National Health Service

HC Deb 05 February 1997 vol 289 cc1012-67

Madam Speaker

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

3.40 pm

Mr. Simon Hughes (Southwark and Bermondsey)

I beg to move, That this House believes that, of the many improvements the NHS needs, immediate priorities should include the reinstatement of free dental and eye checks, a freeze on all finance-driven bed, hospital and service closures which represent a reduction of service to patients pending the first report of an open and independent assessment of national health demand and provision, a move to three year contracts between health authorities and boards and health providers and the immediate scrapping of local NHS pay bargaining. Parliament is, of course, entitled to debate the state of the national health service at any time. But—and above all just before a general election—it strikes us that politicians should also be obliged to say how they would improve it. Public experience and perception is that, however good the NHS may be most of the time, sadly we cannot guarantee that it will be there to do what we need whenever we need it. We cannot at present in the United Kingdom rely on the NHS to do what it was set up to do. That leads my colleagues and me to the conclusion that, sadly, the NHS is not safe in the Government's hands. We also believe that the NHS would not be safe in a Labour Government's hands.

On the basis of agreed commitments given by the Conservative party, the Labour party and ourselves, we believe that the best guarantee for the NHS after the next general election would be for its management to be in our hands. [Interruption.] The hon. Member for Bolsover (Mr. Skinner) grunts—if he looked at the spending commitments and was honest about admitting the facts, I am sure that he would agree with us. I cannot believe that the hon. Gentleman is happy with his party's current policy.

My colleagues and I also believe that all the Irish parties represented in this Parliament and the Welsh and Scottish Nationalist parties would, like us, be willing and able to vote for a more significant commitment to the NHS than either the Tory or the Labour party.

Mr. David Shaw (Dover)

I respect the fact that the hon. Gentleman is trying to identify some party differences over this subject. But does he not accept that two thirds of the health service has been built by a Conservative Government at one time or another and that two thirds of the hospitals and all the capital projects in this country were built by Conservative Governments? Is not the health service a Conservative success?

Mr. Hughes

The NHS is bigger than all of us. In previous speeches I have paid tribute to the Tory successes and progress in the NHS. I am happy to do so again—I have no problem with that. The NHS is what it is today owing to the efforts of three parties. A member of one of those parties devised and proposed it during the war: our party, the Liberal party. A Labour Government enacted it in the post-war Parliament; they did so with our support, opposed by the Tories. The Tory party has often given it extra resources. I shall not argue with the hon. Gentleman about that, because I accept his point. The issue is the current state of the NHS, and where we go from here.

Mr. Dennis Skinner (Bolsover)

It is true that the Liberal Democrats voted against the income tax cut.

Mr. Hughes

Two years running.

Mr. Skinner

Two years running, as the hon. Gentleman says. We should get the record straight. The Liberal Democrats voted against the last income tax cut, which would have produced £1.8 billion extra to spend on the national health service and education. I did the same. However, the hon. Gentleman will recall that there were three further votes that night on measures to spend money. The Liberal Democrats voted against the reduction in income tax, thereby saving money for the health service and education—or so they said—and then proceeded to get rid of that money by voting against the airport tax and the increase in petrol tax.

I told the Liberal Democrats that I was being consistent, because I voted against the income tax cut. I wanted to provide £1.8 billion, but they and the other rag, tag and bobtails went into the Lobby to spend the money that they had tried to save for the health service. I have never seen so much hypocrisy in one night as I saw on that occasion.

Mr. Hughes

The hon. Gentleman is good at blustering.

Mr. Skinner

It is true.

Mr. Hughes

No, it is not true. Like all good stories, the hon. Gentleman's story is partly true and partly untrue. The truth is that we voted against the income tax reductions two years running. The figure he used was correct: it was about £1.8 billion. So that he does not accuse me of misrepresenting him, I have to say that we proposed that that money should go on education.

Mr. Skinner

Why did he vote against the airport tax?

Mr. Hughes

The hon. Gentleman should listen.

We have also costed—I will willingly give him the figures—the other Budget proposals that we voted for. As I shall set out later, our proposals for the health service—

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

The hon. Gentleman has not answered my hon. Friend's question.

Mr. Hughes

I am answering his question.

Our proposals for the health service will mean extra expenditure that has not already been spent or given away on anything else. The hon. Member for Bolsover is embarrassed, because he voted with us on the income tax reduction. The reality is that our party, unlike the Labour party, is willing to make significant further investment in education and health, which is why we are proud of our record, and will be happy to defend it today.

Rev. Martin Smyth (Belfast, South)

rose—

Mr. Campbell-Savours

Will the hon. Gentleman give way?

Mr. Hughes

I give way to the hon. Member for Belfast, South (Rev. Martin Smyth).

Mr. Campbell-Savours

Perhaps the hon. Gentleman will give way after the hon. Member for Belfast, South has intervened.

Mr. Hughes

I may give way once more, but then I want to make progress.

Rev. Martin Smyth

I appreciate the hon. Member giving way. I understand his response to the hon. Member for Dover (Mr. Shaw), but does he accept that he was only partially right? The bulk of the hospitals in Northern Ireland were built under a devolved Administration, and have been run down ever since.

Mr. Hughes

Not only do I accept the hon. Gentleman's point, but I share his view that the budget for the national health service in Northern Ireland would be better allocated and run by people there following a democratic debate in Northern Ireland rather than in the House. One of the frustrations of Parliament is that we have hardly any time to debate public welfare issues for Northern Ireland—far less time than for Scotland and Wales. The people of Northern Ireland rightfully agree.

Mr. Campbell-Savours

May I press the hon. Gentleman on the issue raised by my hon. Friend the Member for Bolsover? He says that the Liberal Democrats voted in three Divisions to spend £700 million, and in another Division voted to save £1.8 billion. There is a shortfall of £1.1 billion. Is the hon. Gentleman saying that that £1.1 billion would cover all the expenditure commitments that the Liberal Democrats have made in debates on education and the health service? Can I tie him down on those figures? Does he understand them?

Mr. Hughes

I understand them, and I am happy to answer the question.

No, we are not tied to that figure. We have made a commitment to put an extra £2 billion into the education service. I shall outline our commitment to the health service in a moment. If the hon. Gentleman has not already seen them, I will happily send him our costed manifestos for the last election and for the coming one, so that he can see exactly where we would raise the money and where we would spend it.

The debate is timely because the position is similar in each of the four countries of the United Kingdom. The NHS is under pressure; those in the NHS, and the people who use it, feel insecure; and the NHS needs further investment. However, as I tried to point out in reply to the hon. Member for Dover (Mr. Shaw), there is a much more important question than whether the NHS is safe in a particular party's hands at a particular point in history That question is, are the public safe in the hands of the NHS today?

That should be the test of whether we are supporting the service efficiently. Can we give a guarantee to the hon. Gentleman's family, my family and the families and friends of hon. Members and their constituents that, when we need it, the NHS will be able to deliver the care that it is there to deliver, without sending people home when they should be operated on, or sending them around the country when they should be admitted to their local hospitals?

We all know that it is not normally through the failing of any individual—although, of course, individuals fail in the NHS, as in any walk of life—that the service is not up to the job. The fact is that, when competent, well-trained, experienced NHS staff become demoralised, overstretched and under-resourced, they are not good for anyone's health. If the NHS is to be a service fit for patients to rely on, adequate staff and facilities need to be there so that patients can rely on them as well.

The task of all politicians in the United Kingdom—and of the Government of the United Kingdom, whoever they are—is not to ensure that we can "sort of" respond to the NHS crisis of the moment and plaster over the long-term structural cracks, but to insure the NHS for now, and to start securing it for the future.

If we are to be honest with the public, we must admit that there will be no one-election wonder. There is and can be no miracle cure. Demand is rising, costs are escalating, and a national debate is needed about how much health care we can fund and how best we can fund it. That debate will, of course, take place in politics, but it must also take place outside and beyond politics. It is not a moment too late to start it now. [Interruption.]

The Minister may mutter, but, in a recent letter to me the Secretary of State said that he would welcome greater cross-party consensus on the major issues in the NHS. I agree that more consensus is necessary, as do the public, the commentators and the professionals. On behalf of my party, I give a pledge to work with anyone and everyone to obtain the maximum possible agreement that will secure the future of the NHS. The NHS is much more important than any divisions along party lines.

Mr. Robert Maclennan (Caithness and Sutherland)

Is it not unlikely that, by absenting himself from the debate, the Secretary of State will promote consensus?

Mr. Hughes

I find the Secretary of State's absence surprising. I am glad that the Minister of State and the Under-Secretary of State are present, but, if the Secretary of State thinks the NHS as important as he claims, he should be here. This may well be the last debate on the NHS before the general election, which is another reason why the person in charge—in a system that I must say is very undemocratic: no other elected person can be in charge even locally—ought to be present.

Politicians will need to be bold. It is widely recognised that the Tory and Labour parties are not yet rising to the challenge. I am not the only one who says that: it was said the other day on a Radio 4 programme in the "Analysis" series, presented by Andrew Dilnot, entitled "Free for All". Let me briefly quote from what he and Chris Ham, professor of health policy at Birmingham, said in the programme. Andrew Dilnot said: Clearly and unambiguously committed"— the Secretary of State, apparently, is so committed— to high quality, universal, tax-funded healthcare … With both major parties so firm in their backing of the NHS, surely we can just relax in the security of knowing that it will be all right. No, we cannot. In fact there is now a real risk that over the next five years the NHS will cease to be a universal, comprehensive, free service, without any real debate, because neither party"— neither of the main parties, that is— is prepared to promise anything like the rate of growth in spending seen throughout the life of the NHS. Professor Chris Ham said: This year is the toughest year for the Health Service in the last decade. There's always been a funding problem in healthcare because demand exceeds supply of resources, but in the current year that's a particularly acute problem. We're finding that hospitals all around the country, health authorities and GPs, are finding it very hard to make ends meet. In that sense the wheel has come full circle because a decade ago Mrs. Thatcher, when she was the Prime Minister, was forced to set up a review of the Health Service because of the funding problems. That review has led to increased efficiency and greater responsiveness but it's not really tackled the long-term underfunding of the NHS and it's that problem that the NHS continues to grapple with.

Mr. Phil Gallie (Ayr)

Will the hon. Gentleman give way?

Mr. Hughes

Not for the moment: I want to proceed.

Therefore, there is no dispute that there is a long-term problem or that we owe an enormous, probably unspeakable, amount to the work of the people who are in the NHS locally in our constituencies, regionally and nationally. There is no doubt that many of them work under perpetual pressure and often regular crisis in the frontline, saving and extending lives and alleviating pain every day.

The predicted winter difficulties have, in large measure, come to pass. Hon. Members do not have to take my word for it. They just have to read reports in the past couple of days from the Greater London Assn of Community Health Councils and the British Medical Association, or a briefing from the Royal College of Nursing for today's debate. I did not know that it was going to be on, but last night I watched a report on "Newsnight" by Alexis Rowell on the health service in Whipps Cross hospital in north London. The report confirmed the crisis and acute difficulties of coping with people, some of whom testified to spending two days waiting in the casualty department before admission to a ward, and to not being able to get a moment's sleep—understandably, because it is a busy place and that is not where they should have been cared for.

Above all, hon. Members do not have to take the word of politicians or journalists if they talk to people in the health service. This morning, my right hon. Friend the Member for Yeovil (Mr. Ashdown) and I met a nursing student and three nurses: Jerry, an accident and emergency nurse from Homerton hospital in Hackney; Tracey, an HIV and AIDS staff nurse from just across the river in St. Thomas's hospital; and Richard, a senior staff nurse working with older people who are acutely ill. They all confirmed that there is a need for more staff, for better training and for urgent provision of methods to ensure that we keep staff—who, at the moment, often choose to leave. They also confirmed that we have the facilities for patients, who are just not receiving them.

Mr. Matthew Banks (Southport)

Will the hon. Gentleman give way?

Mr. Hughes

Yes, but this is the last intervention.

Mr. Banks

I just wonder whether I could ask the hon. Gentleman, in view of that visit, where the right hon. Member for Yeovil (Mr. Ashdown) is at present?

Mr. Hughes

I do not know the answer to that question, but I assume that my right hon. Friend will be here shortly and certainly he has spent a lot of time in recent days on health service matters.

On the motion and the Government amendment, the big questions are these. Is the NHS doing enough, which in Government-speak is a question about volumes? Is the NHS doing it well, which in Government-speak is a question about quality of care; and has the NHS been given adequate resources, which in Government-speak is a question of NHS spend? My party's view is that, sadly, we are not doing enough, and we are not always doing it well enough; and those two conclusions are not surprising because we are not spending enough.

We have real concerns about the volumes. Where we used to count patients, we now count episodes of treatment. People whom we used not to count as admissions—for example, newborn babies—are now additional parts of the statistics. There is now widespread, probably universal, public and professional scepticism about the Government figures on increased volumes. In terms of separate individuals being treated by the NHS, those figures no longer accurately add up. We believe that the NHS statistics must be collected, verified and reported by a body independent of Government and of party politics. We propose a practical way of doing that. We are worried about the fact that no one independent of the authorities vouches, when people are discharged from treatment, for the fact that that treatment has been properly administered. We believe that the quality of work done in the NHS by the NHS should be checked, verified and reported by a body independent of the Government of the day and of the authorities, and independent of party politics in general. We propose a practical way of doing that.

We also have real concerns about costs. Again, no one independent of the authorities vouches for whether the NHS is given enough resources to do even the minimum amount of work that we expect it to carry out. An assessment of what the NHS needs should be done by a body independent of Government and party politics. Here too we propose a practical way of achieving that. The NHS needs an independent assessment of supply and demand, of the quality of its care and of what we should spend on it.

How we pay for the NHS is a separate question. I suspect that the debate over the next few years will develop our idea of hypothecating taxes instead of simply assuming that the NHS can always win its share from general tax and revenue held by the Treasury.

For us, therefore, three issues must be dealt with: investment, planning and accountability. For us, investment means—above all—investment in staff: doctors, midwives, nurses and allied professions. We are committed to spending an amount equivalent to the cost of 10,000 nurses or 5,000 doctors to get the NHS back to a state in which it can do the job.

Waiting lists must be reduced; they are currently rising. The public should not have to wait, as they often do, for 18 months for routine operations. That requires investment; we have identified the money that can go into reducing those waiting lists. We believe that, over a three-year programme, waiting times could be reduced to six months.

Mr. Gallie

rose—

Mr. Hughes

I have already said no. This is a half-day debate, and I want to give colleagues a chance to speak.

We must also make sure—careful language is called for here—that NHS expenditure keeps pace with inflation. The Government say that they are committed to year-on-year real-terms growth—referring to general inflation—but everyone knows that the NHS costs a bit more, and that, unless expenditure on the NHS keeps pace with NHS inflation, a real reduction in funding will occur.

There has been some debate this week about public sector pay. Last year, the nurses were awarded a flat rate—sometimes topped up locally—increase of 2 per cent., which was below the rate of inflation. This year, according to Red Book projected expenditure on health and community services, and if the award recommended by the review committee, when it is announced tomorrow after the Cabinet meets, is about 3.3 per cent., that amount can, we believe, be afforded.

An analysis of the real-terms growth in the budget for health and community services shows that the 3.3 per cent. increase anticipated by the Government for next year leaves money to spare to allow the Government to agree the recommended increase. We believe that the Government should tomorrow, without demur and without phasing, agree to implement the recommended award; and we would expect the Labour party to agree with us that the money should be paid straight away.

If morale is to be restored to the health service, it is essential to honour an independent recommendation on pay for the 1.3 million people at the bottom end of the public sector. We should stop being distracted by the pay of a very few at the top end—although they seemed to be the preoccupation of the shadow Chancellor this morning. Moreover, we must bring back national pay negotiations. Most of the health service has not even settled yet for last year, which is clearly nonsense. It wastes a great deal of professional time; it wastes millions of pounds. We think that the NHS should have a single pay review body, so that the chief executive and the porter, as well as the doctor, the dentist, the midwife and the nurse, all have their pay assessed at the same time.

Our motion also contains the simple proposal that we reinstate free dental and eye checks—an idea which has the support of Members on both sides of the House, as confirmed by their support for early-day motion 471, which was tabled by the hon. Member for Exeter (Sir J. Hannam).

According to the Minister's answer of 27 January 1997, it would cost £120 million a year to reinstate eye tests, and £60 million a year to reinstate free dental checks—a total of £180 million a year. The Royal National Institute for the Blind confirms that people are becoming ill and are suffering incurable eye disease because of the loss of those free checks. We believe that the House and the public would be united in backing as a high priority the restoration of those preventative health measures by finding the relatively small amount of money required.

Thirdly—although the Secretary of State has hinted that he and the Government are moving towards this view—we believe that it is not possible to conduct planning in the health service if contracts between health authorities, health boards and health trusts are renegotiated annually. It is nonsense to do so. It is like painting the Forth bridge—no sooner has one finished than one must begin again. Some people in the service do nothing other than negotiate contracts. A generally held view is that the health service should be funded and that contracts should be entered into for a minimum of three years, and possibly longer, and that contracts should be altered according to the year-on-year outturn. We must stop the stop-start, on-off, nobody-knows planning of the health service. It is a mystery how one can plan on that basis, nationally or locally, the nation's largest service—a mystery not only to us but to those in the service.

The final matter most concerns the public. They just do not believe that the health service can stand any further service reductions, whether in beds or in other services, that are not replaced by equivalent services. The public simply do not believe that there are sufficient resources I do not want to get into a debate with the Secretary of State about how many beds or hospitals there are, because Ministers say that they never know, as figures are not collected centrally—but I want us to have those figures, so that we can have a debate.

If the Government are not believed, and if politicians dialogue does not advance the argument, we believe that there should be an immediate halt to any finance-driven closures—or such a halt could occur on 1 April, for six months. Yes, it would cost something, but during that time there should be an independent audit of health service resources, capacity and demand.

Yesterday, I spoke to the chief executive of the King's Fund, and learned that he and his organisation would be willing to conduct such an audit. Tomorrow the fund will celebrate its centenary, and it is an extremely reputable organisation, but so be it if there is a better organisation in Wales, Scotland or Northern Ireland to conduct an audit. The point is that such an audit should be conducted independently. We should stop the ridiculous nonsense in which we spend half our time disagreeing about the facts. Let us agree on the facts, and we can then consider our disagreements on funding.

There will always be differences in policy and priorities between political parties, but we must get away from the dialogue of the deaf, because patients and patients' interests are not being served. My colleagues and I can initiate a debate on the long-term future of the NHS and go through a litany of problems, but, today, we have limited ourselves to making four practical suggestions, which hon. Members on both sides of the House support and which the public and the professions overwhelming support. In an accountable NHS, realising those proposals would start us on the road to securing in the years ahead the place of the national health service in all four countries. I hope that we can make some progress, and I hope that the House will approve our motion.

4.7 pm

The Minister for Health (Mr. Gerald Malone)

I beg to move, To leave out from "House" to the end of the Question and to add instead thereof: is committed to the National Health Service as a public service, promoting health and offering increasing volumes of high-quality health care on the basis of need regardless of the ability to pay; and welcomes the Government's continuing commitment to real terms increases in NHS spending year by year.". I listened with interest, and mounting incredulity, to the speech of the hon. Member for Southwark and Bermondsey (Mr. Hughes). If we required any further evidence that Liberal Democrats perhaps live on another planet, he has absolutely provided it. We shall now have a health service that is simultaneously "inside", "outside" and "beyond" politics—whatever that may mean.

The hon. Gentleman's wish list of wishful thinking does not sit very comfortably with his ambitions—which I read in my copy of Nursing Times and Nursing Mirror. In the event of a hung Parliament, he will apparently have a difficult choice to make, as he wants to be either a Health Minister or mayor of London. It is always good for him to be ambitious, and it is clear that he and his party are once again preparing for government, as they did—under instructions from the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel)—in the general elections of 1979, 1983, 1987 and 1992. However, if the hon. Gentleman is wondering about his job prospects in a hung Parliament after the next election, he is wasting his time.

I thought it odd—I think that the House will find it odd, too—that the hon. Gentleman and his party have chosen three immediate priorities. The first is a national commission—a sort of fairness commission on statistics. Commissions to gather figures always fascinate the Liberal Democrat party. We are always told that these proposed commissions will be independent. They are surrounded with worthy words, which the Liberal Democrat party hopes will play well with the public, although they will perhaps not do very much at all—[Interruption.] As I hear an Opposition Member say from a sedentary position, a commission such as that being proposed will certainly not do what the Audit Commission does, which is to provide a real insight into how the health service works.

As a second immediate priority, the hon. Gentleman wants to reduce the money spent on patient care by reinstating free eyesight tests and dental checks. I shall deal with that matter in some detail later, but the rather interesting cross-talk on the Labour Benches made it clear that that was what the hon. Gentleman was proposing.

The hon. Gentleman's third priority was to end local pay awards in the NHS. He was long on saying how important it is to accept the review body's recommendations, but I must point out that one of its consistent recommendations has been the introduction of local pay in the NHS. The hon. Gentleman and his party quote selectively when it suits them and depart from a consistent line of argument when it gets too difficult.

I thought that the hon. Gentleman might have had a few other immediate priorities for the health service—probably boring old ideas such as treating more patients, improving the quality of care and the effectiveness of treatment and underpinning the research programme that keeps the NHS at the cutting edge when compared with any health service in the world.

The hon. Gentleman mentioned waiting times. He said that he wants to reduce them, but he failed to acknowledge that, for the first time in the history of the NHS, this Government have focused on waiting times. We have made great progress in identifying the length of time that people wait and then in reducing it according to patients charter standards.

I also thought that the hon. Gentleman would make it an immediate priority to underpin the reform of primary care, which is currently in another place and which will come to the House in the not too distant future. Perhaps the hon. Gentleman will say what he thinks about that. Such ideas may be boring to the Liberal Democrat party, but they are the essence of our health service and they are top of the agenda for patients and the professionals who work in the service.

Mr. Simon Hughes

None of those things is boring or unimportant. The Minister knows that I share his view in that respect. Does he accept that, according to the evidence that he is receiving, waiting times are increasing again?

Mr. Malone

Since we began to examine waiting times and since we bore down on them with the patients charter standard and the setting of benchmarks, remarkable progress has been made. The vast majority of patients are now treated within three months of an operation being diagnosed as necessary. The hon. Gentleman may shake his head, but he fails to recognise that, during the winter months, when there is pressure on the health service, elective surgery will take second place to emergency care. That is perfectly obvious—it is how the NHS has always operated. The important point is whether we are continuing to build on the standards that we have brought into the health service. I confirm that that will be the priority of this Government and of the next Conservative Government.

Mrs. Alice Mahon (Halifax)

Will the Minister answer the question asked by the hon. Member for Southwark and Bermondsey (Mr. Hughes)? Will he confirm that waiting lists in every constituency are getting longer?

Mr. Malone

I told the hon. Gentleman that when the service is under great pressure, of course elective surgery will take second place for a while. Progress on reducing waiting times and securing better standards, if we can, has to be maintained. The hon. Lady is making a non-existent point.

The speech of the hon. Member for Southwark and Bermondsey was rather thin gruel compared with the announcements of my right hon. Friend the Secretary of State in the document, "A Service with Ambitions", which set out clearly not just the immediate priorities, but the long-term priorities for the health service. I shall set out those priorities again to the House.

Mr. Matthew Banks

Before my hon. Friend moves from the subject of waiting lists, will he confirm that the additional £25 million that the Department has put into areas of pressure has been directed to the causes that the hon. Member for Halifax (Mrs. Mahon) is concerned about—blocking and mental health services?

Mr. Malone

That is absolutely right. The history of reducing waiting times—as my hon. Friend understands, but the hon. Member for Southwark and Bermondsey clearly does not—shows that, to maintain progress, it is important to invest in that progress. The Government have consistently done that by setting targets and standards and by the actions that we took to cope with the emergency pressures that we foresaw during the winter.

Mr. Gordon Prentice (Pendle)

Will the Minister give way?

Mr. Malone

No. I want to move on to my next point. I have given way a lot so far.

In "A Service with Ambitions", recently published by my right hon. Friend the Secretary of State, we set out our ambitious alternative for the immediate and long-term future of the national health service. It is an ambition for a quality integrated service that is responsive to patients. Those working in the NHS share that ambition. It can be brought about by having a well-informed public and a seamless service working across boundaries, so that patients understand that they are being treated by an integrated service. It should become more a knowledge-based, decision-making service and should have a highly trained and skilled work force. It should be a responsive service, sensitive to differing needs.

"A Service with Ambitions" sets out the Government's policy of underpinning our national health service, based on the principles on which it was founded, into the foreseeable future. The Government are also committed to real-terms increases in funding, because we believe that the NHS is affordable in its current form and needs continuing investment.

The document gives a detailed commitment to the development of the NHS as a public service. It outlines an exciting vision of an integrated service, sensitive to the needs and wishes of patients. It is very useful to the NHS and has been widely welcomed, setting out strategic objectives to help set future direction nationally and locally. It commits the Government to the future of the service, much criticised by Opposition Members at every opportunity. We will build a service of quality for the future.

The debate introduced by the hon. Member for Southwark and Bermondsey is based on a false premise—the idea that we can somehow remove health from politics. Raising the issue and then claiming to want to remove it from politics is a frequent Liberal Democrat party tactic. The Liberal Democrats go up and down the country, from constituency to constituency—all my hon. Friends are aware of this—making health a political issue in a way that is a disgrace to any party that says that it supports the national health service, and the hon. Gentleman knows it.

The Liberal Democrats have made an industry of saying piously that everything controversial should be removed from politics and then doing exactly the opposite. They want to remove the economy and education from politics. They actually want to remove Government from politics, as it is part of their policy pretty well to abolish Westminster and to set up regional assemblies across the country Now we hear that they want to abolish health as a political issue.

I find it extraordinary that the hon. Gentleman should make the absurd suggestion about central Government clearly not being very important at local level, but for some bizarre reason he and his party are not in favour of local pay.

Mr. Simon Hughes

We could spend the entire debate discussing which issues ought to be non-political. No one has ever argued that the health service should not be political. What is the Minister's objection to removing the accumulation and presentation of statistics on the health service from under the hand of Government, so that they would be believed—as they are not at the moment?

Mr. Malone

It is a disgraceful allegation for the hon. Gentleman to cast aspersions on civil servants who prepare statistics.

Mr. Hughes

Who are they?

Mr. Malone

The hon. Gentleman asks who they are. I hope that everyone who works in the public interest preparing those statistics—and that public interest goes well beyond the Government—will have heard the hon. Gentleman's derision. I shall explain in some detail how we have introduced open government in the health service, and the statistics support the evidence that we bring of its success.

I would take the nonsense that the hon. Gentleman talks about removing the health service from politics slightly better if he used the existing statistics fairly. The description that best befits the Liberal Democrats is that they use statistics in the same way as a drunk uses a lamp-post—for support, not illumination. It is frankly absurd for the hon. Gentleman suddenly to say that if there were a national body, his party would suddenly accept the statistics that it provided, when it does not accept any of the statistics from the organisations that currently provide them to the Government—often at arm's length.

The Liberal Democrat party delighted in counting the people who came off dentists' registers. When I pointed out that the Liberal Democrats did not count people who went back on the registers—as they are rolling registers—they failed to respond. In the face of the evidence, they produced a league table of people ditching dentists.

The Liberal Democrats also twist the statistics that relate to their own spending commitments. We heard a rather good example of that at the beginning of the debate. At the Liberal Democrat party conference last September, the hon. Gentleman claimed to have found a national insurance tax loophole that would provide, as always, a painless £350 million. However, in the Liberal Democrats' self-styled Richmond Park Mail, one of the exciting documents that flutters through letter boxes in a number of constituencies, the Liberal Democrat parliamentary candidate scaled that down by £100 million. What is the hon. Gentleman's commitment?

Last month, the leader of the Liberal Democrat party promised £500 million for the national health service. He said that £175 million would come from additional increases in the price of cigarettes, but that left a £325 million hole—another unexplained statistic from the Liberal Democrats.

Effectively, the Liberal Democrats have said that they would make every family worse off by an average of £12.50 a month, by adding a penny on income tax. Their health promise would double that. As a result, every family would pay an extra £300 every year with no increase in the care provided. Today the hon. Gentleman is committing his party to spending yet another £180 million or £190 million, although he has no funding plans to back that up. His position is absolutely unsupportable.

Mr. Simon Hughes

That is the most extraordinary allegation, given that we obtained the figures—and we have costed them all—from answers that we were wise enough to get from the Government only last week. In the past 10 days, we have obtained Government figures in respect of eye tests, dental checks and closing the national insurance loophole. They are all costed and our commitment remains the same—£550 million a year in addition to keeping up with real NHS inflation.

Mr. Malone

In every election since I have been a boy in politics, the hon. Gentleman and his party have said that they have a wonderfully costed, tested manifesto commitment that will fly and bear all scrutiny. The truth is that none of them ever does, because they are based on false premises throughout. The hon. Gentleman can wave his piece of paper and send it across the Chamber. I shall have a look at it and be delighted to write to him in due course, picking it apart, as we have always been able to do with every Liberal Democrat commitment that has ever been made inside or outside the House. The House is not impressed, and the Government are certainly not impressed.

Mr. Gallie

A point that comes to mind from serving on Select Committees and listening to debates in the Chamber is that I repeatedly hear Opposition Members demand statistics. Is it not so that, the more statistics we gather, the more bureaucracy is required to gather them and the greater the cost imposed on the health service or any other service, yet Opposition Members complain about administrative costs? Is there not a degree of—I should not use the word "hypocrisy". I shall try to think of another—but I cannot.

Mr. Malone

I am sure that my hon. Friend's thesaurus will reach him before the debate goes on much longer. He is right. In my two-plus years in office, I have not noticed that the Department of Health is entirely a statistics-free zone. In fairness to the hon. Member for Southwark and Bermondsey, he was saying something else: the statistics were unreliable. They are unreliable simply because he chooses not to accept them.

I come now to Government accountability and shall address the Government's record of increasing it. The hon. Member for Southwark and Bermondsey may not recollect that—I concede to him—Gladstone formed the Public Accounts Committee and created the post of Comptroller and Auditor General in 1861. Gladstone the hon. Gentleman is not. The national commission that he is proposing would in no way be as powerful or as enduring as both those important offices.

In considering the Government's service, and especially the NHS, we should also remember the National Audit Office, the Audit Commission and, in terms of accountability to the House, the Select Committee on Health. I should point out that the Government established the Audit Commission in 1982. It is far more important to have a commission that looks with some practised insight into what the statistics mean and at the performance of the service rather than one that simply collects statistics that can be published eventually in some unread book that does not serve the service.

The fact that raw statistics, useless in themselves, should not be collected because that is a burden on the health service, as my hon. Friend the Member for Ayr (Mr. Gallie) rightly pointed out, underlines the Government's approach. We are encouraged by the Opposition parties always to try to get rid of forms wherever possible, so it is right that we should not burden the service with collecting unnecessary statistics.

The hon. Member for Southwark and Bermondsey would do better to follow the example of the Audit Commission. In 1990, we extended its role to the NHS and it was given powers in 1992 to require performance indicators from local authorities. Insight offered by organisations such as the Audit Commission not only into the gathering of statistics but into the way in which the service works is far more important than anything that the hon. Gentleman has suggested.

Mr. William Cash (Stafford)

My hon. Friend and I have had many discussions on the status of rural dispensaries and priorities in the NHS in ensuring that, consistent with good Conservative principles of competition, pharmacies on one hand and rural dispensaries in doctors' surgeries on the other do not have an undue advantage over one another. In his role as Minister for Health, my hon. Friend has been immensely successful in applying himself to the question. Will he ensure that we stick to Conservative principles so that my constituents in Madeley and Gnosall can have an assurance, either today or as soon as possible thereafter, that the matter will be resolved, difficult as many people find it?

Mr. Malone

I am grateful to my hon. Friend. I have turned round and noticed that he has not been with us throughout the debate, but arrived breathless in the Chamber to make his point. Although his question is not closely related to what I am talking about now, I had not intended to deal with it in the substance of my remarks, so I shall answer it right away.

The answer, of course, is that there must be a compromise between professions that have found it rather difficult to agree on those issues over time. I believe that there is an opportunity to resolve several of the immediate issues that my hon. Friend raised, which will be taken forward by both professions in the coming weeks. I hope that we shall be able to make some progress and build a better atmosphere between the two professions. I acknowledge my hon. Friend's interest in that subject.

Back to boring statistics. The hon. Member for Southwark and Bermondsey made much of the idea that, if we set up a great organisation, we could remove the question of statistics from politics. For support in my response, I turn to the hon. Member for Blackburn (Mr. Straw), who is also something of a statistics guru. I think that he, too, sometimes shares the hon. Gentleman's interesting belief that one could remove such matters from politics. However, in the same breath he went on to say something else—and in terms of the real world, which is populated not by people such as the hon. Member for Southwark and Bermondsey but by others, the hon. Member for Blackburn made a good point. He said: But often, as someone in the heart of that process I can attest that statistics are used more as hand-grenades to be lobbed at one's opponents, than as a means of illumination. There will always be an element of that in adversarial politics. Therefore, even if we were to go beyond where we are now and provide sufficient information that could be properly audited and accounted for to Parliament, by means of the great new office that the hon. Member for Southwark and Bermondsey wants to set up in the land, anyone who suggested that things would be much different would not be living in the real world. That is probably a truism that both the public at large and anybody who has been in politics will recognise.

I shall now talk about an issue that I promised to address—the integrity of Government statistics. It is wrong of the hon. Gentleman simply to scoff at an extremely important activity. Government statisticians, like all civil servants, have an obligation to serve Ministers, but as part of that obligation, they must ensure the integrity of any departmental statistics and provide impartial advice.

Statisticians do not work alone in some far corner of a Department, and they do not work entirely to Ministers. They observe the official statistics code of practice, published by the Government statistics service, which is based on good practice and designed to promote high standards of accountability and to maintain public confidence in all official statistics and analysis.

The code contains several points that I should draw to the hon. Gentleman's attention because, perhaps inadvertently, he has made an attack on those who provide the information. It requires them to be impartial and objective. They must release information in accordance with the "Code of Practice on Access to Government Information"—open government, as sponsored by this Administration, especially the Prime Minister. They must pre-announce publication dates of statistics, and must take responsibility for the content of statistical press releases. Ministerial press releases containing policy comment must be issued separately; the two cannot be issued together.

It does the hon. Gentleman and his party no credit to try to attack the integrity of the mechanism of government that is underpinned in such a fundamental and clear way, whose standards have been built upon by the Government throughout their period in office.

Mr. Simon Hughes

Is it the fault of the statisticians or of the Government that, when a parliamentary colleague asks how many hospitals have been closed since 1979, the answer comes back from the Minister that those figures are not held centrally?

Mr. Malone

The hon. Gentleman totally fails to understand the point. We collect statistics across the national health service because they may be relevant to its operation. Often, parliamentary questions are asked that are relevant to the operation of the NHS, while other questions are not. The suggestion that we should collect a whole range of statistics of which we could make absolutely no practical use is foolish, and would add to the burdens on the NHS that we are effectively trying to reduce.

The example raised by the hon. Gentleman was a good one, because I should like to hear his definition of what constitutes a hospital, for which statistics might be gathered. Would a hospital be a super-surgery, with a small number of in-patient beds serviced by a general practitioner? If we added such surgeries to the statistics, the hon. Gentleman would say that we were fiddling the figures by adding things that were not hospitals at all. Should we include community hospitals, or hospitals that have a certain range of services? Would a hospital with a minor accident treatment facility be counted in the same way as a hospital with a major accident and emergency unit? If the hon. Gentleman wants to collect statistics which he may find interesting but which are of no practical use to the health service, he will be frequently disappointed when they are not available centrally.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

I wish to ask a follow-up question on the rather intriguing theory now being advanced by the Minister. Clearly, there will be differences in the definition of different facilities within the health service, and I quite accept that. But is the hon. Gentleman trying to tell the House of Commons that, as the Minister for Health, he does not have at his disposal relevant information as to the rate of closure of hospital facilities throughout England and Wales? Surely that information is central to the conduct of his duties.

Mr. Malone

The hon. Gentleman completely fails to understand what is important to the NHS. It is fundamental that decisions should be taken at a local or health authority level on the future of services. That is what is meant by devolved NHS. I understand that it is the ambition of the Liberal Democrats to hand control of the NHS to local councils, and that makes a double absurdity of the suggestion that we should accumulate non-operational statistics of that kind.

Mrs. Mahon

Will the Minister give way?

Mr. Malone

No, I have given way a lot. I intend to move to another point, which is openness in the NHS.

Mrs. Mahon

I wish to ask about openness.

Mr. Malone

Let me develop my point, and I might give way to the hon. Lady in due course. Recently, we have made the NHS a far more open organisation, and it is now more accountable to both Parliament and the public. The code of practice on openness was published in April 1995 and came into effect on 1 June, when the NHS executive published detailed guidance on its implementation. The code supports the Government's commitment in the White Paper "Open Government" of 1993, to increase public access to information about the NHS.

That complements the code on access to information, which applies to the Department of Health, including the NHS executive, and helps the public to know what information is available and where they can get it. All NHS organisations are required to have a named individual responsible for the operation of the code, which sets out the basic principles underlying public access to information about the NHS. I totally reject the implication of the hon. Member for Southwark and Bermondsey that the NHS is not open and accountable. It is, and in a way that it never was before.

Mr. Gordon Prentice

Why was the Minister prepared to tell me the location of the dental practices of the highest-paid orthodontists who practise in Norfolk and Essex, but when I asked him the same question concerning dentists doing primarily non-orthodontic work, who receive £350,000 from the NHS, he told me that the disclosure of that information would be in breach of the code of practice on open government?

Mr. Malone

I can answer that simply. In some cases, it would be possible to identify the individual dentist. That would be in breach of any proper code. If the hon. Gentleman wants a system by which one can gain an insight into people's private affairs without any let or hindrance, it is up to him to explain that to his constituents or to the country as a whole. Of course, any sensible code of operation should protect people's privacy.

The hon. Member for Southwark and Bermondsey mentioned sight tests and dental examinations. In 1994–95, spending on sight tests alone was in excess of £90 million. We assess that £120 million would have to be taken from expenditure on other forms of health care if free sight tests were to be restored. The hon. Gentleman never even touched on whether, if that were done, the quality of health would improve.

There is an on-going debate in the national health service among professionals and politicians about the priorities and direction of targeted resources and where they can be effective. The hon. Gentleman might be interested to know that the number of sight tests has increased since the fee was introduced. Other things are happening as well. For example, domiciliary visits, which are paid for by health authorities and provide sight tests for the housebound—often the elderly, to whom the hon. Gentleman referred—have increased by 105 per cent. in the five years to 1995–96, from 109,000 to 222,500.

I point that out simply to illustrate the fact that, rather than introduce some universal benefit, which the hon. Gentleman might think would play well to the audience, he would be far better advised to ensure that expenditure was targeted, as we are doing in the NHS, for example with domiciliary visits and the targeting of those at risk, such as the relatives of people suffering from glaucoma. That should be his priority instead.

The suggestion on dental examinations would be a fruitless exercise. The hon. Gentleman failed to point out that the number of individual treatments carried out within NHS dentistry has risen from 17 million in 1978 to 24.8 million in 1995–96, which shows that there are even more opportunities for the general examinations that must surely precede such treatments. More facilities are available for examinations now. Again, it is a matter of properly targeting the resource—of targeting those who are at risk. That is why we reformed the child capitation system and why we are ensuring that, in funding NHS dentistry in the future, we shall use purchaser-provider agreements driven by health authorities, which have an insight into the local health needs of their population. Thus we shall target the resource effectively at those who need it, rather than spreading it across the population, as the hon. Gentleman suggests.

Mr. Charles Kennedy

rose—

Mr. Malone

I shall give way for the last time.

Mr. Kennedy

I am grateful to the Minister, as he has been generous about interventions. On dental charges, surely the Minister, like every other hon. Member, will have anecdotal evidence—through his family, for example—and any dentist could tell him the same story. Dentists can give comprehensive and proper preventive and restorative attention to only two categories of patient—those who are fully funded by the benefits system because of their income status and those who can afford to pay. A great swathe of middle-class families do not qualify for support and are having to take short cuts, or are not undergoing the full treatment that the dental surgeon prescribes.

Mr. Malone

The hon. Gentleman should have a care. People can always promise to do more. Within NHS dentistry, anything that is clinically required is available for patients. Of course, there is a system of charges that raises a substantial amount that can be spent elsewhere in the NHS or targeted at at-risk groups in dentistry. The hon. Member for Southwark and Bermondsey completely failed to recognise that properly targeting need in the NHS is far more important than simply spreading the resource thinly across a population: that cannot bring results.

There are immediate priorities for the health service. The Government have pledged funding on a secure basis for the years to come and the Prime Minister pledged to increase spending on the health service in real terms, year on year on year. That is the foundation stone on which the service will rest in the years to come.

We are developing a primary care-led NHS, which is vital for patients and for the profession, especially those in the primary health care team who can now develop their professional roles, and we are continuing to make more effective use of taxpayers' money, so that more and more patients can be treated. That is the Government's record and that is what we intend to continue. We shall continue to build the quality of the whole NHS team—doctors, nurses and other medical professionals—which has greater horizons than ever before.

Our long-term priorities are to build a service in which the public can have confidence, which expands the professional skills of all who work in it, and which invests in work that keeps us at the clinical cutting edge of medical research and development: a service that can take pride in its achievements over the past 50 years, and has ambitions for the next 50 years. That is what the Government have delivered and will sustain after the general election.

4.46 pm

Rev. Martin Smyth (Belfast, South)

I am aware of the positive role of the national health service. I remember that, some years ago, when we were considering long-term financing, we had before us a person who had been in private medicine in the United States and in England. He was asked which was the most effective health management organisation, and his response was, "Yours—the NHS." I accept that, but there is room for improvement in everything.

When the Minister spoke about waiting lists, my mind went back to a little family discussion a good number of years ago, when I had asked my wife whether she would be able to join me on a certain occasion, and she had said no. I turned to my eldest girl and said, "What about you, Rosemary?", to which she replied, "Yes",

whereupon my younger daughter immediately said, "Ha! Using a big word when a small one would be sufficient!" The younger daughter had worked out that if Rosemary had said no—a smaller word than yes—I would have invited her instead. The Minister gave us a long, wandering explanation of the waiting list problem, when the simple reality is that waiting lists are growing. It would have been much easier to say that on the record.

It is not sufficient for Ministers to be on the defensive in the House, even when some hon. Members may be on the offensive, asking questions and putting things on the record. A senior civil servant put on the record the role, at times, of civil servants, when he said in a famous court case that they were economical with the truth. Figures can be used in different ways.

Mr. Gallie

Given the hon. Gentleman's comments on waiting lists, is he aware of the service offered by hospitals in Ayrshire to patients from Northern Ireland for orthopaedic surgery, aimed at reducing waiting lists in Northern Ireland, and does he feel that that strengthens the bond between Scotland and Northern Ireland?

Rev. Martin Smyth

I have no difficulty with that, because it is part of the system. If people who need treatment can receive it in other places, that is fine. The tragedy is that some purchasing bodies are not prepared to go elsewhere, even if, as in the case of Ayrshire and some London providers, the service is offered as a loss leader, to try to fill spare places. If patients who need treatment can be treated anywhere in the NHS, I would support it. Certainly there is a bond, and it will be strengthened when Musgrave Park hospital starts competing and tendering abroad. It, too, has the facility to do that but, unfortunately, it has tried to treat people in Northern Ireland as first priority when the boards in Northern Ireland have not been able to purchase places there.

I am concerned by the phrase on the basis of need regardless of the ability to pay in the Government's amendment. I accept that, but the harsh reality is that that does not always happen in the national health service. We will be told that we offer only anecdotal evidence, but if only one person in a hospital, having been examined by a cardiac specialist, is told, "You need a cardiac operation. I will have to put you on the waiting list. If you can afford £10,000 or £12,000, we can do it in three weeks," something is wrong. Those surgeons are employed in the national health service rather than in private practice: it would different if the patient had gone to a private practice for treatment. If that happens to one person, it is one person too many.

I generally support the motion. It is the way of all Governments, of whatever ilk, that they bring in people from outside to try to resolve problems—to kick them into touch, to use a rugby analogy. They might call it a royal commission but someone else has to take the responsibility. Why did the Minister try to shoot down a mere Opposition spokesperson who suggested using a body, such as the King's Fund, which the Government have used often? As a Member of Parliament, I have found its services very helpful. My constituency has at least two medical facilities that have benefited from assessment by it. I support its use.

Mr. Simon Hughes

The Minister's response to our suggestion was to ask why we should not use the Audit Commission. Many hon. Members would rather have the Audit Commission perform independent assessment of statistics than the Government. If they have some problem with using the King's Fund for this job and the Minister were offering that, it would be an acceptable middle way that the hon. Gentleman might encourage the Government to adopt.

Rev. Martin Smyth

I have no difficulty with the Audit Commission doing the work, but I am concerned about the pressure of work on it. Often, when Select Committees are asked to consider its reports, civil servants or officers come before us to answer our queries and we discover that they are doing their best to kick into touch. They say that were not involved in the misdemeanours of previous years and assure us that they will do better in future. In the end, the same mistakes are perpetrated. However, I have no difficulty with the examination being carried by the Audit Commission.

I am not sure that the Minister fully understood what he was saying in talking about free dental and eye checks. He said that they would mean that there would be less money for patient care. I have a suspicion that the people we are talking about are patients who need care. Some people have found that they can benefit from routine check-ups because other diseases are immediately discovered and helped on their way. We are arguing for something that experts have been asking for.

Only recently I went in to have my eyes tested—admittedly, a year after I should have done, not because of the expense, but merely because I put off until tomorrow what I should have done yesterday—and asked about the figures. I was interested in the Minister's answer. There was a decisive drop in the number of people coming for eye tests when the change took place; the numbers have now begun to rise again.

I am not so sure that they are rising again simply because more people need the tests. It may reflect the fact that some sections of our society are better off financially and are ready to have check-ups earlier. However, elderly people who have to balance their budgets think twice before having a routine eye test. They wait until something affects their eyesight before going for a test. We might save pounds in the long run if we treated patients earlier.

Mr. Simon Hughes

Can the hon. Gentleman confirm that there is now evidence—I think that we have all seen it—from the Royal National Institute for the Blind which confirms that there has been a deterioration in the sight of some of those who are now not being tested? It is not a theory, but practice. The proposal that I and others have made is not that we should take money from the rest of the health service budget to reinstate free eye and dental checks, but that we should raise money elsewhere—we propose putting extra tax on cigarettes. We propose not taking from the health service, but adding to its resources.

Rev. Martin Smyth

The motion deals specifically with that matter. I accept that the Government of the day may have to find some money from another sphere.

I know that we do not want to make political points; there are those who fear that, the nearer we come to an election, the more likely it is that political points will be made. All I shall say by way of guidance to the Government is that the recommended increase for nurses of about 3.3 per cent. might be their best vote winner and it may embarrass others if the Government opt for it. Only yesterday, those close to the core of the matter claimed to me that the money is available for such an increase. That may relate to the argument that the hon. Member for Southwark and Bermondsey (Mr. Hughes) was advancing.

People throughout the nation still believe that those in the front line of medical care at every level, community or otherwise, are those in the nursing profession. Unfortunately, even now, some people have not received last year's increase because the discussions are still continuing. There is something wrong with that. I cannot understand how those who manage different health provisions can argue that they have been wrong-footed and that, if the Government give the increase, they will be short of money because they have already allocated their funds in a different way.

When we discuss financing the health service, we must watch out for what I constantly call medical politics, where each group—whether managers, community groups or elsewhere—argue specifically for themselves. They may bring in patients as an added bonus, but there is undoubtedly a need in the nation. I am discovering that Northern Ireland is being robbed of some of the advantages that it had when it governed itself.

Lest anyone should misunderstand, I shall put the record straight. There is no Minister responsible for Northern Ireland present on the Front Bench. I know that the House will sympathise with the Under-Secretary of State for Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), who lost his wife yesterday. I felt a great sense of sympathy when I was told about his bereavement at the conference of the Royal College of Student Nurses in Belfast. That is why the Minister is not on the Government Bench today.

People in Northern Ireland believe—as do people in other parts of the nation—that there is a great need for more resources to be concentrated on health care.

4.59 pm

Mr. Matthew Banks (Southport)

Thank you, Madam Deputy Speaker, for calling me so early in this important debate on the national health service. Before coming to the substance of my remarks, I shall take a moment to join the hon. Member for Belfast, South (Rev. Martin Smyth) in his expression of sorrow. We were all sorry to hear of the family bereavement of the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss).

The hon. Gentleman also drew attention to the attendance at the debate. I am pleased to see my hon. Friend the Minister for Health on the Front Bench, and also the Minister of State, Scottish Office, who is representing the Scottish component of this important debate, if I may put it that way. As I commence my remarks, I am sorry to see that not a single Labour Back Bencher is present. I get the feeling that the Labour party is trying to make the debate collapse early, in the hope that insufficient Conservative Members will be present to out-vote the Liberal Democrats. No doubt the hon. Member for Warley, East (Mr. Faulds) will be here later, because, as a member of old Labour, he is hardly likely to pay any attention to the antics of the new Labour Whips Office.

I was pleased to hear that the hon. Member for Southwark and Bermondsey (Mr. Hughes) wanted to introduce a non-partisan element into the debate, especially on the development of health provision. His attempt to do that was spoilt when the hon. Member for Caithness and Sutherland (Mr. Maclennan) popped up and demanded to know where the Secretary of State for Health was. I do not think that any convention has been broken by the absence of the two senior Front-Bench spokesmen on health. Most of the colleagues of the hon. Member for Southwark and Bermondsey are not participating in the debate and are not here to support him.

I can say one positive thing about the attendance of Liberal Democrats at their own debate. At least they have come a long way since my predecessor, Councillor Fearn, was the Liberal Democrat party's health service spokesman in the House. Liberal Democrats had to pitch in with helpful interventions to try to keep him on track, until the right hon. Member for Yeovil (Mr. Ashdown) rightly replaced him with the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) when things became a little too hot for him. Councillor Fearn is the Liberal Democrat candidate in my constituency at the next general election. It is his 66th birthday tomorrow, and I genuinely wish him a long retirement from Westminster politics, because I doubt that we shall see him back here.

Mr. Simon Hughes

One never knows.

Mr. Banks

The hon. Member for Caithness and Sutherland drew attention to the fact that the Secretary of State is not present. In his opening remarks, the hon. Member for Southwark and Bermondsey said that this morning he had visited health service premises in his constituency with his right hon. Friend the Member for Yeovil.

Mr. Hughes

The hon. Gentleman is almost right. My right hon. Friend and I had a visit from nurses: the meeting took place in this building, and not in NHS premises.

Mr. Banks

I am grateful to the hon. Gentleman for clarifying that point. It is even more disappointing that his right hon. Friend has not bothered to turn up for a debate initiated by his party. Either this is an important subject for the Liberal Democrats or it is not.

Dame Elaine Kellett-Bowman (Lancaster)

The debate may be of interest to the three Liberal Democrat Members who are present, but it is clearly of no interest to the rest of them.

Mr. Banks

With the greatest respect to the hon. Member for Cheltenham (Mr. Jones), he stayed for about 20 minutes and did not even hear the end of the opening speech by his hon. Friend the Member for Southwark and Bermondsey.

It was suggested that I will have difficulties at the next election, but I suspect that there will be a number of Conservative gains from the Liberal Democrats.

I shall return to the substance of the debate, Madam Deputy Speaker, because I do not want to incur your wrath or get a little too overheated about the impending general election.

Although I did not catch the fact that the meeting with nurses took place in the House, I listened attentively to the substance of the remarks of the hon. Member for Southwark and Bermondsey. He is clearly not a budding Treasury Minister. He should take care when advocating the hypothecation of taxes, because we could end up with a problem if we had to find money to spend on provisions that were not particularly popular.

Although the motion does not refer to nurses' pay and whether it should be negotiated locally, I have read the hon. Gentleman's previous speeches in which he has referred to that, not least in the debate on 20 November. [Interruption.] He is waving the Order Paper at me. I am grateful to him for pointing that out.

I think that the hon. Gentleman is wrong. His point about the independence of pay negotiating bodies is important, but he cannot have it both ways. We either have an independent body whose recommendations we accept, or we do not. The independent body that looks after nurses' pay has recommended that it should not fall below a ceiling of a 2 per cent. rise. However, there is no reason why nurses cannot be paid more than 2 per cent. either across the board in a geographical area or in specific cases on a local basis, depending on the trust.

It is important to have local flexibility in pay negotiations. In an area that is looked after a particular NHS trust, greater flexibility may allow management to reward nurses with an increase of rather more than the 2 per cent. suggested by the independent body. We should not be too rigid. What matters is the local provision of care within the national health service.

I agree with the hon. Gentleman about contracts. I have some sympathy with the view that too much time is spent negotiating contracts. I am not suggesting that every contract that an NHS trust puts out to tender should be a rigid three-year one. We should seek ways to extend, in appropriate circumstances, the one-year contracts that take up so much time to renew each year. That is bound to free management time, so that the management can ensure that the provision of health care is improved in each trust hospital.

I regret that insufficient reference was made to the additional £25 million. That is a constructive criticism by the Minister of State. Insufficient credit has been given to the £25 million additional resources from what I call an emergency contingency fund to deal with some of the winter problems, which have resulted in a marginal rise in waiting lists. I appreciate the action taken by the Department of Health.

I am fairly familiar with the £25 million split. That money will help to deal with bed blocking problems, which have certainly affected my local hospital in Southport, It will ensure that the local health authority has the resources to put more money into care in the community in local authority and private nursing homes, and it will free hospital beds so that people can be treated more quickly.

I pay particular tribute to my hon. Friends in the Department, who have ensured that additional contingency funds have been used to deal with problems in community mental health services.

I believe that a non-partisan approach to some health issues is possible. In this debate, Conservative Members may come closer to achieving that with the Liberal Democrats than with Labour. After all, as the hon. Member for Southwark and Bermondsey pointed out, the Labour party has not in any way met the commitment made by my right hon. Friend the Prime Minister and the Government to year-on-year-on-year increases over and above inflation That commitment was first made in 1992, and has been met. Have we heard such a commitment from Labour? We have not: the silence has been deafening. I look forward to hearing from the hon. Member for Dulwich (Ms Jowell) later in the debate.

I strongly agree with some of the other comments made by the hon. Member for Southwark and Bermondsey. I particularly agree with what he said in the NHS debate of 20 November: Like the Secretary of Stale. I welcome a debate on the NHS. I welcome an opportunity to pay tribute to the service, to praise those who work in it and to say how good I believe it is. It serves hon. Members and our constituents extraordinarily well. Of course, things go wrong and sometimes there are sad mistakes and tragedies."—[Official Report, 20 November 1996: Vol. 285, c. 1021.] I hope that those mistakes and tragedies will be kept to the absolute minimum, and eradicated where possible, but we should all recognise that, because so many more patients are being treated in the NHS than were treated in the 1970s—as a result of the Government's policies—the odd mistake will inevitably be made. It would be frivolous to suggest otherwise.

Nevertheless, I agree with what the hon. Member for Southwark and Bermondsey said in that debate. It took place only a few weeks ago, and nothing has changed since then. I have no doubt that the commitment given by the Prime Minister in Bournemouth last year—which is, of course. Government policy—is one of the many promises that we have kept in the present Parliament and will keep in the next.

Mr. Simon Hughes

I am trying to establish what areas of agreement there are between us. Does the hon. Gentleman accept that it would not be a bad thing—I am trying not to trap him into saying anything that might push him too far—if the question of statistics, to which nurses" pay is relevant, were dealt with by an independent body? The Minister suggested the Audit Commission; I have suggested the King's Fund. All the matters pertaining to the hon. Gentleman's constituents—the number of beds, whether there are too many or too few, whether they are under pressure and whether there are enough hospital places—could then be evaluated independently, before the political debate about which hospitals should be built and which should be closed. That, of course, will ultimately be a political decision.

Mr. Banks

I am afraid that I cannot agree with the hon. Gentleman on that, for two reasons. In fact, I am sure that there are others, but I shall mention two.

First, the Audit Commission is there to ensure that we receive value for money. I do not think that its task is to do what the hon. Gentleman has suggested, although in certain circumstances I retain an open mind. Secondly, I believe that such a suggestion impugns the integrity of the civil service. Over the years, it has been suggested that the civil service has become a little too close to the present Government, but anyone who talks to Ministers privately will be told that that is certainly not the case. Civil servants do an excellent job; no doubt they have their own private views, but they behave very professionally. I do not agree with the hon. Gentleman that the statistics that he receives from the Government—which are compiled by civil servants—are in any need of disinfecting.

Today's debate takes place against a background of record spending on the NHS. Spending has risen by some 74 per cent. in real terms since 1979. For every man, woman and child in the United Kingdom, we are now spending about £724, compared—in real terms—to some £444 in 1978–79. That is a significant difference. The problems of this winter have led to a special cash boost of £25 million. Some of that has been used to deal with bed blocking, and has certainly helped my constituency; £4 million of it has been spent on extra intensive care and high-dependency beds, and £5 million has been used to improve mental health services, which have also been affected by winter problems.

There are more doctors and nurses than there were in the 1970s Since then, the number of nurses and midwives has risen by some 55,000. The number of doctors and dentists has risen by 22,500. For every manager in the NHS, there are some 77 employees directly involved in patient care.

I have mentioned the Prime Minister's commitment to year-on-year-on-year real increases in the next Parliament. I remember that, when he first came up with the idea of the citizens charter, one or two foolish people laughed at the suggestion; but what a difference the charter has made. It has enabled the public to know precisely what level of service they ought to expect, and how it should improve year on year. It has established benchmarks, and if those benchmarks are not met, action is taken.

I very much hope that the Labour party will match that guarantee I thought that the hon. Member for Dulwich was going to intervene and give me such a pledge, but she is only shuffling her papers. I do not think that we should be surprised by the Prime Minister's commitment, because he gave the same pledge in 1992, and has adhered to it. It is, however, staggering to note that there is to be a further increase of some £1.6 billion in NHS spending next year, which means a 3 per cent. real-terms increase in hospital and community health services. In 1995, the NHS share of gross domestic product was about 5.8 per cent.; in 1978–79, it was about 4.7 per cent.

I have mentioned nurses' pay, and the importance of having the flexibility of local negotiation on a trust-by-trust, hospital-by-hospital basis. Nurses' pay has risen from about £68 a week in 1979 to some £311 a week in 1995: that is a real increase, over and above inflation, of around 70 per cent. I believe that locally negotiated pay is the way forward. We have seen great benefits from it in my constituency, and I was heartened to learn that the independent body had made it clear that there should be an increase of no less than 2 per cent.

Rev. Martin Smyth

The hon. Gentleman mentioned our last debate on the NHS. In that debate, the Minister who was responding gave a figure of £1.56 billion for the NHS, but did not say that £56 million was going to Northern Ireland. The hon. Gentleman has mentioned local negotiations. Our budget has not been given an increase of 3 per cent., but has been cut by 3 per cent. This year, it has been reduced to 1.5 per cent. up front.

Mr. Banks

I thank the hon. Gentleman for telling us what is happening in Northern Ireland. I know that he will forgive me if I plead genuine ignorance of the specific case that he mentioned. I am sorry that my hon. Friend the Under-Secretary of State for Northern Ireland cannot be with us, for the reasons that the hon. Gentleman mentioned earlier. Perhaps we will pick up on that matter later in the debate.

All I can say to the hon. Gentleman is that the flexibility that I have seen in and around my constituency—in the Southport and Formby Community Health Services NHS trust and the Sefton district health authority, which covers three parliamentary constituencies—has been welcomed because it has been effective in giving pay rises to people who deserve them most. With such flexibility, it is important to be able in certain instances to do what is best on a local basis. What is perhaps best in Southport is not necessarily good for Northern Ireland, and vice versa.

I mentioned the background that we have in dealing with in the debate. One further point of substance in relation to improvements in the NHS is the private finance initiative. My right hon. Friend the Secretary of State for Health has in many ways, together with the Secretary of State for Transport, pioneered the PFI. It is no surprise or coincidence that both have been Treasury Ministers. Mixed public and private funding for improvements in the NHS is vital. I need to look only to my constituency to see the enormous benefit of such funding. Approximately £12 million is being used to develop new premises to ensure that one of our older hospitals has the opportunity of closing to provide better facilities on the newer site, which was built after the Government's election to power.

That site should have been built in 1970s, but, when the Labour party had to go cap in hand to the International Monetary Fund and cut the capital hospital building programme by 33 per cent., unfortunately my constituents were not able to have the site when they needed it. The PFI is vital. Its critics are being proved wrong. A combination of public and private sector capital is the way to ensure new build where it is necessary, and improvements in existing facilities.

There is no better proof of increasing satisfaction with NHS services than personal experience. I am sure that I am not alone in the House in experiencing treatment on the NHS, although I freely admit that I take the opportunity also of contributing to a private health care scheme. I have had tax relief on those contributions, which have been so opposed by the Opposition parties. I take the opportunity of ensuring that I have choice. I advocate it. That is what we Conservative Members advocate. We have done so, not least in the past, but we continue to do so as we head towards a general election. Choice is vital, but the experience that I was mentioning of hon. Members receiving treatment on the NHS is important.

I recall going to a meeting of the chairman of the NHS trust in my constituency in the early 1990s—I think 1993. I expected the meeting to last some half an hour. I actually left the hospital some seven days later, having spent a week in intensive care. The health care that I received was absolutely outstanding. I had the opportunity not just of remaining in one intensive care ward, but of going to another ward and to two or three different hospitals. I cannot fault the care that I received, and I deprecate people both inside and outside the House who all too frequently criticise unfairly and without good reason the good work by nurses and doctors in the service. We all recognise that there are problems, but too frequently we hear about those few problems and not enough about the success of those who work in the service.

Mr. Simon Hughes

I am glad that the NHS looked after the hon. Gentleman well and brought him back to health. Will he accept, however, that one of the concerns about the health service is that many people who do not want to use the private health sector feel increasingly driven to do so because they cannot be sure that the NHS will be able to do all the things that they need? One of the tests of the NHS's fragility is that there is a consistent increase in people who are opting for private health insurance—it was 11 per cent.; it is now up to 14 per cent. I remember that his previous leader, the noble Lady Thatcher, was happy to have private health insurance, but, when she needed emergency or more acute treatment, she relied on the NHS.

Mr. Banks

I have listened with care to what the hon. Gentleman has said. What I was talking about was choice and I am not going to debate what the noble Baroness did or did not do. I can tell the House my experiences only, and they have been excellent in relation to the NHS.

Mr. Gallie

Surely the words of the hon. Member for Southwark and Bermondsey (Mr. Hughes) underline what my hon. Friend says. He points out the values and the excellence of the NHS. It has been demonstrated that, where someone had the choice between private and NHS, the individual plumped for the NHS. That is surely a great credit to the NHS, and surely backs my hon. Friend's argument.

Mr. Banks

I am grateful to my hon. Friend, who is such an advocate of Ayr; despite what his political opponents say in Scotland, I believe that he will hold his seat.

I should like to make one final local point. May I make a plea to the Minister to take action? The two local health authorities that provide services in and around my constituency have been consulting over a lengthy period on the provision of health care for the future. In some instances, too few patients have been spread over two brand new hospitals, if I can put it that way, some five miles apart—one in Ormskirk and one in Southport. South Lancashire district health authority, which covers Skelmersdale and the west Lancashire region, and Sefton district health authority, which covers Bootle to Southport, have been debating whether health care should be provided on one site and, if not, how the split between the two sites should take place.

The major concern has been that the two health authorities, rightly trying to take decisions locally, have not been able to agree. As a result, they commissioned Sir Duncan Nichol, the former chief executive of the health service, to conduct a review. He decided that there should be a hot site and a cold site, and he further concluded that the hot site should be in Southport.

As part of what I can only describe as a deal, a suggestion was made to transfer maternity services from my constituency five miles down the road to Ormskirk. There are concerns about that in relation not just to geography but to where intensive care and accident and emergency services will be located and where, without those facilities, young babies will be born.

I believe now that, after a lengthy period of consultation, South Lancashire health authority has been dragging out taking a decision on the matter because it knows that, in a few weeks' time, there will be a general election. It is vital that a decision is reached, because my constituents are fully aware that, if there were to be a Labour Government, they would ensure that the North West regional health authority intervened to transfer those maternity services away from Southport to Ormskirk.

Every historical precedent suggests that that will happen. There will be nothing for Southport under a Labour Government because, under them, we could not have even the brand new hospital that the regional health authority wanted to build in the 1970s. The only hope to ensure that Sir Duncan Nichol's recommendations are implemented will be for the regional health authority to intervene, and to do soon, before a general election.

I know that my right hon. and learned Friend the Minister of State, Scottish Office, is not involved in this local review of services. It has come not from the Department of Health but from the region and the locality. I want the Minister to press the chairman of the regional health authority to intervene so that a decision can be taken now. Then we can ensure that the Nicol proposals are implemented, so that all the major services are based in Southport. Once the independent review has been implemented, I shall tell my constituents that that review, commissioned by the two health authorities, has gone ahead, that it is expected that maternity services will stay in Southport and that only a Labour Government could change that.

I have no doubt that the interests of my constituents will be best served by the re-election of a Conservative Government.

5.29 pm

Ms Tessa Jowell (Dulwich)

We too would like to record our condolences to the hon. Member for North-East Cambridgeshire (Mr. Moss) following his recent sad bereavement.

We welcome the opportunity to debate the immediate priorities for the national health service. I share the view of the hon. Member for Southwark and Bermondsey (Mr. Hughes) that we must take every opportunity to provide a view of the real facts of life for staff and patients in accident and emergency departments and GP surgeries up and down the country, as an antidote to the rosy view of the NHS adopted by Richmond house.

I begin, however, by dealing with the priorities outlined in the Liberal Democrat motion. Free eye tests and dental checks are top of that party's wish list. The Labour party recognises the value of eye tests and dental checks as important preventive measures, and we share the concern expressed by the hon. Member for Southwark and Bermondsey that the withdrawal of free tests has had an adverse impact on public health. But restoring free eye tests and checks would not come cheap. The combined cost would be at least £170 million and probably nearer £200 million—roughly the same amount as highly conservative estimates of the hole in the Government's finances for the NHS between now and the end of this financial year.

As the hon. Member for Southwark and Bermondsey knows, the problems of our health authority—Lambeth, Southwark and Lewisham—have led to patients in both our constituencies waiting as long as 18 months to be admitted to hospital, which is longer than patients wait in other parts of the country. The problems have also given rise to what the chief executive of King's College hospital recently denounced as the two-tier health service which he found it impossible to defend to the patients of his hospital.

The acute problems that hospitals have experienced cannot possibly be separated from the pace and scale of the cuts in acute hospital beds in recent years. That is not just our view; it is a view shared by the British Medical Association, which has today published new evidence of the continuing crisis in our hospitals. It has found that Southampton General is "just about coping". In Liverpool, the bed crisis continues. Addenbrooke's in Cambridge is in and out of red alert. Torbay is closed to elective admission and running at full capacity", and in Bristol, waiting lists have grown longer". These problems are inseparable from the fact that a quarter of NHS hospital beds have been lost since the Government's competitive internal market was introduced. Nearly 13,000 beds in all specialties have closed in just five years as a direct result of the Government's doctrinaire obsession with competition. In the battle for patients, hospitals have been forced to cut services to the bone in order to keep costs down.

It is a simple fact that no service, public or private, could withstand such a huge reduction in capacity over such a short time and avoid deterioration in the quality of the service that even the best efforts of staff can provide. Of course we recognise that the needs of the NHS and its patients are changing—that more day surgery is being carried out, for instance; but even so the pace of bed closures has been dangerously fast.

We have in London an example of the damage done to patient care by the pace of change. As long ago as 1994, Dr. Brian Jarman warned that the Tomlinson report, on which the bed closure programme was based, was founded on flawed evidence. Incidentally, it followed the report of the King's Fund, which reviewed the health needs of London. Dr. Jarman pointed out that important data relating to the availability of mental health services and of residential and other long-term services for elderly people had been omitted from the calculations.

Even though the Department of Health seems belatedly to have accepted Brian Jarman's analysis, bed closures have continued at an alarming rate. More than 17,500 beds have been closed in North and South Thames over the past five years.

We support the call in the motion for reducing unnecessary bureaucracy by introducing longer-term agreements between health authorities and hospitals. That is what the health service wants; it will provide important stability and savings on bureaucratic costs which can then be redirected to patient care. It was, after all, the Government's doctrinaire obsession with competition that created the explosion of bureaucracy in the NHS at the cost of patient care.

The BMA has calculated that the internal market costs £1.5 billion. In private the Secretary of State seems prepared to accept that. It is significant that his recent White Paper—his credo, as he put it—"A Service with Ambitions", did not make a single reference to the competitive internal market. Indeed, in one part of the country the Secretary of State has even permitted the suspension of that market. In Newcastle, the city's health trusts have returned to a system of collaborative contracting in which competition has been replaced by co-operation and three-year rolling contracts. The move, the trusts explain, is intended to avoid the perils of over-competitiveness … there is the ever-present danger of trusts becoming too competitive for business at the expense of quality. In other words, trying to do more for less. If this were to continue unchecked, staff would undoubtedly lose confidence in the market system. When the Minister winds up, perhaps he will assure us that, if the Newcastle project can be shown to have brought benefits by improving local standards of care, the Government will immediately encourage hospitals and health authorities across the country to ditch the absurd competition that is imposing such a burden on the health service and creating such an obstacle to best patient care.

We share the concern expressed in the motion about the effect of local pay bargaining on the NHS. It has embroiled hospitals and staff in drawn-out, often acrimonious negotiations and distracted them from their main priority, which should be improving patient care. The Royal College of Nursing has found that only 196 trusts out of 488 have so far reached agreement on pay for the current financial year.

I offer the House an example of what local pay has meant for one trust this year. The Newcastle City Health NHS trust describes how it has been engaged in a long-running dispute with staff over local pay. The chief executive has spent between 80 and 90 hours on negotiations; his deputy has spent 100 hours, and a human resources manager, 200 hours. On top of that, 80 other managers have spent about 20 hours each on the subject. That amounts to a total of 2,000 managerial hours. Given that a further 1,000 hours were lost on the day of a strike, almost 3,000 hours—which could have been spent on more productive work—have been lost to pay negotiations. That is why we support the call to scrap local pay bargaining. It is another example of how the Government have allowed NHS bureaucracy to spiral out of control.

We welcome today's debate, and we support many of the calls that have been made. However, we are sceptical of the remedies suggested by the Liberal Democrats and of how those would be paid for.

Mr. Simon Hughes

I am grateful to the hon. Lady for identifying the issues on which we agree. However, will she tell the House whether she and her colleagues can support our second proposal, which is a freeze on all finance-driven bed, hospital and service closures which represent a reduction of service to patients"? As I said, the public desperately want a national halt to service reductions while an independent assessment is made. Can she and her colleagues endorse and support that proposal?

Ms Jowell

The hon. Gentleman will be aware that we have made clear our commitment to a moratorium on any further acute bed closures in London, because of the particular circumstances and pressures that arose after the Tomlinson report. So we are committed to a moratorium in London. We have not made, and at this stage we would not make, a similar commitment nationally, as he would like. If elected to government after the next general election, however, we will carefully examine the position, particularly in deprived inner-city areas, where—for very obvious reasons—pressure on acute beds tends to be greatest.

Sir Donald Thompson (Calder Valley)

The hon. Lady is making a very careful and interesting speech; and I heard what she said about the difference between London and the provinces, which seem to manage these matters rather better. Nonetheless, will she now take the opportunity to appeal to local government across the country to stop blocking hospital beds? In my constituency, 50 beds are being blocked by the local social services people, who will not allow old people who have been assessed into care homes, because those care homes are private. It is a scandal which the hon. Lady's words would help to alleviate.

Ms Jowell

It is absolutely clear that the way in which the Government have tilted the balance in distributing money for community care towards the independent sector has created the bed-blocking problem in so many parts of the country. There was virtually no independent provision in my own borough—which I shall use as a specific example—and it was therefore very difficult to move elderly people out of hospital and into care funded through community care money, which was made available by the reforms. All types of perverse incentives have been created because of the Government's doctrinaire obsession with care commercialisation, rather than with patients' best interests.

Several hon. Members

rose—

Mr. Malone

The hon. Lady has confirmed that those councils—for political reasons and because they do not like the policies—are taking out their revenge on patients, and that she supports them.

Ms Jowell

The Minister is perfectly well aware that that is absolutely not so. One of the obstacles to many councils being able to provide effective community care has been the perversity of the Government's distribution formula for care in the community money.

Mr. Matthew Banks

Will the hon. Lady give way on that point?

Ms Jowell

No, I will not give way again—[Interruption.] In a short speech, I have already given way many times. I shall move on to the costings—[Interruption.]

Madam Deputy Speaker (Dame Janet Fookes)

Order. I think that the House knows my views on seated interventions, especially when they are repeated.

Ms Jowell

I make no apology for not giving way to the hon. Member for Southport (Mr. Banks), who made a speech lasting almost half an hour.

As for costing the proposals made by the hon. Member for Southwark and Bermondsey and his colleagues, as I said, the Library has already performed some calculations. The cost of restoring eye tests and dental checks, based on 1994–95 prices, would be about £170 million. The pledge to increase NHS expenditure in line with NHS inflation would cost an extra £594 million in 1998–99, and £1.3 billion in 1999 to 2000. The pledge to recruit 10,000 more nurses and 5,000 more doctors, which appeared in 11 October 1996 edition of the Liberal Democrat News, would cost at least £100 million. The pledge to cut waiting lists to a six-month maximum, crudely estimated, would cost £240 million. In short, the Liberals' proposals would cost an extra £2.5 billion.

The way in which the Liberal Democrats have tried to explain where the money to meet those pledges would come from has not been completely convincing. I reiterate that they told us at last year's conference that an extra £350 million for nursing staff would be made available by closing a tax loophole, although that loophole had apparently already been closed. I therefore ask the hon. Member for Southwark and Bermondsey to think twice before he throws stones, and reconsider the credibility of the cost of his own policies.

Opposition Members should not be distracted by the hypothetical and irrelevant question—diverting as it might be—of how a Liberal Democrat Government would fulfil their commitments. Our main concern is the real crisis that is gripping the health service.

In recent weeks, it has become blatantly clear that the Government have only one immediate priority for the NHS—crisis management, so that they can get through to the general election and the end of the financial year Health authorities and hospitals are being told to keep problems under wraps, so far as possible. We have heard how the chief executive of the NHS has dispatched a memo to hospitals on "managing the winter crisis". We have been told that hospitals are being advised not to pay bills so that they can make ends meet, although that means that small businesses which depend on that cash may go to the wall. We have also heard of a hospital in Liverpool being urged to find ways of "judiciously eliminating" patients from the waiting list.

Those are not the actions of a responsible Government who put patients' interests first; they are the actions of a Government and Ministers engaged in a desperate bid for survival. The needs of the NHS take second place to the electoral prospects of the Conservative party. While all that is going on, patients across the country wait on trollies in casualty; elective surgery is being cancelled, often at the last minute; and staff are working under intolerable and unacceptable levels of pressure. The Government should be dealing with those problems as a priority, rather than being concerned with news management and drawing a veil over the circumstances facing hospitals daily.

Every day, we read further evidence of the crisis. This week, the Greater London Association of Community Health Councils published a new report on how accident and emergency departments in London have coped this winter. It paints a bleak picture of the quality of patient care in London's hospitals. It states: People are regularly waiting unacceptably long periods of time on trolleys in A & E departments". New terminology has had to be invented to explain how hospitals are dealing with the crisis. The report states: Overnighters, people waiting overnight in casualty, are becoming a regular feature of London's health services. In the past five years, a new nursing protocol has been created to deal with the pressure sores and dehydration that inevitably follow when very elderly people spend any time waiting on trolleys. The GLACH report adds that this year's crisis is affecting all patients, not just those admitted to A and E. It talks of hospitals running at near to 100 per cent. occupancy and elective surgery frequently cancelled—including cancer operations". Cancer operations are being cancelled elsewhere, too.

A letter from a consultant neurosurgeon at the Salford Royal Hospitals NHS trust to a patient awaiting surgery shows the intolerable pressure on his patients. The letter reads: Because of the problems in other district hospitals brought about by the recent bed crisis, we have not been able to move patients out of the unit and, therefore, this has restricted our ability to bring in patients for treatment. I wanted to reassure you that your brain tumour is not growing rapidly and that you will come to no medical harm as a result of the additional delay which has been forced upon us by this difficult situation. At the moment I cannot give you a date for admission but you can be reassured that you have not been forgotten. The Secretary of State's view that there are no waiting lists for cancer operations does not tally with the experience of patients across the country. Labour has already pledged to treat an extra 100,000 patients and take them off hospital waiting lists by releasing £100 million from the red tape which is the result of the Government's bureaucratisation of the NHS. As part of this pledge, we will ensure that cancer patients do not have to wait for surgery.

There are other immediate priorities to which a Labour Government will give urgent attention. We will end the two-tierism which has been the hallmark of this Government's treatment of patients needing primary care—the division is between people who are patients of fundholders and those who are not. We will extricate the NHS from the perverse incentives of the internal market and halt the moves towards the privatisation of the service.

This debate is an opportunity to pay tribute to the staff of the national health service, not only the doctors and nurses but all who work in it—very often in the most difficult circumstances—and who provide the very best care that they can. We will end the commercial internal market and restore the NHS as a public service which puts patients first because that is what the staff and the people of this country want—the immediate priority for the NHS is a Labour Government who will rebuild it.

5.52 pm

Rev. Ian Paisley (North Antrim)

I wish to offer my condolences and those of my colleagues to the Under-Secretary of State for Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), who is responsible for health in Northern Ireland. At talks yesterday at which all parties were represented, there was a public and unanimous expression of sympathy for him. I trust that the Ministers here today will convey that to him as soon as they can.

I must pay a brief tribute to the Under-Secretary. The Minister for Health said that some people were on another planet. I assure him that North Antrim is not on another planet; indeed, it is not far from Scotland—just 20 miles across the water.

When I entered the House in 1970, there were eight hospitals with acute units in my area. Today there are no such acute hospitals within the bounds of my constituency. Ballycastle, Ballymena and Ballymoney are three local government areas which make up my constituency. Ballycastle hospital is closed, Ballymoney hospital is being closed, and Ballymena hospital, which was to be the main hospital, is also closing.

As Ballymena is the geographical centre of the locality, we were promised that it would be the site for a new acute hospital. That was put on the long finger, and then rejected. A new hospital—or a third of a new hospital—has been erected in Antrim. No one knows when the rest of it will be completed, but I am sure that it will not be in the lifetime of anyone here.

The northern part of the district lost out, and we were then promised a new hospital outside the area, nearer to Coleraine. That was put on the long finger for 30 years. The recent cuts in the finance to Northern Ireland meant that there was a question mark over that, too. In fact, building was stopped, and it was decided not to proceed. It was thanks to the Under-Secretary that the project was retained.

The Secretary of State for Northern Ireland told me himself that the Under-Secretary was lacerated for the bold stand he took to ensure that the promise of 30 years ago was implemented. I pay tribute to the Under-Secretary—but for him, we would not be getting that hospital, although it is outside the bounds of my constituency. I am glad to have put that fact on record.

There is no increase in NHS expenditure in Northern Ireland. As the hon. Member for Belfast, South (Rev. Martin Smyth) said, there has been a year-by-year 3 per cent. cut. We are told that the reductions can be made in so-called efficiency savings, but that is impossible, and the health service is being decimated. The flesh is disappearing, and the bones are beginning to show—anyone can see that by going to the Province. The facts cannot be covered up or argued away. All sections of the community agree on that.

I pay a warm and whole-hearted tribute to all who work in the health service. This is a difficult time not only for the health service but for our Province. The people who work in the service have even more pressure on them; they need even greater patience, and have to make sacrifices. They are providing care and making sacrifices, but if they do not have the finances to do the job, services are seriously curtailed.

Wards have been closed, waiting lists for elective surgery are increasing, and people waiting for major operations are being telephoned on the very day they are due to enter hospital and told that, because of a lack of funds, the operations are cancelled. Indeed, even patients prepared and ready for theatre are being sent back to the ward and then home. That has happened time and again. Of course, the Minister receives representations from all Members of Parliament about such incidents.

Assessments are taking ever longer to complete. There are numerous examples of bed blocking because the community trusts have no money to put care packages in place or provide residential or nursing home care finance. Surely it must be more cost-effective to keep a person in their own home or in residential or nursing care than in a hospital. That has to be faced up to. If we do so, money could be made available. We need to take a decision on that.

The Government's decision not to proceed with adjustment capitation funding will have devastating consequences on the Eastern health and social services board, which covers Belfast, where the major regional hospitals are. A report was submitted last year, but so far the Government have put it on the long finger.

The main hospital in Belfast is the Royal Victoria hospital, but the House must recognise that it is in the heart of IRA Provoland. People do not want to go there, and more and more are objecting. Mr. Nigel Dodds, who is my assistant in the European Parliament and was the youngest Lord Mayor of Belfast, had his young child in the sick children's hospital in the Royal complex. Before Christmas, the IRA attempted to kill him and his wife on the ward when they were going to visit their boy. A bullet from an IRA gun went through an incubator. We cannot ask parents to go to a hospital under those circumstances. It is a very serious situation.

I do not visit the Royal Victoria hospital any more, even though I have pastoral duties that I should attend to, because a massive security operation is needed to get me in and out. I cannot put 40 members of the security forces at risk just because I want to visit one patient. I once went to see one of my church officers, who was seriously ill. When I left the ward, two IRA men came in and demanded to know "the bed that Paisley visited". That is what is happening in the Royal Victoria hospital. We must decide whether to continue pouring money into that complex, where people are afraid to go and where life is being jeopardised. The Government must consider that.

The current review considering the possibility of introducing charging into health provision in the community is rightly causing alarm in my area, where we have the most vulnerable and needy sections of all communities. It would be scandalous for the Government to introduce charges for services such as home help, occupational therapy and a range of other vital work. The people in my area need those services on a no-charge basis. They cannot meet the commitment otherwise.

It is also reprehensible that trusts should be proposing to introduce charges for nurses and other hospital staff to park their cars in the hospital grounds. Just think about that. That is what is happening at the Royal Victoria hospital. Surely there is no better place for them to park their cars than an area where the police have to keep them under surveillance. They have to pay for parking. Even though they have already paid up, nurses from the Royal group of hospitals are not even guaranteed parking space if people get there before them. How can we expect the best from our nurses and doctors if we do not look after them? They need to be looked after. The hospital trusts in my country must think again.

The Government introduced the patients charter, which was widely welcomed by my party, but we warned at the time that a charter is meaningless if the funding and resources are not in place to allow its targets to be met. How can targets be met without the financial wherewithal? That is particularly true on the reduction of waiting lists, which, as I have already said, are on the increase. Many hospitals in my country have made it clear that there will be no more surgery for non-emergency patients until the new financial year in April. They are all stopped.

There is also great concern—mentioned by the hon. Member for Dulwich (Ms Jowell)—about the two-tier health service, which we now have, in effect, in Northern Ireland. GP fundholders have no difficulty getting treatment for their patients, while the patients of non-fundholders have to take their place in the queue. They pay the same taxes and rates as anyone else. Why should they be discriminated against? When everyone has to pay the same taxes to provide health care, can the Government allow discrimination in patient care because of a patient's choice to stay with a non-fundholding doctor?

The hon. Member for Belfast, South mentioned nurses' pay. A serious situation has arisen on that, and I shall not go over the points he made. I remind the House that 80 per cent. of the female work force in Northern Ireland are employed by the NHS. Pay and conditions for those female workers are being driven down, destroying quality standards and equality. I have raised in the House before the on-going dispute between workers, the NHS trusts and Compass. We are in great difficulty. We have had strikes, and there is a lot of opposition.

The Government and the trusts have not lived up to their responsibilities. The Government cannot wash their hands of the issue and claim that it is a matter for the trusts, which has nothing to do with them. The Government have tried to shunt the matter off, saying that it pertains to the private sector. Remember that 80 per cent. of our female work force are employed in the NHS. The pay they are offered is atrocious—it is an insult to them. The Government must take that into account. They cannot wash their hands of it.

Those are some of the serious difficulties that the health service in Northern Ireland is up against. We have rightly emphasised those issues today. We are not trying to do down the health service. The Government have taken credit for building the health service. I ask them not to destroy what they have built. Being a preacher, I am reminded of the apostle Paul's words that, if I pull down that which I once built, I am a transgressor. My final homily to the Government is, "Please do not be a transgressor."

6.7 pm

Mr. Robert Maclennan (Caithness and Sutherland)

I am glad to follow the hon. Member for North Antrim (Rev. Ian Paisley). In particular, I share the concerns he expressed about nurses, who are waiting with great interest and hope for the announcement from the pay review body and the Government's reaction to it.

My party's view is that the presumption should be that the Government accept the findings of an independent pay review body that they established. That must be the starting point. If we are to believe what prior indications and leaks suggest, the proposals are likely to be modest. It certainly ought to be within the Government's capability to meet in full the award, which should have been taken into account in the Chancellor's forward budgetary predictions.

I emphasise the importance of nurses and those who deliver the health service, because they frequently work under enormous pressure.

We often hear about the predicament of young doctors who spend very long hours in hospitals when they are training and in the early years of their specialisations. I am the son of a gynaecologist and a specialist in public health, and have always been conscious of the long hours that doctors work. However, there is considerable evidence that recently the pressure on people upon whom we rely so heavily has become too acute.

Another sector of health providers to whom I pay tribute is the general practitioners. Although the Secretary of State for Health has not attended the debate, the presence of the Minister of State, Scottish Office is most welcome. I believe that, when the House is debating a central issue of policy such as the health service, there is no more important ministerial duty than to be present and hear hon. Members, representing all parts of the United Kingdom, relating widely differing experiences.

Rural doctors can also be under great pressure, not from hour upon hour of accident and emergency treatment, although that may form part of their care and concern, but because they are on constant duty without necessarily having any back up. The case of the inducement practitioners in the highlands of Scotland has to be kept under constant scrutiny and regard lest the pressure upon them becomes insupportable.

I find it unsatisfactory that, in my constituency, there should be arguments about whether 0.5 per cent. of a doctor should be included in the medical resources available to a practitioner whose practice may cover hundreds of square miles, where he is the only person providing medical cover.

Mr. Simon Hughes

My hon. Friend and I probably represent the most different species of constituency in the United Kingdom. Mine is in the heart of London, and my hon. Friend's is in the most remote rural part of northern Scotland. Does he agree that one of the real concerns that affect us both is that, unless a real effort is made and funds are allocated to recruit people to general practice, there will be a shortage of general practitioners in all parts of the United Kingdom, in a way that none of us have known in our adult lives?

Mr. Maclennan

I agree with my hon. Friend, and I call in evidence in support of what he has said what I was told by general practitioners I recently met in Thurso in Caithness. They drew my attention to the substantial number of general practitioners who chose to emigrate to Australia and other countries not entirely different from our own. That is a disturbing factor, which requires advanced consideration. It will not do for us to be scraping around in other countries in five or 10 years' time trying to induce practitioners to come to Britain. That would not be a reasonably priced, cost-efficient option.

Mr. Gallie

The hon. Gentleman comes from Scotland, as I do. Is it not a fact that Scotland has the greatest teaching hospitals in the world, and Scots have always taken their excellent skills worldwide? Should we not be proud of that rather than bemoaning it?

Mr. Maclennan

I take great pride in that fact. My father was a teacher at one of those great teaching hospitals. He was president of the Royal College of Obstetricians and Gynaecologists, which was a Commonwealth college. Of course I welcome to the United Kingdom doctors from abroad, as I understand the impulse of those who want to find their fortunes elsewhere. I hope that the hon. Gentleman will accept that I was seeking to make not a partisan point, but the point that doctors in Scotland have told me that their numbers are becoming dangerously depleted. They are worried about the effect on the service in future. It right for me to convey that anxiety to the Minister.

Many general practitioners, particularly in rural areas, feel that their job has expanded in recent years, not because of the influx of new patients or the necessity of keeping abreast of the latest developments in medicine—although that may be true—but because of the requirements of form filling and meeting the demands of the health authorities to provide information for which they receive no additional emolument. That is another factor that is not adequately taken into account, particularly in rural areas with single-handed or small practices with few partners.

I am not suggesting that the work should not be carried out. Some of it is necessary to provide a proper audit of health treatment and to enable the formation of policy to adequately meet the demands of health in Scotland today. However, it is not adequately taken into account in evaluating the service of doctors.

I now turn from doctors to other servants of the public, in ancillary and related spheres. In the north of Scotland, there is great pressure from the lack of certain services, some of which may be regarded as paramedical, such as speech therapists, of whom there is gross under-supply. That can create serious medical problems. I have to ask the Government why we have been aware of the problem for so long, yet the demand is still unmet. I feel that it has much to do with the inadequate reward offered to people providing those services.

I now draw the Minister's attention to a matter with which he is familiar. Although many ambulancemen provide an excellent service, as I found out 20 years ago, when I fell off the edge of my constituency in north-west Sutherland and was taken some 120 miles over fairly rough terrain by an ambulanceman and have been grateful ever since, there are considerable anxieties in the north of Scotland about the management of the ambulance service.

The hon. Member for North Tayside (Mr. Walker), my hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) and I have expressed those anxieties to the Minister. We have amassed a number of cases that show that there is something seriously rotten in the management of the service, particularly in Inverness, and we look forward to the possibility of discussing our concerns. Although they involve management issues, they raise extremely grave matters that cannot be tackled without ministerial intervention.

I turn from various tributes and concerns to some of the priorities that we have highlighted in today's debate, not because we consider that they are the only issues that matter, but because they touch immediate needs that can be addressed effectively and immediately.

The first requirement that we have put forward, to which I was rather surprised to hear the Minister taking such extraordinary exception, and to which he reacted in such a partisan fashion, is that there should be a proper independent survey and an analysis of the needs of the NHS. He treated that suggestion as though it was somehow impugning the statistical integrity of officials.

The reality is quite different: it appears that Ministers are indicating that there are certain statistics in which, for whatever reason, they are not interested. They apparently do not want to know about hospital closures on a nationwide basis. That is to do not with the integrity of statisticians, but with political bias, the purblind attitudes of those in charge. For such reasons, it is necessary to conduct an independent survey—one that is not capable of being pushed around by Ministers who are anxious to cover up the defects of our NHS.

There are two reasons why such a survey is necessary. The first is that we need to know the outturns of the services that are being provided. That they are different in different parts of the country is absolutely clear. I serve on the council of the Cancer Research Campaign, which spends substantially more money on cancer research every year than the Government.

One of the things that the council put its hand to was a survey of the outturns of cancer treatments in different parts of the country. It revealed quite disturbing figures, of which the Government are aware. Such work should not be left to charitable organisations to fund, albeit in conjunction with particular health authorities. Such work needs to be done all the time if we are to continue to ensure that our treatments and the delivery of services meet the challenges and standards that we demand and expect, especially in a technologically rapidly advancing area of society.

The second reason is the cognate one that it is important that we know where to invest. That should not be a matter of happenstance or of political pork-barrelling, with Ministers looking favourably on their friends' constituencies, or anything of that kind. It should be decided according to need. We need independent facts and figures to calculate that need. Although we certainly have to aggregate and accumulate those figures locally, they must be interpreted nationally. That was missing from the Minister's response.

I turn to the other proposals in the motion. We should recognise that the imposition of prescription charges is becoming so punitive that impoverished people—there are a substantial number of them, perhaps 10 per cent. of the population—are seriously deterred from going to the doctor because they know that they cannot afford what they may be required to pay. We believe that there should be a standstill on prescription charge increases. We have costed that at £9 million per annum, which we believe can be funded by a portion of our proposed tax on cigarettes.

We have also recognised two other specific areas of importance: dental and eye checks. There is very great anxiety that the failure to provide free dental checks is leading to a general deterioration of the dental health of the community. That can have effects far beyond teeth. It can lead to the general debility of an individual. Reinstating free dental checks is a form of preventive medicine that can be extremely cost-effective, and I therefore commend it strongly to the Government. It is not one of the more expensive measures that one might propose. It adds up to £60 million per annum at current prices.

Eye checks are of such importance. There is evidence of people failing to have their eyes checked. There is concern among eye specialists about the spread of glaucoma and preventable diseases due to inadequate cover. I have no doubt from surveys in my constituency that there has been a substantial downturn in attendance in doctors' surgeries for such things of late.

We also recognise the need to increase the number of nurses, and, in some cases, the numbers of doctors. The shortages of doctors have been rather haphazard and very disturbing. I know that one of the great shortages we have suffered in the highlands is among orthopaedic surgeons. We began to catch up after some years of acute shortage, and we now have five orthopaedic surgeons at the Raigmore hospital. They are trying to deal with a great backlog and a long waiting list of people whose operations may be described as elective but who have been suffering great pain. I know, because they come to my surgeries and ask if there is anything that I can do about it.

It has been deeply depressing that, in the past five years, so many medical cases have been raised in my constituency. People used to ask about lawyers, doubts about legal matters or housing, and they still do, but medical matters for a Member of Parliament are something of a new phenomenon. It is due in part to the disturbing medical shortages. We have proposed 10,000 additional nurses and 5,000 additional doctors, and costed that, too. The recommendations are not irresponsible: they are particular.

I draw attention to the rather striking empty assurance from the Labour party that all that is required is the return of a Labour Government. The only money about which the hon. Member for Dulwich (Ms Jowell) was prepared to speak was £100 million that would be drawn from some putative savings in administration costs. I should be delighted if we could make such savings. I hope that it is not just whistling in the wind.

There is an argument that, on occasions, administration is a little top-heavy, but, until the Labour party makes available more particulars, we must view the assurance as rather small beer, especially set against the announcement two weeks ago by the right hon. Member for Dunfermline, East (Mr. Brown) that Labour accepts the Government's budgetary targets for health spending for the next two years.

The hon. Gentleman made that announcement without even bothering to wait to open the books or having the opportunity to examine whether the health administration savings can be made. He has bound his party and his Government-to-be, if there is to be a Labour Government—heaven forfend, if that is to be their policy—to accepting the Conservative party's views. That is a sad thought for the country, which is left with a choice to support the Liberal Democrat party, which has been clear, prioritised and firm about things that need to be done.

I should like to cite a couple of examples of issues that have arisen in my constituency that I think need attention. The example of the Migdale hospital, to which I referred at Question Time today, encapsulates one of the pressure points on the health service: the treatment and care of the elderly. I am not attributing blame either to the health service or to the social work department. It is not satisfactory for health service hospitals to seek to edge out those who have been living there for some time, either into social work departments' non-existent care provision or into private nursing homes.

Those are hospitals which bring together, as the Migdale does, specialisms of many kinds to ease the lives of the individuals resident there and of their families. They give respite care, physiotherapy and occupational therapy, as well as specialist treatment. The health board's proposal to consider depriving Sutherland of that hospital is a retrograde step, which I hope will not be taken.

I am conscious of the fact that this is rather a short debate, so, although there are many other matters of general interest that I should love to raise, I shall follow the example of those from my party who have spoken earlier, and confine my remarks to the priority issues. As I have already said, I am grateful to the Minister for being here, and I hope that his response to the debate will be positive.

6.29 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

We have had a useful set of exchanges, and we await the Minister's wind-up speech. At the outset, I associate my right hon. and hon. Friends with the condolences expressed to the Parliamentary Under-Secretary of State for Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), following his recent bereavement. Clearly, hon. Members on both sides of the House will want to extend their sincere condolences to him.

Secondly, I echo what was said by my hon. Friend the Member for Southwark and Bermondsey (Mr. Hughes) at the beginning of the debate—that it is perhaps regrettable that the Secretary of State cannot be with us today. Depending on the timing of the election, this could be one of the last opportunities for the House to examine the national health service, so it might have been appropriate for the right hon. Gentleman to be here.

Mr. Gallie

rose—

Mr. Kennedy

No, I shall not give way to the hon. Gentleman. [Interruption] I am sorry if he was frozen out of the debate, but the hon. Member for Southport (Mr. Banks), who is sitting close to him, spoke for nearly half an hour, and I am sure that he could have made his telling points in slightly less time.

Mr. Matthew Banks

Tell us where Paddy is.

Mr. Kennedy

I shall answer the hon. Gentleman in a minute.

Some of the debate, especially the opening contribution by the Minister for Health, focused on statistics, but, as he began to deploy his case, one central feature of the restructured health service under the current Administration became clear. It was much in evidence in the way in which the Minister went about his business in the debate.

If there is any credit to be taken on health issues, it is claimed nationally, but if there is any blame or downside, the information is much too difficult to collect centrally, and the issue has to be dealt with locally. That is the political purchaser-provider split that Health Ministers want to establish. If there are problems, they do not have the information centrally, and we are referred elsewhere, but if there is a good song to sing, the statistics magically happen to be at hand. People outside the House who read the text of the debate will see through that.

Sir Roger Moate (Faversham)

The hon. Gentleman talks a lot about statistics, but one important statistic is missing from the Liberal Democrats' presentation. How much money are they committed to spending? We have been listening carefully. They have invented a hypothecated tax on tobacco to pay for all the extra spending, but they did not put a figure on it. Can the hon. Gentleman give us a precise figure for exactly how much the Liberal party is pledging itself to raise in new taxation for health spending in the first year, and in the second year?

Mr. Kennedy

The hon. Gentleman has not been listening with sufficient care, or he would have heard both my hon. Friend the Member for Caithness and Sutherland and my hon. Friend the Member for Southwark and Bermondsey, when he opened the debate, setting out in crystal clear fashion specifically what the commitments are. The hon. Gentleman will find them in the columns of Hansard tomorrow.

My hon. Friend mentioned the proposal for extra revenue to be raised from tobacco. As my hon. Friend has said many times, including this afternoon, that will be specifically earmarked for the pledges or recommendations in respect of optical, dental and prescription charges that we have made in the debate. All that has been categorically set out, and it is nonsense for the hon. Gentleman to suggest that it has not.

Mr. Gallie

Will the hon. Gentleman give way?

Mr. Kennedy

If the hon. Gentleman will forgive me, I want to touch on some of the points made in the debate.

Mr. Simon Hughes

I do not want hon. Members who, for whatever reason, may not have been here for the whole debate to think that there is any doubt about the figures. My hon. Friend the Member for Caithness and Sutherland and I, together with our Treasury spokesman, my hon. Friend the Member for Gordon (Mr. Bruce), have made the figures very clear.

There is a £200 million commitment to be raised by putting 5p on 20 cigarettes, a £350 million per year commitment to be raised by closing the employers' national insurance loophole. There is also another commitment to do with keeping pace with national health service inflation. Those three commitments have been clearly costed, on the basis of Government answers given over the past 10 days.

Mr. Kennedy

I am grateful to my hon. Friend.

On the subject of statistics, the Minister for Health showed characteristic brass neck when he talked about the use of official statistics, in view of the fact that, in the past few days, we have seen the unprecedented withdrawal by the Office for National Statistics of the official Government health spending statistics, as a result of some apparent confusion over the application of the NHS deflator.

That does not fill the rest of us with confidence that the ministerial touch on the tiller in the production of the statistics is as firm and sure as all that. The whole thing becomes all the more suspicious when one notes that the original version showed that real-terms spending on the health service did not match Government rhetoric, yet, lo and behold, when the error spotted by our sharp-eyed Ministers was amended, the graph was slightly more in accord with the Government's case.

That shows that the general point that we have argued in the debate is valid. We should have independent statistical advice, free of the Department of Health, which would do a lot not simply to boost public confidence in the information made available to us but to enable debates on health—debates about the kind of priorities that my hon. Friend the Member for Southwark and Bermondsey described—to be conducted in a more rational and better informed way.

When my hon. Friend opened the debate, as well as calling for that form of independent assessment, he stressed the need for investment—the hon. Member for Faversham (Sir R. Moate) will be able to read about that tomorrow, too—for planning and for accountability. I do not want to go back over those issues, but I shall refer to one or two of the points that came up in the debate.

First, I shall reply to the hon. Member for Southport, who paid advance tribute to our friend and former parliamentary colleague Ronnie Fearn, by wishing him many happy returns for his birthday tomorrow. I do not want to be churlish, but the hon. Gentleman will appreciate the fact that, in the electoral sense, I cannot wish him many happy returns. I hope that Councillor Fearn will be back among us after the election.

The hon. Member for Southport asked about my right hon. Friend the Member for Yeovil (Mr. Ashdown), the leader of my party, who was in the Chamber for a brief part of the debate—[Interruption.] If the hon. Gentleman wishes to listen, he will hear that my right hon. Friend has spent the afternoon visiting Bart's. When political parties are debating the national health service, it is entirely sensible, fitting and appropriate for a party leader to be visiting such a centre of excellence and listening to the people there at first hand.

I shall reply to a couple of other points that the hon. Gentleman touched upon. He said that he chooses, as is his legitimate right, to have private medical insurance.

Mr. Banks

I have never used it.

Mr. Kennedy

The hon. Gentleman happens not to have used his insurance, and I certainly hope that he does not need to. However, the philosophical point that we want to make about our party's stance is that no Liberal Democrat opposes the right of any individual to make private provision out of his or her own disposable income. But we object to the fact that the rest of the tax-paying public should give such a person an additional tax incentive.

Mr. Banks

What about choice?

Mr. Kennedy

Choice is entirely open to the individual in the marketplace, but that choice should not be bankrolled by the state via the tax system. It was the former Prime Minister who insisted on allowing that, although, as was well reported at the time, it went rather against the instincts of her then Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), who is now Chancellor of the Exchequer.

I note in passing that the right hon. and learned Gentleman has not used his present office to reverse that policy, although as Secretary of State for Health he made little secret of the fact that he did not agree with it at first.

The hon. Member for Southport sees the private finance initiative as central to the future delivery of the fabric or infrastructure of health. The jury is still very much out on the PFI in terms of the longer-term accrual of debt that it loads on to future generations, but I should point out to him that, if he thinks that the PFI is the answer to all the problems, he should note that this debate will be answered by the Minister of State, Scottish Office. He is something of a world expert on the subject, having delivered the Skye bridge by means of the PFI. His reputation in Scotland has never, and will never, recover from his involvement in that fiasco.

I was disappointed—although not surprised—by the timid nature of the Labour party's stance on these matters, but I was even more surprised and disappointed by the general tone of the rhetoric of the hon. Member for Dulwich (Ms Jowell). Had one come into the Gallery without being aware of the party politics at work here, one might have thought from listening to the hon. Lady that she was an up-and-coming young Conservative health Minister, speaking in a rather patronising way about proposals to reform and improve the health service, while doing a rather good job of defending the establishment line.

We should note for the record that the only specific commitment that the Labour party feels able to give in terms of the wording of our motion this evening, which refers to a freeze on all finance-driven bed, hospital and service closures", relates to bed closures in London only. There is no commitment whatever from Labour on service withdrawals and bed closures across the whole of the UK.

Mr. Gallie

Will the hon. Gentleman give way?

Mr. Kennedy

No, I am sorry. I only have a few minutes to speak, and I must move on.

The Labour party is not in a position to give a commitment on the system of charges to which we drew specific attention during the debate. That has been made clear from the strictures placed by the shadow Chancellor on Labour's overall tax and spending proposals. We need not look with much hope in that direction if we want to see significant improvements in both the administration and the funding of the NHS.

Turning specifically to charges, there is no doubt, from the surveys and analyses that our party has carried out across the country as to the severe disincentive effect that the current system of check-up charges is having, that it is not just turning people away, but runs against what is supposed to be the central thrust—agreed by all parties—of health care policy, which is in the direction of prevention and promotion.

One cannot have effective preventive and promotional health strategies when, for example, people are making savings on multiple prescriptions when issued by a doctor, when people are not undertaking the entire range of dental treatment recommended by their dental surgeon, and when serious medical conditions—very serious, in some cases—are going unchecked, or are not being picked up in time, as a result of people not resorting to optical tests when they should.

I carried out a survey in my constituency, and I was genuinely surprised by the results. Local opticians were asked how many times in the past year they had detected any of the following conditions. [Interruption.] Please let it be noted for the record that Conservative Members are laughing. The opticians discovered these conditions: brain tumours, on six occasions; cataracts, 718; diabetes, 49; glaucoma, 253; detached retina, 12; multiple sclerosis, two. These conditions are slipping through the net on some occasions at GP level, but—thank goodness—thanks to the technology available to opticians, they can be detected when people go in for a perfectly routine eye test. If more people are being turned away from eye tests, more of these serious medical conditions will not be picked up, and the Government must directly address that.

In respect of general practice, it was alarming to discover the number of doctors—this is a reflection of what is happening nationally—who were contemplating early retirement because of the sheer pressure of the paperwork, the bureaucracy and the demands that have been loaded on to them as a result of the changes that have taken place to their status and to general practice as a whole. The Government will be making a severe long-term error if they do not pay attention to the warnings that are coming from general practitioners, and to the fact that more and more GPs are choosing at an early age to vote with their feet. That is creating long-term difficulties in terms of health care as a whole.

We must look at the question of the annual year-on-year contract negotiations, and hon. Members will be able to provide many examples from their areas, where, because of the protracted length and complexity of the negotiations between the health authorities and individual NHS trusts and the amount of management time devoted to them, all too often the negotiations spill well into the financial year, with the contracts still not signed. Therefore, short-term ward closures and service downgrading must take place.

The Minister of State should consider whether we can have a more flexible rollover system to extend the negotiating period from one to three years, and whether we can allow the managers on both sides greater flexibility than the somewhat artificial constraints represented by the need for the annual renewal of contracts, as they presently stand.

This has been a useful opportunity to set out our priorities for the NHS on behalf of the Liberal Democrats, and to explore the priorities and the scale of the commitment from other directions. If the voters are looking for a real choice in terms of the funding and future of the health service, it is between the maintenance of the status quo—under whichever of the two major parties might be in power after the election—and a genuinely funded and costed improvement. Only the Liberal Democrats will be arguing unequivocally and honestly for the latter at the election.

6.46 pm

The Minister of State, Scottish Office (Lord James Douglas-Hamilton)

We have heard some constructive speeches in the debate. The hon. Member for Caithness and Sutherland (Mr. Maclennan) referred to Raigmore as a centre of excellence and, having visited it, I endorse that view. Our whole purpose is to ensure that the NHS is engaged in the pursuit of excellence. I also wish to associate the rest of the House with the expression of sympathy from the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) towards my hon. Friend the Under-Secretary of State for Northern Ireland following his recent bereavement.

The fact that Scottish National party Members and Labour Back Benchers have not attended the bulk of the debate in no way diminishes the seriousness and validity of the points raised by the hon. Member for North Antrim (Rev. Ian Paisley). He will know that my right hon. Friend the Minister of State, Northern Ireland Office made it clear on 10 December that he was delighted to confirm the investment at Lodge road, Coleraine and the long-standing commitment to replace it. He added that the facilities there, together with the new Antrim hospital, will provide the whole of the north-east of the Province with the most up-to-date acute services available, and that represents an investment of almost £100 million during this decade.

The hon. Member for North Antrim asked when we expected the project to be completed, and the current estimate is that it should be completed towards the end of 2000. He also referred to the McKenna review, and my right hon. Friend the Minister of State, Northern Ireland Office has consulted widely on the recommendations put to him by the project steering group. He is considering all aspects of the matter and is hoping to announce his decisions in the near future.

The hon. Member for Caithness and Sutherland referred to pressures on rural doctors. I entirely agree with him that rural GPs face particular pressures, and that is why we have schemes such as the inducement practices in the more remote areas of Scotland. The needs of particular practices are best considered locally. Highland health board is well aware of the importance of maintaining a comprehensive and well-motivated network of GPs in the area. I also accept that it is important that GPs are able to take part in audit and to contribute their views. It is particularly difficult, of course, for those who are in practices on their own and we are conscious of the need to deal with that problem.

The hon. Member for Caithness and Sutherland mentioned the proposed closure of Migdale hospital. Every closure proposal requires ministerial approval and I assure the hon. Gentleman that the matter will be considered with the utmost care. At this stage, the health board is consulting. The hon. Gentleman also mentioned the shortage of orthopaedic surgeons at Raigmore. I am glad to be able to confirm that there is now a full complement, and he will be pleased that I can also confirm that the hospital is rapidly eliminating the backlog of operations that had built up.

I can tell the hon. Member for Ross, Cromarty and Skye that we have been able to make a further £2 million available in the current year to Highland health board, under the bridging finance scheme for community care developers. Also, the health board and the Highlands community trust have recently submitted proposals for a new acute psychiatric unit and new continuing care and rehabilitation facilities at Craig Dunain hospital. The preference of the board and the trust is to locate those facilities on the site of the existing Craig Phadrig hospital in Inverness.

The trust will be exploring the scope for proceeding with the projects under the private finance initiative. We look forward to learning what conclusions are reached. It is in everyone's interests that the outdated facilities there are replaced at the earliest opportunity, but we shall want to be satisfied that firm plans are properly in place to provide new facilities that fully reflect the needs of patients, before agreeing that the hospital should close.

Mr. Gallie

Does my right hon. and learned Friend get the impression from the comments of the spokesmen for both the Opposition parties that they are obsessed with buildings and beds? Conservative Members are concerned about patients. We want waiting lists to drop and treatment to be improved. We want new techniques to be adopted. Is not that Conservative policy?

Lord James Douglas-Hamilton

Our policy is driven by the needs of patients. That is our top priority and we shall ensure that that happens. I can make one obvious point in response to my hon. Friend. There has been a demand for an increase in day surgery, and we have increased the amount of day surgery enormously. That is to the benefit of families and, above all, patients themselves. It is a shift in the pattern of care that is in accordance with patients' needs.

We are supporting some key themes throughout Britain. The time that people have to wait under the health service is steadily reducing. In Scotland, the number of patients who had to wait a year for in-patient treatment dropped steadily from 1,745 in March 1994 to only 126 last month. In England, the average wait reduced from nine months to around four months between 1990 and 1995. That is undoubtedly progress. The NHS continues to treat an increasing number of people year on year, not only efficiently, but producing good outcomes in terms of curing illness and improving health.

Wherever I go—whether to Raigmore, which is next to the constituency of the hon. Member for Caithness and Sutherland, or to hospitals throughout Scotland—I invariably find patients saying that the care and dedication with which they are looked after are admirable. We are determined to maintain services free at the point of delivery.

On resources, we have fully honoured our manifesto commitment to increase health spending in real terms. Planned Government spending on the NHS is more than 70 per cent. higher in real terms than in 1978–79. Current NHS spending will grow by £1.75 billion in 1997–98—a substantial real-terms increase. In the United Kingdom as a whole, the NHS will spend more than £116 million every day in 1996–97. During my remarks, well over £1 million will have been spent—in fact, the sum will be more than £1.5 million. For the United Kingdom as a whole, spending is £724 for every man, woman or child in 1996–97, compared with £444 in 1978–79 at constant prices. That is, without question, a record of commitment.

I can confirm to the hon. Member for Belfast, South (Rev. Martin Smyth), who is temporarily absent from the Chamber, that we have now been able to make an additional £3.5 million allocation to boards in Northern Ireland in 1996–97, to help alleviate the resources problems arising from emergency admission levels, high-cost blood products and elective activity pressures.

The hon. Member for Dulwich (Ms Jowell) mentioned winter pressures. All parts of the NHS have experienced additional pressure this winter. They always do, and I pay tribute to the hard work of all involved to cope with the peak in emergency admissions. It is right that trusts should constantly keep the way in which they provide acute services under review. With increased numbers of day cases and of non-invasive surgery, the number of patients treated can be increased.

The review of acute services planning assumptions that my right hon. Friend the Secretary of State for Scotland commissioned last year came to the conclusion that it would be counter-productive to prevent acute hospitals from making changes to the acute services that they provide, including the number of beds, in response to changing needs. The same arguments apply to England and Wales. We encourage all health authorities and trusts to plan carefully to cope with the level of admissions that they are likely to face. We believe that the national health service is performing well.

My hon. Friend the Member for Southport (Mr. Banks) mentioned various hospitals in his constituency. Despite comprehensive consultation, the proposed plans remain contentious. They envisage the closure of the Christiana Hartley maternity hospital in Southport—maternity services would be centred on Ormskirk. The Sefton and South Lancashire health authorities are considering the responses to the proposals and all views will be taken into account. As Ministers may be asked to take a final decision, I cannot comment further at this time, but the views that my hon. Friend expressed tonight will be kept in mind.

Remarkable advances have been made in the national health service. The example that I found particularly moving was when I visited the hospital in Kilmarnock where cochlear implantations are performed. There have been more than 100 operations, and persons who experienced profound deafness—both young and old—were given hearing for the first time. I was able to talk to the patients, whose quality of life had been improved enormously. It is not merely the profoundly deaf who have benefited. Thirty years ago, there were no hip replacements, and keyhole surgery has advanced by leaps and bounds.

I should make it clear to the hon. Member for Ross, Cromarty and Skye that one advance that we look forward to is telemedicine—when his constituents go to a health centre, they might be able to speak to a specialist several hundred miles away, who will give them the best possible advice, followed by the necessary treatment where appropriate.

The use of scanners has enabled much quicker and more effective diagnosis and treatment. Heart transplant units are performing effectively and well, as are the liver transplant units that have come into existence throughout Britain. We are developing cancer services steadily and ensuring that there are specialist cancer centres, where expertise and skills can be concentrated and patients assured that they will get the best possible treatment. Similarly, we are ensuring that specialist palliative care is developed throughout Britain. We support the extension of palliative care for conditions other than cancer, and its introduction as soon as possible after diagnosis.

We are determined to ensure that our health service becomes the best in the world. We want to make certain that, when GP fundholders have remarkable pioneering innovations, those should be spread throughout the national health service. We want better access, responsiveness, information and continuing care, and more emphasis on prevention.

The NHS has an overall record of success, with more patients treated, shorter waiting times and improved treatments. We are determined that it should be the best in the world.

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

The House divided: Ayes 44. Noes 309.

Division No. 69]	[6.59 pm
AYES
Alton, David	Maddock, Mrs Diana
Beith, A J	Maginnis, Ken
Bruce, Malcolm (Gordon)	Michie, Mrs Ray (Argyll Bute)
Campbell, Menzies (Fife NE)	Mullin, Chris
Chidgey, David	Nicholson, Miss Emma (W Devon)
Cunningham, Ms R (Perth Kinross)	Paisley, Rev Ian
Dafis, Cynog	Rendel, David
Davies, Chris (Littleborough)	Ross, William (E Lond'y)
Ewing, Mrs Margaret	Salmond, Alex
Forsythe, Clifford (S Antrim)	Simpson, Alan
Foster, Don (Bath)	Skinner, Dennis
Fraser, John	Smyth, Rev Martin (Belfast S)
Harvey, Nick	Steel, Sir David
Hughes, Simon (Southwark)	Taylor, Matthew (Truro)
Johnston, Sir Russell	Thurnham, Peter
Jones, Ieuan Wyn (Ynys Môn)	Trimble, David
Jones, Dr L (B'ham Selly Oak)	Wallace, James
Jones, Nigel (Cheltenham)	Welsh, Andrew
Kennedy, Charles (Ross C & S)	Wigley, Dafydd
Livingstone, Ken	Wise, Mrs Audrey
Llwyd, Elfyn
Loyden, Eddie	Tellers for the Ayes:
McCartney, Robert (N Down)	Mr. Archy Kirkwood and
Maclennan, Robert	Mr. Paul Tyler.

NOES
Ainsworth, Peter (E Surrey)	Baker, Sir Nicholas (N Dorset)
Aitken, Jonathan	Baldry, Tony
Alexander, Richard	Banks, Matthew (Southport)
Alison, Michael (Selby)	Banks, Robert (Harrogate)
Allason, Rupert (Torbay)	Bates, Michael
Amess, David	Batiste, Spencer
Ancram, Michael	Bellingham, Henry
Arbuthnot, James	Bendall, Vivian
Arnold, Jacques (Gravesham)	Beresford, Sir Paul
Arnold, Sir Thomas (Hazel G)	Biffen, John
Ashby, David	Bonsor, Sir Nicholas
Aspinwall, Jack	Booth, Hartley
Atkinson, David (Bour'mth E)	Boswell, Tim
Atkinson, Peter (Hexham)	Bottomley, Peter (Eltham)
Baker, Kenneth (Mole V)	Bottomley, Mrs Virginia

Bowden, Sir Andrew	Gallie, Phil
Bowis, John	Gardiner, Sir George
Boyson, Sir Rhodes	Garel-Jones, Tristan
Brandreth, Gyles	Garnier, Edward
Brazier, Julian	Gill, Christopher
Bright, Sir Graham	Gillan, Mrs Cheryl
Brooke, Peter	Goodlad, Alastair
Brown, Michael (Brigg Cl'thorpes)	Goodson-Wickes, Dr Charles
Browning, Mrs Angela	Gorman, Mrs Teresa
Bruce, Ian (S Dorset)	Gorst, Sir John
Budgen, Nicholas	Grant, Sir Anthony (SW Cambs)
Burns, Simon	Greenway, Harry (Ealing N)
Burt, Alistair	Greenway, John (Ryedale)
Butcher, John	Griffiths, Peter (Portsmouth N)
Butler, Peter	Grylls, Sir Michael
Butterfill, John	Gummer, John
Carlisle, John (Luton N)	Hague, William
Carlisle, Sir Kenneth (Linc'n)	Hamilton, Sir Archibald
Carrington, Matthew	Hamilton, Neil (Tatton)
Carttiss, Michael	Hampson, Dr Keith
Cash, William	Hanley, Jeremy
Channon, Paul	Hannam, Sir John
Chapman, Sir Sydney	Hargreaves, Andrew
Clappison, James	Haselhurst, Sir Alan
Clark, Dr Michael (Rochf'd)	Hawkins, Nick
Clarke, Kenneth (Rushcliffe)	Hawksley, Warren
Clifton-Brown, Geoffrey	Hayes, Jerry
Coe, Sebastian	Heald, Oliver
Colvin, Michael	Heath, Sir Edward
Congdon, David	Heathcoat-Amory, David
Conway, Derek	Hendry, Charles
Coombs, Anthony (Wyre F)	Heseltine, Michael
Coombs, Simon (Swindon)	Hicks, Sir Robert
Cope, Sir John	Higgins, Sir Terence
Cormack, Sir Patrick	Hill, Sir James (Southampton Test)
Couchman, James	Hogg, Douglas (Grantham)
Cran, James	Horam, John
Currie, Mrs Edwina	Hordern, Sir Peter
Curry, David	Howard, Michael
Davies, Quentin (Stamf'd)	Howell, David (Guildf'd)
Davis, David (Boothferry)	Howell, Sir Ralph (N Norfolk)
Day, Stephen	Hughes, Robert G (Harrow W)
Deva, Nirj Joseph	Hunt, David (Wirral W)
Devlin, Tim	Hunt, Sir John (Ravensb'ne)
Dicks, Terry	Hunter, Andrew
Dorrell, Stephen	Hurd, Douglas
Douglas-Hamilton, Lord James	Jack, Michael
Dover, Den	Jackson, Robert (Wantage)
Duncan, Alan	Jenkin, Bernard (Colchester N)
Duncan Smith, Iain	Jessel, Toby
Dunn, Bob	Johnson Smith, Sir Geoffrey
Durant, Sir Anthony	Jones, Gwilym (Cardiff N)
Dykes, Hugh	Jones, Robert B (W Herts)
Eggar, Tim	Kellett-Bowman, Dame Elaine
Elletson, Harold	Key, Robert
Emery, Sir Peter	King, Tom
Evans, David (Welwyn Hatf'ld)	Kirkhope, Timothy
Evans, Jonathan (Brecon)	Knapman, Roger
Evans, Nigel (Ribble V)	Knight, Mrs Angela (Erewash)
Evans, Roger (Monmouth)	Knight, Greg (Derby N)
Evennett, David	Knight, Dame Jill (Edgbaston)
Faber, David	Knox, Sir David
Fabricant, Michael	Kynoch, George
Fenner, Dame Peggy	Lait, Mrs Jacqui
Field, Barry (Isle of Wight)	Lamont, Norman
Fishburn, Dudley	Lang, Ian
Forman, Nigel	Lawrence, Sir Ivan
Forsyth, Michael (Stirling)	Legg, Barry
Forth, Eric	Leigh, Edward
Fowler, Sir Norman	Lennox-Boyd, Sir Mark
Fox, Dr Liam (Woodspring)	Lester, Sir Jim (Broxtowe)
Fox, Sir Marcus (Shipley)	Lidington, David
Freeman, Roger	Lilley, Peter
French, Douglas	Lloyd, Sir Peter (Fareham)
Fry, Sir Peter	Lord, Michael
Gale, Roger	Luff, Peter

Lyell, Sir Nicholas	Shepherd, Richard (Aldridge)
MacGregor, John	Shersby, Sir Michael
MacKay, Andrew	Sims, Sir Roger
Maclean, David	Skeet, Sir Trevor
McLoughlin, Patrick	Smith, Sir Dudley (Warwick)
McNair-Wilson, Sir Patrick	Smith, Tim (Beaconsf'ld)
Madel, Sir David	Soames, Nicholas
Maitland, Lady Olga	Speed, Sir Keith
Major, John	Spencer, Sir Derek
Malone, Gerald	Spicer, Sir Jim (W Dorset)
Mans, Keith	Spicer, Sir Michael (S Worcs)
Marland, Paul	Spink, Dr Robert
Marlow, Tony	Spring, Richard
Marshall, John (Hendon S)	Sproat, Iain
Marshall, Sir Michael (Arundel)	Squire, Robin (Hornchurch)
Martin, David (Portsmouth S)	Steen, Anthony
Mates, Michael	Stephen, Michael
Mawhinney, Dr Brian	Stern, Michael
Mayhew, Sir Patrick	Stewart, Allan
Mellor, David	Streeter, Gary
Merchant, Piers	Sweeney, Walter
Mitchell, Andrew (Gedling)	Sykes, John
Mitchell, Sir David (NW Hants)	Tapsell, Sir Peter
Moate, Sir Roger	Taylor, Ian (Esher)
Monro, Sir Hector	Taylor, John M (Solihull)
Montgomery, Sir Fergus	Taylor, Sir Teddy
Needham, Richard	Temple-Morris, Peter
Nelson, Anthony	Thomason, Roy
Neubert, Sir Michael	Thompson, Sir Donald (Calder V)
Newton, Tony	Thompson, Patrick (Norwich N)
Nicholls, Patrick	Thornton, Sir Malcolm
Nicholson, David (Taunton)	Townend, John (Bridlington)
Onslow, Sir Cranley	Townsend, Sir Cyril (Bexl'yh'th)
Oppenheim, Phillip	Tracey, Richard
Page, Richard	Tredinnick, David
Paice, James	Trend, Michael
Patnick, Sir Irvine	Trotter, Neville
Patten, John	Twinn, Dr Ian
Pattie, Sir Geoffrey	Vaughan, Sir Gerard
Pawsey, James	Viggers, Peter
Peacock, Mrs Elizabeth	Waldegrave, William
Pickles, Eric	Walden George
Porter, David	Walker, Bill (N Tayside)
Portillo, Michael	Waller Gary
Powell, William (Corby)	Ward, John
Rathbone, Tim	Wardle, Charies (Bexhill)
Redwood, John	Waterson, Nigel
Renton, Tim	Watts, John
Richards, Rod	Wells, Bowen
Riddick, Graham	Wheeler, Sir John
Rifkind, Malcolm	Whitney, Sir Raymond
Robathan, Andrew	Whittingdale, John
Roberts, Sir Wyn	Widdecombe, Miss Ann
Robertson, Raymond S (Ab'd'n S)	Wiggin, Sir Jerry
Robinson, Mark (Somerton)	Wilkinson, John
Roe, Mrs Marion	Willetts, David
Rowe, Andrew	Wilshire, David
Rumbold, Dame Angela	Winterton, Mrs Ann (Congleton)
Ryder, Richard	Winterton, Nicholas (Macclesfld)
Sackville, Tom	Wolfson, Mark
Sainsbury, Sir Timothy	Yeo, Tim
Scott, Sir Nicholas	Young, Sir George
Shaw, David (Dover)	Tellers for the Noes:
Shaw, Sir Giles (Pudsey)	Mr. Timothy Wood and
Shephard, Mrs Gillian	Mr. Richard Ottaway.

Question accordingly negatived.

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

The House divided: Ayes 308, Noes 246.

Division No. 70]	[7.13 pm
AYES
Ainsworth, Peter (E Surrey)	Devlin, Tim
Aitken, Jonathan	Dicks, Terry
Alexander, Richard	Dorrell, Stephen
Alison, Michael (Selby)	Douglas-Hamilton, Lord James
Allason, Rupert (Torbay)	Dover, Den
Amess, David	Duncan, Alan
Ancram, Michael	Duncan Smith, Iain
Arbuthnot, James	Dunn, Bob
Arnold, Jacques (Gravesham)	Durant, Sir Anthony
Arnold, Sir Thomas (Hazel G)	Eggar, Tim
Ashby, David	Elletson, Harold
Aspinwall, Jack	Emery, Sir Peter
Atkinson, David (Bour'mth E)	Evans, David (Welwyn Hatf'ld)
Atkinson, Peter (Hexham)	Evans, Jonathan (Brecon)
Baker, Kenneth (Mole V)	Evans, Nigel (Ribble V)
Baker, Sir Nicholas (N Dorset)	Evans, Roger (Monmouth)
Baldry, Tony	Evennett, David
Banks, Matthew (Southport)	Faber, David
Banks, Robert (Harrogate)	Fabricant, Michael
Bates, Michael	Fenner, Dame Peggy
Batiste, Spencer	Field, Barry (Isle of Wight)
Bellingham, Henry	Fishburn, Dudley
Bendall, Vivian	Forman, Nigel
Beresford, Sir Paul	Forsyth, Michael (Stirling)
Biffen, John	Forth, Eric
Bonsor, Sir Nicholas	Fowler, Sir Norman
Booth, Hartley	Fox, Dr Liam (Woodspring)
Boswell, Tim	Fox, Sir Marcus (Shipley)
Bottomley, Peter (Eltham)	Freeman, Roger
Bottomley, Mrs Virginia	French, Douglas
Bowden, Sir Andrew	Fry, Sir Peter
Bowis, John	Gale, Roger
Boyson, Sir Rhodes	Gallie, Phil
Brandreth, Gyles	Gardiner, Sir George
Brazier, Julian	Garel-Jones, Tristan
Bright, Sir Graham	Garnier, Edward
Brooke, Peter	Gill, Christopher
Brown, Michael (Brigg Cl'thorpes)	Gillan, Mrs Cheryl
Browning, Mrs Angela	Goodlad, Alastair
Bruce, Ian (S Dorset)	Goodson-Wickes, Dr Charles
Budgen, Nicholas	Gorman, Mrs Teresa
Burns, Simon	Gorst, Sir John
Burt, Alistair	Grant, Sir Anthony (SW Cambs)
Butcher, John	Greenway, Harry (Ealing N)
Butler, Peter	Greenway, John (Ryedale)
Butterfill, John	Griffiths, Peter (Portsmouth N)
Carlisle, John (Luton N)	Grylls, Sir Michael
Carlisle, Sir Kenneth (Linc'n)	Gummer, John
Carrington, Matthew	Hague, William
Carttiss, Michael	Hamilton, Sir Archibald
Cash, William	Hamilton, Neil (Tatton)
Channon, Paul	Hampson, Dr Keith
Chapman, Sir Sydney	Hanley, Jeremy
Clappison, James	Hannam, Sir John
Clark, Dr Michael (Rochf'd)	Hargreaves, Andrew
Clarke, Kenneth (Rushcliffe)	Haselhurst, Sir Alan
Clifton-Brown, Geoffrey	Hawkins, Nick
Coe, Sebastian	Hawksley, Warren
Colvin, Michael	Hayes, Jerry
Congdon, David	Heald, Oliver
Conway, Derek	Heath, Sir Edward
Coombs, Anthony (Wyre F)	Heathcoat-Amory, David
Coombs, Simon (Swindon)	Hendry, Charles
Cope, Sir John	Heseltine, Michael
Cormack, Sir Patrick	Hicks, Sir Robert
Couchman, James	Higgins, Sir Terence
Cran, James	Hill, Sir James (Southampton Test)
Currie, Mrs Edwina	Hogg, Douglas (Grantham)
Curry, David	Horam, John
Davies, Quentin (Stamf'd)	Hordern, Sir Peter
Davis, David (Boothferry)	Howard, Michael
Day, Stephen	Howell, David (Guildf'd)
Deva, Nirj Joseph	Howell, Sir Ralph (N Norfolk)

Hughes, Robert G (Harrow W)	Peacock, Mrs Elizabeth
Hunt, David (Wirral W)	Pickles, Eric
Hunt, Sir John (Ravensb'ne)	Porter, David
Hunter, Andrew	Portillo, Michael
Hurd, Douglas	Powell, William (Corby)
Jack, Michael	Rathbone, Tim
Jackson, Robert (Wantage)	Redwood, John
Jenkin, Bernard (Colchester N)	Renton, Tim
Jessel, Toby	Richards, Rod
Johnson Smith, Sir Geoffrey	Riddick, Graham
Jones, Gwilym (Cardiff N)	Rifkind, Malcolm
Jones, Robert B (W Herts)	Robathan, Andrew
Kellett-Bowman, Dame Elaine	Roberts, Sir Wyn
Key, Robert	Robertson, Raymond S (Ab'd'n S)
King, Tom	Robinson, Mark (Somerton)
Kirkhope, Timothy	Roe, Mrs Marion
Knapman, Roger	Rowe, Andrew
Knight, Mrs Angela (Erewash)	Rumbold, Dame Angela
Knight, Greg (Derby N)	Ryder, Richard
Knight, Dame Jill (Edgbaston)	Sackville, Tom
Knox, Sir David	Sainsbury, Sir Timothy
Kynoch, George	Scott, Sir Nicholas
Lait, Mrs Jacqui	Shaw, David (Dover)
Lamont, Norman	Shaw, Sir Giles (Pudsey)
Lang, Ian	Shephard, Mrs Gillian
Lawrence, Sir Ivan	Shepherd, Richard (Aldridge)
Legg, Barry	Shersby, Sir Michael
Leigh, Edward	Sims, Sir Roger
Lennox-Boyd, Sir Mark	Skeet, Sir Trevor
Lester, Sir Jim (Broxtowe)	Smith, Sir Dudley (Warwick)
Lidington, David	Smith, Tim (Beaconsf'ld)
Lilley, Peter	Soames, Nicholas
Lloyd, Sir Peter (Fareham)	Speed, Sir Keith
Lord, Michael	Spencer, Sir Derek
Luff, Peter	Spicer, Sir Jim (W Dorset)
Lyell, Sir Nicholas	Spicer, Sir Michael (S Worcs)
MacGregor, John	Spink, Dr Robert
MacKay, Andrew	Spring, Richard
Maclean, David	Sproat, Iain
McLoughlin, Patrick	Squire, Robin (Hornchurch)
McNair-Wilson, Sir Patrick	Steen, Anthony
Madel, Sir David	Stephen, Michael
Maitland, Lady Olga	Stern, Michael
Major, John	Stewart, Allan
Malone, Gerald	Streeter, Gary
Mans, Keith	Sweeney, Walter
Marland, Paul	Sykes, John
Marlow, Tony	Tapsell, Sir Peter
Marshall, John (Hendon S)	Taylor, Ian (Esher)
Marshall, Sir Michael (Arundel)	Taylor, John M (Solihull)
Martin, David (Portsmouth S)	Taylor, Sir Teddy
Mates, Michael	Temple-Morris, Peter
Mawhinney, Dr Brian	Thomason, Roy
Mayhew, Sir Patrick	Thompson, Sir Donald (Calder V)
Mellor, David	Thompson, Patrick (Norwich N)
Merchant, Piers	Thornton, Sir Malcolm
Mitchell, Andrew (Gedling)	Townend, John (Bridlington)
Mitchell, Sir David (NW Hants)	Townsend, Sir Cyril (Bexl'yh'th)
Moate, Sir Roger	Tracey, Richard
Monro, Sir Hector	Trend, Michael
Montgomery, Sir Fergus	Trotter, Neville
Needham, Richard	Twinn, Dr Ian
Nelson, Anthony	Vaughan, Sir Gerard
Neubert, Sir Michael	Viggers, Peter
Newton, Tony	Waldegrave, William
Nicholls, Patrick	Walden, George
Nicholson, David (Taunton)	Walker, Bill (N Tayside)
Norris, Steve	Waller, Gary
Onslow, Sir Cranley	Ward, John
Oppenheim, Phillip	Wardle, Charles (Bexhill)
Page, Richard	Waterson, Nigel
Paice, James	Watts, John
Patnick, Sir Irvine	Wells, Bowen
Patten, John	Wheeler, Sir John
Pattie, Sir Geoffrey	Whitney, Sir Raymond
Pawsey, James	Whittingdale, John

Widdecombe, Miss Ann	Wolfson, Mark
Wiggin, Sir Jerry	Yeo, Tim
Wilkinson, John	Young, Sir George
Willetts, David
Wilshire, David	Tellers for the Ayes:
Winterton, Mrs Ann (Congleton)	Mr. Timothy Wood and
Winterton, Nicholas (Macclesf'ld)	Mr. Richard Ottaway.

NOES
Abbott, Ms Diane	Dunwoody, Mrs Gwyneth
Adams, Mrs Irene	Eagle, Ms Angela
Ainsworth, Robert (Cov'try NE)	Ennis, Jeff
Allen, Graham	Evans, John (St Helens N)
Alton, David	Ewing, Mrs Margaret
Anderson, Donald (Swansea E)	Fatchett, Derek
Armstrong, Ms Hilary	Faulds, Andrew
Ashdown, Paddy	Field, Frank (Birkenhead)
Ashton, Joseph	Fisher, Mark
Austin-Walker, John	Flynn, Paul
Banks, Tony (Newham NW)	Forsythe, Clifford (S Antrim)
Barnes, Harry	Foster, Don (Bath)
Barron, Kevin	Foulkes, George
Battle, John	Fraser, John
Bayley, Hugh	Fyfe, Mrs Maria
Beckett, Mrs Margaret	Galbraith, Sam
Beith, A J	Galloway, George
Bell, Stuart	Garrett, John
Benn, Tony	George, Bruce
Bennett, Andrew F	Gerrard, Neil
Benton, Joe	Gilbert, Dr John
Bermingham, Gerald	Godman, Dr Norman A
Betts, Clive	Golding, Mrs Llin
Blair, Tony	Gordon, Ms Mildred
Blunkett, David	Graham, Thomas
Bray, Dr Jeremy	Griffiths, Nigel (Edinburgh S)
Brown, Nicholas (Newcastle E)	Griffiths, Win (Bridgend)
Bruce, Malcolm (Gordon)	Grocott, Bruce
Burden, Richard	Gunnell, John
Byers, Stephen	Hain, Peter
Caborn, Richard	Hardy, Peter
Callaghan, Jim	Harman, Ms Harriet
Campbell, Mrs Anne (C'bridge)	Harvey, Nick
Campbell, Menzies (Fife NE)	Henderson, Doug
Campbell-Savours, D N	Hill, Keith (Streatham)
Cann, Jamie	Hinchliffe, David
Chidgey, David	Hodge, Ms Margaret
Chisholm, Malcolm	Hoey, Kate
Church, Ms Judith	Hogg, Norman (Cumbernauld)
Clapham, Michael	Home Robertson, John
Clarke, Eric (Midlothian)	Hoon, Geoffrey
Clarke, Tom (Monklands W)	Howarth, Alan (Stratf'd-on-A)
Clwyd, Mrs Ann	Howarth, George (Knowsley N)
Coffey, Ms Ann	Howells, Dr Kim
Cohen, Harry	Hoyle, Doug
Connarty, Michael	Hughes, Kevin (Doncaster N)
Cook, Frank (Stockton N)	Hughes, Robert (Ab'd'n N)
Cook, Robin (Livingston)	Hughes, Roy (Newport E)
Corbett, Robin	Hughes, Simon (Southwark)
Cousins, Jim	Hutton, John
Cummings, John	Illsley, Eric
Cunningham, Jim (Cov'try SE)	Ingram, Adam
Cunningham, Dr John	Jackson, Ms Glenda (Hampst'd)
Cunningham, Ms R (Perth Kinross)	Jackson, Mrs Helen (Hillsborough)
Dafis, Cynog	Jamieson, David
Dalyell, Tam	Janner, Greville
Darling, Alistair	Jenkins, Brian D (SE Staffs)
Davidson, Ian	Johnston, Sir Russell
Davies, Bryan (Oldham C)	Jones, Barry (Alyn & D'side)
Davies, Chris (Littleborough)	Jones, Ieuan Wyn (Ynys Môn)
Davies, Denzil (Llanelli)	Jones, Jon Owen (Cardiff C)
Davis, Terry (B'ham Hodge H)	Jones, Dr L (B'ham Selly Oak)
Denham, John	Jones, Martyn (Clwyd SW)
Dewar, Donald	Jones, Nigel (Cheltenham)
Dixon, Don	Jowell, Ms Tessa
Dobson, Frank	Kaufman, Gerald
Donohoe, Brian H	Keen, Alan

Kennedy, Charles (Ross C & S)	Prentice, Gordon (Pendle)
Kennedy, Mrs Jane (Broadgreen)	Purchase, Ken
Khabra, Piara S	Quin, Ms Joyce
Kilfoyle, Peter	Radice, Giles
Liddell, Mrs Helen	Randall, Stuart
Livingstone, Ken	Raynsford, Nick
Lloyd, Tony (Stretf'd)	Reid, Dr John
Llwyd, Elfyn	Rendel, David
Loyden, Eddie	Roche, Mrs Barbara
McAllion, John	Rooker, Jeff
McAvoy, Thomas	Rooney, Terry
McCartney, Robert (N Down)	Ross, William (E Lond'y)
Macdonald, Calum	Salmond, Alex
McFall, John	Sedgemore, Brian
McKelvey, William	Sheerman, Barry
Mackinlay, Andrew	Short, Clare
Maclennan, Robert	Simpson, Alan
McNamara, Kevin	Skinner, Dennis
MacShane, Denis	Smith, Andrew (Oxford E)
McWilliam, John	Smith, Chris (Islington S)
Madden, Max	Smith, Llew (Blaenau Gwent)
Maddock, Mrs Diana	Smyth, Rev Martin (Belfast S)
Maginnis, Ken	Snape, Peter
Mahon, Mrs Alice	Spearing, Nigel
Mandelson, Peter	Spellar, John
Marshall, David (Shettleston)	Squire, Ms R (Dunfermline W)
Marshall, Jim (Leicester S)	Steel, Sir David
Martin, Michael J (Springburn)	Strang, Dr Gavin
Martlew, Eric	Straw, Jack
Maxton, John	Sutcliffe, Gerry
Meacher, Michael	Taylor, Mrs Ann (Dewsbury)
Michael, Alun	Taylor, Matthew (Truro)
Michie, Bill (Shef'ld Heeley)	Thurnham, Peter
Michie, Mrs Ray (Argyll Bute)	Timms, Stephen
Milburn, Alan	Tipping, Paddy
Miller, Andrew	Trickett, Jon
Mitchell, Austin (Gt Grimsby)	Trimble, David
Moonie, Dr Lewis	Turner, Dennis
Morgan, Rhodri	Vaz, Keith
Morley, Elliot	Walker, Sir Harold
Morris, Ms Estelle (B'ham Yardley)	Wallace, James
Morris, John (Aberavon)	Walley, Ms Joan
Mowlam, Ms Marjorie	Wardell, Gareth (Gower)
Mudie, George	Watson, Mike
Mullin, Chris	Welsh, Andrew
Nicholson, Miss Emma (W Devon)	Wicks, Malcolm
O'Brien, Mike (N Walks)	Wigley, Dafydd
O'Brien, William (Normanton)	Williams, Alan (Swansea W)
O'Hara, Edward	Williams, Alan W (Carmarthen)
Olner, Bill	Winnick, David
O'Neill, Martin	Wise, Mrs Audrey
Paisley, Rev Ian	Worthington, Tony
Pearson, Ian	Wray, Jimmy
Pickthall, Colin	Wright, Dr Tony
Pike, Peter L
Pope, Greg	Tellers for the Noes:
Powell, Sir Raymond (Ogmore)	Mr. Archy Kirkwood and
Prentice, Mrs B (Lewisham E)	Mr. Paul Tyler.

Question accordingly agreed to.

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

Resolved, That this House is committed to the National Health Service as a public service, promoting health and offering increasing volumes of high-quality health care on the basis of need regardless of the ability to pay; and welcomes the Government's continuing commitment to real terms increases in NHS spending year by year.

The Secretary of State for Scotland (Mr. Michael Forsyth)

On a point of order, Mr. Deputy Speaker. At Scottish questions this afternoon, the hon. Member for Glasgow, Hillhead (Mr. Galloway) asked me a question and in my answer I said that the hon. Gentleman had been to Libya and referred to him as Labour's man in Libya. The hon. Gentleman has written to me stating that he has never been to Libya. I withdraw my remarks and apologise to the hon. Gentleman for any embarrassment that I may have caused him.