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National Health Service

Volume 116: debated on Thursday 14 May 1987

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

6.8 pm

I am very glad to have this opportunity of initiating this Adjournment debate on increased expenditure in the National Health Service.

There is no doubt, even though some may be expressed on the Opposition Benches, that the statistics on the public expenditure that the Government have devoted to the National Health Service show that their record is second to none. I shall be adducing in my speech not only the statistics available nationally but personal experience as the hon. Member for Brigg and Cleethorpes, which covers the health authorities of Grimsby and Scunthorpe, of visiting those authorities and the authorities on a regular basis.

When I was elected to the House for the newly created constituency of Brigg and Cleethorpes on 9 June 1983, one of the first invitations that I received from the Grimsby district health authority was to attend the opening of the brand new Grimsby district hospital in July 1983. The opening ceremony was performed by Her Royal Highness the Princess of Wales and was attended by me, the hon. Member for Great Grimsby (Mr. Mitchell) and a large number of local dignatories. We had the opportunity to see for ourselves the results of the Conservative Government's commitment to the Health Service between 1979 and 1983. That hospital was built as part of the capital programme of the Conservative Administration elected in 1979.

I have no doubt that in the coming election campaign we shall see statistics relating to hospital closures in Great Grimsby. Of course, there have been hospital closures there; we closed down the disgraceful 19th century hospital and opened a brand new one. That is the point that has to be borne in mind when the Labour party draws attention to hospital closures. In my constituency, we have a spanking new district hospital which is second to none in the United Kingdom and probably in the whole of western Europe. It has magnificent facilities.

I visited that hospital when it was opened and have had personal experience of it since, and there is a very good story about this. Usually a Member of Parliament visits his local hospital officially to discuss matters with the hospital board, on a formal occasion, as a patient or to see friends or colleagues who are patients. Since 1983, I have had some experience of the work of the hospital. In January 1986, my next-door neighbour fell over and required immediate and urgent casualty treatment. I was with him when he arrived at the hospital, and I saw the magnificent work that was done to repair his injuries. He was not discharged that afternoon; he was told that, although his condition was not serious, he would be kept in overnight. That gives the lie to the claims about pressure on hospital beds. It was, after all, probably not technically or medically necessary for my neighbour to have been kept in overnight.

In autumn 1985, my agent suffered a mild problem with her leg. She was detained in Grimsby district hospital for several weeks. Again, it was probably medically possible for her to have been discharged a little earlier than she was. In fact, she spent several weeks in the hospital, and I visited her about twice a week.

There is no better way for a Member of Parliament to get the feel of how the Health Service is working than by visiting his agent in hospital. There she was, conducting some written business to the best of her ability, and transacting business with me. Everyone in the ward knew who she was and who I was, but no special treatment was given to her simply because she was my agent, and neither she nor I would have expected that.

Both my agent and I can only confirm the fantastic care and attention to detail in the wards of the Grimsby hospital. Visiting the hospital twice a week for five or six weeks, I got to know the sisters on the ward, and the catering and cleaning staff. The people at the reception desk get to know the regular visitor, and he has a feel for the way in which the hospital is working. I have nothing but praise for the way in which that hospital looked after my friend and agent—who, I am delighted to say, has returned to full and radiant health, and is looking forward to the next few weeks. Those weeks will be the greatest test of the success of Grimsby district health authority. I know that my agent will succeed in getting through the election campaign full of fitness and vigour, which I can only put down to the first-rate treatment that she received from the National Health Service in Grimsby district hospital.

As I said, my constituency also includes the Scunthorpe area health authority. When my constituents living in the Brigg area require hospital treatment, they go to Scunthorpe general hospital. Four or five weeks ago, I attended a meeting with the chairman of the health authority, along with my hon. Friend the Member for Glanford and Scunthorpe (Mr. Hickmet), and we went to look at the massive new building expansion programme in progress at the hospital. Many millions of pounds are being invested in it, and a spanking new unit is shortly to be opened, within the budget and ahead of schedule. Scunthorpe district health authority is also responsible for the Boothferry area, and I was delighted when my hon. Friend the Minister was able to bring that capital building programme onstream. She wrote to me a few weeks ago to let me know of the success of that project. It looks as if the hospital will be built ahead of schedule.

That is evidence not of a Government who do not care about the National Health Service, but of a Government who are putting their money where their mouth is. In my constituency, which falls within those two health authorities, there is the brand-new hospital in Great Grimsby, the extension—involving many millions of pounds—of Scunthorpe general hospital and the brand new hospital at Goole.

Hon. Members may ask, "What about Glanford hospital? It is old fashioned, and it has been there for a long time." I visited that hospital a few weeks ago—again, because as a Member of Parliament I get to know people who need hospital care. The president of the Brigg and Cleethorpes Conservative women's advisory committee, who is now 90 years of age and has not been in the best of health during the past few months, was admitted in January to the Glanford hospital, which is a geriatric hospital. Outwardly, it appears to be a typical, old-fashioned cottage hospital, as we used to call them. Inside, however, a magnificent renovation programme has taken place, and the wards are bright, light and airy. Many of the geriatric patients are not in the best of health, being in their 80s and 90s, but the facilities in the hospital are remarkable.

That is a demonstration of what can be done, even to old hospitals. If it were ever suggested that that old-fashioned, 19th century hospital should be pulled down, there would be an outcry from the local people, who recognise the tremendous renovation work done by the Scunthorpe health authority, and the useful purpose that it serves as a local community hospital.

I have given no statistics; I have simply described the way that I perceive the district health authorities and their hospitals from the reactions of visiting friends who are receiving treatment, or from making formal visits to those hospitals. Nevertheless, statistics are important, and it is right that I should use this opportunity to tell the House how my constituency has come to possess those magnificent facilities.

In 1985, the National Health Service in England treated 4·5 million more patients than in 1978, Labour's last full year in office. Under the last Labour Government, the number of patients treated increased by only 1 million. The present Government have cut hospital waiting lists by 70,000, and waiting times for non-urgent cases are lower than at any time in the past 10 years. New initiatives have been announced for further reductions, which my right hon. Friend the Secretary of State made a while ago, with the establishment of the special fund over the next two years. I understand that the first allocation of £25 million in 1987–88 will enable an extra 100,000 patients to be treated.

I can confirm from the experiences that I have described this evening that the Government have embarked on the biggest hospital building programme in the history of the Health Service. Some 200 schemes, each worth more than £1 million, have been started and completed under the present Government, while 440 schemes are in the pipeline. More than 100 of them will be completed in the next three years alone. Spending on the NHS has increased from £7·75 billion in 1978–79 to an expected £20·6 billion in 1987–88, an increase in real terms of 31 per cent. Total spending will reach £22 billion by 1989–90, and in 1987–88 health authorities will be able to use an additional £150 million in cash savings from cost improvement programmes and efficiency measures. There are 63.000 more nurses and midwives than in 1978, and 12,000 more doctors and dentists.

However, the test is not necessarily how much is spent—I have described the massive expenditure under the present Administration—but the position from the point of view of the consumer. The most important health care statistic relates not to the amount of money that is spent on the service, or even to the number of beds, but to the number of patients being treated. Since the present Government came into office, the combination of more resources and better value for money has resulted in clear improvements in the quality of care provided. It is a record of which my hon. Friend the Under-Secretary of Slate and my right hon. Friend the Secretary of State can he justly proud.

I understand that 38,000 hip operations were performed in 1984–10,000 more than in 1978. My right hon. Friend the Secretary of State has announced that the target for 1990 is 50,000. In 1984, 11,000 coronary artery by-pass operations were carried out—more than three times the number in 1978. The target for 1990 is at least 17,000. In 1984, there were 55,000 cataract operations—17,000 more than in 1978. By 1990, at least 70,000 cataract operations should be carried out. In 1984, 350 bone marrow transplants were performed, 320 more than in 1978. By 1990, there should be at least 550. Hon. Members should read tonight's article in The London Evening Standard. It refers to the tremendous advances that are being made in bone marrow transplants.

This Government have also done a considerable amount to harness the benefits of modern technology. New treatments have been pioneered. The first ever heart and lung transplant was performed in 1983. There were 51 heart and lung operations in 1985. In 1986, laser treatment was used for the first time to unblock a coronary artery, and laser treatment of a different kind has meant that certain eye conditions, which previously were untreated, can now be cured. New technology is leading to the earlier detection of illness and to the greater chance of total recovery.

Under the last Labour Government, waiting lists increased by nearly 250,000 to a record 750,000. By September 1981, waiting lists had been reduced by over one-sixth, to 619,000. The House should not forget that the union action in 1982, which was officially supported by the Labour party, hit patients. The Government estimate that in England alone waiting lists grew, as a result of that action, by 140,000, but since then the total number of people on waiting lists has again decreased. In September 1986, the number of places on the in-patient waiting list in England was 681,000–70,000 fewer than under Labour. A special fund, amounting to £50 million over the next two years, is being used to reduce excessive waiting lists and times. The health authorities have already shown that there is a commitment to tackling this problem. This fund will enable them to make further progress, including a reduction both in the time that it takes to see a consultant and in the time before one can have an operation.

My right hon. Friend the Secretary of State and my hon. Friend the Under-Secretary of State have constantly reminded us, and it bears repetition, that the National Health Service is the largest employer in western Europe. In England alone, it employs 1 million people. Manpower costs account for 70 per cent. of the total running costs of the hospital service, yet no system of manpower planning existed until this Government introduced one. The proper planning of manpower and the additional resources that the Government have made available have resulted in a considerable expansion of both medical and nursing staff, while the number of ancillaries has been substantially reduced.

There is no better way for a Member of Parliament to get to know the attitude of staff—what they think about the National Health Service and what their commitment to it is—than by having friends in the National Health Service. I see the Conservative Association's constituency chairman in my parliamentary constituency of Brigg and Cleethorpes on a regular basis—indeed, almost every week. When I go to her house I meet her daughter who works as a nurse in the Grimsby district hospital. She keeps me informed of what is happening in the hospital, from the point of view of the staff.

Of course she deserves to be paid more than she has been paid in the past. I spoke to her soon after the Government's announcement that they were to implement in full the independent pay review body's recommendations. She was grateful to the Government for recognising that nurses are an important group of professional people who are doing a very valuable job for the community. She does not intend to leave the NHS, and she drew my attention to an often quoted statistic—that many thousands of nurses are leaving the NHS every year.

Nurses, like the rest of us, grow older. At the age of 60, female nurses retire, and they show up in the statistics as leaving the NHS. I do not know whether this is unparliamentary, and if it is I shall withdraw the word, but we have to nail the lie that nurses are leaving the NHS because it is not rewarding them properly. The fact is that many nurses are leaving the NHS year by year because they are retiring, but others are coming into the profession.

We need to do everything possible to restore morale in the NHS. We must make nurses, whose training takes a long time, feel that they are being rewarded properly for their vocation. If the Government are able to do in the future what they have done in the past, the standard of morale in the NHS among ancillary workers and nurses will be one of which we can be proud.

I have in my hand a speech that was made by my right hon. Friend the Secretary of State for Social Services to last year's Conservative party conference. There is much in it that deserves repetition. He set out the problem that the Government have to face: of the Labour party and the alliance not telling the people about what is happening in practice in the NHS. He said:
"The fact is that more resources are being devoted to health than at any stage in the history of the health service—£11 billion a year more than when we came to office. The fact is that more doctors and nurses are working for patients than at any stage in the history of the health service…Above all, the fact is that we are providing more and better patient care than at any stage in the history of the health service—4½ million more patient cases being treated today than when this Government came to office."
My right hon. Friend then said:
"against that background it is grotesque to claim that the health service in this country is in decline. It is selling the health service short. It is selling short the success of health service staff. It is selling short the achievement of this Government."
And it is selling short the achievements of my right hon. and hon. Friends who serve so well as Ministers in the Department of Social Security.

When the Opposition parties hear that in England last year we treated 1 million more in-patient cases than in 1978, they dismiss it as statistics. When they hear that we treated more than 400,000 additional day cases last year, they dismiss it as statistics. When they hear that we have provided for over three and a quarter million additional day patient attendances, they dismiss it as statistics. They forget that each of those 4½ million statistics is a personal story of care: of dedicated staff working night and day, of patients such as my agent having been relieved of pain and having been given renewed hope.

We bandy about statistics. I see statistics in terms of the experiences of my agent, my next door neighbour, my president of the women's advisory committee of the Conservative party in Brigg and Cleethorpes—three people I know whom I visited when they were in hospital. Those three people appear as statistics on sheets of paper. In hospital I saw them being given patient care by dedicated staff. They are the real figures of health care in this country. They show that health care has developed and, above all, they show that today the NHS, under this Government, is bringing more help to more people than ever before.

My hon. Friend the Under-Secretary of State has been carrying out her duties for some time. She is as familiar a figure in this House as a Government Minister as she is in the country. I hope and pray, on behalf of all those who need health care in this country, that my hon. Friend will be re-elected with a massive majority as the Member of Parliament for Derbyshire, South. The NHS needs her, just as it needs her colleagues in the DHSS. I hope that the next three or four weeks will pass quickly so that once again the NHS and those who use it will be able to have confidence in the fact that she will be responding to Adjournment debates in the excellent way in which she is responding to them today.

6.29 pm

My hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown) has shown us once again why he is regarded as a most conscientious and active champion of his constituents. Although he is absolutely right in saying that there has been a general increase in Health Service expenditure, I am in no doubt that the remarkable progress that has been made in his constituency and the surrounding area is, at least in part, a direct consequence of his advocacy of the needs of his constituency, which has achieved so much in such a short time. I congratulate him on the superb work that he has done for his constituents over the years.

The issue that I intend to raise may seem minor, but I assure my hon. Friend the Minister that it is a big issue in my part of the world. My hon. Friend the Member for Brigg and Cleethorpes rightly pointed out that there had been a substantial increase in Health Service expenditure. Although that is undoubtedly true, some problems remain. Despite the extra resources given to the Southend health authority, we have serious problems in recruiting nurses because of the high cost of living in our area. Will the Government therefore examine seriously the problems and difficulties of the recruitment of public servants in areas where costs are high and to which it is difficult to encourage people to come?

My hon. Friend the Member for Brigg and Cleethorpes referred to the forthcoming election. In Southend, which I represent and where I live, many people will be thinking just as much about the future of Southend's radiotherapy unit as about the exchanges that will take place between politicians. We should not underestimate the concern felt in Southend about the recommendation by the regional health authority that the radiotherapy unit should be closed and an entirely new one built at Harold Wood about 35 miles away. I emphasise that this is not a party political point; all the parties in Southend and councillors who represent a wide spread of opinion have united in a campaign to persuade the health authority to change its mind and, if that is impossible, to persuade the Government to overturn what they regard as a cruel and costly recommendation.

I understand from a parliamentary answer that my hon. Friend the Minister gave yesterday that she has received about 1,700 individual letters on this subject. They represent not a concerted campaign of letter-writing but an expression of genuine concern from the people of the community. In addition, my hon. Friend the Minister will be aware that a massive petition sponsored by Southend's Evening Echo was delivered to the Secretary of State on Monday by my right hon. Friend the Member for Southend, West (Mr. Channon).

Although extra spending is valuable, it can sometimes be misused. The regional health authority's recommendation is not a means of saving money or reallocating resources so that savings can be made. On the authority's own admission, the new proposal will cost an extra £4·5 million. Sometimes expenditure in itself does not solve problems; indeed, it can create new ones. It is proposed that a perfectly good, modern and popular unit with high standards should be closed and an entirely new one built to replace both it and others. The expert report submitted to the regional health authority appeared to recommend the retention of the Southend unit. In particular, the report stated that the authority's members might take the view that the Southend unit would provide a cheaper and more certain option. According to the report, Southend would be guaranteed 1,600 new patients per year, while the Harold Wood hospital would have no such guarantee, and might lose patients from Southend and district to London. The report made it abundantly clear that the closure would cost more money.

My hon. Friend the Minister is aware that the proposals are going through a long period of consultation. If, following that, our community health council puts forward objections, the region will have to reconsider its position. If it declines to do so, the matter will go to the Minister, and the Minister must decide.

The move would cause enormous hardship to many people undergoing radiotherapy, including a close relative of mine, who lives in Southend. Such patients are often not well enough to travel long distances. Sometimes the treatment can cause sickness, which would make a long journey unpleasant.

I hope that my hon. Friend the Minister will reflect on and answer two specific questions. First, is the Secretary of State absolutely convinced that the policy of centralising radiotherapy departments is in the public interest and in the interests of consumers? The policy decision was taken by the Government a long time ago. They thought that it would be better for the public if the various radiotherapy departments could be concentrated into larger units with 2,000 plus patients per annum.

The only advantage put forward for centralisation is that a larger concentration of medical expertise—perhaps a larger number of consultants—will be available. I suggest that any possible advantage stemming from that will he offset by the enormous hardship that will he suffered by patients having to travel long distances. If it was suggested that such patients should become in-patients, the extra costs would be substantial. I hope that my hon. Friend the Minister will consider whether this is a sensible policy or whether it should be reviewed. She will find that in every case, when centralisation has been proposed, it has caused anguish and concern.

Secondly, bearing in mind the strength of feeling in Southend and the fact that local people believe that they have an overwhelming case—happily, all the parties have worked together; no one has sought to take political advantage of it—will my hon. Friend assure us that if the matter is put on the desk of the Secretary of State one of the Department's Ministers will visit the Southend unit before making a decision? I know that Ministers are very busy people. They have to make important decisions and deal with a flood of correspondence and are sometimes called to the House to answer Adjournment debates which seem to go on for ever. However, I think that my hon. Friend will agree that, given the magnitude of this issue, it is desperately important that the local community should know that the Minister has not just read a report or seen the figures but has seen the unit and spoken to those involved.

In the dying moments of this Parliament, I appreciate an opportunity to put to the Minister a matter which I believe is causing more concern in my area than many of the political points which will be exchanged during the campaign. This matter is not related to Southend alone. In his usual conscientious way, my hon. Friend the Member for Basildon (Mr. Amess) is attending the debate to make it clear that he is interested in the subject and that his constituents, as well as mine, are concerned about the matter—as are those of my hon. Friend the Member for Rochford (Dr. Clark) and of my right hon. Friends the Members for Castle Point (Sir B. Braine) and Southend, West (Mr. Channon), who has been so conscientious in advocating his constituents' interests in this regard. It would be beneficial if during the election campaign—as I have said, this will not be a political issue; all the parties will be expressing the same view—my hon. Friend the Minister could give an assurance that she will contemplate a review of the general policy of concentrating radiotherapy units and a clear assurance that before any decision is made a Minister from her Department will visit the unit and speak to patients, consultants and all those involved.

6.39 pm

I am extremely grateful to my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown) for raising this Adjournment debate and for allowing us to have one last opportunity of bringing home to the British people that over the past eight years the Conservative Government under my right hon. Friend the Prime Minister care deeply for the health and welfare of the British people. No better example could we have of the caring Member of Parliament than my hon. Friend, who came to the House with a small majority but who will show how a small majority can become a large one at this general election when his constituents will show their appreciation for his great care. We are all grateful for this opportunity of placing the success of our policies before the country.

Whatever may be the case in other areas, Burton has no cause to complain about the Government's contribution to the health, welfare and caring for the people. The resources that have been channeled into our hospitals and primary care facilities have been enormous and have resulted in substantial improvements in health care. I am grateful, not only to my hon. Friend the Under-Secretary of State from the neighbouring constituency of Derbyshire, South (Mrs. Currie) for working so hard in the short time that she has been at the Department, but to the chairman of the South-East Staffordshire health authority, Mrs. Margaret Stanhope, the manager of the Burton hospitals, Mr. Tony Hill, the doctors, nurses, ancillary workers and appreciative patients.

As a result of the increased resources that have been made available in my area—the debate is about increased, not decreased, resources—in Burton many more patients are treated than ever before, many more staff are employed in direct patient care and there have been major hospital building improvements. The health authority spend has risen from £13 million in 1978 to £30·5 million, which in real terms is an increase of about 16 per cent. and is still rising. That is a tremendous and praiseworthy achievement.

In 1978, 84,000 out-patients were treated, whereas in 1985 108,176 were treated in Burton's hospitals. The number of in-patient treatments has increased substantially from 16,500 to 23,000 over the same period. Naturally there are those who look, only superficially, and who seek to criticise where no genuine criticism is merited, saying, "But the waiting list has increased in Burton." It has indeed increased substantially, although the number of patients having to wait over a year for admission has decreased from a peak of 831 to 325, which is itself a small reduction on the number of people having to wait so long before the Conservative Government took power. But the reason why the waiting list has increased in Burton is that the standard of health care is so high that it has attracted cases from miles around, so that must be taken into account when we consider the length of the waiting list.

I do not intend to hold up proceedings a moment longer than necessary, but it is important to get the message across. We in the Conservative party are not all that good at doing that. We do not shout from the rooftops whenever we have these great successes, so I am taking this opportunity of doing so now.

In 1979, 1,137 nurses' and midwives' full-time equivalents were in post. The figure rose to 1,527 in 1986—an increase of 34 per cent. Therefore, more nurses and midwives are providing primary health care of the highest standard. The number of medical and dental staff also increased. The number of all staff rose from 2,379 in 1979 to 2,833 in 1986—an increase of 19 per cent. All those people are providing care of the most efficient and effective type for patients.

There is also a remarkable tale to tell about major improvements in buildings. In Burton we have a new clinic in Cross street, costing nearly £500,000 which I was privileged to open; a new clinic in Horninglow, costing £250,000, which I have been invited to open should the electors of Burton be sufficiently appreciative of the Conservative Government for their health provision to reflect that gratitude in support for me; a new clinic about to be built in Stretton which will cost £368,000; a new mental handicap unit which has cost £500,000; a new nurses' education centre about to be completed which has cost £1 million and will train new nurses—a vitally necessary ingredient in future health care; and a new small hospital about to be built in Uttoxeter, with 24 beds for the elderly and a new clinic. The authority has provided finance of £23,000 for the family practitioner committee to engage three doctors to spread its cervical cytology unit. A portable body scanner, costing about £50,000 to use, and a special care baby unit have also been provided.

Most impressive of all, we are about to have phase 2 of the Burton district hospital centre, which will cost £23 million. That will be a fantastic achievement after many years of waiting. We waited through Labour Governments who did nothing, but now the Conservative Government have provided the money and have been able to do so because their economic policies have been so successful.

The regional health authority was slightly over-optimistic about the date at which the building could start. It advanced the programme by about nine months in the expectation that 15 per cent. of the resources would be over-committed because slippage in construction work had been a feature of previous programmes. But the Conservative Government have been so successful that the pace of building has picked up, major developments are ahead of target, and all the money has been used. Therefore, what was hoped to be a nine-month advance has been put back to the original planned date, and that is disappointing.

I am not sure what the Government can do about that, but perhaps my hon. Friend the Minister would say a little more about the "unconventional" financing which, providing it does not run across public expenditure controls, the DHSS is prepared to consider in some circumstances. It may be possible for the health authority to raise some extra finance on the private market which may enable the hospital to be built even faster than planned. That expenditure will mean an additional 380 beds, including a maternity and special care baby facility. It will include five theatre suites, an expanded X-ray department, a new pathology department, dining facilities, children's and antenatal clinic facilities, and expanded rehabilitation and day surgery departments. Health education too requires a large amount of space devoted to classrooms, discussion rooms, demonstration rooms, common rooms, first aid rooms, libraries, offices and all sorts of facilities that are necessary for the strengthening of the teaching of nurses and doctors in patient care.

I could go on and on because I could say something about the savings that have been made. I am told by the Burton hospital management that the privatisation of the cleaning and other services has resulted in huge savings of one third of a million pounds. The new kitchen is likely to save more than £100,000 a year. The laundry is now being looked into to see whether, in conjunction with the Mid-Staffordshire health authority, competitive tendering can produce substantial annual savings of over £100,000 which again will go into direct patient care.

It is a source of great pride to me that, when I go around the Burton hospital and talk to the doctors, nurses and, most important, to the patients, I hear how proud they are to be not only the servants of but the customers of the Health Service that the Burton health unit provides. It is because I feel so proud about it that I will be going into the election that much more confident than I. would otherwise be. I believe that the people in my constituency will show their appreciation of the large amount of care that the Conservative Government have lavished upon those in this quite small midlands town which has always dedicated itself to the production of wealth, through engineering and, above all, beer.

The good health of the Burton people, which I hope will continue, to a substantial extent is encouraged by a moderate consumption of the great product of the town of Burton-upon-Trent, which is renowned not only in Britain but throughout the world.

6.52 pm

I congratulate my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown) on securing the Adjournment debate and allowing us to place on record the Government's achievements in health care. I regret that recently the Labour health spokesman visited my constituency and quite deliberately aroused alarm and despondency among my constituents about health care in our area. My hon. Friend the Member for Derbyshire, South (Mrs. Currie) will recall a meeting that she had with me a few weeks ago when she had the pleasure of meeting the leaders of our local health authority. I think that she was quite delighted to see the achievements of those people in the Basildon area. There is no doubt that our health services are second to none. Our hospital waiting list is down. The whole breadth and style of health operations carried out during the past eight years has been unsurpassed.

My hon. Friend the Member for Derbyshire, South might feel that she is being bullied on the matter, but I know that the hon. Member for Newham. South (Mr. Spearing) will agree that the suggested reorganisation of the cancer services in our area is quite extraordinary. It is without sense, without reason and above all will not help those who are suffering from this terrible problem.

My hon. Friend the Member for Southend, East (Mr. Taylor) mentioned the magnificant support that we have had in our area from the Evening Echo. I think that it was last week that it arranged for a delegation to meet my right hon. Friend the Secretary of State for Social Services and present him with a petition. I understand that my right hon. Friend looked very sympathetically at our case. I hope that my hon. Friend the Minister will recall her words at the meeting, when she said that she would look most carefully at the whole question of travel and how that affects those patients who are being treated with radiotherapy.

I also place on record how proud I feel to represent a constituency where the voluntary sector contributed £500,000 to build St. Luke's hospice. It is a magnificant achievement and an example of the wonderful community spirit that we have developed in my constituency.

6.56 pm

The Parliamentary Under-Secretary of State for Health and Social Security
(Mrs. Edwina Currie)

I welcome the opportunity to debate the subject that has been raised by the hon. Member for Brigg and Cleethorpes (Mr. Brown). I have been most interested to hear the words of my other hon. Friends. By way of aside, may I say that my hon. Friends tonight have demonstrated the sense of the first past the post electoral system. Each of them is an immensely strong and supportive local member closely associated with his constituency. Were we to go to any sort of system such as proportional representation, the specific, caring and direct link that each of them has demonstrated tonight would simply vanish. For example, in Derbyshire, where we have 10 Members serving 10 quite different constituencies, we would have to make some effort to look after everybody and thereby, I suspect, nobody would be looked after terribly well. It is in the interests of the British people that we should have a Member for Southend, East, a Member for Southend, West, a Member for Basildon and so on.

Order. I hope that the hon. Lady will, first, not turn her back on the Chair; and, secondly, will address the subject of the debate, which is not proportional representation, but expansion of the health services.

My apologies, Mr. Deputy Speaker. My hon. Friends are all sitting behind me and I shall end up cross-eyed.

My hon. Friend the Member for Brigg and Cleethorpes made a magnificent speech. I only wish that I could speak as well as that. He was quite right in the points that he raised on the funding of the National Health Service, the staffing of the National Health Service and on the results in terms of patient care. I have checked his points, and he got them all right. Therefore, I shall not go through them again except to draw attention to the results in terms of the care of patients. I shall then indicate some areas where the Government are achieving firsts in patterns of patient care and in ways of running the Health Service.

My hon. Friend was quite right when he said that we are looking after 1 million more in-patient cases every year. We now have 6 million in-patients a year. He was quite right when he said that we are looking after more day cases. Within the next Parliament, I suspect that there will be a substantial increase in the number of day case treatments. We are now looking after about 37,500,000 out-patient visits every year. They are not all individual patients, because some come more than once, but that number has risen by 3 million since the Government took office in 1979. That is an astonishing increase. That is an improvement in productivity of which any business in the country would be proud.

We have also taken up the challenge that medicine offers. When I was young, people used to die of polio, but that disease has disappeared. When my father was young, people used to die from tuberculosis and, indeed, he nearly did. Our generation faces many and varied challenges. Some of those challenges are offered by improvements in medical sciences. For example, we find that the number of patients who received transplants last year was an all-time record. That included kidney transplants, which have now become routine. The number of patients receiving kidney treatment has doubled and we look forward to seeing more such treatments in future. During the lifetime of this Government there has been a threefold increase in heart bypass operations, and they have brought life once more to patients who would previously have been crippled by heart disease.

About 16 million more prescriptions are now dispensed, and that means that about 300 million items a year are now dispensed under the National Health Service. We have also provided about 5 million additional courses of dental treatment. I know that that will he of special interest to my hon. and learned Friend the Member for Burton (Mr. Lawrence), who has views on dental treatment. He knows that the figures for dental disease in his constituency are among the worst in the country. It is immensely useful that such a service is available and that people are making use of it.

As my hon. Friend tempts me, I cannot forbear from asking whether it is not right that in some of the regions in which there has been the sharpest decrease in dental caries in children's teeth there is no flouride in the water?

Yes. I think that my hon. and learned Friend said that to the tune of about four hours and 35 minutes early one morning in a debate at which I was present. I do not tempt him to say it all over again.

We also find that patients are taking up other aspects of our care. About 2·5 million more sight tests are being performed on patients than there were in 1979. That is about 10 million sight tests a year, and it is immensely to the good to know that people are taking up that aspect of health care, which is free.

Perinatal death rates have dropped, and that is a tribute to everybody concerned with the service for mothers and babies. In 1978–79 the death rate for babies, either at birth or within the first week, was about 15 per 1,000 live births. The death rate was very high among some groups in our society, especially among the poorest mothers. The overall death rate has now dropped to fewer than 10 per 1,000, and it means also that about 3,000 more babies are alive year by year than in the 1970s. Most of them can expect to live and grow in a perfectly normal way. That means that about half of all those babies that are born weighing less than a kilogramme—less than the weight of a bag of sugar—can expect to survive and to lead a normal life. That is a remarkable record. What pleases me most is that the death rates for babies from the poorest social classes have improved apace with those elsewhere. The death rate in the lowest social class, social class V, is now only 12 per 1,000. Therefore, it is better than the average death rate of only five or six years ago.

One area of work that nobody ever mentions, but in which I take an interest, is the number of patients in mental handicap hospitals and units who are now able to take advantage of living in the community. Many of the constituents of my hon. Friends and myself are able to do that. Under this Government the number of such people in hospital has fallen by 22 per cent. Most of all, mentally handicapped children who do not require to be in hospital are no longer put there, and the number of mentally handicapped children growing up in hospital has dropped by 73 per cent.

That is a great achievement, but it is more than that, because it shows that this Government have taken on board in the Health Service a determination to break new ground.

This is the first Government who have seriously addressed themselves to prevention and good health. I am delighted that the impassioned pleas of my hon. Friend the Member for Brigg and Cleethorpes that we should have the freedom to smoke does not extend to encouraging his constituents to take up the evil weed. We hope to see prevention and health promotion making rapid progress in years to come. We have set up the new Health Education Authority and have taken on board some of the criticisms that were made about the functioning of the old Health Education Council, which the authority replaces. I hope that the messages will get across far more in future, especially to those who have perhaps not always taken them seriously.

The Government are the first to have taken women's health seriously, and this is the first Parliament in which there has been a Minister with responsibility for women's health. I am delighted to say that. I would not mind who was doing that, but I feel proud and honoured that I have been given that opportunity. The Government are the first in the world to develop a comprehensive nationwide breast cancer screening programme for women. That will tackle the biggest killer of women in early life and will be of immense help. We expect to save many thousands of lives, although, of course, it will be some time before the figures start to show.

It also means that we have under way a major programme for cervical cancer. By this time next year every health district in Britain—nearly 200 of them—will have a fully computerised call and recall system by which women at risk, and that means women between the ages of 20 and 64, will be invited to have a smear test and can he shown to be in the clear from this particularly nasty little cancer. We feel that we can save lives in that way.

The Government are the first to take nurses' pay seriously and to set up a review body for nurses' pay. We recognise that nurses who do not strike have a major contribution to make to the Health Service, not just in terms of their skills and their numbers, but in terms of their approach and their professionalism towards their patients. When we take the latest award into account, we see that nurses' pay has risen by 30 per cent. in real terms. The last Labour Government saw a decrease of 21 per cent. in real terms in nurses' pay.

Exactly 10 years ago, in 1976–77, the Labour Government gave the nurses a miserable 5 per cent. cash uplift. That meant that in real terms the purchasing power of nurses' pay dropped by 10 per cent. in one year. We have done exactly the opposite. As I say, real pay has risen by 30 per cent. and we have deliberately slanted the rise towards the most experienced nurses, who we want to keep in nursing. Given the latest pay award, in real terms a sister's pay has risen by 40 per cent. under this Government. That is also a first. My hon. Friends have drawn attention to the fact that we are the first Government to take seriously management in the Health Service.

Before my hon. Friend talks about management, may I ask her whether she agrees that it is a matter of considerable importance that we have reduced a nurse's working week from 40 to 37½ hours? Is that not a substantial improvement, even on the wage increases?

As usual, my hon. and learned Friend is right. As soon as we came to power in 1979 the nurses asked whether the working week could be reduced from 40 to 37½ hours. We did that and provided additional staff to make up the numbers. We have provided even more staff since to ensure that the Health Service can go on expanding in the way that we want it to expand. I thank my hon. and learned Friend for providing the opportunity for me to draw that to the attention of the House.

Will my hon. Friend confirm that that statistic is the equivalent in real terms of increasing nurses' pay by about 5 or 6 per cent.? That action alone corresponds to that sort of increase in their real take home pay.

My hon. Friend is right insofar as a nurse continues to work 40 hours and will be paid overtime. That tends to happen, especially in London. It means a substantial improvement in nurses' terms of service and recognises that they are professionals and skilled people. In that context, it is worth remembering that we have made vigorous efforts to improve the lot of junior hospital doctors and have banned the most onerous rotas, which required doctors to work very long hours. We are determined to make further progress on that as the opportunity arises. I take a strong view about doctors having to work very long hours.

The Government are the first to take seriously the problem of managing the Health Service. When I speak to business men's groups or business women's groups I am always able to say, "However big your business, mine is bigger because the National Health Service is the largest business in this country." We are the largest employer in western Europe. The only thing to compete with us is the Russian army, which is not a volunteer army in the way that the staff of the National Health Service are. I can say to them, "However big the customer body you may deal with, ours is bigger."

We deal with the whole nation and with 6 million in-patients every year, as well as the other matters for which I have given figures. Therefore, management matters. We could not run the Health Service without good managers and staff. The Griffiths revolution—that is exactly what it is—means that the Health Service benefits from management expertise of a kind that matches that of our best businesses. We are beginning to see the results of that, and more of that is to come.

One example is putting the hotel services of the Health Service—catering, laundry and domestic work—out to tender. That is now saving the Health Service some £93 million a year, which goes straight back into health care. We are on target to reach £100 million a year very shortly. The National Audit Office, which looks at the figures carefully, tells us that we are likely to save £120 million.

Opposition Members—only one is here, but we are glad to see him as it means that we are not talking to ourselves—would do away with contracting out cleaning and catering services to competitive tender. They would have to find that £120 million from somewhere else, or they would not expand the Health Service, because that money would not be available.

That is exactly what happened last time.

The Government are the first to have taken primary care seriously. When we talk about the Health Service, an image of a hospital comes into our mind, but most people are cared for at home. Half a million people go to their general practitioners every working day. Through our expansion of that service we have more GPs with shorter lists to enable them to spend longer on each consultation talking to patients.

Last summer we issued a consultation document on primary care, which was the first time primary care had been looked at properly. The consultation period finished early this year and we are considering how to take that forward. We expect that it will result in legislation in the new Parliament. I am glad to see the attention that has been given to that work.

The Government will go to the country on their record, which in the Health Service is a matter of considerable pride and achievement. We have record funding, record staffing, record patient care and record satisfaction with the Health Service. Independent surveys show that approximately 88 per cent. of those who have been treated in the Health Service are satisfied, or very satisfied, with their care. We have 6 million satisfied in-patient customers in the Health Service.

My hon. Friend is aware that hon. Members receive letters of complaint about matters such as unemployment benefit and the tax office, but how many receive letters such as I have received which they pass on to Ministers, saying, "Dear Mr. Brown, I have just received treatment in the Grimsby district health centre and I was appalled at this, that or the other"? If I have received such a letter, it would have been only once or twice in the past eight years.

My hon. Friend makes a serious point. We have 6 million satisfied customers who come out of hospitals and surgeries saying "Thank God", and quite right too. I wish, as he does, that occasionally they would say thanks also to the staff concerned. It has become fashionable to knock the Health Service. I would wish to see it become fashionable to praise the magnificent work done by the staff of the Health Service. I say that quite deliberately, because it is easy to provide the money, but difficult to translate that money into the top quality patient care that gives a Health Service that is the envy of the world. It would be wonderful if everyone could recognise that and recognise the excellent professional work that goes into making that so.

My hon. Friend the Member for Basildon (Mr. Amess) reminded me of the excellent meeting that I had with the chairman, general manager and others from his local health authority. They had asked for help as a result of what appeared to be a financial crisis at the end of last year. We demurred a little and encouraged them to look at their figures again. We suggested that the regional health authority might discuss some of their difficulties with them.

As a former district health authority chairman, I am reluctant to tell district health authorities how to run their services. By the time we got the meeting organised, they had sorted it out. The result was a magnificient litany of how problems had been faced and tackled with vigour and force, so the Basildon health service has improved and will continue to improve as a result of the learning process those people went through. I congratulate—I am sure my hon. Friend will join me—all concerned; I am sure that they serve his constituents with great distinction.

My hon. Friend the Member for Southend, East (Mr. Taylor) and my hon. Friend the Member for Basildon mentioned the Southend radiotherapy unit. In the past year we have heard about the strength of feeling over the Southend radiotherapy unit. Were there any doubt in the mind of my right hon. Friend the Secretary of State about the strength of feeling, that was dispelled the other night when my right hon. Friend the Member for Southend, West (Mr. Channon) went to him with a petition with over 100,000 names on it. My hon. Friend asked me some direct questions; for example, is the centralisation of radiotherapy still policy? My right hon. Friend the Secretary of State is taking a close interest in that. Such policies are always kept under constant review. My hon. Friend is quite right to demand that we look at the policy, which was drawn up in the days when equipment was rather different and it was necessary to serve a large catchment area with large and expensive equipment. I assure him that the Secretary of State will note his remarks and take them on board.

My hon. Friend asked about a visit. I thank him, on behalf of my colleagues, for the invitation. The thought of spending a day in Southend later this summer rather appeals. I know not whether the invitation will be accepted by me or another incumbent of this post, but I will ensure that the officials know about the invitation so that it can be passed on. I am sure that at least one of the officials would be delighted to accompany whoever goes to meet the very pleasant people of Southend and that they would have an interesting day finding out what is going on down there.

My hon. and learned Friend the Member for Burton lives in my constituency and has a habit of saying that I am his Member, which occasionally produces some ribald comments, as one can imagine. He drew attention to one of the main products—not the sole one—of Burton-upon-Trent's strength, which is the beer. I have a confession to make. The beer is the reason for my being the Member for Derbyshire, South. When my husband and I were attending various interviews around the country some four years ago, we found ourselves sitting in south Derbyshire supping a little of the local brew. My husband is a Yorkshireman and something of a connoisseur of beer. He smacked his lips, looked at me, and said, "You are going to get this one, aren't you?". I tried that much harder, and I am delighted that the good people of south Derbyshire decided that I was what they were looking for, at least on that occasion. I hope that on 11 June they will again decide that I am what they want.

The hospitals at Burton-upon-Trent look after my constituents, and the staff are numbered among my constituents. I share my hon. and learned Friend's admiration for the quality of work in a place which has never claimed to be one of the great cities of our nation and which perhaps in the past lagged behind places such as Birmingham and Sheffield, which have taken the lead in health care.

Burton is showing us how to do it. It has a special quality and I am grateful for the opportunity of putting that on the record. Burton has the most friendly and good natured people in the Health Service. They create a caring atmosphere that is second to none. They deal with their patients with a sweet countenance and I am certain that that helps people to recover more quickly. They seek help, with confidence, earlier so that they can be properly treated. Patients are treated with great skill. I was at dinner the other night with Mr. Glick, a senior consultant. He told me that he now deals with about 40 per cent. of his work on a day basis, and so leads the country. He is showing other parts of the country, including areas that we discussed earlier, how it can be done.

We shall encourage the health authority to take note of what has been said about the new Burton hospital development. I take the point made by my hon. and learned Friend the Member for Burton about creative financing. The difficulty is that by whatever means it is done, and by whatever name it is called, it means an increase in the public sector borrowing requirement, which must be avoided. I am grateful for the opportunity to put on the record my thanks for the way in which my constituents are cared for. The Prime Minister has said that the National Health Service is safe in our hands. I know that my constituents are safe in the hands of the Burton hospitals and their staff.

I hope that my hon. Friend the Member for Brigg and Cleethorpes will not mind that he has had to wait until last for a reply. His constituency is covered by the Grimsby district health authority and by the Scunthorpe district health authority. I am glad to say that a careful examination of statistics shows that health is safe with us in that neighbourhood. The picture there is remarkable.

Between 1982 and 1985 the number of front-line staff—doctors, nurses and others who deal directly with patients—in the Grimsby district health authority area increased from 1,461 to 1,665. That is a substantial increase. Finance increased from about £20 million in 1982–83 to £31·6 million this year. That is the cash allocation that we have made to the health authority. We could add to that savings, growth and development and sales. The authority is, therefore, likely to spend even more than the £31·6 million. In addition, it has received £10 million in capital money over the past five years. My hon. Friend described precisely what it has done with that money. We are pleased at the progress.

More important than input is patient care. In Grimsby between 1982 and 1985 the number of in-patient cases increased from just under 20,000 to nearly 24,000. Day cases increased from 3,300 to 4,800. The number of out-patient attendances also rose substantially. They are statistics, numbers on a page, but they refer to real Grimsby people, who will be real voters on 11 June, when we hope that my hon. Friend's majority will be increased in the same way.

It is particularly pleasing that the main improvements have been across the board. In general medicine there has been a 55 per cent. increase in in-patient cases since 1982. In general surgery there has been a 27 per cent. increase and a 62 per cent. increase in the number of ear, nose and throat cases treated as in-patients.

It is not surprising that between 31 March 1983 and 30 September 1986 the in-patient waiting list in Grimsby dropped from 2,500 to 1,300. That figure is still too high, but it is pleasing that no urgent cases are now on the list for more than a month, and so urgent cases are being seen much faster. The number of non-urgent cases waiting has also dropped substantially, and the number waiting for more than a year dropped between 1983 and 1986 from 850 to just over 100. That is still too high, and I shall not be satisfied until the figure is nil, but that shows the improvement in the neighbourhood and it is a tribute to the hard work of the staff.

The same picture is to be found in the Scunthorpe district health authority area. It cannot be entirely a coincidence. Such figures apply all over the country. In Scunthorpe the number of front-line staff rose from 1,287 in 1982 to 1,401 in 1985. More staff are now available to look after patients. Spending rose from just a shade under £20 million in 1982–83 to £27·6 million this year. That is a substantial increase. Added to that are savings and land sales.

In-patient activity also increased from 20,000 in-patient cases a year in the early 1980s to the current 25,000. Day cases have also increased, as have out-patient attendances. I am pleased that in the Scunthorpe district no urgent cases—none at all—have to wait for more than a month. It seems that there are no urgent cases on the waiting list. The staff simply deal with them. That has been so since 1985. It is a considerable improvement. Similarly, the number of non-urgent cases has dropped sharply from over 5,000 to 2,900. The number on the list for more than a year has also diminished to 801. That is still not good enough. Perhaps that health authority will take the opportunity to look at what it is doing and ensure that people do not have to wait any longer in Scunthorpe than they do in Grimsby.

It is pleasing to note that in Scunthorpe the waiting list for trauma and orthopaedic patients has decreased. A total of 739 people were waiting for non-urgent trauma and orthopaedic treatment, such as hip operations, but that number has dropped to about 400. That has improved the lives of hundreds of people who are now mobile as a result of hip operations.

This has been an extremely useful debate. We have been talking about health for about two hours. I note with interest the empty Opposition Benches. Not a single Opposition Front-Bench spokesman has bothered to turn up. Despite all the trumpeting about health care and what the Labour party intends to do, the Labour spokesmen on health are elsewhere. The House of Commons is still the most important place in the country to discuss health. The voting that allows us to spend all the extra money on the Health Service—to improve nurses' pay, to allocate more staff and to put up all those lovely new buildings—is done in this Chamber. Where are the Opposition?

What about the alliance Members? They are probably allied right now, because all of them are not here. We wonder how seriously they care about the basic work of running a good, modern Health Service and to improving health services for all.

There is one Labour Member here, the hon. Member for Newham, South (Mr. Spearing), who intends to raise an Adjournment debate in his own right. I look forward to answering that debate. I believe that the Health Service is not only safe with the Conservatives, but that under no other Government could the record that has been described be achieved.