Question 1.

On a point of order, Madam Speaker. I object to the extraordinary and unusual procedure involving the notice of motion—

Order. Let me help the hon. Gentleman. There is no Question for me to put to the House in regard to the motion. The return is unopposed by the Minister who will have to make it, and under our procedure no objection can be made. We must now move on to Question 1.

To ask the Secretary of State for Health what new proposals she intends to introduce to reduce the numbers of deaths caused by bronchitis.

It is estimated that 80 per cent. of deaths each year from bronchitis and chronic obstructive airways diseases are associated with smoking. The "Health of the Nation" White Paper commits us to ambitious targets to reduce smoking, and sets out a comprehensive strategy to achieve these targets, including action on price, health education, ensuring effective controls on advertising, and a great national health service role in reducing smoking.

Does the Minister recall giving a different figure when he told my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) that nine out of 10 deaths from bronchitis and emphysema—22,000 deaths per year—were caused by smoking? Does he also recall that during the general election campaign the marketing manager of Imperial Tobacco Limited said that his company had given the Conservative party 2,000 poster sites because it wanted the party to do its bidding when in government? Why do the Conservatives always surrender to the tobacco lobby, ignoring all the weight of scientific evidence? Are they stupid, or are they corrupt?

If the hon. Gentleman seriously thinks that there is any improper connection between the Government and the tobacco industry, he may ask why we have operated a pricing policy which has increased the real price of cigarettes by 43 per cent. in the past 10 years.

Is my hon. Friend aware that, owing to the Government's policy on cigarette prices, the percentage of the adult population who smoke has fallen from 45 per cent. in 1974 to 30 per cent. today?

Indeed—and we intend to meet our target of 20 per cent. by the year 2000.

As usual, the Minister has completely missed the point. He has an opportunity today to do something about the 17,000 children who need hospital treatment each year because of passive smoking. He could also do something about the hundreds of children who take up smoking every day: he could announce a ban on tobacco advertising. The Government and the tobacco industry are alone in Britain, Europe and the world in opposing the banning of tobacco advertising. Is it not about time that the Government stood up for the interests of the 17,000 children who are affected by smoking, rather than standing up for the interests of the tobacco industry?

If the hon. Gentleman thinks that other countries in Europe have better policies on smoking than ours, he may wish to consider why it is possible to buy international brands of cigarettes and import them into this country at prices 20 per cent. lower than ours in Italy, 35 per cent. lower in France, 40 per cent. lower in Spain and 45 per cent. lower in Greece. He may also wish to ask the socialist brothers in Europe why they approve of a policy which subsidises tobacco growers to the tune of £1 billion per year.

Does my hon. Friend accept that Great Britain, where there is viable and energetic marketing of cigarettes, has a higher incidence of low-tar cigarette consumption than almost any other country? Does he also accept that, contrary to the Select Committee report, there is no link whatever between advertising and the incidence of smoking among young people?

My hon. Friend is right to say that there is no proven link, but we shall continue our programme of education to deter young people from taking up smoking.

To ask the Secretary of State for Health if she will make a statement on the capital sums required by London FHSAs for upgrading general practitioner facilities to implement Tomlinson report proposals.

The Government are considering ways in which health care in London can be improved, especially primary health care. I shall make a full statement shortly.

Does the Minister accept that substantial investment is needed to bring GP surgeries up to standard, especially in areas of London such as my constituency, which has the highest proportion of single-practitioner GP practices in the country? Why will not she give the House the estimated cost per surgery? I assume that she must know the figures. Does she not understand that people in London want to know when their primary health care will be improved and what it will cost, and to be assured that the money will not come from cutting other health service facilities?

I accept that the people of London want to know what is going to happen and to bring the uncertainty to an end. They rightly want to be confident that changes will be based on improvements in primary health care. Significant further advances in primary health care have been made. Capital investment, for example, has doubled in the past two years, but very much more needs to be done. We are having detailed discussions before making announcements.

Does my right hon. Friend accept that Londoners are keen to see greater investment in primary health care, but that they also need investment in hospitals? Will she join me in welcoming the opening of the Chelsea and Westminster hospital, at a cost of £204 million, which is the most advanced, state-of-the-art hospital in Europe and will provide magnificent health care to west London? Does she agree that that represents a marvellous achievement for London's health service and is a testimony to the investment that the Government are making in health care in London? Will she also—

No.

Order. This is Question Time, not the time when Members make statements. The hon. Gentleman must have had three bites of the cherry already. I am sure that the Secretary of State is more than capable of answering.

I warmly congratulate my hon. Friend on his fluency in advocating the excellence of the new hospital. London will indeed remain a centre of excellence in hospital care, in research and in education. But we must look forward and make changes. The hon. Member for Walthamstow (Mr. Gerrard) is also right that that must be balanced with proper recognition of the role of primary care. These are difficult decisions, but they are decisions which we shall take.

In reply to my hon. Friend the Member for Walthamstow (Mr. Gerrard), the Secretary of State referred to the improved investment in primary care. She must surely be aware that the Tomlinson report showed that 46 per cent. of GPs are performing below the national average, which is only 7 per cent. She is probably also aware that the Acheson report of 1981 stated that only 15 per cent. of GPs were performing under the national average in London. Since 1981, 5,000 beds have been closed to pay for improved primary care in London. There has been a threefold deterioration in the service. When will the Secretary of State take some action instead of lecturing us and offering platitudes?

The hon. Lady clearly fails to understand that significant improvements have been made in London, mainly as a result of the new GP contracts, which the Labour party voted against. The deprivation payments, the targets payments for immunisation and cancer screening have at last led to improvements in inner-city areas, but more needs to be done. I welcome the hon. Lady's appreciation of many of the valuable points that are made in the Tomlinson report. She also referred to the Acheson report. Many of its recommendations have been implemented, the most important being the new GP contract which has set the tone for family doctor services across the country. The Labour party voted against that.

To ask the Secretary of State for Health what plans she has to develop independent inspection of social services provision in line with the citizens charter.

We shall build on the work of local authority inspection units and the Department's social services inspectorate by increasing independence, accountability and the involvement of lay people. Our plans are set out in the consultation document "Inspecting Social Services" published last October. These will be implemented once we have considered the responses now being received.

Does my hon. Friend agree that anyone who needs a lesson on the need for independent inspection and regulation need only look across the river to the borough of Lambeth? If that is an example of Labour local government at work, is it not better that we introduce Conservative community care reforms as soon as possible?

My hon. Friend is right. The example of Lambeth borough council—a uniquely disastrous blend of socialist dogma and managerial incompetence—is a timely warning of the need for rigorous inspection, not so much of the independent providers, who are already accountable through the registration process and the market, but of the local authorities' own activities, which have only recently become subject to inspection as a result of our legislation and where our proposals will further tighten scrutiny.

The Secretary of State will be aware that, as a result of the implementation of Government community care policy with Government funding, existing services for mentally handicapped people are to be closed in Coventry. How on earth will he inspect and ensure that people have their rights under the citizens charter when the facilities no longer exist?

By far the best safeguard of high standards is the mixed economy of care that we are using as the bedrock of our new community care policies. Coupled with the extraordinarily generous resourcing of the new policy, which next year makes available about 15 per cent. more money for personal social services expenditure throughout the country, it will mean that there is no reason for services to be reduced in Coventry or anywhere else. I hope, however, that the hon. Gentleman will urge his councillors to ensure that the council makes the fullest possible use of the independent sector. For some reason, some Labour authorities have been so reluctant even to consult the independent providers that we have today had to issue a direction requiring them to do so.

When talking about the inspection of social services, will my hon. Friend remember that one of the best and cheapest ways to ensure that standards are maintained is to encourage a much wider use of volunteers in a variety of ways within the social services, not only to extend the reach of professionals but to bring into a range of what might have remained murky corners the bright light of public interest?

Again, my hon. Friend is absolutely right. We want all local authorities to make the fullest possible use of all types of independent provision, most notably the voluntary organisations which have a distinguished role not only in residential or nursing homes but in domiciliary and day care services. Organisations such as Age Concern are already making full use of volunteers, and local authorities that have adopted an outward-looking policy are contracting with voluntary organisations to improve the delivery of services, especially domiciliary services.

To ask the Secretary of State for Health when she last met the Association of Directors of Social Services to discuss the implementation of the changes in community care.

I last met the president and secretary of the Association of Directors of Social Services on Monday 21 December.

The Minister will be aware that Durham county council has already had to close eight old people's homes because of Government policies. Is he also aware that, due to those policies, it is now possible that it will have to close even more and that homes in the private sector might have to be closed? Bearing in mind the fact that the Government argue for choice for elderly people, will the Minister explain how the closure of all those homes will provide choice for elderly people in my constituency?

The hon. Gentleman could not be further from the mark. Frankly, I am astonished that he even raises the point. In his county of Durham, the personal social services standard spending assessment for next year is £54 million, which is more than 18 per cent. above what the county is spending this year. Unless the Labour council in Durham calls in Lambeth borough council for advice, there is no conceivable possibility of any cuts in Durham having anything to do with the resourcing of the policy or with the Government's attitude.

Does my hon. Friend agree that the Government have fully honoured their commitment to funding community care? Is it not now up to the local authorities, which will give the lead in these services, to establish their priorities, accept the challenge and make the decision to use those resources effectively and efficiently?

My hon. Friend is right. In many areas, local authorities already recognise the wisdom of the concept of the policy and the fact that they have been resourced most generously to deliver it. I am confident that a high standard of community care will be available to people, especially in the areas in which there is good co-operation between the social services department and the health authority.

Bearing in mind that we are now a mere nine weeks to the day from the April community care changes, is it not totally unacceptable that disabled people and local authorities still do not know how the successor to the independent living fund will operate? Is the Minister aware that within the past week I have received two totally contradictory parliamentary answers, one from him and one from the Department of Social Security, as to whether there will be a ceiling after April on the cost of help towards independent living? Will the Minister tell me straight whether there is to be a care cost cap?

The hon. Gentleman presumably knows that we have included in the ring-fenced money for community care a further £26 million to enable local authorities to make their contribution to the successor arrangements for the independent living fund. I am happy to make it clear that there will be no ceiling on the amount that local authorities can use to provide services for clients, whether they would formerly have been clients of the independent living fund or not. It will be for the local authority to decide how much local authority money is to be used to provide services.

Now that the independent living fund will no longer make cash payments in cases of severe handicap, will my hon. Friend adopt the Disabled Persons (Services) Bill, promoted by my hon. Friend the Member for Mid-Kent (Mr. Rowe), which is also called for by the Association of Directors of Social Services and by all the local authority associations, and which seeks to reintroduce the practice whereby local authorities could make direct cash payments in deserving cases to severely disabled people.

My hon. Friend raises an interesting point. I am aware that there is a lot of support in a number of quarters outside the House for giving local authorities the power to make cash payments which could then be used by individuals to purchase services on their own behalf. The Government are not ready at this stage to take that on board. We believe that it is the function of the social security system to make cash payments to individuals.

Order. I say to the entire House, Back-Bench Members as well as Ministers, that I want to have direct questions and very speedy answers to them so that we may move down the Order Paper and so that I may call other hon. Members who have substantive questions.

The policy that we shall implement in April will incorporate a number of features that will be of great advantage to individuals.

To ask the Secretary of State for Health what guidance she is issuing to provider units concerning preferential access to hospital treatment for patients from GP fund-holding practices.

Guidance agreed with the joint consultants committee was issued to hospital consultants in June 1991. It precluded contracts for general practitioner fund holder patients that disadvantaged other patients.

In Essex and Hertfordshire, and soon in Norfolk, patients of GP fund holders are being admitted to hospital while other patients will have to wait until April or beyond. What is that if not a two-tier health service?

I will make the position exactly clear. The GP fund holders are funded on the same basis per head as the district health authorities. It is for each of them to spend that money through the year as they think best. In some areas the districts have placed their contracts and the hospitals have more than met those contracts and are delivering fast, effective patient care. In some circumstances, the fund holders have not yet spent all their funds and can set priorities in a different way. Instead of begrudging it, the hon. Gentleman should see how fund holders have spent their resources to show how better the district could set its priorities for the year ahead.

Does my right hon. Friend agree that GP fund holding has been a tremendous success? It has improved patient care and choice for patients and it is popular with practitioners–14 per cent. of the population is now covered by GP fundholders. Does she also agree that clear guidelines have been issued by her Department against fast tracking and that they should be obeyed?

There are clear guidelines and it is important that we continue to observe them. GP fund holding has been a major source of innovation. For those who profess to support the patients, there is no better way of doing so than to give power to general practitioners. GP fund holding enhances the ability of the GP to act as an advocate on behalf of the patient. A recent survey in Doctor magazine showed yet again the way in which fund holders have been able to provide more efficient and effective care, integrating primary and secondary care in ways from which others can learn.

Will the Secretary of State tell us, then, why GPs—including fund holders—throughout the country, consultants in the consultants and specialists committee of the British Medical Association, and all who work in and are aware of the health service are up in arms about a two-tier service, the existence of which the Secretary of State refuses to accept? Is she aware of the case spelt out in The Guardian this morning by David Brindle? In view of her statement this afternoon, what action is she prepared to take to stop minor treatment taking precedence over major surgery and to prevent a two-tier health service in Britain?

The hon. Gentleman simply fails and refuses to understand the way in which the system works. At long last, we have a health service in which we can focus resources on the priorities set by the districts and GPs through the freedom that is given to GP fund holders. It is the job of the district to talk to local GPs about the priorities that they want set year on year as they place contracts. For 20 per cent. of the work, the GP fund holders have the freedom to allocate their priorities in a different way.

Order. These interruptions are a complete waste of precious question time.

I could never support the Labour party because it believes in a system of levelling down, whereas we believe in a system of levelling up.

Are not the facts of the case as given by the hon. Member for Norwich, South (Mr. Garrett) further proof that the fund-holding practices in his area obtain better value for patients than the district health authority does? Is not that further proof that we should extend the fund-holding practices further for the benefit of patients?

My hon. Friend is exactly right. We want to extend the benefits of fund holding to all general practitioners, whether they apply, as do 20 per cent. of GPs, to become fund holders by this April, or find other ways of working more effectively with the district. The aim is to reverse the balance of power so that general practitioners, acting on behalf of patients, can have some leverage in the system.

To ask the Secretary of State for Health what is her estimate of the relative number of deaths of those aged 75 years and over in (a) the summer and (b) the winter; what comparable figures she has for other European nations; and what assessment has been made of the causes of any difference in the figures.

Figures from 1988 to 1992 for England and Wales in respect of people aged 75 and over indicate that, on average, some 55 per cent. of all deaths have occurred in the winter period —October to March. There are no readily available comparable figures for other European nations. Evidence suggests, however, that there are significant variations in winter mortality across Europe, although the reasons for these discrepancies are not yet fully understood.

Is the Minister not aware that facts published in his Department's journal "Health Trends" provide European and international comparisons? Is it not the case that, sadly, these reveal that we are top of the European winter deaths league? These facts are well known. Will the Minister take action to end the annual cold war on Britain's pensioners?

To the extent that the published figures mean anything at all—[HON. MEMBERS: "Oh!"]—they show that Portugal is at the top of the European league, substantially higher than Britain. Given his background, the hon. Gentleman ought to know that the pattern of a higher death rate in winter is a long-established trend. The excess of winter deaths over summer deaths was higher in the winter of 1978–79 than it was in the winter of 1991–92. Therefore, it is difficult to lay blame at the Government's door.

Does my hon. Friend agree that one of the great advantages of being old in Britain is free access to our national health service? Does he further agree that a great many of the thousands of extra patients who have been treated since the Government's health reforms were implemented are elderly? That is why the vast majority of our pensioners support the NHS and think that it provides a wonderful service.

My hon. Friend is absolutely right. The results can be seen in the substantial fall in the number of deaths from hypothermia. Our older people benefit not only from the national health service but from advice under our "Keep warm, keep well" campaign which tells them about a wide range of matters, including benefits and insulation. A relevant factor in our success in helping old people in winter is that 67 per cent. of households containing older people have central heating. That is three times the percentage of 20 years ago.

To ask the Secretary of State for Health if she will make a statement on the impact of budgetary restrictions on hospital admissions in the current financial year.

The amount of money made available to the health service in England in 1992–93 was in real terms a massive 5.4 per cent. more than in 1991–92 which, together with the benefit of cash-releasing efficiency savings, has enabled over 200,000 more patients to be treated in the first six months of 1992–93 compared with the same period in 1991–92.

Is the Minister aware that the Secretary of State's earlier denial of a crisis in the admission of patients to hospital is denied by the experience of patients up and down the country? What does the Secretary of State say to the general practitioner who wrote to me in the first week of January to tell me that he had just been told that, as a non-fund-holding general practitioner in south-east Staffordshire, he would not be able to admit patients to his major referral hospitals in Sutton Coldfield and Walsall until next April? What does the Minister and the Secretary of State say to my constituents who are now being denied hospital treatment? More importantly, what do they intend to do about it?

I shall tell the hon. Gentleman what he should say to his constituent. He should tell him that this year there was a 5.5 per cent. real-terms increase in the resources made available to the Mid-Staffordshire district health authority and that next year there will be a 1 per cent. real-terms increase. He should tell him that there has been a 35 per cent. increase in the number of in-patients and a 100 per cent. increase in the number of out-patients treated by the Mid-Staffordshire DHA, and that there has been a 380 per cent. increase in the number of day cases. The GP should speak to the DHA about structuring the contracts next year so that those figures may be improved even more. I am sure that the hon. Gentleman's constituents will be sad that he is not pleased about the great improvement in health care that has been made available to them.

Is my hon. Friend aware that the country is glad that so many more people are being treated in hospital? Will he confirm that when doctors say that cases are urgent it is rare for treatment not to be made available quickly?

My hon. Friend is absolutely right. It is worth pointing out that in this present year we are spending £629 per person on health care. In equivalent terms, the last figure under the Labour Government was £417. By next year, that will mean a massive 61 per cent. real-terms increase in resources.

Does the Minister accept that budgetary restrictions have led to a number of bed closures and is he aware that Rochdale health care trust has closed three wards? What does he suggest that I say to young patients, aged five and nine respectively, who now have to move to another hospital? It is traumatic enough for a child to be in hospital and they are very upset by a move.

I do not accept for one moment that there have been budgetary restrictions that have led to the results that the hon. Lady has just set forward. What I do accept is that the contracts, which have produced more resources this year and resulted in more patients being treated than ever before, need to be managed properly. They will be managed better if local managers involve local hospital doctors and consultants in the management process. They will be managed even better if GPs locally are brought into the process of determing how the contracting process should be carried forward. This is precisely the time of year when GPs who are not fund holders ought to be talking to the district health authorities about the shaping of contracts for next year.

To ask the Secretary of State for Health what plans the Government have formulated to carry out the strategy outlined in the White Paper "Health of the Nation".

The "Health of the Nation" strategy has been described by the World Health Organisation as a model for other countries to follow. There is a commitment to the strategy across government at the highest level, Action is now in hand to implement it in full. I have placed a summary of current action and initiatives in the Library.

I am grateful to my right hon. Friend for her reply. Does she remember the speech she gave last year to the Conservative party conference? [Interruption.] Everyone appears to remember it. She referred then to aspects and elements of "Health of the Nation" and to her personal commitment to mental illness and the strategy relating to it. Will she therefore accept the grateful thanks of many of my constituents who are extremely concerned about this issue? Would she also agree that, because of the surge of interest in mental illness recently, what she said then has been completely vindicated?

I thank my hon. Friend. Mental illness is three times as common as cancer and is a source of major disability and loss of time from work and must be a priority for us in the health service. It is a key area in the health of the nation and is vital in the implementation of community care. It is a question of resources. We are spending £1.7 billion on our mental health services, £43 million with the local authorities, but it is also a question of the delivery of those services. It is an area where I think that we must work together to secure better and more effective results.

May I question the Secretary of State further on the full utilisation of the capacity of hospitals to give treatment? Notwithstanding the increase to which her Minister referred for the first nine months of this year, does she accept what a consultant said on the radio last week—that he is unable, in the last quarter of this financial year, to undertake as much work as he could because of the shortage of resources? Surely this cannot be in line with her objectives for the health service. Can she try and get something done about it?

The House will well understand that it is a question of the way in which resources are used and the way in which we balance priorities. That will always be difficult, but much can be done from the centre and much has to be done locally. The key targets in the "Health of the Nation"—heart disease, cancer, accident, sexual health and mental illness—all have areas where we want to pioneer and innovate. All have areas where one has to balance between acute and community care. It is a question of taking people with us as we develop a strategy that the NHS reforms have made possible and which we have to deliver by the turn of the century.

To ask the Secretary of State for Health what estimates she has made of the total savings to the NHS from efficiency improvements.

Since 1978–79, hospital and community health services activity has grown by 29 per cent. compared with an increase in current spending—adjusted for hospital and community health services pay and prices —of 9 per cent. This means efficiency has grown by 19 per cent. over 12 years. This includes cash-releasing savings, now running at a cumulative £1.7 billion per annum, and also other efficiency gains from using resources more productively. Total efficiency gains of 2 per cent. are planned for both this year and next.

Are not those figures highly impressive? Will my hon. Friend give the House an assurance that the savings achieved through greater efficiency will not be squandered by retaining excess capacity for hospital provision in London? Does he agree that if the Tomlinson recommendations are not implemented, there will be fewer resources for hospitals outside London and the losers will be NHS patients in the regions, in constituencies such as mine?

My hon. Friend is absolutely right; it is a very good record and it is to the credit of those who work in the NHS throughout the country that it has been achieved. I can confirm that the savings that have resulted have been used for other patient care. With regard to the latter point made by my hon. Friend, it is certainly one of the issues that are in the forefront of our minds as we contemplate the recommendations made by Sir Bernard Tomlinson.

Is the Minister aware that it is the practice of several trusts, and I am thinking of Bassetlaw in particular, to buy expensive cars such as BMWs for their administrators, to take out car insurance for them all, and to spend NHS money in that way? Will he undertake to investigate that practice and find out how much it costs, because rip-offs such as those make Lambeth look like Snow White?

We on the Government side understand how embarrassed hon. Gentlemen are about Lambeth, but it will not go away and it will certainly not go away under the guise of pathetic—HON MEMBERS: "Answer".] I am trying to answer the question; the hon. Gentleman mentioned Lambeth. Secondly, I should have been more impressed by his question if he had bothered to take up the matter with me in a considered fashion by letter, but he has not done that. No doubt, if he does, we shall be able to respond. Trusts are treating more patients, using their resources more effectively and delivering better quality service, and I am surprised that the hon. Gentleman does not welcome that.

On a point of order, Madam Speaker.

Order. The hon. Gentleman is aware that I cannot take points of order in the middle of questions.

Does my hon. Friend agree that the Opposition seem to think that one can buy a better service simply by calling for more money, whereas we like to spend the money effectively? Compulsory competitive tendering has already saved £140 million. Does this not prove that our policies work?

My hon. Friend is absolutely right and puts the case very well.

To ask the Secretary of State for Health what were the total hospital administration costs in the financial years 1990–91 and 1991–92.

In 1990–91 expenditure on administration specifically in hospitals in England totalled £454 million. A strictly comparable figure for 1991–92 is not available, as information is now collected on a provider unit basis, which includes functions previously performed at district level. However, it is clear that the cost of administration has increased: the national health service needs better management and administration to ensure the success of the NHS reforms for the ultimate benefit of patients.

I am quite surprised at that answer, because comparable figures for Scotland were given a few weeks ago, and indicated a 75 per cent. increase in hospital administration costs. Is it not likely to be far worse in England, given the greater number of trusts? Is that not borne out by an answer in Hansard on 23 November, which indicated that the health reforms so far had cost £1.179 billion? Will it not get worse as we have more and more GP fund holders and more and more trusts, especially as so many senior managers in trusts are paying themselves grotesquely large salaries?

The success of the reforms is clear from the activity figures, which show more patients being treated quicker and better. That takes first-class management and investment in information technology. The hon. Gentleman should visit his local hospitals, talk to doctors and management and see how they are using that information technology for the benefit of patients.

Does the Minister agree that those hospital administration charges are only part of a budget which makes it possible to spend £100 million a day on the national health service? Will he remind Labour Members of the promise they made at the last election to spend an extra £1 billion and the fact that that would have represented only 10 days' running costs? That puts the matter in perspective.

An organisation that seeks to spend £100 million a day on health care must be properly managed. We are moving from a system under which nothing was costed to a system under which everything is costed precisely, for the better management of health care for patients.

I beg to move,

That this House regrets the growing crisis within the National Health Service; condemns the commercialisation of the health service and the development of two-tier health care; expresses concern at the total fragmentation of health care due to underfunding and the impact of the internal market, Trusts and GP fundholding; regrets the destruction of NHS dentistry and the uncertainty over the future of London's health care; deplores the lack of accountability now at the heart of the NHS; and calls on Her Majesty's Government to act immediately to tackle this crisis before the end of this current financial year and to begin a review of their so-called health reforms for 1993/94.

I have had to limit speeches to 10 minutes between 6 pm and 8 pm because of the demand by Members to participate in this debate. I have selected the amendment in the name of the Prime Minister.

There is a crisis at the heart of the national health service. That is why I and my right hon. and hon. Friends are moving this motion. The NHS is under-funded. It is being undermined. Unfortunately, it is under the direction of a weak and indecisive Secretary of State. A sophisticated sophistry of statistics is invented by the PR Department who present her, albeit wonderfully, in the guise of mother superior of the NHS.

"record numbers of patients being treated",

"elimination of two-tier waiting lists in the regions".

"a substantial reduction in long waiting times generally".

The hon. Gentleman spoke eloquently a moment ago about broken promises. Does he remember the promise that he made to the Blackpool Labour party conference on 30 September 1992, when he spoke about the Tories' own Frankenstein monster, meaning national health service trusts? He went on to say —I paraphrase—that the people of Britain had a right to know when, if ever, the Government would admit that their great trust experiment was not working and was in urgent need of reassessment. He has just broken that promise, has he not, because he has reversed his policy; he is not going to abolish trusts at all.

I am sorry to disillusion the hon. Gentleman. I presume that he must read The Daily Telegraph, which misreported me. Having not sent a journalist to the briefing meeting and therefore not being aware of the facts, The Daily Telegraph then declined to publish my letter setting out the truth. The Secretary of State said on "Question Time" about 10 days ago that she supports the Bill of my hon. Friend the Member for Hammersmith (Mr. Soley), which is coming forward next Friday, but unfortunately will not be voting for it. She should have a word with the editor of The Daily Telegraph, because the right of reply is important if we are to have an honest and sensible debate.

rose—

I willingly give way.

Order. To whom is the hon. Member giving way? Several hon. Members wish to intervene.

I give way first to the hon. Member for Amber Valley (Mr. Oppenheim), on the ground that at least he knows in which direction he is going.

I am not sure what to read into that, but I thank the hon. Gentleman for his courtesy in giving way.

"integrating them into some future coherent NHS strategy"?

I do not have any difficulty in saying that non-accountable, completely undemocratic, self-governing trusts will not exist under a Labour Government, because we believe in democracy and accountability, with the involvement of local people, by which I mean not just business people and Conservative party friends. I am not talking about the sort of nepotism that is now being practised in a remarkable way throughout the country.

The hon. Gentleman talks about snouts in the trough. Is he referring to people such as Helen Hayman and Rabbi Julia Neuberger, who have agreed to become chairmen of NHS trusts?

The Minister need only talk to her hon. Friend the Member for Macclesfield (Mr. Winterton) to get a picture of snouts in the trough and the facts about the transfer of the chairman of the Merseyside region, Sir Donald Wilson, to the west midlands, presumably to peddle the same nepotistic attitudes and policies. The fact that the Secretary of State can quote the names of Labour and Liberal Democrat members is indicative of how many people are being appointed—[Interruption.]—with Tory party cards in their pockets.

I am grateful to the hon. Gentleman for giving way yet again on the question of accountability. He complains that trusts are not accountable, yet his hon. Friend the Member for Livingston (Mr. Cook) said in the House less than two years ago that the simple test for judging the trusts was whether they did more or less work for NHS patients. Does the hon. Member for Sheffield, Brightside (Mr. Blunkett) confirm that test or does he repudiate it?

I do not confirm the test, the results or that trusts are working. Doctors, consultants and patients across the country, reading their local newspapers, watching their regional television programmes and listening to regional radio, will know what is happening to their health service.

"The service has reached breaking point."

"I shall be putting the boot in."

Will the hon. Gentleman give way?

No, I want to make a little progress. In the same report, Sister Milne said:

"Waiting times on trolleys can be five, six or seven hours."

"Equal access to secondary care has been flouted by hospitals which cancel operations but continue to treat GP fund holders' patients."

"It is increasingly clear that GP fund-holding practices have the capability and are intent on encouraging the development of mini clinics in dermatology outside the hospital service. This has the effect of taking NHS money away from the acute unit to the detriment of that unit. We propose to set up a clinic with sessions at Greenbank hospital every Wednesday evening between 5 and 7 o'clock with the specific intention of seeking patients from GP fund-holding practices."

"While it is clear that this will create a two-tier system within the service, it will have no greater effect than that already commenced by several general practices employing their own dermatologists outside the hospital service."

For the sake of clarity, will the hon. gentleman tell us whether it is Labour party policy to abolish both NHS trusts and GP fund-holding practices?

I think that I have comprehensively dealt with trusts, so I shall comprehensively deal with GP fund holdings. I have made it unequivocally clear—it is on the record of every occasion on which I have spoken—that the Labour party and I, as its spokesman, are against GP fund-holding practices and a two-tier service.

"I know of a case in my practice where a patient had been on the waiting list for two years for a minor complaint and had to be admitted before a patient with a potentially malignant diagnosis because of the patients charter saying no one should wait more than two years … The NHS is rapidly becoming split in two and morale is at the lowest I have experienced in the 25 years I have worked in the service. My only advice to patients now is for them not to vote for the present Government."

Only this week I received a letter from a doctor in north Manchester about the Booth Hall children's hospital and a child aged six who had been referred to it for an operation in January 1992. That child is still waiting and the earliest date for the operation is now May this year. He referred to the child's suffering and to the education that he had missed. It is a disgrace. If we were a third-world country, with a shortage of theatres and wards, we could understand the reason for long waiting lists—but that children's hospital has actually closed a theatre and a ward.

My hon. Friend is quite right. In 1987, when we last had a crisis in the health service—not the worst for 30 years, as the British Medical Association described this one, but so serious that the last Prime Minister had to decide to demolish the whole NHS so that it could be dealt with—there were 100,000 fewer people on waiting lists, and children such as the one to whom my hon. Friend has referred were being admitted and dealt with before minor cases.

Can the hon. Gentleman name any Labour Government who left office with waiting lists lower than when they came to power? In fact, every Labour Government left office with waiting lists higher than when they came to power, whereas all Conservative Governments have seen waiting lists fall.

Had we managed to get rid of the Conservative Government on 9 April we should have had a startling and outstanding example of a Government leaving office with waiting lists much higher than those they had inherited. The Government have to hark back to 1978 for the lowest interest rates, and to 1968 for the lowest level of inflation. People ought to be reminded that many of the great records are held by Labour Governments. And we shall hold them again.

Is my hon. Friend aware that in the very recent past an epileptic young woman of 19 in my constituency was taken into hospital and discharged, was taken into hospital again, and discharged, and was taken in a third time and died? Surely that indicates the nature of the problem in the national health service.

My hon. Friend, as ever, speaks from the heart about the truth that emerges from our postbags day in and day out, week in and week out. Consultants, other doctors and patients write to us about the stark reality that Conservative Members are unable to face.