House of Commons Hansard Debates for 11 May 1989

Mr. Cook : No, I shall not give way to the hon. Gentleman because I am addressing my question to the Secretary of State. We are entitled to know whether we are

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dealing with a fixed budget. Is it a cash limit or, as the Secretary of State would have us believe, something that can be ignored?

Mr. Kenneth Clarke : The patient will look to his GP for his prescription. It is clear in the White Paper that no patient need fear that his doctor will refuse to give him the medicine he requires. No doctor will be driven into bad clinical practice. Regional health authorities do work to cash limits now for the hospital service and they will work to cash limits. The regional health authorities' cash limits will not--

Mr. Cook rose --

Mr. Clarke : No, I am not taking--

Mr. Cook rose --

Mr. Deputy Speaker (Sir Paul Dean) : Order. Two Members of the House cannot be on their feet at the same time. I call Mr. Cook. Mr. Cook rose --

Mr. Clarke rose --

Mr. Cook : No, I am on my feet-- [Interruption.]

Mr. Clarke : On a point of order, Mr. Deputy Speaker. In my experience, when an hon. Gentleman has the courtesy to give way, he cannot then revoke his giving way, decide that he does not like what is being said and leap in to try to take half my answer which he will then no doubt use out of context in the way that he has just used those quotations from the White Paper.

Mr. Deputy Speaker : We had better get on with the debate. I call Mr. Cook.

Mr. Cook : Now we have it absolutely clear. It could not be clearer. The Secretary of State has just said that regional health authorities are, so far, under cash limits for hospital expenditure and that they will now be under cash limits for drug expenditure as well. We now have that clearly and firmly on the record. Those who are concerned about people with high prescription costs have every right to be concerned and to bring their anxieties to the House.

Mr. Clarke : Will the hon. Gentleman give way?

Mr. Cook : No. I have given way three times to the Secretary of State, and I shall now proceed with my speech.

I shall turn to those hospital sectors to which the Secretary of State has just referred.

Mr. Kenneth Hind (Lancashire, West) : On a point of order, Mr. Deputy Speaker. Is it right for the hon. Member for Livingston (Mr. Cook), having given way, then to stand up because he does not want my right hon. and learned Friend to complete his answer which the public want to hear?

Mr. Deputy Speaker : I remind the House that a large number of hon. Members wish to participate in this debate. Let us get on with it.

Mr. Cook : I am mindful of your observations, Mr. Deputy Speaker. The Secretary of State was good enough to say that a large number of hospitals had expressed an interest in opting out--

[Interruption.] Will my hon. Friends allow

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me to proceed? [Interruption.] On the contrary, I have succeeded in doing exactly that which I am accused of not being able to do. I have been through the list that contains a number of reputable trade journals and health service journals. It is an interesting list. There are hospitals which are not in the list of those which have submitted an interest in opting out.

There are currently six hospitals in the resource management initiative which, the House will recall, was to have been the means through which hospitals would acquire the information to price a contract and the key to unlock the door to opting out. Of those six hospitals in the resource management initiative, five wrote to the Secretary of State saying that they had resolved not to express an interest in opting out. They all went into the resource management initiative because they were interested in better financial management. They all welcome, as did those consultants who have worked in the resource management initiative, the opportunity to manage their resources. However, they never entered into it on the basis that it would be paving the way to opt out. There is not a hope--

Mr. Clarke rose --

Mr. Cook : The Secretary of State addressed the House for 52 minutes and he has already intervened three times in the 20 minutes of my speech. Of course, I shall as a matter of courtesy give way to him again on this occasion, but I would like to point out that other hon. Members have rights in this House.

Mr. Clarke : The hon. Gentleman repeated something which he has said before about the letter sent by five of the hospitals in the RMI that were never, particularly, candidates for self-governing-- [Interruption.] They were never special ones. The hon. Gentleman said that five of them had indicated that they were definitely not candidates.

I have a letter from Mr. Meecham, a consultant to the Wirral health authority at Arrowe Park hospital which was written to me after the hon. Gentleman first made that rather startling assertion. I shall read the relevant part about the statement that the hon. Gentleman made and which he has just repeated. It says :

"I certainly did not feel that any part of our letter made a judgement about self-government and would not have wished it to do so. I was amazed and dismayed therefore when a great deal of the coverage in the national press talked of the hospitals involved rejecting self-government or refusing to opt out. I certainly had not intended any such interpretation to be made. I had regarded our letter as a plea for taking it one step at a time rather than being rushed along without assessment of pilot projects being taken into account. Quite how the national press made the interpretation that they made, I do not understand."

The national press interpreted it in that way because the hon. Gentleman did. Arrowe Park will, in due course, decide whether it wants to be self- governing, as will the other five hospitals. It is totally untrue for the hon. Gentleman to say that those hospitals have rejected self-government and untrue for him to repeat it today.

Mr. Cook : It would not be magnaminous of me not to recognise such a useful intervention. I assure the Secretary of State that if he wishes to read any more such letters during my speech, I shall cheerfully give way to him.

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The Secretary of State's difficulty is that he is left with other hospitals in which there is barely a hope that they will have the adequate pricing information to opt out by April 1991, despite the haste with which the Department is cobbling together a software package that cuts corners. I note that the Secretary of State's director of finance information engagingly described that as a "quick and dirty approach" to the problem.

One reason that I am confident that some of the hospitals in the list will not be ready for opt-out in 1991 is that three of them have yet to be built and a number of the others are scheduled to be closed before 1991, including Much Wenlock hospital. I do not wish to disparage Much Wenlock hospital, which I am sure in its own way is a centre of excellence. However, it is plainly not one of the 300 major acute hospitals that we were originally told were prime candidates for opt-out. The dragooning of Much Wenlock cottage hospital into the list of hospitals for opt-out reveals a certain desperation. The most telling demonstration of the fact that the Government are having difficulty in selling the concept is the frequency with which management has been obliged to express interest in flat defiance of the medical staff. I mentioned that five out of six hospitals in the RMI had decided to express no interest. The sixth, Guy's hospital, has expressed interest. Last night, the consultants at Guy's were so fed up with having Panama ballots by the management board, that they called in the Electoral Reform Society, which, in a ballot, discovered that two out of three consultants regretted that Guy's had not joined the other five hospitals in their letter to the Secretary of State.

Even more startling is the case of Leicester, where 140 consultants gathered and voted unanimously against opt-out. Subsequently, at a closed meeting of the management board, it was decided to nominate Leicester royal infirmary as having expressed an interest. Why is medical opinion so overwhelming in rejecting the concept? What is it that worries the profession? First, they are worried that it will fragment the Health Service. The proposal in the White Paper is written by people who see what happens to the patient in hospital as an isolated episode, with no connection to what has gone before or after. A simple model is one in which the patient collects his or her travel voucher from the local district general manager ; the patient disappears to travel the long distance to the hospital in which the contract has been chosen by the district general manager, not by the patient ; the patient may never before have been diagnosed ; there may be no commitment to community services in the area from which the patient comes ; the patient may have no prospect of returning as an out-patient ; and there is no access to the medical records of the patient.

It is bizarre that the Secretary of State should describe such a concept as one that treats patients as people. The consultants have not been taken in by the idea that extra money will follow any extra patients attracted. They have been sharper in seeing through that fraud than the right hon. and learned Gentleman's Back-Bench colleagues. The structure proposed cannot produce extra funds for the hospital sector because there is no proposal to provide extra funds for it. The cheerful notion that everyone's hospital can receive more money by opting out rests on a simple delusion. As the consultants at Guy's hospital in their letter to The Independent the other day observed :

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"The only way we can get more money for Guy's is by concentrating on what is profitable, not what is needful."

Mr. Ashton : Is it not a fact that if a hospital chooses to opt out, it will have to take on a huge debt to buy its own buildings and equipment from the Government? In many instances, it will only be able to service that through extra fund-raising, sponsorship or selling off land.

Mr. Cook : My hon. Friend understates his case. The truth is that not only hospitals which opt out will be faced with these charges. Every hospital in the health sector will be faced with them. They will be faced with a payment on capital charges, not just for rent for the roof over their heads but for every piece of equipment in the building worth more than £1,000. Heaven knows what additional costs that will entail by way of administration of the immense, ponderous effort of gathering together such a mammoth inventory, merely to enable Conservative Members to know where every piece of equipment worth £1,000 is located.

To return to the argument about whether money will follow the patient : even to succeed in selling treatments that are profitable rather than needful, these hospitals will have to compete against each other merely to stand still. The fundamental dishonesty in the White Paper is that it continually presents competition as resulting in an increase in quality-- because the hospitals compete on quality--when the White Paper is really written with the intention of lowering the cost to the NHS by obliging these hospitals to compete not on quality but on price. And the first victim of competition on price will be the quality of patient care.

Anyone who doubts this has only to remember that the contracts will be awarded by health authorities desperately juggling to make ends meet now. On Tuesday, the National Association of Health Authorities issued a statement pointing out the difficulty that it was having coping with 8 per cent. inflation on a budget based on a forecast of 5 per cent. It now calculates--

Mr. Tony Favell (Stockport) : Will the hon. Gentleman give way?

Mr. Cook : I shall happily give way to the hon. Gentleman in a moment. His interventions--he has made one in every speech that I have made in this Parliament--are always worth hearing.

The National Association of Health Authorities now estimates that the cumulative under-funding of the hospital sector in the lifetime of this Government exceeds £3 billion. That is why hospitals up and down the country are running out of money to treat their patients.

Mr. Favell : I greatly resent the hon. Gentleman saying that hospitals that give good value for money do not give good service. Stepping Hill hospital in Stockport has twice been top of the value-for-money league in the north-west, and it gives an excellent service.

Mr. Cook : I am terribly sorry if I caused the hon. Gentleman offence ; I shall make a point of not giving way to him next time. There are undoubtedly many excellent hospitals which provide value for money, such as the one to which the hon. Gentleman referred. Why on earth is it necessary, then, to turn the whole system upside down to tackle the problem of under-funding--

Mr. Hind rose --

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Mr. Cook : The hon. Gentleman has already raised a point in my speech, and once is enough for anyone, apart from the Secretary of State.

The consequence of this under-funding was perfectly illustrated only yesterday in a parliamentary answer given to my hon. Friend the Member for Don Valley (Mr. Redmond). It confirmed that, of the 11 body scanners in operation in the Trent region, seven had to be paid for by public appeal. That is the type of Health Service to which we have been reduced--the Health Service of the collecting can, a Health Service in which the harsh reality is that large numbers of health authorities end each year broke. In such circumstances, they will have no choice but to award their contracts on the basis of where they can obtain the cheapest ones.

Mr. Jerry Hayes (Harlow) : The hon. Gentleman has raised a valid point. One of the difficulties at present is that, since there is an efficiency trap, beds and wards are closed at the end of the year because hospitals run out of money. Under the proposals in the White Paper, which will make the money travel with the patient, does he agree that precisely the opposite will obtain and hospitals will be given a financial incentive to open the 20 per cent. of NHS beds that are closed for stupid economic reasons?

Mr. Cook : I must try again, perhaps a shade more slowly. There can be no removal of the problem of under-funding at the end of the financial year, because no more finance is proposed for the kitty. Even if the hon. Gentleman is correct that some hospitals will attract more money for the patient-- [Hon. Members :-- "Ah!"] Let us assume for a moment the hypothesis proposed by Conservative Members, in which these hospitals will try to undercut each other and will therefore receive no extra money. The corollary of the hon. Gentleman's argument is that other hospitals will face the problems of bed and ward closures even earlier in the year because they do not have the necessary resources.

The most spectacular, technicolour failure of the White Paper was also the most conspicuous omission from the Secretary of State's speech. The right hon. and learned Gentleman addressed the House for 52 minutes in his own speech and for seven during mine without once alluding to the words "community care". The White Paper manages to run to more than 100 pages on the NHS without a single proposal for better patient care in the community. That is a failure that fully matches the deplorable failure of the Government to respond to the Griffiths report one year and two months after its publication. If the Secretary of State wishes to tell us that we must now wait for another White Paper, I shall cheerfully give way to him for the fifth time so that he can name the date when the Government will give their response to the report.--That has managed to silence even this Secretary of State.

Every now and again we see the consequences of this neglect. Last night I sat in the Library and read yesterday's report by the British Geriatrics Society on the abuse of elderly people. It makes harrowing reading. It contains case histories of frail, elderly people, battered and bruised in body and emotions, and often abused by close caring relatives who have been driven to distraction by the strain of constant attendance without break, sleep or help.

I was particularly moved by the case of a daughter who gave up her flat to move in with her mother and sleep on her sofa. The daughter was finally found trying to strangle

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her mother with a towel after a day in which, in 24 hours, she had been called 17 times to lift her mother on and off the commode. This type of condition is the major challenge facing the health and social services at the end of this century. We must provide care and nursing for the growing number who find themselves in conditions that cannot be cured but for whom appropriate services and support from the Health Service can make the difference between pain, squalor and isolation on the one hand, and comfort, dignity and a life of interest on the other. The White Paper is wholly silent on how we should assist these people.

Only one help is offered for the health care of the elderly--the tax relief for private medical cover. No one could read the report by the British Geriatrics Society and still believe that this proposal is relevant to a single one of the case histories I have mentioned. It is a proposal as fatuous in its irrelevance to the real health needs of the elderly as it is central to the political dogma of Conservative Members.

Here we come to the real threat posed by the White Paper. It would be a mistake to judge it as no more than a ragbag of wrong-headed impractical proposals, full of glaring omissions. There is a thread that holds it together. To do the Secretary of State justice, he has a strategy. His strategic objective is to destabilise the National Health Service and replace it with a commercial one. It is a strategy that is not difficult to spot. It keeps breaking to the surface all the way through the White Paper. It breaks through in the suggestion that opt-out hospitals should use NHS facilities for private patients, in the suggestion that general practitioners should use NHS money to buy private treatment for their patients and in the obligation on health authorities to give equal preference to private hospitals in awarding contracts for medical treatment.

We are at the start of a long journey. We can already see where we will end up--with market medicine as it is practised across the Atlantic, where 30 million Americans have no medical cover, where health means organisations are put on the second floor to discourage expensive, disabled people from enrolling, and where patients die in casualty rooms while the accountant is finding out who will pay for them.

If that does not move Conservative Members, let me warn them about what happens to well-heeled people like the people whom they represent. American women are twice as likely to have their wombs removed as British women. American men are two and a half times more likely to have their prostate rebored as are British men, and three times more likely to have their gall bladders removed. That is not because they have any greater need for those operations but because the people who sell the operations believe in what they sell. When a doctor examines a patient, he comes to the conclusion, "Your gall bladder is worth more to me than it is to you." Market medicine gives the worst of both worlds. It denies the poor and the unhealthy the treatment that they need, and it cons the healthy and the wealthy into treatment that they do not need.

We are in danger of losing a Health Service that is motivated by dedication and replacing it with one that is driven by financial targets. We have had plenty of occasions recently to note the danger of what we will lose

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and how important it is. We have been able to note it in the succession of tragic events with major loss of life during the past 18 months. Hillsborough is the latest in that succession. We have had Piper Alpha, Lockerbie and Clapham. On every one of those occasions it has been the ambulancemen, the casualty departments, and the nurses of the National Health Service who have turned out to handle the emergency. It is to them that we turn on such occasions. The Prime Minister has been assiduous in visiting each disaster. On every occasion she has been good enough to say how wonderful the emergency services have been, as they were, but they are just as wonderful between disasters on every other day of the year when they do not provide the opportunity for a photo call. If those services are to be there when they are needed, we have to sustain them all the year round. We must give them the resources that they need to do the job. We must heed the advice that they offer on the future of the service. Above all, we must give them the commitment that we believe in the service that they provide. It is because right hon. and hon. Members on the Government side do not believe in that service that we will vote against them tonight.

5.52 pm

Sir Gerard Vaughan (Reading, East) : Because so many hon. Members wish to speak, I shall speak only briefly. There was a great deal of laughter, particularly from the Opposition Benches, during the speech of the hon. Member for Livingston (Mr. Cook). I found what he was saying distressing ; and it was increasingly distressing as he went on. I worked for the whole of my life in the National Health Service until I came to the House. [Interruption.] I will not indulge in the sort of remarks that have just been made.

What troubled and distressed me, and should distress the whole House, was the constant attempt of the hon. Member for Livingston to undermine people's faith in the Health Service and to create anxiety among people who do not understand what is happening and alarm in places where it should not exist. I would have expected from the spokesman for the Opposition a much more serious look at what the Secretary of State has recommended.

May I remind hon. Members that the National Health Service was started on an all-party basis? Today the Opposition are attempting to undermine the service. [Interruption.] Yes. They are a backward-looking, unserious group of people who are not taking proper account of what has been proposed by the Secretary of State. The hon. Member for Livingston quoted the Conservative Medical Society. I was at the meeting to which he referred. What he said was a total travesty of what happened. My right hon. and learned Friend will agree. I am an honorary consultant at Guy's ; what the hon. Gentleman said about attitudes within Guy's was also a complete travesty of what is happening in the hospital. When he goes round hospitals I wonder whom he talks to. Is it only his union chums, who wish to be activists within the Health Service? They are not the people who talk to me.

Mr. Max Madden (Bradford, West) : On a point of order, Mr. Deputy Speaker. The hon. Gentleman is disputing whom my hon. Friend speaks for. Do you think that in the course of his remarks he will make a disclosure

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of his interests which, according to the Register of Members' Interests, include the directorship of Private Medical Centres plc and the joint chairmanship of Spahealth Ltd.? Do you think that in his trip down memory lane the hon. Gentleman has overlooked the fact that he has those relevant interests which bear directly on the debate?

Mr Deputy Speaker : The House knows that it is customary for hon. Members to declare their interests during debates.

Sir Gerard Vaughan : I have nothing to say. They would not be in the Register of Members' Interests if I was worried about them. [Interruption.]

Mr. Deputy Speaker : Order. Sedentary interventions prolong debate and waste valuable time.

Mr. Allan Rogers (Rhondda) : on a point of order, Mr. Deputy Speaker. The hon. Gentleman also has strong connections with the British pharmaceutical industry. Will he declare those interests before proceeding with his speech?

Mr. Deputy Speaker : We had better let the hon. Gentleman get on with the speech.

Sir Gerard Vaughan : I am grateful, Mr. Deputy Speaker. As I said at the start, I propose to speak briefly. I wish to congratulate my right hon. and learned Friend on what he is proposing for the National Health Service. He is putting forward his proposals with great courage and determination. A great many doctors and nurses have been talking to me and telephoning me to tell me how much they support my right hon. and learned Friend's proposals.

Some doctors have been telephoning me not to criticise what my right hon. Friend has proposed but to ask what it all means. That is where part of the problem lies. The Secretary of State is putting forward very complicated proposals that are difficult to understand. They need much explanation. Opposition Members find it easy to use them to misrepresent people's attitudes.

Mr. Harry Greenway (Ealing, North) : No doubt my hon. Friend will consider the question of resources. Will he draw attention to the £2 billion to £3 billion more that is going into the Health Service in the current year? [Interruption.] The Labour party is wearing its heart on its sleeve about resources-- [Interruption.]

Mr. Deputy Speaker : Order. There are too many speeches going on.

Mr. Greenway : Is my hon. Friend aware that the Labour council in Ealing put up the rates on Ealing hospital by £500,000 two years ago and that it is putting them up by another £500,000 this year? Labour does not care.

Sir Gerard Vaughan : My right hon. and learned Friend the Secretary of State is talking about evolution. Opposition Members do not seem to realise that, as the proposals in the White Paper are put into effect, so the situation will change.

Mr. Thomas Graham (Renfrew, West and Inverclyde) : Does the hon. Gentleman realise that some Scottish Members have been inundated with letters about the ending of the care attendance schemes in September?

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Those schemes have given carers the respite that they need to enable them to continue caring for their mums and dads and sons and daughters at home rather than have them go into hospital, yet the Government are deaf and dumb in the matter. They have not come to the aid of those carers or of the patients that they look after. There has been no emphasis on community care. I do not like to criticise hon. Members who are sincere, but they must look at what we are seeing. I am being sincere when I say that the Government are condemning many carers who cannot take any more. Please take that into consideration.

Sir Gerard Vaughan : I know in whose hands the NHS is safest--my right hon. and learned Friend's.

My right hon. and learned Friend is right when he says that the introduction of more information and of medical and clinical audits will change the situation. For the first time, people will begin to know where the money is being spent and where there are places for the treatment of their patients.

Recently, in my constituency, I had the problem of a lady who required a hip operation and was kept awake every night in pain. The waiting list in our locality for that operation is two and a half years. When I asked the health authority to inquire where else she could go it could not provide that information. It did not have the resources to find out where she might go. I had to phone round and find a hospital where she could be admitted virtually immediately. That should not be done by a Member for Parliament ; it should be done as a matter of course by the local health authority, and that will be possible when the information comes through in the way that my right hon. and learned Friend has proposed.

No doctor would object to a medical audit. It is agreed on all sides that they would be of benefit to us. It is regarded in the same way as a consultant regards a second opinion. If it agrees with him, it strengthens his hand, and, if it disagrees with him, he is interested to know why somebody thinks the job could be done better in a different way.

I shall not go on any further. I know that Opposition Members will be pleased because they do not want to hear too much from someone who has been working in the field. Anyone who goes round the hospitals, as I do, will hear people complaining about the frustration created by delays and the waste under the present system.

My right hon. and learned Friend was right to remind us of what is going on overseas. That is relevant because every other major country is facing the same sort of problems that we in Britain face. Unless we face up to that, we shall not have the services or the reduced waiting lists that we wish. Therefore, I strongly support what my right hon. and learned Friend is trying to do in this difficult area.

6.2 pm

Mr. John P. Smith (Vale of Glamorgan) : Thank you, Mr. Deputy Speaker. I hope that you and hon. Members will bear with me while I make my maiden speech in the course of this important debate. I should like to start by thanking you and all hon. Members for the wonderful welcome that I was given on Tuesday when I took my seat and also to thank hon. Members on both sides of the House for the individual welcomes that I have received. I hope that the warmth that has been shown towards me will continue for many years.

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It is customary in a maiden speech to pay tribute to one's predecessor and, if possible, to avoid controversy. The first custom I am sure that I can meet without difficulty, but I am not so sure about the second custom, given the controversial nature of the debate. But I thought that a safe formula would be to refer to my predecessor's maiden speech in 1951. Unfortunately, it was controversial. Sir Raymond Gower referred not only to the burning issue in Wales of devolution, but to the unbalanced economy and the adverse effect that that was having on his constituency and south Wales.

Therefore, I went even further back, to the maiden speech of Dame Dorothy Rees. Surprise, surprise, I found that she discussed the crisis in housing, homelessness and the problem of eviction, a major issue at the time, and the unbalanced economy. I was going to go back even further until I was told that Lynn Ungoed Thomas was an expert on the NHS and its introduction, so I thought that it might be better to miss that as well.

It is a great privilege for me to pay tribute to Sir Raymond Gower. He commanded tremendous respect within his constituency for 38 years, not least my respect as I had the honour of standing against him at the last general election. During that time, he helped his constituents tremendously. He was definitely a consensus politician and most certainly a one-nation politician. That is why he gained so much respect.

The best tribute that I can pay to the man is to refer to an experience that I had in 1979 when I contested a local election and we had the general election at the same time. I was canvassing for myself when I knocked on the door of a family who referred to themselves as Labour supporters all their lives. They said that they would vote for me in the local election but for Sir Raymond in the general election. I asked why. Surprisingly, they did not say that it was because he had helped them on a particular issue or that he was a good constituency Member of Parliament. Instead they said, "He is a friend of the family." For constituents to refer to their Member of Parliament as a friend is a great tribute, and if I can live up to that I shall be very proud indeed.

My constituency is a beautiful one, as many hon. Members know, having been there in the past three or four weeks. It is made up of the industrial town of Barry, which is celebrating its centenary this year and comprises approximately 50 per cent. of the population, and the beautiful rural Vale of Glamorgan with its rolling green hills, lush farmland and one or two nice suburbs.

My constituency has done reasonably well. It enjoys a higher than average household income and wealth in Wales, and the majority of people there consider themselves middle class. That was why I was delighted to be elected by them last week.

I have no doubt that one of the major issues in that election--in fact, the major issue--was the NHS. The matter is simple. With few exceptions, one's level of income or social status do not matter. My constituents, and, I believe, the British public, recognise that private medicine cannot meet the nation's health needs. In particular, it cannot meet the health needs of the chronically sick, the disabled and the elderly. That message came across clearly during my campaign.

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My constituents were not concerned just about the reform of the NHS. My constituency already has major long- standing health issues with which to deal. For example, my constituency does not have a major casualty unit and that is completely unacceptable. It is dangerous in two ways. First, people have to travel long distances to receive emergency treatment, and, secondly, should there be an emergency or accident in the home, mums will often wait until the following morning to go to the local part-time minor casualty unit, thinking that they are doing the best thing by not putting pressure on the Health Service. That can be dangerous, because the hours immediately after a knock, a scrape or an accident are important. We do not have, and have not had for some time, an adequate ambulance service in the constituency. In the western Vale of Glamorgan, one ambulance serves the entire area between 6 pm and 10 pm and between 12 midnight and 8 am. If there is more than one emergency, it has to be decided to which one to send the ambulance, and I have pointed out the problem of long distances. It was heart-rending when, during the by- election campaign, I spoke to a local lady, Mrs. Margaret Taylor, who told me how she lay in the road in Llantwit Major town centre for 45 minutes awaiting the arrival of an ambulance following a road accident.

In addition, we are faced with the proposed closure of the children's orthopaedic unit in Rhydlafar hospital, which is on the border of my constituency and in that of my hon. Friend the Member for Cardiff, West (Mr. Morgan) but which is used by my constituents. We are also faced with a proposal to shut the most popular hospital in the Vale of Glamorgan, Sully hospital, because clearly, in view of its location, it is a prime development site. It is a beautiful hospital and my constituents do not want it to be closed. The proposed reforms in the White Paper were the icing on the cake. All the problems to which I have referred are problems of under-funding and none of them will be met by the proposals in the White Paper. Indeed, when I had the privilege of having a private meeting with general practitioners in the constituency, before making any reference to the proposals in the White Paper they made it clear that under-funding was the major problem facing the NHS.

It has been a privilege to have this opportunity to make a short and non- controversial speech in a most important debate. I wish to thank my hon. Friends for all the help that they gave me during the by-election campaign, and I extend special thanks to the Secretary of State for Health for the assistance that he gave me. I look forward to making far more controversial speeches in the future.

6.12 pm

Sir Barney Hayhoe (Brentford and Isleworth) : The hon. Member for the Vale of Glamorgan (Mr. Smith), who has come to the House after a memorable by-election victory, has lived up to the traditions of the House in every way in his maiden speech. He spoke with great fluency and absolute sincerity. His speech highlighted local issues of great concern and he paid a most gracious tribute to his predecessor, Raymond Gower, who was a well- loved colleague of hon. Members in all parts of the House and

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of the staff at all levels. I am not sure how long the hon. Gentleman will remain here, but we shall be eager to hear him again, perhaps in a more controversial mood.

Before dealing with the main issue of the debate, I must first declare my interest with a pharmaceutical company, as outlined in the Register.

What a contrast there was in the opening speeches. I congratulate my right hon. and learned Friend on a reasonably argued and realistic speech about improving patient care. The hon. Member for Livingston (Mr. Cook), on the other hand, used his considerable skills to make some amusing cracks, which we enjoyed, some political points, but little else, apart from a moving section concerned with community care.

I imagine that hon. Members on both sides are waiting anxiously to hear the Government's response to the Griffiths report, which was published in the middle of March last year. It is important for the Government to declare their position soon on the important matters raised in that report.

The fundamental issue facing the nation is how to improve our highly cost- effective--at least compared with other systems of health care in other countries--National Health Service. The service can of course be improved, and must be made better able to meet the increasing needs of patients, needs which have been amplified by demographic factors and by the pressure of medical advance. More attention must be concentrated on prevention. We do not have a National Health Service so much as a national illness service. The more that we can move towards a genuine Health Service, by dealing with prevention, the better.

Mr. Michael J. Martin (Glasgow, Springburn) rose --

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