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Commons Chamber

Volume 302: debated on Tuesday 9 December 1997

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House Of Commons

Tuesday 9 December 1997

The House met at half-past Two o'clock

Prayers

[MADAM SPEAKER in the Chair]

Private Business

Scottish Agricultural College Order Confirmationbill

Considered; to be read the Third time.

Oral Answers To Questions

Health

The Secretary of State was asked—

Primary Care

1.

What proposals he has for increasing the role of primary care within the NHS. [18227]

12.

The development of primary care is one of the Government's medium-term priorities for the NHS. We recently launched a salaried doctor's scheme which will improve the quality of services and help tackle health inequalities. From 1 April next year, health authorities will be able to fund local development schemes to improve general medical services. We also intend to proceed with pilots under the National Health Service (Primary Care) Act 1997 to explore more flexible ways of delivering primary care. Our further proposals will be set out in the White Paper to be published at 3.30 pm today.

I thank my right hon. Friend for his reply. Is he aware that general practitioners in my constituency of Gravesham and in the constituency of my hon. Friend the Member for Dartford (Dr. Stoate) have recently developed a highly successful scheme of co-operation? Is he further aware that we have recently opened a minor injuries unit in Gravesend and North Kent hospital, again managed by nurses and GPs, as the first stage to establishing a proper community hospital in the borough? Is not the way forward for the health service putting GPs and nurses in the driving seat and ensuring that they can match local decisions to local needs?

What my hon. Friend says is true and very welcome. Such developments, which we have been looking at and studying, make us confident that the proposals that we shall be introducing this afternoon are going with the grain of the people within the NHS, who are trying to develop better and better services for local people.

Does my right hon. Friend agree that most patients look upon their local nurses and health care professionals as the linchpin of the NHS? Can he assure me that he wants to see places such as Aylesham health centre, Deal hospital and Buckland hospital in my constituency flourish and expand?

What is wanted is a first-class health service, close to home so that people do not have to travel long distances to find primary care, community care and community hospitals. That is what is wanted increasingly by local people and the profession, and we want to help them bring it about.

Is the Secretary of State aware that his emphasis on primary care will be widely welcomed? At a time when the responsibility for developing the health service is shifting increasingly to primary care, is there not something absurd about carrying on the kind of rationalisation of hospitals that is going on now, without any reference to GP preferences? For example, in Kent, the Kent and Canterbury hospital and others are under threat.

As everyone knows, the number and nature of hospitals in the NHS has been changing since the NHS came into being. We are determined to ensure that any changes reflect the needs of people living in a particular area. As I understand it, in the area represented by the hon. Gentleman, the proposals are out for consultation. The new Government want to move to a situation where consultation is genuine and not just a period of time.

Is the Secretary of State aware that Professor Howard Glenerster has suggested that GP fundholding has caused a shift in the balance of power back to GPs for the first time this century? Is the right hon. Gentleman committed to doing everything that he can to build on the success of GP fundholding and extend those opportunities to others?

When our White Paper is published this afternoon, the right hon. Lady will see that we are trying to build on the parts that have worked and dispense with the parts that have not worked.

My right hon. Friend will be aware that Salford has one of the new GP commissioning pilot projects. Despite its unfortunate acronym, the Salford health action group is working tremendously hard to improve the health of the people. Will my right hon. Friend tell us how important he thinks is the voice of patients and users in such projects?

There are some who suggest that I am noted for my vulgarity, but never in the Chamber—or at least, not this Chamber.

My hon. Friend has made a crucial point. We need a national health service that is moulded to the needs of the patients, and the medical and nursing professions are as wedded as anyone to that concept. They are trying to liaise with local people to ensure that the services that they provide meet the needs of local people. We are determined that our changes to the national health service will help to achieve that. I am sure that everyone will be better off as a result.

Herefordshire Health Authority

2.

What plans he has to reduce bureaucracy in the Herefordshire health authority. [18228]

Herefordshire health authority has recently announced that it will be implementing a new management structure which will save at least £100,000 per year. That sum will be available for investment in direct patient care to improve the health of the local population.

I thank the Minister for his answer. Does he agree that the Herefordshire health authority has the widespread support of the people of Herefordshire? Does he further agree that the implementation next April of the Herefordshire unitary authority, with boundaries coterminous with the health authority, will provide an opportunity for excellent co-operation between the local authority and the health authority? Will he give a commitment that his Department will do everything it can to support such co-operation?

We certainly shall—co-operation is in; competition is out. Co-operation is in especially at the boundaries between health and social care. We want there to be much more closely integrated care between health and social services to ensure that people on the boundary of the interface, who are the most vulnerable members of our community—the mentally ill, the disabled and the elderly—get the care and attention that they deserve.

Is my hon. Friend aware of the warm and widespread support for the Government's proposals to reduce bureaucracy and administrative costs in the national health service, which has already contributed to additional money being made available for the treatment of breast cancer? That is very warmly welcomed in my Cambridge constituency.

My hon. Friend is absolutely right. Simply by cancelling the eighth wave of fundholding, we were able to free up £20 million for investment in front-line patient services, £10 million to improve breast cancer services and £5 million to improve children's intensive care services. I hope that all right hon. and hon. Members agree that those are the right priorities for a national health service.

We share the hon. Gentleman's objective of channelling any savings on bureaucracy that he can achieve in the Herefordshire health authority into improving care for people in Herefordshire. By what criteria would he want people in Herefordshire to judge and evaluate his party's stewardship of the national health service?

The people of Herefordshire will be able to judge our stewardship of the national health service very simply—on the proportion of investment that goes into front-line patient services rather than into bureaucracy; on the basis of whether there is an improvement in patient services in Herefordshire and elsewhere year on year; and by whether waiting lists are shorter, as they will be, by the end of this Parliament.

I was interested to hear the Minister talk about funding. Will he promise the people of Herefordshire that the Government will beat the previous Government's record of increasing funding annually on average in real terms by 3.1 per cent?

If the hon. Gentleman had bothered to look at the figures for Herefordshire health authority, he would have noticed that, for the next financial year, the allocations made by this Government will mean an increase in cash terms of 4.69 per cent., compared to 3.38 per cent. for this year under the previous Government.

Distribution Formula

3.

What representations he has received on changes to the distribution formula for allocating resources to local health authorities. [18229]

The allocation formula for 1998–99 was changed better to reflect the health needs of local populations in every part of the country. That was announced on 29 October 1997, Official Report, columns 828–29. I have received no representations on that matter since that date.

I am about to make a representation. Will the Secretary of State confirm that the formula was altered according to deprivation, the effect of which is to channel resources away from rural areas towards urban areas, with the result that the increase for next year will be only 1.35 per cent. in my constituency, as opposed to 2 per cent. nationally? That led to a public meeting in Cirencester, which was attended by 500 people, to protest about cuts in the accident and emergency department. Is it not wholly unfair that resources are being channelled from rural areas towards urban areas? My constituents should have a fair share of the national cake.

As the elected Member for Holborn and St. Pancras—there are few more urban constituencies in the world—I can tell the hon. Gentleman that my health authority received exactly the same percentage increase as his. The changes were made in an effort to introduce more fairness into the allocation. The hon. Gentleman apparently does not know that, for the first time in the history of the national health service, an element of rurality was added to the formula to benefit rural areas. No Conservative Government ever did that, so the hon. Gentleman should be grateful.

I welcome the changes that the Secretary of State has announced. Will they work their way through to Warwickshire health authority where for many years the south of the county, where morbidity figures are low, has received more funding than my constituency of Nuneaton in the north, where morbidity figures are high? Are morbidity figures being taken into account in the new review and the reallocation of resources?

Mortality and morbidity statistics obviously formed a major part of the formula. However, we are not satisfied with the present formula and have set up a group to study it in time for further changes. The aim must be to allocate funds to those areas most in need, and the areas with high levels of mortality and of morbidity—in other words, sickness—must take priority.

I am sure that the Secretary of State will agree that the national health service has been a leader in information technology and getting information to Ministers so that they can deal with problems. Has he read the Financial Times this morning in which professors suggest that the year 2000 problem will affect the NHS badly, and could cause deaths? Is he aware that the IT systems are already overloaded by the work being done on that problem, and that the announcement that he is to make at 3.30 pm in relation to more changes to the IT systems will cause a crisis in IT departments in the NHS?

For a start, only a fool would regard the information technology systems in the NHS as satisfactory. I should certainly not address any laudatory remarks to them. They are incapable of supplying some of the most basic information that people might require. We want the health service to have information systems that help patients and help clinicians to provide better, quicker and more effective treatment. We shall get on with that. Since coming to power, we have taken action to deal with the 2000 problem. The main problem is not in the information technology systems, but in the embedded chips in all sorts of health service machinery, including scanners and other vital equipment in operating theatres. That is being addressed. It will be dealt with, but it will cost money.

Long-Term Care

4.

What action he intends to take to improve the quality of long-term care. [18230]

We are introducing a range of measures to improve the quality of long-term care, including a royal commission on long-term care for the elderly, a long-term care charter, priorities and planning guidance on continuing health care needs for the NHS and proposals for independent regulatory arrangements for care homes and domiciliary care.

My hon. Friend is obviously aware of the warm welcome for the royal commission. Will he assure the House that, when it is set up, he will hurry it up and urge it to reach its conclusions speedily so that care for the elderly can be dealt with as soon as possible?

We share my hon. Friend's concern that the matter should be brought to a speedy resolution. Long-term care for the elderly is a matter of the utmost importance. We have asked the royal commission to report within 12 months. We are determined to replace the delay and prevarication that characterised the performance of the Conservative Government with speed and expedition.

The hon. Gentleman surely cannot deny that, with an aging population and a declining work force, the quality of long-term care will depend increasingly on the ability of people to make some provision for their own health care. Does he not realise that the Chancellor's savage attack on pensions and savings will make that harder—or do Ministers believe that, for the wealthy at least, quality long-term care is best provided by quality, tax-free offshore dosh in the style of the Paymaster General?

Only a discredited relic of the previous Tory Administration could come forward with such a comment. This Government are giving new hope to the elderly. My right hon. Friend the Chancellor is helping the elderly with their fuel bills. We are ensuring that the welfare of elderly people rises to the top of the nation's priorities, rather than remaining at the bottom.

Road Traffic Accidents (Payment Of Care Costs)

5.

If he will take action to ensure that insurance companies pay the full cost of road traffic accident care to NHS trusts. [18231]

Following the statement made by my right hon. Friend the Chancellor of the Exchequer on 2 July 1997, Official Report, column 315, we are taking action to recoup in full the costs that we are entitled to recover from insurance companies for the treatment of road traffic accident victims.

I thank my hon. Friend for that reply, which will please the members of the Norwich community health council who raised the issue with me. Will she consider extending that policy to the treatment of other patients, such as the victims of workplace accidents, many of whom are children?

I thank my hon. Friend for that question. We shall update legislation to make the scheme more effective on road traffic accidents. On other matters, we shall ensure that the principles of a national health service funded from taxation and free at the point of use prevail.

Will the Minister confirm that this is the only occasion on which the Government will ask outside groups to fund a core health service activity?

There is absolutely nothing new about the provision, which has been available since the 1930s. The Government are seeking to update it to make it work and to raise income that can be spent on front-line patient care.

The Minister appeared to agree with the question. May I check her phrasing? Did she agree that the NHS should charge the full cost of the consequences of road traffic accidents or the full entitlement? Are there any plans to alter the entitlement that the NHS can claw back from insurance companies?

As I said in my reply, in redrafting the legislation, we are looking at ways of making the provision work in practice. At this stage, we are considering moving to a tariff system to replace the capped expenditure system that currently applies.

Nhs Trusts

6.

What changes he intends to make to the current role of NHS trusts in shaping local health care. [18232]

The White Paper which will be issued shortly will set out how we shall fulfil our pledge to remove the wasteful competition of the NHS internal market. We shall show how all NHS bodies, including trusts, will play their full part in improving health care.

I thank my hon. Friend for that reply. In examining the role of NHS trusts, will he look especially at major tourist destinations such as Blackpool, which provide for the health care of large numbers of visitors as well as the resident population?

I am aware of the problems faced by local health services in that respect. The thousands of visitors to Blackpool every year usually have a great time—including at the party conferences, when they manage to get there—but occasionally one or two fall ill. The current arrangements do not budget for that and, worse, the health authority has to issue an invoice every single time a patient falls ill on holiday. That is costly and expensive and it is regarded as an anathema by hospital clinicians. If my hon. Friend waits approximately 34 minutes, she may hear some good news.

Is not one advantage of the trust system that it has allowed direct comparisons between hospitals? When a decision comes to be made on the future of the Kent and Canterbury hospital, should not the Secretary of State consider which is the most cost-efficient hospital in Kent, which hospital in Kent is able to recruit and retain the best staff and, above all, which hospital in east Kent has the support of the most general practitioners, who, after all, are the representatives of the patients?

As the hon. Gentleman is aware, the matter is the subject of consultation. If it is contested by one of the local community health councils, it will end up on Ministers' desks, so it is inappropriate for me to discuss the specific issues. Of course the Government recognise the important role of NHS trusts in providing health care for millions of people. We want to build on the success of some NHS trusts, but we want that success to be achieved across the country and to ensure that the shortcomings in some trusts are nipped in the bud rather than allowed to escalate.

Has not one of the worst aspects of the internal market been the way in which it has set GP against GP and hospital against hospital? In overcoming that internal market, is there not an important strategic role for local commissioning groups and health authorities in fostering co-operation? Does my hon. Friend the Minister welcome the review being undertaken by Birmingham health authority, and will he join me in encouraging the fullest public consultation on the proposals in the hope that it will bring Birmingham the capital investment that it has needed for too long?

As my hon. Friend knows, I am aware of the consultation being undertaken by Birmingham health authority. I very much agree that there should be proper public consultation. The review covers public services and the public have a right to expect their voice to be heard. Those charged with the responsibility of shaping and delivering health services in future should operate to a simple maxim: the national health service is a public service—it belongs to the public and should listen to what the public have to say.

I am sure that the Minister will agree that one of the most common pressures on NHS trusts is that of shortage of staff. Given that his answers and official figures show that, at the moment, in England alone, we are short of about 1,000 GPs and there are about 1,500 hospital doctor and more than 8,000 nurse and midwife vacancies, will the Minister assure the House that the health service will be given the money to recruit and fill all those thousands of vacant posts?

The health service is being given the money to deal with such problems. I remind the hon. Gentleman, in case he has forgotten, that, during this year and next year, an extra £1.5 billion will be invested in the NHS in such areas as his. I hope that he will welcome that.

Does my hon. Friend agree that we must consider not only what is happening now but the legacy left by the previous Government, especially relating to debt in trusts? Many trusts, especially those in Northampton in my constituency, are unable to take advantage of our new plans due to the legacy of debt. Will he comment on the desirability of allowing, in special circumstances, extensions to the time taken to pay off debt, which will allow trusts to plan health care more effectively and thus reduce waiting lists?

My hon. Friend makes a very good point. The legacy left to this Government by the previous Government is one of record waiting lists and record debt. That is what we are having to tackle; and we shall tackle it. The Government do not want the NHS to enter the next financial year as it entered this financial year—up to its eyes in debt. That means that difficult and robust decisions will have to be taken. Of course we expect those decisions to be undertaken sensitively. Where it is warranted, I know that the NHS executive will be prepared to discuss with individual health authorities an extension to ensure that debts are paid off over time.

Does the Minister accept that, under the trusts, we were able better to evaluate costs of procedures, and some trusts were doing better than others? Will he acknowledge that the number of procedures has increased the cost to the NHS? The previous Administration forgot that when they were praising the number of procedures undertaken but not funding them. Will the Minister assure the House that, when considering local health care, there will be proper evaluation of pilot schemes, meshed in with trust provisions?

The hon. Gentleman makes a very good point. All incentives under the market system were for NHS trusts to expand their business, regardless of whether that was in the interests of the wider health community—or, i6ndeed, the community in general. In future, we shall be expecting NHS trusts to co-operate and work with one another so that there is maximum gain for patients. Not only doctors and nurses but managers in NHS trusts want that. They want to work together rather than being forced to compete against one another.

In the past, has not federation between NHS trusts on fairly routine services totally ignored the views of the public in consultation exercises? Do not most people want such services to be provided locally and not far from where they live?

My hon. Friend will be pleased to know that, just last week, in Committee, we approved an order opening trust board meetings to the public. That is important because trusts are public organisations and the decisions that they take have a real impact on the local community. In future, there will be no more secrecy concerning NHS trust board meetings and no more commercial, in-confidence information held concerning trust boards. Trust boards and NHS trusts are part of the wider NHS family and they must start acting as such.

Health Authorities And Trusts (Amalgamation)

7.

If he has reached conclusions on the amalgamation of (a) health authorities and (b) trusts; and if he will make a statement. [18233]

The Government have no national blueprint for mergers between health authorities or between NHS trusts. We would seek to encourage mergers of both where that is in the interests of health care in the localities concerned.

I accept that the Secretary of State would not wish to impose amalgamations, but will he encourage amalgamations where small trusts are presently duplicating their administrative costs? If so, will he give some indication of how quickly he would expect savings to take place, especially bearing in mind his comments earlier when he referred to the need to expand front-line services and to encourage the creation and maintenance of local community hospitals? In Cornwall, as the Secretary of State knows, we are currently addressing that problem.

I am a great believer in horses for courses. In many parts of the country, it is right to amalgamate smaller trusts—perhaps two or three smaller trusts or a couple of small trusts with a bigger trust—but in other parts of the country local people and clinicians and, for that matter the NHS regional management, are convinced that keeping some of the smaller trusts in existence may protect services that would otherwise not get the attention they deserve. When proposals come to me, I will assess them against the needs of the people in the area.

Does the Secretary of State accept that the East Cheshire NHS trust has been an outstanding success, not only because of its leadership and the superb support of the executive staff but because it is a united trust that deals with the range of NHS services, including acute services, community services and mental health services. That has been to the advantage of people in Macclesfield. I had a tremendous battle a few years ago to maintain a united trust against what was then the wisdom of separate trusts for virtually every arm of the health service.

The hon. Gentleman reinforces the point that I wish to make. People in east Cheshire are obviously well suited by the present arrangements, but people in other parts of the country do not fancy that arrangement and I do not wish to force it down their throats. As for conventional wisdom, over the years I have observed that it may be conventional but it is seldom wisdom.

Is it not a bit much for the hon. Member for North Cornwall (Mr. Tyler) to whinge about the NHS when my right hon. Friend has provided £10 million extra for health services in Cornwall this year and next? My right hon. Friend knows of the excellent proposal for the merger of two trusts in Leeds, on which all the Members of Parliament for Leeds have been consulted. What criteria will he use to judge whether the merger should go ahead? I hope, however, that he will comment first on the whingeing by the hon. Member for North Cornwall.

My hon. Friend has been in politics as long as I have and he knows that gratitude is the last thing to expect. Every time I come into the Chamber I expect Opposition Members to rise in grateful thanks for the extra funds that we have provided, but I am disappointed.

As a distant observer, I always thought that the merger of the two acute trusts in Leeds was a good idea and I was surprised that, when everyone in Leeds had agreed to it, my Conservative predecessor turned it down. I shall be not unfavourably disposed to the proposition when it comes forward again from the people of Leeds.

Influenza Inoculations

8.

What restrictions are currently imposed on the availability of free influenza inoculations for the public. [18234]

Free influenza immunisation is recommended for people with underlying conditions that put them at most risk of serious illness or death should they develop flu and for people who live in nursing homes, residential homes and other long-stay facilities. Influenza immunisation is not routinely recommended for fit and healthy adults and children.

My hon. Friend will know that, in an average year, 4,000 people die of flu and that in an epidemic year—such as 1989—up to 30,000 die. We have heard suggestions that a particularly nasty epidemic is on its way from Hong Kong. Is she aware that only 3 million—half of the 6 million vulnerable people in this country—have taken their flu jabs? Would it not be a good idea to promote immunisation, because we can prevent many deaths this winter and stop a great cost to the NHS?

I entirely agree with my hon. Friend, who will be glad to hear that, so far, a record 7.1 million doses of flu vaccine have been distributed. Efforts have been made by the chief medical officer to ensure that all GPs and practice nurses are aware of the importance of making flu vaccine available to people who are vulnerable and at risk of suffering serious illness if they contract flu. The drive to maximise the number of people vaccinated this winter against flu is further evidence of the Government's determination to do what works for patient care, based on the evidence of what works as part of delivering a modern and dependable national health service.

Kidderminster District General Hospital

9.

What representations he has received regarding the future of Kidderminster district general hospital. [18235]

The Department has received a number of letters from members of the public, councillors and local Members of Parliament on the future of Kidderminster hospital and health services in Worcestershire generally. As part of its strategic review of services across the whole county, Worcestershire health authority will conduct a formal public consultation during which all of these representations will be taken into account.

The Minister will recognise that any proposal to close accident and emergency services at Kidderminster hospital would be a devastating blow to all those people in north Worcestershire and in my constituency in south Shropshire who are served by the 1,230 members of staff at that excellent hospital, which provides 27 medical services. Does he agree with the hon. Member for Wyre Forest (Mr. Lock), who said in a press release 12 months ago:

"It is a simple matter of funding. We will only prevent further cuts at Kidderminster if the Government provides enough money to the Health Authority to fund the hospital"?

The hon. Gentleman and my hon. Friend make a forceful point which will be taken into account in due course, along with all the other representations made during the formal consultation. Should the matter come to Ministers, we look forward to giving those representations the weight that is their due.

Does my hon. Friend agree that there is considerable anger among the people of Worcestershire who have learnt that the Tory-appointed former health authority was overspending by £8 million to £9 million a year and has run up debts of between £18 million and £23 million—debts that this Government and the new health authority must sort out? That is another example of our having to sort out somebody else's mess. Does he accept that there is concern in Wyre Forest that GPs—who are part of a commissioning group whose proposals include the retention of the accident and emergency centre—have not even had their proposal put on the drawing board for the proposed consultation? Will he see whether that proposal can be included in the forthcoming consultation on the reconfiguration of services?

My hon. Friend makes his point well. It is important that the consultation is wide ranging and takes into account all representations. GPs have an important contribution to make and I look forward enormously to considering their representations on this important issue. Bearing in mind the state of the finances of Worcestershire health authority, I hope that he welcomes the additional £1.5 million that the new Labour Government have made available to the authority to cope with winter pressures. That is the difference between the Labour Government and the Conservatives; they mismanage, but we manage more effectively.

Nhs Building Projects

10.

How many NHS building projects costing over £1 million have been completed since 1979. [18236]

The national health service reported the completion of capital schemes costing more than £1 million only between 1980 and 1985.

Will the right hon. Gentleman acknowledge that £25 million of the money spent during that period was spent creating a full district hospital and 24-hour accident and emergency service at the hospital in Margate that proudly bears the name of Queen Elizabeth the Queen Mother? Will he join me in congratulating the medical staff, nurses and administration team who have achieved a state-of-the-art hospital that serves the people of Dover, Deal, South Thanet, North Thanet, Herne Bay and other areas of south Kent? Will he take the earliest opportunity to ensure that the work of that hospital is not only continued but enhanced?

Given the state of my voice, I will not risk repeating a Cook's tour of Kent. I would like to congratulate the staff of the national health service in every part of the country who have kept the faith and kept us reasonably well and healthy for all these years. I hope that they will be able to continue to do so.

Going back to the original question, is the Secretary of State aware that since 1979 the people of Carlisle have been waiting for a new district general hospital, which was cancelled four times under the previous Government? The go-ahead was given only when we got this new Labour Government. We have started work on the site and the people of Carlisle will have a brand new hospital for the millennium.

I agree entirely with my hon. Friend and I am only sorry that I was unable to attend and, so to speak, cut the first sod.

Given that the level of capital investment in the national health service is important—I am sure the Secretary of State agrees—will he explain why his Department issued a press release on 29 October stating that the level of capital investment in the NHS next year would rise by 2.3 per cent. in real terms, when, as the Department now admits, that was incorrect and the level of investment will rise by only 2.3 per cent. in cash terms?

It is certainly the case, on the basis of the figures in that press release, that the increase is in cash terms, and I apologise for that. In all the years that I was in opposition, I issued thousands of figures and only once got one wrong. In government, I do not intend to issue information that is wrong. We are taking steps to ensure that it does not happen again.

Nhs (Non-Executive Posts)

11.

If he will make a statement on the qualifications required of appointees to non-executive posts on health trusts and similar organisations within the NHS. [18238]

The Government's new criteria for choosing who should serve as chairs or non-executive directors of health boards are designed to make the boards more representative of the communities they serve and to encourage more NHS users and carers to become board members. Candidates should normally live in the area served by the trust or health authority and be able to demonstrate a strong commitment to the national health service and the local community.

I thank my right hon. Friend for that helpful reply. Can he assure us that at least some of the new members will be sympathetic to the aims of a Labour Government? Will he also assure us that the trusts will not remain stuffed full of Conservatives?

I think that I can safely assure my hon. Friend that the odd person sympathetic to the objectives of the NHS has certainly crept on to some boards since we have been making the appointments. In all seriousness, there are Conservatives chairing and acting as non-executive directors of health trusts and authorities who many of my colleagues have said have done a good job, and a substantial number of them have been appointed. Also, a member of the former Conservative Cabinet has been appointed. As far as I know, no one has accused me of political fiddling in appointing Mr. Tony Newton as the chair of one of those boards.

I thank the right hon. Gentleman for his pragmatic approach. Does he agree that what matters is not people's political persuasion but whether they can do the job well, because it is an extremely important job? Does he accept that I fought tooth and claw to have a strong Labour supporter appointed to the board of Crawley hospital because he was an excellent man for the job and did it extremely well? Will he examine all the cases personally to ensure that the process does not become a political charade and that those who are absolutely qualified to do the job are appointed?

I congratulate the hon. Gentleman, as it is indeed the case that he moved heaven and earth to get a Labour supporter appointed to one of his local boards because he thought that he would do a good job. That is what I want to do. I emphasise the fact that no nominee has come to my ministerial colleagues or me who has not been subject to the full Nolan procedure and a process involving independent members and the regional chairs of health authorities, at least half—indeed, seven out of eight—of whom were appointed by the previous Government. If Conservative Members do not like the nominations that are being made, perhaps they could speak to the people they appointed.

Professional Training

14.

What extra financial support he has made available for professional training in the NHS. [18243]

The NHS will spend around £1.8 billion on health professional education and training this year. On 30 September, my right hon. Friend the Secretary of State announced that these budgets would be increased by a further £50 million next year.

What professional training would my hon. Friend expect the NHS to provide to enable people who are currently in administrative work—especially work connected with the internal market—to move into patient care: people such as my constituent Christine Dowsett, who moved from secretarial work to patient care and is building a satisfying new career?

My hon. Friend's constituent is but one example of the way in which the Government are discharging their promise to move money and, therefore, in many cases people from jobs that involved red tape, bureaucracy and paper chasing in connection with the internal market, to front-line patient care. Our provisions for training in the national health service recognise the diversity of skills with which staff need to be equipped in order to deliver the modern and dependable care that people have a right to expect.

Does the Minister realise that all the GP fundholders in Lichfield do not want to be retrained in new systems? They think that the internal market, as she and the spin doctors call it, is a mechanism for providing the best care for their patients. They do not want more training: they want the status quo. What does the Minister say to them?

I am sure that the hon. Gentleman will be here in eight minutes' time to hear my right hon. Friend set out the Government's proposals for rebuilding the national health service and ensuring that his constituents have access to the quality of primary and hospital care that they have a right to expect.

Can my hon. Friend assure me that, in the light of the small trusts that collapsed and were clearly a disaster under the Conservatives, such as Rugby national health service trust, which left us with rubble in place of a robust local health service, there will be clear criteria and guidance to protect local services that should be delivered locally and should not be taken away by predatory, larger, neighbouring trusts?

My hon. Friend knows that mergers involve ensuring that any staff who are affected receive the training that they need to adapt to new circumstances, and that the situation that he described is currently subject to consultation.

Health Authority Funding

15.

What progress he is making towards aligning health authority funding with proposed targets under weighted capitation. [18244]

For 1998–99, under their capitation targets, health authorities received real terms increases in their allocations above the average of 1.9 per cent. and up to 2.65 per cent. As a consequence, more than 90 per cent. of health authorities will be within plus or minus 5 per cent. of their target as set by the national weighted capitation formula.

Is the Minister aware that Berkshire health authority was £19 million under capitation this year and is due to be another £13 million under capitation next year? That is having a cumulative effect and, as a result, health services in Berkshire are nothing like what they should be. That is unfair to the people of Berkshire. Will he make progress towards targets more quickly in future?

If the hon. Gentleman had bothered to examine the figures he would realise that, as a consequence of our changes to the funding formula, Berkshire health authority is closer to its weighted capitation target than it was under the previous Government. It might be worth reminding Liberal Democrat Members of the general largesse that this Government have spread around the NHS and particularly of the figures for health authorities covering Liberal Democrat-held seats: an extra £42.5 million this winter; an extra £257 million for next year; an extra £2.2 million for breast cancer funding; and an extra £1.6 million this year for children's intensive care. A bit of gratitude would not come amiss.

Is not the real unfairness of weighted capitation that which exists between expenditure on health in England and in Scotland? Is it not wrong that 25 per cent. more per capita is spent on health in Scotland than in England? Is that what the Deputy Prime Minister had in mind when he said that we were going to have a fundamental review of regional distribution of moneys?

I remind the hon. Gentleman that the formula has been in operation for the past 18 years; I did not hear him complain before.

Will my hon. Friend confirm that Berkshire health authority will receive £15.5 million extra next year? Does he agree that the hon. Member for Newbury (Mr. Rendel) should be glad that there is a Labour Government because we have already pledged twice as much money as the Liberals promised at the general election?

My hon. Friend is right. The cash increase for Berkshire health authority will be an extra 5.25 per cent. I hope that all hon. Members welcome that and, most important, that it will be welcome in respect of patient care.

Bureaucracy

16.

What action he is taking to reduce bureaucracy in the national health service. [18245]

The Government are committed to maximising the proportion of health service resources devoted to patient care. We are doing that by removing the bureaucracy of the internal market and reducing management costs. On 22 May, we announced a programme of measures to start reducing bureaucracy by £100 million this year. By deciding not to proceed with the eighth wave of GP fundholding, we saved £20 million that had been earmarked for bureaucracy and nothing more; £10 million of that has already been invested instead in better breast cancer treatment for women in every part of the country and £5 million has been invested in improved children's intensive care. I cannot believe that anyone other than a shareholder in a paper company would not think that that money is being better spent.

I thank my right hon. Friend for that excellent reply. Will he join me in welcoming the news in this morning's press that he intends to save an extra £1 billion in the next few years from red tape and to put it directly into patient care? Labour Members believe that every pound that he puts into patient care at the expense of bureaucracy is welcome.

Does the Secretary of State agree that the key to reducing NHS bureaucracy lies in the decentralisation of service, budgeting and management?

Well, we had—[HON. MEMBERS: "Answer."] I shall answer. Those who have been following what has been happening with cancer screening might have noticed that the cervical and breast cancer screening schemes have both been failing because they are too decentralised. We cannot assume that everything should be decentralised, whatever the circumstances. However, we want to devolve as much power, authority and influence as possible to the doctors, nurses and other professionals who do the work in the health service.

Patient Care

17.

What steps he is taking to improve the monitoring, analysis and reporting of (a) the outcomes and (b) the quality of patient care. [18246]

The national health service White Paper, on which my right hon. Friend will make a statement to the House in three minutes' time, will set out a range of means by which the Government will seek to improve quality and outcomes for patients, which are at the heart of our determination to rebuild the NHS.

It is obvious that patients care most about successful outcomes. What steps are being taken to share the evidence of successful treatment and to compare the performance of different areas of the health service to ensure that we achieve the best possible value and the greatest number of successes in treating patients who seek help from our NHS?

My hon. Friend is right: nothing matters more to patients than knowing that the treatment that they receive will work and that effective treatment is available to them regardless of where they live.

Clerk Of The House (Retirement)

3.30 pm

I have a brief statement to make to the House. I have to inform Members that I have received the following letter from the Clerk of the House:

"I am writing to confirm to you my decision to retire as Clerk of the House on 31st December of this year.
I have greatly enjoyed my years in the service of the House, which began in October 1956, and I have felt it to be a signal honour in the last three years to hold the office of Clerk.
During my time there have been many changes in the House's processes and a great acceleration in the activities of committees. The House has taken control of its own finances, administration and works, and more recently has implemented the Jopling Report and dealt with the recommendations of the Committee on Standards in Public Life. No doubt other reforms will be implemented during the lifetime of this Parliament—proof, if any were needed, of the resilience of the institution and of its deserved place in the esteem of the legislatures of many countries in the Commonwealth and beyond.
The six House Departments and other support staff such as the police, as well as the staff employed by Members, all have important roles to play in securing the effectiveness of our parliamentary system. I believe they have responded constructively to the need for change and I am grateful to them for their support whilst I have been Clerk. Finally, I pay tribute to the understanding and friendship of successive Speakers, especially yourself, and of Members on all sides. It has been a great honour for me to have served in this place. Yours sincerely, Donald Limon."

Madam Speaker, your announcement signals the end of the distinguished period of service to the House of Sir Donald Limon, and will be heard with regret by all. I look forward to expressing my appreciation of Sir Donald's work when we debate a motion on his retirement. Our normal practice is to postpone until then the tributes that we would like to pay to him.

National Health Service

3.33 pm

In good times and in bad, I have always been proud to be a member of the Labour party and I have never been as proud as I am today, as a Labour Secretary of State for Health to announce the publication of our proposals to renew and modernise the national health service, which our party founded. These are set out in our White Paper "The New NHS".

This White Paper is a turning point for the health service, the 1 million staff who work in it and all of us who use it. This Government were elected to save the heath service. We were also elected to change it for the better. We want to give it a new lease of life. Today we outline a 10-year programme of modernisation which guarantees that the NHS will get better each year—delivering quicker, higher-quality services for patients. The pace of change will be measured, but each year will bring new and visible improvements. Our plan is to give our country a modern and dependable health service that is once again the envy of the world.

We will make a start straight away. The White Paper abolishes the wasteful and bureaucratic competitive internal market introduced by the Tories. It sets out how services will respond more readily to patient needs, and describes new targets against which performance will be judged. Doctors and nurses will be in the driving seat. It spells out a whole new approach that we have called integrated care. It will break down the Berlin wall between health and social care, so that patients get swift access to care and treatment rather than being passed from pillar to post.

The changes we are outlining today will put quality, fairness and efficiency at the heart of the national health service. Quality will give patients a guarantee of excellence wherever they live. Standards will be raised right across the country. Fairness will give patients an NHS that is there for them when they need it, where they need it, regardless of their ability to pay—a one-nation NHS. Efficiency will deliver more money for patient care. There will be a relentless drive to cut out waste and unnecessary bureaucracy.

We will abolish the internal market, because it has failed. It has failed to deliver quality of care, fairness for patients or efficient services. It has set doctor against doctor, and hospital against hospital. Its business culture has been at odds with the ethos of the NHS and those who work within it. Patients want an NHS where staff can work together to provide better services, rather than having to compete against each other.

When I became Secretary of State, I promised that we would listen to the people on the front line—the nurses and doctors, midwives and other professionals and staff in the NHS. We have kept that promise. We have listened. That is why our proposals go with the grain. We are building on what has worked; we are discarding what has failed. For us what counts is what works. There will be no return to the command and control structures of the 1970s. Nor will there be a continuation of the divisive fragmentation of the 1990s. Instead there will be a third way—a new model for a new century.

We will keep the separation between planning and providing services, but we will end competition and replace it with a new statutory duty of partnership so that local health services pull together rather than pull apart. We will end fundholding and replace it with primary care groups in each area, putting doctors and nurses in charge of shaping services for all patients. We will end the culture of secrecy and commercialisation, and replace it with a new duty of openness that will share best practice for the benefit of all patients. We will end short-term contacts, cost per case contracts and extra contractual referrals, and replace them with long-term agreements that offer stability and focus on quality.

Our detailed proposals for doing all that are set out in the 81 pages of the White Paper. The proposals will cut the number of commissioning bodies from around 4,000 to about 500.

We will set up primary care groups involving family doctors and community nurses in every area. They will be responsible for commissioning services for their local communities, and will account to health authorities for their activities.

General practitioners and community nurses will have a choice about the form their primary care group takes. For example, they will have the power to become free-standing primary care trusts, able to run community health services, including community hospitals. They will have a single unified budget, no part of which will be capped; so money will always be there to guarantee that patients get the medicine they need, when they need it.

The new unified budget will give GPs maximum choice in how patients' needs are met. All primary care groups will work closely with social services to provide properly integrated care.

For the first time, NHS trusts will have a statutory duty to co-operate with other parts of the NHS and to meet quality standards. They will remain responsible for treatment and care, and hospital doctors and nurses will have a greater say in shaping local services for patients.

Over time, health authorities will relinquish most of their commissioning responsibilities. They will be leaner organisations with stronger powers. They will draw up long-term programmes for improving the health of their area—in consultation with local NHS trusts and primary care groups, but also with local authorities, voluntary bodies and education and research institutions. The health improvement programmes will provide the broad framework for local action to improve general health and health services.

All of us who use the NHS deserve a guarantee of excellence. There will be new national action to extend quality and efficiency into every part of the NHS, backed by a new performance framework that will measure what counts for patients.

There will be a new National Institute for Clinical Excellence to give a strong lead on clinical and cost effectiveness, drawing up new guidelines from the latest scientific evidence.

There will be new national service frameworks—on the lines of the Calman-Hine frameworks, which have worked so well in cancer treatment—that will guarantee consistent access to services and quality of care for all patients. The frameworks will draw on the best evidence available to establish the best ways of providing particular services.

To underpin the drive for quality, there will be a new commission for health improvement, to spread best practice and tackle shortcomings.

Patients will also have a guarantee that public money is being used to best effect. NHS trusts will no longer be competing, but they will be comparing: comparison, not competition, will drive efficiency. A national schedule of comparative costs of treating different conditions will be drawn up, and each NHS trust will be judged against it.

Management costs will be capped. There will be clear incentives and sanctions to drive performance improvements at every level. Trust performance will be benchmarked for both quality and efficiency, and the results will be made available to the public.

Over the lifetime of this Parliament, we estimate that the changes will shift an extra £1 billion from bureaucracy into front-line patient services. That will be on top of the extra £1.5 billion that the Chancellor has made available this year and next year for the NHS. We will continue to raise spending in real terms every year on the health service.

The changes will give patients a modern and dependable health service that makes best use of developments in modern medicine and information technology, to offer readily available high-quality services.

We have already promised to cut waiting lists. We will have done so by the end of this Parliament. I announce today three new milestones by which people will be able to chart our progress towards the new NHS.

First—at home—everyone will be able to contact NHS Direct, which is a new 24-hour telephone advice line staffed by nurses. Three pilot care and advice helplines will begin in March 1998. By 2000, it will cover the entire country.

Secondly—at a community level—patients will benefit from quicker test results, up-to-date specialist advice in their own doctor's surgery and on-line booking of out-patient appointments by connecting every family doctor to NHSnet, which is the NHS's own information super-highway. Demonstration sites will be in operation in 1998, and the services will be available to general practitioners across the country by 2002.

Thirdly—in hospitals—everyone with suspected cancer will be guaranteed a specialist appointment within two weeks of their GP deciding that they need to be seen. That will start in 1999 for every woman with suspected breast cancer, and be extended to all other cases of suspected cancer by 2000.

We have great ambitions for the national health service. We will take on those who say that the NHS has had its day, and all we can do is preside over its decline. We will work with the 1 million people who make the NHS so special, even now, to turn it into a modern and dependable service for the coming century.

We know that doctors and nurses and all the staff of the national health service wish to rid themselves of the unfairness and inefficiency of the current system. That is our ambition, too. It is what they want, and it is what the people of this country want.

Next year, the national health service celebrates its 50th birthday. The Labour party that founded the national health service is now setting about modernising it to prepare it for the challenges of the next 50 years: a new national health service, drawing on new technology, new drugs, new quality standards and new ways of working; a new national health service, based on its timeless principle that the best health services should be available to all—the best for all, quality and equality for the new century.

The dilemma facing the Secretary of State in formulating policy is the same one that faced us. His policy objective is one that we share—to improve the quantity and quality of patient care—but that is difficult to achieve in the context of an aging population, medical advances, rising expectations and limited money.

What all that calls for is maximum financial efficiency and maximum clinical effectiveness, and the structure of the national health service needs mechanisms to drive that. We did that when we were in office. We introduced general management and we introduced the purchaser-provider split to separate commissioning from delivery of service, which allowed trusts to get on with providing services.

We gave contestability of contracts to provide some choice between providers. We instituted fundholding, which put money and decisions as near to patients as possible. I remind the House that, although the Labour Government are adopting many of those principles today, they opposed them all when they were suggested.

Those mechanisms drove change. When the Secretary of State and I talk to trusts—although I doubt the Secretary of State asks this question, because he will not want to hear the answer—they say that most of the change achieved in the past five years has been driven by GP fundholders, not by health authorities. In a recent survey, 85 per cent. of the trusts surveyed said exactly that, and 70 per cent. of those said that the changes that had been driven had benefited all patients, not just those of GP fundholders.

Of this country's GPs, 58 per cent. have chosen to become fundholders, and more than 60 per cent. of this country's patients are patients of fundholders—they, too, believe that the change has been effective, and 93 per cent. of them wish to retain their practice-based budget. Almost all academics and health economists agree with that, and their criticism of us is not that we instituted an internal market, but that we never really let it work.

What is crucial is who holds the budget. Fundholders were happy to take that on, balancing their clinical freedom with financial responsibility. If the Secretary of State's commissioning groups do not have that same power, they will not achieve the same results or, indeed, the better results to which he aspires.

I welcome the Government's acceptance of many of the principles of the internal market. I welcome the retention of the purchaser-provider split, with the choices that that allows. I welcome the retention of the principle of a primary-care-led NHS. I welcome GPs remaining in the driving seat in developing primary care and commissioning secondary care. All that builds on principles that were established by our reforms. I congratulate the Secretary of State on accepting and building on those reforms, as his colleagues will find he has done when they take the time to read the White Paper.

However, I am concerned that the new group commissioning model is being imposed on all GPs, and that it may prove too prescriptive. There has been enormous value in the variety of commissioning models that have developed in the past five years, including fundholding and multifunds on one side, and commissioning groups of non-fundholders on the other. We cannot support the total abolition of fundholding, and we shall work over the coming weeks to persuade him that, within his group commissioning model, practice-level budgets should continue for those GPs who want them.

There is a danger that the loss of independence of fundholders will lead to a loss of the initiatives that they have developed for their patients—for example, more patient services available within practices, not in hospitals—and of improvements in hospital services that have been driven by fundholders.

We shall press the right hon. Gentleman to allow maximum flexibility in his new commissioning group structure, and let GPs choose control over practice-based budgets where that is what they want. I am not sure how groups of 50 to 60 GPs will manage to agree anything. If they cannot agree and if they cannot devolve budgets, there is a danger that they will become mini-health authorities.

Flowing through the White Paper—notwithstanding what I have welcomed about it—there is a touching old Labour faith in co-operation and good will; but these new commissioning groups will succeed only if they have the power to make real choices. If the new commissioning groups are not flexible and cannot make real choices to influence providers, they will not achieve the objectives that the Secretary of State has set for them.

The White Paper is unclear on a couple of points. The right hon. Gentleman will appreciate that I have not had a chance to study it in detail, but I should be grateful for some clarification. Will the commissioning groups be able to make choices among secondary care providers? Will they be able to devolve part of their budgets internally within the groups? Will the Secretary of State try to ensure a full day's debate on the White Paper in the new year, once we have all had a chance to study it?

Is the Secretary of State's model for GP commissioning open to further suggestions? Will it give GPs the flexibility to develop commissioning in ways that they may choose—perhaps different ways in different places? Will GPs be compelled to use a particular hospital, or will they be able to choose which hospital to send patients to?

What does the right hon. Gentleman have to say to the 58 per cent. of GPs who have chosen fundholding, or to the 93 per cent. of this group who say that they want to keep practice-based budgeting? After all, they number more than half the country's GPs. Why should they be prevented from improving patient care as they wish?

Will the Secretary of State in due course—perhaps not today—detail how the £1 billion that he says will be saved from reduced red tape will be achieved? Can he promise us today that, under Labour, the number of qualified nurses will increase by at least 3,000 a year on average, as it did under the former Government? Can he promise to beat our record of increasing the number of in-patient and day cases treated by an average of more than 4 per cent. a year? Above all, can he promise to beat the previous Government's record of increasing national health service funding by more than 3 per cent. a year in real terms?

We and the British people will judge the right hon. Gentleman's stewardship of the Department, and these reforms, by those exacting standards.

The response of the hon. Member for Stratford-on-Avon (Mr. Maples) suggests that the country believed that we had a sort of NHS nirvana until the end of April 1997. Most people do not like what has happened to the health service; most people working in it do not like it, either. They find it wasteful and unfair to patients. They do not like the fact that those working in the NHS have been forced to participate in activities that they find unfair and unpleasant.

It was not I who described the effects of the internal market on doctors as repugnant: it was Sandy Macara, the chairman of the British Medical Association, who said that the present system is repugnant to doctors. What is more, he did not try to single out doctors in the way the previous Government tried to.

My hon. Friend the Member for Rugby and Kenilworth (Mr. King) spoke earlier of a problem that had arisen in Rugby because of the internal market: nothing was done, nothing could be done. GPs, whether fundholders or non-fundholders, could not bring about any improvements in the hospital in question. As a result, the people of Rugby have been punished, in effect, by having their hospital taken away from them. Our proposals to establish quality standards and ensure that they are met, and to give more power to GPs and community nurses, will prevent just that sort of episode.

The hon. Gentleman asked me whether GPs will be allowed to send patients to the hospital of their choice. He actually used more obscure language, but I think that that is what he meant. Before the previous Government's changes, a GP could send patients to any hospital in the land. It was that Government who introduced restrictions; we, of course, will allow GPs to do so again. But we must not put GPs in the position of not wanting to send people living in Rugby to Rugby hospital because it is not good enough. They should not be forced to send people to Coventry for a decent level of care. We need to ensure decent care in every hospital in the country. The Tory system has failed to deliver that.

The hon. Gentleman spoke mockingly of a
"touching old Labour faith in co-operation and good will"
I plead guilty to that any day; most doctors and nurses would plead guilty to it as well. They were horrified that their management sometimes told them that they were not allowed to co-operate with the hospital down the road because it might undermine their commercial position.

I have talked to nurses and to cardiac surgeons who tell me that, for commercial reasons, their management prevented them from disclosing to others and publishing scientific papers about improvements in treatment because that local management thought that it would undermine the competitive position of the hospital for which they were working. We will be getting rid of all those absurdities.

The hon. Member for Stratford-on-Avon talked as if everything had worked well. We have to get down to the solid examples of what was going on. Under the present arrangements, we have, in theory, national standards for cervical cancer and breast cancer screening. There is no statutory obligation on the trusts carrying out the screening to meet any of the quality levels that have been established. Virtually their only obligation is to break even, and, under the previous Government, an increasing number could not even do that.

We are putting in place a system that will set standards and place obligations on those who are responsible for meeting those standards. They will be obliged to meet them, and we will put in place quality assurance arrangements which will ensure that they do meet them. Doctors, nurses, midwives, other professionals, non-professionals and managers in the health service have told me that they want the sort of things that we are proposing. If the hon. Gentleman thinks that what we are proposing today will be unpopular with the professions concerned, he should wait for a day or two and see what their response is.

I offer a warm welcome to my right hon. Friend's statement, which will be widely welcomed throughout the country. One of the consequences of the previous Government's record on the NHS is that I regularly find myself writing five, six, seven or more separate letters about one constituent's problems because of all the various agencies which were brought about through the previous Government's fragmentation of the NHS. That occurs particularly where we have an overlap between health and social care.

Can my right hon. Friend say a little more about his proposals to break down what he rightly describes as the Berlin wall between health and social care? If my right hon. Friend goes back to 1974, he will see that, historically, one of the most damaging decisions for health care in this country was that of Sir Keith Joseph, when he removed from local authorities the public health function and started to create the confusion that has reigned ever since on the issue of social care and health care.

I thank my honourable and good Friend for his welcome for what we have announced today. We are trying to address exactly the point he made about patients and the people representing them being badgered and passed from pillar to post because of the need to approach half a dozen agencies within the national health service and the local authority in order to get proper care for somebody.

It is difficult enough for a Member of Parliament, and it must be almost impossible for some poor old lady who probably cannot see very well or has other problems. My hon. Friend obviously shares my view that the touching faith in co-operation and good will might apply there as well as in the arrangements we are making. We will be producing a further White Paper on social care at the beginning of the new year.

On public health, the chief medical officer, Sir Kenneth Calman, is presently looking at how best to deliver the public health function at national and local level. I have not yet seen his report, but I would expect that he might see a greater role for local authorities, which used to play a bigger part than they do now.

A serious White Paper on the future of the NHS is very welcome. As today's successor to the party which was the other parent of the NHS, we will always be constructive in battling for the best publicly funded national health service. We will support the right hon. Gentleman and his colleagues in everything they do to achieve that.

Where we differ, it will not be personal antagonism; it will be because we have a different view of how to get there. That will always be the basis of our criticism. Like other hon. Members, I hope that we have an opportunity for a full debate early in the new year when we have all had the chance to consider the White Paper—as we will carefully—and give a response in due course.

The big questions for the Secretary of State are those asked outside this House: what will the health service do, and will there be the resources to pay for it? However welcome a National Institute for Clinical Excellence may be, there will still be two sorts of rationing for health service patients. First, for this Parliament at least, some 1 million people at a time are likely to be rationed by waiting lists. Secondly, there will still be rationing by post code—or will it be the case that, no matter where people live, they will always have access to exactly the same services as everybody else? That is a main cause of complaint now.

Is there really proof that the proposed system for commissioning will be much more cost-efficient than the present one? There is some evidence to the contrary. Where is the evidence that it will be more accountable? Many of us believe that representatives of the public, democratically elected—not professionals—should choose the priorities in health and social care. The White Paper appears to place more power in the hands of professionals.

Of course we welcome saving money from thousands of unnecessary contracts, if that is the case. However, will the right hon. Gentleman assure me that claims that, for example, £1 billion will be saved in bureaucracy—that is the figure in the White Paper—will be independently verified, as opposed to just being the subject of Government pronouncement and spin doctor repetition? It is a high figure: 10 per cent. of the management costs of the health service. I want the right hon. Gentleman to confirm that he really does believe that 10 per cent. of management costs can be saved during this Parliament.

I have two final points. First, will the right hon. Gentleman confirm that the internal market is not being abolished? The Tory internal market is being abolished, and we welcome that, but, if there are purchasers and providers, and if there are contracts—even if they are called service agreements—the reality is that there is a market. Or is the right hon. Gentleman saying, as he did in the Rugby example, that there will be no opportunity for a purchasing doctor to choose to go outside his area if he so wished? [Interruption.] If there is to be choice, there is a market, and if there is a market, it is continuing—

Order. The hon. Gentleman made the point that we will debate these matters in full in a few months' time. I appreciate that he is the Liberal Democrat spokesman, but even so he is taking an inordinate length of time. There must be 50 or 60 Members trying to catch my eye, and there is no way in which even half of them can be called if this continues. I want just one question from each Member called, and then I shall wind up questions on the statement.

Will the Secretary of State say whether, as well as his good aspirations, the Government intend to increase, in real terms, the amount of public wealth spent on national health? We get it on the cheap. Will there be not just the plans, but the resources that the NHS needs?

I do not know whether I dare welcome the hon. Gentleman's welcome for the White Paper. It is a serious and solid document, and I pay tribute to my hon. Friend the Member for Darlington (Mr. Milburn) for the enormous amount of hard work that he put into its preparation.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) raised a huge number of topics. I shall try to reduce that to a few points. First, there will be massive reductions in the number of transactions within the NHS and the number of people carrying out those transactions. The commissioning will come down from between around 4,000 bodies of one sort or another to about 500. That will have parallel beneficial effects on those dealing with them.

There is no internal market. There cannot be a market unless there is competition, and there is not going to be competition. Generally speaking, most GPs in York, for example, where I came from originally, want to be able to send their patients to York district general hospital, because it is the local hospital and because it is convenient for patients and their relatives.

GPs want the hospital to be absolutely top-notch, but, unlike under the present system, they will be able to send their patients to Leeds, Sheffield or wherever for specialist treatment if they so choose. We cannot have the situation that arose in Rugby, when nothing happened, the hospital went down the drain, and the population of the area were punished for the failures of management within the NHS. That is what we are going to avoid. There will be massive reductions in costs.

Yes, we want to apply national standards. Our arrangements are intended to tackle and eliminate the gross variations in treatment and quality, but I come back to one point: despite everything that has happened, for most people in most parts of the country and for most of the time, the NHS does a damned good job, and they are grateful.

What is to be the form and function of the proposed National Institute for Clinical Excellence?

It is intended to bring together the various professionals to consider the latest evidence on new technology and new drugs, to assess their value and decide which ones are worth pushing, and in effect brand some things as good for the NHS. It will then be up to the rest of the machinery to get on with it, but the process will be led by the professionals. The standards applied will have to be acceptable to the professions. I hope that the institute will be successful.

The proposals represent more evolution and modification than some of the destructive and extremely negative comments that the Labour party made in opposition, but what specific targets is the Secretary of State planning to set?

As my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) said, over the past 18 years, the average increase in spending has run at 3 per cent. in real terms, whereas the right hon. Gentleman is looking at 1.7 per cent. in real terms. He has to do more with less. The only specific target announced so far was to take 100,000 people off the waiting lists, but that was followed by the biggest increase in the number of people on waiting lists that the NHS has ever known. What are the targets, and what redress will there be if the Secretary of State fails to meet them?

I should have thought that the right hon. Lady knew from her experience as Secretary of State that, when anyone starts reciting figures about the money that has been spent on the health service, the public switch off. They switch off if I do it, and they certainly used to switch off when she did it. After all, she was found in several opinion polls to be the least sincere politician in Britain, and God knows there is a lot of competition.

People will see change and improvement in the national health service year in, year out, because we will bring together the people working in the service—doctors, nurses and others—rather than have them working against one another. They will be improving standards, we will be putting in place the appropriate machinery, and we will be increasing the money available to the NHS in real terms year on year.

The right hon. Lady was a member of the Government who set the last budget. This year and next year, we are finding £1.5 billion on top of what her Government intended to find, so a period of quiet from her might not be a bad idea.

On behalf of community nurses and other health professionals, I congratulate my right hon. Friend the Secretary of State. He is proud, we are proud, and I know that Aneurin Bevan would be particularly proud. I welcome the shared role of community nurses and general practitioners. Will my right hon. Friend enlarge on how he envisages the development of the role of community nurses?

There will be a greater role for all nurses who want to increase their contribution, and who have the necessary and skills and training. Community nurses will play an important and influential role, along with general practitioners, in the commissioning process.

Commissioning is not the only issue. One of the problems of the previous system was that the organisation of general practitioners centred on purchasing hospital care. More joint effort and thought should be put into improving primary and community services.

As an honorary vice-president of the Royal College of Midwives, I congratulate the Secretary of State on reversing the fragmentation that was occurring in the national health service, and ensuring that it is an integrated, seamless service. Does he accept that there is some concern about the abolition of fundholding, because fundholding practices provide the widest range of medical services at a doctor's surgery or medical centre rather than a hospital, saving the health service money? Will he give an assurance that his reforms will not bring that to an end?

I thank the hon. Gentleman for his welcome. I have said this before and I shall say it again: he has made a singular contribution—an honest, decent contribution—to health debates. He has always stuck to his guns, and I respect him for that.

We are trying to ensure that the best manifestations of fundholding, together with the big improvements that non-fundholders have made in recent years, remain and strengthen the system. We want to eliminate the disadvantages. We may even manage to convince a substantial number of fundholders. Indeed, I think that we may have convinced them already.

Does my right hon. Friend accept that the White Paper will be warmly welcomed by those doctors and health care workers who have pioneered locality commissioning schemes, such as that in south-east London, on the basis of co-operation and good will in the face of Tory market dogma? The range of services they provide is the envy of many fundholders. Will he confirm that, at long last, doctors and nurses will be put in the driving seat for decisions about the treatment that patients should get?

I can certainly confirm that we intend that doctors, nurses and other health care professionals should be in the driving seat. As for fundholders, as those hon. Members who were at Health questions know, we have established 42 pilot commissioning schemes, most of which involve fundholders from those areas who volunteered to take part.

Multifunds and similar ideas are steps away from the individualistic aspects of fundholding—a recognition that, when all the doctors, community nurses and other primary care professionals in one area get together, they can be more influential and have more scope and choice than when they act as individuals. I know that that may sound a trifle socialistic; but it is true.

Will the right hon. Gentleman assure me that the reforms to the functions of health authorities will ensure the future of joint hospitals trusts, such as the Mount Vernon and Watford Hospitals NHS trust in my constituency? There must co-operation between the commissioning health authorities in a locality rather than competition. The York model, together with the limitless funds supposedly available for general practitioners in the future, should ensure that they will be able to commission services in the local hospital, which my constituents and those in Watford greatly appreciate.

I do not like making promises that I cannot guarantee to deliver, and I certainly cannot guarantee the future of any particular hospital when it is raised in the Chamber as it has just been. I would expect GPs in the hon. Gentleman's constituency to try to make sure that the best secondary hospital services were available to their patients as near to their patients' homes as is sensibly convenient, and reasonably cost-effective. I hope that everyone involved in the health service in the area will co-operate to that end. I welcome the hon. Gentleman as an obvious co-operator among the wild competitors opposite.

Does my right hon. Friend agree that the abolition of the Tory internal market will result in the abolition of the senseless competition between NHS organisations such as hospital trusts? Instead of sharing expertise and information and co-operating with each other, they have been tempted to compete against one another, to the detriment of us all.

I can certainly confirm that, in future, trusts will have a statutory obligation to deliver services to the quality standards that have been laid down. They will also be under a statutory obligation to co-operate with other parts of the national health service. It is a pretty extraordinary thought that, until we change the law, my hon. Friend's local hospital is under no obligation to co-operate with the hospital in Slough, which is not far down the road. It seems crazy, but that is the system we have inherited.

If the Government intend to have no more than about 500 commissioning units, that implies that each will cover a very large area—particularly in rural areas—including some minuscule practices serving no more than 2,000 patients? If a rural area has a natural coherence and identity, will the Secretary of State ensure that there is sufficient flexibility to recognise that and that no artificial limit will be placed on the number of people that can constitute one of the commissioning groups?

As the right hon. Gentleman may recollect from when he was an Environment Minister, I am a great believer in horses for courses. We do not seek to enforce one model in every city, suburb and rural area. We want a system that meets the needs of the patients. We are determined to provide a national health service that is moulded to the needs of the patient, rather than the patient having to be moulded to the institutions.

I warmly welcome the White Paper. Will my right hon. Friend explain its impact on maternity services? In the next 12 months, 750,000 women will give birth, and virtually all of them will be attended by midwives. Will he give an assurance that the budget for maternity services will not rest solely with GPs, but that other professionals such as midwives will have a say?

That is certainly the case. There will be an increased role for everyone involved in primary care, including midwives, who also have a significant role in hospitals. That may be one sector where massive savings can be achieved—in any particular town or city, it is possible to predict how many women will become pregnant in any given year.

However, in many areas, contracts are issued case by case, and the paperwork costs a fortune. Longer-term contracts that are not issued case by case, would produce savings, particularly in maternity services, as it is possible to predict how many people need treatment and run a financial system that suits those circumstances, instead of the ridiculous system now in place.

From reading the White Paper, it would appear that the Secretary of State is not proposing any substantial reduction in the number of NHS trusts, but rather that trusts co-operate in primary care plans and various other things through health authorities. Will he give thought to ensuring that proposals to reorganise NHS trusts are put on hold while implications are considered?

One of the difficulties with the example of the Rugby NHS trust, which the right hon. Gentleman cited, is that it is a small NHS general hospital trust. There must be provision in NHS services for small hospitals, such as the Rugbys of this world or Horton general hospital in Banbury. If he is not proposing substantially to reduce the number of NHS trusts, will he consider putting such proposals on hold until we have all had a chance to consider the implications of today's White Paper, especially for smaller hospitals?

That would not be a sensible way of approaching matters. The point that I made at Question Time was that we want to encourage mergers between trust and trust and health authority and health authority which appear to make sense to people in the locality. We do not want to lay down the law; we want to encourage them.

More than 50-odd trusts are involved in merger talks about which the public know. I do not think that any virtue would be served in going back on our recent decision to agree to the merger in Derby, or holding back our examination of the proposal which I understand will be coming from Leeds to merge the two acute trusts there.

I do not accept the hon. Gentleman's point. In certain particular circumstances, it might be wise to hold off certain mergers, but that should, generally speaking, be a matter for those in the locality concerned.

Will my right hon. Friend confirm that the only basis for the competition in the health service under the previous Government was that they were preparing it for privatisation? Does he acknowledge that people will welcome the White Paper because it proves that, without privatising the NHS or encouraging competition, it can be modernised by encouraging collaboration and all the values which were the basis of the health service when it was created?

The right hon. Gentleman has stressed the need for the health service to reflect patients' needs. That is a view which I share entirely. What safeguards does he intend to build into his system to ensure that medical freemasonry and cosy relationships between some GPs and some consultants do not militate against patients' interests and choice?

No, it is not a googly. We have to work on the assumption that the bulk of the medical profession does a good job, wants to do a good job, does not want a cushy number and wants to look after patients—although there will be a limited number of people who will not fall into those categories. We need in place a system that ensures that they do their job properly to the professional standards that their professional colleagues have laid down. That will certainly come about as a result of the National Institute of Clinical Excellence.

I very much welcome the fairly recent decision of the General Medical Council to address the question of doctor performance and people who are not living up to professional standards of patient treatment. Although self-regulation is not right in other areas, I strongly believe that it is appropriate for the medical and nursing professions. However, it is up to them to demonstrate to their colleagues and the public that self-regulation works. We want to encourage them to do so.

Is my right hon. Friend aware that the reason why he is able to make today's statement is that the British people woke up in time? They realised earlier this year—and perhaps a bit before—that the national health service was on its way to the hands of insurance companies and other speculators, which would probably create a service costing twice as much and similar to that in America?

Blessed with this good fortune, I hope that my right hon. Friend will realise that he will have to fight for every penny with the Chancellor of the Exchequer—£10 billion extra already collected in taxes—due to the advance of medical science. He will always have to remember this: the NHS is not just a service; it is a cause worth fighting for.

I certainly agree with the last point that my hon. Friend makes. The national health service is popular with people in this country, partly because it provides them with such a good service when they and their families are in need, and partly because of the principles on which it is based. When I am doing okay, I pay in to look after people who are in trouble: in turn, if I fall ill or have an accident, other people pay in to look after me.

People believe, because of that principle, that the national health service does not just bind the nation's wounds: it helps to bind the nation together. That is why the people treasure it.

The Secretary of State referred to quality standards and targets. Is there any contradiction between those and the reference he also made to long-term agreements? If too many institutions are committed to long-term agreements and fail to meet the quality standards or targets, insufficient flexibility may exist to enable the institutions to improve to meet the targets.

We live in a world of dilemmas, and the right hon. Gentleman's point contains some truth. Therefore, we will have to try to ensure that the problem does not arise.

It is not a question of the local primary care group making an agreement with its local hospital on how many services will be provided and to what standard and price they will be delivered. I expect that arrangements will be made so that, if standards are not met, either improvements can be enforced or the institutions can break out of the contract.

We do not want the ultimate weapon to be used, but it may need to be available in the negotiations to give weight to the demands of the primary care group. Primary care groups and their patients do not wish to be forced to transfer their trade to another hospital 20 miles away. That is why, in parallel with the pressures that the primary care group will be able to apply locally, we will introduce national measures to drive up standards and to ensure that they are maintained.

Points Of Order

4.27 pm

On a point of order, Madam Speaker. I am sorry to have to ask you for a ruling, but this morning, from the news bulletins, and especially from the "Today" programme, one would have gathered that we would have two statements in the House this afternoon, not one. We were told in some detail what the Government will propose in a White Paper on freedom of information.

As soon as I got to my office, I rang the Chancellor of the Duchy's office; asked whether there would be a statement, and was told that there would not; and asked whether a White Paper would be published today, and was told that it would not be published. Again, we have government by leak and innuendo. I put it to you that it is intolerable that we should hear on the radio what purports to be an accurate account of an important item of Government policy, instead of hearing it in the House. I should be grateful for your guidance.

Order. Hon. Members must wait for my answer, and not be so impatient.

Further to that point of order, Madam Speaker. I should like to apologise most sincerely to you and to the whole House for what appears to have been a premature disclosure of some features of the freedom of information White Paper which I hoped to present to the House this Thursday. I should like to assure you that I myself had no part in this, and no knowledge of it. No one is more annoyed than I that these details should have emerged, and I believe that it is a disservice to the House.

Although it could be informed speculation, we cannot discount the possibility that it may have been premature disclosure from within Government. Therefore, I am taking this matter very seriously, and I have set in train the task of looking further into the circumstances surrounding the reports.

This is a genuine point of order, Madam Speaker. We have listened to exchanges for approximately an hour on the NHS White Paper. At the same time, a booklet relating to the health service in Scotland, "Designed to Care", has been published. However, we have not had a statement from the Scottish Office on the document, although hon. Members appreciate that there are different aspects of the health service in Scotland.

The Secretary of State for Scotland and the Minister responsible for health in Scotland have been briefing the press all day, yet Scottish Members have not had an opportunity to question the issues contained in the document. It almost seems as if the Scottish Office has published a document which should be called "Designed to Ignore Scottish Members of Parliament".

The hon. Lady appears to be asking me whether I have heard from the Secretary of State for Scotland whether he is seeking to make a statement on the document to which she has referred. I have not heard that a statement is to be made, but I am sure that those on the Front Bench will have noticed what she has said.

Further to that point of order, Madam Speaker. You did not ignore Scottish Members of Parliament.

Of course I do not ignore Scottish Members—they are part of the whole in this House, as far as I am concerned. I call them whatever the statement may be, and whatever Question Time it may be.

On a point of order, Madam Speaker. Have you heard from the solicitors acting for the late Robert Maxwell and currently acting for the Paymaster General about whether there is any legal impediment preventing the Paymaster General from coming to this House to make a personal statement about his financial affairs? In particular, we should like to know whether there was any impropriety in his dealings with the late Robert Maxwell's companies.

I have had no communication from solicitors. I am rather delighted that I have not.

Press Complaints Commission

4.32 pm

I beg to move,

That leave be given to bring in a Bill to provide for the establishment of a statutory Press Complaints Commission; to make further provisions in respect of libel actions brought against newspapers; and for connected purposes.

I am seeking leave to bring in a Bill to change the status of the Press Complaints Commission from a self-regulatory, voluntary body to a statutory body with legal authority. I pay tribute to the present chairman, Lord Wakeham, for his tireless work in trying to make the press barons more accountable to the code of practice.

None the less, about 200 people every week feel that they have been wronged by inaccurate press reporting. The majority are forced to settle for less than they should, simply because of the imbalance between the powers and financial clout of the press barons and the powerlessness of the individual. If a newspaper refuses to correct an inaccurate, irresponsible or malicious story, there is very little an aggrieved party can do.

Currently there are two forms of redress; neither is entirely satisfactory. The individual can pursue a libel case in the courts, but the costs are prohibitive. Understandably, there is no legal aid for libel, and facing the financial might of the press barons is quite daunting. Alternatively, the matter can be referred to the Press Complaints Commission. If the Press Complaints Commission upholds the complaint, the newspaper must publish the verdict by way of a correction.

However, the size, position, timing and content of that correction is not a matter for the wronged person, who has absolutely no influence as to what is printed. Inevitably, therefore, the correction fails to rectify the damage done by the original article. So the dice are loaded against the public and there is a clear need for a new body to balance better the power of the press moguls and those who have been wronged. Let me make it clear that I am not proposing a privacy Bill, although the new Press Complaints Commission would certainly be involved in implementing any changes made to privacy law.

I seek the leave of the House to concentrate on another issue, which is not privacy but to redress the damage done by inaccurate, irresponsible or malicious reporting by increasing the remedies available to the individuals. Most people who are wronged by the press want nothing more than for the record to be put straight by way of a correction and an apology, and they deserve nothing less. However, at the moment an apology can mean virtually anything. Editors may offer to write another article, which is favourable to the person wronged, to publish a letter from the aggrieved individual or to publish a correction—never an apology.

Inevitably, such pieces are not accorded the prominence that they deserve and are designed to attract as few readers as possible. Understandably, newspapers do not like to admit when they are wrong and are reluctant to publish anything that suggests that they have made a mistake. They shy away from admitting any blame. People who run newspapers have a public responsibility to get things right. When mistakes occur, they have a duty to put them right quickly and frankly.

Under my Bill, corrections and apologies will have to be of a minimum size. Never smaller than the offending article, they will appear on the same page as the original article, with the same headline size and a wording agreed by the person who has been wronged. It is important that the impact of the apology matches that of the offending article. That is not impractical, as newspaper editors already argue, although it may be unpalatable for some.

If editors refuse to publish a correction and an apology, which they are fully entitled to do if they believe that there is no cause, there will still be other ways for the individual to proceed. The Press Complaints Commission will still have the power to consider the complaint and make a ruling. In addition, two funds will be established—raised by way of a levy on newspapers, either on profits or turnover. The first will be a compensatory fund to repay any expenses to the claimant arising from the publication of an inaccurate article, such as legal fees and so forth, perhaps, up to about £5,000. The other fund will be able to offer an interest-free loan for individuals to pursue libel cases.

In either case, the funds will be made available only after the Press Complaints Commission has judged the claimant to have a bona fide, prima facie case. While the compensatory fund would require an annual top-up, the loan fund would be made good either by the aggrieved party, should he or she lose the libel case, or by the newspaper, should the libel be upheld, although some provisions will be needed to pay off bad debts.

I propose one final sanction, which would be used only in the most extreme and serious cases. If the Press Complaints Commission deemed that an article was written with malice and recklessness and without regard to the consequences of publication, it could suspend the circulation of a newspaper for one day. In effect, it would take the newspaper off the streets because it had been irresponsible and totally reckless. That is a draconian measure, but it would act as an ultimate deterrent for editors who want to publish scurrilous material regardless of the damage that it might cause.

The Bill is not an attack on the press, but an attempt to gain the support of the House to give real teeth to the Press Complaints Commission, with the aim of outlawing inaccurate, irresponsible or malicious journalism. As far as most editors and journalists are concerned, there is nothing to fear because the vast majority of them are diligent and responsible.

My aim in seeking leave to introduce the Bill is to level the proverbial playing field between the individual and the press barons; to reduce the incidence of poor reporting; and to provide David with the rocks to fight Goliath.

Question put and agreed to.

Bill ordered to be brought in by Mr. Anthony Steen, Mr. Clive Soley, Mr. Martin Bell and Sir Geoffrey Johnson Smith.

Press Complaints Commission

Mr. Anthony Steen accordingly presented a Bill to provide for the establishment of a statutory Press Complaints Commission; to make further provisions in respect of libel actions brought against newspapers; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 12 December, and to be printed [Bill 99].

Orders Of The Day

Government Of Wales Bill

Order read for resuming adjourned debate on amendment to Question [8 December], That the Bill be now read a Second time.

Which amendment was, to leave out from the word 'That' to the end of the Question and to add instead thereof:

'this House, deploring the failure of Her Majesty's Government to respond to and allay the legitimate fears of the Welsh people expressed in the referendum vote of 18th September and in particular the omission from the Government of Wales Bill of any statutory assurances in relation to the supremacy of the Westminster Parliament, to the protection of geographic and cultural minorities, to the proper resourcing of Wales to reflect need, and to the safeguarding of the position of Wales within the United Kingdom and its voice within Europe, declines to give a Second Reading to the Government of Wales Bill.'—[Mr. Ancram.]

Question again proposed, That the Amendment be made:—

4.40 pm

On 18 September the people of Wales backed the Government in creating a modern new democracy for Wales. They voted for a new Wales and a new future. They demonstrated that we in Wales are ready for the new century, more confident about ourselves than in the past.

Nobody can pretend that it was a decisive yes vote, but as my hon. Friends the Members for Rhondda (Mr. Rogers) and for Ogmore (Sir R. Powell) said—their contributions yesterday were most welcome—most no campaigners accept the will of the people. As the right hon. Member for Caernarfon (Mr. Wigley) added, only English Conservative Front Benchers want to rewrite the rules of democracy by insisting that a narrow yes vote is somehow really a no vote. Even Conservatives in Wales accept the result and the need to respond constructively to the Bill. Notably, Lord Roberts of Conwy voted no, but he is not trying to turn the clock back and has advanced some interesting ideas.

The truth is that, as my hon. Friend the Member for Cardiff, West (Mr. Morgan) argued, the result was an historic achievement, overcoming old divisions between north and south; English and Welsh speakers; and industrial and rural areas—divisions that were so ruthlessly and contemptibly exploited by the Tory-led no campaigners, who appealed so nakedly to fear and grubby parochialism.

The Tories wanted Wales trapped in the past—weak, divided, and cowering before power centralised in London—but the Government led a broad popular coalition, spanning all parties, to secure a swing of 30 per cent. since the ill-fated referendum of 1979. Significantly, that swing was bigger than in Scotland, even surpassing Labour's 1 May landslide. It was a vote not for separatism but for democracy: for decentralising power from Whitehall to the people and modernising our almost mediaeval British constitution.

It was not a shock to see the Conservatives opposing this extension of democracy: the shock would have been if they had done otherwise. They opposed every great constitutional reform—votes for working-class citizens; votes for women; reform of the House of Lords—so why should they make an exception of Wales? Indeed, as my hon. Friend the Member for Swansea, East (Mr. Anderson) pointed out, they also opposed the establishment of the post of Secretary of State for Wales and the Welsh Development Agency.

Why is the Minister so anxious about the vote? He attacks everyone left, right and centre, and the witchfinder general of Wales tries to extirpate Labour Members who voted no. There must have been large numbers of those—250,000 more than the Conservative vote. What is behind all this? There was a massive rejection on the day: 75 per cent., given the chance to vote yes, did not do so. The Minister is trying to make 75 per cent. seem insubstantial as against his own 25 per cent. What is it all about?

I welcome the hon. Gentleman's spirited attempt to prop up the empty Opposition Benches. I was merely replying to points raised by Opposition Members in yesterday's debate, in accordance with the courtesies of the House.

The Tories wanted to be able to inflict Redwooditis on Wales again, if they returned to government. We want that disease banished forever from Wales, so that never again can the likes of the right hon. Member for Wokingham (Mr. Redwood) trample all over the people of Wales. We all thought that Redwooditis, a form of political BSE, had been made safe by slaughtering more than half the Tory Members at the general election—it was indeed a radical cull, strictly in line with the rules of public health and safety—but we discover that it has not been eliminated.

Redwooditis has remained deeply embedded in the spinal cord of the Tory party and has emerged among Opposition Front Benchers as they stumble groggily through the devolution debate. The hon. Member for Ribble Valley (Mr. Evans) is the Tories' voice for the valleys; Wales is safe with an Essex boy, the hon. Member for North Essex (Mr. Jenkin); and then we have the right hon. Member for Devizes (Mr. Ancram), the Marquis of Lothian, who is the answer to the West Lothian question personified.

Will the Minister confirm that Devizes, and indeed Scotland, where I come from, are rather nearer to Wales than South Africa?

Not nearer than Neath, which I represent—with a record majority at the general election, I might add—but I none the less welcome any more spirited interventions from the right hon. Gentleman.

Yesterday, the right hon. Gentleman spoke of the Bill as a "dangerous dog's breakfast"; I do not know what a safe dog's breakfast might be. He gave a curiously lacklustre performance: perhaps, as a closet devolutionist going back 20 years, his heart is not really in it. By contrast, his Back-Bench colleagues, the hon. Members for Poole (Mr. Syms) and for West Dorset (Mr. Letwin) made thoughtful contributions, and I look forward to hearing more from them in Committee.

I notice that the right hon. Member for Devizes has promised a secondreferendum on devolution. If he does not mind, I will give him some comradely advice: referendums are not that easy to win. I speak from personal experience. If the Tories ever won another general election, I would relish the prospect of fighting a no campaign to keep the national assembly for Wales, but I offer a prediction: that second referendum will be yet another Tory broken promise. We got used to them in government, and now we are getting used to them in opposition.

Look what happened to the Tory Leader's promise of a referendum last time: the right hon. Member for Richmond, Yorks (Mr. Hague), who treated Wales as a youth training scheme for his leadership of the party, promised a referendum on the Amsterdam treaty; but that was in June, and we all know that six months is a long time in Tory politics. Last week, the Tory leadership refused to table an amendment calling for a referendum when the treaty was put before the House. The new Tory leader's motto is, "U-turn if you want to, this man's definitely for turning."

I see from yesterday's The Daily Telegraph that the Leader of the Opposition is now trying to get Scottish Tories to
"break with the past and reinvent themselves"
by changing their name following their disastrous election result. [HON. MEMBERS: "Like new Labour."] We will come to that.

One of the Tory leader's advisers told the newspaper:
The old name is potentially damaged goods".
All sorts of new names are being canvassed: the Scottish Unionist party; the Progressive Unionist party; and even the Democratic Conservative party, which I would have thought a contradiction in terms. I am sure that, if that new thinking is applied to Scotland, Wales will not be left out. Perhaps I can be helpful: what about the Tories calling themselves new Conservatives? In Wales, that could be Ceidwadwyr Newydd, or Toriad Newydd: real vote winners.

Mind you, it is not surprising that they are having this trouble, as the Tories' name came from a gang of 17th-century Irish outlaws known as the bog trotters. Perhaps that explains the incontinent rumblings of the right hon. Member for Devizes yesterday.

Long after our Tory shadows in opposition have faded from memory, my right hon. Friend's name will be entrenched in Welsh history as the person who delivered devolution for Wales. Perhaps future generations will salute him by demanding a St. Ronald's day; I am sure that Opposition Members will support that.

The Bill is not only about democracy. Wales is, by United Kingdom or European standards, a poor country. Our gross domestic product per head is 18 per cent. lower than England's: a gap that has widened over the past 21 years. Average earnings are 11 per cent. lower than in England, whereas in 1979 they were only 3 per cent. lower. Youth unemployment, at more than 19 per cent., is almost half as high again as in England.

Economic inactivity rates for those of working age, especially men, are higher than in England. Health is worse and so is poverty. While some areas, notably the south-east and the north-east of Wales, have prospered, others have stagnated at best. That is the dreadful legacy that the Tories want to maintain with the old style of government.

The Tories want Wales to be poor and divided. We want Wales to be a new, modern world-beating country, united for the first time through an assembly that will ensure that the needs of all parts of Wales are fully understood and fairly represented, a point eloquently argued by the hon. Member for Montgomeryshire (Mr. Öpik).

Before the Minister leaves the question of poverty, could he clarify something? We received in the Library today a document entitled, "Principles to govern determination of the block budgets for the Scottish Parliament and National Assembly for Wales". In paragraph 8b, on the Barnett formula, it states:

"action taken by the Scottish or Welsh administrations in a devolved area has knock-on costs for the UK Government or vice versa."
Can he explain the background of the statement that has appeared?

My hon. Friend always asks penetrating and well-researched questions. I think that he will find that the answer is contained in the memorandum to which he referred.

The speech by the hon. Member for Montgomeryshire was witty and eloquent. I assure him that the Secretary of State will seriously consider his generous offer to construct the assembly building all by himself.

The Tories want to maintain the politically corrupt Tory quango state, which accounts for more than a third of the Welsh Office budget. We want the quangos abolished or merged, and all made subject to democratic accountability through the assembly, which will have sweeping powers to reform them. The Tories want local authorities strangled; the Bill offers a new partnership to empower local government, as my hon. Friends the Members for Clwyd, South (Mr. Jones) and for Conwy (Mrs. Williams) argued.

Meanwhile, we are building an integrated Welsh Development Agency for the whole of Wales. Tai Cymru will be merged with the Welsh Office. Health service trusts will be reduced in number and reshaped. Cardiff Bay development corporation will be wound up. As my hon. Friends the Members for Delyn (Mr. Hanson) and for Gower (Mr. Caton) argued, that amounts to a fundamental shift in the way public services are delivered in Wales.

Most significant is the merger into the WDA of the Development Board for Rural Wales and the Land Authority for Wales. The Bill creates for the first time a single economic development agency for Wales. It will remove the complexity, confusion and waste that result from existing arrangements and give the assembly a powerful vehicle to improve economic prosperity across Wales. In partnership with local authorities, the business community and many others, the new WDA will have a pivotal role in developing and delivering the objectives of economic growth and prosperity for the whole of Wales. It will also be charged with delivering local solutions for local businesses and communities in the different parts of Wales.

How does the Minister square that with the statement this morning in the Welsh Affairs Committee by Mr. Chris Barber of the Federation of Small Businesses of Wales that the merger of the DBRW into the WDA would have a catastrophic effect?

That statement has not been repeated by many, if any, business men across Wales. They see the enormous advantages to Welsh businesses, small and large, of a unified powerhouse agency, especially with the development of English regional development agencies, which I welcome. I am sure that Mr. Barber does not speak for the whole of business in Wales.

The all-Wales remit of the new agency will tackle inequalities in investment. As my hon. Friend the Member for Vale of Clwyd (Mr. Ruane) pointed out in the Welsh Grand Committee last month, inward investment has created 12,280 jobs in Newport, Cardiff and Caerphilly but only 43 in Conwy, Pembrokeshire and Denbighshire. At least in part, that reflects the democratic deficit that Wales has endured for far too long.

Only by bringing the quangos, and especially the enlarged WDA, under the control of a democratic assembly representing the whole of Wales can the needs of areas that have lagged so far behind, particularly in the rural north and west, be properly addressed. To do that, the new organisation will need a strong regional structure, with boundaries closely aligned with those of the reconstituted training and enterprise councils, the economic forums and the strong regional committees for the assembly that are established by the Bill, a matter rightly stressed by the hon. Member for Brecon and Radnorshire (Mr. Livsey) yesterday. The WDA-led powerhouse will be equipped to spearhead our drive for a world-class Welsh economy for the 21st century, and subject to the Bill's passage, will be fully operational by autumn next year. The Bill is therefore the vehicle for not only the political but the economic regeneration of Wales.

The assembly created by the Bill will be a modern institution, accessible to the whole of Wales, in keeping with its mission to serve the whole of Wales. In that respect, I stress the importance of the Secretary of State's advisory committee. It is open to new ideas and suggestions for how business, the trade unions and voluntary groups—from women's organisations to school governors—wish to relate to the assembly. We want to create a new political culture in Wales, a new participatory democracy.

We also intend to pioneer a new digital democracy. The assembly will be designed to make use of new technology, not only in members' offices but in the chamber and externally, to link up with the outside world. I realise that the right hon. Member for Devizes has a problem pronouncing the word "digital", but if he wants I shall show him how to spell it afterwards.

The Bill ushers in an exciting new era for Wales. It is no surprise that the Tories oppose it. History teaches us that the Tories, through the English Tory establishment, always respond in a reactionary way to demands for reform. The familiar pattern is being played out before us over a Welsh Assembly. First, they rubbish the case. Secondly, they resist it, often uncompromisingly. Then, when they see that they are losing the battle, they slide into the third phase of trying to co-opt the pressure for change, as shown by last year's proposals to beef up the role of the Welsh Grand Committee, as if that could substitute for genuine devolution. Fourthly and finally, they are forced to cave in to the will of the people. When that happens, as it surely will, none of them will ever admit to having opposed a Welsh Assembly in the first place.

4.56 pm

I am grateful for the chance to speak on the second day of the Second Reading debate. It is wonderful to follow the hon. Member for Neath (Mr. Hain). It is so good to hear the Neath accent again—although, strangely, despite my 30 years of living in Swansea, I had quite forgotten that it sounded like that. When I refer later in my speech to inward investment, I shall not be referring to the hon. Member for Neath.

This afternoon, I shall touch on issues that were debated yesterday and introduce other matters that need to be addressed in Committee. We have been criticised by the three pro-devolution parties for being negative and for acting as an Opposition. I make no apologies for doing so. I regret that we are the Opposition but we recognise that we are the Opposition. We are the only party that speaks on behalf of the three out of four people in Wales who did not endorse the proposals. Much has been made of the twisting of the figures of 18 September into a resounding endorsement, which they were not.

The result was not brilliant for any of us. At just over 50 per cent., the turnout was down from 58.3 per cent. in 1979, when I voted no in Swansea. The split between yes and no could not have been closer—just 0.6 per cent., with 11 areas voting for and 11 against. As the hon. Member for Cardiff, West (Mr. Morgan) said yesterday, Offa's dyke seems to be moving west.

It would have been better if the percentage majority in favour had been in double figures. That would have settled the issue once and for all, but it did not and it remains unsettled. The Prime Minister knew that it was not a brilliant endorsement because the day after the referendum, on the steps of No. 10, he said that he would need to address the fears of the large number of people who did not endorse the devolution proposals. What action has he taken? The Welsh Assembly is to be called the National Assembly for Wales, cynulliad cenedlaethol Cymru. A name change is always worth a try. As new Labour knows, it sometimes works. But more than a name change will be needed to sell the merits of this case.

The other major change was that the assembly bandwagon, which was due to roll in to a town near you in England, rolled backwards into Wales. It has been derailed. So the English have a great deal for which to thank the Welsh, but the Welsh have little for which to thank the Prime Minister.

Another change, we are told, is that there is to be an advisory committee which will help in setting up the assembly. We are told that it will represent all political shades. That would have been a step in the right direction, had the Secretary of State asked the parties for nominations, as the Secretary of State for Scotland is doing. We were told yesterday that the Conservatives had been consulted, but neither the shadow Secretary of State nor I have been asked to suggest a name. We have checked with a number of our representatives from Wales and they have not been asked to put forward a name. We have tabled a parliamentary question to ask exactly whom the Secretary of State for Wales consulted. We look forward to the answer. Perhaps the Secretary of State would like to intervene now and tell us whom he consulted about the nomination.

I am more than happy to confirm that I have received a parliamentary question from the hon. Gentleman and, of course, I shall give it careful consideration and let him have a full reply. The point that I make is the one that I made in yesterday's debate to the right hon. Member for Devizes (Mr. Ancram). I invited him to the Welsh Office at the same time as I invited the hon. Member for Brecon and Radnorshire (Mr. Livsey) and the right hon. Member for Caernarfon (Mr. Wigley). They came and discussed matters with me, but the right hon. Gentleman chose not to come. In his absence, I could hardly have a consultation with him.

This simply will not do. As even the Western Mail says, recent events do not get this whole thing off to a good start—and that newspaper was pro-devolution at the very beginning. The Secretary of State has a cheek to talk about inclusivity when he has just given that sort of answer.

I was in the room when that telephone conversation took place. The Secretary of State talked about trying to force his own nomination on to the Welsh Grand Committee. Not content with choosing the Conservative nominee on the advisory body, he wants to choose one of the Welsh nominees on the Welsh Grand Committee. This is a strange and twisted form of democracy. Perhaps the Secretary of State will say whether the nominee to serve on the advisory body will be the hereditary peer mentioned in today's Western Mail.

As the hon. Gentleman was with the right hon. Member for Devizes at the time of that conversation, he will be in a position to confirm that I invited the right hon. Gentleman to come to see me at the Welsh Office to discuss a range of issues that were likely to be before Parliament this Session. It is a matter of regret to me that the right hon. Gentleman declined that invitation. The fact that the other two party leaders accepted my invitation and have been involved in the consultation process is a demonstration of their wisdom, and the foolishness and short-sightedness of the right hon. Gentleman who leads for the Conservative party on these matters.

The major difference is that the representatives from the other two political parties are behaving as if they were sitting on the Government Benches. We already know that the Secretary of State for Wales likes to close down debate in his own party. Now he is trying to dictate who should be the Conservative nominees on various bodies. Will the Secretary of State take the opportunity to confirm whether the nominee is the hereditary peer mentioned in today's newspaper? Is that his Conservative nomination for the advisory committee?

The hon. Gentleman obviously has such a thin speech that he needs me to pad it out for him. I can confirm to him that the first meeting of the advisory committee will take place in Cardiff on Friday. All members of the committee will be present and their CVs will be made available. The whole of Wales, including the hon. Gentleman, will have the opportunity then to find out precisely who sits on the committee.

There the Secretary of State goes again, marginalising the House of Commons. He has been given the opportunity to tell it the membership of the Committee today, but no, the information will be spin-doctored away in the media. He should not talk to us about inclusivity.

As the hon. Gentleman wants to take the debate a stage further, perhaps I should explain that the committee will be my advisory committee. The purpose of it will be to consult people in Wales and offer advice to me.

If the hon. Gentleman will contain himself, I shall explain that the purpose of the advisory committee is to offer advice to me so that I can offer advice to the statutory commission which will prepare the standing orders. The committee will offer advice to me as Secretary of State, not to the House of Commons.

Then let us have no more pretence that the advisory committee will represent all shades of political opinion. Let us make the position clear to the Secretary of State for Wales. He seems to be having a little difficulty here. As the hon. Member for Ogmore (Sir R. Powell) put it yesterday, all that we are asking for is a bit of chwarae teg, or fair play, on this. We do not want to hear that all political shades are being included when the Conservative party has not been asked for its nomination.

The Secretary of State for Wales has an opportunity today to seek some sort of consensus and a step forward. He was told by Lord Roberts that we were expecting a letter asking for the Conservative party to put forward a nominee. We are still awaiting that letter. If we receive it, we will put forward a serious suggestion.

If the Secretary of State carries on in this fashion, I must make it clear to everyone in the Chamber and outside that the person whom the Secretary of State has chosen does not represent us and has not been chosen by us. The person has been selected by the Secretary of State for Wales. He does not and will not speak for the Conservative party. He will speak only for the Secretary of State for Wales. I ask the media to take note of this: that nominee, whoever he may be, will never be accepted by us as a spokesman on our behalf.

I am afraid that the hon. Gentleman is far wide of the mark. The people who sit on the advisory committee will not represent anyone. They will not represent political parties or vested interests.

Of course it is different in Scotland. The members bring to the committee their personal expertise and point of view. They do not represent vested political interests.

Let us make it clear that there is no Conservative party representative on the committee. The Secretary of State can ask us to put forward a name. We will do so. But no—all that we have heard today is, "This is my advisory committee." The Secretary of State should not talk about inclusivity or the spread of political views.

Let us move on, as it seems that we shall make little progress on the issue of the committee. It has been pointed out to me that yesterday the Secretary of State for Wales said that there was a Conservative representative on the committee. He is not a Conservative representative and he does not speak for us. I move on.

The other point that I wish to make relates to the scrutiny of the Bill. We are not in the business of wrecking the Bill, but it contains more holes than a Swiss cheese and we, along with other right hon. and hon. Members, will seek to fill them in and improve the Bill. Let us follow the convention and take this important constitutional matter on the Floor of the House. The Secretary of State has said that he will table amendments of his own. Labour Members—of varying persuasions, no doubt—will want to table amendments. Let us not steamroller the Bill through a small Committee Upstairs as if it were perfect. This is another matter on which we can make progress, but only if the Secretary of State will meet us half way.

I now turn to the siting of the Assembly and the farcical nature of this shabby, sorry exercise. I know that it is the pantomime season, but recent events are at a new level. Where shall we site the assembly? In Cardiff city hall, of course. "Oh, no, you won't," says Russell Goodway. "Oh, yes, we will," says the Secretary of State—and now it is likely that the assembly will not be there. All that is missing is the familiar ring of, "It's behind you." The Secretary of State must wish that this whole sorry business was behind him. This does not bode well for an harmonious relationship between the assembly and the Secretary of State for Wales, assuming that he still holds that office when it starts up—I am generous enough to assume that he will be.

What possible relevance do the hon. Gentleman's comments have to the Bill and the debate today?

The hon. Gentleman made a lengthy speech yesterday. The same question could be asked about much of his speech.

The siting of the assembly was mentioned time and time again in yesterday's debate. If we cannot get that right, what can we get right? The Labour leader of the capital's authority is at loggerheads with the Secretary of State, whose warm, magnetic charm has, unusually, failed him on this occasion. We are now witnessing an unseemly, squalid row.

I note that the hon. Gentleman is even laughing at his own lines. Is he suggesting that my right hon. Friend should have agreed to pay more for Cardiff city hall than the independently valued market price?

No, of course not. I find it peculiar that everyone thought that a deal had been done with the Labour leader of Cardiff city council. Everyone thought that the assembly would be based at Cardiff city hall, but after the referendum, after the people of Wales had decided, we found out that there was no such deal. It all seems rather strange to us.

We are naturally taking a keen interest in exactly where the new assembly will be sited. It does not bode very well for the assembly's future if, at the outset, a Labour leader of a local authority cannot get on with a Labour Secretary of State for Wales. What happens if one of them is replaced by someone from another political party?

An unconsultative document has been rushed out to seek suggestions about which lucky area will house what some see as a gravy train. And who can blame all the Welsh authorities for fighting to house something that will bring in its wake public service jobs and all that that entails? Even my old home town, the proud city of Swansea, has become entrenched in the bidding process.

What would have happened if the row about the assembly's location had broken out before the referendum? After all, Cardiff voted no on 18 September and it seems as though it is still voting no today. The Conservative party believes that the financial estimates in the White Paper must be adhered to—after all, the £17 million start-up costs and running costs of between £15 million and £20 million are high enough.

That money must either be saved by abolishing the quangos—the Bill only makes a small start on that—or will have to come from money that would otherwise be spent on front-line services such as doctors, nurses, teachers and policemen. The average nurse costs £325 a week; the average policeman costs £491 a week; and the average teacher costs £432 a week. The price of the average politician in the assembly has not been settled by the Bill, but after the initial salary has been agreed, it will subsequently be set by the members of the assembly.

We know what will happen, because we need only look at the expenses charged by Welsh Labour local authorities when they have a say about them. We will scrutinise those costs carefully. That does not make us penny-pinching, it means that we will hold the Government to account to ensure that they keep to the spending limits presented to the Welsh people.

To help towards that end, we will oppose the ludicrous amendments tabled by the Liberal Democrats to increase the number of assembly politicians from 60 to 70 at a cost of £750,000. We must remember that the areas represented by the Liberal Democrats voted no on 18 September. They did so not because they wanted more politicians but because they wanted fewer. With such crackpot thinking from the Liberal Democrats, come the next general election those people will want fewer Liberal Democrat representatives at Westminster—and so do we.

The Liberal Democrats have a long tradition of support for devolution and—

One would think that that party would make sensible suggestions about the Bill. How long does one need to sort out one's plans?

The hon. Gentleman has implied that the majority of Liberal Democrats voted no on 18 September. What is his evidence? There is none to prove that that is so.

The areas broadly represented by the Liberal Democrats voted no. The hon. Gentleman and his hon. Friends know that, because I appeared on a television programme with the hon. Member for Montgomeryshire (Mr. Öpik) until 4 o'clock on the night of the referendum. Nobody was less pleased than he was when his area's result came through.

The hon. Gentleman will remember my enormous relief that my prediction about a heavier defeat turned out to be unfounded. Would he agree that it is possible that the Liberal Democrats in those two constituencies voted yes while others may not have been persuaded?

That argument may get the hon. Gentleman to sleep at night, but it does not wash with any of us on the Conservative Benches.

The Liberal Democrats' suggestion that there should be an extra 10 seats in the assembly at an additional cost of £750,000 a year is entirely inconsistent with their claim to be a responsible, third party. It is, however, entirely consistent with their position as a high-tax, high-spend party. Perhaps those extra 10 seats would be paid for out of their mystic 1p tax rise. Never has there been a better return on a penny spent—well, almost never.

The Liberal Democrats have joined in the debate on what to call the assembly. The Scots will have a legislative body with tax-raising powers—that is called a Parliament. The Liberal Democrats want to call the Welsh Assembly, which, thankfully, will not have primary legislative powers or tax-raising abilities, a Senedd, which is Welsh for a Parliament. Let us not insult the Welsh any more than they have been insulted already. Such a suggestion is an insult to their intelligence—an assembly is what it is and what it should be called.

Let us consider the issue of proportional representation—or, rather, unproportional misrepresentation, as the proposal is neither a true system of PR nor will be representative of the wishes of the Welsh people. It will cause confusion to the masses. People will not know to whom they should bring their constituency problems. Should they write to their elected constituency Member of Parliament—a process that works extremely well at Westminster—to their constituency member of the assembly, or to an assembly member who is elected under the list system? Will those latter two representatives have the same authority, or will the constituency assembly member's word carry more weight? Can the Secretary of State tell me the answer, or has he not thought it through, as he has failed to think through so much connected with the issue?

If the proposed voting system is introduced, we will have such a complicated system of elections throughout the country and in Wales that I am sure the people of Wales will be turned off by it and utterly bewildered and bemused by the sheer variety of voting systems in use in the United Kingdom. It is almost as though the Labour party is determined to make Britain a showcase for different PR systems—for the assembly, for London, for Europe, and perhaps at local elections. I know that it is also considering the voting procedures for Westminster. Its proposals will offer a fabulous case study for political studies undergraduates and a nightmare for the man on the Clapham omnibus or on the No. 12 bus to Swansea city centre who is trying to take part in an election or write to his representative with a problem.

The Secretary of State claims that the additional member system will be good news for the Conservative party. I thank him sincerely for thinking of us when he made those plans, but if that is the case, it makes our principled stand a moral one as well. Why? Because we believe that the new system will only add to Welsh nationalism and anti-English sentiments, bringing nearer by the day the total break-up of the United Kingdom, as my hon. Friend the Member for West Dorset (Mr. Letwin) feared in his speech yesterday. We will fight against that tooth and nail, for the good of the Welsh people and for the good of the people of the United Kingdom.

We already know that Plaid Cymru sees the assembly as the journey and not the destination. It is not content with the half of the cake that is currently on offer to it. It will come back for the other half soon.

We will make a number of suggestions about the proposed funding arrangements for the assembly, as stated in clause 80, which is a classic of its kind. It states:
"The Secretary of State shall from time to time make payments to the Assembly out of money provided by Parliament of such amounts as he may determine."
That's all right then, isn't it? But as Secretary of State, with his fading glory and influence, is eclipsed by every other spending Department, what real security will there be for the assembly? Yesterday, we heard in speech after speech from those on the alliance Benches about how the assembly will improve education, how it will revitalise the health service, how new jobs will flood in and how roads will be built that will make the Roman roads look like dirt tracks. Wales will become the most powerful country on the planet thanks to the assembly—and all with no extra money.

The Chief Secretary to the Treasury has already said that the Barnett formula will stay. The can of worms has now been opened, however, and the English regions have woken up to the formula's financial implications. Per capita spending in Wales is £4,352 compared with spending in England of £3,743—a difference of £609. If Wales were to be self-financing, the basic rate of tax would be 45p in the pound.

The hon. Member for Blyth Valley (Mr. Campbell) has said that the Government must get rid of that formula and give the money to England. The hon. Member for Brent, East (Mr. Livingstone) believes that London should get all the extra cash. The Barnett formula has not been enshrined in the Bill, nor is the element of needs funding. We will seek assurances about that in Committee. The last thing that Labour Members will want is for the assembly to be tempted to top-slice revenue support grant money to pay for their land of milk and honey.

The hon. Gentleman, as hon. Member for Ribble Valley, will be aware of how important defence procurement is in overall public expenditure. His constituency probably receives more public expenditure in defence procurement per head than any other constituency in the western world. He has made himself known for lobbying for more public expenditure for Ribble Valley and for his constituents who work at British Aerospace factories in the Preston area. I think that he will accept those points. Does he accept that—if we add defence procurement to domestic public expenditure—Wales receives 5.1 per cent. of identifiable UK public expenditure, whereas it has 5.0 per cent. of the population? Will he comment on those figures and relate them to the argument that he has been making?

No, because the Barnett formula was created to ensure that there was a needs formula to protect the needs of the Welsh people and the Scottish people. Since the Government's devolution proposals have come to light with the referendums, a can of worms has been opened, and English people and English Members of Parliament are asking why so much money is going to Wales and to Scotland and not to their own areas. Such a debate is bound to ensue. If there is a review of the Barnett formula, we do not know what the outcome might be, because we have no guarantees. We do know, however, that hon. Members will fight hard to ensure that they win as much money as possible for their own areas, based on the needs of those areas.

Will the hon. Gentleman confirm that his understanding of the Barnett formula is that it is needs-based? Is that what he is saying?,

Population is used as a basis of determining need. In Committee, we will ensure that the needs basis will be continued into the future—something of which there is no guarantee. The Secretary of State is not dealing with the matter in the Bill, although he is doing so in the explanatory and financial memorandum— which, as he knows, has no status. One of the fears of the people of Wales is that, if there is a review, there could be a review downwards. What will happen then?

I am grateful to the hon. Gentleman for giving way, and I am sorry to detain the House, but that is sheer gibberish. He does not understand the Barnett formula, and I urge him to study it. As he is talking about needs, I should point out that Wales's GDP is 18 per cent. less than the English average. GDP in south-east England, which he mentioned, is 14 per cent. above the English average. If there were a genuinely needs-based assessment of resource distribution in Great Britain, Wales would do very well in it.

I am very pleased that that reassures the Under-Secretary of State for Wales. I assure him that a can of worms has been opened. Has he considered the demands that will be made by the politicians who will be elected to the London assembly? They will demand a big slice of the cake. Whereas Labour and other alliance Members think only of how large their slice of the cake will be, Conservative Members fight to ensure that the cake becomes larger, so that everyone can have a greater slice of it.

Part of Labour Members' problem is their inability to answer the question of what will happen if the RSG settlement is top-sliced. We have 22 local authorities in Wales, and we have already seen—thanks to last week's announcement—a 12 per cent. council tax increase. The people of Wales will look back rather nostalgically at such increases if there is top slicing of the RSG, because the resulting shortage will be made up in only one way—in ever higher council taxes.

I should hate to fail to deal in my speech with the role of the Secretary of State. We already know that the current incumbent of that office moves in mysterious ways, but what will he do after the assembly is established? The Bill states only that he will transfer his powers to the assembly—

Yes, most of his powers.

The Secretary of State will also be able to visit and speak in the assembly. But who will speak for Wales? Will it be the assembly's First Secretary, or will it be the Secretary of State—the First Secretary's secretary? If the new leader of the assembly is Russell Goodway, relations just might be strained. If it were the hon. Member for Blaenau Gwent (Mr. Smith), I predict that there would be some friction. Problems would result also if the position were held by many other people. As the botched job on siting the assembly has shown, embarrassment and stalemate are a likely result.

The House must probe more carefully who will do what in the assembly's operation and ascertain more carefully its relationship with Europe. Matters that are so important that they must receive careful scrutiny include the assembly's visiting rights to important meetings of the Council of Ministers, the Secretary of State's residual powers over money, and the role of the new regional committees.

All we know about the regional committees is that they will be established in north Wales and in other areas. If such a device is supposed to calm the people of north Wales, heaven help them. The south Wales-dominated assembly will draw up the boundaries; it will determine how it is advised by the committee; and it may then ignore that advice. The committees sound like a sop, and Conservative Members will press for greater clarification in Committee.

What about clause 47, which deals in
"equality of opportunity for all people"?
It is fine to pay lip service to that goal, but, as our reasoned amendment states, Conservative Members are not satisfied that the assembly will provide an opportunity for all the people of Wales to be properly represented and protected.

Conservative Members will be looking for assurances on the £500-million question: what type of loan will it be? Will it be a recipe for the assembly to borrow on the never-never to fund its raison d'etre, buying instant popularity that will disappear in a flash as the bill lands on people's mats? We still hear concerns expressed by businesses in Wales, which are represented by the Confederation of British Industry, the North Wales Business Club and the F