§ Mr. Chris Smith (Islington, South and Finsbury)
I beg to move,That this House expresses its deep concern at the continuing deterioration of the National Health Service in the provision of both acute services and community care; notes with alarm the publication of the highest ever figures for people waiting for treatment; condemns Her Majesty's Government's continuing failure to rule out completely the commercialisation of General Practitioner services in its National Health Service (Primary Care) Bill [Lords]; believes that the imposition of the internal market system in the health service has fragmented decision-making, has set hospital against hospital and doctor against doctor, and has generated expensive and unnecessary paperwork and bureaucracy; wants to see a transfer of resources from bureaucracy to patient care; salutes the dedication of staff at all levels within the Service who have held it together despite government policies, but expresses grave concern at the damaging impact those policies are having on staff morale; believes that government policy towards disabled people has failed to match the aspirations of disabled people themselves; believes that the Disability Discrimination Act 1995 does not provide effective means for tackling disadvantage and discrimination affecting disabled people; calls for the establishment of a Disability Rights Commission to consider how best to achieve comprehensive and enforceable civil rights for disabled people; believes that under this Government community care has become a discredited term associated with inadequate care for those in need and inadequate protection for the general public; and confirms that the National Health Service is not safe in this Government's hands.We have had a number of debates about the health service in the House in recent weeks, and I make no apology for the fact that many of them have been initiated by the Opposition. That policy area is at the very top of voters' lists of priorities as we approach the general election.
I want to focus on five specific areas of concern. My hon. Friend the Member for Monklands, West (Mr. Clarke) will deal later with questions relating to community care and disability. The first concern that I want to deal with is the general deterioration in the state of the national health service.
Last week, for example, the highest ever waiting list figures were published. The figures for the third quarter, from September to December 1996, show 1.096 million people waiting for operations, including a sharp increase of 46 per cent.—nearly a half—in those waiting for more than a year. We know that the winter is always difficult and that the influenza epidemic hit hard; but winter is not an entirely unpredictable event, and we must remember that the totals are the worst for any winter since records began.
In the Wirral—to concentrate on one specific area—there are 6,000 patients on the waiting lists. One in four patients in the Wirral wait for at least six months for hospital treatment. Two reports, as yet unpublished 23 by the Secretary of State, have shown that both accident and emergency and intensive care services in the whole of the north-west are suffering serious problems.
§ Mr. Michael Fabricant (Mid-Staffordshire)
Given that the hon. Gentleman's party has claimed that £100 million can be saved by cutting back on bureaucrats in the health service, although it turns out that most of those bureaucrats are in fact doctors and senior nurses, will he match the Government's pledge to increase spending on the national health service year on year, or will he join the shadow Chancellor and say that Labour will not match that increased expenditure?
§ Mr. Smith
First, the reductions in bureaucracy that we envisage concern people who process invoices and operate the internal market, not doctors and nurses. Secondly, it would help if the Government themselves had matched their pledge on future funding for the health service. They have not done so; if the hon. Gentleman cares to look at the figures published by the Chancellor of the Exchequer, he will find that the Government have already broken the pledge that the Prime Minister made at the Tory party conference.
I am surprised that the hon. Gentleman is not concerned about what is happening in the north-west. Had he, for example, watched the BBC programme on 30 January, he would have known that it revealed that the report on accident and emergency services in the north-west said that the casualty service there was "in danger of collapsing", and he would have heard a consultant at Arrowe Park hospital describing overcrowded waiting rooms and people having to wait for up to seven hours to be treated as "all too familiar".
The hon. Gentleman might also be interested in a letter from the hospital to a patient in the Wirral who was waiting, on a referral from her general practitioner, for an orthopaedic consultation. Orthopaedics is of particular importance in the Wirral area and is in particular difficulty. The letter from the hospital states:I write to inform you that we are in receipt of a referral from your General Practitioner … I must inform you that currently our routine waiting time is approximately 154 weeks. An appointment date will be sent to you four weeks before the date of the clinic, and this may be at either Clatterbridge or Arrowe Park Hospital.One hundred and fifty-four weeks for a consultation, and the Government have the gall to claim that the national health service is working well and is safe in their hands.
§ Mr. Robert Key (Salisbury)
What was the procedure in question? If the hon. Gentleman can tell me, he might sway me to support him.
§ Mr. Smith
The letter refers to a consultation, not a procedure. As far as I am aware, the consultation was for problems with the lady's hips. I am surprised that the hon. Gentleman should seek to defend the fact that someone seeking a consultation, who has been referred by her GP, has to wait for three years.
All round the country, the same stories are recurring week after week. People are waiting for longer and longer. Operations are being cancelled, sometimes at the last minute. Just last week, a man in Bedford hospital had 24 his operation cancelled as he was being wheeled into the operating theatre. Patients are crowded in beds and on trolleys.
§ Mr. Smith
I wish to make some progress, and then I shall give way.
Last week, in Edgware hospital, a bed had to be shared by three patients taking turns, because of the overcrowding in the ward. General surgery is being cancelled up and down the country, but in many places only for the patients of non-fundholding GPs. If a patient has a fundholder as his GP, he is treated straight away.
§ Mr. Ashby
The hon. Gentleman is making generalised remarks, but we all know how many patients the national health service has to deal with. Can he tell the House the specific reason why the operation was cancelled in Bedford? Was it because the operating nurses had worked more time than they should and a 'flu outbreak meant that extra nurses could not come on duty? If that was the case, how can the health service deal with such occurrences?
§ Mr. Smith
That was not the reason for the cancellation. It was the second time that that man's operation was cancelled. He had a blocked aorta and he was 69 years old. The Bedfordshire on Sunday reported:Despite the urgency, both operations were cancelled because of a lack of intensive care beds.That was the reason why the operation was cancelled, and it has not been denied. It shows a picture of a health service that is not able to respond to people's needs.
As well as the cancellation of operations, we see the cancellation of out-patient appointments. Again, up and down the country, out-patient appointments are cancelled—not for the patients of fundholders, but for the patients of non-fundholders. We now have a two-tier health service. People are being treated not according to need—that is what the NHS is supposed to be all about—but according to who their GP happens to be.
§ Mr. John Sykes (Scarborough)
Last week, I received a letter from a constituent from Whitby, who told me how seriously ill he was. He expressed the wish that the Labour party should not abolish GP fundholding, as he would not be alive today if GP fundholding had not existed. What will the hon. Gentleman say to that constituent in three months' time if he is the Secretary of State for Health and aims to abolish GP fundholding?
§ The Secretary of State for Health (Mr. Stephen Dorrell)
The principle that the hon. Gentleman has enunciated is precisely that which is contained in guidance to the health service today. He has just specifically and in terms endorsed the Government's policy.
§ Mr. Smith
Perhaps the Secretary of State will then endorse that principle not just for life-threatening conditions, but for other forms of surgery and out-patient 25 appointments. Patients should receive treatment and consultation according to need—not according to who their GP happens to be. Will he endorse that principle?
§ Mr. Dorrell
I am happy to endorse the principle of a health service led by the needs of individual patients, and I am grateful to the hon. Gentleman for giving me the opportunity to do so. Where the needs of GPs' individual patients are different, GPs should have a powerful voice in determining what those needs are.
§ Mr. Smith
In that case, will the Secretary of State tell us why Lincoln county hospital, for example, sent letters two months ago just to non-fundholding GPs, to cancel all out-patient appointments for the rest of the financial year? Why are their patients treated differently from the patients of other GPs? That breaches the principle that the Secretary of State claims to uphold.
§ Mr. Dorrell
I am grateful to the hon. Gentleman for giving way again, but perhaps he would like to get on with his own speech. The circumstances that he has just set out allow individual GPs to decide which health care facilities reflect the interests of their patients, and GPs have been empowered to ensure that the service delivered to their patients reflects their needs. That is the principle of fundholding, and it is a principle which, in my view, should determine the empowerment of GPs throughout the health service. It is a principle that the hon. Gentleman espouses, from time to time. Is he now walking away from it?
§ Mr. Smith
The Secretary of State has just endorsed a two-tier health service, and he appears to be proud of the fact that the health service does not operate on the basis of the needs of patients. While the health service struggles under the most intense pressure to meet the needs of patients, he sails serenely on, pretending that everything is absolutely fine, and spending his time running—rather too obviously—for the Tory party leadership, instead of addressing the real issues and problems affecting the health service.
The second issue that I want to raise, which is related, is what happens to elderly patients who go into hospital for treatment and then face the prospect of either staying in hospital to recover—and being labelled as bed blockers—or being sent home too early to an unsupported environment where they will be unable to recover properly. Again, that is an issue of concern in the Wirral. Clatterbridge hospital has a rehabilitation unit that provides excellent care, but it is not able to cope with the needs of elderly patients who have had a course of acute treatment and need somewhere to recover. That problem affects not only the Wirral—important though it is for that area, which has a large number of elderly citizens—but every part of the country.
Often, an elderly patient who has been sent home too early cannot recover properly, with the inevitable result that four or five weeks later, he or she ends up back in hospital. That is wonderful for the Government's statistics, because that patient counts as two finished consultant episodes. When Ministers make speeches, they claim that that is two patients being treated, but it is not—it is one person, who has not had a good and proper full course of care and treatment from the NHS. That is why the proposals of my hon. Friend the Member for Dulwich 26 (Ms Jowell) and I, for the development of a recuperation service precisely to help elderly patients to recover properly for a week or two following acute treatment, before being sent home, are so important.
§ Mr. Ashby
Does the hon. Gentleman agree that elderly patients often recover best in their home surroundings, among the people they know and their relatives? Does he accept that in two cases in my constituency—both close friends of mine—the elderly person was sent home, got fantastic treatment and recovered well as a result? Why is he running down the health service in that way, when it is doing extremely well?
§ Mr. Smith
Of course, if it is possible for an elderly person to return home and to be supported by district nurses—the support that is available from the NHS—and family and friends, who have to be on call to help in such circumstances, that is the best possible place for that person to recuperate, but it may well not be possible for someone to have such support. Some people may not have family and friends on hand to give that sort of support and care. For those in that position, who may well be sent home too early and may not be supported properly, the recuperation service that we envisage would be of enormous benefit.
The third issue is the way in which the Government are seeking to conceal the truth about what is happening in the NHS. Pretending that there is no problem is one thing, but massaging the presentation of the facts to the public is quite another. Recently, a memorandum from the Royal Liverpool and Broadgreen University Hospitals NHS trust let the cat out of the bag. I suspect that my hon. Friend the Member for Liverpool, Broadgreen (Mrs. Kennedy), who is here with us, may have a word or two to say about that later. This is a briefing note sent round the hospital by the hospital, presumably as an instruction to those working in it. [Interruption.] The Secretary of State appears to wish that that note was not being presented to the House and I am not surprised, because the memorandum says:The region"—that is, the region of the national health service executive run by the Secretary of the State—have indicated that the figure of 329 declared by the Trust in November is very high"—that is, the figure on the waiting list. The region has suggesteda judicious elimination of TCI patients"—that is, patients to come in—This has been carried out from the end of the second quarter.It is deliberately getting rid of figures from the list, to make the list look smaller. Clearly, the Government are up to a judicious elimination of waiting list figures.
When the Government say that they are treating more patients than ever before, we know that many of those cases involve two or three consultant episodes with the same person. The Government say that the waiting list figures look wonderful, but we know that they are massaging the figures. We are learning rapidly that we cannot trust the Government on information about what is happening in the health service.
27 It does not stop there. A memorandum from the United Leeds teaching hospital, about answering the telephone to patients, states:As you know, some purchasers have asked us to slow down the rate at which we treat certain patients. I anticipate that this may cause problems if these patients ring you and press for a date … In these cases, please use the following reply to patients, which has been agreed with"—I presume that the name given is that of the relevant officer. It continues:I suggest you keep it by the phone so you are never caught off guard. Do not tell patients that purchasers have asked us to slow down the rate at which we treat patients—for obvious reasons.The memorandum then gives the script that has to be used. Note that this is happening because the purchasers have asked for the rate to be slowed down. The script to be used for the public runs:There has been an increase in the number of emergency cases this year which has taken the health authorities by surprise and has put a strain on their finances.Consequently, they have asked us to defer any non-urgent cases, until later in the year.It is a case of, "Do not tell them that it is the market system that is the problem; tell them that it is unexpected emergency cases." That is another example of people being told a story that is completely different from reality.
§ Mr. John Gunnell (Morley and Leeds, South)
I am a Leeds Member with a general practitioner who has received notices about not being able to get emergency treatment. Does my hon. Friend agree that the real cause is the shortage of funds experienced by both Leeds general infirmary and the health authority, and that the funding formula that the Secretary of State has chosen means that cities such as Leeds are deprived of funds? That is why LGI cut beds to take emergencies.
§ Mr. Smith
My hon. Friend acutely observes that there are important issues that relate to the nature of the funding formula that should be addressed. However, he must bear it in mind that the health service wastes hand over fist money that could be better devoted to patient care—on paperwork, invoicing and the patient bureaucracy associated with the internal market.
§ Mr. Smith
No. I shall make progress for the time being.
We know that instructions are being given in hospital after hospital, to delay payments to contractors and creditors until the next financial year. They are verbal instructions in virtually every case, but they are instructions none the less. Hospitals delay payments to suppliers and contractors, to make their figures for the current financial year look better. So much for the party of small business that is running the Government at the moment.
As a result of what is happening now, the future is being mortgaged, because the bills will have to be picked up in the next financial year. The health authorities and the trusts already face combined deficits of £215 million 28 at the end of this financial year. They will have to be paid off in the course of the next financial year, and then the costs for that year will have to be met, even before inflation is taken into account. They are spending next year's money to overcome this year's problems. The reason for that, of course, is that there is an election coming up and the Government do not want to reveal the true state of affairs.
What about the curious case of ministerial assertions on cancer treatment? My hon. Friend the Member for Dulwich raised that issue during Health questions last week, when she asked the Under-Secretary, the hon. Member for Chelmsford (Mr. Burns), what was happening about waiting times and waiting lists for cancer treatment. The Under-Secretary replied clearly and specifically:no one waits for cancer treatment unless the doctor makes a clinical decision to that effect".—[Official Report, 18 February 1997; Vol. 290, c. 732.]How does one square that with the figures that the Department of Health has published—figures that it must publish? The latest available figures, for 1994–95, show that in England 42 per cent. of patients waited for more than 30 days for treatment of all types of cancer. If one looks at the one area for which detailed figures on the number of patients treated are available—those for South East Thames health authority—one discovers that a total of 1,070 patients were waiting for treatment for more than three months, as at 1 April. That is what is happening in one region alone.
We know from individual cases that treatment has been delayed not just for clinical reasons, by a doctor who decides that someone should wait longer for treatment. The Under-Secretary told the House that no one has to wait unless there are such clinical reasons, but we know that 42 per cent. of cancer patients are waiting for more than 30 days for surgery. That is according to figures published by his own Department. That shows that the Government are failing to offer accurate information on the current state of affairs.
We have a Government who are massaging the waiting time figures; giving misleading advice to the public; deliberately encouraging trusts to default on payments; and telling us that no cancer patient has to wait for surgery, when that is not so. That is what the Government are busy doing at the moment.
§ Mr. Smith
No. I have given way rather a lot and I want to make some progress.
The fourth issue that I wish to discuss is morale. The health service is staffed by dedicated people at all levels. They have held the service together during the years in which the Government have run it down and introduced the internal market. They work under intense pressure. They grieve at the way in which the public service that they thought they had joined has been turned into a series of competing businesses.
The national turnover rates of registered nurses have risen from 13 per cent. in 1992–93 to 22 per cent. in 1995–96. Nearly a quarter of all NHS nurses are changing their jobs in the course of a year. Many trusts are now running more than 1,000 shifts of temporary nursing staff every week. The NHS is spending £1 million every three 29 weeks on advertisements to recruit extra nurses into the service. Some 14,000 registered nurses have had to have time off in the recent past because of back injuries. There is a crisis in recruitment. The number of qualified nurses joining the NHS stands at a quarter of that 10 years ago.
The crisis in recruitment and morale applies not just to nurses, but right the way through the national health service. We need a consistent effort to motivate and inspire staff—giving them better and more flexible career patterns, improving the safety of their working environment, ending the gagging clauses that prevent them from speaking out when they think that something is going wrong, and restoring the ethos of a public service in the NHS, which is what they thought they had joined in the first place. In order to achieve that, we need an end to the internal market in the NHS. The Government are going in precisely the wrong direction, which brings me to my fifth theme: the Government's determination to commercialise the health service.
The National Health Service (Primary Care) Bill is currently passing through the House. We shall leave aside the Government's sheer incompetence. It was supposed to be the Bill in which the Secretary of State had such great pride when he presented it to the House. On the eve of the debate on Report in another place, the Government tabled 90 amendments, most of them drafting amendments to put right mistakes that they had made in the original drafting. My hon. Friend the Member for Dulwich, who leads so ably for the Opposition in Committee, has told me that last Friday the Government tabled another 29 drafting amendments, to try to correct further mistakes that they had made in the original Bill.
However, we should leave all that on one side and instead consider the Government's proposals to commercialise GP services. When the Bill first emerged, we rightly said that it enabled private companies to employ GPs. The Opposition said clearly that that was unacceptable, because it destroyed the fundamental relationship between doctor and patient. At that stage, the Government were busy defending that principle.
In an interview with Pulse magazine on 25 January, the Secretary of State said:If it is a difficult area and a service cannot be provided using other routes, commercial enterprise may offer a solution.In another place, Baroness Cumberlege, who speaks for the Government on health matters, was even more explicit. On 17 December she told the other place:We are serious about tackling these difficulties and do not want to rule out any sensible opportunities, including a GP being employed by a commercial organisation."—[Official Report, House of Lords, 17 December 1996; Vol. 576, c. 1403.]Clearly, in December and January the Government were fully signed up to the principle of the commercial employment of GPs.
It was not just the Opposition, but the entire medical profession, who were saying that that was unacceptable. In the face of concerted opposition, the Government finally decided to back down. Last week, in the debate on the National Health Service (Primary Care) Bill, we witnessed the Government's first climbdown. The Secretary of State told us that the Bill would be changed, to ensure that only a member of the NHS family could employ GPs.
30 The Government tabled a new clause. It included "an NHS employee" as a member of the NHS family, and "NHS employee" was defined asan individual who, in connection with the provision of services in the health service, is employed (or engaged under a contract for services) by an NHS trust or a medical practitioner".It did not take a genius to spot within two minutes the fact that that definition of a member of the NHS family could include anyone from Boots to Rentokil, which are indeed contracted to the NHS for the provision of services during routine work.
Therefore, the Government said that they realised that they had made a mistake, and that they would make a second climbdown; they would further reduce the scope. However, even after removing that provision from the Bill, the Government are still restricting the NHS family provision to the running of a pilot scheme. They do not restrict the commercialisation proposals in any other form of employment of GPs.
What the Government are about in the National Health Service (Primary Care) Bill—we have yet to see whether they will put even that right in further amendments—is a constant retreat from their original position, continuously having in mind that they want to allow commercial employment of GPs. Unless the Government rule out completely, irrevocably and without a shadow of a doubt the possibility of commercial employment, the possibility of GPs teaming up with a commercial company, entering into a financial relationship, and destroying in the process the relationship between doctor and patient, we shall not be minded to support them.
The Government are intent on commercialising the health service in other ways. They are developing several private finance initiative schemes for the development of new hospitals. Until now, we had always thought that the PFI was only about the building and running of ancillary services in hospitals—that the Government were not interested in privatising the clinical services in hospitals. We thought that the Stonehaven project, for which the Secretary of State for Scotland is responsible—
§ Mr. Andrew Mackinlay (Thurrock)
I have always been suspicious of the Government. I thought that that was always their intention. My hon. Friend is too trusting.
§ Mr. Smith
I had thought that the Secretary of State for Scotland was isolated in the Government in pushing the Stonehaven scheme, which privatises clinical services as well as everything else in the hospital. Then we began to discover that other things were happening. We are now being told that the PFI deal for the building of the Stonegrove extension to the Royal Hallamshire hospital in Sheffield will depend on including, as part of the package, the privatisation of radiology and pathology.
31 We discovered more at last week's meeting of the Scottish Grand Committee. My hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm) pressed the Minister of State, Scottish Office on the PFI. He asked:Will the Government categorically rule out, as a manifesto pledge, any PH that involves the privatisation of clinical services?The Minister answered as follows:No, I will not go as far as that. I entirely rule out privatisation. All services must be free at the point of delivery, but if there is strong local support, each case must, of course, be considered on its merits."—[Official Report, Scottish Grand Committee, 17 February 1997; c. 10.]The Minister was thus not ruling out the privatisation of clinical services: that is a matter for local decision, he said.
Now the Secretary of State for Health has confirmed as much. He has written me a letter, which I received just this afternoon. I had put it to him that the Government have always in the past claimed that they do not approve of the privatisation of clinical services, yet now the Scottish Office says that it does so approve. Is there not, I asked, a problem here? The Secretary of State wrote saying that there is no problem—we are all in agreement. His letter says:It is not part of the Government's general policy to transfer the delivery of NHS clinical services into the private sector".The right hon. Gentleman goes on to quote his speech to the Royal College of Physicians, in which he said that NHS trusts would continue to bethe direct employer of clinical staff in the overwhelming majority of cases".In other words, the Secretary of State for Health, the Scottish Office and the whole Government are perfectly happy for privatised clinical services to be provided by doctors and nurses in the NHS in some circumstances.
The Opposition do not accept that principle. The Secretary of State's letter went on to say that that will happen only iflocal clinicians favour such a move".It should not be up to local clinicians; the people should make the decision about whether services should be provided in the public sector and by the national health service. The people of this country do not want their doctors and nurses to be employed by private companies; they want them employed by the national health service. If the Government want that to be a key dividing line between them and us in the coming general election, we shall be delighted to take them on.
The Government are intent on pursuing their policies of an internal market in the health service. It is a market that sets hospital against hospital and doctor against doctor. It fragments decision making in the service; it creates two tiers of service, one for those who have and one for those who have not. It distorts the clinical judgment of doctors and other health care professionals. If, heaven forbid, the Government were re-elected, their real agenda—the commercialisation of primary care, the privatisation of at least some clinical services, the end of the national health service as we know it—would be put into effect.
That is not a vision shared by the people of Britain. They share our vision—[HON. MEMBERS: "What is it?"]—of a health service restored as a public sector service, not 32 run as a private business. It will take a Labour Government to rescue the NHS and to restore that vision to our country.
§ The Secretary of State for Health (Mr. Stephen Dorrell)
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:is committed to the National Health Service as a public service, promoting health and providing high-quality care more quickly than ever before; expresses its support for the continuing development of primary care and community health services; welcomes the Government's commitment to a growing budget for the National Health Service throughout the next five years; supports the Government's policies to increase independence, choice and opportunities for people with disabilities; and welcomes the introduction of the Disability Discrimination Act 1995 as a landmark in legislation for disabled people, of which there is no equal in the European Union.I thank the hon. Member for Islington, South and Finsbury (Mr. Smith) for once again drawing attention to the vacuum which substitutes for Labour's health policy. The hon. Gentleman is developing a taste for masochism. He seems to enjoy advertising his party's nakedness, exposing himself and his right hon. and hon. Friends to ridicule because they are unable or unwilling to evolve anything that remotely resembles a policy for the future of the national health service.
§ Mr. Dorrell
I have hardly reached the end of my third sentence, but it is always a pleasure to give way to the hon. Gentleman: he is at least more fun to listen to than his hon. Friend the Member for Islington, South and Finsbury.
§ Mr. Faulds
It is not a question of fun. This is a serious debate about a serious matter. Will the Secretary of State assure the House that what he has just read was not written before he heard my hon. Friend's speech?
§ Mr. Dorrell
I was writing, as the hon. Gentleman may have observed, during the speech of the hon. Member for Islington, South and Finsbury. I concede that I would have taken bets that the introduction to my speech would have fitted almost any speech that the hon. Member for Islington, South and Finsbury was likely to deliver.
The hon. Member for Islington, South and Finsbury is responsible for developing a health policy for the Labour party, but in every health debate in the House he seems to glory in a demonstration that he has no health policy at all; worse, in every debate he makes it clearer that he is not interested in health policy.
Whenever the hon. Member for Islington, South and Finsbury is asked a question about what he would do, he avoids it. Whenever he is challenged to set out a course for the future, he simply bypasses the question. When my hon. Friend the Minister for Health, who is to reply to the debate, asked towards the end of the hon. Gentleman's speech what he would offer as an alternative vision for the future of the national health service, the total length of the hon. Gentleman's answer to that question was 12 seconds.
33 Again today, we heard the familiar mix from the hon. Member for Islington, South and Finsbury: anecdotes of individual cases told in the language of half-truth and innuendo, covered with a cloak of righteous indignation. Today, he seemed short even of anecdotes of individual cases, so he filled in time with stories of scraps of paper alongside telephones. He made the speech that he would have made in Committee on the National Health Service (Primary Care) Bill, if he had been on the Committee. Then he went straight from five themes to peroration, without pausing to reflect on the future of the health service.
§ Mr. Mackinlay
Will the Secretary of State clarify one point? I notice that the hon. Members for Hendon, North (Sir J. Gorst) and for Harrow, East (Mr. Dykes) are not in their places this afternoon. They stuck out to maintain an accident and emergency department at Edgware hospital. They were faced with their Conservative Associations being dissolved and with being deselected. What did the Secretary of State give them, or offer them as reassurance? They claim that the accident and emergency department at Edgware will remain. Is that true? What was the deal that they hatched, or was it merely a cosmetic exercise to get the Tory party over some difficulty in London?
§ Mr. Dorrell
The position in Edgware has been set out repeatedly by the health authority. I will set out to the hon. Gentleman and the House the three developments that were agreed by the health authority following discussions with all the local Members of Parliament. They concerned a low-risk birth unit, the development of a casualty department involving the presence of GPs and GP-type doctors, and the provision of GP-access beds. Those were the arrangements set out by the health authority after its meeting last September. If the hon. Member for Thurrock (Mr. Mackinlay) was genuinely interested in health in Edgware, rather than in making silly party political points, he would know that, because it is on the public record. [Interruption.] If the hon. Gentleman was interested in health, rather than in silly party political points, he could find all that out for himself by looking at the records of the health authority.
§ Mr. John Heppell (Nottingham, East)
Can the Secretary of State tell me what a GP-type doctor is? Is it similar to a GP doctor? Perhaps he can explain.
§ Mr. Dorrell
A GP-type doctor is a doctor who has qualifications similar to those of a GP. I should have thought that was a fairly straightforward definition.
Once again, the hon. Member for Islington, South and Finsbury resorted to his familiar technique to avoid addressing the issues that confront the future of the hospital service. When will we hear from Labour Front Benchers any recognition of the achievements of the hospital service over the past quarter of a century? When will we hear any constructive ideas from Labour Front Benchers for the development of the hospital service under an alternative Government, if we were ever misguided enough to elect one?
Let me set out the achievements of the hospital service in recent years. The treatment of emergencies is up by 20 per cent. over the past four years, and the hon. Member for Islington, South and Finsbury might have done well 34 to refer to that. He might also have recognised that the trend for increasing the provision of emergency services in our hospitals—a trend that has delivered a 20 per cent. growth rate over four years—continues into the current year with a growth rate of a further 4 per cent. in the first half of this year.
It is true that the hospital service is a system under stress. The hon. Gentleman repeatedly says that I seek to suggest that the health service has no problems. Of course I never suggest that. The winter pressures that the NHS emergency services face each and every year place stress on the health service, and this year is no exception. This year, as every other year, as emergency service pressures reach their peak, some non-urgent operations were delayed in order to treat the most urgent cases first in our hospitals. Does the hon. Gentleman disagree with that principle? If he does, let him come to the Dispatch Box and say so.
§ Mr. James Couchman (Gillingham)
Is it not also the case that a number of trusts undertook the bulk of their non-elective surgery in the summer and autumn months last year to prepare for the winter emergencies? Inevitably, therefore, waiting lists will now rise from a low point last summer.
§ Mr. Dorrell
My hon. Friend is right to say that every well-run hospital seeks to get ahead of its work load in the summer months to make room for the emergency surge that comes every winter. It is also true to say that hospitals have been planning for and expecting the surge in emergency demand that comes in the winter months. That is why, the last time we had a health debate—not five weeks ago—I referred to the fact that we had been opening extra short-term beds during the winter to accommodate the extra demands on the health service at that time of year.
As I said five weeks ago, to accommodate the short-term peaks in emergency demand that come every year at that time of year, Dartford opened an extra 33 beds; Ashford, an extra 40 beds; St. Helier, an extra 35 beds; Poole, an extra 18 beds; Derriford, an extra 11 beds; Plymouth, an extra 35 beds; Rotherham, an extra 33 beds; Doncaster, an extra 38 beds; Mansfield, an extra 28 beds; Burton, an extra 16 beds; and the North West region as a whole opened an extra 200 beds.
The overwhelming picture of the NHS this winter has been, first, of professional staff—we did not hear much from the hon. Member for Islington, South and Finsbury recognising the contribution and commitment of professional staff in the NHS—delivering high-quality care under pressure in the hospital service. We have also seen the results of the much-maligned NHS management system preparing for winter pressures to ensure that those demands are met. It suits the hon. Gentleman never to acknowledge that this year we have seen the results of the Government's political commitment to ensure that the resources and support are there to back the delivery of needs-led health care throughout the NHS.
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
The Secretary of State is right to applaud the efforts of the professional, medical, nursing and all the other support staff in the health service—not forgetting the managers. However, will he deal with the question of the waiting list figures that were published last week? His claims about 35 the performance of the health service are based on those figures. Will he answer a direct question? The Royal Liverpool university hospital has declared that 299 patients waited longer than 12 months for treatment. Does that figure exclude patients in ophthalmology, orthopaedics and ear, nose and throat, or does it include all patients waiting for treatment, irrespective of where they live? The memorandum, a copy of which the Health Secretary has, clearly says that not all such patients are declared. One consultant at the Royal has informed Members of Parliament that, in his specialty, more people wait longer than 12 months than has been declared as a total for that hospital.
§ Mr. Dorrell
The North West region has made it clear, as, indeed, has the hospital, that the published figures are intended to be a full and complete statement of the number of people on the waiting list for out-patient, in-patient and day-case care. The figures were collected as a straightforward public service by people who have no political commitment to the Government, by people working as public servants. Those are the people whom the hon. Members for Islington, South and Finsbury and for Liverpool, Broad Green (Mrs. Kennedy) are attacking—public servants working within the national health service, setting out information about the people who are waiting for non-urgent care in the national health service.
§ Mr. Dorrell
I give way to the hon. Gentleman. The hon. Member for Islington, South and Finsbury seemed to be so terrified of the Liberal Democrat spokesman that he refused to give way to him, but I am more than happy to do so.
§ Mr. Hughes
If the Secretary of State sets store by the statistics as accurate, will he confirm that they show three things? First, for the first time since they were produced in this form nearly 10 years ago, more than 1 million people are now on the waiting list; secondly, the same statistics, produced by a method which he attests is accurate, show that in the North West region, which includes the Wirral, more than 4,000 people—the highest number ever—are on the waiting list; and, thirdly, in my district, south London, which is part of South Thames region, 10,000 extra people went on to the waiting list between the last quarter and December last year. It is a record nationally. If those figures are correct, what will the Secretary of State do to bring them down, not in the future but in the next quarter, so that people waiting today have some prospect of being treated—even within the patients charter limits?
§ Mr. Dorrell
I shall deal with waiting lists now. The hon. Gentleman is right to say that the total number of people on the waiting list, in the figures published last week, is higher than it has been. What is also true is that the number of patients treated in the health service is higher than it has ever been. What matters to a patient on the waiting list is not how many other people are on the waiting list but the time he or she will have to spend on the waiting list.
36 The key point of which the hon. Gentleman and the House should take account is that the average time spent on a waiting list has fallen from nine months five years ago to an average of four months now. The position on waiting lists and waiting times is that the performance of the health service has improved. We have dramatically reduced the number of long waits, about which I shall talk later, and more than halved the average time that a patient spends on the waiting list.
Let us now talk about the non-emergency service, the elective work load of the hospital service. The emergency services that I have been talking of thus far account for less than half the total load on the hospital service in terms of finished consultant episodes. The other half is the elective work load, which has increased by 30 per cent. over the past four years. In that period, the emergency service work load has increased by 20 per cent.
The hon. Member for Islington, South and Finsbury spoke at length about waiting lists. He appears to believe that a simple repetition of the statistics and the fact that waiting list totals are rising are substitutes for thought about what to do about them. In fact, every time he opens his mouth about waiting lists, he reveals how little he understands the real issues that confront hospital managers.
Let me set out the facts of the waiting lists issue. As I have said, roughly half of all cases treated in NHS hospitals are urgent or emergency cases and are treated immediately. The other half go on to a waiting list. The waiting list performance, as I said in answer to the hon. Member for Southwark and Bermondsey, has improved dramatically. Ten years ago, 200,000 people were on waiting on lists for more than a year. In 1979, 185,000 people had been on the waiting list for more than a year. That was our inheritance from the Labour party. Through the 1980s, the figure hovered at plus or minus 200,000. My right hon. Friend the Prime Minister insisted, through the patients charter, that we address the issue of long waits in the NHS and that figure has been reduced to 22,000. It is down from the 185,000 that we inherited and the average of 200,000 through the 1980s to 22,000 in the figures that were published last week.
The superficiality of the hon. Member for Islington, South and Finsbury is revealed by the fact that he said that the figure had increased from 15,000 to 22,000 and called it a 46 per cent. increase. Arithmetically that is correct, but he made no reference at all to the fact that the true comparison is with the 200,000 people who were waiting throughout the 1980s and, indeed, the late 1970s, and the 22,000 who are waiting now. The issue is the waiting time, but the hon. Gentleman consistently prefers to avoid discussing that.
§ Mr. Tom King (Bridgwater)
Presumably the speed with which we were able to make improvements through the 1980s was not helped by the cancellation of the hospital building contracts towards the end of the Labour Government. The whole health programme was put seriously behind when their economic policy ended in such chaos.
§ Mr. Dorrell
My right hon. Friend is right, and I shall speak later about the importance of a proper capital investment programme in the health service, an issue that 37 the hon. Member for Islington, South and Finsbury did not touch on in his speech, which was supposed to be about health policy.
§ Mr. Dorrell
I should like to make some more progress and then I shall give way.
If Labour cannot say anything intelligent about waiting lists, let us move to another fundamental issue which my right hon. Friend the Member for Bridgwater (Mr. King) raised in his intervention. Health care is highly capital intensive. The facilities by which hospital care is delivered are expensive, and furthermore the shape of health care is changing quickly. That means that the NHS appetite for capital investment is considerable: Although there was a huge increase in the capital investment programme through the 1980s, reversing the 28 per cent. cut in capital that the Labour Government imposed in the 1970s, too many hospitals are still caught trying to deliver 21st-century health care in 19th-century buildings.
The issue confronting the health service, which the hon. Member for Islington, South and Finsbury refuses ever to confront, is how to ensure a sufficient capital flow to keep the capital stock up to date so that we can deliver the best high-quality and efficient health care to our patients. That is why the Government have introduced the private finance initiative.
§ Mr. Dorrell
I shall shortly give way to the hon. Gentleman.
The PFI was introduced to allow the health service to escape from the capital trap. Since we started it, we have approved 71 schemes to a total value of £626 million. We have signed contracts for 44 of those 71 schemes to a total value of £432 million. There remain 22 schemes which have been approved in principle and for which approved bidders have been selected. The total value of those schemes is £1.7 billion.
I have not yet given way to the hon. Member for Islington, South and Finsbury, but when I do, I hope that he will take advantage of his intervention to set out Labour's policy for the people of Bishop Auckland, Calderdale, Carlisle, Gloucester, Greenwich, Hereford, north Durham, Bexley, Rochdale and Coventry and other places who are on the list and have preferred bidders under the PFI and the realistic opportunity of seeing the needs of their local health service for capital investment met. Labour's position on the PFI is one of the great unsolved riddles of the hon. Gentleman's speeches. Is he in favour of delivering modern hospital care to those communities? I give way to the hon. Gentleman to give him an opportunity to answer.
§ Mr. Smith
The short answer to the right hon. Gentleman's final question is yes. Will he answer two questions? First, will he confirm that, within the overall national health service budget, he has cut the capital budget for this year and next year by one third? Secondly, will he also confirm that the new Norfolk and Norwich hospital was first announced by his predecessor in 1990, but not a single brick has yet been laid?
§ Mr. Dorrell
I have already made it clear that the PFI was introduced to increase and improve the quality of capital investment available for the national health service.
38 The hon. Gentleman has taken to writing letters to some of my hon. Friends and to Labour parliamentary candidates, copies of which I have seen. In those letters, he says:Where a contract has not been signed by the time we come into office"—I hope that that never happens—we will be seeking urgent ways of speeding up the process.Labour has had 18 years: is it not time it produced just one proposal?
I give way to the hon. Gentleman once more, so that he can come to the Dispatch Box and set out one proposal that will speed up the PFI. I ask for one proposal. If he cannot do that, those letters to my hon. Friends, like the one he wrote to the Labour parliamentary candidate in Worcester, are a sham. What programme does the hon. Gentleman offer under the PFI to speed up hospital projects in the communities to which I referred? Will he come to the Dispatch Box and tell us? I give way to him. What is his idea? He writes letters to Labour candidates, to my hon. Friends and to anyone who will listen promising that Labour will speed up the PFI. I give way to him. I look forward to hearing about those ideas.
§ Mr. Smith
I ask the Secretary of State to answer the two questions which I posed to him, and to which he has not yet replied. He should stop trying to blame the Opposition for the shambles on the PFI that the Government have created. The Government have promised hospital after hospital up and down the country, but have not delivered on their promises.
§ Mr. Dorrell
The hon. Gentleman grossly misunderstands me. I do not want to hold him responsible for the Government's record; I want to hold him responsible for Labour's policy. He promised to speed up the PFI. How does he intend to do that? That is a simple question. He made that promise to his own supporters and to Conservative Members. How will he deliver that pledge? The House will draw its own conclusion from the fact that the hon. Gentleman has set out no proposals. It is empty rhetoric: he has not the beginnings of a shred of an idea of how he will deliver his pledge.
§ Mr. Hartley Booth (Finchley)
I am the recipient of one of the letters from the hon. Member for Islington, South and Finsbury (Mr. Smith) to which my right hon. Friend referred. The hon. Gentleman refers to his anger at the delays in the rebuilding of Barnet hospital caused by the Government's approach to PFI. Is my right hon. Friend aware that Barnet hospital was built in 1939, and it was to be rebuilt at the end of the last world war? The Labour party was in office in the 1940s, 1960s and 1970s, but it never rebuilt that hospital.
§ Mr. Dorrell
I am aware of that. I am also aware that, under this Government, phase 1 A of the rebuilding of Barnet hospital is currently taking place, and will improve hospital care for the people of that part of London. I am further aware that the Government introduced the PFI, which is the basis on which phase 1B will go ahead. The predecessor of the hon. Member for Islington, South and Finsbury used to describe the PFI not as the private finance initiative but as the privatisation initiative. I notice
39 that the hon. Gentleman is rather more circumspect about what he says, even though he has no idea of what he would do about it.
§ Mr. Jim Cunningham (Coventry, South-East)
The Secretary of State mentioned Coventry when he gave his catalogue of PFIs. What will happen to the Coventry and Warwickshire hospital, because there has been an element of doubt, about which I have written to the Secretary of State? What is the state of the PFI for the Walsgrave hospital?
§ Mr. Dorrell
I shall write to the hon. Gentleman about the Coventry and Warwickshire hospital. Walsgrave hospital is one of the projects for which we have a preferred bidder. We are seeking to put in place a plan to replace the existing hospital. It is quite a modern hospital, but it does not provide an efficient use of resources. The private finance option for Walsgrave hospital shows the merits of the private finance approach. Instead of carping from the sidelines, the hon. Member for Islington, South and Finsbury would do well to learn from that approach.
§ Mr. Toby Jessel (Twickenham)
My constituents and those of my hon. Friend the Member for Brentford and Isleworth (Mr. Deva) are extremely keen for the excellent PFI scheme to reconstruct the West Middlesex university hospital to go ahead without delay. My right hon. Friend and his colleagues have been giving us all the help that they can. However, our constituents will be extremely unimpressed when we tell them that the hon. Member for Islington, South and Finsbury, having boasted that he would speed up PFI schemes, was completely unable to say what he would do to achieve that when he was challenged to do so by my right hon. Friend.
§ Mr. Dorrell
My hon. Friend is absolutely right. His constituents will feel the same as those of many other right hon. and hon. Friends around the country. It will be within the memory of those who regularly attend these debates that, on the last occasion we discussed the health service, I referred to the people of Worcester, which is my home town. They are in the same position as my hon. Friend's constituents. The hon. Member for Dulwich (Ms Jowell) came to Worcester after an earlier visit by the right hon. Member for Livingston (Mr. Cook), who said that, if the deal for the hospital there had not been signed by election day, it would be put on ice. The hon. Member for Islington, South and Finsbury had to send his hon. Friend the Member for Dulwich—he has apparently forgotten about it—to dig the right hon. Member for Livingston out of the hole into which he had dug himself. The right hon. Gentleman was able to sit on proposals to privatise the Tote, but the citizens of Worcester will be relieved to know that he failed to sit on their plans for a new hospital.
§ Mr. Dorrell
No, I shall move on.
40 That is not the only threat that the Labour poses to the future of the national health service. The biggest threat hanging over the health service is the threat of another round of bureaucratic change, and the costs that that will entail. The hon. Member for Islington, South and Finsbury made a speech on 3 December, in which he set out his proposals for another round of management change. That speech has rightly been widely reported as threatening real damage to and bureaucratic upheaval in the health service. He began by saying:Everyone from all parts of the health service tells us that the last thing they want is for us to throw everything up in the air again and try to catch the pieces. 'No more major upheavals, please', they tell us. I have heard that message.The hon. Gentleman may have heard it, but about four pages later he made it absolutely clear that he would ignore it completely. He went on to say:So it is our intention that the strategic planning functions of health authorities and the health care provider responsibilities of hospitals should remain, but the decisions about what treatment to organise on behalf of patients should be drawn together in local GP-led commissioning groups.The hon. Gentleman went straight on from his promise of stability to set out a new blueprint for the reorganisation of the purchasing function of the national health service. He continued:Within each current health authority area, there might therefore be between five and 15 commissioning groups.Each area has one health authority—one bureaucracy. The hon. Gentleman is now threatening between five and 15 new bureaucracies in every health authority area.
The hon. Gentleman continued:The health authority would delegate to each local GP group a comprehensive budget covering all aspects of care"—here is the rub—The commissioning group would of course have to have access to the appropriate level of management support.Of course it would. The hon. Gentleman's speech sets out a blueprint that delegates the main purchaser function from 100 health authorities to 500 new bureaucracies. It is abundantly clear that the new version of purchaser-provider would maintain the internal market, but instead of having 100 health authorities and many GPs acting as purchasers, the hon. Gentleman proposes that there should be 500 bureaucracies all operating in the internal market.
As the Financial Times reported the day after his speech:Labour claims this creation will reduce bureaucracy and increase value for money. What it threatens to do is precisely the opposite: to stifle innovation, produce indecision and replace larger purchasing units with less efficient smaller ones.Those are not my words. They are a summary by the Financial Times of the hon. Gentleman's proposal to impose a new bureaucratic cost on the health service in contravention of exactly the principle that he enunciated at the start of his speech—that the health service needs a period of stability.
§ Mr. Chris Smith
First, will the Secretary of State confirm that the last five minutes of his speech have proved comprehensively that his earlier charge that the Labour party has no health policy is untrue? Secondly, will he address what the Health Service Journal said about that speech—that our proposals were coherent and credible?
§ Mr. Dorrell
I shall now address what the Royal College of Nursing said about it: 41We are appalled that Labour has failed to recognise nursing's central role in primary health care.The hon. Gentleman must be the first Labour health spokesman in history to provoke such an unambiguous reaction from the Royal College of Nursing. No wonder he went rushing along to a nursing conference last week to make nurse-friendly noises which added up to a total of £500,000-worth of promises for nursing. I read the hon. Gentleman's speeches to ensure that he is not allowed to get away with the speeches he makes in health debates where he simply reads out a series of anecdotes in order to obscure the damage that Labour's health policy would do to the national health service.
§ Mr. Heppell
It is unfair to make comparisons with Labour's plans. We are proposing an alternative to fundholding. The Secretary of State has probably forgotten the Audit Commission report of 22 May 1996. It said that fundholding costs millions of pounds in extra administrative costs, provides no extra benefit to patients, does not fit in with health authority plans for local people and means that decisions about hospital care are taken without the involvement of hospital doctors. That is what we propose to replace, not what the Secretary of State suggests.
§ Mr. Dorrell
The hon. Gentleman takes me neatly on to my next point.
The speech by the hon. Member for Islington, South and Finsbury in December meant that Labour had at last come off the fence in respect of fundholding. Month after month there were conflicting messages from different parts of the Labour party about fundholding. The Leader of the Opposition briefed The Sunday Times in October to the effect that he supported fundholding and that fundholders had nothing to fear from Labour. Then the hon. Member for Islington, South and Finsbury briefed two separate newspapers with completely contradictory messages. On 4 December, The Independent reported: "Labour to scrap fundholding". That was based on a briefing offered by the hon. Gentleman. One day later, Doctor magazine reported:Labour promises to retain fundholding".The hon. Gentleman was seeking to take a middle way between preserving fundholding and abolishing it, recognising that more than half of Britain's GPs have chosen fundholding because they recognise that it is the way of delivering the best NHS care to their patients.
The hon. Gentleman has now made the position clear, however. He made it crystal clear on the Dimbleby programme yesterday. When asked about Labour's proposed replacement for GP fundholding, he said:There will be a requirement within three years for GPs to join a locality group.When Jonathan Dimbleby said:All fundholding GPs in individual practices now will have to join up in their locality into one supergroup",the hon. Gentleman replied, "Yes, indeed."
The hon. Gentleman has at least made it crystal clear that Labour plans to snuff out fundholding. The hon. Gentleman has bowed to the pressure from old Labour. If he had mentioned that in his speech, he might have got a cheer from his hon. Friends on the Bench below the Gangway. They came in hope and the 42 hon. Gentleman had an opportunity to throw them a bit of red meat, but instead he told a few anecdotes in an irrelevant journey around the national health service.
That commitment leaves the hon. Gentleman with the difficulty of defending a clear commitment which flies in the face of the views of the majority of GPs. Howard Glennerster at the London School of Economics said that fundholding had provideda shift in the balance of power back to general practice for the first time this century.Successive Health Ministers—Labour and Conservative—have sought a shift of power back towards primary care. Fundholding has delivered that, and not just in the opinion of Government supporters and sympathisers. An article in the New Statesman by Mr. Stephen Pollard, a former research director of the Fabian Society, puts the case for fundholding. This scheme has improved the quality of primary care in the health service and, indeed, has improved the health service as a whole.
§ Dame Angela Rumbold (Mitcham and Morden)
I have listened carefully to both sides of the debate, including the proposals by the Opposition spokesman. Until the last few moments of the speech by the hon. Member for Islington, South and Finsbury (Mr. Smith), I could discern proposals relating only to an increase in bureaucracy. My right hon. and hon. Friends and I are alarmed to think that reduction or abolition of fundholding practices will decrease the effectiveness of GP care for patients. I should have hoped that a health debate would be about patients and patient care, but instead there has been great discussion about structures in the health service, and the Labour party want to destroy a structure that has really helped patients.
§ Mr. Dorrell
I could not agree more. My right hon. Friend is making what is the strongest argument in defence of fundholding. That is why barely one in five GPs believe that Labour has produced an adequate answer to the empowerment of GPs that fundholding has provided. A recent survey of fundholding opinion found that 71 per cent. of GPs surveyed rejected Labour's proposals outright, precisely for the reason that my right hon. Friend gives—they undermine the capacity of GPs to deliver high-quality care to their patients.
David Colin-Thome, a former Labour candidate, said that the proposals of the hon. Member for Islington, South and Finsbury amount tothe standard health authority model with a few GPs thrown in".That is what the hon. Gentleman is offering, in the opinion of a former Labour candidate.
§ Mr. Chris Smith
In that case, can the Secretary of State tell us why 56 per cent. of GPs polled by Doctor say that they will vote Labour?
§ Mr. Dorrell
If the hon. Gentleman ever holds my responsibilities, he will have to address how to secure the support of the majority of GPs who have chosen fundholding because they believe that it is in the interests of their patients. Doctors have chosen the option of fundholding because they believe that it allows them to do their jobs better. The hon. Gentleman has tabled a set of proposals that 71 per cent. of those doctors have rejected outright.
43 As Mr. Pollard concludes in his article:That this act of vandalism should be contemplated by Labour is doubly ironic. The NHS is Labour's proudest boast, and it was Bevan who saw the GP as the gatekeeper and patient's best friend. Fundholding is no more than a logical development of Bevan's vision.That is the argument that the hon. Member for Islington, South and Finsbury will have to answer. It is presented not in a Tory newspaper but in the New Statesman in the words of a former director of research for the Fabian Society.
§ Dame Jill Knight (Birmingham, Edgbaston)
Should we not consider another point when looking at fundholding? Does my right hon. Friend recall that, in many health debates and perhaps Question Times too, Labour Members have complained that patients of fundholding doctors get better service than those who do not have fundholding doctors? Are we not back to the old Labour belief that, instead of trying to lift them to the level of those receiving some good, we should get rid of the whole lot?
§ Mr. Dorrell
I could not agree more with my hon. Friend. Such a reaction to a model that has been chosen by the majority of GPs, and, as has been demonstrated, delivers improvements in patient care, is extraordinary. Indeed, the hon. Member for Islington, South and Finsbury argues against fundholding precisely on the ground that it has delivered improvements to patient care. To remove the system that has delivered such improvements in order to rely on the one that has not seems to be a contortion of logic which I find impossible to understand.
§ Mr. Dorrell
No, I shall conclude.
The truth is that, when Labour deals with health, it carries absolutely no conviction. It makes silly, superficial points on waiting lists, has nothing whatever to say about the private finance initiative and promises a huge new upheaval on the purchaser side of the health service. Most fundamentally, the hon. Member for Islington, South and Finsbury is prevented by the leader of the Labour party and the shadow Chancellor from saying anything at all about resources.
In every year since 1979, the Government have expanded the resources available to the NHS—in sharp distinction to our predecessors. I remind the House that health spending was lower in 1979 than in 1976. We have grown the health service year after year through 18 years in office. My right hon. Friend the Prime Minister has made it clear that, during the five years of the next Parliament, the next Conservative Government will deliver growth in real-terms spending on the NHS year on year on year. That is the commitment that the Conservative party gives. As The Guardian said clearly, for the Labour party:Honouring next year's settlement is meaningless. Labour can hardly take away money already promised. What it must do is match the Tory five-year promise: real increases year on year on year.That is a commitment that the hon. Member for Islington, South and Finsbury simply cannot give. It represents the ultimate choice that the electorate and the 44 people who work in the health service will have to make. Until the hon. Gentleman can pledge a growing NHS under a Labour Government, all his rhetoric is so much spit and wind. He likes to think that he can bask in the glow of the memory of Aneurin Bevan. That may be good in Labour committee rooms, but it will not cut ice on the hustings or in the NHS. The hon. Gentleman holds an important key responsibility; he has not begun to measure up to it. I look forward to more and more opportunities to expose his hollowness to the House and the country.
§ Mr. Clarke
Was it in order for the Secretary of State to make a speech that failed to relate to the motion and not say one word—
§ Mr. Deputy Speaker
Order. Had I thought at any time that the Secretary of State was not relating his speech to the motion, I would have intervened immediately.
§ 5.4 pm
§ Mr. Alfred Morris (Manchester, Wythenshawe)
The Secretary of State's long and, at times, repetitive speech reminded me of a celebrated apology by George Bernard Shaw.I'm sorry",he said,for writing at such length. There wasn't time to write more briefly.The right hon. Gentleman spoke at greater length than my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), but not to more effect. Anyone who believes, as the right hon. Gentleman pretends, that the founding principles of the national health service are in safe keeping with the Conservative party will have no difficulty in believing that pigs, even Lord Emsworth's beloved Empress of Blandings, might fly.
§ Mr. Morris
I must proceed.
The Conservatives contested its founding principles when the NHS was created and still seek to undermine them today. As the Prime Minister was beside himself to remind me at an hour-long meeting that I had with him about the Government's obstruction of a private Member's Bill that I was then promoting—my Civil Rights (Disabled Persons) Bill—in the third year of his premiership:This is a non-interventionist and deregulating government",and thus, he said, in fundamental conflict with crucially important provisions of my Bill.
45 The Government are no less in fundamental conflict with the principles of the national health service when it was founded, and the sooner the NHS is under the direction of people who genuinely believe in them, the more likely it is that their purpose will be fully achieved, not least that, as my hon. Friend the Member for Islington, South and Finsbury said, of restoring equity to the service and fairness between its patients.
The opening speech of my hon. Friend the Member for Islington, South and Finsbury was one of high distinction. It was that of a man both determined and well equipped to tackle existing wrongs and to achieve improving quality of care. I am naturally delighted also that my hon. Friend the Member for Monklands, West (Mr. Clarke) shares the Front Bench with him in this debate. As the House knows, the role of my hon. Friend the Member for Monklands, West is one of special significance to me. What he has already achieved for long-term sick and disabled people alone entitles him to the highest regard in all parts of this House.
The Secretary of State has important duties for the well-being of Britain's 6.9 million disabled people: for example, that of ensuring full and ready access to the services to which they are entitled under section 2 of my Chronically Sick and Disabled Persons Act 1970. The right hon. Gentleman must be aware how much the organisations of and for disabled people have wanted him—and want him now—to exercise that duty with the same sense of responsibility and commitment as his ministerial predecessor, Sir Hugh Rossi.
Sir Hugh, one of my Conservative successors as Minister for disabled people, made their mandatory duties under section 2 of the Act strikingly clear to all local authorities when he told the city of Liverpool and the London borough of Wandsworth that they were acting unlawfully in keeping disabled people on waiting lists for services for which they had been assessed under the section. He instructed the two local authorities to clear their waiting lists forthwith by providing the many hundreds of disabled people involved with the help to which they were entitled by law. If the Secretary of State is prepared to listen to no one else in this important matter, I hope that he and his ministerial colleagues will at least concede that what their predecessor said and did is worthy not only of careful study but urgent emulation.
I spoke the other day to a severely disabled woman about ministerial attitudes to the Chronically Sick and Disabled Persons Act 1970 in anticipation of this debate. She said, "They are dragging their feet." Looking down, she added, "And tell them they're lucky to have feet to drag." She is not alone in her anxiety about the Government's growing failure to give meaningful effect to legislation that is so deeply important to their independence and well-being.
The Secretary of State and his colleagues often get themselves into a muddle in trying to decide whether to say that the last Labour Government did too little or too much for long-term sick and disabled people. They try to square the circle by saying both. For example, while boasting that they have given them more help than we did, they repeal hugely important legislative advances that we made for disabled people. That can be documented at length, but I ask the House to consider just one instance.
During my time as Minister with responsibility for the disabled, in 1975, the Labour Government legislated to link disability benefits with growth in prices or average 46 earnings, whichever was the more beneficial to disabled people. The ending of that link, after the change of Government in 1979, had cost recipients of invalidity or incapacity benefit alone £8.57 billion by the end of the year 1994–95. Given the rate of progression of the Government's savings in the final three years for which figures are available, that figure must now be in excess of £12 billion.
Recipients of the attendance allowance had been denied £5.85 billion by the end of 1994–95, which must now have risen to more than £8 billion. Other cash benefits for disabled people have been cut just as drastically below the levels for which I legislated under the last Labour Government. There was even a saving to the Exchequer, by the end of 1994–95, of £420 million on our pioneering invalid care allowance, which today must have increased to more than £600 million.
Ministers would need more polished oratorical powers than Demosthenes to argue away factual information of that eloquence. The figures that I have given are not mine: they are quoted from parliamentary replies that I had from the present Minister for Social Security and Disabled People as recently as 10 February. I am grateful to him for correcting his earlier replies. I urge all right hon. and hon. Members to read the figures he gave me.
The central truth about our achievements and those of our successors is that, by common consent, Britain led the world in the 1970s in legislating to make life better for disabled people and their carers. That is why I was asked by the United Nations in February 1979 to open the discussion in New York that paved the way for the International Year of Disabled Persons in 1981 and why I was invited by Rehabilitation International to chair the world planning group that drafted the "Charter for the 1980s" for disabled people worldwide. Britain was then unquestionably a world leader in this policy area. As everyone knows, we are anything but a world leader today. In the north, south, east and west of the world, there are today countries that used to follow our example but that we now lag woefully behind.
I must make one more point about disability legislation in this debate. In government, we, for our part, went far beyond our manifesto commitments of 1974. There was no commitment then to legislate for the mobility allowance, for the non-contributory invalidity pension, for the invalid care allowance or for the disabled housewife's allowance. Those were advances made over and above our manifesto commitments, and I am totally sanguine that my hon. Friend the Member for Monklands, West will again make action speak louder than words as the Minister.
Far too few resources are spent today on research into tackling even the major scourges that still destroy the health and wreck the lives of their victims. Consider the reply that I had on 18 February to my parliamentary question on the progress of research funded by the Government into Alzheimer's disease. Anyone who reads the reply will be left wondering why voluntary organisations should have to spend so much of their time and meagre resources in funding research, the benefits of which are manifestly important to us all.
Again, why cannot the Government find even a moment of parliamentary time to enact the Disabled Persons and Carers (Short-Term Breaks) Bill, so ably piloted through the House of Lords by Lord Rix? Not to 47 allow it to achieve its admirable purpose of strengthening the ability of carers to cope with their problems will inevitably lead to further dependence and higher spending by the national health service; so it is self-defeating as well as inhumane. Ministers will know that there is another opportunity this Friday for them to stop obstructing the Bill, and I implore them to let this much-needed measure go forward then without further delay.
I turn now to the Secretary of State's responsibility in relation to the compellingly urgent claims of people with haemophilia who were infected by contaminated blood products in the course of NHS treatment. There is a deep sense of injustice among them. The tragic fate of three brothers explains why.
Two of the brothers were infected with HIV by NHS treatment and died of Aids-related illnesses. The third was infected with hepatitis C and died of liver failure. The two who died of HIV infection had financial help from the Government and were able to make provision for their families. The third brother went to his grave having been refused any help at all. He could make no provision for the future well-being of his family.
All three brothers died from the same cause: contaminated NHS blood products; but the third brother was deprived of the help given to the other two by a Government who provided £70 million for people infected with HIV and set up the Macfarlane trust to give them continuing support. The Government accepted their moral responsibility in the case of HIV infection. They have the same responsibility now in hepatitis C cases.
The Government argue that compensating those infected with hepatitis C would take money away from patient care in the NHS. To say that is to bark not just up the wrong tree but in the wrong forest. The payments made in the HIV cases came from contingency moneys, which is what the Haemophilia Society is asking for now for the hepatitis C victims. The society simply wants the terms of reference of the Macfarlane trust to be extended to include them.
Measured against the pain and suffering endured, the claim is extremely modest. Hepatitis C attacks the liver and is life threatening. Current medical opinion is that up to 80 per cent. of those infected will develop chronic liver disease, of whom about 20 per cent. will develop severe liver problems, such as cirrhosis or liver cancer. Scores of those infected have already died, and the death rate is accelerating.
In recognition of the scale of the problems, an all-party early-day motion was tabled in my name and now has 273 signatories: a majority of all Members of Parliament who are free to sign such motions. As the list of hon. Members shows, the issue is treated in the motion not as one of right and left, but of right and wrong.
The Haemophilia Society, with strong support from both sides of the House, is simply calling for parity and has documented in an impressive recent report the appalling effects on families of failure to concede their claim. In none of the campaigns I have been closely involved in here over the years—among them those for the thalidomide victims, for children with dyslexia and autism, for war widows and for haemophiliacs infected 48 with HIV—have I had so strong a sense that no campaigning should be necessary to right such an obvious wrong.
The Government know we are right and that our campaign is completely free from party animus. They know too that, given the nod by Ministers, the Commons would settle the issue within an hour. The Government's legislative programme is gossamer thin. Parliamentary time could unquestionably be found. If Ministers fail to act, and the campaign has to go on, then go on it will, but I most strongly urge the Secretary of State to act now and to make it clear that he is doing so before the debate concludes.
§ Sir Geoffrey Johnson Smith (Wealden)
It is a pleasure to follow the right hon. Member for Manchester, Wythenshawe (Mr. Morris), especially as I have also been involved in the past few years in both the campaigns that he mentioned for haemophiliacs. I agree that disastrous, unwanted and unlooked-for damage was done to their health, which none of us could have foreseen. I hope that eventually the case will be accepted, but there are financial implications and the question of apportioning blame. Those are difficult legal matters that have yet to be settled. The issue is approached in a non-partisan way, which shows that on health matters it is possible for both sides of the House to work together.
It is therefore all the more regrettable that today the speech by the hon. Member for Islington, South and Finsbury (Mr. Smith) was nothing but a brawl. Time and again he initiates these debates, motivated by the approaching general election, but he has little regard for the facts of the case in terms of the development of the health service and the difficulties that it faces: he merely tries to rubbish all that goes on in the health service. That just will not do. If the Labour party were elected, it has already pledged not to increase public expenditure. When the hon. Gentleman was challenged by my right hon. Friend the Secretary of State for Health, he could not give a single example of how he would heal what he calls the wounds of the health service.
We had a simple, stupid brawl from the hon. Member for Islington, South and Finsbury. No one would imagine, from what he said, that people in the health service are working to the highest standard of excellence that can be found anywhere in the world. No one would imagine that the Government had funded such a huge increase in expenditure over many years. In real terms, we have seen an increase in funding from £7 billion in 1979 to more than £43 billion for next year. How dare the hon. Gentleman, aided and abetted by his hon. Friends who know that the election is coming, denigrate a Government who have funded that increase in expenditure? The increase has been nearly 70 per cent., allowing for inflation. I doubt whether any Labour Member would have the guts to make such attacks, were it not for the general election and their wish to make party political capital.
The damage done to people who work in the health service is appalling. Morale can be seriously affected, and the trust of the wider public in the health service is also damaged. Overwhelmingly, people receive magnificent treatment from the NHS which is unrivalled anywhere else in the world. We stand high in the estimation of 49 people who observe our health service. I know people from the United States who have come to study our methods. They do not go home and rubbish the health service: they recognise its positive and solid values.
I do not claim that all is well, and I will come to the problems in a moment, but I ask why the doctors, the nurses, the specialists and the people who clean the wards cannot be taken out of the horrible cockpit of politics. It is not necessary to drag them into it, and it demeans Parliament to do so. I am fed up to the back teeth with that tactic, and I dare say the health workers are too.
In my constituency, the local hospital has developed its services over the years. When I was first elected, it was unusual to speak to a constituent who had had a hip operation. Now when I go canvassing, I meet people who have had operations on both hips. Life expectancy has been prolonged and many services have been improved while I have been in Parliament. We do not hear about that from the Opposition: instead, we get constant bitching as they continually demean the high quality service that we get from the NHS.
We know that there are difficulties, including an aging population, rising expectations, and improvements in technology. All those factors add millions of pounds to the NHS budget. I remember a time, shortly before I entered the House, when we thought that all was well with the health service. It was cheap to run and none of the life-prolonging technologies were in use. We were living in the post-war illusion that the country's health would be improved as time went by and that costs would therefore go down.
§ Mrs. Jane Kennedy
I resent the suggestion that complaints about the current state of the health service are, in the hon. Gentleman's words, bitching. Does the hon. Gentleman accept the words of Robert Tinston, who works for the North-West Regional Executive, in the introduction to his report to Alan Langlands:Over recent years there has been a steady increasing pressure placed on secondary care"—in other words, hospital services—to handle emergency admissions over the winter period. The pressure became so intense at times, during 1995–96"—when the report was written—that the system was in danger of collapsing." Is that bitching?
§ Sir Geoffrey Johnson Smith
It has not collapsed. I am not talking about people in the health service, who are bound to know what the pressures are. I do not deny that there are pressures and I have already given three reasons for them. We have had a winter surge in elderly people seeking hospital beds, because there are more elderly people around than when we started the health service.
It was thought when the health service was introduced that costs would steadily go down, but it was not many years before people started complaining about the cascade of medicine that was poured down patients' throats. That led to the introduction of prescription charges. Who introduced them? The Labour Government of the time introduced them, and one of their Ministers resigned over it. For years, Labour Members have complained about 50 prescription charges, although there is plenty of protection for the chronically sick and those in vulnerable age groups.
The key issue is the efficient use of resources. The Labour party's policy does not promise extra resources for the NHS. Why cannot the Labour party spokesmen be constructive? My right hon. Friend the Secretary of State made a most able speech and he confronted and challenged the hon. Member for Islington, South and Finsbury, who had no answers. In the Secretary of State, we have a man who fully understands the complexity of the health service, the pressures on it and, more importantly, the ways in which we can surmount the difficulties and gradually eliminate them. That is the constructive way to look at the problem.
An article by Kathy Jones in the Fabian Review suggested that the Labour party has taken a paternal interest in the health service. The article continued:But the fact that the NHS is Labour's issue has frequently led to laziness, both in developing policy and in presenting it. 'Jennifer's Ear' is perhaps the best known example.The article went on to say that thesoundbite approach to NHS policy may help Labour to win the election but it will not help the party run the NHS when in power.Instead of concentrating on tackling the problems in the NHS, the Labour party concentrates on ownership. The article continued:Most Labour front bench speeches refer to creeping privatisation. They argue that the introduction of market mechanisms in the NHS is the forerunner of privatisation of NHS providers. They regard Trust status for NHS providers with the same suspicion. I would argue that, first, this is not true and second, it is not important.She is absolutely right, and that is one reason why the negative carping approach of the hon. Member for Islington, South and Finsbury and others is thoroughly wrong.
§ Mr. Kevin Barron (Rother Valley)
The hon. Gentleman started by saying that we should keep party politics out of health, but he has gone into that subject. Is there not a contradiction in that?
§ Sir Geoffrey Johnson Smith
The Opposition have been rumbled. I wanted to establish that the approach of Opposition Members is wrong and that people in the NHS resent it enormously. It is about time that Opposition Members realised that we know what they are doing and that their reasons for doing so do not stand up. I am making a point that I am entitled to make.
Other countries spend no more money on health than the UK—despite what Opposition Members think—and extra funding comes not from the state, but through private provision. Before any Opposition Member comments on the need for increased private provision as a crucial supplement to Government funding, I stress that independent health care is particularly encouraged by socialist countries in the European Union.
In Spain, the socialist Government have a public-private mix in which 31 per cent. of hospital beds are privately owned. In Belgium, there are 48,000 private beds out of a total of 77,000. In France, 33 per cent. of hospital care comes from the private sector. I could go on, as this is the story across the continent. Co-operation between the state and the private sector is now normal, and I am not alone in believing that there is a need in the UK for private provision to be developed.
51 My right hon. Friend the Secretary of State quoted Stephen Pollard, a former research director of the Fabian Society, who has written about this matter. He said:With the electorate unwilling to support a return to the old `top-down' approach to welfare provision, it is now time to examine how the independent sector can … augment the state system".Let us look at other countries. In Sweden, the health care system is going through a rapid transitional phase, and is moving from a traditional budget-based and steered scheme to an internal market model with a separation of purchasers and providers. The changes are running in parallel with developments in Britain, although the Swedish system is more decentralised. Doctors in Sweden have been asked whether the new system is motivating them to become less concerned about their patients, but it is recognised that they have acquired a new attitude and an awareness of the resource aspects of health care. A report on the matter states:So far there are no indications that these changes of behaviour have led to a decreased quality of medical care (that is withdrawal of necessary and meaningful treatments). There are some indications of an increased quality in the service component of the care.How many times have I heard Labour spokesmen state that "creeping privatisation" would lead to doctors being interested only in money and not in the care of their patients?
The Netherlands has also had problems with increases in expenditure and demand, and reforms have had to be made. At the moment, GP services are mostly private, but the system of health care provided by hospitals is mostly public. That is a problem that they must address, and it has caused political divisions in the Netherlands, where there is a larger number of parties than in this country. As a consequence, no decision has yet been made on how far they can improve the use of the private sector.
In France, the characteristic of the system is free choice for the patient with no restriction of access to a general practitioner or specialist. A report from the French embassy on health care states:It might seem strange to someone used to the NHS that a person can go to one specialist in the morning and if not satisfied see another in the afternoon … In France most people expect to go out from the doctor's with a prescription. It is difficult for a doctor to refuse when a patient asks for a particular treatment, since the doctor might lose that client who could go to other doctors to find one who does not refuse.France faces the problems of rising expenditure and an increasing debt that the Government cannot fund, and these are not unique to France. For years, some were convinced that the French system was the best in the world, but they ignored the fact that it had become too expensive and not as efficient as it should be. The report continues:However, despite all this, it will still be possible to survive under the present system, even if one is not rich!
§ Mr. Heppell
The quotations are very interesting, but the Secretary of State might find it difficult to go to his Cabinet colleagues and say that he thinks that we ought to adopt the better European standards of health care. The climate in the Conservative party might not be right for him to say that.
The examples given by the right hon. Member for Wealden (Sir G. Johnson Smith) are interesting, as were the Secretary of State's statistics, but many Opposition 52 Members see the reality. Tory Members are telling me that things are getting better and better, and that I am either bitching or raising a political point. But in my constituency, no elective surgery will be carried out at all on the patients of non-fundholding general practitioners—including at the Nottingham City hospital and the Queen's Medical Centre—until April. That will be a total of seven months with no operations.
§ Mr. Deputy Speaker
Order. The hon. Gentleman should have raised that point earlier in his intervention.
§ Sir Geoffrey Johnson Smith
The hon. Gentleman was obviously too busy talking to his hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) to fully understand what I said. I should make it clear that all those countries are facing rising costs and, without exception, are looking at how they can make more efficient use of resources. As part of that philosophy, they are using the private sector to help them on their way. That is important, and it is happening in socialist countries as well. But Opposition Members will not look at the matter in that way.
§ Mr. Nick Ainger (Pembroke)
Does the hon. Gentleman accept that every country that he has mentioned with a private-public mix spends a far higher proportion of gross domestic product on health than this country does? Our system—which is basically public with a fringe element of private provision—is the most cost-effective health service in the world. To start moving down the road of greater private sector involvement will only increase costs without benefiting patients.
§ Sir Geoffrey Johnson Smith
If they thought that, why are those countries which have to some extent depended on the private sector moving down that road? They are not so daft that they will move to a situation that would lead to the conclusion that the hon. Gentleman advocates. [Interruption.] I have the reports here. Those countries are not moving down the road to more expensive health provision. They believe that by reforms which parallel our own—the purchaser-provider split and things of that order—they are more likely to gain the efficiency and the additional resources that are necessary if they are to fund the higher cost. That was the purpose of the article written in Fabian Review—making better use. That is what we are doing.
Had the hon. Member for Pembroke (Mr. Ainger) been listening, he would have heard me say that much of the increase in the percentage of gross domestic product that other countries can boast for their health services is due to the use made of the private sector and I quoted some figures. That is what brings the percentage in, and it is important.
§ Sir Geoffrey Johnson Smith
The figures are there. If the hon. Gentleman reads my speech, he will realise that those figures support my argument. Those countries are going further down that road. Unless they were blind, daft or batty, they would be unlikely to go down that road if they did not feel that better use of private resources and better management would lead to better delivery of the services, which they all find are under strain. There is 53 nothing about us that is unique or different or that is made more difficult by Government policy. On the contrary, the reforms—trusts and funds, and primary care which we debated the other day—are all constructive measures designed to meet the problems of a service that is expanding because of the extra costs imposed by an elderly population and modern technology. That is why I believe that it is bad for us to continue this debate without tackling those problems.
We need a united view. If we cannot agree on individual points that can improve the health service, I should have thought that we could at least agree on the need and the methodology in general terms and let Ministers and those running the health service get on with the job.
§ Mr. Simon Hughes (Southwark and Bermondsey)
I have great sympathy with the general proposition put forward by the right hon. Member for Wealden (Sir G. Johnson Smith). I have argued from this Bench before that much of our debates on the health service is pointless. It is simply an exchange of statistics and arguing about matters that could be objectively verified, which leaves people out there thinking that they should not trust any politician because they are not tackling the main issues.
I looked up the right hon. Member for Wealden in "Dod's Parliamentary Companion". He was married in the year that I was born, so he has been around a little longer than I and perhaps remembers the pre-NHS health service a little. But we share a commitment to the NHS, which has been a great success. He is right in his analysis that there is a similar challenge in health care the world over. In advanced democracies such as ours, the issues are the same—people are living longer, demanding more, putting on more pressure and costing more.
There is a longer-term debate to be had and I regret that we spend far too much time on these short-term debates. When the election is out of the way, I hope that more politicians will be honest enough to own up to the fact that unless we tackle those issues, we will be serving the people of this country badly. The way we are going on, there will need to be some radical rethinking of how we fund the health service. The right hon. Member for Wealden may have a view about the private sector and more private money coming in. I probably have a different view, as I think that the NHS should remain substantially funded by the taxpayer, but as the NHS is a key part of the welfare state, this issue ought to be addressed and the sooner we get away from short-term exchanges of contradictory information that illuminate nothing the better.
None the less, this is an extraordinary debate. The Labour party has chosen the subject for its sixth Supply day and has entitled the debate "National Health Service"—nothing more specific than that. It is as if the Opposition then suddenly thought that they had better include some other things, so they mixed into the debate about the health service, debates about disability and community care.
§ Mr. Hughes
The hon. Gentleman says yes, but disabled people do not like the idea that health and 54 community care issues are the only things that matter to them. The Labour party has done disabled people a disservice by lumping disabled people's issues together as a subset in a debate on health—they are not even mentioned in the title and the hon. Member for Islington, South and Finsbury (Mr. Smith) did not mention them in his opening speech.
§ Mr. Hughes
Not for a second. Unlike the Labour health spokesman, who would not give way because he knew that I would ask him a question that he could not answer adequately, I will give way to the hon. Gentleman, whom I respect, but first I must quote something written by some of my party's advisers on disability in 1993. They said:It is a sad fact that debate on disability issues is often assumed to be simply about health, social security or community care. It is also very surprising that this should be so because the disability debate is fundamentally about human rights".It is about equal treatment, equal citizenship and access. Although there is a movement in the right direction in Labour policy, it falls short of what disabled people want because it does not commit the Labour party to the introduction of a Bill of Rights that would automatically give people equality of treatment. Until the Labour party goes that far—I stand to be corrected—it will not serve the interests of disabled people adequately.
§ Mr. Clarke
I reciprocate the respect that the hon. Gentleman says that he has for me. Disabled people expect a debate on the health service to be relevant to them and I have had several letters and telephone calls since the Labour party announced that it would use the time to have this extremely important debate. I shall clarify some of the hon. Gentleman's points in my reply, if he is able to stay for the end of the debate.
§ Mr. Hughes
I do not want to be distracted by this dispute, but the Labour party had an Opposition day on health recently and it could have had a full day's debate today on disabled people's issues, but it chose not to do so. The Labour Opposition have added this issue into a debate on the national health service and disability is not even mentioned in the title.
§ Mr. Hughes
We get two days a year and the Labour party gets 17—that is one of the reasons. We have had such debates in the past. We, too, receive representations. There is a range of disability issues that we could raise, but they should not be put into a debate on the national health service. If we are to debate them, I hope that before the election the Labour party will go further than its present commitment, as it is not yet sufficiently committed to the equality of treatment for disabled people that they and their representatives want.
§ Mr. Gunnell
I must take issue with the hon. Gentleman, who should think about what he has said. First, he criticized 55 the motion for being too broad in its scope. Then he suggested that it does not refer to a Bill of Rights, but it refers tocivil rights for disabled peoplewhich seems to press the point as far as it should in a motion. I understand his point that the needs of disabled people go beyond health, but I do not understand his objection to the wording of the motion.
§ Mr. Hughes
I do not want to be overly distracted, but I must repeat Labour policy. The hon. Gentleman can disown it later if he likes. When asked by the Royal National Institute for Deaf People:How do you plan to monitor the effectiveness of the Disability Discrimination Act? Will you appoint a disabilities commission to cover all parts of the Act?",Labour answered:We plan to set up a Disability Rights Commission which would take over the duties of the National Disability Council and represent the interests of disabled people and other interested parties. We expect it to come forward with recommendations on how to achieve comprehensive and enforceable civil rights.A commission will be given the job. As yet—
§ Mr. Hughes
It is not. If we get an advance on Labour policy later, I will welcome it. We look forward to the speech of the hon. Member for Monklands, West.
§ Mr. Hughes
I will not give way again at the moment. We are clear about the need for a Bill of Rights, which needs to come first. With such a Bill, people with disabilities would have, for example, the sort of access to buildings that they have in the United States. It would also give the same access to television by means of signing services. The matter goes well beyond issues of health, social security and community care.
§ Mr. Hughes
I will not for the moment.
A small section of the motion deals with community care. I agree with it but it is a statement of the obvious:under this Government community care has become a discredited term associated with inadequate care for those in need and inadequate protection for the general public".However, not a word follows about what Labour would do about community care.
An article in Community Care magazine on 20 February stated:National standards and a national inspectorate to safeguard the equity of services for elderly people evidently command even less support in political circles than they do among those working in community care. Of the three main parties, only the Liberal Democrats have come close to taking these ideas on board.56 The article sets out criteria for inspection and monitoring.
§ Mr. Hughes
In a second.
The article concludes:So far, only the Liberal Democrats have made a serious attempt to address this agenda.I regret that in a cobble-all-together motion that covers three subjects rather than one, there is not one policy commitment from the Labour party, either on health or community care.
§ Mr. Clarke
I am grateful to the hon. Gentleman. I fear that he is still upset because my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) did not give way. The hon. Gentleman says that the motion makes no suggestions about community care, but is not our call for the appointment of a royal commission very important?
§ Mr. Hughes
A disability rights commission would certainly be better than nothing. We believe strongly that we need one human rights commission to look after everyone's civil rights. We should not segregate racial, gender and disability equality into separate commissions. The Labour party would be better advised to have one general commission. It would be a mistake to have segregated groups of rights upheld by different institutions.
The larger part of the motion deals with the national health service. I welcome this debate, but I share the Secretary of State's surprise that the Labour party still goes on tabling motions on the national health service because, yet again, its motion makes no commitments. That is because, I am sad to say, when it comes to the crucial question of how much more it would put into the NHS, the Labour party is desperately, pathetically wanting. It is committing no new money. It pledges to find £100 million out of existing money for one year only. As the Labour shadow Secretary of State for Health confirmed yesterday on television, he will fight his corner in the second year to see if he can get a bigger share but only of the same cake. Let us not be under any illusions.
Today's Evening Standard puts the picture clearly and I commend the editorial, headed "Debating the NHS", which states:A month before the 1992 election, the campaign was already in full swing: and it concerned the NHS, the NHS and the NHS. Today, at a similar stage in the electoral cycle, there is a strange absence of debate. If the election were decided on health policy alone,"—I do not concede this—labour would be a racing certainty. For Labour is trusted on health, the Tories not. And it barely matters what either party says or does … By committing a future Conservative government to a funding increase in real terms, he"—the Secretary of State—has embarrassed his opposite number Chris Smith, who has been unable make so detailed a pledge.The editorial poses a set of questions to Labour and concludes:|And since the public is always bound to be dissatisfied with a service where demand is greater than supply, Labour believes that the political benefits of simply attacking the Government are too 57 great to give up. But today the issue revolves not around the Conservatives' plans for the NHS but Labour's—and that is a marked change.That is where we are. It is extraordinary that in today's politics, John Maples's memorandum has proved to be wrong and that it is Labour, of all the parties, which is on the back foot on health service policy.
§ Mr. Hughes
It is not a contradiction at all. The party that legislated to create the NHS now has the least to say about funding it and is therefore least likely to change it. That is why we tabled an amendment. Sadly, Madam Speaker did not select it, as is the convention in such debates. I tabled it before the Tory amendment but it was not selected because of some Standing Order. Our amendment set out policy commitments. Whatever criticisms people make, I hope that they will notice that.
§ Mr. Deputy Speaker
Order. The hon. Gentleman said that there was a Standing Order that prevented a Liberal amendment from being selected. The Chair is not aware of such a Standing Order.
§ Mr. Hughes
I checked with the Table Office and there is a Standing Order that says that a Government amendment takes precedence over other amendments. I beg to contradict the Chair on that.
§ Mr. Deputy Speaker
The hon. Gentleman is not contradicting the Chair. He is getting himself out of a difficult situation.
§ Mr. Hughes
I had better not dare to continue this debate. Our amendment is on the Order Paper. It is a wonderful amendment and it has policy in it, unlike Labour's motion.
We believe that the NHS should be secure, strong, efficient and there when people need it. I share the view of the right hon. Member for Wealden on that. There are several immediate issues. First, there should be a commitment to honour pay increases in full, as recommended by the public sector pay review bodies. We suggested that and have budgeted for them to be paid. Labour and the Tories refused to agree to that. They have the same policy and think that the increases should be phased in.
Secondly, we have set out our stall clearly that we want a halt to finance-driven closures and reductions of service as of the beginning of the year. Labour is committed to some halt in London but not anywhere else and the Tories, by definition, are not committed to halting anything and think it should steam ahead because it is all wonderful.
Thirdly, we are committed to £200 million extra a year for staff recruitment, to be funded through taxation. Labour is not committed to that, nor are the Tories. It is evident to everyone that the NHS will need more staff.
Fourthly, we are committed to putting significant money into the reduction of waiting lists. To use a phrase of the Prime Minister's that has been repeated so often that Ministers probably parrot it in their sleep, we are committed to putting £150 million a year, year on year on year on year on year, for five years specifically into the 58 reduction of waiting lists. With such additional money from taxes, we could reduce waiting lists to six months maximum across the board in one Parliament.
We have other important health policy proposals such as the abolition of eye and dental charges. I know that some Conservative Members are sympathetic to that. We believe that there should be a freeze on, and then a review of, prescription charges. We want a ban on all tobacco advertising, save at the point of sale, and on the promotion of sports events by tobacco companies. Those three policies would help our good health promotion policies, as would an independent and effective health education authority.
§ Mr. William Cash (Stafford)
Will the hon. Gentleman take sides on rural dispensing from surgeries and the provision of such services by prescription? Would the Liberals abolish the monopoly in a one-mile radius around existing provision of prescriptions in rural areas? What is the Liberal position on cloning and genetic engineering?
§ Mr. Hughes
I shall not deal with the second, complicated issue that the hon. Gentleman raises; I could not in a sentence do justice to it. On the first issue, the presumption should be that the present dispensing system should continue. However, it must be patient-determined. Where there is not local access to a service provided by an existing practitioner, there needs to be some liberalisation of the service. I am willing to give the hon. Gentleman a copy of the considered, lengthier statement of our position. It is on record and is not a secret, but it is obviously controversial. I have heard the hon. Gentleman speak about the matter in the House before and I am aware of his regular interest.
There are clearly things wrong with the system that the Government have introduced. First, all general practitioners should be treated equally and funded in the same way. There should be no differential according to whether or not they are in a fundholding practice. They should be funded according to their number of patients and the make-up of their practice in terms of local statistical factors such as morbidity, ethnicity and mortality.
Secondly, we should not have a system whereby a patient who goes through the door of one GP receives speedier treatment from the local trust than the patient of another doctor by virtue of the former GP's status as a fundholder. That is evidence of a two-tier health service—it is not worth arguing about that—which is not a national health service available to all.
Other inequalities must also be dealt with. Depending on where one lives, one may not be able to get a dentist on the NHS. Again, there is no longer an equal health service. Depending on where one lives, the chances of being operated on speedily vary hugely because waiting lists are different. Depending on where one lives, one may have a much higher chance of having one's operation cancelled.
As I said in the context of community care, we believe that it is important to establish a national inspectorate of health and social care. Its work would be complementary to that of the Audit Commission and it could check independently to ensure that good practice exists whether in the surgery, clinic, hospital or wherever. The education service benefits from the existence of Ofsted. We need a similar body in the health service which can say, "That is not good enough; you must improve."
59 The last and most crucial issue is funding, which the right hon. Member for Wealden has already discussed. We must address fundamentally where we will get the money for the NHS. We have a cheap health service, which costs us 7p in the pound—we pay less than nearly every other comparable country. The Americans pay the equivalent of 14p in the pound for a far less good health service. We must debate whether more public sector money and more taxes should be devoted to our health service. My party has debated that for the past two years and we have come to the conclusion that, certainly in the short and medium term, the NHS should be funded more from taxation and from public funds. That is why we have made various commitments. I know that that promise may prove unpopular at the general election, but that is the risk we take. In fact, I do not think that that commitment will be unpopular, because I believe that the public want more public money spent on their public health service.
We have made five commitments. First, NHS funding should be guaranteed year on year on year on year on year, but our policy is different from that of the Tories, because we believe that funding should keep pace with NHS inflation not national inflation, which is running at a lower rate. It is no good giving a year on year increase if, in real terms, it does not keep pace with the cost of running the service.
Secondly, we must remove the most bureaucratic elements from the system. I am not slating managers. We need good health service managers, but we do not need people to manage a system when one does not need that part of the system. Money can be saved from bureaucracy. We are not, however, at the beginning of a five-year programme, committed to spending money to be derived from that saving. Unlike the Labour party, I do not believe that one can obtain £100 million overnight from a pot marked "bureaucracy savings". [Interruption.] It is completely impossible to save £100 million overnight after the general election from bureaucracy savings. It is a figment of imagination, and that money will not immediately exist.
§ Sir Geoffrey Johnson Smith
As the hon. Gentleman has rightly pointed out, we are in agreement on certain facts. I should like to question his desire that we should look to the taxpayer to fund the ever-growing gap between resources and people's needs. That gap is apparent in this country and others and nearly all countries are considering how far private provision can play a role even though the main bulk of the expenditure provided will come from public funds. That possibility must be addressed, otherwise expenditure of £150 million year on year on year will be just peanuts.
§ Mr. Hughes
I understand that. Let me clarify that our £150 million yearly commitment is just to reduce the waiting lists. We have committed in total £550 million each year for five years above the inflation-linked amount. I disagree with the right hon. Gentleman that we need to change fundamentally the funding of the health service and opt for an increasingly privately funded one. I am happy to be honest with the right hon. Gentleman because we need to look beyond our manifestos and the general election. The health service in Britain provides a huge amount of fee-paying treatment for people from abroad. 60 We are very successful and offer some of the best health services in the world. People who come from abroad, and who are not citizens paying into the NHS, should pay for the treatment that they receive. There is a market for us to expand that area of health care.
I believe that in the next Parliament we will also have a debate about whether we should abolish national insurance in favour of a separate health and social care tax. The right hon. Gentleman is aware that national insurance contributions no longer fund pensions. They are not directly related to pensions; instead they go into the great Government kitty over the road at the Treasury. I understand that the right hon. Gentleman hopes to be a Member of the next Parliament—with a majority of 20,000 he should be, otherwise the Tories will be in trouble—and on that assumption I look forward to debating that issue with him. We need an urgent debate on the longer-term issues.
Returning to the present funding commitments, the specific list of changes from which the health service would benefit desperately also includes the provision of its funds three years at a time and a move to a minimum of three-year contracts between health authorities and trusts. As the hon. Member for Morley and Leeds, South (Mr. Gunnell) has already said, it should also benefit from a fair allocation policy, according to which the capitation formula should apply fully across the country. That would mean that that formula is not applied partially, according to local criteria. We must correct the current inequity governing the application of the funding formula throughout the country.
Today's great debate has been about waiting lists. The Secretary of State admitted to me that it is unarguable that waiting lists are at their highest level. That is not the end of the story. It matters to the individual more how long he or she waits than how many people have to wait. A study of the relevant table of figures since 1974 reveals two things which are pertinent and interesting. First, according to the figures as they were compiled then, I am afraid to say that from 1974 to 1979, when the Labour party was last in Government, waiting lists consistently went up. That is according to figures provided by the Library, which record that in every quarter of every year the number of patients waiting increased. Secondly, the figures started to come down only in September 1979. They then bounced around and went up and down, but in recent years the number of patients waiting for treatment went down. Those figures have however, started to increase in the past year.
I have tried to persuade the Secretary of State and the Labour spokesman that we must collect independently the relevant statistics. I am not impugning the integrity of the statisticians, but these sorts of figures should be produced independently so that the relevant factual information is taken out of the political debate. Statistics change, as does the assessment of them. We now include the number of day cases treated, as well as all sorts of other information. The key thing that people outside are aware of, however, is that in recent times waiting lists have started to go up. Now, people are not even being treated within 18 months, as stipulated in the patients charter.
The figures relating to the time between one's first consultation and treatment also provide just half the story, because one must often wait a hell of a long time between the first appointment and the consultation. We therefore need to study two sets of figures.
61 We have all studied the current figures. I did the same thing when I did my duty in the Wirral last week—incidentally, I was born in Cheshire and have family in that part of the world. I visited Clatterbridge hospital; it is brilliant and offers an extremely good service. That hospital has done well although there remains a debate about whether it should provide accident and emergency facilities. According to Government figures, however, in the past year, more than 200 operations were cancelled at the last minute in the Wirral. Figures are set out for every quarter. Some patients are not being readmitted to hospital for operations within the one month waiting time stipulated by the patients charter.
We must establish standards that are met. If we have a patients charter that says that if one's operation is cancelled, one will be admitted within a month of that cancellation, that must happen. If not, the charter is a paper tiger and there is no use having it. If the patients charter states that a patient should be seen and admitted within a maximum of 18 months, we must honour that commitment. People must have a right to enforce it—their inability to do so is one of the weaknesses of the current system.
Today's debate was called by the Labour party. The Labour Opposition motion is critical of the Government in certain respects and we can agree with those sentiments. We will vote for it. The first part of the Government's amendment is unexceptional. The second part suggests that the Disability Discrimination Act 1995 offered everything that was needed. We disagree, and we will vote against the Government on that.
I shall, however, end with a warning: it is becoming increasingly clear to us and, I think, to the public in Britain that, on health policy, there is less and less fundamental difference between the Labour party and the Tories. Fundamentally, they are both going to commit the same amount of money; if there were to be a Labour Government health service resources would not be increased. If the Labour party thinks that it can get away with trying to pretend to the country that, under a Labour Government, there would be a great, new, advanced development of funds and support for the health service, it is misleading itself. I hope that it will not be able to get away with that between now and the election. My hon. Friends and I will commit as much of our effort to exposing the hollowness of the Labour party's health policy as we have committed, and continue to commit, to exposing the hollowness of the Government's.
§ Sir Sydney Chapman (Chipping Barnet)
I am grateful to be called to contribute to the debate and it is a pleasure to follow the hon. Member for Southwark and Bermondsey (Mr. Hughes). I agree with some of his points and disagree with others, but at least he always makes a thoughtful contribution. Sadly, the same cannot be said of the hon. Member for Islington, South and Finsbury (Mr. Smith), who led for the Opposition.
Millions of people are treated by our NHS every year and there are bound to be failures and justifiable complaints; however, I fear that the hon. Member for Islington, South and Finsbury was selective in his use of complaints and figures. I shall be selective in my use of NHS statistics so that I can at least give people the other side of the story, which is that, by and large, our national 62 health service is an outstanding success. It treats more sand more people every day; more and more funds are committed to it; and there are more nurses, midwives, doctors and dentists serving it than there were when the Labour party was last in power.
I do not know whether we spend a smaller percentage of our gross domestic product on the NHS than other countries. If so, I suspect that it has something to do with the fact that most of those other countries have a greater proportion of private, as opposed to public, health care schemes. In the last five years of the last Labour Government, the percentage of GDP spent on our NHS went down from 4.8 per cent. to 4.7 per cent. Since the Conservatives were returned in 1979 the amount spent has increased from 4.7 per cent. of GDP to 5.8 per cent.—a commendable trend.
§ Rev. Martin Smyth (Belfast, South)
I can confirm that we spend less of our GDP than other countries, but two aspects must be borne in mind: first, that other countries, including the United States and France, spend more on insurance and bureaucracy; and, secondly, that overall we receive a better return on the money that we spend.
§ Sir Sydney Chapman
I am sure that the hon. Gentleman is correct.
If we take inflation into consideration—I concede that it is inflation measured by the retail prices index—when considering the funding of the NHS in the last five years of the last Labour Government, we find that it was cut by 2.7 per cent. We can contrast that with the increase under the Conservative Government—albeit over the longer period of almost 18 years—of 74 per cent.
The number of in-patient treatments has risen dramatically. We should call such treatments episodes, because they do not necessarily relate to different patients and we would be in trouble if more than 10 million people—almost one fifth of the total United Kingdom population—had had to have NHS in-patient treatment. The number of NHS case episodes has risen from about 6 million a year when the Labour party was last in government to well over 10 million a year now.
Waiting times fluctuate. There is always greatest pressure on the NHS at this time of the year and I do not doubt that waiting times have gone up, which should concern to us all. However, the hon. Member for Southwark and Bermondsey was correct to say that waiting times went up during the stewardship of the last Labour Government. They started to go down under this Government and generally go up and down. I join my right hon. Friend the Secretary of State in saying that what really matters is not the numbers on the waiting lists, but the length of time before patients receive their treatment. Those times have risen recently, which gives cause for concern—but they have sometimes gone down.
The hon. Member for Southwark and Bermondsey is committing his party to more expenditure on the NHS, as we are, but he is committing a specific amount for specific projects. In the mid-1980s, the then Prime Minister decided to commit a huge sum to deal with patient waiting lists—at the back of my mind I have a figure of more than £1,000 million. She committed that money mid-year to the whole of the service, including efforts to tackle the problem of waiting numbers and lists. For a few months, 63 the policy succeeded and the numbers decreased, but it was not many months before the numbers started to rise again.
Pay is better for those who work in the NHS. It may not be sufficient, particularly for nurses, but let us remember that nurses' pay has risen 70 per cent. in the past 18 years. If their pay is insufficient now, it must have been even worse in the dark distant days of the last Labour Government.
The elderly are better cared for. I do not say that with complacency; the elderly need even more care, as do the mentally ill, but there are better provisions for them. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) has contributed to the debate: I pay tribute to him for the work that he has done for the disabled and I appreciate the tribute that he paid to my former colleague, Sir Hugh Rossi. The hon. Member for Monklands, West (Mr. Clarke) and my hon. Friend the Minister for Social Security and Disabled People deserve credit for what they have done for the disabled. If we take into account inflation as measured by the RPI, funding for the disabled—by that I mean not only disabled people, but the long-term sick—has quadrupled. More needs to be done, but much has been done by the Government and I give them credit for that.
There has also been a massive building programme. At my latest count, the Government have been responsible for completing about 750 NHS building projects with a value of £1 million or more. Statistics conceal many things, but it is worth saying that the amount of funding for the building programme—for capital investment schemes—has gone up 66 per cent., or two thirds, since 1979. The record of the previous five-year Labour Government was a cut of no less than 28 per cent., taking inflation into consideration.
In Hemel Hempstead—metaphorically, if not literally, down the road from my constituency—the last Labour Government cancelled the new hospital building programme. Since 1979, that programme has been restored and has been more or less completed. As has been mentioned, Barnet has been waiting for a new hospital for 50 years under successive Governments. It was about to go ahead and was then cancelled by the health Minister in the last Labour Government. At long last it has gone ahead and phase lA of the redevelopment of Barnet general hospital, costing £33 million, is due to open next month.
I do not want to sound complacent, but I believe that, all in all, the Government's record is commendable and is a good record on which to build. Of course there have been problems. My right hon. Friend the Member for Wealden (Sir G. Johnson Smith) mentioned the escalating demand for treatments, which has hugely increased, and the aging population. Another factor is the cost of new medical technology. In short, we have been spending more on the NHS, but we need to spend an ever-increasing amount because the population is getting older. By definition, the very young and the very old need NHS services relatively more than others. An increasing number of treatments and new types of operation are being introduced, which are very expensive indeed. There are tremendous challenges ahead.
64 As I admitted, there are failures from time to time. I know of a lady who went into hospital not once, not twice, but three times for an operation. The matter is the subject of an inquiry at the moment. Before she could have her operation, she needed pre-medical treatment which could be carried out only immediately before she had the operation, not a few weeks before. She received the pre-medical attention, but it was then found that a bed was not available—probably because a more urgent case had come in. The hospital was not in my local health authority but in the next-door health authority. I am confident that those who run those services will learn from that failure.
The best-laid plans go wrong. We may find that the weekend of 3 January to 5 January 1997 was the worst weekend for the national health service in its 50-year history, for many reasons. First, there always appears to be an increase in the number of people needing attention immediately after the Christmas period. There has been a flu epidemic, at least in my part of the country. and it is a sad fact of life that not only patients but nurses get flu, so there have been fewer nurses. The health authority tried to foresee that eventuality and plan for it, but the scale of the problem beat it.
Secondly, the question has been asked, why could not agency nurses be used? People choose to be agency nurses because they do not want to work full time as a nurse. They want time off, perhaps when their children are on holiday from school. That has been the problem and it must be overcome.
At least we have created and implemented a mechanism whereby people can complain. It is known as the citizens charter or, in this respect, the patients charter. We have therefore encouraged people to complain. We have set benchmarks for standard and adequate treatments and I hope that we can tighten those because 18 months is far too long to wait even for non-urgent treatment. That is a challenge to us all.
I want to try to counter what I believe to be the unjustified charge that has been brought by many people: that although we may be spending more on our NHS, far too much is spent on too many administrators. I have tried, albeit as a layman, to make a study of that subject in my locality. I take the opportunity to quote, not a politician, but Barnet's director of public health. In his 1996 report he says:In fact, we"—he is referring to the nation, not Barnet—spend less on management than any equivalent health service in the world.If it is true that, as I believe, we are spending more today on management than we were a few years ago, that is not necessarily a bad thing. My local inquiries show that, in contrast with today, there was far too little financial accountability and much waste before we instituted our NHS reforms. I am not a qualified accountant, but I was appalled at the attitude in the Barnet health authority of yesteryear. I suppose that it was not unlike most other health authorities, as it expected to receive slightly more money every year without attempting to justify the increase by showing that existing funds were being spent cost-effectively, or that the increase would be used cost-effectively.
The Government have taken a lead in trying to reduce unnecessary or—I had better be careful—partly unnecessary bureaucratic costs. We abolished the area 65 health authorities in the early 1980s; we have recently abolished the 12 regional health authorities; we have merged the district health authorities and family health services associations; and I understand that we have reduced the central costs of the Department of Health.
That appears to be a pretty significant beginning, but the main argument against that would be that there are more managers at the sharp end—at district health authority level. I have inquired into that issue and want to make some points regarding my local health authority. The first is the obvious and important point in respect of clerical staff, not managers: I would prefer to have more clerical staff if that meant that consultants, doctors and members of allied professions working in the NHS could spend more of their time concentrating on their medical skills. It is not the number of managers or clerical staff that counts, but the amount of work that they do or that we expect them to do.
In Barnet, nearly half of those categorised as administrators or clerical staff work within clinical directorates, so they are probably not administrators but nurses. The question is: is a nurse manager a nurse or an administrative controller? In Barnet, they are mainly involved in nursing, but they look after some administrative control.
The proportion of NHS staff in Barnet who are administrators or clerical staff is slightly higher than in other health authorities. We have a slightly higher proportion of doctors and members of allied professions than do other health authorities, but that is because the acute services delivered by our health authority are provided on two separate sites, so more people are needed.
That leads me to comment on what may have been one of the most controversial decisions taken in our local health authority. The decision has assumed national proportions and was mentioned in an earlier intervention. This was the decision to close the accident and emergency department at Edgware general hospital to concentrate services on one site at Barnet. The Barnet site will be provided with an enlarged accident and emergency department, which is included in phase 1A. Why did the health authority make that proposal? Why did the then regional health authority and the then Secretary of State agree to it?
My view of this controversial matter is coloured by one of the most shocking statistics I have ever read. It came not from a politician but in a report issued a few years ago by the Royal College of Surgeons. It said that one in four deaths in accident and emergency departments are avoidable. As soon as I heard that, I made further inquiries. The statistic was confirmed in a report by Dr. Richard Warren, who examined the hospitals in what used to be the north-west Thames region. He came to the conclusion that there were 86 deaths a year in that area that could have been prevented but for the then prevalent structures for delivering A and E care.
Another shocking set of statistics comes from the British Orthopaedic Association, which has stated in a report that one in five patients are inadequately treated after major surgery in our A and E departments, and that one in eight are left with a severe avoidable disability.
The political problem lies in the fact that there is a popular misconception that any A and E department can deal with any accident or emergency. That is not true and 66 it never has been. The problem at Barnet general hospital and Edgware general hospital is that the acute services are provided on two sites about four miles apart, so there has never been adequate consultant cover. By concentrating the new, enlarged A and E facilities on one site, I have no doubt that lives will be saved.
It is of course difficult to persuade anyone living in the shadow of Edgware general hospital that the local health service will be improved by closing the local A and E department—indeed, I cannot prove that it will be, but from listening to expert medical opinion I am sure that the health service will be improved by the change. Not only will there be better A and E facilities, with more consultant cover, but there will be better ambulance cover, with two extra ambulance points in the Edgware region. People will be taken more quickly by ambulance to the new hospital as a result. What is more, every blue-light ambulance in my area carries, as of recently, a paramedic. I am told that the critical factor when dealing with a serious injury is not the time it takes for an ambulance to get to the A and E department but the time it takes before the person injured is stabilised by a paramedic on board a blue-light ambulance. I therefore urge the residents of the borough of Barnet and beyond who have hitherto depended on the A and E department at Edgware carefully to consider whether the new service will not be much better. I am convinced that they will find that it will.
To those who are still sceptical about the plan I would point out that the current out-patient and daycare services will continue at Edgware general hospital, and that about 75 per cent. of the sort of A and E cases that currently go to Edgware will continue to be served by that hospital. Only the more serious accident and emergency cases will be sent to Barnet—or if not Barnet, then to Northwick Park or the Royal Free, which are two relatively close hospitals. A minor injuries unit has already been set up at Edgware and other services will be developed on the site, such as services for the mentally ill and the elderly.
I believe that the delivery of hospital and medical services must adapt to changing medical technology.
§ Mr. Booth
Does my hon. Friend agree that what is planned for the Barnet and Edgware hospitals will continue the success already delivered by the switching of serious cases from Finchley Memorial hospital to Barnet general, while our local hospital was kept open to serve the whole community in other ways?
§ Sir Sydney Chapman
My hon. Friend knows much more than I do about Finchley Memorial hospital, but I know he is correct. Moreover, he nicely anticipates my concluding remarks.
We fail the people of our country if we do not ensure that the delivery of health services takes into account increasing changes in medical technology. Those changes will mean decisions being taken that are, at least initially, unpopular. I presume to speak only for my own bailiwick and not for other parts of the country. I want to give Barnet health authority's members and the Wellhouse NHS trust a public accolade—they have received precious few tributes from anyone else—for having the courage to go for this new form of health delivery. I also pay tribute to the former regional health authority and to the former Secretary of State for agreeing to the plan.
The safest political option is always to leave things as they are, with a little more money all round for every part of the health service. We ought to be more sophisticated 67 than that. Next month, phase 1A of the redevelopment of Barnet general hospital opens, with an enlarged state-of-the-art A and E department and new maternity, gynaecological and obstetrics wards. I am even told that it has the largest day surgery unit of any hospital in Europe.
Phase 1B is to go ahead shortly; I hope for an announcement in the near future. I pay tribute to my right hon. Friend the Secretary of State and urge him to make that announcement as soon as possible and certainly no later than the new phase 1A opens next month.
§ Mr. Jon Trickett (Hemsworth)
Listening carefully to the hon. Member for Chipping Barnet (Sir S. Chapman), I had the impression of a national health service being painted in rosy hues in the abstract, but whenever he moved from the abstract, or national, level to local examples, he seemed to reveal problems in his local health service. I want to deal with the particular this evening, not the abstract. I should like to describe some of the issues surrounding the health service in Wakefield district in my constituency.
The health service in Wakefield is in a state of crisis. The Secretary of State has said that we are bitching, carping and being negative in these debates. I say that we are describing reality. I want to describe what actually happens in Wakefield, not to paint an ideological picture of the NHS.
Incidentally, I pay tribute to the many practitioners in the health service who are struggling to do their best, often with great dedication and always with enthusiasm and commitment to the health service and to the principles of patient care. They work within a complex structure and must manage a difficult financial regime.
The information that I shall present to the House has been provided to me by practitioners in the local health service. It will therefore give an accurate picture as presented to me by administrators and clinicians, rather than a gloss that a politician might wish to put on the local health service.
According to the director of finance of the local health authority, the health service in the Wakefield area is facing a £5.8 million shortfall in funding. Such a figure is easily said, but the cuts that will have to be made in the next year will impact directly on the levels of patient care that my constituents and those of other hon. Members will have to put up with.
We have already heard about the effects of the iniquitous formula by which NHS money is distributed across the country. I shall spend some time describing how inequitably one element in the formula operates. I refer to the market forces factor—MFF—built into the formula whereby money is distributed across the nation. Hon. Members know the background to the MFF, so I shall not go into that. I shall concentrate instead on the impact of the MFF on Wakefield which, as I said, already faces a shortfall of almost £6 million in the next financial year.
I read from a letter sent to me by the chief executive of Wakefield health authority, who states that the impact in Wakefield will be significant,in that if the Market Forces Factor did not exist the funding arrangements to Wakefield would see its target allocation increase by approximately £7m, which would put us below target rather than 3.34 per cent. above target.68 Wakefield has the second lowest MFF in the NHS—only that of Rotherham is lower. If one compares the MFF of Wakefield with that of the Westminster and the Kensington and Chelsea health authorities, the result is remarkable: those London health authorities receive 25 per cent. more than Wakefield. The explanation is that the MFF is calculated on the assumption that Wakefield is a low-wage economy. The health service in Wakefield is penalised through the sum that the formula allocates to the area, because our wages are supposedly so much lower than those of the Westminster and the Kensington and Chelsea health authorities.
According to the director of finance for Wakefield health authority, the MFFis calculated largely based on the fact that Wakefield has a low wage economy and should therefore be able to pay NHS staff at lower rates than elsewhere.The director of finance goes on to point out that it is not possible to reduce local pay rates until a system of local pay bargaining is fully implemented. At that point, it might be possible to adjust relative pay rates. At present, 90 per cent. of staff in the health service are paid according to nationally negotiated conditions. The wages of the remaining 10 per cent. are the only element that local health service managers can manipulate in order to secure the differential that they are supposed to introduce in their funding.
I consider it an obscenity to suggest that a nurse, doctor, cleaner or administrator who is doing precisely the same job in almost identical conditions in Wakefield as in Westminster should be paid less. If we reflect on that for a moment, we shall see the immorality of introducing market forces arguments into NHS funding arrangements. Even if one accepts that, which I do not, it is impossible for the local health service to achieve the required reductions, given the fact that staff wages and conditions are negotiated nationally.
As a consequence, the health service in Wakefield has been given a target allocation some £5 million less than the allocation that it ought to receive in the next financial year. On top of the £6 million-worth of cuts that it is expected to make, the health service faces the objective of a £5 million reduction in funding.
In addition to suffering the inequities of the funding formula, Wakefield has been at the forefront—it has almost been used as an experiment—of other health reforms pioneered by the Government, which have had a serious and deleterious effect on the health service in our area. I refer in particular to fundholding practices. Until recently, the Wakefield district had twice the national average number of GP fundholders. Now we have reached 100 per cent: every single GP in the Wakefield district is a fundholder.
I am not opposed to the idea that GPs should have a leading role in determining the general pattern and structure of the health service. What worries me is that the extent to which fundholding has been introduced in Wakefield has resulted in an unplanned and non-strategic approach to health care provision. We are witnessing the emergence of small hospitals that carry out operations and provide other services that would normally be provided by the two general hospitals at Pinderfields and Pontefract.
Work is increasingly being taken away from the two general hospitals and provided in local hospitals established by GP fundholders. In my constituency, 69 a GP practice that is really a small hospital employs almost 100 staff. It purchases specialist and consultant care outwith the district. Consequently, the funding of the two general hospitals is being cut away, almost like a salami being sliced. The money available to the two hospitals is being reduced.
Anecdotes are passed round the district. Patients tell me that they have experience of GP fundholders sending patients by taxi from my constituency as far as Rochdale, for minor operations. A patient told me that he was sent by taxi to Manchester airport by a GP fundholder and flown to Glasgow for a relatively minor operation. The local general hospitals, which already face serious problems as a result of the underfunding of the local health service, face additional financial problems.
I am aware of GP fundholders in my constituency who are not only building small hospitals, but developing leisure centres with swimming pools and leisure activities, using the surpluses generated by savings in health care provision to local patients. Apart from the fact that patients are being taken away, so income to the local hospitals is being lost, I am worried that in the long term, that will affect local health care provision.
Today, an orthopaedic specialist told me that his local GP fundholding practice had acquired its own X-ray machines. Those X-ray machines were then serviced by consultants who had been brought in from outwith the district. When they looked at the X-ray machines, they found that they were inadequate for diagnostic work and therefore for the requirements of both consultants and patients. The orthopaedic and other consultants whom I met this morning told me to say that they are worried sick about the future of the health service in the Wakefield area.
It is clear from all that that the two general hospitals, Pontefract and Pinderfields, are under great financial stress as a result of both the formula, which is unfair to Wakefield, and the ridiculous experiments in relation to GP fundholding. The number of beds in our area has declined almost cataclysmically. In the Northern and Yorkshire region, the number of general and acute beds has declined by 20 per cent. As a result of that and of other processes, an increasing number of patients are suffering the anxiety of being taken almost to the operating theatre and then having their operation cancelled. In the last quarter, almost 2,000 patients in the Northern and Yorkshire area suffered the difficult and traumatic indignity of having their operation cancelled at the last moment. In the Wakefield area alone, more than 350 patients in the past year have had that experience. The hospitals in the Wakefield area are under siege because of a financial regime that declines year on year, an inequitable and unfair formula and the fact that the fundholding experiment has been taken to an extreme in our district.
For all those reasons, the rosy picture painted earlier is ridiculous when we look at what is happening in practice in areas such as mine. It is hardly surprising that almost one in two adults resident in my constituency signed a petition, which I presented in the Chamber a few weeks ago, opposing further changes in the health service. Almost one in four adults in the whole of Wakefield signed that petition. I could have predicted that, within days—not even weeks—the Secretary of State would 70 reject the advice of tens of thousands of the constituents of hon. Members from the Wakefield district and decide to proceed with his proposals to merge the two hospitals.
If I am carping or being negative, I plead guilty. I believe that I am accurately describing the position in my area.
§ Mr. William O'Brien (Normanton)
My hon. Friend and I share the same health authority area, and Pinderfields hospital, to which he referred, is in my constituency. Today, we had a meeting to consider the merger between the two trusts. I am sure that my hon. Friend will agree that we must ensure that the services and resources that are needed for the Wakefield area are made available now that there is to be one trust. The deficit of both hospitals and the area health authority, and the surpluses that apply to the GP fundholders, should be merged so that we have unity of provision in both primary and acute care in the Wakefield area. That is the point that my hon. Friend is making. It is significant and important, and I hope that the Minister will take note.
§ Mr. Trickett
I thank my hon. Friend for making some telling points about the position in our area.
We live in a complex geographical area with a large number of small townships and village communities spread over a large area. At the moment, health services are provided at both ends of the district. We fear that, because of the cutting process in our area and the downward pressure on finances, as a result of the formula and aggregate expenditure on the health service throughout the nation, we shall end up with a single hospital. Just one hospital in any part of our district cannot serve the whole of our community because of the geographical character of the district, its infrastructure and transport services. We therefore resisted the proposal to unify the health service management, because we believe that the next step is unification of the hospitals and the closure of one or other of them.
All those views are shared perceptively by the overwhelming majority of the fellow citizens in our district, as was shown by the petition that I presented.
§ Mr. David Congdon (Croydon, North-East)
I welcome this further opportunity to debate the health service because there is no doubt that the public regard it as the jewel in the crown of public services. The NHS has a good tradition, since its foundation in 1948, of meeting the rising expectations of the public and the demands placed on it.
Why do I say that the health service is a success story? The success is not entirely due to the NHS, but a large part is. Life expectancy has risen—even over the past 18 years, it has increased by a further two years—and, even more important, infant mortality has been halved, but one would not get that impression as a result of listening to some hon. Members' speeches. I argue strongly that the NHS has been and will continue to be a success story.
The NHS has been a success story because of the dedication of its staff and the resources that have been committed to it. Resources have risen by 3 per cent. a year since 1979, in sharp contrast to the period of the last Labour 71 Government, 1974 to 1979. We now spend £43 billion a year on the NHS—£80,000 a minute or £31 million during this debate.
The sums are large in anybody's language and the key is to ensure that they are well and properly spent. I remind anybody who does not believe that that is the issue of what, as long ago as 1953, the Guillebaud committee stated:If the test of adequacy were that the Service should be able to meet every demand which is justifiable on medical grounds, then the Service is clearly inadequate now, and very considerable additional expenditure would be required to make it so … In the absence of an objective and obtainable standard of adequacy"—in other words, what does "adequacy" actually mean?—the aim must be to provide the best Service possible within the limits of the available resources".The resources devoted, rightly and properly, to the NHS have been increased every year—by 75 per cent. in real term since 1979—and, whenever the general election comes, the next Conservative Government are firmly committed to increasing that funding every year in real terms.
As my hon. Friend the Member for Chipping Barnet (Sir S. Chapman) properly reminded the House, health expenditure has risen from 4.7 per cent. of gross domestic product in 1979 to 5.8 per cent. of GDP in 1995–96. That is a significant increase.
Another reason why the public regard the NHS as crucial is that it is there when it is needed. They know that if they are ill, if an emergency occurs, or if they are in an accident, they will receive the best possible care. Even more crucially, the NHS is free at the point of use. If people are knocked down, or have a stroke or heart attack, they know that they will be cared for and will not be presented with a bill afterwards.
It is not and never has been the Conservative party's intention to privatise the NHS. One of the most depressing parts of debates on the NHS for a long time is the continuing attempt—particularly just before a general election, for some reason—to allege that there is a hidden plan to privatise it. If there is—I know that there is not—it has been pretty well hidden for the past 18 years, and especially during the past five years when we have significantly increased NHS expenditure.
The Opposition's motion alleges thatthe National Health Service is not safe in this Government's hands.I would argue categorically that, looking at the record, it is clearly safe in this Government's hands; but looking at the contrasting record of Labour-controlled local authorities on community care, which is an important part of the NHS, it is certainly not safe in Labour's hands.
§ Mr. Couchman
Does my hon. Friend remember the mismanagement of the health service in 1978–79? Does he remember the Labour Government, propped up by the Liberal party, abrogating their responsibility to trade union shop stewards?
§ Mr. Congdon
Yes I do. People were being turned away from hospitals by pickets, who were determining 72 whether someone should receive care. We never want to return to that situation, and my hon. Friend is quite right to remind us of it.
Having said that the NHS provides an excellent service and is safe in our hands, I recognise that it faces great pressures. That is one reason why the Secretary of State allocated an extra £100 million to deal with bed blocking and for intensive care facilities. Why does the NHS experience great pressure? The answer is obvious: advances in medical science have led to cures that were not available 10 or 15 years ago. More people have heart transplants or bypass operations now. That is a great success.
Demographic change has put great pressure on the NHS. The number of people aged 85 and over increased by nearly 50 per cent. between 1986 and 1996. The NHS dealt very well with the enormous extra pressure that that put on it. We all know that, as people get older, they use more health care. The hon. Member for Hemsworth (Mr. Trickett) mentioned the funding formula, but it is designed to take into account the fact that the elderly put more demands on the health service.
The Secretary of State's document, "The NHS—A Service with Ambitions," which was published recently, made it clear that we are over the period of greatest growth in the number of over-85s. Over the next decade-1996 to 2006—the increase will be only 12 per cent. Just in case hon. Members think the percentages confusing, in absolute terms there was a 300,000 increase in the number of over-85s in the decade just finished, and the increase will be 110,000 in the coming decade. That is an important point. I would argue categorically that the NHS can and will cope with the demands that will be placed on it over the next decade and further into the future.
Not enough research has been done on this, but there has been a significant increase in the number of emergency admissions. A number of reasons are given, but there is no firm conclusion. At my local district general hospital, the Mayday Healthcare NHS trust, during December, there was an 18 per cent. increase in the number of emergency admissions. That is a lot to cope with. Despite the planning in many hospitals to bring forward elective surgery, which we heard about earlier, it is difficult to cope with demand.
My hon. Friend the Member for Chipping Barnet talked about the number of patients being treated, which has gone up greatly. I draw the House's attention to some figures about specific operations. Compared with 1990–91, there has been a 70 per cent. increase in the number of heart bypass operations, to 22,000. The number of cataract operations has increased by 54 per cent., to 152,000. Hip replacements are up 26 per cent., to 62,000.
All that has been achieved because extra resources have been devoted to the health service, but perhaps as significant is the fact that it has been achieved with a significant decrease in the number of beds. We have not had to increase the number of beds to cater for more people, because the average length of stay has decreased by 60 per cent. since 1970. As we know, a large number of operations—up to 60 or 70 per cent. in many hospitals—are now carried out as day surgery. That is why more people can be treated in a reduced number of beds.
§ Mr. Simon Hughes
The hon. Gentleman is, as always, making a thoughtful speech. He knows the subject well, 73 but he has avoided the earlier question, which I now put directly to him. He said that the level of funding for the health service should depend on the amount of resources available. There is another question that any Government or politician should answer: what is the minimum adequate level of health service provision? Does he accept that that question needs to be answered—whether it is expressed as the number of beds or the number of people being treated? One cannot just say that it all depends on resources, otherwise resources could be cut to 2 per cent. and that would be the answer to the question.
§ Mr. Congdon
I did not intend to create that impression, although I readily concede that it is very difficult to say what is adequate. There are various measures. It would be possible to look at waiting lists, which we touched on earlier. The average waiting time has come down from nine months to about four. That is a significant improvement. If people—particularly those who need, say, a hip replacement—have to wait nine months, a year, or even longer, that is too long, so for them the service would be inadequate.
I start from the assumption that we are spending a certain amount today. As additional resources become available because of growth in the economy, it is absolutely right and proper to devote additional resources, in real terms, to the NHS. That is why I warmly welcome the Government's commitment to continue to increase resources year on year. The percentage should reflect the adequacy of the service, the pressures that are known to be on the service, and the resources that are available. It is obviously important, therefore, that the economy is run well, as it is today—with falling unemployment and the like—to ensure that we have the resources to devote to the NHS.
Before fundholding was introduced, the criticism was that, if they were given a budget, fundholding GPs would deny treatment to some patients because they would use up too much of their budget and that there was a financial incentive so to do. That was the original scare.
Fundholding has come in; by 1 April, 60 per cent. of the population will be covered by fundholding GPs. We now hear the opposite allegation: that, by using their money better than health authorities, GPs are buying an improved service for their patients. I have always had a simplistic response, for which I make no apology. The challenge is to ensure that all patients receive the same benefits as patients of fundholders; the easiest way to do that is for all doctors to become fundholding GPs.
The Labour party has made great play of local commissioning, but there is great fear among fundholding GPs that local commissioning will be only a talking shop and that the real power will remain with consultants in hospitals. Fundholders value fundholding so highly because it gives them the leverage to put pressure on the system to improve. The key is to try to avoid a stagnant system; to try to ensure that a part of it leads to improvement. Fundholders have been leading that improvement.
I shall say a few words about the reformed health service. At the last general election, it was quite easy to spread all sorts of scare stories about how ineffective the reformed system would be. There was much rhetoric that was not quite in line with what we now know the service is delivering. I argue strongly that the key part of the 74 health service reforms, over and above the issue of fundholding GPs, is the role of the health authorities. They play a key role in determining the health needs of their population and ensuring that they buy care to meet those needs.
Most health authorities have found it quite hard to meet those new responsibilities. They have had to negotiate, which they had not had to do before. They have had to produce contracts, a procedure that they had not engaged in before. Some of them are so immersed in doing that that they have not been able to concentrate enough on the real indicators of health in their communities and on buying the appropriate care.
I shall not be satisfied until I can see exactly what is being bought in Croydon, Bromley, Barnet or anywhere else for, let us say, the elderly in terms of hip replacements—an important operation that improves people's mobility and reduces pain. I defy hon. Members to ascertain from the purchasing plans of their health authorities how many such operations they are buying. The figure will probably be submerged in a much broader heading that may have a financial tag but no details about what is being bought.
The Health Committee is examining children's health. Purchasing plans should contain figures showing what sort of care and mental health service are being bought for children. The challenge is to ensure that health authorities can get to grips with those issues and buy the appropriate amount of care in conjunction with fundholders.
Much nonsense has been spoken about the purchaser-provider split. It has been said that it is a vicious, competitive market in which hospitals bid against each other and that it is designed to do them out of business. That is too crude an assessment of what in practice is much more a managed market. The reason for the purchaser-provider split is simply to try to bring pressure to bear on those parts of the NHS that are failing to deliver good quality care and good value for money. There should be dialogue between the purchaser and the provider about improving what they offer, otherwise the old practices will continue. The service certainly needed managing and it is important that purchasers and providers co-operate and work in partnership. That is the key.
The next matter with which I shall deal is even more important than organisation; clinical effectiveness. What do hospitals deliver? How do they deliver it? Do they deliver it well? Does the patient stand a better chance of surviving in hospital A, B or C? This is a controversial issue. Are the surgeons and consultants in a particular hospital up to date with modern practices, or are they out of date and therefore carrying out inappropriate procedures? The Select Committee inquired into resource allocation and purchasing in these areas and what came through loud and clear was that variations in the quality of care and in the number of procedures carried out are such that they would lead anyone to conclude that more work needs to be done on clinical effectiveness. I am encouraged by the fact that doctors are now taking the lead on that issue. In the past, managers said, "You must improve. Why do you take 10 days on a procedure when other hospitals can do it in two?" Now, doctors are asking such questions.
75 The Select Committee inquired into tonsillectomy and grommets. I asked a parliamentary question on tonsillectomy. I understand that, in the past 30 years, the number of such operations has reduced, but I was surprised by the answer to my question—that tonsillectomies have increased in the past five years. Perhaps in the interests of clinical effectiveness, that should be examined further.
Much good work is being led by the chief medical officer. The famous Calman report into cancers showed that if a surgeon saw only a few patients with a certain type of cancer each year, the outcome for his patients was not good. It is important to have cancer units of a size that enables doctors to see enough patients to keep their experience up to date and ensure quality care.
I spoke about local authorities failing in their responsibilities on community care. This is a serious issue. Local authorities clamoured loudly to have such responsibilities and they have borne them as badly as possible by insisting on buying places in their own facilities, keeping them full and deliberately avoiding sending clients who need residential care into the private sector. It is absurd that people who would be better off in residential care are given expensive intensive domiciliary care. If people want that it is a different matter, but I suspect that many would prefer to go into residential care, although that is not appropriate for everyone. The authorities must get their act together.
§ Mr. Andrew Miller (Ellesmere Port and Neston)
The hon. Gentleman mentions inefficient local authorities. Why is Conservative-controlled Cheshire deeply bitter about the Government's funding of social services? It has enormous problems in meeting statutory obligations. How is it to make progress in the current financial situation?
§ Mr. Congdon
I do not know, but it is clear that local authorities could save between £400 million and £700 million a year by transferring their homes as going concerns to the private, voluntary sector—but they will not do that because of dogma. If they did, the money that would be released could pay for more places in the private sector or on domiciliary care, depending on clients' needs, which would result in better service. That is the challenge facing local authorities.
§ Mr. Couchman
Did my hon. Friend see the report in The Daily Telegraph on Tuesday which stated that, in 1994–95, the average charge for an elderly person in a council residential home was £283 a week, compared with an average of £246 a week in the private sector, and that that gap has widened?
§ Mr. Congdon
I saw that report. It is staggering that those figures were for 1994–95. The difference is so enormous as to be almost unbelievable. My hon. Friend is right to say that the gap is undoubtedly widening. It is ironic 76 that local authorities say that they are short of funds, but are prepared to spend a great deal on upgrading their homes rather than pass the care responsibility to the private, voluntary sector.
The hon. Member for Hemsworth spoke about the funding formula, which is an important means of distributing funds on the basis of need. The Health Committee conducted a detailed investigation into the matter and, although there will always be arguments about where the improvements should be, there have been further improvements to the formula. I welcome the Secretary of State's commitment further to improve the formula and to target it better. There is always room for improvement, but I think that the formula is heading in the right direction.
It is significant that Labour has nothing to offer the people on the national health service. All I have gleaned from Labour is that it will destroy fundholding, which is one part of the reforms that is working well. I am not sure who that will benefit. No one knows how commissioning will work and the Opposition have many questions to answer about why they want to destroy fundholding. It is a success. Why not build on it? The Conservative party has run the NHS for most of the 50 years of its existence and has a good record on it. I hope that, after the election, Conservatives will still be running it—into the next millennium and doing as well in the next century as it has in this.
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
I shall raise some health service issues that are of interest in my constituency. I should like to address two aspects of our motion: the continuing deterioration of the national health service, especially as it relates to acute services, and the highest ever number of people awaiting treatment.
Debates on the NHS are usually pretty bad tempered, and show clear differences between the two sides, as Conservative Members defend the treatment that the Government have meted out to the health service in the past 18 years, and we raise the concerns of our constituents about the treatment that they have received from the health service. The contributions of the right hon. Member for Wealden (Sir G. Johnson Smith) and the hon. Members for Chipping Barnet (Sir S. Chapman) and for Croydon, North-East (Mr. Congdon) were thoughtful, and I do not disagree with much of what was said. I particularly enjoyed the speech of the hon. Member for Chipping Barnet, because he is obviously concerned about the closure of the accident and emergency department of the hospital in his constituency, and the effect that will have on his constituents. I am not sure whether he is retiring at the next election: I hope that he is staying on.
§ The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns)
No, he is not retiring.
§ Mrs. Kennedy
He is staying on. I beg the hon. Gentleman's pardon. Perhaps his electorate will retire him. He could learn a great deal from the experiences of my constituents with the closure of the accident and emergency unit at the Broadgreen hospital.
77 The Government's amendment repeatedly uses pious words. It says that the Government arecommitted toand express theirsupport for",and itwelcomes the Government's commitment to a growing budget".Why do the Government stress their commitment three times in a relatively short amendment to the motion? I believe that it is a fundamental question of trust. Do the British people believe what the Conservatives say about the health service? If they do not, does that mean that the Government have lost the public's confidence over their handling of the health service? I believe that, because of their experiences of health service treatment, and especially the experience of their elderly relatives, the public no longer have confidence in the Government and do not trust them with the NHS.
Patients in the accident and emergency department of the Royal Liverpool university hospital know that the health service is in crisis, because they are told regularly—not just in an isolated crisis—by nurses and medical staff that they must contact their Members of Parliament to effect a change. They know that it is an on-going crisis and not just momentary, and that the Government are failing to address it. Despite the thoughtfulness of the speeches of Conservative Members, they do their case no good if they dismiss our arguments and ignore the experiences of our constituents.
I have a tale of two hospitals. Part one is the story of Broadgreen hospital, which is now part of a merged trust. My hon. Friend the Member for Hemsworth (Mr. Trickett) expressed concern about merged trusts in the geographical area that serves his constituency. Broadgreen Hospital NHS trust was merged with the Royal Liverpool University Hospital NHS trust. At the time of the last general election, Broadgreen was a district general hospital and was directly managed by the health authority. In 1988, it was proud to announce the provision of 11 wards in the new Alexander wing, which were opened by Her Royal Highness Princess Alexandra. Now only six wards remain. That gives the House some idea of the effect of the health service reforms on my constituency.
Four NHS trusts operate on that hospital site: four different units managing independent health service trusts. That leads to chaos and bureaucracy, and it is visible to everyone who visits the site. What does it mean when wards are closed? When those five wards were closed, it was not just beds that were lost; teams of staff from each of those wards were disbanded, and posts were deleted from the establishment of medical and nursing staff.
It is to the great discredit of the current management that the decision just before Christmas to close a 20-bed ward in Broadgreen—this information has been widely published, so it is not new—was communicated to the staff on the ward at 3.30 pm on the Friday afternoon when the nurse in charge was on leave and was unaware that the decision was to be made. Nurses had to tell patients that they were to be transferred within the hour. I leave hon. Members to imagine the chaos. It greatly distressed the patients who were moved, and it caused their relatives great anxiety. An investigation was held and an apology given, but that does not change the fact that chaos was caused and we lost a further ward.
78 In 1988, that accident and emergency department was one of four directly managed units, as they were then called—the jargon has now changed—in the Merseyside region. In 1996, it was finally closed, despite fierce local opposition and fears that the remaining accident and emergency departments would be unable to cope. It is a pity that the hon. Member for Chipping Barnet is no longer present. My constituents were promised brand new, state-of-the-art accident and emergency departments at three other major hospitals across the region. We were assured over and again that they would be able to cope with patients who would previously have gone to Broadgreen, and that we had nothing to fear.
One improvement that followed the closure of that accident and emergency unit was the introduction of paramedics in ambulances. Merseyside was one of the first regions in the country to ensure that every ambulance that left the depot had a paramedic on board. The hon. Member for Chipping Barnet is right: that unquestionably reduces the number of deaths. Merseyside is to be applauded and congratulated.
We were also promised that alongside the closure of the accident and emergency unit at Broadgreen would be improvements in primary care. New primary treatment units were developed, one of which was close to the hospital. They were designed to deal with what we would parochially call the walking wounded—people who were not seriously ill but needed urgent medical treatment, and could face lengthy delays in the big accident and emergency departments. Those people could go to a primary treatment unit, where they would be treated by nurses and, if necessary, a GP would be on hand to examine a patient. Unfortunately, that experiment has not worked. Primary treatment units quickly changed their role, as patients continued to go to the major accident and emergency departments for the treatment of both major and minor injuries.
I said that this was a tale of two hospitals, and I now come to part two. The Royal Liverpool university hospital now has the long title of the Royal Liverpool university hospital, Liverpool and Broadgreen: it is two hospitals merged under one management unit. It is one of only eight teaching hospitals outside London, and is highly regarded within the medical profession: it leads the field in some specialties. A new accident and emergency department opened in August 1995. Shortly before it opened, the NHS trust issued a press release, which said:The Royal's newly extended unit, due to open at the end of next month, will be one of the largest and best equipped in Europe".It is strange how that echoes the words of the hon. Member for Chipping Barnet. The press release said that the unit would have80 nursing staff compared to the present complement of 50.10 senior and middle grade medical staff, one more than the current level.Six resuscitation bays with state-of-the-art equipment, including four with built-in x-ray.That is a superb facility. If I were critically ill and needed resuscitation, I would want to be taken straight to that unit, because I would receive the best treatment available in the north-west. It would have a 30-bed short-stay assessment unit, 13 major treatment cubicles, a large minor injuries unit capable of treating 100,000 new patients a year and staff accommodation, including bedrooms for on-call doctors so that fully qualified medical staff were available at all times.
79 As we were to have the biggest and best accident and emergency facilities in Europe, how is it that, just 18 months later, the BBC regional television news programme "Close Up North" presented a half-hour programme from that very accident and emergency department with nursing staff describing the conditions as "like Bosnia"?
On 6 January 1997, Liverpool health authority put out another press release:The Royal Liverpool and Broadgreen University Hospitals are currently facing considerable pressures resulting from an unprecedented increased number of patients who are presenting for admission. These problems have meant there are prolonged waiting times for admission to the hospital and also that some patients are having to be cared for in emergency designated patient areas.It then listed four measures taken early in January in an attempt to address the problems. Sadly, the Secretary of State has suggested that it is another case of BSE—blame somebody else—and that, if accident and emergency departments or hospitals are unable to cope, it must be because they are badly managed units or trusts.
The press release continued:All these measures have been implemented without an increase in the staff establishment and thus we recognise the great contribution that all our staff are making to the position. Nurses in the Training, Quality, Specialist Nursing and other departments have all volunteered to help in the care of emergency admissions.That is to be applauded, although the authority states that, as a consequence,courses may have to be temporarily suspended. Medical Staff have reconfigured on call duty and are particularly hard pressed and elective surgery remains deferred.Elective surgery had already been deferred for several months, and it remains deferred to date.
Shortly after that television programme, which was screened across the north-west of England, I received a letter from a member of staff at the Royal Liverpool hospital, who wrote:The recent publicity about the Royal Liverpool Hospital … featured on BBC North West has prompted me to speak up. I have worked for the last ten years at the hospital and I have never seen staff morale so low … There have always been patients having to wait for long periods in A & E. This is nothing new but the closure of the A & E at Broadgreen has made it much worse. Surely what has happened could have been predicted?It was predicted repeatedly, by medical staff, patients, the community health councils and others. The letter continued:I used to be proud to work at the hospital but no more. We are not providing safe patient care any more with patients being moved in the middle of the night because heir beds are needed.The letter ended with a challenge:The politicians need to call for an enquiry to expose and sort this mess out for the sake of the patients and the staff.The right hon. Member for Wealden described such comments as bitching. I took offence at that and raised the matter with him. He also referred to scaremongering. The hon. Member for Chipping Barnet said that one of his constituents had to wait an unacceptable time for admission to hospital.
If they were only isolated incidents, I would be more than happy to raise them on a case-by-case basis with the local trust, the local health authority and, if necessary, 80 in a particularly bad case, with the Minister concerned. Unfortunately, they are not isolated incidents. It is an on-going and regular problem. It is so serious that the outpost of the NHS executive in the North West region commissioned a report on accident and emergency units in the region. I quoted from the introduction earlier and I wish to quote some more of its findings, particularly as they relate to a matter that was raised by the hon. Member for Croydon, North-East—community care and moving patients into primary care beds.
In page 5 of his report to Alan Langlands on emergency care in the North West region, published last August, Robert Tinston found:A separate and independent pattern of emergency admissions could be observed".He was talking about patients with non-specific illnesses that were quite difficult to diagnose who might have to wait some time before their treatment could be determined. He continued:Increases are particularly high in Liverpool and Sefton but scarcely significant at all in Wirral, Manchester and Salford. The pattern appears to related to the interaction between NHS Primary and Secondary Care and the Social Services Department and independent continuing care providers.The report continued:Across the North West in December through to February 1995/96 approximately, 600 beds were blocked by people awaiting assessment and a nursing home place at any one time. Many Providers have stated that they expect this figure to increase in 1996/97, as they have indicated that certain Social Services have changed their eligibility criteria and/or their administrative arrangements in order to reduce their expenditure to stay within financial constraints.Here we go again. It is another case of "blame somebody else". This time, it is the fault of the inefficient, ineffective local authority which is deliberately going our of its way to use, in the words of the hon. Member for Croydon, North-East, "expensive" care provided by the local authority rather than the cheaper care provided by the unit. In my experience, that is not the case. It may be that the hon. Gentleman can quote examples, but I can quote back at him cases where local authorities have made great efforts to make residential homes more efficient and effective and to reduce the unit costs without exploiting the nursing and domiciliary staff who provide care within a residential setting.
§ Mr. Congdon
I can quote two examples. The first was raised in an intervention by my hon. Friend the Member for Gillingham (Mr. Couchman), who quoted figures for 1994–95 showing a differential of £50 a week in favour of the private sector. Secondly, Kent university's public research unit has provided figures showing an average cost of some £410 a week for a place in a local authority home and, if my memory serves me right, about £220 a week in the private sector. It is a big differential. That is why I would argue that local authorities do not provide value for money. If that money were freed up, it could provide for more patients.
§ Mrs. Kennedy
The hon. Gentleman has made an interesting intervention. I listened carefully to the figures that he quoted and I will examine them after the debate. In my experience, however, the social services department in Liverpool effectively uses the independent and private sectors. One organisation, Take Care, provides a superb 81 level of care. The social services department does not take a dogmatic attitude, but there is a distinct lack of resources. The department cannot use the private and voluntary sectors more, because of Government underfunding.
Bed blocking is only one aspect of the crisis facing our areas. Robert Tinston went on to say:As hospitals have closed, they have been replaced with new facilities which recognise modern clinical advances … It is becoming increasingly clear that we have removed the bed stock capacity that used to cope with peaks of demand. We see this when we look at towns where rationalisation is yet to take place. They appear to cope for longer.He was talking about coping with what is described in the health service press release asan unprecedented increased number of patients who are presenting for admissionwith problems that were quite unexpected.
The hon. Member for Chipping Barnet should beware. If the rationalisation that took place at Broadgreen takes place in his constituency, his constituents will face the same lengthy waits in undignified and cluttered surroundings as my constituents have at the Royal hospital.
Dr. Tinston made suggestions in his report, some of which would certainly help. He concluded:I can give no absolute guarantee that, should pressures be as bad, or worse, than last year, that we would have radical, new and innovative measures in place to deal with them. These take some time to implement.As I have already said, the BBC report said that this year has been as bad as, if not worse than, last year.
Conservative Members claim to be spending more and more money year on year on the NHS, but such spending must be balanced against the constant reduction in funding of social services and community care through local authorities: one impacts on the other. It is the same old situation. The Government are taking from local authorities to spend on the NHS. Hospitals are not able to discharge patients into community care because of underfunding of social services. Patients are therefore staying in hospital while others are having to wait to be admitted because they cannot get a bed.
§ Mr. Burns
I am grateful to the hon. Gentleman for giving way. [Laughter.] Sorry, the hon. Lady. I do her a disservice. The hon. Lady seems to be suggesting that the Government have cut funding for community care. Nothing could be further from the truth. Money for community care has been increased year after year after year, like health service funding, so that, at the moment, it totals just under £6 billion a year.
§ Mrs. Kennedy
I am very interested in what the Minister has to say, but I must point out that that community care funding has to deal not only with an aging population but with patients coming out of mental institutions. I shall not go into the problems that we have seen in that area. Resources, particularly those relating to local authorities, are inadequate and have been cut. The Minister is referring to funding as it applies to the health service, but I am talking about funding coming through local government.
§ Mrs. Kennedy
I listen to what the Minister says. I will take that on board and look at it. If he is right, I shall come 82 back to him and talk to him further, because I would like to explore the issue. It is clear from Dr. Tinston's report on A and E services in the North West region that the problem is widespread. It is not isolated to Merseyside. We ought to return to the issue.
I turn to the subject of waiting lists, which is of particular interest to me. A calender of events was issued to directors of the Royal Liverpool and Broadgreen University Hospitals NHS trust in the last week of January. The national diary flagged up that it was expected that NHS waiting list statistics for England—resident based—for 1995–96 would be published on 3 February.
I received a copy of a memo from which my hon. Friend the Member for Islington, South and Finsbury has already quoted. I want to take the House back to it, because I believe that it gives the game away. My hon. Friend wrote to the Secretary of State enclosing a copy of the memo, and on 2 February The Independent on Sunday quoted not only the memo but other NHS trusts across England that had experienced similar, shall we say, manipulation of the figures.
The memo, which was compiled by the contracts and information department of the Royal trust, says:The Trust declared 12-month-plus waiters at the end of the second quarter of 1996–97",which would have been in September. It continues:The figures showed an accurate picture for Urology and for General Surgery … in the 12m, 13m and 14m categories"—only for patients of Liverpool health authority—and of other Health Authorities in the 12m category.But not all patients were declared. The memo says:Patients showing in the following categories were not declared in line with the regional request to keep figures as low as possible".Patients waiting longer than 12 months in the categories of orthopaedic, ophthalmology and ear, nose and throat specialties were not declared anywhere. Patients who had been given a date to go into hospital for treatment were also not declared.
I telephoned a number of trusts around the region and asked them about the average time they would ask the patient to wait having been given a date to come in—how long in advance were patients given. The average time was two weeks. We know that one of the trusts in Coventry was able last year to announce to a fanfare that it had reduced waiting lists to less than nine months, yet, on examination, it was discovered that it had simply issued a date to come in for all its patients who had waited for more than nine months and therefore removed them from the waiting list. That is a sleight of hand, a dishonesty, a distortion of the picture and one of the reasons why people have lost their confidence—if they ever had any—in the way in which the Conservative party manages the health service.
The memo goes on to say:The Region have indicated that the figure of 329 declared by the trust in November is very high and have suggested"—as my hon. Friend the Member for Islington, South and Finsbury quoted—a judicial elimination of the TCI patients.There can be no interpretation other than that the regional NHS executive was insisting that the managers of the Royal reduced the number on the waiting list simply by the sleight of hand of giving people a date on which to go into hospital.
83 The memo is very honest. It goes on to say:This elimination of patients with a TCI date is causing problems due to the frequent cancellation of elective work as a result of the bed situation … If the Trust accede to Region's request at this point it will face a greater problem in the future as the true position is likely to worsen substantially.The figures were not published on 3 February—surprisingly. They were published last week. What do we find? Provider units in the North West region have more patients waiting than any other region, and the latest quarter saw a rise of 4,280. That represents more than 25 per cent. of the national increase in that category and was the highest proportionate increase of all regions.
I asked the Secretary of State to confirm whether the figure of 299 waiters declared by the Royal was inclusive of all those waiting for treatment in the orthopaedic, ear nose and throat and ophthalmic specialities to which I referred. He did not answer me. He said that the figures were intended to be a proper statement of the facts. Since recent figures have been published, consultants have complained to Members of Parliament and contested the figures.
The facts have been doctored, manipulated, massaged, amputated—the list of medical metaphors continues. In the words of the memo, there is no doubt that the figures have been subject to "judicious elimination". That calls into question the entire basis of the Government's case.
I echo the call of the member of staff to whom I referred for an inquiry into what has been going on at the Royal Liverpool university hospital, and especially the accident and emergency department. That could be conducted under the aegis of the community health councillors, who are highly regarded locally.
When I visited the cardiothoracic centre in Liverpool, another truth about waiting lists came out. Medical staff are required by the Government's rules to offer treatment to patients based not on clinical need but on who is at the top of the most pressing waiting list, and GP fundholders' patients take priority over other patients.
A great defence has been made of GP fundholding, but because GP fundholders' patients take precedence, the other patients have to wait unacceptably long for treatment. I therefore warmly welcome our proposals to restore GP services by the extension of commissioning. A commissioning pilot in my constituency has been strongly supported by the participating GPs.
The Secretary of State quoted Aneurin Bevan as saying that GPs were to be the gateholders to NHS services. The chair of the local medical committee in Liverpool, Dr. Rob Barnet, said to me that, if we were not careful, hospital services in the future would be on the basis of emergency admission only and that elective work would increasingly be required to be carried out by the private sector.
Real people are affected by the matters that we have been debating. I refer to the case of Mr. James Hartless, who first came to me when he was 73, two years ago. He has been a patient of the cardiothoracic centre in Liverpool for 10 years. He went into the accident and emergency department at the Royal on 18 April 1996. A letter of apology from the department said:it is entirely unacceptable that Mr Hartless arrived in the department at 09.30 hours, to be seen and assessed by the Accident and Emergency Senior House Officer within thirty minutes, and then 84 to wait until almost 18.00 hours before being admitted to a ward. On the day in question, the Accident and Emergency Department was extremely busy. On this day the department was so full that every cubicle and trolley space in the Resuscitation Room and on Majors was blocked, and every bed in the Observation Ward and the overflow area was full, and patients were waiting on trolleys in the corridor.That was not an isolated incident in the middle of winter, with beds blocked by patients with pneumonia: it was in April. The same patient presented at the A and E on three separate occasions in the run-up to July and waited for a combined period of 18 hours for bed space and treatment.
In a letter of 20 September, Mrs. Hartless said:We waited 32½ hours for the Doctor to come back to us to tell us the results. This poor Doctor was away somewhere else, that busy, thus resulting in these long hours on a trolley. This is not a complaint but … morale is so low that it has to be seen … So this is the year of 1996, and I fear for the future.Sorry about this moan, but I thought I would let you know. Here we take each day as it comes, anxiety is at its peak, but most of all it is my husband's care that is paramount.Would that Conservative Members thought the same. If patient care is paramount, it is not acceptable for them to dismiss the experiences of patients such as my constituent as mere scaremongering or bitching. That is not the case. We are talking about real people who have experienced real problems with the health service, and it is to Conservative Members' discredit that they dismiss them out of hand.
§ Mr. James Couchman (Gillingham)
I trust that the hon. Member for Liverpool, Broadgreen (Mrs. Kennedy) will forgive me if I do not follow very closely her 35 minutes of anecdote from Liverpool.
My hon. Friend the Member for Chipping Barnet (Sir S. Chapman) nudged me with his comments about the new complaints procedure following the citizens charter. I should declare that my wife has been appointed one of the lay chairs for complaints—an unremunerated position—and has held that post for a year.
I was also prompted by the account from my right hon. Friend the Secretary of State of how many substantial capital projects are in the pipeline under the private finance initiative. I should mention that the last major national health service scheme that got under the wire under the old capital financing method was a £60 million scheme for the hospital in my constituency, to give us the up-to-date modern 650-bed hospital that we deserve in the Medway towns and which will replace a lot of very outdated, old and worn-out facilities. Construction has been in progress for some months, and we expect to get the new facilities stage by stage over the coming months; we shall be extremely grateful for them.
I want to draw the attention of the House to a sector of health care that receives all too little notice here and on which the policies of the Labour party remain virtually unchanged. I refer to the private sector, which is resourced principally from private medical insurance and has a beneficial impact on the national health service. That sector is under threat from outside financial factors, but also from the Labour party.
Before Opposition Members make the usual cracks from a sedentary position, let me say that I have never paid a medical insurance premium for myself, my wife or 85 my children. The only private care that any of us receives is my dental treatment. We are, and always have been, NHS patients, believing in the NHS and cherishing the excellent care that we have had from it. Moreover, in view of my diabetes and my wife's very serious episodes of cancer, it seems unlikely that any medical insurer would take us on except at a heavily loaded premium or with substantial exclusions of disease, or both.
Our situation is not irrelevant to what I want to say. I and my family do not, and almost certainly never will, pay medical insurance, but I would go to the wire to defend the rights of those who want to pay premiums in order, as they see it, to receive prompt treatment, to avoid NHS waiting times for non-urgent elective surgery and to be operated on by the consultant of their choice in comfortable hospital accommodation. I am certain that such people, having paid through tax and national insurance their contributions to the NHS, are making a substantial further contribution by paying medical insurance in order to receive treatment outside the NHS or in NHS private hospital wings. They free up NHS resources, to which they would be entitled, for others such as myself who remain fully NHS patients.
Towards the end of the 1980s, the number of people covered by medical insurance is estimated to have reached between 6.6 million and 7.5 million. Those two figures were published in articles in The Daily Telegraph on Friday and Saturday last week, and The Sunday Times yesterday inclined to the higher figure. Private medical insurance had become a popular feature of many employers' remuneration packages. Indeed, employer schemes probably account for 60 per cent. of all who have cover.
The Government's imaginative decision in the Finance Act 1989 to allow tax relief on medical, though not dental, insurance for those over 60, and for the spouses of those over 60 even if they are not 60 themselves, helped to soften the twin blows of premiums rising with age and having to take over the payment of premiums from company schemes on retirement.
Since 1990, however, the number covered by private health insurance has fallen sharply, to £5.7 million in 1995—a drop of between 1 million and 2 million from the peak. Doubtless there is more than one reason for that, but the core reason is almost certainly sharply rising premiums for benefits that have risen more slowly or even been frozen. Premiums on average are likely to rise by a further 18 per cent. this year, and for elderly subscribers by much more—perhaps as much as 40 per cent. Those increases will be exacerbated by the increase in insurance premium tax from 2.5 per cent. to 4 per cent. in April. That apparently small increase dictated by the Government, however, is as nothing next to the threat by a putative Labour Government to abolish tax relief on premiums paid by the over-60s. If that abolition of tax relief takes place, premiums for the over-60s will increase at a stroke by 30 per cent.—if the relief is lost at the basic rate of 23 per cent.—and for no additional benefit. It is not easy to quantify the figures in pounds and pence because premiums vary so widely between the major providers. Individual providers now offer a range of products, from simple in-patient-only benefits to policies that give generous cover for out-patient and in-patient treatment, even including mental illness.
86 The number of people covered by medical insurance has fallen, but the amount paid out has risen inexorably. The people who have stopped paying are the relatively younger and healthier subscribers. Those who remain in subscription are the older and less well, who are more likely to claim. Mr. Julian Stainton of the Western Provident Association said this weekend:Private medical insurance is becoming a product that only rich, relatively ill people can afford.He foresees a tightening of the vicious circle, with higher premiums for fewer people, unless steps are taken to break the circle by constraining premiums and attracting back the younger and healthier into subscription.
We should not underestimate the consequences to the NHS of the collapse in the numbers of private subscribers. One in five of all non-urgent operations are now carried out in private hospitals—many are purchased under NHS procedures—and the range of surgery available is much wider than it used to be. The list is no longer made up of varicose veins and hernia repairs. One in five heart bypass operations and one in three hip replacements take place in a private hospital.
It is not difficult to see what a vital contribution private health care under private medical insurance and in private hospitals is making to restrain NHS waiting lists and costs, especially for the late middle aged and elderly. The danger of a further erosion in private medical insurance subscription by the over-60s, catalysed by the withdrawal by Labour of tax relief on premiums, is all too obvious. Hundreds of thousands of patients would be thrown back on to the NHS's already stretched resources. Private patients also pay for drugs and medication, and many of the patients most likely to cease being private patients would be exempt from prescription charges and entitled to free medicine.
In efforts to constrain costs and increase the customer base, providers are trying to offer lower cost packages. One of the key factors is the right of the provider to direct private patients to particular hospitals, but only if the patient would wait longer than six weeks for NHS treatment. The fact that eight out of 10 insurance claims are for less than £500 and nine out of 10 are for less than £1,000—combined with the new restrictive lower cost and lower benefit policies—may act as a further deterrent to private medical insurance subscription. I anticipate that as many as 30 to 50 of the 220 private hospitals could be forced to close. That might appeal to some of the ideologues on the Labour Benches, but it would mean a reduction in the amount of health care available in the United Kingdom.
The present serious decline in private medical insurance subscription could escalate into a full-blown crisis that would have enormous consequences for NHS resources. It is difficult to put a cash figure on such a catastrophe, but hundreds of millions of pounds, perhaps even £1 billion, could be involved. That is close to next year's increase for the whole of the NHS. The spiteful withdrawal of tax relief on medical insurance premiums, on ideological grounds, by a Labour Government exhibiting all the qualities of old Labour is just the catalyst that would bring huge additional costs to the NHS through the defection of subscribers from private medical insurance.
The situation is reminiscent of 1974 when the Labour Secretary of State for Health, Barbara Castle, waged war on private medicine. She managed a unique achievement 87 in NHS staff relations—simultaneous industrial action by every grade of NHS staff from consultant to porter. I remember attending the opening of my local hospital as a new member of the area health authority in Sidcup. Mrs. Castle made her speech to a totally empty room, because the opening had been boycotted by every member of staff of that hospital.
The mischief wrought on the health service by Mrs. Castle was merely the overture to the shambles over which her successor, David Ennals, presided later during the time the Labour Government were propped up by the Liberals. The House has often been reminded of the appalling circumstances of the winter of discontent, when the Lib-Lab Government abrogated their responsibility to extremist trade union shop stewards who assumed for themselves the power to decide who should be treated.
We heard the usual mixture of cant and shroud-waving today from the hon. Member for Islington, South and Finsbury (Mr. Smith). Those of us who were members of health authorities or held office in local government—as I did, as a chairman of social services—during Labour's time in Government from 1974–79 remember all too well the winter of discontent and the spectacular mismanagement of the health service. We doubt that the Labour party has learnt anything from the experience of 1978–79. The sinister emergence of Unison on television and billboards in the past two days has reinforced our memory of the havoc created by Unison's predecessor, the National Union of Public Employees, during the industrial action of the winter of discontent. The prospect of Unison pulling the strings of a Labour Secretary of State for Health should send shivers down the back of every patient.
The hon. Member for Islington, South and Finsbury talked at length about waiting lists. What contribution does he think that the abolition of tax relief on private medical insurance premiums for the over-60s would make to shortening waiting times? Several hundreds of thousands of middle-aged and elderly, relatively ill patients would abandon private health care and return to the NHS. That would lead to an explosion of waiting lists, and waiting times would lengthen.
As I said earlier, my family and I are NHS patients. We always have been and probably always will be, but we believe that those who effectively pay twice for their health care help NHS patients to receive treatment sooner. The 5.7 million people still paying for private medical insurance should be encouraged to do so. NHS resources would not then have to be diverted to look after those who would prefer to continue their contribution but could not afford to do so if their premiums rocketed because of unnecessary burdens such as the withdrawal of tax relief.
I hope that the hon. Member for Monklands, West (Mr. Clarke), when he winds up, will say whether Labour is still determined to cripple private health insurance for the over-60s—the very group of patients most likely to make heavy demands on their health care provider, whether private or NHS. I also look forward to hearing my hon. Friend the Minister for Social Security and Disabled People reassure the House that the Government have no plans to abolish the tax relief that was introduced in the Finance Act 1989.
§ 8.7 pm
§ Rev. Martin Smyth (Belfast, South)
I understand the points made by the hon. Member for Gillingham (Mr. Couchman) about help for private health care although I, too, rely on the national health service as most people do. I apologise for not being present for the opening speeches today, but I was detained in my constituency by a visit from the Secretary of State for National Heritage. While she was in my constituency, she met young people in care, whose voices should be heard. The Children Act 1989 and the recent Children (Northern Ireland) Order 1995 gave such young people an opportunity to make their voices heard.
I listened with care to the speech of the hon. Member for Croydon, North-East (Mr. Congdon). He spoke about the private sector and urged the closing of statutory homes. In terms of provision for young people in care, there has been a tendency in Northern Ireland—this has been reflected in other parts of the United Kingdom—to close statutory homes, and we must acknowledge that voluntary homes have been withdrawn from that sector. We should not rush down that road because we need specific homes available—particularly in the statutory sector—for young people in care.
Mention has been made of referrals to nursing homes. There is concern in some parts of Northern Ireland—a particular example in County Down comes to mind—that private nursing homes which have provided excellent care for a number of years have not had a referral from the statutory sector for several years. I am aware of a recent example where a family was interested in the County Down home, but the social worker concerned recommended another home. That raises the concept of discrimination.
Speaking of discrimination, I recognise that the Disability Discrimination Act 1995 was a major step forward by the Government. However, I must put it on record that disabled people still feel that the very nature of the Act discriminates against them when compared with other legislation dealing with discrimination. I wonder whether the real problem might be discrimination against white males who are disabled as it seems that the commission dealing with disabled people has fewer teeth than those dealing with racial or sex discrimination. We are at an early stage, but disabled people demand that the commission be given teeth now.
In the short time available, I wish to consider several aspects within Northern Ireland. Reference has been made to the rationalisation of health provision, and particularly to the Calman report on cancer services. In taking evidence, the Select Committee on Health has heard the argument time and again that it is better to have surgeons who regularly perform a large number of operations, as they are more successful than others. I have queried that statement for several reasons. First, how does one get experience if one does not operate? In addition, one report has suggested that surgeons who operate on fewer patients have a higher success rate.
Some experienced surgeons—with undoubted gifts in making clinical judgments—have decided that they could give a patient a 50:50 chance of several years of reasonable health by operating when the patient might otherwise have had just two or three months if no operation were carried out. As a result, some of those surgeons have a higher casualty rate than those who prefer 89 to keep their hands clean by not taking such risks. One therefore cannot jump to the conclusion that because a surgeon does an operation more often his success rate will necessarily be greater.
In taking evidence, the Committee heard about maternity provision around Bath, and we discovered that a high proportion of hospital care was provided by smaller units. In every one of those units we found a tremendous sense of satisfaction. It was interesting that a pregnant woman presenting herself to a small unit who—after examination by a gynaecologist and an obstetrician—was found to have problems was transferred immediately to a major centre. The interesting thing was that if things went wrong at the major centre, it did not claim the patient as its own, but referred to her as a patient of the smaller unit. The statistics would then show that the smaller unit did not do so well. I was interested to read over the weekend about a doctor who went to hospital for maternity provision and advised all of us to stay away. Hospitals are not necessarily the safest places, as we discovered in considered maternity provision.
I wish to refer to the acute hospital rationalisation programme in Belfast, on which there have been three interesting reports. We are still awaiting a ministerial decision to press ahead with the major reorganisation of maternity provision for which obstetricians have been looking for years. Obstetricians want a new facility to deal with about 5,000 deliveries a year. Plans are afoot for that, but with the recommendation that it should go on the City hospital site, the cry has gone up that this facility must be provided on the acute hospital site at the Royal Belfast hospital for sick children, where the paediatricians are based. Even now, any child born and developing difficulties in the Royal Maternity hospital has to be put in an ambulance and transported to the main Royal Belfast building. It would take a further five or 10 minutes to take that child to the suggested facility on the City site.
I have a problem with that, because we may be sending a message that any child born outside Belfast is in great danger. What will a mother in North Antrim, South Down, Tyrone, Fermanagh or Armagh say to that? Furthermore, I believe that I am right in saying that none of the specialists lives in west Belfast, so they will be nearer to the City site if they are called out to attend a case out of hours. Unfortunately, medical politics plays a part and politicians get the blame. I would urge the Secretary of State and the Minister to make the decision quickly, as the indecision is causing problems.
Indecision can be seen at another level. We are now at the end of February and, in another month or so, we shall be entering a new financial year. Although we have been contracting for some time, some contracts for next year have still not been worked out. In addition, some contracts for this year have only just been worked out. In the process of health reforms, we need people to get busier and to get their contracts worked out. The indecision may be a result of the change in view at the Department of Health in Northern Ireland, which has had a wonderful reorganisation of its financial structure. Money should travel with the patient, but the Eastern health and social services board—which provides most of the speciality services for Northern Ireland—has found that it is grossly underfunded. It is now seeking to tackle that, but there is still not enough funding for the people. In that context, I would ask for an urgent re-examination of capitation 90 funding and that dealings should be more transparent. I am sure that if that is true for Northern Ireland, it could well be true in other parts of the nation.
Fundholding has been mentioned. People have been encouraged to go down that road, but because the Department of Health and Social Services does not have enough finances in its budget even for the coming year, some of the finest practices in Belfast have been held back in seeking the right to be fundholders. Specious and doubtful reasons have been given, the main one being that it takes time to train people. The practices have all the modern equipment and have been known for controlling their drugs budgets. Eastern Multifund, which specialises in providing services for general practitioners who may not want to be fundholders but would join together in the multifund, was prepared to take several of the practitioners on and take them through the course. The real reason was that the money was not available to bring them in and so it has been put back for another year
Finally, attention has been paid to waiting lists. There are various ways of fiddling figures, as anyone who works with statistics knows. We can read them in different ways. Whereas, in the past when someone was referred to a consultant he or she was put on a waiting list, now a GP is not even allowed to refer the patient so quickly to the consultant. There is a time lag before the patient is seen. It is tragic if that is so in cases where immediate surgery is required.
In the light of the figures available in the Library today, with all the emphasis on our care in Northern Ireland, why have we not tackled the waiting list problem properly? The figures for the total in-patient waiting list—including day cases and ordinary in-patients—comparing the four constituent nations of the kingdom in 1995 and 1996, show a 13 per cent. increase in the waiting lists in Northern Ireland and a 2 per cent. increase in England. There has been an increase of 75 per cent. in Northern Ireland in those waiting for one year. Admittedly, the figures were taken in September and it has been suggested that that might mask the growth in the waiting lists in England since then. The figures for England were low in March 1996, but have increased subsequently.
On the other hand, ordinary admissions show a decrease because of day surgery, but the decrease is given in total numbers. They show that the decrease in those waiting for more than one year is greater in England than in Northern Ireland. In the past year, the numbers have increased in Northern Ireland, while they have fallen in England. In September, 13 per cent. of those waiting in Northern Ireland had been waiting for more than one year compared with 2 per cent. in England. In September 1996, 13.8 out of every 1,000 people in Northern Ireland were waiting, while it was 13.7 in Wales, 10.8 in England and 8.9 in Scotland. I wonder why there is such a variation if it is a national health service. Is there any explanation which will give us some hope that the service will be equitable throughout the nation?
§ Mr. David Porter (Waveney)
In effect, we are discussing a composite motion tonight, which is very old Labour, is it not? Until I saw the Order Paper today I was not aware that a number of other issues had been included. When the title of the debate was announced last week, I was surprised that the Opposition had chosen health yet 91 again. A month or so ago they chose it and every few weeks they trot out the national health service, trying to perpetuate the strange myth that it is theirs alone, when it is a fact that for most years of its life it has been developed and tax funded by Conservative Governments.
Two or three weeks ago, the Liberals were at it too. I listened to almost the entire Liberal-induced debate while trying to catch your eye, Madam Deputy Speaker, and because I thought that they might have something exciting to say about health. I was disappointed on both counts. Then I thought that perhaps they had chosen health to differentiate themselves from Labour, to deny the accusation that they are in pact with one another. I listened for the difference—there was virtually none.
All that both main Opposition parties want to do is to criticise the Government, forget the successes of health care and give the impression that somehow a little more money spent their way would solve all the problems. Labour, in particular, seems to have a two-faced approach to health. One is the public, alarmist, soundbite, shroud-waving face, which slams the Government at every opportunity and for every failing in one of the largest organisations in the world. The other is the more private, allegedly honest, wishfully thinking that it will soon be in power face, which has to admit that many Conservative reforms work, are popular with many health care professionals and are effectively spending more public money to deliver an ever-improving public service, transforming the lives of ever more of our citizens. How else can we regard the Opposition's astonishing assertion that in government they would leave untouched all Conservative spending plans for two years? Bleat, bleat, bleat about spending, year after year, make no connection with tax and spend and then give such a vote of confidence in our spending plans that they will be unchanged for two years—what sort of credibility is that for them, the party of natural opposition? The Liberals are honest enough to say that they would tax more to spend more, but as the Liberals no longer count for much, that is not worth the breath that is used to speak it.
I shall focus on two local issues in my area to illustrate a number of the successes that we have enjoyed and the problems that we face. No one is saying that everything is perfect or finished. It is very much an evolving health service—with technology and public expectations, how can it be anything but?
I have not always been uncritical of some aspects of Government policy. In 1974, the Great Yarmouth and Waveney district achieved a long-held ambition to have its own health authority. Once the James Paget district general hospital was opened in 1982, the arrangement worked well, services increased and the consultant establishment flourished. Although there were, as there still are, specialist services from Norwich, the coastal area east of Norwich had an identity of its own and increasingly met the needs of the people.
In 1994, it was decided that the health authority served too small a community and people would be better served by a large authority. There was opposition on an unprecedented scale from doctors, health workers and all parts of the political world—all to no avail. Bureaucrats in London overrode the Government's policy of localised responses to localised needs. They advised the then Minister to thwart a local health service within the 92 national health service. They laid down a model for local delivery that may have looked neat and tidy on a piece of paper in the Department of Health, but was not in the best interests of local people. That year, in protest, I did not support the Government's programme outlined in the Queen's Speech and my hon. Friend the Member for Great Yarmouth (Mr. Carttiss) did not support the Government on any health issue.
The purchase of services for Great Yarmouth went to East Norfolk health authority and for the Waveney area to Suffolk health authority. We got 15 guarantees, which collectively assured the people that the Great Yarmouth and Waveney communities were considered as a whole and were interdependent for health care. My hon. Friend the Member for Great Yarmouth and I have since concentrated on helping to make the new structure work, ever improving the quality and quantity of services to patients.
All that background is necessary to understand where we are today. Suffolk and East Norfolk health authorities have recently taken decisions that have vindicated all the arguments for keeping the previous health authorities for both areas, but which also came about in response to the charge laid upon them—to purchase the best, most efficient and effective health care within finite budgets. It is a charge that no one disputes—not even the Labour party nowadays.
The health authorities have ended the contracts with Anglian Harbours NHS trust—a first wave and at first a very successful trust—with effect from this coming August. It will be the first NHS trust to go out of business because it has lost all its contracts. Having voted in Parliament not to reduce unnecessary bureaucracy, the Labour party has been caught out with its two faces nationally and locally. It is unable to support the decision publicly, using it lamely to criticise the Government, yet it does not say how it would do things differently, keep within budget or match our year on year real terms spending increase pledge.
When it came to decide on the transfer of services from the Anglian Harbours NHS trust, Suffolk Health consulted widely and set up a project group of local stakeholders before a full public meeting that lasted more than four hours. It finally plumped for a mixed provider arrangement, which, of course, does not please everyone. There is widespread agreement that the people of south Waveney have been listened to and their views addressed. The community hospitals at Southwold, Halesworth and Beccles are assured, in line with Government policy. Lowestoft hospital will be managed by the James Paget hospital, which is enthusiastic and has presented a viable plan to secure its future and development. However, learning disabilities have gone to Allington NHS trust, along with children's and community services.
The community health council feels that Lowestoft hospital will not be used to full advantage. Providers will be doubled up on some sites, while there will be a fragmentation of the delivery of some services. Because of criticism of Suffolk Health's handling of decisions, the CHC has asked for a meeting, through me, with my hon. Friend the Minister for Health. It is the local watchdog and it has barked on the issue to warn the community. In the meantime, it will meet Suffolk Health for reassurances about transfer issues. In a devolved NHS, that is surely the right way forward. I know that other trusts, health 93 authorities and interested parties have their eyes on this issue to learn the national lessons that have been applied locally in an evolving health service.
The health authorities have also reduced their purchasing from All Hallows hospital, across the border at Ditchingham in south-west Norfolk. The hospital is outside the NHS; it is run by nuns and the London hospital management trust. The dilemma for the health authorities and our caring community, which has rightly applauded the quality of care there, is that if there are empty beds in NHS hospitals at Lowestoft, Halesworth, Beccles and Southwold, how can money be spent on non-NHS beds even if they are cheaper and closer to one part of the community?
A compromise has been reached. Some funding will be transferred to All Hallows hospital to allow more time for local GPs to bring forward their ideas for developing the hospital in our primary care-led, GP-driven health service. Hard choices have been made and we expect, thanks to the Friends of All Hallows, £70,000 up front from Suffolk Health, and a larger than expected purchase from East Norfolk, that All Hallows hospital will continue for another year while GPs in Bungay and south Norfolk work up their exciting fundholding plans for the hospital.
From the Opposition, we hear not a great welcome for pushing forward a GP-driven NHS and the further development of a community hospital, but threats. The plan, and therefore the hospital, is under threat from the confusion at the heart of Labour's fundholding plans. Its bizarre threat to abolish fundholding and its hasty promise to keep it, both announced in the same 48-hour period before Christmas by the right hon. Member for Islington, South (Mr. Smith), speak volumes for Labour's two-faced policy approach. It promises all things to all people, tries not to upset anyone, funks the hard decisions, sheepishly adopts Conservative policies and then pretends that it cared all along. If it ever matches our year-on-year spending pledge, the circle of its hypocrisy will be complete.
Labour confirmed its GP commissioning policy in this debate. However, as I understand it, GP commissioning would not cross county boundaries. All Hallows hospital is doomed under Labour. Voters in Bungay need to know that. The Liberals oppose both NHS trusts and fundholders and will, as usual, happily support Labour.
Labour says that it will solve all problems by cutting bureaucracy and management. No one argues with that because it sounds good. The Opposition could have voted with us to cut some bureaucracy. In the James Paget hospital, which serves my constituency and Great Yarmouth, more than half the managers are doctors and consultants. When they are not managing, they have stethoscopes round their necks while they treat patients. Is not that the best sort of hospital management? Is that what Labour will sweep away, or has it not thought that through either?
In our debates and in the press conferences, articles and policy papers that Labour churns out on health, it has not only failed to demolish the Government on health but failed to show any original thinking. If the NHS is in such poor shape, the cash shortages as acute as ever and the crisis all that it is cracked up to be, where are the distinctive, credible, sparkling answers? There is none. Labour's alternative is a policy silence. My right hon. Friend the Secretary of State called it a vacuum. Have we 94 won the argument on health care so resoundingly? It seems that we have. Labour and the Liberal Democrats, and their henchmen in the constituencies, in their own name or in those of bogus campaign and action groups, have played negative politics by issuing dire warnings, alarming pensioners and painting every change as privatisation. In my area, their bogus health campaign group has duped the local pensioners' organisation into becoming political.
Such alarm has struck a chord with people who understandably feel panic for themselves and their families. Hysteria about funding shortfalls and the supposedly sinister agenda of the Conservative party, which fostered and developed the NHS, cover up Labour's two-faced policy approach. Labour virtually admits that the NHS will be run in essentially the same way. It has promised to glean about £100 million from administrative savings. Fine, but Labour should be the first to point out that that is a drop in the ocean of the £42 billion or more a year that we spend on health. It hardly amounts to a credible health policy.
Labour accepts the separation of purchasing from providing as a philosophy. Presumably the Liberals accept it too, because they have called for three-year contracts. Labour's policy is all about crying wolf while catching up with us on health thinking. On present form, and it has had at least five shadow spokesmen since the last general election, Labour will not catch up till the general election after next, never mind the coming one.
In the meantime, we will go on delivering real increases for a locally run NHS, harnessing the benefits of new technology and new health care for every age group. I hope that we will continue to ask and answer difficult questions: what treatments work; which health professionals can do best which job; what measurements beyond bed numbers are more indicative of treatment; how can we further improve the quality of life? It is only the Conservatives who can ask those questions and get the economy right to pay for the answers. Only we are the party of the health service.
§ Mr. Andrew Miller (Ellesmere Port and Neston)
I follow the hon. Member for Belfast, South (Rev. Martin Smyth) in apologising to the House for not being present during the opening speeches. I was stuck with a difficult constituency problem.
My family has much for which to be grateful from the success of the national health service. My daughter was found to be suffering from a congenital hip dislocation and endured a long period of traumatic surgery and recuperation. She had surgery in the famous Myrtle Street children's hospital in Liverpool, followed by recuperation in a hospital in Heswall that is now closed. She has had a tremendously successful full recovery. I balance that against the extraordinary recent developments in human genetics. Conditions such as that, for which there seems to be a genetic propensity, could be resolved in the longer term if we are prepared to invest sufficiently in research and development. That is a huge task for the health service, the Medical Research Council and the private sector. We shall have to revisit the matter in detail.
I want to deal with issues in the north-west, especially those that affect the health authorities that service my constituency, Chester and the Wirral. The Government 95 should be warned. Those health authorities also service Wirral, South, where events this week may well prove embarrassing for the Conservative party.
The hon. Member for Waveney (Mr. Porter) questioned the integrity of some of our data. I notice from "Dod's Parliamentary Companion" that he studied at the New College of Speech and Drama—obviously the dramatic element had the most impact.
The Conservative party should be warned that the state of the health service is a serious issue. The Labour party has not just picked the relevant figures out of the air; the state of the health service has become a key issue in the by-election. The Daily Post of Liverpool, hardly an organ of the Labour party, ran the following sub-heading on 22 February:Daily Post readers put health at the top of their list of concerns as waiting lists grow and staff morale sinks".The headline referred toThe chronic NHS figures which could tip the political balance in Wirral South".Those figures are not from the Labour party, but were collected in a survey undertaken by that newspaper.
That newspaper is right, as is the Labour party candidate, Ben Chapman, to expose the deficiencies in the local health service. I have campaigned with our candidate, and we met an elderly lady on her doorstep who told us of the difficulties that she was facing because the ambulance service could not provide adequate transport to take her for necessary orthopaedic treatment.
I should like the House to consider the problems faced by the Countess of Chester hospital and South Cheshire health authority. I have studied their documents and it is clear that they are in crisis. I invite the Minister to call upon that hospital and the health authority to publish what they have described as their recovery plan. If it is necessary to produce such a plan, there must, by definition, be a problem. The authority has published such a plan in an internal report, which should now be made available to the public. I call on the Minister to ensure that that happens. The report apparently sets out a series of cuts that must be made to services that are otherwise regarded as essential.
It appears that the hospital has a serious funding problem. From the report that has been presented to colleagues in the north-west, it appears that that problem is so serious that the hospital has had to consider how it can pay its staff and suppliers. One must deal seriously with a hospital trust in such severe crisis.
The lack of staff at the hospital has caused problems in the accident and emergency department and has also caused the temporary closure of certain wards. South Cheshire health authority is insisting that the Countess of Chester hospital must cut £500,000 from its staff budget. I am recounting not scare stories, but facts. That is why people in Chester, in my constituency and throughout the Wirral are expressing grave concern about the state of the health service.
Many of my constituents attend hospitals in the Wirral, for example, Arrowe Park, which is in the constituency of the right hon. Member for Wirral, West (Mr. Hunt), and Clatterbridge, which is in the Wirral, South constituency. Both those hospitals have caused serious 96 problems for my constituents, which are connected not simply with basic health provision but with the infrastructure that is necessary to make the health service work. A simple example—which is outside the terms of the debate, so I shall not dwell on it—is that my constituents have great difficulty getting to or from the hospitals, either as day-patients or as visitors, simply because the bus service provided since deregulation makes it almost impossible to travel to them. Patients are now having to follow extremely convoluted public transport routes to meet their health needs.
The biggest issues that have emerged from the debate are undoubtedly waiting lists and bed blocking. Before Conservative Members argue that bed blocking is simply a problem caused by Wirral council, and therefore one that they can blame on the Labour party, I remind them that I represent a constituency in Cheshire, which suffers from similar problems. That authority is controlled by the Conservative party.
Cheshire suffers acutely from long waiting lists and bed blocking. Those problems are especially severe when it comes to orthopaedic surgery, especially hip replacement, because of the elderly population profile. A friend of mine, Mr. Frank McCoy, has been waiting a considerable time for a hip replacement. I believe that the pain and worry that are caused are entirely unnecessary because it should be possible for a well-managed authority to offer proper guidance to patients on how long they may have to wait. That authority should ensure that the waiting time is reasonable.
The Opposition spokesman, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), referred to one case that I have also come across, of an elderly person who was told that she would have to wait 154 weeks for an orthopaedic consultation. That is an extraordinary delay. I found it so hard to believe that I searched out the relevant letter, and I can assure the House that it referred to that suggested waiting time. No explanation was offered. That delay reveals the extent of the crisis that we face.
To answer the hon. Member for Waveney, it is because of that crisis that the Labour party has pledged to use the first £100 million saved from cutting NHS red tape on targeting people on the waiting lists. That is an important commitment. I do not know about the hon. Gentleman's constituency, but I listened with interest to the hon. Member for Belfast, South, who expressed concern about apparent regional discrepancies. It seems from the debate that the experience of some Conservative Members is entirely different from that of Members representing the north-west of England and Northern Ireland.
Waiting lists are an acute problem that has been exacerbated by the way in which health authorities and social services departments have failed to get to grips with the discharge process. A consistent bed blocking problem exists, and in the Wirral and Cheshire, it is seen simply as a case of overcrowding.
A number of issues must be examined. One that has not been touched upon in detail tonight, but which impinges upon the Wirral and the NHS in west Cheshire, is the provision of community care. A current proposal out for consultation calls for the merger of Wirral Community Healthcare trust and the West Cheshire NHS trust. I was particularly interested to learn from that consultative document, which reached me eventually, that 97 it pre-empted what appears to be the perfect managerial solution. It did not adequately address the needs of people in the community. For example, at the outset nobody had addressed the question whether Halton community trust should be drawn into the equation.
The Government seem to accept the principle that GPs should have a lead role in the discussions, and GPs have argued that the debate should be widened. Ellesmere Port hospital provides important recovery services for patients who have had major surgery and suffered strokes in other areas; we must ensure that those patients continue to have a service in future. We do not want a service that is affected by the magnetic pull of either the city of Chester or Birkenhead, leaving those of us in the middle of the Wirral seriously disadvantaged. I am waiting to hear from the Government on that. The results of the application were due to be made public in February, but I understand that they have been delayed. I recognise that there could be potential sensible savings in administrative overheads in bringing the trusts together, but the move must be driven by patient need, not by bureaucratic needs.
There are clear problems with waiting lists; there are clear problems with fewer nurses and more bureaucrats. Since the Government introduced the internal market into the NHS, the north-west has lost more than 4,400 nurses and gained more than 2,500 bureaucrats. It does not matter how one dresses up the definitions of the job functions: those figures stand up to examination. One has only to visit some of the hospitals in and around my area to see that. An extra £284,000 a day has gone into bureaucracy in the north-west; that would pay for about 300 more patients to be treated every day.
There are problems with accident and emergency provision. I referred to the Countess of Chester hospital, which is suffering from cuts in that service. There have also been difficulties because the next accident and emergency provision is at Arrowe Park hospital. That means that some people have to drive past one major hospital to get to the accident and emergency department. I appreciate—and everyone should recognise—the importance of Clatterbridge hospital in terms of its oncology service, which is world renowned. But one should not simply say that we should therefore concentrate another important service—in this case, accident and emergency—miles away, so that people have further to travel.
I am also concerned that the Government appear to be hiding the facts. My hon. Friend the Member for Liverpool, Broadgreen (Mrs. Kennedy) referred to the BBC's "Close Up North" programme, which showed that accident and emergency provision in the north-west was in danger of collapsing. That was not a journalist's view, but a view expressed in a report that the Government had in their hands. Why was that report not published? Unless such information—which is in the Government's hands—enters the public domain, we cannot have a rational debate on the needs of the service. That is not the only report that is being held back from the public. I referred earlier to the debate that is taking place between my health authority and the Countess of Chester hospital about severe cuts at that hospital. Those cuts are affecting people across my community.
I also have serious concerns about intensive care provision. There are proposals to cut 27 beds at St. Catherine's hospital in Tranmere, which will have knock-on effects at the acute trust and the Wirral which, 98 in turn, will have knock-on effects at the trust that covers the Countess of Chester hospital. Serious problems are beginning to emerge in that community as a result of the cuts.
I have referred to orthopaedic services, and we have heard about the case of one elderly lady. Problems are exacerbated when people simply do not get consultant appointments—my hon. Friend the Member for Islington, South and Finsbury gave one such example.
Finally, there has been a series of fiddled figures, which have been most clearly revealed in the context of the Royal Liverpool and Broadgreen hospital, which was officially declared to have only 329 patients even though there are 570 waiting at present.
Today's debate justifies the motion tabled by the Labour party. Some major reforms are needed; if they are not implemented, the Government will have their come-uppance. I have no doubt that the Government will get their come-uppance in Wirral, South on Thursday—they should look at what is happening there, as the figures that I gave are not mine.
§ Mr. Miller
The Minister said that I am not interested in the health service, but only in the by-election. He should look at the record of patient care that I have described.
§ Mr. Miller
I have spoken on matters relating to prescription charges and the health service on a number of occasions in the House. The Minister has forgotten that my constituency abuts Wirral, South—we share health services, so issues affecting that constituency affect my constituents. It will become increasingly clear on Thursday that the people of Wirral, South agree with me. If the Government do not start to address the problems in that area, they will see the result in the general election as well.
§ Lady Olga Maitland (Sutton and Cheam)
I need no lectures from the Labour party on health care. One of the things I find enormously depressing is the constant running down of the health service. I am enormously proud of the health service, and I am very proud of the stewardship that my Government have given it over a long period. The motion consists of 21 lines of carping criticism, out to destroy the power and strength of the health service. The motion is thin on content and long on rhetoric.
I am sorry that we have heard nearly five hours of negative debate from the Labour party. The language has been emotive. It was led off by the hon. Member for Islington, South and Finsbury (Mr. Smith), using words like "serious crisis", "cuts" and "commercialising", jeering at the private finance initiative and focusing on what he called the "continuing deterioration" of the health service and "alarm" at the "highest ever figures" of people waiting for treatment.
99 It is curious for a party that says it believes in the health service to bash that health service and bash patients' confidence in it. I feel keenly that the Labour party is frightening patients, which is irresponsible. It is irresponsible to play politics with vulnerable and distressed people; indeed, it is a disgrace. Patients have become victims of Labour's political football game, and it is curious that that football game intensifies whenever there is a by-election, as there will be this week, or as we approach a general election, as happened in 1992.
How many Labour Members somehow happened to mention the Wirral in their speech? Their speeches came across as soundbites, and the hon. Member for Ellesmere Port and Neston (Mr. Miller) was no exception on that score.
The criticism is affecting people. I find that they are becoming worried and fearful that they will not get their treatment. I ask them why they feel like that, and they say that they do not know. I ask them whether they have had a difficult time or unsatisfactory service from their local doctor or their local hospital, but they say, "No; it was wonderful. My doctor is dedicated, the service I had at the hospital was magnificent, I came home in good time and I am fit and well." I ask, "So why do you feel so anxious?" They reply, "It is what they say the whole time"—"they" being the Labour party, constantly repeating worrying talk about the health service. I believe that Labour Members are proceeding in the hope that, if they mention the word "crisis" often enough, people will believe it.
Interestingly, on Labour's plans for the future, I note that no positive action was mentioned in the debate five weeks ago on the health service and no positive action has been mentioned in today's debate, initiated by the Labour party. Certainly there has been no pledge of an input of investment to match our investment. It would be fair to say that members of the Labour party have become the Scrooges of the health service. There are no promises of new money. They talk big but offer nothing. It reminds me of a well-known phrase from a Shakespeare play; they arefull of sound and fury,Signifying nothing.When Labour was last in power, it cut capital spending on the health service by 28 per cent. That is not a record to be proud of. We should also recall how the country was brought to its knees by the health unions—specifically, the National Union of Public Employees. When I was reading through the Hansard of the previous debate, I noted that one of the most moving interventions was made by my hon. Friend the Member for High Peak (Mr. Hendry), reminding the Labour party of the distressing time he went through when his father was dying in hospital from cancer. His father desperately needed soup as nourishment, but the trade union officials—the NUPE officials—who were controlling the access of care were saying that he could not have soup, which was easy to swallow, but would have to survive on boiled eggs, which he could not swallow.
That haunted me because it was real. My hon. Friend the Member for High Peak spoke passionately. It was an experience that he had had, not just an anecdote. I fear that if, God forbid, we ever have a Labour Government, 100 we could go down that road again. They would find their own health unions dictating the terms on which the service was to be run.
The Labour party claims to be greatly concerned about the nurses but seems to forget that, when it was in power, nurses' pay fell by 3 per cent. in real terms. When it comes to future investment in the NHS, of course, Labour Members are truly embarrassed—but they cannot bring themselves to reveal the truth, which is that the health service is safe in the Conservatives' hands. The Opposition's rhetoric is nothing but empty bluster.
We have said that we will increase spending on the health service in real terms in each of the next five years, including an extra £1.6 billion for patient care in 1997–98. That comes on top of an average 3 per cent. real-terms growth in spending over the past 18 years. To put it in more easily understood terms, that means that £724 is spent on each man, woman and child every year. On average, one multi-million pound NHS capital project has been completed every week since 1979; and more than 750 multi-million pound schemes have been completed in the past 10 years. That is our success story; but will Labour match our record on patient care? In reply, we hear silence and see red faces.
It is worth recalling that the hon. Member for York (Mr. Bayley) wrote in The Times on 16 January:Labour's health policy will not look credible at the general election if we do not commit ourselves to matching the rate of growth delivered by the Conservatives in recent years".Political commentators have repeated the criticism. Perhaps Labour Members would like to hear an independent view; I therefore point them in the direction of remarks by Colin Brown, chief political correspondent of The Independent, writing on 28 November 1996:The big question Mr. Smith has to address is resources. It is no good Labour relying on its present formula of sacking managers to create £100 million for the NHS to recycle. The managers have gone; the savings have been made. He should fight Gordon Brown, the Shadow Chancellor, for the right, at the very least, to match the Tory cash promise for next year.This £100 million—not even new money—is the only measly pledge that we hear from the Labour party. It is not worth the paper it is written on. To give him his due, the hon. Member for Islington, South and Finsbury is slightly more realistic than the hon. Member for Peckham (Ms Harman), his predecessor, who claimed—absurdlylast July that she would cut £1.5 billion from national health service administration costs. That amounts to 60 per cent. of the total of such costs.
What do the Opposition really mean by their attack on bureaucracy? They should come clean on how they intend to achieve it. Which managers will they sack? Do they mean to sack only junior clerks and typists? Will they include nursing managers or former matrons with hands-on experience in the wards? If Labour did sack the 3,000 senior NHS managers or some of the 8,000 other administrative staff, imagine the ensuing redundancy payments—they would cost millions. The so-called savings would disappear, and the clinicians, whom we are trying to free up to get on with their proper task of patient care, would be saddled with more administrative work. In any case, the Labour party has always been opposed to our reforms to reduce bureaucracy. I recall that Labour voted against the abolition of regional health authorities, whereby a whole tier of bureaucracy would disappear.
101 As usual, the Opposition paint a distorted picture. They say that the number of NHS managers has increased markedly since 1985. There are 6,430 senior managers in the NHS—in other words, for every senior manager, there are 77 people providing direct patient care—but the classification "senior manager" is a new term. Two thirds of the increase in manager numbers is accounted for by a reclassification of jobs. In many cases, they had been doctors or senior nurses.
Far from putting more money towards patient care, Labour's commitment to the social chapter and the minimum wage would increase our labour costs and divert money from patients. The abolition of compulsory competitive tendering so favoured by the Opposition would make health service costs soar.
Let us examine Labour's pledge to reduce waiting lists by 100,000, by releasing the £100 million from NHS bureaucracy—another worthless pledge. The NHS waiting list is not a static figure. As people are treated, so more join. The NHS carried out 10.5 million treatments in 1994–95. Waiting times have been reduced dramatically. As has already been pointed out by my colleagues, half of all patients are seen immediately. Half the remainder are seen within five weeks, almost 75 per cent. are seen within three months and 98 per cent. are seen within a year. Nevertheless, the overall waiting list remains virtually static, as more people keep coming forward to take advantage of the new medical procedures and treatments available.
The figure of £100 million is at best a mirage—it could never be realised. Labour claimed in "A Pledge to Patients" published in July last year that all health authorities and trusts would reduce management costs by 3.8 per cent., which, it was claimed, would release £80 million for patient care.
That is a sweeping pledge, which ignores variations in cost—for example, the increased costs of running a teaching hospital. It is also arithmetically faulty; Labour's plan was costed on the basis of published management costs from 1995–96, but that is out of date. Time has moved on. In 1996–97, health authorities and trusts have dramatically reduced their management costs. The chances of finding savings anywhere near £80 million are remote.
Time is short, but I wish to pay tribute to the magnificent health service in my constituency, Sutton. The attacks on the local health service cause great distress to patients locally. My fellow Members of Parliament in the Merton, Sutton and Wandsworth health authority were under a siege of protest because of the scaremongering stories pushed by the Labour party and the Liberals, suggesting that all our services would be cut, especially the services of my local hospital, St. Helier. It was claimed that operations would be delayed, treatments reduced, and so on.
It did not turn out like that. Instead, we read excellent news last week in the Sutton Borough Guardian under the headline "Casualty gets big boost." We found that not only would there be a boost to our annual increase, but £1.5 million was coming to St. Helier. Of that sum, £200,000 has been allocated to the accident and emergency department, which will double in size and receive eight more full-time nursing staff and an extra seven or more treatment bays or casualty beds. The A and E department does magnificent work, coping on average 102 with 207 people a day, or almost nine people an hour. Morale is high and the staff are dedicated. I have watched them at work. That is just one example of new investment. There is also new investment in the renal unit. Waiting times have been cut and the number of patients increased in every department of the hospital.
I am proud of what we have achieved at St. Heliers. In the same way, the Royal Marsden hospital, which is world famous for treating cancer patients, is not only making a success of treating more patients but successfully sending them home to lead useful lives.
I appreciate that time is tight; I regret that I cannot continue with the remarks that I should have liked to make, because I am extremely concerned about the bashing of GP fundholding practices. I wish to make just one further comment: if the Opposition decide to abolish fundholding practices as has been suggested, they will destroy patient care. They will add an extra tier of bureaucracy by introducing collective commissioning programmes; the people who sit on those bodies, whether they are health unions or local politicians, will have a vested interest in feathering their own nests, but that will not benefit patients.
As we approach a general election, the country at large must make crucial decisions about its future health service. There is no doubt that a health service in the hands of the Labour party will be no health service at all, whereas we have an excellent track record in which everyone can feel confident. The people have seen what we have done for patients and know what we shall continue to do.
§ Mr. John Gunnell (Morley and Leeds, South)
In closing this debate as far as Back Benchers are concerned, I should like to spend a minute or two binding together all the different issues in the motion. Any anecdote about the health service would be encompassed by the motion, but it is important to look at some of the principles that lie behind our criticisms of how it has operated under the Government. We are mounting what I regard as a principled critique of the health service, and it is important to place a few matters on record.
One factor that links the different parts of the motion is that we criticise the Government for showing a preoccupation with private provision. I shall give some examples. First, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) referred to the commercialisation of the GP service. He was right to refer to the amendments tabled by the Minister for Health, which are to be found on pages 431–34 of today's Order Paper.
It is clear that the Minister has been at great pains to assure the British Medical Association that the National Health Service (Primary Care) Bill is not intended to pave the way for the commercialisation of GP services. It is obvious from comments in The Independent that the Minister's main concern is to ensure that this does not become an election issue. He has therefore two-timed the Committee that is considering the Bill. It is important that the Committee should discuss the Bill, but it is even more important to meet the BMA committee to sort out the minimum that it will settle for in order not to use its surgeries to campaign against the Tory party and the Government's record. That is why the Minister has tabled a sheet of amendments to the Bill.
103 My hon. Friend the Member for Islington, South and Finsbury was generous in saying that the Government had made mistakes and had got the matter wrong in the first place. They did not make mistakes; nor did they make mistakes the second time, when they again got it wrong in the eyes of the BMA—they were simply trying to get away with as much as possible in preparing for privatisation.
The second issue is the private finance initiative. I have no objection to the PFI per se. I agree with my party, which is about to support it. I have plenty of experience of working with private companies. The difficulty is that it is not possible to get any capital development without a PFI scheme.
A written answer that I received on Thursday from the Secretary of State listed 35 PFI schemes, of which 21 did not have a signed contract. I quite understand that businesses in the private sector do not want to sign contracts unless they are satisfied that they will return a profit—if they do not make a profit, they cannot expect to stay in existence for long; they have to make a profit. What is happening is that the NHS capital spend is determined by the rate at which the private sector signs up to schemes. That is taking the involvement of the private sector too far. There have to be some NHS-funded capital schemes.
Thirdly, and most important, is the issue of community care. I am very concerned at the plans for the privatisation of social services and community care. The Secretary of State, in his discussions with the Association of Directors of Social Services, made it clear that he sees social services not as a provider but as a purchaser of services. There are elements of the community care programme in which social services have to give 85 per cent. of the work to the private sector. The involvement of the private sector and the fact that the Government are trying at every level to push private provision is a matter of considerable concern that affects the future and quality of the service.
Many good things are happening in the NHS—I do not dispute that—but there is a gradual withdrawal by the Government from the fundamental principles on which the NHS was based. The NHS was founded on equity. My hon. Friend the Member for Islington, South and Finsbury gave the telephone patter that was to be given by Leeds general infirmary staff. The Secretary of State dismissed it as an anecdote. It was not. Throughout the country, trusts are finding that they cannot carry out operations at the moment because health authorities are out of money and they therefore have to concentrate on fundholders. That is a way of skewing the waiting list. It makes it longer. It also keeps some people off the waiting list for a few months, so they spend less time on it. There is a fundamental inequity of provision.
The NHS was intended to be free at the point of delivery, but increasingly we see charges. The service that is provided is on the basis of need, or should be, but it is very clear that that is not the only principle involved in the delivery of care.
A study carried out by the Joseph Rowntree Foundation said:Both health care and social care should be free at the point of delivery for all older people.It also said:A complex funding system has shunted the costs of care from services which were free at the point of delivery to more means-tested provision.104 The Government have not only increased the amount of private provision but moved away from the fundamental principles on which the NHS was based.
§ Mr. Tom Clarke (Monklands, West)
The comprehensive nature of our debate has confirmed the wisdom of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) in presenting a motion dealing with health, community care and disability. Time after time we have been shown tonight that those issues relate to each other.
The debate was enhanced by the speeches of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and my hon. Friends the Members for Hemsworth (Mr. Trickett), for Liverpool, Broadgreen (Mrs. Kennedy), for Ellesmere Port and Neston (Mr. Miller)—who will soon have a new Labour neighbour—and for Morley and Leeds, South (Mr. Gunnell).
The debate has shown that, on disability policy, the British agenda has always been led by Labour. I am sorry that the hon. Member for Southwark and Bermondsey (Mr. Hughes) has not stayed to hear my speech, but perhaps he will read it tomorrow. Just as a Labour Government gave birth to the national health service, so a Labour Administration under Harold Wilson led the world on disability policy. My right hon. Friend the Member for Wythenshawe was the world's first disability Minister. He was a Labour Minister, and we are as proud of him tonight as we were throughout his years in government. He knew that, in the decade that began in 1970, we were setting an agenda of health, services and benefits for disabled people. His Chronically Sick and Disabled Persons Act 1970 was in its way revolutionary and must be revisited.
We moved on and, in the mid-1980s my Disabled Persons (Services, Consultation and Representation) Act 1986 excited the House. It was certainly fine that we managed to get the Bill through. I hope to return to that later in my speech. In the late 1980s and 1990s, the disability policy agenda moved further forward, and now we must move to tackle not just disadvantage, but discrimination.
It is Labour and, in fairness, other Opposition parties—but not the Conservatives—who have reflected the demand of disabled people for comprehensive and enforceable civil rights. A succession of Bills was presented by my right hon. and hon. Friends, and on a succession of Fridays hon. Members of all parties and all parts of Great Britain and Northern Ireland voted on them. We must also acknowledge that some Tory Back Benchers also supported our proposed legislation. So impressed were they that three of them crossed the Floor.
Civil rights for disabled people are not matters of dry legal entitlement or some formal claim to equal treatment. Disabled people are not just the stuff of political lobbying or pleading special interest: their rights constitute the vital, legitimate interests of more than 6 million of our fellow citizens. They relate to the blind boy who was about to leave school and who told me about being rejected at a job interview the moment the personnel manager saw his white stick although he could have done the job just as well as anybody else. They also relate to the woman who was refused admission to a cinema because she was in a wheelchair and the one space for a wheelchair in the cinema had been set aside for somebody else.
105 The debate is about the disabled citizens and voters, identified by Scope in its survey of the last general election, who were forced to vote in the streets because no one had thought to make polling stations accessible. In our nation, a disabled person is three times more likely to be unemployed, and six times more likely to be turned down for a job, than anyone else. The average income of disabled workers is just 80 per cent. of the national average income. If ever there was a case for the minimum wage that is it, and I proudly proclaim it.
The case involving ICI, which was brought to our attention by my hon. Friend the Member for Makerfield (Mr. McCartney), was a blatant example of disabled people being exploited, but we heard nothing from Conservative Members about it. In our nation, only one teacher in a thousand is disabled. That has many implications when we suggest that schools ought to be part of our community in every sense. There are only 80,000 accessible homes in Britain, but 4.25 million of our citizens have mobility-related impairments.
The Parliament began with the Government giving the impression that discrimination against disabled people did not exist. What we have witnessed since then does the Conservative party no credit either in the House or outside. The Berry Bill, as it was called, was piloted by my hon. Friend the Member for Kingswood (Mr. Berry) and was backed by a majority of hon. Members. The Government initially claimed that it would cost £17 billion—a ridiculous figure which they have never used again. We saw the disgraceful spectacle of the hon. Member for Sutton and Cheam (Lady Olga Maitland) and the right hon. Member for Chelsea (Sir N. Scott) talking out the Bill. The right hon. Member for Chelsea at least had the decency to apologise to the House.
It is no wonder that disabled people are cynical and sceptical about politicians when they are faced with the tawdry and dirty tactics of Conservative Members. It is no wonder that the recent MIND survey "Not Just Sticks and Stones" shows that the number of disabled people who blame politicians for the discrimination that they face is larger than the number who blame anyone else, including the people whom they encounter day by day. The Government talked out the Bill against the wishes of all Opposition parties.
The right hon. Member for Chelsea was made a scapegoat, and was relieved of ministerial office. He was replaced by the right hon. Member for Richmond, Yorks (Mr. Hague), who made an art form of wringing his hands with concern while washing them of responsibility. At least he was allowed to introduce legislation, which the right hon. Member for Chelsea was never permitted to do in six years in office. That was disgraceful. The Disability Discrimination Act 1995 came as a fig leaf to cover the Government's earlier embarrassment. It was a missed opportunity.
The Government were so terrified that a civil rights Act would eventually be passed that we were offered their tepid Bill, which was a fine example of legislation inspired by panic, not policy. Their White Paper failed even to mention education or transport. The Bill included rail stations and bus termini, but ignored trains and buses. It took a debate and a reasoned amendment on Second Reading for the Government to realise that they had forgotten to include provision for Northern Ireland.
106 The Act abolished the 3 per cent. employment quota and proclaimed to introduce in its place the right to equal treatment at work, but it excluded from that right disabled people working for smaller companies, which account for 94 per cent. of British firms. What a disgrace. The Government claimed that they wanted to outlaw discrimination, that the Act was sincere and well thought out, and that it was rooted in a genuine commitment to the 6.5 million disabled people who demanded full and comprehensive civil rights. However much the Tories patronise disabled people, their measures show that they view them as an irritation, and none of their legislation will be remembered.
In their amendment to the motion, the Government have the effrontery to compare themselves with other European Union nations. Have they considered the implications of their claims? Their amendment does not mention article 3 of the German constitution, which outlaws discrimination. It says:Nobody shall be discriminated against because of a disability.Their amendment does not mention the Danish equal opportunities centre for disabled persons, which was established in 1993 as a watchdog for disabled people, and can bring discrimination cases before the Danish authorities.
I am surprised that the Government's amendment does not mention the Commission on the Status of People with Disabilities, established by the Government in Ireland, which, following extensive consultation, including more than 6,000 submissions, among other proposals, has recommended a fully fledged civil rights disability Act. The Irish Government expect to legislate this year.
Let us consider the Government's policy on mental health, community care and direct payments. Last year, I led for Labour on the Community Care (Direct Payments) Bill. Once again the Conservative Government were introducing a measure in response to demands from disabled people. Having accepted the principle that disabled people should be enabled to organise and pay for their own services by receiving direct payments, Ministers could not overcome their Conservative inclination to limit those new freedoms to as few people as possible. That is why at first they tried to exclude people with learning disabilities as if those service users were incapable of making an informed judgment about their own needs, no matter how well advised they were. The Government backed down on that, but as with civil rights and disability discrimination, they did so only because the parliamentary arithmetic forced their hand.
Above all, the Government refused to allow disabled people over 65 even to apply for direct payments, adding further to the disadvantage faced by older people. Even after the Government lost in Committee not once, but twice, on that issue, they insisted on excluding older disabled people from direct payments for the first 12 months. What utter meanness. They repeatedly rejected our arguments for creating a level playing field as between recipients of direct payments from local councils and recipients of independent living payments from the Department of Social Security, even though many people receive both.
The Government failed to take the opportunity to provide for registration of domiciliary care providers to meet the concern of disabled and elderly people about 107 establishing a common national standard for carers who work in people's homes. Disabled and elderly people are entitled to protection from society.
The Community Care (Direct Payments) Act 1996 was just one example of Tory mismanagement of community care, the Government's lack of commitment and understanding of measures that they have been forced into, and their failure to see them through.
The Government's mental health policy has been a complete failure. We all know of cases in our constituencies. Time and again we are faced with the evidence of a system that is failing. It cannot be right that nearly one third of NHS beds for people with mental health problems have been cut since 1989, yet we still await the appropriate community facilities. It cannot be right that for many people the first time their mental disability is recognised is when they are assessed by a prison medical unit. It cannot be right that only one in five people diagnosed as having schizophrenia and living in the community have access to a community psychiatric nurse. The Audit Commission concluded:Good comprehensive community care for people with mental health problems is slow to develop and its lack of implementation is causing major concern.I trust that that is reflected in our considerations tonight.
The Government's community care policy has provided inadequate care for those in need and inadequate protection for the general public. I am happy to congratulate the work of my hon. Friend the Member for Stockport (Ms Coffey). Her expertise and commitment are well known.
A new Labour Government will be committed to raising standards and ending the lottery in community care so that people have access to care regardless of where they live. As we have made clear many times, we shall establish a royal commission to work out a fair system for funding long-term care for elderly and disabled people. Nothing less will do. The cares identified by Sir Roy Griffiths have become greater still and invite support for that recommendation.
Mencap is particularly concerned about the treatment that people with learning disabilities receive in hospital. The recent community health report, "Hungry in Hospital" revealed that some people with learning disabilities were not eating while in hospital, as catering contractors were merely placing food in front of them without recognising their need for help. The report said that the uneaten food is cleared away at the end of the meal time, and that there is no follow-up action to establish why the food is not being eaten.
There is a great deal of anecdotal evidence, of which I am sure right hon. and hon. Members must be aware, of people with learning disabilities getting wrong or inappropriate treatment in hospital. In another case—[Interruption.] I do not see this as a source of amusement. In another case highlighted for me by Mencap, a young woman was sent home with an untreated broken leg because she could not explain the pain that she was in and the medical staff were not sufficiently trained to help her communicate effectively.
108 People with learning disabilities are often denied the full range of dental care.People like this do not take care of their teeth",one mother was told. Her disabled son had his teeth extracted when a filling would have been sufficient. Such things are a disgrace to modern Britain and must be put right, but a new Labour Government will set our sights even higher and take our agenda one step further. We will demonstrate our commitment to health and social services, in contrast with the past miserable 18 years of Tory neglect.
I welcome the chance to look again at my Disabled Persons (Services, Consultation and Representation) Act 1986, remembering that, after much huffing and puffing, the Government finally backed down and the Bill became law. Half that Act is still to be implemented, which is absolutely shameful and, above all, a shameful disregard for legislation passed by the House. The National Health Service and Community Care Act 1990 provides only the right to assessment, and fails to ensure service provision. Our commitment to the agenda of health and social services is without question—and the people know it, as every opinion poll shows, and as I am sure we will see again on Thursday.
The Disability Discrimination Act 1995 was an opportunity missed. That is why a Labour Government will act quickly. We will create a disability rights commission in place of the two separate bodies that advise Ministers: the National Advisory Council on Employment of People with Disabilities and the National Disability Council. The commission will advise Ministers on a range of issues affecting disabled people. It will be encouraged to be proactive and not just a talking shop. It will work on what changes to the law are necessary and how we can best deliver full civil rights to all Britain's 6.5 million disabled people.
We will act on the commission and further initiatives in consultation with interested parties because we believe that employers, service providers and disabled people themselves should be fully involved in setting out the route that we should follow. In Northern Ireland, we will follow the same principles. I was delighted to visit the constituency of the hon. Member for Belfast, South (Rev. Martin Smyth) just a few weeks ago, and I welcome, too, his speech.
Labour in power will want to go very much further than any Government have ever gone. We believe in a dialogue, but not of the deaf such as we have witnessed under this Government, who claimed to consult but ignored the results of consultation. We will want to move the agenda forward once again, as we did by introducing the NHS, bringing it up to date to meet needs. Just as we will build on the agenda of health and social services begun by my right hon. Friend the Member for Wythenshawe so we will deliver our commitment to civil rights. Just as we will build on that agenda, we will move to a new agenda for disabled people, of skills, knowledge and opportunity—an agenda for the new century which affirms that we have pursued for and with disabled people better social services, health care, social security benefits, independent living and civil rights. We will do that to enable disabled people to make the most of their talents and abilities. [Interruption.] It appals me that Ministers are mocking the rights of disabled people. In time, the people of this country will give their response.
109 We shall ensure that disabled people have access to the education, training and employment opportunities that should belong to us all. We commit ourselves to that progress. In five and 10 years' time people will be able to judge our objectives by the results. All I ask tonight is that we judge the present Government on their record, ignoble though it is.
§ The Minister for Social Security and Disabled People (Mr. Alistair Burt)
Having heard the contributions from the hon. Member for Islington, South and Finsbury (Mr. Smith) and from the hon. Member for Monklands, West (Mr. Clarke), we all know why the motion is so long: they had precious little to say and no policy to convey.
We had an interesting debate until we got to the huff and puff of the past 15 minutes. In contrast with the hon. Member for Monklands, West I want to deal briefly with some of the points that we have heard.
There has been an overwhelming contrast between the two sides this evening. My hon. Friends achieved a sense of balance: they do not underestimate the problems of the health service and our ability to overcome those problems and deliver a good service. In contrast, Opposition Members hardly mentioned the good work done by so many people in the health service. [Interruption.] No, it is true. There was a constant attempt to draw attention to all the problems rather than to anything else.
My right hon. Friend the Member for Wealden (Sir G. Johnson Smith) began with a recognition of the excellence of the staff and the work that they do. The hon. Member for Southwark and Bermondsey (Mr. Hughes), to whom we all enjoy listening, made an interesting contribution. He directed the arrow straight at the hon. Member for Islington, South and Finsbury, who pointedly refused to take his intervention, which would clearly have been about committing money to the national health service, by skilfully turning his back throughout. No wonder the hon. Member for Southwark and Bermondsey described Labour's motion as desperately, sadly politically wanting. What an indictment. For once the hon. Gentleman was absolutely right.
My hon. Friend the Member for Chipping Barnet (Sir S. Chapman), in an excellent contribution, went to the heart of some of the issues that the Government have to face about how to reconcile new techniques, new technologies and advances in medicine with the everyday experiences of people who often want the status quo to remain. When there are difficult decisions to take about how to improve services—sometimes by closing down one facility in order to develop another—difficulties can arise.
My hon. Friend faced that problem by describing the situation in Barnet. He gave us a clue about how to face those difficult challenges, in contrast to the contributions from Opposition Members, who seem to take the line that we should save everything and preserve everything. However, when a new facility opens in their area, they go around smiling for the photographers and take some of the credit.
110 The hon. Member for Liverpool, Broadgreen (Mrs. Kennedy), in her, as usual, interesting contribution, spoke about some of the problems in Liverpool, especially those concerning the hospitals trust. No Conservative Member would condone in any way any massaging of the figures. The hon. Lady will be aware that some of the allegations made about the figures have been disputed by the trust, and an investigation is being conducted.
There was an interesting exchange in two sequential speeches by the hon. Member for Hemsworth (Mr. Trickett) and my hon. Friend the Member for Croydon, North-East (Mr. Congdon). They both mentioned GP fundholding, which was a theme of the debate. The hon. Gentleman described the situation in his constituency where nearly all the doctors are GP fundholders. They are now doing minor operations and expanding their surgeries. The hon. Gentleman seemed to suggest that that was not good news, because of the impact on the local hospitals. As my hon. Friend asked, why do GPs want to provide such services and why do their patients want them? How do hospitals respond when GPs do that work? I would have thought that we all want to expand facilities to allow our constituents to be treated closer to home. If surgeries can provide such services, that is good. As my hon. Friend pointed out, there is no reason for any GP to feel excluded by the system of fundholding, because all GPs can join in.
The acid test is whether one wants to improve services to the level provided by the best or—as the hon. Member for Islington, South and Finsbury suggested Labour would—take away the good to provide poorer services for everyone. There is an interesting contrast between our two approaches.
My hon. Friend the Member for Gillingham (Mr. Couchman) gave us a welcome reminder of the importance of private medicine in the mix of care. He spoke as someone who is an NHS patient, as is his wife. His speech was devoid of cant and he talked about the importance of private health care in a mixed economy. He missed out only a reference to the growing number of workers who enjoy the benefits of private health insurance, either on their own initiative or through their unions. That gives the lie to the Opposition's claims, because trade unionists show by their actions what they think of the availability of mixed care. They have more sense about the future of health care than Opposition Members will ever have.
The hon. Member for Belfast, South (Rev. Martin Smyth) raised two issues that I wish to address. He spoke about the acute hospitals reorganisation project in Belfast. The third report from the project steering group, which is led by Dr. James McKenna, contains proposals on 16 specialties, including maternity services. The steering group and my hon. Friend the Under-Secretary with responsibility for health in Northern Ireland have consulted widely. My hon. Friend has met several delegations to hear their views, especially on the maternity services proposals. He is considering all the arguments, but his primary concern is to make decisions that will be in the best interests of all patients. I assure the hon. Gentleman that his comments have been noted. I have also noted his comments on waiting lists. I am sure that he will be glad to hear that an additional £2 million has been made available to the boards to help keep down waiting lists.
111 The hon. Member for Ellesmere Port and Neston (Mr. Miller) makes good contributions to health service debates, but he cannot reject my accusation that this debate has been timed with the by-election in mind. It was raised in several speeches. My hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland), in an excellent speech, pointed to the Opposition's failure to promise more finance.
The final part of the motion mentions the Government's record on disabled people. The description by the hon. Member for Monklands, West was a travesty. He knows that he and his party cannot hold a candle to the Government's record on disability matters, including increases in expenditure and improvements in opportunities for disabled people. That record deserves recognition. The hon. Gentleman rightly paid tribute to the right hon. Member for Manchester, Wythenshawe (Mr. Morris) who was the first Minister for disabled people in the world, but several of my colleagues have also made significant contributions. I single out especially my right hon. Friend the Member for Chelsea (Sir N. Scott), who made a distinctive contribution to the care of disabled people while he was a Minister.
A range of measures dealing with disability have been brought in by this Government, and our record is second to none. In employment, we have introduced the access to work scheme, which plays a substantial role in providing disabled people with the help that they need to obtain and retain jobs and promotion. The programme's budget has been increased to £19 million. The Employment Service last year helped place 87,500 disabled people in jobs and enabled another 6,000 people to retain their positions.
The major changes that the Government have made in the way in which social care is delivered have meant that disabled, elderly and vulnerable people in need of public support have been given greater choice and better support tailored to their individual needs. In lieu of telling us anything about his policy, the hon. Member for Monklands, West has promised a royal commission on community care. I am sure that that is the first known example of the Opposition seeking the long grass in the absence of any policy that they may have.
Our reforms have culminated in the first-rate work done on the Disability Discrimination Act 1995, our most significant development and the flagship of our policy on disabled people. It is better than its would-be predecessors because the other Bills were flawed. The Act will make a distinctive contribution to the history of social legislation in the United Kingdom. Many events throughout the centuries have marked the beginning of a new era—the creation of the welfare state being one—and the Disability Discrimination Act will be one of those.
Until the introduction of the Act, disabled people were powerless in the face of discrimination, and the hon. Member for Monklands, West gave a number of examples of such discrimination. They have been discriminated against when applying for jobs, promotion and training, and they have been refused services in shops, restaurants and clubs. They have been powerless to do anything about that until now. Under the Disability Discrimination Act, employers can be held to account in industrial tribunals for unjustifiably discriminating against a person because of his or her disability. Service providers can be taken to 112 court for unjustifiably discriminating against their disabled customers. The hon. Member for Belfast, South and others should not mistake the absence of a commission for a lack of determination to enforce the law as, through tribunals and the courts, it can and will be enforced. The flaw with a commission is that it has no budget, and the hon. Member for Monklands, West has retreated again this evening from a position that he previously held on this matter.
The key points of this evening's debate have become clear. The Labour party—having shed the convictions of its past—is now wholly negative about the national health service, and it has only a vacuum where its policy should be. On key criterion after key criterion in terms of the success of policies on health and disability, this Government score highly. Memories of Labour's past failures should encourage a respectful silence from that party.
On hospital building, it was the Labour party that reduced by some 28 per cent. capital expenditure on the health service, while we have increased it. It was under a Labour Government that nurses' pay fell. It was under a Labour Government that doctors' pay rose by only a small amount compared with what we have provided. Total spending on the NHS rose by 17 per cent. in real terms under Labour, but has risen by a massive 74 per cent. in real terms under this Government.
On disability, our expenditure for those most in need has quadrupled since 1978–79. On employment, 87,500 people have found jobs with the help of the Employment Service. On education—so important to disabled people and their families-50 per cent. of those designated as having special educational needs are now in the maintained sector.
On rights and opportunities for disabled people, we have put the Disability Discrimination Act on the statute book—a landmark piece of legislation throughout the European Community. The Act is balanced and responsible in recognising the hopes and aspirations of disabled people, while taking the responsibilities and obligations of the rest of society into account—particularly those who provide employment, goods and services.
Having retreated from their original hostility to the Act, the Opposition now know that it cannot be repealed. The hon. Member for Monklands, West simply offers a sop in the shape of a commission that does not have a budget.
§ Mr. Burt
No. The cost of putting together the National Advisory Council on the Employment of People with Disabilities and the National Disability Council would not amount to bringing together one single, decent case. A commission could not do the job. The House, my right hon. and hon. Friends and the country as a whole will see in our handling of such sensitivities that only a Conservative Government can find the means and can afford to care for the vulnerable people in society. Our stewardship of the NHS and of those who are disabled and vulnerable gives the lie to everything that the hon. Member for Monklands, West has been saying. Our record, compared with the Opposition's, shows that there is only one side of the House to trust on this issue.
§ Question, That the Question be now put, put and agreed to.
§ Question put accordingly, That the original words stand part of the Question:—
§ The House divided: Ayes 281, Noes 311.117
|Division No. 81]||[9.59 pm|
|Abbott, Ms Diane||Cunningham, Rt Hon Dr John|
|Adams, Mrs Irene||Dalyell, Tam|
|Ainger, Nick||Darling, Alistair|
|Allen, Graham||Davidson, Ian|
|Alton, David||Davies, Bryan (Oldham C)|
|Anderson, Donald (Swansea E)||Davies, Chris (Littleborough)|
|Anderson, Ms Janet (Ros'dale)||Davies, Rt Hon Denzil (Llanelli)|
|Armstrong, Ms Hilary||Davies, Ron (Caerphilly)|
|Ashdown, Rt Hon Paddy||Davis, Terry (B'ham Hodge H)|
|Ashton, Joseph||Denham, John|
|Austin-Walker, John||Dewar, Rt Hon Donald|
|Banks, Tony (Newham NW)||Dixon, Rt Hon Don|
|Barron, Kevin||Dobson, Frank|
|Battle, John||Donohoe, Brian H|
|Bayley, Hugh||Dowd, Jim|
|Beckett, Rt Hon Mrs Margaret||Dunwoody, Mrs Gwyneth|
|Bell, Stuart||Eagle, Ms Angela|
|Benn, Rt Hon Tony||Eastham, Ken|
|Bennett, Andrew F||Ennis, Jeff|
|Benton, Joe||Etherington, Bill|
|Bermingham, Gerald||Evans, John (St Helens N)|
|Berry, Roger||Fatchett, Derek|
|Betts, Clive||Faulds, Andrew|
|Blair, Rt Hon Tony||Field, Frank (Birkenhead)|
|Blunkett, David||Fisher, Mark|
|Boateng, Paul||Flynn, Paul|
|Boyes, Roland||Foster, Rt Hon Derek|
|Bradley, Keith||Foster, Don (Bath)|
|Bray, Dr Jeremy||Foulkes, George|
|Brown, Rt Hon Gordon||Fraser, John|
|(Dunfermline E)||Fyfe, Mrs Maria|
|Brown, Nicholas (Newcastle E)||Galloway, George|
|Burden, Richard||Gapes, Mike|
|Byers, Stephen||Garrett, John|
|Caborn, Richard||Gerrard, Neil|
|Callaghan, Jim||Gilbert, Rt Hon Dr John|
|Campbell, Mrs Anne (C'bridge)||Godman, Dr Norman A|
|Campbell, Menzies (Fife NE)||Godsiff, Roger|
|Campbell, Ronnie (Blyth V)||Golding, Mrs Uin|
|Campbell-Savours, D N||Gordon, Ms Mildred|
|Canavan, Dennis||Grant, Bernie (Tottenham)|
|Cann, Jamie||Griffiths, Nigel (Edinburgh S)|
|Chidgey, David||Griffiths, Win (Bridgend)|
|Chisholm, Malcolm||Grocott, Bruce|
|Church, Ms Judith||Gunnell, John|
|Clapham, Michael||Hain, Peter|
|Clark, Dr David (S Shields)||Hall, Mike|
|Clarke, Eric (Midlothian)||Hanson, David|
|Clarke, Tom (Monklands W)||Hardy, Peter|
|Clwyd, Mrs Ann||Harman, Ms Harriet|
|Coffey, Ms Ann||Harvey, Nick|
|Cohen, Harry||Hattersley, Rt Hon Roy|
|Connarty, Michael||Henderson, Doug|
|Cook, Frank (Stockton N)||Heppell, John|
|Cook, Rt Hon Robin (Livingston)||Hill, Keith (Streatham)|
|Corbett, Robin||Hinchliffe, David|
|Corbyn, Jeremy||Hodge, Ms Margaret|
|Corston, Ms Jean||Hoey, Kate|
|Cousins, Jim||Hogg, Norman (Cumbernauld)|
|Cox, Tom||Home Robertson, John|
|Cummings, John||Hoon, Geoffrey|
|Cunliffe, Lawrence||Howarth, Alan (Stratfd-on-A)|
|Cunningham, Jim (Cov'try SE)||Howarth, George (Knowsley N)|
|Howells, Dr Kim||Oakes, Rt Hon Gordon|
|Hoyle, Doug||O'Brien, Mike (N Warks)|
|Hughes, Kevin (Doncaster N)||O'Brien, William (Normanton)|
|Hughes, Robert (Ab'd'n N)||O'Hara, Edward|
|Hughes, Roy (Newport E)||Olner, Bill|
|Hughes, Simon (Southwark)||O'Neill, Martin|
|Hutton, John||Orme, Rt Hon Stanley|
|Illsley, Eric||Paisley, Rev Ian|
|Ingram, Adam||Parry, Robert|
|Jackson, Ms Glenda (Hampst'd)||Pearson, Ian|
|Jackson, Mrs Helen (Hillsborough)||Pendry, Tom|
|Jamieson, David||Pickthall, Colin|
|Janner, Greville||Pike, Peter L|
|Jenkins, Brian D (SE Staffs)||Pope, Greg|
|Johnston, Sir Russell||Powell, Sir Raymond (Ogmore)|
|Jones, Barry (Alyn & D'side)||Prentice, Mrs Bridget|
|Jones, Jon Owen (Cardiff C)||(Lewisham E)|
|Jones, Dr Lynne||Prentice, Gordon (Pendle)|
|(B'ham Selly Oak)||Presoott, Rt Hon John|
|Jones, Martyn (Clwyd SW)||Primarolo, Ms Dawn|
|Jones, Nigel (Cheltenham)||Purchase, Ken|
|Jowell, Ms Tessa||Quin, Ms Joyce|
|Kaufman, Rt Hon Gerald||Radice, Giles|
|Keen, Alan||Randall, Stuart|
|Kennedy, Mrs Jane (Broadgreen)||Raynsford, Nick|
|Khabra, Piara S||Reid, Dr John|
|Kilfoyle, Peter||Rendel, David|
|Lestor, Miss Joan (Eccles)||Robertson, George (Hamilton)|
|Lewis, Terry||Robinson, Geoffrey (Cov'try NW)|
|Lidded, Mrs Helen||Robinson, Peter (Belfast E)|
|Litherland, Robert||Roche, Mrs Barbara|
|Livingstone, Ken||Rogers, Allan|
|Lloyd, Tony (Stretf'd)||Rooker, Jeff|
|Llwyd, Elfyn||Rooney, Terry|
|Loyden, Eddie||Ross, Ernie (Dundee W)|
|Lynne, Ms Liz||Rowlands, Ted|
|McAllion, John||Ruddock, Ms Joan|
|McAvoy, Thomas||Sedgemore, Brian|
|McCartney, Ian (Maketfld)||Sheerman, Barry|
|McCartney, Robert (N Down)||Sheldon, Rt Hon Robert|
|Macdonald, Calum||Shore, Rt Hon Peter|
|McFall, John||Skinner, Dennis|
|McKelvey, William||Smith, Andrew (Oxford E)|
|Mackinlay, Andrew||Smith, Chris (Islington S)|
|McLeish, Henry||Smith, Llew (Blaenau Gwent)|
|Maclennan, Robert||Smyth, Rev Martin (Belfast S)|
|McMaster, Gordon||Snape, Peter|
|McNamara, Kevin||Soley, Clive|
|MacShane, Denis||Spellar, John|
|Madden, Max||Squire, Ms Rachel|
|Mahon, Mrs Alice||(Dunfermline W)|
|Mandelson, Peter||Steel, Rt Hon Sir David|
|Marek, Dr John||Steinberg, Gerry|
|Marshall, David (Shettleston)||Stott, Roger|
|Marshall, Jim (Leicester S)||Strang, Dr Gavin|
|Martlew, Eric||Straw, Jack|
|Maxton, John||Sutcliffe, Gerry|
|Meacher, Michael||Taylor, Mrs Ann (Dewsbury)|
|Meale, Alan||Taylor, Matthew (Truro)|
|Michael, Alun||Thompson, Jack (Wansbeck)|
|Michie, Bill (Shef'ld Heeley)||Thumham, Peter|
|Milburn, Alan||Timms, Stephen|
|Miller, Andrew||Tipping, Paddy|
|Mitchell, Austin (Gt Grimsby)||Touhig, Don|
|Molyneaux, Rt Hon Sir James||Trickett, Jon|
|Moonie, Dr Lewis||Turner, Dennis|
|Morgan, Rhodri||Vaz, Keith|
|Morley, Elliot||Walker, Rt Hon Sir Harold|
|Morris, Rt Hon Alfred (Wy'nshawe)||Walley, Ms Joan|
|Morris, Ms Estelle (B'ham Yardley)||Wardell, Gareth (Gower)|
|Morris, Rt Hon John (Abenavon)||Wareing, Robert N|
|Mowlam, Ms Marjorie||Watson, Mike|
|Mudie, George||Welsh, Andrew|
|Mullin, Chris||Wicks, Malcolm|
|Murphy, Paul||Williams, Rt Hon Alan|
|Nicholson, Miss Emma (W Devon)||(Swansea W)|
|Williams, Alan W (Carmarthen)||Wright, Dr Tony|
|Wilson, Brian||Young, David (Bolton SE)|
|Wise, Mrs Audrey||Tellers for the Ayes:|
|Worthington, Tony||Mr. David Clelland and Mr. Robert Ainsworth|
|Ainsworth, Peter (E Surrey)||Couchman, James|
|Aitken, Rt Hon Jonathan||Cran, James|
|Alexander, Richard||Currie, Mrs Edwina|
|Alison, Rt Hon Michael (Selby)||Curry, Rt Hon David|
|Allason, Rupert (Torbay)||Davies, Quentin (Stamf'd)|
|Amess, David||Davis, Rt Hon David (Boothferry)|
|Ancram, Rt Hon Michael||Day, Stephen|
|Arbuthnot, James||Deva, Nirj Joseph|
|Arnold, Jacques (Gravesham)||Devlin, Tim|
|Arnold, Sir Thomas (Hazel G)||Dicks, Terry|
|Ashby, David||Dorrell, Rt Hon Stephen|
|Atkins, Rt Hon Robert||Rt Hon Lord James|
|Atkinson, David (Bour'mth E)||Dover, Den|
|Atkinson, Peter (Hexham)||Duncan, Alan|
|Baker, Rt Hon Kenneth (Mole V)||Duncan Smith, Iain|
|Baker, Sir Nicholas (N Dorset)||Dunn, Bob|
|Baldry, Tony||Durant, Sir Anthony|
|Banks, Matthew (Southport)||Eggar, Rt Hon Tim|
|Banks, Robert (Harrogate)||Elletson, Harold|
|Bates, Michael||Emery, Rt Hon Sir Peter|
|Batiste, Spencer||Evans, David (Wetwyn Hatf'ld)|
|Bellingham, Henry||Evans, Jonathan (Brecon)|
|Bendall, Vivian||Evans, Nigel (Ribble V)|
|Beresford, Sir Paul||Evans, Roger (Monmouth)|
|Biffen, Rt Hon John||Evennett, David|
|Body, Sir Richard||Faber, David|
|Bonsor, Sir Nicholas||Fabricant, Michael|
|Booth, Hartley||Fenner, Dame Peggy|
|Boswell, Tim||Field, Barry (Isle of Wight)|
|Bottomley, Peter (Eltham)||Fishbum, Dudley|
|Bottomley, Rt Hon Mrs Virginia||Forman, Nigel|
|Bowden, Sir Andrew||Forsyth, Rt Hon Michael (Stirling)|
|Bowis, John||Forth, Rt Hon Eric|
|Boyson, Rt Hon Sir Rhodes||Fowler, Rt Hon Sir Norman|
|Brandreth, Gyles||Fox, Dr Liam (Woodspring)|
|Brazier, Julian||Fox, Rt Hon Sir Marcus (Shipley)|
|Bright, Sir Graham||Freeman, Rt Hon Roger|
|Brooke, Rt Hon Peter||French, Douglas|
|Brown, Michael (Brigg Cl'thorpes)||Fry, Sir Peter|
|Browning, Mrs Angela||Gale, Roger|
|Bruce, Ian (S Dorset)||Gallie, Phil|
|Budgen, Nicholas||Gardiner, Sir George|
|Burns, Simon||GareKJones, Rt Hon Tristan|
|Burt, Alistair||Gamier, Edward|
|Butcher, John||Gill, Christopher|
|Butler, Peter||Gillan, Mrs Cheryl|
|Butterfill, John||Goodlad, Rt Hon Alastair|
|Carlisle, John (Luton N)||Goodson-Wickes, Dr Charles|
|Carlisle, Sir Kenneth (Linc'n)||Gorman, Mrs Teresa|
|Carrington, Matthew||Gorst, Sir John|
|CartBss, Michael||Grant, Sir Anthony (SW Cambs)|
|Cash, William||Greenway, Harry (Ealing N)|
|Channon, Rt Hon Paul||Greenway, John (Ryedale)|
|Chapman, Sir Sydney||Griffiths, Peter (Portsmouth N)|
|Churchill, Mr||Grylls, Sir Michael|
|Clappison, James||Gummer, Rt Hon John|
|Clark, Dr Michael (Rochf'd)||Hague, Rt Hon William|
|Clarke, Rt Hon Kenneth||Hamilton, Rt Hon Sir Archibald|
|(Rushcliffe)||Hamilton, Neil (Tatton)|
|Clifton-Brown, Geoffrey||Hampson, Dr Keith|
|Coe, Sebastian||Hanley, Rt Hon Jeremy|
|Congdon, David||Hannam, Sir John|
|Conway, Derek||Hargreaves, Andrew|
|Coombs, Anthony (Wyre F)||Harris, David|
|Coombs, Simon (Swindon)||Hawkins, Nick|
|Cope, Rt Hon Sir John||Hawksley, Warren|
|Cormack, Sir Patrick||Hayes, Jerry|
|Heald, Oliver||Nicholls, Patrick|
|Heath, Rt Hon Sir Edward||Nicholson, David (Taunton)|
|Heathcoat-Amory, Rt Hon David||Norris, Steve|
|Hendry, Charles||Onslow, Rt Hon Sir Cranley|
|Heseltine, Rt Hon Michael||Oppenheim, Phillip|
|Higgins, Rt Hon Sir Terence||Ottaway, Richard|
|Hill, Sir James (Southampton Test)||Page, Richard|
|Hogg, Rt Hon Douglas (Grantham)||Paice, James|
|Horam, John||Patnick, Sir Irvine|
|Hordem, Rt Hon Sir Peter||Patten, Rt Hon John|
|Howard, Fit Hon Michael||Pattie, Rt Hon Sir Geoffrey|
|Howell, Rt Hon David (Guildf'd)||Pawsey, James|
|Howell, Sir Ralph (N Norfolk)||Peacock, Mrs Elizabeth|
|Hughes, Robert G (Harrow W)||Pickles, Eric|
|Hunt, Rt Hon David (Wirral W)||Porter, David|
|Hunt, Sir John (Ravensb'ne)||Portillo, Rt Hon Michael|
|Hunter, Andrew||Powell, William (Corby)|
|Hurd, Rt Hon Douglas||Rathbone, Tim|
|Jack, Pit Hon Michael||Redwood, Rt Hon John|
|Jackson, Robert (Wantage)||Renton, Rt Hon Tim|
|Jenkin, Bernard (Colchester N)||Richards, Rod|
|Jessel, Toby||Riddick, Graham|
|Johnson Smith,||Rifkind, Rt Hon Malcolm|
|Rt Hon Sir Geoffrey||Robathan, Andrew|
|Jones, Gwilym (Cardiff N)||Roberts, Rt Hon Sir Wyn|
|Jones, Robert B (W Herts)||Robertson, Raymond S (Ab'd'n S)|
|Kellett-Bowman, Dame Elaine||Robinson, Mark (Somerton)|
|Key, Robert||Roe, Mrs Marion|
|King, Rt Hon Tom||Rowe, Andrew|
|Kirkhope, Timothy||Rumbold, Rt Hon Dame Angela|
|Knapman, Roger||Ryder, Rt Hon Richard|
|Knight, Mrs Angela (Erewash)||Sackville, Tom|
|Knight, Rt Hon Greg (Derby N)||Sainsbury, Rt Hon Sir Timothy|
|Knight, Dame Jill (Edgbaston)||Scott, Rt Hon Sir Nicholas|
|Knox, Sir David||Shaw, David (Dover)|
|Kynoch, George||Shaw, Sir Giles (Pudsey)|
|Lait, Mrs Jacqui||Shephard, Rt Hon Mrs Gillian|
|Lamont, Rt Hon Norman||Shepherd, Sir Colin (Herefd)|
|Lang, Rt Hon Ian||Shepherd, Richard (Aldridge)|
|Lawrence, Sir Ivan||Shersby, Sir Michael|
|Legg, Barry||Sims, Sir Roger|
|Leigh, Edward||Skeet, Sir Trevor|
|Lennox-Boyd, Sir Mark||Smith, Sir Dudley (Warwick)|
|Lester, Sir Jim (Broxtowe)||Smith, Tim (Beaconsf'ld)|
|Lidington, David||Soames, Nicholas|
|Lilley, Rt Hon Peter||Speed, Sir Keith|
|Uoyd, Rt Hon Sir Peter (Fareham)||Spencer, Sir Derek|
|Lord, Michael||Spicer, Sir Jim (W Dorset)|
|Luff, Peter||Spicer, Sir Michael (S Worcs)|
|Lyell, Rt Hon Sir Nicholas||Spink, Dr Robert|
|MacGregor, Rt Hon John||Spring, Richard|
|MacKay, Andrew||Sproat, lain|
|Maclean, Rt Hon David||Squire, Robin (Homchurch)|
|McNair-Wilson, Sir Patrick||Stanley, Rt Hon Sir John|
|Maitland, Lady Olga||Steen, Anthony|
|Major, Rt Hon John||Stephen, Michael|
|Malone, Gerald||Stern, Michael|
|Marland, Paul||Stewart, Allan|
|Marshall, John (Hendon S)||Streeter, Gary|
|Marshall, Sir Michael (Arundel)||Sumberg, David|
|Martin, David (Portsmouth S)||Sweeney, Walter|
|Mates, Michael||Sykes, John|
|Mawhinney, Rt Hon Dr Brian||Tapsell, Sir Peter|
|Mayhew, Rt Hon Sir Patrick||Taylor, Ian (Esher)|
|Mellor, Rt Hon David||Taylor, John M (Solihull)|
|Merchant, Piers||Taylor, Sir Teddy|
|Mitchell, Andrew (Gedling)||Temple-Morris, Peter|
|Mitchell, Sir David (NW Hants)||Thomason, Roy|
|Moate, Sir Roger||Thompson, Sir Donald (Calder V)|
|Monro, Rt Hon Sir Hector||Thompson, Patrick (Norwich N)|
|Montgomery, Sir Fergus||Thornton, Sir Malcolm|
|Moss, Malcolm||Townend, John (Bridlington)|
|Needham, Rt Hon Richard||Townsend, Sir Cyril (Bexl'yh'th)|
|Nelson, Anthony||Tracey, Richard|
|Neubert, Sir Michael||Tredinnick, David|
|Newton, Rt Hon Tony||Trend, Michael|
|Trotter, Neville||Whittingdale, John|
|Twinn, Dr Ian||Widdecombe, Rt Hon Miss Ann|
|Vaughan, Sir Gerard||Wiggin, Sir Jerry|
|Viggers, Peter||Wilkinson, John|
|Waldegrave, Rt Hon William||Willetts, David|
|Walden, George||Wilshire, David|
|Walker, Bill (N Tayside)||Winterton, Mrs Ann (Congleton)|
|Waller, Gary||Winterton, Nicholas (Macdesf'ld)|
|Ward, John||Wolfson, Mark|
|Wardle, Charles (Bexhill)||Yeo, Tim|
|Waterson, Nigel||Young, Rt Hon Sir George|
|Wells, Bowen||Tellers for the Noes:|
|Wheeler, Rt Hon Sir John||Mr. Timothy Wood and Mr. Patrick McLoughlin.|
|Whitney, Sir Raymond|
§ 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 311, Noes 279.121
|Division No. 82]||[10.16 pm|
|Ainsworth, Peter (E Surrey)||Carlisle, Sir Kenneth (Linc'n)|
|Aitken, Rt Hon Jonathan||Carrington, Matthew|
|Alexander, Richard||Carttiss, Michael|
|Alison, Rt Hon Michael (Selby)||Cash, William|
|Allason, Rupert (Torbay)||Channon, Rt Hon Paul|
|Amess, David||Chapman, Sir Sydney|
|Ancram, Rt Hon Michael||Churchill, Mr|
|Arbuthnot, James||Clappison, James|
|Arnold, Jacques (Gravesham)||Clark, Dr Michael (Rochf'd)|
|Arnold, Sir Thomas (Hazel G)||Clarke, Rt Hon Kenneth|
|Aspinwall, Jack||Clifton-Brown, Geoffrey|
|Atkins, Rt Hon Robert||Coe, Sebastian|
|Atkinson, David (Bour'mth E)||Congdon, David|
|Atkinson, Peter (Hexham)||Conway, Derek|
|Baker, Rt Hon Kenneth (Mole V)||Coombs, Anthony (Wyre F)|
|Baker, Sir Nicholas (N Dorset)||Coombs, Simon (Swindon)|
|Baldry, Tony||Cope, Rt Hon Sir John|
|Banks, Matthew (Southport)||Cormack, Sir Patrick|
|Banks, Robert (Harrogate)||Couchman, James|
|Bates, Michael||Cran, James|
|Batiste, Spencer||Currie, Mrs Edwina|
|Bellingham, Henry||Curry, Rt Hon David|
|Bendall, Vivian||Davies, Quentin (Stamf'd)|
|Beresford, Sir Paul||Davis, Rt Hon David (Boothferry)|
|Biffen, Rt Hon John||Day, Stephen|
|Body, Sir Richard||Deva, Nirj Joseph|
|Bonsor, Sir Nicholas||Devlin, Tim|
|Booth, Hartley||Dicks, Terry|
|Boswell, Tim||Dorrell, Rt Hon Stephen|
|Bottomley, Peter (Eltham)||Douglas-Hamilton,|
|Bottomley, Rt Hon Mrs Virginia||Rt Hon Lord James|
|Bowden, Sir Andrew||Dover, Den|
|Bowis, John||Duncan, Alan|
|Boyson, Rt Hon Sir Rhodes||Duncan Smith, lain|
|Brandreth, Gyles||Dunn, Bob|
|Brazier, Julian||Durant, Sir Anthony|
|Bright, Sir Graham||Eggar, Rt Hon Tim|
|Brooke, Rt Hon Peter||Elletson, Harold|
|Brown, Michael (Brigg Cl'thorpes)||Emery, Rt Hon Sir Peter|
|Browning, Mrs Angela||Evans, David (Welwyn Hatf'ld)|
|Bruce, Ian (S Dorset)||Evans, Jonathan (Brecon)|
|Budgen, Nicholas||Evans, Nigel (Ribble V)|
|Burns, Simon||Evans, Roger (Monmouth)|
|Burt, Alistair||Evennett, David|
|Butcher, John||Faber, David|
|Butler, Peter||Fabricant, Michael|
|Butterfill, John||Fenner, Dame Peggy|
|Carlisle, John (Luton N)||Field, Barry (Isle of Wight)|
|Fishburn, Dudley||Lang, Rt Hon Ian|
|Forman, Nigel||Lawrence, Sir Ivan|
|Forsyth, Rt Hon Michael (Stirling)||Legg, Barry|
|Forth, Rt Hon Eric||Leigh, Edward|
|Fowler, Rt Hon Sir Norman||Lennox-Boyd, Sir Mark|
|Fox, Dr Liam (Woodspring)||Lester, Sir Jim (Broxtowe)|
|Fox, Rt Hon Sir Marcus (Shipley)||Lidington, David|
|Freeman, Rt Hon Roger||Lilley, Rt Hon Peter|
|French, Douglas||Lloyd, Rt Hon Sir Peter (Fareham)|
|Fry, Sir Peter||Lord, Michael|
|Gale, Roger||Luff, Peter|
|Gallie, Phil||Lyell, Rt Hon Sir Nicholas|
|Gardiner, Sir George||MacGregor, Rt Hon John|
|GareKJones, Rt Hon Tristan||MacKay, Andrew|
|Garnier, Edward||Maclean, Rt Hon David|
|Gill, Christopher||McNair-Wilson, Sir Patrick|
|Gillan, Mrs Cheryl||Maitland, Lady Olga|
|Goodlad, Rt Hon Alastair||Major, Rt Hon John|
|Goodson-Wickes, Dr Charles||Malone, Gerald|
|Gorman, Mrs Teresa||Marland, Paul|
|Gorst, Sir John||Marshall, John (Hendon S)|
|Grant, Sir Anthony (SW Cambs)||Marshall, Sir Michael (Arundel)|
|Greenway, Harry (Ealing N)||Martin, David (Portsmouth S)|
|Greenway, John (Ryedale)||Mates, Michael|
|Griffiths, Peter (Portsmouth N)||Mawhinney, Rt Hon Dr Brian|
|Grylls, Sir Michael||Mayhew, Rt Hon Sir Patrick|
|Gummer, Rt Hon John||Mellor, Rt Hon David|
|Hague, Rt Hon William||Merchant, Piers|
|Hamilton, Rt Hon Sir Archibald||Mitchell, Andrew (Gedling)|
|Hamilton, Neil (Tatton)||Mitchell, Sir David (NW Hants)|
|Hampson, Dr Keith||Moate, Sir Roger|
|Hanley, Rt Hon Jeremy||Monro, Rt Hon Sir Hector|
|Hannam, Sir John||Montgomery, Sir Fergus|
|Hargreaves, Andrew||Moss, Malcolm|
|Harris, David||Needham, Rt Hon Richard|
|Hawkins, Nick||Nelson, Anthony|
|Hawksley, Warren||Neubert, Sir Michael|
|Hayes, Jerry||Newton, Rt Hon Tony|
|Heald, Oliver||Nicholls, Patrick|
|Heath, Rt Hon Sir Edward||Nicholson, David (Taunton)|
|Heathcoat-Amory, Rt Hon David||Norris, Steve|
|Hendry, Charles||Onslow, Rt Hon Sir Cranley|
|Heseltine, Rt Hon Michael||Oppenheim, Phillip|
|Higgins, Rt Hon Sir Terence||Ottaway, Richard|
|Hill, Sir James (Southampton Test)||Page, Richard|
|Hogg, Rt Hon Douglas (Grantham)||Paice, James|
|Horam, John||Patnick, Sir Irvine|
|Hordem, Rt Hon Sir Peter||Patten, Rt Hon John|
|Howard, Rt Hon Michael||Pattie, Rt Hon Sir Geoffrey|
|Howell, Rt Hon David (Guildf'd)||Pawsey, James|
|Howell, Sir Ralph (N Norfolk)||Peacock, Mrs Elizabeth|
|Hughes, Robert G (Harrow W)||Pickles, Eric|
|Hunt, Rt Hon David (Wirral W)||Porter, David|
|Hunt, Sir John (Ravensb'ne)||Portillo, Rt Hon Michael|
|Hunter, Andrew||Powell, William (Corby)|
|Hurd, Rt Hon Douglas||Rathbone, Tim|
|Jack, Rt Hon Michael||Redwood, Rt Hon John|
|Jackson, Robert (Wantage)||Renton, Rt Hon Tim|
|Jenkin, Bernard (Colchester N)||Richards, Rod|
|Jessel, Toby||Riddick, Graham|
|Johnson Smith,||Rifkind, Rt Hon Malcolm|
|Rt Hon Sir Geoffrey||Robathan, Andrew|
|Jones, Gwilym (Cardiff N)||Roberts, Rt Hon Sir Wyn|
|Jones, Robert B (W Herts)||Robertson, Raymond S (Ab'd'n S)|
|Kellett-Bowman, Dame Elaine||Robinson, Mark (Somerton)|
|Key, Robert||Roe, Mrs Marion|
|King, Rt Hon Tom||Rowe, Andrew|
|Kirkhope, Timothy||Rumbold, Rt Hon Dame Angela|
|Knapman, Roger||Ryder, Rt Hon Richard|
|Knight, Mrs Angela (Erewash)||Sackville, Tom|
|Knight, Rt Hon Greg (Derby N)||Sainsbury, Rt Hon Sir Timothy|
|Knight, Dame Jill (Edgbaston)||Scott, Rt Hon Sir Nicholas|
|Knox, Sir David||Shaw, David (Dover)|
|Kynoch, George||Shaw, Sir Giles (Pudsey)|
|Lait, Mrs Jacqui||Shephard, Rt Hon Mrs Gillian|
|Lamont, Rt Hon Norman||Shepherd, Sir Colin (Heref'd)|
|Shepherd, Richard (Aldridge)||Townsend, Sir Cyril (Bexl'yh'th)|
|Shersby, Sir Michael||Tracey, Richard|
|Sims, Sir Roger||Tredinnick, David|
|Skeet, Sir Trevor||Trend, Michael|
|Smith, Sir Dudley (Warwick)||Trotter, Neville|
|Smith, Tim (Beaconsf'ld)||Twinn, Dr Ian|
|Soames, Nicholas||Vaughan, Sir Gerard|
|Speed, Sir Keith||Viggers, Peter|
|Spencer, Sir Derek||Waldegrave, Rt Hon William|
|Spicer, Sir Jim (W Dorset)||Walden, George|
|Spicer, Sir Michael (S Worcs)||Walker, Bill (N Tayside)|
|Spink, Dr Robert||Waller, Gary|
|Spring, Richard||Ward, John|
|Sproat, Iain||Wardle, Charles (Bexhill)|
|Squire, Robin (Hornchutch)||Waterson, Nigel|
|Stanley, Rt Hon Sir John||Watts, John|
|Steen, Anthony||Wells, Bowen|
|Stephen, Michael||Wheeler, Rt Hon Sir John|
|Stern, Michael||Whitney, Sir Raymond|
|Stewart, Allan||Whittingdale, John|
|Streeter, Gary||Widdecombe, Rt Hon Miss Ann|
|Sumberg, David||Wiggin, Sir Jerry|
|Sweeney, Walter||Wlkinson, John|
|Sykes, John||Willetts, David|
|Tapsell, Sir Peter||Wilshire, David|
|Taylor, Ian (Esher)||Winterton, Mrs Ann (Congleton)|
|Taylor, John M (Solihull)||Wnterton, Nicholas (Macdesf'ld)|
|Taylor, Sir Teddy||Wolfson, Mark|
|Temple-Morris, Peter||Yeo, Tim|
|Thomason, Roy||Young, Rt Hon Sir George|
|Thompson, Sir Donald (Calder V)|
|Thompson, Patrick (Norwich N)||Tellers for the Ayes:|
|Thornton, Sir Malcolm||Mr. Timothy Wood and Mr. Patrick McLoughlin|
|Townend, John (Bridlington)|
|Abbott, Ms Diane||Canavan, Dennis|
|Adams, Mrs Irene||Cann, Jamie|
|Ainger, Nick||Chidgey, David|
|Allen, Graham||Chisholm, Malcolm|
|Alton, David||Church, Ms Judith|
|Anderson, Donald (Swansea E)||Clapham, Michael|
|Anderson, Ms Janet (Ros'dale)||Clark, Dr David (S Shields)|
|Armstrong, Ms Hilary||Clarke, Eric (Midlothian)|
|Ashdown, Rt Hon Paddy||Clarke, Tom (Monklands W)|
|Ashton, Joseph||Clwyd, Mrs Ann|
|Austin-Walker, John||Coffey, Ms Ann|
|Banks, Tony (Newham NW)||Cohen, Harry|
|Barron, Kevin||Connarty, Michael|
|Battle, John||Cook, Frank (Stockton N)|
|Bayley, Hugh||Cook, Rt Hon Robin (Livingston)|
|Beckett, Rt Hon Mrs Margaret||Corbett, Robin|
|Bell, Stuart||Corbyn, Jeremy|
|Benn, Rt Hon Tony||Corston, Ms Jean|
|Bennett, Andrew F||Cousins, Jim|
|Benton, Joe||Cox, Tom|
|Bermingham, Gerald||Cummings, John|
|Berry, Roger||Cunliffe, Lawrence|
|Betts, Clive||Cunningham, Jim (Cov'try SE)|
|Blair, Rt Hon Tony||Cunningham, Rt Hon Dr John|
|Blunkett, David||Dalyell, Tarn|
|Boateng, Paul||Darling, Alistair|
|Boyes, Roland||Davidson, Ian|
|Bradley, Keith||Davies, Bryan (Oldham C)|
|Bray, Dr Jeremy||Davies, Chris (Littleborough)|
|Brown, Rt Hon Gordon||Davies, Rt Hon Denzil (Llanelli)|
|(Dunfermline E)||Davies, Ron (Caerphilly)|
|Brown, Nicholas (Newcastle E)||Davis, Terry (B'ham Hodge H)|
|Burden, Richard||Denham, John|
|Byers, Stephen||Dewar, Rt Hon Donald|
|Cabom, Richard||Dixon, Rt Hon Don|
|Callaghan, Jim||Dobson, Frank|
|Campbell, Mrs Anne (C'bridge)||Donohoe, Brian H|
|Campbell, Menzies (Fife NE)||Dowd, Jim|
|Campbell, Ronnie (Blyth V)||Dunwoody, Mrs Gwyneth|
|Campbell-Savours, D N||Eagle, Ms Angela|
|Eastham, Ken||Litheriand, Robert|
|Ennis, Jeff||Livingstone, Ken|
|Etherington, Bill||Uoyd, Tony (Stretf'd)|
|Evans, John (St Helens N)||Uwyd, Elfyn|
|Fatchett, Derek||Loyden, Eddie|
|Faulds, Andrew||Lynne, Ms Liz|
|Field, Frank (Birkenhead)||McAllion, John|
|Fisher, Mark||McAvoy, Thomas|
|Flynn, Paul||McCartney, Ian (Makeifld)|
|Foster, Rt Hon Derek||McCartney, Robert (N Down)|
|Foster, Don (Bath)||Macdonald, Calum|
|Foulkes, George||McFall, John|
|Fraser, John||McKelvey, Wlliam|
|Fyfe, Mrs Maria||Mackinlay, Andrew|
|Galloway, George||McLeish, Henry|
|Gapes, Mike||Maclennan, Robert|
|Garrett, John||McMaster, Gordon|
|Gerrard, Neil||McNamara, Kevin|
|Gilbert, Rt Hon Dr John||MacShane, Denis|
|Godman, Dr Norman A||Madden, Max|
|Godsiff, Roger||Mahon, Mrs Alice|
|Golding, Mrs Llin||Mandelson, Peter|
|Gordon, Ms Mildred||Marek, Dr John|
|Grant, Bernie (Tottenham)||Marshall, David (Shettleston)|
|Griffiths, Nigel (Edinburgh S)||Marshall, Jim (Leicester S)|
|Griffiths, Win (Bridgend)||Martlew, Eric|
|Grocott, Bruce||Maxton, John|
|Gunnell, John||Meacher, Michael|
|Hain, Peter||Meale, Alan|
|Hall, Mike||Michael, Alun|
|Hanson, David||Michie, Bill (Shef'ld Heeley)|
|Hardy, Peter||Milburn, Alan|
|Harman, Ms Harriet||Miller, Andrew|
|Harvey, Nick||Mitchell, Austin (Gt Grimsby)|
|Hattersley, Rt Hon Roy||Moonie, Dr Lewis|
|Henderson, Doug||Morgan, Rhodri|
|Heppell, John||Morley, Elliot|
|Hill, Keith (Streatham)||Morris, Rt Hon Alfred (Wy'nshawe)|
|Hinchliffe, David||Morris, Ms Estelle (B'ham Yardley)|
|Hodge, Ms Margaret||Morris, Rt Hon John (Aberavon)|
|Hoey, Kate||Mowlam, Ms Marjorie|
|Hogg, Norman (Cumbernauld)||Mudie, George|
|Home Robertson, John||Mullin, Chris|
|Hoon, Geoffrey||Murphy, Paul|
|Howarth, Alan (Stratf'd-on-A)||Nicholson, Miss Emma (W Devon)|
|Howarth, George (Knowsley N)||Oakes, Rt Hon Gordon|
|Howells, Dr Kim||O'Brien, Mike (N Warks)|
|Hoyle, Doug||O'Brien, William (Normanton)|
|Hughes, Kevin (Doncaster N)||O'Hara, Edward|
|Hughes, Robert (Ab'd'n N)||Olner, Bill|
|Hughes, Roy (Newport E)||O'Neill, Martin|
|Hughes, Simon (Southwark)||Orme, Rt Hon Stanley|
|Hutton, John||Paisley, Rev Ian|
|lllsley, Eric||Parry, Robert|
|Ingram, Adam||Pearson, Ian|
|Jackson, Ms Glenda (Hampst'd)||Pendry, Tom|
|Jackson, Mrs Helen (Hillsborough)||Pickthall, Colin|
|Jamieson, David||Pike, Peter L|
|Janner, Greville||Pope, Greg|
|Jenkins, Brian D (SE Staffs)||Powell, Sir Raymond (Ogmore)|
|Johnston, Sir Russell||Prentice, Mrs Bridget|
|Jones, Barry (Alyn & D'side)||(Lewisham E)|
|Jones, Jon Owen (Cardiff C)||Prentice, Gordon (Pendle)|
|Jones, Dr Lynne||Prescott, Rt Hon John|
|(B'ham Selly Oak)||Primarolo, Ms Dawn|
|Jones, Martyn (Clwyd SW)||Purchase, Ken|
|Jones, Nigel (Cheltenham)||Quin, Ms Joyce|
|Jowell, Ms Tessa||Radice, Giles|
|Kaufman, Rt Hon Gerald||Randall, Stuart|
|Keen, Alan||Raynsford, Nick|
|Kennedy, Mrs Jane (Broadgreen)||Reid, Dr John|
|Khabra, Piara S||Rendel, David|
|Kilfoyle, Peter||Robertson, George (Hamilton)|
|Lestor, Miss Joan (Eccles)||Robinson, Geoffrey (Cov'tryNW)|
|Lewis, Terry||Robinson, Peter (Belfast E)|
|Liddell, Mrs Helen||Roche, Mrs Barbara|
|Rogers, Allan||Thurnham, Peter|
|Rooker, Jeff||Timms, Stephen|
|Rooney, Terry||Tipping, Paddy|
|Ross, Emie (Dundee W)||Touhig, Don|
|Rowlands, Ted||Trickett, Jon|
|Ruddock, Ms Joan||Trimble, David|
|Sedgemore, Brian||Turner, Dennis|
|Sheerman, Barry||Vaz, Keith|
|Sheldon, Rt Hon Robert||Walker, Rt Hon Sir Harold|
|Shore, Rt Hon Peter||Walley, Ms Joan|
|Short, Clare||Wardell, Gareth (Gower)|
|Skinner, Dennis||Wareing, Robert N|
|Smith, Andrew (Oxford E)||Watson, Mike|
|Smith, Chris (Islington S)||Welsh, Andrew|
|Smith, Llew (Blaenau Gwent)||Williams Rt Hon Alan|
|Soley, Clive||(Swansea W)|
|Spellar, John||Williams, Alan W (Carmarthen)|
|Squire, Ms Rachel||Wilson, Brian|
|(Dunfermline W)||Winnick, David|
|Steel, Rt Hon Sir David||Wise, Mrs Audrey|
|Steinberg, Gerry||Worthington, Tony|
|Stott, Roger||Wray, Jimmy|
|Strang, Dr Gavin||Wright, Dr Tony|
|Straw, Jack||Young, David (Bolton SE)|
|Taylor, Mrs Ann (Dewsbury)||Tellers for the Noes:|
|Taylor, Matthew (Truro)||Mr. David Clelland and Mr. Robert Ainsworth|
|Thompson, Jack (Wansbeck)|
§ Question accordingly agreed to.
§ MADAM SPEAKER forthwith declared the main Question, as amended, to be agreed to.
§ That this House is committed to the National Health Service as a public service, promoting health and providing high-quality care more quickly than ever before; expresses its support for the continuing development of primary care and community health services; welcomes the Government's commitment to a growing budget for the National Health Service throughout the next five years; supports the Government's policies to increase independence, choice and opportunities for people with disabilities; and welcomes the introduction of the Disability Discrimination Act 1995 as a landmark in legislation for disabled people, of which there is no equal in the European Union.