asked the Secretary of State for Energy if he is satisfied wth the arrangements made for the promotion of energy efficiency by British Gas and the area electricity boards.

Yes. The gas and electricity industries have already organised over 200 events for Energy Efficiency Year. I am grateful to them and look forward to their further support in the next major stage of our initiative in the autumn.

Will the Minister actively encourage British Gas to apply its huge surplus profits to improving customers' energy efficiency rather than the Government taking those profits to finance tax cuts?

British Gas has a vested interest to encourage the most efficient use of gas because, in competetion with electricity and oil, it is an essential thing to do, and British Gas is doing that.

What are the implications of the concession made in another place that, after privatisation, British Gas will have specific responsibility to promote energy efficiency over and above what was written into the Bill in this House?

In the other place we have recognised that certain things which would take place might as well be expressed as taking place, and there is no doubt that British Gas will be doing that.

Are not British Gas and the electricity industry in a unique position to promote energy efficiency and such things as home energy audits? Is there not a duty on those major energy producers to encourage and develop efficiency and energy conservation on a much broader scale than is taking place?

More is being done by both industries than has ever been done. My answer to the main question illustrates that. I am delighted at the collaboration that is taking place.

asked the Secretary of State for Energy if he will make a statement on progress with Energy Efficiency Year initiatives.

My right hon. Friend's Monergy 86 initiative is fast becoming one of the most successful campaigns ever. Already more than 750 events have taken place, and we are well on the way to surpassing by a big margin my right hon. Friend's target of 1,000 events. We have issued 140,000 domestic, industrial and educational packs in response to requests generated by our advertising campaign, in addition to the millions of leaflets delivered to households across Britain. Over 3,000 top executives have attended the first six of our Energy Efficiency Year breakfast briefings.

I thank my hon. Friend for his reply and congratulate him on the success of the project. Is he prepared to see an ever-increasing role for energy managers, and does he agree that they have an important role to play in promoting energy efficiency?

I am delighted to confirm the important role played by energy managers in getting the monergy message across. My right hon. Friend set a target for doubling the number of energy managers. That has already been achieved, and we want to see a further doubling of that figure. I welcome the excellent job performed by energy management groups, of which the Bexleyheath management group, in my hon. Friend's constituency, is a fine example. Energy managers are the front-line troops in this vital campaign.

Is the Minister aware that there are still areas where there is a lack of knowledge about energy efficiency, especially in poorer areas? Will he ask energy efficiency boards to make a special effort to bring more knowledge of the improvements that are necessary for energy efficiency in areas of gross unemployment and in the poorer sections of the community?

I am surprised to hear that, but I join the hon. Gentleman in wishing to see the monergy message distributed as widely as possible, especially to those sections of the community who most need help. My right hon. Friend has spearheaded a substantial increase in the grant to the neighbourhood energy action group, and there has been a massive increase in the number of groups which directly help in an efficient way those faced with high fuel bills who need to insulate.

asked the Secretary of State for Energy if he will report on his Department's initiatives in the light of the agreement reached at the Tokyo economic summit recommending that an international convention be drawn up committing the parties to report and exchange information in the event of nuclear emergencies.

The board of governors of the International Atomic Energy Agency at an emergency meeting on 21 May agreed, with the full support of the United Kingdom, an outline programme of action to improve co-operation in nuclear safety following the Chernobyl accident. This included the establishment of an expert group to draft a binding international convention on reporting and exchange of information on nuclear accidents with possible transboundary effects. The United Kingdom attaches the highest importance to this and will participate fully in this work.

I am grateful to my right hon. Friend for that information. Does he agree that in all matters relating to civil nuclear power it is essential that agreements, understandings and exchanges of information should be organised on an international basis, not least for our country—perhaps my right hon. Friend will confirm this—as there are 13 foreign reactors within 100 miles of the shores of Britain and a further 14 within 200 miles?

Yes, it is very important that the subject is organised on an international basis, and I believe that the International Atomic Energy Agency is the right forum for that. I assure my hon. Friend that we shall give every support to its activities.

Does the Minister agree that, after the Chernobyl disaster, we should start looking at the situation at home in view of the discrepancies that emerged between the reports and diagnoses from the tests on the fall-out cloud that came over Britain? Does he agree that we should sort out our own nuclear industry so that people do not feel the present distrust?

I do not share the hon. Gentleman's view. I believe that careful study will show that the various organisations and services in this country acted very efficiently and well, but there is certainly a need for greater international collaboration.

Does my right hon. Friend agree that there should be an exchange of information among all countries operating nuclear power stations, not just when nuclear accidents occur, but at all times in the course of routine operations, so that experience gained in one country can be passed on for the benefit of others?

I very much share that view. That exchange has been taking place effectively between certain countries of the European Community for quite some time. Chernobyl showed the importance of doing that on an international basis.

As the Secretary of State will be aware, the CEGB is engaged in a detailed review on safety of the elderly Magnox stations. When will that review be completed, and will the right hon. Gentleman publish it so that the country can see all the details?

The review is being carried out by the Nuclear Installations Inspectorate, not the CEGB. The inspectorate has that task and the CEGB is collaborating fully. It is up to the inspectorate to decide what to publish.

asked the Secretary of State for Energy if he will make a statement on the effect of the current fall in oil prices on the demand for coal, with particular regard to the proportion of coal output taken by electricity boards.

The current fall in oil prices is reflected in the successful discussions that the National Coal Board has completed with the CEGB. This agreement will enable the CEGB's coal demand to be maintained at its previously planned level and electricity consumers to benefit from lower prices.

That was a reasonably interesting reply, but does the Secretary of State agree that we should be considering energy policy overall? Will he consult his colleague the Secretary of State for Scotland to see what effect the fall in oil prices is having on the coal burn in Scotland? Is he aware that if Torness comes on stream —I hope that the Government will review that in the light of the right hon. Gentleman's previous answer—it will imperil the jobs of about 2,000 miners and the coal industry in Scotland will be linked to just one power station, in the Longannet complex? Will the right hon. Gentleman take that consideration on board?

It is not Torness that is making the difference in Scotland, but the fact that there is a certain amount of oil firing where there are facilities for it. Talks are taking place between the National Coal Board and the South of Scotland Electricity Board and I hope that they will be successful.

Does my right hon. Friend agree that as the oil price goes right down to $10 per barrel it will be unreasonable not to take into account the customers' wish for electricity at the cheapest possible price. bearing in mind a certain responsibility to the coal industry?

Yes, but it is also right for the CEGB to take into account the fact that oil prices have been known to rise to $30 as well as to fall to $10. Rather than relying on the uncertainty of that market, when we have an important form of energy of our own, which one hopes will become more competative through improved productivity, I am sure that for the long-term assurance of supplies it was right for the CEGB to enter into that important five-year agreement.

The fall in oil prices has already cost the NCB an average of £3 a tonne in its recent contract with the CEGB. To what extent will that cause the NCB to fail in its financial objectives next year, and to what extent does the Secretary of State envisage more pit closures as a result?

Obviously, if an industry suddenly loses £300 million a year of revenue, that will put pressure on it. I expect that that will make it difficult for the NCB to fulfil its financial targets next year as envisaged on the basis of the previous ruling price. Obviously it will put further financial pressure on the NCB.

Is the Secretary of State aware that as a result of the CEGB agreement cuts have already been announced in south Wales of about 10 per cent. in manpower and more than £20 million in revenue to that coalfield? Is he further aware that during the past year the south Wales coalfield has come back into a profitable position and is making money, yet suddenly the goal posts are changed again? Why does the Secretary of State not intervene so that we may have a planned energy policy, instead of continually lurching from crisis to crisis?

If we had a planned energy policy such as the hon. Gentleman envisages and our competitors throughout the world did not have similar plans, if we were not careful we could cause a great deal of unemployment and hardship. The last time we had a planned energy policy was under the Labour Government who came in in 1964, and every one of their plans was violated and broken.

Does my right hon. Friend agree that recent events have shown how right Sir Ian MacGregor has been to drive for viability during his period as chairman? Will he take an early opportunity to wish Sir Ian well and to congratulate him on his well-deserved honour?

Yes. As a result of the improved productivity figures, the heavy capital investment in that industry is at long last showing some return.

Surely the Minister must be aware that the understanding—it is not an agreement or a contract—with the CEGB on coal burn will mean more job losses in the coalfields in England and Wales? Indeed, the Secretary of State practically admitted that in answer to my right hon. Friend the Member for Barnsley, Central (Mr. Mason). How many job losses will there be as a consequence of that? Can he explain to the House, when at present in Scotland the total coal production of some pits is going to stock, why the South of Scotland Electricity Board has never tried to have an agreement, a contract or an understanding signed before now? Is it because it is so busy trying to push ahead with the commissioning of Torness?

I am surprised at the hon. Gentleman not rejoicing in the fact that in spite of the immense attractiveness of the present oil price the CEGB has agreed to enter into an agreement with the NCB which will guarantee that 75 per cent. of the NCB's production continues to go to the CEGB for some years to come. I am surprised that there is not more rejoicing on the other side of the House about that.

How can it be consistent for the Secretary of State to argue in this context that he welcomes the fact that the market is responding dramatically to the falling oil price and he sees it as clear evidence of the changed conditions, yet at the same time to argue that the falling oil price has not brought any significant change in the market which would encourage the Government to begin to look favourably on the pledge about incremental investment which the Chancellor of the Exchequer gave in the Budget in March?

The Chancellor of the Exchequer made it clear that he was going to study the position of incremental investment. The majority of oil companies recognise that if we have a fluctuation in the oil price which started only a few months previously the Government will not immediately change the taxation system. If the price moves in the opposite direction, I doubt whether we shall hear many oil companies suggesting that the tax change quickly in the opposite direction.

asked the Secretary of State for Energy if he will make a statement about progress on combined heat and power schemes.

I understand that the consortia who are preparing prospectuses for CHP in Belfast, Edinburgh and Leicester are making steady progress.

I thank my hon. Friend for that reply, but does he agree that if we fail to take advantage of those proposals we shall fail to maximise the energy resources that are available to us? If such schemes are adopted, will it not mean that in the end energy and heat will become cheaper? Is my hon. Friend aware that, leaving aside the question of power stations, my constituency could be heated with the power that is lost through the blast furnace at Scunthorpe steelworks?

My hon. Friend is right to highlight the Government's role. The Government have taken steps to encourage the development of CHP through the Energy Act 1983, which created a guaranteed market for the sale of electricity from CHP schemes and placed a duty on electricity boards to adopt and support viable projects, so we do want CHP district heating to go ahead wherever it is economically viable.

Will the Minister confirm that the thorny problem of individual metering for CHP for consumers has largely been resolved and there is no technological inhibition to its being introduced? Will the Minister give financial encouragement to local authorities to introduce it in their dwellings?

I understand that the problem connected with individual metering has been resolved and I shall carefully consider the hon. Gentleman's point.

Does my hon. Friend agree that the progress of CHP is laudable, along with all the other sources of alternative energy which Her Majesty's Government are now seeking to support? Will he give us an undertaking that they will continue to support those alternatives, perhaps in preference to other more old-fashioned energy sources?

I cannot give my hon. Friend a guarantee in those terms, although he has been one of the leading Members of the House who have been pressing for renewable energy sources to be given their correct priority. I can assure my hon. Friend that, despite any other factors, renewable energy sources will continue to receive the high level of Government support that they have received in the past five years.

Does the Minister accept that the Government's response to CHP has been small when one looks at some of our competitors in western Europe? It may be years before a plant becomes operational in the three lead schemes. Does the Minister accept that if, over and above the present lead schemes, CHP schemes were to be introduced quickly, it would bring jobs to areas in need such as the inner cities and into the steel industry and other industries?

I am not sure that the hon. Gentleman understands the subject. The Government have helped to reduce uncertainties by making available financial help to local consortia to carry out the current work programmes. Surely the hon. Gentleman recognises that until those studies have been completed it is not possible to be specific about a way forward. However, I have clearly laid on the line the Government's intentions in that matter.

I represent the trial area of Leicester, which has been a great supporter of CHP. Can my hon. Friend give any estimate of the number of jobs that could be created, or the likely savings that will be of great benefit to consumers throughout Leicestershire? Surely this is a project from which other parts of the country will soon benefit as much as we have done?

Yes, I pay tribute to my hon. Friend's constructive approach. I also pay tribute to his perseverance in lobbying on behalf of the Leicester consortium. I was happy to visit Leicester to receive a presentation from the consortium recently. I understand now that it expects to be the fist to complete its work programme by autumn 1986 and I look forward to receiving its report.

asked the Secretary of State for Energy when he plans to brief local authority associations on the work of his energy efficiency office in Energy Efficiency Year.

The Government appreciate the helpful part played by the local authority associations, in advising the energy efficiency office on relevant initiatives, and in promoting the benefits of effective energy management to their members. My officials keep in regular contact with representatives of local authorities and their associations on a range of activities.

I am not at all happy with that answer. When will the Minister pull his finger out? Local authorities can make a massive contribution to energy efficiency, yet here we are six months into Energy Efficiency Year and they are fiddling around while we burn energy inefficiently? Why does the Minister not wake up and get something done about it?

I responded positively to the hon. Gentleman, but I remind him that a large number of major initiatives are proceeding at present and the evidence is that local authorities are responding well to the opportunities for energy savings, which were highlighted in particular by the Audit Commission, the local authority associations and many others.

If the energy efficiency campaign is the success that everyone expects it to be, could this not lead to a reduction in the use of coal in power stations and hence an increase in coal stocks? Would not one answer to that problem he the extension of the grant of concessionary coal to the many thousands of miners who were made compulsorily redundant during the 1960s and who did not qualify for concessionary coal allowances, even though they contributed coal to coal pools when they were in work?

All the energy utilities have a great deal to expect from the public in terms of more efficient energy use. My hon. Friend asked about concessionary coal. I admire his perseverance in this matter, and we are carefully considering his further representations.

Has the Minister seen the energy efficiency chart prepared not only by local authorities but by a large number of other organisations involved in energy efficiency? Will he consider adopting that chart as a sensible pragmatic approach to energy efficiency?

My right hon. Friend welcomed the constructive report by the Association of Metropolitan Authorities, and much of its advice about energy management is echoed in the Audit Commission report, which cited the AMA report as a valuable reference source. I understand that my Department's energy efficiency office has agreed to a meeting to discuss progress, and I look forward to further progress being made.

asked the Secretary of State for Energy what plans he has to promote the development of energy audits targeted on low income households.

The energy efficiency office continues to work on the development of home energy audits at a price that householders can afford.

Is not the question of the price that householders can afford the whole point? As I understand it, the pilot heat scheme has not been a great success precisely because people on low incomes cannot afford to pay for the energy audit. If we are to recognise the problems that that will cause this winter of deaths and of people who suffer greatly, would it not be sensible if we were to offer a free energy audit under, for example, the home insulation scheme, or must we wait for more bad headlines this winter and a change of Government?

That question gives me an opportunity to pay tribute to the enormous impact made by the homes insulation scheme and its importance to overall energy efficiency. Under the homes insulation scheme 90 per cent. grants were introduced by this Government in 1980 and have so far helped over 300,000 elderly or disabled householders on low incomes to insulate their lofts and tanks. I highlight for the hon. Gentleman's attention the recently published monergy guide, which can be used as a basic but comprehensive do-it-yourself home energy audit. As I said earlier, we continually stress the importance of voluntary sector insulation projects. They have already insulated over 170,000 homes and expect to do a further 60,000 by the end of 1986. This is a speedy and effective way to get through to the people who need such help most.

My hon. Friend will know that the trial energy audit schemes were not a success. As this is such an important subject, is there not a strong case for trying to target on new private and public sector houses so that at least we can start something positive?

I agree with my hon. Friend. It is sad that that heat audit was not a success, but I defend my Department's participation in it because it was important to monitor its effect. My hon. Friend is right: the major focus of attention must be on new buildings.

asked the Secretary of State for Energy if he will make a statement on the University of Manchester Institue of Science and Technology's project to convert refuse into oil.

My Department is arranging to have an independent evaluation of the refuse to oil process carried out by a firm of consulting engineers. This assessment will be put in hand shortly and should provide an up-to-date appraisal of the technical and economic prospects and of the major problems that remain to be overcome.

I welcome my hon. Friend's reply. Does he realise that we have in Edmonton the country's largest waste incinerator, which is already producing and recycling waste and producing 158,000MW hours of electricity a year? Can he reassure the House that the Government will continue to look for uses for waste to make sure that we get energy from it?

Yes. I agree with my hon. Friend. I know that the country's largest municipal waste incinerator, which handles 400,000 tonnes of waste a year, is located in his constituency. My Department puts a great deal of money into researching ways of ensuring that we make the maximum use of waste. My hon. Friend has previously used the slogan that the nation cannot possibly afford to waste waste.

Can the Minister give us more details about the project? Do the terms of reference include an examination of scaling up and comparisons with other projects, including the deriving of oil or gas from coal?

A study of the Greater Manchester council—UMIST—project on the liquefaction of rubbish to oil was made by my Department's energy technology support unit last year. The indications were that while there appeared to be great potential in the project, a number of technical, economic and scale-up problems still needed to be overcome. The unit's assessment suggested that the process would provide less energy and at a considerably higher cost than direct combustion of refuse and would require a subsidy of about £22 per tonne to break even. However, following representations from my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery), I have agreed to a further study being carried out.

Is my hon. Friend aware that I am most grateful to him for responding to my request to have the project reviewed? One of the leading exponents is Professor McAuliffe, who is a distinguished scientist and one of my constituents. Will my hon. Friend follow my example and visit UMIST to see the Manoil project for himself?

I find my hon. Friend's request irresistible, particularly as he invites me to follow his example. I should welcome an opportunity of seeing the process for myself, and I shall make arrangements to do so as soon as possible.

The hon. Gentleman must give the House more information, because he knows that Salford university's industrial centre carried out a feasibility study on that Manoil project and concluded that a commercial plant, at a cost of £12·5 million, would be feasible. How does the hon. Gentleman propose to fit that work into the remit of the independent consultant engineers? What will their review cost? The hon. Gentleman must also tell us why Harwell has so dramatically changed its mind.

I reject the final point made by the hon. Gentleman, but surely he accepts that where we have a potential of this magnitude it is necessary to conduct the most comprehensive studies. I shall let the hon. Gentleman know the cost, and I accept his view that the study by the consultant engineers must have the widest possible remit so that we can look to the future and examine the potential of the process.

asked the Secretary of State for Energy if he will estimate the latest figure of annual savings in energy costs which have been achieved by industry and commerce energy efficiency schemes.

Action taken by participants in energy efficiency schemes supported by my Department is currently leading to annual savings of £500 million, but much more is possible. Improved energy efficiency in industrial and commercial buildings alone could save £800 million a year.

I thank my hon. Friend for that: encouraging reply. Does he agree that in view of the potential saving of £2 billion from the energy efficiency schemes they could play an important part in helping British industry to be competitive? Will he continue to highlight those schemes and the savings that come from them?

Yes. My hon. Friend is absolutely right to highlight the fact that we cannot afford for a moment longer to allow £2 billion to be wasted in industry and commerce. We are talking about bottom-line savings, because they can feed straight through to making products and services more competitive. They also release more money for investment and, as well as releasing more money for profits, they can produce greater job security for the future.

asked the Secretary of State for Energy whether further resources will be made available for domestic energy saving.

This Government's Energy Efficiency Year already represents a massive step up in the campaign to overcome market barriers and to improve standards of energy efficiency in the home.

is it not true that the amount allocated for that purpose has not been taken up in recent years? Should we not have new incentives, such as grants for thermostats and more money for the voluntary sector scheme, which is working so well?

The hon. Gentleman is right to pay tribute to the way in which the homes insulation scheme has been successful in promoting the insulation of lofts and tanks. However, the history has always been one of underspend. The 1986–87 homes insulation scheme allocation is expected fully to meet total demand. That scheme is a crucial part of any campaign to introduce greater energy efficiency in the home. I shall carefully consider the hon. Gentleman's points.

asked the Secretary of State for Energy if he will make a statement on the ending of the scheme for making refunds on standing charges for gas and electricity.

Tariffs are a matter for the industries. As they made clear when ending the schemes, these had proved to he much more costly than anticipated and were largely providing help to those who clearly did not need it —for example, second home owners. The ending of the schemes was welcomed by the consumers' and consultative councils.

Does my hon. Friend agree that it was right to end the scheme for second home owners who clearly did not need it, but that it was a tragedy to end it for small users, who were generally elderly pensioners or unemployed people who, to my own knowledge, saved on the use of energy in order to benefit from the scheme? Will he have talks with the industry with the intention of restoring the scheme for pensioners and those on very small incomes?

My hon. Friend is uncharacteristically incorrect in saying that most of the scheme's beneficiaries were pensioners and those on low incomes. Standing charges cover unavoidable costs incurred by the industries in keeping supplies available, such as maintenance, meter reading, accounting and billing, and emergency services. Abolition would penalise many of the less well off, because lost revenue of £550 million for each industry would have to be recovered through increased unit charges. That would harm those with large heating needs, such as the sick, the disabled, the very young and the old.

When will the Minister wake up to the fact that standing charges have been a backdoor method of increasing prices for long enough? As the hon. Member for Ealing, North (Mr. Greenway) asked, when will the Minister take note of pensioners and those on low incomes? Those changes are among the items from which they seek relief. Will the Government seriously consider abolishing standing charges altogether?

As I said to my hon. Friend the Member for Ealing, North (Mr. Greenway), there is no reason to abolish standing charges. The hon. Gentleman will realise that help to the less well off is best directed through the social security system. As he will know, the Government have done much to improve provision under the social security system. Supplementary benefit is up 6 per cent. in real terms, and more than £400 million was spent on heating additions in 1984–85, which is £140 million more in real terms than was spent in 1978–79.

I do not normally agree with the hon. Member for Ashfield (Mr. Haynes), but standing charges cause great anxiety to my constituents, particularly the elderly. Should not the cost of the meter, and so on, be included in the tariff, so that one pays more the more energy one uses? Let us do away with standing charges. They are an unfair way of taxing the elderly.

As I have said, it would be disadvantageous to the elderly if the cost of standing charges was included in the unit rate, particularly for those who use a lot of energy as opposed to those who do not use much, but who give rise to certain charges to the industry.

Will the Minister acknowledge that pensioners feel strongly about this issue and that those who do not qualify for heating allowances but who are on low incomes suffer the full brunt of the Government's pricing policy, which is to force up the price of energy? If the Minister is not prepared to abolish standing charges, which is what most people want, he should come up with an acceptable alternative that will benefit pensioners who do not get fuel allowances, and not just say that it cannot be done.

It would not be to the benefit of pensioners overall if standing charges were abolished. The hon. Gentleman is not correct to say that we have been forcing up the price of energy. In the three years 1982 to 1985, domestic electricity prices rose by only 6 per cent. Under the Labour Government they rose by 2 per cent., on average, every six weeks. Domestic gas costs the same in real terms today as it did in 1970.

asked the Secretary of State for Energy if he plans to raise the question of safety standards in the nuclear power industry with the European Council of Ministers.

At its meeting on 3 June the Energy Council discussed the implications of the nuclear accident at Chernobyl. Member states of the Community agreed that internationally the appropriate forum in which to take follow-up action on nuclear safety issues is the International Atomic Energy Agency.

What recent reviews have taken place on the safety factors of our Magnox stations, and what future reviews are planned? Will information about the safety of those stations be published and fully discussed by the European Council of Ministers?

I am pleased to say that the Nuclear Inspectorate of this country has total control over nuclear safety. It is independent, and it constantly inspects and reviews all nuclear installations.

asked the Secretary of State for Energy what recent representations he has received about proposals for a Severn tidal barrage.

My right hon. Friend and I have received a number of representations about the content and timing of the publication of the report by the Severn Tidal Power Group. We are now considering this report, and obviously these comments will be taken with consideration. The Severn Tidal Power Group hopes to release its report shortly.

Can my right hon. Friend confirm that the Severn Tidal Power Group's report has been held up by his Department? Will he ensure that the report is published sooner rather than later, in view of the intense interest in the west country in the barrage?

There is no disagreement between my Department and the power group about the date of publication. One must recognise that potentially the Severn barrage is the second biggest tidal barrage in the world and therefore an important consideration. The study group and the Government, who partly financed the study, are anxious to prepare the publication carefully, and I hope that the report will be published in the near future.

asked the Minister for the Arts what progress the Arts Council is making in directing 4 per cent. of its expenditure to Afro-Caribbean and Asian arts.

Responses to the Arts Council's plan are now being received and will be discussed at the council's meeting in July.

I welcome the Arts Council's initiative, but is the Minister aware that no new money is involved and that therefore its impact will be somewhat lessened? Is he further aware that the Arts Council has just given a £100,000 revenue grant to the black arts centre at the Round House, which is now in a critical position because of its loss of GLC funding?

Will the Minister give £1 million capital grant towards the £8·5 million required to allow the Round House to flourish as a centre for Afro-Caribbean and Asian arts in London? Is he aware that the black community cannot raise that sum through the business community? The Minister may care to reply in the affirmative during the debate on the arts on Friday.

The hon. Gentleman asks two questions. First, the resources for the minority ethnic groups have to come out of the Arts Council's total budget. I think that it has made a sensible decision in deciding to set aside 4 per cent. of its total expenditure for that purpose. It will be distributed to areas where the ethnic minority groups are the strongest.

Secondly, the Arts Council has given £100,000 revenue funding to give the Round House time to decide, in conjunction with the London Residuary Body, how to deal with its redevelopment plans in the long term. The Round House is to be given transitional funding to enable it to decide on long-term planning.

asked the Minister for the Arts what he estimates the outturn expenditure of his office will be for the current year.

My cash limit for the administrative costs of running the Office of Arts and Libraries is £1·2 million in the current year. This is just a little over a third of 1 per cent. of my total programme of £321 million for the year. It is certainly my aim that the office should provide good value for money to the public and the arts.

That is a substantial sum. Will my hon. Friend allay fears that the price of success in artistic and financial terms in the provincial theatre is a sudden cut in grant from the Arts Council? Will he come to Salisbury, to the Playhouse theatre, and see for himself the impact of his policy?

My hon. Friend might be interested to know that the deputy chairman of the Arts Council, Sir Kenneth Cork, is conducting a study on how to subsidise theatres and in the autumn will be producing recommendations on the policies that should be pursued. I can assure my hon. Friend that the Government's policy is to keep up overall funding for the arts.

I am aware of my hon. Friend's interest in the Salisbury Playhouse. I have visited it many times. I propose to go to Salisbury towards the end of J uly to visit the Playhouse.

Does my right hon. Friend anticipate that he may have a little more flexibility within his Department's overall expenditure as a result of the announcement made by our right hon. Friend the Chancellor of the Exchequer in the Budget?

I am grateful to my hon. Friend for raising that point. The proposed Budget changes will provide a new era of opportunity for the arts world. It is for the arts organisations to take advantage of that. Clearly, they must be efficient in fund raising and as efficient as possible in marketing. I believe that the opportunity is now there.

asked the Minister for the Arts if he will make a statement on the future funding of Sadler's Wells theatre.

I am confident that Sadler's Wells has all the resources for a full season in the current year and that prospects for the future are good. Arts Council grants for subsequent years are a matter to be determined at a later stage.

Is the Minister aware that Sadler's Wells not only a centre of excellence for opera and ballet in this country, but has now become an international venue, visited by the whole world? We are grateful to the Arts Council and to the Minister for their efforts to preserve its short-term future, but is he aware that, because of its nature, it needs to have at least a three-year planning programme? It cannot stage an opera at the drop of a hat. Will the Minister negotiate with the Arts Council to secure revenue grants for at least three years so that forward planning can be effective?

I agree that Sadler's Wells is a great centre of excellence. Indeed, I was glad to he there last week for the 60th anniversary of the Ballet Rambert. Although Sadler's Wells is financially secure for this year, the fact is that the vast majority of its funding comes not from the Arts Council or central Government, but from a variety of other sources, including the box office and sponsorship. I am glad that Northern Telecom provided substantial sponsorship this year. In the longer term, Sadler's Wells must look not only to central Government but to a variety of sources.

Is my right hon. Friend aware that recently I was besieged by members of a ballet class in my constituency, when 100 ballet dancers of all ages pleaded for the continuation of Sadler's Wells? I accept that it cannot have a long-term guarantee, but will my right hon. Friend assure us that he will not stand by and see Sadler's Wells go to the wall?

I imagine that that was a siege that my hon. Friend enjoyed. I assure him that the theatre workshop proposal that is being planned for Sadler's Wells is well on the road to being established, thanks to funding support from a number of sources. I am optimistic that that will help.

I welcome the Minister's tributes to the work done by Sadler's Wells, but can he tell us, even at this stage, whether the same order of funding—the £100,000 package for the touring companies that rescued Sadler's Wells this year—will be available next year? If not, despite the frantic efforts of Sadler's Wells to obtain private sponsorship, it will be in serious financial trouble.

I know that the hon. Gentleman, who represents that area, takes the closest possible interest in Sadler's Wells. It is not possible to give a precise undertaking beyond this financial year, because the Arts Council does not know the precise figure that it will receive for next year and the following year, only the broad planning figure. I am confident that it will be possible for Sadler's Wells to continue and that the Arts Council will be able to continue its support.

asked the Minister for the Arts if he will indicate the main achievements of Her Majesty's Government with respect to the Arts in the last seven years.

The main achievements include increasing arts expenditure in real terms, safeguarding the arts against the abolition of the GLC and metropolitan counties, accelerating a major museum building programme, introducing a new scheme to encourage museums to increase their receipts, beginning the major new building for the British library, introducing public lending right and the business sponsorship incentive scheme, creating the National Heritage memorial fund, saving many heritage items and improving the arrangements for acceptance in lieu. These are some of the achievements.

I congratulate my right hon. Friend on his brief synopsis of his achievements and those of his predecessors in honouring their commitments to the arts. Can he say where he thinks future expenditure will come from, bearing in mind the increasing quality and quantity of the arts?

I am grateful to my hon. Friend. The Government will maintain their support. The overall pattern should be that increased resources come from the private sector in a variety of ways. The Budget proposals should be a help in that direction. The business sponsorship scheme should be a help also. There are a variety of other measures that are designed to encourage extra money to be made available from the private sector. I see that as being the fuel for growth.

Despite his answer, does the Minister accept that there are now smaller audiences, greater unemployment among Equity members and more disenchantment amoung theatre administrators than there has ever been? If the right hon. Gentleman would like to be remembered as a caring Minister for the Arts, will he do what he can to stop the imposition of VAT on the living theatre, because VAT is the single greatest evil now to befall the theatre?

I know of the hon. Gentleman's interest, but he gives a poor reflection of the true picture in the theatre world. I accept entirely that there has been a reduction in theatre attendances in recent weeks and months, but over the past two to three years—the hon. Gentleman must know this — attendances have been extremely high. Theatre attendances are higher overall than attendances at football matches. That shows the amount of interest that there is in the theatre.

I congratulate my right hon. Friend and his predecessors on their achievements. Has he assessed what the arts have achieved during the past seven years, especially in terms of earning currency for Britain?

I do not think there is any doubt that the wide range of facilities and excellence in the arts attract many tourists, not only to London, but to our other great cities and to many other parts of the country, and make a strong contribution to tourism.

Will the Minister add to his expected lists of achievements the following? Does he accept that we have seen the disappearance of the best supporters of the arts — the GLC and the metropolitan counties — due entirely to the Government's actions? Will he add to his achievements the crisis into which he has plunged theatres such as Sadler's Wells for the future, despite the present position? Will he add to his list of achievements the fate of arts administrators, who have to spend their time, as they tell us, squabbling for alternative sources of funding as a result of Government cuts? Is it an achievement that our National theatre had to close one of its theatres and allow itself to be saved by the GLC? Is he aware that the director of one of our major museums tells us that for the first time he is running into the red? Is he happy that funding of the arts over seven years has collapsed by 4·7 per cent. in real terms if we use the honest indicator of the retail prices index?

I am astonished by the hon. Gentleman's supplementary question. When I first became Minister for the Arts 10 months ago, the hon. Gentleman was preaching doom and despondency as a result of the abolition of the GLC and metropolitan authorities. He said that there was a major crisis in the arts, yet there has not been. Thanks to the co-operation, not only of the Arts Council, but of the regional arts associations and local authorities, the arts organisations are surviving—indeed, they are flourishing. Only last Friday the last outstanding problem on Merseyside was concluded with an injection of £1·7 million by the Arts Council and the local authorities into the region. That concludes the outstanding problems in all the regions following abolition. I think that the record is a fine one.

asked the Minister for the Civil Service if he will initiate a comparative study of the pressure of work on civil servants in the various Government Departments; and what information is already available on this matter.

Each Department is responsible for monitoring the work load of its staff and exchanges information as to how these issues can best be handled. I can assure my hon. Friend that Ministers and senior civil service managers attach great importance to making sure that work loads are right, and not excessive. Civil servants have responded well to the demands made on them as part of our drive to increase efficiency and achieve better value for money. I am glad to take this opportunity of paying tribute to the hard work and dedication found in all Departments.

I agree absolutely with what the Minister has said about the character and calibre of the British Civil Service, but does he agree that there are some disturbing indications that the volume and pressure of work—for example, on staff dealing with DHSS problems—have reached an alarming level, especially in view of the increased volume of work and the problems in preparing for the social security review? Is there not a case for a comparative study to see whether there is a need for more resources, especially for DHSS staff dealing with the general public?

There is constant monitoring of the work load of civil servants in all Departments to see how they can cope with the work load, but there is flexibility in the Government's policy. My hon. Friend will be aware that my right hon. Friend the Secretary of State for Social Services has announced that an extra 5,000 civil servants will be recruited to the DHSS to help cope with the extra work load. There is flexibility in the Government's policy where work loads appear to be excessive.

asked the Minister for the Civil Service if he will list the organisations, membership of which precludes employment either in the Civil Service as a whole or in particular posts.

No one is precluded from employment in the Civil Service because of membership of a particular organisation. However, no one may be employed on work vital to the security of the state who is or has recently been a member of a Communist or Fascist organisation or of a subversive group whose aims are to undermine or overthrow parliamentary democracy by political, industrial or violent means.

Recognising the loyalty to the Crown which is required of all members of the Civil Service, and paying tribute to the majority of them, does my hon. Friend think it proper that members or supporters of Militant should be allowed to be active supporters of the Civil and Public Services Association, such as the branch secretary, Tony Church, at Leicester's DHSS, and his chairman? Does my hon. Friend think that there is a conflict of interest when civil servants who claim loyalty to the Crown are involved in elections to an organisation about which Alistair Graham, the general secretary, has said, "Do not ever vote for Militant candidates"?

There are two points to consider in my hon. Friend's reflections. First, it is essential that, on security matters, we ensure that civil servants conform with the requirements that I set out in my answer. Secondly, in the pay and conditions of the service code, to which each civil servant has access, there is a requirement that he discharges his service and undertakes his duties loyally to the Government. That is another factor that must be borne in mind. We look to an impartial service. I believe that, in large measure, we have one.

Is the Minister not concerned at the increasing politicisation of the public service? Will he undertake to consider the conclusions of the Widdicornbe report, to be published shortly, to see whether they also apply to the Civil Service?

The hon. Gentleman may have noticed that the Select Committee on the Treasury and Civil Service recently reported on its study of the responsibilities of the Civil Service and Ministers. I noted in the report, to which the Government still have to reply, that the Select Committee came to a clear view, that it did not believe there was politicisation—to use an awful word— in the Civil Service. I welcome the fact that the Select Committee came to that view.

asked the Minister for the Civil Service when he last met the Civil Service unions; and what matters were discussed.

I have had no formal meetings with the Civil Service unions, but I did meet them informally on 25 March, and I attended the dinner of the First Division Association on 14 May. Topics of mutual interest were discussed informally.

When the Minister had an opportunity to discuss matters informally, did he raise the question of the uncertainty surrounding the future of the Crown Agents? Can he tell the House when a supplementary report will be produced and what will be in it?

I cannot give the hon. Gentleman a specific answer to his question. It is a matter for my right hon. Friend the Minister for Overseas Development. I shall draw my right hon. Friend's attention to the hon. Gentleman's question.

Is the Minister aware of the deep resentment within the Civil Service and among the Civil Service trade unions over the Government's pursuit of disciplinary proceedings against those who rejoined trade unions at Government Communications Headquarters? Is he aware that, to many, it appears to be a misuse of disciplinary proceedings as it implies that it is wrong to be a civil servant and a member of a trade union? Will he ensure that his right hon. and hon. Friends call a halt to those disciplinary proceedings before any punishment is meted out?

The GCHQ is a matter for my right hon. and learned Friend the Secretary of State for Foreign and Commonwealth Affairs, who has clearly explained our policy. I have noticed that the report of the Select Committee on the Treasury and Civil Service has expressed the strong view that disciplinary proceedings should be enforced when civil servants abuse their code of conduct.

asked the Minister for the Civil Service what discussions have taken place with the relevant Civil Service unions concerning the future of the Admiralty research establishment at Teddington.

The trade unions have been given the terms of reference for a review, which has recently begun, of the future of the Admiralty research establishment at Teddington and have been invited to comment. The Ministry of Defence stands ready to meet the unions and to consider any comments they may have.

As the future of the Admiralty research establishment is of great concern to 237 staff and their families, will the terms of reference for the management review include a study of whether it might be more cost-effective for the Admiralty research establishment to remain at Teddington? Will my right hon. Friend ascertain how many of the scientific and professional staff might be lost to the Civil Service if there is a move from Teddington?

Although that is principally a matter for my right hon. Friend the Secretary of State for Defence, I can answer in the affirmative to both questions.

asked the Minister for the Civil Service if he will make a statement on the operation of Civil Service recruitment schemes in 1985.

Seven hundred and sixty two recruitment schemes were conducted by the Civil Service Commission in 1985 to fill over 9,000 vacancies in the middle and higher grades of the Civil Service. Further information is given in the Civil Service Commissioners' annual report for 1985, which has been placed in the Library of the House.

Are there any special incentive schemes to ensure that appropriately qualified professional, technical and scientific staff are recruited and retained in the Civil Service?

I agree with my hon. Friend on the importance of that matter. We are concerned about the recruitment, retention and motivation of scientists and people in the professional and technology groups. To that end, not only have they had a reasonable pay increase this year, but a more flexible system of pay additions has been introduced. In addition, my right hon. Friend the Chancellor of the Exchequer is considering ways in which we might improve the starting salary of graduates in the science group, with a view to helping recruitment.

What is the level of black recruitment to the middle and senior levels of the Civil Service? Is the right hon. Gentleman satisfied with the progress that has been made?

Obviously I cannot give a percentage figure in answering that general question. General recruitment is not bad, but specialist groups — whether scientists or accountants — are causing concern. That is why it is important for us to have a flexible pay system, which we are now evolving, to deal with retention and recruitment problems.

asked the Minister for the Civil Service what were the savings to the Civil Service in the last financial year attributable to the Rayner reviews.

In the 1985–86 financial year, savings of £300 million were attributable to the programme of efficiency scrutinies. Scrutinies have also led to improvements in the effectiveness with which the taxpayer's money is spent.

I congratulate my right hon. Friend on that remarkable achievement. Does he accept that many loyal civil servants, especially in the industrial sector, are worried that efficiency in financial terms is being allowed to override the loyalty that they accord to their jobs? Will my right hon. Friend therefore ensure that it is a matter not just of numbers but of efficiency in the Civil Service?

The Civil Service can be proud of its achievements in implementing a large number of the efficiency scrutiny reports which have taken place over the past seven years and which have produced accumulative savings of nearly £1 billion, or £300 million a year. It is the Government's objective, in full co-operation with the Civil Service, to ensure that we use our resources most efficiently and get the best value for money. That is what our taxpayers expect and what our Civil Service is achieving.

I have selected the amendment in the name of the Prime Minister.

I beg to move,

That this House condemns the policies of Her Majesty's Government, which have undermined the capacity of the big city hospitals to provide care for all their patients, satisfactory training opportunities for doctors and nurses, reasonable working conditions for all staff or adequate facilities for research into improved care for patients and the promotion of good health.

On Friday 11 May in Perth the Prime Minister, speaking of her Government's record on the National Health Service, said:

"We have a marvellous record, which we should shout from the rooftops."

Before the month was out, staff at the Maudsley hospital in south London had been told that, for reasons of economy, they were to reduce the amount of jam used in sandwiches in the children's ward. Nothing could better illustrate the gulf between the isolated world of the Prime Minister and the reality of the crisis facing the big city hospitals in England, Wales and Scotland.

Skimping on the children's jam ration was not the only, or indeed the most important, damaging change that was being forced on the patients and staff at the Maudsley. All consultant and nursing posts were to be frozen. There was the weekend closure of the neurosurgery ward, so that patients who had had their heads opened up and undergone brain surgery were to be shifted from their beds to save the cost of weekend working. Closing half the beds serving chronically mentally ill patients, shifting the children from their special in-patient unit to a general hospital ward, closing the alcohol in-patient unit — all that and more at Britain's oldest psychiatric hospital, not because there were not the patients; not because psychiatric illness was on the way out; not because we did not need doctors and nurses trained in the best and most up-to-date techniques; not because we could afford to do without the research done jointly by that hospital and the Institute of Psychiatry, the funds of which the Government have also cut. The reason was that the Government would not find the money.

That hospital is, in theory, so important that it is run by a special health authority, reporting direct to the Secretary of State. I understand that there may be better news. Last Thursday, after this debate had been announced, representatives of the Maudsley met the Under-Secretary. They were told that they could overspend their budget this year. What a pity they had to divert vast amounts of energy and effort just to get a sensible level of funding.

However, several questions arise. Will the Government make up this year's deficit at the Maudesly, or will the hospital have to carry it forward and fund it out of next year's allocation? Will all hospitals in financial difficulties be allowed to overspend, or will it just be those that happen by chance to meet Ministers a day or two before a debate in the Commons? Those are important questions, because what is happening at the Maudsley is happening elsewhere. It is happening to the other special health authorities such as Great Ormond street and the National Hospital for Nervous Diseases.

The postgraduate research institutes associated with those famous hopitals—centres of excellence, of world renown in the struggle against pain and suffering—have seen their staff and work reduced, their capacity to teach diminished, their research curtailed. But it is not just those hospitals that are suffering. The Prime Minister may claim that she is spending more on the National Health Service than ever before, but it is not true. The extra funds do not match the combined effects of the increase in the cost of health care, the growing cost of medical technology and the increased health needs of the growing number of old and unemployed people.

Will the hon. Gentleman give way.

I shall not give way just now.

Even so, the NHS might have just about got by with that level of funding if the Government had not added a further costly element to the equation. That element is change. The Government are demanding massive changes in priorities, endless changes in structure and management, massive redirection of effort and huge geographical shifts of resources. But change costs money. Surely Tories understand that. The cost of change has always been the bulwark of the case for Conservatism, if it has any case at all.

Many of the changes envisaged would command the support of most of those involved if, but only if, the time scale were extended and additional resources provided, at least during the transition period.

Let me give an example of what I mean. Hampstead health authority, which is responsible for the Royal Free hospital, wishes to close the old workhouse at New End and provide a better place for the elderly near Hampstead Heath. The Government will not give the authority the money to build the new unit, so it is forced to close New End, sell it and use the proceeds to build the new unit. That may sound fine, but the problem remains of the existing patients at New End. The suggestion is to turn over to the elderly the wards presently used for other purposes at the Royal Free until the new unit is built. Other groups of patients will suffer because the money for the new unit for the elderly is not available.

This is not simply a London problem. It occurs in every big city in Britain. In all our big cities, the NHS is suffering from reduced funds and demands for massive change. That cannot be done except at the expense of patients and staff.

Is my hon. Friend aware that one solution offered is for private American companies to build and run National Health Service psychiatric hospitals? Such a proposal is being considered in Birmingham. It is widely thought in Birmingham that that hospital will he a loss leader so that those companies can build private profit-making psychiatric hospitals in all our big cities. Would my hon. Friend comment on that?

Yes, I shall comment on that point. My basic comment would be that I am dubious about any American company becoming involved in health care in Britain. I am especially worried about the idea of a psychiatric hospital run by a company which produces drugs used on psychiatric patients. There is bound to be a conflict of interest.

Is the hon. Gentleman aware that that American company is prepared to build that hospital at half the cost for which the district health authority would build it and will provide the same services? Is he interested in patients or in lining the pockets of those who support him?

I am interested in the record of American companies in the United States. When the American commercial companies can ensure that adequate health care is provided for the 30 million Americans who have no health cover in the most powerful and prosperous nation in the world, they may be able to contribute something to health care in Britain.

Big city hospitals were built where they were by the Victorians, or earlier, because that was where people were poorest and sickest. The Royal Victoria in Newcastle, Manchester Royal infirmary, Leeds General infirmary, Bart's Guy's and St. Mary's were built where they were needed — and they are still needed. The communities that they serve are still among the poorest and least healthy. The common measure of the health of a locality is perinatal mortality. The big city figures are bad. Against the national average of 10 deaths per 1,000 Newcastle upon Tyne has 16, north Staffordshire—serving the city of Stoke on Trent—has 15·9, east Birmingham has 14·7, and Tower Hamlets has 13·7.

The big cities have more deaths from cancer and heart disease, but in addition to the old diseases, they also have the highest incidence of alcoholism, drug abuse and AIDS. They also have the longest hospital waiting lists: 22,000 in Birmingham, 14,000 in Bristol, 13,000 in Manchester, 11,000 in Sheffield, 10,000 in Leeds, 8,000 in Newcastle, 8,000 in Nottingham and 8,000 in Liverpool. In inner London, waiting lists are soaring. Small wonder, when £35 million has been cut from the budgets of the inner London health authorities.

One example is Lewisham and North Southwark, where hospital waiting lists increased by more than 1,000 in the six months between September 1985 and March 1986.

The hon. Gentleman said that the waiting list in Bristol was 14,000. Can he confirm that? Information received from the chairman of the Bristol and Western health authority this morning gives the figure for 1986 as 7,944.

I should have thought that a Member from Bristol would have known that that great city is served by no fewer than three separate health authorities.

I will give some more examples of what is happening in the big cities.

In Newcastle it is proposed to close an orthopaedic ward at the Freeman hospital although there are 855 people on the orthopaedic waiting list. A children's ward at Newcastle general hospital is to be closed and two surgical wards at the Royal Victoria infirmary are to go, as is the entire Fleming Memorial children's hospital. Demand for some of the services now provided in Newcastle may eventually decline after the building of the new district general hospital at Ashington, but that is scheduled for 1993 and Newcastle is being asked to make cuts now. So the patients will suffer—more than 900 urgent cases have been waiting more than a month for treatment.

Central Manchester health authority has suffered cuts of more than £2 million and is threatened with a further loss of £3 million in the next two years. Reductions in provision at the Royal infirmary are bound to follow and patients will be turned away. Poorer, less healthy people in Stretford and Old Trafford are being told that they will not be able to go to the Royal infirmary any more, although it is nearer and there is good public transport. They must wait until alternative facilities are provided in a few year's time in the southern part of Trafford, even though it is further away and not so easy to reach by public transport. There are also fears for the future of the Manchester foot hospital.

Proposals for improved facilities for Hope hospital in Salford for neo-natal special care for babies in Salford and other parts of the north-west have been denied funds. The consultants involved have therefore decided that their first duty is to Salford babies and that from the end of this month they will be unable to accept referrals from elsewhere.

In Cardiff, the University hospital of Wales has just closed and padlocked its first ward, and no doubt others will follow. No one could call that a rational response to a waiting list of 5,300 people.

The Greater Glasgow health board has just been told by its general manager that it must cut spending by no less than £20 million per year, involving what he described as

"fundamental changes in the level of provision".

Few Scots believe that the intention is to level up, because levelling down is the message in the Health Service nowadays.

In Trent region, described as a major beneficiary of resource allocation changes, stands the famous city of Nottingham. These days the hard-faced sheriff is more in evidence than Robin Hood. The Government have robbed the regions that they describe as rich. but they still do not fund the poor. Phase 2 of the Queen's Medical Centre was completed as long ago as 1979, but it still stands mainly empty because the health authority cannot afford to run it. Indeed, things are getting worse. One existing ward for vascular surgery is to be closed and there is even a threat to reduce staff at the highly successful special care baby unit at the city hospital. The story is similar in every big city. At Guy's, which serves north Southwark and Lewisham, we discover from the Daily. Mirror—because officialdom will not tell us — that life-saving heart operations for children have been stopped because the hospital has not the cash to nurse all the post-operative intensive care beds. It must be pointed out, of course, that cash for cardiac treatment at Guy's has suffered because no less than £376,000 of National Health Service money was spent subsidising heart operations on private patients, as the recent report of the Comptroller and Auditor General reveals.

In Bristol the health authority's plans are dominated by closures and proposed closures of small hospitals such as the Wendover hospital maternity unit and Ham Green hospital. However, experience suggests that it is no good big hospitals and fashionable consultants offering their smaller neighbours as human sacrifices. It does not work. In Kipling's immortal words:

"once you have paid him the Dane-geld You never get rid of the Dane."

The calls for cuts will increase and the big hospitals will start to lose funds.

My hon. Friend mentioned Bristol. While I do not wish to exonerate the Government from any blame, may I remind my hon. Friend that a great deal of the problem there has been due to the university medical school and private consultants concentrating on rebuilding on an unsuitable site? Nevertheless, I am not against teaching hospitals. From my experience at the Westminster hospital, I have nothing but praise and admiration for its care and treatment. Will my hon. Friend bear in mind that sometimes university teaching facilities override the needs of ordinary patients?

There is something in what my right hon. Friend says. The big hospitals in Bristol, Leicester and elsewhere should regard small hospitals not as sacrifices, but as outposts. They should learn that the loss of those outposts exposes their central citadel to the next round of attacks.

Problems are arising all over Birmingham, but one example will illustrate what is going on. The Secretary of State wrote an article for the Birmingham Evening Mail entitled—would you believe it Mr. Deputy Speaker?—

"Health crisis? What Crisis?"

The East Birmingham health authority is being forced to close three wards while central Birmingham is limiting the number of cardiac operations and closing a ward at its children's hospital. No wonder the Birmingham Evening Mail in an editorial on the same day contrasted what it called the statistics and the reality.

The Government talk about efficiency and improving the management of resources, but what is happening in big city hospitals is putting a premium on inefficiency. Careful studies show that closing wards in a hospital which remains open does not save much money. The gearing is all wrong. A 20 per cent. cut in services gives only a 4 per cent. to 5 per cent. saving in costs. Conversely, a 4 per cent. to 5 per cent. increase in investment would lead to a 20 per cent. increase in services. Needless to say, this penny-wise, pound-foolish Government choose the wrong option.

The most spectacular example of that was in my constituency when the Middlesex and University College hospitals were closed to ordinary admissions for one month — for the non-mathmaticians on the Tory Benches, that is one twelfth of the year. It was intended to save £450,000 on a budget of about £120 million. In the end, they did not even save that—but at what costs to patients turned away and lengthening waiting lists? Such cuts do not merely affect patients but reduce the capacity of hospitals to provide adequate training for the doctors and nurses of the future.

All the changes that I have mentioned are leading to imbalanced admissions of patients, which mean that student doctors and nurses do not encounter the cross-section of patients required for their proper training. That is only the start. Cuts in spending on trained nurses mean that there is now an overdependence on trainees at night. Trainees are working excessive night duty. At UCH, the English National Board noted that a registered sick children's nurse was not always available on children's wards where learners undertook night duty. That is a disgrace.

Cuts in support services are forcing nurses, both trained and in training, to take on tasks which were previously the duty of clerical, cleaning and porlering staff. So much for the efficiency savings on ancillary workers which we have heard about. If the Minister does not like what I am saying, I issue this challenge: to publish the English National Board's reports on nurse training in the big city hospitals over the past few years.

It does not stop there. Junior doctors are also suffering. The only excuse for calling highly qualified hard-working doctors "juniors" is that officially they are still learning. Yet, because of cuts in budgets, they are being refused study leave to learn the new techniques essential for their next jobs. Without that study leave, the training posts they occupy may lose accreditation with the authorities and disappear, and so the cycle of degradation will continue.

The big city hospitals are also rightly famous for their research into the causes of disease, into improved methods of treatment and into ways of promoting better health—some in specialist hospitals, some in the general hospitals. All this is being reduced or threatened at the moment. In one year the Medical Research Council awards to medical students have fallen from 380 to 342, research studentships from 230 to 160, advanced course studentships from 100 to 70. Project grants have been cut by 4 per cent., programme grants by some 12 per cent. Government funds to help with general running costs of research units have fallen so low that, because they cannot afford the general running costs, the research units are having to turn down projects which would otherwise be funded privately. That is not very efficient. Over 200 clinical academic posts have disappeared in the last few years. All this damages vital research, the related teaching and the treatment of patients which is also provided in the teaching hospitals by clinical academic staff.

All the work that is done in the units is intended to relieve human misery, the pain of sick children, the nightmare of psychiatric illness, the horrors of cancer. It is of worldwide renown. It is work of which the researchers and all of us in Britain can be proud. It is practical and purposeful. But it is not being properly funded by a Government who continue instead to pour millions of pounds into weapons research and nuclear power generation. I challenge the Minister or the Secretary of State to come with me to Great Ormond Street Hospital for Sick Children and see the patients, their parents and the staff, and tell them face to face why the necessary funds are not available for that famous hospital and for the Institute of Child Health.

The hon. Gentleman keeps on about funding. The entire burden of his speech, as of the motion to which he is addressing his speech, has been critical and negative. Before he sits down, will he tell us something positive — in particular, what the Opposition would do if they were in power? What has happened to the commitment of a 3 per cent. increase in the payment to the NHS in view of reports in the medical press this week that the Labour party has reneged on its commitments?

The Tories had better learn that there is nothing negative about defending what is left of the NHS. It is the most positive thing that an Opposition can do until they are in power. When we are in power we shall find the funds that are necessary to restore the NHS.

I hope that the Minister will not dismiss the examples that I have given as anecdotes. They are facts; they are what are called evidence in a court of law. They are certainly more truthful than the figures he and his colleagues keep peddling. The Government leave no figure unfiddled in their pursuit—fruitless, as it turns out—of popularity. We now hear they are to try to reduce hospital waiting lists, but they have done it already. First, they left off the day cases. They trumpet about day cases when they are talking about people treated, but they change the rules to exclude day cases waiting for treatment from the waiting lists. More recently they conducted an administrative cull, the object of which was to reduce the list by a further 10 per cent. The doctored list is 661,000—10 per cent. of that is, as near as damn it, 66,000. So comparing like with like the real total is 727,000. That is higher than it was during the industrial dispute in 1982 and even 29,000 higher than the first figures produced after the "winter of discontent".

Our concentration today on the big city hospitals does not mean that the situation in the NHS outside the big cities does not concern us. Of course it does. We need a new approach to the whole of the NHS—supportive and helpful. But the reason why we have concentrated on the big city hospitals is that they and the people that they serve are suffering most from the Government's policies. Of course, many of the people that they serve come from outside the big cities anyway. But it is on the areas suffering most damage that we must concentrate most effort.

Fortunately, between the Government and their objective of undermining the NHS stands one insuperable barrier — the British people. Our people treasure the NHS, which has served them so well. Whenever and wherever it is threatened, local people join the staff involved to resist. Whether in Leeds, Liverpool or London, Birmingham or Bristol, Cardiff or Edinburgh, people resist. They will not forget or forgive the Government's attack on their hospitals. The Labour party, whose proudest boast is that we founded the NHS, is involved in that resistance up and down the country. We promise to protect the NHS, to restore it and to improve it.

Will the hon. Gentleman give way?

No, I certainly shall not.

But we promise more than that. We will change society and attack ill health at its source. We will reduce poverty by the introduction of a national minimum wage and increased pensions and benefits. We will tackle homelessness and improve housing conditions, we will improve health and safety at work, we will make healthy foods available at prices all our people can afford and we will turn back the sickening rise in unemployment. Here again, the communities in the big cities can expect to benefit especially from this investment in good health. We are confident that the people of this country will support us. We are confident that, with the help of the people. the big city hospitals will survive the current crisis. We are equally confident that this Tory Government will not.

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

"commends the Government on the increased resources it has made available for the National Health Service; congratulates the dedicated Health Service staff for their improved performance in delivering high quality health care; reaffirms the principle of equality of access to health care underlying the Government's resource allocation policy; and endorses the Government's decision to review the Resource Allocation Working Party formula under which the allocation of revenue funds is determined.".

The hon. Member for Holborn and St. Pancras (Mr. Dobson), in an exaggerated and distorted account of the NHS, made no reference to the Labour party's plans except to say, in response to an intervention, that it would spend more—but not how much more. There was no sign at all of what increased resources would be made available, nor any real sign of where the money would be spent.

Those outside who follow these affairs will see that the hon. Gentleman's speech was nothing more than a distorted account of difficulties and problems, often exaggerated. There was no constructive element in the speech at all. Indeed, even when the hon. Gentleman talked about perinatal mortality, which is of vital concern to us all, he made no mention of the fact that the rate of 15·4 deaths per thousand which we inherited in 1979 had come down by 1984 to 10 per thousand. There was no reference to that significant improvement which resulted from the dedicated and devoted efforts of the staff involved.

rose—

Nor was there any sign in the hon. Gentleman's speech that the NHS commands a high level of satisfaction from those who have personal or family experience of the vital services that it provides.

The latest poll commissioned by the National Association of Health Authorities and the Health Service Journal has shown that about 88 to 89 per cent. of people are satisfied, very satisfied or fairly satisfied with the quality of care and treatment. This level of satisfaction is probably higher than for any other institution or organisation in the country.

In contrast to what the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, is it not the proudest boast of this Government that the health of people has consistenly improved during their tenure of office? There are now more kidney transplants, more kidney patients, more heart operations, more hip replacements and an improvement in the rate of perinatal mortality. Is it not also our proud boast that resources have consistently grown and have not been cut, as they were under the Labour Government? We may have curtailed growth in places but we have not cut the service.

I am grateful to my hon. Friend for making some of the positive and constructive points which, for reasons of time, I shall not be able to include in my speech. Of course constructive criticisms can be made of the present situation, but it is perfectly clear from the speech by the hon. Member for Holborn and St. Pancras (Mr. Dobson) that I must await speeches from Government Members in order to hear responsible comment and helpful suggestions.

I welcome this opportunity to reaffirm the Government's record on the National Health Service and, perhaps even more important, to pay tribute again to the hard work, dedication and excellence of the hundreds of thousands of men and women who work in hospitals, clinics and day centres throughout Britain. By their efforts day in and day out, it is they, not Ministers or DHSS officials, who ensure that we have a National Health Service of which we can all be proud.

The Health Service does not exist in a vacuum. We can have a good Health Service only if we can afford to pay for it, and health services depend on a healthy economy. The basis of a healthy economy is the prudent management of financial affairs so as to ensure economic growth and low inflation. In 1985 the United Kingdom topped the league of EEC countries in terms of economic growth. Indeed, the 3·5 per cent. growth in 1985 was faster than in the United States, and the fastest rate of economic growth in this country since 1973. Our national income is at an all-time high and this is accompanied by an inflation rate of 2·8 per cent. which is the lowest since the 1960s. Lower costs are good for the Health Service and for its patients, just as they are good for other people in Britain.

The improvement in economic performance has been due to sound finance, an important element of which has been the responsible control of public expenditure. Within this overall control, priority has been given to the National Health Service. That is why Health Service expenditure has grown as a proportion of public expenditure from 12 per cent. when the Labour party left government to 14 per cent. now. That is why, when public expenditure generally has grown by 8 per cent. in real terms, spending on the National Health Service has gone up by 24 per cent.

rose—

The hon. Member for Workington (Mr. Campbell-Savours) is nodding, so there is no need for me to give way to him.

The Health Service has not only shared in the record growth of the economy, because health expenditure has increased its share of the GDP from 5·3 per cent. when the last Labour Government left power to over 6 per cent. now. If that is what the Opposition mean by undermining the Health Service, then words have simply ceased to have any meaning at all. Let me translate all this into what it means for the National Health Service. Spending is up from £7·75 billion when Labour left office to £18·75 billion in 1986–87. This represents a real increase after allowing for inflation of 24 per cent. If Labour's level of spending had been maintained, present spending would be £3·5 billion lower than it is now. Our record is hardly a record of neglect.

Capital spending to replace and improve the hospitals we have inherited and to provide new hospitals and community care facilities will be well over £900 million this year—that is £20 million worth of capital spending every week of the year. A total of 159 new hospital projects each worth over £2 million are presently being planned, designed or built in England alone. Perhaps this is what the Opposition, who cut the capital programme for the NHS when they were in power, mean by undermining the Health Service.

The foundation of a successful and developing Health Service is its staff. We are lucky that the National Health Service recruits so many of the very best people. Since this Government came to power, the National Health Service has taken on more than 60,000 extra nurses and midwives, 36,000 extra after allowing for the shorter working week that was introduced by this Government. We have 5,800 more hospital doctors and 4,000 more GPs than there were under the last Labour Government. Manpower generally is now under proper management control, with the result that far more of the staff are engaged in patient care. Doctors, nurses and professional and technical staff now make up 64 per cent. of total staff, compared to 58 per cent. in 1978. At the same time, the expenditure on management has fallen. Better value for money is just as important as spending more money on the NHS.

The Minister is obviously seeking to show his concern for National Health Service staff. Does he not accept that of late, in London, Health Services staff have been telling him that, although there has been an increase in finance, there has been a greater increase in need, and that the money is not enough? How can he answer a consultant orthopaedic surgeon in Guy's hospital who wrote to me only last week:

"Of course the problems are caused by inadequate funding of our unit, which is extremely busy and in great demand. It would help us all if somebody in your position could help to redress the gross imbalances in the Health Service"?

I am sure that letter is typical of hundreds that the Minister must know about. How does the Minister answer that person, a surgeon who is trying to do a job as a member of the National Health Service but who cannot cope because the money is inadequate'?

I shall say something about those matters in the course of my speech.

More money and more staff, together with improved efficiency, mean that it is possible to treat more patients and improve the service. The record speaks for itself. The Health Service in 1984 treated nine in-patients for every eight treated in 1978; three day cases for every two treated in 1978; and 11 out-patients for every 10 treated in 1978. That is hardly a service in decline or in retreat, as the Opposition and some trade unions would have us believe.

I should like to make two brief points. First, will the Minister include the figure for repeat referrals for out-patients and in-patients? Because of efficiency savings, such people do not spend the right amount of time in hospital. Secondly, the number of patients to which he has referred includes a number of patients who come to hospital three or four times. Will he confirm that in his figures for the total number of nurses he is including for the first time 100,000 nursing auxiliaries?

There is no justification for the first point made by the hon. Member for Brent, South (Mr. Pavitt). I well recognise his long and close attachment to and support for health issues. The figures I have seen would not support his contention. He is arguing about 1,000 in an increase of 58,000. If that is his case, there is not a great deal of difference between us, and the hon. Gentleman ought to be applauding the substantial increase that has been made.

The Health Service is a dynamic and developing institution. It is not a museum reflecting and preserving the past. I listened to the Opposition bemoaning any sign of change or progress, and I am sure that if they could they would attack us for the reduction in the number of leeches available in NHS hospitals. Britain is changing. Medical technology and practice is changing and if the Health Service is to provide the sort of first-rate health care that a modern people demands, it must change also.

Let me give some examples of those changes. There are now many more very old people. The proportion of people aged 75 and over has increased from 5 per cent. to 6·5 per cent. of the population over the past 10 years — an increase of 700,000, at a time when the population generally has remained relatively constant. Those numbers will go on increasing.

The population living in cities has declined. Between 1971 and 1981 the population of inner London fell by one sixth, from more than 3 million to 2·5 million. and the population of the former metropolitan counties fell by 500,000, while the population of the rest of the country rose by 1·5 million.

People want health services conveniently available where they now live and not where their grandparents used. to live. The Health Service must change and adapt and adjust its service provision to the new realities.

However, the change in demography is not the only significant change. Medical techniques and medical practice are constantly developing. For example, one in every six cases treated nowadays is a day case, compared with fewer than one in 10 in 1976. The average length of stay in hospital for surgical cases has fallen by 20 per cent. over the past 10 years; that represents an advance in patient care. Opposition Members seem to wish patients to stay longer away from their families and to be maintained at a substantial cost to the taxpayer, simply to keep beds open. Here, as in other areas, Opposition Members are true to their Luddite traditions.

The Government are concerned not simply to provide more money, but to ensure that it is spent better. One element in that aim is a fairer geographical distribution of resources. In 1978–79, there was a gap of about 22 per cent. between the three most deprived regions and the three that were highest above their target. By 1986–87 that gap had been more than halved and is now below 10 per cent. For the first time ever, no region is more than 4 per cent. below its target fair share of resources.

Will my right hon. Friend accept it from me that, as one who opposed the Resource Allocation Working Party system from the time it was dreamed up by the last Labour Government and introduced by the present leader of the Social Democratic party when he was the Health Minister, I know that areas such as my own have suffered time and again? It is precisely because the centres of excellence—the big teaching hospitals—have been losing money to other places over the years that the scare stories that the hon. Member for Holborn and St. Pancras (Mr. Dobson) can trot out ad nauseam have partly come true.

I am grateful to my hon. Friend, who speaks on these matters with considerable authority.

The Government remain firmly committed to improving access to health services throughout the country, both at national and at local level. Nationally, that is done through the RAWP formula, which allows for age, morbidity and patient flows to produce a target for each region. At regional and district level, the emphasis shifts from the allocation of funds to achieving the real aim of the whole process—improving equality of access to services. In essence that means providing local services.

It is certainly right to concentrate specialist services at centres of excellence; patients are happy to travel to the city teaching hospitals and similar centres for specialist treatment. However, a wide range of services are best provided locally. Examples include the "bread and butter" acute services. Elderly people are the major users of those services, and helping them to return home is a crucial part of their care.

People rightly expect to have access to local maternity and children's services, but too many of our health services reflect population patterns of 50 or 100 years ago, rather than today's needs. It is right that health authorities should be planning to take acute services to the growing populations of the suburbs and shire counties and that they should be working for a better balance of services in the inner cities, where local people need good community services alongside the centres of excellence at the teaching hospitals.

None of that can be achieved by financial formulae.

Is the Minister aware that there is hardly a health district in the country where some argument is not going on about local provision, its reduction and closures? Is he aware that Conservatives are involved in many of these little campaigns and they say that they do not understand why the Government have to cut taxes and cut services? They want to pay higher taxes and retain better services. How does the right hon. Gentleman reply to those Conservatives?

The Government have made more resources available. I understand those who argue that even more should be made available and I shall comment on them towards the end of my speech.

Will my right hon. Friend accept that some superb facilities have been provided in Lancaster and that will inevitably entail the closing of much-loved little hospitals such as the Beaumont hospital, which was a fever hospital in the first world war and cannot be remotely economic?

I am grateful to my hon. Friend. She makes the sort of constructive and helpful comment which I said earlier was most likely to be made from the Government side of the House.

I make it clear that London must, of course, retain its centres of excellence, but London is more expensive and, because of recruitment problems—the hon. Member for Holborn and St. Pancras referred to some of those problems — it is sometimes more difficult to provide services in London than elsewhere. So it makes no sense, as a long-term aim, to bring people into London for treatment that can be equally well provided for them locally. Local provision is also much more convenient for patients and their families.

A fairer regional distribution of available money is not enough. It is also important that that money is directed towards the groups that the Government have identified as deserving priority—the elderly, the mentally ill and the mentally handicapped. The increasing costs of acute medicine and the influence and status of those who practise it could mean that the weakest in our society come off second best. I am anxious to ensure that that does not happen and that the elderly, the mentally ill and the mentally handicapped are not disadvantaged.

Expenditure on the priority groups has increased by more than £400 million—a doubling in cash terms, from £1·3 billion to £2·6 billion—and that is in addition to the help given to elderly people by the acute services. Those priority services also benefit from the increased number of mental illness and mental handicap nurses, which has risen by 16 per cent. since 1978, even after allowing for the shorter working week.

It has been generally recognised for many years that, for historical reasons, inner-city areas have tended to be over-provided with acute beds. The London health planning consortium set up under the last Labour Government concluded that the number of acute beds in London needed to be substantially reduced. Patients in inner cities, such as London, are still more likely to go into hospital and to stay longer than are their counterparts outside the big cities. That is due, at least in part, to the historic pattern of care in the inner cities, with its emphasis on the provision of acute beds in teaching hospitals. Those hospitals include specialists' work in their case load, but in big city districts there are 50 per cent. more senior doctors per case treated than there are in other districts.

Although inner cities tend to be over-provided with acute beds, they tend to be under-provided with primary care, as the Acheson report found for London some years ago. High standards of general practice can make a major contribution to tackling the health problems associated with social deprivation in inner cities. Some outstanding work is already being done in that area and the Government have provided extra money, in the form of financial incentives to GPs to form group practices and 60 per cent. grants to improve the quality of practice premises.

Can the right hon. Gentleman tell us how many of the 114 recommendations of the Acheson report have been implemented?

Not without notice.

Standards of practice are still variable in inner cities. That is why the discussion document on primary health care, which was published in April, lays particular stress on the importance of improving standards in inner cities.

Of course the challenges faced by the Health Service, such as the need to take account of demographic change and changes in medical techniques and medical practices, as well as the need to ensure a fairer distribution of resources between and within regions and between priority groups, can often give rise to problems. But the NHS is facing up to those challenges, and I pay tribute to Health Service managers and staff for the way in which they have managed, and are managing, the rapid rate of change that is necessary to improve Health Service care.

But inevitably problems and pressures come together in the city districts, where the job of readjusting to a new pattern of care causes particular difficulties. Very often, those districts must also adjust their education and training responsibilities while at the same time, for historic reasons, their hospitals are located in older buildings, which all have their passionate supporters for retention.

The Government are acting to ease the process of change on several fronts. First, they are improving significantly the capital stock of the Health Service. A listing of all the projects would take until 7 pm, so I shall just mention a few: the redevelopment of the Royal Victoria infirmary in Newcastle at a cost of £20 million, the Leicester Royal infirmary development costing £13 million, the new Good Hope district general hospital in Birmingham on which £12 million is being spent, provision in Manchester, expenditure on the Mayday hospital in Croydon, the redevelopment of St. Mary's, Paddington, phase 2 of the development a t St. George's, Tooting, phase I of the Homerton hospital, and the upgrading of St. Thomas's hospital across the river. That hardly sounds like undermining the Health Service in inner cities or observing its collapse.

I am pleased to announce today that I have given approval for phase 2 of the Derby city hospital redevelopment at a cost of nearly £9 million, and that work on the construction of the new national heart and chest hospital on the Brompton site begins today. That adds to the long list of schemes that we have recently approved, many of which deal with patients living in our largest cities, or who would otherwise be treated there. The development at St. Luke's, Bradford, two schemes in Liverpool, the commencement of work in the south-east Thames region on three major new district hospitals, and the undertaking of further work on the new district general hospital at Milton Keynes in the Oxford region all represent increases in the capital programme. The Labour Government cut that capital programme.

Health services are improving in the big cities. Our statistics show that, for all large city districts, the number of in-patients treated rose by 11 per cent. between 1979 and 1984, with nearly 6 per cent. more out-patients treated and nearly 60 per cent. more day cases. It is absolutely moral humbug for trade union leaders to complain about increases in waiting lists, when they and their members were responsible for the damaging strikes of 1978–79 and 1982, which led to record increases in waiting lists and record lengths of waiting lists.

Another issue that is often used to whip up a sense of crisis is that of hospital closures. In any developing service, some hospitals arc bound to close while others are opening. To look only at the closures makes as much sense as reading the deaths column in the newspaper and ignoring the births column, and thereby assuming that the population is dying out. Opposition Members have distinctly selective memories in that area. Although 227 hospitals closed in the first six years of this Government, 270 hospitals closed in the five years of the previous Labour Government. But what count are services, not hospitals, and patients, not beds. As I have said, under this Government services have continued to improve and the number of patients treated continues to increase.

The Government recognise that inner-city districts have particular problems in coping with change. But they must also look critically at their activities and resources. It is right that health authorities that have fared well in the past should re-examine the use that they make of expensive estate and the resources that they have tied up in non-clinical work. It is significant that the Thames regions' cost improvement achievements and plans have been significantly above the national average in every year of the cost improvement programmes. For 1986–87, the Thames regions plan cash-releasing cost improvements equivalent, on average, to more than 2 per cent. of their allocations compared with a national average of some 1·5 per cent. Those are not Government-imposed targets but the regions' and districts' own plans.

Since much of the clamour about a shortage of resources has come from the consultants in London teaching hospitals, it is perhaps worth asking whether those hospitals have looked carefully enough at the cost-effectiveness of the services that they are using to support their clinical activity.

They certainly have.

Well, my Department's performance indicators show that, after making allowance for extra costs in London, many of those hospitals have higher catering costs, higher domestic service costs, higher linen service costs, higher operating theatre costs and higher pathology and portering costs. Is it not incumbent upon those who resist change and who demand extra resources to look carefully at whether existing costs need to be so high compared with other teaching districts and the rest of the country generally?

The Government recognise the particular problems of big city districts. I have already referred to the major capital programmes and to the review of primary care, but I must mention two other things that we are doing which should help the health services in the big cities. I turn first to the review of RAWP, which was referred to by my hon. Friend the Member for Hampstead and Highgate (Sir G. Finsberg). It has been suggested that, although substantial progress has been made in redistributing resources, the present RAWP formula needs to be refined to improve its measurement of need.

The Government have therefore set up a review of RAWP, which will consider among other issues whether proper account is taken of social deprivation and inner-city problems, teaching hospital costs and patient flows across regional boundaries. Those are all issues of particular concern to the big cities. I am anxious to see good progress on that review, and have asked the management board to report by the end of the year.

Secondly, the Government have recently added an extra £50 million to health authority cash limits in England, following decisions on this year's pay awards. Of that money, more than £16 million will go to the Thames authorities and to the special health authorities in London, £7 million will go to the north-western and Mersey regions, £5 million will go to the west midlands and over £3 million will go to both Yorkshire and the northern regions. Those are substantial additions for regions that contain most of the big cities.

That has been done in a year when we have already allocated some £650 million more to hospital and community health services in England. With the extra £50 million, we are talking about growth, in real terms, of 3·8 per cent.—the highest figure since 1980–81. In addition, health authorities, with their cost improvement programmes, plan to release a further £150 million this year, with further planned increases in activity and productivity within existing resources. Health authorities are also benefiting from the fall in general inflation brought about by the Government's policies. The reduction in inflation below that assumed when setting cash limits will be worth £20 million on non-pay expenditure.

Of course I am not suggesting that more could not be done, that no improvements could be made or that there are not problems and pressures. Health care generates demand upon demand. Its needs are never satisfied. But this Government have shown their commitment to the Health Service as a whole, and that is reflected in the improvement of health services in our cities. The Opposition's contention that we are undermining health services does not stand up to any critical consideration, and I ask the House to reject the motion and to support the Government's amendment and their efforts to improve health services for all.

The Minister is becoming quite a juggler. In the speech that he has just made he sounded almost as good as the Secretary of State for Employment with his figures showing conclusively that unemployment is spiralling downwards. The Minister's figures are questionable and designed to show that far more money is being spent on the National Health Service. People's experience belies the figures and contradicts the picture painted by the Minister of a growing and expanding National Health Service.

The Minister said that there was a high level of satisfaction with the National Health Service. People would laugh their heads off at such a statement. However, we discovered that the Minister is not really speaking about the attitude towards the Health Service as a whole. He was speaking of comments in the Health Service Journal in which the quality of care was being discussed. People do not like criticising doctors and nurses. They are only too anxious to pay tribute to them. Such a comment gives a false impression about what people really think about National Health Service provision, which is disastrous in many areas. The Minister fails to take note of the anxieties and very real concern expressed by thousands of people.

The hon. Member for Hampstead and Highgate (Sir G. Finsberg) spoke about the excellence of teaching hospitals in London and of the scare stories from some areas. He does not know what he is talking about. I support centres of excellence in London and elsewhere, but it is not scare stories that come from the regions.

I have a horror story to tell the House today which I hope to confine to 10 minutes. It is a horror story of what has happened in Stoke-on-Trent and in north Staffordshire. I emphasise my support for my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and others who want the centres of excellence to be assisted, but that must be done by giving new resources to those centres of excellence, not by sapping their income and transferring the funds to the regions. That is wrong.

My main concern today is to put the case for helping the scandalously deprived, underprivileged areas such as north Staffordshire, which has been deprived for a long time. The tendency is for the Government and the public to accept that deprivation with complacency. The appalling inequalities have existed for far too long.

I shall illustrate the massive disparities by referring to red alerts. A few months ago there was a red alert at a London hospital. My hon. Friend was the first to shriek and condemn it. The people of London agreed that it was disastrous. The red alert meant that only emergency cases were admitted to hospital. There was a stop on other admissions.

North Staffordshire experienced red alerts in September—that was not even in winter—from the first part of November until December, for over six weeks from January into February, from February to early April and from mid-April to 6 May. North Staffordshire experienced red alerts for almost the entire winter. There was a stop on admissions and only emergency cases were admitted.

One can imagine the suffering caused to the sick people of north Staffordshire by that interminable period of red alerts. It was not one crisis, but a perpetual crisis. I hope that the House will take note of that scandal. We must do something about it because the sick people of north Staffordshire are suffering. The medical staff are bearing a heavy burden.

The Minister referred to the resource allocation working party which is dealing with the reallocation of resources. According to RAWP, north Staffordshire is 12·5 per cent. below target. Planned progress for improvement has been extremely slow, even without interference with the RAWP formula, so that by 1990 north Staffordshire would still have been 9 per cent. below target—the third worst district in the west midlands region.

According to the DHSS figures published last summer on the value of National Health Service provision for people in all health districts, north Staffordshire is seventh from the bottom. The value of acute services received is only £58·45 per person. Those at the top of the scale—the first 15—are all London district health authorities. They are receiving over twice as much as the people in north Staffordshire. The Minister cannot justify that disparity. He cannot deny the people of north Staffordshire. He cannot give them only half of what Londoners receive. That is wrong and cannot be justified.

I recognise that those figures are not a perfect measure of Health Service deprivation, but they are a significant indicator and should be taken into account by the House.

What I have described makes a mockery of the rhetoric in the Government amendment about reaffirming

"the principle of equality of access to health care."

I do not criticise the Minister on that score because he says that he intends to review RAWP, which I welcome. But I hope that he does not mean that resources will be cut so that deprived regions will suffer still further cuts.

The people of Stoke-on-Trent are suffering gross inequality in access to health care. That inequality is not vague or hypothetical; it leads to genuine human suffering. People who are desperately ill and in pain are suffering unnecessarily. The House should do something about it.

In Stoke-on-Trent people in severe pain because of an arthritic hip joint, for example, have to wait for up to 46 weeks for a first appointment with a consultant. There can be no justification for that. About 60 per cent. of people in my area whose cases are not regarded as "urgent"—that is a medical definition—as most orthopaedic cases are not. have to wait for over one year for an operation. Last December, overall in north Staffordshire, 3,336 people had been waiting for a so-called "non-urgent" operation for over a year. Such cases might be non-urgent in medical terms, but that phrase masks great human suffering.

Urgent cases, naturally, receive quicker treatment, but even that can be appalling. No less than 75 per cent. of "urgent" cases in general surgery wait for over one month. One can imagine what it is like to be told, "You are very ill. You need an urgent operation, but come back in a month's time."

Because of the revelations about unfair allocation, together with pressure from myself, my parliamentary colleagues and officials of the district health authority in north Staffordshire, the West Midlands regional health authority has begun to move and has given a £10·5 million boost over the next five years, which I welcome and appreciate. That authority also has problems, but fortunately it is shortly to receive an additional £40 million. I regret that the boost for north Staffordshire is far from adequate and cannot possibly solve the problems, although it is a move in the right direction towards the RAWP recommendations. However, some people in the south-east are now suggesting that we drop or change the RAWP formula. The hon. Member for Hampstead and Highgate spoke of scare stories in my area. They are not scare stories; they arc true.

I conclude with this plea—that RAWP will not be invalidated in any way. If the Government want to refine it, that is all right—but please do not interfere with the reallocation of funds from the better-off south-east to neglected areas such as mine. I hope that the use of the word "review" will not be a euphemism for stopping reallocation. The Government must face reality—they cannot provide a fair allocation of resources and good health treatment if they do not increase the total resources available. The answer to the problem must be increased resources. Reallocation is important, but juggling with figures is no substitute for increased cash for the NHS. I hope that the Minister will win his battle with the Treasury to increase funding for the NHS.

I offer my apologies to the Opposition spokesman for not being here during the opening speech. That was due to circumstances beyond my control. It is unlikely that I shall repeat exactly what the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, because I intend to devote my speech entirely to my constituency of Old Bexley and Sidcup, the borough of Bexley and the Bexley health authority.

It is many years since I made a speech in this House about matters concerned solely with my constituency—indeed, it must be more than 35 years—but I find the current position intolerable and I cannot remain silent any longer. Some of us have held our peace when believing that wrong decisions were taken, but it is apparent that the damage is becoming so great that the facts must be stated. I do not blame my right hon. Friend the Minister, who is a prisoner of the system. It is the system that must be changed. I am glad that there is to be a review of the system, but we cannot wait very long to change it because of the damage it is causing to Bexley.

This country apportions about 6·2 per cent. of gross national product to health services. The general figure for countries of comparable size and wealth is 8·5 per cent. That, therefore, is our first lesson. We must be prepared to devote more of our resources to health, both private and public.

Secondly, I do not believe that allowing the Health Service to go private is the answer, other than to a limited extent. Those who suggest that we follow the American system are urging something that is wholly unacceptable in this country. The United States, its President and Congress are large enough to ignore the fate of millions of their under-privileged citizens. We are not only unable to ignore it, but are not prepared to ignore it. That is why we cannot follow that system. By all means, let us encourage those who can afford it to indulge in private health care, but the great majority cannot afford it.

Thirdly, as I have said many times, the Government are wrong if they think that the first priority is to reduce taxation still further. I know that taxation is still much higher than it was in the years 1970 to 1974, but that is no justification for saying that it must be reduced still further. If I ask my constituents, "Do you want your taxes reduced?", they will say yes. Indeed, I would say yes. However, if we ask them, "Do you want your taxes reduced at the expense of the education of your children and the health of your family?", the immediate answer is no. Yet that is what is happening.

Bexley is part of the great city of London; it is not part of a declining inner city. The population in 1981 was 217,000, in 1985 it was 218,500, and it is projected that by 1996 it will be 220,000. It is an expanding population, with a great demand on services, especially health. Moreover, there is an increasing elderly population. In 1981 the percentage was 29·8, in 1985 it was 31·2, and it is projected that by 1991 it will be 32 per cent. Bexley, therefore. meets the requirements set out by the Minister that it should be an increasing, not declining, population with an increasing, not declining, proportion of elderly people.

As the Minister said, people expect to be treated locally, and I can tell him that the people of Bexley expect to be treated in Bexley. My right hon. Friend was wrong to suggest that people needing specialist treatment are willing to travel to teaching hospitals and for relatives to have to travel to visit them after a serious operation.

That is precisely the argument that has been taking place over the Brook hospital cardiac unit. I am grateful to my right hon. Friend the Secretary of State for overruling the regional committee and keeping the unit there. However, the argument took seven years. That is an example of the bureaucratic incompetence of regional committees. They can argue for a long time about such a major facility as the cardiac unit at the Brook hospital. Indeed, that unit has a better success record than the teaching hospitals, and the cost of operations is cheaper than in the teaching hospitals, for obvious reasons.

Yet the same argument is taking place about the neurological unit at the Brook hospital, and that, too, has been going on for seven years. We still do not have a settlement, review after review goes on, and that is just not tolerable. I hope that I have established that Bexley has an expanding population with a larger proportion of elderly people who want to be treated with the necessary facilities.

I shall now deal with existing facilities, which is the real point of the argument. Bexley has Queen Mary's hospital which was built just over 10 years ago. It was opened by the then Labour Minister for Health. It has 556 beds, an outstanding maternity unit, many effective specialised departments and a major accident unit. It is up to date. It is a modern creation, yet it is being damaged because it is being refused the money to carry out its services.

I fully support equalising health treatment throughout the country. After all, I spent a large part of my political life trying to obtain a better deal for Scotland, Wales and the north-east of England. As Secretary of State for Industry, Trade and Regional Development in 1963–64, I dealt with this matter in the context of north-eastern regional development. Alas, those policies have been abondoned by this Government. I am in favour of equalisation, but not at the cost of the nonsense of refusing to use the modern facilities that we already have. That cannot make sense by any criteria.

Surely the first priority must be to ensure that modern hospitals with all the facilities are used, and then go on to build additional hospitals that are required to replace the older hospitals. One problem with the present formula is that when an area has to build a modern hospital to replace, for example, two older hospitals, as is happening in north and east London, extra money is required to run the two older hospitals while building the new one. That is why Bexley is suffering from less money. We cannot make use of the modern hospital that we have. The system is based on a fallacy and the Government took a wrong policy decision.

The Bexley health authority found that for 1986–87 it was due to have a deficit of £750,000 and that in 1989–90 the deficit would increase to nearly £1·5 million. Bexley has been told that it must meet the deficit by cuts or increased efficiency. Queen Mary's hospital is proven to be well above the national average in terms of efficiency, the speed of its throughput is faster than the national and regional average, and the cost per patient is lower than average. What more can be asked of it than that? A stage is reached when it is not possible further to increase efficiency and make cuts of up to £1·5 million.

The Government say that they are spending 20 per cent. more on real resources for the hospital service, but we know that 70 per cent. of this spending goes on nurses' salaries. That leaves a much smaller sum to make improvements elsewhere in the country. As there are shorter working hours for nurses, the burden on them and the demand for nurses is much greater than it was. That cannot be taken into account merely by saying, "Greater efficiency."

I have often been accused of being a technologist who is keen only on management. I am interested in management, but I have never suggested that someone who is a good Army officer or good at running an electronics factory will be admirable at running a hospital. If I have to go into hospital, I do not want someone running the show who has only just left the Royal Air Force. Nor do I want someone in charge who is especially good at producing television screens. I would want a good matron, and on that basis I would know where I was.

As my hon. Friends the Member for Bexleyheath (Mr. Townsend) and for Erith and Crayford (Mr. Evennett) are present, I should say that the Bexley mental hospital, which has 907 beds, is affected by the Government's policy. Similarly, the Erith district hospital, which has 31 beds, is affected by the cuts.

In dealing with the Government's demands, cuts are being made. What is the result? One ward has already been closed at Queen Mary's hospital. That means that the modern facilities in which the Government have invested capital are not being used. That ward will remain closed. There was a threat that the ward for disabled young people would be closed. We have been able to avert that threat purely by blackmail. Bexley has said, "A great deal of private money has been provided and if you dare close the ward you will never get any more money for a hospital in Bexley." The ward has not been closed. Unfortunately, a general ward remains closed.

In addition, one operating theatre is to be closed. That will reduce operating capacity by 20 per cent., or 1,760 operations a year out of 8,800. That will happen and that will be the direct result of the Government's policy.

There is to be a reduction in the number of beds in the surgical wards because of the closure of one operating theatre. As a result, there will be a reduction in emergency admissions. That follows logically from the closure of the operating theatre.

Less than a month ago one of my constituents said, "I know that you can do nothing about this, but you should know that my wife was taken seriously ill. I called her doctor and he came at once. He told me that she must have an immediate operation. We rang Queen Mary's and were told that no emergency place was available. We telephoned Dartford and were told, 'There is a ward, an operating theatre and a surgeon; bring her over,' only to find that there was no bed available for her after the operation. We were told that Dartford could not accept her. Finally, she was taken to Gravesend." For someone living in Sidcup, that is a considerable distance to travel. That is an example of what is already happening, and that is why the situation has become intolerable. I must make it plain that that is so.

In addition, the family planning surgical service at Queen Mary's hospital is to be abolished. That is surely a loss. My constituents do not understand why cuts are being made on their doorstep when the Government say that many millions of pounds of extra money are being provided for the NHS.

The Bexley mental hospital is to be closed eventually. Twenty old ladies who are psycho-geriatric patients have been taken from their ward—they were accustomed to it, as were those who looked after them—and spread around the hospital so that the ward can be closed. That is certainly not a step towards perfection. That is not making the hospital more effective. To move patients in that way is damaging and should not be allowed to happen.

The operating theatre at the Erith district hospital is to be closed. All consultants' beds are to disappear, along with the loss of 15 general practitioners' beds in one ward. That is because the necessary money is not to be made available, and not because of inefficiencies.

The community services will suffer as well. Two clinics are to close. Three dental clinics are to close, and there is to be a reduction of dental staff. The number of family planning clinics will be reduced from 10 to four. When these things are happening, how can I say to my constituents that they are getting a better health service and better individual care? It is not possible for me to say that that is happening. If I were to say that it was, I would he incredible, and I do not wish to be incredible.

I support what my right hon. Friend is saying. Does he agree that, far from having too many hospital administrators in the Bexley health area, we have rather too few?

That is the case. My hon. Friend and I have spent a vast amount of time talking to hospital administrators, to the Bexley health committee and to the chairman of the regional health authority. It is easy to say that a reduction in the number of administrators will bring about the savings that are required, but a point is reached when it is damaging to the service to reduce the administrative staff.

The ambulance service will be cut because of the abolition of the GLC. Many chair cases will not be taken by ambulance and walking cases will have to find other means of transport to get to the hospital when required. This is happening already.

Will the right hon. Gentleman give way?

I have taken too long already. I know the point that the hon. Gentleman wishes to make. We have sometimes been in agreement about the GLC.

I have outlined the facts with which we must deal. It is intolerable that Bexley should have its modern services damaged because new services are going to be made available in other parts of the country. New services can be provided only if we have an expanding economy and are prepared to use a greater share of our wealth to support the Health Service. If we try to take the opposite approach, we shall damage the new resources which have already been provided. That is no answer to the problem. If the Minister is bound to have the review of RAWP, so be it, but I ask him to ensure that it is done quickly. I would much prefer no review to be undertaken. It would be better if he took the action which he knows to be necessary, my colleagues and I having had long talks with him.

My right hon. Friend may know that there are some who criticised the last part of his period in power on the ground that the money supply was growing too fast. Sterling M3 has grown over the past three months at an annualised rate of 39 per cent. What measure of growth would he like to see? By how much more would he like to see credit expanding?

I appreciate my hon. Friend's anxiety. The most recent figures show that M3 money supply is growing at one and a half times the maximum rate at which it grew between 1970 and 1974. It is natural that my hon. Friend is alarmed when we have a Government whom he supports, which was not the case with my Government. My hon. Friend is out of date on M3. He must listen to the Chancellor of the Exchequer, who says that M3 no longer matters. My right hon. Friend has already abolished M3, M2 and M1. We are back to MO. Perhaps my hon. Friend will wish to follow him and to take up MO, which suggests that everything is all right. That will mean that we can have more money, which will stop the Government ruining a good service. That is why I urge my right hon. Friend the Minister not to waste a great deal of time on reviews. He has seen the problem clearly. It is necessary to let those of us who are fortunate to have modern resources to use them effectively and to keep them. We cannot justify to the electorate doing otherwise.

The right hon. Member for Old Bexley and Sidcup (Mr. Heath) described perfectly what is happening in every constituency. I am sure that if Conservative Members were willing to ascertain what is happening in hospitals in their constituencies they would find cases similar to those that the right hon. Gentleman described. The Select Committee has spent some time considering the problems. We have ventured into areas, as the right hon. Gentleman said, where there is considerable pressure on hospitals. I am not surprised that the Minister for Health did not refer in his opening speech to the catastrophe that has befallen him in the resignation of Mr. Victor Paige. Mr. Paige, who was in post for a matter of months only, was head-hunted at an enormous salary. He decided that he could no longer continue in the job. The Select Committee will probably want to pursue that matter in the near future.

Mr. Paige gave evidence to the Public Accounts Committee some two months before the Secretary of State for Social Services announced the resignation. In that session with the PAC, Mr. Paige listed his achievements. In 1985–86, there was a cost improvement of £150 million, of which £120 million was cash-releasing. Short-term programmes for the regions for 1986–87 also show a cost improvement of £150 million, cash-releasing — an increase of £30 million over 1985–86. Taking those figures back to 1984–85 and up to 1986–87, a total of £700 million cash-saving will be produced for the National Health Service. By the end of 1986–87, that will produce £400 million for the National Health Service on a recurring basis. When the 1987–88 CIP commences, a base of £400 million will be rolled on and repeated. Anything achieved then under cost improvement cash-releasing will be over and above the £400 million. That sounds absolutely marvellous. Hon. Members might say, "What are we worrying about? All that lovely lolly is available for all the development that we have not been able to fund." The challenge is, as Mr. Paige admitted, that savings must be made and retained to keep on improving services. Certainly, this year the regions are committed to delivering a cost improvement, cash-releasing programme of £150 million.

The other part of the package is that manpower savings must be made. Mr. Mills, from the Department, told the PAC that for every million pounds released by any region

"we could expect to see at least 100 people being reduced from the payroll."

That is, in a full year. There is the rub. Those considerable savings are expected to be made. but they must not include the withdrawal of services or service reductions. The North East Thames regional health authority was examined and the board was satisfied that it was not trying to hide service cuts within a CIP.

However, the Select Committee discovered, in reply to questions on 4 June, that the volume of resources going into hospital and community health services has increased by only 6·3 per cent. since 1979–80—about 1 per cent. per annum—and most of that was in the earlier years. Since 1980–81, the increase over five years has been only 3·1 per cent. In fact, in the three years since the last election the increase has been less than over half of 1 per cent. In other words, the purchasing power of the hospital service has been at a standstill for three years. That is where all the problems lie.

Hospitals, especially those in the London region and in all the large cities, are struggling with an increasing number of elderly patients, with finding resources to introduce and develop further medical advances. Ministers have generally agreed that we need a service growth of 2 per cent. per annum. That that is not forthcoming is a matter of acute concern to the medical profession—the nurses, the paramedics, and so on. That is what led the leaders of 12 teaching hospitals last Monday to describe the crisis they are facing after inner London had suffered cuts of £35 million last year. We cannot cut that amount out of a large city without damaging the fabric of the Health Service. The consultants, those responsible for delivering expert care and those who have academic teaching responsibilities have complained. Dr. Croft of St. Thomas' hospital has said:

"The crisis was a national disgrace, many useful and productive human lives have been lost and staff, including nurses, secretaries and porters are leaving because of their rotten pay. Beds are being closed and waiting lists increase."

We cannot overlook the effects of the review body awards to doctors, nurses, and other NHS staff. Morale falls when pay levels to all but the highest paid are well below the average. Whitley staff, in particular, have become very disillusioned.

The Secretary of State has the following questions to answer. First, can pay settlements be adjusted and cost improvements contrived, as far as he requires them to be, without harming patient services still further? If not, will he provide additional resources to maintain growth? Secondly, is he satisfied that the NHS management board's new accounting framework can properly assess, monitor and provide information about local value-for-money strategies? Thirdly, I ask what response he makes to Mr. Paige's reference in his letter of resignation to

"the different perspectives, priorities, objectives and restraints of Ministers and the Chairman of the Management Board".

Fourthly, how is he facing up to the problem—which he and his predecessor embraced wholeheartedly—of the growing cost to community care of those patients discharged from long-stay hospitals and the effects of that both on NHS and local authority expenditure? The problem affects every region, large city and local authority. What is the answer to the question? The Select Committee has referred to it, but we have not had a satisfactory answer. Fifthly, it is generally agreed that we need 2 per cent. growth per annum. Will the Secretary of State tell us whether that will happen?

My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) referred to the Institute of Psychiatry. The Minister will have read the letter that appeared in The Times on 27 May from Professor Griffith Edwards who runs an important and internationally known alcohol abuse clinic at the Maudsley hospital. The Minister will know exactly what was said in the letter signed by various consultants, some of whom are acting as advisers to the Select Committee in its inquiry into the prison medical service. We hope that in the not-too-distant future the results of the inquiry will be published. I can promise the Minister that the inquiry will show some serious problems that need urgent attention. I do not suppose that that will surprise him.

The consultants at the Institute of Psychiatry also wrote to me on the same day as the letter appeared in The Times pointing out that the work they do concerns important areas that the Government have said require attention as a matter of priority. They referred to the aspects which I have mentioned—mental illness and mental handicap—as well as to drug and alcohol abuse and caring for the elderly. They stated:

"the hospital's DHSS grant has failed to keep pace with inflation in recent years, and in consequence the hospital is underfunded by approximately £400,000 per annum and has accumulated an £800,000 deficit. The health authority's initial plan to recover this deficit involved closing our … Alcoholism Treatment Unit (directed by Professor Griffith Edwards), substantial portions of the Child Psychiatry Department … a neurosurgical ward, and part of the Mental Handicap Unit. Because of the public outcry the Special Health Authority has postponed these closures".

Unless the money is forthcoming, those closures will take place.

The dean, who wrote to me, said that the second reason for the institute's difficulties arose from the progressive squeeze on universities. He said:

"The Institute of Psychiatry receives approximately £2 million per annum from the University Grants Commission via London University"

for its teaching responsibilities. It gets another £4 million from other sources, such as research councils, industry and charities. The institute's basic university income provides the salaries for those who seek the additional funds. The erosion of the university grant means that the institute is running a deficit of about £200,000 a year.

The squeeze on academic salaries adds to the problem. The Institute of Psychiatry has already lost three professors and five clinical posts, which is a serious loss for a teaching hospital. I hope that the Under-Secretary of State will paint a more convincing picture than the Minister for Health.