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Ms. Mildred Gordon (Bow and Poplar) : I listened carefully to the Secretary of State and some of what she said surprised me greatly. She expressed great respect and admiration for workers in the NHS, but went on to denounce members of the National Union of Public Employees and other trade unions. Apparently, she respects only those NHS workers who are not members of a trade union.
The right hon. Lady talked about the hot line, or the information line, that she is opening today. That will not be much use to the gentleman in my constituency who wrote to me recently to say that his urological operation had been cancelled three times and to ask whether I could find out when he was likely to have it. In reply to my inquiry, the Royal London hospital trust said that the district health authority was low on funds and could afford only emergency and urgent operations and my constituent would be considered in April in the new financial year.
The Secretary of State said that people often do not know to what services they are entitled. In the old days, my constituents knew very well how to get their services. They used to go to their GP, wait a few weeeks and get an appointment with a consultant who would then put them on his list and they would have an operation within a fairly short time. Now they do not know how to obtain the services that they need, because those services are not there. Such services are not free ; people have paid national insurance contributions throughout their working lives to receive them. Some of those people have hardly used the national health service in the past, but, when they are older and need an operation, they find that the service is no longer there for them.
I am sure that the Royal London hospital has not given up all elective surgery ; but for whom is it performing that surgery? Is it performing surgery for people who live outside London and whose GPs are budget holders? That is very likely.
An old friend of mine, whom I have not seen for years, telephoned me today : he said that he had had four heart attacks, and was waiting for a bypass operation. He went to Kings College hospital in south London, and was told that he would have to wait for at least 15 months. He said
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to me, rather naively, "Strangely enough, the only three people who were admitted came from quite far away : one of them lived in Ramsgate. I could not understand it. All of us local people were sent home. Perhaps they were emergency cases." I thought, "Perhaps their GPs were budget holders, or their district health authorities had not run out of funds."The system is becoming totally unfair. As many hon. Members have pointed out, it is turning into a two-tier system. This callous, inefficient, doctrinaire, bungling Government are destroying the benefits of a service that people have enjoyed for four decades. The Royal London hospital trust- -the very organisation that wrote to tell me how sorry it was that my constituent's operation had been cancelled three times ; that the trust understood how awful that must be, but he still could not have the operation--is in favour of the Tomlinson report. It is closing one of its two accident and emergency departments in February, but says that it can deal with some of the specialty work currently handled by Bart's, along with paediatric work currently handled by the Queen Elizabeth children's hospital : a merger is proposed between that hospital and the Homerton hospital. The trust also says that it can take on the work of the London chest hospital and sell its site. It can do all that it is into empire building--but it cannot operate on a man whose operation has already been cancelled three times.
I recently visited the Queen Elizabeth children's hospital and the London chest hospital, and met the general managers of both hospitals. The London chest hospital is in a rather salubrious, unusually green part of the borough of Tower Hamlets, near Victoria park. It has a wonderful reputation : many people have written to me saying how awful it would be if it closed and how it saved their lives, or their mothers' lives. If it becomes part of the Royal London hospital--separated from the Brompton chest hospital-- the building will be sold in the medium term : that is the plan. Patients with severe respiratory problems will be treated in the Whitechapel area, in the midst of filth and dust, rather than in the green area that contains the London chest hospital, with all its marvellous facilities. That will not benefit the people of London, no matter how the Secretary of State twists the truth and tries to pull the wool over our eyes. It will damage their chances of good treatment, and will prevent lives from being saved and improved.
Although Tomlinson treats it as a general hospital, the Queen Elizabeth children's hospital is more than that. It is a specialist hospital. If it is merged with Homerton, Great Ormond Street hospital will be affected very badly. I was told by officials at Queens that, without the Queen Elizabeth children's hospital, Great Ormond Street would be unable to provide the full range of paediatric care for which it is universally renowned. The research in pathology, radiology and anaesthetics which, for babies and children, represents a very special sphere of practice is done at the Queen Elizabeth children's hospital. If the Tomlinson proposals are implemented, the Great Ormond Street hospital will have to compete in the market, and is unlikely to be able to do so successfully : a comparatively
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small volume of the population uses its services, and the highly specialised procedures for small children are expensive.The Carshalton and Westminster children's hospitals are closing, so that London will be the only capital city without a specialist children's hospital. Hospitals in Toronto, Boston and Melbourne, for instance, all work on the system used by the Queen Elizabeth and Great Ormond Street hospitals. We should view the matter in context : 30 per cent. of babies in London attend an accident and emergency department in the first six months of their lives, and 15 per cent. are kept in--mostly with respiratory and gastroenterinal problems. The child population in Tower Hamlets, on the borders of which the Queen Elizabeth hospital is situated, will grow by up to 19 per cent. in the next few years, and the area has twice the average number of premature births. These recommendations can only lead to the death of babies and children through lack of facilities. In these circumstances, do hon. Members think it is worthwhile to implement a doctrinaire policy about market forces in order to save money? I certainly do not ; nor do my constituents, and nor would any right-minded person.
The Tomlinson proposals will affect Londoners severely. We want better primary health care in Tower Hamlets ; there are many single-person practices there, and, although the position has improved, it could improve further. We want better care in the community--and we want the funding for it : in the past, care in the community has meant increased burdens on carers of both sexes, but especially women, and, often, on the whole family. "Care in the Community" has meant no real care, but the imposition of more burdens on people who are already doing more than their fair share- -picking up the pieces of the welfare state that the Government are destroying. As my hon. Friends have pointed out, 13,000 Londoners are on waiting lists. The Americans are currently demanding, and moving towards, better health care provision ; meanwhile, our Government are moving us towards the bad arrangements that have existed in that country hitherto.
A number of hon. Members on both sides of the House have mentioned dentistry. The Government have offered early retirement to all dentists over the age of 55. My dentist has taken it ; he would have been stupid not to. But it is a way of encouraging large numbers of dentists to leave the health service. The other day, my husband had a small filling and his teeth cleaned : it cost £12.60. He was told, "This is the last time ; at the end of January, the dentist will retire and do only private practice. He will not work in the health service any more." That dentist had spent 20 years in the health service. I said, "What will the same cost privately?" I was told, "Between £45 and £50."
I remember the days before the health service. I remember when many people in my constituency--not necessarily old people ; some were not much more than 20--had no teeth. Their teeth had been pulled out, they could not afford false teeth, their gums had hardened and they had had to eat sops. I recall clearly their gummy faces. Do we want a repetition of that? I fear that, with prices such as this, many people will be unable to afford dental treatment. Meanwhile, competition to get on to the list of a national health service dentist is becoming increasingly fierce.
Opposition Members are proud of the health service. Labour created it, and is justly proud of its creation.
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Londoners are proud of their hospitals, and do not want them to close. I have had an enormous postbag about Bart's, although it is in an adjacent constituency. We want to modernise and improve the health service, but on the basis of the fundamental principles- -Ms. Gordon : May I finish my sentence?
Madam Deputy Speaker : No ; I am sorry.
7.37 pm
Mr. Gerald Malone (Winchester) : I am sorry to have to disagree with one of the points made by my hon. Friend the Member for Harlow (Mr. Hayes), but I feel safe in doing so because he is not in the Chamber. He suggested that the hon. Member for Sheffield, Brightside (Mr. Blunkett) was not nearly so welcome as his predecessor. I profoundly disagree : I believe that in this debate we can put in context some of the remarks made by Opposition Members before the general election, and some of their predictions about the health service which would result from the re- election of a Conservative Government. One of my hon. Friends mentioned that earlier, but chose not to return to the assertions made then. It may be worth detaining the House for long enough to quote some of those predictions, so that we can see whether they would be endorsed yet again by Opposition Members.
We were told by the hon. Member for Livingston (Mr. Cook) that we were moving quickly towards a system in which patients would die in casualty rooms while the accountant was finding out who would pay for them. My hon. Friend the Member for Broxbourne (Mrs. Roe) said that she had never heard of waving the shroud before : I commend that totally unsupported assertion as just one example of what was happening on the Opposition Benches during the last Parliament. We also heard from the Labour party that the Government were planning to embark on the final stage of selling off those hospitals that they had prepared for privatisation, that we were proposing to return health care to the free market of the 1930s and that we were creating trusts which would not be part of the NHS. That was one of the five great scare stories, which ran for some months without any foundation, none of which came to pass and none of which will come to pass. I welcome the transition of the hon. Member for Livingston to another post and the arrival of the hon. Member for Brightside, from whom we heard not scare stories but nothing at all. We certainly heard little to support the contention in the Opposition motion that the health service is in crisis, and we heard nothing about the second part of the motion, which calls for reform. What reform? I doubt that we shall hear more detail from the hon. Member for Bristol, South (Ms. Primarolo) because the truth of the matter, whether she or other Opposition Members like it or not, is that Labour has conceded that our reforms will remain broadly in place--and quite right, too.
I wish to deal with the free market in health, which has not been mentioned so far. It is not a free market at all. Opposition Members suggest that the unseen, hidden hand of the market is directing reforms in patient care. That is sheer balderdash. There is a seen hand in the internal marketplace which has been created by national health service trusts--the seen hand of primary care. We must not
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forget that what underpins the reforms is the fact that, for the first time in the health service, provision will be dictated by primary carers. It is not the unseen hand of accountants that will dictate what happens, but the seen hand of need as determined by general practitioners who will be able to place contracts and have them fulfilled.Many eloquent speeches have been made on the Tomlinson report by Opposition Members who have constituency interests, I too, have a constituency interest, but it is somewhat different. It lies at the heart of what Tomlinson is trying to do--to reallocate resources within the health service to areas of population expansion and away from areas of population decline. That is what drives the report. Wessex region has, historically, received one of the lowest allocations of resources in the country, principally because a tremendous amount of resources have been siphoned off to nearby London. I am delighted to tell my hon. Friend the Minister that Wessex's 1.5 per cent. increase in real terms for 1993-94 is extremely welcome, taking Wessex's budget to over £1 billion for the first time, but still leaving it as one of the lowest areas of expenditure per head of population. However, Wessex has experienced the highest growth in population of any area in the south in the past 10 or 15 years. I welcome the Tomlinson report because it will mean that resources follow population in a more sensible pattern than hitherto, which will be to the long-term good of health care not only in the Wessex region but throughout the country.
My right hon. Friend the Secretary of State made a tremendous speech in opening the debate. She and other health Ministers have made remarkable efforts to visit all the hospitals affected by and mentioned in the Tomlinson report and to listen to what is said. I hope that she will decide that some of the decisions about hospitals will be determined by those in the primary care sector, who by the contracts that they provide will show what the health service pattern should be in London. I hope that that will determine the process. An application made last year for the Winchester integrated health care trust was rejected because it was deemed not to be in the interests of the Government's policy for it to be an integrated trust. The application has been resubmitted with some changes, and I commend it to my right hon. Friend the Secretary of State. It is important that Winchester should be carried along in the fourth tranche of health care trusts. Some changes have been made since the previous application was submitted. Some fear was expressed that the extent of current clinical and management integration in the health service in Winchester would not enable a self-standing trust to operate. I have taken considerable care to speak to all those who provide the service. Management changes have been effected and are being implemented. I believe that it will be well worth while giving the application close consideration again. I do not want to go through all the details in this short debate, but I shall write to my hon. Friend the Minister soon to back up the arguments advanced by those who provide health care in my constituency.
I join other hon. Members in paying tribute to those who provide health care in our constituencies. We owe them a tremendous debt. They do a tremendous job, but they do a better job under the reforms that the Government have put in place than they were able to do before. A record number of patients have been treated in Winchester this year. Like many other hospitals, we are
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now experiencing problems with pressure, but they do not disguise the fact that 28,000 patients have been treated. That was the target, but it has been exceeded by 400 already and there is still some time to go. It is a bit rich to suggest that such success, where budgets are being used by enthusiastic medical personnel and where more patients are being treated than before, is not an improvement on the previous situation.The debate has exposed clearly the paucity of Labour policies for the health service. They criticised the health service in the run-up to the last election and exaggerated its position, saying things which were not going to happen and, what is worse, which they knew were not going to happen and formed no part of the Government's policy. We have now seen a collapse into inactivity. Labour Members do not know what their policy is. They have fumbled and mumbled about what they would do, but they will not come out--I shall be interested to see whether we hear more about this in the winding up speeches--with a detailed policy about why we are wrong and what they would do about it.
7.47 pm
Dr. Joe Hendron (Belfast, West) : The World Health Organisation has defined health as
"a state of complete physical and mental well-being and not merely the absence of disease."
Health economists inevitably place themselves in an uneasy position if the economy being promoted by them undermines that well-being, which should be central to their endeavour. In short, what has gone wrong with the national health service?
Rationalisation really means centralisation, whereby the central, powerful and big are allowed to colonise the weak, small and peripheral. In other words, central institutions are dictating people's need, rather than responding to needs of the people. We have the technology to put men on the moon, yet there is much debate about whether women can have their babies in the local hospital. Since the Westminster election of 1987, the Conservative Government have embarked on a reorganisation of the health service that owes more to the ideology of the marketplace than to real concern for the health and well-being of people. Northern Ireland has adopted a copy of those proposals, regardless of the different circumstances of small size, high levels of deprivation and the fact that regional specialist services are provided in a single location.
The Government's changes are not intended to reform the national health service as a public service but to deform it into a commercial business. Hospitals are being forced to compete against each other for business rather than to co-operate with each other for the benefit of the patient. The national health service is not and should not be treated as a marketplace. There is no proper democratic accountability.
The Royal group of hospitals in Belfast, which includes the Royal Victoria, the Royal Maternity and the Royal Belfast Hospital for Sick Children, and which is in the heart of my constituency, is among the finest in Western Europe. It is not only in the front line of medicine but has been in the front line of civil unrest and conflict in Northern Ireland for more than 20 years. It serves the people of Belfast and, through its regional services, the
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people of Northern Ireland. I pay tribute to the nurses, doctors and other professionals who, with the non-professional staff, have given so much to the health and welfare of the people.It takes much more than manpower to run a health service. Under the so- called rationalisation of services, many peripheral hospitals in Northern Ireland have been closed and there has been a serious reduction in the number of beds in the larger ones, including the Royal group of which I spoke.
The incidence of coronary artery disease in Northern Ireland is one of the highest in the world. Through its research, the Northern Ireland Chest, Heart and Stroke Association has shown that 1,200 bypass operations are needed each year, but only half that number was being carried out because of a lack of staff and resources. However, I accept that the chief medical officer in Northern Ireland is doing something about that at present.
The Royal group of hospitals has applied for trust status and will become self-governing on 1 April. While I wish the chief executive and his staff well, I believe that the road ahead is fraught with great difficulties. Only in the past few days we have been informed that the Eastern health board had a secret meeting last week. It is to hold a public meeting on, I think, Thursday and will put forward proposals that will decimate those great hospitals. Even those seeking trust status have been taken by surprise.
Like other hon. Members who have spoken in the debate, I read last week's British Medical Journal which said that many hospitals around Britain are working at less than full capacity because health authorities do not have enough money to buy their services. Apparently, some of those hospitals will have to scale down admissions and operations unless they can obtain more funds from the health authorities and fund-holding general practices that buy their services.
The Government have ignored the wishes and needs of the people. Perhaps they will listen to the British Medical Association which said that the breakdown of many hospital services, which will lead to a two-tier provision to patients in many parts of the country, is wholly unacceptable. The current cash-limited funding is inadequate to deliver fully comprehensive patient care. Also like other hon. Members, I read the letter that the Consultants Specialist Committee recently published which speaks of the difficulties of most of the hospitals in Great Britain.
In the Government's strategy for community care, it is right to place great emphasis on keeping the elderly, the mentally and physically handicapped and the chronically sick in the community if at all possible. However, proper resources and care for the carers are extremely important. There are an estimated 210,000 carers in Northern Ireland according to the Carers National Association and without them current Government policy would be a nonsense. They are unpaid and largely uncomplaining. Much greater emphasis must be put on respite care which can be of such tremendous benefit to the carer.
Earlier, reference was made to the young man who went into the lion's den. One of the greatest problems in primary health care is with the young psychotic or schizophrenic who refuses treatment. I know that the Secretary of State for Health expressed her concern at the time and I shall certainly wait with great interest for any realistic proposals to resolve that burning issue.
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Insufficient attention has been paid to the implications for health of social inequalities, including unemployment and poor housing, which were identified in the 1980 Black report, "Inequalities in Health", and in "The Health Divide" published in 1987.Rev. Martin Smyth (Belfast, South) : I share the burden that the hon. Gentleman is bringing before the House. Does he agree that where there is a need for cardiac surgery in Northern Ireland, there could also be room for co-operation? The City hospital had the theatre space and nursing staff, if only surgeons had been prepared to use them instead of saying that there was not sufficient surgery space in the Royal Victoria, as a result of which many people are still waiting for surgery.
Dr. Hendron : The hon. Member for Belfast, South (Rev. Martin Smyth) makes a point, but I understand that it would be difficult to have the extremely expensive technology for cardiac surgery in two hospitals that are literally only a mile apart. However, I understand that there are plans to increase the number of operations in the Royal Victoria.
The health service in Northern Ireland is in a state of chaos. Senior executives are attempting to defend the indefensible while people in need of urgent care are being neglected or ignored. The Government have unashamedly helped to secure the acquiescence of a significant number of senior staff by enhancing their terms of employment.
The national health service is in a state of crisis, and I seriously believe that the Government should take heed of that message which is ringing out across the land.
7.56 pm
Mr. Michael Trend (Windsor and Maidenhead) : From listening to the Opposition, one would think that a £37 billion national health service was the end of the world, instead of the envy of the world which indeed it is. We have witnessed the political football marked "underfunding" being kicked about wildly and heard the national health service being talked down. Overall, I believe that the national health service is in good shape and improving all the time, but there are aspects still to be considered. That is the work of the Select Committee on Health, of which I have the honour to be a member.
One particular issue which recently came before the Select Committee was tobacco advertising, which I shall deal with in the context of the prevention policies mentioned in the Government's amendment and of the unjustified criticism of the Government by the Opposition spokesman. The Select Committee considered tobacco advertising and took evidence from a number of witnesses. There was general agreement on most of the analysis which resulted from our inquiry--that it was a laudable aim that smoking should be reduced, and that the means to achieve that should be considered. There was a great deal of agreement, but there was also an important dissenting voice on the final recommendations in our report last week which, in a magnificent week for Select Committee reports, was slightly overlooked by the press.
Of the eight members voting, three did not agree with a total ban. As background to what I shall say later, I should like to explain the two main reasons why I and two others did not agree with such a ban. First, in the context of the European dimension, we were being asked to subscribe to a European directive which we did not think
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was an appropriate vehicle. We did not think that it was necessary for the completion of the single market. It was not a matter of competence for trade but a matter of health--and health is not and should not be a matter for majority voting.There was also much bogus talk about what happens in the rest of Europe. Is it not odd that all countries with nationalised tobacco industries support a ban? Some may say that that is to discourage imports. Is it not odd that the vast majority of those countries which grow tobacco and support a ban receive more than £1 billion in European Community subsidies? Is not our record on curbing smoking second only to that of the Netherlands where, as here, there is no statutory ban? Yet there are countries in Europe where tobacco consumption is still rising, and the highest rises in consumption coincide with the lowest prices.
The second reason why we objected to the final recommendations of the Select Committee report was the important matter of commercial freedom of speech. Tobacco is a legal product. A ban on its advertisement would be a serious step in a free country. Commercial freedom of speech is part of freedom of speech itself. I can think of no other example of the makers and vendors of a legal product not being allowed to advertise that product, but I can think of many areas to which some people might want to extend an advertising ban if the proposed tobacco advertising ban set a precedent. There could be a knock-on effect in many areas, such as alcohol, some fatty foods, fast cars, fireworks, gambling and guns.
There may be an argument for banning tobacco, but I should like to see someone brave enough to put that argument forward in this context. Unless tobacco is made illegal, commercial freedom of speech should not be sacrificed in terms of banning tobacco advertising. A statutory ban on the advertisement would turn a hard case into bad law. If we need to consider the whole idea of restricting commercial freedom of speech, we should do so openly and honestly. We should not do it in this way. We should start with the basics and establish new ground rules from which to judge particular cases. One generation's unique evil will soon be overtaken by another's. If we changed the general rule on commercial freedom of speech, bans would be extended.
I support the Government's present position--a basket of measures which have been notably successful. Effective prevention, as mentioned in our amendment, has been the heart of our policy. The Government have done much in terms of price. The price of cigarettes has gone up by 43 per cent. in real terms in the past 12 years. It is calculated that each 10 per cent. increase in price leads to a 3 per cent. to 6 per cent. fall in consumption. It is a serious mechanism. The Government have insisted that warnings are put on tobacco packets. The tobacco industry is often accused of being a friend of our party, yet it has taken the Government to court over what it regards as the over-zealous size of the warnings that it is required to put on packets. Some people have said that the only way to spot a cigarette advertisement nowadays is by the large Government health warning on it.
The Government have made much progress in education, through the health education authority and through the inclusion of aspects of smoking in the national curriculum. The GP contracts include a remit for health promotion clinics which deal with smoking. There is also
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the general determination of the Government and especially of the present Secretary of State as shown in the White Paper, "The Health of the Nation". There is no doubt that the Government intend to bear down strongly on smoking.Social pressure is even stronger. In the past 10 or 15 years, people have made their own decision in companies, in factories and elsewhere. In restaurants and in trains, smoking has become socially more unacceptable as the years have gone by. The climate of opinion has been a strong mechanism. Against that background, I support the Government's package of measures. I should like to see the continuation of the voluntary agreement--indeed, I should like to see it strengthened, especially for children and young people. I am suspicious of conceding a false point to the European Community over the directive, especially when I consider the bogus practices which I have described. I have said that I am suspicious of making new case law for commercial freedom of speech without first looking long and hard at the deeper implications of such a move. I am also suspicious of the idea that there is a quick fix to be had by banning tobacco advertising. Although I do not deny the obvious link in general terms between the advertising and consumption of all products, I did not find any convincing evidence in the recent Smee report that a ban now would lead to a major drop in the smoking of cigarettes in the United Kingdom. His own evidence was decidedly ambiguous on that point.
I am against the quick-fix school of politics in general. Those who advocate quick-fix policies seem to be permanently fixed on the Opposition Benches. They use the NHS as a political football, but, as the past four general elections have shown, all that they have done by kicking the ball around in their characteristically volatile and hare-brained manner is to score an impressive series of own goals. To continue the football metaphor, that is why Labour Members are sitting on the Opposition terraces looking as sick as parrots. 8.4 pm
Mr. Malcolm Chisholm (Edinburgh, Leith) : The one benefit of the recent economic chaos from the Conservative party's point of view is that it has masked the health chaos developing in the wake of the NHS reforms. The two problems are connected because, just as an ideological obsession with the market has damaged the economy, so an ideological obsession with the market will destroy the national health service unless action is taken to check it.
We in Scotland are protected at the moment from the worst excesses of the market. There are only two GP fund holders and no trusts yet in Edinburgh, but it is with alarm and dismay that we have looked on as events have unfolded in England. We hear from the British Medical Association that we face the worst crisis for 30 years. We see hospitals under red and yellow alerts, patients turned away and admitted only when they become emergencies and an all-round preference being given to GP fund holders as a two-tier system develops.
We also read about plans to axe hospitals in London when waiting lists there clearly show that the problem is
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not that there are too many beds for the patients, but that there is simply not enough money to cover the necessary treatments. The Government know that the market system, with itspurchaser-provider split, is the most effective method by which to cash- limit hospital services. While cynically claiming that choice has been increased, as the Secretary of State said today, the Government know full well that the reverse is true.
The most extreme manifestation of the market system on the provider side is the trusts, which are now about to be imposed on Lothian region and on Scotland as a whole. The phoney consultation for the West Lothian trust has just been completed, and the phoney consultations for all the hospitals in Edinburgh are about to begin. The dates for all the opt-outs were pencilled in in a document in the Scottish Office at the time of the general election and no serious consideration has been given to the alternative, which is directly managed units. Even the Select Committee on Health, with its Conservative majority, suggested that the Government should proceed with caution with trusts. The Committee referred to problems of accountability, of strategic planning and of conditions for staff, yet within two years Scotland will be covered with trusts in the way that England is at present. That is undemocratic from several points of view, not least because the vast majority of people in Scotland are totally opposed to the imposition of opt-out hospitals. It is also irrelevant to the real problems of the health service in Scotland and will make them far worse.
The real problems in Scotland, as in England, are to do with underfunding, with lack of health service democracy and with the social conditions in which people live. The Government may ignore the connection between poor health and poverty, but Dr. Helen Zealley, the director of public health for Lothian health board, recently asked the health board to take seriously the greater rates of death and of illness among people living in deprived areas of Lothian. The figure for such people was 29 per cent., and many of them live in my constituency. It is scandalous that that link was not highlighted in the recent White Paper "The Health of the Nation".
The effects of underfunding in Lothian can be seen in waiting lists, accident and emergency services, continuing care of the elderly and community care. More than 25 per cent. of people wait more than one year for general surgery in Lothian. There is no way of reducing that list without spending more money.
Accident and emergency services in Edinburgh were centralised in the Royal infirmary following the cash crisis in 1990. I and three of my hon. Friends visited that hospital on Friday and saw the consequences of that centralisation of services. We were told that 80 per cent. of beds were tied up in emergency admissions. Of course, that is one reason why it is difficult to reduce the waiting lists. We were told that there were not enough beds in the coronary care unit but that every 999 heart attack call had to go to that hospital because it was the only one in Edinburgh with an accident and emergency department. We were also told, as I knew full well, that people from all over Edinburgh had to go to that hospital with even the most minor injuries. That has been the result of the centralisation.
Care of the elderly is another issue which is being hotly debated in Edinburgh. Following the English example, Lothian health board proposes to cut the number of NHS
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continuing care beds from 1,800 to 500. That means that 1,300 beds will be privatised. The reason is simply that the board does not have a sufficiently large capital allocation to build the necessary new buildings. That means that we cannot have the continuing care hospital in my constituency of Leith for which many people have been planning in the past few years.Another cause of anxiety to which my attention was drawn at a recent surgery is the drugs which the Government will allow on prescription. A newspaper article was brought to me which said that many drugs would no longer be available on prescription. When I sent it to the Secretary of State, she did not deny that that was the case. Examples of such drugs were the contraceptives Femodene and Minulet. They are more expensive than others and may be taken out of the list for that reason, even though they have no side effects and may help to protect against breast cancer.
The Government claim that they are putting a great deal of money into the health service in Scotland. However, detailed analysis of the figures shows that the outturn health expenditure this year for Scotland is £3.64 billion. The planned health expenditure for next year is £3.75 billion. That is an increase of slightly more than 3 per cent.
Mr. George Kynoch (Kincardine and Deeside) : Does the hon. Gentleman recognise that health expenditure in Scotland is some 50 per cent. higher in real terms than when his party was in office ? Does he accept that a record number of patients are being treated in Scotland and that there has been a great deal of major hospital development in Scotland since his party was last in office ? We now have more hospital beds and more doctors and nurses. Far from being in crisis, the health service in Scotland is faring well under the Conservative Government.
Mr. Chisholm : I cannot reply to all of those points, but the number of nurses has declined recently. I ask the hon. Gentleman to use all his influence to ensure that his Government approve a new hospital for Edinburgh. The proposal has been with the Treasury for a long time and many people in Edinburgh want an answer soon. The 3 per cent. increase in health expenditure in Scotland covers normal inflation, but everyone knows that health service inflation runs at 2 per cent. beyond that. That is not covered. Everyone knows that an extra 1 per cent. is needed to cover the needs of the increasing elderly population. That is not covered. Everyone knows that at least an extra 0.5 per cent. is needed to cover developments in medical technology. That is not covered either. So the much-trumpeted deal on health expenditure for Scotland is not acceptable and is not enough.
The example of the accident and emergency services which I gave a moment ago also raises the important issue of health service democracy. When the Public Accounts Committee recently investigated accident and emergency services in Scotland, my right hon. Friend the Member for Swansea, West (Mr. Williams) asked the chief executive of the national health service in Scotland whether local people had been consulted about removing the accident and emergency service from the Western General hospital. The chief executive was reluctant to answer for the simple reason that no consultation had been carried out.
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In my constituency people from Granton, Pilton and Muirhouse opposed vigorously and vociferously the closure of the accident and emergency department. Yet their views were ignored.The rhetoric on trusts is all about taking account of local needs and paying attention to local people. But the reality is the opposite. Reference has been made in the debate today to new appointees to the health boards. There is no democracy about that. The political affiliations of new appointees have been referred to by several hon. Members. I would point out that few women and few representatives of the ethnic minorities sit on the new trust boards. The proportion is even lower than in the House. That shows how bad the position is.
The new agenda for the national health service must involve emphasising the connection between poverty and poor health. It must involve developing health service democracy and replacing the market. That is not going back but going forward. The Conservative party lives in the past with its market obsessions. It has taken 14 years for many people to see the Conservative party's failures in economic policy, but its health policies are imploding after only two years. It is time for another U-turn. Let the Government start by saving all the hospitals in London and not proceeding with any more trusts in either Scotland or England.
8.16 pm
Dr. Liam Fox (Woodspring) : It is a shame that the debate, which could have been an opportunity for rational and mature discussion about the future of the national health service, has been turned into something of a circus by the Opposition. The hon. Member for Sheffield, Brightside (Mr. Blunkett) made a supposedly keynote but ultimately sournote opening speech. He made personal attacks on the Secretary of State. I am sure that she is flattered that the Opposition feel that they have to attack her personally on so many occasions.
The hon. Member for Brightside failed to grasp the main issues. Startlingly enough, he did not come up with a single suggestion about how to move ahead in the national health service. Instead, he carped on about this and that problem and threw up individual cases, as we have heard Opposition Members do in every debate in the House since the election. Not one constructive idea has been given. For a party that believed that it would form a Government last April, it is amazing that, after all this time, it cannot come up with one constructive idea about the way forward.
However, Conservative Members like to listen. I am sorry that the hon. Member for Rochdale (Ms. Lynne), the Liberal spokesman, is not in her place. Conservative Members like to consult. We do not take lightly the views of any who work in the NHS, not least the British Medical Association. Therefore, we must take the BMA chairman seriously when he says :
"The low morale in all areas of the service is largely due to the poor state of so many of our hospitals, lack of equipment to improve and, in some cases, save the lives of patients, shortage of staff, and the proper rewards to which all health workers are entitled." I am sure that Opposition Members support those words. Unfortunately, that was the BMA chairman in 1978, when the Labour party was in government.
That was the year when I went to medical school. My first experience of the national health service was of a
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service falling round our ears--that was when we could get into the hospitals, when they were not being blockaded by the unions and when the health workers were not on some sort of strike.My first experience of the national health service was of staff having to push patients into the wards because porters were on strike, supported, needless to say, by the National Union of Public Employees and the Confederation of Health Service Employees, which have gone all white and caring in recent years.
Of course, 1978 was one of Labour's years of record. The hon. Member for Brightside talked about Labour records. One of the records of which I am sure that the Labour party does not want to be reminded is that it is the only party to have cut spending on the NHS ; 1978 was the only year in the history of the NHS in which spending was cut. The Opposition cannot get away from that, but I do not intend to dwell on their record in office compared with ours, as it is becoming statistically insignificant.
We must look at the health service in 1993 and its problems and compare it with my early experience. In the first six months of this financial year we treated 200,000 more patients than last year. National health spending has reached £100 million per day and capital spending has gone up by 76 per cent. from when I entered the medical profession. Those are all achievements.
We are looking at ways to make the service more efficient and to bring doctors and others with medical expertise into management. That is one of the great benefits of trust hospitals.
We have heard much from the Opposition about how encumbered we are by management, but those in management at all levels in the NHS constitute only 2 per cent. of its work force. Total spending on management in the NHS is only 3 per cent. of total health service spending, and that makes the NHS one of the most efficient health services--if not the most efficient-- in the world. Compare that with the United States where current management expenditure is 19.5 per cent. of total health care funding. That shows the efficiency of our NHS.
There are 17,000 more doctors in the NHS than there were when I went to medical school in 1978. General practitioners' lists are 18 per cent. lower than when we came to office in 1979. Preventive medicine is now at the heart of medical policy making and that was unheard of, even unthinkable, in 1978-79. Those are all major achievements and the House would be held in higher esteem if, from time to time, the Opposition accepted such achievements. Problems may still exist and may always be there for us to tackle, but for the Opposition to pretend that everything in the health service is rotten makes a mockery of rational debate.
The hon. Member for Bow and Poplar (Ms. Gordon), who is not in her place, said that the Labour party created the NHS and that it was proud of its creation. When were the Opposition last proud of the NHS? Was it when they left office, which they occupied from 1974 to 1979, when the NHS was falling apart? At no time that I can remember since 1979 have the Opposition said that they are proud of the NHS. When advances are made, why can they not say that they agree with the Government, congratulate them and then move on to rational debate? The answer is that
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they simply cannot bear Conservative success. Even when it is staring them in the face, they refuse to accept that what we have done has benefited the health service.Over the past few years, we have been subjected to all sorts of predictions about what would happen under the Conservative reforms. Listening to some Opposition Members, one would think that the health service was absolutely perfect before we instituted our reforms. We introduced those reforms simply because the NHS was such an inefficient system and was failing to deliver what we regarded as modern standards of health care. Standards have improved as a result of the reforms, not least of which is the GP contract.
The hon. Member for Bristol, South (Ms. Primarolo) shakes her head. The Opposition told us that we would never reach our targets for immunisation or cervical smears. We surpassed them, and that is another major achievement. In view of those rising levels of immunisation it beats me why for once the Opposition cannot say, "You have done well."
The hon. Member for Peckham (Ms. Harman) said that there was no support among GPs for the concept of fund holding. How is it that already we have 3,000 GP fund holders and by April there will be 5, 000. When the Secretary of State relaxes some of the conditions governing GP fund holders, as she told us she will, there will be even more. I welcome the fact that GP fund holders will be able to come in with a list of 7,000. Many Opposition Members and Liberal Democrat Members--when they decide to come to the House --are keen to speak about consultation and pilot schemes. We said that we would limit GP fund holding to those with a practice size of 9,000 and later said that we might extend it. Did we get credit for that pilot scheme? No, we did not, but it has been an undoubted success and now we shall extend it because that is the prudent way to go forward and it has always been the Government's policy.
The magazine Doctor, hardly a mouthpiece of the right, this month conducted a survey of GP fund holders. The survey showed that over 70 per cent. reported cuts in waiting times and improved efficiency for their patients. Over 60 per cent. reported improved services for follow-up appointments, over 50 per cent. reported improved dealings with consultants and were providing extra services such as chiropody. Over 40 per cent. reported better pathology services and improvements in the prescribing service and almost 40 per cent. of practices now have consultants visiting their practices. Those are all good for patients. We must get away from the idea that the health service is for those who provide it. We run it for those who use it, and that is one of the biggest differences between the Conservative party and the Labour party. It is one of the reasons why we are in government. [Interruption.] I shall give way to any Opposition Member who wishes to intervene.
We are concerned philosophically to move in the health service in a direction that allows decisions to be made closer to the patient. That is why it is correct to concentrate more power in the hands of general practitioners. There has always been rationing of one form or another in the provision of health services. There was hidden rationing for a long time and it worked in the following way. If I wanted to refer a patient for consultation I ticked one of four boxes at the top of the letter. The boxes are labelled "emergency", "urgent", "soon" or "routine". That was how GPs always rationed
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