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Mrs. Alice Mahon (Halifax) : This Bill and the White Paper on community care do not face the real health demands of a growing elderly population who are becoming more frail by the day and more dependent on all of us. The Bill does not deal with the problem of caring for the mentally ill or handicapped, or the problem of those who are languishing in prison and on remand and who would not be so doing had there been proper care in the community.

The Bill does not address the problem of the large number of homeless people who have suffered from mental illness in the past-- [Interruption.] If the Secretary of State would pay attention for a moment he might agree that it would be a good exercise to carry out a survey of the number of such prisoners on remand or of people who have ended up in cardboard boxes on the Embankment. He would then have to admit that his policies on community care have been a total failure ; and to judge from the White Paper, they will get even worse.

The Bill and the White Paper do not deal with how to shift our policies towards preventing bad health and they offer no strategy for real care in the community. Most of all, the Government proposals will do nothing to improve the low morale that is endemic among NHS staff.

I have mentioned, in an intervention in the speech of my hon. Friend the Member for Makerfield (Mr. McCartney), what is happening to enrolled nurses. It is scandalous that neither document contains a word about retraining of and proper training for nurses.

I cannot remember morale among nursing staff and everyone working in the NHS being so low. The Secretary of State said that I was not qualified to vote on the Bill ; that highlights his attitude to the rest of us. At least I gave many years of my life to working in the NHS and I have a greater understanding of its problems and of the staff who work for it than he has.

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The logical conclusion of the Government's proposals on opting out of district health authority control and setting up hospital trusts is privatisation, and no amount of denial by the Secretary of State, other Ministers or Conservative Members will convince the public otherwise. If these proposals go through, the hospitals in my area will be called "Halifax General plc" or "Halifax Royal Infirmary plc". Unless public pressure can make the Government change their mind, that will be the logical outcome. Once hospitals are set up as businesses, with information systems that show the cost of every treatment in the smallest detail and with the freedom to borrow in the City and to hire and fire at will, that will be the direction in which we shall move.

The Secretary of State treats the rest of us with contempt if he does not realise that we have rumbled him and his plans. What he says about doctors scaremongering is rubbish. I hope that they carry on with what they are doing. The only people who appear not to be listening to them are the Secretary of State and those who support him.

I asked the Secretary of State some months ago to give me a guarantee that the accident and emergency services in my district health authority area would remain there. He did not give that guarantee, and I warn all Government hon. Members that they could lose their accident and emergency services if managers decide that they can purchase them adequately from elsewhere. I am not willing to hand over that reponsibility without a damn good fight. The manager in my area came from British Steel, where he did a good job closing it down for the Government before being made redundant. Will a Minister give us a guarantee tonight that he or she has had a change of heart about this proposal?

There has been much talk about privatisation and the saving of money. There was a small example of privatisation in my local authority area when the Secretary of State was a Minister at the Department of Health and Social Security in 1983--he was not then top dog. There were proposals to build a new laundry in Calderdale before the 1983 general election. The proposals had been worked up and costed and we were going to go ahead, but we were told that a decision could not be made for some months because of other priorities. After the election the Secretary of State said that the laundry had to be put out to tender and that we could not build a new one. We put it out to tender and won by a margin of just over £12, 000. The Secretary of State said, "That's not good enough. Try again." With the help of the trade unions which are much maligned by the Conservative party, we worked up another scheme and won the tender by a margin of £250,000. The Minister said that we still had to privatise. So we did. Since then, the laundry service in my district health authority has gone from bad to worse. Elderly patients have had no underwear and patients were sleeping on paper sheets. There has been a series of disasters because the Minister said that privatisation had to go ahead regardless of the fact that it would have been cheaper not to privatise by a margin of £250,000.

Mr. McCartney : The privatisation of laundry services highlights most effectively what goes wrong when a market philosophy is imposed on a health authority. The laundry services in my district health authority have been

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privatised. The district general hospital had to cancel operations because the privatised service could not provide clean linen when the hospital required it.

Mrs. Mahon : Many hon. Members have experienced similar difficulties in their constituencies.

Privatisation in the NHS is bad for the patients. The Government introduced managers into the NHS from the business sector and they propose to introduce more of them under the Bill. The community health councils are not to be strengthened and the local authority representatives are to be kicked off DHAs because

Government-appointed managers do not want any opposition. In many instances managers do not have the interests of patients at heart, as the Minister would like us to believe. In my district health authority a couple of years ago a manager referred to elderly patients as "bed blockers". I cannot think of a more dehumanising statement than that.

The management have done their job for the Government. They have privatised the care of the elderly almost wholesale. What is left of that care is to be finished off under the White Paper. What choice does the White Papter offer to the elderly and their relatives? If all that the elderly have on offer is a private home, where is their choice to enter the public sector? There is no choice, as the Government are well aware.

The Government have based the White Paper and the Bill on the model that they saw in America. Under that disgraceful model, 40 million people in the richest country in the world have no access to any kind of free health care. The future for Britain can be seen in the provision of health care in America.

The Government do not want to improve access to decent free health care in this country. Their cynical and provocative attitude to the NHS staff over the past 10 years proves that. Indeed, nothing proves it more than the way in which the Secretary of State is upping the dispute with the ambulance service. We know what he is up to and we do not trust him.

It has been said that the Secretary of State is ambitious. In the past, I understand that his name has been put forward as a possible leader of the Conservative party. That has nothing to do with me and if I pursue that I might be ruled out of order. However, the writing is on the wall for the right hon. and learned Gentleman and his career. Just about every section of opinion is against his proposals in the Bill and in the community care White Paper. He cannot fly in the face of that tide of human hostility and hope to get anywhere in politics. He is finished and I for one think that that serves him right.

8.43 pm

Mr. David Nicholson (Taunton) : I welcome the provisions in the Bill for community care, and I also welcome the presence of my hon. Friend the Minister for Health in the Chamber. I believe that this will be the first debate in which I have spoken to which she will reply, although I did speak in the debate on community care in October. I also support the points made about community care by my hon. Friend the Member for Sevenoaks (Mr. Wolfson).

In The Times today there is a headline

"Hospitals account for over 80 per cent. of mental health care".

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The article states that a report published by the Office of Health Economics today points out that spending is concentrated in hospitals rather than in community provision. I welcome the fact that, since we debated community care in the House, my health authority in Somerset has produced a consultative document about the provision of services for health and community care and the measures it is taking to update those services.

The report states that the current pattern of services does not provide the ideal network for ensuring that the population of Somerset, which the district health authority serves, has an equality of access to a modern health service. It states that through the introduction of efficiency savings and income-generation programmes additional funding has been provided. A good example of that are the major funding strategies supporting the successful care in the community policies for the mentally handicapped and mentally ill. The report states that large institutions, to which I referred in our earlier debate, such as Mendip and Tone Vale were an enormous drain on resources requiring huge expenditure every year on such items as fuel and maintenance. Many of the buildings in that care group have serious building defects and are uneconomic to repair and modernise. They are also too large and functionally unsuitable for modern mental health care practice. The sooner the authority's strategy of replacing those institutions with small community units can be implemented, the more it will be possible to avoid expenditure on repairs and fuel in those old buildings. I strongly commend that proposal by Somerset health authority and I hope that it will be able to serve the Bill's principles with regard to community care. I want to make three basic points about the main issues facing the National Health Service and its future. I want first to refer to resources to which my hon. Friend the Member for Harlow (Mr Hayes) and others have referred. I draw the attention of the House to the contrast between two sets of figures showing total NHS spending per head for England over the past 10 years. Over the four-year period1982-83 to 1985-86, inclusive total NHS spending per head rose by £52. Between 1986-87 and 1989-90 it rose by £104, the rise being from £340 to £444 per head. I have not translated those figures into real terms, but I believe that they show a marked increase in resources in the Health Service over the past four years. Hon. Members asked earlier why the proposals in the Bill did not feature in the 1987 Conservative party manifesto. All of us encountered strong pressure in our constituencies with regard to NHS resources at the time of the 1987 general election. Since then the resources have been provided and we have produced proposals to ensure tht those resources are used properly. Within the context of resources, I support the point made by my hon. Friend the Member for Sevenoaks with regard to the pay of certain NHS staff. I am not referring to the doctors, nurses or even the ambulancemen. I am referring to the semi -forgotten sections of staff who are badly paid. I hope that as a result of the thrust of the reforms in the Bill we shall see a certain negation of the trade unionism in the NHS. That trade unionism has meant low productivity and also low pay for so many people working in the NHS. I hope that the Bill will remedy that.

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Mrs. Mahon : Will the hon. Gentleman give way?

Mr. Nicholson : I am afraid I will not give way, because, as the hon. Lady knows, several other hon. Members wish to speak. Earlier this year we saw a concentrated argument about GP services. The Government have made clear their commitment to GP services and made clear pledges against the deceitful propaganda put out by the British Medical Association. Last Thursday my right hon. and learned Friend the Secretary of State cited, as an example of the misuse of drugs under the present system, the fact that 1 million tablets had been found in the space of two weeks in Avon and Somerset. For me, that example was pretty close to home.

In recent weeks the controversy has switched to the issue of self-governing hospitals. Certain hon. Members have suggested a referendum, but it is impossible to hold a referendum on such a hypothetical matter when everyone is being bombarded with propaganda to the effect that the service will get worse. I would have no objection, however, to a local poll to assess the performance of self-governing hospitals--two years, say, after they had become self-governing--and I hope that my right hon. and learned Friend will consider that suggestion. After all, if the measures in the Bill do not lead to an improved service, they are not worth enacting. My final point is political. The Bill's opponents--the Opposition, the British Medical Association and, at times, my hon. Friend the Member for Macclesfield (Mr. Winterton)--claim that the Bill will lead to lower standards of health care, and at the beginning of the debate the hon. Member for Glasgow, Garscadden (Mr. Dewar) claimed, like others, that a two -tier system would result. Let me emphasise that I have no intention of allowing my constituents, my neighbours or indeed my family to be dragooned into using private facilities instead of the National Health Service that we have all used hitherto. They are committed to the service, as am I, and I believe that my right hon. and learned Friend also uses and is committed to it. I entirely reject the accusation that the Government's proposals are a Trojan horse to promote the extension of compulsory private facilities.

My hon. Friend the Member for Cheadle (Mr. Day) spoke about health in the debate on the Queen's Speech. He and I were the only Conservative Members from the 1987 intake to vote against the abolition of free eye tests, a subject on which the hon. Member for Livingston (Mr. Cook) has spoken forcefully, as he did in this debate. Many of us listened to the hon. Gentleman with rather more than respect on the earlier occasion ; I am sorry that he did not find a rather more worthy cause to which to devote his talents today and on Thursday. Nevertheless, I think that lessons have been learnt from our experience in the Lobbies when we voted on eye-test charges, and that is one reason why I believe that the underlying principles of the NHS will be safe under the Bill.

I do not believe for a moment that our opponents are right. They are on a high-risk road, because they do not simply claim that the Bill would make no difference. That might be credible, for we have all witnessed the introduction of legislation accompanied by a flourish of trumpets--the Health Service legislation of some 10 years ago is an example--only to find its implementation and

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practice somewhat disappointing. Our opponents, however, have chosen to claim that the Bill will restrict and neglect the NHS, while my hon. Friends and I believe that it will enhance and expand it.

As we draw near the end of this two-day debate we must ask, "What if our critics were right and virtually every Conservative Member was wrong?" In that event there would, I think, be three consequences. Two are fairly obvious, being political and personal, but the third would be much greater local political interference in the NHS. No hon. Member worth his salt would tolerate a worse or more inconvenient service for his constituents : we all want and intend to enhance the present service.

As for the other two consequences, they would affect my party and my right hon. and hon. Friends who are in charge of the Bill. I do not believe for a moment that either my party or my right hon. and hon. Friends are bent on political suicide. For that reason, I strongly support the Bill and believe that, before the next general election, it will bring forth the fruits for which we aim. I therefore hope that the House will give it a powerful Second Reading vote.

8.53 pm

Mr. Eric Martlew (Carlisle) : In the debate on the Gracious Speech, I spent some time comparing the amount that we devote to our Health Service with that devoted by Europe and America to its counterparts. The fact is that we devote a far smaller proportion of our gross national product to our Health Service, which means that our Health Service is very efficient. I wish that Conservative Members would accept that.

I also spoke about reorganisation, pointing out that over the past 15 years the Health Service had been reorganised three times, each time by a Conservative Government. The Conservatives seem to accept that those reorganisations failed ; what frightens me is that, if the Bill becomes law, it will succeed--succeed, that is, in privatising the NHS. For that is what the Bill is about : it is a privatisation enabling Bill.

If we do not defeat the Bill, or defeat the Conservatives in the next election, within 10 years the spivs of the City, Wall Street and the Tokyo stock exchange will be picking over the bones of the National Health Service, and we shall see our local hospitals quoted on the Footsie index. The Secretary of State is encouraging such an outcome by attacking those who provide the care and deceiving the general public.

Was it not the Secretary of State who accused the doctors of reaching for their wallets? Was it not he who gave the impression that GPs earned £65,000, when in reality they earn half that? Was it not he who gave the impression that they were working 24 or 38 hours a week, when the flu epidemic is forcing doctors in my constituency to work 50, 60, 100 or 138 hours a week to care for the sick? That is happening in every constituency, but the Secretary of State tries to tell us that doctors do not work hard. Was it not he who attacked the ambulance personnel? He said at the Dispatch Box that they had not been responding to emergencies ; in fact, they have not only responded but done so without being paid for it.

The Government told the nurses that their regrading and pay claim would be fully funded. I met a delegation from the Royal College of Midwives in my constituency. They were very perturbed that the core of the Bill made no

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mention of maternity services, and were also very concerned about regrading. They know that they are worth more than East Cumbria health authority is prepared to regrade them to, but the fact is that the health authority cannot afford to regrade those midwives. I accept that a considerable sum of money went towards nurses' pay last year, but how the Government and Ministers can put that amount of money into a service and make such a hash of it that people are more demoralised after the pay increases than they were before is almost beyond me. The reality is that the Government are so inept that they squandered the resources. As a result, the nursing service is more demoralised now than in any of the 14 years in which I have been associated with the NHS. The National Health Service is the largest employer in western Europe. It needs great skills and great leadership in man-management at its head, yet we have a Secretary of State who goes around acting like a boorish bully.

I turn now to community care. The principles of care in the community are excellent, but during the past 10 years those principles have been degraded by the Government's efforts. To the Government, care in the community has meant saving money and closing wards. As we leave the Chamber tonight and go home to our nice comfortable flats, we shall be able to see the results of that care in the community--on park benches, sleeping in shop doorways in Victoria street, and in cardboard boxes under Waterloo bridge. That is what community care has meant under this Government.

I have received a letter from voluntary organisations in my constituency which are deeply concerned about the White Paper. In essence, they have said that they cannot be the substitutes for statutory services. The Government cannot get away with voluntary organisations doing that work on the cheap. Those volunteers volunteered to help society, or a specific part of it. They do not want anything to do with taking over statutory responsibilities.

Mr. McCartney : I have had experience of the way in which the Government are attacking the voluntary sector in my constituency. An elderly lady in her 80s has been looked after at home for several years by her daughter who is now in her late 60s. That saves the National Health Service and the community care budget between £300 and £400 per week. However, the daughter was notified only last week that the number of incontinence pads would be cut from 300 to 120. The daughter, herself a pensioner, will have to make up the difference because the health authority does not have the resources to maintain the supply of pads so that that elderly pensioner can look after her elderly mother at home. That is the Government at work.

Mr. Martlew : I accept what my hon. Friend says because there are similar cases in my own constituency.

The voluntary organisations are also concerned because there is no talk in either the White Paper or the Bill of extra funding for community care. Community care is not a cheap option. It needs extra resources and we are fearful that the Government will not provide them.

The question tonight is not whether the community cares, because the community that I represent certainly cares. The community cares for the sick, for the elderly and

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for the dispossessed. The question is whether the Government care, and the answer is that they do not give a damn.

9.1 pm

Mr. Peter Thurnham (Bolton, North-East) : I welcome the Bill and congratulate the Government on their necessary reforms. I am sorry to hear the view expressed by Opposition Members. The hon. Member for Makerfield (Mr. McCartney) talked about ideology, but he is blinkered by his own ideology and is turning his back on private sector funding initiatives that will give better patient care. He reminds me of the old guard in eastern Europe, which the people of eastern Europe are busy throwing out so that they can have the benefits of a mixed economy.

Mr. McCartney : Is the hon. Gentleman saying that I should not defend my constituents who are currently in beds in a National Health Service facility and who are suffering from senile dementia? My constituents, aged between 75 and 95, are being kicked out into the private sector without their relatives or the community health council having a say in whether the alternative facilities being provided are up to the standard required for their care.

Mr. Thurnham : The hon. Gentleman's constituents will benefit from the Bill.

I should like to speak principally about those aspects of the Bill relating to care in the community but, first, with regard to the National Health Service reforms, I was thankful of the opportunity to take a delegation to see my hon. Friend the Under-Secretary of State.

Care in the community is a challenging and radical part of the Bill. Perhaps my hon. Friend the new Minister of State will find the opportunity to visit Bolton to see the scheme that was introduced there at an early stage to pilot some of the ideas that are now expressed in the Bill. The pilot scheme has been described as successful, and that success relates to the commitment of the officers and staff of the health authority and the local authority. As a result of the pilot scheme, nearly 100 people have been settled in neighbourhood network homes.

However, although the scheme has been described as successful, there are problems, principally with funding. I have written to my right hon. and learned Friend the Secretary of State about those funding problems and now appeal to him to consider the funding deficit that has arisen in Bolton. As a result of the commitment given to the pilot scheme, there is a deficit of over £400,000 in the current year and a projected deficit of £200,000 for next year. The local authority has written to me, stating that it entered the pilot scheme in good faith. The local authority believes that it would be a betrayal of the initial good will if nothing could be done to help overcome the deficit that has arisen. The danger of leaving matters as they are is that we may end up with a two-tier service in Bolton. There is a good network scheme for some 100 people who have found places in neighbourhood network homes, but hundreds more people in Bolton desperately need a better service.

Two priority areas were identified in the recent Audit Commission report, "Developing Community Care for

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Adults with a Mental Handicap." One priority is the 19 or 20-year-old with challenging behaviour and profound handicaps, the other priority is older people with frail parents who can no longer look after them. In the normal course of events they might have looked for a home in one of the old institutions, but now they are unable to go there because the number of places has been run down. They cannot have a place on the neighbourhood network scheme because of the lack of funding for the provision of additional places. Will my right hon. and learned Friend the Secretary of State consider funding and ask the Audit Commission to examine Bolton's scheme to see what lessons can be learnt? The shortfall in funding arises from the need to have a ratio of one member of staff to three residents rather than one to four, which means that costs run nearer to £400 than £300. Those lessons can be learnt elsewhere in Britain. The more they are studied now, the easier it will be to introduce new proposals.

I commend the success of the Bolton Handicap Action Group to my right hon. and learned Friend. I helped to set up that group after the last election, when I was besieged by people who had problems caring for handicapped children and adults at home.

The action group has been extremely successful in lobbying local services and exposing scandals--for example, the fact that it takes a bus more than two hours to do a journey to a day centre and a further two hours to come back again. That scandal is just the tip of the iceberg of inadequate services.

The recent social services inspectorate report on inspection of day services for people with a mental handicap says :

"Units frequently had little contact with families. Few families and no clients were involved in overall planning of services." That is the most welcome part of the Bill.

I hope that parents' groups and carers' groups will be incorporated into family services.

Will the Secretary of State consider funding a pilot scheme allowing the Bolton Handicap Action Group to set up a charitable company to quote for the services that are so inadequately provided by the local authority at the moment? I mentioned the bus services, and there is also a problem with day centres that are grossly overcrowded and not sufficiently well-staffed to provide the service that people attending them want. It would be helpful if my right hon. and learned Friend would consider funding that pilot scheme so that the Bolton Handicap Action Group can provide those services itself. I notice that the Bill will enable local authorities

"to provide community care services by making arrangements with any organisation capable of providing them."

I think that a word stronger than "enable" is needed. Many local authorities will need a strong push to use a novel form of service that will provide better care to the mentally handicapped and to other patients.

The Audit Commission's report says that the fundamental change will be that

"in future the care manager must be the principal budget holder This will come as a shock to many social workers and councillors." I am sure that we need a stronger Bill to ensure that reforms and changes are properly introduced.

Many groups need to benefit from the changes outlined in the Bill which we shall consider closely in Committee. There are more than 125,000 mentally handicapped adults,

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of whom about one half are at home and one half are in residential care. Those at home need the greatest help possible for carers, and a great deal more help than is available at the moment.

The survey of the Office of Population Censuses and Surveys identified more than 5,000 handicapped children in institutional care. That is 5,000 too many. I appeal to my hon. Friend the Minister to do all that she can to help find families to care for those children, who should not be in institutions.

9.10 pm

Ms. Diane Abbott (Hackney, North and Stoke Newington) : Conservative Members have said that they do not believe that Ministers are bent on political suicide. We beg to differ. An enormous amount of cant has been spoken about Conservatives' care for the Health Service. Conservative Members and Ministers say how they want to preserve a free Health Service and that it is safe in their hands, but that is cant. The professional organisations know it, the public know it and the Opposition Members know it.

To illustrate my point, I shall take the House back to November 1987, shortly after the last general election. Quite by chance, I happen to have the confidential minutes of the Carlton club political committee. The document is stamped "Confidential. Restricted circulation. Strictly private and confidential." I shall tell the House all it needs to know about the document in the few minutes available to me.

The minutes are of a top secret seminar at which the future of the Health Service was discussed. Who was there? Nurses? Doctors? Patients? People from voluntary groups with a record of concern and care for the Health Service? No. Bankers. Plenty of bankers. At least 50 per cent. of the people there were from private health care companies. There were people from the Institute of Directors, people from Central Office, a man from the No. 10 policy unit and, above all, Ministers. What proposals did they come up with? First, opting out. Surprise, surprise. Secondly, proposals to extend the principle of charging and to create a costed service. Does that sound familiar to Opposition Members? Thirdly, a joint venture between the private sector and the NHS was proposed. Fourthly, there were proposals for tax relief on private insurance. All of those will be familiar to the House and the country.

The seminar also came up with proposals which were too bizarre even for the Prime Minister. One was to rename the Health Service so that the public would know that the whole thing had changed. That seems to have been jettisoned. It came up with a proposal with which the Secretary of State seems now to be involved, to smash "old fashioned" Health Service unions such as the National Union of Public Employees and the Confederation of Health Service Employees to force the creation of a single union with professional sections for the Health Service. That appears to be the Secretary of State's aim with the ambulancemen.

The seminar also came up with proposals to privatise intensive care, pathology and the ambulance service. These are proposals which business men, people who run private hospitals and Ministers discussed in November 1987. It is no surprise to us that the Bill has emerged in this form.

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Behind it lies no concern for the Health Service. There is no real interest in what professional organisations and workers have to say. Behind it lies pure, naked ideology.

When Ministers tell us that the underlying principle of the Health Service is that free medical treatment should be provided regardless of need, how can they expect people to believe them?

Way back in November 1987 Lord Skelmersdale, a Government Minister, said at the secret Carlton club seminar :

"the NHS has never been a full, comprehensive and entirely publicly funded system :"

Among other things he said that there may be a

"need to allocate resources which could involve establishing priorities so that elective procedures were either paid for by the patient or only took place when more urgent needs had been satisfied"

The origin of the Bill is ideology and secret seminars. A major Bill has been introduced without proper consultation with nurses, doctors, patients or the public. The Government refuse to do pilot studies, but way back in 1987 they were consulting at the Carlton club. The Bill comes out of the Carlton club and ultimately will benefit only the members of such clubs.

We know the reality of the Government's position on the Health Service. We remember what they said about charging for eye tests. We remember the Secretary of State telling the House that charging would have no effect on the level of eye tests and that at most the charge would be £10. We know that the average is higher and that the number of people having eye tests has plummeted. That means that the elderly, the poor and the sort of people that I and my hon. Friends represent are not having eye tests. We know the Secretary of State's purpose because of what he told us about eye tests and because of his sustained campaign to starve the ambulancemen back to work as a preparatory project for privatisation of that service, among others. We can see the reality of the Government's promises about the Health Service when we look around us at local areas. In my constituency in east London, St. Bartholomew's hospital, the oldest teaching hospital in London, is half empty because of Government cuts. The Government will not fund the nurses to keep the wards open. I receive letters every day from people who have spent years in pain waiting for surgery that the Government will not fund.

We know the Government's purpose for the Health Service. The Bill is the first step towards privatisation. The public know it, Health Service workers know it, professional organisations know it and the public know it. As someone whose mother worked for more than 30 years in the Health Service until her retirement a few years ago, one of the many millions of ordinary people who have worked to build the Health Service, I shall be proud to go through the Lobbies this evening and vote against the Bill.

9.17 pm

Ms. Harriet Harman (Peckham) : This debate has been conducted against a background of overwhelming opposition to the Bill. The only response from the Government and from Conservative Members is that people oppose the Bill because they do not understand it. People do not want the Bill precisely because they do understand it. They understand that the family doctor service will be cash limited and that, for the first time, people will receive the treatment and care that their GP can afford rather than the treatment and care that they

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need. They understand that, for the first time, they will lose the ability to choose which hospital they go to for treatment and that, instead, that choice will be made by managers. Patients will simply have to go where the managers have placed the contract. People understand that when placing contracts managers will look at the cost rather than the quality. A patient will be sent where the care is cheapest rather than where it is best.

People understand that the Bill will enable the Secretary of State to allow their local hospital to opt out from the local National Health Service and that patients will have no way of stopping him. They understand, too, that the Government plan to cheat on community care spending and blame councils for the lack of local services. They understand that the Government are rigging the system so that people will have to go into private commercial care homes rather than have the choice of a council home or a NHS nursing home.

I shall deal first with community care. The Secretary of State for Health said virtually nothing and the Secretary of State for Scotland said absolutely nothing about it. It is lamentable that the community care provisions have been tagged on to the Bill as nothing more than an afterthought. Undoubtedly the Government hoped that community care would be an uncontroversial appendix to the Bill.

The publication of the White Paper and the clauses on community care in the Bill have met with widespread apprehension. In particular, there is anxiety that the Government will not make available the resources necessary to make good-quality care in the community a reality. Again and again the worry about resources surfaces from organisations such as Age Concern, MIND, Mencap and numerous others which represent those who will use the services in the community. Even the National Association of Health Authorities and the Institute of Health Services Management have expressed anxieties about resources.

Why should the Government command any respect in this area? The Secretary of State for Health is fond of quoting the increase in services for people with mental illness, such as day and hostel places. But he never mentions that the increase in provision is far outweighed and cannot nearly match the numbers leaving mental hospitals. He quotes the increase in local authority social services spending as if somehow he can take credit for it, when councils' increases in social services spending have taken place despite the Government, not because of them, as hard-pressed Labour councils have tried to improve and increase the services they make available in the community despite Government spending cuts.

The Conservative commitment to care in the community can be seen in action in Conservative-controlled local authorities where the provision of home helps and meals on wheels for the elderly, the vulnerable and the dependent takes second place because the priority is to keep rates down. Social services are already underfunded and my hon. Friend the Member for Wakefield (Mr. Hinchliffe) gave us a case in point. He told the House of a young disabled male constituent who lives with his parents. The social services authority could not provide enough domiciliary or respite care to enable that family to carry on caring for the young man, so he had to go into residential care. As no National Health Service

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nursing care or council residential care was available, he had to go into a private home. That family now faces the prospect of having to sell their house to pay the private nursing home fees. Councils are already underfunded and their services are overstretched, yet downward pressure on spending, which is the intention of the poll tax, will reduce that already inadequate base still further. Councils throughout the country have been calculating what they will have to do if they are to levy a poll tax of £278, which is what the Government have said will be the average. A council in London calculated that if it had to rely on a poll tax of £278, it would mean a 30 per cent. cut across its social services. It would have to cut all its home help and all its meals on wheels services. A council in the north-west of England calculated that even to bring its poll tax down to £400 would mean that it would have to withdraw its home help services from 2,000 of the people who depend on it or find another way of cutting social services by £13 million. It is against that background that the Government make local councils responsible for care in the community. That is why there is deep suspicion that there is to be no earmarked funding for community care. The Government and their Back Benchers criticise us for asking for earmarked funding and say that that shows that we do not trust councils. It is not that we do not trust local councils. It is because we and local councils do not trust the Government that we demand earmarked funding for community care.

As my hon. Friend the Member for Halifax (Mrs. Mahon) said, there is already little choice for someone who needs residential or nursing care in the community. As cottage hospitals and geriatric wards have been closed, those who might previously have been able to use their services have been forced into private nursing care. As my hon. Friend the Member for Makerfield (Mr. McCartney) said, virtually no NHS nursing care is left. As council spending is squeezed, fewer places are available for the elderly and the disabled. Despite the growing demand, there are fewer places in council residential care, with the result that people have been moved into private residential care homes. A major privatisation programme has been achieved by means of a combination of Department of the Environment spending cuts on local councils and social security handouts by means of payments to private homes.

The Bill takes privatisation one step further. It is nonsense to say that it will provide a level playing field for private and council care. People will retain the right to income support and housing benefit only if they go into private care. To go into council care results in people losing their right to those benefits. Councils are unable to monitor the standard of care in private homes. I have read all the decisions of the Registered Homes Tribunal. They tell an appalling tale of abuse, neglect and ill- treatment. Vulnerable and dependent people are tied to chairs, drugged and abused. People with strings of convictions have set up private old people's homes because they see the chance of making a quick profit. I shall refer to two out of many cases. The first is Mrs. Scorer who ran a residential home in Cambridgeshire. According to the findings of the Registered Homes Tribunal,

"There was mental cruelty residents were abused and insulted by being called names to their faces and humiliated by being shamed in front of other residents. They were physically abused in that some were roughly

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handled, pushed and pulled unnecessarily, frog-marched, slapped ; some had their clothes yanked off Mrs. Scorer shouted at residents ; insulted and humiliated them by calling them names ( fat old pig', stupid', dirty', smelly' and filthy')".

Mr. Hind rose --

Mr. Hayes rose --

Ms. Harman : The other case concerns Mrs. Canning who ran an old people's home called Warwick Hall. Witnesses to the Registered Homes Tribunal spoke of her using obscene and filthy language and that, "She said to one resident, I do hate you, your family hate you, that's why you're here.' A former employee said of Mrs. Canning she loathed children and said mongols should be gassed.' Another former employee told of Mrs. Canning's attitude to a resident who had chronic diarrhoea.

If they mess the bed, don't change it, let them lie in it.' A relative said : New residents wanted to go home and stood by the door. She shouted at them loud and aggressive. It was awful and sad.' "

For all their lip service to quality--

Mr. Hind rose --

Mr. Hayes rose --

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