House of Commons Hansard Debates for 11 May 1989

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landlord of their choice, instead of having housing associations foisted upon them ; and calls upon the Warrington and Runcorn Development Corporation and the Department of the Environment to give the tenants the opportunity to exercise their democratic rights.] Will my right hon. Friend find time to debate this early-day motion. It incorrectly asserts that the tenants of the Warrington and Runcorn development corporation will not be given a choice about their future landlord. Should not that mistake be set right? Should we not have an opportunity to put forward the advantage of housing associations over Socialist borough landlords?

Mr. Wakeham : Absolutely. It is an important issue and I wish that I could find time to debate my hon. Friend's point. I can confirm that there is no question of denying tenants the right to choose their ultimate landlord. My hon. Friend the Parliamentary Under-Secretary of State has made it clear that there will be a ballot about transfer of housing when the necessary legislation is in place, and that tenants' wishes will be respected. Meanwhile, the housing associations are being used on a temporary basis as management agents at Warrington.

Mr. Peter L. Pike (Burnley) : The Leader of the House has already agreed that there should be a debate on the Select Committee's report on toxic waste and the Government's response to it, which many people consider disappointing. When does he envisage that the debate will take place? Have he and his right hon. and learned Friend the Government Chief Whip not been able to pencil a date into their diaries for that debate?

Mr. Wakeham : I recognise that this is an important subject but I cannot add anything to what I have already said.

Mr. Neil Hamilton (Tatton) : Why is the Second Reading of the Human Organ Transplants Bill to be taken in Committee upstairs rather than on the Floor of the House? My right hon. Friend knows that a small number of people are opposed to the Bill and they will be deprived of the opportunity to participate in the discussions. Those, who like me, take such a view, feel resentful that we shall be unable to make our voices heard on the matter.

Mr. Wakeham : I recognise that my hon. Friend holds views on this matter. I think that he will agree that his views are probably in a minority but, nevertheless, they must be respected. The reason for the Bill being considered by a Second Reading Committee is that that is what the House resolved to do. The Bill will return to the Floor of the House on Third Reading. I do not know whether my hon. Friend is on the Committee.

Mr. David Winnick (Walsall, North) : Would it be possible to have a Question Time slot every time the so-called Secretary of State for the Environment is taken to court? That has become such a regular event that perhaps there should be such a slot.

Has the Leader of the House had discussions with the Home Secretary about the proposed rally this weekend of Nazi fanatics? Why are well-known Nazi and fascist fanatics being allowed into Derbyshire for an event that is deeply deplored by the overwhelming majority of British people? Why has there not been a statement from the Home Secretary?

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Mr. Wakeham : The hon. Gentleman's first suggestion would have the disadvantage of guaranteeing that he would be at every session to ask a silly question. The hon. Gentleman's second point is serious and I shall refer it to my right hon. Friend the Home Secretary.

Mr. John Redwood (Wokingham) : I agree with those who say that next Thursday's debate should be prospective. Will the House have the opportunity soon to debate the interesting work on new roads and railway lines said to be taking place in the Department of Transport? Will we be able to link that with the recent welcome statement by the Chief Secretary to the Treasury about abolishing the Ryrie rules and therefore allowing a new increase in private capital, in addition to expanded public provision?

Mr. Wakeham : I can imagine that my hon. Friend's last point, which is important, could well form part of the discussion in the later stages of the Finance Bill. The matter relating to roads is important, but I cannot promise an early debate on it, although I feel that it will arise in one form or another before too long.

Mr. Greville Janner (Leicester, West) : In his answer to my hon. Friend the Member for Walsall, North (Mr. Winnick), the Leader of the House said that he would refer to the Home Secretary the problem of the proposed European neo-Nazi gathering in the east midlands. Is he aware that what is required is not a referral but a statement tomorrow, or it will be too late to prevent people with criminal records for violence from entering the country, and too late to prevent the event from occurring?

Is the right hon. Gentleman further aware that we need a full debate on the infiltration of Nazi movements into this country, not least because of the rally on 27 May at which, apparently, there is to be a skinhead concert organised by a man with a criminal record for violence--a person called Ian Stuart of the Screwdriver band? We must take these matters seriously. For some reason that I do not understand the Home Secretary, who is a resolute opponent of Facism and Nazism, has not replied to the letter I wrote to him 10 days ago. May we have an urgent statement?

Mr. Wakeham : I still think that I was right to answer the hon. Member for Walsall, North (Mr. Winnick) by saying that I would refer the matter to my right hon. Friend the Home Secretary. My right hon. Friend is of course already aware of these matters and is no doubt taking whatever action is appropriate. However, in view of the concern I shall see to it that this is drawn to his attention.

Mr. Harry Greenway (Ealing, North) : Will my right hon. Friend undertake to arrange for a suitable amendment to be tabled to the Opposition's Supply day motion on publicity next Tuesday, so that the House may consider the position of the Leader of the Opposition who, among others, has to receive mendacious literature on housing, education and other matters from Ealing council? Can arrangements be made for him to be sent the true facts about the issues on which the council has misinformed people?

Further, can an amendment be tabled to enable the House to consider the wrongful expenditure of taxpayers' and ratepayers' money on minority interests which discriminate against the majority? I have in my hand a

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leaflet that Ealing council has put out at public expense advertising a self-defence course in Ealing that is only for lesbians, thereby discriminating against all other women.

Mr. Wakeham : The Government will certainly consider what is the appropriate amendment to table to the Opposition motion for the debate next week. We cannot do that until we have seen the terms of their motion. There is nothing to stop my hon. Friend tabling an amendment to the motion if he wants to do so. Which amendments are selected is a matter not for me but for Mr. Speaker.

Mr. Dennis Skinner (Bolsover) : Will the Leader of the House confirm that the Home Secretary is still in charge of the BBC? Does he realise that there has been a series of strikes there in the past few weeks? When many of us on the Labour Benches visited the picket lines at Bush house, Broadcasting house and the Television centre we were astonished to learn that there are people at the BBC who take home £80 a week, while others, such as Wogan, pick up millions. Is the right hon. Gentleman aware that the top four directors at the BBC have had a salary increase of 33 per cent. in the course of the past year, bringing their total earnings between them to £340,000? What is good enough for Tory apparatchiks at the top of the BBC should be good enough for those doing the donkey work.

Mr. Wakeham : I can understand that the hon. Gentleman has had a hard week. He has spent the week having his basic Socialist principles marketed by other people and I do not think that he liked it very much. I can understand why he asks such a ridiculous question.

The Home Secretary is not in charge of the BBC, as the hon. Gentleman knows full well. The BBC operates under an independent charter ; perhaps some of us might have different views on it if it did not.

Mr. Kenneth Hind (Lancashire, West) : My right hon. Friend has arranged for a debate on Europe on Thursday. As, in future, many decisions that affect Britain will be taken by the Council of Ministers, will he arrange for such decisions to be discussed in future at a reasonable hour in this House a short time before Ministers attend the council, so that hon. Members may express their views on matters that are vitally important to our constituents?

Mr. Wakeham : My hon. Friend is quite right. Part of the review should enable us to have debates earlier, with at least a number of them being at a more convenient time. Perhaps there might be a better allocation between the debates that are held upstairs and those which are late at night. It requires agreement with hon. Members in all parts of the House. That is what I am seeking to obtain.

Mr. Richard Caborn (Sheffield, Central) : Will the Leader of the House arrange next week for time to be available for the Minister of State, Home Office, the hon. Member for Oxford, West and Abingdon (Mr. Patten) who replied to question No. 3 this afternoon to withdraw the statement that he made about a school in my constituency, Ellesmere road? The statement was totally misleading and scurrilous. It will do nothing to resolve the small problems in that inner-city school. May I inform the House that this morning, contrary to what the Minister said, there was an assembly with parents, teachers and pupils present? While there have been some small problems, it does no credit to the Minister to come to the Dispatch Box and try to exploit the problems that we have

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in the inner city. The school is on an even keel and it is well managed. It is under an education authority that has been commended by Her Majesty's inspectors.

Mr. Wakeham : I do not accept for a minute the strictures of the hon. Gentleman, but I shall certainly refer to my hon. Friend the points that the hon. Gentleman has raised.

Mrs. Teresa Gorman (Billericay) : Can my right hon. Friend find time for a debate in the near future on the rights of our fellow citizens in Northern Ireland to representation in the House by the mainstream political parties in view of the overwhelming vote yesterday at the Perth conference by the Scottish Conservatives in support of Irish Conservatives who wish to have official Conservative candidates to vote for? Surely he must think that it is wrong that we exclude 1.5 million of our citizens from full participation in the political process that we all enjoy.

Mr. Wakeham : I recognise that it is an important point and that my hon. Friend has strong views on it. I am not sure that it is a matter appropriate for debate in the House, certainly not at present.

Mr. Tony Banks (Newham, North-West) : The Leader of the House was quite wrong to dismiss in such a peremptory fashion the point made by my hon. Friend the Member for Bolsover (Mr. Skinner) when he asked for a debate about the BBC dispute. It affects the House because BBC listeners were deprived yesterday of the opportunity to listen to the delightful experience, in which we were all able to participate, of Gummer-baiting. We should have an opportunity to debate the matter. It seems appropriate that we should discuss a dispute that has been caused by management at the top of the BBC giving themselves 30 per cent. increases while telling the rest of the workers in the corporation that they have to take a pay cut. Will the

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Leader of the House reconsider his answer? Can we have a debate on the position within the BBC? Perhaps we could combine it with a discussion about televising Parliament.

Mr. Wakeham : We have debates on broadcasting from time to time but, as the hon. Gentleman well knows, pay within the British Boradcasting Corporation is a matter for the management and the staff to negotiate and deal with. It is not in my view a matter that is suitable for debate in the House. That is the point. With regard to a television debate, the hon. Gentleman will be pleased to know, though not as pleased as I am, that the report has been completed and will be published in the very near future.

Mr. Frank Haynes (Ashfield) : You are a real expert, Mr. Speaker ; you always leave quality to the very end. Is the Leader of the House aware that I serve on a Select Committee and work like billy-oh? One person who comes to the Select Committee is a marvellous man from a wonderful Department, the Parliamentary Commissioner. Is the Leader of the House aware that many hon. Members from both sides of the House make use of that wonderful Department? Since I have been here we have never had a debate on the report of the Parliamentary Commissioner. I ask the Leader of the House to pull his socks up and consider having a debate on the report on the Floor of the House so that people outside as well as in the House may know about the Department and exactly where they should go with their problems.

Mr. Wakeham : I certainly share the high opinion that the hon. Gentleman has of himself, and I think that it is also shared by hon. Members on both sides of the House.

This is the first time since I have been Leader of the House that I have been asked for such a debate and I shall look at the matter. I cannot promise the hon. Gentleman that I shall arrange such a debate in the near future, but, coming from him, the request has a better chance than if it came from anyone else.

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Points of Order

4.15 pm

Mr. Greville Janner (Leicester, West) : On a point of order, Mr. Speaker. This is a matter on which I have given you notice, albeit brief.

The answers to questions 14 and 15, answered by the Foreign Secretary or a junior Minister, were unfortunately omitted from yesterday's Hansard. I am sure that that was simply an error, but on this occasion it was a sad one because question 15--

Mr. Robert Hughes (Aberdeen, North) : --was your question.

Mr. Janner : It was my question, of course.

I asked a question to which, not surprisingly, the Government did not give an answer. It concerned the Government's deplorable failure to take any action on the proposed Nazi rally this weekend. That should not have been omitted from Hansard. May I ask, please that that matter be drawn to the attention of the Editor of Hansard and that there be some procedure so that when an emergency is recognised there can be a special printing of the missing material, which can perhaps be delivered as a leaflet to at least 35 million homes?

Mr. Speaker : I thank the hon. and learned Member for drawing that to my attention. In the interests of accuracy, I must tell him that question 14 was answered with question 3 and was correctly reported in Hansard.

Mr. Janner : Only mine was left out.

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Mr. Speaker : Yes, the hon. and learned Gentleman's question was left out. That was a mistake and it will be corrected in Hansard . The missing text will have been reinstated when the bound volume is published.

Mr. Bob Cryer (Bradford, South) : On a point of order, Mr. Speaker. You have a duty to announce to the House when any hon. Member is charged with a criminal offence, but I am unclear whether that would be the case if a Minister was imprisoned for contempt. Since the leaflets that were the subject of an injunction yesterday are apparently still being delivered today, it would be interesting to know whether the Secretary of State for the Environment is in imminent danger--welcomed by many millions--of being committed to prison. We should know whether it would be incumbent on you, Mr. Speaker to make the necessary announcement.

Mr. Speaker : That is a hypothetical question. If, sadly, any hon. Member were to be arrested, I have a duty to report that, but the hon. Gentleman raises a different matter.

Mr. Jeremy Corbyn (Islington, North) : Further to that point of order, Mr. Speaker. A number of people in my constituency have expressed concern that yesterday the Minister for Local Government claimed that the London borough of Islington was distributing misleading leaflets about the poll tax. That is not the case. The leaflets are accurate. They have been legally cleared and no action has been taken against the borough council. What can be done in the House to correct the information given by the right hon. Gentleman so that the people of Islington can be assured that the information they are receiving from the borough council is correct, in contrast to the information that they are receiving from the Government?

Mr. Speaker : The hon. Gentleman has just done it.

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"Working for Patients"

[Relevant documents : Fifth Report from the Social Services Committee of Session 1987-88 on the Future of the National Health Service (HC 613) and the Government Response thereto (Cm. 599).]

Mr. Speaker : I have selected the amendment in the name of the Leader of the Opposition.

In view of the number of hon. Members who wish to participate in the debate, I propose to limit speeches to 10 minutes between 7 and 9 o'clock. However, I appeal to those hon. Members who are fortunate enough to be called before that time to bear that limit in mind. 4.20 pm

The Secretary of State for Health (Mr. Kenneth Clarke) : I beg to move,

That this House approves the programme of reform of the National Health Service set out in the White Paper, Working for Patients (Cm. 555), and the reaffirmation of the basic principles of the National Health Service which will continue to be available to all, regardless of income and financed mainly out of taxation ; and believes that the proposals in the White Paper will raise the standards of all of the health service to the high standard of the best and will lead to an extension of patient choice, a more responsive health service, better value for money and an even better standard of health care for the decade to come.

I returned yesterday from a 24-hour visit to Geneva, where I took part in the affairs of the World Health Assembly, an annual gathering of Health Ministers from the member states of the United Nations who discuss the affairs of the World Health Organisation and health core policy in general.

I was struck during my brief visit by the fact that the subject of health care is now remarkably similar in many countries. Indeed, I dare assert that in practically every developed country, on both sides of the iron curtain, Governments are now involved to some degree in quite drastic reform of their health care systems. What we are addressing--the British Government have been addressing this consistently throughout our period in office--is a great change in the problems confronting health care systems. There is an explosion in the cost of health care of all kinds. The level of demand for health care is rising at a rapid rate, largely because of changing demography and the huge increase in the proportion of elderly people in our population and in similar countries. In countries such as ours, the expectations of patients and professionals are much higher than they were even a decade ago, and medical advance and rising expectations go on remorselessly. It is absorbing when considering health care policy to note that, whenever one looks at the affairs of a great health care system- -in this case the National Health Service--one is looking at one of the great challenges facing Governments throughout the developed world. It is a challenge that must be tackled without unnecessary delay and it must be solved correctly if our great health care system is to rise to the increased costs, increased expectations, increased demands and satisfy our population.

I can promise nobody that this process of reform will be free from political controversy, because when this trade union of Health Ministers is gathered, it is amazing to discover that health is at the heart of public and political controversy in just about every major state one can mention, for the reasons I have given.

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In some countries, Governments are finding great difficulty in making progress. In the Federal Republic of Germany, for example, an extremely controversial programme has been put through, largely aimed at getting down what they regard as their unacceptable costs and rescuing a bankrupt social insurance system. It is not adding to the popularity of the Government there as they carry that through. In Hungary, on the other side of the iron curtain, the Minister of Health has been attempting to introduce new charges for patients, for their prescriptions and pharmaceutical goods, and to introduce the concept of private insurance and so on--at present a popular idea throughout the Socialist world. When I met her, I got the impression that she had had some setbacks and was having to abandon the controversial proposals that she was keen on a month or so ago. In New Zealand, a great report was produced for the reform of that country's health service, taking its starting point from our Griffiths proposals of a few years ago and setting out proposals for a market for health care which I found attractive. The Socialist Government in New Zealand have abandoned those proposals in the face of resistance from their medical profession and are now starting again to tackle the problems of management and use of resources. Opposition Members have a great narrowness of view on these issues. It is important for us to place in context what we are doing. We are tackling problems that are bound to face any responsible Government in modern circumstances in coping with the pace of change in health care. In this country we are determined to be more successful than others have been, and we have begun to address these problems many years before most other developed countries.

Some of my hon. Friends--indeed, some of the faint-hearted on both sides of the House--may ask, "If there are always political difficulties, why bother to reform the Health Service at all?" Last weekend Brian Walden, with whose views I seem to agree more nowadays, implied more or less as much and invited the Government to give up reforming the NHS because, as he put it, it was impossible to talk common sense to the British public about it. He implied that it should be allowed to decline unchanging and be left to its own devices. Other Ministers abroad would agree about the political difficulties.

It is an easy subject on which to alarm patients as soon as any reform is advocated. It is a feature of great professions, here and abroad, that they are instinctively suspicious about change and jealous of their practices and procedures. It is therefore necessary to embark on reform realising that it will always be a difficult and sometimes controversial process.

The reason why the Government have published their White Paper and embarked on this reform is straightforward. We want the British NHS to rise to these challenges, with which others are having to contend. We want to ensure that in this country we have a better NHS serving all our patients, even in the face of those challenges. We shall not be overwhelmed by the pressures and, once reformed, our Health Service will remain in the forefront of the world's health care systems.

Mr. Michael Grylls (Surrey, North-West) rose--

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Mr. Clarke : I shall give way shortly, but if I do so often, I shall take too long to speak in what will anyway be a crowded debate.

There are other straightforward reasons for reforming the National Health Service and for remedying problems that already exist. Although the Opposition are on the point of producing policy proposals of their own, they sound sometimes as though the Health Service belongs to them and is a perfect, unchangeable and unimproveable system which does not require reform. Although the present system is excellent, and although its principles of being free at the point of delivery, being financed out of taxation, and providing treatment on the ground of medical priority must be retained, its delivery of health care is not always perfect and could be improved.

The most obvious perception that people have of the service's inadequacies is the great variation in waiting times for certain types of surgery, which vary from place to place throughout the country--sometimes for quite inexplicable reasons--by comparison with other health authorities whichse allocations have been made in similar ways, but which in some cases keep up with the demand for specialties better than their neighbours.

Anyone managing the service and trying to identify where the taxpayers' money goes will find wide variations in the use to which that money is put. I refer to the vexed subject of drug and prescribing costs, which now total £2,000 million annually and are rising rapidly. Some general practitioners spend nearly twice as much as others on drugs per patient, even though they appear to have similar patient lists. Some GPs refer more than 20 times as many of their patients to hospital as do others. A fourfold variation is quite common, and will obviously have an effect on the ability of people locally to deliver patient care.

If one examines the detail and some of the things that the introduction of better management has started to throw up, it becomes clear that anyone who imagines that the Health Service is perfect as it is and should not be improved, but merely requires more money, is deceiving himself. In Lancashire, for example, we found a specialist in community medicine who refused to allow GPs to perform child immunisation, with the consequence that uptake rates in the area concerned were amazingly low. A London ophthalmologist decided to keep discharge decisions for all his patients to himself, but toured his wards only once a week. As a result, some of his patients waited six days in a hospital bed before they could be discharged. I could cite many similar examples. They have been dealt with, but many more have yet to be.

One great variation is the way in which patients are treated as people. The sensitivity that is exercised and the willingness to give information to patients vary from place to place, and there are many ways in which performance in that regard could be improved. That is what lies behind our White Paper reforms. If one is to reform the Health Service, one might as well reform it in a way that not only protects the service but gets rid of inequalities and raises its performance to the standards already achieved by the best, so that access to health care across the country is the same.

Mr. Grylls : Does my right hon. and learned Friend agree that, despite the rather sad and Luddite-like opposition of the British Medical Association and of the Labour party, once the public see the results of his far-sighted reforms in establishing a competitive market

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for health care--something there has never been before--they will appreciate that that is the only way of improving the delivery of health care to all our people?

Mr. Jeremy Corbyn (Islington, North) : There was nothing wrong with the Luddites.

Mr. Clarke : I hear some critical cries from Opposition Members. Probably my ancestors and those of many of my constituents were Luddites, so I must be careful ; Ned Ludd came from my part of the world. However, parts of Nottinghamshire have moved on by comparison to those represented by our opponents and most people in the Health Service accept the case for change that I make.

What they are reluctant to do is to agree to specific proposals. We have to explain that the White Paper is necessary, for the reasons that I have given, and then take them with us in implementing the changes to produce the improved situation.

Mr. Allen McKay (Barnsley, West and Penistone) : Does the Minister accept that when looking at differences in prescribing the quality and quantity of drugs, there is some merit in looking at various areas? If area is compared with area they are never alike. Perhaps the Minister would look at the question of a practice in Gleneath which was accused by his Department of over-prescribing, to the extent that an extra post was created for a doctor to look at it. He found out that there was no over- prescribing but that the prescriptions were necessary because of the prevalence of dust-related diseases in that area.

Mr. Clarke : I agree with that entirely. It is obviously not the case that all variations between areas of practices have no clinical explanation, but we also know that in some cases there is no clinical explanation and that there are places where the medicine chests of patients are full of drugs that they do not want. Some practices carry on repeat prescribing for patients whom they have not seen for a very long time. Where those cases occur and where there are no clinical reasons, if we can catch that waste we can divert the resources to better use within the Health Service. We are aiming to ensure that where there are no clinical reasons, and only there, high prescribing costs are tackled.

Dame Elaine Kellett-Bowman (Lancaster) : Will my right hon. and learned Friend make it absolutely plain that although the immunology rate and expectation of life in Lancashire are bad, in Lancaster itself we are extremely good at immunology and the expectation of life is higher than the national average?

Mr. Clarke : The case that I described was in one part of Lancashire. The practice has now been stopped and the situation has been improved. I know that my hon. Friend is very pleased with the advances being made and the level of care attained by the health authority in her constituency.

Going on, therefore, to the need to carry people with the reforms, I believe that, despite the formidable difficulties of embarking upon reform, we are already making progress in satisfying people inside and outside the service that this is a sensible way to proceed in order to make sure that our National Health Service remains as good as it should be. In recent weeks, between the publication of the White Paper and this debate, there have been a number of very interesting developments. I can

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certainly think of three, that I will begin by citing, which show that the Health Service is already on the move in the direction of accepting worthwhile reforms.

The first development, which I will deal with briefly, because we debated it last week, is the advance we have made on the contract for the payment of general practitioners. I am glad to say that last week we reached agreement with the negotiators for the profession. They have agreed to commend to the profession a new form of contract which offers great benefits to the service, to patients and to GPs, particularly those who do the work and hit the highest standards. We accepted that it was desirable to have a new contract, that we should set performance targets for the vaccination of children and the screening of women. The Government's targets were accepted for the highest payments. Those practices where a doctor makes a night visit to patients so that they see a doctor from the particular practice will be paid at a higher rate than those that use commercial deputising services and it is agreed that capitation is a good reflection of the hard work that GPs do. All those things are now accepted and I believe that the way is clear for raising the standards of the family doctor service.

Progress on that one front, which was in the air when the White Paper was produced, shows what can be achieved on other fronts where there is still controversy. We asserted to each other in discussions about the contract that we shared exactly the same aims in efforts to improve the general medical service. By sitting down together and talking about how best those aims could be achieved we were able to make progress and agree on reforms in the service for the benefit of patients. That approach offers great prospects for the other features of the White Paper. Discussion and the support of the profession are plainly a key element in ensuring that satisfactory progress is maintained.

Mr. John Redwood (Wokingham) : The fourth objective in the White Paper is particularly welcome : appointment times that mean something, and an attack on waiting lists. Does my right hon. and learned Friend think that he will receive support from both sides of the House and from the profession to ensure that that objective is implemented swiftly?

Mr. Clarke : I do not wish to discuss leaked documents about the Labour party's proposals, but Labour seems to have pinched part of its health proposals from our White Paper. On that subject Labour seems to be supporting us. I believe that the public support us very strongly, and we now look to health authorities to implement that support in practice throughout the country.

My second point about the progress that we have made is that many of the changes proposed for the rest of the service in the White Paper have already been accepted, and I find that they do not provoke controversy in discussions with the profession. [Interruption.] The hon. Member for Bassetlaw (Mr. Ashton) is trying to intervene : I do not think that he and others appreciate the extent to which discussions are turning on those parts of the White Paper that still pose difficulties. People have not noticed that key proposals are being accepted by consultants, nurses and others throughout the service.

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Let me try to help the House to understand why that acceptance makes me already sure that the necessary changes will come about. I think that it would be difficult for any hon. Member to claim that he had recently met a consultant or nurse who opposed the idea of better financial management to enable both doctors and nurses and the management to know more about what they are doing and where the resources go.

It is now some weeks since I met either a consultant or a nurse who did not think that medical audit or quality control--another key issue--were a good idea, and who did not accept the Government's framework. There has been a dramatic change in opinion since four or five years ago. I have worked in the Department before, and all these ideas have quite a long history. A few years ago it was difficult to find a consultant who did not regard the idea of financial management as a commercial intrusion in his affairs, and the idea of clinical budgeting as a threat to his clinical freedom. Medical audit, when first canvassed by the royal colleges three or four years ago, was regarded as a significant threat to clinical freedom by a large proportion of the profession.

What has now been accepted with enthusiasm is the idea that the Health Service needs to know how it spends its resources. It needs management information so that it can control the use of those resources, and the continuing quality checks that medical audit will ensure. Because of that acceptance, such proposals are about to become matters of little controversy and less interest in the outside world.

A great transformation will be wrought in the Health Service. The age of the computer, of information technology and of management decisions based on a knowledge of what things cost and where the vast resources go will come into the Health Service as it came into most other giant organisations a few years ago. Personal involvement in quality and output and the comparison of performance with that in other parts of the service will also come in. Management and clinicians will acquire far more information than they have ever had about what they are actually doing for their patients, how successful their activities are and how they are using their resources. A few years ago my favourite comparison was between the NHS and the Indian state railway, because of its vast size and the way in which it was administered. Now the NHS is about to become an up-to-date, efficient, well -managed organisation. More information will become available, particularly to those at the sharp end--the doctors and nurses in the hospitals and practices. What we must decide is what to do with that information, and the White Paper shows the way, explaining how we can use our ability to control the service, improve its performance and serve patients better.

Mr. Chris Mullin (Sunderland, South) : Has the Secretary of State seen the latest edition of "Conservative Newsline", which contains a large photograph of him under the slogan

"Our commitment to the NHS is absolute"?

Out of the same newspaper flutters a glossy leaflet from a company called Prime Health Plus advertising private medical insurance. Does he understand that such cynicism is the basis of many people's failure to take seriously the Government's plans for the National Health Service?

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Mr. Clarke : My commitment to personal choice is also absolute. Every country in the developed world, including most behind the iron curtain, is now developing private health care systems. Only the British Labour party continues to believe that they are an unwanted intrusion into health care. The reforms of the National Health Service will ensure that private health care in Britain has a strong competitor in the National Health Service, and that people will look to the National Health Service for a comprehensive service and then decide for themselves whether there is some feature of it that they wish to add to or enjoy outside it.

Mr. Joseph Ashton (Bassetlaw) : The Secretary of State said that he had consulted practically everyone in the National Health Service, but what consultations has he had with the public? Is he aware that in Nottinghamshire--his county and mine--Bassetlaw health authority has decided to set up a trust to opt out of Bassetlaw hospital? There has been no consultation with the public, almost all of whom voted Labour last Thursday. The decision has been taken by non-elected Tories with no consultation whatsoever with the public. The consultants that the right hon. and learned Gentleman talks about will all become directors and set their own salaries, as will the management who will decide about waiting lists and many other matters with no public consultation, agreement or referendum.

Mr. Clarke : Bassetlaw district health authority has taken no such decision in the terms described by the hon. Gentleman. I shall return to the reports about self-governing hospitals, but the hon. Gentleman misunderstands entirely what is happening in Bassetlaw. I shall return to that point.

I was explaining that we have achieved a substantial change of opinion within the Health Service that I would never have expected to happen five years ago. People accept the case for modern financial management and much more quality control. Almost without exception they accept that it will enable us to ensure that the money follows the patient to where the work is done best and reflects patient priorities.

The White Paper sets out a considered framework, over which we took a lot of time, showing how the new information can be used to create a better National Health Service for patients. How do we allocate resources best? In our opinion we should introduce competition and choice to ensure that resources go to where the quality of care and efficiency are highest. What about the role of the patients? We shall ensure a more patient-friendly and patient-led service by sending the resources with the patient to where, so far as is possible, he and his GP wish him to go.

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