National Health Service

HC Deb 21 January 1997 vol 288 cc746-841 3.53 pm

Mr. Chris Smith (Islington, South and Finsbury)

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 (Mid-Staffordshire)

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. 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.

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 (High Peak)

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 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 (York)

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.] 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 (Halifax)

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 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 (Kingston upon Hull, West)

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 (Southwark and Bermondsey)

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 should freeze while that was under way, but I welcome his approach and look forward to further discussions with him.

Mr. Nigel Waterson (Eastbourne)

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 (Workington)

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 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— 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 (Carshalton and Wallington)

rose—

Mrs. Margaret Ewing (Moray)

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, 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 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 (Morley and Leeds, South)

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 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.

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 (Sunderland, South)

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 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 (Birmingham, Northfield)

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 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 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 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 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 (Bristol, East)

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 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 (Twickenham)

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?

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 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 (Wycombe)

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 (City of Durham)

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 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 (Birmingham, Northfield)

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.

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

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 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 (Renfrew, West and Inverclyde)

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 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 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 (Southwark and Bermondsey)

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: 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 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 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, 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.

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 (Wycombe)

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 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 (Nottingham, East)

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 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.

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 (Morley and Leeds, South)

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 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.

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. 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 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 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 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 (Birmingham, Edgbaston)

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, 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.

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 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 (Rother Valley)

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.

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 (Cardiff, West)

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 (Warrington, South)

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.

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 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.

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.

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 (Carshalton and Wallington)

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 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 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 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.

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.

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 (Belfast, South)

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". 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 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 (Belfast, West)

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."

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 (High Peak)

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 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.

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 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 (Nottingham, East)

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 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 (Havant)

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 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; 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 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 (Eastbourne)

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 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 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.

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 (City of Durham)

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 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 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, 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 (Beckenham)

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 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.

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.

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 (Ceredigion and Pembroke, North)

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.

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 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 (Dulwich)

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 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 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, 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 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 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 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 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.

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.

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

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

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

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

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

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

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

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

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)

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.