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trust with so much capital debt that it would render the business plan meaningless, and the trust would be bankrupt even before it had been set up. Perhaps the Secretary of State will compensate the university for the loss of the site. However, that would be a blatant misuse of public funds for politically doctrinaire ends.It would be utterly absurd for the same person to decide what level of compensation the university would receive for the loss of facilities, if the trust application went ahead, and to sit in judgment on the trust application itself. It would be a classic conflict of interest. It would not be allowed in the council chamber, and it should not be allowed in the Cabinet. That alone should render the entire application for the Foresterhill opt-out null and void forthwith. If the Government are not willing to give that message at the end of the debate tonight, they will get that message from the public in the by-election on 7 November.
What about the existing trusts which have already gone ahead in England? They should be reviewed case by case, given the remarkable financial holes which have opened up among many of them. Their financial viability, the community responsiveness and the extent to which they can be brought back under the health authority's ambit should all be guiding principles here. The membership of the trusts, and the whole question of the extent to which the buildings and the sites involved can be brought back directly into NHS public ownership, are also relevant.
It is not enough to look at the existing tranche of trusts, as the Labour party proposes to do, and to say that, on the appointed hour, all the gears will be thrown into reverse and there will be a further reorganisation in the other direction. I can assure the House that anyone talking to professionals in the health service knows that they are sickened by reorganisation after reorganisation, and that morale would be further depressed by that. A more pragmatic approach will have to be taken to the first wave of trusts.
Mr. Robert Hughes (Aberdeen, North) : The hon. Gentleman is on an interesting point, especially in relation to the Foresterhill hospitals. Is he saying that, if the Secretary of State for Scotland agrees to the opting out of Foresterhill, matters should be left there, and that the health of the people in my constituency should be left to the vagaries of the trust? The hon. Gentleman cannot have it both ways. He is either for the trusts or against them. He cannot hedge any more in Kincardine and Deeside.
Mr. Kennedy : There is no hedging going on in Kincardine and Deeside, or anywhere else, as the hon. Gentleman knows. The Liberal Democrat candidate in Kincardine and Deeside has organised a massive petition for many months before the by-election on the issue. I have just made the position clear. In Wales and in Scotland, there should be no opt- outs, full stop, because they are not there already. In England, there should be a complete cancellation of the second wave of proposed opt-outs.
For the first wave opt-outs which have already gone ahead, the presupposition must be against the continuance of NHS trusts, which means studying the membership of the trusts and the statutes under which the trusts have been established, including the ownership of the sites and of the land, the conditions of service of the staff, the contracts of employment and the lack of democracy that has bedevilled
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the entire process, to ensure that the national erosion of the health service does not go further. That is a clear and unequivocal statement of position.Mr. Jim Sillars (Glasgow, Govan) : Let us consider the position in Scotland. If the Tory Government ignore public opinion in Kincardine and Deeside and, let us say, in Ayr, where the Ayr district general hospital is also a candidate for trust status, will the Liberal democrats wish those hospitals not to be transferred back into the national health service?
Mr. Sillars : The hon. Gentleman says no. Why should it be different in England?
Mr. Kennedy : With great respect to the hon. Member for Glasgow, Govan (Mr. Sillars), I must point out that I have said no such thing. The smile on the hon. Gentleman's face suggests that he knows that. I have made the position clear. In Committee and in the House, the Liberal Democrats opposed NHS trust status, and we continue to do so. I am talking about the first wave that have been approved in England. They are already up and running. The question that has to be addressed is how, in practical terms, they can be brought back under proper national health service management control. Practical legislative means are available to the Department of Health, and we argue that such means should be used. That position is clear. Mr. Bob Cryer (Bradford, South) rose--
Mr. Kennedy : I want to continue.
The great financial difficulty into which the Government have got themselves into is that they have confused cross-boundary flows with an internal market. That has now been seen by the health authorities that are losing in terms of extra-contractual referrals. Indeed, halfway through the financial year, some health authorities find that the money that was set aside for extra-contractual referrals has been almost used up. So much for money following the patient ; the patient is now following the money, due to the nature of the block contracts which have been entered into. They reduce GP and patient choice, and make nonsense of the so-called citizens charter--let alone any patients charter.
What, then, should be done about NHS funding? First, the Government have never properly recognised that the true level of health service inflation runs persistently higher than that expressed by the retail price index. The opinions of experts differ, but I think that it is fair to say that the difference is between 1 per cent. and 2 per cent.
That being the case, surely it is essential for the Government to increase annual expenditure on the health service by a minimum of 1 per cent., in real terms, above the level of health service inflation. If they are committed to growth in the service, that will be necessary not only to keep pace with developments in medical technology and with the demographic change that has increased the proportion of elderly people, but to advance.
Secondly, within that total the Government must include the abolition of charges for eye and dental tests. There is no doubt that, in the long term, the disincentive that those charges produce will cost the country more. People will choose not to use the excellent preventive services that are now available.
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Mr. James Couchman (Gillingham) : Is the hon. Gentleman aware that the number of eye tests currently being carried out has risen almost to pre-charge level?Mr. Kennedy : I am afraid that the hon. Gentleman is very badly informed. An analysis that we have conducted over the past 12 months, which covered several hundred constituencies, proved conclusively that, in the case of opticians, the opposite is the case. Any dentist or optician will tell the hon. Gentleman that there are now two income categories that they can treat, providing the full range of preventive and promotional health services that they wish to provide. The first category comprises people on income support, whose treatment has been fully funded ; the second comprises those who are sufficiently well off not to have to worry about the cost. Those who fall between the two categories--who now form the majority--are having to cut corners, and are not proceeding with the full- scale preventive treatment that is considered essential. The hon. Member for Gillingham (Mr. Couchman) is, quite simply, wrong.
The Labour party says--I do not doubt the sincerity of its intent--that it would make extra finance available as economic growth was achieved. We should, I think, view the position with a little more optimism : we should take the view that, in the event of 1 per cent. real growth on top of health service inflation, any economic growth on the basis of which further NHS funds could be provided should be seen as a health dividend--as a means of bringing Britain, bit by bit, more into line with our continental neighbours in terms of the proportion of GDP that we devote to health.
Mr. Rowe : Will the hon. Gentleman give way ?
Mr. Kennedy : In fairness to Conservative Members, I want to finish my speech soon.
Thirdly, the Government must be prepared, if necessary, to use contingency reserves for the full funding of national pay awards. We must end the ludicrous and unfair system whereby awards that are decided centrally are not funded nationally, necessitating the making of local cuts. Our approach is honest, in that it recognises the need for those who criticise the Government for not spending enough to spell out the details of the additional expenditure that they themselves advocate. I sympathise with some Conservative Members, who must feel irritated when they hear complaints from Opposition Members who give no pledges or figures to back up those complaints. That is not the stance that we have taken ; we have already made our costing public.
Trusts currently dominate the health debate, and I noticed that the word "trust" also dominated the conference address of the Conservative party chairman, who almost invoked Baldwin by saying, "Trust the people." The people do not trust the Government with the health service, and they certainly do not trust what the Government are telling them about the health service and hospital trusts. The result of the Eastbourne by- election contributed somewhat, I believe, to the atmosphere that led to the downfall of the right hon. Member for Finchley (Mrs. Thatcher) ; the Ribble Valley result contributed somewhat to the circumstances that led to the withdrawal of the poll tax. I think that an appropriate result in the Kincardine and Deeside by-election--appropriate from our point of
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view, and that of the health service--could contribute to an end to further opt-outs, and a reversal of the policy itself.The Government's reforms are as misconceived as the present Secretary of State for Health is miscast. There is a case for a realistic costed alternative ; the Liberal Democrats will continue to argue in favour of it in the House, on the hustings and whenever the opportunity provides itself.
6.46 pm
Mr. Michael Morris (Northampton, South) : First, I declare an interest : I am married to a general practitioner, and I am an adviser to two pharmaceutical companies.
This evening marks the first occasion on which I shall have voted with the Government on the national health service issue since the introduction of the GP contracts and the NHS reforms. I shall be doing so because it is now clear to me that the present Prime Minister is 110 per cent. committed to the national health service. He has made it abundantly plain to the nation not only that he believes in the service, but that he has used it throughout his life, and that his children were born into it. That commitment represents a gold standard that the public should understand and respect, and I think that they do.
My right hon. Friend the Secretary of State has shown doggedness and tenacity in achieving a real increase in funds for the national health service. That is long overdue, and I pay tribute to him. Those of us who were here at the time of the 1974 Labour Government remember all too clearly the cuts that were made then ; perhaps the hon. Member for Livingston (Mr. Cook) was not here, but if he was, he must remember the debates that took place--I spoke in some of them. In particular, he must remember the 3 per cent. cut in nurses' pay, the 17 per cent. cut in doctors' pay and the 29 per cent. cut in capital expenditure on hospitals. I must tell the hon. Gentleman that that record does not stand up against the record achieved by the current Secretary of State.
Having conferred those words of praise on Ministers, I do not wish them to think that I am entirely satisfied with what is happening on the ground. I want to ask them some questions. First, are they really doing enough to chase the NHS executive up hill and down dale to implement the reforms? Let us look briefly at the role of the GPs as gatekeepers for a successful hospital service.
There is little doubt that the concept of fund holding--the concept, in effect, of the self-employed general practitioner--is attractive, and GPs will wish to continue in that role. Having read the medical press and listened to the views of many doctors all over the country, I am convinced that there is a general desire to adopt such arrangements. I hope that the artificial restriction in respect of the number of patients will be removed. There are GPs in my constituency who are under that level, but they are perfectly capable of becoming fund-holders if they so wish, although there is no compulsion.
Morale remains too low among our GPs. A letter about GPs' pay arrived this morning from the general medical services committee. It stated that targets have been achieved under the contract, but that it is the review body's desire to claw back the extra remuneration achieved by meeting those targets. If my right hon. Friend the Secretary of State wants to switch off every GP in the
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country, there is no surer way to do that than to ensure that, if a GP meets his target, the extra money that he earns will be clawed back for achieving the target.My hon. Friend the Under-Secretary of State for Health issued an excellent press release on 18 October about the increase in the number of GPs using computers. That was a good press release, but it would carry more weight if there were not family health service authorities around the country which were unaware of their budget until this year was five months on and which have said that there will be no remuneration for maintenance payments. Even today, funds available for GP computerisation are inadequate to meet the targets that my hon. Friend the Under-Secretary of State wishes to achieve. One of the problems is how to tackle the FHSAs. We must stop some of the nonsense that is occurring. The exceptional FHSAs, which do something other than the norm, cause the trouble. In some cases, authorities will transfer resources from one budget to another, and that distorts general practice in that area. In other cases, money set aside for staff and premises is transhipped to another category of expenditure. There are GPs in some parts of the country--thankfully, not in my constituency--who are not being paid the full amount for what they achieved in the previous quarter. If my right hon. Friend the Secretary of State reflects on the GP contract, he must realise that it was probably a mistake to have only one medical representative or doctor on FHSAs. The experience of those dedicated people is necessary to make the system run smoothly.
Trust hospitals are, and always were, part of the national health service. They are part of devolved management, which was the concept behind trust status. The problem, as many of us who have studied these matters know, is that the strategy of my right hon. Friend's predecessor, the former Secretary of State for Health, to rush in with 57 new trusts without clear monitoring has proved to be a sticking point.
I agree with the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) that it makes no sense to proceed without a thorough analysis of what those 57 hospitals have achieved. If the vast majority are a success, we can go forward with total confidence. I believe that that may be the case, but I should like it confirmed. With regard to the second wave, I considered the applications for the Oxford region, part of which I represent, and I was happy to support the majority of those applications. However, I thought that the submission by the Milton Keynes acute hospital was distinctly thin. That unit has not managed to live within its budget since it was created and it has been feather-bedded because it is a brand new city hospital for the new town of Milton Keynes. Nevertheless, its application was approved. Decisions of that kind cause difficulties. Northampton general hospital has not sought trust status yet, but what safeguards will apply to that hospital if the hospital in Milton Keynes faces difficulties? Will Milton Keynes once again receive the extra resources to the detriment of the remaining hospitals in the Oxford region? If devolved management is the basis of the development of the hospital side of the NHS, we should remember that there are two forms of devolved management in education-- grant-maintained status and
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local management status. Although trust status may be one form of devolved management in the health service, one hopes that there may also be others--this should not be a black or white issue. I fervently believe that it the right of every patient--and, through the patient, the GP--to know how long he or she will have to wait. I congratulate my right hon. Friend the Secretary of State on setting firm targets, so that, by next March, no one will be on a waiting list for more than two years, and that, by March 1993, no one will be on a waiting list for more than one year. Both those targets are praiseworthy. However, it is not sufficient simply to consider in-patient waiting lists ; we must also consider the delays in obtaining out-patient appointments. We must highlight that dimension as well.The changes will not occur simply as a result of exhortations from the chief executive of the NHS. There must be a combination of relentless pressure for continuous quality improvement similar to that achieved by the quality control methodology of manufacturing industry. It also requires extra targeted resources. Why can we not have a monthly statement to show what we are achieving in comparison with our targets? All hon. Members receive a monthly statement about unemployment which is broken down to constituency and ward levels. If we can have such a service from one section of the state, why can we not have such information about the NHS?
The basic position of my right hon. Friend the Prime Minister is crystal clear. Whatever may have been the intentions of my right hon. Friend the Member for Finchley (Mrs. Thatcher), it is clear that the present--and, I believe, the future--Prime Minister uses the NHS ; he believes in it, and he is grateful for what it has done for him and his family. The basic concept of its being free at the point of use is fundamental to him, to me and to all Conservatives. The other significant change is that my right hon. Friend the Prime Minister recognises that the NHS requires extra real resources. However efficient the management may be--there is still a long way to go in that respect--we cannot hide the fact that the NHS's percentage of GNP must rise in this country. We should not be on a level with Greece and far below France, Germany, Italy and our other European partners in that regard. My right hon. Friend the Prime Minister recognises that.
Labour never got the economy moving. Labour Members have never been able to achieve what they wanted in their hearts to achieve. Their desires remained desires and aspirations, never becoming a reality. I remain critical of what is happening on the ground and of the way in which some of the strategies are interpreted at district health authority and FHSA level, but for the first time I can honestly say that we have a Prime Minister and a Secretary of State for Health who believe in a national health service. I shall therefore have pleasure in supporting the Government today.
Several Hon. Members rose --
Mr. Deputy Speaker (Sir Paul Dean) : I remind the House that the 10- minute limit on speeches operates from 7 pm.
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6.59 pmMr. Michael Foot (Blaenau Gwent) : I am the only Member who was present in the House to hear Aneurin Bevan make his Second Reading speech which introduced the national health service and also heard him, from the same Bench on which the hon. Member for Northampton, South (Mr. Morris) sits, deliver his resignation speech about charges that were imposed. I was hoping to have discussed some of that history, especially because the Secretary of State gave a most misleading account of it. He should not have done that. He should have taken a bit more notice. He might even have learnt something from a letter which appeared in The Independent the other day, which states :
"Sir : I am absolutely thrilled by William Waldegrave's undertaking for a complete reversal of Conservative policy on the NHS, that is, equal access to free health care throughout the country for everybody, regardless of their means'. My last two sessions of free' health care cost £52 (teeth) and £176 (eyes)."
Aneurin Bevan would have been especially interested in that letter. It was on precisely the charges that were introduced for teeth and spectacles that he resigned. He had some other excellent reasons for his resignation, but he tried to give a warning to the country, a warning to the Labour party, which was on the Government side of the House at that time, and a warning to some others, too. The whole country would have been wise to listen to what he said. He said : "The Chancellor of the Exchequer in this year's Budget proposes to reduce the Health expenditure by £13 million--only £13 million out of £4,000 million."
He went on to state :
"What is to be squeezed out next year? Is it the upper half? When that has been squeezed out and the same principle holds good, what do you squeeze out the year after? Prescriptions? Hospital charges? Where do you stop? I have been accused of having agreed to a charge on prescriptions. That shows the danger of compromise. Because if it is pleaded against me that I agreed to the modification of the Health Service, then what will be pleaded against my right hon. Friends next year, and indeed what answer will they have if the vandals opposite come in?"
He was referring to the Opposition. He went on to state : "What answer? The Health Service will be like Lavinia--all the limbs cut off and eventually her tongue cut out, too."--[ Official Report, 23 April 1951, Vol. 487, c. 41-42.]
Many of us think that Aneurin Bevan had great prescience. I do not think that he foresaw the way in which the present Government would seek to impair the rights of people in the health service to raise their voices against the methods that were forced on them by the Government. He made a careful prophecy, and I hope that everyone will take account of it. The Secretary of State was wrong in his history of the subject, so I advise him to read the excellent history of the national health service by Charles Webster. Many of the problems that the health service had to face are set out.
The Times Literary Supplement review of that publication states :
"The miracle of the British National Health Service is not that it survived its delicate infancy but that it ever came to be born." Then comes the prophecy :
"If it required a politician with the weight of an Aneurin Bevan to create the NHS, it will probably require one in the mould of Margaret Thatcher to dismember it."
The word "dismember" may be just as good as "privatise" because it means pretty well the same thing. It means
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exactly what my right hon. Friend the Leader of the Opposition and my party have been describing to the country that the Government seek to do.We can review the history of this measure as well as the history of what happened in the days of the Labour Government and the way in which we introduced the national health service and fought for it against all the opposition raised from Conservatives all over the country. There has been a history of this measure. The hon. Member for Northampton, South has made many brave speeches criticising the Government on the subject of the health service. He has much more knowledge of the health service than most of the rest of his party rolled together. They should take note of what he says. On previous occasions he has been even more critical. He now says, "It is different. The policy that is now being pursued by the new Prime Minister is different from the one that was introduced by my right hon. Friend the Member for Finchley (Mrs. Thatcher) when she was Prime Minister."
We must be fair to the right hon. Member for Finchley. It may seem very strange for an Opposition Member to say that, but we should be fair even to her. She was responsible for the introduction of the measure. She was responsible for refusing to listen to the doctors, the British Medical Association and the royal colleges. She is the one who slammed the door in their faces and would not listen to them. It is most unfair that all the blame should be put upon her. She was much too impatient, but she had Ministers who were much too subservient. She was always hectoring and they were always cringing. She knew what she wanted to achieve ; they knew they wanted to hang on to their jobs.
If anybody questions what I say, he or she has only to imagine what would have happened if any Secretary of State for Health--heaven knows, there are plenty of former Secretaries of State for Health on the Government side of the House--had dared to have the latter-day conversion which afflicted the right hon. Member for Henley (Mr. Heseltine). He belatedly decided that he would oppose the poll tax, even though he was quite prepared for the poor Scots to endure it. But he at least revolted. If one Secretary of State or one member of the Cabinet had dared to revolt, the Government would not have led us down that dangerous path which threatened the future of the national health service.
Ever since the new Prime Minister took his job--an Edmund Burke phrase rings in my mind--his Ministers have attempted meanly to sneak out of difficulties into which once they proudly strutted. Pretty well all of them strutted in. A couple of years ago, even the hon. Member for Northampton, South was an enthusiastic supporter throughout the country. He gave almost as much support to the proposals then as his right hon. Friend is giving to the present proposals. We see no great difference between them. Anyone who studies the reality will see that they are very much the same proposals-- the same proposals which the right hon. Lady forced on her subservient Cabinet and the same proposals which they devised in the Cabinet committee that had never examined any of the proposals and objectives from the medical profession or the British Medical Association, as the hon. Gentleman will be keen to confirm. Even more serious is the fact that the heads of the royal colleges pleaded with the Government, the right hon. Lady and her subservient Ministers to listen. We could have been saved all that trouble.
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Five months, 10 months or two years ago, huge sums of money could have been saved. I am not sure whether we would have saved more than the losses on the poll tax--that would certainly mean setting it pretty high. As my hon. Friends have often said, we could have had a united, intelligent review of the health service.Aneurin Bevan was never opposed to reviews of the health service. He even said that they should happen every five or 10 years to see how we should make the best advances and how we could make the whole apparatus more democratic. Indeed, he set out the measures to do that. In 1958, in his last speech on the health service, he told the Conservative Government, "You have had about five or six Ministers of Health. They have not been much good because, apart from their other disqualifications, they have been here such a short time that they are unable even to learn their job, and the main point of their job is how to stand up to the importunities of the Treasury." That was the delicate way in which he described it.
When we win the next election, as I am sure we shall, I hope that my hon. Friend the Member for Livingston (Mr. Cook) will be given the same five- year period at the Ministry of Health as was given to Aneurin Bevan in 1945. When he was given the chance, Bevan said, "I want to stay here for five years to carry through the whole programme." One of our very best days since 1948, when the NHS provisions were introduced, will be when my hon. Friend the Member for Livingston, who has earned so much respect because of the way in which he has put his case, takes up the office of Secretary of State for Health and starts to clear up the terrible mess that the Conservative Government have made.
7.9 pm
Sir Timothy Raison (Aylesbury) : I am one of those who enjoys listening to the right hon. Member for Blaenau Gwent (Mr. Foot) speaking as Aneurin Bevan's vicar on earth. It will be a sad day when we can no longer hear him speak in the House. Unusually for him, when the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) spoke on behalf of the Liberal Democrats, he used a tired phrase ; he talked about health being treated as "a political football". I think that we all know in our hearts that that will continue and that there is absolutely no possibility of the House of Commons ceasing to take an interest in health or of its ceasing to do so in a thoroughly partisan way. Indeed, it is right that we should debate the health service in the Chamber and even inject party politics into the subject.
Having said that, however, we are reaching a situation when the Labour party's posture on this matter--and especially that of its Front-Bench spokesmen--is becoming more and more ludicrous. The scale and nature of Opposition Members' attacks on the health service are totally misleading and mendacious. Their case is becoming absurd and beginning to fall apart.
We all heard the hon. Member for Livingston (Mr. Cook) once again trailing out a list of touching hard cases. The public are beginning to see through all that. It is time that the hon. Gentleman looked for something else to talk about. I notice that he is about to leave the Chamber, and
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I do not blame him for that. He talks a lot about long waiting lists, but the longest waiting list is the one that he is on in his search for office.I genuinely believe that my right hon. Friend the Secretary of State has managed to reverse the gravamen of the political onslaught in the past few weeks. The way in which he has responded to Labour's irresponsible attacks and has clearly shown exactly what is happening in the health service has been enormously to his personal credit. It is beginning to get through to the public that there is something false in the Opposition's assertions.
I firmly believe that our structural changes are on the right lines. The introduction of the trusts and of budget-holding practices is a thoroughly good idea. I do not go along with those who say, "Let's sit back for a few years to consider whether they are a good idea." It would be totally wrong to block the growing impetus for reform in many parts of the country. I do not know what people in Scotland and Wales are saying--perhaps they do not want to experiment with trusts--but the blocking or deferral of the proposed trusts in my part of the country would lead to great disappointment. Anybody who has looked at what is happening or talked to the people involved will know that what I am saying is true.
I do not claim that we have always got our health service reforms right. It is pretty obvious that our reforms at the beginning of the 1970s were wrong. Although I dutifully voted for them, I now think that we introduced a grossly over-bureaucratic system in which tier was piled upon tier. That had to be dismantled. I am not trying to claim any unique virtue for my party's approach to such things, but I believe that we have now evolved a system that offers the possibility of a greater directness of management. It will be a much leaner system than in the past and one in which decisions will be taken where they should be taken. To use a naval analogy, we are trying to ensure that decisions will be taken on the bridge of the ship rather than in the Ministry of Defence. If that principle is sound in war, which it most certainly is, exactly the same should be true of running the health service.
As a result of the reforms, I believe that we shall see a more clear-cut management with incentives to efficiency through competition. It was interesting that the hon. Member for Livingston ended by saying that a Labour Government would be looking for incentives to try to increase efficiency and to reward success. Curiously, therefore, at the end of his speech he started to concede part of the philosophical argument. Of course, a Labour Government would not actually do that, whereas we have found a system that will achieve it. Indeed, until recently, socialism everywhere always led to a bureaucratic approach. The irony is that socialists elsewhere are now beginning to recognise the failures of the bureaucratic approach and are working hard at decentralisation. That is happening in the countries of eastern and central Europe--only the British Labour party is living in the past.
We all know that the health service will not be magically transformed overnight. Nobody expects that. However, given time to mature, I believe that the new system is heading in exactly the right direction. I should like to illustrate that point by examples from my constituency where the state of play is that we have four trusts or potential trusts. One has just been approved by the Secretary of State ; one has been deferred ; and two are included in the third wave.
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The new trust that was accepted last week is the Aylesbury Vale community healthcare trust. I am sure that it will be outstandingly successful. The trust will cover adult mental health, the elderly mentally ill, mental handicap, physical rehabilitation and general community work, such as district nursing, health visiting, chiropody, and palliative care. It will come into being with strong popular support. Indeed, there was very little opposition to it at the discussion stage. Those who will operate the service are committed to it and the community health council supports it. It would be a bitter blow to say to those people, "Sit back, go away and do nothing for the next year or two." As I said, I can see no reason why that trust should not be outstandingly successful.The trust in south Buckinghamshire, to be based around Wycombe, was deferred. Although that is sad because much good work went into its preparation, I do not necessarily blame my right hon. Friend the Secretary of State for deciding to defer it, because it would be a single-district trust and I have always had some reservations about whether such trusts are the right way of proceeding. Perhaps some financial questions remain to be resolved. I am delighted, however, that although my right hon. Friend has made it clear that he cannot accept the application at this stage, he believes that the trust will be able to go ahead in due course and he will consider its application sympathetically. If we were to have a single health authority for the whole of Buckinghamshire instead of three different health authorities, I am sure that we would overcome the single district trust problem and that such a trust would then have the viability that it does not have at the moment.
The proposed third wave for the county ambulance service seems to make good sense. The other proposed third wave trust would cover Stoke Mandeville hospital. Although it is famous for its spinal injuries unit, it is, of course, a district general hospital as well. It has had some difficult problems and some disappointments over the delay in its redevelopment programme. It has also had various other problems, including overspending. Again, I believe that the best way of tackling those problems and of making use of its highly skilled staff would be to run the hospital from within the unit rather than imposing management from outside.
I am not criticising the past management, although they have had their difficulties, but if one asks what is the best way of running a unit that faces problems, of having a happy staff, of building up their morale and of tackling some tricky development problems, who could seriously deny that that is far more likely to be achieved by managing the unit from within-- rather like a battleship--than by imposing the management from outside?
I believe that the underlying philosophy behind what we are setting out to achieve is absolutely right. Of course, there will be problems. The health service will be underfunded, but then, it will always be underfunded. Anyone who is honest will accept that it will always demand more and more money. However, on the crucial question of how we can best tackle the problems, increase morale and achieve clear-cut decision making, I believe that the idea of the trusts is right. It would be a great error to be pushed off course and to delay or abandon their implementation.
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7.19 pmMr. David Young (Bolton, South-East) : The Conservatives have always argued that the national health service is safe in their hands. In fact, it is about as safe as a chicken in the hands of a farmer who is about to wring its neck. The public support for the Labour party stems not from propaganda but from ordinary people's experience of the health service-- people who are told that they have to wait for one or two years on the waiting list for an operation but that if they paid privately they could have the operation within days or weeks. That is not choice--that is extortion.
The Government have consistently argued that we have a free health service, but by extending the payment per prescription from 20p to £3.40, they seem to have flown in the face of that principle. They have certainly cancelled eye tests. They have also cancelled the dental test. The main sufferers when such tests are cancelled are the young and the old--the people most at risk whom we as a community should seek to help. If high blood pressure and glaucoma are not detected in an eye test, does that not lead once again to hospital lists being extended by people who have to go for remedial treatment, when preventive treatment would have been less costly?
During the past 12 years, we have seen the Conservatives create a two-tier health system. With 900,000 people on the waiting list, the incentive to the patient to go private is not choice but pain. The Government's policy has made the long waiting list the recruiting sergeant for private practice. A two-year waiting list may be acceptable to the Secretary of State, but when an 81-year-old woman is waiting for a hip replacement, the question which goes through her mind is, "Will the surgeon get to me before the undertaker does?" That is the choice that the party of choice provides.
Underlying the whole system is the fact that the quality of life of people on waiting lists is affected and undermined. In a civilised society, we should consider quality of life, if nothing else. The Conservative party claims to be the party of choice. What chance is there of going to the hospital of one's choice if one wants to go to a hospital to which the district health authority has not contracted out and if the extra referrals budget has gone by the board? What choice is there then?
What choice is there for the single elderly person who requires long-term nursing care if there is little or no community budget? What choice is there except a private nursing home? I am aware of what the Secretary of State for Social Security has said today about giving more money to such people, but unfortunately it is not elderly people but owners of private nursing homes who will receive the extra money. We shall soon see the charges at those private nursing homes increase once again.
However, that is not the question. What about the many people just above the benefit level and those who throughout their lives had saved for a rainy day? It will be a pouring day when they have to fork out £15,000 to £20,000 per annum for private treatment in a nursing home. What about people who are told that they have to sell their home in order to obtain treatment? Where are they when they can no longer afford that treatment? Will they be downgraded, as in America, from one nursing home to another? Is that the type of society that the Tory Government want? It is certainly the kind that they have created.
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As a Member of Parliament for Bolton, I have always been concerned about the health of Bolton. No hon. Member who represents that area can be otherwise when one reads the Black report and other reports from the director of medical services which tell one about the health of Bolton. On 27 January 1981, I got the go-ahead from Sir George Young for the new Bolton general hospital. For almost a decade the Government failed to come across with the money. If the speculation in yesterday's Sunday Mirror is correct and the £37 million is to be diverted for other purposes--the article mentioned opting out and hospital trusts--that will be a gross betrayal of the people of Bolton.Mr. Thurnham : The hon. Gentleman says that he is concerned about health in Bolton. Will he retract the bogus scare stories to which he was party about cancelled operations in the north-west? Does he accept that no health authority has said that there is any truth in it? In Bolton, there were only 651 operations not cancelled, but postponed, and 780 operations were put off because patients did not turn up for them. Is that financial cuts?
Mr. Young : I wish that the hon. Gentleman would use his own time and not mine. He will have a chance to make his speech. I have represented Bolton and I know of the cuts. One of the things that sickens the people of Bolton is this. When the right hon. Member for Finchley (Mrs. Thatcher) says, "I want the surgeon of my choice at the time of my choice," that is fair. But it is not fair that her policies have denied that to everyone else. A plasterer in my constituency has to remain idle because he has months to wait before he can have an operation on his elbow. That is what I am talking about when I complain about waiting lists.
It is no wonder that certain hon. Members become coy when they attack us on our assertions but will not declare whether they and their families depend on the national health service. That is the only criterion on which to judge whether people believe in the national health service. If they do not go into those hospitals or see the waiting lists, it is easy to argue in statistical terms, but one person on the waiting list for two years is one too many. If there had been an incentive to remove the waiting lists, it could have been done. Instead, the Government provided handouts in terms of private health insurance for the elderly, which the Secretary of State has retracted now that an election is approaching. I want a health service for all the people, not just for those who can buy their way out of the system. That is the health service that we want in Bolton and for the country--and that is why, after the next election, there will be three Labour Members of Parliament for Bolton.
7.29 pm
Sir Jim Spicer (Dorset, West) : I am delighted to follow the hon. Member for Bolton, South-East (Mr. Young). I and most hon. Members owe a great deal to the national health service over many years. I certainly do in personal terms, but even more in family terms. My eldest daughter broke a leg. She had a broken leg for eight years. During that period she had 14 major operations. The last one took thirteen and a half hours. She is now walking on that leg and is healthy. Not once did she dream of moving out of the health service, and not
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once did she not receive superb treatment. I am sick and tired of hon. Members who try to say that we have the worst service in the world. We have the best service in the world, and the sooner we all recognise that, the better.I am sorry that the hon. Member for Livingston (Mr. Cook) is not here. I, too, shall return to that marvellous television programme, "On the Record", which I enjoyed enormously yesterday. In that programme, the hon. Gentleman was trying to be a good fairy--I mean that in the nice, old-fashioned sense. He was saying, in effect, "Vote for me and all will be well." As my right hon. Friend the Secretary of State made clear, the hon. Gentleman avoided some questions. First--this question will return time and again-- how much additional funding does the Labour party believe to be essential for the NHS? Is it £2 billion a year, £3 billion, £4 billion, £5 billion or £6 billion? Hon. Members can ask that at various times of various Labour-Front Bench spokesmen and they will always get different answers.
My second question relates to the hon. Gentleman's speech today. How will he translate his obvious dislike of and distaste for private residential care, where so many elderly people reside with the help of the Government, into action if, unfortunately, he ever becomes the Secretary of State? Hundreds of thousands of people throughout the country would like an answer to that question.
I knew a geriatric hospital with wards of 10 or 20 beds which was to be closed. The spirit there was marvellous. I followed the case of each patient moved from that hospital. One old lady said to me, "I never thought that I would be able to live out my life in a room of my own with a view like this--I thought that I was condemned to living in a ward for the rest of my life." Is the hon. Gentleman against taking elderly people out of hospital institutions and putting them into private accommodation? The country and certainly my constituents would like to know.
The same "good fairy" gave the impression that he would wave a wand and, miraculously, the money to achieve everything would appear. He said that it would come from "the economy", but what possible growth in the economy can we rely on under a Labour Government? How many years does he expect that it will take to wipe out his theoretical underfunding? Yesterday the hon. Gentleman was coy about that, as he has been in the past. As my right hon. Friend said, the hon. Gentleman has changed his tack and stance on this time and again. My third question is : how carefully has the hon. Gentleman researched authorities with trust status? In particular, has he looked at the West Dorset health authority, which has been fully trusted for its acute, community and mental health services since April? Perhaps he would like to visit us. If he or the hon. Member for Peckham (Ms. Harman) would like to come, we should be delighted to welcome them. They would see the resounding success achieved through wonderful co-operation between the authority, the trusts, the consultants, the doctors and all health service employees. I will give some quick examples of what we achieved. From an annual budget this year of £77 million, we have already achieved a saving of £1.3 million, which will be devoted entirely to cutting waiting lists. Since April, 80 per cent. of patients have been treated within six months. Soon none will wait more than a year. Nobody will wait for two years, as the hon. Member for Bolton, South-East said. Even that one year wait will be exceptional. For each of the past three years, 6 per cent. more patients have been
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treated. There is a total commitment to the second phase of our splendid district hospital, which will combine all our acute resources on one site. Coupled with that, we have major improvements in all our community hospitals under our community trusts. On the mental health side, we have seen the closure of Harrison and Coldharbour hospitals --two marvellously run hospitals, but built 150 years ago. Their patients are now back in the community. I have seen what has been achieved even in six short months, and it is remarkable.Will someone from the Opposition Front Bench please come and look at what is happening in west Dorset? I extend the same invitation to the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). He mentioned Yeovil hospital. That was where my daughter had most of her operations. There is no better hospital. It has trust status. The hon. Gentleman said that the right hon. Member for Yeovil (Mr. Ashdown) visited the hospital recently and discovered that some people there were unhappy or, at least, uneasy about the future. Perhaps he talked to different people, because I have spoken to some people there in the past three or four days and they are happy. I hear that the number of patients treated in Yeovil hospital is up by 5 per cent. since April, that waiting lists are substantially down and that only 63 patients have waited for more than a year, a decrease of 70 per cent. on last year's total. The hon. Gentleman said that he was sure that there must be a fly in the ointment somewhere and that the hospital would probably run into financial difficulties. It will not. It has a balanced budget. It is appointing five new consultants, three arising directly from the trust status, and more improvements are expected across the board. I am delighted that the right hon. Member for Yeovil will gain so much in his constituency as a result of the policies instituted by the Government and I hope, although I fear that it is a forlorn hope, that he and his colleagues will vote with the Government tonight.
I have made my position clear. I depend on the NHS and always will, and so will my family. So long as we have a Conservative Government wholly committed to it under our present Prime Minister, that NHS will continue to operate at an increasing level of efficiency and with better management. As has been said, proper management of scarce resources is the key. We cannot go on always throwing more money at the NHS. We must use that money more efficiently. Surely no one can deny us the right to do that.
7.37 pm
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