HC Deb 25 October 1996 vol 284 cc236-301 9.34 am
The Secretary of State for Health (Mr. Stephen Dorrell)

It is good, in a crowded House on a Friday morning, to see two of the three Opposition health spokesmen whom I have faced as Secretary of State for Health in the past 15 months. Perhaps group therapy will lead to greater clarity of health policies for the Labour Front Bench this morning.

The purpose of today's debate is to examine the social policy measures in the Queen's Speech, which contains a wide variety of different aspects of social policy. The Bill to be presented by my right hon. Friend the Secretary of State for Education and Employment is at the heart of the development of social policy; the various Bills promoted by my right hon. and learned Friend the Home Secretary are at the heart of the delivery of a stable society and of social policy; and the Bill that I and my hon. Friends from the Department of Health will present to the House to develop primary care within the national health service is a key part of the Government's programme for the last Session of this Parliament.

First, I shall set out the background to the introduction of that primary care Bill, the approach that we take to developing NHS primary care and why we regard it as a key element of the totality of the national health service. As I have said many times, I regard NHS primary care and, within primary care, the family doctor service, as the jewel in the crown of the national health service. It is one of the success stories of the NHS—

Mr. Frank Field (Birkenhead)

Does the Minister intend to speak to the Bill?

Mr. Dorrell

It is a success story, and I should have thought that the hon. Gentleman would agree with that. It is a widely held view within and outside the health service, and abroad, that NHS primary care is one of the national health service's success stories. It is a success because it has been built on some key principles: first, that patients choose the GP with whom they register. The service is available universally to any patient who wishes to use it, but which practice delivers it to an individual patient is a matter of patient choice. The second principle is that, once a patient has chosen the practice with which he or she wishes to register, the patient becomes the responsibility of that practice. That important principle underlies all the reforms to be set out in the Bill that we shall introduce and the policy papers that will follow it.

NHS primary care is not simply a service available to people who walk through the door. When a patient registers with a general practitioner, a GP accepts responsibility for health promotion and health advice, and general responsibility for the health of that patient. That is why we have introduced cervical smear programmes targeted on a GP's whole patient base; that is why we have introduced targets for childhood immunisation; and that is why last autumn I renegotiated the arrangements for delivering health promotion to patients registered with a general practice. The principle that, having chosen a general practice, patients are on a register and the practice recognises its responsibility for the whole practice population, is an important principle of NHS primary care.

Mr. Nigel Spearing (Newham, South)

I am grateful to the Minister for giving way so early in his speech, but this is a matter of cardinal importance. He rightly emphasises the importance of the patient. Does he agree that the changes envisaged in the White Paper will encourage competition between health practices, bringing in new sources of finance, perhaps under the private finance initiative or through borrowing? It will turn practices into businesses of which doctors must take account. Some of us feel that that would be to the detriment of patients. Does the Minister agree?

Mr. Dorrell

May I suggest to the hon. Gentleman that we shall have a more structured argument about that proposition, which I know some of his hon. Friends will want to advance, if he lets me develop my argument a stage further first? I do not accept what he says.

General practitioners already operate their practices and, as I emphasised at the outset, patients have absolute—or virtually absolute—freedom of choice on the practice with which they register. The principle of patient choice of practice already exists. I should have thought that the hon. Member for Newham, South (Mr. Spearing), who represents an inner-city constituency, would agree with the Government that the variation in quality of general practice between some of the easier, fashionable areas and some of the more deprived areas should be addressed. We plan to introduce more flexible models for the delivery of NHS primary care precisely to address some of the problems that the hon. Gentleman will encounter in parts of his constituency—the inadequate development of primary care in some inner-city areas, particularly in parts of the east end of London. We seek to address that concern.

Let me develop my argument. We have a system that is based on patient choice. Once patients have chosen a practice, they are registered with the general practitioner. The GP is then responsible for delivering a wide range of health care to those registered patients. The range of care has grown exponentially over recent years and that growth partly reflects changing medical practice. Change has come about through medical advance and the availability of new diagnostic and therapeutic techniques, which make it possible to offer diagnosis and therapy within the surgery in a way that was not possible given the state of medical knowledge and technology a generation ago.

A broader range of services within the surgery, at the front line of the NHS, is the third principle on which NHS primary care is built. The fourth principle is that when a patient needs health care that is not available in the primary care context, the NHS general practitioner is the most important gateway into the secondary and specialist care services of the NHS.

I have stressed that I regard general practice within the health service as a success. I have no doubt that that is true. That success is not new: it has been built over half a century. During that period, we have seen better trained GPs, the availability of a broader range of medical treatments, a wider range of non-medical professional staff working in a primary care context, and better buildings and facilities to allow those professionals to deliver care to their patients.

The result of the development of primary care is that the patient has greater access to what modern health care can provide. Critically for anyone interested in the sustainability of a tax-funded model for the delivery of health care, the development of primary care offers not only better access to health care, but the discipline of more efficient use of health care resources to ensure that the resources committed to health care are used efficiently and effectively and contain the cost burden inevitably entailed in delivering a modern health service.

NHS primary care is a success, but even the best system can be improved. The Government have made it clear year by year from 1979 that we are committed to the continued development of NHS primary care because we regard it as important for the interests of the patient that health care should be accessible. We regard the development of NHS primary care as the key to maintaining the efficiency lead that the NHS has, compared with health care systems elsewhere in the world. The success story must be continually improved.

When we considered what was good in the health service in 1990 and what needed to be further improved, one thing was clear to anyone who took a dispassionate interest in the NHS primary care sector. Although the services that were available within the primary care sector were developing and were of high quality, there was a frustrating failure to communicate between the primary and secondary care sectors of the health service. Large numbers of general practitioners were frustrated because they considered that resources were being inefficiently used—used in a way that did not represent best value for their patients—in the secondary care sector. They also saw, from the patients' perspective, how the secondary care sector was failing to respond as effectively as it should—[Interruption.] That is another example of modern technology, but it should have an off switch.

Madam Deputy Speaker (Dame Janet Fookes)

Order. Madam Speaker has strong views about modern technology—it should not be heard in the Chamber.

Mr. Dorrell

I am sure that the hon. Member for Dulwich (Ms Jowell) will find the high-tech, off switch.

The development of primary care has resulted in a wide range of services being provided in the surgery, but no proper linkage or accountability within the secondary care sector to the views and priorities of the primary sector has been established.

The idea was not partisan, it was not invented in 1990 and it is not recognised only by Conservative Ministers. Every one of my predecessors, from both Labour and Conservative Governments, made that speech about how it was important for the hospital sector to respond to the views and priorities of people in the primary care sector, who saw more patients every day than the hospitals. Every one of them—from Lady Castle to David Ennals and all my predecessors—going right through the 1990s, said that it was important to make secondary care more responsive. It was such a commonplace that it was seldom reported and never listened to—it was simply regarded as conventional orthodoxy. Every Health Minister said it and no one listened—people thought that it had merely come off whatever the predecessor to the word processor was at the Department of Health in the 1960s.

This Government then introduced fundholding—

Mr. Frank Field

What is the Bill about?

Mr. Dorrell

The Bill is about the development of primary care—building on the success of fundholding. The Government gave general practitioners the opportunity not simply to continue to deliver services and be frustrated by the failure of the secondary care sector to back them up in the way that they felt it should, but to help shape the secondary care services that their patients needed. That opportunity has been taken up by doctors who cover 58 per cent. of all national health service patients. We have given general practitioners that choice and more than half of them have opted for fundholding.

Not only have more than half of all GPs opted for fundholding, because they think that it is in their patients' interests—more fundamentally, that objective of making the secondary care sector more responsive to the wishes of primary care, which was consistently articulated by Labour and Tory Ministers for more than 30 years, has been delivered.

The relationship between primary and secondary care has changed and not merely for the benefit of fundholders. The majority of GP commissioners—certainly their leaders—recognise that they are using the changed relationship between primary and secondary care that came in with fundholding to develop their ideas for GP commissioning.

The question that anyone who is seriously interested in primary care must ask themselves is whether the fact that that changed relationship—which every one of my predecessors sought—arrived when fundholding was implemented, was a result of that implementation or of a massive historical coincidence, whereby people expressed that ambition for 30 years and it was realised on the day that fundholding was implemented, but the two are unrelated. I simply suggest that there is, to put it mildly, circumstantial evidence to support the Government's assertion that the changed relationship between primary and secondary care, which we have in the health service today and which benefits the patients of both fundholders and non-fundholders, is the result of our introduction of the fundholding scheme.

Mr. Simon Hughes (Southwark and Bermondsey)

I do not disagree with anything that the Secretary of State has said so far, but I wish to ask him a question that he has not yet answered, which is on the controversial issue that arises from fundholding. I shall give an example. I was told yesterday that the Royal Devon and Exeter NHS trust put out a notice in August, as a result of its contract with its health authority, which stated: The Trust has a fixed price contract for its work for North and East Devon Health Authority. Because of this, if we need to do more emergency work, it is necessary to do less non-urgent work. Patients will continue to be treated as before if they"— it gives a list, including— are the patient of a fundholding GP and the procedure is a fundholding procedure. Does the Secretary of State accept that fundholding has also brought advantages in speed of treatment to the patients of fundholding practices which other patients do not have?

Mr. Dorrell

I do not accept that point, because the basis on which funds are made available for the care of the two groups of patients is the same. I could understand the argument—although I did not agree with it—in the first days of fundholding, when the scheme was developing and not every general practitioner had the opportunity to join. Now that we are six years into the scheme, every general practitioner has exercised a choice. Presumably, some GPs have opted for fundholding because they think that it is in the interests of their patients, and other GPs have opted to be non-fundholders because they think that that is a better way to deliver care to their patients. I am sufficiently humble about the expertise of the Government to think that it is possible, in the different circumstances in which those professional people work, that both groups are right. The idea that everybody has to operate under the same model is absurd.

I seek to offer GPs a choice. They may opt for whichever of the options they think offers the best national health service care to their patients. On the track record so far, the GPs who cover 58 per cent. of patients have opted for fundholding and those who cover the other 42 per cent. have opted for non-fundholding. I am sure that both groups are motivated by the interests of their patients. Some 42 per cent. think that, in their circumstances, non-fundholding—including GP commissioning and other connections with their health authorities—offers the better model, and 58 per cent. of patients are covered by GPs who have chosen the other option. I am prepared to believe that both groups are right.

Mr. Peter Bottomley (Eltham)

My right hon. Friend's argument is convincing, but it leads to a further problem. If all GPs were fundholders and the same increase in emergency treatments took place during a year, what could be done to bring the resources through so that non-emergency treatments, which may be just as important to many people, could be met by the fundholders and the hospitals? That is not an attacking question, but a logical question.

Mr. Dorrell

Whether GPs are fundholders or not, the health service must choose its resource commitments to emergency services and non-emergency services, and indeed to all the other services that do not fall neatly into those two categories. It is not as simple as a straight choice between emergency and non-emergency services. Is a maternity service an emergency service? The service is clearly needed—and without delay. It needs to be demand led, but it is not what would normally be defined as an emergency service. Obviously, choices must always be made, within a tax-funded budget, between relative priorities.

Under the present fundholding arrangements, emergency services are outside the fund and are the responsibility of the health authority. The fundholders deal with the rest of the package of care. In the total purchasing pilots, the GPs make choices across the whole range of hospital secondary and tertiary services for their patients. The introduction of a right for GPs, if they so choose, to be the decision makers—in consultation with other GPs, the health authorities and other providers—and not simply consultees, has delivered the change in the relationship between primary and secondary care that every Health Minister from the 1960s onwards has argued for but was unable to deliver, until my right hon. and learned Friend the Chancellor of the Exchequer did so.

Mr. Simon Hughes

I do not disagree with anything that the Secretary of State has said, but he did not answer my specific question. Like him, we would not abolish fundholding—unlike the Labour party—but fundholding, although it has given choice to GPs, has caused disadvantage for some patients. Does he accept that some patients do not now get the same speed or standard of treatment because of the choice given to fundholding practices?

Mr. Dorrell

The hon. Gentleman -approaches the issue from an odd point of view, because he considers only the difference between the pattern of care provided by a fundholder and that provided by the health authority, but every health authority makes different choices in its use of resources.

Mr. Hughes

I asked a specific question.

Mr. Dorrell

The hon. Gentleman asked about the Royal Devon and Exeter NHS trust. People who live in Exeter are close to the eastern county boundary of Devon. On the other side of the county boundary, the health authority in that area will make different choices on the use of resources for its patients.

Mr. Hughes

That is not a direct answer.

Mr. Dorrell

It is. The hon. Gentleman seeks to distinguish between two groups of patients—those covered by fundholding and those who are not. Of course, there are differences between the care delivered by one fundholding practice and another fundholding practice, because that is the purpose of introducing the scheme. It allows the fundholding practice to improve the care available to its patients and, by definition, that means that the better care provided by the fundholders—in their opinion—is different from the care provided by the neighbouring practice. Otherwise, there is no point to the scheme.

The hon. Gentleman is right to say that there is a difference, because that is the purpose of the scheme. As a result of the scheme, the fundholder improves the efficiency with which resources are used to meet his patients' needs. Once the fundholder has shown how resources can be used more effectively, that creates a pressure on the health authority, non-fundholding practices and other fundholding practices to match the advances that the fundholder has made. The proposition that we cannot do anything unless we can do it for all 40 million people who live in England on the same day is patently absurd. We have to give people the opportunity to improve care for their patients, and that automatically creates pressure on others to match that improvement.

Mr. Hughes


Mr. Dorrell

I shall give way once more, but then I must get on. I am still on my introduction to the terms of the Bill.

Mr. Hughes

This is a long warm-up. I still agree with everything that the Secretary of State has said and he is bright enough to understand that he has not yet answered the question. If I exercise my right in Exeter or in that part of Devon to be on a doctor's list and that doctor chooses not to be a fundholder, is it not the case that today, in October 1996, I shall be at a disadvantage in receiving non-emergency treatment from the local NHS trust as opposed to those who are the patients of fundholding practices? That is a two-tier system, to the disadvantage of patients of non-fundholding practices.

Ms Harriet Harman (Peckham)

If it is a two-tier system, why do the Liberal Democrats support it?

Mr. Dorrell

The hon. Lady has always made it clear that she would abolish fundholding. It is nice to hear her being so clear and direct on the subject. She always sought to persuade me previously that abolishing fundholding was different from the concept of replacing fundholding. I never quite understood the difference, and I am glad to hear confirmation from the hon. Lady that she never really understood the difference either.

Ms Harman

That is sexism. The right hon. Gentleman thinks that women do not understand anything because they are stupid.

Mr. Dorrell

No. I am merely picking—

Madam Deputy Speaker

Order. It does not make for good debate if there are sotto voce comments, especially from a seated position.

Mr. Dorrell

I resent the proposition that, because I pick up a comment that the hon. Member for Peckham (Ms Harman) lets slip, which everyone knows to be her view, that makes me sexist. The hon. Lady is claiming a protection from normal and legitimate debate which anyone who wants to see equality of the sexes would not wish to claim on her behalf.

I have twice answered the question posed by the hon. Member for Southwark and Bermondsey (Mr. Hughes). The hon. Gentleman is focusing on one specific aspect of patient care. It is my case that we provide resources on the same formula to both fundholder and non-fundholder patients. Every practice has a different experience, of course, of the NHS. I am not talking about 42 per cent. or 58 per cent. The purpose of the scheme is to create pressure for improvement.

Mr. Frank Field

I am grateful to the Secretary of State for giving way.

Mr. Dorrell

The only trouble with that is that I am not going to give way, but I am always happy to accept the hon. Gentleman's gratitude. I wish to make progress, or we shall spend the whole morning on fundholding. I have been on my feet for more than 20 minutes and it is probably time that I moved on to the Bill that we intend to put before the House.

I wished to stress by way of introduction to the Bill that the fundholding scheme—more than half the doctors have chosen to be part of it, and it was based on the introduction of an idea by means of a pilot scheme—has delivered significant change and benefit to the NHS. The hon. Member for Islington, South and Finsbury (Mr. Smith) will have to avoid the fudge that has recently been revealed by the hon. Member for Peckham. There is no fudging possible of the Labour party's policy on fundholding. Those interested in primary care will want to hear from the Labour party whether the hon. Gentleman agrees that replace and abolish in these terms amount to precisely the same policy.

The Bill that we propose to introduce will build on the success of the fundholding scheme and primary health care more generally. I shall outline the objectives that lie behind the Bill, but I shall begin by making two points about what it is not. First, there is speculation in some parts of the professional press that the Bill will constitute big bang in the primary health care sector. I have made it clear repeatedly, and I do so again, that the Government's approach to the implementation of new bases of contract is explicitly a pilot-based approach. It is an incremental approach to change in the primary health care sector.

I do not understand how a big bang can be piloted. We have either a big bang policy or a pilot incremental policy. I have made it explicitly clear that we have a pilot incremental policy. It has not yet been explained to me how I can pilot a big bang. That is the first thing that the Bill will not be.

Secondly, the Bill will not represent a policy for introducing a huge range of new general practitioners based on supermarkets. I have made it clear already that I am in favour of NHS primary care, by which I mean a service delivered by NHS practitioners, NHS staff and the NHS generally. I set out the principles at the beginning of my speech. The patient chooses the general practitioner. Critically, the patient then goes on the GP's register. It is not a reactive service. The GP delivers the range of care that we expect of the modern NHS primary care GP. General practitioners act as the gateway and as the patient's advocate for the rest of the NHS. I am not interested in developing a new competitor idea of what general practice means. Instead, I am interested in developing the present system, which in the sector that we are discussing I believe to be the best in the world.

So far as I know, no supermarket operator has evinced the slightest interest in developing his own primary care sector. I find it difficult to understand why much of the commentary so far has concentrated on those who have never expressed any discernible interest in primary care. That commentary has avoided discussing the group for which there is real interest in extending opportunities for developing primary care, which is NHS community trusts.

Having made those comments by way of introduction, I come to the real options that we shall be introducing in the Bill.

Mr. Richard Burden (Birmingham, Northfield)

I imagine that the Secretary of State is aware of Mr. Roy Lilley, a former Conservative councillor and currently the chair of the Homewood NHS trust. The right hon. Gentleman may be aware also that in 1994 Mr. Lilley said that general practitioners had three duties. One was to themselves, one was to the organisation within which they worked and the third—it was interesting that it took third place—was to their patients. The right hon. Gentleman is suggesting that GPs could become the employees of trusts, including, I assume, acute trusts—

Mr. Dorrell

That is unlikely.

Mr. Burden

If the Secretary of State is saying that the suggestion is ruled out, that is fine.

Mr. Dorrell


Mr. Burden

If he is not saying that it is ruled out, how can it be said that there will be a primary health care-led NHS if the GP—as the right hon. Gentleman said, the gatekeeper—is employed by the secondary sector?

Mr. Dorrell

The secondary sector includes community trusts. My sedentary reaction to the hon. Gentleman's proposition that acute trusts could be included was that it was unlikely but possible. There are two reasons why I am not ruling it out. First, there are many trusts that are both acute and community in a single trust. In that instance, it would be the community sector typically that would be most likely to be the employer of a salaried GP.

Secondly, if we reflect on some of the ways in which we manage pressure on an accident and emergency department, for example, some acute trusts are providing a proper, high-quality GP-based primary care sector as a front-line service, close to where the acute trust is. That is already being done within the existing contract scheme. It has been widely recognised as an improvement in the quality of care and in the management of the work load in inner-city accident and emergency departments. It may be that some trusts will find that approach—the salaried optionp—a more efficient means of delivery. For both reasons, I am not ruling out the proposition that an acute trust could put forward a suitable proposal.

There is no point in our constantly being taken down a cul-de-sac. As far as I know, Sainsbury, for example, has never expressed an interest in those matters. When we ask, "How do we address the failures of general practice in areas such as east London?" the answer, repeatedly, turns on the inability of the community trust to employ salaried GPs. It is thought that that is a significant difficulty in the development of NHS primary care.

If a young GP is contemplating going into NHS general practice on the basis of the present national contract, he is in reality required to make a substantial commitment, if not a lifetime commitment, to the area in which he wishes to practise. That has led to NHS GPs gravitating away from the most difficult areas. As Secretary of State, I regard it as part of my responsibility to set up systems that allow us to create a countervailing pressure against that tendency.

Mr. Burden

Again, the Secretary of State is not answering the question. If he does not rule out a GP being employed by an acute trust that is a secondary care organisation, how is that GP, being responsible to the acute trust, to act in the gatekeeper-advocate role, which the right hon. Gentleman said was perhaps the most important role of the GP?

Mr. Dorrell

I thought that I had answered the hon. Gentleman's question at some length and quite specifically. I gave two examples of why I am not ruling it out. I also made it clear that I do not regard general practice as the core responsibility of an acute trust. Nor, critically, do health authorities. We are talking about a pilot-based scheme, under which proposals will come from health authorities for the approval of the Secretary of State.

If the hon. Gentleman is concerned that all GPs will be subsumed into a hospital and that a patient will have to go to a hospital to see his or her primary care physician in future, I can give him an assurance that that is the policy neither of any health authority nor, certainly, of this Secretary of State. That is not what we are talking about, and the hon. Gentleman is raising an Aunt Sally.

Let us return to the real options, which are based on the listening exercise that was led by my hon. Friend the Minister for Health. My hon. Friend spent the first six months of this year going round listening to primary care practitioners, patient groups and other interested groups as well. There is broad agreement, and that has been revealed in the House. Hon. Members have questioned me on whether I plan to continue to deliver the objectives on the development of primary care, but those objectives are agreed throughout the House and in the primary care world. The questions are essentially agreed. My hon. Friend was engaged in looking at how we can address the weaknesses—the areas that need to be improved—in NHS primary care.

It is true that we have good general practice, but there is too wide a variation around the country, particularly in inner cities. It is also true that there is an unhelpfully rigid distinction between GP services and secondary services, which is preventing the development of the range of services that are available and which could be made available in the community, in the GP's surgery. It does not in every circumstance make it impossible, but it is inhibiting the development of what I might term a "super-surgery"—a surgery that can do things beyond what was imagined as a definition of GP services a decade or two ago.

Furthermore, that rigidity is inhibiting modern ideas about the distinction between the service that is delivered in the hospital and the service that is delivered in the community. It is engaging one of the more unhealthy aspects of NHS primary care, the introduction into health care of a rigid distinction between the role of the community primary care physician and the hospital doctor.

A general practitioner might want to be engaged more actively in sub-acute hospital care or in establishing hospital-at-home schemes—ensuring that there is proper support with general practitioner input—for recovery at home, to enable beds in hospital to be used for those whose needs are more acute. The development of hospital-at-home schemes is not impossible, but it is inhibited by the present rigid distinction between primary and secondary care in the contracting system. The development of primary care has been inhibited in the sense of the divide not just between primary care and hospital services, but between primary care and community health. That is particularly true in mental health.

The contract has demonstrated itself to be a powerful instrument for developing high-quality primary care, but it is rigid. That has led to another characteristic-that it has not been possible to respond as flexibly as we should to the different circumstances and different priorities of different parts of the country.

Furthermore, it is important in primary care to talk not only about general practitioner services. There is also dentistry. We need to ensure that we continue to have not just the growing NHS dentistry service that we already have, but more equitable access. We want more flexible systems to ensure that access is available to NHS dentistry around the country. Pharmacy and optometry are important parts of NHS primary care. We need to allow more flexible development of the pharmacy service and more active integration of the optometry service into the rest of the national health service.

Those are not issues that were invented by the Department of Health, still less by Conservative central office. Those are matters that are raised whenever one has intelligent discussions with practitioners about the development of NHS primary care. In June, we set out our approach in a document that details the things that we can do without legislation. It also recognised that there are key legislative bars to the development of those ideas.

The purpose of the Bill that will be introduced this Session is simply stated: to pilot different, more flexible types of GP and primary care contract, to allow us to address some of the issues in today's primary care. As the House knows, every NHS primary care principal is currently employed on a national contract. There are different national contracts with individual professions, but it is a national contract framework.

What we plan, on a pilot basis, is an opportunity to develop a more varied basis of contract between local health authorities and local primary care principals, to address more precisely the specific needs of the health service in the district for which they are responsible. The document sets out the range of options that we have in mind: practice-based contracts; contracts with organisations such as NHS trusts, which may employ GPs, in the way that we have already discussed; and contracts that target money on GP services that may be weak in a particular area, and make that possible by flexing the boundary between primary and secondary care, which is currently defined in statute. There is also development of super-fundholding, to allow fundholders the same freedoms across the primary and secondary divide as would be available for those who are not operating a fund.

The Government plan to proceed on the basis of pilots proposed from the field. We would undertake to assess and evaluate the results, which would be made available. Critically, every pilot would be voluntary. The status quo remains open to any clinician who wishes to continue to operate within the existing structure on the same terms, and any clinician who engaged in a pilot that proved not to be successful would have the opportunity to return to the existing basis of service delivery.

To describe that as a big bang is nonsense. What is true, however, is that it represents the Government's clear commitment to continue the development of NHS primary care. I regard the primary care sector as a key part of the NHS. We want high-quality NHS services to be available on an accessible basis in the community, and the primary care sector offers us the opportunity to do that.

The Bill will build on the success of GP fundholding, and it shows critically that it is the Conservative Government who continue to lead the health agenda in Britain. The challenge to the Opposition is to catch up, at least to the extent of acknowledging that they were wrong about fundholding. More than half of Britain's GPs have rejected the Opposition's advice and chosen the option that the Government have created. Labour must begin the debate on the Bill by acknowledging that they were wrong on the debate about the last major phase of primary care development.

10.18 am
Mr. Chris Smith (Islington, South and Finsbury)

Perhaps we can begin with what we agree on. The Government tell us that they are introducing a primary care Bill, and that is the only subject that the Secretary of State spoke about. We presume that the contents of the Bill will more or less follow the outline in the White Paper published last week.

There is much in the White Paper that the Opposition welcome. We welcome, for example, the fact that the Government now endorse the approach of piloting—the incremental approach, as the Secretary of State called it. That contrasts with the approach that they took when they brought in the internal market: the then Secretary of State for Health, now the Chancellor of the Exchequer, said then that the Government would make all the changes immediately and would not consider pilot schemes because the demands for piloting were merely an attempt to obfuscate, filibuster and delay. I am delighted that the present Secretary of State has learnt from that mistake.

In its response to the primary care White Paper, the British Medical Association said: The voluntary nature of the proposals, which are to be piloted and evaluated,"— I note in passing that even now the Government have conducted no proper evaluation of fundholding— is a welcome change from the Government's previous dogmatic initiatives which were imposed on an unwilling profession. I am pleased that the Government have seen how wrong they were the first time round and have chosen a more incremental approach.

We welcome the idea of an enabling Bill that will permit a variety of models of progress in primary care to be developed, fostering diversity, trying out different ideas and enabling the health service to pick the best, to see what works and to develop from there. We welcome that pragmatic, commonsense approach.

The Secretary of State got rather bogged down in the part of his speech about the relatively new-found strength of primary care in its relationship with secondary care. I accept entirely that the balance has changed for the better over recent years, putting primary care in the driving seat. However, the Secretary of State claimed that that change was entirely a result of the Government's introduction of fundholding. There is a grain of truth in that; the introduction of fundholding has given some GPs extra power in their dealings with hospital providers, but the Secretary of State conveniently ignored the fact that the additional funds allocated to fundholders and the relative freedom given to both fundholders and non-fundholders, which is evident in the commissioning groups now being established, were rather more important factors.

Far from demonstrating that single-practice fundholding is the be-all and end-all, as the Secretary of State wants us to believe, the proposals in the White Paper show that there is a growing demand in primary care for a development away from that.

We support the proposal to develop super-surgeries. That will be important for the development not so much of surgical procedures by GPs but of a recuperation service for people coming out of hospital; it will offer them care and support nearer their home, in their community, so that they need no longer take up acute beds in acute hospitals.

I welcome the Government's new-found reconversion to the principle of the cottage hospital; it would have been happier for everyone if they had not closed 245 of them in the past five years. I welcome the Secretary of State's acceptance that there is a continuum between primary and secondary care, that there need not be a rigid division between two separate parts of the health service and that we need to facilitate flexibility in the system.

I welcome the proposal—the Secretary of State did not even mention it—to reform the way in which single-handed practitioners are replaced. The absurd existing rules stipulate that as long as there is a candidate, that candidate, however poor, has to be appointed; that is clearly nonsense and it will be good to do away with it.

I welcome the proposal that salaried GPs should be employed by community health trusts. A serious problem of GP recruitment is developing in our inner cities. People in practice after practice tell us that they cannot find new partners to join them in providing high-quality primary care in inner-city areas. To have salaried doctors employed by community trusts is a possible solution. Anything that we can do to tackle the problem is welcome.

When my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) pressed the Secretary of State on whether he envisaged GPs being employed by acute trusts—by hospitals—the reply was that that option had not been ruled out. If that option is to be countenanced, what price now the purchaser-provider split? If a GP is employed by a hospital and is ordering care for his or her patients from that hospital, the purchaser and the provider are the same. I would have hoped that the Secretary of State would have ruled that out.

Mr. Dorrell

Will the hon. Gentleman speculate on how we could rule that out when many NHS trusts have both acute and community facilities?

Mr. Smith

I am coming to that. I was about to point out that the Secretary of State ruled out in the White Paper the idea of GPs being salaried employees of the health authority. Why has he ruled that out, when it is surely the solution to the problem of trusts that are both community and acute trusts? That would maintain the purchaser-provider split on which the Government are so keen and which we accept as a sensible division. The Government have given no reason for ruling out that option and the Secretary of State has offered no explanation today. We would be delighted if he would amplify the matter.

There is much to welcome in the White Paper, but we have one serious disagreement with the Government. I warned about this last week, and since then there have been various articles and reports in confirmation, yet the Secretary of State is sensitive about the possibility floated in the White Paper that GP services could be provided by commercial companies. He did not tell us that he had ruled out that possibility; he spoke of his belief in the GP service as part of the national health service, which is fine, but he has not disavowed the two paragraphs in the White Paper that clearly spell out the possibility. Chapter 2, paragraph 2.4 of the White Paper deals with a salaried option for GPs, either within partnerships or"— and here is the crucial phrase with other bodies, such as NHS trusts. We have already dealt with that NHS trusts point but the White Paper clearly says "with other bodies", which are unspecified.

Paragraph 8 of appendix A of the White Paper deals with contracts and states: Ordinary contracts would be used when services were provided outside the NHS. Therefore, in two places the White Paper envisages the possibility of GP services being provided outside the NHS by commercial companies. They may not necessarily be supermarkets. For example I suspect that some pharmaceutical companies may be interested in establishing GP services. If the Secretary of State goes down the road of allowing commercial companies to establish primary care GP services it would pose a serious threat to the importance of the doctor-patient relationship.

In his speech the Secretary of State was right to praise the role of GPs in the British health system. They are the cornerstone of everything good about the NHS over the past 50 years. The GP is an independent, professional person. He is the patient's advocate and friend and if he is answerable not just to his patient but to a commercial company, the independent professionalism of that relationship will be in danger. If that possibility remains in the Bill we shall take a very severe view of it.

Mr. Dorrell

Is the hon. Gentleman saying that every NHS pharmacist or every NHS pharmacist employed by a company is incapable of offering a professional service to patients?

Mr. Smith

Of course I am not saying that. In case the Secretary of State did not listen to the last two minutes of my speech I repeat that I am talking about the general practitioner and the relationship between the GP and his patients. That is the crucial point that the right hon. Gentleman has so far ignored.

Mr. Dorrell

I listened to every word. The pharmacist and the general practitioner are professionals and in some circumstances pharmacists are employed by a commercial outfit. Is the hon. Gentleman saying that such pharmacists are not delivering professional services to their patients?

Mr. Smith

Of course I am not saying that. The Secretary of State has fallen straight into the trap that he has created because he is saying, "Why cannot a GP provide a professional service?" The implication of that is that he would be perfectly happy to welcome GPs being employed by commercial organisations. That is the logic of his interventions. If that is in the Bill he will have a hard time justifying it.

There is much to be welcomed in the primary care Bill that is flagged up in the Gracious Speech but there are some dangerous loopholes which we shall examine carefully. The Gracious Speech is remarkable more for what is not in it than for what is in it. For example, what has happened to a measure on adoption on which there was a White Paper and a draft Bill? The Secretary of State knows that it is supported by hon. Members in all parts of the House and provides a golden opportunity to put right some of the anomalies in adoption procedures. However, it is not in the Gracious Speech and that seems to suggest that the Gracious Speech is more about trying to embarrass the Opposition parties than about sensible, constructive legislation.

The draft Bill on adoption contained some entirely sensible and welcome proposals. They were a new welfare checklist for adoption agencies and the courts to assess the child's interest when adoption is being considered; a new complaints system to include independent assessment and easier procedures to allow step and foster parents to adopt. At the heart of the White Paper and the draft Bill on adoption was the simple and sensible proposition that the crucial matter in adoption procedures is the ability of the prospective parents to parent—to nurture, love, cherish and bring up the child. It put the child's interests first and had an entirely commonsense approach to adoption issues.

Under pressure from the Opposition saying, "Go on, do it—we agree with it and we will support you," it has become the fashion this week for the Government to pop up and say, "Yes, we will do it." If the Secretary of State presents the Bill on adoption in the same form as the draft Bill and on the lines of the White Paper he will have the Opposition's full support. He can get it through quickly and earn himself a place in the history books for doing the right thing for once. I make that offer and wait in anticipation for a letter from the Prime Minister tomorrow stating that he will do that.

Mr. Mike Gapes (Ilford, South)

Is my hon. Friend aware that a former Secretary of State for Health set up a working party in July 1989 to consider the Bill on adoption? As my hon. Friend has said, the previous Secretary of State published a White Paper three years ago. Can my hon. Friend shed some further light on why it has taken the Government so many years to come up with precisely no legislation although a measure on such an issue would be widely supported and welcomed throughout the country?

Mr. Smith

My hon. Friend has put the main points of the answer in his question. I look forward to hearing the Secretary of State trying to defend the Government's inactivity on this matter when so much has already been published and much of the work has already been done. I am sure that civil servants have a Bill in the top drawer waiting to be presented. We should be told why it is not in the Gracious Speech.

Not only legislation on adoption but measures on long-term care seem to have fallen through the net. We have not had the Bill that was promised or the legislation that the Prime Minister at last year's Tory party conference and at the one this year said would solve the problem of elderly people having to sell their homes to pay for long-term care. What is the Government's solution to a problem that affects many thousands of people? We are to have a draft Bill. How it will differ from the White Paper I am not sure. That may mean that the Government are having sensible and serious second thoughts about their daft insurance scheme which they said was the big solution to the problem.

Mr. Dorrell

It is a U-turn.

Mr. Smith

It is not. If the Secretary of State looks back at everything that all of us have ever said about long-term care, he will find that we have always criticised the Government's policy of a 1:1, a 1.5:1 or a 2:1 insurance scheme to try to protect the assets of people who are approaching retirement. The scheme is daft because it assumes that people who are approaching retirement will have £5,000 or £10,000 in cash available to put down as payment for an insurance policy premium. If the Government seriously believe that the many hundreds of thousands of people in Britain who are worried about the prospect of losing their homes because of their payments for long-term care are in a financial position to make such a commitment, they are examining the wrong problem.

That is all that we have in the Queen's Speech. It is not much from the Secretary of State for Health. At the same time, he is running around Britain producing White Papers and consultation documents and doing surveys. All sorts of things are happening. Some of them are welcome; some are not.

Let me take just one example: Insight, the firm of management consultants that is considering the role of community health councils. Its draft report makes alarming reading. Among its proposals are that CHCs should consider moving away from monitoring local services towards specific projects agreed with the Health Authority", that CHCs should consider moving away from information provision to the public and that CHC involvement in supporting complainants should be scaled down". Clearly, this draft report envisages changes to the patient advocacy role of CHCs, which is one of the most important things that they do. It is clear that the agenda that is being prepared by management consultants for the Government is to get rid of CHCs' patient advocacy role. I hope that the Secretary of State will quickly say that Insight's proposals are no part of the Government's agenda.

We have hardly any legislation, but a series of reports producing alarming ideas that fundamentally and adversely change the health service in Britain. The health service faces a serious crisis this winter. Just a week ago, the British Medical Association consultants' committee set it out clearly. Its chairman, James Johnson, said: From the reports I have heard today, I fear that the hospital service will be close to collapse this winter. Elective procedures will virtually cease in many parts of the country. What purchasers need to recognise is that you cannot simply open and shut wards at will to control the money flow. When you want to re-open services, you find that the skilled staff are no longer available. In the meantime, patients who are not emergencies but who genuinely need treatment are waiting in pain and distress. That is the verdict not of the Labour party, but of the BMA's consultants' committee. That is the prospect facing the NHS in the coming winter.

My hon. Friend the Member for Newham, South (Mr. Spearing), who I am delighted to see with us, flushed the Government out on this matter with a parliamentary answer that he managed to extract from them just a week ago. The Government's inadequate figures—but at least there were some figures—showed that, if we took all the health authorities in England and added up their likely surpluses or deficits by the end of the current financial year, for England alone, there was a gap in funding of £120 million. My hon. Friend has done the House a great service in flushing out from the Government the admission that what the BMA and the Association of Community Health Councils for England and Wales have been saying is true.

Mr. Spearing

I am grateful for my hon. Friend's comments, but is it not even worse than that? Is he aware that on 22 July I asked for the figures and that the Under-Secretary of State for Health, who happily is here, said that they were unsuitable for publication?

Mr. Frank Field

That is not surprising.

Mr. Spearing

Indeed. It was only after the recess and the happy chance of coming up in the ballot and of securing the Adjournment debate last Wednesday, the Session's last debate, which lasted 50 minutes, that we managed to extract the promise that the Minister would supply some figures. Some came last week, but not all the ones that I asked for.

Mr. Smith

It was noticeable that the Government's figures were produced the day after my hon. Friend's Adjournment debate, so that the figures could not form part of the debate. Not only were they unsuitable for publication on the Government's part; they were somewhat embarrassing on the Government's part.

Perhaps the clearest evidence in recent days of the crisis facing the health service comes from the discussions currently under way in London on ways in which accident and emergency services should respond to the likely pressure that will face them this winter. The Greater London accident and emergency co-ordination protocol group is drawing up emergency plans for what A and E services facing intolerable pressure should do in London. Those plans, which I have here, give the options that will be available to A and E services when they are under extreme pressure. They are divided into complete closure of an A and E department, agreed diversions and rotas. Those categories mean that, this winter, A and E services in London will close completely to taking emergency admissions, either on a temporary or a semi-permanent basis, because the pressure will be so great. Small wonder that the accident and emergency consultants to whom the proposals were put yesterday unanimously rejected them.

Those discussions revealed that NHS emergency services in London are having to accept as normal not occasional but regular bouts of intense pressure, causing temporary diversions or closures. That speaks volumes about the pressure to which not just accident and emergency services but, as a run-on consequence, elective acute surgery will be subjected.

Any sensible person putting together procedures for dealing with emergency services will devise a simple formula. I will entertain the House by quoting a paragraph that describes how such a rota system is supposed to operate: To implement a Rota, the Responsible Person at each hospital will fax Form 1 to the London Ambulance Service CAC, who will implement the Rota once the requisite three or more forms have been received. Each Responsible Person will also fax the form to all hospitals that their hospital is listed as 'Covering For' in the Cluster list, whether or not they form part of the Rota. This is to alert those nearby hospitals that may be affected by the Rota diversions. Form I will also be faxed to the EBS, Host Purchaser and any other ambulance service that may be affected. The form will specify the category(ies) of patients included in the Rota.

Mr. Frank Field

The Minister, thank God, is against issuing parliamentary nasties.

Mr. Smith

As my hon. Friend says, but that is precisely the way that the internal market leads to disaster in the health service.

A crisis is looming this winter across the accident and emergency services in London and elsewhere in the country, elective surgery has been abandoned in many parts of the country and difficulties are facing health authority after health authority, yet the Government come up with a Queen's Speech that does not address the many real issues affecting the NHS and the patients who depend on it.

The Government are busy trying to pretend that they love, cherish and believe in the health service. We were expecting a White Paper on the NHS next week, but I gather that the Government are delaying that demonstration of love and belief in their cherished health service for a couple of weeks.

The Government claim that the health service is safe in their hands, but the competitive internal market continues to do its damage, accident and emergency services are heading for crisis, the Anglian Harbours NHS trust has gone down the pan, patients have to wait on trolleys in corridors and the British Medical Association says that the service is close to collapse. It is time that the Government made way for a Government who really care about the NHS and who will set about rescuing and renewing it for a new century.

10.52 am
Sir Rhodes Boyson (Brent, North)

I welcome the Gracious Speech and want to give my views on three issues—two of them concerned with social security and one with education, on which I shall speak at greater length.

The same social security issues arise time and again because human nature remains consistent. One may try to solve problems but 10, 20 or 30 years later, they arise again. Social problems that were covered by Acts of Parliament in 1601 and 1834 are recurring today, to be dealt with again.

One such problem is the breakdown of the family, which is threatening social welfare, education and behaviour, and which poses a real challenge to our society. When any new Bill is proposed, one must ask whether it will strengthen the family or weaken it. So much that has been done—with the best of intentions—in recent years has weakened the family. Of that there is no doubt. For example, the cut in the married person's tax allowance, by which it was decided that we should all be treated as individuals, hampered the family. Before any Bill is introduced, we should be told not just the financial implications, but the implications for the family. If the family breaks down, social welfare will be in a massive mess.

In certain parts of the country, the family is already breaking down. One boy in three grows up without a father figure. That has a serious effect on discipline in schools and on many other matters. So we must buttress the family, because otherwise we shall be in a massive mess in social welfare, education and many other areas.

My second point is also a financial matter. Long-term care has been mentioned this morning. How can long-term care be afforded, particularly bearing in mind the fact that people now live so much longer than before? Nobody is really dealing with the issue of long-term care—we are just playing around with it. I know that the hon. Member for Birkenhead (Mr. Field), for whom I have great respect, has considered the issue, but society, the Government and the Opposition in general do a bit here and a bit there without considering it as a major issue.

Long-term care is a moral issue. It came up in 1601, it came up in 1834 and it is coming up again. Should a person spend their money on a cruise abroad every year, knowing that the state will look after them at the end—and it will—or should they save for their old age so that they will have independence? Those who are spent up when they reach 65 or 70 will be looked after in the same way as those who have saved throughout their lives. A saving society is being destroyed.

The issue is not a party one. The hon. Member for Birkenhead is pointing in certain directions, but the issue of what should be done is a problem for the whole House, not just for one party. A case in 1871 showed that if it is seen that people who have put nothing towards their care are as well looked after as those who look after themselves, certain sections of society will break down.

As we are considering social security today, I shall leave those two points and go on to a third issue, which I shall take by the neck. I cannot imagine any dispute on what I have said already, except on whether we are really facing up to the issues. I do not think that we are. However, there is dispute between hon. Members on both sides on my third issue—selection in education. The Government have grasped the nettle on selection in education and I must commend their actions and the contents of the Gracious Speech on that issue.

For a long time, the Labour party did not believe in selection and the Conservative party apologised for it, as though it were an evil aspect of human nature, but we were born that way. Selection was not considered to be necessary. I am not a Darwinist on this, but selection is necessary. We are selecting all the time. We have been selected here. Some hon. Members may wonder why other hon. Members have been selected, but we have been selected and elected to the House. We have been through a series of selections. A candidate is put on a list and is interviewed time and again. If one is liked by a panel one day, one gets the chance to be elected to the House. Then, 50,000 to 70,000 people make their selection. The House lives on selection, and any party that does not like selection should not be in the House.

Mr. Frank Field

It is not so much selection as deselection that worries hon. Members, is it not?

Sir Rhodes Boyson

If the hon. Gentleman is under threat of deselection, most Conservative Members will hire a coach, go to his constituency and temporarily wear red roses to help him gain re-election to the House.

Mr. Peter Bottomley

That will help.

Sir Rhodes Boyson

I thank my hon. Friend for that comment.

There is selection in many spheres. The tone-deaf are not encouraged to take up music. I am slightly tone-deaf, and in church my wife always tells me to shut up if suddenly I feel an urge to sing at the top of my voice. Perhaps in church I should be selected to be placed with others who cannot sing in tune. In music, someone who has a part 1 certificate does not play with someone with a part 6, because they are not so selected. Everyone is good in some spheres and not in others.

Selection takes place in sport. There is no mixed-ability football. I shall believe in mixed-ability football when there is a centre forward with a wooden leg. We shall have mixed-ability football when there is such a player. There is no mixed ability in other spheres, but there certainly has been in education in recent years.

The question is how the selection is made, and whether it is fair. We have selection in many parts of the United Kingdom. There was an authority in the north-east that had 5 per cent. selection, whereas in Wales and in other areas there was 40 or 50 per cent. selection.

What happens to people who are selected out? Every time one person is selected in, someone else is not. What happens to them? Let us consider the situation in Halifax, in the north of England. The mess in comprehensive schools in dealing with lower ability pupils is worse than ever it was in secondary modern schools. Secondary modern schools never broke down like the school in Halifax has, because they took account of children's interests, interested them in what they should be doing and attached the school's image to achieving that goal. The system of merits and demerits in that school in Halifax, and bringing together two schools, illustrates the fact that comprehensive schools do not work in themselves. We must realise that pupils have different abilities and that they should be in separate classes.

Mixed-ability teaching is evil—that is a good four-letter word. Mixed-ability teaching makes the very able arrogant, because they think that they are the answer to everyone else. The poor little beggar who is in a mixed-ability class and cannot get on will put a brick through the window—or he should do. If I were such a pupil, I would do that. It is an insult to such a pupil to have to go to school every day and never be able to shine in the classroom. At its worst, mixed-ability teaching is evil.

Let us consider some examples from abroad. Apart from Sweden and some places in the United States, there has always been some form of selective schooling. Sweden is about the only place in the world with lower abilities in mathematics than the United Kingdom, and one can draw one's own conclusion from that fact. The situation in America is also very messy. There is, however, selection in the rest of the world. There are three types of schools in Germany, and students can move easily between them. One school is academic, one is technical and one is general. General schools in Germany usually have better standards than most British comprehensive schools.

Before the collapse of the Soviet empire, I was visited by the headmaster of a school of mathematics in Moscow. Each year, after an examination, that school admits only 50 pupils in mathematics, out of a population of 5 million people. I believe that that is still the situation. The exams are called "the Olympiads". I do not suggest that we go to that extent here, but I know that Russia did quite well in getting to outer space—or perhaps it was inner space; I get mixed up about that, not having flown up there. That school did very well in the mechanics of what they were doing, and it worked very well.

At last the Government have grasped this issue. As I said earlier—I will say it again to remind hon. Members—the Labour party took the baton of non-selection and ran with it, and Conservative Members tried to slow down that drive. We now offer the alternative philosophy that selection is best for children. Children should be selected fairly and they should be able to move if their abilities blossom or decline. They should be given a fair chance in life.

There will be selection in grant-maintained schools, which even some Labour Members believe in. When I hear them express that belief, I raise my eyes to the stars. Grant-maintained schools can select, as can the so-called "general" and specialist schools.

I am sorry that the hon. Member for Sheffield, Brightside (Mr. Blunkett) is not in the Chamber, because I have great respect for him. I disagree with him, but there is no one for whom I have more respect. The only way in which we can have comprehensive schools is with selection. It must be done. The ultimate selection is practised by comprehensive schools—because they must contain an equal percentage of each ability group—although the Labour party has never realised it.

Mr. Simon Hughes

On a point of order, Madam Deputy Speaker. Obviously the right hon. Gentleman is very experienced in these matters, but I am a little confused, because a day is allocated next week for a debate on education policy—[Interruption.] This is a serious point. Today we are supposed to be debating health, social security and social policy. I wonder whether a debate on education is appropriate or in order, as no education Ministers or Opposition spokesmen are in the Chamber.

Madam Deputy Speaker

The allocation of subjects for days is for guidance, so that the relevant Ministers can be present in the Chamber, but that does not prevent an hon. Member from dealing with an issue within the ambit of the Queen's Speech, which is quite broad.

Mr. Peter Bottomley

Will my right hon. Friend give way?

Madam Deputy Speaker

Order. There cannot be one intervention immediately following another.

Sir Rhodes Boyson

I will give way.

Mr. Bottomley

My right hon. Friend was making a very important point. Most hon. Members who have represented inner London constituencies, and perhaps those in other areas, remember a time when children could not enter the school their parents chose because they had done too well in the hidden 11-plus examinations. All children in inner London were required to take the 11-plus, and if they did too well they could not get into the school of their choice. That practice struck me as being deceitful to those children and their parents. It also provides completely the wrong incentives for parents, given that the Plowden research studies of primary schools, published in 1967, stated that the most important aspect in a child's education was appropriate interest and encouragement.

Sir Rhodes Boyson

I agree that parental involvement is vital but in addition children must be taught at the level of their ability.

I will explain why I am speaking on this subject now. I know that the Liberal Democrats have many narrow objections—that is probably why the country does not like them—but the debate on the Queen's Speech should be a wide one. It should not deal only with bits and pieces—we can do that at any time—but should address Government policy as a whole. The hon. Member for Southwark and Bermondsey (Mr. Hughes) may raise his eyes to the skies if he wishes, but he should have some vision and not count paperclips.

We were discussing comprehensive schools. During the many years when I was a headmaster, London tried to make comprehensive schools work. Ability groups were divided in an attempt to secure the same spread of ability in every school, but it could not be done. People would not stand for it and used every means to outwit the system. Human nature always outwits systems that it dislikes. People moved house or gave other people's addresses and the system broke down.

Anyone who wants selection should want comprehensive schools, because in theory they represent the ultimate in selection. Twenty per cent. of a comprehensive school's pupils should be from the top 20 per cent., 40 per cent. from the next 40 per cent. and 40 per cent. from the bottom 40 per cent. That was attempted in London, but it simply did not work. It has never worked anywhere in the country except in rural areas which have only one school. In rural areas, there is a general feeling that comprehensive schooling works.

Grant-maintained schools which have become some of the most selective in their areas have done very well. To introduce grant-maintained schools was an imaginative gesture by the Government and formed a bridge to enable the return of selection as Conservative policy and, I hope, Labour policy. In my constituency, I did not interfere in parents' wishes for their children, whether they wanted local authority or grant-maintained schools, but now all but one of the schools in my constituency are grant maintained and they have been transformed. At the general election, I shall not hesitate to remind my constituents of the Labour party's intentions for such schools. The Labour party has delivered voters into my hands by saying that it would return schools to local authority control, without selection by interview or examination. Five grant-maintained schools serve my constituency: Claremont school, Preston Manor, Kingsbury school, Copeland school and St. Gregory's. Only one secondary school in my constituency is not grant maintained.

I wish to conclude on some broad themes. First, the role of the family in our society must be restructured. We must ensure that every piece of legislation that we pass helps the family and does not hinder it. Secondly, as a society we must decide how we will look after our aged citizens, of whom there will be more in every generation. We must find ways of encouraging people to save for a contented old age. Thirdly, we must continue the return to selection and ensure that it is carried out fairly and well.

All schools have to teach a basic curriculum in English, mathematics, some science, geography and other subjects. The current national curriculum is too narrow, but it is a start. However, every school should have a specialty—a subject for which it can fly the flag and of which it can be proud. I want there to be a vast number of specialist schools. We are basically a city people and, as I have said, the comprehensive system really worked only in rural areas. We could have classical or foreign language schools, sports schools or music schools and children would want to go the school that specialised in the subject that interested them. Each school could offer two hours daily tuition in its specialist subject.

We do not want schools ranked in order from one to 20—we want different schools doing different things. I hope that the grant-maintained schools will move over to such a system, so that there are no sink schools, only schools offering the national curriculum plus a specialty. If we could marry the two sides of the House in the cause of that sort of selection, we would have a chance to get education right in our country again.

11.16 am
Mr. Frank Field (Birkenhead)

It is a pleasure to follow the right hon. Member for Brent, North (Sir R. Boyson). I strongly agreed with his last point, and I hope that hon. Members on both sides of the House will adhere to that wisdom. I also agree that the Queen's Speech offers us the chance not to carry out a sectional analysis of society, but to take a broader view of Britain and its place in the world. There were powerful themes in the right hon. Gentleman's speech—the role of human nature in our society and the folly of politicians who think that, with their schemes, they can outwit human nature, which is a lesson we should all learn. Although I do not normally disagree with my friends on the Liberal Benches, I do so today because, as the right hon. Gentleman said, we must try to be visionary in our approach.

Listening to the Secretary of State for Health, who spoke for 48 minutes, I thought that the media had, for once, undersold the content of the Queen's Speech, because we learnt that the Government's strategy was to take out all controversial measures and spend the next six months piloting through the remaining few Bills on which there was substantial agreement. For the first 45 minutes of his 48-minute speech, it appeared that the Health Secretary had hit on another strategy: although he had a Bill, so to speak, hinted at in the Queen's Speech, I thought that he was not even going to comment on it and that it would be kept secret for as long as possible. I was, therefore, pleased when he managed to spend the last three minutes of his 48-minute speech telling us what would be in that primary care Bill, which acts as a suitable starting point for my speech.

The measures that the Secretary of State said that the Government would introduce and the medley of themes in the Queen's Speech that are designed to establish greater order in our society will strike a chord in most constituencies, not least in Birkenhead. However, the way in which my constituents will judge the Queen's Speech may differ from that of the Treasury Bench. The vast majority of voters in Birkenhead, decent people, are attempting to hold the line against a new form of barbarism that is sweeping through inner-city and other areas. It obviously relates to primary health care, which the Secretary of State said was the jewel in the crown of the NHS, because, in the poorest areas, those services are under enormous pressure and some are being withdrawn.

I cite what was my own doctor's practice in Birkenhead. Obviously, any decision is taken for many reasons, and therefore the reasons that I give are not the only ones that led to the loss of that primary health care centre in the centre of Birkenhead, but the behaviour of a very small minority of constituents played its part in the closure of the practice. The doctors were fed up with being physically threatened by a minority of my constituents. The receptionists were fed up with being stoned by very small minority of my younger constituents. Unbreakable glass was not enough to protect them against such behaviour.

When the Government lightly talk about a Queen's Speech that restores order, people will ask why there is such disorder, and whether the measures do much to protect the vast majority of my decent constituents, who are trying to hold the line against that new barbarism. They will ask whether it will deal effectively with the minority who plague the majority who want to continue to lead a decent life and adhere to civilised standards.

The Home Secretary's proposals in the Queen's Speech for successive law and order measures, although increasingly draconian, will be widely supported by many of my constituents among others; but are the root causes of the disorder in our society being tackled? In that context, it was important for the right hon. Member for Brent, North to speak about education.

In Birkenhead, as in many other places, unskilled jobs have been wiped out like snow disappearing in sunshine, so it is crucial that our schools do not continue to produce large numbers of school leavers who are suitable only for unskilled jobs. We must go further than even the right hon. Member for Brent, North advocates to cut the supply routes to the underclass.

If people leave school—as they do even in some of the best schools—unable to read and write, their chances of ever holding a job are almost nil. It is criminal, therefore, to allow people to leave school unable to read and write, let alone to acquire other necessary skills for the fast-developing labour market. Instead of a statutory school leaving age, there should be a school leaving period, defined by a person's skills.

We should not be prepared to condemn people to a life of unemployment, for that is what we do if they do not have basic skills. As a society, we should make a pact with them, telling them, "We shall not put you into the labour market if there is not a fair chance of your acquiring a job." I am not saying that there are enough jobs, but figures show that a person with skills has far less chance of being unemployed than a person without skills. That applies in my constituency as it does in the Secretary of State's constituency, which is, thank goodness, much better off than mine. I wish that my constituency were as well heeled as his is.

I welcome the chance that the Queen's Speech gives to bring various aspects of Government policy to bear on the law and order issue as the Government define it. Although some of the moves are welcome, they will prove inadequate for the vast majority of our decent constituents, who are trying to hold the line and defend civilised values against what they regard as the spread of a new barbarism, which engulfs and destroys their lives. It is easy enough for me to speak; I do not suffer the incessant gang warfare that is unleashed against them for trying to hold the line. They seek much more imaginative measures from the Government to help them to do so.

Like the right hon. Member for Brent, North, I shall comment on social security and the part that it plays in destroying decent civilised life, but I shall also welcome some of the Bills that the Secretary of State for Social Security will introduce this Session.

I believe that I can fairly draw the attention of the House to the special relationship that the Select Committee on Social Security has developed with the Secretary of State. If they are lucky, other Select Committees receive Government responses published as White Papers. The Social Security Select Committee now expects Bills to follow its reports. We ask for a major inquiry into pension law reform; we get it and we get a Bill. We look critically at the compensation recovery unit; we get a Bill. We suggest that the Government talk a lot about fraud in benefits, but not nearly effectively enough; we receive an inadequate response, a holding reply, and now, if we are lucky enough to have read the Financial Times this morning, we shall have read a great deal about the fraud Bill, about which I am sure the Secretary of State will tell the House later.

I shall welcome that Bill, as, I am sure, will the Labour Front-Bench spokesmen. We shall aim to strengthen it by adding to it, for, if the Financial Times report is correct, it is an inadequate measure for one of the major issues that confront us. Although I do not blame the Secretary of State for putting a spin on the Bill, he is trying to move the debate about fraud back to claimant fraud and away from organised serious criminal fraud, which is where the Select Committee pitched the debate. The Bill will be judged not only on the extent to which it tackles claimant fraud but on the extent to which it tackles fraud by gangs who take large sums from the social security fund.

Although it may be important that, as I learn from the Financial Times today, the Secretary of State will have powers to gain information from local authorities in the administration of housing benefit, we shall note whether similar powers are sought to gain identical information from landlords, who may be behaving in a way that allows serious loss from the social security fund into their bank account, not into the right people's pockets.

Even giving the Secretary of State the benefit of the doubt, which of course I always do, and assuming that the report in the Financial Times is only partial, I want to suggest how inadequate the Government's response on fraud will be.

We do not have a standard form for housing benefit. The Secretary of State speaks about computers in one borough talking to those in another, but they cannot have much of a conversation if different boroughs collect different information. The Secretary of State could, in two weeks, insist that a standard form is introduced, and that no local authority gets its rebate unless it agrees the form—although I hope that he has the humility to ask local authorities how best to design that form. Then, when identical information is collected and fed into computers, perhaps the measures that he will take to enable a computer in one borough to talk to computers in Wirral will be a necessity.

The Secretary of State for Social Security (Mr. Peter Lilley)

I am grateful to the hon. Gentleman for giving way and for his remarks. I can go farther; we are ahead of the Select Committee. We have informed the Select Committee that we are consulting local authorities on the possibility of a national computer system to overcome the problems that he talks about and provide a coherent national service to all local authorities, and a national validation process to ensure that all local authorities use uniform minimum standards.

Mr. Field

The rhetoric is fine, but we should examine the Department's ability to get its computer system right, never mind the computer systems of the Child Support Agency and other agencies. When the Government say that they are going to establish a national computer system, I hope that we shall not hear hollow laughs in the rest of the country. Let us be modest and begin by producing a standard application form that can be used by existing computer systems throughout the country in our fight against fraud.

No one doubts that the Secretary of State is keen to counter fraud, but that requires co-ordination between Departments and not just at local authority level. If we read the paper on child benefit fraud that was submitted to the Select Committee and then read the Home Office's letter to the Committee, we can see that, never mind about introducing a national computer system, it would be good if the Secretary of State for Social Security occasionally spoke to the Home Office on this key matter. The paper on child benefit fraud says that either a passport or the standard acknowledgement letter for child benefit can be used to identify an individual for child benefit purposes. The Home Office told the Select Committee that on no account should the standard acknowledgement letter be used as an identification document.

The Home Office issued a statement saying that on no account should there be identity documents, whereas the Secretary of State for Social Security told the Select Committee that, when there is a doubt about the children of asylum seekers, child benefit will be paid on production of either a passport or the standard acknowledgement letter. Before we embark on the grand strategy of sweeping the country with a new computer system, will the Secretary of State occasionally talk to the Home Office about preventing benefit fraud?

Even if we had a wonderful computer system, it would be of little value if we continued to have a national insurance system—a number system—that was clearly overrun in the 1980s. I referred to the standard acknowledgement letter—the Secretary of State may mumble, but this is the crucial point—because during the 1980s hordes of people went to Croydon to pick up that letter, which was accepted by the Secretary of State's Department, to show that they were genuine asylum seekers. They were issued with national insurance numbers, which accounts for the discrepancy in the number of national insurance numbers. Until we clean up the national insurance system, all the fine talk about the fight against fraud will, sadly, be just that, and the measures taken will be less effective than they should be. I hope that the Opposition will massively strengthen the Bill to fight fraud.

I want to return to the most important theme of this debate, which was raised by the right hon. Member for Brent, North—the impact of the massive social security budget on not only the operation of government but the character of the nation. I hope that we have now gone through the long, dark tunnel. Many of us worry about whether there should be advertisements that promote smoking, because we believe that that affects people's behaviour, yet at the same time we believe that a Government can spend £95,000 million on social security and it will have no effect on people's behaviour. It certainly will.

When the Secretary of State replies to the debate, I hope that he will show—at least on these criteria, and perhaps on many others—whether the Government can present a proper face to the electorate. Spending on social security constitutes the largest part of the Government's budget, so the first thing we want to know from the Queen's Speech is whether we are spending that money in a way that supports people's natural, decent instincts. If there were no welfare state, how would people behave? How would they survive? We should mould our welfare state so as to encourage decent instincts, rather than, as at present, use so much of our money to destroy those instincts.

Secondly, we want to know whether, for the first time, the Secretary of State has got a grip of his budget. Every year that he has been in office, he has pleaded with his Cabinet colleagues, saying that he needs more money. His Cabinet colleagues regard him as a tough right winger, so he must find it easier to deal with them than some others. He has always obtained more money—usually about £3,000 million extra. He has presumably promised that he will be a good boy and will control his budget, but he is usually over budget by another £3 billion. He then goes back to them the following year, and so the process goes on.

The Secretary of State says that this year, for the first time, the rise in the social security budget will be below the increase in gross domestic product. He might manage that this year thanks to the Chancellor, who has his mind on when the election may be held. The growth rate in GDP this year is about 4 per cent., so if the Secretary of State does not keep social security expenditure growth below that level, matters are very serious indeed.

Thirdly, we will be looking at the Queen's Speech and the measures that flow from it to see whether the Secretary of State is putting in place—he cannot do so immediately—effective measures to combat social security fraud. Fourthly, we want to know whether the measures that have been enacted under his stewardship in the past four years, and those that will be enacted in the last period of his stewardship up to the general election, will reshape our social security system to fit the country for the new millennium. The Secretary of State can take credit for enabling public discussion of the massive changes in the labour market, so that people are aware of how the social security system can help them to survive more effectively under those much changed conditions. The question will be whether he has gone far enough in those big changes.

11.36 am
Sir Roger Sims (Chislehurst)

The House always enjoys listening to the hon. Member for Birkenhead (Mr. Field). He invariably presents us with thought-provoking arguments, which he expresses with clarity, and today was no exception. This is a broad debate, so I am sure that the hon. Gentleman and the House will understand if I do not deal with the topics that he covered.

I was particularly impressed by the penultimate passage of the Gracious Speech, which states: My Government will also publish Bills in draft for consultation". The concept of draft Bills was explained by the Prime Minister in his speech on Wednesday. It is not an entirely new idea—reference has already been made to the draft Bill on adoption—but it is not a familiar device. After 22 years in the House as part of the legislative machine, I am not satisfied that the process that we use is without imperfection. It is unfortunate that a Government of whatever colour introduce a Bill determined that it will go through the House and emerge in almost the same state as when it was introduced. It is a principle of the Whips that they discourage their hon. Members from altering a Bill. The assumption is that Ministers and their civil servants have produced a perfect Bill that is incapable of improvement, but I do not think that that is helpful.

The other difficulty is that organisations and individuals affected by that legislation may find it difficult to have an input into the contents of the Bill. Once the Bill is published, the only way in which they can have any influence is by finding an hon. Member who is on the Committee and who can be persuaded to take an interest in their concerns. That is a somewhat limiting factor, to put it no higher. Many of us have a range of interests outside the House and seek to represent those interests during the legislative process, but some organisations, companies and charities have no such voice. Now, thanks to Nolan, even if a commercial organisation or similar body comes to an arrangement with a Member to look after its interests and ensure that its voice is heard, if any money changes hands, the Member is debarred from speaking in the House or in Committee. That, I think, is unfortunate, but I have made clear my views on Nolan before. It is a serious limitation on the ability of Parliament to reflect the views of those whom it is supposed to represent.

It was a step in the right direction to introduce the concept of Special Standing Committees, under which—albeit to a limited extent—people with a particular interest in the Bill under consideration could appear before the Committee and express their views. I sat on one or two of those early Committees and thought that they were very successful for certain types of Bill.

The idea of a draft Bill that would go out to consultation seems a considerable improvement on those Committees. If, as the Prime Minister implied, draft Bills are to be published in each parliamentary Session for consideration in the subsequent Session, there will be ample opportunity for all those likely to be affected by the legislation to put their points of view, whether on policy or on technicalities.

We all know how, so often, we in Parliament pass a clause that becomes part of the law of the land, then a problem arises, the matter eventually goes to court and the judge says, "When Parliament decided so and so, it obviously meant such and such." The fact is that on the Tuesday morning when the Committee passed the clause, no one visualised the particular combination of circumstances that produced the case that went to court. The more people who can go through a draft Bill and put forward their views before it is presented to Parliament, the better the chance that the Bill will achieve what is intended and will be understood by those responsible for implementing it and by the courts. I therefore welcome the idea of draft Bills.

One of the draft Bills that we are to consider will be on measures to help people make better provision for their long term care needs in old age. I am not sure, Madam Deputy Speaker, whether under Nolan I should declare an interest, as in a few months I shall be a retired pensioner in my late 60s. The long-term care of the elderly is clearly a matter of concern to us all. The House will be aware that the Select Committee on Health has been carrying out a detailed inquiry and published a first report about a year ago and a second report in July, which dealt with the issue of meeting the costs. We anxiously await the Government's response.

In my view, insurance has a part to play, especially—as the hon. Member for Islington, South and Finsbury (Mr. Smith) implied—for those who are relatively comfortably off, are approaching retirement and can pay a lump sum to insure against the costs that they might incur in a nursing or residential home. The main purpose of that insurance, as I see it, would be to safeguard people's assets for their own benefit and that of their children. In any case, insurance will be of value only to the relatively small section of our community that has that sort of money available.

We must face up to the fact that not only are people living longer but, happily, more of them have assets in their old age which previous generations did not possess—assets on which they are expected to draw if the need arises. We have a twofold task. First, we have to educate people that the state cannot meet in full the cost of those whose age makes them frailer and in need of what is described as social care—indeed, it has never done so. Secondly, we have to deal with the problem that many people feel that it is unjust that they are expected to pay for care in a nursing or residential home which would previously have been given in a hospital, under the national health service, at no cost to themselves.

People do not feel that that is fair, which is understandable. There are people whose state of health is such that they need some care, although it is not reasonable for them to occupy a hospital bed needed by others. I am attracted, therefore, by the proposition put forward by the Royal College of Nursing that nursing care should be free wherever it is given, be it in a hospital, nursing or residential home, whereas the cost of social care should be met from the pockets of those with the means or by the local authority for those whose income or assets are small.

I look forward to seeing the draft Bill and hope that it will lead to widespread consultation and debate, not simply on insurance, but on the wider issues. I hope that that will be another issue on which we can reach consensus.

I welcome the sentence in the Gracious Speech referring to the introduction of legislation to help and develop primary health care services. My right hon. Friend the Secretary of State for Health made a statement last week and issued a White Paper on the subject, the theme of which is to encourage local flexibility so that services can be delivered in a way which is better attuned to local needs and circumstances". This morning, he explained his thinking on that. Increasingly, general practitioners are able to and want to offer a wider range of treatments in their surgeries, which obviously benefits the patient, who does not have to go to hospital. As we have heard, there has been speculation that that will lead to GPs setting up surgeries in supermarkets. My right hon. Friend commented that it would be by no means impossible for there to be a doctor's surgery in a pharmacy.

We should recognise the desirability of medical services being easily available to all. People who may be considering whether they should consult their general practitioner might think twice about having to make an appointment and a special trip to see the doctor, particularly if he is not conveniently situated, and may well be inclined to put it off until the next day. If they can have such a consultation while they are out shopping, they will be more inclined to do so.

Yesterday, I visited the private, walk-in surgery set up in Victoria station a couple of months ago. Already, 25 people a day walk in for medical advice and treatment. They are able and willing to pay for that treatment, and the surgery is conveniently placed for them. If those people are willing to do that and to pay for it, might there be a greater demand for similarly situated NHS surgeries? It is, of course, important that patients should be registered with their own GP and that, if they do pop into Victoria station or anywhere else, there is proper liaison between that doctor and the patients' usual GPs.

Primary care depends on an adequate number of well-trained doctors now and in the future, so we have to ensure that we are training good doctors. I am sure that my right hon. Friend the Secretary of State and my hon. Friend the Under-Secretary, who is in his place, will be aware of the present impasse in making pay awards to clinical academic staff, which has led to a serious shortage of lecturers and professors at medical schools. If we are to have continuous quality training of doctors, it is essential that we continue to have professors and lecturers of a high calibre. I urge my right hon. Friend to resolve the issue of academic pay for medical staff without further delay.

If primary care is to be developed, the role of district nurses, health visitors and practice nurses is bound to have to increase. Four years ago, Parliament approved a private Member's Bill, which I promoted and which had Government support, to allow appropriately trained nurses to prescribe a limited range of drugs and dressings. The measure was, needless to say, embraced enthusiastically by the Royal College of Nursing and nurses generally, although they recognised, as I do, the need for careful trials and evaluation before such a scheme could be introduced nationwide.

In a letter to me on 1 August, my hon. Friend the Minister for Health told me that the evaluation of the eight pilot sites would be published this autumn and that the evaluation of a district community trust pilot was to be reported in late 1997. I raised the point again last week with my right hon. Friend the Secretary of State when he made his statement on the White Paper, and I have to say that his response was rather vague and general. That does not suggest that the Government are pursuing the matter with the enthusiasm and vigour needed if nurses are to play their full part in developing primary care. I strongly urge my right hon. and hon. Friends to pursue the matter with far more energy than they have shown hitherto.

A measure that was not in the Gracious Speech, but which has rapidly popped back into the programme, is the register of paedophiles. I am glad to see that restored as it reflects one of the recommendations of the National Commission of Inquiry into the Prevention of Child Abuse, whose report was published this week. I sat on that commission, which was chaired by Lord Williams of Mostyn. We did two years' work on it, and that work, and the compilation of the report, was far more extensive than anything that I have done as a member of several Select Committees.

The thinking behind our inquiry was the pattern of events after instances of child abuse: so often an inquiry has been set up, a report issued, recommendations made, some implemented and some not and then little more seems to happen until the next incident of child abuse. We started with the question of what can we do to prevent child abuse as a community, as a Government and as local authorities. We can never prevent child abuse completely, but we must be able to take steps to prevent it. Our report is a substantial volume, and a similar volume will be printed containing some of the paperwork and submissions made to us. We made some 85 recommendations and I hope that at some point an opportunity will be found for the House to debate the report, when hon. Members have had time to digest it adequately.

However, I wish to make a few brief comments, if only to correct some of the misunderstandings and misinterpretations that have been put on the report, perhaps inevitably, given its size and attempts by certain people to reduce its details to a paragraph or two or even a headline. We have been criticised for our definition of abuse and for the statistics that we produced. We devote a whole chapter in the report to seeking an appropriate definition of child abuse and another, even longer chapter to trying to assess its extent. We are not saying definitely that 1 million children are seriously abused every year, but we are saying that that number are harmed, whether by isolated incidents or by systematic and long-term maltreatment.

The truth is, of course, that we do not really know the extent of child abuse. Much of it is concealed. In a fascinating exercise as part of our work, one of our number, Deirdre Sanders, who will be known to some hon. Members as the so-called agony aunt of The Sun and who also speaks on television, put references in her column, as did several of her agony aunt colleagues, to the work of the commission. They invited readers to write in if they had had experience of child abuse. More than 11,000 adults wrote to tell us about their experience of child abuse, many of them writing for the first time about their experiences. We derived some valuable material from what they said about what had happened, the circumstances, why they did nothing about it and what they thought could be done to prevent abuse. Their responses make my point that abuse happens and we know nothing about it.

In trying to make an assessment of the extent of abuse, we drew on a range of official statistics and also on a number of surveys to try to provide an estimate. Indeed, one of our recommendations is that the collection of appropriate data should be carried out so that we know the extent of the problem.

Another of our recommendations is that the Secretary of State for Health should have his title expanded to Secretary of State for Health and Children, and we suggest also that the junior Minister who at present has responsibility for children should be upgraded to a Minister of State and given the specific title of Minister for Children. I was sorry to learn that my hon. Friend the Under-Secretary who at present has that responsibility seemed to dismiss the proposal out of hand. It is a little surprising that, having been offered such promotion, he should reject it in such a manner, but I wish to emphasise that that recommendation is not simply a gimmick or cosmetic, or an attempt to catch a headline.

The members of the commission believe that children's needs should be given a higher profile. Changing the titles of the Secretary of State and the Under-Secretary would spearhead a public awareness campaign on children's needs. An opportunity would be provided to enhance co-ordination between Government Departments and departments at local level. There are now eight Government Departments that have some involvement in children's welfare. It would be the specific responsibility of the Minister for Children to head up a committee that would not merely co-ordinate activities, but ensure that any activity of any Department that impinged upon children was carefully examined to ascertain its effect.

The commission felt that it would be very much in children's interests and to the benefit of those who care for them to have a professional regulatory body for social workers. I am disappointed that last week my right hon. Friend the Secretary of State rejected the proposal for a general social services council. I have had first-hand experience of professional self-regulation as a lay member of the General Medical Council. Most professions have some form of self-regulatory body, and surely the social services profession should, too.

I hope that the commission's report will be carefully studied by Ministers, Members and those further afield. I hope also that it will stimulate a national debate that will be based on the consideration of facts rather than headlines. I hope again that it will focus especially on the commission's contention that child abuse is a matter not only for social workers, charities, the police and the courts, but for us all. It is an issue that should be the concern and responsibility of every one of us.

12.2 pm

Mr. Simon Hughes (Southwark and Bermondsey)

I am happy to start by taking up some of the remarks of the hon. Member for Chislehurst (Sir R. Sims). I wish to endorse some of them. My colleagues and I welcome, as the hon. Gentleman did, the idea that we should have Bills in draft. It is a good idea and I hope that it will become the normal established practice of this place from now on. The proposed Bill on long-term care for the elderly is one of two measures referred to in the Queen's Speech which is especially suitable for the House to receive in draft.

If Parliament is to legislate anew for long-term care for the elderly, it is essential that we seek to get that legislation right on a cross-party basis, as the hon. Member for Chislehurst rightly said.

I endorse also the hon. Gentleman's comment that we have a different responsibility in dealing with those who have made arrangements in the past from our responsibility towards those who, like some of us in the Chamber who are slightly younger than the hon. Gentleman, have time to make arrangements for our own long-term care when we become elderly. It is inevitable that the goalposts and rules will be changed.

The welfare state has to adapt and move on but we must not change it to the detriment of those who will find it too late to make alternative arrangements. Our first concern must be for those who are now in or approaching old age who do not have the assets and facilities to look after themselves in any new way that Parliament might decide for the future.

It seems clear that in future there will have to be the assumption that, as people earn, the employer and the employee together will help to make arrangements for residential provision in old age. There will be a different and more complex debate on who takes responsibility for health and social care provision. I vote for the health service and its funds to look after health care. I recognise, however, that there will always be a grey area when it comes to determining where health care ends and social non-health care begins. Such a debate should be conducted carefully and conscientiously on a cross-party basis.

The hon. Member for Chislehurst also rightly alluded to the commission of inquiry upon which he sat, which published its report this week. I had the benefit of reading it on its publication and, as my party's spokesman on such matters, I was alerted to its findings shortly before publication. Like the hon. Gentleman, I was encouraged by the seriousness of the report and by the commission's careful deliberative method. It sat for two years and it did its job extremely thoroughly. I was encouraged also by the broad range of its recommendations.

One finding complemented the rather alarming fact that, within a broad definition, there are 1 million youngsters who are the subject of abuse—which is extremely worrying. Even if we break down that figure into sub-categories, including those who are clearly abused in various forms, abuse takes place at a horrifying level. It is encouraging, however, that the report concludes that most child abuse is preventable. It appears that most child abuse is committed by those who have a close relationship with the children concerned. It often happens, however, that those outside that relationship do not blow the whistle as early as they should. I hope that, before there are any further knee-jerk reactions, we can have a debate on the report in Government time during this Session.

Like the hon. Member for Chislehurst, I was disappointed to hear the Under-Secretary of State who has recently assumed responsibility for these matters so summarily and, it seemed, grudgingly, reject both the report and some of its recommendations. That did him no credit. Similarly, it did the Government, the report and the National Society for the Prevention of Cruelty to Children, which commissioned the report, no credit. If we can have a Minister with responsibility for disabled people and a Minister with responsibility for the youth service—who in my view should be the Minister with responsibility for young people—surely we can have a Minister with responsibility for children's issues. It is nonsensical that we do not have a Minister responsible for co-ordination in this area.

I accept, of course, that we are participating in a wide-ranging debate. However, the right hon. Member for Brent, North (Sir R. Boyson) talked specifically about education policy, which I know will be the subject of debate next week. That is why I raised questions about his speech earlier. But the themes to which he drew attention, and those referred to by the hon. Member for Birkenhead (Mr. Field), are clearly both among those that underlie how we respond to the social issues of the day.

One of the great social concerns is the future of the NHS. It is an overwhelmingly held view that the NHS represents one of the most civilised acts achieved in this country since the second world war. We created the NHS and we have sustained it. It is something that makes us all more equal, or it should do. It makes for the better health and welfare of our nations, and many of us want to ensure its secure future. For it to be in the Government's programme, for there to be a large degree of consensus about proposed legislation and for there to be a willingness to make primary care better and more accessible are all good things. My colleagues and I, subject to finding that the Bill does not say what we expect, will vote for the Second Reading of the Bill that has been announced. We shall support it and generally welcome it, as I said last week.

Two particular issues, which were touched upon earlier, will be important in relation to primary care. First, if we do not improve it, we shall be desperately short of GPs. I have one figure to illustrate that. Until about five years ago, when practices advertised for trainee GPs they would often receive between 10 and 20 applicants. Today, many practices are lucky if they have one applicant. General practice should be built up, as it is already in some places, to become a viable, valuable and valued part of the national health service so that trainee medics—and trainees in other allied professions—want to enter primary care as much as they want to enter the acute sector. There will be a great GP crisis ahead unless we do something, because many of the large number who started to practise in the 20 years after the war are coming up to retirement, and because GPs around the country are demoralised.

Next, there is a smaller issue to do with registration. The Secretary of State rightly said that we have a system based on the fact that it is the right of every citizen to register with a GP, who is then the person principally responsible for his or her care. When GPs say that somebody can no longer remain on their list, which happens increasingly, finding another GP who will take them is not always easy. Some patients are difficult, but by definition they are probably the ones who need a GP the most. We need to ensure that the procedures for re-registration and finding another GP work properly. They certainly do not at the moment.

On the specifics of the Bill that we anticipate—we are all working on the basis of the White Paper of last week rather than anything else, other than one sentence in the Queen's Speech—I accept and endorse, as the White Paper does, the fact that the purchaser-provider split should be retained and that health authorities should therefore not employ GPs but should exceptionally be responsible for appointing them where no other GPs are willing to do the job.

Secondly, it is nonsense to appoint an incompetent person to be a GP in a single-handed practice. When I was elected, I was told by the local health authority that more than half the practices in my area were below standard. Sadly, that has been the case in the inner city for far too long. We need to ensure that single-handed and multi-GP practices have GPs of a decent standard. Our patients must not be prejudiced by anything else.

There is another concern. Here I need to deal with the point that was in dispute last week and today between the Secretary of State and the hon. Member for Islington, South and Finsbury (Mr. Smith). There is a difference between a commercial employer employing a general practitioner and a commercial employer, such as Boots, employing a pharmacist. The general practitioner is the personal professional with whom someone registers for their general health care. The GP is their gateway and point of access. The pharmacist is not. I am not signed up to one local pharmacist, to whom I go for all my pharmacy requirements. I go to Boots the chemist in Westminster Bridge road if I need something while I am here, but I will also go to any other pharmacist throughout the land. That is the difference. Just as the hospital—I see that the hon. Member for Peckham (Ms Harman) agrees—to which someone goes when they are suddenly taken ill or need an acute service has to deal with all that person's acute needs, so a GP or practice—it may be a practice nurse—has to deal with a whole range of needs. They really cannot have a double loyalty to the patient and a commercial employer. Of course, GPs are private practitioners and have a contract with the national health service, but their loyalty is to their profession, their ethical code and their patients, and not to anybody else who might be pulling the strings. That is why we want some reassurance.

I am in favour of pilot schemes, and we welcome the provisions in the Bill, but I cannot believe that the Secretary of State does not understand the difference—there is a big difference—between privately employed general practices and general practitioners and GPs who are employed by local community trusts.

Having a general practice in the high street or in Victoria station is a good idea. I am absolutely not opposed to it. Indeed, I am positively in favour of putting practices where the people are. I see no reason why GP practices should not be in shopping malls and shopping centres. In Victoria station there is a private practice. That is the difference. I hope that, in time, we may have public practices in main line railway stations, shopping centres and elsewhere. The hon. Member for Vauxhall (Miss Hoey) and I, who share responsibility for Waterloo—her constituency includes the station itself—would like one in Waterloo station, but run by the national health service. We had better consult our local GPs before we get too enthusiastic about it, but we would be happy to pilot a scheme there.

We also welcome the imminent measures on social security, which will be supported by my colleagues and me as the Bill passes through the House. Reforming the compensation recovery unit is a good thing, and shifting the burden of benefit recovery from the victim to the person responsible for the accident makes more sense.

We welcome too the Government's attempts to clamp down on housing benefit fraud and social security fraud. It must be right that people should not receive money to which they are not entitled—as long as the big fish as well as the little fish are caught and there is not an imbalance.

There are more Bills in the Queen's Speech for which there is cross-party agreement—certainly now that the two belated arrivals have been included—than there are Bills that can be perceived as "intended to flush out" the Opposition parties. We should be honest and say that, in a small programme, the majority of measures are not party controversial. I suppose that that was the only way in which the Government could get a significant number of Bills through the House between now and the prime ministerially endorsed date of 1 May.

Mr. Peter Bottomley

That is not what he said.

Mr. Hughes

I heard the interview. The Prime Minister certainly said that it would not be later than 1 May and he indicated general support for the idea that it might be 1 May. Of course he did not commit himself, but I think that we can all work on the assumption that if it were after 1 May it would be a disaster for the Tories because of the local government elections on 1 May, and they would not want that as a trailer to their general election.

There was not much in the Queen's Speech that was controversial, although we will give all the Bills proper scrutiny. As the hon. Member for Islington, South and Finsbury said, often it is what is not in the Queen's Speech that is equally the subject of debate. I shall briefly identify the missing issues that for us need to be flagged up. The Secretary of State for Health heard my question and understood it, but failed on three occasions to answer it. What does he intend to do about removing the two-tier consequence of fundholding in the health service? He must be honest with the House and accept that, as evidenced in the example that I gave him from the Exeter and Devon Health Care trust document, which was sent on official paper, someone who is a patient of a fundholding practice will get non-emergency treatment more quickly than the patient of a non-fundholding practice. There is a two-tier health service for many non-fundholding practice patients. The Government could and should change that.

The health service does not treat people equally in all parts of the country. We sometimes have much better service in some parts than in others. Of course, to a degree, that will always be the case, but there is a serious issue about ensuring that the allocation of moneys is fair if we are to avoid significantly different waiting times in different parts of the country.

The health service is clearly also not properly co-ordinated. It is not only me who says that. It is the answer given to the hon. Member for Newham, South (Mr. Spearing), who asked a question about what the deficits are this year and was told that no information was suitable for publication. The reason why it was not suitable for publication was that it showed the fact that there is a large deficit. My colleagues and I calculated it at £133 million. The Government have conceded that it is £122 million. There is a significant shortfall of money this year.

The third special report of the Select Committee on the Parliamentary Commissioner for Administration—as objective a body as any—was published yesterday. On the responsibilities of the NHS executive, it said: We are concerned that public and parliamentary accountability are being ignored. If management is being devolved locally, we believe that one of the prime duties of the NHS Executive is to ensure that Parliament is not thus deprived of information by which it can judge the overall performance of the Health Service. The King's Fund annual health care report contains a significant and weighty article by Sean Boyle and Anthony Harrison, who conclude that there should be much greater clarity and that current national policy is inadequate because it fails to state clear primary targets … and to monitor policies in a way which would allow swift, effective reactions in order to avoid crisis management. The article continues: Nationally there has been no clear responsibility for ensuring that there are sufficient intensive care facilities to meet the needs of the whole population. There will be a crisis in the health service this winter, partly because the left hand does not know what the right hand is doing, and the Secretary of State and the NHS executive do not seem to know what people are doing either. There are endless examples of hon. Members being told in response to parliamentary questions that information is not available or is not held centrally.

My office and I undertook a wild paper chase in September to try to obtain information about health authority deficits. The Secretary of State said, "Don't ask me"; the NHS executive said, "Don't ask us"; the local NHS regional chairman—such chairmen chair nothing these days—said, "We don't know"; and in the end we had to collect the information ourselves. Having telephoned six different ports of call we had collected two horrifying quotations. A fax from one regional office said: Please be advised that you should address this query to the Minister. When we did so, the Minister of course said, "Don't ask me." The second response was extraordinarily direct and honest. It said: There is actually no one collecting that sort of information at the moment. At the end of the day it will hopefully all get sorted out. God knows how. If that is all the information that a health service official can provide, we are at a pretty sorry pass.

Mr. Malcolm Wicks (Croydon, North-West)

Safe in their hands.

Mr. Hughes

Indeed. It is hardly evidence of a health service safe in their hands.

It is some consolation that the Government have now seen fit to publish the deficit figures, even though the figures that we have are for only the first three months of this year. They confirm that some authorities are in deficit by up to £10 million and that co-ordination and control in the health service are not working. We do not have a national health service in the true sense, because nobody is properly nationally responsible for it any more.

Leaving aside the questions of health promotion, improving public health, restoring free dental and eye checks, banning advertising and sports promotion of tobacco and ensuring that we have properly independent health education authorities and public health commissions, all of which should be covered in the Queen's Speech but are not, there are two other specific matters that have not been addressed.

The first is the removal of unnecessary bureaucracy. I will defend NHS managers, but not a system that requires annual contracts and forces people to renegotiate every year or a system whereby people in 488 different places have to negotiate their own pay. Even now, six months into the financial year, people are being called away from looking after their patients to attend pay negotiation meetings. The sooner we get back to nationally negotiated NHS pay, the better.

The second question that was not addressed—the Secretary of State may say that it is a matter for the Budget, but all legislation has implications to do with money—is where the resources are to come from. There is no guarantee that the primary care part of the NHS will have the resources that it needs and that they will not be taken away from the acute and hospital sector.

These concerns about the Queen's Speech come not only from politicians but from professional bodies, including the British Medical Association, the Royal College of Nursing and the National Association of Health Authorities and Trusts. They are all concerned about the resources.

The Prime Minister made a commitment at his party conference that if the Tories are re-elected—I hope that they will not be—they will provide at least enough money for the NHS to keep pace with inflation for the next five years. A sub-question arises about how inflation is defined and whether it is NHS inflation—which is higher—or general inflation, but, assuming that we are talking about NHS inflation, the health service is still in deficit already. To make up for last year's funding shortfall, £178 million was taken out of this year's money, and there are already projections of big deficits for this year and the year to come.

The health service needs catch-up money to enable it to do its job. That means extra money: much more than the £100 million to which the Labour party is committed and much more than the Government have committed. There was silence on that in the Queen's Speech, in the Prime Minister's speech and in the speech made by the Secretary of State today. Unless we find more resources, the closures and the reduction of services that we are experiencing will not be stopped, the new staff that we need will not be recruited, the increasing waiting lists will not start to decrease, necessary health promotion initiatives such as free dental and eye checks will not be restored and the unnecessary bureaucracy will not be cut.

My party has made a commitment and a budgetary allowance for an extra £350 million a year on top of necessary growth money. I challenge the Government to do the same. If Ministers cannot respond to that today, we look forward to a positive response in the coming Budget.

12.26 pm
Mr. Piers Merchant (Beckenham)

I listened to the Gracious Speech with some surprise and much satisfaction. I certainly did not recognise the description of it given by the hon. Member for Islington, South and Finsbury (Mr. Smith) because I consider that there is a great deal in it.

It would not be surprising, in the last six months before a general election, if a Queen's Speech was thin and offered no more than some tidying up legislation, but that was not the case: it was large in quantity and in substance. That is welcome and demonstrates the Government's commitment to continuing in their clear direction for as long as possible. That is true on health, with which we have been concerned today, and it is excellent that there is a commitment to legislation on extending primary health care reform.

The commitment reflects two important principles that have powered Government policy on health. First, there is an unshakeable commitment to the national health service and to the provision of free basic health care facilities for all. Secondly, there is a continued attempt to improve quality as well as quantity of provision, with an important emphasis on achieving better value for money. Those reforms have involved an emphasis on primary health care. I very much welcome that, because primary health care is the pivotal point of a good national health service.

Why is a greater concentration on primary care so important? First, because it emphasises—this is an emphasis that most people want—the role of the patient's own doctor and the personal relationship between the patient and their general practitioner, providing choices that may be impossible at other levels of the national health service. Secondly, it reflects a welcome development in health treatment: the availability of ever more forms of treatment from the GP—the lowest possible level closest to the patient. Thirdly, primary health care offers a flexibility and efficiency that is more difficult to achieve at other levels.

For all those reasons, I welcome the greater emphasis being placed on primary health care. It has been an important part of the reforms and the success of widening the base of primary health care has been evident. It is certainly evident in my constituency, where many more services can be provided than was possible five years ago. Of course, that is possible for non-fundholding GP surgeries and for fundholding surgeries, but it is clear that the fundholders have set the pace and led the way.

One surgery in my constituency—the Elm Road surgery, to which I have referred before in the House—has provided a massive extension of services. I am glad to say that I recently gave successful support to the surgery's plan for a physical extension to its health centre, which has made the provision of even more services possible. The former—now retired—principal partner of the practice, Dr. Ken Scott, was one of the first and leading advocates of GP fundholding. He is now the president of the National Association of Fund Holding Practices. I compliment him on the great work that he has done on the principle and the practice of GP fundholding.

All those advances are very welcome, but there are still several severe problems linked with primary care, particularly in inner-city areas. The Government's attempt to tackle those problems in the new Bill is therefore welcome. From what my right hon. Friend the Secretary of State for Health said this morning, it seems that the Bill will cover all the issues that I intend to raise, but if, when all the details of the Bill emerge, any of those issues are not covered, I hope that means can be found to tackle them.

The first difficulty is faced by single-handed practices, particularly those in inner-city areas. For historical reasons and reasons relating to premises, the proportion of single-handed practices in inner-city areas tends to be greater than that in outer areas. That is so in my constituency, with the practices in the less urban area to the south and east tending to have more doctors—sometimes a large number—attached to them, whereas in Penge and Anerley, which abut inner London and where there is much greater deprivation, with properties built closer together and a higher population density, the majority of practices are single-handed.

I have nothing against single-handed practices, which can often provide a worthwhile and efficient service, but if we are to expand primary health care in the direction in which I believe it should be expanded, inner-city areas need more health centres of the sort seen elsewhere. Such centres can provide a continuity of service—with longer opening hours—and a breadth of provision that single-handed practices find it difficult to provide.

I hope that creative means will be found to encourage the development of multi-doctor health centres in such areas. Bromley health authority has led the way in the creation of what are called multifunds. I also strongly support the prospect of bringing together single-handed practices to share some services in the smaller local hospitals. I will return to that in a few minutes.

A second concern is the level of liaison between health authorities and newly set up practices. There is an anomaly in that, when the ratio of population to GPs rises above a certain level, it is possible for any GP to go into an area and, after going through the appropriate application process, more or less set up a practice straight away, without the local health authority even knowing and without its say-so. That does not make for good and efficient co-ordination. It would be wise to amend practices to involve the health authority more and, where necessary, to give it a more proactive role in ensuring that there is adequate provision.

Linked with that is the fraught issue of the doctor-population ratio itself. It is a set ratio throughout the country. Consideration should he given to adjusting it to take into account some of the greater pressures that increasingly come to the fore, particularly in deprived and urban areas. For example, in fixing the regulations, the additional services that doctors have increasingly provided since the 1990 contract should be taken into account. At a certain trip point, as it were, practices can take on assistance or part-time assistance. I believe that the figure is around 2,500 patients per GP. Perhaps it would be wiser, certainly in some regions, for that figure to be lower to take into account the extra strain on some GPs, particularly single-handed ones.

In the Bromley region, only 78p per patient is allowed to follow a patient to a GP if his existing GP retires. That needs to be adjusted to enable quick and adequate provision to be given to patients if they have, sadly, lost their GP's services and until such time as they can find a new and permanent practice.

No locum payments are permissible in an urban area such as the one covered by my constituency. They are possible in rural areas. Some attention needs to be given to making the regulations more flexible in relation to that matter. All those suggestions will, I hope, help to deal with the rigidity and perhaps the now outdated regulations that govern the way in which GPs can set up and operate.

Recruitment is the fourth well known concern. It is especially difficult in some parts of London and in the Bromley region. Just in the past few months, doctors' practices have raised two cases with me about the difficulty of obtaining new GPs to replace ones that have either retired or moved on for other reasons.

I took up those cases with my hon. Friend the Minister for Health, who told me that the Government had launched initiatives, which I welcome, to deal with the matter. They include the London initiative zone, which has enabled extra payments to be made where flexibility allowances are needed and encourages medical schools to take on new students to train as GPs to increase the flow. It also encourages people who have left the profession to return—they are described by that awful word "returnees"—so that the NHS benefits from people who were trained, who still have much to offer and who could be encouraged, if conditions were right, to return to the profession. There is also a role for salaried GPs, particularly when a health authority identifies a problem and urgently needs a solution that is easy to implement, and which may be temporary or not because of traditional recruitment pattern difficulties. I welcome that additional flexibility.

I mentioned my keenness for linking single-handed practices and others with local secondary facilities, particularly small hospitals, where no health centre exists. Beckenham hospital is an excellent example. My right hon. Friend the Prime Minister mentioned that he would like to see the encouragement of cottage hospitals in Bournemouth. Beckenham hospital meets that description, although health professionals do not like to use the phrase any longer. Three or four years ago, Beckenham hospital appeared to have no future. There was grave concern about its likely closure and the suggestion that all secondary health facilities would be concentrated on one central location in Bromley borough. I am glad that that did not happen, but the reverse.

After a while, the health authority recognised that such hospitals have an important role, for which there is a strong demand in the community. The authority adjusted its plans and made a long-term commitment to Beckenham hospital's future. Over the past 18 months, that has produced investment of £1 million, new diagnostic facilities, out-patient facilities and a range of specialist clinics, a new pharmacy, a range of health education facilities, minor treatment suites and other facilities best provided in the community but not always available at a surgery—an intermediate stage. That innovation has proved extremely popular. The number of people using the hospital has increased dramatically, with a 5 per cent. jump in the number of out-patients over the past two quarters. A new stroke clinic has also been opened.

Doctors unable to provide at their surgeries the range of facilities available at larger fundholding practices could collaborate and use the services available at hospitals such as Beckenham. Day surgeries, and even short-term overnight stays for patients who could benefit from them, could be supervised by the GPs—an arrangement that both they and their patients would probably prefer.

I am keen to see the provision in Beckenham and elsewhere of a minor injuries unit, which would take the pressure off larger, centralised accident and emergency units and those GPs unable to offer an appropriate service. Constituents with a minor injury often feel aggrieved when immediate treatment is not available from their GP and they are referred to an accident and emergency unit. It would be better if they could receive attention at the minor injuries unit of a smaller hospital, possibly at the hands of a duty GP. Such provision presents great possibilities in primary care, and I should very much like to see it implemented in my constituency.

I end my speech by moving on to issues other than primary care, because primary care can hope to work only if we know its limits and if it is backed up by good hospital facilities. Clearly, GPs cannot be expected to deal with the entire range of health problems, and they must have back-up when necessary.

There is a desperate need in my constituency for a new district hospital to provide such facilities. The need arises not because the Bromley hospital system is not manfully trying to provide the best possible level of support to the local population—it does—but because, for historic reasons, provision is split between four sites in the borough, which is inefficient and means that running the system is more expensive and difficult. The current system creates unnecessary duplication and overheads, and makes it difficult—in some cases impossible—for a patient's entire treatment to be conducted at one hospital. A patient may present at the accident and emergency department, but after stabilisation will probably have to be moved to another hospital across the borough to receive specialist or long-term care.

The local hospital structure has been working very hard to overcome that problem, and it now has a clear plan in place. Only yesterday, it announced its private finance initiative preferred bidder—a group called United Healthcare, which is an equal partnership between Taylor Woodrow and the Healthcare Group. That group will provide a new £120 million hospital, which will overcome all the problems that I have described.

I urge my right hon. Friend the Secretary of State for Health and Ministers in his Department, in co-ordination with the Treasury, to reach as hasty a decision as possible on that hospital's future. I very much hope to see—and I am reasonably confident that I will see—bricks and mortar in place in the near future, which will help to complete the balance that the reforms have brought in my constituency.

The new hospital will build on the excellent work that Bromley hospital has been able to deliver over the past few years to the people of the borough. By March 1995, waiting lists at Bromley hospital were brought down to a maximum of 12 months. In the year to June 1996, there has been a 25 per cent. reduction in the size of the waiting list, and there has been a 4 per cent. reduction since then. That achievement should be considered against a background of increasing demand in the form of referrals from GPs and from accident and emergency departments. There have been other spectacular reductions, such as a 44 per cent. reduction in urology waiting. In 84 per cent. of cases, people requiring orthopaedic treatment are now seen within 13 weeks, whereas, a year ago, the figure was only 48 per cent.

Some real progress has been made, although I should like to see further action taken. I expect that there will be further results from planned legislation to improve and diversify primary health care and by the provision of a new hospital, which I hope will be approved in this Session. The achievements to date demonstrate the real progress that has been made in the health service, which has been made possible by the health service reforms implemented by the Government. The reforms are very welcome, as is the commitment to pass new legislation to improve the health service, and I am sure that those successes will now be carried forward.

12.48 pm
Miss Kate Hoey (Vauxhall)

Before I remark on the social security aspects of the Queen's Speech, I want to comment on guns, although I know that that subject will be more fully debated next week. I wanted to speak during the statements last week but was not called.

I have a strong concern arising from my borough where, in the past year alone, the police have been called out to 845 incidents involving guns—all of which were illegally held. I query how any action on guns that we take will do anything about illegally held weapons, which are the day-to-day danger facing my constituents.

In the controversial, emotional debate that we are to have on guns, it is important that we remember that the people—certainly those whom I know in my constituency—who shoot in rifle clubs and who attend pistol shooting are decent, honourable citizens who are going about their legal pleasure. We should not imply—as some hon. Members have, although they might not have meant to do so—that anyone who has been shooting in a gun club is a psychopath in waiting. We should get that message across clearly in the coming debate.

It strikes me as strange that the House could be attempting to stop a sport—pistol shooting—that is currently legal and that is and will be part of the Olympic games. We might be preventing those who have endeavoured and worked hard to become part of an Olympic team from practising their sport. This morning, we heard of a woman who has spent a long time becoming an expert pistol shooter, but who might now have to move to Jersey to continue. In the understandable emotion resulting from Dunblane, it is important that we remember that what appears to be the easy solution might not always be the best.

As a member of the Select Committee on Social Security, I am delighted that, as my hon. Friend the Member for Birkenhead (Mr. Field) said, the Secretary of State has, as usual, followed our lead, not only on the compensation recovery unit but on the question of fraud. My rignt hon. and hon. Friends and I welcome and want to strengthen the proposals dealing with fraud control, because the benefit system was designed to help those in greatest need and the poor. It is not right that some sections of society, whether individuals or gangs, should exploit it. I have not yet seen the relevant Bill, so it is difficult to comment in detail, but I hope that we shall adopt all the measures recommended in the Select Committee report.

The Secretary of State has not, however, followed the Select Committee's report on benefits for asylum seekers. The Secretary of State said that there would be a commitment to give local authorities help and support for the extra costs arising from changes in legislation dealing with asylum seekers. I want to give the House an account of some of the serious difficulties affecting some inner-London boroughs, especially the borough of Lambeth, as a consequence of the recent judgment on asylum seekers.

The judgment in the case of the four asylum seekers against the London boroughs of Lambeth, Westminster and Hammersmith and Fulham was given on 8 October. As hon. Members will know, the three boroughs lost the case. The judge clearly found that the boroughs should offer support to the asylum seekers under the National Assistance Act 1948 on the ground that they were destitute. He found it impossible to believe that Parliament intended that asylum seekers should be left destitute, starving and at the risk of grave illness and even death and felt that, if it did, it should have said so clearly and repealed the parts of the Act that provided a safety net for people who were destitute. He went further in his judgment. He said that, if Parliament was clear that that was its intention, it would almost certainly put itself in breach of the Geneva convention. He was also clear that, although he had great sympathy with local authorities and the financial difficulties that would be caused by the judgment, if a duty exists, it must be performed". The judgment has significant implications for social services in many London boroughs, but I shall describe the repercussions in the borough of Lambeth. The housing department no longer has the power to offer housing to asylum seekers, and they are entitled to no social security benefits. The social services department is therefore responsible for their housing, food and support and also, potentially, for necessary expenses such as prescription charges.

The judgment potentially has a wider significance, in relation to those people who fail the habitual residence test, but at the moment, as hon. Members know, there are three different categories of asylum seekers. First, there are individual adults, such as the four adults who brought the case, who are usually fit and healthy and whom the local authority must now support under the National Assistance Act. Secondly, there are families with children, who, by reason of their destitution, are in need and must be supported under the Children Act 1989. Thirdly, there are unaccompanied refugee children, who must be supported under the Children Act.

Since mid-August, Lambeth social services has seen 250 units—either an individual or a family, as I have just defined. They have offered support to 109 units—. 70 families, 37 adults and two children, and that excludes children who are already in care. In August and September, applicants averaged 18 to 20 a week. However, on the day following the judgment, 9 October, 36 individuals—all single adults—arrived. By lunchtime on 10 October, 15 further people had applied. The borough estimates that, in the next few weeks, applicants may average 30 to 40 a day.

Where appropriate, people are offered housing—bed and breakfast arranged through the housing department and cross-charged to the social services department—and income support at 85 per cent. of its usual level. Expenditure on income support is currently about £4,500 a week and rising, and extra money is being sought for prescription charges, travel, and so on.

The social services department incurs other costs. Three additional social workers are hired from an agency at £500 a week each. There are the costs of transporting cash. There are the significant costs of Language Line—£3 to £5 a minute for interpretation—and the significant time of a team manager.

Lambeth was previously regarded as a local authority that mismanaged and had elements of corruption. I accepted all those allegations. All those problems have been tackled and the position is being turned around. I therefore strongly emphasise that Lambeth is not a soft touch. All applications are scrutinised in detail; many are rejected. Lambeth currently offers income support at a lower level than do other London boroughs. Additional expenses have so far been rejected, despite constant pressure from solicitors and from the Refugee Council, whose headquarters is in the London borough of Lambeth.

The Secretary of State will probably mention the two Government grants that are available. There is a grant to local authorities for unaccompanied children. However, we must spend £2 million before we qualify, which effectively means that no money will be available. There is a grant for children and families. Again, we must spend a large sum and we then receive only 80 per cent. of our expenditure above that figure. Lambeth is therefore obliged to subsidise the costs of asylum seekers significantly through the budget. There is no money for single adults.

Lambeth, Hammersmith and Fulham and Westminster have the most asylum seekers, as they were the initial targeted boroughs. We feel that the presence of the Refugee Council increases the number of asylum seekers who approach the borough of Lambeth. The Select Committee visited the Refugee Council a week or so ago and saw its wonderful work. We also visited the special day centre which has been set up in my constituency, just across the river.

The presence of the Refugee Council and other organisations has, however, increased pressure on Lambeth's budget. One or two nights spent in a local refugee centre is claimed as the "Lambeth connection". That also happens in boroughs such as that of the hon. Member for Southwark and Bermondsey (Mr. Hughes). Lambeth social services department will probably spend £1 million to £2 million more this year. Westminster council estimates that it will spend a similar figure, rising to £7.7 million in 1997–98. Significant numbers of asylum seekers are also being accommodated by the housing department while they wait for their next asylum decision.

The concerns on this matter are, primarily, financial. The department already overspends its community care resources and faces major cuts. Such expenditure is simply not affordable. Other community services will have to be cut further, which will impact on hospital discharges. There is already great difficulty in getting people out of hospital if they have nowhere to go. Given that the housing department says that the stock of bed-and-breakfast accommodation will be exhausted within the next couple of weeks, the problem is extremely urgent. There will be repercussions on the community generally. Major cuts have already been made and will continue to be made in services for the disabled and elderly, while new services must be set aside for asylum seekers. That does not bode well for race relations, so it must be dealt with.

In practical terms, the department has few resources to dedicate to the task, especially as Lambeth has had to prepare, propose, consult on and implement significant cuts that must take place anyway. Moreover, the new centres must be agreed and resourced. Although the problem does not exist all over the country, it is severe in some parts of London and the Secretary of State must take action. The Government are responsible for helping with additional costs because the cumulative effect of asylum seekers on budgets such as Lambeth's, especially as all the current grants imply a local authority subsidy, is extremely serious. The Government must take urgent action to set up a resettlement centre to which all local authorities can refer applicants. That might avoid using the national assistance legislation and reduce numbers.

This problem will not go away and action is needed urgently. It cannot wait for an appeal. As the supply of bed-and-breakfast accommodation throughout London vanishes, local authorities will have to set up their own emergency shelters. Lambeth social services is already making contingency plans to reopen a closed elderly persons home in Streatham within the next two weeks. One can imagine the repercussions that that will have on the local community. I understand that Westminster and Hammersmith and Fulham are taking similar action. Although local authorities can do some of the work, the Secretary of State is responsible for working closely with the Refugee Council to ensure that it directs asylum seekers all over London, not just to the boroughs which, for historical, geographical or community reasons, are targeted currently.

My constituency has 85 organisation headquarters and they all think that I am their Member of Parliament. Although that is correct in theory, in practice I cannot possibly be the Member of Parliament for all those headquarters, which range from those of important national organisations to small local ones. The problem is that, because many people claim a local connection by staying in my borough with one of those organisations or their friends, Lambeth takes a much greater proportion than it should. Obviously, the borough must take its share, but certain boroughs take more than their fair share.

We must also warn the health authorities and trusts, because hospital discharge arrangements may no longer be adhered to and Lambeth will simply be unable to afford the expenditure.

I am sorry if I have been parochial, but it is important to make that point about the legislation on asylum seekers. We have heard the court ruling. In his response, the Secretary of State should tell us what he intends to do to help the local authorities affected. We cannot afford to wait until the appeal.

1.4 pm

Mr. Peter Bottomley (Eltham)

I had anticipated that I would follow the hon. Member for South Antrim (Mr. Forsythe), speaking on Northern Ireland.

The Bills set out in the Queen's Speech are important, but the most important objective is to establish a framework to ensure that social advance matches economic advance. In the next 25 years, we expect to achieve roughly what we have achieved in the past 30 years: a doubling of the material standard of living. There is not much point in that, however, if it is not accompanied by an uplifting—in modern terms, a remoralisation—of what is going on around us.

When I first became a Member of Parliament, my constituency included parts of the Ferrier estate, where deeply caring people such as myself, with the help of better qualified professionals, created a town for 5,000 people in which for five years there was no pub, no post office, no chapel, no police officer and nowhere within a mile and a half where people could work. That was a mistake, and I hope that we have learnt from it.

There are estates of perhaps 1,000 to 2,000 people, mainly in the inner cities or outside large towns, where, if one asks children what there is to do after school—assuming that they are in school each day—they say, "Nothing." They are not always being accurate, but every child and parent should be able to talk about worthwhile activities.

Many hon. Members, if they did not have to work for a living, could fill their time twice over with worthwhile activities—voluntary service to others, academic and educational interests, entertainment and sporting interests—that they enjoy. That should be possible for all people—the young, the middle-aged and those in retirement. Yet the shortage of actual or perceived opportunities for young people is one of the reasons why they engage in so much worthless activity or inactivity.

I must add a comment in parentheses, addressed to those in the media who believe that people who speak about such issues should accept all that is thrown at them about their families or extended families, should lead perfect lives, or should deny any connection with wives, children, parents, mothers-in-law or anyone else. If problems are to be properly discussed in Parliament, even if all the answers are not provided, Members should not be expected to have skins sufficiently thick to endure insults to themselves and others close to them.

I shall give a minor example. When an in-law of mine went into hospital, two newspapers sent pairs of journalists to find out whether she was receiving special, advanced treatment. They discovered that she was not. Then, after a serious procedure, she woke up at 1 am to hear that a different newspaper had reported that she had had to wait too long for her treatment. Frankly, that demonstrates why newspaper editors rightly have a code that states that people should not achieve fame or notoriety simply because of their connection with someone involved in public service.

I return to the major issues. What is the avoidable disadvantage, distress and handicap that we are trying to relieve? Part of it may be due to feelings of alienation or anomie; part of it may be the need to help people achieve relationships that are more lasting; but most of it is to try to apply to others what we have experienced ourselves. What we have experienced and enjoyed, others should be able to choose to share. What we or our constituents have experienced or hated, others should have a better chance of avoiding, or choosing to avoid if they want to.

It is a matter not of laying down laws of social behaviour, but of trying to spread information and knowledge. The hon. Member for Croydon, North-West (Mr. Wicks) was director of the family policies study centre, which made available such information to people of all ages and to those moving through the stages of life.

If I were to make one criticism of our approach to social and economic policies since the last war, it would be that we have forgotten to bring the individual and family life cycle, and the family and household perspective, into our social and economic planning. For that matter, we do not normally gather our statistics in a way that enables us to monitor how cohorts are developing and changing. The European Union could usefully provide framework funding so that a new cohort study could start every seven years and each cohort could be re-examined every seven years. Researchers who wanted detailed information would not then have to argue with Government Departments and research funders to start from scratch, because they could tie in to the framework system and it would be far easier to research such issues.

I will share with the House an illustrative example of how such an approach can work, although we did not use one of the famous cohort studies. When I became a junior Minister in the Department of Transport, someone asked me what I would do to improve road safety. I asked how we would notice that there had been an improvement in road safety and the answer was that we would see a cut in the casualty figures. So I suggested that we start by trying to cut casualties. We then looked at the dominant reasons for casualties—crashes. Of the factors associated with injury crashes, 90 to 95 per cent. involve the road user's mistake, 30 per cent. involve some obvious defect in the road environment and 8 per cent. involve a vehicle defect, as conventionally defined. The most common factor was young men who had taken alcohol above the legal limit and then driven.

We then found a clue as to how to approach the problem, which was not to change the law. The clue came from research on a campaign that I inherited on drink driving in December 1986. The research in early 1987 showed that a high proportion of the target audience had received most of the message from television advertising. Fine, but there had not been any television advertising. What had people been seeing? They had seen news and current affairs coverage of the launch of the poster campaign.

If we need to change people's understanding of a serious subject, which is the first step towards changing their behaviour, why do we rely so much on paid-for advertising on only half the television channels? If the subject is important, it should be discussed and argued in mainstream life. If we can do that for a possible one in 50,000 chance of thrombosis caused by a brand of contraceptive pill, we should be able to do it for behaviour that in those days killed 1,200 people a year.

So we started trying to get young people to discuss the issues. At that point, it became obvious that instead of a 44-year-old Minister, as I then was, talking on Radio 4, we needed a 58-year-old disc jockey talking about the issue on Radio 1.

Once the issues were talked about in the media with which people were familiar and were not preached about, we started seeing a change in understanding. That led to an estimated cut in the number of occasions each week on which young men drove a car when they were above the legal limit, from 2 million times a week—which is low compared with France, Germany or the United States, although still a large number—to 600,000 within two years. Two thirds of an illegal, socially acceptable, body-breaking habit evaporated with no change in the law, sentencing or enforcement.

Let us suppose that we start being concerned about issues such as school attendance. The figures are improving now, but about five or six years ago, a third of young people aged between 14 and 16 and who attended inner-city schools were not in school. Whatever happened to the teacher-pupil ratio in those schools would not have helped those young people.

The approach can be used to tackle other issues, some involving behaviour that is against the law and others involving behaviour that is undesirable.

I have estimated that the number of times each week that young people, normally young males, commit a serious criminal offence for the first time, is 2,000. A third of men have already collected a serious criminal conviction by the age of 30, and the mathematics easily cascade down to at least 2,000 people committing a serious criminal offence for the first time every week. That problem is never discussed in the media relevant to those young people. No one person can be expected to stand up against a culture in which certain behaviour is acceptable or predictable, and we have to try to make it a more general issue.

The number of people each week who for the first time take up smoking is 5,000. That is 250,000 a year. But when we see a young person smoking, our only response is, "You are too young to smoke." Perhaps the more general response is to take up the argument about banning the remaining tobacco promotion. We do not say that taking up smoking is a relatively normal thing for a child to do, but not for adults. Smoking may be an adult thing to do, but it is not adult to start smoking, because that is irrational.

We see young people smoking who are in their teens or older. We see some of those people standing outside their offices having a quiet fag. Instead of looking them in the eye and saying, "What a blithering idiot you are, spending more each day on tobacco than most people spend on the national lottery in a week," perhaps we should develop an idea that I have had, having seen people wearing red ribbons. One feels sorry for them, because they or a friend of theirs have been affected by HIV or AIDS.

Perhaps we should develop a new and accepted reaction, by looking away from the smoker and rubbing our hand down our cheek as if rubbing away a tear. That would be a way of saying, "I am deeply sympathetic. I am so sorry." Most people, especially when they are young, can take criticism; what they cannot take is sympathy. I suspect that if smokers found themselves getting sympathy two or three times a day, their numbers would fall away quite quickly.

Each week 6,000 people contribute to a conception that ends in an abortion. The House has been good in saying, "Let us fill Trafalgar square one Sunday with a quarter of a million saying that the unborn child has a right to life, but with a quarter of a million people saying the next Sunday that a woman has the right to choose." But we still have about 150,000 home-grown abortions a year. It takes two to tango, so 300,000 people are involved.

Most of the response tends to come from hon. Members, often Tory, including perhaps a 44-year-old. First, we say, "Don't do it." That is as if celibacy is something that we can inherit from our parents. We then say, "If you do it, think about family planning or birth control." I suspect that average active people leaving, perhaps, a new Labour drinks party, a Tory one or a Liberal Democrat one for that matter, except that the Liberal Democrats seem to have gone to a party already, do not say, "Let's plan a family. Let us control births." They will say, "Let's be closer than sharing a toothbrush." If they are to be bold enough to do that, let them pick their embarrassment beforehand. Do they want to talk about the embarrassment of conception afterwards or the embarrassment of discussing conception control beforehand?

I suspect that if we were rather more open about those issues, we would find the number of people becoming involved in conceptions that end in abortions falling from 6,000 a week to about 3,000 and then to about 1,000 within months.

One of the reasons why such matters are not discussed is that we do not have statistics in reasonably real time. We know each month the unemployment figures and the retail prices index to one place in a thousand, and we tend to discuss them. If we had available to us social statistics on age participation in crime, or if we found a way of producing surveys of the number of 15 or 16-year-olds taking up smoking, and we talked about them, we would begin to see changes in the figures. We would begin to discover what sort of interventions made a difference.

On drink driving, I was given much encouragement, to put it gently, from programmes such as "Panorama" saying that the only answer is mass random breath testing. Esther Rantzen on "That's Life" advocated mass random breath testing. The British Medical Association and police officers took the same line. They were all saying that a technique that appeared to have worked in New South Wales was the answer for us. But if we reduced drink-drive deaths from 1,800 a year in 1979 to 1,200 in 1986 and to 550 now without random breath testing, we must have been doing something more effective than the practice and experience in Australia.

I happen to believe from experience that Parliament can do three things. First, it can pass laws, which are quite good at turning offences into criminal offences. That does not necessarily stop them happening. Secondly, it can be quite good at giving people rights. Thirdly, it is quite good at giving people a dispute resolution system through the courts or in another way. Unfortunately, it is not particularly good at changing people's behaviour.

I am quite a big believer in spending money on the right things. For example, let us spend money if that is the answer to poverty. However, we would do better sometimes in providing help to get more people to move from income support to becoming taxpayers when they choose to do so. Rather than saying, "Squeeze those on benefit," or, "Tax those who are in work," it would be better to move people from one to the other.

I shall interrupt myself. We have not had a serious debate in the House about—we do not have a word for it—something that might be a called a wedge or a social cost to income ratio. If I were to employ an extra person at £200 a week, he or she would probably take home about £150 or £160. The cost of employing that person would not be £200 a week, which is officially the salary. It would probably be about £270 plus some other overheads. So the ratio of the £160 to the £270 is an uplift of quite a heavy proportion. People work for what they end up with in their pocket. The cost to the employer is what he has to pay out. We do not yet have a word to describe that ratio. That is one of the reasons why people cannot easily move from being out of work, and probably on income support, to being taxpayers.

Tax and spending can make a difference, but they are not the reasons for the biggest differences in social behaviour. Anyone who believes that restoring the child tax allowance or lifting the married person's tax allowance is the way to keep families together has not been paying attention to the basic improvements in some of those issues over the past 20 years. The child tax allowance gave extra help to higher taxpayers, no help to non-taxpayers and roughly the same to people in work. People should realise that going on to the child cash allowance is a better idea.

I argue strongly that the level of the child cash allowance should be set by the Chancellor and not, in theory, by the Secretary of State for Social Security. It is the equivalent of a tax allowance. It has the same purpose as a tax allowance. It should be set by the Chancellor.

Secondly, I would make the cost of the child cash allowance come from the income from tax revenues rather than treat it as part of public spending. We do not treat tax expenditures of personal allowances as social spending, so we should not do so for the child cash allowance.

For those who argue that the married man's tax allowance should go up, let us remember that half those who receive that allowance have a spouse who is working and half do not have dependent children, so it is the least targeted way of helping people when they have children.

The third thing that the Government could do is to go for exhortation: make a speech about a subject. If it was a really serious speech, the Minister could make a series of them around the country. At least we would get on with running the Department while he was away.

Those who make proposals for changes in the law—changes in tax and spending—and for the continuation of exhortation, should have an understanding of the situation. We should always try to make available to others the background on why we consider a change to be necessary or important. Once that understanding is shared—as in the drink-driving example and the other examples that I mentioned—we can begin to achieve social advances that will match the economic advances. I am not particularly interested in people having more and foreign holidays, more cars and more discretionary money to spend, if they find that, outside their front door or at different stages of their lives, life is unnecessarily miserable.

We cannot hide the fact that life ends in death, and often in disease and illness as well, but we can avoid much unnecessary disadvantage, distress and handicap. We have not yet found a way to bring those issues to the public's attention. If we were to have a big debate now about the future of Europe, the House would be packed with hon. Members whose views we know already. They would not be bringing forward their constituents' views.

We in the House represent housing estates, whether social or private housing, the ups and downs, the different ages and stages, and we should do that rather better, so that the social advance over the next 25 years matches what we can expect of the economic advance.

1.23 pm
Mr. Clifford Forsythe (South Antrim)

Northern Ireland's constitutional position has been regularly discussed in the House, and sadly the security situation also requires much attention from right hon. and hon. Members. The media in general prints many column inches and uses many feet of film and tape to cover both subjects.

While that is understandable in our sad situation in Northern Ireland, one of the casualties is the lack of attention given to the many social problems experienced every day by people of all shades of opinion in Northern Ireland. I am almost certain that my remarks on social affairs could be applied to many other parts of the kingdom, although each area has its particular slant on the subject.

I welcome the commitment in the Gracious Speech to treat the fight against drug misuse and trafficking as a priority. The problem has grown steadily in recent years. Unless resolute action is taken, the robberies and assaults—and, yes, the murders—associated with that evil trade will get out of all control and adversely effect the lives of all our citizens.

The same paragraph of the Gracious Speech states that priority will be given to action to protect and improve the environment. "Environment" can mean many things; it can mean the football field that I used to play on; it can mean the trees, the rivers or even the roads. I wish to mention another little part of the environment: the living space that surrounds our homes. In his remarks on the Gracious Speech, the Prime Minister mentioned with pride the number of people who had purchased their own homes. Most of us agree that it is good to have responsible home owners who take pride in their homes, but what about their surroundings?

Tenants were encouraged to purchase their homes from the local authorities. In Northern Ireland, it was from the Housing Executive. They may be paying less for a mortgage than they used to pay for rent. So far, so good. They own their dwellings but their neighbours are often still tenants. They are good friends with their neighbours, especially their next-door neighbours. However, one day their good friends and neighbours next door move away and in come new tenants. Those people are not good tenants; indeed, they are outrageous. They play loud music at all hours of the night and in the early hours of the morning; their children pull down the fences; windows are broken; broken cars appear on their drives; and large dogs roam around, frightening people and creating mayhem.

Gradually, the people who are still tenants get transfers from the local authority or the Housing Executive, leaving the few home owners to cope with the bedlam. They have no escape because they cannot sell their homes. The police say that they must catch the culprits in the act. The local authorities say, "We are sorry but you are now home owners and you are not our responsibility." I hope that action will be taken on that environment. It is not a great advantage to own your own home in what rapidly becomes a rundown and hostile environment that other people avoid at all costs.

Of course a similar situation can arise for tenants and I have experience of how elderly tenants suffer from youths walking along their bungalows on the ridge tiles and looking through their bathroom and bedroom windows night and day. I hope that action will be taken to help people who live in that sort of environment.

The Gracious Speech promises consultation on measures to help people to make better provision for their long-term care. I am sure that that consultation will be closely followed by us all. However, most of us will be aware that many of those who need such care already feel that they made such provision by paying national insurance contributions over the years. They were given the impression that those contributions would provide for all their social needs, but we now know the truth: to provide all that would be desirable for people's needs requires someone to foot the bill. That bill can either be paid by us today through taxes, by our children and grandchildren tomorrow or, as some have suggested, through reducing the bill by reducing the provision of social services and benefits. Germany has had a taste of that in recent days.

The problem must be realistically faced by the House and not treated as a political football for short-term gain. Everybody and every hon. Member and political party will have to face that. As the total of social security payments rises, it becomes even more important to force fraud from the system so that available finance is targeted at those in greatest need. I strongly support the Secretary of State's proposed Bill to combat fraud and I support the other measures.

I am sure that all hon. Members could recount cases of fraud that have been reported to them over the years and I sincerely hope that we can expect action in this area as soon as possible in that part of the United Kingdom for which the Secretary of State for Social Security does not have responsibility—in Northern Ireland. I hope that the Social Security Agency there and the Department that is responsible now have a strategy in place: they did not have one in place when we took evidence from them almost a year ago.

It was illuminating that when checks were being carried out by Department of the Environment transport section inspectors on private hire taxis, 40 per cent. of those who were stopped and questioned had to be reported to the Social Security Agency for further investigation. That is a measure of the problem. Probably they were not all guilty. Nevertheless, 40 per cent. of those stopped were reported.

We all want eligible claimants to receive their entitlement but it is essential that those who defraud the system are detected and dealt with at an early stage. Nevertheless, all claimants should be treated courteously and hassled only when fraud becomes apparent.

There have been many recent changes to social security legislation and more problems have landed on my desk from constituents. The system for dealing with claims seems to have slowed down. I suspect that it is mostly due to the legislation's increasing complexity. Changes are difficult to absorb quickly and the system needs a chance to settle down before other changes are made.

At this stage, I take the opportunity roundly to condemn the cowardly and outrageous threat a few days ago to Benefits Agency staff by a telephone caller to the Falls road social security office. Such threats are disgraceful. I remind everyone that the staff merely implement, at the coal face, as it were, the legislation passed by the House. I am sure that the House will join me in congratulating all social security staff, but particularly those in Northern Ireland, who do an excellent job in difficult and sometimes, as I have illustrated, dangerous circumstances.

I have also been made aware of hold-ups in arranging tribunal appeals, so I checked the system in Northern Ireland and discovered that it was a bit similar to that of some of the quangos of which we in Northern Ireland are not particularly fond. I discovered that the president of the tribunals is appointed by the Lord Chancellor's Department and that the chairman is appointed by the Lord Chief Justice. Even though the "Public Bodies" book shows a president for each of the four appeal tribunals—the child support, disability, medical and social security appeal tribunals—I discovered that the president was the same person for each and that the chairman was the same person for each.

In a smaller part of the United Kingdom such as Northern Ireland, that is perhaps understandable. Do we want to appoint all those presidents or chairmen? I then discovered, however, that all the tribunal members are appointed by the president, so the president appoints 52 male and 38 female tribunal members. With that number of members, why do appeals take so long to be heard, and if the president and chairman cover all four bodies, do any of the members serve on more than one tribunal? I shall investigate further and perhaps have the opportunity to report to the House on another occasion. Perhaps it would help if the names of the people who serve on such bodies could be included in the 1996 edition of "Public Bodies".

The Government's programme up to the general election is before us. In saying that, I understand that two extra important items have been added. My party will examine carefully the fine detail of all those measures and will play its part by supporting or opposing them as appropriate for the general good of the country and of Northern Ireland in particular.

My party regrets that although Northern Ireland is an integral part of the United Kingdom, references to it in the Queen's Speech appear in that section devoted to external affairs, which offends us. My party and I are also disappointed that we still have to suffer Northern Ireland business being dealt with by Orders in Council.

1.40 pm
Mr. Tom Cox (Tooting)

I listened with great interest to the Secretary of State for Health. Few right hon. and hon. Members, to whichever party they belong, disagree about the importance of primary health care and family doctor services, which we all want to see developed. However, we did not hear in the right hon. Gentleman's lengthy speech any explanation of how his proposals fit in with the current situation in the health service and of the source of their funding. Who will pay for the kind of developments mentioned this morning?

St. George's in Tooting, in my constituency, is one of the largest hospitals in the United Kingdom. I spoke in two debates last year of the problems that afflict that hospital, which were also the subject of an entire "World in Action" programme. Subsequently, I received a large number of letters from not only my constituents but people throughout the country. They wrote, "The remarks that you made about the hospital in Tooting are the same that we would make. We have an excellent hospital with superb, dedicated staff, but it is being pushed to the limit by Government policies."

The situation was bad enough last year, but Merton, Sutton and Wandsworth health authority—which covers a large number of parliamentary constituencies—is now confronting a major crisis in respect of St. George's, which faces a deficit next year of more than £14 million. Last year, I spoke of the conditions in that hospital's accident and emergency unit, where seriously ill people were left lying on trolleys in corridors for hours because there were no hospital beds for them. Wards were closed because the health authority did not have the money to open them or to employ the necessary staff. Sadly, the situation has not improved over the past 12 months.

I heard the Secretary of State's comments today about the new proposals on primary health care, but I must ask how the proposals will help to deal with the problems that we have faced in my health authority for such a long time. In recent weeks, we have heard of the total closure of treatment waiting lists for some medical conditions. No more names will be added to lists for hip replacements, cataract operations or for the treatment of varicose veins. At a meeting in the House a few days ago, we were told by senior health representatives that, because of financial problems, they envisage that they will be permitted to perform only about 25 per cent. of the operations in the next year that they have been able to perform in past years.

I am sure that all hon. Members hold advice services at which they meet people from all types of backgrounds. A couple of weeks ago, I met a lady at my advice service who told me that she was 50 years old and suffered appallingly from varicose veins. She has a very sympathetic doctor, who has helped as much as he can, but she said—this was backed up by her doctor—that the tablets that he prescribes for her no longer provide any benefit. She said that her health problem is not life threatening, but that her quality of life is continually declining. She is not able to pay for a private operation. She told me that, unless someone makes some medical provision for her, someone else will soon have to provide her with other services, because she will no longer be able to perform the tasks that she has been able to perform for so much of her life. I am sure that all hon. Members can speak of similar cases.

In the past few days, all hon. Members should have received a letter from the British Medical Association. If ever there was a damning indictment of what is happening to health services in the United Kingdom, this is it. The letter states: The BMA held a press conference today to highlight the concerns expressed by doctors throughout the country about the implications for patient care due to chronic underfunding of the NHS. There are massive health authority deficits, rising waiting lists, and non-emergency procedures will virtually cease in many parts of the country. Patients who are not emergencies but who genuinely need treatment are waiting in pain and distress, and their diagnoses are being delayed. From doctors' reports, it appears that the crisis is more widespread and deeper than in previous years with doctors facing these problems only halfway in the financial year. That statement is a description of what is happening in my constituency.

The list attached to the BMA's statement shows how many areas of the United Kingdom suffer from the same problems: Oxfordshire, Lancashire, Devon, Cornwall, North and South Thames, Derbyshire, the midlands, Scotland, Wales—across the United Kingdom. The BMA has provided documentation about the scope of the crisis that we are facing.

Earlier in this debate, some hon. Members mentioned accident and emergency services. I have already mentioned A and E services at St. George's. The Evening Standard of 23 October 1993 contains a full-page article entitled "One woman's diary of her struggle in a London accident ward". My only quote from that article is that it is a startling picture of the treatment Londoners are receiving. That clearly shows the enormous problems faced not only by the people of London—other London Members of Parliament have touched on that subject today—but by people throughout the country.

Another matter is causing great concern in my constituency and at St. George's. We have a hydrotherapy pool that is in constant use. All hon. Members will agree that the use of a hydrotherapy pool to treat certain medical conditions is, without doubt, of enormous benefit to sufferers. The pool is currently open because a Hong Kong business woman made a £350,000 donation—it costs about £70,000 a year to run. We have been told by the health authority that the pool will be closed next year because of a lack of money. When hon. Members consider that it is estimated that the area will have a deficit of £14 million next year, the case presented by me and by other Members of Parliament for the area looks hopeless. One has to be realistic and ask whether we have any real chance of keeping the pool open in the face of such an enormous deficit.

That brings us back to the theme of the debate—primary health care. We are losing the essential day-to-day health services that are so crucial. Against the background related by hon. Members today, one has to ask where the Government's targets are now. We have heard a great deal about targets for the patients charter and waiting lists, but, when set against the enormous problems, one has to wonder what relevance they will have. I cannot believe that the public will see them as credible.

I know that my hon. Friend the Member for Ilford, South (Mr. Gapes) wants to speak, so I shall make only one more point. In his opening remarks, the Secretary of State made much of primary care and family doctor services. Doctors in my constituency warmly support such action—we want progress to be made. But local people must have access to the sort of services that they need now. They should not have to wait until a condition is life threatening, as has the woman I described who was refused urgent hospital treatment. Treatment that is crucial to our constituents is, sadly, unavailable to them.

I have sat in on the debate since it started and listened to all that the Secretary of State said, but not once have we heard how his proposals are to be paid for. With the enormous problems that exist within the health service, one has to question the Government's sincerity in presenting a Bill while refusing to tackle those problems.

1.53 pm
Mr. Mike Gapes (Ilford, South)

In the time available, I cannot cover all the points I had hoped to cover, but I wish to start with an extremely important one—it is a disgrace that the adoption Bill is not being brought forward at this time. Such a Bill would have been passed easily by the House and would have commanded widespread support, especially among the millions of people who are step-parents, who have step-parents or who are the siblings of stepchildren.

There was a renal possibility of important action being taken to which the revious Secretary of State for Health was very committed, as was the hon. Member for Battersea (Mr. Bowls), formerly a junior Minister at the Department of Health but now the Under-Secretary of State for Transport. Apparently, the Government have again given way to the reactionary views held by some of their Back Benchers and have decided not to bring forward the proposals.

I shall concentrate on the problems suffered by Redbridge and Waltham Forest health authority and north-east London generally. The Under-Secretary of State for Health, who has just resumed his seat, will recall that, a few months ago, in an exchange with me, he at least admitted that my constituents were experiencing special problems. Those problems are getting worse.

The bogus league tables produced by the Government show that seven of the 20 worst performing trusts in the country are in the North Thames health authority area and in Essex. In my health authority are Forest Healthcare NHS trust, the second worst performer in the country, and Redbridge Healthcare NHS trust, the sixth worst performer. Havering Hospitals NHS trust and others nearby are also in the bottom 20.

For many years, there has been a serious loss of hospital beds in central London, which has had knock-on consequences out into north-east London and Essex. My health authority is discussing with five local trusts a scheme to manage the crisis in accident and emergency care expected this winter.

We have a health authority with a £2.9 million deficit. We have Redbridge Healthcare NHS trust, with a predicted deficit of between £500,000 and £1 million. We have Forest Healthcare NHS trust, with an on-going £8 million deficit and a programme of change to try to manage that. The deficit is partly due to the double running costs of the large Claybury mental hospital, whose recent closure had been planned for 20 years.

In the same health authority we have the large Goodmayes mental hospital, which is due to close by 1999. We are told that it will be reprovisioned by the private finance initiative. Do not hold your breath. We expect that to have serious costs. I do not know what their impact will be, but I guess that they will place an already stressed budget in extreme difficulty.

Local newspapers regularly report problems in accident and emergency departments. We read that the need to provide beds for A and E causes elective operations to be cancelled. In August—a relatively light time—at the Redbridge Healthcare NHS trust, King George hospital cancelled 25 elective operations a week.

The position is very bad, but the adjoining Barking and Havering health authority is to close the A and E department at Oldchurch hospital and concentrate all services at Harold Wood. The nearest hospital for people who live in Barking and Dagenham is not Harold Wood but King George in Redbridge, on the Al2. It is estimated that, every year, another 20,000 people will attend the A and E at Redbridge—a hospital built for 50,000, which is already coping with 70,000. My constituents' operations for elective work will be cancelled to make space to allow for the additional pressure on that hospital from the accident and emergency department.

We are in crisis already, and the Government are not providing the necessary resources. I have a message for this Government and the next Government. The problems in the North Thames regional health authority area and in north-east London are acute, and my constituents already cannot cope. We have hard-working, dedicated nurses and midwives in our hospitals. It is reported that 12 nurses—disastrously, a third of the nurses in the department—left the A and E department in King George hospital in the past few weeks because they felt that management was not preparing adequately to meet the expected problems. The Government should be prepared to admit that there are special problems. North Thames health authority and Redbridge and Waltham Forest health authority need resources to solve the imminent crisis in accident and emergency services and to prevent the cancellation of operations that will otherwise be necessary well into next year.

I do not have time to say more. Those problems must be dealt with now, or we will face unmitigated disaster in the next few months.

1.59 pm
Ms Harriet Harman (Peckham)

It is difficult to do justice to the extremely thoughtful contributions of hon. Members on both sides of the House to this wide-ranging debate. We have talked about the state of society, guns, drugs, adoption, child abuse, general practitioners and hospitals.

Mr. Burden

Does my hon. Friend agree that the debate should perhaps have covered accountability of hospital boards? Is she aware of the apology recently made by Mrs. Pat Marsh, the chair of the Birmingham Children's Hospital NHS trust, for her remarks at the Conservative party conference? She cast an outrageous slur on Labour party policy. The script of the video shown at the Conservative party conference was no doubt approved by the right hon. Member for Peterborough (Dr. Mawhinney), so he, as well as Mrs. Marsh, should apologise to the people and patients of Birmingham.

Ms Harman

I totally agree with my hon. Friend.

In his response to the Queen's Speech on Wednesday, my right hon. Friend the Leader of the Opposition said that the Government must be judged on their record. It has clearly emerged from today's debate that the Government's record on social security is a record of failure. The best welfare is work, and the Government have failed on welfare because they have failed on work. None of the Bills proposed in the Queen's Speech will set that right.

The Government have failed to achieve even the social security objectives that they set themselves. They said that they would reduce dependence on benefit, but the number of people on means-tested benefit has doubled. They said that they would cut social security spending, but the social security budget has risen. They have failed people who are without work, their families and their communities and they have failed the taxpayer, who must pick up the bill.

The Government have failed because they refuse to tackle the causes of the problem. They blame the rising social security bill on the people who claim benefits. Their approach is founded on the view that the unemployed will work only if their benefits are cut enough. The result is a social security system that becomes more and more expensive, and more and more brutal and degrading for those who depend on it.

The poverty that drives up the social security bill is a direct consequence of the Government's policy of high unemployment and low wages. They ignore the plight of the people at the bottom: the marginalised and excluded in a divided Britain and a fractured society.

Mr. Lilley


Ms Harman

I shall give way to the right hon. Gentleman, although it is hard to understand how he can disagree with the notion that we have a divided Britain and a fractured society.

Mr. Lilley

The hon. Lady is wrong to say that the current rise in the social security budget is due to rising unemployment. We, almost alone in Europe, have falling unemployment. The biggest and most rapid rise in the social security budget relates to the state earnings-related pension scheme. The hon. Lady opposes our measures to cap the growth of SERPS. The biggest unexpected growth in the budget comes from the increasing numbers of elderly people who are living longer. That is not the price of failure; it is the price of success. The next biggest source of growth comes from the increasing availability and generosity of benefits to disabled people. Does the hon. Lady count that as a failure or as a success?

Ms Harman

I shall deal with the points made by the Secretary of State in an intervention only one and a half minutes into my speech.

It is no good the Secretary of State quoting unemployment figures. His budget and his benefit bill cover many people who are of working age but who are not working. They, too, must be taken into account. I shall deal with that matter later.

The Government said that unemployment was a price worth paying, but look at who is paying the price. The young man who has left college; despite his hard work at school and college, cannot find a job and feels that he has been thrown on the scrapheap before he has even begun. Look at who is paying the price—the man who lost his job two years ago and still cannot find another, despite his skills, because no one wants those skills, and the woman bringing up her children on her own, who wants to work but cannot. The price is being paid by their communities, which are shattered by poverty and unemployment.

Labour believes that work is the best form of welfare for people of working age. Work restores dignity to individuals and helps to rebuild communities. But when unemployed people get work, too often it is low-paid work which must be topped up by benefits, or it is insecure. People get a job one day and lose it the next. High unemployment, a low-wage economy, an insecure labour market—that is the Tories' record and there is nothing in the Queen's Speech to deal with those problems.

Matters do not have to be like that. We will tackle the problems to get people off benefit and into work because that is the only way fairly and justly to reduce the social security bill. Our priorities are clear. On unemployment among young people, for example, we will end the situation where young people see their father and mother out of work and are themselves consigned to a life on benefit, the second generation unemployed—not wealth cascading down the generations, as the Government promised, but despair and poverty.

We will impose a windfall levy on the unfair and excessive profits of the privatised utilities to pay for a new deal for those under-25s who are excluded and left out. We will help the long-term unemployed back into work with a tax break for employers who take on those who have been unemployed for more than two years.

We will do more. There are 1.5 million women bringing up children on their own. Under the Conservatives, lone mothers have the lowest employment rate and highest benefit dependency rate in Europe. British single mothers are less likely to be working to support themselves and their children and are more likely to be dependent on benefit than single mothers in any other country in Europe. The position is getting worse. More women who are married or cohabiting and who have children are going out to work, but the number of lone mothers at work has fallen. Lone mothers are the ones who most want and most need work. Surveys show that 90 per cent. would work if they could. They do not want to depend on benefit, but they are trapped.

I recently spoke to a woman called Beth who lives in Manchester. She is bringing up three children on her own. She had a job, but had to give it up. With the cost of her child minder and the loss of her benefit, she was worse off in work and now she is back on benefit. She and her kids are living—existing—on £120 a week. She does not want a hand-out; she wants a hand up. She wants to work, but she cannot do it on her own. She needs Government support to overcome the barriers that are shutting single mothers out of the world of work and trapping them on benefits: the problems of matching work with school hours and making work pay.

The Government's failure to act hits everyone. Mothers who cannot work are stuck on dependency and the taxpayer picks up the bill, to the tune of £10 billion a year. Most important, perhaps, is the fact that those women are bringing up children who see nothing of the world of work and expect that their fate will be the same as their mother's—to depend on benefit. I see that clearly among my constituents in Peckham. They want to work not just for themselves, but because they do not want to bring up their children to expect benefit.

Mothers need basic advice and information, the chance to train and gain new skills, and child care. That is the purpose of our programme for single mothers. We will give advice and information. We will make sure that single mothers have their own adviser who will look at the difficulties of their circumstances and will help them to find the jobs, training and after-school care that they need.

We will create more nursery places by scrapping the costly and bureaucratic nursery voucher scheme and we are examining how to use some of the deadweight of the £10 billion spent on income support and other benefits for lone mothers, by transferring some of that money to support a network of after-school clubs. Such clubs would be good for mothers, good for communities and good for children. It is good for children to be involved in what the hon. Member for Eltham (Mr. Bottomley) referred to in his thoughtful speech as worthwhile activities. In after-school clubs, children can enjoy art, sport, homework, chess and many other activities. The Tories just say to lone parents, "Here's your weekly giro. Come back when your youngest child is 16." That is not good enough.

After four years of denigrating and sneering at lone mothers—remember the Secretary of State's little list not so long ago of women who get pregnant to jump the housing queue—I suppose that we should be grateful that at least he has come up with a pilot project, "Parent Plus". We welcome the U-turn in his language, but his policy is still to attack single mothers. We fully expect that he will cut or freeze the value of benefits for lone mothers in the social security uprating, without giving any help to get them into work. It is not so much a carrot and stick approach as a fig leaf and stick. Some 1.5 million single mothers will have their benefit cut, with possibly—only possibly—10,000 receiving advice.

Government failure has meant that dependency has stretched from the cradle to the grave. The Secretary of State mentioned people in retirement who were dependent on benefit. That is due in large part to the Government's failure to ensure a safe and secure second-tier pension in which people can invest during their working life to ensure that they do not retire on to means-tested benefit. They have cut the value of the basic state pension, they have cut the state earnings-related pension scheme twice, they have put VAT on gas and electricity and people have had to sell their houses to pay for long-term care. The Government have betrayed pensioners.

We have plans for action to support people moving from benefit to work and to ensure that they can save for their retirement so that they do not retire on to means-tested benefit. We are proposing action that people want, which will also reduce the social security budget and its burden on taxpayers.

The Secretary of State is nothing if not brazen. First, the Government create the conditions for housing benefit fraud on an unprecedented scale, then the Secretary of State blames local authorities for causing that benefit fraud, even though 90 per cent. of them have exceeded the targets on fraud that he set them. Having caused the problem and blamed someone else, he expects credit from the House for his actions to bring a partial halt to the fraud that he has created. I very much fear that, were it not for my hon. Friend the Member for Birkenhead (Mr. Field) and the work of his Social Security Select Committee, we would not have even that partial measure. I hope that the Secretary of State will take up my hon. Friend's sensible and practical proposals, but the Government's proposals, as they appear at the moment through briefings in the papers, appear not to tackle the heart of the problem that they have created. We have yet to see the Bill, but I fear that it will need to be strengthened massively.

The Government have borne down on claimant fraud, but they have ignored landlord fraud and have failed to tackle the major problem of organised fraud. We propose that the Government should give local authorities greater powers to fight organised landlord fraud. The Social Security Select Committee found evidence of widespread abuse of the housing benefit system, amounting to one fifth of all direct payments of housing benefit to private landlords.

Local authorities should have the power to refuse direct payments to private landlords in all but the most exceptional circumstances to stop phantom tenancies. Councils should be required to provide details of payments to landlords direct to the Inland Revenue to make sure that they pay their income tax.

Today's debate and the limited proposals that will be set out in the Bill on fraud show that the Government have nothing to offer on social security. All their promises have been broken. The Government hand out benefits and then blame the recipients. They leave people trapped in poverty, dependence and hopelessness. Governments and communities have to bear the cost of Government economic failure. We would offer a partnership between the individual and Government to tackle unemployment, low incomes and the disintegration of communities.

The British people have heard all the Government's promises before. Indeed, they have heard them over and over again and they have seen them broken. They are saying, "Enough is enough." It is time for the Secretary of State and his Ministers to make way for Labour so that we can bring hope and opportunity to the young unemployed, to the long-term unemployed and to the mother who is trying to bring up her children on her own.

2.15 pm
The Secretary of State for Social Security (Mr. Peter Lilley)

I begin by paying tribute to the hon. Member for Islington, South and Finsbury (Mr. Smith). I had the pleasure to be shadowed by the hon. Gentleman for the past year or so and I came to admire the ability and integrity that he brought to his role as shadow spokesman on social security matters, which he fulfilled with distinction. I did not think that he deserved demotion in the last reshuffle.

That is not to say that the hon. Member for Peckham (Ms Harman), whom I warmly welcome as my shadow from now onwards, has not fully earned her promotion. I know that she will bring her immense dedication and commitment to her new role and the expertise that she acquired when she was formerly an Opposition shadow spokesman on matters concerning the Department, and during her previous career at the National Council for Civil Liberties. I rather suspect that because of that earlier background she and I may find that occasionally our approach to various matters, including some that will be set out in the Bill referred to in the Queen's Speech—I attach great importance to the forthcoming legislation—with have rather more in common than that of rather more gung-ho Back-Bench Members on both sides of the House.

I welcome the hon. Lady in the particular hope that she will bring the same warm and personal endorsement to our policies on social security as she brought to those on schools. I suspect, however, that if she ever chooses a private pension for herself she will probably still want to force the rest of us into Labour's state scheme.

As the hon. Lady said, this has been a valuable debate. It began with my right hon. Friend the Secretary of State for Health, who asked me to convey to the House his apologies for his absence, comprehensively demolishing Opposition arguments about the health service. He set out a positive programme that will be contained in the legislation on primary care following the Queen's Speech.

We had an interesting speech from my right hon. Friend the Member for Brent, North (Sir R. Boyson), who made a powerful statement on education, on which no one is better placed to speak than he. There was another powerful speech from the hon. Member for Birkenhead (Mr. Field), lucid and original as always. He was right in his emphasis on the importance of education and the damage that is done to people by illiteracy. More and more of our studies show that that is a principal reason for long-term unemployment and it is something that we are determined to tackle.

I am grateful to the hon. Gentleman for his support for the Bills that will stem from the Queen's Speech. I can assure him that we shall have the power to tackle more effectively landlord fraud. The hon. Gentleman mentioned the standard acknowledgement letter and its relevance to child benefit. It is no longer of the same importance as he supposes because asylum seekers are not entitled to child benefit. I know that that is opposed by the Opposition, who are keen to take away child benefit from 16-year-olds but want to restore it to asylum seekers.

My hon. Friend the Member for Chislehurst (Sir R. Sims) welcomed the publication of Bills in draft. He made a valuable speech which was enhanced by his knowledge of the problem of child abuse, having been involved in a recent important report on the subject.

My hon. Friend the Member for Birkenhead made one of the most lucid and knowledgeable speeches in the whole debate. [Interruption.] I should have said my hon. Friend the Member for Beckenham (Mr. Merchant). The two hon. Members have a great deal in common, and I am sure that there will be great Conservative victories in both constituencies in the next election. It was a speech informed by my hon. Friend's great knowledge of fundholding practices and it was very valuable.

The hon. Member for Vauxhall (Miss Hoey) made some brave remarks on guns. She has shown courage on many issues. She raised the issue of asylum seekers, particularly in her constituency, where, as she knows, I have some connections and get some first-hand arm twisting on a Sunday. I shall draw her speech to the attention of my right hon. Friend the Secretary of State for Health, who is directly responsible for personal social services and local authority involvement in that.

My hon. Friend the Member for Eltham (Mr. Bottomley) made another genuinely original and practical speech about his approach to changing social attitudes without coercion.

There were other original contributions to the debate. The hon. Member for Antrim, South (Mr. Forsythe) mentioned the danger of bad neighbours and spoke about the need for legislation in that area. I particularly welcome his warm support, which I echo, for the staff of the social security office in the Falls road and his condemnation of those who threaten them when carrying out their duly to provide benefit for those in need.

The hon. Member for Peckham will already have recognised the supreme importance of the subject that she is now shadowing. It is important not just in this country but worldwide. Reform of social security is the cause of crisis in the coalition in Germany. It has been the cause of riots and demonstrations and strikes in France. It is important because it is so large. It has grown—as I never tire of pointing out to the House—to the point where it costs every working person in this country £15 every working day. That is why we have set out a programme of reform. As well as those contained in the Gracious Speech, the additional Bills will bring to a total of 12 the Bills that we have introduced in the course of the reform programme that I initiated. I believe that it is essential for any Government or anyone pretending to be capable of governing this country to be willing to undertake the very difficult task of reforming the welfare system and not to pretend that it can all be done by mirrors or by spending yet more money.

As we have been going about the process of reform, we have become increasingly aware of two limitations on our legal powers. First, there are legal restrictions on our power to cross check data that we hold about social security claimants with data that are available to the Inland Revenue or Customs and Excise. We have developed powerful computer programmes to cross match data within the Department. It is sensible now to try to apply those techniques to cross checking data between Departments. The public already give us this information, so we are not talking about a further intrusion or burdens on them. It is only right that we should be able to cross check and establish, where there is a suspicion, whether people are working at the same time as claiming benefit.

The second area where our powers are limited is in the handling of housing benefit and council tax benefit. It is, after all, the responsibility of local authorities to handle those benefits. Therefore, they are responsible for stopping fraud. It is the most blinding complacency for the hon. Member for Peckham to suggest that the record of local authorities has been satisfactory and that the only shortfalls are those of central Government, which does not have direct responsibility. The fact is that, until I introduced rewards and punishments for local authorities, the record was even more deplorable. We have achieved a doubling in a single year and a further increase since then. Surely the hon. Lady must accept that there are still local authorities that are not putting as much effort or bringing as much expertise to bear as is needed to prevent housing benefit fraud. That is why the Bill will give us powers to establish an inspectorate and to require local authorities to obey its recommendations. The inspectorate will also be able to inspect the performance of different parts of the Benefits Agency and to offer its advice and expertise to enhance our efforts.

We want to be positive throughout the public sector, but it is important to begin where the need is greatest, as the hon. Member for Peckham frankly admitted. However, most of the Labour party's proposals on the subject are absolute nonsense, which is why she joined her predecessor in signally failing to try to justify or flesh out any of the figures previously published by Labour in its proposal to reduce spending by £1 billion in order to spend that money elsewhere.

The second Bill in our portfolio is on compensation recovery. A key principle in which we believe is the encouragement of responsibility. When employers or others are responsible for accidents at work, the company or its insurers, not the taxpayer, should foot the bill, and we are introducing legislation to ensure that that happens. The victims will be allowed to keep in full the compensation that they receive for pain and suffering and taxpayers will save about £40 million. The overall effect will be to encourage safety at work by giving employers more responsibility, to give a fairer deal to victims and to ease the burden on taxpayers.

In the coming year we intend to build on our programme to get people from welfare into work. I spelt out recently at a seaside resort some imaginative new measures to bring that about. For the first time, we will involve the private sector in the provision of services to help lone parents in particular, and later other unemployed people, back into work. Private firms will compete with Government teams from both the Benefits Agency and the Employment Service. They will be paid by results, so that they will make a profit only if they succeed in helping people back into work and keeping them in work, thereby saving taxpayers' money; it is a win-win-win situation. The proposal is positive, and I am astonished that the Opposition have chosen to rubbish it outside the House and to ignore it within.

The Opposition are right to recognise that the most intractable problem is getting lone parents back to work. That is why we have initiated the parent plus programme. I congratulate the hon. Member for Peckham on having today relaunched the out-of-school-hours child care programme that my right hon. Friend the Secretary of State for Education and Employment has been implementing with great success. The programme has already created about 72,000 extra out-of-school-hours places for an investment of about £48 million and we intend to spend nearly £20 million more to boost it further. I see no difference between the hon. Lady's proposal and what we are already doing.

In his speech, the Leader of the Opposition said that the fracturing of our society was in large measure due to the Government's decision to remove entitlement to income support from 16 and 17-year-olds and to replace it with a guaranteed training place. I invite the hon. Lady to tell us whether the Labour party would reinstate income support for 16 and 17-year-olds.

Ms Harman

We were absolutely right to oppose the Government who, in their attempt to find cuts without getting people into work, ripped away the benefit to punish those who were most vulnerable, including young people. We have said that we will make sure, using the windfall levy from the privatised utilities, that all those under 25 will have either a job or training or a combination of the two or will be in full-time education. They will not simply be left without jobs, training or benefit, which is what the Secretary of State has done.

Mr. Lilley

I thought that I would have got an answer from the hon. Lady, but I did not. I think the sentiment was that we were wrong to remove the benefit but that Labour will not replace it.

My second question is whether the Opposition propose to remove income support from those aged 18 to 25, replacing it with the sort of provision that we have made for 16 to 17-year-olds. I understand that to be the case, although the provision—

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed upon Monday next.