Sitting of 25 March 1983

Preamble
The House met at half-past Nine o'clock
The Clerk, at the Table, informed the House of the absence of MR. SPEAKER from this day's sitting, pursuant to leave given upon Thursday 24 March.
Whereupon MR. BERNARD WEATHERILL, The CHAIRMAN OF WAYS AND MEANS. proceeded to the Table, and, after Prayers, took the Chair, as DEPUTY SPEAKER, pursuant to the Standing Order.

PETITION

  Gipsy site (Northolt)
  9.35 am
  Mr. Harry Greenway: I beg leave to present this petition, signed by 3,000 residents of Northolt who live in a built up area and do not believe that it would be possible reasonably to accommodate a gipsy site within their boundaries, and I support them:
  To the Honourable the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled.
  The humble petition of residents of Ealing, Greenford and Northolt showeth:—
  That we support our Member of Parliament, Mr. Harry Greenway, in opposing the siting of a gipsy encampment at the rear of Yeading Green Estate.
  That we believe that this site will not be in the best interests of the Community.
  That local amenities are already utilised to the maximum.
  Wherefore your petitioners pray that your honourable House will urge the Secretary of State for the Environment to intervene to prevent the siting of a gipsy encampment at the rear of Yeading Green Estate, Ruislip Road, Northolt.
  And your petitioners, as in duty bound, will ever pray.
  To lie upon the Table.

Welfare State
9.36 am
Mr. William Hamilton: I beg to move,
That this House notes with alarm the threats to the future of the welfare state emanating from sources in the Conservative party; and will resist such threats by all means at its disposal.
The purpose of the debate is to call attention to the future of the welfare state. This is the first debate after that famous victory in Darlington last night—a victory for the Labour party, for common sense and for Britain generally. It is also a warning to extremism everywhere, whether from the extreme Right as exemplified by the Prime Minister herself or from the extreme Left. Darlington has spoken for Britain and I hope that others will get the message.
In recent months there has been massive evidence of a determination by the Tory Government to dismantle and destroy the welfare state, by which I mean the provision through taxation of the vast bulk of our health services, the greater part of the nation's education from nursery schools to universities, a lage part of our housing through council housing and other public sector housing and, not least important, our system of social security by means of which we cater for the basic needs of our old people, our vast growing army of unemployed and minorities such as the disabled and other handicapped people.
The quality and extent of all these services play a valuable role in softening the harshness of life for millions of our fellow men. For Socialists these services are one invaluable way of redistributing the wealth of the nation from the privileged to the under-privileged, from the rich to the poor and from the healthy to the ill. In the name of equity, social justice and the national interest, it is vital that all these services should expand and improve, yet a great fear exists and is growing in the minds of many that all these services are being fiercely and critically reexamined with a view to horrifying mutilation by the Government.
In the vanguard of this march back to the 19th century is the Prime Minister. She has said publicly that she yearns for a return to what she calls Victorian values and virtues. Presumably she yearns for a return to the days when we sent infant children up chimneys and down coal mines, when old people were put into workhouses because they could not stand on their own feet. The consequences—[Interruption.] You will have to stand a lot more of it yet.
Mr. Deputy Speaker (Mr. Bernard Weatherill): Order.
Mr. Hamilton: I apologise, Mr. Deputy Speaker. Everyone will have to stand a lot more of it.
The consequences of those Victorian so-called virtues and values were the cancerous growth of widespread poverty, ignorance, disease and deprivation. It was those values that led at the onset to the Boer war to the revelation that one in three Army volunteers had to be rejected because they were so emaciated and poverty stricken that they were not fit to serve in the armed forces. It was those conditions and those revelations which motivated the beginning of the welfare state in the years immediately preceding the first world war. Since then that welfare state has grown hugely in both scope and in cost. It is precisely because it has become so comprehensive and so costly that the Prime Minister and others in the Conservative party who think like her are determined to destroy it.

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I shall devote my remarks, which will be fairly long, to education, health, housing and social security. The Prime Minister is reported as having said on television recently that state education is "a disaster". Therefore, according to her, 95 per cent. of our children—all our children who go to state schools—are having a disastrous education. Sadly, but perhaps understandably, she is aided and abetted in her nefarious undermining of the public education system by the many Tory Members of Parliament who were educated in the expensive fee-paying sector at places such as Eton and Harrow. Indeed, the Secretary of State for Education and Science is a product of that privileged and expensive section of the education system. I read in the Daily Mirror this morning, after its attack on the consequences of the vicious cuts in education that have been perpetrated by the Government, that the right hon. Gentleman is saying that it is not his fault. Whose fault is it if it is not his? He is the Minister who carries the can for education matters.
These strident criticisms of the public sector of education are being made precisely to undermine the confidence of parents in the public provision and to foster support for the private fee-paying sector. Since 1979 enormous financial help and privileges have been given by the Government to the private sector, while the public sector has been ravaged. The savage expenditure cuts have been far greater than was warranted by the drop in the number of children of school age.
The greatest cut has been in higher education, where one in every six of the 80,000 teaching posts in polytechnics and universities in 1981 will have been eliminated by 1985. Yet the Government's Think Tank—this is one of the leaks that has revealed much about Tory thinking in the past few months—has suggested the ending of all public financing for all institutions of higher education. It has suggested that, instead of the taxpayer footing the bill, fees should be set at market rates—currently about £12,000 for the average three-year course—and student grants should be abolished. Such a system would penalise the lower paid sections of our community. The Think Tank's paper stated that there would be great savings if the state no longer had to provide for primary and secondary education. Instead, parents would be given a voucher which they could cash at schools of their choice to pay for their children's education. In other words, the great Think Tank, containing the intelligentsia of the Tory party, is saying that education should be sold as others sell margarine and sausages. This is intolerable and incomprehensible. These proposals are favoured by the Secretary of State for Education and Science and by the Prime Minister's advisers.
What is happening now in our schools? A bleak picture of the devastation in the education service was presented in a survey published a short while ago by the Birmingham association of the National Union of Teachers. I shall not go into it in great detail but I shall quote from the magazine entitled The Teacher. I am a member of the NUT, so I have a great interest in what happens to our children, and everyone else should have too. The article stated:
"Because of the shortage of funds, teachers were having to make do and mend and act as fund raisers. And it was the profits from the sale of biscuits and crisps, sponsored walks and jumble sales which were keeping the schools going. All this has had a devastating effect on teacher morale. 'The staff feel they are
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spending valuable teaching time collecting money and organising fund raising events. They are tired of begging for money and gifts to keep the schools running '"
That is an example of what is happening under the Government.
Other Cabinet Ministers have come up with their own wheezes. The Chancellor of the Exchequer, in his thinking as presented by the Cabinet's family policy unit, came up with the brilliant wheeze that parents should set up their own schools. I am sure that the folk in Keighley and Hackney will be dancing in the streets at the prospect of setting up their own schools and financing them themselves by rattling their cans in the streets on flag days. The right hon. and learned Gentleman thought that we should set up more religious schools with a clear moral base and train our kids how to manage their pocket money. I suppose that that thought was set against the soaring crime rate under the Government. Those are serious educational proposals from one of the key men in the Government. It is almost unbelievable that apparently intelligent and well-educated men and women can seriously advance such loony ideas about the education of our children, which is the most vital investment that any nation can make in its future.
There are other issues in which the Government talk glibly and smoothly of the need for freedom of choice, the freedom to spend one's own money in one's own way and the virtues of self-reliance and responsibility. When all that jargon is applied to the provision of education, housing, pensions or health, it means that the Government are determined to opt out of those services as much as they can get away with politically.
The fears that are engendered by the Think Tank loonies must be heightened by a mere glance at the Government's public expenditure White Paper for the next three years. It is all starkly there. Since 1978–79 the vast proportion of the real increase in public expenditure, taking account of inflation, has been spent on paying the unemployed who have joined the vast and continually growing dole queues. Our dole queues have grown twice as fast as the international average since 1978–79.
The spending priorities that that White Paper reveals are typical of the Prime Minister and the Conservative party. Next year's defence budget, for example, is 23 per cent. higher in real terms than it was in 1978–79. The Falkland Islands adventure alone will cost about £3,000 million—all for defending 1,200 people who live 8,000 miles away. That represents more than £2 million per head of population. The Prime Minister is on record as saying that we shall continue to support them, whatever the cost. Law and order will cost 30 per cent. more in real terms next year than it did in 1978–79, but crime figures are soaring. On other issues, the Government say that the problem cannot be solved by throwing money at it. They have thrown and continue to throw money at law and order but the crime rate continues to rise, whether it be in London, Glasgow or elsewhere. In that respect, they have proved the truth of their own argument.
There has been only a modest increase in expenditure on the Health Service. It is nothing like the 23 per cent. increase on defence or the 30 per cent. increase on law and order. Education is to be cut by 6·5 per cent. and art and the libraries are to be cut by 4 per cent. Housing, an important social service, has been cut by 55 per cent. in the past three and a half years. That is the biggest and probably the most monstrous cut of them all.

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The Government take great credit for the compulsory selling of council houses at bargain prices, claiming that that extends the property-owning democracy and the rights of individuals. The real aim of that policy has nothing to do with that. The real aim is to take housing out of the public sector so that the tax burden in the form of subsidies can be relieved and housing can be taken to the market place to give the Government's friends in the building industry rich pickings. They hope eventually to eliminate housing subsidies.
Kirkcaldy district council, which is in my constituency, already receives no subsidy. If it builds houses, it must charge an economic rent for them or not build at all. In 1979, subsidies on council houses were roughly equivalent to the concession given to private buyers in the form of mortgage interest relief. Private owners are now given £2,000 million a year. That should be compared with the £550 million that is given to council house tenants in the form of subsidies. In other words, the poorest folk, who, by and large, are council house tenants, are penalised while the better off who buy their houses benefit. The Budget has given another boost to that inequality.
Mr. Ronald W. Brown: The hon. Gentleman is quite right. Does he agree that selling off valuable four-bedroomed houses which cannot be replaced means that large numbers of families are waiting for such houses but cannot get them?
Mr. Hamilton: I am coming to precisely that point. The policy that I have mentioned does not add one house to the total housing stock. Moreover, it adversely affects people on waiting lists who, for one reason or another, cannot afford to buy. That is a measure of the Government's irresponsibility.
The slashing of housing subsidies has resulted in enormous increases in council house rents. In 1979, the average rent was £6·45 a week, whereas it is now £13·55. Moreover, the number of public sector houses that have been built has dropped from 94,000 in 1980 to 40,000 last year. That policy adds greatly to the misery of young people who are getting married who cannot even find the deposit to buy a house, let alone make the monthly mortgage payments.
Perhaps a few Scottish figures would be of interest. As in England and Wales, housing in Scotland has borne the brunt of the Government's expenditure cuts. Almost everywhere there is an acute shortage of public housing for rent. The hon. Member for Hackney, South and Shoreditch (Mr. Brown) referred to four-bedroomed houses, but all types are in acutely short supply. That is especially true of sheltered housing for old folk. In a survey conducted in 1980–81, Shelter estimated that there was a waiting list of 157,000 for houses in the public sector. Just over 7,000 houses for that sector were completed in 1981. At the end of 1980, one Scottish family in 11 was waiting for a local authority house to rent. The prospect for those families is as grim as it has ever been in living memory.
Only last week, the Scottish Office directed the five Scottish new towns, one of which—Glenrothes—is in my constituency, not to build any more public sector houses for rent. In future, all houses will be built privately for sale. There will be cheers from the Barratts of this world. Barratts is building the slums of tomorrow throughout Britain, especially with its smaller houses. I have received letters from all over Britain confirming that description.
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In the middle of the Tory party conference last year a large cat was let out of the bag. One of England's 14 regional health authorities, which covers a population of more than 2 million people, announced that it was considering withdrawing comprehensive health care. Shortage of funds had driven it to that disastrous conclusion, which would have meant complete abandonment of the principles on which the National Health Service is based.
That bombshell from Oxfordshire followed hard on the heels of the now notorious Think Tank report which pointed the way to the dismemberment of the welfare state, especially the Health Service. The Oxford proposals were as follows. First, there would be no entitlement to health care unless the patient had a residential qualification. Holidaymakers and visitors would have to get out because there would be no care for them in Oxfordshire. Anyone allowed into hospital would be in and out in a day except in the case of serious operations. Childbirth was not regarded as serious. If the stay was longer, the hospital authority would ensure that the patient's sickness benefit was deducted in whole or in part to pay for his stay in hospital. Road accident victims would pay all costs of treatment and long-term patients would have to be fed by their relatives. Their families would have to bring in the grub and possibly towels, soap and everthing else. I suppose that the Prime Minister would call that self-reliance.
It is easy to wax indignant and to pretend that Oxford must be exceptional—the odd man out.
The Minister for Health (Mr. Kenneth Clarke): The document to which the hon. Gentleman refers was never a proposal of the Oxford regional health authority but a paper prepared by its officials based on a misunderstanding of its financial position and putting forward proposals that the authority had no power even to consider. Since then, the Government have greatly increased the authority's budget so that 1·4 per cent. growth money is available for improvement in services in the coming year over and above all increases in costs.
Mr. Hamilton: The Government consistently produce apologies of that kind whenever there is an exposure of this nature. They say that things are not nearly so bad and indeed are a great deal better. I shall deal with that argument later.
Oxfordshire is not exceptional. Other health authorities even harder hit by the Government are considering similarly severe restrictions. Savage economies are being resorted to elsewhere, as an article in The Sunday Times—not a newspaper of Socialist persuasion—made clear on 10 October 1982. The article was headed:
"NHS: the truth they dared not speak at Brighton".
Whatever the jargon used by the Department—stringent economies, efficiency savings, levelling down, top slicing, skimming—it all amounts to the same dismal story. Savage cuts are being enforced throughout the length and breadth of the United Kingdom. That is the view of The Sunday Times and the evidence is all around us—the closure of wards, closure of hospitals, understaffing, and so on. Only yesterday the BMA stated that more than 2,000 doctors were unemployed. There were 500 two years ago and 1,000 last year. There are now 2,000. How many will there be next year?
Mr. Laurie Pavitt: What about the nurses?
Mr. Hamilton: I am coming to the nurses. My stepson is a surgeon and looking for a general practice, but I doubt whether he will find one. It is an outrage. As for nurses, a press report a few weeks ago stated:
"The new state registered and state enrolled nurses will face unemployment when their contracts run out …
In Nottinghamshire, Sheffield and Leicestershire, there are only jobs for two thirds of the students".
There is increasing evidence throughout the country that all is not well. As The Sunday Times stated, the northeast Thames authority has said:
"Urgent schemes for old people and the mentally handicapped … at Clacton and Ilford, may have to be dropped" and new hospitals in Colchester and Chelmsford may not open. The south-west Thames authority has said that it "will be some £10 million short in budgets up to 1985".
Its regional treasurer described the financial position as "extremely serious".
The Think Tank proposes not to give additional state money to the hospital authorities but to replace the National Health Service with private health insurance, with an estimated saving to the taxpayer of about £4,000 million per year. It proposed, for instance, that anyone visiting a doctor should pay a fee. The Government have already imposed greatly increased charges for drugs. Prescription charges have risen between five and sevenfold in the past three and a half years. The Think Tank also proposes to limit social security payments. It says that pensions should no longer be raised in line with inflation, still less with increases in earnings. The Government are already putting that into practice through the Budget. That could save £3 billion per year. Significantly and ominously, after the leak was published the Chancellor and the Chief Secretary made sympathetic noises, saying that all the proposals were very good and should be seriously examined.
With the Think Tank leak and the spilling of the beans about Oxfordshire, the Prime Minister was quick to see the electoral danger of the indecent exposure of the way in which her thinkers were thinking. She therefore told her adoring Brighton conference last October that the Health Service was safe with her. It is about as safe as leaving a baby with a tiger. As The Sunday Times said on 10 October:
"that ringing declaration conceals the grim reality up and down the country the NHS, starved of funds, is being cut back at an alarming rate. Very soon some local authorities—like Oxfordshire last week—may have to acknowledge that a full health service, of the kind we have known since 1947, is finally on the way out."
The National Health Service is being bled to death by a thousand cuts while private hospitals and private medical practice are being actively encouraged by the Government.
The Tory party as a whole is incapable of judging the worth of any enterprise except by means of a balance sheet—a profit and loss account in hard cash terms. It is determined to run a National Health Service financed by charity days and nurses rattling collecting cans. The provision of a public service, whether it be a local authority school or a hospital, on the basis of need and irrespective of ability to pay is a philosophy that Tories cannot comprehend—or, if they comprehend it at all, they find it hard to accept. It is a Socialist philosophy, wholly alien to their narrow, selfish, greedy capitalist views.
The Secretary of State for Social Services and others constantly make claims alleging that the Health Service has grown each year since the Government took office,
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that there are more nurses, more doctors and better services than ever before. We shall nail those lies. The truth is exposed in an article in The Guardian of 14 March called "Mr. Fowler's three card trick". The Secretary of State is fiddling the figures and the article shows how he is cooking the books. Every health authority in the land knows that. The evidence is all around us to be seen. He is fiddling the figures on the Health Service as blatantly as his right hon. Friend the Secretary of State for Employment is busy cooking the unemployment figures.
I have vivid memories of how the Government last year starved into submission the nurses and ancillary workers in the recent pay fight. The Secretary of State for Social Services and, not least, the Minister for Health and the Prime Minister all said that the nurses should accept the settlement that they imposed, and claimed that it was a fair, just and even generous award. Let us have a look at the facts. As a result of the Government's generosity to these dedicated men and women in our Health Service, some of the nurses are "better off' by 10p a week. The 8,000 nurses living-in in Scotland are mostly in that category, and the worst off of all are nursing sisters living in. They got a pay rise under this munificent Government of £7·92 a week after tax. Their rent increase, backdated to last October, was £7·82 a week. They are better off by l0p and that has to last two years.
I asked the Secretary of State for Social Services a question in the House on 2 March and he gave me the figures showing that a student nurse after those increases is actually £2·50 a week worse off in real terms than she was in April 1980. Those are the official figures from the Government. A state enrolled nurse is £3 a week worse off, a staff nurse is £4 a week worse off and a ward sister is £5 a week worse off. This is the consequence of the Government telling the nurses to accept their generous offer for two years.
The evidence against the Government in this matter is overwhelming. The NHS is being strangled to death, and nobody in his right mind can believe that the service is safe in the hands of the Prime Minister or any other Minister.
Mr. Kenneth Clarke: The hon. Gentleman has gone back to his preposterous proposition that the Health Service is being strangled to death and killed by a thousand cuts and so on. However, as he knows, he is denying all the published figures on expenditure, employment of doctors and nurses and the number of patients treated. He said in passing that we were "fiddling the figures". Would he like to explain how we are doing this so that we can relate his extraordinary case to the published facts before the House?
Mr. Hamilton: I shall send the Minister a copy of the article in The Guardian. [Interruption.] If the hon. and learned Gentleman has a case to argue against that—[Interruption.] I am making the charge that the Government are fiddling the figures and I stand by it. Every health authority in Britain knows that its practical experience denies the facts given by the Government.
The Minister is going to publish a document next week at the expense of the taxpayer, but purely as party propaganda, saying how well the Government are doing in the NHS. I shall send the article from The Guardian to the Minister and ask him to give me a blow-by-blow account. I can give him an example. The Government have imposed a vast increase in Health Service charges.

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They are adding that to the amount of public money that is being spent on the Health Service, but it is being taken out of the pockets of the people every time they go into a chemist's shop.
As another example, the Government are estimating a certain percentage of money because of increased efficiency. They are telling local authorities that if they increase efficiency by 0·5 per cent. or 1 per cent., that increases the productivity of the NHS. That leaves the local health authorities to carry the can in one way or another. Let the Government not pretend that people think that the NHS is doing marvellously, or that the Government are doing marvellously by it. The Government are committed to dismantling it. All the evidence is there. I can produce some of it and we shall produce more over the next few months to show that all is not well, and the problem is getting worse all the time.
Mr. Pavitt: The chairman of the north-west Thames region, Dame Betty Patterson, issued a statement last week in which she said that the authority was facing a grim year because, in real terms, it had no growth, even though it was one of the largest regions in the country. I had a reply from the Minister yesterday to a written question which gives a number of figures that almost prove the point that my hon. Friend is making—the figures are being juggled.
Mr. Hamilton: We know that, and the local health authorities know that. They are labouring under great difficulties.
The Think Tank has suggested that there should be limitations all round on social security, whether on pensions or anything else, and action on these lines is already proposed in the Budget. A classic example is the old age pension. It is clear to the old age pensioners and their friends and relatives that there will be about 6 per cent. inflation in November and they will be getting a 4 per cent. increase in their pensions. In other words, there will be a clawback from the pensions, however one juggles the semantics, and there will be a reduction in the standard of living of pensioners as from next November. That is indefensible, and an outrage. For the life of the present Government, successive measures have hacked away at social security benefits.
An answer given to one of my hon. Friends on 18 November 1982 revealed the grisly facts admitted by the Government. The current year's social security budget has been cut by £1,410 million, which is £27 million every week. The principal sufferers as a result of successive pieces of legislation—the Social Security Acts, Nos. 1 and 2, and the rest—the elderly have had taken from them £610 million, the sick and disabled £300 million, the unemployed £300 million, widows and orphans £50 million and families £150 million. These are the Government's figures.
No wonder that, in the context of the Government's record, the reaction in Whitehall and the country to the leaked proposals of the Think Tank and the family policy unit was a mixture of derision, anger and fear. There was derision because many of the proposals are plainly impractical, in political or any other terms. There was anger because many of the propositions would virtually destroy the welfare state, severely penalise millions of our poorer citizens, and take us back to the squalor and misery of the 19th century, for which the Prime Minister yearns
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so much. There was fear because any attempt to implement those proposals, even in part, would be bitterly opposed and might have catastrophic social, economic and political consequences.
Perhaps I may now summarise what I have said. I think that I have shown beyond a shadow of doubt that the present Government—certainly a future Tory Government—would destroy the welfare state as we know it today. The evidence is there for all to read, whether in the Think Tank leaked report, the work of the family policy unit of the Cabinet, or the White Paper on public expenditure.
A recent example came to light on Tuesday this week. The Government are currently seeking to hand profits to their friends by hiving off to private profiteers the catering, cleaning and laundry services of hospitals throughout Britain. The Guardian of 23 March reported
"A health authority is being pressed by Mr. Kenneth Clarke, the health minister, to spend an extra £18,000 a year oil a private laundry service rather than £2 million on replacing outdated equipment."
I hope that the Minister will reply to that point. If he is saying to the Calderdale health authority in Halifax that it should hand over its laundry services to a private company because he will not allow it to modernise its equipment to the extent of £2 million, is that to be his practice throughout Britain? Will health authorities be told, "No, you must hand the service over to our own private profiteering friends"? The Calderdale authority and others are watching carefully what happens
Mr. Kenneth Clarke: I shall deal with that point now. The Calderdale authority is considering how best to use £2 million of capital investment. The hon. Gentleman might be interested to know that the private contractor that it has considered is actually a co-op in the locality, not one of my private profiteering friends. [HON. MEMBERS: "Ah."]
Mr. Hamilton: That is interesting. Is the Minister now saying that he will encourage all co-ops throughout the country? If that were so, I should be well pleased.
Mr. Pavitt: Especially in Darlington.
Mr. Hamilton: Especially in Darlington, as my hon. Friend says. Health authorities would probably suspect that it was the thin end of a very dangerous wedge. Most health authorities have outdated laundry equipment. If the Minister tells them, "You will not be allowed to modernise. You must put that service out to private profiteers, whether it be the co-op or anyone else", it is a very dangerous precedent.
I come back to the general point. As the Government have raped the economy and destroyed our industrial base, thousands of firms have been forced into bankruptcy. Week after week firms are going to the wall. As a result, no fewer than 4 million people have been put on the dole, whether by action or design. The wastelands that are being created cease to produce wealth, which is the wherewithal for sustaining the welfare state. Having created the desert, the Government proclaim that inflation is now down to 5 per cent., as if that were a merit in itself. The price paid has been unacceptably high. The price paid is the desert that we see in large and growing parts of the United Kingdom, the millions on the dole, the millions living in grinding poverty, the decaying, rotten and rotting environment of houses, hospitals, schools, roads, railways and sewers. Our social fabric is in decay. The Government

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say that that is the price that we have to pay if we are to get inflation down. Inflation in the Sahara desert is nil; the Government are working on that.
More than 40 years ago, in his 1942 report, William Beveridge warned that if unemployment got into the millions the welfare state could not prosper. Services such as the National Health Service, the national insurance scheme, and our educational and housing services can function only in the broadest national interest so long as working men and women are fully employed and paying taxes and contributions to finance those services. Our present battered welfare state is grim testimony to the truth of Beveridge's warning. We are paying £15 billion a year to keep those men and women on the dole. That money could be better used in getting those people to work. building houses, roads and hospitals, and helping the old, the sick and the disabled and many others in desperate need.
It is a wretched story of cruelty and incompetence. In their vicious attacks on the welfare state, the Government concede that they have no solution to the problem of unemployment. If the dole queues go on growing, the death knell will be sounded loud and clear for the welfare of our people. We should all fear the consequences of such a black future.
10.27 am
Mr. Reg Prentice: It is an old custom of the House to congratulate an hon. Member who wins the first place in the ballot for private Members' motions. I congratulate the hon. Member for Fife, Central (Mr. Hamilton) on winning the ballot, but that is all. The speech to which we have listened was disgraceful, even by the current standards of Labour Back benchers. As week succeeds week and month succeeds month, the exaggerations of their arguments become more silly, more frantic and more neurotic, and they become more and more obsessed with the conspiracy theory about the future.
In the background of the hon. Member's thinking there are two myths to which he gave expression this morning and to which Labour propagandists give expression all the time. The first is that in some way or other the Labour party invented the welfare state and has been fighting for it all along, whereas others have been opposing it. According to that theory, before the first majority Labour Government of 1945 children were still in the coal mines—I believe the hon. Gentleman actually mentioned that—children were still going up and down chimneys, and the only form of welfare relief was the soup kitchen. According to the myth, since 1945 the welfare state has been switched on and off as Labour Governments have come into office or left office.
The second myth about the Government's thinking and the work of the Think Tank is that, if fundamental mistakes are made in considering the priorities of the welfare state and how public resources can best be spent, there is a conspiracy to destroy the welfare state. I noted at least one of the hon. Gentleman's colourful phrases—that this would amount to a horrifying mutilation. However, anyone who wishes seriously to consider such matters will recognise that we should constantly look at the cost-effectiveness of our public services and the way in which the use of public resources can give the most help to those in need.
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All three main political parties in Britain, and Governments of those parties, have contributed to the growth of the welfare state over many generations. Conservative Members can take pride in the record of Tory reformers such as Shaftesbury and Wilberforce, and Conservative Prime Ministers such as Disraeli, Macmillan and Churchill, who were not defenders of the status quo, but social reformers in their time. We can also take pride in the record of Conservative Governments during the past decade. I succeeded my right hon. Friend the Prime Minister as Secretary of State for Education and Science. During her term of office there was the biggest ever expansion of nursery education and schools for handicapped children. When I succeeded her, under pressure from the Labour Chancellor of the Exchequer, who is now deputy leader of the Labour party, I had to cut both programmes.
During the same period of Government the then Secretary of State for Social Services introduced a range of new social benefits, including for the first time pensions as of right to the very elderly who did not qualify under the 1948 arrangements, the family income supplement to provide help for hard-pressed families where the breadwinner was in work, but was low paid, and a range of other services. During that Government the provision for personal social services in the hands of the local authorities was increased by about 50 per cent. in real terms, thus bringing extra help to the sick, the chronically sick, the disabled and the very elderly. It was a period of social reform.
During the past four years, despite the severity of the world recession and the economic position that we inherited, public spending on the welfare state has been higher than ever. If the hon. Member for Fife, Central talks about a service where there has been a modest reduction, he talks about savage cuts. If he looks at a service where, on the record, there has been a clear increase, he says that the books were fiddled. When asked how he knows that they were fiddled, he says that he read it in The Guardian.
We are entitled to a serious debate on serious matters. The total provision for the National Health Service and personal social services in 1979–80 was less than £9 billion, but in the financial year that is just about to start it will be £14·6 billion in cash terms. That total includes pay increases. My right hon. Friend the Secretary of State for Social Services announced recently—my hon. Friend the Minister of State may expand on this later—that since 1979 there has been an increase of 7·5 per cent. in the provision of services to patients in the National Health Service. That is a real improvement that brings great credit to the Government in view of the difficult economic background.
The hon. Gentleman talked about retirement pensions and other national insurance benefits. Anticipating the likely uprating in November, my right hon. and learned Friend the Chancellor of the Exchequer could tell the House that, after that uprating, and compared with the level of pensions when this Government took office, there will have been an increase in cash terms of about 75 per cent. during years when the cost of living increased by about 70 per cent. Therefore, pensioners will have more than kept pace with the cost of living at a time when economic circumstances have forced wage earners to

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accept salary increases that are less then the cost of living. During those years the pensioners' share of the national income increased.
I was privileged to be Minister with responsibility for the disabled for almost two years. There has been an improvement in cash services to disabled people of 9 per cent. in real terms. I make special reference to the mobility allowance, which is of great value to the severely disabled, who need special help. The increase in that area has been 83 per cent. in cash terms, which is well ahead of inflation. In the Budget of April 1982 the Chancellor freed the mobility allowance from tax, and 18 months earlier I had announced that the Government were phasing in the mobility allowance for those aged over 60 much earlier than the Labour Government had planned, and in one tranche for those aged between 60 and 65, whereas the previous Government had planned to do it in two stages.
One could continue to give details from other parts of the welfare state, and I am sure that my hon. Friends will do so. This is a story not of a Government who have cut the welfare state, but of a Government who have been improving it against a background of great economic difficulty. If the Government have failed in any respect, it has been in public relations. They have failed sufficiently to convince the public of the truth and have allowed far too much exaggerated talk about cuts in services to go unchallenged.
The hon. Gentleman made great play of the discussion papers circulated by the Think Tank some months ago and other recent reports that were leaked, especially to The Guardian, by civil servants who should have a better sense of their professional duty. No hon. Member who claims loyalty to our constitution should refer to such leaked reports without strongly condemning civil servants who break their trust in that way and Civil Service unions that encourage them to do so.
Mr. Derek Foster: It is hypocritical of the right hon. Gentleman, as an ex-Minister, to talk about leaks in that way. He is familiar with the system of Government-inspired leaks. How do we know that this was not one such Government-inspired leak?
Mr. Prentice: One would know that simply by reading the accounts. When I was a Minister—it has certainly happened since—from time to time confidential documents that were supposed to be seen by only a few got into the hands of the Civil Service unions and were, in some cases, printed verbatim in The Guardian. That reflects no credit on The Guardian or on the unions that encourage the practice, but above all it is a disgraceful dereliction of duty by individual civil servants. I hope that they are identified and sacked.
We must reconsider the shape of the welfare state. I wish that we had an Opposition in the House who were not so neurotic. If we had a constructive Opposition, the House could get down to a serious discussion of priorities and of how limited resources can be used. At present, the Government, including local government and the national insurance fund, spend about 44 per cent. of the GDP each year on all public services, many of which come within the broad category of the welfare state. Yet we are all aware that there are human needs in our society that are not being met to our satisfaction and that the concept of the welfare state raises expectations that we are not fulfilling, and
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which have not been fulfilled by any Government. There should be a serious examination of priorities and a constant search for efficiency.
There is all-party agreement in the House, and there always has been since the National Health Service was founded, on the central principle that sick people should receive medical services irrespective of their means. That is not being challenged and the Think Tank report did not challenge that concept, and the hon. Member for Fife, Central knows that.
Mr. Hamilton: Of course it did. The right hon. Gentleman has not read the report.
Mr. Prentice: It is right to seek for a better and more effective way of financing and organising the National Health Service. We want to see less of this precious money going into administration and more going direct to the patients. It is right to examine what is being done in other countries. In Belgium, for example, the system of compulsory insurance works to its satisfaction and it certainly would not exchange its system for ours. I am not sure whether we want to exchange ours for that of Belgium, but I am sure that it should be examined and that there should be a detailed study by the Think Tank and within Whitehall and the Conservative research department. That should be reflected in non-partisan debates on the Floor of the House.
It is a sad reflection on the Labour party that every time someone starts thinking about this subject it pounces on it and tries to pretend to the country that there is a plot to destroy the National Health Service. Similarly, with the social security system—in the financial year 1983–84 we shall spend about £33 billion on contributory and noncontributory national insurance benefits. It is a massive transfer payment from about three quarters of our population to the other one quarter. The system is so complicated that none of us can understand it fully and the staff who have to administer it in local offices cannot always understand it. In the 12 months during which I was Minister for Social Security there was a 14 per cent. error in supplementary benefit payments because of the complexities of the system. In other words, many people were being paid too much and others were being paid too little.
It is right that we should keep the system under review, seek to simplify it and meet real human needs that are perhaps not being met at the moment. We should ask ourselves whether the system, as it stands and it has stood for some years, is not spreading the jam so widely that the jam is also spread too thinly, and that some people receive resources that they do not need and others have needs that are not being met.
I said earlier that these matters should be debated in a non-partisan way, but the hon. Member for Fife, Central has made it a partisan debate. He has invited us by his motion to note with alarm what he calls
"the threats to the future of the Welfare State".
I should like to examine some threats to the future of the welfare state—those contained in the document "Labour's Programme 1982" which was approved by the last Labour party conference and is the official policy upon which the next Labour party manifesto will be based.
First, there is the threat to the National Health Service, which is to be found on pages 102 onwards. There are four proposals in particular. One is the phasing out of pay beds. The second is the complete discouragement of all private

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practice. The third is the phasing out of all National Health Service charges and the fourth is the proposal to abolish charges for hospital treatment for overseas visitors.
Mr. Pavitt: I cannot believe this.
Mr. Prentice: The hon. Gentleman says that he cannot believe it. Are we to believe that declared Labour party is not, in fact, Labour party policy?
Mr. Pavitt: It is a good policy.
Mr. Prentice: The hon. Gentleman says that it is a good policy, so I am invited to believe it. He will, therefore, confirm that those four items are in the document. If the hon. Gentleman catches your eye, Mr. Deputy Speaker, and he probably will because there is hardly any competition on the Labour Benches—they are all celebrating the Darlington result and the fact that they held on narrowly to a seat that they won in 1979—let him comment on the cost of all this and the exra burden that will fall upon the taxpayer, who is already the main provider for the Health Service and under these proposals will become the sole provider of those resources. It is a programme for savage cuts in the National Health Service. There is no other way in which a Labour Cabinet could attempt to balance the books and carry out the policy on the National Health Service as contained in those pages.
If one goes to the chapter on education on page 127, one sees:
"Our aim is to abolish all private schooling—with the exception of special schools for the handicapped—within a period of not more than 10 years."
So within that period the cost of educating the 6 per cent. of the nation's children who are now educated privately is to be transferred to the ratepayers and taxpayers, representing an enormous extra burden on local education authorities and, therefore, something that can be met only by cutting the provision for education.
The hon. Member for Fife, Central asks us to resist threats to the welfare state. If he wants us to do so he should get up in the House or at the Labour party conference and resist those proposals, because they are threats to the welfare state. They are putting National Health Service patients and the children in our schools at risk for ideological reasons and nothing else.
I believe that the biggest threat is the agreement reached this week between the Labour party and the TUC on a new social contract. There is a temptation to discuss that in detail, but I shall resist it. It is a much worse document than the original social contract of 10 years ago. If one takes the record of that social contract, what was the sequence of events?
Mr. Donald Thompson: The IMF.
Mr. Prentice: My hon. Friend says that it was the IMF. I am coming to that in my next sentence. In 1974, 1975 and 1976 the Labour Government were falling over themselves to carry out their side of the bargain, which involved billions of pounds of extra public expenditure, while the trade unions were failing to deliver their side of the bargain in terms of pay restraint.
The result was galloping inflation and an economic crisis that took this country cap in hand to the IMF. The result of going to the IMF was a programme of Government cuts in school building, hospital building and
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many other aspects of the welfare state. There again is a threat to the welfare state, and let it be discussed in that context.
Conservative Members believe in the welfare state. We believe that it could be better than it is and that in many countries it is better than it is in Great Britain. However, those countries that have succeeded in providing better health and welfare services are those that over the past quarters of a century have made a greater success of free enterprise economies. Free enterprise and a social conscience must go together. They have been proved to go together elsewhere. They will be proved to go together in this country's future during a long period of Conservative Government.
10.50 am
Mr. Derek Foster: My hon. Friend the Member for Fife, Central (Mr. Hamilton) is to be congratulated on initiating this important debate on the welfare state.
I listened with great interest to the speech of the right hon. Member for Daventry (Mr. Prentice). He shows the truth of the statement that there is no greater zealot than the convert.
Mr. William Hamilton: It is nauseating.
Mr. Foster: I understand my hon. Friend's case to be not that all Conservative Governments have been bad, but that the present Conservative Government are different from past Conservative Governments. I understand that certain members of the Government take great pleasure on that. They boast about it and attempt to dissociate themselves from the consensus politics that have been pursued by past Conservative Governments. The case is not that the Conservative party did not, in the past, believe in the welfare state. Indeed, there was an impressive consensus of all parties from 1945 onwards in believing in and defending the welfare state. We now fear that there is in the ascendency a wing of the Tory pary that does not believe in the welfare state and is hell bent on dismantling it.
That issue promises to be one of the most important battles in the coming general election. There could be no greater example of the divide between the two major parties. Sometimes it appears that the very words enshrining the concept of the welfare state are anathema to the new Tory party. Indeed, the country suspects that the concept itself is deeply repugnant to the new Right, yearning as it does for a return to the rampant individualism of the mid-19th century.
In financial affairs, its supporters proclaim Gladstonian "sound money"; in industrial affairs they worship the free market and competition; and in social policy they worship voluntarism and privatisation. They say that it is essential to roll back the frontiers of the state, that three decades of Socialism, welfarism and egalitarianism have sapped the nation's enterprise, leaving the British people clamouring for their rights and ignoring their responsibilities.
The Prime Minister has hijacked the concepts of moral rearmament as enthusiastically as she has endorsed President Reagan's arms race. "Go and think about the family," she lectures the Cabinet—but does not refer to the 4 million unemployed. "Let us return to Victorian values that made the country great," she hectors from the television screen, forgetting the grinding poverty, virulent

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disease, stinking streets, brutal prisons, asylums and workhouses and the desperately dangerous working conditions of those days.
Victorian respectability and religiosity comfortably ignore the squalor of the nation's working classes. Then, as now, the well-off had the best of excuses for ignoring the poor and the disadvantaged: the nation cannot afford to do anything to help them, and standing on their own two feet, being disciplined and thrifty is good for them. The Prime Minister's rampant individualism endorses the greedy and grasping selfishness which is the inevitable result.
In their anxiety to roll back the frontiers of the state, the Government seek to erase the long and painful history that preceded the birth of the welfare state. All the paternalistic voluntarism of the aristocracy and the middle classes could only scratch the surface of poverty and disease. The best of private insurance schemes, even if they could be afforded, could not eliminate the fear of impoverishment, following unemployment or ill health.
The Labour party swept to power in 1945, determined to end that all-pervading fear. Crucial and central to its approach was the commitment to a high and stable level of employment. Nothing was more demoralising, more humiliating, more likely to destroy self-respect and self-reliance effectively, more likely to put greater strains upon the family and more impoverishing and wasteful than frequent and prolonged spells of unemployment.
I must tell the Government that that commitment still holds today. There is no greater waste of human and financial resources than mass unemployment. Nothing saps the nation's enterprise, its talent, energy and resourcefulness more than mass unemployment. The Government are the true waste makers in our society. But they have been rumbled by the voters in Darlington, and they had better heed the warning. The social cost of reducing inflation has been far too great. "Get the nation back to work and hands off the welfare state" is the cry coming from Darlington.
Although the welfare state is underpinned by full employment, it envelops that great edifice of social security, the National Health Service and state education—the foundations of which were laid in the 1940s and the objectives of which were to eliminate poverty and the fear of illness, to break the power of the privileged and the purse in health and education and to provide a safety net for the unfortunate and the disadvantaged. The welfare state, the compassionate society and the caring community are concepts crucial to a society making any claims to be humane and civilised. They are the practical embodiment of Christian Socialist values.
The Government continually deny that they are dismantling the welfare state, or that they have any plans to do so. But let us examine their record on benefits. Because the Government cancelled the 1979 uprating planned by the Labour Government, child benefit is now worth 25p a week less than in 1979. But the total loss per child during those four years to November this year is £80·60. The loss to a two-child family has been £161·20 and to a three-child family £241·80. That is a far cry from the statement of the right hon. Member for Daventry of his grandiose plans to make child benefit a central tenet for family policy.
National insurance beneficiaries can receive a child dependency addition to their benefit, as well as child
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benefit. The Government have exploited a loophole in the law to cut the value of those additions. As a result, total child support for someone on short-term benefit is worth £1·68 less in real terms than in 1979, and total child support for someone on long-term benefit is worth £1·43 less in real terms.
The Government have broken the earnings link for pensions. The right hon. Member for Daventry made great play of the Government insulating the pensioners from the erosion of inflation. That is true. But the result of the break in the link has been a loss of £2·25 per week for a pensioner couple and £1·45 for a single pensioner. Because they are basing the next uprating on what will be the lowest inflation rate in May—which is expected to be 4 per cent.—in the knowledge that the rate is expected to be 6 per cent. in November, single pensioners will lose 65p a week and married couples £1·05 per week.
Then, of course, they broke the earnings-related supplement. A Government estimate has suggested that the average supplement that would otherwise have been payable in 1982 would have been £13 a week for sickness benefit, £11·20 for unemployment benefit, £14·10 for injury benefit, £8·80 for the maternity allowance and £14·90 for the widows allowance. More than 1 million children live in families whose head is unemployed and are dependent upon benefit. At the end of 1979 almost 3 million claimants—with dependants it was about 4·4 million people—were receiving supplementary benefit. The latest available figures show about 4·1 million claimants and about 6·5 million dependants. That record is not very impressive. It sustains the case of my hon. Friend the Member for Fife, Central that there has been a whittling away, if not, as yet, a dismantling of the welfare state.
Although the figure for unclaimed benefits by those entitled to them is between £350 million and £500 million, the Government are more concerned to root out scroungers, as in the well-publicised but inept Oxford operation where claimants' legal rights were flagrantly denied. At the same time, the Government refuse co pursue with vigour tax avoiders who get away with about £4,000 million. The Government, in their desperate attempts to cut taxation, have been forced to cut services and benefits even though they promised in 1979 that public expenditure could be cut by eliminating waste. Even so, the British people are more heavily taxed now than they were in 1979. Public expenditure is still a higher percentage of gross domestic product than it was in 1979. In a written answer in c. 240 of Hansard, of 17 March 1983, the Chief Secretary to the Treasury showed that, whilst defence spending had increased by £2 billion in real terms from 1979–80 to 1983–84, spending on housing had more than halved and spending on education had fallen by £1 billion since 1980–81. Whilst there has been some increase in health and social service spending, when demographic factors are taken into account there has been no real growth in the service. There have been substantial cuts in benefits and services and that substantiates the case of my hon. Friend the Member for Fife, Central.
The Government are obsessed with privatisation. They say that they have shelved for the time being their plans to fund from private sources great tranches of health and education. However, there are reports of privatisation from all parts of the country. I understand that the Cambridgeshire social services department has awarded a

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meals-on-wheels contract to an engineering company, perhaps on the ground that as it makes the wheels it may as well make the meals.
Lothian regional officials have been asked by the Tory group to discuss the possibility of privatising the home-help service, and in some areas it is considering selling off sheltered housing.
As far-fetched as these examples seem, the Government will be driven to these and even further extremes if they are to have any chance of keeping faith with the electorate on taxation and if they remain determined to slash public expenditure. If they have no more success in gaining growth in the economy and if, as even the Government's public expenditure plans assume, unemployment continues to rise, they will be forced either to dismantle the welfare state or to find private funds for the services. No other course is open to them. This irresistible logic underlies the Think Tank study, summoned, then so quickly disowned, by the Prime Minister. This gave the nation an extraordinary glimpse of what to expect after the next election if the Tories win. This time no one should be fooled because the Think Tank, so strongly denied, has come back in a more sophisticated guise from the family policy group.
I quote from the The Guardian newspaper, which outlined some of the points mentioned by my hon. Friend. It is up to the Government to deny that they have any such proposals. Let them do so. The article states:
"Some of the more controversial proposals include:
Women: proposals to encourage mothers to stay at home; a re-examination of the usefulness of the Equal Opportunity Commission; more family involvement in looking after the elderly, disabled and unemployed 16-year-olds (who would appear to face losing their automatic entitlement to welfare benefits).
Welfare State: Defining the minimum 'safety net' for welfare needs; handing over more personal social services to the private sector: encouraging private provision of social needs; and a review of policies for one-parent families so that the state encourages 'responsible self-reliant behaviour by parents', as well as ensuring adequate child support.
Education: Help for parents to set up their own schools; more aid for schools with a 'clear moral base' like the religious schools; support for the education voucher system; increased powers for headmasters, including powers to dismiss teachers and recruit teachers on short-term contracts".
As to the social engineering objectives, which were particularly insidious, the report states:
"In a confidential note prepared for the committee by the think tank, those objectives are summed up as: `to identify and to seek ways of countering those factors which tend to undermine, or even prohibit, the exercise of personal responsibility and a sense of individual self-respect.
'As such, the group's remit is far reaching and a large number of the government's present policies and programmes are relevant to it.'
Among the cultural and social changes the group seeks are:

1. A change in social values so that wealth-creation becomes more acceptable.

2. New ways of 'encouraging the development of children, the country's major resource of the future, into self-reliant, responsible, capable, enterprising and fulfilled adults.'

3. A study to 'identify characteristics of behaviour and attitude which Government might legitimately hope to see adults possess or, conversely, avoid.'"

This high-sounding moral double talk amounts to slashing the social wage; unloading substantial burdens from the state on to individuals and their families, either in funding the services now paid for out of taxation or in providing those services themselves. It must result in
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greater inequalities in health, education and welfare, a two-tier health service, a two-tier education service, reinforcing queue-jumping and privilege, or in a substantial reduction in those services, because individuals and families cannot or will not meet these new burdens.
What about the jobless? What about the 1 million one-parent families? What about all those on supplementary benefit already sinking beneath intolerable burdens? Who will bear the brunt of these new and growing burdens? The answer is predominantly women, whose lives and opportunities will be immeasurably constrained, and that from the first woman Prime Minister. What a reward for those of her sex who brought her to power in 1979.
The Labour party is immensely proud to have constructed the foundations of the caring society. Caring is not cheap and has to be funded by the growth of wealth and its fairer distribution. Of course, we must have value for money. Good husbandry and trusteeship of resources are central tenets of ethical Socialism. We owe that to our fellow citizens and we owe it to future generations. We, too, want a less complex social security system that is more sensitively administered. We want decentralised education and social services that are more sensitive and more responsive to individual needs. We want the whole system to be reinvigorated by a deeper sense of service to one another.
However, what we have is immeasurably good, and is highly valued by the majority of our people. Whatever gloss they put upon it, the Government want a fundamental shift of services away from the poorer members of our society so that they can give to the richer citizens even juicier handouts than they already have.
The voters of Darlington have rumbled this Tory Government, just as the whole country will when the election comes. The writing is on the wall. The days of greed and grasping are numbered. The days of caring are yet to come, and the sooner the better.
11. 10 am
The Minister for Social Security (Mr. Hugh Rossi): I intervene briefly simply to deal, on a purely factual basis, with those matters that are within my sphere of responsibility. However, I congratulate my right hon. Friend the Member for Daventry (Mr. Prentice)—whom I was privileged to succeed—on a very powerful speech, in which he rightly put in perspective the absurd nonsense that we have been listening to from the Opposition. They continually speculate what might have been if uprating had been carried out on a different basis two or three years ago. However, both we and the country are concerned with reality and with the benefits that are being derived at present.
The hon. Member for Fife, Central (Mr. Hamilton) suggested that there had not been a real increase in social security benefits. I do not know how he arrived at his figures. Indeed he did not even tell us what his proposition was. Until the March 1983 retail price index figures are known, it is impossible to compare 1982–83 expenditure in real terms with that for 1978–79. Therefore, I do not understand how the hon. Gentleman can produce figures showing what real change has or has not taken place. He must have guessed the March 1983 figures, yet it is he who suggests that we are fiddling them.
Perhaps I can give the hon. Gentleman some actual figures. The social security programme has grown from £16,437 million in 1978–79 to £28,510 million in 1981–82.
Mr. William Hamilton: It is mostly money for the unemployed.
Mr. Rossi: That is a real growth of 15·5 per cent. To suggest, as the hon. Member for Fife, Central has done from a sedentary position, that that represents solely dole money for the unemployed is just another of his absurdities. Expenditure on pensions increased from £8,480 million in 1978–79 to £13,670 million in 1981–82.
Mr. William Hamilton: In real money?
Mr. Rossi: That is a real gain of 7·4 per cent., and the answer to the hon. Gentleman's question is yes.
If the hon. Gentleman had taken the trouble to look at the figures for social security expenditure, he would have seen that unemployment benefit for 1982–83 is forecast to be £1,650 million out of a total expenditure of £32,000 million. The hon. Gentleman will see from those figures that unemployment benefit is 5 per cent. to 6 per cent. of the total social security budget. Therefore, it is nonsense to suggest that the growth in that figure represents a high proportion of the total social security budget. The highest proportion relates to the old age pension.
Mr. Foster: How much of that increase is due not only to the increase in the number on unemployment benefit, but also to all those who are on supplementary benefit because they have exhausted their entitlement to unemployment benefit? More than 1 million people have now been out of work for over 12 months.
Mr. Rossi: If the hon. Gentleman refers to the table that I have just cited he will see that the supplementary benefit figure is £1,408 million for the year in question, as against £32 billion for social security expenditure. Again, it represents a very small proportion of the entire budget. Even if the two figures were added together, they would still represent a small percentage of the budget. However, the figures are in the table and I have quoted them to the House,
Great play was made of the change from the forecasting to the historic method. Of course, the Opposition forgot to remind the House how we inherited the forecasting method. The Labour party would rather forget about that, but I shall remind the House. In 1976, the Labour Government decided to reduce the uprating of pensions not by 1 per cent. or 2 per cent., but by 6 per cent. It altered the basis of the uprating in that year to save itself £500 million. The Labour party stole £500 million from the pensioners in 1976. Barbara Castle is on record as saying that the real reason for that was to save public expenditure. The Labour party cannot escape from that. As a result of that sleight of hand, this Government have inherited a system in which the uprating is based on guesswork. It is called forecasting, but it is guesswork, because it is based on assumptions.
Mr. Foster: Is the Minister denying that, under the previous Labour Government, there was a 20 per cent. increase in real terms for pensioners while the hon. Gentleman can claim an increase of only 7 per cent. during the past four years?
Mr. Rossi: I appreciate that under the previous Labour Government rampant inflation, eroded the value of the pension and pensioners' savings throughout the land. We have reduced inflation to a tolerable level, but at some sacrifice on the part of our people. However, that was necessary to put right the devastation caused by the Labour
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party when it was in government. Because we had to deal with that forecasting, or guesswork, method, we had found that in the spring of 1980 the forecast for the uprating was 1 per cent. too high. Therefore, an adjustment had to be made the next year. In the spring of 1981 it was 2 per cent. too low, so an adjustment had to be made in the following year. In the spring of 1982, it proved to be 2·7 per cent. too high, so we were faced with the prospect, to follow logically the method of adjustment, of having to reduce the uprating of the pension or make the uprating 2·7 per cent. less than it might have been otherwise. Year in, year out, for five years out of seven, that method of guessing has proved wrong, impractical and unfair to the pensioners. Therefore, we rightly wondered why we should continue to be lumbered with a method of uprating pensions that the Labour Government brought in simply to bale themselves out of public expenditure, reduce it and cheat the pensioners.
Therefore, what we have decided to do consciously this year is to say that in future pensions will be uprated in line with actual inflation. There can be no messing about. There will be no guessing. The uprating will be based upon actual prices and we shall delay the announcement until the last possible operational date to narrow the gap between the date of the announcement and the increase in pensions. However, should it appear that inflation, heaven forbid, is going up again, the following year the pensions will be made up automatically as they will be geared to actual increases in prices and we shall have got rid of this method of guessing.
The hon. Gentleman spoke of the way in which the pensioners have allegedly lost under the Government. I remind him of the pledge that we made to keep pensions in line with prices, and to protect pensions and other connected benefits from inflation. I shall give the hon. Gentleman some figures that he did not find in The Guardian. They are the sort of figures that The Guardian chooses not to print. Since the Government came to office, the basic retirement pension has been increased four times by a total of 68·5 per cent. Compared with that, the increase in the RPI from May 1979, when we came to office, until the most recent figures were available in February 1983 has been 51·6 per cent. If the hon. Gentleman feels, as some hon. Members feel, that the RPI is not the right index to apply to pensions and that one should look at the pensioner price index, I can give the figures for that. The increase in the single pensioner's PPI from the second quarter of 1979 to the fourth quarter of 1982 was 48·4 per cent. compared, as I said, with an increase in pensions over the same period of 68·5 per cent.
If the hon. Gentleman is not satisfied with that, and wants to look at earnings, I shall give him the figure for the increase in average gross male earnings from May 1979 to January 1983, the most recent figures that I have. The increase is 61·1 per cent. compared to an increase in pensions of 68·5 per cent. Therefore, on all the indicators, we have not merely fulfilled our pledge to maintain the level of pensions but exceeded it and given the pensioners more than the increase in either wages or prices. Let the hon. Gentleman digest those figures, which are the true figures.
There have been references to what might now be the position if child benefit had been uprated a couple of years ago, when we were faced with extreme economic stringencies as a result of inheriting an economy devastated by the Labour Government. We have raised the

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child benefit in this Budget to £6·50 per week, an increase of 11.1 per cent. when inflation is running well below that figure. As a result, child benefit will be at its highest level ever in real terms. The cost of that will be £332 million in a full year and the increase will benefit some 7 million families with children.
Opposition Members did not mention one-parent families. Why were they silent about them? Is it embarrassing for them to suggest that the Tory party has given hellp to one-parent families? There again, we have increased the benefit by 11 per cent., so we shall help those people considerably. We inherited a £2 rate. In November we shall have increased it by more than 100 per cent. since we came to office—again, well ahead of the rate of inflation.
Opposition Members did not wish to talk about the invalidity trap, although I recall that they have previously been vocal about it. We have abolished it. From November most invalidity beneficiaries will be able to go on to the long-term supplementary rates after 12 months on incapacity benefit. In addition, they will become entitled to be passported to ancillary benefits such as housing and heating additions, diet and house repair payments under the supplementary benefit scheme. Some 30,000 sick and disabled people will be helped as a result of that change. We have also announced as a separate measure that all men over 60, whether sick, disabled or unemployed, will be able to qualify immediately for long-term rate of supplementary benefit.
Are those changes the action of a Government determined to dismantle the welfare state? The terms of the motion are absurd. Why was there no mention of the increase in the therapeutic earnings rules, which will be of great benefit to people who are on incapacity benefit but who can do a little work? The new level will be £22·50, a 12·5 per cent. increase over the present figure.
Those who have suffered in the service of their country are not best loved by some Opposition Members. There are constant criticisms of the Falklands and the rest of it. Perhaps that is why not one word has been said either today or on a previous occasion about the new measures that are being brought in by the Government to help the war pensioners with a new mobility supplement so that they will get a scheme similar to the mobility allowance, but with a war pensioners' preference of £2·10 more. Some 11,000 war pensioners will benefit as a result of that innovation by us.
I could continue to talk about point after point in the Budget that affects the area for which I am responsible. I reject the motion. I ask the House to reject it. It is absurd and founded on a tissue of lies and distorted figures.
11.29 am
Mr. Ronald W. Brown: I do not wish to follow the Minister's tirade, but I suppose that it would be churlish if I did not make a comment on Darlington, since the Government and the Opposition have done so. We all see something in the Darlington result that gives us satisfaction. Perhaps the best thing that I can extract from what is to me clearly a disappointing result is that, with an increase in votes cast of about 3 per cent., the successful Labour party candidate polled about 6 per cent. fewer than the Labour party candidate in 1979.
Sir Peter Mills: Labour did well.
Mr. Brown: The Labour party may have done well, but the Conservative party does not have much to cheer about. The Conservative candidate polled about 8 per cent. fewer votes than the candidate in 1979.—
Mr. Deputy Speaker: Order. The debate is about the welfare state.
Mr. Brown: I was alluding to the welfare state, Mr. Deputy Speaker. If Labour and Conservative candidates continue to lose votes in this way, they will all be receiving supplementary benefit before long. The alliance candidate polled 25 per cent. of the votes, which is more than double what the Liberal candidate received in 1979. The message from Darlington is that the voters are serving notice on the old parties that they will support the alliance from now on.
I congratulate the hon. Member for Fife, Central (Mr. Hamilton) on his motion. We have just heard a tirade of alleged statistics, but when I produce statistics that are barely 10 hours old and fresh in everyone's minds Conservative Members jeer, laugh and question them. I do not understand that.
The hon. Member for Fife, Central has tabled an excellent motion. However much the right hon. Member for Daventry (Mr. Prentice) urges us to believe that his heart and soul are in perpetuating the welfare state, I must tell him that people outside the House do not believe it. I do not believe it. If the right hon. Gentleman says that one cannot expect a pill for every ill, the only interpretation that I can draw is that he will make it impossible for me to get a pill for every ill. The Minister said that, not I. That was his response when he was arguing that he had to withdraw money from the National Health Service.
There is clear evidence that the Conservative party is going back to its traditional ethos. Conservatives argue that people should stand on their own two feet—someone else's feet if possible—and that people must look after themselves. I do not go as far as the hon. Member for Fife, Central. I believe that the Conservative party has had a heart. Conservatives have always argued that it is their responsibility—they go to church on Sunday to prove it—to look after the very poor. They have accepted that responsibility. In my constituency there is still an office for the relief of the poor.
I pay tribute to the fact that the Conservative party has always accepted responsibility for the relief of poverty. The Conservative party now sees its role as that of relieving poverty. It has decided to orientate its arguments to that role and to leave the rest of the country to fend for itself. The current jargon of the Tory party is that somehow we should return to a more self-reliant society.
As the hon. Member for Fife, Central said, the Prime Minister has returned to the argument of Victorian standards. The Conservatives have always recognised their responsibilities under Victorian standards. In the past, the poor were taken care of. The Conservatives built houses for them and called them workhouses. People in the workhouses were paid, provided they worked to earn it. I believe that the Conservatives are still hooked on that argument. The Government are engaged in a massive exercise to destroy the welfare state. They have resented it ever since 1948. We should never forget that they voted against it consistently. They never accepted the argument and the ethos for the setting up of such a system. The

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arguments today only serve to underline the fact that they cannot allow the people of this country to see what their major objective really is.
The Government now want to transfer the burden to the sick, to the poor, to the needy and to the elderly. If those groups cannot cope, they will have to turn to the voluntary sector because there is little else to which they can turn. The voluntary agencies cannot cope. Such a philosophy explains why the Government are cutting down on the provision of primary care. There is a difficulty with regard to the responsibilities of different Departments. The Department of the Environment is deliberately cutting back the grants from which local authorities pay for primary care, while at the same time hospitals are being cut back because the Government claim that primary care is available and therefore the hospital service is not needed in that way. The Government have not shown how we can bring those responsibilities together. They are simply returning to the concepts of a bygone age.
There can be little doubt that, in the post-war years, there has been a massive improvement in the health of the nation, from the safe birth of babies to the extension of the life span of the elderly. This has been achieved by a substantial growth in the resources devoted to social services and medicare.
My hon. Friends and I believe that four areas must be considered. First, we believe that there must be equality of service and prompt treatment for all people irrespective of their ability to pay and where they may live. Secondly, we must develop preventive medicine and community care. Thirdly, there must be an increase in accountability, participation and responsibility to satisfy the consumers' requirements, and more efficiency in achieving those objectives. Fourthly, increased co-operation must be developed between health and social services and other authorities, particularly between the statutory authorities and the voluntary sector.
One accepts that it is just not possible for the National Health Service alone to do all that needs to be done. I have long argued that. It is not possible, and never has been possible, for it to be the sole provider. The health and primary care parts of the provision are totally interdependent and must be developed together.
My criticism over the years is that they never have been so developed. Primary and community care must become the active front line of health care. For the past 10 years successive Governments have failed to grasp this nettle. Secretaries of State have authorised closures of hospitals on financial grounds, based upon an assumption that primary care was available.
In my constituency, the right hon. Member for Norwich, North (Mr. Ennals) authorised the closure of a hospital—the House will know this case, as I have raised it many times—although I had assured him time and again—the Minister of State at the time knew this—that the primary care services in Hackney were almost nonexistent. Yet the right hon. Gentleman went ahead and closed the hospital, taking no notice of my protestations. Today we are in exactly the same position, with a totally inadequate primary care service. I accept that one cannot expect a local authority to provide such a service if it does not receive sufficient financial resources from the Government to do so.
The district health authority is again proposing to close St. Leonard's hospital. It is advancing the specious argument that full primary care services are available. I
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hope that the Minister will refuse to sanction the closure until such services are available. As I have often said, I should welcome the opportunity to take him to the area of Hackney which I represent to show him that what I have been saying is the fact. I am not relaying to him figures or stories that have appeared in The Guardian. I am prepared to take him to my constituency in my car to show him exactly what I am talking about.
We must develop active participation with complete teams of professionals—nurses, midwives.. general practitioners, health visitors and social workers. We must establish ways of working together, developing contacts and working with voluntary organisations and local individual volunteers. The objective must be to identify and pick up problems at the earliest stage possible to prevent them developing. My criticism over the years has been that we seldom undertake preventive work. If the problems were found at an earlier stage, they would not develop into the need for hospitalisation. Prevention must be cheaper than ultimate hospitalisation, but we shall have to challenge established practices if that approach is to be implemented.
Why, for example, is it still argued that the family practitioner committee should continue to be independent of the main structure of the National Health Service? There is clear evidence that GPs are suffering by being isolated from the main stream of the Health Service. It is being realised more and more that the independent FPC is not the panacea that it was once thought to be.
It is also being realised that the integrated approach to primary care is the next major step for the NHS. My colleagues and I in the SDP will encourge experimentation and give financial and legislative support to those who are willing to seek a better way of providing primary care. The Acheson report signposted the way. Unfortunately, that excellent report is still lying on the shelf. Nothing has been done to implement its recommendations.
We need enthusiasm, imagination and a willingness to be bold in seeking solutions. Successive Governments have relied on the argument that there is enough fat in the Health Service to absorb the cuts that have been made year after year. I am bound to say that the statement by the hon. Member for Brent, South (Mr. Pavitt) about the north west Thames regional health authority was right. I declare my interest, because I am a member of that authority. The authority is nowhere near the growth to which the Minister referred. That is clear, and he knows that it is not true to suggest that there is growth. The House does itself no service when hon. Members bandy figures across the Floor of the House and everyone outside knows that they are not true. It is a fact that the north west Thames regional health authority has no growth. It is no good saying that it has a growth rate of 1·5 per cent., because that is not true. The chairman was right to make the position clear.
Mr. Kenneth Clarke: The hon. Gentleman is suggesting that I denied what was said about the north west Thames regional health authority. It is true that that authority has no growth money in its provision. I was talking about national growth money. We are distributing the available growth money to the most under-resourced and deprived areas. That is consistent with the first part of the SDP's policy, which is that there should be equal access to care throughout the country. The SDP's spokesman on these matters is usually the hon. Member for Newcastle upon Tyne, East (Mr. Thomas), and he is

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one of those who most consistently argue that the Government are not redistributing quickly enough to the area that he represents from places such as Hackney.
Mr. Brown: Taking from the poor to give to the poor is the very philosophy that we are discussing and questioning. The hon. and learned Gentleman has reinforced my argument. I am sorry that the right hon. Member for Daventry is no longer in his place, because I am highlighting what he has misunderstood. The area that is covered by the north west Thames regional authority is deprived. There are a great many problems in the area and we are being "RAWP'd" to provide extra resources for other areas that are equally deprived.
If the statement had not been corrected, the message would have gone out that the north west Thames regional health authority had enjoyed a growth rate of 1·5 per cent. in its funding. If that had been the fact, the people within the authority would have been right to expect signs of that growth. However, it has been established that there is no growth.
The Government are cutting the NHS budget on the assumption that efficiency gains will offer considerable compensation. There is no evidence that such gains will be forthcoming. The corollary must be that services will be cut instead. It is no good relying on exhortation. We need to provide the staff with incentives to identify their own costs. By so doing the Government would reap the reward of being able to use the money thereby saved to improve services rather than see it frittered away in the general NHS budget.
The same applies to other departments. It has been said on many occasions that the principle should be applied to the catering and laundry departments. They would help themselves a great deal if they were encouraged to follow that lead. This self-regulation would lead to rewards for the NHS. There should be a much more dynamic role for the community health and social services councils. There is no reason why community health councils should not have social service responsibilities. They could then develop schemes for advising patients and clients of their rights and ensuring that they were treated as individuals, with dignity, privacy and autonomy. There would thus be more opportunities for choice.
We want to make the system more sensitive to the individual's needs, more responsive to local preferences, more efficient and more able to provide value for money. Secondly, action needs to be taken on the production of generic substitutes for drugs. More than anything else, we need a commitment to retain and improve the welfare state. The post-war years have shown beyond doubt that the health and welfare of the people have improved since the advent of the welfare state in 1948. To break up such a service merely to satisfy party political dogma must be sheer vandalism. The SDP is committed to encouraging and developing Britain's health and welfare services.
11.48 am
Mrs. Angela Rumbold: I am grateful to have the opportunity to participate in the debate and to respond to the postulation that the Conservative party is considering dismantling or destroying the National Health Service. The more I listen to the arguments advanced about the way in which the Government and the
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Conservative party are planning to dismantle the welfare state, the more I believe that I am not sitting in the Chamber of the House of Commons in central Westminster. It seems much more likely that I am instead on a planet somewhere in outer space.
Mr. William Hamilton: Like the Think Tank.
Mrs. Rumbold: I cannot believe that Opposition Members are living in the same world as myself. I cannot believe that they are walking, working, eating, sleeping and mixing with the community outside the House that I know and see in my constituency. I find that amazing.
I was struck when the hon. Member for Brent, South (Mr. Pavitt) said that the Conservative party—I think that he named the Prime Minister—was anxious to send women back to the home to look after their children and generally to return to the Victorian era. There is no evidence to suggest that women do not participate in the working world or that they are not being encouraged to play their full part in society or that they cannot take jobs and work hard and continue to do so. Indeed, as far as I am aware, the Conservative party has always said that women, especially those who are able and want to, should have equal opportunity with men to work.
There is no harm in saying that many women long to be with their small children when they are first born. I was one such woman. I willingly gave up my career and went home to look after my children, for a variety of reasons. One reason was that I had a biological urge to bring up my children and another was that I believed that it was the right thing to do for the children as they would benefit and become better people. Moreover, I knew that when my children had grown up, I could go back to work and would be welcomed on my abilities.
I entirely refute the charge that the Conservative party suggests that women should go back to their homes. Equally, I plead that women be allowed to stay with their children if they want to do so. We have a splendid example of a girl who loves her child in our own Princess Diana, who has taken her baby with her to Australia. We should examine her example carefully and recognise that many women, the real women, like her example and can identify with her.
Mr. Clement Freud: Would the hon. Lady suggest that women also take their ladies' maids, their nannies, their hairdressers and their manicurists wherever they go?
Mrs. Rumbold: Of course I would not. I take the hon. Gentleman's point. I do not want to speak only about women. I shall deal with that part of the welfare state with which I am somewhat familiar.
Mr. Foster: I agree with much of what the hon. Lady has said, but does she not recognise that, if the Government genuinely want to impose an additional burden of responsibilities on the family, the people who will have to bear them, whether they like it or not, are women? They will be forced to give up their jobs to look after elderly relatives and teenage children who cannot get jobs. That is our point. We are not suggesting that people should not be able to give their children proper care; our point is that they will be forced to lose the opportunity of working and fulfilling themselves.
Mrs. Rumbold: I have not heard anyone say that it should be the women who look after the elderly or

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children. There is no earthly reason why men should not do so if they are so inclined. The argument that I am refuting is that the Conservative party is deliberately trying to put women back into the home. That is not so, as women have every opportunity to be breadwinners or to be more successful if they so wish. Moreover, the choice not to have children is now entirely theirs.
Much has been said about this and other Governments' records in education. I must repeat what my right hon. Friend the Member for Daventry (Mr. Prentice) said—that 93 per cent. of British children are educated by the state. That is done through local education authorities, which are funded partly by rates and partly by taxes. In the 1970s, a Labour Secretary of State for the Environment said that the party was over and spending in local government had to come to its senses. Some 60 per cent. of local government spending goes on the education service. Therefore, that Secretary of State must have been referring, at least in part, to a reduction in education expenditure. Indeed, he made such reductions.
In 1977, when the right hon. Member for Cardiff, South-East (Mr. Callaghan) was Prime Minister, he made a speech which started off something that became known as the "great debate". He said that education needed quality and should go back to first principles, that money was not necessarily the answer. Therefore, the argument that the Conservative party is taking money out of the education service and destroying it does not stand up.
Since about 1975, the majority of local education authorities have had to examine their expenditure carefully. They have also had to note that, since 1975, there has been a perceptible reduction in school rolls. The first thing that happened after the Government were elected in 1979 was that the teaching force was awarded an enormous pay increase. Not only were teachers given the Clegg comparability increase which the Prime Minister had undertaken to honour, but they received an annual pay award which was roughly in line with inflation. Those two combined gave the teachers an increase of some 40 per cent. That money had to come out of local education authority budgets. It is right that they had to pay a proper wage for a proper day's work. I defend teachers' rights to have a fair wage, but I also defend the right of local authorities to say that, if they are paying a given number of teachers, other things must be examined to see whether the available money is being spent properly.
One of the provisions of the Education Act 1980 was to protect the very nursery education that my right hon. Friend the Member for Daventry talked of, which was introduced by the Prime Minister when she was Secretary of State for Education and Science. Nursery education has expanded considerably under the Conservatives. The 1980 Act makes it almost impossible for a local education authority to stop providing nursery education as the matter must be referred to the Secretary of State. The present Secretary of State is convinced of the importance of such provision. That is a simple example of how the Conservative Government have protected educational provision through legislation.
Although the number of children going to school has fallen, the quality of state education has been carefully examined. We sincerely believe that every child who goes to school is entitled to excellent teaching and education. For that very reason, Secretaries of State for Education and Science have closely examined curriculum and teaching
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quality and have shown enormous concern for the way in which young people are taught. That can scarcely be described as dismantling and destroying the welfare state.
The Government have shown great concern for the 16 to 19-year-olds who are about to go out into the world Successive Governments have talked about the need to train young people through education for work but have not done anything about it. This is the first Government actually to do something about encouraging young people to train for proper jobs with the injection of £1 billion to assist education in training and industry this year. The assistance for the future given to young people through the new training initiative should be welcomed by everyone. Not only is money being injected to encourage young people to train for employment, but it is directed towards relevant employment and jobs that they will be able to continue throughout their working lives.
Various possibilities for the future such as the voucher scheme and loans for students have been mentioned. Like the programme that the Labour party is about to propose, these ideas are bound to be leaked to the press and discussed, but there is no particular commitment on my part or, I believe, on anyone's part to do more than discuss the options.
The provisions of the 1980 Act and the voucher scheme have given or could give freedom of choice to parents, as will the retention of church schools. There is nothing destructive to the concept of the maintenance of the welfare state and state education in offering choice to parents within that system.
Mr. William Hamilton: The hon. Lady talks about choice for parents. Does she agree with her own local authority's abolition of the school meals service? Does that enlarge freedom of choice?
Mrs. Rumbold: I should be happy to discuss the provision of school meals in Merton with the hon. Gentleman, although I fear that it is not especially relevant to the debate. I have discussed and considered the matter at some length. In fact, the uptake of school meals in that authority was about one eighth of the total.
Mr. William Hamilton: There is no choice
Mrs. Rumbold: I understand that the authority is carefully considering alternative methods of providing school meals for children if their parents so wish. I see nothing in the concept of the maintenance and sustenance of the welfare state and good education provision that conflicts with the concept of freedom of choice for parents. If that freedom is taken away, the concept of the welfare state as I understand it will indeed be destroyed. The welfare state involves the provision of an education service through rates and taxes but also the right of parents to choose within that system the best they can to meet the needs of their own children. In the 1981 Act the Government introduced better and more civilised provision for children in special schools. It is therefore utter nonsense to contend that the Conservative party or the Conservative Government have done anything but increase the provision of good education within the welfare state.
12.4 pm
Mr. Laurie Pavitt: It is a pleasure to follow the hon. Member for Mitcham and Morden (Mrs. Rumbold), as she is at least more decorative than most of

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her colleagues. I do not agree with much that she said, but she said it clearly. I should have preferred to follow the hon. Member for Canterbury (Mr. Crouch). I hope that he will catch your eye, Mr. Deputy Speaker, as he is the one Conservative Member who speaks with authority, understanding and compassion about the National Health Service—which, as the House will expect, will be the main theme of my speech.
I am pleased to follow the hon. Lady as it seemed at one point that I might have to follow the right hon. Member for Daventry (Mr. Prentice). I regard the right hon. Gentleman with a good deal of sadness, but by the time he had finished talking about the National Health Service I was suffering an acute attack of nausea. I felt sick to the stomach because I knew the right hon. Gentleman when he was a trade union organiser, many years before he became a Member of Parliament. I regret that he is not present now as he addressed a number of points to me and I had hoped to be able to deal with some of them.
I have two comments for the hon. Lady. First, she rightly said that the cuts in rate support grant affect education more than any other service because it is the biggest spender in local authorities. Last year, my authority had to close one of its special schools to make the cuts bite. We managed to make some alternative arrangements, but they were less satisfactory.
Secondly, I listened with interest to the hon. Lady's comments on women's liberation. The House always enjoys listening to an hon. Member who brings personal experience to the debate. I think that we can agree on one thing. The hon. Lady's choices about work, family, home and leisure in her own life seem to rely on a Labour victory at the next general election. She envisages returning to a job when she loses her seat, but unless something is done about unemployment there may not be a job for her to go to.
I hope that the Minister will answer one specific question. Three years ago, Back Bench and Front Bench Members of both Houses had to form a committee for the protection of Westminster hospital, which is more or less the House's hospital and was under threat as a result of the Flowers report and the report of the London consortium. In the past fortnight, we have become increasingly worried as a result of two important developments. Her Majesty opened a new operating theatre section at Westminster hospital at a cost to the National Health Service of £1·7 million of public money. All hon. Members, including myself, who have had the good fortune to be cared for by that hospital in times of illness will agree that no hospital is more deserving of that expenditure.
A fortnight ago also, however, there were reports that Westminster hospital was due for the chop. The reports are unsubstantiated, so the Minister may either substantiate or deny them today. With the Government's sincere commitment, as I am sure the Minister would describe it, to privatisation and to the extension of private enterprise into all aspects of life, it would be a fraud if, after the NHS had spent £1·7 million on one of its hospitals, so convenient to this area and to Harley street, any question then arose of the hospital being closed and sold off. It would fetch a very good price on the market, given the recent expenditure of £1·7 million. It would be scandalous if all that went to private medicine and ceased to be part of the public provision.
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I hope that the hon. and learned Gentleman can state categorically that there is no intention of closing Westminster hospital, and does not garnish that by saying that there is no immediate intention to close the hospital. I hope that he and his right hon. Friend the Secretary of State will vigorously oppose any attempt at selling it off to the American Medical (Europe) company or any other private enterprise company that seeks, on the back of our Health Service, to make a profit out of sickness.
I was challenged on some points by the right hon. Member for Daventry. He claimed that there was a great need for an examination of where the NHS and the social security service fit into the welfare state. Anybody who knows anything about these subjects will know that we have been inundated with reports and analyses. The Conservative party made the initiative on costing when the late lain Macleod commissioned the Guillebaud report, and changed the Conservative party's policy from its 1951 anti-NHS policy to one in favour of the NHS. This was because the report showed beyond question and peradventure that the NHS system of provision of health services was, in comparison with the United States, more economical and efficient and, for about two thirds of the per capita cost, was giving twice as much medical care and attention on all three sectors of primary care, hospital care and community services.
We do not need any more reports. Has the right hon. Member for Daventry ever read or heard of the Merrison report, the Acheson report or the Black report? To request that the Government should examine the facts of life in the Health Service is not something new. It may be new to the right hon. Member for Daventry but to the hon. Members for Canterbury and for Hackney, South and Shoreditch (Mr. Brown) and others on the Opposition Benches there is nothing new about examination of the Health Service. The hon. Member for Canterbury and I have been doing that for nearly the whole time that we have been sitting on the Back Benches on opposite sides of the House.
The right hon. Member for Daventry said that the Health Service should be a non-partisan subject. However, the break of the partisanship came in 1977. The right hon. Gentleman is right in saying that, from 1953 to 1977, in the debates on the Health Service in the House there was 95 per cent. consensus. The small points of difference between us were usually on details that were not within the mainstream. However, in 1977 there was a confrontation over the phasing out of pay beds. From that time the Health Service has once again become a political football between the parties.
The right hon. Gentleman seemed to think that it would be a tragedy to phase out pay beds and spoke of all the lost income to the NHS. Does he not know that, when we last phased pay beds, only 2,900 were left, but there were still 470,000 beds left in the NHS? Does he think that those 2,900 beds would prevent the Government from pouring the necessary resources into the Health Service? Despite the charges, pay beds have always been a political and not an economic factor in the Health Service.
The right hon. Member for Daventry spoke of the 1982 Labour party manifesto, which is extremely good. He challenged me on the part concerning the Health Service, and I did not intervene because, looking around at the Benches, I got a vague idea that with a bit of luck I should be able to answer him later without further interruptions. The right hon. Member spoke of four specific points in the manifesto, all of which I thoroughly endorse, and asked

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what they would cost the taxpayer. The Labour party programme is the most constructive thing that has happened since Kenneth Robinson, who was once a Minister for Health, published a paper which was aptly entitled "Members One of Another". I know that my hon. Friend the Member for Bishop Auckland (Mr. Foster) will recognise the sentiment.
The policy put forward by the 1982 Labour party conference on the welfare state affects all parts of it. The reforms will cost a 3 per cent. real increase in the first year of a Labour Government. The programme will need to be phased, with priorities, over eight years. The priorities in the first four years will have to be costed and approved by general and open consultation and discussion not only in the House but within all the sectors that are affected. It is not just that we descend on these Health Service problems like gods from heaven and have all the answers. The Minister knows the importance of consulting, and we shall be consulting about the way in which the phasing can be put into effect.
Mr. Kenneth Clarke: The hon. Gentleman knows about these matters and has been working on the Labour party policy for the future of the Health Service. Is the hon. Gentleman talking about a once-and-for-all 3 per cent. increase in spending, or is the proposal a 3 per cent. per annum increase on spending in the NHS? Is he talking of 3 per cent. in real terms as compared with the retail price index, or of 3 per cent. growth in services in the NHS using the ordinary conventions by which Health Service spending is measured?
Mr. Pavitt: I cannot go much further than the first year, because the commitment in 1982 was that in the first year of a Labour Government it would be 3 per cent. in real terms. As to costing, there will be no fiddling the figures and telling health authorities that because they have saved 0·5 per cent. through more efficiency they have therefore had an increase in their money. When a Labour Government come into office after a Conservative Government have completely devastated the finances of the economy, we have to put things right. In 1951, 1964 and 1974, we had to spend most of the time clearing up the mess before getting cracking on anything else.
I cannot take the hon. and learned Gentleman beyond the first year of a Labour Government. However, this is a comprehensive programme for the NHS, social security and unemployment—mainly unemployment, because that is the obscene thing of the 1980s. Unemployment was obscene in the 1930s but it is worse now. With a Labour Government, Education, Energy and Transport Departments will all have bustling Labour Ministers. They will fight their corner, just as the hon. and learned Gentleman fights his in Standing Committee. The overall four-year phased expenditure will be contained in a complete projection. The first year's improvements will cost 3 per cent. on health and 4 per cent. on social security.
Mr. Kenneth Clarke: I do not accuse the hon. Gentleman or his hon. Friends of fiddling figures, but none of them gives figures for this great commitment, the biggest breakthrough since 1982. Can the hon. Gentleman say how much his party will spend in the first year on the NHS?
Mr. Pavitt: The Minister for Social Security gave us many figures on social security, and I watched the House
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get more and more tired listening to them. Many figures were bandied about. If I give the hon. and learned Gentleman a complete economic analysis, I shall be diverted from saying what I intended to say. The right hon. Gentleman can work out for himself 3 per cent. of the overall NHS expenditure for 1982–83 of £14·5 billion. He can also work out the increased figure for social security benefits, which is more than £ 14·5 billion, as he well knows. If he has a computer in his pocket he will know what 4 per cent. of the amount will be. If he wants me to give him an analysis of the differing costs for implementing the switch to primary care from hospitalisation, I am prepared to come to his room for half an hour to give him the figures, and I should be quite happy for his boffins to be present to refute them.
I return to the matter about which I was challenged by the right hon. Member for Daventry. He said that we shall lose resources because we shall repeal the charges for overseas visitors. I wonder how much those charges have yielded. The Secretary of State claimed, originally, that they would yield £3 million, but when the matter came before the House he doubled it. It was a case of "Think of a number and double it".
In my local general hospital the problem is acute. The hospital serves central Middlesex, the area of Harlesden, Kensal Rise, Kensal Green and Stonebridge. In the schools in that area, 80 per cent. of the kids are black, and 43 per cent. of the people in my borough come from the ethnic minorities.
I have an analysis of the number of questions that had to be asked in the first three months of charges for Health Service visitors. There are two phases in the exercise. This is the biggest bureaucratic nonsense that the Conservative party has ever thought up. It says that it wants to devote money to patient care, then it brings in this bureaucratic system. In my area, just under 2,000 questions were asked. About eight people went through to the second stage. Of those eight, one proved eligible for payment, and the amount for which he was eligible was so small that it did not even pay for the amount of time and energy spent on the second lot of questions. We shall repeal the whole system because, apart from causing more bureaucratic work, it does not raise money and means lack of equity for the people involved.
My hon. Friend the Member for Bishop Auckland, who knows that we are proud of the NHS, will recognise the system that we called "the stranger within the gate". It was not for people to come to this country to have free health services, but it recognised that if we had guests we should treat them as such. The Minister may say that there is nothing racial in imposing charges, but one cannot say that to someone of Caribbean ethnic minority status. The first thing that person will say is, "I am being challenged because I am black". I know that that is not true, but he does not know it.
What my hon. Friend the Member for Fife, Central (Mr. Hamilton) said in his devastating speech was quite right. It is not copyright, and when the election comes on 9 June I should like to use it for some of my material. The way in which our welfare state has been run down in an area with a high ethnic minority is an ingredient of racial disharmoney and dispute. In the last analysis, it can lead to race riots. The right hon. Member for Daventry claims that we shall destroy the Health Service by taking away this iniquitous system of having millions of questions asked to prove entitlement to a service which has been

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free, but that is what we shall do. The right hon. Gentleman should go back to being a trade union organiser and do a bit more homework on this matter.
We have to compare the £6 million that the Minister thought so important with what has happened with the Greenfield report on resources for the National Health Service. That report was given to the Secretary of State more than 13 months ago. It did not see the light of day until 12 months later. What was the Greenfield report? It said that, of the £1,700 million that we spent on medicines, it was possible to make savings—not £6 million, but probably at least £100 million.
The Pharmaceutical Society—not Labour party supporters, but a professional society—says that on 10 drugs alone there will be a saving of £29 million. Instead of brand names being flogged by one drug company representative calling on nine general practitioners—apart from the enormous promotions that are involved, in spite of the price regulation scheme—£29 million would be saved on 10 drugs alone, with generic prescribing.
Other estimates from the pharmacology departments of universities are closer to £150 million to £200 million a year. If the Minister reads the Pharmaceutical Journal as assiduously as I do, he will have seen some of those remarks.
The Association of British Pharmaceutical Industry used its leverage with the Government to force them to brush the report under the carpet for 12 months. Although they have now produced it, they have not yet decided what to do. I expect that nothing will be done until after the general election. The House will know that the second private Members Bill that I introduced this Session relates to generic drug prescription. It is a short Bill with only two clauses and would require little time in Committee. I know that it is supported on both sides of the House.
The Greenfield report suggests the amendment of a practice that has existed since the National Health Service started and that is mentioned every time the cost of medicines is discussed. The practice is that one must not interfere with the clinical freedom of a doctor to prescribe the drug that is best for his patient. It has been preserved by both Labour and Conservative Governments, but the Greenfield report gives us a way out. It states that any doctor who writes an FP10 prescription note can add to it the words "no substitute". If he does that, he will get what he ordered. However, if the note does not contain those words, the country will save millions of pounds, not the piddling £6 million from charging a few overseas visitors.
I regret that the right hon. Member for Daventry is no longer in the Chamber. However, he can read, and if I am lucky he may read my comments on Monday. You were not in the Chair, Mr. Deputy Speaker, when he challenged me on several points. I should have preferred him to be here when I answered them.
I hope that hon. Members will take note of the figures given by my hon. Friend the Member for Fife, Central for housing in Scotland. Those figures are echoed in all constituencies, but especially in Brent. The Government put a block on house building in 1980 and prevented local authorities, for eight months, from repairing properties that they had bought with the intention of renting them. The Minister for Housing and Construction delights in telling the House how many more building starts there are this year than last year. However, if we start from almost
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nil, it is easy to have a 150 per cent. increase very quickly. It is yet another example of the juggling of figures in which the Government indulge.
Brent council spends £30,000 a week on bed and breakfast accommodation for the homeless. We have 500 such families and, if the numbers increase as they have done during the past 18 months, in three years the figure will be nearer 900. I am not very good with figures, but I know the personal tragedies. Many Hon. Members must be visited in their surgeries by homeless couples, perhaps with small children, who must live in hostel accommodation, which is very expensive. There are 10,000 people on the housing waiting list in Brent. In my surgeries I hear case after case of heartbreak. Marriages break up because the couple believed that they could move in with mother and get a place of their own eventually. However, if they have a child, tension grows because of lack of space. This has happened under the party that believes in the family. There is much unhappiness in multi-occupied homes. I welcome the Bill introduced by my hon. Friend the Member for Leicester, South (Mr. Marshall) to do something about multi-occupied houses. However, the statistics are not as important as the families who are affected by this problem.
Brent has a progressive council that encourages housing associations such as the Paddington Churches Housing Association Ltd., the Brent People's Housing Association Ltd., shared accommodation schemes and co-operatives. Two years ago housing associations bought houses to refurbish. My borough council, like so many others, made the mistake in the 1960s of bulldozing large slum areas and building modern concrete high-rise fortress blocks of flats. It was the biggest mistake that we ever made. I regret it and so, I believe, does every hon. Member who represents a concrete jungle.
It was later recognised that it would be better to improve some of the solid old Victorian houses and those built early in the century than to knock them down and build something else. Two years ago the then Secretary of State for the Environment unfortunately put a stop on local authority property repairs for eight months. It resulted in houses that had been bought by housing associations being vandalised and when the Secretary of State lifted the ban in April 1982, the cost of putting the houses right was fantastically high. If only the welfare state had not been undermined then.
I want to deal with the point raised by the hon. Member for Hackney, South and Shoreditch, and which I mentioned in an intervention. I took the trouble to check Hansard for 24 March and study the written answer in c. 484. I congratulate the hon. Member for Hackney, South and Shoreditch. I feel sick when I hear about the right hon. Member for Daventry, the right hon. Member for Plymouth, Devonport (Dr. Owen), and the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) talk on these subjects. I understand the psychological process. Those right hon. and hon. Members are converts and they have to attack their former colleagues. I give the hon. Member for Hackney, South and Shoreditch his due; he has never wavered. He has never attacked his former comrades. I always listen to him with more respect when he speaks on these matters than I do to some of his colleagues.
The question related to the provision of resources. Dame Betty Patterson had issued a statement implying that the regional health authority was busy trying to shore up

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the system. Conservative Members will say that the Labour Government introduced the Resource Allocation Working Party. Of course they did, but we accept that things can go wrong. Fourteen regional health authorities cannot have blanket authority over their district health authorities. Statisticians can deal with such figures but not administrators.
I believe that there are about 170 hospitals in the north west Thames region. There is to be an increased provision of 0·7 per cent. when the number of elderly people is increasing to 9 million. In a few years there will be 1 million people over 80 years of age. The Health Service recognises that we should pay the general practitioner more for his care of ladies over 60 and men over 65 because we know that they make twice as much demand on his services. The regional health authority faces demographic change and Dame Betty Patterson says that the position will be impossible next year because it will not be able to cope without cutting patient services heavily. That is the authority's only option. I do not envy her. I should not envy the hon. Member for Hackney, South and Shoreditch having to make such decisions. He cannot have everything he wants unless he has more money.
I took a deputation to see the Minister and I thank him for his courtesy. It consisted of the borough's chief executive officer, members of the local borough council and the director of social services. They were worried that for the year 1983–84 Brent district health authority must find savings of £1·3 million out of a budget of £44 million.
Mr. Kenneth Clarke: London Labour Members mount attacks on policies for redistributing resources based on the RAWP, which their Ministers invented and which Labour's present spokesmen are defending. I wish to quote from "Labour's Programme 1982", from which the hon. Gentleman drew. It states:
"We are also faced with gross regional inequalities. In 1980–81, expenditure per head varied from £125 in North Tyneside to £435 in Kennington, Chelsea and Westminster. Within an expanding budget, we must continue to channel extra resources into those regions which have traditionally been under-financed. But within regions we must ensure that resources are distributed to the most deprived districts."
The hon. Gentleman was referring to an over-resourced district in an over-resourced region. It has an over-provision of acute beds. Is he not speaking in direct contradiction to the Labour party's programme on which he claims to have worked?
Mr. Pavitt: As usual, the hon. and learned Gentleman is wrong. I live, not in an over-resourced area, but in a deprived one. We have been given programme status as a urban area of deprivation. Labour party policy is right. I have never disputed that the basic principle of RAWP is correct, but it is not operated as effectively as it could be.
Unlike the Conservative party, the Labour party is prepared to adopt the mark 2 edition of RAWP. The RAWP system can be refined within the terms of the background which the hon. and learned Gentleman has described, and the difference from the present arbitrary, statistical manner in which the system is operated by the Government would be as chalk is to cheese.
The hon. and learned Gentleman is obsessed with two things—that the National Health Service is hospitals and nothing more, and that those hospitals consist of acute,
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orthopaedic and surgical beds and we can forget about the rest. He merely works out how to chop a few acute beds to provide a few more geriatric beds.
The Central Middlesex hospital is one of the greatest in Europe. I served on its committee, which received delegation after delegation from overseas. Mr. Edward Kennedy, a past contender for the United States presidency, visited the hospital. There are now plans to reduce the facilities at that great hospital—although I admit that they are no more than plans. That has come about because of the statistical arrangements for bed occupancy. I do not refute the fact that the hon. and learned Gentleman has no immediate plans to close that hospital, but when I led a delegation to meet him to discuss the matter we received an equivocal answer. It was a Micawberish "Not yet, but wait and see." The implications of that remark scare the daylights out of me.
A marvellous hospital, Willesden general, is in the heart of my constituency. It once had 127 beds providing a great service to the community. Plans were put forward to close the hospital, but I fought that when I 'was a member of the regional authority, and also in the House. Although it has not been closed, it now consists of only 38 geriatric beds. That is why we are warned about the Central Middlesex hospital—it may not be closed, but it may be run down. It is a great hospital and takes students from the Middlesex teaching hospital. Sir Francis Avery Jones is perhaps the most famous gastro-enterologist in the world. Sir Richard Doll, who is emeritus professor at Oxford, is a Central Middlesex man.
I told the Minister that we had a fight on our hands to preserve and progressively use resources and that we would not maintain a defensive position, but would attack. We shall do that with the support of the borough council, the district health authority, the community health council and the medical profession, including the doctors at that hospital.
I raised the question of the privatisation of the laundry service at Northwick Park hospital with the Secretary of State, who promised to write to me, and he has done so. It is a beautiful letter, consisting of two paragraphs, which say nothing. Northwick Park hospital is the pride and joy of the Health Service, because it is the only clinical research centre in the country. Of the 800 beds, 200 are maintained by the Medical Research Council and the remaining 600 are maintained by the area health authority. That hospital was in the Brent and Harrow area health authority. Brent and Harrow have now divided, so the Central Middlesex hospital is in the Brent area and Northwick Park hospital is in the Harrow area.
When the overall planning of the Central Middlesex hospital was being considered, it made sense to upgrade the laundry machinery at the Central Middlesex and £250,000 was spent on it to do the laundry from North wick Park more cheaply. What has happened is that a laundry company based in Birmingham, of all places, has been given the contract, and the machinery that was paid for by public expenditure could become idle and rot unless it is sold to a laundry company, probably at a cheap rate.
I asked the Secretary of State to write to me about this matter, because the information that I had from the laundry manager was that the tender accepted for the Northwick Park hospital was higher from the private sector than the one tendered by the Central Middlesex hospital. I have received no reply to that letter. In local government, and in other areas, the rule is to accept the lowest tender. This

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issue was raised by some hon. Members about Calderdale. Hon. Members would like to know how far the ideology of the Conservative party means that, provided privatisation allows one to get away from community responsibility, cost does not matter because friends in the industry will benefit.
I rejoiced in the fact that the Minister was a good Cooperative member, because when he answered that question he hoped that the laundry that would get the contract would be a good co-op organisation. That delights me today, because he represents an area where the cooperative college exists. I expect that he has visited it many times. He, like me, will rejoice in the fact that a Cooperative college lecturer will be joining us on these Benches. It will mean that the co-operative group will have one more Member in the House. When Ossie O'Brien comes to the House, I trust that my hon. Friend the Member for Fife, Central will make sure that he receives a copy of his speech, because that is precisely what Ossie O'Brien has been saying for all the years that I have known him.
The House has been talking about the tragedy of 4 million unemployed.
Mr. Tom Benyon: Oh, get on with it.
Mr. Pavitt: You, Mr. Deputy Speaker, have known me for many years. I reckon that 15 minutes is the right amount of time for a speech, but as I have been speaking for 17 minutes I apologise. This is the first Friday on which throughout my 24 years in the House I have spoken for more than 15 minutes. I trust that the House will forgive me, because I have several important points to raise, and my hon. Friend raised various points for discussion. It is our job to discuss them.
Therefore, I come to the point about unemployment. We can bandy the figures around, but Conservative Members must know from their constituency surgeries of the tragic way in which unemployment affects the family. In my area, it affects two main categories. In June, 80 per cent. of those who leave school will not find jobs. My constituency has a high proportion of people from the ethnic minorities, and of that 80 per cent., 75 per cent. will have black faces. If that is not a recipe for racial tension, I do not know what is.
All hon. Members will have experienced tragic cases. Last week, I met a skilled electrician, who has one child at school and a couple of others who are grown up. At the age of 52, he has found that there is no room at the inn. He knows that he will never get another job. The Department of Employment's statistics for the long-term unemployed—those who have been unemployed for more than a year—depict the tragedy and the heartache. That point links up with my main area of concern, health.
I draw attention to the reports that have been made on the effects of unemployment on health. The Minister will know of the Newcastle report, which was prepared by Dr. Malcolm Colledge. It shows that the social security system now carries a tremendous burden because of the increase in social security benefits. In addition, the Health Service now makes a heavier demand on its resources. The report shows that jobless men are twice as likely to commit suicide as those in work. I am talking not about statistics, but about death. It also shows the effects of unemployment on tension and stress, with the resulting use of the Health
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Service. Despite the Minister's obsession with acute surgery, he knows that mental illness and stress represent one of the biggest growth areas in the Health Service. The report showed statistically and conclusively that there had been a direct increase in demand in all sectors of the Health Service as a result of unemployment. We talk about jobcentres, leisure centres and training centres, but what do we do about a man who is debilitated by his anxiety for himself and his family? Local health authorities should consider what they can do in terms of health education to mitigate that man's call on the health services. Preventive medicine could be at its most seviceable in forestalling the illness and stress caused by unemployment.
I read with some interest another report on the health aspects of unemployment from the John Hopkins university in Baltimore. A different group of unemployed people was compared in a different social background. In addition, the health care available was different. There was no National Health Service or national insurance, only Blue Cross and Blue Shield coverage. Anyone who knows anything about health will be interested to know that the American study contains almost exactly the same factual information as that provided by Dr. John Colledge of Newcastle upon Tyne.
I wonder whether in the resource allocations for the Health Service next year the Minister for Health will consider preventive medicine. He should send a circular to health authorities emphasising what could be done with a combination of primary and institutional care, especially in psychiatry, to prevent those health problems. Like smoking, unemployment can damage one's health.
Mr. Clive Soley: In the context of the motion and my hon. Friend's knowledge of health, does he share my view that the philosophy of Beveridge was predicated on the assumption of full employment and not mass unemployment, and that the report recognised that if there was mass unemployment the welfare state would be threatened? That is precisely what has happened because the Government have chosen to use public expenditure to finance mass unemployment. That, as Beveridge said at the time, is the death knell of the welfare state.
Mr. Pavitt: My hon. Friend is absolutely right. That point was made in response to the claims of the right hon. Member for Daventry. That is a problem.
After the Beveridge report, when it was said that it was impossible to have a policy for full employment, a Labour Government established a policy for full employment. I remind the House of the conditions in which they did so. Some 3 million men were in the armed forces and had to be brought back to other employment. The whole of industry was geared to the production of Spitfires and other aeroplanes, tanks and guns. The whole industrial economy had to be changed. In five years, when Clem Attlee was Prime Minister, we did it. That is what the manifesto that we shall fight in the next general election is talking about. It is not just an armchair Fabian philosophy, but it is based on practical experience.
The Minister for Social Security and others have said that the main thing that the Government can claim credit for is that, having pushed up inflation in the early days to 20 per cent., they have now got it down to 5 per cent. They inherited 9 per cent. inflation.
Mr. David Crouch: On a point of order, Mr. Deputy Speaker. I would not seek to criticise the hon. Gentleman because he has given the House a trailer of the speech that I shall make if I am lucky enough to catch your eye. We have heard for the past 40 minutes not so much a debate as a one-sided discussion from almost empty Opposition Benches. We are missing an opportunity for debate. May we be treated to a debate on this important subject, which was raised by the hon. Member for Fife, Central (Mr. Hamilton) and which has now degenerated into a lecture?
Mr. Deputy Speaker (Mr. Ernest Armstrong): The content of speeches is not my business, except that hon. Members must keep in order. As long as the hon. Member for Brent, South (Mr. Pavitt) keeps in order, I have no power to intervene.
Mr. Pavitt: I should like to reassure the hon. Gentleman. He is the last person in the House to whom I would not want to listen because he is one of the few people in the Conservative party who talks any sense. I hope not to delay the House too long. As has been said, I have had a good innings.
I refer now to the Labour Government's record on employment. In the Council of Europe, on which I and other Members serve, we have been discussing employment. In every one of the 21 countries employment has been falling and unemployment has been rising. We have been looking at the experience of Great Britain from 1945 to 1950. In a recent debate in Strasbourg I dug out a report by my late colleague Anthony Crosland. That report followed on from the 1942 Beveridge report. It mentioned running the economy against the background of the problems of inflation, the value of the pound, unemployment, prices and price rises. The report showed that the Labour party was successful because it gave priority to unemployment and put inflation into second place. That is why, when we win the next general election, we shall do the same thing again and why, without any dramatic fall in the first year, there will be a steady decrease in unemployment.
Mr. John Farr: On a point of order, Mr. Deputy Speaker. I rise in relation to a point raised by my hon. Friend the Member for Canterbury (Mr. Crouch). While the hon. Member for Brent, South (Mr. Pavitt) is no doubt in order, it has been the practice in the past, when long speeches have taken place, for the Chair to suggest to the hon. Member in question that reasonably brief speeches might be the occasion to let a general spread of debate take place. The hon. Member for Brent, South has spoken for almost an hour and for him to be moving on to further points now is, I suggest, an abuse of the House.
Mr. Deputy Speaker: Order. I have explained to the House that it is not in my discretion to rule on the length of speeches. The hon. Member for Brent, South has spoken for 56 minutes, but that is a matter for the hon. Gentleman.
Mr. Ronald W. Brown: Further to that point of order, Mr. Deputy Speaker. I wish to draw attention to the number of hon. Members present in the Chamber. The record should be clear that there are no more hon. Members on the Conservative Benches than on the Opposition Benches.
Mr. Pavitt: Over the years, I have been the last hon Member to treat the House with discourtesy. This is an off-the-cuff speech. I did not intend to make it.
Mr. William Hamilton: It is a very good speech.
Mr. Pavitt: I have good ammunition for at least another 40 minutes. I would hate to deprive the Minister of the right to reply. It is only fair that, if I fire the shots, he should have the right to be able to respond to them.
I wish to deal with pensions and the way in which the method of calculation is to be altered. The Prime Minister stated at the Dispatch Box when challenged that the Government had changed the rules. The Minister for Social Security said that pensions would catch up in a year's time, but if one is 82 a year is a long time.
The issue of nurses is of prime concern. I have no time to deal with the issue now, but I hope, Mr. Deputy Speaker, to catch your eye in a future debate, when I shall deal with the way in which the nurses have been treated. I will also deal with the bottlenecks that occur and with the failure of the Government to deal with the problem of renal dialysis, nurses, theatre sisters and many other areas of concern in the Health Service. I should like also to deal with the way in which private health services, such as BUPA, are gradually cutting down on benefits, which means that the elderly and mentally ill are treated by the Health Service, while highly expensive operations are dealt with elsewhere. I hope that the Minister will deny the rumour that there are plans afoot in the DHSS for high-priced surgery to be hived off to private hospitals while the National Health Service hospitals will act more or less as a conduit to direct high-priced operations into the private sector.
I should have liked to deal with the disabled, but time does not allow. I shall leave that to my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) whose Chronically Sick and Disabled Persons Act 1970 is still regarded as the guideline. The Government claim the support of the disabled, yet all the organisations of the disabled, including the Brent Association of the Disabled, are lobbying me constantly about the way in which their position has deteriorated.
The hon. Member for Harborough (Mr. Farr) will be pleased to know that I am about to conclude. My hon. Friend the Member for Fife, Central moved an excellent motion. We are seeing in the country, especially in the past 24 hours, that, at long last, we are moving away from personality politics. This argument is a rehearsal for the fundamental argument that inevitably will follow. When the issue is joined, it will be based on the real and differing ideologies of the two main parties on the way in which we should deal with people. The basis of the argument will not be the attributes of certain personalities. There is no such thing as a perfect Member of Parliament, a perfect leader of a party or a perfect Government.
I congratulate my hon. Friend the Member for Fife, Central on allowing us to return to reasoned argument between the two sides of the House and on giving hon. Members an opportunity to rehearse their views. I look forward to hearing the views of Conservative Members.
1.5 pm
Mr. Nigel Forman: I think that my hon. Friends will agree that the hon. Member for Brent, South (Mr. Pavitt) spoiled what could have been quite a good speech by continuing at inordinate length.
Mr. William Hamilton: No. My hon. Friend cut short his speech.
Mr. Forman: I hope that I shall not lay myself open to the same charge. I shall attempt to be a good deal briefer. In the early part of the hon. Gentleman's speech I found myself strongly in agreement with one of his arguments. I was listening at that stage, so I appreciated that we were in agreement. I accept that the Government must ensure that the excellent Westminster hospital remains open. Having had some contact with it, I am aware of the excellent work that is done by all who work at the hospital.
We are indebted to the hon. Member for Fife, Central (Mr. Hamilton) for introducing such an important subject for debate. I suggest that the future of the welfare state is probably the most important subject with which we and our constituents are concerned. It is a topic central to the political debate that takes place in Britain. For that reason it is unfortunate, but slightly predictable, that the hon. Gentleman should have laced his speech with so many scare stories, bogies, hobgoblins and things that go bump in the night, including cuttings from The Guardian. Much of his speech was the product of a rather fevered imagination. I was tempted to seek to answer what he said point by point but I shall not do so because I believe that that was done effectively by my right hon. Friend the Member for Daventry (Mr. Prentice). Suffice it to say that I think that much of what the hon. Gentleman said was misguided and fevered.
It is interesting to recollect that nearly 40 years ago a distinguished Prime Minister spoke on the radio on 4 July 1948 about the provision of social services. He said:
"All social services have to be paid for in one way or another from what is produced by the people of Great Britain. We cannot create a scheme which gives the nation as a whole more than we put into it … Only higher output can give us more of the things that we all need."
That was Clement Attlee speaking on the radio the night before the NHS came fully into operation. It was the day before vesting day, as it were, for the service in 1948. He was speaking about the Health Service, which is the quintessential service within the welfare state, but more broadly about the welfare state itself. That being so, we would all do well to bear in mind the cautionary words of one of the most distinguished forebears of Labour Members.
I shall devote my brief remarks first to the National Health Service. I regret that on every occasion when hon. Members on either side of the House wish to denigrate the service they do so on the basis of ill-founded information. The service's record on administrative costs needs to be put straight. There are only about 107,000 employed on the administrative side, strictly speaking, within the service and national administrative costs are about 5 per cent. of total costs.
The Government's target is shortly to reduce administrative costs to about 4·6 per cent. It is as well to bear that in mind because some people say that if we move to a completely insurance-based or some other system such as exists in other countries, we will give better value for money. It is evident from the record, the Merrison report and everything else that a largely tax-financed Health Service is the most efficient form that one can have and that, on the whole, we have a fairly firm grip on administrative costs, as has been shown by the figures in the public expenditure White Paper.
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Equally, if the Health Service wants to keep the good reputation of which it is jealous, it must take urgent steps to guard against the unsatisfactory things that crop up from time to time. The Guardian has been much quoted in this debate. I shall offer a quotation from the Yorkshire Post written by Bernard Dineen, who drew his readers' attention to some extremely unsatisfactory evidence about pilfering in NHS hospitals. The article was based on what the chairman of the Association of National Health Service Security Officers said at a recent conference. I shall not weary the House by reading the full quotation but its essence is that the chairman said that
"as much as £7 million worth of food alone was disappearing from hospitals without being accounted for. Even bigger losses occurred in linen, sheets, towels, overalls and clothing with between 10 and 20 per cent. 'disappearing' every year. The reason was mostly theft."
Those are not my words, but those of the chairman as reported in the Yorkshire Post. If the reputation of the NHS is to stand as high as I and my hon. Friends want it to stand, it is vital that management in the NHS at all levels ensures that that practice diminishes rapidly.
Any fair-minded student of these matters will agree that the Government have a creditable record on the NHS. From 1978–79 to 1982–83 the Health Service has grown by about 6 per cent. in real terms. That growth is projected to be about 7·5 per cent. by 1983–84. As has already been said, we now employ about 4,000 more doctors and dentists and about 45,000 more nurses and midwives in the Health Service. Those figures are tangible expressions of our commitment. I am glad to pay tribute to our keenness to promote partnership with the private sector. The idea is that money saved by contracting out support services for the NHS can be kept by health authorities for patient care.
I was also glad to see from Social Services Question Time recently that my right hon. Friend the Secretary of State for Social Services attaches great importance to preventive medicine. I have always strongly argued for that. I was also glad to see that he attaches importance to the Health Education Council. The Government have nothing to be ashamed about in regard to the Health Service and I commend them.
The Government also have a creditable record on education. I admit that there has been a slight decline in spending on education in cost terms between 1978–79 and 1982–83, but total spend on education and science is still about £11·75 billion in 1982–83. That slight decline in spending reflects falling rolls in schools, as the House realises. Those rolls from 1982–83 to 1985–86 are expected to be 4 per cent. down for primary schools and 10 per cent. down for secondary schools. Because of those falling rolls, the Government can preside over more improvement in pupil-teacher ratios, which are now at their historic best, at about 18·5 overall.
We cannot, however, be complacent when considering the future of education, as it is a vital aspect of the welfare state. The Government must now concentrate even more on raising the standards of education for our children. They should address themselves to the content of the curriculum, especially the content of the curriculum in teacher training colleges. In that context, I welcome the Government's recent White Paper on quality in teaching. The Government must address themselves to the problems of discipline, behaviour and truancy, which are fundamental to good education in large classes. Above all,

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they must address themselves to the needs of the nonacademic 40 per cent. in our schools, for whom provision hitherto under successive Governments has not been so good as we would hope.
In view of all the important problems that face them, I believe that the Government would be unwise in the present circumstances to spend too much time being distracted by such market ideas as education vouchers or student loans. There may have to be experiments to demonstrate the shortcomings of such schemes, but I hope that we shall not go lock, stock and barrel for such ideas. As my hon. Friend the Member for Mitcham and Morden (Mrs. Rumbold) said, the vast majority of our children are now educated in state schools and it is to them that we must turn our most urgent attention.
It is equally important that the Government give a further fillip to the idea of greater industrial involvement and local community involvement in higher and further education. We could learn from West Germany, where the involvement of industry in this sphere is closer than it is here, with consequent benefit to its education and training systems.
On social security, too, the Government have a proud and creditable record. Between 1978–79 and 1982–83 total contributory benefit expenditure rose from £10·6 billion to £18·8 billion and non-contributory benefit expenditure from £5.1 billion to £12·2 billion. The total social security programme has therefore grown from £16·4 billion to £32·4 billion, representing about 30 per cent. of total public spending.
The problems in this sphere are enormous for any Government and any Chancellor because benefit expenditure is essentially demand driven and dependent on legal eligibility, demography and the extent of social need. It is clearly right that we should seek to meet all those requirements. The Government have a good record in this sphere, especially with this year's Budget, with the uprating of child benefit and one-parent benefit, the abolition of the invalidity trap and the restoration of the 5 per cent. cut in unemployment benefit.
Two aspects of benefits expenditure must be considered more closely. First, it is significant that expenditure on the elderly represents about 50 per cent. of total spending on benefits. Clearly, we must continue to look after the elderly and to ensure that they are price-protected. In a sense, this is enlightened self-interest, as we all hope to be old some day, so in the longer term we are looking after ourselves.
Secondly, expenditure on the unemployed is now about 17 per cent. of total benefit expenditure and we must continue to look after them as well, especially the 1.3 million long-term unemployed, not only for the sake of the individuals but for the sake of their families who find themselves in straitened circumstances through no fault of their own.
In the case of expenditure on the elderly, we are very much at the mercy of demography, life expectancy and medical and technological advances in the National Health Service. In the case of the unemployed, we are at the mercy of demography, the length and depth of the current recession and changes in technology and working practices. The Government must contend with all those problems and do the best that they can in a compassionate way, but many of the major factors that decide the great sweep of events are largely outside the Government's control.
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I remind the House, if any reminder is needed, that, as Clement Attlee said, a satisfactory welfare state depends on the satisfactory performance of the economy. The dilemma is that when the economy is performing least well more people need the support of the welfare state. We must therefore try to get through the present difficult period with the minimum damage to the most vulnerable people in our society.
Therefore, in those circumstances I suggest that there is a role for the private sector in support of and in partnership with the public sector. Equally, it is vital that the public services in the welfare state do not become simply things run to suit the convenience or the ambitions of the caring professions, much though we respect their commitment to the services. There must be a genuine trilateral partnership between the Government, the professions concerned and the voluntary bodies within the private sector.
This is an occasion to think of some of the strategic choices that face the House and the country on the welfare state and the future. In crisp terms, there are three possible choices. First, we could seek to hold the line or existing welfare state commitments and decide deliberately to introduce no further improvements and no new benefits. Even if that were our policy, it would lead to increased spending in real terms where demography points in that direction—for example, increases in the number of the elderly, and, when the economic recession dictates it, in unemployment.
The second choice, which I would not favour, would be to cut back on existing commitments in the welfare state by putting greater burdens on individuals—for example, by encouraging private individuals to assume a greater burden for their pensions or by discontinuing certain forms of medical treatment or educational provision on a rather arbitrary basis. That would be socially unacceptable and would lead us into the danger of creating a two-tier welfare state and a two-tier welfare society.
The third option, which would be the nicest of all, would be a real increase in and extension of the welfare state, but in present and foreseeable economic circumstances that is probably unattainable, and would be irresponsible and unrealistic until we can get the economic growth to pay for it. The Government are doing a service to present and future beneficiaries of the welfare state by seeking to create conditions for wealth creation as top priority. The important point is that, as and when we succeed in reviving the economy, we should give a higher priority to looking after children, the unemployed, the sick and the elderly. I am convinced that this can best be done in a partnership among the three main bodies to whom I have referred.
In the long run, we must look towards the development of a fully fledged tax credit scheme, or negative income tax, as the answer to the redistribution of cash in society. We cannot do all those desirable things simply with cash, even if some hon. Members think we can. There must at the same time be adequate provision of care, and this is where the NHS, adequately funded, comes in, as does state education. There must be a joint effort between cash and care. Experience from the United States, West Germany and elsewhere suggests that too much emphasis on private provision or insurance financing is less efficient, more expensive and more socially divisive.
All Governments, whatever their political label, need to be careful with the welfare state. It is a great British

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institution of which most people are justifiably proud. While it is legitimate and sensible to try to reduce the burdens of the public sector on the rest of the economy, we should be careful not to undermine those public services that either would not or could not be provided by voluntary efforts in the private sector.
For example, we should recognise that if ordinary families are to be encouraged by fiscal and other means to take more direct responsiblity for their children and elderly relatives, heavier burdens will be placed on married women, millions of whom are already doing two jobs, one in the house and the other in paid employment outside. At a time of economic recession, such part-time work as married women do is more vital than ever to millions of families who need the money from that source. This trend can be reversed only if the incentives for those women to stay at home are made far larger than the Treasury is likely to feel able to afford.
Another example is that, while many of us can see the sense of encouraging the partnership between public and private provision in the welfare state, that does not mean that it would be right at a time of recession to require individuals to shoulder more of the burden of their own pensions, or to accept the idea of employers deducting charitable contributions at source from the pay of their employees. Fifty eight per cent. of social benefits are already contributory, and people in work already pay more than enough, as they see it, through the parallel tax system of national insurance.
In short, in a free society voluntary efforts should be voluntary. Let me give one final example, familiar to those who have read the writings of Ivan Illich. It is the extent to which many professionals in the welfare state and outside often appear to undermine individual responsibility and choice by arrogating to themselves too much power of decision over their clients' lives. In other words, disabling professionals tend to produce psychologically disabled people. Equally, however, it is no answer to say that this professionalisation of the welfare state should be countered with little more than high assertions of the virtue of self-reliance and the vice of professional restrictive practices. A better approach would be to concentrate on raising the standards of prefessional training and reforming its contents so as to encourage the professionals to develop enabling attitudes for the benefit of all those whom they seek to help.
In the long run, if we are to reform and modernise the welfare state in a way which will not alarm people and which will carry consent, we must not talk or act as if we believed in tearing things up by the roots. That is not a Conservative approach. I suggest that we can be reassured by the words of the Prime Minister who said, in a long interview on "Weekend World" on 16 January this year:
"Yes, I want to see one nation … but I want everyone to have their own personal property stake. Property, every single one in this country, that's why we go so hard for owner-occupation, this where we're going to get one nation. I want them to have their own savings which retain their value, so they can pass things on to their children … everyone strong and independent of Government, as well as a fundamental safety net below which no-one can fall … You want a ladder, upwards, anyone, no matter what their background, can climb, but a fundamental safety net below which no-one can fall."
That must be the right approach. What we need to do in a cold economic climate is to look for sensible ways of
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supplementing existing arrangements, so that the welfare state is something of which this country and this nation can be proud.
1.26 pm
Mr. David Crouch: First, may I say to my hon. Friend the Member for Carshalton (Mr. Forman) that his speech was worth waiting for. He always makes a reflective speech and treats the House to a considerable amount of thought behind his words. So we are grateful to him. I am sorry that the promoter of this debate, which has been a most important debate on the future of the welfare state, the hon. Member for Fife, Central (Mr. Hamilton), did not hear my hon. Friend's speech, but I appreciate that there are times when an hon. Member must leave the Chamber.
I do not intend to speak for long, and I do not want to disappoint the hon. Member for Brent, South (Mr. Pavitt) who, as I said earlier, gave a trailer of what I might say, should I catch your eye, Mr. Deputy Speaker. However, he is still in his place, and I hope that when I sit down I shall not have disappointed him. However, I shall confine myself to the subject of health.
The hon. Member for Fife, Central presented an unbalanced case. He presented his case in grossly exaggerated terms. That is permissible in this House, when one feels passionately and strongly on a subject, but in a discussion on the welfare state, the state of the welfare state, and this Government's intentions towards that welfare state, I believe that it was unworthy of him, of the House, and of those of us who have come here interested in the welfare state and its progress. Moreover, it was unworthy of patients and workers in the Health Service. In my opinion, his speech was an insult to our intelligence. Worst of all, it was adversarial. I do not believe that this great institution, the welfare state, properly so described by my hon. Friend the Member for Carshalton, should be the subject of an adversarial approach.
We must have debate, discussion, examination and criticism, but the matter should not be fought over here. Our constituents wish to see the Health Service in good shape and progressing. The hon. Gentleman's approach today is out of time and out of place. Not even Aneurin Bevan, were he alive today, would have welcomed such an approach.
The welfare state will not be destroyed by any party represented in the House, and certainly not by the Tory party. The hon. Member for Fife, Central cannot say that my right hon. Friend the Secretary of State and my hon. and learned Friend the Minister for Health are a danger to the institution of the Health Service. They are very sound guardians of our health services. Of course, we all want more money for the NHS. Every health authority would love, and could use, more money. But this Government have increased spending in the NHS considerably. That fact must be taken into account when we read the comments of the hon. Member for Fife, Central. We can all be proud of the fact that we spend about the same sum on national health as we spend on defence. We may wish to spend more, but £14·5 billion a year and rising is a considerable sum, and represents a growth in real terms, since this Government came to office, of 6 to 6·5 per cent. There has been no reduction in service and in the delivery of health care, and we have heard today about a 66,000 increase in staff, including 45,000 more nurses and midwives. We should be proud of those figures. One

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cannot criticise them unless one says that there is wastage and that we should not have increased the numbers of those capable of delivering health care. However, no one believes that. One can say only, "That is an achievement in three and a half years."
Nor has there been a reduction in capital spending. We all know that the fabric of the Health Service is old and that many of our hospitals are 120 years old or more and are crumbling. They are held together by the spirit and determination of those who work in them to make them do the best possible job. But Governments have a duty to improve that fabric so that, as modern health care demands better facilities, and as patients should be given better facilities, they are provided. The Government have spent more than £2 billion in the past three years on capital projects alone, which is 12 per cent. more in real terms than when they came to office. Does that show a Government who are a danger to the Health Service? We cannot allow those exaggerated phrases to sink into the consciousness of the public.
My right hon. and learned Friend the Chancellor has just presented a Budget, and we are about to consider it in Committee. The Government recently published their expenditure plans for everyone to see. Under the heading "Output and efficiency", the document states:
"The main needs that the NHS should aim to meet have been described most recently in the Government's policy document 'Care in Action'. Services need to be expanded in order to keep pace with population changes—particularly increasing numbers of old and very old people—and to make greater use of new medical advances."
Is that the statement of a Government who are trying to weaken the Health Service?
I stress that point, because sometimes we do not realise the enormous demands made on the Health Service today because people are living longer. It is estimated that, by 1985, there will be nearly 500,000 more people aged 75 or more than there were in 1979. We must plan and budget to provide for such people. The cost per head of looking after a person aged 75 or more is over £1,000 a year, compared with £145 for looking after an average citizen. We recognise our duty in the welfare state to look after those who have reached the age when they become expensive to the state.
Much more needs to be done—more than we can afford. My right hon. Friend the Member for Daventry (Mr. Prentice) properly spoke of the need to live within our limited resources. Governments have a duty to do so, but this Government have been increasing the limited resources as fast as they can. All right, let the Opposition say, "You should go a bit further." They are entitled to say that. It is perfectly legitimate. We have all to strive continually to improve the National Health Service and enlarge it for some of the reasons that I have just mentioned—to meet the advance of medical science which requires additional expenditure and to meet the demands of older people who are more costly. We must try to improve efficiency and eliminate waste all the time. The Government and Parliament are the custodians who ensure that we do not waste the £14·5 billion or more that is being spent on the National Health Service, that we receive value for money, provide value for patients and produce value for other people.
It is not enough just to spend money. We must modernise all the time to improve service to patients. Modernisation within limited resources requires rationalisation of some of the special services that are
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needed and can be provided today in a modern health service. They are sophisticated, highly scientific and expensive, but people and patients have the right to demand the best. We must find the money to pay for the best, but we cannot provide it everywhere. We must rationalise and provide specialised treatment in certain special centres. Such rationalisation and change is not easy, nor is it readily accepted. I believe that it is vital to rationalise to contain the costs of new expensive developments within reasonable bounds.
Plans can be drawn up in the Elephant and Castle by my hon. Friend the Secretary of State and my hon. and learned Friend the Minister and his advisers. A circular can be issued from the National Health Service to health authorities. Work will be done in regional headquarters and districts will be told to carry out instructions. That is not the whole story. There is much more to the National Health Service than just planning and issuing circulars and directives, because many people must be consulted, not just Members of Parliament reacting to pressure from their constituents or other pressure groups about possible hospital closures—of course, they have to be heard and responded to—but also consultants, general practitioners, nurses, administrators, ancillary workers, patients and the public. The community health councils have an important part to play, which they are playing well. They have the right to be heard. I believe that they are being heard. They are doing a valuable job.
Above all, the Government and Parliament must study the problem of rationalisation and modernisation which embraces the advance in medical science and treatment. We must see it from the patient's point of view and from the medical point of view at the sharp end, where medical treatment and health care are delivered. We must study what these changes might mean in the hospitals that we are thinking either of closing or of enlarging as a centre of particular excellence. The hospital, the wards, the waiting rooms, the operating theatres and the other areas where special treatment is given, such as radiotherapy must be examined.
I had an opportunity recently to spend more than half a day at Guy's hospital looking at the radiotherapy treatment. It is not the beginning and the end of the treatment of cancer. It can move on to chemotherapy and, perhaps, surgery will not be necessary. Those three disciplines of medicine need to work together as a team. There is rapid advancement in the treatment of that serious illness, with a great development of the knowledge in the various areas. In the past, the immediate treatment was surgery, but that is now moving to treatment by radiotherapy or chemotherapy, or a combination of both. There is a good success rate.
That process is taking place in some of our old hospitals. There is a new tower block at Guy's hospital—the Robens block—but there is also a very old building. It is part of the old fabric of the National Health Service. In that building one receives some of the finest medical excellence in the world in the treatment for cancer. It is certainly second to none in Europe. My only criticism is the age of the fabric of the building. It might provide the most excellent treatment and modern machinery for health care, but it has no waiting room and patients have to wait in corridors or the basement. We must think of the attitude of the patient before he receives treatment. It is important not to neglect that.

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There is room for criticism. There may be excellent services and excellent scholarship and research, but we must ensure that we develop the surrounding aspects, such as reception facilities that make it so much easier for a patient to accept treatment.
That is all that I wish to say today. I wish to highlight that I believe that we still deliver some of the best health care, if not the best health care, in the world—even if it is from old buildings. We must pour money into capital programmes to produce better buildings. We must consider rationalisation because otherwise we shall waste money on expensive new development. As we do those things, we must consult, consult and consult again.
1.42 pm
Mr. Nigel Spearing: I agree with a great deal of what the hon. Member for Canterbury (Mr. Crouch) said, because it was an encomium of the Health Service, but I doubt whether his right hon. Friend the Prime Minister would agree with him. The hon. Gentleman and his colleagues on the Back Benches might be described as belonging to the Chesham school of community irrigation. That is not a club much favoured by the Conservative Front Bench or the Cabinet. The hon. Gentleman may be disappointed in what I have to say, because I believe that the Government are undermining the concept of the welfare state.
I apologise to my hon. Friend the Member for Fife, Central (Mr. Hamilton) for not being here earlier. I had a long-standing appointment with my dentist. I was especially sorry to miss the speech of the right hon. Member for Daventry (Mr. Prentice). He may read my speech. He used to be my hon. Friend. I must put on record that he never tried to persuade me that the Labour party was changing. Indeed, I have every reason to suppose that it is the right hon. Gentleman who has changed. I hope that he takes my remarks in the spirit in which they are offered.
Those who did not know pre-war Britain cannot appreciate what the so-called welfare state is about. It was born from a number of individual movements which coalesced in the wartime years into what was then called post-war reconstruction. The welfare state as such was not talked about until the late 1940s or early 1950s. There were a number of strands to that. The 1944 Education Act of Mr. Butler and Mr. Ede was one of those strands. The idea of town planning on a proper basis and having good and proper standards in housing were developed apace during that period.
Above all, the report of Sir William Beveridge in 1942 set the seal on the related matters of employment, the Health Service, pensions and social security. His report, entitled
"Social Insurance and Allied Services",
arose out of a departmental committee appointed by the late Arthur Greenwood, who was a member of the Labour party. As many Whitehall Departments were involved, in the end, it turned out to be more or less a one-man Select Committee of Sir William himself. Like the Select Committees of today, he took evidence from many bodies in this country, both in writing and orally, and he had the support of experts drawn from all the Whitehall Departments involved. The combination of that talent
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produced this epoch-making report and its recommendations, which I happen to believe—for reasons to which I shall come—the Government are undermining and, in the end, will destroy. The Minister has to reply to that case.
The report—Cmnd. 6404—has on its title page some extraordinary statements. Part VI states:
"Assumption A: Childrens Allowances; Assumption B: Comprehensive Health and Rehabilitation Services; Assumption C: Maintenance of Employment."
On page 58, under the heading
"Assumption B: Comprehensive Health and Rehabilitation Services"
it says:
"It is a logical corollary to the payment of high benefits in disability that determined efforts should be made by the State to reduce the number of cases for which benefit is needed. It is a logical corollary to the receipt of high benefits in disability that the individual should recognise the duty to be well and to cooperate in all steps which may lead to diagnosis of disease in early stages when it can be prevented."
That is not just curative help, but preventive medicine as well.
The report continues:
"Assumption C: Maintenance of Employment.
There are five reasons for saying that a satisfactory scheme of social insurance assumes the maintenance of employment."
I shall not read out all of the five reasons, although some are very interesting. Sir William Beveridge spoke about payments for short periods of unemployment and said that
"after that, complete idleness even on an income demoralises."
Sir William then spoke of the test for unemployment:
"This test breaks down in mass unemployment and makes necessary recourse to elaborate contribution conditions, and such devices as the Anomalies Regulations, all of which should be avoided in a satisfactory scheme of unemployment insurance".
He went on to say that any scheme of that sort would break down at a time of mass unemployment.
The vision and the understanding of the gentleman and those who advised him, and the degree to which all these matters are related, are being neglected by the Government, not just to their peril, but to that of society and the nation as a whole.
I wish to mention some of the evidence that was presented to Sir William Beveridge by one of the many organisations that appeared before him. More senior hon. Members will know that before the war national health insurance was conducted by approved societies, some of which were commercial organisations, run by trade unions, Churches or occupational groups.
The Association of Approved Societies, whose officers I had the privilege to know, put in evidence to the Beveridge committee. Some of it was very important. Paragraph 31 emphasises that
"The first fundamental point is to recognise the administrative unit as the small local group (possibly called 'The … Welfare Society') and not the national aggregation."
Paragraph 77 of the evidence suggests that
"Each local General Meeting would be attended by a Public Relations Officer who could make a short introductory statement on behalf of the Fund, and deal, with the assistance of welfare officers who should also be present, with questions of general interest (excluding specific cases) which might be asked at the meeting."
Paragraph 79 states:
"It is submitted that the obligation to provide the answer to a simple question in circumstances of this kind would have a healthy influence upon the attitude of mind regularly adopted by a welfare officer."
I believe that no other part of the Beveridge report places that emphasis on welfare. I may be wrong, but it may well be that these ideas, which were not adopted by Sir William Beveridge—because he had a large national

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organisation founded, perhaps, on his experience of national unemployment offices—did not incorporate the concept of local welfare societies, each offering a national scale of benefits, but accountable and run to some extent by members of the community. I wonder what would have happened if the party of which I am privileged to be a member had adopted that way of implementing the Beveridge report and of structuring the NHS. I fancy that the Labour party would have avoided some of the less admirable features of both of those services. Beveridge saw them as an integrated set of services. The undermining of one would inevitably undermine the coherence and ability of the other.
Those who were fighting for our freedom were told that that was one of the features of the post-war society. I have heard men talk about being paraded on ships' decks in heaving Arctic seas and about being paraded in the deserts of Africa while they were lectured on post-war reconstruction, the British war aims, the Beveridge report and the features of the welfare state, which were put to them as fundamental to the attitudes of both parties. Up to a point, that is what happened. The legislation was largely implemented by Labour Governments, but not entirely, because a Conservative Government enacted the Education Bill 1944. Most of the legislation was accepted in the post-war political scene. It was even accepted by the late Lord Butler. Perhaps that is one reason why he never became Prime Minister. However, it was accepted on both sides of the House.
I have mentioned three concepts in particular, and the Beveridge report perhaps leads the way. However, that grouping of concepts became, for many of us who lived through those traumatic years, the post-war compact. It was almost a social understanding. Although the Conservative party resisted the introduction of the Health Service as much as it could, it has never openly attacked it. However, it has undermined it. Indeed, it is doing so in all sorts of subtle ways, including by starving it of cash. Indeed, the hon. Member for Canterbury referred to that.
My constituency has had to fight to keep the community health councils. What sort of Government can proclaim their belief in a so-called safety net and in the National Health Service when just over a year ago they wanted to abolish community health councils? The Minister for Health may not know that but he should go to Nottingham and ask the people there. They will tell him how they had to fight to maintain the community health councils, which perform a vital role in the Health Service.
In my constituency of Newham we have a new hospital, not built to generous standards, thanks to Her Majesty's Treasury, which knows nothing about health matters, but we are now threatened. We have been told by the North East Thames regional health authority that the current ratio of acute beds to population, 2·5 per 1,000, in the next 20 years will be cut to 2·0 per 1,000. The method of adjustment for out-area patients is to be altered. That is a nibbling away and an erosion of the standards of our service.
While giving lip-service to those co-operative endeavours, the present Administration do not believe in them, although the Chesham-inclined Members and supporters may. I say that because the difference is between those who believe that public expenditure is not wrong in principle and those on the Front Bench—including, I think, most of the present Cabinet—who believe that public expenditure in principle
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is wrong and must be diminished to the smallest extent that they can get away with. That is the difference between the so-called wets and the so-called dries.
The hon. Member for Carshalton (Mr. Forman) talked about a safety net. It is the last resort, not the first resort. In our welfare state—perhaps we can include transport in today's grouping of topics—the core needs to be run by public money and by effective and efficient public administration. Conservative Members often quote the objectives of my party in respect of public ownership. They forget the second part. We always refer to the most effective means of public and popular administration available. Many Conservative Members, in their own way, agree with that. However, the Cabinet and the Prime Minister do not, because they regard any form of cooperative and statutory coming together for mutual purposes, with the expensive machines about which the hon. Member for Canterbury reminded us, as wrong in principle. That is the difference. No Conservative Government since the war have emphasised that and gone across the ideological divide that separates them from all previous Administrations.
Mr. John Farr: In the five minutes—
Mr. Spearing: On a point of order, Mr. Deputy Speaker. I thought that the hon. Gentleman wished to intervene and challenge my remarks.
Mr. Farr: I thought that I had been called to make my speech.
Mr. Spearing: I hope that the hon. Gentleman will have a little time for his speech.
The destruction of the welfare state and the support for that destruction that has been given, perhaps reluctantly, is a matter of concern. If the right hon. Lady the Prime Minister and those who support her in the Conservative party believe in the 19th century theory that one cuts down public enterprise and public expenditure as much as one dares, the welfare state is eroded, undermined and parts of it come crashing to the ground. One principle follows absolutely from the other. I do not suppose that even Joe Chamberlain, the great Birmingham municipal reformer, would agree with what the right hon. Lady and her Friends are doing. One has only to look at the public edifices in Birmingham or Manchester, which were not built entirely by Socialists, to see that, even in the 19th century, public promotion, works and enterprise were highly respected and looked upon with great favour.
The dictatorship of the market—both the Common Market and the cash market that the right hon. Lady has espoused—is destroying the livelihoods of our people and their employment. It is undermining our education system and our preventive and curative Health Service. It is provoking social tension by encouraging 19th century vampire values against the virtues which were also practised in that age. The right hon. Lady is camouflaging this by recourse to calls of false patriotism—the worst jingoism of Edwardian Britain. By going into the next general election with their present programme, the right hon. Lady and the Conservative party are tearing up the social compact of post-war Britain, of which the welfare state is the keystone and monument.
2 pm
Mr. John Farr: In the five minutes that are left to me, I have no time adequately to discuss what

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has gone before except to say that the speech of the hon. Member for Fife, Central (Mr. Hamilton) was, to say the least, disappointing and that the speech of my right hon. Friend the Member for Daventry (Mr. Prentice) was excellent. In the short time that is available to me, I shall seize on two points about the welfare services.
First, as has already been highlighted by my right hon. Friend the Member for Daventry, we have a fantastic record of expenditure on the health services, in particular since 1979. But how does one translate that massive expenditure of thousands of millions of pounds annually to the customer, the recipient at the other end? The other day I visited the Norton street office of the Department of Health and Social Security in Leicester which caters for tens of thousands of people. After talking to the staff and discussing various problems with them, I crossed the counter into the waiting room and mixed with the 200 or so people who were waiting to be interviewed by the clerks. It appears to me that Governments, whether Labour or Conservative, have a duty to make the waiting rooms accessible, cheerful and attractive to people who approach them hesitatingly. When people go to the DHSS for help, advice and financial aid, when it is needed, the waiting room is the one contact point with the general public for all the thousands of millions of pounds of expenditure.
I can only commend the staff of the Norton street office in Leicester. They generally keep a person waiting for only 10 minutes. Visitors are given a number as soon as they call, and the waiting time is to allow the staff to find the claimant's file. There is no doubt that the staff have a difficult task which they are performing very well.
I should like also to touch on the present structure of the Health Service administration in the United Kingdom which consists of the regional health authorities within which fall the district health authorities. In the east midlands, what used to be called the Sheffield region is now called the Trent region. Within the Trent region, what used to be called the Leicester area health authority is now called the Leicester health authority. In the 25 years or so that I have been a Member of the House, at no time has Leicester been near the Trent or Sheffield. Never mind, we are still in that positon.
I am concerned about the allocation of resources to the Leicester area. For years we have felt under-privileged and have seen more money go to London and the south than to the east midlands. We would like to believe that, after the general election, the next Conservative Government will examine the structure of the present regional and area health authorities, possibly with a view to doing away with the regional authorities and restructuring the system on an area basis. In that way, there would be a fairer allocation on a district basis to areas such as Leicester.
2.5 pm
The Minister for Health (Mr. Kenneth Clarke): As my constituency falls within the Trent regional health authority, I followed with care the closing remarks of my hon. Friend the Member for Harborough (Mr. Farr). I endorse what he said about the need to continue to redistribute resources fairly between different areas. I hope that the hon. Members for Brent, South (Mr. Pavitt) and Hackney, South and Shoreditch (Mr. Brown) will take
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note of my hon. Friend's remarks. At certain stages, they appeared to be contradicting their parties' respective policies on the redistribution of resources.
In the short time left to me, I shall try to answer the motion that was moved in such extraordinary terms by the hon. Member for Fife, Central (Mr. Hamilton). The language of the motion is extreme enough—it accuses the Government of seeking to undermine or take back the welfare state—but the language that he used this morning took him far away and he came close to suggesting that the Prime Minister's reference to Victorian values called for a return to the days when children were sent up chimneys and down coal mines.
Mr. William Hamilton: It does.
Mr. Clarke: Apart from that vitriolic nonsense, there was a serious side to what the hon. Gentleman was saying and to the remarks of his hon. Friends. They tried at some length, especially the hon. Member for Brent, South, to prove that the Conservative party is plotting secretly to undermine the welfare state or to destroy the National Health Service.
Mr. William Hamilton: What about the Think Tank?
Mr. Clarke: There have been repeated protests from my hon. Friends. My hon. Friends the Members for Carshalton (Mr. Forman) and Mitcham and Morden (Mrs. Rumbold) could not conceivably be accused of being hostile to the welfare state. They expressed their surprise at Labour Members' allegations and between them gave a completely adequate reply to the attacks that have been made on the Government's education policy. All Conservative Members have a full commitment to the welfare state and we see ourselves as protecting and taking care of the NHS among other things. A preposterous charge has been levelled against us.
There is a serious side to the attack, because it is mounted not only by mavericks such as the hon. Member for Fife, Central—I use that term in a friendly way—but by the Opposition Front Bench. It is obvious that, in the run-up to the general election, the big lie technique will be used. It will be suggested that, in some way, the welfare state or the National Health Service will be threatened if a Conservative Government continue in office.
We are finding difficulties in dealing with politically motivated leaks of a few random documents that are followed up by politically motivated journalism in some newspapers, especially that which has appeared in The Guardian, on which the hon. Gentleman relied. Both of the parties that oppose us are making selective use of that material in trying to maintain a nonsensical case.
I shall deal first with the arguments about what the Government are doing for the National Health Service. As my hon. Friend the Member for Harborough said, we have an excellent track record of putting resources into the service. My right hon. Friend the Member for Daventry (Mr. Prentice)—
Mr. William Hamilton: Where is he?
Mr. Clarke: My right hon. Friend offered his apologies for leaving before the end of the debate, as did others of my hon. Friends. My right hon. Friend made an excellent speech in which he insisted that Ministers set out factually the Government's record in supporting the NHS. The figures are not complicated until people try to complicate them. I shall turn to some of the articles on

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which the hon. Member for Fife, Central relied when I have dealt with the figures. First, I shall present some irrefutable facts. In 1978–79, revenue spending on the NHS was £7·75 billion. By 1983–84, it will rise to £15·5 billion. When compared with the retail price index, which is the usual measure of spending as against inflation, revenue spending on the NHS will have increased by 16 per cent. in real terms during the Government's period of office. It will be about 17·5 per cent. ahead of the RPI by 1983–84.
Let us compare capital spending during the last year of the previous Labour Government, 1978–79, with the 1982–83 spending of this Government. Capital spending each year has increased by 15 per cent. in real terms under this Government. I mention in passing that capital spending on hospitals and the NHS generally was slashed by the previous Government. It fell in real terms by 35 per cent. between the first and last years of their Administration. The figures that I have given are an accurate and reliable measure of the demands which the NHS has been allowed to make on the economy. The Government have been willing for this to happen.
The best illustration of how we have changed the priorities in favour of Health Service since we came into office is that the share of gross domestic product spent on the Health Service has increased from 4·9 per cent. in 1978–79 to 5·6 per cent. in 1981–82, which is the last year for which I have figures. Those figures compare spending with the retail price index.
Of course, one must take account of increases in pay and prices in the Health Service. That has led successive Governments to adopt a method of measuring the growth of services which leaves out pay and price increases and takes account of the differential price effect because some prices go up faster than average. Having extracted those costs, we try to measure the growth in services. By that convention, services have grown by 7·7 per cent. in our period of office to 1983–84.
Anyone who doubts that that growth has taken place—I shall return to the attacks made by The Guardian and the Social Democrats later—has only to re-examine objective statistics about what has been happening to services and patients in the Health Service. During our term of office from 1978 to 1982, the number of doctors and dentists in the hospital service has increased by 6·5 per cent. Therefore, there are 3,600 more doctors in the hospital service than when we came into office. In addition, 1,250 more family doctors were employed from 1978 to 1981. Therefore, there are 4,800 more jobs for doctors and dentists in the NHS than when we came to power. There are also 45,000 more nurses, representing a 10·5 per cent. increase during our period of office.
We have also been dealing with more patients. As my hon. Friend the Member for Canterbury (Mr. Crouch), who made a well-informed speech based on years of experience of the NHS, said, the demands have increased as more people are growing older and medical advance has led to rising expectations. In 1978, there were 5·37 million inpatient discharges and deaths whereas there were 5·76 million in 1981. That represents a 7 per cent. increase. There was a 0·56 million day-care attendance in 1978, which had increased by 27 per cent. to 0·71 million in 1981. There were 33.95 million outpatient attendances in 1978, which increased by 5 per cent. to 35·57 million in 1981. The number of people visited by health visitors has
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increased in 1·4 per cent. in each year between 1978 and 1981. The number of people treated by home nurses has also increased by 2·2 per cent. each year.
The figures are not simply a measure of spending and, by convention, measured in such terms the improvement in service is showing in the number of professional staff employed and, most important of all, the treatment that they give to patients. I agree with my hon. Friends the Members for Canterbury and Harborough and the hon. Member for Brent, South that the quality of care given by professional people and the staff of the Health Service is one of the highest in the world.
The hon. Member for Fife, Central described all of that as fiddled figures. He relies on an article in The Guardian. When I asked him in what way he would illustrate his claim that I had fiddled the figures, he said that he had read it in The Guardian. The article in question is called
"Mr. Fowler's three card trick?"
and was written by Melanie Phillips. The hon. Gentleman did not attempt to explain how that article of 14 March 1983 reached that conclusion. I do not blame him as it is quite unintelligible. One of the first things that is clear is that Miss Melanie Phillips does not understand all of the figures that she used. Indeed, she makes highly selective use of one year's figures. She falls by the figures in the end—they will crop up again in articles in The Guardian that I shall deal with—if she starts drawing on the hon. Member for Newcastle upon Tyne, East (Mr. Thomas), who has not spoken on behalf of the Social Democratic party today, but who emphasises that theme. She quotes what she calls the "Thomas table" which says that the growth in services amounts to about 6·2 per cent. during the Government's term of office up to 1982 and claims that that 6·2 per cent. is not enough to meet the increase in demographic change and the advance in medical science.
The Thomas table and the repeated speeches and claims of the hon. Member for Newcastle upon Tyne, East are based on a combination of misunderstanding of what the figures mean and elementary arithmetical errors. The hon. Gentleman keeps repeating those errors, which seem to be the basis of SDP policy and a great deal of The Guardian journalism. When the hon. Gentleman tried to restate his case in the Budget debate, his errors were again pointed out to him.
Briefly, the hon. Gentleman's errors are twofold. First, he insists on regarding expansion of services to meet: an aging population and to keep up with medical advance as though it were not growth in the service. The population is not getting iller. We are not all getting sicker. The Government are developing the service to keep ahead of age and medical advance. In fact, we are well ahead in both respects, but the hon. Gentleman seems not to understand that. He insists on deducting from 6·5 per cent. the figure that he says should be applied for demography and medical advance. He makes the mistake of taking from our figure for the entire NHS a percentage attributable only to health and community services. From our figure of 7·7 per cent. next year, 4 per cent. should be deducted as attributable to higher demands with regard to demography and medical advance in the hospital service. The hon. Gentleman takes a higher figure and then tries to make out that there is a fall in real spending. I do not say that the claim is fraudulent in the hon. Gentleman's case, but it is totally mistaken. It is the hon.

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Gentleman who is fiddling the figures and playing the three-card trick. He simply does not understand the straightforward figures that we present.
When the Opposition have given up trying to prove that we are cutting resources from a service that is actually growing rapidly they try to upstage us by suggesting vaguely that in addition to the largesse that the Government are putting into the Health Service they will add some indefinable extra sum. I taxed the hon. Member for Brent, South on this as I understand that he has worked on the Labour policy group and had something to do with the 1982 programme, but he was no more informative about what was meant by 3 per cent. growth than were his colleagues in the Budget debate.
I have with me a copy of "Labour's Programme 1982". The hon. Member for Crewe (Mrs. Dunwoody) says:
"We shall increase the NHS budget in real terms by at least 3 per cent. per annum."
If that is just 3 per cent., compared with the RPI it does not mean much. We have done better than that in a number of years. In trying to explain what that meant in the first year, the hon. Member for Brent, South suggested that I simply add 3 per cent. to present cash spending on the NHS. That would not even keep up with inflation, so he was actually advocating a cut. I think that he has got his commitment slightly wrong there. If one takes it to mean 3 per cent. growth in services, following the conventions that I described earlier our best estimate is that in the next three years alone the hon. Member for Crewe is promising on behalf of her party to spend between £2 billion and £3 billion extra public money.
Mr. Pavitt: That is right.
Mr. Clarke: It is, however, almost impossible to know exactly how much it would be and where it would go because it is crucial to remember that the bill for the National Health Service depends in part on pay. The Labour party's main contribution to Health Service activity in the past four years has been to support unwaveringly a strike against patients in the Health Service and to set back patient care and waiting lists considerably. In the course of supporting the strikers, Labour spokesmen said that they would engage in pay bargaining with Health Service staff on a basis unfettered by cash limits and with an open-ended pay commitment.
Mr. Pavitt: Like the Tory party and the doctors.
Mr. Clarke: I believe that £2 billion to £3 billion is an underestimate of what the Labour party proposes to spend. As we well know, the Shadow Chancellor is becoming increasingly nervous about the various daft promises being made to various groups by his Front Bench colleagues. That is why the hon. Member for Brent, South can no longer say exactly how much he wishes to spend beyond the first year of Labour's next period of office, if it had one. I shall deal in a moment with the implications of another light-hearted promise tossed out by the Labour party—the promise to increase personal social services expenditure by 4 per cent. per annum in real terms as well.
So far, I hope that I have demonstrated the Government's commitment of resources and manpower to the Health Service. I have time for only one brief comment on what my hon. Friend the Member for Mitcham and Morden said. Because of such lines of attack, we spend
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our time talking of money, resources, White Papers, spending and so on. That is only the input into the service and we should be concentrating on output. The Government's main priority is to maintain and improve the quality, as well as the quantity, of service to the patient provided by the NHS.
We keep selecting priority areas for spending our growth money and use it for the Cinderella services such as the geriatrics and the mentally and physically handicapped. New initiatives were announced last year to deal with the elderly with senile dementia and to provide new care for the under-fives, and more care for drug abusers and intermediate treatment. We are presiding over an increase in spending but we also intend to preside over an NHS in which the service improves.
Therefore, we are not only putting more money in but we are increasing our efforts to improve the management, efficiency and cost-effectiveness of the Health Service so that we can get more value for patients out of the money that we have spent. That is where our policy of contracting out of support services comes in. It is typical of the Labour party that when we seek to advocate policies that reduce the cost of providing services that are incidental to the medical services, such as laundry and cleaning, it resists because it is reacting to the pressure of those public sector trade unions upon which it is so dependent.
I have not left myself time to deal fully with personal social services, but we realise that those provided by local authorities are a valuable adjunct to everything that the Health Service does. They are important in dealing with many of our social problems and need to work in close cooperation—I agree with the point that many hon. Members have made—with the NHS. During our period of office, despite all the assertions of the Labour party that we have cut to the bone the personal social services, there has been a 9 per cent. growth in real terms. The cash figures of spending on these services by local authorities during our period of office are astonishing. I refer hon. Members to the answer that I gave to the hon. Member for Newcastle upon Tyne, East on Monday 28 February 1983, in which I set out the cash increases and the real change in service each year during our period in office.
We are legislating at the moment to improve the so-called joint finance arrangements and to develop our care-in-the-community policy, which will enable long-stay patients to transfer to the care of social services departments either at their homes or in smaller units near to their homes. We have provided £11·3 million extra for the joint finance funds next year alone.
I have supplemented two of the aspects of spending on social security to which my hon. Friend the Minister has already referred, and underlined what matters, which is what we have done in practice with the welfare state, and the commitment that we have shown to develop these services despite the serious recession. That shows that our priorities are to show concern and care for those who are most vulnerable in our society.
Political arguments are raised that are based on leaks in The Guardian which make selective use of a Central Policy Review Staff report last year, which made a passing reference to alternative sources of finance. The Government have already rejected the report in a reply given to the House in July by my right hon. Friend the Secretary of State for Social Services, who made it clear that the Government have no plans for changing the basis on which the NHS is financed.
Mr. William Hamilton: Did not the Chancellor of the Exchequer and the Financial Secretary to the Treasury go out of their way when that leak from the Think Tank was exposed in The Guardian to say that its proposals were alternatives that must be examined, and thus did not put them on the shelf or rule them out?
Mr. Clarke: The Chief Secretary made a speech in Bakewell which was interpreted in that way and that was followed by my right hon. Friend the Prime Minister at the party conference reaffirming that the NHS, to use her words, was "safe in her hands". The CPRS document—[Interruption.] I am just giving the record. I congratulate hon. Gentlemen who are ready to bounce back with their familiar charges despite the fact that they missed 20 minutes of the evidence in which, at great length, I condemned as palpable nonsense their claim that we are cutting back on the NHS. Now they rely on reports of the so-called family policy unit, which the Prime Minister told the House she set up to take account of all our policies and their effects on the family. Only two or three documents have emerged, and of course they give only a snap shot, and a misleading snap shot, of parts of the family policy unit's work.
However, the political damage is then done by the write-ups in The Guardian, particularly by Mr. Malcolm Dean, who keeps analysing these matters. One thing that many of his readers may not realise is that Mr. Dean is not just an objective searcher after truth; he is the prospective parliamentary candidate of the Social Democratic party in Bath. We all realise his problems, in that he is opposing my hon. Friend the Member for Bath (Mr. Patten) who, in political terms, is known as a "wet". In fact, my hon. Friend has an extremely sharp intellect, and he is one of the most enlightened and liberal men in the Conservative party, one of its most able members, and a great friend and no critic of the welfare state. Poor Mr. Dean keeps producing these articles in The Guardian, seeking to analyse the documents that he has gleaned from the family policy unit as though they were an attack on the welfare state. I believe that there are now six SDP candidates writing as journalists for The Guardian, and I think that they should do more to distinguish between political campaigning and their journalism when they write for that newspaper.
Plainly, we have a family policy unit, and its purpose demonstrates the Government's determination to safeguard the family in all our policies and to make sure that we give individuals and their families more choice and freedom to exercise personal responsibility, at the same time as we protect the welfare state and concentrate its resources where they can be most effectively used. In my opinion, it is extremely good that the Government are taking a forward-looking view of policy, that we are considering the impact on the family of what we are doing, that we are looking at social policy in the round, and that we are looking at developments outside the narrow confines of the Health Service, local government, and so on, which are our day-to-day responsibilities.
It is remarkable that a party, which has now had nearly a full period in office, is having all the new ideas in this area. We are the party that has set up policy study groups that is taking a forward look, rejecting some ideas, taking others forward, and trying to make sure that the welfare state continues to evolve to meet the needs of a modern society.
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The Labour party which, despite the fact that it has been in opposition for four years, does not seem intellectually refreshed, has not had a new idea on the subject since the Beveridge report, which the hon. Member for Newham, South (Mr. Spearing) mentioned. It was, of course, written at the time of the coalition Government during the last war under a Conservative Prime Minister, with many Conservative Members involved. The only new idea that the Labour party has had recently—unfortunately leaked to the newspapers, so that it cut it out of its policy documents—was the proposal yet again that occupational pension funds might be invested by the Government, presumably, in ways in which the commercial managers of those pension funds might not desire. In other words, that innovation on social policy was to take away the pension funds on which many people's old age pensions rely and no doubt invest them in British Leyland, Liverpool docks, and various other enterprises by which the ultimate pension rights of pensioners might be threatened. That is just one example of the contrast between the Labour party's claims of what they mean and the effects of their actions that they have shown many times in the past.
I have contrasted the Labour party's criticisms of us with our actual record, and I believe that we in the Conservative party can not only say that we believe in a welfare state, a developing welfare state, and that we protect the National Health Service, but that our record supports what we claim and what our policy is.
2.28 pm
Mr. Peter Bottomley: It is clear that the absence of nearly every Member of the Labour party from this debate shows—
Mr. Michael English: Will the hon. Gentleman give way?
Mr. Bottomley: No. —that they knew in advance that the welfare state has improved over the past few years, and will improve further. If Malcolm Dean is seriously interested in family policy, he should apply to the acknowledged expert on family policy in this House, which is myself. I might say the same thing to my right hon. and hon. Friends. If they seriously think that they are to get good results from the family policy unit, they should apply to me.
The welfare state is concerned with well-being, and the crucial element in well-being is the family. The state has an important role to play in ensuring that medical, education and other services are available, but the way to avoid most problems is to build up the sense of responsibility and to bring together the resources of families. If they do that, they will be in a better position to cope with their own needs. Once that happens, we shall discover that debates on the welfare state and social services will continue—
Mr. English: On a point of order, Mr. Deputy Speaker. Is it not true that there are more Labour Members present than Conservative Members?
Mr. Deputy Speaker (Mr. Ernest Armstrong): Mr. Peter Bottomley.
Mr. Bottomley: It is typical of a Labour Member to come in and say that, having missed the entire debate. It would appear that the hon. Gentleman is not interested in the welfare state, and I am sorry that he missed the

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opportunity of hearing how well the Government are coping with it. If we wish to have a service designed by families for families, we must get away from the idea—
It being half-past Two o'clock, the debate stood adjourned.

SOCIAL SERVICES
Ordered,
That Mr. Timothy Smith be discharged from the Social Services Committee and Mr. David Crouch be added to the Committee.—[Mr. Ronald W. Brown, on behalf of the Committee of Selection.]

Orders of the Day

  TRUCK ACTS (ABOLITION) BILL
  Order for Second Reading read.
  Hon. Members: Object.
  Mr. Deputy Speaker (Mr. Ernest Armstrong): Second Reading what day? No day named.

Health Provision (Surrey and Hampshire)
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Brooke.]
2.30 pm
Mr. Julian Critchley: My hon. and learned Friend the Minister for Health has had a hard day, and I have no wish to add unduly to his burdens.
The district health authority responsible since 1 April 1982 for the management and provision of health services for my constituency in Hampshire is the West Surrey and North-East Hampshire health authority. As the name implies, it includes part of Surrey and part of Hampshire—the whole of Rushmoor borough and a major part of Hart district. Just over half of the population of the health district are in the Hampshire part, which includes my constituency. The health authority is one of 13 in the south-west Thames region, while the rest of Hampshire rests happily within Wessex region.
I emphasise two major problems facing the new district health authority that were inherited from Surrey area health authority. Those problems are in addition to the great difficulty of relating Hampshire county council, Surrey county council and five district or borough councils, and at the same time having to manage outside our area a large mental illness hospital at Brookwood, which also serves other health districts. The first problem is that, although our health district is relatively under-provided, it is within an over-provided region. Secondly, the rate of growth of the population following housing and employment development since 1979 has outstripped the provision of Health Service facilities and the money provided. The current targets for housing and population growth to the end of the 1980s would repeat the growth from 1971 to 1981, but as yet there is no major capital development scheme for the district.
The effects of the growth in need for health services, without additional funds or facilities, have created frustration and concern among the general public, their elected representatives and the Health Service workers and professionals in the district. They feel strongly that there has been inadequate resource allocation, to an unfair extent, in recent years and that, despite efforts towards far greater efficiency, we risk losing adequate standards of provision.
To illustrate the nature and seriousness of the problem in our area I offer the following evidence. The population of the Hampshire part of the district increased between 1971 and 1981 by more than 17,000, or more than 14 per cent. The Surrey part of the district grew almost as fast, and there were more than 32,000 additional residents in the health district by 1981, out of a census count of

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265,000. This part of Hampshire and Surrey is within area 8, which is a major growth area as part of the strategy for south-east England.
Within the health districts, the fastest population growth over the past decade, and forecasted also for the next decade, is in Hart and Surrey Heath. Frimley Park hospital was one of the first to be built to an identical design—a best-buy hospital opened in 1974. When it was planned it was decided to have a lower provision for acute specialties than the norm, and the number of beds was related to a population of 170,000, after some account had been taken of the military hospitals within the district.
The funding for the new hospital was, like the capital cost, extremely closely controlled. There was, at the same time, a closure programme of small local hospitals to release money. I am advised that insufficient allowance was made for the change in activity level. Since its opening the hospital has reached and surpassed its planned performance level. Emergency and other non-waiting list work accounts for more than half of the total. There have not been sufficient funds to use the intensive and heart care unit fully. The result is that there are an increasing number of occasions when the unit, a major accident unit, has to stop admitting emergencies. In addition, it has been the practice for the health districts to be given targets for reduction in expenditure on a pro rata basis. The combined effect of such restraints has resulted in 37 beds at Frimley Park and Farnham hospitals not being used because of a lack of funds.
The health district has a lower than average proportion of residents over 65 years, following the inflow of new population and a higher than average birth rate. There is a similar increase in the number of elderly as elsewhere and there is a shortfall in hospital provision for the elderly. There is a very short length of stay in specialties, with an increase in the work for community services. There are no facilities within the district for psychogeriatric patients.
The rapid increase in the population, the movement of families and the higher than average child population make additional work. However, the expenditure per resident on community health services is the lowest of the 13 in the region. In 1980–81 more than £500,000 extra would have had to be spent in the district to reach the national average. The health district has fewer in-patient facilities available for acute mental illness than the regional health authority 1982 guidelines and, indeed, has fewer than the two other Surrey health districts for which Brookwood hospital provides a service.
There are no specific National Health Service facilities within the district for the younger chronic sick or for mentally handicapped children. Restrictions on local authority spending and the population increase have also limited the ability of both county councils to provide additional services or take on extra commitments within the health district for groups such as the elderly and the mentally ill.
The district has had to make efficiency savings in 1981–82 and 1982–83 in real terms. In 1983–84, the 0·5 per cent. requirement—£150,000—will, however, be made available for re-use within the district following the RHA's decision to ask four London health districts to produce additional savings as the region's contribution to redistribution of NHS resources within England. That gesture is, in part perhaps, thanks to the delegation from my part of the world that went to see the Minister and other authorities last December.
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Expenditure on mental illness and community services is already low. The cost per patient per day at Frimley Park and Brookwood hospitals, which account for two thirds of the district's expenditure, is among the lowest in the region, as is the cost per case at Frimley Park hospital, which has one of the fastest throughputs and shortest lengths of stay. Ironically, increasing the number of patients being treated, while being more efficient and more effective, would increase total expenditure. The local view is that the hospital has gone beyond the optimum point. One symptom is the need to cancel planned admissions.
I am aware that the health district has already done many of the things that any good housekeeper would do to reduce expenditure; for example, rationalising the number and size of unit, reducing management costs and running productivity schemes.
As previously stated, the health district now has a shortfall in hospital-based service provision for nearly all specialty groups as compared with the average. More and more patients are sent by GPs outside the district for surgical and other conditions. The demand within the district is depressed artificially because there is not enough capacity to provide NHS care within the districts—it is a vicious circle of declining expenditure.
Patients requiring non-acute care and those who require community-based health service care and support can get those only within the district, and the little available is being spread thinner and thinner. The recent population increase without matching funding to develop services has meant that there has been a cut in provision. The RHA's recently published figures for resource allocations to districts for 1982–83 compared with 1979–80 show that west Surrey and north-east Hampshire had the lowest increase in spending power.
Change is needed in three main ways. First, the district should receive additional revenue at the earliest possible date to provide more community services and to make the best use of existing facilities. Secondly, the RHA should include additional, general acute specialty hospital facilities in its major capital programme, with a start at the earliest possible date. Its current review of its programme has included a feasibility study of an addition to the Frimley Park hospital of 110 to 120 beds, plus support departments. Thirdly, we need an opportunity to achieve an overall balanced Health Service provision in the district.
The district has been told that it will not receive any development moneys from the region for 1983–84. That decision is regrettable, given the weight of evidence available. The region appears to be incapable both of saving money to pass to other regions and of moving resources internally quickly enough to keep pace with population changes that have taken place in west Surrey and north-east Hampshire. That is especially so when its capital allocation is insufficient.
Will the Minister consider how, either in overall allocations of revenue and capital to the regions, or in specific guidelines, the needs of west Surrey and north-east Hampshire might be met sooner than appears possible? The district will be making proposals through its region for a pilot project under the care in the community programme. Success with that, or with other bids for special funding, would also help to meet our requirements.
There is a need for close co-operation between local and health authorities, with the aim of harmonising plans for the development of housing, personal social services and

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health services. There seems to have been some improvement. However, the DHSS cannot cope with, or keep up with, the ambitions of the Department of the Environment. Is it not high time that my right hon. Friends got their acts together?
2.45 pm
The Minister for Health (Mr. Kenneth Clarke): I am grateful to my hon. Friend the Member for Aldershot (Mr. Critchley) for raising this important issue. He has taken a close interest in it for a considerable time and he and my hon. Friend the Member for Surrey, North-West (Mr. Grylls) have been with deputations to see Mr. Tony Driver, the chairman of the south-west Thames regional health authority. He came to see me in December and put the case that he has developed in the House this afternoon. He has been concerned for a long time about the need for additional health care facilities in the west Surrey and north-east Hampshire district health authority. This Adjournment debate has followed on closely from the debate that has just taken place on the welfare state.
The particular problem in this district health authority is not so much that cuts have been made in terms of reduced spending or resources, but that the DHSS is having to keep up with the expected population growth, which is expected to be rapid, in the area it serves. He has helped to make me well aware of the pressure that is now being imposed upon the health services in the west Surrey and north-east Hampshire district. I appreciate his final point of the need to ensure that we match planning which gives rise to population growth with planning for a future health provision. Perhaps those two matters could be tied more closely together in future in his part of the country than they have been in the past.
The south-west Thames regional health authority is initially responsible for allocating capital and revenue resources to each of its districts. It has ensured that much development has taken place in this district and more is planned. I appreciate that there is pressure on all health services in the district and that the throughput in the beds at Frimley Park hospital is already high, especially in the surgical specialties. That does show, as my hon. Friend said, that there is an urgent priority for more acute beds to be provided.
Work has been proceeding to identify the possible scale of the additional provision that would be needed and the way in which it might most quickly and cost-effectively be provided. My hon. Friend referred to the work that the officers of the regional and district health authorities have recently done by way of detailed analysis of the probable future population to be served. That analysis was carried out to assess the future needs for acute beds in the district. A feasibility study has been undertaken of the proposed extension to Frimley Park hospital because an extension to that hospital is the most sensible way of coping with future demands.
I am told that both authorities have agreed a planning population of 300,000 for acute services as a basis for an immediate development in the district. They have also agreed that there can be an acute bed ratio lower than is normally found throughout this region because, as my hon. Friend said, there is a younger age structure in the population as compared with the average.
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The officers of the two authorities have taken account of other matters, such as the expected population growth to 1990–91, the contribution made by the military hospitals to both military personnel and the civilian population, the cross-boundary flows of patients within different districts inside the south-west Thames region with the Wessex and Oxford regions and the unusually young population that I have referred to.
On this basis, the health authorities have agreed that there will be a need for 110 extra acute beds within the district. Those beds could most effectively be provided by building on land that adjoins Frimley Park hospital. That land is to be purchased from the Ministry of Defence. That is one good piece of news which emerged last year. The difficulties that might have arisen about the purchase of that land have been completely resolved.
The estimated capital cost of extending Frimley Park hospital is now thought likely to be about £7·8 million. That will impose additional revenue consequences by way of extra annual costs being incurred of up to £3 million. The regional authority has considered the feasibility study of Frimley Park hospital and the region's finance panel examined that study yesterday. A full report on that and other proposed schemes for inclusion in the south-west Thames forward capital programme will be put to the regional health authority for a decision on 13 April.
To put that into context and to explain the way in which the regional health authority will be making its decisions in April, I shall give an explanation of what the region has been doing. After I met my hon. Friend on his most recent deputation, I had a discussion with the regional chairman, Mr. Tony Driver, and his officers and examined the ways in which they are handling their capital programme, and they explained that to my full satisfaction.
As my hon. Friend is aware, the region's capital programme is under considerable pressure, with all 13 districts in south-west Thames, including west Surrey and north-east Hampshire, seeking capital investment for district general hospital developments at a time when the region is not only trying to keep up with the growth in population in parts of Surrey and Hampshire, but also has an important policy objective of trying to divert capital and revenue resources into improving services for the mentally handicapped. The south-west region has many hospitals for the mentally handicapped and there is a clear need to improve some of the services as rapidly as possible. Against that background, the region has recently undertaken a comprehensive review of the capital programme, in consultation with its districts, in an attempt to make a broad assessment of overall priorities by considering districts' bids for capital against a set of common criteria.
Several new feasibility studies have now been undertaken, including that on the Frimley Park hospital. As I have said, the regional health authority will be asked to decide which schemes should be given a firm place in the forward capital programme. On 13 April, therefore, the regional health authority will be deciding from a number of bids whether to extend Frimley Park and finding what can be fitted into a realistic capital programme. Having heard my hon. Friend's argument, I trust that the region will give the fullest possible weight to the case that he has put forward on behalf of his constituents, bearing in mind the likely increase in the number of his constituents in future. We appreciate that the region is having difficulty with its capital programme, because of

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the demands of the growing population and the need to make some new provision for the mentally handicapped. We have already helped the region with its recent programming difficulties by giving it a £2 million strategic loan for 1983–84, and have promised it a further £3 million in 1984–85 and 1985–86.
If the proposed extension to Frimley Park hospital is approved by the regional health authority in April, and gets through the subsequent checks that my Department carries out, the aim will be to start work on the extension in 1986, and to complete the development by 1989–90, when it is expected that the demand for those additional beds will be made to the extent that has been calculated.
I realise that between now and the end of the decade there will be some difficulties for the west Surrey and north-east Hampshire district health authority, particularly, as my hon. Friend said, in the provision of community services within the district. The south-west Thames region has taken steps within its resource allocation policy to help the district with its immediate revenue problems. With the Government's full support and approval, the south-west Thames region is committed to a policy of revenue redistribution among the districts in its region in order to move towards resources that are more fairly distributed and that allow equal access to health services for those in the different parts of the region. At the moment, the region has some rather over-resourced districts, particularly nearer to central London, and some under-resourced districts, where the population has grown most quickly, further away from London.
The pace at which the region moves towards equalisation of resources depends on several factors, including the need for development of particular services and the pace that it can achieve, in practice, in rationalising services in the relatively better provided districts, to ensure that a proper level of service is provided within realistic resource levels. In addition, it must bear in mind the time needed to recruit and train staff, and to provide facilities to improve or increase services to patients who are in the relatively less well provided districts. For that purpose, south-west Thames region regards my hon. Friend's district health authority as one that is less well provided for. However, the present figures seem to show that the area is somewhat over-resourced for its population, although it is proper to regard it as under-re sourced, given the rapid growth in the population and the demand that is imminent.
The south-west Thames region is redistributing resources by asking its above-target districts to meet
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between them the 0·5 per cent. efficiency savings that the region has agreed with us to contribute towards the development pool that we are using to develop services nationally.
Therefore, the 0·5 per cent. efficiency savings that we are looking for from the region are all being found from the above-target districts. The other districts, which include my hon. Friend's district, are not being asked to make any contribution towards that national development pool. Like any organisation with a large budget. they will be able to make savings by increased efficiency and in other ways. The 0·5 per cent. saving is a modest measure of what can be achieved by good management by bodies of that size year by year. Any sums saved in that way will all be available to be put towards developing the local services in the district.
Although the west surrey and north-east Hampshire health authority is shown on present measurements to be above its revenue target, the region has nevertheless allowed it to retain what would otherwise have been its contribution to the efficiency pool. It can use its own resources in the way that I have described. That will go some way towards helping the district to make better use of existing facilities, such as reopening closed beds and increasing the throughput in existing beds as far as possible. It should help them to look at ways to develop community nursing and other services.
I hope that I have been able to give my hon. Friend an assurance that the health care needs of the west Surrey and north-east Hampshire health authority have not been ignored or overlooked. Plainly, he will continue to press Ministers in my Department and the regional health authority on the matter and make sure that we do not ignore or overlook them.
The next immediate decision that we are awaiting is the decision to be taken by the regional health authority in April on its capital programme. We shall see whether the extension to Frimley Park hospital can be included. If it can, that will be good news for my hon. Friend's constituents. I hope that I have also been able to give him some reassurance about the way in which the revenue demands of the district might be met over the next few years to make it clear that there is no question of any improvements of efficiency and cost-effectiveness made in his district being taken away from the district. They will all be available to develop better patient care.
Question put and agreed to.
Adjourned accordingly at four minutes to Three o'clock.

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