducing administrative costs. The hospital's management structure is flat, with authority and responsibility delegated close to the point of patient contact.
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  Kingston Hospital trust is set to achieve the target of management cost savings of 5 per cent., a reduction of more than £150,000. It is all very well to swap insults across the Floor of the House, but it is more sensible to look at the figures and see what is actually happening.
  The same good developments are to be found at St. Helier NHS trust and at Queen Mary's NHS trust in Roehampton, which also serves a few people from my constituency. Furthermore, I have good news about the Nelson hospital—one of the old cottage-type hospitals which had been virtually condemned to closure. Thanks to efforts at local and national level, it will now have a future, providing the Labour-controlled council is co-operative, offering enhanced day care facilities, physiotherapy, occupational therapy and radiology—all in the heart of my constituency: a most welcome development.
  I pay tribute to the community health council in my constituency. My first contact with such councils was in Islington, where I was the prospective parliamentary candidate in 1979. I do not know whether things have changed in Islington, in line with the change of attitude represented by the Leader of the Opposition, but at the time its CHC was a politically motivated left-wing pressure group. Nevertheless I pay tribute to the community health council in my area, which could not be less politically motivated. I have not the slightest idea of the politics of those who serve on it, whom I meet regularly and who offer a uniformly constructive and helpful analysis of what is going on. I congratulate them on that.
  The Secretary of State extolled the virtues of removing unnecessary tiers of administration throughout the NHS. I vividly remember the time I sat in the office of the chief executive of the South-West Thames regional health authority, in Paddington. On the wall was an idiotic map, showing his area of responsibility, stretching from Wandsworth to the south coast of Sussex. At the time, my elder son was a patient in an NHS Chichester hospital. I could discern nothing—apart from excellent medical care—linking Paddington, Wandsworth and the southern reaches of Sussex, however. It was ludicrous, and it just showed what a good idea it was to abolish the regional health authorities and put in hand the subsequent reorganisation.
  Not only has Merton and Sutton health authority merged with the local family planning committee; we have gone further and merged the Merton, Sutton and Wandsworth health authority with the family planning committee. That will lead to financial savings, and give my constituents a much better service.
  I do not want my speech to be a litany of good news and congratulations for the Government. There have been problems in my constituency—in fact, I am surprised that Labour Members have not intervened in this regard. For example, there has been national publicity about accident and emergency facilities at St. Helier hospital, which serves my constituents who live in the southern part of the borough. I have had regular meetings with the management of St. Helier hospital, and I have every confidence that it will tackle what is an uncomfortable situation—patients have been left, inappropriately, in corridors. That is unacceptable.
  The management at St. Helier hospital has told me that the main problem is the phenomenon known as bed blocking—I suppose that we will get used to the term.

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  Apparently, "bed blocking" means that patients who are perfectly fit to be discharged from hospital do not have the facilities to be so discharged and thus take up beds that could be used for emergency admissions. This is unacceptable.
  I offer my hon. Friend the Minister a radical solution to the problem—I do not know how receptive he is to radical solutions. If he is in a tier-abolishing and streamlining mood, he might examine the merits of looking at the roles of the community NHS trusts in relation to local authority social service departments to see whether the liaison between the two is good enough. If it is not, would he consider talking to his colleague in the Department of Social Security? There could be scope for further amalgamations and abolitions of tiers.
  The Labour party is coy about its plans for the future. I do not wish to jeopardise the hon. Member for Peckham's chances of re-election to the Labour shadow Cabinet—if such an election takes place—but some of the semantics we heard from her today were quite extraordinary. She was asked whether fundholding will be abolished, or whether it will re-emerge as general practitioner commissioning.
  If the Labour party believes in choice and diversity, will it say whether new Labour believes in a mixed economy in health care? The hon. Member for Stockport (Ms Coffey) is shaking her head—but I do not know whether it is in response to my argument. I hope that the hon. Member for Fife, Central (Mr. Mc Leish) will clarify the situation in winding up.
  The former research director of the Fabian Society, Stephen Pollard, stated:
  "For Labour to put forward a credible social and economic policy—with specific costings for healthcare—it should examine the approach adopted by its Socialist colleagues abroad and embrace the benefits that can be derived from an enhanced British independent healthcare sector."
  What is the Labour party's official view in that regard? Geoff Mulgan, the director of Demos, stated:
  "Mutual help can fill the gaps in provision of everything from money, to food shops and housing."
  Does the Labour party endorse a trend towards the great mutuals of the past and of the present, such as the John Lewis Partnership, the Co-op and BUPA? The Labour party should let the House and the country know its views in this regard.
  I was once a consultant to BUPA. When Frank Chapple was the general secretary of the Electrical, Electronic, Telecommunication and Plumbing Union, the union joined BUPA. He wanted to ensure that his members had the best possible health care available. I am not carping from a purist point of view, because, as a Conservative, I believe that everyone has the right to the best possible treatment available. If the general secretary of the EETPU chose to sign up all his members for private health care, well and good. I congratulate him, and I hope that they all benefited from it.
  As I said in an intervention, there has been a long tradition of the trade union movement looking after its members with private health care outside the national health service—I refer to the Manor House hospital and to the Benenden hospital, one of the largest independent hospitals in the country.
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  The Labour party's argument is riddled with hypocrisy, and it is about time it came clean and told us what it stands for and what its plans are for the future. Does it believe in a mixed economy in health care?
  In years to come, the most important thing will be getting value for money. The right hon. Member for Sedgefield (Mr. Blair) made a speech in this regard earlier in the week. The Times refers to his speech, and states:
  "If Labour won the general election there would be no unnecessary reorganisation in the NHS. He said also that he had no intention of pumping in more money until it had been established whether the present budget was being well spent."
  Hear, hear, to that. I wonder whether he has told the hon. Member for Peckham. Why should we look in a crystal ball when we can read the book? I have read the book according to the Leader of the Opposition.
  Mr. Bayley: Sit down.
  Dr. Goodson-Wickes: I shall conclude my speech—if hon. Members do not wish to intervene.
  I refer to a saying of Sir Richard Doll, which I used to have framed in my consulting room—I used to get my patients to read it. He is well known by hon. Members as one of the supreme epidemiologists—and he was suitably honoured in a recent honours list. He first came to prominence when he demonstrated the causal link between smoking and carcinoma bronchus. He said:
  "It is not for doctors to advise people to live their lives as invalids in order to die healthy."
  I suggest that the essence of Labour policy is to spread alarm among patients, when all the trends—while far from perfect—are for the better and in the interests of patients. I have the greatest confidence in the reforms proposed by the Government. They have been tackled in a practical and robust way. I suggest that the Labour party offers only uncertainty—and uncertainty is one of the worst things in this life. A patient, by definition, feels unwell, uneasy and uncertain. The last thing a patient wants is uncertainty about what the Labour party is going to do to the national health service, which we all value.
  Several hon. Members rose—
  Madam Speaker: The 10-minute limit on speeches now applies.
  7.9 pm
  Mr. Don Touhig: The hon. Member for Wimbledon (Dr. Goodson-Wickes) spoke for about 27 minutes—but I do not know whether hon. Members are any wiser. We know that history is not his strong point because he spoke about the Tories supporting the foundation of the national health service. I wonder what Aneurin Bevan, the architect of the national health service, would say if he knew that this week the British Medical Association has said that the health service is being cut to the bone. No one should pretend that today's national health service is the one that Nye Bevan and the Labour party created. The task of providing health care is as great a challenge now as it has ever been. Health care systems across Europe face conflicting demands, from the political pressure to provide every citizen with better access to care to the need to keep costs at a level that the nation and its taxpayers are prepared to pay and can

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  afford. Added to that political juggling are the pressures of modern health care—the mounting costs of care, a general aging of the population, changing disease patterns, increased expectations and advances in medical science and technology.
  Health care in Europe has developed from the two basic models of a system of mandatory insurance supplemented by public funds and a universal system of state-funded health care. Rising public expectations set against the difficulties of financing health care inevitably lead us to examine how we fund health care, but that is a subject for another debate. Today, we are addressing the issue of bureaucracy in the health service.
  The task of providing an adequate health service for the next millennium is not an easy one. We need to consider carefully how we will rise to the challenge. The Government's response has been to increase bureaucracy and to pour resources into an ever-growing army of administrators, rather than into primary health care. That is not the way to meet the challenge. Bureaucracy has risen to ridiculous levels in the health service. In 1993–94, the Government put an extra £1.4 billion into the NHS and every penny went on bureaucracy, not on patient care. As my hon. Friend the Member for Peckham (Ms Harman) said earlier—she is not in her place at the moment—the health service now has 50,000 fewer nurses compared with 1989, but it has 20,000 extra managers. The cost of administering the NHS has increased from 9.2 per cent. of the total expenditure on the NHS to 15.6 per cent.
  While all that is happening, hospitals are refusing people who need treatment because of problems with funding. That is a scandal that cannot be tolerated in a civilised society on the eve of the new millennium, but it is being repeated across the country. I was in Hamburg recently and I learned about some initiatives that the German health service has taken to overcome the problems of meeting public aspirations for health care at the same time as controlling costs. The cost of some 25 per cent. of hospital procedures has been agreed between the Government, the medical profession and others by identifying diagnostic related groups. Those patient management categories have been negotiated between the hospital association and the insurance funds in all state hospitals to ensure quality and good care. It is intended that that practice will apply to 80 per cent. of hospital procedures.
  Meanwhile, the Government continue with their obsession to develop the market in the NHS, instead of balancing costs against expectations. That obsession means that young diabetics, in my county of Gwent, have to pay for special insulin syringes because the local hospital cannot afford the £4,000 yearly cost of the service. In my constituency, a group of local women provide a cancer advice surgery. Last year, the bulk of its funding came from the mayor's charity appeal and it operates from a portakabin in a car park behind the high street. The group is sustained by volunteers and they are doing the work that should be done by the NHS. Such gaps are all too common.
  Another reason why today's national health service is not the one that Bevan created is the element of commercialisation that has been allowed to sweep in like the incoming tide. While it might be appropriate to market-test for some services in a hospital—portering, catering and cleaning—it is not acceptable or effective to
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  privatise clinical services that directly affect patient care. Already sterile supplies, dental care, ophthalmology, pathology and pharmacy services have been handed to the private sector. Abortion services, psychology, speech therapy, physiotherapy and occupational therapy services have been market-tested as the inevitable consequence of an NHS that operates with a blind faith in market forces. No balance has been sought or achieved.
  The markets may do many things well, but left to themselves the markets will not educate our children, they will not provide the infrastructure that the country needs and they will not provide an acceptable level of health care for our people. Health care is not a product that can be packaged, marketed and sold by formula, at least not in a civilised society which, while valuing the individual, cares for the whole community. Health care is not simply an economic question of supply and demand: it has a human element that makes it unique. Health care is about curing the sick, relieving pain and caring for the young, old and infirm. For most of us, the possession of all the wealth in the world would be no substitute for good health. We must bear that unique element of health care in mind when we consider the subject of effective management.
  We need effective management in the NHS. We already have some good and effective managers in the NHS—some of the managers working in my area do a splendid job—but we do not need managers who are fixated on market testing and contracting out. The NHS needs skilled managers who can develop strategies and schemes, balance budgets and control costs properly, but who also appreciate that they run a unique service of health care. Those who are active and working in health care need to have a say in the management of the health service.
  I recommend to the House the United Kingdom nursing leadership programme, which is sponsored by Johnson and Johnson and the King's Fund. The programme seeks to tap into the unrealised potential of nurses to produce leaders who can make vital contributions to the development of health care. It operates over two years and nurses have a non-nurse, board-level mentor and undertake relevant secondments to improve their knowledge and skills. That break with the traditional career paths for nurses is to be applauded because it is one way in which experienced health care staff can move to board level, thus aiding their personal development and, most importantly, providing a much needed health care perspective at board level. We should welcome that major new learning opportunity.
  Nurse leaders will need to be strategists, environmentalists, slick political operators and confident leaders and they will need to show a sense of purpose. The programme will help them develop those skills. There is a need
  "for nurses to work with the whole system"
  so that they too are
  "stake-holders",
  and can contribute fully to the development of new approaches to health care.
  Mr. Peter Luff: Stakeholders!
  Mr. Touhig: The word "stake-holders" was a quotation from the programme set out by the King's Fund.

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  The rub is that the participants have to contribute £1,000 towards the cost of the programme. The Government are prepared to put £1.4 billion a year into the bureaucracy of health service, but they have not invested in that programme. They are concerned about bureaucracy and administration, but they are not concerned about the nurses—those at what my father would call "the coal face".
  The Secretary of State for Health, who is not in his place, said in February that the policy on the nurses' pay award was not for a 2 per cent. rise, but for locally negotiated pay. Why is it that, four months later, 75 per cent. of health trusts have failed to make deals with nurses on local pay? That is a disgrace.
  Hospitals are not oil companies, supermarkets or engineering firms and it is wrong to think that we can take managers from such backgrounds and expect them to provide effective health care. Obsessive political dogma mixed with blind faith in the markets is a potent medicine that produces privatisation—a prescription that will kill the national health service.
  7.18 pm
  Mr. Michael Fabricant: The debate so far has revealed confusion and empty platitudes from the hon. Member for Peckham (Ms Harman) on the Labour Front Bench. I shall identify three areas in which Government policy has been shown to work by setting a safety net below which nobody can fall. That is Conservative party policy and what we would want from the NHS.
  The first issue is the private finance initiative. There is a clear chasm between Labour Front Benchers, because the Leader of the Opposition supports the PFI but the hon. Member for Peckham has said again today that she thinks that the PFI is a recipe for the privatisation of the NHS. I shall refer also to trusts and, if I have time, to GP fundholding. I commend to the hon. Member for Peckham and to all Opposition Front-Bench Members the excellent book published by the Treasury entitled "Private Opportunity, Public Benefit", which explains the private finance initiative. It shows how the PFI acts to support the national health service—which is why the Leader of the Opposition has a different view from the shadow health spokesperson.
  According to page 9, more than 50 small schemes—that is, schemes under £10 million—are under development or are already in operation. They include waste incineration schemes for south Kent hospitals, a magnetic resonance imaging scanner for the Mid-Sussex NHS trust, a combined heat and power scheme for St. James's University Hospital NHS trust, dialysis services for South Tees Acute Hospitals NHS trust, the completion of negotiations for a concourse development for the Queen's medical centre in Nottingham, and a number of other projects that are under way in Scotland. They are examples of the PFI working for, and not against, the NHS. The PFI is providing additional resources for the NHS. I cannot understand why the hon. Lady disagrees with her leader and insists that the PFI be opposed.
  As to trusts, I find it incredible that Opposition Members continue to use what I call Mandelson alliterations. The latest one is "market madness". Far from
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  creating the market to which the hon. Lady referred, I believe that the trusts have created efficiency. That efficiency has not saved money for the Treasury, but provided better services for patients. That is good news. As my hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes) said earlier, every Government Department has limited resources and we must determine how best to use those resources.
  It is interesting to note that the Government have increased spending on the national health service by four times since 1979 and by £9.5 billion in the past few years. It is fascinating that the Labour party is not prepared to make a commitment this evening to similar increases in expenditure. We have heard only empty rhetoric from Labour Members.
  I recently visited the Staffordshire ambulance trust, which the National Audit Office has identified as having the best response rates of any ambulance trust in England and Wales. I congratulate the service—particularly the chief executive, Roger Thayne—on that achievement. The Staffordshire ambulance trust has introduced an interesting new concept that it developed partly from a computer package from San Diego. It is the first ambulance trust to apply the concept. Every nine seconds, the trust has updates on where its ambulances are located in Staffordshire. Instead of being in depots as in other ambulance trusts, Staffordshire ambulances are placed strategically around the county and thus are able to respond quickly to calls.
  That is the sort of innovative idea that can be introduced under local management. However, the Labour party derides local management. If Labour were to come to power, it would abolish local management, even though that provides the innovation which leads to better health care provision in Staffordshire.
  Mr. Purchase: Will the hon. Gentleman give way?
  Mr. Fabricant: No, I shall not give way, as I may speak for only 10 minutes.
  I pay tribute also to the Premier Health trust in Staffordshire—which is ably chaired by Mrs. Margaret Whalley—and to the chief executive, Dr. Diana Rawle, who recently replaced Mike Marchment. The trust is responsible for the Victoria hospital in Lichfield, which has expanded its facilities. At one time, it was thought that a major district general hospital should be built some distance away from Lichfield to serve the people of Lichfield. However, the Premier Health trust—under local management and working hand in glove with local doctors and nurses—has ensured that the Victoria hospital provides the services in Lichfield for the people of Lichfield.
  The hospital has a larger minor injuries unit, a new antenatal and maternity ward—which I opened recently—and increased facilities in the renal ward. There has been a rebuild of the in-patient facility, the rehabilitation department has been expanded and there are increased day surgery and out-patient services. Those facilities are available through the Premier Health trust, which owes its existence to so-called "market madness".
  As to GP fundholding, it was incredible to watch the hon. Member for Peckham wriggle on the end of her hook. She said that she would not abolish GP fundholding, but then she said that she would abolish it

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  and introduce in its place "contracting"—or some other Mandelson expression. At the end of the day, we need the managers, the market and, most importantly, the resources. [Interruption.] However, I am sure that the hon. Member for Carlisle (Mr. Martlew)—who tries to intervene from a sedentary position—will not make any financial commitments.
  Today I received a fax from Dr. Simon Elsdon, who is based in Staffordshire. I spoke with him last night and he said that he is not obsessed with dogma regarding who owns hospitals or who employs doctors and consultants, so long as good, efficient health care is free at the point of delivery. That is what GP fundholding is all about.
  Labour Members are fond of using soundbites, but they have demonstrated today that they lack the ability to manage the economy or the health service. As with its education policy, Labour seeks not to push up health standards but to aggregate at the mediocre. Labour, through the abolition of the critical purchaser-provider divide, would destroy the expansion of hospitals such as the Victoria in Lichfield, or the expansion of the efficient Staffordshire ambulance service. Labour, through its abolition of fundholding, would emasculate general practitioners and thus weaken service provision to patients. Labour, through its opposition to the private finance initiative, would halt hospital building in its tracks.
  Labour, by not committing itself to extra funding in the NHS, is limited to empty rhetoric and alliterative Mandelson soundbites. Labour, through its adherence to dogma, is determined to set in concrete an outmoded and ill-planned structure that was designed before 1948. While the Government can take pride in the fact that we have quadrupled NHS resources and empowered doctors for the benefit and well-being of their patients, Labour merely offers surgery by soundbite.
  7.27 pm
  Ms Rachel Squire: We have just heard 10 minutes of empty rhetoric and classic soundbites from the hon. Member for Mid-Staffordshire (Mr. Fabricant). I hope that he will listen while I tell him a little about life in the real world for those who depend on the national health service.
  I begin by paying tribute to the vast majority of NHS staff for their dedication, commitment and expertise. That is what has kept the national health service going, as it struggled against the impact of 17 years of Conservative Government policy. As a reward, the staff have been paid peanuts for providing vital health care. They have seen the privatisation of health care and they have watched while millions of pounds of public money was spent lining the pockets of the Tories' friends and creating more and more tiers of management.
  I wish to use the brief time available to me tonight to highlight what is occurring in the real world. I shall focus particularly on what is happening at my local district general hospital, the Queen Margaret Hospital NHS trust in west Fife. For months, patients, their relatives and the staff have told me how the trust's bureaucracy and its managerial approach have led to the early discharge of patients—particularly the frail elderly—a lack of information and to ever-longer waiting lists.
  I have raised my concerns with the chief executive and the health board. I have spent months listening to them saying, first, that I have not heard the full story; secondly,
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  that prompt action has been taken; and, thirdly, that the complaint that has been raised with me is not a common one. I have been willing to accept that, as a Member of Parliament, I tend to hear rather more complaints than praise, but I have reached the conclusion that I have used the procedures for too long, and it is time for me to make public my concerns about what NHS bureaucracy and the Government's policies, encouraged and promoted by Fife health board and the Queen Margaret Hospital NHS trust, have meant to my constituents.
  Let me outline a few of the examples that I had hoped to quote in more detail tonight. Until recently, the Queen Margaret hospital had four consultant radiologists, covering the whole of Fife. Even that is not enough to deal with the demand and provide a fully comprehensive service. But from August there will be only one full-time consultant radiologist, because the other three resigned in disgust at the managerial approach to radiology services, which they believe has resulted in a reduction in quality patient care. When I met the chief executive at the beginning of this month, he put the resignations down largely to personality conflicts. Yet, surprise, surprise, the consultants who are leaving have been snapped up by nearby hospitals.
  I quote what one of the consultants said in his letter of resignation:
  "When I first came to the Queen Margaret Hospital three years ago, like the rest of the staff at the hospital, I was excited by the new challenges, new equipment and the future potential of developing appropriate and top quality services to Fife patients. However, in the last three years I have seen this deteriorate to a point I find professionally and personally unworkable due to a style of management that has no concept of prevalent future roles in modern Radiology which puts balance sheets and outward appearance before patient care and staff requirements for working conditions."
  The problems in providing a radiology service became apparent to me during the past two years in complaints from constituents. I have raised the matter on more than one occasion with the hospital trust management, but as a direct result of its behaviour, the Government's policies and the behaviour of Fife health board, which is supposed to ensure that such services are provided, the people of Dunfermline and Fife as a whole will be without an essential quality service that affects many areas of diagnosis and treatment, including surgery. There is a national shortage of consultant radiologists, so what hope is there that patient services will be provided or restored?
  The second example of NHS bureaucracy and the Government's policies concerns a consultant ophthalmologist. As I said earlier, I have detected growing concerns for a considerable time, but it was difficult to get substantial evidence because patients and relatives were afraid to go public with their complaints in case they came back on them, and staff were afraid that if they spoke out they would be dismissed. A consultant ophthalmologist did speak out and he was dismissed, even though the vice-chairman of the trust said:
  "I should stress that Dr. Hunter's clinical competence has not at any time been at issue."
  Dr. Hunter was sacked because he dared to complain about the senior trust management. Is it any wonder that the people of west Fife have no faith in the hospital trust management?
  As well as the treatment of consultants, that approach has affected the whole staffing of the hospital. The House will not be surprised to learn that the ancillary staff,

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  who do such essential work, as my hon. Friend the Member for Preston (Mrs. Wise) said earlier in an excellent point, have not only been subject to private contractors, who offer lower pay and worse conditions, but they were recently told that when their contracts come up for renewal in the autumn, the trust will not even bother to make an in-house bid. Yet this is the trust that spent time drawing up a reward package for itself and the people who supported it.
  Let me make it clear that the people of west Fife, indeed, Fife as a whole, never wanted trusts. They felt that the time and money involved could be better spent on providing patient care, but they have been landed with three of them. When they complain to me, they make it quite clear that they are not complaining about the vast majority of staff at the hospital. They blame the senior management and the Government for what is happening to patient care.
  I was going to quote a number of complaints, but I have time to quote from only one—a letter that I received from a lady last month. I shall quote extracts from it, as it is about the real world of NHS bureaucracy and the Government's policies. She said:
  "Dear Ms Squire,
  I am returning to work after three months' leave following major surgery … I was in Ward 19 … and was astonished to find on my arrival that I was sharing a room with two geriatrics and two patients awaiting eye surgery. I was told that Ward 10—the original Gynae ward—had been closed last year to make way for another Day Hospital ward. In the course of that week … as the continual battle for beds went on … lack of funds meant that the ward lacked a permanent charge nurse … On my sixth day, my consultant informed me that I would probably be allowed home three days later but that unfortunately I would have to be moved to another ward otherwise he would be unable to perform the next day's operations … On my return from the bathroom about 9.30 am, my bed had been stripped … and so I sat in a chair until I was finally moved downstairs to a short stay ward at 1.30 pm"—
  four hours later.
  "One of the other ladies moved was 78 years old and had been moved five times in a week! … In my opinion, there are too many 'people in suits' with no medical knowledge who put money before patients' welfare.
  My conclusion is that the Conservative Government is guilty of serious underfunding in health and, if it was not for the unstinting dedication of all professional and ancillary staff, the National Health Service would be moving ever more quickly into line with the substandard healthcare".
  Those words speak more powerfully than mine. I challenge the Government to conduct a full investigation—
  Mr. Deputy Speaker (Sir Geoffrey Lofthouse): Order. Time is up.
  7.37 pm
  Mr. David Porter: On one level, we should feel some sympathy for the Labour party, caught as it is on health policies with two faces, one of which is its more public soundbite, alarmist, shroud-waving face, which slams the Government at every opportunity; the other, its more private, supposedly honest, wishful-thinking-that-it-will-soon-be-in-power face, which has to recognise the fact that many Conservative reforms work,
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  are popular with many health care professionals and are more effectively spending more public money to deliver an ever-improving public service.
  What the Labour party is trying to do with its contortions of producing a credible alternative policy is to criticise the Conservatives and at the same time devise similar policies with other names. It cannot have it both ways. Even double-jointed contortionists cannot do that. We know that any health care policy must take account of the primary aim of the NHS: the appropriate and effective care of the people. It must then take account of the simultaneous relentless rise in public demand and expectation. Just witness hip replacements and cataract removals, which were unheard of just a few years ago but are now taken for granted as of right. It also must allow for developments in technology and changes in medical science and practice, including working practices. Then there is the ever-present reality of a finite resource, however much the economy grows. All that adds up to a complicated equation, and I think that it is a tribute to all professionals in the NHS and Conservative policies that we have such a success story with health in Great Britain.
  One of many benefits of the reforms has been a move towards more localised responses to local needs. Where there are high incidences of asthma or a more elderly population than average, for instance, we can deliver a more local health service—an LHS within the NHS. That brings me to some specific comments about my own area. I am entirely in favour of doing away with needless bureaucracy, but, to me, that also means not letting the NHS bureaucracy lay down a model for local delivery that fits the bureaucratic mind but is not in the best interests of local people. For that reason, my hon. Friend the Member for Great Yarmouth (Mr. Carttiss) and I fought hard to oppose the break-up of the former Great Yarmouth and Waveney health authority, with the two halves going to Suffolk and east Norfolk. We lost that battle to the bureaucrats who advised the then Secretary of State.
  We fought the fight, both locally and in the House, because the district general hospital, the local community hospitals and the health authority were seen to be very much part of the community. Since then, we have moved into a new era—and there is the possibility of moving even further, cutting bureaucracy and putting more money into patient care.
  I have asked the authority to examine the set-up of the two health trusts that provide most health care in north Suffolk and east Norfolk. I am definitely not talking about a merger or takeover by the James Paget NHS trust, but a new trust—possibly called the Great Yarmouth and Waveney NHS trust—could be formed, and management costs of £1.5 million could be saved. I have asked for the money to be ring-fenced for the patients of Waveney and Great Yarmouth, rather than being reclaimed centrally. That has the potential for a creative and cost-beneficial reform of bureaucracy, although I recognise that some staff will not look kindly on further administrative changes.
  In general, over the years, my area has seen agreement across the parties and consensus about people's health needs, regardless of how we represent them at different levels. However, as the next election has been getting closer, there has been a good deal of scaremongering from my opponents. One piece of panic-raising has concerned care of the elderly—hospital beds for them, and the viability of the community hospitals at Lowestoft,

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  Beccles, Southwold and Halesworth. The introduction of eligibility criteria has given rise to fears among elderly people that continuing care will not be available when they need it. That fear has been fed by local Labour activists who, apparently, can measure a service only by bed numbers—even empty beds—and seem incapable of looking at the totality of the service.
  It is clear that the NHS has important responsibilities for arranging and funding care of people who require in-patient care under specialised clinical supervision in a hospital or nursing home in the voluntary or independent sector, but it must be funded by the NHS. Suffolk Health is closely monitoring the new eligibility criteria with a group of GPs, NHS providers, community health councils, carers and users. That is the local NHS at its best.
  Labour is right to draw attention to occasions when the service falls short of expected standards, but it has neither told us what it would do if given a chance nor cited any of the thousands of daily success stories involving people living longer, more fulfilled lives thanks to our NHS, with waiting lists declining in Suffolk as elsewhere, more positive patient outcomes and the achievement of patients charter standards. I congratulate Suffolk health authority, and its chairman Joanna Spicer in particular. I also congratulate James Paget hospital and the Anglian Harbours trust on all that they have achieved, and express my confidence in what they will achieve in the future.
  I do not expect members of the Opposition Front-Bench team to be interested in putting their views into perspective by reference to Suffolk, but I did expect their national account to reflect a more accurate picture, to support the health service and to tell us more of their own plans so that the public could consider them. All that we heard was, "Labour will renew the NHS." The Labour party should wake up to the fact that the NHS has been renewed during the past 15 years.
  Health care in north Suffolk and east Norfolk has been transformed during the lifetime of the present Government. I know, because I use the service a good deal: I do not speak only as a politician. I use it perhaps more than the average amount, given that I have four children and a condition in my feet that is health care intensive. The service that I use is good and deserves to be commended, even as we seek to improve it further.
  Mr. McLeish: On a point of order, Mr. Deputy Speaker. May I brighten up the proceedings—I hope that Conservative Members will agree about that—by informing the House that England is winning one-nil as a result of a goal by Shearer? As a Scot, I am quite glad to raise that in the House.
  Mr. Deputy Speaker: That is not a point of order, but I am happy to allow it.
  7.43 pm
  Mr. Eric Martlew: I do not know whether you have heard the rugby results, Mr. Deputy Speaker. England is playing Wales tonight.
  I am pleased to have been called, even on a day on which we should all be watching television, if not actually at Wembley. The debate is important. The motion concerns the way in which the Government have run down the NHS, and the way in which bureaucracy is choking the service. The position in my constituency is
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  no different from that anywhere else. We now have 429 trusts, all with chief executives and board members, and all producing minutes stamped "Private and Confidential". In some hospitals, people have as much chance of meeting an auditor or accountant as of meeting a consultant—and the consultant is likely to be from Coopers and Lybrand, and nothing to do with medicine.
  Reference has been made to the private finance initiative. So far, in my constituency, the PFI has produced a good deal of paper and a good deal of money for consultants and solicitors, but no new building. The same is true throughout the country. There are no big schemes, and in Carlisle the PFI has delayed a scheme by three years. That means that we are unlikely to get 474 beds for a new hospital—a figure decided not just by medical consultants in the hospital but by the previous chief executive of the Carlisle Hospitals NHS trust, Mr. Clive Moth. I think it only right to say something about Mr. Moth's unexpected departure from the trust. On 3 May this year, the trust suddenly issued a short press release saying that he was taking early retirement. When pressed on whether he would serve his full notice, the trust told us that he had already cleared his desk and left.
  Mr. Moth was a crucial figure in the PFI scheme. He was negotiating with the Treasury, with AMEC, the only company involved in the bid—there was no competition—and with the Department of Health. No one in my constituency believes that he took voluntary early retirement: that is a fairy tale put about by the trust, which does no credit to the trust or its chairman. The truth is slowly starting to come out, however. It appears that Mr. Moth was not anxious to reduce the number of beds in the new development, or to reach a deal for the trust that would mean that it would not be able to afford to pay the rental in the future. He was not prepared to accept that the rent would be paid while patients would have to be: turned away, so he had to go. We do not know whether he was forced out by AMEC or the Government; it could have been a combination of the two.
  Miraculously, the Government just happened to have a spare civil servant to take Mr. Moth's place—a Mr. Peter Johnson. Mr. Johnson, a former Whitehall civil servant, had been sent north to arrange for hospitals to become trusts, and had done a good deal of work on the PFI in recent years. However, he had no experience of running hospitals in the recent past, if at all. I understand that he will do this last task for the NHS before retiring.
  The football situation seems to be getting worse. I understand that the score is now one-one.
  Mr. Johnson was given the task of putting the PFI through at all costs. Perhaps the Minister will be able to tell me whether the acting chief executive is on performance-related pay, and, if he is, what the target is. Is it to get the deal signed and the PFI hospital built? No other hospitals are currently being built. Can the Minister confirm that the Carlisle Hospitals NHS trust has a deficit of between £500,000 and £1 million? If so, will that mean redundancies?
  The PFI scheme was originally part new build and part refurbishment. I understand there has been a departure from that specification and that the contractor, AMEC, is suggesting that it should build additional accommodation and take the central tower block, which was going to be refurbished. It is 30 years old but still in reasonably good condition. There are fears in my constituency that AMEC

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  will use the tower block for a hospital—it was designed for that purpose. We could end up with a private hospital right in the middle of the infirmary, which is not wanted by my constituents.
  On 3 June, the hospital's medical staff committee unanimously passed a resolution that it would not accept fewer than 474 beds and that, if the trust accepted the contractor's proposal, the staff would not work with the trust. If PFI provides 474 beds and the trust can afford the project, it should go ahead—we have been waiting more than 20 years. If that is not the case, I am assured that in the past the Government have provided public money if a PFI scheme has not come off.
  When I intervened on the Secretary of State, I said that things have changed since 1977, when Cumbria had one area health authority. The Secretary of State was wrong to say that there were district health authorities, but there were family practitioner committees. Cumbria's health authority had one paid member—and I declare an interest, because that person was me. I received £2,000 a year, which is equivalent to £6,600 today. I thought that I was most fortunate and it was a great privilege to chair that authority. Today, Cumbria has two health authorities and seven trusts. Each chair receives £17,000 a year and each non-executive member receives £5,000 a year. The total cost exceeds £330,000, which could be spent on patient care. The Government say that the number of regional health authorities has fallen, but if one adds them to the number of trusts, they total 529 quangos. Their chairmen each receives an average of £17,000 a year and the 2,645 non-executive directors each receives £5,000. Therefore, it costs £22 million to service the quangos with the Government's place persons. Cumbria does not need all those trusts. The ambulance trust is nonsense, and Carlisle has a community trust and a hospital trust when only one is needed.
  I suggest to Labour Front Benchers that if those organisations are to be retained, their chairs should be paid a small salary—£6,600, equivalent to that paid in 1977—and the board members should receive compensation for loss of earnings and expenses. Those boards have brought no benefits to the NHS and the quality of the people who serve on them is no better than when I served on a health authority in the 1970s and 1980s. The big difference is that some people who served on boards in those days were known because they had been before the electorate and had won elections, so they were locally accountable.
  Mr. Deputy Speaker: Order. The hon. Gentleman's time is up.
  7.53 pm
  Dame Jill Knight: When I know that the House is to debate the health service, I always read what the British Medical Association has to say before I prepare my speech. One can always rely on the BMA to spread alarm and despondency. Sometimes, I think that BMA should stand for Boundless Misery Alliance. The BMA has attacked every Government reform ferociously and has portrayed every advance as a retreat. As generic prescribing, fundholding and trusts have been introduced over the years, the BMA has fought
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  them tooth and claw. As time passes, the association realises how good are those reforms and its objections gradually peter out. Then the BMA says, "If there is the catastrophe of a Labour Government, we hope to heaven that they will not alter Conservative reforms."
  The BMA only grudgingly acknowledges the ever-increasing amount of money allocated to the NHS and the extraordinary advances in expert treatments. Of course those advances are due to the cleverness of medical practitioners, but they also mean that the NHS has to find a great deal more money to fund them.
  The leader in this week's British Medical Journal calls for a debate on rationing health care. It states that
  "governments should come clean with the public and lead a debate on how best to ration health care"
  and that neither the Government nor the Opposition face the facts. The leader continues:
  "Most commentators accept that rationing is inevitable, but the debate keeps returning to this point because the politicians refuse to acknowledge it."
  The word "rationing" is totally inappropriate in this context because it conjures up visions of hard-faced bureaucrats producing ration books, tearing out coupons every time someone visits a doctor, dentist, chemist or optometrist and saying, "You can't have an appendectomy, a hip replacement or a baby because you have used all your tickets."
  I checked three different dictionaries for definitions of rationing in the Library. One was a
  "fixed daily allowance of food served out for man or animal".
  That has nothing to do with health care. Chambers dictionary defines rationing as a
  "fixed allowance or portion, especially of food".
  The Oxford dictionary defines rationing as a
  "fixed allowance or individual share of provisions … daily allowance of food allotted to each officer or man."
  It even mentions a ration of one pound of bread and three quarters of a pound of meat, and refers to an officially limited allowance for civilians in time of war. That has nothing to do with the problems facing health care.
  Opposition Members should understand that the BMA is blaming them as much as us. The association says that neither party has the guts to debate the most important matter in health care today—rationing.
  The British Medical Journal acknowledges that doctors have always judged whether a particular patient should receive certain treatment. There is nothing new about that. Suddenly, it has to be called rationing and there is a big public debate. The leader blows the gaff later. It states:
  "We use rationing as a summary term to describe the process of choosing between beneficial services. We have adopted this term because it provokes the greatest public controversy."
  In other words, it is all about frightening the horses. I wonder whether the BMA wants Government decrees on which patients should receive expensive drugs, whether smokers should receive cancer treatment, whether drinkers should be given liver transplants and whether there should be an age cut-off for any treatment. Surely those must be medical decisions. The BMA is totally on the wrong track. How can such decisions ever be taken by Government, or even by public agreement? The Government cannot decide whether or to what extent a patient might benefit from a particular treatment.

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  There might be a case for decreeing that fertility treatment for women over 55, for example, should not be allowed. Others might say that it is madness to spend millions of pounds on aborting babies, then spend further millions of pounds on enabling women who cannot have babies to have them. I can imagine the howls of rage from the BMA and from the medical profession if the House tried to lay down rules on those matters.
  The BMJ article does not finish there. It goes on to state:
  "The British Government likes to suggest that the drive for effectiveness will obviate the need for rationing."
  I have never heard one Minister say any such thing in any speech, and I have never seen such a statement in writing.
  Let us be clear about what the BMA is asking. I understand the BMA's position if it is suggesting that GPs should not be called out on trivial matters or that ambulances should not be called out—as many are—on very trivial matters when people could manage perfectly well to take themselves to hospital. However, this week's call from the BMA to demand that we have a great national debate on rationing is wrong.
  It is right that we ask the public to regard the health service with some sensitivity, to recognise that we should not call out a doctor if one is not needed and that we should not call an ambulance if it is possible to get to hospital without one. That is not what the BMA is saying, and we should be absolutely clear about that.
  Moreover, to help us in our deliberations, the BMA produced a paper for this very debate today. It is a parliamentary brief on bureaucracy and patient care. In that paper, the BMA states that there is
  "a huge duplication of administrative effort",
  but it does not describe that duplication. Of much more relevance, the paper states that a scrutiny team's report on administrative overweighting, produced in July, was welcomed by the Government, and its recommendations will be implemented by December this year. Simpler claim forms will be in place by next Monday. The BMA is therefore saying in this briefing paper that the issues that the BMA has raised with the Government on bureaucracy and overmanning have been well addressed.
  The paper speaks of the turmoil in public district health departments because of the Government's initiative to reduce management costs. I point out to Labour Members that they cannot accuse us of doing nothing when the BMA has itself made it clear that we are doing something.
  I realise that all hon. Members have an extremely short time to speak in this debate, and that others have still to speak, but any hon. Member who thinks that any Government of any colour will be able immediately to address every medical need as it arises—such as a preferred doctor or hospital—is living in cloud cuckoo land. Our record on health care is very good, and I support it all the way.
  8.3 pm
  Mr. Richard Burden: I do not know how to follow that speech, Mr. Deputy Speaker. However, I shall take you back almost a year—to 3 July 1995—when there was a debate in the House on the national health service. I made a speech in that debate, in which I told the House about a primary health care centre
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  in my constituency. Actually it was not "in" my constituency—but it was scheduled to be built in my constituency.
  I told the House about how that project—which had been promised several years previously and talked about for many years before that—had not yet been started. The first reason was that—as a result of the market mechanism imposed by the Government on the NHS—none of the trusts could decide which of them had the responsibility to build that primary health care centre.
  We had also been told by the then regional health authority—the West Midlands regional health authority, which was particularly popular with the Government—that the capital had been made available. However, last year, I was told that there would be a further delay in building the primary health care centre because—although the capital had been earmarked some years before, and the problem of who had the responsibility to co-ordinate its building had been overcome—the project had to be financed through the PFI. I was assured that matters would still be all right. I was assured that all the tenders would be in by last October, a business case would approved, and that matters would be well in train by this year. That is the problem.
  The first stone has not been laid in the primary health care centre. As late as last January, I was still being told by the health trust and by managers that the project was on track. However, a couple of weeks ago, it transpired that the health care centre will be delayed yet again. Why is that? It has been discovered that the PFI—which is much vaunted by the Government—cannot produce the goods for it. Two years after the capital was allocated, the project was delayed because of market operation. It was then put through this ridiculous mechanism, the PFI, which did not work in the first place.
  I shall quote from a letter that I received from the developers of that site—called Rubery Hollymoor—who put in a bid and have now found that their bid is unacceptable. They said:
  "You will be aware that the assessment criteria for PFI schemes are constantly changing and without a clear direction many consortia involved in healthcare projects are becoming increasingly frustrated. Our consortium alone have expended approximately £100,000 in abortive costs on this relatively small scheme.
  The sad fact is that unless public sector funding can be secured for this project in the very near future, the local community will not have the benefit of the planned facility for several years."
  They enclosed a copy of their most recent letter to the trust.
  The fact is that something that was promised some years ago has still not been built, and it is now in question. I ask the Minister whether he will now guarantee that the finance and capital that was promised all those years ago will be made available. He may say that he cannot answer that question without some notice, but last week in Health questions I asked this Minister—the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam)—that very question. I asked him whether it is fair that local people should be denied facilities that they have been promised because of a scheme that they did not invent or ask for, but which the Government have imposed on them.
  I am glad that the Minister is in the Chamber today. In reply to my question last week, he told me:
  "I do not know the particular scheme to which the hon. Gentleman refers, but I shall look into it. None the less, the PFI is accelerating the process. We are breaking out of the traditional system whereby

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  everybody has to wait for the Treasury—waiting for Godot, one might say. If the scheme is good, provides value for money, and the risk is properly apportioned, it can obtain private sector finance. We are talking about a new era for hospital building in Britain, yet we still do not know what the Opposition think about it."—[Official Report, 18 June 1996; Vol. 279, c. 678.]
  I will tell the Minister what I think about it. I am all in favour of trying to attract private finance when it speeds matters up, when it helps and when it is additional. I am not in favour—I do not know anyone who is, apart from Conservative Members—of schemes that delay the process, cost the private sector thousands of pounds and destroy their confidence, or that end up requiring public funds but with question marks over a capital budget that was supposedly already there.
  In his reply, will the Minister for Health tell the House what that scheme and other PFI schemes have cost the NHS in bureaucratic costs, paperwork and preparation? What have they cost the private sector? Will he give a guarantee—no ifs, no buts and no plans—that that primary health care centre, which has been demanded by the people of Longbridge and promised to them, will be built next year? If he cannot give that guarantee, the private finance initiative, in the way that it is operated by the Government, will be shown up for the sham that it really is.
  I want to touch on one other area that also concerns primary care—community services. For too long, that has been the Cinderella service of the NHS. Time and again, Ministers tell us that waiting times are coming down. I acknowledge that, in parts of the acute sector, waiting times have come down, but why do Ministers never give all the figures for all the services provided by the NHS? Why are they rather vague when they talk about community services?
  In my constituency, a little five-year-old boy called Matthew Kelsall has been on the waiting list in Birmingham for occupational therapy since May 1995. His mother was told that he would probably be seen in July this year. She has now been told—after pressure from me—that an action plan is being drawn up to improve services and to tackle the waiting list. The result of that action plan is that Matthew is not likely to be seen until December. I may not be very good at sums, but I think that that is a rather longer wait than was originally promised.
  That is the operation of the market. It is the way that the health service is being treated by the Government. Community services—the services that are less visible and so do not catch the headlines—suffer time and again. When will the Government come clean and admit that they have not properly funded the waiting list initiative? When will they come clean and admit that they have funded it by borrowing against the future and borrowing from general practitioner underspends? There is no continuing commitment to fund the waiting list initiative.
  At the end of the waiting list initiative, when waiting lists are, perhaps, down a little more, how will the Government maintain that improvement? Will they put in the necessary money? Is so, where will it come from? Or will they allow waiting lists to rise again? If they do put the money in, will it be taken from other parts of the NHS? Will it once again be dragged away from community services, family health care services and so on? The public have a right to know.
  The Government have trumpeted their so-called waiting list initiative, but the public should know the full truth about what will happen to it. They have a right to the
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  community services that they require. Earlier, the Secretary of State said that the NHS is now led by primary health care. Despite the best efforts of the staff who work in primary health services and in community services—the front-line staff and the managers—the circumstances under which they operate, the market mechanism and the way that resources are being diverted away from primary health services give the lie to the Minister's claim. They and the House have a right to expect straight answers from the Government.
  8.13 pm
  Mr. Piers Merchant: I welcome the opportunity that the Opposition have provided today for a debate on health. There needs to be a serious debate on the dilemma, which all future Governments will increasingly face, of an almost limitless demand for new health provision, following more and more innovations, and the limited resources available. Unfortunately, the Opposition have ducked that debate. Instead, they have reduced the level of discussion to party political point scoring. That is a great pity, because that debate should take place.
  The Opposition want to talk about all the things that they can find wrong with the national health service as well as a great many things that they cannot find wrong, but which they invent. The most obvious recent ploy has been to talk about bureaucracy because they think that will go down well with the public. The reality is that if they stripped out dozens of administrators, either it would be impossible to obtain an efficient use of resources or the clinicians would end up doing administrative tasks when they should be looking after patients.
  The Government have been tackling the whole issue of bureaucracy, to try to keep it to a minimum. They have introduced a whole series of initiatives over the past few years: the abolition of the 12 regional health authorities—a whole tier of administration taken away, but a move that the Opposition opposed—the joining together of district health authorities and family health services authorities; the reduction in the number of health authorities in Wales; the requirement for a 5 per cent. reduction in administrative costs across the board; as well as the efficiency scrutiny teams that have quite literally cut out millions of forms. In my area, the Bromley Hospitals trust has saved £350,000 by streamlining its management operations through natural wastage, without affecting either clinical standards or staffing. It has done away with two director level posts to gain the greatest efficiency from the minimum number of administrators. That is the reality on bureaucracy.
  I want to deal with a few of the issues that are of concern to real people. First, there is the issue of waiting lists. There have been waiting lists ever since the NHS started, but, quite naturally, patients want them to be kept to the minimum. That is precisely what the Government have achieved. Waiting lists have been reduced to their lowest-ever level. In fact, the last figures that I saw showed that the number of patients waiting more than a year for an operation had fallen to only 4,000—the lowest level since 1948. They also showed that 50 per cent. of all patients are treated immediately, a further 50 per cent. of the remainder are treated within five weeks and 75 per cent. of the remainder within three months. In my area, Bromley Hospitals trust has reduced to zero the number of patients who wait for more than one year and its overall waiting list has come down by 25 per cent.

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  Secondly, all areas have benefited from new facilities during the past few years, not least the area that I represent. However, we are badly in need of a new acute hospital, as my hon. Friend the Minister knows only too well. The advance plan for a new acute hospital has reached the PFI stage and three tenders are expected by the end of July, with a firm business plan by October and a financial agreement by the end of the year. I hope soon to see the plan set in bricks and mortar.
  That is being provided on top of the significant investment that has already been made—for example, a new day treatment unit that has resulted in a 25 per cent. increase in day cases. I visited the unit after it opened in March. It is an excellent unit that has been warmly welcomed by both clinicians and patients. At the local community hospital in Orpington, my hon. Friend the Minister's constituency, there has been a £2.4 million investment to upgrade its services. Last year in Beckenham, my constituency, £1 million was spent on new facilities for local people—a minor treatment unit, new diagnostics, a paediatric clinic, community health facilities, education and so on. All those have brought great benefit to local people. In May, there was a 16 per cent. increase over last year in patients being treated.
  Thirdly, there were problems with accident and emergency facilities earlier this year, especially in January when there was an unprecedented level of demand. Like other health authorities, Bromley has taken firm action to deal with the problem. Between last September and March, waiting time in Bromley hospitals has been reduced by a third. In Bromley hospital itself, where the A and E unit is located, there have been a number of major innovations—a new consultant; minor treatment facilities that screen out people who do not need major A and E attention, which makes the system more efficient; two new wards; some specialised beds to look after people with the most serious illnesses and injuries; and a new observation ward. So major work has been done that matches investment into the three next nearest accident and emergency hospitals, all of which have benefited in the past year by investments of £1 million or more.
  At Bromley hospital, £1.26 million will be spent on new investment this year and about £900,000 in the following year—all to improve the accident and emergency facilities. I am very happy that that problem, which should not have occurred but did, has been swiftly dealt with, the necessary money has been provided and the necessary investment has been carried out. I am sure that that is already delivering great benefits.
  Developing and widening primary care is of the essence. I am delighted with the Government's approach to that—part of which, of course, is the extremely beneficial GP fundholding scheme. The widening of the scope of GPs' provision will not only satisfy patients, who would prefer services to be available from the GP whom they know, trust and can get on with easily and to whom access is easy, but take pressure off hospitals. It will take pressure off A and E departments because minor injuries can be handled by the GP, off consultancy services because they can sometimes be provided at the GP's clinic, and off diagnostics because, although much of it has traditionally taken place in hospitals, it can now be carried out by GPs.
  It is time that the great advances that have been made in the NHS and the great benefits of the Government's reforms were properly recognised. It is time that the
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  Opposition paid proper tribute to the teamwork between clinicians and administrators who, by working together, are essential to the many excellent facilities and success stories in the NHS—they exist, whatever the hon. Member for Peckham (Ms Harman) may think. Most important, it is time that the Opposition stopped the point scoring, the double think and the double talk, and recognised the reality of the excellent NHS and the extent to which it has improved as a result of the Government's reforms.
  8.21 pm
  Mr. Robert Ainsworth: I want to use this debate to raise two local issues that are causing great concern in the Coventry area. They are, first, the impact of the Government's policy, including the private finance initiative, on the hospital services in the city, and secondly, if I get time, health inequalities.
  The Secretary of State said that the PFI had freed the national health service from short-term capital restrictions. Actually, what has been achieved is nothing other than delay. In 1987, Walsgrave hospital, the biggest hospital in the Coventry area, was identified as in urgent need of capital repairs. It is a 1960s building that looks fine from the outside, but, as hon. Members know, buildings built in that period cause some grave concerns. The hospital was in the queue for £20 million, but reorganisation by the Government, who insisted that there was far too much inefficiency in the NHS and intended to sort it out, put that capital allocation on hold, and the much needed work was not done.
  We in the area were then told that, if the hospital applied for trust status, we would get the required capital. Walsgrave hospital did exactly that, and became a trust in the second wave. We cleared all the hurdles right up to political clearance at ministerial level for a £30 million capital allocation that was needed by the hospital. Then the Government changed the rules again and said that all capital must be referred to the PFI. Again, the capital allocation was cancelled.
  Many good news stories have been generated during the process. We heard, "Good news—Walsgrave is in for a £30 million bid." Halfway through the PFI process, we heard, "Good news—Walsgrave is in for a £50 million bid." Now that we are down to one preferred operator, we hear, "Good news—Walsgrave is in for a £100 million bid." The proposed deal is basically for large land disposal, extensive development and 25-year control of clinical and non-clinical services. There is much to be commended, but some great concerns have been thrown up by a dilemma.
  The second hospital in the city, Coventry and Warwickshire hospital, is on a central site. As part of the proposals—although those who are putting the good news spin on the story are trying to keep the two separate—the Coventry and Warwickshire hospital will all but close. My fear is that we will get the very worst of all worlds.
  Birmingham central hospital was replaced by a minor injuries unit in order to offset public concern at the loss of facilities. It closed within a year. There is massive concern in Coventry that it will get exactly the same treatment. There is great public pressure to keep facilities in the city centre. It is a good location that is accessible to the entire city. I fear that we will get a minor injuries unit that will dissipate public concern and get rid of the

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  pressure. In order to push the main proposals through, we will wind up with an unviable facility that will close within a relatively short period at cost to the public purse.
  The other concern among people is affordability. As I said, we are down to a single bidder in the PFI process, but there is a huge gap of millions of pounds—I cannot get the information to pin the figure down—between what is in the district health authority's budgets that would fund the PFI proposal and what the private sector is saying that it wants in order to make the scheme work. The public money is simply not there, unless the Minister is prepared to give assurances that there is an alternative public route to the necessary works at Walsgrave.
  Alternatives are not available, so what on earth is going to happen to health service budgets in order to lever in the PFI proposal? What will be scrapped? What will be chucked aside? What savings will be made? What will it mean for the terms and conditions of people who work there? What will it mean for the actual service by the time the private sector has knocked it into shape to get the profit that it needs to fund the 25-year, £100 million proposal?
  Another concern I have over the way in which the Government are operating the PFI, which all hon. Members are entitled to have, is about the process, and the lack of accountability. The proposed scheme in Coventry has come out at twice the original cost at the end of a nine-month process, during which, as a Member of Parliament, I have been offered access to the detail only on the basis that it is private and confidential, and that I share it with absolutely no one.
  The chief executive of the community health council has been told by the chief executive of the Walsgrave Hospitals trust that the PFI is nothing to do with the CHC; it has no remit whatever to consider the PFI, despite the fact that the proposal will effectively set the scene for health service delivery in the entire city for many years to come. That is quite disgraceful. There are grave concerns about the loss of city centre provision and the affordability of the scheme. The last thing we want is a hospital that no one can afford to run or use, as I understand already exists in Solihull.
  Will alternative funding be available? I want the Minister to say what control he is prepared to give up in return for the risk transfer. Even if we can shoehorn the proposal into the existing budgets, the private sector will not be prepared to accept the risks involved in running clinical and non-clinical services for a 25-year period without having total control.
  Another issue, which I shall have to raise briefly because of the 10-minutes rule, relates to health inequalities. Much work has been carried out in Coventry to identify the scale of the problem there.
  Earlier this evening, we discussed funding inequalities. Hon. Members know jolly well that proposals were made to ensure equality of funding across the nation, but they were rejected or amended by the Government in the most deplorable way. Although Coventry suffers as a result of funding inequalities, I shall concentrate on health inequalities.
  Research conducted in Coventry some time ago, which has not been challenged, proves that, on average, men living in the more affluent parts of the city such as the
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  Bablake ward live nine years longer than men living in the Henley ward. Women in the Earlsdon ward live 10 years longer than women in the Henley ward.
  Research on child health issues demonstrates further inequalities. The results of a study conducted in Coventry show that, if national statistics were applied to Coventry, 20 out of 47 stillbirths or first-week deaths of infants would have been avoided. It shows that 13 out of 31 neonatal deaths would have been avoided, and that 200 out of 383 infants born under 2,500 g would have avoided that difficulty.
  The broad thrust of those findings is that the problem in Coventry is worse than the national average by more than a third. That must apply to other cities, as our problems are no worse than theirs. It is an absolute disgrace that those problems should occur in a so-called developed western country. One would expect them to be limited to third-world countries as we approach the end of the century. Nothing is being done to address those issues.
  Mr. Deputy Speaker:) Order. Time is up.
  8.31 pm
  Mr. Peter Luff: Having listened to the speeches of the hon. Members for Carlisle (Mr. Martlew), for Birmingham, Northfield (Mr. Burden) and for Coventry, North-East (Mr. Ainsworth), I have started to feel sorry for the Opposition. I realised that they have to believe—or try to believe—the worst of absolutely everything, when the reality—if only they would look at it objectively—is so very different. I now know where Eeyore's sad and gloomy place is—on the Opposition Benches.
  If time had permitted, I had hoped to share with the House an article written by Roy Porter, a medical historian at the Wellcome Institute for the History of Medicine, that states that the problem goes back some 200 years to the 18th century. It is not so much new Labour as very old Labour indeed.
  How refreshing it was to hear the speeches of Conservative Members, particularly the speech of my hon. Friend the Member for Beckenham (Mr. Merchant). My experience reflects his. New facilities have been provided in partnership with the private sector at Evesham community hospital and the Spring Gardens health centre in Worcester. The Worcester royal infirmary has a new accident and emergency service and improved rheumatology services, and we are to have a new hospital at last, having been in the queue for 30 years.
  Opposition Members wring their hands in despair at delays of a year here and there. I do not want delays in the building of hospitals, but we have been waiting 30 years for a new hospital under the old Treasury capital funding system, and the PFI gives us the hope of getting one at long last.
  The short title of the debate is "Bureaucracy and Patient Care in the NHS". We are all enemies of bureaucracy and in favour of patient care. Bureaucracy is a word that was coined in the 19th century. John Stuart Mill wrote in the "Westminster Review" of
  "that vast net-work of administrative tyranny … that system of bureaucracy, which leaves no free agent in all France, except the man at Paris who pulls the wires."
  A bureaucrat is defined in the Oxford English Dictionary as

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  "An official who endeavours to concentrate administrative power in his bureau."
  We are all against bureaucracy, but I hope that we are in favour of management. There are four pages in the Oxford English Dictionary defining management, and almost all are complimentary. I thought that it was common ground across the House.
  My right hon. Friend the Secretary of State reminded us that, when the right hon. Member for Derby, South (Mrs. Beckett) was the Opposition spokesman on health, she said on television:
  "I don't think it's really in question any more that the traditional NHS was under-managed".
  One would not think that from the speech of the hon. Member for Peckham (Ms Harman) this afternoon.
  I am dispirited by the dishonesty of Labour's attack. A year or two ago, the Opposition targeted company cars, some of which are used by district nurses and health visitors. They totally ignored the reclassification of many nursing grades as managers in their artificially inflated figures for so-called bureaucracy, and, as Conservative Members have repeated time and again, they have resisted every serious attempt by the Government to reduce bureaucracy. They have opposed it nationally and locally.
  Labour voted against the abolition of regional health authorities. That saved hundreds of jobs in my region, and released thousands of pounds for better patient care. Locally, the former Labour leader of Worcester city council recently urged his Labour colleagues on the community health council to vote against the merger of two community health trusts. That would have reduced bureaucracy and released funds for patient care. Labour says one thing and does another.
  When will Labour come clean on where it stands on my right hon. Friend the Secretary of State's attempt to reduce administrative costs by 5 per cent. in cash terms or 8 per cent. in real terms? It is extraordinary that we have heard nothing about that.
  Of course I understand that the change that the Government have brought to the health service threatens established relationships. It makes consultants feel uncomfortable and imposes extra burdens on GPs, but huge benefits flow from that change. GPs are responding magnificently in seeking to reduce bureaucracy. The "GP links" initiative has reduced the number of forms that GPs need to fill in for the health authority. Many practices have direct computer links to the health authority, vastly reducing the administrative burden.
  The "patients, not paper" initiative has responded to exactly the same concern. Extensive consultations with GPs and practice managers have achieved dramatic results. Forms have been simplified and eliminated, in a way that would gladden the heart of my right hon. Friend the Deputy Prime Minister.
  Form GMS1 for patient registration replaces eight old forms. The new maternity form GMS2 replaces three old forms. Form GMS3—the multi-purpose claim form for non-registered practices—replaces eight old forms. Form GMS4 is a new payment booklet that replaces nine old forms. Those four new forms replace 28 old forms. What an achievement that is, and what a dramatic increase in bureaucracy. For the benefit of Hansard, that was said with irony.
  GP fundholders have cut red tape. They are providing in-house services leading to better patient care and less bureaucracy. They provide physiotherapy services,
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  out-patient clinics and surgical procedures. Some GP practices even offer vasectomies. There are electronic links with hospitals making direct bookings for day case surgery offering patients the choice when they want to be treated. They are improving communications with consultants and reducing unnecessary follow-up out-patient attendance by seeing their patients in their surgeries. They are providing better patient care and less bureaucracy time and again.
  Where does Labour stand? What is Labour's policy? I think that we heard it from the Front Bench, although I was unclear earlier. It is to strengthen the power of bureaucrats in the national health service by abolishing GP fundholding and returning responsibility for purchasing to the health authority bureaucrats—managers, as I prefer to call them. They are the very managers who now recognise with stark clarity that GPs are in the best position to manage patient care.
  The role of NHS managers in a primary care-led NHS should be to facilitate greater purchasing by GPs. They should manage the performance of GPs and hold them to account, but they should not buy services for patients they do not know and will never meet. The success of GP fundholding in my area is a great tribute to the system, and all the scare stories have been proved false. No practice has overspent in the year that has just ended, and the resources have been used by GPs significantly to improve services. They have done so, for example, by increasing the number of social workers in practices.
  The trouble that the Labour party has in this debate is the thought that dares not speak its name and which lurks behind all its rhetoric. The shadow Chancellor will not let Labour Members speak that thought, which is, "Is there: more money or not?" That is the question they cannot and will not answer. It is true that the UK spends less on health than most other OECD countries, but that is not: because the Government have not provided the expenditure. Other countries are spending more because there is increased spending by free citizens on private health care. Perhaps that is a policy that Labour might like to consider—giving people choice, something that the Conservatives favour.
  The BMA says that an extra £6 billion is needed—a figure plucked from the air. It reminds me of what J. Paul Getty said in response to the question, "How much money does it take to be happy?" He replied, "Just a little more." That seems to be the policy of the BMA. In fact, the Government have given a lot more, but there has been little gratitude from the BMA. I must be careful what I say here, but I work in the Lord Chancellor's Department as a PPS, and I am used to professional groups wanting "a little more" and dressing it up as professional concern.
  Labour's misrepresentation constantly shocks and amazes me. It chooses the few figures that suit it, and ignores all the others. There are great Labour press releases about the reduction in bed numbers. However, I judge the success of the NHS not by how many beds it has, but by how healthy the country is and by how many patients it treats. The NHS is not an hotel—it is meant to make people better.
  Labour ignores the increase in resources and the increase in the hospital building programme—something it cut the last time it had control. It ignores the real terms increase in staff pay—something, again, that Labour cut when it last had control. It ignores the reduction in waiting

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  times, although a disparaging reference was made to it earlier. Labour ignores the fact that there are 55,000 more nurses and midwives and 22,500 more doctors and dentists. That is 85 nurses and 35 doctors for every constituency in the land.
  I am not saying that there is no more that we could do, as there is always more to do. For example, we could help pharmacists, nurses and therapists to play a wider role in the NHS, and give more of them the ability to prescribe. A practical suggestion is that we could review the NHS superannuation regulations to enable practice nurses to work together effectively. The real test of the health service is what it is doing. The Government have increased life expectancy in this country by some two to three years, and that is the real test of what our health service is doing today.
  8.42 pm
  Mr. Jacques Arnold: This debate is about bureaucracy and patient care in the NHS, and I would like to concentrate on patient care.
  The Government have carried out massive reforms of the NHS, and the British people should judge patient care within the NHS by the results. In the past year alone, the NHS has carried out 8.6 million consultant episodes in our hospitals.
  It is worth reflecting that in the four years since the reforms the number of such episodes has risen by no less than 25 per cent.—a massive increase in health care. I well remember that when I first entered the House the talk in the NHS was very much about waiting lists. It is worth noting that, following the reforms, no more people are waiting more than 18 months for an operation, and the 12-month waiting list has fallen throughout the country to just over 4,000 people.
  That is no surprise, as the Conservative Government have spent an immense amount on the NHS compared to the previous Labour Government. There are now 55,000 extra qualified nurses and midwives and 22,500 extra doctors and dentists, so we should take no lessons from Labour about our record of improving health services and about the treatment given to our constituents.
  The motion refers to bureaucracy in the NHS. There has been an increase in the number of administrators in the NHS, but let us be clear about what has been going on. We always used to take pride—and perhaps some amusement—from the fact that the NHS was the largest employer in the world after the Indian railway and the Red Army. The massive bureaucracy that we inherited from Labour has been transformed into a new structure that provides better health care for our people.
  In making this massive transition, the scope for cock-ups and disasters has been immense. Therefore, I do not begrudge the Government and the NHS taking the sensible decision to manage the transition as they have done. We must not put at risk the lives of patients. There are massive transitions in industry, but we are not talking in this case about tins of beans that can be left out in the rain as a result of a change in management practices—we are talking about the lives of our constituents. The Government have had to think carefully about the administration of the transition. It is worth bearing it in mind that, in this year alone, the Government have set a
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  target—now that the reforms are bedded down—of an 8 per cent. reduction in the administrative costs of the NHS. Unsurprisingly, Labour made no mention of that policy decision in the motion.
  Where are the bureaucrats and administrators? They are up front and at the sharp end, ensuring that we get value for money from our NHS. For instance, there are now more secretaries, bursars and administrators in fundholding practices to ensure that, under the direct control and instruction of GPs, efficiency is achieved. More than half my constituents now receive excellent services from general practitioners who have chosen to become fundholders. Why have they done so? They have done so because they care about the health of their patients and they want to be able to get things done. That is precisely what they are doing by investing the funds available to the NHS much more sensitively. Considerable as those funds are, we want value for money.
  Fundholding practices are now contracting consultants to their surgeries. One of the fundholding practices in my constituency now has a physician consultant once a week, a surgical consultant every fortnight and a urological consultant every month. The practice is bringing more and more expert health care closer to the patient. But that needs to be managed and administered so that the practice gets the maximum value from those consultants by carefully timetabling and co-ordinating what needs to be done.
  Proper administration is a good thing, but that is not mentioned in the motion. During the transition, we said goodbye to the massive bureaucracy so beloved of the Labour party. In my area, the regional health authority, which has a vast building at Bexhill-on-Sea, is a thing of the past. It has packed its tent, and gone off to goodness knows where. But we no longer have that massive bureaucracy trying to direct health care in my area from all the way up the Sussex coast.
  Likewise, the district health authority's vast bureaucracy at Darenth Park is no more, and I am delighted to see that even the buildings have been bulldozed. As I told the House this morning, the whole area has been cleared for our brand new £100 million district general hospital. That is being built not thanks to the old-fashioned capital provision arrangements to which the Labour party is harking back but because of the PFI. Hospital work is well advanced for that site.
  The purpose of administrators is to help to reduce waiting lists. When I became a Member of Parliament, one of the first problems that I encountered at my surgery was constituents complaining about the handling of their bookings for consultations at hospital. They were called 20 or 50 at a time, like so many potatoes in a row and stuffed in a waiting room. Consultants suited themselves about how many patients they would see and in what order. Under the old Labour system, consultants were responsible to the region for contracts, so the local hospital service had no control over them. When consultants had completed the time that they had deigned to make available, patients were sent packing to book another time. Under proper administration, with the efficiency required by the Conservative Government, patients are seen on time.
  The hon. Member for Peckham (Ms Harman) spoke with ghoulish glee about patients whom she claimed had to lie on trolleys in corridors. She does not realise that in

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  any big business such as the health service decisions must be made. To be certain that beds will be available for a peak demand from accident and emergency departments, 20 per cent. of bed space must be left unutilised to ensure that there is enough room for emergency admissions at all times. A choice has to be made. Should bed use be kept down to 80 per cent.? If so, higher waiting lists will result, as they did in the past. The number of operations achieved by the NHS has gone up and up while waiting lists have gone down and down because of the maximum use. The price that we pay is that at times of unexpected peaks, which, thank goodness, are comparatively rare, patients may have to wait on trolleys.
  We must understand that trolleys are not like the things Mrs. Mopp wheels the tea through offices on; they are like mobile hospital beds. Their mattresses are thinner than those of hospital beds for obvious clinical reasons. The pejorative use of the word "trolley" is a misnomer. If beds are run at high usage, cancellations of constituents' operations will occasionally result.
  Mr. Deputy Speaker: Order
  8.52 pm
  Mr. Kevin Hughes: Once again, we are debating health issues at an embarrassing time for the Government. Then again, every time that we debate them it is embarrassing for the Government. We can tell that from the tirade of personal attacks that have been launched on my hon. Friend the Member for Peckham (Ms Harman), not least by the Secretary of State. He and other Conservative Members have launched such attacks, rather than political ones, because they are bankrupt of policies. Never mind what the Secretary of State said; I have every confidence that my hon. Friend will be the Secretary of State for Health after the next general election.
  The British Medical Association is holding its annual conference, at which it has warned that disaster threatens our national health service because of the exodus of general practitioners. The issues that we are debating show why doctors and nurses suffer from low morale and are leaving the medical profession and why most people do not trust the Tories with our national health service.
  It is obvious that bureaucracy in the national health service has risen sharply since the reforms of 1991. Even the Government admit that. However, they have failed to clarify to the public how huge the rise is and how detrimental the misallocation of resources is to patient care. They keep saying that the NHS is funded sufficiently. Yet at a time of limited resources, they have introduced reforms that have sent the bill for NHS bureaucracy rocketing sky high. At the same time, patient care is suffering because of a lack of funding.
  More than one in six NHS acute beds have been cut since 1990–7,664 beds were cut in England last year alone. Patient services are being cut. Paediatric intensive care has faced a crisis. Accident and emergency provision faces financial catastrophe. Only this week, the chairman of the BMA commented that dangerous cuts in funding were sinking the NHS, yet the Government do not respond to the crisis. They do not listen to the medical profession. The cost of bureaucracy in the NHS continues to soar.
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  Today, Labour released figures on administrative spending by health authorities that highlight the huge rise in bureaucracy. In the Trent region alone, the cost of bureaucracy rose by £32 million to more than £90 million—a rise of nearly 55 per cent. in only four years. That is the highest rise of any region. During the same period that administrative costs have soared, patient care has suffered because of the lack of financial resources: 2,986 beds have been cut in Trent region since 1990–91. That is a shocking 13 per cent. of its total beds. In the past year, the number of cancelled operations in the region has risen by 36.5 per cent. and the number of nurses has been cut by 9 per cent. in only five years. However, in the same period, the number of managers in the region has increased by a staggering 470 per cent.
  In Doncaster, the purchasing administration budget has risen by £641,000 in only three years—an increase of more than 25 per cent.—yet patient services have had to be cut at local hospitals for financial reasons. It is absurd. Money is being thrown into paperwork, management and massive bureaucracy in negotiating contracts while patient services are being drastically and wrongly cut because of a lack of resources.
  Primary care is also suffering from increased bureaucracy. GPs feel that additional bureaucracy is putting them under pressure and that patient care is therefore suffering. Many responses to our recent consultation of GPs concerned bureaucracy. There was frequent mention of the massive increase in the paperwork involved daily in general practice. Comments that I received from GPs in my constituency highlighted concern about mushrooming bureaucracy and the increase in the management tier, which needs to be kept in proportion to the number of people being managed.
  The BMA also condemns the increase in bureaucracy, citing it as a reason for
  "GP morale being at its lowest ebb for many years",
  and warns that that is
  "stifling innovation and the further development of patient services in many practices."
  A 1992–93 survey of GPs' work load showed that the reported average weekly time spent on practice administration associated with the provision of general medical services had increased by 85 per cent. since 1985–86.
  In a survey carried out by Middlesex university earlier this year, 98 per cent. of GPs questioned complained that their paperwork had increased by nearly 90 per cent.
  It is clear that the changes in the NHS brought about by the Government are swamping GPs with paperwork and damaging patient care. Britain has an excellent record on primary care. We cannot let the Government go on pushing it past its limits.
  The GP fundholding scheme has increased spending on managers. Management costs within health authorities and extra contracting and transaction costs for trusts are not met by efficiency savings. Those are the findings of the Audit Commission; they are not mine. GP fundholding carries a huge burden of increased bureaucracy. Management costs are as high as £80,000 per practice. A recent NHS executive report comments that GP fundholding carries a significant administration tail, which, in a number of places, is excessive.
  In addition, hospital trusts are being financially hammered by the costs of administrating fundholding contracts. The NHS executive report states:

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  "Income from fundholding for most Trusts is between 5 and 10 per cent. of the total revenue … yet most employ at least twice as many people to support fundholder contracts … as they employ to support the Health Authority contracts."
  The amount of paperwork generated by many individual contracts is astronomical.
  Another problem concerns GP fundholder underspending. Underspending by GP fundholders in the Doncaster area has resulted in £900,000 not being spent on hospital services. That has resulted in two hospital wards in Doncaster being closed. GP fundholders' underspending is being blamed for those hospital ward closures. It is not just me who is saying that, but people at the Doncaster royal infirmary as well.
  Mr. Jacques Arnold: Will the hon. Gentleman give way?
  Mr. Hughes: No, I will not give way because my colleagues are waiting to speak.
  The sad fact about the Government and their changes is that market forces do not work in health care. The reality is that market forces driven by the Government are wrecking our health services. The truth is that our health service is not safe in the Government's hands and everybody except Conservative Back Benchers knows that.
  9.1 pm
  Mr. Hugh Bayley: I shall speak briefly about paediatric intensive care in Yorkshire because current provision is wholly inadequate. It is inadequate to the point that it is putting the lives of children at risk.
  In the whole of Yorkshire we have just seven general paediatric intensive care beds to serve a population of more than 1 million children. It is one of the worst population-bed ratios in the country. Five of those paediatric intensive care beds are at Leeds general infirmary and last year it had to turn away 75 desperately ill children during the year, 61 of them during the winter months, because all the beds were full and none could be made available.
  On 6 March the Secretary of State made a statement to the House about improvements that he intended to make to intensive care services. He promised that those extra beds would be in by the coming winter. The Yorkshire regional health authority carried out a study of the needs in our region and determined that three extra paediatric intensive care beds and six extra high-dependency beds were required.
  The local purchasing authorities have agreed to fund just one of the nine additional beds which the regional health authority decided were required. That shows the consequences of the Government's NHS internal market working at its worst. Year after year of efficiency savings have forced hospitals to cut beds; but the pressure to cut beds is greatest on intensive care beds because they are the most expensive. That leads to the perverse result that the beds of which there is the severest shortage are the very ones needed for the most severely ill patients.
  Earlier, my hon. Friend the Member for Peckham (Ms Harman) referred to the case of Nicholas Geldard. Let me remind the House briefly of what happened to
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  him. He was a 10-year-old boy who was taken ill. His parents called an ambulance and he was taken to Stockport general infirmary. The casualty department decided that he needed a scan but did not have a scanner, so an ambulance was called to transfer the child to Stepping Hill hospital. It took an hour to arrive; by the time the boy got to Stepping Hill hospital the scanner had closed for the day. It operates only from nine to five. So it was decided to leave the scan to the following day. When the child became more ill in the night he was transferred to Hope hospital.
  At the Hope hospital a brain haemorrhage was diagnosed and doctors said that the boy needed an immediate operation—but they had no paediatric intensive care bed. So they telephoned around the region, and then further afield, and eventually found a bed at Leeds general infirmary. So nine or 10 hours later the child was taken by ambulance over the Pennines through a snowstorm. When he got to the hospital and doctors examined him the child was found to be dead: he had arrived too late.
  I have here a letter from Dr. Mark Darowski, the director of the paediatric intensive care unit at the LGI. He says:
  "I was the clinician who had to declare him dead and to deal with the understandable anger and devastation of his family … I would therefore like to bring to your attention the impending crisis which will occur in Yorkshire despite the assertions of the Minister. Without adequate provision it is only a matter of time before other families suffer in the way that Nicholas Geldard's has."
  I have written to the Secretary of State about the points raised with me by the LGI unit, asking two questions. I asked whether the right hon. Gentleman was satisfied that the one additional paediatric intensive care bed that our region is to get will be adequate to meet the need. Secondly, if he does not believe it adequate—he cannot believe that, given what he said to the House on 6 March—I asked him what action he and the NHS executive will take to override the internal market decision to supply only one additional bed, so as to ensure that the nine that are needed are provided.
  Because I have given notice in writing of my questions to the Secretary of State well in advance of this debate, may I have an answer tonight from the Minister of State? Is one extra bed enough for the needs of desperately ill children in Yorkshire? If not, what will the Minister and the Department do to increase provision so that, contrary to the warning issued by the director of the LGI paediatric intensive care unit, there are no more desperate cases like that of Nicholas Geldard?
  9.8 pm
  Mr. Ken Purchase: I am grateful to hon. Members for allowing me a few moments in which to bring to the attention of the House a serious matter in my constituency. First it is necessary to provide a little background. But even before that I want to contradict one or two of the assertions made this evening by Conservative Members.
  First, disregarding the changes in the administration of the health services that the Government have made, it must be remembered that the thousands of people who worked as administrators in our health services throughout the 1960s, 1970s and 1980s did an absolutely splendid professional job and deserve recognition for it. More of that in a moment.

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  I abhor the suggestion that only general practitioners who have gone for contract holding are giving a good service to our patients. General practitioners, and those working with them in the health services, give their best— their work is of a tremendously high standard—whether they are on payment by results, whether they are fundholders or whether they are working under the old-fashioned rules of public service in the interests of patients. The balance should be redressed because some people pretend that there have been improvements in the health service only since these reforms. That is nonsense.
  I shall refer to the way in which we have reached this point of additional bureaucracy in the health service. I— along with many other people—served in the health service on district committees and on area committees, and for no pay. We were proud to do so. In those days, we did not need the kind of reward that we see today— it is multiplied again and again on trusts and on other organisations that have been put together by the Government as part of the quangocracy. It is an absolute disgrace—there is no need for it whatsoever and it has not led to a qualitative improvement in any of the administrative services within the health framework.
  I refer to competitive tendering. I wonder whether it will ever be possible for us to get a figure on the amount of money that has been spent on financial consultants. They allegedly helped the in-house teams put their tenders together and conducted the training that was necessary for them to promote their services. There was a business plan, and cash flow problems resulted therein. There was a change in the working hours and the practices that had to be undertaken. Thousands of pounds—if not millions of pounds—were spent on consultants who were offering so-called management advice.
  The upshot of all this is that up and down the country the in-house teams are still doing the same work—and probably for less money in terms of the hourly rates and the salaries that they receive. In many instances, we have lost workers off the wards, particularly those who were cleaners in the hotel services. They have suffered tremendously as a result of that part of the Government's so-called reforms.
  I refer to contracting out, particularly in the west midlands. Millions of pounds were lost in computer scams—contracting out failed miserably. It ultimately resulted in the ignominious resignation of the then chairman of the region, Sir James Ackers. He literally had to be forced through the door—there was a public outcry—because of the way in which he administered the Government's reforms in the health service in the west midlands. However, worse was to follow in the litany of waste that the Conservative Government thrust on the national health service. The Government had the temerity to pay this man to leave the health service—he was paid thousands of pounds in compensation. What an absolute disgrace.
  Mr. Andrew Mackinlay: It is endemic.
  Mr. Purchase: Yes, it is endemic. The Government filled the quangocracy with their friends, many of whom had no experience in the health service or in the ethos that underpins it. There has been one scam after another in Wales, in Scotland, in the south-east of England and in the west midlands.
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  I draw the attention of hon. Members to the serious problem that we have in Wolverhampton in relation to the hospital services. This year, for the fifth year in a row, they have to find £2.4 million is worth of savings— equivalent to 3 per cent. The Government seem to think that efficiency savings can continue ad infinitum, but the savings have to be taken from a smaller total resource and many departments are already stressed because they have to provide an increasing level of service. They have been asked to treat the same number of patients for 3 per cent. less or to increase the amount of work they do, but this year, in Wolverhampton, the hospitals are being asked to find £2.4 million in cash by the NHS executive. That will be difficult, if not impossible.
  I shall tell the House what will happen in Wolverhampton to meet that programme of cuts in services. Two intensive care beds out of a total of seven will close. That is not many to start with, but we will lose two. A day surgery unit will close for two weeks during August and two weeks at Christmas to try to recoup some expenditure. The main operating theatres will close for two weeks in August and at Christmas. Seven orthopaedic beds, six surgical beds, 10 gynaecology beds and nine neurology beds will be lost. The list goes on. Those closures will be made to meet the programme of cuts demanded by the Government and administered through the NHS executive.
  The closure of an acute medical ward that specialises in the care of the elderly has been proposed and that will mean a reduction of 33 per cent. in the service. The freezing of posts is an old chestnut, but so many posts have been frozen for so many years that few or no posts are left that are not urgently needed. The quality of patient care is bound to diminish as a result. A further 11 posts in the operating theatres will not be filled.
  That is the programme that faces my authority in Wolverhampton. The question is not whether the trusts are efficient or effective, because the health service has been run effectively and efficiently for as long as people can remember. I accuse the Government of misunderstanding the nature of what they call market-driven efficiency. We have seen year-on-year improvements in technology, management techniques and operating practices. Those improvements would have happened anyway.
  Mr. Malone indicated dissent.
  Mr. Purchase: Yes, they would. The Minister should ask the people who have worked in the service for years, probably before he started work. They have given the community their best, but he might not understand that. The way in which the Government have acted in the public services has demoralised the staff and demolished the spirit of the people who have provided those services since 1945 and the great reforms of the then Labour Government.
  We have heard many individual examples of suffering and difficulties created by the so-called market reforms. They are not reforms: they are a diminution of the service and that is shown every day. The dreadful cuts that I have mentioned, which will befall the people of Wolverhampton, exemplify that point. Earlier, the hon. Member for Birmingham, Edgbaston (Dame J. Knight) suggested that Labour Members told scare stories to frighten the horses. Our stories do not frighten the horses, but they scare the patients to death.
  9.17 pm
  Mr. Henry McLeish: Unfortunately, I have not been given the up-to-date result, but I imagine that it is full time and if the score has stayed the same it will be one-all. Extra time will be played and, as the nation will be on a knife-edge, we can get on with the health debate. I am sure that if more information comes into the Chamber, we can pass it on to those assembled.
  It is interesting to hear the different approaches of hon. Members on both sides of the House. Most of my hon. Friends have made sensible, constructive and incisive points about health problems in their areas.
  Mr. Dorrell: Come on.
  Mr. McLeish: The difference between the Opposition and the Government is that we deal with reality and we do not seek to hide within a self-constructed fantasy.
  We have had excellent contributions from my hon. Friends, who have tried to bring the real concerns of the people whom they represent to the Chamber.
  In sharp contrast, and despite the efforts of the Secretary of State, three Conservative contributions highlighted the differences in the approaches of the Government and the Opposition. The hon. Member for Mid-Staffordshire (Mr. Fabricant) let the cat out of the bag when he said that the Government are providing a safety net. We argue that the Tories are making that claim throughout the country. The second extraordinary contribution came from the hon. Member for Wimbledon (Dr. Goodson-Wickes), who said that there were sound reasons why the Tories voted against the NHS legislation in 1946. The Conservatives have clearly continued to accept only grudgingly the unique and best public service in this country.
  The hon. Member for Gravesham (Mr. Arnold) crystallised the Government's approach to health when he said that trolleys should become an accepted part of NHS culture and language.
  Mr. Jacques Arnold: Will the hon. Gentleman give way?
  Mr. McLeish: No, I will not give way at this stage.
  Mr. Arnold: On a point of order, Mr. Deputy Speaker. Is it in order to misquote an hon. Member and then not allow him to correct that misquote?
  Mr. Deputy Speaker: The hon. Member for Fife, Central (Mr. McLeish) is responsible for his own speech.
  Mr. McLeish: In a grown-up political environment, if one makes a comment, one lives with the consequences. The hon. Gentleman suggested that trolleys were more comfortable than people think. Labour Members believe that patients should have beds and not trolleys. We believe that patients should be in wards and not in corridors and that patients should be seen by doctors and not left waiting for hours in accident and emergency wards. The hon. Gentleman may not like it, but that is what he said. It is important that the nation understands what is happening.
  Mr. Arnold: I said in my contribution that a choice must be made. In order to make certain that beds are
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  available, one must operate beds at 20 per cent. below capacity. The decision to operate them at a higher capacity is one of the reasons why waiting lists have been reduced. One must make a choice and strike a balance. If the hon. Gentleman wishes to say categorically that a Labour Government would operate at only 80 per cent. of capacity, he should do so. He must make a choice.
  Mr. McLeish: The hon. Gentleman did not deny my comments—that is the important point. He can exaggerate and set up smokescreens but, at the end of the day, the Conservative party has advocated trolleys as an acceptable part of NHS language and culture.
  It was interesting to note also the characteristic contribution by the Secretary of State. It was uninspiring, but that is nothing new. It is important to note that, while he decided to go on the attack—with their record, that is the only thing that the Government can do—he failed to tell the House about his contribution at the conference of the National Association of Health Authorities and Trusts. The Times of Saturday 22 June summed it up by saying:
  "Dorrell gives the go-ahead for longer hospital waiting lists".
  If that is not a white-flag surrender job, I do not know what is. The Government have lambasted every political party about their views on the NHS. They claim that they are cutting bureaucracy and that they will invest more in patient care. That is not happening in the real world of the national health service.
  The Secretary of State said that, as a consequence of the crisis in the national health service, the Government's great initiative to reduce waiting lists has been abandoned. The Government's market-driven NHS simply cannot cope with the burgeoning bureaucracy and the fact that there is not enough investment in patient care. Bureaucratic costs in the national health service are spiralling out of control.
  It is hypocritical of Ministers to come to the Dispatch Box and wax lyrical about their actions now that the horse has bolted. The stable door cannot be closed: health costs are spiralling out of control and Ministers do not have a clue what to do about it. Even more worrying is the fact that they simply do not care. Ministers are sitting at the centre of the market-led NHS, unconcerned about the crises throughout the health service. They know about them, but they are unwilling to address them. Today the Secretary of State confirmed our belief that, in his opportunism, he is more concerned about the future of the Conservative party after its defeat at the next election than about real patients in the national health service.
  More important, the debate has been about defining points in the NHS for the debate that will take place between now and the general election. Let us be clear what those points are. First, the Government want a residual NHS. They do not want to see a one-nation health service.
  Mr. Arnold: Rubbish!
  Mr. McLeish: The hon. Gentleman may shout "Rubbish!", but if the Government want to ignore the reality of public opinion, public perception and professional concern between now and the general election, that is fine by me, because, in government, we shall start to address some of the issues that they are ignoring.
  Secondly, Conservatives regard the health service as a business—a view that is not shared by the Labour party or the country. The health service is a public service with a

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  very distinct ethos. That is what makes it work. That is why we have commitment from nurses, doctors and ancillary services throughout the length and breadth of the land. The Conservatives are in danger of squandering that most precious of resources, and that is a defining issue.
  The main issue, which is what the debate is about, is the Conservatives' obsession with bureaucracy and the market. The Secretary of State and the Minister can shed crocodile tears about what they are doing, but it simply will not wash. The Conservative party has constructed a market that is destroying the heart of the NHS, but it cannot do anything about it because, despite the disappearance of the previous Prime Minister, it is still gripped with ideology when a bit more pragmatism would do well in the NHS.
  In contrast to the Conservatives' market obsession, the Labour party wants to see a collaborative model. We want to see a national health service that co-operates. Look at the shambles of British Rail. We want to avoid that prospect for the NHS. We want to put the NHS back together again. That makes sense for everyone who works in it, and it makes sense for patients.
  One defining point that the Conservatives simply cannot run away from is their ability to squander vast sums of taxpayers' money, not in the interest of patients or professionals but in the interest of ideology. There is something fundamentally immoral about other people's moneys being used for a political and ideological adventure. But they are guilty of that, and whatever they say about it, that is a key issue.
  The most important defining issue between Labour and the Conservatives is the fact that we believe in the NHS.
  Mr. Dorrell: Come on.
  Mr. McLeish: In 50 years, the NHS has provided an excellent quality of life for people in this country. We believe in a world-class service for the next 50 years, not the residual service that the Government are working towards.
  We have talked about defining points, and that is crucial, because the next election will be fought not on the evasion that we see from Conservative Members but on the reality that faces patients and professionals in every part of England, Scotland, Wales and Northern Ireland. The Conservatives can run, but at the time of reckoning they simply will not be able to hide. Let me give a warning to the Government. They may think that the five years of reforms have changed the face of the NHS. They have not. The great work that has been done by the NHS in the past 50 years has not been undone by five years of reforms, but if we have another five years of these crazy reforms, the next 50 years of the NHS will be completely and utterly destroyed. We simply will not stand for that. The Minister and the Secretary of State should be warned that they will face a vigorous campaign about the choice that we will offer at the next election.
  Mr. Mackinlay: The only point on which I take issue with my hon. Friend is the fact that he referred to only five years of Government-imposed reforms. Their reforms are like the painting of the Forth bridge—they start on one end and they never finish. They keep reforming their reforms. I remember that it was "Sir Sheath Durex"—[Laughter.]— or whatever his name was—Sir Keith Joseph—who reformed the NHS. He created the area health authorities and the regional health authorities and set up the
  428
  bureaucracy which then had to be abolished, and the Conservatives have continued with reforms since they came back into office.
  Mr. McLeish: No doubt it would be unparliamentary for me to repeat part of what my hon. Friend said, but he chose an excellent analogy in the Forth bridge. Never mind the painting; the bridge has been sold. It is an interesting analogy, given what may happen to the national health service.
  The Government are out of touch with national sentiment, and out of step with public concerns. Let me repeat the obvious: the sooner they are out of office, the better it will be for the future of the NHS. My central charge is this. The artificial market is being propped up by the spending of more and more money on this market madness, and a paperchase is being substituted for the delivery of patient care. We believe in a patient-centred NHS—in patient choice and patient care. We have heard speeches defending managers, bureaucrats and almost everyone, but I did not hear much mention of patients. Perhaps that is another defining issue that the Government have forgotten to challenge.
  It is important to remind the Government of the catalogue of chaos that currently constitutes parts of the NHS. We have heard about intensive care tonight: we have heard about paediatrics, and accident and emergency departments. We are seeing the development of two-tierism throughout the country. The Government defend that. They enjoy the fact that some patients have more rights of referral than others. It is a disgrace, but they are happy to trumpet it as a success.
  The Government also defend the private finance initiative. We have posed an interesting question to the Secretary of State, which he ducks on every occasion. Where are the contracts? How many are there, and how many openings will my hon. Friend the Member for Peckham (Ms Harman) be attending as Secretary of State; for Health when we take over in a few months' time? I fear that it will not be as many as she would like. [Interruption.] Ministers are now discussing the future of the PFI. The fact is that it is going nowhere, because it is expensive. [Interruption.] Perhaps I should sit down, and allow the: debate on the Government Front Bench to become public.
  Ministers have mentioned the sum of £500 million, but that figure could be £500 billion. Unless it is translated into positive action—bricks and mortar—patients will not be helped.
  Let me raise a more serious point. There is a crisis in relation to health inequalities, which the Government simply will not address. In 1994, there were 11.4 infant deaths per 1,000 live births, but in Kingston and Richmond the figure was 3.1. It is a factor of four. Why is that? Poverty and affluence are clearly involved, but another key issue is lack of access to health care throughout the country. The Government talk of bureaucracy, but I submit that saving people from early death should always be a priority in any health service.
  Mr. Dorrell: I agree.
  Mr. McLeish: That is fine, but I want to know what the Secretary of State intends to do. Let me give him another statistic for good measure. In 1994 there were 126 deaths from breast cancer per 100,000 of the population, but in

  429
  Chichester there were only 51. On the vital issues of coronary heart disease, breast cancer, infant mortality and long-term illnesses, there are unacceptable differences throughout a so-called one-nation health service. I think that we know the reason for that: the Government have simply run out of energy, enthusiasm and commitment to health equality.
  Here is a statistic that the Government do not like. Over the past five years the number of nurses has fallen by 50,000, and there are 19,000 fewer in training—but, of course, there are 20,000 extra managers. Does that not constitute a comment on the current state of the NHS? [HON. MEMBERS: "Not true."] Conservative Members chorus "Not true," but they are the Government's figures—sourced by the Library from Government computers.
  Two other issues dominate the health scene. One is the crisis in cancer care.
  Mr. Bowen Wells (Lord Commissioner to the Treasury): Ah!
  Mr. McLeish: I can tell the Whip that if the health service is fragmented, contractorised and competitive, there can be no rational or regional planning. Thousands of cancer patients have been badly served by the Government's crazy market set-up. Perhaps the Whip will reflect on his reaction and support my remarks.
  The health aspects of food are also in a shambles, as we have seen with the beef and powdered baby milk crises. When the Government do not trust the people, they end up in a mess. Of concern to all is that we have doctor against doctor, hospital against hospital, GP against GP and district health authority against district health authority. One cannot deny the realities of the market. The present competitive system is costing the taxpayer an absolute fortune and all that the Government can say is that we are denying reality. It is clear from the practical problems experienced by our constituents that that is so.
  I have spoken about the manifestations of the crisis in the health service, so now I will highlight the core issues. It is impossible to imagine that the Government will continue to squander money on bureaucracy when investment in patient care is required. Hon. Members spoke earlier about the wonderful asset of NHS staff and the key players, but their morale is at rock bottom, with 900,000 people looking for leadership. They need not look to the Government Benches because in a privatised set-up, staff are regarded only as hired hands. We regard those staff as a vital asset. They must be given leadership and allowed to participate.
  The privatisation of the railways has provided a classic example of a Government whose ideology blinkers them from reality. [Interruption.] Conservative Members may tut, but the British Rail network has been split into 100 parts, and that is called efficiency. The same is happening with the health service. There are free-standing GPs, free-standing trusts and a PFI that seeks to embrace services rather than bricks and mortar. All the building blocks are there and the market will ultimately destroy much of the legacy that it will inherit over the next decade.
  Nor is there any momentum in the NHS; instead there is a yearning for a change of Government. The Minister will know from visiting GPs that they are sick and tired of a Government who preach the principle of listening but never
  430
  listen. A few years ago, the Government created the monster of the market, which is eating up cash and cannot be controlled. My hon. Friend the Member for Peckham said that when there is a Labour Government, we will control the market. We will ensure that hard-earned taxpayers' money is transferred to patient care, which is the big issue for the next century—not patient charters or crocodile tears over not being able to save on bureaucracy.
  After 50 years of the NHS, why should the public have to wait and worry? The country should have a Government who address all the issues in the interests of patients. That ultimately means cutting bureaucracy and giving a new boost to the NHS culture that the patient is the most important consideration. If that is done, all the talk about positive outcomes will be proved right, because we will stop people dying unnecessarily. We will overcome health variations, which are impossible to support in a modern society. We will also give leadership to the 900,000 NHS staff—who are yearning for change, which only Labour can provide.
  9.39 pm
  The Minister for Health (Mr. Gerald Malone): In his closing remarks, the hon. Member for Fife, Central (Mr. McLeish) said that this debate had had several defining points, and he is the Labour Front Bencher who decided to say that one of those defining points was finance. I must tell him and the hon. Member for Peckham (Ms Harman)—who dodged the issue when opening the debate—that I shall spend some time in my speech pressing Opposition Members to state precisely how they would fund the NHS. That is the core of the issue.
  On a year-on-year basis, in real terms this Government have spent more than any other Government have ever spent, and we have issued a commitment to continue doing so. We heard nothing from any Opposition Member about how they would deal with that core point.
  The hon. Members for Fife, Central and for Peckham have approached this debate principally on the hypothesis that they will be able to fund the necessary increase in NHS spending by cutting bureaucracy. They have supported that statement with figures that are dodgy, to say the least. I shall set out the true position and describe what the Government have done to bear down vigorously on management costs in the NHS.
  Last October, my right hon. Friend the Secretary of State for Health announced a 5 per cent. cash reduction—8 per cent. in real terms—in the costs of running health authorities and in trust management costs in 1996–97, the merger of district health authorities and family health services authorities and the abolition of regional health authorities. In a debate that is based on the abolition of bureaucracy, the House will be interested to note that the Labour party opposed the measure to abolish regional health authorities.
  Those measures will release about £300 million for patient care by 1996–97. That is composed of £54 million from cuts in health authority costs, £95 million from cuts in trust management costs, £101 million from abolition of regional health authorities and £55 million from streamlining the Department of Health—which has been done with great vigour.
  When it comes to bearing down on bureaucracy in the NHS and ensuring that we get the best value for taxpayers' money, the Government have a first-class record. In a

  431
  moment, I shall deal with some of the points made by Opposition Members about bureaucracy in some detail and show how their argument is flawed, but first I shall deal with the speeches made by hon. Members on both sides of the House.
  My hon. Friend the Member for Broxbourne (Mrs. Roe) made a robust defence of management. As Chairman of the Select Committee on Health, she was able to do so from a position that provides her—and other Committee members—with a great insight into the importance of proper management. I find it somewhat paradoxical that Opposition Members are constantly saying that we have too much management and bureaucracy in the NHS, yet, when they sit on the Select Committee and when they table parliamentary questions, they are the ones who demand NHS facts, figures and proper accountability—which requires that a proper management structure is in place.
  My hon. Friend the Member for Broxbourne quite rightly made the point that if our national health service, which is responsible for £40 billion of taxpayers' money per annum, is to be accountable, it must be properly managed: first, to be accountable and, secondly, to be effective.
  The hon. Member for Southwark and Bermondsey (Mr. Hughes)—who has not returned to the Chamber—came out, as he always does, with many interesting figures, none of which I recognise. He made one point about the National Health Service Consultants Association. I can tell him that a reply to the letter that he mentioned will be on its way to that association soon.
  The hon. Member for Preston (Mrs. Wise) expressed some concerns about community health care for children. I am sure that she will be pleased to know that, after full consultations in which more than 250 responses were received, a guide on community child health services is with the printers and will be issued soon. I hope that she will welcome that.
  Mrs. Wise rose—
  Mr. Malone: I apologise for not giving way to the hon. Lady, but my time is limited, and I want to deal with all the speeches by hon. Members on both sides of the House.
  My hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes), who said that he might not be able to be in his place for the winding-up speeches, made a historical speech. He reminded us of pointless past bureaucracy in the health service. He was right to make that point vigorously. The Government are focusing the management function on providing effective increases in patient care and on ensuring that inefficiency is driven out of the service. My hon. Friend specifically said that he hoped that liaison between community health trusts and social services committees could be encouraged. I heartily endorse that view. Indeed, we encourage that practice wherever possible.
  The hon. Member for Islwyn (Mr. Touhig) derided the voluntary sector. I was amazed. Unfortunately, it is something that he and his friends do too often. He complained that some services for patients—in particular a voluntary, I presume counselling, service for cancer patients—are delivered by voluntary
  432
  organisations. As I go around the country, I frequently hear that argument, usually levelled at leagues of friends who in fact do tremendous work for the public sector and underpin the connection between the health service and the community.
  When Labour Members deride those organisations and say, as the hon. Gentleman did, that those services should be delivered from public funds—[Interruption.] That is exactly what the hon. Gentleman said. Labour Members do no service to the thousands of people who add to the services provided by the NHS.
  Mr. Touhig rose—
  Mr. Malone: No, I will not give way.
  The hon. Member for Islwyn went on to make some useful points about nurse leadership and development, which I heartily endorse.
  Mr. Touhig: On a point of order, Mr. Deputy Speaker.
  Mr. Deputy Speaker (Mr. Michael Morris): Is it a point of order for the Chair?
  Mr. Touhig: It is, Mr. Deputy Speaker. I am entitled to ensure that my remarks in this Chamber are not misrepresented. I made no such statement and I seek the support of the Chair in this matter.
  Mr. Deputy Speaker: Order. The hon. Gentleman has been in the House for sufficient time to know that there are opportunities available to him to deal with that—for example, the Order Paper, and so on—and that he should not attempt to bring the Chair into any interpretation of any hon. Member's speech.
  Mr. Malone: My hon. Friend the Member for Mid-Staffordshire (Mr. Fabricant) rightly praised trusts for being efficient. He mentioned one in particular in his constituency, which I visited some time ago, where I saw precisely what NHS reforms have been able to bring to trusts. It is not just that they are more efficient and can deliver better health care; it is that as in Newham, where I was this week, and in Andover, where I was yesterday, trust hospitals, with their new freedoms, are now able to provide more efficient, but better, health care to patients in their community by entering into partnerships with other trusts and developing those in a way that the Opposition entirely ignore.
  The hon. Member for Dunfermline, West (Ms Squire) made points relating to her constituency, which I shall draw to the attention of my right hon. Friend the Secretary of State for Scotland.
  My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) made an important point about the British Medical Association acknowledging that the Government have addressed the problems of bureaucracy. The BMA has welcomed that. In the light of this conference season, praise from the BMA is, perhaps, not usual, but it is clearly something that the Government welcome when it comes. The BMA made an important point.

  433
  My hon. Friend the Member for Beckenham (Mr. Merchant) rightly referred to bureaucracy being streamlined and waiting lists going down in his constituency. He also pointed out that, as a result of NHS reforms and changes that the Government have brought to bear, there is new hospital building in his constituency. I welcome that, too.
  The hon. Member for Coventry, North-East (Mr. Ainsworth) referred to private finance solutions for Walsgrave and Bromsgrove. He said that he was afraid that they would not be affordable. I have to disappoint him—Walsgrave Hospitals NHS trust will be announcing its plans and its preferred private sector partnership at the end of this week.
  As business cases are approved and the PFI is going out on a planned process towards completion, Opposition Members crow, but they crow too early, for the PFI will be a fundamental way to provide new funds for the NHS and capital development. Before, people had to wait for an inordinate amount of time. The hon. Member for Peckham will know full well about the cases when they are finally announced in a formal way, and I promise her that she will then be smiling—perhaps—slightly on the other side of her face.
  My hon. Friend the Member for Worcester (Mr. Luff) made a powerful speech in which he set out the proper role of management and talked about the course of change to reduce bureaucracy that had constantly been opposed by the Labour party. He was quite right to do that. On one hand, the Labour party decides to feature bureaucracy as the basis of this debate, and on the other it entirely ignores and stands in the way at local level of the effort to get bureaucracy out of the health service and improve efficiency.
  The hon. Member for York (Mr. Bayley) made a specific point to which he asked me to respond. I have asked officials about the prior notice that he gave, but I am sorry to tell him that there is no trace of it. There is an outstanding letter to my right hon. Friend the Secretary of State to which the hon. Gentleman will receive a reply in due course.
  During the opening speeches, a degree of sensitivity was displayed by the hon. Member for Fife, Central. It was because the issue strikes at the heart of Labour's problem. Labour Members talk in soundbites about health, but propose nothing. When they propose something and they are found out for proposing it, their first reaction is to deny it, as the hon. Gentleman did. Let us pin the Labour party down about fundholding, which now services 52 per cent. of England's population. The hon. Gentleman is quoted as saying that once in power
  "we will remove the internal market and the principle of a single practice holding a budget will not be there."
  Mr. McLeish: Replace.
  Mr. Malone: Replace or abolish? I am not quite sure which. In the eyes of any fundholder, "replacing" is a euphemism for "abolishing". I understand that those who attended the conference at which the hon. Gentleman spoke were not convinced by the euphemism and entirely understood the purpose of the hon. Gentleman and his party: it was to do away with all the excellent work that
  434
  fundholders have built up over seven waves of fundholding. I shall give way to the hon. Gentleman if he will deny that.
  Mr. McLeish: I would have thought that the intervention in relation to the Secretary of State's comments would iron out that particular point, but it would appear that, to gain some cheap political points, the Minister will not acknowledge the sincerity and honesty with which I said that the comments reported by the Secretary of State were simply untrue. Does the Minister accept the sincerity of the point that I am making or is he going to ignore it and make political points anyway? [Interruption.]
  Mr. Malone: We want to know what the Labour party and the hon. Gentleman mean—so do fundholders, and so do the 150 of them who were at the meeting. They will no doubt have their views on what the hon. Gentleman has said, which, of course, I accept in the spirit of a debate across the Dispatch Box.
  I said that I would look with some care at what the Labour party was saying about bureaucracy and figures. I accuse it of playing fast and loose with figures all the time and of ensuring that a false picture of the health service is represented. I shall refer to one instance of that.
  I nodded in the direction of the hon. Member for Darlington (Mr. Milburn). I am perfectly happy to answer his parliamentary questions. He issued a press release today on a subject at the core of this debate—health authority administrative spending, which, according to his press release, rose by more than £315 million to £1.1 billion between 1991 and 1994–95.
  I remember answering the hon. Gentleman's parliamentary question and I also remember writing to him because I thought that the figures should not be misunderstood and should be properly explained. My letter said:
  "The figures have not been adjusted to constant prices. Changes over the years and the roles and responsibilities of health authorities and the transfer of functions to NHS Trusts … also mean that the figures are not strictly comparable."
  Health authorities now fulfil a substantial number of functions that they did not have in the past—involving public health and programmes for the relief of AIDS. An analysis of the figures on the proper terms—which I set out in my letter to the hon. Gentleman—shows that the truth is rather different. To fund those increased and changed activities, there has been an increase in expenditure from 1991–92 to 1994–95 of 0.1 per cent. per annum in real terms. That puts matters in a different context. What is more, those figures do not take into account the abolition of regional health authorities, saving some £101 million. Although the hon. Gentleman says that he wants to decrease bureaucracy, the Labour party opposed that £101 million.
  If we want to look at the defining moments to which the hon. Member for Fife, Central referred, there is one source to which we can turn with confidence—the recent speech by the Leader of the Opposition at the NAHAT conference. It was a speech full of contradictions. He heard the message loud and clear when he said:
  "You do not want more major upheaval".

  435
  However, in the next breath, he promised the health service that he would replace the internal market, causing the upheaval that he claimed it did not want. In the following breath, he said:
  "Planning and delivery of health care will remain distinct functions".
  That undertaking from the right hon. Gentleman totally undermines the case of the hon. Member for Peckham, as it defends the mechanisms of purchasing and delivery and promises that they will remain firmly in place. It is absolutely typical of the Opposition to make an assertion and slide away from it.
  It is important to note that that speech supported a deceitful party policy. At its centre is Labour's big lie. Labour refuses to say how much it will spend on health. Where is Labour's commitment to build on the success of the health service that Opposition Members have persistently mentioned tonight? Everyone involved in the health service understands that the engine of growth in our NHS is, and always has been, proper funding. Of course, efficiency gains improve patient care, as does cutting bureaucracy—which Labour opposed in the House. However, if one asks anyone who works in the NHS what is the litmus test of the Government's commitment, the answer will be a commitment to fund on a continuing basis. My right hon. Friend the Prime Minister has set out that commitment to increase funding in real terms in the next Parliament, as the Government have done consistently since we came to power.
  What does the Leader of the Opposition have to say about that? It should have been up front on page 1 of his speech. I read page 1 of his speech and it was not there. Nor was it on pages 2, 3, 4, 5, 6, 7 and 8. On page 9, in the dying moments of the speech, the right hon. Gentleman steels himself. The audience sits on the edge of its seat and hears that a Labour Government would look at whether there was a funding gap that needed to be bridged. That is highly courageous, but utterly meaningless. The Opposition constantly complain that we do not spend enough as a percentage of GDP on health. I invite the right hon. Gentleman to let us know what Labour would do. We have increased spending as a proportion of GDP by more than 1 per cent.
  The NHS has been well defended and well supported by the Government. It now delivers more health care than ever before, and has more doctors and nurses delivering health care to patients. Yet again, that figure has been entirely distorted by Labour. Since 1984, the number of qualified nurses in the NHS providing care for patients has increased by 22,950.
  This has been a debate in which the Opposition have failed the test of supporting the NHS. They run for cover as soon as any suggestion is made of a true commitment.
  Ms Ann Coffey rose in her place and claimed to move, That the Question be now put.
  Question, That the Question be now put, put and agreed to.
  Question put accordingly, That the original words stand part of the Question:—
  The House divided: Ayes 217, Noes 260.

  Division No. 158]

  [9.59 pm

  AYES

  Abbott, Ms Diane

  Garrett, John

  Adams, Mrs Irene

  George, Bruce

  Ainger, Nick

  Gerrard, Neil

  Ainsworth, Robert (Cov'try NE)

  Godman, Dr Norman A

  Allen, Graham

  Godsiff, Roger

  Anderson, Donald (Swansea E)

  Golding, Mrs Llin

  Austin-Walker, John

  Griffiths, Win (Bridgend)

  Barnes, Harry

  Grocott, Bruce

  Barron, Kevin

  Gunnell, John

  Battle, John

  Harman, Ms Harriet

  Bayley, Hugh

  Hattersley, Rt Hon Roy

  Beckett, Rt Hon Margaret

  Henderson, Doug

  Bell, Stuart

  Heppell, John

  Benn, Rt Hon Tony

  Hill, Keith (Streatham)

  Benton, Joe

  Hinchliffe, David

  Bermingham, Gerald

  Hodge, Margaret

  Berry, Roger

  Home Robertson, John

  Betts, Clive

  Hood, Jimmy

  Blunkett, David

  Howarth, George (Knowsley North)

  Bradley, Keith

  Howells, Dr Kim (Pontypridd)

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

  Hoyle, Doug

  Burden, Richard

  Hughes, Kevin (Doncaster N)

  Byers, Stephen

  Hutton, John

  Caborn, Richard

  Ingram, Adam

  Callaghan, Jim

  Jackson, Glenda (H'stead)

  Campbell, Mrs Anne (C'bridge)

  Jackson, Helen (Shef'ld, H)

  Campbell, Menzies (Fife NE)

  Jamieson, David

  Campbell-Savours, D N

  Janner, Greville

  Canavan, Dennis

  Jenkins, Brian (SE Staff)

  Cann, Jamie

  Jones, Barry (Alyn and D'side)

  Carlile, Alexander (Montgomery)

  Jones, Lynne (B'ham S O)

  Chidgey, David

  Jones, Martyn (Clwyd, SW)

  Chisholm, Malcolm

  Jones, Nigel (Cheltenham)

  Clapham, Michael

  Jowell, Tessa

  Clark, Dr David (South Shields)

  Kaufman, Rt Hon Gerald

  Clarke, Eric (Midlothian)

  Keen, Alan

  Clarke, Tom (Monklands W)

  Kennedy, Charles (Ross, C&S)

  Clwyd, Mrs Ann

  Khabra, Piara S

  Coffey, Ann

  Kilfoyle, Peter

  Cohen, Harry

  Lestor, Joan (Eccles)

  Corbett, Robin

  Liddell, Mrs Helen

  Corbyn, Jeremy

  Livingstone, Ken

  Corston, Jean

  Lloyd, Tony (Stretford)

  Cousins, Jim

  Loyden, Eddie

  Cunningham, Jim (Covy SE)

  Lynne, Ms Liz

  Dafis, Cynog

  McAllion, John

  Darling, Alistair

  McAvoy, Thomas

  Davidson, Ian

  McCartney, Ian

  Davies, Bryan (Oldham C'tral)

  Macdonald, Calum

  Davies, Chris (L'Boro & S'worth)

  McFall, John

  Davies, Rt Hon Denzil (Llanelli)

  McKelvey, William

  Davies, Ron (Caerphilly)

  Mackinlay, Andrew

  Dewar, Donald

  McLeish, Henry

  Dixon, Don

  McNamara, Kevin

  Dobson, Frank

  McWilliam, John

  Donohoe, Brian H

  Madden, Max

  Dowd, Jim

  Maddock, Diana

  Dunwoody, Mrs Gwyneth

  Mahon, Alice

  Eagle, Ms Angela

  Mandelson, Peter

  Eastham, Ken

  Marshall, David (Shettleston)

  Ewing, Mrs Margaret

  Marshall, Jim (Leicester, S)

  Fatchett, Derek

  Martin, Michael J (Springburn)

  Faulds, Andrew

  Martlew, Eric

  Field, Frank (Birkenhead)

  Maxton, John

  Fisher, Mark

  Meacher, Michael

  Flynn, Paul

  Meale, Alan

  Foster, Rt Hon Derek

  Michael, Alun

  Foster, Don (Bath)

  Michie, Bill (Sheffield Heeley)

  Foulkes, George

  Michie, Mrs Ray (Argyll & Bute)

  Fraser, John

  Milburn, Alan

  Fyfe, Maria

  Mitchell, Austin (Gt Grimsby)

  Gapes, Mike

  Moonie, Dr Lewis

  437

  Morgan, Rhodri

  Short, Clare

  Morley, Elliot

  Simpson, Alan

  Morris, Rt Hon Alfred (Wy'nshawe,

  Skinner, Dennis

  Morris, Estelle (B'ham Yardley)

  Smith, Andrew (Oxford E)

  Morris, Rt Hon John (Aberavon)

  Smith, Chris (Isl'ton S & F'sbury)

  Mowlam, Marjorie

  Smith, Llew (Blaenau Gwent)

  Mudie, George

  Soley, Clive

  Mullin, Chris

  Spearing, Nigel

  Murphy, Paul

  Spellar, John

  Oakes, Rt Hon Gordon

  Squire, Rachel (Dunfermline W)

  O'Brien, Mike (N W'kshire)

  Stevenson, George

  O'Brien, William (Normanton)

  Stott, Roger

  O'Hara, Edward

  Strang, Dr. Gavin

  Olner, Bill

  Straw, Jack

  O'Neill, Martin

  Sutcliffe, Gerry

  Parry, Robert

  Taylor, Mrs Ann (Dewsbury)

  Pearson, Ian

  Timms, Stephen

  Pike, Peter L

  Touhig, Don

  Powell, Sir Ray (Ogmore)

  Trickett, Jon

  Prentice, Gordon (Pendle)

  Tyler, Paul

  Purchase, Ken

  Walker, Rt Hon Sir Harold

  Quin, Ms Joyce

  Wallace, James

  Radice, Giles

  Wardell, Gareth (Gower)

  Randall, Stuart

  Wareing, Robert N

  Watson, Mike

  Raynsford, Nick

  Welsh, Andrew

  Reid, Dr John

  Wicks, Malcolm

  Rendel, David

  Wigley, Dafydd

  Robertson, George (Hamilton)

  Williams, Rt Hon Alan (Sw'n W)

  Robinson, Geoffrey (Co'try NW)

  Williams, Alan W (Carmarthen)

  Roche, Mrs Barbara

  Winnick, David

  Rooker, Jeff

  Wise, Audrey

  Rooney, Terry

  Worthington, Tony

  Ross, Ernie (Dundee W)

  Wright, Dr Tony

  Rowlands, Ted

  Young, David (Bolton SE)

  Sedgemore, Brian

  Sheerman, Barry

  Tellers for the Ayes:

  Sheldon, Rt Hon Robert

  Mr. Peter Hain and

  Shore, Rt Hon Peter

  Mrs. Jane Kennedy

  NOES

  Ainsworth, Peter (East Surrey)

  Butterfill, John

  Aitken, Rt Hon Jonathan

  Carlisle, John (Luton North)

  Alison, Rt Hon Michael (Selby)

  Carlisle, Sir Kenneth (Lincoln)

  Allason, Rupert (Torbay)

  Carrington, Matthew

  Amess, David

  Carttiss, Michael

  Arbuthnot, James

  Cash, William

  Arnold, Jacques (Gravesham)

  Channon, Rt Hon Paul

  Ashby, David

  Chapman, Sir Sydney

  Atkins, Rt Hon Robert

  Churchill, Mr

  Atkinson, Peter (Hexham)

  Clappison, James

  Baker, Rt Hon Kenneth (Mole V)

  Clark, Dr Michael (Rochford)

  Baker, Nicholas (North Dorset)

  Clarke, Rt Hon Kenneth (Ru'clif)

  Baldry, Tony

  Clifton-Brown, Geoffrey

  Banks, Matthew (Southport)

  Coe, Sebastian

  Banks, Robert (Harrogate)

  Colvin, Michael

  Batiste, Spencer

  Congdon, David

  Bellingham, Henry

  Coombs, Anthony (Wyre For'st)

  Bendall, Vivian

  Cormack, Sir Patrick

  Beresford, Sir Paul

  Couchman, James

  Biffen, Rt Hon John

  Cran, James

  Body, Sir Richard

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

  Bonsor, Sir Nicholas

  Curry, David (Skipton & Ripon)

  Booth, Hartley

  Davies, Quentin (Stamford)

  Boswell, Tim

  Day, Stephen

  Bottomley, Peter (Eltham)

  Deva, Nirj Joseph

  Bowis, John

  Devlin, Tim

  Boyson, Rt Hon Sir Rhodes

  Dorrell, Rt Hon Stephen

  Brandreth, Gyles

  Douglas-Hamilton, Lord James

  Brazier, Julian

  Dover, Den

  Bright, Sir Graham

  Duncan, Alan

  Brooke, Rt Hon Peter

  Duncan Smith, lain

  Brown, M (Brigg & Cl'thorpes)

  Dunn, Bob

  Browning, Mrs Angela

  Dykes, Hugh

  Budgen, Nicholas

  Eggar, Rt Hon Tim

  Burns, Simon

  Elletson, Harold

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  Emery, Rt Hon Sir Peter

  Lilley, Rt Hon Peter

  Evans, David (Welwyn Hatfield)

  Lloyd, Rt Hon Sir Peter (Fareham)

  Evans, Jonathan (Brecon)

  Lord, Michael

  Evans, Roger (Monmouth)

  Luff, Peter

  Evennett, David

  Lyell, Rt Hon Sir Nicholas

  Faber, David

  MacGregor, Rt Hon John

  Fabricant, Michael

  MacKay, Andrew

  Field, Barry (Isle of Wight)

  Maclean, Rt Hon David

  Fishburn, Dudley

  McNair-Wilson, Sir Patrick

  Forman, Nigel

  Madel, Sir David

  Forsyth, Rt Hon Michael (Stirling)

  Maitland, Lady Olga

  Forth, Eric

  Malone, Gerald

  Fox, Rt Hon Sir Marcus (Shipley)

  Mans, Keith

  Freeman, Rt Hon Roger

  Marland, Paul

  French, Douglas

  Marlow, Tony

  Fry, Sir Peter

  Marshall, John (Hendon S)

  Gale, Roger

  Marshall, Sir Michael (Arundel)

  Gallie, Phil

  Martin, David (Portsmouth S)

  Gardiner, Sir George

  Merchant, Piers

  Gamier, Edward

  Mills, Iain

  Gill, Christopher

  Mitchell, Andrew (Gedling)

  Gillan, Cheryl

  Mitchell, Sir David (NW Hants)

  Goodlad, Rt Hon Alastair

  Moate, Sir Roger

  Goodson-Wickes, Dr Charles

  Molyneaux, Rt Hon Sir James

  Gorst, Sir John

  Monro, Rt Hon Sir Hector

  Grant Sir A (SW Cambs)

  Montgomery, Sir Fergus

  Greenway, Harry (Ealing N)

  Moss, Malcolm

  Greenway, John (Ryedale)

  Nelson, Anthony

  Griffiths, Peter (Portsmouth, N)

  Neubert, Sir Michael

  Grylls, Sir Michael

  Newton, Rt Hon Tony

  Hague, Rt Hon William

  Nicholls, Patrick

  Hamilton, Neil (Tatton)

  Norris, Steve

  Hampson, Dr Keith

  Ottaway, Richard

  Hanley, Rt Hon Jeremy

  Page, Richard

  Hannam, Sir John

  Paice, James

  Hargreaves, Andrew

  Patten, Rt Hon John

  Haselhurst, Sir Alan

  Pickles, Eric

  Hawkins, Nick

  Porter, Barry (Wirral S)

  Hawksley, Warren

  Porter, David (Waveney)

  Heald, Oliver

  Portillo, Rt Hon Michael

  Hendry, Charles

  Powell, William (Corby)

  Heseltine, Rt Hon Michael

  Redwood, Rt Hon John

  Hicks, Sir Robert

  Renton, Rt Hon Tim

  Higgins, Rt Hon Sir Terence

  Richards, Rod

  Hill, Sir James (Southampton Test)

  Riddick, Graham

  Horam, John

  Rifkind, Rt Hon Malcolm

  Hordem, Rt Hon Sir Peter

  Robathan, Andrew

  Howell, Rt Hon David (G'dford)

  Roberts, Rt Hon Sir Wyn

  Howell, Sir Ralph (N Norfolk)

  Robinson, Mark (Somerton)

  Hughes, Robert G (Harrow W)

  Roe, Mrs Marion (Broxbourne)

  Hunt, Rt Hon David (Wirral W)

  Rowe, Andrew (Mid Kent)

  Hunter, Andrew

  Rurnbold, Rt Hon Dame Angela

  Hurd, Rt Hon Douglas

  Sackville, Tom

  Jack, Michael

  Sainsbury, Rt Hon Sir Timothy

  Jenkin, Bernard

  Scott, Rt Hon Sir Nicholas

  Jessel, Toby

  Shaw, David (Dover)

  Johnson Smith, Sir Geoffrey

  Shaw, Sir Giles (Pudsey)

  Jones, Gwilym (Cardiff N)

  Shephard, Rt Hon Gillian

  Jones, Robert B (W Hertfdshr)

  Shepherd, Sir Colin (Hereford)

  Jones, Nigel (Cheltenham)

  Shepherd, Richard (Aldridge)

  Kellett-Bowman, Dame Elaine

  Shersby, Sir Michael

  Key, Robert

  Sims, Sir Roger

  Knapman, Roger

  Skeet, Sir Trevor

  Knight, Mrs Angela (Erewash)

  Smith, Tim (Beaconsfield)

  Knight, Rt Hon Greg (Demy N)

  Smyth, The Reverend Martin

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

  Spencer, Sir Derek

  Knox, Sir David

  Spicer, Sir James (W Dorset)

  Kynoch, George (Kincardine)

  Spink, Dr Robert

  Lait, Mrs Jacqui

  Spring, Richard

  Lang, Rt Hon Ian

  Sproat, Iain

  Lawrence, Sir Ivan

  Stanley, Rt Hon Sir John

  Legg, Barry

  Steen, Anthony

  Leigh, Edward

  Stephen, Michael

  Lennox-Boyd, Sir Mark

  Stem, Michael

  Lester, Sir James (Broxtowe)

  Stewart, Allan

  Lidington, David

  Streeter, Gary

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  Sumberg, David

  Walker, Bill (N Tayside)

  Sweeney, Walter

  Ward, John

  Sykes, John

  Wardle, Charles (Bexhill)

  Tapsell, Sir Peter

  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

  Willetts, David

  Thurnham, Peter

  Wilshire, David

  Townsend, Cyril D (Bexl'yh'th)

  Winterton, Nicholas (Macc'fld)

  Tredinnick, David

  Wood, Timothy

  Trend, Michael

  Yeo, Tim

  Trotter, Neville

  Young, Rt Hon Sir George

  Twinn, Dr Ian

  Viggers, Peter

  Tellers for the Noes:

  Waldegrave, Rt Hon William

  Mr. Derek Conway and

  Walden, George

  Mr. Patrick McLoughlin

  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.
  MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
  Resolved,
  That this House congratulates the staff of the National Health Service for providing high quality care to a record number of patients, and notes that their achievements have been underpinned by the Government's unique commitment to increasing National Health Service funding, which has meant an extra £9.5 billion since 1992, and is dismayed that the Opposition proposals put ideology before patients, in particular by removing the option of fundholding from the 50 per cent. of general practitioners who have decided that this system offers the best prospect for their patients.

  DELEGATED LEGISLATION
  Mr. Deputy Speaker (Mr. Michael Morris): With permission, I shall put together motions 3, 4 and 5 relating to delegated legislation.
  Motion made, and Question put forthwith, pursuant to Standing Order No. 101(6) (Standing Committees on Delegated Legislation),

  HARBOURS, DOCKS, PIERS AND FERRIES
  That the draft Ipswich Port Authority Transfer Scheme 1996 Confirmation Order 1996, which was laid before this House on 4th June, be approved.
  FAMILY LAW
  That the draft Child Benefit, Child Support and Social Security (Miscellaneous Amendments) Regulations 1996, which were laid before this House on 5th June, be approved.

  SOCIAL SECURITY
  That the draft Jobseeker's Allowance (Pilot Scheme) (Amendment) Regulations 1996, which were laid before this House on 10th June, be approved.—[Mr. Burns.]
  Question agreed to.

  DEREGULATION
  Motion made, and Question put forthwith, pursuant to Standing Order No. 14A(1)(a) (Consideration of draft deregulation orders),
  DEREGULATION

    STILL-BIRTHS
    That the draft Deregulation (Still-Birth and Death Registration) Order 1996, which was laid before this House on 20th May, be approved.—[Mr. Burns.]
    Question agreed to.

  Secondary Schools (Chorley)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Burns.]
  10.11 pm
  Mr. Den Dover: It gives me great pleasure this evening to raise the matter of secondary school allocations in the Chorley area in Lancashire and to be joined by my right hon. Friend the Member for South Ribble (Mr. Atkins) and the hon. Member for Bolton, North-East (Mr. Thurnham), who have adjoining constituencies to my own and who have similar problems to some that I shall be raising.
  Secondary schooling is the most important step or change in any child's school career, and the maximisation of children's abilities at the delicate age of 11 when they move from primary to secondary school is of paramount importance. Education is the best investment of all and it is up to us, as representatives of the people, to ensure that the allocations are fair and appropriate, and that the best is brought out of all children according to their abilities.
  My worry is that, in the Chorley area, parents are asked for their first, second and third preferences of secondary schools, so they spend a lot of time with their children and put in a lot of effort going round the various secondary schools of varying natures in my area, in the borough of South Ribble, and perhaps across the border in Bolton. They may develop an affinity with a particular school, and their child likes it, so they put down their first, second and third preferences on a form supplied to them by Labour-controlled Lancashire county council.
  The unfairness is that many of my parents, particularly in the north and east of the Chorley constituency, have not been getting any of their first three preferences. That is unacceptable and a total waste of time and effort, and I want to ask my hon. Friend the Minister this evening whether it will be possible for her to lean on Lancashire county council and obtain some change.
  I wrote to the chief education officer in March. I quote his letter to me of 19 March:
  "In general the county council is unable to guarantee a place at one of the three preferred schools, although it is only a very small percentage of children who cannot be offered a place at any of their parents' preferences. In Lancashire"—
  Lancashire as a whole, not the Chorley area—
  "first preferences are up to 92.6 per cent., second preferences 3.5 per cent., third preferences 1.2 per cent., no preference 2.7 per cent.".
  The chief education officer confirms, however, that the information is not readily available for Chorley because it is held according to schools. I would ask that the first, second and third preferences be allocated on a postcode area basis. They should not really relate to schools; what matters is where parents live, as shown by their postcodes. They should be given the preferences that they want.
  Parental choice is paramount. It is the policy that the Government for the past 17 years have proudly boasted and honoured. I greatly welcome the policies in yesterday's White Paper, which will allow more selection by schools. That in turn will permit a
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  50 per cent. increase in the intake of grant-maintained schools. I regret the fact that, a few years ago, the Government flirted with the idea of allowing more popular schools to expand, to the detriment of those that were less popular. The results can be seen in Chorley. All the schools there do well in the performance league tables, but several are more popular than others, and that gives rise to a larger number of preferences.
  I accept the difficulty for the county council, but it is not too much to ask that each child be allocated one of its first three preferences. One problem is that the local education authority changes the rules every two or three years. Three years ago, villages to the south and east, towards Bolton, were affected. Schools there with a history of working in conjunction with local families from the surrounding villages suddenly found that the ground rules had changed—and that the time for the appeals procedure, April to June, had already arrived.
  No one likes change; people like to know what the ground rules are. This year changes affecting the north and east of my constituency have been made. Is the LEA carrying out any consultation? I do not think it should just change the rules and then force the changes on heads, parents and children. That is quite wrong. The guidelines and policies should be transparent, and people must have their say. If they think the system fair, fine; if not, they should be able to make their views known through their elected representatives and then bring about change.
  Yesterday's White Paper stresses that some LEAs are defensive and try to protect their own methods of working. I am delighted to note that the Government intend to force much more education spending—as much as 95 per cent. of it—down to school level, and not allow LEAs such as Lancashire's to channel only 85 per cent. down to the schools. The more money is spent at school level, the better value for money we get and the more local the decision making will become. Thus, we shall get away from the red tape and bureaucracy that are so much a part of activities at county hall in Preston.
  I am not satisfied that the appeals procedure is entirely independent. I find it, for instance, unacceptable that heads are kept out of it. They should have a major input to appeals procedures, so perhaps the situation needs reviewing.
  I care very much about the children in my constituency, and I have found the county council unresponsive, uncaring and bureaucratic in its past dealings with allocations to Catholic and Church of England schools or to voluntary-aided schools. The council has defended its patch and released only the minimum amount of money to schools. It has unfairly given less money to areas such as South Ribble and Chorley than to other parts of the county. Therefore, I condemn its actions.
  However, I praise the efforts of the Education Ministers, particularly the Under-Secretary who will reply to the debate this evening. I commend the Secretary of State for yesterday's White Paper. It is the vision for the future. The future is our children. What could be more important than ensuring that they get to the schools that they want and choose in their

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  preferences? My key question is: is it possible for the Minister to force Lancashire to honour at least one of the three preferences?
  10.19 pm
  Mr. Robert Atkins: I thank my hon. Friend the Member for Chorley (Mr. Dover) for raising this subject in the Adjournment debate and for allowing me to contribute to it. Consistently, Lancashire Conservative Members of Parliament have led the fight for the protection and development of education in the county of Lancashire, in the face of what can be described only as the inept administration of the Labour party in county hall. The Department for Education and Employment has received many letters from Lancashire Conservative Members of Parliament about the administration of Lancashire's education authority.
  My hon. Friend has raised yet another example of the council's bungling. Over the years, parents have visited my surgery because they have been extremely upset about the fact that their first choice, and sometimes their second choice, of school has not been acceded to—I am sure that most hon. Members have experienced this.
  One understands the pressures. One understands that, as a result of Conservative education policy over the years, we are developing some good schools. For example, I refer to Leyland, St. Mary's in my constituency—it has become a grant-maintained school. It has been extremely successful and a lot of parents want to send their children there.
  As my hon. Friend said, across the constituency boundaries of South Ribble and Chorley, parents in South Ribble are being offered schools in Chorley, and parents in Chorley are being offered schools in South Ribble. That is unacceptable because it is inconvenient. As my hon. Friend said, we are concerned at the apparent lack of care and attention—particularly in the area of appeals—that has been given to our constituents and to their children. I have had parents and children visit my surgery because of the way that this matter has been dealt with—some have been in tears.
  I join my hon. Friend in seeking to press the Minister to listen to the pleas of Lancashire Conservative Members of Parliament. We are speaking out, yet again, for the schools, for the children, for the parents and for the teachers—for those who share our concern about education.
  10.22 pm
  Mr. Peter Thurnham: I congratulate the hon. Member for Chorley (Mr. Dover) on his success in securing the Adjournment debate and on raising this subject. I also thank him for allowing me to contribute to the debate. The Lancashire education authority has priority for places at Turton school in my constituency. That popular school is over-subscribed. I am concerned about the Bolton education authority's policy of not giving priority to sibling links. It is a grossly anti-family policy, and it causes considerable distress.
  This week, I wrote to Mr. Jackson of the Bolton education authority about one particular case. I said:
  "I understand that Robert is very distressed at not being able to go to the same school as his sister and his friends, after attending Eagley Junior school in Bromley Cross all his life. I
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  believe Robert's GP has written to advise you of the stressful effect this is having on Robert, and I fully support any request that Robert be reconsidered for Turton."
  I would be grateful if the Minister used her influence to ask the Bolton education authority to reconsider its policy. Few education authorities do not give priority to sibling links. I believe that there is considerable support throughout the constituency, and throughout the other parts of Bolton, for a change in policy so that priority can be given to sibling links. We wish to avoid the stressful situation where one sibling goes to one school, but another sibling is unable to go to the same school. I hope that the Minister will be able to give the issue her consideration.
  10.23 pm
  The Parliamentary Under-Secretary of State for Education and Employment (Mrs. Cheryl Gillan): I am grateful to my hon. Friend the Member for Chorley (Mr. Dover) for raising his concerns, and I shall do my best to respond to him and to the concerns raised, rightly, by my right hon. Friend the Member for South Ribble (Mr. Atkins) and my hon. Friend the Member for Bolton, North-East (Mr. Thurnham). I know from the amount of correspondence that I receive from my hon. Friend the Member for Chorley that he takes a close interest in education matters, on which he works tirelessly on behalf of his constituents.
  We have of course come a long way since 1979, when parents had no right to specify their preferred choice of school. Schools could be half empty, but parents still might not have been offered a place for their child, and they had no right to appeal against the decision on where their child was to be educated.
  The Government gave parents the right to express a preference for a school. We required admission authorities to satisfy that preference unless the pupil did not meet the religious or selective entry requirements. We later introduced legislation that required schools to admit up to their standard number or any higher admission limit that was set. Admission authorities could no longer keep spare places at popular schools to safeguard less popular ones. If a school had spare places, eligible pupils had to be admitted.
  Not only did we strengthen the initial admissions process for parents, but we strengthened their right of appeal. All appeal committees must now contain a lay member, and representatives of the admission authority cannot be in the majority. Parents now have more confidence that their appeals will be heard by an independent and impartial panel that will carefully weigh up the needs of the child against the implications for the school.
  Parents now have more rights, more information, and access to a wider choice of different schools under a Conservative Government than ever before. The Government have tried to remove the artificial barriers which, in the past, have all too often stood in the way of parental choice. Evidence suggests that some 90 per cent. of first-choice applications are successful, but my hon. Friend the Member for Chorley has voiced his concerns about the admission arrangements in place in Lancashire, and especially the problems that his constituents have faced in getting their children into a school of their choice.
  It is never easy when popular schools are over-subscribed, as I know has been the case for a number of schools in Chorley. The Government firmly believe

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  that responsibility for admissions rightly lies with admission authorities, and that admission arrangements should be determined at local level. Admission authorities are able to respond directly to the wishes and needs of parents and pupils.
  That said, we expect admission authorities—the local education authority in the case of county and controlled schools, and the governing body in the case of voluntary-aided and grant-maintained schools—to determine arrangements that are clearly and accurately described, so that parents can judge the chances of gaining a place for their child at the school before expressing their preference. I hope that my hon. Friend the Member for Chorley will pass on to his education authority the requirement for arrangements to be expressed clearly.
  Lancashire local education authority is responsible for determining the admission arrangements for its schools, following an annual consultation with the governors of schools. During that consultation, the governors, if they wish, can propose changes to the school's arrangements for admission. Such proposals may include a change to the over-subscription criteria, or may suggest an increase in the school's admission number for that year.
  My hon. Friend the Member for Chorley is right to highlight the problems that can arise when admission authorities change admission arrangements without adequate consultation or notification. He will wish to know that yesterday my Department issued a revised circular on admissions that provides up-to-date guidance on admissions, and explains the basic principles that the Government consider important in the management of school admissions, including local determination, diversity, clarity, consultation and co-ordination. But it is for the authority to finalise arrangements, after taking into account any views put forward by governors, and to set out the admissions policy, giving the number of places available at the school and the criteria to be used in the case of over-subscription.
  In the case of county and controlled schools, Lancashire LEA gives priority to first-preference applications. In cases of over-subscription, the authority considers first those applications with sibling links, then those with medical, social or welfare reasons, and finally the admission authority allocates the remaining places with reference to the distances between the home and the parents' first-preference school and between the home and the nearest alternative school at which a place is available.
  Lancashire LEA must allocate places in accordance with the published arrangements for its schools. It is, of course, unfortunate that, when a school is over-subscribed—as was the case with Parklands High school—some parents may not receive a place, as the school can be filled with pupils with higher priority for places.
  I have looked into the situation that has arisen in Lancashire. It seems that the authority received more than 270 first-preference and an additional 260 second-preference applications for 206 places at Parklands High. Southlands High was also over-subscribed, with 169 first and 127 second-preference applications for only 187 places. A voluntary-aided school, St Michael's—with which my hon. Friend will be familiar—was also over-subscribed with applications.
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  I understand from the authority that a number of parents in the Eccleston area in particular who expressed a first preference for Parklands were not offered a place, as they live closer to another school, Bishop Rawstorne CE school. In applying its admission criteria, the authority was unable to give them priority for the available places. However, those parents were allocated places at the school of their second choice.
  I am also aware of the difficulties that some parents who live in the north-east of Chorley have faced in obtaining a place at Parklands. Again, that appears to be because they live closer to another school, Albany, which still has places available. I understand that the authority is in discussion with those parents about alternative places for their children.
  There is also a question over the number of pupils that Parklands can accommodate. The governors of the school can, of course, place a formal request with the authority to publish a higher admission limit. If the authority refuses to comply with that request, it is open to the governors to make an application to the Secretary of State for an increase in the school's standard number.
  I hear my hon. Friend's plea to ensure that parents receive at least one of their three preferences. In the allocations to Chorley schools this year, only 4.5 per cent. of parents—including those who applied from outside the area—have not received a place at a school for which they expressed a preference. Of those, nine parents live in the Chorley area. Unfortunately, it is never possible to guarantee places where many more parents have expressed a preference for a school than there are places available.
  When parents are unsuccessful in gaining a place, they may wish to exercise their right to appeal to independent appeal committees. Appeal committees offer parents an important second chance, and they must consider any appeal in light of the evidence available and on the merits of the case before them.
  I turn now to the case of Mrs. Finney, to which my hon. Friend the Member for Bolton, North-East referred. I understand that Mrs. Finney's son, Robert Rogerson, was unable to get into the school she chose—Turton school. I ask my hon. Friend to ask Mrs. Finney whether she wishes to approach the LEA to place Robert Rogerson on the waiting list for Turton school. I understand, and sympathise with, his constituent's problem.
  About 40 per cent. of appeals are successful. I believe that, through that route, several parents have been successful in gaining places at schools for which they expressed a preference. Although I stress that I appreciate the deep disappointment that parents feel when they are unsuccessful in gaining a place at a school of their choice, the number of such parents remains small. However, it is a significant issue for the parents concerned.
  But the Government have shown that they are committed to extending parental choice by the steps that they have taken, which have ensured that as many parents as possible receive their first choice of school for their children. Indeed, I was glad to receive the warm welcome from my hon. Friend the Member for Chorley for the White Paper that was published yesterday, which is another step forward and another plan in an excellent education policy that will provide choice for parents—more choice, and choice where there is none.

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  Finally, I shall take up the points raised by my hon. Friend the Member for Chorley and my right hon. Friend the Member for South Ribble, who expressed concern. My right hon. Friend often speaks out on behalf of his constituents, and I understand his heartfelt plea about the way in which the LEA is managed. I hope that I can throw a little light on the problems that my right hon. and hon. Friends mentioned.
  Both will wish to know that, thanks not least in part to the efforts of my hon. Friend the Member for Chorley, the new chief education officer in Lancashire, who was
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  appointed in January 1996, is currently seeking views from schools in the area about how their admission arrangements could be improved. I think that that is proof that the representations that Members of Parliament make in this place can make a difference, and I look forward to hearing the successful review of the admission arrangements in Lancashire.
  Question put and agreed to.
  Adjourned accordingly at twenty-four minutes to Eleven o'clock.