§ The Secretary of State for Health (Mr. Alan Milburn)
First, Mr. Speaker, I inform the House that, owing to prior engagements, I shall not be here for the winding up of the debate, as I have already informed you and the hon. Member for Woodspring (Dr. Fox).
The twin pillars of the Government's legislative programme for the year ahead are the creation of an opportunity economy and a responsible society. Those are the basis for the better Britain that we seek to build.
First, the opportunity economy will be built on the firm foundations of stability, extra investment, low inflation, cheaper mortgages, falling unemployment and rising employment—where work, not welfare, is a genuine pathway out of poverty; where the performance of local schools is central to the performance of the national economy; and where all groups in our society and all parts of our country share in rising economic prosperity.
Secondly, a responsible society will be built on respect for the law, founded on strong communities and strong families, strengthened by good neighbours—where people look out for one another; where young people know the difference between right and wrong and act accordingly; and where an injury to one is an injury to all.
We are introducing 15 Bills and four draft Bills—on crime and fraud, on homes and health, on care and children, and on security and justice—to improve public services and strengthen public protection. Measures such as the tobacco advertising and promotion Bill will honour the Government's manifesto commitment to ban tobacco advertising in this country once and for all. That ban was opposed by the Tories while they were in office; it was blocked by the European courts and will be implemented by the British Parliament to help to save thousands of British lives.
§ Mr. Michael Fallon (Sevenoaks)
I thank the right hon. Gentleman for giving way so early in his speech. I hope he will deal with the fact that a Bill on adoption and a review of mental health legislation are absent from the Queen's Speech. Why do the Government give the Bill on tobacco advertising a higher priority than the long overdue reform of adoption and the important review of the Mental Health Acts?
§ Mr. Milburn
The ban on tobacco advertising was a manifesto commitment, and it is important that we honour 136 such commitments. I am sure the hon. Gentleman would agree that that is the right thing to do—at least for the Labour party—even though his party never quite managed it.
The hon. Gentleman is well aware that there will be a White Paper on adoption before too long and that my right hon. Friend the Prime Minister has given a commitment to legislation next year. These are key issues; I certainly think that Members on both sides of the House regard the strengthening of adoption law and procedures as an extremely important priority.
§ Dr. Howard Stoate (Dartford)
I remind my right hon. Friend that smoking kills 125,000 people a year in this country. It is the biggest single preventable cause of ill health, so I am very pleased indeed that the Government are introducing such an important and useful measure to reduce the enormous burden of deaths caused by such an avoidable condition.
§ Mr. Milburn
As a GP, my hon. Friend is well versed in these issues and is well aware of the impact of tobacco on health. As he rightly points out, about 120,000 people a year die from tobacco-related disease. Our best estimate is that bans on tobacco advertising—like those in countries such as Finland—have contributed to a reduction in smoking. That is good. Our best estimate is that about 3,000 lives a year will be saved as a consequence of measures to ban tobacco advertising.
Cancer and coronary heart disease rates are of common concern in the House, so I hope that all hon. Members will support a measure that will make a real contribution to tackling those two big killers.
§ Mr. Andrew Rowe (Faversham and Mid-Kent)
Did the Secretary of State see a television programme last night that showed that, as a consequence of the enormous differential tariffs on tobacco, large quantities of cigarettes—of an infinitely more lethal quality than those that we allow—are being smuggled into this country? What are the Government going to do about that?
§ Mr. Milburn
The hon. Gentleman is absolutely right, and he will be aware from his experience of representing a constituency in the south-east that this is a very real problem. And it is not just a problem for the south-east; in my own part of the world there is increasing evidence of an illegal trade in imported, smuggled cigarettes of the type that he describes.
I very much hope that the hon. Gentleman will support the measures that the Government are taking to strengthen the Customs and Excise effort, so that such issues may be tackled more effectively. I also very much hope that the Conservative Front-Bench Treasury team will be able to give a commitment to match our increased spending on Customs and Excise officers. I note that, to date, they have failed to do so.
These are measures, then, to build on the foundations that we have laid for a stronger economy and a fairer society: Bank of England independence, the new deal, a statutory national minimum wage, the working families tax credit, record increases in child benefit, extra help for pensioners, and investment in our key public services. These are the foundations that we have laid—each and every one of them opposed by the Conservative party.
137 The Conservatives said, in opposition to the national minimum wage, that it would destroy 1 million jobs. Since we came to office, the policies that we have pursued have helped to create 1 million jobs. The Conservatives said that the extra cash for health, education, transport and the fight against crime was reckless, madness, irresponsible. As recently as Tuesday 5 December, the Leader of the Opposition described the comprehensive spending review as "a great strategic mistake".
The Conservatives obviously believe that our spending plans are beyond what the country can afford. Well, they are certainly beyond what they could afford. For 18 years, they short-changed the health service. Growth in NHS budgets was just 3 per cent. a year—in their last Parliament, even less. In their last year in office, they even managed to cut spending on health in real terms: cuts for the short term, causing lasting damage for the long term; cuts in nurse numbers, cuts in nurse training places, cuts in beds, cuts in GP trainees, cuts in spending on buildings, and cuts in spending on equipment.
There can be no greater contrast between Labour and the Tories than our records on this issue. In the last Parliament, capital investment in the national health service was cut by an average of 2.1 per cent. a year. In this Parliament, it will grow by an average of 8 per cent. a year. Step by step, we are putting right what they did wrong. In these five years, the NHS budget will grow by one half in cash terms and one third in real terms—the biggest growth that the national health service has ever seen.
Yes, it will take time for the resources to produce results, but after decades of neglect, the NHS today is moving in the right direction. Provisional figures show that there are at least 6,000 more nurses working in the NHS than a year ago. Since the general election, nurse numbers have risen by more than 16,000. The number of nurse training places is up by 5,000 since 1997, and applications for nursing and midwifery courses rose by 73 per cent. last year.
Let me make this clear: no one, least of all the Government, is claiming that every nurse shortage problem is solved. It is not, but the Government are straining every sinew to bring nurses back into the health service. With more nurses from countries such as Spain, where standards are high but shortages are few, more pay—particularly in areas where the cost of living is highest—more flexible working, more power and more resources for nurses to spend, we are now turning the corner on nurse shortages.
§ Rev. Martin Smyth (Belfast, South)
I am aware of an increase in the number of nurses. Many of them are outside the national health service. Is the Minister saying that there is a definite increase in the number actually in the national health service?
§ Mr. Milburn
Yes; that is precisely what I am saying. The number working in the national health service—that is, those recruited minus those who have left—is increasing. There are more nurses working in the national health service than there were just a year ago: 6,000 more than in December last year, and 16,000 more since the general election.
That is not to say that there are not parts of the country, and very many hospitals and parts of our community services, that still have problems recruiting nurses; they 138 certainly do have such problems. However, I am sure that the hon. Gentleman does not want to give the impression that those on the Opposition Front Bench seek to give. He must not give the impression that the national health service is not moving forward—it is. Just because we have not solved every problem does not mean that we are not solving problems along the way.
§ Mr. Tim Loughton (East Worthing and Shoreham)
Let me give the Secretary of State an example of where that is not happening. When I became a Member of Parliament, the Worthing and Southlands hospitals trust had some 75 nursing vacancies. Three and a half years later, having gone to recruit in Australia, South Africa and—as we speak—the Philippines, that hospitals trust still has 75-odd nursing vacancies. Why is the improvement not happening in my constituency?
§ Mr. Milburn
There is a clear explanation for the changes in nurse vacancies: the NHS is in a period of expansion, so trust hospitals are advertising for more nurses. That is the right thing to do. We are not in a period of contraction, such as we saw when the previous Government were in office. In every part of the country we are making progress, thanks to the investment that we are making and the measures that we are taking to improve nurse numbers in the NHS.
The same is true for bed shortages. For 40 years, acute and general beds in the NHS were cut. In their last 10 years in office, the Tories cut 40,000 beds alone. Today the number of hospital beds is rising again. In the last year, there has been an increase of 1,350 general and acute NHS beds in England. The long decline in bed numbers is finally beginning to be reversed.
I know that Opposition Members are keen to give the impression that the NHS is either totally broken or totally mended. It is neither. The NHS today is a service in transition. The internal market has gone, more patients are being treated, in-patient and out-patient waiting lists are falling, more heart operations are being performed and cancer waiting times for referral to hospital are coming down. After decades of neglect and, incidentally, a refusal to hypothecate funding for these services, in the next year alone £450 million extra will be invested in cancer and heart care to make services better and faster for patients. The nation's top clinical priorities are the Government's top clinical priorities.
§ Mr. Bob Blizzard (Waveney)
My constituent, Mr. Stephenson of Lowestoft, feels strongly that his wife was badly let down by a particular oncologist who was treating a cancer from which she sadly died. He feels even more badly let down by the General Medical Council because of the way it refused to investigate the matter fully. Does my right hon. Friend agree that across the country there are lots of people like my constituent who have lost confidence in the GMC in this respect and feel that it is not sufficiently independent? How does my right hon. Friend propose to address this problem? Is there anything in the Queen's Speech that will contribute to making doctors more accountable?
§ Mr. Milburn
Obviously, I am not aware of the circumstances leading to the situation that my hon. Friend describes, so I cannot comment on the individual case. I am sure that the whole House will want to join him in 139 passing on our condolences to Mr. Stephenson. When I read in the newspapers about a cancer or a meningitis diagnosis being missed, as can happen in the NHS and in every health care system in the world, it is not because the doctors are not trying or because they are not well trained. They are, but sometimes these diseases are difficult to diagnose. It is important that none of us gives the impression that somehow medicine or clinical science is a perfect science. It is not. It is a human science and, sadly, sometimes things go wrong.
We have to learn the lessons when things go wrong and we have to have a form of professional self-regulation—I support that, although other Members do not, because I think it is the right thing for the medical profession—that is accountable, open and subject to public scrutiny and that commands the confidence of the profession and the public. As my hon. Friend is aware, even now the GMC is discussing proposals for its own reform. That is a matter for the GMC and it will discuss the proposals in the weeks and months that follow. It will be for the Government and, indeed, Parliament to judge whether its proposals are capable precisely of restoring the public confidence that has been damaged by some of these incidents. We shall consider that matter very carefully, and hon. Members on both sides of the House will also wish to do so.
Of course no one denies that there are very real problems in the national health service today—how could there not be after years of neglect and decades of under-investment? It is true that many patients still wait too long for treatment, that more doctors, nurses and beds are still needed and that staff are still under very real pressure, but it is also true that real progress is being made on all those fronts and many more.
The investment and the reforms that we are making will deliver expanded services for patients. During the next few years, there will be 20,000 more nurses; 7,500 more consultants; 2,000 more GPs; 1,000 more medical students, on top the 1,000 already in the pipeline; waits of weeks, not months, for cancer treatment; guarantees for patients on cancelled operations; and maximum waiting times for treatment.
§ Dr. Peter Brand (Isle of Wight)
That is an impressive list of achievements that the right hon. Gentleman wants to put in place in the next few years, but can he tell us how many more cleaners and porters are employed by the NHS as of today? Those people do not take three or six years to train, but we need them.
§ Mr. Milburn
The first part of that intervention was absolutely brilliant, but the second part flagged slightly. I do not have those figures, but I shall try to let the hon. Gentleman have them. Of course the cleaners, porters, scientists, technicians and all the other members of the health care team play an absolutely crucial role in the NHS, as well as the doctors, nurses and managers. Some of the previous Government's reforms—for example, those on cleaning—have been abject failures. That is precisely why we have got rid of compulsory competitive tendering in the NHS. It failed to keep our hospitals clean and failed to raise standards. In fact, it led to a decline in standards, and not just in hospitals.
The health and social care Bill will take forward the investment that the Government are making in the NHS. Most important, it will take forward the programme of 140 reform outlined in the NHS plan. First, the Bill will enact the NHS plan reforms to give greater freedom to the best performing local health services. The principle of earned autonomy will ensure that as modernisation takes hold, so there will be more devolution to the NHS front line. A performance fund of £100 million next year will rise to £500 million by 2004. That decentralisation will complement the decisions that I have already taken to surrender the Secretary of State's powers to make appointments to local health boards and to consider controversial changes to local health services.
§ Mr. Graham Brady (Altrincham and Sale, West)
Is the Secretary of State concerned that eight months after the Commissioner for Public Appointments found that his practice in public appointments in the health service was one of systematic politicisation, she has had to begin further scrutiny of the appointments to primary care trusts that have been made since then? Is that not disgraceful?
§ Mr. Milburn
The hon. Gentleman has been here a moment or two, so he can presumably confirm what I have just read out to the House: we are giving away precisely those powers to an independent appointments commission, partially because of the concerns that have been raised. That is the right thing to do, and it will happen. It represents massive decentralisation and devolution of power.
§ Mr. Milburn
No, the hon. Gentleman has had two cracks of the whip on the matter—once with the Leader of the House and now with me. He will fail to be satisfied because he is not getting the answer that he wants, but it is the right answer.
Secondly, the Bill will strengthen the power of patients in the health service. Community health councils were created a quarter of a century ago. Some CHCs have done a good job and some have not, but all are in part appointed by the Department of Health and, indeed, by me as Secretary of State. They are insufficiently independent and lack the democratic legitimacy needed in today's NHS. The Conservatives abolished local democratic scrutiny in 1991, when they purged health authority boards of locally elected people. Today, no part of the NHS is subject to democratic scrutiny, except through Ministers in the House. That must now change.
Under the Bill, the scrutiny of how well local health services serve the local community will be undertaken by those in local government, precisely by those elected by that local community. In addition, patients will be represented for the first time, as of right, on trust boards, and complaints will be dealt with on the spot. Patients' representatives will be able to trigger inspections not just in hospitals but in all parts of the NHS. We want more protections for the patient, more powers for the public, more democracy in the NHS and a bit less bleating from the Conservatives.
§ Mr. Milburn
The hon. Gentleman has already had one go. I want to make a little progress.
Thirdly, the Bill will deliver the NHS plan proposal to provide faster, more seamless care to patients by breaking down outdated barriers between services and staff. 141 Appropriately trained nurses and other health professionals will be able to prescribe drugs to speed up care for patients and relieve the burden on doctors. Local health and social services will come together in a single care trust, overcoming the institutional boundaries that serve to confuse patients, limit services and block beds.
Fourthly, the Government are committed to improving health and social care services for older people. Standards of care must rise, access to care must improve and nursing care in nursing homes must be free on the NHS. The health and social care Bill will mean that people who are assessed as needing nursing care will no longer have to pay for the care and supervision provided by registered nurses in nursing homes or for specialist nursing equipment, thereby lifting the burden of care costs for about 35,000 people.
Fifthly, to complement the biggest hospital-building programme in the history of the NHS, the Bill will take forward the biggest ever capital programme of investment in primary care. Family doctor premises are the first port of call for most patients. Many of the premises are in urgent need of repair. Through a new joint venture company with the private sector, the NHS local improvement finance trust—NHS LIFT—the Bill will unlock £1 billion of new investment to refurbish 3,000 family doctor surgeries and primary care premises by 2004. NHS LIFT will have the greatest impact in those areas where it has traditionally been hardest to attract investment or GPs. It will deliver new health service facilities that are fit for this new century to the most deprived communities and rural areas.
§ Dr. Fox
The Secretary of State makes an important point about the improvement of GPs' premises, especially in inner cities. He will be well aware that one of the difficulties most often encountered is with planning problems for those surgeries. What talks has he had with the Deputy Prime Minister about easing the path of such plans?
§ Mr. Milburn
The hon. Gentleman is right—there are sometimes planning difficulties with new surgeries and, indeed, new primary care centres. In that context, we are not simply concerned with the traditional GP surgery. We should try to house in a single centre services that are provided by GPs, nurses, midwives and social workers for a simple reason—to make care easier and faster for the people who take advantage of those services. So, yes, discussions are taking place between my Department and the Department of the Environment, Transport and the Regions.
Moreover, the measures that we are taking to encourage, for example, personal medical services in general practices mean that those very real gaps in provision that occur particularly in the hardest hit inner-city areas are finally beginning to be plugged. I know from the discussions I had when I was in Sunderland recently that that city has real problems, 142 especially on some council estates. For many years, the area has been unable to attract GPs, but now it can do so through the PMS route that we are seeking to roll out into general practice more generally. Many GPs are voting with their feet for the measure, which will make a real difference.
More investment is going into the NHS and more reforms are being made. The Conservatives cannot match that investment, although they claim that they can. The Leader of the Opposition and the shadow Chancellor claimed just this week that they would match Labour's expenditure on the NHS and on health more generally. That is not what the hon. Member for West Dorset (Mr. Letwin), the shadow Chief Secretary to the Treasury, told Jeremy Paxman on "Newsnight" on Tuesday. In response to a question, the hon. Gentleman said of spending cuts:It would be right across all departments of course.Jeremy Paxman asked: "Except for health?" The hon. Gentleman replied:No … Our commitment on health is to the hospitals … We are not saying that the administration … the costs of administration can't be reduced right across the board. It can.First, on a point of important information, the national health service consists not only of hospitals but of GP services, mental health services and other services provided in the community. Secondly, let us be clear about what administration in the Department of Health is. It is the Food Standards Agency, the National Blood Authority, the UK transplant service and the childhood vaccination programme, including that for meningitis C. It is the Public Health Laboratory Service, particularly the control of infectious diseases, and the budgets to train doctors and nurses.
There is a further issue that the hon. Member for Woodspring will perhaps clarify when he replies. Are he and his party now saying that they will match our spending on social services? His is the party that complains about care home numbers, bed blocking and delayed discharges. Let us hear from the hon. Gentleman. Let there be urgent discussions on the Opposition Treasury Bench. Are the Conservatives backing our 3.4 per cent. real-terms increase in social services funding—yes or no? That is what the country and the House want to know.
The truth is that the Conservatives cannot match our spending because their tax and spending policies are riddled with black holes from top to toe. The Conservatives cannot explain where the money is coming from to fill the £400 million black hole created by their failure to support us on putting extra tobacco revenue directly into the NHS. They had an opportunity to vote for that; they did not. They cannot explain where the money is coming from to fill the £750 million black hole created by their policies of tax subsidies for people who already have private medical insurance.
The only answer is that the £1 billion black hole will be filled at the expense of the NHS, its patients and its staff. There will be fewer beds, fewer nurses and fewer doctors. As sure as night follows day, that is the Conservatives' cuts guarantee for the NHS, and NHS 143 patients will pay the price. The one health policy that the Tories do not want to talk about is the one health policy that they have: forcing people to pay for their care.
§ Mr. Milburn
Well, on 16 January the hon. Member for Woodspring told The Sunday Times:Philosophically we have moved on. Insurance companies could cover conditions that are not high-tech and expensive, like hip and knee replacements, and hernia and cataract operations.That is what the hon. Member for Runnymede and Weybridge (Mr. Hammond) told "Sky News" on 31 January, and he confirmed it in the House on 29 June.
Just in case the hon. Member for West Chelmsford (Mr. Burns), who is shaking his head, thinks that that was just a passing fancy, he should consider what the shadow Chancellor told the "Today" programme on 30 October. He confirmed that a future Conservative Government would expectpeople who can to make a little extra contribution … changing the way people think about the way they support the health service.Yes, there will be problems in parts of the NHS this winter; there will be pressures, but there will also be real progress, made by the Government, social services and health services together. NHS Direct will be taking calls nationwide to relieve pressures on GPs and hospitals. There will be millions of extra free flu jabs for pensioners and thousands of extra support packages for the elderly in care homes, as well as those in their own homes. There will be thousands of extra operations on NHS patients in private sector hospitals, 455 extra critical care beds, 6,000 extra nurses, 159 modernised casualty departments and 1,350 extra beds in NHS hospitals. Not every problem will have been solved—not by a long way; but, thanks to the Government's investment and reforms, the NHS is moving in the right direction. The NHS will be immeasurably strengthened by the legislation proposed in the Queen's Speech.
There are choices before the country: the stop-go of the past or the stability and growth of today; cuts in public services or investment in public services; the old social divisions of the past or a society providing opportunity for all and so able to demand responsibility from all. Nowhere are the choices starker than in the NHS. In the end, it all comes down to this: with the current Government, an NHS modernised and reformed providing care according to need, not according to ability to pay; or, with the Conservatives, a health care system in which how much one pays, how much one earns, how much one is worth determines the health care one receives. That might be the Conservative future for Britain, but it is a future that neither the Labour party nor the British people will support.
§ Dr. Liam Fox (Woodspring)
I must have made something of an error in thinking—until now—that the Government were in their fourth winter, not their fourth week, of managing the NHS. The Secretary of State has just easily shrugged off all of Labour's mismanagement of the national health service since the party entered office and all of the promises that Labour made before entering 144 office, as though all the years of responsibility had never happened, but this is Labour's fourth winter in charge of the national health service.
Last night, the British Medical Association council met. Its report states:The mood was one of despair with doctors feeling powerless to influence improvements in patient care. But doctors are determined to do their best in the circumstances they face.The "general feeling" is that there isa winter crisis all the year round.Examples of the problems facing doctors include year-long waits for patients to receive physiotherapy, and orthopaedic appointments only just being received for 23 September 2002; GPs keeping patients who, clinically, should be sent to hospital in their own homes, because it is preferable to a long wait on a trolley; and trolleys being replaced by trolley beds, so that waits on them do not contribute to trolley-wait statistics. Hospitals are now on red alert, even though there is no flu epidemic; and, yesterday, there were no critical care beds available for children in London.
I suppose that all that has nothing to do with the Secretary of State or with the Government—it has everything to do with everyone else whom they normally blame, but nothing to do with them. In all my political life, I have never known a group of people take so little responsibility for their own actions. They are happy to take the salaries, but not any of the responsibility.
The Labour Government's failure to deliver on the exaggerated expectations with which they entered office has given rise to a great amount of cynicism among the electorate. The string of broken promises has resulted in unparalleled disillusionment. We all remember the slogans: "24 hours to save the NHS", "Health to be an early priority" and "Things can only get better". According to Lord Hunt this summer, things had got better. He said thatthe reforms set out in the NHS Plan will ensure that the NHS will be in the best position ever so each patient receives the care they need when they need it this winter.Then, last week, the Prime Minister admitted that things had not really got better, but the Government had a 10-year plan. He held a press conference in Downing street to apologise for the failure that has not yet happened, but to which the Government know their policies will inevitably lead. We get an endless diet of soundbites—witness the Secretary of State's speech—photo opportunities, spin, spin and more spin. The Secretary of State should tell the Prime Minister that telling the people, "Trust me, I am a spin doctor" does not have much credibility with the public.
Increasingly, there is a gap between the rhetoric of Ministers, who keep telling us that things have become better, and the reality experienced by doctors and nurses who are working in the NHS and patients who use the NHS. Ministers tell us that waiting lists are down, but the waiting list to go on the waiting list has rocketed, so more patients are waiting. They tell us that more operations are being carried out, but last week an orthopaedic surgeon from one of the London hospitals told me that he was told to stop doing so many hip replacement operations and to do more minor operations because that would reduce the list faster.
Ministers tell us that clinical priorities are not being distorted. Yet as clinical outcomes in many of the areas that the Secretary of State says are a priority— 145 for example, cancer—continue to deteriorate in relation to those in other countries in northern Europe, we are continuing to speed up the treatment of bunions, ingrowing toenails and impacted wisdom teeth so that the so-called waiting list is reduced. The fact that we are having a debate about whether we should treat the sickest patients first shows how far down the spiral of ethical decline we have gone in health policy.
§ Mr. David Tredinnick (Bosworth)
In support of what my hon. Friend is saying, is he aware that I have received reports from surgeons stating that the extension of the requirement for them to have longer waiting lists has made it difficult to treat urgent cases? That is definitely reality. It should be taken into consideration when the Minister replies.
§ Dr. Fox
It is clear to anyone who talks to any surgeon throughout the country that that is the pattern. Hospital managers are under immense pressure to put pressures on surgeons to deliver reductions in the waiting list, however they achieve that, because of the financial penalties that they face if they fail to meet the targets set by the Secretary of State. It is symptomatic of a hugely politicised system in a hugely centralised system. It is a system where the Labour party has appointed, as Dame Rennie Fritchie said so damningly in a report, increasing numbers of Labour party hacks to health authorities and trusts, not because of their expertise in running the health service or because of what they may offer, but because of the loyalty that they will give to their party political masters.
I look forward to the plans that the Secretary of State mentioned. I look forward to confirmation that they will be in the Bill to create an independent appointments body for the NHS, that they will be enshrined in that legislation and that the Secretary of State will not be given even reserve powers to intervene in appointments. If the right hon. Gentleman would like to confirm that now, I am sure that the House would be extremely grateful—so we get more promises. It seems that spin has found its way into the House as well as anywhere else.
We have a politicised service and a micro-managed service, where the decision is taken behind a ministerial desk in Whitehall on the basis that there lies immense wisdom and that Ministers know how to run a system on the micro level that employs almost 1 million people. We had a good example yesterday in the Department's notes on the coming Bill on the formation of care trusts. The document states:Care trusts would be largely set up voluntarily.At the bottom of the page, we are told:The Bill would provide the Secretary of State with the power to require a Care Trust to be established.That is the voluntary principle of the press gang—"We would love you to do it, but if you don't do it we will make you do it." That is indicative of the Government's obsession with the Whitehall centralist culture that is doing so much damage inside the health service.
§ Mr. Rowe
As part of the Government's attempt to give the impression that they are decentralising, the Secretary of State explained that he is putting local authority members back on trusts. Does my hon. Friend share my concern that local authority members—the ones 146 who take an interest in these matters—are those who are not doing their council work fully and effectively? The ones who are doing their council work fully and effectively are too busy to sit on trusts. We shall find, as we did before, that those who are interested in drawing their expenses and have no serious interest in the national health service will be responsible.
§ Dr. Fox
For the interests of clarity, I think that the Secretary of State was referring to community health councils and having local authority scrutiny in place of the CHCs. In fairness to the right hon. Gentleman, I do not think that he suggested that local councillors would be appointed to health authority boards. I am sure that I am right in that interpretation.
There is one area in which the Secretary of State must accept fully the responsibility for the Government's actions—that is, in respect of the care home sector. We know that between March 1997 and April 1999, some 25,000 care home beds were lost, first in local authority homes, but towards the end of that period increasingly in the private sector. We know that the Government's plans for intermediate care and some of their other plans were drawn up against a background of an expanding care home sector at the time.
The trouble with the diminishing capacity in the care home sector is that it puts extra pressure on the acute sector. In other words, there is no way that elderly patients can be discharged into the community if there is a dramatic reduction in capacity out there in the community. That leads to more blocked beds, and the trend is accelerating.
The present figures show that there may be a reduction of as much as 10 or 11 per cent. over the current year in the care home sector. That would mean a loss of some 50,000 to 55,000 beds in the care home sector. [Interruption.] The Secretary of State says that that is nonsense. After the debate, I will be happy to supply him with figures for the beds already lost in the community in places such as Cornwall, where 10 per cent. of the capacity has been lost, and Surrey. If we extrapolate a 5 per cent. loss in some areas in the six months up to now, the overall loss is even greater.
§ Dr. Fox
I will take an intervention from the Secretary of State in a moment. If he tells us that those beds are not being lost, that will be contrary to what is being told, I happen to know, to hon. Members on both sides. They find that throughout the country nursing homes are being closed with increasing frequency.
§ Mr. Milburn
I am grateful to the hon. Gentleman for giving way. It is true that there has been a reduction in the number of nursing home and residential care beds between March 1999 and March 2000. That is right, but not on the scale that he suggests. Laing and Buisson who, as he knows, are the foremost market analysts, say that about 7,300 beds were lost during that period. That is absolutely true. It has hit hardest in some parts of the country, especially the south coast.
We know that, but we also know that the number of intensive home care packages of support has dramatically increased, and that the number of local authority-supported 147 residents in residential or nursing homes has increased too, more than offsetting the loss of—remember—empty beds. The crucial question for the hon. Gentleman is this: if he is so concerned about the loss of capacity, particularly in the social care sector, will he now confirm that he will match our spending on social services for the next three years?
§ Dr. Fox
It is entirely typical that the Secretary of State throws in statistics—[Interruption.] Hon. Members should control their passion. First, the Secretary of State employs his usual technique of throwing into the debate figures that are utterly irrelevant, in the hope of throwing us off track. Secondly, it is typical that the Government would think that all the problems in the sector are related to money.
It is a problem of far more than money. For example, the Care Standards Act 2000, many of whose basic proposals were in principle correct, has put a blight on the industry, because we do not know what the regulations attached to the Act are. Who can invest, and who will lend or borrow, on the basis of such uncertainty? It is the Government's policy that has caused the uncertainty. Increasingly, those who have not had a return on their investment are seeking a quick way out, especially in the areas of the country mentioned by the Secretary of State, which happen to have rising house prices. They find that the quick way to get their money back is to sell out to residential development.
That problem needs to be tackled, because the lack of confidence in the sector is undermining the Government's plans and making them more difficult to implement. The Government are planning to use the beds for intermediate care. As a result of a reduction in capacity, it is more likely that beds will be blocked in the acute sector. More beds blocked in the acute sector, combined with seasonal pressure, leads to a rise in the cancellation of elective surgery. We know that over the past six months there has been a rise in the number of cancelled operations across the NHS.
The Government's failure to understand the implications of their own policy will result in more blocked beds and more cancelled operations. [Interruption.] The Secretary of State is trying to trivialise the point, but within a few months he will have to explain why more operations are being cancelled and why more beds are blocked. No doubt we will hear the same excuses as the Government always give: it is due to decades of under-investment, they always say, and bad planning in the past. In fact, it is a result of the Government's mismanagement over three years. Three years ago, there were a lot more beds in the community than there will be at the end of this year.
§ Dr. Fox
I shall come back to the Secretary of State in a moment.
There is another area where we have a problem with incompetent micro-management by the Government. The Secretary of State talked about manpower numbers in the NHS, and the problems that may exist. However, the Government have done the very thing guaranteed to maximise opposition from the medical profession, especially from those who will soon be consultants and 148 will be under the heaviest requirement to deliver the programmes in the Government's national health service frameworks and their cancer and cardiac pledges. In the Prime Minister's statement, the Government pledged that consultants will not be allowed to work in the private sector for seven years after they qualify as consultants. Understandably, the medical profession has reacted by saying that as its members have worked long hours for relatively low wages and undertaken a very difficult training period, they will not work for a service in which their training period is to be extended by the Government for another seven years, as a result of which they will get none of the financial rewards that they might have expected for all the efforts that they have put in.
If the Secretary of State takes such action, he is in danger of precipitating a manpower crisis in the NHS. There is still time for the Government to back off from their flawed ideological proposal. Will the right hon. Gentleman take this opportunity to say that the Government will abandon their plan? If they go ahead, they will further damage morale in the system, which will lead to a loss of manpower. As the Secretary of State does not wish to respond, I assume that, regrettably, the Government will press ahead. They are putting ideology above the running of the service, which will create only division and dismay in the medical profession. We need a more regulated system, as opposed to a managed one. We need less political interference and less micro-management, but we are getting more and more.
§ Rev. Martin Smyth
The hon. Gentleman referred to consultants and the health service. Is he not concerned that the 10,000 GPs who are expected to man the health service will not be in post as quickly as the Government had imagined? Will that not impose additional pressure when the health service is moving in the direction of primary care as well as hospital care?
§ Dr. Fox
There are two aspects to the important point made by the hon. Gentleman. One is the rate at which doctors are taking early retirement; there is quite a haemorrhage of those who are approaching retirement. As well as the loss of numbers, the loss of quality care is extremely worrying, not least in primary care. Fewer junior doctors are going into primary care, but we want to encourage them to do so. There is a cultural problem in the health care system regarding young doctors' experience of pre-registration training in primary care, which affects their willingness to go into that discipline. As well as doing six months in medicine, all junior doctors should do six months in accident and emergency and six months in general practice as part of their training. That is important in terms of what patients receive and what it provides us —
§ The Parliamentary Under-Secretary of State for Social Security (Angela Eagle)
Will the hon. Gentleman fund the increase in social services' budgets?
§ Dr. Fox
Will the hon. Lady hold back? I am happy to take interventions, but I should be grateful if, for once, she had some manners while I answer the point made by the hon. Member for Belfast, South (Rev. Martin Smyth).
It is important that we have doctors with all-round skills and that their experience is appropriate to an increasingly integrated service. For a consultant to qualify without ever 149 having worked with a district nurse or for a GP to work in a rural area without having done accident and emergency is the result of a poor-quality medical education. Those things must be addressed, and entry into and departure from general practice must be tackled together.
§ Mrs. Alice Mahon (Halifax)
The hon. Gentleman accuses the Government of ideology. However, is it not pure ideological dogma that leads the hon. Gentleman to oppose NHS Direct? According to all the evidence, NHS Direct has left millions of people satisfied and happy with the service. A constituent of mine recently told me that NHS Direct led her to seek immediate medical help that almost certainly prevented a stroke. She asked me to thank my right hon. Friend the Secretary of State—I did so last night—for the establishment of NHS Direct. Is not the constant undermining of the scheme by the hon. Member for Woodspring (Dr. Fox) merely ideological dogma? Is not it time that he welcomed a terrific Government initiative?
§ Dr. Fox
I am happy to answer the hon. Lady's question directly. I do not object in principle to NHS Direct. I shall be giving evidence to the National Audit Office inquiry on it next week. I shall say that the idea potentially has great merits, but that it must be trialled and worked properly. We must, however, consider the evidence to ascertain where it is working well and not working well. For all the anecdotes that the hon. Lady can supply on where it is working well, we also have anecdotes about the mistakes that are being made.
We must consider where the scheme is giving us good practice and where it is not. When I speak to the NAO next week, my words will reflect the Opposition's position that there is still a case to be made. If there is evidence to suggest that it works well, we will welcome it. That is a reasonable and sensible position. People with reservations about NHS Direct are often concerned that it was rolled out too quickly. That is one of the reasons why the NAO is considering a joint referral from the Liberal Democrats and the Conservatives about the workings of NHS Direct and whether it provides value for money in a health care system. One of the measures of its performance must be whether expenditure on it is a good use of the money that is available within a finite budget.
§ Mrs. Mahon
If NHS Direct prevents elderly people from having strokes and from having to go into hospital, and if it prevents health problems among people who would not usually bother the doctor, surely it is working. It is certainly working in Halifax; I am sorry that it is not working in Woodspring.
§ Dr. Fox
The important word is "if". The question is whether the case has been made and whether sufficient proof exists. I am afraid that anecdotal information is not enough. We must know whether the scheme is an appropriate use of money and whether it provides the best clinical outcome for that money throughout the system. That is exactly why the NAO is right to consider the matter. It is reasonable to expect any publicly funded body to provide better value than would be achieved spending the money in any other way.
§ Dr. Stoate
I thank the hon. Gentleman, who is being generous with his time. In reply to an earlier intervention, 150 he made an interesting observation about training doctors. He said that he felt that all doctors should spend six months in general practice and six months in accident and emergency. He will already know that general practitioners must have a minimum of four years' postgraduate education before they can take up that position, so his points are covered in so far as the majority of doctors have accident and emergency training. Personally, I agree that hospital consultants also should have significant training in general practice to enable them better to understand its pressures. However, will the hon. Gentleman give a commitment that Opposition Members would be prepared to pay the significant extra cost that would have to be met to ensure that all doctors received such training?
§ Dr. Fox
I do not agree that there would be extra cost. There would be no extra cost in merely asking those who are currently paid at senior house officer level to undertake six months in medicine and six months in surgery. Of course, there would be administrative disruption in the system, especially in the first year.
§ Dr. Fox
No. I have already given way several times and I shall do so again later.
Let me consider the Bill on tobacco advertising. It is clear that smoking in the United Kingdom must be reduced. Smoking is currently a particular threat to young people and especially to young women, among whom it is rising. The test for the House must be the evidence on measures that could be taken to reduce smoking's prevalence. I have an instinctive, uncomfortable feeling about banning advertising of any legal substance. Of course, tobacco is a substance on which the Treasury is annually raking in a fair amount of money. However, I am willing to put that to one side if there is scientific evidence to suggest that any particular mechanism can achieve a reduction in smoking prevalence.
I think, therefore, that the onus is on the Government to demonstrate as they introduce the Bill that there is evidence to show that banning the promotion and advertising of tobacco would produce the reduction in smoking that they seek. The House, irrespective of its views about the libertarian aspects of the Bill, must consider the evidence on its merits.
The Government will have difficulties because there are enormous loopholes—not least in terms of product placement and goods carrying labels such as Dunhill or Marlboro—that go beyond the advertising of tobacco. The Government will face a difficult balancing act, but we will take the evidence produced at face value and judge it accordingly. That is a reasonable basis for the Opposition to proceed with any Bill. I give the Secretary of State a commitment that I will be open-minded about the issue.
At the European summit, the Prime Minister must raise a matter that offends Members on both sides of the House—the enormous sums of money used through the common agricultural policy to grow tobacco in Europe which is then parcelled off to the third world. That is a national and international disgrace. If we are serious about reducing smoking, ending that practice should be an integral part of our policy.
§ Mr. Kevin Barron (Rother Valley)
Is the hon. Gentleman telling the House that he is not satisfied that 151 the ban on the advertising of cigarettes and tobacco products on television and radio for the last 30 years has been justified?
§ Dr. Fox
Despite those measures, smoking rates are beginning to rise. We are going beyond television and radio advertisements to address wider issues, so it is not as simple as the hon. Gentleman makes out. Questions arise about our health education—for example, whether it has conveyed the right message and whether it has been aimed at the right age groups. My view is that, very often, we have sent the wrong message, aimed at the wrong age group. We need the correct message, which must be sustainable and receive proper funding. All those matters go together. We cannot simply say that a ban on advertising on its own makes a difference.
§ Mr. Geoffrey Clifton-Brown (Cotswold)
Is my hon. Friend aware that since the Government came to power, the proportion of cigarettes smuggled has increased from one in eight to one in four and that the figure for hand-rolled cigarettes has increased to three in four? During debates on the Finance Act 1997, the Opposition pushed the Government to change their decision to reduce the number of staff of Her Majesty's Customs and Excise, which was one of the first things that the Government did. We asked them also to provide much better X-ray equipment to try to stop some of the smuggled cigarettes getting into this country. Would not the Government be better doing that, rather than proposing an anti-advertising Bill?
§ Dr. Fox
The Government would be well placed to do that in any case without it being linked to tobacco advertising.
The House must understand that smoking is the biggest threat to the health of our nation. It is increasing our heart disease and cancer rates way beyond those in many other countries. We need to take action to reduce smoking, at a time when the prevalence of smoking is increasing. We must examine all the associated aspects, including the work of customs, the imposition of duties, health education and the promotion of products. There is no simple solution and no one should pretend that there is.
§ Dr. Stoate
In fact, the prevalence of smoking in this country is going down and has been doing so for the past 30 years. I believe that is in part due to the fact that tobacco advertising has largely been banned. The only group among whom tobacco smoking is going up is teenage girls, of whom something like one third now smoke. Previously, the figure was not that high. Overall, however, the prevalence of smoking is down significantly and we are seeing reductions in lung cancer because of that. However, because of the extraordinarily long lag-time of cancer formation, we do not necessarily get reductions as quickly as we would like. Does not the hon. Gentleman agree that anything we can do to reduce this enormous burden on public health must be worth doing? If the experts tell us that a ban on tobacco advertising would help, surely we should take it seriously.
§ Dr. Fox
I am not sure that Parliament should do what experts tell it. We should take into account the evidence 152 that experts give us and come to our own judgment. That is why we have an elected House of Commons and why we are not run by groups of so-called experts. However, I think that this issue will be debated at length in future.
We are also looking forward to the details of the Government's plans for long-term care, especially in regard to workability. Christine Hancock, head of the Royal College of Nursing, is one of the strongest supporters of the NHS plan. She has said that the college would lobby against an artificial distinction between nursing and personal care that wouldcreate perverse incentives and inequities.That is an important point. In health debates in the House, we have often spoken about how all members of the nursing and medical profession are obliged to work at the ceiling of their abilities and skills. The perverse incentives would apply when nurses would be likely to stop carrying out the less complex tasks that could be done by others for fear the treatment would be regraded and therefore cost patients more. We shall examine that when we see the details of the Bill.
There will be widespread disappointment in the House at the Government's approach to adoption and mental health. Both issues were mentioned earlier by my hon. Friend the Member for Sevenoaks (Mr. Fallon), and command widespread agreement among hon. Members. There is no reason why legislation on adoption has not been presented to the House. I am sure that I was not alone in expecting to hear about an adoption Bill in the Queen's Speech—in fact, I know that certain Labour Back-Bench Members expected that too.
The Prime Minister's review on adoption stated thatnew primary legislation is required to support the implementation of the new approach to adoption.When the Care Standards Bill was considered on Report, the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), said of the national adoption register:If legislation is required to establish the register, we will include those proposals in the legislation that we plan for next year.—[Official Report, 12 July 2000; Vol. 353, c. 973.]He was talking about including such proposals in yesterday's Queen's Speech, but they did not appear. That primary legislation is necessary, because local authorities will face problems without it. For example, local authorities that block a couple from getting their names on the adoption register could face a legal challenge and be on very unsteady ground without primary legislation on the matter.
Therefore, I hope that the Government will be sympathetic to our plans to use a private Member's Bill to introduce those elements of adoption legislation that already command widespread consensus in the House. That would ensure that adoption legislation is present on the statute book in this Parliament, which is what many people outside the House want.
I certainly do not want to give the impression that the House's priorities are distorted. For example, Liv O'Hanlon, director of the Adoption Forum, has said:We wouldn't like to think—given fox hunting is on the legislative agenda but not adoption—that the Government believes children are less important than nice little furry animals.The House needs to send out a clear message about its priorities.
153 I am also sorry that the Queen's Speech contained nothing about mental health. There is broad agreement that there have to be changes in our approach to mental health. When care in the community was introduced, there was wide agreement that the principle behind taking people out of the old acute institutions and moving them into the community was right. However, many of us feel that that was done too quickly in some parts of the country, and with inadequate preparation. Sometimes that has led to a dual failure of care—for patients and for people in the wider community.
That matter needs examination. I think that there would be wide agreement between the parties in this House about that, but it seems likely that a whole Parliament will have passed with nothing being done, even though the matter was a high priority for the present Government before the last election.
Finally, I turn to the proposed abolition of community health councils, which we intend to resist most strongly. I have written to the chairmen of all the CHCs in the country, and have received some interesting replies. For example, the chairman of the South Durham and Weardale community health council—which covers the Sedgefield district—wroteWe are … gratified that William Hague has … raised the question during Prime Minister's Question Time. The truth of the matter is, there has been no consultation either before, or since the NHS Plan was drafted or published.Ministers have a very odd sense of responsibility. The Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), attended a meeting of the health councils' association, but wrote in advance to say:I will be unable to answer questions relating to the Government's proposal to abolish CHCs.So Ministers are willing to attend the meetings of bodies that they intend to abolish, but not to discuss the matter that is of greatest concern to those bodies.
Even more tellingly, perhaps, the letter from the South Durham and Weardale CHC also stated:We are concerned that the Government have announced the intention to abolish CHCs as a cynical attempt to silence any negative publicity during the winter and in the lead up to the General Election as they know they are most vulnerable in regard to the NHS. What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS?I guess that the man who wrote that can say goodbye to his job under the current culture, but he is being abolished anyway, so what has he got to lose? It is typical of the Government that they seek to abolish any voice that speaks out against them. We have a Prime Minister who regards Prime Minister's Question Time as impertinent, so it is entirely unsurprising that as the community health councils were willing to criticise the Government, the Government reacted in their usual fashion and decided to get rid of them.
We do not claim that the CHCs are perfect; they require substantial reform, which could be undertaken. There are also strong arguments for addressing patients' complaints. All those factors, however, are arguments for improving the way in which CHCs function. The Government will find widespread resentment of their plans among many of their own supporters.
Even at this stage, I ask the Government to drop what is a particularly damaging proposal. The Opposition will campaign to retain and reform community health councils. 154 We will oppose the plans to abolish them and fight for the re-establishment of an independent body outside the NHS to monitor and inspect NHS plans. The Government are trying to convince us that a body entirely under the auspices of a trust would have the freedom and willingness to criticise that trust. We know that that is not true in the bullying NHS that we now have. They are asking us to believe that their Labour party cronies in local government who have not yet made it on to a trust or health authority will be willing to criticise their cronies who have already been promoted. That certainly will not happen in new Labour's current culture.
The Government were elected and have continued to run the health service on the "trust me" principle. They said, "You can trust us more than any other party. We believe more in the NHS than any other party. We are more committed than any other party, therefore trust us."
In June 1996, the Prime Minister said:Today I want to announce that in Government we will set up a task force to report urgently—we should note the use of that word—on how we can end trolley waits in the NHS for good and how we can make sure that the NHS can cope with the extra pressure on Emergencies. I do not see why people should have to wait on trolleys for hours in a modern NHS.All the words that we associate with the Government are there—"new", "modern" and "urgent". At the end of last month, not in a winter crisis, but at the beginning of Labour's fourth winter in charge of the NHS, a 62-year-old lady with chest pain spent 17 hours on a trolley at the Darent Valley hospital in Dartford. A 79-year-old man with renal failure spent 14 hours on a trolley at the King George hospital, Redbridge. A 79-year-old man with a fractured leg spent more than 10 hours on a trolley at the William Harvey hospital in Ashford.
To listen to the Secretary of State's rhetoric one would think that the Government were responsible for none of it—that they had only just come to office. It is their fourth winter in charge of the NHS, yet when the problems pile up they say that it has nothing to do with them and their failure turns into a blame culture. They blame the previous Government, the NHS managers, the hospital consultants and the dark forces of conservatism. They blame GPs for misusing the waiting lists to get their patients into hospital more quickly. How dare they want to do that. So, we have the wrong managers and the wrong doctors. It is only a matter of time before we have the wrong patients, but never the wrong Ministers.
We no longer have a seasonal crisis in the NHS; we have a structural crisis. Patients are frustrated, doctors and nurses are demoralised and the public are disillusioned. The Government have promised so much, but delivered so little. They are out of touch, incompetent and obsessed with control. As the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State for Health, said:We raised people's expectations sky high and have not delivered.We know it, the Government know it and increasingly the electorate know it.
§ Mr. Kevin Barron (Rother Valley)
I have one or two points to raise in today's debate on the Queen's Speech. First, let me say how pleased I am, and I hope all right 155 hon. and hon. Members are, about the proposed measures on long-term care for the elderly. I recognise that it is not just a matter of health and social services and that the recommendations of the royal commission have wider implications, some of which involve the Treasury. I hope that these can be dealt with as soon as possible. We are all familiar with individual cases in our constituencies which show the unfairness of the current situation. That needs to be put right.
The hon. Member for Woodspring (Dr. Fox) spoke about the new arrangements for protecting and representing patients' interests. I have been in this House since 1983 and have dealt with my community health council on many occasions. The remit that such councils have been given by Parliament over many years has been quite restrictive in many areas. I refer to their opinions about closing hospitals and different aspects of the national health service in their areas. To that extent, CHCs have been good sounding boards, and I hope that whatever replaces them will continue to provide a public sounding board.
Rotherham community health council has helped me with constituents' complaints over the years. It is to be congratulated. It is a strong body and an advocate for patients, but only after something has gone wrong for people in the acute sector of the health service. That may not be such a useful role in the years ahead.
We are introducing into the health service proper independent inspection of hospitals and primary care through the Commission for Health Improvement. It will help us to get to grips with the real issue for patients—the quality of clinical services—in a way in which community health councils, despite what we think about them, have been neither able nor equipped to do. This is an important and fundamental part of the Government's approach.
Community health councils have had no remit to inspect or monitor primary care, yet that is where, for the most part, the real interface with the health service is for our constituents. We ought to look at how the new patients forums, which will take over that part of the role of the CHCs, will apply to primary care. In that way, the community as a whole can be considered—primary care as well as the acute sector.
We have heard the Opposition's rhetoric about abolishing the community health councils, and about improving them instead. In a sense, that is what the Government are doing. They are trying to improve the national health service and how patients—our constituents—interact with it. There is not a great deal of difference between those approaches, if that is really what the hon. Member for Woodspring wants to do. Of course, if he is making the point because he is in opposition and that is what Opposition Members do, I can quite understand his position. However, nothing that I have heard Ministers say so far—and I have listened closely—will impact in a negative way on my constituents. I think that we will all want to make sure that that does not happen.
§ Dr. Fox
Does the hon. Gentleman accept that the changes that he suggests could be made by reforming CHCs; that the Commission for Health Improvement is not independent because, by the legislation passed in this 156 House, it must take directives from the Secretary of State; and that the real harm has been caused because the CHCs feel that they have been very shabbily treated and the idea that there has been consultation is a complete lie?
§ Mr. Barron
Ministers can speak for themselves on the hon. Gentleman's last point, but there is evidence that there has been public consultation on the future of CHCs, although it has not been widespread. [HON. MEMBERS: "Ah!"] Conservative Members cannot say that there has been no consultation when they are nodding because it has not been widespread. Conservative Members should come clean: the consultation might not have been widespread, but it has taken place, and people have given their opinions. I have read copies of letters sent to the Department of Health—indeed, I have written to the Department on this issue—so saying that there has been no consultation is wrong.
§ Dr. Brand
I agree with the hon. Gentleman that there should be an inspection regime for primary care. Will he accept from me that relationships can be so positive between good CHCs and well-established primary care that this is now happening on a voluntary basis? Does that not show that there is good practice within the NHS? Are the Government not making a mistake in throwing away what can work and introducing a system that is much more fragmented?
§ Mr. Barron
On the hon. Gentleman's comment about bringing in something that is much more fragmented, the way in which community health councils work varies, and we must all accept that. From what I have read and from personal experience, I know that they vary greatly. Under those circumstances, as that is what we have now, we ought to improve that system. By and large, improving the system is what the Government are doing in order to look after patients' interests.
§ Dr. Stoate
The hon. Member for Isle of Wight (Dr. Brand) alluded to the fact that good community health councils have good relationships with good general practitioners, which is good news. That begs the question of what happens when that does not occur—when there are not good relations, there is not a good CHC and there is not a good practice. That is where the gaps occur. We all understand that good practice is to be applauded and should be rolled out throughout the country, but the Government must take account of the areas where it is not in place.
§ Mr. Barron
My hon. Friend is right. We must all see how the situation develops in the next three months and find out what is to be put in place. When I saw the proposal published in the national health service plan my first instinct was that I would rather that someone was an advocate for my constituents while they were in hospital. I hope that that will ensure that mistakes do not occur and things are not done wrongly, which will prevent a complaint later. Waiting for people to complain about the service that they received is not the way to look after patients' interests or those of the NHS. We must look at the matter in that light.
On the Bill to ban the advertising and promotion of tobacco products, some hon. Members will know that I tried to introduce a private Member's Bill to deal with that 157 problem in the 1993–94 Session. Sadly, it was effectively talked out by Conservative Government Back Benchers. This debate allows us the opportunity to put down a marker before a Bill receives its First Reading, and to say how it should be pitched—how we should deal with the advertising and promotion of tobacco products.
We must anticipate the reactions of the tobacco industry to any legislation to ban advertising and promotion. We must not only ban poster advertisements and those in the press—I believe that the posters have now gone—but anticipate the industry's reaction to a ban. Parliament must take pre-emptive action against the companies in the legislation.
The experience in other countries has shown what the industry can do when faced with a simple ban on advertising or a ban that contains loopholes. I will list some of the problems that I unearthed when I was attempting to promote my Bill and that I have encountered since. One such problem is indirect advertising. The tobacco companies resorted to that in Italy and Norway. They used the imagery associated with cigarette brands while purporting to advertise other goods.
In Norway, the issue was Camel cigarettes. We have all seen people wearing Camel boots and jackets carrying the Camel logo. The advertisements for those products were barely distinguishable from the previous Camel cigarette advertisements, and were accepted by the Norwegian Government only when the word "Camel" and the trade mark were dropped.
In Italy, as long ago as 1962, a ban on advertising was introduced, effectively to protect the beleaguered Italian tobacco industry. At the time, one long television advertisement focused on Marlboro billboards at a formula one motor race and on the Marlboro flashes on drivers' clothes. However, in the final shot, the small print revealed that the advert was not for cigarettes but for the driver's helmet. I have visited Italy a few times, but I have not seen many people walking about wearing formula one racing helmets—that does not seem to be part of their culture. That was one of the ways in which the tobacco industry tried to overcome the ban.
The industry also resorts to the closely related practice of brand stretching—finding legitimate merchandise on which to place tobacco brand names and trade marks. There have been many instances of that in this country over the years. I shall cite one of the thousands—there are now millions—of leaked documents from British American Tobacco in 1979. It was an internal document directed to the constituent parts of that massive multinational company, which operates throughout the world. It stated:Opportunities should be explored by all companies [viz, in the BAT group] to find non-tobacco products and other services which can be used to communicate the brand or house name, together with their essential visual identifiers … The principle is to ensure that tobacco lines can be effectively publicised when all direct lines of communication are denied.That is what tobacco companies will do when the proposed legislation is introduced. We need to ensure that our regulations and laws will cover such practices.
Another strategy is brand borrowing. If advertising is banned, the industry may introduce new brands of cigarettes that share an existing high profile brand name with non-tobacco goods—for example, Levis. Again, we must ensure that the tobacco industry does not get round the advertising and promotion ban in that way.
158 Direct mail may also be used by the industry. Many Members will have received petitions or letters from retail organisations—for example, at one time newsagents wrote to us about tobacco taxes. I am in favour of such taxes; indeed, the previous Conservative Government favoured increasing them for public health reasons—although the Opposition no longer appear to support that. No doubt we shall debate the matter in the future.
There has been a major collection of names and addresses at newsagents in relation to tobacco products. If the companies cannot advertise, they may use direct mailing—as they do in promotions. Catalogues and the saving of vouchers in exchange for what are, in effect, free goods offer another route for direct mail into people's homes. We all know about such promotions—they are advertising. When we consider a ban, we need to take into account those detailed forms of advertising and promotion.
I shall not say much about sponsorship, as measures are already in train to deal with that. I should have liked a shorter time scale for the banning of certain forms of sports sponsorship. However, it is being carried out in a balanced way, taking account of the points of view of the people involved in that debate. I hope that the practice will be ended as soon as practicable. As I pointed out in my earlier intervention, although cigarette products have not been advertised on television for more than 30 years, when people are asked if they have seen such advertising, the majority say yes. People take their information from television—whether it be NatWest cricket or formula one motor racing. It is important that we realise that.
When I introduced my private Member's Bill, we decided that rather than specifying what was not allowed, it should outlaw anything that could reasonably be considered to promote the smoking of tobacco. Obviously, someone must interpret the word "reasonable".
In a recent report, the all-party Select Committee on Health said that we should consider creating a tobacco regulation authority in this country. I believe that that proposal was supported by all the parties represented on the Committee. There is justification for creating such an authority, as it could interpret the word "reasonable" in the context of the promotion of cigarettes. Our close neighbours in Eire have an Office of Tobacco Control, so there is precedent. That office looks into all the issues relating to tobacco.
In the past two years, there was a European directive on which we were ready to pass regulations in this country. I understand that it was introduced by the Competition Commissioner because it concerned marketing. In the European Court, the tobacco companies argued that the Competition Commissioner was used to introduce a directive that was, ostensibly, about public health, and that it should have been a public health directive, not a competition directive. I am not a lawyer; I did not read the details. However, I know that that initiative failed in the end, and that the regulations that we proposed to introduce were never passed, as a result of the legal challenges.
There is a lesson there. I tell the Minister for Public Health, who has direct responsibility for these matters, that this issue is not about competition; it is not about product—it is about public health. On that basis, when the 159 new legislation is passed, we must do all that we can to ensure that public health is given the priority that it deserves.
My final argument arises from what has happened in a country that has very successfully banned tobacco advertising on television and so on. A packet of cigarettes was brought to me from Australia. It shows the way in which the cigarette companies try to promote their product when their sponsorship of sport has been banned. I have in my hand a packet of cigarettes in a neat clear plastic purse. It contains a little notebook and pen, designed to be attractive to young people, who will be able to use it as a purse. That is the level to which tobacco companies—in this case, Philip Morris—will sink as we restrict their promotion of tobacco products in and around this country.
We must ensure that we prevent such practices being repeated in this country. We can do so in the wording of the Bill or—more probably—of regulations. Such packaging attracts the very teenage girls among whom, as my hon. Friend the Member for Dartford (Dr. Stoate) said, smoking continues to increase even when it is, fortunately, decreasing by the year in most other age groups, especially adults.
The tobacco companies know how to market product. We should not deceive ourselves that, as long as there is a health warning on the packet, packaging does not matter. It matters in all sorts of ways. Some countries have even considered generic packaging, which would prevent anyone marketing cigarettes in a way that is especially attractive to young people. That is not a matter for the House, but it may be a matter for a tobacco regulation authority, if we ever create one. The authority could interpret the word "reasonable" in such a way as to give us the secure knowledge that the new legislation, which I hope that we shall pass this Session, will make its mark in improving public health for many years to come.
§ Mr. Nick Harvey (North Devon)
I apologise because I, too, have a long-standing commitment that will prevent me from being present for the winding-up speeches.
I welcome the opportunity that the debate gives us to address the condition of the national health service as the winter pressures begin to mount, and to address the success or otherwise of the Government's policies to meet those pressures, some of which will require legislation in the coming Session.
The biggest problem facing the NHS continues to be its overall lack of capacity. I make no apology for starting by saying that, had the Government started, straight after their election in May 1997, to make the necessary investment to address capacity shortages, the health service would be considerably better placed now, as we go into this winter, than it is. The Secretary of State said that he could not argue that the NHS was completely fixed. That was realistic, even if something of an understatement.
§ Dr. Stoate
The hon. Gentleman mentions a lack of capacity and the Government's apparent failure to address it. As he was a Member of the House at the time, he will recall that one of the Government's first acts was to pass 160 legislation to permit private finance initiative hospitals, one of the first of which was in my constituency. Next, the Government increased nurse trainee places, returning them to where they were before they took office. They have also increased the number of doctors in training by 1,000 a year and a further 1,000 a year as of next year. Surely that is addressing capacity at its root. The hon. Gentleman must agree that these issues will take many years to resolve because training nurses and doctors and building hospitals take a long time. Therefore, we could not possibly expect the Government to have put all those matters right in this three-year period.
§ Mr. Harvey
If a serious number of nurse trainees had been recruited by the Government in the autumn of 1997, their three-year training would by now be complete and there would be more nurses in the health service this winter than there are. As for the PFI, Mr. Will Hutton observed in The Observer last Sunday that capital investment by Government as a proportion of gross domestic product was lower today than when the Conservatives left office. If there is one single reason for that, it has been the failure of the PFI programme, particularly in the health service. It has caused delays and meant that hospitals that have been built have a smaller bed capacity than the ones that they replace. The Government's PFI policy, far from increasing capacity, has had precisely the opposite effect and is contributing to the present capacity difficulties.
More generally, the hon. Gentleman's point about the long-term policy of putting trainees into places is absolutely right. That is why we have to consider the short-term and long-term predicaments of the NHS. It is only right to say that many of the difficulties that the NHS is experiencing now are the result of cuts in trainee places for doctors, nurses and other health professionals that were made a decade or so ago.
In July, the Government published a national plan that set out a policy of recruiting considerably more trainees into all these professions in future. I applaud that. They could have gone further, but what they have committed themselves to is welcome. Naturally, it will take a considerable time to have an impact on NHS capacity. In the short term, all that the Government can do realistically is try to recruit back into the NHS the many qualified nurses who have left the profession and to recruit doctors from abroad.
The position, particularly regarding nurses, may get considerably worse before it gets conspicuously better. I make that point with reference to the age profile in the nursing profession, but also in some other key professions in the health service. The fact that there will be so much retirement in the next few years means that the health service will have to recruit even more trainees to come in at the bottom, fill the gaps and maintain the capacity. Medical professionals who are supportive of the overall aims of the NHS plan have been pointing that out consistently. There needs to be a strong emphasis on the recruitment and retention of staff for as long as conceivably possible.
§ Mr. Harvey
My hon. Friend makes a good point. Conditions for trainee nurses are difficult. They are neither fish nor fowl. They do not get the advantages that trainees in many other professions get and, although they are treated as students, they do not get many of the practical advantages or the support that students on entirely academic courses get. Theirs is the worst of all possible worlds. Addressing the financial and support package for nurse trainees should be a high priority if, as my hon. Friend says, all those who start are to qualify and take up paid posts in the health service.
The hon. Member for Woodspring (Dr. Fox), who opened the debate for the Conservative party, made several points in his characteristically bullish fashion. However, a British Medical Association poll, which was published today, will not have given the Government enormous comfort. It shows that the number of people fairly or very dissatisfied with the NHS has risen from 17 to 28 per cent. The Government will be relieved to know that more people blamed the Conservatives than Labour, but not that many more—only 9 per cent. more when unprompted and 3 per cent. more when prompted with options.
As the hon. Gentleman said, this is the fourth winter that the Government have been in office, dealing with winter pressures in the NHS. As time passes, it becomes increasingly difficult to convince the public that all the problems predate 1 May 1997, although I do not suggest that they all started after that date. With all those capacity problems, the Government are right to consider creating better working relationships between the different professions and giving nurse practitioners and perhaps pharmacists powers to prescribe.
Many hon. Members will welcome the fact that more and better screening procedures are available for a variety of conditions, but of course they all need to be processed by laboratory staff, who already have many other duties in the NHS. I make a particular plea for laboratory staff. Their training is every bit as rigorous as that of others in the health service—in many cases, they have attained higher academic qualifications—but they are absolutely the poor relation in terms of their financial package. I worry that there will not be enough people in the NHS to carry out the tests that open opportunities for many new treatments for a variety of conditions. Pay is a real issue for those people. The NHS has many pay and staffing problems, but laboratory staff have a particularly strong grievance in their own right.
Some 25 or 30 years ago, bed occupancy rates in the NHS were about 70 or 75 per cent., but they can now be as high as 97 per cent. That lack of spare capacity—a problem that exists all year round—provides the background to the difficulties experienced in winter. It is not unique or unprecedented for scheduled elective surgery to be cancelled when pressures mount in the winter. That has been going on for at least the past decade or so. No one should pretend that the phenomenon is entirely new, but it has become increasingly apparent as bed occupancy rates have increased from 75 to 97 per cent.
I shall refer again to the PFI. There is absolutely nothing wrong in principle with the private sector shouldering some of the investment burden and, indeed, 162 helping to take some of the risks. There is no reason in principle why the PFI should not be used to build new hospitals. However, it has not been shown—the information simply has not been put into the public domain—that using the PFI to build new hospitals represents better value for the taxpayer. The new hospitals being built are popular locally, but many clinicians resent the suggestion that decisions to build smaller hospitals with fewer beds are being taken on the basis of clinical judgment. It is perfectly clear that such decisions are far more to do with the commercial judgments being made about the investment.
Our other major misgiving is with the 30-year deal into which the PFI ties the NHS. Clearly, the NHS changes very fast in today's world, and 30 years is simply too long a period in which to make financial commitments to particular capital plant. Such plant may need to be configured once or twice, or even more often, during that time. It made sense, when the nation could lay its hands on so little capital and when previous Conservative Chancellors were presiding over a public sector borrowing requirement that rose to almost £50 billion at one stage, to look elsewhere for sources of capital investment. However, it makes altogether rather less sense when the Chancellor has the embarrassment of a huge surplus but does not know what to do with it.
One of the key matters that the legislation in this Session will address is another factor that contributes to the pressures in the winter, namely, nursing and residential care. I once again put on record that the Liberal Democrats deeply regret the fact that, although the Government set up a royal commission to examine the real difficulties that exist in that sector, they rejected what to our mind was the commission's key recommendation. We welcome the fact that the state will meet the expense of providing nursing care, but the decision not to follow the whole logic of the commission's report through to its ultimate conclusion, and the decision about paying for personal care, will exacerbate the problems in the nursing and residential sectors, to which the hon. Member for Woodspring referred.
I listened with interest to the hon. Gentleman and to the leader of the Conservative party. They suggested that the collapse in capacity in the nursing and residential home sector during the past year relates to the forthcoming regulations that will govern the physical and practical arrangements for running those homes. I share some of their concerns about those regulations, but they are mistaken to suggest that the regulations have much to do with the contraction that has occurred so far. Some owners of homes or the foundations behind them have wanted to get out of the market for quite a while, and it has been suggested that they are using the pending regulations as an excuse for doing so. We have seen little detail of the regulations, the impact of which will depend not on what they say but entirely on how pragmatic and sensible the Government are when they implement them.
Let us consider the number of places in nursing homes and what has happened in the past year or so. One can take the figure that the Secretary of State acknowledged, which I believe was 7,000 during the year to last April, or the figure of 15,000 during the year to October. I believe that the Conservatives even referred to 25,000 during the past two years. Whatever the figures, the fact remains that there has been a very significant contraction 163 of this vital sector. That will add to the problems in winter, for all the reasons that we have rehearsed. If those places are not available, there will be bed blocking.
I welcome the fact that there are now more care packages in the community, but I am sceptical about the suggestion that the figure involved with those packages can possibly be greater than the number of lost beds in nursing and residential care homes. I do not see how that squares with the difficulties on the ground—social services departments are struggling with completely inadequate budgets and are cutting, and further cutting, the amount of support and care packages that they can buy or provide. That will create more winter pressures than there would otherwise have been.
I urge the Government to review yet again the funding formula that they use for social services authorities and health authorities, and to consider the weighting that they give to the number of elderly people that those authorities have in their population. The case of my own social services authority, Devon county council, is relevant. Before it was decided to move funding from the Department of Social Security to local authority budgets, Devon had about 16.5 per cent. of the national spend on long-term residential care for the elderly because we had 16.5 per cent. of the clients and patients. Under the system involving social services budgets, we have about 4 per cent. of the national spend, but we still have about 16.5 per cent. of patients and clients.
The funding formula does not give accurate or sensible weighting to the number of elderly people who live in a given area. About a year ago, my authority calculated that 500 residents would have to die before it would have the funding to put further clients into residential care. No one can run a budget on that basis. The authority has to raid other social services and county council budgets, such as those for education and highways, to make up for the deficiencies. Social services and health authority budgets need more funding in areas with many elderly people.
Had the Government accepted the royal commission's recommendation that free personal care should be delivered by the state, they would have made a huge contribution to relieving winter pressures in hospitals. We need to revisit that issue. I hope that it will be reflected in legislation and that the Government will invest in personal care.
§ Dr. Stoate
The hon. Gentleman raises the issue of paying for personal care, but surely he accepts that that would put a huge financial burden on the taxpayer, which is not necessarily a bad thing. Can he clarify the matter for the House and say whether his party would commit itself to raising the finance to pay for that?
§ Mr. Harvey
My party has been committed to that and will go into the election with a manifesto that retains such a commitment. I accept that it would be quite expensive, but in the past month the Government have seen fit to allocate £2.5 billion to resolve their problems with fuel protesters and a similar amount to deal with the pensions problem. The royal commission's proposal would cost nothing like that. Had the Government accepted the commission's recommendation, they would have helped the people who need personal care and improved their ability to run a health service that copes with pressures not only in winter, but all year round.
164 I can only echo the words of the chairman of the British Medical Association's community care committee, Dr. Andrew Dearden, who said:It seems patients themselves are going to be responsible for the personal caring element of the way they are looked after. This will be related to their ability to pay. In nursing homes their need for help with personal care is likely to be much greater as these patients are usually more dependent. Perhaps the Government should recognize this and look at providing an element of that personal care.If individuals have to pay for this increased level of personal care it is almost like a tax on being sick. I don't believe that is an ethos the NHS should be satisfied with.I entirely agree and urge the Government to think again.
On the Government's proposals to abolish community health councils, I have talked to many people concerned with community health, all of whom recognised the need for a big shake up and reform of patient representation and advocacy. The Government's suggestions in the national plan on how that should be done worry me for two reasons: first, the lack of independence and, secondly, the fact that there is no way for the various parts of the new service to operate together. The whole may be less than the sum of the parts.
The patient forums will be funded by, and will draw their staff support from, the very NHS and primary care trusts that they are supposed to observe. I do not understand how patients can have the slightest confidence in the independence of such bodies if they are funded and staffed by the trusts that they monitor. That is palpably absurd. They should be independent of the NHS. If the Government are not prepared to go that far, surely they must consider it more logical for forums, and the patient advocates who work with them, to be funded by health authorities instead of by the trusts that they are set up to monitor.
Local authorities are to be asked to take on the role of statutory consultee. I am not clear as to how they are to do that if they do not undertake the monitoring and inspection roles that CHCs have carried out in the past, and if they do not have contact with patient groups on whose behalf, in part, they act because they are not in touch with the individual complaints work that is undertaken.
I urge the Government to consult far more openly. It is generally recognised in the House and in the country that a significant reform is needed, and the propositions that the Government have put on the table might, if suitably refined, offer a way forward. If the Government would only openly discuss the issues with all involved, I believe that they would find a way forward that commanded a reasonably broad consensus. However, by conducting the consultation as they have done so far—by holding four seminars for hand-picked attendees and not opening the door to anyone who wants to offer their view—the Government appear to be putting on their tin helmet and sending the message that they have devised a method, they are going to implement it, and that is their last word on the subject. I urge them to think again, because the issue is extremely important. The Select Committee on Health identified major problems in connection with patient representation and made a string of excellent suggestions on how to improve matters. Improvements should be founded on that report, not on the breaking up of the various components of CHCs' functions.
The ban on tobacco advertising is welcome, albeit belated. I am glad that the domestic difficulties that caused the delay have been resolved and that the correct 165 course of action is now to be adopted. I can think of no other industry that needs to recruit 100,000 new customers a year to replace those who have died as a result of consuming its product. No one should doubt that that is a significant element in the tobacco industry's motivation to advertise on the scale that it does.
We shall examine the measures that the Government introduce in the coming Session. We welcome the general direction indicated by the Government's NHS plan, but we regret that they have not gone further faster. We believe that the NHS will experience significant winter pressures this year; the Government can do little about some of those pressures in the short term, but they can do something about others.
There is no better way in which the Government could act to relieve the pressure than to ensure that social services departments throughout the country have adequate budgets to provide care for people in the community. That is the best way in which to reduce the number of people going into hospital, to ensure the earliest possible discharge from hospital, and to avoid the spectre of emergency readmission of people who have been released from hospital only to find that inadequate care is available for them in the community. Such a system of care could be swung into action almost immediately. Many social services departments face budget crises this winter. If there is one thing above all others that the Government can do to relieve winter pressures, it is to get emergency funding to social services departments as quickly as possible.
§ 2.8 pm
§ Dr. Howard Stoate (Dartford)
I welcome the great commitment that the Government have shown to the national health service, especially the 50 per cent. increase in cash terms and the one third increase in real terms in the resources available to the NHS over the next five years. That is extremely good news, and compares well to the Opposition's woolly statements on the subject. Today it has become apparent that although their funding commitment to the NHS extends to hospitals, it seems that primary care, and central matters such as the Food Standards Agency, the Public Health Laboratory Service and the child immunisation programme, occupy a less certain position in Conservative plans for the future.
Given the investment they are making, the Government are right to expect significant changes in they way in which the health service is managed and health care delivered in this country. Society is changing rapidly, as are people's expectations—and rightly so. People deserve different provision of health care. People who work expect the services that they use to offer longer opening hours; they expect services such as banking to be available at the weekend, and, to an increasing extent, they believe that they should have access to health services at the weekend. Therefore it is right that society should change its views on the way in which it wants its health services to be delivered. It is also right that the Government should expect changes in delivery—first, in response to society, and secondly, in response to the real money and commitment that the Government are putting into the NHS.
Let us consider how some of the proposed changes might function. As the House knows, I still do some general practice, and one of the key proposals for general 166 practitioners is that by 2004 a patient should be able to see a doctor within 48 hours, and a practice nurse within 24 hours. On the face of it, that seems a great challenge, but about 50 per cent. of GPs can already provide that service, and many more become able to do so year on year. There are another four years before the programme will become a deadline, but I understand the real concerns of the British Medical Association and others that some practices will face a significant challenge in trying to meet the targets.
I look to the Government to do what they can to ensure that the practices that are struggling receive the extra help that they need in terms of more doctors, nurses and receptionists, and enhanced premises. I am pleased that the Government are on course for achieving many of those aims by ensuring that general practice is much better resourced, so that patients can receive a better service without putting undue and impossible strains on GPs, who are under great pressure. The fact that the Government are focusing on providing extra resources will go a long way towards easing some of the burdens.
We have heard a good deal about private finance initiative hospitals. I am pleased to say that in my constituency there is a brand new PFI hospital up and running. It has been open for two months, and is providing an excellent service for people in the area. It is true that it is smaller than the hospitals that it replaced; it has 400 beds, whereas its predecessor had 500. There is no question but that bed numbers are extremely tight. I shall concentrate on how the system is working, and explain some of the difficulties and challenges, and some of the solutions that we have reached.
There is a clear change in the way in which hospitals are run, and how patients are treated. Hospital stays are now much shorter. The average bed stay is down to about two or three days. When I was a junior doctor, it was quite common for somebody having a varicose vein operation, for example, to be in hospital for more than a week. Such a patient would now go home on the day of the operation. Medical practices have changed tremendously. Most people would like to be at home as soon as possible, and not lie in a hospital bed for seven days after an operation. It is right that community resources are being directed to ensuring that nursing and other care is available in the community to enable patients to go home sooner.
Given the way in which hospitals are delivering their care, perhaps the 400 beds in the new PFI hospital in my constituency could be sufficient. We do not know yet how things will settle down over the next few months. The acute trust in Dartford and Gravesham has spent a vast amount of time, effort and energy ensuring that community services are available. Stroke rehabilitation teams are in place, and there is a "closer to home" strategy to allow some people to be nursed at home throughout their illness, and others to be returned home much more quickly.
As Darent Valley hospital is brand new, with brand new services, it will take time to bed down. We are heading for the first winter under the new system, and it has taken time for the new teams in the community to be fully staffed, fully trained, fully used to the system with which they are dealing, and to get up and running. About 40 patients at any one moment are subject to delayed 167 discharges. They are ready to move out of the acute hospital, but services are not available in the community to enable them to be moved. That is a real issue.
The hon. Member for Woodspring (Dr. Fox) mentioned a patient with chest pain who had been left on a trolley for 17 hours at the Darent Valley hospital. He was mentioned in this context in the Daily Mail yesterday. It is important to put it on the record that that charge is mischievous and not true. To be left on a trolley for 17 hours with chest pain would be extremely frightening for my constituent, and frightening for me as a doctor.
I have taken the trouble to ascertain the truth, and I have received a statement from the acute trust in Dartford and Gravesham, which sets out the reality. The statement clearly says:The Accident and Emergency Departmentat Darent Valley Hospital
has the same facilities as a Coronary Care Unit for monitoring patients.This was not a patient on a trolley. He was in an accident and emergency unit on a high-tech bed with high-tech facilities, and with the same level of nursing care and staff as he would have had in a coronary care unit.
There were two patients in a similar situation, and the statement says that they weremonitored, treated and cared for on beds in the Majors area of the Accident and Emergency Department.Following assessment by the Consultant Physician that morning, the decision was made that these two patients required Cardiac monitoring. The Trust has 4 areas that provide this service, one of which is in the A&E department. Clinically, it would have been unsafe to place them in any other area, therefore they were in the most appropriate area for their clinical needs.That is the truth of the matter. A patient was not lying on a trolley for 17 hours, and, by implication, not being cared for. Instead, he was properly cared for in a high-tech unit in the accident and emergency department, which was properly staffed. The hospital doctor says that he was in the most appropriate and safest place for him in the hospital. It is important to look behind the facts when talking about scare stories.
§ Mr. Chris Pond (Gravesham)
The hon. Member for Woodspring (Dr. Fox) should return to the Chamber and apologise.
§ Dr. Stoate
My hon. Friend makes an important point. Perhaps the hon. Gentleman should apologise to the House for misleading it, and to my constituents and my hon. Friend's constituents. My hon. Friend and I have been working hard to make sure that we get the truth, and not scare stories.
§ Mrs. Caroline Spelman (Meriden)
In the absence of my hon. Friend the Member for Woodspring (Dr. Fox), does the hon. Gentleman accept that the example was drawn from a body of evidence put together by the community health councils, entitled "Casualty Watch", with which I am sure he is familiar? The document is produced monthly, and contained many other examples of unacceptable waits, often in accident and emergency departments. Is the hon. Gentleman saying that the validity of such a document is completely undermined by 168 the one piece of information that he has brought forward? A body of evidence has been brought forward by CHCs and it should not be ignored—but it will be, if they are abolished.
§ Dr. Stoate
If we are to hear and read such stories in the House and in the newspapers, it is important that the facts are checked. I took the trouble to check, as did my hon. Friend the Member for Gravesham (Mr. Pond), whereas the hon. Member for Woodspring appeared not to want to do that before he went to a national newspaper. That is one example of Opposition Members using NHS stories as scare tactics without bothering to ascertain the reality. I am upset not because they are scoring political points, which is their purpose, but because they are undermining what the NHS, the doctors, the nurses and the other staff and managers of the new acute hospital are doing to try to build confidence in a brand new unit. It is a great shame when we hear such stories.
As I have said, bed numbers at the hospital are tight, and we must make sure that it is properly run. The hon. Member for North Devon (Mr. Harvey) appeared to criticise the PFI, but the hospital in Dartford and Gravesham was built on time and on budget. There is a 30-year contract with the company that built it. What hospital will be knocked down after 30 years? Hospitals have a habit of lasting more than 100 years. The fact that there is a 30-year contract with the company is surely no great cause for alarm.
The hospital has been built in such a way as to ensure that it is flexible. It can be changed, because of the way in which it has been laid out. It has been designed so that if we require changes in service delivery over the next 30 years, which I confidently expect we will, all the internal walls can be moved, removed and remodelled at low cost, and with little disruption. It has been designed for a possible 200-bed extension, as the need arises, without destruction of core services, which are large enough and robust enough to cater for increased capacity. This is an achievement—a tribute to the company that built it and the management that is running it.
§ Mr. Harvey
No one is suggesting that hospitals will be knocked down within 30 years. That is far-fetched. I am sure that the hon. Gentleman is right when he says that the hospital has been designed so that it can be reconfigured. That is all very good, but even after it has been reconfigured, the public will still be paying for the original design. That is the problem that I have with the PFI. We are mounting one set of debt on another. That is why I think it is preferable to pay for such constructions on a shorter time scale if we are to involve the private sector—or, indeed, if we take the usual public sector routes. There is the problem of mounting debt.
§ Dr. Stoate
I accept the hon. Gentleman's point. I, too, have certain reservations about the PH. It is brand new and untested, and we must see how it rolls out over the next few years. However, I have carefully examined the Darent Valley hospital PFI project, and I am satisfied that the hospital has been designed for the future, so as to reflect changing needs.
Effectively, we are buying on a mortgage. At the end of 30 years, the hospital freehold will revert lock, stock and barrel to the NHS. First, however, it must be returned to the NHS in good condition. There cannot be 30 years 169 of decay and neglect. There must be 30 years of routine regular maintenance to ensure that it is kept in good condition. Secondly, and importantly, the private sector has taken on the risk. If something goes wrong—for example, the operating theatres are out of action, or a major piece of equipment breaks down—the hospital does not have to pay for the equipment or facilities until they are repaired.
There is therefore a huge incentive to make sure that the hospital is running at full capacity and maximum efficiency the whole time, otherwise the NHS will not have to pay for the facilities. In previous times, if an X-ray machine broke down, it might not be repaired until the end of the financial year, because of lack of money—but that will no longer be the case in Dartford and Gravesham, where there is a real incentive to ensure that the hospital is working properly.
As I said, with 400 beds, numbers are tight, and we do not know how the hospital will bed down over this winter, even with the new community resources. That is why my hon. Friend the Member for Gravesham and I have been working hard to try to set up a step-down facility—a convalescent unit, effectively—at the North Kent hospital in my hon. Friend's constituency. The idea is to set up 24 beds there, to allow for any possible overstretch from casualty or from the acute hospital at Darent Valley, to make sure that patients are properly looked after and to reduce the risk of delays and hold-ups in casualty.
We have been working hard with all the authorities involved, including Ministers, who have been extremely helpful. The problem that we face is a problem for the NHS because, in a way, the Government are the victim of their own success. The resources are available to fund the unit, we have the unit in place and it could be up and running fairly quickly, but we cannot find enough nurses to run it.
As hon. Members know, nurse recruitment is a problem. Despite the fact that the Government are recruiting and training more nurses than ever before, there is a significant shortage, and we are finding it extremely difficult to recruit the nurses for the hospital. Managers have rightly told us that they cannot open the 24-bed unit over the winter until extra nurses can be recruited.
If there are any nurses out there in Dartford and Gravesham who are following the debate, I should be grateful if they would apply for some of the existing vacancies. I can offer them a good deal and a good job working in the acute hospital or in the new step-down unit that we are trying to establish.
The shortage of nurses is clearly an issue, but, as I said, with changes in the way in which hospital stays are organised and changes in hospital practice, I believe that we can make a success of the hospital. However, it will not be a success if Opposition Members continue to talk it down, drive down morale and frighten patients. We should see it as a brand new facility and a brand new opportunity. Generally, the patients to whom I have spoken—I am sure that my hon. Friend would echo this—have been extremely pleased with the service that they received at the hospital, despite certain teething problems.
We are moving towards new methods of delivering care in the community. Far more community care will be delivered in people's homes or closer to their homes, with shorter hospital stays. That requires much more flexibility in the community, which is sometimes extremely difficult 170 to manage. My own practice, for example, currently has on its books 19 patients who are terminally ill. That is quite a large number.
Our policy in the practice is to try to keep people at home for as long as possible, because that is where they want to be, but that depends on the availability of enough highly trained community nurses and others. It is clearly a matter of capacity, both in hospitals and in the community. I am sure that the Government are doing all they can to address the problem, but I should like them to focus on increasing the resources available for community care, particularly nursing, so that such people can be looked after for as long as possible in their own homes.
§ Mr. Barron
My hon. Friend raises an important point, especially in view of the exchanges at the beginning of the debate, when the official Opposition were asked whether they would support the increased expenditure on social services that the Government are promoting. There was no answer. Unless they undertake to continue that expenditure, they will precipitate a crisis in the health service, because there will no longer be the community support that my hon. Friend outlines.
§ Dr. Stoate
That is a good point, because many of the plans rely crucially on the availability of adequately resourced and trained social services staff in the community to deliver them. If there are hold-ups and bottlenecks at social services level, the plans will be difficult to implement and patients will suffer. I am therefore disappointed that the Opposition were unable to give a commitment to the adequate funding of social services care.
I have one final point to make. There are many people in the NHS who could do more, and would like to do more, in terms of their professional development. I refer to a particular group, community pharmacists. The House knows that I am chair of the all-party group on pharmacy, and I work hard with pharmacy groups and individual pharmacists. I get from them the feeling that they are highly trained and motivated, and clearly they can do more than they are currently doing. What is more, they clearly want to do more.
I am pleased that the Government have launched a new plan for the future of pharmacy, which has been well received by pharmacy groups. I hope that when the Minister replies to the debate, he will address the fact that pharmacists want to do more, although I believe that it will probably require primary legislation to allow them to do so. I refer in particular to patient group directions and prescribing under that scheme, whereby pharmacists and others, including nurses, will be able to prescribe more medications to patients direct.
I shall focus on two issues. The first is emergency hormonal contraception. In a number of pilot schemes around the country, pharmacists under patient group directions have been able to supply emergency hormonal contraception directly from the pharmacy's premises, without patients needing to go to a general practitioner first.
§ Mr. Michael Mates (East Hampshire)
I am grateful to the hon. Gentleman for giving way. He is making a serious speech from his long-time professional expertise and raising a number of serious health issues. Is he 171 disappointed that there is not a single Minister from the Department of Health on the Front Bench for such a debate?
§ Dr. Stoate
The Opposition Benches are not particularly well stocked today, either. A shadow Minister is present, but it is a great disappointment to me that Opposition Members in general have not seen fit to take part to a greater extent in the debate on the Queen's Speech.
I was making an important point about pharmacy. I believe that under patient group directions, pharmacists could do a lot more than they are doing. The pilot schemes, especially in Manchester, have been extremely useful. Patients have come forward in large numbers, have received the emergency hormonal contraception that they needed, and have been well satisfied with the service.
I would support a great extension of that. A good example might be the prescribing of Relenza. As hon. Members may know, the National Institute for Clinical Excellence has given the go-ahead for the use of Relenza for the treatment of acute influenza, in certain circumstances. The problem is, first, that flu is extremely difficult to diagnose, and secondly, that the drug must be given within the first 48 hours if it is to be of any use. Clearly, it will be difficult for GPs to see all the patients who may think that they have flu and get them through their surgeries in the required time.
I should like to see a system, perhaps in conjunction with NHS Direct, whereby pharmacists, nurses or a combination of both could prescribe Relenza under patient group directions and clearly defined protocols. That is an example in which the professionalism of a wide range of staff in the NHS could be maximised, and their expertise, enthusiasm and will could be used so that patients would receive a greatly enhanced service, without overburdening GP practices, which in any winter suffer a certain amount of strain.
There should be more focus on such an approach, and I hope that these issues will be dealt with in the health Bill outlined in the Queen's Speech. I am sure that primary legislation would be required, but I would be pleased to see the Government addressing the issues, and considering the circumstances in which it would be appropriate for pharmacists and others to prescribe, how that might work and what the benefits might be, and examining the financial aspects.
I hope that close attention will be paid to that proposal. From my meetings with pharmacists, I know that they are keen to go ahead. Of course I understand the implications, and recognise that the Government would need to consider them closely.
In conclusion, I believe that the NHS is generally in robust shape. The Government are committed to it. It is improving year on year, and my personal experience in the NHS is that my partners and I can give enhanced services year on year. People who may be suffering from cancer can be seen much more quickly, and we are getting people through the system much more quickly than ever before. Nurses have better training than ever before and can deliver more care in the surgeries. Overall, it is a good story, and I am pleased that the Government are showing a renewed long-term commitment to the NHS. I look forward to the debate on the Bill when it comes before the House.
§ Mr. Simon Burns (West Chelmsford)
Although I fully appreciate the reasons, I am disappointed that the Secretary of State for Health is not in his place. What I shall say at the beginning of my remarks about certain aspects of his speech I would have preferred to say to his face rather than behind his back, through Hansard.
In the Queen's Speech, the section on health begins:My Government remains committed to the founding principles of the National Health Service.I wholeheartedly agree with the Government and share a belief in those principles.
Lovable rogue as the Secretary of State may be to some of his friends, I resent bitterly those sections of his speech that were based not on fact but simply on trying to obtain cheap political gain by suggesting that Conservative Members are not committed to the health service and would seek to privatise it. There is no truth in that whatever, as the record of the previous Government shows. Whatever criticisms Members may have of health care in their constituencies in those 18 years, policy on the NHS under my noble Friend Baroness Thatcher and my right hon. Friend the Member for Huntingdon (Mr. Major) was based on the principle underpinning the founding of the NHS—that it should be free at the point of delivery to those who are entitled to free health care. That remains our policy, and it is cheap, erroneous and wrong for a Secretary of State to try to cast doubt on that without a scintilla of evidence.
The Queen's Speech states that the Government will introduce legislation to fulfil the commitments in their national plan, particularlyto improve the performance of the NHS.Of course, nobody would argue against improvements to a service, especially one as critical as the health service. I support wholeheartedly any Government who seek to improve the provision, standard and quality of care in the NHS. However, I question some of the premises behind the Government's commitment.
The national plan will introduce a rolling programme over several years to reduce the time that people must wait for hospital treatment. That is a laudable aim that any sensible Government would seek to achieve. We sought it and achieved an 18-month waiting period. Time has moved on, and the present Government are rightly seeking to tighten the service and reduce further the maximum waiting period, as well as waiting periods for certain types of care. It will be interesting to see the small print of the legislation that will bring those proposals into force, as it would be nice if the Government could achieve the targets that they have set themselves before moving on to the next stage.
I apologise for mentioning hospital waiting lists again, but I am gravely concerned about them. On 1 May 1997, we were promised that things could only get better, but those things seem to have passed my constituents by. As I told the Prime Minister 10 days ago at Prime Minister's Question Time, we have had three and a half years of a Labour Government, but hospital waiting lists in my area are longer, with 1,100 more people than when the Government came to office. In fact, since 1 May 1997, there has not been a single day when the numbers on hospital waiting lists in mid-Essex have gone below their level on 31 March 1997.
173 As my hon. Friend the Member for Woodspring (Dr. Fox) said, the Government have compounded the problem by creating a second waiting list to get on to a waiting list for hospital treatment. Out-patient waiting lists in my area have gone up from 555 people waiting 13 weeks or more to see a consultant in May 1997 to more than 2,800. Before we put in place grandiose schemes that were undoubtedly meant to attract voters' attention at the next election—which, I suspect, will be in spring or summer—we need more concrete evidence that existing targets are being met and that we are not creating waiting lists to help the Government try to cover their political embarrassment if the little pledge card that the Prime Minister produced at the last election is not honoured. The Secretary of State must behave more responsibly when speaking in the House, and should not seek to lash out for partisan gain.
I should like to concentrate on long-term care, although not at great length. It is a crucial area of NHS responsibilities, as older people make up the largest single group of patients using the NHS. As I remember, people over 65 account for two thirds of hospital admissions and 40 per cent. of all emergency admissions. From those figures, it is self-evident that our elderly population is possibly the most vulnerable section of our society and is entitled to proper care, dignity and privacy in the NHS. Sadly, many problems in our NHS are associated with care for the elderly. For example, there are severe strains on personal social services budgets, and indignity and financial waste are associated with delayed discharges from hospitals throughout the country. There are problems with the assessment of the kind of care package that should be provided. There is anecdotal evidence that financial considerations sometimes dictate whether an individual receives residential or nursing care, rather than that being determined on clinical grounds.
We now have the additional problem of a falling number of care home beds and a distortion of provision across the country. Some areas may well have a surplus of care home beds, but other areas in the south-east—including my own area of Essex, which has been mentioned—have a shortage of beds and a terrible problem trying to find places that are acceptable for people to go to. Despite the best intentions of Conservative and Labour Governments, we are still trying to end the undignified and financially wasteful problems of bed blocking.
In the past two weeks or so, as well as in today's debate, different figures have been bandied about in the House concerning the number of beds lost over the past year or so. Ten days ago, the Prime Minister told my right hon. Friend the Leader of the Opposition that the overall net reduction was 5,000. I was slightly surprised at that because five weeks ago the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), told the Select Committee on Health that, in the same time scale that the Prime Minister talked about, 7,000 to 8,000 beds had been lost overall, which is about 4 per cent. of total capacity.
My hon. Friend the Member for Woodspring came up with figures based on more up-to-date evidence about what is happening at the moment. However, the problem has got to be addressed. The Government say that they will have discussions with care home owners, but they should do something more positive and urgent, as the problem is on-going. Two care homes in my constituency, 174 Southborough lodge and Upleathams house, are closing, causing a terrible problem for people who have come to regard them as their homes and are now having to try to find accommodation, preferably in the town of Chelmsford. However, as a result of shortages in Essex and the eastern region, they may well have to be dispersed further afield, away from their families who visit them and help to care for them. That pressing problem needs to be addressed quickly.
However, I accept that, overall, the Government are seeking to move forward on long-term care. It will be interesting to see how the details of the Bill that they promised in the Queen's Speech are fleshed out. Following the royal commission's recommendations, the Government will provide the full costs of nursing care from October 2001. In all honesty, I welcome that decision, which I expected the previous Government to make, had the Conservatives been re-elected in 1997—[Interruption.] The hon. Member for Exeter (Mr. Bradshaw) laughs, but he was not in the House at that time. I was a Health Minister then, so I am a little better qualified to form a view about the accuracy of that statement.
I am pleased that the Government will take that course of action.
§ Dr. Brand
I am grateful to the hon. Gentleman for giving way, unlike his colleague the hon. Member for Woodspring (Dr. Fox). Is the hon. Gentleman clear about what Conservative Members would do regarding the commission on long-term care? We have heard an explanation of how difficult it is to distinguish between personal care and nursing care, but no commitment has been made on whether to accept the majority, the minority or none of the report.
§ Mr. Burns
I hope that the hon. Gentleman will bear with me, as I should like to develop my argument a little further before specifically answering his question.
The Government are funding only the nursing care aspect. Before expectations are raised too much, it is important to remember that individuals in particular financial circumstances must contribute towards the cost of personal care and accommodation while they are in a nursing home. Similarly, the age-old problem of costs remains in respect of residential care.
The Government are going to follow the example of my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), the last Conservative Chancellor of the Exchequer, by increasing capital limits. They propose also to introduce a disregard from the means test of the value of people's property for the first three months that people are in a residential home. Undoubtedly, that will provide some relief, but, in some ways, the Government have missed an opportunity and only scratched the surface of the problem. The three-month disregard on the value of an individual's property means that if a person spends more than three months in a home—albeit that that is a welcome break—the same old problems will be perpetuated after that period. People will have to sell their homes to finance their residential care until their assets come down to the capital limits.
Another age-old problem will also be perpetuated. I genuinely do not know how it can be avoided, in respect not only of residential care but of other social security 175 issues. I refer to a feeling of unfairness among people who have been sensible all their lives, saved money and put away savings for a rainy day. Such people can feel that they are being penalised: because they have been careful, cautious and sensible, they will not receive the same financial help as those who have not put aside any savings and who will automatically qualify for state assistance and benefits. I am sure that all hon. Members encounter that feeling among constituents who visit them in their surgeries or write to them. I am not suggesting—
§ The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley)
The hon. Gentleman described his policy as a missed opportunity for the Labour Government. Will he explain why his party missed the opportunity during its period in office to disregard the value of a home as we have done? Will he also explain—this is perhaps more important than that party political point—his party's current policy on that?
§ Mr. Burns
I am grateful to the Under-Secretary, as he anticipates precisely my next point. I was starting to say before he intervened that I was not suggesting that the solution was simply to spend £1 billion of taxpayers' money to pay all the residential costs of those who live in residential homes. I believe that there is genuinely a third way—I hope that that will appeal to the Under-Secretary. The third way was a proposal made by the previous Conservative Government in a White Paper that was published, if I remember rightly, in January 1997. It proposed the creation of a proper insurance scheme that operates on a voluntary basis. Such a scheme would ensure that members of the public who want to do so can take out an insurance policy at whatever level they want, in order to provide for the financing of their long-term care in a residential home. That could allow them to bypass the means test so that they do not have to sell their homes to finance their long-term care.
If the Conservative party had been re-elected and appropriate legislation had been put before the House, the White Paper proposal would have ensured that individuals or families were encouraged to take out policies. Like many changes, the proposal would have involved a change of culture. The best way of ensuring that a necessity such as preparing for one's old age is ingrained in an individual early on is to promote awareness from a young age. The younger one is when taking out a policy before retirement, the cheaper the premiums will be. Personal pension provision has ballooned during the past 20 years or so and, as the educational culture has changed, people have become far more sensitive to and interested in what will happen to them when they reach the age of 65.
Of course, people who are 20 or 25 years old do not have a care in the world. For them, the age of 60 or 65 is so far away that they do not think about it and are not concerned. Private pension provision has shown that if people are educated and provided with a proper explanation, they become more interested and concerned and want to provide for their financial well-being later in life. An insurance policy for long-term care would have 176 gone the same way, if it had been properly marketed and explained. To my mind, that is the way we should have proceeded—the third way.
§ Dr. Brand
Would such an insurance policy cover all existing long-term care costs, and would it include medical and nursing costs? Would it distinguish between personal and nursing care—the problem highlighted by the hon. Member for Woodspring? Furthermore, would it extend Conservative policy on insurance-based national health services?
§ Mr. Burns
It is nothing to do with an insurance-based national health service. I was explaining the policy with which we would have proceeded in 1997 for meeting the total costs of residential and nursing care, if we could have introduced the legislation. To be fair, I appreciate that the royal commission did not consider the idea of voluntary insurance policies attractive. It is perfectly reasonable for the royal commission to express that view if it wishes, but I personally think it is wrong. It is a missed opportunity, especially in comparison with doing nothing except introducing a three-month disregard, however helpful that is in the short term.
Finally, I should like to deal with the procedures for assessing somebody's needs under provisions for free nursing care. The Government are working on plans to make assessments more uniform across the country through a new assessment protocol. I believe that the work is currently being carried out by the chief nursing officer for England, with help from a variety of organisations, including the royal colleges, the Alzheimer's Society, Age Concern, Help the Aged and other relevant bodies at the sharp end of helping the elderly in long-term care. Those organisations rightly want to achieve a fair process with a standard form of assessment that avoids the wide variations that often arise now.
It will be interesting to see how the policy will work in reality. I suspect that one major problem will be the ability to distinguish between nursing care and personal care. In his typically frank way, the previous Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), said before a Select Committee that he thought it impossible to offer a definition that distinguished between the two. However, I understand that current Health Ministers do not share that view and that they are far more confident of being able to produce a definition. It will be interesting to see whether their definition is viable and works in the way that the current Department of Health team believes it will.
I wonder whether the assessment procedures relating to the provision of care will be more successful than the existing regime, which has input from both the NHS and social services and represents a natural conflict of interest. For example, if a local NHS or social services budget is severely under strain, a way of saving money is to assess that an individual's need is for residential care rather than nursing care. In many cases, an assessment could go either way, but the pressure, owing to budgetary strains, is to ensure that residential care is chosen because it will save money from hard-pressed budgets. I am not sure how the Government's proposed changes will prevent that conflict of interest and stop people being assessed for residential care when they should be in nursing care.
The Secretary of State said that there would be no cap on the cost of nursing care for the individual patient. That is a laudable aim. However, I wonder whether it can be 177 sustained. Nursing costs will be totally uncapped, which means that the global nursing cost budget could skyrocket. If costs were to skyrocket beyond the Department of Health's estimates, and if the Department's budget were under severe strain, would the Government be able to perpetuate that open-ended commitment? Time will tell.
The Government are a little over-optimistic to believe that they can continue with a scheme that gives unlimited funding to every individual requiring nursing care. That is unrealistic. The Department of Health might think that it is the right way to proceed, but I suspect that, at some point, the Treasury might not be quite so happy with such a scheme.
Much of the proposed health legislation will require careful reading of the small print when the Bills are published, and as they progress through the House. The Government have been timid, and they have missed opportunities on funding and on the provision of long-term care. The Secretary of State was overenthusiastic in his reading of this morning's newspapers, which suggested that this was a modest Queen's Speech in preparation for an early election. Rather than address the minutiae of the Government's proposals for the new Session, he decided to take a broadbrush approach and make a rather dishonest party political speech with the aim of winning votes rather than the arguments pertaining to the proposals.
§ Mr. Gareth Thomas (Clwyd, West)
I propose to make a more wide-ranging speech than those made by other hon. Members. I shall comment later on social security, as I am conscious that the Secretary of State for Social Security will wind up the debate.
I welcome the Queen's Speech and the legislative proposals that it contains. However, it must be viewed in the context of the Government's long-term policies that have been in place since 1997. I refer specifically to the Government's sound economic management that has enabled them to invest in the vital public services that are dear to the hearts of our constituents, including health and social security. That long-term approach to tax and spending is in stark contrast to the legacy of boom and bust that we inherited from our predecessors.
I am pleased that the Government are building on the foundations of the welfare-to-work policy, the minimum wage, and the record increases in child benefits, which will go a long way to combat child poverty and social exclusion, even though to achieve that may take longer than people expect.
The Government are right to focus on the need to combat crime, especially disorderly, rowdy and drunken behaviour. As a barrister, I know that many banisters would have gone out of business a long time ago were it not for the fact that a great deal of crime—including domestic violence and other problems—is caused by people who have consumed an excess of alcohol. Many of our constituents are concerned that disorderly behaviour appears more prevalent than it was 10 or 20 years ago. The Government must add to the armoury of measures available to the police to combat that problem.
I welcome the measures to raise the age applicable to curfew schemes, and the powers that will be given to the police to close licensed premises that are not being 178 properly run. The introduction of fixed penalties for offences of disorderly behaviour in public places is also a valuable tool for police officers.
Practical issues will need to be considered, and we must strike a balance between the measures available to the police and the need to place equal emphasis on the need to divert young offenders from reoffending. The Government have invested heavily in programmes to combat truancy and to educate parents in their responsibilities. That is part of the whole picture of combating anti-social behaviour. The devil will be in the detail of the Home Office measures. The Home Office will be very busy during this Session, as it was in the previous one.
§ Rev. Martin Smyth
The hon. Gentleman said that the devil would be in the detail. How far will a curfew for young people of up to 16 years of age restrict ordinary young people going out to evening activities of a positive nature, such as the Boys Brigade, Scouts, Guides and so on? How far should such a curfew be prescribed in law?
§ Mr. Thomas
The hon. Gentleman makes a pertinent point. We must strike a balance between civil liberties, the need to encourage youngsters to take part in social activities that create a responsible society and the use of the proposed measures, which could be draconian in their effect. I hope that the Government will take that into account, as well as the need to ensure that the legislation conforms to the Human Rights Act 1998.
I am disappointed that the Government have seen fit to reintroduce a Bill dealing with the mode of trial. I voted for the previous Bill on the subject, but I question the wisdom of introducing such proposals again, especially as the Auld commission, which is charged with the task of undertaking a fundamental review of the whole criminal justice system, has yet to report.
As a Welsh Member of Parliament, I am particularly pleased that a special Bill will be introduced to establish a children's commissioner for Wales. Many hon. Members will be aware of the grave concern in Wales following the north Wales child abuse inquiry. The Government are committed to strengthening the role of the children's commissioner and—crucially—to giving the commission a role in promoting children's rights. Those were among the key recommendations of the Waterhouse report.
I know that the Government will be anxious to make progress on hunting. That is a vexed issue and my view is a minority one in my party. I do not consider that it would be appropriate to enact an outright ban on hunting. I represent a constituency that is very divided on the issue, but hill fanning is a crucial industry there, and I would be failing in my duty if I did not express the view that I cannot condone an outright ban on hunting.
The Queen's Speech contained some good news for those who have responsibility for children with disabilities and special educational needs. It is high time that the law was strengthened to provide clearer rights for such children and their parents. There is a hotch-potch of provision, and inconsistency between local authorities. Clarification is direly needed. The question of special educational needs figures saliently in my postbag, and demands urgent attention.
§ Mr. Roy Beggs (East Antrim)
The hon. Gentleman has touched on a serious point. Health boards and education 179 boards have failed to make proper provision for children with special needs, and that has led to failure at primary school level. Does not the hon. Gentleman agree that children identified as needing speech therapy, for example, require that therapy long before they start primary school? That treatment should be provided much earlier by the health authorities.
§ Mr. Thomas
The hon. Gentleman makes a good point, with which I agree wholeheartedly. I shall be interested in the Government's response.
In my constituency, there is considerable interest in the Bill to ratify the treaty establishing the international criminal court. There is increasing interest in international issues arising out of the need to create a safer international community and to spread respect for human rights across the world. In that sense, we are living on a shrinking planet.
I have a particular interest in housing law. I am pleased that there will be a homes Bill in the new Session, and that one section of it will deal with homelessness. The measure will provide greater access to housing for those vulnerable people who fall outside the safety net at present, but I am dismayed that the legislative programme has no room for measures to resolve the vexed question of houses in multiple occupancy. That is a pity: the social effects of that problem are marked right across the country, but especially in coastal areas such as my constituency.
I know that the Government have published a draft Bill on commonhold and leasehold properties. It is high time that the regime of leasehold enfranchisement was simplified. My specific plea is that, when the Government draft the Bill and consider amendments, they pay particular attention to the needs of people in purpose-built retirement flats. I tried to introduce a private Member's Bill on that issue, and I am sure that the matter will receive attention.
To a large extent, health matters have been devolved to the National Assembly for Wales, although primary legislative power in respect of health issues still resides in this House. I welcome the huge extra investment in the health service that the Government have provided, and I also agree that that must be accompanied by a rigorous programme of modernisation.
My hon. Friend the Member for Rother Valley (Mr. Barron) made an impressive contribution and spoke eloquently about the need to combat and ban tobacco advertising. I am pleased that there will be a measure in the new Session to deal with that. I tend to agree with my hon. Friend that there should be a tobacco regulation authority—if only to prevent the ingenious avoidance of regulations that might occur if no body existed with a roving brief to deal with problems of regulation when they arise. More work may have to be done in that regard.
I want to ventilate a few issues to do with welfare reform and pensions. I am a member of the Select Committee on Social Security, and I suspect that its Chairman, the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), will wish to speak soon. I shall be interested to hear what he has to say.
The basic state pensions will rise from April next year—by £5 to £72.50 for single pensioners, and by £8 for couples. That will be very welcome. Personally, 180 I should have liked the Government to have taken the view that there was life still in the contributory principle, and to have breathed new life into the idea of social insurance, but I accept that they have to cut their suit according to the cloth available.
The Government have decided, quite legitimately, to target help at the worst-off pensioners. Clearly, the major increases in the minimum income guarantee—by £13.70 to £92.50 for single pensioners, for example—are very welcome. I detect that pensioners in my constituency are pleased with the progress that the Government have made in what is a very important area.
I am pleased that the Government are to introduce a regime of pension credits as a way of combating the savings trap into which many pensioners fall. People just a few pounds above the minimum income guarantee level lose all entitlement to it. It is high time that the new regime was introduced if we are to create proper incentives for saving.
The Queen's Speech builds on the Government's record in welfare reform. The Government have concentrated on making work pay, reducing barriers to work and tackling child poverty. The working families tax credit is especially valuable to many of my constituents, who will be dismayed that the Opposition's policy is to scrap what is an important social measure. The result of that Conservative policy would be that no fewer than 1.1 million families would face an effective tax increase of £30 a week.
This country has an unfortunate and tragic legacy of child poverty, to which the previous Government contributed to a large extent. One child in three lives below the poverty line. It is a pertinent fact that social security spending doubled when the Conservative party was in government, but we must not underestimate the challenges facing the present Administration as they try to achieve their ambitious target of taking 1 million children out of poverty. Yes, there is room for integrated child credits. I welcome the fact that, as a preliminary measure, child tax credits will be introduced from next year. There is a need to ensure that the working poor, as well as those who are not in work, receive adequate levels of income. That will be a major feature of integrated child credits.
In closing, I should like to strike a note of caution. I should be particularly interested to hear what the Government have to say on the proposed social security fraud Bill. I am well aware that any Government have to take a robust approach to fraud within the social security system, but one is entitled to be somewhat sceptical about what further scope there is for squeezing fraud out of the system. Perhaps we could be given an indication as to what figure the Government have in mind.
Techniques of data matching need to be improved. I understand that under existing legislation the Benefits Agency has access to the records of the Inland Revenue and that the proposed legislation will give benefit agencies and others access to private bank accounts. It would be useful to know what safeguards the Government propose in relation to that measure.
In respect of what appears to be a quite draconian step—to withdraw benefits from those who have been found guilty of two offences of benefit fraud—it is right to ask, bearing in mind that social security is meant to protect the most vulnerable in society, how the 181 Government propose to ensure that that measure will conform with the Human Rights Act 1998. How would it ensure that the children and dependants of those guilty of benefit fraud will not be badly affected? How much discretion will there be within the statutory regime to develop a just solution and avoid undue hardship in cases of benefit fraud?
I understand that the proposed social security Bill will tighten up the rules on housing benefit, but one of the major features of the inquiry conducted by the Social Security Committee into that benefit was the fact that those rules are extremely difficult and complicated. One of the problems for local councils, bearing in mind that it is a national benefit administered locally, is the pace of change and the fact that regulations are constantly changing. It is a bureaucratic nightmare and it is causing severe problems. I would welcome hearing what the Government have to say about that.
In conclusion, I welcome the broad outline of the Queen's Speech. It builds upon the Government's successes.
§ Mrs. Marion Roe (Broxbourne)
I listened to the speech by the Secretary of State for Health and, like many others, I have come to the conclusion that the Labour party is still up to its old tricks—promises, promises, promises, all delivered with spin and grin, to be followed inevitably by failure, failure, failure. The Secretary of State appears to be living in a world of his own.
It is time that the Prime Minister and his colleagues realised that the people of this country are not as daft as the Government would like to think. Certainly in my constituency, people are carrying out comparisons between what the health service was like before 1997 and what it is like now.
The Labour party is now being rumbled. The electorate know that at the last general election, Labour bribed them with pledges which they had no hope whatever of delivering, particularly on health. The message that is being put about nowadays is that the Labour Government cannot be trusted.
Nearly every day, one reads in the newspapers or sees on television a crisis in the NHS caused by mismanagement and inefficiency and my constituents now know that they have been let down badly by an ambitious Labour Prime Minister and his party. There is no doubt that in spite of their dedicated commitment to the NHS and in spite of coping with the enormous burdens placed on them, all those working in the NHS have become disillusioned, disappointed and frustrated that their high expectations of a promised improved NHS have been shattered. It is no wonder that their morale is so low. I pay tribute to them for their magnificent achievements under very difficult circumstances because we all know that under Labour the NHS has become worse.
I quote from a letter dated 4 September, which I received from my constituent, Mr. John Rose, of Hoddesdon:I rang my GP practice today in an attempt to make an appointment to get attention and advice on what is at this time a non-emergency minor ailment and was astonished to find that the earliest appointment that could be made with any doctor in the practice was for the afternoon of 11 September, i.e. eight days time.This does not seem good enough to me and so I contacted the Area Primary Care Unit at the County Hospital in Hertford to enquire if this was an unreasonable time to wait for attention and was told that locally this was "about par for the course" ….182I also contacted the Community Health Council in Ware, who agreed that a period of eight days is too long to wait for an appointment and I understood from them that the government in the shape of the Prime Minister has stated that appointments with GPs should be available within 48 hours. I presume that this is a distant aspiration because it is a considerable distance from the actuality.I would stress that my major concern is not my individual case but the generality that people must wait eight days for an initial consultation with a doctor. How many non-emergency cases can become emergencies within that length of time?Mr. Rose is not alone. Mrs. Susan Thornton of Broxbourne told me recently that she had to wait three weeks to see her GP for a non-emergency consultation. That never happened in my constituency under the Conservatives.
I also received a letter, dated 1 October, from Mrs. Darlow of Waltham Cross. She wrote:Dear Mrs. Roe,I wonder if you could help me please. I am due to have an operation for a hysterectomy and was put onto a fast-track system of 3–8 months waiting time. It is now 19 months later and I am still on the waiting list which only gets updated on a 6 month basis. My next update is end December which will take it up to 22 months. I have also been on their emergency cancellation list for months now, but still no joy.Again, Mrs. Darlow is not alone; I constantly receive letters of complaint from constituents about cancelled operations and excessive waiting times. That never happened under the Conservative Government.
Some elderly patients are now raiding their meagre savings to pay for private health care because they cannot face the pain, agony and discomfort of their condition during a wait of 18 months or more for an operation in the NHS—that is known locally as Labour's privatisation of health care by stealth.
Three and a half years ago, the usual maximum waiting time for elective surgery at the QE2 hospital in Welwyn Garden City was 12 months, but patients frequently had their operations much sooner. Within six months of the Labour Government coming to power, the waiting time rose to 18 months as the norm. So much for Labour's promises at the last general election about improving the NHS. My constituents now feel that they were conned.
There has, however, been one organisation within the NHS structure that has had the full respect and confidence of patients and all those working within the NHS and on which they have relied for impartial and independent help and support. I am, of course, referring to the community health councils.
My constituency does not have a district general hospital. In consequence, my constituents go to three major hospitals, two of which are outside the county. My local community health council, East Hertfordshire, has monitored all three hospitals from the point of view of Hertfordshire residents. It conducts up to 50 monitoring visits a year, and has a reputation with the three hospitals and the health authority of carrying out effective quality monitoring, making constructive recommendations and achieving changes to services for the benefit of patients. Its skill and expertise have been built up over many years. I cannot see this work being effectively continued by parochial local patients forums in each hospital, where my constituents will be in a minority.
We have one small community hospital in my constituency. It owes its existence to the efforts of myself, the borough council and the CHC, which resisted plans to 183 abolish it some years ago. In the past month, the CHC alerted me to the closure of the hospital's minor injuries service—done without consultation or notification—and, in turn, informed the health authority and the borough council, neither of which were aware of what had happened.
This is the CHC performing its watchdog role on behalf of patients and residents. The Government are proposing independent local advisory forums for each health authority. In Hertfordshire's case, this will probably mean one for the whole county. The forums will perform some of CHCs' current functions. I cannot imagine such a forum being local enough to know that such a closure had happened, or independent enough to stand up for the people who use it in the face of an NHS trust decision.
I have indicated that the nature of health service provision in my constituency is diverse, with many services coming from out-of-county providers. That has sometimes meant that the health authority has not always concentrated its attention on what could be seen as a peripheral part of its area. The CHC has unfailingly—and sometimes exasperatingly—insisted that my constituents and their health needs should not be forgotten. The CHC has championed the cause of those neglected services such as mental health and learning disabilities to some effect, so that services have improved. It has worked constructively with the health authority, primary care groups and NHS trusts to remedy other deficiencies.
East Hertfordshire CHC has always provided an independent service to the residents of its district, giving help and information about the national health service and, in particular, giving advice and support to those patients or their carers wishing to complain about the treatment that they have, or have not, received. Complainants have been grateful that such a body exists. It is perceived as separate from the rest of the NHS, yet knowledgeable about its workings and the workings of its complaints procedure. Crucially, it is perceived as independent enough to give impartial advice and help. The NHS plan for PALS—patient advocacy liaison services—with staff in every trust to act as customer relations officers and local troubleshooters does not replace what CHCs do. There will still be a need for independent advice. Current examples of PALS provision have continued to rely on the existence of CHCs, and the present proposals leave a gap that reformed CHCs could more than adequately fill.
Community health councils have been accused of being dinosaurs. That is not my experience. My CHC has been innovative over the years in a number of ways. Apart from producing an effective and well-thought-out monitoring system, it successfully instigated a conference on clinical effectiveness at a local level involving the six NHS trusts that provide the majority of services to my constituency. It has, in the past two years, originated a new approach to its role in consultation over major changes in services. With the other Hertfordshire CHCs, it has held public inquiries, based on the principles of a Select Committee of this House. All interested parties have been called to give account before a panel of CHC members and to express their views on the proposals. The result of that approach has been to secure guarantees about future developments, which have safeguarded public interests.
184 Such public inquiries have also clarified the issues for the public and for professionals. This approach has been welcomed and supported by the health authority, NHS trusts, primary care groups, local authorities and, most importantly, the public. It has been copied by at least one local NHS trust.
In Hertfordshire, community health councils are respected by all parts of the NHS, by local authorities and by social services departments. They are appreciated by the voluntary sector and the general public. That respect has had to be earned. That has been achieved by the professional and competent way in which their functions have been carried out, and by the wide local knowledge base that they have built up.
In my constituency, the CHC has a clear overall understanding, drawn from fulfilling its different functions, of the complex way in which services are provided, what needs exist, how they are or are not met and how different agencies interact. The proposals in the NHS plan fragment these functions, and mean that no one organisation will have an overarching view of the issues in a local district.
The Government have made much of the fact that CHCs and their national body, the Association of Community Health Councils for England and Wales, have recognised the need for reform. East Hertfordshire CHC has long recognised that need; it proposed, through the national body, that CHCs' powers of inspection or monitoring and consultation should be extended to cover primary care. Its members would also have welcomed changes in the way appointments are made.
The CHC would have welcomed constructive change. However, it did not expect or deserve to be abolished. That abolition, without warning, and with only a belated acknowledgement of the contribution that CHCs have made since their inception in 1974, was like a slap in the face. Its effect was instantly demoralising.
The abolition of CHCs will mean that the NHS will run the risk of losing invaluable knowledge and skills. It will lose the CHCs' particular experience of relating to the general public, as well as an objective, informed, independent, lay contribution. It will also lose the hours of voluntary time and enthusiasm given unstintingly by CHC members.
With ill-conceived policies such as the abolition of the community health councils and a persistent quest to centralise control, it is no wonder that under this Government the NHS is failing the people whom it was designed to serve.
§ Mr. Jon Trickett (Hemsworth)
May I apologise to you and the House, Madam Deputy Speaker, if I am unable to come back for the Minister's reply to the debate? I am shortly going into hospital, and have a number of domestic and constituency matters to which to attend.
Because of two separate medical problems, I have recently used the health service, sitting quietly alongside patients in my GP's surgery and in hospital. My experience of the health service is nothing like the one described by the hon. Member for Broxbourne (Mrs. Roe). It is of a service staffed by people who are always courteous and professional. In my experience, they 185 are generally optimistic about the service and its future. My view is shared by patients I have sat alongside, and it will no doubt be shared by those I sit alongside next week when I am in hospital for an operation.
Most of my constituents did not expect the health service to be transformed overnight with the election of a Labour Government. They expected—and they are seeing—a steady and gradual improvement in the quality of the service. That is the experience throughout the United Kingdom. The description that we heard from the hon. Member for Broxbourne does not mirror the reality for patients in constituencies such as mine and for many tens of thousands of people throughout the country.
My constituents understand that the legacy of the previous Government will take some time to repair. I shall describe my constituency to explain the impact of Conservative policies on such an area. It is in the heart of the Yorkshire coalfield and my constituents suffer acute and chronic ill health.
One word describes the effect of Conservative policies on the health service throughout the 18 years that they were in power: inequality. The reforms that brought about a two-tier GP service meant that the quality of the service received by patients varied remarkably according to the sort of surgery that they attended. Effectively, fundholding was an opted-out service—it was outside the health service and run to its own rules. One received a different service in a fundholding practice than that received in an NHS practice.
The inequality was clear, as has been revealed so startlingly in the recent debate in the press and the House about what has become known as the lottery of postcode prescribing. An illness would be treated one way in one area and entirely differently in another—using different drugs or no drugs at all. In 18 years, the Conservatives failed to tackle that. I am pleased to say that that problem is being dealt with in a practical way through the establishment of the National Institute for Clinical Excellence.
My area is served by two hospitals, neither of which is in my constituency. Due to the underfunding of Wakefield health authority for many years, the Pinderfields general hospital in Wakefield is a disgrace. It has lacked capital funding, the buildings are shocking and it should have been replaced a long time ago.
Underfunding prevailed throughout acute services. There was pressure on clinicians to come up with a solution. In addition to the effect on acute services, the underfunding resulted in the effective, but surreptitious, closure of Southmoor hospital in Hemsworth and the running down of other hospital provision throughout the Wakefield district.
On top of that, a number of aged persons' homes that were run by the local authority were closed. The people I represent live in villages. When one has grown up and lived all one's life in a village, working down the pit there, one expects to be able to retire, live out one's life and die there. With the closure of those homes as a result of financial pressures, elderly people who require support often cannot live out their lives in the villages where they were born and worked.
People have been moved from South Kirkby and elsewhere in the area to as far away as Selby. That may not seem far when one looks at the map. To people who live in metropolitan areas, 15 or 20 miles may not seem 186 far, but for people who have spent 80 years in a closed community, which every pit village was, to be moved from South Kirkby, Upton, or South Elmsall to a small town such as Selby seems almost like moving to another planet. The move can result in ill health and all the further consequences of which we know. Those were the consequences of the inequalities that Conservative policies produced in areas such as mine.
The Government have recently provided us with an excellent service. They have produced a statistical analysis—the index of deprivation. There are seven or eight indices and one is for health. I was shocked to find that my constituents must be among the most sick in the country. Of the six electoral wards, four are in the worst 5 per cent. in health terms. There are 8,000 electoral wards. Hemsworth, after which my constituency is named, is the 108th worst, South Kirkby is 139th, South Elmsall and Upton is 205th and Featherstone is 330th. To have four wards in the worst 5 per cent. for health provision is a shocking statistic.
The ill health left by the mining industry was further exacerbated by a failure of care in the 18 years of Tory control. I will describe the effect of the financial stringencies that were imposed on the health service in those days, and the proposals that had begun to emerge when I came to Parliament in the dying days of the previous Conservative Administration. The financial pressures were such that the health authority was faced with difficult choices. Effectively, clinician-led solutions began to emerge, which would have meant the closure of one of the two acute hospitals—the one in the east of the district. Hon. Members must bear in mind the fact that, geographically, the communities in the area are dispersed. They suffer from chronic and acute illness and poverty. My constituents have difficulty getting to hospitals in any event because they do not have motor vehicles and there is a lack of transport infrastructure.
I do not attribute blame to the clinicians, who were dealing with severe financial problems. Their decision was to close the hospital in Pontefract that was used by most of the villagers in the villages that I have described. The closure would mean that they would have to travel greater distances. Many of the old men suffer from chronic bronchitis, emphysema and other miners' respiratory diseases. Many of them can hardly get from their living room television to their toilet without using an oxygen cylinder. To have to travel all the way to Wakefield is almost like travelling to another civilisation.
The situation that I have described—the run-down of Southmoor hospital in Hemsworth and the closure of the aged persons' homes—has exacerbated the problems that the community I represent was facing. I described the problems with GP fundholding and the other Tory legacies. No one in my area expects an immediate turnaround. Given the poor position that we are in, no one in my constituency imagines that it would be possible to achieve even an average standard of health in the area, never mind the length and quality of life that people elsewhere in the country expect, but we expect a gradual and steady improvement.
First, we had to begin again with a new plan for the area. I am pleased to say that my noble friend Lord Lofthouse, who became the chairman of the health authority, operated wisely and transparently to review the situation in the Wakefield area and has produced a plan that has been almost unanimously accepted. His plan will 187 not mean a reduction from 1,900 to 1,300 beds, which is what a district with such poor health was facing; he has produced a plan that will save Pontefract hospital. Indeed, it will put £18 million or £20 million into the hospital and give it a future. One can be proud of that.
The Queen's Speech will allow us to build further on that steady improvement. The development of intermediate care provision for the elderly is especially to be welcomed. After a recent meeting with the health authority, my suggestion for a working party was agreed. It will look in particular at the needs of my constituency—for example, the site at Southmoor that is on the verge of closure because it has been run down over many years. I hope that the working party will draw up a rescue package, building on the national beds inquiry and other Government initiatives.
For a long time, the Wakefield and Pontefract and District CHCs have stood alongside their communities. Wakefield CHC defended and promoted Pinderfields hospital, which desperately needs £150 million worth of capital improvements. The Pontefract CHC, which services the rest of my constituency as well as that of the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), was also steadfast in the campaign to retain some medical provision on the Pontefract site. It did an eminently good job.
Although I understand that my right hon. Friend the Secretary of State is determined to press ahead with the proposals in the NHS plan to abolish CHCs, I regard those proposals with some trepidation. CHCs are susceptible to criticism; their powers are limited—although that is not their fault; and, as we have heard, they cannot deal with primary care. Some CHCs are not of the same quality as others, although I have no experience in that matter. I know three CHCs extremely well: Leeds, Pontefract and Wakefield. They are all well led, and they try to make themselves accountable and to work professionally.
When there was a proposal to close the hospital at Pontefract surreptitiously, the CHC was adamant that the hospital would not be shut. When my noble Friend Lord Lofthouse became chairman of the health authority and began to work differently, the CHC showed itself capable of pragmatism; it did not stand in the way of change and accepted that there would have to be changes at the hospital. The CHC promoted the new proposals.
CHCs are probably most vulnerable over accountability. It is clear that they are not accountable in the same way as hon. Members or locally elected councillors. That is an Achilles heel for CHCs. Given the weaknesses that I have described—there may be others—CHCs are due for reform. However, if my right hon. Friend the Secretary of State intends to press ahead with their abolition, I and Members on both sides of the House will look carefully at his proposals. We shall need reassurance that services currently provided within one institution are not fragmented and made incoherent. For example, if a patient advocate works in a CHC that is examining the strategic character of clinical services, it is clear that the advocate's experiences can inform the views of the CHC when it evaluates particular departments. That close proximity can produce a synergy that may be lost if the two functions are separated and dealt with by two institutions, especially as it 188 seems likely that patient advocacy services will be incorporated by trusts—with the fear that such services may lose their independence.
We shall examine the proposals carefully to ensure that fragmentation does not result in lack of coherence. If that were to happen, many of us would find it difficult to support them. They have of course barely been formulated, so we await the detail. However, there is a further problem in that CHCs are statutory consultees when services are being reconfigured. They try to represent the community, but if—as seems likely—their functions are to be hived off elsewhere in the NHS, it is important that the exercise of those functions is not influenced solely by clinicians.
Clinicians are powerful advocates for the health of an area, but they are equally—perhaps more so—excellent advocates for clinicians. That does not necessarily mean that they would advocate a service that was in the best interest of the rest of the community. Questions as to who should be consulted, and how, about the closure or reconfiguration of services are crucial. Again, we await the details. It would be a mistake if hiving off that function of the CHC resulted in clinicians predominantly determining reactions to proposals on reconfiguration from the Secretary of State or others. I would find that difficult to support.
I have no doubt, however, that, as the Secretary of State is a distinguished advocate for the health service, he will bear all those matters in mind—as well as many others—when reaching a conclusion. We shall examine the proposed legislation with interest in the hope that he will have addressed many of our worries about the CHC proposals.
The Queen's Speech included proposed legislation on crime, which I hope will be universally welcomed in the House. All our constituents, especially the poor—many of whom I represent—are subject to crime and criminality. They expect us to improve the ability of the criminal justice system to deal with what is felt to be a rising tide of crime and criminality.
In the west end of Hemsworth, for example, we have had particular problems with youths. Perhaps if the curfew powers had been in place, those problems would not have arisen. Elderly people, and even those who are not so elderly, feel incredibly intimidated by crowds of young people, some of whom are drinking—often under age. The police and local authorities seem to lack the power to deal with that. We welcome measures on those matters, and I hope that we shall see a continued reduction in crime.
I hope that, in the legislative burden that the Home Secretary continues to take on his shoulders, we shall continue to pay attention to victims' needs. Hon. Members on both sides of the House and people outside this place often talk about victims, but the criminal justice system does not yet give sufficient attention to the needs, feelings and aspirations of the victims of crime.
Anna Fisher, aged 14, was killed as a result of reckless driving. Obviously, the victim was that lovely young girl who had all her life before her, but her parents and family were also victims. The criminal justice system—the police, the coroner, the Crown Prosecution Service—demonstrably failed to meet the bereaved parents' needs. The parents learned that the trial had taken place—and that a conviction had been made, which resulted in a 189 £100 fine and a three-year driving ban for the person who had committed the crime—by reading the newspaper. No one had even bothered to tell them that the trial relating to their young daughter's death was taking place; they discovered it in the newspaper. It was also bizarre that the parents were not told that an inquest was to take place after the trial. You, Mr. Deputy Speaker, might think that that is extraordinary, but apparently it can happen. During the inquest, facts emerged about the nature of the incident that had not been considered at the time of the trial. It seemed to me that insufficient attention was paid to the victims' needs.
I hope that, if the Home Secretary cannot find room in the legislative programme to remedy this situation, he will at least bring forward administrative measures to ensure that all the enforcement agencies are fully aware of the need to bear in mind the needs of victims.
All the legislation that the Home Office is introducing would increase the authority of the state apparatus—the police and the criminal justice system. Fine; they are there to protect victims and to protect us all from criminals, so I do not mind that the state apparatus is being strengthened. However, it seems to me that from a Government who speak about rights and responsibilities, duties and obligations, we should be looking for some balancing moves that protect the citizen.
I am thinking particularly of the police complaints procedure. The time is long overdue for the Home Office to bring forward proposals, as it said it would at the time of the Stephen Lawrence inquiry—I spoke about that when we debated the previous Queen's Speech, when several months had already passed—to the effect that the police complaints procedure should be reviewed and made independent, at least for serious complaints. The Home Secretary has several times promised in the House to bring forward proposals, but as yet they are not here. Apparently, they are still not in the Queen's Speech. I know how busy he is and I accept that he must deal with priorities first, but somewhere in his priorities and somewhere on his desk is a report that makes proposals about the criminal complaints procedure.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
That was a very powerful speech by the hon. Member for Hemsworth (Mr. Trickett). I had the privilege of spending some time in Hemsworth before a by-election there in the last Parliament. Although I was only there for a few days, I can perfectly understand the hon. Gentleman's passionate plea to get some extra resources into his constituency, and I am sure that we all support him in that. I cannot resist the observation that if he is really looking for special treatment before he goes to hospital, telling the House in a speech that he is going to hospital is a sure-fire way of getting a consultant physician to meet him at the door with a cup of tea. None the less, we wish him well—a safe operation and a speedy recovery.
I preface my remarks with a procedural observation, directed at the hon. Member for Nottingham, North (Mr. Allen), who is our big cheese among the business 190 managers of the House. Traditionally, for the four or five-day debate on the Loyal Address, Her Majesty's official Opposition choose the subject days. There may be some purpose in trying to reach agreements on the major departmental days on which subjects will be debated. I do not want to take everything from the official Opposition—perhaps we could leave the Friday as an open day.
This has been a good debate, composed of good speeches, but some key players, such as my hon. Friend the Member for North Devon (Mr. Harvey), have been caught. If we get only 24 hours notice of the disposition of the subjects, it makes it difficult for some of the important Front-Bench spokesmen to be as attentive to the debate—an important debate—as they otherwise might be. Perhaps the usual channels will consider that suggestion for next year. Obviously, it would need to be taken up with the consent of the official Opposition, but it would improve the ability of Front-Bench spokesmen and others to accommodate their diaries and attend a debate. I do not by any means imply criticism of people who are not present.
This year's has been one of the best Queen's Speeches that I have ever come across, for this reason if for no other: that it is the right size. I do not believe the rumour that there will be a general election soon. I am a trusting kind of chap. This year's Queen's Speech is exactly the right length for the House to contemplate at the start of a full year's Session, because we are suffering from legislative overload to a ridiculous extent. As you know, Mr. Deputy Speaker—and as the members of the Chairmen's Panel, your colleagues who chair the Standing Committees, know—the number of statutory instruments and Orders in Council that the House now seeks to scrutinise in a year is excessive.
I consider that the Queen's Speech sets out a full year's work. I shall certainly treat it in that way, and I hope that in future its size will be used as a model for a Queen's Speech that is contemplable and capable of being properly scrutinised.
The speech by the hon. Member for Rother Valley (Mr. Barron) was particularly apposite. He has been campaigning for the proposed tobacco restrictions for many years, and it must be a pleasure to him at last to see a realistic prospect of success. There were some other excellent speeches, too, by the hon. Member for Broxboume (Mrs. Roe) and others, and this has been a good debate.
As Chairman of the Select Committee on Social Security, I must mention that I see a motion on the Order Paper for the replacement of one of the distinguished members of the Committee, the hon. Member for Gainsborough (Mr. Leigh), who since the start of this Parliament has played a crucial role in the Committee on behalf of the Conservatives. We are very sad to lose him, but he is going on to do other important things. We are glad that he is to be replaced by the hon. Member for Congleton (Mrs. Winterton), who is also a very experienced Member—but I place it on the record that I, as Chairman of the Committee, have appreciated all his support, help and hard work.
I would also like to say—I hope that the Minister might pass this on, although she is from a different Department—that the work that the Committee has been able to do has been considerably enhanced by the support of the ministerial team in the Department and the staff who serve Ministers. The Committee is just about to 191 produce an annual report, which returns to all the outstanding reports that we have prepared earlier in the Parliament. The Department has done an enormous amount of work to reprise where all the recommendations and various subjects that we raised are at the moment in terms of the Government's consideration. When the document is published, it will be of great interest not just to parliamentarians but to the community of interest that looks after and takes an interest in social security and welfare benefit matters. They will all find it a mine of useful information. It is a tribute to the Department that it has done so much work, and we look forward to publishing that document very soon.
I shall say a word about the context of this year's Queen's Speech. I do not know about anyone else, but I got rather frightened in the course of the summer uprising—I suppose that is how one would describe it—of discontent about fuel prices. I was in the middle of a series of the rural tours that I always do at that time of year, and I was perplexed by the discontent, alienation and disfranchisement that I came across in my constituency. It was as though the whole country had suffered a collective loss of trust, not just in the Government, but in the whole political process. I hope that we do not assume that that was a complete aberration—a one-off, which will never happen again.
We must be very careful. The whole political process, not just the Government, must be careful to ensure that we understand what is going on and reconnect public opinion with the political process here in Parliament. That applies to Opposition parties just as much as to Ministers.
From my experience during that summer period, there certainly seems to be a world of difference between the reality on the ground and the political rhetoric—and the economic indicators. Indeed, all the economic indicators are looking positive. From the books and statistics alone, one would think that the country was doing well, but that is not the experience on the ground, and other Members who have spoken have reflected that in their own way. The experience on the ground is hard, and people are facing difficulties. That is the context of this debate, as we pick our way through next year's programme for the mother of Parliaments.
My constituency covers a rural area. The older I get, the harder it seems to make social security systems and public policy matters apposite both for Hemsworth and for Roxburgh and Berwickshire. They are worlds apart. The problems and the scale of the problems are different. The contexts and geographical settings are different. In my major town of Hawick there are lots of empty houses. There are perfectly reasonable, well appointed council and housing association tenancies going a-begging.
The right hon. Member for Camberwell and Peckham (Ms Harman) is present, so her constituency springs to mind. I am sure that the pressures there are different, and the attention that her constituency has been getting reinforces that opinion. I listen to my colleagues on the Select Committee, the hon. Members for Regent's Park and Kensington, North (Ms Buck) and for Hendon (Mr. Dismore), and realise that the extent and scale of the problems facing them are wholly different from those facing me in my rural constituency in south-east Scotland.
192 That is not to say that we do not have our problems. I was pleased to get from the Leader of the House at business questions the positive response that Ministers will be present for the important European Standing Committee debate on total allowable catches in advance of the Fisheries Council in Brussels later this month, and that we shall all have a chance to make our points. White fish stocks in the North sea are under pressure. The whole of the eastern coastal community in my constituency may be under blight if the catching capacity of the fleet is reduced to such an extent that the processing sector on land is without the raw material for its products. That will further challenge employment levels in an area where they are already being challenged. The situation is exacerbated because the farming industry is in a serious state of decline, and has not been assisted in any way by the inclement weather from which we have been suffering.
People in rural parts perceive the political process, and Whitehall's centralised approach, as ignoring their difficulties. Their noses are being rubbed in it by the Government's proposal to introduce anti-foxhunting legislation. That must be a low priority. I am not in favour of banning the hunting of foxes with dogs, so I was interested in the speech made by the hon. Member for Clwyd, West (Mr. Thomas). He rather bravely is taking the same view, and I congratulate him on that. Legislation to ban foxhunting will do no more in my constituency than divert police and criminal justice resources to chasing men and women who are riding across the Border hills in pink coats. When there is a small number of police officers who already face a challenge in doing the real work of criminal detection, that suggests a warped sense of priorities. The proposal is going down extremely badly in rural areas, and I hope that the Government will think about that carefully.
Post offices are under threat. I know that the Minister of State is aware that the Department has a continuing interest in that issue. I give his colleagues in the DTI credit for acting in good faith to develop the universal bank as a platform on which to build. I hope that they succeed—and that if they do not, the Department will be prepared, even at the last minute, to consider postponing the withdrawal of the system of benefit books and girocheques for a while, if that will provide the extra time necessary to ensure that the Post Office network is not challenged. As things stand, it is seriously challenged. Rural post offices are often the heart of little villages in constituencies like mine.
South-east Scotland faces real long-term problems—for example, skills shortages and an aging work force. The political process should focus on finding local solutions to some of those problems. Some policy making remains too centralised. A lot of resources are available, but they are not allocated so that local communities can find solutions to meet their needs. There are difficulties, for example, in matching funding. European aid is available through structural funds to help deal with some of these problems, but because of the shortage of capital available to local authorities and local enterprise companies, we cannot develop solutions apposite to our communities. That feeling will not be unique to south-east Scotland. There is a feeling in the rural hinterland of the United Kingdom that people are being ignored, and that perception needs to be addressed.
I support, and always have supported, the Government's thrust of addressing poverty by encouraging people into work. In general, that is going well. Some issues, however, 193 are of real concern. We need constantly to assess the adequacy of benefits. When the Select Committee on Social Services was conducting its pensioner poverty inquiry, the Minister admitted that he could not live on the level of benefits on which some pensioner households have to live. I give him credit for his honesty. It was brave to say that. Indeed, we used it against him, although only gently. It is important to recognise that even if the benefits system is working 100 per cent.—everything is paid correctly first time, every time—some families are struggling.
The work being done by John Veit Wilson and others to establish minimum income standards is important. I am not saying that a Government can immediately leap to meet these new levels and that households can look forward to them. That is unrealistic. Sister European nations use minimum income standards effectively to measure how far the Government of the day still have to go at any given time. The work being done by the family budget unit is instructive, and I hope that Ministers will continue to consider it.
The Minister probably knows that I have always been in favour of cross-cutting Government work to bear down on poverty. There is no other way of doing it. Sir Michael Partridge, who has been released from his previous role as permanent secretary, but knows a thing or two about the inner workings of the Department, said in evidence to the Public Administration Select Committee that the influence of the Treasury in the micro policy-making process was getting slightly out of hand. The direction, initiatives and new benefits delivered through the Inland Revenue all seem to be coming from the Treasury. That worries me. Obviously, the Treasury must be on board and involved in any sensible evolution of policy in this area, but there is concern that it is dictating the pace to an unhelpful extent. I hope that Ministers will bear that in mind in future.
There is a welter of change and much of it is positive. Certainly the principle and intention are good. However, the pace of change and the rate at which reforms are introduced raise questions of implementation and coherence. We all know how tricky it can be to get proper IT systems up and running. The Child Support Agency remains deeply mired trying to get that aspect sorted out.
I acknowledge that for the first time, under the comprehensive spending review, Ministers managed to get their hands on adequate resources to do the job. The policy will take time to implement, and I am patient enough to wait to find out whether that will be done. There are employment credits, integrated child credits and the working families tax credit, and even those who specialise in such matters find them hard to understand; it must be hard even for Ministers.
The Department of Social Security must try to achieve sensible time scales and programmes of implementation and structures in future. The Minister of State has headed part of the disaggregation process in the Department, which has resulted in a pensions agency. That process is welcome, but we must ask ourselves where it will end. It is conceivable that the Department could be abolished in the next Parliament. I am not necessarily against that, but if we are heading in that direction, it is not good enough for the Prime Minister suddenly to issue a fiat one Monday, saying, "We have a successful free-standing pensions agency, a working families agency and the ONE programme, and children are being looked after through an integrated child credit paid for through the Inland 194 Revenue, so we do not need the Benefits Agency any more." My plea is that if we are seriously contemplating such a proposal, or even if there is a suggestion that we are moving in that direction, we need a proper debate. Such changes must not be sprung on us at the last moment.
I shall make two more points about social security. I am becoming increasingly concerned about the growing number of households in the United Kingdom below income support level. Those who do not study such issues as closely as members of the Select Committee on Social Security tend to believe that everyone has a safety net. However, a growing number of people—some of them, such as asylum seekers, may be less deserving in some people's eyes—live in households that must find a way to live below income support levels. They include, for example, families whose housing benefit is restricted because their rent is too high. Thousands of households are in that situation.
Families on housing benefit can be subject to a non-dependant deduction, and those deductions are not made good by the non-dependant who is part of the household. Some people have deductions taken from their benefit because of debts under the social fund. The Select Committee will consider that matter next. We are conducting an inquiry into the social fund because we think that many families are in that position. Hon. Members will know that many people are formally on incapacity benefit, but if they appeal against a decision to be taken off that benefit, their income is paid at 20 per cent. below the normal rate. People can be disqualified from jobseeker's allowance if they have lost their jobs through misconduct or have refused reasonable job offers. People who have opted to pay a financial penalty rather than face prosecution for fraud because they have incurred an overpayment in circumstances which could lead to prosecution not only have to repay the money, but incur a 30 per cent. penalty as well. I could cite other examples of households that have to live below income support levels, and I have not even begun to mention pensioner households that refuse to claim means-tested benefits. I hope that Ministers will consider those real problems during the coming year.
I shall now talk about the anti-fraud provisions in the Queen's Speech. I have carefully studied the consultation document "Safeguarding Social Security", which was produced in July, although the consultation did not end until 21 October. In so far as the Department wants extra powers to gain access to third-party commercial organisations—whether building societies, banks, insurance companies, or student grant or loan bodies—I am absolutely content, so long as any action taken is proportionate, lawful and falls within section 8 of the European convention on human rights, although we shall look carefully at the safeguards involved. No right-thinking person could be against such measures.
I am worried that the concentration on fraud and crackdowns, and all the emotive rhetoric that is used, increases the level of stigma. That is always the dilemma. We must always bear in mind the fact that the system is becoming increasingly means-tested. Whether that is right or wrong is a different argument, but the more means-testing in the system, and the more people talk and write up the fraud, the more people will leave Benefits Agency offices flitting from shadow to shadow, not wanting to be seen claiming because people may think that everyone 195 who claims is a fraudster. That is certainly not the case, as the Minister of State knows. We must be careful about the language that we use.
The extra powers that the Government want to take are right, but they are only minor; they represent prudent housekeeping. It is much more important to invest in front-line staff, to have proper computers and IT systems that work, and to use home visits and ethnic translators for claimants who do not speak English as their native language. I have learned that from the work that I have done with my Labour colleagues on the Social Security Committee. The problem is big, and the solution will not be cheap. The official Opposition propose to clock up benefit savings by bearing down on fraud. To stop fraud, to get it right first time, to keep it right and to prevent further fraud, will cost a lot of money in the first five years. It would be a spend-to-save policy, which would be worth while, but it is certainly not cheap to take £2 billion from public expenditure each year.
Simplification is an important part of bearing down on fraud, especially in the housing benefit system. If the Labour Government can be accused with some justification of one failure, it is the fact that they have done nothing about housing benefit. The problem is not easy, but simplifications are readily available. However, those opportunities have not been properly taken.
The "two strikes and you're out" policy goes against the grain. It is improper to use the benefits system to impose sanctions on people. I do not know who will take the decisions to dock people's benefit. I do not know how long benefit docking will last, nor whether discretion or any waiver will be allowed in terms of who will be hit if they make mistakes twice. The benefit verification programme has produced some unfortunate casualties—
§ Mr. Kirkwood
Let me finish the sentence.
The last two offenders whom I came across who had been washed up by the benefits verification programme were both pensioners aged over 80 who had not declared their capital properly. If that represents one strike, and if they will be chucked off the minimum income guarantee if they do it again—
§ Mr. Kirkwood
I am sure that that is not the Minister's intention, but without proper flexibility and discretion in the system, silly things like that could happen.
§ Mr. Rooker
The hon. Gentleman refers to making two mistakes, but the sanction will be imposed after conviction in court. It is not an administrative sanction. The courts will decide whether people have defrauded the Benefits Agency once or twice. People will have to go through a court process. As my right hon. Friend the Secretary of State for Social Security will probably say, if he has time, some benefits cannot be subject to sanctions. There is a no-go area in which some benefits cannot be sanctioned, and there will be a hardship scheme. 196 The proposal is a very much a deterrent; we expect several hundred people, not thousands, to be caught. Such a deterrent is required.
§ Mr. Kirkwood
I do not want to detain the House too much longer. Perhaps I have misunderstood the proposal; we have not yet seen the Bill and I do not know the detail. If the decision is taken by the courts, it will be an entirely different matter. As a former solicitor, I know that the courts can look at the means available to the household. One of my main objections is that if it were an administrative act, households could be deprived of income, which could bear down on dependent children. Part of the Government's policy is to eradicate child poverty, so the left hand does not seem to understand what the right hand is doing. I may be better informed after the winding-up speech.
§ Mr. Rooker
I hope that I am not in danger of being misleading. Two frauds against the Benefits Agency represent the two strikes, but there must be a court conviction. What happens after a second conviction will be fairly automatic. When people are convicted of defrauding the agency, they will be warned exactly what will happen if they do so again. They will not go back to court a third time. However, they will be required to go to court twice, so there is no question of a mistake being made.
§ Mr. Kirkwood
Does that mean that the sanction could be visited on someone who had just been fined in a sheriff court or a magistrates court? The proposals may simply be deterrents, and may never be used. However, I do not think that the measure, which offends my liberal sensibilities, is necessary. I shall, of course, examine the Bill's provisions carefully, but as things stand, and in view of what I currently know, I believe that it is a mistake. I hope that the Government will think again.
§ Mr. Deputy Speaker (Sir Alan Haselhurst)
Order. I inform hon. Members that I do not have the power to impose a time limit at this stage in our proceedings. However, if hon. Members proceeded on the basis that I could do so, and that the limit would be about 13 minutes, that might be a helpful guide. It might ensure that all those who want to make a contribution can do so.
§ Mr. Huw Edwards (Monmouth)
Thank you, Mr. Deputy Speaker, for that guidance.
It is an honour to follow the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). His expertise in social security is well appreciated in the House. I am sure that the Government will take his thoughtful comments into account when they consider the social security Bill.
Like me, the hon. Gentleman represents a rural constituency. If there is one point in his speech with which I certainly agree, it is that about the sense of disillusionment that many people in the farming community have about policy and the policy-making process. They often feel disengaged from decision making, which affects their lives in many ways. Agriculture is highly regulated, and it is influenced greatly 197 by the European Union, the Government in Westminster and now by the Welsh Assembly. I fully support that, but I appreciate the fact that many in the farming community feel that the policy-making process is rather mystifying.
The hon. Gentleman said that this is one of the best Queen's Speeches ever. I am inclined to want to agree with him, but he may have been referring to its shortness rather than to its comprehensiveness. However, he made some valuable points.
The Queen's Speech begins with the premise that the Government have successfully maintained economic stability. We have had steady growth in this country, low inflation and stable interest rates. I was interested to see that there was no increase today in interest rates by the Monetary Policy Committee of the Bank of England. That economic stability gives the Government the resources to invest in the national health service, our education services, law and order services and other essential public services.
I represent an area in Monmouthshire that has benefited from improvements in the economy. Recent research in Wales by Professor Talbot of the university of Glamorgan showed that Wales is now enjoying the best economic conditions since the 1950s and 1960s. I am sure that my hon. Friends who represent Welsh constituencies will acknowledge that the Welsh Development Agency has helped to contribute to that. That effort was emulated by the Government's decision to have development agencies in the English regions, but the Conservatives are committed to abolishing them.
Monmouthshire has benefited from economic growth but even that county, which is generally regarded as one of the more affluent parts of Wales, suffers from social exclusion. I am privileged to be a member of the Select Committee on Welsh Affairs, which is currently carrying out an inquiry into social exclusion in Wales. We visited parts of my constituency, including Abergavenny and Llanelli Hill, where there are pockets of social deprivation. People in those areas often lose out. I represent an area that is outside the objective 1 and objective 2 areas, but we suffer from lower local government support than other parts of Wales. People in those communities are doubly disadvantaged. The Select Committee's report will come out in January, and I look forward to debating it then.
The Queen's Speech contains new legislation on health care. I welcome the national plan. There is a concern in Wales that a national plan refers to the nation of England, not necessarily to Wales. However, I am sure that the best principles for the national plan for health will be introduced in Wales as well.
My constituency has benefited from the Government's investment in the national health service. Recently, I was at the opening of the new community hospital in Chepstow. It was opened by my right hon. Friend the Member for Cardiff, West (Mr. Morgan), who is also First Secretary of the National Assembly. A day surgery unit has also been opened at Nevill Hall hospital in Abergavenny. It is another initiative that has been introduced under this Government. I welcome the new emphasis on collaboration between health and social care, which will be in the new health Bill, and the Government's commitment to abolishing or reducing inequalities in health.
198 On the national plan for health, I have attracted some controversy in my constituency over the role of consultants. I was interested to read the report of the Select Committee on Health on private practice undertaken by NHS consultants. It contained the recommendation that NHS consultants need to be better rewarded when they work exclusively for the NHS. I believe that the Government have adopted that recommendation. There is a concern that NHS consultants' private practice is often more lucrative in those specialties that have the highest waiting lists.
I am concerned about the Government's proposals for community health councils. I have made representations to Jane Hutt, the Assembly Secretary for Health and Social Services in Wales, on behalf of the North Gwent and South Gwent community health councils, whose work I commend because it represents consumers' interests and highlights inadequacies in the service. A good example of that in my constituency involves the inadequacies of the ambulance service. I am pleased to be having a meeting with the chairman of the all-Wales ambulance trust next Friday to discuss that.
We in Wales particularly welcome the proposal in the Queen's Speech to establish a children's commissioner. That was an important recommendation of the Waterhouse inquiry into child abuse in north Wales. I inform the House that a major police investigation is still going on in my constituency following allegations of child abuse at Ty Mawr, which is a residential school in Gilwern, Abergavenny. There has been strong support for a children's commissioner in Wales from the Assembly and child care specialists. It is right for the commissioner to be able to promote children's rights. The Government proposed giving that new power to the proposed commissioner. The commissioner will be able to observe child abuse investigations. That is a good example of Wales taking the initiative. It could lead to the establishment of an equivalent commissioner in due course in England.
The special educational needs and disability Bill is an important part of the Queen's Speech. I have a particular interest in that area. I welcome the Government's aim to strengthen the rights of SEN pupils to attend mainstream education. Like many other hon. Members, I recognise that when SEN children are integrated into the mainstream education system they thrive, and that can reduce some of the stigma and disadvantage that many children with learning or physical disabilities suffered from when more discriminatory policies, involving different schools, were applied. I commend the special educational needs unit at Overmonnow school in Monmouth. It was commended in a recent inspection report. I have recently been involved with St. David's school in Abergavenny, where 43 per cent. of the children are on the SEN register. I pay tribute to teachers at that school who are dedicated to working with SEN children.
The Bill will place a duty on local authorities not to discriminate against pupils with disabilities. A constituent of mine, Sarah Griffiths, lives next to a local comprehensive school. However, she does not have access to the school because of her disability and her mobility needs. She attends a comprehensive school in Abertillery, which is very supportive, but she faces a long taxi ride to and from school every day. It is important that our school system examines the question of access and makes schooling more accessible to children and young people with disabilities.
199 I am concerned about aspects of SEN provision in my constituency. It has been pointed out to me that some parents feel that children with equal needs do not always get equal provision. The concern has been expressed that the support children receive depends on where they live, what type of school they attend and what level of parental support they receive.
It is important that all children who are likely to benefit from statementing should have access to it. Staff in a school in my constituency thought that children who should have been assessed for statementing had not been put forward for it. Parents of children with special educational needs in my area are concerned that Monmouthshire is one authority in Wales that has not implemented the named person scheme, which would give advice and support to children who are statemented and to their parents. I hope that that will be rectified, and I understand that Monmouthshire is reviewing its provision of special educational needs.
The criminal justice and police Bill will be an important measure. There is a widespread belief that our town centres are unsafe environments for many people because of violence and disorder, which is often related to alcohol. That has been a problem in my constituency. I would not wish to exaggerate it—it is far worse in other towns and inner-city areas—but people have been worried about the rowdiness, especially at weekends, in Abergavenny, Chepstow and Monmouth, and they are uncomfortable and unlikely to go out to participate in community events.
I have discussed those problems with the local police and I am sure that they will welcome provisions to give them more powers to close down pubs where disorder occurs. Hopefully, schemes such as pub watch will mean that such measures will not need to be implemented. That scheme is an important initiative that involves collaboration between the police and local licensees. I also welcome the serving of fixed penalty notices for threatening or abusive behaviour by drunk and disorderly people or for people causing criminal damage.
It is important that the criminal justice Bill is not seen as an attack on young people, who are often victims of violence and disorder late at night as a result of alcohol-related incidents. I do not like over-use of the phrase "yob culture"; sometimes we need to be a little more restrained in our language.
Gwent police will welcome the measures. I am sure that the House will be pleased that crime has been reduced in Gwent. The Prime Minister recognised that achievement, and I had the great privilege the other day to present the chief constable of Gwent with a letter from the Prime Minister, written to me, commending Gwent police on the reduction in crime in that area and the increase in the number of drug dealers who had been arrested.
I was also pleased to make representations to Ministers following the recognition that Usk prison—one of four prisons in Wales—in my constituency had recently received the Investors in People charter mark and a good inspection report. The prison governor has congratulated the Government on their commitment to having positive regimes in prisons. Usk prison in particular has a very successful sex offender treatment programme. It is important that such prisoners are rehabilitated and do not reoffend.
200 I represent a rural constituency where hunting has been a long-standing tradition. Farmers value the role of the hunt in removing fallen stock and in destroying foxes which are a threat to livestock. However, the Hunting Bill is not just about foxhunting, but about the hunting of animals with dogs. I fail to see any conservation value in hare coursing or stag hunting with dogs. There is a debate to be had on foxhunting, but my constituents' representations to me were overwhelmingly of the view that hunting with dogs as a sport is morally wrong. I supported the Bill promoted by my hon. Friend the Member for Worcester (Mr. Foster) and I will support such a measure again. It is a moral issue and Members are entitled to decide whether the hunting of animals as a sport is morally right or wrong. I support my constituents who believe that it is the latter.
I welcome the Government's commitment to establish the international criminal court. I am pleased that the United Kingdom will become a partner to the court. I remember that my right hon. Friend the Foreign Secretary made an inspiring speech when it was first announced, soon after the general election. Domestic courts will have the jurisdiction to ensure that crimes are covered in ICC areas and that there will be greater co-operation for the law enforcement agencies. I want to pay tribute to people in my constituency who belong to Amnesty International or who have written to me to urge the Government to legislate on that matter. I am sure that they will be very pleased to know that legislation will be introduced to bring to justice people who perpetrate crimes against humanity.
I welcome the Queen's Speech. It is a further step towards achieving a fairer society, economic prosperity, less social exclusion and better public services. I am sure that the people of Monmouthshire will support it.
§ Mr. Michael Mates (East Hampshire)
When I intervened on the hon. Member for Dartford (Dr. Stoate)—who had asked, rather plaintively, whether anyone was listening—I said that it was a discourtesy to the House that no Minister from the Department of Health was present. I meant no discourtesy to the Under-Secretary of State for Social Security, the hon. Member for City of York (Mr. Bayley), any more than I mean any discourtesy to the Minister of State, Department of Social Security, the right hon. Member for Birmingham, Perry Barr (Mr. Rooker), but in a debate on the health and social security aspects of the Queen's Speech, surely it is not too much to expect that, out of nine fully paid Ministers, one would be present from each Department so that the Government could at least pretend to be listening to Parliament. Mr. Speaker said that he aimed to ensure that the Executive gave Parliament the respect that it was due. Perhaps, Mr. Deputy Speaker, you could tell him about this unsatisfactory state of affairs.
This is the first time—I think—in about 26 years in the House that I have spoken in a health debate. I do so unashamedly to raise issues of local health, which is in severe crisis in Hampshire. Those who know me are aware that I am not given to telling horror stories or raising unnecessary scares.
The hospital that concerns me is not an old Victorian institution in a run-down inner-city area, but a relatively modern building on the outskirts of Portsmouth. 201 Queen Alexandra hospital is going through the most desperate crisis of its relatively short life. It has many problems, but I want to concentrate on the orthopaedic department and the ophthalmology department.
The problems came to the attention of laymen last July, when a consultant whom I know well turned up to see the seven patients on his list, and the theatre nurse asked him which five patients she should send home because there was sufficient equipment for only two operations. That quickly led to the ceasing of all elective orthopaedic surgery. There has been no such surgery during the past three months, and consultants estimate that there will be none until at least the end of next summer.
The hospital reluctantly took that decision because if it used the orthopaedic instruments for elective surgery, it would not have enough to cope with trauma cases and the accidents that are bound to need treating in a large hospital with a large catchment area of about 600,000 people. That was bad enough, but the hospital could no longer guarantee that it could carry out emergency surgery. That was brought to light when a lady arrived at the hospital four weeks ago with multiple injuries, including a compound fracture of her leg, where the bone was outside the skin. It took the hospital six hours to assemble the right equipment to deal with her injuries.
It was at that point that the consultants felt that they had to tell the trust that it was more dangerous to say that they could cope with trauma surgery than to cancel it altogether. All nine consultant orthopaedic surgeons wrote to the trust to set out their concerns. The letter said:Despite stopping elective Orthopaedic surgery we have not seen any improvement in the supply of sterile instruments for trauma. Indeed, the situation has become worse … we now feel that patients lives and well being are at serious risk.Shortly before that, the situation was brought to my attention and I asked to see the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), whose actions have been entirely commendable: she saw me quickly and, as a result of her intervention, certain measures have been taken for which we are all grateful. That they were too little and too late is not the hon. Lady's fault. I admire the way in which she tried to address the problem when it was brought to her attention.
The problem in the hospital is the central sterilisation unit, which cannot cope. If the problem had arisen gradually over the past two or three months, the fact that we now face a crisis would be more understandable, but people have known that there was a problem with the unit for the past two years. A report on the matter was commissioned, looked at, then shelved, and now a collapse has occurred.
The problem has several causes: first, there is inadequate steam; secondly, some of the autoclaves broke and were not replaced; and, thirdly, the staffing problem is so dire that it is not possible to put through the amount of equipment that is needed to sustain surgery in the hospital. If that were purely an employment difficulty, it could be addressed, but I have discovered that the problem is that the Portsmouth trust pays the lowest rate of pay in the area: it trains people to work in the washing and sterilisation unit, but the moment they complete their training, they realise that they can earn £2,000 a year more by going 10 miles to Winchester or Southampton, so they up and off.
202 That is not a fundamental problem with the health service, but one of local management allowing many problems to develop into a crisis. Surgeons tell me that they were being presented with instruments to use in operations that had yesterday's bone and skin still on them, and that is why patients had to be sent home. I am sorry to present the case so graphically, but those are the facts.
A different problem, but one that has the same roots, affects ophthalmology. All intra-ocular surgery has had to be stopped because of the risk of infection. I am told that four or five infections in 2,000 procedures is about par for the course; but when six infections in a row occurred because equipment was not sterile, the procedures had to be stopped altogether.
There is a solution, which I was hoping to put directly to a Health Minister—I hope someone will read my speech and respond. Some years ago, it was thought right to centralise all sterilisation, but that was before the introduction of laser surgery and the development of micro-instruments. Now, such highly sensitive instruments are chucked into the central sterilisation unit along with the hammers and chisels used by orthopaedic surgeons, and they come out bent and damaged. The simple answer is to let the laser surgery department have its own small sterilisation unit, and it will then be able to get on with its work. Currently, its instruments come back not only unsterile, but damaged, and therefore have to be replaced.
The crisis is a symptom of problems of management. If hon. Members are surprised to learn that there are management problems in the hospital, they should not be. There has been no chief executive for the past six months: the former chief executive left and the newly appointed chief executive does not start until next March. The result is paralysis. I have no doubt that the acting chief executive is doing his best, but he cannot make strategic decisions ahead of the arrival of a new boss, so he is confined merely to putting his fingers into all the holes of the dam.
The net result is that, for three days now, Queen Alexandra hospital, Portsmouth has not been able to offer trauma facilities; if there had been a major accident, the victims would have had to be dispersed to other hospitals. The hospital now accepts trauma patients on a day-by-day basis, which is to say that, twice a day, the duty consultant has to go and see whether there is sufficient sterile equipment to cope with the expected number of trauma patients; if there is not, ambulance services have to be told to take patients to other hospitals in Winchester, Southampton or Chichester.
That is the current state of affairs, so when the Prime Minister warns that there might be a crisis this winter, my response is to tell him that there is a crisis in our part of the world, right now. All it needs is winter and a night of freezing fog and black ice and major accidents to cause the accident and emergency service for 1 million people, many of them my constituents, to grind to a halt. I am sorry to have to put it all so starkly, but I believe that the public and Ministers need to know what goes on down at the end of the line.
Everybody has been doing their best to get around the crisis. Much elective orthopaedic surgery is now being carried out 10 miles away at Haslar hospital, which is under threat of closure. It was an excellent Royal Naval hospital, but the services have no further use for it, so the 203 Government and local health management think that it should be closed. However, Haslar now takes 10 per cent. of all orthopaedic procedures formerly carried out at Queen Alexandra hospital, and it has opened an extra ward of 16 beds; meanwhile, a 16-bed ward has been closed at Queen Alexandra, not because of the crisis, but because it cannot recruit the nurses needed to man the beds. What an amazingly topsy-turvy state of affairs.
My greatest complaint and the reason that I believe that Ministers, rather than anyone else, must act is that there is no strategic plan for my part of the world. I have told the House about Queen Alexandra hospital and Haslar hospital; now, I shall tell the House about a third hospital in the ring—Lord Mayor Treloar hospital, which is a specialist orthopaedic hospital. Only four or five years ago, £5 million was spent upgrading the theatres, but, for the past three years, the facility has stood empty because the local health authority thinks that it is surplus to requirements and wants to close it. In fact, it is not that the health authority wants to close it, but that the hospital occupies land on which 150 houses can be built which is the main factor in determining its fate. The health authority thinks that it can make some money out of selling the site.
What I mean when I say that there is no strategic plan is that we have one district general hospital in crisis over orthopaedics, another hospital under threat of closure trying to do something to plug the gap, and a third, which has had all its theatres upgraded, standing empty because someone somewhere in the system wants to make money by selling the land on which it stands for development.
It should be plain to the simplest layman that if the work of the three hospitals could be co-ordinated, we could have the district general hospital back to doing its proper job, we could have orthopaedics properly organised so that elective orthopaedic operations could be carried out and trauma cases could be coped with. We could have a sensible and comprehensive policy.
I am not clear who it would be who would organise the co-ordination. I have been to almost everybody. I asked the Prime Minister a question about Lord Mayor Treloar's hospital in the summer, and he promised to look at the matter. The issue went all the way down the chain and up the chain, and we were told that the decision had been taken to close it. Somebody should be examining the strategic way in which we deliver the health service. I know that every Government, including the previous Conservative Government and the present Government, want to do their best for everybody's health. However, I have drawn attention to a situation where resources are being wasted, money is being badly spent, management is not present, hospitals have been closing, waiting lists are growing and almost nothing is happening.
It takes somebody, as did the Under-Secretary, to put a bomb under the issue. The hon. Lady managed to get many things moving. She now needs to be re-armed and to examine the entire management system so that someone will say, "What is going on here makes no sense, let us rationalise and produce a better service for the people who live in the south of England."
§ Ms Harriet Harman (Camberwell and Peckham)
I am pleased to follow the hon. Member for East Hampshire (Mr. Mates). He makes a compelling case on behalf of his 204 constituents. I am sure that my colleagues the Ministers will want to look carefully at the points that he raised in such detail today.
I, too, want to focus on issues to do with my constituency. I am grateful for the opportunity in this debate on the Queen's Speech, which does focus particularly on crime—on tackling crime—to raise in this House the tragic death of Damilola Taylor. I would like to start by giving my apologies for not having been in the Chamber when the opening speeches in this debate were made, because I was at a service for Damilola in my constituency.
Today, Damilola would have been 11 years old; it would be his birthday. But last Monday he was murdered. None of us can even begin to imagine the despair and pain that the Taylor family are feeling. We offer them our deepest sympathy for their loss, and we offer them too our great respect for the dignity with which they have faced this tragedy and the dignity with which Mr. Taylor spoke yesterday about his beloved son.
This death has been felt across the community in Peckham. As Kemi, a Peckham mother and a leading member of the African community, said on Monday:We have lost an African boy, but it could have been an English boy, it could have been a Turkish boy, it could have been a Jamaican boy.She also said:We have all lost a son.I am sure that we will all join the local community—as the minister did today when he spoke so movingly at the service for Damilola; I believe that he gave such comfort to the family and such hope to the local community—in calling for the killers of Damilola to be brought to justice. As one father who lives on the North Peckham estate said to me, none of us will be settled until justice is done.
The whole community is backing the police investigation. Althea Smith, the chair of the Southwark police consultative committee, has given an unambiguous lead, calling on everyone who has any information to come forward. I would like to pay tribute to Althea and also to the tireless work of the entire police team—that is, the local police officers, the investigating officers and the family support team, all led by Acting Commander Rod Jarman.
The local community has been united in their response to this crime and have been deeply resentful of the description of the community as riven by gang warfare between different parts of the community—on the one hand those who have recently arrived from Africa and on the other those whose families came from the West Indies. That is not a true description of Peckham. As Dr. Koroma of the Southwark Confederation of African Community Organisations has made clear, they will have no truck with divide and rule.
The House will know that Peckham is a multiracial area, enriched in the past by immigrants such as Sam King, who came to this country from Jamaica on the Windrush. But I want to tell the House something about the new immigrants—the Africans. They come from many different countries in Africa—some are from Sierra Leone—and when they come and sit down in my surgery and get out their family photos, often my heart sinks. I have seen family photos that start with smiling snaps of weddings and family gatherings in a village, and end with 205 photos of the same village now showing burned-out homes and mutilated bodies. We must never forget that some who come here are fleeing from political turmoil and unimaginable terror.
Though my new constituents come from many different African countries and from very different circumstances, they all want to get on, they all want to be part of and contribute to the community and they all have strong family values and a powerful work ethic.
It is typical that Damilola was in church on the Sunday before the Monday he was killed. My new African constituents are the backbone of the local churches and the community organisations. It is typical that Damilola was coming from the computer club when he was killed. Peckham's new African immigrants are keen for their children to succeed in school. They value education and are, frankly, impatient with the standards in our schools.
One mother complained to me that she had had a better education in rural Nigeria than her daughter was getting in Peckham. She took her daughter out of the Peckham primary school that she was attending and, although she does not earn very much money as a care attendant in an old people's home, she now actually sends her daughter to a private school. We must all do more to improve the standards in our local schools—both academic standards and standards of behaviour.
Above all, as Mr. Taylor reflected in his statement yesterday, the immigrants from the different African countries who come to Peckham believe in work. For them, it is a matter of principle—morality, almost—that they work in the community that they have joined. They do work—they work in this House, they clean our offices, they chop food in the kitchens of our local hospitals, they are teachers and they nurse in the local care homes. The stereotype is that immigrants are scroungers, leeching off the welfare state, yet the truth is that much of our welfare state in south London would simply not function without the new African immigrants.
Damilola bled to death from a stab wound. Commander Rod Jarman echoes the views of many locally when he speculates that whoever killed Damilola intended to wound, but probably not to kill—but what starts as a scuffle ends up in murder where there is a knife.
One young woman who came to my surgery on Friday said that when she came from Nigeria to Peckham 12 years ago and went to school, she was teased mercilessly and she was bullied. She had a heavy Nigerian accent and a strange-sounding Nigerian name. But she said that although children were bullied then, they were safer because kids were not carrying knives. People tell me that there are now many knives on the streets of Peckham. Parents, teachers and we politicians wring our hands and ask why kids carry knives and what we can do about it. Certainly, people locally want more police on the beat. Peckham is not a walk-on-by community, and there are many mothers in the North Peckham estate who think nothing of taking on a group of boys who are up to no good, but people are more likely to get involved and less likely to hurry on home if they feel safer, and to feel safer they need more police on the streets.
We really must look again at how many beat police there are on Peckham's most difficult estates, and also tackle the problem of recruiting them, against a background where police expect to be able to buy their own home, but cannot possibly afford to buy a home in 206 Southwark. Housing is part of the solution to our problem with recruiting police, and it is the same for nurses and teachers. We must act to ensure affordable housing for these vital public servants.
But why do some kids need knives to feel important? Why do they feel that they need knives in order to win respect? Most of the kids in Peckham are law-abiding and want to make something of their lives, but why are such a large number opting out? As well as more police, we must try to understand and tackle the causes of crime. As the Prime Minister said yesterday, opportunities and responsibilities go hand in hand. The fact is, "If you are black you do not get your fair share of opportunities." Dr. Koroma, whom I mentioned earlier, says that 75 per cent. of the African cab drivers in Peckham have a degree. It is hard, I imagine, to teach children the importance of education if a degree qualifies them only to drive a cab. We must tackle discrimination in employment to give people a sense that they are in a fair society and opportunities are there for them too.
Damilola was killed on the North Peckham estate. He was found in a deep, bleak, dark stairwell. The estate is being pulled down and replaced by houses in streets. Three quarters of the work has been done and the new houses are lovely. We could shut our eyes, walk into the middle of the North Peckham estate, open our eyes and think we were in Camberley or some of the other areas that Opposition Members represent. Southwark council's regeneration programme, which was started by the previous Government, has seen £260 million invested, and it will work. It is the largest regeneration programme in Europe and has taken five years. However, we must all ask ourselves why parts of the estate, like Blakes road, were not properly boarded up, and why some tenants are still left in semi-deserted, dangerous blocks that are falling apart while they await their new homes.
We must all look again at why, though the problems were clear, the responsibilities for solving them were not. The Peckham Partnership, not the council housing committee, was responsible for the regeneration of the five estates project. That partnership was a bold attempt by Southwark council to work across different council departments and involve tenants directly, all in the board. However, the lines of accountability became blurred. I am very pleased that Trevor Phillips, who is chair of the Greater London Authority, has offered to lead an inquiry into the process of regeneration so that we can learn lessons. Many other areas in London are about to have similar sorts of regeneration. Southwark itself is just about to embark on two further regeneration projects, one on the Aylesbury estate and one at the Elephant and Castle. We must not make the same mistakes again.
Amidst the grief and heart-searching, we have been touched by the incredible acts of generosity and concern. From all over the country, people have written, and I want to thank them and say how much that has encouraged the local community. I have had letters of support and concern from Perthshire to Eastbourne, from Cheltenham to Tottenham, and from Norfolk to the west midlands. From York, Joyce Pickard sent me a box of baby clothes for the local community. She tells me that she and her friends—mostly elderly ladies, she says—knitted these "offerings". Mrs. Gleave from Cambridge has offered to give the £100 that she and her husband each receive for winter fuel payments.
207 Last Friday, I got a phone call from Lord Harris of Peckham, who was actually born and brought up on Blakes road, where Damilola died. With huge generosity, Lord Harris has offered to build a community centre for young people and tenants on the North Peckham estate. Damilola Taylor's name will never be forgotten in Peckham and that offer, amidst the grief, has given fresh hope.
On the North Peckham estate, despair and hope are neighbours; they live side by side. Today, we share the despair of the Taylor family. However, the local community are determined to have hope for the future—people like Sabena Emmanuel and her son, who is doing his GCSE mocks at Sacred Heart school today; people like Debbie Welsh, whose teenage son Dominic, like his mum, now does community work, unpaid; people like Ali Bali from the Gloucester Grove estate and Maria Williams from the North Peckham estate. After the media spotlight has moved on, they and their families will still be there—and they want to be there. As they strive to improve their neighbourhoods, we all owe it to them to spare no effort to back them in their task.
§ 5.2 pm
§ Rev. Martin Smyth (Belfast, South)
We have all been impressed by the presentation of the right hon. Member for Camberwell and Peckham (Ms Harman), who spoke about the situation in her constituency. We all sympathise with the family. I understand from personal experience what the loss of a child means to a family, especially when extra tragedy is involved. It is understandable that the right hon. Lady went on to deal with the causes of those mishaps, accidents and, at times, deliberate mob violence. It is equally important that she spoke about education. I remember being in a school in Malawi that was still teaching logarithms. We do not find that challenge being given to many school children in our own kingdom. In fact, when I was asked how the Minister was getting on when education in Northern Ireland was being reformed, I said that I did not understand why he was trying to bring our standard of education down to that of England. I certainly support the thrust to improve the standard of education here.
I echo the right hon. Lady's point that the matter is not necessarily one of racism. Unfortunately, in the area of Northern Ireland that I represent, there has been a tendency for people of different ethnic backgrounds to be involved in robbery and attacks that are immediately construed as racist. Tragically, however, a standard of society has been generated that has allowed such things. We used to settle things by going round to the entry and using our fists. Whether or not that would be acceptable today, when we are not allowed to lay our hands on anybody, it would be much better than the use of knives and other violent weapons. I hope that we shall all support police services throughout the land in preventing crime and apprehending those who have perpetrated criminal acts.
I appreciate the opportunity to speak on the Loyal Address. I am aware that health and education are devolved matters in Northern Ireland, but I believe that the standards set in this House can impact on other regions of the kingdom. I should like to think that the House can 208 sometimes learn from what has happened in the devolved regions. I am a little puzzled, for example, about why the Government are now legislating to establish a children's commissioner for Wales, but not for England. Some people have been pressing for a commissioner in England for some time. People in Scotland would also like to have such a commissioner and I have in Northern Ireland a mailbag of letters from people who want a commissioner there. As the Government have decided to provide one for Wales, it seems appropriate that they should introduce legislation before the end of the Session to include England as well.
I welcome the Government's movement on long-term care, but there is some apprehension. Scotland has expressed an interest in implementing the royal commission's plans before the end of its parliamentary Session, but we still have a long way to go. I hope that we will not short change the commission by implementing only the aspects of its report that we like and leaving aside some of the more important, long-term proposals that would provide help for people who require care in the eventide of life.
I support the plea of the hon. Member for Rother Valley (Mr. Barron) on tobacco advertising. We fought the same battle at an earlier stage and I am glad to see that we have advanced this far. I underline the plea from the Select Committee on Health for a tobacco regulator. Many years ago, when I was a young assistant minister, I visited a home where a mother was speaking about the influence of advertising—the subtle influences of subliminal advertising which some of us have discovered recently. There were visitors in the home, and the mother, with Ulster hospitality, asked them what they would like to drink, meaning coffee or tea. A seven-year-old girl asked, "Would you like it wet or dry?" On the basis of my understanding of advertising, I believe that it is important for a degree of regulation to exist. Subliminal messages can lead youngsters in a direction in which no hon. Member would want them to travel, perhaps by encouraging them to endanger their health by starting to smoke at an early age. It is important to keep an eye on that.
With regard to nurses, it is a funny old world. We are recruiting nurses from Australia, while our nurses are going there to work. That can be good, as we can exchange ideas, learn new methods and such like. None the less, a cry of concern has come from the royal colleges and especially from midwives, who fear that the standard of midwifery has been dumbed down. If the late Audrey Wise were present today, she would be pleading for the midwives of the nation. Her activities in helping the Health Committee to produce its report on midwifery, as an occupation of health, not sickness, helped to transform midwifery in the country at large. I should like to think that we shall not minimise the value of midwives' work.
Last year, I campaigned on behalf of those who had been placed in respite care for a time and who, as a consequence, had become ineligible for their winter fuel allowance at the time when they needed it, back in their homes. I am delighted that the Government have acted on this issue. I am also pleased that, in the quest for equality, men who have retired under the age of 65 will now also qualify for the allowance, even though they are not state pensioners. I am glad to see some equalisation on that issue.
209 May I plead that Social Security Ministers examine the question of widowers who have been short-changed by decisions in Europe and overlooked in the past? The state and various charitable bodies were ready to assist widows in their affliction, but failed to realise that many men had been left in a parlous state to look after children and to carry on working with no extra support. When we examine questions of equality, we should remember those widowers.
Many proposals in the Queen's Speech are helpful, and I hope that they will be enacted. That will depend on whether the Government are serious about getting the proposed legislation through. I trust that they will give the House permission to scrutinise the provisions, rather than employing that old French invention to curtail freedom of debate.
Some may feel that crime has nothing to do with health, but when one is on the receiving end of criminals' actions, one discovers that it has. The problems of a widow came to my attention as a result of an article in Tuesday evening's Belfast Telegraph. Her husband had served for some seven years as a police reservist. Fourteen months after leaving the police reserve, while working as a taxi driver in County Armagh, he was murdered. The IRA stated at the time that he had been executedfor his services to the British war machine.Although the man was buried with police honours, his widow receives no pension. Because she had slipped through the net, the police benevolent fund has only recently begun to examine her case. She is now 81, and she has carried on to the best of her ability for about 20 years. Her sons, who were young at the time and are now mature, have tried to help her. People such as her are victims of our society and ought to receive more attention from the Government than the criminals who disturb our society.
In that context, I welcome the proposals for an international criminal court. I had misgivings, however, when I read the article by Lord Hurd in the Financial Times in which he argued against it, saying that there would have been no peace in Northern Ireland, or in another part of Europe, if the court had existed. Was he saying that we should let those guilty of the most violent crimes against humanity go free for the sake of a specious peace?
I was amused yesterday to hear Her Majesty say:In Northern Ireland, my Government will continue to work closely with the political parties and the Irish Government to secure the full implementation of the Good Friday Agreement.I thought immediately of the moment when Jacob received his father's blessing, and I was reminded of it this morning when I heard the Moderator of the Church of Scotland speaking in the Crypt. Although Her Majesty read the Address, it seemed to have been penned by the hand of the Secretary of State for Northern Ireland. I wonder whether that represented a way out for the spin doctor, in suggesting that things might not go as we want, because the Good Friday agreement does not exist: it is the Belfast agreement. I trust that we shall turn from spin to substance in the proposed legislation.
§ Mr. Andrew Rowe (Faversham and Mid-Kent)
I am pleased to follow the hon. Member for Belfast, South (Rev. Martin Smyth), and I was encouraged in what I 210 want to say by the contributions by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), the Chairman of the Select Committee on Social Security, and from the right hon. Member for Camberwell and Peckham (Ms Harman).
Beneath all its prosperity, the United Kingdom is in crisis. Despite all their opinion polling and focus groups, the Government seem to have failed to understand that. The public do not understand it exactly, but people sense that we are being taken in a wrong direction. They know now, for example, that in their lifetime the seas may become empty of fish. It is consoling to blame the European Union and global warming, but people know in their hearts that human greed will be responsible. They sense that we are close to disaster, even if they do not define it. In Kent, people have seen one river dry up completely, and are aware that the Stour, the last chalk stream in the county, may follow.
There is a growing sense in the towns that the war against drugs is being lost, and that the areas where the police are ineffective are growing faster than the laws to help them can be passed or implemented. Parents shop around for the right school, with the desperate sense that if they get it wrong, their children will learn nothing but how not to learn. People know, too, that the NHS will always lag behind demand. The Queen's Speech may claim that the Government stand firm on the founding principles of the service, but says nothing about Beveridge's key misapprehension—that a better service would result in reduced demand.
I submit that the Government do not understand what the country needs—and what is more, that this House seldom asks the right question either. Is the best that we can do as a nation really to devote all our energies and efforts to clawing our way up from being the fourth largest economy in the world to being the third largest? Should we follow the short-term, knee-jerk responses of opinion polls and seek to spread designer labels and Sony game consoles out to a slightly wider band of our citizens?
Should we be straining every muscle to extend life expectancy by a year or two, even if those extended lives are lonely and anxious? Do the Government share my unease that, in a world awash with guns and genocidal violence, the UK is the second largest arms dealer in the world? Do they share my shame that UNICEF believes that the plague of AIDS among the world's children could be arrested if the EU spent as much of its money on AIDS as its citizens spent last year on ice cream?
Modern democrats have so developed their power to taste public opinion that they are losing sight of true government, which does not consist of ascertaining the public mood of the moment and tailoring policy to match it. True government consists of taking a view of where the country should be heading and persuading people to share that view. On that test, this Queen's Speech fails almost entirely.
I believe that the Government Front Bench holds several Ministers who genuinely want to do good, but I also perceive that they do not know how to do it. Like mere managers, they substitute for the difficult art of truly understanding what makes their organisations tick the much easier device of pouring extra money and exhortation into the machine. That may produce some temporary improvement, but it does not solve the problems.
211 I shall offer some examples of what I mean. The Secretary of State for Health mocked me at Question Time the other day for not having read the NHS plan. I had accused him of destroying local responsibility for the service, and he replied that if I had read the plan, I would have seen how full it was of the rhetoric of devolution.
I had read the NHS plan, so I had seen the rhetoric. However, I say again today that local autonomy means very little if local trust boards find each month that their priorities are overruled by the Secretary of State's. Waiting list initiatives for various forms of treatment mean that local trusts can no longer respond to local priorities as they perceive them. Getting rid of the postcode lottery puts a pressure on trusts that destroys their local autonomy. If that continues, good people will cease to come forward to serve on trust boards.
Another example is the hours worked by young doctors. The rules have been changed, but the reality has not. I know a young doctor whose first years of married life have been extraordinary. On call for absurdly long periods spent mostly in hospital, he returns home too tired to do anything but sleep. Small wonder that it is hard to recruit and retain doctors.
I know a young teacher who went into her first job in an inner-city school full of life and enthusiasm. Her primary school class consisted of 35 children speaking 16 mother tongues. One little Turkish boy was so disturbed that he would rock himself until he was sick. Who cleared up? That was for the teacher to do, alone, in her first job. She cleaned him up while trying to keep the other 34 children in order. So good was she at the job that at the end of her first year she was offered the deputy headship. As a result of all that, she is taking her enthusiasm for teaching to Australia. Small wonder that teachers are hard to recruit and retain.
In my constituency the police tell me that drugs are no worse a problem there than elsewhere. If that is true, I can only despair. In some housing estates drugs are dealt in openly by day and night. The police know the houses where they are available; the residents know them too. The dealers threaten anyone who complains about them. Occasionally, dealers are sent to jail and their partners keep the business going until they come out. The new addicts that they hook are getting younger every day.
We have just been told by the Commissioner of Police of the Metropolis that despite the law on knives, they have become a fashion accessory among the young, but the number of arrests for carrying one is falling. Of course it is. Not only are there too few police, but they are frightened, not just of possible injury—that was part of the deal when they entered the force—but of committing an offence against the growing codes of correct behaviour.
Naming and shaming is one of the Government's favourite devices. It has to be said that one of its consequences is often to paralyse action all together. What is more, although it sticks in the gullet to say it, we have to remember that the children who killed Damilola Taylor are our children too. I can tell the Government that passing laws may look good to their spin doctors and focus groups in the short term, but they do not solve the problem.
212 We need a change in direction. We shall not reverse the tide of drugs, hooligan behaviour and greed by bringing in more and more ineffective punishments. We already lock up more people than almost any other country in Europe. Young men kill themselves, both in our care and outside it, at a higher rate than anywhere else. When we do find a prison that succeeds in rehabilitating more of its prisoners than any other, the Prison Service removes its governor and carries out a terrifying raid on it. The position is so bad in our prisons that they can make room for new villains only by releasing other villains early, yet the Government want to be still more punitive. In order to curb the few, they propose a generalised curfew that will simply antagonise the many without helping to solve the problem. This way madness lies. Sanity lies in affirming the good, not waving big and largely useless sticks at the bad. It is time the Government worked for the good people in society to change it—and the opportunities are all there.
Let us consider the Christian Churches, for example. It has been the custom among the Government and the media to mock and ignore the Christian communities in the UK. I accept that they have not helped themselves. It is a scandal that black Christians have had to found their own Churches because the established Church has been so unwelcoming. It is a scandal that so many Christians use the Bible to shore up their own prejudices rather than living out their faith in their own lives. However, the fact remains that if we were to remove all those who seek to serve Christ through their work, our public services, non-governmental organisations and many of our most successful businesses would collapse.
It is also worth remembering that in many of the most deprived areas of our cities the vicar is the last professional still resident, yet too often the Government give the impression that they are indifferent or even hostile to the Church. Sometimes this is because they are afraid of upsetting the minority faiths. They should not worry about that. The minority faiths are far more concerned about the spread of the consumer society, relativism in moral teaching and the erosion of the family than they are about the Christian tradition in the United Kingdom. Sometimes the apparent indifference and hostility is a result of the Government's fear that to encourage teaching of the Christian message will smack of indoctrination. They should not worry about that, either.
When JC 2000, the millennium arts festival for schools, set out a challenge to all UK schools based explicitly on the Gospel, not only did more than half UK schools respond, but they did so enthusiastically, and proportionately more state schools than Church schools took part. They welcomed the chance to explore questions of morality in a new way with their pupils. Many claim that the experience has changed the way in which they teach, and the way in which their children look at life.
Indeed, many schools with a huge majority of ethnic minority pupils also took part gladly. When Ofsted carried out a survey of religious foundation, it found that when it was well taught, it was a favourite subject among pupils. Children long to explore issues of right and wrong, justice and injustice, the purpose of life and similar issues. However, if we are afraid to encourage teachers to help them to do this—if we are paralysed by the idea of using volunteers from the faith communities to assist—we shall 213 further impoverish our society and encourage the spread of the uncaring individualism that contributes to yobbishness.
Let me suggest ways in which the Government could improve the situation. First, they could affirm what good schools are trying to do, rather than undermine them. I have a high regard for the motives of the Secretary of State for Education and Employment, but I believe that he has allowed his enthusiasm to outrun his common sense. If wishes were horses, beggars might ride. So it is at the Department for Education and Employment. I am sure that he is right to believe that more children with disabilities should be included in mainstream classes. However, the present inclusion policy, with so few assistants in place and so little training available to teachers, makes it very hard for teachers to give sufficient attention to all the other children in their class.
Similarly, I am sure that the right hon. Gentleman is right to cast doubt on the justice or propriety of excluding so many children on disciplinary grounds. Yet when the head of an inner-city school, who has made his school the most sought-after in the borough, tells me that he spends more than half his time on disciplinary matters because there are no effective sanctions left to him, I ask whether the Government are not contributing to teacher stress by trying to run before they can walk.
In passing, I ask whether it would not be sensible to ensure that children entering primary school have at least the basic tools with which to benefit from the education on offer. In a school where 43 mother tongues are spoken, and the pupils come and go as the tides of immigration or rehousing ebb and flow, is it fair to expect teachers to solve the problems that that throws up? Why not ensure that the local communities have prepared the children to speak at least basic English before they come to school?
Secondly, the Government remain strangely reluctant to give local people control over serious money. They talk a lot about trusting people, but clearly they do not. If local people were allowed to indent for the money that they want to spend on local services, such as clearing up after the bin men or removing the hypodermic syringes from the grass in front of their flats, we might see an improvement in local conditions and a growth in local confidence.
Thirdly, the Government should take seriously both the voice and the practical contribution of young people. I am grateful for the support that they have given me for the UK Youth Parliament so far; I am afraid that I shall need to come to them for some serious money. They have left us to raise almost all our own finance, and for many reasons that is taking longer to achieve than I had hoped. The result is that between 300 and 400 young members of the Youth Parliament, elected amid huge enthusiasm all over the UK, will come to London in February, but we cannot pay for their accommodation. The sum required—£200,000—seems huge from where I sit, but to a Government who spend new billions almost weekly on carrying out their policies, it is a tiny figure. I hope that if the Government who in the Queen's Speech reveal an intention to introduce a curfew on under-16s are serious about listening to the voice of the young people directly affected, they will be able to find us the money, even if only in the form of a loan.
I end where I began. Amid our superficial prosperity, the country is close to crisis—a moral crisis. People are beginning to know it. A brave Government would respond 214 to that crisis and that realisation. They would build on the compassion for the wider world articulated by Jubilee 2000. They would respond to the hundreds and thousands of men and women who work night and day to redeem their communities—by trusting them with the resources that they need. They would affirm teachers, social workers and doctors as they wrestle with unending and often incompatible demands. They would be grateful for the continuing struggle of the Christian tradition, rather than ignoring or positively undermining it. In those respects, the Queen's Speech was sadly lacking.
§ Mr. Michael Fallon (Sevenoaks)
It is customary to begin by welcoming the Bills in the Queen's Speech with which one agrees. The difficulty is that those I would have agreed with have been left out. I was looking forward to a Bill on adoption, but there is not one—nor is there a Bill to reform mental health legislation.
I pressed the Secretary of State about five hours ago as to why he gave a Bill to ban tobacco advertising greater priority than the necessary Bills on adoption and mental health, and his answer was revealing—it was in the Labour manifesto. That is why it has a higher priority. Incidentally, he answered me on adoption, but he did not tell me what has happened to the proposed reform of mental health legislation. Perhaps the Minister of State could assist as he has been responsible for the matter.
§ The Minister of State, Department of Health (Mr. John Hutton)
I am grateful to the hon. Gentleman for allowing me to put the record straight. In the summer, we answered a parliamentary question of which I am sure he is aware, in which we made it clear that we would publish a White Paper on reform of mental health legislation before Christmas. That is still our intention. As a former Minister, he will agree that it would be unusual to produce a Bill ahead of a White Paper.
§ Mr. Fallon
I accept that and I am grateful for the explanation. I rest my case on the general point that mental health was a Government priority when they came to power. Before the election, they talked big about it and I should have hoped that something would have been done by now. If it is done in the next year, I will welcome it.
Much of the rest of the Queen's Speech seems to be a great deal of fuss. I welcome the Bill to reform again the law on special educational needs and want to take an interest in it. The Prime Minister's phrase yesterday was revealing. At one point he said:We are legislating at every level.—[Official Report, 6 December 2000; Vol. 359, c. 29.]That is what the Government are good at. They are good at legislating, regulating and bureaucratising at every level. It does not necessarily follow from the Queen's Speech that the legislation promised will crack down on violent crime, or help to raise standards in the first years of secondary education. I do not see how one can do that through legislation.
We need more nurses and teachers in our public services and less bureaucracy. We have to subject all the proposed Bills—Home Office, education and health Bills—to the street test. Will they help the delivery of front-line public services? Will they make things easier in our hospitals? Will they make things easier for the police? Will they help our teachers to teach?
215 The fastest and the most important way to help the health service to improve is to assist it with recruitment and retention. One problem is the high cost of living and the way the Government are tackling it. They have become very confused with their various initiatives to help nurses, teachers and the police to find accommodation in higher-cost areas.
The Government have a starter home initiative, which has got to the Green Paper stage. A young teacher in my constituency who teaches at Fawkham primary school and who is getting married next year asked me on Friday what had happened to that initiative, which was supposed to assist young professionals like her in the public services. I had to tell her that I did not know. The Green Paper has been published, consultation finished in July and the money was earmarked for the start of the new financial year—£50 million from April—but as yet we do not know which areas it will cover, which public service workers will qualify or how the scheme will be administered.
The Home Office is running a separate scheme. It is giving an extra £3,300 to Metropolitan police officers. That has had an immediate effect on areas around the metropolis. We face the absurd situation that police officers serving in Essex or north Kent can resign and then join the Metropolitan police and receive that extra sum. They are still in the police service, but in a different force just across the border. The Home Secretary is aware of the problem and proposes a 30-mile radius around London where other areas might also qualify for that sum. I am not clear whether that will extend from the centre of London or from the London boundary.
That beings me to the national health service. When the Secretary of State for Health announced his plan last month, he said that he was introducing a cost of living supplement for high-cost areas outside London. He read out a list of counties that qualified—Buckinghamshire, Berkshire, Sussex and Surrey, but not Kent.
When I visited the brand new Darent Valley hospital, which the Secretary of State will visit next week, I was asked the same question that he will be asked: why does Kent not qualify for that supplement? Why should a nurse receive more just over the boundary in Sidcup than in Kent? Perhaps Kent qualifies, but it was not in the list of counties that he read out. I was even more puzzled when the hon. Member for Romsey (Sandra Gidley) was told that Portsmouth and her part of Hampshire qualified for the cost of living allowance.
The Government need to join up those matters. If there is a problem in finding accommodation in high-cost areas for those people whom we want to attract into nursing, policing and teaching, we do not need separate allowances, operating from different dates in overlapping areas. I urge the Minister to address that matter with his colleagues in order to achieve some coherence across the Government.
We are promised more reorganisation in the health service. Since I re-entered this place in 1997, the trusts with which I deal have changed constantly. Every few months, I receive a letter saying that this trust is to be merged with that trust—the names keep changing. That process will continue; there are to be primary care trusts and the community health councils will be abolished. We are to have more and more reorganisation. The NHS does not need that.
216 When I read the NHS plan, I was struck by the series of bureaucracies that are to be created—agencies, boards and commissions—a huge amount of extra bureaucracy. If that is what the proposed Bill is about, I urge the Minister to take it away and find a better way to help those in the front line of nursing and hospital care. The last thing they need is even more reorganisation.
I was struck by a note of humility in the Queen's Speech: the Government will introduce a Bill to reduce the regulatory burden—there will be more regulation to reduce regulation. After three and half years, that is an extraordinary admission. They need to reduce the burden that they have created. The best way—indeed the only known way—to reduce that burden is not to heap regulation on to business in the first place. It is absurd to produce more regulation, designed toincrease the effectiveness of the power to reduce regulatory burdens.If the Government want to do that, they could do so straight away by telling the Department of Trade and Industry to stop piling regulations on to small businesses.
The Government could introduce more sunset clauses, as we propose, so that some bureaucracies and regulations disappear when they have served a useful purpose. The Government could copy the techniques of regulatory budgeting used in other countries, whereby Ministers are not allowed to add to the statute book unless they undertake to remove unnecessary and redundant legislation in the same field.
What was missing from the Queen's Speech—as it has been from all the Government's programmes—was a serious attempt to reform welfare. Furthermore, there are no measures to encourage rather than to over-regulate small businesses.
Yesterday, the Prime Minister admitted that transport is in chaos, but the Queen's Speech proposes no action to deal with the chaos that our constituents have to face day after day as they commute into the capital or take longer journeys across the country. Connex South Eastern told me yesterday that it has now been told by Railtrack that the commuting delays into London will last well into February. There is something for the Government to get on and try to sort out, instead of introducing all this unnecessary, fussy regulation. This is a Government, after all, who had a huge majority, who could have passed any law that they wanted, who started off with big popular support, who had an economy in good shape and who have plenty of public money to spend; and, nearly four years later, what have they got excited about? This Parliament will be remembered for getting rid of the hereditary peers, changing the law on homosexuality, and now the attempt to ban hunting.
Hereditaries, homosexuals, hunting—these are all interesting causes, but they are not, I think, of direct consequence to people in my constituency. The NHS is short of nurses. Its staff are demoralised. There are fewer police in Kent than there were when Labour started back in 1997, and our teachers and the schools are overwhelmed by bureaucracy. Those are the priorities, but they are not the priorities of the Government.
§ Mr. David Tredinnick (Bosworth)
You can imagine how pleased I am to catch your eye, Mr. Deputy Speaker, having sat in the Chamber almost continuously for six hours. It is a considerable relief.
217 It is a great pleasure to follow the Kent Members, my hon. Friend the Member for Sevenoaks (Mr. Fallon)—I nearly said Darlington—and my hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe), who entertained us and made some serious points about law and order, and some religious issues.
I am very relieved to see the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), on the Front Bench. I apologise to those on both Front Benches because, owing to a long-standing engagement of some months, I may have to leave before the winding-up speeches are complete. It is a pleasure to see the Minister because there was some very real concern on the Opposition Benches earlier that when some speeches were made no Health Minister was present. That is very regrettable.
My hon. Friend the Member for East Hampshire (Mr. Mates) has been in this place for 26 years. I have been here for only half that time, but I cannot remember speaking in a Queen's Speech debate and there not being a relevant Minister on the Front Bench when we were addressing issues pertaining to a particular Department. It is a sadness because the Minister would have heard, in particular, the eloquent plea by my hon. Friend the Member for East Hampshire about the catastrophic circumstances at Queen Alexandra hospital, where not enough surgical instruments are sterilised for operations. I am not sure whether the Minister was present to hear my hon. Friend the Member for Broxbourne (Mrs. Roe) say starkly that waiting times had lengthened from 12 to 18 months. Those were very powerful contributions.
I want to try to help the Minister this afternoon. [Interruption.] I saw his smile disappear and the corners of his mouth turn down when I said that. In a way, I do want to help him. This afternoon, we heard from the Secretary of State that there would be problems in the NHS this winter—we know that from Conservative colleagues—but we also heard of some of the plans for the future of the performance fund, which will increase from £500 million to £1,000 million, and of intentions to strengthen the power of patients and to give more power to the public. I want to suggest to the Secretary of State ways that he may not yet have considered to implement those intentions.
The Secretary of State says that he wants to break down the barriers between the services, improve help for older people and provide new health facilities. Most of those are recommendations in the Lords Select Committee on Science and Technology report on complementary alternative medicine. It will be no surprise to some colleagues that I choose to speak on that topic this afternoon, as I have had such a long-standing interest in it since my election in 1987.
I put it to the Minister that it really is time for Her Majesty's Government to embrace complementary and alternative medicine. When I was preparing these notes, I remembered a speech made by the right hon. Member for Chesterfield (Mr. Benn), who has just celebrated 50 years of service in the House, although it was broken once. What he said is very apposite to the arguments that I want to make about complementary medicine. He said:I have referred in the past and I would like to refer again—I know that it is very painful to the House of Commons to be told and reminded yet again—to how social progress is made. We like to think that it is made by an amendment from a Back Bencher, and accepted by the Government. It is not like that at all. Social progress is made when public pressure builds up.218 That is exactly what has happened with complementary and alternative medicine. About a quarter of the population use it. There is pressure in surgeries on doctors who are being asked about it and huge media coverage, so there is grass roots pressure for it.
The right hon. Gentleman continued:My experience is that when people come along with some good idea, in the beginning it is completely ignored; nobody mentions it at all. If people go on, they are mad, and if they continue, they are very dangerous. After that, there is a pause and then nobody can be found who does not claim to have thought of it in the first place. That is how social progress is made.—[Official Report, 3 March 1995; Vol.255, c.1316–17.]That applies to complementary and alternative medicine.
When I entered the House in 1987 and started talking about osteopathy and chiropractic for the health service, I was thought to be coming from some sort of loony health tendency. These were disciplines that doctors despised and would have nothing to do with. If one went to a chiropractor, one certainly did not tell one's doctor. When in 1983 I was treated by a chiropractor for a fracture of the spine, I certainly did not tell my doctor. The chiropractor solved the problem.
Paradoxically, those disciplines that in 1987 were seen as completely off the wall are now not only formally on the wall, but have gone past the Table and are now more or less enshrined in statute law. That is perhaps a reason why the issue has attracted so much interest in the House. It will not have escaped the attention of the Minister of State that yesterday 131 Members from all corners, backgrounds and parties signed the early-day motion in my name, which supports the acceptance of some of the ideas in their Lordships' report on complementary medicine. In fact, they constitute one fifth of the House of Commons and that is a fair reflection of the population who use complementary medicine.
If McKinsey or another management consultancy were given the opportunity to visit the Department of Health and the Secretary of State told them that we were going to have another health problem this winter, they might ask to look at the health resources available. Sooner or later, down the list past the doctors and nurses, they would find 50,000 complementary and alternative medical practitioners. They would ask him what was happening about those people and he would say, "Actually, because the regulation is not quite right and because we have not conducted clinical trials on all their disciplines, we don't use them very much. We don't have much to do with them."
In his speech the Secretary of State said that the health service was in a period of expansion. That is a contentious remark. It is certainly not the case with complementary medicine, which is in a state of contraction. Under the old GP fundholding arrangements, which this Government have much maligned, doctors could allocate some of their budgets to complementary practitioners who took pressure off the hard-pressed doctors.
Since the primary care group system has been introduced, the amount of treatment has decreased. I have written to the Secretary of State and his Ministers about this with examples. That happened because when the primary care groups were set up there was not enough time or expertise to shop around for complementary therapies. Today the Secretary of State said that we want more doctors, nurses, beds, GPs and consultants. He said that we shall have more money, but there was nothing about more complementary care in the health service.
219 In a sense I want to help the Minister. The powerful report from the House of Lords gets him off the hook because it categorises the complementary world into three sections, which The Independent described as the acceptable, the not so acceptable and the unacceptable. It is a list of the so-called big five. I have already referred to the first two—osteopathy and chiropractic care. They are regulated by statute and doctors recommend them. That is fine; they are almost in mainstream health. It then lists homeopathy. The Faculty of Homeopathy has existed for a long time and has a charter. Other homeopaths are sorting themselves out and are almost ready for statutory regulation. The list also contains herbal medicine, which has been around since time immemorial, and acupuncture.
There is no reason why the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), cannot expand such activities. Already in the past 12 months a new homeopathic hospital has opened in Glasgow, but the Royal London Homeopathic hospital NHS trust has had to cut back because the local health authority decided to chop the budget. That confirms a point that I made earlier. The Minister of State should tell his colleagues to implement the first list and make more use of those treatments. If he did so, he would take pressure off the hard-pressed doctors and hospitals in the winter. Complementary practitioners are effective in dealing with what, behind closed doors, doctors call heart-sink patients—those whom they cannot treat. The Minister of State could make life much easier if he got the big five more involved.
If someone goes to a doctor's surgery with a terrible cold, the doctor will almost certainly say, "I can do nothing for you." Unfortunately, no doctor is present at the moment. [Interruption.] I apologise to the hon. Member for Isle of Wight (Dr. Brand); he was obscured by another distinguished colleague. Doctors might say that about colds, but that is not so with homeopathy. I have a list of nine remedies for colds, which I pulled out of a box that I keep at home. The list includes aconite, allium cepa—which is onion—bryonia, dulcamara, gelsemium, hepar sulph, nux vomica, phosphorus and pulsatilla, and they all deal with different symptoms. The hon. Member for Poplar and Canning Town (Mr. Fitzpatrick) may not help his career if he nods in favour of my speech, but I am grateful to him for doing so. The list of remedies includes the symptoms, such as:Thirsty for small amounts of water. Throat raw, sore and hoarse. Much sneezing.Homeopathy empowers patients—the very thing that the Minister of State wants to do. It gives patients the chance to make up their own minds. Of course, for the past four or five years people have been able to buy a range of homeopathic preparations from any chemist shop in the country. The Minister of State needs NHS-qualified homeopathic doctors who can give "constitutional remedies" which require sophisticated diagnosis. Homeopathy is a sophisticated science.
The Minister of State must act on the recommendations in the report on standards, regulation and training. If he does so, he could move more complementary practitioners into the main stream of health. Some of the recommendations in the Select Committee report are aimed at the Government. It recommends a central mechanism for 220 co-ordinating and advising on complementary medicine reform. It wants the NHS research and development division and the Medical Research Council to pump-prime areas with dedicated research funding. Again, that is something for the Minister of State to consider. It recommends that centres of excellence should be set up across the country to help to develop and integrate those services.
The Minister of State is off the hook on the first five categories; they are covered by Act of Parliament and are well regulated. The second category that the House of Lords drew up—including aromatherapy, reflexology and healing—is more difficult. They found that the governing bodies were insufficiently co-ordinated. Aromatherapy, which I know well, has about 12 different governing bodies. The problem is that they do not have the resources to get together. If the Government can find the time and money to draw those bodies together, they could achieve statutory regulation. At Hinckley in my constituency, Shirley Price Aromatherapy trains nurses at the Leicester Royal infirmary to use aromatherapy oils to prepare patients for operations. That is an important category of treatment.
In respect of reflexology and spiritual healing, there are 14 different healing organisations in the country. Most of them are regulated by the Confederation of Healing Organisations. Those people treat terminally ill patients among others. Organisations such as the National Federation of Spiritual Healers do not even accept payment; it is a free service. It can help patients and augment doctors' work.
I have some problems with the third category in the report, because the House of Lords almost ran out of steam in its consideration of it. It included in the category of so-called questionable therapies Ayurvedic medicine from India and traditional Chinese medicine. It was a terrible mistake to suggest that neither of them is proven.
Ayurvedic medicine goes back 3,000 years. Of it it has been said:The Mind, Body and Spirit is the tripod of life so deal with each with Respect".That was said not last week or last year but in 800 BC by a Mr. Chavak. At that time, the ancient Greeks travelled to India to study at the universities there. Aspirin was invented only in the previous century—that is how far back our conventional medicine goes. I mean no disrespect to the doctor, the hon. Member for Isle of Wight, but the Ayurvedic system is very old.
I am astonished by the report's view of traditional Chinese medicine. Beijing university offers postgraduate courses in traditional Chinese medicine to doctors in London. There are about 60 universities across China. I shall give the Minister an early Christmas present—a House of Commons box of chocolates—if he can guess, with a margin of error of 10 million, how many patients in the world are treated with traditional Chinese medicine. I see that he is not going to rise to the Dispatch Box, so I shall tell him: 1 billion patients—between one fifth and one quarter of humanity—are treated with traditional Chinese medicine. However, the report from the other place states that the case for it is not proven. Traditional Chinese medicine has been around—and has been proved—for thousands of years.
Complementary medicine can help to treat patients with cancer. That subject is important in the House, which has three or four cancer groups. Yoga can help with cancer, 221 as can diet, and healers can also help. There are masses of ways to deal with the problem. [Interruption.] I am advised that other colleagues wish to speak. Despite having sat in my place for six hours, I do not want to deny other hon. Members the opportunity to speak.
All the therapies listed in the Lords report, even crystal therapy, have validity. To finish, I shall quote Professor Karol Sikora, professor of international cancer medicine at Imperial college school of medicine, Hammersmith hospital. Speaking at a cancer care conference last week, he said that by 2020 all the complementary therapies would be integrated into the health service, alongside other therapies, and would be part of a formal care package offered by the national health service.
I think that patients will expect that from the doctors; the doctors will provide it. It is only a question of time. Either the Minister will ignore the issue of alternative and complementary medicine, in which case he will be overtaken by it, or he will swim with the current. I wish him well.
§ Mr. Tim Loughton (East Worthing and Shoreham)
I am glad to follow my hon. Friend the Member for Bosworth (Mr. Tredinnick), not least because he reminds me that my supply of echinacea is running low, and I need to book an appointment with my aromatherapist. Geranium and evening primrose is my chosen cocktail.
To return to the Queen's Speech, perhaps, I take issue with my hon. Friend on one matter. It is news to me, as a student of classical archaeology, that the Greeks sailed round the Cape of Good Hope in 800 BC. However, we can talk about that at a later date.
Yesterday's Gracious Speech was one of the worst examples of boom and bust, to use that favoured phrase of the Government. There was a boom last year, when 28 Bills were crammed into last year's Queen's Speech. Five of those Bills were still lingering during the final week of the previous Session. Hundreds of amendments were agreed to in the concluding weeks of that Session, but they were not considered in the House because our debates were guillotined. That boom involved legislation that was ill thought out and rushed through, and I am sure the Government will come to regret that at a later date.
After last year's boom, this year we have a bust—there is a great paucity of legislation. There are only 15 Bills in the Queen's Speech, a few draft Bills and several vague promises of progress on legislation. It contains a fairly motley collection of pseudo Bills and sloganising, and it is aimed cynically and solely at cutting and running to a spring election.
One of the most cynical measures in the Queen's Speech is the last-minute Bill on hunting. Regardless of what one thinks of hunting—I am no fan of it—the Bill has been included in the knowledge that it is unlikely to become law. It was proposed after a Government commission published the Burns report which made no case that hunting was cruel or that it should be banned. The Bill has been included primarily to pander to the class-war posturings of Labour Back Benchers for whom hunting is all about toffs on horseback and bashing the establishment, and for whom the welfare of animals is a lesser consideration. I say that as someone who has never been involved in hunting and who has no ambition to be, but I am incensed by the onslaught on civil liberties that the Labour party's hijacking of the issue has become.
222 The Queen's Speech is largely about addressing problems that have worsened under the Government, not least, as my hon. Friend the Member for Sevenoaks (Mr. Fallon) said, in the proposed deregulation Bill, which will tackle the 3,473 extra regulations that have sprung up in the past three and half years. However, a third of the Bills that we are vaguely promised are to do with law and order. The Government promised to be tough on crime and its causes, but that has manifested itself in a reduction of police numbers, which have decreased by more than 3,000 since May 1997. That has no doubt contributed to the first rise in crime in the past six years and the additional 190,000 offences that were committed last year.
We hear so much from the Prime Minister and the Home Secretary about recruiting new police officers, but we are never given the net figure. In 1999–2000, 4,535 new police officers were recruited, but against that must be set 5,948 who left the force. There were 5,391 new recruits in the year before, but 6,104 police officers left the force. Those are the true figures. In addition, the demoralisation of the police force, which has to work in very difficult circumstances, is exacerbated by the Government's releasing criminals early and allowing police numbers to be so reduced. That is a real problem that we face.
After three and a half years, we are promised more legislation to deal with crime, which has worsened under this Government. The Session will include a new Bill for curfew orders, which were first proposed in a Bill a couple of years ago. Since that measure came into effect, not a single order has been used. Anti-social behaviour orders have also been introduced. They sound good in principle and I would support them if they were properly implemented, but only 130 have been applied in the whole country. The measure has not been properly followed through or set up.
Law and order is about getting the mechanics of enforcement right and in place, and influencing attitudes. The Government have failed dismally in all those respects. Measures in the Queen's Speech are a late attempt to Sellotape over their failings, but they are all spin and sloganising ahead of a general election; they have precious little to do with delivery. Why should my constituents again trust this Government on law and order? At least this year they have learned the lesson of last year's Queen's Speech, which was disgracefully littered with highly political new Labour soundbites such as the aim to modernise, references to the challenges of the new millennium and a claim that more people are in work than ever before.
If there is one issue on which my constituents have completely lost confidence in the Government's ability to deliver, it is that of health.
We all remember the slogans ahead of May 1997—"24 hours to save the NHS." We all remember how health was supposed to be an "early priority" of new Labour. We in my constituency remember local sensationalist campaigns about the crisis in the NHS, supposedly organised by local Labour activists and councillors, all of whom have fallen strangely silent, despite all the problems that we in the area continue to face. Let us read that part of the 1997 Labour party election manifesto headed "We will save the NHS", in which we were warned,if the Conservatives are elected again there may well not be an NHS in five years' time;223 we were promised,if you are ill or injured there will be a national health service there to help;and we were told thatAfter six years, bureaucracy swallows an extra £1.5 billion per year.Despite all the complaints heard before the elections, what has not been mentioned since is that there are now more bureaucrats and managers employed in the NHS than ever before—certainly more than there were three and half years ago.
The promises have not borne fruit for the people of my constituency. Seven months after tabling a parliamentary question to the Secretary of State for Health asking for the average in-patient waiting times in hospital trusts throughout the country, I recently received the answer. It reveals that, of 260 hospital trusts in the whole of England, the Worthing and Southlands hospitals NHS trust in my constituency has the seventh longest waiting times—the seventh worst.
It has nothing to do with the dedication and the hard work against all the odds of the staff in local hospitals, but we have now been told that the average waiting time in my local hospital trust is 149 days—and even that will come as a surprise to the many constituents who complain to me that they still have to wait 15 or 18 months for an operation, especially hip or cataract operations. Worse still is the fact that the average 149 days they supposedly wait now represents a deterioration of about one quarter from the 118-day average wait recorded in March 1997. The position continues to worsen.
That has happened in the relatively affluent area of Sussex, which does not have many of the inner-city health problems experienced in other parts of the country, but also in the top seven trusts with the longest and worst waiting times is the neighbouring Surrey and Sussex Healthcare NHS trust. The population of constituency has one of the highest proportions of pensioners and retired people in the country, and Worthing itself has the highest proportion of pensioners in the country—people who have the least time to wait for important operations. Given the large elderly population, the pressures we face are not surprising.
There is a knock-on effect in the shortage of care beds, which the Government so often deny, and in the residential homes being forced out of business, especially in my part of the world, such that I believe that the largest owner of residential homes in the country is now an accountant acting as an administrator for those that have gone out of business.
Why is it that, recently in my constituency, a lady came up to me full of praise for the NHS? She had just had a toe operation—a relatively small procedure. She had been taken into hospital within weeks for an easy operation and, after an overnight stay, she had been bandaged up and discharged. However, the lady next to her, who then approached me, had waited 17 and a half months for a hip operation, even though she had been hobbling around for many years. It strikes me as a warped sense of 224 priorities when real clinical need makes way for patients who can be treated quickly, easily and inexpensively and so be subtracted from the number on the waiting list.
Why is that, in 1997, there were 75 nurse vacancies in my constituency and, three and a half years on, there are still 75 nurse vacancies in my constituency? Many nurses who have left the NHS return as agency nurses to fill the shortages and often work in the same wards alongside colleagues with whom they previously worked, but they are paid, on average, more than 13 per cent. more than they were paid before. That is absurd, especially in the light of the added costs placed on the hospital trusts concerned. That position is becoming worse and nurses are becoming more demoralised despite all the warm words from the Government.
What is the Government's response? It is a health and social care modernisation Bill. As my hon. Friend the Member for Sevenoaks said, that is more about reorganisation for reorganisation's sake and yet more managers. A priority within that Bill is the abolition of community health councils. Legislation will also be introduced to ban tobacco advertising, another one of the health measures promised in the Queen's Speech, three and a half years after the Government promised such changes in their manifesto. They drew back when Mr. Ecclestone came calling at No. 10.
I was a member of a community health council in Wandsworth for about four years. I am aware that CHCs play an important role in the NHS as the independent friend of patients. That gave rise to comments by the Prime Minister's agent, who wanted toadd congratulations to the work that CHCs have done … wishing them every success in the future.Now we know that that was a hollow congratulation because they are to be abolished unequivocally with no consultation.
It was interesting that at the beginning of the debate the Secretary of State for Health ran off a list of criticisms about the way in which CHCs did not work in many instances throughout the country. Many CHCs will take that extremely badly, after all the hard work, much of it voluntary, that they do. The CHC experts, the patients concerned, said through their spokeswoman that the proposal to set up a patient forum in every trust is a step forward, but only if these are in addition to an independent outside body with some form of national co-ordination. She said that the national plan pays lip service to the idea of strengthening the influence of patient views and that, in reality, the new arrangements are likely to leave the patient voice fragmented, localised and easy to ignore. Is not that right?
The success of CHCs is that they are physically at arm's length from the local health authority, often set up in shops in the high street. They are seen to be independent, with much voluntary input and much good will, and they get on with their job. If there is one criticism of CHCs, it is that they are not well known enough and that more people do not go to them sooner.
I work closely with the Worthing CHC under its excellent head, Trevor Richards. It has been responsible in my constituency for highlighting the threat of the closure of the Southlands hospital and fighting against it. It has highlighted gaps within the mentally ill health facilities in West Sussex in particular, which is a great concern of ours.
225 The proposed measures will mean that CHCs will be replaced by talking shops and panels which, in the words of Joyce Robbins, will amount toa hospital trust employee sitting in the reception area of a hospital smiling nicely at cross patients.The Government have strange priorities. A key measure on health in the Queen's Speech is about abolishing an independent watchdog in the NHS. The inevitable dilution of scrutiny will do nothing to help my constituents who are waiting 18 months for a hip operation. It will not do anything to help my hospital improve on its position of 253rd in terms of the longest waiting times throughout England.
The Government have strange priorities also when we are promised measures on adoption, housing, consumer protection, urban renewal, voting systems, reform of the House of Lords and on commonhold, for example, but find that they have all been nudged out by a small, scruffy little Bill to ban tobacco advertising. I hold no particular flag for smokers. I am delighted that at the age of 66—today is his 66th birthday—my father has remained off the weed for about three months, after 45 years of smoking incessantly and annoyingly. He was not remotely influenced by brand advertising, either when he took up smoking as a student or when he gave it up as a pensioner. He would have been much more influenced by well-designed advertising about the hazards of smoking, particularly recent advertisements from the Department of Health carrying the message that it is never too late to give up, although I do not think that he would admit it if I put it to him directly.
By means of a ban, the Government hope to reduce smoking by 2.5 per cent., especially among young people. That is a laudable aim, yet under the Government smoking has already increased by 3 per cent, largely due to smuggling. That is where funds, resources and Government time would be better directed. The biggest single threat is from cigarette smugglers selling cheaply from car boots outside school playgrounds, as happens throughout the country. It would be much better if the Government targeted their resources at those problems, rather than using the usual blunt instrument of politically correct regulation.
It is ironic that a Government who allegedly intend to regulate the availability of another health hazardalcohol—by moving to 24-hour licensing are now clamping down instead on tobacco advertising, although they seem to have shied away from measures on alcohol. They are going for the easy hit on tobacco, although there is little evidence to prove a link between advertising and increased usage, and despite the impact on sport funding, after the lottery has lost so much money for sport because of the sixth good cause.
I am for anything that will persuade more people to shun smoking, but the Government's proposed measure is not it. For a ban on tobacco advertising to take precedence over all the areas that I have mentioned shows a warped attitude to priorities on the part of the Government.
There is to be a Bill to compel police to hunt hunters, ahead of empowering police to hunt down the proceeds of drug dealing; a Bill to introduce gimmicky and unproven house buyer packs, instead of long-awaited legislation to deliver reforms in the provision of decent housing, which has so deteriorated under the Government; a Bill for bouncers, ahead of any progress on the 226 constitution of the upper House; and a Bill to ban tobacco advertising, ahead of any primary legislation to produce the much-needed boost to urban regeneration so hyped up in the vastly oversold urban White Paper—what strange priorities. Surely the entire Queen's Speech, so typical of new Labour's approach, is all spin and no delivery.
§ Dr. Peter Brand (Isle of Wight)
I am grateful to the hon. Member for East Worthing and Shoreham (Mr. Loughton) for leaving me a few minutes. I noted his contribution, but I did not agree with a great deal of it.
The debate has been wide ranging. I shall not speak about the NHS part of the Queen's Speech. My concern is the missed opportunity to examine what all the Government Departments are doing in relation to health—the broader aspects of health.
Health is not the business only of the Department of Health. It is the business of the Home Office to make sure that people feel secure, that the streets are safe and that people feel connected with their community. A curfew will not help with that.
Health is very much the business of the Department for Education and Employment. I look forward to seeing the details of the legislation dealing with disabled children in schools. At present, there is not a good link between the two Departments, and with social services, to establish what constitutes proper care, for example, of people with autism. Such guidelines require education, health and social services input.
I am pleased that we are linking health and social security. People should feel secure socially, but I am sorry to say that the way in which social security is accessed often creates ill health, rather than overcoming it. The mechanisms for getting support are complicated. If people are prepared to abase themselves, they do well, but if they are confused, upset, mentally ill or stroppy, it is extremely difficult for them to get access to some of the services that they need.
People with a mental illness cannot get their housing benefit verified until they have been seen by a verifying officer. The word of their community psychiatric nurse, whom they may know, or a psychiatric social worker is insufficient.
Even within the limited scope of the legislation that will come before us in the next year, there are opportunities to address some of these issues, so that the legislation will reflect some joint thinking at the top, at Government level, so that the people who deliver at client, patient or citizen level are helped, rather than obstructed, by Government initiatives.
§ Mr. David Willetts (Havant)
We have had a wide-ranging debate this afternoon, with some fascinating contributions. I learned a lot about complementary medicine from my hon. Friend the Member for Bosworth (Mr. Tredinnick), who is no longer here. We also heard from my hon. Friends the Members for East Worthing and Shoreham (Mr. Loughton) and for West Chelmsford (Mr. Burns).
I want particularly to refer to two speeches that raised acute constituency problems. We were all struck by what the right hon. Member for Camberwell and Peckham 227 (Ms Harman) said about the situation in Peckham and the death and horrific murder of Damilola Taylor. I am sure that everyone on both sides of the House would like to associate themselves with what the right hon. Lady said about the tragic murder in her constituency.
My hon. Friend the Member for East Hampshire (Mr. Mates) spoke powerfully about a constituency matter that affects the people in Havant whom I represent, and who have suffered grievously as a result of the crisis at the Queen Alexandra hospital. It is the main hospital serving my constituency, and I was there last Friday for an up-to-date briefing on the problem.
The Secretary of State for Social Security sometimes disappoints me with his failure to answer my questions on social security, but I wish to make it clear that I do not expect him to display any familiarity with the crisis at the QA hospital. However, given the disappointing absence of Health Ministers from the Front Bench, to which my hon. Friend the Member for East Hampshire drew attention, I hope that he will draw to his colleagues attention the seriousness of the situation in south-east Hampshire. I see that a Health Minister is here now—the hon. Member for Barrow and Furness (Mr. Hutton) has finally arrived.
There is a serious problem in health care in south-east Hampshire as a result of the problems at the QA hospital that my hon. Friend the Member for East Hampshire described. I endorse everything that he said, but I should like to add a further point now that a Health Minister is on the Front Bench. I asked the acting chief executive about the reasons for the collapse of the sterilisation service which led to the almost complete abandonment of orthopaedic and eye surgery. As a layman, I asked why the hospital had all its eggs in one basket and why it was trying to operate with only one central sterilisation unit, especially when the services required for sterilisation of large instruments for orthopaedic surgery are so different from those for instruments for delicate eye surgery.
I asked why the problem could not be solved bit by bit. Some eye surgeons would like to have a dedicated small-scale sterilisation unit for their delicate instruments. I was told that safety regulations and specifications from the Department and the health service were pushing the hospital in the direction of a large-scale sterilisation unit that is supposed to treat everything from the largest instruments used by orthopaedic surgeons to the delicate ones used for eye surgery. Any sensible assessment of risk would suggest that it is dangerous to go that way because any problem would bring the entire hospital to a halt. It also puts greater strain on the staff, who must be trained to have sufficient skill to handle both the instruments for eye surgery and the very different ones for other surgery. If we break down the problem and separate out the sterilisation activities, we might find that it is easier to train the staff to do the work well. As both Ministers of State, Department of Health are now here, I should like to endorse what my hon. Friend the Member for East Hampshire said and stress the seriousness of the crisis that we face in south-east Hampshire.
The Queen's Speech as a whole reveals what historians will say as they get to grips with the Government. As my hon. Friend the Member for Sevenoaks (Mr. Fallon) said, the Government began with an extremely favourable economic inheritance and a massive parliamentary 228 majority. They could have done just about anything, as they had the power to push reforms through Parliament on whatever scale they chose. They have had no economic crisis to distract them and no problems with securing the passage of legislation. However, what do we see after four years of a Government who had such enormous opportunities when they came into office? A pathetic, damp squib of a Queen's Speech and a Government who had all those opportunities, but are frittering them away.
That is why the most extraordinary aspect of the Queen's Speech is its omissions. It has already been pointed out, for example, that it omits any mention of legislation on adoption. However, will the Secretary of State for Social Security clarify the strangest omission of all, about which there has been confusion for the past 24 hours? What will happen to the improvements that he has offered to the vaccine damage payment scheme? He will recall that on 27 June, in his statement to the House on the matter, he said:We shall legislate at the earliest available opportunity.—[Official Report, 27 June 2000; Vol. 352, c. 719.]In responding to that statement, I made it clear that the Opposition would fully co-operate in ensuring that any such legislation was passed as quickly and speedily as possible.
We were surprised and disappointed, therefore, that that uncontroversial and simple measure was not contained in the Queen's Speech, as my right hon. Friend the Member for Richmond, Yorks (Mr. Hague) pointed out in his powerful speech yesterday. When I explained what had happened, an enterprising journalist from the Daily Express telephoned the No. 10 press office. He was told first that there would be no legislation on the vaccine damage payment scheme, but later the press office changed its line and said that there would be legislation on the scheme and that, amazingly, it was somehow to be squeezed into the regulatory reform Bill, even though the background notes on that Bill contain no reference to it.
Will the Secretary of State clarify that muddle? I would be happy to give way to him if he wants to make it clear. The lady who chairs the vaccine victims support group has made clear her disappointment. She thought that legislation would be introduced, as we did. The Secretary of State said that the Government would legislate as soon as possible, but now we simply do not know whether there will be legislation. I hope that the Daily Express and my right hon. Friend the Member for Richmond, Yorks have led the Government to make one of their faster U-turns on the Queen's Speech and that we will now be told that that legislation will be introduced. That would be good news and would confirm what we always suspected: No. 10 listens to the Daily Express rather than the Secretary of State. If vaccine legislation is to be introduced, we will welcome and support it, but we need to know.
The debate has also touched on long-term care and care in nursing homes for our frail and elderly people. The shadow Secretary of State for Health, my hon. Friend the Member for Woodspring (Dr. Fox), spoke powerfully about that earlier. There is nothing short of a crisis in the care homes sector. Many homes are closing as a result of the interaction of uncertainty and onerous regulation on the one hand, and inadequate funding on the other. The Government cannot both impose extra regulatory burdens, with their attendant uncertainties, and then fail to 229 fund them. That is simply dishonest. The extra costs imposed on the care homes sector must either be properly funded, or ill-thought-out regulatory changes should not be embarked upon in the first place.
We understand that ending the preserved rights regime could be a feature of the legislation. If that change is happen, will the Secretary of State guarantee that no residents who are currently in care homes will have to move as a result of ending the preserved rights regime? That is the subject of widespread anxiety, so I hope that he will make the position clear.
If the right hon. Gentleman touches on that subject, will he also explain exactly what the Government have against pensioners living in residential accommodation or nursing homes? His social security policies seem deliberately designed to make the lives of such pensioners as wretched as possible—although the Government claim differently. A Department of Social Security press release published on 16 December 1999 referred to the following statement by the Secretary of State:The annual Winter Fuel Payment will be payable to everyone over 60.As the right hon. Gentleman knows, however, that is not strictly true. I tabled a parliamentary question asking him to specify how many people aged over 60 were not entitled to the winter fuel payment. His Minister replied on 29 November with a table which showed that 220,000 pensioners living in residential care, nursing homes, and part III accommodation were not entitled to it.
The rules are even more absurd than that, in that pensioners who pay their own bills are entitled to the winter fuel payment, but those who receive financial assistance from social services are not. The latter group would gain from receiving money directly through a guaranteed increase in their basic state pension rather than through a special scheme that does not reach them. Many of those people already get their television licence at the reduced rate of £5. Almost nothing that the Government have announced over the past year, supposedly to help pensioners, has helped the hundreds of thousands of pensioners in residential care and nursing homes. We will emphasise that point in the months ahead, because those pensioners would be major beneficiaries of our proposals to simplify the pension regime.
We shall scrutinise carefully the proposed Bill on fraud, because we are used to the Government's claims to be tackling that problem. At the last count, they had issued 42 press releases about their crackdown on fraud, averaging about one a month. There has, however, been no reduction in fraud and error in the social security system. The Government mass produce press releases, but they produce no action. We hope that, at last, there will be some action on fraud, but the auguries are not encouraging.
The Secretary of State commissioned a report by John Scampion, the social fund commissioner, on organised benefit fraud. The report contained telling criticisms and uncomfortable truths about the way in which the Department of Social Security was failing to tackle welfare fraud. The report was smuggled out on a Friday night in a shabby, cyclostyled edition with none of the gloss that we associate with Government press releases.
I shall contrast that report with "Voices", the Government's magazine guide to opportunities for all, of which hundreds of thousands of copies have been 230 published. The contrast between the Government's approach to "Organised Benefit Fraud" and to propaganda aimed at securing the women's vote explains why we are suspicious when the Government suddenly tell us that, after four years, they are at last going to get serious about tackling welfare fraud. We shall believe that when we see it.
The Secretary of State claimed last week that there had been a significant reduction in fraud and customer error in income support and jobseeker's allowance. He said that, between October 1998 and September 1999, fraud was running at £1.02 billion. What, then, did the Government achieve as a result of all the initiatives outlined in their 42 press releases? Between April 1999 and March 2000, the figure had fallen to £1.01 billion. Although his press release stated that that was a great achievement, a warning from the statisticians, buried in the statistical notes, said that the figures were full of uncertainties. The difference between £1.02 billion and £1.01 billion is so narrow as to be statistically insignificant.
The Government are not making progress. There is a massive volume of fraud out there—a figure of £7 billion has been mentioned by Ministers—and they are not tackling it. The £7 billion figure breaks down, according to Ministers, into £3 billion of definite fraud, £2 billion of probable fraud, and a further £2 billion of possible fraud.
The Scampion report is scathing. It states:There are no strategic discussions between BFIS [Benefit Fraud Investigation Service] and BASIS [Benefits Agency Security Investigation Service].Who would have imagined that those two separate organisations—BFIS and BASIS—would find it difficult to communicate with each other? It is ludicrous: measures such as that should be brought together in one clearly structured attack on organised benefit fraud. Scampion states:Their work is fragmented, resulting in organised frauds not being pursued.He goes on:The amount of data that is held within the benefit system is immense. It is at present being garnered and assessed by a number of discrete organisations without a readily observable strategic framework.We set a challenge to the Secretary of State this evening: what is the strategic framework within which he is tackling organised benefit fraud? He has had the Scampion report for nearly a year, but he has failed to implement its recommendations. We are looking for serious action, not more press releases and spin.
Perhaps the Secretary of State's biggest failure in his Department is the same as that of the Government as a whole, as revealed in the Queen's Speech. It is the complete absence of any sense of strategic direction, or of any coherent vision in the legislative programme before the House, with regard to the reform of social security and welfare.
Insofar as I can understand the Secretary of State's strategy for social security, it appears to consist of taking lone parents off means-tested benefits, and of putting pensioners on means-tested benefits instead. That is what it seems to boil down to, and the tragedy is that the right hon. Gentleman is failing to deliver either policy.
The rate at which lone parents are leaving income support is falling all the time. The latest statistics show that, in the last quarter for which we have figures, the 231 number of lone parents leaving income support is the lowest since Labour came to office in 1997. In fact, the moment that the Government introduced the new deal for lone parents, the rate at which lone parents left income support started to decline. It is now much slower than under the previous Conservative Government.
In May 2000, there were 910,000 lone parents on income support: by August, after the heroic efforts of Ministers and their programmes, that number had fallen—amazingly—to 909,000. At that rate of progress, it will take quite a long time to achieve the Government's objectives for getting lone parents off income support.
Meanwhile, the Secretary of State is financing an expensive advertising programme aimed at trying to get pensioners on to means-tested benefits. He is also failing in that: he is getting pensioners on to means-tested benefits no more quickly than he is getting lone parents off them.
In its document entitled "Income-Related Benefits Estimate of Take-up 1999"—which I am sure is the Secretary of State's bedtime reading—the Department estimates that the number of pensioners entitled to the minimum income guarantee but not claiming it at between 530,000 and 870,000. The mid-estimate is therefore 700,000.
What has the Secretary of State achieved with his £15 million take-up campaign? We know that the Department has written to 2.5 million pensioners, and that about 500,000 or more have torn off slips or telephoned the helpline for further information. At that point, however, the Government's problems begin. Of the 500,000 people who have applied for the minimum income guarantee, only about 60,000 have returned completed forms to the Department. If the Secretary of State wishes to give the House an update on that when he responds to the debate, I should be very grateful.
Although Ministers would not answer Opposition Members' questions on the matter, they inadvertently provided answers to one of their Back-Bench colleagues and miraculously released information to him that was not available to us. That information made it clear that, of the 60,000 returned forms, fewer than half were leading to successful benefit claims. The latest information is that 24,746 responses have resulted in successful claims—again, I should be grateful if the Secretary of State were to provide the House with an update.
Thora Hird has appeared on our television sets morning, noon and night, £15 million has been spent on an advertising campaign, income support has been renamed after a Soviet fighter aircraft—and, despite all their best efforts, the Government have managed to get 24,746 pensioners on to the minimum income guarantee, and 1,000 lone parents off income support. It is not a very good strategy, is it?
§ The Secretary of State for Social Security (Mr. Alistair Darling)
Today's debate has concentrated on health and social security. As the hon. Member for Havant (Mr. Willetts) rightly anticipated, I shall not endeavour to respond to some of the detailed points that were made on health. The hon. Member for East Hampshire (Mr. Mates) raised a quite detailed matter 232 about hospital administration to which the hon. Member for Havant also referred. My colleagues at the Department of Health were present for much of the debate. They will certainly read what was said and will no doubt respond to it.
Like the hon. Member for Havant, I wish to single out the speech by my right hon. Friend the Member for Camberwell and Peckham (Ms Harman), who spoke extremely movingly about the tragic death of Damilola Taylor. She spoke of both despair and hope. I was struck by what she said about people living in the area being determined to help themselves and each other in a way that is not always apparent from some of the reports that we have read during the past few days. I am sure that the House was impressed by the feeling with which my right hon. Friend spoke.
Let me make a couple of observations on health. I was struck by the fact that the Opposition seemed remarkably anxious not to talk about the difficulties that they have got themselves into on health spending or to tell us what their policy is. There is a fundamental problem here. A number of Opposition Back-Bench Members spoke about the health service in their constituencies, and nearly all of them said that more resources should go into improving the health service. It is difficult for us to reconcile the demand that was made repeatedly for more money to be spent on the health service with the same Conservative party that opposed our extra spending at just about every turn.
We are introducing legislation today, but it is only a small part of the reforms that are necessary for the health service. We are backing that legislation with a significant increase in spending on the health service, which is up by one third over a five-year period. Every pound of that spending was opposed by Conservatives Members at the time of our spending review.
The shadow Chancellor has made it clear that he does not believe that spending should be increasing at the rate of growth that the Government propose. The gap between our proposals and those of the Tories is £16 billion, but they have not been able to tell us where they would cut those £16 billion.
One of the problems that the Tories face is a complete lack of credibility. We know where their instincts lie. They want to cut public spending, but they cannot or will not tell us where the axe will fall. Their attempt earlier this week to proffer a mere £5 billion of the £16 billion total has no credibility whatsoever. I intend to refer to one or two instances where their figures fall apart on examination.
The difficulties that the Tories are in were perhaps demonstrated when their health spokesman was asked whether or not the Tories would match the Government's 3.4 per cent. real-terms increase in social services. He was asked twice whether the Tories would match that figure and he declined to do so. He had ample opportunity to say that he would, but he would not. That is because, as the shadow Chief Secretary said on television the other night, it would appear that the Conservatives' commitments do not stand close examination.
It is also interesting that when there was a brief debate about the Conservatives' policy on the health service, perhaps illustrating why they cannot match our figures—they want to introduce more tax breaks for people to go private—the hon. Member for Woodspring (Dr. Fox) had 233 nothing at all to say. Earlier this year, he said that insurance companies ought to be coveringconditions that are not high tech or expensive, like hip and knee replacements, hernia and cataract operations.He was backed up on that by the shadow Chancellor in October this year. It is no wonder that he does not want to talk about it.
I quite fancy going out with a Conservative campaigner at the next election and knocking on pensioners' doors. In addition to telling them that the winter fuel payment of £200 would go, that there would be no more free TV licences or Christmas bonus, the Conservatives will have to tell pensioners that those on the minimum income guarantee will be £20 worse off on average as a result of their axing the minimum income guarantee.
§ Mr. Darling
The hon. Gentleman says that there would be no loss of means-tested benefit, despite everything that he has said this evening about his opposition to means-tested benefits. How could anyone believe that?
In addition, the Tories will have to say that if non-essential operations are no longer on the NHS, a hip replacement—according to BUPA's latest price list—will cost some £7,800. A hernia operation costs £1,500 and a knee replacement £8,400. That is a rather large bill for pensioners—it is mostly older people who face such operations—to face. No wonder the Tories did not want to talk about their spending or health policies. Once we look at them, we see the same old Tory ideas—spending cuts and privatisation.
The hon. Gentleman faces the same credibility problem on social security. He has been told that he must come up with some £3 billion—at least, that was the figure two weeks ago—towards the £16 billion that the Tories must find. Earlier this week, he said that he could find only £2 billion. Of that figure, £1 billion was on fraud. I wondered how the Conservative party, given its record, was going to find this £1 billion of fraud. Very helpfully, the shadow Chancellor wrote an article in The Independent. Although it was on page 6 of the review section, I managed to find it. He said:We're going to set up a single benefits investigation squad, a national body that would have responsibility for investigating all forms of welfare fraud administered by the Benefits Agency. Common sense measures like these will yield at least £1 billion.So setting up a quango will automatically save £1 billion, just like that. It seems pretty obvious, from a casual examination of the Tories' proposals, that this is not common sense—it is proceeding on a wing and a prayer.
The £1 billion on fraud rang a bell with me. The hon. Gentleman was anxious to assert that the amount of known fraud in the system amounted to some £7 billion. I dimly remember a debate that took place the year before the previous election. The right hon. Member for Hitchin and Harpenden (Mr. Lilley), the deputy leader of the Tory party, was standing in my place, and he said that Labour—the then Opposition—hadevery incentive to exaggerate. It wants to appear tougher than the Government, so as to con people that it is no longer soft on fraud. Above all, it needs to conjure up imaginary "savings" to offset the real cost of its spending plans.234 That is very familiar, is it not? The same thing seems to be happening now.
The figure of £1 billion rang another bell with me. The right hon. Gentleman also said at the time:The Opposition, having seized on the flimsy figure of an extra £1 billion of fraud, then had to invent even flimsier claims they could get it back. So they put together … rather tenuous fraud programmes, and plucked estimates for each of them out of the air. By an extraordinary coincidence, the savings from those three fraud programmes add up to exactly £1 billion.— [Official Report, 18 June 1996; Vol. 279, c.702–04.]The present Tory party is doing exactly what its then deputy leader was suggesting.
There is no evidence from the Tories' proposals that they could save £1 billion over and above the amount that we are already determined to save. Let us look at some of their other proposals announced earlier this week. They said that they wanted a freeze on civil service recruitment. Given the turnover in the Benefits Agency in the past year alone, that would mean 5,000 fewer staff. We know that the best way to stop fraud and error in the social security system is to have tight gateways to the benefits system, with staff checking claims and making sure that they are properly vouched for.
When we came to office, we found that two out of every five income support cases were wrong. We have halved that figure, saving £1 billion alone. The reason that there was so much error and fraud in the system was because the Conservatives had run down the front line, and they propose to do exactly the same again.
The hon. Member for Havant also mentioned organised fraud. He is normally pretty good at picking up our press releases and publicity, but he seems to have missed something. Earlier this year, I announced that we were setting up a national intelligence unit to look at organised fraud. As for the lack of publicity—I think it was not on a Friday but on a Monday—there was quite a lot of publicity about it, and I am sorry if the hon. Gentleman missed it.
I am also sorry that he missed the figures that we published a couple of weeks ago. They showed that, for the first time, there has been a significant reduction in fraud—some 6.5 per cent. in income support and jobseeker's allowance. That is just a beginning; we have a lot more to do. However, the hon. Gentleman must bear in mind that his party spent 18 years in office without even trying to measure fraud. Not until 1995 was there any attempt to measure fraud, let alone stop it. Indeed, it is an indictment of the Tories that when they left office the Department of Social Security was losing more in fraud and error than it cost to run it. What an indictment of a Government who were around for 18 years.
The National Audit Office first qualified the DSS accounts in 1988 because of the amount of fraud and error. The Tories had nine years after that to do something about it, but they did not, so their credibility on tackling fraud is not strong.
We are introducing new legislation and the House will have ample time to scrutinise it. We are introducing four new provisions. As we believe that people have rights to claim social security but also responsibilities, we are clear that if someone is convicted twice of benefit fraud, they ought to lose the right to benefit. We are also giving the DSS greater powers to access people's records if we suspect that they are not telling the truth, or we have 235 reasonable suspicion about someone's honesty. We will also make it an offence not to declare a change of circumstances, which is one of the biggest sources of fraud within the social security system. There will be other powers too.
The hon. Member for Havant complained that the Queen's Speech and the welfare reforms did not demonstrate any vision. One contrasts the Government's position with that of the Opposition. On the economy, people know where we stand. We sorted out the debts that we inherited from the Tory party. In the previous Parliament, 42p in every pound of extra spending went to social security or debt servicing—debt repayment. That is now down to 17p.
We cleared the deficit that the Tories left us, and we now have a stable economy. We have low interest and mortgage rates and, because we have those, we can make the investment that we need in public services—the investment that is essential, in education for example, if we are to sustain growth at the levels that people expect. That is why we are driving up standards in schools and spending more money on education.
None of that would have happened if the previous Government had been re-elected at the general election. Their determination—their instinct—then, as now, is simply to slash and burn, regardless of the consequences. We are living with some of those consequences, not least in the health service. The problem with health, as in transport, is year after year of under-investment. We are putting that right. We have a lot more to do, but we are prepared to make those reforms. However, it is only because we have sorted out the economy—we have a stable economy—that we can produce that investment, which will in turn ensure future stability.
§ Mr. Willetts
The Secretary of State seems to be diverging. One important question is of concern: will there be provision on the vaccine damage payment scheme as part of the Queen's Speech?
§ Mr. Darling
I was about to come to that matter. I was going to draw attention to some of the changes that we have made in the past three years. The hon. Gentleman was critical of the Government's record on welfare reform. I want to demonstrate that we are reforming the welfare state and, importantly, that we are delivering results.
I was about to start with children and, indeed, vaccine damage. The House will bear in mind that the primary change that we made in the summer was to increase the amount of money that went to children who were damaged because of vaccine from £40,000 to £100,000. That change did not need primary legislation and the money is going to the parents of children affected.
We needed to reduce the disability threshold from 80 per cent. to 60 per cent. and to increase the time limits. We intend to use an order under the regulatory reform Bill, which is also in the Queen's Speech, to implement that change. We did not include it in the social security legislation because it would not have been possible to do so without significantly widening the scope of the Bill. We can do it through the regulatory reform Bill and we will do it.
236 That is not all that we have done for children in the reform of the welfare state. We are the first Government to have committed ourselves to eradicating child poverty within a generation. We are reforming the Child Support Agency—something that was long overdue. We have increased child benefit, introduced the working families tax credit and we are spending more money on families. The Conservatives opposed all those measures.
For people of working age, we have recognised that there is a real need for incentives to make work pay, to make it possible and to get more people into work. Measures such as the new deal have contributed to the fact that more people are now in employment than there has been for a generation. Youth unemployment, which we debated many times in the House in the 1980s and the early 1990s, and about which the previous Government did nothing, is down by 70 per cent. The reforms that we are making through the new deals are a significant reason why more people are in work.
For older people, we have reformed bereavement benefits—to which a Liberal Democrat Member referred—by increasing the amount available and ensuring that men and women have equal rights. We have reformed the state second pension and introduced stakeholder pensions. We have cleared up the mess of inherited SERPS—albeit at a cost of £12 billion because of the mistakes made in the 1980s.
I make no apology whatever for introducing the minimum income guarantee; it has helped about 2 million of the poorest pensioners—people who lived in poverty under the Tory Government and who are now, on average, about £20 a week better off. Since we began the take-up campaign, 750,000 people have responded. The hon. Member for Havant asked why they were not all successful. It appears that most of them have just too much money in the bank because of the ridiculous limits that we inherited from the previous Government. That is why we are doubling the limits next year and why, when the pension credit comes in, we shall abolish the limits on the amount of money that old people can save.
We know that the hon. Gentleman is against the pension credit; no doubt at the next general election—whenever it comes—he will explain why he opposes a measure that, for the first time in the history of the social security system, gives people a credit for having saved. It rewards saving rather than penalising it, as the present system does.
I said that we had reformed the welfare state, and the hon. Gentleman asked about results. I can say something that he could never say: for the first time since the second world war, the social security budget is growing at its lowest rate. The hon. Gentleman was never able to say that. When the Tories were in office, they doubled social security spending. It is now growing at one of the lowest rates since the second world war. If it were not for the spending that we have chosen to allocate to families and pensioners, the rate would be falling in real terms.
The reason for that low rate is that we are getting more people into work and bearing down on fraud and error in the system. The Tories would never have been able to say that. They have nothing to say on that. Instead, we hear policy after policy with no great philosophy behind them; the Tories seem motivated only by the desire to slash and burn. For example, the hon. Gentleman seems to assume that every lone parent with a child aged over-ll will be 237 able to find work just like that—including the 4,000 widows in that category. Presumably, they will have to find work on the first day under his new rules—as would 8,000 parents of disabled children.
Of course, the hon. Gentleman would remove the new deal and all the help that we have provided. That is ridiculous when we consider that 54 per cent. of those lone parents have no qualifications at all; they will receive no help as a result of Tory policies, but will be forced off benefit. The Tories simply hope that they will find work. When the Tories came into office in 1979, about 300,000 lone parents were on benefit. Their approach meant that when they left office, the number was more than 1 million.
The hon. Gentleman said that he would save more than £1 billion on industrial injuries. This week, the figure came down to £160 million. The only way to save such an amount is to transfer all the costs on to employers—a jobs tax for every employee.
There is no coherence to Tory policies. In contrast, we have set out our vision for transforming the welfare state. We are making changes. We are getting children out of poverty and getting people into work. We are reforming the pensions system so that it reflects our present needs and those of the next 50 years. None of that was done by the Tories. Under their regime, social security spending escalated—so did child poverty and pensioner poverty—and there was mass unemployment.
We are making coherent changes to reform the welfare state; the results are there. Spending is under control for the first time in decades—something the Tory party could never do. We are sorting out the economy; we are getting more people into work and providing them with better schools, higher standards and greater opportunity—all matched by greater responsibilities, as the Queen's Speech shows.
It has been evident yesterday and today that, even at this stage of the Parliament, the Tories have no coherent or credible strategy for this country. That stands in stark contrast with the fact that we have put stability in the economy; we are making the necessary investment to ensure that, for the future, we have an economy where enterprise and fairness go hand in hand.
§ Debate adjourned.[Mr. Jamieson.]
§ Debate to be resumed tomorrow.