It is something of a privilege to be able to speak on the Adjournment of the House at such an early hour in the afternoon. I suspect that the hon. Member for Derbyshire, South (Mrs. Currie), the Under-Secretary of State, will riot thank me for this, because I believe that there is a queue of further Adjournment debates to which I suspect she will respond, happily and willing as ever.

In raising the issue of health care for the elderly in Islington, it is worth reflecting for a moment on the background to what has happened to the health services in the borough of Islington, part of which I have the honour to represent in this place, since the Government came into office. For example, we have lost the entire casualty department at the Royal Northern hospital. It is much missed and much lamented by my constituents. Within the Islington district health authority the waiting list in September 1982 stood at 1,098. In March 1986 it stood at 2,410. That was an increase of 119 per cent., the greatest increase over that period of any health authority in the London area.

I fear that the position since 1986 has become worse. It is worse particularly for prospective patients who are awaiting urgent operations. The number of people within the Islington district waiting more than a month for urgent treatment amounts to 83 per cent. of the total. That puts the Islington district health authority in 182nd place out of the 191 health authorities. The figures for the Bloomsbury health authority, which adjoins the Islington health authority, and which has some responsibility for the care of elderly patients in the Islington area, are far and away the worst of any health authority. The hospital waiting list is the worst in England, and Bloomsbury takes 191st place, there being 191 local authorities.

That is the background on waiting lists, and the rhetoric from the Prime Minister and from the Government generally about the Health Service being safe in their hands and about spending more in real terms on it now than in 1979 falls on unreceptive ears among my constituents. Their experience is of a Health Service that is severely in decline. They are waiting longer and they are suffering as a result. The Islington draft operational plan reveals that there is to be a reduction by 1993 in the number of acute beds that are available. From 1983 to 1985 the number decreased from 982 to 812, and it is set to be reduced further to 659 by 1993. That is the draft operational plan that has been established by the Islington health authority. Sadly, it is not alone in facing the prospect of further decline among inner London districts.

Earlier this year the King's Fund, an independent agency, produced a report on the planned health services in inner London. It was called "Back to back planning". It revealed, among other rather frightening facts, that there was no coherent and comprehensive picture on inner London's health needs available from reading the reports, plans and future strategies of the four regional health authorities that between them cover inner London.

Another issue that it raised was extremely worrying, and the 12 chairmen of the district health authorities that cover inner London set out the position starkly in the foreword to the report. They wrote:

"Regional plans for inner London Districts require a reduction of £109 million"—

a reduction of 12·9 per cent.—

"in the period from 1983–84 to 1993–94; this is equivalent to the combined annual cost of St. Thomas', St. Bartholomews and the Royal Free Hospitals."

Those are three major teaching hospitals. The equivalent cost of the three hospitals put together is expected to be taken out of the health budget for inner London over the 10 years from 1983–1993. That is the background against which I raise this debate.

Lengthening waiting lists, reductions in the number of acute beds and future cuts in funding for inner London health authorities affect severely the elderly in my constituency. My constituency has a higher than average number of elderly people, especially elderly people living alone. Many of them need proper and decent health care, but, unfortunately, they are not getting it.

Primary health facilities do not constitute the only problem. There are other areas of the Health Service that cause me to be concerned. The London ambulance service is one of them, and I know that my hon. Friend the Member for Newham, South (Mr. Spearing) will be raising the issue in greater detail later this afternoon. Last summer the London ambulance service cut drastically the number of non-urgent journeys that it was prepared to undertake. It claims now that the number of non-urgent journeys is increasing, and there is some slight evidence of improvement, but last summer there were drastic cuts in non-urgent journeys. The sector of the population most affected by those cuts are the elderly, with their transport to day centres and the difficulties that they have in getting out of their homes. The elderly in my constituency are faced with the problem of a health and ambulance service that is fundamentally in decline.

To add to that difficulty, for many years we have not known precisely where the responsibility for the planning of health services for the population of south Islington has lain with the Bloomsbury district health authority, which has supposedly been responsible for planning hospital services for the elderly. Sadly, althouth it has had that responsibility, and although supposedly within the funding that has been made available to it by central Government some account has been taken of that responsibility, it has not been exercising it.

It was nonsense in the first place for a portion of the health responsibility of one area to rest in the hands of a health authority for a different area. It may be adjacent, but none the less it was not a health authority that covered that part of the population. The people of Finsbury and the southern part of Islington were falling between two stools. Primarily they looked to Islington district health authority for support and assistance, but that health authority was not funded to provide it; Bloomsbury health authority was funded to provide it, but unfortunately it did not do so. To make matters worse, much of the population, especially in Finsbury, expected St. Bartholomew's hospital to provide hospital care for them, but St. Bartholomew's is run and administered by the City and Hackney health authority, which was yet a third health authority involved in the confused picture in the provision of hospital services for the elderly in south Islington.

For several years I have been endeavouring to establish exactly where the responsibility lies, who is prepared to take it up, and where the funding should be directed. It seems that some small amount of progress is being made. I wrote to the Minister some weeks ago specifically about where the precise responsibility for hospital services for the elderly in south Islington lies, should lie and where, in the Government's view, it should lie in the future. Should it lie with Islington district health authority, which is presumably the logical place to put it? Should it lie with the City and Hackney health authority because St. Bartholomew's hospital is run by it and is the hospital that is immediately adjacent to the boundary? Should it lie with Bloomsbury health authority, which has had the responsibility for funding up until now?

I received a very helpful letter, not from the Minister, but from the chairman of the North East Thames regional health authority, who the Minister had asked to reply on her behalf. I was pleased to read the first sentence of the second paragraph of that letter. He said:

"I acknowledge that Services for the Elderly in South Islington are inadequate."

It is extremely good to have received that clear statement of the problem in writing from the chairman of the regional health authority. He went on:

"I am delighted that some progress has now been made and that there is agreement between Bloomsbury, Islington and City and Hackney Health Authorities about how to deliver improved services. The Regional Health Authority has also agreed to allocate some resources to ensure the planned improvements."

I shall return to that point, because the information that I hope the Minister will give us this afternoon is exactly what planned improvements there are and what funds are coming from which authority.

The chairman continued:

"The Health Authorities acknowledge that GPs refer elderly, acutely ill patients living in South Islington to St. Bartholomew's Hospital and City and Hackney District, with capital support from the Regional Health Authority, has agreed to provide an acute assessment ward designated for this purpose which should be available in 1989."

So far, so good. What happens—this is my first specific question to the Minister—between now and 1989? A specifically designated ward in St. Bartholomew's hospital in 1989 is welcome, but between now and then where should GPs refer elderly patients who come from south Islington who are acutely ill and require hospital treatment?

The chairman continued:

"There is agreement also that longer stay health service provision should be provided by Islington Health Authority to complement the range of services provided by the London Borough of Islington."

I am glad to receive that assurance from the chairman of the regional health authority, but I suspect that he has forgotten that the London borough of Islington is a rate-capped authority and therefore will find it impossible to devote additional resources to assist in this process. He also seems to have forgotten that with the impending closure of Friern Barnet hospital many patients from that hospital will be returning into the Islington community over the next five or six years and for whom joint provision by the health authority and borough will have to be made. That will be a major drain on resources and funds, and to envisage, at the same time as that is occurring, provision being made for the longer stay health needs of the elderly is stretching credulity. It will require a major injection of funding into the health authorities and the borough to ensure that those needs are properly met.

My second specific question to the Minister is in relation to the longer stay Health Service provision. What funds will be made available to enable Islington health authority and Islington borough council to provide between them the sort of service that the chairman of the regional health authority envisaged? What funding will be available to enable that to happen in full and proper form?

My third specific question to the Minister relates to the agreement between Bloomsbury, Islington and City and Hackney, which is referred to in the earlier paragraph of the chairman's letter. Obviously, that agreement is welcome. It is long overdue and it is about time that the three district health authorities and the region agreed a strategy on what to do about patients who need proper hospital provision, proper planning of their health needs and a way of meeting them.

What are the precise terms of that agreement? How much funding will come from each of the three district health authorities, and how much funding will come from the regional health authority to provide these improved services? What improvement will occur? At present, many elderly patients from south Islington are dealt with at St. Bartholomew's hospital, but from where will the improvement come? Some improvement may be coming with the new ward in 1989, but what will happen between now and then?

A rather ominous note was set in the middle of an appendix to one of the recent reports to the district health authority meeting in Islington, which referred to possible cuts in provision for the elderly in southern Islington. A number of figures were set out beside the figure for possible cuts. The figures related to the three district health authorities. I should dearly like to know from the Minister exactly how much funding will come from the three district health authorities, and how much will come from the region, to cope with the health and hospital needs of elderly people in the southern part of my constituency. They need and deserve better treatment than they are getting at the moment.

I look forward to hearing the Minister's specific replies to my questions and also her commitment to a rather better future for my constituents' health needs and health facilities than they have had for any of the past eight years. I look forward to hearing what the Minister has to say. I hope that she will give some comfort.

These are the dying days of the Government. The Government will shortly be replaced by a Labour Government who are determined to support the Health Service, particularly in inner areas such as Islington, to a much greater extent and with much greater care for the needs of people'than the present Government have shown. I hope that the Government, even in their dying days, will relent and that we will have a deathbed conversion to the principle of proper funding for our health services and a proper way to meet the needs of elderly people—my constituents—who deserve a much better deal than they are getting at the moment.

I congratulate the hon. Member for Islington, South and Finsbury (Mr. Smith) on his efforts to publicise the needs and concerns of his constituents. He wrote to me on 25 February 1987. I am deeply hurt that he failed to acknowledge that I wrote back. Indeed, I have a letter dated 18 March, which I shall read. As a result of that correspondence, I have a great deal of progress to report on some of the specific issues that he has raised. Indeed, since this debate is a little earlier in the evening than usual, I shall have the opportunity to report some progress in a wider area of interest; that is, the care of and the level of services for the elderly that the Government have been able to provide, and some aspects of care, particularly in the Islington health authority.

The hon. Gentleman is quite right: the number of acute beds has been reduced. Even now, however, the total number of acute beds in London for its population runs at twice the national average and about two and a half times the level of acute beds for the population of outer London. That is for the obvious reason that the population of London has shifted. Indeed, about 2·5 million people have left central London in the years since the war. However, on the whole, the health services have continued to maintain the pattern that was established 100 years ago and subsequently. Therefore, in any calculation of acute services for the population, London has been substantially over-provided. I am not the first Minister who has said it, and it has not been only Conservative Ministers who have said it. It has been said for some time.

The plan to lose some 1,500 acute beds over the 10-year period from 1984 to 1994, which was actively debated a short time ago in the regional health authorities and the district health authorities, has been put into operation rather faster than anybody expected. Three years into a 10-year programme, 1,100 beds out of the 1,500 beds have already gone. It is realistic to state that that rapid changeover has brought some of the problems that the hon. Gentleman has described.

However, there are two aspects. The first is that, in many cases, acute beds have been replaced by geriatric services, and some of the developments that I shall describe are of exactly that kind. Our elderly people fill half the acute beds in the country, but it does not automatically follow that they are getting the best service that they need by remaining in the acute side of the service. Where, as in much of London, the geriatric service has been inadequate and the acute service was over-provided, the switch from acute to geriatric has been widely recognised as necessary and sensible. The problem has been the speed with which some of it has happened rather than the pattern of change.

indicated assent.

The hon. Gentleman agrees. Since he entered the House, he has taken a keen and intelligent interest in the subject. He would recognise that to have gone in the opposite direction—to have diminished geriatric services and to have increased acute services—would not have been sensible.

Secondly, in many parts of London much better general practitioner services are reducing some of the pressure on hospitals. We are particularly pleased to see that, in one or two places, better GP work is resulting in far fewer requirements for people, particularly elderly people, to be admitted to hospital. In other words, they are getting better care and service from their GPs. I am sure that they welcome that—I certainly do. We hope to see rather more of the same, not just in London and not just for elderly people, but all over the country.

We recognise the special difficulties in London—I say that as a Member from the Trent health authority area. Two important studies are under way. They should bear fruit in some of the directions that the hon. Gentleman and his colleagues would want. We recognise that simply comparing London's needs with its population does not work for London because its population swells with commuters. One is attempting, in many parts of the London region or regions, to provide two lots of health services because people want them at home in Kent, Sussex, Bedfordshire, or wherever they live, and also in London, where they work. If someone collapses with a heart attack at Waterloo station, he will not promptly be taken back to his district hospital 30 miles away, but will be treated in one of the main London hospitals, and he will get good service. That fact is recognised. Detailed studies are under way as to how that might properly be calculated. I am sure that the hon. Gentleman realises that they are far-reaching discussions. That matter is now being looked at with some care.

The other major study that is under way is about patterns of nurse recruitment in London and the difficulties in recruiting and retaining nurses in London, which might be rather different from some of the problems in the rest of the country. I think we now recognise how serious a problem accommodation is in some parts of London. The results from some studies will come to us shortly. We hope that we shall be able to make some announcements on that matter.

The hon. Gentleman might care to look at the Official Reportof last Friday's Adjournment debate about Newham health authority. He may find that it is not only a problem about nursing but that there are one or two problems in a wide range of services. We are aware of the problems and we are determined to ensure that we have adequate information and some decent long-term studies on which sensible decisions can be made.

I turn now to services for elderly people in the country as a whole. There are now about 10 million pensioners. We now have a higher proportion of pensioners than any other major country except Sweden. Our pensioners are living longer—we are all living longer. The life expectancy of a baby girl born today is 81 years. That is a tribute to the Health Service and the quality of services provided by it. It is a tribute to better housing and better prosperity all round, much of which, thank goodness, pensioners are also able to enjoy.

In regard to the Health Service and local authority services for the elderly, I am glad to report some substantial improvements since 1978–79, when last there was a Government of the colour that I suspect that the hon. Gentleman might prefer to see after the election. Under our Government very substantial improvements have been recorded and it is worth putting them on record. My figures are for England. The number of elderly people treated in geriatric units has increased substantially, as in-patients by some 60 per cent. and as out-patients by some 40 per cent., between 1978 and 1985. Nearly 400,000 elderly people are treated every year as in-patients in geriatric departments. They are therefore getting the service that they particularly need. Day hospital attendance has risen by nearly 20 per cent. in the same period. Indeed, some 1·6 million old people regularly attend day hospitals.

We have seen increases in hospital staffing. The number of consultant geriatricians rose by nearly 50 per cent. between 1978 and 1986, and we now have nearly 500 whole-time equivalent consultant geriatricians in a sphere that used to be the Cinderella service in which very few people wished to work. Similarly, the number of nurses caring for geriatric patients between 1978 and 1985 increased by 22 per cent. We now have nearly 45,000 such whole-time equivalents working for the elderly.

Of course, the vast majority of the elderly are cared for in the community. The community health services have also seen improvements. The number of district nurses has jumped by 18 per cent. The number of elderly people treated in their own homes by district nurses is 1·6 million every year. That is a remarkable achievement. That figure has increased by 28 per cent. under this Government. About 74 per cent. of district nurses' time and nearly 90 per cent. of auxiliaries' time in the community is spent caring for elderly patients.

We do not neglect either the problems of mobility. The number of chiropodists treating the elderly has risen. The total number has gone up by nearly 24 per cent. and the number of elderly people treated by National Health Service salaried and sessional chiropodists is up by 25 per cent. to 1·5 million a year. That is a remarkable tribute to all the staff concerned.

Turning to local authority provision, we find a slightly more mixed pattern and perhaps not quite as much growth, but local authority provision is not entirely under our control in the way that the Health Service is. Local authority provision for the elderly has to compete with other interests in many local authorities. Islington is one with such important bodies as a peace committee, a women's committee and other such committees. In some parts of the country local authority provision has not risen quite as fast as the health care provision——

I must intervene momentarily to correct the hon. Lady. For a start, there is no peace committee or any such entity in Islington borough council. There is a women's committee which does extremely good work on health and safety issues which worry many women in the constituency.

I suspect that the elderly women in the constituency might prefer more home helps, but that is an opinion from one who was a Birmingham city councillor for 11 years.

I noticed last week, following the hammering that the Labour party got in the city of Birmingham when its majority was slashed by some 10 votes on the city council, that the first thing the Labour leader of the council, Mr. Dick Knowles, did was to abolish the women's committee and the race committee and take issue strongly with those who felt that it was wise to have them. He said that he had intended to abolish them anyway; it was just pure coincidence that he did so the day after a disastrous election.

On local authority provision for the country as a whole, I am delighted to report that between 1979 and 1985 the number of places in day centres went up by 15 per cent. and nearly 22,000 elderly people can go to day centres each day. Since people do not go every day, obviously that provision is available to more than 22,000 people over a week.

The number of meals served through the meals on wheels service has risen to 43 million a year; 70 per cent. of the meals are served to people in their own homes. The number of home helps has gone up by 14 per cent. There are now some 53,000 full-time equivalents. As most home helps are part-timers, that is a substantial army of people helping the elderly to stay in their own homes. We have also seen overall an improvement in residential care, not through the local authority service but mainly through the increased provision of excellent residential care in the private sector.

Islington district health authority, as the hon. Gentleman knows, is chaired by a former Member of the House, Mr. Eric Moonman, and a very good job he is doing. If we look through some of the funding and other developments in that health authority, evidence may be called in aid against the broad case that the hon. Gentleman tried to put. The gross revenue expenditure of the health authority in 1985–86, for example, was a shade under £45 million. This year the initial cash allocation for that health authority has risen to nearly £51 million. That is a substantial increase in a period of barely two years. I know that the authority will use it wisely under Mr. Moonman's guidance.

Between 1985–86 and this year the authority has had some million in capital. The result is that it is looking after more patients. Between 1982 and 1985, the most recent year for which I have figures, the number of in-patient cases treated in Islington went up from 26,900 to 28,200 and the number of cases treated on a day basis went up from 2,500 to 3,500. I have examined the performance indicators for similar authorities and it may be possible to look after more patients on a day basis. In some parts of the country surgeons find that 25 per cent. to 30 per cent. of the kind of cases done in Islington can be carried out on a day surgery basis. In Islington the percentage is still small. The most popular area of day surgery is still less than 20 per cent. of the total. So that there is scope for doing more.

In one branch of particular interest to the elderly, trauma and orthopaedics, there has been a substantial increase in the number of cases that the authority is able to look after. In 1982, the number of in-patient cases was 1,700. In 1985 it was up to 2,100. Therefore, many hundreds of additional elderly people in Islington have been assisted in that way.

The number of people being treated at home has remained steady. Health visitors and home nurses can give a good service. I suspect that the hon. Gentleman is right in saying that the proportion of elderly in the neighbourhood is high. Perhaps it is slightly higher than the average because the death rate from ischaemic heart disease and cerebral vascular disease is lower than the national average. Islington is doing well on prevention, and I congratulate it on that.

As for the responsibility for the care of the elderly in Islington, and particularly in the hon. Gentleman's constituency, he is right in saying that there is a frightful muddle. In addition to community services, Islington health authority is responsible for hospital services for the elderly in north Islington and also in Hornsey within the boundaries of Haringey health authority. Responsibility for hospital services for the elderly in south Islington and the Finsbury area lies at present with Bloomsbury health authority. But because of the proximity of the hospital For acute admissions many patients are sent to St. Bartholomew's hospital, which is within the City of London and Hackney health authority. I count four health authorities so far, with the regional health authority taking a close interest in what goes on, of course.

I therefore wrote to the hon. Gentleman on 18 March 1987, in response to his letter, saying:

"As you say, this would seem to be a matter for agreement between the various District Health Authorities concerned. I have therefore written to David Berriman, Chairman of the North East Thames Regional Health Authority, asking him to reply to you direct about this matter at the same lime as reporting to me."

I am therefore happy to recognise that perhaps the Department had some small role in encouraging the progress since February.

It is accepted that the provision of health services to the elderly people of south Islington is unsatisfactory. Discussions have been taking place for a short time now between officers of the three district health authorities mainly concerned—that is, Bloomsbury, City of London and Hackney and Islington—and the regional health authority about the provision of hospital services to the elderly of the area. Progress is being made in these discussions and there is now agreement in principle about how improved services should be provided in south Islington.

The hon. Gentleman asked me specifically what funds there will be in future for the health and local authorities. I shall give him some detailed figures for the health authority schemes that are under active discussion right now.

For local authorities as a whole this year I per cent. additional funding has been given for community care of all kinds, and that has amounted to some £27 million. How they spend it is up to them, because most local authorities resist being told specifically what to do. It is a convention that Ministers do not commit the Government too wildly about future funding in the weeks leading up to a general election. It will therefore depend, I suspect, on the outcome of the coming election. I have no doubt that whoever is the Member for Islington after the election is likely to be invited to the opening of some of the establishments and wards that I am about to describe. I hope that the hon. Gentleman may also have the opportunity of attending.

First, there will be £180,000 for community services in south Islington. I understand that the North East Thames regional health authority is permitting the Islington health authority to retain half the efficiency savings that will be developed this year, and that will be about £180,000. The emphasis will be on community services for the elderly in south Islington. I am sure that the hon. Gentleman will be in touch with the chairman of the health authority and will hear from him in some detail precisely how that additional money is to be spent.

Since, as the hon. Gentleman said, many elderly, acutely ill patients living in south Islington are referred to Bart's, which is in the City of London and Hackney health authority, the regional health authority has allocated £250,000 capital for an acute geriatric assessment ward at Bart's, which I have no doubt will give his constituents some of the finest care and treatment available in this country and possibly in the world. The ward will have up to 25 beds and it is planned to open it in 1989.

However, I take the hon. Gentleman's point and I will ask the regional health authority to give further consideration to the care of these patients in the intervening period. It may he possible to look after these patients in existing facilities that might be not quite as acceptable as the most modern facilities while the additional money is being spent. I undertake to ask the regional health authority to take a look at that.

In addition, the North East Thames regional health authority will be providing £400,000 for Southwood ward at the Hornsey central hospital, which should also be of assistance to elderly people in the neighbourhood. This is subject to detailed agreement on the content of the scheme.

There is also an urban programme bid in for a day hospital of which perhaps the hon. Gentleman is aware. I understand that the Islington health authority has made an application to the Department of the Environment for urban programme funding for a 20-place geriatric day hospital at the Whittington hospital, at a capital cost of some £750,000—they do not come cheap in London—and I understand that this bid is currently being considered. The urban programme funding would provide day hospital facilities in the Archway wing at Whittington, where associated geriatric wards are already sited, so it would be a good location.

I was very interested to hear of Islington's joint policy on the care of the elderly and I know that a great deal of detailed work has gone into that. I have read the joint policy, and I hope that as much as possible will come to fruition. It is very encouraging to see evidence of such close co-operation between a district health authority and a local authority and such commitment to the development of community care services.

We think that in taking that work forward the district health authority could make rather more use of the performance indicators now available for services for the elderly and also of the balance-of-care planning system which has been developed by my Department and was made available from 31 March 1987. What I am saying is that there are now management tools available that may assist health and local authorities in the planning of their services, particularly when they are going into new areas, as these are hoping to do. I am willing to make officials' time available to the local health authority and the local council to ensure that they are able to plan their services along the best possible lines.

I am glad to have had the opportunity to debate this subject tonight. I look forward to seeing the hon. Gentleman once again in the House, perhaps not for Islington—that will be for the voters of Islington to decide—but I am quite certain that it will be a Conservative Minister answering him.

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.

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.

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.

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.

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 what happened last time.

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.

The tradition and practice of the House has been to express grievances on the Adjournment. The Minister's closing remarks in the previous Adjournment debate do not accord with the traditions of this place. The Minister knows very well that when private Members raise Adjournment debates, whether it is the first, second or, as in this case, the third Adjournment, it is not the custom for Opposition Front Bench spokesmen to be present, nor is it the custom for other hon. Members, other than by arrangement, to be present to express their views. We have had not a formal debate on health, but a debate on the Adjournment in which individual hon. Members have excercised their right to raise particular items. It so happens that three of those items have been about health.

My Adjournment debate relates to the out-patients ambulance service in London, or, perhaps more accurately, the non-emergency ambulance service in London. I hope to be typically robust because this Adjournment before grievance is not just for this week or this day, but is, in effect, the Adjournment before grievance for this Parliament.

In the Minister's closing remarks in the previous debate she made the claim, often repeated, about the Health Service being safe in the hands of the Government. However, my speech will show that the Health Service is clearly not safe in their hands. It is true that the Minister and her hon. Friends reeled off a host of statistics in the last few minutes of the previous debate. They have used the usual public relations trick of semi-truths. In the same way, the Minister referred to the empty Benches on the Labour side and implied that we are not concerned about health. That is not the case, but such was the implication. Semi-truth is of course only a next door neighbour to an economy of the truth.

I will seek to prove—I challenge the Minister to deny it—that my thesis and that of my hon. Friends about the Health Service is correct. Indeed the Minister has already accepted that. A written answer on 5 March 1987, column 679, showed that there had been a 41 per cent. reduction in the number of non-emergency cases carried by the London ambulance services between 1984–86. That is a shocking figure. The fact is that the administrative edict that brought about that savage reduction was not originally from Alexander Fleming house or from Health Ministers or the Department of Health and Social Security. It came from a Rayner-style edict from No. 10. That is a remarkable example of the elected dictatorship that is now on offer before the electorate.

In an Adjournment debate on 31 October 1986 I showed how that reduction had come about. Since then I have received further figures and further answers from the Minister. I wish to draw the attention of the House to those answers to make this issue a major matter of grievance. On the occasion of that Adjournment debate the Minister—I am glad to see that she is present because she has to answer for these matters—admitted that some 10,500 fewer walking patients were being transported—a reduction of 44 per cent. The Minister said:

"I am more than happy at that development."—[Official Report, 31 October 1986; Vol. 103, c. 666.]

What greater expression of ministerial responsibility and approval can there be?

On that occasion, by way of assurance, the Minister told us that the acute ambulance service, the vehicles that run through the streets with sirens sounding and lights flashing, were being protected. The Minister had said in an earlier debate that if someone suffered a heart attack at Waterloo they would be taken right to Barts. However, if one of my constituents has a heart attack in Newham, what chance is there that Newham hospital's accident department—opened less than two years ago by the Queen—will be open? That accident department has been closed twice since Christmas, once for 40 hours and once for 60 hours. Even if one is transported in an acute ambulance, one is not necessarily transported to the emergency department of a new hospital, manned and ready for action.

There are some 350 acute ambulances in London and they travel some 3·5 million miles a year. There are 230 tail-lift non-emergency ambulances and some 400 so-called "coach" ambulances. They travel 7·5 million miles a year—twice as much as the acute ambulances. However, it was those non-emergency ambulances that were cut by 41 per cent. I am sure that the public are not aware of that reduction because the administration of the London ambulance service is arcane almost to the point of imbecility. It is run by the London ambulance services, quartered at Waterloo, and it used to be part of the Greater London council services for London. The ambulance service was transferred to the management of the South-West Thames regional health authority, which manages it on behalf of the four regional health authorities of London that meet in the centre of the city.

The London ambulance service has, quite sensibly, four district organisations that relate to the district health authorities. Therefore, the chain of accountability to the House is complex almost to the point that the service is not easily accountable other than in a debate of this nature.

As I explained in the previous Adjournment debate, several years ago, a gentleman from the East Birmingham health authority, Mr. Payne, was asked to make a survey on how non-emergency ambulance services could be provided more efficiently. One person, one study, but consider the results. In the course of that study Mr. Payne said that there was some misuse of the non-emergency ambulance service. I am prepared to believe that. However, when a non-emergency ambulance takes somebody to a hospital or a day centre that action must be certified by a medical person. As a taxpayer I am happy to give that medical person a little bit of leeway. Mr. Payne estimated that there was a 4 to 10 per cent. misuse of the service. He suggested that a possible saving of £9·4 million could be made. In London—the Minister is aware of this because she answered one of my questions on the matter—there is no evidence of such misuse, but the cuts went ahead.

Not now there isn't.

The Minister may say that, but I asked a question about previous misuse. If I am wrong, no doubt the Minister will correct me when she replies.

Mr. Payne—I do not wish to single him out unreasonably as the civil servant responsible, but his name was given on the document—presented his paper to the Minister. The Minister agreed that the way to reduce the cost was to make each district health authority in some way accountable for the ambulance service it received. Monetarism or Marks and Spencerism may make sense in the retail business, but it was pushed on to the Health Service.

During the debate on 31 October, in column 659, I quoted from the document that had been produced. I wish to do so again because it makes the case clearly. It states:

"It would he open to districts to buy in part of the service from other public agencies or the private sector if this was more cost-effective, providing the quality of the service was maintained."

In other words, local health authorities were being given some sort of quota, in terms of mileage, or of financing, or the number of ambulances available. If they wanted to buy in more, they had to obtain them from the private sector. I shall be saying more about that anon, because the writing is clearly on the wall.

The way to get the costs down was by tightening up the finances. I have no objection to that, provided that the level of services for the people who need them, and their cost effectiveness and efficiency, were maintained. However, I do not necessarily think that they have been. Last summer, as everyone involved in the service in London knows, there was chaos. A letter went out from the South-West Thames regional health authority asking district health authority chairmen to cut demand by 40 per cent. It was an appealing letter, which read like a charitable letter in reverse. So the service was reduced. The results for people such as those in Newham, which is the area with the fewest cars in south-east England, were catastrophic. Those people are the least able to get out on their own, and the least able to be driven by kind neighbours—not that the people in Newham are not kind, but they do not have the same number of cars as people elsewhere. The bus service there is now under threat, and chaos, hardship and heartache have ensued.

One might say that such a threat was not intended; but its results were malign, vindictive and inhuman. The hon. Lady and the Government, who were responsible for them, may say that they did not know that that was going to be the result. However, anyone would know that a 40 per cent. cut, which was the aim, would result in those sorts of difficulties; and so it turned out. In a question that I asked on 6 November 1986—I shall read it because the hon. Lady disputed the point—I asked the Secretary of State:

"what evidence he has received, concerning alleged non-appropriate use of the non-emergency ambulance services in London; and by what percentage those calls have changed between 1984 and 1986."

Referring to my accusation, the hon. Lady said:

"We have no information on alleged non-appropriate use of non-emergency ambulance transport."—[Official Report, 6 November 1986; Vol. 103, c. 598.]

It is clear that all this was not even based on Mr. Payne's call for a 9 to 10 per cent. reduction. It was quite baseless, apart from the desire to save money. And the Government say that the Health Service is safe in their hands.

What were the actual reductions? The hon. Lady provided me with a table, published in Hansard at columns 679 to 682 on 5 March 1987. The reduction in non-emergency services between the years 1984 and 1986 was 41 per cent. in London. The figures were further broken down into four divisions of the London ambulance service. I asked about the quarterly and the annual reductions. It is ironic that the biggest reduction of all—45·5 per cent.—is in the north-west division, which covers the London borough of Barnet and the constituency of the Prime Minister. Let her go to her constituents and say, "The Health Service is safe in my hands." The hon. Lady's figures show a reduction in non-emergency ambulance services of 45 per cent. in the Prime Minister's area.

Those are the facts—not the half truths that we heard in the hon. Lady's PR speech of a few minutes ago. I have challenged the hon. Lady to deny those facts.

There is more: in addition to the out-patients who are carried and who are getting better, there are out-patients who are sick and need treatment—people who, perhaps, come out of hospital rather too soon and are taken back. Out-patients are not necessarily fit and well. In addition to such people, who are carried by the London ambulance service, the districts bring in other people by services which are not run by the LAS. These are the so-called indirect services. Old people are taken by minicabs, which are difficult to get into and out of. Minicab drivers may be sympathetic and willing, but they are not skilled That service is growing. An indirect service may be run by a contractor, too—that is being encouraged, and the increase in indirect services is quite startling. Of course, a relatively low figure is involved. It started with 212,000 miles in 1984 and increased to 346,000 miles in 1986—an increase of 63 per cent. So the public sector service in the Prime Minister's area has declined by 45 per cent., and the increase in indirect services in the whole of London has been one of 63 per cent.—services bought in from outside contractors. That is the trend.

We know that the Government, if returned to office, will privatise as much as they can. Do they wish further to privatise the non-emergency ambulance services in London, as distinct from the acute services? They appear to want to do so, because they are increasingly separating personnel.

How have the Government got away with this in the minds of the public? What about all those cancellations about which we heard? Last summer, there was chaos, and there were cancellations. In reply to questions that I have asked her, the hon. Lady has said that, in Newham hospital and in the Newham district health authority, there are now no cancellations worth mentioning. That, again, is a PR fact: we are all right; the Government say that the services are slightly increasing.

I have made inquiries about that and I understand that, because there was so much chaos, the medical staff concerned said that they could not tolerate the situation. Out-patient lists were in chaos, and people were missing appointments. An old lady who had missed eight in a row wrote to me. So the authorities concerned understandably tightened up the criteria for those whom they certificated as being able to be called for by an ambulance. In other words, what they did—as you, Mr. Deputy Speaker, or I, or even the hon. Lady would have done—was say that, as the ambulances were not available, they would ensure some sort of continuity in the service. Consequently, they upped the limit, which is, to some extent, variable, as it is a matter of judgment. That is what I have been told has happened.

Other matters, too, have been dealt with in the way that anyone with common sense would deal with them. A lady, for example, who comes in once a week might be asked to come in once a fortnight. The criteria of need and requirement have now been geared to different considerations. The administrative impact of this lack of flexibility has resulted in a change in the criteria. There has been a squeeze and, as a result, no doubt the costs have fallen, but the price has been paid in the quality of service that dedicated people can give to their patients.

Another change has been the introduction into this important service of 200 part-time staff. The hon. Lady is nodding her agreement. Two hundred part-timers are now engaged in the London ambulance service and more may be recruited. I have been told—I do not have any figures to prove it—that it is possible for someone to do two part-time jobs: the economics are such that one starts early and takes people to the day centre or hospital, then has a long break, and then does a second part-time shift in the evening. This is a lowering of the standards of the staff, their expectations and their training.

I have a number of questions to ask the Minister. First, is it the DHSS's intention as it is now constituted further to separate acute ambulance services from non-emergency services in London? The hon. Lady might not be able to give an undertaking tonight but she might be able to write a letter tomorrow or on Monday to that effect. Secondly, how is the availability of money for ambulances calculated for each district health authority? In other words, what is the base? Is the Payne memorandum, which came from Downing street and which might be softened to some extent, still the basis of policy for the DHSS? Thirdly, is it the Government's policy to permit the contracting out of ambulance services to small firms or individuals?

On 6 May I asked the Secretary of State for Social Services

"what tests of competence or other conditions relating to standards of remuneration and safety arc applied by district or regional health authorities when using ambulance contractors for non-emergency ambulance services."

The answer read:

"Health authorities are responsible for the day-to-day management of National Health Service ambulance services. It is for them to arrange the most appropriate, efficient and cost-effective means of transport for each of the patients the ambulance service is asked to convey. This may involve the use of taxi, hire car or other private contractors as well as volunteers. Standards of safety and payment to private contractors are not set centrally: health authorities are responsible for negotiating contracts locally and for setting standards of service, patient care and safety."—[Official Report, 6 May 1987; Vol. 115, c. 429.]

That is a recipe for undermining the proud standards of the London ambulance service. As Winston Churchill said in this Chamber, or rather its predecessor, the bad contractor drives out the good and the worst drives out the bad. How can we expect district health authorities, with all their problems, to monitor and apply standards of decent employment and decent standards of safety? That should be done by the London ambulance service as a whole, and that is what has been done. We are faced with a recipe for undermining the quality of the service and the London ambulance service itself. I ask the Minister to deny that that will be the result of that which is proposed. We know what is happening within the bus service—I shall not pursue this—and we know also what happened on Monday. We do not want that to happen to our ambulance service. Unfortunately, the Prime Minister, the Government generally and, self-admittedly, the Minister, are driving the London ambulance service in that direction.

Does the Prime Minister care? On 2 April my hon Friend the Member for Tooting (Mr. Cox) asked the Prime Minister about hot beds—two patients and one bed—in Barts. There is one person in the bed while the other is up and out of it during the middle of the day. The Prime Minister said that the practice of day surgery was welcome and claimed that expenditure in London on the Health Service had increased under her Government. She may make that claim, but the expenditure on the London ambulance service has dropped. That has been determined by what she has brought out of No. 10 Downing street. It might be said that it is only the ambulance service that has been so affected, but both the staff and the customers—our citizens—have been undermined, demoralised and dismayed.

This trend has been accompanied by a regrading of staff and a change in their terms and conditions of service. There has been a change in negotiating patterns and a reduction of public resources. There has been a threat of privatisation and in some services there has been an accompanying lack of public repute. Is it a coincidence that what has happened in the London ambulance service has been repeated to some extent in other public services such as schools, the DHSS, universities, polytechnics and sectors of the Civil Service and local government? The same formula has been applied time and again.

There is an epitaph for this Administration that comes from the experience of the London ambulance service. If anything, we have a parable, but it is almost the reverse of that of the Good Samaritan. It is the obverse of what this Administration started with following a bizarre quotation on the steps of No. 10, but one which is well known. The example is the London ambulance service, but many other areas of the public service provide it because the same formula has been used. I give the Government an epitaph as they finish their administration. It is as follows: Where there was harmony, we have brought discord; where there was truth, we have brought error; where there was faith, we have induced doubt; where there was hope, we have brought despair.

The case in respect of the London ambulance service is proven—it is clear that the service is unsafe in the Prime Minister's hands. If that is true of the London ambulance service, it is true, as I have tried to prove, of the Health Service and of the nation.

I am grateful to the hon. Member for Newham, South (Mr. Spearing) for raising once again the issue of the London ambulance service.

The new salary structure for ambulance men came into effect in March 1986 and it changed radically the pay arrangements for ambulance personnel. It provided an opportunity for all ambulance services to rid themselves of inefficient working practices. With the introduction of the new structure, the London ambulance service took steps to improve the front line—in other words, the emergency service that it provides. This meant that temporarily staff resources had to be transferred from non-emergency services to be redeployed on front-line work.

The South West Thames regional health authority, which manages the London ambulance service on behalf of the four Thames regions, took immediate steps to increase recruitment within the non-emergency service to make up for the shortfall. The hon. Gentleman has referred to the number of part-time employees who have been taken on, and he was right when he spoke of about 200. Part-time employees were introduced into the service a year ago to try to enable the work force in as flexible a way as possible to cover the different and increasing demands made on the service. I see nothing wrong with that.

Since March 1986 there has been a significant increase in the number of full-time ambulance staff employed. Almost every month last year about 30 recruits were undertaking training within the London ambulance service. There was a low turnover and the results have led to a substantial increase in staff. I believe that we are seeing the benefits of a sustained recruitment campaign, and I am sure that the hon Gentleman's concerns will be met in this way. I hope that he will accept that I shall scrutinise the Official Report and write to him on all the other issues which he has raised at very short notice this evening.

Before the Minister sits down——

I have sat down.

will she accept for the record that there was notice last week of this debate, which was given to the Minister for Health? I am grateful to the hon Lady for saying that she will write to me, but I am sorry that she will not answer my questions this evening.