Mrs. Ann Clwyd (Cynon Valley) : On a point of order, Mr. Speaker. I understand from the aid agencies that Ethiopia is threatened with a new famine even worse than that of 1984 in which 500,000 people starved to death. We were all moved at that time by pictures of dying children on television and the magnificent response to Bob Geldof's aid appeal.
The aid agencies are deeply worried--
Mrs. Clwyd : I understand that the Minister for Overseas Development has today made a statement outside the House. In view of the House's concern about this desperate situation, we think it important that the Government should make a statement and give the House an opportunity to discuss the volume, quantity and type of aid that Ethiopia should receive.
Mr. Speaker : Order. Allow me to deal with one point of order at a time. I think that the whole House listened with concern when this matter was mentioned on the news at lunchtime today, but it is not for me to call a Minister to make a statement about it. [Interruption.] Order. I am sure that what the hon. Lady has said has been heard by those on the Government Front Bench.
Mr. Morris : You are right to say that a number of us heard that item on the news at 7 o'clock this morning. Is it not open to any Member of Parliament to ask for a private notice question before 12 noon?
That the draft European Communities (Definition of Treaties) (European School) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the draft European Communities (Privileges of the European School) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the Alcoholic Liquor Duties Act 1979 (Repeal of Section 31) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the Food Protection (Emergency Prohibitions) (Contamination of Feeding Stuff) (Wales) (No. 3) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the Food Protection (Emergency Prohibitions) (Contamination of Feeding Stuff) (Enland) (No. 3) Amendment Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.-- [Mr. Greg Knight.]
That European Community Document No. 8680/89 on pigmeat prices be referred to a Standing Committee on European Community Documents. That European Community Document No. 7871/89 on protection of animals during transport be referred to a Standing Committee on European Community Documents.-- [Mr. Greg Knight.]
Debate on the Address
Order read for resuming adjourned debate on Question [21 November].
That an humble Address be presented to Her Majesty, as follows : Most Gracious Sovereign, We, Your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland, in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.-- [Mr. Gow.]. Question again proposed.
Health and Social Security Mr. Speaker : I must announce that I have selected the first Opposition amendment in the name of the Leader of the Opposition. I must tell the House that again many right hon. and hon. Members have written to me to say that they wish to participate. I propose to put a 10-minute limit on speeches between 6 pm and 8 pm. I ask those called before that time and afterwards to bear in mind that limit.
Mr. Graham Allen (Nottingham, North) : On a point of order, Mr. Speaker. This is the first day of oral questions since we returned. Several Ministers have made it their practice to reply lengthily to questions. Will you consider this matter and perhaps, if necessary, make some recommendations? As today is the first day of questions, it is important to set the right precedent.
Mr. Speaker : The House knows that the Chair is not responsible for answers given to questions--or, indeed, for their length. Nor am I responsible for the length of supplementary questions. However, it is a fact that, the longer the answers and the questions, the fewer questions we deal with.
Mr. Beaumont-Dark : We all accept the view that speeches should be brief. Why is it, sir, that the 10-minute rule comes into force only at 6 pm? Why is it that senior Members--right hon. Members--can speak for longer? Why not make the rule from the word go?
Mr. Speaker : I sometimes wish that I had that authority, but I have not. It is written into Standing Orders that the Chair may designate a limit of 10 minutes on speeches between 6 pm and 8 pm or between 7 pm and 9 pm. the hon. Member should go back to the Procedure Committee--he may be a member of it--to see whether he can have the time limit extended.
Column 4423.37 pm
But humbly regret the Government's failure to safeguard the National Health Service ; are concerned at the evidence that members of the public cannot secure access to the treatment they need ; regret Her Majesty's Government's intention to proceed with its legislation to undermine the National Health Service and to commercialise health care ; believe that the pressure for competition on the basis of cost will be at the expense of quality of care and the necessary treatment required by patients with chronic and expensive conditions ; are alarmed that the proposals for care in the community threaten the public provision of social services and fail to provide a designated central grant to fund local responsibilities ; note that the Government has no mandate for these proposals which have never been put before the electorate at any election and have been consistently opposed by every measure of public opinion since they were first published ; reject the decision of Her Majesty's Government to persist in ignoring democratic opinion ; and commit ourselves to defending the National Health Service as a public service free at the time of need.
Before I turn to the gravamen of the amendment to the Gracious Speech, and as I have a rare opportunity to speak before the Secretary of State for Health, may I invite him to comment on a development last week in the ambulance dispute, which is now concluding its third month? Last Wednesday, the Secretary of State repeatedly attacked--first in his press conference on the proposed NHS Bill and subsequently on television--an ambulance crew for refusing to answer an emergency call to attend a new-born baby. The Secretary of State was wrong on two counts. The emergency call was not refused by the ambulance station but referred to a nearer station by the crew at the first ; and the baby was not new-born. When the crew eventually arrived at the scene, it found a corpse which, understandably, the police refused to allow the ambulance crew to move, on the grounds that it would interfere with their inquiries.
Although the Secretary of State was anxious to hand round allegations when he was badly informed, by contrast he has been unusually quiet since the truth came out. Last Thursday, he put up a spokesman to field inquiries about the allegation, who said that the Secretary of State had acted in good faith and that he did not think that he would say sorry. I am happy to set the mind of that spokesman at ease. I do not imagine that the Secretary of State will ever say sorry.
The most pressing matter is not whether the Secretary of State will apologise. The really interesting question is whether he wants to resolve the ambulance dispute. What he said last Wednesday and every other recent intervention in the dispute might have been calculated to undermine opinion and prolong the dispute rather than to resolve it.
The Secretary of State has already lost the dispute. This Chamber is probably the only place in Britain where he would not lose a vote on the ambulance staff claim. Nor will he roll back the public tide of support for the ambulance staff by the advertising campaign which we read is about to start. He will not convince the public that he has a case by buying advertisements in the press. He will convince the public that he has a case only if he has sufficient faith in his own case to put it to arbitration. So long as he continues to refuse arbitration, he shows that he has no confidence in his case. Having given the Secretary of State notice of what he may wish to tell the House and of what we expect him to
Column 443say about the ambulance dispute, I shall turn to the Government motion and the Opposition amendment before the House.
Today and tomorrow we conclude the debate that commenced last week on the Gracious Speech. The visit of the sovereign to read a speech written by Ministers elected by the people is an annual symbol in the British constitution of our claim to be a country free of arbitrary Government, and of Parliament's claim to represent the people who elect us. It is an offence against both those claims that this year the Queen's Speech contains the Government's intention to persist with the unloved, unworkable changes to the National Health Service, on which not one hon. Member was elected.
Last week I noticed something of an epidemic of Tory Back Benchers desperate to intervene before 5 pm. I propose, therefore, to make a public service announcement, which I hope will cure that fever : I shall happily give way to any Tory Member who can confirm that in his or her election address he or she warned the electorate that the Government whom they would support would encourage local hospitals to opt out, would limit general practitioners' spending on drugs-- [Interruption.] If Tory Members object to my words, I am happy to accept the word of any hon. Member who can confirm that his or her election address included any form of words about self-governing hospitals opting out, how the Government would limit GPs' spending on drugs or how they would direct patients to a hospital, not of the patient's choice, but where the health authority got the cheapest bargain.
Mr. Neil Hamilton (Tatton) rose --
Mr. Hamilton : In his election address in 1974, did the hon. Gentleman tell the British people that the Labour Government would reduce spending on the Health Service over the following five years by 30 per cent. in real terms?
Mr. Tony Marlow (Northampton, North) rose--
The Government do not have a mandate for these changes. Nor have they been able to obtain any support for the proposals since they were published.
In a press conference last week, the Secretary of State was pressed to name one health organisation which supported his Bill. I am told that he answered with the Institute of Health Services Management. The only support that he can claim from the IHSM is that it chose not to publish the survey of its members. I can tell the Secretary of State that that survey showed that 37 per cent. of its members were in favour of the hospitals in their districts becoming self-governing and 56 per cent. were opposed ; and that 37 per cent. were in favour of GP's having practice budgets and 62 per cent. were opposed. It is a sign of desperation that that body is the nearest that the Government can get to an organisation which supports their proposals.
Column 444The Secretary of State keeps advising us that what matter are not the views of the staff in the National Health Service but the views of the patients that the NHS exists to serve. He has gone out of his way to make it clear that he does not pay any attention to the views of the people who work in the Health Service. The problem of turning to the views of the patients is that every patients' organisation is overwhelmingly against the White Paper. I have now received 37 replies to the questionnaire that I circulated to associations representing patients in the NHS. They included the Spastics Society, the Asthma Society, the Haemophilia Society and the Royal Association for Disability and Rehabilitation. I asked them whether hospitals should be encouraged to become independent and self-governing. I did not use the contentious term "opt out", which causes such pandemonium among Conservative Members. Out of the 37 who responded, 35 disagreed with that statement.
I cheerfully concede to Conservative Members that the people responding to that question do not represent the public as a whole. They differ from the public as a whole and from hon. Members in that, between them, they have more first-hand experience of the National Health Service. They use the service most regularly, they understand it best and they need it most. They refuse to swallow the Secretary of State's prescription.
At the end of the day, the importance of the National Health Service is that we are all potential patients. Its future is a central political issue because it is a public service that serves every member of the public. Therefore, major surgery to that service should not be attempted unless there is sufficient consensus among the public whose health is at stake. However, Parliament is about to be asked to pass changes which enjoy a degree of public support that is barely greater than the ratings of the Liberal Democrats in current opinion polls. Not one opinion poll since the White Paper was published has failed to produce a majority against the proposals of more than 3 : 1 or 4 : 1.
The Secretary of State has an answer to that too. He dismisses these measures of public opinion on the grounds that the public do not understand the proposals and therefore are not entitled to a view. The problem for the Government is that, the more the public know about the proposals, the less they like them. In the 10 months since the White Paper was published, there has been a vigorous debate on the proposals, and over that time opposition to all the key proposals has hardened.
What about Conservative voters? Surely Conservative Members will not tell us that Conservative voters are easily misled or that they misunderstand what Conservative Governments intend to do. We know what Conservative voters think about the proposals, because the MORI omnibus poll carried out in September asked them. On each of the key proposals, more Conservative voters oppose what the Conservative Government are doing than support them.
I have a warning for Conservative Members. They can ignore the views of the people who elected them and spend two busy years pushing through this uniquely despised measure and taking apart the NHS to make it fit the design that they have wished upon it. But they must not imagine that their voters will forgive them for being ignored. One in eight Conservative voters say that they are likely to switch their vote if the Bill goes ahead. Conservative
Column 445Members have six hours in which to ponder that statistic. In case they missed its significance, that shift alone is sufficient to wipe out the Government's majority of 100.
We can tell that the Government are embarrassed by the unpopularity of the proposals because of where we find the reference to the NHS in the Queen's Speech. Where does the Secretary of State's grand design for the Health Service rank in the order of the Queen's Speech? What prominence is given to his plans to reshape the Health Service as NHS plc? The proposals are 10th in the Queen's Speech, just above legislation for Scotland. As a Scottish Member of Parliament, I understand just how marginal that is in the Government's priorities. Since the Queen's Speech, we have had the Secretary of State's Bill. The evidence of the comments from outside Whitehall shows how unpopular the Bill will be, and the evidence of the Bill from inside Whitehall shows how unworkable it will be. We warned that the plans would represent a threat to the continuity of care. We warned that the White Paper had been written on the model of a patient who falls ill and who is then taken off to hospital for surgery and put back out repaired. It is the garage repair service model of health care. That is the model that has been adopted by the private sector, which picks on conditions which can be put right on the basis of a quick fix and fast profit. Unlike the public sector, it is a model which is designed for those of working age who are bssically fit and who require health care only for episodes when they are ill.
The bulk of the activity of the National Health Service is related to chronic long-term conditions which cannot be treated by that quick fix. It is for the elderly, the chronically sick and the disabled, who require long -term care. That care is best provided by co-operation and teamwork between general practice, community nursing and hospital services. No one from the Government Benches has ever explained how that teamwork will be improved by breaking up the Health Service and the co-operation between the different parts and re-forming each of them as a separate business enterprise that is supposed to seek the cheapest contracts from the other enterprises.
Mr. Andrew Rowe (Mid-Kent) : In giving this long catalogue of misrepresentation--that is what it is, to a considerable degree--will the hon. Gentleman explain how it is that so many of those who use the NHS are concerned that those who are most successful at carrying out operations are the very people who are most likely under the present arrangements to be forced to close their wards? Will he explain how it is that, throughout the NHS, there are
well-authenticated tales of extravagance? How does he suggest that he would achieve local management efficiency under any scheme that he is likely to propose?
Mr. Cook : I am happy to respond to the hon. Gentleman's intervention. Is he suggesting that the provisions in the Bill will increase local management discretion? I do not know whether the hon. Gentleman has read the Bill. If he has, he will have found in almost every page of it that a panoply of new powers will be given to the Secretary of State and not to local management.
We have warned the House that the Bill will not provide a model that will devolve local control. Instead, the Bill
Column 446will increase central control. That is clear in the Bill. The Secretary of State will appoint every member of the regional health authorities. It is he and the regional health authorities that will appoint every member of the district health authorities. It is he who will then direct those authorities. He will tell them what to do. If the hon. Gentleman is seeking local discretion, there is only one central power and control that I can find that will be relaxed as a result of the Bill's enactment. I refer to the Secretary of State's power to limit the number of pay beds in NHS hospitals. It is significant that that is the only issue on which the Secretary of state will give more discretion to local managers and therefore relinquish his own controls.
Mr. Cook : I shall not give way now. If the hon. Gentleman contains himself, I shall give way to him at an appropriate moment. I hope that he will forgive me when I say that I wish to proceed with my speech. I do not like to disappoint the hon. Gentleman, who I think has intervened in almost all my speeches. I would not wish to be churlish by making an exception in this instance.
My right hon. and hon. Friends and I have warned that the Bill will reduce patients' rights. Patients will lose the right to go to the hospital of their choice. They will be sent to the hospital where the health authority has a contract. Anyone who has any doubts about that should read clause 3, which wrestles with the problem of emergency patients. It offers an interesting solution to the emergency patient who is from a health area where the health authority has no contract with the hospital concerned. The clause states that the patient will be admitted if
"the condition of the individual is such that he needs those goods or services and, having regard to his condition, it is not practicable before providing them to enter into an NHS contract for their provision."
That text makes it clear that, with the single exception of the direst emergency, the Bill provides not for money to follow patients but for patients to follow money. It will not be doctors who decide which hospitals give their patients the best treatment, but accountants who will choose which hospitals are the best buy for those patients.
That brings us to the Bill's financial effects. We warned also that the proposals would result in wasted expenditure on paperwork. The scheme proposed by the Government is for an internal market that will run on paper. It will need more paperwork, administrators and overheads. It will result in a National Health Service that will be both less fair and less efficient. Anyone who doubts that has only to examine the explanatory memorandum to the Bill on the effects on public service manpower, which state that the Bill will result in a need in the Health Service for 4,000 extra staff. The memorandum describes them as "certain specialist staff". Will they be specialists in paediatrics, cardiology or ear, nose and throat? No, the specialties frankly spelt out in the financial memorandum are finance, personnel and information technology.
When the Secretary of State for Health addressed this year's Conservative party conference, he promised that the Bill would change the bureaucracy of the NHS. Certainly he is changing its bureaucracy, by offering it the longest gravy train ever seen in the history of the Health Service. Immediately before I entered the Chamber for this debate, I was given the front page from today's Glasgow Evening
Column 447Times, reporting that not one of 24 state registered nurses who have just graduated with a BA in nursing studies is able to find a vacancy in today's Health Service. Our advice to any young person watching this debate and thinking of looking for an opening in the NHS is that they should forget about studying medicine or nursing and instead obtain a degree in accountancy--[Hon Members : "Disgraceful".] That is the type of opportunity that is offered by the Government's scheme.
Mr. Hayes : Apart from that appalling slur on the nursing world, which recommended Project 2000, which my right hon. and learned Friend accepted, I refer to the hon. Gentleman's long catalogue of woe about the Bill. Does he not accept that the British Medical Association and the president of the Royal College of Nursing welcome medical audits, resource management, and money travelling with the patient? Those aspects account for 80 per cent. of the Bill. Will the hon. Gentleman have the honesty and grace to accept the truth of that?
Mr. Cook : As I pointed out earlier, the Bill is not about money following the patients but about patients following the money. It is a Bill about patients going where contracts are placed by the health authority. The 4,000 new jobs that the Bill creates will not include any openings for nurses or doctors of the kind that the Health Service desperately needs. The people who obtain employment under the Bill will be those responsible for controlling costs, not serving patients.
The Queen's Speech refers to the legislation as
"A Bill to improve the National Health Service".
If the House and the country are to believe that, we must have regard to the Government's record on improving the NHS. Let us examine the recent evidence. Almost the first information that we received on our return was the waiting-list figures for March, which reveal that the number of patients who had been waiting for an operation for more than a year had risen by 17,000. I know that those cases have been classed as non-urgent, but they include cardiac patients who are breathless, distressed and unable to work, elderly people waiting for hip operations who are in pain, housebound or bedridden, and women waiting for hysterectomies who are in acute discomfort.
We need not look far for the reason for such a rapid increase in those figures. The same tables show that, in the same year, the number of operations fell--March being before the start of the new financial year. Announcing the spending plans for the current financial year, the Secretary of State promised a "spectacular boost" to health spending. We are now two thirds of the way through the financial year, and in the month since those waiting-list figures were presented to the House there have certainly been many spectacular cases ; but none provides evidence of a boost in spending. Each demonstrates a spectacular cash squeeze in Britain's hospitals.
Mr. Thurnham : The hon. Gentleman cannot get away with what he has said. The present Government's Health Service record has been immeasurably better than that of the last Labour Government : that is why the electorate
Column 448have voted again and again for a Conservative Government. The Government's plans for the Health Service were in the Conservative party manifesto.
The hon. Gentleman talked about the removal of discretion from the local health authorities. Why does the Labour party propose to remove discretion for competitive tendering, which has saved at least £40 million for patient care?
Mr. Cook : I am absolutely confident that the next Labour Government will return discretion for competitive tendering, and will take away the compulsion. If the hon. Gentleman wishes to claim that the NHS is in a better state now than it was in 1979, he had better explain to the public outside why one in seven acute beds and one in five non-acute beds have been closed, and why 170,000 more people are on waiting lists for operations.
My hon. Friends know how intense is the cash squeeze on the inner-city areas that they represent. I have no doubt that they will tell the House what Government under-funding means to their constituents. But the same applies to Conservative constituencies. Let me share with the House what that under-funding means to them. In a letter to his consultants, the general manager of Queen Mary's hospital, Bexley, explains that the hospital is under-funded for the current year. He writes that, with effect from 9 October, he has "decided to increase the average monthly cancelled operating theatre lists fom 26 per month to 56 per month Cancelled lists for the 5 week period are attached."
There follows a four-page list of cancelled operating sessions. The Government will no doubt put that down as a saving, but it is not a saving ; it is an expensive waste of resources and skilled personnel, which will result in a less efficient hospital and longer waiting lists.
I am pleased to see that the hon. and learned Member for Colchester, North (Sir A. Buck) is in the Chamber. Colchester general hospital is under- funded by £2 million, and with effect from the week beginning 27 October it has closed 86 beds, including half its paediatric beds. As the hon. and learned Gentleman will know, the hospital's consultants have written to all the Members of Parliament who serve the area, expressing the view that
"The effect on our services is going to be disastrous. It will mean that we can barely provide an emergency service."
Sir Antony Buck (Colchester, North) : Of course one is concerned about the under-utilisation of a magnificent facility that this Government have provided, in the form of a new general hospital. Does the hon. Gentleman acknowledge that it was a Conservative Government who provided that new general hospital, whereas the previous Labour Government promised it but never provided it?
Mr. Cook : I do not have the slightest difficulty in acknowledging that Colchester general hospital was built during the last five years. I have visited the hospital. However, I must invite the hon. and learned Gentleman to acknowledge that the result of the Conservative Government's under-funding is that 86 of the beds in that new hospital have just closed. There is not much point in taking credit for building a hospital if it cannot be kept open when it has been built.
Column 449The Royal United hospital, Bath, is equipped with 21 intensive care cots. It can currently afford to staff only seven of them. A fortnight ago, a mother in Somerset went into premature labour. The ambulance was turned away from the Royal United hospital in Bath because no intensive care cots were available. The ambulance took her to Bristol maternity hospital, where again she was turned away because no intensive care cots were available. She was then taken to Southmead hospital in Bristol, where she was again turned away because no intensive care cots were available. She was finally admitted to the Royal Gwent hospital in Newport.
If, after listening to this debate, hon. Members were to go to the television lounge and flick through the television channels, they would find on one channel pointed comment on the funding of maternity services. This year's Blue Peter appeal is for tin cans to sponsor an intensive care cot. I am aware that some Conservative Members regard that as an appropriate way to fund the National Health Service. Last week, the hon. Member for Battersea (Mr. Bowis) tabled a parliamentary question to the Leader of the House inviting him to place receptacles in the cafeterias and bars of this place so that hon. Members might improve the NHS by contributing their tin cans to the Blue Peter appeal. That is the economics of the primary school. It is not the job of Tory Members of Parliament to fund intensive care cots by saving up their beer cans. Their job is to vote the funds so that women in labour can find intensive care cots without having to tour four alternative hospitals across two different countries in Britain.
I began by saying that these changes will be imposed on a public who do not want them, by a Government who do not have a mandate for them. I end with a warning to the House--that apparently our powers of scrutiny are to be curbed in the process. I have an extract from the minutes of a meeting of regional co-ordinators for self-governing units, held on 20 September 1989 at Richmond house. Paragraph 3.4 says that there will be
"inevitable Parliamentary interest in the next session". My hon. Friends and I can guarantee that.
"current intention to give low key answers to P. Qs as and when made."
What that sentence betrays is a Government who are too embarrassed by the unpopularity of their proposals to answer questions about them frankly, a Government who have given up on the hopeless task of convincing the public that a commercialised Health Service would be good for them, a Government who know that their only chance of foisting this idea on a rebellious people is to proceed by stealth under cover of low priority parliamentary answers.
I warn them now that breaking up the National Health Service will not be a low-key affair. We shall put it centre stage throughout the Session. We shall expose and challenge it at every stage. In every week of the Bill's passage, we shall appeal to the majority of people who are against it, either to join us in defeating it before it can be passed or to join us in defeating the Government before the legislation can be implemented.