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In that context, the Secretary of State should remove the veto that the SDLP and Sinn Fein have had over political progress and announce a revamped local government social service health structure as soon as possible. To enable us to find out the problems, and for several other reasons, my colleagues have suggested that there should be a Northern Ireland Select Committee. One reason is the reform of the National Health Service, and particularly the issue of patient choice, which is a subject dear to the Prime Minister's heart. I have received a letter from a consultant in Northern Ireland who is sympathetic to the review, but he says that, in the initial guide issued by the Department, outlining steps self-governing status for hospitals,"boards would have the right to refuse to fund cases where the patient chooses to attend a hospital with which the board have no contract."
Last week the right hon. Member for Plymouth, Devonport (Dr. Owen) raised the same matter. He emphasised that patient choice will not work out as many patients fondly believe it will.
There are serious implications for patients. They should be able to go elsewhere in the United Kingdom for treatment if they so wish, and if they believe that a specialist at a particular hospital can provide the best treatment for them, on the advice of their general practitioner. What is more important is that, despite the concept of decentralisation, the Bill will allow bureaucracy to build up, as boards choose who they want to have contracts with. That will be under the supervision of the Department.
Another issue that concerns us in Northern Ireland is the operation of the social fund by the Department of Health and Social Services. I believe that the social fund does not meet certain genuine cases of need, and that the money is running out. The Government have said that allocations to the social fund do not need to be increased, as they will be able to meet demand with the existing fund. I question that.
A social security office in my constituency has been extremely helpful by providing me with social fund priorities. The picture is alarming. Social fund officers place need for community care into a low, medium or high category. According to figures that I have been given, 65 per cent. of applications for community care grants were turned down between April and August this year, in constrast to the period between April 1988 and March 1989, when only 25 per cent. of applications were refused. Many more people applied for community care grants because of publicity, but that did not result in a higher take-up, because local officers could not pay out.
Budgeting loans are being paid only to people who have high priority. Many people who approach the DHSS for help with the cost of washing, travel to hospital, household items and for payment of debts that they may have run up while looking after relatives, may not get anything because they are in a low or medium priority group. That is happening in Northern Ireland and in other parts of the United Kingdom.
I urge the Minister to state the position. I understand that many local social security officers are unable to issue budgeting loans. Will the Minister provide figures which show the pattern, circumstances and priority of those people who have been refused help by DHSS officers? I emphasise that the staff who have to work the system are extremely unhappy with it.
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I join the right hon. Members for Stoke-on- Trent, South (Mr. Ashley) and for Manchester, Wythenshawe (Mr. Morris), in urging the Minister to implement the Disabled Persons (Services, Consultation and Representation) Act 1986.6.54 pm
Mr. Bob Dunn (Dartford) : I congratulate the Government on the Queen's Speech and the proposal for legislation on health and community care.
When the Health Service was constructed in the late 1940s it was relevant to the time. During the decades since, changes have been made to make it more relevant to the needs of modern society. If we do not continue to make progress in health and community care provision we must, of necessity, fall back.
During the debate, I have listened for new ideas other than the constant emphasis on extra resources. Many hon. Members accept, as I do, that there is a need for adequate and substantial resources to fund health care in Britain. However, there have been no new ideas from Opposition Members, nor did I expect them. I would not be so foolish as to believe in that fantasy.
We need new ideas to deal with the problems of health care--for example, operations which 10 years ago would have been considered impossible. We need new initiatives to care for the elderly, as no hon. Member can be unaware of the fact that there were 530,000 people over the age of 85 in Britain in 1980 ; by 1989 that number had risen to 750,000, and by the year 2000 there will be over 1 million people aged 85 and over. There will be a commensurate increase in the number of people aged 65 and over.
Accordingly, I welcome the Government's care proposals, and I endorse the two principles behind them. First, people should be enabled to live as normal a life as possible in their own homes, or in an environment similar to their homes in the local community. Secondly, people should be given the right amount of care and support to enable them, as individuals and as members of a family, to achieve maximum independence.
Thus, the proposal which gives me the greatest heart is the one to give practical support to carers and to give them a higher priority. The new carers' premium, introduced in income support, will direct an extra £15 million a year to those caring for the severely disabled--some 30,000 beneficiaries.
That is my message of congratulation, and now I have some problems for my hon. Friend the Minister for Health. First, will she undertake to re- examine the formula for the Resource Allocation Working Group? It seems that the formula militates against the south-east, to the benefit of other regions. Consequently, there is a need to reflect on the age of some of the hospitals in my constituency. In the health district which I represent, there were nine hospitals in 1979, and with rationalisation that number has fallen to six. However, those hospitals are old. They were built for a different purpose to that for which they are now being used--as fever or isolation hospitals, workhouses and asylums. That needs to be changed. The Resource Allocation Working Group formula needs re-examination.
I also urge my hon. Friend to use her considerable influence to bring unity of purpose between the Departments of Health and the Department of the Environment to deal with derelict and unneeded, unused
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hospital land in the home counties and the south-east. Indeed, my first Adjournment debate in the House, more than 10 years ago, was about hospital structures in the Dartford and Gravesham health authority. During that debate, I said that there were hundreds of acres of unused and derelict hospital land which could be released to provide for housing, industry and roads, and which could make a major financial contribution to funding the Health Service. I hope that my hon. Friend the Minister will take account of those feelings and perhaps give me the answer that I deserve and which I hope to get tonight.I was disappointed by the speech of the hon. Member for Livingston (Mr. Cook). He was clearly a bit off colour. The Opposition are on trial tonight. We need to know what they intend to do when they have finished making their parrot-like call for more money, What are their plans? How much will they spend? More important, how much will they spend as a commitment, because they are likely to spend only as much as Mr. Mandelson lets them spend? We have had from Labour views, policy changes and policy initiatives, only to have them withdrawn again on the orders of Maison Mandelson. We know that the policy announcements made by Labour are as relevant as a stale pork pie in Hartlepool's Labour club, but we hope to get more information from the hon. Member who is to wind up for the Opposition at the end of the debate.
I also hope for some honesty. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was right to touch that chord. The Health Service has problems and needs major reform, but it is also doing sterling work in every area of human activity relating to health care. Constantly to denigrate the Health Service, as the Labour party likes to do, is continually to slur many thousands of people who work in it. I hope that the Labour party will step off the fence and start walking on terra firma. I know that is hard, in the light of the changes of style which are being recommended by Mr. Mandelson, but if we had some honesty, some beef on which to chew, all of us would be happy.
Finally, the high-speed rail link is a topic to which I intend to return time and again-- [Interruption.] Opposition Members may laugh at what I say. My constituents will be told that they laughed. Many hundreds of my constituents are suffering stress, anxiety and mental breakdown because of the high-speed link that is to come through north-west Kent. I pay tribute to the Health Service and counselling services in north-west Kent for the sterling work being done to help real people in real need.
7.2 pm
Mr. Terry Fields (Liverpool, Broadgreen) : It should, but it never ceases to amaze me what attitude Conservative Members take on issues that we discuss here. We know of the wave of opposition to the Government's policies on the NHS--the facts, figures, opinion poll results and statistics are clear--but Conservative Members persist in their old arguments, as did the hon. Member for Dartford (Mr. Dunn). An ounce of experience is worth a ton of theory, as Vladimir Ilyich Lenin once said. Conservative Members get their experience in the same way as that woman in
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Downing street. She goes to hospital only for a photo-call after a tragedy. It is no wonder that Conservatives are ignorant about the Health Service.Merseyside has been mentioned. In Liverpool, five hospitals are to close in the next round of cuts. Some 1,000 beds are going. In my constituency, the accident and emergency unit, which is half a mile from the M62 and covers that area, is to close. People for whom minutes and seconds are important will have to go all the way into town to the Liverpool teaching hospital, which is overstretched and has staff and bed shortages. The staff there are being run into the ground.
Members of the working class in Liverpool have always had community care. We have always looked after our own. There have always been people to act as carers for those who cannot look after themselves. We do not need any lessons about care in the community from Conservative Members.
In my constituency, the Park and Rathbone hospitals are being closed. In theory, people are being put back into the community, but there are no resources with which to tend them once they are there. The latest move is to put them into homely homes. Hundreds of people are going through the Park and Rathbone hospitals. Homes for about 20 people will be built at some time in the future, but we do not know when. Everyone else will be thrown out into the community. Old men and women, some of them mentally subnormal, will be left to wander around Liverpool. They may end up in cardboard boxes at night because they have nobody to look after them. The staff at the hospitals are devoted and commited to the people they work with. As part of a campaign throughout the Liverpool area, they are organising to defend their jobs and, more important, care and attention for people who are unable to look after themselves.
At our teaching hospital, between 400 and 500 nurses have been given notice that if they do not comply with new rotas to be imposed by management by 1 January, which means £70 or £80 being taken out of their pay packets each year, they will all be sacked as from 2 January. That is how the Government, and the management they put in, treat staff. The Government talk of the Health Service getting all this money. If people want to know where it has gone, I can tell them. It is being used to employ management whose sole job is to butcher the Health Service. They are people with no connection with the Health Service. They have established a record of sacking workers on the docks and that is the principal criterion for employing them. Women will be most affected by the hospital closures. Maternity services will suffer. Gynaecology and family planning are not included in the Government's list of core services. It is proposed to open an old condemned Victorian building--the old Royal hospital. It is considered good enough for the women of Merseyside to close down good units and to reopen an old Victorian building which was condemned as unfit for habitation some time ago--and all this in an area with the highest incidence in the north-west of death from breast and cervical cancer. Services for women in Liverpool will be non-existent.
I am sickened, and workers I know have had it up to here with stupid statements from the Government claiming that they are spending more in real terms on the Health Service. In May I asked the House Library to find out what percentage of gross domestic product has been spent on the National Service. In 1949-50 we spent 3.6 per
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cent., and in 1987-88 we spent 4.8 per cent. of GDP on the NHS. To use the Government's phrase, in real terms, spending has increased by only 1.2 per cent. in 40 years. Since the Government came to power, the increase has been less than 0.5 per cent. Those are the real figures.The ambulance staff dispute is symptomatic of what is happening in the Health Service. I spent two years doing national service and worked in a field ambulance, so I know the level of training that ambulance personnel in the armed forces receive. I am not denigrating them, but young people in the armed forces are nothing but economic conscripts. They are not there to fight for the Union Jack. They are there because there is sod all else to do in places like Liverpool. They are in the front line of a life and death struggle provoked by the Government and by the Secretary of State for Health, who is playing Russian roulette with people's lives. I had first- hand contact with the troops called in during the 1977-78 fire service dispute. They were unable to man the green goddesses and to deal with emergencies just as the troops are incapable of dealing with emergencies in the present dispute. Yet the Government were still prepared to call in the troops in the ambulance dispute.
Whether the Government admit it or not, privatisation is on the agenda for the National Health Service. Movement towards the American method of health care is on their agenda.
Ms. Harriet Harman (Peckham) : That is absolutely true.
Mr. Fields : As my hon. Friend says, that is absolutely true. I spoke earlier about experience. In May this year I went to New York at the invitation of the American health service workers who wanted to learn about the NHS in Britain. Workers in America have had a bellyful of private medicine. In the United States between 37 million and 40 million people have no health insurance. Millions of families have inadequate health cover or none at all, and their life savings are wiped out at a stroke if they are ill.
We are moving in the direction of the United States system of health care. In a Harris poll conducted in 1988, 89 per cent. of American people called for a fundamental change in the profit-based health care system and 61 per cent. pointed to the national health care service in Canada as a system that they would prefer. The polls show that 75 to 80 per cent. of people in the United States favour a national health system. Indeed, the president of the Lous Harris organisation said that the poll
"confirms all one's worst fears about the American system. We have the most expensive--least well-liked--least equitable and in many ways the most inefficient"
health service in the world.
An organisation called Physicians for a National Health Service was set up two years ago, made up of 1,200 doctors campaigning for a national health service. The New England Journal of Medicine, an authoritative medical journal, contained an editorial entitled "Universal health insurance--its time has come." Yet the Government continue to devastate the National Health Service in this country. Conservative Members have said that the Opposition have no ideas on the NHS. We admit that it needs more funding. As my hon. Friend the Member for Islington, North (Mr. Corbyn) said, the Labour party would provide
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more funding by diverting into the NHS some of the finance devoted to weaponry and destruction. Another way would be to nationalise the drug companies--Madam Deputy Speaker : Order. I call Dame Elaine Kellett-Bowman. 7.12 pm
Dame Elaine Kellett-Bowman (Lancaster) : I am happy to follow the hon. Member for Liverpool, Broadgreen (Mr. Fields), who was absent at Question Time and failed to--
Mr. Terry Fields : On a point of order, Madam Deputy Speaker. Is it in order for an hon. Member to raise that matter in ignorance of the difficulties on the motorways which prevented me from being here earlier?
Madam Deputy Speaker : Order. Let me deal with this. The hon. Lady knows that she should not raise that matter and that the Chair cannot resolve it.
Dame Elaine Kellett-Bowman : The hon. Gentleman should have set off earlier.
Madam Deputy Speaker : Order. It seems that I am being asked why it is not a matter for the Chair to resolve. The Chair is not responsible for an hon. Member arriving at a particular time.
Dame Elaine Kellett-Bowman : My right hon. Friends on the Front Bench know that I am an enthusiastic supporter of the principle of money following the patient, from which Lancaster health authority will benefit substantially. My right hon. and learned Friend the Secretary of State knows that in Lancaster health authority hospitals are well run and attract a large number of patients from outside our district. He has seen the excellent pie charts produced by the district health authority showing patient flow across the district border. It is a staggering fact that in one specialty 49 per cent. of patients come from outside the district. That is a great compliment to all who work in our local hospitals, but it puts a great strain on resources under the present method of funding.
In Lancaster we were delighted to hear that 100 new consultants and teams were to be appointed, but we were sad that we did not get one of the first 35 appointments. We desperately need another orthopaedic surgeon. Twenty- nine per cent. of orthopaedic beds are occupied by patients from outside the district and the strain on our staff is enormous. It is an astonishing and distressing fact that in Lancaster, no orthopaedic surgeon has ever lived to retire and the last one died in his forties. We did not get an extra appointment because, our bid was slightly above the £500,000 target. As I explained to the Minister for Health, that was partly because, until we get phase 3 of our hospital building programme, which the Secretary of State has confirmed, our costs are higher because we have a split site. Nevertheless we have managed to prune our costs and brought them below £500,000. That being so, we are very anxious for an early appointment. Now that we have hit the target, we should like an immediate go-ahead for an extra orthopaedic consultant immediately after Christmas. It would be a lovely Christmas present.
We also need an extra urologist, and have put in a good case for that. However, those reforms cannot help us next year. We are in an unique position in Lancaster. The
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population in the north-west of the region is falling, but in Lancaster it is rising. My hon. Friend the Minister has seen the bar charts showing population rises in Lancaster and we need more funding to cope with such rises.We have two Victorian hospitals in the district, one for the mentally abnormal and one for the mentally deficient. They are expensive to maintain because the buildings are old. We are delighted but not surprised that my right hon. Friend the Secretary of State succeeded in obtaining an extra £2.6 billion for the Health Service in the autumn spending review. I have already put in a bid with my right hon. and learned Friend and with the North Western regional health authority for a substantial share of the increase. We know that his prudent planning assumptions of a reduction of 0.3 per cent. was to ensure that no district health authority exceeded its subsequent allocation in advance of the Autumn Statement. Now that the figures are known, I look for a proper increase to cover our local, legitimate health needs.
One point worries me. There is no mention of midwifery among the core services. We have an excellent maternity hospital in Lancaster, but my midwives are anxious for those who are less fortunate. I ask my right hon. and learned Friend the Secretary of State and his team to look again at this point. Above all, please may we have an extra consultant at the earliest possible moment?
7.17 pm
Mr. Gerry Steinberg (City of Durham) : I have listened carefully to the debate this evening. Some of the comments from Conservative Members appalled me. They do not live in the real world and I am sure that they do not see what is happening in their own constituencies. I also listened to the Queen's Speech with dismay. The measures proposed in it will only reduce the quality of life of most of my constituents. It is proposed to maintain a policy of high interest rates, which will mean high mortgage repayments.
The Queen's Speech included a Bill that will take the first steps to privatise the coal industry, a Bill to cripple the trade unions, a Bill to reduce the quality of our television, a Bill which will by no means adequately protect the environment, a Bill to introduce student loans which will further restrict working-class young people from entering higher education and, worse of all, a Bill on the National Health Service.
On 10 August, the Select Committee on Social Services, the majority of whose members are Tories, reported that the White Paper was ill-conceived, moved far too quickly and, if implemented, would not meet the needs of the NHS. Have the Government listened to that report? No, they have taken no notice whatever. The legislation will create a two-tier system. It will take us back to the 1940s, when private hospitals competed with the voluntary sector, and people were brought to the edge of bankruptcy. The Bill will create an internal market for health, with NHS hospitals and GPs competing with the private sector.
A vast new system will be needed for cross-charging patient treatment between hospitals and health authorities, between opting-out hospitals and between GPs and hospitals. Every injection, bandage and therapy, and every minute of staff time, will have to be accounted for, costed and allocated to the patient. Then the bill will be sent to the health authority. The debate started in the first place
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because of the lack of funding for the Health Service, yet the White Paper never mentions funding. Tremendous additional administration will be required to carry out the system that it describes.The key proposal in the legislation is opting out for hospitals. [ Hon. Members :-- "No."] Tory Members like to talk about self-governing hospitals, but I prefer to speak about opting-out hospitals, as do my colleagues, because that is exactly what they will be. We are not told how the procedure will work. We are told that a hospital may show an interest in opting out and produce a prospectus. There will be limited discussion between managers and senior doctors and no staff involvement within the hospital. Cleaners, porters and nurses will not be allowed to express their opinion. Neither the staff nor those living in the area which the hospital covers will be balloted. The decision will be taken by the senior management of the hospital, and the Secretary of State will make the final decision. That is the democracy that we have come to expect from this Tory Government. Some opting-out hospitals will be successful, but others will not. Those that cannot cope in the system will decline. Will they close or will they be accepted back into the Health Service? We do not know. Those that remain within the Health Service will become second-class and have limited functions. The logical progression from opting out is privatisation. The result will be a two-tier system of health care, with the less desirable cases--the chronically sick and elderly--having to go to health authority hospitals. Opting-out hospitals will specialise in profitable activities and drop all other functions. As a result, local communities will not receive the guaranteed comprehensive service that they are used to and deserve. Opting-out hospitals will have financial incentives to treat patients who will bring the hospital the most profit.
Opting-out hospitals will have the option of paying their own salary rates and operating their own conditions of work. They will be able to attract the so-called best members of staff, leaving the remainder to the health authority hospitals. I always thought that the NHS was established to stop such inequalities. The service will be returned to the days when inequalities were the norm. That is what the Government are encouraging in this legislation.
The Government are designing an NHS for acute services only. They are ignoring the rest of its functions. We hear about core services, yet within that term there is no mention of maternity, paediatric care or family planning. The people who will suffer most will be women. The core services guarantee accident and emergency services, immediate admission to surgery and so on, but not less urgent work. District health authorities will have to shop around and purchase that care from opting-out hospitals, health authority hospitals, other district hospitals or the private sector. That is not how the NHS should progress but, unfortunately, it is how it will progress under this Government.
The second major element is the change in GP services. GPs with large practices of 11,000-plus will become budget holders. They will have to buy all their patient care, including hospital treatment, from any of the options available. Budgets will be limited, so GPs will be discouraged from taking on heavy consumers of drugs and services. A pool of problem patients will find it difficult to get on doctors' lists. I am not an expert on this, but I am relating information that doctors have given me. Obviously, if a doctor has the choice of a healthy
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30-year-old or a 60-year-old with arthritis, Parkinson's disease or diabetes, he or she will choose, not the 60-year- old, but the healthy 30-year-old.Budgets will put doctors in an invidious position. They will always have to seek savings, for example by postponing referrals to hospitals. If the patient has severe or advanced symptoms, the doctor may wait to see how they develop. The patient may then become an emergency case and have to be rushed to hospital. If the doctor has not sent the patient to hospital, the cost will not be taken from his or her budget. As a result, patients will wonder whether that consideration has anything to do with the doctor's decision, and patients' trust in their doctor will be considerably undermined. 7.27 pm
Sir David Mitchell (Hampshire, North-West) : I will not follow the flights of imagination of the hon. Member for City of Durham (Mr. Steinberg) about the development of the National Health Service. I know that others want to catch your eye, Madam Deputy Speaker, so I shall make a brief speech about the ambulance dispute, the question of arbitration and other NHS matters.
The ambulance men's union has identified an emotive group for whom there is much public support and sympathy. All of us should recognise that fact. But much of that public support is misplaced. The NHS has some 1 million staff engaged in a whole range of different skills and activities. The ambulance men are part of that team and spend 70 per cent. of their time on routine, not emergency, work.
Within the National Health Service, there are carefully balanced relativities on wages and salaries that have been agreed through the Whitley negotiating machinery. NUPE wants 11.2 per cent. for the ambulance men. That would wreck those relativities and would immediately lead to leapfrogging claims by other groups of workers. That has not been sufficiently appreciated by some of the ambulance men, and certainly not by the general public.
About 300,000 National Health Service workers have already settled for 6.5 per cent. Nurses have settled for 6.8 per cent. If the ambulance men receive 11.2 per cent. that will cause disappointment, and other groups that have settled at lower rates will want to restore the relative pecking order. The Government have announced substantial additional funding for the Health Service and there is a battle over whether the money should go to the staff or the patients. I agree with most of my constituents who, I think, want the money to be spent on patient services.
The hon. Member for Livingston (Mr. Cook) called for arbitration to settle the ambulance dispute. The problem with arbitration is that the arbitrators invariably split the difference, and in the case of an extravagant claim that means an extravagant settlement. However, it is not an arbitrator's money : it belongs to the management of the Health Service. An arbitrator can withdraw from the scene after delivering his judgment and it is left to the unhappy management of the Health Service to decide how many beds will be closed or how many operations will have to be delayed to find the money that the arbitrator gave to the staff instead of to improvements in the service. We should all bear that in mind.
The hon. Member for Livingston challenged us to say whether any Conservative candidate or manifesto at the
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last general election had set out a programme for the reform of the National Health Service. He knows perfectly well that no such programme was set out because it was not until after the general election that we started to get a groundswell of complaints about the Health Service. Those complaints were hugely orchestrated by Opposition Front-Bench spokesmen. Time and again small cases were picked out, thrown into relief and made subjects for debate in the House. Of course the Government have reacted, and the hon. Gentleman now complains about that reaction.The hon. Member for Livingston spoke about hospital waiting lists and growing problems. He told us about a patient taken from hospital to hospital without being admitted. Those matters show that there is something wrong with the Health Service, yet for some extraordinary reason the hon. Gentleman and his colleagues spend their time lambasting the Government for seeking to do something about it. The country should take note of that.
I want to turn from dealing with the ambulance men's militant trade union to deal with another militant trade union, the British Medical Association. It has sought to use patients, and I employ the word "use" in its worst sense.
Mr. Jimmy Hood (Clydesdale) : The hon. Gentleman talks about militant trade unions. Is he aware that the Police Federation fully supports the ambulance workers? Would he say that the Police Federation is a militant trade union?
Sir David Mitchell : I was addressing the use by the BMA of patients as a means of extracting concessions for the doctors in negotiations with the Secretary of State. The BMA has gone over the top in a big way, and the public now recognise the fact. In terms of its advertising campaign, it has gone over the top in an expensive way as well.
My constituents have three worries about the National Health Service. Their first is that budgets will mean that, three quarters of the way through the year, practices may run out of money and be unable to prescribe the drugs that patients need. Some of my constituents have been frightened by that aspect of the BMA's campaign. It is disgraceful that the BMA has tried to put the frighteners on patients so that they will lobby Members of Parliament to persuade the Secretary of State to give doctors a limitless budget.
Some doctors spend 50 per cent. more on prescribing than other doctors with similar profile practices. It is right that such doctors should be asked to explain if they overshoot the notional budget. Let us be absolutely clear : the budget is notional and doctors who overrun it will be asked for an explanation. There may be a perfectly good explanation--perhaps a unique characteristic among patients in a certain area--in which case the doctors will be allowed the additional resources that they need. If there is not an adequate reason, it is right that the public purse should seek value for money. I understand from the Minister--I hope that it will be repeated-- that in no case will patients go without drugs because a doctor has overshot his notional budget.
The second anxiety of my constituents relates to the capitation fee, which, it is alleged, will force doctors to take on many more patients and therefore have less time for each patient. Where will the extra patients come from? Will there be a sudden and huge increase in the
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population? Of course not. Like Members of Parliament and people in other professions, doctors have different characteristics. Some of them are ambitious and want to build up a big list and do a great deal of work. Others want to take life more easily because they see life in a different hue. They are less ambitious and would rather enjoy life, so they have a smaller list.There is nothing revolutionary in the concept that doctors with large lists should be paid more than doctors with smaller lists. I have discussed the matter with doctors in my constituency, and when I probed I was fascinated to discover that most of them have above-average lists and would gain from the capitation fee change. Certainly they will not need to take on more patients. Some of them could shed some patients and give a bit more time to those who remain. The fear about capitation is quite widespread and I hope that it can be laid to rest. The third worry of my constituents is that they will have to travel long distances to hospital. That will be entirely at the discretion of the patient and the doctor in consultation.
7.38 pm
Mr. Jimmy Wray (Glasgow, Provan) : It is difficult to understand how Conservative Members can say that they care. They have spent most of their time in the debate criticising my hon. Friend the Member for Livingston (Mr. Cook). The Minister attacked my hon. Friend and then went on to attack my right hon. Friend the Leader of the Opposition. This is an important debate for the Opposition and we shall not stand for hypocrisy from the Minister. He may not understand what privatisation means, but we do.
I have just visited 15 hospitals in my city of Glasgow. The people there understand what privatisation means and every health worker is sweating in case he loses his job. I should be grateful to be presented with a clear definition of competitive tendering. Despite the explanations offered by some Conservative Members, I see it as privatisation. In this year alone, 17 per cent. of the domestic, catering, laundry and portering staff in Glasgow's hospitals have been the subject of privatisation. That is just the start. There remain for tendering transport, radiology, medical reports, payroll functions and pharmacy, laboratory and clinical support. What will be percentage of privatised sectors when those services have been subject to the tendering process? The Secretary of State said that he was angry at the suggestion that the Government are privatising the Health Service, and even the Prime Minister denies that it is being done. I cannot understand that reaction.
The Greater Glasgow health board seems to be the Government's politburo-- hellbent on implementing everything that the Government have introduced. The board must surely be aware that the Government have an appalling record. The Secretary of State has told us that he is spending billions of pounds, but there has been neglect over the past 10 years. If so much money has been pumped into the Health Service, why is there a shortage of 87,000 beds? Why are operations being cancelled? Why is that happening when the Government claim to be spending more money?
The Greater Glasgow health board has produced a document which reflects its concern about health care in
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the 1990s. I represent one of the most impoverished constituencies in Europe, with the worst health record and the worst infant mortality rate. It has the worst mortality rate for those aged between 40 and 65 years and the worst cervical cancer rates for females aged 16 to 25 years. There are appalling health conditions in the constituency. Why has there been no improvement in the past 10 years? It is because the money has been wasted. It has been paid to high fliers and bureaucrats who are interested only in making savings. The other month, the bureaucrats in one hospital said that savings could be made by cancelling six packets of Alpen and four pints of milk each day. That is the mentality of the managers. The Queen Mother's hospital and the Glasgow Royal maternity hospital at Rottenrow--two strategic maternity hospitals in Glasgow--are being closed. If the Greater Glasgow health board believes in community health care, why is it ignoring the advice of all the obstetricians, paediatricians, and other clinicians? Having listened to all those who have been involved in the consultation exercise, the board still wishes to site its maternity units at Stobhill and Yorkhill. The response to that policy has been complete opposition. My constituency lies in the east of Glasgow, and my constituents and I want centralisation.The hon. Member for Hampshire, North-West (Sir D. Mitchell) attacked the BMA. He described it as militant. If I were a member of the BMA, I would take a shotgun to the Government. In 1985, the then Minister for Health met the BMA and asked its members what their priorities were. They responded by participating in discussions and giving the matter careful consideration. They produced a list of 16 priorities, at the top of which was an extension of the cervical cancer cytology screening programme to include all women over 20 years at three-year intervals. The Government have failed to respond to that priority. They have introduced a five-year screening. The result is that every year 2,000 women die needlessly.
Another priority was a comprehensive scheme for paediatric surveillance at general practice level. It was wished to encourage general practitioners to carry out minor surgery. There were another 14 priorities. None of the priorities has yet been implemented. That shows the extent of the Government's concern about the health of the nation.
Who cares about your White Paper? Who cares about your "Working for Patients"? On 28 November 1987, the Government published a White Paper entitled "Promoting Better Health". During the discussions that ensued, the Government introduced "Working with Patients." That happened before the practitioners had had a chance to discuss the previous White Paper. The Government decided to open Pandora's box. Despite what we have been telling you today, you still do not understand. The shadow Minister, my hon. Friend the Member for Livingston (Mr. Cook), has told you. Nobody wants your Bill. Nobody wants your White Papers. Nobody wants changes. We do not want Americanisation of the NHS.
Dame Jill Knight : On a point of order, Mr. Deputy Speaker. Is it not the normal practice in the House that hon. Members must not refer to you?
Mr. Deputy Speaker (Sir Paul Dean) : I am grateful to the hon. Lady for pointing that out.
Mr. Jimmy Hood (Clydesdale) : Absolutely pathetic.
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Mr. Wray : I take the point, Mr. Deputy Speaker.On 21 June, the Glasgow medical committee discussed your White Papers ; they were rejected by 160 votes to 150. That, however, was not enough. It seemed that the Government wanted the opinion of all doctors throughout the country. A referendum shows that 82 per cent. of all doctors have rejected the Government's White Papers. Unfortunately, I have only one minute left to me. I would have needed an hour and a half to explain the damage that that gang of crooks on the Government Benches have done to the NHS. [ Hon. Members :-- "Withdraw."] They are playing with the NHS and with the lives of innocent men and women. Let them pay the ambulance men and women what they deserve. The Government should understand that they provide an essential service and treat them in the same way as the police and the firemen.
7.49 pm
Mr. Peter Robinson (Belfast, East) : I am delighted to be able to take up the remarks of the hon. Member for Glasgow, Provan (Mr. Wray). I understand many of the concerns that he has expressed, and I share the anxiety that has been voiced by many other hon. Members about the state of the National Health Service. It is no better in Northern Ireland than it appears to be in the rest of the United Kingdom. I must ask for your forgiveness, Mr. Deputy Speaker, for attempting to drag the House away from the theme of the debate to discuss the situation in Northern Ireland.
I read the Gracious Speech with great interest, and especially the remarks about Northern Ireland. Perhaps I could be forgiven for being delighted initially to see that the Government were advocating the defeat of terrorism in Northern Ireland. I said that I could be forgiven for so thinking, because unfortunately the Secretary of State for Northern Ireland made remarks that gave encouragement and succour to the men of violence, when he indicated that the IRA could not be defeated.
I cannot for the life of me believe that, in his senses, the right hon. Gentleman could really have meant the remarks that he made. I hope that the Minister who winds up the debate will take the opportunity to lay at rest the Secretary of State's remarks--not to replace them with the neutral comment that neither can the IRA win. The people of Northern Ireland want a clear and unambiguous statement that the Government are not only prepared to defeat terrorism but believe that they can do so and that their policies are aimed in that direction.
If the Government cannot give such an undertaking, they are saying to the widows of policemen, UDR men and soldiers that their loved ones died in vain, in a cause that is useless and cannot be won. They are saying to the men who put on a uniform and who comb the streets and patrol the roads of Northern Ireland, "You are putting your lives in jeopardy for nothing. You cannot win this war against terrorism." Is that the message that the Government want to give their forces in Northern Ireland? Is that the message the Government want to send to the long-tried and hard-pressed people of Ulster? The Government should take the opportunity to make it clear that the IRA can be defeated and that it is Government policy to defeat terrorism in Northern Ireland.
If the Government will not make that declaration, then tonight I shall say that terrorism can be defeated. At
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