House of Commons Hansard Debates for 11 Dec 1989

Mr. Pike : I do not want to be sidetracked by the hon. Gentleman. In any event, many additions have been made to the original limited list which is constantly under review. I shall not be sidetracked on that point as it was not a finite decision at the time.

The general practitioners made two points about the provision of services to their patients. They do not believe that the decisions that they take concerning the medical treatment of their patients should be influenced by politicians, in the House or anywhere else, or by accountants. They fear that their judgment will be affected if the Bill is enacted in its present form.

The Under-Secretary of State wrote to me on 24 July stating : "It is not our intention that budget pressure would ever affect a clinical decision.".

In a subsequent letter he wrote :

"If a doctor spends significantly over his budget, he will be subject to peer review from another doctor who will consider whether there are sound clinical reasons for the level of spending. A doctor will only be subject to a financial penalty if he cannot give a clinical explanation for expensive prescribing practices." The Minister failed to recognise my point that in any event GPs' prescriptions will be influenced by the indicative drugs budget.

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

Mr. Pike : No.

In his opening speech on Thursday, the Secretary of State referred to a practice with a list of 7,000 patients which was spending £800, 000 a year on drugs. He said that was 185 per cent. above the average for its family practitioner committee area. He said that that practice dealt with the average number of elderly people, but he did not take into account other factors that may have affected that expenditure. Housing and working conditions also affect people's health and the problems for which they have to visit the GP and could therefore affect the prescriptions. We have to be careful how we judge these matters as we could reach hasty and wrong decisions when determining whether a doctor is overprescribing and that could be extremely dangerous.

I am particularly worried by the Government practice that they always anticipate that their legislation will be

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enacted. Burnley, Pendle and Rossendale health authority meets this Wednesday. This year it has an additional allocation from the North-West regional health authority of £149,500 to spend on preparation for the implementation of the Bill--before it has received parliamentary approval. The health authority received that extra money when it had to close a maternity ward--it has the highest perinatal death figures--and another hospital was closed in October to save money. Yet suddenly extra money is made available to health authorities. Lancashire has operated a quota system for ambulances since 1986 and we need money to deal with those problems. The Government do not like to talk in terms of hospitals opting out, but we know that if hospitals move in that direction the Health Service will be absolute nonsense. We should aim for a system in which hospitals provide the maximum possible services locally, although we will always have regional centres of excellence for certain specialised services and needs.

Other hon. Members wish to speak, so I shall conclude by saying a few words about community care, which was hardly mentioned in the Minister's speech. I welcome the Government's decision to make county councils responsible for assessing and supervising the provision of community care, but I should have been much happier if they had made local authorities the major providers of services. Care for our elderly, mentally handicapped and sick people should be provided publicly. The massive growth in private homes and in the profit being made from old people is obscene-- [Interruption.] Conservative Members obviously agree with that, but I believe that the care of our elderly, mentally handicapped and disabled people is a public responsibility. In my area, the Government are trying rapidly to run down and close Brockhall and Calderstones.

The Government say that they accept that community care, which we all support and believe to be right, is not a cheap option, but however many times they say that, they still hope that it will be a cheap option. Community care will work only if we ensure that sufficient cash resources are made available and that there are sufficient adequately trained staff to provide services for our elderly, mentally handicapped and sick people.

The Bill fails to tackle the problems facing community care and the Health Service. I hope that it is defeated and that the Government will tackle the problem by providing sufficient resources to deal with both issues.

5.51 pm

Mr. Michael Latham (Rutland and Melton) : I shall not follow the terms of the speech of the hon. Member for Burnley (Mr. Pike) because I do not agree with what he said.

I apologise to the House for not being present to hear the speech of the Minister, but I was at the Public Accounts Committee. I am grateful to hon. Members in that regard.

The Bill and the proposals in it were not in our manifesto, so when they were first produced I thought it necessary to think carefully about them. Having done so and, as other hon. Members have done in their constituencies, having listened to GPs in my constituency, it is right to give my hon. Friends on the Front Bench and the Secretary of State the benefit of the doubt ; I shall support the Bill tonight.

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However, there is still some doubt, and I hope that in discussions inside and outside the House, and while the Bill is passing through the House, Ministers will listen to members of the profession and continue to discuss it with them. In answer to the hon. Member for Burnley, my hon. Friend the Member for Pembroke (Mr. Bennett) mentioned the limited list, which was an example of how Ministers acted properly. They discussed the proposal with the profession and allowed changes to the limited list, which was much more acceptable and is the way to proceed. I hope that the pilot schemes and the proposals for introducing hospital trusts carefully and deliberately will be followed by the Government.

I should like briefly to mention rural services, which are particularly important to me, as my hon. Friends on the Front Bench will know. Tomorrow, Leicestershire district health authority will visit the House to meet Leicestershire Members of Parliament. I have been dissatisfied with its policy of closing rural maternity units, which I regard as unacceptable, particularly as its chairman gave assurances that closures would not be allowed. He said that the Oakham maternity unit in my constituency would not be closed, but it closed last September. That was extremely regrettable because it deprived my constituents of a service that they regarded as extremely important.

The hon. Member for Burnley referred to the interaction of community care and the Bill. I take it as axiomatic--I assume that Ministers will confirm this--that there will be no question of closing down old geriatric hospitals until community care supportive welfare is in place. We simply cannot allow that to happen-- [Interruption.] Hon. Members shout, but in the paper that we shall be discussing tomorrow, regarding the Catmose Vale hospital in my constituency, Leicestershire health authority says that

"Closure will follow the opening of the new buildings" of the Rutland Memorial hospital in 1990-91. I believe that that is the proper way to proceed. New buildings should be provided at one hospital, and then the buildings at the old one can be closed. I expect community support to be in place before decisions are taken, which is essential for elderly people.

I hope that Ministers have not closed their minds--originally it seemed that their minds were closed--to smaller hospitals being hospital trusts. The original intention undoubtedly was that district general hospitals should opt for the status of hospital trusts within the Health Service. I am concerned that smaller hospitals, particularly cottage hospitals in rural areas, may feel so threatened and isolated that they will want to set up their own trusts. I am sure that they would receive much local support for so doing, and I hope that that will not be ruled out by Ministers.

I should like some assurances about the rights of GPs under the new arrangements to be able to send their patients where they want. I was a little concerned by some replies that my hon. Friend the Minister for Health gave. I asked :

"to what extent general practitioners who are not budget holders will be permitted to choose the hospital to which they send their patients for (a) non-emergency treatment on an in-patient basis and (b) maternity care, including the delivery of the baby".

My hon. Friend replied :

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"For all services, including non-emergency and maternity services, GPs should usually be able to choose the hospital that they consider most appropriate, taking account of their patients' needs and wishes. GPs who are not fund-holders will normally refer patients to hospitals with which the district health authority has placed contracts. In placing those contracts, the DHA will be expected to secure the referral patterns which local GPs wish to see put in place, unless there are compelling reasons for not doing so."--[ Official Report, 28 November 1989 ; Vol. 162, c. 222. ]

I hope that that will be the proposal, because many excellent GP practices in my constituency will not be large enough to be budget holders. I should like them to have the right to send patients to local hospitals in Melton Mowbray and Oakham or across the border. I welcome this aspect of the Bill- -to hospitals in Lincolnshire, Northamptonshire, the constituency of the Under-Secretary of State for Health, my hon. Friend the Member for Kettering (Mr. Freeman), or to Nottinghamshire if they believe that that is suitable for their patients. I hope that they will not be prevented from doing so but will be encouraged to do so because they are not large enough to be budget holders.

With those reservations--I shall watch carefully how the Bill proceeds in that regard--I wish my hon. Friends well and will support the Bill tonight.

Several Hon. Members rose--

Mr. Deputy Speaker (Mr. Harold Walker) : Order. I remind the House that earlier Mr. Speaker announced that he will impose the 10-minute limit on speeches between 6 o'clock and 8 o'clock. 5.57 pm

Mr. Andrew Welsh (Angus, East) : I had hoped to address my remarks to Ministers at the Scottish Office, but none is present ; indeed, I am the only Scottish Member present in the Chamber. Although they are not present, I hope that they will read Hansard tomorrow, because the Bill illustrates how inadequate the House is to deal with Scottish legislation. These are devolved matters that are very important to Scotland, yet the House is not capable of dealing with them properly. Fundamental changes affecting major Scottish institutions are being tagged on as afterthoughts to legislation for England and Wales. If ever there were perfect subjects for scrutiny by the Select Committee on Scotland, these are they. The House is in breach of its Standing Orders by not having a Scottish Select Committee.

As with Scottish education, the Bill, affecting the National Health Service in Scotland and our community care system, is being pushed through with minimum Scottish input and little or no time properly to debate its Scottish aspects. I should like to place on record my disgust and protest at this cavalier treatment of Scotland. No Scottish Government would ever allow it, and it is to the shame of this place that such circumstances should occur.

The Government are out of step with the majority of people in their treatment of the National Health Service. There is massive mistrust of the motives for the end product of the Governmnent's changes, and I certainly share those feelings. The National Health Service is not safe with the Government, and I fear that the concept of community care will suffer at their hands. Basically, we are being offered a managerial, cost accountancy solution which is inadequate to meet the health problems of the

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decade that will take us into the 21st century. How do we cope with our increasingly aging population, which is estimated to be 1.1 million by the year 2001? How do we continue to shift resources towards health promotion and the prevention of illness? How do we ensure the supply of professional trained staff, both ancillary staff and those directly connected to health care?

I look for answers but the Bill does not supply them. Nowhere in the proposal do I see consideration of quality of care in medicine and health provision. There is plenty of emphasis on finance and some on technology, but where are the quality assurances? There are dangers of fragmentation of national health services and the creation of a divided, warring, competitive system driven by the profit motive and cost-cutting, rather than a national, comprehensive health care system that is available when and as needed by each individual. That is what we all have a right to expect and what we should be working towards. I do not want a system that pits doctors against patient or hospital against hospital.

The Government heard the united opposition of health care professionals and the general public, yet they have responded only reluctantly and in small measure to the range of thoughtful and considered responses to their NHS proposals. I am worried about the quality of care in the National Health Service and the community care system. The Scottish section of the White Paper dealing with community care is devoid of targets to be pursued. There are 10 references to discussion papers and guidance papers yet to be published, as well as matters which "require further consultation". This leaves a vagueness and tenuousness which all but obviates discussion on the Scottish aspects of the Bill. How can there be meaningful discussion or analysis when many fundamental matters are to be left to the diktat of the Minister?

This Scottish vagueness is in direct contrast to the Welsh section of the White Paper which details the existing situation and sets out targets and objectives for community care in Wales. Why are we not given similar provision by the Scottish Office? Will such information be produced and, if so, when? Scottish legislation is in enough of a shambles without adding these extra handicaps.

Despite the generally accepted underdevelopment, which even the Government have acknowledged, of community care in Scotland, the White Paper on which the Bill is based is weak and lacks a positive sense of direction. Since much is left to further consultation and guidance, how can there be effective debate on these issues without some flesh being placed on these bones? What is the Government's timetable for the 10 matters that require consultation in Scotland? Given their placing in the Bill, how can a full debate in Standing Committee be assured to deal with the Scottish clauses, some of which are very different from those applying to England and Wales? Given all that, are Scottish Office Ministers prepared to have joint meetings with repesentatives of the professional and voluntary organisations to discuss the details in the White Paper and the Bill, in view of the limited parliamentary time available for discussion? I should like them to take that on board. It is a matter of urgency for Scotland.

More generally, what will be the relationship between local authorities, the Government and private provision as part of an overall strategy for community care? In contrast to the Welsh and English position, there appears to have been little positive thought about an overall co-ordinated

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approach or even specific goals or targets on housing. Scottish Homes does not even rate a mention in the White Paper- -perhaps that is a statement of the Government's opinion of its usefulness regarding the provision of housing in Scotland. Why is there no reference to homelessness or to people with mental illness? The approach of the Scottish Office seems to be less adequate than the English one. I should like assurances that something will be done during the Bill's passage to remedy these defects.

In particular, why will not the Government provide proper income to carers? The bulk of caring in the community is met by informal carers, saving the Exchequer billions of pounds because of their work. The Government have failed to recognise that caring for a sick and sometimes terminally ill relative is a full-time job that puts tremendous strain on the carers. When carers cease their caring activities, they are not eligible for benefits in their own right. They have difficulty re-entering the labour market. The proposed review of disability benefits offers the Government the opportunity to provide support through the benefit system, for example, by providing training schemes for young carers. Those people should also be eligible for unemployment benefit.

Changes in the pattern of community care are likely to affect women disproportionately. There is a danger that many women will be trapped into providing care for relatives and become a support safety net. That problem must be urgently addressed. What action will the Government take to protect carers in the front line?

From statements made by Ministers earlier in the debate it could be thought that the NHS has few or no problems and that the Bill provides complete security for the NHS, its patients and work force. Like the majority of people, I have no confidence in the Government or in their approach to the NHS. The Bill is a trojan horse placed before the NHS. It is inadequate to meet the needs of proper health care. I hope that it will be strongly and unitedly opposed. 6.5 pm

Mr. Michael Morris (Northampton, South) : Once again, it gives me no pleasure to voice deep concerns about proposed changes to the National Health Service. Once again, I declare a series of interests in that two of my immediate family are doctors and another is a physiotherapist. For all my working life before becoming a Member, I was associated with the pharmaceutical industry, and I advise two companies--Upjohn, and Reckitt and Colman. As my hon. Friend the Minister knows, I have served on the Public Accounts Committee for some 10 years and have asked a fair number of questions on the NHS. I am the first to admit that changes in the NHS are necessary. A number of items in the Bill are right and should be supported, but--it is a big but--we all need to recognise that this is probably the most dramatic change that the NHS has faced since Aneurin Bevan set it up, based primarily on work done by a Conservative Member, Mr. Brown. Both sides can therefore take pride in the creation of the NHS. The big difference between then and now is that the NHS had a long period of gestation. There was time to reflect and a groundswell of opinion in favour of the changes. If I felt that the preparation for the Bill had been

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as thorough as the preparation for the NHS, I could readily support it. I am afraid that I do not. I have studied the Bill in considerable depth and, unfortunately, I feel that there is a degree of shallowness and unreality and a feeling of policy being made on the hoof. It is not good enough that the White Paper referred to GP budgets of £700,000, when it transpired following academic work that the figure was nearer £1.4 million. Now in column 513 of Hansard for Thursday last week we are told that the matter is to be negotiated. This is far too reminiscent of what happened over the limited list, where we started with 31 products on the list, but then the number increased to 156, and it started with a claimed saving of £125 million, but ended with a claimed saving of £75 million, as yet unsubstantiated.

The last thing that any Member should do is undertake ill-thought-out change. One need only look across the Atlantic to see what happens when one pushes through a Bill that is ill thought out in terms of health care. Two weeks ago in the United States, what was called the Catastrophic Health Act had to be repealed. It had been introduced to help the elderly, at their request, but it was found to have unrealistic time dimensions and budgets.

There are some real problems, which we must face. We cannot get away from the fact that the first problem is money. We need to recognise that we spend about 6.5 per cent. of gross national product on health, that the United States spends about 12 per cent. and that the rest of Europe spends about 8.5 per cent. Those figures are indicative of the problem. Those of us from the Oxford region who attended a presentation the week before last had it made clear to us that if in the past five years--and Oxford is allegedly the most efficient region in the country--we had had increases to meet the cost of inflation, we should have had an extra £35.3 million, which would have gone a long way in helping us to deal with problems such as the closure of wards.

If one plans to change the service radically, one must work with the people and with the grain. It is sad that last Thursday, my right hon. and learned Friend the Secretary of State said that waiting lists were a "badge of status" for consultants. They are not in Northampton or elsewhere.

One also has to think clearly about what overseas experience teaches us. Recently, I had the opportunity to go to the United States and to try to relate the proposals for hospital trusts with what has been done there. The American experience suggests that in a market-based system, hospitals and other providers react quickly to changed financial incentives and that contract specification is crucial. The Bill does not seem to anticipate that problem. The American evidence also suggests that providers will change methods of service delivery to maximise income and will engage in favourable selection of patients if there is freedom to do so. What are the safeguards to prevent that?

Quality of care in the United States is, to a great extent, dependent on elaborate arrangements for the external monitoring of quality. The Americans have peer review organisations and I do not know what we have to equal that. From the United States, one learns quickly that administrative costs spiral and we learn from previous announcements that administration costs may spiral here.

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In the past 10 years, one of the areas that the Public Accounts Committee has challenged has been trying to bring down administrative costs.

The medical audit raises another problem. We all accept that it is a vital area, but I find that the Government have set aside only £1.25 million in the coming financial year, which is less than £100, 000 a region. Every experience, not only in the United States, but on the continent, tells us that it is an expensive area. Yet we have not provided major financial resources. A paper by the Medical Audit Advisory Group suggests that teams of general practitioners will go round GP practices. Where are all the GPs who can be spared for the medical audit?

The hon. Member for Burnley (Mr. Pike) referred to the major problem of drug budgets. This is a real fudge issue. We already have the pharmaceutical pricing regulation scheme, prescribing analyses and costs-- PACT--formularies, over-the-counter medicines, generic products and the limited list, yet on top of all that my right hon. and learned Friend the Secretary of State wants indicative drug budgets. Only 25 per cent. of GP practices are computerised, so the proposal will not work in the time scale that has been set. It is also incumbent on the House to understand that, although drugs represent 10 per cent. of NHS cost and are highly visible, many modern medicines are preventive medicines and will stop people having to go to hospital. We also need to understand that the number of elderly people will increase. One can work out that there will be an extra 4 million scripts for people who are 60 to 65 now and another 4 million for those over 75. On top of that, there will be screening and public health programmes, so the number of scripts is bound to increase and the drugs bill will also increase. We need urgently clarification of one central point. How is it that there is a Treasury fixed budget in overall terms for drugs, yet there is to be no restriction on GPs through indicative budgets?

The pharmaceutical industry is important to this country. Such a strong, research-based industry, which makes an £850 million surplus for this country, should not be ignored or forgotten and we must recognise the importance of the new medicines that it has introduced.

I believe in the ethos of the NHS, in good management and in strategic objectives to meet proven needs, but we should cost what has been achieved, experiment, test the market and assess the results before making decisions. We should involve the whole team and work with them. We should look at the implications of the decisions on others who are friendly to the industry. We should learn from the experience of others and we should set realistic time dimensions and realistic targets. Sadly, the Bill tries to do too much in wholly unproven areas, with too few resources. Sadly, I shall not support it.

6.15 pm

Mr. Joseph Ashton (Bassetlaw) : I shall confine my remarks to local issues, because of the 10-minute rule, and I hope that the House will bear with me. Bassetlaw health authority is one of the three smallest in the country. After great pressure from myself and others under the Labour Government, it was agreed to establish Bassetlaw health authority, although the population is just over 100,000 and the population in the average health authority is about 370,000.

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When the Bill was announced, there were immediate cheers from my local Tory-controlled health authority, which offered to opt out not just the local hospital, but the entire authority. That decision was greeted with acclaim by the Minister and the Social Democrats. The health authority sent out a letter asking staff to give it full support and stating :

"The public opposition to our expression of interest has come so far, to the best of my knowledge, solely, from Minister Joe Ashton MP"--

I assume that that meant Mr. Joe Ashton--

"who represents part of our Health District and a relatively small number of Labour Party activists ; and this opposition has been couched in party- political, ideological terms."

The authority gave press releases and said that it hoped that most staff would strongly support the scheme from its introduction. The authority spent a lot of money putting out the Update newspaper using money that should have been spent on health. The authority has been £1 million short of its budget for the past 12 months. The authority said that it would engage Price Waterhouse to investigate the method of setting up a trust and that staff at all levels should be prepared to support it. The authority aroused a great hoo-ha. It placed advertisements in local newspapers and spent a great deal of cash pushing the political idea of the whole health authority opting out.

The authority also said, which I welcomed, that there would be a public referendum after consulation next year. When that was announced, the Parliamentary Under-Secretary of State for Health began to have second thoughts. He visited the area, as did the Secretary of State. The one thing they did not want at any price was any form of public referendum. Public consultation was entirely against their policies.

While congratulations were levelled at the health authority, it suddenly had cold feet about the referendum. In June, the trumpets and fanfares were sounded. What happened last Friday? The local newspaper announced :

"NHS trust abandoned. Bassetlaw Health Authority has abandoned its plan to set up an NHS trust. The opt-out plan, which met with strong opposition in the area, is, announced the Authority yesterday, no longer an option being pursued".

When these opt-outs are analysed and costed they may not turn out to be such a good thing after all.

The health authority maintains that it is going ahead with opting-out the hospital, but again with no mention of a referendum. The whole area has campaigned for many years, as have I, for a brand-new hospital. This is a mining area and we finally got the hospital, which the Government delayed for many years despite six visits by Ministers to the area, because, by an act of God, a miner was carried in on a stretcher, having broken his leg. Stinking, black and bleeding he was brought in from one of the many accidents in the pit and he had to be treated in a corridor in a collection of tin huts--that was what finally convinced Ministers that the need for our hospital should go to the top of the list, and we managed to get one built.

Now we discover that all our pressure does not matter. The people at the top will decide whether the hospital will opt out, not the people who use it, who campaigned for it and who paid their stamps every week for it. The people who will decide are those at the top who wanted to keep their good administrative jobs by opting out the small health authority.

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The staff have been consulted, meaning that they were told of this at a mass meeting and asked whether they had any questions. Naturally, they did not want to jeopardise their jobs or to be awkward and shout their disagreement like Oliver Twist. They all want promotion, so they say nothing, enabling the people who held the meeting to claim that the staff agreed without complaint.

If there were a secret ballot it would be different. If a trade union wants a political fund it must hold a secret ballot of its members. If a council estate is to be sold off to, and run by, a private landlord the Government insist on a ballot, but hospital patients and visitors and people living in the area are not balloted on whether their hospital should opt out. The Secretary of State will not entertain that at any price.

Last week the National Union of Public Employees conducted an opinion poll in the east midlands in which 400 people canvassed 7,000 respondents. In that reliable survey 94 per cent. of those questioned said that there should be a ballot. They did not say that the hospital should not opt out, but they were in favour of a ballot. Many were Conservatives who had voted Conservative all their lives and who might even support much of this Bill, but they want a referendum before the hospital decides to opt out.

There has been much propaganda about how self-sufficient hospitals will be, but that will depend where they are. If a hospital is new and owns a lot of land, having bought an extra couple of fields paid for by the NHS, it will be able to survive the first few years by selling off surplus land, holding extra flag days and selling off ancillary services. Undertakers will set up in the foyer, flowers and food will be sold under franchise and people will be turned away and told that they should have gone private. Insurance may even be sold under franchise, and in that way the hospital will make a profit. The Minister has assured staff that they have nothing to fear. They have everything to fear. They are assured that they will be guaranteed Whitley council wages and the same sort of pensions and holidays as they receive now, but that is nonsense. Once hospitals no longer have to pay regular wages they can pay the market rate. There is still 9 per cent. male unemployment in my area, despite all the part-time jobs in supermarkets that have been created. Hospitals will pay a damn sight less than they have to pay under the NHS. I cite Mr. James Butler who held a top-level job as a commissioning officer in Bassetlaw hospital. He was made redundant in March last year and Bassetlaw health authority refused to give him an early pension even though it was guaranteed by the Whitley council and the Minister had said that he was entitled to it. God help him if he had not been in the union, which took the health authority to court. The authority took legal advice and then backed down because it realised that Mr. Butler, NUPE and the Minister were right--after having spent several thousand pounds on legal advice.

This shows that once a hospital has opted out under these provisions it will pay any wages and pensions that it likes, it will privatise what it likes, it will adjust holidays and it will destroy the long tradition of fair conditions. And staff will have no comeback. Hospitals that have opted out will be run as they used to be--on flag days. If they are hospitals in Bournemouth, where there is plenty of local cash and millionaire do-gooders abound, they will make money as they did in the 1930s. If they are in places

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such as Barnsley and Bassetlaw, people will put 20p in the box--the hospitals will not be left big legacies in wills-- and the hospitals will have to scratch around, send people where it is cheaper and turn them away, sometimes advising them to go private.

All these matters must be explained at length and in a democratic way to the people of the country, who must be given the chance to vote in a full referendum after extensive local discussions. I hope that the Minister will insert in the Bill a clause providing for referendums.

6.26 pm

Mr. Jerry Hayes (Harlow) : I listened carefully to what the hon. Member for Bassetlaw (Mr. Ashton) had to say. I suspect that hon. Members on both sides were none the wiser having heard his speech because if the hon. Gentleman puts his hand on his heart he must admit that he has not read the White Paper or the working documents or the Bill ; if he had, he would not have said what he did. We are not talking about hospitals opting out of the Health Service ; we are talking about self-governing National Health hospitals-- [Interruption.] That is in the Bill. Why has the hon. Gentleman not read it?

Thank heavens, the electorate are rather forgiving.They can forgive us for messing around with their jobs and taxes and perhaps even for messing around with their rates, but they will not forgive us if we misinform them about their health and about what will happen to the health of their loved ones, the frail and the vulnerable. The BMA and the Opposition have done for the truth of the White Paper and the Bill what King Herod did for babysitting.

On 7 December the hon. Member for Livingston (Mr. Cook), the shadow Secretary of State for Health, made a speech which I should like to go through, analysing precisely what he said. I asked him whether he was going to commit his party to voting against medical audit, against money travelling with the patient and against resource management. All those points were medically led--they did not drip out of a back room of 10 Downing street or Richmond house. They were advanced by the medical profession and supported by it.

The hon. Member for Livingston replied :

"I am sorry to disappoint the hon. Gentleman. There is nothing in the Bill about a medical audit. If the hon. Gentleman is thinking of voting for the Bill because he supports the idea of a medical audit, I would welcome his joining me in the Division Lobby".

Of course the Bill does not mention medical audit ; it does not mention resource management either--but these things are all in the White Paper. They are all in the working documents. So much has been written about it that I suspect that whole Amazonian rain forests have been destroyed.

Mr. Tom Pendry (Stalybridge and Hyde) : How irresponsible.

Mr. Hayes : I expect nothing less from the hon. Gentleman. The shadow health spokesman then referred to money travelling with patients. He said :

"Of course we do not oppose the idea of money following the patient. The question is whether the Bill does anything to provide for money following the patient."

In other words, this is all about resources. If it was all about resources, the Government would have fudged it

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long ago because we are spending 45 per cent. more now than in 1979. The difficulty is that we have a ridiculous state of affairs where there is no financial incentive for health authorities to reduce their waiting lists. In fact they are penalised. There is also no financial incentive for hospitals to treat more patients. At this time of the year, money runs out and beds and wards are closed.

Mr. Doug Hoyle (Warrington, North) : That is scandalous.

Mr. Hayes : It is absolutely scandalous. Opposition Members do not accept that that scandal is finally being laid to rest. Money is travelling with the patient and there will be a financial incentive to reduce waiting lists and to keep beds open.

The Opposition claim that the amount of money involved is not mentioned in the Bill or in the White Paper. Of course, that is not mentioned there. It is a matter for the Autumn Statement. However, I can give the Opposition a clue. Believe it or not, a lot of people distrust politicians. They put us on the same level as journalists, estate agents and burglars. I want to remind the House of what Mr. John James, a senior civil servant, said to the National Association of Health Authorities. He made it clear that because of the system of money travelling with the patient, more money would have to flow into the Health Service. If hospitals and health authorities know precisely what their unit costs are and how much operations and treatment cost--which they do not know at the moment--they will be able to put in bids to the Treasury which would lead to more money coming into the Health Service.

The Bill is all about resources and the patient.

Mr. Kenneth Hind (Lancashire, West) : What about the 12 per cent?

Mr. Hayes : I want to draw the attention of the House to other points made by the shadow health spokesman on 7 December. He said : "The Bill does not extend choice to patients."

He was making the same point as the hon. Member for Bassetlaw about self- governing trust hospitals. He wanted to know why we do not have a ballot and ask the patients, doctors, nurses and cleaners. How can we do that? We do not even do that under the present system when there is a proposal to close a hospital. In those circumstances, we consult the people in a proper and statutory fashion through the community health council involved. I believe that a ballot would divide communities and divert valuable resources and attention from patient care. [Interruption.] The hon. Member for Cardiff, South and Penarth (Mr. Michael) will say that I am shooting myself in the foot. How ridiculous. If we do not have a ballot or a referendum when a hospital closes, why should we not use the existing procedure which has worked perfectly for many years to express people's views?

Mr. Alun Michael (Cardiff, South and Penarth) : Will the hon. Gentleman give way?

Mr. Hayes : No, I want to make progress. The hon. Gentleman will have plenty of opportunities to hold himself spellbound in a few moments.

The shadow health spokesman also said :

"Under this Bill, the GP will not have the opportunity to send his patients to hospitals at which the district health authority does not have a contract."--[ Official Report, 7 December 1989 ; Vol. 163, c. 518- 20.]

Column 715

That is nonsense. It has been made absolutely clear that a special fund will be available for those referrals. Has the shadow health spokesman not read the Bill or the White Paper? Has he not seen the guidance from the Department of Health stating that referrals will be much the same as they are now? Of course he has not. Regrettably that is the mass deception by the Opposition, the BMA and others. At last the BMA, the presidents of the royal colleges and the other caring professions accept 80 per cent. of the Government's proposals. Some Opposition Members say that the Health Service is just a wonderful quaint museum piece. They believe that we just have to pat it on the shoulder, patronise it and throw it a few more pounds and everything will be all right. Several thousand of my constituents have been waiting 24 months for elective surgery and they waited 12 months before that to see a consultant.

Mr. Ian McCartney (Makerfield) : And the Government are responsible for that.

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