House of Commons Hansard Debates for 11 Dec 1989

Mr. Nicholas Bennett (Pembroke) : On a point of order, Mr. Speaker. You will know that from time to time the Opposition complain about Ministers making statements outside the House rather than to the House. I understand that a statement was to be made at 4 o'clock by the Leader of the Opposition on the matter which was raised by my hon. Friend the Member for Colne Valley (Mr. Riddick), referring to the hon. Member for Birkenhead (Mr. Field). This is a matter of keen constitutional importance to all Members. I wonder whether some way can be found to change the procedures of the House so that the Leader of the Opposition can make a statement to the House and we can question him about it.

Mr. Speaker : That is as may be, but it is not a matter of order in the House.

Mr. Dennis Skinner (Bolsover) : On a point of order, Mr. Speaker.

Mr. Speaker : Order. I remind the House that we have a very busy day ahead of us.

Mr. Skinner : I thought that I saw you wince when the hon. Member for Northampton, North (Mr. Marlow) submitted his Standing Order No. 20 application and

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spoke about the incitement of racial hatred. When Conservative Members want to stir up racial hatred, I wonder whether you could provide these members of the goose-stepping tendency with a pair of jackboots. They could be kept with the opera hat which is with the Serjeant at Arms. In that way, hon. Members could dress properly for the occasion and the viewers would know what they were up to.

Mr. Tony Marlow (Northampton, North) : On a point of order, Mr. Speaker.

Mr. Speaker : I shall take the point of order because the hon. Member was mentioned.

Mr. Marlow : I am grateful to you, Mr. Speaker. I am sorry that the hon. Member for Bolsover (Mr. Skinner) feels that it is wrong for a Member to put forward the views that he knows are held by the majority of his constituents. If that is his position, let the hon. Gentleman tell his constituency about it, because my constituents would rather have my views.

Mr. Speaker : Perhaps I can clear up the matter. Every Member has a right to make his speech in his own way. We often have to listen to speeches with which we may not wholly agree. The hon. Member for Northampton, North (Mr. Marlow) has a right to make his submission, and he has done so.

Statutory Instruments, &c.

Mr. Speaker : With the leave of the House, I will put together the two motions relating to the statutory instruments.

Ordered,

That the draft Driving Licences (Community Driving Licence) Regulations 1989 be referred to a Standing Committee on Statutory Instruments, &c.

That the draft European Communities (Definition of Treaties) (European School) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.-- [Mr. Greg Knight.]

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Orders of the Day

National Health Service and Community Care Bill

Order read for resuming adjourned debate on Question [7 December], That the Bill be now read a Second Time.

Question again proposed.

[Relevant documents : Eighth Report from the Social Services Committee, Session, 1988-89, Resourcing the National Health Service : the Government's plans for the future of the National Health Service, (House of Commons Paper No. 214-III, 1988-89), the Government's reply to that Report (Cm. 851), the Second Report from the Social Services Committee, Session 1984- 85, Community Care with special reference to adult mentally ill and mentally handicapped people (House of Commons Paper No. 13-I 1984-85), the Government's reply to that Report (Cmnd. 9674), Community Care : Agenda for Action (1988 HMSO), and the White Paper Caring for People : Community Care in the next decade and beyong (Cm. 849).]

Mr. Speaker : I must announce to the House that I have not selected the amendment in the name of the right hon. Member for Yeovil (Mr. Ashdown), but the arguments that are advanced in that amendment can, of course, be made in the debate.

I must repeat what I have said : a large number of hon. Members wish to participate. I therefore propose to put a limit of 10 minutes on speeches between 6 and 8 o'clock. The hon. Member for Nottingham, North (Mr. Allen) raised a point about the time limit on speeches, but I have no authority to limit speeches to 10 minutes before 8 o'clock. Nevertheless, I hope that hon. Members who are called before and after that time will bear that limit in mind so that more hon. Members may be called to put their points of view.

4.18 pm

The Secretary of State for Scotland (Mr. Malcolm Rifkind) : Today is the second day of debate on the Bill. Before I address myself to the major issues that are covered by the legislation, I want to report to the House a welcome development on the position of doctors in the rural and more sparsely populated parts of Scotland of which, I believe, the House will approve. In the White Paper "Working for Patients", the Government gave a guarantee that they would seek to protect the position of such doctors, and that has been a priority for us.

The new general practitioner contract already includes a transitional payments scheme which will help small practices to adjust to their new circumstances. However, the evidence that the Department of Health submitted to the doctors' and dentists' review body last week also stated that I intended to fulfil the undertaking given in chapter 10 of the White Paper by funding from Scottish block resources a scheme analogous to the transitional payments scheme, but on a long-term basis. Scottish doctors who are normally eligible for rural practice payments and who fulfil the obligations of the contract will have their level of income protected under the new contract. As a matter of practical convenience, the fund will be administered by the Scottish rural practices fund committee as the body best

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placed to ensure that the payments are targeted to doctors who are entitled to receive them. I understand that the proposal has been welcomed by the British Medical Association and I am sure that it will be welcomed by the House as a whole.

I want to begin by giving what I hope will be seen as friendly advice to the hon. Member for Glasgow, Garscadden (Mr. Dewar), who will speak on behalf of the Opposition. On a previous occasion, he expressed some criticism of the fact that the Government's Scottish proposals are incorporated in a Great Britain Bill. I advise him, in the friendliest way, not to pursue that line of reasoning. If he does, he should bear in mind that in the 40 years since the National Health Service was founded, no fewer than 13 Bills affecting it have applied throughout Great Britain as a whole and only three, including a consolidation measure, have dealt with specific aspects in Scotland. As the Government's proposals apply throughout Great Britain, this is the proper approach to take.

Two debates are taking place in the House and in the country on the Government's National Health Service proposals. There is a bogus debate and a real debate. It is appropriate to address myself to both issues and I shall start with the bogus debate because I know that Opposition Members will be more interested in it as it dominates their thinking on the matter.

Mrs. Margaret Ewing (Moray) : Will the right hon. and learned Gentleman give way?

Mr. Rifkind : I hope that the hon. Lady will allow me to continue for a moment.

The bogus debate has taken three forms. It was begun by an assertion that the Government were seeking to destroy the NHS. It was then claimed that the Government's proposals were intended to lead to a reduction in NHS funding and, finally, it was suggested that the Government were putting profit before people and were seeking to commercialise the NHS. Let us address the evidence and see what justification those arguments have.

In its submission to the Government, the BMA states categorically that, in its view, the Government's proposals will

"destroy the comprehensive nature of the existing service." The Labour party, in a document produced by the hon. Members for Kirkcaldy (Dr. Moonie) and for Strathkelvin and Bearsden (Mr. Galbraith), stated that the Government's proposals represent "opting out" of the NHS. The National and Local Government Officers Association, in its--as usual--constructive contribution to the NHS debate, suggested that the Government are proposing the "break-up" of the NHS. It is a compliment to the Government in a sense that, as the critics are unable to direct their attention and concern to the contents of the White Paper and of the Bill, they seek to divert attention from those matters by referring to matters that have never been the Government's intention.

One simply needs to quote from the White Paper, which says categorically and unequivocally :

"The NHS is, and will continue to be, open to all, regardless of income, and financed mainly out of general taxation."

Those are the principles on which the NHS is based and on which it will continue to be based. The first assertion--that we intend to destroy the NHS--is of such manifest absurdity as not to justify further attention by the House.

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No less a body than the BMA then suggested that the Government sought to reduce the funding of the NHS. In paragraph 2.4 of its submission, the BMA said :

"The Government's main proposals would appear to be to contain and reduce the level of public expenditure devoted to health care." That is a serious allegation from the BMA. I say to the BMA and to those who think similarly that when one puts forward such a proposition, it is proper to judge matters not by what people say, but by what they do. The achievements of the Government over the past decade make the falsity of that accusation undeniable.

Over the past 10 years no fewer than 67,000 more nurses have been working in the NHS ; no fewer than 14,000 more doctors have been working in it ; and expenditure on the Health Service has risen from £8 billion in 1979 to about £26 billion. Before I give way to the hon. Member for Moray (Mrs. Ewing), I want to give her a Scottish aspect to this discussion. In 1979 expenditure on the NHS for every man, woman and child in Scotland was about £385 which, in today's prices on a common price basis, has risen to £509. I hope that when I give way to her she will concede that that represents a fundamental and real increase in the resources available to the NHS. I hope that if she is as fair about that as she would wish to be seen to be, she will happily acknowledge the point.

Mrs. Margaret Ewing : The Secretary of State has raised so many points that it is difficult to include them all in a short intervention.

There is a difference between funding and meeting the task that lies ahead. The requirements in Scotland are so extensive that we shall need to examine the NHS budget carefully. I welcome what the right hon. and learned Gentleman said about rural practices, but what provision has been made for part-time women doctors in practices? What provision is being made for state-enrolled nurses who want to take bridging courses to meet the requirements of Project 2000? If these nurses do not want to take bridging courses, what provision will be made to safeguard their contracts?

Mr. Rifkind : I thank the hon. Lady for her welcome for my earlier remarks. We recognise the importance of those who want to work part time in the NHS--particularly female doctors and other female members of staff. For the first time a part-time contract is now available to them, and I am sure that the hon. Lady will welcome that. The third assertion to which I referred some moments ago was the claim that the Government somehow want to put profit before people or, in the quaint phrase used by the hon. Member for Livingston (Mr. Cook) on Thursday, that we are seeking to commercialise the NHS. I presume that he was not suggesting that we are seeking to obtain value for money--no : the implication of his remarks was that the Government see the NHS as a profit-making body, or believe that it should become one, working in a commercial way without giving priority to the needs of patients.

I hope that the hon. Member for Garscadden will not associate himself with such a foolish argument. If the Government wanted to put profit before people they would hardly have brought forward these proposals, fundamental to which is the idea that any resources saved by a general practice budget will remain with the general practice to improve the quality of its service, and that any savings obtained by an NHS hospital trust will be

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reinvested in that hospital for the benefit of its patients. In no circumstances can the Treasury or any doctor obtain financial benefit as a consequence of these changes. That adequately meets the point about the Government's priorities.

The bogus debate should not detain the House for more than a few moments, so I turn to the real issue that should attract the attention of the House and the country. The real issue in the NHS debate of the past few months is simple and straightforward. It is how, in a modern society, we should administer the vast resources--the £26 billion or £27 billion-- that are required to run the NHS. Can we continue to administer it in a centralised bureaucratic way, or can we, through the benefits of modern information technology, adopt a decentralised method of administration for the benefit of the patients whom the NHS exists to serve?

In addition, we must examine the origins of the NHS and how it was administered when it was first set up. At the time of its inception some 40 years ago there was a basic belief, no doubt sincerely held, in the virtues of central planning and of a benign bureaucracy. There was undoubtedly a widespread belief, perhaps extending beyond the Labour party at the time, that the best way to administer resources of that scale was through a form of rigid, centralised planning which would then feed its way through the system to the benefit of the public as a whole. We did not see that approach only in the NHS ; it was evident in various other sectors of the economy and our society. It was reflected in the great nationalised industry legislation of the Attlee Government. The assumption was that there should be nationalisation and many small concerns should be brought together into massive conglomerations and that would achieve the best use of resources. That view was shared in western and eastern Europe as well.

The hon. Member for Garscadden and his colleagues should appreciate that a structure established 40 years ago does not necessarily make sense in the dramatically changed circumstances in the 1980s and 1990s.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : Does the Secretary of State accept that his Government have reorganised the NHS twice since then?

Mr. Rifkind : The hon. Lady is quite correct. Of course there have been changes. However, even today we still have an essentially centralised system administering vast resources. The Government have realised that we must change constantly as circumstances change and it is unfortunate that the Labour party appears to be caught in a timewarp and is attached to a system of administration of the resources which might have been relevant 40 years ago, but is certainly not relevant to the vast sums of money and the vastly changing circumstances at the moment.

It is also sad that the BMA, with its particular involvement in the NHS, should remain so resistant to change. It is resistant not because it is caught in a timewarp, but because it has a fundamental antipathy to change. The BMA opposed the NHS 40 years ago because setting up the NHS represented change. It opposes the Government's proposals today because they also represent change and that is something it cannot come to terms with.

If we consider the way in which circumstances have changed over the past 40 years, I do not believe that Labour Members can seriously suggest that we should not

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take cognisance of those changes. We have seen a vast increase in resources dating back 40 years. When the NHS was first formed, the expenditure in 1948 was £270 million for the whole of the NHS. Today it is £26 billion. Even taking account of inflation over the past 40 years we have seen an increase in real terms under both Conservative and Labour Governments of 610 per cent. It beggars imagination to suggest that the system of administration of such vast resources can remain untouched by those changes.

It is not simply the scale of resources that has changed. In this country and elsewhere we have also seen a growing disillusionment with central planning and central control as a means of administering resources and getting the best benefit from the way in which we run the NHS. New information technology also offers an exciting opportunity. If we had wanted to decentralise control and the administration of NHS resources in the past, there would have been grave practical limitations on our ability to do that. Hospitals and health authorities did not have the information and could not have been expected to obtain information essential to making rational decisions between different priorities for resources.

Mr. Michael Foot (Blaenau Gwent) : If it was so evident to everyone that changes had to be made along the lines that the Government are now proposing, why did the Government make no mention of the proposition in their election promises to the country?

Mr. Rifkind : As the right hon. Gentleman knows, the scale of the resources has increased as the years have passed. If he wants to accuse us of being a little tardy in approaching the need for reform, perhaps we will plead guilty to that. However, the right hon. Gentleman should at least appreciate that the Government are serious in their attempt to ensure that resources are used for the maximum benefit of patients.

Perhaps the greatest single change since the inception of the NHS has been the extent to which both sides of the House now emphasise the virtue and importance of choice for patients as a crucial requirement for the way in which the system should be administered.

Dr. Lewis Moonie (Kirkcaldy) : Will the Secretary of State give way?

Mr. Rifkind : I will develop this point and then I will happily give way to the hon. Gentleman.

I am glad that the hon. Member for Garscadden agrees with me that the desire for choice has now been represented as common to the views of both sides of the House. In its document "Patients First", a discussion document on the NHS in Scotland, the Labour party actually goes so far as to say, in the most eloquent terms :

"The National Health Service should provide patients with treatment when they want it, where they want it, by whom they want it, and in suitable surroundings. In other words, choice. This choice must be available to all, and free at the time of need."

The document goes on to refer to

"Choice in primary care Choice in the hospital service ... Choice of day and time of hospital appointments Choice of consultant Choice within hospitals and health boards and between health boards Choice of date for in -patient treatment Choice of in-patient accommodation."

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Those are fine words and fine sentiments, but the question to which the Opposition have so far failed to address themselves is how such fine aspirations can be translated into reality. We are dealing with a society of no fewer than 55 million men, women and children. How can individual men, women and children be provided with effective, meaningful choice without a dramatic decentralisation of the administration of our vast resources?

Not only will we require such a massive decentralisation, but, if individual citizens are to be given effective choice, we must ask ourselves where they will exercise that choice. Such people do not enter the Department of Health or the Scottish Home and Health Department ; they do not enter the regional or the district health authorities. The point of contact with the NHS for the vast majority of ordinary citizens is a visit to either their GP or their local hospital. Only if we can give GPs and local hospitals more freedom in how they use the resources provided for them will it be possible for them to respond to the individual wishes of individual members of the public.

That is the crucial and fundamental point to which the Opposition have not yet addressed themselves. Fine words about choice, and marvellous sentiments about individual members of the public being able to determine which doctor or hospital they visit on which day, can have no hope of translation into reality unless those who provide the services--GPs and local hospitals--have sufficient autonomy in their use of their resources to be sensitive to individual wishes in any meaningful way.

Dr. Moonie : Will the Secretary of State tell us how it will improve choice for patients to implement a directive such as that sent out by the Scottish Home and Health Department last week to all health boards, instructing them that once the Food Safety Bill becomes law all chicken served in hospitals will have to be irradiated?

Mr. Rifkind : The hon. Gentleman knows perfectly well that the Government made some announcements about irradiation recently, and we shall no doubt have an opportunity to discuss that subject at an appropriate time.

If the hon. Gentleman, who has a medical background, does not believe in the need for proper standards of public health, he is a very surprising example of his profession. We are talking about a view that is common to both sides of the House, and one that was expressed in the hon. Gentleman's own document--for it was his document to which I referred. When I gave way to him, I hoped that the hon. Gentleman would put forward real, serious propositions on how sentiment could be translated into reality, other than through the granting of far more autonomy to individual general practices and hospitals.

Dr. Norman A. Godman (Greenock and Port Glasgow) : Has the Secretary of State seen the article in today's Glasgow Herald about the service offered by Yorkhill children's hospital? Serious allegations have been made there about delays in carrying out operations on young children. Will the Secretary of State give me an assurance that he will initiate an investigation into those allegations?

Mr. Rifkind : I, too, was concerned when I read the press reports this morning. I have already made inquiries, and I understand that there has been a recent increase in demand for intensive care beds in a number of specialties, leading to the unfortunate postponement of a number of planned operations. The board has already funded an

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increase of two beds in the intensive care unit and I understand from the board that there is no question of money being transferred away from paediatric-cardiac surgery. The recent unfortunate cancellation is now the subject of a full investigation by the board. I am grateful to the hon. Gentleman for raising that matter. I referred to the general agreement existing between hon. Members of all parties about the need for increased, meaningful choice for individual patients. However, the practical debate--the real debate--is about how one translates that sentiment into new administrative procedures that give the opportunity for effective choice rather than simply for splendid political rhetoric. Therefore, I turn now to the specific practical criticisms that the Opposition have sought to make about the Government's proposals. Essentially, when one removes the rhetoric and the emotional dimension to the Opposition's position, one comes down to allegations about two basic alleged failures in our proposals. First, the Opposition suggest that our proposals represent what they call a "fragmentation" of the National Health Service. Secondly, they seek to suggest that the effect of our proposals will be to reduce choice, rather than to increase it. Those are serious matters which represent the core of the serious part of this argument, rather than the wild political posturing on which I commented earlier.

With regard to the first accusation--that our proposals represent a "fragmentation" of the National Health Service--clearly the word "fragmentation" has not been chosen unconsciously. It is an emotional word which seeks to suggest something improper or undesirable--

Mr. Donald Dewar (Glasgow, Garscadden) : It is a descriptive term.

Mr. Rifkind : The hon. Member for Garscadden says that it is a descriptive term, but if we are talking about fragments, that term is appropriate only if we refer to the size of the fragments with which we will end up. The hon. Gentleman should look at, for example, the proposals for National Health Service trusts, which are proposed--at least in the first instance--to apply to the large and acute hospitals. If the hon. Gentleman examines the budgets for such hospitals, he will find that they range between£10 million and £50 million per hospital. If that is fragmentation, it is a pretty substantial fragment, as I am sure the hon. Gentleman will agree.

Dame Elaine Kellett-Bowman (Lancaster) : My point has nothing to do with Scottish hospitals. On my right hon. and learned Friend's point about fragmentation, I must advise him that I have received one or two letters from constituents who are diabetics, and who are worried that treatment may become more fragmented, as between care in the hospital and care in the community. Will my right hon. and learned Friend or his hon. Friend the Minister of State deal with that point at some stage?

Mr. Rifkind : My hon. Friend is perfectly right to raise that matter. Clearly, it will be important for the health authority to continue to use its strategic role for ensuring provision of the services required by the public, including diabetic patients, in its locality. That is important when determining what contractual relations the health authorities should enter into with individual hospitals and others providing medical services. It is important that the needs of the community should continue to be identified

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by the health authorities which will not, of course, provide resources unless they are satisfied that the services that are required will be met.

I should have more time for the Opposition's accusation about fragmentation if their own position and the proposals in their documents did not point in the same direction, at least in theory. I read with considerable interest the document entitled, "Working with Patients--A Critique", of which the hon. Member for Kirkcaldy was co-author. There is a section on the White Paper, entitled, "What's Good in the White Paper". Indeed, it may delight the House to know that the hon. Gentleman has found a number of things that are good in the White Paper and presumably, therefore, in the Bill. He stated that the quality of care proposals in the White Paper are good. Indeed, they must be good in his view because he claims that they were taken from the Labour party's White Paper and it is always a good sign if the Opposition have to fall back on that claim. The hon. Gentleman welcomed efficiency in the delivery of care and more information being made available to consultants and general practitioners. He also welcomed a flexible accounting system to reflect clinical-led doctor-patient choice.

However, most important of all, which is why I am drawing attention to this point, is the hon. Gentleman's particular welcome to what he describes as

"further devolution of management to hospital and unit level". Indeed, the hon. Gentleman comes close to the Government's thinking in a way that must alarm some of his hon. Friends on the Opposition Front Bench. He stated, "This should be done", and claimed that it is done already under the current structure.

The hon. Member for Kirkcaldy then went on to say what a Labour Government would do. This should be of particular interest to the House, because he said that a future Labour Government

"would issue hospitals with their own budgets."

-- [Hon. Members :--"Oh."] We have suddenly discovered that, far from being antipathetic to hospitals having their own budgets, the Labour party, which spends half its time accusing the Government of creating an administrative shambles through such a scheme, is putting forward such a proposal itself. However, there is a qualification. Indeed, there is always a qualification and it is right that I should repeat it. The document states :

"We would issue hospitals with their own budgets, but only WITHIN health boards. Savings should go back to the health board for use in priority areas."

We know what that means. It means that hospitals will be given their own budgets, encouraged and no doubt praised for making savings, but they will not be allowed to keep the savings. Savings will have to be returned to the health board. We know of the prospects of hospitals striving as hard as possible to make savings if they themselves are not going to have any benefit as a result of their success in so doing.

Dr. Moonie : I thank the Secretary of State for giving way again. Most of the debate seems to be about papers that were published last year. However, I should like to put two points to him. First, general management has been in place for only four years and the right hon. and learned Gentleman has not yet conducted an adequate evaluation of the success of that general management, which was established within an integrated community-based set-up, by which I mean involving both hospitals and the

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community side. Does the right hon. and learned Gentleman recognise that it might have been better to evaluate the existing change in management before trying to bring in a separate structure? Secondly, the right hon. and learned Gentleman rightly referred to hospital budgets and savings therefrom. Does he not agree that, when we are dealing with finite resources, savings should be allocated to the most appropriate area of need in a community?

Mr. Rifkind : On the hon. Gentleman's first point, his criticism would be valid if we were proposing that as from the enactment of the Bill every single hospital in Great Britain should be required to set up an NHS trust. However, we are not doing so. Not only is the proposal entirely optional, but inevitably there will be only a relatively modest number of participants to begin with and, depending on how matters then develop, that number will increase if the system is seen to be successful by those who have not so far volunteered. What better way could there be of moving towards a more decentralised system, which the hon. Gentleman claims in his document to support? On the hon. Gentleman's second point, he must appreciate that what he says may sound fine in theory, but will not be realised in practice-- [Interruption.] No, because the hon. Gentleman knows as well as I do the practical consequences of telling individual hospitals that they will have a budget and that if they do not use the whole of that budget, any excess will be taken away immediately. The only practical way in which one can achieve the benefits of which the hon. Gentleman claims to be a supporter is by giving hospitals generous budgets and if, by careful use of those resources, the hospitals find that not all their resources are required for the purpose for which they were given, telling them that they may use those extra resources to improve the quality of the provision in the individual hospitals to make them even more attractive to the general public.

Mr. James Couchman (Gillingham) : Does my right hon. and learned Friend know whether the budgets suggested by the hon. Member for Kirkcaldy (Dr. Moonie) will be cash-limited and, should a hospital overstretch its cash limit, what penalties will be exacted by the hospital board? That is an interesting line of thought because it accords with some of our thoughts on this matter.

Mr. Rifkind : My hon. Friend has asked a fair question, but I must advise him that we have not been blessed with such information. As is so often the case with Opposition proposals, generalised statements are made, but there is an unwillingness--or perhaps an inability--to expand on exactly what is meant. Perhaps the hon. Member for Garscadden, who is hoping to speak immediately after me, will be able to explain exactly the kind of budgets that the Labour party proposes to give to hospitals and will answer the relevant points raised by my hon. Friend.

Mr. Tam Dalyell (Linlithgow) : Before we leave the subject of new information, the Secretary of State for Health, who is sitting beside the right hon. and learned Gentleman, has rightly in my view, for what it is worth,

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said that he would be casting his vote in favour of research on embryos. Will the right hon. and learned Gentleman be in the same Lobby?

Mr. Rifkind : The hon. Gentleman had better await that debate and then his curiosity will be satisfied.

I shall turn to the other allegation that the Opposition made against the Government's proposal--that its practical consequence will be to reduce choice, rather than to increase it. The hon. Member for Livingston has said :

"Patients will lose the right to go to the hospital of their choice--[ Official Report, 27 November 1989 ; Vol. 162, c. 446.] I am not familiar with the existence of any such right at the moment. The hon. Member for Peckham (Ms. Harman) should appreciate that. A member of the public may express a preference, but the idea that a patient has a meaningful, enforceable right at the present time is not in accordance with the way that the National Health Service has operated at any time since its inception. The real question is whether individual GPs will be more able or less able to respond to the declared preferences of their patients in the future. The Bill provides for a system in which there will be an incentive for GPs with practice budgets to respond to the wishes of their patients, because that will materially influence the way in which the practice is financed. The consequence of that will be entirely to the patients' benefit.

I hope that the hon Member for Garscadden will address himself to the objectives that he says his party is committed to--the practical consequence of the measures. The hon. Gentleman should appreciate that we are seeking, through group practice budgets and NHS hospitals, to provide a decentralised system of administration that will enable the individual GP and the individual hospital to be more sensitive to the wishes of the general public.

Several Hon. Members rose--

Mr. Rifkind : Many hon. Members wish to take part in the debate and I shall not give way.

Opposition Members are perfectly entitled to express their views on the administrative consequences of the proposals in the Bill, and to give their own view of the Government's achievements. What they may not do is express a view that is based on the belief that the last Labour Government made a splendid contribution to the well-being of the NHS. During the period that they were in office, the proportion of resources devoted to the NHS fell, nurses' pay fell by no less than one fifth and waiting lists increased by a quarter of a million.

In 1978 the then chairman of the British Medical Association said of the Labour Government's record on waiting lists :

"The sum of human misery represented by those record figures is a scandal without parallel in any technically developed country". That was the last Labour Administration's achievement. When they comment on the Government's proposals, I hope that they will do so with the appropriate humility.

4.53 pm

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