Commons Sitting of 9 July 1998

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

  LLOYDS TSB BILL [Lords] (By Order)
  Order for Third Reading read.
  To be read the Third time on Thursday 16 July.

Oral Answers to Questions
  EDUCATION AND EMPLOYMENT
  The Secretary of State was asked—
  EDUCATION AND EMPLOYMENT

    Education Action Zones
    Mr. John Gunnell: What is the timetable for (a) applications and (b) decisions on the remaining education action zones which come into effect in 1998–99. [48088]
    Mr. Phil Willis: What plans he has to increase the number of education action zones in the next four years. [48094]
    The Secretary of State for Education and Employment (Mr. David Blunkett): We had 60 applications for the present bidding round, 25 of which have been chosen to commence from September and/or January 1999, each receiving £750,000 a year for at least three years from public funds and £250,000 from other sources.
    Mr. Gunnell: I thank my right hon. Friend for that information. Can he confirm that the Leeds local education authority can submit an application in the second phase of announcements for zone status for the inner-south Leeds family of schools, having withdrawn its earlier submission owing to reconsideration of the future for Middleton Park high school in my constituency? Will such an application get equal consideration alongside those remaining earlier submissions?
    Mr. Blunkett: I am happy to confirm that applications from Leeds on the lines that my hon. Friend outlined would indeed be welcome. I was greatly impressed with the east Leeds initiative when I went to see it earlier this year with Madame Cresson, and I know the excellent work that is being undertaken by the schools, the governing bodies and the local education authority in Leeds. Should we be fortunate enough next week to secure the resources in the spending review to expand the
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    number of education action zones in the remainder of this Parliament as we intend, Leeds will be a welcome bidder indeed.
    Mr. Willis: I am deeply grateful to the Secretary of State for his final comments. He will know that my former school, John Smeaton community high school, was part of that east Leeds consortium and those words will be welcome there. Does he agree that the Liberal Democrats have strongly supported the introduction of education action zones? Indeed, we welcome their expansion, provided they are successful. Does he also accept that if an education action zone fails, it is the local education authority that has to pick up the pieces, so it is important that LEAs have representatives on education action zone forums?
    Mr. Blunkett: We see education action zones as a partnership. Sometimes the LEA is the chair, sometimes business, and sometimes the schools have led the bid, as is the case with east Basildon and Croydon. Wherever the leadership comes from, partnership is crucial. The representation of all interests ensures that they can work together. Although I share the hon. Gentleman's sentiments about that partnership approach, the pieces would have to be picked up by all working in and being educated in the zone—the schools, the governing bodies and the LEA would be included, but parents and children would be at the receiving end. Our task is to ensure that education action zones do not fail, but we should learn the lessons from them and spread what works best as quickly as possible to the remainder of the education service.
    Mr. John Cryer: Does my right hon. Friend accept that there is some concern about the commercial input in certain education action zones? Can he specify exactly what will be the role and input of companies such as Shell in the zones?
    Mr. Blunkett: I want to make it clear that I greatly welcome the tremendous commitment and enthusiasm that is being shown by business, in both cash and kind, to education action zones. I deprecate the abuse that some companies received at the hands of the broadcast media when we made the announcement. The spectacle of Jeremy Paxman and others attacking those who were giving freely of their time and committing their resources, equipment and materials was a disgrace.
    We welcome commitment—whether from Shell, British Aerospace, Marks and Spencer or BT—such as that in Hull, where British Aerospace is linking Hull with Rotterdam, and that in north-east Lincolnshire and Grimsby, where assistance is being given to link every home to schools, so that the network can provide education in the evenings, at the weekend, in the holidays. It is the beginning of a process for the future which will be achieved only if people come together and commit themselves to making it work.
    Mr. Nick St. Aubyn: Schools in education action zones will be buying books, computers and equipment from companies that operate for profit. Does the Secretary of State have any objection in principle to

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    schools or schemes buying management or teaching services from companies that operate for profit, such as the Edison project in the United States?
    Mr. Blunkett: I should be extremely careful not to endorse any private enterprise that is engaged in the education system, as I would disqualify it automatically from any future partnership or bidding process. As people buy equipment, design, cleaning and other services, we will expect the education service, not just in education action zones but elsewhere, to buy expertise wherever and whenever it is required. I make it clear again, as I have done publicly before, that education is not for sale. Education action zones are not the beginning of a process of privatisation.

    Further Education Colleges
    Ms Beverley Hughes: What plans he has to ensure that the members of the boards of corporations of further education colleges are representative of the communities they serve. [48089]
    The Parliamentary Under-Secretary of State for Education and Employment (Dr. Kim Howells): My right hon. Friend the Secretary of State published on 5 March a consultation paper, "Accountability in Further Education", which addresses the matter. Responses are invited by 24 July.
    Ms Hughes: I thank my hon. Friend for that answer. May I inform him that, on a recent visit to my local further education college, I discovered that, of the 22 board members, seven represent staff and six represent local schools and business? Another eight—the single largest group—were appointed by the funding council; and of those, only one lives in the area served by the college. The other seven live up to 30 miles away in highly suburban areas, which are very different from the inner city where the students come from. There is no one from a minority ethnic community, despite the composition of the student group, and there are no parental links among that group with the college. Does he think that right?
    Dr. Howells: I certainly do not think that that is right. We recommended in our Green Paper "The Learning Age" a great deal more accountability for the boards of further education colleges. The changes that we are proposing are designed to assist that process. For example, we shall restore the ability of local authorities to provide governors. Arrangements will be monitored very rigorously by the Further Education Funding Council, and the findings will be available publicly as part of its inspection reports.

    Welfare to Work
    Mrs. Linda Gilroy: What steps he is taking to help people who are unemployed and over the age of 25 off benefits and into work. [48090]
    The Secretary of State for Education and Employment (Mr. David Blunkett): My right hon. Friend the Minister for Employment, Welfare to Work and Equal Opportunities and I launched on 29 June the programme for adult long-term unemployed people,
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    providing £75 a week subsidy, advice and counselling on the lines of the initial gateway for the younger unemployed, and up to a full year's full-time education for those for whom it is appropriate. In pathfinder areas, we are also providing forward funding for the skills initiative, which will help to overcome the skills shortage that has been identified so far by our skills task force.
    Mrs. Gilroy: I thank the Secretary of State for that reply. Does he agree that, for the 678 people in my constituency who are over the age of 25 and have been unemployed for two years, the new deal represents a good deal to help them back into employment? Is he satisfied with the progress in the pilot employment zone in Plymouth, which has already attached 50 people to personal advisers who are identifying personal barriers to getting back to work and staying in work?
    Mr. Blunkett: I am very pleased to give the employment zone and those who got it off the ground the credit that they deserve. It is an excellent initiative and we hope to be able to build on it. We are delighted with the progress made in offering the adult unemployed a real opportunity. Major companies right across the board have been prepared to sign up to the programme since 29 June, and an extra £479 million of new money is going towards helping the longer-term unemployed, on top of the £450 million that is already being put in through the Employment Service, training and enterprise councils and local enterprise companies in Scotland. That makes it possible to give hope to the long-term unemployed at the same time as investing in the future of young people.
    Mr. Andrew Rowe: Is the Secretary of State aware that some elements of the voluntary sector, especially those with long experience of helping people back into work, have been rather disturbed by some of the language used by his Department, which appears to imply that they have no role in the programme? Will he take this opportunity to say that that is not the case?
    Mr. Blunkett: Yes, I am happy to do so. In each of our initiatives, as I said earlier in relation to education, there is an emphasis on partnership. The voluntary sector and those with long-standing experience have an essential part to play not only in delivering the programmes but in giving advice on imaginative ways in which we can re-engage with those who, often through no fault their own, have been out of employment for a very long time.
    Mr. John Healey: Does my right hon. Friend agree that programme centres have proved more successful and more popular among the long-term unemployed, whom they were designed to help, than the Employment Service jobsearch programme? Is he aware that Rotherham is one of the national pilot centres, and that one of our two programme centres, run by QMAT—Quality Management and Training Ltd.—will celebrate tomorrow its 300th client placed in work? Given that the pilot programme centres have already proved their worth, what plans are there to extend the centres throughout the country?
    Mr. Blunkett: I am delighted to commend the work that has been done in Rotherham, and those 300 people

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    have clearly benefited greatly from programmes tailored on a modular basis to their specific needs. The same principles are beginning to be applied across the board. Employment zones, with the personal job accounts, are also a new and imaginative way of making progress. My right hon. Friend the Minister for Employment, Welfare to Work and Equal Opportunities and I want to build on the experience that has been gained and develop the programmes more widely.
    Mr. Paul Keetch: Is the scheme under the new deal for unemployed over-25s compulsory? The design document suggests an element of compulsion, but it is not exactly clear. If there is compulsion, does the Secretary of State agree that, to offer no fifth option for the unemployed under 25 might be acceptable, but to offer no third option for the unemployed over 25 is not acceptable?
    Mr. Blunkett: Attending for interview is compulsory, but taking one of the options available in the programme for the longer-term unemployed is not. When we develop our pilot programme from November, with £129 million of new money and programmes tailored for the 12-month to 18-month unemployed, further options will be available based on the principles set out for the under-25s.
    Mr. Andrew Reed: I welcome the announcement that the over-25s will benefit from the new deal. In my constituency, the vast majority of the unemployed are over 25. Will my right hon. Friend confirm that one of the pilot projects to be launched later this year will be in Leicestershire; and that we are still on schedule to get the over-25 unemployed in my constituency back to work as soon as possible?
    Mr. Blunkett: Yes, I can confirm that that will be one of the pilots, with Fernley business services. It will provide a way for us to test out the most effective and imaginative ways of ensuring that we put behind us the scourge of allowing people to languish on the unemployment register without the prospect of being able to earn their living.

    Unemployment
    Sir Teddy Taylor: What assessment he has made of the likely trends in unemployment in the UK over the next two years; and if he will make a statement. [48091]
    The Minister for Employment, Welfare to Work and Equal Opportunities (Mr. Andrew Smith): By long-standing convention the Government do not publish forecasts of this kind.
    Sir Teddy Taylor: While some of us think that the general outlook is rather depressing, does the Minister accept that the special problems of seaside towns like my constituency, where unemployment is particularly high, deserve his attention? One of my wards has 25 per cent. unemployment, yet we are denied all kinds of grants because we are counted as being in travel-to-work areas where unemployment is much lower.
    Would the Minister be willing to have a special look at this problem, particularly over the next two years? Would he discuss with other colleagues in the Cabinet the
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    possibility of changing the travel-to-work area basis for grants, bearing it in mind that in Southend we have lots of unemployment but no grants whatever?
    Mr. Smith: As the hon. Gentleman will be aware, we have as part of the new deal and our wider welfare-to-work initiative looked at the problems of seaside areas and the particular issues of seasonality as a factor in unemployment, and we have amended the criteria for early entry to the new deal programme to allow personal advisers the discretion to admit people early where seasonality and the pattern of work have been damaging prospects for employment.
    I hope that the hon. Gentleman and other colleagues who represent seaside areas will acknowledge that we appreciate their particular needs. The hon. Gentleman referred to definitions of areas for particular help, and the matter is under consideration. It is primarily the responsibility of my right hon. Friend the President of the Board of Trade; I shall make sure that the hon. Gentleman's concerns are drawn to her attention.
    Ms Hazel Blears: As my right hon. Friend is aware, the Manchester City Pride partnership responsible for delivering the new deal in Salford has applied to be a pilot project for the extension of the new deal to the long-term unemployed. Would not that be an excellent way to attack the unemployment problem, particularly in inner cities? A key issue for people wanting to become self-employed and to start their own business is access to capital, but in many inner-city areas, that is difficult. What help can the Minister provide to ensure that unemployed people have a real chance to set up their own business and so reduce the unemployment which is the scourge of many inner-city areas?
    Mr. Smith: As part of the new deal for the young unemployed, help and advice will be available on progress to self-employment, and that will include advice on access to capital. As part of the new deal for the long-term unemployed, which started on 29 June, we shall extend access through work-based training to self-employment help and business start-up support. Where local TECs, like City Pride, can make that available, that will also be a feature of all the pilots which will be starting in November. I cannot endorse any particular pilot because we have to make a selection judged on the merits of the case, but I recognise the high quality of the delivery of the new deal for the young unemployed in Manchester.
    Mr. David Willetts: The Minister may not want to forecast unemployment now, but before the election he was happy to promise that he would make savings in benefits to unemployed people in order to spend more on education. Will he confirm that the number of unemployed people claiming benefit is now rising? Is that why the Government are incapable of delivering their pledge to raise the proportion of GDP on education spending?
    Mr. Smith: The hon. Gentleman would do well to recall that since the Government were elected to office, employment has risen by 300,000, unemployment claimants are down by 270,000, and International Labour Organisation unemployment is down by 265,000.

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    The hon. Gentleman referred to recent trends. In the first quarter of this year employment increased by 60,000 and unemployment decreased by 35,000.
    When the public hear these claims from the Opposition, they will not forget that it was the Conservative Government who took unemployment above 3 million, who condemned more than 1 million young people to unemployment, and who presided over interest rates at 15 per cent., inflation at nearly 10 per cent., and record levels of bankruptcies and repossessions. There can be no return to the boom and bust and the incalculable damage inflicted on the British people by the Conservative party.

    Moral Instruction
    Mr. Tony McWalter: If he will issue guidance to schools to develop the capacity of school students to reason about moral issues; and if he will make a statement. [48092]
    The Parliamentary Under-Secretary of State for Education and Employment (Ms Estelle Morris): The advisory group on education for citizenship and democracy has identified moral reasoning and responsibility as a vital component of citizenship in its initial advice and will be making final recommendations in July.
    Mr. McWalter: I thank my hon. Friend for that answer and for her interest in the question. Does she accept that many people leave school with an elementary or poor grasp of moral concepts and moral reasoning, and that perhaps we should get on with this matter with rather more haste than we have so far?
    Ms Morris: I am grateful to my hon. Friend for that question. We could not have acted with more haste—we set up an advisory group that has looked at this issue, among others, and reported within the first year of the Labour Government. I look forward to further recommendations from the group and in due time to seeing citizenship, which includes moral reasoning, represent a full part of the curriculum for all our students.
    Mr. Patrick Nicholls: Does the hon. Lady agree that denominational schools are well placed to make a contribution in this process? Does she share my concern that, having gone out to public consultation on the issue following a previous outcry, the Liberal Democrat-controlled Devon county council has introduced a charging regime on parents who want to send their children to denominational schools, using figures described by the principal of Cuthbert Mayne school as nonsensical? Is it possible that, in the study that the hon. Lady mentioned a few moments ago, she might consider the question of denominational transport? While it clearly is not her fault that this situation has arisen, she is now in a position to do something about it.
    Ms Morris: I congratulate the hon. Gentleman on managing to bring denominational transport into a question about moral reasoning. It is for him to deal with what local Liberal Democrats are doing in the area that he serves. I agree with the first part of his question, however. I am greatly persuaded when I visit denominational schools in my constituency and beyond
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    that they have a clear understanding of the shared values of the religious community. Part of the work on this aspect of education involves the encouragement of all our schools to acknowledge the shared values that are so important to every community—both school communities and the wider community.
    Mr. Eddie O'Hara: Does the Minister agree that the way to develop moral reasoning is not only to impart knowledge to pupils but to give them the opportunity to put that knowledge into practice by interacting in curricular and extra-curricular activities? That is a good example of how both didactic teaching and active learning have their part to play. Those who overemphasise passive learning are pointing the route towards moral illiteracy among pupils.
    Ms Morris: I have some sympathy with what my hon. Friend says. It is important to remember that giving children the opportunity to develop moral reasoning is not about telling them blindly to obey what other people say but about teaching them to become active citizens, to understand shared values and to grasp why there is a need for right and wrong both in school and in the wider society. That is what we aim to do with the extra emphasis that we are putting on citizenship. We want to enable students to grow up to be full and active citizens. That means teaching why we have right and wrong and why moral values are so important to society.
    Dr. Julian Lewis: Is it not ironic that politicians should be talking about giving moral guidance to schoolchildren in a week in which the phrases "cash for access" and "Tony's cronies" have passed into the political lexicon? Is it not doubly ironic that this talk should be happening at a time when religious education and religious moral guidance are continually under pressure in schools?
    Ms Morris: It is interesting that the hon. Gentleman should raise that issue—one that I thought might be raised. One of the reasons why we set up our advisory group on citizenship, including moral reasoning, so speedily was that we saw the lack of ability to develop moral reasoning in the past as one explanation of why the previous Government thought that it was acceptable to receive cash for questions.

    Local Education Authorities
    Mr. Mark Todd: What proposals he has to redress inequities in resources allocated to local education authorities. [48093]
    The Minister for School Standards (Mr. Stephen Byers): We are currently reviewing the education standard spending assessment formula and the additional education needs index with the objective of achieving a fairer system. Decisions will be taken in the autumn.
    Mr. Todd: I thank the Minister for the time that he spent meeting representatives of two deprived schools in my community, Newhall infants and Church Gresley St. George's. May I draw his attention to comments made by David Hart, the general secretary of the National Association of Head Teachers, who described the current

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    system for allocating money to schools as grossly unfair? May I also draw his attention to the discrepancy between Derbyshire, where a primary school child receives support to the tune of £1,275 a year, and Kensington and Chelsea, where a child has £2,384 spent on his or her education? Can he explain or justify such a difference?
    Mr. Byers: I do not intend to justify a system that we intend to change. We inherited from the previous Government a system under which the additional education needs index, which is supposed to measure poverty, lists Torbay as being more impoverished than Sheffield, and Barnsley as being in less poverty than Bournemouth. The system is clearly fundamentally flawed, and we will change it to ensure a fairer system for counties such as Derbyshire so that money can be invested in schools in areas that deserve funding.
    Sir Sydney Chapman: Do I take it from that reply that the Minister does not deny a report in the Evening Standard a week ago that the Government plan to transfer funding from London to other parts of the country? [HON. MEMBERS: "Good idea."] My constituents will be interested to hear that. As the Minister is undertaking a review, will he consider seriously the need to increase funding in London because of huge cost increases exemplified by an alarming increase in vacancies for teachers in the metropolis?
    Mr. Byers: We will move to a fair and transparent system for allocating resources. The standard spending assessment regime is only one part of the picture, and it must be considered alongside the comprehensive spending review, which will be made known to the House next week. Together, the review and the new assessment regime will put in place financial support so that every school can deliver high standards and the quality of education that our children deserve, both in London and elsewhere.
    Ms Joan Walley: I thank the Minister for turning his attention recently to the needs of education in Stoke-on-Trent and Staffordshire. His review of the SSA will be crucial in dealing with the year-on-year cumulative underfunding our schools have suffered. May I refer him to the recent Coalfield Communities campaign report, which will tell him that educational achievement in Stoke-on-Trent averages 30 per cent. whereas the national average is 45 per cent. Will his fair and transparent review take into account the needs of Stoke-on-Trent and Staffordshire?
    Mr. Byers: My hon. Friend has been a strong campaigner for schools in her constituency and in Staffordshire. I am sure that the steps that the Government have already been able to take to assist schools in her constituency are making a difference at long last. However, that is only a start. Step by step, we must continue to invest properly and effectively in schools in her constituency and other parts of the country. I am confident that the outcome of the comprehensive spending review next week will bring money to modernise our schools system, money for reform and money to deliver the quality of education that our children deserve and our nation needs.
    Mr. David Willetts: Does the Minister agree with the Secretary of State, who admitted to the Select
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    Committee on Education and Employment the other day that the proportion of national income devoted to education fell during the Government's first year of office compared with our last year in office? Does he agree that that is the opposite of what Labour pledged to the electorate? Will he say how much it would cost to meet the pledge to increase educational expenditure as a proportion of national income?
    Mr. Byers: My right hon. Friend the Secretary of State was referring to the budget for 1997–98, which was set by the Conservative Government when the hon. Gentleman was in office. I agree with the hon. Gentleman. I condemn the fact that a reducing proportion of national wealth was going into education, but that is the legacy of his Government. Next week, it will begin to change because we shall have the outcome of the comprehensive spending review when Labour's priorities will be identified. They will include not waste, but education, health and other areas in which people want investment.
    Mr. David Drew: What progress has been made on the stripping out of common costs? It is bizarre that while the cost of employing a teacher in most parts of the country is similar, that factor is not taken into account in the standard spending assessment.
    Mr. Byers: My hon. Friend raises an important point about the area cost adjustment factor in the education standard spending assessment. The Department of the Environment, Transport and the Regions is the lead Department on those matters, but I confirm that it has begun a review of how that factor works within the SSA. The outcome will be announced some time in the autumn.

    Grammar Schools
    Mr. Graham Brady: How many representations he has received from parents of grammar school pupils in the recent consultation document. [48095]
    The Minister for School Standards (Mr. Stephen Byers): The draft grammar school ballot regulations were issued for consultation on 3 June. The consultation period is continuing and will end on 31 July.
    Mr. Brady: I thank the Minister for that answer. Will he accept my warm congratulations on the wisdom that he and his colleagues have shown in selecting Ashton-on-Mersey school in my constituency as a beacon school? Does he agree that that is a tribute to a selective system of education that is working well? The pupils who do not go to grammar schools in the borough of Trafford, far from being consigned to failure at the age of 11 as he and Labour Members suggest, are consigned to beacon schools. Is that not a tribute to a system of education that has some of the best results in the country?
    Mr. Byers: No, it is a tribute to a Government who are prepared to put dogma to one side in the interests of children. The 75 schools that we announced as beacon schools on Tuesday demonstrate a range of abilities and talents, whether they are selective, non-selective or comprehensive. Wherever they are, if good work is going on, we want them to share the secrets of their success.

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    We will put the interests of children first and we believe that the interests of all children are best served in a non-selective education system.
    Mr. Damian Green: I am interested by the Minister's comment that he is against dogma, but against selective education as a matter of dogma. Among the 75 beacon schools that he identified this week as providing best practice was Torquay grammar school. Will he confirm that he would not want that school to be changed in any significant way because he has identified it as a beacon school? Will he urge local Labour activists to desist from any attempt to change its status, lest parents, governors and teachers at the school think him guilty of hypocrisy?
    Mr. Byers: The future of Torquay grammar school is a matter for local parents in Torquay, as is appropriate. I have no doubt that if a school is doing well, it will have parental support and there is nothing for it to fear. Let us be open. The policy of the Labour party and the Government is clear. We are not going to return to the days when at 11, the majority of our children were condemned as failures so that a few could have a superior education. Our goal in government is to ensure that all children have a high-quality education, and we intend to achieve it.

    Family-friendly Employment
    Mr. Vernon Coaker: What steps he is taking to promote family-friendly employment practices. [48096]
    The Parliamentary Under-Secretary of State for Education and Employment (Mr. Alan Howarth): We are working across Government to promote family-friendly employment policies in a range of ways. My Department's contribution includes the national child care strategy and publicising the business case for such policies.
    Mr. Coaker: Does the Minister agree that this is a most crucial area of Government policy and that, if we are to bring about change in the country, family-friendly employment practices are extremely important? Does he agree also that there is a long way to go in terms of increasing employers' awareness of all that is available and bringing the standards of practice of the poorest employers up to the standards of the best?
    Mr. Howarth: My hon. Friend makes a fair point. There is much happening through the national child care strategy and the policies set out in the "Fairness at Work" White Paper, which reflect the importance that my hon. Friend and I and the Government attach to family-friendly policies. I appreciate that it is a complex story, and we shall make every effort to explain the case. We have produced a summary version of our Green Paper on child care, which is available on the internet and in a range of languages in accessible formats. We are supporting parents at work by producing a pack for employers. This afternoon, I shall meet Joanna Foster, head of the National Worklife Forum, which is a campaign sponsored by industry to make the case for family-friendly policies.
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    I shall brief business men next week for an hour at breakfast—when I hope that my hon. Friend's alarm clock will not have gone off.
    Mr. Roy Beggs: Does the Minister accept that more families now depend on the income of both parents to ensure reasonable living standards for them and their children? Does he accept also that, although the situation will be improved by the introduction of the minimum wage, more friendly employment practices would be achieved if employers provided more flexible working hours for mothers of young children and creche facilities for the children of working mothers?
    Mr. Howarth: I agree very much with the hon. Gentleman. More and more employers are recognising the business case for family-friendly employment practices. Such practices mean that they will be able to recruit from a wider pool of labour and retain workers whom they have trained to skill levels. Productivity will be greater because there will be less stress and absenteeism among the work force. Employers can help in a variety of ways: by supporting the child care costs of staff, sponsoring places in out-of-school clubs and holiday play schemes, linking their employees with child minding networks and operating flexible working hours and term-time working. In all those ways, employers can help their colleagues in work to balance their obligations to the employers with their obligations to their families.

    Child Care
    Mr. Tony Clarke: What steps he plans to take to ensure the safety of children in child care facilities. [48097]
    The Parliamentary Under-Secretary of State for Education and Employment (Mr. Alan Howarth): The welfare of children under the age of eight in day care facilities is protected by statute under the Children Act 1989. This Department and the Department of Health jointly published a consultation paper on 27 March which poses a range of questions about the future regulation of early education and day care.
    Mr. Clarke: Is the Minister aware that only one in three child care workers are subject to police checks and that this is due largely to inconsistencies among local authorities? Some local authorities check only their staff while others check their staff and those in the voluntary sector. In light of the Government's planned increase in child care provision, will the Minister ensure that there is greater consistency and access to police checks, thus affording more protection to our children?
    Mr. Howarth: The safety and welfare of children is paramount among our concerns. We shall focus on it continuously in the expansion of child care that we are determined to bring about. Part X of the Children Act 1989 requires local authorities to register and inspect day care settings and child minders and, in that context, to satisfy themselves that a person is fit to care for

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    young children. Many local authorities use police checks, but that is not at present a statutory requirement. That is a key issue in our consultation.
    Miss Anne Begg: What arrangements he intends to introduce for the delivery of the national child care strategy at local level. [48098]
    The Secretary of State for Education and Employment (Mr. David Blunkett): Local child care partnerships—forums in Scotland—will be established and built on in every area of the country. They will enable us to use the £12 million that we have allocated this year to establish the structures for the development of the child care strategy of the future, building on the Green Paper "Meeting the Childcare Challenge".
    Miss Begg: I am sure that my right hon. Friend will agree that there is still great variation in both the quality and level of child care, depending on the locality in which one lives. In my own constituency, a play group will not be meeting next year because it failed to find suitable accommodation. What was lacking was co-ordination to make sure that all the different aspects of child care that make up a child care strategy were in place in a locality. May I urge my right hon. Friend to ensure that such co-ordination is present in each locality, to make sure that the different elements required to make up a full strategy are in place?
    Mr. Blunkett: The local partnerships will ensure not only that there is co-ordination, but that we do a thorough audit of what already exists; that we put in resources to save projects that are viable and popular but are currently threatened; that we build on those by expanding those partnerships to incorporate new child care facilities, including the voluntary and private sector; and that we prepare for the introduction of the working families tax credit child care disregard, which will make it possible for millions more parents to take advantage of satisfactory, high-quality, properly inspected child care—[Interruption.]—in a way that has never before been possible in the United Kingdom and was never even thought of by the Conservative Members who are currently barracking me.

    National Music Service
    Mr. David Kidney: What standards he will set the national music service for the teaching of music. [48099]
    The Parliamentary Under-Secretary of State for Education and Employment (Ms Estelle Morris): We have no plans to create a national music service. However, I can assure my hon. Friend that we do recognise the contribution that music can make to every child's education, and its importance in supporting children's cultural, spiritual and social development. That is why my Department's recent consultation paper, "Fair Funding: Improving Delegation to Schools", proposes new funding arrangements to protect existing local music services.
    Mr. Kidney: In Staffordshire, there is an excellent music service, as I am sure the capacity audience who were at Birmingham symphony hall last Sunday will testify, after hearing 1,000 Staffordshire schoolchildren perform before them. My hon. Friend's consultation on possible central funding of the music service is of concern to areas such as Staffordshire that already have an excellent service. Will she assure me that there will be no dumbing down of music teaching in Staffordshire in the event of moving to central funding? The objective of equal access to music, both learning and performing, is excellent, but will she take the time to ensure that any change in funding leads to effects that are harmonious, not discordant?
    Ms Morris: I am sure that last Sunday's performance by Staffordshire schoolchildren at the international convention centre, which is a very special hall in Birmingham, was well worth attending. I assure my hon. Friend that the reason for the change is to protect music services, because they have not been protected in the past and year on year, there have been cuts that have damaged what is an essential part of a child's education and development. I can give my hon. Friend the assurance he seeks that the change is not about dumbing down, but about enhancing and extending opportunity, so that never again will music in our curriculum be threatened as it has been in the past.
    Mr. Nicholas Soames: In endorsing the words of the hon. Member for Stafford (Mr. Kidney) about Staffordshire children's musical ability, may I say that the same is true in my constituency and in West Sussex? I am sure that the Minister knows that anything that she and the Government can do to improve music teaching and the music service in this country will be greatly welcomed. However, does she agree that there is an opportunity to establish regional centres of excellence for music teaching? Perhaps it would be a good idea to select one or two schools in each region that have exceptional musical skills and to channel children to those schools for special teaching.
    Ms Morris: The hon. Gentleman has raised that question with me before and I have said that we are sympathetic to the idea. That is why we are putting far more resources into the specialist schools initiative, which now allows schools to make bids to specialise in music. One or two weeks ago, I was able to announce the first of the specialist schools that will concentrate on music; I am sure that the hon. Gentleman will welcome that.
    I know that the hon. Gentleman will also welcome, as has been welcomed throughout the education and music world, the announcement by my right hon. Friend the Secretary of State for Culture, Media and Sport that we shall launch the youth music trust, which will enhance opportunities to learn and practise music, not only in school, but outside school. We are determined that music will play its part in the exciting programme of out-of-school learning that the Government have launched. Children will have the opportunity to spend extra time on and to have access to extra expertise and resources in learning and practising music, as in many other subject areas.

    New Deal
    Mr. Ivan Lewis: If he will make a statement on the voluntary sector's contribution to the new deal. [48101]
    The Minister for Employment, Welfare to Work and Equal Opportunities (Mr. Andrew Smith): I very much welcome the important contribution that the voluntary sector is making to the new deal. It has been involved from the initial planning and design stages to the delivery of gateway services and the provision of work and training opportunities. Those are now operating throughout the country, with scores of voluntary sector organisations involved, making places for thousands of unemployed young people.
    Mr. Lewis: I welcome the central role that voluntary organisations have been given in delivering the new deal programme across the country and in my constituency. Will my right hon. Friend consider the problem that is increasingly experienced by voluntary organisations with existing projects that are working across Employment Service boundaries? They are finding it difficult to gain access to the contractual process because they are not confined to one geographical area, but their innovative projects would give young people the opportunities that they need to gain skills. Will my right hon. Friend clarify how such organisations that work across geographical boundaries can gain access to the new deal so that they can offer opportunities?
    Mr. Smith: Yes, the new deal is a flexible and pragmatic programme, and we are developing it in response to need and potential. We are currently reviewing the operation of contracting in the new deal. There is nothing to prevent any voluntary organisation from contracting for more than one unit of delivery in the new deal, but I realise that the co-ordination of that might involve complexities that would particularly tax smaller voluntary organisations. I will ensure that the review considers that issue and that appropriate guidance is given, because we want to make the most of the enormous potential offered by the voluntary sector.
    Mr. Don Foster: In view of the success in the pathfinder areas of the voluntary sector option in the new deal for the under-25s, will the Minister explain why there is not a similar option for the over-25s? Will he explain in more detail his plans for voluntary sector involvement in the new deal for the over-25s, particularly in view of the answer that he gave earlier to my hon. Friend the Member for Hereford (Mr. Keetch)?
    Mr. Smith: My right hon. Friend the Secretary of State referred in an earlier response to voluntary sector involvement in the new deal for the over-25s. I underline that the new deal for the long-term unemployed not only fulfils our manifesto commitment to make available subsidies of £75 a week to employers taking on unemployed people over 25 who have been out of work for more than two years, but goes well beyond that commitment in opening up thousands of full-time education and training opportunities. What is more, in the pilots that we are developing for November, which will open up opportunities to 90,000 people who have been
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    unemployed for 12 or 18 months, there will be a specific range of options, including the full involvement of the voluntary sector, for which the hon. Gentleman asks.
    Mr. Nigel Evans: The Minister will remember that a few weeks ago, I mentioned the good work of Skillshare in my constituency, which provides much of the work that Skillshare does in other parts of the country and is under threat of closure because of the withdrawal of funding by Lancashire county council. The Minister has written to me about that, although he offered no hope whatever, but will he today congratulate Skillshare on obtaining funding from a trust set up by Ultraframe, a private firm in my constituency? Its owners, John and Rosemary Lancaster, have today guaranteed funding for the next 12 months. Will he also take a fresh look at ways in which he can assist organisations such as Skillshare to ensure that they will have some hope of life after the 12 months is up?
    Mr. Smith: I commended Skillshare, along with other voluntary sector providers to the new deal, in my answer to the hon. Gentleman last month. As he says, I have written to him, and I have encouraged those in the field to make contact with Skillshare to find out what help can be made available. This is not, perhaps, the week unreservedly to endorse any commercial sponsorship arrangements without knowing the details, but if Skillshare is able to continue to provide good-quality support to programmes that help the hon. Gentleman's constituents, no one will welcome that more than me.

    GCSE Students
    Mr. Barry Sheerman: If he will estimate how many students achieving average and above average results at GCSE level do not continue into further education. [48102]
    The Parliamentary Under-Secretary of State for Education and Employment (Dr. Kim Howells): The youth cohort study of 1996 showed that 44 per cent. of all GCSE candidates in England achieved at least five passes at grades A* to C. Of those, some 2 per cent. did not go on to any form of further education or training.
    Mr. Sheerman: I am grateful for that information, but it does not exactly square with what I have from the House of Commons Library, which suggests that only 90 per cent. of high-ability students go on to further education and that about 40 per cent. of average students are lost to further education. Even if we split the difference, the situation is serious. Could not my hon. Friend encourage sixth-form colleges and the rest of the further education sector to take a leaf out of the book of the private sector, and to start looking at their supply chain to see what happens to good-quality students who fail to go on to A-levels and university? Saving those kids before it is too late must be the best investment that could be made in the education sector.
    Dr. Howells: We are revamping the careers service to concentrate on precisely those young people who appear to be dropping out when they should be going on to further study. It was a great pleasure for me this morning to launch a new initiative called the Eagle campaign,

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    linking St. John's college, Cambridge, with Lambeth local education authority. It will try to construct compacts with schools in the area to encourage children to reach for the sky in their educational attainment. That is important. Far too many of our universities tend to look beyond the towns and wards that surround them and search nationally for students, when they should be looking on their own doorstep and finding out how to encourage young children to raise their aspirations and sense of self-esteem so that they go to university and good further education colleges.
    Mrs. Theresa May: If further education colleges are to encourage more students to come through their doors in the innovative way suggested by the hon. Member for Huddersfield (Mr. Sheerman), they need to retain their independence and flexibility in order to innovate and provide the courses that best meet the interests of the local community and local employers. Is the Minister aware of the concern in the further education sector that the Government might reduce independence and impose the dead hand of centralisation on the sector? Will the Minister take this opportunity to give some comfort to the sector by assuring it that at least the Government will not reduce the proportion of business governors on the corporation bodies of further education colleges?
    Dr. Howells: We are not interested in placing dead hands on anything; we are interested in tearing off the dead hands that the previous Government imposed on so much of the education system. We will open up the accountability of further education college boards so that they reflect the communities that they serve. That means that they will be able to tap the full potential of the community, not just friends of business men who happen to have been placed there by the previous Government.
    Ms Margaret Hodge: Does my hon. Friend agree that the previous Government's legacy of the worst participation rate of 16 to 18-year-olds in education of
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    any of our major competitors is disgraceful? Will he give serious consideration to the proposal in the report by the Select Committee on Education and Employment to abolish child benefit and transfer those resources to a means-tested allowance for students as an incentive for young people to remain in education?
    Dr. Howells: My right hon. Friend the Secretary of State and my hon. Friends in the Department are looking very closely at post-16 provision in this country. In doing so, we shall talk to every other Department in Whitehall about how it might be possible to move towards the optimum in terms of persuading young people to partake in education and training after 16. We shall be looking at every possible means of attaining that; no holds are barred.
    Mr. Tim Boswell: At least the Minister spared us the suggestion that his aspiration is to ensure that all children are above the average, but leaving that aside, will he acknowledge that the most important thing is to cause them to aspire to achievement, and to provide the means of giving them the information to achieve their full potential? In that connection, will he remember the importance of the further education colleges and—despite his somewhat grudging remarks—the remarkable fact that, when a previous Administration gave them their independence and released their energies, the level of participation and of involvement rose with unprecedented speed?
    Dr. Howells: I would be the last person to begrudge the achievements of further education colleges. I believe that they have done a superb job, especially given the appalling situation in which they found themselves under the previous Government. That is why two thirds of them found themselves in very difficult financial circumstances, and why they must cut their way out of the jungle of absurd bureaucracy that characterises the brokering of education in further education colleges in this country.

Business of the House
3.30 pm
Sir George Young: May I ask the Leader of the House to give us the business for next week?
The President of the Council and Leader of the House of Commons (Mrs. Ann Taylor): The business for next week will be as follows:
MONDAY 13 JULY—Opposition Day (17th allotted day). Until about 7 pm, there will be a debate that the Opposition have entitled "The Crisis of Manufacturing and the Deterioration in Industrial Relations". That will be followed by a debate that they are calling "Incompetent Management at the Department of Social Security". Both debates will arise on Opposition motions.
Consideration of a Lords amendment to the Teaching and Higher Education Bill [Lords].
TUESDAY 14 JULY—Estimates Day (2nd allotted day).
There will be a debate on the UK beef industry, followed by a debate on the structure and funding of university research. Details will be given in the Official Report.
At 10 pm, the House will be asked to agree all outstanding estimates.
Remaining stages of the Registration of Political Parties Bill.
WEDNESDAY 15 JULY—Until 2 pm, there will be debates on the motion for the Adjournment of the House.
Proceedings on the Consolidated Fund (Appropriation) (No. 2) Bill.
Consideration of any Lords amendments that may be received to the School Standards and Framework Bill.
THURSDAY 16 JULY—Debate on public expenditure on a motion for the Adjournment of the House, which will follow a statement on the White Paper on public expenditure, which will take place on the previous Tuesday, the 14th.
FRIDAY 17 JULY—Debate on NATO enlargement on a motion for the Adjournment of the House.
The provisional business for the following week will be as follows:
MONDAY 20 JULY—Second Reading of the Northern Ireland Bill, which will be published next week.
TUESDAY 21 JULY—Opposition day (18th allotted day). There will be a debate on an Opposition motion, the subject of which is yet to be announced.
WEDNESDAY 22 JULY—Until 2 pm, there will be debates on the motion for the Adjournment of the House.
Consideration of any Lords amendments that may be received to the Government of Wales Bill.
Progress in Committee of the Northern Ireland Bill.
THURSDAY 23 JULY—Consideration in Committee of the Northern Ireland Bill.
FRIDAY 24 JULY—Consideration in Committee of the Northern Ireland Bill, which I envisage will be brought to a conclusion on Monday 27 July.
The House may also be asked to consider any Lords messages that may be received.
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[Tuesday 14 July 1998:
Estimates Day [2nd allotted day] Class IV, Votes 1 and 2: Intervention Board-Executive Agency and Ministry of Agriculture, Fisheries and Food in so far as they relate to the UK beef industry. Relevant reports: third report from the Agriculture Committee, Session 1997–98, on "The UK Beef Industry" (HC 474) and the Government's response thereto (HC 720). The Ministry of Agriculture, Fisheries and Food and the Intervention Board departmental report 1998 (CM 3904). The second report from the Welsh Affairs Committee, Session 1997–98, on the "Present Crisis in the Welsh Livestock Industry" (HC 447).
Class V, Vote 2: Department of Trade and Industry: Science in so far as it relates to the structure and funding of university research. Relevant reports: the first report from the Science and Technology Committee, Session 1997–98 on "The Implications of the Dearing Report for the Structure and Funding of University Research" (HC 303-I) and the Government's response thereto (HC 799). The Department of Trade and Industry's departmental report: "The Government's Expenditure Plans 1998–99" (Cm 3905).]
Sir George Young: The House is grateful to the right hon. Lady for next week's business and for an indication of the business for the following week.
This morning we had further leaks from the Government, this time on the roads programme. Does that not underline the need for a statement on the much-delayed White Paper? Can the right hon. Lady help the House by saying when that might be?
When might we debate the reductions in the defence budget that were announced in yesterday's strategic defence review? Have we lost the two remaining one-day debates on the Army and the Navy?
Last week, my hon. Friend the Member for South Staffordshire (Sir P. Cormack) asked for an assurance that the Government's proposals on the North sea oil tax would be given in an oral statement. The Leader of the House could not give an assurance at that time, as she had not considered the matter, but there is much uncertainty on that, and it is of great interest in Scotland. Can she give an undertaking that that decision will be announced in an oral statement?
In the light of the difficulties that have confronted the Government over recent days, on which the Leader of the Opposition focused with such effect yesterday, may we have a debate on the new rules of conduct that are being circulated by the Cabinet Secretary, so that the House can judge how effective they might be in disengaging Ministers and their special advisers from the rest of the circle that the Prime Minister built up around him in opposition?
Finally, can the right hon. Lady shed any further light on the likely date of the summer recess? Last week she said that it was clear that the House could not rise before the end of July. I appreciate the turbulence in the programme, but if she could share her latest thinking with the House, we would all be grateful.
Mrs. Taylor: I shall try to be as helpful as possible. On the suggestion of a leak on the roads programme, I did indeed hear some of the speculation this morning, all of which concluded with comments to the effect that the

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Deputy Prime Minister had all the schemes on his desk and had yet to make decisions, so I do not think that the decisions have been taken, let alone leaked.
I hope that we can have a statement on the White Paper on transport before the House rises. There is great pressure on time, but I am looking to find time for such a statement.
The right hon. Gentleman asked about a debate on the strategic defence review and the days on the Army and the Navy. I believe that it will be possible to have those debates in the spillover period. If so, it will of course be possible for the views of the Select Committee on Defence to be taken into account—I understand that the Select Committee intends to comment on the defence review.
I cannot guarantee the right hon. Gentleman the statement that he requested on North sea oil. There are many decisions still to be made and many demands for a statement. Some judgment must be exercised.
The right hon. Gentleman says that the new rules of conduct are to be circulated by the Cabinet secretariat. Perhaps I may remind him what the Prime Minister said yesterday:
"I have instructed the Cabinet Secretary, therefore, to revise the rules that we inherited that govern such contracts and to strengthen them in any way that he thinks fit."—[Official Report, 8 July 1998; Vol. 315, c. 1065.]
We are working to the rules of the previous Government, and if there is a need for strengthening, that will happen.
The announcement of any recess is always subject to the progress of business: that is especially so this year. With that proviso, I hope that it will be possible for the House to rise on Friday 31 July, but I cannot yet guarantee that, as we still have some extremely important business, including the Northern Ireland Bill, which I mentioned in my statement. We must make progress on that and on other outstanding matters that have yet to be debated in the House.
Mr. Richard Burden: Will my right hon. Friend have further discussions with the Opposition about the timetabling of their business and the issues selected for debate? I ask that in the light of events last Friday, when Opposition Members—one of whom, the right hon. Member for Bromley and Chislehurst (Mr. Forth), I see in the Chamber—talked out the Fireworks Bill. They implied that in doing so, they had the support of the firework industry. However, they had no such support and have been told so by representatives of the firework industry, who said that the actions of the Opposition could contribute directly to an increase in firework-related accidents.
As Opposition Front Benchers stated that they wished to give the Bill a fair wind, will my right hon. Friend propose to the Opposition that they make some of their time available, so that we can ensure that firework-related injuries go down rather than up as a result of irresponsible actions of Opposition Members?
Mrs. Taylor: Many people both outside and inside the House would be appalled at the behaviour of those who sought to prevent that Bill from making further progress last week. Firework-related accidents are an important issue. I hope that those who stopped the Bill will have a clear conscience because they will bear a great deal of
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responsibility for any further problems that might arise. The Opposition said that they would give the Bill a fair wind. They acted irresponsibly, and I can well understand why my hon. Friend and others say that the whole procedure for private Members' Bills must be considered by the Modernisation Committee.
Mr. Malcolm Bruce: Given that the timetable is under pressure and that the Leader of the House is anxious, through her Committee, to reduce the number of late sittings, will the right hon. Lady acknowledge that the Government could make a contribution by accepting on Monday the amendment passed by a substantial majority in the other place? Will she acknowledge the comment of Lord Russell that, if the Government do not accept that modest and reasonable amendment, it will raise the question of whether they want a revising Chamber?
When will the Prime Minister either correct or confirm his statement that medical students will be exempt from student fees? Obviously, those students would like to hear him confirm that that is Government policy.
May I endorse the plea by the shadow Leader of the House for an early statement on North sea oil and gas taxation? The Leader of the House may be surprised to hear that The Press and Journal (Aberdeen) led on that story this morning. Tens of thousands of jobs are at risk as a direct result of the Government's failure to give a clear statement on something that they promised in April.
Mrs. Taylor: I have nothing to add on the last point.
We shall not accept the Lords amendment in Monday's debate. Indeed, I have found that accepting amendments rarely leads to shorter debates, but we shall not support the amendment because we do not think that it is right. The hon. Gentleman quotes Lord Russell; I remind him that Lord Dearing spoke and voted for Labour's position on the matter.
Mrs. Linda Gilroy: Reference has already been made to the demise of the Fireworks Bill. We spent five hours debating a range of narrow amendments, and at the conclusion of the debate we were discussing a tidying amendment. The Bill has been thoroughly scrutinised in both Houses and has been through both Houses' full procedures. May I seek discussions with the Leader of the House about what opportunities might be available to bring back the most essential parts of that measure? I know that the CBI's explosive industry group has written to my right hon. Friend to say that it considers the consequences for firework safety in the millennium celebrations to be extremely grave.
Mrs. Taylor: My hon. Friend makes an extremely serious point. Many of us were pleased when she decided to introduce that private Member's Bill on such a serious safety issue. As she points out, the CBI and many others are extremely concerned that we should make progress. I can make no promises about future progress, but I am certainly willing to meet her and to discuss the matter.
Mr. Nicholas Soames: In view of the unfortunate connotations of the way in which the Labour party's ridiculous campaign on cool Britannia has gone,

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will the Leader of the House try to make time for the House to debate the British Council, which does invaluable and remarkable work for this country overseas? To my shame, its budget was cut under my Government and it needs more resources to enable it to carry forward its remarkable work of promoting British culture throughout the world.
Mrs. Taylor: I am not sure about the hon. Gentleman's reference to cool Britannia, but I endorse what he says about the good work of the British Council. Many hon. Members on both sides of the House have been happy to help the British Council from time to time and we appreciate the good work that it does. There will be an Adjournment debate on the issue next Wednesday morning, so perhaps the hon. Gentleman could catch Madam Speaker's eye then.
Mr. Paul Flynn: Will my right hon. Friend arrange a debate on early-day motions 6 and 318?
[That this House should impose new restrictions on the activities of potentially-corrupting commercial lobbyists in influencing parliamentary decisions, in order to improve access to Government and honourable Members by those groups and individuals who cannot afford to employ lobbying organisations.]
Both were tabled more than a year ago; the first calls for a new, rigorous system for controlling lobbying in the House, and the second draws attention to the dangers of insider information being supplied to lobbying firms by new employees who were previously employed by political parties.
Although a great deal of humbug has been spoken over the past few days, it is worth recalling that, only two years ago, many Conservative Members were described as having their snouts so deeply in the trough that all that could be seen of them was the soles of their feet. We have a serious problem: we have failed to control lobbyists whose main work is to ensure that their rich and powerful clients become richer and more powerful, to the detriment of other clients and other people who cannot afford their services.
Mrs. Taylor: I agree with my hon. Friend that a great deal of humbug has been spoken on this topic in the past few days. He will recall that Lord Nolan considered controlling the activities of lobbyists and decided that there were important restrictions in terms of taking further action. Many of us would be concerned if it was suggested that the House of Commons should license lobbyists and give a seal of approval to certain ones, which is one of the proposals that has been made. I accept that there is concern about certain activities; the House should make it clear that the allegations have been about the way in which lobbyists conduct themselves, not about the way in which Members of Parliament or Ministers conduct themselves.
Mr. Michael Colvin: The right hon. Lady confirmed that there will be a debate on the strategic defence review when the House resumes after the recess. Will she confirm that it will be a two-day debate? To assist the House, I can confirm that the Select
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Committee on Defence will have a report ready on the strategic defence review. The dates of the recess are immaterial to us, because we shall be working throughout the recess to get the report ready so that hon. Members can take it with them when they visit the beaches. Our job has been made somewhat easier by being able to start on our study four weeks earlier than expected because of the leaks that have taken place.
Mrs. Taylor: I hope that the Select Committee on Defence did not waste too much time on the various and conflicting so-called leaks that were circulating in advance of publication. I confirm that I should like to provide time for a two-day debate—obviously that will be subject to further discussions through the usual channels—and I am pleased that the Select Committee will be able to do its work. I am happy to confirm that many Select Committees do extremely good work during the recess, which knocks on the head the idea that the recess is simply a holiday for hon. Members. A lot of work is done, not only by the Select Committee on Defence, but by many others.
Mr. Dennis Skinner: Does my right hon. Friend agree that there should be new legislation regarding the activities of lobbyists, especially in the light of the fact that in the past few days there has been an opportunity for us to clean up the Augean stables? Fortunately, that opportunity has come at the beginning of the Parliament, not at the end. Does she agree that the day that lobbyists become more important than Ministers and Members of Parliament will be the day that democracy dies?
Mrs. Taylor: I remind my hon. Friend of what I said about the Nolan committee. His basic point about lobbyists being more important than Members of Parliament is very alarming.
Mr. Elfyn Llwyd: During yesterday's defence statement, I strenuously, but unsuccessfully, attempted to catch your eye, Madam Speaker. I fully realise, being of limited physical stature, why I was not called.
Will the right hon. Lady confirm that there will be no further statements by any Defence Minister before the debates in the overspill? I ask that because I clearly heard the Secretary of State for Defence say yesterday that the Minister for the Armed Forces would be making further statements about the Territorial Army very soon. Will she please clear the matter up? It is extremely important to both Welsh regiments, and I hope that she will be able to give some assurance about this delay.
Mrs. Taylor: The hon. Gentleman asks that there be no further statements. I hope that he is not suggesting that no further details should be given, and that no questions should be answered by the Department. We now have the strategic defence review, and hon. Members will be able to read it. The normal decision-making process will continue, and if other information should be made available, that will be done in the usual way.
Mr. Jim Fitzpatrick: May I bring to my right hon. Friend's attention the fact the Commission for Racial Equality has decided that the

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leaflet distributed by Poplar and Canning Town Conservative association in Newham in May this year is in breach of the guidelines to which all political parties signed up, in that it contained offensive material? My local newspaper, the Newham Recorder, also regard the leaflet as racist. Despite having written to the Leader of the Opposition three times, I have yet to receive a response with the Conservative party's official view of this literature.
May I also draw to my right hon. Friend's attention the fact that there is a by-election in Custom House and Silvertown ward in Newham? In conflict with the spirit of the Registration of Political Parties Bill, which is going through Parliament at the moment, a candidate is standing in that by-election under the name of Real Labour. Coincidentally, four of the persons nominating the Real Labour candidate had nominated Conservative candidates at the borough elections in May. Should time be set aside to debate the dirty tricks that Poplar and Canning Town Conservative association seems to be playing?
Mrs. Taylor: All of us should be concerned if offensive material such as my hon. Friend describes is being circulated. I hope that the Opposition Front Benchers will ensure that the Leader of the Opposition replies to my hon. Friend soon.
As my hon. Friend said, the Registration of Political Parties Bill is before the House. I am not sure whether there will be scope for him to raise this matter on Tuesday. Descriptions of candidates, nominations and the use of terminology are being investigated by the Home Office, and ideas have been sought to ensure, for example, that candidates cannot abuse the names of other political parties. I shall certainly draw my hon. Friend's remarks to the Home Secretary's attention.
Mr. Stephen Day: In her statement, the right hon. Lady said that she hoped that the Government would be able to announce the results of the review of the roads programme before the House rises, which is welcome news. It is essential that she is clearer about the Government's intentions and that she guarantees that a statement will be made before the House rises. If decisions about bypasses and major road schemes were to be made when the House was not sitting, and if those decisions were adversely to affect areas such as Cheadle—where we desperately await completion of the Manchester airport eastern link road—the people of Cheadle and elsewhere would be furious with the Government.
Mrs. Taylor: I said that I envisaged a statement on the White Paper and that the roads review announcements would follow that. I shall ensure that hon. Members receive proper information, and I expect that to be available before the start of the recess.
Dr. George Turner: The Government have made it clear that they intend to replace the existing standard spending support for local authorities with a much fairer system. Will my right hon. Friend assure us that the House will have an opportunity to discuss that issue before decisions are taken, so that we do not whinge afterwards? She will be aware that Labour Members represent the majority of rural constituencies. The history of spending has dominated Government
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support in the past, and we are frightened that the history of spending in the past 18 years could determine that of the next three. Will she assure me that the House will be given a proper opportunity to influence what happens, and that we will debate the issue before decisions are taken?
Mrs. Taylor: My hon. Friend will understand that there is no scope for a debate on this matter in the near future. However, there are many other ways in which hon. Members can influence the decisions of Ministers. The Department of the Environment, Transport and the Regions has published a range of consultation papers, and has invited comments from anyone who wants to contribute to that decision-making process.
Mr. Eric Forth: Will the Leader of the House please provide an opportunity, next Thursday and every subsequent Thursday, for the Prime Minister to come to the House to correct the obfuscation and errors of fact that he perpetrates each Wednesday?
Mrs. Taylor: There is absolutely no need for such a statement.
Mr. David Winnick: If the situation at Drumcree were to worsen, would the Leader of the House consider arranging a statement that would—I hope—give members of all parties in the House an opportunity to make it clear that the rule of law must prevail? Should it not be made clear that the recommendations of the Parades Commission—which was set up with the authority of Parliament—should not be ignored, that both communities are expected to accept such recommendations and that there must be no repeat of what happened 24 years ago, when the undermining of the rule of law led to action by mobs in the street? In those circumstances, I hope that the Opposition will make it clear that they fully support the Government's attempts to ensure that the rule of law prevails in Northern Ireland. I see the hon. Member for Bracknell (Mr. MacKay), the Opposition spokesman on Northern Ireland, nodding in agreement.
Mrs. Taylor: I hope that circumstances will not arise in which such a statement is needed.
I believe that all hon. Members are very concerned about the position in Northern Ireland. We all hope that the progress made so far in the peace process can be maintained, and I think it is incumbent on all of us to do everything that we can to maintain it.
Sir Robert Smith: Is the Leader of the House aware that Ministers promised an oil taxation consultation paper in mid-April?
Will the right hon. Lady find time for a debate or statement on a wider issue affecting the North sea—the Government's position at the conference on the Oslo-Paris convention, involving the removal of oil platforms and discharges of nuclear waste? Surely it makes sense for the House to debate the Government's position before the OSPAR conference, rather than being faced with the rubber-stamping of a decision made at the conference after it is over.
Mrs. Taylor: The hon. Gentleman must understand why it is not possible for me to find time for such a

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debate. It may be appropriate for him to apply for an Adjournment debate; but we shall have the usual three-hour Adjournment debate before the summer recess, at which issues of that kind—along with any others that concern hon. Members—could be raised.

Royal Assent
Madam Speaker: I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified Her Royal Assent to the following Acts:
Registered Establishments (Scotland) Act 1998.
Pesticides Act 1998
Criminal Justice (International Co-operation) (Amendment) Act 1998
I have been extremely remiss. I was going to allow the hon. Member for South Staffordshire (Sir P. Cormack) to catch my eye at the end of business questions. Will the Leader of the House allow me to call him now?
Mrs. Taylor indicated assent.
Madam Speaker: It is my fault; I am so sorry.
Sir Patrick Cormack: I am extremely grateful to you, Madam Speaker, and to the Leader of the House.
The Leader of the House will have gathered from the comments of her hon. Friends the Members for Newport, West (Mr. Flynn) and for Bolsover (Mr. Skinner) that concern about recent events is not limited to Opposition Members. When my right hon. Friend the Member for North-West Hampshire (Sir G. Young) asked about the new rules of conduct, the right hon. Lady said that new rules were being drawn up; but my right hon. Friend asked for a debate on those rules. May we have a response to that question? If the right hon. Lady cannot promise a debate before the House rises for the recess at the end of this month, may we at least have an undertaking that the rules will be published, and will be widely available?
Mrs. Taylor: I cannot see any prospect of a debate on any improvements that we might make to the rules, which we inherited from the previous Government, in the near future. As for publication, it is currently intended that the same procedures should apply.

National Health Service
Motion made, and Question proposed, That this House do now adjourn.—[Jane Kennedy.]
3.58 pm
The Secretary of State for Health (Mr. Frank Dobson): As you know, Madam Speaker, it is exceptional for the House to devote a whole day's debate to a celebration, but that is what we are doing today, and it is right that we should join the rest of the country in marking the 50th anniversary of the national health service, which has served our country so well for so long, and in thanking all the people working in the NHS and their predecessors for doing such a wonderful job. There have been church services, a royal garden party, major conferences and hospital open days—even a special rose has been produced—for the 50th anniversary.
On a personal note, it has been a great privilege to take part in the celebrations, to have the honour of being Secretary of State for Health at such a time and to have the opportunity to share in the rejoicing over the success of the most popular institution in Britain. It is all the more a privilege to be a Labour Secretary of State for Health at this time, because the national health service was founded by a Labour Government, is based on Labour principles and is our party's greatest contribution to improving the lives of the people of this country. Since it has existed, no one concerned about their health has had to worry about not being able to pay the doctor.
Fifty years ago, our country was emerging from the aftermath of the second world war. That war—the most destructive in the history of humankind—had dealt a series of body blows to our country and our people. It had laid waste to homes, schools and hospitals, destroyed factories, and blitzed harbours, railways, roads and bridges. Yet despite all those huge problems, a new spirit was abroad. To win the war, the people of this country had worked together and had shared its perils. They were determined to share a better and fairer future. A new bargain was struck—everyone accepted a duty not merely to try to provide for themselves, but to help provide for others. Whoever was doing well would pay in to provide for others who fell ill, lost their job, had an accident or grew old. They could do that in the sure and certain knowledge that if they in turn fell ill, lost their job, had an accident or grew old, others would pay in to look after them.
Thus Labour's welfare state, including the national health service, was born. The NHS was founded on the principle that the best health services should be available to all—the best for all, quality and equality. That appealed to the fair-minded people of our country. It still does. No one dares challenge those principles. No one says that the best health services should not be available to all. Of course, it did not appeal to the Tories, who fought tooth and nail against the establishment of the NHS. They did not merely put up a token resistance; they voted against its general principles and its detailed proposals. The Tories voted 51 times against Labour's proposals to establish the NHS—one vote for every year that we are

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talking about and, no doubt, one for the pot. They did not merely vote against it, but denounced it—they railed against it. According to them, the NHS
"will destroy so much in this country that we value."—[Official Report, 1 May 1946; Vol. 422, c. 232.]
It
"would be a fatal step."
It would sap
"the very foundations on which our national character has been built."
One Tory woman Member predicted:
"bitterness will result"
and even went on to say that it
"may lead to civil war".—[Official Report, 30 April 1946; Vol. 422, c. 81–91.]
Another said that it would be
"the death knell of the family doctor"
and another generous spirit said that it was
"a very carefully prepared measure of highway robbery."—[Official Report, 1 May 1946; Vol. 422, c. 205–61.]
All those predictions were made by the Tories under the moderating influence of debates in the House of Commons—what they said outside, God only knows. Since then, some Tories have claimed that they did not oppose the NHS. All that I can say is that they had a funny way of expressing their support.
Despite the efforts of the Tories, in Parliament, in the press, and in the more backward parts of the medical profession, my most distinguished predecessor Nye Bevan pressed on with turning his great vision into reality and, despite everything that they could do to obstruct it, the NHS came into being on 5 July 1948. Because of Tory propaganda, it was not particularly popular up to that point, but no sooner was it up and running than it soared in popularity. It has been that way ever since. The NHS is remarkable; it is one of the few examples in history of something that proved more popular in practice than when it was just a nice theory.
Mr. David Winnick: In view of my right hon. Friend's reminder of Tory opposition to the creation of the NHS, would not it be an appropriate moment for the right hon. Member for Maidstone and The Weald (Miss Widdecombe), who speaks on behalf of the official Opposition, to apologise to the British people?
Miss Ann Widdecombe indicated dissent.
Mr. Winnick: The way in which the right hon. Lady dismisses the suggestion demonstrates only too well that, had she been around at the time, she would have been the staunchest opponent on the Tory Benches to a concept such as the NHS.
Miss Widdecombe: How does the hon. Gentleman know?
Mr. Winnick: It is obvious from the right hon. Lady's attitude.
Mr. Dobson: To the best of my knowledge, not a single member of the then parliamentary Tory party rebelled
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against the Whip, which resulted in 51 votes against the establishment of the NHS. I do not like to demand anything of the right hon. Member for Maidstone and The Weald (Miss Widdecombe); what she does is up to her.
In 1947 and 1948, some said—and some still say today—that we could not afford the best for all and that the principles of the NHS were not practicable and could not be delivered. The past 50 years have proved them wrong; the NHS has served this country well. Most of the time, most people in most parts of our country have received top-quality treatment and care. The NHS has proved to be the cheapest and most cost-effective health care system in the developed world. That is not despite the principles on which it is based but because of them. Fairness and cost-effectiveness have gone together; they are two sides of the same coin.
The NHS is paid for out of taxation, so it is free to people when they use it. That is not just a fine principle; it is efficient. It avoids the need for costly paperwork that is inevitable in systems in which patients must pay. That is one the main reasons why our system is so cost-effective. Our tax-based NHS puts a bigger proportion of resources into patient care, and a lower proportion into paperwork. That is true even after the worst excesses of the Tories' attempted introduction of an NHS internal market.
The NHS works well in practice. It is not just a success story; it is a brilliant bargain. Let us compare our spending on health with that in the United States. The United States spends twice our proportion of national wealth on health, yet women in Britain live as long as women in the United States, and British men live longer than American men. The state of our health compares favourably with other major European countries, although we spend less on health care. I cannot claim that the NHS alone is responsible for our favourable international health rating, but it is certainly responsible for favourable comparisons on cost. That is a vital economic asset.
At any given level of performance, our system consumes less of the national wealth than others. Its benefits do not stop there. Funded from taxation, it imposes little direct cost on employers. Countries with other systems finance their health care in a way that places high non-wage costs directly on employers; ours does not. That keeps down the cost of employment here and helps our businesses compete in world markets. Our low non-wage employment costs are generally recognised as one of the major attractions for foreign company investment.
One can see why, deep down, the Tories do not like the NHS. The national health service is based on a socialist ethic, it is superior in principle, it works in practice, and it is the most popular institution in the country. It is no wonder the Tories do not like it. It is no wonder they tried to introduce competition and left it in such a state. They left us a system that had set doctor against doctor and hospital against hospital—a two-tier system of health care, underfunded, overworked, overstretched—which managed to keep going only because of the dedication of its staff, who had been battered from pillar to post, whose professional views had been ignored and whose commitment had been taken for granted. It is not enough today to celebrate the past. We must plan for a better future. We have to modernise the

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service, and that will take time: a long time. When it takes at least three years to train a nurse and six to train a doctor, shortages cannot be ended overnight.
The new Government have already provided more resources. We have put into the NHS £2 billion more than the Tories planned, and £1 billion more than the Liberal Democrats promised. That is still not enough, which is why we shall shortly announce more money for the NHS for the next three years.
It is not a question only of money. Like everyone working in the NHS, and like patients and carers, we recognise the need to improve and modernise. New hospitals, new plant and equipment, new technologies and new drugs must be provided. New ways of working will be required. New arrangements must be made to enable doctors, nurses and midwives to keep up with ever more rapidly changing technology. Unlike the previous Government, we are consulting the people involved about how best to make the changes that are needed. We have to carry the full support of the professions if patients are to benefit in full from all the new opportunities that modern technology has to offer.
Mr. Simon Hughes: The Secretary of State links the view of the professions and the cost of the health service. Does he accept that all the consultation has shown that there is general agreement among the professions that, merely to stand still, the NHS needs 3 per cent. real growth per year, and that just short of £9 billion has to be announced next week in order to achieve that over this Parliament?
Mr. Dobson: I will save next week's announcement for next week.
Miss Widdecombe: The Secretary of State was not asked to prejudge next week's announcement. He was asked whether he agreed that, in order to stand still, the sum required would be just short of £9 billion. He was not asked whether or over what period it would be made available. Is £9 billion required merely to stand still?
Mr. Dobson: The Tory sum has increased. The last time Conservative Members asked the question, it was £8 billion, and now it has gone up to £9 billion; if I say that we will find more than £9 billion over the weekend, it will go up to £10 billion, and the Liberal Democrats will come in at £11 billion. People have waited for six months or more for the result of the comprehensive spending review, and when they hear it, I hope that they will be satisfied.
Mr. Dennis Skinner: Do not leak anything, Frank.
Mr. Dobson: My hon. Friend and I are alike: we never leak anything.
The NHS has been underfunded and beleaguered, and change has come to be seen as a threat. Some economists talk about the threat of people living longer, the threat of new technology or the threat of new drugs—strange people, economists. Think about it: how many of us feel threatened by the thought of living longer? It seems a good idea to most people.
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Is new technology a threat? As a teenager in the 1950s, I saw my father waste away and die from kidney failure. Today, the new technology of transplants or dialysis could probably have saved his life. Given the resources and the help to cope with it, new technology is not a threat; it is an opportunity and a promise.
New drugs are another new opportunity. With new drugs, we can cure diseases that not long ago were incurable. A short course of tablets can replace painful, dangerous, invasive surgery. New drugs are another opportunity, provided that the people working in the NHS have the resources and the help and guidance on how best to make use of them.
What have we done since we got in? For a start, we have put together the biggest hospital building programme in the history of the NHS. New hospitals are planned for High Wycombe, Calderdale, Hereford, Wellhouse in Barnet, Worcester, Bishop Auckland, South Manchester, South Tees, Swindon, Bromley, Newcastle, Reading, West Middlesex, Dudley, Walsgrave in Coventry, Central Manchester, Gloucester, University College hospital in London, in my constituency, King's College in London, St George's in London, the Royal London in Whitechapel, Sheffield and Hull.
Mr. Alan Duncan: Will the Secretary of State give way?
Mr. Dobson: Abide a minute. Work has already started on new hospitals at Dartford and Gravesham, Carlisle, Norfolk and Norwich, High Wycombe, Durham, and Greenwich. What a contrast to the Tory record—£33 million paid out to the lawyers and accountants and nothing got started at all.
Mr. Duncan: Will the Secretary of State give a firm undertaking to the House today that all those hospital building programmes that he has just listed will definitely go ahead?
Mr. Dobson: We certainly intend that they should go ahead—[HON. MEMBERS: "Ah."] It may well be that one or two fall by the wayside, but I have to say that we found them lying on the wayside, left there by the useless lot that we followed. They never got one of them started. The roof has been put on Dartford and Gravesham and I am shortly to do the topping-out ceremony at Carlisle. The only thing that was topped out when the Tories were in was the topping-out of the wallets of the lawyers and accountants whom they got in.
Dr. Peter Brand: Does the Secretary of State intend to rely on private finance initiatives for that impressive list of hospital building? Is there no concern that he might have to up his £9 billion estimate in future years to pay for the enormous revenue tail that the PFI contracts will create for the NHS?
Mr. Dobson: I do not know where people dig these figures up from. Certainly, a substantial number of the ones that I have read out are PFI schemes. I am confident that, whatever else, the hospitals will get built, they will be built on time, they will be built to price, they will come into operation and they will provide a service for people. That is what people want.
Lorna Fitzsimons: My right hon. Friend does himself a disservice and hides his talent under a

1251
bushel. He forgot one very important development. I had the honour to cut the first sod of my hospital in Rochdale, to celebrate the 50th anniversary of the NHS. Would my right hon. Friend like to take this opportunity to rectify his mistake and add Rochdale to his list?
Mr. Dobson: I am delighted to stand corrected and discover that I am not guilty of exaggeration or hyperbole—litotes, I think, is the proper description. I apologise to my hon. Friend and to the people of Rochdale for leaving out their hospital. So we have seven hospitals started, which is a rather better record than that of the mob opposite.
Mr. Elfyn Llwyd: While the Secretary of State rolls out the achievements of the Government in the past 12 months, will he comment on why waiting lists in Wales have risen from more than 67,000 when the Labour Government took over to 73,000?
Mr. Dobson: They certainly rose in England, but they have stopped rising. I trust that they have stopped rising in Wales, but I cannot give the hon. Gentleman that assurance.
We said that we would help the hard-pressed staff in the NHS and social services cope with the pressures of last winter. And so we did. Over 1,500 special schemes were put in place, funded by the extra £300 million that we found. The result was a brilliant success. The people in social services and the health service worked together and put on the best winter performance in recent times. They dealt with more emergencies than ever before without the chaos and indignities of people waiting for treatment for days on trolleys and mattresses on the floor in what used to be called Bottomley wards.
Dr. Evan Harris: Much of the winter pressures money was given direct to social services to help to unblock jams. It would have been better to give money directly to social services in the spending round rather than make cuts of 1.1 per cent. in 1997–98 and 1.1 per cent. in 1998–99. Those cuts, measured in real terms, and before demography, meant destruction of social services in Oxfordshire and more bed blocking than will ever be undone by extra money for winter pressures.
Mr. Dobson: I am fascinated by the concept of a world before demography, but I must get on. No is the answer. No, no, no. Funding the social services part of the winter pressures effort through the NHS meant that I could guarantee that the money was spent on what it was intended for. If it had been handed out to local authorities, I could not have guaranteed that. I find my relations with the Chancellor of the Exchequer easier if I can guarantee that when he gives me extra money for X, Y or Z, it is actually spent on people in hospitals.
We said that we would get waiting lists down. With the help of the extra £500 million that we found this year, the NHS is doing just that. The lists stopped rising in May, and started to come down in June. I understand that the right hon. Member for Maidstone and The Weald will press me "hot and strong"—her words, not mine—about a suggestion that waiting lists are being fiddled in Worcester. I have checked, and the people concerned tell
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me that they are doing nothing different from what they have done with waiting lists for the past 10 years. I assume that the presence of the right hon. Members for Charnwood (Mr. Dorrell) and for South-West Surrey (Mrs. Bottomley) implies that the right hon. Lady has followed the convention of warning her colleagues to be in the Chamber when she makes her personal attack on their integrity.
What the right hon. Lady does not know is that waiting list figures for Worcestershire have not been reduced by the recent validation process. In fact, the reverse is true. The figures for March include, for the first time, more than 2,000 people who had simply been left off the lists previously. Some of those people should have been put on the list before the general election. I am still trying to find out why they were not.
Waiting lists are coming down, and will continue to come down, as will waiting times. Our waiting lists initiative is not confined to one year, but is part of our long-term programme to modernise the NHS. We are determined to improve health and health care in the most deprived parts of the country, and that is why we have set up health action zones in the South Yorkshire coalfields; Bradford; the east end of London; Lambeth, Southwark and Lewisham; Luton; Manchester, Salford and Trafford; North Cumbria; Northumberland; Plymouth; Sandwell; and Tyne and Wear.
To test out the effectiveness of using modern technology, we have set up three pilot schemes for NHS direct—a 24-hour nurse-led helpline—in Milton Keynes; Preston, Chorley and South Ribble; and Newcastle, North Tyneside and Northumberland. The pilots have been such a success that the scheme is being extended to cover more than 10 million people, and that will include Greater Manchester, Birmingham and Cornwall. It will cover the whole country by the end of 2000.
Mr. Richard Burden: May I welcome the choice of Birmingham for one of the new NHS direct schemes? Does my right hon. Friend agree that making good-quality advice available 24 hours a day, seven days a week, is a lot better than having market madness and a two-tier health service available 24 hours a day, seven days a week? Does he further agree that NHS direct will help to boost primary care, and will he look with favour on plans soon to come forward from Birmingham for primary care improvements that will ensure that the people of the city receive the health care that they need and deserve?
Mr. Dobson: I am sure that NHS direct greatly benefits the people concerned. It has another merit, in that it will provide job opportunities for trained nurses who because of injury, often back injury, find that they can no longer use their nursing skills to deal with patients. It has many merits. It is clear that many people are willing to ring the 24-hour helpline knowing that it is there for 24 hours. Some of them, because they are considerate of others, are reluctant to go to accident and emergency or ring for a doctor or ambulance. In some cases, people who clearly would not have rung for an ambulance have rung NHS direct and ambulances have been sent round straight away because the cases were urgent. In many cases, nurses have given immediate reassurance to concerned parents, the children of elderly parents and people worried about their neighbours. It has been a great success and I commend the people who have been carrying it out.

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We also promised at the general election that we would conduct an independent review of health services in London. We established the Turnberg review. The report was published and we accepted all its recommendations. With the exception of one or two—far from all—Conservative Members in London, there have been no substantial criticisms of the report or our implementation of it.
As part of our programme to get rid of the divisive arrangements that we inherited from the previous Government on primary care, we have made much progress towards the establishment of primary care groups involving GPs, community nurses and social services. Contrary to Tory propaganda, we reached amicable agreement with the GPs and everyone else concerned.
Mr. Simon Hughes: You gave in.
Mr. Dobson: It is giving in now, is it? The representative of the Liberal Democrats does not believe that the reasonable points that the British Medical Association made on behalf of its members should have been conceded. We should not have given in. We should have stuck it out, behaved like the Tories and ignored the representatives of the profession. That is not the way we operate.
Mr. Hughes: The Secretary of State knows what happened. His Minister of State was faced with the prospect of the GPs making a large protest last week. He negotiated with them the week before and has now delivered primary care groups with seven GPs and a GP in the chair. The groups are meant to represent all the professions and the community. Effectively, they will be run by GPs.
Mr. Dobson: For the first time in the history of our health care, nurses will have a say in what happens in primary care.
Mr. Hughes: The Tories introduced that.
Mr. Dobson: No, they did not. They did not introduce primary care groups in every part of the country. The hon. Gentleman should not reinvent history. He will be claiming that the Liberals invented the national health service next.
Mr. Hughes: We did. [Laughter.]
Mr. Dobson: I have been practising with that fly for some time.
We have other main tasks. We have to provide the staff of the NHS with the education, training and retraining necessary for them to cope with the ever increasing demands of their jobs. We must put in place new arrangements to set and deliver high-quality performance standards across the NHS. We must give more priority to public health and to reducing the inequalities in health that leave poor people ill more often and dying sooner. Once the outcome of the comprehensive spending review
1254
is published, I shall be able to spell out our new arrangements for continuing professional development for all NHS staff.
Let me give a simple example of what is needed. We all still expect nurses to provide tender loving care. These days, we also expect them to cope with using highly complex, high-tech equipment. They cannot be expected to do that without the necessary training and time for training, including training specific to new equipment. When we took office, we discovered that there is no machinery in the NHS to set performance standards or ensure that they are delivered. Without those arrangements, things go wrong. Nothing is done; people die. That is what happened with the children in Bristol, with breast cancer screening in Devon and Exeter, and with cervical cancer screening in Kent and Canterbury. We are determined to change the NHS, so that such systematic failures never arise again.
Today, the Government are putting quality at the heart of the NHS. We are doing something that no Government have done for 50 years: implementing new mechanisms to set standards, deliver standards and monitor standards. The Government are not prepared to leave quality in the NHS to chance, as occurs at present. Patients deserve a first-class service wherever they are treated.
We shall establish a professional-led National Institute for clinical excellence, to provide authoritative guidance to all health professionals on the latest technologies and drugs. There is no such organisation at present. We shall introduce national service frameworks to lay down what treatment and care should be provided for patients suffering from particular conditions. Except for cancer and children's intensive care, there are no such arrangements at present. We shall place on all local hospital boards the duty of clinical governance, to make sure that standards are met. They have no such duty at present.
We shall establish a Commission for Health Improvement to monitor the performance of every part of the NHS, carrying out a rolling programme of spot checks and troubleshooting. There is no such organisation at present. We shall require all hospital doctors to participate in national external audits. There is no such requirement at present. We shall give all GPs and their patients the right to get information on the success rates of treatments in their local hospitals. They have no such right at present. We shall carry out annual independent surveys of the experience of patients and carers in the NHS, to ensure that their voices are heard and heeded. There are no comparable national surveys at present.
I emphasise that all those proposals have been welcomed by representatives of the professions, which reflects both their commitment and the practical common-sense nature of what we propose. They are some of the practical steps that we have been taking to improve the NHS. We are equally committed to improving the health of the public and reducing inequalities in health. Under the Tories, the gap between rich and poor widened, as did the gap in health. That is true, and I shall give just one example.
In the early 1970s, there was scarcely any difference in the number of deaths from heart disease among men in social class 1 and those in social class 5. Today, men in social class 5 are three times more likely to suffer from heart disease. That constitutes a widening of the

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health gap. We are determined to reduce that gap, and the NHS has much to contribute to that process. However, other Departments' programmes will help even more.
Unemployment makes people ill. Our investment of £3.5 billion in the new deal for jobs will help improve the health of the people involved. Bad housing makes people ill, so our £900 million investment in new housing from the takings from the sale of council houses will provide decent homes and improve the health of the families concerned. Low pay makes people ill. Our national minimum wage will improve the health of the worst-off workers. Those and other measures are geared to helping the most deprived families and most deprived neighbourhoods—both have been neglected for far too long.
All those changes simply apply the basic socialist principles of the national health service to modern circumstances. Some people do not like that. Some so-called experts make a living travelling around the world attacking the principles of the NHS and demanding that we abandon its principles and charge everybody for everything. When they are in Britain, they ignore the evidence of the intrinsically cost-effective NHS. When abroad, they ignore the evidence of the intrinsically more expensive systems in the countries that they visit. They are a group of self-perpetuating ignoramuses. However, they are wasting their breath and whoever is paying their travel bills is wasting his or her money.
At the general election, the British people voted for the NHS—free when they need it, paid for by the taxpayer. The Government accept the verdict of the British people. Tories may argue, as some do, for a different system, but the Government are committed to the one we have. Today, we salute the people who work in the NHS—people of all colours, of all races, of all religions and of none. For every minute of every hour of every day of the past 50 years, they and their predecessors have bound up the wounded, healed the sick, cared for the afflicted, comforted the dying and consoled the bereaved. Frustrated by lack of resources and obstructed by archaic systems of organisation, they have never thrown in the towel. They have fought the good fight, but they have seldom received rewards to match their contribution to the well-being of our country.
Fifty years ago, our fathers and mothers—in some cases, our grandfathers and grandmothers—made an act of faith: they agreed to found the national health service. They had faith in the future, faith in the health care workers and faith in the principles of the welfare state. Today, as a country, we are rich beyond the wildest dreams of people in 1948. It now falls to us to renew and modernise the NHS, so that it is fit to face the challenge of the new century and the new millennium. We must not flinch or falter now.
Fifty years ago, people could only hope that the NHS would work. Fifty years later, we know that it works. We have experienced its benefits. We know that Nye Bevan was right when he wrote:
"Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide."
It is our job now to make sure that we renew the national health service, so that future generations experience the benefits that he gave to us. Nothing less will do.
4.36 pm
Miss Ann Widdecombe: The Opposition welcome the debate. We are especially glad because, on this occasion, for once, the subject has been raised by the Government. Hitherto, to get the Government to account for their stewardship of the national health service, the Opposition have had to demand the debates. To this moment, we have still not had the debate that we have consistently demanded on the White Paper.
The 50th anniversary is indeed a time for celebration. It is a time to remind ourselves that our health service is a service for the whole nation, conceived and planned by the wartime coalition Government—[HON. MEMBERS: "Oh!"]—and developed beyond the original scope of its founders by a succession of Governments spanning half a century. The original plans for a universal health service, free at the point of delivery, are in fact more than 50 years old. A White Paper was published by Mr. Churchill's coalition Government in 1944, containing proposals for a comprehensive, free health service.
Our health service is the property of the whole nation, not merely of particular sectional interests, or professions, or political parties. Our health service serves the whole nation, and individuals do not serve our health service by trying to claim sole moral ownership of it, or a monopoly of concern for its best interests.
Our health service is now infinitely more comprehensive than the plan envisaged by its founders. That is its greatest triumph, but it also poses some of the greatest problems. The demand for resources resulting from new technology, pharmaceuticals and changes in society has increased exponentially.
Mr. Winnick: The right hon. Lady mentioned briefly the White Paper produced in 1944, but she sort of skipped the next few years. Will she explain why her party was strongly opposed to the conception of the national health service and why it voted against the measure at every possible opportunity? After all, some explanation would be useful.
Miss Widdecombe: If the hon. Gentleman cares to consult our manifesto of 1945, he will find that the Conservatives were in favour of a universal health service. The difficulties that we had with the detail of the setting up of the health service were reflected in changes that the Labour Government of the day subsequently made. I suggest that he re-research that history, and he will find that what I have just said is true. Until today, I did not know that Beveridge was the property of the Labour party. The hon. Gentleman will find that the national health service is the property of all political parties and the entire nation, and we should be grateful for that.
The previous Conservative Government, contrary to the present Government's propaganda, increased spending in real terms by an average of 3.1 per cent. per annum. By 1997, health spending was three quarters more again than in 1979. We treated 4 million more patients; 6,000 more every day since 1991 than in 1979. Most crucially, those patients waited a much shorter time than their predecessors. The number waiting for over one year was

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cut from 200,000 in 1987 to just 15,000 in 1997. Four out of 10 patients on waiting lists were treated within one month and over 50 per cent. within six weeks.
Mr. Bob Blizzard: How then would the right hon. Lady explain the fact that every possible gauge of public opinion—every survey, poll and questionnaire—during the previous Government's time in office clearly showed that very few people thought that the national health service was safe in the hands of the Conservative party? Was that fact not reflected in the general election, in that so few Conservative Members are now on those Benches?
Miss Widdecombe: The disillusion, if there was disillusion, with the degree to which the health service could deliver services was as nothing compared with the disillusion in 1978 when the Labour party completely wrecked the health service by making enormous cuts, causing industrial action, slashing the capital spending programme and reducing the pay of medical staff. We had to rebuild the health service. The Labour party has not delivered on the propaganda pledges that it consistently churned out before the last election.
Furthermore, the last 10 years of Conservative government saw the largest capital building programme in the history of our health service. The Secretary of State read out some schemes today which are very commendable, but more than 750 schemes, worth over £1 million each, were completed in the last 10 years of Conservative government. The capital stock of our health service was modernised to a level unimaginable in 1979.
We have never tried to claim that our health service was perfect, but two thirds of its life has been spent under Conservative Governments, and we can feel proud of its achievements during that time. The Secretary of State has come to the House and, rightly, praised the health service and what it can do now compared to what it could do when he watched his father suffer, praised the new technology that was not available a few decades ago, and praised all those who have worked in the health service delivering the range of care that he described. After giving so much praise, it would have been generous of him, on a day of national celebration of the health service, to give credit where it is due and say that two thirds of the credit should go to us and one third to Labour.
We should be aware that many challenges that face our health service over the next 50 years will be met not by simple, comfortable and neatly packaged solutions, but by resolving very difficult questions, the complexity of which the Secretary of State underestimates, and by the care and dedication of everyone who is a part of the service.
Last May, we were led to believe that our health service was about to enjoy a golden period. It was, apparently, to be "saved". That now seems a very long time ago. Far from being saved, our health service has entered a period of crisis: record waiting lists, fiddled figures, clinical freedom under threat, hospital cuts and closures, GPs forced into collectives, spending cuts, bureaucracy on the rampage and Tony's cronies packed on to trust boards, all against the backdrop of the slickest, spin-doctored public misinformation campaign since the formation of our
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health service 50 years ago. It is now time to strip away the sugar-coated sophistry that threatens to suffocate the life of our health service and to expose the dark truths that lurk behind the Government's insidious propaganda, revealing the damage that they are inflicting on the very foundations of the service.
Before the election, the Labour party, deliberately and in its own interests, raised expectations to whip up public discontent with the health service. It did not mention the excellent work that we had done on reducing waiting times, but instead promised to reduce overall waiting lists by 100,000, using £100 million. That was an early pledge. The 100,000 reduction was to be, in Labour's words, "a first step". People could naturally be forgiven for inferring that Labour really meant that and for imagining that early meant sooner, rather than later, as it usually does. They could be forgiven for thinking that, by the time of the next election, waiting lists would have fallen by more, possibly many more, than 100,000, because that was, after all, a first step.
One would not expect the public to think that, within a year of Labour taking power, waiting lists would rise to record levels of almost 1.3 million—a queue for beds which would stretch more than twice the way around the M25. One would not expect the public to welcome the fact that even the Secretary of State for Health believes that it will take five years of Labour government to reduce waiting lists to 1.06 million, falling at a miserly rate of slightly more than 900 a week. One would not expect the public to imagine or understand that routine operations, such as for varicose veins, lipomas and sebaceous cysts, would be cut from general availability in different areas to remove, at a stroke, the possibility of waiting for such procedures.
Mr. Dobson: Will the right hon. Lady tell me—not necessarily now, but in a letter—where the availability of those operations has been withdrawn? She has made that accusation for about a fortnight, but she has not specified anywhere. Her accusation is slightly at variance with her equally misleading suggestion that we are urging hospitals to do varicose vein operations instead of heart transplants.
Miss Widdecombe: I shall indeed give the right hon. Gentleman examples, starting with Lambeth—I have just talked to a consultant who says that he can no longer perform such procedures. A gentleman in the north-west of Manchester was given a date in May 2003 for treatment of his varicose veins. He will have to wait for the next Conservative Government before he can have his varicose veins operation.
Mr. Dobson: He had to wait only until I knew about his position. Now he has an appointment in two weeks. Unlike the right hon. Lady, that gentleman thanked me for my help, in front of two television cameras at Trafford general hospital.
Miss Widdecombe: I am sure that he did because if he was put on a waiting list for an appointment in 2003, when the Secretary of State has been calmly telling the House that nobody is waiting for more than 18 months, he must have been extremely thankful to find that he would not have to wait until 2003.
Mr. Dobson: The 18-month wait is, as the right hon. Lady knows, for in-patients, and she should remember

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that this gentleman is an out-patient. Even so, his situation was ludicrous and had to be dealt with. If other people are being given out-patient waiting times of that length, they should get in touch with me and I shall sort out their problems too.
Miss Widdecombe: What those incidents prove is that those people should get in touch with us because every time we have raised a problem in the House, the Secretary of State has rushed out and taken action on it. He is now consulting his pager—does he want to correct the information that he just given me?
Mr. Dobson: My message is that, just before the general election, Lambeth, Southwark and Lewisham health authority started restricting access by sufferers of what it described as non-painful varicose veins.
Miss Widdecombe: That is quite correct. Before the general election, the authority said that it would restrict access. Access is now virtually impossible except in cases of serious clinical need.
Dr. Brand: Will the right hon. Lady give way?
Miss Widdecombe: No, I want to make some progress. I have given way four or five times already.
Further, one would not expect the general public to imagine that, to achieve that eagle-like descent of 900 a week, it would cost not £100 million, as Labour promised, but more than £400 million. Any business man who achieved his goal more than three years late and four times over budget would be booted out, with his P45 following by return of post, but the Secretary of State and the Prime Minister tell us that we should be grateful for that masterly piece of mismanagement.
But more than merely hopelessly bungled and inept mismanagement surrounds the Government's dismal failure. We have evidence, previously anecdotal but now documentary, that the Government have been presiding over manipulated waiting list figures. Put simply, they realised that they will not be able to meet their modest pledge by legitimate means, so cheating has started. I shall now give the House an example.
The Alexandra Healthcare NHS trust in Redditch has been told to cut 759 patients from its waiting list. The letter that I have received says:
"The Trust is being put under enormous pressure to remove 759 patients from its waiting list without giving the treatment originally deemed necessary."
Dr. Brand: The right hon. Lady has given many historical references. During an earlier waiting list initiative, plastic surgery centres throughout Britain were told to take patients off the waiting list as of then and a series of operations were abolished overnight. I know of 40 of my patients who were denied even an existence on a waiting list.
Miss Widdecombe: The Government have put the reduction of waiting lists at the centre of their credibility and we are entitled to ask how they are achieving it. That is what I am now asking.
Dr. Phyllis Starkey: Will the right hon. Lady give way?
Miss Widdecombe: No, I want to continue my point about the Alexandra Healthcare NHS trust.
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It has been decided that it is politically necessary that those patients do not receive the treatment. The Government's health matters more than the health of the patients. But the political pressure placed on the collection of Labour activists and Tony's cronies appointed to trust boards has been immense. A director was dragged out of a board meeting to take a telephone call specifically to ask him to go back in and try to persuade the board to accept the approach of denying patients treatment in order to fiddle the figures. Another was recently told that he had to produce an urgent briefing for the Prime Minister with an excuse for why waiting lists were rising, not falling.
The 759 patients who, presumably, are being told to get on their bikes are not the end of the story—not by a long way. It is proposed than an extra 2,300 waiting list cases will be slashed from Worcestershire health authority's waiting lists by what is innocuously termed an administrative clean-up. In reality, for patients, that means that the list is to be reprioritised. That is, simpler cases will be treated first at the expense of more complex and perhaps more serious ones—patients left waiting in pain to avoid the pain of political embarrassment to the Government.
Dr. Starkey: Will the right hon. Lady give way?
Miss Widdecombe: In a minute. I want to finish my point on the Alexandra Healthcare NHS trust first.
Perhaps even more serious, however, is that part of that 2,300 clean-up will be removed by reducing the referral rates of general practitioners to the trust. Why do I say that? Do I just imagine it? No, I have here the paper that went to the board:
"The health authority proposed that 2,300 of the 8,000 cases should be removed from the waiting list by a combination of reprioritising the list, administrative clean-up and the reduction of referral rates of GPs to the trust."
Then, with masterly understatement—litotes, I think the Secretary of State called it—the paper states:
"that objective was received by the trust with a great deal of caution and is accepted as, exclusively, a health authority target."
I listened carefully to what the Secretary of State said and I listened to his weasel words. He said that nothing is being done that is different from what was done under the previous Government. Nothing is being done—no. Semantically, that is right. These are proposals for actions to meet his current targets and the pressure that he is putting on chief executives by telling them that they will be sacked if they do not deliver his election pledge.
Mr. Dobson: I am accused of being all sorts of things, but weasel is fairly unusual.
Mr. Deputy Speaker (Mr. Michael J. Martin): Order. Such terms are not appreciated. Temperate language is preferable.
Mr. Dobson: I have no attributions from the right hon. Lady for any of the statements that she has made, other than the paper that went to the board. First, I do not know why the board considered the matter in private, because, under the new rules, it should have been considered in public. Secondly, I have a paper here from the regional

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office from a man called Steve Hilton, about whom I know nothing, which says:
"Validation like this has been common practice for over a decade."
Nothing new is happening as far as I can make out. Nothing different is being done. As I said earlier, in the previous validation exercise in Worcestershire, 2,000 people were added to the waiting list. We are entirely in the hands of this statistical lunacy to which I referred at the previous Health questions.
Miss Widdecombe: No, there is no statistical lunacy in the clear statement read from papers to the board, which the right hon. Gentleman has, that one of the means of achieving this is to reduce the referral rates of GPs to the trust. In plain English, that means that, unless patients' conditions are very serious, they cannot even get on to the waiting list. Patients will, in effect, be told that they can pay up and go private or sit and suffer.
The hospital has not even been given enough money by the Government to fiddle the figures properly. The special funding, touted so heavily around the media as a panacea for the waiting list funding, is actually short-changing it to the tune of £1.9 million.
If that fiddle—the Secretary of State might prefer to call it a pattern of behaviour—in private or in public, is repeated throughout Britain, it becomes almost impossible to contemplate the damage that is done to patients' health, and the extent to which the fiddled waiting list figures misrepresent the true picture of the mess that Labour has created.
Dr. Starkey: Will the right hon. Lady give way?
Miss Widdecombe: I shall finish my point on the Alexandra Healthcare NHS trust. I have remembered the hon. Lady and when I have finished my point I shall come back to her.
The picture to emerge from this sorry tale of sordid deception is of a Government who will commit any act of manipulation, spin any convenient sophistry and break any trust to present what must be seen not only as a deeply misleading picture of their waiting list disaster, but a highly dangerous practice which can only be harmful to the well-being of patients.
Perhaps I am too harsh. Perhaps I have misjudged the Secretary of State. Perhaps he does not know that that is going on, and would not countenance it if he did. Perhaps he would wish to stop it. I shall give him the benefit of that doubt and suggest what he can do to reassure us.
Will the Secretary of State tell the House in terms that he would rather see waiting lists rise than see fiddled falls that will mislead the public and endanger patients? Will he go further and issue a letter to health authorities informing them that waiting lists are not to be cut by using dubious expedients and specify that that includes removing from the list patients who have not received their treatment, placing pressure on GPs to reduce referral rates, removing the general availability of certain smaller operations, and treating simple but less urgent cases before more complex but important ones? If he will offer that assurance, and if he will send such a letter—
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preferably today, but I shall give him until the weekend if he is busy—we can be less suspicious about the Government's attitude to such foul play.
Will the Secretary of State commend—indeed, praise—the whistleblower on the trust? The Secretary of State is keen on whistleblowing. On this occasion, the whistleblowing has been done on his waiting list figures. Will he commend the whistleblower, and will he write that letter?
Mr. Dobson: I do not mind who publishes which of those figures; if the trust had been following the guidance that it has been given, the figures would have been public anyway. I do not know who the whistleblower was. If anyone wants to release such information, he or she should. I am in favour of its being released. I do not think that these things should be done behind closed doors.
In response to the request for an instantaneous letter, most of the things that the right hon. Lady specified are in the instructions to the entire national health service about waiting lists. On the accuracy of waiting lists, when the figures were increasing as a result of tracking down people whose names had not previously been on the list, I have told officials and regional chairmen to get the figures right. The figures need to be right.
The policies of Worcestershire health authority—whose members, I might add, I did not appoint—are, generally, to try to get more people treated, if appropriate, closer to home by their GPs rather than, in some cases, going into hospital. As I understand it, that explains the line in the document about which the right hon. Lady is talking.
If anyone anywhere is fiddling the figures, it should be drawn to my attention and I will stop it. The only purpose of shortening waiting lists is to get people treated, not to do a statistical exercise. I return to the point that, as far as we know, the whole process that Worcestershire health authority is going through is exactly the same it has been for the past 10 years.
Mr. Deputy Speaker: Order. May I make an appeal to Front Benchers, as Back Benchers want to take part? This is a debate for everyone, so the hon. Lady should not entice the Minister to come in on an intervention. [Interruption.] Order. What I am trying to say is that—
Mr. Dobson: I shall try to resist temptation.
Mr. Deputy Speaker: Order. The Minister will try to resist and the right hon. Lady will try not to entice him.
Mr. Duncan: Why not?
Mr. Deputy Speaker: The Government have an opportunity to reply at the end of the debate, and so do the Opposition. The hon. Gentleman asks, "Why not?" I have to look after the interests of Back Benchers as well as Front Benchers.
Miss Widdecombe: I have seldom found any of your instructions difficult to follow, Mr. Deputy Speaker, but being told not to tempt the Secretary of State may give me the odd piece of difficulty.
Dr. Starkey: Is the right hon. Lady aware that Milton Keynes general hospital, in my constituency, has already

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started to reverse the trend, which occurred under the Conservative Government in which she was a Minister, of increasing waiting lists? It held the waiting list increase over the winter to only 29 extra patients; the previous winter, there was an increase of 631. The hospital did so thanks to the £1.1 million of extra money that it got, which allowed it to save more than 4,000 patient bed days. Is the right hon. Lady further aware that the new chairman of that hospital trust is a former official of the Milton Keynes Conservative association, put forward by me and nominated by my right hon. Friend the Secretary of State?
Miss Widdecombe: It never surprises me when Conservatives are successful. I must tell the hon. Lady that, of course, none of us has seen the figures, because they have not yet been published. At the moment, the only knowledge that we have of revised waiting lists comes from the Secretary of State's warm and woolly claims. We have not read any detail.
Mr. Blizzard rose—
Miss Julie Kirkbride rose—
Miss Widdecombe: I shall make progress, because you will get cross with me if I do not, Mr. Deputy Speaker.
Recently, the Secretary of State for Health announced that no patients were waiting more than 18 months, and that the first step in the delivery of Labour's "early" pledge had been delivered. Unfortunately, as the House knows, that did not happen. Even as he was saying that, we produced the case of a young boy of eight years who had been waiting more than 18 months, in considerable discomfort, for a simple tonsillectomy.
On 16 June, I brought that information to the House. The Secretary of State denied all knowledge, but—as if by a miracle, dispatched at the speed of light—a motor cycle courier was sent on his mission of mercy to deliver, posthaste, an in-patient appointment. The Minister of State, the hon. Member for Darlington (Mr. Milburn), told the House that the boy would
"have an operation within the next few days, as the NHS trust had always planned."
Presumably, that is now standard procedure in new Labour's NHS. The appointment card will be delivered by motor cycle courier, on the day of an Opposition debate when they raise an embarrassing case, and we shall be told by the Minister that that had been planned by the trust all along. The mother of the boy says that she had an appointment; it was for several weeks later.
Dr. Stephen Ladyman: Will the right hon. Lady give way?
Miss Widdecombe: Mr. Deputy Speaker is not looking. Okay.
Dr. Ladyman: I also have a constituent who has been told that his son must wait six months for a tonsillectomy. He was also told, however, that he could have it the
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next day, done by the same surgeon, privately. Will the right hon. Lady join me in condemning that type of queue jumping?
Miss Widdecombe: I shall not condemn anyone having a remedy against the present Government's inefficiencies. [Interruption.]
Mr. Deputy Speaker: Order.
Miss Widdecombe: That was not for me that time, was it, Mr. Deputy Speaker? No.
There is something faintly sinister about all this. It is a bit like the miraculous, phoenix-like rebirth of the Trafford general hospital children's unit, which was "reprieved from closure" two days before the Secretary of State for Health was to make a highly publicised visit. The right hon. Gentleman tells us that he did not know anything about it. Well, I wonder whether he will now do me a big favour and instantly arrange for highly publicised flying visits to Kent and Canterbury hospital, Burford community hospital, many community hospitals in Cornwall and various others that he is about to close. Then, perhaps, the need to save his face will coincide with the need to save those hospitals.
Miss Kirkbride: On the subject of the closure of hospitals, I hope that my right hon. Friend will urge the Secretary of State for Health to visit Kidderminster, where the Kidderminster general hospital, which serves my constituents, faces closure.
On the wider front of Worcestershire, I wonder whether my right hon. Friend has any advice for doctors in Bromsgrove, who feed patients into the Alexandra in Redditch. I shall meet those doctors tomorrow, and I would welcome her advice on what to say to them about how to resist the cynical bully-boy tactics of the present Government, which are preventing my constituents from having their names put on the waiting list for the medical treatment that they deserve.
Miss Widdecombe: It is all right. Now that the subject has been mentioned in the House, I am sure that there will be an instantaneous solution, and that, even now, there will be a rush and a motor cycle will be on its way to those patients. I therefore urge my hon. Friend not to worry too much about it.
Dr. Ladyman: Will the right hon. Lady give way?
Miss Widdecombe: No; I shall make progress. If the hon. Gentleman has a hospital in his constituency, will the Secretary of State visit that hospital, too?
Because the Government have made their rather modest pledge on waiting lists, and associated propaganda, the fundamental goal of their health policy, subsequent media interest and the Secretary of State's obsession have eclipsed many other issues of great importance to patients and the profession. We can see the extent to which the waiting list panic has come to dominate Health Ministers' every thought and act, at the expense of other areas of our health service.

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During the 16 June debate on the waiting list crisis, the Minister of State, the hon. Member for Darlington, assured the House:
"The hon. Gentleman asked me for an assurance that no other sector of health care would suffer as a consequence of our getting NHS waiting lists down. I will give him that assurance".—[Official Report, 16 June 1998; Vol. 314, c. 187–89.]
However, it appears that the chairman of the British Medical Association profoundly disagrees with the Minister. On the "Today" programme on Monday 6 July, when asked about giving priority, for political reasons, to patients whose need is less, Dr. Sandy Macara said:
"Unfortunately"
this
"is happening because the Government have put themselves, and therefore all of us, on a most unfortunate hook."
I ask the Secretary of State who is correct. Is Dr. Macara—a figure for whom I understand the right hon. Gentleman has great respect—factually incorrect, or was his Minister in danger of misleading the House on 16 June? No reply comes.
Other areas of our health service are bound to suffer as the Government become increasingly like a one-eyed man over the waiting lists. The changes that they have introduced will only make matters worse for people in lengthening queues for simple operations. Dragooning GPs into collectives and then preventing a collective from choosing which trust to send its patients to will increase the lists and deter trusts from making the improvements that are necessary to ensure a uniform standard of service throughout the country.
Reductions in clinical freedom, imposed through NICE—the National Institute for Clinical Excellence—and backed with cash-limited GP drugs budgets will cause morale to plummet and patient care to suffer.
Mr. Dobson: Will the right hon. Lady give way?
Miss Widdecombe: No, I have been told not to do so.
Mr. Dobson rose—
Miss Widdecombe: The Secretary of State gives in to temptation an awful lot. Will he please be tempted to look again at the bureaucracy resulting from the introduction of NICE, the Commission for Health Improvement, the Advisory Committee on Resource Allocation, local education consortia and the co-ordinating bureaucracy between health and local authorities, which will divert money from front-line patient care into administration? GP collectives alone will cost £150 million a year to run. In short, Labour's White Paper is a blueprint for increasing the people's waiting lists.
Perhaps the situation would not have been so dire, had our health service been given the money to meet the high expectations. Under Labour, however, that has not happened. Our health service is now worse off by more than £800 million over and above inflation than if our average spending levels had been adhered to. That does not take into account money squandered through efficiency losses and unnecessary new bureaucracy.
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The mantra that Ministers have repeatedly chanted over the past few weeks is that the comprehensive spending review will lead us to the promised land of health service bliss. I wonder. I have calculated that the Government will have to spend at least £8 billion over three years to stand still and to match average Conservative spending levels. People do not have to take my word for it. Every hon. Member has access to the House of Commons Library, which has independently calculated that my figure is an underestimate, that more money will be required, and that the figure cited by the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) is nearer the mark, at £9 billion.
That has been another well-presented, slick PR exercise designed to mislead the public. Now I shall ask the Secretary of State a few simple questions.
Mr. Dobson: I am not allowed to answer them.
Miss Widdecombe: I will incur the wrath of Mr. Deputy Speaker by allowing the right hon. Gentleman to answer them, if he can. I know that the Government like their questions to be helpful, but we will not have a serious debate on the future of the health service by indulging in the good-news culture of his party.
Critical questions must be asked about rationing—which the Secretary of State denies is happening, but it is—rising demand, clinical freedom, recruitment of doctors and the role of the private sector. Those questions are already being debated by sensible people in the health service, but they are not happy bedfellows of new Britain and the new NHS. Such questions cannot be asked helpfully while the Government remain on-message.
How much, over three years, does the Secretary of State believe must be spent on our health service, simply to stand still? I have asked him before, the hon. Member for Southwark, North and Bermondsey has asked him before, my hon. Friends have asked him before and I still live in hope that he might answer. How much will primary care groups, CHIMP, ACRA, LECs and health authority-local authority co-ordinating bureaucracy cost our health service per annum?
Was the Minister of State making an unsubstantiated statement to the House when he assured us that other areas of the health service were not suffering as a result of the Government's obsession with their waiting list publicity? If not, how does that accord with Dr. Macara's view of the situation?
If the Secretary of State could give us the figures, fiddled or not, for over-18-month waiters before the customary time, why can he not give us the full waiting list figures? We are told by trusts throughout the country that a huge amount of time is taken up with supplying information on a weekly basis. If the Secretary of State has asked for weekly reports, how much is that costing and why is that information not released to the public, who are paying for it? Finally, how widespread throughout the country is the manipulation—I even use a neutral word—that we discovered in Redditch?
The Government are obsessed with their own propaganda, but behind it is a catalogue of incompetence, mismanagement and manipulation. They told us that no one was waiting more than 18 months for an operation. That was not true. They told us of 2,000 new beds, which turned out to be mainly recycled or temporary beds.

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The Government enjoyed that one so much that they released the same statement twice. All I can say is that, if some of their announcements were about food, there would have been a prosecution. The Government told us that they did not know how many hospitals they would close. They told us that waiting lists were falling, but they have been caught red-handed chucking patients out of the queue.
This is a fiddling, cheating, gerrymandering, dissembling, spin-doctoring, bullying, arrogant Government and they have finally gone too far.
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng): The right hon. Lady does not believe that.
Miss Widdecombe: I do believe it and, what is more, the people are beginning to believe it. Running our health service for the benefit of their own PR, not for patients, has come to be the defining feature of the Government, for whom getting headlines is more important than getting results.
Several hon. Members rose—
Mr. Deputy Speaker: Order. Before I call the next speaker, may I say that 25 Back Benchers want to speak, on both sides of the House. Hon. Members can draw their own conclusions. Long speeches will squeeze other hon. Members out.
5.16 pm
Mr. David Hinchliffe: I am grateful for an opportunity to make a few observations in the debate. There is a common perception that the political agenda of the two major parties has in, recent years, moved closer together in several policy areas—economic and foreign policy, penal affairs and to some extent social policy. It is no secret that I feel uneasy about that process, but I have a great sense of relief that the outlooks of the two parties on the national health service remain as polarised as ever.
I commend the Secretary of State for his work to ensure that that polarisation remains. He has a remarkable record in defence of the basic principles of the national health service. I commend the Government for their excellent work over the past year in various areas. There is to be an announcement next week on the Secretary of State's record of winning new investment in the NHS, which is remarkable. I commend him on the national health service White Paper and on dismantling the internal market.
Primary care has already been mentioned. I commend the Secretary of State on restating in the White Paper the vision of Nye Bevan in respect of primary care—a vision that has never been delivered since the original plans and proposals were drawn up in the 1940s. I commend the restatement by the Secretary of State and his Minister for Public Health of the crucial importance of public health, an issue that disappeared from the agenda during the Tory years because of the political inconvenience of unemployment, bad housing, poverty and other issues about which the Tories never cared, but which had a crucial connection to the issue of personal health and ill health.
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I commend the Secretary of State on developing links with social services and on the impact of the winter beds initiative on the difficulties that have been experienced in the past with lengthy waiting lists. Most importantly, I commend my right hon. Friend on returning to the fundamentals of the national health service—to collectivised, socialised provision, and to a co-operative and collaborative national service. He used the term "the socialist ethic" of the NHS. That is what the Government's policies are all about, and I am proud of that fact.
I was waiting for the shadow Secretary of State to give us some idea of what she would do if, God forbid, she ever came to power. She analysed her version of the Labour Government's record, but I want to know what a Conservative Government would do in the current circumstances. Last week, I had the dubious opportunity of doing a couple of interviews with her in celebration of the 50th anniversary of the NHS. One was on the "Today" programme and the other was on breakfast television. I was interested in her lack of response to my hon. Friend the Member for South Thanet (Dr. Ladyman), who told us what happened when his constituent was advised to go private. The right hon. Lady's advice to the nation in those two interviews was that people should take out private insurance. The clear implication was that the country could no longer afford a national health service, so people should go private.
Miss Widdecombe: There is a sum of money that goes into the nation's health; some is put in by the state through general taxation and some by individuals and organisations, including trade unions, who take out private insurance. Does the hon. Gentleman accept that, if the private element is removed, the total sum that goes into the nation's health is reduced?
Mr. Hinchliffe: What I do accept is that the system that the right hon. Lady offers is very different from what I believe in. I do not believe that, because I am wealthier than someone else, I as a human being have the right to queue-jump over somebody whose needs are greater than mine. I have seen that happen in the context of my family. My father waited for a heart bypass for two years. My predecessor raised the issue with the Minister of State in the previous Government, and my father finally got into hospital after the intervention of the then Minister of State. Having worked hard all his life, my father had retired at 65 and been ill until the age of 67. I vividly remember the man in the next bed telling him that he had gone private and waited for only three months. He had queue-jumped and pushed everybody else back down the queue. That is an immoral system. The shadow Secretary of State professes to be a moral person, but she advocates a profoundly immoral practice. I hope that the Government will do something about that practice because that is the unfinished business of Bevan.
Miss Widdecombe rose—
Mr. Hinchliffe: I have given way once, and I am conscious that many of my hon. Friends wish to speak. The right hon. Lady had a chance to make her point, and I have responded to it.
The Tories regard private insurance as the way forward, but what about those who cannot get it? They should talk to people who are chronically ill, or to those who are fit

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and well, but have in their families illnesses that are passed down from generation to generation. They do not feature on the Tory agenda. The right hon. Lady should deal with the concerns of people who do not believe in the system that she advocates because it is profoundly unfair and immoral.
On this 50th anniversary, the key task is to restore the original ideas and framework of the NHS, which has been so damaged by the Conservatives over several periods in government. The shadow Secretary of State said that the Tories had been in power over many years of the existence of the NHS. In this debate, we shall look at the history of the national health service and at what has happened in the past 50 years. In 1974, the Conservative Secretary of State, Sir Keith Joseph, introduced changes to the national health service. At that time, I was a young councillor serving on a local authority. I also worked in a social services department, so I saw the situation from two perspectives—as a politician and as someone who was professionally involved with the national health service. I hope that the Government will repair the crucial mistake that was made at that time, when public health was removed from the local democratic debate.
As a young councillor in Wakefield, I recall discussing smokeless zones, slum clearance, the sexual health of young people and mortality rates. Those key public health questions should be dealt with at a local level, but in 1974, the Conservatives removed that ability and separated public health from fundamental health-related issues, such as housing, the environment, transport, education and, especially, social services.
That Tory decision caused the start of what my right hon. Friend describes as "the Berlin wall"—the divide between social care and health care. We are still trying to deal with the consequences of that totally false divide. It was the beginning of the bureaucratic explosion, which culminated in the internal market with the establishment of unelected, locally unaccountable health authorities. In the late 1980s and early 1990s, I served on Committees considering health legislation with the right hon. Member for South-West Surrey (Mrs. Bottomley), who was then the Secretary of State, and we spent many hours arguing about the internal market.
In my home town of Wakefield, the functions of one health authority were replaced by four different agencies, which made no sense to me. Most of the time, those agencies were arguing about where the boundaries were, who did what and who was responsible. They were constantly blaming each other. We never saw any real impact of the new money put in by the previous Government because it was wasted in an incredible bureaucratic paperchase, which they introduced because they believed that the national health service should be run on the basis of a market philosophy rather than on the basis of collectivism, in which my right hon. Friend and I believe.
The right hon. Lady will recall that, at the same time, she began the process of the wholesale privatisation of community care, which reinforced the Berlin wall. Elderly people had to pay for services that were previously free at the point of need. That was the Tory Government's record, and people will not forget it easily.
Dr. Harris: Does the hon. Gentleman accept that cuts to social services funding, which the House of Commons
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Library figures show were greater than 1 per cent. in real terms in each of the past two years, mean that local authorities and social services must tighten eligibility criteria and put up charges? Thus the desperate, difficult and unfair situation to which he refers gets more desperate, difficult and unfair when social services funding is cut. Those cuts have been made for the past two years, because the Labour party has adopted Tory spending plans.
Mr. Hinchliffe: The hon. Gentleman has been in the Chamber when I have pressed the Secretary of State on the issue of social services. The Select Committee on Health is about to produce a report on that issue, and I am sure that it will help the Government in considering what to include in the White Paper on social care to be published in the autumn. I am optimistic that the Secretary of State will listen to concerns such as the hon. Gentleman and Labour Members have expressed.
I mentioned the pre-1974 structure because I believe that it was a more sensible and effective framework. In a sense, that is the standard by which I judge what the previous Government did and what this Government are doing. I wish to outline some key areas that the Government must address in returning to the framework that we inherited from the Bevan era because they made a lot of sense to people like me when I was working in the system, but they have been destroyed by subsequent Governments and particularly by the Conservatives' internal market.
I welcome the Green Paper on public health and the work by the Minister for Public Health in that direction. I am concerned that the issue of public health is marginalised within health authorities and has shifted away from local democratic debate. We must get it back in the mainstream of democratic debate. I welcome health improvement programmes, smoking initiatives and health action zones, but the Secretary of State will not be surprised to hear me say that I would welcome a more central role for local authorities, which have a great deal to offer. A great deal of progress was made in the past as a consequence of public health being part of their responsibilities.
I want the work that is already done on links with social services to be enhanced. My right hon. Friend knows that I favour moving towards the local government health model; I know that that is not my party's policy, but I support it on the basis of my working experiences. Perhaps I am out of date and have not had his experiences of some rather questionable people in London boroughs whom he would not trust to run the health service—I understand his problems.
Mr. Dobson: Lady Porter.
Mr. Hinchliffe: I missed that one, so I shall revisit it in Hansard.
The organisational split of health and social care is nonsensical; I am sure that my colleagues on the Health Committee would agree that it does not make any sense, whatever solutions we reach when we discuss the matter. I welcome the White Paper's proposals on links with social services in primary care, but we need radically to enhance such links along the lines of those that my colleagues on the Health Committee studied in Northern Ireland.

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We went into a primary care centre at which everyone—nurses, midwives, health visitors, care managers and child protection officers—was working in a local GP's surgery, together in one body. That is the system that I experienced before 1974; it was destroyed by the Conservatives, which has taken us so far back in comparison with my career experiences several years ago.
I also want to refer to the continuing concern about the democratic deficit in health, and my discomfort, which I think my right hon. Friend the Secretary of State shares to an extent, at the continuation of the appointments system. I suspect that he has had more difficulties over the past year with who should be appointed and who has been recommended and by whom, and with checking that those people are suitable, than with many other issues. There should be new arrangements giving service users a real voice. Let us get some young mums involved; they are the main users of the NHS, and they should be running it and making the decisions.
That takes me on to my final, local points. Young mums in Wakefield are a concern to me, because a number of policy issues affect them directly in respect of maternity services and gynaecology. I wanted to make a general speech, but it would be wrong not to refer to the serious concerns in Wakefield about proposals in respect of maternity services. I know that I do not look it, but I shall be 50 in October, so I share this anniversary with the NHS. [Interruption.] Who said that?
I share this anniversary with the NHS—I came in during 1948 as well. An excellent example of family planning, I was born at Manygates hospital, three months after the NHS was set up. My children were also born there, but Manygates was recently closed by the Tories on the ground that we needed anaesthetic cover, and that little hospital did not have it. Services had to move to Pinderfields district general hospital but, as my right hon. Friend the Secretary of State knows because I have raised the matter with him before, there is a proposal to close the maternity unit at Pinderfields. The central argument is that anaesthetic cover is not adequate, which is why services were moved there in the first place.
We were promised a new unit, but we have never had it. I hope that my right hon. Friend will consider this issue, because I think that we are being sold a pup by the health authority. I have a lot of respect for the difficult work that it is doing, but there are serious questions about some of its arguments. For example, it is proposed to move gynaecology and maternity to Pontefract on the basis that the Calman-Hine proposals on cancer will mean that a large part of the gynaecology work load will have to go to Leeds. I have checked the matter factually, and, over the past 12 months, only 63 of 2,179 new referrals related to malignancy of the ovary, womb, cervix and vulva. We have been given the wrong information, and I hope that my right hon. Friend will consider this issue because the women and the public of Wakefield are facing profound changes on the basis of untrue and misleading statements.
Audrey Wise: Will my hon. Friend also ask the Secretary of State to take another look at how "Changing Childbirth", a useful report based on the Select Committee report to which my hon. Friend and I contributed, is being implemented? It is my strong impression that, having had impetus for five years, we are in danger of forgetting the valuable principles enshrined
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in "Changing Childbirth". Our right hon. Friend should look again at that issue for the sake of women awaiting childbirth.
Mr. Hinchliffe: I commend my hon. Friend for her key role in the report, which was her idea. The conclusions have moved things forward radically, but the direct issue in my constituency, and a key question in respect of "Changing Childbirth", is that women should have choice. My constituents are being denied choice, and I hope that my right hon. Friend will consider that.
The Secretary of State has more than kept the Government's promises nationally. He has an excellent record in his year in the job. The socialist ethic is being restored by the Government, and I warmly welcome that. I look forward to the health service going from strength to strength—in the hands of a Labour Government.
5.35 pm
Mrs. Virginia Bottomley: I welcome the opportunity to speak in this important debate. The national health service, its achievements and its future, is a subject which concerns us all. Like the hon. Member for Wakefield (Mr. Hinchliffe), I am of the 1948 vintage, and I think that he looks very young indeed.
The hon. Member for Wakefield and I are part of a generation that has a passionate commitment to the health service. I have spent most of my working life working with it, and I should declare an interest: the NHS employs more members of my family than any other employer. The health service is a concern to our constituents, but it is a source of pride to our country as we talk about its achievements and, above all, its culture and ethos around the world.
Much has been made of the socialist contribution to the NHS. Dare I say that it has also led the NHS to be cumbersome, bureaucratic, reluctant to change, paternalistic and unresponsive to patients. That contribution led to many of the necessary changes during the past 18 years. For all the lofty rhetoric over the past year, imitation is the sincerest form of flattery. There has been a massive rebadging exercise, and I shall talk through some of the uncomfortable hooks, as Sandy Macara described them, that the Government left for themselves in opposition. They have been working hard to get off those hooks and back on to the programme of evolution and modernisation of the health service.
In opposition, the Government said that they would end the internal market, but they have rebadged the internal market—the distinction between purchasers and providers remains. It would have been strange of them to dismantle a system that the Organisation for Economic Co-operation and Development has been commending to other countries around the world since 1994. The combination of the patients charter, the strategy in "The Health of the Nation" and the establishment of the distinction between purchasers and providers was described by the OECD as putting Britain
"in the forefront of countries attempting to achieve more coherent health policies which recognise that health care is only one part, but still an important one, in improving health."
I welcome the continuation of the internal market, but I deplore the fact that the Government's political rhetoric about ending GP fundholding has resulted in the introduction of far more cumbersome, bureaucratic

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GP co-operatives. Whoever would have thought that GPs—all of them—would be forced to become budget holders, for that is the effect of the bounce that they have received from the incoming Government? I dare say that we might, in due course, have done that ourselves, but, when in opposition, members of the present Government would have been deeply irresponsible, and hostile to any such measure. They also said in opposition that they were against hospital closures, and that there would be no more. Since then, they have been back-tracking hard.
This is a difficult issue for us as constituency Members of Parliament, because we all know that our own hospital is a more loved and understood institution than almost any other. The dilemma for any Secretary of State for Health is whether to champion the future—changing technology and styles of health care—and whether to follow the Calman-Hine protocols on cancer treatment. I am delighted that Sir Kenneth Calman was appointed when I was in office; I congratulate him on his achievements, and wish him well for the future.
I commissioned and published the Calman-Hine report. The logic of the expert views on the delivery of health care is to change the fabric—the bricks and mortar. Is the health service its values and its treatments, or is it its institutions? I believe that it is the ethos and the service, and it must look to the future rather than the past.
The Secretary of State will have greater and greater difficulties with his socialist instincts. The introduction of protocols, guidelines and centralising techniques will make change and evolution harder and harder. There is a growing concern that the end of fundholding and many of the other new measures will stifle innovation. It is through innovation that we will conquer the diseases and frailties of the future.
In opposition, the Labour party irresponsibly heralded endless individual cases devoid of a context. The case of Jennifer's ear will be with us for ever. In government, it must tackle the underlying challenges. I wish the Secretary of State well, and I hope that he will do at least as well as we did on funding.
We delivered an average real-terms increase of more than 3 per cent. a year. It is nonsense to say that the Government are spending what we would have spent. Any Health Secretary who lived with the figure in the Red Book would have been deeply humiliated. That was the opening of negotiations: the Health Secretary, with the chief executive of the NHS, then went out to bat with the Treasury so that targets could be met. That is why I had hardly any summer holiday for six years—neither did my successor, and nor, I imagine, will the present Secretary of State.
So far, the Secretary of State has not done well enough. I shall welcome it if he gets the three-year funding package. I do not advise mid-year rescue packages, because they result in shroud waving and crises. People become adept at gaining access to sources of funding. We increased NHS funding by a full percentage point of gross domestic product. I wish the Secretary of State well, and hope that he can say the same when he finishes his term of office.
The local effect is dire. My health authority has had a mere 1.3 per cent. increase. It has an acute shortage of nurses. It may, objectively, have little health need, but it
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has massive health demand. It is having great difficulty recruiting staff, and the position will get progressively more difficult as a result of the changes to the formula that the Secretary of State is introducing.
The Secretary of State's approach of naming and shaming officials is unacceptable. I have always condemned him for criticising health managers. When he was in opposition, no opportunity was resisted to attack health managers—I have a list of quotations, if he would like to see it. I am pleased to say that he has made progress, but the Prime Minister still takes every opportunity to attack what he calls "bureaucrats". The managers in the health service, as much as the doctors and nurses, are committed to the general good and to philanthropy: they believe in the service. It is not fair, and not right, for them always to be the scapegoats.
I am sure that the Secretary of State is aware of the growing unhappiness about late-night calls from the boot boys in the Box. People have spoken out about the telephone calls they have received telling them to keep quiet and not to say what they believe. If the Secretary of State wants me to identify those people, I shall do so later outside the Chamber. There is a bullying atmosphere at the centre. People are excluded from policy making, and there is a loss of confidence in his ability to work with people and not make them scapegoats when difficulties emerge.
Mr. Dobson: The only person I named and shamed, so to speak, was the chair of the National Blood Authority, whom I named, shamed and sacked. As I understand it, the right hon. Lady's successor, my predecessor, was broadly sympathetic to my action. Indeed, my announcement was welcomed by the Opposition Front-Bench spokesman.
There is no question of anyone on my behalf trying to prevent people from speaking out. I have made it crystal clear to every health authority and trust that they must dispense with the gagging clauses that were introduced into people's contracts when the right hon. Lady was the Secretary of State.
Mrs. Bottomley: I give the House and the Secretary of State my solemn word that I have heard of repeated incidents of intimidation by his office. I do not want to add to those people's discomfort by naming them now, because that would compound their difficulties. If he is not aware of that intimidation, he should know that people are behaving in that way on his behalf.
There are further allegations of cronyism. The Secretary of State appointed Baronesses Hayman, Jay and Dean. New Labour Members have approached me and commented on their experiences as members of a health authority or trust. It is difficult to understand the high-handed, contemptuous manner in which a great number of people who gave many years' service to the NHS were dismissed. Ann Galbraith from Newcastle, the NHS representative on the citizens charter, is a person of impeccable integrity. She first knew that she was being dismissed when she was told by her successor.
The other day, the Secretary of State accused one of my hon. Friends of being too lazy to make nominations for health appointments. I have made a number of recommendations, but he has dismissed the vast majority of my suggestions and has appointed people of his

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choosing. Nolan, when he investigated health appointments, commended the steps that had been taken to introduce panels and to achieve a more open system. The Secretary of State's recent announcements have resulted in a loss of confidence, and we have taken many steps back. It may be that it is early days, and that a great number of appointments have had to be made. I hope that that is the case.
Mr. Dobson: The Nolan panel still exists. Nominations come to me, as they used to come to the right hon. Lady. I make different judgments in some cases. Conservative Members have thanked and commended me for appointing people they have recommended. The right hon. Lady was appointing people for a long time, so perhaps she should get used to the fact that she is no longer doing so.
Mrs. Bottomley: I am much enjoying the fact that I have weekends free and can have a holiday, and that I no longer have the responsibilities of the Secretary of State.
It is interesting that the chairman of the Prime Minister's Labour club, the parliamentary agent of the Chief Whip and the parliamentary agent of the Minister for Local Government and Housing have all been given health appointments. I leave that thought with the Secretary of State. I do not have access to the vast amount of information on each appointment, but those three immediately come to mind, and there are many more.
Ill will in the health service is growing. It is important for people who have to carry out difficult tasks to feel that they have the Secretary of State's support. When they come to the end of their term of office, there should at least be recognition of and gratitude for the steps that they have taken.
Dr. Ladyman: The right hon. Lady mentioned a number of Labour party supporters who have been given positions on health trusts. Is she suggesting that, if she were still Secretary of State, they would not have got those positions? If so, is that not every bit as bad as what she is accusing the Secretary of State of doing?
Mrs. Bottomley: I am saying that many people who have spent many years serving the NHS are affronted by the shabby manner of their dismissal. A vast number of new people have been appointed whose claim for such recognition is not immediately apparent.
Let me now move from the role of politicians to that of professionals. Over the years, their role has changed. They have consistently resisted new developments. Doctors were initially hostile to the introduction of the NHS, and at each moment there has been further resistance. The Secretary of State has recently experienced difficulties of his own, and no doubt there will be more.
Let me comment on each group of professionals, because this concerns the future. First, there are the doctors. There has been a shortage of medical leadership. There is the British Medical Association, the doctors' trade union, and there are the royal colleges, which are concerned with education and training; but neither body contains the courageous leaders the profession needs. In many ways, the management that emerged did so because doctors did not want to take on such responsibilities
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I strongly believe that the Secretary of State would do well to do all that he can to encourage medical management—the work of Sir Cyril Chantler and others. Doctors cannot simply resist change, because they are the people most trusted by the public to achieve change with public confidence. Their role becomes more and more difficult as the public expect more: they expect to be treated as partners, and people engage in litigation when they do not receive satisfaction.
Secondly, there are the nurses. Mention has been made of the recruitment of doctors, but the recruitment and motivation of nurses is more important still. There are real difficulties in the nursing profession, and I urge the Secretary of State to give priority to considering how we can make nursing a long-term, rewarding career. During my time in government, we joined Opportunity 2000 in an attempt to become a model employer, particularly of women, providing part-time employment and career breaks.
Finally, there are the health managers. Already, there are stories that health managers are leaving the NHS and finding employment elsewhere, because they do not believe that they are being given recognition and respect by the Secretary of State and his team. I commend the award of a knighthood to Sir Alan Langlands, who, as chief executive, has acted with great distinction.
The appointment of my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) as shadow health spokesman has been welcomed—for many reasons, but not least because of her reputation for standing up for officials and not allowing them to be fall guys for politicians' policies. I believe that health managers, and all in the health service, will have a staunch ally in my right hon. Friend.
Let me say a little about patients. We talk of a primary care-led NHS: we share that language. Indeed, in many respects the language that we used in government has been taken over by the Labour party. I made any number of speeches about "co-operation as much as competition" and "progress through partnership". Such phrases are now used as if they were a whole new language, representing a new step forward.
The Patients charter represented an important cultural change in the NHS. It meant that patients must no longer be seen and not heard, and put up with a "like it or lump it" service in which doctors spoke disparagingly of them and scarcely attended to their interests. The charter has put great pressure on the service, and has aroused even more expectations in the public.
We now live in a world of increasingly assertive patients. They can call up vast amounts of information about their conditions on the internet, and there are patient self-help groups that encourage them to expect more and more. The challenges faced by the NHS are not due so much to the aging population—which is increasing at only a third of the rate that we have seen over the past 10 years—or to changes in technology, which will lead to savings as well as costs. The real dilemma for the future is caused by a massive increase in expectations. In this consumer society, people want not just their health needs but their health wishes to be met: they feel that they are entitled to more and more.
I am not convinced that the NHS can provide everything for everyone, for free, for ever. The Secretary of State would show more courage if, instead of rebadging

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and helping old Labour to accept that new Labour has taken on Tory policies lock, stock and barrel, he re-examined the whole question of priorities. Call it rationing if you will, but I think that priority setting is the right term. We need to know what the NHS will and will not provide: it needs to be more explicit about that.
I was interested in the comments of our former colleague Michael Portillo. If the Government remain committed to low tax, the NHS needs more money. If the NHS is not to become a third-rate service, it will be vital for the Government to meet health wishes and wants as well as providing for health needs. That must come, even if it means more co-payment, more insurance, more charging or a more positive attitude to the private sector. The Secretary of State will serve no one if he keeps his head in the sand.
The issue of prescription charges has become ridiculous. We are talking about higher and higher charges, which fewer and fewer people pay. The exemptions cannot be justified. Before the Secretary of State asks why we did not tackle that when we were in government, let me say that I am not convinced that many people thought that we were short of difficult issues to tackle. Given the patients charter, the health strategy, the health reforms, junior doctors' hours, the research and development strategy and much else besides, I do not think that we could have addressed the issue—but it can be addressed in the first part of a Parliament with a large majority, and I think that the Secretary of State should address it.
I believe that we shall achieve greater understanding, broader co-operation and a more civilised approach to the NHS if there is a wide understanding of what the service is trying to achieve. When it comes to schools, the public understand that exam results are a good outcome measure; the dilemma in the health service is caused by the fact that the public are less aware of what outcome measure they should look for.
The Government have made fools of themselves over waiting lists. In fact, they were the wrong target. We made huge progress on waiting times. If I had been in opposition I would have wanted to move the debate on, because the message had been conveyed that waiting times and waiting lists are an affront to the public. For Labour Members to make so much of the issue, to say repeatedly in the House, "We keep our promises; they broke theirs," and then to make such fools of themselves with such record waiting lists, has done no one any good.
I urge the Government to look for better outcome measures that the public will understand. That will require a greater sense of what I have termed health literacy. The public need to understand the relationship between hospitals and primary care, and the importance of immunisation, screening and other prevention programmes. I commend the King's Fund for setting up citizens' juries, people's panels, which are trying to bring about more recognition and understanding of what the NHS can realistically deliver.
In the past, there was rationing by waiting list and, frankly, by ignorance. If one knew how to get access to the NHS, it was brilliant, but if one did not, no one was going to make it his or her business to help one find out. Waiting lists are to be tackled in due course, I understand,
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but the population are generally fascinated by health and are much more knowledgeable, so the rationing that has always existed in the health service will have to become more explicit, which will again require considerable courage on the part of the Secretary of State. Otherwise, the worry is that the articulate will always win over the inarticulate, and the fashionable over the unfashionable.
I am critical of the Government because they have always taken the focus-group-driven priorities. This week, they were rightly condemned by the British Medical Association for focusing on cancer services—they have also focused on paediatric intensive care rather than other services. Those are the priorities of the focus groups, not the community. Yet again, I must point out that the Secretary of State made no mention of the fact that mental illness is one of the greatest causes of suffering and ill health in our community.
Mr. Dobson: Obviously, I shall have to withdraw my compliment to the right hon. Lady. When we went ahead formally with the proposals for changes in children's intensive care, I said that she had originally started the changes, which were continued by her successor. If she is now telling me that we were wrong to do so, I had better not make such references in future.
Mrs. Bottomley: We all like to be flattered and it is a characteristic of this place that people like the credit for success and Pass the buck for failures.
The dilemma is how the Secretary of State can give greater priority to the greatest health needs, not the most fashionable causes of concern. There is no doubt that mental health is the priority that we have to tackle. In "The Health of the Nation", I insisted that mental health should be one of the priority areas. I am pleased that it is included in his document, but there is no mention of it in many of his publications and there was no mention of it yet again today. I urge him to ensure that whenever he considers health priorities mental health concerns are at the top of his list.
Dr. Harris: Does the right hon. Lady agree that cuts in social services impact on mental health? That is one of the areas of the NHS that is most sensitive to cuts in social services because of their role, and it is vital that, if the Government allow health and social service authorities to work together, they should be allowed to stress their own priorities instead of having to bid for money for cancer services or paediatric intensive care, for example, when that may not be their priority locally.
Mrs. Bottomley: I entirely agree with the hon. Gentleman, and he is well aware of my preoccupation with the fact that the attack on local government has meant that it is ever harder for social service departments to undertake their responsibilities and act in partnership with the voluntary and private sectors and the NHS.
As we face the future, we must accept that there has been extraordinary progress. The changes that we set in motion have left the NHS stronger and the population healthier. I was never able to fathom why the Labour party voted against the introduction of targets for immunisation, cancer screening and the capitation system, which gave more to inner-city areas with the new GP contract. More than any other step, that ensured that the poorest areas received the health care that some of the most prosperous were getting.

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I am pleased that the Secretary of State has evolved the London implementation zone concept into health action zones. The National Institute for Clinical Excellence is a good step forward in the establishment of evidence-based medicine, although I do not know how one can justify all the expenditure on the launch, the rhetoric and glamour of NICE when the NHS research and development budget is being cut following the Culyer commitment to a 1.5 per cent. target. That is being widely questioned. So far, under the Secretary of State there has been a triumph of style over substance. For the future, I want him to have a triumph of courage over fashion.
6.4 pm
Mr. Denzil Davies: I shall not detain the House as many of my hon. Friends wish to speak. I suppose that it is inevitable in debates on the health service that there should be calls for more money. Most people realise that, even if it is forthcoming—money is never easy when one is in government—it is important to target it and ensure that it arrives at the point at which it is supposed to arrive; in a large organisation, it is never easy to pursue the money to ensure that it arrives at its destination. Also, debates on the health service are inevitably a combination of the general and the particular—the general problems and principles and also particular problems.
I must briefly raise one matter that relates to my constituency among others in south-west Wales. I hope that the problems that I raise will lead to a general inquiry and to concern. In what I am about to say I am not picking a quarrel with my right hon. Friend the Secretary of State or anyone else, and I do not expect the Minister who replies to deal with my points, because the matter relates to Wales, the Secretary of State for Wales has responsibility, and I have no quarrel with him about the health service, either.
Dyfed Powys health authority covers more than my constituency, and encompasses five hospital trusts. Recently, it published a strategic document—a financial recovery plan. The right hon. Member for South-West Surrey (Mrs. Bottomley), a former Secretary of State, talked about language, and when I read the document I detect the language of that ridiculously named and conceived internal market—a fundamental contradiction if ever there was one. Perhaps my points relate merely to language and there is not a problem, but the so-called financial recovery plan—it is actually called the "Financial Recovery Five Year Plan" and I am not sure whether that it is also some sort of contradiction, but I will let it go—properly states that the health authority has sat down with the five hospital trusts and tried to work out income and expenditure for the next five years, adding them all together. That is a commendable effort. However, the figures seem horrendous—they may not be large in terms of national expenditure, but they are quite large for us in south-west Wales.
The figures are not necessarily relevant to my case, and I merely mention them for accuracy, but for the year 1998–99 there is to be a shortfall, for the health authority and/or the trusts, of just over £20 million. Presumably that means that, in April 1999, the people who run those organisations will have a shortfall—they will have no money, which is the simplistic way in which I would have looked at it. My right hon. Friend the Secretary of State is a graduate of the London school of economics and no
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doubt understands those things better than I do, but a shortfall of £20 million is a lot of money for someone from west Wales.
With commendable clarity, the recovery plan goes on to say that, if certain things are not done by the end of the five years, the shortfall will be around £73 million—it is cumulative. The health authority proposes certain measures and says that certain things will be done to try to reduce the shortfall. I will not comment on those, but they will obviously involve some difficulties.
Even after the five years and the attempts to reduce the shortfall, we read—in curious language, which reflects the odd accounting world in which hospital and health trusts seem to live—that it will still be £62 million. They manage to reduce the shortfall over five years by about £10 million or £11 million.
What happens at the end of years one, two, and three? Does the manager of Dyfed Powys health authority go down the road to the Abbey National or NatWest and say, "I have a shortfall of £20 million. Could I please have an overdraft"? Does he borrow £20 million from the Welsh Office? There used to be something called the Public Works Loan Board. I remember, as a Treasury Minister, very late at night, trying to introduce orders to change the rate of interest that the board charged. No doubt it does not exist in that nomenclature any more; I am sure that it has another name.
I hate to mention something as antediluvian as the public sector borrowing requirement; I believe that it is all cash flow now. Perhaps that is the problem. What do such managers do when they end up with a cumulative shortfall? It is a fair question, which I ask rhetorically, to which, no doubt, the Welsh Office will provide answers at some time. The document is a curious presentation of an accountancy exercise which flies in the face of any basic rules of accountancy. I suspect that that shows the fundamental contradiction in trying to run an NHS internal market and present it in management and accountancy-speak.
On the basis of the document, the health authority and hospital trusts that cover my constituency and my constituents will be £62 million in the red at the end of five years. Perhaps the money will be forthcoming. There is certainly nothing in the document to tell my constituents that it will. I am not saying that the money will not be forthcoming. I am sure that the Welsh Office will do its utmost to ensure that the problem is resolved. I must read the document from my point of view. It came in the post last week, and it seems to cause certain problems.
The document assumes that capital private finance initiative moneys, as they are called these days, will provide £13 million—or whatever—for the health trusts. I do not know the possibility in south-west Wales—its gross domestic product results in a relatively poor area—of grand or, indeed, semi-grand PFI projects. Perhaps such projects are impossible.
Dr. Brand: Does the right hon. Gentleman share the concern of Unison, which lobbied the House yesterday, about the effects of the PFI? Will it not have disastrous consequences for the budget in Dyfed Powys, given that up to 30 per cent. of revenue can be tied into private sector contracts?
Mr. Davies: I have no idea; I am not arguing for or against the PFI I am merely saying that one of the

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assumptions in the document, which enables the health authorities to arrive at a better figure, is that PFI moneys will be available. I do not know whether that will be so.
The document states:
"The key assumptions included in the plan represent major risks."
It is assumed:
"There will be no underfunding of inflation."
That is curious language. I assume that it is supposed to mean that the Government will link any available money to inflation—the retail prices index, RPI, minus X or Y, or plus Z. I remember that, at one time, there was a special health service inflation, a pensioners' inflation and a Ministry of Defence hyper-inflation, which I suppose is still around. I take the phrase about inflation to mean that, somehow, £62 million will still be required and that inflation, be it 0.5 per cent. or 3 per cent., will have been taken into account.
There is an assumption in the document that there will be no underfunding of cost pressures. I do not live in the world of health professionals; I am not an expert on the health service. Some of these debates tend to be rather inbred. I am not quite sure what underfunding of service developments or cost pressures means—except, I suppose, there are always cost pressures. The document makes very large assumptions, yet, if everything goes right, the health authority will still be £62 million in the red at the end of five years. Perhaps I should look forward to five years' time. Perhaps the figure is unrealistic.
Under the curious sub-heading "Balancing the Recovery Plan", the document states:
"It is obvious that in its current form the Recovery Plan does not balance."
Indeed; perhaps I spent too long trying to point out that fact. There has been lots of work, and we have lots of paper and many figures, yet this curious recovery plan is not a recovery plan at all. Not only will patients suffer: the plan will not recover. I do not know whether most other health authorities release documents in such a form and use such language.
The document does not really tell us where the £62 million will come from—except that the final paragraph says:
"Trusts have indicated that they will require £15–17 million in cash in 1998/99."
We are back to our friend the cash flow. Dairy farmers in west Wales used to think that they were rich when the milk cheque arrived every month, and no doubt bought their wives new clothes or themselves a new tractor. They were not really rich. Now, the milk cheque does not even make them feel rich.
The underlying asset valuations and accountancy in those days was probably pretty wobbly. As far as I can tell, accountancy in the document is pretty wobbly too. Perhaps the matters are not presented in the right way and should be reconsidered. I hope that the money will be available. I make neither claim nor criticism. As an ordinary Back Bencher, I find such a document extremely worrying, to say the least.
To introduce a Welsh note, there will be a Welsh Assembly after 2000. If one discounts the first year and a half of the cumulative deficit—about £30 million—when the Government or the Welsh Office will be responsible,
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one is left with a debt of £30 million, which will be the Welsh Assembly's responsibility, unless the Government wipe it out. I am sure that this will be considered an esoteric, internal Welsh point. The Welsh Assembly will have a block grant and be able—at least in theory, although in practice it is not so easy—to shift money from one head of expenditure to another. What will happen to my health trust's huge deficit and my hospitals?
I have no doubt that such matters will be addressed and—I hope—resolved. Nevertheless, I have a real problem with them, which I hope my right hon. and hon. Friends will consider. Perhaps they can look at the way in which such matters are presented, and encourage a move away from this crazy world of pretending that we are in an internal market and that the normal rules of accountancy apply. Income, expenditure, assets, recovery plans and such ridiculous jargon does not apply—and cannot be applied—to the national health service.
As I said, I have no quarrel with my right hon. Friend the Secretary of State or anybody else. I am sure that he, like my right hon. Friend the Secretary of State for Wales, will consider the matter.
6.18 pm
Mr. Simon Hughes: I cannot comment in detail on the Dyfed Powys finances of which the right hon. Member for Llanelli (Mr. Davies) spoke, but the issues that he raised relate to a problem that is endemic in the health service. We have had a tradition of having to budget year by year, when planning of any public service should be for the medium if not the long term. He also said that he was not arguing for more resources, but he must know that if his trust, like many others, has shown a deficit this year and last year, that is because there is a cumulative deficit in the health service generally, which can be addressed only by reducing services or spending, or by additional money.
Over the past week, like many other hon. Members, I have tried to do my bit to pay tribute to the national health service on the occasion of its 50th birthday. I did a loop of visits, starting and ending in my constituency. I started by talking to users of mental health services from Lady Gomm house, which is run jointly by social services and the health authority in Bermondsey. On Saturday, I went up to the Freeman cancer centre in Newcastle, where, on a personal note, one recent patient of that premier cancer centre was the late wife of my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith). I understand that she had good and loving care and attention there.
On Sunday, I went to Stepping Hill hospital in Stockport, near where I was born, with the hon. Member for Stockport (Ms Coffey) and my hon. Friend the Member for Hazel Grove (Mr. Stunell), and looked at paediatric and maternity services. That evening, I came back to Guy's hospital in my constituency, which I visit often and about which I have often spoken to the Minister.
All the staff at those places wanted more resources for nursing, mental health care, night and weekend cover and other services. The Freeman cancer centre needs more plant and buildings. People go there with worrying, often terminal, conditions. Ladies and gentlemen have to use the same toilet facilities, there is no shower and the curtains do not even go round the beds. That is not acceptable in 1998. At Stepping Hill, the paediatric

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services are being rebuilt in a new building that staff had been waiting for and greatly welcome. The common, underlying theme is that people in the health service give loving care and attention and nearly always do competent, professional work, as patients almost always acknowledge. They said as much to me in Newcastle, Stepping Hill and at Guy's—although at Guy's people complained that the lunch on Sunday was pretty grim, which is a little matter that I shall take up with the authorities.
This debate is about the achievements and the future of the health service. In a non-party way, I pay tribute to all those who have had responsibility for the health service, for its inception and continuation over 50 years of service to the public. It works; it is cost-efficient, taking only 6.5 per cent. of gross domestic product; it is hugely effective in delivering health improvement: things may not be perfect, and other countries may do better on certain measures, but death rates have gone down and longevity has gone up; and it is the most popular public service by miles.
The Secretary of State for Health, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) and I were in Manchester on Sunday morning for a Granada television programme. A couple of hundred ordinary users of the health service, randomly chosen from around the country, were assembled for the weekend and were given information and given the chance to quiz experts and also the three of us. They were asked several questions both before and after the weekend.
When asked whether the Government should spend more on the health service, 71 per cent. said yes before the weekend, and 76 per cent. after. Before the weekend, 1 per cent. said that the Government should spend less, and nobody said so after. There is a pretty good public consensus that the health service needs more funds.
When asked who should pay, 58 per cent. before the weekend said that the Government should put in money for everybody, but 75 per cent. after. The proportion who said that the Government should pay only for those who cannot afford it went down to 22 per cent. after the weekend. Not a single person after the weekend—down from 2 per cent. before—said that health care should be paid for through private medical insurance.
Before the weekend, 57 per cent. said that they were satisfied with how well the NHS catered for everyone's needs, and after it 70 per cent.
There is a high satisfaction rate, agreement that more money is needed and a widespread belief that funding should be through taxation.
I am sorry that the Secretary of State is not here. I was somewhat offended by his failure to acknowledge that the NHS was not only a socialist idea. Beatrice Webb had the idea in the 1920s, and of course I acknowledge that she was a socialist, but it was taken up by Keynes, and it was Beveridge—a Liberal both here and in the other place—who came up with the plan.
Mr. Brian Sedgemore: It is ours.
Mr. Hughes: It is not the hon. Gentleman's at all.
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In his book, "The Five Giants—A Biography of the Welfare State", speaking of Beveridge's description of the five evils that the health service and other services were intended to tackle, Nicholas Timmins said:
"In that one ringing paragraph Beveridge encapsulated much of post-war aspiration. By seeking not only freedom from want but a national health service, improved education, full employment and an attack upon Squalor…he gave the vital kick to the five giant programmes that formed the core of the post-war welfare state: social security, health, education, housing, and a policy of full employment".
I do not either in any way underestimate the work done by Nye Bevan, because I believe that pluralist politics and the recognition that we have all contributed are simply a matter of honesty. But for the Secretary of State not to have mentioned Beveridge struck me as selective amnesia nearly to the point of self-denial.
Over the 50 years, during which, sadly, my right hon. and hon. Friends and I have not been in government, and for much of which the Tories have been in office, there has been significant improvement in the health service, and many measures taken by the Tories over those years have consolidated the service. No Tory leader and no Tory manifesto—just as no Labour or Liberal Democrat manifesto—has ever argued that the NHS should be dismantled. None of the three main parties in the House has ever taken the position that the national health service should be other than free at the point of delivery.
Of course, some individuals, in the Tory party and elsewhere, may have argued differently, but the great commendation of the health service is that, 50 years on, it is still the view of the three great parties of this country that it should be free at the point of delivery. The sooner we can concentrate on the issues on which there is real debate, the sooner we shall serve the public well.
Dr. Ladyman: Is the hon. Gentleman aware that two individuals who are now Conservative Members, one of whom is a Front—Bench spokesman—the other one may be, but I am not sure—proposed what they called a pill tax, and a charge for every single NHS service? Those hon. Gentlemen are gaining preferment in their party and may one day be in positions of significant power.
Mr. Hughes: I have tried to make the broader point. We could all make nitpicking points. I am not going to do that. The three main parties' positions for 50 years on keeping the NHS have been consistent in their generality. The sooner that the hon. Gentleman and his friends remember that and we start having a debate about how we get the best health service free at the point of delivery instead of artificial debates about things that may interest us in here but do not matter a jot to people out there, the better we shall be serving the public.
Mr. Gareth R. Thomas: Will the hon. Gentleman give way?
Mr. Hughes: No, I will not give way for the moment.
I applaud some of the things that the previous Government did, such as the work to advance the importance of research and development and education and training and to develop mental health services, pursued by the two previous Secretaries of State. I applauded them for those policies when the Conservatives were in power, and I applaud them now.

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I applaud some of the things that the current Government have done. They have accepted that we must bring health and social services closer together. My party goes further and argues that they ought to be merged. I strongly believe that in a few years they will be merged. It is a nonsense to have a national health service and locally run social services—one free at the point of delivery and the other charged differently depending on the area. I think that in Great Britain, as in Northern Ireland, we should have merged health and social services soon.
I welcome the Government's announcement the other day of a decision to set up a Commission for Health Improvement. My party's manifesto said that there should be an inspectorate for health and social care. Every doctor's surgery, hospital and health centre should be inspected, as schools are inspected by the Office for Standards in Education. The commission should have teeth and should be able to regulate.
I welcome the fact that the Government are concentrating on clinical excellence. It is nonsense that so many things are done that are not proven to be good for anyone. I welcome the fact that people will be free to speak out when things are going wrong. A restriction was imposed by the previous Government, which we opposed.
I welcome the end of fundholding. The differential between fundholding and non-fundholding GPs allowed some people to jump the queue. I welcome the Minister of State's answer to my hon. Friend the Member for Northavon (Mr. Webb) last week, in which, for the first time that I remember here in this place, he conceded that in effect we have rationing because there is differential service provision in different parts of the country.
I welcome the fact that the Government admit that more money is needed. I have done this job for a few years and I have always been clear that we have rationing. We have rationing now and we shall always have rationing. Bevan was clear from the beginning that not all national health services could be introduced at the beginning. Services depended on the funds. I would far rather that availability decisions were made publicly and accountably than that they were made by the professionals privately. The sooner that we get a system for sorting that out, the better.
I will not rehearse in this debate the difficulties that the Government are in with their waiting list pledge. The Government know my view. They made the wrong commitment. It should have been on waiting times, not waiting lists. In any case, to take 100,000 people off a waiting list of 1,300,000 is hardly radical socialist nirvana. To take one out of 13 people out of the queue for treatment is hardly a revolution. The Government's pledge is modest, weak and rather feeble as well as the wrong one.
We are troubled, as my colleagues demonstrated yesterday, that many community hospitals are under threat. Horncastle hospital in Lincolnshire, which I know because my grandmother used to live in the town, has closed and 27 others are under threat in various ways. I hope that following the comprehensive spending review announcement next week, one of the things that the Government say is that they will review decisions in every part of the country where a community hospital is under threat in the light of the additional money. The point made
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by the right hon. Member for Llanelli applies very well. It would be nonsense for a hospital to be closed this year to balance budgets, when more money will be in the kitty that might allow it to remain open next year. We really must have a longer-term view.
The Government in the end wobbled and fell over tobacco sponsorship. They promised in the manifesto:
"We will therefore ban tobacco advertising."
That was a promise for this Parliament. That is why parties produce manifestos. Yet we shall not have the ban until the next Parliament. Everyone knows that this has been a bit of a bottling out. I am sorry about that, because stopping youngsters smoking is one of the key health strategy objectives that we should pursue.
The health service is safe not in our hands but in the hands of the professionals who work for it. We are desperately short of professionals. I hope that the Government, with the money that is announced next week, will make it clear that one of their priorities is to retain and recruit the professionals whom we need. We cannot expect the health service to do what we want unless the 8,000 nurse vacancies, the GP vacancies, the hospital doctor vacancies, the consultant vacancies and others are filled as soon as possible. Personnel planning has been very bad in the health service, and we need to remedy it as a priority.
I ask Ministers to consider giving financial incentives to students to go into health and related professional disciplines in return for a commitment to stay with the health service, as the armed services and the private sector often do. We should make sure that never again do we face the problem that a staff nurse in Newcastle and I discussed. When nurses reach a certain grade in the health service, they can gain further promotion only by leaving nursing to become a manager. We must allow people to continue to get more money while continuing to do their professional job.
We must end the system whereby independent pay review bodies recommend that nurses, doctors and dentists are paid more, and the Government say, "Oh no, you can have only half now and half later." That has devastating effects, and Parliament has no say. My party has been clear. Governments may not have the money sometimes, but only this House should overrule a pay recommendation. Ministers should not do it without putting their decision to a vote in the House. We in the House should be accountable if we do not honour a pay recommendation. This year, the nurses were furious. There was plenty of money in the kitty and they could and should have been paid.
We must consider—Ministers are doing so—a more flexible employment system, so that people can stay on the payroll for the whole of their professional life, even if it means that they do 20 hours a week for a period and 10 hours for another period. That would be much more valuable.
Dr. Harris: On staging of the pay awards, the Minister looked puzzled when my hon. Friend said that there was plenty of money in the kitty. Surely the point is that, however much money there is in the kitty, it is more expensive to fail to stem the rising tide of disillusionment and loss to the nursing profession and medicine by undermining morale and staging pay awards than to pay

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the money up front, thereby avoiding the need to pay for expensive advertisements and to go to Finland, Australia and New Zealand to find nurses.
Mr. Hughes: That is certainly the case put to my hon. Friend, to me and to others. I think that Ministers know that that is the truth. I hope that they will never make the same mistake again.
We need a massive programme of capital renewal to improve the plant of the health service. I say to colleagues on the Labour Benches that if they keep going down the road of the private finance initiative, they will have to answer the allegation that they have privatised more of the health service than the Tories ever did. That is the truth of the PFI route. My hon. Friends and I are clear. I have here two medical colleagues who both believe, as do others, that the PFI is inappropriate. It is not strategic. It allows a bottom-up approach rather than strategic planning. At the end of the day, it costs more as well as resulting in a loss of control.
I hope that we shall ensure that we have enough money in the kitty to fund staff and capital programmes. The Minister of State and the Secretary of State derided both me and the right hon. Member for Maidstone and The Weald when we put some figures on the table. I do not intend to play a bidding game, but I shall put a figure on the table. We need £8.8 billion more for the NHS to be announced in he comprehensive spending review next week if the NHS is to stand still. [Interruption.] I will show the hon. Member for Crawley (Laura Moffatt) the figures if she does not believe me. They are figures produced by the Library and available to her.
Laura Moffatt: It is a stupid game.
Mr. Hughes: It is not a stupid game. I will tell the hon. Lady. If she thinks that she can go out of here defending something that does not give the NHS a real-terms increase next week, we shall harry her and her colleagues like hell until the next election.
My colleagues who shadow Treasury Ministers have made our position clear in our alternative Budget. We believe that the NHS should have 5 per cent. more in real terms this year, and 4 per cent. in real terms for each of the remaining years of this Parliament. In real terms, that would mean £11.5 billion more in next week's review. I shall happily go through our figures with the Minister of State if he wants. If the Government come up with more, we shall not outbid them or ask for an increase. We have costed what is needed, and we believe that it is £11.5 billion, the figure by which we shall judge the Prime Minister, the Chancellor and the Secretary of State for Health. If they produce less than that, we shall give them a hard time. If it is as low as £8 billion or £9 billion, I promise them that they are in trouble.
Miss Widdecombe: The hon. Gentleman is talking much good sense about the amount required for the NHS to stand still. Will he confirm that in addition to the £9 billion needed for that, we should consider the huge extra cost of administrative reforms being set in motion by the Government? That must be removed from any increase announced next week.
Mr. Hughes: The right hon. Lady was with me until that point, but I cannot agree with her assertion. Increased
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bureaucracy was a legacy of her Government. The new Government can reduce the amount spent on bureaucracy, although some items in their programme will add unnecessary bureaucracy, for example, the way in which primary care groups are structured.
I want to conclude, to let other hon. Members speak. I hope that over the next 50 years the NHS becomes more democratic, although I am troubled that that is not happening yet. The Minister has told me that he will not reinstate the democratically elected regional health authorities that we ought to have in England to do strategic planning. There should also be locally accountable health authorities.
Health and social services should merge. We must give more resources and attention to mental health, which, in spite of all our fine words, remains an under-resourced service. Mental health is of equal importance to physical health, as Bevan made clear from the beginning of the health service. We must regulate the unregulated professions allied to medicine, such as psychology, and also those who practise alternative therapies. We must not cut back on research and development. The public health laboratory service has been cut back in recent years, and even with no extra money it does excellent work.
As the Prime Minister said at Earl's Court last week, we must realise the benefits of information technology. The health service is, in many ways, terribly old-fashioned. It is nonsense that we cannot see the information held on us, or transport it to other areas or have it passed from general practitioner to hospital, through information technology. The NHS must get its IT right.
The NHS must continue to exist in the community. It must be where the people are. The doctor on duty at Victoria station should not be from the private sector; he or she should be from the NHS. The NHS should be in the shopping malls, or wherever people are in the evenings, at weekends, 24 hours a day. The NHS must respond to the changing life styles of Britain in the years ahead.
One way to remove unnecessary political argument from the NHS would be to create a forum for debate outside this place among the professions, the patients and the public. I do not pretend that a standing conference for the future of the health service is the only model, but such a conference could come up with ideas and a strategy for the future. We should ensure that the public are as involved in the health service in future as they have been committed to it in the past. The NHS is the best of British institutions. We all have a duty to make it stronger in every year ahead.
6.44 pm
Jane Griffiths: I thank my right hon. Friend the Secretary of State for drawing the broad picture of the number of new hospitals being opened or nearing completion after so many years of stagnation in the national health service. The previous version of the private finance initiative in the health service foundered repeatedly. In Reading for example, there were repeated promises that a new hospital would be built under the PFI to replace the antiquated buildings on two sites, which serve a population of more than 200,000. Year after year, the promises came to nothing. Huge sums were spent on consultancy and feasibility studies, but there was no new

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hospital. Finally, last year, under a Labour Government, the PFI was reviewed, and we achieved a hospital building programme.
Dr. Brand: That is fascinating. Is the hon. Lady saying that the Labour Government are better at implementing Conservative policy and doing what the previous Government wanted to do?
Jane Griffiths: Absolutely not. If the hon. Gentleman allows me to finish my point, he may understand it a little better.
The constituencies of hon. Members on both sides have benefited from that programme, although not only because of the PFI. More than £90 million in NHS finance has at last been found for two hospitals, and those projects are in progress. The Royal Berkshire and Battle hospital in Reading has already achieved a new maternity block and a gynaecological day case unit. I had the privilege of visiting it last Monday, where Joshua Gledhill was born on Sunday, the 50th anniversary of the establishment of the NHS. He can look forward to modern, excellent, local NHS facilities—although I hope, of course, that he will not have to use them often.
If we look back 50 years ago, when the proposal to establish the NHS was being debated, we find that the fine claim that everyone has always supported the NHS was not quite true. The Conservative former coalition Health Minister, Henry Willink, now deceased, was often said to have had his own plans for a national health service before the Labour Government were elected in 1945. Henry Willink is, incidentally, well remembered in Reading, not least because Willink school in Wokingham—I fear that the right hon. Member for Wokingham (Mr. Redwood) is not here—is named after him. As a former Conservative Minister, he described the proposed service as an idiosyncrasy that
"will destroy so much in this country that we value."
He said:
"I could never vote for it or indeed abstain from voting against it."—[Official Report, 1 May 1946; Vol. 422, c. 232–42.]
It was said in the debate that if the Bill came to pass, the doctors of the future would be worse than the doctors of the past. We should remember the true state of opinion 50 years ago, and we should look forward.
I am proud to echo my right hon. Friend the Secretary of State's salute to all the authors of the NHS, and to those who work in it today. We must look to the next 50 years. The Government have brought it back from the brink, and it will go on to a better future.
6.48 pm
Mr. Stephen Dorrell: The Secretary of State began his speech by saying that the debate had been organised by the Government to provide the opportunity for a national celebration of a national institution. That would be welcome, and I hope that that will prove to be the debate's dominant tone. He had a strange means of launching that national celebration because, having declared that that was his objective, he launched into a party political diatribe that would go down well in Holborn and St. Pancras, or in front of other Labour
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audiences, but would stretch the credulity of any audience not packed with old Labour Members. It used to be said of Lord Whitelaw that there was a Whitelaw bluster ratio. He believed what he was saying in precise inverse proportion to his bluster at the Dispatch Box. If we apply that principle to the Secretary of State's speech, I think well enough of him to believe that he was convinced by very little of the rhetoric that he was using.
One example of high bluster ratio was the Secretary of State's comments on the private finance initiative. The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) and I have debated the PFI on several occasions. I am a strong supporter of the PFI. I congratulate the Secretary of State on the progress that he has been able to make in implementing a policy that we developed during our period in office, as the hon. Member for Isle of Wight (Dr. Brand) rightly told the hon. Member for Reading, East (Jane Griffiths).
The Secretary of State said that he gone to top out the new Dartford hospital and that a roof was being put on it. He noted that building was proceeding on the hospital in Norwich and that it would soon have a roof. He appeared to be asking the House to believe that that was all done, in the 15 months after the general election and when both projects are well over £100 million in value, from a standing start by the new Labour Government. Life is not like that.
I congratulate the Secretary of State on continuing to implement a policy that will prove to be an important step forward in the development of the NHS. I was associated with it as Secretary of State for Health and before that as Financial Secretary to the Treasury, when I was responsible for pushing through the early development of ideas on the PFI.
I trace some of my interest in the subject to my early days as a junior Health Minister at the start of the 1990s when I was told that I was responsible for what in those days was called "unconventional finance". I inquired what it meant and after a little briefing, it became clear that in the NHS-speak of the time, it meant what the rest of the world regards as conventional finance because it is a more flexible and efficient means of managing a capital programme. I am pleased that over the years we have been able to move the NHS from regarding private finance and the private management of capital developments as a discrete minor interest, dealt with by the junior Minister responsible for unconventional finance, to regarding it as a core part of the NHS capital investment programme.
More fundamentally, the debate allows us to look back at what has been achieved by the national health service and look forward to what it needs to be in future. I regard the NHS as one of the things that we have got right in Britain over the past 50 years. I do not propose to inquire into the words in Hansard by various spokesmen in a debate that took place five years before I was born. That is not salient to modern politics. The NHS is a great British success story for which Governments of both major political parties have been responsible. As my right hon. Friend the shadow Secretary of State said, it is statistically true that the Conservative party has been responsible for more of the development of that great British success story over the past 50 years than has the Labour party. I do not seek to draw party political advantage from that but to celebrate a great British success story.

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There are two fundamental reasons why I regard the NHS as something of which we should all be proud. The first is the most fundamental reason of all: the social policy objective that the NHS delivers. I do not believe that health care is simply another consumer service. One can examine that with any amount of academic analysis, but I do not find it very useful. There should be something in our bones that tells us that access to health care and the availability of the skills of doctors and nurses to sick people should be decided by a principle different from those that determine access to the majority of other consumer services in Britain.
The national health service has been built to deliver a simple social policy objective. High-quality care should be available to any sick person who needs it on the basis of their clinical need, without regard to their ability to pay. It is a simple, powerful idea on which the NHS has been built by parties of both political complexions throughout the past 50 years. There is virtually unanimous agreement about it among the British electorate. The hon. Member for Southwark, North and Bermondsey rightly said that that principle has not divided the major parties since the earliest days of the NHS. In truth, it is sufficient reason by itself to support the British national health service on the basis on which it has developed.
I said that there were two reasons for supporting the British NHS. The first is by itself sufficient, but there is another reason for supporting our model for the delivery of health care which is also by itself sufficient and compelling. Put together, the two arguments create a knock-out case. Not only does the British NHS deliver equitable access to health care, by international standards—this point is inadequately recognised—it delivers the world's most efficient health care system. That is not the same as saying that there are no inefficiencies in the health service or no opportunities to improve its efficiency. Of course, its efficiency can always be improved, but it is a simple fact capable of relatively easy confirmation that the British NHS is the world's most efficient means of delivering health care to a population.
The World Health Organisation publishes a range of public health indicators: life expectancy, infant mortality, recovery rates from the major life-limiting diseases. It is not my case that Britain is in first position on all those measures. That is not true. Britain is in the middle of the pack for performance on those major public health indicators. Where Britain is in a league of its own is in the efficiency with which we use resources in the delivery of health care to achieve those public health objectives. These are statistics that are perhaps better known than people realise, but their message is inadequately recognised.
Taking public and private health spending together, Britain spends less than 7 per cent. of national income on health care. In France and Germany, perhaps our main European comparators, the figure is roughly 9.5 per cent., and in America 14 per cent. I may be a simple man, but this is a pretty simple test of efficiency. It delivers the same result for a lower cost input, and I know of no better definition of efficiency than that. Whether we consider the NHS as an instrument of social policy or of economic policy reducing the national overhead in the delivery of health care to the population, there is a compelling, convincing, knock-out case in favour of our approach to the delivery of health care.
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It is interesting to examine what some people say when presented with the figures that I have cited regarding the proportion of national income spent on health care. I shall identify two reactions so that I can demonstrate why I think that they are wrong. The first reaction is occasionally identified with the British Medical Association and other interest groups that press the Government to spend more money than Chancellors or Health Secretaries feel able to recommend. That argument says, "Look, in Britain we spend only 7 per cent. of national income on health care, but elsewhere in Europe they spend 8 per cent. and, in France and Germany, they spend 9 per cent. Why don't we spend 9 per cent.?"
There are all kinds of arguments in favour of increasing expenditure on the delivery of different parts of the NHS, but that is the weakest of them all. It is simply an argument for driving up costs. Anyone who wants to make the case for increasing health spending must prove the benefits in terms of output and public health gain. We must not simply drive up costs in order to make our health service as inefficient as those on the continent—that is the most stupid argument of all—or as monumentally inefficient as the system in the United States, which spends double the share of a higher national income in order to produce a worse public health outcome. That is not a very strong argument.
I also reject another, more insidious, argument. There are those who make a different comparison using the same international figures. They say that, if we look behind the public and private health spending total in Britain, we will see that the proportion of health spending committed privately is very low by international standards. That is also true. The figures are quite interesting. In Britain, of the total of just under 7 per cent. of national income that is committed to health care, 16 per cent. comes directly from individuals by way of a private spending decision. In other words, that funding does not come from taxation. In France, the figure is 22 per cent.; in Germany, it is 26 per cent.; and, in the United States, the figure is more than 50 per cent.
Some conclude from those statistics that, therefore, we should increase the share of Britain's health expenditure that comprises individual private spending decisions. It is worth pausing for a moment to reflect on that argument. In each of those countries where private money constitutes a higher share of total health spending, the tax-funded health spending is a higher proportion of health spending than in Britain. So the idea that there is a saving to the taxpayer does not stand up to analysis.
However, I have a more fundamental objection to that argument. It seems to me to be the ultimate irony that, although we begin by recognising that Britain has the world's most efficient health care system, we look around the world to see how others are doing it—recognising that their systems are less efficient than ours—and propose changing our system to make it more like those more inefficient systems. I have never heard that argument explained convincingly.
You do not have to take my word for it, Mr. Deputy Speaker. There are other more surprising and less predictable advocates of that point of view. I was struck by a quotation from Lord Lawson on that subject in a book that was widely and favourably reviewed as a thought- provoking and thoughtful retrospective on his time as Chancellor. Speaking, not as Chancellor of the Exchequer, bound by collective responsibility and

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unwillingly supporting socialised health care because that was the policy of the time, he told the story of why, as Chancellor, he had concluded that the national health service was the right model for Britain and that it would be wrong to try to encourage more private money to play a part in the delivery of NHS services. He wrote:
"We looked…at other countries to see whether we could learn from them; but it was soon clear that every country we looked at was having problems with its provision of medical care… They were all in at least as much difficulty as we were, and it did not take long to conclude that there was surprisingly little that we could learn from any of the other systems."
I think that that is an interesting reflection from a source that is less predictable than others quoted in the debate. I agree strongly with Lord Lawson's conclusion.
Ever since its foundation, the NHS has been the subject of virtually continuous re-examinations by those who are convinced that it cannot work. In the year that I was born, Rab Butler—to take another less predictable contributor to the debate—was convinced that the NHS could not work and, as Chancellor, he set up the Guillebaud commission in order to prove it. It is interesting to examine—as I did as Secretary of State for Health—the arguments that led to the establishment of the commission, which finally went public in 1953. It was claimed that pressures would make the national health service insupportable and that it would collapse under the weight of its own contradictions by 1960.
Let us look at what was going to make that happen in the view of 1953—the arguments have a familiar, contemporary ring. In 1953, people were convinced that the NHS would not work because of, first, a rising elderly population and, secondly, the rising cost of modern medicine. With due deference to my predecessor, my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), the third perceived pressure then was exactly the same as it is now: the rising expectations of the post-war generation.
Those who claim that the NHS cannot work have not only 50 years of history against them—in 1953, at least Rab Butler had the excuse that it was an untried, bold experiment—but 50 years of arguments that have been proved wrong. The pressures—no one who has been Secretary of State for Health would deny that those pressures exist; they are meat and drink to the Secretary of State—are reconciled better in this country through our structures than by any other system so far developed elsewhere.
I believe that those who are concerned about the next 50 years of the national health service would find it more instructive to look at the history of the service under Governments of both political complexions in order to understand how those pressures have been reconciled with an affordable burden for the taxpayer during the past 50 years, rather than speculating in theory without looking at the evidence of how that success story was achieved. There are three specific lessons to learn from that history, which I believe is more instructive than the theory.
Mr. John Gunnell: The right hon. Gentleman's comments encompass the fact that this Government are far more ambitious than he was as Secretary of State for Health. It is very clear that our
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interpretation of health care includes social care. There seems to be a great difference between the way that this Government approach health and social care—I have seen that in my capacity as a member of the Health Select Committee that studied relationships between those areas—and the proposals that the right hon. Gentleman left us in a social services White Paper, which made it clear that his vision of the health service did not include social care in the way that the Government's vision does.
Mr. Dorrell: I have read with considerable care the Government's White Paper, "The new NHS: Modern—Dependable" and I shall comment later on one or two of the points that it contains. However, I have to say that, although the hon. Gentleman might hope that the Government intend to embrace the whole of social services within the national health service commitment of a tax-funded service available on the basis of need to all those with an established clinical need, and that that is to be the idea that underwrites the future development of social services, it is not in the White Paper. I make it clear that I do not agree with the conclusion, but I do not think that the Minister of State agrees with it either.
Turning to the key lessons that I draw from history about how we deliver successful NHS care in Britain, the first concerns the question of the global level of resources. My right hon. Friends the Members for South-West Surrey and for Maidstone and The Weald (Miss Widdecombe) drew attention to the fact that, over the 18 years that the Conservatives were in office, real-terms expenditure grew, on average, by 3.1 per cent. per annum. That is not only the record between 1979 and 1997; it is the record of the previous Government in office between 1974 and 1979; and it has been established on several different occasions as the long-term trend rate at which the real budget of the NHS has to grow in order to accommodate the pressures that exist within the NHS.
In other words, if we are to continue the lesson of our own history and accommodate the pressures within the NHS, what we must expect is that, in the long run, there will be a gentle rise in the share of national income that is committed to the NHS. That rise is not a huge one—nobody should take fright from it; anyone who wants to take fright should simply remind himself of how much all our comparator countries end up spending on health care when they try the different systems that people recommend to us. However, it is true that there is a gentle long-term rise in the share of national income taken by health expenditure. That should not be surprising: society becomes richer and one of the things on which developed countries want to spend more of their money is improving health care delivery, increasing that spending at a rate somewhat faster than the increase in GDP.
One of the challenges I offer to the Secretary of State is that, following the Government's spending review, if they really want to underwrite their commitment to continued development of the national health service on the basis of a model that has proved to work over the past 50 years, they should at least be able to say, as they have said in respect of education, that health will, under a Labour Government as under their predecessors, take a rising share of national income. The Prime Minister has made that pledge in respect of education and, if the Government mean what they say about the continued development of the NHS in line with the model that we have seen work over 50 years, a commitment in words

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that the Government will ensure that, over the life of this Parliament, the share of national income committed to the NHS will rise, would be a means of underlining their commitment to continuing to deliver that model.
Frankly, I doubt whether the Government will be able to deliver the model if they do not steel themselves to the commitment to ensure that, by the end of this Parliament, health takes at least 0.1 per cent. more of GDP than it did at the beginning of the Parliament. I remind the Government that, in the period 1979–97, the share of GDP taken by health rose, if memory serves, from 4.5 per cent. to slightly less than 6 per cent.—rather more than one full percentage point over 18 years. The Government cannot do the same over five years, but the least they can do is ensure that they avoid what happened when Labour was in office in the late 1970s, when the share of national income taken by the health service fell. I apologise to the Minister for lowering the tone, but, if he wants his commitment to the continued delivery of the health service to be taken seriously, that must not be allowed to happen again.
Therefore, first, we must make the same commitment to health that the Government have made to education: a rising share of national income. Secondly, comes the question of priorities.
Mr. Gareth R. Thomas: The right hon. Gentleman has been making some interesting comments, clearly designed to be a shot across the bows of the right-wingers who currently prevail in the shadow Cabinet. However, before he moves on, may I draw his attention to a written answer that the Minister of State, my hon. Friend the Member for Darlington (Mr. Milburn), gave to the right hon. Member for Horsham (Mr. Maude) on the subject of NHS capital spending? That answer revealed that, on average, between 1978–79 and 1997–98, the percentage net real-terms growth under the Conservatives was minus 0.6 per cent., whereas in the first year of the Labour Government, growth increased by 4.9 per cent. I am not a supporter or a fan of the right hon. Member for Horsham, but I shall warm to him if he continues to elicit such useful information on the Conservatives' record in comparison with ours.
Mr. Dorrell: I spoke about the capital programme at the beginning of my speech. As I said on numerous occasions when I was Secretary of State for Health, the capital programme of the NHS, under Conservative and Labour Governments throughout its 50-year history, is an object lesson on how not to manage a capital programme. That is why, as Financial Secretary to the Treasury, I pushed through the changes in the rules on the private finance initiative. It is why, as Secretary of State, I tried to develop the PFI in the national health service. It is why one of my first remarks this evening was to congratulate the Secretary of State on his continued and successful prosecution of a Tory policy.
The second issue that the Government must face and continue to face, if the NHS model is to continue to be delivered successfully, is how the NHS addresses the question of priorities. Every Secretary of State is told, "You must not use the dreaded 'R' word," and every Secretary of State develops his or her own circumlocution—hon. Members can read Hansard to satisfy themselves that I am sufficiently wedded to my ways not to use the dreaded "R" word. However, every
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Secretary of State develops the essential language to ensure that the NHS must address questions of priority in the use of taxpayers' resources. It is simply a rewording of the central founding idea of the NHS: if we say that health care should be available on the basis of need and not the ability to pay, that means that we inquire where need arises, we rate one need against another, we set priorities in the use of taxpayers' resources and we target the resources on need. If the health service does not believe that, I do not know what it believes, for that is what the health service is there for.
The NHS must take a disciplined approach toward deciding what its priorities are and then use the resources available to it to deliver those priorities. The Secretary of State has to give a lead in that process, but it must involve the whole service. There will always be those doctors who say, "That is a matter for politicians. You set up a committee to decide what we should or should not prescribe," but the fact is that the process has to involve the whole service, including the Secretary of State. I commend the Secretary of State on his work on developing ideas for improved assessment of quality and effectiveness in the delivery of health care. I think it fair to say that that work develops some of the ideas in "A Service with Ambitions"—to pick up the point made by the hon. Member for Morley and Rothwell (Mr. Gunnell) about the ambitions for the health service. One of the purposes of "A Service with Ambitions" was to encourage development of new ideas on the measurement and monitoring of quality through the NHS, which is something that we sought to develop when we were in office.
The Secretary of State was kind enough to refer to the development of paediatric intensive care units as being one of the differences of nuance between me and my predecessor, my right hon. Friend the Member for South-West Surrey. I take the strong view that it is hard to think of a higher priority in the delivery of health care than the provision of high-quality intensive care treatment to very sick children. I said that I thought that such care ought to have a very high priority.
It is also necessary to make decisions that are less popular than others. At the end of the previous Parliament, I was responsible for confirming the screening committee's decision that we should not run a national prostate cancer screening programme because the case for that was not as strong as the equivalent case for women on breast cancer screening and it would not have represented a good use of NHS resources on a properly prioritised basis.
Those are two examples of decisions that I made. I am prepared to acknowledge that I left behind unfinished business. One example is in vitro fertilisation. An orthodoxy developed that IVF is a luxury. I never shared that view. If we take the view that health care ought to be available to people on the basis of clinical need, not ability to pay, I do not understand the argument that an infertile couple should be able to have a baby if they can afford private IVF treatment but the infertile couple who cannot afford IVF, but whose clinical status is such that it has a reasonable chance of success, cannot have a baby. I do not agree with that argument. Deciding such priorities is one of the remaining challenges for the health service.
Another example that is increasingly covered in the literature is access to kidney dialysis. Historically, the priority attached by the health service to the development

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of easy-access dialysis units is not, in my view, as high as the clinical priority would justify. I have offered the Minister of State two less comfortable examples of difficult questions that the Government must face. They must ensure that questions of priority and clinical standards are decided.
I conclude my remarks about priority by underlining the point that we cannot leave the medical profession out of those decisions. We cannot allow to develop the frame of mind that such decisions are for politicians and managers, and that the health authorities must simply provide lists of what resources are available. Of course, guidance can be given and an emphasis suggested, and I have said that that is what the Secretary of State should do, but in the end the judgment of the clinical priority of one patient against that of another must involve the patients' clinicians, particularly their doctors. The overwhelming majority of doctors want to work in a tax-funded service where clinical priorities determine the use of resources, so they must be involved in making those decisions.
Finally, I come to the issue that is critical to the efficient use of resources in the health service: the importance of ensuring that decisions are made as locally as possible. As I have said, I have read the White Paper and I agree with much of its content, but there is some with which I disagree. It builds on the approach that we adopted in government, and I do not deny that some changes still needed to be made when we left office.
I am particularly pleased, since I was given such stick at the time, that the Secretary of State is wholly unpersuaded by the Labour party's rhetoric about the two-tier service. If different primary care groups are making different decisions about their priorities, it is, of course, inevitable that some groups will be more successful than others. Inevitably, the care available to the patients of one group will be, in some respects, different from the care available to those of another group. That is the purpose of having different groups. People in the health service can then find new means of delivering care and order their priorities to reflect those of their patients.
I regret that fundholding is to end. Primary care groups would have been more successful if membership of them had been voluntary, but I certainly do not disagree with the idea behind such groups. I could hardly do so because they were made possible by the National Health Service (Primary Care) Act 1997, for which I was responsible. If those ideas are to work, the Secretary of State must allow different groups of local managers in different parts of the health service to reach different conclusions. Otherwise, it is all a sham. There will be local variety in priorities and ideas, and that must be reflected.
My central argument is that if we continue to develop the health service on the path that has proven successful in its first 50 years, that success story should be supported on both sides of the House. There are those who say that the problems that have existed since the day the health service was founded have suddenly become insoluble, and I fear that those people are in danger of proving yet again the truth of the old adage that to every difficult problem there is a solution that is simple, obvious and wrong.
7.25 pm
Mr. Brian Sedgemore: The right hon. Member for Charnwood (Mr. Dorrell) is genuine Front-Bench material and I am sure that he will have every chance of replacing the lady of the night if he keeps up his form. I was interested in his notion, with which I broadly agree, that infertile people have a right to treatment because infertility is an illness. I wonder what he thinks about the similar problem of impotence and whether impotent people should have the right to take Viagra. Perhaps he can tell us about that on another occasion.
It is a genuine privilege to participate in this historic debate to celebrate 50 years of the people's national health service, which was set up by the people's party—old Labour. The last time I intervened in the House on the subject of health, I was accused of being a new Labour crawler when I praised the Prime Minister and the Secretary of State for Health for their heroic decision to save St. Bartholomew's hospital and suggested that the Secretary of State would find himself in the pantheon of the gods when the definitive history of the world came to be written. It is not my fault that we have a wildly popular and hugely effective Secretary of State.
A few weeks ago, the Secretary of State went to a dinner given by the alumni of St. Bartholomew's hospital and the medical college. He told us that his son had said to him, "Come on, Dad, tell the truth. By the time you retire, what will you have done that you could tell people had affected the world and done some good?" My right hon. Friend said that he had thought long and hard and eventually said, "I have saved St. Bartholomew's hospital." Even as he spoke, all the alumni, professors and consultants leapt from their seats, as though an electric charge had gone around the room, and cheered and cheered. That is the kind of popularity that we want our Ministers to have. Old Labour or new Labour: this is our health service and today we rejoice.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) claimed that Beveridge had thought of and created the health service. I am sure that the hon. Gentleman has many good features—he is probably kind to animals and, for all I know, he loves children—but he is a rotten historian. I have here what is probably the definitive biography of William Beveridge by José Harris, which concentrates for most of its 500 pages on the Beveridge report of 1942 and all its complexities. Its main source is no fewer than 500 boxes of Beveridge's personal papers, which were deposited in the British library of political science.
Harris's conclusion about the argument that we are having tonight is that my right hon. Friend the Secretary of State is right and the hon. Member for Southwark, North and Bermondsey and the right hon. Member for Maidstone and The Weald (Miss Widdecombe) are wrong. On page 459—this is the definitive judgment—he says:
"He"—
Beveridge—

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"was rather embarrassed by his reputation as 'father of the welfare state'… He was even more embarrassed when people referred to him as creator of the National Health Service—insisting that this term could only be applied to the Labour Minister of Health, Aneurin Bevan."
Mr. Simon Hughes: Will the hon. Gentleman give way?
Mr. Sedgemore: No, the hon. Gentleman has had his say. Beveridge knows his own views better than the hon. Gentleman.
Mr. Hughes: If the hon. Gentleman has read all that book and all the other books about Beveridge, he will know perfectly well that Beveridge, because he was modest, was clearly saying that he was happy to be associated with the report, which dealt with many other things, but that, because the detail of the NHS legislation was left to Bevan and others at the beginning of the Government, the model proposed was a Labour creation. He was clearly never embarrassed about the idea.
Mr. Sedgemore: I honestly do not think that the hon. Gentleman understands the complexity of Beveridge's political beliefs. At some times, he was a pure free marketeer; at others, a statist. But on the NHS he was clear—the credit went to Bevan, not to himself. It had nothing to do with modesty; it was due to the fact that he constantly changed his mind about what kind of programme he wanted after he had produced the Beveridge report of 1942. If the hon. Gentleman is claiming that he has read it, I suggest that he re-read it and try to understand words in their ordinary and natural meaning. That is what we lawyers were taught to do, and that is what politicians should try to do.
It is a shame that we will not be having a vote in the House tonight whereby we can condemn Conservative Members for seeking to destroy the NHS with their internal market reforms, which showed that, while they know the price of everything, they understand the value of nothing.
Tory opposition to the creation of the NHS was writ large in the debates in 1946 in the House. My right hon. Friend the Secretary of State gave some examples—I can understand why the right hon. Member for Charnwood does not want to talk about such things—but perhaps I can mention a couple that my right hon. Friend did not mention.
On 1 May 1946, Sir Harold Webbe, Conservative Member for Westminster Abbey, completely lost his marbles, referring to the
"deplorable, reactionary, and destructive proposals…now before us."
He then had the temerity to compare Nye Bevan to Adolf Hitler when he described the creation of the NHS as a
"hotchpotch of political prejudice…and a very large measure of intuition… I do not want to remind the Minister that the last leader of men who relied on his intuition is dead and his country in ruins."—[Official Report, 1 May 1946; Vol. 422, c. 271–74.]
Sir Harold, a knight who in argument regularly moved from false premises to false conclusions by way of faulty logic, was unfit to lick Nye Bevan's boots.
Two months later, on Third Reading on 26 July, Mr. Linstead, Conservative Member for Putney, where I used to live, set out to reinvent the Conservative party in its 19th-century image as the Stupid party, when he said:
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"We find this Bill remote in principle, in practice and in spirit from those conceptions of what a health service should be."—[Official Report, 26 July 1946; Vol. 426, c. 400.]
We have just heard the right hon. Member for Charnwood say that the NHS is the best thing that the world has ever known. That is because those conceptions that were damned by the Tory party in the House in 1946 have survived for 50 years intact and, while Labour stays in power, they will live unto eternity.
Bizarrely—I am sorry that the right hon. Member for Maidstone and The Weald has left the Chamber—the Conservative health team today is led by a person who admits that she is unfit to be Secretary of State for Health. The right hon. Lady is now here, so perhaps I can repeat that. Bizarrely, the Conservative health team today is led by a person who admits that she is unfit to be Secretary of State for Health. Her unfitness stems from shrivelled and irresponsible attitudes based on trashy theology towards sex education in schools, the use of condoms and abortion.
The right hon. Lady's views on condoms stem from an apparent belief that God has ordained that every sperm should have an equal chance of impregnating the egg. I imagine that she goes around from church to church and climbs into the pulpit holding up a placard on which is written, "God believes in equality for sperms. Do you?" My answer is that I do not believe that, and nor can any Secretary of State for Health who is concerned for the health of the nation.
Any Secretary of State for Health has to accept not only that sex is fun, sex is cool, sex is hot, but also that unwanted pregnancies and sexually transmitted diseases can destroy people's lives. Those problems, like sex, may be a foreign country in the minds of chilling theologians, but they have to be understood and dealt with by Secretaries of State for Health.
As a member of London Brook, I wonder how the shadow Secretary of State for Health will approach the summer of love project for holidaymakers which the Brook advisory centres intend to run in July and August by giving free advice and condoms to holidaymakers.[Laughter.] The project—not at all laughable actually—is aimed at preventing teenagers from catching sexually transmitted diseases while on holiday and arises out of a recent survey which showed that 24 per cent. of young adults had sex with one or more new partners on holiday, yet most did not use condoms.
I very much hope that, before the next century begins, services that are related to women's rights and that are readily available through the NHS and Government support in England, Wales and Scotland will be made available in Northern Ireland. It is disgraceful that there is little or no sex education in schools in Northern Ireland, and less sex education than in schools in the Irish Republic, and that there is rabid opposition to organisations, such as Belfast Brook, that encourage safe sex through the use of contraceptives. It is equally deplorable that abortion is illegal in that part of the United Kingdom, and that, if Sinn Fein comes out in favour of abortion, as apparently is forecast—that is what we were told when I sat on some adolescent hearings a few weeks ago—it will be the first political party in Northern Ireland to do so. Good luck to Sinn Fein if it has the courage to do that.

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My right hon. Friend the Secretary of State may, like his forebears, consider Ireland to be a upas tree of woe in this respect, but I would hope that he will have a word with Northern Ireland Ministers, who have been just a little reticent on these subjects.
I end my brief contribution not by ingratiating myself with my right hon. Friend the Secretary of State, but by congratulating him on the galaxy of good works that he has initiated. They include the establishment of a health action zone in east London—local Members of Parliament, including me, will meet tomorrow morning to discuss future action on that subject with the East London and the City health authority—extra funds for the Homerton hospital in my constituency; the promise of a new hospital in Whitechapel, although there are concerns about the way in which the private finance initiative will work here and elsewhere; steps to improve primary health care; and, of course, saving Bart's.
Next week, my right hon. Friend the Chancellor of the Exchequer will be coming up with extra billions and billions of pounds for the NHS—
Mr. Skinner: Twelve billion pounds.
Mr. Sedgemore: I have no inside knowledge, but my guess is £10 billion.
The future of the people's NHS is safe not only in our hands, but in the hands of its brilliant, dedicated and hard-working staff.
7.37 pm
Mrs. Marion Roe: I am grateful to you, Mr. Deputy Speaker, for calling me in today's debate to mark the 50th anniversary of the NHS.
Not only as an NHS patient, but as a former governor of the St. Peter's group of hospitals in London, a former member of the South East Thames regional health authority and chairman of the Select Committee on Health for five years, I have always taken a special interest in health matters.
The NHS is the largest employer in Europe and I first place on record my personal tribute to the doctors, nurses and all personnel involved in delivering health services. Nor should we forget those undertaking research and the voluntary organisations such as the hospice movement. For the past 50 years, that dedicated band has made the national health service what it is today: an institution of which the whole country should be proud.
Secondly, however, as my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) said, one should acknowledge that, for 35 of its 50 years, the health service has been supported by Conservative Governments. More important, the health service has received real increases in funding in excess of inflation in all but three of those 50 years—and the three years in which there was a real reduction were the Labour-administered years of 1976, 1977 and 1979.
Undoubtedly, the Labour Government's funding for the NHS still does not match Conservative spending policies, and will not be sufficient to enable them to deliver on the promises that they made to the public of reducing the
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length of NHS waiting lists and spending more money on patient care. All the evidence is that, for real health benefits, it is the Conservatives on whom the country and the sick can rely. The facts show that to be the case.
Today, however, is not a day purely to dwell on party politics; we are also here to celebrate the national health service and its successes. The service is admired throughout the world, providing guaranteed, comprehensive, 24-hour care irrespective of colour, creed or wealth. Its hospitals meet the demands of acute illness, medicine, surgery, paediatrics, gynaecology and a host of other specialties.
Enormous strides have been made in the management of mental illness and disability. Far more health care is being moved to the community, so that patients who, as recently as 20 or 30 years ago, would have stayed days or weeks in hospital need be in hospital for their treatment for only a matter of hours, and can then be supported by nursing and other staff at home.
In 1948, if a child was admitted to hospital, he or she commonly stayed weeks, months or even years. Children with major disabilities often spent their whole childhood in an institution, and those with a learning disability their whole lives. Hospitals usually forbade visitors, so opportunities for contact with family or with the local community—and even facilities for play or education—were rare. Even health care professionals rarely had specific training in children's needs. The NHS has radically changed all that.
Nowhere is the service more popular and more effective than in primary care. I believe that the general practitioners are the jewel in the crown of the NHS. The service has undergone dramatic changes as medical knowledge has improved. Many of us well remember the GP of the 1950s, resplendent in his three-piece suit, working from his house, supported by his wife, who worked as his nurse and receptionist. He—in the 1950s it was almost invariably "he"—offered a basic sickness consultation service, with little in the way of outcome other than a prescription or referral. General practice has changed out of all recognition. It has become primary care, offering a comprehensive diagnostic and preventive service, meeting ever-increasing expectations from an increasingly demanding population.
During the past 15 years, consultations have increased by 60 per cent. I am glad to say that GPs have risen to the challenge. Doctors now work in groups, from well-equipped, purpose-built premises providing a host of additional services—family planning, maternity services, immunisations, minor surgery, health screening and child surveillance. Many of those GPs are now women, increasingly highly trained and with additional skills. The total number of GPs increased from 28,000 in 1982 to more than 32,500 by 1995 and, during that time, the average number of names on a GP's list decreased from 2,100 to 1,800 per doctor.
I have been proud to support and encourage a range of excellent developments during the past 15 years. My constituency has the first surgery to provide a purpose-built preventive care unit, the first surgery to open a fully equipped operating theatre with recovery beds, the first surgery to sign up to the fundholding scheme. I have witnessed the wonders of cardiotocography—the technique whereby information about the heart and circulation of an infant developing in a pregnant woman can be recorded and sent down a

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telephone line to a consultant in a hospital miles away. In short, I have witnessed an explosion in the range and complexity of care provided locally for patients by what is now known as the primary health care team.
Let us give credit where it is due. Those successes have been due to the visionary and progressive health policies operated by the Conservative Government since 1979, including the provision of funds for new buildings, the encouragement of schemes to encourage practice staff and programmes to finance computers. The changes in the GP contract have resulted in considerable improvements in service provision as a consequence of the introduction of a range of item-of-service and target payments, as well as capitation payments and allowances.
What has been the outcome? Immunisation rates for diphtheria, tetanus and polio increased from 82 per cent. in 1981 to more than 95 per cent. by 1995, and, even more spectacularly, those for whooping cough increased from 46 per cent. to more than 93 per cent. during the same period.
Healthy children are much more likely to become healthy adults, and we must always ensure that we invest in the future. Let us not forget that our NHS provides services for all children while, in 1998, 14 per cent. of children in the United States of America lack state or private health insurance. For women, cervical screening rates now exceed 70 per cent. in most practices. What a success for the GPs. I believe that we should acknowledge that success.
Our primary care is the envy of the world. It provides a cost-effective, high-quality service. It has been able to develop more quickly than ever before as a result of the previous Conservative Government's policies, which placed the general medical practice at the heart of medical care and made the GP the gatekeeper.
What are the challenges of the future? Good practice is not always implemented for children. They are still admitted to adult wards. They still remain in hospital rather than leave, because only 50 per cent. of the country has community children's nursing services, although I am delighted by the recent announcement of community children's nursing services specially for children with a life-threatening or life-limiting condition, as a memorial to Diana, Princess of Wales. Too often, staff have not received specific training in children's needs; too often the service is fragmented, and too often it is based on traditional custom and practice.
We know that respiratory conditions, especially asthma, are increasing and now affect 70 in every 1,000 of the population. Although death rates are decreasing, chronic illness as a whole is increasing. Fifteen per cent. of under-fives now suffer from a chronic illness, as do 60 per cent. of 70-year-olds. Mental health services are coming under increasing and intense pressure as a result of the inexorable increase in mental illness. Much work is still to be done in those areas.
During the next five years, there will be a serious shortage of doctors and nurses because of retirement. There are 1,000 GP vacancies at the moment. The Labour Government have not honoured their pledge to reduce waiting lists, which have lengthened by 133,000 in a year. In any case, as I said in the Chamber previously, I believe that the Government should be concentrating on reducing waiting times. That is where the focus should be. GPs are
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concerned that, with the new arrangements for primary care groups, all their achievements under the previous Conservative Government might be undermined.
The 50th anniversary of the NHS is an important landmark in health care in Britain. We have seen tremendous successes in improving the quality of life of our population over the past 50 years. Our goal must be to make sure that those achievements are not undermined, but enhanced—high-quality, effective health care matched by value for money. Let there be no mistake. All Governments will face the problem of infinite demand to be met by a finite budget.
7.50 pm
Mr. Peter L. Pike): I am glad to have an opportunity of speaking in the debate. I was born in the constituency of the hon. Member for Broxbourne (Mrs. Roe), 11 years before the national health service was formed. She described a pregnancy in modern-day Broxbourne, but I am sure it was not like that in 1937. The hon. Lady also reminded me of the concern shared by many women that automatic recall for breast and cervical screening stops at 65. At least women who have a history of cancer should be identified and called back for regular checks.
I recall the birth of the NHS and recognise the significance of the debate today. Whether or not Beveridge was responsible—I do not dismiss the importance of the Beveridge report—I thank Nye Bevan, Clem Attlee and that Labour Government for having the guts to go ahead and implement the national health service. I have been an in-patient, as have my wife and two daughters. I thank the NHS, as do millions of others who depend on it for their GPs and primary care, and for hospital care. We depend on the NHS for the service that it provides, and we thank it for being there when we need it.
I recall that during the 1992 general election campaign, I was suffering from a shoulder that had been broken in five places, and my wife was having a major operation for cancer. Ironically, although I did very little in the election because of that, my majority increased.
Two former Secretaries of State have spoken in the debate. The right hon. Member for South-West Surrey (Mrs. Bottomley) suggested that we were appointing cronies. That is outrageous when one considers what the Conservative Government did for 18 years. In my area, Miss Muriel Jobling was well respected as a person who fought for the health service. I do not know her politics. She is active in the hospice movement and elsewhere, but because she did not implement the Tory Government policy speedily enough, she was removed overnight and replaced by Mr. James Rawson, who later had to resign. Hon. Members may remember that Burnley NHS trust had a major problem when for a few days, we had no manager, chief executive or chairman because for various reasons, they all had to disappear.
Mr. Rawson was typical of the Tory party's appointments. He was seen canvassing in the next constituency with John Lee, the Tory candidate. When challenged, he said that he was Mr. Lee's national health service adviser. I pointed out that he did not come out canvassing with me, as my national health service adviser.
I welcome the fact that my right hon. Friend the Secretary of State has made it clear that the three main criteria for appointments to trusts and health authorities

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are, in addition to ability, that candidates should live in the area and use the NHS. I congratulate him on that. We are already beginning to see a major improvement in the people serving on those bodies.
The second former Secretary of State who spoke, the right hon. Member for Charnwood (Mr. Dorrell), made an extremely good contribution to the debate. I do not agree with everything that he said, but I hope that he is asked to design the Tory party's health policy. However, I also hope that he remains on the Opposition Benches for the rest of his political career.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) spoke about the private finance initiative. I recognise the benefits of the PFI in the short term, but we must consider the long-term implications. I acknowledge the short-term advantages that a capital fund could deliver now, but I am worried that if we are not careful, there will be revenue and other implications in years ahead that could squeeze the budget. I respect what my right hon. Friend is doing for the NHS and I know that he will fight for resources. It is important that we get the funding issue right.
If we look at the way in which health authorities and trusts are operating now, after 14 months of a Labour Government, it is clear that they are much more open and honest. That encouraging change is partly due to the new people serving on those bodies, but more importantly, they recognise that there is a new agenda and that the Government have a positive approach.
I shall quote from the response by the East Lancashire health authority to the Green Paper, "Our Healthier Nation". It stated:
"The East Lancashire Health Authority welcomes the publication of this Green Paper on people's living conditions and public health. We are pleased to have the opportunity to respond to it.
The Green Paper is strong on analysis, including a clear recognition of the interplay between many factors, operating at a range of levels, on the health of populations and subgroups. There is a strong case made for investing in health for the benefit of the whole country, in the same way as we might invest in education or research.
East Lancashire is an area of generally poor health and we welcome this analysis. Among the main wider influences on local health are a legacy of industrial manufacturing; a preponderance of low skill based and low paid employment; a large proportion of pre-1919 housing, much of which fails the housing fitness definition".
My right hon. Friend has persuaded his Cabinet colleagues that the health service cannot be compartmentalised and judged in isolation from social issues such as housing and poverty. My area has a tremendous amount of poor housing. I lived in it for many years, and it has improved, but there is still much substandard housing. Local people worked in the coal mining industry, where the working conditions were obviously bad for their health. Others worked in the textile industry. Steam was pumped into the cotton mills for the benefit of the cotton, but not for the benefit of the workers. They, too, suffer health problems in their old age, which we must still deal with.
Burnley has a high rate of premature deaths, particularly in the urban areas. The most common causes of death are heart disease, stroke, respiratory diseases and lung cancer. There are also high levels of self-reported,
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limiting, long-term illness—in other words, people who cannot lead a full life because the state of their health restricts what they can do. Again, the greatest prevalence is in the urban areas.
Burnley also has major problems in respect of dental health. Burnley's children have the worst dental health in east Lancashire, and east Lancashire has the worst dental record in the country. I had some difficulty myself a few weeks ago. I had been a national health service patient with the same practice since it opened in 1963, but my original dentist had retired and I had been put with someone else. She was changing to part-time work because she had a young child. She was a good dentist and I fully understood her reasons, but because I wanted to be seen on a Friday, she transferred me to another dentist. The first time that I went to see him, he had transferred to another practice and I had to be seen by someone else.
These days, many people cannot get a national health dentist. Indeed, in some places, it is absolutely impossible to do so. The previous Government virtually destroyed the NHS dental service. The Secretary of State and his team need to look at re-creating the dental service.
Dr. Ladyman: I was wondering whether my hon. Friend would be interested in my experience. I had a very good national health service dentist until a few weeks ago when he committed the crime of becoming 65. Under the current rules, he must now either go into private practice or work for somebody else. I have thus lost my NHS dentist for no good reason.
Mr. Pike: My hon. Friend makes a valid point.
A number of issues need to be looked at. For example, why do dental practitioners have one of the highest suicide rates in the country? The pay system for dentists is wrong and needs to be completely reviewed, which may require a major rethink.
People are entitled to a national health dental service. I must admit that, when I was given my bill after my last visit, I said, "I am a national health service patient," and I was told, "That is a national health service bill." It seemed very high to me.
I wish to outline a point that the Multiple Sclerosis Society put to me on the availability of treatments. It says:
"The Government has now provided more information about its plans to give more central guidance on the effectiveness of treatments. The new National Institute for Clinical Excellence will give guidance about the effectiveness of new treatments.
Ministers have said that they expect the guidelines to be implemented consistently across the NHS and have said they will monitor compliance with this guidance.
Ministers have hinted that purchasers may be forced to comply with this guidance if variations in health care persist. The MS Society believes that the Government should make an unequivocal commitment to ensure that guidance is implemented across the UK.
The history of beta interferon's introduction to the NHS shows that health authorities have systematically refused to comply with national guidance and have disputed judgements made by specialists at a national level."
I hope that my right hon. Friend will give a commitment to ensure that there is compliance in that respect. I accept that it is fair enough if it is determined that a treatment is not appropriate in a specific case, but it must be a medical decision. Moreover, the medical

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decision must be the same in Burnley as it is in Broxtowe, South-West Surrey and Wakefield. We need consistency across the board, not simply in respect of beta interferon and MS.
Incidentally, Burnley health care trust welcomes the additional moneys that have been made available to reduce waiting lists, which have allowed it to appoint new consultants in a number of areas and ensure continuity in that respect. We are all waiting to see what the spending review will yield.
The Labour Government have made a good start on the national health service. My right hon. Friend has spoken many times about the ship moving in one direction and having to change direction. As the captain of the ship, he is doing a good job. The national health service is much safer in the Labour party's hands. I hope that we remain in control of it so that, in another 50 years' time, we can celebrate its centenary.
8.4 pm
Rev. Martin Smyth: I welcome the opportunity to take part in this debate and to follow the hon. Member for Burnley (Mr. Pike), who referred to aspects of improved health care. The Southern health board lost a distinguished director of social services because, when the health board was regrouped, the role of the social services directorate was restricted and he felt that that was limiting its work. He returned to a position here in England where he had responsibility, among other things, for housing, which is an important factor if we are to have good health care.
I was trying to remember whether I was ever at a 50th birthday party at which people raked over the stories of the birth. When women look back to childbirth—men do not do so—they usually pay tribute to the midwives, but rarely say anything about the obstetricians. The humorous aspect of tonight's debate is that we have spent some time raking over who did it. Perhaps there is a lesson to be learnt from that.
I was privileged to be at a thanksgiving service for the 50th anniversary of the NHS on Sunday in St. Anne's cathedral in Belfast. Incidentally, no Minister was able to be there and I was the only politician, apart from the deputy lord mayor of the city. I have a commitment to the health service. For 19 years, I ministered in a Belfast congregation. The first Minister of Health in Northern Ireland, the late William Grant, who introduced the health service in Northern Ireland, had been a member of that congregation, and I had contacts with members of his family. For four years, I was an assistant chaplain in a hospital and I have done some 25 years of regular pastoral work in hospitals. At a personal level, I have always been committed to the national health service.
I join those hon. Members who have paid tribute to developments in the health service. The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) referred to the availability of the 24-hour service. In one sense, there has always been a 24-hour service through the emergency services. His remarks reminded me of a doctor in a village in Northern Ireland who said that he was always glad when Tuesday and Thursday nights came because the local cinema was open and that reduced the number of people who came to his surgery. Many came just for company and a chat, but they wanted something from the doctor as well. I wondered about the staffing of the 24-hour service.
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We must examine the use of the language of accessibility. The White Paper says that one of the main points about the service is that it should be "prompt and accessible" right across the country. If accessibility has been defined as medical help being available to everyone at the point of need free of charge, that is one thing, but in rural areas of Northern Ireland, people think of accessibility as being the possibility to get to hospital in the shortest possible time. As hospitals in rural areas have been closed, people are not terribly happy. We must at least use language that does not mislead people into thinking that they will receive something that cannot be delivered.
I agree completely with the concept of local responsibility for implementing national standards, and I look forward to those standards being set. I have a word of caution, however, arising especially from recent debates about the tragedies in Bristol. I received a letter from a specialist in my constituency who felt, first and foremost, that, at times, the media highlight the issues but do not give the whole story. In the light of debates in this place, I was equally concerned, because I am mindful that there are people in the medical and surgical profession who protect their reputations rather than serve their patients.
I have in mind a surgeon who gave dedicated service over many years. He had realised that he was gifted and had skills, and he had to evaluate whether he could help his patients. Anyone who has been treated by a doctor or who knows someone who is being treated by a specialist will be aware that individuals hear what they want to hear and, quite often, may misunderstand what the specialist is saying. In this modern world, we have almost deified doctors and think that they have a cure for virtually everything.
The surgeon whom I have in mind always did his best to explain things to patients, and many people were cured, made recoveries and had three, four, five or even 10 extra years of quality of life, but there were more casualties in his surgery than in others. Some patients decided, "It's too risky, I'm not taking it. I'll die anyway, so there is no point in doing anything." Doctors are evaluated by their peers, who have to judge them, but we should be careful of condemning specialists, because they have difficult tasks to perform in making diagnoses and prescribing medicines.
The White Paper refers to cutting bureaucracy. I have no difficulty with efficiency, but how are we to cut bureaucracy? When I was a member of the Health Committee, there were those in the early days of programmes for changing NHS care who shouted about too many managers. I noticed a significant change, and in one of our investigations, I challenged a specialist in the care of children about the concept of management. He was honest and said, "We don't want fewer managers. We want more money." The average doctor does not consider himself or herself to be a manager. Doctors believe that their time should be spent mainly in clinical services.
We need good managers—people who know what is going on and can keep a grip on things—but how will we cut bureaucracy? When we were reducing the number of health boards in Northern Ireland and developing trusts, GP fundholders and multiple fundholders, there was a subtle exodus from the boards into funds and trusts. Job

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protectionism is found in most areas of life, and we must be careful about how we cut bureaucracy and have an efficient health service at the same time.
Although we have a good service in Northern Ireland—tribute has been paid to the combination of health and social services, and I recognise that health boards in Northern Ireland have more functions than health boards here—I still find it difficult to accept that for 1,700,000 people, we need a Department of Health and Social Services, a health management executive, four area boards and 20-odd trusts. That seems to be out of kilter. We have to examine that structure and cut it down to size, without moving that bureaucracy into other areas.
I could make a lengthy contribution, like some hon. Members, but others want to speak. I shall, therefore, simply issue a word of caution. The White Paper says that
"management costs will be capped in health authorities and Primary Care Groups and the Government will continue to bear down on NHS Trust costs. Transaction costs will be cut."
I remember rows in this place about the capping of local authorities. What happened when local authorities did not have the money that they thought was needed to provide even social services? We should be careful when we talk about capping management costs, because management will find ways in which to keep their budgets going and someone else may suffer. Usually, the people who suffer most are in the front line or at the coal face.
I shall curtail my comments, but I must refer to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore). It was fascinating to discover that the Government do not propose to delegate powers over abortion within the devolution of powers to Scotland. The hon. Gentleman referred to that, and also referred to poor sex education. I do not know how many schools he has visited in Northern Ireland, but I believe that there has been a tremendous improvement, as there has in other places. I have noticed that, even where there are Brook clinics which, supposedly, cut the number of unwanted pregnancies, the number continues to grow.
Here in England, no one should kid themselves that such clinics are the answer to the problem. The people of Northern Ireland have not gone down the road of social abortion, so to suggest that they should have such clinics imposed on them against their will hits at a basic concept of democracy. I was fascinated when the hon. Member for Hackney, South and Shoreditch cheered on Sinn Fein. He may have been unaware that, although that party supported the extension of the Abortion Act 1967 to Northern Ireland, its supporters largely did not like it. Sinn Fein had to turn the legislation down, and tone down its position dramatically.
In debates such as this, we think about the disposal of innocents with potential for development, so perhaps there is something to be said about the fact that credence was paid to Sinn Fein, the masters in disposing of people.
8.18 pm
Ms Joan Ryan: I make my contribution on behalf of my constituents in Enfield, North, who have had first-hand experience of the differing approaches to the national health service of the Labour Government and their Conservative predecessors.
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I shall elaborate on those differences, but I should first congratulate my right hon. Friend the Secretary of State for Health on two major achievements. The first is his programme for the future of the NHS, focusing provision on patient need, and delivering for that need through primary care commissioning. I am proud to tell hon. Members that that approach has been pursued for some time by dedicated and far-sighted GPs and primary care professionals through the total care project in my constituency.
The second achievement is that the Secretary of State has managed to restore the public's faith in the national health service. Their faith has been sorely tested by the policies of the previous Government, who are now consigned to the Opposition Benches as a consequence, among other things, of their policies.
The people of Enfield, particularly those in Enfield, North, depend for their acute health care provision on Chase Farm, North Middlesex, the Whittington, and Barnet general hospitals. Several hon. Members will be well aware of the recent histories of those hospitals. Other hon. Members may find the experiences of north London residents illuminating.
Under the last two Conservative Governments, each of those hospitals and their services were either threatened or seriously undermined. The people who were dependent on them and their services were faced with an ever-changing landscape of secondary health care provision, which destroyed the morale of national health service staff and the confidence of the public.
The threat to the accident and emergency department of the North Middlesex hospital was fought off through the campaigning of local people and on the strength of their arguments. The threat not just to the accident and emergency department of Chase Farm hospital but to its very existence in any shape or form was also fought off by local campaigning, which was strongly supported by our local newspaper, the Enfield Advertiser.
The threat to Barnet general hospital was lifted, only for the neighbouring Edgware hospital to be identified for closure. The previous Government closed Edgware hospital as we approached the 1997 general election. The Labour Government have since established a community hospital at Edgware. I congratulate my hon. Friend the Member for Hendon (Mr. Dismore) and all those locally who resisted the closure of Edgware hospital and fought for and achieved the community hospital.
There is a pattern to this history. It is a pattern of arrogant disregard for the opinions of health service professionals; of disdain for the people who are dependent on the Government to provide a decent health service; and of incompetence. The decisions taken by the previous Government were frequently reversed, only to be reintroduced somewhere else. Each time—with the unfortunate exception of Edgware—the Tory Government were forced to back down when their misjudgments were exposed. The history of the NHS may record that those hospitals survived the Tory years, although scarred, but it will not record the consequences of their bungling on the day-to-day management of those hospitals.
Chase Farm hospital in my constituency is an excellent facility. It engenders a sense of loyalty in the local community that it serves so well, which is not uncommon among good hospitals across the country. What is also not uncommon is the fact that it has more than once faced the

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threat of closure despite a remarkable performance record. It has managed to survive the years of illogical planning under the previous Government. It has managed to survive in a climate of uncertainty about its future and in an environment in which its neighbouring facilities were constantly in fear of closure. It has managed to survive the folly of the internal market through skilful management of tight budgets and by tailoring its services to the people it serves. It has drawn on that invaluable resource in the NHS: the commitment, dedication and professionalism of its staff.
As we stand here today in the glow of the 50th anniversary celebrations of the founding of the national health service, I am proud to be associated with a Government who see their tenure of office as a chance not just to rebuild the NHS, but to develop it for the future. The Government have rejected the Tory approach of conflict before consultation and destruction before design. I am sure that this is a matter of relief throughout the country, but we in London have particular reason to feel relieved about the change of Government and the change of approach.
The Tories commissioned the flawed Tomlinson report, which claimed that London's acute health facilities were over-bedded. That report has been superseded by the Turnberg report, which painted a picture that was much more readily identifiable by Londoners. It was apparent to all that London was not over-bedded, and that, in particular, the care of the elderly and those with mental illness was falling far short of what was required.
However, it is not right merely to blame the Tomlinson report. It is the Government's responsibility to make decisions. It is their responsibility to make the right decisions.
What should we have expected from the Tories? While we are celebrating the creation of the national health service 50 years ago, it is appropriate to reflect further on the contributions of some of the Members of the House during that incredible post-war period and the debates that set the course for the NHS. It is an enjoyable subject for Labour Members, who should feel proud to follow in the traditions of the great Nye Bevan and his colleagues. However, I suspect that a few Conservative Members will know enough about the Tories' behaviour in those debates to hope that their shameful contributions are left hidden on the pages of Hansard in the Library, away from the scrutiny of the public, but I am sorry to disappoint them.
The record of the debates exposes the Tories' contempt for the national health service even then, as they fought to prevent it from ever coming into existence. As the Secretary of State said, they voted 51 times against the National Health Service Bill of 1946. Next year, perhaps the NHS could celebrate a year for each one of those votes: 51 times. What were they voting against? What was it that they so feared? It is hard to ascertain from the transcript of the debates whether they knew that themselves.
My hon. Friend the Member for Reading, East (Jane Griffiths) told us about Henry Willink, who claimed that the Bill threatened
"the patient's right to an independent family doctor".
He said that the Bill would
"destroy so much in this country that we value."—[Official Report, 1 May 1946; Vol. 422, c. 223–32.]
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He may have had a point if we value poor health, inequality and injustice.
Richard Law, quite shockingly, said:
"the doctors of the future will not be as good as the doctors of today."—[Official Report, 30 April 1946; Vol. 422, c. 81.]
How would he explain that comment in the light of the fact that, since the foundation of the NHS, life expectancy for men has risen from 66 to 74 years, and for women from 71 to 79 years? I accept that that is not the only factor, but it is a significant one.
I, too, read with some disgust the comments of Viscountess Davidson, who predicted "civil war". That was a bit strong, although there was something of an uprising in her constituency of Hemel Hempstead on 1 May last year, because that seat is now held by Labour. The constituents of Pudsey reacted the same way last year, although I am sure that it was not simply a late reaction to Colonel Stoddart-Scot, who held the seat in the Conservative cause in 1946. He thought that the Bill
"does nothing for positive health, and gives no assurance to the people that the hospitals will generally reach a higher standard."—[Official Report, 2 May 1946; Vol. 422, c. 365.]
Given what future generations of Tory Health Ministers have got up to, he should have been congratulated on his foresight.
I could make the same point about the constituents of Putney—who famously returned a Labour Member—and others, but my point has been made. Each of the seats I have mentioned was held by a Conservative before the last election, and they all came to Labour. The ever-present threats in the past 10 years
to north London, especially the Enfield-based hospitals, was a strong factor in Enfield returning three Labour Members in place of three Conservatives. The British people, who cherish our national health service, trust Labour. That is because the Labour Government have embraced and reaffirmed the values of the NHS: the simple values of equality in health care, and the commitment to prevent ill health as much as to cure it.
Labour's programme is firmly rooted in the prevention of ill health. Prevention is possible only by pursuing the Government's broad approach to defeating the causes of ill health. We have already seen some of their measures to combat poverty, poor housing and unemployment: structural issues that cause and promote poor health. That approach is reinforced by the development of primary care, and has already been recognised in my constituency.
The family doctor—the GP—is the foundation of the national health service. That is as true today as it was in 1946, whatever Mr. Willink may have claimed. The scrapping of the abominable internal market and the move to primary care commissioning recognises that. As an aside, while we are on the subject of the internal market, I can tell the House that the other day I heard some non-executive members of a local hospital trust having a little chat, and they referred to the Secretary of State who introduced the internal market as a "regular kind of guy". I could not quite agree with that, until I realised that they probably meant "regular" in the medical sense.
In Enfield, North, there are exciting developments for our primary health care, with the establishment of modern facilities in the constituency. I recently attended the opening of some of those facilities, and was impressed by what I saw. In particular, the new Eagle house centre in Ponders End is continuing its marvellous tradition in

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modern premises and facilities. Dating from 1729, Eagle house has played a central part in the history of the area, having sheltered local residents from everything from religious persecution to first and second world war air raids.
In large new premises, the centre will be a base for health visitors and district nurses, and will provide a wider variety of services than ever before. There will be enhanced teaching and education facilities, better capacity and equipment for minor surgery and individual consulting rooms for general practitioners. The practice will serve a relatively deprived population from a range of ethnic backgrounds, in an area where the unemployment rate is about 14 per cent. The practice and its team have been key players in the delivery of primary care in Enfield, and I am delighted to say that my hon. Friend the Minister of State will formally open the facility later this month.
I have also visited the medical team from the Riley house surgery, who recently held an "asthma care day" in a local community hall. They are taking care to the community, involving people, and being accessible. On the day of the anniversary of the introduction of the NHS—last Sunday—I was asked to open the new Jephcott suite at the White Lodge medical practice in Enfield town. That is another new primary care facility in my constituency that is developing better conditions for patients and their families.
Finally, let me return to the benefits of Labour's approach for acute health care in Enfield. After the years of uncertainty and gloom, there is a new spirit of partnership in north London. That is evident in the preferred partner working arrangements between Chase Farm and Wellhouse NHS trust at Barnet general hospital.
The two hospitals have been working together since January—two hospitals, six miles apart, serving the same population with the aim of delivering the very best health care, in which quality and meeting patient needs come first. Those two hospitals are no longer pitted against each other in competition, but are able to work together. We look forward to the progress of their partnership, and recognise the good sense of arrangements that will benefit our local population.
Given the improvements in life expectancy I mentioned, if the Government continue with the same level of success, perhaps many of us who are here today will be back in the Chamber celebrating the centenary of the NHS in another 50 years.
8.32 pm
Dr. Evan Harris: I am delighted to speak for the first time in a major NHS debate. Because of the paucity of NHS debates, there have been few long enough for two Liberal Democrats to speak.
I am particularly pleased to follow an enjoyable, interesting and powerful speech from the hon. Member for Enfield, North (Ms Ryan), who gave a history lesson for the Conservative party; but I intend to deal with the present situation, and to ask the Minister a number of questions relating to how we deal with quality in the NHS, how we deal with the distortion of clinical priorities by politicians, and how we deal with rationing. The
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Government have now admitted what is obvious to everyone in the NHS—that, to a certain extent, rationing takes place, both in itself and on the basis of postcodes. I also want to give the Minister some advice—as I would give advice to any potential Treasury Minister—about how to save money in the NHS by getting rid of false economies.
There has been a great deal of discussion today about how much should be spent on the NHS. I do not want to repeat what has been said by many speakers about the need to provide money to cover not just inflation, but NHS inflation. What has disappointed so many NHS professionals, so many people whose families use the service and so many patients and patient groups is not only the underfunding of the service over the past 20 years—18 years of Conservative government, but 20 years of Conservative spending plans—but the contrast with slogans that raised expectations before the last election, claiming that waiting lists would be shorter and that "Things can only get better".
Two weeks before the election, I was working hard in my constituency, canvassing and talking to people who had been my patients. At that time, it was said at a Labour party press conference that there were "14 days to save the NHS". We knew then that, if Labour stuck to Conservative party spending plans, however, it would take at least two years—and even now we remain to be convinced that the NHS will be saved even after two years of Labour government.
The first page of a press release that I received from Labour party headquarters told us that the NHS was in a mess, but Labour could save it in 14 days. It then quoted what a Dr. Evan Harris of the BMA had said on "Kilroy". If the Government are using "Kilroy" as a source of evidence-based policy, I am concerned; but I think that they chose the right author of such policies.
I was quoted as saying that there was a two-tier system—that the patients of non-fundholders would have to wait longer than those of fundholders, and that those who had to wait longer were "stuffed" unless they were very fortunate. In fact, my point was that, even if we got rid of fundholding, there would still be a huge difference in status between those who could not afford private treatment and those who could. While long waiting times and the underfunding of some Cinderella specialties continue, there will continue to be a two-tier system—waiting times of 12 or 15 months on the NHS, or of 15 days privately. That is what I opposed.
When the press asked me whether, as a Liberal Democrat candidate, I endorsed the Labour party's taking my name in vain and supported its policies, I said that I could not see how the two-tier system that I had been quoted as condemning could be got rid of while Labour stuck to Conservative spending plans. I think Labour Members now recognise the damage—the increase in waiting times and waiting lists—that has been done.
Let me now deal with the issue of improving quality in the NHS. I think it rather unfair of Ministers to say that that has been a random occurrence in the past, left entirely to chance. I know that doctors, nurses and other professionals think carefully about their work in the NHS. After their day is finished and they stop being paid—I know that this was true of me, but I think that it was more true of my colleagues, as I was busy with politics—they go to the library to read the latest research, in their own time, with the aim of applying it to their practices.

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If the Government intend to make external audit compulsory, as they should do, and if they want to ensure that not only new but existing treatments are of the best possible quality and are shown to be effective, investment in research must be a priority. Sadly, the NHS research and development budget has fallen in the last two years, year on year in real terms. It is difficult to see how we can secure the new evidence we need for the National Institute of Clinical Excellence at a time when R and D funding is falling.
It will be difficult to get the best out of compulsory audit and clinical governance if those who work in the health service—doctors, nurses and those in the professions allied to medicine—are not given time within working hours. It requires an increase in the number of nurses, rather than vacancies. It will also mean an increase in the number of doctors, and it will mean dealing with the recruitment crisis in professions allied to medicine.
The problem relating to doctors is one of which I have particular knowledge, because I worked in medical education and training. There is a shortfall in the number of students coming through medical school who will be the consultants of the future; last November, the Government's own advisory group recommended an increase in the annual output of medical schools of 1,000 trained medical students—trainee doctors five years down the line. We are now waiting to find out whether the Government will implement the advice of their advisory group. If they need to do so, they must bear it in mind that they will see the fruits of that investment only in 10 years' time, which may be rather longer than some patients and some of my former colleagues are prepared to wait.
At the moment, we are taking in doctors from overseas to fill the gap. Only 38 per cent. of new General Medical Council registrations last year were for people trained in the United Kingdom. The European Union will reduce the number of doctors it produces, so we will not be able to rely on them any more, and it is wrong to bring doctors here from developing countries, allegedly to train but often merely to be exploited for service in staff grade, or other non-consultant posts, to make up the shortfall.
I was sad to hear that a leading academic from the Sudan has been headhunted to work in psychiatry in this country when, with his skills and the Sudan's investment in his training, he should be working there. That is also the case with other developing countries: their doctors should not be working to prop up our underfunded health service.
As my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) said, during the most recent Health questions we were delighted to hear the Minister of State agree, in response to a question from my hon. Friend the Member for Northavon (Mr. Webb), that some drug treatments that were probably not effective were being introduced into the NHS too quickly. I agree, and it is important to ensure that pharmaceutical companies and the NHS—or both in partnership—get better information about which groups of patients some apparently widely applicable drugs will work well for.
The Minister of State also agreed that some drugs that are clearly effective are being introduced too slowly, which is an example of rationing. They are being introduced too slowly not merely because of ignorance but because of funding problems, and some of them have been around for some time.
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Another example of rationing is the long waiting time for some operations, and the fact that certain operations that used to be offered on the NHS are simply not available any more. My hon. Friends the Members for Southwark, North and Bermondsey and for Isle of Wight (Dr. Brand) and I have been saying since May 1997, and before that, that the reduction of waiting lists by the deletion of certain operations from NHS indicators was rationing by another name.
Mr. Jim Cunningham: Does the hon. Gentleman agree that his hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) accepted that there would be rationing in the national health service? He even quoted Aneurin Bevan to substantiate his argument.
Dr. Harris: I am not sure that I fully understood the hon. Gentleman's point, but I hope that this will answer it. We recognise that rationing takes place. The problem is that the people of this country have never been told at a general election that the NHS is anything other than a universal service, available to all and free at the point of delivery. At the last election, they were told that they could have a wonderful health service and that it would get better, but that no one would have to pay any more and it was a universal service.
Opinion polls have consistently found that people would be prepared to pay more for a health service that was truly universal and readily available. There will always be some need to wait for the sake of efficiency, but waits of more than six months are unacceptable for people who have paid their taxes.
People would be prepared to pay a little more for a decent health service. It is not fair for the Government or Labour Back Benchers to say, as the hon. Member for Burnley (Mr. Pike) did, perhaps inadvertently, that health authorities should pay for prescribed beta interferon on demand, and for all the other drugs for which there are guidelines. Some treatments do not have guidelines. For certain Cinderella specialties, there are no clearly measurable outcomes. We can ask whether beta interferon is being given to all patients with multiple sclerosis whose consultant neurologists feel that they can benefit from it. Mental health services and services for the care of the elderly have no such parameters.
Health authorities are left with the problem of a demand for beta interferon and for expensive new anti-psychotics as well as statins, all of which are proven and effective treatments. They cannot raise funds locally, but people are blaming them for the rationing—I hope that the Government will not blame them for that.
It is the Government's responsibility at least to initiate a public debate about whether people want such treatments to be widely available and whether they would be prepared to pay more through taxation for them—whether through taxes on cigarettes, the closure of loopholes in the health service, or income tax. That was our platform at the election, as it was for education. It is the Government's role to initiate such a debate, as they have finally recognised that rationing takes place.
If the Government think that there are problems with beta interferon, which would at least reduce in-patient costs if it produced health improvements, and if they think that there will be benefits from prescribing statins to

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reduce blood cholesterol through the reduction in coronary artery disease, they will see the long-term benefit of the appropriate prescribing of effective medicines.
However, with the new drug Viagra, there will be no down-the-line financial benefits to the health service, as the Minister knows and as has been reported in the press. It is likely to be a popular drug in all senses of the word, but it is also likely to be widely applicable. The Government will find it difficult to ration it through referrals to consultant urologists, who will have little time to do anything other than the impotency work-ups on patients referred by general practitioners. That nettle will have to be grasped, and there will be an opportunity for the Minister or a colleague to do so in an Adjournment debate next Tuesday, when we will discuss how Viagra can be prescribed.
My Liberal Democrat colleagues and I will work with the Government and the pharmaceutical industry to solve the problem of how to ensure that effective drugs are introduced, when they are known to be effective, and not rationed by postcode. There will be an outcry about Viagra if we see not merely treatment by postcode, which is what is happening now, but sex by postcode, as was reported in the papers following a debate at the British Medical Association.
The Government's policies on waiting lists have distorted clinical priorities. My hon. Friend the Member for Southwark, North and Bermondsey said today, and has said on many previous occasions, that the concentration on waiting list numbers rather than waiting times is causing immense problems for people who may need expensive operations but will be moved further down the queue because health authorities—on pain of the sacking of their managers and chief executives—have to get the numbers down.
I challenge the Minister to reassure me that, for the waiting list initiative, the format of operations planned matches pretty exactly the range of operations already in the contract. In other words, will he assure me that there will not be proportionately more small operations, for example on ganglions, and that there will be as many, if not more, hip replacements? People waiting for the latter are in pain, their movements are restricted, and they need the support of social services.
That is a problem, and if we keep concentrating on Government-sponsored initiatives with a clear outcome, such as waiting lists, we will not provide services where there is no clear outcome, such as in mental health and the care of the elderly. The false economy of taking money from social services, which suffered real-terms cuts in the past two years even before demographic increases are considered, and putting it into the NHS, must become clear to the Government when they recognise that patients cannot be discharged from hospitals because social services do not have the money to pick up their funding in nursing homes. The threatened closure of two community hospitals in Oxfordshire is a case in point.
Finally, I have two questions for the Minister. First, will he place in the House of Commons Library the figures that the NHS executive gathers on bed blocking, to show whether the winter pressures money and other
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such schemes really reduced the number of delayed discharge days or the bed blocking from which hospitals were suffering?
Secondly, does the Minister accept that, if it can be shown that it would be a false economy in Oxfordshire or elsewhere to close community hospital beds—the Liberal Democrats are not wedded to any particular bricks and mortar, because it is beds and services that count—health authorities should be allowed to use this year the money that may be available next year to provide the services that patients, many of whom are elderly, deserve, and for which they have paid taxes over the past 50 years?
8.49 pm
Dr. Howard Stoate: As one of the few proper doctors in the House, I am particularly grateful for this opportunity to speak. I think that I am only one of two who continue to do a small amount of work in the national health service. I also want to declare my great pride in being part of the work force that has ensured that the health service has been the envy of the world over the past 50 years. I hope that all hon. Members are able to join me in thanking all NHS staff on behalf of all our constituents.
Whenever I get the chance, I take a look at the various publications that are sent to general practitioners' surgeries. Apart from articles concerning my own activities, there are occasionally other interesting articles. Quite recently, I came across an interview with the right hon. Member for Maidstone and The Weald (Miss Widdecombe), the shadow Secretary of State for Health, in Doctor on 25 June, in which she was described as a hardliner. She claims much for her Government's record on the NHS between 1979 and 1997. Fortunately, the electorate did not believe much of what she or the previous Government said, and voted instead to defend the NHS.
The article makes it clear that the right hon. Member for Maidstone and The Weald has learnt something from my right hon. and hon. Friends in the Department of Health. She says that she will be listening to people's suggestions, taking the debate to the country, coming up with a strategy that can be tested on experts and putting policy to the people. If only the Conservatives had done that through their 18-year stewardship of the NHS. The internal market, which set parts of the health service against each other, was not tried and tested before its implementation, and we are having to sort out the mess that they left behind.
At least in 1998, the Conservative Front-Bench team claims to support the NHS. As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) pointed out, however, the right hon. Lady seems to want to introduce far more private health insurance. I am particularly opposed to that line of thinking, for one simple reason. Let us suppose that a young male driver of a Lamborghini finds that his insurance premiums go through the roof. He can always sell his Lamborghini and buy a Lada. If, on the other hand, the same young man happens to have diabetes or a chronic mental health problem or renal failure, what can he do? He cannot just take his renal failure elsewhere and try to get a better quote for his health insurance.
There is a simple inverse law: those in most need are the least insurable. That will always be so; it is the same anywhere in the world. In any example, such as house or

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car insurance, the inverse law applies. As bad luck would have it, those most in need tend to be those least able to pay. They suffer a double whammy. We know from statistics that the Department of Health releases frequently that people in difficult social circumstances are also those who happen to suffer the worst medical problems. For all sorts of good reasons, introducing more private health insurance in the NHS would be a disaster.
I should like to concentrate on what is happening in my constituency. In Dartford, we are at the forefront of the new NHS, preparing for the changes of the new millennium. On Saturday, I was pleased to attend the topping-out ceremony for the new hospital in my constituency—the first to be built under the private finance initiative—to serve the needs of Dartford and Gravesham. The Government ensured that legislation was in place to allow the private-public partnership between the NHS trust and Tarmac to go ahead to build the much-needed facility in north-west Kent. I am pleased that the project is on time and on budget. Many eyes are on it, and are willing it to be a great success. If, as I believe, it lives up to our hopes, it will form a template for many similar schemes.
My hon. Friends the Minister and the Paymaster General joined me and my hon. Friend the Member for Gravesham (Mr. Pond) in September to mark the start of work on the hospital. I hope that it will not be long before they and other colleagues join me to mark the opening of the hospital. It will be a flagship for the NHS, and shows what a Government who are committed to the health service can do. It would never have happened without the tremendous effort of all those involved and the vision of Ministers to will it into being.
Earlier this year, community trusts in north Kent merged to form the Thames Gateway NHS trust. The trust is seeking to make savings by streamlining management and administration so that more money can go into patient care. At the same time, economies of scale and merging of expertise will lead to improved standards. As long as the quality and availability of care at local level are preserved and—I hope—enhanced, I see nothing wrong with trust mergers, either to create a larger geographical area or, vertically, to integrate health care for a locality.
All the developments in Dartford and Gravesham are supported by significant amounts of extra cash, which has gone into the NHS since we were elected last year. West Kent health authority has received £26 million of new money. That includes £5 million to tackle waiting lists, so that we can make our own contribution to meeting the pledge to reduce over the life of this Parliament the number of people waiting for hospital treatment. Waiting lists in Dartford and Gravesham are already lower than they were in May 1997. The Dartford and Gravesham NHS trust will have an extra 48 beds to treat even more patients.
GPs and community nurses in Dartford and Gravesham are pioneering our plans for primary care groups in a pilot project. Fundholders and non-fundholders alike have embraced the idea with enthusiasm. I am sure that there will be lessons to be learned from their experiences, which will benefit the implementation of primary care groups throughout the country next year. I applaud the efforts of the British Medical Association and Ministers to ensure that such groups work. As with any venture of such vision, there have been some tough negotiations on both sides, and I understand the threat that such change may
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pose. I hope that some of the groups will try to be even more innovative than the guidelines propose and that, in time, groups will experiment with ways of working together.
Someone who has not visited north-west Kent may imagine a leafy idyll. They would, of course, be right. However, we have many pockets of deprivation, and West Kent health authority thought that it was worth while submitting a bid to form a health action zone. The bid was unsuccessful, but many useful lessons were learnt. The health authority has already begun to work with county and borough councils, and they will be in a good position to work on a health improvement programme for west Kent when we implement the plans for a healthier nation.
Our plans are for the next 10 years; we shall be working on many elements during the lifetime of this Parliament and the next. The agenda is full, but I should like to encourage the prioritisation of some items. Recruitment and retention continues to be of concern, particularly in primary care. We need to research the causes of the shortage of doctors and nurses who want to enter primary care. We need to improve undergraduate medical education, vocational training and continuing education, so that general practice becomes more attractive. Efforts are already being made to provide more flexibility for doctors. That needs to continue and develop. There is particular pressure in inner cities, and incentives should be considered to attract new doctors to fill gaps.
I would welcome an early response from Ministers to the findings of the Campbell committee. One thousand new medical students will take time to work through their training, but there will be plenty of work for them to do when they qualify. With encouragement to enter primary care, they will go a long way to filling the gaps that are appearing.
No debate about the success of the NHS can ignore the enormous contribution made by Britain's innovative and successful pharmaceutical industry. It is one of our largest exporters and leads the world in research and development. I hope that that vital part of our research base is not forgotten when, this year, the Government renegotiate the pharmaceutical price regulation scheme, which sets the basis for the price paid for drugs by the NHS. Many new drugs are available, as hon. Members have mentioned. We need clear departmental guidelines on how they should be used. It is very important that new drugs are put into perspective rather than introduced through the media and through patient demand, without proper regulation and control and a balanced approach on how best they should be used.
During this 50th anniversary celebration, there have been many welcome announcements from my right hon. Friends the Prime Minister and the Secretary of State for Health. The Prime Minister launched the innovation fund, which will demonstrate that the division and competition of the internal market are not necessary for new ideas to develop. The NHS, during this period of co-operation, will see innovation flourish.
There are many beacons of excellence in the NHS. Their example should be celebrated and shared throughout the NHS, so that everyone can benefit from good practice. My right hon. Friend the Secretary of State launched the drive to improve quality of care in the NHS. Doctors

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welcome the promise of national guidelines, and we shall ensure that they are adhered to. Patients will be asked regularly how they think the NHS is performing.
I am sure that everyone in the NHS is hoping to hear about funding for the future. Of course, we cannot expect to have the result of the comprehensive spending review before time, but it is clear that the £2 billion of extra money so far is not enough for my right hon. Friend the Prime Minister, and there has already been a hint of money—a lot more money—from my right hon. Friend the Secretary of State, and that is very welcome.
I look forward to next week's announcement, confident that it will fulfil our manifesto commitment to raise spending in real terms every year. I know that the workers at the front line of the NHS will spend the money efficiently to improve patient care.
We can look back to 1948 and celebrate the life of the NHS, but we must also look forward. As Nye Bevan said, the NHS must always be changing, growing and improving. At no time has it been better prepared to face the challenge of the new.
8.58 pm
Mr. David Amess: I welcome this debate to celebrate the national health service and its achievements and talk about its future. Unfortunately, I missed the opening exchanges. I believe that they were splendid. My hon. Friend the Member for Belfast, South (Rev. Martin Smyth) is not here at the moment, but I certainly agree with what he said.
There has been a familiar tone to the debate. We can talk about history, but the reality is that for 35 of the 50 years during which we have enjoyed the national health service, the Conservatives have been in power. Labour Members have chastised Conservative Governments for what they did, but in a democracy, if the people had been unhappy with the way in which the Conservatives were running the health service, they could have voted them out.
My hon. Friend the Member for Belfast, South was also right about abortion, embryo research and related matters. I listened carefully to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore). When I talk about the achievements of the national health service, I certainly do not include the huge number of babies who have been aborted.
It is an absolute disgrace that we can now abort up to term on the basis of disability. The Human Fertilisation and Embryology Authority is a fiasco. The idea that experiments can be done on embryos up to 14 days and that inspectors can magically deal with the situation is absolute nonsense. It is a further disgrace that, when I tried to introduce a Bill to stop sex selection, it was defeated overwhelmingly, and largely by women Members.
We should not take pride in that aspect of the health service, but we should celebrate its achievements. People are living longer; more premature babies are surviving; and the general public are healthier than ever. We can see immediately in schools that children are much healthier than ever, and for that we should thank every doctor, nurse and other member of staff in the national health service.
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Let there be no doubt that, were it not for the army of volunteers throughout the country, we would not have the magnificent health service that we do. One has only to look at America: when President Clinton was first elected, he tried to persuade Congress to deliver a national health service, and they spent two years debating it before deciding that it was simply not possible. I am sure that, if we were starting from scratch today, we would also find it impossible. We have a magnificent health service, and we should all delight in it. It is the envy of the world.
Like other hon. Members, I was present on Sunday at local celebrations in my constituency. Southend hospital was recently recognised with the award of associate university teaching hospital status, making it an integral part of London university. That demonstrates the high quality of its education facilities for clinical staff. We are also very proud to be recognised as a major cancer centre, and in December last year we were awarded the King's Fund organisational audit accreditation award, about which the Government should be delighted, because it means that there could be no better administration than that at Southend hospital. Fairhaven is a magnificent hospice in Southend, and only two weeks ago, the Duke of Gloucester opened our children's hospice, which is the only one in an area that includes the whole of Essex and part of London.
Mental health is an extremely difficult matter to deal with, and not everyone wants to talk about it, as the Minister will know only too well. We have difficulties in Essex at the moment, and I am sure that he and his colleagues are trying to deal with them.
Mr. Gareth R. Thomas: Will the hon. Gentleman give way?
Mr. Amess: I certainly will, but I am trying to co-operate to allow another Labour Member to speak.
Mr. Thomas: On the subject of difficulties, the hon. Gentleman will know that his party does not have a policy on the health service at the moment. In terms of future policy, does he agree with the vision of the right hon. Member for Charnwood (Mr. Dorrell) or the vision of the right-wingers in his party who support some form of privatisation or charging?
Mr. Amess: I made a big mistake in giving way. What the former councillor for Westminster had to say did not add anything to the quality of this serious debate on the national health service. As far as the hon. Gentleman's remarks about the Conservatives are concerned, we have lost the plot. Labour is the Government and the Conservatives are the Opposition. The Conservative party has nothing whatever to be ashamed of with regard to our management of the NHS. My right hon. Friend the Member for Charnwood (Mr. Dorrell) was an excellent Secretary of State for Health, and the present Government are trying to copy much of what he and his predecessor, my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), did. But as we are increasingly finding out, they are not making a terribly good job of delivering Conservative party policies.
I move on to the second part of my speech, which is on the future and politics in the NHS. One or two hon. Members have said, "Oh well, it is no good talking about

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appointments. Let's look at what the Conservatives did." Again, we have lost the plot. It was the new Government who on 1 May, celebrating with "Things can only get better", said that we would not have any politics in the NHS. Yet only four Conservative councillors as against 111 Labour councillors have been appointed to trust boards. Labour introduced a new criterion into the appointments process. It wrote to council leaders rather than to chief executives of local authorities. Conservatives have been largely excluded from the appointments process.
The final joke on politics is this. I have nothing whatever against the individuals who have been appointed as chairmen in my area, but when two names are submitted to me as the local Member of Parliament, and they are both Labour activists, that says it all. Even more bizarre, the press release on the new appointments starts off by saying that "Labour activist" X has been appointed. It is no good the Secretary of State for Health saying that there are no politics in the NHS when people are being told to push out press releases saying that new appointments are of Labour activists.
One of my local cancer consultants has made a number of good points about cancer treatment. This might be a controversial point, but I watched two weeks ago the television programme that showed someone dying. I as an individual thought that that was a great mistake, but there it is, it was shown. The current maximum number of new patients seen by a consultant clinical oncologist should not exceed 350 per year. The Board of Faculty of Clinical Oncology recommends that the maximum number of new patients seen by a consultant clinical oncologist should not exceed 315 in any one year. I should like the Minister of State to write to me on a later date to tell me whether he agrees with that suggestion. If he does, given his Government's position on hospital waiting lists, how does he intend to resolve that problem? The other point about cancer treatment concerns the machinery that is used. Many cancer consultants are very concerned about the age of the machinery that they are using. Will the Minister write to me about what his Department intends to do about that?
Another constituent who is an eye consultant has brought it to my attention that one in five of the doctors who qualify in the United Kingdom are lost to the NHS within 10 years. The British Medical Association helpline receives 6,000 calls a year from doctors who are stressed and feel that they cannot continue to work. Will the Minister let me know what the Government will do about that?
The Prime Minister used to jump up at the Dispatch Box to rubbish Essex county council after it had been controlled by the Conservatives for only seven weeks. After 15 months of a Labour Government, however, anything that goes wrong can still be blamed on the Conservatives. The Conservative Essex county council has addressed bed blocking and put £4 million into the service, so that 450 people in hospital beds can go to residential homes.
I shall write to the Secretary of State on behalf of United Response, which delivers quality services in the community, and which wants to raise a constituency point.
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Every parliamentarian should rejoice in the achievements of the wonderful NHS. The Conservatives have for 35 years assured its future. It is now up to the new Labour Government to do the same.
9.10 pm
Mr. John Heppell: I congratulate the hon. Member for Southend, West (Mr. Amess) on his brevity. He was much quicker than I expected.
The Ulster Unionist party is the only one not to have claimed credit for the national health service tonight, and even it claimed a connection. The truth is that the people of the United Kingdom formed the NHS, and they did so by electing a Labour Government with the vision, commitment and political will to do so in the teeth of opposition from the Tories who fought it tooth and nail. The Liberals have claimed the credit, too. I accept that an individual, Beveridge, had something to do with the creation of the NHS, but he did not do as much as Nye Bevan. In reality, in 1945, the Liberals had no real political influence, and they had not one iota of influence on the NHS. Nothing has changed there of course.
Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I share a birthday with the NHS; mine was in 1948. I was reassured by what the Secretary of State said today, but the most reassuring thing that I have heard is that my hon. Friend is older than me. I was an NHS baby, as were my children and my grandchildren, and as are the 2,000 NHS babies who will have been born today. As a child, I broke my arm, and an ambulance came to take me to hospital, just as 8,000 ambulances will have arrived to take people to hospital today. Whenever I was ill, I went to the doctor, as 700,000 people will have done today. When I had toothache, or before I got it, I went to the dentist, just as 130,000 people will have done today.
All that is part of the success of the NHS, but its real success lay in taking away the fear of illness that so many people had before its foundation. I have a fair appreciation of the NHS; indeed, I am often passionate about it. I was amused to hear the hon. Member for Broxbourne (Mrs. Roe) give her romantic vision of a general practitioner. I had a mental picture of James Herriot, until I remembered that he was a vet. Well, if we cannot be romantic, or sentimental, about the NHS, what can we be romantic or sentimental about? It is an institution that everyone loves. The people who really appreciate the NHS are the generation before mine. They knew what it was like not to have it.
Mr. Jim Cunningham: Does my hon. Friend agree that a major feature that made the national health service what it was, leaving politicians to one side, was the efforts of the staff over the past 50 years, especially through the 18 years of turmoil under the Tories?
Mr. Heppell: That is very true. I and my hon. Friend the Member for Wakefield did not suffer the problems that the national health service had. We were not battered by the Tories at birth or for the past 18 years, but looking at the three of us, people would think that the national health service came out with the best health. The NHS has survived in spite of Conservative Governments, not because of them.
The generation before mine were the people who formed the NHS. They knew what the fear of illness was like. They knew what it was like to have brothers, sisters,

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wives, daughters and sons suffering illness or injury while being unable to get adequate treatment. They knew what it was like to live in a country where treatment depended either on charity or ability to pay. That is why the NHS was formed and why people feel so strongly about it now. That is why this Government will ensure that the NHS is not only saved but modernised and improved.
Mr. John Hayes: Will the hon. Gentleman give way?
Mr. Heppell: No. The hon. Gentleman has only just come in. I worry about the lapses of memory of Conservative Members.
Mr. Jim Dowd (Lord Commissioner to the Treasury): Where are they?
Mr. Heppell: There are more here now than there have been during the rest of the debate. The Tories say how good things were under them. Many of the new Members will not remember the 1996 debate here. I showed the House these headlines from my local paper: "Government health warning", "Excellence at risk", "Longer to wait", "Ambulance fears", "Treatment limits", "Cancer plan threat".
Miss Widdecombe: Tell us about the 1978 headlines.
Mr. Heppell: You were in. It was 1996. The man quoted in those headlines was a Conservative appointee to the health authority in Nottingham. Even more important was a later report that showed that 350 operations were postponed because of the winter crisis in 1996. People will not forget the many people who lay injured or ill in corridors on trolleys that winter. They were not there in the winter of 1997 because we did something about it. We delivered when your Government could not.
Miss Widdecombe: The hon. Gentleman is brandishing a set of headlines. Does he remember the headlines of 1978, when his Government were coming to the end of their unlamented period in power? We were glad to see the end of it. Far short of lying around in corridors, patients could not get into hospital at all. Medical staff were on strike and the ambulance men were out. The junior doctors threatened industrial action. Everyone's pay was going down in the health service. People could not get treated and the nation threw his lot out.
Mr. Deputy Speaker (Mr. Michael Lord): Order. That was an extremely long intervention.
Mr. Heppell: I remember the problems of 1978 but I also remember the problems of 18 years of your Government.
Mr. Deputy Speaker: Order. The hon. Gentleman must use the correct parliamentary language.
Mr. Heppell: I am sorry, Mr. Deputy Speaker.
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The Government have done many things that directly affect the people of Nottingham. I have little time, so I will concentrate on the fact that since coming to power, we have put an extra £20 million into Nottingham health authority and £2.36 million to help with the winter crisis. That was extra money that was not planned before this Government came in. The cash increase for 1998–99 was £14 million when it would have been only £6 million under your Government.
Mr. Deputy Speaker: Order. The hon. Gentleman must concentrate and get the parliamentary language right.
Mr. Heppell: I apologise, Mr. Deputy Speaker. I am getting carried away by my own rhetoric.
Mr. Deputy Speaker: We have rules about parliamentary language so that hon. Members do not get carried away.
Mr. Heppell: I shall ensure that I do not make any more mistakes in terms of parliamentary language and sit down, Mr. Deputy Speaker.
9.19 pm
Mr. Nicholas Winterton: It is right for the House and the country as a whole to celebrate 50 years of the national health service. The United Kingdom national health service is the best, most comprehensive and integrated service in the world, and it is noted as such wherever one goes. Whether one travels to north America or to other countries in the European Union, one will find that our national health service is envied throughout the world. We should be proud of that fact. We owe a great deal to the nurses, doctors, paramedics, auxiliary service staff and all those who work in the national health service.
I was privileged to serve for a time as Chairman of the Health Select Committee, and I have been involved in health and social service issues for most of my political career. The health service is supported by the overwhelming majority of people in this country, whatever their party political affiliations.
Mr. Ivan Lewis: Will the hon. Gentleman give way?
Mr. Winterton: I am sorry, but I promised to speak for only two minutes, and I shall try to keep within that time constraint.
Governments should appreciate the widespread support that the health service enjoys. I only wish that there were more consensus across the House as to how the health service should be organised and managed. One of my greatest honours was to be made a vice-president by the Royal College of Midwives on the strength of the maternity services report produced by the Health Select Committee when I was its Chairman.
We should value the national health service and seek to work across the Chamber on its behalf. It is appreciated by the overwhelming majority of people in this country and, if we did that, they would appreciate the House a lot more.
9.21 pm
Mr. Jim Cunningham: I obviously do not have much time left in which to speak about the national health service. However, it is important to pay tribute to the loyal national health service staff who have worked hard over the past 50 years. We must remember also those people who fought for the national health service before it was established. Hon. Members have mentioned tonight people such as Aneurin Bevan, but we should also remember others such as Beatrice Webb. I shall not say who thought of doing what, but, at the end of the day, it was a Labour Government who introduced the national health service. It was not an easy task for the Attlee Government to create the national health service, and they spent hundreds of hours in negotiation with the British Medical Association alone.
I acknowledge that the Government intend to spend about £30 million on improving health services in the west midlands. Coventry will receive £1.7 million and there is a new private finance initiative of £174 million for the city. In addition,£1.2 billion will be spent nationally on the national health service. The Government have already spent about £300 million in meeting the pressures of last winter and more resources will be spent on creating 3,000 new beds.
I pay tribute also to the NHS staff in Coventry. Last Sunday, the staff and I took a birthday cake around the two remaining hospitals in Coventry to celebrate the 50th anniversary of the NHS. We heard some interesting comments and I noticed that morale had improved as a result of the Government's actions. We still have a long way to go, but we have the lifetime of this Parliament and probably beyond to put right the mess created by the previous Government over 18 years. Finally, I again pay tribute to all the great pioneers of the national health service.
9.24 pm
Mr. Philip Hammond: I am delighted to take the opportunity of this debate to salute the achievements of the national health service over the past 50 years and the achievements of all those who have given their time and dedication to it. However, it is also time to take stock of the issues facing the service now and the longer-term challenges.
This has been a high-powered debate, with one current Secretary of State and two former Secretaries of State taking part. The current Secretary of State was somewhat predictable, reiterating the rhetoric with which we have become familiar. He listed the pet schemes and initiatives that are no substitute for additional resources across the board. He failed to mention the pressing issues in respect of mental health, disability and care of the elderly. He did not mention dentistry, chiropody, physiotherapy, or the other professions allied to medicine. Although he mentioned the NHS direct scheme, he did not mention the threat to community pharmacy presented by the Government's Competition Bill.
The other rather predictable aspect of the debate has been the short canter around what was or was not said in the 1940s—about a decade before either the Minister of State or I was born. The Labour party is not in a position to lecture anyone on the evolution of ideas in political parties. We certainly would not need to go back 50 years to find examples of views held by current members of the Government that have, shall we say, matured over time?
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The hon. Member for Wakefield (Mr. Hinchliffe) told us that the socialist ethic has been restored to the Government's health policy, which leads me to wonder whether his pager is working properly, and he told us that the debate on health was as polarised as ever.
My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) said that imitation is the sincerest form of flattery and mentioned the rebadging of our policies that has been a hallmark of the Labour Government when trying to avoid acknowledging the debt that they owe to the initiatives of the Conservative Government. She also raised the important issue of the anti-management culture of the Labour Government and the bullying of managers by the Secretary of State's office. She cited one example, of which we have heard several, of health service managers either leaving, or seeking to leave, the service because they are fed up with the way in which they are treated and because they feel undervalued.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) addressed the Secretary of State's claim to ownership of the health service. Although not noted as a friend of the Conservative party, he acknowledged our role in consolidating and strengthening the NHS over the 50 years of its existence. He demolished the Secretary of State's spurious claims to ownership of the NHS.
My right hon. Friend the Member for Charnwood (Mr. Dorrell) gave a ringing endorsement of the effectiveness of the NHS. He demonstrated, if demonstration was ever needed, that where there are disagreements or nuances of opinion about the NHS, they are not along party lines, but across the party political divide. The hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) did likewise.
My hon. Friend the Member for Broxbourne (Mrs. Roe) rightly drew our attention to the importance of GPs and the role they play in the service. She highlighted the role that a primary care-led service has in delivering the cost-effectiveness that is an important hallmark of our NHS. She also drew attention to the staff shortages that ought to be one of the Government's primary concerns when considering the NHS. In the next three years, 24 per cent. of all the nurses active on the register will reach retirement age. That is a time bomb ticking under the Government and a problem that we expect them to address as a matter of urgency.
Seven months ago to the day, the Secretary of State presented his NHS White Paper to the House, yet this is the first chance that we have had in Government time to discuss the subject of health. That tells us something about the Government's priorities, or perhaps their reluctance to expose their performance on health to scrutiny.
Mr. Ivan Lewis: Does the hon. Gentleman agree that one of the two most telling contributions to the debate by Conservative Members was that of the hon. Member for Macclesfield (Mr. Winterton), who was removed from his post as Chairman of the Health Select Committee because he was brave enough to express grave concern about health policy under his Government? The other telling contribution was that of the former Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell), who felt obliged in the debate to speak to right-wingers in his party about laying down a marker for

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the appropriate future of the health service. Were those not the two most significant contributions and do they not demonstrate why the Conservative party is not fit to be in control of our national health service?
Mr. Hammond: I do not intend to get involved in a discussion about the relative merits of my right hon. and hon. Friends' contributions to the debate. We need to move the debate forward, not dwell on the past as Labour Members are so anxious to do.
The timing of the debate is no coincidence. The week after the 50th birthday of the NHS, the Government seek to bask in the reflected glory that properly belongs to the men and women who have devoted themselves to the service over the past 50 years. The week before the announcement of the comprehensive spending review, the Government seek to take credit for an as yet unannounced increase in NHS spending, which may or may not be enough to make an impact on the pressing issues that the NHS faces.
The Conservative party, like all parties in the House, is committed to the NHS and its core principles. As my hon. Friends have said, we have had stewardship of the service for more than two thirds of its existence. Between 1979 and 1997, NHS spending grew by 3.1 per cent. per annum in real terms. The annual number of treatments increased by more than 3 million over that period. The numbers of nurses, midwives and doctors increased dramatically. We are rightly proud of those achievements, but we should like to enter the second half-century of the NHS looking to the future. To do so, we need to move away from the sterile arguments of the past, but we find that the Labour party has come into office carrying the baggage of its rash promises and the opportunistic criticism that it made in opposition of every action that the previous Government took on the NHS.
As my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) said, the Labour party's pre-election rhetoric led many folk who knew no better, and some who ought to have known better, to believe that all the NHS needed was a Labour Government. The Minister will remember Lee Bosley, and probably his mother, who, when that whole sorry business was over, said to me, "What really gets me is that some people were stupid enough to believe Labour and vote for them."
The Labour party in opposition refused to acknowledge the huge achievements in the service over the previous 18 years and pretended that it would tear them down. It dug itself into a hole with promises that it need not have made, was advised not to make and cannot deliver. Today, those "early promises" are costing British patients and taxpayers dear. Our health service is being driven by the primary objective of getting the Government off a political hook of their own making.
Listening to the Secretary of State congratulating himself on the fact that, apparently, waiting lists have started to fall, one would be forgiven for thinking that the early pledge was only to allow waiting lists to increase by 140,000 before gently turning them around and bringing them back to their original level. The Labour party chose the wrong target. It misled the electorate. It has failed to deliver on that target. We could forgive all that, but we cannot and will not forgive the Secretary of State's
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coercion of the entire system to achieve the ridiculous target that he has set himself. It is ridiculous not because we say so, but because, without exception, professionals in the NHS say that it is the wrong target and it is addressed in the wrong way, at huge cost to the needs of patients across the country.
If the Minister of State believes, as he told my hon. Friend the Member for Rutland and Melton (Mr. Duncan) the week before last, that no other part of the health service is suffering as a result of the focus on elective surgical waiting lists, he needs to get out of Richmond house and talk to doctors, nurses and NHS managers throughout the country. He should ask them whether that is the best use of the available resources.
Mr. Hayes: The Minister should speak not only to those professionals but to the people in the communities that are faced with hospital closures. My constituency is faced with the closure of our local hospital. Throughout Lincolnshire and other counties across the land, community hospitals are being closed, and people are amazed at the contradiction between that and the claims that Labour made before the election.
Mr. Hammond: My hon. Friend makes a helpful contribution. One of the advantages of being in opposition is that we can talk to doctors, nurses and health professionals throughout Britain. I understand that Ministers are burdened with their boxes and are forced to spend more time than they would like in Richmond house.
Doctors are pressured to work extra hours. In some cases, they are bribed to work extra hours. We have heard examples of doctors offered 10 times their usual sessional payments to work an extra shift to help clear waiting lists. Can that be a sensible use of NHS resources?
The Minister of State, Department of Health (Mr. Alan Milburn): Where?
Mr. Hammond: If the hon. Gentleman would like the information, I will send it to him. It came to us from the Hospital Consultants and Specialists Association, citing specific examples, and I shall write to the hon. Gentleman tomorrow with the details.
We are not talking about extra hours to deal with major clinical priorities. If you, Mr. Deputy Speaker, were a trust chief executive and you were told that your job was on the line if you did not get waiting lists down, what would you do? You would not attend to the most complex and difficult cases; you would deal with the trivia, the easy and the cheap procedures. You would do the grommets, the hernias, the wisdom teeth. Such actions will get the numbers down, but do nothing to address the real health care priorities in Britain. It is a cynical diversion of scarce resources. The hon. Member for Oxford, West and Abingdon (Dr. Harris), who is no longer in his place, addressed the Minister specifically on that and I hope that the Minister will answer him.
Next week, we will hear from the Government how much new money the NHS will get. As my right hon. and hon. Friends have said, that announcement must be a minimum increase of between £8 billion and £9 billion per annum over the current annual level and achieved by 2001–02. We shall be looking for a plain-speaking announcement, couched in terms of annual spending

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increases—no funny figures, no fudging, just a simple figure that people can understand and compare with what has gone before. If that announcement stands up to analysis, and if it delivers real new money over and above the trend rate of real growth that the Conservative Government established during 18 years, we will welcome it. Whether it delivers the increased real growth in practice will depend critically on the Government's ability to meet their own inflation targets, and so far the omens are not good.
How will the money be distributed? How much will be ring-fenced into the Secretary of State's pet projects? How much will be available to NHS managers to spend across the board on the expansion of day-to-day services?
Several hon. Members have emphasised the Government's wide view of what constitutes health care, embracing, according to some Labour Members, everything from social care through housing to unemployment and low pay. I hope that the announcement of £X billion next week as an increase in the health budget will not be disseminated across that wide range of Government activity. I hope that we shall not find that some of the money is draining away to other areas which have traditionally been the responsibility of other Departments. [Interruption.]
The Secretary of State mocks that idea from a sedentary position, but at the margin there are areas where money from the health service budget could be allocated to other budgets that have traditionally been separate. We saw that happen with the winter pressures money, when cash was deliberately moved through the health budget to local authorities for social services purposes. We seek an assurance that next week's announcement will be an announcement of money for use in the NHS, not money to be channelled through health for use in other areas. The Government have already broken their promise not to raise taxes. We must hope, as a minimum, that the tax hoard that they have been collecting will at least come back in part to the NHS.
Before the general election, the Labour party deliberately raised expectations that waiting lists would be slashed, resources increased and hospital closures halted in order to entice voters into the polling booths, only to dash them. Waiting lists have soared. Real spending increases have been lower than the average of the 18 Conservative years. Scores of hospitals face closures, mergers or downgrading. In opposition, Labour criticised the staging of pay increases; in government, it staged them. In opposition, Labour cynically attacked the operation of the internal market; in government, seeing that it worked, Labour retained the essence of it.
Patients will understand what is going on, because they will live with the consequences. No matter what the statistics tell him, Joe Public will know from experience, and from the experiences of his family, friends and neighbours, whether the Government's promises to deliver a better, more effective health service have been kept. Moreover, if he voted Labour because of its pledges on the NHS, he will know that he has been conned. He is the one who will pay the price for the diversion of resources away from the real priorities, the most pressing areas of clinical need, and into the massaging of figures to suit the Government's need. It is the allocation of resources, not by doctors, but by spin doctors.
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There lies the challenge for all Governments. The public, the users of the service, are interested, not in statistics, but in receiving quality care when they need it. Their perception of that care will be shaped partly by their expectations, and the Prime Minister would be wise to reflect on that before he makes any more rash promises about a wait-free accident and emergency service.
However, let us rise above the short-term issues—the political knockabout. Let us assume that the Government, in an almighty act of contrition, acknowledged the achievements of the past two decades in the health service, recognised the folly of their own adventure into the cul-de-sac of waiting list manipulation, and acknowledged the complexity of the challenges confronting the NHS. If they were to embark on a constructive, non-partisan debate about the future of the health service, we would welcome that, the vast majority of professionals in the service would welcome it and the public would welcome it.
What would that debate address? Several hon. Members have acknowledged that there is cross-party consensus on the objectives of the modern NHS: the cost-effective provision of state-of-the-art, free-at-the-point-of-delivery health care on the basis of clinical need. The political debate surrounding the NHS is not about objectives but about how best to achieve them.
Fifty years on from the foundation of the service, Britain is a very different place. We are living longer, we expect higher standards of health care and we are immensely wealthier. When the service was created, the range of treatments available was limited, not by rationing, but by the level of development of medical technology. The question whether procedures or treatments should be available is now becoming a burning issue. The forthcoming availability of Viagra may focus public attention on that issue. We are told that the costs of providing Viagra could be £1 billion a year, and many people will question whether that is a proper use of NHS resources.
The great British public know that health care is rationed, even though they will never hear that word from the Government. Most of the public understand and accept that a system such as ours requires some element of rationing, but they do not accept that the rationing that takes place should be arbitrary or should be done behind closed doors. The first subject for national debate, therefore, is how we prioritise need and how we define the limits of our publicly funded health service in a way that is fair and equitable.
The second subject for debate is how we provide the resources for the health service that the British people need and expect in the 21st century. That debate must be undertaken on the basis of pragmatism—a desire to deliver the best possible health service to the people of this country—not on the basis of political dogma.
We on the Opposition Benches will not shrink from criticising the Government if they fail to deliver on their reckless pre-election pledges, nor shall we shrink from criticising them if they simply divert money from more important things to achieve them. We shall attack changes that are proposed for ideological or political reasons, and that are flawed as a result. We shall continue to be proud of the success of the Conservative reforms of the health service, while never falling into the arrogance of imagining that there was not scope for improvement and

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evolution. We shall challenge and test the Government on their innovations—such as the National Institute for Clinical Excellence—searching for weaknesses, seeking ways to improve, as is the Opposition's duty.
Above and beyond that, when the Government are ready, we shall be ready to engage in the bigger debate: the debate about the scope and resourcing of our health service for generations to come, because that is what matters to the British people as we enter the new millennium.
9.43 pm
The Minister of State, Department of Health (Mr. Alan Milburn): Over the past few weeks, the entire country has been celebrating the 50th anniversary of the national health service. It is appropriate that the House should take part in those celebrations this evening. Many of us have visited towns and cities over the past week and seen a national celebration of a national institution that is still the envy of the world, as the hon. Member for Macclesfield (Mr. Winterton) pointed out.
For me, it has been a special privilege to be a Health Minister in this 50th year, as I have been able to meet so many people who have contributed so much to the national health service over those 50 years. At the outset, I pay particular tribute to the staff of the NHS—the 1 million people who work in the health service today, and the many millions more who have contributed so much to the service of others during the past five decades. As my hon. Friends the Members for Enfield, North (Ms Ryan) and for Coventry, South (Mr. Cunningham) reminded the House, all of us who depend on the health service owe those people an enormous debt of gratitude, and it is right that we record that.
During the progress of the National Health Service Bill through the House, Nye Bevan predicted what the health service would bring to our country. He said:
"I believe it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead… It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain."—[Official Report, 30 April 1946; Vol. 422, c. 63.]
Nye Bevan was right. Fifty years on, it is impossible to imagine life in Britain without the national health service, and we should all be proud of what the NHS has achieved: the great advances in medicine, the improvements in life chances, the banishing—as my hon. Friend the Member for Nottingham, East (Mr. Heppell) rightly said—of the fear of becoming ill. We should also be proud of how those achievements have been made, through the simple but practical principle of providing care on the basis of need, and need alone.
My right hon. Friend the Secretary of State for Health had the pleasure of meeting one of the first patients to be treated in the NHS, a lady called Sylvia Diggory, who is still alive and well today, I am pleased to say. She aptly summed up the achievements of the NHS and what it means. She said that we should be proud of our country because, "We still have a health care system where, if you collapse in the street, they feel your pulse before they feel your wallet."
The Government abide by the principle on which the Labour Government created the health service 50 years ago—that the best health services should be available to
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all on the basis of need, not on the ability to pay or who the patient's GP happens to be. We were elected in May last year to make sure that the country once again has a national health service that is true to those founding principles.
The 50th anniversary of the NHS has been accompanied by much comment about its past, and much more comment and speculation about its future—about whether the NHS is sustainable as a comprehensive service providing care free at the point of use, funded from general taxation. That debate has been going on for 50 years.
Fifty years ago, the Opposition Benches, just as now, were filled with people who believed that that could not be done. This evening, we have seen a spectacular rewriting of history on those Benches—cases of selective amnesia on a grandiose scale. Thanks to my hon. Friends the Members for Reading, East (Jane Griffiths) and for Hackney, South and Shoreditch (Mr. Sedgemore), we have unearthed some of the history that the Tory party would prefer to forget: not just that the hon. Friends of the hon. Member for Rutland and Melton (Mr. Duncan) 50 years ago voted against the National Health Service Bill once, twice or three times—that might have been reasonable, as there may have been points of detail that were not quite right—but that they voted 51 times against the National Health Service Bill. Some things never change.
We heard from the right hon. Member for South-West Surrey (Mrs. Bottomley), for example, who questioned the ability of the NHS to progress in the next 50 years as it has over the past 50 years. She hinted that the future of the NHS must lie in rationing and charging, and many supposedly well-informed commentators share that view. However, the Government reject that analysis. As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, the NHS, funded from general taxation, is the best, most efficient, most cost-effective and fairest means of providing health care. We have given the world something that we should be proud of: a system that works, is efficient and is fair.
I pay tribute to the compelling speech by the right hon. Member for Charnwood (Mr. Dorrell). He argued the case for a modern health service based on its founding principle: to provide care on the basis of clinical need. He rightly pointed out the great clinical and economic advantages of that approach, because it is inherently more cost-effective and efficient than alternative systems of health care provision.
I do not know whether it was deliberate, but the right hon. Gentleman's speech was in marked contrast to that of the right hon. Member for Maidstone and The Weald (Miss Widdecombe) to the Conservative Medical Society. She posed many questions about the future of the national health service and came up with precisely no answers, apart from one, as my hon. Friend the Member for Dartford (Dr. Stoate) rightly said—the need for what she called "a flourishing private sector" in health care. What a starting point for someone who aspires, at least on the face of it, to being the Secretary of State for Health.
There could not be a clearer difference between the Conservative party and the Labour party on the future of the health service. Our starting point is not to persuade people to opt out of the national health service; it is to

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make the NHS the best health care system, public or private, in the world. That is our ambition, and it should be the right hon. Lady's, too.
Miss Widdecombe: May I put two questions to the Minister? First, do his remarks suggest that the Government want to ban the private sector? [Interruption.] That is the logical conclusion of what he is saying. Secondly, as I told the hon. Member for Wakefield (Mr. Hinchliffe) earlier, there is a sum of money that goes into the nation's health, some of which comes from general taxation and some from private health insurance, individual payments and large organisations such as trade unions. Does the Minister accept that, if we remove completely the private element of that money, the only effect is to reduce the total sum that goes into the nation's health?
Mr. Milburn: The answer to the right hon. Lady's first question is no. In answer to the second, I refer her to the speech of the right hon. Member for Charnwood, which extolled the virtues of a system of health care funded from general taxation, in which the priority is to see year-on-year improvements in the public's health service.
Mr. Dorrell: The Minister said some kind things about my remarks earlier this evening. I am, indeed, fully committed to the principle of high-quality, universal provision through a tax-funded national health service. However, my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) asked a different question. Does the Minister accept that it is a paltry definition of a free society that people are free to spend their money on foreign holidays or on Mars bars, but not on their own health? Is it not part of a free society that we have a high-quality, tax-funded health system and that, alongside that, people can choose whether to spend their money on their health if that is what they choose to do?
Mr. Milburn: Of course, that is a matter of individual choice. The difference between my party and the right hon. Gentleman's is that we do not believe that the public should subsidise private medicine, which is why we have ended public subsidies to private health insurance.
Mr. Simon Hughes: My colleagues and I share the Minister's conviction that the objective of those in charge of the national health service should be to ensure that the health service increases the proportion of the population that it serves so that people do not gain advantages through paying. The test is whether the health service improves to the extent that there is no advantage in going private and everybody can be served by the public sector.
Mr. Milburn: The hon. Gentleman is absolutely right; that should be the ambition for our health service. We should be encouraging people to opt into it rather than out of it.
I paid tribute to the right hon. Member for Charnwood, who made a genuinely compelling speech, but the only problem is that, in government, he did not always practise what he preached this evening. He lectured the House about the dangers of importing an alien ethos into the NHS, and about people from our country examining health care systems abroad. The problem is that that is precisely what happened when he and his right hon.
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Friend the Member for South-West Surrey were in charge, when we had this crazy internal market in the NHS. The internal market introduced competition, but the founding ethos of the NHS, and the way in which it works day in, day out, is based on co-operation and partnership rather than competition.
Mr. Dorrell: I thank the Minister for giving way again. I promise not to weary the House too often with these exchanges, but if the previous Government imported ideas on the proper management of a public sector health service, why does he think that, once we had introduced those changes, a considerable amount of ministerial time was consumed by people coming from France, Germany, the United States, New Zealand and Australia to see what we had done? We had delivered a more flexible public sector health service ahead of other countries, and the flow of ideas was not from them to us, but from us to them—and, belatedly, to the Labour party.
Mr. Milburn: That was a good try; if that was why those people visited this country, they were wrong, as the right hon. Gentleman is wrong. His system—the internal market—failed and left the NHS with record debt, record levels of decay in capital infrastructure and record levels of demoralisation among staff.
Over the past year, the new Government have been righting the wrongs that the previous Government introduced to the NHS, and we are restoring partnership to the heart of it, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) rightly said. That is not all; we have embarked on a 10-year modernisation programme, because however much the founding principles of the NHS still have resonance today, as they of course do, and however great its achievements—they have been immense—the NHS has to change, as all hon. Members recognise.
The NHS has to move on, keep pace with change and with public expectations and become far more modern and dependable in the way in which it operates. The Government were elected with a mandate not only to change the NHS, but to modernise it. We are modernising the NHS, by making it more responsive to the needs of its users; cutting waiting lists and cutting waiting times; introducing new, easy-access services such as NHS direct; and using the information technology revolution to give patients and staff instant access to test results and booked admissions.
We are modernising the NHS, secondly, by putting quality at the top of the agenda; placing new duties on trusts to assure quality and introducing new quality assurance systems in every part of the NHS; and implementing new standards—jointly drawn up by the Government and the professions, as the hon. Member for Belfast, South (Rev. Martin Smyth) wanted—to provide guarantees to patients that, wherever they are treated, they will receive a first-class service in the NHS.
Thirdly, we are modernising the NHS by making sure that the needs of patients, not the needs of any institution, are the driving force for change. We want patients to receive more integrated forms of care than was possible under the old internal market. Whether staff work in the health care sector or the social care sector, they know that elderly people, disabled people and people with mental health problems need the support of not only the NHS, but social services and housing services.

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That is why we shall place new duties of partnership on the NHS and local government, create new co-operative ways of working between health and social services and set up new health action zones to modernise services and tackle health inequalities. This partnership approach recognises that the job of improving the nation's health is not only for the NHS. It requires action to cut unemployment, to build homes, to improve the environment and to tackle deprivation—to tackle the root causes of ill health.
The Government's programme—including getting councils to build homes again, the new deal and the minimum wage—amounts to the biggest anti-poverty, pro-health crusade that this country has seen in more than two decades. It will do what no Government, Labour or Tory, have ever done: it will improve the overall health of the whole population while improving the health of the worst-off at a faster rate.
That is an ambitious agenda for Government, and we make no apologies for that. We do not pretend that it can be achieved overnight, but we believe that our programme will, over 10 years, see the NHS getting demonstrably better year by year. Fifty years ago, neither staff nor patients could have dreamt of what the NHS is able to do today: heart transplants, keyhole surgery and telemedicine. The NHS tomorrow and over the next 50 years will do things that are now beyond our wildest dreams.
It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

SCOTTISH GRAND COMMITTEE
Motion made, and Question put forthwith, pursuant to Standing Order No. 100 (Scottish Grand Committee (sittings)),
That the Order of the House of 30th April relating to sittings of the Scottish Grand Committee be varied by substituting for the words 'Tuesday 14th July' in paragraph (4) of the Order the words 'Tuesday 21st July'.—[Mr. Jon Owen Jones.]
Question agreed to.

LANDMINES BILL (PROGRAMME)
Ordered,
That the following shall apply to proceedings on the Landmines Bill—

1. Proceedings on the Bill shall be completed at the sitting on Friday 10th July.

2. Proceedings on Second Reading shall, unless previously concluded, be brought to a conclusion one and a half hours after the commencement of those proceedings.

3.—(1) Proceedings in Committee of the whole House shall, unless previously concluded, be brought to a conclusion at the end of the allotted periods specified in the following table—

Proceedings

Allotted period after the commencement of the proceedings specified in column 1

Clauses 1 to 5

two and a half hours

Clauses 6 to 29, new Clauses and new Schedules

three quarters of an hour

(2) On the conclusion of proceedings in Committee, the Chairman shall report the Bill to the House without putting any
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Question, and if he reports the Bill with amendments, the House shall proceed to consider the Bill, as amended, without any Question being put.
4. Proceedings on Consideration and Third Reading shall, unless previously concluded, be brought to a conclusion a quarter of an hour after the commencement of those proceedings.
5. Standing Order No. 15(1) (Exempted business) shall apply to proceedings on the Bill at the sitting on 10th July.
6.—(1) For the purpose of bringing to a conclusion any proceedings which have not previously been brought to a conclusion, the Chairman or Speaker shall forthwith put the following Questions (but no others)—

(a) any Question already proposed from the Chair;

(b) any Question necessary to bring to a decision a Question so proposed;

(c) any Question on any amendment moved or Motion made by a Minister of the Crown;

(d) any Question necessary for the disposal of the business to be concluded; and on a Motion made for any new Clause or new Schedule, the Chairman or the Speaker shall put only the Question that the Clause or Schedule be added to the Bill.

(2) If two or more Questions would fall to be put—

(a) under sub-paragraph (1)(c) on amendments moved or Motions made by a Minister of the Crown, or

(b) under sub-paragraph (1)(d) in relation to successive provisions of the Bill, the Chairman or Speaker shall instead put a single Question in relation to those amendments, Motions or provisions.

7. Standing Order No. 82 (Business Committee) shall not apply to proceedings on the Bill.
8. No Motion shall be made to alter the order in which proceedings on the Bill are taken.
9. If a Motion is made by a Minister of the Crown to vary or supplement the provisions of this Order in relation to proceedings on the Bill, the Motion may be proceeded with, though opposed, at any hour and the proceedings on that Motion, unless previously concluded, shall be brought to a conclusion three-quarters of an hour after thay have been commenced.—[Mr. Jon Owen Jones.]

PETITIONS

  Imphal Barracks (York)
  10 pm
  Mr. Hugh Bayley: I wish to present a petition signed by the lord mayor of York and supported by the signatures of the lord mayors of Leeds, Sheffield, Hull and Newcastle, the mayors of Sunderland, Durham, Hartlepool, Middlesbrough, Richmond in Yorkshire, Ripon, Harrogate, Scarborough, Wakefield, Calderdale, Doncaster, Driffield, Hornsea, Grimsby, North Lincolnshire, Kirton in Lindsey, and the chairs of Alnwick district council, Wear Valley district council and Wansbeck district council, which states:
  To the Honourable the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled.
  The Humble Petition of the Lord Mayors, Mayors and Chairs of Councils of the cities, boroughs and districts located in the Number 2 Region of the Armed Forces of the United Kingdom sheweth
  That the said Petitioners support the continued presence of the Army's 2nd Division Headquarters at Imphal Barracks in York, and are opposed to any move of this command of soldiers based in the region to Edinburgh.

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  Wherefore your Petitioners pray that your Honourable House makes representations to Her Majesty's Government about the importance of retaining the Army's Northern Division Headquarters at Imphal Barracks in York.
  And your Petitioners, as in duty bound, will ever pray.
  To lie upon the Table.

Wirral Metropolitan College
10.2 pm
Mr. Ben Chapman: There is great concern in Wirral, South about the plans of the board of Wirral Metropolitan college to close the Carlett Park site. That facility is a highly prized asset to further education in the area, and my constituents are outraged at the prospect of its closure. The petition, containing some 7,000 signatures, calls for a review by the Further Education Funding Council of the decision by the board of Wirral Metropolitan college. It states:
Wherefore your Petitioners pray that your Honourable House shall urge the FEFC to consider the residents' plight and investigate the reasons for the closure of a much used and highly valued local education facility, without which further education in this part of the Wirral would surely suffer.
And your Petitioners, as in duty bound, will ever pray.
To lie upon the Table.

Keresforth Centre, Barnsley
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jon Owen Jones.]
10.3 pm
Mr. Eric Illsley: I am pleased to have secured this debate on continuing care and respite facilities for people with learning difficulties. The Keresforth centre looks after people with learning difficulties in my constituency. It is fitting that I am able to debate this health issue relating to my constituency so close to the 50th anniversary of the national health service, and immediately after a debate devoted to the NHS. I pay tribute to my hon. Friend the Minister of State, Department of Health and his colleagues—especially my right hon. Friend the Secretary of State—for their stewardship of the Department since the election.
My constituency has benefited from the extra money that the Government have provided for the waiting list initiatives. It has also been made part of a health action zone covering Barnsley, Doncaster and Rotherham. That is particularly important in my area, which has a higher than average proportion of elderly infirm people and a very large number of elderly people suffering industrial diseases—a legacy of our industrial past. I sincerely hope that our health action zone status will help to deal with the problem, but I believe that, despite all the problems that Barnsley has now and has suffered in the past, ours is the lowest-funded health authority in the country; so we are somewhat hampered.
I want to discuss learning disabilities and long-term continuing and respite care in the Barnsley area, with particular reference to the Keresforth centre. My attention was drawn to some of the problems surrounding the centre by a number of elderly carers who wrote to me or visited my advice surgery. They were worried about staffing levels and problems in attracting staff; but on further investigation, and following discussions with the health authority, the community and priority services trust—which is responsible for the centre—and the local authority, problems came to light that went a little further than the immediate question of staffing levels. I refer to long-term planning problems.
There is a short-term problem in relation to the improvement of facilities, but what I want to discuss specifically is how, in the light of changes that have occurred over the past few years, we can make plans to deal with the problems of people with learning disabilities. In my constituency—and presumably throughout the country—there has been an increased demand for continuing care for such patients.
As my hon. Friend the Minister said when winding up the last debate, that is partly because the NHS now enables those people to live far longer than they could in the past. Planning assumptions made many years ago about the throughput of patients, how long carers would have to look after their children and so forth, must now be re-examined. Carers who are now elderly are looking after their adult children, and finding that respite care is not readily available because of the increase in demand for existing facilities.
A number of factors contribute to the present position. I have mentioned the longevity of patients, but there is also the increase in the number of emergency admissions.

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Such issues are well understood by Barnsley health authority and Barnsley metropolitan borough council—and, as I have said, by the trust that is responsible for the Keresforth centre. Blame should not be apportioned to anyone; it is a case of flagging up the issue for future reference, and considering how it can best be dealt with.
All the organisations that I have mentioned reacted swiftly when the issue was raised a couple of weeks ago, and the health authority has not been slow to provide money for the recruitment of nurses to alleviate the staffing problems that led to our investigation.
I also pay tribute to the staff of the trust and, in particular, those at the Keresforth centre, who do a difficult and demanding job. They perform their tasks well. I visited the centre two or three weeks ago, and was impressed by the difficult job that the nurses have to do, and the surroundings and circumstances in which they do it.
The problem is one of recognising the increased need in the area and providing for it—planning now for increased facilities. We have to start planning now.
The Keresforth centre opened in 1984, which was not long ago, yet the planning assumptions on which it was based are now somewhat out of date. At that time, most of the long-term care for learning disability was provided out of district. The centre opened with 48 beds in the day hospital, and grew to a maximum of 68 beds with day hospital and community mental health teams by about 1989. Unfortunately, there was little investment in the centre after that, and it suffered continuing problems.
The buildings which make up the centre were built for able patients. At the time, the people with learning difficulties for whom the centre was to cater were ambulant—they could walk about and use the facilities. Now, more and more patients are severely disabled and require wheelchair access, for which the facilities simply were not built, so there are immediate access problems.
Due to the increased demand, patients now have to share bedrooms and facilities. Some rooms are shared by four adult people with learning disabilities. As I said, those people are living longer—into adulthood—and they have problems of dignity and privacy. Some patients even enter into relationships with other patients, and they do not have the privacy to pursue those relationships with some dignity. Thus the facilities available for patients cause problems, which obviously causes friction, especially with patients with challenging behaviour—I understand that they are on the increase.
Responsibility for the buildings passed to the local authority, and, as my hon. Friend knows well, during the 18 years of Tory government—in particular since 1990—my local authority suffered greatly because of the amount of revenue support grant it receives as a result of the standard spending assessments. The money simply has not been there to invest in that provision. Sadly, one of the houses within the complex closed in 1995—an example of what the health service has done is that the initial cost of the buildings to the health service was 20 per cent. above average, and now it is 20 per cent. below average. The authority has gone a long way to improve its financial position in that regard.
The inadequacy of the buildings is compounded by increased demand. The learning disabled are living longer, which again is a tribute to the NHS. Assumptions were
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made on that basis. The number of severely disabled people has increased. Previously, there was a 50:50 split between the severely disabled and the mildly and moderately disabled. Now, the majority of patients are severely disabled. Emergency admissions have to be dealt with by the Keresforth centre, as that is the only remaining flexibility within the system, and it puts an extra strain on the availability of beds.
An increasing number of clients have challenging behaviour, which basically means violence. It is not a case of a patient being difficult to handle or a little boisterous, but of a patient going up to a nurse with a knife—that is difficult behaviour with which to deal. The result is a waiting list for placements at the Keresforth centre and a reduction in respite facilities for the elderly carers whom I have mentioned, many of whom are finding it very difficult to manage.
One carer appeared in a short television programme about the Keresforth centre. Mr. Madeley is 88 years old and cares for his 54-year-old disabled daughter. On national television, he repeated the claim that he has made many times, that he wishes that his daughter dies before he does, because he does not know what will happen to her if he is no longer able to care for her. Such a problem is not confined to Barnsley; there are carers of that age group all over the country. I came across a reference to one carer in Sheffield who, at the age of 95, is caring for an adult child. How can such people cope and look after their children in such circumstances?
Some of the letters I have received are very moving. One is from a Mrs. Robinson, who looks after her brother. She writes:
"It is hard enough for me to let my brother go for respite care, but I need the break now and again to spend more time with my husband, daughter and son."
That lady must have a very understanding family.
A letter from Mr. and Mrs. Dobson—no relation to my right hon. Friend the Secretary of State, I assume—states:
"We are the parents of Shaun, aged 31, who suffers from severe learning difficulties, epilepsy and double incontinence. He requires and receives lots of love, care and attention."
Their son attends the day care unit.
Mrs. Crossley writes:
"My son is 25 years old and is severely mentally handicapped…hyperactive and incontinent."
The father of the 25-year-old is in his 70s. He is also worried about provision for his son after he passes on.
Staffing shortages at the Keresforth centre have, to some extent, been resolved. Every one of the letters that I have read out, and all the others that I have not, pay tribute to the staff, who do a marvellous job. They were originally employed to look after more able patients, but now look after more severely handicapped patients and those with challenging behaviour. The centre had some difficulty in finding suitably qualified staff, but the health authority came forward with additional funding to help to attract staff to Barnsley. I hope that, next year, further help will be made available.
There is a problem, and it is increasing as more and more pressure is put on the system. Elderly carers worry about what will happen to their adult children, and the number of patients is increasing. There appears to be no available funding for at least three years to expand and improve bedrooms and facilities at the Keresforth centre.

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Can my hon. Friend the Minister say anything to encourage us on that front? At the same time, will he take a long-term view and especially consider the nationwide problem of elderly carers? Then, we can begin to plan for their future and perhaps relieve some of their worries.
10.17 pm
The Minister of State, Department of Health (Mr. Alan Milburn): I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on his choice of subject for this debate. It is of great importance to many people because it concerns not just people with learning disabilities but, as he rightly pointed out, parents, relatives and friends of people with learning disabilities.
My hon. Friend raised the particular issue of the Keresforth centre in Barnsley. Like him, I pay tribute to the staff who I know from what I have read have done a sterling job, often in extremely difficult circumstances. The joint review of Barnsley social services, which was undertaken in January and February last year, concluded that services for people with learning disabilities were of good quality. That is important and, I hope, offers some assurance at least to friends, relatives and carers of those who are provided with important services in that area.
I am pleased that the local statutory authorities are now fully aware of the concerns that my hon. Friend raised, and are seeking to address the problems. Barnsley health authority, Barnsley Community and Priority Services NHS trust and Barnsley borough council all acknowledge that there is a shortfall in community placements. They are holding discussions to find ways of addressing the problem.
I gather that there was a very constructive meeting last night. I do not know whether that was a coincidence, or whether this debate has acted as a spur. There is clearly joint ownership of the issue, and a recognition of the need to provide group homes for individuals with learning disabilities currently living in the community, where their current care arrangements are likely to break down.
The health authority has responded to the pressure on learning disability services by making some additional investments. For example, it has put in an additional £140,000 a year to increase nurse staffing. It has also put in £16,000 to maintain the provision of respite care.
The authority recognised that, because of the increasing dependency of residents at the Keresforth centre, there was a need for more nurses in the unit, and it recently increased the number of full-time nursing posts by four, as the first instalment of an acknowledged greater need. It also upgraded all vacant posts to E grade, and by the end of last month all posts had been filled. Furthermore, it created a separate fund to start addressing the need for long-term continuing care packages.
Both the health authority and the local authority recognise the need for more residential places, and the effect that those would have on the provision of respite care. They recognise the importance of working together to make the best use of available resources.
My hon. Friend asked about funding for Barnsley health authority, and I understand the problem. We increased Barnsley's allocation this year by nearly £6 million—a 5 per cent. increase in cash terms—to £110 million. It is nevertheless the health authority furthest from its capitation target, and we are committed to bringing all health authorities to their targets as soon
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as practicable. That is why Barnsley health authority received the highest growth in percentage terms this financial year of any health authority in England. Who knows—before long there might even be some more good news around the corner.
The issues that my hon. Friend highlighted are important nationally as well as locally. They reflect the fact that the pace of change in all walks of life has increased. Advances in medicine and science are helping people to live longer and better than ever before. Those are surely welcome developments. Patterns of family life are changing, and public expectations are rising, especially in what people seek from their public services.
People with learning disabilities and their carers are rightly expecting more from services than they did in the past. That is a welcome development. Many people with learning disabilities now aspire to a home of their own and a job, when previously their future would have been life in an old long-stay hospital or attendance at a large adult training centre. People with learning disabilities are also living longer, and an increasing number of people with multiple disabilities are surviving into adulthood.
In order to meet the pressures that those welcome developments bring, the health and social care systems need to change and to work more in concert. As my hon. Friend knows, the Government are determined to break down what my right hon. Friend the Secretary of State rightly called the Berlin walls between health and social care which work against the provision of well-co-ordinated services.
That is particularly true in the field of learning disabilities. People with learning disabilities can be on the fault line of the divide between health and social care. A recent national inspection of learning disability services found that successful arrangements for services for people with learning disabilities crucially depend on social services departments working together with other agencies, especially health, housing and further education. Where such arrangements are not in place, users are less well served. The measures that we are taking should make it easier for authorities to work more closely together.
My hon. Friend rightly referred to the breaking down of barriers that is epitomised by the successful bid for a health action zone in his area. Indeed, I was pleased earlier this year to launch the health action zone in the South Yorkshire coalfields. I know that a huge amount of hard work went into preparing the bid. An even greater amount of work is now going into making it successful and making it work on the ground.
The zones are at the forefront of the implementation of our plans to improve health and health care. They are the most vivid expression of a new spirit of partnership between organisations which, after all, have a common purpose—to improve the lot of local communities. That is certainly epitomised by the South Yorkshire coalfields HAZ, which is led by a partnership of health authorities and the metropolitan councils.
To give substance to the co-operation that will be necessary in the future, a new statutory duty of partnership will be placed on local NHS bodies to work together for the common good and to ensure that local government services and NHS services work in a much more integrated fashion than has perhaps been the case in the past. Before too long, a White Paper will be published on the development of social services and significant work on the regulation and inspection of services.

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My hon. Friend referred to the important role played in his local community, and communities up and down the country, by people who care for others. The Government value the vital role that carers play. Carers are a hugely important part of the fabric of our society. Caring is something that touches us all, and I know of the difficult decisions that families sometimes have to take.
My hon. Friend has raised those issues here this evening. As he said, carers often take on enormous responsibilities at a significant cost to themselves. That is why my right hon. Friend the Prime Minister recently announced that he had asked my hon. Friend the Under-Secretary of State to lead a Government-wide review of measures to help carers. The aim is to develop an integrated approach to carers across government as part of a new national strategy for carers. We want to address carers' concerns and give them more support than they have at the moment, which is what my hon. Friend's constituents are rightly crying out for.
In considering the needs of carers, we have recognised the importance of good-quality and accessible respite care to them and the people whom they care for. There is a lot more that we can do to ensure that appropriate and cost-effective services are available. The social services inspectorate has almost completed a project on short-term breaks for carers.
The aim has been to examine what works and why in the organisation, delivery and quality of short-term breaks. This has been done through a review of current
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research on the subject and by fieldwork visits to schemes of particular interest. We hope that the resultant report will assist authorities to drive up standards and get better value for money in this important component of their services.
Nationally, we have in place a programme of work to support the development of better services for people with learning disabilities, including increasing training levels and investing in initiatives to improve the recruitment, retention and return to practice of trained staff, who are desperately needed, especially in the learning disabilities field. However, it is for the local statutory authorities to determine the pattern of services to be developed locally in the light of local needs and resources.
As I said, a joint review of Barnsley social services, conducted by the Audit Commission and the social services inspectorate early last year, concluded that services for people with learning disabilities in Barnsley were generally of good quality. My hon. Friend has rightly drawn attention to the concerns of his constituents about the current levels of services and the future for their sons and daughters who have learning disabilities. The local statutory authorities fully recognise the need to develop the local capability to deal with demand and are seeking to address the problem. I have asked my officials to continue to monitor the situation in the hope that things can improve locally.
Question put and agreed to.
Adjourned accordingly at twenty-eight minutes past Ten o'clock.