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National Health Service

Volume 82: debated on Tuesday 2 July 1985

The text on this page has been created from Hansard archive content, it may contain typographical errors.

I must announce that I have selected the amendment in the name of the Prime Minister.

4.36 pm

I beg to move,

That this House condemns the net reduction of 13,000 hospital beds in the National Health Service since 1979; anticipates with alarm a further loss of beds, especially in view of the inadequate provision for the elderly, the chronically sick and the mentally ill; deplores the Government's insistence that the nurses' pay award be funded at the expense of health service jobs or with cuts in services to patients; considers that these policies, together with the huge rise in unemployment, the cuts in housing investment, the weakening of health and safety controls and reductions in research funding are undermining the health and well-being of the nation whilst being neither efficient nor compassionate; and calls upon the Government to halt its policies of privatisation, promotion of private health care schemes and cuts in provision in order to provide patients and medical, nursing and ancillary staff in the Health Service with the means of gaining and administering improved treatment more quickly.
Those who 37 years ago this week founded the National Health Service—the greatest monument to Socialism, which is enduringly prized and valued by the overwhelming majority of British people, like most doctors today, let alone most patients — are deeply disturbed by the almost unrelieved catalogue of cuts that has been the history of the NHS for the past few years.

The hon. Gentleman should contain himself until he hears the trend of my speech.

It is not just money that is involved. I agree with the Government that the criterion for judging the Health Service is not and should not be the level of expenditure alone. I stress the word "alone". It is the adequacy and quality of medical care, in the widest sense, and its distribution strictly according to need without barrier of income, class or geography. On those criteria, the Government claim that the NHS is safe in their hands. They even issued a leaflet in January of this year entitled "The Health Service in England" to prove it. That leaflet was misnamed. It should have been entitled "Selective Fibs and Fowler's Howlers".

The flagship of the Government's defence in that leaflet —no doubt it will be repeated today by the Minister for Health—was that there had been a 12 per cent. increase from 1978 to 1983 in the number of in-patient cases. For misleading propaganda, that takes the biscuit. First, that may merely reflect the fact that more people are ill under this Government, as a result—[Laughter.] Before hon. Gentlemen laugh, perhaps they will listen to the consequences of their actions — of the trebling of unemployment, the halving of housing investment, the doubling of poverty, the weakening of controls over health and safety at work, and the huge extra burden placed on women forced involuntarily by the Government to care, unpaid and unsupported, for ill or elderly relatives under the fiction of community care.

Secondly, it involves no credit, even if true, to the Government. It simply is an index of overworked nurses, ancillary workers and doctors. But, thirdly, it is not even true. It is a measure not of more in-patient cases but of episodes—the number of discharges from hospital added to the number of deaths in hospital. Indeed, if more people die in hospital or more people have to be readmitted twice or more in the same year, that is scarcely an indication of greater medical progress.

The leaflet says that 35 new hospitals have been built. What it does not say is that 220 hospitals have been closed. The leaflet says that 11,000 new beds have been brought into service. What it does not say is that the overall average number of available beds in the National Health Service has decreased by 12,900. The leaflet says that waiting lists have been reduced since 1979 by 8 per cent. What it does not say is that every other comparison made in the leaflet is with 1978, and that on that basis waiting lists have increased by 15 per cent.

The leaflet says that there are more nurses and midwives working in the National Health Service. What it does not say is that most of that is accounted for by the reduction in the working week which automatically increases the number of whole-time equivalents in post and the rest of the increase, given that the birth rate has increased by about 5 per cent. over these same years, is no more than necessary simply to keep pace with extra demand and so on. Far from the National Health Service being safe in Tory hands, not even National Health Service statistics are now safe in Tory hands.

Anxious as I am sure the hon. Gentleman is that there should be a constructive debate on the National Health Service, will he recognise that under this Government resources in the National Health Service have increased by 20·5 per cent. in real terms, measured against the retail price index? Is he saying that, had a Labour Government been in power, the resources would have increased beyond that point?

Will the hon. Gentleman also take note that the RPI is an extremely inappropriate indicator of the growth of National Health Service resources, as the Minister of State will be the first to admit, because National Health Service pay and prices increase faster than the RPI? When that is taken into account, and 1 per cent. extra resources are needed each year over and above inflation because of the greater number of elderly people, plus an extra 0·5 per cent. over and above inflation for the costs of medical technology, he will realise that the increase, if it exists at all, is almost nothing. But that is the past, with which I will deal later.

One does not have to be a statistician to know that things are going badly in the National Health Service. Just ask anybody in the street. Ask the 3·5 million people living in north and west London, Hertfordshire and Bedfordshire, where more than 2,000 beds and nearly 5,000 Health Service jobs are to go in the next 10 years in order to cut no less than £47 million from the budget of the north-west Thames area. Ask the 180 patients on Guy's hospital waiting list for open heart surgery who were told that the quota for operations was already overshot so they would have to wait until the end of a financial year. I know that they were reprieved at the last moment by a private donation from America, but the National Health Service should not have to depend on private philanthropy from wealthy foreigners. If the Government are so keen on private charity, why do they not cut defence expenditure in the way that they have cut expenditure on the National Health Service and introduce instead some flag days for Trident?

Does the hon. Gentleman not realise that the picture which he is painting was completely contradicted last year by a publication called "Cost containment in health care"? It is clear from that publication that the picture which the hon. Gentleman is painting of increased queues and cuts is completely wrong. That publication was not written by a Tory supporter but by Professor Abel-Smith, a former special adviser to two Labour Secretaries of State. Is the hon. Gentleman going to address that sort of evidence as well?

I suggest that the hon. Gentleman should ask members of the public what they feel about the state of the National Health Service. He should ask them whether they feel that the National Health Service in their area is expanding or contracting. I do this regularly and each experience leads me to believe that there has been a continual catalogue of cuts, that 220 hospitals have been closed, that the number of beds — even taking into account the extra beds that have certainly been created —is decreasing and that the National Health Service is in decline. That is the national view, and it is correct.

Will my hon. Friend remind the Tories, when they talk about facts in the National Health Service, that 1,000 people died last year because they could not get a kidney machine in this starved Health Service? They did not get a reprieve. Two thousand people died of cervical cancer. They did not get a reprieve. Five thousand people died of breast cancer. They did not get a reprieve. Those are facts that have been brought about because the Government are prepared to spend more money on Trident, cruise missiles and so on than they are on the National Health Service. Those are the real facts.

My hon. Friend is absolutely correct. Indeed, he anticipates much of my speech. I therefore suggest that Conservative Members might ask the views —this is precisely the point my hon. Friend has been making—of the 1,000 women who, as my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) has very tellingly revealed, die needlessly each year because the Government have lamentably failed to establish a national comprehensive call and recall system for cervical cancer screening, or ask the views of those patients, often in pain and discomfort, who have to wait for more than a year to get treatment. According to the College of Health, there is no less than 75 per cent. of patients needing orthopaedic treatment in Southampton today, 62 per cent. of patients needing gynaecological treatment in Northamptonshire, 71 per cent. of patients needing ENT treatment in Grimsby. They should ask the views of patients who die of old age before they can get to the top of the hip replacement waiting list.

Order. It is quite clear that the hon. Member for Oldham, West (Mr. Meacher) is not giving way.

I am suggesting the number of persons whom right hon. and hon. Conservative Members might find it profitable to consult about their attitudes towards the National Health Service today, because their attitudes are very clear. The Minister might like to ask for the views of the parents of some of the 6,000 premature babies born each year who need intensive care to survive, but who are turned away because financial cuts prevent the employment of sufficient nurses to look after them; or, as my hon. Friend, the Member for Bolsover (Mr. Skinner) rightly said, the 1,500 kidney patients who each year have their death warrant signed when they are denied access to the kidney dialysis machines that they need to keep alive.

These people are denied assistance on the ground that insufficient money is available to provide all the machines which are needed, while at the same time the Government are spending £13 billion on the Trident nuclear weapons system. I could go on with examples, because the list of cuts and those affected is indeed a long one.

The hon. Gentleman is not normally seen as one with much experience of the NHS but, as he is pressing me, I shall give way.

On a point of order, Mr. Deputy Speaker. Would you remind hon. Members that it is the normal convention and courtesy of the House to listen to other hon. Members who are speaking? If hon. Members choose to intervene, as the hon. Member for Grantham (Mr. Hogg) is doing, they should be present at the beginning of the debate. That is a convention of which most of us approve, and we should like hon. Members to be reminded of it.

I do not know how hon. Members regard the conventions of the House. The hon. Member for Oldham, West (Mr. Meacher) did give way to the hon. Member for Grantham (Mr. Hogg).

Why does the hon. Member for Oldham, West (Mr. Meacher) spend such a long time grumbling about expanding waiting lists when he supported the strikes that contributed to their expansion?

The Government should recognise that £50 a week is a disgracefully and unacceptably low wage for any person when the average wage is £160 or £170 a week. The hon. Gentleman should recognise that we are defending a principle of minimum pay. If he has any decency, he would regard that as a sum that other people deserve to have.

Is my hon. Friend aware that many NHS workers, despite being the lowest paid workers in the public service, have sought first and foremost in every dispute that they have had with their employers to defend the NHS and its service, despite the Government's efforts to split health workers from the NHS and from the patients that they are there to look after?

I must make progress with my speech. I shall confine myself to one point. For all the reasons that I have given, we insist, in contrast to the Government, that, although better value for money is desirable and should be striven for, it is not and never can be a substitute for adequate funding. The Government have preferred to lavish huge increases in real expenditure on defence and law and order, even if it means starving the NHS.

The Government like to pretend that they have safeguarded the NHS, but their figures show that they have not. According to the Government, between 1978–79 and 1984–85 real input volume expenditure — which is a relevant measure—on hospital and community health services grew by 5·7 per cent. The Government have estimated that, over the same period, demographic changes increased the demand for hospital and community health services by 4·7 per cent. and that the implications of technological advances involved a further 3 per cent. increase in expenditure — a total of 7·7 per cent. Because hospital and community health services expenditure has not been increased over the past six years to keep up with the dual demographic and technological pressures, we are right to insist that NHS spending has been cut in real terms since 1979. That is all according to the Government's data.

The figures given to me three weeks ago on 7 June by the Minister of State revealed that, in five of the six years under this Government, real expenditure in terms of NHS pay and prices has declined in comparison with demographic and technological demands. I hope that Conservative Members note those facts, because they are the Government's case.

The public expenditure White Paper contained a series of measurements of efficiency and output in the NHS. There are 24 separate measurements of activity in the NHS. Can the hon. Gentleman mention a single one in which the record is not substantially better than it was in 1978?

Certainly — the one that I was quoting, which is table I from the DHSS's evidence to the Select Committee on Social Services whose fourth report for 1983–84 was entitled, "Public Expenditure on the Social Services".

That is the past, but the future is bleaker still. The Government's public expenditure White Paper reveals that the proportion of the nation's resources spent on health will decrease over the next few years. By 1987, the Government may well be spending not even the present inadequate 5·7 per cent. of GDP—which compares with 8 per cent. for France and Germany and 9·5 per cent. for America—but probably less than 5 per cent. That is the measure of the shortfall in expenditure on the NHS under this Government, when each 1 per cent. of GDP amounts to £3·4 billion. If we instead spend the same proportion of national resources on health as the United States, there would be an extra £14 billion in the Health Service budget this year. I am not saying that that can be done immediately, but it is a measure of the shortfall and puts into perspective some of the Government's niggardly penny-pinching on the NHS.

The Government have one more shot left in their locker. They like to insist that efficiency savings—or cost improvement programmes, as I think they are now equally euphemistically called—have added considerably to the resources available for health care. Last year, that amounted to £100 million, which is 0·5 per cent. of the total NHS budget. What is so specious about that argument is that these so-called savings are often achieved at the expense of reductions in maintenance and repair work, land sales and the postponement of new projects. In other words, savings are secured today but only at the expense of storing up greater problems tomorrow. That is especially serious for the NHS which, unlike industrial corporations, makes no budgetary provision for capital depreciation. The need to replace buildings and equipment as they wear out is becoming an increasing burden on the same budget that pays for new developments.

We are witnessing what operation candle-ends has brought us. Morale among staff has plummeted. Last week, the Nursing Mirror published a stress survey which stated:
"The replies came thick and fast showing many nurses feel overtired, inadequately trained and unsupported in the current climate of NHS cutbacks."
It reported that, in the past year—[Interruption.] I hope that Conservative Members will pay attention to what nurses feel, because they are the backbone of the NHS. The Nursing Mirror reported that, in the past year, two out of every five qualified staff had often reported to a senior member of staff that resources or staffing were dangerously low. It reported also that one in every three learners said that they often had been left in charge of a ward with no qualified staff present. That is intolerable.

An equally serious consequence of operation candle-ends is that no, or virtually no, new funding is ever made available for the whole range of new needs that are steadily uncovered—for research and treatment to counter AIDS, for well women's clinics, for the build-up of a genuine community care network of services, for preventing fresh outbreaks of legionnaire's disease, for a proper cervical screening recall scheme, for strengthening primary health care where it is needed in the inner urban areas, for containing and treating the spread of hard drugs, for reducing class differentials in infant mortality which are still far too wide, and so on.

I am grateful to the hon. Gentleman for giving way. He knows that I always listen carefully to what he has to say. The hon. Gentleman has produced what he believes to be a compelling catalogue of alleged cuts in services and a catalogue of areas in which he believes that the Government are guilty of not providing resources. How many of those things would he intend to put right if he became a Minister and how much extra money would he plan to spend on doing so?

The Opposition have made it clear that we would not have increased defence expenditure by 3 per cent. in real terms for the past six years. If that money had gone to the Health Service, there would have been about £3 billion extra health provision. We would redistribute from the rich to provide public services for all citizens. We are also committed to reducing the dole queue by at least 1 million within a five-year period. That would release a further £7 billion to £10 billion.

A candle-end philosophy gives no leeway for redressing long-standing grievances such as the unduly low pay of nurses and ancillary workers without drastic redistributary consequences for the rest of the Health Service, which is already stretched to breaking point. It is moral blackmail to insist that a 5·6 per cent. pay award to nurses, inadequate though it is, shall be funded in as much as it exceeds 3 per cent. either by cuts in nurses' jobs or by cuts in services to patients. For most district health authorities this will mean a budget reduction next year of between £1 million and £1·5 million. That cannot be achieved without a significant and damaging reduction in services to the public.

In Brecon, such a reduction would have led to the closure of St. David's geriatric hospital, but this hospital was mysteriously reprieved three weeks ago. It appears that a by-election is the only device known to man which offers protection against closures by the Government—a by-election which the Tories look like losing. I hope that the electorate is aware of that.

It is no accident that the Government have adopted this candle-end policy towards the NHS. Such a policy deliberately opens the way for the Government to hive off the Health Service bit by bit to the private sector and to create a two-tier service. That is the whole purpose of Toryism. Such a policy allows the Government to commercialise the NHS and to appoint bankers as general managers, as the Secretary of State did in West Sussex; to appoint business men instead of general practitioners as chairmen of family practitioner committees, as the Secretary of State did in Newcastle; to flood health authorities with Tory party hacks, as the Secretary of State has done almost everywhere; and to appoint as chairman of the new NHS management supervisory board Mr. Victor Paige who, at his first press conference, said that he and his family never used the NHS because they had private health insurance. When Mr. Paige was asked what he knew of NHS management, he replied that he had been chairman of the National Freight Corporation and the Port of London Authority.

The Government's policy is ugly and has ugly consequences for the NHS. Widespread corruption in private medicine has been revealed by the Comptroller and Auditor General, and standards have been skimped in many privatised services. There is profiteering by Tory Members from consultancies or directorships in companies now making lucrative pickings in the Health Service market. Indeed, the list of those with a place on the privatisation gravy train reads like a roll call of the modern parliamentary Tory party. We despise such a philosophy.

The Government are soft on private medicine. They have built up the private sector so that it now undermines the National Health Service. Our commitment is wholeheartedly and unequivocally to support a Health Service which provides the best possible medical care for all citizens, not just a privileged and pampered few. The Government are obsessed with cost cutting and with greater managerial efficiency even if the patient dies. Our commitment is to a new, wider vision of health care with more emphasis on prevention and public education. The Government have ruthlessly deployed patronage to destroy democracy in the National Health Service and they have centralised decision making in Whitehall. Our commitment is to a new democratic structure which will make local management and local services directly accountable to the local electorate.

The Government have done their best to dismantle the NHS. Our commitment is to making it once again the provider of the best possible medical care in the western world—and that is what we shall be voting for tonight.

5.5 pm

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:

'applauds the improved levels of service to patients achieved by the National Health Service and its staff under this Government; congratulates the Government on making this possible through its record of increasing expenditure on the Service; welcomes the fact that improved levels of service have been achieved while the pay of nurses has been raised by 23 per cent. in real terms; and supports the Government's determination to ensure, through improved management and greater efficiency, that maximum benefit is derived for patients from the resources available to the Service.'
I am sorry that the hon. Member for Oldham, West (Mr. Meacher) gets such a rough ride when understandably he is in a rather more subdued mood than on previous occasions. It should be obvious to him that he is causing increasing annoyance by wheeling out the same speech and the same motion so regularly. I suspect that he is also causing increasing tedium among the Opposition. The motion has such a familiar air that in my view it comes close to being an abuse of this House.

The motion is a travesty of the facts. It is based on the fiction, constantly and persistently repeated by the Opposition, that the Government have been making cuts in the National Health Service. I realise that the Opposition believe that there is political value to be gained from repeating that fiction and no doubt the hon. Gentleman believes that he has created a mood that is receptive to that in some parts of the country. However, the Opposition should reflect on the fact that their continued assertion and ingenious use of statistics to support their claim actually lowers the morale of staff who are achieving a great deal and causes dismay, anxiety and considerable fear among the public.

I shall use the kind of statistics that Governments have always used to show that the National Health Service has greatly improved in recent years, that it has expanded its services to the public under the Conservative Government and that services continue to develop and improve.

I shall give two simple facts to the Minister, which are not statistics and can be easily checked. Is the Minister aware that an eminent doctor arrived in Aberdeen recently to take up a post and was shocked to discover that in the Aberdeen hospital cleaning was done daily whereas the hospital in England which he had left was lucky if there was enough money to have it swept once a week?

Secondly, will the Minister comment on the situation at the Royal Free hospital where the kitchens are in a disgusting state and infested with cockroaches? The hospital administrators say that they cannot improve the kitchens because there is no money available. How can the Minister say that the Government have a commitment to the Health Service in those circumstances?

The Opposition are scraping the barrel by resorting to an anecdote about the report of a man in Aberdeen to substantiate what is meant to be an Opposition Supply day motion. The deplorable state of affairs in which cockroaches infested a kitchen arose from a low standard of hygiene. The Opposition must be desperate to try to make politics out of cockroaches. Plainly kitchens where cockroaches occur need to be cleaned with more care and efficiency.

The hon. Member for Oldham, West did not merely resort to anecdote. He continually strives to produce factual support for his assertions. He uses strange statistics, which must be read with the greatest care to discover the footnotes which surround them, and he goes in for partisan descriptions of particular local circumstances. I can tell when a debate such as today's is about to take place because written parliamentary questions begin to flow in to my Department while the hon. Gentleman tries to find his version of the figures. He and his research assistant occasionally make errors because sometimes I am asked the same question twice. I then have to refer him to the earlier answer. The subject matter of the question is a guide to the hon. Gentleman's intentions.

The hon. Gentleman always stipulates his measure of inflation, relies on particular notional figures for demand, for which he wishes measurements, and concentrates heavily, as in this motion, on beds and the number of bed closures. His motion glides over the fact that the Labour Government closed 15,000 beds as part of their rationalisation and modernisation of the service. The number of beds in the NHS is affected by changing medical practice. Historically and nationally, individual patients stay in hospital for shorter periods. Moreover, there is more day surgery. Therefore, more patients are treated with fewer beds.

We are not concerned with hospital furniture, spurious notional statistics or solely with money, as even the hon. Gentleman said. His pages and pages of Hansard questions and speeches try to get round a few incontrovertible facts about spending. He must face the fact that there has been an increase in NHS spending as a whole of 20 per cent. above the general level of inflation since the Conservative Government came to office. If spending is compared with the general level of inflation —the GDP deflator—it shows that we are spending one fifth as much again as the Labour Government were in 1979. The nearest that the hon. Gentleman got to conceding that that was the bedrock behind his arguments which he could not shift was to say that the increase in spending was "almost nothing". We are spending one fifth as much again as the Labour Government, and all his wriggling will not enable him to get round that fact.

Does the Minister understand that some hon. Members are greatly concerned not about mathematical proportions, but about whether or not sufficient money is being put into the NHS? He has just rejected the argument about furniture. I regret that rejection because in the Rochdale health authority 54 beds must be closed in acute specialties, in addition to the 56 which were closed last year. Further, 82 members of staff must be made redundant in the next 10 months, if the north-west regional manpower statistic is to be achieved. Whether or not the Government have increased expenditure on the Health Service, is it not a fact that there is insufficient money in the NHS to deal with present needs?

I agree with the hon. Gentleman that we should be discussing whether sufficient resources are going into the NHS and, like the hon. Gentleman, I refute the absurd statistical maze into which the hon. Member for Oldham, West keeps leading us.

I must finish with one intervention before I listen to another.

Reductions in beds have taken place continually under successive Governments as surplus facilities in a locality are closed, either because modern medicine can deal with the same number of patients faster or because those facilities are being replaced. That is inevitable, if the service is to change, evolve and keep up with modern medicine.

Regarding staff, our manpower targets for all regional health authorities are being undershot because greater efficiency and productivity is in some places producing staff savings and in others greater deployment of staff, especially nurses. The north-western manpower figure is far above the figure in post at present, and I assume that any reductions in Rochdale result from the better deployment of manpower. The Government's manpower targets are not below the present number of people employed by health authorities but above it. We want reductions in unnecessary staff, and administrative and clerical staff. We are glad about the continuing increase in the number of nursing, professional and technical staff in the service.

The best answer to the hon. Member for Rochdale (Mr. Smith) about how we should measure whether adequate resources are being made available, which is what matters everywhere, is not to argue about beds and notional levels of demand, but to examine patient services in England. Yet the hon. Member for Oldham, West never asks me about patient services. Patients are irrelevant to his written questions. I shall show the hon. Gentleman our success by comparing the 1978 and 1983 figures. Today, he made a ludicrous attempt to get round them to support his case about so-called cuts.

There are 650,000 more inpatient cases in our hospitals now than five years ago. The hon. Gentleman tried to knock that fact down by saying first that perhaps more people were ill, which is a preposterous proposition, and secondly that the measurement used was of deaths and discharges, which, as he well knows, is always used for the number of inpatient episodes and cases. There is no other measurement of the number of patients in hospitals. Most patients are discharged, but a few, unfortunately, die. The two figures are added together to establish the number of inpatient cases. Both the Labour and Conservative Governments have done this calculation. If the number of patients who die is ignored, the measurement will be different, but it will not measure hospital activity. It is absurd to try to escape the fact that 650,000 more patient cases are now treated in hospital each year and to say that the service is being cut.

Similarly, there are 250,000 more day cases each year than when the Labour Government were in power. There are 2·5 million more outpatient attendances than under the Labour Government. Heart bypass operations — a priority operation which the hon. Gentleman often cites —have trebled since we came to power. In 1978 the figure was 3,191, whereas in 1983 it was 9,443. Hip replacements— an operation which is waited for with impatience — have increased by 30 per cent. in five years. New renal patients admitted for treatment have increased by more than 60 per cent. In 1984, kidney transplants totalled 1,470, which was an increase of 35 per cent. over the previous year alone, and is the highest figure in western Europe. Regarding service in the community, health visitors and home nurses visited and treated 650,000 more people each year, 250,000 of whom were elderly, than under the Labour Government.

It is preposterous in the light of those figures to assert that we are cutting the services because plainly we are increasing the volume of services to patients. My hon. Friend the Member for Horsham (Sir P. Hordern) intervened, and I join him in challenging the hon. Gentleman or the hon. Member for Holborn and St. Pancras (Mr. Dobson) to find a significant part of the service where the quantity of service has diminished. They know that they cannot. The challenge mounted by the Opposition depends on ignoring those national figures, which show a substantial growth in the national service, and on resorting to anecdotes about a kitchen here, a ward there, a man in Aberdeen and ear, nose and throat cases in Grimsby. That is all held together with placards and banners of support for the NHS, and the assertion that a rapidly expanding service is being cut.

Is it an anecdote or an official DHSS figure that the hospital waiting list in the Bloomsbury health authority, part of which I represent, is 12,697 people long, while his Department urges that health authority to reduce its acute beds by 150?

I shall come to the question of Bloomsbury after I have dealt with London generally. The Opposition must face the policy of regional allocation of resources, which they started and which the Government have continued. The problem of the surplus of acute beds in London, identified under the Labour Government and this Government, cannot be dealt with simply by cutting patient services. We must follow the logic of the policy and alter the allocation of services, especially in London. The hon. Member for Holborn and St. Pancras—as a London Member — constantly challenges the regional allocation of resources and the policies of successive Governments in seeking to achieve a fairer distribution.

If we are to have a reasonable debate, the Opposition parties must decide what their position is on the RAWP formula. It was introduced by the right hon. Member for Plymouth, Devonport (Dr. Owen) when he was Minister for Health in the Labour Government. It has usually been supported in general terms by the spokesmen of both Opposition parties. The distribution of resources should be based on an all-party approach. I regret to say that most Labour spokesmen tend to be in favour of fairer allocation of resources when they speak in the north of England and against it when they come down to London. The hon. Member for Holborn and St. Pancras has a special interest in resisting its implications.

Those of us who represent the Medway towns are especially grateful for the way in which the allocation procedures are working. For the first time for many years we are beginning to see the necessary improvement in the services that is consonant with our growth in population. That has been achieved because London has been persuaded to disgorge some of its surplus.

I am grateful to my hon. Friend. My hon. Friend's constituents are benefiting from a policy started under the Labour Government but pursued with more vigour and consistency by the successor Government. It is still supported by the alliance as far as I am aware. The all-party consent on that policy has produced a fairer distribution of resources between the south-west and the north and, as my hon. Friend the Member for Mid-Kent (Mr. Rowe) rightly pointed out, between London and the rest of the south-east where there is an unfair distribution.

Contrary to the allegations of The London Standard and Labour Members, the policy is producing a change in the way in which services are provided to the inhabitants of the home counties and not a cut in patient services. If we are to have RAWP—I challenge anyone to say that they will abandon RAWP or some equivalent, and certainly I challenge him to say that in Bolton, Wigan or Sheffield —we must face the logic of the policy. If it is pursued, there will be a change in the pattern of services in London.

London services have improved under the Conservative Government. The number of inpatients treated in London hospitals is up 10 per cent. The number of day cases is up 70 per cent. Since 1979 the number of outpatient attendances in London is up by 250,000. But we shall not continue to provide the same services that were provided in over-resourced inner London.

We must preserve London hospitals, especially the teaching hospitals, as centres of excellence. The country looks to centres such as St. Thomas's, Guys and Westminster as examples for national services. London hospitals should also provide local services to central London constituents who are on waiting lists which they share with others from all over the country who are diverted for treatment to London hospitals. Routine services should no longer be provided in central London for these other patients. They should be provided in new hospitals that the release of resources enables us to provide in the home counties. The people of the home counties would prefer to have their services closer to hand and would rather not use the southern electric or other train services to central London, as long as they are satisfied that the right service of the same quality is available near their homes. That was the logic of the policy that the Opposition introduced when in government and the logic of the studies that they carried out. Our studies show a surplus of acute beds in central London and a need to redistribute. Now that we carry out the policy, the Opposition make shallow party political capital and cite anecdotal evidence about changes in Bloomsbury which have inevitably followed the more sensible redistribution.

The surplus of acute beds can be reduced because we have restored the capital programme. We are providing the new district general hospitals needed to deliver services where the patients live. The Labour Government cut the capital programme by one third. They caused huge delays to the hospital building programme throughout the country. We have restored the capital programme and we are building hospitals all over the country, especially round London.

Some of the hospitals that we have started and opened as a result of the restoration of the capital programme are in London and the home counties. I will cite some of the hospitals and major schemes that have been carried out under this Government since 1979. Apart from all the places in the north and elsewhere, we have carried out major schemes at Hemel Hempstead, Watford, Colchester and Homerton in Hackney. I include in my list the new phase 1 of the Newham hospital. Other major schemes include Lewisham district general hospital, Maidstone district general hospital, Orpington, the new Mayday hospital at Croydon and the two blocks at St. George's hospital at Tooting.

The capital programme has provided spanking new high-quality district general hospitals in parts of the home counties from which previously patients had to go to Guys, St. Thomas's and Barts. Inevitably that has enabled us to rationalise the service in central London and has enabled Bloomsbury and others to release money for the home counties and for the community services, which the inhabitants of Holborn and St. Pancras also desperately require.

Will the Minister tell us when the average capital spending of this Government per year is expected to reach the average capital spending per year of the previous Labour Government?

The hon. Gentleman is learning quickly from his hon. Friend the Member for Oldham, West. He has chosen to ask me about a marvellous statistic. He knows that the Labour Government inherited a high-spending capital programme from the Conservative Administration who preceded them. The level was rising in 1975 and 1976 as the Heath Government's programme came on flow. However, the Labour Government cut that programme by a third in 1976 in real terms and it never recovered until 1979.

The hon. Gentleman wants me to produce the average between the high level of the programme initially and the level to which it dropped. The present Government inherited a low-spending Labour programme——

The level of the programme went down first when the Conservative Government took office.

The pipeline was showing a decrease. I accept that at first the level of the programme went down. Since then, as the hon. Gentleman knows, it has steadily gone back to what it was. The pattern of capital spending is a high capital programme cut by the Labour party and a low capital programme increased by the Conservative party, with a Labour trough in the middle. And what does the hon. Gentleman want to know? He wants to know the average.

I wish to inquire why the hon. Members for Croydon, North-West (Mr. Matins) and for Lancashire. West (Mr. Hind) are standing and holding up their hands. Will the Minister tell them that they may leave the Chamber if they wish to do so?

I prefer that intervention to anecdotes about a man in Aberdeen.

I return to the capital programme, which has benefited London and the rest of the country. It cannot be denied that capital spending is vastly higher now than it was after the Labour Government's cuts in 1976. We have started major schemes on site during this year alone at Bridlington, Goole, Staincliffe, Stoke, Walsall and Oldham. Phase 1 of the new district general hospital is about to start at Oldham after the programme had been delayed by the Labour Government. We have 15 more schemes for the remainder of the year. I believe that I am entitled to assert that against that background it is nonsensical to claim that cuts are being made. It is unscrupulous nonsense for the Opposition to continue asserting it, using such fancy figures and denying the plain evidence of growth in patient services and the construction of new buildings to make a better service for the future.

Not all the money is going to new services. Some is going to pay, and particularly nurses' pay, which the hon. Member for Oldham, West chooses to make a cause of complaint in his motion. The Government can be proud of the way in which they have dealt with the nurses. The creation of the review body arrangements for them will be one of the major achievements of the Government in this sector, and a lasting achievement. When the nurses look back at the history of their pay settlements, they look to Halsbury, the benefits of which were entirely eroded after it was implemented during the period of Labour Government, when the real income of nurses fell extremely sharply, to 1979 and Clegg, although the nurses did not benefit so much from that.

Both those settlements were pre-election exercises implemented shortly post-election. Neither gave the nurses a lasting resolution of their problem. They now have an objective system. The Government have made it available to them, because we recognise their abstention from industrial action and the fact that the country, the Government, and the patients in particular owe them a great obligation. It is irrefutable that it is good news for nurses to have major pay increases, in the second instalment, particularly for the staff nurses and the ward sisters. It is irrefutable that it is a major advance for the nursing profession to have a lasting system.

There has been argument about how this award is to be paid for. I can give the English figures, which show that the cost of the entire settlement is £240 million in 1985–86. Health authority allocations in England alone have an increase in cash of over £500 million. The cost improvement programmes that we are achieving from greater efficiency—an object that the hon. Member for Oldham, West supports in theory but the products of which he derides in practice—will release at least £150 million in the estimation of the health authorities.

We paid the review body award in two instalments because that was our calculation, after some discussion with those in the field, of what could be afforded in this year out of the large budgets that we have given health authorities. It is obvious, apart from anecdotal evidence that the Opposition have produced from a few places, that pay for nurses and improving the services can go hand in hand if one continues to improve the way that the service is delivered, as the Government have.

The right hon. and learned Gentleman referred to the nurses' award being in two stages. Does he deny that using this method will cost a staff nurse £300 and a sister £700? He lauds nurses for the fact that they do not take industrial action. I am suprised that they do not.

If the hon. Gentleman is encouraging nurses to take industrial action, that is even worse than the activities of his party in recent years. The settlement for the nurses this year means that all of them will immediately get 5 per cent. or up to 5 per cent. if their award is less. When the second instalment is paid in February, staff nurses will get an increase of more than 11 per cent. on last year's pay and a ward sister will get up to a 14 per cent. increase. Those are substantial pay awards, and it is ludicrous for Labour Members to suggest that that is an unsatisfactory settlement. That is not the view of nurses.

The Minister keeps dismissing any criticism as being purely anecdotal. I appreciate that the figures that he has given are for England only, but the principle at stake is the same throughout the country. My health authority has told me that it is particularly worried about the potentially more serious financial problems for it because of

"the lack of knowledge about the Government's plans for funding the costs of these awards in 1986–87."
What will the Minister do by the autumn to fund those awards, because what he is claiming is a real increase now will shortly turn into a real cut?

Health authorities will say things like that because they are firing the preliminary shot in this year's public spending round. They do not know what the total allocations will be in 1986–87, and never have known such figures. Under no Government have firm allocations for future years been announced in advance. The published plans in last year's White Paper show the Government planning to increase spending on the NHS by £2 billion over the next three years. This year's budget spending round in the autumn will settle the allocation to health authorities next year, and it is then that the Government will have to take into account everything, including the nurses' pay settlement.

It is no novelty when people do not know what their firm allocations will be. Each year, it is true of the entire public service that we have to say that next year's problems will have to be addressed when the Government address the question of public spending and produce the public expenditure White Paper.

One important aspect of service should be dealt with amidst all these statistics. I have concentrated on the volume of service that we are delivering and have tried to show how the changing pattern in service is taking place. I have concentrated on geography, but I shall also touch on the way in which we are trying to deliver a more modern pattern of service all the time. We are concerned about preventive medicine as well as curative medicine, and in particular about female cancers, a subject upon which the hon. Member for Oldham, West touched.

The hon. Member for Holborn and St. Pancras has run a great campaign about cervical cytology. He has used great skill, and he has done extremely well to make any political mileage out of an essentially non-political subject. As he knows, screening was introduced in 1966, since when there has been a national screening policy, which has been based at the national centre at Southport more or less ever since.

As far as I can see, during the period of the last Labour Government, no move of any kind was made on cervical cytology. No improvement was made in the screening or treatment services. One reason why this country is backward compared with many others is that 1974 to 1979 was a period of benign neglect of the subject. It was not tackled until 1981, when we had a look at the national screening system and replaced it with a local screening system.

The mileage that the hon. Member for Holborn and St. Pancras has made out of the subject comes about because, by careful research, he has shown that a number of health authorities were not following the Government's policy or the efficient care and the guidelines that we laid down two years ago. Every time we produce improvements in those guidelines or accelerate the process of computerisation or the introduction of call and recall schemes, the hon. Gentleman tries to turn that to his advantage by finding places where they are not yet up to the standards on which the Government are insisting and that we are about to begin achieving in practice.

Will the right hon. and learned Gentleman confirm that the committee on gynaecological cytology advised the Government to set up call and recall schemes in every part of the country and that the Government ignored the word "call" and did not mention it either in the House or in the circular? The failure to get health authorities to establish call and recall systems has condemned more than 1,000 women to death each year simply because the Government did not accept the principal part of the committee's recommendations.

The Government concentrated on local recall schemes to replace the national recall system at Southport. At the same time, we introduced the computerisation of patient registers, and age-sex registers, which are essential before one can have a call and a recall system. The hon. Gentleman is aware that a substantial number of family practitioner committees now have such systems and he knows that our policy is to have such systems in all FPCs.

I agree that there are 2,000 avoidable deaths, but numbers are coming down, although I should like them to come down more quickly. It is tasteless to pluck out of the air the figure of 1,000 people whom the hon. Gentleman claims are dying needlessly because of neglect by us. We are introducing a system into an area in which the Labour party when it was in office showed monumental inactivity and disinterest. The hon. Gentleman has latched on to two tragic cases in Oxfordshire to get greater publicity for his views.

With the greatest respect, Opposition Members cannot start cheerily talking about 1,000 needless deaths — using the language of the hon. Member for Bolsover (Mr. Skinner)—and then say it is cheap when I accuse them of making political capital out of tragic cases.

Breast cancer is another area where we must take action to protect women against a serious health hazard. The problem is not, as the hon. Member for Bolsover seems to believe, one of neglect on our part. The trouble lies in finding a reliable method of screening for breast cancer to protect women. There have always been scientific doubts about the effectiveness of the various screening methods. Therefore, the Government have been financing a multi-centre United Kingdom trial as part of the search for a worthwhile screening method. But events have overtaken us. The recently-published findings of a study carried out in Sweden have removed many of the doubts previously attached to the value of mammographic screening for breast cancer, especially for women over 50.

Therefore, in accordance with our policy of keeping services up with modern technological developments, we have to take practical steps to formulate a policy. We have therefore asked Professor Pat Forrest, regius professor of clinical surgery at the university of Edinburgh, to chair a working group which will examine the information available in support of breast cancer screening by mammography. I have asked the group to consider the extent to which policy changes are needed towards the provision of mammographic facilities.

The group has also been asked to suggest a range of policy options and to assess the service planning the manpower and the financial implications associated with these options. I have asked Professor Forrest to let me have a report as soon as possible. We are issuing today the precise terms of reference and membership of the working group.

This should be the sort of issue which unites the House. We should, as the hon. Member for Rochdale says, be anxious to know whether we are spending enough on the Health Service and not get lost in a maze of figures. We should examine what is produced for the patients and consider whether we are catching up with the needs and expectations of the people. We should also be ready to change, and should not be defending old workhouses such as Thornton View, which the staff occupied for a time to try to stop the patients being moved to better accommodation. We should not defend every vested interest of the National Union of Public Employees, the National Association of Local Government Officers or some local interest group. We should be trying to get a better and more up-to-date service that can cope with the big demands such as the rising number of old people or the demands of changing modern technology.

Our concern is for a better and more modern welfare state. This Government are a reforming Administration in the best sense of the word. We are bringing to the National Health Service the qualities of better management, cost-effectiveness and clear decision-taking. These qualities are needed to support the efforts of doctors, nurses and all staff.

Our efforts, coupled with all the extra cash that we, on the taxpayer's behalf, are putting into the service, are producing a Health Service which supports our amendment and utterly refutes this ridiculous attack which has been mounted yet again, but probably for the last time on behalf of his party, by the hon. Member for Oldham, West.

5.43 pm

(Wolverhampton, North-East): I take a dim view of the Minister's attitude—he is not willing to listen to criticism from this side of the House.

If he accepted that we are just as enthusiastic as I hope he is that the Health Service should be improved, we might make more progress.

When he says that nurses have left the service, he ought to be aware that 3,000 nurses left the service between March 1983 and March 1984. That is quite a large number. If he were to look at the reports that were produced by the Royal College of Nursing, for example, he would see why nurses have left the service.

The research commissioned for the Royal College of Nursing commission on nursing education gave clear evidence of the manpower crisis that will occur in nursing in the early 1990s unless something is done. The college has written:
"We believe that the inadequacy of the education and training of nurses is one major contributory factor to the high wastage rates among nurses."
Another survey, carried out by Nursing Mirror, said that many nurses leave because they feel too tired or stressed to work, but carry on anyway until they have to leave. More than 50 per cent. of respondents admitted that they had taken time off sick when they were not really ill. They felt that they could not carry on, as they were too fatigued and stressed to work.

Those are important contributory factors to nurses leaving the service. The Minister ought to find out why he cannot offer better salaries to nurses and recruit more nurses so that the burden and stress are reduced. Until that is done, the crisis in the nursing profession will continue. That crisis has a considerable and damaging effect on patients.

In regard to the Royal College of Nursing report, does my hon. Friend remember the recent statement: in Nursing Standard that nurses are getting tired of the privatisation of auxiliary services as, in addition to their nursing duties, they are having to clean wards?

That is clearly not a nurse's job, and the Minister should do something about it.

The Minister criticises us for pressing for more resources in the NHS, but expenditure on health care continues to rise in all Western countries. If our expenditure is rising, we are not unusual. We are certainly not the leaders, as we are well below the OECD average and only Greece, which is much less wealthy than we are., spends less on the health service. That is a sobering comparison.

The hon. Lady occupies an important position in the House. With the knowledge that she has accumulated in that position, can she tell us how much, in extra resources, should be devoted to the Health Service to meet the demands that she has in mind?

I shall not be led down that path because so many considerations must be taken into account. We are not the Government at the moment. I hope that, after the next general election, we will be, and that we shall be able to devote a greater proportion of gross national product to the Health Service.

Medical research has made massive and exciting progress in the past 50 years. As a result, many of the diseases that were killers have been eliminated or can be controlled. Tuberculosis, pneumonia and diabetes can all be controlled. However, because of this development, many people live much longer and greater demands are put on the Health Service. Cost effectiveness has therefore become more important than cost benefit. In this decade, cost utility analysis, or the assessment of how modern treatment affects the length and quality of life, is more important, so of course the Minister has to be prepared to spend more on the greater number of patients who are living to 80 or beyond.

I am sure that the Minister is conversant with the Nottingham health profile, which is used to assess patients' progress and reactions to their condition. The method was used to assess women's health during pregnancy. Similar methods have been used in America to assess new methods of treating rheumatoid arthritis with oral gold preparations, for example. More recently, the method has been used to evaluate heart transplants at Harefield and at Papworth, as well as coronary artery bypass patients. The results of those assessments will be interesting.

When asked, women are found to be most anxious about the lack of adequate screening for breast and cervical cancer, to which my hon. Friend the Member for Oldham, West (Mr. Meacher) has referred, when safe and sure techniques to detect both serious conditions early enough for successful surgery have been well known for years. This is not a new development, yet more than 2,000 women die each year from cervical cancer, including—and this is alarming—an increasing number of younger women. More than 20,000 women die from breast cancer each year. Yet proper screening and recall systems are not available. Why not?

Many thousands of people suffer from smoking-related diseases such as lung cancer, bronchitis, coronary heart disease and so on. The facilities for diagnosis and treatment are grossly inadequate. The Government are unwilling to forgo the money they receive from cigarette manufacturers—tobacco tax boosted by sales resulting from constant and specious advertising. I find it unacceptable and disgusting that the Government are willing to rely on funds from tobacco firms to supplement, for example, resources for the arts. The Government should take on board the question of tobacco advertising. Singers and dancers should not smoke, but many of them would be out of work were it not for the conscience money paid by tobacco firms to opera and ballet companies. It is difficult to reconcile that.

I hope that the Minister will respond positively to those serious matters. I hope that he will tell us what proposals he has to extend cancer screening for women, whether through general practitioners, well women's clinics, the Women's National Cancer Control Campaign, or the financing of a national call and recall system. Other than that, will he provide more resources for those organisations working within the community to provide a measure of screening for women?

The Parliamentary Under-Secretary of State for Health and Social Security
(Mr. John Patten)

The hon. Lady was listening as carefully as I was to the remarks of my right hon. and learned Friend about cancer screening. He outlined clearly our women's health policy. I am sure that she will agree that one of the problems is not the provision of services but trying to persuade women of all ages—especially elderly women—to make use of the services. I hope that there will be bipartisan agreement across the Chamber this afternoon that we must all do more to ensure that women make use of the services. Any advice that the hon. Lady can give us about that will be very welcome.

It is all very well to say that we must persuade women to use the services, but unless facilities are available they cannot be persuaded. I am closely related with the Women's National Cancer Control Campaign. When our caravans go around the country, we do not find that we are short of women coming forward for screening. The Minister should look rather more carefully at that point and not assume that it is the fault of women for not coming forward, when resources and services are not available.

Screening is very much cheaper than treating a patient for deep, invasive carcinoma of the cervix or for breast cancer. The Minister should bear that in mind because it is cost-effective. The Select Committee's 11 members are closely watching the expenditure of the Department and the results of that expenditure in the NHS week after week, year after year. Over the years it has provided the Secretary of State with much more valuable ammunition to use in his battles with the Chancellor of the Exchequer for more resources for the care and treatment of patients. We would like some sign that that ammunition is being used.

Let us consider the problem of babies who die from serious handicap each year, many of whom need not die. Thousands survive serious handicaps that could be prevented. The rates in 1980 were a disgrace, when 9,000 to 10,000 babies died, but one third to one half of those deaths could have been prevented. Most of those babies were born to mothers in the lowest socio-economic groups and many to mothers in the ethnic minority groups. Poor nutrition, unwanted pregnancies, smoking and drinking alcohol were identified as causes.

In June 1984, the Select Committee published its first monitoring report on perinatal mortality. The rate has fallen — three cheers for that — but it has not fallen enough. The Government must do better — [Interruption.] I am telling them that they cannot sit back because there has been a decline and say that they have solved the problem — they must do better. We must provide the resources needed for the acceptance and provision of minimum standards of nurse staffing in the specialist intensive care units.

The Government must stop the enticement of nurses trained by the NHS away from intensive care units to private hospitals. That leaves NHS consultants with no alternative but to close some of their intensive care cots. That is scandalous. It means that they have to refuse to accept ill babies recommended by obstetricians in the peripheral hospitals. In other words, the Government should pay nurses decent salaries and generously recognise additional skills in specialised areas of the NHS. The Government are not doing that. Because the private sector offers higher rates, the nurses are enticed away.

Interesting proposals for the training of nurses have been made. The Judge report and the report of the English National Board for Nursing, Midwifery and Health Visiting show the need for reform and for a closer relationship between nursing education and higher education. Unless urgent steps are taken to improve nursing training, we shall face a serious crisis by the early 1990s. The present high wastage among nurses appears to be closely related to dissatisfaction with their training, their working conditions and their career prospects.

If higher education were to embrace education for nursing, as the reports propose, the pessimistic view of the Secretary of State for Education and Science about the decline in applications for higher education in the 1990s would prove unjustified. More women would be brought into the higher education system and the general level of training for the nursing profession would be greatly enhanced.

The Select Committee's report dealing with medical education and the career structure which was published in 1981 highlighted serious shortages in certain specialties of medical practice. It recommended a considerable increase in the number of consultants and a reduction in the number of juniors. I am glad to say that there was some improvement between 1980 and 1984, when the number of consultants throughout the country rose by 1,148. However, the British Medical Association said that that was not enough, and the Select Committee wanted progress to be made more rapidly.

Pathology is related to the problem of cervical cancer and breast cancer screening because specimens have to be examined by pathologists. The Select Committee identified that area as a shortage specialty in 1981, yet it still has a low rate of expansion—6·3 per cent. overall. There is still a shortage of those specialist scientists in the NHS to carry out the work that would accrue if more women were screened.

Obstetrics and gynaecology levels increased by 8·1 per cent., and both Royal Colleges recently expressed concern to the Select Committee about the slow rate of progress in those areas. In psychiatry, radiology and anaesthetics, expansion has been better—between 13 per cent. and 16 per cent. Therefore, there is a considerable difference between the specialties, with some making better progress than others. There still needs to be an increase in the number of consultants and a reduction in the number of juniors—then, the career imbalance will be rectified and we can realise the savings that will be made when many more patients are treated by fully trained doctors. We have reiterated that on many occasions, but I am not sure whether the Minister has taken that point on board. The savings in outpatient departments will be seen readily—with considerable relief to patients as well as relief to the expenditure of the hospital—when the Government fully implement the Select Committee's proposals.

Few junior posts have been closed or replaced by consultant posts following a loss of recognition for training purposes. Will the Minister now act on what we in the Select Committee said in 1981, and freeze all new senior house officer posts in England and Wales? Although he supported that proposal in the House of Commons 82/4 paper the number of SHO's rose by 5·1 per cent. between 1980 and 1984, contrary to what the Committee recommended, and contrary to what he said he would accept. Only between September 1983 and September 1984 has there been a tiny fall of fewer than 16 posts out of a total of 10,000. Clearly, there is a long way to go.

What is the Minister proposing to do now, in the light of our monitoring report, to bring about changes that will give better service and better value for money in the Health Service as a whole, and to individual patients who will be treated better by fully trained doctors?

What does the Minister intend to do to recognise alternative medicine — for example, chiropractic and homeopathic medicine — which has made so much progress in treating many difficult cases that orthodox medicine seems unable to treat? I refer particularly to all sorts of back conditions and back pain which result in millions of lost working days per annum and cost the Health Service a great deal of money. General practitioners are not able to deal with those patients adequately.

Before the hon. Lady leaves the subject of homeopathic and alternative medicine, I should like to ask my right hon. and learned Friend the Minister for Health whether he will pay particular attention to providing the same level of financial support, and perhaps increasing financial support, to homeopathy within the Health Service in view of the great consumer demand for that treatment. The hon. Lady has mentioned the need to review some hospital doctor posts. That is particularly important within homeopathy, where there is a grave danger of a decline in the number of hospital posts in that specialty. The hon. Member for Holborn and St. Pancras (Mr. Dobson) touched upon some giggly points about the Bloomsbury health district in an earlier intervention, but my right hon. and learned Friend will be aware that the Royal London Homeopathic hospital is within the Bloomsbury health district. The failure of that health district to give clear support to that specialty is a grave problem at present.

The hon. Gentleman has made his point very clearly and very well. I hope that the Minister was listening.

Order. Many hon. Members are still waiting to speak, and interventions are made only at the expense of other hon. Members' speeches.

I shall stick to your ruling, Mr. Deputy Speaker, and not give way to the hon. Gentleman.

It has been estimated that back pain alone costs £156 million each year to treat, and it is not being treated successfully within the Health Service at present. I hope that the Minister will give more consideration to recognising homeopathic medicine, a matter referred to by the hon. Member for Maidstone (Sir J. Wells), and chiropractic medicine for treatment within the National Health Service.

I am glad that the Minister has taken steps to reduce the number of overseas doctors who have been brought into this country simply as pairs of hands who are being used particularly in the Cinderella specialties. We want to bring those doctors to Britain for postgraduate training, particularly in the specialties that their own people need. We must not exploit them here.

I hope that the Minister will show that there are ways in which we can save the existing resources that are spent on the National Health Service. I believe that we can give better treatment to patients if we listen to the good advice that comes from the Opposition and to the joint voice that comes from the Select Committee. Two of the members of that Committee are now in the Chamber.

Order. This is a short debate. Short speeches will reduce the number of disappointments.

6.4 pm

Anybody listening to a debate that is ostensibly about Government cuts in the National Health Service would expect the Opposition to prove conclusively that there was a forced reduction by the Government either in the financial support that they were providing or in the physical structure of the service in terms of fewer doctors, surgeons and nursing staff. In fact, exactly the opposite has been proven. Therefore, in those terms alone it seems that the Opposition motion fails.

The description by the hon. Member for Oldham, West (Mr. Meacher) of the National Health Service is very different from the one that looks after me three times a week. His description and his speech failed to deal with the real question, which is the continuing and evolving nature of the Health Service and what resources will be required as that evolution continues. The hon. Member for Oldham, West will probably remember the words of the annual report for the Health Service in England for 1984 that
"Needs will always be running ahead of what can be generally available and the pattern and organisation of care will always be evolving".
Because the Health Service is not a static service, we will continuously have to recognise that more and more resources will be required. We shall have to find ways of finding those resources other than by simply saying that the Government will spend more.

The advances in medical care — many have been referred to already in the debate, and I am the recipient of one of those advances — are expensive in terms of capital costs and the trained personnel needed to operate them. But they are all-important to the particular sufferers from the particular diseases. It is a brave man who will choose his priorities as to which disease should take pride of place when money is allocated.

I think that the House knows that I am personally involved in the treatment of kidney failure, having been on dialysis for the past 18 months. I am fortunate in being looked after in the Oxfordshire health authority area at the Churchill hospital. I am particularly fortunate in coming under the able leadership of Dr. Desmond Oliver. He has demonstrated that dialysis can be successfully given to children and through all age groups, even to those over 70. His example should be an example to all regional authorities of what can be achieved.

I am one of the lucky ones. I get dialysis. But, as we know, in many regional authorities, somebody of my age —I am now 54—would be refused dialysis, not because the Government said so, but because the regional health authority has chosen to allocate its resources in other directions. Now we are insisting that regional health authorities should treat 40 kidney patients per million on dialysis. The real figure should be 100, but to get there many more resources will be required, and if they are to be found they will have to come either from services already being provided or by more money going into the Health Service in that direction.

Put in those terms, can anyone say what the total sum is that should be spent on the NHS to achieve all the objectives that are worthy of support? The hon. Member for Oldham, West did not attempt to answer that. He did a bypass operation, and talked about other things that he would not spend money on. The fact of the matter is—and he knows it as well as I do—that this Government are spending more that his Government spent on health care. He knows as well as I do that if there is a shortfall in dialysis, it is not because this Government have decided to deny resources to kidney dialysis; it is because Governments of each party decided that resources had to be spread widely over a whole range of projects, so certain resources that were required did not necessarily go in the direction of any one treatment. I do not think that anyone would argue that that should be so.

So the question of resources seems to me to be the real argument in the Health Service, and to some extent it should not be a party political argument, for where is the gain? I have been treated by the National Health Service, as I have said, for the past 18 months. I spent at least eight of those months in hospital. I can only say to the hon. Gentleman that I have not noticed the cuts that he talks about. I have been in general wards. I have been having the same treatment as anybody else, and I can tell him only that there was no sense of scarcity of resources, of care, of consideration or of medical staff. I can speak only from my experience which I know is limited but which must be worth something, perhaps something more than the annecdotal evidence that we have heard in this debate.

Just the same, I agree with my right hon. and learned Friend the Minister for Health when he says that what is required is the channelling of resources towards patient care and away from administration. In the Oxfordshire health authority 36 per cent. of expenditure goes on administrative services. Overall in England the figure is 45 per cent. Anyone might argue that those figures are too high, that we should try to reduce that national figure of 45 per cent. to the 36 per cent. that Oxford achieves. In fact, Oxford might be able to reduce its figure still further.

The hon. Gentleman shakes his head. I suggest he looks at the annual report for the Health Service in England and he will see, I hope, that what I have just told him is borne out by the facts. If I believe that administration is still taking too big a share of resources — and when I say "administration" I mean anything other than jobs done by consultants, doctors, nurses, physiotherapists, radiographers and scientists — I also believe that we ought to consider the nursing staff in the words of the hon. Member for Wolverhampton, North-East (Mr. Short). I am thinking in terms of raising the levels of that profession by recognising that qualifications should bring higher salaries and thus give nurses the incentive to obtain those qualifications and therefore greater skill.

We must consider the nurses' pay settlement because whereas we may say that an average of 8·6 per cent. is higher than anything that one can think of in the public sector to date, in fact it is 5·6 per cent. between April 1985 and February 1986. If the city editor of The Times is to be believed in the article he wrote on Saturday, inflation looks like turning out at 7 per cent. for the year. In those terms I find it difficult to see how nurses pay will stay abreast of inflation, which is surely a minimum requirement.

Will the hon. Gentleman, in considering nurses, also please link—because he has experience of it—the technical people and the paramedical professions who have to undergo long training periods and who start with minimum standards? I hope he will agree that they at all times should be linked to nurses' pay. Does the hon. Gentleman agree?

I shall leave that question to one side. I do not know enough about their pay scales to talk with any objectivity. If I may, I will just stay with the nurses for the moment at least and refer to extra duty payments. There is uncertainty in the nursing profession about whether these payments will continue, whether they are going to be increased in line with inflation or whether there is any danger of them disappearing. Nurses wonder why there are payments made to doctors for what are called distinction awards when the same money is not made available to them. If one looks at the criteria governing the committee which makes these awards, it is difficult to see why nurses have been excluded from benefiting from the £52 million annually which is spent on these awards. I would ask my right hon. Friend to consider that point.

Before I leave nurses' pay, may I point out to him that district nursing officers, senior nurses, senior nursing officers and sisters, all earn less, according to the pay scales supplied to me by the Oxfordshire health authority, than the three level administrators: the district administrator, the principal administration assistant and the general administration assistant. As a patient I know which of those groups matters most to me and I suggest to my right hon. Friend that something might be done to bring nurses' grades more into line with those of the administration staff.

I should like to see my right hon. Friend's policy of channelling resources to patient care carried as far as it can go. I know there is controversy about privatisation most of which is spurious. Two of the hospitals I have been in have been privatised while I have been in them. I can only say as a patient that I have noticed no variation in the service provided. The service will be as good as the motivation of those providing it, not as good as the employer. If the motivation is there, the patient will benefit. If it is not, he or she will suffer.

Because I believe that the future funding of the NHS is such a key question, I want to refer to a personal experience within the last six weeks when I entered the Radcliffe infirmary in Oxford for two further operations. When I came to the admittance office I was asked whether I wanted to be treated on the NHS or as a private patient. I am a member of a private medical insurance scheme. I replied that I wished to be treated on the National Health Service. My answer was prompted partly by my admiration of the service, for it is a superb service, as I have said many times, but also because of that insidious propaganda which the Labour party has managed to convey, that to be treated as a private patient is to do something which is anti-social. It is to seek a privilege denied to lesser mortals, and, as a representative of the people, I should share the same treatment as the poorest of my constituents. During the weeks I lay in hospital I had time to reflect on my decision and I now realise that I made the wrong decision, not because I would have been treated better as a private patient—as it happens I would have been treated in the same ward in the same way—but because, by selecting the NHS rather than the private scheme, I denied the NHS the resources it would have derived from the private scheme, resources that could have gone towards treating somebody else. I believe that that denial of funds in my own terms was to me at least a turning point in my thinking about the funding of the NHS.

Recently I was reading some remarks by Mr. Bob Graham, the chief executive of BUPA. He said:
"Where locally there are NHS waiting lists and also spare capacity in private hospitals it is surely right, in order to relieve suffering, to bring the supply and demand together. It also makes sense for each sector to concentrate on what it can do best. The NHS does many things superbly well which the private sector could not hope to emulate, but which the NHS alone must do —casualty and emergency services for instance. But on the other hand a quarter of all hip replacements in Britain are now carried out privately, and the proportion is increasing. The stimulating combination of co-operation and competition between the two sectors is in my view a most practical step towards solving some of the health care problems in Britain … If a political party wants to provide the best health care for the electorate it must now take into account the growing resources and potential of the independent sector in its overall planning … Not to do so would be to defy logic, to frustrate freedom of choice, and would be a futile attempt to stem the tide of consumerism."
I find myself wholly in agreement with those remarks and I hope from now onwards we will not draw this artificial line, this line of animosity between the private and the public sector, but see one as complimentary to the other and both about the care of the patient.

6.19 pm

Whatever the feelings of hon. Members on the issue, there can be no doubt about the respect with which the hon. Member for Newbury (Mr. McNair-Wilson) was listened to, given his personal experience. We all wish him good health and a continuing recovery from his illness. I will follow in a moment his theme—the general question, almost the philosophical question, of funding for the NHS.

It is worth reflecting first on some of the things that the NHS has had to grapple with in just the two years since the last election. In July 1983 the Chancellor announced the manpower and resources cut that caused great difficulty. A tier was abolished and we had the Griffiths report with all its implications and at times the controversy to which it has given rise. There has been rate capping, with its effect on joint funding of projects, particularly in the care and community programme.

Community care itself is now partially referred to in the social security reviews and will be used partly as a pump-priming exercise. We have had the limited list controversy, the privatisation of ancillary services and the recent decision on the pay review boards. I can understand the Secretary of State being anxious to bring forward another Green Paper on the reorganisation of primary care before the House rises for the summer recess.

That is an immense catalogue of things for any service, particularly one as fundamental and as complex as the National Health Service, to assimilate and carry through in the course of two years. Without doubt it is a mark of what the Minister was talking about, which is the radical approach that the Government have taken.

There are many sensible ideas incorporated in all those changes. This is very much a man-in-the-street opinion bin I wonder if so many changes in such a short period can in the end be productive. With further changes and radical departures being promised, and indeed heralded by the Minister this afternoon, one wonders if health care will benefit.

On the question of funding the Health Service and the cuts that it is experiencing, I think the House would be at one with the Minister when he says that there is infinitely rising demand, by definition, because of demographic changes, particularly with the growing number of elderly people, and because of the excellent but nonetheless straining pace of the growth of medical technology. People have greater aspirations and therefore make more demands on the system. Because of the ability of the Health Service to provide more sophistication in curing, new avenues of health provision are opened up.

All those things place demands on the system which any Government would find it difficult to meet. I know that the Labour Opposition do not agree with this, but I have said before that their promises about funding are not to be taken even at face value, far less with any seriousness. It is reasonable for any Government to try to set a target of 1·5 per cent. real growth per annum—in other words, to keep pace with the demands of the system and to try to find a bit extra to expand the frontier zone.

The Minister is also on reasonable ground to argue, as he does, that cuts in the number of beds do not always mean that there are cuts in health care. That is a blinkered approach that the Labour Front Bench would like us to believe. I would, not deny for a moment that if a hospital ward can be organised more efficiently or if health provision can be made in such a way that, for example, geriatric beds are no longer occupied because people are being cared for in the community, that is a welcome development. On the geriatric front, I find it hard to believe that of the 10,000 beds that have been cut since 1979 — these are 1984 figures — every one of those signifies in the locality where the reduction has taken place a welcome corresponding provision in the community. The facts do not bear that out.

In relation to that, I was grateful that the Minister mentioned the resource allocation working party formula. He was right to point out that the RAWPing approach continued to command support. The figures are worth considering.

That was introduced by the right hon. Member for Plymouth, Devonport (Dr. Owen).

I am glad that we have been reminded that it was my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) who introduced it. Let us look at the figures to see what has been achieved. In 1979–80, the poorest health region was 9 per cent. below its RAWP target and the richest 13 per cent. above. That is a major disparity. By 1984–85, the range was 5 per cent. below to 9 per cent. above. The disparity is still there but the Minister is to be credited for continuing the implementation of a policy that is slowly bringing closer together within a narrower spectrum the disadvantaged and the more advantaged areas.

The hon. Gentleman will be replying to the debate and he can pick up the point then.

The RAWP formula was carried through before the International Monetary Fund crisis. At that point it was dependent on and envisaged economic growth. Clearly, in times of recession or economic stagnation, such as we have at the moment, it will cause the more advantaged areas not just to help disburse their above average quota but to suffer in the process. That is one of the reasons why the Minister spent some time defending his policy in regard to London.

In the longer term, as we move into the post-RAWP period there is a need to decentralise the Health Service further and to move towards an equalisation pool for funding so that we do not just use the RAWP formula as it stands but leave the way open for perhaps democratically elected health authorities themselves to consider ways of raising revenue locally on top of what would be available centrally.

Two other points have arisen on the motion and the amendment and on the topical issues under consideration. First, in regard to the pay award for nurses, midwives and health visitors, I appreciate that the Scottish health Minister is not present—I am not criticising him for that — but perhaps my remarks will be communicated to him. The principle involved is typical elsewhere in the country.

The Highlands health board has issued a consultative document which envisages major cuts in a variety of services, particularly maternity services, and also affects two hospitals. One geriatric hospital is to be closed down and another general needs hospital in my constituency is to be downgraded, because two new hospitals are being opened, one in Inverness and one in Wick. However, they are not receiving a penny extra from the Scottish Home and Health Department to provide the revenue costs to run the new buildings. Therefore, the revenue savings have to be found in other aspects of health care to run the hospitals that are coming on stream. We all want to see improved medical technology and welcome it without qualification but it is a "Yes, Minister" state of affairs to find that we can run new hospitals only by axing other facilities that are needed elsewhere in the community. That is unsatisfactory. It is similar in principle to the problem that my hon. Friend the Member for Rochdale (Mr. Smith) has been experiencing locally as well.

The problems faced by the health board in my constituency are likely to be accentuated because of the uncertainty of the nurses' pay award and its future funding, particularly in 1985–86. It is not enough for the Minister to say that this has always been the case, because it has not always been the case in the past that independent pay body awards have been thrown entirely on to the backs of health authorities and health boards — in other words, that a welcome and much-needed increase justly deserved by some sectors of the Health Service should be funded by cuts at the expense of patients and that health authorities should be left with unpalatable decisions. I do not think that the Minister can take responsibility on the one hand and then shrug it off on the other.

Looking to the Green Paper which we are expecting, it is surely unacceptable that the Government would ever consider moving towards privatisation of a general practitioner, family-based service. It is the backbone not just of the Health Service but in many ways of the whole structure of the family within the community. Although there may be a strong case to be made for some private health care, given the commitment which is at least expressed— I assume sincerely—on both sides of the House towards the National Health Service, free at the point of use and funded out of general taxation, I cannot see, in the medium term at least, any more than marginal room for private health provision.

Therefore, in many respects the Government are to be held guilty for their handling of the Health Service, and the nurses, midwives and health visitors' pay award proves it. They are doing good things and they are doing some radical things and are to be congratulated on that, but on balance they are not showing sufficient responsiveness or understanding of the needs and the lack of resources in the Health Service. On that basis, along with my hon. and right hon. Friends, I will be voting for the motion this evening.

6.31 pm

I find this motion extraordinary. After the case put forward from the Opposition Front Bench—I devoutly hope that the hon. Member for Oldham, West (Mr. Meacher) stays in that position — the call that faces the House in this motion must come under the head of special pleading, because it mentions cuts in funding, when all the Government do is pour more and more money into the Health Service. The hon. Member for Oldham, West said that the Government had put a bit more in, but said it was almost nothing — £10,000 million per annum almost nothing! The motion mentions reductions in hospital beds, yet there are apparently more new hospitals being designed and built than at any time in the history of the NHS. The motion says that the nation's health is being undermined, but more patients are being treated and getting much more advanced and complicated treatment than ever before. Reflecting on this extraordinary catalogue of claims, it seems to me there can be little doubt that the Opposition are suffering from paranoia, schizophrenia, deafness or blindness. Whichever it is, they certainly need more money to be spent on the NHS for their own purposes.

The record of improvements in the NHS is far too long to go into in a short speech, so I want to mention just two things. The waiting lists are coming down, and this is a matter of great satisfaction, but may I suggest that my right hon. and learned Friend looks into the possibility of using more computers in waiting lists? I know that, in Birmingham, there are vacancies at once for some types of treatment for which patients in other hospitals are waiting needlessly. I should be pleased if he could look at that.

Then I should like to ask my right hon. and learned Friend to look at a matter which has been touched on in several speeches this evening — the question of spending. Every penny we spend in the NHS should be spent as wisely and as sensibly as possible. Would he therefore look again at what has perhaps been an unpopular policy in some parts of this House—the possibility of bringing in hotel charges for those who can afford them in National Health Service hospitals? I find as I go round the hospitals that many people warmly recommend these charges. They could be quite modest and I would not wish them to fall on people who could not afford them. They would have to pay for the cost of their food if they were still at home.

Other countries certainly use the system of hotel charges. I have some details about France but I will not weary the House with them now. Other countries have found great savings there. If there are 6 million patients a year, even if we charge five pounds a week, which wound be a most modest amount of money, we should surely get more than £1,000 million a year from that alone. I know it has been said there are difficulties with administration, but I am simply asking my right hon. and learned Friend to look at it again. Many people in the Health Service want money spent wisely, and feel that there are savings to be made there.

6.35 pm

I shall be brief because this is a short debate. It is regrettably short and I should say at the outset that my interests in the debate are the interests of someone who represents an inner city constituency suffering badly from cuts in the National Health Service expenditure and also as someone sponsored in this House by the National Union of Public Employees. I make no apology for that and it would be nice if all Conservative Members with shareholdings in private cleaning and catering companies also declared their interests during the debate.

The Minister mentioned the way that the RAWP formula operates. What he fails to understand is that the formula operates in London and the south-east to create a continual outflow of essential capital and revenue from the inner city areas to the suburban and outer suburban areas in the home counties. When Conservative Members mention that new hospitals are being built in the home counties, nobody wishes to detract from that, because we are all glad if health services are improving in those areas. But they should consider what is happening to an area such as mine which will suffer a 15 per cent. cut in real terms over the next decade in Health Service expenditure. Every few years another hospital is up for closure, and we are now going through the process of closure of the acute wards of the Royal Northern hospital after the Minister's predecessor assured us that the hospital's acute services would be preserved, despite the closure of the accident and emergency department.

We see a continual erosion of health care in the area and that, compounded with the closure of the Friern Barnet psychiatric hospital outside my constituency, means there is greater and greater pressure on the centralised Whittington hospital, which in the long run will have fewer beds and longer waiting lists for local people. The pattern there is not very different from that in all the other inner London health areas. If the Minister examines the length of the waiting lists and the long-term provision of acute and geriatric and psycho-geriatric beds in those areas, he will have to concede that the major point I am making is absolutely true. We are seeing a long-term decline in Health Service prospects in those areas.

I should like briefly to mention the nurses' pay award and the pay awards of all Health Service workers. I am a former organiser for the National Union of Public Employees in the Health Service and a former member of an area health authority. I know therefore that when health workers are accused by the Government of being greedy, grasping people trying to take as much money as they can out of the Health Service, when they are already among the lowest paid public sector workers anywhere in the country, they find it offensive in the extreme. They also resent the way that Health Service budgets are so made up that the wage claims of health workers are falsely set against the service that may or may not he provided to patients.

The Government are attacking the lowest paid people in the Health Service instead of looking at the overall levels of expenditure or, indeed, the profits that are made out of the Health Service by private contractors, by drug companies or by others. Recently I received a letter from a constituent who wrote:
"I am fortunate in that as a Senior Clinical Nurse I am not one of the lowest paid members of the nursing staff. I do, however, continue to work weekends and Bank Holidays, having total responsibility for all medically ill and elderly patients at all times and spend the majority of my working day as the sole nurse responsible for care throughout the hospital. After 12 years' experience I consider that my take-home pay of little more than £100 per week as totally inadequate."
He is doing a major and very responsible job for that kind of money and that is typical of how nurses are now being treated. NUPE, my union, told the pay review board meeting:
"The Government defrauded nurses to the tune of £109 million. The PRB's recommendations were costed at £283 million but the Government's insistence on staging means the award is now worth £173 million.
The Government has compounded this deceit by its dishonest claims that the award amounts to an increase of 9%. With nurses held to a 5% rise for ten months, and the balance of the full rates applying for just two months, the real increase over the year will be on average 5·6%."
Nurses are being very badly treated and undervalued, as are other health workers.

Because of the merit awards system for consultants announced in the last couple of months the NHS is about to spend £42 million on such awards to a very small number of Health Service consultants. I question a sense of priorities which gives that amount of money to consultants but which treats nurses and ancillary workers so badly.

My union recently surveyed the way in which contract cleaning has been introduced into hospitals. It also looked at the terms and conditions of the workers. It concluded:
"Widespread use of part timers below the 16-hour threshold for national insurance contributions and benefits was found. One cleaning contractor—Reckitts Cleaning Services—lists all its 9,500 part time staff as working below this level. This represents a saving of employers' National Insurance Contributions as well as taking away from employees their employment protection rights. Virtually none of the contractors offered any improvement on the statutory provision for maternity leave, pensions and sick pay."
It goes on to list a category of disasters, bad employment practices and the abuse of low-paid cleaning workers in the NHS. The Government are handing a large part of the NHS over to the lowest form of profit motive in private cleaning and catering companies. The motive of profit making by contractors within the NHS cannot be reconciled with the basic motive of the NHS, which is to provide the best standards of health care for all people irrespective of their wealth or ability to pay. I want to see a return to the basic principles of the NHS, not its continuing destruction in which this Government are taking part.

6.41 pm

Anyone who listened to the Minister will have concluded that we were living in some sort of medical demi-paradise. Whatever the Minister may say, or whatever the odd friendly news editor may say on his behalf, people around the country know from what is happening in their localities that what the Minister is saying is not true.

It is not just people in the Labour party who are saying that. The right hon. and learned Gentleman must remember that the British Medical Association, most of the royal colleges, all the trade unions involved, the Royal College of Nursing and the community health councils throughout the country are all saying that the Government are cutting and damaging services that are vital to local people.

Ministers claim that they are putting more money into the NHS. In fact, they are not keeping up with the combined effects of inflation, the extra costs of medical technology and the increased health needs of the growing number of older people, the unemployed and the impoverished. That is obvious to people living in practically every part of the country.

In an inner-city area such as my own the Government's response to a hospital waiting list of no less than 12,697 is to call for the closure of 150 acute beds. In a rural area such as Powys, the health authority is meeting on the day of the Brecon and Radnor by-election to consider cuts of more than £1 million to help pay for the nurses' pay award. In Birmingham, where the Minister lives, and part of which is represented by the Secretary of State, 23,662 people are awaiting operations, and the figure is increasing.

In Hereford, which provides a district hospital service for people from Brecon and Radnor, the waiting list totals nearly 3,000, yet the Hereford district is proposing to pay for part of the nurses' wage increase by postponing the opening of a unit that has cost £2·5 million to build.

In Milton Keynes, the new district hospital had not been open for a year before beds were closed because there were not enough nurses to staff them, and patients, including injured children, were diverted to hospitals elsewhere.

The story is the same around the country. There are cuts for patients and demoralisation for staff. To save money, health authorities are rejigging work rosters to cut money that they pay to the better trained and more senior staff. The result is that at nights and weekends more and more of the burden of work and responsibility is being borne by the most junior staff. The recent Nursing Mirror survey showed that 92 per cent. of learner nurses had been left in charge of a ward with no qualified staff present. Most instances related to late shifts, nights or weekends. A total of 70 per cent. of nurses said that they were tearful because of the stress to which these new regimes subject them. To hear Ministers, including the Prime Minister, crowing about the output of these overworked, underpaid, overstressed, tearful but still dedicated nurses, is sickening in the extreme.

The position is no better for senior nurses. They feel responsibility for what is happening to their staff, but they do not have the power to do anything about it. What influence they had in the past is being eroded by Griffiths' general managers who are downgrading nursing. Unlike Ministers, nurses are not fooled by grandiose management titles such as "director of patient relations and quality assurance", which is a title used in Wirral. They would be happier just to be called "chief nurse" if they were assured that proper weight would be given to their professional advice and that they would have the resources to do the job. The same applies to many other dedicated people who have devoted their lives to the NHS. They are being downgraded and degraded by the Government's priorities.

When the Oxford regional health authority issues a document that lists "front line functions" as
"strategic planning, personnel management, finance, information and estate management",
the people who work in the Health Service do not think that it was the one they joined. They wonder what happened to the Government's earlier motto, "Patients First".

They see the ill effects of privatisation at first hand. At Addenbrookes hospital in Cambridge, they know that a contractor's employee recently had to be sacked for selling booze to patients suffering from alcohol-related diseases. They also know that, according to the health authority, cleaning standards in acute surgical wards and operating theatres at that hospital sank to 63 per cent. of the required level in June this year. They are also aware that post-operative infection cases have increased nationally by 14 per cent. under this Government.

They wonder at the priority of Ministers. Who can blame them when they know that some 50 DHSS staff are involved in promoting privatisation? They also know that, when the Bromley health authority terminated a contract with the Care Services Group because of repeated poor performance, representations from Richard Clements, a former DHSS employee, and the hon. Member for Shipley (Mr. Fox) were so effective that within 24 hours every district health authority was telephoned and told not to terminate such contracts without first consulting the DHSS. They contrast that with the five days that elapsed before the DHSS sent letters to remind health authorities about measures to guard against legionnaire's disease after the Department was told of the suspect water system at Stafford hospital.

It goes wider than that. The Government's general policies are making our people sick. That is why the numbers of people visiting their doctor or being treated in hospital are at record levels, without any substantial reduction in waiting lists. We all know that people's health will suffer if they are impoverished, under-nourished, badly clothed, badly housed and unemployed. Previous Governments recognised that and improved the nation's health by better living standards, better housing, better food and less unemployment.

Under this Government, all that progress has not just been halted, but reversed. Record levels of homelessness have been matched by record levels of failure to build new houses. The school meals service, described by The Lancet as the sheet anchor of child nutrition, used to provide a meal for two thirds of our children. It now provides a meal for only half of them. If the Secretary of State has his way, free school meals will be available only to the children of parents who are on supplementary benefit. When the Secretary of State talks of targeting, can he think of any more accurate or effective way of filling the belly of a hungry child than by giving that child a meal, because I cannot?

For a long time the Government denied that unemployment leads to ill health. They cannot deny it any longer. Reputable surveys show that general practitioners face higher demands for primary health care from people who are out of work, that school leavers are more likely to suffer psychological strain if they are on the dole, that death rates among unemployed men can be over 20 per cent., that para-suicide is nine times more likely among the unemployed and that unemployment affects their families, too. Above all, it undermines the health of their children. They are underfed, badly housed, ill-clothed, provided with no new toys and have no holidays. All this affects children whose parents feel humiliated and whose love for one another and their children is soured by the feeling that they have failed. That characterises the life of the child who lives in a home where unemployment reigns.

But it is not the parents who have failed. It is the rich, the greedy and the powerful who have failed. It is this Government of the rich and the greedy who have failed. Because they are powerful, they visit the consequences of their failure upon others, but they will not get away with it. Those who create a hungry generation will find that it treads them down. The Government believe that they can succeed for ever in their appeal to greed and selfishness. They are wrong. Given the chance, the vast majority of the British people will work together to help to sustain one another in sickness, adversity and old age.

The British people believe that the best kind of health service should be made available to everybody and that all of us have a responsibility to bring that about. The Labour party founded the National Health Service and treasures it. It believes in a National Health Service and a society which will make people healthier.

6.51 pm

The Parliamentary Under-Secretary of State for Health and Social Security
(Mr. John Patten)

When the hon. Member for Oldham, West (Mr. Meacher) got up to start his speech, the Leader of the Opposition left his place. There were six hon. Members sitting behind the hon. Gentleman—some improvement on the three hon. Members who were behind him last week when he began his speech on child benefit.

The speech last week on child benefit of the hon. Member for Oldham, West was characterised by contradiction after contradiction. First, tax relief on mortgages was going to taken away; then it was not. Secondly, child benefit was going to be taxed; then it was not. At one moment we were told that it was official Labour party policy; then we were told that it was only a Labour party Green Paper. At one moment we were told that it had been accepted by the Shadow Cabinet; then we were told that it had been rejected. There have been exactly the same contradictions in the hon. Gentleman's speech this afternoon.

First, the hon. Gentleman admitted that there had been a small increase in expenditure under this Government. He said later that there had been cuts. What does he mean? Has there been an increase in expenditure, or have there been cuts in expenditure? At one stage he said that the Labour party would increase expenditure. A sum of £3 billion was whistled out of the air and then rapidly put back into the locker. He produced no costed plans of future expenditure. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) does not often indulge in wishful thinking, but when she said that she hoped that the hon. Member for Oldham, West would for ever lead for the Labour party on social services. I am afraid that she was indulging in wishful thinking. In the first world war there was a song:
"We don't want to lose you,
But we think you ought to go."
Amidst all the rumours about reshuffles in the Labour party, the hon. Gentleman's monument when he leaves his position, as surely he will this autumn, will be that he made his predecessor as spokeswoman on social services, the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), seem by comparison to be an intellectual giant and prodigy.

At least the hon. Member for Holborn and St. Pancras (Mr. Dobson) who wound up for the Opposition has the merit of consistency. He is utterly consistent in his total and blanket condemnation of everything that this Government have done about the National Health Service. During the two years that I have sat opposite him, I have never heard the hon. Gentleman admit that there has been any improvement whatsoever in any part of the NHS. His attitude contrasts very much with that of the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), who takes a much more balanced view. I hope that the Social Democratic party and the Liberal party will not go into the Lobby tonight to support this absurd motion.

The hon. Member for Oldham, West is absolutely consistent in his condemnation of the ways in which this Government are setting about trying to improve patient care and getting waiting lists down and better value for money. We are saving a substantial sum of money—about £13 million a year—on competitive tendering. That money can be spent upon patient care. What is the hon. Gentleman's policy? Will he go to a hospital like the St. Helier hospital, which is under the Merton and Sutton regional health authority, and say, "I understand that you have saved £800,000 through improved cleaning services carried out by a private company. If we came to power we should ask you to take that money away from patient care and spend it again upon inefficient and over-expensive cleaning services." Is that Labour party policy? Is that what ought to happen in the drive towards greater efficiency? That seems to be the Labour party's way of attempting to improve patient care.

I should very much like to give way to the hon. Gentleman but I have very little time in which to reply to the debate.

I very much welcome the contribution of my valiant hon. Friend the Member for Newbury (Mr. McNair-Wilson). He made a constructive speech about competitive tendering. It was based upon his personal experience of cooperation with the private sector. I welcome the speech of the hon. Member for Ross, Cromarty and Skye. He supported our resource allocation working party proposals. I hope that his compliment to the Government will keep him out of the Labour party Lobby.

I welcome also what my hon. Friend the Member for Edgbaston said about the need to experiment with computerised forms of care so that patients can go from one part of the country to another for the operations they need. After some local opposition—even, surprisingly, from the West Midlands regional health authority, to which the Government had given money—a bed bank experiment is taking place. It is examining exactly this problem.

We hear a great deal about waiting lists. My right hon. Friend the Secretary of State for Social Services and my right hon. and learned Friend the Minister for Health receive many letters from the hon. Member for Oldham, West. His last letter dealt with waiting lists. First, he asked us to validate the waiting lists, which we are doing.

Secondly, he asked us once every six months to publish the results of waiting lists and to set out what patients are being treated, and where. We are doing that.

The hon. Gentleman then asked us to set maximum levels for waiting lists. The maximum waiting lists in this country were to be found in March 1979, when 752,000 people were waiting for operations. Waiting lists went up by 250,000 under the last Labour Government. If waiting lists had continued to increase at the rate at which the last Labour Government—of which the hon. Member for Oldham, West was a member—left them, they would now stand at more than 1·5 million. In the event, waiting lists are going down and waiting times are going down. That is one measure of the success of the National Health Service under this Government.

At a time of great medical advances and an increasingly elderly population the NHS is dealing triumphantly with the care of the British people. The quality and the style of medical care has greatly increased. My right hon. and learned Friend the Minister for Health referred to this. We are improving the quality of life for the elderly and the way in which they are looked after. To do so when medical costs are increasing and the number of people being treated is increasing is a major achievement. This Government's achievements since 1979 have wiped out the dereliction in the National Health Service with which the Labour party left us.

The Government's record on the NHS stands on its own feet. We have nothing to say about the Labour party's record except that it failed, as was shown by the way it left the NHS in 1979. I invite my right hon. and hon. Friends to vote firmly against the motion.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 135, Noes 235.

Division No. 254]

[7.00 pm

AYES

Abse, LeoConlan, Bernard
Alton, DavidCook, Frank (Stockton North)
Anderson, DonaldCorbyn, Jeremy
Archer, Rt Hon PeterCowans, Harry
Ashdown, PaddyCraigen, J. M.
Ashley, Rt Hon JackCrowther, Stan
Ashton, JoeDewar, Donald
Atkinson, N. (Tottenham)Dixon, Donald
Banks, Tony (Newham NW)Dobson, Frank
Barnett, GuyDormand, Jack
Beckett, Mrs MargaretDouglas, Dick
Beggs, RoyDubs, Alfred
Bell, StuartDuffy, A. E. P.
Benn, TonyDunwoody, Hon Mrs G.
Bennett, A. (Dent'n & Red'sh)Ewing, Harry
Bidwell, SydneyFatchett, Derek
Boothroyd, Miss BettyFaulds, Andrew
Boyes, RolandFlannery, Martin
Bray, Dr JeremyForrester, John
Brown, Hugh D. (Provan)Foster, Derek
Brown, R. (N'c'tle-u-Tyne N)Freeson, Rt Hon Reginald
Brown, Ron (E'burgh, Leith)Gilbert, Rt Hon Dr John
Bruce, MalcolmGodman, Dr Norman
Campbell, IanGolding, John
Campbell-Savours, DaleGourlay, Harry
Canavan, DennisHamilton, W. W. (Central Fife)
Carter-Jones, LewisHarrison, Rt Hon Walter
Cartwright, JohnHealey, Rt Hon Denis
Clark, Dr David (S Shields)Hogg, N. (C'nauld & Kilsyth)
Clarke, ThomasHolland, Stuart (Vauxhall)
Clay, RobertHughes, Robert (Aberdeen N)
Clwyd, Mrs AnnHughes, Roy (Newport East)
Cocks, Rt Hon M. (Bristol S.)Hume, John
Cohen, HarryJanner, Hon Greville

Jenkins, Rt Hon Roy (Hillh'd)Pavitt, Laurie
John, BrynmorPowell, Rt Hon J. E, (S Down)
Johnston, Sir RussellPrescott, John
Kaufman, Rt Hon GeraldRandall, Stuart
Kennedy, CharlesRees, Rt Hon M. (Leeds S)
Kilroy-Silk, RobertRichardson, Ms Jo
Kinnock, Rt Hon NeilRoberts, Allan (Bootle)
Kirkwood, ArchyRoberts, Ernest (Hackney N)
Lambie, DavidRobertson, George
Lamond, JamesRoss, Stephen (Isle of Wight)
Leighton, RonaldRoss, Wm. (Londonderry)
Lewis, Ron (Carlisle)Short, Mrs R.(W'hampt'n NE)
McCartney, HughSkinner, Dennis
McDonald, Dr OonaghSmith, C. (Isl'ton S & F'bury)
McKelvey, WilliamSmith, Cyril (Rochdale)
MacKenzie, Rt Hon GregorSmith, Rt Hon J. (M'kl'ds E)
Maclennan, RobertSoley, Clive
McNamara, KevinSpearing, Nigel
McTaggart, RobertStott, Roger
Madden, MaxStrang, Gavin
Marek, Dr JohnTaylor, Rt Hon John David
Martin, MichaelThomas, Dr R. (Carmarthen)
Mason, Rt Hon RoyThompson, J. (Wansbeck)
Maxton, JohnTinn, James
Maynard, Miss JoanWainwright, R.
Meacher, MichaelWalker, Cecil (Belfast N)
Michie, WilliamWallace, James
Mikardo, IanWhite, James
Mitchell, Austin (G't Grimsby)Wigley, Dafydd
Molyneaux, Rt Hon JamesWilliams, Rt Hon A.
Morris, Rt Hon A. (W'shawe)Wilson, Gordon
Nellist, David
Nicholson, J.Tellers for the Ayes:
Orme, Rt Hon StanleyMr. James Hamilton and
Park, GeorgeMr. Ray Powell.
Patchett, Terry

NOES

Adley, RobertFarr, Sir John
Amery, Rt Hon JulianFletcher, Alexander
Ancram, MichaelForman, Nigel
Atkins, Rt Hon Sir H.Forsyth, Michael (Stirling)
Atkins, Robert (South Ribble)Forth, Eric
Baker, Nicholas (N Dorset)Fox, Marcus
Banks, Robert (Harrogate)Franks, Cecil
Beaumont-Dark, AnthonyFraser, Peter (Angus East)
Best, KeithFreeman, Roger
Biggs-Davison, Sir JohnGale, Roger
Body, RichardGalley, Roy
Bonsor, Sir NicholasGardiner, George (Reigate)
Boscawen, Hon RobertGarel-Jones, Tristan
Bottomley, PeterGilmour, Rt Hon Sir Ian
Bottomley, Mrs VirginiaGlyn, Dr Alan
Braine, Rt Hon Sir BernardGorst, John
Brandon-Bravo, MartinGow, Ian
Bright, GrahamGreenway, Harry
Brittan, Rt Hon LeonGregory, Conal
Bruinvels, PeterGriffiths, Sir Eldon
Buchanan-Smith, Rt Hon A.Griffiths, Peter (Portsm'th N)
Budgen, NickGround, Patrick
Carlisle, John (N Luton)Grylls, Michael
Carlisle, Kenneth (Lincoln)Hamilton, Hon A. (Epsom)
Carlisle, Rt Hon M. (W'ton S)Hamilton, Neil (Tatton)
Cash, WilliamHannam, John
Chapman, SydneyHarris, David
Clark, Sir W. (Croydon S)Harvey, Robert
Clarke, Rt Hon K. (Rushcliffe)Haselhurst, Alan
Clegg, Sir WalterHavers, Rt Hon Sir Michael
Colvin, MichaelHayes, J.
Coombs, SimonHayhoe, Rt Hon Barney
Cope, JohnHayward, Robert
Couchman, JamesHeathcoat-Amory, David
Crouch, DavidHeddle, John
Currie, Mrs EdwinaHenderson, Barry
Dicks, TerryHeseltine, Rt Hon Michael
Dorrell, StephenHickmet, Richard
Douglas-Hamilton, Lord J.Hicks, Robert
Durant, TonyHiggins, Rt Hon Terence L.
Dykes, HughHind, Kenneth
Emery, Sir PeterHirst, Michael

Hogg, Hon Douglas (Gr'th'm)Portillo, Michael
Holland, Sir Philip (Gedling)Powell, William (Corby)
Howard, MichaelPowley, John
Howarth, Alan (Stratf'd-on-A)Price, Sir David
Howarth, Gerald (Cannock)Proctor, K. Harvey
Howell, Ralph (N Norfolk)Rathbone, Tim
Hubbard-Miles, PeterRenton, Tim
Hunt, David (Wirral)Rhodes James, Robert
Hunt, John (Ravensbourne)Rhys Williams, Sir Brandon
Hunter, AndrewRidsdale, Sir Julian
Irving, CharlesRippon, Rt Hon Geoffrey
Jessel, TobyRoberts, Wyn (Conwy)
Jones, Robert (W Herts)Roe, Mrs Marion
Kellett-Bowman, Mrs ElaineRossi, Sir Hugh
Key, RobertRost, Peter
King, Rt Hon TomRowe, Andrew
Knight, Greg (Derby N)Rumbold, Mrs Angela
Knight, Dame Jill (Edgbaston)Ryder, Richard
Knowles, MichaelSackville, Hon Thomas
Knox, DavidSainsbury, Hon Timothy
Lamont, NormanSayeed, Jonathan
Latham, MichaelShaw, Sir Michael (Scarb')
Lawrence, IvanShelton, William (Streatham)
Lee, John (Pendle)Shepherd, Colin (Hereford)
Leigh, Edward (Gainsbor'gh)Silvester, Fred
Lennox-Boyd, Hon MarkSims, Roger
Lester, JimSkeet, T. H. H.
Lord, MichaelSmith, Tim (Beaconsfield)
Lyell, NicholasSoames, Hon Nicholas
McCurley, Mrs AnnaSpeed, Keith
Macfarlane, NeilSpeller, Tony
MacKay, Andrew (Berkshire)Spencer, Derek
Maclean, David JohnSpicer, Jim (W Dorset)
McNair-Wilson, M. (N'bury)Squire, Robin
McNair-Wilson, P. (New F'st)Stanbrook, Ivor
McQuarrie, AlbertStanley, John
Madel, DavidSteen, Anthony
Major, JohnStern, Michael
Malins, HumfreyStevens, Lewis (Nuneaton)
Malone, GeraldStokes, John
Maples, JohnStradling Thomas, J.
Marlow, AntonySumberg, David
Mates, MichaelTaylor, John (Solihull)
Maude, Hon FrancisTaylor, Teddy (S'end E)
Mawhinney, Dr BrianTemple-Morris, Peter
Mayhew, Sir PatrickThomas, Rt Hon Peter
Mellor, DavidThompson, Donald (Calder V)
Merchant, PiersThompson, Patrick (N'ich N)
Meyer, Sir AnthonyTownend, John (Bridlington)
Mills, Iain (Meriden)Townsend, Cyril D. (B'heath)
Mills, Sir Peter (West Devon)Trippier, David
Mitchell, David (NW Hants)Trotter, Neville
Moate, RogerTwinn, Dr Ian
Monro, Sir Hectorvan Straubenzee, Sir W.
Montgomery, Sir FergusWaddington, David
Moore, JohnWakeham, Rt Hon John
Morrison, Hon C. (Devizes)Waldegrave, Hon William
Morrison, Hon P. (Chester)Walden, George
Moynihan, Hon C.Walker, Bill (T'side N)
Neale, GerrardWaller, Gary
Needham, RichardWalters, Dennis
Nelson, AnthonyWard, John
Neubert, MichaelWardle, C. (Bexhill)
Newton, TonyWatson, John
Nicholls, PatrickWells, Bowen (Hertford)
Normanton, TomWells, Sir John (Maidstone)
Norris, StevenWhitfield, John
Onslow, CranleyWhitney, Raymond
Oppenheim, PhillipWiggin, Jerry
Osborn, Sir JohnWilkinson, John
Ottaway, RichardWolfson, Mark
Page, Richard (Herts SW)Wood, Timothy
Parkinson, Rt Hon CecilYeo, Tim
Patten, J. (Oxf W & Abdgn)
Pawsey, JamesTellers for the Noes:
Peacock, Mrs ElizabethMr. Ian Lang
Percival, Rt Hon Sir IanMr. Peter Lloyd
Pollock, Alexander

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No.33 (Questions on amendments), and agreed to.

Resolved,

'That this House applauds the improved levels of service to patients achieved by the National Health Service and its staff under this Government; congratulates the Government on making this possible through its record of increasing expenditure on the Service; welcomes the fact that improved levels of service have been achieved while the pay of nurses has been raised by 23 per cent. in real terms; and supports the Government's determination to ensure, through improved management and greater efficiency, that maximum benefit is derived for patients from the resources available to the Service.'.