Commons Sitting of 21 January 1997

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

  KING'S COLLEGE LONDON BILL [Lords]
  Order for Third Reading read.
  To be read the Third time on Tuesday 28 January.

Oral Answers to Questions
  HEALTH

    Capitation Funding (Nottingham Health Authority)
    Mr. Tipping: To ask the Secretary of State for Health what level of capitation funding the Nottingham health authority will receive in 1997–98. [10356]
    The Parliamentary Under-Secretary of State for Health (Mr. John Horam): In 1997–98, Nottingham health authority will receive an integrated allocation of £285.6 million—a cash increase over this year of £12.1 million.
    Mr. Tipping: Will the Minister confirm that, under the capitation formula, Nottingham will next year receive a growth in funding of 0.34 per cent. over this year? Given that fact, will it not take another seven years for it to reach 100 per cent. formula funding? The Queen's medical centre has not carried out non-urgent operations since November. Should not Nottingham people and Nottingham health services receive a fair share of the cake?
    Mr. Horam: I hear what the hon. Gentleman says, but I note that Sir David White, the chairman of Nottingham health authority, said that Nottingham's funding in the next year is in line with that authority's proposals for development, and that
    "Due to a better than expected national settlement for the NHS and the case put forward by the authority … I am happy to say that the prospects for the development of our local services—and the maintenance of excellence—looks more certain for next year."
    While I understand what the hon. Gentleman says, we can offer him much faster progress in seven years. The hon. Gentleman should be worrying about the Labour Government after the next general election. Will they be able to maintain the progress that we have made in the past 18 years?
    Sir Jim Lester: Does my hon. Friend understand that those of us who seek the return of a Conservative Government recognise that both parties acknowledge that
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    Nottingham needs the additional money? The settlement is a step in the right direction, but it is only one step and we want considerably more money, year on year, to restore us to the correct position of parity with other similar teaching areas.
    Mr. Horam: As I said in reply to the hon. Member for Sherwood (Mr. Tipping), he has got a far better deal out of this Government than he will ever get out of a Labour Government. Progress was made last year and this year, and will be made next year—if a Conservative Government are re-elected, funding for health authorities will ensure that progress is made in every year to come. I am sure that my hon. Friend looks forward to the re-election of a Conservative Government.

    National Health Service Funding
    Mr. Loyden: To ask the Secretary of State for Health what representations he has received from the Centre for Policy Studies concerning the future funding of the national health service. [10357]
    The Secretary of State for Health (Mr. Stephen Dorrell): I have received no such representations.
    Mr. Loyden: Will the Minister confirm that a pamphlet recently issued by the Centre for Policy Studies, the author of which was a special adviser to the former Secretary of State for Health, now the Chancellor of the Exchequer, proposed that future policy on the NHS should involve the introduction of top-up fees and vouchers? Does not that show that it is now undeniable that a Conservative Government serving their fifth term would abolish the national health service as we know it and as its founders intended it to be?
    Mr. Dorrell: The hon. Gentleman asks me about the future funding of the national health service. The Government's policy on that is set out not by the director of the Centre for Policy Studies, but by the Prime Minister. He set it out clearly at the Conservative party conference, when he laid down a challenge, which the Labour Front Bench has so far refused to take up. A re-elected Conservative Government will increase real-terms funding for the health service through the life of the next Parliament, year by year by year by year by year. When will we hear from Labour Front Benchers how they will match that pledge?
    Mrs. Roe: Is my right hon. Friend aware that the Centre for Policy Studies document "A Conservative Agenda" congratulated the Government on their record of increasing NHS funding since 1979? Does he agree that it is only against a background of guaranteed financial growth throughout the next Parliament that the NHS can continue to thrive?
    Mr. Dorrell: My hon. Friend is precisely right. The CPS made another suggestion—that we should abolish the regional health authorities. The Government have already done so and delivered as a result £100 million of administrative savings. That was done over the opposition of Labour's Front Benchers, who would be taken a great

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    deal more seriously on the question of administrative savings if they ever voted for one, instead of voting against them.
    Mr. Simon Hughes: The Secretary of State and I probably agree that the health service needs more money, although we would disagree about how much. I would argue for more than he would and both he and I would argue for more than the Labour party would.
    Mr. Campbell-Savours: Where did the hon. Gentleman get that line from?
    Mr. Hughes: From Labour's figures.
    Laying that argument to one side for the moment, will the Secretary of State accept that there is one area on which we can agree immediately—that, for one year, we could halt all closures while an independent body such as the King's Fund assessed demand and supply in the health service, so that we could at least agree on the facts before returning to the debate about money?
    Mr. Dorrell: With great respect to the hon. Gentleman, I do not believe that it is in the interests of the health service or, most important, its patients to freeze the development of the health service. We need to have a service that uses a growing budget, year by year, to deliver improving service to patients. That is the commitment that the present Government give. The commitment given by the Opposition is that they invite patients and the health service to rely on the hon. Member for Islington, South and Finsbury (Mr. Smith), who told Pulse,
    "I'll fight my corner for NHS funding."
    We know what that means—he will lose his corner, as the right hon. Member for Dunfermline, East (Mr. Brown) made clear yesterday.
    Mr. Congdon: Does my right hon. Friend agree that the increase in real-terms funding for the NHS—of more than 70 per cent. since 1979—demonstrates the Government's continuing commitment to the NHS? Does he also agree that the record number of patients being treated, including the increase in the number of people having hip replacements and heart bypasses, also demonstrates that firm commitment to the NHS?
    Mr. Dorrell: My hon. Friend is exactly right. The figures for the past seven years are: an increase of a quarter in the real funding for the NHS and an increase of a third in the number of patients treated. That is the Government's record—extra funding, used efficiently to treat patients. It is a record that the Labour party cannot match in office and would not and cannot match now, ahead of a general election.
    Mr. Chris Smith: Is it not the case that the so-called promise made by the Prime Minister about year-on-year increases in real-terms funding for the health service was disavowed two months later by the Chancellor of the Exchequer, when he published the figures in the Red Book? Will the Secretary of State admit that page 142 of the Red Book shows clearly that, in the second year, the Government expect a fall in real-terms expenditure in the Department of Health and that, in year three, they expect
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    a standstill in real-terms expenditure in the Department of Health? Does not that show, first, that the Government have already broken the promise that they made at their party conference and, secondly, that they are not to be trusted with the health service or with the government of this country?
    Mr. Dorrell: Page 142 of the Red Book deals with excise duties, tobacco, fuel, air quality package, and alcohol. The hon. Gentleman cannot even get his page references right. He is probably referring to table 5A.1—
    Mr. Smith: No.
    Mr. Dorrell: I am looking at the 1997–98 Red Book, published in November 1996. The hon. Gentleman has the wrong reference.
    The substance of the hon. Gentleman's point, as he knows very well—we dealt with it repeatedly around Budget time—concerns the commitment set out in the Red Book to real-terms increases in NHS funding, provided at 3 per cent. growth in current funding for year one, and provided at more modest levels in years two and three. That still represents real growth, which the right hon. Member for Dunfermline, East will not allow the hon. Gentleman to match.
    Mr. John Marshall: Can my right hon. Friend confirm that the right hon. Member for Dunfermline, East (Mr. Brown) will not increase health service spending but will burden the health service with the costs of a national minimum wage, which will mean extra pay for manual workers in the health service and less money for patient care?
    Mr. Dorrell: My hon. Friend is exactly right. The right hon. Member for Dunfermline, East is so unconfident of his ability to deliver a growing economy that he knows he cannot match our commitment to the national health service. What is more, even the paltry budget that the slow-growing British economy under Labour would allow the hon. Member for Islington, South and Finsbury includes a prior commitment to abolishing compulsory competitive tendering. That will cost him £90 million. There is also a prior commitment to introducing a national minimum wage, which the right hon. Member for Livingston (Mr. Cook) was the last Labour spokesman to cost—at £500 million. That makes £590 million that will come out of patient care before the hon. Member for Islington, South and Finsbury can even begin to think about a growing health service.

    Mental Health Services
    Mr. Miller: To ask the Secretary of State for Health when he last met the chairmen of health authorities to discuss services for mentally ill people. [10358]
    The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns): I meet chairmen of health authorities whenever issues of mutual interest need to be discussed.
    Mr. Miller: Will the Minister comment on the report published today by the King's Fund commission? Does

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    he agree that it shows that, after 18 years of Conservative rule, London does not have a comprehensive mental health strategy? In the light of that report, will he also look carefully at the proposed mergers of NHS trusts such as the West Cheshire and Wirral Community Healthcare NHS trusts in my constituency, and ensure that any mergers are approved only on the basis of patient care and need, not managerial convenience?
    Mr. Burns: The King's Fund report, published today, is important in that it coincides with much of the work that we have done at the Department of Health on the provision of mental health services in London. No one could disagree that those services are under pressure. Unfortunately, since the creation of the NHS, both inside and outside the medical profession, mental health care has been the Cinderella service. That has been tackled over the past five years with significant increases in funding and targeted funding to deal with particular issues.
    The important issue that the report highlights—weighted capitation funding—has already been decided on by the Government; we have changed the system and implemented the proposal so as to improve comprehensive community services. In that respect we are one step ahead of the report.
    As for the hon. Gentleman's constituency point, the merger is subject to consultation, and a decision will be taken in due course. I know that he would not expect me to comment at this stage.
    Mrs. Ann Winterton: Does my hon. Friend accept that there is a gap in the services for mentally ill young people, and that the services offered for children and adults, many of the latter elderly, are not appropriate for this age group? Will he give support to voluntary groups, such as VISYON in Congleton, which seek to highlight the problem and to support mentally ill young people and their families?
    Mr. Burns: A great deal of work is going on with regard to young people and adolescents because of the problems that have arisen. One such problem is that, because of the age of that group, they have never been used to institutional care. As part of the programme of improving and developing a comprehensive mental health service, we have in place the children's and adolescent mental health programme. We are well aware of the problems facing that target group. More must be done in the area because, as I said earlier, in the past—since the creation of the health service—it has not had the same priority as, say, accident and emergency services. We welcome all input to improve and enhance the provision of care, from the voluntary sector as well as within the health service.
    Ms Coffey: As today's King's Fund report on mental health in London clearly shows that services in the inner city are in a state of near collapse, will the Minister explain the huge gap between his recent reassurances and the reality outlined in the report? Is he now finally prepared to accept that that Cinderella service is not providing care in the community for mentally ill people and their families or proper protection for the public in London or elsewhere?
    Mr. Burns: No, I do not accept that analysis. The hon. Lady is well aware that record sums of money are being
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    put into mental health care. For example, the mental health challenge fund, the mental illness specific grant and the £5 million emergency pressures fund are targeted where help is most needed. In addition, because by definition the problem is greater in London—because more people suffer from mental illness there—London receives a significant proportion of the available funding. It is important to build on everything that has been done to create a comprehensive and effective service that provides proper patient care. My right hon. Friend the Secretary of State announced last February a programme to ensure that health authorities draw up plans for a comprehensive community service for mental health. That is going ahead and being monitored. We shall continue to do that to ensure that we catch up and get the best service possible. That is how we should move forward, rather than carping and criticising at the margins.
    Sir Roger Sims: Services for mentally ill people include not only medical provision in hospital but the provision of adequate housing accommodation when patients are ready to leave hospital so that they do not block beds. May I suggest that my hon. Friend urges the chairmen of health authorities to work closely with local housing associations to ensure that appropriate housing is provided? May I also suggest that he discusses with his colleagues in the Department of the Environment the fact that they, too, should urge housing associations to make such provision and ensure that housing associations have the resources to do so?
    Mr. Burns: I hope that my hon. Friend is reassured that he has identified two important areas that are already at the crux of Government policy. We encourage housing authorities, housing associations, social services and health authorities to work together so that there is a multidisciplinary approach. That is the best way to cut through the problems and reach a solution as quickly as possible. Another area where the Government are doing a great deal of interrelated work is on drug and alcohol abuse, which is a contributory factor in much mental illness.

    Hospital Closures
    Mr. Skinner: To ask the Secretary of State for Health what are the latest figures for the number of hospitals closed since 1979. [10359]
    The Minister for Health (Mr. Gerald Malone): This information is not available centrally.
    Mr. Skinner: I am surprised that the Government have not fiddled those figures as well. All of us on Opposition Benches know the figures—they are in the Library. Since 1979, 20 per cent. of all hospitals have been closed by this lousy, rotten Government. That is the truth.
    On a day when we are told that 400 critically ill children have been turned away from intensive care in the past three months by the tawdry lot opposite, is it not a fitting epitaph for this Government that the national health service is now filled with patients on trolleys in corridors from the cradle to the grave? It is time that the Government got the sack.
    Mr. Malone: The hon. Gentleman's reference to the exercise by his own party earlier this morning will be exposed by my right hon. Friend in the debate that follows as a disgraceful ruse. The statistics for hospitals have never been collected centrally. That has been explained in a number of written answers, as the Opposition know. For a party that wants to cut bureaucracy, it would be bizarre if Labour started to collect those figures now, as they are far less relevant than the figures that show how many people are being treated in the NHS, which is what counts.
    The hon. Gentleman might be interested to know that, during the past few years, there has been an investment of £15 million in capital building in his health authority. Why does he not welcome that, along with the fact that more patients are being treated? That is what counts.
    Dame Jill Knight: Is it not also true that a great many new hospitals have been opened since 1979? Furthermore, is it not true that some hospitals, which were very old and not in a suitable state to serve the public properly, have been renovated, such as the general hospital in Birmingham, which is being converted to the new children's hospital? When Opposition Members speak like the hon. Member for Bolsover (Mr. Skinner), they show that they are dinosaurs who want hospitals built in the early 1900s to remain unchanged and unimproved.
    Mr. Malone: My hon. Friend is right to point that out. The hon. Member for Bolsover (Mr. Skinner) an expert in supporting outdated Victorian industrial practices, now seems to want to do the same for Victorian buildings and hospitals. There has been substantial investment in real estate in the NHS. That investment is now threatened by the Opposition, who do not accept the private finance initiative which will be responsible for the building of more hospitals in their constituencies. They would put that at risk.

    Redbridge and Waltham Forest Health Authority
    Mr. Gapes: To ask the Secretary of State for Health when he next plans to visit Redbridge to discuss the financial position of Redbridge and Waltham Forest health authority and the situation in local hospitals. [10360]
    Mr. Malone: The national health service executive is in regular contact with national health service Organisations on behalf of Ministers. I have no immediate plans to visit Redbridge and Waltham Forest health authority.
    Mr. Gapes: Why not? Does not the Minister know that, in my health authority, there is a £6 million deficit, that Whipps Cross hospital has cancelled elective admissions since just after Christmas because it cannot cope with accident and emergency admissions, and that King George hospital has 97 per cent. bed occupancy? People are frequently left on trolleys for 12, 15 or 20 hours. Why does not the Minister have the courage to come to my local hospital? I will take him there and show him the problems that the Government have created.
    Mr. Malone: If invited, I shall visit the hon. Gentleman's constituency, and I shall be delighted to see the excellent work that has been carried out by the trust in his health authority. He fails to recognise the
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    additional investment that has been made available for this year—an increase of £1.7 million in real terms, a further £4.4 million funding for strategic change and £845,000 for priority services for the rest of the year. Much of that money is now being deployed in trusts in the hon. Gentleman's constituency. I will gladly come along and celebrate the success of that fund as it builds even more facilities.
    Mr. Duncan Smith: I encourage my hon. Friend to visit that health authority. Notwithstanding any difficulties that it, like many other health authorities, experiences, will my hon. Friend point out that more than £23 million of capital expenditure has been put into the main hospital there, Whipps Cross hospital, which has resulted in brand new surgeries and a brand new accident and emergency wing, from which local people now benefit?
    Mr. Malone: A cross-party invitation is almost impossible to resist, even with a busy diary. If invited formally, I shall certainly try to make time to acknowledge the progress in the constituency of the hon. Member for Ilford, South (Mr. Gapes) and the progress to which my hon. Friend drew attention—progress that would not take place if a Government ever got into office who could not make the pledge made by the Prime Minister, that a Conservative Government would continue to fund the health service and to increase funding in real terms year on year.
    Ms Jowell: The nation would be reassured if the Minister would face up to the crisis that is confronting accident and emergency departments throughout the country. What does he have to say to the nurse whom I met recently at Edgware hospital—
    Madam Speaker: Order. This question refers to hospitals that are local to Redbridge and Waltham Forest.
    Ms Jowell: As at Whipps Cross hospital in Redbridge, which has also been gripped by crisis, the nurse said:
    "It has been like a war zone here. We have had to put up 18 beds in the minor injuries unit and the Government tells us that there is no crisis."
    When will the Government face the fact that there is a winter crisis in the national health service?
    Mr. Malone: I would be delighted to meet the ambulatory nurse to whom the hon. Lady refers. She seems to move with great felicity from one health authority to another, depending on the question that is posed. I would tell that nurse that I am sure that she recognises the investment that the Government have made in the health service. If the hon. Lady wants to set the nation's mind at rest, perhaps she and her Front-Bench colleagues could stop drumming up spoof reports—which are based on no facts whatsoever—to scare the public.

    Renal Services (Greater Manchester and Cheshire)
    Mr. Nicholas Winterton: To ask the Secretary of State for Health if he will make a statement on the provision of renal services in Greater Manchester and Cheshire. [10361]
    Mr. Horam: Health authorities serving Greater Manchester and south Cheshire have recently consulted the public on proposals to reorganise renal services in the area. The health authority that is co-ordinating the review is presenting its evaluation to all seven participating authorities this month. Afterwards, health authority members and others will have the opportunity to consider the proposals further.
    Mr. Winterton: Does my hon. Friend accept that renal failure is a complex illness that often needs the support of other specialties? Does he accept that Macclesfield community health council, which has conducted an in-depth inquiry into the matter and sought public views on the provision of renal services in Cheshire and Greater Manchester, has advanced the unanimous opinion that Wythenshawe hospital, under Dr. Mike Venning and his colleagues, would provide a wonderful hub for the provision of renal services? It found that it would be an advantage to retain three hubs—the Manchester royal infirmary, Hope hospital and Wythenshawe hospital—rather than reducing the hubs to two, with all the associated problems that that would create for those with renal diseases.
    Mr. Horam: I hear what my hon. Friend says. He raises an important point. I put it to him that this is a clinician-led review that involves a lot of capital investment. It will obviously be predicated on the desire to secure better health care for renal patients. I am delighted to tell my hon. Friend—the House will understand my relief in saying this, knowing my hon. Friend's formidable lobbying attributes—that it will include improved satellite facilities in Macclesfield which, as he knows, are not nurse or clinician-led at the moment. They will receive full medical support under the proposals.
    My hon. Friend will also understand that, if there is opposition to the proposals, or if the health authorities cannot agree on them, they will come to Ministers. In light of that, I must retain the independent view of Ministers to judge the proposals properly when they come before us. However, I shall certainly take into account the points raised by my hon. Friend.
    Mrs. Dunwoody: Would the Minister like to astonish us all by putting the patients' interests first? This is not a matter that can be decided by the ill-mannered fighting of individual consultants: it is a matter of providing high-quality satellite facilities to serve not just Macclesfield but any patient in south Cheshire who requires renal assistance. Will the Minister confirm that, as far as he is concerned, the quality of renal services will always take precedence over the particular interests of individual Members of Parliament?
    Mr. Horam: Of course that is the case. As I pointed out to my hon. Friend the Member for Macclesfield (Mr. Winterton), this is a clinician-led review with the object of putting more capital investment into a necessary area in order to provide a better service. I am sure that the proposals will achieve that aim, but we take into account all points of view—both those opposed and those in favour—when we consider them.

    GP Fundholding
    Mr. Butler: To ask the Secretary of State for Health how many residents of (a) Buckinghamshire and (b) Milton Keynes are served by fundholding general practitioners (i) as a percentage of the population and (ii) in total. [10362]
    Mr. Malone: The total registered population in Buckinghamshire covered by a fundholding general practitioner is appropriately 486,000. In Milton Keynes, fundholders serve around 156,000 people. Those figures represent 71 per cent. of the registered population of Buckinghamshire and 80 per cent. of the registered population of Milton Keynes.
    Mr. Butler: As a registered patient with one of the best fundholding GP practices, not just in Newport Pagnell and my constituency but in the country, may I invite my hon. Friend to join me in congratulating the doctors who have demonstrated that this policy works in providing an ever-improving and outstanding service to their patients? What advice would he give to my constituents and others who are anxious to continue to enjoy the benefits of GP fundholding after the next election?
    Mr. Malone: I am grateful to my hon. Friend for pointing out the excellent work that is being done not only by his GP fundholder but by others in his constituency. I extend that to across the country as well, where the majority of the population of England are now served by GP fundholders. There is a very simple answer to the question that he posed, because in the election one party will be pledged to abolish GP fundholding—the Labour party. The Conservative Government will sustain GP fundholding when re-elected, so my advice is pretty clear: vote Conservative.

    Health Service Savings
    Mr. Richards: To ask the Secretary of State for Health what assessment has been made of the likely savings to be made for the health services as a result of the measures contained in the Health Authorities Act 1995. [10363]
    Mr. Dorrell: Total annual savings as a result of the Health Authorities Act 1995 are estimated at £150 million: £100 million from the abolition of regional health authorities, and £50 million from the introduction of single, unified health authorities. Those savings will be used for direct patient care.
    Mr. Richards: Does my right hon. Friend recall that the savings from administration that he just announced were bitterly opposed by the Labour party? Will he confirm that an additional £300 million a year will be diverted to patient care from cuts in hospital bureaucracy? Therefore, is it realistic for the Labour party to claim that a further £100 million a year can be saved? Where would the money come from?
    Mr. Dorrell: My hon. Friend is absolutely right. There will be an extra £300 million a year for patient care as a result of the Government's squeeze on unnecessary administrative processes.

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    The hon. Member for Islington, South and Finsbury (Mr. Smith) loves talking about savings from reduced administration, but he is not serious about it. Indeed, so unserious is he that the Health Service Journal, which circulates among health service managers, says:
    "Managers will not lose their jobs, says Smith".
    So he will reduce costs on administration but he will not reduce the number of people in administration.
    Mr. McNamara: The Minister will be aware that, a fortnight ago, a patient from Leeds was sent to the intensive care unit in Hull, a journey of 60 miles, because there was no room in the Leeds intensive care unit. Last Tuesday, because of no room in the Hull royal infirmary intensive care unit, a constituent of mine, Mr. Dennis Drax, was sent to Leeds, another journey of 60 miles. Sadly, both patients died. How much of the new surplus will be given to our intensive care unit?
    Mr. Dorrell: The hon. Gentleman raises an important point; it is not directly relevant to this question, but I shall answer it none the less.
    Any individual case where the service may be seen to have failed will of course be investigated, but I hope that the hon. Gentleman will tell the House the whole story of intensive care referrals this winter. I hope that he will remind the House that, this winter, for the first time, every intensive care unit in the health service is connected to an emergency bed referral system, and that an intensive care clinician who needs to refer a patient to another intensive care unit has immediate access to availability in the health service for the first time. The hon. Gentleman might have spared time to welcome that development of service.

    Private Finance Initiative
    Mr. Jacques Arnold: To ask the Secretary of State for Health if he will make a statement on the development of the private finance initiative for the construction of new hospitals. [10364]
    Mr. Horam: Contracts have been signed for 43 private finance initiative schemes, with a total capital value of £317 million.
    Mr. Arnold: Does my hon. Friend remember that, three years ago, when the PFI policy was in its infancy and we were considering the prospects for a brand new district general hospital in Darenth park for the people of north-west Kent, the then spokesman on health for the Labour party, the hon. Member for Peckham (Ms Harman), derided the project as being on a B list and highly unlikely to take place? Will he tell the House what progress is being made with that project, and emphasise the excellent quality of the team in our local NHS trust and the very strong support for the project from the people of north-west Kent?
    Mr. Horam: If, indeed, it was on a B list when the Opposition said it was, it has done pretty well since. The Darenth park scheme is progressing extremely well and making good progress. As the House knows, my right hon. Friend the Secretary of State, not least among many others, has put a great deal of effort into introducing a successful product. I am glad to be able to say that he is
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    not alone. There are many schemes throughout the country that are benefiting from PFI, where otherwise there would perhaps be no hope of having a new hospital.
    Mr. Barron: Is the hon. Member for Gravesham (Mr. Arnold) aware that he has some support from the Opposition? He said in his last election manifesto that he had taken a leading role in securing the recently announced district general hospital. In fact, it has still not been agreed. We await the hon. Gentleman's next election manifesto.
    The Minister referred to 43 projects under the private finance initiative. Not one of them is a new hospital. The Tories have promised PFI hospitals since 1990 but not one has been delivered. The Secretary of State has promised the Prime Minister £500 million of new PFI hospital contracts by April, yet has not delivered £1.
    The Government have tried to sweeten PFI deals with tailor-made Acts, but have failed to do so. I understand that, last week, new guidelines were offered to prop up the PFI scheme by making available national health service budget building cuts.
    Is not the scenario that I have outlined jeopardising the future of our NHS? When will the Government clean up the mess and start to build new hospitals instead of talking about so doing?
    Mr. Horam: That was a long question. In turn, I will ask the hon. Gentleman a short question. Are the Opposition in favour of PFI or are they not? It is—
    Madam Speaker: Order. The Government are here to answer questions, not to ask them.
    Mr. Horam: We would like some answers, Madam Speaker.
    The hon. Gentleman seems not to understand that the proposal for a Norfolk and Norwich general hospital is indeed for a hospital. It will amaze hon. Members on both sides of the House in that area to learn from him that the proposal is not for a new general hospital. In fact, we all know that it is for a new general hospital. What is the hon. Gentleman talking about?
    Mr. Dunn: I remember a time when the International Monetary Fund, not the then Government, determined our health expenditure. Will my hon. Friend accept my thanks on behalf of the people of Dartford for all the help that he has given to the PFI, leading to the construction of a new district hospital with 400 beds—a state-of-the-art hospital—in my constituency, which was opposed by the Labour party throughout, by its Front-Bench spokesmen?
    Mr. Horam: That is a fact. The reality is that hospital projects are going forward throughout the country and not only in west Kent. We are seeing projects going forward in Norfolk and Norwich, Durham, Worcester and Carlisle. Such projects are progressing throughout the country as a result of the PFI, with no thanks to the Opposition, who have constantly sniped and accused us of privatisation, all to no effect.

    NHS Pay Awards
    Mr. Robert Ainsworth: To ask the Secretary of State for Health what assessment he has made of the efficacy of local pay bargaining as a means of determining pay awards for NHS staff. [10365]
    Mr. Dorrell: Local pay is delivering fair and affordable rewards to staff while supporting the development of flexible and responsive health services.
    Mr. Ainsworth: Is the Secretary of State aware of the recent comments made by Ken Jarrold, the director of human resources of the national health service executive? He said that local pay arrangements would be considered successful only if deals had been made in 50 per cent. of NHS trusts. Surely the right hon. Gentleman is aware that, to date, almost a year after the system was set up, settlements have been reached in only 25 per cent. of NHS trusts. Does he agree with the director's comments or does he not?
    Mr. Dorrell: The hon. Gentleman has got the facts wrong. As of last Friday, 228 trusts had agreed local deals with their staff. They represent 53 per cent. of all trusts. The substantive question that parties must answer is whether they are in favour of accepting the recommendations of the independent review bodies. The independent nurses' pay review body recommended a system of local pay. The question that every party must answer is whether it is in favour of the continuation of those review bodies and of respecting their advice. The Government are in favour of respecting their advice, which is why we accepted their recommendation in favour of local pay, and why we are implementing it.
    Mr. Bill Walker: Does my right hon. Friend remember a time when pay was agreed centrally, when there was civil war in the Labour party, and when there was a pay freeze, which led to the winter of discontent? Is that not the likely scenario ahead of us if we ever get a Labour Government?
    Mr. Dorrell: My hon. Friend has quite an authoritative figure on his side. No less a figure than the right hon. Member for Dunfermline, East (Mr. Brown) was busy yesterday warning nurses:
    "Pay squeeze here to stay, Brown warns the nurses".
    It will be interesting to see how quickly Labour Members have learnt their party's new lines when they meet members of the Royal College of Nursing in their constituencies.

  PRIME MINISTER

    Engagements
    Mrs. Anne Campbell: To ask the Prime Minister if he will list his official engagements for Tuesday 21 January. [10386]
    The Prime Minister (Mr. John Major): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.
    Mrs. Campbell: In April last year, the Health Secretary promised to deliver a proper level of paediatric intensive bed space. Will the Prime Minister explain to the House why, despite that promise, 15 critically ill children have been turned away from Addenbrooke's hospital in Cambridge in the past few months? Can he not keep any of his promises?
    The Prime Minister: The hon. Lady should check that her facts are accurate before she mistakenly sets out such policies. Every child needing a paediatric intensive care bed this winter has been found one. The bogus figures that the Labour party has produced can self-evidently be seen as bogus. Perhaps the hon. Lady would care to hear what Dr. David Hallworth, chairman of the independent Paediatric Intensive Care Society, said. He called Labour's claims "pretty meaningless", and very wisely added that this issue should not be
    "subject to party political point scoring."
    Sir Terence Higgins: Does the Prime Minister agree that the electorate are not naive? They know that a promise not to increase rates of income tax is not the same as a promise not to increase personal taxation. If one says that one wants a starting rate of 10p, that is utterly meaningless if one does not also say at what level it will start and how wide the band will be. Will my right hon. Friend comment on the Government's record on such matters?
    The Prime Minister: One simply needs to look at which was the last party to put up the basic rate of tax; and one recalls that it was the Labour party. One should look at which party has never supported a single Conservative tax cut and has done nothing to get the basic rate down to 23p—I think that Labour Members know that it is their party—at which party has supported absolutely no measures to control expenditure—the Labour party has supported none—and at which party has made £30 billion-worth of promises that it has not yet disclaimed, but that it must disclaim if it is to stand up its ludicrous claim that it will not increase taxes.
    Mr. Blair: The Conservative party's 22 tax rises since the last election must have slipped the Prime Minister's mind for a moment.
    May I return the Prime Minister to the point about intensive care beds for children? Does he accept that the figures given by hospitals of the number of children turned away—eventually found a bed in other hospitals, but turned away—are correct? If they are correct, how does that square with the Health Secretary's promise that the whole matter would be dealt with, and that there would be no repetition of that practice, given what happened last year?
    The Prime Minister: I said a moment ago that the report produced by the Labour party was alarmist nonsense. I repeat that point. Every child needing a paediatric intensive care bed this winter has been found one—
    Mrs. Ann Taylor: Not to the parents.
    The Prime Minister: Of course not to the parents—but, unless the hon. Lady will persuade the shadow Chancellor to provide more resources for health, I suggest that she and the right hon. Member for Sedgefield (Mr. Blair) should not criticise a service that is treating more people, and treating them better. Just occasionally, it would be wise of them to praise the health service for the way in which it deals with the growing demands of health care, rather than always criticising it.
    Mr. Blair: We do praise the national health service. We built the national health service. What we condemn is the Government's record on the national health service.
    May I put this to the Prime Minister? Of course it is the case that children are eventually found another bed—that was the case even in the tragic instance of Nicholas Geldard, which gave rise to this whole problem—but the Secretary of State for Health claimed that the business of having to go from hospital to hospital would stop. May I give the Prime Minister an instance from Bristol children's hospital? Since January this year—even this year—15 children, just at that hospital, have been turned away because of a shortage of beds. Does the Prime Minister accept—[Interruption.] Hon. Members may shout, but does the Prime Minister accept that we are talking not just about intensive care beds for children? Has he seen the report prepared on community care for the mentally ill, and what today's newspapers say about problems for doctors' practices? Can he not accept that there is a crisis in some parts of the national health service, and that it is not good enough for him and other Ministers just to conceal the true state of affairs this side of a general election?
    The Prime Minister: If there is a crisis, and the right hon. Gentleman is concerned about the language of priorities, why does he not match our pledge on spending in the national health service? If there is a crisis, why are more people being treated in the national health service than ever before? If there is a crisis, why have we met the charge set out by the shadow Foreign Secretary, the right hon. Member for Livingston (Mr. Cook), on whether our reforms are working—that is, whether more people are being treated?
    There are more intensive beds; there are more treatments; there are better treatments; there are speedier treatments. Unless the right hon. Member for Sedgefield is going to follow the lead that we have set in providing resources for the health service over the past 18 years, and committing ourselves to do so in the future, he is doing nothing more than seeking to make political capital out of a service that is dealing with a growing demand with great skill.
    Mr. Blair: May I put it to the Prime Minister that, over the past few years—since he has been in charge of the national health service—the service has been given 20,000 more managers but has 50,000 fewer nurses? Is it not the case that the national health service would be better if it were run as a proper co-operative service again, rather than hospital against hospital and doctor against doctor? The only party that will rebuild Britain's national health service is the party that created it.
    The Prime Minister: It is perfectly true that the Labour party established the national health service, and I offer it full credit for its role in following up the Beveridge report instituted earlier by an all-party Government; but it is the Conservative party that has built up the health service. We have been in power for two thirds of the period that has elapsed since then, and we have built up the health service from its beginnings into a service that is now recognised as the best in the world.
    The figures that the right hon. Gentleman quotes on managers are wrong. The impression that he consistently gives of the health service runs it down. It would be very refreshing if, just for once, Labour Members acknowledged that we have on our hands the most successful national health service in the world, which provides more and better treatments than ever before. The reality is that the people of this nation who use the health service understand that, even if the Labour party, using it as a political football, does not.
    Mr. Rathbone: During the course of today, when the Prime Minister looked back on his trip to the far east, did he remember seeing there a beautiful and very rare flower called the rafflesia amoldia, which is parasitic in nature, is without a stem or roots and which with its vines embraces any handy, strong tree? If he did, did he draw any conclusions from seeing it?
    The Prime Minister: I saw no such flowers on that occasion.
    Mr. Ashdown: Will the Prime Minister accept that, in last night's vote, the Government won no part of informed opinion, including that in his own party, in support of their proposals for bugging people and their homes through the Police Bill? Surely he cannot accuse four past Home Secretaries, including a Conservative one, one past Conservative Attorney-General, the present Lord Chief Justice and many Law Lords of failing to back the police because they insist that those wide-ranging powers ought to be subject to prior judicial authority. We all understand that the Home Secretary must take time to digest that vote, but will the Prime Minister at least assure us that, rather than riding roughshod over that opinion, he will listen and respond to it? Will he note that, if he wishes to do so on a cross-party basis, we stand ready to participate?
    The Prime Minister: The whole House, including I assume the right hon. Gentleman, knows that intensive surveillance has been going on under successive Governments under the mantra of guidelines for about 30 years: there is nothing new about it. The purpose of the Bill was to put it on a statutory footing: that was what my right hon. and learned Friend the Home Secretary was seeking to do, and he proposed that it should be put under independent review. The amendments tabled by the Labour and Liberal parties in the Lords contradict one another. They are unsatisfactory and will need to be changed. Of course my right hon. and learned Friend the Home Secretary will reflect upon the view that was expressed in another place, but the right hon. Gentleman has to realise that intensive surveillance can be used only in investigating serious crime and where there is no other way of obtaining the intelligence. That is an important principle, and I hope that the right hon. Gentleman will not wish to move away from that principle.
    Sir Patrick Cormack: Will my right hon. Friend remind those who listened with incredulity to the yesterday's speech by the shadow Chancellor that, although imitation is the sincerest form of flattery, it is no substitute for the original?
    The Prime Minister: I suppose that every Conservative Member regards imitation as the sincerest form of flattery, but the reality is that, whatever the best intentions of the shadow Chancellor, the sheer nature of the Labour party is such that he certainly could not deliver that which he has promised. He knows that, I think the electorate know that, and the faces behind him portray that very clearly.
    Mr. Donohoe: To ask the Prime Minister if he will list his official engagements for Tuesday 21 January. [10387]
    The Prime Minister: I refer the hon. Member to the reply I gave some moments ago.
    Mr. Donohoe: Since 1989, some 25 per cent. of beds have been lost to the national health service in Scotland. Today, the senior Duke, the Duke of Hamilton, who happens to be the brother of the Minister who has responsibility for health in Scotland, told the people of Scotland that the Tories cannot be trusted with health. Does the Prime Minister agree?
    The Prime Minister: Perhaps the hon. Gentleman could explain, after yet another attempt to denigrate the health service by the Labour party, why more people are being treated in the health service in Scotland and elsewhere. Can the hon. Gentleman explain that, or is he playing "follow my leader" by trying to use Britain's national health service as a party political football for the Labour party?
    Mr. John Greenway: Will my right hon. Friend ask to see a report of the incident overnight at Full Sutton prison? When he does, does he expect to find that the progress that has been made in the Prison Service in recent years will be reflected by the fact that the disturbance was quelled quickly by the excellent work of the Prison Service and prison officers, to whom praise is due? Will he note that Full Sutton is a modern prison with no overcrowding, but that it holds some of the most violent prisoners in the country? It is their behaviour that was the cause of the riot.
    The Prime Minister: My hon. Friend makes his point with great clarity and I need not add to it. I agree with him. I shall be seeing the report of what happened last night and I am delighted that it was handled so swiftly and efficiently.
    Mr. Clelland: To ask the Prime Minister if he will list his official engagements for Tuesday 21 January. [10388]
    The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.
    Mr. Clelland: Will the Prime Minister accept some facts about the national health service? The Royal Victoria infirmary in Newcastle has turned away 23 children in need of intensive care beds in the past three months, including a 20-month-old baby who had to be taken 120 miles north to Edinburgh. If we add to that the case of my elderly constituent who, tragically, died after being driven 40 miles south to Hartlepool because there were no beds available in Gateshead, surely even the Prime Minister can see why the Tories are no longer trusted with the national health service.
    The Prime Minister: Of course I cannot respond immediately to the individual cases that the hon. Gentleman raised—if he had wished me to do so, he would doubtless have given me notice of them—since literally hundreds of thousands of people are treated in the national health service every day. The hon. Gentleman gave some facts about the health service; perhaps I can give him some. We now spend £724 for every man, woman and child in the country compared with £444 in 1979. [Interruption.] It is nice to see that the mouth of the Humber has returned from Hong Kong.
    The hon. Member for Tyne Bridge (Mr. Clelland) will also know that, each and every year since 1979, there has been a significant real-terms increase in resources in the health service. More people are being treated and there are more doctors, more nurses and better and wider treatments. That is a success story and, try as it might, the Labour party—the Labour party is certainly very trying—will not be able to damn the success of the national health service.

  BILL PRESENTED
    REGULATION OF DIET INDUSTRY
    Mrs. Alice Mahon, supported by Mrs. Ann Clwyd, Mrs. Audrey Wise, Ms Dawn Primarolo, Ms Jean Corston, Ms Diane Abbott, Mr. Tony Banks, Mr. Ken Livingstone, Ms Clare Short, Mrs. Helen Jackson, Ms Mildred Gordon and Ms Harriet Harman, presented a Bill to regulate the diet industry; to bring all medicines relating to diets under control; and for connected purposes: And the same was read the First time; and ordered to be read a Second time upon Friday 28 February, and to be printed [Bill 72].

United Kingdom Membership of the European Union (Referendum)
3.32 pm
Mrs. Teresa Gorman: I beg to move,
That leave be given to bring in a Bill to provide for the holding of a referendum on the United Kingdom's membership of the European Union.
The question I propose is whether we should renegotiate our membership, limiting it to trading arrangements, or pursue full integration, probably with a single currency. The Bill does not advocate leaving Europe.
In another place on Friday, quite by coincidence, the noble Lord Pearson, with cross-party support, will propose the repeal of section 2 of the treaty of Rome—which, incidentally, would allow renegotiation to take place.
It is 22 years since the last referendum on this subject, and a great deal of water has gone under the bridge since then. The issues that concern us today were not even mentioned then. Then it was about trade, but today the issues are far more political, and impinge far more on the everyday lives of our constituents. Indeed, at the weekend Mr. Santer was putting forward sweeping proposals for social changes and intervention, which would affect the matters on which the election will be fought—health, education and so on.
Parliament is no longer sovereign as it once was. However the small print of Rome was written, it was not explained in detail to the British people at the time, and now the chickens are coming home to roost.
Everywhere I go in my constituency of Billericay—which now includes a large slice of Basildon, incidentally—in the pubs and clubs, the supermarkets and the high street, people do not complain to me about the health service—they think it is splendid. Nor do they complain about the schools—they are excellent. They are delighted that, for example, more children will be able to go to nursery school. The questions they all ask me are, "What are you going to do about Europe? When are we going to get a referendum?" They see a referendum as the only way in which they can have a say on matters they read about in newspapers and see on television every day.
Hardly a week goes by without some row between us and Europe over new legislation that we apparently did not expect and apparently do not want, so it appears very much as though we are at odds with those who are supposed to be our partners. At my local fish and chip shop, constituents see a large banner saying, "Save British fish". They have to go to the nearest supermarket for their meat, because the local butcher—a shop that had been there for 150 years—was closed down because of all the new regulations, which literally prevented him from using his old chopping block and the knives that his father and grandfather had used. The butcher could not afford the new regulations—[Interruption.]
Madam Speaker: Order. The House will come to order and hear the hon. Lady properly. Any hon. Member who wants to oppose the Bill can do so, but there is a time to do so, and it is not while the hon. Lady is speaking.
Mrs. Gorman: Many of the regulations originate in European directives, and they are killing small enterprises.
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The list goes on and on. My constituents bitterly resent that, but they feel impotent to do anything about it. Most of the time, we seem to be at daggers drawn with people we call our partners. My constituents know no other way of reasserting what they consider to be the rights of the British people except to say, "Can we have a referendum to put our point of view across?" [Interruption.]
This is not a party political, but a national, issue. I must tell the hon. Members on the Opposition Benches who are busy chortling that many people have told me that they are normally Labour voters but will vote for me because I stick up for them on the European issue and put their point of view across. Those hon. Gentlemen may be laughing on the other side of their faces when, at the next election, Basildon again declares its results early and returns a Conservative Member of Parliament.
In a recent poll carried out by a national newspaper in my constituency, 64 per cent. of people said that they would totally oppose giving up the pound, and others said that they would like to get out of Europe altogether—my Bill does not advocate that. There has been a massive shift in public opinion.
One constituent, putting it his own way, said, "Who wants pockets full of bottle tops instead of good old British money?" [Interruption.] Hon. Members may laugh, but the new currency would mean 15 new pieces of paper and metal, none of which would equate to the current values of coins and notes. People would have to learn a new financial language. When we introduced decimalisation, people had a lot of trouble with that—Chancellors might not have done, but the people did. We will have even more trouble if we go ahead with this scheme.
Sometimes it behoves the people who are barracking or chortling away on the Opposition Benches to remember that these grandiose schemes boil down to their effects on the lives of ordinary people. The utopian ideas of Brussels sometimes end up as Essex man's bankruptcy petition. The idea that a single currency is the only way in which European trade can proceed is totally absurd. I hope that we can gain a commitment that we will not go ahead with that silly idea.
The views of most hon. Members are well known, especially to you, Madam Speaker, because you have to call us in the few European debates we have; but we do not know what the bulk of our 58 million constituents think about Europe these days. We are in the run-up to a general election and all parties are setting out their stalls, but there are very few discussions about Europe, which is the issue that I know that my constituents want me to bring to the attention of the House.
We cannot run away from or keep a lid on the issue of Europe. A referendum may not be ideal, but it is the only way I know of finding out what people want and giving them that outlet. When all the parties have similar views on Europe, Dicey tells us that extremist parties arise. He says that, to solve the problem, we should have a referendum, and that is what I am calling for today.
Madam Speaker: I call Mr. Denis MacShane to oppose.
3.40 pm
Mr. Denis MacShane: Thank you, Madam Deputy Speaker. [HON. MEMBERS: "Now you've had it."] Forgive me, Madam Speaker.
I do not think that, in pure terms, the hon. Member for Billericay (Mrs. Gorman) will find much opposition to her Bill, because for some time it has been the policy of the Labour party and of the official Conservative party to put to the people the question of continued membership of the European Union or the specific question of a single currency. [HON. MEMBERS: "That is not the same thing."] It is not the same thing at all, but were that simply the technical debate before us, the Bill would not be worth opposing.
It is a paradox that the hon. Lady, in defending the sovereignty of Parliament, is proposing to remove from Parliament its sovereignty to decide a great question. It is also perhaps a paradox that she, who has often gone through the Division Lobbies in her long years as the hon. Member for Billericay to remove from many British people—from local authorities, civil society organisations, trade unions and others—the right to decide for themselves in various areas of their lives and activities, should now complain that Britain has to share some of its power with our partner nations in Europe.
The hon. Lady is, however, an adornment to the House, and I think that it is fair to say that we all love her—[HON. MEMBERS: "No."]—but she is about to hear the iron maiden of truth clamping around her farrago of fantasy and misleading information. She may be the chirping chimpanzee presenting the Bill, but behind her are organ grinders with a deeper purpose.
The motion concerns not only a technical debate on a referendum: it is the opening shot of a campaign to get Britain out of Europe. I wish that every business man and every ally of our country was here today, so that they could understand the deep, persistent and unbridgeable divisions in the Conservative party. At home and abroad, the Conservative party is seen as profoundly anti-European.
I am not interested in Tory divisions. We shall see whether the hon. Member for Stafford (Mr. Cash) and the right hon. Members for Wokingham (Mr. Redwood) and for Kingston upon Thames (Mr. Lamont), all of whom are in the withdrawalist camp, come to vote today, and whether members of the Cabinet who are busy issuing anti-European manifestos turn up to join them.
In the few minutes left, I want to put a positive case for Europe, because I believe that continued British membership of the European Union is vital for our trade and security, and for consolidating democracy. As a great trading country, we sell more to France than to all the Commonwealth countries put together. We sell more to the Netherlands than to Korea, Taiwan, Singapore and China put together. Every pound of inward investment into the United Kingdom, such as the Nissan jobs announced yesterday, comes because we are part of the world's biggest trading community.
To the east of the Community, we have an enormous new opportunity as countries such as Poland, the Czech Republic, Slovenia and Hungary post east Asian levels of growth. They are clamouring to join the Europe from
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which the hon. Member for Billericay, and her referendum supporters such as James Goldsmith, wish us to become semi-detached.
It is no coincidence that the leaders of the new democracies in eastern Europe, as has been said by Gyula Horn, the Prime Minister of Hungary, are prepared to alter their judicial, legal and social norms to become part of the EU. They understand that pooling sovereignty and sharing power are essential prerequisites for the new international global economic order. We are doing that through the World Trade Organisation, and it is sheer fantasy to imagine that we can start to withdraw from the EU and have an a la carte, pick-and-choose Europe. We may pick the things we want; the rest of Europe will pick what they want, or do not want from us.
Britain has always been an open, free-trading, welcoming nation, and we cannot turn from that path. The hon. Member for Billericay and I had a discussion on the BBC yesterday. She asked whether the British people really wanted to take orders from people with foreign-sounding names. She should be careful about that, because among the Cabinet, among the fathers and grandfathers of the Cabinet, and among Opposition Members, there are plenty of foreign names. The best of the British tradition has been when we have been open to every possible foreign influence.
The problem is only in Britain. As hon. Members tramp around Europe, as many of us do, we find that of course there is a debate on economic and monetary union and the technical modalities, on reform of the common agricultural policy and on security and immigration policy. However, everyone asks me how Britain can have open borders with Ireland, a sovereign republic with which we have many differences, when we put up so many obstacles to people visiting from France or Germany.
It is only in Parliament that we hear the rising clamour for withdrawal. The hon. Member for Billericay has many friends in the media; much of the press is on her side. People who put the positive case sometimes have difficulty in getting their voices heard. Even some of the pro-European newspapers are like foxes running from covert to covert, trying to find a policy on which to settle.
However, there are many Government and Opposition Members who will not allow the distortions and dishonesties of Goldsmith and his followers to go unchallenged. Our country has seen that tradition before: the tradition of hostility to faraway places of which we know little, and foreign-sounding people we do not like; of isolationism; of appeasing forces operating from some hacienda or bunker that tell us what to do.
I believe that the House, and the country, will not have that. That is why I am not frightened of a referendum or of the forthcoming general election, in which the party that stands clearly for a positive Britain in Europe will win handsomely, and the party that is divided, unsure, isolationist and frightened of Europe will be defeated.
Question put, pursuant to Standing Order No. 19 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—
The House proceeded to a Division.
SIR TEDDY TAYLOR and MR. BILL WALKER were appointed Tellers for the Ayes but no Member being willing to act as Teller for the Noes, MADAM SPEAKER declared that the Ayes had it.

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Bill ordered to be brought in by Mrs. Teresa Gorman, Mr. David Trimble, Mr. Tony Benn, Sir Teddy Taylor, Mr. Christopher Gill, Mr. Austin Mitchell, Mr. Edward Leigh, Sir Richard Body, Mr. Rupert Allason, Mr. Graham Riddick, Mr. Richard Shepherd and Mr. John Wilkinson.

United Kingdom Membership of the European Union (Referendum)
  UNITED KINGDOM MEMBERSHIP OF THE EUROPEAN UNION (REFERENDUM)
  Mrs. Teresa Gorman accordingly presented a Bill to provide for the holding of a referendum on the United Kingdom's membership of the European Union: And the same was read the First time; and ordered to be read a Second time upon Friday 31 January, and to be printed [Bill 73].
Opposition Day
[3RD ALLOTTED DAY]
Opposition Day

  National Health Service
  3.53 pm
  Mr. Chris Smith: I beg to move,
  That this House expresses its deep concern at the grave situation now evident in the National Health Service in England, Scotland, Wales and Northern Ireland; believes that anxiety about Her Majesty's Government's policy for this situation now transcends party lines; notes with alarm that throughout the United Kingdom beds have been cut, operations are being cancelled, intensive care beds are unavailable, and emergency services are under intolerable pressure; believes that the spiralling costs of the internal market—now totalling an extra £1.5 billion a year—and its diversion of resources away from front-line patient care have created these problems; salutes staff of all kinds and at all levels in the NHS who have worked hard to keep the service going; believes that government policy has left many people in urban and rural communities without the access to health care they need, especially in relation to services for the elderly and for those being discharged from hospital after surgery at an increasingly early stage; deplores the way in which many NHS decisions, especially on the future of hospitals and casualty services, are being taken in a manner that does not give due weight to the views of local people; and calls upon Her Majesty's Government to set about restoring the NHS as a public service that puts patients first.
  The starting point for the debate must be that the national health service is in a serious crisis. It is not just the Labour party which is saying that, but the British Medical Association, the Royal College of Nursing and the report of the King's Fund on mental health services in London. The figures that we published this morning, to which I shall refer later and which were the subject of discussion in relation to the question on paediatric intensive care at Prime Minister's Question Time, also show it.
  Mr. Michael Fabricant: I am grateful to the hon. Gentleman for giving way to me so early in the debate. On the subject of crisis, did he see the ITN news last night, when a member of Unison—a hospital worker—having heard the speech of the right hon. Member for Dunfermline, East (Mr. Brown), said that if Labour were elected there would be another winter of discontent and the national health service would be in crisis?
  Mr. Smith: I like to think that we should be discussing, not one individual's views of what might happen in a year's time, but what is happening here and now. In wanting to address those issues, we share the Secretary of State's views.
  A rather plaintive letter from the NHS executive of the South and West region, dated 28 November and sent out to all health authority chief executives, begins as follows:
  "The Secretary of State has asked for regular fortnightly briefing on winter pressures. We understand that he wishes to have a full understanding of the pressures the acute services are under during the winter."

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  The Secretary of State wants information, so let us give him some. Let us tell him, for example, about the waits being experienced in casualty units up and down the country. Let us tell him about Geoffrey Coppin, a stroke victim who spent two and a half days on a trolley in St. Helier hospital. His daughter had to go out and buy pillows at Woolworths to make him comfortable. Let us tell the Secretary of State about Stanley Coombs, a 69-year-old man from Mitcham with chronic lung disease who had a 20-hour wait in casualty at St. George's hospital in Tooting. Those are not isolated examples: they occur time after time around the country.
  Let us tell the Secretary of State about those people who, owing to long casualty waits, eventually feel forced to opt for private medical treatment to shorten their wait. Let us tell him about Mary Vaughan, an elderly pneumonia sufferer. After she had spent 21 hours on a trolley in St. Helier hospital, her son paid for a private bed for her at St. Anthony's hospital, Cheam. Mildred Brown, a 77-year-old with a broken ankle, had an eight-hour wait at Wythenshawe hospital and finally went to the private Alexandra hospital in Cheadle. Why should people who have paid into the national service all their working life now have to use their last pennies to pay for private care?
  Let us tell the Secretary of State about the new experience of people who are waiting not just on hospital trolleys in casualty departments, but on ambulance trolleys. At the end of December, patients at Llandough hospital near Penarth in south Wales had to wait 45 minutes on ambulance trolleys before being admitted because accident and emergency staff were swamped. As a result, ambulance crews had calls backing up because they were tied up at the hospital waiting for trolleys to become free.
  Let us tell the Secretary of State about the patients being discharged too early—the patients being sent out from Bristol royal infirmary in the middle of the night to make way for emergencies that the hospital could not accommodate. Let us tell him about the search for intensive care beds around the country. A child was taken to Sunderland general hospital with breathing difficulties, but because no intensive care beds were available in Tyne and Wear he had to be driven 120 miles to Scotland to find a place to be treated. Edna Harrison was treated at St. James's hospital Leeds after suffering a heart attack. She was unable to be admitted because all 13 intensive care beds were taken. She was then taken 60 miles by ambulance to Hull after two hospitals were unable to find her a bed. Those are examples of the search around the country for beds in accident and emergency or intensive care units.
  Let us tell the right hon. Gentleman about cancelled operations—about Queenie Harrild, the 69-year-old heart operation patient from Lewisham who died after her operation was cancelled four times in 11 days, or about the 3,000 non-urgent operations cancelled or postponed at the Royal Devon and Exeter hospital, including in some cases patients in severe pain. Four major hospitals in Wales are now closed to non-emergency cases. In Nottingham, the Queen's medical centre has said that only emergency and life-threatening cases will be admitted until further notice. The North Staffordshire Hospital NHS trust has said that all elective surgery has been cancelled until further notice.
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  That is the reality of what is happening up and down the country, affecting patients and hospitals. For the Secretary of State and the Government to claim that everything is hunky-dory is to fly in the face of the real experience of real people and real patients.
  Mr. Charles Hendry: Perhaps I may give the hon. Gentleman another example—that of my father, who was dying of cancer when the last Labour Government were in power. It was not a doctor who decided what he could be fed when in hospital, but a trade union official who decided that he could not be given soup, which he could swallow, but that he would have to be given hard-boiled eggs, which he could not swallow. He died. That is one of the reasons why people like me will never believe that the health service can be safe in Labour's hands.
  Mr. Smith: Any such imposition by anyone on any patient is completely unacceptable and no one would argue to the contrary. We argue that the current state of the health service shows that it is not in good hands. The evidence of what is happening to patients clearly demonstrates that. The Secretary of State says that people have long memories, and that is true: they know what the Government have done to the national health service and they will remember it when they come to the ballot box.
  My hon. Friend the Member for Dulwich (Ms Jowell) painstakingly carried out a survey on the state of paediatric intensive care. We talked to hospital after hospital and established the precise figures in each case. The Government have said that the figures are complete nonsense and the Prime Minister airily dismissed them at Prime Minister's Question Time, but they are not complete nonsense: we have a recording of every telephone conversation with every one of the 19 hospitals that provided information and we know precisely how many children each of those hospitals has had to turn away.
  The Secretary of State for Health (Mr. Stephen Dorrell): The hon. Gentleman does not accept the words of my right hon. Friend the Prime Minister, but does he disagree with the chairman of the British Paediatric Intensive Care Society, Dr. David Hallworth? My right hon. Friend quoted Dr. Hallworth, who said:
  "Figures in isolation are pretty meaningless."
  Mr. Smith: I disagree with the application of that point to Labour's figures.
  Mr. Dorrell: Will the hon. Gentleman give way?
  Mr. Smith: In an act of unusual generosity, I will give way to the Secretary of State again.
  Mr. Dorrell: The hon. Gentleman has made it clear that he rejects the advice of the chairman of the British Paediatric Intensive Care Society—a man who devotes his life to providing the sort of care that the hon. Gentleman is talking about. Will the hon. Gentleman tell the House whose advice he does take?
  Mr. Smith: The advice I certainly do not take is that of the Secretary of State, who obviously did not hear what

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  I said. I said that I did not agree with the application of that remark to the figures that Labour has produced. The figures were accurate and painstakingly collected—
  Mr. Dorrell: They tell us nothing.
  Mr. Smith: They actually tell us an awful lot. They tell us that children referred to paediatric intensive care units near where they live and where they can get immediate treatment are being told, by hospital after hospital, that they cannot be seen there. Quite possibly they get a bed somewhere else eventually—100 or 200 miles away—but that is not an adequate response to the needs of very sick children.
  Mr. Dorrell: Will the hon. Gentleman confirm that no child who needed intensive care and was referred to the emergency bed service was denied intensive care? Will he also tell the House, if that is not the right standard, what standard he would apply to the service?
  Mr. Smith: The Secretary of State has quoted one paediatric intensive care consultant to me. I will quote another to him. Dr. Mark Darowski, paediatric intensive care consultant at Leeds general infirmary, says:
  "Mr. Dowell has not learnt the lessons of last winter".
  He told the Yorkshire Evening Post on 4 January:
  "It is just luck that we have not had another Nicholas Geldard. On New Year's eve there was one paediatric intensive care bed available in the whole of the North of England. We've been operating at 100 per cent. and only luck has prevented the system crashing."
  It is all very well the Secretary of State claiming that there have been only 40 referrals to the intensive bed central monitoring unit over this period—nothing like the figures that the Labour party has produced. He ignores the fact that many referrals are made outside the centralised system—
  Mr. Dorrell: Successfully.
  Mr. Smith: I do not call it success when children have to be carted from one end of the country to the other to find intensive care beds.
  Mr. Hugh Bayley: I remind the House that Dr. Mark Darowski was the doctor who admitted Nicholas Geldard to Leeds general infirmary and who had the unpleasant task of telling the child's parents that he had died on his way over the Pennines through a snowstorm. A year ago Dr. Darowski wrote to me drawing my attention to the fact that the regional health authority, just before it was abolished, recommended that the Northern and Yorkshire region needed seven additional paediatric intensive care beds to meet patient demand. Since then, just one has been provided. Surely the Secretary of State must explain how the promise that he gave the House in the spring of last year is to be kept.
  Mr. Smith: I have the Secretary of State's words of 6 March 1996 in front of me. He said:
  "There is no doubt about the need now to deliver a proper level of paediatric intensive bed space. It will be done".—[Official Report, 6 March 1996; Vol. 273, c. 360.]
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  Certainly, the Secretary of State organised a report which was published and put in the Library of the House a couple of months after his statement. About 20 more beds were provided around the country—
  Mr. Dorrell: Thirty, actually.
  Mr. Smith: The latest Library figure was 20. In any event, it is welcome news that more beds have been provided, but it is clear from what happened this winter that we still do not have a proper service. It would behove the Government rather more, instead of trying to bluster their way out of the problem, to admit that the service is not yet adequate and tell us how they intend to make it so.
  One of the problems is that the Government do not know what is happening in relation to many aspects of health care. It is interesting that they can now give us precise figures for paediatric intensive care beds. When my hon. Friend the Member for Dulwich asked, in a parliamentary question on 12 December last year, how many paediatric intensive care beds there were in this country, the Secretary of State replied that the information was not held centrally. He can tell us how many extra beds the Government have created since his statement of 6 March last year, so perhaps he can now say that the information is held centrally. It is important that it should be held centrally for the proper planning of serious emergency services. I shall return to that point in a moment because it is not the only area in which the Government do not know what is happening.
  It may be because the Government do not know what is happening within the health service that they blithely claim that everything is going wonderfully well. I was struck at Prime Minister's Question Time when, in response to an Opposition question about the Government's handling of the national health service, the Prime Minister's final remark was that this was a success story. How can it be a success story when patients have to wait on hospital trolleys or ambulance trolleys, operations are cancelled, beds are closed, accident and emergency services are in crisis and children are being sent halfway across the country for paediatric intensive care? I do not call that a success story.
  The Secretary of State told the "Today" programme this morning that the NHS is improving year by year. I do not call it improvement. In the real world, people who work in the health service are struggling in the face of ferocious odds to preserve a decent service, provision for ordinary people is collapsing, operations are being cancelled in hospital after hospital and in many parts of the country it is now impossible to get elective general surgery before the next financial year.
  Mrs. Alice Mahon: This morning I contacted hospitals in Leeds to find out why a constituent of mine who has been waiting 14 months for heart bypass surgery had been sent a letter saying that he could not have the surgery in the foreseeable future, but that if he went to Leicester he could have it in two or three months' time. I understand that all Calderdale patients waiting for heart bypass surgery are in exactly the same position. That is the reality of Conservative health care.
  Mr. Smith: That is, indeed, the reality of what is now happening. It is even worse because not only are

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  distinctions made between people in different areas, depending on their hospital or health authority, but distinctions are also made between availability of and access to treatment, depending on the general practitioner. GP fundholders' patients who happen to come under the aegis of Lincoln county hospital can have their out-patient appointments within the following month, but patients of a non-fundholding GP cannot have an out-patient appointment until the next financial year. Not only are people told that they must wait months for operations or out-patient appointments, but they are treated differently even though they have the same medical condition. The health service was supposed to treat people according to need, not according to where they happen to live or the type of GP that they happen to have.
  Mr. Stuart Randall: Is my hon. Friend aware that at Hull royal infirmary the unit which deals with coronary cases is no longer making forward appointments? I am advised that that is because the beds are being used for orthopaedic and medical cases.
  Mr. Smith: My hon. Friend gives me information of which I was not aware, but it adds to the overall picture of the condition of the NHS.
  Perhaps the Secretary of State does not realise what is going on, as he has had other things on his mind. One day during the Christmas and new year recess, he popped up on our television screens as the Conservative spokesman on the family. A couple of days later, he popped up on the radio as the Conservative spokesman on the constitution. A few days after that, he decided to give us his considered views on Europe, which do not appear to have done him much good with either wing of his party. While all that frenetic activity was going on, it is small wonder that the NHS was falling to pieces without the Secretary of State noticing.
  Mr. Simon Hughes: The hon. Gentleman knows that I share his view that much in the health service is not going right. It is difficult to take an objective view of the aspects that have or have not improved; many aspects have improved. Does he object to the idea that I proposed to him—that we should try to separate the argument from the facts, and that we take out of the political arena an assessment of what the NHS has by way of beds and hospital capacity and what it needs? We should get independent people to examine that, so that we can argue on the basis of objective, agreed facts, and not on the basis of the hon. Gentleman's political views, mine or those of the Secretary of State.
  Mr. Smith: I hesitate to point out to the hon. Gentleman that the last time that a supposedly objective examination was conducted, it was carried out by a character called Professor Tomlinson in relation to London's hospital provision. I am not sure that a repetition of that exercise would be helpful. However, I sympathise with the hon. Gentleman's suggestion. A proper assessment of provision across the country, conducted as far outside the political football arena as possible, would be a sensible approach. I am not sure that I would go along with him in saying that everything
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  should freeze while that was under way, but I welcome his approach and look forward to further discussions with him.
  Mr. Nigel Waterson: Can the hon. Gentleman confirm that in the dying days of the last Labour Government, which seems a long time ago, as indeed it is, the foundations were laid for the collection and collation of NHS statistics—for example, for finished consultant episodes? How can he therefore take issue with the basis on which the facts are produced?
  Mr. Smith: I do take issue with the basis upon which many facts are produced. I have no particular quarrel with using a finished consultant episodes accounting mechanism, provided that it is made clear that it does not refer to the number of patients treated. That is the fatal conflation that the Government always make: they take the finished consultant episodes figures and, because they have increased, claim that the number of patients treated has also increased—ignoring the fact that they do not know how many patient readmissions form part of the finished consultant episode figures.
  We have insufficient information about the level of NHS readmissions at present. We should have those figures, as they are good indicators of how well or how poorly patient treatments are working. However, that information is not held. The Government should be more accurate in their language, instead of talking breezily about patient numbers when they are really talking about the number of treatment episodes.
  Mr. D. N. Campbell-Savours: I can speak from personal experience as I have been a patient in many hospitals over the years. In some hospitals, the readmissions figure can be as high as 20 per cent. on surgery wards. That is a substantial figure which totally destroys the credibility of any statistics produced in that area.
  Mr. Smith: Absolutely. A major problem is that the internal market—to which I shall refer in a moment—places intense pressure on hospitals to get patients through as quickly as possible. Inevitably, that means that patients who enter hospital for a course of treatment are often sent home too early—particularly elderly patients who are unable to recuperate as quickly as younger patients. Such patients often receive no proper support at home and are unable to recover properly. As a result, they end up back in hospital four or five weeks later. That is wonderful for the Government's statistics, because they count that readmission as another patient, but the quality of care provided is not good and the overall cost to the health service is increased. That is one way in which the operation of the internal market acts as a distorting pressure on the system at present.
  I said earlier that the Secretary of State does not seem to know what is happening in the health service. His lack of knowledge about the NHS is extremely revealing. My hon. Friend the Member for Dulwich tabled a series of parliamentary questions and received a bonanza of answers on 12 December 1996. They showed that the Secretary of State does not have a lot of basic information about the current nature and form of the health service.
  For example, my hon. Friend asked about the number of acute hospitals in each health authority area. That is a fairly simple question. My hon. Friend the Member for

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  Bolsover (Mr. Skinner) asked earlier about the number of hospitals that have closed since 1979. Ministers did not know the answer to that question, but perhaps they know how many hospitals the national health service comprises—after all, they are supposed be in charge of the NHS. However, we were told that the information "is not held centrally." When we asked how many community hospitals are in the national health service, the answer was the same. We asked how many ambulances are owned by ambulance services across the country—that is fairly basic information—but we were told that the information is not held centrally. We asked how many acute hospitals have been closed in the past five years—a matter of intense interest to many local communities throughout the country—but again the Government replied that the information is not held centrally.
  Given the promises that the Secretary of State made last March on intensive care and on accident and emergency care, we asked how many intensive care units there are in each health authority area. We were told that the information is not held centrally. The Government do not know how many intensive care beds there are in each health authority area, or how many paediatric intensive care units or beds there are. They do not know the number of nurses who have ceased to practise in each of the past six years or the number of trusts that have cancelled elective surgery until the end of the current financial year.
  The Government have placed every possible emphasis on the cost of operations in the health service and on how the internal market will sort it out, but they do not know the average cost of a hip replacement operation in England. Given all that the Secretary of State does not know about the health service, it is no surprise that he presides over a health service that is in such a disastrous condition.
  The principal problem, of course, lies in the operation of the internal market, which has led to the fragmentation of decision making and directly to the problems in intensive care and accident and emergency services that we have seen in the past few weeks. It means that there cannot be the overall look that we need and which the hon. Member for Southwark and Bermondsey (Mr. Hughes) advocates. It has also led to a loss of beds—a fall of 24 per cent. overall in England since the changes were introduced. The chairman of the British Medical Association council laid the blame for that squarely on the internal market. Hospitals are downsizing their capacity to the minimum, rather like airlines double-booking many of their seats.
  The internal market has also led to a distortion of clinical priorities. I will cite just one example—Glenfield Hospital NHS trust, in Leicester, which issued a letter on 7 January to local general practitioners. It is interesting to note that the letter was issued to GPs who are covered by health authority contracting. It was sent only to non-fundholding GPs. Fundholding GPs are exempt from the letter, which begins:
  "After several weeks of negotiation, this Trust has reluctantly reached agreement with Leicestershire Health, Southern Derbyshire Health Authority and North Nottinghamshire Health Authority, to restrict services. With immediate effect, for Cardiology and Cardiac Surgery"—
  we are talking about serious surgery—
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  "only emergency patients and those potentially breaching the 12 month Patient's Charter guarantee, will be admitted. This restriction will apply until 31st March 1997."
  This action is not being taken because of any wish to do so on the hospital's part. The letter continues, and this is the real sting in the tail:
  "It does not reflect this hospital's capacity to treat patients. We have the capacity to perform all the work which GPs could refer to us".
  Do we not live in a crazy world? We have a hospital which says that it has the capacity to carry out all the work that GPs in cardiology could refer to it. We know that there are patients who need treatment. Yet because of the procedures and rules of the internal market the hospital must close its doors to those patients. The internal market distorts priorities within the health service.
  Mrs. Mahon: I spoke earlier about patients from Calderdale who cannot have their operations performed in Leeds. The letter from Leeds General infirmary reads:
  "Your local health authority has found a suitable alternative hospital which is … the Glenfield Cardiac Unit in Leicester."
  It would seem that patients from Calderdale who cannot get into the Leeds infirmary until after July will be taken to Leicester, where local patients cannot be operated upon because a restriction has been placed on their local hospital. That is mad.
  Mr. Smith: My hon. Friend, whose information I did not know, redoubles the force of my argument about the absurdity of the way in which the market system that the Government have imposed on the NHS is distorting the manner in which the NHS operates.
  The market system has led also to spiralling bureaucratic costs amounting to £1.5 billion a year. That is the British Medical Association's estimate, not one produced by the Opposition. That is the cost of the bureaucratic procedures of the internal market. That is why our proposals for the replacement of single-practice GP fundholding by locality commissioning, a move from annual contracts to three to five-year agreements, with agreements based on the process of co-operation rather than competition, an end to the system of individual invoicing and reducing to one tenth the number of contracts swimming around in the system, will all help to reduce the bureaucratic costs. The money saved can be diverted into patient care.
  Mr. Nigel Forman rose—
  Mrs. Margaret Ewing rose—
  Mr. Smith: I want to make progress because I have given way on many occasions. I shall, however, give way briefly to the hon. Lady.
  Mrs. Ewing: Exactly how much money does the hon. Gentleman expect will come from the savings that he has outlined and how quickly will it move into the system? We have heard a clear statement from an Opposition Treasury spokesperson that there will be no additional funding. It is important that we know what is being promised by the Labour party and the time scale involved.
  Mr. Smith: As the hon. Lady knows, we have identified an immediate £100 million which, as a start,

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  we shall take from the system's bureaucratic costs. I believe that more money will be available by reducing bureaucracy after that start has been made. The early target is £100 million. I believe that that money can be better spent on patient care.
  The answer to many of the problems that we are seeing lies, first, in recognising that there is a crisis. It would help if the Government would admit that they are facing some problems. It would help also if they would stop being quite so complacent and smug as the Secretary of State can sometimes be. Secondly, they need to end internal market procedures, with the distortions that they bring to patient care.
  Thirdly, we need to bring back strategic thinking and preparation into the health service. Fourthly, we need to end the inequity between patients that we all too often see. Fifthly, we need to divert money from wasteful bureaucracy and transfer it into patient care. That is the way forward.
  The chairman of the BMA council put it rather well on 11 October. This is the leading voice of the medical profession, not the Labour party's voice. He said:
  "We are facing the most difficult winter in the NHS since the internal market was introduced."
  It is not as though the Government were not warned. He continued:
  "We need to reform the market, eliminate the perverse effects of competition, restore co-operation and stability to hospital and community health services and begin the task of rebuilding a comprehensive national service where patients' clinical needs come first".
  I do not disagree with any of his sentiments.
  What Sandy Macara could not say, but the British people can, is that there is a sixth requirement in order to restore and rescue the NHS, and that is a Labour Government. Labour created the national health service—even the Prime Minister had to accept that this afternoon—in the teeth of opposition from the Conservative party, and a Labour Government will rescue and renew it. The Labour party will fulfil its fundamental aim of restoring the NHS so that it is run not as a commercial business flooded with paperwork—as it has become under the present Government—but as a public service that puts patients first.
  4.35 pm
  The Secretary of State for Health (Mr. Stephen Dorrell): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
  "notes that the National Health Service is providing high quality care to more patients than ever before; congratulates the dedication and professionalism of the National Health Service's staff during the recent cold weather which has placed exceptional demands upon them; believes that the National Health Service requires a growing budget for patient care and therefore welcomes the Health Service Guarantee given by the Prime Minister to increase spending on the National Health Service in real terms in each of the next five years, including an extra £1.6 billion for patient care in 1997–98; and believes that this guarantee reinforces the Government's consistent record of investment in the National Health Service and its professional staff."
  The speech by the hon. Member for Islington, South and Finsbury (Mr. Smith) shows why Labour is about to lose the fifth general election in a row. The hon. Gentleman seems to believe that all that is required of him on these occasions is to parade a few individual cases
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  that are supported by incomplete facts, make a half-researched charge about the Government's record, wave a shroud, repeat the mantra that Labour will abolish the internal market and base metal will be transformed into gold. He thinks that Labour's claims will be vindicated by that process. His predecessor, the hon. Member for Peckham (Ms Harman), never carried conviction when she had the job. We expected more and better of the hon. Gentleman, but we have been disappointed every time he has come to the Dispatch Box, and we were disappointed again this afternoon.
  Labour's approach is best summarised by referring to the war of Jennifer's ear, which was the technique that discredited Labour in the run-up to the last election. It did not work: Labour Members were found out then, and they will be found out again. If they want to be taken seriously on health, they should say what they would do about it. So far, they have shown a taste for the politics of the gutter. They play on public emotions and fear, run down the efforts of the dedicated professional staff of the health service and cover the whole concoction with a thin veneer of synthetic concern. They believe that that will suffice in place of a health policy. It is the politics of perpetual opposition, which is clearly what the hon. Gentleman is preparing for.
  I shall consider the issues raised by Labour from the Dispatch Box, and I shall begin with paediatric intensive care. In its press release, Labour says:
  "Over 400 children turned away".
  That is a grotesque misrepresentation of the facts, and it is specifically designed to cause maximum concern and alarm among parents of young children.
  The facts about what has actually happened in paediatric intensive care are clear. Last spring, I assured the House that we would increase the total number of places available for paediatric intensive care, and that is what we have done. There were then 249 beds in paediatric intensive care and high-dependency care, and there are now 279 beds—as I said in May there would be by this time this year. I apologise to the hon. Member for Islington, South and Finsbury if he was not provided with those figures. He has my assurance that he will be provided with them if he asks a further parliamentary question. I gave the House an assurance in May that those beds would be provided, and provided they have been. The Government have nothing to conceal on paediatric intensive care.
  Mr. John Gunnell: Are those beds going to the regions in which they were promised? I do not think so. I do not think that the Leeds paediatric intensive care unit, about which we have had correspondence, has had the increase that was anticipated. When I visited that unit a year ago it had five beds, but it could have accommodated six at a squeeze. The Secretary of State says that it now has six beds, but it had that capacity before; has it the resources to take care of six beds?
  Madam Deputy Speaker (Dame Janet Fookes): Order. The hon. Gentleman's question is becoming far too long for an intervention.
  Mr. Dorrell: I published the commitments that the Government had given in May last year. There is a

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  published document on the record. If the hon. Gentleman tables a question about the availability of paediatric intensive care and high-dependency care by region, we will provide the information and he can test it against the undertakings that were given at that time. If he again studies the document that I published in May, he should also note the emphasis that I placed on the availability of both bed space and proper retrieval systems, providing ambulances to take children needing intensive care who are in hospitals that cannot provide beds to meet their needs to the hospitals that are best able to meet those needs.
  This afternoon, the Leader of the Opposition said from the Dispatch Box that I had given an assurance that every child who needed intensive care would be provided with it in the hospital to which that child reported. I never gave that assurance, and the fact is that no responsible Health Secretary could ever give it. Such an assurance would not be supported by the paediatric intensivists who know how to deliver high-quality care to children in that condition. The service that they want to deliver is based on specialist paediatric intensive care units with proper ambulance services to take children to the units best placed to meet their needs. That is the assurance that I gave the House in May, and it is the assurance that the Government are in the process of delivering.
  The doctor whom the Prime Minister quoted at Prime Minister's Question Time is the chairman of the Paediatric Intensive Care Society—the leader of the group of doctors responsible for delivering this service. Let me repeat his words:
  "I don't think this should be subject to party political point scoring. To look at something in isolation as they"—
  the Labour party—
  "are apparently attempting to do is wrong, because it doesn't give the whole picture."
  The Opposition motion seeks an all-party approach to some of the key health issues. I accept that, because what I have set out to do in paediatric intensive care is deliver the pledge that I gave the House last spring. I believe that the best measure of the delivery of that pledge is that no child—
  Mr. Bayley: Will the Secretary of State give way?
  Mr. Dorrell: I will finish this point before I give way to the hon. Gentleman. His Front Benchers allege that his party is interested in paediatric intensive care, and I am replying to their concerns.
  Last May, I gave the House an assurance that we would establish a proper basis for the provision of paediatric intensive care. Since 1 December, when we established the computer bed clearance system that I undertook to deliver then, not one child has had a need for intensive care confirmed by a clinician and then not been offered bed space. Indeed, since that date 40 cases have been referred to the emergency bed service, and on each occasion we were able to offer at least two paediatric intensive care units to accept the transfer—not just one, but two. I believe that such a paediatric intensive care service, delivered through the national health service, can be seen to be addressing the real needs of children who require intensive care.
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  I might have hoped that, if the Labour party was seriously interested in the issue, it would—rather than seeking to make cheap party points—welcome the improvement in the quality of the delivery of the service for which the Government have been responsible over the past 12 months.
  Mr. Bayley: This afternoon, the Prime Minister told the House that we should not be unduly concerned about 400 children being turned away from paediatric intensive care, because they were all found intensive care beds elsewhere. I am told by the head of a paediatric intensive care unit that, although of course all those seriously ill children were found intensive care beds elsewhere, they were not all found paediatric intensive care beds. Some were placed in ordinary intensive care beds, which are not at all the same thing and which are not designed to meet the intensive care needs of children. Will the Secretary of State clarify the position, and tell the House whether a paediatric intensive care bed was provided for each of those 400 children?
  Mr. Dorrell: I remember, when this issue was the subject of intense debate last spring, being engaged in a studio discussion with Professor Sir Roy Calne, who made the clear point that, in his view, the best way of treating a child who did not have access to paediatric intensive care was to provide that child with a place in an adult intensive care unit.
  If what the hon. Gentleman says is true, I still rest my case on the proposition that we have put in place an expansion of paediatric intensive care provision—as we said that we would—and the monitoring system for which the Labour party press release calls. In fact, the gentleman whom Labour spokesmen have been so keen to brush aside in their comments this afternoon is the chairman of precisely the monitoring system called for in the press release. We have put all that in place in order to deliver the commitment to parents of young children that children who need intensive care will be provided with such care by the national health service.
  Mr. Chris Mullin: Will the Secretary of State give way?
  Mr. Dorrell: I will give way once more on this subject; then I will move on.
  Mr. Mullin: I think everyone accepts that it is not always possible for a particular intensive care unit to accommodate a patient, but does the right hon. Gentleman agree that the 120 miles that a 20-month-old child in Sunderland was taken by ambulance was too far? It was a hazardous journey, as the child was having difficulty breathing. On the way back, the ambulance broke down; had that happened when the child was on its way to the hospital, the outcome might have been different.
  Mr. Dorrell: The hon. Gentleman says that 120 miles was too far, but I am pleased to say that I am told that the child is now at home, out of danger and making a full recovery. It is rather difficult to argue that the distance travelled was too far if the case has a successful outcome. The hon. Gentleman's argument is undermined by what actually happened.
  Mr. Chris Smith: Let me pursue the point a little further. Is the Secretary of State saying that every single

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  one of the 400 paediatric intensive care applicants whom we identified as having been turned away from various units ended up—to his certain knowledge—in a paediatric intensive care bed?
  Mr. Dorrell: No, I am certainly not saying that. There are numerous examples of clinicians ringing a paediatric intensive care unit to discuss a case, and then agreeing that intensive care is not needed in that particular case. There are a number of reasons why children are refused admission following telephone conversations of the kind that the Labour party has been counting.
  If the Labour party would stop making cheap points and listen to the chairman of the Paediatric Intensive Care Society, the hon. Gentleman would find that the statement on the Press Association wires answers his point very directly. As I have said, there are a number of reasons why cases are not admitted to paediatric intensive care following discussion between clinicians. What I am saying is that if, in the opinion of the clinician caring for a child, that child needs intensive care, I imagine that—failing to find any other bed—the clinician would use the emergency bed service which was established precisely to meet the need he feels he has on behalf of his patient. If we use that test—earlier, I invited the hon. Member for Islington, South and Finsbury to define any other test—40 cases were referred, every one of which was offered at least two options.
  Mr. Richard Burden: Will the Secretary of State give way?
  Mr. Dorrell: I want to deal with other emergency services.
  It is true that, since Christmas, the national health service has been under pressure. I do not seek to deny that; it regularly happens during the first few weeks of the year, and it is not difficult to see why the emergency services are affected in that way. There were two weeks of extremely cold weather at the beginning of the year and there has been a high incidence of 'flu. As a result of those developments, some hospitals have admitted emergency cases at roughly double, and in some cases more than double, their normal admission rate for this time of year. The emergency services have been working under considerable pressure and I pay tribute to the doctors, nurses, therapists and managers who kept the service working through that period to ensure that the emergency need was met.
  It is not right to seek to create the impression that nothing has been done to meet the peaks of emergency demand that have been experienced over the past few weeks. Plans have been made and acted on to ensure that the health service meets the peaks of emergency demand. This winter, as it does every winter, the NHS has taken the steps that are necessary to meet those emergency peaks. One such step is to delay less urgent cases. If there is a doubling of the emergency admission need at a hospital, the rational response is to delay some less urgent admissions for a week or two. That has certainly been done.
  We have also provided short-term extra bed capacity. In Dartford, we provided an extra 33 beds; in Ashford, an extra 40; in St. Helier, an extra 35; in Poole, an extra 18; in Derriford, an extra 11; in Plymouth, an extra 35; in
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  Rotherham, an extra 33; in Doncaster, an extra 38; in Mansfield, an extra 28; in Burton, an extra 16; and in the north-west region we provided a total of 200 extra beds.
  Faced with emergency pressures, the health service has acted rationally by deferring less urgent cases and opening short-term ward capacity, as it planned to do when it thought during the summer and autumn about winter pressures and about how to meet the peaks of demand that are experienced at this time of year. Some other responses have been set out by the National Association of Health Authorities and Trusts in the press release issued this morning which deals with the winter emergency in the health service.
  I had hoped that, as that was the subject of the Opposition debate, they might refer to what health authorities and trusts have done to meet the winter peak of emergency pressure. There is a page and a half of specific changes that have been made by health authority and trust managers to meet those peaks. The Opposition have not referred to that report by NAHAT, because, although the health authorities have been under pressure, the report concludes:
  "Undoubtedly, despite the problems, the service generally has been maintained".
  Faced with emergency peaks, the NHS has taken action to respond and, overwhelmingly, the story is of the service meeting the emergency need that has been placed upon it.
  Mr. Burden: The Secretary of State says that all the right preparations were made. If that is so, why did his Department get into such a pickle over 'flu vaccine? Apparently it did not order enough vaccine and issued instructions to hospitals to be careful about which members of staff it was given to, to ensure that enough was available for patients and old people. Is not the result that when 'flu increased—as it is likely to do in winter—more staff than necessary went down with it and there was more pressure on staff numbers and patient care suffered? Why were there no preparations for that? It should have been easy for anybody to predict what would happen during the winter months.
  Mr. Dorrell: The 'flu vaccination programme has been running for many years and, rationally, focuses on those who are at risk. Of course, we all run the risk of experiencing a bout of 'flu, but for most of us there is no serious health risk associated with it. For the elderly and others for whom a serious health risk is associated, 'flu vaccination is available. The health service has pursued that policy for many years.
  Mr. Simon Hughes: I welcome the steps that have been taken since March to improve paediatric and general intensive care. On the best current information, what is the Secretary of State's assessment of whether there are enough paediatric intensive care beds to ensure that no parent runs the risk of his child not being admitted, which is what we all wish? Are there enough intensive care beds throughout the country? If the answer to the second question is yes, something is wrong when people die in hospitals such as Guy's in my constituency after being told that there is no intensive care bed there. The right hon. Gentleman's answer would enable us to judge whether we have arrived or whether we are still on the way to providing the service that the NHS should supply.
  Mr. Dorrell: The problem with the hon. Gentleman's question is that it implies that there is a final answer to

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  these problems, and that is not the case. He asked whether we have arrived. Last spring, I took the best advice available on the extra intensive care places that were needed to deliver the service that I wanted. I also set up a process for continual assessment. The gentleman who has been quoted so much in the debate is responsible for the special committee that is analysing the current situation and for producing a report that will allow us to project the question further and see what, if anything, needs to happen next.
  Our analysis last spring led to the conclusions that I announced at that time. They were widely welcomed in the field and they have been delivered. The Government have made clear their commitment to an expansion of the adult intensive care service. That is why I made two announcements following the Budget. First, I announced a targeted fund to support the growth of intensive care facilities, and especially such facilities for adults, in the next financial year. Secondly, just after Christmas I announced a £4 million fund to bring forward that expansion of intensive care into the current financial year. I announced the distribution of the money and said that it would be used to deliver almost 100 extra adult intensive and high-dependency beds in the last quarter of this financial year. The process is one of growth and assessment of need, but we can never reach the final destination, which is what the hon. Member for Southwark and Bermondsey (Mr. Hughes) implies in his question.
  Mental health is a key part of the national health service. The hon. Member for Stockport (Ms Coffey), who is no longer in her place, said that for too long, under Governments of every political complexion, mental health has been the Cinderella service of the NHS. But the Government have raised the priority of mental health and we have made clear our determination to improve the quality of the mental health care that is delivered by the NHS. We have not merely accepted the central recommendation of today's King's Fund report, but have announced our intention to implement it as soon as that is possible, on 1 April.
  From that date, the NHS cash distribution formula will reflect the differing needs of different parts of the country for community health services. That central recommendation of the report has been implemented and will lead to increased resources being targeted at mental health problems, especially in inner London. That is the latest of a series of initiatives over the past few years, the effect of which has been to strengthen the commitment and raise the priority that the health service attaches to mental health.
  The mental illness specific grant, introduced six years ago, is now supporting about £100 million of extra expenditure by social service departments on mental illness provision. The national health service challenge fund, which I introduced for the first time in the current financial year, has been extended into next year and will then be supporting £25 million of new expenditure by the NHS.
  In this year's Budget, I introduced a special fund to improve the provision for mentally disordered offenders, which is a particular problem in inner London, particularly east London and south-east London. That is a targeted fund addressing one of the specific needs
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  identified by the King's Fund report. As is now widely known, within the next few weeks the Government will introduce a Green Paper canvassing options for the strengthening of the management of the mental health service.
  I have never made any secret of my recognition of the fact that, under Governments of all political complexions, mental health services have not been accorded the priority that we should have seen over the past few years. That is a weakness that the Government have acted to remedy, and I had hoped that the hon. Member for Islington, South and Finsbury would welcome that.
  The Labour party's charges on the health service do not add up, but there is something more serious than that about the speech of the hon. Member for Islington, South and Finsbury: as everybody knows, this Parliament does not have much longer to run and, when the election comes, the electorate will ask both major parties and the Liberal Democrats about their policies. Behind all the bluster and cases such as Jennifer's ear and the updated version of that, they will want to know the health policy that the Labour party is offering to the people of this country. When that is the question asked, we are faced with a gaping void.
  The first question must be about money. Let me remind the House of the Government's record on financial support for the health service. Since 1979, there has been an increase of roughly three quarters in the real budget available to the NHS. That represents 3 per cent. real-terms growth on average every year over the past 18 years. That is the Conservative's record of commitment to the NHS. I remind the House again of the Prime Minister's pledge to our party conference to continue real-terms growth year on year on year through the five years of the next Parliament.
  We then come to what the Labour party offers in reply. The editorial of The Guardian said that the Labour party
  "needs to match the Tory spending promise. 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 the challenge that comes from a newspaper that Labour must be hoping will support it in the general election campaign. The same challenge is posed by Conservative Members and Liberal Democrats and all around the community. They want to know whether the Labour party will set out clearly its commitment to a real, growing national health service. The Labour party never answers that question. It dodges and fudges and finds a formula to get around it, but will it answer it? Will it hell. That is the question that will be asked by every elector in every public meeting attended by the hon. Member for Islington, South and Finsbury. They will be asking him why he will not match the Tory party pledge for a real growth in the national health service.
  Mr. Chris Smith: It would help if the right hon. Gentleman and his Government had not already broken that pledge. The Red Book shows that they have.
  Mr. Dorrell: The hon. Gentleman keeps saying that, but it is absolute nonsense. The Red Book sets out clearly—I can give the hon. Gentleman the correct reference—a budget that represents real growth year by year, throughout the three years of that spending

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  programme. Furthermore, I can give a commitment that there will be real growth of the health service budget through not only the three years of that spending programme but the remaining years of the next Parliament. That is the commitment that we have given and delivered through 18 years. We give the same commitment for the five years of the next Parliament and the Labour party will not match it.
  Ms Jean Corston rose—
  Mr. Dorrell: I will give way when I have finished dealing with the hon. Member for Islington, South and Finsbury on funding.
  When Colin Brown was writing in one of the health service magazines recently, he said that the Labour party
  "should fight again to keep the Tory promise alive for future years so that he"—
  the hon. Member for Islington, South and Finsbury—
  "can promise that every year, year on year, Labour will increase spending on the national health service in real terms. I bet he can't."
  Well Colin, no bets, because that is a pledge that the right hon. Member for Dunfermline, East (Mr. Brown) will not allow the Labour party to make.
  Ms Corston: Does the Secretary of State accept that the people of Bristol will judge the Government on their record, not just on the rhetoric of Front-Bench spokesmen? On the night of 5 January, 10 patients at Bristol royal infirmary were asked to get out of their beds after 10 o'clock at night because their beds were needed for other patients who were waiting on trolleys. One of them was a man in his 80s. The patients were sent home in taxis or relatives were asked to collect them, sometimes as late as 2 am when the temperature was minus 2 deg. That has received widespread publicity in Bristol and has caused a great deal of anger. Is the right hon. Gentleman surprised that people do not believe him when he denies that the health service is in crisis?
  Mr. Dorrell: It is not me they will not believe; it is the Labour party. The hon. Lady is trying to make me return to discussing individual cases. I will not do that. The challenge for the Labour party is to demonstrate how it will deliver a health service that matches the Government's pledge.
  It is not only a matter of total spending levels. There is worse to come when one thinks about the implications for the health service of the commitments that Labour has given. As I said at Question Time, the Labour party is committed to abolishing compulsory competitive tendering in the NHS. Such tendering is currently estimated to save £90 million on the health budget. Within the budget, which will not be growing because the right hon. Member for Dunfermline, East will not allow it, the Labour party has to earmark £90 million to pay off its trade union paymasters through the abolition of compulsory competitive tendering.
  The Labour party is also committed to the introduction of a minimum wage. When the right hon. Member for Livingston (Mr. Cook) held the health brief, he was honest enough to admit that that had a cost attached to it. He put that cost at about £500 million. I look forward to hearing the up-to-date estimate from the hon. Member for Islington, South and Finsbury. The hon. Gentleman was
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  chiding me about not knowing every detail of what goes on in the health service. If he can break off his private conversation with his hon. Friend the Member for Dulwich (Ms Jowell), he might be able to offer the House an estimate of what he believes the minimum wage will cost the health service. Can the hon. Gentleman improve on £500 million? Can he offer any analysis? He must have made an analysis. I can offer him the full resources of my Department and any information that he needs to provide an accurate assessment of the cost of that commitment to the NHS.
  The cost of that commitment is an important element in the choice that the electorate have to make. If the hon. Gentleman has not thought of that, I look forward to the correspondence that will enable us to develop a figure that we can then debate. We can then know whether that commitment will be a sensible use of health service money and whether it reflects a sensible priority in the frozen budget that the hon. Gentleman will have to put up with.
  An issue that will be of considerable concern to many of my hon. Friends and their constituents is what is to happen to the private finance initiative. The Government have made it clear within their spending plans that they are determined to deliver a major investment programme for the national health service through the PFI. We have already signed up 43 schemes with a total spend of £317 million. A further 28 schemes have been approved with a total value of £309 million. There are 150 schemes being worked up by individual trusts under the PFI. The health service investment programme for the period ahead is £2.1 billion, to be provided by private sector partners through the private finance initiative.
  Mr. Toby Jessel: Is my right hon. Friend willing to comment on the private finance initiative in relation to West Middlesex University hospital, which, as he and the Under-Secretary are well aware, is a matter of eager and enthusiastic interest to my hon. Friend the Member for Brentford and Isleworth (Mr. Deva) and to me? We very much hope that the scheme can go ahead lickety-spit without delay. Can he give us any encouragement on that matter, which is important for our constituents, so that the existing, old hospital can be replaced?
  Mr. Dorrell: My hon. Friend is right to raise his constituents' concerns about that hospital. He will know that it is one of the many schemes that local managers are preparing to meet real local need with health authority support and that the Government are determined to see carried through to projects that modernise the capital stock of the health service. I can give him every encouragement that the Government are determined to carry that through.
  The question whose answer my hon. Friend and his constituents will want to hear from the hon. Member for Islington, South and Finsbury is: what would be the implications of a Labour Government for that investment programme, which is valued at a lot more than £2 billion to the future of the national health service? Will the hon. Gentleman carry on with the private finance initiative, in which case he will have to eat mountains of words—both his own and those of his hon. Friends—or will he honour those words and scrap the schemes, so that they too have to be financed out of the frozen budget that the right hon. Member for Dunfermline, East will not let him increase?

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  I know what is being said to the electorate in my home town of Worcester on that subject—once again, by the right hon. Member for Livingston. The hon. Member for Islington, South and Finsbury ought to have a word with the right hon. Member for Livingston, as when the latter travels around the country he appears to be rather too honest for his hon. Friend's good.
  When the right hon. Member for Livingston recently visited Worcester, he made it crystal clear that, if the Worcester scheme went ahead before election day, as I know the citizens of Worcester hope, Labour would honour it; but if the contract was not signed by election day, it would go out the window. Bad luck to the citizens of Worcester. For them, the slogans are, "Vote Labour. Ditch your local hospital scheme" and "Vote Labour. Cancel your hospital project". Those are the slogans on which the hon. Member for Islington, South and Finsbury will go to the country, because he has no public capital—the right hon. Member for Dunfermline, East will not provide it—and he is not committed to the future of the private finance initiative, so he will not get it from that source either.
  Every scheme that is not signed up before election day will be out the window, because the right hon. Member for Dunfermline, East can offer no hope that the schemes will go ahead. It is a good vote-winning message for the Tory party: "Vote Labour. Ditch your local hospital".
  Mr. Gunnell: The Secretary of State has told us about the 43 schemes totalling £317 million. Can he tell me in how many of those schemes work has started, which scheme is most advanced and how much money has been spent on it?
  Mr. Dorrell: Thirty-two have been finished.
  The final question is one that Labour has invented for itself. It goes to the heart of the structure of the modern national health service. When we introduced local management, the Opposition fought us every inch of the way. The present Opposition Chief Whip said that Labour was
  "implacably opposed to the provisions for hospital trusts outlined in the White Paper."—[Official Report, 11 December 1989; Vol. 163, c. 696.]
  The present Labour spokesman on education said, "We will abolish trusts."
  Mr. Chris Smith: Before we move too rapidly away from the private finance initiative, will the Secretary of State confirm one or two things? First, he told the House more than a year ago that every month from then on he would announce a major new hospital scheme under the PFI. Will he admit that no such hospital has been confirmed in that intervening period? Secondly, will he confirm that in the case of the Norfolk and Norwich hospital, which was announced by the Chancellor of the Exchequer in the Budget and was the only major hospital scheme supposedly signed up under the PFI, although the contract with the contractors has been signed, the finance has not yet been finalised? Will the right hon. Gentleman also draw a conclusion from that about how much trust the people of Worcester or anywhere else can put in this
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  Government to come up with actual bricks and mortar, rather than windy rhetoric about the hospitals that they are going to get?
  Mr. Dorrell: As a citizen of Worcester, I was eager to give the hon. Gentleman the opportunity to clarify Labour's policy about the projects that rely on the continued commitment of the Government to the PFI. The citizens of Worcester need have no doubt about this Government's commitment. We are determined to deliver hospital projects through the PFI. What the citizens of Worcester—myself among them—want to hear from the hon. Gentleman is whether he is committed to those projects or whether all the £2 billion plus of projects being carried forward under the PFI would be ditched if there were a Labour Government. If that is the Labour party position, the hon. Gentleman owes it to the electorate to make it clear. Will the schemes go ahead under the PFI? Will the hon. Gentleman produce the money from the right hon. Member for Dunfermline, East, or are we talking about taking £2 billion out of patient care to allow those hospitals to go ahead? Or—by far the most likely option—are we talking about schemes that will go out the window if the country is misguided enough to elect a Labour Government?
  Sir Raymond Whitney: In pursuance of that question, to which my right hon. Friend has conspicuously had no answer from the Opposition, will he remind the House that, over five years, the last Labour Government cut capital spending on the health service by 28 per cent? Does that not give us a clue to the answer to the important questions that my right hon. Friend poses?
  Mr. Dorrell: My hon. Friend is right. It was not merely the capital budget that the last Labour Government cut, however. When nurses are considering the prospects under a Labour Government, they might remind themselves that nurses' pay fell in real terms by 3 per cent. and doctors' pay by roughly a quarter under the last Labour Government. That is what the right hon. Member for Dunfermline, East has got lined up for the hon. Member for Islington, South and Finsbury. The right hon. Gentleman is refusing to provide him with any money for the national health service.
  Mr. Gerry Steinberg rose—
  Mr. Dorrell: I have given way a great deal and I think that the House will want me to get through my final point.
  The final question is one that Labour has invented for itself. Labour fought local management and trust management in the health service. Now the Opposition say that they are in favour. At the same time that they fought the introduction of local management of hospitals, they were also fighting the introduction of the purchaser-provider arrangement. The present shadow education spokesman said in 1993, which is not that long ago:
  "I am vehemently against the notion, currently in vogue, of splitting administrative responsibility for health from delivery of care—divorcing regulation from provision."
  That was the position of the Labour Front-Bench spokesman a little more than three years ago. The hon. Member for Islington, South and Finsbury has changed that and I give him credit for it. He is now in favour of

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  the purchaser-provider split—the fundamental change that was introduced in health service administration in 1991. He cannot persuade his party that he is in favour of it, however, so he has invented a new distinction: he distinguishes the purchaser-provider split from the internal market. We have the ridiculous spectacle of the hon. Gentleman saying that he is in favour of the purchaser-provider split, but against the internal market. Until the hon. Gentleman discovered that distinction, the rest of the world thought that those two phrases meant exactly the same thing. The hon. Gentleman has not begun to explain how he has discovered a difference between those two phrases which have precisely the same meaning. It is a distinction without a difference that makes the hon. Gentleman look totally ridiculous.
  Labour is in a state of total confusion. Every time the hon. Member for Islington, South and Finsbury speaks about health, he reveals new depths of his own ignorance. With every passing day, it is becoming clearer that the hon. Gentleman is determined to continue to act like the Opposition spokesman he is destined to remain.
  The day of reckoning for the Opposition is drawing near. When the claims that they enjoy making are put under the spotlight, they melt like morning dew, and all that is left is a squalid determination to make political capital out of human misery. It is a sad commentary on the depths to which a once great party has sunk, and when polling day comes, the electorate will treat it with the contempt that it richly deserves.
  5.19 pm
  Mr. Richard Burden: I am pleased that the Secretary of State finished by talking about the private finance initiative. Such matters are part of the debate and I want to discuss them.
  The title of the White Paper launched shortly before the Christmas recess, "Choice and Opportunity", was rather interesting. My constituents, and people throughout the country, would appreciate a little more choice and opportunity in the national health service than the Government have given them over the past 17 or 18 years.
  On the previous two occasions on which I spoke on national health service issues in the Chamber, I mentioned the proposed primary health care centre in my constituency. It was promised on several occasions many years ago by the then regional health authority—now swept away by the Government—and every time that I speak on health service issues, I ask the Government when it will be built.
  The delays have arisen because of precisely those matters on which my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) was questioning the Secretary of State: the operation of the internal market, organisational structures in the health service that simply do not work and, most recently, the private finance initiative of which the Secretary of State has been singing the praises today.
  The latest but one phase was when the plan to build the centre was forced to go through the private finance initiative. Some time ago, I asked the Secretary of State and the Minister what were the administrative costs associated with processing that health centre, which had not yet been built, through the private finance initiative. The answer was £50,000.
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  When I asked the Minister what the administrative costs—supposedly associated with a value-for-money exercise—consisted of, I received the usual answer about the information not being held centrally, or something to the same effect. I was therefore referred to the trust, which told me that the £50,000 was spent on consultants' fees. Was the £50,000 well spent? Clearly not, because now we have been told that the project will go ahead with public money, because the private finance initiative did not work.
  As a result of that merry-go-round, not only has something that was promised to local people years ago been delayed time and again, but public money that could have been spent on patient care has been put into the pockets of consultants, even though the project was never appropriate for the much vaunted private finance initiative.
  That is the reality of the scheme by which the Secretary of State sets so much store. He challenges us on whether we intend to go ahead with the PFI projects, but I would like to know whether they would go ahead in the very unlikely event of the Government being re-elected. The plain fact is that projects promised under PFI do not get confirmed: not one has started in bricks and mortar.
  I want to give the Secretary of State another example of how bureaucracy has gone mad in the health service under the Conservatives and of how the PFI is operating. In Birmingham, there used to be several health authorities. Later, we had the North Birmingham and the South Birmingham health authorities, which recently merged, with the family health services authority, into a single authority for Birmingham.
  There was a problem with premises, because each of the former authorities had its own headquarters. It clearly made sense, in the interests of patient care and of ensuring that NHS resources were spent appropriately, to rationalise the buildings and save money. The health authority considered the most cost-effective and economical way of providing a single headquarters, and found an appropriate set of offices that was competitively priced and would enable it to get rid of the expensive former premises. In one of its buildings, owned by someone else, it had been given notice to quit, and in another it had installed some tenants to bring in some revenue; and it proposed that the third building could be sold. It was a rounded plan that made economic sense.
  The authority sent a costed business case to the Department of Health for moving into the new rented offices. After several weeks, or even months, it received an incredible letter saying that its plan to save money had to be processed through the private finance initiative.
  The contents of the letter sound like something straight out of a "Yes, Minister" script. It says:

  "1. Thank you for the opportunity to review the above business case. I apologise for the length of time taken in its completion.

  2. It is not clear whether the case is an OBC or an FBC. This makes it difficult to decide on the criteria against which it should be assessed. In summary, a number of issues have been raised about the failure to develop the case along the lines set out in PFI in Government Accommodation, economic appraisal issues and more general business case issues (such as failure to consider project risks and project management arrangements). These points are developed below.

  3. The status of the document needs to be clarified. Is it an Outline Business Case or is it a Full Business Case? The purpose and requirements of both documents are different.

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  4. The former establishes the need for the investment and identifies a preferred option (assumed at this stage to be a publicly funded option), whilst the latter evaluates methods for funding the preferred option (based on the results of the PFI procurement process). I presume this is submitted as an OBC. Apart from this difference, an FBC would also address issues centred on the management of the project (ie Benefit Realisation Plan, In-Project and Post-Project Evaluation Plan, Risk Management Plan and Contract Management Plan)."

  The letter goes on and on in that vein. It is comical to read, but it is the outcome of that bureaucratic madness. The letter was dated 27 November 1996.
  The end result is that the problem of the Birmingham health authority's accommodation is still unresolved. The only reason why it will not be sorted out is the crazy, bureaucratic rules laid down by the Department of Health. If the problem is not sorted out, the health authority will have to move out of the building that it occupies because it has been given notice to quit and does not own the building. It will have to move back to the place that it has sub-let and get rid of the tenants, thereby losing income for the NHS. It will have to pay more in rent than the cost that would have had to be paid had the Department accepted its original suggestion. That is the reality of the bureaucratic nightmare of the Government's way of running the NHS.
  One health authority, admittedly a big one, and one set of buildings—how did we get to this stage? Because the health authority was unable to pursue a simple transaction, the health service will have to pay more—money that should be going into patient care. The PFI is not a miraculous way of finding new investment for hospitals, as Ministers and Conservative Members claim. It is an incredibly expensive bureaucratic morass with unclear rules that has not yet produced one hospital, health centre or health service establishment. I am all in favour of attracting private finance to public projects and of proper partnerships, but they must work, they must be clear and they must be designed to do the job. They must not delay things and cost more money.
  Earlier, I mentioned primary care. I shall give credit to the Secretary of State for making some attempt to address that in his White Paper, some points of which are worthy of support. It was interesting that he made little reference to the matter in his speech. I am still waiting for an answer to a question that has been put to the Government several times. How do they think that the provisions in the White Paper will work?
  The White Paper suggests that general practitioners need not necessarily retain their traditional role of independent contractors in the NHS. They could become employees of other bodies, which would be the contractors to the NHS rather than individual GPs or groups of GPs. It has been acknowledged that GPs could therefore become employees of trusts. There is no problem with that if the trust concerned is a community trust involved in the provision of primary care. However, the Secretary of State has not satisfactorily dealt with the case of acute trusts that wished to employ GPs. A body whose main operation is the provision of secondary care would employ family doctors, whose job is to provide primary care.
  The Minister for Health (Mr. Gerald Malone): Let me set the hon. Gentleman's mind at rest. General practitioners are not in the NHS; they are independent
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  contractors. We foresee that they may be able to organise themselves in a different way, either through another body or by coming together to provide services or most likely, as he said, through a community health trust. He asked about acute trusts. The answer, in respect not only of acute trusts but of any other organisation where a conflict of interest might arise in the proposals made, is that the conflict of interest would be recognised and we would not expect such an application to be honoured. Clearly, if there were such conflicts, they would not be desirable.
  Mr. Burden: I am grateful for that answer. I shall give way again if the Minister can clarify the matter further. Groups of GPs getting together to provide expanded primary care services is potentially a good development. Labour has been pioneering such developments in talking about local commissioning teams, and local pilot teams have been working. In Birmingham, there are proposals to develop such services. Such a pattern of service would fit more easily with the locality commissioning suggested by the Opposition than grafting it on to the internal market that Conservative Members have imposed on the NHS.
  I must press the Minister further on conflicts of interest. I am pleased that he says that if there is a conflict of interest, he would not expect the application to be honoured. Is he saying that acute trusts would not be allowed to employ GPs?
  Mr. Malone indicated dissent.
  Mr. Burden: If he is not saying that, the Minister is heading down the road of conflicts of interest.
  Mr. Malone: I shall say what I said again, because it was perfectly clear. There could be applications where conflicts of interest might arise. If they did, they would be addressed at the time in the light of the individual application. I am not going to rule out an acute trust making proposals. I cannot predict whether there would be conflicts of interest. If there were, they would prevent the proposal from reaching fruition.
  Mr. Burden: I am afraid that that is not good enough. It might be just about tolerable if an acute trust employed GPs in its own area, because the pattern of referrals in a given area tends to be static and predictable. Where they can, GPs like to refer patients locally. What if an acute trust tried to contract out of area? That is where conflicts of interest would develop. Such a system could already be in place through the mechanism to which the Minister referred.
  What if private health care organisations such as PPP and BUPA wanted to set up a nice little local health centre to employ GPs? GPs would tell the Minister, if he asked them, that there can be pressure on them to refer patients to places that they do not necessarily believe will provide the best clinical services but which are often euphemistically described as the preferred providers. Private patients, perhaps those in insurance schemes, are already affected by such pressure. Currently, GPs can insist that referrals go to the place that they consider to be the most appropriate clinically.
  If we move down the road that the Government want to go down, what barrier will there be against a private health insurance firm buying up a local health centre and

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  employing GPs and against the employer putting pressure on its employees—the GPs—to refer patients to places that are not the most clinically appropriate in the judgment of GPs but that are the preferred providers in the interests of the employer? Those issues need to be addressed. I raise the matter today because when the Secretary of State talks of ensuring that there is a primary care-led NHS, I believe that that is what he wants.
  The Secretary of State needs to square a circle in order to achieve his goal, but he cannot do that unless he fundamentally challenges the assumptions according to which the Government have operated the NHS. In answer to my hon. Friend the Member for Islington, South and Finsbury, he said that no one had ever recognised the difference between the internal market and the separation of the commissioning of health care from the provision of it. I must tell him that most other people have always recognised that difference.
  Let me tell the right hon. Gentleman precisely what is the difference—I find it sad that he does not know. If he merely believes that the split between those who plan health services and those who provide them is equivalent to an individual contracting relationship, governed by a financial transaction, he has a problem in ensuring that the NHS keeps to the principles on which it was founded. Those principles are meant to guarantee the provision of health care, free at the point at which it is needed and to ensure equity in its provision. If the relationship between the provision and commissioning of health care is purely governed by a financial transaction, those principles cannot be adhered to. That failure is at the root of the problems of the system that the Government have imposed on the NHS.
  A new Government will fundamentally change that relationship. We shall get away from a system under which hospital is set against hospital and, increasingly, area is set against area; patient is set against patient; and GP is set against GP. We want to establish a co-operative framework for NHS planning and provision, which allows decisions to be made at the lowest possible level by those who are best able to make them.
  The NHS stands or falls by its own recognition of the fact that it is a national service. It must recognise that each branch is dependent on another, be it the doctor who is dependent on the nurse; the nurse who is dependent on ancillary staff; the GP who is dependent on the secondary care centre; or primary care that is dependent on tertiary care. That patchwork of provision, under which decisions are made locally, should be founded on a co-operative ethos, operating in the interests of the patient. That is different from a system in which the market rules, and that is why the Secretary of State is wrong when he says that there is no difference between the internal market and a system for the commissioning of health care. There is a big difference.
  Sir Raymond Whitney: Whether the hon. Gentleman realises it or not, he is proposing to take us back to the system of the 1970s with all its inefficiencies, disasters and total failure sensibly to allot resources because people were not aware of the value of those resources. The hon. Gentleman's propositions show that he has a fundamental misunderstanding of the history of the development of the NHS.
  Mr. Burden: The hon. Gentleman needs to read the policy document that my colleagues on the Front Bench
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  have issued about how the NHS will develop under a Labour Government. He will discover that it does not talk about turning the clock back. I agree with him that we need to learn from experience and learn certain lessons about NHS provision. We can learn some lessons from past over-centralisation, but the hon. Gentleman's constituents will be sad if he has not learnt that trying to run the NHS like some glorified supermarket has not been in the interests of patient care, clinicians, or the services. That is at the root of the internal market that has been imposed by the Government.
  The end result of that process, which was outlined ably by my hon. Friend the Member for Islington, South and Finsbury, has been the crisis of provision of hospital beds that we have seen this winter. The system has also failed to provide the required number of paediatric intensive care beds. That has happened not by accident but because of a Government who do not understand, or refuse to understand, what a NHS is meant to be, and how it can be run in the interests of patients.
  That lack of understanding needs to be changed. In the next few weeks or months, such a change will occur with the election of a different Government.
  5.44 pm
  Mrs. Marion Roe: I am as surprised as anyone that the Labour party has called this debate. In doing so, it was surely not unreasonable for those of us on the Conservative Benches to expect, at last, some explanation if not clarification of the Opposition's policies for the national health service. To date, we have had to contend with a mishmash of confusing ideas, coupled with the barest minimum of concrete policy decisions.
  The Labour party has had 17 years in which to produce credible ideas of its future vision for the health services. Frankly, so far, the Opposition have failed to do that. Judging by the reaction of the hon. Member for Islington, South and Finsbury (Mr. Smith) to the weekend reports on improving efficiency within the social services, I fear that we might have to wait a long time yet for such ideas.
  Once again, we have heard nothing of note from the official Opposition, so once again it has been the Government who have set the pace. I congratulate my right hon. Friend the Secretary of State on continuing to run the agenda.
  Since the previous full debate in November on the health service we have had a Budget that has more than met the pledge given by my right hon. Friend the Prime Minister to increase year by year the real level of resources committed to the NHS. We have had the Second Reading in another place of the National Health Service (Primary Care) Bill, when the Government were able to describe and enlarge on their policies for important developments in primary care. Since November, we have also seen the publication of the White Paper, "Delivering the Future", which set out some 70 practical proposals to further the improvement of patient care. A number of other important announcements have been made, for example, the allocation of an extra £25 million which my right hon. Friend the Secretary of State for Health announced on Christmas eve to aid health authorities and NHS trusts with seasonal pressures. I am therefore proud to support a Government who abide by their commitment to the NHS by thought, word and deed.
  Debates on the health service are sadly characterised by selective memories—the last one was no exception. When I prepare my speeches, I do not rely on anecdotal

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  evidence, nor do I try to extrapolate a general picture from a single incident. I turn to the people who can give me an accurate report on the situation. I asked the Queen Elizabeth II hospital, which serves my constituency so admirably, to tell me how it coped in the past few weeks, based on its experiences.
  As many hon. Members have already said, the especially cold weather and the 'flu-like illness that took hold over Christmas increased hospital admissions. That happened on top of the already high base line of emergency admissions which, in common with other hospitals in the area, the QE II is experiencing.
  The week after Christmas was characterised by an even greater surge of emergency admissions than the typical seasonal influx that traditionally occurs from Boxing day onwards. The hospital saw many people and admitted some 50 patients compared with the average weekly figure for the year of 28 admissions. I would like to emphasise that during that incredibly busy period all elective cancer patient cases continued to be brought. Despite the exceptional number of patients who arrived at the hospital, all were admitted and treated.
  Mr. Thomas Graham rose—
  Mrs. Roe: Forgive me, Madam Deputy Speaker, but I will not give way to the hon. Gentleman, who has not been present for the debate. I intend to proceed to put my case on the record.
  I repeat that despite the exceptional number of patients who arrived at the hospital, all were admitted and treated. That was achieved first and foremost by the dedication and exceptional commitment of the staff. I pay tribute to them for the personal efforts that were sometimes made over and above the call of duty—that is typical of NHS staff. The situation was complicated by the added pressure of a third of the nurses, who would normally be working, being off ill themselves.
  Mr. Graham: Will the hon. Lady give way?
  Mrs. Roe: No, I shall not give way to the hon. Gentleman, who has not been listening to the debate. I regard it as discourteous to enter the Chamber and start intervening in the middle of the debate. [Interruption.]
  Madam Deputy Speaker: Order. The hon. Member for Renfrew, West and Inverclyde (Mr. Graham) will not endear himself to the Chair if he persists in making seated interventions.
  Mrs. Roe: Many staff were on 24-hour call and more than 100 people—nurses on holiday, staff from other trusts and members of the public—rang in to offer help after an appeal was made on the local radio for nurses to return from holiday to assist. Such was the response that services were maintained despite incredible pressures.
  The second reason the hospital was able to cope was the quality of the management. In that period of extreme difficulty, thanks to the powers invested in them by the Government, the managers were able to adopt a flexible and practical approach so that they could tailor their
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  response to the situation, often on a daily basis. The matron, as co-ordinator across the hospital, worked closely with the chief executive on key decisions that had to be made throughout each 24 hours to keep the hospital capable of managing the high volume of patients. The hospital's success depended on good team work.
  A team of directorate service managers and the hospital social work team managers met daily to review the situation and to make contingency plans for the next 24 hours. The hospital social workers assessed the patients daily to identify those who would need social care support to be discharged home. As a result, bed blocking was less of an issue. Arrangements were speedily put into place through utilising vacancies that appeared in social care contracts when the social services users had been admitted to hospital. In that way, beds were freed, enabling the hospital to fulfil its prime function of treating sick and injured people. Careful forward planning had already alleviated the hospital's bed blocking problem; whereas last winter the hospital experienced 40 to 50 bed blockers, this winter it experienced its lowest number yet, with 24 bed blockers going through the system.
  Team work was also vital in other areas; the ambulance service was a key factor. The director of operations for the Bedfordshire and Hertfordshire ambulance service kept constant contact with the accident and emergency department. In particular, he would give early warning of the surges in patient flows as requests came in from general practitioners and the public for ambulance support. One such example was the notification on 3 January of 19 patients who were to come in two hours. That information was used to introduce contingency plans to deal with the high level of expected admissions. The staff in the accident and emergency department also played their part in effecting the smooth treatment and flow of patients.
  The majority of patients were admitted for acute medical conditions. To ensure that appropriate treatment was given as soon as possible and that discharges occurred promptly, all the consultants in the medical team carried out daily ward rounds. With delays cut to the minimum, more treatment could be given to others.
  Some contingency measures were taken, such as reopening the ophthalmic unit to provide extra beds; the children's area in the accident and emergency department was temporarily converted into a ward for adults. Children's admissions were then dealt with directly on the paediatric ward. When two emergency admissions were assessed as requiring intensive care, as all the intensive care units were full, the patients were transferred immediately to other units via the emergency intensive bed register. The matron of the Queen Elizabeth II hospital referred to the register as a "godsend" and "smashing" as it saved valuable time and energy by preventing unnecessary ringing round. The arrangements worked both ways: the hospital was able to take a patient from the register into intensive care when a space was available.
  It would be unrealistic to think that the efforts that were made to meet a period of great demand could be sustained. However, we are talking about a period of extraordinary pressure in a very short time—and the hospital was able to bear it. The way that the management coped showed the strength of good staff relationships, careful forward planning and strong internal management systems. It showed that the trust had the ability to take

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  and act on decisions quickly. It showed local decision making and a team pulling together at its best. Above all, it proved the Government's good sense in allowing those who manage the hospital the freedom to do so unhindered by central interference.
  Mr. Jessel: On a point of order, Madam Deputy Speaker. There is a power cut at No. 3, Dean's yard which began earlier today. As a result, secretaries to hon. Members who work there have been unable to carry out their work properly; many of them have called it a day and gone home, to the detriment of the constituents of right hon. and hon. Members. Could you, Madam Deputy Speaker, ask the Serjeant at Arms to report as soon as possible on what has happened and why, and to ensure that heat and light are restored by first thing tomorrow morning without fail?
  Madam Deputy Speaker: I know a little about the matter and I think that it is more than a power cut. I understand that there was flooding in the building overnight and, as a result, water has got into the electrical system. I know that the Serjeant at Arms is making every effort to ensure that normal working can be resumed. I also know that Madam Speaker is aware of the situation and is keeping a close eye on it. I thank the hon. Gentleman for raising the matter.
  5.56 pm
  Mr. Simon Hughes: The Serjeant at Arms has many powers, but I am not sure whether he can bring back the power when it goes off.
  I welcome today's debate; it is always good to debate the national health service and it is good that the Labour party has chosen it as the subject for the third of its 17 Opposition days in the parliamentary year. At 10 o'clock my colleagues and I will vote for the motion, which has been drafted to win maximum support in the House. I hope that all Opposition Members will support it. If they are true to some of the things that they have said, one or two Conservative Members will also support the motion. If all Opposition Members are present and all Conservative Members are present, there will be a tied vote. I understand that if that were to happen tonight, following the usual precedent, the Government would survive by Madam Speaker's casting vote, although they might not do so on other occasions. It would take a Conservative Member to abstain or to vote with us for us to win—we live in hope.
  Mr. Malone: Get on with it.
  Mr. Hughes: The Minister has told me to get on with the debate; I am keen to do so, but I want the Government to realise that their hold on the confidence of the House is, at most, very insecure.
  The problem is that, although everything in the motion is easily supportable, everything but the last line is criticism of the current position and the last line does not contain a positive proposal. Sadly, yet again, the Labour party, as the Secretary of State rightly said, has been weak on content, weak on performance and poor in attendance. Today is an Opposition day, but there have been more Conservative Members than Labour Members present at all times. [HON. MEMBERS: "That is not true."] It is true:
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  during the Secretary of State's speech, and subsequently, only five, six, seven or eight Labour Members have been present. I have been here all the time and added up the numbers regularly.
  Let me take the five points in the motion in turn. First, the Labour party argues that the internal market is the cause of all the problems in the national health service. The internal market, as designed by the Tories, has caused many problems and is the cause of many of the costs and the pressures, but it is not fair to say that it adds to all of the problems of the NHS. Many of the pressures on the NHS are caused by demand that is rising in a way that was not predicted even a few years ago.
  I acknowledge that there is bureaucracy that could be got rid of. My colleagues and I have argued that, instead of one-year contracts, there should be at least three-year contracts and I am sure that that would save a lot of time and money. We are opposed to local pay bargaining, because it imposes huge extra costs and distracts professionals from their work. However, even if the British Medical Association is right and expenditure on bureaucracy could be saved by having a redesigned NHS—albeit one that keeps purchasers and providers—and even if that saved the £1.5 billion that the BMA says would be saved, the savings could not be delivered overnight.
  The first flaw in Labour's argument is that to give only £100 million over the Government's commitment, but only for the first year, as the hon. Member for Islington, South and Finsbury (Mr. Smith) said, will clearly not begin to answer the public's concerns about the NHS. That is the fundamental flaw and after yesterday's announcement by the right hon. Member for Dunfermline, East (Mr. Brown), I have to say that any hopes that the Labour party will deliver the resources that the NHS needs are scuppered, not only for the first year but for subsequent years.
  Whereas it has traditionally been the expectation that the Labour party would put more funds into the NHS, now, for the first time, we face a general election when it is absolutely clear that the Tory party is committed to putting in more resources in the near future than is the Labour party. The Liberal Democrats are committed to putting in even more—we have done the sums and we will do it. After the next election, if no single party has a majority of seats—we have committed ourselves to not keeping the Tories in office—we will use our votes in this place to ensure that the Labour party breaks its spending commitment not to put more money into the NHS and that more money is put in. I believe that the public will back us in that.
  Mr. Bayley: The hon. Gentleman is wrong to say that the Labour party will not match the Government's spending pledges on the NHS—[Interruption.]—the Labour party has done so. I read with great care his article in The Guardian of 9 January in which he set out the Liberal Democrats' health policy, and it included a number of specific spending pledges, which I asked the statisticians in the House of Commons Library to cost. They tell me that their best estimate is that in 1998–99 the package of measures proposed by the Liberal Democrats would cost an additional £650 million and roughly an additional £1 billion in the following year—it depends on the level of NHS inflation. Given that the Liberal

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  Democrats have already committed 1p in the pound on income tax to education and given that his 5p on cigarettes will raise only £175 million—
  Madam Deputy Speaker: Order. Hon. Members are aware of my views on interventions—they should be short. The hon. Gentleman should seek to catch my eye and make his points in a speech of his own.
  Mr. Hughes: The hon. Gentleman did not quite finish, but I shall say that we have made a commitment. I shall be happy to talk to him outside the Chamber and go through the figures, but our commitment is clear. First, we have made a commitment to keep pace with NHS inflation throughout the life of the next Parliament. The Government have made a commitment only to keep pace with ordinary inflation and the Labour party has a commitment to fund only one year—the first year—at the rate of the increase in ordinary inflation. Secondly, we have committed an additional £550 million a year, which, as the hon. Gentleman rightly said, will be raised from 5p on cigarettes, which will raise £200 million to restore free dental and eye checks, and from tax collection from employers through national insurance, which will raise £350 million.
  If NHS inflation starts to rise again, instead of decreasing, we will have to address the question of where the money will come from. However, there is absolutely no doubt—we have checked our figures with the Commons Library, too—that an analysis of the present commitments on the table of the three main parties in the House shows that the Liberal Democrats have committed far more resources than the other parties; the Tories are clearly second and the Labour party clearly third in the league table.
  Mr. Forman: Does that mean that the oft-quoted remark of the leader of the Liberal Democrats that his party would simply put 1p on the standard rate of income tax to fund its education commitment is not the Liberals' only public expenditure commitment and that the Liberals are also committed to other forms of tax increase?
  Mr. Hughes: I do not want to be distracted from my speech, but we shall commit an extra £2 billion for education and if that has to come from an increase in income tax—1p in the pound raises about £2 billion—we shall do that. It depends on how much is in the kitty, how many people are in work, what is the social security budget and other factors, but we shall do it. We are committed to further tax increases in respect of the health service: first, imposing additional duty on cigarettes and, secondly, closing various employers national insurance loopholes. Those are tax increases for specific groups in society—they are not general. Those two specific additional commitments have been agreed by all Liberal Democrat Members and by my hon. Friend the Member for Gordon (Mr. Bruce), who speaks for us on Treasury matters, and they are supported by my colleagues in Wales and Scotland who recognise the benefits.
  I shall now return to my speech and the five points in the motion. Secondly, I pay tribute to the fact that the NHS works because its staff operate extremely well. Throughout the country, they are under great pressure at
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  this time of year and they are doing an extremely good job. I was in the John Radcliffe hospital in Oxford a couple of weeks ago and staff there are coping, although they have had to delay admissions and put off operations so that patients have had to stay in waiting lists. The staff are doing all that they can to manage. This morning, I was at the South Westminster health centre, which is just round the corner in Vincent square and is run by the Riverside Community Health Care NHS trust. It is an excellent health centre and is clearly doing a good job. With one of my colleagues, I went to a large GP surgery in Elephant and Castle, the Princess street group practice, which is doing an excellent job. Queenie Harrild—a constituent of the hon. Member for Lewisham, East (Mrs. Prentice)—died in Guy's hospital a week ago and that tragic case was mentioned by the hon. Member for Islington, South and Finsbury. Her family specifically said that they were critical not of the staff at the hospital, but of the system and the lack of beds.
  Thirdly, it is true to say, as Labour says in its motion, that the result of current policy is that
  "government policy has left many people in urban and rural communities without the access to health care they need".
  In urban areas, that may be a lack of an intensive care bed when and where one is needed. In rural communities, it may be a lack of a dentist anywhere near one's residence or a lack of a community pharmacist. In all cases, there is a risk that an individual might find himself or herself discharged too early. The hon. Member for Bristol, East (Ms Corston) mentioned the outrage felt in Bristol at people being woken up and sent home from hospital in the middle of the night. Of course, that is what happens to less urgent cases, but that should not be the way in which a publicly funded national health service is run.
  Mr. Hendry: Will the hon. Gentleman give way?
  Mr. Hughes: No, I am conscious that other hon. Members want to speak.
  Fourthly, we share the Labour party's view that we need a more democratically accountable NHS. There should be regional health authorities in England, and democratic authorities in Scotland and Wales, to decide on strategic policy. They should decide whether hospitals are needed or not, instead of that being arbitrarily decided by the Secretary of State. At a local level, trusts and health authorities should be more democratic.
  Fifthly, we believe that we must restore confidence in the NHS.
  We could have tabled no amendment to the motion, or we could have just congratulated the NHS on its successes and paid tribute to the progress that it has made. Certainly, there has been progress both in paediatric intensive care and in intensive care generally. By convention only the Government amendment is selected on such occasions, but I am glad that the two ideas in our amendment were not completely dismissed either by the Secretary of State during questions today or by the shadow health spokesman when I intervened earlier.
  First, the public want the NHS to be removed from the party political battleground. I recently appeared on a Granada television programme with spokesmen from the other two main parties, and someone in the audience made precisely that point. Facts, for instance, could be removed from the battleground. We may disagree about funding,

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  but the facts should be agreed—for instance, about how many intensive care beds there are and how many hospitals have closed.
  Today the King's Fund issued a report on mental health. It is a well-respected independent body; perhaps we could agree to let it do this statistical work. Before the end of this Parliament, I would hope that the three major Great Britain parties, the Irish parties and the Scottish and Welsh nationalist parties will agree to allow an independent, respected and recognised body to provide us with the evidence on which to base political decisions.
  Earlier today the Secretary of State referred to the report by the National Association of Health Authorities and Trusts, the last paragraph of which reads:
  "Undoubtedly, despite the problems, the service generally has been maintained, although some elective treatments are being deferred. But however hard the NHS is working, the initiatives taken do not solve the underlying problems of capacity and demand. It can be expected that comprehensive reviews of current clinical and workload practices will be undertaken by health authorities and trusts. But overriding this is the need for a high-level review of both the current position and the implications for the future provision of services."
  That is why we need agreement on the size of supply and demand, whereupon the politicians can sort out, and put to the public, the best way of dealing with the problems.
  Of course some more funding will be needed. We calculate that if people's lives are not to be put at risk by the closure of beds, wards or hospitals in any part of the country, the finance-driven closure programmes and any consequent reductions of services must be put on hold. Doing that will cost about £350 million a year—perhaps we could achieve all-party agreement about that.
  I hope that the other political parties will respond to my twin proposals, to obtain independent information and to provide the money that will stop the running down of services. It is no good Conservative Members claiming that the Tomlinson report or the other reports commissioned by the Government are independent and objective. The Government ordered the reports; their authors reported back to the Government. The Nolan commission is more along the lines of what I have in mind—enjoying the confidence of all Members of the House.
  Tomorrow we will debate intensive care, so I do not intend to go into it now—except to comment on the fact that the Secretary of State only partly answered the questions about it. Of course the demand for intensive care will change, but we need to hear from Ministers on the record whether they think that we have enough paediatric intensive care beds and other intensive care beds to meet current needs. I hope that such a statement will be made tomorrow morning in the debate; anything less would be a fudge.
  One effect of the pressures on the health service is that many operations are deferred. People sometimes die as a result. The lady I mentioned earlier died of a heart attack which, according to the consultants, she would not have had if a bed in Guy's hospital could have been found for her to use after her heart bypass. Theatre and staff were available, but there was no intensive care bed. Thus someone with more years to live lost her life.
  Part of the solution must be to separate elective beds for non-emergency admissions from emergency beds, so as to avoid the problem of those with booked beds being put off while they serve as emergency beds.
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  Many of us are grateful for the universal recognition today that mental health services have been the Cinderella services of the NHS. Those who lose out most are the people with conditions that are not quite acute but are nevertheless immense. I am told wherever I go that only those who present with the most severe mental illnesses are treated, and that people whose needs are slightly less urgent but still serious do not get the service they require. Hence the need to go on building up these services. A mental illness is an illness like any other; those who suffer from mental illness deserve the NHS just as much. Yet they are often treated as lesser beings. Mental illness can come to any one of us. That is why we should ensure that those who suffer from it are given as much chance to recover as people with physical illnesses.
  Another problem arises because health authorities and trusts are eating into next year's budgets to pay for this year's, and this year they ate into last year's. I do not know whether the Government can raid the coffers before the general election; I do know that there is always a contingency fund and that, as the election draws nearer, it is eyed ever more keenly. I hope that the Secretary of State and Ministers at the Department will be able to persuade the Chancellor that as little as £200 million, if released this year, would remove some of the pressures and prevent the perpetual delays in treatment that afflict the service.
  When the election comes, it will not be about whether we should have a national health service—all the parties are signed up and committed to one. The debates will be about whether to fund it properly. I therefore end where I began. The job of politicians is to be honest with the public. The NHS will be the brilliant jewel of our welfare state only if we inject it with the necessary amount of public money. That is what will divide the parties at the election. My colleagues and I believe that if we fund health and education properly, we shall have a society that is both well and well equipped. Only that will make us the sort of successful nation that our people want us to be.
  6.17 pm
  Sir Raymond Whitney: I agree with a great deal of what the hon. Member for Southwark and Bermondsey (Mr. Hughes) said, especially with his plea for a more sensible debate about how to go on developing and improving the national health service—a debate that will be possible only by removing the political animus from the subject. Unfortunately, the Labour party is incapable of that.
  We have heard two depressing examples this afternoon; and at Prime Minister's Question Time there were two more examples of it from the Leader of the Opposition. He made the same tired old claim that "we"—the Labour party—created and built the national health service. To make such a claim shows either total disingenuousness—I must be careful of my language in this Chamber—or total ignorance. I shall do the right hon. Gentleman a favour by suggesting that his claim is based on ignorance. That is not true of the whole party—some Labour Members know perfectly well who created the health service.
  I shall take a moment or two to remind those who may conveniently have forgotten that the first step in the creation of the national health service, which took some 40 years—we may lament why it took so long—was taken

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  by a Liberal, Lloyd George, in 1911. It originated with the National Insurance Act 1911. That legislation created sickness benefit, which became known as the medical benefit scheme, and was the kernel of what became the national health service.
  Who opposed that measure at the time? It was the British Medical Association. We should remind ourselves of that fact each time we hear from the current Jeremiah of the BMA—over the past year or two it has been Dr. Marks. But there has always been a Dr. Marks at the BMA, opposing virtually every change for the better in the national health service.
  In 1918, before the end of the war, the Liberal and Conservative coalition Government launched the Department of Health. It therefore had nothing to do with the Labour party, but was created by the other two parties. I offer that little history lesson because we do not want to hear yet again the nonsense that the Labour party created the national health service.
  In the 1920s, Neville Chamberlain, who subsequently became the leader of the Conservative party and the Prime Minister, called for a national hospital service to fuse voluntary and public hospitals, many of which were of an extremely high standard. It could not make much progress because of the economic conditions between the wars, but, in 1938, all those national hospitals were brought together in the emergency medical service. Who did that? It was not the Labour party but the Conservative Government, so that was a Conservative creation.
  In 1944, a White Paper laid the basis of what we now know as the national health service. The wartime coalition Government, in which the Labour party participated, had a Conservative Health Minister, Henry Willink, who introduced that White Paper. So let us hear no more nonsense about the health service being the Labour party's creation—[Interruption.] If the hon. Member for Nottingham, East (Mr. Heppell) would like to intervene on this history lesson, I am happy to give him that opportunity.
  Mr. John Heppell: The hon. Gentleman's account is a little misleading. It would be better if he told us how the Conservatives voted when the national health service was proposed. If he is telling the truth, he will have to say that they voted against the NHS at every stage in this Chamber.
  Sir Raymond Whitney: I am happy to come to that. The hon. Gentleman slightly pre-empted me.
  Everyone greeted the creation of the White Paper except, again, the BMA and the British Medical Journal. The 1944 White Paper was strongly endorsed at the Labour party conference of that year in Blackpool. I now come to the point raised by the hon. Member for Nottingham, East. No one was arguing against a comprehensive health service, free at the point of delivery. That was not the debate, and if the hon. Gentleman thinks that it was, he is dead wrong. The debate was whether to have a centralised organisation that would become overly bureaucratic or a regionally based organisation. The then Herbert Morrison, who may be familiar to some Labour Members, was very much in favour of the local concept. At the very last minute, Bevan
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  persuaded the Labour Government to go for the centralised version—the one opposed by the Conservative party—and, when Morrison told Bevan that it would become a bureaucratic nightmare, Bevan said, "No, we can find ways round it." Sadly, it has taken us many years—we are not yet out of the wood—to find a way to resolve the problems of a centralised health service. We all know that.
  Let me continue with the "Labour party's national health service". Who first introduced prescription charges? There are no prizes for the answer—it was the Labour party. Who, in the 1970s, cut hospital building by 28 per cent. in real terms over four years? It was the Labour party. Who cut nurses' pay in real terms? It was the Labour party. For three years out of four, the pay rises granted to nurses during the period of Labour government were below the rise in the cost of living.
  In 1977–78, there was a real cut in spending of 2.7 per cent. That is the Labour party's reputation and record, and Labour Members and the country should never forget it.
  Mr. Hendry: Will my hon. Friend confirm that the Labour party's approach of seeking to cut the health service goes back a little further? The first financial crisis in the health service was in 1949—a year after it was started—when the then Labour Cabinet said that, as the health service had been in operation for a year, the population should be healthier, so the money going into the health service could be cut.
  Sir Raymond Whitney: My hon. Friend is right. However, in the 10th anniversary debate of the founding of the national health service in 1958,when happily there was a Conservative Administration, the Conservative Minister for Health, Derek Walker-Smith, said that, if we spent just a little more, the nation would get healthier, and we could then spend less. With the wisdom of hindsight, it now seems incredible that our distinguished and intelligent predecessors should ever have thought that.
  We now know the reality, which is what we must all wrestle with. As the hon. Member for Southwark and Bermondsey rightly said, if only we could wrestle with it in a calm and intelligent way instead of with the party clap-trap that we hear all the time about it being the Labour party's national health service, we might make some progress.
  We all know the factors: the rise in demand; an aging population; improvements in, but increasing costs of, medical techniques; and the rising aspirations, quite rightly, of our people. All those factors add up to a huge challenge, to which we are rising and have risen during the period of Conservative government, and of which we should be extremely proud.
  Just imagine if, in 1979, we had gone to the electorate and said, "Over the next 18 years, we shall increase real-terms spending on the health service year on year by 3 per cent." Who would have believed us? What would the Labour party of the day have said? However, that is what we have done. Had we said that to the BMA, it would have said that all the problems would be solved. Every year, BMA spokesmen say, "Just a little bit more—2 per cent., £2 billion or £10 billion more—and we shall all be OK." Had we offered them a 3 per cent. annual increase in real terms for 18 years, they would have said, "This is utopia; this is heaven." Everyone would have been happy.

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  We did not say that, but that is what we have achieved. We now have more than 20,000 more doctors, who are paid 33 per cent. more in real terms. We have 55,000 more nurses, who are paid nearly 70 per cent. more in real terms. That is a great record, and we are proud of it.
  It is not a matter just of employing more doctors and nurses and paying them more, however, but of treating more patients with better, more advanced treatment, and that is what is being achieved. Our constituents know that, although they are still fooled by the Jennifer's ear war which the Labour party persists in waging. Labour Members have learnt nothing since 1992 in that regard. We get the same old tired vacuity.
  If I speak to my constituents, they say that they hear about the terrible problems in the NHS. When I ask them about their personal experience, they say, "My general practitioner is fine." There are GPs of a high standard in my constituency, I am happy to say, and many of them are in budget-holding practices, with all the benefits that that brings. My constituents tell me about Aunty Mabel, who was in Wycombe general hospital a few weeks ago, where the treatment was wonderful. That is what we all hear, time and again.
  Despite all the challenges and the Labour party hypocrisy, we have a great national health service, which is getting better. That is partly a tribute to the healthy economy that we have created, which has enabled us to put in substantial resources, but it is an even greater tribute to the contribution made by all those who work in the NHS, who are daily denigrated by the Labour party. It is time for that to stop.
  6.30 pm
  Mr. John Gunnell: A week ago, I was one of those who raised on a point of order the failure of the NHS to meet the extra demand generated by the extremely cold weather over the Christmas and new year period.
  That failure was highlighted for me by the death of a constituent of my neighbour, my hon. Friend the Member for Leeds, East (Mr. Mudie). In dire emergency, that constituent had to travel to Hull for treatment, despite the fact that she lived within one mile of a major hospital and within two miles of each of the major hospitals in Leeds. We have become used to Leeds hospitals receiving emergency cases from as far away as Kent, so people in Leeds were surprised to find that our hospitals could not deal with an emergency on their doorstep.
  I raised the point because I thought that the number of incidents and the severity of the shortage of treatment would bring the Secretary of State to the House. Surprisingly, it did not even get him to the studio on the day that the House resumed its business.
  That anecdote and others that we have heard during the debate demonstrate a widespread failing in the health service, but it is important to look beyond anecdotes, because, with so many people being treated by the health service, we cannot expect every case to work out satisfactorily. There will always be anecdotes about people who did not receive the treatment that they felt they should have had.
  We should accept that the reforms introduced into the health service are not all working as smoothly as is claimed by those who introduced them. The public
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  demand changes in our approach to the health service, and I am sure that, after the general election, we will respond to those demands.
  The BBC "Panorama" programme just over two weeks ago advanced the thesis that the NHS was being kept afloat in an attempt to see the Government through to the election, that health authorities would be about £150 million in debt by the end of this financial year, and that they were being allowed to overspend by a supposedly fiscally responsible Government in order to create the impression of stability. In effect, that debt will prove to be a deferred cut in NHS spending.
  "Panorama" also reported that, in the past five years, £500 million could have been spent on patient care by health authorities, but that, because of short-term political concerns, that was stopped by the Government through the health authority chairmen they had nominated. That charge needs answering.
  We must discover why there are severe shortages in the health service. The series of anecdotes is not haphazard, but part of a pattern that reveals deficiencies in the service.
  Mr. Forman: I also saw the "Panorama" programme, which I found interesting. Does the hon. Gentleman recall the powerful point it made about the great advantage to patients from the constant provision of new facilities and new hospitals for the health service, as has happened over the past 18 or 20 years or longer? That requires older facilities to be closed down, but it is important that continuity of provision should be maintained.
  Mr. Gunnell: The programme suggested that potential savings had not been made, because of reluctance to close down some facilities that had passed their useful life and that did not have the skilled staff to deal with emergencies for which they were supposed to cater.
  I agree with the hon. Gentleman, but the fundamental argument of the programme was that the Government were allowing health authorities to run up large debts in order to keep the health service afloat and maintain the impression of stability until the general election. The hon. Gentleman may not agree with that, but I am sure he will agree that that was the main thesis of the programme. The Government must answer the charge.
  I hope that we would all agree that deficiencies exist in the NHS. As a result of closures, there is undoubtedly a shortage of beds. The British Medical Association, which is clearly not popular with the hon. Member for Wycombe (Sir R. Whitney), says that the reduction in bed numbers is a key reason for the current NHS crisis.
  The Conservatives have cut almost one in four beds since the internal market was introduced. In the North and Yorkshire area, which is my area, there has been an incredible 33 per cent. drop in geriatric beds, a 25 per cent. drop in maternity beds and a 19 per cent. drop in general and acute beds since 1989–90—a 27 per cent. drop overall. We must accept that those figures are accurate and based on a count by the BMA.
  In a recent report on the state of the health service, Leeds general infirmary was highlighted by the BMA for bed closures due to lack of money. The infirmary closed 40 beds because it was the focus of criticism last year about the number of patients on trolleys. I drew attention to two relatives from south Leeds who had died as a result of being left too long on trolleys.

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  I accept that an attempt was made to increase the number of intensive care beds. That attempt was partially successful: we have not had quite the same level of crisis this winter, but that has been achieved at the expense of ordinary services. Those 40 beds and others were cut, resulting in the postponement of operations and delays in admission.
  I have been invited to visit a hospital in the next week or two to meet one of the consultants and hear why people must wait so long to see him. The crisis in the NHS is fundamentally a beds crisis. The BMA has warned that, unless the chronic underfunding is tackled, an "emergency-only service" will characterise the NHS in the winter months ahead. Routine surgery, treatment and investigations are already being cancelled or slowed down.
  The Sunday Telegraph, which I would not usually expect to support the Labour party's position, recently reported an accident and emergency official who described the entire hospital service as being
  "stretched beyond its capacity to cope."
  Even the Minister must accept that the health service is under great strain because of a shortage of hospital beds.
  I shall not rehearse the argument about intensive care beds. However, the Secretary of State must examine the position in Leeds and in the North and Yorkshire region, as I do not believe that that region has received the number of paediatric intensive care beds that he specifically promised in his statement. That is why I asked him about the situation in that area.
  The right hon. Gentleman accepted in correspondence with me that the paediatric intensive care unit at Leeds General infirmary is the most highly skilled facility in the region. It is logical to expand the best unit, but the facility at Leeds General infirmary occupies an enclosed space, and it would have to be relocated within the hospital in order to accommodate more than one additional bed.
  We are told that an extra bed has been added to the unit, but the facility is unchanged from when I visited it a year ago. It has space for five beds, and, at a time of real crisis, it can expand to six. That extra bed is shoved in at the expense of the space available to the other beds. It is all very well for the Secretary of State to claim that the unit now has an additional bed, but that bed was always available when needed. The difference is that, previously, it was not counted as an official paediatric intensive care bed, and now it is. I believe that the Secretary of State has failed to fulfil his promise to the North and Yorkshire region, and I shall be interested to hear his comments on the matter.
  A shortage of capital funds in the Budget has also caused problems. The Chancellor has revealed a 16 per cent. cut in capital spending, in the expectation that the private finance initiative will make up the difference. The matter was raised previously in debate.
  I think that the Government should come clean about the PFI's achievements in terms of completed projects. When I asked the Secretary of State about it, he said that 43 PFI projects had been signed, which were worth a total of £317 million. When I asked how many of those projects had progressed to building work on a hospital site, he said that 32 such projects had been completed.
  786
  I can only assume that he meant that the signing had been completed in 32 cases and that the projects were ready to go ahead.
  I ask the Minister of State: how many projects are under way? I am interested not only in signed contracts but in bricks and mortar. Can those whom the new facilities are intended to serve see something happening? I do not know of a single instance where construction is under way.
  It is all very well to assume in the Budget that the PFI will make up a shortfall in expenditure—I hope that the private sector ventures will prove successful and that the projects will go ahead, because the NHS needs them—but we must be sure that the projects have progressed beyond the mere signing of pieces of paper. Parliament enacted the National Health Service (Residual Liabilities) Bill last year to enable the contracts to be signed, and now I want to know what progress has been made. Is the private sector confident about those contracts?
  Mr. Steinberg: I asked the same question of the Library, and I was told that no PFI project has begun, and not one brick has been laid on any site. Where the Secretary of State gets his 32 starts from is anyone's guess—in fact, I suspect that he was misleading the House.
  Mr. Gunnell: I thank my hon. Friend for his intervention.
  Mr. Deputy Speaker (Sir Geoffrey Lofthouse): Order. Do I understand that the hon. Member for City of Durham (Mr. Steinberg) is accusing the Secretary of State of misleading the House? If so, I think that he may want to withdraw that remark.
  Mr. Steinberg: I did so inadvertently, Mr. Deputy Speaker, and I obviously apologise to the House. However, when information from the Library states that not one brick has been laid on site and the Secretary of State says that 32 projects have been completed, someone somewhere is supplying the wrong information.
  Mr. Deputy Speaker: Do I understand that the hon. Gentleman has withdrawn the remark?
  Mr. Steinberg: Yes.
  Mr. Gunnell: Thank you, Mr. Deputy Speaker. I do not think that the Secretary of State tried to mislead the House. When I asked about completions under the PFI, I think that he thought that I was referring to contracts rather than buildings. Like my hon. Friend, I understand that the projects have yielded no concrete results.
  Mr. Steinberg: According to the Library, the schemes' commencement dates have not been announced.
  Mr. Gunnell: I must move on rapidly.
  Mr. Malone: Perhaps I can assist the hon. Gentleman. I cannot allow the intervention of the hon. Member for City of Durham (Mr. Steinberg) to stand. I shall deal with the matter in some detail in my winding-up speech, but I rise now merely to state that I celebrated the completion

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  of a PFI scheme involving the internal refurbishment of part of a London hospital about six to eight months ago. The scheme was valued at some £5 million to £6 million.
  Mr. Steinberg: What a load of cobblers!
  Mr. Malone: The hon. Gentleman may mock—I am sure that those at the hospital will note his comments—but I can vouch for the fact that the PFI principle is delivering within the NHS.
  Mr. Gunnell: I thank the Minister for his comments, and I accept that he has seen that project completed. However, I am sure that he does not intend to imply that the Secretary of State meant that 32 such projects have been completed.
  I believe that the shortage of capital in the NHS—I hope that my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) has noted it—is causing real concern within the service. There is also clear dissatisfaction with the purchasing system.
  On Sunday, the Minister of State responded to claims that 20 per cent. of expenditure on purchasing in the NHS is unnecessary. A group claimed that £8 billion of the £40 billion spent on purchasing in the NHS could be saved. The group did not substantiate its case, and I think that we would need more information if we were to pursue that line. However, it is important to examine the way in which money is spent.
  I have written to the Department about the concerns expressed by a company in my constituency—I think that it is the only firm in England that manufactures operating theatre lights—as a result of its experiences of trying to win contracts in the national health service.
  As a member of the Select Committee on Public Service, I am a little concerned about the meeting that we had with the Audit Commission. We talked to the Audit Commission. The freedom it has when it examines local government, whereby it can examine almost anything that local government is doing, is not available to it in the national health service. It is not able to investigate hospitals.
  I hope that the Minister and my hon. Friends on the Front Bench will consider the use of the Audit Commission in the NHS. If the commission were not restricted in what it can do in individual hospitals and trusts, we might get some useful information from it. Certainly, if purchasing does not, as was alleged, ensure value for money, I would expect the Audit Commission to be able to make a positive contribution. I hope that the Minister will consider that.
  My hon. Friend the Member for Islington, South and Finsbury made a point about which we feel very strongly: if so little information is held centrally, as the Department of Health is willing to reveal to us in answers to parliamentary questions, it is no wonder that some of the decisions that are taken are not the best decisions for the service. I am amazed at the number of times we are simply told that the information is not held centrally, even when my hon. Friend the Member for Bolsover (Mr. Skinner) asked how many hospital closures there had been.
  Let me give examples of matters that are important for an understanding of the workings of the health service. I have been looking at the Mental Health Act 1983 and the
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  way in which electro-convulsive therapy treatments are given—I have a constituent who is concerned about this—and particularly the way in which they are often given without specific consent. I attempted to find out, through the Department of Health, the extent to which such treatments take place, but was told that the information was not held centrally.
  I tried to find out what information the Department collected centrally to determine the performance of the health service in relation to its "Health of the Nation" targets on strokes. It told me that, although it holds a certain amount of information concerning mortality, it was not able to tell me much about the people who experienced strokes and went into hospital, and what treatment was effective in preserving them, perhaps for a later stroke but perhaps for very much longer than that.
  If that information is not held centrally, what is? How do Ministers get the information they need to make policy decisions? The health service is now so fragmented that it must be difficult even for Ministers if the Department of Health is not able to give factual data about the state of the nation's health—and, indeed, how far we have progressed towards meeting the "Health of the Nation" targets.
  After the general election, a change will come about that will be extremely helpful to the service. In the first instance, in office will be people who always use and rely on the service. That is very important. It makes a difference. The attitude of someone who is able to contract out of the health service and pay for his or her private health care is very different.
  I lived in the United States for eight years, where I had to pay for my own health care. The health care that I received there was very good, but that was because I was able to pay for it. We do not want different standards of care according to people's ability to pay. There will be a positive effect from the presence in office of people who recognise that, in times of emergency, they have only the health service on which to rely.
  We have within the health service an enormously committed work force. The Government say that we run down those who work in the health service, but that is not true. We have very strong praise for those who work in it. Often, the conditions under which they work do not help their morale. I am thinking, for example, of those who work on temporary contracts. A little while ago, my wife had an operation in the Huddersfield royal infirmary. The treatment that she received was extremely good. I have nothing but praise for those who carried out the service.
  Some of the staff on temporary contracts explained their position. They did not know whether, in the next financial year, they would have a contract. The morale of people who work in the health service is affected by such matters. If they cannot live their normal lives because they are uncertain whether they will have a permanent job, that makes it more difficult for them to show commitment to the service. In this instance, however, I found that the people concerned showed extremely good care, and I saw their commitment to the service.
  Under a Labour Administration, there would be ways of working to correct the low morale in the service. There would be much greater participation. On local commissioning, we are concerned that more people take part in decision making. I believe that real savings can be

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  made by reducing bureaucracy. One area where a Labour Government could make savings is the enormous bureaucracy within the service on billing those who receive treatment outside their areas. It is possible to make the savings that we have spoken about without detriment to the service.
  We should make use of the services of the Audit Commission to ensure that purchasing is carried out on a value-for-money basis. The Minister was accused on Sunday, by the person with whom he was debating, of wanting to remove from the NHS the very people who are making good decisions. It is important that we have advice, so that any changes we make in the service do not affect patient care.
  Tonight's debate has highlighted deficiencies in the service. The Government are unusually complacent about the service for which they are responsible. It has proved to be less than safe in their hands, and I feel confident that the election of a Labour Government will be welcomed throughout the health service. The Government will have to explain why, in every survey, the public believe firmly that the health service will be safer in Labour's hands. It is because they know that it is a service on which we ourselves will rely in emergencies. We believe that the health service is essential for the health and well-being of the nation.
  6.58 pm
  Dame Jill Knight: I leave the hon. Member for Morley and Leeds, South (Mr. Gunnell) to dream on.
  Undoubtedly, all hon. Members read the Order Paper each day. I am sure that they do so devotedly and thoroughly from start to finish. I am beginning to be glad that the public do not follow our example. If they did and read the motion that is before us, thousands of people would be astonished. We read of the "grave situation" of the national health service, of "anxiety," "alarm" and "intolerable pressure". We are told that many people are
  "without the access to health care they need".
  What tommy-rot.
  I can say without question that anyone who has been in hospital, or been to their doctor, and experienced the level of care that my hon. Friend the Member for Wycombe (Sir R. Whitney) described, would not recognise the terms of the motion. The motion is so far from reality that there is virtually no connection between what it states and the reality of the health service.
  It is not an infrequent occurrence for me to receive letters from constituents or to receive visits at my surgery. People write or visit to say, "I want to let you know that I have been in hospital"—it might have been one of a number of hospitals—"and I had the most wonderful care. The most wonderful nurses and doctors looked after me. The treatment I had, the drugs I received and the operation performed were magnificent." Yet those who have not had the misfortune to be ill, or the good fortune to be looked after in an NHS hospital, must think that our hospitals are appalling, especially if they read the rubbish contained in the Opposition motion.
  It is true that the press, especially local newspapers, seem to glory in presenting bad news. They will rejoice at someone being left on a trolley. They will not mention,
  790
  of course, how many patients the same hospital is treating on any given day when someone is in a corridor on a trolley. Newspaper reports portray a service that has no connection with the real service.
  Intensive care units were mentioned at Question Time, including Prime Minister's Question Time, and in this debate. If we had so many extra intensive care units available that every patient who suddenly had a need for such a bed could immediately be placed in a unit within 20 minutes of his or her home, we would need a huge increase in the money that is available to spend. If that provision were made available, thousands of intensive beds would be left empty day after day. I can imagine the fuss that would be generated by the newspapers, let alone Her Majesty's Opposition, about the waste involved in all those beds remaining empty in the absence of emergencies, accidents, children having serious heart conditions or whatever. The expense of having an intensive care unit available for everyone who might—not would—have a need for one, having fallen under a bus or out of a window, would be amazing to contemplate.
  The same point can be made about ordinary hospital beds. Patients on trolleys in corridors are not there for fun. They are there because every bed in the hospital is full. We never hear, however, about the numbers of patients who are being treated in hospitals. We know—[Interruption.] It is no good the hon. Member for Doncaster, North (Mr. Hughes) laughing. God forbid that he should have any responsibility for providing the country with health care as he clearly knows little about it. We cannot possibly keep empty beds available just in case we are faced with a 'flu epidemic. It is clear that Labour Members are living in a dream world. [Interruption.] The hon. Member for Doncaster, North laughs and refuses to face the facts. He will hear a few more from me, whether he likes it or not.
  I have attended health debates in the House for many years. Whenever Conservative Governments have initiated reforms or improvements, or introduced new ideas, Labour has voted against them. If we are realistic, we must accept that reforms have to be made. We all know—perhaps the hon. Member for Doncaster, North does not, but he would be the only Member in that position—that if we are to give everyone every care that he or she needs at any particular time, we shall have to make more money available. I happen to believe that voters agree with that assertion. I recognise, of course, that they want a good health service and are happy to see that their taxes are spent to provide one.
  Many of the reforms that we have introduced, against which Opposition Members voted, were designed to ensure that all moneys spent within the health service were spent wisely. At one time we had no idea how much it cost to keep someone in a hospital bed overnight. We did not have a clue. We also did not know how much it cost to perform operations, ranging from those to remove varicose veins to heart transplants and complicated liver surgery, for example.
  Mr. Chris Smith: Will the hon. Lady give way?
  Dame Jill Knight: No, the hon. Gentleman must listen for a short while.

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  We Conservatives ensured that inquiries were made and careful costings undertaken. I do not know whether the hon. Gentleman—
  Mr. Smith: Will the hon. Lady give way?
  Dame Jill Knight: Let me finish my sentence. When I have done so, he can have his go.
  I remember—perhaps my memory is better than the hon. Gentleman's on these matters—that we initiated schemes to enable us to ascertain costs. The Labour Opposition voted against them.
  Mr. Smith: The hon. Lady is making much of the supposed fact that we now know the cost of operations. I specifically asked the Secretary of State in a written question in December 1996 to supply the average cost in England of a hip replacement operation. Why, then, did I receive the answer that he did not know?
  Dame Jill Knight: The hon. Gentleman cannot deny the truth of what I have said. It may not be possible in every instance to state the cost of a hip replacement operation, but we Conservatives initiated schemes—if the hon. Gentleman was in the House at the time, he would have voted against them—to try to determine costs. I am talking about the principle of needing to know what hospital stays and operations cost. We now know a great deal more—I accept that we do not know everything—about costs. Much time, care and work were expended on finding answers to questions of costs.
  Why was that? We had the opportunity for the first time to ask, "Why is it that this hospital can run its operation theatre at a cost of only £X per hour while another hospital is running its theatre three times more expensively?" We were able to say, "This hospital is able to accommodate a patient overnight at a quarter of the cost incurred by the hospital along the road. Why is that?" On that basis, each hospital and each hospital chief executive could examine why one hospital was cheaper than another.
  It is no good the hon. Member for Islington, South and Finsbury (Mr. Smith) thinking that what I have described did not happen. He lives in cloud cuckoo land most of the time, but he must understand that without a knowledge of costs, which we most certainly have and have used, we would not be able to make comparisons and introduce savings.
  A great deal of money was saved once we could ask cost questions. We found that many areas of hospital care—for example, cleaning, the provision of food and laundering—would be much more cheaply provided on a privatised basis. Labour voted against such schemes. It is hilarious now to hear what Labour is saying about privatisation. Never in 100 million years would it have introduced privatisation. We said, however, that it would be sensible to adopt schemes that would enable us to have more money, and they have provided that. Private firms were employed if they could do those jobs better.
  I remember Labour Members jeering at us and accusing us of thinking that it is all a matter of money. You think that it is not at all a matter of money—I beg your pardon, Mr. Deputy Speaker, I am not referring to you. Her Majesty's Opposition may think that money does not come into it, but doctors and nurses have to be paid, new
  792
  hospitals are being built and they cost money; adaptations to modern methods of treating people must be made and they are expensive.
  Labour Members accuse us of trying to save money, every penny of which we have spent on the treatment of patients—our reforms gave us much more money to do that. None of that would have happened were it not for the Conservative party's reforms, all of which the Labour party voted against. Since they were introduced in 1991, our reforms have enabled no fewer than 3,500 more people per day to be treated. What a lot of pain that must alleviate. What a lot of comfort that must give to relatives who are concerned about their sons or daughters.
  Her Majesty's Opposition seem to set themselves up as the friend of the health service. If that is so, it is the first time ever.
  Mr. Kevin Barron: The Tory Government voted against it.
  Dame Jill Knight: If the hon. Gentleman had listened to an excellent speech by my hon. Friend the Member for Wycombe, he would know a little more than he does about the history of the health service.
  The fact of the matter is that more money will be necessary. Although we have made a clear pledge to provide more money, the Labour party has not. When the general election campaign comes—it cannot be far away—people will not believe a word that Labour Members say. The Labour party refuses to promise to spend any more money; it says that it may spend more money but that it will not increase tax. If it will not increase tax, where is the money to come from? Will national insurance contributions or excise duties be increased? Will Labour extend VAT? No. Apparently it will be possible to make much more money available to the health service merely by ending bureaucracy.
  I should like to read a quick snip from The Independent of 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".
  No such matching promise has been made. Furthermore, I could not help noticing what a Labour Member said in The Journal on 4 December 1996:
  "Labour will match any spending pledges made by the Conservatives".
  That was on 4 December, but I am still waiting for Labour to match the spending pledges made by the Conservatives. There is more. He said:
  "we will also cut £100 million from the NHS bureaucracy bill and use it to treat … 100,000 patients".
  His arithmetic is a little dodgy. Labour has made no spending pledges, and it is perfectly obvious that the electorate will not be told whether there will be more spending and where the money will come from.
  The Opposition are always attacking health service managers, but managers are necessary: it would be extraordinary if a hospital could be run without a manager. I am sick and tired of hearing Labour Members attack managers, who to my mind do a very good job.

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  When we consider the health service in other countries, even those of our European partners, we begin to see how extremely fortunate we are in this country with our excellent health service. In parts of Europe, people have to have their food, linen and blankets brought to them in hospital, and they do not get even the most modest and insignificant nursing care unless they pay for it directly.
  Mr. Rhodri Morgan: It is called privatisation.
  Dame Jill Knight: No, in hospitals run by countries in the European Union.
  It is improper for the Labour party to keep attacking the health service and suggesting, quite wrongly, that people are getting a bad health service. The people of this country are not fools: they know perfectly well what the service is like, because they receive health care and they know that it is beyond compare. Her Majesty's Opposition should be ashamed of themselves.
  7.16 pm
  Mr. Mike Hall: In opening the debate, the Secretary of State for Health tried to lay the foundations of his argument for the coming general election. He treated us to the view that, when the election is called, the people will side with the Conservative party. I do not believe that, but if he is so sure of his ground, he should go to 10 Downing street and persuade the Prime Minister to call the election and let the people judge for themselves to whom they want to entrust the health service.
  It is worth remembering that the health service is in its 49th year. I sincerely believe that it is facing a crisis: I say it no more strongly than that, because I do not want to be accused of scaremongering or shroud waving.
  It is important to put the record straight. It is unfortunate that the hon. Member for Wycombe (Sir R. Whitney) is not present, because he treated us to a view of history with which I do not concur. He claimed that, between 1940 and 1945, the national Government endorsed the findings of the Beveridge report. The Beveridge report was rejected by the national Government. The only political party that took forward the principles of the Beveridge report was the Labour party. Those principles were rejected by the Liberal party and the Conservative party. In 1946, when the vote for the creation of the health service took place, that rejection was plain for all to see, because the Conservative party voted against it.
  Conservative Members are being disingenuous when they say that they supported the creation of the health service and the concepts in the Beveridge report. The Beveridge report was so controversial that it was disowned by almost everyone, including his own party. The Labour party can be rightly proud of the fact that it used the report as a blueprint for the national health service under the auspices of a Labour Government.
  Mr. Hendry: Will the hon. Gentleman give way?
  Mr. Hall: No, I shall not give way.
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  If the Conservative party wants to stick to its claim that the health service is safe in its hands and that it will care for those in need, we should consider how it is dealing with the current crisis in intensive care across the whole country. That is a powerful example of the Government's complacency and shows how they are disintegrating. Last week, the Secretary of State for Health refused to come to the House to answer questions on the crisis in intensive care provision.
  If we need confirmation of that complacency, we need only consider the way in which the Prime Minister dealt with the issue at Question Time this afternoon, and the way in which the Secretary of State dealt with it in his opening speech. The Secretary of State refused to recognise that there was any problem with the provision of intensive care, but there are enough examples to prove him wrong. The right hon. Gentleman's strategic intellectual non-intervention does him no credit—although I had some regard for him when, as Chief Secretary to the Treasury, he spoke from the Dispatch Box in a different vein, adopting a far more considered approach.
  The Secretary of State should not be surprised that there is a crisis in the health service, because on his desk is a report to Alan Langlands, chief executive of the national health service executive, on emergency care in the north-west region. The report mentions a separate report on intensive care. The report on the north-west region has been published, and was presented to Alan Langlands in September 1996.
  I wanted to use the report to strengthen my arguments about the intensive care problems in my town of Warrington, but the north-west regional office refused to give me a copy, saying that it had not been published and was only for internal use. I do not know what the office has to hide, but the document has been published, and should be available to hon. Members. I do not understand why the Department of Health, through its regional office, wants to suppress it; I can conclude only that the information contained in it would be damaging to the Government if quoted in the debate, and would underline my view that Warrington is experiencing a crisis in internal intensive care provision.
  To strengthen my argument, therefore, I shall have to refer to the report of which I have a copy, which concerns emergency care in the north-west region. I shall read just one paragraph from the introduction, which is very powerful. It states:
  "Over recent years there has been a steady increasing pressure placed on secondary care services to handle emergency admissions over the winter period. The pressure became so intense at times during 1995/96 that the system was in danger of collapsing."
  No wonder the Department did not want me to see the report on intensive care in the north-west, as submitted to the chief executive of the health service.
  The report confirmed that there had been dramatic bed losses in my region. We know from Government answers placed in the Library that, since 1989–90, 10,510 beds have been lost in the north-west; furthermore, 1,238 acute beds have been lost since then. It also confirmed that there was a crisis in emergency care provision, and predicted peak demand for such provision in November and December last year, adding that no extra resources would be available to meet that demand. Although the report goes some way to admitting that there is a demand and

  795
  talks of managing resources in the health service to meet that demand, it does not go the extra yard in terms of intensive care provision.
  The borough of Warrington is served by Warrington's district general hospital. Warrington's population is 200,000 and growing, but the hospital deals with trauma admissions from a wider population in Halton, in the borough of Widnes and Runcorn, and from Leigh. That catchment area contains 350,000 people.
  Warrington hospital has three intensive care beds and one high-dependency bed. Last year, the occupancy rate for those beds was 98.9 per cent. If we use the NHS guidelines on the provision of intensive care beds, according to the rule of thumb there should be 2.2 beds per 100,000 people. If that were applied in Warrington, we would have eight intensive care beds, but at best we have only four. North Cheshire health authority funds only three, however; the hospital provides the money for the other one.
  The existence of a crisis is underlined by the fact that, in 1996, there were 142 intensive care admissions and 216 high-dependency admissions. The other side of the coin is the refusal of 83 admissions—but that is not the whole picture. Once doctors know that the intensive care unit is full, they do not even apply for places for their patients. There were 18 transfers from the intensive care unit—out of Warrington—but that, too, does not give the true picture, because transfers from other wards or from the accident and emergency unit are not included. Both the refusal rate and the transfer rate should be higher.
  The postponement of elective surgery and the cancellation of operations owing to the lack of beds is also a problem in Warrington hospital. Warrington is developing a very good reputation for treatment of the three major cancers, but when operations are cancelled, patients who are desperate for surgery must go through the trauma of having their appointments cancelled and their treatment delayed—although, as we all know, the earlier patients are treated for cancer, the better are their prospects of recovery. The chief executive of the hospital tells me that it is very difficult to quantify the number of patients who are not scheduled for surgery because of the lack of beds.
  It is clear that there is not enough intensive care provision in that hospital, as North Cheshire health authority has recognised. Warrington is a net exporter of intensive care, which means that more patients go out of Warrington for treatment than come in from outside. The consequences have been fatal for at least one of my constituents, and probably more. I refer to the tragic case of Mr. Pitcher, who was admitted to Warrington hospital in September for routine bowel surgery. During post-operative care, he suffered a heart attack and needed an intensive care bed, but no bed was available at the hospital. He was taken by ambulance to Fazakerley hospital, 30 miles away. He died.
  At the inquest a couple of weeks ago, the coroner was so concerned about the lack of intensive care at Warrington that, in giving his verdict of death by misadventure, he said that he would refer the case to the Secretary of State for Health. The consultant who had dealt with Mr. Pitcher said that taking him to Fazakerley hospital in an ambulance had not been the treatment that he had deserved, and I am certain that the lack of an intensive care bed in Warrington led directly to his untimely death.
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  Another case involved a lady who lived in the village of Barnton in mid-Cheshire, just outside my constituency. She had a severe respiratory problem. The doctor telephoned all the hospitals in the area looking for an intensive care bed—Countess of Chester hospital, Warrington hospital, Halton general hospital and others—but no bed was available in the north-west. The lady was transferred by ambulance to Rhyl, but was dead on arrival. I am certain that, if an intensive care bed had been available anywhere in Cheshire, she would be alive today.
  In another tragic case, a gentleman called Mr. Wilson was found unconscious in the grounds of Winwick hospital, a mental hospital in north Warrington. He was taken to Warrington's accident and emergency unit, but there was no place for him in intensive care. He was transferred to Trafford general hospital. He then contracted pneumonia, and has been in a coma for nine weeks. I cannot say whether he will regain consciousness, but one thing is certain: the journey from Warrington to Trafford did not do him any good. He is now taking up a bed at Trafford, and preventing others from obtaining the intensive care that they need.
  My final example concerns a lady recovering from surgery at Warrington hospital. Her case worsened and she needed intensive care, but, as no bed was available, she had to be taken across the Pennines in an ambulance to Leeds, 60 miles away. There have been problems with intensive care provision in Leeds as well.
  Those are just four examples of transfers of people who could not be given the treatment that they should expect from hospitals in their areas. It is clear that intensive care provision in Warrington is inadequate to meet local demand. I was encouraged by the Secretary of State's announcement of challenge funding of £4 million to provide 37 intensive care beds and 53 high-dependency beds. The total number is 90 and not the 100 that the Secretary of State claimed in the debate. However, in his case, a 10 per cent. inaccuracy can be forgiven.
  North Cheshire health authority put in a bid on behalf of Warrington hospital for an extra high-dependency bed. The Secretary of State said that such beds would be provided where the need was greatest and Warrington had a demonstrable need. However, on 27 December he announced the bad news that Warrington had not been given the extra bed that it required to bring it even halfway towards the provision that we should expect for it.
  North Cheshire health authority, the regional authority and the hospital have decided to put together a package to provide one intensive care bed from 1 April. The health authority will provide £100,000, the regional authority will try to find the same amount and the hospital has been asked to find £50,000 for the provision of that bed. It is a step in the right direction, but it is rather like putting a finger in a dyke because, for straightforward reasons, in six months there will be an increase in demand in Warrington that will not be met.
  Warrington has been underfunded for as long as I can remember. It is a growing and prosperous new town in north Cheshire whose population has trebled in the past 25 years. It is surrounded by a motorway network consisting of the M6, the M56 and the M62. Because of geographical features, the trauma admissions to Warrington hospital are the highest in the region.

  797
  In the early 1980s, Warrington's two hospitals were merged and, in its so-called wisdom, the health authority decided to use £1 million of revenue to fund part of the capital building at the hospital. That revenue has never been repaid and, on today's figures alone, that is costing the hospital £4 million. Every month the hospital is on red alert. As the Minister will know, that means that its finances are at the absolute limit. It is in danger of overspending every month and its financial position is reported to the regional arm of the executive, yet it has been asked to provide £50,000 towards the provision of intensive care.
  The 1997–98 budget for North Cheshire health authority, which is a purchaser, showed the lowest increase in the region and Government constraints mean that any attempts to address the inadequacy of provision in Warrington hospital are resisted.
  I am certain that there is a crisis in the health service. I have been told, although I do not know whether it is true, that three weeks ago there was not a spare intensive care bed in the whole of England. If there had been any more admissions for intensive care, the nearest suitable bed would have been in Scotland. Warrington hospital is an example of the crisis in intensive care. Does the Minister of State recognise, even at this late stage, that there is a crisis? If he does, what does he intend to do about it? Does he appreciate the problems that I have outlined in Warrington? If so, what does he intend to do about them? What will he tell me in his winding-up speech so that I can return to my constituents and say that the Secretary of State has taken heed of the problem and is prepared to take steps to ensure that they receive the health service that they deserve?
  7.33 pm
  Mr. Nigel Forman: The House will agree that it is always a tragedy when patients die or become more ill than need be because of misfortune, failures in clinical judgment or organisational failures in the health service. Every hon. Member and every fair-minded person deplores such eventualities, but that is not to say that in a service as large and varied and, if I may say so, as successful as the national health service, it is correct to approach such a serious debate by lacing speeches, whether in the House or outside, with endless repetitions of the six letter word "crisis". If I had £1 or even lop for every time I have heard Opposition Members or distinguished adornments of the media use that word in relation to the health service, I would be fairly well off. Such speeches are the wrong approach.
  I agree with the wise words of the hon. Member for Morley and Leeds, South (Mr. Gunnell), which I hope the House has noted. He said explicitly that it is not sensible for individual anecdotes on this matter to do more than inform policy. Those were not his exact words but my rendering of what he said. Such anecdotes should certainly not determine policy and still less should newspaper headlines be taken as a guide either to the real situation or to what should be done.
  I was appalled recently, and not for the first time by such an example, when I saw that the sub-editor of one of my local papers had chosen the headline "Nightmare in Casualty". That is a distortion of the truth, and I say
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  that with some authority, because I keep in close touch with the accident and emergency department of St. Helier hospital in my constituency. It has been mentioned several times in the debate and is a successful and admirable hospital whose staff work hard and show considerable devotion towards their professional tasks.
  I agreed with the hon. Member for Southwark and Bermondsey (Mr. Hughes), who said that we should lower the temperature of these debates, at least in relation to the facts and to what we all know the situation to be, and should seriously and quietly consider the best way forward to improve and expand the service in a way that the taxpayers can afford. As my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) said, the debate is not helped by being initiated by a party that is long on fine words. There are 17 lines in the Labour motion, but as my hon. Friend said, only the final one and a half lines contain anything prescriptive, and even then there are no figures or precise recommendations.
  I do not know how the electorate can sensibly judge Labour policy on the health service when Opposition Members refuse to commit themselves to what is manifestly necessary in the light of their own speeches—a real increase in expenditure year on year. As many of my hon. Friends and my right hon. Friend the Secretary of State have said, we adhere to that commitment year after year. As far as I know, Labour does not. All that Labour seems to offer is the marginal redirection of money that is now spent on 22,000 administrators towards the employment of 50,000 more nurses. Obviously, such a switch would be welcome if it were the solution to the problem, but it is little more than a token gesture in the hope that this part of the public service will be transformed by such a marginal move. That is plainly not the case and such an attempt at policy is not commensurate with the scale of the challenges that face the national health service.
  It is not doing the House and the country much of a service to present a motion that is long on piety and sanctimony but decidedly short on content. The Opposition Front-Bench spokesman, the hon. Member for Islington, South and Finsbury (Mr. Smith), was not much better in that regard. He did not give way to me when I sought to ask him a pertinent question about locality commissioning. Perhaps he would like to answer my question now: on what evidence does he base his view that, if a future Government moved towards what he described as locality commissioning, that would be any less bureaucratic or costly in terms of overheads than the present structure?
  Mr. Chris Smith: The answer is simple. It would do away with a layer of bureaucracy at single practice level. It would do away with a purchasing function at health authority level and it would do away with a substantial amount of invoicing work done at hospital level. Therefore, as a result of our proposals, there would be substantial savings in bureaucratic procedures.
  Mr. Forman: That is a better attempt than the hon. Gentleman made in his opening speech. There is a reference in the Labour motion to greater local representation in decision making, and I assume that would mean a greater role for local authorities in some of the decisions. It seems that we are likely to get a range of new quangos and committees which will add to the

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  bureaucratic overheads. It remains to be seen whether the hon. Gentleman will get a chance to put his nostrums into practice.
  I am critical not of the Liberal Democrat spokesman in today's debate, but of the Liberal Democrat opponent in my constituency. He does not seem to observe the admonition of his colleagues to deal fairly and squarely with the facts. I am sorry to say that it is an all-too-familiar example of people trading in scares, shroud waving and imaginary problems, which turn out not to exist. For example, in a publication calling itself "The Carshalton and Wallington Chronicle", there is an article headed "NHS Cash Crisis: Huge hardship for patients at St. Helier". The words used in the article are categorically wrong, as I know because I took the trouble to check this morning. The Liberal Democrat candidate says:
  "St. Helier hospital is facing a winter crisis due to a lack of money. Twelve beds at St. Helier hospital are standing idle, in a locked ward, because the hospital has over-performed, and recently the Accident and Emergency unit had to close temporarily, due to a lack of resources."
  In fact, no beds are standing idle in a locked ward. A decision was taken on 3 January to open—or more correctly to reopen—ward A4 at the hospital. The extra facilities, coupled with the 35 extra beds that have been brought into commission and to which my right hon. Friend the Secretary of State referred, have greatly alleviated the situation at St. Helier. I base that information not just on my contacts with the management, with whom I took the trouble to check this morning, but on my visit to the accident and emergency unit just last week.
  I wish that people involved in politics, in all parties, would try to cling to the truth and observe accuracy, because it does no favours for our constituents or the worried families and friends of patients if such shroud waving continues.
  It is significant that the Conservative party is the only party in the House that is committed to more public expenditure on the health service in real terms. The Liberal Democrat commitment involves shuffling money around from one heading to another. I listened carefully to the hon. Member for Southwark and Bermondsey (Mr. Hughes) and I intervened on his speech, but I am not convinced that he has squared the line with the leader of his party, who frequently says that the only commitment that his party has to raising taxation is a penny extra on income tax if that were necessary to improve the education service. I remain to be convinced on that.
  It is interesting that the pledge made by Ministers and Government spokesmen demonstrates our continuing commitment to the health service. Equally, we must recognise that, as a country, we are not likely to be able to meet all the demands for NHS health care in all its forms without some delays from time to time from those with non-urgent and non-life-threatening conditions. It is much better to talk about the reality than to lead people to believe that everything is possible, when clearly it is not.
  When I was thinking about this aspect of my argument earlier today, I recalled the fact that many people, myself included, have often believed that all the problems in the health service could perhaps be solved if Ministers allocated about a 3 per cent. increase each year in real
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  terms to health service expenditure. That argument has been made from time to time by representatives of the British Medical Association, community health councils and others.
  When I looked more closely—I checked the figures with the Library this morning—I found, to my surprise, that the NHS budget for England has been increased by 3 per cent. in real terms each year over the entire period of this Government. If a 3 per cent. compound increase had been put into effect for England alone, the figure for 1996–97 would have been about £31.5 billion. I assumed that I would discover the true figure to be less than that. Much to my surprise and pleasure, I discovered that the actual figure for England for the same year and on the same basis was about £33 billion. I had underestimated rather than overestimated the Government's financial commitment to the health service. I want to place that on record, because it shows that I am no mere party hack. I underestimated the achievements of my right hon. and hon. Friends and I commend them on their ability to persuade the Treasury to release money for these desirable purposes.
  The figures imply that our record of putting taxpayers' money into this premium service, which all our constituents value, is exemplary. In spite of that, even at the level of finances that we are able to allocate, problems can and do arise. I want to mention one or two problems of which I hope my hon. Friend the Minister will take account in his winding-up speech.
  There are realities that the House should recognise and about which it should be a little humble. As my hon. Friend the Member for Birmingham, Edgbaston said, we have a health service of enviable quality and quantity by European or global standards. It is no good for people to talk it down. At St. Helier hospital in my constituency, we find reason to welcome the extra resources from which it will benefit in 1997–98, as a result of not only effective and timely lobbying by me and many of my hon. Friends but the way in which the Secretary of State listened to our arguments and responded clearly and positively to them.
  I am delighted that St. Helier will benefit from the district health authority's decision to concentrate its extra resources for elective activity on local hospitals and not go to providers further afield. It will secure relief from the health authority's decision to fund its share of unavoidable costs and service changes in my area. There is no doubt that that will be a great help to the hospital. It is equally reassuring that many of the specialties that were previously thought to be at risk will now become priorities for the extra resources that have been made available following the Secretary of State's decision. Those specialties include arterial surgery, ophthalmology, which essentially means cataract operations, major orthopaedic interventions such as hip replacements, oral surgery and orthodontics. All that is good news and is in stark contrast to dire predictions by the Conservative party's political opponents which are fanned by an excessively sensational media.
  In all fairness, I must say that, in spite of those achievements and the considerable relief that they bring to my constituents, there are still some underlying problems which must be mentioned because they are continuing and are independent of whoever happens to be politically responsible for the health service at any time. I shall give three headline examples.

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  Having followed these issues closely for a number of years, I believe that in Greater London the planned reduction in hospital capacity and in-patient beds may have been taken too far in light of the Tomlinson report; I say that with some experience, as I was a Minister at the Department for Education when Tomlinson was advising on that. I therefore welcomed the ability of St. Helier hospital to reopen ward A4 on 3 January, largely for haematology and short-stay medical investigations.
  We need to revisit the question of the number of beds in the Greater London area. The evidence shows that our area has been expected to remove beds from its capacity levels slightly faster than is prudent or equates with what has had to happen in areas outside London.
  The Government, my hon. Friends and local authorities together—it has to be a matter of partnership—need to provide more capacity to care for the chronically sick and elderly patients who come into their care. When I visited St. Helier hospital last week, I could not help but notice that a significant number of the patients brought in through accident and emergency were aged over 75, over 85 or, in some cases, as they explained to me, over 90.
  Obviously, health does not go in a linear progression with age. Some people seem young and are sprightly and very healthy at a remarkably old age; others deteriorate more quickly. The fact is, however, that old people need special medical attention. Obviously, if they can be supported and cared for in their own homes, so much the better; that is all well and good. There will be instances, however, as I am sure you would say you agree, Mr. Deputy Speaker, if you could speak from the Chair, when caring for people in their own homes is not the most appropriate approach.
  We must be prepared gradually and responsibly to increase the facilities in cottage hospitals, such as the Carshalton War Memorial hospital in my constituency, and in nursing homes—whether in the public or the private sector—and sheltered accommodation so that our elderly can complete their lives in safety, dignity and, if possible, good health.
  The added benefit of making such a shift in emphasis would be to release some medical and surgical beds in district general hospitals that are occupied by elderly patients who cannot be discharged because there is nowhere appropriate for them to go at the time such a decision has to be made.
  My final example was again brought home to me on my latest visit to the accident and emergency department at St. Helier. It is that the goals of the patients charter, to which we all want the Government to subscribe, will be achieved in full only if we all understand the facts of life in our hospitals today. On my most recent visit, it was brought home to me that major trauma accounts for a small percentage of the total admissions through an accident and emergency department; typically, it is somewhat less than 10 per cent. The vast majority of patients admitted—this connects with something that I said a few moments ago—arrive with medical conditions, some of which may be acute but many of which are chronic and require medical beds, care and treatment in other parts of the hospital. We need to recognise that, because it is the lesson that the professionals instilled in me when I listened to them.
  802
  Better results could be achieved with a greater role for primary care and a more proactive role for general practitioners' surgeries, whether fundholders or not, and for health centres, as long as they perform their contractual obligations to provide 24-hour cover for their patients, seven days a week. I am sorry to say that, too often, there are examples of where reliance is only on locums, who are sometimes hard to contact, or of GPs slipping into the easy habit of referring patients to the local accident and emergency department when they should deal with the problems themselves at first hand.
  With those three cautionary observations about areas in which further improvements could still be made, my conclusion is that we all have a part to play in improving the national health service. The NHS is something of which we can be proud. Clinical personnel can do so by using their wonderful professional skills to maximum effect. The much maligned bureaucrats can do so by managing what is, by any standard, a vast undertaking—the largest single employer in this country. We politicians and others who take a close interest in these matters, including pressure groups and the media, can best make our contribution by conducting a mature and measured debate, by resisting the temptation to exaggerate and, above all, by making sure that we do not indulge in shroud waving.
  7.54 pm
  Rev. Martin Smyth: It is a pleasure to follow the hon. Member for Carshalton and Wallington (Mr. Forman), who gave us some cautionary warnings. I was interested in his reference to the Tomlinson report, for it reminded us in this computer age of the expression, gigo—garbage in, garbage out. Tomlinson admitted later that not all the figures had been given to him correctly. When we deal with statistics, it is important that we get them right or we can come up with the wrong conclusion. I also share the hon. Gentleman's view about a positive approach to the health service.
  I took part in the debate on the 40th anniversary of the health service. On that occasion, I sensed some depression and commented that the only encouraging thing was, as the old saying goes, life begins at 40. Nine years on, we are still going on and there have been tremendous changes for the good in the health service.
  Some of us remember bed blocking—beds were not occupied because the surgeon in charge did not want anyone else to use them so that he could put his patients in them in due course. Other things went on. We pay tribute to the improvements.
  One of the great problems is that of growing expectations, whether of those who want to terminate life, those who want children through infertility treatment, or those who, at 80-odd years of age, want a hip replacement. Other people aged 40, who are having their hip replacements delayed because they are assessed as being too young for the operation, are no longer economically viable.
  Expectations have changed and we have to face up to that. It is also true to say that how we view things depends on who is doing the recording. I was interested in the references in the gospels to the woman who had haemorrhaged for some 12 years. Doctor Luke, the "beloved physician", reports that she had spent all her
  "living upon physicians, neither could be healed of any".

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  Mark, who as a layman is a little more stark in his approach, said that she had
  "suffered many things of many physicians and had spent all that she had, and was nothing bettered, but rather grew worse".
  It all depends on the position of the person who is doing the reporting.
  Often, however, the key is finance. I am sorry for those who were beginning to practise in the health service at the time, as the Government and practitioners did not listen to the advice of Enoch Powell—then my colleague, the right hon. Member for South Down—when he reminded them that he who paid the piper called the tune. Sooner or later, people discovered that, if the money was not forthcoming, there were difficulties. In the light of the motion and the statement by the shadow Chancellor of the Exchequer that there is to be no more spending or direct taxation, where will the money to meet the demands of our people's growing expectations come from?
  The health boards in Northern Ireland and the health authorities in England and Wales depend largely on allocations from the Department of Health and, ultimately, on the Treasury, for the moneys to be expended. I would have liked to have been able to say that the recent injection of cash to make up deficiencies in capital expenditure and running expenditure allocated to England and Wales included money for Northern Ireland, but it did not.
  The pressure is on to reduce expenditure in the health service. Some years ago, expenditure in Northern Ireland was 25 per cent. per capita above that in England and Wales. Now, we are behind both Scotland and Wales. Recently, the gap between us and England has narrowed to 11 per cent. No consideration is given to the different health needs of a people with a different spread of population. We do not have the large conurbations that make it easier to provide certain specialist services.
  The Government pledged a year on year increase in Great Britain, but in Northern Ireland we have a year on year decrease of 3 per cent. Thankfully, we managed to convince the Minister that, as we have been squeezed for a long time, 3 per cent. up-front cuts would not be workable this year, and the figure was reduced to 1.5 per cent. However, the cuts remain a factor.
  The people of Northern Ireland are not entirely happy with certain strictures that Ministers have been making. There is a parallel with those who are quick to criticise doctors who refuse to treat patients because they smoke or engage in behaviour that causes or aggravates their illness. The doctors say that they will not waste their time and money if the behaviour continues. This year, Ministers have lectured us to the effect that, because of the resurgence of terrorism, there will be cuts in funding for the health service. The Government are apparently prepared to punish the people of Northern Ireland because of the failure of successive Governments to deal with terrorism and with republican activists who seek to destroy the Province.
  We must be realistic. Particular problems arise. The division between boards and trusts, purchasers and providers, has been helpful in some ways, but in others it has added problems. The boards pay for emergencies and the GP fundholders purchase elective surgery. The bodies are served by humans and, as with humans everywhere, there are differences of attitude. Some seek to balance the
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  budget—some of us live in a city where we remember the mother in the home having envelopes for groceries, rent, fuel and insurance—but others are spendthrifts.
  Some boards and some GP fundholders have been watching carefully how they purchase and how they provide services through the trusts, but some fundholders might spend up front because they rely on the boards to deal with the emergency purchasing and because they have the clout to jump queues for those in their practices who require emergency provision.
  Dr. Joe Hendron: Does the hon. Gentleman accept that in Belfast and many parts of Northern Ireland the boards ring-fence the costs for fundholders' patients but not for non-fundholders' patients? That is particularly true in Belfast, and many patients suffer as a direct result, but it is not the general practitioners' fault. One could argue that it was the boards' fault, but in reality it is the Government's fault.
  Rev. Martin Smyth: I take the hon. Gentleman's point. He will also be aware that some practices—including, I suspect, the one with which he has been associated—have sought to join multi-funds and have been held back by the argument that training would not be available. Some are excellent practices with a high reputation for patient care and service provision.
  I suspect that this year, as last year, the boards, which have been holding back funds—I am thinking particularly of the Eastern health and social services board—will suddenly discover that they have a fair amount to spend before the end of March and operations will be performed on Saturdays and Sundays while they try to clear the backlog. In the meantime, unnecessary suffering and distress are caused by the lack of a proper flow through the season.
  Last week, the Belfast Telegraph carried the headline, "Cancer Unit in Crisis". It has been said this evening that perhaps local newspapers carry such headlines more than national newspapers. However, the headline refers to the major cancer service in Northern Ireland. For some time it has wanted another simulator to locate tumours and plan treatments, as the existing machine has broken down.
  The problem is not that the staff are not doing their work properly. I know that personally, and the newspaper article quoted a staff member as saying:
  "'We are working really hard—I was in yesterday from 7 am and wasn't leaving until after 11 pm.'"
  I know of other parts of the health service where people working under pressure have not even taken their statutory holidays, never mind days off in lieu for working extra hours.
  The pressure is on, and I wonder why there are delays. Is it because discussion is taking place about where the centre of excellence should be? In the meantime, cancer patients who should be treated as soon as possible—doctors keep telling us that more can be done if treatment is given earlier—are left waiting. Why do we have that problem throughout the country?
  I agreed with the arguments made by the hon. Member for Birmingham, Edgbaston (Dame J. Knight) about the pricing of surgery. It is easier now to target and to price. I wonder how right hon. and hon. Members would react if, in a national health service hospital trust, a cardiac surgeon said, "You need an operation; we could do it; but the board has not enough money to purchase it."

  805
  As I understand it, the cost is primarily to pay for the skills of the surgeons, specialists and nursing staff, although some money will certainly have to be spent on materials and so on. The operating theatre will be the same in any case, because there is only one hospital that does cardiac surgery in Northern Ireland. It is a scandal that we have got into the position where a surgeon employed by the national health service in a trust can say that for the want of £12,000 an urgent operation cannot be performed. We must get beyond that because, apart from anything else, it puts intolerable pressure on people.
  I want to issue a word of caution. Amid the resumption of terror, I wonder whether we should consider again the provision of regional services. If there are those who want to desecrate the sanctuary that is a hospital by murdering patients or their visitors, regional services should not be provided there. The hospitals may be local or may be doing the work of a district general hospital, but the people of Northern Ireland should not have to visit for health care places where lives are endangered by terrorist thugs.
  8.8 pm
  Mr. Charles Hendry: My constituents would not recognise the picture of the health service painted by the Opposition, which was a travesty of what is happening on the ground. They would recognise that more patients are being treated more locally in more modern facilities, that waiting lists have been shortened and that they have the most outstanding general practitioners and other health service professionals that they have ever had.
  I offer the House a balloon trip across my constituency so that we can look down on some of the health service changes on the ground. As we went over Glossop, we would see how two old hospitals have been transformed and given new lives. One is a centre for the elderly mentally ill; the other a homeward bound unit. In New Mills, a new future is being given to 011ersett View hospital. In Buxton, there is a debate about how the town's three historic hospitals can best meet its health needs into the next century.
  A little way across the constituency border, Tameside general hospital has had massive new investment, much of it under the chairmanship of Tony Favell, whom many hon. Members will recall with affection from his time in the House. Stockport's Stepping Hill hospital has also had massive investment. That is the picture of what is happening in hospitals that my constituents appreciate.
  If we were to go closer down, we would see what is happening in GPs' surgeries. New surgeries have been built in Glossop, Buxton, New Mills, Chapel-en-le-Frith, Whaley Bridge, Hayfield and Hope. Across the constituency, there is new investment in our health service, and services are being delivered in a way never seen before. That is the Government's record on health: a thriving partnership with GPs, investing for the future and delivering better services.
  In case some people think that High Peak is the only place where the improvements are happening, right across the country better health services are being delivered. We are treating 3 million more people than when we came to power 17 years ago, and 1 million more than when the
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  health service reforms started only five years ago. Waiting lists are being reduced: the number of people waiting for more than 12 months has been reduced from more than 200,000 to 15,000. Infant mortality has been halved and life expectancy has been increased by two years. That is a formidable track record of which we can be justly proud.
  The most exciting aspect of what is happening in our health service is the way in which we are looking to the future and seeking reform so that proper attention is given to primary care. I welcome that because GPs know what is most needed and important in their localities and because the more that we can do locally, the less need there is for patients to travel long distances to faraway hospitals in communities that they do not know.
  In High Peak, we were privileged to receive a visit from the Prime Minister recently. As more than 90 per cent. of my constituents are covered by fundholding practices, I thought it appropriate that he should be taken to see one for himself. As it happened, we took him to the one that had won the fundholding practice of the year award, but it could have been any of the outstanding practices in my constituency. They offer new surgeries and treatments to our community. It is important to recognise that that does not benefit only the patients of fundholding GPs but the community across the board.
  In Glossop, the average waiting time for in-patient treatment has dropped from 18 months to three and a half months since fundholding was introduced. For out-patient services such as dermatology, the waiting period has fallen from two years to four weeks; for gynaecology, from more than 11 weeks to four; for ear, nose and throat treatment, from 20 weeks to four. Those dramatic reductions have been brought about by fundholding practices and they help people across the community, not only those who use fundholding doctors.
  Fundholding practices have been examining new ideas. Part of a cottage hospital has been brought back into use and turned into a rehabilitation unit. That process was started by my right hon. Friend the Secretary of State five years ago when he was a Health Minister. He stopped the closure of that hospital. Now, thanks to the way in which our GPs and health authority have considered the matter, it has been given new life, enabling people who leave hospital to spend time there to ensure that they are ready to return home.
  New services have been introduced. I shall not mention them all but they include locally provided electrocardiography, audiology, dermatology, an additional district nurse, a physiotherapist, an occupational therapist, and new chiropody services. Complementary therapies such as acupuncture and the Alexander treatment are provided by one Glossop surgery. That is the difference that fundholding has made.
  The motion states that the Opposition
  "believes that government policy has left many people in urban and rural communities without the access to health care they need, especially in relation to services for the elderly and for those being discharged from hospital".
  That is sad because a few weeks ago the hon. Member for Stockport (Ms Coffey), as a shadow health spokesman—and unannounced as she did not have the courtesy to follow parliamentary protocol by telling me that she was coming—visited my constituency to see the services. According to the local papers, she said that she was greatly impressed. She should have seen how those services were being improved in a rural area and how they were delivering better services for my constituents.

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  It is not only fundholding doctors who are making great strides. Last week, I met Dr. Richard Fitton, who has a small practice in Hadfield. He sends all his patients who go to hospital a survey form to find out what was good, bad or needed improvement. If there are problems, he asks them to come and discuss them to assess how they can be addressed. That information is fed back to hospitals so that they can improve services and ensure that problems do not recur. That is the sort of health service that we want—one that is listening, learning and improving. That is why I so passionately believe that GPs should be at the forefront of taking reforms forward.
  I thank my hon. Friend the Minister for the way in which he has listened to GPs in his consultation process on improving the health service. He met GPs in Buxton some months ago and took direct action on what he heard. In particular, he enabled them to implement their ideas, which had previously been impossible, on improving out-of-hours cover when surgeries are closed. GPs appreciate that the Government listen to their views.
  As we consider how to take things forward, I hope that we will examine how to extend pilot schemes more widely than is currently proposed. We should encourage GPs to think widely about how to improve services. We need a no-holds-barred approach to deciding what to do next. I fear that some health authorities may try to stifle some of those excellent ideas. I want to ensure that there is a right of appeal so that ideas can be heard and developed.
  The Government have suggested that through the efficiency index, GPs should improve their efficiency—their level of activity—by 2.75 per cent. One surgery in High Peak has improved not by 2.75 per cent. but by 34 per cent. That massive improvement in activity was the result of becoming a fundholding practice. I hope that my hon. Friend the Minister will examine the formula that has been set by the Department whereby one episode in secondary care equates to 54 in primary care. That is a disincentive for health authorities to reconfigure their services and should be reassessed. He should also reconsider whether there should be a requirement that there should be a GP on the board of every health authority so that we can be certain that the views of GPs will be taken into account as their ideas and policies are developed.
  In Buxton, there is an important review of our hospital services that centres on the Devonshire royal hospital, which is one of the most remarkable hospitals in the country. It must be the only hospital in the country that was built not as a hospital, but as riding stables 200 years ago. As time passed, and the landed gentry stopped coming to Buxton in such large numbers, and thus no longer required somewhere to exercise their horses, the building was covered with a dome and was gradually turned into a hospital. In fact, it is the widest dome of any building in Europe outside St. Peter's in Rome—not what one might expect to find on top of the Pennines. It has now become one of the most important centres for the delivery of health care, especially recovery from serious injuries, using the remedial powers of our local spa waters.
  Inevitably, the building's running costs are high because of the history of the building and its structure. I welcome the imaginative new approach that has been taken, thanks to Ministers, to find a joint way forward by combining the health aspects of that building with its
  808
  heritage aspects to see how best we can keep that hospital in operation. Currently talks are going on between NHS Estates and English Heritage. I hope that the Minister will keep a close eye on those discussions to ensure that they come to a fruitful and valuable conclusion.
  I have listened to Opposition Members' speeches, and the most important point to remember is that we must look at the reality of our health service. Year on year, the health service provided in High Peak is improving, as it is right across the board. New services and new treatments are being carried out in better facilities. Those services are being provided more locally after a shorter waiting period and are delivered by a wonderfully dedicated and expert staff.
  Of course there are difficulties and problems—they are inevitable in a service that treats millions of patients every year. We seek to consider them in detail to see how, in each year, we can learn from the problems that we face and move on to improve the service yet further. The sadness of it is that all that would be ruined by a Labour Government, for all their fine talk about their commitment to the health service. We know from their history that the real funding crises in the health service have occurred under a Labour Government—the only time in its history when funding was cut occurred under a Labour Government.
  We also know that there is a real problem now because of the Opposition's complete confusion over policy and the future of fundholding. The motion is fundamentally flawed because the Labour party does not have any proposals to take our health service forward. That motion should be defeated in the interests of patients not only in High Peak but across the country.
  The country will soon have to exercise choice on health issues. It will have to choose between a party that is committed to a year-on-year increase in health service funding—the Conservative party—and the Labour party, which is not. People must make a choice between a party that is committed to creating a health service led by patient need—the Conservative party—and a party which is still led too much by producer interests. The choice will be between a party that believes in increasing efficiency, but not at the cost of quality of patient care—the Conservative party—and the Labour party, which has opposed virtually every step that we have taken to improve efficiency.
  The health service is in a better condition now than it has been in the 49 years since it started. There is no ground for complacency because a huge amount still needs to be done. The way to show that is by rejecting the motion tonight.
  8.22 pm
  Mr. John Heppell: The hon. Member for High Peak (Mr. Hendry) says that there is no cause for complacency, but I have sat here and listened as every Conservative Member has been complacent. I have listened to a lot of speeches in the House: some have been boring and some have been controversial, but I congratulate the hon. Member for Wycombe (Sir R. Whitney) on managing to combine the two qualities in one speech.
  I do not think that the hon. Gentleman was trying to mislead the House, but he did try to rewrite history when he gave us a lesson about how the Tory party set up the

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  NHS and has been one of its backers since 1918. If I may badly misquote Nye Bevan, one does not need a crystal ball to see what the Tories thought of the NHS—one has only to read Hansard, which shows that the Tories not only opposed the establishment of the NHS in principle, but opposed every clause, every line, every dot of the enabling Bill. I do not need any more history lessons from the hon. Gentleman.
  Mr. David Willetts: Will the hon. Gentleman give way?
  Mr. Heppell: No, the hon. Gentleman has only just walked into the Chamber.
  I do not agree literally with some of my constituents who feel that Parliament is often a pantomime, but we had a good performance from the pantomime dame tonight. All that we have heard about from Conservative Members has been good news. The hon. Member for Carshalton and Wallington (Mr. Forman) gave the game away when he started to say, "Here is the good news." He then cited a great list of operations now being carried out, including those on cataracts. It would be good news indeed if anyone in my constituency had had any such an operation, but not 1,000, not 100 or even 10 people have managed to have any of those operations carried out.
  The hon. Gentleman's contribution made me think back to our previous debate on the health service, on 20 November, when my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) revealed that the Tory party had launched a campaign to try to get people together who had good things to say about the NHS because it was worried about the bad stories coming out. It became clear today that all Tory Members have signed up to the good news club. We get no bad news at all from the Tories—only good news: there is no crisis, no problem and nothing to worry about.
  It is a shame that that feeling is not shared by my constituents, nor by the National Association of Health Authorities and Trusts nor by the members of those trusts. That is clear from the letter of 9 January, which was sent to all members of trusts and health authorities and states:
  "Dear Council Member
  Emergency Admissions
  NAHAT is receiving many messages of concern from trusts and health authorities about the growing pressure being experienced by the NHS through rising emergency admissions. This has been exacerbated by the current bad weather and restrictions in the provision of personal social services during the Christmas period."
  The trusts and the organisation that represents them and also the health authorities recognise that there is a problem, but the Minister and his hon. Friends still do not seem to recognise that.
  The crisis in my area did not start at Christmas, as it seems to have done for many others. In the debate on 20 November, I recounted how the chairman of Nottingham health authority had said that the authority faced a deficit of £11 million and that it would be a disaster if it did not manage to overcome it.
  Mr. Malone: I am grateful that the hon. Gentleman is now discussing finance, as I assume that his thesis is that his health authority has received insufficient funding. In fact, it was increased by 2.36 per cent. in real terms
  810
  this year. Is he saying that any reduction in that on an annual basis during the lifetime of the next Parliament would be unacceptable to him, because that is exactly what those on the Opposition Front Bench are proposing?
  Mr. Heppell: I do not agree with the Minister that that is what my right hon. and hon. Friends are proposing. The Minister should know that Nottingham health authority has been traditionally underfunded. According to the Government's own formula, it should receive more than 100 per cent. in funding because of its teaching hospitals, but it has never been funded at that level. The Government recognised that and gave it an extra £5 million; according to the Government's formula, it is being funded at 97.6 per cent.—which is still not equivalent to 100 per cent, but at least it is an improvement.
  I am worried, however, because the Under-Secretary of State for Health—the hon. Member for Orpington (Mr. Horam)—has acknowledged that the extra allocation is for next year and that this year the authority already faces a £7 million deficit. The problem for me is that nothing has been done to help the authority this year. On 20 November, I stated that Queen's medical centre at Nottingham had had to cancel 350 non-emergency operations for October, November and December because of that funding crisis. Because of the exceptional circumstances at Christmas and the new year, even more operations have now had to be cancelled.
  I recognise that there were exceptional circumstances this winter, but I do not completely accept that argument. The Queen's medical centre said that there was a 50 per cent. increase on normal levels for Friday evenings and Saturdays. It should not compare the Friday and Saturday over Christmas with a normal weekend; it should compare those days with Fridays, Saturdays and Christmases in the past, and with days when there has been bad weather. Many of the circumstances are predictable: winter, Christmas and the new year are not exceptional—we know about them. I do not pretend to be a great fan of Michael Fish, but when he forecasts sub-zero temperatures, I do not need Mystic Meg to tell me that if there is ice, some people will slip on it and hurt themselves, and that if they hurt themselves badly they will end up in hospital, which will mean that more hospital beds will be needed. It all seems fairly simple to me. I am sure that people should be better able to plan for that.
  My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) talked about past problems when people have been left on trolleys for hours. At one stage over Christmas and the new year, the Queen's medical centre in Nottingham ran out of trolleys. It was not just a case of people not having beds: they could not even get trolleys. I took the problem up with the chief nurse, who assured me that it was not a problem as it was only the accident and emergency department that had run out of trolleys and that staff had managed to get spare trolleys from elsewhere in the hospital.
  I did not know that there were spare trolleys lying about, and it makes me wonder why the same argument is not used about beds: why cannot all the spare beds that are left lying around in hospitals be used? That never seems to happen. The reason is that there are not so many beds as there used to be. In my own region—the Trent area—there were 11,085 acute beds in 1989–90;

  811
  by 1995–96, the figure was down to 10,333. Overall, the total number of beds lost in that short period was 5,197. I accept the arguments for some beds going and I recognise that the different ways in which patients are now treated mean that not so many hospital beds are needed, but if some of those beds had been saved, the problems experienced at Queen's medical centre might not have occurred. Some 3,193 of those beds were general or acute beds; they were not beds that were no longer needed because of care in the community.
  I am not so concerned about what happened on those nights when the emergency services almost reached breaking point. I am more concerned that not only were 350 operations cancelled in October, November and December, but there is now a hold on all operations. Although there have been plenty of examples in the local press since Christmas—headlines include
  "Ops fall victim to QMC rush"
  and
  "Ops put on ice at QMC"—
  the public have still not been told the complete truth. On 30 December the medical director instructed that only urgent surgical cases and people who had spent more than 18 months on the waiting list would be taken in for treatment, the latter being done to help the Government figures for waiting lengths of more than 18 months, not for medical reasons.
  On 6 January that policy was changed again. It was said that the only patients to be admitted for operations were emergency and life-threatening cases. None of the operations and new procedures that the Government say are great and can be done on the NHS is being carried out on my constituents. They were denied operations in October, November and December and they are now to be denied them in January, February and March. For six months of the year, all that my constituents can get is emergency provision. When will that become a crisis? Will it be when they can get only emergency provision for nine, 10 or 11 months of the year? The Government must accept that there is a crisis now.
  The problem may seem slight to the Minister. The press release lists conditions such as hernias, which people think are not that special. I will describe some of my constituency cases involving people waiting for treatment. One woman is waiting for a hysterectomy. She was expecting to have the operation on 29 November; now she is not likely to get it until the new financial year. Men may not think that that operation is important, but I bet that there are not many women who take that view.
  Another case involves an elderly lady with an arthritic spine; she, too, will have to wait until the new financial year before she can have an operation. Someone with a swollen bladder was taken into the operating theatre and then taken out again; he was sent home two days later and told to ring to find out when a bed would be available for him. By the time he did so, the ban had been imposed and he was told, "Sorry—no operations until the next financial year." If I had a swollen bladder, I would not think that it was trivial. Someone whose knee is in danger of packing in and who has already had two operations on it has now been told, "We'll have to wait until it gets worse: when it goes completely, we'll fit you up with a new knee rather than doing the surgery now."
  Those problems are serious. Ministers may say that such operations are merely routine, but they are important for those waiting for them. If Ministers had to rely on the
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  health service as most of my constituents do, rather than having private health insurance, they would ensure that such problems were put right tomorrow.
  8.35 pm
  Mr. Nigel Waterson: I am delighted to have the opportunity to participate in the debate, having only recently renounced my Trappist vows as a parliamentary private secretary in the Department of Health.
  In discussions and debates on the national health service in this country, we owe it to the Opposition to do them the courtesy of adopting their definition of success. The definition of success that we can rely on is that of the right hon. Member for Livingston (Mr. Cook), who said that the acid test of the success and effectiveness of the NHS in this country was the number of people treated. He speaks from some knowledge and experience as it was his party that cut spending on the NHS in real terms during the last Labour Government in 1977–78. To bring the matter up to the present day, despite all the bluster and the individual case studies about which we have heard today, we have still to hear a commitment from the Opposition Front Bench to match the Government's pledge to increase NHS funding year on year above the rate of inflation.
  All that we need to do to see the success of the NHS is to look at the figures. Despite all the arguments about finished consultant episodes—a basis for gathering statistics, the origin of which lay in the last days of the last Labour Government—so long as we use the same yardstick, we can track an increase in the amount of treatment available to individual patients in the NHS. When all the rhetoric and party politics are stripped away, that is what really matters.
  We know that more than 3 million more treatments were carried out in 1995 than in 1979—and 1 million more than in 1991, when we introduced the NHS reforms. That means that 3,500 more treatments were carried out each day. Do not those statistics put into stark perspective the individual cases culled from hon. Members' constituency correspondence? The number of hip replacements is up from under 29,000 in 1978–79—and from zero not many years before that, when the operation was not available—to more than 58,000 last year.
  Another acid test of whether the NHS is working well is waiting times, about which we hear much less from Opposition Members than we used to. Could that be because since 1987 the number of patients waiting more than a year for hospital treatment has been cut from more than 200,000 to just 15,000? Half of all patients are seen immediately and half of the remainder are seen within five weeks. Nearly 75 per cent. are seen within three months and 98 per cent. within a year.
  Another commonly accepted yardstick of the health of a specific nation and of its health service's success is life expectancy. We know that in Russia male life expectancy has decreased in the past few years, but a child born today in this country can expect to live two years longer than a child born in 1979. Over the same period, the proportion of babies dying in the first year of life has fallen by almost a half. By any standards, those are impressive figures.
  We have heard about the increase of 55,000 in the number of nurses and midwives and of 22,500 in the number of doctors and dentists. We hear a lot about

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  so-called bureaucracy in the NHS, but it is worth remembering that, according to recent figures, for every senior manager in the NHS there are no fewer than 77 other people providing direct care to patients.
  Of course, measuring the success of the NHS is not only a matter of figures; it also depends on the experiences of individual patients who present to their doctor or their local hospital. As I go around local GPs' surgeries and local hospitals, I think that the experience of patients is much as is reflected in the figures. Record numbers of patients are being treated—some 39,000 were treated last year in Eastbourne hospitals, and that figure is likely to be exceeded this year. Around 40 per cent. of the electorate in my constituency is of retirement age or older and, on average, as happens across the country, the elderly members of the population account for a greater proportion of NHS spending than other age groups, as is absolutely right and proper.
  The increasing figures do not happen simply by accident; they are the result of the magnificent efforts of doctors, nurses, ancillary workers and—yes, let it be said—managers. We have increased funding year on year and we have promised to continue to do so. This year's increase for my area was the second largest in the country—some £15.8 million extra in cash terms for the local health authority, which represents a real-terms increase, after inflation, of 2.38 per cent. Even the hon. Member for Southwark and Bermondsey (Mr. Hughes) was good enough to describe such increases as "relatively generous" and he was absolutely right.
  A primary care-led NHS is a cornerstone, if not the cornerstone, of Government policy. Primary care is doing well, not only in my constituency, but across the country. By April, some 60 per cent. of patients in this country will be part of a fundholding practice. Only the other day, I visited one such practice in my constituency—that of Dr. John Clarke and his partners—and was present at the unveiling of a new bone scanner to gauge conditions such as osteoporosis. The scanner was installed at that practice, but it will be available for use by other GPs throughout the area. That would have been almost inconceivable in the old NHS and it is a perfect example of the flexibility and high aspirations of the modern NHS under the Conservative Government.
  Another exciting development in and around my constituency has been the recent setting up of a pilot total purchasing project, which involves family doctors and all 15 practices in Eastbourne and the surrounding area and covers a staggering 135,000 patients with a total purchasing power of £70 million. It is an incredibly impressive scheme and I believe that it is the largest in the country. The board represents some 70 GPs in nine non-fundholding and six fundholding practices, as well as the health authority and the community health council. I foresee provision in many other parts of the United Kingdom developing in a similar manner and our local total purchasing project will show the way.
  We have heard a great deal in the debate about winter pressures. The problem tends to happen every year: it is a combination of influenza, cold weather and illness among medical staff. Like other hon. Members, I keep in touch with the accident and emergency department at my local district general hospital and staff there have been coping well. I spoke recently to the consultant, Mr. Rowland
  814
  Cottingham, and to the chief executive and they believe that they are coping well, despite the extra pressures. I hope to visit the accident and emergency department again very soon. I should mention in passing that Mr. Cottingham and his colleagues were recently involved in the piloting in my area of the health services accreditation initiative, which was launched only a few days ago as a national programme for the NHS.
  Nationally, we have learnt the lessons of previous winters. As mentioned, we have set up the national intensive care bed register and we have pumped an extra £25 million into the system to help it to cope with winter pressures. In my area, arrangements for handling emergency hospital admissions have been agreed between East Sussex, Brighton and Hove and the aim of that co-operation between hospitals in our area is to ensure that hospital beds will always be available for emergency patients. The hospitals have agreed to keep the Sussex ambulance service up to date with how many beds are available and to work together, sharing the pressure, if one hospital is full. Local GPs are also being kept informed. That is a sensible, straightforward way of dealing with the inevitable peaks and troughs of pressure on accident and emergency departments.
  Finally, I turn to Opposition policy on the national health service—if policy is not too ambitious a word to describe the ragbag of prejudice and anecdote that we have heard today from Labour Members. The problem facing the hon. Member for Islington, South and Finsbury (Mr. Smith) is this: the right hon. Member for Dunfermline, East (Mr. Brown) has bowled out his middle stump—indeed, he has gone further and broken the hon. Gentleman's cricket bat over his knee. The hon. Gentleman therefore has no way of promising extra money for the NHS—it would appear that that option has gone. Either the right hon. Member for Dunfermline, East means what he says, in which case a Labour Government—if such a thing were ever to happen—would apply Conservative spending plans, or the hon. Member for Islington, South and Finsbury is right to promise extra money for the NHS and his right hon. Friend is wrong. Which is true? We should be told.
  The Labour party is now apparently committed to working on the basis of the Conservative Government's spending plans if Labour were to win an election—this at a time when Labour has still not matched nor come close to matching our pledge on NHS spending. The British people do not need to take our word on NHS spending—they need only look at our record to see how, year after year after year, we have increased spending on the NHS in real terms and how the Government have made it a priority. NHS spending has increased by a massive 74 per cent. in real terms since 1979; as we have heard, it now represents spending of £724 for every man, woman and child in this country, whereas the equivalent figure in real terms for 1978–79 was only £444.
  The other worry lurking behind what passes for Labour party policy on health is the trade unions. We have heard once or twice today about the winter of discontent. It has been rightly said that a two-year freeze on public spending would be the equivalent of two winters of discontent. Last time, the dead remained unburied, cancer patients had to cross picket lines for treatment, and earlier today my hon. Friend the Member for High Peak (Mr. Hendry) told the moving story of how his father was treated at that time when he was suffering from cancer.

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  The people to whom I talk on their doorsteps and in my surgeries have nothing but praise for our NHS. Opposition spokesmen have a vested interest in denigrating and running down the NHS and the efforts and commitment of those who work in it. It is a measure of their growing desperation that the picture that they paint of the NHS is wholly unrecognisable, not just to those who work in it but to those who use it. Anyone who has recently used the NHS, or who has a close family member who has, will have nothing but praise for it. I suggest that Opposition spokespersons talk to those people instead of listening to the horror stories that they have been spinning today. The fact is that the NHS is a great British success story, and it deserves the support of us all.
  8.50 pm
  Mr. Gerry Steinberg: I want to discuss two topics that have resulted from the NHS reforms; and to be very parochial. The first is the new district hospital for Durham; the second is the shortage of hospital beds in Durham.
  The project for the new hospital was promised more than 20 years ago. The old area health authority and the North-West Durham health authority had had the lowest capital expenditure in the whole northern region. In the early 1990s, therefore, it was agreed to build a new district general hospital. In February 1992, when the choosing of a site for the new hospital was proving difficult, the then chairman of the North regional health authority, Peter Carr, wrote to me as follows:
  "You can be assured that the new hospital will be constructed. The capital funds have been set aside and the Durham project is top of our priority list."
  Five years later, we still have no new district general hospital, and I am not confident that we will ever get it.
  Since then, the Government have refused to build any new hospital buildings out of public sector funds and have turned to their so-called private finance initiative, which is a complete and utter failure. At the moment, the PFI is nothing but a con trick—a promise of new hospitals which just do not happen.
  In 1994, the Minister for Health told me that, since the launch of the PFI in 1992, the NHS had been encouraged to exploit the benefits of collaboration with the private sector. He continued by saying that, increasingly, the private sector is bringing in its innovation, dynamism and experience to the NHS, to improve services and get better value for money. Perhaps the same Minister tonight will tell me where there has been a successful PH incorporating these conditions: it is certainly not in Durham. I am led to believe that there is not one in the whole country either. Indeed, the Library told me this morning that no building work had started on any scheme, and that there was no date set for any to start.
  I was originally told that the preferred bidder and the business case would be finalised by the end of 1994; yet today, at the beginning of 1997, we have not even reached that stage. Is that an example of the success of the private finance initiative?
  In 1996, the trust told me that the full business case had been prepared, and that—in conjunction with County Durham health authority—the preferred option would be forwarded to the Treasury for final approval. We are still waiting. The trust continues to claim that this is quicker and more efficient than building in the public sector; and
  816
  the trust continues to tell us that the hospital will be completed quicker than it could have been by the public sector. What a load of hogwash.
  The cost of the PFI process so far has been well over £1 million; this cost has been incurred just by the procedure, nothing else. Meanwhile, the trust's financial position has worsened. More than 50 beds have been closed; theatre sessions have been reduced; targets have been set; and there are limits for certain operations. The trust was told that it had to save £2 million during the current financial year. Those measures are a direct result of financial pressures, but they are also in line with the trust's long-term strategy for the new district general hospital in Durham.
  In 1996–97, there is a £2 million loss of revenue. In 1997–98, a further £2 million loss is projected. For 1998–99, another £1 million loss is projected. Even with all these savings, there is still no guarantee of a new hospital being built. An interim rationalisation plan continues in place—the running down of services in the sister hospital at Shotley Bridge, and the transfer of services to Dryburn in Durham.
  The situation in October was so grave that I received a letter from the consultant dermatologist, Mr. Ire, and signed by another eight senior consultants at the hospital. It concerned the acute crisis in medical services in north Durham. He said:
  "There is a great danger of a collapse of general medicine, including cardiology and heart attacks in North Durham, as a result of a halt being called to a process of site rationalisation, whereby Shotley bridge was going to gradually decant into Dryburn. The situation has gone so far that we are now unable to recruit junior staff to Shotley Bridge beyond February and the Post Graduate Dean would certainly not allow junior staff to work there beyond that time."
  What a dreadful situation for the health service in Durham to be in.
  I do not blame the hospital trust or County Durham health authority, although both could have acted slightly differently at times. The fault clearly lies with the Government, and with the health reforms that have created this appalling mess. I blame privatisation and the breaking up of the health service.
  As for building the new district general hospital, things go from bad to worse. Last September, the director of technical and leisure services for Durham city council contacted me by letter. He informed me that senior members and officers of the council had met representatives of the North Durham Acute Hospitals trust, the health authority and representatives of Consort Healthcare, which is the PFI partner of the authority. He wrote:
  "It is apparent that for the hospital to be built and fitted out, the PFI partners wish to raise finances by the utilisation of surplus land on the Dryburn site for a retail development. Senior members are concerned that the City Council will be faced with the proposal for inappropriate development to finance a funding gap to provide a much needed district general hospital. They feel that the citizens of Durham should not be required to make such a choice, nor would they be able to recommend that they do so."
  In effect, it was being requested that a supermarket be built in the hospital grounds in one of the most sensitive parts of Durham—a suggestion both stupid and unreasonable. I immediately made my position clear on this issue, and said that I would not support such a supermarket development on the hospital site and would

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  not be prepared to have the council or myself blackmailed into accepting the retail development, even if it meant losing the new district general hospital.
  The trust was adamant that it was blackmailing no one, but was simply requesting that the land be built on to make extra money to help fit the hospital out. However, the presentation which the hospital trust gave the local authority made it clear that there was an attempt to influence the council's decision on whether to grant planning permission on the basis that the hospital would not be built. It said:
  "Funding issues: funding shortfall exists. Not possible to realise full extent of service provision. More existing buildings retained and new buildings left as a shell until cash available. Disposal of surplus land necessary. Complete scheme relies on maximum return on surplus land. Food retail development is only solution for surplus land to bridge the gap."
  It was clear that, unless the trust obtained planning permission to build a retail development, our district general hospital was threatened. That is what the PFI means—no new facilities unless the private sector can make a killing.
  I shall now deal with the lack of beds in the hospital. In 1995, prior to the cost improvement measures taken in the hospital, there were 670 beds. At one stage before that, there were 900 beds. There are now 580 beds. The original outline business case, which was approved in December 1994, gave the PFI bid a figure of 565 beds. We are now told that the trust has undertaken a fundamental review of bed numbers and the number of beds in the new PFI bid has been cut to 454.
  The trust tells us that that is all that is necessary. I neither accept nor believe that. The drastic cut in the number of beds has taken place simply because of the amount of cash available under the PFI bid. If we ever get a hospital, it will not have enough beds. How on earth can a new hospital with 454 beds cope when the present hospital with 580 beds cannot cope?
  Morale is so low among consultants in the hospital that many are thinking of leaving. When I discussed the matter with a consultant, he said: "There is a smell of decline." What are we coming to when a consultant says that there is a smell of decline in a hospital? The interim rationalisation programme has made virtually no savings, and straight cuts will have to be made over the next three years. Cuts totalling some £8.6 million—15 per cent. of the budget—are now forecast. That is even higher than originally thought.
  If the PFI bid cannot produce more than 450 beds, it is not worthy, and should be looked at again. The brand new state-of-the-art hospital that has been described, with 450 beds, will be unable to cope.
  Although I have been receiving complaints from my constituents over the past year or so about the lack of beds, in the space of a week, I have been contacted on two separate occasions about the lack of beds in the hospital.
  On one occasion, Mrs. Budd, a constituent of mine, had been on a waiting list for a serious operation. She was twice given a date and, on both occasions—once in October and once in November last year—her operation was cancelled and no further date was offered to her. She was informed that her operation had been cancelled because, although the consultant could do the operation,
  818
  no intensive care bed was available for her after the operation. I was told this morning that last week she was given another date. Guess what happened—the operation was cancelled again. It is a sad state of affairs when a consultant cannot proceed with an operation because he cannot be sure that an intensive care bed will be available once the patient has had the operation.
  A further appalling case was brought to my attention at the beginning of January. Mr. Taylor, an 84-year-old from my constituency, was admitted to hospital for treatment, but, unfortunately, no beds were available. Eventually, he was found a bed, but he tragically died some days later. The coroner was so concerned about this case that in court he advised the man's family to contact their Member of Parliament, because, he said, the case was so serious. The hospital is currently investigating the case.
  The twist in the tail is that the chief executive of the trust, Mr. Brian Waite, the most vociferous supporter of the PFI bid, has done a runner. I am told that he has gone to a job with neither promotion prospects nor a wage increase. He has gone to Carlisle. Who would go to Carlisle when he could stay in Durham? I should have thought that Mr. Waite would have wanted to wait for the PFI bid to be completed and see his dream come to fruition. Perhaps he thought that, by the time that happened, he would have retired and might need a bed in a geriatric unit in Durham, which would not be available because all the beds would have been closed. That is probably why he has gone.
  Mr. Waite's departure sums up the exact position: had he believed that the PFI would give us a new hospital, he would have waited to see it come to fruition. The fact that he has left tells us clearly what he felt was happening with regard to the future of the bid.
  The private finance initiative is a farce, as are the national health service reforms. I suspect that the case in Durham is not unique, and, in the meantime, my constituents wait for a new district general hospital and have a steadily deteriorating service.
  9.3 pm
  Mr. Piers Merchant: There is often a tendency in the House to generalise to such an extent that the conclusions are almost worthless. Conversely, individual cases are sometimes dealt with so specifically that extrapolation to policy is virtually meaningless.
  The hon. Member for Islington, South and Finsbury (Mr. Smith), to whom I listened with great interest, as I always do, is a past master at those two dubious arts. Today he surpassed even his usual ability in that respect. I was astonished at his nerve in citing a handful of sad and undoubtedly unacceptable cases and giving the impression that those illustrated the norm, which they palpably do not.
  The hon. Gentleman seems to luxuriate in the idea of crisis. He has a fantasy that the national health service has reached such a point of crisis that it is about to collapse, which is plainly untrue. When he is unable to establish that theory, he insinuates that there is a cover-up and he cannot get all the facts. The only cover-up is the Labour party's policies—or lack of policies—on health.
  The hon. Gentleman's speeches in the House are usually of a high standard, but today he rambled, probably because he saw lurking behind him the figures of his

  819
  party's Treasury spokesmen. If they exercise such influence on him in opposition, I shudder to think what would happen if he were in government. The effect was that no policies emerged until the end of his speech, when he plucked out of the air two ideas that appear to be policy.
  The first was about saving money. The hon. Gentleman claimed that he would be able to save £100 million by cutting bureaucracy. The House needs to know precisely how he will do that. One hundred million pounds is paltry, compared with what my right hon. Friend the Secretary of State has already saved recently in bureaucratic costs: £300 million—three times that. How does the hon. Gentleman square that claim with the supposed policy of his party to restore the regional level of NHS bureaucracy? The regional level was cut out by this Government, saving precisely £100 million.
  The hon. Gentleman's second policy seemed to be to do away with the internal market, yet he seems to defend the purchaser-provider split. That is a strange semantic exercise. I fail to see how he will do away with the market but keep the mechanism of the internal market. He owes the House a detailed explanation of how that will operate, what the cost will be and what disruption will be caused to the NHS by another apparently large reorganisation.
  We also need to know what the impact of Labour's policy, whatever it may be, will be on the PFI. I listened with considerable interest to the remarks of the hon. Member for City of Durham (Mr. Steinberg) on that, because he described a situation surprisingly similar to that in my constituency, but moving in an entirely different direction.
  Will the hon. Member for Islington, South and Finsbury stop all the PFI schemes? How will he explain that to the people in the towns and cities throughout the country who are expecting hospitals to be built because PFI schemes are virtually in place? How will he justify robbing them of their hospitals?
  What will the Labour party do about GP fundholding? How will it explain its intentions to the thousands of people who are benefiting because they are on the lists of GP fundholding practices? What will the hon. Gentleman say to them? What is his policy on GP fundholding? What he says in the Chamber contradicts what he told The Guardian on 1 November, when he seemed to advance some powerful and rather impressive arguments in favour of GP fundholders.
  Dr. Hendron: I am in medical practice and have some experience of such matters. Some fundholders and their patients do very well, but is the hon. Gentleman aware that many non-fundholders who want to become fundholders are now not accepted? Government funding in the north of Ireland has not been ring-fenced for patients of non-fundholders. That is a serious problem—I do not know whether the hon. Gentleman has encountered it.
  Mr. Merchant: I am grateful for that information. I am not an expert on Northern Ireland and I was not aware of the situation there. Thousands of my constituents benefit from belonging to GP fundholder practices and I welcome a change in the law that would, I hope, extend the scope of GP fundholding and make it more easily available to other GPs. I hope that that opportunity will be extended to Northern Ireland also.
  820
  The Labour party's final policy admission concerns the fundamental question of funding the NHS. I will not labour the point—which has been made effectively in the debate not only by Conservative Members but by the Liberal Democrat spokesman, the hon. Member for Southwark and Bermondsey (Mr. Hughes)—but, if the Labour party is to convince people that it has a credible policy for the health service, it must have a credible policy for funding the health service. That is completely lacking from its policy agenda. The Government have pledged to ensure that funding for the health service increases in real terms every year for the next five years. That is a powerful, and I think very welcome, pledge to the people of this country.
  The remainder of my remarks shall concentrate on some local topics affecting my constituents which also illustrate important elements of national policy. I think that we can measure the worth of a policy most effectively by gauging how it affects individuals in a particular area. We should not use single examples or make national generalisations, but look at the impact of policy within a constituency or a health authority area.
  My constituents consistently raise three issues with me. The first is waiting lists. That is a good-news story as far as the health service is concerned. Waiting lists are potentially the source of greatest concern to the ordinary person. Therefore, their reduction must be a priority and, when that is achieved, it is a triumph. That is precisely what has happened in my constituency. In the year end at March 1996, not one of my constituents waited for more than 12 months for medical treatment. That is a dramatic improvement on the record of the previous 10 years. I am assured that the results will be just as good this year, give or take a handful of people—we are seven over at present and we were seven under a few weeks ago. I am sure that the yearly average will show a wait of no more than 12 months. I think that that is real and welcome progress.
  The results in my constituency match the national figures that have been cited: a reduction since 1987 from 200,000 people waiting 12 months or more for treatment to only 15,000. That is a marked policy achievement that reflects the Government's commitment in that area. Our record funding for the health service of £43 billion and the extra £1.6 billion that will be spent next year are reflected at a local level. I pay tribute to Mark Rees, the chief executive of Bromley hospital, for ensuring that funding is well used at local level. Nationally, 75 per cent. of all patients are treated within three months, which is another excellent achievement.
  The second issue is accident and emergency services. It is a difficult area and I do not disguise the fact that the service is not running perfectly in the Bromley area. However, to speak of a crisis or of collapse would be completely to distort reality. The period over Christmas and new year is always difficult owing to a surge in the number of accident and emergency cases. Local staff are working extremely hard to handle the increased work load and they are succeeding admirably. Although there are some unacceptable cases of people waiting too long for treatment—they receive emergency treatment immediately, but must sometimes wait in A and E until beds become available—there is no question of the system collapsing or of the A and E unit being closed. That is because of the forward planning that was done. Bromley hospital has created a new observation ward, into which it could channel some admissions for observation before moving them on to hospital beds when needed.

  821
  It is important, too, to appreciate why there is a difficulty in that area. It is all very well hon. Members giving examples of problems that have emerged, but unless the reason is understood, little can be done to tackle them. The reason in Bromley is complex and long term and could not be solved overnight. For historical reasons, we have four different hospitals, serving a population of around 250,000, whereas ideally we would have only one.
  Because we have four small hospitals, when A and E patients come in, they then have to be observed and stabilised, and, if it is decided to admit them, many have to be transferred to another hospital in the borough. There is no other way of handling the situation, because the hospital with the A and E department is not large enough and cannot be expanded. There is no room; it is right in the centre of the town. Therefore, they have to be moved elsewhere, which brings me to my third and final point.
  There is a crying need—it is the only solution to this and a number of other local health problems—for a new acute general hospital. That would solve the problem of transfers and create a much more efficient system. There would not be the complex process of managing beds, wards and specialities in different locations. Patients would not have to be moved around, transported from hospital to hospital. There would be no need for diagnostic transfers. All those problems could be solved with a new acute general hospital. That is a PFI operation.
  I return to the speech of the hon. Member for City of Durham. Bromley has been in a similar situation, in that, originally, 20 years ago, the need for a new acute hospital was realised. In 1992, there was a problem with planning over the then chosen site. We have now passed the planning stage, the preferred bidder stage and the interim business plan stage. We are now finalising the final business plan. All that has been achieved in a remarkably swift period, which shows that the PFI can work.
  Shortly, a submission will go to the Treasury. I ask my hon. Friend the Minister to do his best to ensure that, when the Treasury considers this case, which I believe it will in February, it does so thoroughly, and that a decision is expedited so that we can see bricks and mortar—the construction of a new hospital—because it is a priority for the people of my area. It will show that the PFI works, and will overcome many of the smaller problems to which I have alluded.
  It is because I believe in the national health service, in the provision of free health care for all, across the board, that I also support the PFI. I believe that it will bring a bright new future for health care for my constituents, and will be another strong argument as to why they should support Government policy on health.
  9.18 pm
  Mr. Cynog Dafis: I shall be as short as possible, Mr. Deputy Speaker. However, I want to draw the attention of the House to the situation that has emerged recently in the Dyfed Powys health authority. Two days before Christmas, the health authority published a strategy document in which it made some swingeing recommendations. I believe that it published the document only two days before Christmas because it wanted to defuse the public reaction that it feared was inevitable. That reaction is now mounting and it needs to be taken seriously.
  822
  The review is the outcome of a funding crisis that the health authority has for the moment. That crisis is being passed on to the trusts within the authority's area. The crisis has been caused by factors that I shall not take up now. However, the health authority reveals in its document—this part of it I believe—that it is underfunded because rurality is not considered significantly in the formula. It is a large region—the whole of Dyfed and Powys—and so needs four district general hospitals for a population that would need only two in an urban setting. Those hospitals are needed because of travelling distances.
  The document states:
  "there is a strong case for additional funding separately from a capitation basis for an area which has the scarcity of population and geographic area of Dyfed Powys."
  The authority says in the previous paragraph, however, that it does not think that the Welsh Office will respond. It thinks that the formula will not be changed, and that even if it were, things might be made worse.
  That is an appalling example of defeatism and a signal to the Welsh Office that the authority intends to do the business that the Welsh Office wants of it, which is to balance the books and cut services. In reality, we are talking only about cutting services. Let us not mince words about that.
  The health authority reckons that it must pull back or save more than £11 million over the next four years. Accordingly, it makes proposals that are designed to achieve such a saving. First, it is proposed to reduce the number of trusts from eight to two or three. There is no problem with that in theory but the proposal raises the question why so many trusts were created only four or five years ago.
  Secondly, it is proposed to close eight of 19 community hospitals. That is peculiar, given the endorsement from the Welsh Office in a document published only in August 1996, which emphasised the important role that community hospitals should play. I shall not quote at length from the Welsh Office document now, but another important institution in Wales, the Office of Research and Development for Health and Social Care, argues that community hospitals should or could be playing an enhanced rather than a reduced role.
  It is clear that the health authority has not thought through its proposals for community hospitals. Its document states:
  "We are prepared to discuss other options which would save the necessary money and provide effective services. In view of this, we are not being specific on the hospitals which close. We believe we have to work with our trusts".
  It continues in that vein. It is clear that the authority is looking for cuts without having made a clear analysis of why community hospitals should be closed. On what basis has it made such a radical proposal—to close nearly half the cottage or community hospitals in the area?
  The third proposal is to reduce the range of treatments or specialisms at a number of district general hospitals in the name of centralising activity. It is claimed that that is necessary because of an increasing trend towards specialisation and that sort of thing.
  In reality, if the range of specialisms at a place such as Bronglais were reduced, the status of the district general hospital would be reduced. Indeed, it would no longer be a district general hospital. It would not survive in a

  823
  meaningful sense as a DGH. That is an unthinkable option, bearing in mind the fact that the nearest other DGH is 50 miles away at Carmarthen. The others are much further away than that.
  The content of the document is poor stuff. The paper is full of vague proposals that are based on unjustified preconceptions. Crisis management is masquerading as strategy, and that is unacceptable. If the proposals were implemented, decisions would be taken that in all likelihood we would be bitterly regretting five years later.
  What is to be done in all the circumstances? Two things should be done now. If action is not taken, public reaction will justifiably be fierce. First, the health authority and the trusts should commission a properly conducted and objective study of the health care needs of Dyfed Powys. They should do so in association with the Office of Research and Development for Health and Social Care, which has expert knowledge and experience. It is in the business of building up a research understanding of health care needs in Wales. To that extent, I am much in sympathy with the Liberal amendment. The outcome of such an objective study, and the evidence that it provides, should be the basis of any restructuring.
  There is a funding crisis and the Welsh Office could and should step in with £4 million per annum additional funding until 2000 when, according to the health authority, the situation would improve because the cuts resulting from the change in the formula would no longer apply. We need that kind of money. We need a proper approach to restructuring and a strategy based on evidence, and we need money in the meantime.
  Many people in Wales are looking forward to the election, because they hope that the position will improve thereafter. In view of what has been said in the past few days, I question whether their optimism is justified. Many of us are profoundly worried that Labour has put itself in such a position that, following the election, it will find it difficult to add to public expenditure and investment, even though it may decide that it needs to do so. That issue will loom large in the next couple of months in the debate on health care in south-west Wales.
  9.25 pm
  Ms Tessa Jowell: This has been a necessary and timely debate, but not one that the Government wanted. On two occasions, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) sought an emergency statement on the winter crisis, but the Secretary of State declined to make one.
  The British Medical Association said that this winter's crisis is the worst ever, and it provided a catalogue of evidence in support of that claim. What was the Minister's response? On the radio—not in the House—he said, in effect, "This is the winter. What do you expect? Demand always rises in the winter." Of course it does, but we expect the Secretary of State to be ready for it. He should be ready for the 'flu, bronchitis and other ills that winter brings, and for the inevitable and predictable spate of accidents caused by icy roads and footpaths, not to mention the increased fragility of elderly people in freezing weather.
  The Secretary of State and his colleagues have obviously been on a course at the Yorkshire Water school of management studies. Only there could they have learnt
  824
  to be surprised at the inevitable effects of the seasons. For Yorkshire Water, summer comes without anticipation of drought. For the Government, winter brings surprising new demands on the health service.
  The Secretary of State will go on any radio or television programme at any hour of the day to tell a disbelieving public that there is no difference between Labour and the Tories on health. The Government believe that the market is the cure-all for the national health service. We shall get rid of the internal market. We shall keep commissioning separate from the provision of care, but co-operation, not competition, will be our approach, and it will work. That is what people who work in the health service want, because they know that that will begin to dismantle some of the obstacles that stand in the way of the delivery of best patient care.
  As hospitals are forced to compete like businesses, so the purpose of their existence—the care and comfort of patients—is relegated. It is now commonplace for patients who arrive at a hospital to find that it is so short of beds—because they have been taken by emergency admissions—that planned operations have to be cancelled. Many of my hon. Friends have given examples of that problem. Other hospitals are so short of money that doctors, nurses and operating theatres work at below capacity, unable to perform operations until the next financial year. Increasingly, it is only the patients of GP fundholders who are able to have their operations before the end of the financial year.
  The public are understandably mystified by this misallocation of resources—but not Ministers. Cancellation of operations and discrimination between patients on grounds other than clinical need are part of the ineffable wisdom of the market. It is the triumph of the ideologue, but the politics of the bargain basement.
  My hon. Friends have given clear examples of the crisis. My hon. Friends the Members for Birmingham, Northfield (Mr. Burden), for Warrington, South (Mr. Hall), for Nottingham, East (Mr. Heppell) and for City of Durham (Mr. Steinberg) expressed concern on behalf of their constituents. Ministers have scorned the use of individual cases—and so would Opposition Members, if it were not that those cases illustrate the experience shared by so many others, and demonstrate the pressure on the service.
  A 70-year-old man died in Sheffield after being ferried 90 miles from his home in the west midlands, where a bed could not be found for him. In London, 22 patients had to spend the night on trolleys at Kingston hospital, while patients awaiting treatment at Lewisham hospital have been told that they will not be seen until the end of the financial year. In Liverpool, 30 acutely ill patients were left waiting in a hospital corridor after a ward was forced to close. Those are the everyday stories of our national health service during this time of winter crisis. The examples that my hon. Friends and I have given, however, are not—as Ministers try to claim—what patients should have to expect from the NHS in winter.
  The growth of bureaucracy has become a cancer in the operation of the national health service. According to the British Medical Association, since 1990 it has cost an extra £1.5 billion a year. That was entirely predictable, because every organisation has its own overheads. When organisations are competing, it is difficult to share, and each trust has its own director of staff, technology and

  825
  communications; but, if resources were allocated properly, the overheads could be shared, as they were in the past. The internal market is an extravagant and inefficient way of allocating resources in a national health service.
  Of all the fictitious slogans ever coined to mislead the public, none was more misleading than the one that proclaimed that the national health service was safe in Tory hands. What are the origins of the failure? First, there is the pace at which acute beds have been closed throughout the country, which has been described so clearly by my hon. Friends on the basis of their experience in different parts of the country, and which has given change such a bad name. For most people, change means less: it means that their local hospital will close, and that nothing will be provided in its place.
  Secondly, the competition between hospitals that has resulted from the internal market means that, instead of co-operating, hospitals have become what they have aptly been described as—city states at war with each other. Thirdly, there is the demoralisation of staff who must push paper and fill in forms rather than tending patients and performing operations. That demoralisation is driving doctors and nurses away from the national health service in numbers that begin to threaten the service itself. Let me make it clear that Opposition Members draw a clear distinction between the bureaucracy that, like bindweed, consumes the efficiency of our national health service, and the importance of skilled and effective management, to which we pay tribute.
  Fourthly, there is the failure to provide elderly people with support as part of community care. We know—any visit to any accident and emergency department over the past few weeks will have shown—that, overwhelmingly, the patients who are lying in bays waiting for beds are very elderly people. A ward sister said that the average age of 18 of the patients whom she had nursed in temporary beds on a recent Saturday night was 85.
  It would be asking too much of the Government to admit that they were wrong, but it is not too much to ask Conservative Members before they vote to think of their constituents. This winter's crisis was not inevitable, nor was the deterioration in standards of care. It was not like that before and it does not have to be like that in future. A few days ago, a senior nurse told me, "We simply did not have patients on trolleys in 1989."
  Sir Raymond Whitney: The hon. Lady has just said, "It was not like that before". She is right, because during the time of the Labour Government, 7 million people were treated each year. Now we treat 10 million patients a year. There are 55,000 more nurses and 20,000 more doctors than when Labour was in government, and they are all paid more. There are no NHS strikes to prevent people getting into hospital. The hon. Lady is right; it was not like that before.
  Ms Jowell: That intervention shows precisely the problem with Conservative Members. They paint a picture of the national health service that is unrecognisable to those who work in hospitals and to patients throughout the country who are waiting for treatment. As usual, Ministers have failed to notice, even less to accept,
  826
  the recent advice to London hospitals by inner-London chief executives whose study of the balance between planned and emergency admissions led them to recommend a bed occupancy rate of 85 per cent. instead of the 98 per cent. or more than 100 per cent. at which most hospitals are now required to operate under the strictures of competition.
  As today's King's Fund report makes clear, psychiatric hospitals are barely coping because in some cases bed occupancies are running at 125 per cent. It is called hot bedding. In paediatric intensive care, 70 per cent. bed occupancy is recommended to guarantee consistent levels of care. Apparently, there is a difference between the inevitable and the entirely predictable. Ministers believe in the inevitability of patients on trolleys, cancelled operations and the consequent despair, but apparently none of it is predictable.
  My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) spoke about the growth of the NHS as a safety net service. There is an intolerable and rising level of violence in accident and emergency units. For staff seeking to offer treatment, it is appalling and unforgivable that people in need of emergency treatment should attack those who are there to help them. However, that is what happens when the accident and emergency department becomes the safety net and the court of last resort.
  There is an alternative to the crisis. Even at this late stage in their life, let the Government admit that the internal market, or what Dr. Sandy Macara of the British Medical Association prefers to call the infernal market, has failed. Let them free hospitals to co-operate in delivering a public service rather than forcing them to compete as private businesses. That would create flexibility and allow hospitals to match beds and treatment to need. That is especially important at this time for the elderly who make up the majority of those who are queuing for beds.
  We shall shortly publish proposals for a recovery service that will bridge the gap between hospital and home for elderly people. I have no hope that the Government will accept our proposals, but I urge them to study them carefully during their leisure days. They will have plenty of them in opposition. We must stop the haemorrhaging of staff, particularly nurses, from the national health service.
  The Secretary of State said on the radio this morning that the national health service can never be perfect. Perhaps that is the standard that Conservative Members are prepared to settle for. The achievements are great, but they are great despite the Government rather than because of them.
  For the sake of staff and patients, we have attempted in this debate to puncture the Government's complacency and provide a glimpse of the difficult reality being faced by our hospitals throughout the country, but we have no hope that the Government will listen, and act on what they have heard. Rebuilding the national health service will come with a Labour Government after the next election.
  9.40 pm
  The Minister for Health (Mr. Gerald Malone): General elections are won on substance and there has been no substance from the Labour party on what will be one of the key battlegrounds of the general election whenever

  827
  it comes. Early in her speech, the hon. Member for Dulwich (Ms Jowell) mentioned co-operation, not competition. That is the only policy that the Labour party has to offer for health. It is a cliché, a mere slogan, which is as meaningless as the social contract of the 1970s. Anybody involved in the health service will understand that that is so.
  Many hon. Members have participated in the debate and I should like to deal with the detailed points they raised. The hon. Member for Birmingham, Northfield (Mr. Burden) was concerned about the Longbridge primary care centre in his constituency. Approval for funding of £2.5 million for that centre has now been forthcoming and we are awaiting planning permission, which is being sought. I hope that there will be rapid progress.
  Mr. Burden rose—
  Mr. Malone: If the hon. Gentleman does not mind, I will not give way, because I want to respond to all the points raised rather than enter into a debate on each of them.
  My hon. Friend the Member for Broxbourne (Mrs. Roe) spoke wisely and with care about the real world of the health service as she has experienced it in her constituency. Not for her the single unsubstantiated allegation: she had gone to considerable effort to find out what was going on in the hospitals in her constituency this winter of difficult pressure.
  What my hon. Friend told the House was probably typical of what is happening in many hospitals. She said that there was an excellent spirit among the staff and that many of them returned to work during periods of leave when other staff were ill. She talked about positive management of the problems in hospitals, with team work helping to solve the problems that many of them face when there is increased pressure, which we concede has occurred during this winter.
  The hon. Member for Southwark and Bermondsey (Mr. Hughes) introduced what I thought was an interesting approach, and the House may agree. He wanted to take politics out of the NHS. Whenever we hear that from a Liberal Democrat spokesman, we look to our constituencies to see whether the party is taking politics out of the NHS there. I thoroughly agree that the NHS should not be the political football that the Labour party tries to make it, but admonitions from the hon. Gentleman suggesting that we need a system of independent statistics, to be set up in a way that he did not entirely explain, are bizarre.
  My hon. Friends will be aware of the tactics of Liberal Democrats in their constituencies when it comes to presenting statistics. We have nearly all been subject to spoof surveys issued by the Liberal Democrats' campaigning department, announcing what the results of the survey should be before it has been carried out. At least I accept that the hon. Member for Dulwich probably made some telephone calls before she reached her conclusions. The party of the hon. Member for Southwark and Bermondsey does not even bother to do that.
  I can also tell the hon. Gentleman that, if we are to hear any lessons about playing fair with the health service, perhaps he or those responsible for his party's operations will stop parliamentary candidates across the country
  828
  setting up false stories so that they can simply knock them down. I had an example of that in my constituency this week. The prospective Liberal parliamentary candidate set up a story about a closure, which was a complete myth and was not even being suggested. He then said that he would be the saviour to step in and solve the problem. It was all bogus. We need no lessons from the hon. Member for Southwark and Bermondsey about independent statistics of that kind.
  My hon. Friend the Member for Wycombe (Sir R. Whitney) was right to remind us of the history of the national health service and how far its roots go back beyond 1947–48. In an excellent speech, he made it perfectly clear that, as a Government, we had custody over these matters before the inception of the NHS, which has developed in our hands for far longer than it has been in the hands of the Labour party.
  The hon. Member for Morley and Leeds, South (Mr. Gunnell) seemed to support the spending plans of the British Medical Association. I hope that he has got that message through to his Front-Bench team. Many Opposition Members were keen to support every suggestion that extra spending should take place in the NHS—that was a common theme of the debate. I suggest that all those Opposition Members look to their Front-Bench spokesmen to find out whether the commitments that they expect to be honoured if Labour were ever elected would be honoured. On the basis of the stated policy of the Labour Front-Bench team, that would not happen.
  The hon. Member for Morley and Leeds, South also referred to private finance initiative schemes. I can confirm that 32 schemes have been completed, at a value of £78.6 million. In spite of what the hon. Member for City of Durham (Mr. Steinberg) may have asked for in the Library, if the Library does not have the information, I will undertake to put it there.
  I hope that Opposition Members understand that the shilly-shallying of Opposition Front Benchers about their proposals for the PFI damages the prospects of building hospitals and facilities in each and every one of their constituencies.
  My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) said something important about the changed structure of the NHS, which the Opposition are criticising. She said that our reforms have given us some facts about costs, so we have been able to save money. Labour has consistently voted against that. My hon. Friend is right to remind us of that fact; when the Labour party says, "Co-operation, not competition," and says that it believes in the purchaser-provider split, but not in the internal market, it is saying that it wants to avoid all the difficult decisions that have to be taken in health care if one is going to drive better-quality health care out of the system for every pound of the taxpayer's money. The two go hand in hand. Ask anyone in the national health service if that can be done entirely comfortably and one will be told that Labour's policies are an Alice-in-Wonderland world.
  The hon. Member for Warrington, South (Mr. Hall) asked about intensive care facilities. I can give him the figures for the north-west region, where 20 additional intensive care beds have opened in the past 18 months, bringing the regional total to 204. Six have been

  829
  commissioned this month. These have been funded from national challenge moneys announced by my right hon. Friend the Secretary of State just before the end of the year.
  Mr. Hall: Will the Minister give way?
  Mr. Malone: I have already said that I do not intend to give way. My right hon. Friend the Secretary of State made it clear that that was part of an important strategy that he had put in place to tackle the winter problems that we knew we would be facing, and that is working extremely well.
  In addition, nine extra high-dependency beds have been opened this month, a further 11 are funded to open in the year beginning April 1997 and an additional intensive care bed is to open in Warrington general hospital in April, following discussions between the Warrington Hospital NHS trust and North Cheshire health authority. I hoped that the hon. Gentleman would welcome that improvement in facilities in the area that he serves as a Member of Parliament.
  Mr. Hall: On a point of order, Mr. Deputy Speaker. In my speech, I recognised the fact that that extra bed was being provided and it is wrong for the Minister to suggest that I did not do so.
  Mr. Deputy Speaker (Mr. Michael Morris): Order. That is not a matter for the Chair.
  Mr. Malone: My hon. Friend the Member for Carshalton and Wallington (Mr. Forman) listed the achievements of the health service in his area. As he and I both know, that is a hard-pressed area for the health service in south London. I want to respond to his points.
  With changes in the health service, when a reordering of services is needed to meet new clinical demands and needs, there will always be an on-going debate about the right balance of provision. I assure my hon. Friend that there is no suggestion that the Government are following a rigid template towards a conclusion. Of course, as change takes place we consider its effect on individual services; the provision of a higher-quality service is the watchword that governs those developments.
  My hon. Friend also made a specific point about the chronically sick. He may care to note two points in that regard. First, the general improvements in primary care facilities in London as a whole, funded through the London implementation zone, are certainly helping to deal with the chronically sick. Secondly, my hon. Friend will understand and acknowledge that the National Health Service (Primary Care) Bill, currently in another place and shortly to come to the House, provides excellent opportunities for primary carers to do exactly as he suggested, and bring together innovative services to deal with special problems such as the chronically sick.
  The hon. Member for Belfast, South (Rev. Martin Smyth) made several points, many of which centred on funding. I shall ensure that his other points are drawn to the attention of my right hon. and learned Friend the Secretary of State for Northern Ireland, but I want to respond to some of the funding points now. For 1997–98, £1.642 billion has been made available for health and
  830
  personal social services, providing an extra £56 million over the previous year. The hon. Gentleman may need to argue out the figures at a later stage, but I did not entirely recognise his interpretation, because they represent a 3.5 per cent. cash increase and a 1.5 per cent. increase allowing for inflation.
  The hon. Gentleman mentioned the comparison between Northern Ireland and the rest of the United Kingdom—and England in particular. We are spending about 15 per cent. more per capita on health and social care in Northern Ireland than in England. There have been various difficulties, not least in the present year, but the figures speak for themselves and reaffirm the Government's intention to continue to honour our commitment to the health service, despite adverse circumstances.
  My hon. Friend the Member for High Peak (Mr. Hendry) spoke about fundholding. He was right to speak of the benefits of a system that the Labour party would simply sweep away. I am delighted to endorse what he said. As he pointed out, I visited his constituency on one or two occasions, and I have seen the innovations that are taking place there, not least the modern cottage hospitals that are often manned by primary carers.
  The general practitioners' plans about which my hon. Friend spoke cannot be stifled by the Labour party—particularly because that party will never get into government—or by health authorities, because if, after the National Health Service (Primary Care) Bill becomes law, GPs propose plans to rearrange primary care services in my hon. Friend's constituency, there will be an automatic right to bring them to the Secretary of State for approval as pilots.
  The hon. Member for Nottingham, East (Mr. Heppell) spoke about his constituents and funding. As I pointed out during the hon. Gentleman's speech, following three bids for special national funding, Nottingham health authority has been funded very generously in real terms for next year, receiving £500,000 of extra funding.
  My hon. Friend the Member for Eastbourne (Mr. Waterson)—until recently my parliamentary private secretary, but now able to participate in these debates—pointed out that in his constituency there are pilots in purchasing that he knows would be abolished by a Labour Government. He was right to point that out, because those pilots are providing great benefits for his constituents.
  The hon. Member for City of Durham asked about the trust business case. I can confirm that it was received by the NHS executive headquarters and by Her Majesty's Treasury in December 1996, and I hope that a decision to approve the full business case will be taken shortly. It is more likely to proceed with his active support than with the denigration that he tended to bring to the issue during the debate.
  My hon. Friend the Member for Beckenham (Mr. Merchant) rightly pointed out that the Opposition were luxuriating in an idea of crisis. That was characteristic of their speeches, especially those of their Front-Bench spokesmen, which were devoid of policy content. My hon. Friend rightly pointed to good management initiatives in his constituency that were managing the pressure.
  I shall ensure that the speech of the hon. Member for Ceredigion and Pembroke, North (Mr. Dafis) is drawn to the attention of my right hon. Friend the Secretary of State for Wales.

  831
  Not only the House but the country could reasonably have expected to hear in this debate what the Labour party would seriously propose for the health service in the coming general election campaign. The truth is that nobody now believes the Labour party on health. To every interest group, it peddles high expectations that are shot down by the right hon. Member for Dunfermline, East (Mr. Brown). Even when the hon. Member for Islington, South and Finsbury (Mr. Smith) dines with the private sector, no new treatment that is canvassed is entirely ruled out. He nods his head and says that all is possible. He and other Labour spokesmen dine with the private sector to give it false assurances that Labour would be no threat.
  I understand that the private sector has invested a considerable amount in Labour's shadow health team over the past two years. Just as one team goes out the door after pudding, a new one comes in for the first course of the next meal. In spite of all that, no one believes that the hon. Member for Islington, South and Finsbury will deliver. Every solution to the problems of the NHS suggested by Opposition Members in this debate has implied more cash, which Labour is not prepared to pledge.
  Labour has made one firm pledge, which was alluded to by my hon. Friends. It pledged to abolish GP fundholding, but it could not even get that right. That policy is Labour's two-card trick. On almost the same day, Labour managed to get two headlines: "Labour set to scrap fundholding" in The Independent, and in Doctor magazine, "Labour promises to retain fundholding".
  On NHS savings, which will be the sole visible means of support for the health service under a Labour Government, we hear a variety of things. We hear that the savings will be £100 million and that it will all come from bureaucracy—but from where? Will it be health authorities, trusts, GP practices, or practice managers? Again, part of the problem is that it is a two-faced policy. A headline in This Week said, "Managers will not lose jobs in £100 million drive says Smith". The head of Unison, Bob Abberley, said that he was pleased about Labour's move away from attacking NHS managers. However, today Labour has attacked people who do a first-class job of delivering quality care in the NHS—and delivering it in a way that Labour would never have thought possible.
  We heard nothing of some of the plans that Labour used to trumpet. It used to talk about using part of the £100 million savings to reduce waiting times for cancer surgery. A British Medical Association spokesman—Labour is usually keen to talk about such people—said that cancer surgery was usually done pretty promptly and that it was not helpful to set zero waiting lists. A simple matter of its declared policy has turned out to be an own goal for Labour.
  At the centre of the debate lies the question of resources. Everyone in the health service understands that, although we can secure increased efficiency year on year, it is the commitment of the Government through our lifetime and beyond into the next Parliament to sustain spending on the NHS in real terms that is at the core of how our health service will grow. Labour's Front-Bench spokesmen have not yet matched the Prime Minister's pledge to increase spending on health during the next Conservative Government year on year on year.
  832
  I can tell the hon. Member for Islington, South and Finsbury that no Labour delegation that has come to my office has not sought resources even greater than those that we are spending. The implication of every speech of Opposition Members has been that the Opposition will be satisfied only with far more spending. When the right hon. Member for Dunfermline, East issues his strictures, he should look to the party behind him. There, every single one of them sits, political eunuchs one and all—all their spending parts neatly snipped away from them by the right hon. Gentleman. In a secret meeting at the weekend, the hon. Member for Islington, South and Finsbury was not part of the magic circle.
  Mr. Kevin Hughes: (Doncaster, North) rose in his place and claimed to move, That the Question be now put.
  Question, That the Question be now put, put and agreed to.
  Question put accordingly, That the original words stand part of the Question:—
  The House divided: Ayes 312, Noes 319.

  Division No. 47]

  [10 pm

  AYES

  Abbott, Ms Diane

  Cann, Jamie

  Adams, Mrs Irene

  Carlile, Alex (Montgomery)

  Ainger, Nick

  Chidgey, David

  Ainsworth, Robert (Cov'ty NE)

  Chisholm, Malcolm

  Allen, Graham

  Church, Ms Judith

  Alton, David

  Clapham, Michael

  Anderson, Donald (Swansea E)

  Clark, Dr David (S Shields)

  Anderson, Ms Janet (Ros'dale)

  Clarke, Tom (Monklands W)

  Armstrong, Ms Hilary

  Clelland, David

  Ashdown, Paddy

  Clwyd, Mrs Ann

  Ashton, Joseph

  Coffey, Ms Ann

  Austin-Walker, John

  Cohen, Harry

  Banks, Tony (Newham NW)

  Connarty, Michael

  Barnes, Harry

  Cook, Frank (Stockton N)

  Barron, Kevin

  Cook, Robin (Livingston)

  Battle, John

  Corbett, Robin

  Bayley, Hugh

  Corbyn, Jeremy

  Beckett, Mrs Margaret

  Corston, Ms Jean

  Beggs, Roy

  Cousins, Jim

  Beith, A J

  Cox, Tom

  Bell, Stuart

  Cummings, John

  Benn, Tony

  Cunliffe, Lawrence

  Bennett, Andrew F

  Cunningham, Jim (Cov'try SE)

  Bermingham, Gerald

  Cunningham, Dr John

  Berry, Roger

  Cunningham, Ms R (Perth Kinross)

  Betts, Clive

  Dafis, Cynog

  Blair, Tony

  Dalyell, Tam

  Blunkett, David

  Darling, Alistair

  Boateng, Paul

  Davidson, Ian

  Boyes, Roland

  Davies, Bryan (Oldham C)

  Bradley, Keith

  Davies, Chris (Littleborough)

  Bray, Dr Jeremy

  Davies, Denzil (Llanelli)

  Brown, Gordon (Dunfermline E)

  Davies, Ron (Caerphilly)

  Brown, Nicholas (Newcastle E)

  Davis, Terry (B'ham Hodge H)

  Bruce, Malcolm (Gordon)

  Denham, John

  Burden, Richard

  Dewar, Donald

  Byers, Stephen

  Dixon, Don

  Caborn, Richard

  Dobson, Frank

  Callaghan, Jim

  Donohoe, Brian H

  Campbell, Mrs Anne (C'bridge)

  Dowd, Jim

  Campbell, Menzies (Fife NE)

  Dunnachie, Jimmy

  Campbell, Ronnie (Blyth V)

  Dunwoody, Mrs Gwyneth

  Campbell-Savours, D N

  Eagle, Ms Angela

  Canavan, Dennis

  Eastham, Ken

  833

  Ennis, Jeff

  Kennedy, Mrs Jane (Broadgreen)

  Etherington, Bill

  Khabra, Piara S

  Evans, John (St Helens N)

  Kilfoyle, Peter

  Ewing, Mrs Margaret

  Kirkwood, Archy

  Fatchett, Derek

  Lestor, Miss Joan (Eccles)

  Faulds, Andrew

  Lewis, Terry

  Field, Frank (Birkenhead)

  Liddell, Mrs Helen

  Fisher, Mark

  Litherland, Robert

  Flynn, Paul

  Livingstone, Ken

  Forsythe, Clifford (S Antrim)

  Lloyd, Tony (Stretf'd)

  Foster, Derek

  Llwyd, Elfyn

  Foster, Don (Bath)

  Loyden, Eddie

  Foulkes, George

  Lynne, Ms Liz

  Fraser, John

  McAllion, John

  Fyfe, Mrs Maria

  McAvoy, Thomas

  Galloway, George

  McCartney, Ian (Makerf'ld)

  Gapes, Mike

  McCartney, Robert (N Down)

  Garrett, John

  McCrea, Rev William

  George, Bruce

  Macdonald, Calum

  Gerrard, Neil

  McFall, John

  Gilbert, Dr John

  McGrady, Eddie

  Godman, Dr Norman A

  McKelvey, William

  Godsiff, Roger

  Mackinlay, Andrew

  Golding, Mrs Llin

  McLeish, Henry

  Gordon, Ms Mildred

  Maclennan, Robert

  Graham, Thomas

  McMaster, Gordon

  Grant, Bernie (Tottenham)

  McNamara, Kevin

  Griffiths, Nigel (Edinburgh S)

  MacShane, Denis

  Griffiths, Win (Bridgend)

  McWilliam, John

  Grocott, Bruce

  Maddock, Mrs Diana

  Gunnell, John

  Mahon, Mrs Alice

  Hain, Peter

  Mallon, Seamus

  Hall, Mike

  Mandelson, Peter

  Hanson, David

  Marek, Dr John

  Hardy, Peter

  Marshall, David (Shettleston)

  Harman, Ms Harriet

  Marshall, Jim (Leicester S)

  Harvey, Nick

  Martin, Michael J (Springburn)

  Hattersley, Roy

  Martlew, Eric

  Henderson, Doug

  Maxton, John

  Hendron, Dr Joe

  Meacher, Michael

  Heppell, John

  Meale, Alan

  Hill, Keith (Streatham)

  Michael, Alun

  Hinchliffe, David

  Michie, Bill (Shef'ld Heeley)

  Hodge, Ms Margaret

  Michie, Mrs Ray (Argyll Bute)

  Hoey, Kate

  Milburn, Alan

  Hogg, Norman (Cumbernauld)

  Miller, Andrew

  Home Robertson, John

  Mitchell, Austin (Gt Grimsby)

  Hood, Jimmy

  Moonie, Dr Lewis

  Hoon, Geoffrey

  Morgan, Rhodri

  Howarth, Alan (Stratf'd-on-A)

  Morley, Elliot

  Howarth, George (Knowsley N)

  Morris, Alfred (Wy'nshawe)

  Howells, Dr Kim

  Morris, Ms Estelle (B'ham Yardley)

  Hoyle, Doug

  Morris, John (Aberavon)

  Hughes, Kevin (Doncaster N)

  Mowlam, Ms Marjorie

  Hughes, Robert (Ab'd'n N)

  Mudie, George

  Hughes, Roy (Newport E)

  Mullin, Chris

  Hughes, Simon (Southwark)

  Murphy, Paul

  Hume, John

  Nicholson, Miss Emma (W Devon)

  Hutton, John

  Oakes, Gordon

  Illsley, Eric

  O'Brien, Mike (N Warks)

  Ingram, Adam

  O'Brien, William (Normanton)

  Jackson, Ms Glenda (Hampst'd)

  O'Hara, Edward

  Jackson, Mrs Helen (Hillsborough)

  Olner, Bill

  Jamieson, David

  O'Neill, Martin

  Janner, Greville

  Orme, Stanley

  Jenkins, Brian D (SE Staffs)

  Paisley, Rev Ian

  Johnston, Sir Russell

  Pearson, Ian

  Jones, Barry (Alyn & D'side)

  Pendry, Tom

  Jones, leuan Wyn (Ynys Môn)

  Pickthall, Colin

  Jones, Dr L (B'ham Selly Oak)

  Pike, Peter L

  Jones, Martyn (Clwyd SW)

  Pope, Greg

  Jones, Nigel (Cheltenham)

  Powell, Sir Raymond (Ogmore)

  Jowell, Ms Tessa

  Prentice, Mrs B (Lewisham E)

  Kaufman, Gerald

  Prentice, Gordon (Pendle)

  Keen, Alan

  Prescott, John

  Kennedy, Charles (Ross C & S)

  Primarolo, Ms Dawn

  834

  Purchase, Ken

  Strang, Dr Gavin

  Quin, Ms Joyce

  Straw, Jack

  Radice, Giles

  Sutcliffe, Gerry

  Randall, Stuart

  Taylor, Mrs Ann (Dewsbury)

  Raynsford, Nick

  Taylor, John D (Strangf'd)

  Reid, Dr John

  Taylor, Matthew (Truro)

  Rendel, David

  Thompson, Jack (Wansbeck)

  Robertson, George (Hamilton)

  Thurnham, Peter

  Robinson, Geoffrey (Cov'try NW)

  Timms, Stephen

  Robinson, Peter (Belfast E)

  Tipping, Paddy

  Roche, Mrs Barbara

  Touhig, Don

  Rogers, Allan

  Trickett, Jon

  Rooker, Jeff

  Trimble, David

  Rooney, Terry

  Turner, Dennis

  Ross, Ernie (Dundee W)

  Tyler, Paul

  Rowlands, Ted

  Vaz, Keith

  Ruddock, Ms Joan

  Walker, Sir Harold

  Salmond, Alex

  Wallace, James

  Sedgemore, Brian

  Walley, Ms Joan

  Sheerman, Barry

  Wardell, Gareth (Gower)

  Sheldon, Robert

  Wareing, Robert N

  Shore, Peter

  Watson, Mike

  Short, Clare

  Welsh, Andrew

  Simpson, Alan

  Wicks, Malcolm

  Skinner, Dennis

  Wigley, Dafydd

  Smith, Andrew (Oxford E)

  Williams, Alan (Swansea W)

  Smith, Chris (Islington S)

  Williams, Alan W (Carmarthen)

  Smith, Llew (Blaenau Gwent)

  Wilson, Brian

  Smyth, Rev Martin (Belfast S)

  Winnick, David

  Snape, Peter

  Wise, Mrs Audrey

  Soley, Clive

  Worthington, Tony

  Spearing, Nigel

  Wray, Jimmy

  Spellar, John

  Wright, Dr Tony

  Squire, Ms R (Dunfermline W)

  Young, David (Bolton SE)

  Steel, Sir David

  Steinberg, Gerry

  Tellers for the Ayes:

  Stevenson, George

  Mr. Eric Clarke and

  Stott, Roger

  Mr. Joe Benton.

  NOES

  Ainsworth, Peter (E Surrey)

  Brazier, Julian

  Aitken, Jonathan

  Bright, Sir Graham

  Alexander, Richard

  Brooke, Peter

  Alison, Michael (Selby)

  Brown, Michael (Brigg Cl'thorpes)

  Allason, Rupert (Torbay)

  Browning, Mrs Angela

  Amess, David

  Bruce, Ian (S Dorset)

  Ancram, Michael

  Budgen, Nicholas

  Arbuthnot, James

  Burns, Simon

  Arnold, Jacques (Gravesham)

  Burt, Alistair

  Arnold, Sir Thomas (Hazel G)

  Butcher, John

  Ashby, David

  Butler, Peter

  Aspinwall, Jack

  Butterfill, John

  Atkins, Robert

  Carlisle, John (Luton N)

  Atkinson, David (Bour'mth E)

  Carlisle, Sir Kenneth (Linc'n)

  Atkinson, Peter (Hexham)

  Carrington, Matthew

  Baker, Kenneth (Mole V)

  Carttiss, Michael

  Baker, Sir Nicholas (N Dorset)

  Cash, William

  Baldry, Tony

  Channon, Paul

  Banks, Matthew (Southport)

  Chapman, Sir Sydney

  Banks, Robert (Harrogate)

  Churchill, Mr

  Bates, Michael

  Clappison, James

  Batiste, Spencer

  Clark, Dr Michael (Rochf'd)

  Bellingham, Henry

  Clarke, Kenneth (Rushcliffe)

  Bendall, Vivian

  Clifton-Brown, Geoffrey

  Beresford, Sir Paul

  Coe, Sebastian

  Biffen, John

  Colvin, Michael

  Body, Sir Richard

  Congdon, David

  Bonsor, Sir Nicholas

  Conway, Derek

  Booth, Hartley

  Coombs, Anthony (Wyre F)

  Boswell, Tim

  Coombs, Simon (Swindon)

  Bottomley, Peter (Eltham)

  Cope, Sir John

  Bottomley, Mrs Virginia

  Cormack, Sir Patrick

  Bowden, Sir Andrew

  Couchman, James

  Bowis, John

  Cran, James

  Boyson, Sir Rhodes

  Currie, Mrs Edwina

  Brandreth, Gyles

  Curry, David

  835

  Davies, Quentin (Stamf'd)

  Howard, Michael

  Davis, David (Boothferry)

  Howell, David (Guildf'd)

  Day, Stephen

  Howell, Sir Ralph (N Norfolk)

  Deva, Nirj Joseph

  Hughes, Robert G (Harrow W)

  Devlin, Tim

  Hunt, David (Wirral W)

  Dicks, Terry

  Hunt, Sir John (Ravensb'ne)

  Dorrell, Stephen

  Hunter, Andrew

  Douglas-Hamilton, Lord James

  Hurd, Douglas

  Dover, Den

  Jack, Michael

  Duncan, Alan

  Jackson, Robert (Wantage)

  Duncan Smith, Iain

  Jenkin, Bernard (Colchester N)

  Dunn, Bob

  Jessel, Toby

  Durant, Sir Anthony

  Johnson Smith, Sir Geoffrey

  Dykes, Hugh

  Jones, Gwilym (Cardiff N)

  Eggar, Tim

  Jones, Robert B (W Herts)

  Elletson, Harold

  Jopling, Michael

  Emery, Sir Peter

  Kellett-Bowman, Dame Elaine

  Evans, David (Welwyn Hatf'd)

  Key, Robert

  Evans, Jonathan (Brecon)

  King, Tom

  Evans, Nigel (Ribble V)

  Kirkhope, Timothy

  Evans, Roger (Monmouth)

  Knapman, Roger

  Evennett, David

  Knight, Mrs Angela (Erewash)

  Faber, David

  Knight, Greg (Derby N)

  Fabricant, Michael

  Knight, Dame Jill (Edgbaston)

  Fenner, Dame Peggy

  Knox, Sir David

  Field, Barry (Isle of Wight)

  Kynoch, George

  Fishburn, Dudley

  Lait, Mrs Jacqui

  Forman, Nigel

  Lamont, Norman

  Forsyth, Michael (Stirling)

  Lang, Ian

  Forth, Eric

  Lawrence, Sir Ivan

  Fowler, Sir Norman

  Legg, Barry

  Fox, Dr Liam (Woodspring)

  Leigh, Edward

  Fox, Sir Marcus (Shipley)

  Lennox-Boyd, Sir Mark

  Freeman, Roger

  Lester, Sir Jim (Broxtowe)

  French, Douglas

  Lidington, David

  Fry, Sir Peter

  Lilley, Peter

  Gale, Roger

  Lloyd, Sir Peter (Fareham)

  Gallie, Phil

  Lord, Michael

  Gardiner, Sir George

  Luff, Peter

  Garel-Jones, Tristan

  Lyell, Sir Nicholas

  Garnier, Edward

  MacGregor, John

  Gill, Christopher

  MacKay, Andrew

  Gillan, Mrs Cheryl

  Maclean, David

  Goodlad, Alastair

  McNair-Wilson, Sir Patrick

  Goodson-Wickes, Dr Charles

  Madel, Sir David

  Gorman, Mrs Teresa

  Maitland, Lady Olga

  Gorst, Sir John

  Major, John

  Grant, Sir Anthony (SW Cambs)

  Malone, Gerald

  Greenway, Harry (Ealing N)

  Mans, Keith

  Greenway, John (Ryedale)

  Marland, Paul

  Griffiths, Peter (Portsmouth N)

  Marlow, Tony

  Grylls, Sir Michael

  Marshall, John (Hendon S)

  Gummer, John

  Marshall, Sir Michael (Arundel)

  Hague, William

  Martin, David (Portsmouth S)

  Hamilton, Sir Archibald

  Mates, Michael

  Hamilton, Neil (Tatton)

  Mawhinney, Dr Brian

  Hampson, Dr Keith

  Mayhew, Sir Patrick

  Hanley, Jeremy

  Mellor, David

  Hannam, Sir John

  Merchant, Piers

  Hargreaves, Andrew

  Mitchell, Andrew (Gedling)

  Harris, David

  Mitchell, Sir David (NW Hants)

  Haselhurst, Sir Alan

  Moate, Sir Roger

  Hawkins, Nick

  Monro, Sir Hector

  Hawksley, Warren

  Montgomery, Sir Fergus

  Hayes, Jerry

  Moss, Malcolm

  Heald, Oliver

  Needham, Richard

  Heath, Sir Edward

  Nelson, Anthony

  Heathcoat-Amory, David

  Neubert, Sir Michael

  Hendry, Charles

  Newton, Tony

  Heseltine, Michael

  Nicholls, Patrick

  Hicks, Sir Robert

  Nicholson, David (Taunton)

  Higgins, Sir Terence

  Norris, Steve

  Hill, Sir James (Southampton Test)

  Onslow, Sir Cranley

  Hogg, Douglas (Grantham)

  Oppenheim, Phillip

  Horam, John

  Ottaway, Richard

  Hordern, Sir Peter

  Page, Richard

  836

  Paice, James

  Stewart, Allan

  Patnick, Sir Irvine

  Streeter, Gary

  Patten, John

  Sumberg, David

  Pattie, Sir Geoffrey

  Sweeney, Walter

  Pawsey, James

  Sykes, John

  Peacock, Mrs Elizabeth

  Tapsell, Sir Peter

  Pickles, Eric

  Taylor, Ian (Esher)

  Porter, David

  Taylor, John M (Solihull)

  Portillo, Michael

  Taylor, Sir Teddy

  Powell, William (Corby)

  Temple-Morris, Peter

  Rathbone, Tim

  Thomason, Roy

  Redwood, John

  Thompson, Sir Donald (Calder V)

  Renton, Tim

  Thompson, Patrick (Norwich N)

  Richards, Rod

  Thornton, Sir Malcolm

  Riddick, Graham

  Townend, John (Bridlington)

  Rifkind, Malcolm

  Townsend, Sir Cyril (Bexl'yh'th)

  Robathan, Andrew

  Tracey, Richard

  Roberts, Sir Wyn

  Tredinnick, David

  Robertson, Raymond S (Ab'd'n S)

  Trend, Michael

  Robinson, Mark (Somerton)

  Trotter, Neville

  Roe, Mrs Marion

  Twinn, Dr Ian

  Rowe, Andrew

  Vaughan, Sir Gerard

  Rumbold, Dame Angela

  Viggers, Peter

  Ryder, Richard

  Waldegrave, William

  Sackville, Tom

  Walden, George

  Sainsbury, Sir Timothy

  Walker, Bill (N Tayside)

  Scott, Sir Nicholas

  Waller, Gary

  Shaw, David (Dover)

  Ward, John

  Shaw, Sir Giles (Pudsey)

  Wardle, Charles (Bexhill)

  Shephard, Mrs Gillian

  Waterson, Nigel

  Shepherd, Sir Colin (Heref'd)

  Watts, John

  Shepherd, Richard (Aldridge)

  Wells, Bowen

  Shersby, Sir Michael

  Wheeler, Sir John

  Sims, Sir Roger

  Whitney, Sir Raymond

  Skeet, Sir Trevor

  Whittingdale, John

  Smith, Sir Dudley (Warwick)

  Widdecombe, Miss Ann

  Smith, Tim (Beaconsf'ld)

  Wiggin, Sir Jerry

  Soames, Nicholas

  Wilkinson, John

  Speed, Sir Keith

  Willetts, David

  Spencer, Sir Derek

  Wilshire, David

  Spicer, Sir Jim (W Dorset)

  Winterton, Mrs Ann (Congleton)

  Spicer, Sir Michael (S Worcs)

  Winterton, Nicholas (Macclesf'ld)

  Spink, Dr Robert

  Wolfson, Mark

  Spring, Richard

  Yeo, Tim

  Sproat, Iain

  Young, Sir George

  Squire, Robin (Hornchurch)

  Stanley, Sir John

  Tellers for the Noes:

  Steen, Anthony

  Mr. Patrick McLoughlin

  Stephen, Michael

  and

  Stern, Michael

  Mr. Timothy Wood.

  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 319, Noes 312.

  Division No. 48]

  [10.16 pm

  AYES

  Ainsworth, Peter (E Surrey)

  Atkinson, Peter (Hexham)

  Aitken, Jonathan

  Baker, Kenneth (Mole V)

  Alexander, Richard

  Baker, Sir Nicholas (N Dorset)

  Alison, Michael (Selby)

  Baldry, Tony

  Allason, Rupert (Torbay)

  Banks, Matthew (Southport)

  Amess, David

  Banks, Robert (Harrogate)

  Ancram, Michael

  Bates, Michael

  Arbuthnot, James

  Batiste, Spencer

  Arnold, Jacques (Gravesham)

  Bellingham, Henry

  Arnold, Sir Thomas (Hazel G)

  Bendall, Vivian

  Ashby, David

  Beresford, Sir Paul

  Aspinwall, Jack

  Biffen, John

  Atkins, Robert

  Body, Sir Richard

  Atkinson, David (Bour'mth E)

  Bonsor, Sir Nicholas

  837

  Booth, Hartley

  Fox, Sir Marcus (Shipley)

  Boswell, Tim

  Freeman, Roger

  Bottomley, Peter (Eltham)

  French, Douglas

  Bottomley, Mrs Virginia

  Fry, Sir Peter

  Bowden, Sir Andrew

  Gale, Roger

  Bowis, John

  Gallie, Phil

  Boyson, Sir Rhodes

  Gardiner, Sir George

  Brandreth, Gyles

  Garel-Jones, Tristan

  Brazier, Julian

  Garnier, Edward

  Bright, Sir Graham

  Gill, Christopher

  Brooke, Peter

  Gillan, Mrs Cheryl

  Brown, Michael (Brigg Cl'thorpes)

  Goodlad, Alastair

  Browning, Mrs Angela

  Goodson-Wickes, Dr Charles

  Bruce, Ian (S Dorset)

  Gorman, Mrs Teresa

  Budgen, Nicholas

  Gorst, Sir John

  Burns, Simon

  Grant, Sir Anthony (SW Cambs)

  Burt, Alistair

  Greenway, Harry (Ealing N)

  Butcher, John

  Greenway, John (Ryedale)

  Butler, Peter

  Griffiths, Peter (Portsmouth N)

  Butterfill, John

  Grylls, Sir Michael

  Carlisle, John (Luton N)

  Gummer, John

  Carlisle, Sir Kenneth (Linc'n)

  Hague, William

  Carrington, Matthew

  Hamilton, Sir Archibald

  Carttiss, Michael

  Hamilton, Neil (Tatton)

  Cash, William

  Hampson, Dr Keith

  Channon, Paul

  Hanley, Jeremy

  Chapman, Sir Sydney

  Hannam, Sir John

  Churchill, Mr

  Hargreaves, Andrew

  Clappison, James

  Harris, David

  Clark, Dr Michael (Rochf'd)

  Haselhurst, Sir Alan

  Clarke, Kenneth (Rushcliffe)

  Hawkins, Nick

  Clifton-Brown, Geoffrey

  Hawksley, Warren

  Coe, Sebastian

  Hayes, Jerry

  Colvin, Michael

  Heald, Oliver

  Congdon, David

  Heath, Sir Edward

  Conway, Derek

  Heathcoat-Amory, David

  Coombs, Anthony (Wyre F)

  Hendry, Charles

  Coombs, Simon (Swindon)

  Heseltine, Michael

  Cope, Sir John

  Hicks, Sir Robert

  Cormack, Sir Patrick

  Higgins, Sir Terence

  Couchman, James

  Hill, Sir James (Southampton Test)

  Cran, James

  Hogg, Douglas (Grantham)

  Currie, Mrs Edwina

  Horam, John

  Curry, David

  Hordern, Sir Peter

  Davies, Quentin (Stamf'd)

  Howard, Michael

  Davis, David (Boothferry)

  Howell, David (Guildf'd)

  Day, Stephen

  Howell, Sir Ralph (N Norfolk)

  Deva, Nirj Joseph

  Hughes, Robert G (Harrow W)

  Devlin, Tim

  Hunt, David (Wirral W)

  Dicks, Terry

  Hunt, Sir John (Ravensb'ne)

  Dorrell, Stephen

  Hunter, Andrew

  Douglas-Hamilton, Lord James

  Hurd, Douglas

  Dover, Den

  Jack, Michael

  Duncan, Alan

  Jackson, Robert (Wantage)

  Duncan Smith, Iain

  Jenkin, Bernard (Colchester N)

  Dunn, Bob

  Jessel, Toby

  Durant, Sir Anthony

  Johnson Smith, Sir Geoffrey

  Dykes, Hugh

  Jones, Gwilym (Cardiff N)

  Eggar, Tim

  Jones, Robert B (W Herts)

  Elletson, Harold

  Jopling, Michael

  Emery, Sir Peter

  Kellett-Bowman, Dame Elaine

  Evans, David (Welwyn Hatf'ld)

  Key, Robert

  Evans, Jonathan (Brecon)

  King, Tom

  Evans, Nigel (Ribble V)

  Kirkhope, Timothy

  Evans, Roger (Monmouth)

  Knapman, Roger

  Evennett, David

  Knight, Mrs Angela (Erewash)

  Faber, David

  Knight, Greg (Derby N)

  Fabricant, Michael

  Knight, Dame Jill (Edgbaston)

  Fenner, Dame Peggy

  Knox, Sir David

  Field, Barry (Isle of Wight)

  Kynoch, George

  Fishburn, Dudley

  Lait, Mrs Jacqui

  Forman, Nigel

  Lamont, Norman

  Forsyth, Michael (Stirling)

  Lang, Ian

  Forth, Eric

  Lawrence, Sir Ivan

  Fowler, Sir Norman

  Legg, Barry

  Fox, Dr Liam (Woodspring)

  Leigh, Edward

  838

  Lennox-Boyd, Sir Mark

  Shaw, Sir Giles (Pudsey)

  Lester, Sir Jim (Broxtowe)

  Shephard, Mrs Gillian

  Lidington, David

  Shepherd, Sir Colin (Heref'd)

  Lilley, Peter

  Shepherd, Richard (Aldridge)

  Lloyd, Sir Peter (Fareham)

  Shersby, Sir Michael

  Lord, Michael

  Sims, Sir Roger

  Luff, Peter

  Skeet, Sir Trevor

  Lyell, Sir Nicholas

  Smith, Sir Dudley (Warwick)

  MacGregor, John

  Smith, Tim (Beaconsf'ld)

  MacKay, Andrew

  Soames, Nicholas

  Maclean, David

  Speed, Sir Keith

  McNair-Wilson, Sir Patrick

  Spencer, Sir Derek

  Madel, Sir David

  Spicer, Sir Jim (W Dorset)

  Maitland, Lady Olga

  Spicer, Sir Michael (S Worcs)

  Major, John

  Spink, Dr Robert

  Malone, Gerald

  Spring, Richard

  Mans, Keith

  Sproat, Iain

  Marland, Paul

  Squire, Robin (Hornchurch)

  Marlow, Tony

  Stanley, Sir John

  Marshall, John (Hendon S)

  Steen, Anthony

  Marshall, Sir Michael (Arundel)

  Stephen, Michael

  Martin, David (Portsmouth S)

  Stern, Michael

  Mates, Michael

  Stewart, Allan

  Mawhinney, Dr Brian

  Streeter, Gary

  Mayhew, Sir Patrick

  Sumberg, David

  Mellor, David

  Sweeney, Walter

  Merchant, Piers

  Sykes, John

  Mitchell, Andrew (Gedling)

  Tapsell, Sir Peter

  Mitchell, Sir David (NW Hants)

  Taylor, Ian (Esher)

  Moate, Sir Roger

  Taylor, John M (Solihull)

  Monro, Sir Hector

  Taylor, Sir Teddy

  Montgomery, Sir Fergus

  Temple-Morris, Peter

  Moss, Malcolm

  Thomason, Roy

  Needham, Richard

  Thompson, Sir Donald (Calder V)

  Nelson, Anthony

  Thompson, Patrick (Norwich N)

  Neubert, Sir Michael

  Thornton, Sir Malcolm

  Newton, Tony

  Townend, John (Bridlington)

  Nicholls, Patrick

  Townsend, Sir Cyril (Bexl'yh'th)

  Nicholson, David (Taunton)

  Tracey, Richard

  Norris, Steve

  Tredinnick, David

  Onslow, Sir Cranley

  Trend, Michael

  Oppenheim, Phillip

  Trotter, Neville

  Ottaway, Richard

  Twinn, Dr Ian

  Page, Richard

  Vaugnan, Sir Gerard

  Paice, James

  Viggers, Peter

  Patnick, Sir Irvine

  Waldegrave, William

  Patten, John

  Walden, George

  Pattie, Sir Geoffrey

  Walker, Bill (N Tayside)

  Pawsey, James

  Waller, Gary

  Peacock, Mrs Elizabeth

  Ward, John

  Pickles, Eric

  Wardle, Charles (Bexhill)

  Porter, David

  Waterson, Nigel

  Portillo, Michael

  Watts, John

  Powell, William (Corby)

  Wells, Bowen

  Rathbone, Tim

  Wheeler, Sir John

  Redwood, John

  Whitney, Sir Raymond

  Renton, Tim

  Whittingdale, John

  Richards, Rod

  Widdecombe, Miss Ann

  Riddick, Graham

  Wiggin, Sir Jerry

  Rifkind, Malcolm

  Wilkinson, John

  Robathan, Andrew

  Willetts, David

  Roberts, Sir Wyn

  Wilshire, David

  Robertson, Raymond S (Ab'd'n S)

  Winterton, Mrs Ann (Congleton)

  Robinson, Mark (Somerton)

  Winterton, Nicholas (Macclesf'ld)

  Roe, Mrs Marion

  Wolfson, Mark

  Rowe, Andrew

  Yeo, Tim

  Rumbold, Dame Angela

  Young, Sir George

  Ryder, Richard

  Sackville, Tom

  Tellers for the Ayes:

  Sainsbury, Sir Timothy

  Mr. Patrick McLoughlin

  Scott, Sir Nicholas

  and

  Shaw, David (Dover)

  Mr. Timothy Wood.

  NOES

  839

  Abbott, Ms Diane

  Davies, Ron (Caerphilly)

  Adams, Mrs Irene

  Davis, Terry (B'ham Hodge H)

  Ainger, Nick

  Denham, John

  Ainsworth, Robert (Cov'try NE)

  Dewar, Donald

  Allen, Graham

  Dixon, Don

  Alton, David

  Dobson, Frank

  Anderson, Donald (Swansea E)

  Donohoe, Brian H

  Anderson, Ms Janet (Ros'dale)

  Dowd, Jim

  Armstrong, Ms Hilary

  Dunnachie, Jimmy

  Ashdown, Paddy

  Dunwoody, Mrs Gwyneth

  Ashton, Joseph

  Eagle, Ms Angela

  Austin-Walker, John

  Eastham, Ken

  Banks, Tony (Newham NW)

  Ennis, Jeff

  Barnes, Harry

  Etherington, Bill

  Barron, Kevin

  Evans, John (St Helens N)

  Battle, John

  Ewing, Mrs Margaret

  Bayley, Hugh

  Fatchett, Derek

  Beckett, Mrs Margaret

  Faulds, Andrew

  Beggs, Roy

  Field, Frank (Birkenhead)

  Beith, A J

  Fisher, Mark

  Bell, Stuart

  Flynn, Paul

  Benn, Tony

  Forsythe, Clifford (S Antrim)

  Bennett, Andrew F

  Foster, Derek

  Bermingham, Gerald

  Foster, Don (Bath)

  Berry, Roger

  Foulkes, George

  Betts, Clive

  Fraser, John

  Blair, Tony

  Fyfe, Mrs Maria

  Blunkett, David

  Galloway, George

  Boateng, Paul

  Gapes, Mike

  Boyes, Roland

  Garrett, John

  Bradley, Keith

  George, Bruce

  Bray, Dr Jeremy

  Gerrard, Neil

  Brown, Gordon (Dunfermline E)

  Gilbert, Dr John

  Brown, Nicholas (Newcastle E)

  Godman, Dr Norman A

  Bruce, Malcolm (Gordon)

  Godsiff, Roger

  Burden, Richard

  Golding, Mrs Llin

  Byers, Stephen

  Gordon, Ms Mildred

  Caborn, Richard

  Graham, Thomas

  Callaghan, Jim

  Grant, Bernie (Tottenham)

  Campbell, Mrs Anne (C'bridge)

  Griffiths, Nigel (Edinburgh S)

  Campbell, Menzies (Fife NE)

  Griffiths, Win (Bridgend)

  Campbell, Ronnie (Blyth V)

  Grocott, Bruce

  Campbell-Savours, D N

  Gunnell, John

  Canavan, Dennis

  Hain, Peter

  Cann, Jamie

  Hall, Mike

  Carlile, Alex (Montgomery)

  Hanson, David

  Chidgey, David

  Hardy, Peter

  Chisholm, Malcolm

  Harman, Ms Harriet

  Church, Ms Judith

  Harvey, Nick

  Clapham, Michael

  Hattersley, Roy

  Clark, Dr David (S Shields)

  Henderson, Doug

  Clarke, Tom (Monklands W)

  Hendron, Dr Joe

  Clelland, David

  Heppell, John

  Clwyd, Mrs Ann

  Hill, Keith (Streatham)

  Coffey, Ms Ann

  Hinchliffe, David

  Cohen, Harry

  Hodge, Ms Margaret

  Connarty, Michael

  Hoey, Kate

  Cook, Frank (Stockton N)

  Hogg, Norman (Cumbernauld)

  Cook, Robin (Livingston)

  Home Robertson, John

  Corbett, Robin

  Hood, Jimmy

  Corbyn, Jeremy

  Hoon, Geoffrey

  Corston, Ms Jean

  Howarth, Alan (Stratf'd-on-A)

  Cousins, Jim

  Howarth, George (Knowsley N)

  Cox, Tom

  Howells, Dr Kim

  Cummings, John

  Hoyle, Doug

  Cunliffe, Lawrence

  Hughes, Kevin (Doncaster N)

  Cunningham, Jim (Cov'try SE)

  Hughes, Robert (Ab'd'n N)

  Cunningham, Dr John

  Hughes, Roy (Newport E)

  Cunningham, Ms R (Perth Kinross)

  Hughes, Simon (Southwark)

  Dafis, Cynog

  Hume, John

  Dalyell, Tarn

  Hutton, John

  Darling, Alistair

  Illsley, Eric

  Davidson, Ian

  Ingram, Adam

  Davies, Bryan (Oldham C)

  Jackson, Ms Glenda (Hampst'd)

  Davies, Chris (Littleborough)

  Jackson, Mrs Helen (Hillsborough)

  Davies, Denzil (Llanelli)

  Jamieson, David

  840

  Janner, Greville

  Orme, Stanley

  Jenkins, Brian D (SE Staffs)

  Paisley, Rev Ian

  Johnston, Sir Russell

  Pearson, Ian

  Jones, Barry (Alyn & D'side)

  Pendry, Tom

  Jones, leuan Wyn (Ynys Môn)

  Pickthall, Colin

  Jones, Dr L (B'ham Selly Oak)

  Pike, Peter L

  Jones, Martyn (Clwyd SW)

  Pope, Greg

  Jones, Nigel (Cheltenham)

  Powell, Sir Raymond (Ogmore)

  Jowell, Ms Tessa

  Prentice, Mrs B (Lewisham E)

  Kaufman, Gerald

  Prentice, Gordon (Pendle)

  Keen, Alan

  Prescott, John

  Kennedy, Charles (Ross C & S)

  Primarolo, Ms Dawn

  Kennedy, Mrs Jane (Broadgreen)

  Purchase, Ken

  Khabra, Piara S

  Quin, Ms Joyce

  Kilfoyle, Peter

  Radice, Giles

  Kirkwood, Archy

  Randall, Stuart

  Lestor, Miss Joan (Eccles)

  Raynsford, Nick

  Lewis, Terry

  Reid, Dr John

  Liddell, Mrs Helen

  Rendel, David

  Litherland, Robert

  Robertson, George (Hamilton)

  Livingstone, Ken

  Robinson, Geoffrey (Cov'try NW)

  Lloyd, Tony (Stretf'd)

  Robinson, Peter (Belfast E)

  Llwyd, Elfyn

  Roche, Mrs Barbara

  Loyden, Eddie

  Rogers, Allan

  Lynne, Ms Liz

  Rooker, Jeff

  McAllion, John

  Rooney, Terry

  McAvoy, Thomas

  Ross, Ernie (Dundee W)

  McCartney, Ian (Makerf'ld)

  Rowlands, Ted

  McCartney, Robert (N Down)

  Ruddock, Ms Joan

  McCrea, Rev William

  Salmond, Alex

  Macdonald, Calum

  Sedgemore, Brian

  McFall, John

  Sheerman, Barry

  McGrady, Eddie

  Sheldon, Robert

  McKelvey, William

  Shore, Peter

  Mackinlay, Andrew

  Short, Clare

  McLeish, Henry

  Simpson, Alan

  Maclennan, Robert

  Skinner, Dennis

  McMaster, Gordon

  Smith, Andrew (Oxford E)

  McNamara, Kevin

  Smith, Chris (Islington S)

  MacShane, Denis

  Smith, Llew (Blaenau Gwent)

  McWilliam, John

  Smyth, Rev Martin (Belfast S)

  Maddock, Mrs Diana

  Snape, Peter

  Mahon, Mrs Alice

  Soley, Clive

  Mallon, Seamus

  Spearing, Nigel

  Mandelson, Peter

  Spellar, John

  Marek, Dr John

  Squire, Ms R (Dunfermline W)

  Marshall, David (Shettleston)

  Steel, Sir David

  Marshall, Jim (Leicester S)

  Steinberg, Gerry

  Martin, Michael J (Springbum)

  Stevenson, George

  Martlew, Eric

  Stott, Roger

  Maxton, John

  Strang, Dr Gavin

  Meacher, Michael

  Straw, Jack

  Meale, Alan

  Sutcliffe, Gerry

  Michael, Alun

  Taylor, Mrs Ann (Dewsbury)

  Michie, Bill (Shef'ld Heeley)

  Taylor, John D (Strangf'd)

  Michie, Mrs Ray (Argyll Bute)

  Taylor, Matthew (Truro)

  Milburn, Alan

  Thompson, Jack (Wansbeck)

  Miller, Andrew

  Thurnham, Peter

  Mitchell, Austin (Gt Grimsby)

  Timms, Stephen

  Moonie, Dr Lewis

  Tipping, Paddy

  Morgan, Rhodri

  Touhig, Don

  Morley, Elliot

  Trickett, Jon

  Morris, Alfred (Wy'nshawe)

  Trimble, David

  Morris, Ms Estelle (B'ham Yardley)

  Turner, Dennis

  Morris, John (Aberavon)

  Tyler, Paul

  Mowlam, Ms Marjorie

  Vaz, Keith

  Mudie, George

  Walker, Sir Harold

  Mullin, Chris

  Wallace, James

  Murphy, Paul

  Walley, Ms Joan

  Nicholson, Miss Emma (W Devon)

  Wardell, Gareth (Gower)

  Oakes, Gordon

  Wareing, Robert N

  O'Brien, Mike (N Warks)

  Watson, Mike

  O'Brien, William (Normanton)

  Welsh, Andrew

  O'Hara, Edward

  Wicks, Malcolm

  Olner, Bill

  Wigley, Dafydd

  O'Neill, Martin

  Williams, Alan (Swansea W)

  841

  Williams, Alan W (Carmarthen)

  Wright, Dr Tony

  Wilson, Brian

  Young, David (Bolton SE)

  Winnick, David

  Wise, Mrs Audrey

  Tellers for the Noes:

  Worthington, Tony

  Mr. Eric Clarke and

  Wray, Jimmy

  Mr. Joe Benton.

  Question accordingly agreed to.
  MADAM SPEAKER forthwith declared the main Question, as amended, to be agreed to.
  Resolved,
  That this House notes that the National Health Service is providing high quality care to more patients than ever before; congratulates the dedication and professionalism of the National Health Service's staff during the recent cold weather which has placed exceptional demands upon them; believes that the National Health Service requires a growing budget for patient care and therefore welcomes the Health Service Guarantee given by the Prime Minister to increase spending on the National Health Service in real terms in each of the next five years, including an extra £1.6 billion for patient care in 1997–98; and believes that this guarantee reinforces the Government's consistent record of investment in the National Health Service and its professional staff.

BSE
10.32 pm
Dr. Gavin Strang: I beg to move,
That an humble Address be presented to Her Majesty, praying that the Selective Cull (Enforcement of Community Compensation Conditions) Regulations 1996 (S.I., 1996, No. 3186), dated 18th December 1996, a copy of which was laid before this House on 18th December, be annulled.
Madam Speaker: I understand that with this, it will be convenient to discuss the following motion:
That an humble Address be presented to Her Majesty, praying that the Bovine Spongiform Encephalopathy Compensation Order 1996 (S.I., 1996, No. 3184), dated 18th December 1996, a copy of which was laid before this House on 18th December, be annulled.
Dr. Strang: The Minister of Agriculture, Fisheries and Food will not be surprised to hear that the Opposition have tabled the prayer in order to debate this important subject, although we do not intend to vote against the selective slaughter programme.
The selective slaughter scheme that the House is debating tonight is part of the Florence agreement that the Prime Minister accepted in June. The House will recall that the Prime Minister said that the Florence agreement meant that all the conditions for lifting the beef export ban would be met by last October. However, today the beef ban is in place 100 per cent. and the Government have delayed progress for six months.
In September, the Government announced that they would not meet their side of the Florence agreement after all. Ministers gave various reasons for the delay, citing, first, the new scientific work available. However, as we pointed out at the time, any new scientific evidence simply meant that we could have a more effectively targeted selective slaughter scheme and certainly did not justify the Government's reneging on the Florence agreement.
The Minister also gave as an excuse the statement that the backlog in the Government's over-30-months scheme meant that there was not the abattoir capacity to begin a selective slaughter programme. I make the point that the enormous backlog—in October last year, it was estimated at 400,000 animals—was the Government's fault. They were responsible for the chaos. We appeal to the Government to ensure that the implementation of this slaughter scheme is operated considerably more efficiently and without all the problems that surrounded the OTMS.
Secondly, I do not accept that if the political will had been there, the Government could not have made some progress towards implementing the Florence agreement. The Minister admitted in December that no attempt had been made during the six-month delay even to identify the animals that were likely to be slaughtered under the selective slaughter programme. Valuable time was wasted.
The final reason that the Minister gave for the six months in limbo was that if we went ahead with our side of the Florence agreement, the European Union would not meet its side of the bargain and start to lift the beef ban. That is the most important question that the Minister must answer tonight. Now that the Government have done a U-turn on the Florence agreement, what hope can he offer

843
our beef industry, our farmers and our food industry that the European beef ban will be lifted? Does the Minister care to follow the Prime Minister's example of last June and give us a timetable for the lifting of the ban?
The Government have still not submitted the working paper to the European Commission regarding the lifting of the ban on certified herds. I trust that the Minister will enlighten us on that. Indeed, if Radio 4 was correct this morning, I trust that he will advise us that the formal submission will go ahead and that progress can be made so that we can at least achieve quickly the first step of allowing the export of beef from certified herds and then have the whole ban lifted.
It is a terrible day for our livestock industry when Parliament has to agree that thousands of productive animals are to be slaughtered. It is vital that the selective slaughter programme is carried out sensitively. Some farmers and herdsmen will deeply resent the fact that animals that have not reached the end of their working lives are to be compulsorily killed. The cattle, some of them high-value pedigree animals, will have been a source of great pride to the herdsmen and farmers involved.
The Ministry must adopt a flexible approach to minimise the damage to farm businesses, accommodating concerns such as the operation of the milk quota scheme, and seeking to ensure that any herd involved in the compulsory slaughter is treated in such a way that farm businesses do not lose out in terms of fulfilling the milk quota. There is also the quota for suckler cow herds. It would be wrong if businesses were penalised through a reduction in the suckler cow quota as a result of animals being slaughtered under the programme. Indeed, I hope that the Minister will be able to assure us that the flexibility will enable them to avoid not only a reduction in quota but losing out on any suckler cow premium payments as a result of the scheme.
The House will also be aware that there is concern about the definition that the Government are using to determine herd size. If more than 10 per cent. of the animals in a herd are to be slaughtered, the compensation is so much higher and a premium is payable. There is great concern, however, that on this occasion the Government have, unusually, chosen to include for the first time heifers in calf. That will reduce the number of herds that qualify, in terms of over 10 per cent. of the animals being taken.
The Minister will be aware of many of the concerns about which the National Farmers Union and the Country Landowners Association have written to us. I trust that he will address these in the course of the debate. I must also impress upon the Minister that the highest standards of animal welfare must be upheld during the implementation of the programme.
There is the issue of maternal transmission. The Minister will remember that the Oxford study paper, which was published by Roy Anderson and his colleagues, included an assumption of maternal transmission. Indeed, Roy Anderson and his colleagues advised that the most effective targeting scheme would make some allowance for such transmission, albeit on a small scale. Is it the Minister's intention that if there is no change in the present fairly inconclusive position, and bearing in mind the evidence that will become available in February or March, nothing will be built into the targeting to include maternal transmission? It would be
844
helpful if the Minister cast further light on the matter. As he knows, the Ministry has made it clear in its consultation document that a decision will be taken in February or March.
I know that many Members wish to speak in the debate. In conclusion, I remind the House that there can be no doubt that we would not be facing a crisis on such a scale had it not been for the fact that successive Conservative Governments throughout the late 1980s and early 1990s delayed in regulating to protect human and animal health. Above all, they failed abysmally to implement and enforce the regulations that they had put in place.
As I have said, it is a terrible day when the House has to agree to the slaughter of thousands of our cattle. However, the industry is facing a crisis on a huge scale.
Mr. Edward Garnier: Will the hon. Gentleman give way?
Dr. Strang: This is a short debate that will continue for only one and a half hours. To allow as many hon. Members to speak as possible, representing as they do the length and breadth of the United Kingdom and all political parties, I do not intend to give way.
This is a terrible day. I am sure that the House accepts, however, that we must sanction the slaughter of so many productive cattle. The industry is facing a crisis and the worldwide ban on the export of beef and beef imports is inflicting enormous damage and is costing thousands of jobs and damaging livelihoods. The only mechanism available to us to get the ban lifted is to implement the Florence agreement, and for that reason we believe that the Government are right to set about putting into effect the selective slaughter programme of that agreement.
10.42 pm
The Minister of Agriculture, Fisheries and Food (Mr. Douglas Hogg): The House has discussed the selective cull on a number of occasions and is well acquainted with the issues. Furthermore, the time allocated for debate is short. Therefore, my intention is to be brief.
There are two statutory instruments before the House. The first is the Selective Cull (Enforcement of Community Compensation Conditions) Regulations 1996 and the second is the Bovine Spongiform Encephalopathy Compensation Order 1996.
The House will be aware that there is another order, the Bovine Spongiform Encephalopathy (No. 2) Order 1996, which provides the powers to restrict and slaughter animals. That order is not subject to parliamentary procedure, but was made available in draft to hon. Members last summer when we discussed the cull before the summer recess.
The selective cull compensation regulations, if I might so describe them for brevity, make provision for the enforcement of certain requirements of the relevant Commission regulation, which itself provides for European Union co-financing of the compensation. The requirements relate to the slaughter, treatment and disposal of animals subject to the cull. They are identical to those for the over-30-months scheme. These regulations create offences and specify penalties.
The other order is the Bovine Spongiform Encephalopathy Compensation Order 1996, which revokes and replaces the 1994 order. It contains new

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provisions that prescribe the amount of compensation payable for animals slaughtered under the selective cull. The compensation arrangements are based on the proposals that we discussed last summer with farming organisations and others. In drawing up those compensation proposals, we have tried to strike a balance between reflecting the cost to the farmer and avoiding overcompensation. Although it has been difficult to strike that balance, I believe that we have got it about right.
Mr. Robert Jackson: I congratulate my right hon. and learned Friend on pressing ahead with the selective cull. I hope that our partners in Europe will respond on their part of the deal. I put it to him that, until the tracing arrangements for the cull have been fully completed, we will not know what the impact will be on particular herds. On compensation, will he consider sympathetically any cases that may emerge of herds that turn out to be particularly badly affected?
Mr. Hogg: I am about to give details of the compensation. I suspect that my hon. Friend has in mind the problems that may be experienced by the closed herd and the suckler cow herd. I shall deal with that in the next few moments.
I shall briefly summarise the compensation provisions. For male animals, compensation will be at the market value. For female animals, it will be 90 per cent. of the replacement value or the market value, whichever is the higher. That is in recognition of the point put to us by farming organisations last year that replacements may cost more than the present value of the animal to be replaced.
In addition, a top-up payment will be available for herds that lose more than 10 per cent. of their productive animals. That is designed to meet the concerns of farming organisations, by recognising the dislocation to the business during the re-establishment of the herds. It will be available to suckler herds as well as to dairy herds. The top-up is subject to a ceiling of £250 per animal, which reflects a maximum deemed value for top-up purposes of £1,000.
Mr. William Cash: Does my right hon. and learned Friend accept that this saga has caused enormous anxiety and concern among farmers, including many in my constituency? Will he explain why he has adopted such an arbitrary and artificial definition of a herd, and why the top-up calculations are so restrictive?
Mr. Hogg: We have to define a herd for the purposes of the regulations. In defining a herd, we have taken into account the productive animals. That seems sensible. I suspect that what is on my hon. Friend's mind is the inclusion in the definition of in-calf heifers. If we were not to include in-calf heifers in the definition of a herd, the compensation payable to a farmer would depend on the exact moment that the veterinary experts visited the farm. That would create a difference between a farm where the heifers had not calved and a farm where they had calved. That disparity would be impossible to justify.
As to the basis of the top-up, in the end we must make a judgment. There are two elements to the compensation that we will pay. First, there is the full value for the beast itself; and then there is the top-up in respect of the
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dislocation. We must strike a balance. I believe that we have struck it fairly, but clearly it is a matter on which people have a variety of views. I am persuaded that the balance is a fair one.
Mr. Christopher Gill: I listened carefully to my right hon. and learned Friend's explanation in reply to my hon. Friend the Member for Stafford (Mr. Cash). Surely the issue of in-calf heifers is just as complicated at one end of the scale as it is at the other. It is just as complicated for inspectors to adjudicate on whether the in-calf heifer is to be included as it is to decide whether the heifer has conceived or not. Does the Minister concede that it is most unusual—unprecedented, in fact—to include in-calf heifers in such an equation?
Mr. Hogg: There is much that is unprecedented in this matter, not least the slaughtering of healthy beasts, but we have done our best to be fair. My hon. Friend might consider this question: why should in-calf heifers not be included in the definition of a productive herd? I have had to consider the argument both ways, and I have concluded that it is fair to include in-calf heifers, for the reasons that I have given.
Mr. Tony Marlow: Will my right hon. and learned Friend give way?
Mr. Hogg: I am going to make a little progress; then I will give way.
Mr. Marlow: It is on that point—
Mr. Hogg: I am going to make a little more progress; then I will give way.
I have been talking about the valuation for individual beasts, but I also mentioned the question of the top-up. Closed herds will receive one and a half times the normal top-up payments, which is intended to reflect the greater difficulties that are likely to be experienced by owners of such herds in obtaining replacement animals, and hence a longer period of disruption.
Mr. Marlow: May I take up the point made by my hon. Friend the Member for Ludlow (Mr. Gill), and ask how it is possible to know whether a heifer is in calf or is about to return to service? Must a pregnancy test be carried out, or what?
In the case of pedigree breeding stock of high value, in terms of thousands of pounds, will farmers be compensated to the extent of that value?
Mr. Hogg: A distinction needs to be made between the compensation paid in respect of top-up, and the compensation paid in respect of the individual beast. For top-up there is a ceiling value of £1,000, which means that each animal can attract a payment not exceeding £250. Compensation for the beast itself, however, will be at full value as at the date of valuation, in accordance with the formula that I have already outlined. As for whether or not a heifer is in calf, that will be a matter for determination during the visit to the farm by the veterinary expert, as a result of the consultation that will take place between the farmer and the expert.
Mr. Peter Hardy: Will the Minister give way?
Mr. Hogg: I will make a little more progress; then I will give way to the hon. Gentleman.

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We fully appreciate that, despite these measures, the coming months will be difficult for many of the farmers affected by the cull; so we will try to be as sensitive and flexible as possible in the general conduct of that cull. The hon. Member for Edinburgh, East (Mr. Strang) asked about that. The operation of the cull will be explained to and discussed with farmers, and veterinary officers will endeavour to keep them fully informed about discussions affecting their businesses.
It is clearly in our interests, and those of the industry as a whole, to complete the cull as rapidly as we can. Our aim is to complete it within six months, but, within that overall aim—
Mrs. Helen Jackson: Will the Minister give way?
Mr. Hogg: I will finish this section of my speech, and then give way to the hon. Member for Wentworth (Mr. Hardy).
Within that overall aim, where it is reasonably possible, we shall try to take farmers' wishes into account when timing the slaughter on individual farms. For example, when a cow is in calf we may discuss with the farmer the possibility of delaying slaughter until it has calved, and the calf can properly be separated from its dam. If a farmer is to lose a large proportion of his herd, we could consider slaughtering in two groups rather than slaughtering all the cattle together.
Mr. Hardy: I may be wrong, but I suspect that the deep anxieties of dairy farmers may be more nearly met by these various arrangements than those of the beef producers, particularly the small ones. The Minister was kind enough to give way and allow me to make a similar point some months ago. Does he not appreciate that the smaller beef producer facing the "upper millstone" of the economic effect of the BSE crisis and the "lower millstone" of the disintensification policy that the Ministry is pursuing could threaten the smaller farmer, and imperil entry into, and maintenance of interest in, farming among such people? That itself would appear to contradict Government policy. Will the Minister re-examine the position of those smaller beef producers, to ensure that they are not ruined by the performances of the past year or so?
Mr. Hogg: I do not share the hon. Gentleman's pessimism. Leaving aside payments made under the 30-months scheme, which have gone a long way towards underpinning the market, we have made available about £265 million in direct support of beef producers. Markets have recovered somewhat over the past few months, although I accept that they are at a lower level than they were before the crisis.
Looking forward, it is clear that there will have to be a change in farming practice. The consumer is expecting a change from the past and I suspect that there is an imbalance between production and consumption that will have to be addressed. As I have said, I do not take the hon. Gentleman's pessimistic view.
Mr. Alex Salmond: Over the holiday period, the Minister with responsibility for Scottish agriculture made an optimistic statement about
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the prospects for the return of Scottish beef to European markets. He even estimated the percentage of the market that could perhaps be recaptured when that return was allowed. I have been trying to work out the basis for that optimism. Will the Minister give his estimate of the date on which that return might be realised, as the Prime Minister has done? Given the measures that have been put in place, on what date does the Minister expect Scottish beef to return to European markets?
Mr. Hogg: I shall shortly outline the steps that we intend to take with the European Commission to secure a relaxation of the ban. However, our optimism is based on the high quality of Scottish beef, a factor that is acknowledged throughout Europe.
Mrs. Helen Jackson: The Minister says that he expects the cull to be completed in approximately six months. Does he mean that in that time the cull and the disposal process of the slaughtered beasts will be completed, bearing it in mind that so far a mere 3.8 per cent. of those disposed of under the 30-months scheme have been finally incinerated?
Mr. Hogg: By the cull, I mean the slaughter. There are large quantities of beef, particularly as a result of the 30-months scheme, in cold storage and it will take a long time to dispose of that. When I mentioned six months, it was in relation to the slaughter programme and did not relate to the beef in cold storage plants.
I shall now deal with maternal transmission. What we are discussing does not include measures in relation to maternal transmission, if I may use the jargon. I hope that we shall have a clearer view in February or March about whether there is true maternal transmission. When we have that evidence, we will be better able to determine whether it would be right to seek to add to the numbers contemplated under the present arrangements to take account of potential maternal transmission. At this time I am unable to say whether we shall seek to extend the cull to reflect possible maternal transmission. That will depend on our assessment of the scientific evidence that I hope will be available in two or three months.
Mr. Andrew Welsh: Will the Minister give way?
Mr. Hogg: Perhaps the hon. Gentleman will forgive me if I do not give way. I should like to make some more progress.
Subject to the House agreeing the statutory instruments, I currently expect the first visits to farms in Great Britain to begin tracing cattle to take place in the next few days. The first visits will be to the natal herds—those in which BSE cattle were born. After that it will be a matter of tracing any animals that have moved from those herds. Our aim is to complete the process of tracing and culling the affected cohorts within six months. That is the matter on which the hon. Member for Sheffield, Hillsborough (Mrs. Jackson) sought further clarification. The tracing of animals moved out of these cohorts might take a little longer.
As I have said, I recognise that the cull will create uncertainty and upheaval for many of those farmers affected, and that it represents an interference with their

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private property. Nevertheless I commend it to the House because, without it, there is no prospect of any lifting of the export ban on United Kingdom beef. I am pleased to see that that point is now generally accepted by farming organisations and by my colleagues in the House, including the Opposition.
By implementing the cull, all five of the preconditions in the Florence agreement will be met and it will allow us to move to the second part of the agreement which sets out the procedures for a relaxation of the ban. We are ready with a proposal for a certified herds scheme to submit to the Commission. I anticipate submitting our proposals early next month. I must tell the hon. Member for Edinburgh, East that it would be presumptuous of me to submit any proposals to the Commission before getting the clearance and approval of the House, which is what I am seeking and which I regard as a necessary precondition to the next step.
Our certified herds scheme would permit exports of meat and meat products from animals whose movements are fully documented and which could be certified as having no association with BSE. Once we have secured agreement on such exports, we shall aim to move on rapidly to other categories, such as animals born after a given date. In other words, we regard certified herds as being the first step in the relaxation of an unjustified ban on British beef and beef products.
Mr. Tom King: In seeking the approval of the House, will my right hon. and learned Friend confirm the cost of the scheme to the British taxpayer? Am I right in thinking that it is an entirely a United Kingdom cost and does not involve any refund from the Community? On the terms that have been set out, can my right hon. and learned Friend tell me what the Government are putting forward as funds to meet the cost of the scheme?
Mr. Hogg: The net cost is about £120 million. My right hon. Friend is not entirely right to say that there is no co-financing. There is co-financing to about 70 per cent. of market value. That does not take account of all the elements of compensation encompassed within the compensation scheme. My right hon. Friend will have noticed that I talked about 70 per cent. of market value and he will recall what I said about top-up and about the fact that replacement value is one of the benchmarks for calculating compensation. The recovery is based on market value. As I have said, doing the best we can, the net cost will be about £120 million.
Mr. Welsh: Will the Minister give way?
Mr. Hogg: No, because I have given way to the hon. Gentleman's party already.
On the basis of my comments, I commend the statutory instruments to the House.
11.2 pm
Mr. Paul Tyler: I believe that all hon. Members would prefer not to have to debate this issue, but here we are. Many of us have to take a serious and sober attitude towards this issue as we represent many livestock farmers.
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A farmer in Cornwall wrote to me yesterday saying:
"It is a very dangerous precedent to kill healthy animals on this basis, a thing the United Kingdom has never done."
I believe that that is the view of many hon. Members.
There are only two possible justifications for the action: first, that it will accelerate the eradication of BSE in the British beef herd and, secondly, that it will accelerate the reopening of the worldwide beef export opportunities. It must be on both counts that we test the statements made by the Minister today.
Many hon. Members on both sides of the House will recall the words of the Prime Minister on his return from Florence. He said:
"It is now up to us in this country—the farming and ancillary industries and the Government—to ensure that we meet them. The point is that this timetable is essentially in our hands.—[Official Report, 24 June 1996; Vol. 280, c. 22.]
When the Minister replies, I hope that he will be more specific about the timetable that he sees ahead of us as a result of the action that he is asking the House to take. To justify it, the Government have to believe that this scheme will accelerate both the eradication of BSE and the reopening of the export markets.
Some important questions were left unanswered. First, after Florence, why did Ministers not at least consult the industry so that they could move as quickly as possible as soon as the legislative process had been completed, so that we would not have these last-minute glitches? Six months have been lost during which such consultation could have taken place and uncertainty could have been removed. As it is, livestock farmers have found their business plans totally up in the air because they were not able to plan ahead.
Secondly, will the cull be managed in the same way as the over-30-months scheme? As yet, we have had no answer to that question. On 16 December, when the Minister made a statement on the subject, I asked him whether the accelerated cull would be by competitive tender, enabling the participation of all those slaughterhouses—they are represented by Members on both sides of the House—that have been squeezed out of the over-30-months cull and have lost out disastrously as a result. I was given no answer. When I raised that matter in the debate on the Christmas Adjournment on 18 December, the Leader of the House assured me that he would put that point to the Ministers responsible and get an answer, to ensure that there was no profiteering out of the new programme as there has been with the over-30-months scheme. I have had no answer as yet, nor have I heard one today.
Thirdly, what notice have Ministers taken of the response from the farming organisations to the Government's consultation document? The definitions in paragraph 11 are still incredibly vague, causing widespread concern. There is considerable concern at the apparent mismatch of cohort years with feeding groups. Do we yet know that the scheme is acceptable to the Commission, or are we passing something that is still a pig in a poke as far as acceptability in Brussels is concerned? Representations have been made to the Minister and copied to many other hon. Members from the Scottish National Farmers Union, the Country Landowners Association, the South-West National Farmers Union and individual livestock farmers, all of which have been constructive and positive—not negative

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in the least, but they still have not had an adequate response in terms of the statutory instruments placed before us today.
On statutory instrument No. 3184, there has already been much discussion on both sides of the House about the definition of a herd. Clearly, the issue of in-calf heifers is incredibly important for closed herds. Since the Minister acknowledges that closed herds will have considerable difficulty in replacing without great cost, and that the dislocation to the management of those herds will make things extremely difficult, surely it must be important to establish what farmers and their representatives think is the best way to define a herd. As hon. Members have said, the new definition is totally unprecedented. There must be an extraordinary reason for including in-calf heifers in the way suggested. The Minister used the phrase "productive animals only". Why can we not stick with that definition? Similarly, in schedule 2, the way in which consequential loss is compensated is still causing considerable concern.
Suckler cow producers also have a major problem. We are receiving representations from all parts of the country. Surely it is essential for Ministers to allow producers to ghost those animals during the period when they are being retained for Buckler cow premium. Otherwise, it will cause a major problem for the cash flow of the enterprises concerned.
Similarly, flexibility is being quoted on all sides. The Minister says that he intends to be flexible, but there is nothing very flexible about the provisions of the two statutory instruments. It is difficult to foresee how the provisions can be extended to ensure that there is flexibility to assist farmers who have a particular difficulty.
We must consider, for example, the question of local milk supply, especially where there are producer-processors and producer-retailers, and most especially where there are speciality milks such as Channel Island or organic milk. There will be a major problem if that is not taken into account in compensation. There must be maximum flexibility in the timing of the way in which cattle are taken to cull.
Flexibility may be the Minister's watchword—I hope that it is—but there is no evidence so far, from our experience of the over-30-months cull or from what we have heard today, that flexibility will in fact be delivered. In its response to the consultation document, the National Farmers Union, summing up the position of most livestock farmers represented by hon. Members of all parties, said:
"The removal of healthy animals off farms will be traumatic. A sensitive approach will be needed throughout in order to secure the cooperation of producers, many of whom will be seeing a lifetime's breeding work disappear. Whilst the national benefits of the scheme are well understood, many producers are participating in the scheme with the utmost reluctance."
We should all recognise that everyone who takes part in the scheme will do so with great reluctance. It is not a scheme in which anyone would want to participate. In those circumstances, the unwilling participants, who are the victims and not the authors of the situation, have every right to expect from the Government—from every Minister and official—the maximum flexibility, sensibility and sensitivity to their needs.
11.11 pm
Mr. Paul Marland: As the hon. Member for North Cornwall (Mr. Tyler) said, this is an extremely disagreeable subject to have to debate, but if we do not debate it, the situation will go on for ever. The only reason for having the debate and for introducing a selective cull is to get the ban lifted. I should like a reassurance that the European Community will accept the method of selection that we use, and that it will not use it as an excuse and say that we should have a different method of selection.
Mr. Marlow: Moving the goalposts.
Mr. Marland: Exactly. We do not want the Community to move the goalposts. We want it to accept our method of selection and consider lifting the ban. There is no doubt that with the passage of time attitudes towards the selective cull have changed, and not only among farmers. The farmers of Gloucestershire—obviously the ones whom I know the best—were against the selective cull to start with, but now they are all in favour.
In the debate that we had in November on BSE, the hon. Member for Edinburgh, East (Dr. Strang) gave a cast-iron commitment that he would support a selective cull order of the type that we are debating today. To many of us, it does not come as much of a surprise that on this matter, as on so many others, the hon. Gentleman and the whole of his party have changed their minds. I well remember that when we discussed the export of live animals, the Labour party as a body came out against it; but when Labour was last in office, the hon. Member for Edinburgh, East was in favour. The Labour party does one thing when it faces in one direction, but something completely different when it faces in the other.
It is also worth remembering that already more than a million cattle have been slaughtered under the scheme to try to eradicate BSE in this country and that the forecast for the selective cull is about 100,000. The answer to the question whether the Government will cope competently and implement the measures well is that of course they will. The Government can be relied on to learn from and take advantage of past experience, so we shall have a totally worry-free operation as we carry out the cull. If we do not go ahead with the selective cull, the ban on the export of British beef will never be lifted.
I and farmers in Gloucestershire favour the selective cull because it will restore confidence. I do not know about other Members with rural constituencies, but confidence in British beef among the beef eaters of Gloucestershire never went down. The beef sales of an independent butcher in Newent in my constituency, Andy Crease, never fell off. The favourite Sunday lunch in the Forest of Dean is still British beef, as it always was.
I hope that the implementation of the selective cull will restore the confidence of institutions such as schools, too many of which have banned British beef. I hope that McDonald's, the brand leader in the fast food industry, will quickly reintroduce British beef to its restaurants. I salute, as will other Conservative Members, the Meat and Livestock Commission's campaign to rebuild confidence in British beef mince.
We want worldwide sales of British beef to take off again because the markets are still there. Foreigners want to buy our beef. [Interruption.] Yes, foreigners want to

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buy British beef. I say that again in case there was a misunderstanding and the Labour party changes its mind again and decides to back British beef instead of continually chipping away at it and at the British agriculture industry.
Many months ago, I told the House that I had discovered at Gloucester market that there were outbreaks of BSE in France. Few believed me or my source of information at the market, but it is now widely recognised that BSE is endemic in France, Belgium and Holland. I wonder whether hon. Members know that the Russians and Egyptians have banned the import of beef from southern Ireland because there have been 70 BSE cases there in the past year. If they are going to ban the import of beef from Ireland, what does the European Community propose to do about the export of Irish beef?
Mr. Gill: Is it not terribly unsatisfactory that Russia can ban the importation of beef from five Irish counties but that the same beef can be exported to the United Kingdom, to the detriment of British cattle producers?
Mr. Marland: My hon. Friend has pinched my next point. I understand that the price of British beef has fallen by 5 per cent.—it may be more; he can correct me if I am wrong—as a result of the import of Irish beef.
On the detail of the slaughter, I join other hon. Members in urging my right hon. and learned Friend the Minister that his Department should be as flexible as possible in the execution of the policy so as to minimise the losses of income that farmers will sustain. It should be sensitive to farmers' replacement plans. That is especially important for farmers who are carrying extra in-calf heifers on their farms to replace the stock that will be taken out by the cull.
Compensation should help farmers, not penalise them. I believe that it is wrong to regard in-calf heifers as being involved in establishing the herd. That is a serious departure from normal measurement practice, as only productive cattle are included in Government schemes, legislation and for taxation purposes. Why change that? The inclusion of in-calf heifers penalises farmers who seek to help themselves with replacements, especially as some of them may be carrying extra cattle on their farms.
It would be sensible to reconsider top-up payments, which are not available until at least 10 per cent. of the herd has been slaughtered. With the extra heifers that farmers are carrying on their farms, that could seriously disadvantage the very people whom we are seeking to help. Perhaps the top-up scheme should be on a sliding scale so that it is not cut and dried at 10 per cent. and there is some give in the system.
The setting of a maximum value on the compensation payable for a beast could further disadvantage those valuable pedigree herds, which, as other hon. Members have already said, may have been built up over the lifetime not only of the current owner but of his father. I hope that that matter will be reconsidered.
Mr. Douglas Hogg: I do not like to interrupt my hon. Friend, but I think that he may have made a mistake. There are two elements in the compensation—compensation for the individual beast and the top-up.
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There is neither ceiling nor cap on the compensation for the individual beast—full value will be paid. The cap applies only to the top-up formula.
Mr. Marland: I thank my right hon. and learned Friend for putting me right on that because that is a weight off my mind. If I made a mistake, I am quite happy to admit it. We want the farmers to co-operate with the scheme, some of which is voluntary. If we expect them to step forward and volunteer to participate in it, we must make the compensation scheme as fair as we possibly can.
As I said earlier, we want to get the ban lifted. To do that, we must know what the quid pro quo is from the European Union. Other hon. Members have mentioned the Florence agreement. It is true that before today's debate we had instigated five out of the six conditions that were laid down at Florence in order to get the ban lifted. As a result of today's measures, we shall instigate six out of six.
For a long time many of us have thought that the EU has had its own agenda: to inflict pain on UK farmers while letting others walk away without persuading them to take any steps to put the problem right. I have already cited the example of southern Ireland. I very much hope that my right hon. and learned Friend will take steps to ensure that there is no more duplicitous behaviour within the EU, and that the ban is lifted as soon as possible.
11.21 pm
Mr. Ieuan Wyn Jones: There is considerable interest in the debate because, although one understands that there is a political rather than a scientific imperative behind the need for the statutory instruments, it is generally accepted by hon. Members on both sides of the House that the accelerated cull, regrettable though it is, must go ahead. That is why I believe that the House will not divide on the measures.
I shall briefly address the issues that are of most concern to the farming industry because I know that a number of colleagues wish to speak. The Minister will be aware of the considerable disquiet that has been expressed by many hon. Members about the definition of the herd. It is proposed to define it as including the replacement heifers in calf. That is contrary to accepted practice in all countries of the United Kingdom. Farmers believe that that has been done to reduce eligibility for the top-up payments. In view of the representations made tonight, I ask the Minister to reconsider the matter.
The industry has obviously welcomed the fact that the Government have accepted the case for replacement value to be the basis of compensation for the cattle. After all, we are dealing with some of the most productive of the dairy cows in our herds, and they will be slaughtered when they are at their most productive capacity. Considerable disappointment has been expressed, however, at the fact that that compensation has been limited to 90 per cent. of their replacement value. I am sure that the Minister will have noted all the representations on that.
The way in which dislocation costs are calculated is also a matter of concern. I am anxious particularly about small dairy farmers—they may lose only one or two cows, but that may not represent 10 per cent. of their herds. In those circumstances, will the Minister consider whether an element of flexibility should be included in the system

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because, proportionately, the small producer will lose substantially more than the larger producer in terms of their herds' productive capacity?
It is important that compensation is paid promptly, particularly for productive cattle, which must be replaced quickly. Many farmers had to wait a considerable time before they received their compensation under the over-30-months scheme, which had a considerable impact on their cash flow problems. Will the Minister give an assurance that the compensation payments under this scheme will be paid promptly, so that farmers can ensure that they have the money in their bank early enough to pay for the replacement of their stock? Will he also ensure that the farmers are made fully aware at an early stage of when the payments will be made?
My final point relates to the raising of the beef ban. As the Minister is aware, many of us have been persuaded of the necessity of the accelerated cull because of the prospect of the ban being lifted as a result. I understand what the Minister has been saying tonight and his reluctance to give us a firm date for raising the ban, but the industry is waiting for his views and the Government's views on that subject. He will understand that it is because of that prospect that farmers support the regulations on accelerated culling. In his winding-up speech, or in some other form, will the Minister make it clear that the lifting of the ban forms the basis of the statutory instruments?
11.25 pm
Mr. John Greenway: I am grateful for the chance to contribute briefly to the debate.
I do not believe that the dispute at the heart of the measures necessarily extends across the Floor of the House. All of us who represent fanning constituencies know only too well the unprecedented damage and turmoil that the beef industry has suffered over the past 10 months. Our dispute is with our European partners and, to a degree, with the European Commission.
I do not see myself as one of the most extreme Euro-sceptic Conservative Members. I have always tried to be measured in the comments that I make about Europe. The debate is the best opportunity that we have had for a long time to put on the record the fact that the farmers, the beef producers, of the United Kingdom—it is commendable that so many of our colleagues from Northern Ireland are present, and I shall be brief because I am sure that some of them want to contribute—have made great sacrifices over the BSE problem in the past 10 months, or even eight or nine years. It is high time that the rest of Europe recognised the sacrifice that has been made.
Mrs. Margaret Ewing: And America.
Mr. Greenway: And America—the hon. Lady is right.
When the cull that we are debating tonight is completed, it will mean that 1.2 million animals will have been slaughtered. I cannot claim that there is a shred of scientific support for the slaughter of any one of them. They have all been slaughtered for political reasons because the European Union decided, in its infinite stupidity, to impose a ban on British beef as a result of the statements made by my right hon. and learned Friend the Minister of Agriculture, Fisheries and Food and by my right hon. Friend the Secretary of State for Health.
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The European Union made a gross misjudgment. It judged that, because BSE might be seen as a problem confined to Britain, if British beef were banned, it would reassure consumers throughout the rest of continental Europe. Of course, the ban had the opposite effect. Every housewife or consumer, not just in Europe, but throughout the world, has concluded that if—it is still a big if—there is the prospect of humans contracting a brain disease as a result of eating beef, they should not buy it. All cases of Creuztfeldt-Jakob brain disease throughout the world cannot have occurred as a result of British beef. I do not believe that the link has been proved. The decision to ban British beef reinforced in the minds of consumers throughout Europe the idea that all beef may be harmful. For that reason, beef consumption throughout Europe has slumped. It is to the credit of our meat industry, our farmers and our consumers that consumption of beef in Britain has not fallen to the levels seen in other countries. That, combined with the massive financial support that the Government have given to the industry, means that we still have a beef industry for the future.
The European issue is exacerbated by an outrageously hypocritical draft report that was recently published by the European Parliament—the so-called Ortega report—and we need to examine carefully two issues relating to that. We understand that the report has been highly critical of the British Government's response to the BSE crisis and that there is also some criticism of the European Commission. In fairness to the Government—I remember many of the debates we had in the late 1980s, when I was first elected to Parliament—I must point out that they have been working one step at a time. Facts were not known and scientific advice emerged generally. We are now much clearer on what needs to be done to ensure that the beef on consumers' plates is safe.
With the benefit of all that hindsight, however, what has the European Parliament recommended should be done to protect consumers throughout mainland Europe? Precisely nothing—none of the measures that we have implemented to ensure that our beef is the safest in the world has been recommended by the Parliament for implementation in the rest of Europe. We are well on the way, not only to eradicating BSE from British herd, but to ensuring that, once eradicated, BSE does not return and that British beef on consumers' plates is the safest in the world, but I am gravely concerned about whether we can say the same about the rest of Europe.
It is acceptable to suggest that the incidence of BSE in Europe is not as high as it is in Britain, but I cannot understand why the rest of Europe continues to turn its back on the prudent measures that we have introduced in respect of specified bovine offals, meat and bonemeal. I am worried that, because of that, we shall see more evidence of BSE on the continent and that the worst of all worlds could befall our farmers—that we have the cull in order to get the European ban and the worldwide ban lifted, but that in two, three or four year's time, other countries will impose a ban on European beef because of the increase of the incidence of BSE in other member states.
I hope that I am wrong, but I want my right hon. and learned Friend the Minister to take a message to the European Councils dealing with this matter: that we are prepared to ask our farmers to continue to make this sacrifice, but that we expect the other member states to deliver the goods—not only to lift the ban, but to

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implement the necessary measures throughout Europe. It is no good saying that Britain will be free of BSE unless we can say that Europe is free of BSE.
Several hon. Members rose—
Mr. Deputy Speaker (Sir Geoffrey Lofthouse): Order. In the 20 minutes available for the remainder of the debate, four hon. Members hope to catch my eye. I hope that they will all be successful.
11.33 pm
Mr. William Ross: In the light of what you have said, Mr. Deputy Speaker, I shall be as brief as is humanly possible.
The hon. Member for Ryedale (Mr. Greenway) drew attention to the turmoil in the beef industry and on farms during the past year or so. We in this House would be remiss if we forgot all the other people who have lost their jobs or whose businesses have gone to the wall. We must not forget the tremendous misery that this whole affair has caused to the ordinary men and women who depended on a week's wages from the beef industry in one form or another. While I have every sympathy with the farmers, we should also remember the misery that has been suffered by others.
The statutory instruments deal with Great Britain, but the Minister will know that the corresponding orders affecting Northern Ireland passed into law about two weeks ago, even though they were laid on the same day, 18 December. I am curious to know why the orders for the whole of the United Kingdom were not dealt with on one day. Perhaps that has to do with our different legislation; but this is a UK-wide problem, so we should make every effort to deal with it uniformly.
Every farmer in the country will welcome this further step towards clearing up the BSE crisis in the UK, and will hope that the certified herds scheme will be acceptable to Europe. I trust that we will rapidly be able to clear up the remaining stock that may have come into contact with BSE. I am, however, still worried about the suckler herds. What protection will be offered to producers' claims for suckler cow premiums, for example? If those herds are decimated, the farmers concerned could lose out. Furthermore, could such producers be exempt from the quota usage rules for long enough to enable them to get back into full production? That may apply more to closed than to general herds, but the problem needs attention.
Has the problem of flagged holdings, as opposed to flagged animals, as yet been resolved? The matter urgently needs sorting out, but I am not sure that much progress has been made so far.
The Minister will understand that farmers' losses will be compounded by the changes in the green pound. I am told that another change in its value could be here in 50 days' time; it will cause more mayhem and another fall in the price of beef. If the price fell correspondingly in the butchers' shops and supermarkets, we might not mind so much.
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Farmers are concerned when they hear advice to the effect that they must finish their animals a bit earlier. The plain truth is that Northern Ireland has long been engaged, with Government encouragement at every level, in producing large, heavy animals for the continental market. Any man who has ever reared cattle knows perfectly well that cattle first grow their bony frames and then put on the beef after that. It is impossible to finish a large-framed beast before it reaches a certain maturity. It is therefore ridiculous to believe that an animal bred to finish at 450 kg can be finished at 350 kg—it is nonsensical, but intervention weights keep dropping, and I should like to know what the Minister intends to do about that, to relieve the producers.
11.38 pm
Sir Jim Spicer: My right hon. and learned Friend the Minister and his team will know only too well that, over the past year, it has been Dorset in particular and the west country in general that have been hardest hit by BSE. I wonder whether, six months ago, the hon. Member for North Cornwall (Mr. Tyler) would have liked to have been a Minister telling the farmers in north Cornwall or Dorset, "We have this enormous backlog of animals to deal with under the 30-months scheme, but of course I want to talk to you today about the continuing problem we will face once that is done."
In the past two debates in the House, I have quoted my county chairman, John Hoskin, who has been hit harder than almost anyone. Had the hon. Member for North Cornwall tried to approach John Hoskin not just in May, June or July but in August, September or October with such a farcical suggestion, I know exactly what the response would have been, and the hon. Gentleman would have caught the next train back to North Cornwall and probably moved on beyond there as well.
Over the past six months, my right hon. Friends have dealt with the most massive task that we have ever had. My right hon. Friend the Prime Minister made one point clear: this is the greatest crisis that we have faced since the last war, and we have dealt with it. People may criticise, but no one else could have done more than we have to deal with more than a million cattle in the time that we have done it. Let there be no more hypocrisy from the Opposition on that point.
We have lived up to our side of the bargain, and we are now doing what we ultimately promised, at the behest of the National Farmers Union and the Country Landowners Association. They have all reluctantly come to accept that we must go that little extra mile. We are going that little extra mile; we shall complete our part of the Florence deal, and the ball will then be firmly in the court of our European partners.
There remains a big question. There was a time when I had stars in my eyes about the European Community and thought that, if it said that it would do something, it would do it. I am not so sure now. The ball is, however, in its court and, if it does not live up to the undertakings that it has given, we must face up to the fact that we must go it alone. We must make our own dispositions, not just for one or two years but up to 2001 and beyond.
When we debated the matter on 15 May with the hon. Member for North Cornwall and others, I said that, within those dispositions, if our European partners did not lift the

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ban, we would have to consider taking action against them and say that, unless the beef that they produced was up to the standard and quality of ours and had the same safeguards, we would have to think about banning their beef and building up a fortress Britain in terms of beef. That is the last thing that we want, but the ball is in their court and they must play their part.
By 2001, BSE will be eradicated in this country, but will it be eradicated in Europe? As my hon. Friend the Member for Ryedale (Mr. Greenway) said, we doubt that very much, so we must ensure that we have access to those world markets.
I thank my right hon. and Learned Friend the Minister and all those who played their part in bringing us to this point where we can do our final part. If the others do not live up to their side of the bargain, I simply say, "Let it be on their heads, not on ours."
11.42 pm
Mr. Eddie McGrady: In two short sentences, I should like to remind the House of the great calamity that BSE has been to the Northern Ireland farming community. Of a population of 1.5 million, 60,000 people representing 8 per cent. of the work force are engaged in the farming industry. Two thirds of the farms in Northern Ireland, small as they usually are, are involved in rearing cattle, and they produce a disproportionately high 12 per cent. of the entire UK herd. That is the enormity of the problem facing the Northern Ireland base industry—agriculture—which consists mainly of cattle rearing.
Those in the farming community generally welcomed the proposals for the selective cull and they want it implemented as quickly as possible so that they can re-enter the European market. Northern Ireland exports 75 per cent. of its meat, and 50 per cent. outside the United Kingdom.
I want to raise with the Minister one or two quick points for consideration, as they are causing concern to farmers in Northern Ireland. Although the farming industry in Northern Ireland accepts the reasoning behind the voluntary nature of the slaughter of the 1989–90 cohorts, and the fact that there is a problem given the traceability in Great Britain, nevertheless that traceability is total in Northern Ireland. Could not the slaughter of those 1989–90 cohorts be made compulsory in Northern Ireland? It could be carried out quickly and efficiently, thereby completing the five requirements of the Florence convention.
The other matter that farmers want the Government to address is the proposed method of counting herd size, which will be used to calculate the compensation top-up payments for the cull. We know that it differs from the method that is already in operation for the temporary reallocation of additional milk quota. The method used for calculating herd size for the temporary milk quota allocation should be used for the purpose of the cull as well.
The Ulster farmer is concerned that top-up payment is triggered only when the producer loses 10 per cent. of the herd. The Minister spoke about flexibility. It would be beneficial to the very small farmers, of whom Northern Ireland has a considerable number, if there was a tapering scale from 1 per cent. to 9 per cent. The flexibility offered by such a sliding scale would bring adequate and proportionate benefit to the very small farmer.
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The certified herds scheme should recognise the part played by the selective cull as a step towards certification. To ensure that the scheme is of practical benefit, the farming community offers four proposals for consideration. First, as has been said, the flagging of herds should be introduced, instead of the flagging of farms. The flagging of herds occurs throughout Europe. The UK is the only country where farms are flagged. I understand that that is the result of an administrative slip-up at an earlier stage. It could be corrected virtually by the stroke of a pen, if that is done now.
Secondly, the certification of animals should replace the certification of herds. Thirdly, all animals born after 1 August 1996 should be eligible for the scheme, irrespective of the BSE status of the holding from which they originated. Fourthly, BSE-affected herds should be accepted into the certified herds scheme once they have completed an agreed restriction period of no more than six years.
In view of the time restrictions, I am grateful for the opportunity to make those points. I ask the Minister to consider them in the light of the flexibility that he said would be adopted. In recognition of the enormous problem that we have in Northern Ireland, where the industry is such a fundamental part of our economy, I ask him to address the issues sympathetically.
11.48 pm
Rev. Ian Paisley: I shall not repeat the matters raised by my two colleagues. They have underscored what is in the mind of the farming community in Northern Ireland. As a Member of the European Parliament, let me tell the House that there is no promise from Europe that, if we do what we are doing tonight, we will receive a firm assurance that the ban will be raised.
The damnable report due next month will raise the matter to new heights. It has been purposely planned so to do by the political managers in Europe. There will be an attack on British beef and wild accusations which will reverberate throughout Europe and build an almost impassable wall.
I regret that my proposal in a previous debate was not adopted. Because Northern Ireland has the traceability scheme, we should have proposed that as a pilot scheme, carried out the cull according to the Florence terms in that part of the UK and awaited Europe's reaction. If Europe had said no, the Government would have known that their actions tonight would not evoke the response necessary.
Baroness Denton, the Under-Secretary of State for Northern Ireland with responsibility for agriculture and the economy, announced recently that Northern Ireland had weathered the BSE storm. It has done nothing of the sort. A review of the economy, which will be released this week, states that not only the farmers but the food processors, road hauliers, feed merchants and renderers of Northern Ireland will go under. We are facing the biggest crisis since world war two. If we do not find a way out, the agricultural sector—the basis of the entire Northern Ireland economy—will go under. I must be a prophet of doom tonight—I cannot be anything else—because we would be foolish to believe that, by taking this action tonight, we shall see the ban lifted in Europe. That will not happen.
11.50 pm
Mr. Edward Garnier: Having listened to the remarks of my hon. Friend the Member for Ryedale (Mr. Greenway), I am tempted to say that I agree with all that he said and to add nothing further. However, I must take this opportunity to proclaim my faith in British beef and in the British farming industry, particularly in so far as it affects my constituents.
I ask my right hon. and learned Friend the Minister to consider the question of compensation. I appreciate the fact that a huge amount of money has been spent supporting the beef and dairy industries in the past nine or 10 months, but will he ensure that payment is made under the scheme as speedily as possible? As other hon. Members have said, there is nothing worse than having to wait for one's money—especially in circumstances such as this.
I also draw my right hon. and learned Friend's attention to the question of economic loss. I acknowledge that there will be almost 100 per cent. compensation for individual beasts, but I am concerned about the potential for tremendous economic loss with the top-up regime. For example, if 40 per cent. of a herd is culled, it will be almost impossible to return that herd to an economic basis—not least because the milking cows introduced into the herd will take some time to come on full stream and milk at the same rate as the cows they replaced. I urge my right hon. and learned Friend to bear that factor in mind.
I also ask my right hon. and learned Friend to keep an eye on the nature of replacement beasts, especially if they come from abroad. We must be assured that the beasts that are introduced into the United Kingdom pass our stringent tests for quality. Can we be sure that they will not have been fed meat or bonemeal, which would cause a new schedule of disasters that we would face at our peril?
I hope that the brevity of my few short points will commend them to my right hon. and learned Friend.
11.53 pm
Mr. Christopher Gill: I preface my remarks with a tribute to the patience and tolerance displayed by the meat and livestock industry during the past 10 very difficult months. Those in the industry on either side of the farm gate—both those who have been compensated and those who have not—have adopted a most responsible view in a joint endeavour to see British beef once again assume the position that it rightfully deserves as the best in the world.
In July, I sponsored early-day motion 1180 which said, among other things, that there was no guarantee when the beef export ban would be lifted. I believe that those comments are equally true today. We are debating the issue tonight, not for scientific reasons or because of human or animal health considerations, but because of purely political considerations. Right hon. and hon. Members have already referred to that fact.
What I regret more than anything else in this whole sad business is that our Government, who up until 27 March last year steadfastly said that every action they took in respect of beef and the safety of food in the British Isles would be based on scientific evidence, have been driven because of force majeure from that position to the point
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where today our every consideration, our every resolution, is dictated by the politics resulting from the fact that we are now subject to the vagaries of the European dimension. That is a matter of very great regret.
We will have needlessly slaughtered more than 1 million cattle to comply with this political imperative, in just the same way that, as I speak, fishermen at sea are dumping back into the sea thousands of fish that are perfectly saleable and could provide meals for housewives and their families; in the same way that, because of the failure of politicians to make the right decisions, 3,750,000 head of poultry have been killed to comply with the zoonoses orders when so many of us well know that the answer to that problem was to convince the British housewife, the cooks and the chefs in kitchens to cook their eggs and poultry correctly.
For how long can the animal kingdom tolerate this abuse, brought about by the failure of politicians to discharge their responsibilities properly and adequately rather than to blame the fowl of the air, the beast of the field and the fish in the sea for their own inadequacies?
Because of what we are doing tonight, which is serious and to a greater or lesser extent immoral, we must put the European Union on notice that, unless what we are doing tonight results in the ban being lifted, we can no longer tolerate this imposition.
Finally, I say one thing specifically to my right hon. and learned Friend the Minister. The inclusion of in-calf heifers in herds is unprecedented. It is without justification, and I do not think that the House has been convinced tonight by his explanation. I just hope that he will find some way in which to amend the statutory instrument to ensure that in-calf heifers are not included in the herds for compensation purposes.
11.58 pm
Mr. Douglas Hogg: I am conscious that the debate concludes in five minutes, so I hope that the House will forgive me if I answer many of the points briefly—
Mr. Deputy Speaker: Order.
Mr. Hogg: I should have said, "With the permission of the House". I am so sorry.
I entirely agree with the point made by my hon. Friend the Member for West Dorset (Sir J. Spicer). It was very important to complete the removal of the backlog under the over-30-months scheme before we embarked on the selective cull.
My hon. Friends the Members for West Dorset, for Ryedale (Mr. Greenway) and for Ludlow (Mr. Gill) asked whether there was a timetable for relaxing the ban. There is not. We will proceed as fast as we can, in stages, but I do not conceal from the House that this will be a difficult task and will take time. I do not wish to mislead anybody on that point.
Mr. Welsh: Will the Minister give way?
Mr. Hogg: No, I have only three minutes.
Various important points were made about the suckler cow premium, for example, by the hon. Member for Edinburgh, East (Dr. Strang). I am aware of the point, which relates to the culling of cattle during the retention

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period. We take the view that the culling of cattle during that period is covered by the force majeure principle. We have already approached the Commission on that point. We have not had a concluded answer yet, but our arguments are strong, and I hope that we shall get a sympathetic response.
My hon. Friend the Member for West Gloucestershire (Mr. Marland), and others, asked whether the Commission was happy with the eradication plan as is. The House will remember that the plan as it was submitted at the time of the Florence agreement, was approved by the Standing Veterinary Committee and received the endorsement of the Commission. That does not mean that we will not face suggestions that we should extend the scheme to a cull based on maternal transmission in certain circumstances that I outlined to the hon. Member for Edinburgh, East.
There will be tendering for the period after 1 April. The hon. Member for Ynys Môn (Mr. Jones) and my hon. and learned Friend the Member for Harborough (Mr. Garnier) talked about prompt payments. Payments should be made within 21 days of slaughter or registration, whichever is the later. In reality, that will be 21 days from slaughter, and that is extremely important.
My hon. Friend the Member for Ryedale talked about the temporary committee of inquiry. There is only a draft at this stage. Lord Plumb said properly that it is based on prejudice, not on evidence. I take the view that Ministers who are accountable to the House should not be summoned by the European Parliament simply because it is seeking to exercise a supervisory role over nation states. I regret that the Liberal Democrats appear to take a different view.
The hon. Member for East Londonderry (Mr. Ross) raised an important point about the green pound and revaluation. The hon. Gentleman knows that there have been many devaluations over the past few years. He knows also that as regards 60 per cent. of the direct payments there is a freezing at current rates, which is worth about £200 million.
We have been criticised for not listening to the farmers. I do not believe that that is true. We adopted replacement value as a consequence of what was said to us. The second consultation paper on cohorts reflected the points made to us by the farming industry, as did our proposals on consequential loss.
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My hon. Friends the Members for Ryedale and for West Gloucestershire made an important point about the absence of a specified bovine material regime in Europe, and they were entirely right to do so. The absence of such a regime is lamentable. The matter was considered at the December Council and Agriculture Ministers decided not to accept the Commission's recommendation. I regard that as a serious omission.
I take no pleasure in the statutory instrument, for all the points and reasons that have been advanced by other hon. Members. If we do not agree to it, however, there is no prospect of securing any relaxation of the ban. On that basis, I commend it to the House.
Question put and negatived.

SCOTTISH GRAND COMMITTEE
Motion made, and Question put forthwith, pursuant to Standing Order No. 94H (Scottish Grand Committee (sittings)),
That the Order of the House [6th November] shall be amended in paragraph (6), by leaving out the word 'Scotland' and inserting the words 'the Town Hall, Montrose'.—[Mr. McLoughlin.]
Question agreed to.

EUROPEAN COMMUNITY DOCUMENTS
Motion made, and Question put forthwith, pursuant to Standing Order No. 102 (European Standing Committees),
EUROPEAN COMMUNITY DOCUMENTS

  DRAFT BUDGET FOR 1997
  That this House takes note of European Community Documents Nos. 9372/96, the draft general budget of the European Communities for 1997, SEC(96)1677, the Letter of Amendment No. 1 to the preliminary draft budget of the European Communities for 1997, PE252.724, the European Parliament's resolution on amendments and proposed modifications to the draft general budget of the European Communities for 1997, 11689/96 and 11690/96 on the Council's Decisions on the European Parliament's proposed amendments and modifications to the draft general budget of the European Communities for 1997, and the unnumbered explanatory Memorandum submitted by HM Treasury on 15th November relating to the Letter of Amendment No. 2 to the draft general budget of the European Communities for 1997; and supports the Government's efforts to maintain budget discipline in the Community.—[Mr. McLoughlin.]
  Question agreed to.

Pinderfields Hospital
Motion made, and Question proposed, That this House do now adjourn.—[Mr. McLoughlin.]
12.2 am
Mr. William O'Brien: I am grateful for the opportunity to talk about what I term my local hospital. Pinderfields hospital, which is located in my constituency, is an acute services general hospital, offering good and much needed services to the people of Wakefield. The hospital has wards in permanent buildings and temporary buildings. The temporary buildings were erected in the early 1940s to provide medical treatment for wounded personnel in the forces during the second world war.
On at least three occasions, programmes have been launched to replace the old outdated wards with new, modern wards with modern facilities. In the past 17 years, the Government have made a number of promises to build new premises. The most recent promise, of 1995–96, was made under the private finance initiative proposals. The publicity and hype about those proposals have now faded, due to the Government's policy on hospital mergers. I want to make it clear to the Minister that we do not need a merger, and that we want to develop our own Pinderfields hospital.
People who rely on Pinderfields for medical services keep asking when the new buildings will be ready. Perhaps I could extract a response from the Minister on that issue. The conditions under which nurses and staff work, and the premises in which patients receive treatment, would not be tolerated by many hon. Members, who would demand changes and improvements.
The hospital has recently been under tremendous pressure because of the number of referrals from general practitioners and the number of admissions through the accident and emergency unit. The local newspaper, the Wakefield Express, is a creditable newspaper with a creditable reporter. On 10 January, its headline read: "Hospital on brink of crisis". That referred to Pinderfields hospital. Health officials admitted that, had there been a major accident or incident in December or January, the hospital would have had to close its doors to all but the most urgent cases. Due to the dedication and sterling work of the staff at the hospital, it remained open and continued its good work.
Wakefield area health authority provided funding for extra beds to cope with the high demand. It opened a short-stay surgical ward at the nearby Clayton hospital to help to minimise the impact on waiting lists. That was sound judgment by the health authority.
My concern is heightened by the fact that the Wakefield area health authority is facing an overspend in its budget of about £5 million in the current year. It also has an over-commitment of almost £6 million on the expected budget allocation for 1997–98. The hospital is facing a financial crisis, and the stress on the staff due to the extra admissions and the heavy work load is exacerbated by the overspend on the budget and the cuts required to keep within budget. The staff are conscious of the fact that further economies must be made to keep within the budget provision.
There is no evidence of unjust spending. The hospital works within the Government's guidelines, and there are no surpluses. The problem is with the formula for the
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allocation of resources, as set by the Department of Health. Pinderfields hospitals faces a deficit of £3 million in the current year, with a further debt of £3 million for the fixed costs of the transfer of neurosurgery from Pinderfields to Leeds later this year. Will the Minister explain how such a crazy situation arose? Pinderfields had a first-class neurosurgery unit, which provided a first-class service. It was a regional unit stationed at Pinderfields, but it was stolen from us and located in Leeds.
Why should we have to pay £3 million fixed costs? That will push the hospital budget further into deficit. Why should the purchasers of services from Pinderfields hospital pay the costs of the neurosurgery unit that no longer exists?
All the health agencies in Wakefield, including Wakefield and area health authority and the three trusts, are concerned about the funding formula applied by the Department of Health for health care in Wakefield. I readily accept that there is no perfect formula for allocating resources, but there are fairer formulae than the one that currently applies there. How, for instance, did the Minister arrive at his decision that the population in our area was falling, which was one of the reasons for reducing our resources? I do not consider that to be true.
Why are we penalised for being a low-paid, low-income area? That is how the formula applies in Wakefield and we are being told that, in some areas where incomes are higher, we do not need as much. Why should the fact that only 1.75 per cent. of our population consists of ethnic communities influence the allocation of resources?
Does the Minister take into account the elderly population who suffer from respiratory diseases? A mining community such as ours contains chronically sick people, and a significant number of children and adults are troubled by asthma. The Wakefield and Pontefract asthma group is committed to addressing the apparent gap in provision between hospital and community, and to developing closer collaboration between primary and secondary care.
Does not such suffering influence the Minister's decision on a formula for the allocation of resources? We need money to ensure that our hospitals have a respiratory consultant. Research shows that the recording of information with such a consultant is far more accurate and revealing than it is with a non-respiratory consultant.
Earlier, I referred to the transfer from Pinderfields of the neurosurgery unit, which used to generate an income of around £3 million a year, which helped to provide services at the hospital. I consider the loss of that £3 million a betrayal of Pinderfields and of my constituents.
Wakefield community health council raised the loss of revenue with the regional health authority, which promised that £1 million would be given in assistance, that a "regional centre of excellence" would be provided at Pinderfields and that an MIRI machine—which is a kind of scanner—would also be provided. None of those promises has been fulfilled. Mr. Ron Beneford, chairman of Wakefield community health council, agrees with me that all at Pinderfields hospital feel betrayed by the regional and national health authorities.
Will the Minister give me an assurance that the promises made to the community health council will be fulfilled? If we cannot rely on promises made in good

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faith, how can we trust the people who made those promises and reneged on them—or the people in authority—in the future? The funding of health care and the formula for allocating resources are fundamental to Pinderfields hospital.
As I have said, there is a massive acute services deficit in the Wakefield area, yet it is reported that GP fundholders in the district have underspent by £7.6 million over the past three years. Why is primary health care in surplus, while secondary and acute health care are in crisis? The malaise is caused by crazy accounting.
Pinderfields hospital provides intensive care and high-dependency units, but additional demand could leave the hospital in difficulty. Last year, Wakefield health authority considered the provision of intensive care and high-dependency units at Pinderfields, and there was some investment in additional units. That investment had a serious impact on the health authority's budget. Will the Minister assist Wakefield health authority to cover the cost of the extra intensive care units that had to be provided?
I have spoken about promises. When the maternity hospital at Manygates in Wakefield was closed, a new maternity unit at Pinderfields was promised, but the promise was not fulfilled, and we again feel betrayed by the Government. My constituents use Pinderfields hospital and the staff there would like to be able to see to the needs of patients. One of my constituents who suffers from multiple sclerosis needs Interferon treatment. Pinderfields would like to treat that constituent with Interferon, but cannot do so because of the cost. My constituent tells me that patients in the south of England can get treatment without difficulty. That is another example of the north-south divide.
The treatment that the hospital can afford to give my constituent makes her feel worse, and she complains about the deterioration in her health because of what I have described. I have written to the Secretary of State for Health on this matter and received a response, but the issue has not been resolved.
Pinderfields hospital contains the Yorkshire regional spinal injuries unit and the famous burns unit. Because the neurosurgery unit is being stolen and taken to Leeds, there are fears that, if Pinderfields and Pontefract hospitals are merged, we could lose two prestigious units and finish up with two cottage hospitals. That is another reason for objections to the proposed merger.
I have made the case for Pinderfields hospital to be given special consideration by the Minister. I seek fairness and justice, and that is not unreasonable.
12.18 am
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am glad to have the opportunity to respond to the hon. Member for Normanton (Mr. O'Brien) and to congratulate him on securing time to debate a subject that is linked to health services in Wakefield—Pinderfields hospital. This is the fifth time since January 1995 that we have had an opportunity to debate health services in Wakefield. Opposition Members certainly deserve full marks for persistence. I acknowledge that you also have an interest in this area, Mr. Deputy Speaker. I, too, have an interest, because, as the hon. Gentleman will be aware, I went to school in Wakefield. I have known Pinderfields over many years, particularly when I was a teenager.
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I have listened to the hon Member's concerns and the case that he has outlined against the proposed merger of the trusts at Pinderfields and in Pontefract. I am aware of the strong local feelings on the proposal. However, as I said in the Adjournment debate in November on the proposed merger of the two trusts, it seems that some hon. Members might be trying to link two separate issues—the management of the acute trusts at Pontefract and Pinderfields, and the delivery of services.
The consultation, which, as the hon. Gentleman knows, ended last week, was on a proposal to merge two trusts, not on a proposal to change the health services in the Wakefield area.
The proposal that is under discussion in Wakefield, and in Pontefract, is a proposal to merge two trusts—or, to be more exact, to dissolve two trusts and create one new one. It is a proposal to change the management structure of NHS trusts in Wakefield, and it is not a proposal to change the services.
The responses to consultation on the merger proposal are now being considered by the NHS executive. It is likely to be referred to Ministers for consideration shortly. I must and will keep an open mind until the appropriate time. As I have said, I am aware of the strong local opposition to the proposal, including from local hon. Members and from the local community health councils. On the other hand, I am told that there is strong clinical support for a merger from local consultants and from general practitioners.
As I said in November, Wakefield health authority has announced that it will look again at its health strategy, and will hold a separate public consultation on that later this year.
The Secretary of State for Health is required to consult on proposals to establish new health trusts. There has now been a long consultation, lasting from July 1996 until the middle of this month, on the proposed merger of Pinderfields and Pontefract trusts. As soon as it was realised that more was needed to be done to fulfil the statutory requirements, Wakefield health authority was asked to consult on behalf of Secretary of State, and the consultation period was extended. That has meant that consultation has taken longer than might have otherwise been the case.
However, the extra consultation period will certainly not be wasted. All the views expressed during both periods of consultation have been passed to the NHS executive, and will ultimately be seen by Ministers. The extension has allowed local people almost double the usual time to express their views. There can be no doubt that the consultation period has been thorough.
Many factors need to be taken into account when considering a proposal such as this. We will carefully consider the adequacy of the consultation process and the views of local people, including those who took the time to sign a petition organised by Normanton town council and presented by the hon. Member for Hemsworth (Mr. Trickett) recently. We will also look at the likely impact on effectiveness, efficiency, and accessibility of the potential creation of a new trust. Any potential economies of scale will have to be balanced against any possible loss of patient choice.
I can assure hon. Members that this is most certainly not a fait accompli. We had a statutory responsibility to consult publicly, and we will weigh the results both fairly

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and carefully. We will look closely at the interests and the health of the people of the Wakefield health authority area.
The hon. Gentleman and his hon. Friend the Member for Wakefield (Mr. Hinchliffe) have previously expressed concern about the results of past consultations. I understand their feelings on this subject. In particular, they have cited the investment in rehabilitation which the former Yorkshire regional health authority had planned to place in Wakefield, following agreement that neurosurgery should be concentrated in Leeds. There were good reasons for concentrating neurosurgery in Leeds, but I understand the way in which the hon. Member for Normanton expressed his feelings this evening.
We cannot turn the clock back to 1994, because the regional health authority was abolished in March of that year, almost three years ago. We live in a changing world, but it is also a fact that the NHS executive northern regional office has offered support in the form of research and development support worth around £50,000 for an academic development in rehabilitation medicine. So at least something will come to Wakefield out of that situation, which is now past and gone.
The hon. Gentleman also reported on the winter pressures that he has experienced in the local hospitals in the Wakefield area, particularly in Pinderfields hospital. Although the position is undoubtedly difficult at this time of year—it usually is—the trust is coping and has coped well. Indeed, I hear that some general practitioners have complimented it on its performance.
Some non-urgent elective admissions have had to be cancelled, but the Pinderfields hospitals trust chief executive has emphasised that the percentage is small—about 33 out of around 1,000 planned operations. Hospitals cancel operations occasionally, but they try to keep cancellations to as few as possible because a cancellation is undoubtedly extremely unfortunate for the patient concerned—it is very disappointing indeed. It is only right that emergency and urgent cases should have priority.
As the hon. Gentleman said, the trust has made six new beds available at its Clayton hospital to ease the pressure on Pinderfields. A similar thing has been happening throughout the country. Admissions units have been opened and additional beds made available where possible. I am glad that Pinderfields was able to make that effort to ease the pressure. I am sure that that sort of sensible management move has helped during this winter.
Once the proposal for a merger is decided, we can look at the management arrangements. Meanwhile, Pinderfields hospitals trust has an able acting chairman and an experienced acting chief executive, in a trust that has also recruited 25 new consultants since 1993—a considerable investment in the appropriate skilled health care for the area.
I also recognise that the Pinderfields hospitals trust is facing a complex set of interdependent issues. As I have said before, the ultimate goal is to ensure that sustainable, high-quality and cost-effective clinical services are provided with modern facilities. Although the consultation on the proposed merger and, separately, the configuration of health services will take time, those
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processes should ensure that whatever solution emerges is based on informed debate among the public and the professions. I am committed to seeing that that happens.
The hon. Gentleman also, very fairly, raised the question of the finances of the health authority, the trust and the GP fundholding practices, which, as he knows, are extensive in the Wakefield area. I must point out that, in November, we announced that an additional £1.6 billion would be available to the health service next year to safeguard and improve patient care.
Hon. Members have criticised the funding for Wakefield, but the health authority is above its weighted capitation target. Despite that, it will receive an integrated revenue cash increase of £5.3 million next year, which is a real-terms increase of £2.3 million, or 1.6 per cent. Surely that is not a cause for complaint. Wakefield has done rather better than the average, despite the fact that it is over its capitation target.
The hon. Gentleman was also concerned about how that capitation target is made up, and was worried that the needs of Wakefield people were not taken into account. I acknowledge his interest in the problems of asthmatics and in the National Asthma Campaign. I was glad to hear about the activities of the Wakefield and Pontefract asthma group. I am sure that that is very relevant. I can well imagine the sort of respiratory diseases that are common in that area.
I assure the hon. Gentleman that the formula, particularly next year, when it has been adjusted to take account of community health needs, including mental health, is more focused on need than it has ever been in its history. If anything, the sort of area in which Wakefield is situated will have gained from the reformulation of the formula for the cash handed out next year.
I also want to stress that the work on the formula is undertaken as a result of the effort and research by York university. It is independent, and considers objectively the population needs of areas such as Wakefield. It is as objective a measure as we can possibly make it. That is the basis on which the Wakefield health authority gets its money.
The hon. Gentleman was also concerned about the trust's finances. Certainly, I would not deny that there have been some problems over the finances—that has been the case for some time—but I am assured that the situation is not deteriorating but is, on the contrary, improving, and that a firm three-year plan is in place to resolve the problems. That will be affected by the merger, but it is none the less in hand to put things on a sound footing. There is no reason to believe that that sensible approach will not be successful.
The hon. Gentleman further expressed concern about the amount of money in the GP fundholding system and asked in effect whether it could in some way be transferred to help with the problems in the acute hospitals. My point about that is that it would essentially destroy the whole point of the GP fundholding system, which is that, where fundholders generate surpluses, they can put them back into improving primary care. They must be allowed to do that.

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The health authority may hold those surplus funds for the moment, but they are in effect held in trust on behalf of the GP fundholders who generated them, and it is right that they should go back into primary care. We are, after all, talking about a primary care-led service.
I am sure that the hon. Gentleman will be aware that Wakefield is at the cutting edge of a primary care-led system, because about 82 per cent. of the population are in 33 GP fundholding practices, and it is expected that that proportion will rise to nearly 100 per cent. by April this year. Wakefield is setting a trend in that area, which will be extremely good in the medium and long term for the health of people living there.
I should also point out that Pinderfields has benefited recently from considerable additional investment. For example, an advanced eye surgery unit was opened last year at a cost of £500,000. It is considered one of the best in Europe, and will certainly reduce waiting times for eye surgery.
Mr. William O'Brien: Will the Minister address the point about the historic debt from the transfer of
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neurosurgery, which will cost the trust about £3 million, when the transfer of the service is not the trust's responsibility?
Mr. Horam: I take the hon. Gentleman's point, but, in the transfer of the neurosurgical unit to Leeds, revenue is lost but so is cost; so that would not necessarily disadvantage Wakefield, considering the net position, balancing revenue and cost. However, the point was new to me, and I shall certainly investigate it and perhaps write to the hon. Gentleman. I am not sure that he is right: the situation is probably more balanced than he thinks.
The burns unit in Pinderfields is famous and, considering it alongside the other facilities that are available, the situation in Wakefield is extremely promising. The combination of primary development, in which Wakefield is well ahead of most other parts of—
The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at twenty-eight minutes to One o'clock.