Commons Chamber

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House Of Commons

Wednesday 10 May 1995

The House met at Ten o'clock

Prayers

[MADAM SPEAKER in the Chair]

Mental Illness

Motion made and Question proposed, That this House do now adjourn— [Mr. Kirkhope.]

10.4 am

The tradition in debates in this House is that one begins by declaring an interest. I declare an interest in that I am a member of the advisory council of the Jewish Association for the Mentally Ill, although I suspect that I receive much more advice than I give.

This debate is in the interest of the thousands of mentally ill individuals who are inadequately treated under the present system; of parents who see their sons and daughters suffer and, all too often, cannot influence the psychiatrists who treat them; of preventing the avoidable suicides and murders which take place because of failures in treatment.

I last raised the subject of the mentally ill in an Adjournment debate in December 1993. Although I have been silent in the House on the matter since then, I have frequently written to Ministers questioning the principles of the Government's policy, and have pointed out to the relevant authorities a number of individual cases where treatment has been inadequate.

The backdrop to the debate in 1993 was a local tragedy. In the summer of 1993, I attended the funeral of a constituent. There is nothing unusual about Members of Parliament doing that, but in that case I was attending the funeral of a 24-year-old constituent who had been receiving psychiatric treatment for some time. His mother had frequently written to me saying that the treatment was inadequate. I had written many letters to the psychiatrist and others trying to help him, saying that the care in the community that he was receiving was inadequate, that his mother knew her son much better than any psychiatrist did, and that the psychiatrists should listen to the mother.

They did not listen to the mother, and eventually, that 24-year-old boy dropped from the sixth floor of a building in my constituency and committed suicide. The death of a young man, which could have been avoided, is a galling experience which I shall always remember—the day life was tragically cut short because experts would not listen to a parent who knew much more about her child than they did.

During the eight years in which I have been a Member of this House, I have attended only three debates on the mentally ill, two of which, including this morning's, I have instigated. Since the debate in December 1993, a raft of reports has suggested that the care in the community policy is failing many of those whom it seeks to help.

In February 1994, we had a report into the murder of Jonathan Zito by Christopher Clunis. One must remember that Christopher Clunis had passed through the hands of 150 doctors, nurses, social workers and policemen, and had been into 14 hospitals, prisons and hostels, yet he was in the community and able to kill an innocent individual in London.

Another report in April 1994 said:

"Thousands of the mentally ill are relying on variable, patchy and under-funded services."

In August 1994, it was pointed out that more than half of the 22 people who had killed an innocent individual after discharge into the community had refused to take the drugs that they had been prescribed, or to attend treatment.

In September 1994, the Department of Health's mental health task force referred to

"a serious problem of emergency access to appropriate care for severe mentally ill people."

In September 1994, the Mental Health Foundation said:

"some services, particularly acute hospitals in inner cities are under such pressure that proper discharge planning of any sort is an unattainable dream."

The Royal College of Psychiatrists produced a report in 1994, in which it said:

"It is common for there to be no admission beds at all, available in the South of England. In these circumstances patients … may have to be nursed for 24 or even 36 hours in a room in an accident and emergency department while doctors or nurses make numerous phone calls to locate a bed, often at a hospital many miles outside London. There have been instances where suicidal or dangerous patients have absconded while waiting and others where patients, who would have accepted voluntary admission to their local unit, have had to be compulsorily admitted because they did not wish to go to the distant hospital."

The report concluded:

"It would be difficult to argue that to admit a London resident to a hospital on the south coast is any advance from the days when such patients would have been admitted to the large psychiatric hospitals that ringed London".

More recently, in April 1995, the Royal College of Psychiatrists reported:

"'True' bed occupancy was very similar to that in"

its previous survey—123 per cent. It said that that figure was

"accounted for by the fact that 189 people who should have been in London admission beds were inappropriately placed elsewhere.

102 of the 189 people … had to be admitted to distant hospitals because of bed shortages."

That emphasises the fact that in London there is a shortage of beds in mental hospitals. Surely that should guide Government policy in future.

The Royal College of Psychiatrists also said:

"Violent incidents (mainly assaults on staff and other patients) are very common on psychiatric admission wards. 131 incidents were reported during the week of the census, 47"

of which

"had resulted in some injury."

The policy of closing large mental institutions by the year 2000 was instituted by Mr. Enoch Powell in 1961. It is ironic that that gentleman, who made his economic fame by attacking long-term or even short-term economic planning, should, as Minister of Health, have indulged in a policy of mega-long-term planning in deciding in 1961 what should be done by the year 2000. In the early 1960s, there were 140,000 beds in mental institutions; today there are 20,000.

The Powell thesis was fundamentally misguided. It was a reaction to the excessive incarceration, in the 1940s and 1950s, of people in mental hospitals who should never have been there. However, the fact that some people were wrongly admitted in the 1940s and 1950s was no reason to decide in 1961 that no one would need to be admitted into large mental hospitals in the year 2000, or indeed in the year 1996.

There is no doubt, to my mind, that the pendulum, which swung too far in the 1940s, has swung back too far in the opposite direction. Self-evidently, many of those who were in mental hospitals in 1961 should not have been there, because they have subsequently managed to cope by living in the community. However, it is equally true, and it is visible to anyone looking round London today, that some people cannot cope in the community and should be in an asylum.

That would be better for them. Their quality of life would be better. It would be far better for their families, who worry about what is happening to their sons and daughters, wives and husbands, and it would be better for society at large.

I recently sent several letters to my hon. Friend the Under-Secretary of State, the hon. Member for Battersea (Mr. Bowis), questioning the adequacy of the number of beds in London. There is a great deal of apocryphal evidence to suggest that I am right, and that some of the statisticians in the Department of Health are wrong. There are too many examples of patients being released prematurely, and of others having difficulties securing admission.

It is equally true that, just as there is a shortage of beds in the hospitals, there is a shortage of beds in the community. The shortage of beds in hospitals encourages the premature discharge of mental patients, and I am afraid that it is sometimes compounded by professional misjudgments.

I shall always remember one of my earliest surgeries. A large deputation came to visit me from one of the council estates in my constituency, and I wondered what the council had done. The people said, "It is Mr. Campbell," so I wanted to know whether he was the caretaker. They said, "Oh no, nothing like that. Mr. Campbell has just been admitted into the N block, and he has just come out of hospital." I asked what the problem was. They said, "He has been discharged from a mental hospital and he does only one thing—he plays music. The trouble is that he starts at 8 o'clock at night and finishes at 8 o'clock in the morning. We are all trying to sleep when he is playing his music, and when he is not playing his music we are trying to work." I wrote to the hospital. On that occasion they admitted that Mr. Campbell needed to go back into hospital, and he was taken back, but probably he should never have been released into the community.

The care in the community policy rests on the paradox that people are told that they are sufficiently fit to live in the community, but they are sufficiently unwell to need medication—and thoroughly nasty medication to boot. None of us like to take nasty medicine. I always remember that, as a child, when I had a severe illness during the war and I was given very nasty medicine, I once asked my mother, "Why don't you try the medicine?" She took it. I then said to her, "You have taken it today. I don't need to take it." She gave me a short shrift answer that that was not a logical response, and I agree with her in retrospect.

None of us likes to take nasty medicine, and most of those people who have been buoyed up by discharge into the community believe that they no longer need to take the nasty medicine. That is when they regress. That is when they become violent. That is when they sometimes lose their general practitioner. That is when they become aggressive to other people. That is when they end up in prison.

It is surely wrong that someone should be discharged into the community because it is thought that they are unsuitable for institutional care, and then end up in another institution—a prison.

Does my hon. Friend agree that there are people living in the community perfectly satisfactorily and taking drug therapy regularly, and that they now have a freedom that they would never have had if they had remained in one of the large institutions? Surely the key is that those people should be adequately supervised.

My hon. Friend has anticipated the next part of my speech, when I was going to discuss the Government proposals for supervised discharge.

One of the other ironies of care in the community is that many of the people who have been released into the community end up sleeping rough. I shall always remember one of my first constituency engagements, in, I think, September 1987, when I visited the National Schizophrenia Fellowship. I asked one of the members, "What is your problem?" and she explained that her daughter was schizophrenic. I asked where her daughter was, and she replied, "She is sleeping on a park bench somewhere in London tonight." If one talks to them, one discovers that a significant number of the people who will sleep rough in London tonight are people who have been released from mental hospitals throughout the capital.

Some people criticise the Government's power of supervised discharge in the Mental Health (Patients in the Community) Bill—which will shortly receive a Third Reading in another place, and will shortly thereafter come to this place—on civil liberty grounds, but those who do so are, I believe, making a completely flawed argument. That argument assumes that someone who is sufficiently troubled to need psychiatric help is sufficiently sane to decide rationally about his treatment. The protection of one person's civil liberties may well mean that they are denied to someone else.

Those who criticise supervised discharge ignore the fact that many of those who are released into the community commit suicide. There is no doubt that the official figures understate the number of suicides committed by released schizophrenics. The courts will take account of the religious susceptibilities of those who may or may not have committed suicide, or recognise that the validity of a life insurance policy will be determined by the verdict reached by the coroner. The NSF estimates that between 300 and 500 released schizophrenic patients commit suicide each year.

When we talk about civil liberties, we must also remember the civil liberties of those adversely affected by current arrangements. Jayne Zito had the civil liberty to expect that her husband would not be killed. Georgina Robinson, an occupational therapist, had the right to expect the civil liberty of being able to work in a mental care health centre without being killed by a patient. Ruth and John Gore's civil liberties should have meant that they were not hacked to death by their schizophrenic son. Jason Dalson's civil liberties should have meant that he was not killed by his mother at the age of 6.

Those are the civil liberties that we must remember. In each of those murder cases, the law recognised the concept of diminished responsibility when the individuals charged went to court and pleaded guilty to manslaughter rather than to murder. Is it not right to recognise the concept of diminished responsibility before a crime is committed rather than after?

One of the ironies behind the problem is that the strongest advocates of supervised discharge are the relatives of those affected. They do not believe that such discharges would affect their son's, daughter's, husband's or wife's civil liberties. They believe that it is essential that the discharge of their relatives should be better supervised than it is now, so that those relatives can enjoy a better quality of life.

One of my concerns about the treatment of the mentally ill is the attitude of GPs. I am sure that virtually every colleague in the House has received more than one letter from one of my constituents. That lady is convinced that her telephone is being tapped; that her mail is being intercepted; that foreigners are coming into her home whenever she is out of it; and that Mossad and the Japanese—a strange combination—are after her. It is rather odd that both of them should be after the same innocent lady living in Hendon.

I visited that constituent at her home. She saw me outside first and said that everything I said would be recorded by bugs. I went into the house to look for those bugs, but could not see any. She pointed to where the intruders had come in, and showed me where they had left their mark. In fact, she had metal windows, and the mark was rust. I asked that poor lady who her doctor was. Her initial reaction was to say that she did not need a psychiatrist, but I then discovered the identity of her GP. I have pestered the man to try to do something about that poor lady but he has done nothing.

I could spend the next hour recounting other similar examples, but I know that other colleagues, such as my hon. Friend the Member for Macclesfield (Mr. Winterton), want to take part in the debate. My hon. Friend the Minister should try to ensure that GPs are better educated about the problems of mental health, and show a greater willingness to do something about it.

As I have already said, I am a member of the advisory council of JAMI. It has encountered problems with two local authorities in London. The London borough of Barking and Dagenham has written to say:

"The value of JAMI is recognised".

Mr. X

"is seen to benefit from his contact with you. However, I regret that my efforts to secure funding have not been successful".

JAMI has been asked to carry on that beneficial treatment, but will be given no money for it by that London borough. The London borough of Ealing, with which I used to be associated, has refused to give any funds to the course of treatment and support that JAMI has been giving to one of its residents, because it feels that, although the treatment was helpful, the gentleman concerned would not need residential care if he did not get it. It has therefore decided to give nothing towards that treatment.

We need a change of emphasis in our treatment of the mentally ill. Mental health needs to cease to be the Cinderella of the health service. I should like the Minister to announce a moratorium on further hospital closures until adequate alternative services are in place. The bulldozer must stop: the destruction of existing hospitals must cease. We should construct new, smaller mental hospitals and provide better facilities in the community. Hospitals must not disgorge patients into the community when they are unable to provide them with adequate treatment.

The Royal College of Nursing has made it clear that

"there are grave concerns that the closures of psychiatric institutions have not been offset by sufficient alternative support and treatment in the community. There is an increasing body of evidence which exposes the inability of the current aftercare arrangements to meet the needs of people with serious mental health problems."

I should like the Minister to make it clear that the Government recognise the need for more community psychiatric nurses. At present, about 4,000 psychiatric nurses treat 180,000 schizophrenics. Many of those schizophrenics may not be attached to a particular psychiatric nurse, but each nurse has a case load of about 55 clients. That means that she—or he: one must not be sexist—can see each client for about half an hour a week. I do not believe that that time necessarily provides the right amount of treatment. The Royal College of Nursing has certainly said that it believes that the number of psychiatric nurses should be more than doubled.

The professions concerned should recognise that they should pay more attention to the views of the parents and relatives of those suffering from mental illness. On 18 January 1995, The Independent stated:

"The time has come to jettison an Act which neither protects the public effectively nor provides the care which seriously mentally disordered people require to achieve a more fulfilled and happier life."

That single sentence underlines the nub of what I have said, at greater length. Were that recommendation met, it would fulfil the needs of the country.

10.27 am

I am grateful for the opportunity to take part in this debate. I congratulate my hon. Friend the Member for Hendon, South (Mr. Marshall) on securing the debate, and on putting his argument so coherently.

When "The Health of the Nation" was published in July 1992, handbooks on different key areas were also published. What struck me about the handbook on mental illness was the revelation that 18,000 people die from mental illness, directly or indirectly, but most notably from suicide.

It is true to say that this generation has stopped trying to sweep the issue of mental disability under the carpet. That happened before, greatly to our shame, but we now recognise that mental illness affects people across the nation. It is fair to say that there is not a family in the land that has not been struck, directly or indirectly, by some form of mental illness, temporary or permanent.

People have phobias, anxieties, compulsive eating disorders and more serious conditions, such as schizophrenia. All those conditions cause immense distress to the families and friends of sufferers. Almost 90 per cent. of those who commit suicide suffer from mental disorders. No fewer than 66 per cent. of suicides consulted general practitioners within the month leading up to their suicide, and 40 per cent. consulted their GPs in the previous week.

Just over a year ago, I initiated a debate in the House as a result of an experience in my constituency. My attention was drawn to a truly tragic case of a young lady with behavioural problems who fell between all of the stools of the mental health process. She was not defined as psychiatrically unwell, so she could not be treated. It was believed that she suffered from a behavioural problem, and a psychiatrist told me that the criminal justice system was the only route for her to follow.

That young lady suffered from an illness, whether behavioural or psychiatric, which prompted her to cause damage to herself, and which created fear within her family and in the community. As a result of that case, I have become particularly interested in the area of mental health, and I have been moved by the plight of those who are affected by such problems, and that of their families.

As my hon. Friend the Member for Hendon, South said, many mental health beds have been removed from the national health service. However, some 80,000 beds remain, both on a daily or permanent care basis, for those who suffer from mental afflictions. In the past decade, the number of clearly mentally distressed people who are living rough has increased throughout the industrialised world. It is significant that the Homeless Network's audit of rough sleepers found that 91 per cent. of those in that unhappy situation had one or more special needs, and that one in three suffered from mental health problems.

The homeless mentally ill initiative was introduced almost five years ago in order to provide specialist psychiatric accommodation for those with mental health needs in London. It has addressed, at least in part, that particularly worrying problem which affects not only the individual sufferers but all those who live in London. I certainly share my hon. Friend's view that communities feel threatened as a result of well-publicised cases of mentally ill people who have been released into the community prematurely.

Three large institutions are located in my constituency, two of which have virtually closed, and the other will close in five years. Does my hon. Friend agree that the concept of care in the community is absolutely correct? The scheme costs twice as much money as the old Victorian system, but we must ensure that those who need help can receive it.

There have been a number of highly publicised cases of people who were released into the community, who are sleeping rough and who are suffering as a result of deficiencies in the current system. As a consequence, the whole care in the community system is suffering also. Does my hon. Friend believe that we should target more resources at the small number of people who are now falling between two stools in the health service, in order to ensure that the care in the community system receives the credit it deserves?

I am grateful to my hon. Friend for putting his point of view so eloquently. I will examine the effect of the proposed new legislation, and I shall also inform my hon. Friend how we are trying to address the problems in Suffolk. I believe that we must reassure the public about this matter. The situation is akin to the public's reaction to crime: statistics may be falling, but the fear of crime is extremely damaging to people's sense of well-being.

I hope that the Mental Health (Patients in the Community) Bill will address some of the legitimate concerns that have been raised by my hon. Friend the Member for Ribble Valley (Mr. Evans) and other colleagues. My hon. Friends the Member for Ribble Valley and for Hendon, South have asked what level of supervision is adequate to deal with the problems of individuals and to provide proper comfort to the communities and to the families which are blighted by mental illness.

A supervised discharge will be required for those who leave hospital after having been detained under the Mental Health Act 1983. The new legislation will also tighten up provisions for returning to hospital those patients who go absent without leave. The period wherein patients can be recalled will be extended from six to 12 months. My right hon. Friend the Secretary of State elaborated on the legislation in a press notice of 12 August 1993, in which she said:

"Under supervised discharge, patients would be subject to conditions, including a treatment plan negotiated with them and their carers, and a requirement to attend for treatment. A named key worker would be immediately responsible for that patient's care. He or she must ensure that the procedures agreed in advance are followed and that decisive action is taken if the patient does not co-operate".

We know of well-publicised tragic cases that have horrified and touched the heart of the nation. Therefore, the safety of the public must be uppermost in our minds. The supervised discharge arrangements, which I accept are a valuable advance in this area, include a treatment plan and an obligation to receive treatment. Any failure to do so will lead to a recall to hospital.

I hope that the my hon. Friend the Under-Secretary of State for Health will assure the House that hospital discharge procedures will be improved. It is also critical that the supervision register is monitored properly and adequately upon its introduction. Every year £2 billion is spent on mental health. The number of community health nurses has increased substantially, despite the pressures that my hon. Friend the Member for Hendon, South referred to. More psychiatrists and psychologists are involved in the national health service than ever before.

My hon. Friend the Member for Ribble Valley said that it was incumbent upon the health authorities to draw up proper care programmes for mentally ill people who are discharged from hospital. I contacted the Suffolk health authority to seek assurances that my county is undertaking such programmes. The authority is appointing a programme manager for mental health services to oversee the formulation of a programme, and I am pleased that that appointment is in the pipeline. The health authority is also introducing a number of other initiatives, including the improvement of acute in-patient services, and the provision of a consultant psychiatrist in Suffolk to examine proper rehabilitation procedures.

Community psychiatric nurses are providing an important new assessment service to individuals with mental health problems who are in police or court custody. The link between the justice process and mental illness is inextricable, and the distinction is often unclear. The service began last month, and decisions will be made as to those who need treatment and those who should be punished. That distinction was blurred previously, and it was certainly not taken into account when I introduced my Adjournment debate.

The legislation in another place will advance the issue in a wholly constructive manner. However, my hon. Friend the Member for Hendon, South eloquently highlighted the remaining potential imbalance involving premature discharge and inadequate bed space for those who still require care. When the new procedures are introduced in the next year or two, we must monitor the situation carefully and compassionately. We have not struck the right balance over many decades. We are now moving in the right direction, but I believe that it is incumbent upon all hon. Members to watch the developments very carefully.

Of course we do not want monstrously large hospitals for the mentally ill. Specialists in the area have said that the best success can be obtained by developing smaller units, which are properly coordinated and humanely supervised. I hope very much that that will become increasingly the pattern in the next few years. We need a balance, and I hope that we are moving towards one. I am sure that we will need to monitor the situation carefully in the next few years.

10.39 am

I congratulate the hon. Member for Hendon, South (Mr. Marshall) on calling for this debate, and on the manner in which he and the hon. Member for Bury St. Edmunds (Mr. Spring) presented the problems.

Neither side of House has a monopoly of concern for mental illness. This sort of debate allows the concerns of hon. Members, based on our direct experience of the problems in our constituencies, to be properly drawn to the attention of the Minister, so that he can carry them into responsible action by his Department.

We can understand the pattern of care needed for the mentally ill if we distinguish between the different stages of a mental illness, and, indeed, the differences between individual cases, because such differences are enormous.

The stage at which a mental illness presents itself most dramatically can be at a patient's first appearance at an accident and emergency department, or, preferably, a specialised mental health clinic. It is the experience of many patients that an accident and emergency department is not a good environment for a mental patient first to contact the health service. There is enough trauma in an accident and emergency department in dealing with acute physical cases.

To introduce a distressed mental patient into such an environment causes chaos in the department, and is unfair on the medical staff and on other patients, who desperately need attention but cannot get it because the whole place is disrupted by the behaviour of a mental patient.

However, if a 24-hour specialised emergency clinic open 365 days a year is available—as there has been for some years at the Maudsley hospital in London—the staffing and the expert care that can be given to mental patients provide an entirely different environment. It is still hugely distressing for the patient—that is unavoidable—but nevertheless it is a quite different environment from that of the ordinary general district hospital accident and emergency department.

I understand that the clinic at the Maudsley is now available only to people living locally in the area covered by the hospital, rather than to the whole of London. If that is the case, it is a great pity, and I hope that the scope of its service can be changed. We need such clinics in every major urban centre and city throughout the country, so that they are available to people in those desperate circumstances.

The greater proportion of patients presenting themselves for first care do not require emergency admission. However, some do, and they face a desperate situation in terms of the availability of beds. Dr. Paul Lelliott, who is the head of the research unit of the Royal College of Psychiatrists, recently carried out a survey of the availability of beds in London. He will present his report at 6 o'clock this afternoon at a meeting of the all-party mental health group, of which I am privileged to be the chairman.

The report found that not only was there not a single bed available in the whole of London on some occasions in January, but that there was a 23 per cent. shortage of beds for those patients who needed admission. It was not just a flash in the pan of one patient not being offered a bed. A 23 per cent. increase in the number of beds was needed to deal with the number of patients who required emergency admission under newly identified diagnoses in January.

The hon. Member is making an extremely important point. Does he accept that the situation is compounded because of a number of cases in which people with mental illnesses have been brought before the courts? The courts would like to commit those people to mental hospitals for care and treatment, but cannot do so, because there are no beds. As a result, as my hon. Friend the Minister knows, those people are committed to prison, which is the last place where such people should be committed. We need extra beds—not in the future: we need them now.

Yes, indeed. The hon. Gentleman is absolutely right.

Beyond the shortage of beds, there is the question of what sort of beds. The hon. Member for Bury St. Edmunds pointed out the problem of beds becoming blocked up because hospitals do not have channels through which patients can be reasonably discharged, and because there is an inadequate support system in the community.

It has been proposed that hospitals should be allowed to run hostels, which can be a transitional stage for people returning to the community. Such hostels are run by several hospitals around the country for the physically ill, not the mentally ill. They work very well, and costs per bed in them are far lower than they are in the hospitals themselves. It would be possible considerably to ease the channels of discharge from mental hospitals if, under the control of the hospitals, there were hostel places where people could be accommodated as they got used to returning to the community.

People often do not have any circumstances in the community to which they can return. They do not have a house, or, if they have been allocated a council house, there is no furniture. If it is minimally furnished, there is no community support. To construct all that apparatus of support takes time and organisation. It needs all the different support services to get together to create such apparatus for cases where the person has no family. A hostel can greatly ease that problem of transition.

There is also the need for continuing care. The supervised discharge proposals are concerned with cases where people who are mentally ill have attacked members of community. However, the number of suicides and cases of self-inflicted harm is far greater—10 times or more—than the number of people who are attacked by the mentally ill. Consequently, the greatest physical suffering is that of people who are mentally ill.

The Minister could confirm that forensic psychiatrists are not making a case for the expansion of their particular services. They tell me that their service is the best staffed part of psychiatric care services. The extreme cases that are looked after by the forensic psychiatrists are already the best provided for. I am not saying that the system has no problems to consider or that need working through, but its problem does not seem primarily to be that of resources. We therefore need to get public pressure and public concern about such cases properly directed and channelled into the organisation of the services and the balance of support in the community as a whole.

After moving on from the more intensive period of community care, there are the various forms of therapy and counselling which are needed to tackle some of the behavioural problems faced by patients. There is no unique therapy or counselling, but there are many cases in which it has been helpful to try out various channels in order to find the most appropriate type of counselling or the most suitable person. Because that has proved successful in many cases, it needs resources. The resources that could be absorbed by counselling and therapy are unlimited, but there should be channels through which people can feel their way through the services.

As well as the responsibilities of the Department of Health, other Departments—specifically Social Security and Employment—are also involved in a patient's return to the community and to work. I accept that there is good will on the part of the Departments concerned, but there is sometimes a lack of an appreciation of the nature of mental illness. The Department of Health must ensure that the various schemes produced by the other Departments are realistic for the mentally ill.

For example, a clear vital statistic in the performance of the disability working allowance, apart from the sums involved and the conditions under which it is paid, is the consideration of how likely it is that a mentally ill person returning to work will be able to sustain 40 or even 20 hours a week of consistent attendance for the indefinite future, or even for six months. There needs to be tolerance when a patient knows that it is best to stay at home and not risk going into work and provoking a crisis.

That is well understood by everybody concerned with mental health, but it does not fit easily into the structure of social security or a job placement scheme, which is concerned with people who, quite properly, need other encouragements and disciplines. We shall be debating how all that is put together when we consider the legislation about supervised discharge. The health service and the Department of Health must make a major contribution to the basic planning stage and the perception of the problem.

Hon. Members undoubtedly see many different types of case. It is a healthy sign that there is legislation going through the House now and that there is increasing concern by individual Members arising from work in their constituencies. It reflects a greater public sensitivity to the needs and problems of the mentally ill. The younger generation have a much deeper understanding of the problems of mental illness than some of their forebears. It is that concern, together with the relationships they form and the support they give in the community, that offers the best hope of care for the mentally ill in the future.

10.53 am

I congratulate my hon. Friend the Member for Hendon South (Mr. Marshall) on initiating this debate this morning.

I am extremely concerned about the good name of care in the community. We must do all we can to ensure that any deficiencies within the system are corrected as soon as possible. My hon. Friend the Member for Bury St. Edmunds (Mr. Spring) talked about the high-profile cases in which people have fallen between two stools and are not receiving the proper care or supervision in the community. Some are not taking their tablets, are found wandering the streets at all times of the day and night, and are sleeping rough.

Those are the cases that the public see. They are not aware of the 99 per cent. of cases in which patients are receiving proper care. They see only the small number of cases, including the suicides, that make the newspapers. Therefore, the whole concept of care in the community is tainted. I am extremely concerned that we should do everything possible to ensure that the targeting of resources and help is aimed at those who are in need so that they receive proper care in the community.

As I said in an intervention, I had three large mental institutions in my constituency, which must be quite unusual. Brockhall has now closed, and is being taken over. No doubt the site will soon be turned into a housing estate. Whittingham will also close shortly. That institution is what everybody thinks of when they think of an old Victorian asylum. It has superb gardens, where the mentally ill can wander within the confines of the institution. The people outside the community never see those people, because they do not go into the hospital grounds unless they need to do so. Again, planning permission is being sought to turn that site into a housing development.

In a number of years, Calderstones, another large mental institution, will be closing. There will be a small unit on the site looking after those with extreme and difficult problems. Having said that, there are currently 600 people living there, who will all be discharged into the community. If one considers how many people were living in those three large mental institutions and who have now, over a short time, been discharged into the community, one can grasp the task that was before the Government in implementing this policy.

Many people have reservations about the speed at which all this has been done. They think that it should have been carried out more slowly. Some people, myself included, think that it has been more cruel than kind to take people who have been institutionalised all their lives out of the large institutions and put them somewhere else. Do not get me wrong: I am not a defender of the large institutions; they were a mistake, and we have moved on. However, we must ensure that the resources are there, so that those who are discharged into the community receive the proper care.

I was horrified by what my hon. Friend said about the closure of a number of institutions in his constituency. He said that some of the sites will be developed for housing. He said that Whittingham had superb grounds. Will my hon. Friend accept from me, having taken a deep interest in mental health over almost 20 years, that one of the treatments for those suffering from schizophrenia in particular is found in the environment in which they live and are being treated?

Is it not sad that those wonderful hospital grounds, many of them quite close to cities and town centres, and therefore very much part of the community, are being disposed of merely for the capital gain of housing development? If a smaller and more modern unit could be constructed on those sites to care for the mentally ill, the environment, which is so important for the treatment of some people with mental illness, could be retained.

I accept everything that my hon. Friend says. The grounds at Whittingham are large, and it is appropriate in certain circumstances to have that sort of atmosphere and quietude. That institution is on the outskirts of Preston. Some of the high-profile cases involve people who have been in that environment but who are now wandering the streets of Preston. That must be wrong.

I know that, with the redevelopment of Whittingham, a new unit will be put on that site. I hope that sufficient grounds are kept aside within the development, so that people are able to enjoy the quietude and the asylum, away from the noise and the grind of everyday living.

Get a commitment from the Minister.

I know that my hon. Friend the Under-Secretary of State for Health, the hon. Member for Battersea (Mr. Bowis) has been to Calderstones in my company. I was there only a few weeks ago, taking a look at the good work that was being done, particularly with people with learning disabilities. My hon. Friend will know of the good work and commitment of the staff who work at such institutions. One of my concerns is that the spread of people going into the community will mean that there are insufficient numbers of adequately trained experts to deal with the problems.

I thank my hon. Friend for giving way—he has touched on some valuable points.

Does he agree that we should be carefully considering another category of patients? We need to consider not just those who have been sectioned and come out of hospital, but those who are vulnerable and who do not quite qualify for being sectioned, but who desperately need supervision so that they do not harm themselves and others.

I agree with my hon. Friend. That is exactly what we need. Those people do not necessarily need large institutions; they need smaller institutions, with sufficient grounds, so that they are not any danger to themselves or other people.

Whittingham has a tradition of looking after people with mental illness, to which a stigma is attached. Mental illness is something that one does not talk about. The people in Whittingham have grown up with the institution, and enjoy the fact that it exists in their area. The people with mental illness mix with the people in the village, and the position is a total reversal of the not-in-my-backyard syndrome—NIMBY. If one tried to set up such an institution in some districts, the residents would fight tooth and nail against it, but the people of Whittingham fought hard to retain the institution in their community, because they know and understand the problems that those people have.

The problem of people with mental illness being referred to prisons because there are insufficient beds available has already been mentioned, and it worries me. One of my constituents, whose son unfortunately has a mental illness, came to seem me a couple of weeks ago. He became involved in a crime; his parents say that he should not be on the streets, but receiving care, because of his problem. He is now in prison. He is not receiving the care that he needs.

At the end of his sentence, he will be released back into the community in no better shape—perhaps worse shape—than when he went in. We must ensure that sufficient beds are available for people who might become involved in crimes because of their illness, and we must ensure that those people receive the proper treatment they need.

Does my hon. Friend agree that there is another problem: the shortage of longer-term beds? There is a danger that patients who return into the community enter the carousel system. They come out of hospital, after a period they are desectioned, they commit another offence and have to return to hospital. They never receive treatment in hospital for long enough—the required period could be six months, one year or even longer. The problem is that such people are released too soon.

I agree with my hon. Friend. Nothing can be more distressing to professionals than to see those with whom they have worked released into the community prematurely and being sent to prison because they have committed a crime, or falling into rough ways because they are not taking the tablets and are not being properly supervised. The process then has to start all over again.

I shall bring my remarks to a close, as I know that other hon. Members want to participate in what has been a useful debate. We need to target the resources at those who are not receiving the proper care in the community. Those who receive care in the community benefit from the small cluster homes, where they receive virtually one-to-one attention from the dedicated staff. We must ensure that they can benefit in future, and we must not throw the baby out with the bath water.

11.3 am

I congratulate my hon. Friend the Member for Hendon, South (Mr. Marshall) on instituting the debate.

I very much agreed with the hon. Member for Motherwell, South (Dr. Bray) about the change in attitudes in our society in recent years. It is right to start by praising the policy of care in the community and the great strides that have been made in taking individuals who did not enjoy freedom out of asylums, so that they are now able to make their homes in the community. Such people have been de-institutionalised and are free to become part of the community and take up jobs—many of them responsible jobs—due to the new drugs and treatments that have become available. It is a tribute to the House and the Government that the change has been made, and has been largely successful.

When one makes such a change, one also has to manage it and deal with its effects. We must all accept that, in a tiny minority of cases, the failure to take drugs or to follow the care programme have led to disasters such as that involving Jonathan Zito, which has already been mentioned.

We must consider three issues. First, we must ensure that only those who are likely to co-operate with their care programme and with those trying to help them, and who take the drugs they need are discharged from hospital. The people who take the decision to discharge such patients should not be under pressure—be it financial pressure or the pressure to adhere to the convention or dogma that everyone can be treated in the community.

Secondly, we must ensure that everyone who is released from hospital is properly supervised, with proper accommodation and finance for that purpose. When the decision is being made as to whether to discharge a patient, proper account must be taken of the resources available. That may mean that somebody who could be released or discharged into the community purely on the basis of medical science if there were a huge input of resources and supervision, may not be discharged immediately because it is not possible to provide such support and supervision. The available resources must be taken into account when the decision is made as to whether to discharge a patient. There must be adequate supervision to protect the individual and the public.

My hon. Friend the Member for Hendon, South mentioned the Mental Health Task Force report. It stated:

"Patients with severe and chronic mental disabilities are being discharged without adequate supervision, or the provision necessary to meet their housing, social and health needs. This could incur risks not only to public safety but also to the safety of the individuals concerned".

My hon. Friend is making an important point. Does he accept that, if someone is discharged from a mental illness hospital into the community, the person who is nominated to be in charge of that case—in charge of that person—should be medically qualified, because mental illness is a disease, not something that a social worker can properly supervise? Does my hon. Friend agree that the person nominated should always be medically qualified?

I am grateful to my hon. Friend for making that point. A high level of expertise is needed. I am not an expert in social work and mental health—my hon. Friend knows far more about it than I do. There may be social workers who are so highly trained that they have more expert knowledge about care in the community than some of the doctors who deal with the specialty in hospital.

The important point is that hon. Members have responsibility for the public at large. We also have responsibility for those individuals. However, if there is a question of the safety of the public, the House should always err on the side of protecting the public, because the freedom of the public at large is always a high consideration for the House, and more important than an individual's freedom in such circumstances.

The hon. Member for Motherwell, South (Dr. Bray) said that the number of suicides was greater than the number of individuals who are attacked by former patients. That is not the right balance. It is vital that the public are protected.

Will my hon. Friend give way?

No. I do not have time to give way.

The freedom of many individuals will be less if the public reach the point at which they are completely dissatisfied with the protection available to them.

If individuals are discharged into the community and they fail to co-operate, it is important that they are detained speedily and placed back in hospital. The Mental Health (Patients in the Community) Bill, with its provision for after-care supervision, taking to the House the power to effect a speedy readmission to hospital, is vital if the public are to be satisfied.

I hope that the Minister will tell us the current guidelines on the discharge of patients, and when the guide to co-operative working will be available.

11.10 am

I congratulate the hon. Member for Hendon, South (Mr. Marshall) on initiating the debate. Other hon. Members have contributed sincere thoughts and concerns about the current situation relating to the care of the mentally ill. In particular, my hon. Friend the Member for Motherwell, South (Dr. Bray) has a deep personal commitment to the issue, as chairman of the all-party mental health group.

As I listened to the debate, I had the feeling that one or two hon. Members were harking back to a golden age of the asylum that, frankly, never existed. Many years ago, as an authorised mental health officer, I had the misfortune, to some extent, to witness the system working. Some people who hark back to that system are thoroughly misguided, and do not appreciate exactly what it was all about. The process of moving from the 19th-century asylum system has rightly had all-party support over the past 30 years.

Public confidence in community care policy has been shaken in recent times. That has been due not only to some of the tragic cases that have been mentioned this morning, but to a much wider belief that the Government are more concerned with running down the existing system to save money than with developing an alternative system of community care.

In responding to public anxiety, the Government have been unable to answer two particularly important questions: first, in halving the number of psychiatric in-patients by 70,000 between 1982–83 and 1992–93, what has happened to the people leaving hospital? I have tabled questions but received no answers. Secondly, what has happened to the public resources that have been released by the huge closure programme? They have clearly not been invested in alternative provision within the community.

Immediately before moves towards community care in the late 1950s, 15 per cent. of national health service expenditure was on mental health. Now it is about 11 per cent. Although there have rightly been important developments in community re-provision since that time, it comes nowhere near matching the 4 per cent. drop in expenditure that has occurred. Key elements in community care are missing in many sectors.

The central emphasis of many hon. Members' contributions this morning is to urge the provision of acute beds—urging asylum. I urge them to look at examples of asylum within the community. People do not have to be in parks miles from the public, locked in institutional care. Asylum exists within the community. There are safe houses, supported accommodation and sheltered environments in which people can be enabled to live without being in the old bin system that many of us, unfortunately, knew intimately.

It concerns the Labour party that, within community care, mental health appears to be the poor relation. The Chartered Institute of Public Finance and Accountancy found that only 3 per cent. of the overall community care budget is spent on mental health. The Mental Health Foundation found that, of every pound spent on mental health services, 91p goes on NHS treatment, while the remaining 9p covers all community provision by local authorities and the private and voluntary sectors put together.

The public can see that the Government's mental health policy consists almost entirely of piecemeal initiatives, not a coherent thought-through strategy. That point was made not specifically but in general terms by hon. Members, including the hon. Member for Hendon, South. Each tragic incident, some of which have been referred to—I take them all very seriously—results in an ad hoc attempt to patch the holes in the care system, when it is clear that the system itself needs a thorough overhaul. I hope that the Government will respond to the points that were made by Conservative Members this morning.

The central issue that the Minister must address is the organisational framework of community care. When the National Health Service and Community Care Act 1990 was being debated in the House, I thought that it introduced a fundamental contradiction, especially in planning mental health services. Within the NHS, it introduced a competitive market in health, but alongside that was the requirement at local level to plan community care. The two elements were completely contradictory.

We have seen the result at local level, which has a bearing on some of the tragic cases that have been mentioned. The result has been the fragmentation of local provision, duplication in some instances, and gaps in provision, as has been mentioned by hon. Members. We must add to that the joker in the pack, which was not mentioned this morning—GP fundholding—which is undermining coherent planning in community care. If a fundholder purchases a community psychiatric nurse from outside the immediate area, in such circumstances local collaboration simply does not exist. The Government seem to be turning a blind eye to some of the inherent problems in the operation of the market as it applies to community care.

The divided structure between the national health service and local authorities adds to such organisational problems. Administrative difficulties undermine attempts at inter-professional and inter-agency working. No doubt the Minister will mention last year's Audit Commission report, which mentioned poor co-ordination, ineffective use of resources, and lack of communication and effective multi-disciplinary team working. Only 25 per cent. of health and social services authorities had actually established the criteria for operating the care programme, let alone actually got it working.

I have listened carefully to comments on the Mental Health (Patients in the Community) Bill that will shortly come before the House, but I am concerned that it addresses just one element, despite considerable pressure from a variety of sources for a much wider review of existing mental health provision and legislation. Indeed, the Mental Health Act Commission itself has called for the existing legislation to be updated and to reflect the shift towards care in the community.

There is concern that mental illness is regarded by that legislation primarily as a medical condition. That is where I disagree with the hon. Member for Macclesfield (Mr. Winterton),, for whom I have great respect. Mental illness is a much wider issue than a clinical problem to be dealt with by doctors. I shall deal with that point in a moment.

One matter that the Government must address—in a sense, it was ignored by the hon. Member for Macclesfield—is the clear connection between mental illness and social factors. There are social reasons why people become mentally ill, and they must be looked at in the context of reviewing the policy on the care of people who have mental health problems.

Although "The Health of the Nation" identifies mental illness as a key issue for prevention, there is tie acknowledgement of the need to shift towards social remedies to mental health problems. There is no acknowledgement that the deliberate widening of social inequalities has impacted significantly on mental health.

Will the hon. Gentleman give way?

I do not have time to give way. I apologise to the hon. Gentleman; I have two minutes left.

For example, a range of studies—I shall happily refer hon. Members to them—have now confirmed the connections between increased unemployment, mental illness and suicidal behaviour. Each year, more than 5,500 people commit suicide—more than those who die in road traffic accidents. We need to consider the social factors that result in such tragic figures.

It is crucial that the Government understand the clear connection between their own core policies and mental ill health. Housing policies result in record levels of homelessness, as people are dumped on the street because councils no longer have the ability to offer them proper accommodation. In areas such as mine, industrial policies that have wiped out entire industries, such as coal, and left people rotting on the dole, influence their mental health. The Government must address those problems.

Economic and social policies that lead to the redistribution of wealth away from poorer people towards those who have money have a bearing on the mental health of poorer people in our communities. Until the Government address those points, our debates will be on the periphery of the real issues we have to address.

The most important steps that any Government can take are preventive. Until the Government learn the central lesson that preventive measures are the key element, they will not come anywhere near dealing with the fundamental issues that need to be addressed in respect of the care of the mentally ill.

11.20 am

I congratulate my hon. Friend the Member for Hendon, South (Mr. Marshall) on initiating the debate and raising this subject in the House for the second time. I know that he has provided long and effective support for a number of national and voluntary organisations, and I welcome his involvement and his thoughts.

I also welcome the thoughtful contributions from both sides of the House and all sides of the arguments. I should mention those from my hon. Friends the Members for Bury St. Edmunds (Mr. Spring), for Ribble Valley (Mr. Evans) and for Hertfordshire, North (Mr. Heald), and from the hon. Members for Motherwell, South (Dr. Bray) and for Wakefield (Mr. Hinchliffe), and the interventions from my hon. Friends the Members for Macclesfield (Mr. Winterton) and for Sutton and Cheam (Lady Olga Maitland), not forgetting the supervising presence of my hon. Friend the Member for Leeds, North-East (Mr. Kirkhope), who is a founder member of the Mental Health Act Commission.

The Minister should not forget the Whips. He has mentioned everyone else.

I mentioned supervising presences, and hon. Members can read into that what they will.

I congratulate my hon. Friend the Member for Hendon, South on his choice of title for the debate. The element of care, perhaps caritas, is crucial to all health care, but perhaps it is even more fundamental when we are helping people to cope with an illness which, after all, frightens them and other people. It can be invisible and unpredictable, it is widely misunderstood and it produces prejudices in others which exacerbate the problem for the sufferer.

If we start with the concept of care in both its strands—of mattering to us and looking after those who are ill—we begin to build the understanding that will help us do better for people with mental health problems.

We need to care enough to care for the mentally ill. We need to care enough to overcome ignorance, remove stigma and provide the range of services that we all need. It is not just the 10 per cent. of us who currently need those services; it is the one in four of us who will do so during our lives. Mental illness can affect any of us, and will affect many of us.

The hon. Member for Wakefield spoke about prevention. Of course prevention is crucial. That is why our policies put so much emphasis on initiatives such as the "Defeat Depression" campaign and our work with employers, helping people to cope with stress and to lead mentally and physically active and fit lives. Everyone can play a part. At work, a flexible employer with a counsellor on board can help people who may be under stress at home or at work and need that additional support.

As my hon. Friend the Member for Hendon, South said, it was Enoch Powell, some 30 years ago, who first advocated moving people from the old institutions back to the community, where many of them could live more fulfilling lives if given proper support. The development of new drugs for treating mental illness means that is possible for many more people. That does not mean that we can simply close down all the old hospitals and walk away. We need a range of facilities for care to work in the community.

It is our policy that hospitals should not close until and unless alternative provision is available. We need residential care—some of it sheltered—in or near communities. We need modern hospital facilities—long-term, medium-term and short-term. I have preached the case for medium-term hospital hostels to providers and purchasers in our health service, and I shall continue to do so. We need 24-hour crisis beds for those who cannot cope in the short term, and we need asylum in the best sense of the word—a place of safety in which to rest and improve one's mental health.

Some patients will need much longer spells in hospitals, and a few, sadly, will need to spend all their lives there. Some will need different levels of security, including medium-secure units, and a small number will need the high-security services in our special hospitals.

We have been concentrating on developing a range of facilities. Let me dwell for a moment on medium-secure provision, which is so important to so many issues that have been raised today. It fills a gap that was perceived and identified in 1974 by the Glancy committee. When the Government came to office in 1979, there was not a single medium-secure psychiatric bed in the country. We have invested £47 million in the programme, and by the end of next year we shall have provided 1,200 of those places. That makes so much more possible. In addition, further places are being developed by regions from mainstream NHS capital allocations, as well as in the private sector.

Reference has been made to enabling people to leave prison. In the past four years, we have enabled 2,500 patients to move from prison to hospital. I understand the impatience of my hon. Friends and the courts, but it is worth bearing in mind the fact that, a few years ago, that option was not available, as medium-secure beds were not being provided. The option has become available only recently, and it will increasingly be the route for the appropriate placement of people.

Reference has been made to the Mental Health (Patients in the Community) Bill, and I welcome what has been said about that. In answer to my hon. Friend the Member for Bury St. Edmunds, we have issued new guidance on hospital discharge. I commend to him the discharge handbook, which is helping people to make the right decision and to ensure that the decision to discharge somebody is made only if the care programme is available and ready in the community, with the key worker in charge, and there are provisions for that individual's needs.

We have introduced through the House the new code of practice to the Mental Health Act, stressing that a person's health, as well as the risk to himself or to others, is sufficient to take him for assessment and into hospital. We have introduced supervision registers, identifying those patients at significant risk of causing harm, committing suicide or harming other people if they are not given extra protection and care. Those are now in place in every health authority in the country.

We recognise the point, well made by hon. Members, about the need to have the right person in charge of someone in the community. It is not always a medical person. Sometimes the key need is social functioning. Sometimes—indeed more often—it is right that it should be a medical person, probably a community psychiatric nurse. We are making sure that those people are properly trained and know their role as key workers.

I am conscious of London's particular problems, which were referred to in the Royal College of Psychiatrists report, which drew attention to the fact that too many people were in the wrong beds. It was not just that there were insufficient beds, but that they were inappropriate beds. The medium-secure programme goes some way towards meeting that, as does the extra £10 million we put in and the mental health task force project, which identified good practice and listed where we needed to do better. It was followed up with a further report showing what had been achieved.

The £20 million homeless mentally ill initiative for London has funded 10 hostels, providing 150 bed spaces. Outreach teams are now taken on by the respective health authorities. In respect of accommodation, where the Housing Corperation agreed initially to 150 supported places, I am pleased to say that approval has now been given to some 162.

The mental illness specific grant is enabling local authorities to develop their community services. It has provided an extra £10 million this year, and £66 million in total. That has already supported 1,000 schemes throughout the country and helped 100,000 people.

The NHS has a role in ensuring that the care programme approach, registers and the priority that we give mental health are effective throughout the country. The beds are there, but we must ensure that they are the right ones. There are 20,000 acute beds and 80,000 long-term beds, as there have been over the past decade, but they are in different places. That is good news—provided that those beds are everywhere, to meet the range of need.

Nobody can be complacent about mental health. We must work together, because there is an inter-agency task ahead for us all. I re-emphasise, in this short response, our commitment to providing effective, appropriate and safe care for people with mental health problems.

Personal Financial Services

11.30 am

I am grateful for this debate and, following the recent Personal Investment Authority statement on the mis-selling of personal pensions and the Office of Fair Trading report on the selling of endowment mortgages, I hope that the debate will provide a timely opportunity to examine the serious problems that still exist in the sale of many personal financial services. I declare an interest, as I receive a modest contribution to my office research costs from the National Union of Insurance Workers. That is not a party political union or one affiliated to the Labour party. In fact, I believe that at the last general election it sponsored a Conservative candidate.

That union's sponsorship brings me no personal pecuniary benefit, but taking an interest in personal financial services since becoming a Member of Parliament has brought me personal financial benefit. As I began to take a closer interest in the operation of the financial services industry, I realised that I had been mis-sold a personal pension some time ago. Four years before I entered the House, I chose to become self-employed and acquired a personal pension. The mis-selling that occurred in my case was not one of the spectacular instances that hit the headlines in the past year, but a mundane, everyday example of mis-selling of the kind that collectively waste the savings of too many people. I was sold a regular premium policy even when I had made it clear to the financial adviser that I was most unlikely to continue in a personal pension scheme for more than a few years. I remember making it clear that I hoped to join within a reasonable period the generous occupational pension scheme offered to Members of Parliament.

In those circumstances, I should have been advised to make single premium payments into my personal pension policy, because, with a regular payment scheme, charges in the early years are much higher. Unless the policy is kept until maturity, it is an expensive way of saving. When I raised that matter with the company concerned, the error was admitted without fuss. The recalculation of my personal pension savings over the four-year period showed that, had I made single premium payments, my pension savings would have increased by no less than 50 per cent.—a significant difference.

When I told that story to a colleague in the Tea Room the other day he said, "If I'd been as daft as that, I certainly wouldn't go around telling people about it." That is part of the problem. Many people who are not unintelligent are unsophisticated when it comes to financial matters but are reluctant to admit to the fact. That makes them over-dependent on advice from people who may have a vested interest, and reluctant to ask hard questions or to complain when they fear that things are going wrong. I suggest that that is true of the majority of the people who bought a variety of personal financial services in recent years.

I shall outline some of the steps that need to be taken to minimise mis-selling, avoid wasting hard-won savings and restore public confidence in an industry of immense importance to the country and the British economy. It is important to set the scene.

The problems of mis-selling that came to light over the past couple of years occurred at precisely the time that the Government were urging ever-greater individual dependence on personal financial services, savings and insurance. The Government have openly and clearly pursued a twin-track strategy. They have provided financial incentives to leave state provision and to take out personal savings and pension policies, and they have progressively reduced the value and benefits of state provisions. The effect of that for many individuals has been to give them a choice between a rock and a hard place.

Over the past 10 years, the Government have encouraged opting out of the state earnings-related pension scheme, and the Pensions Bill now in Committee will take that further. The Government Actuary suggests that Government measures will reduce the national SERPS bill by nearly 50 per cent. over the next 45 years.

The Government have encouraged pensioners to take out health insurance while reducing access by the sick elderly to national health service beds. The Government are now requiring new mortgage takers to provide their own insurance cover because the Government are removing income support on interest payments on mortgages taken out from October.

The really damning indictment of Government policy is not just the shift from public provision to private insurance but the way that the Government made that shift without ensuring that consumers were guaranteed value for money and financial security from the private provision that they are encouraged to make. The scale and range of problems now facing consumers taking out private insurance and making private savings are daunting.

Half a million people will have their opt-outs and transfers from occupational pension schemes individually reviewed. The cost of restoring lost benefits to them is estimated at between £1 billion and £2 billion. The cost of administering the review is expected to run into hundreds of millions of pounds. The ultimate cost of compensating people who were mis-sold and of conducting the review and paying the fees and other charges will have to be met from the pockets of consumers.

According to the Office of Fair Trading, endowment mortgages—which accounted for 84 per cent. of the home loans market in the late 1980s and which are still the choice of an astonishing 60 per cent. of home owners—pose a higher risk and frequently are a more expensive option than repayment mortgages. The OFT strongly suggested that the existence of high commissions on endowment policies biased sales advice and distorted the market towards inappropriate policies for many people.

When the Department of Social Security and the Securities and Investments Board report later this year, they will confirm that people on low incomes—as many as 2 million—were wrongly advised to leave SERPS for personal pensions because their incomes were low, rebates were low and personal contributions over and above the rebate were low or non-existent. Fees and charges are eroding the savings of people who opted out for personal pensions. Some will be left with pensions of a lower value than they would have had under the state earnings-related pension scheme. At the very least, people on low incomes, who can ill afford risky saving strategies, have been exposed to an unacceptable degree of risk in the marketplace.

The cost of the opt-out has been enormous. By 1992, the cost of giving incentives to low-income savers—people on less than £10,000 a year—to opt out of the state scheme was £3.6 billion of public money given away, much of it now being absorbed in the fees and charges of insurance companies. By now, that figure is probably around £5 billion. That is an enormous amount of public money to transfer to the private sector to leave people with inadequate pensions which, in most cases, will be no better than they would have received under SERPS, and may be worse.

The extent to which that strategy has failed means that there will not even be a public saving in the long run. Projections made by such organisations as the National Association of Pension Funds in evidence to its income inquiry show that for many people those pensions will be below foreseeable state benefit levels, so people will have to have their pensions topped up through state contributions.

Bacon and Woodrow have recently suggested that many people are being sold private additional voluntary contribution schemes despite the fact that AVC schemes available to them through their occupational pension scheme provide better value at a lower cost.

Huge losses are incurred every year through the early cancellation of schemes. Evidence shows that 30 per cent. of endowment policies, which in most cases bring reasonable value only if they are kept to maturity, are cancelled within five years, and only 20 per cent. are kept to maturity. A couple of years ago, the Office of Fair Trading estimated that the cost of early cancellations to savers was running at £250 million a year. That is more or less a Maxwell scandal every year or so in the life assurance industry.

The cost is much greater than that because those savings were due to be kept over a long period. They were due to mature in 20 or 25 years' time. Therefore, the loss to savers at the time that they might have expected to get some return on their savings will be about £750 million to £1 billion a year.

Other problems are becoming apparent in other financial services that are not regulated under the Financial Services Act 1986 because they do not involve investment. Permanent health insurance policies often turn out to be anything but permanent. People find that their ability to claim on their policy is subject to the arbitrary decisions of company doctors who are subject to less accountability and fewer grounds for appeal than the doctors of the Department of Social Security who, in the general view of my constituents, are not always regarded as the most sympathetic members of the medical profession.

Loss of income policies, which are expensive to operate, in many cases turn out to have severe penalties. People who return briefly to work find that they can no longer renew their policy and end up with little to show for their money. Contracts are revoked arbitrarily when companies become aware that particular groups of employees are likely to be subject to redundancy.

Insurance on unsecured bank loans is enormously expensive and, in practice, subject to little competition at the point of sale. The Government have refused to regulate the market that they are creating in mortgage insurance. I predict with some confidence that, unless the Government change their mind on that, within months, and certainly within some years, it will become clear that mortgage lenders are selling policies that over-insure when compared with the benefits that the Government are taking away.

The sum total of those problems is pretty disastrous. First and foremost, the waste of the public's money is a scandal. These days, people can ill afford to see their hard-won money frittered away; nor can the country, which faces a growing bill for future pension provision, afford to see money which could be accumulating as savings, as future pensions, absorbed in excessive fees, charges and the waste of early cancellation.

It is a sobering thought that, even when nothing goes wrong in the sales process, the results are far from satisfactory. With many companies selling personal pensions and endowment mortgages, nearly £1 in every £3 invested by the consumer is lost in fees and charges. One third of the potential pension, one third of the potential endowment return, goes to the company for its administrative costs and, in the case of shareholder companies, payment to shareholders. The Government cannot seriously expect to see private savings replace state provision when so much of the potential benefit, so much of the potential investment, is lost in that way.

The second problem is no less important. The current crisis threatens the integrity of a major important British industry which employs hundreds of thousands of people, makes a major contribution to Britain's national wealth and generates savings for investment on a scale unparalleled in most other European countries.

In the past year or so, there has been a sharp fall in the sale of some personal investment products. For example, there was a 10 per cent. fall in the sale of regular premium products between _1993 and 1994, and I am told that the first quarter of 1995 has been the most difficult for the industry for decades.

If that were a sign that individual savers were shifting away from some of the policies towards more prudent forms of investment, that would probably be good, but I suspect that that is not happening. I suspect that the fall in sales, the difficulty of making sales, reflects the drop in public confidence in the industry and is the effect of the highly publicised difficulties of recent years. If that is the case, individuals are simply failing to make any form of investment saving at all and, in the long run, that will bring a significant cost to themselves and the country.

The effect on the industry is also important because there are major opportunities for the United Kingdom insurance industry in Europe. Problems in the funding of state pension schemes in Britain, which most people recognise although they may have different solutions, are writ large in other European countries that have less developed non-state pension provision.

Therefore, there is an enormous potential market in Europe for expertise and direct services for the British insurance industry. However, I suspect that someone coming from most other European countries to look at the British industry and seeing 'the type of problems that I have outlined would be less than impressed with the record of recent years and less certain that under this Government ways of developing effective personal financial services had been developed as well as they could have been.

I did not seek this debate in order to rubbish the insurance industry. It is an important industry and, whatever the differences between the two sides of the House on where exactly the line is to be drawn between public and private provision, there is clearly a need for an active personal financial services industry. As working patterns change, as life-time employment in one company becomes a rarity, as the role of parents change, there will be a growing need for savings that only personal financial services can meet.

For example, most people need and will need a non-state pension in addition to any state pension. It is sometimes said that we cannot afford a state pay-as-you-go pension scheme. Logically, that is not true. The cost of any given pensions bill to the resources of the nation in 30 years' time is the same however it is funded. It is nearer the truth to say that, although we may happily pay the taxes to fund our parents' pension bill, we do not trust our children an inch. We are not certain that, in 30 years' time, they will be willing to vote for a Government willing to levy sufficient levels of taxes to pay our pensions. Demography shows that the demands on those children will be greater than they are on us.

Faced with that political risk—that is what we are talking about—prudence suggests that we should have our eggs in more than one basket and that people should have non-state pensions. If we are to sort out the mess and have a secure form of non-state pension, we will have to address the root causes of the problem. I do not have time to survey all the current regulatory issues, but I want to focus on some that have been given insufficient attention.

The failures of state regulation have been widely discussed in the technical and financial press. The attempt to turn poachers into gamekeepers failed, and all we got was poachers. But the tabloid press has had a different target. The tabloid press has greedy salesmen—sales reps who have eyes only for the commission that they can earn. In the popular mind and the popular media, they have been universally blamed for the mis-selling of recent years.

Some people, obviously, have been driven by greed or straightforward, outright dishonesty; but it offends against common sense to suggest that half a million people could have been induced to opt out of occupational schemes, and 2 million or more low earners could have been enticed from the security of SERPS, simply by the greed of individual financial advisers and sales representatives. Over the past year, I have talked to people who sell pensions and other insurance policies, and the picture that I have seen is rather different from the popular tabloid image.

Those people say—rightly—that much responsibility for the current problems lies with the Government. When the personal pension boom began, the Government spent £1 million on advertising the benefits of personal pensions, giving little or no warning of the problems. One memorable advertisement showed someone tied upside down in chains representing that person's existing pension provision. The advertisement told people about the new personal pensions: "employees will be able to choose their own Personal Pension scheme instead of staying in SERPS or an employer's pension scheme." It is now the received wisdom of the regulators that very few people who have the opportunity to join an occupational scheme should be encouraged not to do so, that very few people who are members of such a scheme should be encouraged to leave it, and that very few people who have deferred pensions from an occupational scheme should do other than leave them in that scheme. In their advertisement back in 1988, however, the Government clearly endorsed the idea that people should opt out of their employers' schemes.

I am not attempting to whitewash the industry, but it makes a fair response when it says that the Government encouraged the idea among the public that opting out was a good idea. None the less, the management of most insurance companies—the very people who were then put in charge of self-regulation—actively encouraged their sales forces and financial advisers to target those who have now been mis-sold policies.

There is still a great deal of foot-dragging in the industry in regard to sorting out problems. It has been dragged kicking and screaming into dealing with the problems of opt-outs and transfers from occupational schemes. It is now two years since the regulators told insurance companies that they needed to re-check the policies of all who had been sold personal pensions to ensure that they had been given good advice. The reasonable expectation—shared by the regulators—is for a substantial number of people on low incomes to have been advised by insurance companies to opt back into SERPS and out of their personal pensions, but as far as I know there is no sign that the industry is taking such action or that such a shift is taking place.

The main conclusion that I have reached, having spoken to people working in the industry, is that most of those who sell at the sharp end of insurance companies suffer employment conditions and practices in which mis-selling is likely to be an inherent danger. Commission on products plays an important role in that, less because of commission-driven greed than because for the majority of financial advisers—tied agents—commission is the source of their income. If they do not sell, they do not eat, pay their own mortgages or clothe their children. Some companies have recently introduced higher basic salaries, but for most employees any reasonable income is entirely dependent on sales performance.

That is not the only pressure on financial advisers, however; others are equally insidious. Many sales managers depend on override for their income. The managers obtain their own income from the commission generated by financial advisers working under them, which creates permanent pressure to sell throughout the management hierarchy. Companies use sales targets, often set at unrealistically high levels, to keep the financial advisers in a state of permanent job insecurity: anyone who does not meet the sales targets that cannot be achieved is constantly liable to dismissal for poor performance.

Financial advisers are vulnerable to the peculiar contracts in force in the industry. Sales representatives are held personally responsible for lost commission on policies that are cancelled early—which means that they can run up debts of thousands of pounds on policies that they sold in accordance with their companies' instructions and the regulators' own good practice guides. Indeed, in some cases people who move from one company to another see their own clients "churned"—sold new policies—and the resulting bills for the early cancellation follow them.

People with personal debts are not allowed to work in the insurance industry, so the consequence of such action is the denial of employment. More worryingly, people are tied into an insecure position in which pressure is on them to sell. Other companies push the legal interpretation of self-employment to the nth degree: companies in which people are clearly working permanently and receiving free training, software and support systems and are nevertheless encouraged—or forced—to work as self-employed.

It has been common practice for new entrants to the industry to be lent commission in advance of sales. It looks like a salary and feels like a salary—until the sales do not materialise, when it becomes a personal debt that those employees are liable to repay. Despite recent improvements in the regulatory requirements, it is clear that training standards and professional support for financial advisers vary widely. I was given more than one example of sales advisers' being assisted, quite improperly, to pass basic competence tests that are now required.

At the same time, the real burden of higher compliance standards is often felt by the front-line financial advisers. They are liable to lose their jobs if they make mistakes, at a time when they are under greater pressure to sell. Frequently, those responsible for disciplining financial advisers for making compliance mistakes are the same people—or part of the same management structure—as those who are setting unrealistic and demanding sales targets.

That puts the problem of commission in a different light from that generally shown by the tabloid press. Commission is a problem for three reasons. First, it is part of a complex set of pressures leading to job and financial insecurity for financial advisers. Highlighting commission alone will solve nothing unless the other pressures are tackled. Secondly, the effect of commission on the consumer is not so much salesman's greed as the distortion that it creates between products that offer different levels of commission. The Office of Fair Trading has highlighted the distortion between endowment mortgages, which carry high commissions, and products such as repayment mortgages, which carry little or no commission.

The most fundamental problem affecting employment in the financial services industry, however, is the fact that employment pressures run directly counter to the requirements of good regulation and the legal requirements of the Financial Services Act 1986 for the giving of best advice. It is a widely understood principle of any effective regulation of markets that financial incentives should reinforce the aim of the regulation. For the financial adviser—the tied agent, the sales representative—that means that giving best advice, which may be not to buy anything or to buy a product that carries little commission, should involve the same financial reward as selling a product attracting a high commission. That is not the position today. Until the problem is tackled and financial advisers are rewarded for their advice as much as for what they sell, mis-selling is bound to continue.

Over the past year or so, the number of people selling insurance has halved, but we have not yet created the network of financial advisers and tied agents that would provide the highly qualified, totally objective and well-rewarded individuals whom the industry and the consumer need. It is a sad fact that the regulators, whether SIB or LAUTRO—the Life Assurance and Unit Trust Regulatory Organisation—in the past or the Personal Investment Authority, have had almost nothing to say about employment practices in the industry; when they have, it has all been at arm's length. It is hoped that increasing training standards and costs will improve staff retention, and that commission disclosure will change the reward structure. But it is all too little, too indirect and too ineffective.

In other areas of financial services product not covered by the Financial Services Act, the Government have relied overmuch on industry codes of practices rather than on direct regulation. As Which? revealed this month, poor financial advice is still widely available in the high street from insurance companies, building societies, bank assurance companies and independent financial advisers. Until employment practices in the industry are tackled, mis-selling will continue.

I accept that it is difficult for regulators to prescribe exact employment terms, but a number of things could be done. The regulators could study and issue good practice guidance on contracts, remuneration, discipline procedures and the setting and management of sales targets. That should emphasise the need for a substantial element of basic salary and for performance-related pay that reflects the quality of advice given, and not just the volume or value of sales achieved. Such guidance would provide a focal point for unions in the industry and for consumers to judge the company from which they were buying.

The regulators could and should introduce direct registration of all those selling insurance in the industry, making the contractual obligation of individual financial advisers to meet compliance standards one between the adviser and the regulator, not between the adviser and his own manager. Creating a directly regulated sales force would be a major step towards the genuine professionalisation of the industry and raising the status of financial advisers, and it would give some protection against the arbitrary use of discipline by managers and companies in the industry.

The Government could, of course, bring financial advisers' representatives into regulators' governing bodies or, more to the point, perhaps draw on the experience of financial advisers' representatives in establishing a system of statutory regulation. It is a real indictment of self-regulation that self-regulatory structures have never seriously tried to draw on the experience of people who actually sell personal financial services to try to improve regulation. I hope that that matter will be dealt with.

Another aspect of regulation has had too little attention. The whole emphasis of the regulatory effort has been on the sales process, not on the quality of product. It is hoped that improved disclosure will improve the quality of products. Indeed, the Minister of State, Treasury said:

"the new regime for disclosure will—we hope and intend—substantially improve the avoidance of problems of mis-selling."—[Official Report, 28 April 1995; Vol. 258, c. 1124.]

That is over-optimistic.

Certainly, league tables showing the dramatic effects of fees and charges are becoming available. They show, for example, that on a £50,000 endowment mortgage, an individual's choice of company can influence the final value of his investment by as much as £9,000. I doubt, however, whether disclosure will have much effect. Few signs exist that most tied agents are being trained to deal with increasing competition in the marketplace. In general, people still remain dependent on the building society, the bank assurer whom they first contact, or the tied adviser who first contacts them. Under the present regime, it will be many years, if ever, before disclosure really creates genuine competitive pressures that work in consumers' interests.

We need to consider ways of improving not only the quality of products in the market but the sales process. The Office of Fair Trading and consumer organisations have done far more to highlight the failure of different types of products than the regulators. That must change. A number of key areas for action exist.

First, when sales are made, customers should be told how their potential insurer compares with the industry as a whole in relation to key measures, such as the impact of fees and charges on the effective rate of return. Choice of company can influence the return on a personal pension of £50 a month by as much as £70,000, on total savings of, say, £250,000. That is the effect of the different charges levied by a company on the same assumed rate of investment return. It is in the consumer's interests to know how his potential insurer compares with others.

The shilly-shallying over disclosure of persistency rates should end. I have already the highlighted the waste through poor persistency rates. It is unacceptable that people do not receive information about how effective their company is at retaining its clients in any consistent form. If agreement cannot be reached with the industry—that seems to be the big problem—the Securities and Investments Board or the Personal Investment Authority should impose a standard definition of persistency rates to be used by all. Once again, that information should be available on a comparative basis to potential customers as well as on an individual company basis.

If companies choose to bump up their assumed investment returns or to reduce their premiums by assuming abnormally high rates of return, something needs to be done about that. The industry average assumed rate of return on investment is less than 8 per cent. Some companies, however, have produced projections assuming rates of return of 9.25 per cent. It enables them to produce large presumed bonuses or to reduce their premium rates substantially. A case exists for underlining that for consumers. They should be informed about what the current average industry assumption is so that they will be aware that they are being sold a policy that has an abnormally high assumed rate of return.

None of the measures that I have outlined would be expensive to enforce. Information could be regularly collected by regulators and supplied centrally on, say, a quarterly basis to companies to pass to customers. It would bring some genuine consumer choice and competition. Even if that were done, more would need to be done. Regulators should take on the responsibility of applying direct pressure on costs. The spread of fees and charges levied is far too wide. As I said, it is unacceptable that such a large proportion of people's savings—£1 in £3 in many cases—is absorbed in fees and charges. Nationally, that is an expense that we cannot afford. Consideration should be given to introducing over time a minimum acceptable level of charges, and companies exceeding that limit should be highlighted.

Action should be taken to prevent mis-selling to low-income individuals who would be better off in a state earnings-related pension scheme. One possibility would be to set a floor below which no transfer could take place. It might be more in tune with the market to introduce a requirement that any personal pension sold to someone below a given income level—perhaps £12,000 per annum—should be guaranteed by the company to perform no worse than the SERPS equivalent. That would soon sort out companies that had genuine confidence in their investment performance from those that did not.

We should be aware, as the regulator should be, of companies that, according to the Office of Fair Trading, use the money they make on early cancellations to bump up published maturity values of policies that are kept to term. The regulator should be prepared to tackle that abuse if necessary.

The Government should be boosting the industry by introducing more helpful and responsible measures than they have introduced to date. An underlying problem exists in that many people are under-insured and under-provided for in their retirement. The Government have simply said, "Take this private sector step," without underlining to people the fact of their under-insurance and under-provision.

The Government should undertake a regular survey of the real pension position of a large sample of the population at different ages and earning levels, and they should project forward the type of pension entitlement that is being developed. In many cases, that would highlight the degree of under-insurance and the need to make provision. Such a move would help to make the transition from a society where insurance products have to be sold to one in which informed consumers would choose to buy.

I have gone on longer than I intended, but I should like to make one final point. The Government also have a responsibility to set the framework in which people can take long-term decisions about personal financial services and personal savings. One of the things that has tipped the balance from endowment mortgages to repayment mortgages is the reduction of tax relief on mortgage interest payment. When the Government embarked a few years ago on their strategy of reducing and probably phasing out MIRAS, they gave no consideration to the impact on people's decisions to take out endowment mortgages. If the Government want to claim that they are encouraging greater dependence on personal financial services, they have a responsibility not to make decisions that change the. ground rules after people have become locked into an investment decision.

For most people who have taken out an endowment mortgage, there is now no way out. It may have been a bad decision at the time, but trying to get out of it now would leave them even worse off, taking into account the costs of early cancellation. Of course, there is also the saga of the tax that never was, or the tax that may be—we are not sure which. That recent episode has highlighted the dangers of encouraging people to make personal provision and then threatening them with the possibility that they will be taxed on the money that they have put aside. What needs to go hand in hand with the Government's strategy of privatising social provision is long-term stability in Government policy, which the Government have been reluctant to provide.

We need an effective personal financial services industry and people need to be able to buy its products with confidence and security. So far, the Government's record has been marked by a mixture of irresponsibility and complacency. The regulatory system is by no means at the level required to ensure that the industry can offer consumers what they need. It also does not offer those who work in the industry the employment conditions that would enable them to act as truly objective and professional advisers. The quality of products on sale is much lower than it should be or needs to be. It is important that the Government deal with those problems in the very near future.

12.11 pm

I congratulate my hon. Friend the Member for Southampton, Itchen (Mr. Denham) on securing this debate. During his time in the House, he has acquired a formidable reputation in the financial services area. It is to his credit that he has not only secured the debate but has made a number of constructive suggestions with the aim of improving the current unsatisfactory position.

The financial services industry is of immense importance to this country. Although, to a certain extent, my hon. Friend and I have a number of criticisms—in the proper sense of that word—to offer, no one should be in any doubt that we fully support the industry. Edinburgh—part of which I represent—is the fourth biggest financial centre in Europe, so I well understand that the industry is of immense importance. No one can level a charge against me that I do not have its best interests at heart when I make some suggestions to improve the present position. My hon. Friend shares my view.

The industry employs 2.5 million people, and many towns and cities depend on it for employment. Indeed, the industry as a whole, broadly defined, produces about 18 per cent. of this country's gross domestic product. As my hon. Friend said, it is of crucial and growing importance as a service provider, so it is important to have a regulatory system that commands confidence. It is also important that if there are problems—and undoubtedly there are—they should be dealt with in the spirit of trying to persuade more people to make provision for themselves, both for their benefit and for the benefit of the industry as a whole.

As my hon. Friend said, more and more people will want to make provision for themselves through savings, both long term and short term. The Government should encourage that as a matter of principle. Saving has worth for the individual as well as value for society as a whole because saving makes money available for investment—and long-term investment is something that this country needs.

Pensions are of growing importance, so it is crucial that we get the right regulatory regime. If an individual makes a mistake when he takes out a pension, it could be 20 or 30 years before he realises that the mistake has been made, by which time he can do nothing about it. We must remember the changing working patterns in this country, which make it unlikely that people will work for 30 to 40 years for the same employer before retiring with a gold watch. Instead, people will have many jobs and will go in and out of employment. It is important that they make the appropriate choice of pension. My hon. Friend was fortunate to discover his mistake at an early stage, so he had an opportunity to put matters right.

The problem we face—I use the word "we" advisedly—is that a mistake made at an early stage may not be discovered for many years, so nothing can be done about it. It is a catastrophe not only for the individual but for us collectively because in the end the state has to put the matter right, inasmuch as it can do so.

People will want to buy other protections from the industry, and my hon. Friend mentioned endowment mortgages. I want to say a word about the concept of caveat emptor, which is important to the law of contract. I do not believe that the regulatory system or the Government can ever substitute their judgment for that of individuals and they cannot protect people against foolishness, stupidity or, in some cases, dishonesty. No one should try to get away from the fact that caveat emptor—buyer beware—is an important concept.

However, when dealing with public policy and matters as important as, for example, the sale of a pension, the doctrine of caveat emptor should be qualified by the recognition that there must be a regulatory system that at least tries to minimise the risk that people will be sold inappropriate products. In other words, there is a public interest in proper regulation. That is something that the Opposition have long recognised, but I am not sure that it is universally recognised by the Government.

We need a regulatory system that commands the confidence of the industry and the public: both are important. Currently, the problem is that the regulatory system commands neither the confidence of the industry—where more and more people are saying publicly as well as privately that the system simply is not working—nor the confidence of the general public. There is a need for that confidence, for the benefit both of individuals and of us collectively as members of society. It is not in our interests that people should be scared off or discouraged from making provision for themselves.

My hon. Friend referred to the pension transfer problem, which has been raised in the House on many occasions. The problem continues. I am disappointed to note that the industry—or at least certain parts of it—are determined to challenge, through the courts or by other means, the determination of the Personal Investment Authority to resolve the problem and examine cases where mistakes may have been made. The industry must understand that if the public sees it trying to avoid putting right mistakes made in the past, they will understandably say, "I will not trust the industry in the future." The selling of financial services, in particular pensions, demands trust more than anything else. If a mistake has been made—and it is common ground that mistakes may have been made—it is far better for the industry to put up its hands and say, "It's a fair cop," and try to put things right.

I understand the legal constraints on the trustees of funds and their duty towards those funds, but the industry must understand that if it prevaricates, delays and gives the impression that it is not willing to put things right for the people to whom it has sold its policies, the industry itself will suffer. That would be in nobody's interest.

My hon. Friend referred to the SERPS problem, where there may have been substantial mis-selling. That problem is only just beginning to come to light. It will haunt the Government for the rest of their time in office, and it will also haunt future Governments. That is why it is important to deal with problems when they come to light, rather than shovelling them into a dark corner, hoping that they do not return.

Significantly, figures show that since the pension transfer problem came to light sales are down by about 10 per cent., and even more in some cases. That is largely because the public have lost trust, which now needs to be restored. A number of steps should be taken to achieve that.

First, the regulatory system needs to be reformed. As I have said, I believe that self-regulation, in particular, has been discredited. Few people are now prepared to stand up and defend self-regulation. Unfortunately, those few are in the Chamber. The Government simply will not accept that a mistake was made in the mid-1980s when self-regulation was thought to be an appropriate way of dealing with these sales. If the Government accepted that, they would propose fresh legislation to correct the fundamental flaw in the Financial Services Act 1986.

Self-regulation is a fiction anyway, because the present system is rooted in statute. A tennis club is self-regulated, as are voluntary organisations. When the Personal Investment Authority was set up, we had the fiction of it bidding for recognition by the Securities and Investments Board, when the PIA knew that it would not be recognised unless it complied with every last dot and comma required by the SIB. The legal fact is the PIA's obligation to its members.

That fiction is cumbersome, expensive and results in duplication, as we have seen in the sale of personal pensions. Both the SIB and the PIA are prescribing rules and regulations and are making pronouncements. Significantly, when the problem with pension transfers first came to light, some within the Financial Intermediaries, Managers and Brokers Regulatory Organisation, which has been subsumed within the PIA, stated that the problem was being greatly exaggerated. That may have been so, but it does not help public confidence when the regulator appears to be acting as if it were a trade association.

I do not believe that it is possible to serve two masters—the trade interest and the public interest—at the same time. Our proposed reforms should leave no one in any doubt that the ultimate master of the regulators must be the public interest, not the trade interest. I do not suggest that it is not in the industry's interests to have a regulatory system that commands confidence, but I do not think that self-regulation can command confidence in the 1990s. It may have had its day in the 1980s, but the Government must accept that that day has gone.

Different regulation is required for different ends of the market. The problems at Barings—I shall not go into those, as we are not discussing them today—were of prudential supervision. At the other end of the market—the market we are discussing today—we are dealing with the need for proper customer protection and rules of conduct.

Any reform of the system must recognise that there are two distinct needs and that they must be dealt with appropriately. In that connection, I wish to consider briefly the nature of regulation required. It is necessary to tread a fine line between sufficient regulation to maintain public interest and over-regulation, whereby we may lose sight of what we are trying to achieve.

I suggested that it was not possible to exclude stupidity, greed and foolishness, but one can try to reduce the likelihood of their occurring. That is why I believe that the time has come to look at the nature of regulation. Many people say that the industry is being strangled by regulation. Independent financial advisers are important if we are to provide a facility for proper impartial advice, and many of them believe that they are being squeezed out by the new rules.

We must get away from the box-ticking approach to regulation, whereby advisers are told to tick boxes to show what they have done. That does not prove anything. If Robert Maxwell had been alive today, he would have ticked every box that was ever shoved in front of him. I never ticked a box when I was in practice as an advocate, and people who consulted me relied on the trust that they had in their professional adviser. My hon. Friend said that the regulatory system should be geared towards promoting a long-term commitment to the industry and professional integrity.

I have some sympathy for those who believe that all the rules and regulations have been put in place to protect the regulator, so that if anything goes wrong it can say that it has a rule to deal with the problem. It is necessary to look at the regulations, to streamline them and to put them in broad terms. We should have four rules and regulations which work, rather than 400 or 4,000 which do not. The PIA should undertake the fundamental review that is necessary now, rather than going further down its present road of having so many rules and regulations that we lose sight of what we are trying to achieve.

We must also look at the way in which products are sold, and my hon. Friend spoke on this matter with a great deal of force. He mentioned the role of the Government, but I do not want to say very much about that as I have made these comments before. It is worthy of note, however, that the Government created the culture in which mis-selling can take place.

My hon. Friend drew attention to the advertisement that has been shown again and again as a public information advert, although it seems to me to be stretching public information almost to the point where credulity is broken. The advertisement refers to the mis-selling of pensions. In the late 1980s, the Government led people to believe that the very act of going private was enriching in itself. It did not matter how much money one had, or what one's prospects were: if one got a private pension, one must be better off.

That allowed a climate in which unscrupulous salesmen, as well as people who thought that they should do what the Government wanted, could sell policies that were manifestly unsuitable for the people to whom they were sold. It is no wonder that the Government promoted self-regulation at that time, because self-regulation, which became increasingly equated with self-interest, went hand in hand with the culture that so dominated our lives in the late 1980s—a culture which, I am happy to say, is being increasingly discredited, and not just in the area of financial services.

My hon. Friend stated that many commentators tended to blame what are called unscrupulous salesmen, but they have not concentrated on the role of the employer, who usually sends salesmen out into the market. Those in the industry who complain about its image and who say that the industry is not held in high esteem should grasp the fact that the problem is substantially of their own making. If there is no trust between someone who is buying a product and the person selling it, it is inevitable that mistakes will be made and that people will not trust each other. That is why I fully support the independent sector, which is very important if it is genuinely independent.

People in the industry have been content to send salesmen out to areas devastated by pit closures, for example. Firms recruited people who had perhaps been in the NUM and were well known in the community to go through the area selling policies that should never have been sold. People were persuaded to opt out of the coal board pension. The management of those firms knew full well what was going on.

The industry must recognise that it is not in its long-term interests to sell inappropriate policies or policies that may be surrendered. My hon. Friend made a very good point about that, and the sooner some light is shone in some dark corners of the industry, the better for everyone.

I have never understood why, when something goes wrong in a mutual company, the regulators should impose a fine on the company and not on its directors and management. The fine imposed on a mutual company is paid by policyholders, who lose twice. They buy a policy, and then discover that the fund has been diminished by the extent of the fine. That is entirely inappropriate.

My hon. Friend drew attention to the role of commission and its influence on sales. I visited a prominent national life company—I shall not name it, as I do not think that it is unique in this respect—where I was shown its great training course. I was told that it had complied with every rule and regulation in the book. I had an opportunity to speak to some of the people on the course, and one of them told me that the salesmen had to make 10 contacts—a contact is reported back to management—and three sales every week, or they would lose their jobs. What happens on a Friday afternoon when the salesman has made only six contacts and one sale? I suspect that the conditions are then right for mis-selling to take place.

As my hon. Friend has said the problem that many sales people face is that they need to sell to make ends meet and to keep their jobs. In that climate, it is not surprising that mistakes are made. My hon. Friend and others have drawn attention to what has happened with pensions transfers and endowment mortgages. It cannot be right that people are put under pressure to buy something, simply because an individual needs that sale or commission to keep his job. If that is allowed to continue, it will be bad for industry and for society as a whole. That is why it must be stopped.

I do not believe that one can abolish rewards or incentives and I would not seek to do so, but the industry needs to look at how commission influences sales. Individuals can be rewarded for effort in other ways, and people should be rewarded for increased effort. The industry should remember that opposing disclosure, as it did for many years, does it no good whatever. It now opposes moves to do something about commission. It is high time that it grasped that difficult nettle and did something about it.

The Government's policy towards the pensions market is misplaced. We believe that state and private provision are complementary. It is appropriate for many people to have private pensions—I have had some in my time—but it is important for others to have occupational pensions. It is wrong to suggest that private personal pensions are always best, and it was wrong of the Government to act as a recruiting sergeant for the sale of personal private pensions, as they did as a matter of policy in the 1980s.

It was a triumph of Conservative party ideology over common sense and public interest. It is the Government's job to promote the idea of having pensions and savings and then set appropriate standards and an appropriate framework so that individuals can make a choice that suits their personal circumstances. It is not for the Government to tell people that they must do one thing or the other.

It is important for the long-term interests of the industry and the country as a whole that people make proper pensions provision for themselves. Many thousands of people do not have adequate cover and some have no cover at all. The regulatory system should therefore be geared towards promoting the holding of pensions and savings.

The situation with regard to pensions in this country is bleak. By 2015, there will be 15.5 million pensioners. Although the present pension is worth about 15 per cent. of average male earnings, by 2030, on present policy, it will be worth 7 or 8 per cent. People will therefore want to provide for themselves and increase what they can expect from the state, and should be encouraged to do so.

It is the Government's role to educate people in the broadest sense and to create a regulatory system that gives them the confidence to deal with the industry on a basis of trust and assurance, knowing that they will be sold policies that are appropriate for them.

The regulatory system should be used far more to promote competition. We hear much rhetoric about competition—I dare say that we shall hear some this morning—but that rhetoric differs from actual competition. It is perfectly true to say that there are hundreds of different providers, but there is less apparent difference among the products available.

We need more openness. Fees, commission and administrative costs must be exposed, as knowledge of those will make for a better and more informed choice. I am glad that the Government accepted last year the need for disclosure. It is too early to say how successful disclosure will be. Ultimately, the best compliance will come from the public if they are in a position to make an informed choice and judgment.

The regulatory system should be used far more, acting in the public interest to look at problems with a view to opening up the market so that people can make an informed choice. The regulator should be not a passive but an active organisation, looking into matters such as persistency rates and other problems that come to light, so that consumers can make an informed choice. The regulatory system cannot substitute its judgment for that of individuals but it can create the right environment, and we want to promote that fact.

I mentioned disclosure and the need for openness because, as my hon. Friend said, there is something wrong when people buy a product—he mentioned endowment mortgages—simply because it is better for the building society or whoever sells it. It is curious that building societies, which are mutual bodies that exist for the benefit of their members, should conspire to sell inappropriate products to their members. Building societies might wish to reflect on that. The sums that building societies receive by way of insurances generally need to be looked into more.

My hon. Friend the Member for Itchen mentioned comparisons and league tables, and he was right to say that those are not the complete answer.

My hon. Friend is right to say that the industry needs regulation to restore confidence in it. All the evidence that the Treasury and Civil Service Select Committee has taken from the industry and elsewhere suggests that confidence needs to be restored and that effective regulation can ensure that confidence exists. Whatever the costs, the cost of not having regulation will be far greater for the industry in the long term than the cost of ensuring that regulation is proper and effective.

I agree with my hon. Friend. First, we should all be alarmed at the compliance cost of regulation because, ultimately, money spent on compliance will not be available to pay out when policies mature. That is one reason why we should look at how the regulatory system works. All those rules and regulations cost a great deal of money and it is ironic that, because of the nature of self regulation, the Government, who say that they want to get rid of red tape, are conspiring to create more red tape. Self-regulators, more than regulators set up on a proper footing, tend to take the belt-and-braces approach to protect themselves against criticism, and that needs to end.

Secondly, I have said time and again that good regulation will pay for itself, which is why we want to put it on a proper footing. There should be unanimity for putting it on a proper footing, not just between the industry and the public but on both sides of the House, but that unanimity does not yet exist.

I wish to make an important point about comparisons. Put simply, the regulatory system should put individuals in exactly the same position as chief executives or chairmen of life assurance companies. A couple of years ago, I attended a seminar at which the chief executive of a respectable life assurance company showed the audience a graph of the performance of three different policies with a term of 30 years. The first steadily increased in value so that, if it were cashed in at any time, its value would have steadily increased. The second policy gained nothing for the first 10 years but, if it were cashed in thereafter, the gains would not have been too bad. The third policy would have yielded absolutely nothing unless it was kept for at least 29 years, after which its value rocketed and its performance was good.

The public would like to have such information. That chief executive had it because he worked inside the industry. At the end of the seminar, I was staggered to see all the other chief executives approach him and ask which companies he had quoted from, which makes me wonder whether we could do something better with the regulatory system. That example makes the case for publishing comparisons so that members of the public are in the same position as that chief executive. It is important that we ensure that people make the provision that best suits them and do not simply accept an option that is most profitable for the salesman.

We should all reflect on the fact that many people have inadequate pension provision. Many more people honestly believe that they have provided for themselves but are in for a rude shock when they reach 60 or 65 and discover that the pot contains not nearly as much as they had been led to believe. It is extremely important that this Government and future Governments educate the public so that people understand that, to maintain the standard of life that they have come to expect or would like to have, the decisions that they make, particularly on pensions, are absolutely crucial. It is the job of the regulatory system, acting in the public interest, to ensure that that happens. Our view that self-regulation does not work is finding growing support throughout the country and inside and outside the industry.

The Minister may pray in aid the familiar refrain for all those sensible reforms: a lack of parliamentary time. In the past few weeks, we have all been struck by the fact that the Government seem to be stuck for matters to put before Parliament. We have plenty of parliamentary time to deal with this problem. We shall deal with it, but it would be nice to think that, in the remaining time allotted to them, the Government might start to accept the problem.

The financial services industry is immensely important, not just to those who work in it or to the country for the wealth that it creates but because of its crucial role in enabling people to make provision for themselves. We need to support that, and it is important that people make the right choices.

Unfortunately, the present system is not working. Consequently, many people continue to receive inappropriate advice and make the wrong choices, with the result that, in 20 or 30 years, those who follow us will have to pick up the pieces. That thought, more than any other, should motivate the Government to act, and to act now.

12.39 pm

I hope that everything that I say today will reassure the House that the Government take investment matters very seriously, and that we have supported several measures to try to crack down on mis-selling.

I congratulate the hon. Member for Southampton, Itchen (Mr. Denham) on being chosen for the debate and on selecting a subject which is of great importance to millions of people outside the House and which, as he acknowledged, also has economic implications.

The Government have sought in several ways to improve investor protection, not only in the Financial Services Act 1986. Increasingly, in recent years, following some unhappy incidents of mis-selling and the collapse of certain firms, we have revisited the regulations under the legislation and also the personalities and the mechanisms for giving effect to the regulations.

We have increasingly created a system of law and a structure of regulation which can provide greater investor confidence. However, it is not a sector in which absolutes, certainties or guarantees can be provided. Self-regulation lies best with the investors themselves. There is a responsibility on individuals to seek good advice, to spread their investments, to ensure that they rely to some extent on their education and common sense, and not to confuse authorisation with a guarantee. Those are essential components in sharing the responsibility for safe and secure investment in the United Kingdom.

The hon. Member for Itchen was honest enough to admit that part of his interest in the subject was aroused by the fact that he had been mis-sold a personal pension. I think that anyone should be careful about approaching the hon. Gentleman in future in that regard as he has demonstrated a considerable grasp of the subject and it would now be difficult to mis-sell him anything. However, I welcome his honest admission that it is an extremely complicated subject even for intelligent people, let alone those who are more vulnerable to mis-selling. It therefore behoves all of us, in trying to build systems of investor protection, to remember the simplicity alongside the accustomed complexity that is sometimes necessary to deliver that protection.

It is not correct that I became interested in the subject because I was mis-sold a pension. It was only when I became interested in the subject that I realised that I had been mis-sold a pension. I should hate to think of all the consumers out there having to spend as long as I did trying to understand the industry before realising that they have been sold a pup.

A little knowledge has proved to be a valuable thing for the hon. Gentleman, and I am delighted about that.

The hon. Gentleman demanded many changes. I wish to reflect carefully on several of his arguments. I shall also make it my business to ensure that the positive suggestions that he made are considered carefully by the regulators outside the House—the Securities and Investments Board and the Personal Investment Authority. Indeed, I believe that they are already considering several of his suggestions.

If I may say so without causing embarrassment, the contents of the hon. Gentleman's speech were far more specific, relevant and constructive than those of the speech of the hon. Member for Dunfermline, East (Mr. Brown) who, when speaking to the Labour finance and industry group on 1 May 1995, heralded a great package of new Labour plans for investor protection. In fact, it was nothing of the kind, and the thin coverage subsequently given by the media to the paucity of his proposals shows what a vacuum it was. Today, however, we heard a speech of substance. I give credit where it is due, and it is due to the hon. Member for Itchen.

The hon. Gentleman suggested that there should be direct regulation of salesmen. I know that the PIA is considering that, but I would say to the hon. Gentleman and to the hon. Member for Edinburgh, Central (Mr. Darling), who came close to recognising it towards the end of his speech, that there must always be a balance between the imposition of regulation and the cost of compliance. The costs are already the source of great complaint from the industry and, as was recognised in the debate, they are passed on to the customer—no one else pays them—so there must be a limit to the extent to which we can bind the Leviathan of that industry with the tape of regulations and requirements which impose impossible costs on the viability of those who offer those services, as well as the people who invest through that medium.

Does the Minister not grasp my argument that many of the costs are being incurred in a futile manner because they achieve nothing? If we are to spend any money on regulation, we should try to do so effectively, so that it bears fruit. At present, we have plenty of regulation, but it is not clear that it achieves the ends that we want.

That is simply not true.

Let us consider the important issue of personal pension mis-selling, which was mentioned by the hon. Member for Itchen. That problem came to light initially partly because the Life Assurance and Unit Trust Regulatory Organisation identified certain problems. It was then the subject of scrutiny by the SIB, which in December 1993 identified the problem and said that it would undertake a survey to identify the extent of it.

In March 1994, the SIB introduced revised rules for selling to prevent such mis-selling occurring in future. In October 1994, the SIB made proposals for the reviewing of the cases of all those people who had been mis-sold personal pensions. I am amazed that the hon. Member for Edinburgh, Central has not got the message. That is not a deficiency but a success of the regulatory system. It may be uncomfortable. It may be costly for people to identify and seek redress—at the cost of the industry—for the cases in which mis-selling has occurred, but a responsible and effective regulatory system should aim to do exactly that.

Let us consider the report about endowment mortgages which was recently published by the Office of Fair Trading. It may be uncomfortable for the industry and for people who feel that they should perhaps have chosen a repayment rather than an endowment mortgage, but it would have been even more uncomfortable if that situation had persisted without being identified and some redress suggested. That is another success of the system.

Success is not always welcomed as a beneficial move from which everyone gains. We sometimes have to recognise that a part of success lies in identifying where problems have occurred, however difficult it may be to face up to those—and, my goodness, the costs and problems of facing up to personal pensions mis-selling are considerable; nevertheless, the Government and the regulatory system set up by the Government's legislation have identified those problems and made proposals to redress them.

It is not a perfect system. It is not a perfect world. We shall not always uncover every instance of mis-selling. However, considering the changes that have taken place—especially, with the establishment of the PIA, the re-vetting of more than 5,000 firms which are being admitted into the PIA—the hon. Member for Edinburgh, Central, should be more generous in recognising that the Government are, through our system, seeking seriously and substantially to identify the ways in which things have gone wrong and to make redress where appropriate.

Does the Minister accept that the pace of change is far too slow? It is nine years since the passage of the Financial Services Act 1986, and we still do not have a satisfactory regulatory system. Does the Minister accept that there is a complete lack of evidence that the regulatory system can respond quickly enough and develop quickly enough as new problems become apparent?

No, not really. It is true that I have my frustrations with the existing system, but such frustrations would be felt about any system. Putting a statutory label on either an existing or partially revised system is not a panacea. The answer does not always lie in structures or the people within them, but it certainly lies in the decisions made by people within whatever structure exists.

The Labour party is hung up, as it always has been, by legislation. A week ago, the first words of the hon. Member for Dunfermline, East were, "We will regulate. We will legislate." That was his clarion call and that is the starting point for the Labour party. I do not want to introduce a partisan note, because the hon. Member for Itchen did not make a partisan speech, but passing simple legislation designed just to shake up the system does not mean that people will not be mis-sold inappropriate products. The answer is much more complicated. We must consider some of the genuine suggestions made by the hon. Member for Itchen to see whether we can improve the system.

The hon. Gentleman referred to personal pensions and the state earnings-related pension scheme. It is right that the SIB should give priority to redressing the mis-selling of personal pensions because, although we shall not know the extent of that mis-selling until we have the results of the review that is being conducted at an individual level, the problem associated with SERPS appears to be a smaller one than that of personal pensions.

The hon. Gentleman suggested that the Government were responsible for all the problems of mis-selling because we promoted personal pensions. It is true that, when my right hon. Friend the Prime Minister was a junior Minister at the Department of Social Security, he was instrumental in bringing the programme forward. I say that with acclaim, not recrimination, because personal pensions were, have been and remain appropriate for many people. They are a flexible means of providing for retirement and many people should continue to hold one or to take one out in the future.

The Department of Social Security has, however, made it clear in the leaflets that it has published and in other publicity that people should think carefully before entering into personal pension arrangements. It is a fact, however, discovered and redressed within our existing system, that mis-selling has happened. That is being put right in order to re-create and redress the confidence that the industry should rightly deserve.

As I said when the Office of Fair Trading report on endowment mortgages was published, and which I have now read, I shall wish to consider its contents carefully. We hope and intend that the system of disclosure which came into effect at the beginning of this year will go a long way towards redressing some of the mis-selling problems and those caused by inappropriately taking out endowment mortgages. I place rather more reliance on that transparency than do the hon. Members for Itchen and for Edinburgh, Central, who seemed to suggest that disclosure would not do the trick and was not sufficient in itself. I agree that it is not sufficient in itself, but I place rather more reliance on it than I perceive that they do.

I welcome the fact that the Council of Mortgage Lenders is working on a code of practice for the selling of mortgages. The building societies ombudsman now has a pre-contractual remit—admittedly, not retrospectively dated—which essentially means that he will be able to investigate individual cases when people complain that they have been mis-sold a mortgage. He may be able to make recommendations in such cases. Endowment mortgages come, of course, under the Financial Services Act 1986 to the extent that the endowment or investment aspect is covered by it.

The hon. Member for Itchen made an important point about the relationship between the problem of mis-selling, changes in the industry and opportunities within the European Union. He rightly said that we are ahead of other countries, if that is the right description, in having funded pension schemes and long-term savings schemes. I agree with him that there is a tremendous opportunity for our investment services industry to be the haven and trustee for long-term savings within the European Union. I also agree that part of the prospect of obtaining that business will be delivered only if confidence in the industry and its reputation are recreated and adequate arrangements, both fiscal and regulatory, are introduced in the European Union to deliver that. Hon. Members will know that some of the changes that we have introduced in this year's Finance Bill are determined to exactly that end.

About a week ago, I announced proposals for open-ended investment companies. I predict that they will be one of the most exciting vehicles for long-term savings in this country. Over a number of years they will transform the landscape of savings in this country. As unit trusts convert into open-ended companies, we will also be on a par with many of the savings products and savings vehicles sold out of Luxembourg and Dublin docks. We should all have a party when some of the firms come home from those locations and attract the funds, employment, liquidity and benefits to the United Kingdom economy. That will happen as a result of some of the Government's proposals in conjunction with the industry. That is a positive development.

The hon. Member for Itchen referred to commission. He was concerned that the commission-led system, as he saw it, led to some bias in the selling of investment products. He would prefer a system that rewarded best advice. I share and understand those sentiments, but I have some difficulty in endorsing proposals either to put an end to commission, which he is not suggesting, or to introduce some rapid change to create alternative systems, as yet unspecified, which reward only best advice. As the hon. Gentleman said, sometimes the best advice may be to do nothing or not to buy any product.

People can pay an independent financial adviser to give them advice, which may be to do nothing. That is the benefit of such a person and that is what those advisers proclaim to be their unique role. Commission is an interesting but complex issue. In its absence, will people pay others to receive objective advice? I am afraid that all experience tells us that people simply will not do that. People are not prepared to go to another person and write out a cheque to him in order to get independent financial advice. They will get that advice if it appears to be free, and then subsequently a commission payment is involved.

My fear is that by arbitrarily getting rid of the commission system, if one were to be so radical, one would end up with much lower standards of investment advice and much more inappropriate selling of investment products. I do not think that the answer lies in such a radical move, but I understand the sentiment which led the hon. Gentleman to suggest that we should reward best advice rather than allow it to be market-driven by those who could offer and provide the greatest commission.

The hon. Gentleman made an important point about training and competence in the industry. I hope that he, like me, welcomes the fact that the PIA recently issued proposals and rules for training and competence, which will require all investment advisers to obtain a financial planning certificate. There will be no grandfathering into the scheme, because all those advisers will have to take the new exams to varying levels. Various organisations, such as the Securities Institute, have a keen desire to improve professional competence through more adequate training. I believe that in the future we shall see a sea change in the quality of people on the doorstep and on the telephone selling of investment products.

The hon. Gentleman expressed doubt that disclosure would do the trick and called instead for some product control. Some of his proposals would not so much control the product as attach a few bells and whistles to the proposed system. He called in particular for comparative company charges, persistency rates disclosure and current average industry consumption, but the PIA is already proposing to publish lapse rates. Proposals relating to key fact documents will also be implemented. The Securities and Investments Board will review the system of disclosure once it settles down.

In these and other ways the Government, the SIB and the PIA are taking the issue of investor protection very seriously. We hope that the future will be better than the past and that many of the problems that the hon. Member for Itchen and others have identified will be solved. I thank the hon. Gentleman for the positive suggestions that he has made, and I hope that my answer has reassured the House.

Prisoners Of War (Japan)

12.59 pm

There were obviously many emotions sweeping the country during the VE day celebrations. Many people were thinking about their family members and friends who died during the second world war, and many more were thinking about their fallen comrades and reflecting upon the fact that they themselves survived. Despite that sombre note, it seemed to me that the overwhelming feeling was of joy not simply that a great battle had been won, but that there had been a degree of reconciliation between those who had fought on opposing sides.

The press carried a number of moving stories of how those who had fought on opposing sides had come together for the celebrations. We also heard about the sons of former Army commanders who had met and found, perhaps not surprisingly, that they had at least as many things in common as they had differences. Whatever the complex mix of sentiments expressed during the VE day commemorations, overwhelmingly the mood was one of joy and celebration.

However, there is one group of survivors from the last war for whom I suspect that the celebratory aspect was very muted indeed. They had undergone suffering which defies imagination. Even those of us who are of a generation who do not remember the war, who have perhaps been hardened by an unremitting diet of man's continuing inhumanity to man, and who have been brought up in a society where we see death and mutilation in our own homes whenever we turn on the television news, are chilled when we remember what those people-went through. I speak of those people who survived the prisoner-of-war camps of the Japanese.

I do not intend to use the debate to castigate the nation of Japan or to suggest that the Japanese of my generation bear a responsibility for what happened during the second world war. I do not suggest that for one moment. However, I think that it is essential that I remind the House and the former prisoners-of-war that we have not forgotten their trauma and their nightmarish experiences.

Many years after the war, Field Marshal Lord Slim, who led the 14th Army, recorded how he and the liberating armies had uncovered prisoner-of-war camps that were

"little more than barbed wire enclosures in which wild beasts might have been herded together".

He went on to describe the Japanese gaolers

"almost without exception as being callously indifferent to suffering, or at the worst, bestially sadistic. The food was of a quality and a quantity barely enough to keep men alive, let alone fit them for the hard labour that most were driven to perform. It was horrifying to see them moving slowly about those sordid camps, all emaciated, many walking skeletons, numbers covered with suppurating sores and most naked apart from the ragged shorts that they had worn for years or loincloths of sacking. The most heart-moving of all were those who lay on wretched pallets, their strength ebbing faster than relief could be brought to them".

The testimony did not end there. In his book "The Night of the New Moon", Laurents van der Post described his experiences in a POW camp on Java. He described how POWs were forced to watch Japanese soldiers having bayonet practice on live prisoners tied between bamboo posts, and how POWs were made to witness different types of executions—I shall omit the details he gives. Ernest Hiller wrote of his experiences in a similar camp in his book "The Way of a Boy". He described how the military police—the Kempetai—tore out finger nails, burned the stomachs of pregnant women, locked POWs in bamboo cages for days without food or water, and much more besides.

Of the thousands of prisoners-of-war who were forced to build the Burma-Siam railway, it is estimated that one person died for every sleeper laid. Some 50,000 British troops were taken into captivity, of which a stunning 25 per cent. died. That is a truly remarkable figure, which says something about the unique nature of their experiences.

It is hardly surprising that the suffering of the people who survived those experiences continues to this day. It is even more heart-rending to learn that it not only continues but increases. I shall quote from "A Study of the Post-Captivity Health of ex-Prisoners of War of the Japanese" by J. Watson, which I believe is the leading work in this area. It was published in July 1986.

Mr. Watson details the conditions from which ex-POWs suffer. He concludes:

"It has for some time been recognised and accepted that ex-FEPOWs do suffer from a variety of psychiatric manifestations. These can include nightmares about their experiences, general irritability, anti-social behaviour, chronic anxiety and intermittent depression. It is also recognised and accepted that such features may not have manifested themselves until many years after the period of captivity had ceased and, indeed, the occurrence has sometimes been described as the late-onset ex-FEPOW syndrome'. It is therefore not surprising that 44.5 % of the sample had exhibited psychiatric manifestations at some time".

He goes on to describe psychiatric manifestations as covering anything from nervous symptoms to full-blown psychosis. It is clear that those who survived the prisoner-of-war camps continue to undergo suffering that is every bit as real today as it was during the war.

It must be said in passing that I do not decry in any way the experiences of those who suffered imprisonment at the hands of the Germans during the second world war. However, what was the exception under German captivity—to which the late Eric Williams drew attention—was the rule in the treatment of British and allied prisoners under the Japanese. It was an entirely different situation for prisoners of the Japanese. What was considered to be in breach of German military law was accepted as the norm and the appropriate way to treat Allied prisoners of war. That is what the POWs suffered in Japanese hands.

A treaty of peace with Japan was signed in 1951. Article 14(a) of the treaty provided:

"Japan should pay reparations to the Allied Powers for the damage and suffering caused by it during the war".

It went on to talk specifically about the "undue hardship"—an amazing euphemism—that prisoners had suffered at the hands of the Japanese. There has been much debate about the implications of the treaty.

Article 14(a) stated that the

"resources of Japan are not presently sufficient, if it is to maintain a viable economy, to make complete reparation for all such damage and suffering".

As a result, compensation of £76 10s per prisoner was decided upon. Those who had served on the Burma railway received an extra £3 each. Times change, but even at today's value that is only £1,000 per prisoner.

Many people would look at the terms of that treaty and assume that it was a payment on account. The treaty talked about the "present inability" of the Japanese nation to be able to make sufficient reparation. That explanation may appeal to those people whose views are driven by common-sense and humanity, but it has been accepted that, although it may have appeared to be a payment on account, the treaty represented the final legal obligation on the part of the state of Japan.

That point has been made on a number of occasions, and I do not question it now. It was made finally by my hon. Friend the Member for Morecambe and Lunesdale (Sir M. Lennox-Boyd), when he was a junior Foreign Office Minister, in reply to a debate in 1991. He responded to a speech by my right hon. and noble Friend Lord Braine of Wheatley, who has done so much to keep the matter in the public eye.

There is no doubt that the Japanese have met their legal obligations. However, there is a great deal more to life and death than legality; morality plays a part also. To his great credit, my right hon. Friend the Prime Minister raised the matter directly with the Japanese Prime Minister in September 1993. That represented a departure from the way in which previous Governments of both main political parties had dealt with the issue.

In the relatively short time remaining, I do not think that it will be particularly useful to rehearse what has occurred since then. Suffice it to say that it was hoped that Japanese business men might take part in an initiative to provide compensation to POWs. However, that has finally fallen through. A number of former prisoners-of-war have filed suit in Japan for the sum of £14,000 each.

Ironically, that sum is based on the compensation paid to Japanese American internees for having been interned after Pearl harbour. However, the sufferings of being interned in America are light years away from what allied prisoners underwent. I cannot say, any more than can my hon. Friend the Minister of State, whether those legal moves will be successful.

I believe that the matter goes much further. The crux of the issue is that nobody who has been brought up in a Christian tradition could say for one moment that the present-day inhabitants of Japan must bear the guilt for what was done by their forefathers. However, if they do not bear the guilt, they do, at the very least, have a responsibility to face up to the consequences of what was done by their forebears. The charge that must be laid before the Japanese Government, representing, as do any Government, the people of their nation, is that they have not yet faced up to that responsibility.

To even talk about sums of money, be it £1,000, £14,000 or £14 million, seems a ludicrously inappropriate response to what has gone before, because one can never reverse what has happened. In my conversations and meetings with the Far East Ex-Prisoners of War Association in Torbay I have been told that what matters to them—God knows, they are the only ones who could know—is that there should be some tangible recognition by those who bear the responsibility for facing up to the consequences. If there was some recognition by the Japanese nation of what they had gone through, it would make their continued suffering in their twilight years much more bearable.

As I said, we have just celebrated—that is the right word—VE day. There is another day approaching on which I believe that the celebrations will be of a much more sombre tone, and that is VJ day—victory in Japan. The first VJ day was on 15 August 1945. Given what we know about the psyche of the Japanese nation, I cannot imagine that in any shape or form the Japanese people will find the celebrations easy. After all, it represented Japan's destruction as a military power, its humiliation and loss of face, and the de-deification of their emperor. It was a shattering experience for them, and it cannot be a day to which they are looking forward.

There may be one way in which the Japanese nation could look forward to that anniversary. Japan has marvellous potential, and is a force for good in the world. It generates great wealth and contributes to culture, as well as having generated many jobs throughout the United Kingdom. All that means that, in a real sense, it has a right to say that it should belong to the community of nations in the fullest sense, subject to one caveat; it must finally atone in the way that I have described for what was done in the past.

Surely it could be a cause for celebration in Japan as well if, before or on that date, the Japanese Government admit, apologise and atone for what was done in their name. Atonement would then be complete.

The contribution of Her Majesty's Government is simple—it is not to argue the legal point before the Japanese courts, because that would be entirely inappropriate, and it is certainly not to question whether the treaty has been implemented legally because it clearly has. To his great credit, my right hon. Friend the Prime Minister has taken a moral stand, and made representations to the Japanese Government.

I hope that what my hon. Friend the Minister of State will say today in his winding-up speech is that the Government have not forgotten the suffering of those who survive, and that they will continue to make and reinforce those moral points and representations until justice is done.

1.13 pm

I congratulate my hon. Friend the Member for Teignbridge (Mr. Nicholls) on his choice of subject for debate, and on his speech. As he said, we have spent the weekend commemorating the tumultuous events of 50 years ago in Europe. It has been a time to give thanks for the peace that we have enjoyed, and to remember the sacrifices of so many brave men and women who made that possible.

This anniversary has reminded us all that the conditions of peace and democracy that we now tend to take for granted in Britain were won only after a mighty struggle against tyranny and injustice. It has been a profoundly moving occasion, with important lessons for post-war generations.

My hon. Friend has reminded us that the victory and peace in Europe which we have been commemorating is only part of the story. The second world war did not end on 8 May 1945. It is true that Nazism and fascism had been decisively defeated in Europe, but the war against Japanese militarism was to continue for over three more cruel and hard-fought months. On 8 May, the Fourteenth Army had just recaptured Rangoon, after one of the most desperate and heroic campaigns of the war. There could by then be little doubt that the tide of the war in Asia and the Pacific was running towards victory over Japan, but no one knew how much longer it would continue, or with what cost.

The end of the war in the far east was devoutly desired by many, but by none can it have been so deeply yearned for as by those allied prisoners who were enduring captivity at the hands of the Japanese, and by their loved ones at home, whose personal agonies had, if anything, been made even worse by the end of the war in Europe. For the prisoners, it would mean the end to years of misery and maltreatment. The extracts from the work of the late Lord Slim and Laurents van der Post which were quoted by my hon. Friend gave us a small reminder of that suffering.

For many, the final liberation and release came too late. About a quarter of the allied prisoners in the far east died during the war, compared with 5 per cent. of those captured by the Germans. My hon. Friend has reminded us eloquently of the acts of wanton cruelty which were perpetrated on allied prisoners in the far east, for which hundreds of their gaolers were tried and executed after the war. This was not "victors' justice" as is sometimes claimed, but a natural remedy for acts of gross inhumanity.

I join my hon. Friend—and, I believe, all hon. Members—in expressing the most profound respect and sympathy for the former prisoners and their families. We shall have occasion to do so again more formally when we commemorate the 50th anniversary of VJ day—the true end of the war—on 19 and 20 August. I am glad that there will be a special service of remembrance in St. Paul's Cathedral for all the veterans of the far east war. It is right to remember today that, for the prisoners, for the men fighting in Burma and for many others in Asia and the Pacific, the war continued beyond 8 May, and so did their sufferings and sacrifices.

Most of us can picture the terrible conditions of captivity endured by the prisoners of war—the young soldiers, sailors and airmen—captured during the fall of Singapore or at other moments during the war. We can picture the forced labour on projects such as the Burma railway, as well as the random brutality that they endured. We have read the many heartrending written accounts of their appalling treatment or heard of it from their own lips.

We should not forget that whole families of civilians, including women and children, were interned when the Japanese overran east Asia. They were also held prisoner for the rest of the war. They suffered grievously, and I pay tribute to their courage and endurance.

My hon. Friend set out the case for the survivors to receive compensation as the 50th anniversary of the end of the war draws near. As my hon. Friend said, that is a cause long championed by my noble Friend Lord Braine, who is now president of the Japanese Labour Camp Survivors Association—the JLCSA. That association, together with the Association of British Civilian Internees—Far Eastern Region, has commenced legal action in the Tokyo courts against the Japanese Government.

As my hon. Friend said, they are seeking $22,000 in compensation for each former prisoner. Their first delegation visited Tokyo at the end of January, and our embassy was able to arrange a meeting for them with a representative of the Japanese Foreign Ministry, as well as providing an opportunity for them to take part in an act of remembrance for their former comrades at the Commonwealth war graves cemetery near Yokohama.

Those legal proceedings are now under way, and I am not in a position to intervene in them. For the British Government, the legal position is clear, and has been reaffirmed by successive Governments of both political complexions. The issue of compensation was legally settled by the peace treaty of San Francisco in 1951, and it is not open to us to raise the matter formally with the Japanese Government.

My hon. Friend stated that, under those arrangements, the amounts paid to former prisoners were small. He has alluded to the reasons for that at the time. Japan had been devastated by the war and the allies were determined not to repeat the mistakes—as they were then perceived—of the treaty of Versailles. An agreement was reached, and a treaty signed with Japan—today that remains the formal legal position. In that respect, the United Kingdom's position is no different from those of the other allied Governments, including the United States, Australia, Canada and New Zealand, who also had prisoners in Japanese hands.

The legal position has not prevented British Governments from representing to the Japanese authorities the strong emotions that the issue has continued to arouse in this country. We have made representations at all levels, including the highest. My right hon. Friend the Prime Minister has raised the matters informally with successive Japanese Prime Ministers.

It is fair to claim that, under my right hon. Friend's leadership, we have had more intensive discussions of the situation of the former prisoners with the Japanese Government than have our counterparts in the Governments of the other western allies. Throughout those discussions, we have encouraged the Japanese Government to work with us to identify solutions in the spirit of the modern co-operative relationship between our two countries.

The visit of my right hon. Friend the Prime Minister to Japan in September 1993 marked an important stage in that process. When he arrived, he found a new Japanese Government, with a greater will to address the issues than some of their predecessors. He was able to discuss the matter fully and constructively with his counterpart, Mr. Hosokawa. During those discussions, as was reported to the media, Mr. Hosokawa expressed

"his deep remorse as well as apologies for the fact that Japanese past actions had inflicted deep wounds on many people including former prisoners of war".

Both Prime Ministers confirmed the legal position which I have outlined. My right hon. Friend told Mr. Hosokawa that if, in future, the Japanese Government contemplated taking steps to redress the matter, it would be necessary for the position of those involved in Britain to be fully taken into account. He informed Mr. Hosokawa that we were also examining whether non-governmental measures would assist in solving the problem. Mr. Hosokawa agreed that that approach was worth examining.

The two Prime Ministers recognised that immediate solutions were not possible, but agreed to keep closely in touch about the matter. Those discussions at prime ministerial level have provided the basis for the work on the issue that has been subsequently undertaken by the two Governments.

The British Government followed up the reference to "non-governmental measures" by bringing together a small group of people under the chairmanship of Sir Kit McMahon, a former deputy governor of the Bank of England, to explore the scope for a non-governmental charitable foundation. Our idea was that such a foundation might provide practical help to both former prisoners of war and civilian internees. We hoped that it might be possible to persuade Japanese companies and foundations to donate funds for that cause.

The basic medical and welfare needs of the former prisoners of war are already met by the national health service and the social security system, and, in particular, the war pensions scheme, but there is always room to do more. As my hon. Friend said, many of the survivors still suffer from medical problems deriving from the conditions of their captivity. It will surprise nobody when I say that the most prevalent are psychological problems relating to the horrors that they experienced.

I am aware that some former prisoners criticised the concept of a foundation, and said that they did not want what they called "Japanese charity". I believe that that was a misunderstanding. The Government were attempting to define an approach that might bring practical benefits to the former prisoners in a way that would recognise the special nature of their case.

Sir Kit McMahon, who undertook the work at the Government's request and received no personal benefit from it, handled the matter with great skill. In my judgment, nobody could have pursued it with a greater combination of determination and tact. I take this opportunity to thank him and the other members of his small committee for the time and effort they have devoted to the subject.

It was therefore a matter of regret that, when Sir Kit visited Japan last November, he found the reaction of the Japanese private sector uniformly negative. I should make it clear that the Japanese Government, while never formally committed to supporting our approach, were constructive and open throughout. But the message from Japanese companies and foundations could not have been clearer. Sir Kit concluded, and we accepted, that our approach was unlikely to succeed in those circumstances.

Meanwhile, with a new Prime Minister, Mr. Murayama, the Japanese Government had been giving more thought to the general issue of the nation's wartime responsibility. On 31 August last year, Mr. Murayama formally expressed remorse for Japan's wartime actions and announced a peace, friendship and exchange initiative. That will provide £650 million of Japanese Government money over 10 years. It will mainly be devoted to exchange visits and historical research.

The main focus of the programme will be on Japan's Asian neighbours, but the United Kingdom and other allied countries are specifically included, and we expect a substantial proportion of the funds to be spent in this country. The first year of the programme is to be the present financial year.

The programme does not meet the wishes of former British prisoners of war to receive compensation, but I do not believe that we should dismiss it out of hand. It provides evidence that the Japanese Government are sensitive to the need, as Mr. Murayama put it, to

"face up to the facts of history",

and to respond to the concerns felt in this country.

Similar evidence is provided by the recent improvements in the way in which the events of the second world war are described in the textbooks used in Japanese schools. Only if the facts of history are honestly taught to later generations can we hope that lessons will be learned.

I have been privileged to meet many of those who suffered as prisoners of the Japanese. Many of us count former prisoners among our constituents and, indeed, our friends. It is impossible to hear them recount their experiences without being deeply moved. Some, even now, prefer not to speak about what happened to them 50 years ago. Others have said to me that they cannot expect anyone who was not there to understand what it was like and what they feel about it now.

Even if we can never grasp the depth of emotion felt by those men and women, the simple recital of the facts of what they endured and witnessed cannot fail to make the most profound impression on us all. Instinctively, we feel humbled by it. Instinctively, we respect the feelings of those who have experienced such things. Instinctively, we are drawn to help. In that respect, the members of her Majesty's Government feel no differently from any other hon. Members or members of the British nation. That is why the Government have taken the steps I have described to try to find a solution. Those efforts continue.

My right hon. Friend the Prime Minister sent two messages to his Japanese counterpart, Mr. Murayama, last autumn. My right hon. Friend the Foreign Secretary has discussed the matter with the Japanese Foreign Minister, who is also the deputy Prime Minister, both when they met last September in Japan and on 19 April this year when they met in New York. In addition, there has been a series of discussions between senior officials about what might be done to help.

There is no doubt in the mind of the Japanese Government about the seriousness of the issue, or the widespread public sympathy in this country for the former prisoners. Today's debate will have underlined both those points. At the same time, the disappointing reaction to the proposal for a foundation shows the sensitivity and difficulty of trying to identify possible remedies in present circumstances. That is no excuse not to keep on trying. We are continuing our discussions of all those matters with the Japanese Government.

I cannot yet report to the House that we have arrived at an outcome that will satisfy all parties, but I can assure my hon. Friend and the House that we will continue those discussions and explore every possible avenue available to us for identifying further action in the non-governmental sector to enlarge upon the initiatives that have already been announced by the Japanese Government.

Hospitals (Grampian Region)

1.29 pm

I am glad to have the opportunity of raising this extremely important matter so soon after the Government announced—as far as I can gather, for the first time anywhere in the United Kingdom—that an entire hospital, including the provision of core clinical services, is to be put out to private bid to all corners. Before I deal with that point, I should like to address some of the background of how it came about.

In recent years, there has been a fundamental rationalisation of hospital services in Grampian. For those of us who represent rural constituencies, too often that has meant a closure of rural services and centralisation in Aberdeen. For example, the maternity unit in Inverurie in my constituency was closed and demolished. At that time there was a promise that a new GP or geriatric unit would be built on the site, but priorities changed and it has never materialised. In fact, the site is now a car park. Other maternity units were also closed at that time, although strenuous local campaigning ensured that we saved Keith, Huntly and Torphins.

Over the past year, hospitals for the mentally ill at House of Daviot and Kingseat in my constituency have closed. Most of the patients have been transferred to Aberdeen, some into the community, and 12 to a unit in the Jubilee hospital in Huntly. We are still awaiting a decision on the future of Woodlands hospital for the mentally ill, after a controversial and badly mishandled public consultation. In fact, along with the hon. Members for Aberdeen, North (Mr. Hughes) and for Aberdeen, South (Mr. Robertson), I met the Minister of State. We called on him to reconsider plans to close Woodlands and transfer to a new site to be built on the Cornhill site, and to come forward instead with plans to redevelop the site to meet the needs of the long-term mentally ill requiring permanent care or rehabilitation.

There is concern that we have heard nothing further about the proposal. If there is anything that the Minister can do to update us, or at least if he can say when an announcement will be made, I should be grateful.

More recently, there has been a welcome if limited recognition by health care providers in the north-east that there is strong demand for local community hospitals. Inverurie is lucky to have one. A review of the range of services that could be added to the hospital is still under consideration. Huntly has had a welcome investment in upgrading the Jubilee hospital. There is a growing campaign, backed by local doctors, for a community hospital to be provided in Ellon, where the former hospital was closed years ago and made into the golf clubhouse. Since that time, the community of Ellon has trebled if not quadrupled.

The health board has said that it recognises the demand. It has written to me, following consultations with GPs, stating the sort of provision that is being considered for Ellon. It suggests that it would include in-patient care, post-acute rehabilitation, respite care, rehabilitation, palliative and terminal care, day care, obstetric care limited to the post-natal phase, specialist out-patient clinics and home care support. The board went on to say that a Grampian-wide services review identified the potential for such a facility in Ellon.

However, it had other commitments first, including the replacing of the Woodlands hospital and potentially on a reprovision in Stonehaven. It is of concern to me that the announcement a couple of weeks ago about Stonehaven could further delay provision there and, consequently, have a knock-on effect on making progress towards commitment to a community hospital in Ellon. I am concerned about what was done, the way it was done and the knock-on effects elsewhere.

This time last year, Stonehaven saw the announcement by Grampian Healthcare trust in its business plan—that is no way to make announcements about the future of hospitals—that Arduthie and Woodcot in Stonehaven were to be closed. That announcement was sweetened with a pledge to build a new community hospital. I understand that, in accordance with that, towards the end of last year, Grampian Healthcare submitted plans—I have copies—for a new 47-bed hospital to be built on the site of Arduthie hospital at a cost of £2.4 million, which was based on the Scottish health executive's own standard costings.

That hospital would have replaced 77 beds that are currently provided by the two hospitals, which have a total full-time equivalent of 130 staff. The proposed new hospital is to include casualty services, 16 long-stay geriatric beds, 12 psycho-geriatric beds, 17 GP beds and two post-natal beds, and it would be similar to the community hospital in Peterhead, in the constituency of the hon. Member for Banff and Buchan (Mr. Salmond).

Grampian Healthcare must have been wondering at the delay in responding to its proposal, and indeed asking why it had not heard. It was as stunned as anyone when a press release was issued by the Scottish Office last month, stating that the new community hospital, including its core clinical services, was to be put out to tender to all corners. That is a first for anywhere in the United Kingdom. I am advised by Grampian Healthcare that to date it has received no direct formal notification of that, just a copy of the press release sent through the post.

That is in spite of the fact that, in a letter to me last year about Ellon hospital, the chief executive of Grampian health board said that it was already working with Grampian Healthcare on replacing Woodlands hospital and potentially on a reprovision in Stonehaven. Well, not any more; it is not. Not only has Grampian Healthcare had only a copy of the press release but, when it attempted to obtain more information from the health board, it was told that it was not entitled to it; it is no different from any other potential bidder for the hospital.

There will now be a further delay while the specification for the new hospital is drawn up. I understand that that will take four to five months. Presumably, that specification will then be made available to all potential bidders—private and public sector. That takes the private finance initiative way beyond anything that has been tried so far in the health service, and indeed beyond what the Government's own guidelines specifically suggested would happen. New guidelines published in March stated in a key paragraph:

"An option that many projects will need to explore is one in which the private sector would undertake the design, building, financing and operation of the non-clinical services."

That was a new departure in March, and in April we had the entire hospital clinical services—nursing services, doctors and all the paramedics—being put out to tender: design, build and operate.

As far as I can ascertain, the closest that anywhere has come to that situation is Morriston hospital in Swansea, where a cardiac centre attracted bids from three private health care companies, but the bid was finally awarded to the local trust. I am advised also that that was under active consideration in Portsmouth, until the chief executive of the trust committed suicide. In both cases—it is an important distinction—the initiative to involve the private sector came from the trust. All right, it was under encouragement from officials and Ministers, but it was not imposed, as is the case with the proposed community hospital for Stonehaven.

Most people who live and work in the north-east of Scotland and those who represent communities in the north-east of Scotland take pride in our communities as being forward looking, progressive and flexible, but we see no reason why we should be the guinea pigs for experiments that Ministers would not dare to try anywhere else, and certainly not south of the border.

Ministers and others contend that the hospital will still be in the NHS because the services will be provided free to patients. That is a spurious argument as ownership, control and operation will be in private hands. It is comparable to a local council putting homeless people into bed-and-breakfast hotels and saying that those hotels are in the public sector. It is absolute nonsense; they are privately owned businesses selling their services on commercial terms to the public sector. That is not just my opinion. I quote Mr. Jeremy Taylor, chief executive of Grampian Healthcare trust:

"If the services go to a private company it will not be NHS services, it will be a private service."

In those circumstances, it is difficult to see how quality can be assured, complaints effectively pursued or costs saved other than by cutting corners, staffing levels, pay or probably all three. Private sector finance may be appropriate for the property. That is a matter of debate and it has been recognised that it may be a practical compromise involving the private sector, but it is not appropriate for core clinical services. The Government deny that there was any intention to put core clinical services in private hands and their own guidelines specifically limited the private funding initiative to non-clinical services.

Not surprisingly, the announcement has outraged the local community. I am advised that last night Stonehaven community council passed the following resolution:

"The decision of the community council is that we strongly oppose the measure that the Government is to take over the NHS in Stonehaven and we shall do everything in our power to oppose it."

A number of relevant local interest groups were at that meeting. Local Liberal Democrats collected more than 2,000 signatures in the town on Saturday alone, to a petition calling for the retention of Stonehaven hospital services within the NHS.

If an entirely new hospital is to be owned and run by a private company, it will not be an NHS hospital in any terms that the public understand. Likely bidders could include construction companies, organisations such as BUPA, breweries, property companies and almost anybody from public companies to private individuals—possibly, last week's lottery winner.

It is preposterous for the Government to suggest that they are not transferring fundamental national health service assets to the private sector. That is borne out by the fact that potential bidders will have to get their own legal advice as to their likely liabilities under the transfer of undertakings directive. As the House knows, that has already caused the Government considerable embarrassment and it may deter some people from making a bid. If potential bidders depend on lower staffing levels, they may subsequently have to pay for all the contractual obligations for workers whose contracts they amend or terminate.

All that preparation spells nice work for lawyers. The more bidders there are, the more counsel's opinions will have to be sought and the more consultants will be involved in the preparation of bids. That is characteristic of the Government. Far from cutting down bureaucracy, they have increased it. They have also increased the complexity of supervising the service and securing public accountability. They have created an enormous expansion in publicly funded consultancies and they have expanded the bureaucracy necessary to supervise a much more complicated way of delivering services.

There is no difference of opinion about the practicalities of what we want. We want new and improved community hospitals in Grampian. I certainly want improvements in Inverurie and a new hospital in Ellon. The population is growing faster than anywhere else in the country. I can provide figures that show that the population of Grampian is estimated to grow from 506,100 in 1990 to 517,409 in 2001. The population over 75 is estimated to increase from 32,063 to 36,063. There are comparable figures for Kincardine and Deeside and for Gordon. It is a general characteristic. We need the services; our populations demand them and they are not being delivered fast enough.

The Government's change in ideology and their desire to drive an experiment through in north-east Scotland mean that a hospital that could have been started this year will be delayed for another year—just to test the Government's ideology.

The decision was announced without public consultation, without consulting Grampian health board or Grampian Healthcare and certainly without consulting local doctors, who would be the main users of the hospital. It is a matter of treating public opinion with total, absolute and utter contempt and showing no interest in getting an input from the people who will ultimately manage, deliver, control and secure the service for patients, and indeed, value for money for the taxpayer.

I know, having spoken to them recently, that local doctors in Ellon are anxious to know how long they will have to wait for outline plans to become a firm promise. They are not keen on Stonehaven becoming the next guinea pig.

As I have said, there is room for private finance in aspects of the health service if there are genuine benefits, but the proposals are a step too far. They take the NHS out of Government hands and further from effective public accountability. I assure the Minister that it will be a long, bitterly fought battle.

1.45 pm

First, I would like to answer the question that the hon. Member for Gordon (Mr. Bruce) asked about Woodlands. My noble and learned Friend the Minister of State recently met relatives of the people cared for at Woodlands and local Members of Parliament to hear their views at first hand. Before reaching a decision on the proposals, the Secretary of State will wish to be satisfied that the alternative model of care proposed is geared to meeting patients' individual needs, whether care is provided in the community or in a hospital setting. That matter remains under consideration.

We have heard a certain amount today about perceived threats to the NHS, about privatisation—by either the back door or the front door—and about the concept of free health care being undermined by the possible involvement of the independent sector in the provision of services.

The proposals for Stonehaven are certainly not about privatisation. They are about seeking to achieve a high-quality, responsive service, tailored to the needs of the local community. Let me be quite clear that the health board, as purchaser of health care services in Grampian, is leading the exercise and will continue to do so. The board will set and monitor standards and pay for the service, as it does at present.

Let me say what I believe the NHS is about. It is primarily about patient care and putting the interests of patients before all other considerations.

Will the Minister give way?

No. I must answer the points raised by the hon. Member for Gordon first.

The NHS is about providing that care free at the point of delivery to those who need it, and ensuring that the best possible quality of care and treatment is delivered in the best possible facilities in the most efficient and cost-effective way.

Despite the alarmist and somewhat misleading press reports about Grampian health board's announcement that it intends to put hospital services in Stonehaven out to open tender, nothing in the board's proposals is inconsistent with the principles that I mentioned.

It may be helpful if I put the record straight by outlining the background to what is now proposed in Stonehaven, which is in the constituency of my hon. Friend the Under-Secretary of State, the hon. Member for Kincardine and Deeside (Mr. Kynoch). He has taken an assiduous interest in the matter ever since he was elected. He has repeatedly been to see my noble and learned Friend the Minister of State and regularly written to him urging a resolution.

There are at present two hospitals in Stonehaven—Arduthie and Woodcot—providing GP-managed acute beds, long-stay services for the elderly, casualty and other therapeutic support services. Both hospitals are old and no longer provide an ideal base for modern hospital care. Neither is suitable for development to meet future service needs.

Grampian Healthcare NHS trust, which currently provides the services from those hospitals, recognised the need for change and highlighted its intention to modernise services in its business plan published early in 1994.

The trust also carried out an option appraisal in 1994 with the close co-operation of Grampian health board, which is responsible for assessing need, planning services and purchasing them on behalf of the board's resident population. Representatives of the local community were also involved in the process.

The appraisal examined a number of options, ranging from the status quo through modification of one or both the existing hospitals to provision of a new hospital. The conclusion was that a new hospital, to be built on the existing Arduthie site and designed to replace both existing hospitals, was the best way forward.

Having reached that conclusion, the trust submitted its appraisal and recommendations to the Scottish Office. There are two main reasons for the Scottish Office being involved. First, new hospitals have to be paid for and any proposals that might involve investment of NHS resources must be considered in the context of competing bids for capital development funded elsewhere in Scotland. Secondly, any proposals to close existing hospitals must be consulted on publicly by the health board and ultimately approved by the Secretary of State.

On the first point, my right hon. and learned Friend the Chancellor of the Exchequer made it clear in his November 1994 statement that no public sector capital projects would be approved unless the scope for involving the private sector had been fully explored. In discussing the recommendations made in the trust's option appraisal, the Scottish Office and Grampian health board agreed that that should be done in seeking to secure a new hospital for Stonehaven.

The object of the exercise would be, without being prescriptive in any way, to invite potential providers to say how they would provide the new hospital and to establish whether there were previously unconsidered and perhaps innovative ways of doing so. It would also help to establish clearly the solution that best met the health care needs of the people of Stonehaven, while offering the best value for money.

With the agreement of my noble and learned Friend the Minister of State, the health board has been asked to draw up a detailed specification of the services that it wants to purchase in Stonehaven, and thereafter to invite tenders from a range of organisations for providing the new hospital. It will be open to the Grampian Healthcare trust, other NHS trusts and the independent sector to bid for the contract separately, or in conjunction with each other or general practitioners. It will also be open to those organisations to bid for all or part of the service.

On 26 April, Grampian health board announced that it had been asked to proceed in that way, indicating that it would start work immediately on preparing the specifications—which, on its present timetable, it expects to complete by the autumn. Thereafter, the tendering process would begin. The board's aim is to be in a position to make a decision on the bids by the end of April 1996.

The board publicly stated that it would work closely with local GPs and with the local community and its representatives to establish the nature of services required at the new hospital before preparing the service specification. Mechanisms will be put in place to enable members of the public to comment individually if they wish. There can be no doubt that the views of health care professionals and of users of the service will be fully taken into account.

That is where things stand. No decisions on who will provide the new hospital in Stonehaven in the future have yet been taken, and it seems wrong to me to speculate on the likely implications for health care services in Stonehaven before that point has been reached.

It might be helpful if I outline what those proposals mean and do not mean. They mean that a new hospital will be provided in Stonehaven—my noble and learned Friend has already made that clear. They offer the opportunity of providing a new hospital earlier than might be possible under a conventional NHS solution, if the private sector shows interest in building it. They will ensure that all possible options for providing a modern service geared to the people of Stonehaven's needs are fully explored. They will provide the opportunity for the local community to be involved in determining their own needs, through the board's intention to consult on the preparation of its specification and the consultation that will be required before either of the existing hospitals can close.

The proposals do not mean that people will be asked to pay for services. We remain committed to providing health care free at the point of delivery. The proposals do not represent a fundamental change of policy compared with existing arrangements. General practitioners currently provide the services at the existing hospitals and will continue to do so at the new hospital. Private sector involvement in the provision of long-stay services for the elderly and other care groups is already well established.

The proposals do not mean a reduction in the quality of service. The objective is to identify the best way of providing those services. The health board will remain responsible for specifying the service requirements. We expect the board to be rigorous in monitoring quality and standards through its contract with whatever provider is successful in the tendering process.

The proposals do not mean a wholesale move away from provision of health care services by the NHS. We are committed to ensuring that people have access to high-quality, cost-effective services funded through the NHS wherever they happen to live. Each proposed new service development will continue to be considered in the context of best meeting the needs of the people to be served.

The proposals do not automatically mean that services in Stonehaven will be provided by the private sector. Once all the options have been appraised, a conventional NHS solution may yet turn out to be best. Grampian Healthcare has welcomed the proposed approach and is clearly in a strong position to submit a competitive bid. The proposals do not cast any doubts on the quality of the service currently provided by Grampian Healthcare staff. Their skills and dedication are not in question, and they will also be a powerful weapon in the trust's armoury in preparing any bid.

Inviting bids from a wide range of potential providers and minimising the restrictions on what they are asked to say they can provide, or the manner in which they can provide it, will ensure that providers have the scope to develop innovative solutions to delivering the best possible services in terms of quality and value for money.

We have heard a great deal of civil service speak. Will not the Minister acknowledge that the proposals for Stonehaven are a step further than anything proposed anywhere else in the United Kingdom?

Despite the Minister's remarks, it is not a question of inviting providers to ensure that they secure the maximum public participation. It is a question of putting the entire hospital out to bids from all corners. In those circumstances, when the hospital could be owned entirely by a brewery or anybody else, it is difficult to see how the palliatives that the Minister mentioned can be secured. If that is the way that the NHS is going, can he really believe and maintain that the service is safe in his hands?

Yes. What matters is that the best possible services are provided to consumers in the best possible manner. That will certainly happen. Of course the health board has the right to monitor closely and to enforce the terms of the specification. If they were broken by anybody, the board would be in a position to take the necessary remedial steps immediately. I would expect it to do so. It is the board's duty to make certain that the highest possible standards are maintained, which is in the best interests of consumers.

The hon. Gentleman called for this debate under the general heading of new hospital provision in Grampian. The city of Aberdeen already enjoys the benefits afforded by a hospital in a central location at Foresterhill, which provides for the majority of acute service needs.

Will the Minister give way?

No. I must explain the general position.

The existence of Foresterhill has not prevented our approving capital expenditure of £9 million in recent years further to service provision at Aberdeen royal infirmary and a further £21 million to facilitate rationalisation of acute and other services in the city and beyond. Only two weeks ago, my noble and learned Friend opened the new infection unit at the infirmary—the first of its kind in Scotland and the first to be incorporated within an acute teaching hospital. In the mental health sector, investment of £29 million has made the Royal Cornhill one of the most modern hospitals of its kind in the United Kingdom.

Outwith Aberdeen, a major redevelopment and expansion of Dr. Gray's hospital in Elgin, costing some £22 million, will ensure that the people of Moray have ready access to a wide range of hospital services, many of which they would previously have had to travel to Aberdeen or Inverness to obtain. Peterhead cottage hospital has also been completely rebuilt at a cost of £4.4 million and is now a fine example of a modern community hospital providing a range of services in a local setting.

Will the Minister give way now?

If the hon. Gentleman has a question about Peterhead, I shall answer.

I actually want to ask a question on the subject of the debate. The Minister mentioned the role of the Under-Secretary, the hon. Member for Kincardine and Deeside (Mr. Kynoch). Was that hon. Gentleman consulted in any way before the initiative was launched—or was he kept in the dark, like the rest of us? That is a simple question, so may we have a straight answer?

If the hon. Gentleman is seeking to get me to reveal private and confidential discussions between my hon. Friend and other members of the Government, the answer is that they remain confidential. My hon. Friend the Member for Kincardine and Deeside has been foremost in putting the interests of his constituents first on every conceivable occasion.

Capital expenditure of more than £100 million has been approved for hospital building or improvement in Grampian since 1979. I do not see that as an indictment of the Government's record. On the contrary, I see it as a clear indication of our commitment to ensuring that the people of Grampian enjoy modern, efficient hospital care.

I am confident that the NHS is alive and well in Grampian. We are committed to it remaining so. Our first priority, which the current proposals for Stonehaven are intended to support, is to ensure that NHS users in Grampian and elsewhere in Scotland enjoy the kind of responsive, high-quality services that they are entitled to expect.

Grampian has made rapid and effective progress in developing care in the community and in ensuring that people are only—

Order. Time is up.

Executive Power

2 pm

This week we have been celebrating the victory 50 years ago of democracy over fascism. Sadly, however, there has been little contemplation in the Chamber, no debate on the fundamentals of democracy, the clash of philosophies or even a step back to take stock and discuss the future of our political system. In a different context, the director general of the BBC recently called on the media to devote as much time to reflection as to antagonism—words which could equally apply to our own Parliament, the forum of the nation.

It is Parliament's failure to carry out a serious and regular MOT on our democracy which so vividly illustrates that our legislature, and even its agenda, is the creature of the Executive. In no other western nation is the Executive, the Government, so dominant. It is as if the democratic revolutions of the United States, France and elsewhere have passed us by, and the keystones of democracy, a separation of powers and checks and balances, are irrelevant to our own country. Hence, we have a unitary state rather than pluralist one, stagnant one-track politics instead of an active diversity which continually guarantees and renews our political evolution. The textbooks may say that Parliament is meant to be sovereign, but the reality is that Parliament is controlled by the Executive and, for our country, that spells Executive sovereignty.

In the United Kingdom, the leader of the Executive, in the shape of the Prime Minister, controls the appointment of the Cabinet, commands a majority of the legislature, appoints the members of the judiciary and the second Chamber and controls the spending and even the structure of local authorities, all uninhibited by a Bill of Rights or a written constitution. Those untrammelled powers would make a starling salivate and, in the wrong hands, have wrought massive, uncheckable destruction on our social fabric. The Thatcher years proved beyond doubt that our democratic culture, good as it is, must be bolstered by democratic institutions resilient to those who would seek to abuse our democracy.

The democratic socialist answer must be to replace one-track politics with pluralism and to hear all the voices, some of which may be our salvation. I am particularly pleased that the Labour party recently, for the first time in its history, decided to put such a commitment into its constitution—a commitment to

"an open democracy, in which Government is held to account by the people; decisions are taken as far as practicable by the communities they affect; and where fundamental human rights are guaranteed".

That is now the commitment of my party. I hope that the Conservative party, should it ever have a constitution, will adopt a similar view.

My party is now pledged, through successive leaders and successive decisions of our party conference, to create a new democratic settlement, including a Bill of Rights for British citizens, an elected second Chamber, free local authorities, assemblies for the regions and nations of our union, a diversity of electoral systems, an effective House of Commons, an accountable Europe and a revitalised judiciary. The next Labour Government will be remembered for nothing unless it is remembered for changing for good the way in which we govern ourselves. The whole of that agenda is, in essence, designed to tackle the problems of unrestrained Executive power in the United Kingdom. We can do that in two ways—first, by putting in place the checks and balances that are central to a separation of powers, and, secondly, by directly curbing the size and scope of the Executive itself.

I should make it clear that in referring to Executive power, I refer specifically to that authority nominally found in the Crown, but in reality exercised by the Government of the day. I do not refer here to the residual power of the Queen and the royal family, or to their status as royalty. Some of the most ardent centralisers and woolliest thinkers in that area would have us attack the soft target of the Queen rather than confront the key sources of political power. It is the inherited use by Government of that Crown or prerogative power which lies at the heart of the strength and overdominance of the Executive. As my hon. Friend the Member for Blackburn (Mr. Straw) recently said:

"The prerogative is all about the power of Government over the people and virtually nothing to do with the power of the people over Government."

The reality is that today a massive hinterland of power is exercised by Executive decree without accountability to Parliament, and sometimes without even the knowledge of Parliament. That is extra-parliamentary activity writ large indeed. In practice, after using Executive power in a high-profile policy area, Governments will often seek to come to the House to give some parliamentary window dressing to a decision already taken in the corridors of Whitehall and No. 10 Downing street. That window dressing, however, limited though it is, is entirely voluntary and at the whim of the Government rather than a right of Parliament—a right of the legislature.

A recent example was the renewal of the royal charter of the BBC. The Government will kindly allow the House some sort of debate. They will find a contrivance so that Members of this Chamber and the other place can discuss the issue. However, we shall not be allowed to amend or reject the charter because that comes under the royal prerogative.

In certain areas of foreign policy, such powers are absolute. For example, agreeing to treaties is currently a matter for prerogative power, not for Parliament. It can be argued that the Maastricht treaty need not even have come before the House until consequential legislation was due. Treaty after treaty is concluded without the formal consent of Parliament. Foreign policy as a whole is almost a democracy-free zone, free of democratic control and accountability.

Powers devolving from the Crown, free from parliamentary scrutiny, are vested in Ministers and go virtually unchallenged. The Scott inquiry has revealed that Ministers can even write their own sick notes to mask errors and omissions concerning matters such as by the use of public interest immunity certificates. It is here that parliamentarians need to refocus the debate.

The threat is not to a mythical parliamentary sovereignty from Europe or Maastricht. The focus must be on restoring the strength of Parliament in the face of its domination by Executive sovereignty. Again, as parliamentarians, our task is to expose what little power Parliament has in the face of Government by Executive decree.

The Executive is generally free to bind the country under international law regardless of the express wishes of Parliament. These powers have effectively privatised us out of our democracy and all of them need to be placed under the public ownership of our representative institutions. Such powers should no longer be the personal and private domain of Ministers; there should be accountability to us in the House.

Treaties can be negotiated only by the Executive—we all realise that—but the power to ratify them should lie with our democratically elected representatives, as it does in virtually all other democratic cultures in the western world. Going to war is another deeply significant issue, but that, too, is a matter for prerogative power—not for the House, but for Whitehall and No. 10—when it should be in the parliamentary domain. Although it is usually debated after the event, no Government of any political colour have a duty to obtain the consent of Parliament before going to war, as has been illustrated by the Gulf war, the Falklands war and the war in Bosnia.

I accept that, in a national emergency, the Government may be forced to act without the immediate consent of the House, but there should be safeguards to ensure that, if British service men and women are sent into battle, there will be adequate debate about the reasons for the decision. Formal ratification by Parliament of Executive action is the minimum that should be accepted in a modern democracy. The technical device of squaring one or two members of the Privy Councillors freemasonry is no longer an appropriate substitute for public scrutiny by democratically elected institutions.

The Privy Council is one of the many devices that have been used successfully over the years to assimilate politicians of all parties into the Executive culture. The seduction of "One day, all this will be yours" must be replaced with a clear moral and political stand for democracy; without that, the core of our democracy will remain on shaky ground.

The bible of our unwritten constitution, "Erskine May", says:

"The prerogatives of the crown, in connection with Parliament, are of paramount importance. The legal existence of Parliament results from the exercise of the Royal Prerogative. To a Queen's writ the House of Commons owe their election as representatives of the people."

Similarly, Parliament is dissolved by the Queen, acting on the advice of the Prime Minister but using prerogative powers that cannot even be questioned in the House.

Honours are doled out without a nod to our elected representatives. Institutions as important as the BBC—which I have already mentioned—and the civil service are the creation of Executive power, with no statutory basis agreed by Parliament. Given such a system, and the arrogance of Ministers grown fat on 16 years of unchecked authority, we are beginning to see developments such as that involving the current Home Secretary, who was caught red-handed trying to abolish the criminal injuries compensation scheme without parliamentary consent. But for the vigilance of the Fire Brigades Union and others—and the Law Lords—he would have got away with it.

The accountability of Ministers to Parliament, under statute, is already tenuous enough; accountability without statute is virtually impossible. In a modern democracy, it is no longer sufficient for matters of such potential importance to be dealt with on the basis of hearsay and secrecy. We need to define—openly, publicly and in writing—the institutions of the state, their role and their inter-relationships. That can best be done by means of a systematic definition and creation under statute of all the most important prerogative powers. We must bring the rule of law—statute law—to the conduct of Government.

That has occurred quite recently in the case of the security services, and civilisation as we know it has not collapsed because the security services now operate under statute law rather than prerogative power. If that example is extended to the other activities that I have mentioned—treaty making, war, the civil service and the dissolution of Parliament—it will necessarily end the vagueness surrounding such powers, and restrict their exercise by increasing their transparency and the accountability of those involved.

Although these immense extra democratic powers will fall to the Labour party after the next general election, the acid test of our commitment to a devolved and pluralist democracy will be whether we resist the temptation to abuse them as the current Government have and instead ensure that they are legitimised in statute law and irrevocably placed within the democratic arena. It is conceivable that the incoming Government could introduce all the other elements of our democratic agenda, but then fail to tackle Executive power. If we do not do that, we shall merely count the days before the centre of a unitary state—perhaps still under the control of a Labour Government—erodes the effects of a wider reform package, and regathers effective control.

The unitary state, controlled by an unchecked Executive, is a political system that has demonstrably failed in the 1980s and 1990s; it must be replaced by a pluralist, democratic system. That is the best way in which Parliament and parliamentarians could honour those who, 50 years ago, gave their lives for our democracy.

2.16 pm

The hon. Member for Nottingham, North (Mr. Allen) has done a service to the House, but he is not right in saying that the subject has never been debated. It was debated two years ago, in 1993, and some of his arguments—as well as some of those that I shall advance in rebuttal—were aired then. The matter has also been touched on in subsequent debates, so it is not an entirely debate-free area.

The hon. Gentleman deserves considerable credit for producing, in January, a pamphlet entitled "Reinventing Democracy". It is a major work, including everything about democracy except the kitchen sink. I was slightly disappointed to see that Madam Speaker was not in the Chair—I am making no personal reference to you, Mr. Deputy Speaker—as I intended to say, "We authors, Ma'am", since I have also produced a pamphlet, though on a different subject: it is called "The Competitiveness of Britain", and it was published about a year before the hon. Gentleman's.

I am aware of the hard work and lack of appreciation involved in the production of such pamphlets, and I congratulate the hon. Gentleman on his production of a volume which—having read it—I consider robust and coherent. I must add, however, that although I agreed with a great deal that the hon. Gentleman wrote about the procedures of the House in the section concerning parliamentary democracy, I had to dissent from many of his conclusions. That will not surprise him.

As the hon. Gentleman knows, having conducted research for his pamphlet and the debate, the powers of the royal prerogative—as he pointed out, we are talking of the prerogative as exercised by the Government, not any residual powers of the royal family—have a long history. They are, in effect, a residual item: as parliamentary power spread over almost the whole area of authority, that was left by custom and practice because it was not felt necessary to take it over. Some rather piquant phrases are used: "the undefined residue", for instance, and "the attenuated remnant". We are talking about a small element of our total power structure—in fact, all that is left following the gigantic spread of parliamentary power which has rightly taken place over the centuries.

Secondly, despite the hon. Gentleman's remarks, things have not changed a lot since 1979. One would think that, somehow or other, there had been a great diminution of parliamentary power over the Executive since 1979. In fact, the contrary is the case: things were much the same before 1979 as they are now. The hon. Gentleman mentioned that only last year the intelligence services were brought within statutory control. That example shows that the element of prerogative has been reduced in this Government's lifetime. Far from standing still and being no better than the last Labour Government, we are considerably better in some respects. We have recognised where in some degree it is necessary to take over the prerogative, and we have done so.

Thirdly, despite the existence of this small residual item of Executive power, Parliament is still sovereign. Parliament's power is unlimited. We can take whatever power we want. That is the prerogative of the House. It is what parliamentary sovereignty is all about. We can enforce such measures, as far as our writ runs. It is true that small items of the prerogative still exist, but they are subject to the overriding power of Parliament, which we can exercise at any time.

Fourthly, "If it ain't broke, don't fix it." That is part of the reason why many items still remain as part of the prerogative and are exercised by the Executive. It simply makes sense for them to remain so. The issuing of passports, for example, is done by prerogative, and not on a statutory basis. Whichever party is in power, the Government of the day sometimes need the discretion not to issue a passport for certain reasons. That is well understood. It is handled in a sensible and sensitive way. I—and, I am sure, the hon. Gentleman—have never had any particular problems as a result of the practical application of that prerogative.

It is not necessary to bung up the House of Commons with legislation designed simply to change the formality of such things when in practice they work well as they are. As the hon. Gentleman said in his pamphlet, quite enough legislation goes through the House already. We do not want even more going through, which would be designed nominally to change the status of something that in practice is working extremely well. The hon. Gentleman will face that problem if he tries to implement his pamphlet.

At the end of the pamphlet, the hon. Gentleman helpfully gives a programme for the first, second, third and fourth years of a potential Labour Government—an ambitious thing to do, as we may never get a Labour Government. The pamphlet has already got the first four years mapped out. He wants four items to be put through in the first year. Frankly, if he were able get all that through, it would produce parliamentary gridlock. Little else could be passed.

The hon. Gentleman was not a Member of the House when the Labour Government tried to put through Scottish devolution. If he consults his colleagues who were in the House at that time, he will find that an immense amount of effort goes into even one small constitutional change of that sort. He wants major constitutional change on many different fronts. He would find that that would have a time-consuming effect that is out of all proportion to what he may imagine.

The hon. Gentleman is perhaps over-egging the pudding rather a lot when he talks about the unaccountable nature of Executive power. In fact, it is accountable. Changing it would mean changing only some of the formal positions involved, not the reality of how power is exercised. The hon. Gentleman said that in some sense Ministers were not properly accountable for actions under the prerogative. He is clearly mistaken about that. I should like to make that point in case any misunderstanding exists.

Wade and Bradley, the Bible, if I may put it like that, of administrative law is unambiguous on that point. It states:

"Except in those special circumstances where prerogative powers involve the personal discretion of the sovereign"—

the hon. Gentleman will agree that we are not talking about that—

"prerogative powers are exercised by or on behalf of the Government of the day. For their exercise, just as for the use of statutory powers, Ministers are responsible to Parliament."

In practical terms, that means that, even where Ministers exercise prerogative powers or powers under the prerogative, they are still answerable to the Parliamentary Commissioner for Administration. One can make a complaint against a Minister for maladministration, whether he exercises powers under statutory obligations or under a prerogative. Similarly, the exercise of the royal prerogative is judicially reviewable—provided, of course, that the matter in question is justiciable. On those grounds, Ministers are accountable for the use of the prerogative, just as much as they are under statutory law.

The hon. Gentleman made a number of points about the use of the prerogative by the Government. One particular point involved the British Broadcasting Corporation and royal charters. The BBC would be reluctant to have the position changed, because one of the things that protect the independence of such institutions is the fact that they exist under royal charter. In many ways, that is a better protection than being brought under statute law and therefore being susceptible to changes following political decisions in the Houses of Commons or the House of Lords.

The hon. Gentleman made the point that, in emergencies in relation to war and making treaties, Governments must act, but more so in relation to war. He said that there should be a process of ratification subsequent to decisions being taken. That is a poor substitute for what, in practice, has happened.

The hon. Gentleman began by recalling that this weekend we celebrated the 50th anniversary of VE day. With great affection and gratitude, he remembered the events of 50 years ago, but he will also recall the events of 55 years ago, when the last war started. Matters were determined in the House. The Prime Minister was changed as a consequence of pressure from the House of Commons, and the whole conduct of the war possibly changed because of the debates that took place here.

Post hoc ratification is no substitute for the sort of debates that should and do take place in the House, as they did in the second world war and, subsequently, during the wars in the Falkland Islands, Bosnia and the Gulf. In practice, the hon. Gentleman's demands are met by the sort of procedures that we traditionally follow in the House.

None of my hon. Friends would seriously agree with the hon. Gentleman that somehow or other treaties are agreed to in the House without any particular remonstrance or debate. We spent a great deal of time in Parliament discussing the Maastricht treaty, which I believe is branded on the souls of some of my hon. Friends who had to speak in those debates. They went on so long and it was a close run thing, as the hon. Gentleman is aware. No doubt the Opposition can defend their actions in that debate, although at times it seemed as though they were voting against what they believed in.

The Minister is one to talk.

I can certainly defend my position on Maastricht. No one could seriously complain that there was a lack of debate on that. Similarly, other treaties that have come before the House have been thoroughly debated.

The current position is sensible. It has been improved, where possible, by the Government. The hon. Gentleman may be aware that even Al Gore's specialist advisers said the other day that this country is in the forefront of the world movement towards reinventing government. We can take credit for the fact that, with the possible exception of New Zealand, no other country and no other Government have done as much to reinvent government as our Government have done. We are well ahead of other countries in that regard.

I should be amazed if implementing some of proposals in the hon. Gentleman's pamphlet led to an improvement in democracy. At the heart of his proposals are no fewer than six different tiers of democracy—including not only parish, district and county councils, but regional assemblies and a European Parliament to which he would give additional initiative and powers. That would not be more democracy: it would be gridlock.

It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Oral Answers To Questions

Trade And Industry

Media Ownership

To ask the President of the Board of Trade what is his policy in respect of concentrations of ownership of the media. [21942]

The Government are currently reviewing their policy on media ownership and my right hon. Friend the Secretary of State for National Heritage will make the Government's views known once that process has been completed.

The Under-Secretary will be aware that, in a debate exactly a fortnight ago, hon. Members on both sides of the House expressed their concern about the serious implications of the Murdoch News Corporation's involvement in the proposed rugby super league. What steps have the Government taken to evaluate the implications of that development, especially for media coverage of British sport as a whole?

If a monopoly of televised rugby league emanates from any registrable agreement, that matter would be considered under the provisions of the Restrictive Trade Practices Act 1977, not under the monopolies legislation. In those circumstances, it would be for the Director General of Fair Trading to look into the new agreements. As I know that the lion. Gentleman has taken an exceptional interest in this matter, I am sure that he will draw his concerns to the attention of the director general.

Does my hon. Friend agree that there is a great deal of obsession in this place with News International, yet Longman Pearson, The Guardian group and Associated Newspapers all have a considerable degree of cross-media ownership covering newspapers, television and other media? Does he further agree that mechanisms exist—such as the Monopolies and Mergers Commission and the Office of Fair Trading—to ensure that there are no monopolies in the media?

I have already referred to the structure of our current competition law. However, within the context of the question asked by the hon. Member for Wakefield (Mr. Hinchliffe), the whole matter of cross-media ownership is complex. The issues outlined by my hon. Friend the Member for Mid-Staffordshire (Mr. Fabricant) make that clear. For that reason, the whole matter is currently the subject of a review and it would be wrong of me to pre-empt its outcome.

Does the Under-Secretary agree that my hon. Friend the Member for Wakefield has raised a subject of considerable importance relating to monopoly and, in particular, the coverage of British sport? I understand that, in the case of rugby league, there is a monopoly issue because the contracts will exclude non-Murdoch players from international competition. Does the hon. Gentleman accept that the implications of that go far beyond rugby league? Is it not time to send out a strong signal that the Government are not prepared to allow whole sports to be bought, with access to them then being conditioned by people whose interests are in the media rather than in the sport?

The question raises two distinct issues. The first relates to the review of cross-media ownership, and I have made it clear that my right hon. Friend the Secretary of State for National Heritage is deeply involved in that. The Government will announce their policy at the appropriate time.

Within the context of the issue raised by the hon. Member for Wakefield, I have outlined the current structure of competition law. If the hon. Gentleman feels that he has real concerns which he believes should be raised in relation to other sports, I have suggested to him that he draw those concerns to the attention of the Director General of Fair Trading.

May I return my hon. Friend to the question of predatory pricing? If News International has 37 per cent. of the daily national newspaper market, and if the Director General of Fair Trading satisfies himself that a sustained price cut will increase the losses of The Times, why is it fair and reasonable to allow that media concentration to continue and to hit the other newspaper groups that are trying to compete in the broadsheet market?

I am aware of the concerns which my hon. Friend has outlined on previous occasions in relation to this issue. He will be aware that the Director General of Fair Trading is the appropriate person for considering allegations of predatory pricing. The director general looked at the issue when the pricing war between major national newspapers began, and it is a matter that will continue to excite his interest.

British Gas

To ask the President of the Board of Trade what discussions he has held with British Gas about levels of consumer satisfaction. [21943]

Overall levels of consumer satisfaction are a matter for British Gas. Thirty-nine specific standards of service are regulated by the Office of Gas Supply.

Does the Under-Secretary think that British Gas's blind, elderly and disabled customers are happy with the service that they are getting, when the home advisory service which British Gas has provided up to now is being cut by 50 per cent.? Does he think that those customers will be satisfied with the fact that the British Gas chairman is giving himself a 75 per cent. pay rise?

British Gas is not going to cut its services to the elderly and the blind, and it is in fact spending £170 million a year on those services. It also provides a gas care register. Ofgas has agreed some standards of service with British Gas, and British Gas has failed in three areas of service. For example, Ofgas wanted a level of 100 per cent. for the reading of meters for customers moving home, but British Gas has reached only 98.9 per cent. A level of 100 per cent. was demanded for energy efficiency, but British Gas is getting only 99.8 per cent. British Gas is addressing those shortcomings.

In view of the soaring number of complaints, will the Under-Secretary join the Pensions Investments Research Consultants—an organisation that advises pension funds that hold £70,000 million in their funds—in condemning the soaring boardroom pay-outs at British Gas, which are in breach of the Institute of Directors' guidelines on best practice? Will the hon. Gentleman advise shareholders at the British Gas annual general meeting on 31 May to support resolution 13 on controlling the pay-outs and perks in the boardroom, as I shall be doing at that meeting? If not, why not?

The Government have made our position clear on the pay of the directors of British Gas. We will await the report of the Greenbury committee. I hope that the pensioners connected with the PIRC are happy with the 21 per cent. reduction in gas prices since privatisation.

Does my hon. Friend agree that gas consumers have every right to be pleased not only with the reduction in gas prices since privatisation but with the healthy profits being made by British Gas, taxation on which goes to help finance the improvements in public services to which the Government are committed?

My hon. Friend makes a powerful point. Last year, British Gas contributed £504 million to the Treasury. That was a valuable contribution, and British Gas should be congratulated on that.

Volvo Site, Workington

To ask the President of the Board of Trade what efforts are being undertaken by his Department with a view to help find an occupant for the Volvo site in Workington. [21944]

Primary responsibility for finding a new occupant for the factory falls to the company and its agents. However, the local development organisations, together with Inward, the regional development organisation, and the Government office for the north-west are fully aware of the opportunities that the site has to offer. They continue to promote the site at every suitable opportunity.

Will the Minister refer my comments to his departmental officials with gratitude for the work that they are doing in trying to market that very important site? Will he join me in reiterating that we have in Workington a 500,000 sq ft modern factory in an assisted area where European moneys are available? Anyone watching Parliament today who knows of a potential client should come forward as soon as possible.

I thank the hon. Gentleman for the generosity of his remarks about the work undertaken by Government officials. It may reassure him to know that I had a meeting with Inward last week at which that subject was at the top of the agenda. Inward is very much aware of the statements which have been made not just in this House but throughout the north-west by the hon. Gentleman, who has taken a leading role in seeking to promote the occupation of the site.

Gas Supply

To ask the President of the Board of Trade if he will arrange to meet the chairman of British Gas to discuss gas supply. [21945]

My right hon. Friend and I meet the chairman regularly to discuss a range of issues.

Will the Minister demand an explanation from the chairman on why more than 16,000 disconnections were made last year because of fuel poverty and why the number of consumer complaints increased by 150 per cent. during the first quarter of this year compared with the first quarter of last year? Will the Minister instruct the chairman, the chief executive and all the other fat cats on the board of British Gas that it is high time that they put their house in order and started providing a better standard of service instead of lining their pockets with exorbitant salary increases and share options?

The hon. Gentleman mentioned the current figure for disconnections but failed to mention that, some six years ago, just after privatisation, there were 61,000 disconnections a year, which shows that British Gas has improved its standard of service to those clients by a very high degree. Moreover, the standards with regard to the introduction of pre-payment meters have improved sharply. The 39 standards of service set out by the Office of Gas Supply have been met in full, with the exception of three specific services, two of which my hon. Friend the Under-Secretary of State referred to. British Gas has said publicly that it is committed to improving its standards further. If that is not enough for the hon. Gentleman, he should know that we shall introduce competition into the domestic gas market, which will almost inevitably lead to a reduction in prices for domestic consumers and an improvement in standards of service.

When my right hon. Friend meets the chairman of British Gas, will he congratulate him on the massive increase in investment since the industry was privatised, the massive increase in productivity and the substantial real terms reduction in prices? Does he agree that the snivelling comments of the hon. Member for Falkirk, West (Mr. Canavan) show that the new Labour party is just the old Labour party writ large, with the same prejudices it has always had?

I absolutely agree with my hon. Friend.

Is it possible that the Minister is unaware that British Gas is now held in public odium and that, at the annual general meeting later this month, the British Gas board faces a revolt by small shareholders, not just on salaries but on a range of other issues? When will the Department of Trade and Industry stop waffling on about British Gas being a world-class company and recognise that it has created a privatised Frankenstein's monster that is now totally out of touch with its customers, shareholders and staff?

British Gas is a world-class company and is winning business for Britain throughout the world. The hon. Gentleman should welcome that.

Instead of making down-market and emotive allegations about Frankenstein's monsters, privatisation and the rest of it, will my right hon. Friend tell my constituents, who have a real interest in this subject, what has happened to gas prices in real terms since privatisation and how those compare with prices before privatisation? Behind everything else, that is the issue that really matters to them.

My hon. Friend is absolutely right. Gas prices have fallen by more than 20 per cent. in real terms since privatisation and by 15 per cent. when account is taken of the imposition of value added tax. Furthermore, standards of service have improved and the number of disconnections has fallen, which is concrete evidence of the success of our privatisation policy.

When the Minister sees the chairman, will he take account of the fact that the assurances which he gave in Committee on schedule 5 to the Gas Bill, that the changes were no different from those that would take place in any other privatisation legislation, will result in the prospect of a world-class company like British Gas abrogating its contracts on gas supply with a number of companies, both British and international? Does he realise that he is putting Government support behind the possibility of a major British company betraying undertakings that it has entered into faithfully with other companies, both British and worldwide, to take their supplies of gas at prices that were agreed some time ago?

The point that was made in Committee with regard to schedule 5 was that there was a clear precedent for the allocation of existing contracts in such a position. The most recent precedent was the Gas Act 1986 and the previous one was in 1981, in the sale to Enterprise Oil.

As the hon. Gentleman said in Committee, and as I reiterated in that debate, it is appropriate that there should be commercial discussions between the producers and consumers of gas—in that case, between British Gas and several suppliers. That is what I believe that the hon. Gentleman said in Committee he wanted, and that is what I continue to want. I hope that there will be successful commercial discussions in the coming weeks.

Rural White Paper

To ask, the President of the Board of Trade what submissions his Department has made for inclusion in the proposed White Paper on the rural economy. [21946]

The President of the Board of Trade and Secretary of State for Trade and Industry

(Mr. Michael Heseltine)

Officials in my Department are in close contact with the White Paper team and have been working with them to ensure that the interests of businesses in rural areas are fully represented.

Does my right hon. Friend acknowledge that, although 23 per cent. of our population live in the countryside, only a small proportion work there, and that the more that can be done to encourage jobs alternative to agriculture, the better that is for our transport system and our rural economy as a whole? Will he support the proposal for the rural business unit, which would enable farmers and landowners to lump together for tax purposes not only their farming enterprises but alternative enterprises, which would do a great deal to encourage the alternative industrial use of redundant farm buildings?

My hon. Friend raises a very important point. I am aware of the proposal that has been made by the Country Landowners Association. I can assure him that, in the context of that proposal and of a wide range of other representations to enhance the wealth-creating potential of the countryside, my right hon. Friends the Secretary of State for the Environment and the Minister of Agriculture, Fisheries and Food are giving the most urgent consideration to those matters.

Will the President of the Board of Trade ensure that the White Paper demonstrates support for tele-cottages in rural areas, especially ones like that recently set up by the Lambourn Valley trade and tourism association in my constituency, with support from the Liberal Democrat-run county and district councils, and will he tell us how many other authorities are supporting tele-cottages at present?

I think the hon. Gentleman will recognise that the changing technological capabilities of people to work in outlying areas or at home are well understood by the Government and will play a significant part in the findings of the White Paper.

The President may not be aware that in Rotherham 65 per cent. of the land area is rural and there is a very important small rural economy there, but how can any rural economy function without an efficient network of public transport? Bus deregulation and privatisation have ripped out the heart of bus transport and, if we continue with rail privatisation, there will be no rail transport to keep the rural economies alive.

The hon. Gentleman will know that there has been an improved arrangement and facility for rural buses, and that has been one of the advantages of changes that we have introduced.

Does my right hon. Friend agree that the Rural Development Commission and the Department of Trade and Industry are doing extremely good work in developing new businesses in the countryside? However, I wonder whether he could do more to ensure that other colleagues in other Departments make sure that we obtain the right planning permission and that we restore the right enterprise culture to the countryside, because that will ensure that we have a growing rural economy rather than a dying one.

My hon. Friend is right to press those arguments. As I said, the two colleagues in the Government who are responsible for that matter are taking the White Paper very seriously.

Coal Industry

To ask the President of the Board of Trade what recent meeting he has had with owners of the newly privatised coal industry with regard to overall production and costs. [21947]

DTI Ministers have met representatives of successor coal companies on a number of occasions and a range of issues have been discussed. I invite the hon. Gentleman to agree with me that there was nothing crooked in the arrangements that brought those companies into existence.

There is one easy way to find out, is there not? The President of the Board of Trade has one story. "Panorama" and some other people, including myself and other Opposition Members, believe another story. He must do the decent thing and clean the matter up. Why does he not set up a fully independent public inquiry to find out the truth about the sequence of events that led to one of his friends, Richard Budge, getting the coal pits and then having £100 million knocked off the bid? Only an independent inquiry will be able to find out the truth.

I am glad that the hon. Member has not repeated the disgraceful allegations he made yesterday. What he does not understand is that all the papers relevant to this matter will be at the disposal of the National Audit Office and that it will be for it to determine whether any matters should he drawn to the attention of the Public Accounts Committee.

What I find utterly intolerable in the hon. Member's allegations is that he thinks that a Minister in my position has the power so to order civil servants in my Department that they would carry out the sort of activities of which he is accusing them and the Government. To suggest that the permanent secretary in my Department and all the civil servants involved would behave in the way suggested by the hon. Member is an intolerable abuse of the privileges of the House.

Does my right hon. Friend agree that, since privatisation, jobs have been created in the mining industry every single day and coal is being produced more competitively? Does he not think it a bit rich that, when the lot opposite were in power from 1964 to 1970 and from 1974 to 1979, 313 pits were closed, with the loss of 230,000 miners' jobs? Is that what is meant by the new, caring, sharing Labour party of the lot opposite?

My hon. Friend, as so often, has hit the nail firmly on the head. The real determination of the Labour party is to try to obscure by smear the remarkable success of the privatised coal industry. That coal industry is seeing increases in productivity; sales of British coal overseas and increased profitability. It has kept open far more pits in the private sector than the nationalised industry considered possible in the public sector. Once again, privatisation has proved immensely successful, despite everything that the Labour party has said.

Anti-Competitive Practices

To ask the President of the Board of Trade what action he intends to take tackling anti-competitive practices. [21948]

The Government are committed to pursuing a vigorous competition policy under existing competition law, and to introducing legislation to reform the law on restrictive trade practices and abuse of market as soon as parliamentary time permits.

Is not the Government's competition policy in as much of a shambles as their party, so much so that the Director General of Fair Trading, Sir Bryan Carsberg, who is widely respected, is stepping down after only two years in office? The Government have not even been able to find a successor. Why does the Minister not adopt the Labour party's policy of merging the Office of Fair Trading and the Monopolies and Mergers Commission to create a dynamic new regulatory body that could stamp out anti-competitive practice?

One of the sights of new Labour with which it is somewhat difficult to come to terms is the image of the hon. Gentleman as a spokesman for competition in the marketplace. That unreconstructed Tribunite socialist is now portraying himself as a friend of competition.

I think that the hon. Gentleman referred to the speech made by the hon. Member for Dunfermline, East (Mr. Brown), who suggested that he supported the remarks of the Director General of Fair Trading when he recently gave evidence to the Select Committee on Trade and Industry on the issue of a unitary competition policy. It is clear that the hon. Gentleman did not understand that evidence, because Sir Bryan Carsberg actually suggested that there should be a lesser role for Ministers and for the House. The hon. Member for Dunfermline, East, however, made it clear in his speech that he wants to substitute his personal judgment for the independent analysis of the MMC.

Last year, industrial output in this country was at its best ever level and manufacturing exports rose by 14 per cent., also to their best ever level. Does my hon. Friend not think that it is a bit rich that the hon. Member for Neath (Mr. Hain) should talk about anti-competitive measures when the measures that the business men of this country fear most are the imposition of a social chapter and the minimum wage—precisely the policies adumbrated by the Labour party?

My hon. Friend is absolutely right. He will have noticed also that the hon. Member for Neath had difficulty understanding what he was talking about.

It is Government policy to keep the competition policy mechanism under review. For that reason, changes were introduced last year in the Deregulation and Contracting Out Act 1994 in order to refine the system. The Government have also announced that they will legislate further when parliamentary time permits. As my hon. Friend made clear, the greatest threat to competition within our economy comes from the policies advocated by the Labour party.

Does the Under-Secretary of State agree that the Government's commitment to effective reform of competition policy can be gauged by the fact that the proposals to which he referred—which apparently have not been acted upon because of lack of parliamentary time—were first announced in 1988, seven years ago? Is it not clear that the Government's commitment is not to the competitive markets but to the privatisation of as many large-scale monopolies as possible in order to raise revenue to bail out their mismanagement of the economy? Is that not obvious from the Government's ill-considered, hastily arranged statement yesterday about the privatisation of the nuclear industry? That is another cynical measure—a pre-election tax bribe—which will end up costing the taxpayers much more in the long term.

That effort was no better than that of the hon. Member for Neath. The right hon. Member for Copeland (Dr. Cunningham) is correct in that we wished to legislate earlier in relation to the restrictive trade practices matter. However, I should correct his assertion that the announcement was made in 1988; it was 1989. It is only one part of a range of measures that the Government have announced. The abuse of market power consultation was undertaken in 1993 and a large number of the responses that we received supported the eventual outcome as proposed by the Government. The right hon. Gentleman has not referred to the fact that the Deregulation and Contracting Out Act 1994 confers new powers on the Director General of Fair Trading to accept undertakings. I know that the right hon. Gentleman welcomed those provisions previously.

Machine Tools

To ask the President of the Board of Trade if he will list the top six countries exporting machine tools by value to the United Kingdom in the most recent complete year and in 1979. [21949]

The top six countries exporting machine tools by value to the United Kingdom in 1997 were, in descending order, the Federal Republic of Germany, the United States of America, Switzerland, Italy, Japan and France. In 1994, the top six on the same basis were the USA, Japan, Germany, Switzerland, Italy and Belgium/Luxembourg.

I realise that the Minister is known for his foresight, but surely he does not know what the figures for 1997 will be. Nonetheless, it is a very interesting answer.

Is it not a fact that for many years we had a machine tools and transport machinery trade surplus, yet from 1983 we have had a deficit in all years except 1991? In 1994 there was a trade deficit of about £5 billion on machinery and transport. We do not export to many of the countries from which we import. Why do we have a balance of trade deficit with Japan? Why can we not export machine tools to Japan, which is our largest source of imports?

I thank the hon. Gentleman for correcting my transposition of 1997 for 1979. I also congratulate him on giving me the opportunity to set the record straight. In 1979 there was a machine tools trade deficit of £50 million and, by contrast, in 1994 the industry ran a balance of trade surplus of £28 million. In 1993 and 1994 we saw the first balance of trade surpluses for two years. I thank the hon. Gentleman for giving me the opportunity to draw that success to the attention of the House.

Is my hon. Friend aware that, in the real world of the west riding of Yorkshire, the machine tool industry is doing even better than it did last year, and will he join me in congratulating Denford Machine Tools in my constituency, which this very day is celebrating publicly the expansion of its business?

My hon. Friend is absolutely right. The machine tool industry is showing significant improvement. In fact, on Sunday, subject to the business of the House, I hope to be allowed to fly to Milan to attend the EMO machine tool exhibition, which is one of the largest in the world and at which some 33 United Kingdom-based machine tool companies are exhibiting. I hope to do my bit to secure them some orders and bring more work and jobs to the United Kingdom.

Would not that industry do even better if Britain had the same opportunity to export machine and hand tools to some of the countries on that list, and to two or three other significant exporters to Britain, that they have to export to us?

The hon. Gentleman makes a valid point, but our machine tool industry has undergone a considerable revolution. We are starting to make computer-controlled machine tools that are suitable for export. Back in 1979, machine tools were manually operated and few were run by computer. That is the world in which we are operating.

Mk Electric And Pms

To ask the President of the Board of Trade what plans he has to visit MK Electric and PMS to discuss the provision of new jobs. [21950]

Neither my right hon. Friend nor I have any immediate plans to visit MK Electric or PMS, even though they are in Basildon.

Would my right hon. Friend join me—[HON. MEMBERS: "Labour gain."] Is that old Labour or new Labour? Would my right hon. Friend join me in welcoming the news that the Princess Royal will visit Basildon on Tuesday to open the new headquarters of MK Electric, the company that produces the finest plugs in Europe, and PMS, the company that produces the finest gifts and novelties in the world? Does he agree that such expansion and investment are further evidence of this country's economic recovery?

I am disturbed to note that my hon. Friend did not mention Basildon in his question. [HON. MEMBERS: "He did."] I correct myself: he mentioned it only once.

I am delighted that Her Royal Highness will visit Basildon on Tuesday, not least because MK Electric, as my hon. Friend knows, has recently received an "Investors in People" award as well as transferring its headquarters to Basildon, and PMS is creating 170 new jobs. As my hon. Friend is aware, the number of people unemployed in Basildon has fallen by no fewer than 700 over the past 12 months, and that is recognition of the economic success in Basildon.

Micro-Businesses

10.

To ask the President of the Board of Trade what assessment he has made of the survival rate of micro-businesses in their first year of operation. [21951]

To avoid placing undue burdens on small firms we use administrative sources to monitor survival rates of new businesses.

Recent estimates of the survival rates of new, mostly micro, businesses have been produced by Barclays bank. For the period 1989–1993, it estimates that on average 77 per cent. of start-ups were still trading after their first year of operation.

As the Minister is aware, the enterprise allowance scheme, which last year in Stockport enabled 350 people to set up their own businesses, has disappeared in a cloud of smoke into the single regeneration budget. There is no DTI funding for business links to give help and financial support to start up businesses. What advice, apart from do-it-yourself, can he give my constituents who will lose the benefit of the enterprise allowance scheme, and what proposals has he to help small businesses and people who prefer self-employment to benefit?

As the hon. Lady said, the single regeneration budget provides some start-up support to help unemployed people into self-employment. She made the valid point that the first moments after any birth are the most fragile. There is a fond belief that running a small business is easier than running a large business, but that is not so. The important point is that survival rates for smaller businesses would be much better if those wishing to start them went along to business links and took strong advice on the viability of their financial package before going ahead. What is even more important for small businesses is a stable economic environment in which they can plan with certainty.

One of the greatest challenges facing small businesses in 1995 is the over-burdensome and over-zealous enforcement of regulations by petty bureaucrats across the country. A year ago the House passed the Deregulation and Contracting Out Act 1994, at which time the Government promised to introduce a system of appeals to help small business people. What has happened to that procedure?

My hon. Friend is absolutely right to refer to the fact that we introduced that Act. We shall consult on how better to advance that to help small businesses.

Manufactured Goods

11.

To ask the President of the Board of Trade what estimate he has made of when the United Kingdom will achieve a surplus in the balance of trade for manufactured goods. [21952]

My right hon. and learned Friend the Chancellor of the Exchequer will publish new forecasts for the balance of payments in June. Manufacturing exports were at record levels in 1994 and the prospects for this year are excellent.

I do not blame the Minister for not answering the question, but will he confirm what the Under-Secretary failed to in his answer to my hon. Friend the Member for Newham, North-West (Mr. Banks)—that Central Statistical Office figures show that in 1979 in the key manufacturing sector of transport, equipment and machinery there was a surplus of £2 billion and that in 1984 there was a deficit of £5 billion? In the face of those incontrovertible facts, I suggest to him in a friendly and helpful way that the Government should abandon their policy of getting the message across, because in that key area their message has been one of 16 years of failure.

Every month the hon. Gentleman comes back for more; he often asks these questions. Let me give him the figures for cars. In 1979, exports of cars from the United Kingdom were worth £838 million and imports of cars into the United Kingdom were worth £2.6 billion—exports were a third of imports. In 1994, we exported £5 billion-worth and imported £9 billion-worth. We have more than halved the gap in one of the most important areas of manufacturing about which the hon. Gentleman asked. Between 1974 and 1978, the United Kingdom had 4.9 per cent. of world trade and between 1989 and 1993 we had 5.2 per cent. Will the hon. Gentleman please congratulate the Government on their magnificent achievements?

Imports of capital equipment have increased during the past year, which has reflected a welcome revival in the confidence of British manufacturing industry. Is it not especially pleasing that exports of the British capital equipment industry have done very well and that we are now in surplus with the rest of the world? Does not that demonstrate a favourable currency position and the fact that our exports are capable of competing effectively in terms of quality anywhere in the world?

My hon. Friend draws our attention to the capital goods sector, our share of which to non-OECD countries has increased from 5 per cent. two years ago to 7 per cent. last year. Wherever one looks, the success story of British manufacturing is there to be seen. Of course, we had to get over the 1960s and 1970s when we had to live with the results of Labour Governments, and it took some time to do so. Our good results are now coming through.

The Minister mentioned the 1960s and 1970s, but he might have also mentioned the 1980s. In that regard he might have read an interview with Sir Denys Henderson, the chairman of ICI in The Times on 17 April. He made it clear that in the 1980s his relationship with the Government had lapsed because, in his words, it was the Government's view that manufacturing industry did not matter. Is it not true that because of the policy pursued in the 1980s we had a deficit on our manufactured trade last year of £10.7 billion. The Minister does all that he can for exports, which we welcome, but he never tells the House that our imports have risen higher than our exports. As he mentioned the Chancellor of the Exchequer in his opening remarks, I remind him that the Government's only policy seems to be whether to raise interest rates, and even that depends on local election results.

The hon. Gentleman is a fair and reasonable opponent, although he always likes to reflect on the negative rather than the positive. He must accept that the legacy that was inherited in the 1980s meant that it took some time to set things right. Between 1974 and 1979, UK productivity rose by less than 1 per cent., in Germany it rose 4.5 per cent., in France it rose 5 per cent., in Italy it rose 5.5 per cent. and in Japan it rose 5.9 per cent. Between 1979 and 1993 our productivity has risen, on average, 4.1 per cent.—more than three times the amount that it rose under the last Labour Government. After Japan, we have had the highest increase in manufacturing productivity of any country in the Organisation for Economic Co-operation and Development. That is a magnificent achievement. The facts can be seen in the figures that I quoted on car exports. The hon. Gentleman should give some credit to the Government and to the people of this country for that.

Ministerial Visits

12.

To ask the President of the Board of Trade on how many occasions since his appointment a car parking space has been provided for him when visiting static exhibitions in London in his official capacity. [21953]

It is not possible, without incurring disproportionate costs, to research my many visits to exhibitions in the past three years to see where a car parking space has been provided.

Would my right hon. Friend accept that I do not begrudge him an official car parking space, which is one of the last great luxuries in life? Would he also accept that traffic is congested and parking is in short supply in Olympia and Earls Court in west London, where the main exhibition centres are currently situated, and that not the least argument in favour of the proposed new major international exhibition centre in the royal docks is that, in addition to ease of access, ample parking space would be available? As such a centre would not only assist in the regeneration of east London but enhance the potential of our capital city as a national asset, will my right hon. Friend do all in his power to support that proposal?

I thank my hon. Friend for his generosity in allowing me the privilege of a parking space. I can reassure him that I have just visited the potential site of the exhibition centre in the London Docklands development corporation area. It is for the scheme's promoters to propose appropriate financial arrangements and to secure the necessary planning undertakings. If they are successful, no one will be more pleased than me.

Libya

13.

To ask the President of the Board of Trade what was the value of the trade with Libya for any convenient years in the 1960s, 1970s and 1980s, at adjusted or current prices; and what is the value in the last financial year. [21954]

In 1966, UK imports from Libya were worth £61 million while exports were worth £29 million. In 1974, imports were worth £386 million and exports £64 million. In 1984, imports were worth £165 million and exports £246 million. In the financial year ended March 1995, imports were worth £153 million and exports £185 million.

Is it not true that, partly because the present generation of decision makers in Libya were mostly educated at British universities and British technical colleges, not in the United States, British industry has been hit far harder than industry in America, let alone in Germany, Italy and Greece, which pay not a blind bit of notice to the sanctions? Will the Department ask two or three senior officials to look carefully at the film on Channel 4 which is to be screened for more than two hours tomorrow evening and which casts the gravest doubts on whether the Libyans were responsible for the Lockerbie crime? Are we not hurting British industry by looking at sanctions without a certain critical faculty?

I know that the hon. Gentleman takes a deep and understandable interest in the Lockerbie tragedy, which has led to his asking many questions about Libya. Libya is, at best, a marginal market for us, so it is not possible to evaluate exactly the effect on British business of our observing the United Nations sanctions. However, our relations with Libya have been troubled over a period.

I cannot comment on the film "The Maltese Double Cross", which is' due to be shown tomorrow evening on Channel 4. Its editorial content must be the responsibility of the producer, but I have heard comments by others and, indeed, I saw comment in The Sunday Times, which cast doubt on the authenticity of the argument advanced. We will have to watch and judge, but at the moment the Government are upholding the UN sanctions that were imposed in 1992.

Insider Dealing

14.

To ask the President of the Board of Trade if he will make a statement on the outcome of meetings with the Securities and Investments Board on insider dealing. [21955]

My Department has regular contacts with the Securities and Investments Board plc on a wide range of subjects, including, but not limited to, insider dealing.

In the nine years since the insider trading legislation was enacted, fewer than 10 people have been convicted. As that crime is widespread, why have so few people been convicted? When can the small, ordinary investor expect Government action and protection? Are the Government, having indulged in a spot of insider dealing themselves over the sale of National Power, too ashamed to legislate?

Perhaps the hon. Gentleman, if he has an ounce of generosity in him, will recognise that the Government introduced that legislation. A Conservative Government attempted to legislate in 1973, but the Bill was overtaken by the election in 1974. Between 1974 and 1979, no such legislation was enacted by the Labour Government. The legislation was introduced by the Conservative Government in 1985. It was recognised at that time that tackling insider dealing is difficult and complex for evidential reasons as much as for anything else.

indicated assent.

I note that the hon. Gentleman accepts that.

It was for that reason that the law was subsequently refined. The hon. Gentleman will know that, in 1993, further provisions were taken through the House by the Government, which became operable on 1 March 1994. The Government consider it appropriate that we should look at the way in which that legislation is working.

Does my hon. Friend agree that it would be a rather perverse way of judging the effectiveness of the criminal law if we based it on the number of criminal prosecutions? It would not be a very good advertisement for the criminal law if we said that the more murders there are, the more effective are our courts and criminal law. Does my hon. Friend agree also that a balance has to be struck between the flow of information between companies and the market and the restrictions that we place on that flow of information with insider dealing rules? Would it not be wrong for unrealistic share prices to be shown on screens in our dealing markets because the flow of information was too stifled?

My hon. Friend accurately describes some of the evidential difficulties in attempting to characterise certain behaviour as insider dealing. He shows that we must proceed in such cases on the basis of evidence of wrongdoing rather than party political prejudice.

In view of the ease with which almost everyone under suspicion, including, most recently, Lord Archer, avoids even being charged with insider dealing, will the Minister confirm that, at recent meetings, the Securities and Investments Board has pressed his Department to change the law? Is it not obvious that such changes could mean civil rather than criminal sanctions, thus making it easier to surcharge wrongdoers, and that his Department is the Department that is objecting to and blocking such changes? Apart from the obvious protection of the old pals act, will the Minister tell the House why that is?

I can deal with the right hon. Gentleman's question very shortly: he should not believe everything that he reads in the newspapers.

Manufacturing Industry

15.

To ask the President of the Board of Trade when he next expects to meet the President of the Confederation of British Industry to discuss manufacturing industry. [21956]

I and other DTI Ministers regularly meet the Confederation of British Industry to discuss a range of issues. The latest CBI survey confirms the strength of manufacturing industry. Export orders are growing faster than ever and export optimism is at its highest for a generation.

Does my right hon. Friend agree that reasonably stable exchange rates are particularly important if manufacturing exports are to continue to rise, as they have recently? Will he confirm that, whether or not we are in the exchange rate mechanism, it is a major objective for the Government to prevent fluctuations in the exchange rate, as upward and downward movements are particularly detrimental to the manufacturing sector?

I know that my right hon. and learned Friend the Chancellor of the Exchequer will have all those matters carefully in his mind. My hon. Friend will understand that the Government's determination to maintain strict control over the economy is at the forefront of our objectives.

Does not the President of the Board of Trade realise that when he meets the CBI he has no credibility at all if he pretends that in the past 16 years we have not lost market after market and home market after home market? Is not his credibility zero if he does not talk to the CBI about how we haul back on that long path to securing those markets for British manufacturers?

The hon. Gentleman makes an interesting point by suggesting that the problem existed 16 years ago. I agree. Precisely because the last Labour Government did so much to undermine the competitiveness of British industry, it has been a hard and painful process to turn it round. However, the latest CBI survey shows exactly how substantial our success has been. Inflation has been below 3 per cent. for the past 18 months—the first time that has happened since 1961. Exports are some 11 per cent. higher. Growth in the economy has been 3.9 per cent. over a year. Understandably, the CBI reflects those exciting figures in its forecasts of the state of optimism of British industry.

Despite the huge improvements in British manufacturing industry in the past decade or so, will my right hon. Friend discuss with the financial institutions the gap that appears to exist in long-term finance for firms with a turnover of between £3 million and £50 million? In Britain, those medium-sized firms still find it difficult to get long-term secured loans—true secured loans, not overdrafts dressed up as loans—for expansion and developing new products. It would pay dividends if my right hon. Friend used his influence in that direction.

My hon. Friend takes a great interest in those matters. I am totally sympathetic to the point that he makes. I have frequent conversations with representatives of the financial institutions and the Bank of England on those important issues.

Research And Development

16.

To ask the President of the Board of Trade if he will outline the measures he is undertaking to encourage business expenditure on research and development. [21957]

There are a substantial number of measures, ranging from grant schemes such as SMART and SPUR, to those which improve the market intelligence available to business, such as the UK R and D scoreboard and the technology foresight programme, in which the DTI has been heavily involved.

Does the Minister support the view of the Science and Technology Select Committee that the evidence in favour of tax incentives to encourage business expenditure on research and development is sufficiently strong to warrant a Government review? Can he confirm that one is being carried out?

I can reassure the hon. Lady that we constantly keep under review the need to encourage research and development and innovation in the United Kingdom. The competitiveness White Paper, which is due to be launched in a few weeks' time, will demonstrate just how extensive our thinking on those matters has been. There are provisions for companies to write off revenue or current account against related profits. That is not often drawn to our attention, but it already exists in law.

Does my right hon. Friend agree that research and development is extremely expensive? There is absolutely no guarantee of success, but it is absolutely vital to the future of Britain or of any country. In the circumstances, may I reiterate what the hon. Member for Cambridge (Mrs. Campbell) said? We need always to pay attention to the tax position as well as other measures. My hon. Friend's Department can do more than any other to encourage research and development.

I understand exactly what my hon. Friend says about the importance of R and D and innovation for British business. It is one of the keys to our competitiveness. That is why the DTI is now actively engaged in benchmarking to help companies. It is why we have expert counsellors in the business links, which are growing up around the country, promotions and conferences to encourage business to understand the importance of research and development and discussions with the City to change its attitude to the relationship between dividend policy and long-term investment in research and development.

As the Minister accepts that innovation is vital to the competitiveness of British industry, can he explain why his Department cut support for it by £5.5 million while allocating £30 million to the renovation of No. 1 Victoria street?

The hon. Gentleman, sadly, lowers the tone of a constructive discussion. Civil research and development in this country has been rising. The overall figures are affected by the decline in defence in R and D expenditure, but I assure him that the DTI is concentrating on assisting British industry to understand the importance of long-term R and D—particularly smaller companies. There will be further announcements in due course, when the competitiveness White Paper is published.

Japanese Trade Barriers

17.

To ask the President of the Board of Trade what representations have been made to the Government of Japan about the trade barriers against British goods; and if he will make a statement. [21958]

We take every opportunity to make representations both directly and through the European Commission where the interests of British firms are damaged by trade barriers. We have regular and frank discussions with the Japanese Government on such issues. My right hon. Friend the President of the Board of Trade and my right hon. Friend the Minister for Trade both visited Japan this year and raised current trade problems.

Does my hon. Friend agree that there is a general perception that exporters from the empire of Japan have easier access to our markets than do British exporters to the empire of Japan? Will my hon. Friend be ever determined to ensure ease of access to Japanese markets by our industrialists and that free trade actually is free trade?

I can give my hon. Friend some good news. In the first quarter of this year, our exports to Japan were up 40 per cent. The changes that the Japanese Government are now making voluntarily and in response to the yen crisis are likely to lead to further opportunities for British business, which we enthusiastically support. Our relationship with Japan, which has further to go in some key sectors, is best resolved through the multilateral arrangements of the World Trade Organisation. We hope that, in an effort to build the WTO's credibility, all nations—including the United States—will take that into account. That is why we referred our problems with whisky supplies into Japan to the WTO, backed by the European Union in the last few days.

The Minister said that our net exports to Japan are up 40 per cent. What is the balance of manufactured trade between this country and Japan?

We have a deficit in manufactured trade but the figure for overall visible trade is a good deal more positive and in credit. Our overall position is extremely important. In 1994, our exports to Japan totalled £2.9 billion and imports totalled £8.9 billion. Those are the full year figures, so I prefer to use those.

Trade Marks

18.

To ask the President of the Board of Trade how many applications have been (a) received and (b) processed by the Trade Marks Registry since October 1994. [21959]

In the period from 31 October 1994 to 31 March 1995, the Trade Marks Registry received 24,241 applications, of which 23,717 were processed by the formalities section. In the same period 19,344 cases were examined, 13,090 cases published and 10,973 cases registered.

Is my hon. Friend aware that the volume of applications is such that it typically takes about five months to produce an acceptance or rejection, notwithstanding the registry's hard-working and diligent staff? Does he agree that such delays produce an unnecessary commercial handicap'? Will he introduce a maximum target time of no more than three months?

My hon. Friend refers to a problem that has arisen because of the success of trade mark applications following enactment of the Trade Marks Act 1994. I hear what my hon. Friend says and we will look further into the matter. Improvements are being made and staff have adjusted to the high volume of applications, which shows how well the British economy is performing. Otherwise, there would not be the demand that we are experiencing.

Trade Statistics

19.

To ask the President of the Board of Trade what is his latest estimate of Britain's share of world trade (a) in visibles, (b) in invisibles and (c) in (a) and (b) combined. [21960]

In 1993, the latest year for which information is available, the United Kingdom had a 5 per cent. share of world visible exports, an 8 per cent. share of world invisible exports and a 6 per cent. share of visibles and invisibles combined.

Will my right hon. Friend confirm that, under the Government's policies, Britain is more than maintaining its share of world trade compared with the years of decline when we suffered under socialist anti-enterprise policies dictated by trade union barons?

The hon. Member for Huddersfield (Mr. Sheerman) said that we were losing market share after market share. In fact, that is not true. Our share of world trade has gone up from 4.9 per cent. under the last Labour Government to 5.2 per cent. now. For a nation of 1 per cent. of the world population to have 6 per cent. of the world's trade is no mean achievement.

Although we have improved our exports and general share of world trade, we have not kept pace with the general increase in world trade, which, during the past 12 months, has averaged more than 8.5 per cent., a total which we have fallen somewhat below. Is it not true that we are suffering now from a lack of capacity in our exporting industries which, had it not been wasted during the 1980s, would have stood us in good stead now?

The hon. Gentleman knows that our share of world trade increased last year. Our share of exports in volume terms was 11 per cent. up against an increase of 8.5 per cent. Instead of being somewhat down, it was a hell of a lot up.

Drugs (White Paper)

3.30 pm

With permission, Madam Speaker, I should like to make a statement about the Government's drugs strategy for England, set out in a White Paper presented jointly by myself, as chairman of the Ministerial Committee on Drugs, my right hon. and learned Friend the Home Secretary, my right hon. Friends the Secretaries of State for Health and for Education, and my hon. Friend the Paymaster General. Copies are available in the Vote Office.

The White Paper follows the Green Paper published last October, to which more than 400 organisations and individuals, including the Opposition parties and the all-party committee on drugs, have responded. A list of all those who submitted written responses has been placed in the Library.

The consultation showed wide general support for the main lines of what was proposed. The White Paper therefore follows it closely, while making a number of modifications reflecting particular points raised in the consultation.

There are two main themes. The first, alongside a continuing commitment to legal deterrents and firm enforcement of the law by the police and Customs and Excise—and a reaffirmation that we do not intend to legalise any currently controlled drug—is a new emphasis on education and prevention. We need to educate our young people about the dangers of drugs, and develop their skills to resist. We need to convey clear messages against drugs to parents and to everyone in the community. We also need to ensure that people who do misuse drugs can get help through information, advice and treatment. The other theme is to establish key priorities, with clear programmes of action and indicators of performance in progress towards achieving them.

The priorities we propose are three. They are interdependent and of equal importance. The first is to increase the safety of communities from drug-related crime. To that end, my right hon. and learned friend the Home Secretary has already included a specific reference to drug-related criminality in the five key policing objectives for 1995–96.

All police forces, where they have not already done so, will now establish their own comprehensive drugs strategies, to be developed by April 1996. Those will cover not only the targeting of drug dealing and related crimes, but also, importantly, the wider role of the police—for example, in working with schools and in the community.

My right hon. and learned Friend will shortly also issue guidance to probation services about their work with drug-using offenders, including the necessary links between drug misusers and treatment services. He has already set out, in the prison service drug strategy published on 26 April, his plans for tackling the problem of drugs in prisons, for which more than £4.5 million will he made available this year.

HM Customs and Excise will of course fully maintain its effort in stopping drugs entering the country, dismantling trafficking networks and organisations, and working closely with the police to enforce the law.

A second priority is to reduce the availability and acceptability of drugs to young people. My right hon. Friend the Secretary of State for Education is today issuing guidance on that front, based on the draft issued for consultation last November. Nearly £6 million is being made available this year to support teacher training and new drug prevention projects. The effectiveness of drug prevention work will be included in school inspections.

But the problem is not for schools alone. My right hon. and learned Friend the Home Secretary has renewed and extended the Home Office drug prevention initiative, under which local teams work with communities to develop effective ways of preventing drug misuse. We will also be co-ordinating new publicity campaigns, using a variety of expertise—in the private and voluntary sectors as well as in Government—to make the messages credible and effective.

For those young people who do experiment with drugs, whatever the messages they receive, we need to ensure that appropriate treatment services are available as soon as they need help. Pending the findings of the current review of the effectiveness of drugs services, which includes early intervention services for young people, my right hon. Friend the Secretary of State for Health is providing an extra £1 million this year for the development of such services.

The third priority is to reduce health risks and other damage related to drug misuse, and in particular to ensure that individual drug misusers have access to cost-effective treatment. The findings of the task force conducting the effectiveness review to which I have just referred are expected early next year. In the light of them, my right hon. Friend the Secretary of State for Health will issue new guidance.

Her Department will also ask health authorities to review the arrangements for sharing the care of drug misusers between specialist providers—including voluntary organisations—and the normal providers of primary care such as GPs. Those efforts will be backed up by improved access to information about drug misuse and the local treatment services that are available. A free and confidential national telephone help line, operating 24 hours a day, has been operational since 1 April.

Important though it is to have a clear strategy and objectives at national level, with the various Departments working together, such a strategy will work only if it is carried through at local level in similar partnership between the many statutory and voluntary agencies involved. The White Paper therefore proposes the establishment of new drug action teams throughout England.

To the membership of those teams suggested in the Green Paper—senior representatives of the police, probation and prison services, health authorities and local authorities, including the education services—we are, in the light of consultation, adding social services, and encouraging the teams to co-opt representation from the voluntary sector, which often plays a very valuable role in delivering advice and treatment services.

Chief executives of health authorities are being asked to organise the teams, but on the basis that each team should decide for itself who should take the chair, according to what seems best locally. There will be similar flexibility over boundaries, as the boundaries of the various agencies concerned do not always coincide. But all parts of the country must be covered, and health authorities will therefore be required to report to central Government on the boundaries that are proposed.

To reflect the fundamental importance of wider community involvement, each drug action team will have an advisory drug reference group with a wide-ranging membership of relevant interests. The Government will provide some £8.8 million over the next three years to establish and support the new local arrangements.

The implementation of these proposals will be overseen by the Ministerial Committee on Drugs, supported by the central drugs co-ordination unit that was established some 18 months ago.

I believe that the White Paper sets out a clear, practical and comprehensive strategy, based on partnerships both national and local, which can make a real difference. I commend it to the House.

Opposition Members welcome the right hon. Gentleman's statement. There is no doubt that the problems associated with drug misuse have reached new heights: nearly every community in Britain is affected, and every parent is worried about the impact of drug misuse on individuals and families. The effects of drug-related crime and a drug culture are undermining the potential of our young people, pervading every community and devastating some.

Will the Leader of the House confirm that, when research shows that nearly 50 per cent. of our 15 and 16-year-olds have been offered drugs, and two thirds of all thefts are drug-related, we are indeed facing a problem of record proportions that needs urgent action?

The Lord President is aware and has acknowledged that the Labour party has taken a positive approach to the Green Paper that preceded the report, and we are pleased that many of our points have been taken on board, especially about the need for a national strategy and co-ordinated action. I hope that he will confirm that today.

The Labour party is opposed to the legalisation of cannabis. Will the Lord President acknowledge that that is common ground between us: that, given the need to send a strong and clear anti-drugs message to young people, action to legalise cannabis would be wrong, and that the debate about that can serve only as a distraction from the real issue?

I regret, however, that the report does not deal with another problem that affects many young people: the consumption of cigarettes and tobacco products. It is time that the Government turned their mind to tobacco product advertising, which is not covered by the report.

Having generally welcomed the Lord President's approach, may I ask him several specific questions? First, how much of the £5.9 million, which will be available through the Department for Education's 1995–96 grants for education support and training budget to train teachers and support drug education projects, will be completely new money? Will he give an' assurance that that funding, which works out at just £240 per school, will be sustained, so that we do not see a repeat of what happened a few years ago, when a new budget for drug education co-ordinators was announced, but was rapidly followed by cuts that reduced their number from 135 to 75?

Secondly, as the Office for Standards in Education is rightly to be given the task of inspecting the quality and effectiveness of schools' policy on drug education, what will be done to ensure that the 9,000 school inspectors are trained in that specific area? What is to happen to schools that have already been inspected and will not be reassessed for four years or more?

Thirdly, why are the localised drug action teams—something that again we welcome in principle—to be set up by the chief executives of district health authorities? Would it not have been more appropriate for local authorities to be the co-ordinators? While on this point, does the Lord President envisage just local authority officials having a role in those teams, or does he envisage a role for elected councillors? On the funding of the teams, is the £8.8 million over three years for the development fund new money, and who will determine the allocation of that specific budget?

Has the Lord President read the report published today by Judge Tumim about the initiatives needed to deal with drug dealing in prison, not least because, in some prisons, up to 80 per cent. of prisoners are drug users? In view of the concern expressed today, which has been repeated on other occasions, surely his specific recommendations should have urgent consideration.

May I ask the Lord President about the impact of cuts in the number of Customs and Excise officers, who do so much, including at times risking their lives, to stop drug trafficking? Surely such Government cuts conflict with the task of fighting drug abuse, as expressed in the document.

Co-ordination across Departments has long been called for by Labour Members. We are glad that, for once, the Government have listened, and that is why we welcome today's announcement.

First, I express my gratitude to the hon. Lady for the general tone of her earlier remarks, the welcome she gave for my statement and her acknowledgement of the importance of the problem. I am also grateful for the positive and constructive response, which I am happy to endorse, of the Labour party, and, indeed—I say this to the right hon. Member for Berwick-upon-Tweed (Mr. Beith)—of the Liberal Democrat party, to the Green Paper.

Just as I believe that a great deal will depend on the partnership between the Departments represented and between the different agencies on the ground, I also believe that the whole process will work better if it is also a political partnership similar to that displayed in these exchanges. I especially welcome the firm declaration by the hon. Member for Dewsbury (Mrs. Taylor) of her opposition to the legalisation of cannabis. I agree with the reasons that she gave for that.

I will not spend too much time on what the hon. Lady said about cigarettes and tobacco—she might also have included alcohol—as those are the subject of actions, programmes and targets that the Government have set under a different heading, the "Health of the Nation" strategy. It is not that those matters are not being tackled: they are being tackled in ways somewhat different from those set out in the White Paper.

The hon. Lady asked me about the GEST programme. The funding of programmes to train teachers in drug education and innovative projects is new money for those purposes. However, it was, of course, taken into account in planning for the whole of education expenditure during the negotiations last autumn, when we had already published the Green Paper and outlined the direction in which we wished to move.

The question of training for Ofsted inspectors is a matter for that body, which is independent. However, I have no doubt that it will take appropriate steps to ensure that any necessary training is given.

The reason we asked district health authorities, rather than anyone else, to take the lead in establishing the teams—although, as I said, not necessarily to chair them, as that will depend on local circumstances—is that, of all the bodies involved, they have a direct line of accountability to central Government. That in particular was a point to which we attached importance.

The hon. Lady asked about the involvement of local authorities on the drug action teams. It is certainly envisaged in the White Paper that that involvement would be at the level of director or assistant director in the various services involved, because the intention is that those bodies should take executive action. However, I hope that councillors in the authorities will be involved in informing the work of their officials on those bodies.

On the point about Judge Tumim's report, at this stage I can say only that it appears amply to justify and underline the need for the prisons drugs strategy that my right hon. and learned Friend the Home Secretary and the Prison Service set out only a few weeks ago.

On the point about Customs and Excise, I simply say that intelligence activity in this area is being supplemented by some 50 posts redeployed from other locations. I see no reason to believe that a more effective use of Customs and Excise resources, which was what the fundamental expenditure review was about, will in any way detract from or diminish the increasingly successful efforts of Customs and Excise in this area.

Will my right hon. Friend accept my welcome for his statement and, indeed, the welcome from both sides of the House—especially members of the all-party drug misuse group, which argued for a Government strategy on this subject for many years, in an awareness of the difficulty the Government have in accepting the need for a strategy on anything, most of all when it is interdepartmental?

Will my right hon. Friend also accept my thanks for his personal catalytic efforts, and for the way in which he and his colleagues have listened to the submissions made on the Green Paper, which was published last autumn? Will he extend to the central drugs co-ordination unit the thanks of the whole House for the job that it has done, while also accepting that we are worried, because the unit has been promised an extension only until the end of 1996, whereas the White Paper stretches into 1998? I hope that the unit will be given an extension until at least the end of the period covered by the White Paper.

The Lord President has touched on one or two—

Order. I must draw the attention of the hon. Gentleman to the fact that this is the time for hon. Members to ask questions following a statement, and the House has an important debate coming up. I hope that there will be brief questions and speedy answers. Otherwise, I shall not be able to call all the Members who wish to ask a question.

I was trying to suggest a way out of that dilemma, Madam Speaker, by expressing the hope that the Lord President will find time for a debate on the White Paper as soon as possible.

In that case, I may not have to call any other hon. Member.

First, I thank my hon. Friend for his generous remarks about the successful way in which the exercise has worked. Secondly, I warmly endorse what he said about the central drugs co-ordinating unit, led by Sue Street. It is only a small group, but it has done a fantastic amount of work with considerable success. It has support among those with whom it has spoken, and I well understand why my hon. Friend wishes to see the unit continue, and I shall bear that very much in mind.

So far as the question of a debate is concerned, my hon. Friend makes me put on my other hat and reply cautiously. I would be pleased if I, as Leader of the House, were able to find time for such a debate.

We welcome the approach and direction of the White Paper, and the priority it gives to education and access to health services. Will the Leader of the House confirm that it does not provide resources for hard-pressed individual schools to make teaching time available for the vital work of drugs education?

Will he explain the philosophy which lay behind the Department of Education's guidance to schools that they need not report to the police cases of possession of cannabis among school pupils, or suspend pupils in those cases? To those of us who believe that it would not be appropriate to legalise cannabis, is that a recognition that there are some complicated problems associated with the matter?

Does the right hon. Gentleman recognise that, while he has been deliberating, the Chief Inspector of Prisons has castigated the Prison Service for failing to deal with the scale of the drugs problem in prisons? Will he recognise that the drug action teams will have to listen to young people, people who deal with addiction and people in the health services, who often take a rather different view of the matter from politicians and civil servants?

There appeared to be some ambivalence in the right hon. Gentleman's remarks about cannabis, just as there has been—to put it mildly—some ambivalence in his party's resolutions on cannabis. I will leave that subject to be explored on another occasion, rather than engage in acrimony today, against my natural nature.

As for the right hon. Gentleman's comments on the reporting of the discovery of illegal substances in schools, I understand from my right hon. Friend the Secretary of State for Education—the right hon. Gentleman will observe that she is not far from me—that what he has said is just plain wrong. If schools find illegal substances, it is expected that they will report that to the police.

On the right hon. Gentleman's other point, one hopes that not just the drugs action teams but everybody involved in the field will make sure that they maintain their contacts with young people, because it is only by fully understanding the nature of the problems and how people feel that we can have effective action to deal with those problems.

May I give a warm welcome to what my right hon. Friend has told the House, and particularly the initiative for local drug action teams? Will the teams be sufficiently flexible to build on the work that is being done in many rural communities to set up pavement projects which are related not just to drugs but to alcohol and solvent abuse, so that we avoid duplication and harness local support and funding, as well as the Government funding which my right hon. Friend has suggested this afternoon?

The answer is yes in every respect. The White Paper does not set out a rigid prescription of how the teams shall be set up, what areas they will cover and who should take the chair, because we are anxious that they maintain the flexibility to relate to local circumstances, and we do not want to suppress the very good activities which are taking place in many parts of the country.

Equally, my right hon. and learned Friend the Home Secretary's recent extension of the drug prevention initiative teams has led them to be covering much wider areas than before in many cases—including, I am glad to say, a new one covering the whole county of Essex. That means that they take in rural areas, as well as the urban ones which have often been the focus of activity in the past.

A constituent of mine persuaded her heroin-addicted daughter to seek treatment from our local drugs team. Despite the fact that the daughter has a baby that was then being breast-fed, the response was that there was a waiting time of four months before she could receive help or treatment.

To tell a drug addict that she must wait for four months is effectively to say, "Go away—we're not bothered." My inquiries elicited the fact that it was because of a shortage of resources. Will the measures announced by the Lord President today ensure that sufficient resources will be available in my area to prevent such dreadful things from happening?

Although I understand why the hon. Lady raised that point, she will realise that I cannot comment here and now about a particular case. If she sends me details, my right hon. Friend the Secretary of State for Health or I will look into it. If we thought that there was no room for improvement in services, whether treatment or other, I would not be standing here now, nor would the Department of Health be conducting an effectiveness review. We shall seek to do everything we can to overcome any problems we discover.

I welcome the White Paper, but may I concentrate my right hon. Friend's attention on public concern about drug-related crime committed to feed a drug habit? One of the key objectives in the White Paper is to ensure that

"the law is effectively enforced, especially against those involved in … supply and trafficking".

What measures will the ministerial committee take to tackle the criminality of the drug user who creates the market?

I have already said that my right hon. and learned Friend the Home Secretary has included drug-related crime in his key police objectives for the forthcoming year, which would embrace efforts to deal with the problem that my hon. Friend mentioned. More than 1,000 police officers throughout the country are principally concerned with drugs work, including more than 300 concerned specifically with that work with regional crime squads. If we find that more effort is required as the strategy develops, I am sure that it will be put in.

May I say with great respect to the Lord President that Ministers are still not sufficiently seized of the extent of the problem of drug abuse around the country? Some 60 to 70 per cent. of everyone in prison is there, at some point, because of a drug-related offence, and it is easier to get drugs inside prison than outside.

Young people usually get their first experience with drugs through introduction by another member of their family. In the east end of London, abuse of drugs, particularly crack cocaine, is rampant. Is the Minister prepared to come to the Newham drug awareness project to find out for himself just how extensive the problem is?

I know that this is unacceptable to those on both Front Benches but, unless this country is prepared seriously to consider the legalisation of certain categories of drugs—[HON. MEMBERS: "No."]—we shall never deal with the problem any better than the United States has.

The answer to the hon. Gentleman's last point has already been given by hon. Members on both Front Benches, and I shall not add to that. The answer to his question of whether I am prepared to visit the project in Newham is: yes, although I cannot give an exact time. Nor can I guarantee to give the same response if I have a stream of similar requests, although I shall do my best.

On the first point, I refer again to what my right hon. and learned Friend the Home Secretary has already set out in the prison drugs strategy, which recognises the problem to which the hon. Gentleman refers. A range of measures to tackle it involve additional resources, including the introduction of mandatory drugs testing.

I warmly welcome my right hon. Friend's statement, but will he give maximum priority to preventing 14 and 15-year-olds from becoming addicted to heroin and so leading a life of crime, as is happening in Bolton?

I certainly acknowledge that, if that is happening, as it may be in other places as well, it is a serious problem, which I want to see tackled in any possible way. I hope that the measures that I have set out this afternoon will help.

Does the Leader of the House recall that the Scottish Office published a consultation document at about the same time as he published his? Is it not therefore a disgrace that the White Paper does not apply to Scotland? Does he agree that it may prove futile to introduce more Customs and Excise controls in England but not in Scotland and Wales?

My right hon. Friend the Minister of State, Scottish Office, in another place will shortly set out further plans for the development of the strategy that he has already described, following the findings of a working party that he chaired in Scotland.

I do not think that it is ridiculous that there are distinct, although closely related, approaches in the four component parts of the United Kingdom. They do have their differences, including, in Scotland, the fact that the organisation of social services and probation services, and the relationship between them, is different. It is sensible to take account of those differences, but it is also sensible to do what we are doing, which is to have a strategy in every part of the United Kingdom.

My right hon. Friend's statement will be well welcomed by parents throughout the country, and I think that they will also welcome the apparent cross-party support in the House. However, does he agree that, in my constituency, which has a Liberal Democrat-controlled council, there will be problems in local implementation in view of the fact that, at its most recent conference, the grass roots of the Liberal party voted to legalise cannabis?

I have already made some reference to that matter, and I do not want to become involved, even at the behest of my hon. Friend, in the internecine warfare in the Liberal party, but I am sure that all Members of the House—and I think that that would include those on the Liberal Democrat Bench—would, whatever their opinions on that matter, want all local authorities to co-operate to the full in implementing that strategy.

Does the Leader of the House accept that communities such as Hackney are desperate for a real war against drugs, because of the crime, the gangs and the gun use increasingly associated with the drugs trade in the inner city?

Although his White Paper is fine as far as it goes, should not the Government pay more attention to choking off supply, considering the resources available to the customs and, on a wider front, looking to our relationship with those third-world countries that act as drug producers and drugs transshipment points?

A great deal can be done to give resources to some of those countries to increase the strength of their own customs and coastguard, and we need to ensure that, on the wider trade front, we are not pursuing trade policies that force agriculturists in South America and the Caribbean into drug production.

I agree with most of what the hon. Lady says. This country does have a good record as a major contributor, for example, to United Nations programmes in that regard and to collaborative international action to try to tackle that problem. On customs, and enforcement generally, I draw attention to the fact that about half of the £500 million that is spent each year in this country in that respect is spent on police and customs enforcement, including more than £100 million this year on customs enforcement, and that seizure values doubled from about £250 million in 1990 to well in excess of £500 million in 1994. A great deal of effort is being made.

Is my right hon. Friend aware that he and his ministerial colleagues are to be congratulated on the serious and comprehensive way in which they have approached that difficult problem?

However, in the interests of taking quick, effective action to tackle what is probably the most serious social problem confronting advanced countries, especially among young people, will my right hon. Friend give a high priority to the existing efforts that are taking place, quite successfully, in my constituency and elsewhere, of voluntary organisations such as the youth awareness programme, which has already been tangentially mentioned, and the community drug help line in my constituency, which are doing sterling work very cost-effectively?

I can give my hon. Friend an unequivocal yes to that. As I said in my statement, one of the changes we have made since the publication of the Green Paper is to urge the co-option of representatives of the voluntary sector on to the drug action teams, and the drug reference groups, the advisory bodies, will certainly include representatives of groups such as those that my hon. Friend mentioned.

It is extremely welcome that the Government are now encouraging police forces to target serious drug trafficking. May I ask the Leader of the House, however, how much new money will go into that, and how many new resources will be available to police forces to enable them to carry out that very important work?

The resources available to police forces were only recently set out by my right hon. and learned Friend the Home Secretary on a considerable scale, together with a range of measures designed to ensure that those resources are used to full effect. We would expect that, as the police develop the force-wide strategies to which I have referred, those efforts will become yet more effective.

The report refers to the dangers of Temazepam, but it appears that no steps have been taken to subject its issue to more control. Would my right hon. Friend be prepared to comment on that?

My right hon. and learned Friend the Home Secretary and the Secretary of State for Health are taking immediate steps to reduce the misuse of Temazepam. That will be done by imposing safe custody controls on manufacturers and wholesalers under the Misuse of Drugs Act 1971, and by immediately starting consultations, which is legally required in this case, on banning the prescription of gel-filled capsules by general practitioners under the General Medical Services Regulations 1992. In addition, we are carefully considering the recommendations of the Advisory Council on the Misuse of Drugs to reschedule Temazepam under the 1971 Act. I hope that what I have said will encourage my hon. Friend.

The Leader of the House has chaired a committee that has presented a White Paper with some good things in it, but I warn him that one action upon which the Home Secretary and the Government are embarking could destroy all that good. People used to describe the prison system as the university of crime, but it is not just Stephen Tumim who recognises that today's prisons are centres for gangs, the drug culture and the dissemination of gang culture and of drugs. Should the Home Secretary introduce boot camps, they will be the worst way of spreading gangs and the drug culture. They will do more damage to this country's drugs policy than any other single act.

The hon. Gentleman will have noted that my right hon. and learned Friend is sitting next to me, and his whispered comments about the hon. Gentleman's remarks were not entirely complimentary. I will simply fall back on the very point that I have made two or three times—within the past three weeks, my right hon. and learned Friend has demonstrated his clear determination to adopt new measures on drug abuse in prisons, both to prevent it and to ensure proper treatment and rehabilitation for those who are already drug misusers.

Is my right hon. Friend aware that his statement is particularly welcome, and that the cross-party support he has received is significant? Can he say any more about the wider role of the police, particularly their work with schools, which is such an important part of the operation to get the drug problem under control?

I am grateful to my hon. Friend. As I have said, part of developing police force strategies is related to their wider role, as described by my hon. Friend. I know from my conversations with Chief Constable Hellawell, of West Yorkshire, who is the chairman of the Association of Chief Police Officers committee on the subject, that the police are receptive to the need to do more on that part of their work. I am glad to say that work with schools is a marked feature of police work in Essex.

I welcome the Lord President's decision on the legalisation of cannabis; to have acted otherwise would have sent the wrong signal at this stage in the war against drugs. As a strong supporter of the strategy, I ask the right hon. Gentleman to reconsider the membership of the drug action teams.

The decision not to appoint a local authority member to them instead of a senior local government officer is a tactical mistake. It is more representative of Government thinking in the 1980s rather than the new partnership that is supposed to exist in the 1990s. If the Lord President wants dynamic, co-ordinated local authority action, it is tactically wrong to appoint senior local government officers and to have no elected representation.

I cannot add to what I have already said, but, just as we looked carefully at the results of consultation on the Green Paper, so obviously, with an initiative of this kind, we will look at experience as it develops. If it reveals the need to modify the existing approach or to adopt a different approach, I, at any rate, and I am sure my right hon. Friends, will always be willing to consider that.

May I give a warm welcome to the White Paper? What focus has my right hon. Friend given to solvent abuse, given that half a million children in this country experiment with solvents, of whom a proportion, sadly, go on to use soft drugs?

I have made it clear that, in some cases, the drug action teams may wish to embrace other aspects of substance misuse, including misuse of solvents. We do not wish to prevent or discourage that exercise. I hope that my hon. Friend was encouraged by the publication on 20 April of the Advisory Council on the Misuse of Drugs report about solvent abuse. My right hon. Friend the President of the Board of Trade is now taking action with regard to one very important recommendation, and is establishing an industry-led forum to consider ways in which producers can ensure that their products are less liable to be misused.

I am a little concerned about the resourcing of the drugs strategy. The Leader of the House has already said that no new money will be available for the police, although he is asking the police to do a considerable amount of work with the community, which will have an associated cost in police time. The Leader of the House mentioned that £8.8 million will be available in the next three years to support local action on drugs. That amounts to about £2.9 million per year, which does not seem very much.

We already have a drug action team in Stockport, but we do not have the resources to back it up. How will the money be allocated? Will there be bids for it as part of a "drug challenge"—an analogy of city challenge—or will the money be allocated according to need? If it is to be allocated by the latter method, I think that the Leader of the House will discover that the money is not sufficient to meet need in the community.

As far as resources in Scotland are concerned, the hon. Lady must obviously direct her questions to the Secretary of State. [HON. MEMBERS: "It is not Scotland."] I misheard the hon. Lady; she may disregard that comment.

As to resources for England, I have already said that the Government are spending more than £500 million in the drugs area each year. In today's statement, I announced a total additional resource of slightly more than £13 million—that is £5.9 million for education, £1 million for health and £4.6 million for prisons, which makes a total of £11.5 million.

To that sum is added just under £2 million from the £8.8 million that I announced over three years for the drug action teams. The £8.8 million is directed at establishing and supporting—particularly administratively—the drug action teams. They in turn will be concerned with many projects that relate to other flows of funding out of the £500 million to which I referred.

Does my right hon. Friend agree that, as 60 per cent. of all crime is said to be drug-related, the measures that he has proposed today will reduce crime substantially, particularly among the young? Does he also agree that the need to restrain the importation of drugs makes it all the more necessary to maintain our border controls, whatever anyone else in Europe may demand of us?

I agree with my hon. and learned Friend. He will know that my right hon. Friend the Prime Minister has said clearly on many occasions that we stand firm on the question of border controls.

I hope that the measures that we have announced today will contribute to a reduction in drug-related crime. That is what they are intended to do, and I remind my hon. and learned Friend that the first of the equal priorities to which I referred was ensuring that communities are safe from drug-related crime.

Will the Leader of the House confirm that the amount of money that the Government are offering under the drugs strategy equates with the profit from perhaps one good drugs haul? How will the Warwickshire police implement that strategy when the size of its force has been cut by 50 police officers this year?

I agree that we need a clear policy in this area, and that we must monitor it closely. However, the Government have failed to implement Judge Tumim's recommendations concerning drug dealers and gangs in prison—in fact, he has criticised the Government on that issue in the last day or so. How can we be confident that the Government will implement this policy?

We are going over slightly old ground. I have already referred to the increase in general police resources that my right hon. and learned Friend announced at the time of the public expenditure round late last year. I will not try to add to those comments.

So far as Judge Tumim's report is concerned, I think that the hon. Member is straining a little. My right hon. and learned Friend has clearly acted in advance of Judge Tumim's report to tackle the problems to which it refers.

Will the Leader of the House recognise that if we are concerned about the link between drug use and crime, the very high price of highly addictive drugs such as heroin and crack cocaine are more important than the arguments about cannabis, unpalatable though that may be to hon. Members of both sides of the House?

In particular, the right hon. Gentleman should seriously consider those examples where the link between money and purchasing of drugs has been broken by prescribing drugs such as heroin, perfectly acceptably, under the national health service. Will he take that as an example of how to deal with heroin addicts in a way in which they are prepared to be dealt rather than through exhortations, which will not work?

I have referred several times to the review of the effectiveness of treatment services, which include a number of pilot projects that deal with, for example, methadone substitution. I do not think that any of us can be certain that we know all the answers in this field. The White Paper takes us forward. I hope that the effectiveness review will take us forward on that front as well.

Public Interest Immunity Certificates

4.15 pm

On a point of order, Madam Speaker, of which I gave you notice. I wonder whether I could ask you to reflect on the powers of Parliament in respect of the issuing by the Executive of public interest immunity certificates, the so-called gagging orders. As you know, Ministers issue such orders from time to time, and it is for judges to decide whether they are upheld in the courts.

Could you reflect and subsequently clarify in a ruling whether departmental Select Committees now have powers to ask any Minister who issues such a certificate to justify that action, and, in cases that involve national security, whether those rights extend to the Intelligence and Security Committee?

Finally, Madam Speaker, as the Scott inquiry, which would not have been established had not a judge refused to uphold a series of such gagging orders, will report shortly and is likely to comment on the use of such certificates, such a ruling from you would be much appreciated by all those who wish to defend the rights of Parliament in relation to the Executive.

Madam Speaker: I am grateful to the hon. Gentleman for giving me notice of his point of order. I have had an opportunity to reflect on the matter about which he wrote to me. His concern relates to the powers of Select Committees of the House. I must advise him that such matters are not in the hands of the Speaker.

Statutory Instruments, &C

Motion made, and Question put forthwith pursuant to Standing Order No. 101(3) (Standing Committees on Statutory Instruments, &c.).

Prisons

That the Prison (Amendment) Rules 1995 (S.I., 1995, No. 983) be referred to a Standing Committee on Statutory Instruments, &c.— [Mr. Bates.]

Question agreed to.

War Widows And Pensioners (Equal Treatment)

4.17 pm

I beg to move,

That leave be given to bring in a Bill to end discrimination and to review the effect of differential treatment of war disablement and war widows' pensions; to bring forward the means for equal treatment; and for connected purposes.

Last Friday, Madam Speaker, you led this House in our commemoration in Westminster Hall of those who served the country in the last war. Over the weekend, many hon. Members will have attended the services, commemorations and events and the two-minutes silence to pay tribute to those who died or were bereaved.

Today, I seek leave, with very welcome support from both sides of the House, to introduce a Bill that seeks to deal with some of the remaining discrimination and unfairness that is suffered by those who were alive in the last war or who are the widows of those who served, and who now feel that they are being unfairly treated by the state.

In early-day motion 186, the right hon. Member for Manchester, Wythenshawe (Mr. Morris) draws attention to the concerns of that group of our community. That early-day motion has attracted over 240 signatures. I understand that nearly 50 other hon. Members, who do not normally sign early-day motions, have written to the Officers Pensions Society expressing their unequivocal support, and that there are getting on for 100 Government Members who support the proposals.

My Bill contains four matters that I hope that the Government will consider if the House allows the Bill to continue.

First, if somebody receives a war pension, where he lives will determine whether it is regarded or disregarded for the purpose of council tax and housing benefit. There is a statutory disregard of £10, and local authorities have the discretion to decide whether to disregard further. That does not apply in Scotland and Northern Ireland, where there is a full disregard for all war pensioners.

The only fair system that would ensure that people were not penalised by a decision made by their local authority that was dependent on entirely other factors would be a centrally regulated system. There should be total disregard for all war pensioners in relation to their council tax and housing benefit.

The bill for such a system would be small. My information is that not 60 per cent. but almost 90 per cent. of local authorities have already introduced some such system. The best calculation of additional public expenditure shows that it would require less than £2 million more to ensure that all our war veterans and war widows are treated equally.

Secondly, if someone has served in the war, receives a war pension and is injured, his war pension may disentitle him from legal aid when pursuing any action arising from his war injury. That matter has been pursued by the hon. Member for Derbyshire, South (Mrs. Currie), who has taken it up with the Lord Chancellor. It causes great unhappiness and discontent among people who gave their service, have been injured and are rightfully entitled to pursue their legal remedies. It seems the grossest injustice for them to be told that, because they have served and have been given by the state a reward for their service, they are unable to receive legal aid.

The third and fourth issues would require the Government to look at two subjects on which they have made no concessions, which arose during debates on the Pensions Bill in the other place and on Second Reading, and which the right hon. Member for Manchester, Wythenshawe (Mr. Morris) specifically mentioned. Other hon. Members and I welcome the concession by the Secretary of State for Social Security in relation to the new clause on second bereavement or divorce introduced in the other place. That leaves two categories of people who are still treated unfairly.

There are about 2,000 widows who, if they remarry, will lose their entitlements. Whether they become divorced again or bereaved or their marriage breaks down, they cannot claim what was intended to be a war service entitlement. The evidence of those who deal with the issue all the time—the War Widows Association and services associations—shows that probably only one in 100 widows have remarried. The widows would rather not remarry. Some of them cohabit—sometimes they are forced to do so—rather than lose financially as a result of remarriage.

The cost of introducing a system to deal with the problem would probably be very small, and could even benefit the Treasury. Such a system would be much fairer on those involved. In 1989, the then Secretary of State for Defence, the right hon. Member for Bridgwater (Mr. King), accepted that the pension entitlement had been paid for by such people, who had earned their rights. It is anomalous that, whereas all other pension schemes, including ones in this place, give people a right which they retain for as long as they are widows, the war widows pension scheme, unusually, excludes those with a war service background.

The last category of people who are unfairly treated are those who married subsequent to the war service of their husbands. If someone served in the war and married later, his widow cannot take the pension that he earned and nobody else has inherited.

Every one of the 14 comparable armed forces schemes makes a pension provision for widows of post-retirement marriages.

The widows of Members of Parliament who married those Members of Parliament after their retirement receive the pension that their former husbands earned as a result of their service, yet the widows of service men who die before the beginning of the next century will be eligible for only a fraction of the service widows' pension, and the widows of service men who died before 1978 currently receive no pension at all.

We gave, rightly and properly, fine words of tribute over the weekend. There are a small and diminishing group of people who now want us to live up to what we say about the importance of what they did by what we do. It is shameful that, 50 years later, we as a state are unwilling to pay that small price.

I hope that Ministers will concede those matters as a result of the Bill, in the context of other Bills, or, at the latest, in the Queen's Speech, the Budget and the social security statement in the autumn. There is overwhelming support for the proposal. This is a great injustice, and the price we would require the state to pay to remedy it is minute compared with the service for which those people are entitled to their proper reward.

Question put and agreed to.

Bill ordered to be brought in by Mr. Simon Hughes, Mr. James Molyneaux, Mr. Alfred Morris, Mrs. Margaret Ewing, Mr. Dafydd Wigley, Mr. Winston Churchill, Mr. David Alton, Mrs. Edwina Currie, Mr. Nicholas Winterton, Mr. Andrew Mackinlay and Mrs. Diana Maddock.

War Widows And Pensioners (Equal Treatment)

Mr. Simon Hughes accordingly presented a Bill to end discrimination and to review the effect of differential treatment of war disablement and war widows' pensions; to bring forward the means for equal treatment; and for connected purposes: And the same was read the First time; and ordered to be read a Second time upon Friday 14 July, and to be printed. [Bill 120.]

Opposition Day

[11TH ALLOTTED DAY]

National Health Service (London)

I must tell the House that I have selected the amendment standing in the name of the Prime Minister. I have had to limit Back-Bench Members' speeches to 10 minutes throughout the debate. I hope that Front-Bench Members will exercise some voluntary restraint in their remarks, as, my researches show that 30 Back-Bench Members seek to speak.

4.26 pm

I beg to move,

That this House notes the public's concern over the closure of accident and emergency facilities in London, the reduction in numbers of intensive care, general medical and surgical beds, and the now widely-challenged assumptions that underpin the Tomlinson Report; and calls on the Secretary of State for Health to halt the withdrawal of hospital services and to moderate the pace of change in the NHS across London with particular reference to St. Bartholomew's, Edgware, Guy's and Brook hospitals and to refrain from allowing any further bed losses or service withdrawals, until she has re-examined the case for change and reported her conclusions to this House.

The Secretary of State has called into question the need for a debate today on the future of London's health service, but two simple examples explain why we do not share her view, When she announced the closure of the accident and emergency department at Edgware general hospital, she said that many of its patients would be treated instead at other hospitals, of which one was Northwick Park. Within the week, a terminally ill cancer patient, Maggie Curtin, was left in pain for nine hours on a trolley in that hospital, in which, the day after, her husband found her dead in bed. The Secretary of State deems Northwick Park able to cope with the extra work load that will come its way when Edgware is closed, yet clearly it is already a hospital in which staff and resources are under intense pressure.

When Bart's accident and emergency department closed, we were told that patients would go elsewhere, particularly to the Homerton. Before that closure, it was pointed out that the Homerton itself had had to stop taking admissions on no fewer than 10 occasions in the period during which Bart's A and E department was at risk because it could not cope with the existing pressure. Nevertheless, the closure went ahead.

Yesterday, in both radio and newspaper interviews, the Secretary of State demanded to know why my colleagues were not praising the Homerton and the investment there. She continued to stress that theme all day long—long after she must have become aware that the accident and emergency unit at that hospital had been closed for 39 hours because it could not take any other admissions, and that a motor cyclist who had had an accident 200 yards from the hospital had to be sent elsewhere.

Nor are those isolated examples. At 10.15 this morning, London's emergency bed service told us that no fewer than 13 London hospitals are at present restricting admissions because of the pressure on their facilities, yet the Secretary of State says that there is no need for a debate in which we can allow hon. Members to explore the nature and the consequences of the Government's decisions about London health care in greater depth than could ever be possible in the aftermath of a statement, when each Member is allowed only one question.

In the most recent debate on London's health, the Opposition called on the Secretary of State to reconsider the proposals initially put out for consultation in the light not only of the responses to that consultation, but of further evidence that was not available when the initial decisions were made. We drew attention to potentially dramatic changes that were still in the pipeline. For example, special health authority hospitals had been subject to the full operation of the internal market for only a month, so no one knew what the effect would be on those hospitals and the number of beds that they could sustain.

There is nothing to suggest that the Secretary of State has heeded either that further evidence or the outcome of the consultation. That is why our motion calls on her

"to halt the withdrawal of hospital services and to moderate the pace of change … and to refrain from allowing any further bed losses or service withdrawals, until she has re-examined the case for change and reported her conclusions to this House."

Those are the views of millions of Londoners who are not convinced by the Government's case and who are calling for those decisions to be genuinely reviewed and reassessed.

We all know that many hon. Members on both sides of the House are deeply uneasy about whether the Government are pursuing the right course. Not all of them have even suggested that they will abstain or vote against the Government tonight, but many of them would be secretly relieved if there were some way to halt the juggernaut that may be carrying them to destruction along with London's health service.

In the debate that we initiated in February before the Secretary of State's announcement, it was noteworthy how many Conservative Members, having ritually abused the Labour party, expressed considerable concern about what was happening in their constituencies. I hope that they are under no illusions about which part of their speeches the Secretary of State took into account. The right hon. Lady has given too much evidence that her ears and her mind are closed to the voices of those whose opinions she does not share.

In that debate, the Secretary of State said that she welcomed the chance to set out her policy for London and the rationale behind it. Frankly, I doubt that. If there is one outstanding characteristic of her tenure at the Department of Health, it is that she has never come to the House of her own volition to advance, explain or defend in debate the policies that she claims are without need of amendment.

As recently as the weekend, the right hon. Lady said that there would be no concessions on the proposals that she announced finally and reluctantly to the House a month ago; although faced with debate and potential defeat, she is now said to be willing to offer some amelioration to the proposals that she believed so recently to be beyond the possibility of improvement.

Therefore, Conservative Members can be in no doubt that any announcement of change today should be carefully scrutinised for its real impact—being designed to get the Secretary of State off the hook for a few hours while leaving their constituents firmly on the hook in the years ahead.

Will the right hon. Lady give way?

If the hon. Gentleman's intervention is very brief and does more than reaffirm his loyalty to the Government's health policy, of which I hope his constituents are in no doubt.

As an hon. Member whose constituency has been through the trauma of the closure of two accident and emergency units in West Essex health authority, I know that the closures were deeply unpopular at the time. There were burning effigies in the streets. Harlow has been through that and we now have a £10 million accident and emergency unit that will serve the area well. With her hand on her heart, never mind the party politicking, does not the right hon. Lady accept that, despite all the medical evidence, a review of a review of a review will not help one single patient?

Order. I hope that other interventions will not be as long.

The hon. Gentleman has not done himself or his colleagues any service. Under the pressure of time, I shall be reluctant to give way again to an hon. Member who makes the same point that he made in the previous debate.

I do not know what the hon. Gentleman's point is. We are discussing today proposals for other constituencies and other hospitals without any suggestion that the impact of those changes will be addressed in the way in which he claims it was in his locality.

There have been long-standing assumptions about London—that it received a disproportionate amount of money for health care and had a disproportionate number of hospitals and beds, which created problems that had to be addressed. Far-reaching change has already occurred. The number of medical schools was formerly nine but is now five. No fewer than 83 London hospitals have closed since this Government came to power in 1979. The total number of NHS beds in London has halved—the number of acute beds has almost halved and the number of non-acute beds has more than halved. There is no dispute among the experts that more beds have been lost since the Tomlinson report.

There has been a slightly unseemly dispute between Professor Jarman and the Department over whether all the beds that Tomlinson recommended should go have gone. I say unseemly because, in the Department's determination to produce different figures, it has taken a different scope of closures and a different time scale. However, there seems little doubt from the most recent Library figures that almost 2,500 beds have gone from the figures on which Tomlinson made his recommendations.

Some people assume that those bed losses in London are a good thing because they are bound to advantage other parts of the United Kingdom. Those happy optimists overlook the fact that what is happening in London is happening elsewhere. The process of change is the same and often just as damaging, whether in cities or rural areas. Decisions are taken in private, with nominal consultation, if any. The end result in every part of Britain is that the pattern of care delivery is changing without local people being fully involved and feeling that they have a say.

Under the present Government, consultation is a word. At most, it is a formal process that the Government endure, usually without much grace. It is not a process during which the Government listen.

When I was elected in 1983, my local hospital had been neglected by successive Governments for many years, and had been starved of funds as a result of the disproportionate amount of money going to London. Today, my constituency has £24 million-worth of new hospital, which will treat my constituents on site instead of them having to travel to London. I commend the actions of my right hon. Friend the Secretary of State.

I am not sure what the hon. Gentleman is saying. Is he saying that because there have been improvements in health care provision in his constituency, which we all welcome, health care in London should be destroyed? Is that what he is saying? That is the reality of what is beginning to happen under Government policies.

In our earlier debate, we sought to persuade the Secretary of State to heed not only the further evidence accumulated but response to the consultation process. Hon. Members on both sides of the House sought from the right hon. Lady measured consideration and a measured response. What happened? The conclusions of South Thames regional health authority reached the Department of Health on 16 March. Those of North Thames regional health authority were submitted as recently as 23 March.

The Secretary of State announced her decision on 4 April. That was in stark contrast to the right hon. Lady's response to the report of the clinical standards advisory group on urgent admissions to United Kingdom hospitals, which apparently did not recommend proposals to the Secretary of State's taste. She considered that report for 13 months before she even published it, whereas the closures were agreed after only seven to 10 days.

The right hon. Lady's own recommendations following those proposals seemed to be no more than a ringing endorsement of what was, in all its essentials, the answer of which she first thought. It is a wonder that she did not introduce her recommendations with the immortal words, "Here's one I prepared earlier."

The right hon. Lady's call for a measured response is really a call for procrastination. She is one of the few Labour Members who have served in government. Has she forgotten that that involves making hard choices? Will she acknowledge that throughout this century, a series of reports have made the case for the reorganisation of London's hospital provision? Does she accept that there is widespread admiration for my right hon. Friend's courage in grasping this nettle?

Yes, I do remember what it is like to make hard choices, and I also well recall that the making of hard choices involves a great deal more than simply accepting proposals that are put before one. The making of hard choices involves exercising a political judgment and saying sometimes, to those who come forward with proposals, "Yes, there is an admirable case in logic for some of what you say, but it is not the right way to proceed." That is what politicians are paid for.

What the Secretary of State has announced are decisions that could irreversibly affect, among other things, the future of Bart's—an institution which, for almost 900 years, has served the people of London. That is not a reason for saving Bart's. If the people it served had all moved away, if people had ceased to travel in their tens of thousands into that area to work, if it had lacked investment to keep it up to date or had lost the teams of clinicians to make it great, no matter for how many hundreds of years it had existed, its future would be bound to come into question. But that is not the position.

I am not entirely sure that I know quite how to express what I am about to try to say to the Secretary of State. We all know—

Do not say it, then.

This is not a matter for flippancy, and I have not finished with the hon. Gentleman yet, either.

We all know that people's health is bound up with external factors. Poverty, housing conditions and, above all, stress and insecurity, play a large part in affecting their need for health care. Bart's serves some of the most deprived areas of London. The people who live in those communities already face high levels of stress and insecurity. The removal of an institution on which, for generation after generation, they have depended for health care is bound to add to that insecurity. The Secretary of State is not even listening.

The removal of that institution is bound to add to that insecurity. It is bound to have a deep effect on people's emotions in ways that probably neither I nor the Secretary of State—we have not shared that experience—can fully understand. I see no sign at all that the Secretary of State has weighed any of those matters in the balance.

According to the King's Fund, whose initial report promoted the most recent round of changes, what is now needed in London is a comprehensive and full reassessment of London's health needs and provision. I remind the hon. Member for Harlow (Mr. Hayes), who seems to think that none of this needs to be reconsidered, that they are the people who started the most recent process and they now say that it needs a reassessment.

The Secretary of State still talks as if none of that is needed. Her case is that it is unnecessary because the Government are putting money into primary and community health services in London. But that is as if the investment, which we support, had already addressed and dealt with the continuing problems to which the King's Fund is drawing attention.

But in trying to assess the progress of that investment, the King's Fund said:

"there has been no systematic attempt so far to gather and evaluate the evidence of the impact of the government's initiatives in London. In fact, a detailed comprehensive description of the kind of projects which have been supported is not available."

In other words, neither what has been done nor the effect that those projects have had is yet known. Yet it is on the basis of those unknown projects, that unknown impact, that the decisions that we are discussing today are being made.

Will the right hon. Lady give way?

I had better press on a little. If I have time later, I shall give way.

The information that is available is not reassuring. Although building up primary care means more than simply increasing the number of general practitioners, it would appear that the hard fact is that the number of GPs in London is falling and that there remain major difficulties in recruitment. For that reason, the Department has been working with the British Medical Association on a package of proposals to encourage recruitment in London. I understand that the Secretary of State has had those proposals for a year without doing anything about them.

Of the GPs who are working in London, a BMA survey showed that 65 per cent. disapproved of the Government's proposals as detrimental. They are calling—the people who are supposed to be delivering the primary health care development that the Secretary of State says will remove the need for these beds—for an increase in the number of hospital beds.

Waiting lists in London are higher than they were a year ago. Even the figures for the last quarter alone, announced by the Secretary of State today, do not show a reduction in the area that covers London. They show a total waiting list of more than 1 million in the south-east as a whole.

London is caught in a vicious spiral, facing the breakdown of an integrated service. Accident and emergency departments are being forced to absorb the pressure as best they can. Increased pressure on A and E departments means more emergency admissions; more emergency admissions mean the cancellation of an increased number of scheduled admissions; those whose admissions are cancelled end up in the A and E department in need of emergency admission—and so it goes on.

According to Casualty Watch, from the Greater London Association of Community Health Councils, in Enfield the A and E department has sometimes been so busy and so full that even people injured in road traffic accidents have had to be seen in the minor injuries department, which is neither staffed nor equipped to deal with such cases. In Newham, children wait for hours for operating theatres to become available. In Redbridge and Waltham Forest, waiting lists are probably the longest in the country. There were more than 10,000 people on the Redbridge waiting list in 1993; by January this year, the figure had risen to nearly 15,000—an increase of 46 per cent.

The London ambulance service faces severe difficulties in coping with a 10 per cent. increase in accident and emergency work. Consequently, every London citizen faced with a crisis that requires the ambulance service must deal with the fact that it can achieve only a 74 per cent. response rate within the prescribed standard.

Will the right hon. Lady give way?

If I am going to give way, I shall give way to the hon. Member for Harrow, West (Mr. Hughes).

The right hon. Lady quoted some of the reports that have been produced. Many reports have been produced about the health service in London throughout the century. Given that all the scientific evidence and all the studies of accident and emergency services have concluded that the reorganisation announced by my right hon. Friend the Secretary of State would produce a better service and save lives, why does the right hon. Lady lack the political courage to back what my right hon. Friend is doing?

I have no idea on what evidence the hon. Gentleman bases his assertion, but the evidence available to me suggests that he is simply wrong.

At the beginning of the debate, I referred to the closure this week of Homerton hospital. According to the London ambulance service, that is the second occasion on which the hospital has been closed to "blue calls" since the beginning of April. On five occasions during the past five months, different hospitals have advised the service that they are closed to "blue calls", including St. Helier hospital, which was closed for 38 hours in January.

Ministers know that those are not isolated problems, that they are occurring without a winter epidemic and that they are grave. Only today my office received information about two separate and disparate cases that highlight public concern. Yesterday Mrs. Edith Berry was taken to West Middlesex hospital. Her kidneys were not functioning properly, and Parkinson's disease was diagnosed. A bed was finally found for her at 1.30 this afternoon, 20 hours after she was taken to casualty.

To underline our contention that the problems are widespread and exist not only in London, Mrs. Helen Kime has sent me a copy of a letter that she sent to the Minister of State, whose constituency contains Winchester hospital. She writes:

"On Monday evening"—

that is, Monday of this week—

"at 7.00 pm … we took a friend with a badly broken arm to the casualty department at Winchester general hospital. He was admitted to the Taunton ward and put on the list for the operating theatre the next day.

As I write this letter at 11.00 on Wednesday May 10th, 40 hours after his admission, his arm has still not been set.

He was left without food or water. He was not washed.

If he was a dog, the hospital would be reported to the RSPCA."

What has that to do with London?

In a not so sotto voce intervention, the hon. Lady asks what that has to do with London. I have pointed out to the hon. Lady and people like her that those problems do not only exist in London, although we are focusing on London's problems today, and that London cannot be sacrificed because every other area in the country will benefit; every area is experiencing the same difficulties.

Against that background, what are the Secretary of State's proposals, particularly for London? She proposes to close world-famous hospitals, and to take even more beds out of use. Let us look at Guy's, because, apart from anything else, it illustrates the need to scrutinise all that the Secretary of State says today very carefully.

A few weeks ago, the Secretary of State said that Guy's accident and emergency department would not be closed for some years, that Philip Harris house would be used

"for most purposes for which it was intended"

and that Guy's would continue to

"provide a wide range of specialist and local hospital services."

I am sure that many of those who heard that announcement thought that it meant that Guy's would be saved as they now know it. Answers to parliamentary questions that I have tabled show, however, that in-patient beds at Guy's will be cut from 702 to 112.

The transfer of services to St. Thomas's will not apparently be possible without even more rebuild, expense and disruption to clinical services than was originally suggested. It will still leave empty eight floors of Guy's tower and all 11 floors of New Guy's house, both recently built and in clinical use. I understand that, even if all the developments required to replace at St. Thomas's facilities provided at Guy's were carried through, available space for clinical services would be less than existing space.

Estimates of the cost of that transfer are in excess of £200 million. Suggestions seem to be made that much of that money will come from private sources. Those who make that investment will no doubt expect a return, yet that investment is being made in large part to replace facilities that already exist. Despite what the Secretary of State said last month, it still appears that 18 state-of-the-art intensive care beds are among the facilities provided in Philip Harris house which will be lost. That is on top of the loss of up to 31 existing intensive care beds at Guy's, when everyone knows that there is intense pressure on such beds in London as a whole.

In many ways, that aspect of the proposals symbolises the Secretary of State's failure. When Philip Harris house is handed over, it will include 12 surgical and six medical intensive beds, which, according to contract, will have been equipped with all the most modern purpose-built facilities and equipment. Such beds are needed. Intensive care beds are under pressure everywhere in London, yet the Secretary of State intends to authorise the spending of millions of pounds of public money to rip out and destroy those facilities so that they can be replaced by something else. No matter what the blueprint is to which she is working, and no matter who the experts are who drew up the blueprint, however long ago it was, that makes absolutely no sense.

There is concern about the practical and financial impact of the proposals for Edgware hospital. The money allocated to build up Barnet hospital is, I understand, sufficient for the first third of redevelopment, but London Health Emergency estimates that the Barnet project needs to be at least two thirds completed before it will be practical even to consider going ahead with the proposals for Edgware. That is apart from the question of redeveloping and making changes in transport patterns in the region, to which Conservative Members have drawn attention.

My chief criticism of the Secretary of State is that a pattern runs through all the proposals and all the problems that the Government create. They anticipate the effect of the change that they have decided is desirable. They presume that what they expect will happen, and that the unexpected will either not arise or be insignificant. When the unexpected does happen, such as the increase in emergency admissions, they carry on regardless.

Surely the logic of the right hon. Lady's argument is not, as she has already stated, that there should be a pause or a review, but that the closures to which she has referred should be reversed completely and, in my view, for all time.

The hon. Gentleman will no doubt make his case and that of some of his hon. Friends, but unless the Secretary of State is made to realise the depth of concern about the whole range of her proposals, some irreversible changes will take place. It may or may not be in the area that affects the hon. Gentleman's constituency, or in the constituency of the right hon. Member for City of London and Westminster, South (Mr. Brooke), who represents Bart's, but irreversible change will take place. We believe that no such change should take place without review.

Will the right hon. Lady give way?

I cannot. I am sorry. I would have given way to the hon. Gentleman, but time is not on my side.

The Government assumed that the new computer system for the London ambulance service would work as planned and they pushed ahead with its implementation. Across the country, day case surgery increases and, as a result of technical change, there is increased throughput of patients, but either no allowance or insufficient allowance is made for the knock-on effects, for the fact that facilities to resolve the problems of people receiving day case surgery are all too often inadequate or non-existent, and for the fact that speedier discharge of in-patients means far greater pressure on wards as everyone still in hospital is at the peak of their need for care and attention.

Beds in psychiatric hospitals have been taken out of use in huge numbers. Over-ambitious anticipation of reduced levels of need has meant that even though the number of beds in the private sector has increased, there is still well above 100 per cent. occupancy in all too many cases. Psychiatrists despair that the facilities required to help them cope with those with a mental disorder no longer exist on a level to meet the need. What is true in all those areas of policy is especially true in spades of the funding of primary care in London.

The Secretary of State's chief argument for the reduction in hospital beds is that the Government assume what almost nobody else now takes for granted—that investment in primary care will reduce the demand for hospital beds. In fact, there is a growing suspicion that by revealing unmet need, it will actually increase the demand.

What no one doubts is that the public have lost confidence in this Government's handling of the NHS—something for which the Secretary of State blames everybody but herself. The public have lost confidence in the Government's competence, their good faith and their ability to listen.

One of the Secretary of State's colleagues recently spoke of her family's history in terms that, for me, evoked the 1914 war rather than the more recent conflict. Her colleague spoke of her in family tradition marching towards the gunfire. I thought that analogy to be more than a little misconceived. If there is a parallel with the experience of that conflict, it is that the Secretary of State, far from being a brave subaltern or even one of the poor bloody infantry marching towards the guns, is the general, safely back at headquarters ploughing on with a doomed strategy and refusing to take any notice of the fact that there is any alternative.

The right hon. Lady claims to have a mailbag full of correspondence supporting her proposed changes to London's health service. However, when we tabled a parliamentary question asking what percentage that was of the total correspondence that she received on the changes, I am afraid she told us that the figures were not available. It probably would not matter if they were, because I am beginning to think that the right hon. Lady's outstanding political characteristic is that she hears only what she wants to hear. Her ears are as closed to other voices as her mind is to other opinions.

I know that many hon. Members in the House today do not support the policies that the Secretary of State is advocating and that if there were a free vote, she would be defeated. Those who do not support her proposals must weigh seriously whether they should support her in the Lobby tonight. She will take no heed—and I suspect that the Government will take no heed—of measured words of caution or of anxieties, no matter how deep, how sincere or how seriously expressed.

If the House wishes to send a message that even the Secretary of State cannot misinterpret or misunderstand, that message must be clear. It must be bold. It must be defeat.

4.57 pm

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

'noting that the problems of London's health service have been the subject of at least 20 reports in the last 80 years, all of which have come to broadly similar conclusions, believes that a better service for patients lies in implementing decisions and not a further review; commends the Government for its record in investing in modern hospitals, first class specialist centres and primary care and for its determination to take necessary decisions in the long term interest of the Capital's health service and the people of London; and calls on the Government to ensure that the decisions are now carefully carried forward taking due account of concerns that they should be properly paced so that patients continue to benefit from new and better services before old ones close.'.

This is a serious debate and a matter of great importance and consequence. It is a subject of, frequently, great conviction and of great emotion, not only for my hon. Friends but, I accept, for Opposition Members and for those whom we serve in constituencies throughout the land. I believe that our task is to achieve a health service worthy of our capital city for the next century.

"To argue merely for the status quo is a grave disservice to the future well being of the health service in London."

The right hon. Member for Derby, South (Mrs. Beckett) will recognise—or at least she should recognise—those words not as my words, but as those of her immediate predecessor.

Sadly, as the right hon. Lady's speech today has shown, the Labour party has gone downhill since then. What is remarkable about the so-called new party is how it has scuttled away from the sound consensus on the need for change in London's national health service. The right hon. Lady's moratorium is a cop-out. Dithering in Opposition shows why her party would be a disaster in Government. This debate is a cynical and opportunistic piece of parliamentary gamesmanship, and once again shows beyond doubt that Labour will always put party politics before the nation's interests.

rose—

Give way. [Interruption.]

Order. I wish to hear the Secretary of State. Does she wish to give way?

In a minute.

Governments must rise above such tactics. Our task is to take the necessary decisions that the national interest demands. There are no instant answers or scratch-card solutions. It is not a question of a bit more money here or a review there. Those are smoke-screens thrown up by the Labour party to disguise the real questions at the heart of the debate.

Do we want London to continue to enjoy an outstanding national and international reputation for service, teaching and research, or are we to submit to a second-class service? Do we want Londoners to have the most modern and advanced hospitals, or is it more important to preserve every building and site even when they are outdated and ill suited to today's needs? Do we want to bring general practitioners and community health services up to the standards of the best, or is the current patchwork a price worth paying to maintain the hospitals status quo?

These issues have been debated endlessly:

"For 30 years, reports have been written and schemes put forward for improving medical care and teaching … Everyone who has studied the problems accepts that specialist services are duplicated, too few patients live near the sites in inner London and those in outer London are deprived. Everyone agrees that the first priority is to improve primary care and help GPs."

Those were not my words but those of Lord Annan, a distinguished former vice-chancellor of London university. Lord Annan speaks for many.

I pay tribute to the many doctors, nurses, scientists, academics, commentators, the independent specialty review members, the research team members and the patient groups who have prepared and argued the case for change. They believe that the time has come for the Government to stand firm in London's interests. They speak with a powerful and authoritative voice which we all must hear. They believe that we must build for the future, rather than remain fossilised in the past.

It is not just the distinguished academics and eminent doctors who have been calling for change. Those closest to patients know that the services in London are not good enough. We must address change to make sure that we have a capital health service for the people of tomorrow.

I wish to refer to a point that my right hon. Friend made earlier in her speech, when she described the tabling of this debate as opportunism by the Opposition. May I inform her that I sought from the Leader of the House an opportunity for such a debate and remind her that I wish to register my vote against these proposals?

I accept my hon. Friend's constituency interest, and I shall say more about the situation in Edgware and Barnet later in my speech.

The Labour party knows full well that, if it ever pretends to be a party of government, addressing change in London is necessary. Many Labour Members are seeing phenomenal and unprecedented investments in their constituencies as we build hospitals near to where people live. For them, today's debate is a piece of outright cynicism and opportunism. I repeat those words strongly.

Will the Secretary of State give way?

No, wait. [Interruption.]

Order. The House knows full well that is up to a Minister or any Member who has the Floor to decide whether to give way or not.

rose—

On a point of order, Madam Deputy Speaker. Whatever gibberish the Secretary of State wishes to propound today, should she not be called to order? Is there not a long-established tradition in the House—I have been in the House longer than the Secretary of State—that when the leading speaker from the Opposition gets up, the Secretary of State sits down?

Order. The hon. Gentleman may have been here for a long time, but he has still not grasped the point.

I shall give way to the right hon. Member for Derby, South in a moment, but I want to get on a little further in my speech first.

There are difficulties and problems, and it is well understood that hon. Members feel close to their constituents and the institutions which have served them over many years. It is inevitable that when we are faced with such complex and fundamental change, great sensitivity is necessary in handling the delivery of that change. But the difficulties and the problems make the case for change even stronger.

The stories and accounts that we have heard of the difficulties in hospitals are precisely because there are many separate units instead of larger units, which are better managed and which co-operate better in handling the ebbs and flows of health care more effectively. Report after report makes the point that we must deliver a health service which is right for the future, and not a service that was right for the past.

The Secretary of State has repeated today what she has said repeatedly in the past few days on radio and television. She has said that there is something cynical and opportunistic about the Opposition tabling the debate. As her hon. Friend the Member for Hendon, North (Sir. J. Gorst) reminded her, we called on the Secretary of State to provide a debate during which the House could thoroughly assess and thrash out the consequences of the proposals. We have called on her to do that many times in the past, and it is a demand that she has consistently refused.

If the Secretary of State thinks that it is not the purpose of Members of this House or members of Her Majesty's Opposition to provide an opportunity for proposals of this magnitude to be assessed, debated and discussed by people of different points of view, she does not belong in the House at all. That is what we are here for.

I totally accept that the Labour party is the natural party of opposition. It constantly criticises and interprets developments in a cynical fashion, but never has any constructive proposals. Those of us who are now seeing the third health spokesman for the Labour party are still waiting for a policy from any of them. "A moratorium", "out to consultation" and "another review" is what we hear. The Labour party does not want to offend anybody, and it never says yes or no. That is always the way forward for the Labour party.

The right hon. Member for Derby, South responded to an intervention from my hon. Friend the Member for Hendon, North in that way—she said neither yes or no. The Labour party will say anything to try to achieve power ruthlessly and cynically.

rose—

I intend to proceed.

Will my right hon. Friend give way?

In a moment.

The change must be handled sensitively and it must be properly paced, but there is no serious challenge to the direction of travel. "Go carefully," we are told, "but do not go back". I give my hon. Friends, Members of the House and London patients a strong assurance that there can be no going back. The issue now is not the policy, but the implementation of the policy.

It is the duty of the health service to carry out the decisions with skill, tact and perseverance if the benefits to London and the rest of the country are to come through. I have just written to the chairmen of the two Thames regions to stress precisely that message. Those chairmen, and the health authority and trust chairmen involved, will be held to account for carrying the policies through. They must explain, listen, lead and reassure staff and public alike that the changes will bring tangible and important benefits to patients. That is a message that they welcome. They are committed to working for the future, and not clinging to the past.

My right hon. Friend will have noticed that the right hon. Member for Derby, South (Mrs. Beckett) said that if there were a free vote tonight we would not vote in support of the proposals. Should not the right hon. Lady give a free vote to Opposition Members to see how her northern Labour Members vote? They do not want more money for London, but more money for the provinces.

As ever, my hon. Friend is acute on matters of health policy.

While I fully understand the views of local Members of Parliament, will the Secretary of State confirm that the over-concentration of hospitals and spending in central London inevitably mean that other areas in the region are seriously and consistently under-funded? Would it comfort the Secretary of State to know that many of us have a great deal of admiration for her courage in facing up to an issue that has been neglected for years, but only contempt for the Opposition, who pretend that the problem does not exist?

I thank my hon. Friend. He represents a constituency where, in the past, constituents routinely travelled to London for care that they now receive at home. It is time to have a better balance of service and funding. London has long had many specialty hospitals, which are duplicated and fragmented and do not deliver the care that we expect for the future. We seek to achieve a balance within London and the home counties.

The result of the changes will be more modern local hospitals that are better geared to meeting the needs of Londoners today and tomorrow. For example, in Greenwich a new hospital—the Queen Elizabeth—will be available to NHS patients from August, bringing services from two other hospitals on to a better site. Neuro-sciences will transfer from the Brook to King's. Close links with the internationally respected Institute of Psychiatry will establish a truly world-class centre of excellence.

Hon. Members will know how strongly I believe that our job is to maintain not only national but international excellence in this country's research and teaching. The Brook hospital will close as it is old, cramped and ill-suited to modern health care. Incidentally, it has no "e" on the end, as the Opposition wrote in their original motion.

My right hon. Friend will know of my concerns for the national health service in London, which I have frequently discussed with her. The hon. Member for Newham, South (Mr. Spearing) and I have often raised the issue of the London ambulance service. Is she aware that this morning I called an ambulance for a lady who collapsed before my eyes? It arrived within seven minutes and the lady was in hospital and being properly treated shortly afterwards. Will that be the future pattern for London?

Is my right hon. Friend also aware that, just a few years ago, Labour-controlled Ealing council put £500,000 on the rates of Ealing hospital and other medical or hospital institutions in Ealing, so much did they care about the health service for my constituents—

Order. I have already said that interventions must be brief.

My hon. Friend is right about the significant developments in the London ambulance service, which for many years has been a troubled and unsatisfactory service. We now see extremely encouraging progress: better manning and staffing arrangements, clearer leadership and, above all, a better service for the people of London, including my hon. Friend's constituents.

The Secretary of State will know that last year one of my constituents suffered third-degree burns to 40 per cent. of his body on a Sunday. He had to be taken to hospital in a fire engine because no ambulance was available in north-west London. When I drew that case to the attention of the Secretary of State, the letter that I received in reply led me to believe that new ambulances would be provided for that part of London. A subsequent letter has told me that the proposal to cut the ambulance service within my constituency from its present complement of eight ambulances to two is a step forward. I do not regard that as an advance and nor do my constituents.

I shall look into the hon. Lady's case. I can inform her, however, that 180 new vehicles are being provided for the London ambulance service and there is a formidable programme of investment. We have long sought better management and leadership of the London ambulance service, which is one of the few services left that has not gained trust status. It is old-style NHS, not the NHS that we have been so keen to put in place.

As well as the changes that I have described, many other hospitals are being strengthened and improved. I challenge the Opposition to admit that their constituents often see the benefits. The hon. Member for Hampstead and Highgate (Ms Jackson) is all too keen to criticise, but we rarely hear about the improvements taking place at the Royal Free hospital or the extra investment. The hon. Member for Islington, North (Mr. Corbyn) never mentions the £2 million spent on his accident and emergency service.

Will the Secretary of State explain why there was no elective surgery in the Whittington hospital between December and April this year? Why are 3,000 people waiting for operational appointments at the Whittington hospital when she has managed to spend so much money on improving health care in Islington by closing Bart's and the Royal Northern hospitals?

Time and again, the Opposition fail to appreciate why it is so necessary to introduce change in London. Waiting times are coming down, but we need larger and better balanced units, A and E services which deliver a high quality of care, and investment in primary care. That is exactly what we are delivering.

Although we hear from the hon. Member for Dulwich (Ms Jowell) about Guy's, she never mentions what is happening at King's—the new neuro-sciences unit, liver unit and magnificent day surgery unit, and the £8 million going into the A and E services. Nor do we hear from the Opposition that by tackling the problems in London we can better help hospitals outside London, which so many of my hon. Friends are concerned about.

Before my right hon. Friend leaves the subject of constituency interests and loyalties, is she aware of the great irritation felt by many patients outside London at the assumption that any serious case must be treated at a London hospital? She will be aware of all the new regional specialist centres that have been founded in recent years. Will she undertake not to seek to pacify pressure groups from London at the expense of funding for the new centres of excellence throughout the country?

My hon. Friend is exactly right. What we need is a national health service which serves patients' interests but does not have its agenda dictated by the patterns of the past.

I wonder whether the hon. Member for Plymouth, Devonport (Mr. Jamieson) will speak on behalf of his constituents. Does he still want them to travel 200 miles from Plymouth to the London Chest hospital for their heart operations, or will he have the courage to admit that the changes in London will deliver a new cardiac unit in Plymouth?

The person who deserves a prize for the ultimate cynicism is the right hon. Member for Derby, South. Did we hear a word from her about the £10 million for the Derbyshire Royal infirmary? Of course not. It is the height of hypocrisy for the right hon. Lady to criticise changes in London when similar concentrations of specialist services are taking place in her constituency along with the development of community services, and her constituents are seeing the benefits.

My right hon. Friend is right to say that Conservative Members do not need advice from the Labour party. When it was last in government, some 60 hospitals a year were wholly or significantly closed down. Does my right hon. Friend appreciate the difference in the complex arguments between central and outer London hospitals and the severe crisis that Edgware General hospital in outer London faces? If its A and E unit is closed down, Barnet General hospital and Northwick Park hospital will be too far away for ambulances to get there in time. Her suggestion of two additional ambulances is insufficient and inadequate. Will she respond to those arguments for Edgware General hospital?

My hon. Friend will understand that I have already said that I hope to say more about Edgware General hospital later. I shall refer specifically to the matters that he has mentioned, but he is absolutely right about the Labour party.

The right hon. Member for Derby, South may be an endangered species, as one of the few members of her party to have served in government, but she appears to have forgotten that Government's record, in which I am not surprised that she takes little pride. Sixty hospitals closed in every year that Labour were in office. They cut nurses' pay and cut—

The Secretary of State has now said two things in an attack on me. The first I find extraordinary. She says that I do not welcome investment in my constituency; of course I do. But why—[Interruption.] I simply add that, when the Derbyshire Royal infirmary, to which she referred, was contacted, it asked where the £10 million was, but we shall not go into that.

I do not know why the Secretary of State should suppose that, because there has been investment in hospitals in my constituency, I should be indifferent to the problems that she is causing in London. That is a peculiar attitude to express.

Secondly, it is untrue that 60 hospitals a year closed under the most recent Labour Government. The figures show that 128 hospitals were built in five years under the most recent Labour Government, compared with 21 under the present Government.

We can clarify the figures further at a later time. [HON. MEMBERS: "Oh."] Sixty hospitals closed—[Interruption.] The hospital closure programme of the most recent Labour Government is the least of their record. What about a party that cut nurses' pay, cut doctors' pay and cut national health service spending for the only time in its history? That is what the right hon. Lady—

Will the Secretary of State give way?

No, I have given way quite enough. [HON. MEMBERS: "Give way."] No, I will not.

That is what the right hon. Lady described a moment ago as exercising political judgment. Those of us who worked in the health service at that time remember what that political judgment was like: it was painful for staff and patients, and none of us wish it to be repeated.

It is being repeated.

That is interesting. The hon. Gentleman said that it is being repeated, but it was a strange use of language because there has been an enormous advance in nurses' and doctors' pay, there has been an improvement in training and, most important, we have opened—not closed, but opened—a new hospital development, on average, every week that we have been in government.

Would my right hon. Friend note that we in north-west Kent, which goes for many of the home counties, resent the fact that so many of our constituents have to travel at great inconvenience all the way into central London for treatment, where added on-costs of 40 per cent. apply? That is because resources have always been concentrated on central London. If my right hon. Friend presses on and releases resources to improve the type of centres to which my hon. Friend the Member for Reigate (Sir G. Gardiner) referred, and Darenth Park hospital in my constituency, she will have support for putting health care where people actually live.

I share my hon. Friend's opinions, but it is important that the specialty services which remain in London—the tertiary services—should become even greater centres of excellence.

The dilemma is that, as fewer patients come to London, for all the understandable reasons, because of the massive building programme that we have established throughout the home counties, when they do come to London they will expect a level of care and a quality of expertise that is among the absolute best. Only by bringing those specialty services together shall we achieve that excellence. That is what the specialty review said. That is what the academics and the researchers said time and again. That is the reason why we have received such strong support for those proposals from the leaders of the profession, especially those who mind about excellence, not only for the present century, but for the century ahead.

Will the Secretary of State give way?

I will not.

Before I leave the subject of the record of the right hon. Member for Derby, South, it is irresistible for me to remind the House about the cuts over which we have indeed presided—the cuts in waiting times. Five years ago, before our reforms, there were 200,000 one-year waiters in the country. It is interesting that the Labour party sneers when it talks about waiting times because, if one asks people what they think about the national health service, time and again they say that they cannot fault the care that they had, but that they waited too long. We have consistently made waiting time a priority. Yesterday we announced that, instead of 200,000 one-year waiters, we now have fewer than 32,000. That is a splendid and remarkable achievement.

When my right hon. Friend talks about the record of the national health service, for which she is responsible, in Derbyshire, will she acknowledge that not only have new buildings been built at the Derbyshire Royal infirmary but a new children's hospital will soon open in the Derby City General hospital and a brand new hospital has been built in Chesterfield? That is our commitment to the health service and the capital programme, which was cut by the Labour party in Government.

Once again, my hon. Friend exactly identifies the issue. The Labour party appears to argue that one can have all the new hospitals, the new developments, the centres, the equipment, the expert staff, without ever closing an old hospital, without ever taking a difficult decision, ducking every difficult problem, pandering to every pressure group. The new Labour party makes Michael Foot's old outfit look like international statesmen.

If we ducked the decisions, the Opposition would have a legitimate cause for grievance, but they know that it is not so, because we are tackling the issues that matter. I have talked about improved hospital services closer to where people live. Improved primary care in London also matters. It matters that the poor, the sick, the homeless and the mentally ill can rely on effective local services to meet their needs.

When the right hon. Member for Derby, South was a Labour party researcher, I was researching in the east end, in Bethnal Green. I know how people in Bethnal Green were deprived of even a moderate level of primary care, of general practice, of the basics of a health service. Yes, there were any number of institutions, but the basics, which must be the essential foundation of a health service, were lacking. I do not take it kindly when the right hon. Lady suggests that I do not know the realities of life in the inner cities, having spent more of my life working in the most impoverished districts in the inner cities than I have in politics, let alone in government.

Will the Secretary of State give way?

I shall come to the hon. Gentleman in a moment, when I discuss his area.

Time and again, the Labour party used to urge us to invest in primary care. It does not make that charge so much any more, because we have exceeded the commitments that we promised at the beginning of the process. The King's Fund and Tomlinson recommend investment in primary care. Tomlinson recommended £140 million for primary care. We have invested £210 million in 1,000 or more schemes throughout London—new general practitioner services, modern health centres, community health teams, hospitals at home. That is a great range of provision. When did the Labour party ever do as much for the people of London? When did it ever do anything for the people of London?

What matters is decent community care. It matters that elderly infirm people are well looked after at home or in homely surroundings. Since the publication of the Tomlinson report, we have committed an extra £338 million to London local authorities for social services. The first fruits of that investment are becoming apparent. An extra 200 nursing beds opened in inner London in the past year, another 800 were approved and there are plans for at least 1,000 more. Those are the necessary services to meet the needs of an aging population.

It matters that patients who need emergency care receive it from a well equipped centre, staffed by highly trained doctors and nurses, with all the back-up that they need—not from old, isolated units where care might become a lottery and lives might be put at risk.

"A small number of larger clinical teams gives the patient the best chance, each team supported by a greater number of intensive care and specialist beds"—

not my words, but those of a doctor who works in one of the busiest accident and emergency departments in the capital, Dr. Howard Baderman, who also advises the chief medical officer on A and E services.

The clinical advice is clear and consistent. No responsible Government could construct a health service disregarding the advice about the way to have the best clinical outcomes from A and E services—the basic and fundamental element in our health service.

When the Labour party cannot attack the argument, it plays on the fears of the vulnerable and the sick and spreads scares, but the public have seen through that. They remember Jennifer's ear: that lost Labour the last general election, and it will lose it the next.

What matters is harnessing new technology to treat more patients to an ever higher standard. Many more patients can be treated without staying overnight in hospital or by their GPs. The new specialist centres outside London, to which my hon. Friends have already referred, mean that patients can be treated locally rather than in London. Health authorities have a duty to plan the level and range of services that their areas need, which must, of course, have an adequate and appropriate supply of beds.

The Government do not have a target for bed numbers. We expect health authorities to balance services to needs, year by year. They must take account of the prevalence of disease, the age structure of the population, the formidable advances in clinical practice and all the other factors that affect the demand for services. Contrary to what is suggested in the motion put down by the Labour party, there has been a significant increase in the number of intensive care beds. As the House is aware, we are now looking again at how we can better manage those intensive care beds. Time and again, the advice is to bring them together in larger settings so that the health service can better cope with the ebbs and flows.

Does my right hon. Friend agree that most of us understand the special constituency interests of those who represent inner London, who are concerned about hospital closures? Despite that, the reform of health care in London is long overdue and the relevant report has been sitting around Whitehall for far too long. Most of us recognise my right hon. Friend's courage in taking up the reform and her determination to see that good health care is provided not only in London but in the provinces, to which a lot of people from London have moved out.

I thank my hon. Friend for those remarks, which I appreciate.

It is important to set the record right about beds. We need the right balance. The number of beds closed in recent years does not match that quoted by the right hon.

Member for Derby, South. In the past three years, we have seen a 30 per cent. increase in activity [HON. MEMBERS: "Activity?"] The number of beds in inner London has reduced, but the reduction has been more cautious than the level set out by the King's Fund and it is in line with the Tomlinson proposals.

We have always made it clear that the proposals need to be carefully implemented and monitored. We need to be watchful as we take forward those plans, and that is why the report of the inner London chief executives is so important. It is their duty to ensure that they plan services according to local need and get the balance right. Their report, which was published just the other day, made it clear that what is needed is not more acute beds in total, but a better disposition of specialist and general acute beds, and medical and surgical teams to meet the needs of patients. They have set up an action programme to address the problems that exist. It will provide better bed management, better discharge arrangements and will tackle bed blocking. That programme will ensure that there is better co-operation on emergency admissions.

The right hon. Member for Derby, South referred to Homerton. It has always been the case that there have been ebbs and flows in the pressure on hospitals. Co-operating carefully on those arrangements represents the best way of managing the health service. Not only are there more beds open at that hospital, but a great many more are planned. That hospital will be subject to a £30 million programme. The same is true of Northwick Park, where at least 30 beds have been opened this year and 40 will come through next year. We have identified the need for change in those hospitals and are addressing it.

Will the Secretary of State give way?

No.

Specifically on Homerton?

I hope that the hon. Lady will understand if I do not give way. I have already spoken for a long time and if I do not make progress, hon. Members who want to speak may not have the opportunity to do so. I am sure that the hon. Lady will find an opportunity to speak later.

I must refer to some of the areas that have caused great concern. My right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) has argued powerfully that the ethos, traditions and culture of St. Bartholomew's should be preserved as services move to Whitechapel. I agree with him. He knows that a task force chaired by Sir Ronald Grierson is examining alternative uses for the St. Bartholomew's-Smithfield site in keeping with its proud past. In addition, a working group led by the Corporation of London has been developing plans for the alternative provision of community services at St. Bartholomew's to meet local needs. Others have suggested that the name of St. Bartholomew's should live on in the title of the trust—I accept that—in practice as well as in spirit. [Interruption.] I am pleased to say that the trust is considering that suggestion and I hope that it will be able to make that announcement soon.

My right hon. Friend and my hon. Friend the Member for Chislehurst (Mr. Sims) have queried the pace of change at the Guy's-St. Thomas's development. During consultation a number of modifications were made. Let me reassure my hon. Friend the Member for Chislehurst that the A and E at Guy's will not close until alternative services are ready to take its place and able to provide better care. Those services include improved primary care, the minor injuries unit and the alternative casualty units at King's, Lewisham and St. Thomas's.

The trust will continue to provide at Guy's a wide range of hospital services, many of them geared to the needs of local people. In fact, 80 per cent. of patients currently seen and treated at the hospital will continue to go there. In keeping with its pioneering traditions Guy's will be at the forefront of developing state-of-the-art diagnostic and day case and out-patient services. It will genuinely be a hospital of the future.

How can the Secretary of State accept the recommendation that a date be fixed for the closure of an A and E department when the number of people presenting to such departments is rising? How can she accept that recommendation when it is clear from the advice of the people who run that department that they need it for the foreseeable future and that it would be unsafe to predict when it will not be needed? The consultants say to a person that to remove an A and E department and leave a major hospital, which treats a huge number of out-patients, and which has in-patient beds, without an intensive care unit, will render it so dangerous that they will find it impossible to operate in those circumstances.

The hon. Gentleman already knows that informing all our work on A and E services was the report by Sir Norman Browse and his team. We would not dream of accepting proposals if we were not satisfied that they conformed with the advice of the president of the Royal College of Surgeons and his team. The hon. Gentleman will also be aware that I have set not a date when the department will close, but one before which it will not close. I repeat my commitment that until or unless alternative arrangements are in place no final closure can take place.

I have sought not to speak at great length about the opportunities for medical schools and the link-up with the multi-faculty colleges at London university. The merger of Guy's and St. Thomas's offers a unique opportunity to develop the biomedical sciences campus on the Guy's site. It will become a major research and teaching campus as good as any in the country. I should also like to confirm again that Philip Harris house will be properly used—85 per cent. of the services it will provide will be those for which it was originally intended.

The future of Edgware hospital is of particular concern to some of my hon. Friends. A new £60 million hospital is being built at Barnet in north London, which brings to an end 25 years of uncertainty about the way forward for the two hospitals at Edgware and Barnet. Edgware hospital is not closing, because four out of five patients currently treated there will continue to attend.

As a result of the representations made by my hon. Friends, the opening of the proposed new minor accident treatment service will be brought forward to the earliest opportunity. They made a number of suggestions during the consultation period and subsequently, all of which I have sought to heed, take seriously and to match with practical proposals. Both the minor accident treatment service unit at Edgware and the new fully equipped and staffed casualty department at Barnet will be well established before full-scale A and E services move from Edgware.

The trust is already discussing with local GPs a possible GP presence at the minor accident treatment service unit. I have sought and received assurances from the local health authority and the London ambulance service that extra investment will strengthen the ambulance service in that area. The health service is investing in full non-emergency transport at Edgware to serve those who need to go to other hospitals. In addition, the Parliamentary Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville), is having discussions with the Department of Transport about how we can improve transport arrangements further.

My hon. Friends the Members for Finchley (Mr. Booth) and for Hendon, South (Mr. Marshall) have argued strongly for the need to improve primary care in advance of the hospital changes. I am pleased to say that the regional health authority has decided to provide an additional £2 million—taking the total to £17 million—for improvements to family doctor and community services in the western part of Barnet, the area that is closest to Edgware hospital.

By 2000 we shall have spent more than £1 billion building a top-class health service in London. The programme of change has been preceded by an unprecedented amount of discussion, consultation and review. Decisions were needed to bring an end to uncertainty and delay for staff and patients alike.

Will my right hon. Friend give way?

I hope that my hon. Friend will bear with me, but I must bring my remarks to a close.

Now that the decisions have been made, it is vital that they are implemented sensitively, properly sequenced and carefully paced. For the period of transition, I give this seven-point pledge to the House. There will be no closures until alternative and better services are up and running. There will be modern emergency services, including an improved London ambulance service. We will continue to hold health authorities to account for providing comprehensive and effective services in each area, including a proper supply of beds to meet demand. Waiting times will improve further; the patients charter standards must be met.

Will my right hon. Friend give way?

I will not give way to my hon. Friend again, as I have already done so. We will continue to recruit and retain the very best doctors and nurses. The staff and the public will be involved in the changes so that they can see and contribute to the objectives. Finally, we will support innovation and development in teaching and research so that London maintains its prime position and we can invest in the next generation.

Since 1948, Parliament has given government the statutory duty to provide comprehensive health services for all who need them. We believe that we are building a health service in the capital that will serve our children and our grandchildren well, rather than the one that was right for our parents and grandparents—such is the phenomenal rate of medical advances. We have a crucial opportunity to prepare for the 21st century. The price of doing nothing—the price of Labour—would be to let our hospitals and our health service slip into decline and to fail London and Londoners. We are not prepared to pay that price.

We want a health service in which people can take pride. We shall succeed by holding firm and by being prepared to lead and not surrender. Edmund Burke said—[Interruption.]

Order. Hon. Members may not like what the Secretary of State is saying, but she is entitled to be heard, just as the right hon. Member for Derby, South (Mrs. Beckett) was entitled to be heard.

Edmund Burke said:

"A state without the means of some change is without the means of its conservation".

So it is with the health service. The Conservative party did not win four general elections by backing away from tough and sometimes, in the short term, unpopular decisions. We did it by sticking to our principles. Our duty is clear and our courage is intact. We shall hold firm because the interests of our health service, our capital and the rest of the country depend upon it.

rose—

Order. Before I call the next hon. Member to speak, I remind the House of Madam Speaker's decision that there will be a limit of 10 minutes on all Back-Bench speeches.

On a point of order, Madam Deputy Speaker. In her speech, the Secretary of State had an argument with my right hon. Friend the Member for Derby, South (Mrs. Beckett) about hospital closures. The Secretary of State said that she would clarify those figures later. Hon. Members who have tabled parliamentary questions about hospital closures, including me, have received the answer that the Department of Health does not keep that information centrally. Some of us would regard it as inconceivable— Madam Deputy Speaker: Order.

It must have been lying— Madam Deputy Speaker: Order. I remind the hon. Member for Leyton (Mr. Cohen) that when the Speaker or the Deputy Speaker rises, the hon. Gentleman must resume his seat. It is perfectly clear that the hon. Gentleman is raising a matter of debate and of fact. The Chair is not responsible for the content of speeches.

Further to that point of order, Madam Deputy Speaker. I am not raising a point of debate. I am asking you to investigate the answers to those parliamentary questions because I think that false information was given to hon. Members.

I thought that I made my point crystal clear: what is said in the House, whether it is correct or incorrect or falsely made, is not a matter for the Chair.

5.45 pm

Today's debate is crucial for hon. Members who believe that the announcement that the Secretary of State made before the recess is misguided, wrong and not in the best interests of the health service.

I shall address my initial remarks to my colleagues in the House who do not represent London constituencies and who often attend debates on the London health service assuming that London Members are simply trying to persuade Ministers to give London more than it deserves. There is always a danger of a divide-and-rule approach to such debates.

I ask the Secretary of State: does she believe that the money that is currently allocated to the London health service is a fair amount, given the proportion of the population who live in London and who use its health service? It could have been argued some years ago that London received more than its fair share of resources. In general terms, 15 per cent. of the health service was located in London but it received 20 per cent. of the funding, but that is no longer so. There is no evidence to suggest that London receives more than its fair share of resources. Indeed, the rising population in inner and outer London is sufficient to suggest that the balance may need to be readjusted in the future.

No one is arguing against the rest of the country having a decent, renewed health service. Londoners argue that those who live in London and those who are sent here by their doctors or consultants for treatment—some of the centres of excellence in London health provision will continue in our lifetime to treat people from all over the country—should receive a fair share of resources, and that that share should be allocated fairly.

The motion tabled by the Labour party does not argue that all change within the London health service should stop. On that basis, the motion will be supported not only by Opposition Members but by some Conservative Members.

I understand that the Secretary of State receives particularly voluminous advice from many experts and advisers whom she has cited. However, she has not tempered that advice with experience on the ground.

The Secretary of State knows that I have gained practical experience, particularly from the three hospitals that serve the community that I represent—Guy's, King's College and St. Thomas's. The experience of patients and practitioners no longer accords with what the Secretary of State considers to be the unqualified and unalterable advice that she receives from her advisers within and outside the Department of Health.

As to acute services, practitioners are saying that the number of people who are presenting themselves for treatment in casualty and accident and emergency departments is rising, not falling. The number of people on waiting lists for out-patient appointments is rising, not falling. Figures show that people had to wait for 16 weeks in 1991 and for 40 weeks in 1995. The number of people in intensive care unit beds is rising, not falling. Many intensive care units are not just full but overspilling into other bed provision, which is not prepared for intensive care use.

The trend, and this is not invented by politicians or based on political rhetoric, is towards more pressure on the health service in the capital city. The worry, which is supported by evidence, is that when people need the health services of the capital they regularly cannot be admitted to them.

When a doctor rings up for a bed, no emergency bed is available. When patients arrive at a hospital, there is no space in the ward. London hospitals are meant to have enough capacity, but patients end up being sent to Leeds. The evidence is abundantly clear that, day by day, London health services are not working.

Will the hon. Gentleman give way?

I will not because we each have only 10 minutes and I want to respect that limit.

One hospital after another has regularly had to close its doors because it just cannot cope any more.

Let the Secretary of State not meet one point with an answer to a different one. Nobody argues against new facilities or that we do not want old buildings such as Hunt's house in Guy's hospital knocked down. Nobody argues that we do not want Philip Harris house, which was built at a cost of £150 million, to be opened. We are arguing exactly the opposite.

We want the best facilities. That is why the argument for Philip Harris house is so clear: it is the best building in the health service. It would be madness not to use it for the purpose for which it was designed and built. However, we do not want commitments to changes in the future that the present circumstances do not appear to justify.

The right hon. Member for Derby, South (Mrs. Beckett) made a hugely important point about the waste of public resources. The health service is expensive, as it should be. It should provide the best possible care for everyone, no matter how poor they may be. It is nonsense to plan new buildings on one site when we have buildings waiting to be used on another. That is not a good use of public resources.

The argument that we are trying to win today, and for which we seek support from Conservative Members, some of whom have declared their support, is not about trying to unravel the health service reforms or changing direction. I am trying to win the argument, as was the right hon. Member for Derby, South, that the evidence does not support the academic and so-called expert advice that the speed, pace and details of the proposals are compatible with the needs of the different parts of the capital city.

Let me choose one example. The Secretary of State for Health wrote to me about Guy's last month and used an argument that I have often heard before as part of her case for closing Guy's accident and emergency department, although I think that she now accepts that it may be impossible to close it even in 1998 or 1999. If it is not possible to close it then, it seems foolhardy to set a date at all because it might take another five, 10 or 15 years or might never need to be closed. Why say that it will certainly be closed when it might not be?

In her letter, the Secretary of State says that evidence shows that between 25 and 40 per cent. of people who attend accident and emergency could be better treated by their GP. That is not uncontradicted advice. It is not even the balance of the advice.

There is strong research evidence that only 20 per cent. or fewer of accident and emergency patients could be treated by their GP better or more safely. In any event, the figure may be much nearer to 25 per cent. than 40 per cent.

It is the failure to accept that there is another side of the story that concerns me as a Member who represents 80,000 people in an area with some of the worst scores on the indices of deprivation, morbidity and mortality. It also concerns the people themselves who are saying, "For heaven's sake, don't ask us to write blank cheques." They do not trust that a better new service will replace the old one until the new service is there and working. When the ambulances turn up, when people are not kept lying in trolleys and when they are seen by nurses who do not leave people unattended because they are so over-stretched that they cannot cope, we will believe that London's hospitals are working.

Today we must ask the Secretary of State why she is unwilling on the basis of what she has said to concede that her proposals are causing concern and fear to users of the service and to accept the advice of practitioners, who are arguing the same case.

I have two other points. First, it is not sufficient to go through a consultation process and then ignore its results. It is no good having a semblance of consultation in the health service without taking account of the concerns of the people who have responded to that request for information.

It would be different if national health service trusts were democratically elected or local health authorities were democratically accountable because then, at the end of day, accountable people would be making the difficult choices, but they are not. The people on those bodies are appointed.

When bodies that meet in secret and are accountable to the Secretary of State, who by definition is a party political person, make such decisions, they do not receive the automatic confidence of the public and the public do not feel that they are being listened to by the people who make the decisions. I ask the Secretary of State to say that no proposal will be pushed forward unless and until it has the support of those who were consulted about whether it was right or wrong.

I shall use our local circumstances in south-east London as an example of my last point, but it applies to Edgware and east London as well. Many of the people who have advised the Secretary of State have made it clear to her that there are preconditions for what she says being acceptable. Our local health commission said that it needed £28 million extra to deliver changes that it was proposing. There has been no guarantee of that extra money, although a request has been made to the region. That is symptomatic of the way in which people are being asked to trust the administrators of a service which at the moment they see is not delivering.

At the end of Secretary of State's speech, she made her pledge, which had seven points. If I had to describe the end of her speech, I would call it a statement made by a Snow White of the health service with seven dwarf pledges following behind. Her pledge was mere words, and it is not borne out by the money that is available or by the evidence.

Nobody argues against renewing the health service. We argue rather that the health service in London should be developed with the consent of the people who use it. As with policing, one should not run a health service without the consent of the people. If the Secretary of State persists, I fear that she and her colleagues will pay the political price. I would rather that she retrenched and retracted now and listened to the overwhelming view of health service users who say that she is has got it wrong and should slow down, listen to the people and look at the facts. They can help her get the health service that Londoners need and deserve far better than her experts and advisers and the people who are not in the front line of the changes that she recommends.

5.58 pm

It is a pleasure to follow the hon. Member for Southwark and Bermondsey (Mr. Hughes). Before the great Reform Act 1832, when there were six Members of Parliament for what is now my constituency, there were two Members for the rest of Middlesex and two Members for Southwark. It is because we both have ancient seats that we have ancient hospitals and common cause in connection with them.

This debate has been years in gestation—not just the years since the Tomlinson report but the 80 years to which the Government's motion refers. I have spoken in three preliminary debates since Trafalgar day last year. I have expressed my general support for what my right hon. Friend the Secretary of State is seeking to achieve. There is no point in repeating the arguments that have already been rehearsed. I have stressed Bart's own recognition, as far back as 1977, that London specialties needed to be rationalised and concentrated.

A month ago, I criticised my right hon. Friend the Secretary of State for not coming to the House to make a statement. Although I do not think that the Executive should take the legislature for granted, I confess that I felt a little like Shakespeare's second murderer. I admire and respect my right hon. Friend, not least for her courage in tackling London's endemic problems, which have remained untackled for so long, and by so many of her predecessors. However, I have said time almost without number, and not least to my right hon. Friend, that merging an institution as great as Bart's is a highly delicate venture.

The three great opportunities for this country in the post-industrial society are government, education and medicine. Bart's features in two of those. Thus, the survival of its ethos and reputation in the merged institution is critical, as it is a national asset. For them to survive in an atmosphere of intense change requires a high sensitivity to people as well as to detail. On that score, the Government's ultimate handling of Bart's has been inadequate.

I am curtailed by the restraints of time, but I shall cite a series of instances, in no particular order. The background is that Bart's has been happy to engage in the merger but the issue is whether it should be on one site or on two. The failure of public education about Bart's future remains stunning. Long ago, I recall the noble Lord Flowers saying of the urban transportation of irradiated fuel that, although he might know it to be safe, what mattered was that the public should believe it to be so.

The public do not believe the Government's case about Bart's and the health authority's handling of the responses to the consultation will not have improved credibility. I acknowledge that there were several options in the consultation document. Because they did not respond to the document's precise terminology, those who asked for Bart's to remain open, which was implicitly a vote for the two-site option, were treated as having expressed no preference.

In the preparations for the new hospital, there are 32 clinical directorates. A total of 22—more than two thirds—are headed by staff from the Royal London hospital, and nine are headed by staff from Bart's. The Royal London is the host in the merger, and I can see no evidence of a change in welcome such as I said was needed as far back as the Trafalgar day debate last year.

Next I come to the press release of 8 March from the Royal Hospitals trust which is headlined:

"Royal Hospitals Trust hits back at defective report."

I referred to that obliquely in the House on 5 April. The press release was an attack on the motivation of Bart's medical council and the professional reputation of the York Health Economics Consortium. It was issued five days before the health authority met to reach conclusions on the consultation.

Dr. Posnett, the director of the York Health Economics Consortium of the-University of York, did not go public with his reactions to the press release. On 17 March he wrote a reasoned letter of rebuttal to the chief executive of the trust. Nearly eight weeks later the chief executive has not replied. Dr. Posnett was specifically seeking to avoid a public row. However, to ignore a professional letter is not professional. Circulation of the correspondence to the trust board was first promised and then denied.

A single press release would not normally warrant such attention, but the conclusion of the York Health Economics Consortium had been that the business case for a £200 million investment on a single site at the Royal London had been insufficiently substantial to warrant not looking at alternative options more closely. In terms of the sensitivity of which I have spoken, the press release was crass and the silence since then has been contemptible.

On 21 October last year and on 5 April this year my right hon. Friend the Secretary of State and her hon. Friend the Minister of State said things about Bart's which history has since proved to be inaccurate. I do not quarrel with that because Ministers are only as good as the briefing that they receive. I hope that the briefing on the York report has been better, not least because of the circumstances.

Given the Secretary of State's concern to transfer the ethos of Bart's to Whitechapel and the health authority's confidence in the consultation document that this can be done, the financial aspects, although important, are academic by comparison with the practical consequences of this serial handling.

On 21 October I spoke of the need to ensure that the staff at Bart's should not haemorrhage away if the ethos was to survive. My right hon. Friend will know the figures. Against a background where, historically, few people have left Bart's—11 people have left, or will leave—the medical college since last August, two more are thought to be about to leave and seven others are at risk. Four of those earned absolute stars in the 1992 research ratings competition. A haemorrhage of that sort runs the risk of being fatal.

What should an individual Member do? I feel no sense of community with the chancers on the Opposition Front Bench. The predecessor of the right hon. Member for Derby, South (Mrs. Beckett) said that the status quo was no longer an option in London, yet the right hon. Lady comes to the debate without the courtesy of publishing her party's NHS policies in advance.

As the hon. Member for the City I also represent the western tip of east London. With the other hon. Members representing east London, for whom Bart's is a neighbourhood hospital, I do feel a sense of community. I am careful of the company I keep but hon. Members representing east London are entirely proper company at this time. My right hon. Friend the Secretary of State has said that she will pay attention to the view of the House and I must, on current knowledge, vote against her.

I realise that many of my hon. Friends will wish to give my right hon. Friend the benefit of the doubt. I would not ask them to come into the Opposition Lobby for they do not have the same knowledge of Bart's as I have. However, in a party such as ours, I ask them to pause for a moment to decide whether they should give Bart's the benefit of the doubt and abstain. I have seen the haemorrhage of staff already and I dread the haemorrhage that is to come. I cannot believe that any of my hon. Friends could read the York report, with its commentary on the methodology used to reach the single-site decision, without having a scintilla of doubt about what the trust, the authority and the Department are up to.

The financial figures are, in any case, finely balanced in a world where the Chelsea and Westminster figures could overrun as they did. If the House endorses the death warrant on Bart's, each and every one who votes for it is responsible. I respect the Secretary of State's certainty that she is right, for she knows how appallingly her reputation will be undermined if she turns out to be wrong.

My reading of the Government's capital investment manual reveals that it asks under the heading "Options":

"have there been any changes in available options and/or all these additional options that should now be considered?"

My reading of the York report reveals that consultation on alternative options should have occurred and should still occur.

On Bart's, I close with some words by Larkin, an unbeliever who said in church:

"It pleases me to stand in silence here;

A serious house on serious earth it is,

In whose blent air all our compulsions meet,

Are recognised, and robed as destinies.

And that much can never be obsolete,

Since someone will forever be surprising

A hunger in himself to be more serious,

And gravitating with it to this ground,

Which he once heard, was proper to grow wise in,

If only that so many dead lie round."

6.8 pm

It is an enormous privilege to have heard the speech made by the right hon. Member for City of London and Westminster, South (Mr. Brooke). We have always held him in high esteem and today, for the first time for a long time, we had a reaffirmation of honour in the House of Commons. We can only salute and applaud the right hon. Gentleman for the grace with which he delivered his speech and for the difficulty with which he has made his decision, for the moment, about his conflicting loyalties. We all know that loyalty to party often conflicts with loyalty to constituents, conscience and principles. The right hon. Gentleman has told us that, for the moment, he believes that it is right that he should go along with his loyalty to his constituents, his conscience and his principles. We salute him.

At the weekend, the Secretary of State called in some of the press and told them that she had a bundle of letters in support of her plans to close hospitals in London. I wonder how her bundle of letters compared in quantity to the 1 million people who signed a petition stating that Bart's should not be closed and to the 1 million people who signed a petition stating that Guy's should not be closed. I wonder how it compared in quality with the letters that Professor Lesley Rees, the dean of Bart's medical college, received from 344 heads of departments from 42 countries around the world and the 245 letters that he received from medical and scientific institutions from around the globe. I wonder how her little pile of letters compared with the shoal of letters—I have a copy of each one—that the Prime Minister received from top medical experts from around the world.

On the evidence of the correspondence that I have seen—I have looked through it all—the Secretary of State has been charged, indicted and found guilty by the public and by the medical establishment, not just in this country, but worldwide. It only remains for the House tonight to pass sentence and to seek retribution for what the Secretary of State has done.

Two weeks ago, the Prime Minister came to Hackney to praise Hackney council for its inner-city initiatives. He said that he wished there could be cross-party support for them and that Conservative boroughs as well as Labour boroughs could follow the example of Hackney. I was delighted to see him there and discussed some of the problems with him.

Hackney council said that it would work with anyone providing that it was in the interests of the council. It said that it would like some support from Conservative councillors on some of the steps that it wanted to take. Conservative councillors have voted for a motion that is an unequivocal indictment of the Secretary of State's proposal to close Bart's and the London chest hospital. They will be delighted with the decision of the right hon. Member for City of London and Westminster, South tonight. I think that they, like many other people, will be wondering anxiously about how other Conservative Members will respond to the debate.

Yesterday I visited Bart's to open an exhibition of paintings by patients in the Strauss ward—the only ward at Bart's that deals exclusively with those receiving treatment for mental illness. The exhibition took place in St. Bartholomew the Less, a beautiful church inside the hospital.

The irony is that the Strauss ward was opened on Wednesday 25 May 1992 by Her Majesty the Queen. Members of the royal family, including the Queen, have all been instructed that they are no longer to pay visits to Bart's, for fear that the anger that already exists due to the impending closure will be made worse. I asked yesterday and I ask the House today: what sort of a society is it where the Queen can be told by second-rate politicians that she cannot go in to the world's oldest and best hospital, even to open new wards or to see and respect some of its past glories?

Over lunch yesterday, I spoke to some of the consultants. I did not intend to stay for lunch, so none of the consultants were hand picked, and we had a general talk about what was going on. It was interesting that they all, without exception, said that they were angry and bemused. They said that, when challenged to produce a profit inside the internal market, they did precisely that. They said that, when asked to enter into a merger with the Royal London hospital, they did so in good faith and thought that it might work, only to be told shortly afterwards that it was not to be a merger, but the closure of St. Bartholomew's hospital. They accused the Secretary of State of bad faith and a lack of integrity.

The consultants used words similar to those that I heard the hon. Member for Hendon, North (Sir J. Gorst) use on television. They said that they thought that the Secretary of State did not listen and that some of her arguments were incomprehensible. Some of the consultants were ruder and said that they thought that the Secretary of State was unintelligent, was living in a fantasy world created by her civil servants and had lost all contact with reality.

I remember when the hon. Member for Hendon, North said movingly on television that there was an important thing called a political process, in which one had to take note of people's fears, people's aspirations and—a phrase that I particularly remember—even people's prejudices. I do not believe that the 2 million people who have signed the petition are all prejudiced, but even if they were, it would be extraordinary for a Secretary of State to say, "You 2 million people have had your say, now listen to the experts. I am going to get on with it and take the advice of my civil servants." That does not seem to be the way to conduct politics seriously.

The right hon. Member for City of London and Westminster, South spoke about the haemorrhaging of the centre of excellence at St. Bartholomew's hospital and of the staff that were leaving. The dean of the medical college yesterday faxed me some updated figures. I am afraid that they are even slightly worse than the right hon. Gentleman said. I have the fax and the names—obviously, I will not read out the names.

The figures show that seven professors and six senior lecturers have already been lost and are going to such places as Sheffield, Manchester, Oxford, University college hospital and the Royal Free hospital. They also show that four professors, three senior lecturers and a recorder are at risk.

Some people may say that the figures amount to only 20 people and there are hundreds of people carrying out research at Bart's, but it is important to remember that each senior figure who goes will take a clutch of research workers with him or her. Those research workers do not just carry out abstract medical research; they help with the provision of clinical services at Bart's. They have been helping, not only at Bart's, but at the Homerton and the Queen Elizabeth hospital for children in Hackney.

One does not need to be super intelligent to realise that the Homerton could seriously suffer in the future because it is no longer linked to a teaching hospital. It does not have the links that it should have with the Royal London hospital and St. Bartholomew's hospital. We need to consider medicine in east London in the context of the Royal London hospital, St. Bartholomew's hospital, the Homerton hospital and, probably, hospitals in Newham, and come up with a sensible solution and sensible amalgamations. There is no need for war between St. Bartholomew's hospital and the Royal London hospital.

A few weeks ago the Secretary of State said that the ethos of Bart's could be transferred to the Royal London. From a sedentary position my hon. Friend the Member for Bolsover (Mr. Skinner), who was here at the time, asked how the bloody hell we could transfer an ethos. I phoned up the Department of Health and was told that it could be bottled and transported. I was told that the extract of Bart's would be issued in bottles to each of the patients moved to the Royal London hospital.

Order. I call Sir Nicholas Scott.

6.18 pm

Hanging in my office in the Norman Shaw North building is a cartoon that was given to me in 1987. It was drawn by that marvellous cartoonist, Marc. It shows two Back Benchers—I think that my hon. Friends would probably recognise them—and one is saying to the other:

"I used to have this nightmare that she'd made me Minister for Northern Ireland, but lately it's been Minister of Health".

I do not think that many of us in the House envy my right hon. Friend the Secretary of State and her team of Ministers some of the difficult decisions that they are having to face as they try to ensure that constituency Members of Parliament and existing institutions are properly looked after while at the same time ensuring that we have a health service for London that is up to date as new developments and new techniques are introduced into the health care of our capital city. They have a difficult job, but we too have a difficult job. I ask my right hon. and hon. Friends to understand how difficult that job sometimes is when, as my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) said, marvellous institutions with long histories are too easily challenged and face extinction.

We look at the arguments and the statistics in the Tomlinson report. We refer to a report by Professor Jarman, which challenges many of those ideas and statistics. We listen to my right hon. Friend the Secretary of State and to my hon. Friend the Minister on the "Today" programme, with a soothing and, I am sure, accurate flow of statistics to challenge some of the arguments that are being put against them. We then look at the Evening Standard and the claims of the community health councils. It is difficult for us, as constituency Members of Parliament, to see where the real value in the arguments lies.

I know that my right hon. Friend wants to get it right not just for today's London but for tomorrow's London, and that gives her several difficult considerations.

Sometimes, too little notice is taken of a number of factors other than the existing population and the existing needs of the population of central London. The population of central London does not consist entirely of those who have a residence in central London. We have a huge additional daytime population whose needs must be met by many hospitals in the city centre. We also have a considerable number of overseas residents, visitors and tourists who might need attention by our health service. Many visitors come to this country specifically to take advantage of the excellent health service in central London, and they bring with them other economic advantages to the centre of London.

There are two other factors that we should bear in mind when we look at the pattern of health provision in central London. I understand the first factor, because the Department in which I recently served shared some of the burden of it with the Department of Health. I refer to the policy of care in the community—perfectly proper and perfectly understandable. There is no doubt at all in my mind that a significant number of those who have been released from institutional care and put into community care packages need from time to time to go into mainstream hospitals in central London because of a deterioration in their condition. Perhaps there is no other place to which they can turn to be properly looked after.

We should not ignore the possibility of terrorism as we look at the need for hospitals in central London. I am not talking about Northern Ireland and its influence on this side of the water, which we have had to endure for many years. However, bearing in mind what happened in Oklahoma and the growing number of organisations that seem to believe that they can turn to terrorism to publicise and achieve their ends, we must take account of that trend as we consider proper health care provision in our major cities, particularly in London.

The second factor that all Members of Parliament in central London can regard with pride, and for which we must fight to ensure its continuity, is that London maintains its widely recognised reputation throughout the world as a centre for health excellence. We must not lose that. I know that my right hon. Friend wants to keep that reputation and, indeed, to enhance it, and it should be a major factor in our consideration. We should consider not only the existing population who need such services in central London, but those from across the world who come to take advantage of them.

I have three major hospitals in my constituency. One is the Chelsea and Westminster hospital—a new, flourishing, expensive hospital. Whether in today's terms that hospital would ever have been built is not for me to say, but it exists and it is performing extremely well. It is still not used to absolute capacity. It has an excellent contract with the Kensington, Chelsea and Westminster health agency. I believe that it has a glittering future.

Since that hospital opened in early 1993, the number of in-patients and day-patients has steadily increased by more than 15 per cent. in each of the two years that the hospital has been open. Attendances at the accident and emergency department have increased from fewer than 40,000 in the first year to more than 60,000 this year. I recently paid a visit to that A and E unit, and I speak very strongly in support of the service that it provides.

That hospital has also introduced something that exists elsewhere—I hope that the practice will steadily increase—and that is a rota of general practitioners serving in the A and E department in the evenings. They are able to cope with the less serious visitors to the department, just as GPs would in their own surgeries. We should encourage that development in our hospitals.

The Royal Marsden hospital is also in my constituency. On 21 April, my hon. Friend the Minister was asked whether he had had any meetings about the closure of the Royal Marsden hospital and whether he had any plans for its closure and he answered none to both questions. I hope that I can count on him to continue to use that precise and brief answer to subsequent questions. There is no doubt that the Royal Marsden is a fine institution with a glittering reputation for high-quality research, and it deserves to flourish in future.

The third major hospital in my constituency is the Royal Brompton. My hon. Friend the Minister knows that board members of the Royal Brompton hospital have invited companies to meet them with a proposition to introduce a new ambulatory care centre without beds, to be known as the Royal Brompton clinic, which might be developed using the private finance initiative that the Government recently introduced. The private sector has shown great interest in that proposition. We have the chance, in Sydney street in my constituency, to have a new day clinic for respiratory and heart cases, along the lines of the Mayo clinic in the United States of America, and not costing a penny to the Exchequer but provided by private finance. It would be a tremendous addition to the quality of health care in central London.

I very much hope that my right hon. Friend the Secretary of State -and her team of Ministers will be able to overcome any objections that may be encountered elsewhere in the Government in order to bring that imaginative scheme to a proper conclusion.

My right hon. Friend has shown great political courage in the way in which she has tackled her job. She needs, too, clear judgment about the future needs of London against the background that I have sought to describe in this brief speech. In the months and years ahead, that will be a difficult task for her, but I wish her well.

6.27 pm

The right hon. Members for City of London and Westminster, South (Mr. Brooke) and for Chelsea (Sir N. Scott) have injected the reasonable and measured tone that such debates sometimes lack. It is a shame that, on occasions, our debates are reduced almost to cliché and stereotyping. The idea that this debate is an argument about London versus the rest of the country is not only inaccurate but fraudulent, and those who peddle it do so to try to obscure what is happening in London.

As my right hon. Friend the Member for Derby, South (Mrs. Beckett) said, the debate is of much greater significance; it is about the shape, nature and purpose of the national health service after the market reforms. What is happening in London hospitals today is only because they have been at the sharp end of those reforms, and it will ripple into other parts of the country before long.

The allocation of resources to health will always be difficult for any Government. I speak as somebody who was a member of the area health authority for Lambeth, Lewisham and Southwark from 1976, and who became a member of the district health authority for Lewisham and north Southwark, which succeeded it.

I and my colleagues on that authority spent many of those 16 years ensuring that we got the best value for money. Many of our decisions were extremely difficult. Sometimes we were comparing apples with oranges, but decisions had to be taken in the best interests of the people in the area.

In one of today's newspapers, the Secretary of State apparently attacks me for not supporting the Government's investment in the improvements to Lewisham hospital, among others. That was another piece of shorthand. Over the years, I was deeply involved in what became phase 2 at Lewisham and phase 3 at Guy's.

Philip Harris house has already been mentioned this evening. I am pleased with what has been achieved. My major concern, and the reason why I am speaking this evening, is that so much of that achievement is being put at risk. The improvements at Lewisham are welcome, but they have not achieved the objective of providing a service adequate to the needs of the area.

When the proposals for the future of Guy's and St. Thomas's were put out for consultation by the current health authority, the majority of responses outside the area immediately surrounding Guy's hospital were from people in my constituency who overwhelmingly used Lewisham and King's. That is because those people know that Lewisham and King's cannot cope at the moment, let alone if the accident and emergency department at Guy's were to the close.

In 1976, when I started on the health authority, there were about 16 hospitals in Lambeth, Lewisham and Southwark. Today there are four. Anybody who says the idea of change is new and needs to be faced now is misleading himself. Change in the provision of health care in London has been a fact of life, certainly since the formation of the national health service.

Many of those hospital closures were bitterly contested at the time. The decision to close Sydenham children's hospital had the capacity to be extremely emotional. I supported the closure of that hospital for a number of reasons, not least of which was how the process was approached. Ultimately, the authority and the clinicians convinced people in the area that a better service could be provided elsewhere—at Lewisham hospital. It was only with some reluctance that the people in the area agreed to the closure of Sydenham children's hospital, and subsequently moved to Lewisham hospital, which is doing very well.

That element of consent is totally lacking in the issues before us this evening. What has been most clear in the process post-Tomlinson is that change has been pushed forward almost with a life of its own. Theoretically, the people of London were consulted, in so far as they were given the opportunity to write letters to the Secretary of State and their local health authorities, but there is a widespread feeling that the consultation was a sham, and that nothing they said, except at the very periphery, was taken into account, and their views had no impact on the decisions that were taken. The issues that we are discussing this evening involve public confidence as well as health care provision.

The timetable for Tomlinson was set four or five years ago. A great deal of contrary authoritative information has emerged as the process has unfolded, and there is some doubt as to whether Tomlinson has achieved its objective. For example, since 1992, bed closures across the country have reached some 3,000, and 45 per cent. or more than 1,300 were in London alone. That shows how rapidly health care provision—certainly acute provision—has changed in London. Mention has been made of the Jarman report, the work of the King's Fund and others.

It is not reasonable, particularly in the case of Guy's, though the same case can be made for other hospitals, that no alternatives have been produced. The "Save Guy's Campaign"—I pay tribute to the hon. Members for Southwark and Bermondsey (Mr. Hughes) and for Chislehurst (Mr. Sims), and to my hon. Friend the Member for Dulwich (Ms Jowell), who have done so much work for that campaign—got KPMG Peat Marwick to carry out an extensive and detailed analysis of the options available under two or three site configurations, in concert with Guy's, St. Thomas's, University and King's College hospitals. Nobody said that it was the perfect blueprint, but those proposals made it clear that there was room for a reasoned and informed debate to decide on an alternative to the current proposals.

Hon. Members on both sides of the House are concerned about the proposals for accident and emergency provision at various hospitals, because the accident and emergency department is the heart of a hospital. All experience shows that, once the casualty department is closed, before the- decline of the rest of the hospital is simply a matter of time. It is sometimes accelerated and sometimes delayed, but it is inevitable. That is why the accident and emergency unit at Guy's is critical for people in south-east London who have been at the forefront of change in acute provision in London.

A perfectly reasonable argument has unfolded over the years for the rationalisation of specialties. The arguments are far more technical, although the assessment of their benefit is easier to calculate than that for accident and emergency provision. The rationalisation of specialties will always cause dispute, but there is more broad agreement, certainly in the light of technical and technological developments, about how developments should unfold. Accident and emergency provision is an entirely different matter, as that is how people define their local hospitals.

The hospitals in south-east London, including Guy's, cannot cope with the current demand. Speaking to a friend, I asked after his mother, who is one of my constituents in Sydenham. He informed me that she had been very ill with pneumonia, and that at one stage her GP wanted to admit her to Lewisham hospital. He said that had there been a bed available, she would have been admitted.

When I asked him what he meant by that, he said that, when they had asked for a bed at Lewisham, Hither Green or Guy's, no beds were available, so she stayed at home. Fortunately, she is better now, but those decisions cause not only distress to the individuals concerned but untold distress, inconvenience and worry to their families when they are given medical advice that they should be admitted to hospital but they cannot get in.

I was interested to hear the Secretary of State further refine the delay in announcing the closure of Guy's. She has now given a date before which it will not be closed. That is another tactical retreat, which will enable her to come back and steal the show by announcing a date 20 years on from that, and by then we might have dealt with many of the issues relating to Guy's. The announcement of the delay in itself shows how overwhelming pressure has been against the proposals of the trust.

The trusts are unresponsive, and the performance of the London ambulance service remains a source of considerable concern to all of us in London. Sadly, the figures are deteriorating, after a marginal improvement.

The Secretary of State's decisions are virtually irreversible, but the motion provides an opportunity to think against before it is too late for the people of London and the NHS they prize.

6.37 pm

It is a pleasure to follow the speech of the hon. Member for Lewisham (Mr. Dowd), who was extensively involved in the health service. I agree with a number of the points he made about health services in London that were refreshingly free of the partisan camp that so often disfigures such occasions. There has been a measured quality to the debate that might not have been anticipated, given some of its pre-publicity.

One of the reasons that impelled me to speak was my anger at the campaign of vilification that has been mounted against my right hon. Friend the Secretary of State in recent weeks. It is inevitable in the extremely difficult waters in which she has to fish.

As one of those who took on the job of Minister of Health not long after the cartoon to which my right hon. Friend the Member for Chelsea (Sir N. Scott) referred, I can assure him that, of all the posts I occupied in 11 years in government, health was far and away the most stressful and difficult. The Archangel Gabriel himself would have difficulty emerging in pristine condition from occupying that post.

It was a genuine pleasure to be in the House to hear the exceptionally eloquent and stylish speech of my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). The fact that he takes the view that he does is a sign of how difficult is the task of my right hon. Friend the Secretary of State.

All of us who care about the health service in London will be concerned about some things that are happening, and all have reservations about some of the detail of the proposals. However, overall there is no doubt that that which my right hon. Friend is doing needs in some part—probably the greater part—to be done.

It cannot be ignored or avoided by anybody who wants to discharge effectively the office of Secretary of State for Health with any distinction, particularly in the eye of history. I hope that it will be possible to conduct debates without trying personally to vilify the holder of an office merely because that individual cannot shrink from taking difficult decisions.

I need not rehearse the justifications for Government policies. London is no longer the place to which patients from all over the country must come for a range of specialist treatment. It should be a matter of pride that, under this Government, we have for the first time a truly national health service. One can have a heart transplant at the Freeman hospital in Newcastle, and St. James's hospital in Leeds is a European leader in liver surgery. Nobody is far from a modern hospital that can fulfil almost all their needs.

Whether we like it or not, the transformation of some central London hospitals from great centres of excellence offering services to a substantial part of the nation to district general hospitals was always going to be difficult and painful. That does not mean that some of the decisions and detail should not be examined, and I cannot quarrel with a number of the points made on behalf of Guy's and Bart's. It is clear that London could not go on the way it was.

The right hon. Member for Derby, South (Mrs. Beckett) has left the Chamber. It would have helped if at some point in her speech she had recognised that the process of reducing the number of hospital beds in London began under the last Labour Government, which established the London Health Planning Consortium—although it reported in the first 12 months of this Government.

My hon. Friend the Member for Reading, East (Sir G. Vaughan), who was Minister of State for Health at the time, will remember that the consortium recommended 6,200 bed reductions overall, amounting to 20 to 25 per cent. of central London's bed stock. If, by some miracle, Labour had won the 1979 general election, presumably it would have embarked on much the same course, because it set in hand the first substantive report.

I longed—in the course of a speech that lasted half an hour and seemed much longer—for the right hon. Member for Derby, South to say what Labour, which we are now meant to see as a credible and serious party of government, would do to deal with London's health service. It is deplorable that we were treated to an opportunistic assault on the Government, merely for being the people who must run the health service.

If one day—contrary to our wishes and expectations—the right hon. Member for Derby, South became Secretary of State for Health, the idea that people would be cheering her through the streets six months after she had taken office is ludicrous—the right hon. Lady, in her innermost thoughts, must realise how deeply ludicrous.

It is also ludicrous for the Labour party to imagine for one moment that it can get away, in the run-up to a general election, with making low-road points about the Government. The Opposition must say what they intend. They made that mistake before. They are unaccustomed to answering substantive points, and fall apart in the run-up to an election. In their private thoughts—although they would not admit this—they must be only too aware that that is the likely fate that could still overtake them, however full of optimism they are at the moment.

I will turn to one or two points of substance. I made it clear that I accept that my right hon. Friend the Secretary of State must take the steps she has, but it is inevitable that there will be resentment on these Benches and everywhere else if it appears that the health service that was subject to the major reforms introduced by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) are still being run according to the principles of a group of faceless people at different tiers, making decisions of fundamental importance as to which institutions remain open and which do not.

I was there at the formation of the policy, and it was always my understanding that the aim of the reforms was to empower patients and their doctors, and that the new mechanisms were to be responsive to their choices. The whole purpose of self-governing hospital trusts was to allow hospitals to respond in a much freer way to patients than before and to offer services whose popularity or otherwise would make it possible, with cash following the patient, for institutions to succeed or fail.

A number of us find it difficult that a number of manifestly successful institutions can nevertheless be challenged by what appears to be a return to the old-style dirigiste principles that I hoped had gone out of the window with the advent of the reforms. I say that in relation to Queen Mary's University hospital, Roehampton. I am grateful to my right hon. Friend and to the predecessor to my hon. Friend the Member for Winchester (Mr. Malone) for determining last year that the threat to which Queen Mary's was subject should be lifted.

Now we understand.

I shall fight for the hospital in my constituency, as the hon. Gentleman fights for his. If I do so more successfully than the hon. Gentleman, he can draw his own conclusions.

Of the four hospitals in south-west London that were under scrutiny, Queen Mary's University was the hospital that doctors and patients regarded most highly. That was a reason for promoting its cause, and that cause was successful.

The problem for the health service is that there are too many cooks stirring this particular broth. I particularly draw to the attention of my hon. Friend the Minister the role of purchasing authorities. At present, Queen Mary's hopes to pioneer a new way of making hospitals more responsive to community needs through the rapid diagnostic centre, for which the region has already made £2 million funding available for the coming year. However, Kingston and Richmond health authority is now intervening and holding a pistol at the head of Queen Mary's, saying that, unless it is prepared to announce plans for closer co-operation with Kingston hospital, the investment cannot proceed.

It is the role of purchasing authorities not to usurp such functions, but to facilitate the choices that doctors and their patients make. If I walked down Putney high street today, none of my constituents would be able to identify one member of those health authorities. The Government would get the blame if things went wrong.

As my right hon. Friend and her colleagues have found, trip wires are set for them by people who are grinding their own axes and who hold no responsibility for maintaining public confidence in the health service or for ensuring that a manageable pace of change is promoted. Against that background, it is extremely important that processes go forward with a recognition that there are political elements in this that are too important to be left to the experts.

6.48 pm

It is timely to remind the Minister of the comments of the hon. Member for Hendon, North (Sir J. Gorst) on 5 April, when he asked the Secretary of State:

"Does my right hon. Friend accept that democratic politics is about delivering to people what the majority want, and not about telling the majority of people what they should have?"

He said:

"she is doing the wrong thing, in the wrong way, at the wrong time and in the wrong place."—[Official Report, 5 April 1995; Vol. 257, c. 1738.]

The hon. Gentleman was referring to the problems relating to Edgware general hospital, but the same applies to other Greater London hospitals, such as Oldchurch and Greenwich district.

When I visited Edgware, I was struck by the lobby outside. Those people were not the usual rent-a-crowd lobby that one might have expected outside a hospital proposed for closure. I was handed a leaflet by a constituent of the right hon. Member for Brent, North (Sir R. Boyson), who I believe was also a member of his party, relating to Edgware. It said:

"Five CHCs agree with the people, all the local MPs agree with the people, the GPs agree with the people. Those who want to close Edgware have no friends."

The Secretary of State and the Minister for Health seem incapable of listening to any advice from any source with any contact with the service that is being delivered.

One comment that has been made to me in relation to Edgware, which has also been made in relation to the Brook, Greenwich district and the move of Oldchurch to Harold Wood, concerns the beds that will be lost in the process. I am continually told by the Secretary of State and the Minister that the new proposals take into account the changes in practice, developments and techniques, the increase in day surgery and the shorter stay in hospital, and that that is why there may be a bed loss.

That might have some credence if there were spare beds at the moment. But in all those hospitals, not only are there no spare beds, but bed occupancy is higher than the Minister recommends as a reasonable level and it is achieved by the use of trolleys and beds in corridors.

Hon. Members who have been patients awaiting an operation will appreciate that, no matter how routine an operation is for the hospital, for the patient it is a traumatic experience. To have to psych oneself up and prepare for the trauma of an operation only to be told on the day of or the day before the operation that no bed is available is not the kind of hospital service that people in London deserve or expect.

The Secretary of State referred in her opening remarks to the Brook hospital and neurosurgery. She says that she wants to locate neurosurgery services close to an institute of academic excellence, close to the Institute of Psychiatry at the Maudsley. Why does she not talk to the neurosurgeons at the Brook hospital and throughout London who question the rationale of locating neurosurgery with a psychiatric unit?

No one denies that some patients who need neurosurgery may at some stage require some psychiatric services. But neurosurgery should be accessible to patients and located close to a major trauma centre. The hon. Member for Gravesham (Mr. Arnold) spoke about taking services out of central London to the areas that they serve. I remind the Minister that the Brook neurosurgery service and the Brook cardiothoracic service serve the people of south-east London and north-west Kent. To move those services to Guy's, St. Thomas's and King's, further into central London, makes no sense at all to the people of Gravesham, Chislehurst or Old Bexley and Sidcup.

It is not just Labour Members who have made such representations. The right hon. Member for Old Bexley and Sidcup (Sir E. Heath), the Father of the House, has called for a meeting with the Secretary of State to discuss the Brook neurosurgery services. Those services should move with the rest of the Brook hospital services into the new Queen Elizabeth military hospital. But if they were to go to Queen Mary's, Sidcup, I would not complain, because at least they would be located in a key area serving the sub-region.

Dermatology services do not receive a great deal of publicity, and people do not think that they are particularly important, but they are one of the most heavily used medical specialties. We have talked about the loss of beds. London has seen 70 per cent. of dermatology beds disappear. The dermatologists do not argue that all those beds need to be maintained. They accept that there can be some rationalisation of beds and their location in centres of excellence. But with the disappearance of those beds has gone 60 per cent. of the dedicated dermatology nurses who would be required to provide the services in out-patient clinics and in the community. Why were the dermatology services not the subject of a specialty review and why was there no input from the London dermatology planning group in any of the Minister's considerations? Those matters need to be considered.

The Minister will know that the Select Committee has considered the London ambulance service. I do not want to speak at great length about that, but I say simply that it is on the record that almost every person who gave evidence to the Select Committee said that the drastic reduction in accident and emergency units in London had been a contributory factor to the problems of the London ambulance service.

People talk about the response times of the London ambulance service improving, for which, at the end of the day, the Minister is responsible, but in the key area of the rapid response time there has been virtually no improvement during the past two years since the Minister has taken up the matter.

The right hon. Member for Chelsea (Sir N. Scott) referred to psychiatric services. I agree with all the points that he made. We have heard about over-occupancy of beds in London. Nowhere is that more apparent than in the area of psychiatry. My local hospital is talking about bed occupancy rates of 120 per cent. We have heard of patients from Sidcup having to be flown to Leeds for acute services. In psychiatry, it is not uncommon for patients from Greenwich and Woolwich to have to go as far afield as Oxford or Woking on a regular basis. A consultant psychiatrist has said that it is not uncommon for patients to have to wait some 36 hours to be placed and for telephone calls to have to be made to up to 35 different hospitals. That does not imply a pattern of over-provision in London.

I want finally to say a word about the Tomlinson-Jarman debate. Tomlinson was considering acute services in inner London, not the totality of health services across London. I do not think that anyone, certainly not Professor Tomlinson, would dispute the figures that have now been put forward on the totality of care in London by Professor Jarman. In the conclusion of his article in the British Medical Journal, Professor Jarman says:

"It is clear that neither hospital use by London residents, nor the availability of hospital beds, nor considerations of relative efficiency provide a case for a reduction of the total bed capacity in London … It is important that any changes should be considered in the context of London's transport system and the particular problems in primary care and social services, relatively longer hospital waiting lists, below average availability of places in residential homes, and the increasing pressure on available hospital beds."

That is why so many Conservative Members are so concerned. We all accept that there is a need for change in London, but the pace of change and the kind of change that is being proposed are wrong.

With regard to the Government's assumption about the improper use of resources, we all accept that primary care in London is underdeveloped, but the secondary care should not be taken away before the improvements in primary care are put in place.

6.57 pm

The proposals for Edgware hospital have probably given rise to the greatest cause for concern in my constituency in the 21 years that I have represented it. People in London have a certain expectation of their hospitals. They are used to having specialist hospitals—such as Bart's and Guy's—in the centre, with a spread of friendly little hospitals around. That is why they feel so strongly about Edgware hospital.

We all accept that there must be reorganisation. We all accept that experts must be consulted. But I do not believe in the rule of experts. Experts can change their minds. It was the experts who ruined education in Britain with the discovery method and comprehensivisation, from the shackles of which the Labour party is now freeing itself.

What worries me about my right hon. Friend the Secretary of State, for whom I have obvious respect, is that she spends so much time talking about the experts rather than the people at the bottom of the pile who know what it is like in their area. The same applies to the size of schools and hospitals. Schools have now returned to their previous sizes. I have always said that in 10 years' time the present fashion will change, and change will be necessary.

Consultation has been mentioned. There has been no real consultation with the man and woman in the street, although various semi-quango committees have given their opinions. Perhaps ordinary people should have written letters, gathered in the streets or marched. In any event, the lack of consultation with them has made the position more difficult.

I have been re-reading some of what has been said about elective dictatorship. A Parliament is elected for five years; a large number of us are members of the Government, and a certain number are parliamentary private secretaries. They are all very good people; I am surrounded by them, so I am living dangerously. The Executive, however, has taken over Parliament, and it has become more difficult to ask whether the system is working and whether it is possible to do things in a certain way.

Between 1986 and 1990, Edgware's accident and emergency department was rebuilt; three years later, its future was threatened and it began to be run down. It seems that, if we live long enough, we are bound to be in fashion at some point.

Leadership means convincing our constituents that we are acting in accordance with their best interests. I accept that that is difficult when it comes to the health service. Last week, the mayors of our three boroughs came to the House. They were seen not by the Secretary of State or the Minister of State, but by the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville). Bolton must be a good place; certainly the football has not been too bad this year. What the mayors reported to the council, however, did not make the council feel very confident that its views had been properly represented. Some higher contact would have been useful.

Another problem is travel. It takes 45 minutes to travel from Edgware to Northwick Park on the 83 bus, and it costs 80p; it costs about £1.20 to travel to Barnet, and the journey can take up to an hour and a quarter. By that time, a person could be dead. As for ambulances, we do not know when they will arrive—and how fast they can move through the street: in many instances, they can move no faster than a bus. If an ambulance is stuck behind a bus for 10 minutes, there may be another two fatalities in that time.

A letter that I received this week from a rabbi in my constituency shows the level of concern. He wrote that the closure of Edgware general hospital would

"not only put at risk the lives of my own members, but also of all the residents of Brent … I therefore earnestly request that you make known our concerns at the highest levels. It seems totally criminal that the Government is determined to effect their policies, without any regard for the welfare of the population."

That is the feeling not just of the rabbi and his congregation, but of many people in the area. If we are to get things right, a good deal of public relations and change will be necessary in Edgware and elsewhere. I hope that the Department will see to that in the morning, and will consider what we can do in Edgware to set people's minds at rest.

In the current circumstances, I cannot support the Government tonight. It gives me no pleasure to say that, but we are debating a major issue, and I speak on behalf of my constituents. I hope that there will be further discussions in the long term, which will reassure both them and me.

7.4 pm

I have probably discussed the Black Paper of the right hon. Member for Brent, North (Sir R. Boyson) with him for as long as 30 years. I believe that he would be a much better author of a White Paper on health than the Secretary of State.

I wish, however, to return to the point made by the right hon. Member for City of London and Westminster, South (Mr. Brooke). Exactly six weeks ago, he, my right hon. Friend the Member for Bethnal Green and Stepney (Mr. Shore) and I attended on the Secretary of State to beg for a different decision on east London. I think that the right hon. Gentleman struck the right note: in this debate, constituency interest has properly overridden older and, perhaps, more permanent loyalties.

I believe that the health service reflects—in the minds and hearts of the people of this country—the common faith shared by some hon. Members: the same faith that motivated St. Bartholomew. Some of us could deliver sermons about what has happened to saints in the past—and, indeed, to the originator of our faith. We might draw parallels with what is happening to St Bartholomew's hospital.

I do not think that the Secretary of State understands what she is about. I try not to say anything about people that I am not willing to say to their faces. Some time ago, when the right hon. Lady was struggling to give answers to questions on a statement, a benign Opposition voice shouted, "Come on Virginia, you can do better than that." "Oh no, she can't," someone said. I am afraid that that is true of the right hon. Lady's performance.

The Government amendment refers to benefits to be gained from "new and better services". That may apply to some services, but far more are worsening and diminishing. Newham general hospital has only seven posts of an establishment of 11 in its accident and emergency department. In the past few weeks I have learnt that it is not a requirement of the Royal College of Surgeons for qualified surgeons seeking membership to serve in such departments. I learned that from a parliamentary answer given by the Minister of State. What on earth has the Secretary of State done about it? Surely the Royal College of Surgeons recognises that such service is a national duty—but, if it does not, the right hon. Lady should have advertised the fact, and perhaps changed the policy of the college.

The Secretary of State's plans consist entirely of projections—the projections of Tomlinson, the King's fund and so forth. We have heard a great deal about her projections in regard to the ambulance service. I have said time and again that they were inadequate and that the Secretary of State had got it wrong; I have been told, "Oh no, it is all right. We have the funds." After five or six years, an extra £14 million had to be injected into a service that is nowhere near as complicated as the health service as a whole. If the right hon. Lady and her colleagues have got it wrong in regard to the ambulance service—and they have, to the tune of £14 million—how can we expect them to get it right in regard to beds in London? I do not believe that we can.

On 26 April, I secured a half-hour debate in which I made various accusations about what was going on. The Minister was good enough to write to me and did not deny some of the points that I made. I mentioned Homerton hospital. Despite the warnings, the right hon. Lady has lauded it to the skies when clearly it is not adequate for the task.

In her speech, the right hon. Lady mentioned the London chest hospital. I agree with her. Why should people come from Plymouth to be treated at the London chest hospital, which deals with respiratory diseases—a problem that is on the upturn in London, particularly among children? They should not have to do so, but people from Petticoat lane will not be treated there, because the hospital is being closed. The Minister cannot deny that fact.

Nor can the Minister deny the fact that a teenager desperately in need of psychiatric assistance had to be put in a police cell in Newham because secure accommodation was not available, and that 250,000 people in the borough of Newham had one psychiatrist in post a week or so ago. For all I know, that position continues today. The right hon. Lady, those who advise her and those who support her have no grip of what is really going on.

I refer now to the speech of the right hon. and learned Member for Putney (Mr. Mellor). A deeper malaise has yet to be identified. Surely within the organisation of the health service, a number of vicious, declining spirals exist. Units, trusts, authorities—all of them have had their marching orders. Because of that, they are unable to co-ordinate together.

Health provision is not a business. Sainsbury's and Boots provide only what they wish to provide, unless they prescribe medicine. They take goods, cut them up, put them on the shelf, freeze, process and transport them. There is a willing buyer and a willing seller—that is the market. But each of us is unique in our health requirements. Health provision is a service, not a business, and in their White Paper entitled "Working for Patients" the Government have tried to turn what was essentially a service into a business.

Last Monday, I could not rejoice. The post-war period was one of consensus. I know that party differences existed, but for nearly 40 years from about 1950 to about 1990 a consensus existed among the people of this country and in the House about the national health service. I hope that we get it back because it has been shattered, as have other services. The health service especially affects the needs of the elderly and of women.

I could not rejoice last Monday because we have lost the unity for which those who died and those who risked their lives strove. We have lost it in the House. I hope that we can get it back, that the debate will enable us to do so and that many Conservative Members who share something of that vision will decline to support the Government in the Lobby tonight.

7.12 pm

As Chairman of the Select Committee on Health, I should first like to inform the House of what the Committee has been doing in connection with London's health service. Its members have not only conducted an inquiry into London's ambulance service and prepared a report, which is about to be published, but kept a watching brief on the implementation of the proposals in the Tomlinson report. We have taken oral evidence from Sir Bernard Tomlinson and his team, the Secretary of State for Health, Department of Health officials, Sir Tim Chessells, the former chairman of the London Implementation Group, and my right hon. Friend the Secretary of State for Transport when he was Minister for Health.

As our evidence-taking sessions are in public and frequently televised, we believe that the questioning of our witnesses provides the opportunity for greater understanding of the issues, both inside and outside Parliament. We shall interview my right hon. Friend the Secretary of State for Health tomorrow afternoon, when no doubt my colleagues will probe for further clarification and information on the controversial matter of London's health services.

We have visited many London hospitals on fact-finding missions—Bart's, Guy's, St. Thomas's, Kings College, Charing Cross, Westminster and Chelsea, the Royal Marsden, Queen Elizabeth hospital for children and Hammersmith. This morning, we visited the Edgware and Barnet hospitals. We have arranged to visit London hospital and St. Mary's, Paddington within the next few weeks. You can therefore see, Mr. Deputy Speaker, that the future of the national health service in London has an important place in the programme of the Committee, and we shall give it the focus that it deserves in the future.

As a Member of Parliament for a constituency in Hertfordshire, I am acutely aware of the reasons why so many reports have been commissioned on the future of London's hospitals—20 in all. Immediately before the war, the resident population of Greater London was nearly 9 million; today it is 6.9 million. Londoners have moved out of the capital to new towns, the home counties and beyond. It was deliberate Government policy to encourage a shift in the population out of inner-city areas.

I know from personal experience that those former Londoners now wish to receive high-quality health care where they live today, not where they and their families used to live. They do not wish to travel considerable distances into London for hospital services that are more expensive and less convenient than local services.

It has always been a bone of contention in Hertfordshire that, over many years, the NHS funding available through the regional health authority was being drawn into London, and that our area was underfunded as a result. In truth, there has been resentment that London's hospitals have taken more than their fair share in the allocation of resources. I make that point because I fear that that important aspect of the debate is frequently forgotten or ignored.

So often we hear only of complaint, accusations of failure and gloom and doom in relation to London's health services, yet some outstanding successes should be recognised—for example, St. Mary's NHS trust, covering St. Mary's hospital, Paddington. The trust has achieved a balanced budget for four years in succession. It has treated 57,023 patients in 1994–95—an increase of 2 per cent. on the previous year. It has cut the average waiting time for an operation to four months. It treated 8 per cent. more people as in-patients and day-care cases in 1994–95 compared with 1992–93. It has treated 40 per cent. more cardiac patients since 1992–93. It has taken 40 per cent. more kidney failure patients on to its end-stage renal failure programme, including dialysis and kidney transplant, since 1992–93. It has treated 15 per cent. more people in accident and emergency in 1994–95 compared with 1992–93. There has also been a 20 per cent. increase in ophthalmic accident and emergency cases. It has cut by 10 per cent. the number of non-clinical managers, although many are clinically qualified. It has appointed a woman chief executive, who was formerly the hospital's chief nurse.

The trust has introduced a number of successful innovative services at St. Mary's. For example, as one of the first hospitals in the United Kingdom to establish a general practitioner's service located in the A and E department, St. Mary's is committed to the increased effectiveness of that model of care. I am sure that you, Mr. Deputy Speaker, will understand that a mobile local population, many of whom are not registered with a GP, can gain access to appropriate primary care, and that GPs and hospitals benefit from increased co-operation and understanding.

St. Mary's has developed a number of new services provided on an out-patient basis and designed according to the needs of patients and their GPs. The new one-stop breast care service allows GPs to refer patients with palpable lumps to a clinic where they will be seen within a week. The multi-disciplinary approach incorporates a consultant cytologist, a consultant radiologist, a specialist breast surgeon, an oncologist and a specially trained breast care nurse specialist. It is designed so that patients are supported through the necessary steps to determine their condition. Tests are performed on the same day so that concerned patients can be reassured or treated as quickly as possible.

St. Mary's has undertaken a successful pilot to make pathology test results available immediately to GPs in the surgery. Using simple technology and incorporating existing equipment, an effective link has been tried and tested. That system will result in NHS savings where the need for duplicate tests by a hospital doctor and GP will be removed.

Cited frequently as a blueprint for other units, the minor injuries unit at St. Charles' hospital, which opened in 1993, is one of the first of its type. One thousand patients per month have used the new nurse-led unit, which offers quick and effective care.

St. Mary's has developed an innovative policy of integrated care pathways for individual patients, which ensures that patients can be discharged as soon as their condition allows and with a high level of follow-up care and treatment. A discharge planning group, which reviews and changes practices both within the hospital and in social services, has reduced lost bed days dramatically during the past two years. Not only does that benefit patients: it increases the number of beds available for new cases.

Patients are brought from across the United Kingdom, often using an air ambulance, to the very specialist paediatric intensive care unit at St. Mary's. The trust continues to pioneer care for very sick children and it commands an international reputation for excellence. It has demonstrated its commitment to that specialist service by investing to increase to six the number of PICU beds during 1995–96.

St. Mary's is a centre of excellence for the provision of care to cardiology patients and those requiring cardiac surgery. About 1,000 cardiac cases will undergo surgery during 1995–96 and they will receive a service among the best in the world. Patients wait an average of just two months for surgery. Care is patient focused, including a pre-admission visit where patients and their carers or family watch a video, meet nursing and medical staff and have an opportunity to share their concerns in a familiar and supportive environment. Surgery is followed through with a rehabilitation support group.

The trust has taken steps to increase the number of ophthalmology patients treated effectively on a day-care basis at the Western eye hospital. A newly formed department using highly trained, existing hospital staff to provide answers, advice and support to patients, visitors, carers, family, friends, general practitioners and purchasers has been set up. It includes a free phone care line. In addition, the trust has even managed to pay the nurses' pay award in full.

I believe that hospitals that achieve should be rewarded. It can be bad for morale when hospitals that seem to be profligate or inefficient are apparently rewarded with additional cash and support, while those that demonstrate tough management are not. When doctors and nurses make sacrifices and change working practices, their efforts should be recognised. We seem to hear not much good news about health services in the capital, but there are hospitals that have not only embraced the health reforms but have actually proved that they can and do work to the benefit of patients.

My Committee and I look forward to welcoming my right hon. Friend the Secretary of State before us tomorrow so that this debate can be further explored.

7.22 pm

The reality of life in London is that there is a long and frustrating wait for operations that involves great pain, causes stress to immediate family and friends, and means the loss of very many working days. The waiting list in London now totals more than 180,000. The health service in London simply is not working. The staff are strained to the point of breaking, while those desperate for an operation cannot get one.

The information provided throughout this debate and the numerous inquiries into London's health service leads to one inescapable conclusion—that the experience of most Londoners is of constant closures, threats and a decline in the local health service and the ability to obtain treatment from it.

Professor Jarman, who has frequently challenged both Government statistics and the Tomlinson inquiry, has provided information showing that 7,000 beds were closed between 1982 and 1990. More than 3,200 have been closed since 1990. In 1982, London health districts had 26,000 acute hospital beds; there are now only 17,000, with plans to close even more. The number of long-stay beds for the elderly has dropped to 6,000 and the number of psychiatric beds has been reduced by 3,000 over the past three years.

The list goes on and on—yet the Secretary of State heads blindly towards oblivion, telling us that somehow or other things are getting better, that it is all an Opposition plot, and that we exaggerate the problem. The problem is there, it is real and it is very serious.

The debate has been presented as though there is some competition between London and the rest of the country. There is nothing of the kind. We are not discussing the centres of excellence, the specialties or the fact that people have to travel to London for such treatment; we are discussing ordinary people with ordinary illnesses who need good hospitals. Those hospitals are constantly threatened with closure.

We must recognise that in London, as in the rest of the country, no real planning is taking place in the health service. It is impossible to plan if the health service is run by the pressures of an internal market economy, where the buck is passed from the Secretary of State to her junior Ministers, to the district health authorities, to the health service trusts and then back to the Department. The merry-go-round goes round and round. The London group of Labour Members recently interviewed the two regional chairs, but all they told us was that they were sending things back to the districts. Nobody takes responsibility.

When questions are asked of the Secretary of State, we are told that apparently no figures are kept centrally on anything any more. We are told to write to our health authorities, but they tell us to get in touch with the Secretary of State. They think that it is easier for us to meet her than it is for them to do so. Unfortunately, they have rather serious illusions about the power of parliamentarians.

The closures that we are debating this evening are tragic beyond belief. Many of my constituents in Islington, North and those of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) use, love and cherish Bart's hospital—not just because it is 800 years old, not just because of its traditions and excellence, but because it provides a good service. The closure of Bart's is a monstrous act of vandalism. There is no other way to describe it. The same is true of other hospital closures.

The knock-on effect of the closure of Bart's is enormous. It has already been felt in casualty units, and in the waiting lists that are developing elsewhere. The same is true with the closure of Guy's, Edgware and the Brook. The closures are wrong, they are not necessary, and they do not even save money. Indeed, the cost of closure is far greater than any potential savings.

In previous debates, I have referred to hospital closures in my borough—for example, the Royal Northern hospital. Before I was elected to this place, there was a huge campaign to defend that hospital's casualty unit. One of the first pieces of correspondence I received as a new Member of Parliament in 1983 was from the then Minister, the hon. Member for Reading, East (Sir G. Vaughan), saying that the Government were withdrawing their previous undertaking to maintain the Royal Northern, and that it would be closed. The hospital has been closed, and the site sold for property development. It has not even been sold for social development.

There were pleas from the Islington Pensioners Forum and many other people to provide nurse-managed beds at the Royal Northern. Indeed, I raised the matter with the Minister during one of our previous debates. Nevertheless, the concerns and the demand were lorushed aside, the hospital closed and the site sold to the highest bidder. Of course, highest bidders are those who can afford to speculate with their money on property development; they are not elderly people who need somewhere with nurse-managed beds where they can recuperate from treatment. The opportunity to provide that service has now been lost.

We need to consider the problems facing the emergency service. I wrote to the Minister on 21 March requesting a meeting after cancer patients had been turned away from the Whittington hospital because the emergency service had taken over several wards at that hospital following the closure of Bart's, which had forced patients to look to the emergency service. The casualty unit is working at more than 100 per cent. capacity.

One morning recently, 16 people were waiting on trolleys to be treated—but there was even a waiting list to get on a trolley. Some nine people had to wait for a trolley even before they had to wait to be treated.

The Government always say that the alternative to overcrowding and to the pressure on hospitals is to develop primary care facilities. It is not either/or—we need hospital facilities and primary care facilities. We need more GPs, better GP facilities, better primary care and far better health education. We also need to understand some of the causes of people becoming ill, such as the number of homeless, unemployed or very poor people in London.

I speak proudly as a member of Unison, and I think that we must look at the work that is done by the staff in hospitals. Morale in hospitals is at breaking point. Ancillary staff and manual workers are earning less in cash terms than they were many years ago, and their jobs are put up for sale to the lowest bidder every so often as the contractors try to move in and take over their jobs.

One has to wonder who is running the health service, and in whose interests it is being run. An attempt has been made by the Secretary of State to break up national pay bargaining, and to tell local hospitals that they must fund 2 per cent. of the 3 per cent, nurses' pay rise. What is going on is simply wrong. We must look ahead.

The Secretary of State says that the Labour party has no policies on the matter. I shall tell her straight—we have a lot of policies on health. First, we must address the democratic deficit in the running of the health service in London. No one knows who the members of the district health authorities are. They are faceless people, who are carrying out the Government's policies. We need a democratic, Londonwide health authority, and the necessary planning which goes into that.

We must also look at the poverty which people in London face. One of the most interesting documents I have read recently was the chief medical officer for health's report on Camden and Islington. The report showed that the borough's mortality rate was 25 per cent. above the national average, and that the borough had higher rates of infant mortality, drug abuse and homelessness. That is not unusual to my borough, and it can be replicated in borough after borough across London. We need some understanding of the causes of ill health in London, which are in part the environment and in part poverty. The health service in London must be able to meet those needs.

I conclude by referring to a letter which I received from the Islington Pensioners Forum, which I believe was sent to many inner London Members of Parliament. The secretary of the organisation, Angela Sinclair, said:

"The pensioners have paid for the NHS through national health insurance all their working lives, and that they depend on it in their old age. They feel bitterly let down when chunks of the family silver are sold off."

That is a plea to keep Bart's and the other hospitals open, and to develop a health service in London that we can be proud of and upon which we will he able to rely.

7.31 pm

I acknowledge the need for reform, and there can be no doubt that it is necessary. But it must be done with flexibility, not rigidity. It is a difficult problem, and one might say that what is important is not so much what one does, but how one does it.

I do not overlook the importance of preserving the national monuments—the hospitals such as Guy's and Bart's. They have been described as international centres of excellence, but I personally regard them as medical cathedrals, because they attract talent from all over the world. Other hon. Members—particularly my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke)—are greater experts on Guy's.

I will concentrate my remarks on the accident and emergency department in Edgware general hospital in my constituency. I would like to confine my remarks to amplifying four points which I made on 5 April, to which the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) referred.

When my right hon. Friend the Secretary of State answered questions on the London closures, I said that closing Edgware hospital was

"doing the wrong thing, in the wrong way, at the wrong time and in the wrong place".—[Official Report, 5 April 1995; Vol. 257, c. 1738.]

At the outset, I shall make one concession—if that is the right word—to the Government. I recognise that they have addressed themselves belatedly to both the timing and the manner of the closures. They were important considerations, but they were not relevant to the central issues. Of course it was never right to scrap an accident and emergency department until something was up and running in its place. I welcome the Government's willingness to correct that. But we must recognise that that is a palliative, or perhaps I might say a sedative. It is not a concession.

However much of a delay there may be before the closure takes place, regardless of the improvements in ambulance performances, and taking into full account the expanded capacity at alternative hospitals, the very distance and remoteness of those hospitals remains an obstacle to people living in Edgware. In short, we are left with an insuperable argument against closure. The measures are being taken in the wrong place, and will affect the wrong people. That is why 40,000 petitioners have united with one voice against the proposals.

I have repeatedly tried to point out to my right hon. Friend that Edgware general hospital has certain unique features. I have pleaded and argued for 18 months behind closed doors that those features should be recognised. As we are now discussing the matter publicly, F may regret those discussions, but I make no apologies.

Edgware general hospital serves an area with special social problems, and that is why the outcry has been so loud and so angry, and may perhaps be so prolonged. People on low incomes live within walking distance of the hospital, as do a large proportion of elderly and disabled people, many of whom are housed in purpose-built accommodation because of their disabilities. A significant number of refugee immigrants from troubled parts of Africa, with their attendant health and language problems, are also housed near the hospital.

To force those hard-pressed citizens—few of whom have their own transport—to struggle to find medical attention in an emergency not a few steps away from their doors but up to an hour away is a blind and, in my view, insensitive form of planning. After all the Government's palliatives, postponements and assurances, people on low incomes and elderly people will still be living there, and onerous travel will still be something that they have to face. As there have been no meaningful concessions by my right hon. Friend the Secretary of State, I shall be voting against the Government tonight.

I am not impressed by the emollient Government amendments, which are couched in what I must describe as blandly seductive language. Beyond the confines of Westminster, the niceties of who tabled what, and whether the amendments were expressed in harsh or moderate terms, is immaterial. Through the media, everyone knows that the vote tonight is about whether certain hospital facilities will be closed or kept open. My vote will be for the latter. The provenance of the motion is of secondary importance to the achievement of the objective.

The debate is significant in two respects. First, are the Government going to prove to everyone that they really mean what they say about listening to people at the grass roots? In the case of Edgware, that means listening to what 40,000 petitioners have been asking for.

Secondly, we in this House must be responsive to something more than cost-efficiency and clinical factors. We must acknowledge the weight that must be accorded to ordinary people's fears, desires, prejudices and conveniences. We are their servants, not their masters. Through their taxes, they pay the bill for what we run up on their behalf. The demands of those who elect us may outstrip the economies which Ministers' deskbound advisers think prudent. Obviously, Ministers must heed such cautious advice as they receive but, in the final analysis, they must also balance and reconcile it with what ordinary people want.

I therefore end my speech with this observation: human beings, not balance sheets, come first.

7.39 pm

For every London Member, today's debate is of critical importance. The blinkered destruction of the national health service in the capital, driven by dogma and devoid of common sense, will leave the people of our capital not with a first-rate health service fit for the 21st century, as the Government proclaim, but with a second-rate two-tier service, where money means more than lives, and where flashy computers are valued more highly than the Dr. Kildares of the past.

Like others, I listened to the Secretary of State on the radio yesterday morning when she talked enthusiastically about how the changes in London's health services have been driven by the needs of technology. The Opposition have called this debate because we want a health service that is driven by the needs of the people. That is the fundamental principle on which the health service was founded almost half a century ago, and we reaffirm that principle today. Technology should be the servant of humanity, not its master.

What do the Government's proposals mean to ordinary people? I am currently dealing with three tragic deaths in my constituency, which, on the face of it, could have been avoided had the health service not been ravaged and fragmented. That is shocking. I am just one Member of Parliament; I do not know how representative my caseload is, but never a surgery goes by without three or four people coming to see me with yet more desperate stories of delays and incompetence in the local health service in dealing with their health needs.

At its most devastating, there are the deaths. In January this year, a constituent, Maria Ayling, died tragically at her home in Barking. She was only 20, and she died of a deep-vein thrombosis in her leg. She had been desperately trying to get into hospital for nearly two months before she died. Had she been seen and properly diagnosed, her untimely death could have been avoided.

Last Friday, I met the chief executive of Redbridge Healthcare, along with Maria's father and his solicitor. The day after Maria died, a letter arrived from the hospital giving her an appointment. It is not just the hospital that is to blame in this case; what the chief executive said about that letter says it all about the state of our national health service.

Maria was given the appointment not because the hospital had finally realised that she needed urgent medical care, but because the purchasing authority had unexpectedly released more money so that more people could be seen and new appointments made. That appointment came too late for Maria. What an indictment. That tragic case well illustrates the current state of the health service in London. It is always worth while reminding ourselves of the human reality that lies behind the statistics, which is what the Government fail to do.

Tonight, the focus is on north London, but what is happening in north London is also happening in east London. It is a national scandal that the Government determine their programme of hospital closures on the basis of simply buying another Tory Member's vote and thus buying another discredited day in government. That is Tory decibel planning at its worst. It is not just the closure of the A and E services at Edgware that matter, but the closure of A and E departments across the capital. If it is wrong for one constituency, it is wrong throughout the capital, and all hon. Member have a duty to their constituents to vote with us tonight.

My constituency has no hospital. The Government closed Barking hospital, despite a vigorous campaign led by my predecessor, Jo Richardson. The borough of Barking and Dagenham has no hospital, as the other hospital was also closed by the Government, and soon we shall lose our next nearest hospital, Oldchurch.

Despite universal condemnation, Ministers have decided to go ahead with the closure of the A and E department at Oldchurch. Hon. Members on both sides of the House, including the hon. Members for Hornchurch (Mr. Squire) and for Romford (Sir M. Neubert), have said that they oppose that proposed closure. If they mean it, they will vote with us to-night. If they do not, their constituents will know that they are not prepared to defend the national health service in their areas.

Closing accident and emergency departments is the most disastrous and dishonest way for the Government to proceed. If the A and E department of any hospital is closed, that hospital is condemned to a slow and painful death. Most admissions come through the A and E route; if those admissions are stopped, under the rigidities of the market, unit costs will increase, and the hospital will price itself out of existence and be forced to close. The Government do not even have the guts to tell us the truth. When they close the A and E department at Oldchurch, Bart's or Edgware, they are passing the death sentence on those well-loved and much-needed hospitals.

"But ah!" the Secretary of State will say. "We're opening minor injuries units to serve local communities." Those are another con. The minor injuries units will not even he able to set a broken leg. If all they can do is stitch cuts, that service should be provided by GPs in modern surgeries, and it is no substitute for an emergency unit.

If the vote of hon. Members from north London has been bought by the promise of a minor injuries unit, they have been conned. The units will do nothing for those who need an emergency service. They will still have to travel much further; they will still be dependent on the inadequacies of the London ambulance service; and they will still be transported far from their homes and families, as doctors desperately hunt for an empty bed. Primary health facilities are simply not in place to take over the burden created by the closure of hospitals.

Let us look at the reality facing real people in real communities like mine in Barking. "Don't worry about losing Oldchurch," we are told. "There's always Newham, Harold Wood and King George's." This morning, I rang those hospitals to establish whether, on their most recent figures, they could cope. As we know, and as the Secretary of State persistently refuses to acknowledge, they could not cope on the Minister's guidelines for an acceptable occupancy level.

Newham hospital told me that its occupancy level is over 100 per cent. It had to open 46 extra emergency beds to cope with the pressure from Homerton, which could not cope with the pressure caused by the closure of Bart's. Havering hospitals are running at nearly 96 per cent. occupancy and, on Friday, King George's was running at 93 per cent. occupancy.

The knock-on effect of other closures in that chaotic and fragmented market will add pressure on those hospitals. For example, closing Bart's will mean added pressure on the London hospital, which will therefore have to push people towards Newham hospital from the west, while we add pressure on Newham from the east with the closure at Oldchurch.

Will my hon. Friend give way?

No, I do not have time.

Opposition Members do not deny the need for change in the pattern of health services in London. What we oppose is the headlong rush for change being pursued with such zealousness by the Secretary of State. There are simply not enough beds, and there is a critical and urgent need to stop, think and listen, before the Government destroy what we all value. Our plea to every hon. Member, and particularly to the Secretary of State, is this: take the medicine of listening; swallow hard, and do the right thing—and withdraw the inept, penny-pinching proposals to close yet more hospitals.

7.48 pm

I have been involved in public life in London for a good many years now and I am pleased to speak in this important and serious debate. The subject has engendered a great deal of discussion in this Chamber and other parts of the House for a long time between my colleagues and me and the Secretary of State and her junior Ministers, so there has been no lack of serious discussion of the points behind it.

In studying the history of health discussion in this place, it is interesting to note that the subject of London health and London hospitals has been turned over for at least 100 years. There is on record a report on the subject from a Select Committee of the other place in 1892. As the Government's amendment to the motion on the Order Paper says, the discussion has been going on seriously for 80 years. In a recent letter to The Times, Lord Annan recollects very serious discussion going on for 30 years.

The fact which repeatedly emerges from accounts of that debate is that on all occasions there has been a strong argument for changing the pattern of health treatment in London—the hospitals and the primary care of our people. In an account that I have read in the past few days, a professor at the university of York who studied the subject concludes:

"the … problems … have remained largely unresolved for lack of political courage."

Unfortunately, that message has been expressed to me many times by people who, although they may not be so passionately involved in the subject as hon. Members on both sides of the House naturally are, nevertheless realise that there has been a fundamental change in the population patterns in our capital city and in the various needs for treatment.

Unquestionably, the London hospital pattern suited the needs of the past. The large hospitals in central London were set up many years ago to treat serious ailments on behalf of the country. That is no longer the position. As many colleagues have said earlier, people now want to be treated closer to their homes and progress in the technology of surgery and in the technology of treating ailments has made that possible. That is at the root of the Government's health reform policies.

Tonight we are discussing the pattern of health care in London, and we must concentrate on that, especially those of us who are London Members, but we must also heed the cries of colleagues on both sides of the House—most of whom, admittedly, are Conservative Members—for resources to flow out of London to their constituents, who previously may well have been transported to central London to be treated at Bart's or Guy's or St. Thomas's or any of the other great hospitals.

The Government are even closing accident and emergency departments outside London.

There has been a change, as I said, in the pattern of treatment.

I do not believe that any Members of the House have sufficient knowledge to disagree with the President of the Royal College of Surgeons or the President of the Royal College of Physicians. They are on record as saying that, because there are now methods of day surgery, methods of cold surgery and various other forms of treatment for many ailments, allowing patients to be treated quickly so that they may leave hospital and return to their homes, we no longer need the vast number of acute beds that were previously required.

Therefore, conclusions have been drawn, in all the studies commissioned by the Government, including the one by Sir Bernard Tomlinson—backed up, incidentally, by Professor Jarman, who has been quoted by Opposition Members—that the pattern of surgery is changing and there may not be so great a need for acute beds as there once was.

The hon. Member for Thurrock (Mr. Mackinlay) made a sedentary intervention about accident and emergency departments. A wealth of study and research—carried out not only in this country but in other parts of the world, in war zones and in other large conurbations on the other side of the Atlantic and so on—shows that the pattern of accident and emergency treatment is no longer the same as might once have been considered necessary.

A fact which emerges from those studies is that one of the most important aspects is to bring paramedic treatment to the scene of an accident as soon as possible. Studies undertaken in the United States of America show that, when paramedics reach the scene quickly, with properly equipped ambulances—in London, paramedics do not necessarily need ambulances because there are high-powered motor cycles to take them to the scene of the accident—the treatment they administer at the scene can do a great deal more to help save a life or prevent serious injury and its consequences for those unfortunate people than simply sending an ambulance and rushing them to hospital as soon as possible.

The evidence is there. Documentation is in the Department of Health—I believe that it has also been deposited in the Library—showing that accident and emergency treatment of that newly researched type is more successful than maintaining a proliferation of A and E departments in every hospital throughout the capital.

The Government have suggested to my right hon. Friend the Member for Brent, North (Sir R. Boyson) and my hon. Friends the Members for Hendon, North (Sir J. Gorst), for Hendon, South (Mr. Marshall) and for Finchley (Mr. Booth), that the proposals for the hospitals in their constituencies may well solve many of the problems that they have rightly drawn to the attention of the Secretary of State. Obviously, that is a problem for them to resolve, and I have every sympathy with them in trying to resolve it in the best possible way for their constituents.

The hospital which treats my constituents and those of my right hon. Friend the Member for Kingston upon Thames (Mr. Lamont) is Kingston hospital, which has grown in stature and expertise in the past few years. There has been considerable investment in the maternity unit—£7.5 million in recent times—which is much welcomed by local people. A sum of £1.5 million has also been spent on the Royal Eye hospital unit in Kingston hospital. As part of the reforms, there have also been considerable improvements in primary care in our part of south-west London. Ninety-four per cent. of the population of the Kingston and Richmond health authority are now treated by general practitioners who are fundholders. We have the largest percentage of fundholders, who have accepted that important advance in health care, in our part of London.

The reforms must progress. They should be pursued with resolve by the Secretary of State, and thereby the health of London will be considerably improved.

7.58 pm

The hon. Member for Surbiton (Mr. Tracey) suggested that his constituents wish to be treated near where they live. That is also true for people who live in inner and outer London boroughs. They, too, wish to be treated near where they live.

I pay tribute to the hon. Member for Hendon, North (Sir J. Gorst), who was an example to every Member of the House in the way in which he defended so honestly and openly the interests of his constituents and, I thought, even more, the interests of some of his most vulnerable constituents.

That is true for all of us, because we are attempting to defend people who, in many instances, are suffering from illnesses that they do not understand or are recovering from accidents which, by their very nature, came upon them when they were unprepared. To exacerbate those people's concerns by possibly making them travel for treatment to an area that they do not know, which makes it difficult for relatives to visit them to offer comfort as they recover, acts against the basic tenets of medicine and health care.

The hon. Member for Broxbourne (Mrs. Roe), in her guise as Chairman of the Select Committee on Health, gave us a comprehensive list of the London hospitals that she intends to visit and listed the witnesses from whom the Select Committee intends to take evidence. I hope that the Select Committee will also find time to take evidence from a constituent who earlier today submitted a green card asking to meet me. When I went out to Central Lobby, she told me of her grave concern about the outcome of the debate. She works in the cancer department at Bart's hospital and I am afraid that I could not reassure her that the outcome of the debate would be that Bart's will continue to flourish and to serve people as it has done for 800 years. She is a dedicated worker in the national health service and she told me that what is happening within the NHS in London is "a disgrace", to use her words. She cited instances where people suffering from cancer have had to wait more than four weeks even for an appointment, let alone any kind of treatment.

I regret that my hon. Friend the Member for Islington, North (Mr. Corbyn) is not in his place, as he made a salient point about the availability of health care, which impacts on all hon. Members who represent inner London constituencies. He said that there is obviously a need for primary health care in London, but an equal need for hospital health care. He argued that the health care provided for millions of Londoners at accident and emergency departments should continue to be offered until primary health care facilities are up and running.

As he said, it is not an either-or situation. Undoubtedly, it could end up as a neither-nor one, because many people in London—possibly hundreds of thousands—are not registered with any general practitioner. They look to the A and E departments of their local hospitals for treatment. If those departments are closed, some of the most vulnerable people in London will be left without any health care at all.

Various figures have been bandied today about the actual population of London. Some Conservative Members have argued that, since 1979, which seems to be a watershed for some of them, the London population has fallen. The hon. Member for Kensington (Mr. Fishburn) made a valid point, however, when he said that the population of London is not just made up of those who are residents, but includes the vast influx every morning of those who work in our capital city. They, too, require health care and health services when they are in what could be deemed the city of London, even though they live outside it.

In the past few years, there has also been a great influx of people looking for work and for homes in London. In many cases they appear on no register or census. My constituency seems to have an increasing population of homeless men. In many cases their homelessness has been exacerbated by problems occasioned by drug and alcohol misuse. It is extremely difficult for them to obtain any kind of medical treatment unless they register with a GP. In many cases pride, foolish though it may be, prevents them from doing so. They can, however, use the facilities that are provided by A and E units.

My central concern undoubtedly rests with the hospitals in my constituency, the Royal Free and the Whittington. We hear about restructuring day by day—on occasions, it seems like hour by hour—including the closure of Bart's and the possible closure of the A and E department at Edgware. If such facilities are lost, the hospitals in my constituency will be expected to take up the slack. They will be expected to be able to provide services for the sick and those involved in accidents.

Camden and Islington health authority has been told by the Department of Health that, in the next five years, it must look to a reduction of £25 million in its budget. I have asked the Secretary of State directly where the money will come from to expand facilities, as will be necessary, at the Royal Free and at the Whittington and to pay for the additional staff, but answer comes there none.

I add my voice to those of other hon. Members who have urged the Secretary of State to call a halt to the seemingly mindless rush to change existing health care provision in London. As my hon. Friend the Member for Barking (Ms Hodge) has already said, we are talking about the treatment of patients—individual human beings. It is their needs that we attempt to serve through the NHS in London.

I regret that the Secretary of State is not in her place. Surely she can take on board what constituency Members from London hear day in and day out, not only from our constituents but from people who are daily at the sharp end of NHS delivery in London. They all say that there is something wrong with that service provision. Day in and day out, we hear that the NHS in London is under inhuman pressure and that, in many cases, it is beyond the point of restitution and is suffering from internal decay. We are told that it is failing to do that which it was set up to deliver and to which those people who have dedicated their lives to working in it are still committed: to make the ill well and to ease the suffering of those who, for whatever reason, are particularly vulnerable.

I urge the Secretary of State to listen. She has been asked by hon. Members on both sides of the House to listen to the people who know best—not just the patients who use the health service, but most definitely those people who provide that service.

8.7 pm

The hon. Member for Hampstead and Highgate (Ms Jackson) said that the health service was failing generally, but such characterisation is a great insult to the people who work in it. That has never been my experience of the health service when either I or my family have used it.

In the seven or so years in which I have been a Member of Parliament, I have seen improvements in NHS provision in my constituency. There are still some problems, which were highlighted today by the Opposition, but they have not offered us a shred of evidence that they have a policy to deal with those problems. One must warn the Labour party that shroud waving did it a disservice at the previous general election—it partly cost it that election—and that shroud waving does not win it any votes.

As we were told that this debate is a non-party political occasion—

Eh?

Yes, that is what we were told on the radio by the Opposition, who said that the debate was about the health service. Presumably that is why the leader of the Labour party did a photo-call at Bart's this morning and why the right hon. Member for Derby, South (Mrs. Beckett) made such a highly political speech. I therefore thought that I would look back at the last debate on the health service when the Labour Government were in power.

On 15 March 1979, there was a debate in the House during which it was revealed that 600 hospitals were dealing only with emergencies, nine had closed completely and 5,500 beds were out of action. That did not cause cries of alarm at the time because that was an improvement on the situation when the House had last debated the subject the previous November. That is what the Labour party did to the health service when it was in government—it closed hospitals, reduced nurses' pay and cancelled the hospital building programme. Labour party members have no standing in this debate.

I came to the debate wondering on what evidence my right hon. Friend the Secretary of State had based her plans to allow the closure of the accident and emergency department at Edgware. The subject has been covered disgracefully by the Evening Standard and by other media outlets. I heard a journalist on London News Radio say, "Doubtless the Secretary of State will provide an argument for the closure, if there is one." That is a disgraceful way to approach the debate.

I tabled a question to my right hon. Friend asking for the scientific evidence upon which she had based her decision. I put that evidence before the right hon. Member for Derby, South and my questions clearly caught her on the hop. The fact that she had not examined the scientific evidence proved the emptiness of her arguments. I think that that is a disgraceful performance by a leading Labour party spokesperson.

The review of that evidence is available in the Library of the House of Commons—it is not hidden away—so the right hon. Lady and her colleagues may examine it if they can be bothered. It talks about the relationship between the size of accident and emergency departments and clinical outcomes. If we are talking about providing the best possible health service, we must talk about clinical outcomes. What happens when people use the accident and emergency facilities? All the evidence suggests that more lives will be saved in the future when the changes are implemented. I put that point to the right hon. Lady, but she did not seem to understand it.

In 1992, the North West Thames task force suggested that accident and emergency departments with fewer than 50,000 new patients per year did not have the necessary throughput for cost-effective care. It said that departments should have the capacity to deal with at least 50,000 new attendances per year as smaller departments are unable to employ experienced staff at night and at weekends. I argue that this matter does not revolve around financial considerations; we must examine what happens when A and E departments are concentrated in one area.

The results of a survey carried out in Orange county in the United States indicated a severe reduction in the number of deaths judged preventable. Labour Members may read about it in the "Archives of Surgery"—which I think is rather more authentic than Labour party briefing notes read by Labour Members. [Interruption.] Labour Members should listen to this, because it is important for their constituents as well as my own.

In a one-year experience, trauma care in Orange county California, where patients were taken to the closest hospital, was evaluated and compared with San Francisco county where all trauma victims were brought to a single, centrally-located trauma centre. The survey concluded that

"73 per cent. of the non-CNS deaths in Orange County might have been prevented if the patients had been taken directly to a trauma centre".

That idea is not restricted to the United States; nor is it anything new. The hon. Member for Barking (Ms Hodge) suggested that the measures were being rushed through. It was first suggested in 1961 that there could be an advantage in changing the accident and emergency arrangements. That suggestion has been ignored many times since then by many Secretaries of State and I pay enormous tribute to my right hon. Friend for having the political strength and courage to carry through the reforms.

Residents in Edgware will be no more than five or six miles from an A and E department. I appreciate the traffic problems in that part of London and I will turn to that issue in a moment. Some £60 million is being invested to upgrade the Barnet general hospital.

A scare story has been circulated in my constituency that that will put extra pressure on the Northwick Park hospital. That sounds reasonable on the face of it, but it is not true. As was said earlier in the debate, 30 new beds have been opened at Northwick Park hospital this year and it is planned to open another 60 beds next year. Admissions through the accident and emergency department currently total 13,000 and it will have the capacity to deal with 16,500 admissions in April 1997—the date of the proposed changes at Edgware hospital.

In addition, Northwick Park hospital will employ more staff and the hospital is about to engage a second consultant in the accident and emergency department so that it has the expertise to enable it to realise the scientific evidence which indicates that large, well-staffed A and E departments will save lives.

I agree with the remarks by my hon. Friend the Member for Surbiton (Mr. Tracey) about the lamentable record of the London ambulance service. The Pinner ambulance station in my constituency answers only 60 per cent. of calls within 14 minutes. Anyone who is familiar with the Harrow and Pinner area knows why that is so—the ambulances are concentrated on what must have been a very good site for that area many years ago, but it is no longer suitable. We need to disperse those ambulances. We need to implement some of the radical changes—I must explain it in shorthand because my time is brief—adopted by the Northumbria ambulance service.

It has made enormous improvements and I am sure that the hon. Member for Newcastle upon Tyne, East (Mr. Brown) would confirm that fact. It has a first-class ambulance service, which is measurably the best in the country. If it is good enough for Northumbria, it is certainly good enough for London. I hope that the ambulance service will introduce radical changes and use the extra money wisely. The service would benefit from employing paramedics on motor bikes who would get medical assistance and equipment to accident victims quickly.

8.17 pm

Six months ago, when we last debated the health service in London, I raised concerns about the future shape of community health services in east London. At that time deep anxiety was expressed about the proposal to have a single trust-run community health service for Newham, Tower Hamlets, Hackney and the City. I was delighted when the Government announced at the beginning of December that there would be three separate trusts, and I welcomed the Government's response to the points that were made during the debate.

We were anxious that there should be separate trusts in order to expose how much money was being spent in each of the three areas. Our suspicions about funding disparities were confirmed when advertisements for senior positions in each of the new trusts were published. The published budget for Newham per head of population was less than half of that for the rest of the area. That fact highlights the issue of health service funding in London upon which I shall concentrate my remarks this evening.

The Government's amendment to the Labour party's motion on the Order Paper

"commends the Government for its record in investing in … the long-term interest of … the people of London;"

That choice of words betrays a complacency which rings very hollow all over London. There is growing and compelling evidence, including work commissioned by the Government, that areas such as Newham are deeply under-resourced and yet are still being cut back further in the allocation of national resources.

Two weeks ago the King's Fund published a report, called for by the former Government chief medical officer, entitled, "Tackling Inequalities in Health". The report's conclusions were forthright and unequivocal. It says:

"People who live in disadvantaged circumstances have more illnesses, greater distress, more disability and shorter lives than those who are more affluent."

It continues:

"During the 1980s social divisions accelerated at a rate not matched for such a sustained period by any other rich industrialised country. Not surprisingly, the impact that this increase has had on health is now beginning to emerge. Death rates in some of the most disadvantaged areas in Britain not only worsened in relative terms between 1981 and 1991 … but among some age groups, such as young men, the death rates actually rose."

That cannot be accepted as just an unfortunate fact of life. It must be addressed by those responsible for the health service.

The King's Fund report also says:

"The injustice could be prevented but it will require political will. The situation could be substantially improved if the political will existed to recognise that tackling inequalities in health is a fundamental requirement to social justice for all citizens. The question is: can British policy makers rise to the challenge?"

We cannot afford to ignore that challenge. The spiral of poor health and under-achievement cannot be allowed to continue. The social and economic costs as well as the moral responsibility will he borne by us all.

In October, the Centre for Health Economics at the University of York reported to the Government on the distribution of health resources. Its findings were unambiguous. It said:

"The current formula (introduced in the early 1990s) has resulted in a shift of resources away from the poorer and sicker areas."

The York report produced a new capitation formula which would yield a significant shift of resources to the inner cities.

Tragically, the Government's response has been to water down that report and we are now told that in my area of east London we are to lose out even further when the Government's adaptation of the formula is fully in place. We will lose out by £14 million in a budget of £322 million. The pattern is the same elsewhere in inner London. It is a travesty of the York report's recommendations and the figures show that the Government are moving in the opposite direction to that recommended by the York team.

There is a crisis in the health service in London. Departing general practitioners cannot be replaced. In our accident and emergency unit at Newham general hospital, only seven of 11 vacant posts could be filled in the last recruitment round. The work load for many health workers is far greater than would be tolerated in more prosperous areas. There is a shortage of children's nurses, and orthopaedic wards have to rely on agency staff.

I want to raise deep concerns about what has happened to the funding that has been earmarked for primary care improvements in east London. The Secretary of State made a great deal about the need to redirect resources into primary care. We all welcome improvements in primary care and there is no doubt that, by one means or another, the Government have made some funds available. What has become of that money? Where are the improvements that it is supposed to bring?

I have with me an astonishing document. It is the latest district audit management letter on the City and East London family health services authority—the body that is charged with the responsibility for overseeing the primary care improvements that the Government have promised in east London. Those improvements are, without doubt, desperately needed. The document talks about the affairs of the authority and it says:

"there have been clear failures to recognise that there are legal limits on the powers of the FHSA … there have been instances where officers have maintained unofficial bank accounts in respect of FHSA funds … little regard was given to recommendations at audit for improving the management and financial affairs of the authority."

Those serious allegations are documented in the report, which goes on to conclude that

"such failures have resulted in the consequent loss of scarce resources to health services in the area."

The document tells us that significant sums of money have been wasted.

I am aware that there have been personnel changes at that FHSA, but it has shown itself wholly unable to oversee the capital projects that the Government have required it to deliver and which the Government have promised to the people of east London.

The Star Lane medical centre in the constituency of my hon. Friend the Member for Newham, South (Mr. Spearing) was allocated a grant of £1.9 million in the first year of the London implementation zone programme. Three years later there is no sign of a single brick being laid. I have tabled a parliamentary question asking where that money now resides.

This morning I received a letter from the Newham GP forum which says:

"We are at the bottom of a major recruitment crisis as well as suffering from rock bottom morale."

The root of the problem is a catalogue of projects involving GP premises which have gone catastrophically wrong. The letter lists five of them. About one project it says that, because of his experiences with the FHSA, the doctor

"is on the verge of a nervous breakdown and bankruptcy."

It says about another project:

"Despite this length of time and commitment no clear path has been agreed as to how these premises can be developed any further."

That "commitment" involved a dentist putting in £150,000 of his own money.

About the next project the letter says:

"there is a strong possibility that recently started building works will be stopped before completion because"

the doctor's bank has

"advised him that he has too much negative equity."

Another doctor secured a promise of £700,000 towards the cost of the premises from the London Docklands development corporation, subject to the work being started by 1 July this year. The letter states:

"there is no likelihood of any building works commencing before the deadline and as a result the whole project may have to be shelved."

The letter adds that if that happens the doctor has decided to leave his practice, and Newham.

That is a catalogue of appalling mismanagement. Far from improving primary health care in east London, it is literally wrecking it. Those charged with delivering the improvements have been wholly incapable of doing so. I call on the Secretary of State to make an urgent and thorough investigation of what has happened to the London implementation zone funding for east London, because I am increasingly worried that terrible damage has been done.

8.27 pm

I have been amazed by some of the speeches in the debate. When my right hon. Friend the Secretary of State was speaking, some hon. Members from outside London were suggesting that the health service in London was somehow overfunded. I do not believe that that is true. For example, there is a 23 per cent. shortfall in psychiatric beds in London. One has only to look at the performance of the London ambulance service, which, by common consent, is the worst in the country. If one looks also at the difficulties that sometimes affect the supply of intensive care beds in London, one recognises why people in London do not believe that the health service is overfunded.

For colleagues from outside London to talk as if the health service in London is overfunded does a disservice to the debate, because it is not true. It was true in the 1970s when the then Labour Government instituted the resource allocation working party formula, which affected resources in London in the late 1970s and throughout the 1980s. Now those resources have been removed. It is wrong for people to recycle the speaking notes that they have used for the past 20 years and assume that they are still accurate. I know that in politics it is a great temptation to do that, but we should not seek to follow it.

I heard one comment about Edgware, which suggested that the hon. Member concerned probably did not know either its geographical location or even how to spell it. He suggested that it might be in central London.

When the Secretary of State announced in a written answer that she had approved the closure of Edgware accident and emergency department, I subsequently made a number of points. I said that she was proposing a system of primary health care whereby most of the extra £15 million would be spent after the Edgware accident and emergency department was closed, which seemed unacceptable.

I am pleased to say that this afternoon the Secretary of State has come to the House and agreed to spend an additional £2 million—as I understand it, £1 million this year and £1 million next year—mainly in the western part of the London borough of Barnet, which includes a significant amount of my constituency. Obviously, it is difficult to be too beastly to a Secretary of State who has this afternoon given some money to my constituency.

However, I have a number of questions that I want to ask about the other four issues that I have raised with the Secretary of State. The first involves the London ambulance service. We are told that there will be two additional ambulance crews in the Edgware district. We are told that the London ambulance service will continue to be monitored against the patients charter standards. If the London ambulance service fails to meet those patients charter standards—

If it continues to fail to meet them.

As my hon. Friend says, if it continues to fail to meet those patients charter standards, what will the Secretary of State do? Will further additional resources he put into Edgware? Will there be a radical reorganisation of the London ambulance service, or what?

I have raised the issue of transport links with the Secretary of State on a number of occasions. This afternoon she said that she was setting up a working party-50 per cent. of that working party is sitting on the Government Front Bench and the other 50 per cent. is to come from the Department of Transport.

Transport links between Edgware and Barnet are particularly poor. During the Easter recess, my hon. Friend the Member for Chipping Barnet (Mr. Chapman) and I were due to meet the chairman of the Wellhouse trust at Barnet. We arrived on time at 2 pm. The chairman arrived at 2.15 pm and said that the trouble was that transport links between Edgware and Barnet were not what they should be. I understand that my hon. Friend the Member for Finchley (Mr. Booth) had a similar experience and was kept waiting even longer. The chairman was not trying to be discourteous or to prove a point, but the point was very well made. I am glad that the Secretary of State is setting up a working party.

We have a right to know when that working party will report. Will it report to the House? How will we hear what it decides? If it recommends significant expenditure, it might be open to the Secretary of State to reopen the issue of the closure of the accident and emergency department at Edgware because, if a lot of money is to be spent on roads, further questions must be asked.

We are told that the minor accident unit at Edgware will be opened as soon as possible—it will be opened in 1996 rather than 1997. That is of benefit, in that it will be up and running before any closure takes place. We have been told in a letter from the Secretary of State that there could be a general practitioner presence in the minor accident unit, which is currently expected to be solely a nurse-based unit. We should like to see that possibility fleshed out. We should like to know how likely it is that the unit will have a GP presence rather than just a nurse presence. That is an important question that must be answered, as the matter will clearly be of concern to us over a considerable period.

Everyone who knows me well knows that the past few weeks have been particularly painful. I think that even the Government Whips Office would accept that I am normally a loyal Government supporter. I have rebelled only twice: once over the social security reforms in 1988—

Twice?

I should remind my hon. Friend that the Government changed their mind within 10 days of my rebellion, so I was right. I rebelled for a second time in 1989 over the Football Spectators Bill and again I was right as the Government tore up the Bill, so I shall not take any lessons from my hon. Friend about when I should and should not rebel. I accept that, in the role that I have held for some time of parliamentary private secretary to one of the most decent and nicest men, I have had obligations.

I hope that never again will announcements about Edgware hospital be made by way of written replies on the day before Adjournment debates on the future of that hospital. Such a procedure was discourteous to my hon. Friend the Member for Harrow, East (Mr. Dykes), who instituted the debate.

I believe that this will not be the end of the saga and I suspect that it will be revisited from time to time. This evening, in view of what the Secretary of State announced earlier, I am minded to support the Government. But before my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) gets too broad a grin on her face, I should tell her that if her grin becomes much broader, I certainly will not support them.

8.36 pm

There is an enormous amount of public anxiety and anger at the consequences of the mishandling of the national health service in London. Some of the blame is put at the door of the managers, but most of it is laid at the door of the Secretary of State for Health and the Government.

I pay tribute to the few hon. Members who have spoken out and stood up to be counted tonight. They made eloquent speeches, fighting for their constituents and for London hospitals. They made a good point when they said that the Secretary of State refuses to listen to the concern of Londoners and refuses to acknowledge the reality of what is going on in the health service. I shall give some examples of the realities.

Casualty Watch recently published a report stating that it carried out 11 spot checks in London hospitals between April 1994 and February 1995. It found that more than 170 people had been waiting more than five hours on trolleys in those London hospitals and that most of those who were waiting were elderly. It even found one woman of 101 years old who had been kept waiting for six hours at Queen Mary's university hospital in Roehampton in January this year.

I have taken up the issue. In late February, I complained that my hospital of Whipps Cross had a shortage of hospital beds and a shortage of trolleys. That shortage meant that patients were left on the ambulance trolleys that had brought them, thus tying up 10 ambulances that would be needed in an emergency. The chief executive of the Forest Healthcare trust said that the hospital was overwhelmed.

Waltham Forest community health council has just published a report giving examples of the crisis in the district. It stated that one woman who had a burst appendix was a priority 1 patient; she had a four-hour wait to see the doctor. She was in great pain and had to wait a total of seven and three quarter hours before she was found a bed. Another woman with a priority 2 illness was finally treated after a nine-and-a-half hour wait. An elderly woman with diabetes who had recently had a triple bypass operation was seen briefly by a doctor after half an hour, but she was then left on a trolley for seven and a half hours without any food or drink.

Another case involved an elderly disabled woman who had a nine-hour wait for a bed. Three months later, she went back to the accident and emergency unit with pleurisy. On that occasion, she waited 12 hours on a trolley for a bed, which eventually was not available, and she was sent home.

Those are just four examples in a recent report from my local community health council. It points out that Whipps Cross has one of the busiest casualty departments in the country, with more than 80,000 patients. The number of patients has increased by 3,000 in the past three months because of the closure of Bart's accident and emergency department and the knock-on effects of that; there has also been the staff shortage that was mentioned by my hon. Friend the Member for Newham, South (Mr. Spearing).

The CHC takes apart the official patients charter, to which the Government keep referring, to say how wonderful things are. It says that the

"official patients charter statistics disguise the major problems patients face when using A and E services."

It goes on to say:

"it is claimed that 97 per cent. of patients at Whipps A and E have an 'initial assessment' within five minutes, but this does not acknowledge that they then have to wait for a proper assessment to be carried out. That can take one hour."

Official Forest Healthcare trust figures relating to patients in each priority group seen by a doctor show that 78 per cent. of priority 1 patients are seen within two hours, 82 per cent. of priority 2 patients are seen within four hours, and 84 per cent. of priority 3 patients are seen within four hours. My CHC asks, "What of the patients who are not seen within those times—how long do they wait?" Even after being seen by a doctor, a patient may wait hours for further attention because of the pressure of work on the A and E Department.

Several hon. Members have referred to the London ambulance service. We all know that it descended into a shambles when the computer broke down. Many of us would blame the Government in their pressure to privatise the service. Whatever the situation, let us look at the current position. Mr. John James, who is responsible for the service, has written to me saying:

"Overall, the total cost of the emergency services has risen from £63.9 million in 1994–95 to £82.2 million in 1995–96, an increase of 28.6 per cent. However, because £4 million in 1994–95 was met from central funds in 1994–95, which were not made available in 1995–96, the overall increase in cost to DHAs was 37.2 per cent."

That means that district health authorities in London have had to find an extra £22.3 million from their hard-pressed budgets to pay for that London ambulance service shambles and to try to get the service back into order. That £22.3 million has been taken out of patient treatment in London, whereas the Government should have provided that money.

The hon. Member for Hendon, South (Mr. Marshall) talked about the £2 million for Edgware that has bought his vote tonight. A couple of million will come out of patient care in Edgware and in Hendon to pay for the London ambulance service. The money with which the hon. Gentleman has been bought off has been swallowed up very quickly. [Interruption.] That certainly is true. I have done a survey and I can show hon. Members the results.

The House of Commons Library presented for me figures that show that 83 hospitals in London have closed between 1979, when the Government were first elected, and March last year. On top of that, there have been a large number of accident and emergency unit closures. Many more are in the pipeline. All that has occurred without any publicly stated Government policy or anybody's policy on accident and emergency provision in London. Those closures are carrying on apace because trust managers regard them as the best way of further reducing acute beds in their areas. A and E closures are financially driven.

Our vote tonight is the last chance for London Members, particularly Conservative Members, to save the health service in London, particularly A and E provision in London. Even if some A and E units are not under threat now—and many of them are—the Government will come for hon. Members' accident and emergency units if they carry the day.

In the 1980s, the Government said—they have continued to try to use the phrase—that the health service was safe in their hands. There comes a time when that phrase must be proved, and we shall find out tonight. We shall discover whether the Conservatives can stand by it. Unless London Conservative Members show courage, as some who have spoken tonight have done, a significant proportion of the NHS in London will slip like sand through our fingers.

8.45 pm

I have previously commended my right hon. Friend the Secretary of State for her courage in tackling the issue of London hospitals, and I do so again today. The amendment refers to the 20 or more reports that have recommended action that is clearly overdue. The action that was needed my right hon. Friend has initiated. To bring everything to a complete halt now, as the motion appears to demand—indeed, those were the words of the hon. Member for Hampstead and Highgate (Ms Jackson) a few minutes ago—seems to me to be unacceptable. If the Opposition thought that the wording of their motion would seduce me into supporting them, they have failed.

Of course, these are matters in which, whatever decisions are taken, some people will be upset. Every hospital has a loyal following of local residents, patients, general practitioners, doctors and nurses at the hospital, and doctors and nurses who have trained there and perhaps have moved on. If we always bowed to all their wishes, there would never be any changes. But, if it is proposed to close a hospital or substantially to change its character, there must be a process of consultation. That, surely, is a moral obligation as well as a legal obligation. Consultation surely means listening to the views expressed and considering them, and not being averse to responding to reasoned arguments.

The Secretary of State and the Minister for Health have their advisers—political advisers and medical professional advisers—but they should take account, too, of what may be different advice offered by others who are as well qualified professionally and of those who are as able, if not better able, to reflect the views of the communities affected, including, of course, local Members of Parliament. I fear that that is not always done. My right hon. Friend enjoys my admiration as a most able, enthusiastic and dedicated Secretary of State, but a Minister must also be a politician, and in politics one is more likely to get things done if one listens to what people have to say and tries to take them with one.

My concerns, as the House will be aware, are with the proposals concerning Guy's and St. Thomas's hospitals. Let me make it clear that the issue is not about spending money on those hospitals in inner London as against expenditure further outside London or in the suburbs. Indeed, I shall want the Bromley hospital trust to be given adequate resources to enable it to develop a new hospital on the Farnborough hospital site. In this case, the issue is not about closing down complete sites, because both sites will remain open.

It is certainly not a Guy's versus St. Thomas's contest. The issue is the need to obtain the best possible use of limited resources—that is buildings, equipment and staff. It is, to quote the words of the Secretary of State in a letter that she wrote to the hon. Member for Southwark and Bermondsey (Mr. Hughes),

"to ensure the most efficient and clinically coherent balance of services between its sites".

On 29 March, when the consultation process was completed and the proposals were on the Secretary of State's desk awaiting a decision, I secured a Wednesday morning debate on Guy's hospital. I summarised the original and final proposals for the two hospitals and the consultation process. I spoke of the work of the Save Guy's Hospital Campaign, of which I am joint chairman. 1 outlined our concerns and raised a number of issues.

A week later, the Secretary of State announced that she was confirming the proposals without modification. Of course I accept her word that what I and others said in the debate was read and considered, but I am sure that she will understand that some people have the impression that our words were completely ignored. Personally, I was surprised that no attempt was made to answer the points that were raised in the debate before the decision was announced. I have since had a letter from my right hon. Friend, but some of the issues remain unresolved.

It would be unreasonable of me to repeat the speech that I made on 29 March, even if time allowed, which it obviously does not, but the Government amendment invites me to call on the Government to ensure that their decisions on London hospital services are carried forward.

If I subscribed to that, I would be endorsing, among a number of other propositions, first, leaving the City of London and its 300,000 daily commuters—some of whom are my constituents—after 1998 without any accident and emergency facilities to deal with another Cannon street train crash or Bishopsgate bomb outrage; secondly, not using to the full Philip Harris house for the purposes for which it was designed and built at a cost of £154 million; thirdly, using Guy's for day surgery, elective surgery and minimally invasive therapy without any intensive care facility on the site; fourthly, the separation rather than the integration of out-patient and in-patient services for specialties such as renal, oncology, cardiology and ENT; and, fifthly, I would be endorsing the expenditure of £90 million on new building and refurbishment at St. Thomas's to accommodate the services moved from Guy's, while leaving some 19 floors or 35,000 sq m of unused space at Guy's.

I cannot in all conscience endorse such plans, so the House will understand why I shall not support the amendment which calls for their implementation.

8.52 pm

I consider that Londo3's hospitals are underfunded and I appreciate all the arguments advanced by hon. Members representing part of Middlesex and London in respect of the Edgware general hospital. Before I came to the House, I worked in Golders Green for 12 or 13 years and I empathise with local people who appreciate and want to keep the accident and emergency department open in Edgware. I shall return to that in a moment.

The motion refers to London's health service. Strictly speaking, there is no such thing: there are two regional health authorities. My area of Essex is part of the North Thames region and in the context of today's debate I would argue that it is part of London's health service.

I am unique inasmuch as I am the only Opposition Member representing Essex and the counties that skirt London or the M25 ring. I can legitimately claim to speak on behalf of those constituents who are not represented in the Chamber at the moment, except by the Government Whip, the hon. Member for Chelmsford (Mr. Burns), who has to remain silent.

We listen to the Government's argument that the closures will provide additional resources for counties outside London, but that is not the experience of my constituents and those who live in areas surrounding London. Frankly, we do not believe the Government. [Interruption.] Somebody from a sedentary position said, "Rubbish," but my constituency of Thurrock endured the pain and anxiety of losing the accident and emergency department at Orsett hospital.

Regrettably, only when the closure of the accident and emergency department at Edgware general is proposed, or hon. Members representing Westminster and the City are aggrieved, does the House pay attention to a crisis that is not peculiar to the old GLC area, the boundaries of which resulted from a decision made in the House of Lords at 2 am in 1963 and which do not represent "London" in the context of this debate. London is much wider, especially with regard to health provision.

Conservative Members are aggravated by the political fallout that was demonstrated in stark terms last week. As we approach a general election, they want to distance themselves from the Government's policy of cuts in the national health service. They did not speak up when the accident and emergency department in my constituency was closed or when accident and emergency departments were closed elsewhere around the M25 ring.

It is time to make it clear that the Government are cutting hospital provision for many people in London and elsewhere. I heard all the arguments advanced by the hon. Member for Hendon, South (Mr. Marshall) excusing why he would not support the Opposition motion tonight but would sustain the Government. They involve palliatives and promises that extra facilities will be provided as compensation for losing A and E departments. They are not worth the paper they are written on.

I should say, as a lesson for other hon. Members who are considering supporting the Government, that when our accident and emergency department was closed in Thurrock, we were assured that the rest of Orsett hospital would be maintained. They were solemn and binding undertakings, but a few months ago it became clear from a leak that they intended to close the whole hospital.

My constituents and others joined in a massive campaign to retain Orsett hospital, or what was left of it. We succeeded, but we do not believe that that will the prevent faceless men and women who run our health authorities and the trust from again trying to close totally our Orsett hospital.

I use my constituency as an example of what could happen elsewhere. It is in the fastest growing area of south-east England outside London—the Thames gateway—yet the madness of Government policy and their lack of planning led to an attempt to close our hospital.

My constituents now have to travel to Basildon to get hospital care, which has put an inordinate extra burden on Basildon and other hospitals. My hon. Friend the Member for Barking (Ms Hodge) described how Oldchurch hospital would close and put extra demands on Harold Wood hospital. Since my local accident and emergency department closed, my constituents are putting extra demands on Harold Wood hospital, because that is one of the places where they are taken by bus or ambulance to receive accident and emergency and other treatment. It is foolish that this policy should be allowed to continue.

The motion calls for a halt and a major review. That is prudent. It would be appropriate to encompass in any review everything in an area wider than the old GLC area—everything around the M25 ring—as we are as vulnerable to the cuts as elsewhere.

There has been some commendation of the few Conservative Members who have said that they will not support the Government tonight. I join in that, but there is a danger of going over the top and implying that the hon. Member for Hendon, North (Sir J. Gorst) is equivalent to the Archangel Gabriel. I give him full marks but where has he been all this time? He is faced with the closure of an accident and emergency department on his own doorstep now, but he would not have dreamed of supporting me in defending the A and E department at Orsett. I do not suppose that he knows where Orsett is to be found.

If Conservative Members generally are concerned about the thrust of Government policies, they must support the Opposition motion so that the Government will pause and rethink the totality of the policies on which they are now embarking. I do not know whether it was implied or said by an Opposition Member on radio this morning that this is not a party political matter. If so, I dissociate myself from that remark because it is party political. In the months leading to the next general election, I shall unashamedly point the prosecutor's finger at Conservative Members who do not join us in the Lobby tonight. They are all the same and they are all to blame by acquiescing through their silence in a rundown and haemorrhaging of the NHS in and around London. It is time to spell that out without ambiguity.

I cannot find words to describe the lasting resentment among my constituents at the Government's deceit and betrayal over hospital care. I include in that the people of Basildon, whom our loss at Orsett also affects. My constituents now have to be sent to Basildon hospital and endure inordinately long waits on trolleys and in the casualty department. In addition, many of my constituents are taken not only to Harold Wood hospital but across the River Thames to Kent, such is the absurd lack of planning.

I welcome being able, perhaps for the first time, to muscle in on something that is wrongly described as a "London debate": it goes much wider. It affects people in Harlow, Basildon, Thurrock, Gravesham, Dartford, Slough and other constituencies around the London area, which are not being properly represented in the House, and whose national health service is not being championed by Conservative Members.

9.2 pm

It is a pleasure to follow the hon. Member for Thurrock (Mr. Mackinlay) who, as usual, was robust in his remarks, and on this occasion robustly wrong.

The debate has been characterised by a mirage of the past, suggesting that the health service in London was always better then—a sort of never never land of wondrous results. In fact, we are dealing with the same problem that has existed for hundreds of years.

Liverpool Street and Broad Street railway stations are built on the foundations of a medieval hospital that was well known at the time. Some people might think that it would have been better if it had been kept as a hospital. A retired doctor from St. Thomas's reminded me that 30 years ago patients were left on the floor in a crisis. Only in 1968 was the first accident and emergency consultant in the country appointed. Today, such consultants can be found everywhere. We have been improving, and we should put that fact on the scales tonight.

The Opposition motion criticises the closure of accident and emergency facilities in London, while the Government motion stands for new and better services and says that the Government—will take due account of concerns. I hope so. I do not accept that the description "closure of … facilities" is apt, accurate, balanced or fair in respect of Barnet. A new hospital costing £61 million is being built, and we are promised that a new casualty unit will be kept open in Edgware. However, I shall be making some demands of my right hon. and hon. Friends on the Front Bench.

Edgware hospital is being kept open, and there is a list of improvements for the new area trauma centre to be built at Barnet General hospital, costing £1.5 million. It will offer a major treatment room with greater availability of specialist piped medical gases, decontamination showers and a sound attenuating examination room. The "physical specs", as they are called, state that the centre will be 250 per cent. larger than the present A and E department. There will be an operating theatre for major trauma, diagnostic imaging and a pneumatic tube system—all costing an arm and a leg in more senses than one.

I asked an orthopaedic surgeon at Barnet General for his thoughts on the centre. He welcomed it. He had possibly wanted a new hospital situated midway between the two existing hospitals, but he is grateful and delighted that there will be a new hospital in Barnet—not least because he currently has to travel between Edgware and Barnet in rush hours and in crisis situations. I shall refer to transport later, if there is time. At present that consultant has to cover two hospitals.

Do we want to retain the A and E department on the same basis as at present, as suggested by my hon. Friend the Member for Hendon, North (Sir J. Gorst), whom I deeply respect? No—we want to improve on that situation. Are we against all change? Of course not. At present, there is an orthopaedic consultant only at Barnet General and none at Edgware, and there is no maternity department at Barnet. That cannot be left as it is. There must be change.

Safety is paramount, as was mentioned by my hon. Friend the Member for Harrow, West (Mr. Hughes). The Royal College of Surgeons states that 25 per cent. of all deaths in A and E departments are avoidable. I could not have deaths on my conscience, so I must speak out tonight to say that such deaths are avoidable if we have the improved A and E departments that our new hospitals and constituents deserve. We must satisfy the public's fears.

How do we do that? I have been fighting for better transport links across the A1, which is a huge physical barrier. I am grateful to my right hon. Friend the Secretary of State for saying that she will bear that in mind. We shall be watching for such improvements. We certainly do not want people dying en route to hospital.

I hope that the Edgware injury clinic—the new casualty department, as the chairman of the local NHS trust calls it—will not only have 80 per cent. of current casualties, but that it will be supported by general practitioners, not just nurses or paramedics. We need better transport links and I am glad that we have improved community medicine, to which my hon. Friend the Member for Hendon, South (Mr. Marshall) referred. On behalf of the people of Barnet and Finchley, many of whom cross the A1 to Edgware, although many more go to Barnet, I thank the Government for the new hospital that we are getting. It would be niggardly not to be grateful for it. We shall keep Ministers to the four promises that we have heard today. We shall be watching.

We ask what Labour, whose debate this is, would be doing. Would it reverse the decision over Bart's? Would it reverse the decision to give us a new hospital in Barnet? Would it keep Edgware open? Answer comes there none. The Labour party is vacuous in the absence of real answers to difficult questions in this area. Literature has been quoted to us this evening by my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). I will quote Shakespeare: the Labour party is

"full of sound and fury,

Signifying nothing."

9.11 pm

I offer my apologies to the House for having missed the first part of the debate. I am Chairman of the Select Committee on Northern Ireland, which has been taking evidence this afternoon.

I want to speak, if only briefly, on a number of matters. First, I wish to make a point which I suspect may have been made before, so I shall therefore make it briefly: the fundamental problem with the Tomlinson report was that it did not take into account the impact of outer London on inner London. One of the powers and strengths of Professor Jarman's report was that it recognised that inner London could not be treated as though there were some dividing fence between inner and outer London. Once that artificial fence is taken away, the problem in London is seen to be not so simple as Professor Tomlinson's report made out. That is why things have gone badly wrong.

My second point, and one of the prime reasons why the Secretary of State is in such serious trouble, is that the main problem in the health service—one which has to some extent been there since the 1974 management changes, but dramatically more so in recent years—is the lack of an effective method of consultation. As a Conservative Member said, people felt that consultation was not working. That is certainly my experience in west London. The feeling is that things happen without a strategy. I acknowledge that the Secretary of State has said that she wants a strategy for health care in London, but the various community groups, including the community health councils and others who should be taken into the confidence of the hospital management structures, do not feel that they know what is happening or why.

The general feeling about consultation is that a paper is published, people are asked for their views, which they give, but at the end of the day the rubber stamp comes down reinforcing the original proposal without people's views and comments being taken into account in any effective way. Consequently, there is much anger and lack of understanding when decisions about hospitals' futures are made. A simple but dramatic example occurred in west London when the new Chelsea and Westminster hospital was built, massively over cost—more than £200 million. In retrospect, that was an incredible decision. Had it been made by a local authority, it would probably have led to councillors being surcharged.

The Secretary of State was then faced with the unenviable decision whether to close Charing Cross hospital or Hammersmith hospital. Charing Cross hospital was only 20 years old, but Hammersmith hospital is the world's premier postgraduate medical school with an immense reputation in Britain and overseas. Eventually, the right decision was made and the two hospitals were merged into one trust. However, that still leaves the question of what is to happen to the three large hospitals in west London. It is not that there is over-provision; rather there is under-provision in certain key areas. I receive the same sort of letters as other hon. Members about the lack of bed space and the lack of time for operations.

The closure of an accident and emergency department in effect means the closure of the hospital. That is why there is such concern—certainly in west London and, I suspect, elsewhere—that the purchasing authority, which in my case is the Hammersmith, Hounslow and Ealing authority, will choose to buy from only one hospital, perhaps Charing Cross, leaving Hammersmith, which has had less investment in its accident and emergency department, more vulnerable. If we get into the ball game in which the purchaser decides which accident and emergency department survives, in the long run the purchasers will make the decisions about which hospitals survive. That is not the most sensible way to proceed.

I suspect that psychiatric patients have not been discussed in any great depth today. In my area and, indeed, throughout the capital, the provision of beds for such patients is a major problem. Care in the community is clearly a good policy, which we all endorse—provided that the community facilities are there; if they are not, the policy becomes a disaster. In that event, there is no care in the community. There have been some horrendous cases in recent years.

The provision of housing, hostels and follow-up nursing care is vital, and the lack of psychiatric beds poses a major problem to the safety of patients and, indeed, the public at large. Some of the patients are very disturbed; some, though not all, are offenders. We should bear in mind that the regional secure units also feed into the system of care in the community. There is a human problem for the individuals concerned, but a drastic problem for the health service and the general public.

Let me say this to the Secretary of State: for heaven's sake start looking at a management system which is so secretive that people feel—rightly, in my view—that they do not know who is making the decisions, how those decisions are being made or how they themselves can have any impact on those decisions. The problem with the NHS, in this context, is that it is paid for by the taxpayer but the taxpayer knows virtually nothing about what is being proposed and how the money is to be spent. We need to think long and hard about the sort of management structure that is necessary in the health service to deliver an efficient health care system combined with accountability to the public.

Finally, I do not think that we shall have the morale in the health service that we ought to have until we provide a proper pay structure for nurses, midwives and other key groups who currently feel battered and undervalued.

9.16 pm

Thank you for calling me at this late stage, Mr. Deputy Speaker. I appreciate it very much. Having launched an Adjournment debate on 5 April which lasted much longer than usual, and having made a long speech on that occasion, I do not resent the fact that others have spoken earlier than me today, and I am glad that the Chair made those selections.

It behoves me to say—as did my right hon. Friend the Member for Brent, North (Sir R. Boyson)—that I shall not be able to support the Government tonight after what I have heard so far. I am extremely disappointed that the Secretary of State was unable to make any significant concessions to alter the drastic position in which we find ourselves.

For geographical reasons, my hon. Friend the Member for Hendon, North (Sir J. Gorst) and I—with the permission, approval and support of our other colleagues—have led, for over a year, the great campaign to save the accident and emergency unit of Edgware general hospital from closure. The closure is proposed by the district health authority, and supported by the regional health authority. We continue to think that a grave mistake.

The position is not the same as that of the old central London hospitals—although I wish them well, and do not want them to be closed, either. This vital unit in an outer London borough is heavily used, efficient and popular; as my hon. Friend the Member for Hendon, North has said on many occasions, it is also part of a much-loved social institution. It is on the Edgware road, on the border between my constituency and that of my hon. Friend. If it is closed, the journey to Barnet, the Royal Free hospital in Hampstead or the Northwick Park hospital will be too long in congested traffic.

The Northwick Park hospital, incidentally, is the most important district general hospital in my area and the constituencies of Brent, North and Harrow, West. I wish it and its future development well; that does not contradict what I am saying about Edgware general hospital.

I am disappointed. During the last minutes of the debate, the Minister has the chance to make the additional concessions that we would require to support the Government tonight. I would not have any pleasure in supporting a Labour motion. I cannot remember the previous occasion when I did that. That is not the job of a Government-supporting Member.

I strongly support all the Government's policies, but we need extra movement, an extra concession and extra realism from Ministers. They should not respond only to the medical bureaucrats in their Department, whose easier solutions are to combine units to try to save accounting costs at the margin. Everyone can do that. It is not a particularly difficult exercise, despite the obvious complexities, but for the sake of all our constituents—the human beings in our constituency—we want the hospital to be saved.

If the A and E department goes, the hospital dies. That is an obvious reality. Everyone knows that. Every medical expert knows that. If the Minister could make extra concessions saying that closure would not take place by the target date, that further time would be given for consideration, and that the Government were not humiliated or embarrassed by having second thoughts on an unwise proposal, I could reconsider my position. From what has been said so far, I doubt whether that will happen, but this is the last opportunity for the Government to say, "Yes, we have listened not only to the people, but to our own Members of Parliament."

9.20 pm

This is our fourth debate on London's health in the past 13 months. That shows the level of interest in and concern about the future of health care in London.

One of the most depressing things about today's debate has been the unwillingness of Opposition Members to face up to the difficult challenges involved in taking decisions on health care in London. We have had a bit of a pretence that London is not over-resourced in terms of teaching hospitals and specialist facilities, but the facts stand for themselves. In 1993–94, average spending per capita in inner London was £565 per person compared with the national average of £370 per person. That shows that London is over-resourced.

In saying that, I recognise that today pressures exist on beds in London. That is why I have urged, and am pleased to urge again, caution on the pace of change in London. Many changes are occurring at the same time. We have care in the community and the internal market. All those issues must be taken into account.

In listening to the debate, especially in relation to Edgware general, Barnet, Bart's, St. Thomas's and Guy's hospitals, I am struck by the need for us to redefine what we mean by accident and emergency services. People who are injured in a major road accident, who suffer a severe stroke or cardiac arrest or who need intensive care, do not care which hospital an ambulance takes them to, so long as they receive first-class treatment. Frankly, they do not want to be taken to a third-rate A and E department where no consultant is on duty, where perhaps a junior has worked for only a few months, and where their chances of surviving are slight. We need to distinguish firmly between what I would define as major trauma centres and minor injuries departments.

My plea to my right hon. Friend the Secretary of State would be this: we need to be clear what we are talking about when discussing minor injuries departments. I should like them to be open 24 hours a day with a general practitioner on duty. It is rightly said that one of the problems in London is that the people of inner London use their hospital rather than their GP surgeries. That is partly because of poor primary care. We will not change that and, in a sense, I am not sure that it really matters, so long as those people receive the care they need. That is why local provision of minor injuries units could go a long way to allaying public concern about the closure of major A and E departments.

My only other main point, because I know that time is short tonight, relates to Bart's and the Royal London hospital. I have no axe to grind in relation to whether Bart's stays open or closes, but I have a concern, which I have expressed before, about the capital costs involved in relocating to the Royal London, which in gross terms amount to about £240 million. Given the comparatively small scale of the saving involved—£30 million a year—I am concerned about whether that represents good value for money, especially bearing in mind the fact that the dual-site option would achieve roughly half the savings at a small capital cost.

We all know the extent to which capital costs can be underestimated and revenue savings overestimated. I urge my right hon. Friend to ensure that the figures for Bart's and the Royal London are subjected to close scrutiny. As an outer London Member who for many years has been pressing for major capital investment at the local Mayday hospital, and who now knows the large sums that will be invested in the facilities at the Royal London, I must question whether that is the best value for money. We need rigorously to assess whether the single-site option is always better than the dual-site option.

I have no reservation in supporting the general direction of the changes proposed by my right hon. Friend the Secretary of State. She has taken courageous decisions, and she deserves our support.

9.25 pm

My hon. Friends the Members for Hampstead and Highgate (Ms Jackson) and for Newham, South (Mr. Spearing) echoed many of the speeches made during the debate when they asked the Government to think again. Whatever can be said for the Government's position as it has been represented tonight, it cannot possibly be said that it commands public support.

The petition to save Guy's hospital has been signed by more than 1 million people. Three mayors from three separate boroughs, one Labour, two Tory—at least, that was the roll call at the time—visited the Under-Secretary of State to discuss the Department's plans for the Edgware hospital. They represented 700,000 residents in north-west London. They were bluntly dismissed, told that the decision had already been made and that the time for negotiations had passed. The right hon. Member for Brent, North (Sir R. Boyson) expressed concern about that, as well he might. Some 183 local councillors have expressed their opinion on the Government's plan to close Edgware hospital. Only one has said that he supports the Government's position; the others do not.

Today, we have had the promise of a minor injuries unit at the earliest possible date. What sort of promise is that? Why was not it promised for the earliest possible date before today's debate? As my hon. Friend the Member for Barking (Ms Hodge) pointed out, such a promise is a con; it is nothing of any substance.

Some 1,244 people responded to the consultation on the Government's plans for Bart's—88 per cent. opposed the Government's plans. More than 1,000 people attended the health care crisis in London conference, which was organised by the National Health Service Support Federation last February. The conference unanimously adopted a resolution demanding an immediate halt to the shutdown of accident and emergency departments, to bed reductions and to hospital closures—a call that has been echoed by Labour Members throughout the debate.

The right hon. and learned Member for Putney (Mr. Mellor), no doubt unintentionally, made our point for us. While defending the broad thrust of Government policy, he also said that he has fought hard for local provision in his constituency. We can understand him saying that, so why cannot he allow his parliamentary colleagues the same right to fight for Edgware and the service that it provides to their constituents? My hon. Friend the Member for Thurrock (Mr. Mackinlay) pointed to the hypocrisy of some Conservative Members who support the thrust of Government policy, but defend provision in their own areas while not supporting other Members of Parliament, including Labour Members, who are trying to defend similar facilities in their constituencies.

Much has been said in the debate about political courage. My hon. Friend the Member for Leyton (Mr. Cohen) referred to the political courage of those Conservative Members who will not support the Government in the Lobby tonight. That takes courage, and I applaud them for that.

The political courage of the Secretary of State for Health has also been mentioned. I am all in favour of political courage, but not when it is providing the motivation to do the wrong thing. As has been said frequently in the debates which we have had on these topics, the Tomlinson report, on which the Government's decisions are founded, is fatally flawed. Tomlinson got it wrong. My hon. Friend the Member for Islington, North (Mr. Corbyn) said that the claim that London is over-bedded is inaccurate. London is not over-bedded. We are all grateful to Professor Jarman for the work that he has conducted which has shown that London is not over-bedded, but may well be under-bedded.

The hon. Member for Southend, East (Sir T. Taylor) talked about the over-provision of resources for London, but that is not true. It used to be believed, as the hon. Member for Southwark and Bermondsey (Mr. Hughes) pointed out, that London got 20 per cent. of the funding for only 15 per cent. of the population. However, the figures which the Department of Health publish include the costs for London allowance and for teaching facilities, and when allowance in the calculations is made for those additional costs, the funding and the population figures are broadly in line.

It was believed when Tomlinson reported that somehow primary care provision—I shall have more to say about this later—would reduce the demand for hospital services. It is my view that that is a false premise. By increasing the number of people who see a GP, the rate of diagnosis will be increased, and this will increase the number of referrals to London's hospitals.

Tomlinson believed that the location of casualty services was unimportant, but a number of lion Members—not least some Conservatives—have said that they do not accept that point of view. The closer a seriously injured person is to a casualty department, the more likely that he will be saved. Clinicians talk about the golden hour, which is vital. Certainly, a patient's chances are substantially diminished if the method of treating him is to put him on a helicopter and fly him up to Leeds. The right hon. Member for Brent, North (Sir R. Boyson) made that point rather well.

My hon. Friend the Member for Hampstead and Highgate (Ms Jackson) said that it was a mistake to assume that the two London regions can perform like an average English region. London is in many ways a special case. It has a large transient population, high levels of social deprivation and poverty, more mental illness, a lower than average provision for personal social services, and poor provision for the long-term care for the elderly. That puts extra pressure on accident and emergency units, and to some extent it is right to say that accident and emergency units are being used as a substitute for GP provision and good primary care.

My hon. Friend the Member for Hammersmith (Mr. Soley) made the point very well that Tomlinson misunderstood the relationship between inner and outer London. Tomlinson believed that patients from outer London do not make significant use of inner London hospitals. That is just wrong. Recent research carried out by the King's Fund shows that, of the 500,000 in-patients treated in inner London, 150,000 came from outer London and from other parts of the country. My hon. Friend the Member for Lewisham, West (Mr. Dowd) made reference to the service which Guy's hospital provides to his constituents.

When calculating the level of hospital provision in the capital, the Tomlinson report did not make a distinction between different types of hospital bed; it should have done. There is an important distinction between surgical beds, which are mostly used for elective cases, and medical beds, which are mostly used for emergency cases. The broad-brush proposal to close some 4,200 beds ignores the complexity of maintaining sufficient medical beds for urgent cases. If that were not understood at the time, we are informed every week of the outcome of that misunderstanding by the local press, who have yet another incident to draw to our attention.

The Tomlinson report referred several times to transitional funding. It was regarded as necessary to facilitate hospital closures and the development of primary and community services. The report did not cost those programmes and the Government provided no new money for them.

My hon. Friend the Member for Newham, North-East (Mr. Timms) spoke of a spiral of poor health and underachievement, and referred to the recent King's Fund report. That is of enormous importance for the whole country, but it has specific and special relevance to inner London, so it is right that we should look at primary care provision in London.

The Secretary of State is fond of quoting specialist experts—usually employed in her own Department—who support her point of view. Professor David London of the Royal College of Physicians said:

"London, like other big cities, needed a degree of rationalisation and that was always going to be painful. But it needed to be thought out. Money should have been put into it to ease the change, instead of being the cash-saving exercise it now appears to be."

The hon. Member for Surbiton (Mr. Tracey) spoke about improvements in primary care. My hon. Friend the Member for Woolwich (Mr. Austin-Walker) made the sensible point that it is neither fair nor right to get rid of hospital beds before enhanced primary care provision is put in place.

Between 1984 and 1992, the number of general practitioners per head of the population increased by 10 per cent. in England, but that was not so in London. Over the same period in inner London, there was a 2 per cent. decrease and only a 2 per cent. increase in outer London. Yet, not surprisingly, London has the highest percentage of waiting lists of a year or more. The Secretary of State made much of the fact that the figures are coming down, but she should have said that London still has the highest figures and the lowest reduction in waiting lists from December 1994. London has fewer family health centres per thousand of population than Newcastle, Leeds, Birmingham, Liverpool, Manchester or Bristol. It thus has a specific primary care problem, which the Government have not yet resolved.

It is no secret that we hope to encourage Conservative Members to support us in the Lobby tonight. The House should be treated to some advice, which I hope it will respect because it was commissioned by the Government. It comes from the chief executives of the inner London health authorities whom the Government appointed. In their recent report, they say:

"On the basis of the evidence presented to us there are reasons for anxiety about the ability of the system to cope with a further round of bed closures."

Yet assuredly, if our motion is defeated tonight, the system will have to cope with a further round of bed closures. They say:

"Some hospitals were found to be operating at 100 per cent. occupancy much of the time, and an average of 90–95 per cent. was common … generally speaking an average level of 85 per cent. occupancy is to be preferred."

So the hospitals are working at capacity. They said:

"The overall conclusion is that London's acute hospitals are operating under very considerable pressure."

I have not quoted those comments to make a party political point. We all have a duty to represent our constituents in this place and, as we consider how to vote tonight, we should consider those points, which come not from me but from the chief executives of the London health authorities. Every hon. Member would do well to bear them in mind.

Mr. Alan Lettin of the Royal College of Surgeons, speaking for health care professionals, says:

"Consultants feel the facilities are inadequate for the service we are expected to provide. We did warn the Government. The basis on which the cuts have been made was the King's Fund report, which has now been discredited.

What consultants would say to the Government is: 'We never believed your figures because there are too many patients waiting for beds, emergencies and for routine surgery."'

My hon. Friend the Member for Barking echoed that point.

If I am to encourage Conservative Members to support us in the Lobbies tonight, perhaps I should quote from someone whom I know that they all respect—the Secretary of State for Wales. In a speech on 4 April 1995, he said:

"I do not wish to see bed reductions while waiting lists are still quite long"—

but waiting lists in London have just reached an all-time high of almost 180,000. He said:

"Make sure there are enough intensive care beds"—

but recent tragedies in London and the south-east have shown that there are dangerously few intensive care beds.

One of the saddest aspects of the debate is to go, as I did recently, to Phillip Harris house to see the newly installed provision for intensive care beds. It was explained to me that all that provision is to be ripped out and smashed to pieces, even after it has been paid for, because the Government are no longer willing to provide the revenue funding. That is a shame. It is an act of vandalism, and should be resisted by the House.

The Secretary of State for Wales said:

"Make sure there are enough general medical and surgical beds."

That is what our motion says, so I invite him, at least, to vote for it tonight.

The Secretary of State for Wales said:

"I suspect it is a myth that it is cheaper to close the older hospital and do everything in a new large one."

My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) made the same argument. He may not often be found on the same side as the Secretary of State for Wales, but he made the same argument when he said that the transfer of services from the Bart's site to the Royal London hospital is by no means a move that will save money, let alone do anything else.

The Save Guy's Campaign commissioned a report by independent consultants, which showed that a retention of an accident and emergency unit and in-patient services at Guy's was financially viable. Those arguments deserve consideration and, dare I say it, reconsideration.

The motion does not demand—as the Labour party would ideally like it to—reconsideration by an independent organisation. It asks only for reconsideration by the Secretary of State for Health. It asks her to think again.

The Secretary of State for Wales, who may be the next Secretary of State for Health, said:

"The local hospital remains a cherished institution."

Of course, he was speaking for Wales, but he might have been speaking for Edgware as well. He said:

"I am asking the health authorities to slow down their passion for reorganising. It must go at a pace people accept."

He is certainly not the only Conservative Member of Parliament to have said that recently. He also said, referring to reorganisation:

"It must be based on health arguments, not financial considerations."

The hon. Member for Hendon, North (Sir J. Gorst) said:

"human beings, not balance sheets, come first."

That remark found a cheer from the Opposition, at least.

I urge the House to listen carefully to what was said tonight by Conservative Members as well as Labour Members, worried for their constituents. This is the last chance for health provision in London. The Opposition's motion deserves the support of the whole House in the Division tonight.

9.42 pm

Never has there been a more unlikely suitor of Conservative Members than the hon. Member for Newcastle upon Tyne, East (Mr. Brown). It was an astonishing performance, in which he admitted that he had not even been able to table the motion that he wanted to. I wonder who stopped him. Is it yet another story of a split between the hon. Gentleman and the right hon. Member for Derby, South (Mrs. Beckett)? Mr. Nicholas Brown: It is self-restraint.

Doubtless, when he takes over, we shall see the end of all that, shall we not?

When my hon. Friend takes over?

From his right hon. Friend the Member for Derby, South.

I thought that in this, the fourth debate about health in London in which I have spoken as Minister of State, we might have heard something positive from the right hon. Member for Derby, South or from the hon. Member for Newcastle upon Tyne, East. However, I agreed entirely with my right hon. and learned Friend the Member for Putney (Mr. Mellor) when he said that there was no policy; that we had heard nothing in the debate about what the Labour party would do. On four successive occasions, health in London has been debated and we have heard nothing positive. That point was reiterated by my hon. Friend the Member for Croydon, North-East (Mr. Congdon).

Today's debate gave the Opposition the opportunity to fill in the blank pages of their policy. They could have told the House what they would do about London's health service. They could have told it, and Londoners, about their plans to improve primary care and prepare hospitals in London for the 21st century. We heard nothing about that. The Opposition could have made commitments to validate their charge, perhaps, that the Government have got it wrong.

With any charge from any responsible Opposition that the Government have got it wrong comes an important corollary: they must have an argument about what they would do to put it right. I thought that if we did not hear it from the right hon. Member for Derby, South, we might hear it from her hon. Friend the Member for Newcastle upon Tyne, East, but we heard nothing.

Let me sum up the Government's case briefly. It is in three parts. First, clinical excellence is very important for London's hospitals. That means bringing specialist services together. It means, of course, that some hospitals have to change and, indeed, that some have to close. There was consensus on that under the reign of the right hon. Lady's predecessor, but that seems to have disappeared. Other hospitals—for example, Edgware, which has been quite rightly mentioned frequently in the debate—will have to change in character to community hospitals, delivering care closer to patients than they were able to do before. That change is in the interests of the community.

It is extremely important to meet the challenges of technological change, as well as those associated with increasing day care, earlier discharge and the falling number of referrals from outside London—not just from outer London to inner London hospitals, but from the home counties and the rest of the country.

Has my hon. Friend had the chance to study the letter that I sent to him from my health authority? It explained that the rapidly accelerating switch to treating people locally meant that, last year, North West Surrey health authority had to encourage my local GPs and local consultants to persuade their patients to go to central London rather than be treated locally, to use up contract money. I must tell my hon. Friend that my constituents want to be treated locally, not bundled off to central London to help to keep other hospitals viable.

I have read the letter that my hon. Friend sent me. He made a valid point, which will be echoed by many hon. Members.

It is important that London meets the challenge of changing referrals. It is essential to ensure that funds that are allocated to health authorities in London go on patient care and are not swallowed by high-cost institutions.

The investment that the Government have made in primary care for London—£210 million in recent years—is second to none and is transforming the face of primary care in the city and bringing new facilities on stream on a day-to-day basis.

The hon. Member for Southwark and Bermondsey (Mr. Hughes) asked the fundamental question: is London being overfunded? If he looks at the weighted capitation basis of funding, he will see that it is overresourced by £91 million. That does not take into account top-sliced funding that goes towards transitional payments to maintain institutions. That overfunding is not the main argument, because the hon. Gentleman and other hon. Members who clearly have constituency interests in the city should ask themselves whether they want to see the resources that are given to their health authorities, which are meant to be spent on patient care, absorbed by institutions that are not run on an efficient basis. I suggest that, in their constituency interests, that should not be so.

My right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) asked specifically about consideration of the York report. I can tell him that it was given proper consideration. The Treasury has scrutinised the business case and it said that the case for a single-site solution seems robust and well founded in contrast to what was put forward.

My right hon. and learned Friend the Member for Putney made a number of valid points about the difficulty of the detail. I agree that the detail is difficult. That is what the Opposition find difficult to understand. Until now, they have all gone with the policy for change and argued that change is essential, but when we get down to the agenda of change, they disappear over the horizon without an idea to bring to bear on the argument.

My right hon. and learned Friend the Member for Putney asked about the role of the purchasing authority with regard to the hospital in his constituency. The health authority is still to be persuaded about that case, but I have no doubt that my right hon. and learned Friend will follow up the representations that he has already made to me, and that he will continue to press the authority very firmly about that matter.

My right hon. Friend the Member for Chelsea (Sir N. Scott) raised an important point about the Royal Brompton hospital. My Department and the Royal Brompton are currently looking at various development possibilities and I know that my right hon. Friend continues to make strong representations on the hospital's behalf. My hon. Friend the Member for Surbiton (Mr. Tracey) emphasised the technological advances that have been made in health care. It is important that we recognise technology changes and build hospitals for the 21st century; we must not be left behind.

I now come to the comments of my right hon. Friend the Member for Brent, North (Sir R. Boyson) and my hon. Friends the Members for Hendon, North (Sir J. Gorst) and for Harrow, East (Mr. Dykes). They have clear constituency concerns, and I must admit quite frankly that I cannot meet all the points that they raised. However, I ask them to bear in mind the fact that Edgware hospital will not close, as has been suggested in the popular press. I know that they recognise that fact.

Edgware hospital will remain as a community hospital that will deliver patient care to the community. It will provide a minor accident treatment service, which will cater for approximately 50 per cent. of those who use the current accident and emergency service. Some £60 million will be invested in the hospital in Brent in order to turn it into a first-class facility.

So that I may be absolutely certain that I will enter the correct Division Lobby this evening, I ask my hon. Friend to leave aside the palliatives, sedatives and tranquillisers that have been dressed up as concessions and, even at this 11th hour, to give an undertaking that the accident and emergency department at Edgware hospital will remain open.

I cannot give that undertaking, because it would be the wrong thing to do. The Government will put in place new, worthwhile facilities, and I hope that hon. Members in the area will be able to reassure their constituents about service provision. If my hon. Friend were to visit some minor units that have been established already—for example, the St. Charles's hospital minor injuries unit that was referred to in the debate—he would find that they are first-class facilities that could meet the needs of his constituents extremely well. [Interruption.] I hear an intervention from a sedentary position that no one believes me. I do not ask Labour Members to believe what I say; they should go and see for themselves what those units, which are close to the community, can provide. They are excellently run and they have zero waiting times. They are first-class facilities.

Even if the Minister cannot give that concession to my hon. Friend the Member for Hendon, North (Sir J. Gorst), can he not at least postpone the closure of the A and E unit at Edgware hospital and confirm that there will be additional ambulance provision pending further examination of the whole question?

My hon. Friend knows about the additional ambulance provision that has been promised already. I cannot promise any further delay or postponement of the closure of the A and E unit at Edgware hospital. However, I emphasise the pledge that my right hon. Friend the Secretary of State has given, that we will put in place equivalent, if not better, facilities that will soon be up and running. That is not merely a pledge from Ministers or from the health authorities; buildings of bricks and mortar will be occupied by doctors and nurses who will run the facilities in a proper way. I hope that my hon. Friend will accept my assurance.

I come to the remarks of my hon. Friend the Member for Broxbourne (Mrs. Roe), who is Chairman of the Select Committee on Health. She referred to the way in which the Committee scrutinises the Government's policies. That scrutiny is very welcome and I know that my right hon. Friend, fresh from this debate, is looking forward to appearing before the Select Committee tomorrow.

The hon. Member for Islington, North (Mr. Corbyn) talked about London waiting figures. May I say to the whole House that there has been a tremendous achievement on waiting figures in London? In the 12 months up to March 1995, the number of people who had been waiting for more than one year fell by 26.3 per cent. That is an enormous achievement. I do not know why Opposition Members who claim to support the health service denigrate it when it makes such achievements, and try to cast it down.

I tell the hon. Member for Newcastle upon Tyne, East that the health service in London is not as good as in other parts of the country because we have got to get London's health service into the same shape as the health service in other parts of the country. It is the Opposition motion that stands exactly in the way of that.

The hon. Member for Newham, South (Mr. Spearing) made an interesting speech. He gave a historical analysis of what has happened in health, with which I do not quite agree. He harked back to the good old days before 1990, when he said that there was a consensus on health policy. I remember being in the House between 1983 and 1987. To echo the words of my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler), if that was consensus before 1990, God help us if war had broken out, because the truth is that the Opposition have attempted to thwart every attempt made by the Government since 1979 to reform the health service and make it more efficient.

The hon. Member for Woolwich (Mr. Austin-Walker) talked about resources and said that we would have to be extremely careful not to take away care provision before we had provided other facilities. That is right, and it was one of the pledges that my right hon. Friend the Secretary of State gave the House; I am pleased to reiterate it in my winding-up speech.

My hon. Friend the Member for Hendon, South (Mr. Marshall) welcomed the primary care initiative. [Interruption.]

Order. The House should settle down and hear the last minutes of the Minister's winding-up speech. The House is much too noisy. Too many meetings are taking place.

I am glad that my hon. Friend the Member for Hendon, South welcomed that initiative. I assure him that the pledge to continue to improve the London ambulance service will be honoured.

The right hon. Member for Derby, South made much in her remarks about the NHS building programme. I have to tell her, on behalf of my right hon. Friend the Secretary of State, that my right hon. Friend stated that there had been one new building programme a week in the five years to March 1994. I have to apologise on behalf of my right hon. Friend, because she misled the House. That would have led to a total of 260 building programmes over that period. There were, in fact, 375 building schemes, each costing over a million pounds, completed in an NHS programme worth over £1 billion nationally. Since 1979, the Government have put £22.5 billion into NHS building programmes.

What we get from the Opposition is impresario politics. Today, as the right hon. Member for Derby, South was speaking, we saw that the soundbites were taken by the Leader of the Opposition as he appeared in Bart's hospital. I have a question that everybody in Bart's hospital would like to ask the Opposition. If they take the political credit for appearing to save Bart's hospital, are they prepared to stand up at the Dispatch Box today, tonight, at this moment, and say that they would save Bart's hospital?

The Minister will find out in the Lobby in three minutes' time.

The hon. Gentleman gave no policy commitment or anything of that sort. There never has been from the Labour party.

At the core of this debate is the point about hospitals.

"There is a tendency in some quarters to defend the very small hospital on the ground of its localism and intimacy … but everybody knows today that if a hospital is to be efficient it must provide a number of specialised services. Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one."—[Official Report, 30 April 1946; Vol. 422, c. 44.]

I wonder whether the Opposition agree with that. They probably do not. That is from the speech of Aneurin Bevan in moving the Second Reading of the National Health Service Bill on 30 April 1946. The Opposition have resiled from what was promised then. They have no policies. Bevan took on the challenges, which the Opposition are not prepared to do. That is why the House should reject the Opposition's motion.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 308, Noes 320.

Division No. 144]	[9.59 pm
AYES
Abbott, Ms Diane	Blunkett, David
Adams, Mrs Irene	Boateng, Paul
Anger, Nick	Boyes, Roland
Ainsworth, Robert (Coventry NE)	Bradley, Keith
Allen, Graham	Bray, Dr Jeremy
Alton, David	Brooke, Rt Hon Peter
Anderson, Donald (Swansea E)	Brown, Gordon (Dunfermline E)
Anderson, Ms Janet (Ros'dale)	Brown, N (N'c'tle upon Tyne E)
Armstrong, Hilary	Bruce, Malcolm (Gordon)
Ashdown, Rt Hon Paddy	Burden, Richard
Ashton, Joe	Byers, Stephen
Austin-Walker, John	Caborn, Richard
Banks, Tony (Newham NM)	Callaghan, Jim
Barnes, Harry	Campbell, Mrs Anne (C'bridge)
Barron, Kevin	Campbell, Menzies (Fife NE)
Battle, John	Campbell, Ronnie (Blyth V)
Bayley, Hugh	Campbell-Savours, D N
Beckett, Rt Hon Margaret	Canavan, Dennis
Beith, Rt Hon A J	Cann, Jamie
Bell, Stuart	Carlile, Alexander (Montgomery)
Benn, Rt Hon Tony	Chidgey, David
Bennett, Andrew F	Chisholm, Malcolm
Benton, Joe	Church, Judith
Bermingham, Gerald	Clapham, Michael
Berry, Roger	Clark, Dr David (South Shields)
Betts, Clive	Clarke, Eric (Midlothian)
Blair, Rt Hon Tony	Clarke, Tom (Monklands W)

Clelland, David	Hinchliffe, David
Clwyd, Mrs Ann	Hodge, Margaret
Coffey, Ann	Hoey, Kate
Cohen, Harry	Hogg, Norman (Cumbernauld)
Connarty, Michael	Home Robertson, John
Cook, Frank (Stockton N)	Hood, Jimmy
Cook, Robin (Livingston)	Hoon, Geoffrey
Corbett Robin	Howarth, George (Knowsley North)
Corbyn, Jeremy	Howells, Dr. Kim (Pontypridd)
Corston, Jean	Hoyle, Doug
Cousins, Jim	Hughes, Kevin (Doncaster N)
Cox, Tom	Hughes, Robert (Aberdeen N)
Cummings, John	Hughes, Roy (Newport E)
Cunliffe, Lawrence	Hughes, Simon (Southwark)
Cunningham, Jim (Covy SE)	Hume, John
Cunningham, Rt Hon Dr John	Hutton,John
Dafis, Cynog	Illsley, Eric
Dalyell, Tam	Ingram, Adam
Darling, Alistair	Jackson, Glenda (H'stead)
Davidson, Ian	Jackson, Helen (Shef'ld, H)
Davies, Bryan (Oldham C'tral)	Jamieson, David
Davies, Rt Hon Denzil (Llanelli)	Janner, Greville
Davies, Ron (Caerphilly)	Johnston, Sir Russell
Davis, Terry (B'ham, H'dge H'l)	Jones, Barry (Alyn and D'side)
Denham, John	Jones, leuan Wyn (Ynys Môn)
Dewar, Donald	Jones, Jon Owen (Cardiff C)
Dixon, Don	Jones, Lynne (B'ham S O)
Dobson, Frank	Jones, Martyn (Clwyd, SW)
Donohoe, Brian H	Jones, Nigel (Cheltenham)
Dunnachie, Jimmy	Jowell, Tessa
Dunwoody, Mrs Gwyneth	Kaufman, Rt Hon Gerald
Eagle, Ms Angela	Keen, Alan
Eastham, Ken	Kennedy, Charles (Ross,C&S)
Enright, Derek	Kennedy, Jane (Lpool Brdgn)
Etherington, Bill	Khabra, Piara S
Evans, John (St Helens N)	Kilfoyle, Peter
Ewing, Mrs Margaret	Kirkwood, Archy
Fatchett Derek	Lestor, Joan (Eccles)
Faulds, Andrew	Lewis, Terry
Field, Frank (Birkenhead)	Litherland, Robert
Fisher, Mark	Livingstone, Ken
Flynn, Paul	Lloyd, Tony (Stretford)
Foster, Rt Hon Derek	Llwyd, Elfyn
Foster, Don (Bath)	Loyden, Eddie
Foulkes, George	Lynne, Ms Liz
Fraser, John	McAllion, John
Fyfe, Maria	McAvoy, Thomas
Galbraith, Sam	McCartney, Ian
Galloway, George	McCrea, The Reverend William
Gapes, Mike	Macdonald, Calum
Garrett, John	McFall, John
George, Bruce	McKelvey, William
Gerrard, Neil	Mackinlay, Andrew
Gilbert, Rt Hon Dr John	McLeish, Henry
Godman, Dr Norman A	Maclennan, Robert
Godsiff, Roger	McMaster, Gordon
Golding, Mrs Llin	McNamara, Kevin
Gordon, Mildred	MacShane, Denis
Gorst Sir John	McWilliam, John
Graham, Thomas	Madden, Max
Grant, Bernie (Tottenham)	Maddock, Diana
Griffiths, Nigel (Edinburgh S)	Mahon, Alice
Griffiths, Win (Bridgend)	Mallon, Seamus
Grocott, Bruce	Mandelson, Peter
Gunnell, John	Marek, Dr John
Hain, Peter	Marshall, David (Shettleston)
Hal, Mike	Marshall, Jim (Leicester, S)
Hanson, David	Martin, Michael J (Springburn)
Hardy, Peter	Martlew, Eric
Harman, Ms Harriet	Maxton, John
Harvey, Nick	Meacher, Michael
Hattersley, Rt Hon Roy	Meale, Alan
Henderson, Doug	Michael, Alun
Hendron, Dr Joe	Michie, Bill (Sheffield Heeley)
Heppell, John	Michie, Mrs Ray (Argyll & Bute)
Hill, Keith (Streatham)	Milburn, Alan

Miller, Andrew	Shore, Rt Hon Peter
Mitchell, Austin (Gt Grimsby)	Short, Clare
Moonie, Dr Lewis	Simpson, Alan
Morgan, Rhodri	Skinner, Dennis
Morley, Elliot	Smith, Andrew (Oxford E)
Morris, Rt Hon Alfred (Wy'nshawe)	Smith, Chris (Isl'ton S & Fsbury)
Morris, Estelle (B'ham Yardley)	Smith, Llew (Blaenau Gwent)
Morris, Rt Hon John (Aberavon)	Smyth, The Reverend Martin (Belfast S)
Mowlam, Marjorie
Mudie, George	Snape, Peter
Mullin, Chris	Soley, Clive
Murphy, Paul	Spearing, Nigel
Oakes, Rt Hon Gordon	Spellar, John
O'Brien, Mike (N W'kshire)	Squire, Rachel (Dunfermline W)
O'Brien, William (Normanton)	Steel, Rt Hon Sir David
O'Hara, Edward	Steinberg, Gerry
Olner, Bill	Stevenson, George
O'Neill, Martin	Stott, Roger
Orme, Rt Hon Stanley	Strang, Dr. Gavin
Parry, Robert	Straw, Jack
Patchett, Terry	Sutcliffe, Gerry
Pearson Ian	Taylor, Mrs Ann (Dewsbury)
Pendry, Tom	Taylor, Rt Hon John D (Strgfd)
Pickthall, Colin	Taylor, Matthew (Truro)
Pike, Peter L	Thompson, Jack (Wansbeck)
Pope, Greg	Timms, Stephen
Powell, Ray (Ogmore)	Tipping, Paddy
	Touhig, Don
Prentice, Bridget (Lew'm E)	Trimble David
Prentice, Gordon (Pendle)	Turner, Dennis
Prescott, Rt Hon John	Tyler, Paul
Primarolo, Dawn	Vaz, Keith
Purchase, Ken	Walker, Rt Hon Sir Harold
Quin, Ms Joyce	Wallace, James
Radice, Giles	Walley, Joan
Randall, Stuart	Wardell, Gareth (Gower)
Raynsford, Nick	Wareing, Robert N
Redmond, Martin	Watson, Mike
Reid, Dr John	Welsh, Andrew
Rendel, David	Wicks, Malcolm
Robertson, George (Hamilton)	Wigley, Dafydd
Robinson, Geoffrey (Co'try NW)	Williams, Rt Hon Alan (SW'n W)
Robinson, Peter (Belfast E)	Williams, Alan W (Carmarthen)
Rogers, Allan	Wilson, Brian
Rooker, Jeff	Winnick, David
Rooney, Terry	Wise, Audrey
Ross, Ernie (Dundee W)	Worthington, Tony
Ross, William (E Londonderry)	Wray, Jimmy
Rowlands, Ted	Wright, Dr Tony
Ruddock, Joan	Young, David (Bolton SE)
Salmond, Alex
Sedgemore, Brian	Tellers for the Ayes:
Sheerman, Barry	Mrs. Barbara Roche and
Sheldon, Rt Hon Robert	Mr. Jim Dowd.
NOES
Ainsworth, Peter (East Surrey)	Batiste, Spencer
Aitken, Rt Hon Jonathan	Bellingham, Henry
Alexander, Richard	Bendall, Vivian
Alison, Rt Hon Michael (Selby)	Beresford, Sir Paul
Allason, Rupert (Torbay)	Biffen, Rt Hon John
Amess, David	Body, Sir Richard
Ancram, Michael	Bonsor, Sir Nicholas
Arbuthnot, James	Booth, Hartley
Arnold, Jacques (Gravesham)	Boswell, Tim
Arnold, Sir Thomas (Hazel Grv)	Bottomley, Peter (Eltham)
Ashby, David	Bottomley, Rt Hon Virginia
Atkins, Robert	Bowden, Sir Andrew
Atkinson, David (Bour'mouth E)	Bowis, John
Atkinson, Peter (Hexham)	Brandreth, Gyles
Baker, Rt Hon Kenneth (Mole V)	Brazier, Julian
Baker, Nicholas (North Dorset)	Bright, Sir Graham
Baldry, Tony	Brown, M (Brigg & Cl'thorpes)
Banks, Matthew (Southport)	Browning, Mrs Angela
Banks, Robert (Harrogate)	Bruce, Ian (Dorset)
Bates, Michael	Budgen, Nicholas

Burns, Simon	Greenway, John (Ryedale)
Burt, Alistair	Griffiths, Peter (Portsmouth, N)
Butcher, John	Grylls, Sir Michael
Butler, Peter	Gummer, Rt Hon John Selwyn
Butterfill, John	Hague, William
Carlisle, John (Luton North)	Hamilton, Rt Hon Sir Archibald
Carlisle, Sir Kenneth (Lincoln)	Hamilton, Neil (Tatton)
Carrington, Matthew	Hampson, Dr Keith
Carttiss, Michael	Hanley, Rt Hon Jeremy
Cash, William	Hannam, Sir John
Channon, Rt Hon Paul	Hargreaves, Andrew
Churchill, Mr	Harris, David
Clappison, James	Haselhurst, Alan
Clark, Dr Michael (Rochford)	Hawkins, Nick
Clarke, Rt Hon Kenneth (Ru'clif)	Hawksley, Warren
Clifton-Brown, Geoffrey	Hayes, Jerry
Coe, Sebastian	Heald, Oliver
Colvin, Michael	Heath, Rt Hon Sir Edward
Congdon, David	Heathcoat-Amory, David
Conway, Derek	Hendry, Charles
Coombs, Anthony (Wyre For'st)	Heseltine, Rt Hon Michael
Coombs, Simon (Swinton)	Hicks, Robert
Cope, Rt Hon Sir John	Higgins, Rt Hon Sir Terence
Cormack, Sir Patrick	Hill, James (Southampton Test)
Couchman, James	Hogg, Rt Hon Douglas (G'tham)
Cran, James	Horam, John
Critchley, Julian	Hordern, Rt Hon Sir Peter
Currie, Mrs Edwina (S D'by'ire)	Howard, Rt Hon Michael
Curry, David (Skipton & Ripon)	Howarth, Alan (Strat'rd-on-A)
Davies, Quentin (Stamford)	Howell, Rt Hon David (G'dford)
Davis, David (Boothferry)	Howell, Sir Ralph (N Norfolk)
Day, Stephen	Hughes, Robert G (Harrow W)
Deva, Nirj Joseph	Hunt, Rt Hon David (Wirral W)
Delvin, Tim	Hunt, Sir John (Ravensboume)
Dicks, Terry	Hunter, Andrew
Dorrell, Rt Hon Stephen	Hurd, Rt Hon Douglas
Douglas-Hamilton, Lord James	Jack, Michael
Dover, Den	Jackson, Robert (Wantage)
Duncan, Alan	Jenkin, Bernard
Duncan Smith, Iain	Jessel, Toby
Dunn, Bob	Johnson Smith, Sir Geoffrey
Durant, Sir Anthony	Jones, Gwilym (Cardiff N)
Eggar, Rt Hon Tim	Jones, Robert B (W Hertfdshr)
Elletson, Harold	Jopling, Rt Hon Michael
Emery, Rt Hon Sir Peter	Kellett-Bowman, Dame Elaine
Evans, David (Welwyn Hatfield)	Key, Robert
Evans, Jonathan (Brecon)	King, Rt Hon Tom
Evans, Nigel (Ribble Valley)	Kirkhope, Timothy
Evans, Roger (Monmouth)	Knapman, Roger
Evennett, David	Knight, Mrs Angela (Erewash)
Faber, David	Knight, Greg (Derby N)
Fabricant, Michael	Knight, Dame Jill (Bir'm E'st'n)
Fenner, Dame Peggy	Knox, Sir David
Field, Barry (Isle of Wight)	Kynoch, George (Kincardine)
Fishburn, Dudley	Lait, Mrs Jacqui
Forman, Nigel	Lamont, Rt Hon Norman
Forsyth, Rt Hon Michael (Stirling)	Lang, Rt Hon Ian
Forth, Eric	Lawrence, Sir Ivan
Fowler, Rt Hon Sir Norman	Legg, Barry
Fox, Dr Liam (Woodspring)	Leigh, Edward
Fox, Sir Marcus (Shipley)	Lennox-Boyd, Sir Mark
Freeman, Rt Hon Roger	Lester, Jim (Broxtowe)
French, Douglas	Lidington, David
Fry, Sir Peter	Lilley, Rt Hon Peter
Gale, Roger	Lloyd, Rt Hon Sir Peter (Fareham)
Gallie, Phil	Lord, Michael
Gardiner, Sir George	Luff, Peter
Garel-Jones, Rt Hon Tristan	Lyell, Rt Hon Sir Nicholas
Garnier, Edward	MacGregor, Rt Hon John
Gill, Christopher	MacKay, Andrew
Gillan, Cheryl	Maclean, David
Goodlad, Rt Hon Alastair	McLoughlin, Patrick
Goodson-Wickes, Dr Charles	McNair-Wilson, Sir Patrick
Gorman, Mrs Teresa	Madel, Sir David
Grant, Sir A (SW Cambs)	Maitland, Lady Olga
Greenway, Harry (Ealing N)	Major, Rt Hon John

Malone, Gerald	Skeet, Sir Trevor
Mans, Keith	Smith, Sir Dudley (Warwick)
Marland, Paul	Smith, Tim (Beaconsfield)
Marlow, Tony	Soames, Nicholas
Marshall, John (Hendon S)	Speed, Sir Keith
Marshall, Sir Michael (Arundel)	Spencer, Sir Derek
Martin, David (Portsmouth S)	Spicer, Sir James (W Dorset)
Mates, Michael	Spicer, Michael (S Worcs)
Mawhinney, Rt Hon Dr Brian	Spink, Dr Robert
Mayhew, Rt Hon Sir Patrick	Spring, Richard
Mellor, Rt Hon David	Sproat, Iain
Merchant Piers	Squire, Robin (Hornchurch)
Mills, Iain	Stanley, Rt Hon Sir John
Mitchell, Andrew (Gedling)	Steen, Anthony
Mitchell, Sir David (NW Hants)	Stephen, Michael
Moate, Sir Roger	Stern, Michael
Monro, Sir Hector	Stewart, Allan
Montgomery, Sir Fergus	Streeter, Gary
Moss, Malcolm	Sumberg, David
Needham, Rt Hon Richard	Sweeney, Walter
Nelson, Anthony	Sykes, John
Neubert, Sir Michael	Tapsell, Sir Peter
Newton, Rt Hon Tony	Taylor, Ian (Esher)
Nicholls, Patrick	Taylor, John M (Solihull)
Nicholson, David (Taunton)	Taylor, Sir Teddy (Southend, E)
Nicholson, Emma (Devon West)	Temple-Morris, Peter
Norris, Steve	Thomason, Roy
Onslow, Rt Hon Sir Cranley	Thompson, Sir Donald (C'er V)
Oppenheim, Phillip	Thompson, Patrick (Norwich N)
Ottaway, Richard	Thornton, Sir Malcolm
Page, Richard	Thurnham, Peter
Paice, James	Townend, John (Bridlington)
Patrick, Sir Irvine	Townsend, Cyril D (Bexl'yh'th)
Patten, Rt Hon John	Tracey, Richard
Pattie, Rt Hon Sir Geoffrey	Trend, Michael
Pawsey, James	Trotter, Neville
Peacock, Mrs Elizabeth	Twinn, Dr Ian
Pickles, Eric	Vaughan, Sir Gerard
Porter, Barry (Wirral S)	Viggers, Peter
Porter, David (Waveney)	Waldegrave, Rt Hon William
Portillo, Rt Hon Michael	Walden, George
Powell, William (Corby)	Walker, Bill (N Tayside)
Rathbone, Tim	Waller, Gary
Redwood, Rt Hon John	Ward, John
Renton, Rt Hon Tim	Wardle, Charles (Bexhill)
Richards, Rod	Waterson, Nigel
Riddick, Graham	Watts, John
Rifkind, Rt Hon Malcolm	Wells, Bowen
Robathan, Andrew	Wheeler, Rt Hon Sir John
Roberts, Rt Hon Sir Wyn	Whitney, Ray
Robertson, Raymond (Ab'd'n S)	Whittingdale, John
Robinson, Mark (Somerton)	Widdecombe, Ann
Roe, Mrs Marion (Broxbourne)	Wiggin, Sir Jerry
Rowe, Andrew (Mid Kent)	Wilkinson, John
Rumbold, Rt Hon Dame Angela	Willetts, David
Ryder, Rt Hon Richard	Wilshire, David
Sackville, Tom	Winterton, Mrs Ann (Congleton)
Sainsbury, Rt Hon Sir Timothy	Winterton, Nicholas (Macc'fld)
Scott, Rt Hon Sir Nicholas	Wolfson, Mark
Shaw, David (Dover)	Wood, Timothy
Shaw, Sir Giles (Pudsey)	Yeo, Tim
Shephard, Rt Hon Gillian	Young, Rt Hon Sir George
Shepherd, Colin (Hereford)
Shepherd, Richard (Aldridge)	Tellers for the Noes:
Shersby, Michael	Mr. David Lightbown and
Sims, Roger	Mr. Sydney Chapman.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments):—

The House divided: Ayes 319, Noes 302.

Division No. 145]	[10.17 pm
AYES
Ainsworth, Peter (East Surrey)	Devlin, Tim
Aitken, Rt Hon Jonathan	Dicks, Terry
Alexander, Richard	Dorrell, Rt Hon Stephen
Alison, Rt Hon Michael (Selby)	Douglas-Hamilton, Lord James
Allason, Rupert (Torbay)	Dover, Den
Amess, David	Duncan, Alan
Ancram, Michael	Duncan-Smith, Iain
Arbuthnot, James	Dunn, Bob
Arnold, Jacques (Gravesham)	Durant, Sir Anthony
Arnold, Sir Thomas (Hazel Grv)	Eggar, Rt Hon Tim
Ashby, David	Elletson, Harold
Atkins, Robert	Emery, Rt Hon Sir Peter
Atkinson, David (Bour'mouth E)	Evans, David (Welwyn Hatfield)
Atkinson, Peter (Hexham)	Evans, Jonathan (Brecon)
Baker, Rt Hon Kenneth (Mole V)	Evans, Nigel (Ribble Valley)
Baker, Nicholas (North Dorset)	Evans, Roger (Monmouth)
Baldry, Tony	Evennett, David
Banks, Matthew (Southport)	Faber, David
Banks, Robert (Harrogate)	Fabricant, Michael
Bates, Michael	Fenner, Dame Peggy
Batiste, Spencer	Field, Barry (Isle of Wight)
Bellingham, Henry	Fishburn, Dudley
Bendall, Vivian	Forman, Nigel
Beresford, Sir Paul	Forsyth, Rt Hon Michael (Stirling)
Biffen, Rt Hon John	Forth, Eric
Body, Sir Richard	Fowler, Rt Hon Sir Norman
Bonsor, Sir Nicholas	Fox, Sir Marcus (Shipley)
Booth, Hartley	Freeman, Rt Hon Roger
Boswell, Tim	French, Douglas
Bottomley, Peter (Eltham)	Fry, Sir Peter
Bottomley, Rt Hon Virginia	Gale, Roger
Bowden, Sir Andrew	Gallie, Phil
Bowis, John	Gardiner, Sir George
Brandreth, Gyles	Garel-Jones, Rt Hon Tristan
Brazier, Julian	Garnier, Edward
Bright, Sir Graham	Gill, Christopher
Brown, M (Brigg & Cl'thorpes)	Gillan, Cheryl
Browning, Mrs Angela	Goodlad, Rt Hon Alastair
Bruce, Ian (Dorset)	Goodson-Wickes, Dr Charles
Budgen, Nicholas	Gorman, Mrs Teresa
Burns, Simon	Grant, Sir A (SW Cambs)
Burt, Alistair	Greenway, Harry (Ealing N)
Butcher, John	Greenway, John (Ryedale)
Butler, Peter	Griffiths, Peter (Portsmouth, N)
Butterfill, John	Grylls, Sir Michael
Carlisle, John (Luton North)	Gummer, Rt Hon John Selwyn
Carlisle, Sir Kenneth (Lincoln)	Hague, William
Carrington, Matthew	Hamilton, Rt Hon Sir Archibald
Carttiss, Michael	Hamilton, Neil (Tatton)
Cash, William	Hampson, Dr Keith
Channon, Rt Hon Paul	Hanley, Rt Hon Jeremy
Churchill, Mr	Hannam, Sir John
Clappison, James	Hargreaves, Andrew
Clark, Dr Michael (Rochford)	Harris, David
Clarke, Rt Hon Kenneth (Ru'clif)	Haselhurst, Alan
Clifton-Brown, Geoffrey	Hawkins, Nick
Coe, Sebastian	Hawksley, Warren
Colvin, Michael	Hayes, Jerry
Congdon, David	Heald, Oliver
Conway, Derek	Heath, Rt Hon Sir Edward
Coombs, Anthony (Wyre For'st)	Heathcoat-Amory, David
Coombs, Simon (Swindon)	Hendry, Charles
Cope, Rt Hon Sir John	Heseltine, Rt Hon Michael
Cormack, Sir Patrick	Hicks, Robert
Couchman, James	Higgins, Rt Hon Sir Terence
Cran, James	Hill, James (Southampton Test)
Critchley, Julian	Hogg, Rt Hon Douglas (G'tham)
Currie, Mrs Edwina (S D'by'ire)	Horam, John
Curry, David (Skipton & Ripon)	Hordern, Rt Hon Sir Peter
Davies, Quentn (Stamford)	Howard, Rt Hon Michael
Davis, David (Boothferry)	Howarth, Alan (Strat'rd-on-A)
Day, Stephen	Howell, Rt Hon David (G'dford)
Deva, Nirj Joseph	Howell, Sir Ralph (N Norfolk)

Hughes, Robert G (Harrow W)	Page, Richard
Hunt, Rt Hon David (Wirral W)	Paice, James
Hunt, Sir John (Ravensbourne)	Patnick, Sir Irvine
Hunter, Andrew	Patten, Rt Hon John
Hurd, Rt Hon Douglas	Pattie, Rt Hon Sir Geoffrey
Jack, Michael	Pawsey, James
Jackson, Robert (Wantage)	Peacock, Mrs Elizabeth
Jenkin, Bernard	Pickles, Eric
Jessel, Toby	Porter, Barry (Wirral S)
Johnson Smith, Sir Geoffrey	Porter, David (Waveney)
Jones, Gwilym (Cardiff N)	Portillo, Rt Hon Michael
Jones, Robert B (W Hertfdshr)	Powell, William (Corby)
Jopling, Rt Hon Michael	Rathbone, Tim
Kellett-Bowman, Dame Elaine	Redwood, Rt Hon John
Key, Robert	Renton, Rt Hon Tim
King, Rt Hon Tom	Richards, Rod
Kirkhope, Timothy	Riddick, Graham
Knapman, Roger	Rifkind, Rt Hon Malcolm
Knight, Mrs Angela (Erewash)	Robathan, Andrew
Knight, Greg (Derby N)	Roberts, Rt Hon Sir Wyn
Knight, Dame Jill (Bir'm E'st'n)	Robertson, Raymond (Ab'd'n S)
Knox, Sir David	Robinson, Mark (Somerton)
Kynoch, George (Kincardine)	Roe, Mrs Marion (Broxbourne)
Lait, Mrs Jacqui	Rowe, Andrew (Mid Kent)
Lamont, Rt Hon Norman	Rumbold, Rt Hon Dame Angela
Lang, Rt Hon Ian	Ryder, Rt Hon Richard
Lawrence, Sir Ivan	Sackville, Tom
Legg, Barry	Sainsbury, Rt Hon Sir Timothy
Leigh, Edward	Scott, Rt Hon Sir Nicholas
Lennox-Boyd, Sir Mark	Shaw, David (Dover)
Lester, Jim (Broxtowe)	Shaw, Sir Giles (Pudsey)
Lidington, David	Shephard, Rt Hon Gillian
Lightbown, David	Shepherd, Colin (Hereford)
Lilley, Rt Hon Peter	Shepherd, Richard (Aldridge)
Lloyd, Rt Hon Sir Peter (Fareham)	Shersby, Michael
Lord, Michael	Skeet, Sir Trevor
Luff, Peter	Smith, Sir Dudley (Warwick)
Lyell, Rt Hon Sir Nicholas	Smith, Tim (Beaconsfield)
MacGregor, Rt Hon John	Soames, Nicholas
MacKay, Andrew	Speed, Sir Keith
Maclean, David	Spencer, Sir Derek
McLoughlin, Patrick	Spicer, Sir James (W Dorset)
McNair-Wilson, Sir Patrick	Spicer, Michael (S Worcs)
Madel, Sir David	Spink, Dr Robert
Maitland, Lady Olga	Spring, Richard
Major, Rt Hon John	Sproat, Iain
Malone, Gerald	Squire, Robin (Hornchurch)
Mans, Keith	Stanley, Rt Hon Sir John
Marland, Paul	Steen, Anthony
Marlow, Tony	Stephen, Michael
Marshall, John (Hendon S)	Stern, Michael
Marshall, Sir Michael (Arundel)	Stewart, Allan
Martin, David (Portsmouth S)	Streeter, Gary
Mates, Michael	Sumberg, David
Mawhinney, Rt Hon Dr Brian	Sweeney, Walter
Mayhew, Rt Hon Sir Patrick	Sykes, John
Mellor, Rt Hon David	Tapsell, Sir Peter
Merchant, Piers	Taylor, Ian (Esher)
Mills, Iain	Taylor, John M (Solihull)
Mitchell, Andrew (Gedling)	Taylor, Sir Teddy (Southend, E)
Mitchell, Sir David (NW Hants)	Temple-Morris, Peter
Moate, Sir Roger	Thomason, Roy
Monro, Sir Hector	Thompson, Sir Donald (C'er V)
Montgomery, Sir Fergus	Thompson, Patrick (Norwich N)
Moss, Malcolm	Thornton, Sir Malcolm
Needham, Rt Hon Richard	Thurnham, Peter
Nelson, Anthony	Townend, John (Bridlington)
Neubert, Sir Michael	Townsend, Cyril D (Bexl'yh'th)
Newton, Rt Hon Tony	Tracey, Richard
Nicholls, Patrick	Trend, Michael
Nicholson, David (Taunton)	Trotter, Neville
Nicholson, Emma (Devon West)	Twinn, Dr Ian
Norris, Steve	Vaughan, Sir Gerard
Onslow, Rt Hon Sir Cranley	Viggers, Peter
Oppenheim, Phillip	Waldegrave, Rt Hon William
Ottaway, Richard	Walden, George

Walker, Bill (N Tayside)	Wilkinson, John
Waller, Gary	Willetts, David
Ward, John	Wilshire, David
Wardle, Charles (Bexhill)	Winterton, Mrs Ann (Congleton)
Waterson, Nigel	Winterton, Nicholas (Macc'fld)
Watts John	Wolfson, Mark
Wells, Bowen	Wood, Timothy
	Yeo, Tim
Wheeler, Rt Hon Sir John	Young, Rt Hon Sir George
Whitney, Ray
Whittingdale, John	Tellers for the Ayes:
Widdecombe, Ann	Dr. Liam Fox and
Wiggin, Sir Jerry	Mr. Sydney Chapman.
NOES
Abbott, Ms Diane	Corbyn, Jeremy
Adams, Mrs Irene	Corston, Jean
Ainger, Nick	Cousins, Jim
Ainsworth, Robert (Cov'try NE)	Cox, Tom
Allen, Graham	Cummings, John
Alton, David	Cunliffe, Lawrence
Anderson, Donald (Swansea E)	Cunningham, Jim (Covy SE)
Anderson, Ms Janet (Ros'dale)	Cunningham, Rt Hon Dr John
Armstrong, Hilary	Dafis, Cynog
Ashdown, Rt Hon Paddy	Dalyell, Tam
Ashton, Joe	Darling, Alistair
Austin-Walker, John	Davidson, Ian
Banks, Tony (Newham NW)	Davies, Bryan (Oldham C'tral)
Barnes, Harry	Davies, Rt Hon Denzil (Llanelli)
Barron, Kevin	Davies, Ron (Caerphilly)
Battle, John	Davis, Terry (B'ham, H'dge H'l)
Bayley, Hugh	Denham, John
Beckett, Rt Hon Margaret	Dewar, Donald
Beith, Rt Hon A J	Dixon, Don
Bell, Stuart	Dobson, Frank
Benn, Rt Hon Tony	Donohoe, Brian H
Bennett, Andrew F	Dunnachie, Jimmy
Benton, Joe	Eagle, Ms Angela
Bermingram, Gerald	Eastham, Ken
Berry, Roger	Enright, Derek
Betts, Clive	Etherington, Bill
Blair, Rt Hon Tony	Evans, John (St Helens N)
Blunkett, David	Ewing, Mrs Margaret
Boateng, Paul	Fatchett, Derek
Boyes, Roland	Faulds, Andrew
Bradley, Keith	Reid, Frank (Birkenhead)
Bray, Dr Jeremy	Fisher, Mark
Brown, Gordon (Dunfermline E)	Flynn, Paul
Brown, N (N'c'tle upon Tyne E)	Foster, Rt Hon Derek
Bruce, Malcolm (Gordon)	Foster, Don (Bath)
Burden, Richard	Foulkes, George
Byers, Stephen	Fraser, John
Caborn, Richard	Fyfe, Maria
Callaghan, Jim	Galbraith, Sam
Campbell, Mrs Anne (C'bridge)	Galloway, George
Campbell, Menzies (Fife NE)	Gapes, Mike
Campbell, Ronnie (Blyth V)	Garrett, John
Campbell-Savours, D N	George, Bruce
Canavan, Dennis	Gerrard, Neil
Cann, Jamie	Gilbert, Rt Hon Dr John
Carlile, Alexander (Montgomery)	Godman, Dr Norman A
Chidgey, David	Godsiff, Roger
Chisholm, Malcolm	Golding, Mrs Llin
Church, Judith	Gordon, Mildred
Clapham, Michael	Graham, Thomas
Clark, Dr David (South Shields)	Grant, Bernie (Tottenham)
Clarke, Eric (Midlothian)	Griffiths, Nigel (Edinburgh S)
Clarke, Tom (Monklands W)	Griffiths, Win (Bridgend)
Clelland, David	Grocott, Bruce
Clwyd, Mrs Ann	Gunnell, John
Coffey, Ann	Hain, Peter
Cohen, Harry	Hall, Mike
Connarty, Michael	Hanson, David
Cook, Frank (Stockton N)	Hardy, Peter
Cook, Robin (Livingston)	Harman, Ms Harriet
Corbett, Robin	Harvey, Nick

Hattersley, Rt Hon Roy	Meale, Alan
Henderson, Doug	Michael, Alun
Hendron, Dr Joe	Michie, Bill (Sheffield Heeley)
Heppell, John	Michie, Mrs Ray (Argyll & Bute)
Hill, Keith (Streatham)	Milburn, Alan
Hinchliffe, David	Miller, Andrew
Hodge, Margaret	Mitchell, Austin (Gt Grimsby)
Hoey, Kate	Moonie, Dr Lewis
Hogg, Norman (Cumbernauld)	Morgan, Rhodri
Home Robertson, John	Morley, Elliot
Hood, Jimmy	Morris, Rt Hon Alfred (Wy'nshawe)
Hoon, Geoffrey	Morris, Estelle (B'ham Yardley)
Howarth, George (Knowsley North)	Morris, Rt Hon John (Aberavon)
Howells, Dr. Kim (Pontypridd)	Mudie, George
Hoyle, Doug	Mullin, Chris
Hughes, Kevin (Doncaster N)	Murphy, Paul
Hughes, Robert (Aberdeen N)	Oakes, Rt Hon Gordon
Hughes, Roy (Newport E)	O'Brien, Mike (N W'kshire)
Hughes, Simon (Southwark)	O'Brien, William (Normanton)
Hume, John	O'Hara, Edward
Hutton, John	Olner, Bill
Illsley, Eric	O'Neill, Martin
Ingram, Adam	Orme, Rt Hon Stanley
Jackson, Glenda (H'stead)	Parry, Robert
Jackson, Helen (Shef'ld, H)	Patchett, Terry
Jamieson, David	Pearson, Ian
Janner, Greville	Pendry, Tom
Johnston, Sir Russell	Pickthall, Colin
Jones, Barry (Alyn and D'side)	Pike, Peter L
Jones, leuan Wyn (Ynys Môn)	Pope, Greg
Jones, Jon Owen (Cardiff C)	Powell, Ray (Ogmore)
Jones, Lynne (B'ham S O)	Prentice, Bridget (Lew'm E)
Jones, Martyn (Clwyd, SW)	Prentice, Gordon (Pendle)
Jones, Nigel (Cheltenham)	Prescott, Rt Hon John
Jowell, Tessa	Primarolo, Dawn
Kaufman, Rt Hon Gerald	Purchase, Ken
Keen, Alan	Quin, Ms Joyce
Kennedy, Charles (Ross,C&S)	Radice, Giles
Kennedy, Jane (Lpool Brdgn)	Randall, Stuart
Khabra, Piara S	Raynsford, Nick
Kilfoyle, Peter	Redmond, Martin
Kirkwood, Archy	Reid, Dr John
Lestor, Joan (Eccles)	Rendel, David
Lewis, Terry	Robertson, George (Hamilton)
Litherland, Robert	Robinson, Geoffrey (Co'try NW)
Livingstone, Ken	Robinson, Peter (Belfast E)
Lloyd, Tony (Stretford)	Rogers, Allan
Llwyd, Elfyn	Rooker, Jeff
Loyden, Eddie	Rooney, Terry
Lynne, Ms Liz	Ross, Ernie (Dundee W)
McAllion, John	Rowlands, Ted
McAvoy, Thomas	Ruddock, Joan
McCartney, Ian	Salmond, Alex
McCrea, The Reverend William	Sedgemore, Brian
Macdonald, Calum	Sheerman, Barry
McFall, John	Sheldon, Rt Hon Robert
McKelvey, William	Shore, Rt Hon Peter
Mackinlay, Andrew	Short, Clare
McLeish, Henry	Simpson, Alan
Maclennan, Robert	Skinner, Dennis
McMaster, Gordon	Smith, Andrew (Oxford E)
McNamara, Kevin	Smith, Chris (Isl'ton S & F'sbury)
MacShane, Denis	Smith, Llew (Blaenau Gwent)
McWilliam, John	Snape, Peter
Madden, Max	Soley, Clive
Maddock, Diana	Spearing, Nigel
Mahon, Alice	Spellar, John
Mallon, Seamus	Squire, Rachel (Dunfermline W)
Mandelson, Peter	Steel, Rt Hon Sir David
Marek, Dr John	Steinberg, Gerry
Marshall, David (Shettleston)	Stevenson, George
Marshall, Jim (Leicester, S)	Stott, Roger
Martin, Michael J (Springburn)	Strang, Dr. Gavin
Martlew, Eric	Straw, Jack
Maxton, John	Sutcliffe, Gerry
Meacher, Michael	Taylor, Mrs Ann (Dewsbury)

Taylor, Rt Hon John D (Strgfd)	Welsh, Andrew
Taylor, Matthew (Truro)	Wicks, Malcolm
Thompson, Jack (Wansbeck)	Wigley, Dafydd
Timms, Stephen	Williams, Rt Hon Alan (Sw'n W)
Tipping, Paddy	Williams, Alan W (Carmarthen)
Touhig, Don	Wilson, Brian
Trimble, David	Winnick, David
Turner, Dennis	Wise, Audrey
Tyler, Paul	Worthington, Tony
Vaz, Keith	Wray, Jimmy
Walker, Rt Hon Sir Harold	Wright, Dr Tony
Wallace, James	Young, David (Bolton SE)
Walley, Joan
Wardell, Gareth (Gower)	Tellers for the Noes:
Wareing, Robert N	Mrs. Barbara Roche and
Watson, Mike	Mr. Jim Dowd.

Question accordingly agreed to.

MADAM SPEAKER forthwith declared the main Question, as amended, to be agreed to.
Resolved,

That this House noting that the problems of London's health service have been the subject of at least 20 reports in the last 80 years, all of which have come to broadly similar conclusions, believes that a better service for patients lies in implementing decisions and not a further review; commends the Government for its record in investing in modern hospitals, first class specialist centres and primary care and for its determination to take necessary decisions in the long term interest of the Capital's health service and the people of London; and calls on the Government to ensure that the decisions are now carefully carried forward taking due account of concerns that they should be properly paced so that patients continue to benefit from new and better services before old ones close.

Statutory Instruments, &C

Agriculture

Motion made, and Question put forthwith pursuant to Standing Order No. 101(5) (Standing Committees on Statutory Instruments, &c.),

That the Farm and Conservation Grant (Variation) Scheme 1995 (S.I., 1995, No. 890), dated 23rd March 1995, a copy of which was laid before this House on 28th March, be approved.—[Mr. Bates.]

Question agreed to.

National Health Service (Wakefield)

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Bates.]

10.32 pm

I am grateful for the opportunity to raise serious concerns about the future direction of health provision in the Wakefield metropolitan district—concerns that I know are shared by my hon. Friends the Members for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien). I know that they hope to catch your eye later, Mr. Deputy Speaker.

At the centre of those concerns is the fear that Wakefield Healthcare, the health authority purchaser, is considering a strategy that could result in the closure of either Pinderfields general hospital, Wakefield, or Pontefract general infirmary—or, indeed, both. Such is the level of public concern that I feel that the Government must be made aware of local feeling in the Wakefield district, and made to address their own responsibilities for the future health care of our constituents.

I make that specific point because I believe that the direct consequences of the Government's health policies are at the root of proposals that could totally undermine existing services. In short, the internal market is not working in Wakefield district. To try to make it work, Wakefield Healthcare is contemplating options for change that could result in cuts in service provision that are unacceptable to my constituents and to those of my hon. Friends.

Before I set out in detail my concerns, I want to make it clear that, although most of my constituents use Pinderfields hospital in Wakefield, I have no desire for that hospital to be sustained and developed at the expense of Pontefract general infirmary. My personal agenda—and I believe that of yourself, Mr. Deputy Speaker, and my hon. Friends—is to ensure that the future of both hospitals is secured. Both are popular, well used and major employers in a region that has recently suffered more than most from job losses.

Under the provisions of the National Health Service and Community Care Act 1990, for the past two years Wakefield Healthcare has been the major purchaser of health care in Wakefield district. Under the Government's health changes, that body is responsible for strategic planning of health care, and for determining its overall direction.

The three major providers in the region are the two trusts based at Pinderfields and Pontefract hospitals, and the Wakefield and Pontefract Community Health NHS trust. It would not be unfair to the health authority to say that, from the outset, it would have been preferred the establishment of one single trust, covering acute provision and based primarily in Wakefield and Pontefract. Indeed, the authority has proposed the amalgamation of the Pinderfields and Pontefract trusts—an option, as you know, Mr. Deputy Speaker, that is strongly resisted locally, because real fears exist that it would lead to the rationalisation of services and a serious loss of provision.

In recent years, my constituents in particular have seen significant closure programmes, and they simply no longer trust local health managers' assurances. Through the House of Commons Library, I have calculated that, between 1979 and the last general election, more than 1,000 hospital beds have been lost in hospitals serving my constituents in Wakefield. They have good reason, therefore, not to trust assurances given in the local health service.

As you, Mr. Deputy Speaker, will recall, we lost Snapethorpe hospital after being given assurances of alternative provisions which came to nothing. During consultation on the closure of County hospital in Wakefield, we were promised purpose-built geriatric provision on the Pinderfields site. It never happened.

More recently, during consultation on the closure of Manygates maternity hospital in Wakefield, where I, my son and my daughter were born, we were promised a purpose-built maternity unit on the Pinderfields site. That never happened either, so when new proposals emerge under the title of "Reconfiguring Hospital Services", my constituents and those of my hon. Friends know what to expect.

I learned of the proposals in a conversation with the chairman of Wakefield Healthcare, Mr. Brian Hayward, on the evening of Monday 6 March. I was left in no doubt that serious consideration was being given to the closure of both Pinderfields hospital and Pontefract general infirmary on the basis of building a new hospital somewhere between the two. He confirmed his statement on the following day, when we had a further conversation over the telephone.

On Friday 10 March, the Wakefield Express weekly newspaper reported Wakefield Healthcare's chief executive, Mr. Keith Salisbury, as stating that discussions about the idea of a new hospital were only "tentative", and that there was no question of closing Pinderfields. On that same day, however, I was telephoned by Mr. Roy Cusworth, chairman of Pinderfields hospital NHS trust, who, along with his chief executive, Mr. Peter Ward, had that week been made aware of the possible closure of Pinderfields.

Bearing in mind the fact that that trust had only recently published revised proposals for a major redevelopment of the hospital, and that it had been given approval to seek private financing for the project, the trust chairman was understandably incensed at suggestions of the hospital's closure. I know that he discussed his concerns at the time with the chairman of the Northern and Yorkshire regional health authority, Mr. John Greetham.

On the following Wednesday, 15 March, the chair, vice-chair and chief executive of Wakefield Healthcare met you, Mr. Deputy Speaker, my hon. Friend the Member for Hemsworth (Mr. Enright) and myself at the House of Commons. We discussed in some detail the issues facing the authority. I was alarmed to be told that any decisions about investment in new hospital provision at Pinderfields, Pontefract or on a new site would be a matter for the private investors under the private finance initiative. I would welcome the Minister's comments on that specific point.

I gained the clear impression that, regardless of the proposed development at Pinderfields or other options that might be suggested by the Pontefract trust or the health authority itself, the central determinant would be the choice of those investing private capital. I know that it was not just me who gained that impression. The minutes of the Pontefract and District community health council meeting, held on 10 April, recorded your view, Mr. Deputy Speaker. The minutes state:

"Mr. Lofthouse said in his opinion, the issue would be totally influenced by private capitalists investing monies. At the end of the day, these people were looking for returns on their monies and this would be the biggest consideration."

I recognise that Wakefield Healthcare has been landed with an extremely difficult task in implementing Government policy in the Wakefield district. The extent of those difficulties is made clear in its health strategy document, which I saw for the first time only yesterday. That document itemises various changes that have a bearing on the future plans of every health purchaser, including changes in professional practice, shorter hospital stays, day surgery and moves towards primary care.

In its specific policies for hospital provision in the Wakefield area, it makes particular reference to the reduction in junior doctors' hours, shorter training and the specific funding problems affecting Wakefield as a result of the Government's new allocation formula.

The Minister will recall that I previously raised the allocation formula with him in another Adjournment debate. As he knows, the formula assumes that Wakefield is overfunded by 4.9 per cent, or £7 million at current levels. The health strategy document states:

"It is therefore likely that development funds will be scarce during the strategic period and that there will be a continued need for redeployment of resources."

As well as serious resourcing difficulties, the other key element affecting Wakefield's health care strategy is that it has one of the highest concentrations of general practitioner fundholders in the country. Fundholders now cover 75 per cent. of the district's population, and by next April the health authy will be a minority purchaser.

We have to ask, how on earth can a health authy, supposedly in the context of public consultation, be expected to develop a strategy as a purchaser when, in future, the main purchasers will be groups of fundholders whose only tentative link to accountability is to the regional office of the national health service executive. If we throw in the fact that Wakefield has five practices with 55,000 patients moving to total fundholding, is it any wonder that, to the objective observer, the planning of health provision in Wakefield appears to be degenerating into total chaos?

The health authority's four options for the future pattern of provision are all, for various reasons, unacceptable. The first option of no change is dismissed by the health authy itself. The second option of redistribution of specialisms between Pinderfields and Pontefract means constituents being forced to travel miles for care that is currently provided within their own localities. There is concern that specialties cannot be traded between sites because of the need to reflect best clinical practice, to ensure linkages with other specialties and to make the best use of equipment and support facilities.

The third option, of providing most emergency work at one hospital and most elective work at the other, would mean massive duplication of equipment and support facilities. More importantly—as you well know, Mr. Deputy Speaker—it would result in serious delays in treating accident and emergency cases, and could cost lives.

My hon. Friends the Members for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien), and you yourself, Mr. Deputy Speaker, are probably more aware of the exact time it takes to travel by road between Pontefract and Wakefield, but I would say that 25 minutes is a reasonable estimate. In that period, people moving to either end of the district could die. That is what happens if access to accident and emergency units is delayed in the way in which it may well be as a result of the suggestions put forward by the health authority.

The fourth option is establishing a new hospital. The report that I have seen does not make it clear whether or not that would entail closing existing hospitals. It will inevitably result in the loss of many existing services at previous sites, inconvenience to patients and—of course—serious job losses.

The strategy document accepts that Pinderfields trust has been given permission by the regional health authority to explore the potential for private financial support for the redevelopment. While the trust states that it

"would not wish to adversely affect this private finance bid",

it would surely come as no surprise to Wakefield Healthcare to learn that potential private investors attracted by Pinderfields may be somewhat put off to be made aware of the options in the strategy document, and their implications.

A backdrop to the Wakefield health pantomime is the current review of health provision in Leeds. Wakefield Healthcare's inability to defend regional neurosurgery provision at Pinderfields from the raid by the United Leeds Hospitals trust does not exactly inspire confidence in its willingness to rebuff the further predicted incursions in the direction of other regional specialisms within Wakefield.

Pinderfields—as you well know, Mr. Deputy Speaker—has a proud record in many of its specialisms, with its burns unit, plastic surgery provision, spinal injuries and younger disabled units, and other services which are very widely respected. But the Government's internal market means that such key services can be grabbed and moved elsewhere. There is a scarcely hidden agenda within the Leeds review, of shifting further specialisms to Leeds and leaving Wakefield's hospitals as mere satellites.

That is not acceptable from my point of view, or from the point of view of my hon. Friends who represent the Wakefield district. It is not acceptable that the Government can avoid responsibility for the problems which are now being faced within Wakefield. It is not acceptable for the Minister to give me parliamentary answers of the kind he has given to me on this issue in the past few weeks.

I shall quote two of those answers before I end my speech. On 16 march, I asked whether the Secretary of State

"will seek reports regarding the future of Pinderfields hospital, Wakefield from (a) the chair of the Yorkshire and Northern health region, (b) the chair of the Wakefield health authority and (c) the chair of the Pinderfields trust; and if she will make a statement."

The answer from the Minister was:

"This is a matter for Wakefield Healthcare. The hon. Member may wish to contact Mr. Brian Hayward, chairman of Wakefield Healthcare, for details."—[Official Report, 16 March 1995; Vol. 256, c. 707.]

Having spoken to that gentleman, I am none the wiser.

On 27 March, I asked the Secretary of State

"if she will make it her policy to ensure that Pinderfields hospital, Wakefield, remains open as a district general hospital maintaining regional specialisms."

The Minister answered:

"This is a matter for the Northern and Yorkshire regional health authority. The hon. Member may wish to contact Mr. John Greetham CBE, chairman of the authority, for details."—[Official Report, 27 March 1995; Vol. 257, c. 422.]

In conclusion, I would say that this is a matter for the Government. I want answers to some questions tonight.

10.47 pm

May I pay tribute to all that you have done, Mr. Deputy Speaker, in the campaign in the area? I would not have time tonight to reveal all you have done. I wish to make some short but extremely important points. My constituency has seen Southmoor in Hemsworth slimmed down, Ackton hospital in Featherstone closed down and Warde Aldam in South Hensall pulled down. That is what we have found from the internal market in my constituency.

On top of that, the threat to Pontefract general infirmary is simply not acceptable. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) has just referred to the time it takes to get to Pinderfields in terms of accident and emergency units. Attention has not been paid to the difficulties in transport at certain hours. I myself have spent over an hour getting into the centre of Wakefield in a small car. That is not unusual in the rush hour when such accidents can occur.

The internal market has been a disaster for our area. The only body that has benefited from it is a doctor's practice, which made a record surplus, enabling the doctor to extend his surgery in a totally unnecessary fashion. Yet that is the main capital expenditure that Wakefield has had. If that is an example of the internal market, we have had quite enough of it, and the Minister must take control and do some indicative planning.

10.50 pm

It is not long since the Minister came to our area and agreed to close the accident and emergency unit and other facilities at the Castleford and Normanton hospital, which serves a large part of my constituency. People in the Ossett area of my constituency would have to travel tremendous distances if the Pinderfields hospital is somehow to be moved to the east of Wakefield. There are strong rumours that that could happen.

I want the Minister to be honest and open with us tonight, and say what future he envisages for hospital provision in Wakefield. There is strong opposition to the proposal to close Pinderfields hospital and Pontefract general infirmary with a view to building a smaller hospital in the area. People in the metropolitan area of Wakefield will not accept that proposal.

There are now strong rumours that the hospice services could face difficulties because general practitioners in the area will, in due course, be responsible for purchasing services at the hospices in Pontefract and Wakefield. People are tremendously concerned about the future of hospice services, because the Government are contemplating the purchase of such services in the future.

Will the Minister assure us that constant provision will be made for people who need hospice services in Wakefield and Pontefract? I hope that he will assure us that no changes will be made to hospital provision in Wakefield, and that the hospices in the area will continue to receive the same resources to maintain their services in both towns. That is important to our area, and we look to the Minister for assurances on that provision.

10.52 pm

I am grateful for an opportunity to reply to this debate. I am aware of the strength of concern felt by the constituents of the hon. Members for Wakefield (Mr. Hinchliffe), for Hemsworth (Mr. Enright) and for Normanton (Mr. O'Brien), as well as your constituents, Mr. Deputy Speaker. You and I have corresponded about local health services and had more than one meeting at Pontefract hospital and elsewhere to discuss those matters.

The question of resources has come up a couple of times in the debate.

It has been alleged in a previous Adjournment debate, and it was mentioned in this debate, that the Wakefield health authority is over target, and it has been said that therefore there will be cuts. I must tell the House that, in the current year, there is an increase of 4.4 per cent., and that means a real increase in resources.

Although, compared with some other districts, Wakefield may be above the target, it is unlikely, given that there is likely to be a continuation of real increases in health resources in the years to come, that any over-target district health authority will lose resources in real terms as a result of redistribution. Fears raised about future resources should therefore not be exaggerated.

There are other reasons why Wakefield health authority, like many others, must consider the future pattern, not only of hospital acute services, but of all health services throughout its district. Obviously, resources come into it, but the pattern of health services is evolving. The hon. Member for Wakefield mentioned some of the reasons—the growth in day surgery and the increase in the numbers of patients who will be seen in primary care settings rather than in hospitals in future. All sorts of changes are taking place that will make it necessary to reconsider the number of acute beds and acute hospitals in each region and each district.

It goes without saying, therefore, that it would be irresponsible of Wakefield or any other health authority not to look very hard at the pattern that it envisages for the future, looking 10, 20 or 30 years ahead and making proposals now.

I also refer to what the hon. Member for Normanton (Mr. O'Brien) said about hospice services. I will inquire into that matter. There has been anxiety that, because the central funding of hospices and palliative care has been devolved to districts, there would be a detrimental effect on local hospices. There is no reason why that should happen, but I will inquire into the matter for the hon. Gentleman, because the resources that are provided centrally by the Department of Health for hospices have increased sharply in the past, and I am sure that we intend to continue to support that sector, in which the country has such a splendid record.

On the subject of Wakefield Healthcare's health strategy document, which lies at the heart of the anxieties of the hon. Member for Wakefield, consultation on a proposed health strategy in Wakefield between July and October 1994 was extensive. It covered the needs of the whole population of the Wakefield metropolitan district council area. About 1,000 copies of the proposals were issued, and a further 125,000 copies of the summary were printed and issued through the free press or distributed at various local events.

Representatives of Wakefield Healthcare spoke to several local groups about the strategy, as well as holding meetings of the three local national health service trusts and two community health councils in Wakefield and Pontefract. It is worth emphasising that the Wakefield health strategy discusses the way in which services in the Wakefield area may be shaped in the next five years and considers the need for any shift to primary care that may be appropriate.

Wakefield Healthcare set up a sub-group to consider responses. The group included three local general practitioners, the director of public health and two directors of Wakefield Healthcare. The two community health councils were invited to contribute, especially about the proposed move of some services to the primary care sector.

The sub-group looked at four main options, which were: option 1, to do nothing; option 2, to redistribute specialities over two hospital sites; option 3, to identify one hospital to undertake elective care and one for emergency care; and option 4, to build a new hospital on a new site. Those options were discussed informally with local Members of Parliament and other representatives. Since then, the focus of attention has understandably been on one section of that strategy—the possible reconfiguration of acute services.

It has been stressed a number of times that the discussions are at an early stage. I am therefore unable to give any definitive idea to hon. Members as to which option will finally be recommended. I understand that the proposed health strategy will be published later in May. Wakefield health authority also proposes to take a series of steps—for example, to explore the cost benefit and feasibility of each of the four options with local hospitals and, in particular, the three trusts.

Services that support any future configuration will be reviewed. There will be further consultation on the proposed way ahead with hospital clinicians, GPs, community health councils and all other local organisations. I understand that that is likely to begin in the summer. It will be followed by confirmation of the preferred option for the future configuration of services for the district.

Will the Minister specifically address the problem of fundholding that I raised? Will he consider the difficulty in which the authority will find itself next year as a minority purchaser?

It goes without saying that the health authority will continue to be a major force and a major purchaser of acute services for all fundholding GPs in the district. It would be wrong to suppose that it is not possible to plan health services where there is a wide distribution of fundholding.

I reject the hon. Member's description of health planning descending into chaos, or words to that effect. The consultation exercise must be gone through, because health services are evolving. It will be for the health authority, principally, to decide what option should be recommended. Those matters must be planned coolly and rationally, because they affect the pattern of health services for decades to come.

I assure hon. Members that the outcome of the deliberations will mean a better and more modern health service for the entire district for generations to come.

Question put and agreed to.

Adjourned accordingly at two minutes past Eleven o'clock.

Volume 259: debated on Wednesday 10 May 1995

House Of Commons

Prayers

Mental Illness

Personal Financial Services

Prisoners Of War (Japan)

Hospitals (Grampian Region)

Executive Power

Oral Answers To Questions

Trade And Industry

Media Ownership

British Gas

Volvo Site, Workington

Gas Supply

Rural White Paper

Coal Industry

Anti-Competitive Practices

Machine Tools

Mk Electric And Pms

Micro-Businesses

Manufactured Goods

Ministerial Visits

Libya

Insider Dealing

Manufacturing Industry

Research And Development

Japanese Trade Barriers

Trade Marks

Trade Statistics

Drugs (White Paper)

Public Interest Immunity Certificates

Statutory Instruments, &C

Prisons

War Widows And Pensioners (Equal Treatment)

War Widows And Pensioners (Equal Treatment)

Opposition Day

National Health Service (London)

Statutory Instruments, &C

Agriculture

National Health Service (Wakefield)