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Sir Michael Grylls (Surrey, North-West) : Since my right hon. Friend referred to the quite disgraceful slur against the honour of my right hon. Friend the Prime Minister, which was repeated from the Opposition Front Bench this afternoon, has he any knowledge that the Opposition wish to make a statement to the House to apologise for the incorrect slur on my right hon. Friend and clear the matter up once and for all ? It is quite wrong for the matter to be left as it is.
Mr. Lamont : I made it clear that the hon. Member for Dunfermline, East (Mr. Brown) surprised me--
Mr. Alistair Darling (Edinburgh, Central) : It is in the report.
Mr. Lamont : It is not in the report. The report makes it quite clear that my right hon. Friend the Prime Minister did not know of the contents of the section 41 report and the fraud in the United Kingdom until he received a report from me at the end of June. I must tell the hon. Member for Dunfermline, East that, when one has made one scandalous allegation, one should not make another.
Ms. Diane Abbott (Hackney, North and Stoke Newington) : The Chancellor will be aware that some people believe that the Bank only moved against BCCI in the end because it was well aware that the New York authorities under Mr. Morgenthau were about to unveil the results of their investigation which would have reflected very badly on the dilatory and incompetent supervision that the Bank had given BCCI. However, with regard to the auditors, this is not the first instance when big City accountants have proved to be unable to recognise fraud when it is being practised under their noses. Hon. Members will recall the Maxwell pension fund and the role that auditors played in that.
It seems that Price Waterhouse had a particular problem in the BCCI affair. On the one hand, it was supposed to be BCCI's auditor, while on the other hand it was earning huge fees from other parts of BCCI as management consultants. Will the Government take a
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further look at the role of auditors and perhaps take steps to ensure that auditors are not faced with potential conflicts of interest in future ?Mr. Lamont : On the last point, Lord Justice Bingham considered the issue that the hon. Lady has raised, and he concludes that the so-called conflict of interest is not something that he believes action should be taken upon. However, as I have told the House, we intend to impose a duty on auditors in future to report to the supervisory authorities when they have good reason to believe that fraud is taking place.
The hon. Lady referred to Price Waterhouse, and there is a criticism of Price Waterhouse in the report. However, in fairness to Price Waterhouse, it should also be stressed that on other occasions--for example, in April and October 1992--when the firm had made its audit report to the directors of BCCI, it ensured that some information was passed on to the Bank of England. Lord Justice Bingham concluded that perhaps that could have been done more fully, but a careful reading of the report discloses that on several occasions that is precisely what Price Waterhouse did.
The hon. Lady's first point was that the Bank of England acted only because of what the district attorney in New York was about to reveal. That is not correct. What finally triggered the action of the Bank of England, which Lord Justice Bingham concludes was appropriate, was the Price Waterhouse report. I stress that BCCI continued to operate in New York and California when it was closed by the Bank of England. That ought to be seen in the context of the fact that the bank operated worldwide in 60 countries with 400 branches. I do not believe that it is correct to pin it all on the Bank of England just like that.
Mr. John Townend (Bridlington) : Does my right hon. Friend agree that many Conservative Members welcome the immediate response of the Bank of England and would feel that it was in everyone's interest that the Governor should be able to introduce the reforms suggested in the Bingham report? Does he also agree that depositors will always lose money when a bank closes down in such unfortunate circumstances? A difference in the timing only means a difference in who loses their money. Does he also agree that people who deposit money in overseas banks can never expect them to be 100 per cent. risk-free?
Mr. Lamont : I agree with my hon. Friend, but I do not wish to cast slurs on overseas banks in comparison to any other banks. Obviously it is very important that people should take a view about banks with which they deposit money as they should take a view about any financial institution to which they entrust their capital. However, I very much agree with the general thrust of my hon. Friend's comments.
It is important that depositors and savers should have some responsibility. No system of supervision can guarantee safety or eliminate fraud. There will always be a risk of that. We have an example of a gigantic fraud which had gone on for well over a decade and throughout the world. I entirely accept what my hon. Friend said about the need to press ahead with the legislative changes and accept the implementation of the Bingham report.
Mr. Dennis Skinner (Bolsover) : Does the Chancellor recall that, when this fraud was becoming apparent around 1984-85, some other money in a bank was being
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transferred from Luxembourg and various other banks from the National Union of Mineworkers? Somehow or other, they managed to trace that genuine, real money--not fraudulent money--which the NUM was trying to save for the miners. The bankers represented by the Government managed to find that money when they could not find the fraud in BCCI. I find it very strange that there is a gang of people on the Government Front Bench, most of whom come from the belly of the banking establishment, who cannot detect fraud over a period of eight or nine years.It is very odd that the Government can supervise the 400 local authorities and check every penny they spend, but they cannot supervise or look into massive fraud. I do not think that it is just a question of the boss of the Bank of England resigning--the whole lot on the Treasury Bench should get out of the way.
Mr. Lamont : The hon. Gentleman expressed something like that view yesterday. He thinks that every debate is about the miners. This one is not.
Sir Peter Tapsell (East Lindsey) : Before we debate this unhappy subject, will my right hon. Friend give further careful thought to whether he is quite sure that the Bingham recommendation is correct in advising that we should make no change in the institutional method of bank supervision bearing in mind that the Bundesbank does not have responsibility for such supervision? I have held the view for a long time that, with the deregulation of financial institutions and the complete internationalisation of money markets, bank supervision is an extraordinarily difficult task. While I am certainly not one of those who are in favour of making the Bank of England independent, I am very strongly in favour of its prestige being maintained as strongly as possible--
Madam Speaker : Order. We are now getting into an Adjournment debate. I have asked hon. Members to ask questions.
Sir Peter Tapsell : Therefore, may we not continually put the Bank in a position which is likely to recur, that of in being involved in such scandals because of its supervisory role?
Mr. Lamont : I note what my hon. Friend says, although in many countries the central bank has responsibility for supervision. That point has been examined in detail by Lord Justice Bingham. He has come to the conclusion that there is no reason to change the existing arrangements. I have announced that I am accepting those changes that he thinks should be made, but obviously I will reflect on what my hon. Friend, who has very considerable experience of these matters, has said. I note what my hon. Friend says about the Bundesbank, because he was not so friendly about it a few weeks ago.
Mr. Robert Sheldon (Ashton-under-Lyne) : The report recommends that attention should be concentrated on suspect banks. That is a very elementary proposition. We must ask why on earth suspect banks were not supervised properly from the beginnning--right from 1979. I myself was asking others why the conditions of the Banking Act 1979 were not applied to BCCI. It was a highly disreputable operation and there was great concern about it. The powers to approve and authorise should have been used against that bank right from the beginning. What
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concerns me most is that the Bank of England has failed miserably in this matter, and its reputation must concern us all.Mr. Lamont : Because I have had to reply to some rather extreme points that have been made by the Opposition, I do not wish in any way to deny that very serious criticisms have been made. I do not wish to give that impression.
The right hon. Gentleman asks, "Is it not rather obvious that resources should be concentrated on suspect banks?" The point that Lord Justice Bingham is making is that he feels that there is not a great deal of point in intensifying supervision generally. Supervision has to deal not just with fraud but with matters such as capital adequacy and the resources that shareholders put into banks. He is saying that, when it comes to fraud, there is room for being even more selective and for having machinery that responds more rapidly and more sensitively than has happened in the past to some of the receipt of information that has occurred.
Mrs. Judith Chaplin (Newbury) : My right hon. Friend has said that the supervisors should be more flexible and discriminating. What will the Bank of England do to ensure that that happens?
Mr. Lamont : The Bank of England intends to increase the resources devoted to supervision. It also intends--this is the point that I was making to the right hon. Member for Ashton-under-Lyne (Mr. Sheldon)--to set up a special unit to deal with allegations that are made against particular suspect banks. It is also increasing the staff and setting up a legal unit within the Bank. In addition, it is going to take the initiative in making sure that we have a lead supervisor when banks are spread across several countries. That is one of the key points that come out of the report. It is extremely important to have a lead supervisor in all cases.
Mr. Calum Macdonald (Western Isles) : As regards the Chancellor's intention to give the Bank of England the power to revoke or refuse authorisation when the structure of a bank is opaque, does not Lord Bingham, in paragraph 3.1.5, say that it already has that power and that it simply refused to exercise it? Given that that is the case, it is not a lack of power that caused this debacle but a failure to exercise that power. Is not there a moral obligation on the Chancellor to come forward with a scheme of compensation for all those who have lost money in this disaster?
Mr. Lamont : What Lord Justice Bingham says--[ Hon. Members :-- "Lord Bingham."]--Lord Bingham, the Master of the Rolls, Sir Thomas Bingham now--is that it is his legal opinion that that power exists but that, if there is any ambiguity, the Government should consider action. We have considered it. We think that there is some ambiguity and that therefore we should take the legislation to make the situation absolutely crystal clear. I hope that that answers the hon. Gentleman's point. I do not think that the conclusion that he drew about compensation follows from what the hon. Gentleman has said. I deeply regret that so many people have lost as a result of what has happened, but let the House be absolutely clear--I wish hon. Members would just occasionally say it--that responsibility for what has happened lies with the criminals and those who perpetrated the fraud. Not one
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Opposition Member has made that point. They just seek to get whatever miserable political advantage that they can out of the situation.Mr. David Shaw (Dover) : Will my right hon. Friend the Chancellor confirm that what is unusual about this fraud is not that it was massive or that it was international but that it involved the collaboration of a large number of individuals on an international scale? How did that happen in such a way that no authority in the world managed to discover it? Therefore, is it not logical that the British Government should lead in bringing together a number of regulatory authorities in the world so that we will have a better international regulatory system? What will the British Government be doing about that?
Mr. Lamont : My hon. Friend is right, and that is why we propose to take such an initiative within the European Community. That is why we also intend to use the supplement to the Basle concordat to ensure, as I have said, that there is always a lead supervisor.
One of the most powerful points in the report is that for a long time there was no lead supervisor. One of the criticisms that Lord Bingham makes is that the Bank of England was unwilling to assume the role of lead supervisor and relied too long on Luxembourg. We must ensure that there are arrangements that make it absolutely certain that in all cases in future there is a lead supervisor, and we will be doing precisely that.
Mr. Brian Sedgemore (Hackney, South and Shoreditch) : Bearing in mind that, years before the Governor of the Bank of England tried to close down BCCI, he had been told that the management was incompetent, that the directors were hopeless, that the accounting methods were so dreadful that one firm of accountants, Ernst and Whinney, had simply given up and that there had been serious fraud in the treasury department of BCCI in 1985 and further serious fraud through Capcom Financial Services, would it not be seemly if the Governor of the Bank of England were to give way to someone else who is better able to enforce not only the decencies and proprieties of public life but the provisions of the Banking Act 1987--or does the Governor stand outside the laws of England?
Mr. Lamont : I have explained why I believe that it is absolutely right that the Governor, while he assumes responsibility for this matter, should remain the Governor, and I have every confidence in him.
The hon. Gentleman makes a point that is made repeatedly by hon. Members, which is that, at various times in a decade and a half, information has entered the public domain of wrongdoing in BCCI in different parts of the world. There were the arrests over the Tampa incident and treasury frauds in 1985. Hon. Members have made that point repeatedly and then asked why then something was not done about it.
What they have omitted to mention, which in fairness should be mentioned, is that, on several occasions in the long history of that bank since 1972, there have been changes in the management and changes in the shareholder. There have been attempts to reconstruct the bank. On each occasion, the Bank of England faced the dilemma of either closing it down or attempting remedial
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action and reconstruction. It attempted that reconstruction of the bank on several occasions, even though we knew--the hon. Gentleman knew ; everybody knew--that there had been some wrongdoing in the bank in different parts of the world.The fact that things went wrong in this case should be placed against the fact that, in the past five years, there have been about 34 occasions on which the Bank has actually succeeded in reconstructing banks or bringing about remedial action, which has saved depositors and worked to the advantage of everybody. That was the motive of the Bank of England. It is very easily condemned with the advantage of hindsight.
Mr. Tim Renton (Mid-Sussex) : It was obviously right to publish Lord Bingham's report, and I congratulate and respect my right hon. Friend on his frankness and openness in doing so. Clearly, the supervision of the Bank of England has been lax, but does my right hon. Friend not agree that the difficulty for the central supervisory authority where there is an international bank with what he described as an opaque structure is for the central bank to know the precise moment at which it is right to step in and close branches? If that step is taken too early, for whatever reason, it can lead to far greater loss for creditors and depositors than would otherwise be the case. I noticed in Beirut last week that BCCI was still operating freely and openly because the authorities, depositors and creditors did not wish to close it.
Mr. Lamont : I am grateful to my right hon. Friend, especially for his opening remarks. He makes a powerful point, which is similar to that which I made about the dilemma facing the Bank. It has been well illustrated that Opposition Members have, at various times, criticised the Bank either for closing BCCI or for not closing it--they have made both criticisms together.
Mr. Alistair Darling (Edinburgh, Central) : Will the Chancellor address himself to paragraph 2.512 and the following paragraph of the report dealing with responsibility of both the Treasury and the Bank? Does he accept that no Opposition Member or anybody else is suggesting that the Prime Minister knew of the alleged fraud until very near the time when the bank closed. No one is impugning his conduct or that of any other Minister. The point that Lord Bingham is making is that the Bank, the Treasury and its Ministers knew for a considerable time before the bank was closed that there was a problem. Does the Chancellor not accept that the responsibility of the Treasury and its Ministers is an important matter for both this case and the future, and for the issue of compensation? Many people think that it is high time that those who take decisions stand up and accept responsibility when things go wrong.
Mr. Lamont : The report clearly says that the conduct of Treasury Ministers
"is not in my view open to criticism in any respect."
The hon. Gentleman says that nobody is alleging that my right hon. Friend the Prime Minister knew about the fraud until a very late date, but that is not what the former Leader of the Opposition, the right hon. Member for Islwyn (Mr. Kinnock), said on 23 July 1991, when he repeatedly accused my right hon. Friend of covering up and knowing about the position. The right hon. Gentleman said :
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"The Prime Minister has already misled the House once today by saying that he referred to the irregularities, when it is in the recall of this House that he did not say a word Despite what he knew as Chancellor of the Exchequer, he did nothing to warn innocent people of the trap into which they were moving and of a bank that was near bankruptcy,"--[ Official Report, 23 July 1991 ; Vol. 195, c. 1029.]My right hon. Friend knew nothing about that, and the report makes that crystal clear.
Several Hon. Members rose --
Madam Speaker : Order. We must now move on. I have given the matter quite a long run, and Ministers have already made it clear that we are to have a debate on it.
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Points of Order
Mr. John Cummings (Easington) : On a point of order, Madam Speaker. Some 14 hours after last night's vote on the coal industry, 900 miners at Vane Tempest colliery were informed that the colliery would cease production on Friday. Those 900 men were sacked last week, were reinstated this week and are to be mothballed next week. Like the President of the Board of Trade, those 900 men do not know whether they are coming or going.
Should we not invite the President of the Board of Trade back to the Chamber now to explain in unequivocal terms precisely what his intentions are for Vane Tempest colliery, which is inextricably linked with Easington colliery because of shared pumping costs? It is important that the matter should be clarified as quickly as possible.
Mr. Dennis Skinner (Bolsover) : Further to that point of order, Madam Speaker. The President of the Board of Trade gave assurances yesterday--repeated by the Secretary of State for Wales late last night-- that the 10 pits would be treated to the same degree of consultation as the other 21. It seems incredible that consultation on the fate of the 900 men at Vane Tempest could have taken place within 14 hours.
In view of the confidence trick played on those hon. Members who were intending to vote with the Opposition, the President of the Board of Trade should be brought here to give a statement to make it clear that British Coal should not be allowed to get away with sacking 900 men at Vane Tempest.
Madam Speaker : As both hon. Members are aware, those are not points of order with which the Chair can deal. I have received no information from the Government that they wish to make a further statement on the issue.
BILLS PRESENTED
Housing and Urban Development
Mr. Secretary Howard, supported by Mr. Chancellor of the Exchequer, Mr. Secretary Heseltine, Mr. Secretary MacGregor, Mr. Secretary Hunt, Mr. Secretary Lang, Sir George Young, Mr. John Redwood and Mr. Tony Baldry, presented a Bill to confer rights to collective enfranchisement and lease renewal on tenants of flats ; to extend the right to enfranchisement of tenants of houses ; to make provision for auditing the management, by landlords or other persons, of residential property and for the approval of codes of practice relating thereto ; to amend Part III of the Landlord and Tenant Act 1987 ; to confer jurisdiction on leasehold valuation tribunals as respects Crown land ; to amend Parts II, IV and V of the Housing Act 1985, Schedule 2 to the Housing Associations Act 1985, Parts I and III and section 248 of the Housing (Scotland) Act 1987 and Schedule 4 to the Local Government and Housing Act 1989 ; to alter the basis of certain contributions by the Secretary of State under section 569 of the Housing Act 1985 ; to establish and confer functions on a body to replace the English Industrial Estates Corporation and to be known as the Urban Regeneration Agency ; to provide for the designation of certain urban and other areas and to make provision as to the effect of such designation ; to amend section 98 of the Local Government, Planning and Land Act 1980 and section 27 of the Housing and Planning Act 1986 ; to make further provision with respect to urban development corporations and urban development areas ;
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and for connected purposes : And the same was read the First time ; and ordered to be read a Second time tomorrow and to be printed. [Bill 67].Asylum and Immigration Appeals
Mr. Secretary Clarke, support by Mr. Secretary Hurd, Mr. Secretary Howard, Mr. Secretary Hunt, Mr. Secretary Lilley, Mr. Secretary Lang, Secretary Sir Patrick Mayhew and Mr. Charles Wardle, presented a Bill to make provision about persons who claim asylum in the United Kingdom and their dependants ; to restrict certain rights of appeal under the Immigration Act 1971 ; and to extend the provisions of the Immigration (Carriers' Liability) Act 1987 to transit passengers : And the same was read the First time and ordered to be read a Second time tomorrow and to be printed. [Bill 69].
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The Health of the Nation
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Nicholas Baker.]
5.7 pm
The Secretary of State for Health (Mrs. Virginia Bottomley) : This is the first opportunity that the House has had to debate health in detail since the general election. I want to begin with the significance to the national health service--and to the health of the nation--of the outcome of that election.
Before that, however, it is a pleasant duty for me to welcome the hon. Member for Sheffield, Brightside (Mr. Blunkett) to his place on the Opposition Front Bench. With community care much on our minds, I am sure that the House will benefit from the experience of local government that he will bring to our debates. If there is one regret about the hon. Gentleman's appointment, it is that our deliberations will in future be without the often unique insights of his predecessor. We remember the predictions of the hon. Member for Livingston (Mr. Cook). He predicted that the targets under the GP contract were "so heroic" that no GP would ever reach them.
Madam Speaker : Order. I am sorry to interrupt the right hon. Lady. It was remiss of me not to say at the outset that I have had so many requests from hon. Members wishing to speak today in this debate that I have had to limit speeches to 10 minutes between 7 pm and 9 pm. I am sorry to have interrupted the right hon. Lady, but I thought that the House should be told right away of the depth of interest in the debate.
Mrs. Bottomley : I am delighted to hear that there is such an interest in this debate. I was only worried that you, Madam Speaker, were going to try to confine my remarks to 10 minutes, which would have been difficult.
I was referring nostalgically to the predecessor of the hon. Member for Brightside who predicted that the targets were "so heroic" that no GP would ever reach them. He once likened the idea of an NHS trust to a "bicycle with a flat tyre" that would never get anywhere. He predicted that the true test of the trusts would be whether they treated more patients. The GPs are meeting and beating the targets. NHS trusts have become an unstoppable movement, and they are treating more patients. Among the hon. Member's more famous sayings was that the general election would be a referendum on the future of the NHS. I do not think that he predicted the right outcome in that case either.
However, the hon. Member was correct in one important way. The general election was crucial to the future of the national health service. The Labour party fought the election with a socialist plan to turn the clock back 40 years--to the days of central planning, command systems of control, when the Minister was expected to know whenever a bedpan was dropped in a ward. Anyone who knows anything about running a £36 billion organisation knows that such ideas just will not wash. While such policies were being hastily dismantled in Leningrad and Leipzig, they were all the rage in Livingston. Had it won the general election, the Labour party would presumably be putting those ideas into practice now. One can imagine the resulting chaos and vandalism.
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My hon. Friends will be only too aware that 156 trusts would be told to stop innovating on behalf of patients and report to Whitehall immediately. More than 3,000 GP fund holders would have had their budgets snatched away ; they would have had no more power to pioneer for patients, and all the efforts of their staff and all the progress, hard work and achievements of reform would have been dumped in a dash for socialism.Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : The Secretary of State will be aware that the trusts are anxious that they should not be responsible to her--they do not like that idea. If there are increasing numbers of trusts and if they continue to use taxpayers' money, will she be kind enough to tell us to whom they should be responsible?
Mrs. Bottomley : The trusts are unequivocally accountable to me, as Secretary of State, and there are effective mechanisms for monitoring their work. They have been singularly successful, they have treated many more patients and they have provided an excellent working environment for their staff. They have achieved much in the NHS, and I am sure that the rest of the service could learn from their record. The hon. Lady's remarks are a sign of what the trusts might have had to face in the miserable event of the Labour party winning the general election.
It is a very different NHS under this Government--it is a good service and an improving service. The Conservative victory in the general election has given new confidence and a reinforced sense of direction. The consensus grows day by day that the health reforms are the right answer to a series of management problems that have built up over 40 years.
Two weeks ago, I announced a further 128 trusts, and more are waiting in the wings. Family doctors are queueing to take control over their own budgets. Health authorities are discovering the immense potential of their new role as commissioners and purchasers of health care. The GP contract is delivering better health care and better health, and public confidence in the health service is growing-- [Laughter.] The hon. Member for Brightside may laugh. I wonder whether he knows about the recent survey that showed that 95 per cent. of the patients who had used his local NHS trust were satisfied with the service that they received.
The true significance of these achievements was well summed up recently by the British Medical Journal. Referring to the Government's three White Papers, "Promoting Better Health", "Working for Patients", and "The Health of the Nation", it said :
"Taken together, the White Papers are unusual because they represent a continuum in Government policy as a conceptual feat it can rarely have been equalled in the realm of public administration".
Mr. Hugh Bayley (York) : During the summer I was asked to intervene by one of my constituents whose mother was about to be discharged from a Bristol hospital. Her daughter was told that she could not be discharged until she and her daughter had paid a fee of £600 to Avon ambulance trust. Is that the type of outcome that the right hon. Lady intended when she created trusts? Did she expect me, as a Member of Parliament, to have to phone half a dozen health administrators in Bristol to explain to them that it would be more costly if my constituent
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blocked a bed in her hospital than if the NHS paid for her ambulance transport to the nursing home to which she was going?Mrs. Bottomley : Had the hon. Gentleman wanted a serious answer to his question, he would have been in touch with my office with the details. I have consistently and unequivocally been committed to an NHS available to all and free at the point of delivery. The hon. Gentleman can easily give me the details and I will look into the case immediately. I should very much like to know what lies behind the circumstances that he has described. [Interruption.]
Madam Deputy Speaker (Dame Janet Fookes) : Order. The Secretary of State is doing her best to answer, and I do not expect a whole lot of seated interventions.
Mr. Bernie Grant (Tottenham) : Will the right hon. Lady give way?
Mr. Grant : I was pleased to hear the Secretary of State say that the NHS trusts are directly responsible to her and that mechanisms have been set up to monitor their progress. Can she tell me, a poor working Member of Parliament who is not quite au fait with bureaucracy, whom I should go to if a mistake has been made in the tendering procedure between the health authority and the trust? Who can rectify that?
Mrs. Bottomley : I should like to know more of the details, but the system is clear. The district health authority places a contract with the NHS trust in which it specifies the quality and nature of the service to be delivered. That never happened in the past. It was never possible to place such contracts or to identify improvements needed in the quality of care that the health authority sought. In the first instance, the hon. Gentleman should therefore go to the district health authority.
It is also clear who has responsibility in the NHS trust. The position of trust chairman has clarified the structure in a new way. It is therefore easier to know what is being provided, what standards are being adhered to and what plans there are for the future.
Mr. Richard Burden (Birmingham, Northfield) : I want to raise a matter that the right hon. Lady knows about. She says that trusts are accountable to her, as Secretary of State. Are regional health authorities also so accountable? If so, why are she and her Department colluding in the suppression of a report commissioned by the West Midlands regional health authority into the causes of a multi-million pound cash crisis in South Birmingham health authority which is threatening to close two hospitals, to transfer services from a third hospital, to cut community services by about £300,000 and to cut services for the mentally ill by about £200,000? If she believes that public confidence in the trust is so high, why will she not publish this report?
Mrs. Bottomley : Like so many other Labour Members, the hon. Gentleman is trying to denigrate the achievements of the NHS in his area. That is an insult to all the people who work in the NHS. The hon. Gentleman may be aware that I have asked the deputy chairman of the policy board, Sir Roy Griffiths, to advise on some of the systems of the West Midlands and to report to me.
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The establishment of the trusts, the fact that health authorities can assess health needs, and the placing of contracts mean that we are in a position to develop a health strategy that we would not have been able to develop without the reforms. As purchasers, health authorities can now respond strategically to the health needs of the populations they serve. Through their contracts with hospitals and other providers, they can write prevention firmly into the structure of the NHS. The GP contract, another key element of the reforms opposed by the Labour party, made health promotion a priority. Among other things, it made a real success of our childhood immunisation programme. The 90 per cent. targets have been exceeded, setting us on course for the 95 per cent. target set out in the White Paper. When I used to work in the health service when the Labour party was in power, figures of this sort would have been inconceivable and unattainable. Building on an already sound base, the White Paper has set a new target for childhood immunisation--95 per cent. coverage by 1995. I am pleased to be able to report that one NHS region, East Anglia, has already reached that level for all seven immunisations. Three other regions, Oxford, South Western and Wessex, have reached 95 per cent. for all diseases except whooping cough. At the end of last month, we announced that the new HIB vaccine against childhood meningitis has been added to the routine immunisation programme. Thanks to these changes, which the general election secured, we can now lift our sights about the structural issues which have preoccupied the national health service for over 40 years. Never have we been in a better position to secure the most important founding goal of the national health service : better health for the people of our country.Mr. Brian Sedgemore (Hackney, South and Shoreditch) : The right hon. Lady said that we have got over the structural difficulties now. She also said that we should not denigrate the health service--we should pay tribute to its work. Would she care to pay tribute to the work of St. Bartholomew's, St. Thomas's, Charing Cross, Middlesex and University College London, and then tell the House why she will make a statement tomorrow suggesting that four of them be closed?
Mrs. Bottomley : I have read with some interest the correspondence between the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) and the person I had taken to be the Opposition spokesman on this matter. I am interested to know who it is who speaks most accurately for the situation in London.
Mr. Sedgemore : Will the right hon. Lady pay tribute to those hospitals?
Mrs. Bottomley : I pay a warm tribute to much of the excellence achieved by the health service in London. However, no one who has even half focused on the situation in London could fail to know that for many years we have been over-dominated by institutions and under-provided for in terms of community services. The need for the reform of the health service in London is supported by the British Medical Association, the nurses' organisations and virtually every even half-enlightened Member of Parliament, as well as by the public.
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I should like to remind the House, if I have not already done so, that the Labour party opposed every turn and every measure that has made better health a realistic goal. While we were working through the logical progression towards better health, the Labour party shouted, "Go back" at every point. This debate would not have taken place if the Opposition had had their way. The purpose of the Opposition is to exploit the NHS for their party-political aims. The public are heartily sick of them using the health service as a political battering ram.The new mood is to lose politics and to gain health. The White Paper "The Health of the Nation" has been a handsome investment to that end. The Labour party should come clean and acknowledge that. That White Paper and the strategy it sets out received a warm and enthusiastic welcome. The World Health Organisation described it as a model for other countries to follow. The British Medical Journal said that it was
"a huge step forward for Britain's health policy".
A distinguished former president of the Royal College of Physicians called it a "mighty initiative". Those remarks illustrate how the strategy has captured both the hearts and the minds of everyone concerned with health.
No one should underestimate the significance of the White Paper. It has provided the first-ever coherent strategy in this country for securing real improvements in health and the first-ever national targets for reducing death and disability. It is the first time that we have ever had a Cabinet committee concerned with health. Most important of all, the White Paper has made us one of the first countries to specify action to achieve those targets. Most other strategies simply set targets, but our White Paper is not just an index of destinations ; it is the road map as well.
One hundred years ago the average life expectancy was 44 years. Today I am pleased to tell my hon. Friend the Member for Broxbourne (Mrs. Roe) that it is 73 years for men and 79 for women. The step-change a century ago was achieved not by doctors, pharmacists or physicians, but by plumbers. Clean water and better sanitation revolutionised our health prospects. If we want to see a further step-change in the fight against disability and disease today, it will be achieved by prevention and by the strategy that we have set out in the White Paper.
The five priority areas, the 25 national targets and the action to meet them are of direct relevance to everyone and every group in this country. The areas on which we have focused are the ones where the public want action.
Mr. Anthony Coombs (Wyre Forest) : One item of public health that is not included in those key areas is asthma. My right hon. Friend is aware that I have raised this matter on a number of occasions and she will know that 2.5 million people and 700,000 young people suffer from asthma. It is one of the few preventable diseases for which mortality rates are increasing.
Some work has been done at East Birmingham hospital on the relationship between the increased incidence of asthma and environmental pollution, in particular the effects of greenhouse gases and the depletion of the ozone layer. Can my right hon. Friend tell me whether the Medical Research Council might be persuaded to study the important relationship between environmental pollution and the incidence of that disease?
Mrs. Bottomley : I welcome my hon. Friend's comments on this important problem, which affects a great number
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