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care in the health service, but in many cases it was not explicit. However, GP fund holders can decide which groups of their patients can be seen more quickly than others, and surely GPs are better placed than bureaucrats in health boards to decide whether a group of patients in a specialty should take precedence over another group. That is why we must continue to extend the fund-holding practices. Not all services are covered by GP fund holders. The Opposition seem to think that GP fund holders are keen to involve themselves in coronary care and every other acute service. They cover "cold" services for which GPs can make a rational decision--one that does not involve acute patients. The Opposition say that a two-tier system is being created. If they believe that GP fund holders can offer a better service to patients than GPs who are not fund holders, surely the logic of the argument is to extend the fund-holding scheme to more and more GPs. However, the Opposition are intent on destroying our improvements and returning to the lowest common denominator, which is the base line for all their policies.Of course, there will be problems during the transition. We are some way from knowing how GP fund holders use their contracts and how they will pan out. It is not entirely unexpected to encounter problems nine months into the financial year. No matter how we decide to use the funding, problems will remain throughout the decade. Medical science is advancing at a far greater pace than we can ever fund by public money. The gap between what can be provided by medicine and what we can afford to purchase will increase. Within whatever finite budget is in place there will have to be choices between acute and chronic care, between centralised hospitals and community hospitals, an issue raised by the hon. Member for Edinburgh, Leith (Mr. Chisholm).
There is a conflict of interest in my constituency about whether funding should go to Bath or to one of my local hospitals in Paulton. It is a matter of trying to decide at the lowest possible level to respond to what local people want. We must take a fresh look at the advantages of community hospitals as opposed to centralised care. There will be a limit to the level of increase in funding that can be internally generated by efficiency. Sooner or later, we shall have to make explicit judgments about the rationing of health care. I asked in a previous debate whether it was acceptable, when there is a shortage of money in certain sectors, to pay for tattoo removal and so on. We shall have to look explicitly at whether we make these things freely available on the NHS. We have to use the personnel who work in the NHS in the most efficient way, and that is especially true of general practitioners. They are at the forefront of all the advances that we are making. As GP fund holding is extended, they will be asked to make more and more specific rational decisions, but their time must be used appropriately and, while many benefits have come from fund holding, not least the ones I have mentioned about cancer screening and immunisation, we must make sure that GPs are not overburdened with regulation.
It is prudent now, a couple of years into GP fund holding, for the Government to look at which areas are being productive and which may be unnecessarily overregulated. As we have asked for unnecessary regulation to be swept away in other areas of government, the Department of Health should also look at whether it is using GPs' time most efficiently.
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We also have to look at whether we must have the regional tier because, while we are waiting for the internal market and its working to become clearer, as it will over time, there is still some need to keep the regional tier but there will come a point in the not-too- distant future when the regional tier will become over-bureaucratic and interfering and we may no longer require it. I hope that the Government will seriously look ahead to that time. I want to make a final point, about the mental health changes, following the comments made by the hon. Member for Belfast, West (Dr. Hendron). I also feel strongly about this subject. It is dangerous to try to oblige any one fashionable medical idea across an entire spectrum and that is what has happened with mental health. I do not believe that it makes any more sense to say that all the mentally ill should be institutionalised than it does to say that they should all be in the community. There has to be a balance, and I very much welcome the commitment by the Secretary of State a few weeks ago when she said that the Government would be reviewing all those guidelines. Surely we must have a balance in that system so that those who can integrate will be integrated and those who require institutional care can get that institutional care.I hope that we shall turn back a little of the medical fashion which is putting everybody into the community which, as one can see on the streets of any city, is proving to be something of a mistake, especially for patients suffering from schizophrenia.
The Government have been brave in recent years in carrying forward their proposals. They have always done so against the wishes of the Opposition, who cannot tolerate anything that smacks of change and movement away from bureaucracy, and often in the face of criticism from the medical profession.
It has taken seven years for the Labour party to change their mind about council housing policy ; five years for them to change their mind about British Telecom. I wonder how long it will take them to change their mind about NHS trusts and fund-holding practices. I am sure that the real world will catch up with them in this, as in all the other policies which they have foolishly turned their faces against. I hope that it will be sooner rather than later, but for the electorate it will not make any difference because the Opposition will not get the chance to put their policies into practice.
8.34 pm
Mr. Alan Milburn (Darlington) : The hon. Gentleman's belief that everything in the NHS garden is lovely is not a view shared by NHS professionals or NHS patients. He will know that the BMA recently condemned the breakdown of many hospital services leading to a two-tier provision of service. The BMA has also condemned underfunding and flaws in the reforms and has called for radical reforms of the Government's changes immediately.
They know, and we in the Opposition know, that two years into the market all the impact that we predicted would occur with the introduction of the market into the NHS is now coming to fruition. The chickens are coming home to roost. Hon. Members on both sides know in their heart of hearts that the Government have created a system in which hospital services in many parts of the country lie idle for three months of the year because there is not
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sufficient money. It is unfortunate that NHS patients refuse to become ill for just nine months of the year. They become ill for 12 months and many are having to wait longer and longer for treatment. The lack of resources for clinical care contrasts markedly with the booming resources that seem to be made available for bureaucracy within the NHS. The hon. Member for Woodspring (Dr. Fox) and some of his colleagues have spoken of the relatively small ratio of bureaucrats to clinical staff in our national health service. That was something to be proud of. I speak in the past tense because the figures from the Department of Health, as the Minister knows full well, point in a startling new direction.Mr. Malone : So that we can get something positive from the Opposition, with what structure would the hon. Gentleman replace the management structure?
Mr. Milburn : I will deal first with the point that I was attempting to highlight and come to that later. We have more and more red tape in the NHS. Arguably, it is strangling the service. We have had a boom in bureaucracy in the past few years. The figures that I have received from Ministers indicate that during the period when the market was introduced into the NHS, between 1989 and 1991, the number of managers tripled while the number of nurses and midwives available on our hospital wards and in our communities fell by some 8,500. That has to be coupled with the enormous growth in administration generally. We now have 9 per cent. more clerical staff and more administrative staff as a result of the Frankenstein that the Government have created. Once one has the market, one has the purchasers and providers, opted-out units, more accountants, more financial directors and more of the institutions of the market. In my region in the north, during that three-year period we saw a 500 per cent. increase in the number of managers. I would happily have lived with that, and many of my hon. Friends would happily have lived with that, if it had been complemented by a 500 per cent. increase in the number of nurses and midwives, but it was not--it was accompanied by a real decline in their number. There are fewer nurses on our wards. Many nurses are losing their jobs altogether and almost 5,000 health workers were made redundant between 1989 and 1992 because of the closure of their hospital units. Those are not my figures. They are not NUPE's figures. They are not the BMA's figures. They are the figures of Ministers from the Department of Health. They know in their heart of hearts exactly what is happening. Job losses were up by 50 per cent. in the first year of the market. It will not surprise my hon. Friends to learn that the biggest wave of redundancies took place in NHS trusts because there the ethics of the market are running amok. We are seeing more redundancies and sackings and fewer nurses and midwives at the sharp end of health care. I go back to the introduction of the market and the Government's White Paper promising all these changes. I vividly remember as a humble parliamentary candidate that we were promised a leaner and fitter national health service. We were promised that it would be more efficient and less bureaucratised and that there would be a freeing of resources to enable the health service to treat patients at
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the sharp end. But it is not leaner : it is fatter--fatter with bureaucracy. It is bureaucracy gone mad. I understand that the Secretary of State enjoys being well briefed and therefore might want extra staff to monitor the effects of her policies, but do we need thousands of extra bureaucrats, accountants and administrators at the expense of qualified nurses? That is what we have got. That is a national scandal because it has done precisely nothing to improve patient care in this country.I will allude briefly to some of the problems in my own area. Darlington's NHS is suffering a three-fold crisis because of underfunding, continuous administrative upheaval and the emergence of a two-tier health service. Darlington health authority is being denied any growth funding until 1995, despite having a greater than average elderly population. The local hospital is in dire financial crisis. In the current financial year, it is rumoured to be facing a £2 million deficit, and that is having a real impact on patient services. Hon. Members have spoken about looking after, listening to and ensuring that the concerns of NHS staff are taken fully on board, but in Darlington there is a vacancy freeze on new NHS staff. In the past six years the hospital's cost improvement programme has taken £3.25 million away from hospital services. As a result, we have seen acute medical and surgery wards closed, children's wards being merged and, finally, desperate underfunding of our accident and emergency provision. The accident and emergency department treats some 10,000 patients every year. In the event of a major crisis on the east coast mainline railway, at Teesside airport, just two miles from Darlington, or on the A1M, just one mile from Darlington, that accident and emergency department would have to deal with a catastrophe without having any specialist accident and emergency consultant because the hospital cannot afford to appont one in this financial year. That is courting disaster and gambling with local people's lives.
Mrs. Audrey Wise (Preston) : Before my hon. Friend leaves the point about the lack of jobs for nurses, he may be interested to know that a student nurse recently described to me graphically how, as an official part of the course in the final year, students are being lectured on how to find opportunities to work overseas when they qualify.
Mr. Milburn : I am grateful to my hon. Friend. I believe that we face a major brain drain from the health service precisely because opportunities are lacking for qualified nursing staff.
Money can always be found for managers, of course. I understand that Darlington health authority is about to appoint a new project manager to lead the opt-out of acute services, on a salary of up to £53,000 per annum. That appointment is quite unnecessary. It is a direct product of the interference from Whitehall in local decision making about the future make- up of local health services in Darlington.
Dr. Liam Fox rose --
Mr. Milburn : I have given way on a number of occasions and I should like to begin to wind up my remarks.
One of the final issues that I want to address is the decision which has just been taken today about the future make-up of health services in my constituency. We are sick and tired of governmental interference with our local
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health service. Just today, the regional health authority agreed a merger between Darlington and South West Durham health authorities, in the teeth of opposition from patients, staff, the two community health councils, the four Members of Parliament, the local authorities and local people. It is claimed that the Government are prepared to listen, but where is the listening there ? They have not listened ; they have ridden roughshod over the wishes of local people in my town. There will be no choice for patients as a result of that merger, because increasingly patients will have to travel for treatment to Bishop Auckland and out of the town altogether. Some patients, of course, will not need to travel at all. They can take advantage, if they are lucky, of the top tier of health care in a two-tier service. Fund-holding GPs in my constituency have the benefit of referring patients directly to fast-track treatment. They do not do so through the NHS ; they refer patients directly to the local private hospital. Hon. Members have attempted to mock some of the statements made by my hon. Friend the Member for Livingston (Mr. Cook) prior to the general election. He warned about creeping privatisation. That is not creeping privatisation ; it is full steam ahead privatisation. Hon. Members should be ashamed that we have seen the development of a two-tier health service in this country. I do not blame the GPs or the patients ; they are playing by market rules, but the market means winners as well as losers and I am afraid that the NHS has become a national lottery. Lucky patients hit the jackpot, but this is not the sort of NHS that the British people want. They want an NHS which is free at the point of use, guaranteeing equal access to expert medical help when it is needed. That is the sort of NHS that we had in 1948 and the sort of NHS that we had in 1979. Unfortunately, it is not the sort of NHS that we have today.8.45 pm
Mr. David Willetts (Havant) : I am grateful to you, Mr. Deputy Speaker, for calling me to speak in this debate because the motion put forward by the Labour party reveals that it fails to understand the basic objective of the Government's health reforms and how they work for the benefit of patients. Hon. Members talk about commercialisation of the health service and fragmentation of health care, but what the Labour party calls commercialisation and fragmentation is freedom for the providers of health care to serve the best interests of patients for whom they have responsibility. A piece of doggerel that was circulating in the NHS many years ago summarises the purpose of the Government's health service reforms. It was said of doctors :
"Masters of their patients when servants of the state,
Servants of their patients when masters of their fate."
It is the purpose of the Government's health reforms to make GPs and self- governing hospitals masters of their fate, no longer tied up in elaborate bureaucracy, and in doing so to ensure that they can properly serve the interests of their patients.
I will look first at primary care and the role of GPs now that they have the opportunity to be budget holders. Here I draw on my experience of serving for several years as a member of a family practitioner committee. Although many advocates of the old-style NHS have said that one of its strengths was the so-called gatekeeper function carried
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out by GPs, in practice the division of responsibility between primary and secondary care was one of the great weaknesses of the old NHS. It was a weakness that went back to Bevan's original design. On the one hand, GPs had the freedom to refer wherever they wished ; on the other hand, they had no power to send resources to the places to which they were referring patients. The allocation of resources was determined by the Department of Health--determined, as Nye Bevan famously observed, by a department where, if a bedpan was dropped in any hospital in the NHS, the sound could be heard in Whitehall. That was no way to run the NHS.If GPs are to be given proper freedom to refer, that freedom must be backed by the power to send the money to the places to which they are referring. That, of course, is the crucial significance of the option for GPs to become budget holders. It is an innovation which resolves one of the contradictions in the old-style Nye Bevan NHS. It not only solves the problem of that tension with which the NHS had wrestled for a long time, but also goes with the grain of technological development. The old-style view of the NHS as a service which required larger and larger hospitals, with more and more functions centralised in enormous hospitals, is not what the patients want, it is not what communities want, and it is no longer what medical technology requires. The power of miniaturisation and medical advance makes it possible for many treatments to be carried out in the GP's surgery or in the local clinic. Only 10 years ago, such procedures would have been thought to require hospital treatment. GPs are now properly reimbursed for minor ops--lumps and bumps. In future they will be able to carry out in their surgeries pathology tests with the use of small sensors, enabling patients to have immediate results. In the past, patients would have had to go to hospital, lie on a bed, have a blood test, return home, and be called to see the GP or hospital a week later for the result. Many enormous
simplifications will be made possible by technology.
The old style NHS stood in the way of such advance. It had no interest in services becoming available at the primary care level because there was no financial system by which the pattern of funding the NHS could keep up with the pattern of technological change. Freedom to spend the money that they are allocated in the way they know to be in the best interest of their patients will result in GPs saying, "I need not send my patients to the big district general hospital 10 miles away for some tests ; I can invest in the technology which will enable me to do those tests in my surgery." The strengthening of the GP has been one of the great success stories of recent reforms, going beyond the wildest hopes of Ministers when they originally planned those reforms. In the old days, the contempt with which many hospitals and district health authorities treated GPs had to be seen to be believed. I recall the way in which the local district health authorities, as they saw the review of the NHS coming into effect, for the first time realised that if they really wanted to make sure that money was properly allocated, they had to conduct research into what GPs thought about the current pattern and quality of hospital services. They were horrified when, for example, they came across GPs who could say, "We are not satisfied with the quality of treatment from this or that hospital or department."
When writing contracts and deciding the services that they wanted to buy on behalf of patients, DHAs for the
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first time seriously consulted GPs to find out what they wanted. They now know that if they ignore GPs' views, many more GPs will become budget holders. The threat of becoming a budget holder has improved the quality of care for GPs who are not budget holders as much as it has improved the quality of care for those who are. That is why the reference in the Opposition motion to a two-tier health service goes against the reality of developments in recent years.Dr. Liam Fox : Does my hon. Friend agree that what is important in cases of referral is not where patients go--whether to a private sector or a NHS hospital--but how quickly they are treated? The Labour party is tied to dogma, whatever Opposition Members say about Conservatives being dogmatic on the issue.
Mr. Willetts : I agree with my hon. Friend. He reveals the cynicism with which Labour Members speak of privatisation. They use it in the sense of people having to pay for their health care. That is not, and never has been, Conservative party policy and what we are discussing is not in any way privatisation in that sense. Completely different is the concept of a patient enjoying health care free at the point of use--that care perhaps being delivered most expeditiously by a private hospital with which a DHA has a contract so as to reduce its waiting list. That is not privatisation, but delivering publicly financed health care free at the point of use in the most cost-effective and efficient manner. Only blinkered ideology could lead anyone to oppose such an approach to health care. The patient gains by getting the best possible health care without having to pay for that care at the point of use.
I move from primary to secondary care--the hospital service. An irony of the hostility of Labour Members to self-governing hospitals is that they oppose a measure which was modelled in many ways on a feature of Nye Bevan's health service which deserved approbation. When he was establishing his health boards, he deliberately decided, after consulting the leading representatives of the hospitals, that the leading teaching hospitals, with their medical schools, should not be brought under the direct control of medical boards. The old teaching hospitals were to remain self-governing.
Bevan envisaged that they would be self-governing, and so they remained until--the irony of what occurred will not escape my hon. Friends--Lord Joseph's reforms of the health service in 1970 to 1974, which brought those teaching hospitals under the direct control of health authorities. It was not a fundamental feature of the post-war NHS, but a relatively recent development. Indeed, in Guy's hospital there is a notice on the wall with a rather melancholy inscription saying that the board of governors met there for their final meeting, in the 250th year of their existence, in February 1974.
An idea behind the reforms which has proved enormously popular is now to give every NHS hospital the opportunity to enjoy self-governing status, the sort of freedom which Nye Bevan envisaged should be enjoyed by our great teaching hospitals. It is in no sense a dismantling of the NHS, but an attempt to ensure that all hospitals can enjoy the freedom which teaching hospitals had up to 1974. It is ironic that Labour Members should be
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committed to a stout defence of an over- bureaucratic, over-managed structure of the NHS introduced in the 1970 to 1974 period. There is no reason why that should be regarded as a fundamental feature of the NHS. As we see with several waves of applications for trust status, doctors, nurses and managers at those hospitals greatly relish the opportunity to employ staff more flexibly so as to serve patients in the ways that they know best.Much has been said by Labour Members about the management of the NHS. If one wanted an indication of the inability of the Labour party to take seriously concepts such as efficiency, effectiveness and high quality care, it is their manifest opposition to anything regarded as management in the NHS. They do not like the idea of managers or accountancy or the efficient use of money. The NHS is one of the largest organisations in western Europe. The idea that it can survive simply by the endeavours of doctors and nurses, crucial though they are, without a professional cadre of people committed to the efficient use of resources, the proper control of money and the proper management of large and expensive hospitals is at best naive and at worst shows an extraordinary disregard for what is in the real interests of patients. I hope that we shall hear no more attacks on the essential work that managers do in the NHS. We do not say that the only staff doing a real job in ICI are chemists or that the only people doing a worthwhile job in Shell are those who work on oil rigs. We accept that large, complicated organisations have management functions which need to be carried out by experts.
Mr. John Gunnell (Morley and Leeds, South) : The hon. Gentleman has philosophically explained his case for fund holders and has made a similar case for trust hospitals. Now he is moving on to management. He has left out the purchasing authority. He obviously envisages an increase in the number of fund holders and presumably he wishes all GPs to become fund holders. What role does that leave for the purchasing authority? Or is the purchasing function to be entirely in the hands of individuals?
Mr. Willetts : The hon. Gentleman has raised an important question. The reply is twofold. First, the Government have always made it clear that becoming a GP fund holder is a voluntary option. Nobody is being dragooned into becoming a fund holder. I welcome the enormous number of GPs who have already exercised that option and I expect that many more will do so in future, but it is not compulsory.
Secondly, as my hon. Friend the Member for Woodspring (Dr. Fox) has already pointed out, the GP budget does not cover all services that the NHS provides. It covers the services which are frequently used at relatively low cost, but it was not thought feasible or sensible to include expensive and relatively rare treatments because they are randomly distributed. A relatively small number of cases would risk overturning a GP's ability properly to plan his budget, so such treatments remain financed through DHAs as purchasers. We may hope that some of the services currently bought by district health authorities will in future be bought by GP budget holders, but I expect that there will always be a wide range of services to be purchased by DHAs and not by GP budget holders.
I return to the point about management with which I was concluding, and to the record and the figures that we
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heard from my right hon. Friend the Secretary of State for Health today in a speech that I thought was so effective and persuasive.Mr. Willetts : My hon. Friend describes it as a brilliant speech-- [Interruption.] Opposition Front--Bench Members say that they were deeply impressed. I am pleased to have such confirmation of its quality. That speech included figures on the record number of patients treated and the record activity in the new style NHS which have been achieved by a combination of high-grade management and the freedom at last for people working in hospitals and for GP budget holders to act without the crippling control of the state. I therefore strongly oppose the Opposition motion.
9.2 pm
Mr. Richard Burden (Birmingham, Northfield) : The Opposition, and indeed the country, are getting quite used to the bland assurances of Conservative Members that there is no crisis in the NHS.
The picture of fund-holding GPs, hospitals and health authorities all competing in perfect harmony and patients armed with their own personal copies of the patients charter waiting only a short time for treatment is about as believeable as the adverts for private health care which show healthy people sitting up in hospital and smiling, being treated by nurses who never look tired while the patients never look sick. I cannot comment on whether that is an accurate picture of a private hospital because, unlike some Conservative Members, I do not use them. However, I do know that that is not a picture of care in the national health service in my region, the west midlands. In that region, the Government's health reforms are creating a kind of Trotter's Independent Traders, without the same social conscience but with the same financial acumen.
Qa Business Services, the computer division of the regional health authority, was sold off and went bust within 18 months. Millions of pounds have been spent on a value-for-money exercise that saves no money. We see HealthTrac, a new all-singing, all-dancing supply system that has to be investigated by the Audit Commission. That is what is happening under the new-look national health service. It would not be so bad if the effects were simply financial. But it is not simply money ; it affects real people such as those who worked for Qa Business Services--pensioners who stand to lose two thirds of their pension entitlement because of that mismanagement.
In my area of south Birmingham a merger was forced through against the wishes of local people and community health councils. It resulted in a deficit of about £25 million. That is leading to the closure of hospitals. It has already led to the loss of beds, and it means that the Royal Orthopaedic hospital in my constituency is to close, as is the accident hospital which has one of the best burns unit in the country. Services are also to be transferred from the general hospital in the city centre. Consultants opposed it and the local community opposed it. Consultants have warned of the danger of cross-infection--but because the market dictates, the policy must be pushed through.
Even before that happens, the Royal Orthopaedic hospital has to offer bargain basement prices to get contracts from other health authorities, but it cannot get
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them because those authorities do not have the money. A constituent of mine has been told that he must wait 92 weeks even to see a consultant. He needs the services of that hospital. The services exist, but he cannot use them because the market dictates that he cannot do so.Another constituent of mine, a young boy aged nine called Thomas Leavy, has cerebral palsy. The health authority has told him that, because it does not have the resources as a result of the financial crisis caused by the health reforms, he cannot get adequate physiotherapy treatment and he must wait six months just to see somebody about the possibility of occupational therapy.
That is the reality of the Government's health reforms. It has been summed up much more eloquently than I could put it by a Birmingham consultant, who wrote to general practitioners in the north Birmingham and Bromsgrove areas --copying the letter to the Secretary of State, among others--saying that it was not possible to place patients from their authority in his hospital. He said :
"My medical colleagues and I believe that this is a totally unsatisfactory state of affairs. The NHS reforms are not working. Money is not following the patients. The choice of patients and General Practitioners is being restricted not preserved as promised. We are into the realms of a two-tier health service depending on who has got the money and where patients live."
Those are not my words, nor the words of the Labour party, nor even the words of NUPE--which Conservative Members like to quote--but the words of a consultant. That is the reality of the health service as it operates today.
Everything happens behind closed doors ; secrecy surrounds the health authority. I and other Birmingham Members have tried to get answers time and again. We have asked the Secretary of State, Ministers and the regional health authority to provide us with the reports of the investigations into the financial crisis facing the South Birmingham authority. We have asked for copies of audit reports on the financial scandals in the West Midlands authority. Time and again, the Government insist that they listen and consult, but they have fobbed us off. Time and again, the Secretary of State has refused to meet Members of Parliament from the south Birmingham area to discuss the plans to close hospitals such as the Royal Orthopaedic. Of course, they say that it is a matter for management. We know what management means in the west midlands--financial scandals. It has meant Sir James Ackers running the flagship of the authority's internal reforms. We called for his resignation for months and months. Finally, after ignoring those requests, the Secretary of State was forced to accept his resignation a month or so ago, under circumstances not yet revealed.
There is now new management in the authority--Sir Donald Wilson, formerly of the Merseyside authority, which is itself the subject of calls for a public inquiry. He has been foisted on us. We are told that there is a new regime with a new open-door policy. That sounds great, but still all the hon. Members who have been asking for those reports have not been given them. That new management has not said that it will save one hospital or one hospital bed.
The new management is not much change on the old. When we discovered that, we asked the Secretary of State to direct the new management to ensure that the reports were made available to us, the local democratically elected representatives. Although she said in the debate today that she was in favour of all information being made available,
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her hon. Friend the Minister for Health replied to our requests, "No, it is a matter for management whether those reports are released."A stop must be put to the situation in which the health service is run as if it were some kind of glorified supermarket. When we say that privatisation is creeping into the NHS, we are not exaggerating. We shall have in the health service what has happened in a number of other industries. First, the financial structure is changed and financial shackles are applied. Then there is the pretence that there is some kind of decentralised decision-making, whereas the only thing that is being decentralised is responsibility. When that system breaks down, Ministers say, "Wouldn't it be much easier if you went independent, if you freed yourselves from the shackles of Government control?"--the Government that put the shackles on in the first place. That is what Conservative Members intend for the national health service, although they do not have the guts to say so, and it is what Opposition Members will oppose and oppose and continue to oppose because we support and defend the health service that we created. Conservative Members have asked us what our alternative is. Let me make three points for a start. First, the market mechanism, which is alien to the concept of health care and proper health planning, should be abandoned. Secondly, the health service should be given the funding that it needs. No amount of jiggery-pokery, with purchasers, providers and contracts, can make good the underfunding. Thirdly--and equally important-- people who believe in the national health service, who use it and who live locally should be put in to run the service in a way that does not suggest that it is some kind of glorified supermarket.
9.10 pm
Mr. Jeremy Corbyn (Islington, North) : I should like to put on the record my thanks to my hon. Friend the Member for Bristol, South (Ms. Primarolo) for giving me five minutes of her time.
I want to put on the record too--so that it will not be possible for anyone to claim otherwise--the fact that, as a Member of Parliament, I am sponsored by NUPE. I am not ashamed of that connection ; indeed, I am rather proud of it. Members of my union and, indeed, of the unions with which we are about to merge do very valuable work in the health service and are dedicated to the principle of a health service free at the point of use. They will remain dedicated to that principle, as has been demonstrated by their many years of service.
I wonder how those people are expected to continue their dedication when they are told that their pay rise in April will be limited to 1.5 per cent. despite the fact that the rate of inflation is far higher than that. Conservative Members may find this extremely amusing, but they are quite concerned about the future of their own jobs--especially the London Members, to whom I wish to address my comments tonight.
The Government's treatment of the health service in London is nothing short of appalling. We have seen 5,100 beds lost since 1982 ; during the same period there has been an increase of 18 per cent. in demand for hospital places ; and regional health authority decisions have been imposed on London health districts, with no democracy whatsoever
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in the decision-making process. With the growth and merging of health authorities, we now have bigger, more impersonal and less accountable bodies in London and a continual drift of resources out of London and into the home counties.I do not intend to be dragged into a false argument about the needs of inner London as opposed to those of Essex, Hertfordshire, Surrey and Kent. What we require is recognition by the Government of the needs in inner city areas. In London there are 60,000 people living in temporary housing accommodation, a considerable number sleeping on the streets, 1 million people living in poverty, above-average levels of deprivation and a high incidence of suicide, AIDS and many related diseases and illnesses. If the Secretary of State were to look at statistics produced by any family health service authority in inner London, she would recognise the degree of deprivation.
But what did the Government offer? The Tomlinson inquiry. It is proposed that a considerable number of hospitals, including Bart's, about which my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) spoke so eloquently, should be closed, with the loss of a very large number of beds. It is claimed that, somehow, this will solve the problem of a London waiting list of 130, 000 people. The implication is that the problem will be solved by transferring resources from the hospital sector to the primary care sector. That is not the alternative for which we are looking. What we want is recognition of the fact that the people of London need and deserve a proper health service. That means increased resources for the primary sector, increased resources for general practitioners, and better general practitioner services. But that will not be achieved if much of the general practitioners' time is taken up as a result of premature discharges from hospitals and inadequate hospital services in the first place. The Secretary of State and the Government must recognise that Tomlinson has got it fundamentally wrong. What Tomlinson is talking about is mass closures, with loss of beds, in order to solve the problem of underfunding of primary care in the first place when what we require is a recognition of those needs.
There is at last an inquiry into the activities of the London ambulance service, after years of providing an inadequate service because of an incompetent management and a particularly incompetent board. What we need at the same time is the recognition that the health needs of London will be met not by things like the Tomlinson inquiry but only by an increase of resources as a whole to the people of London. It is not right that people living in inner London suffer a higher level of infant mortality, a shorter life expectancy and a higher level of notifiable diseases than those living in the rest of the country. These problems must be addressed by an adequate provision of resources by Government to meet the need.
9.15 pm
Ms. Dawn Primarolo (Bristol, South) rose --
Ms. Primarolo : Perhaps I should sit down now and quit while I am ahead, with the support from my hon. Friends.
The debate has been about the realities of the national health service and the experience of people using and working in the service. My hon. Friends who have taken part in the debate have adequately described that
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experience. My hon. Friend the Member for Don Valley (Mr. Redmond) pointed out the political nature of the appointments, the placemen who are put on to trusts and rewarded generously while poor pay continues in the national health service and there is a pay freeze of 1.5 per cent.My hon. Friend the Member for Halifax (Mrs. Mahon) spoke about the human cost of the national health service reforms, the bed closure programme and the desperate situation in her constituency because of bed shortages.
My hon. Friend the Member for Bristol, East (Ms. Corston), speaking about her constituency in particular, concentrated on what the national health service was created to do and what it does now in our communities. She spoke particularly from the personal experience of her constituents waiting 19 months not to be treated but merely to receive an appointment to see a consultant. She also mentioned the problems with dental services in Bristol, the ambulance cover, which is only 90 per cent., and the two-tier system whereby the patients of general practitioner fund holders are treated in advance of those on the waiting list.
My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) was cut off in his prime. He had enthusiastically defended Bart's hospital, and I am sure that the Minister on his frequent visits to Bart's will likewise defend that excellent institution, but my hon. Friend was cut off before he could tell us that Bart's has now eradicated its deficit. It is, I hope, about to tell the rest of the London hospitals how it managed it, and then the closure programme proposed by Tomlinson can be abandoned as irrelevant. My hon. Friend the Member for Bow and Poplar (Ms. Gordon) spoke about the importance of access to care on the basis of need, the cornerstone of the national health service, and went on to describe why the basic facts and data used in the Tomlinson report were incorrect.
My hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm) spoke about the experience in Scotland and drew comparisons with England ; he rightly said that the British Medical Association describes the crisis now being experienced in the national health service as the worst for 30 years. That is nothing for hon. Members on either side of the House to be proud of, and it is something which we should address.
My hon. Friend the Member for Darlington (Mr. Milburn) spoke with great authority and accuracy, cutting through the assertions made by Conservative Members about our now having a leaner, more efficient national health service in which the bureaucracy has been reduced. Using Department of Health figures, he put paid accurately to that misrepresentation. As he pointed out, there has been no freeing of resources for patient care.
My hon. Friend the Member for Birmingham, Northfield (Mr. Burden) talked eloquently about Trotter's independent trading company, as he called it, in the west midlands, and the secrecy that persists about the misuse of money in the NHS. He pointed out that one of his constituents had a 92-week wait to see a consultant. That is disgraceful.
My hon. Friend the Member for Islington, North (Mr. Corbyn) pointed out further shortfalls in the Tomlinson proposals. Most important, he showed that at no point had there been any assessment of London's health needs or any assessment of the tremendous problems that London faces, as do many of our other inner cities.
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The Secretary of State told us that she had launched a new health help line to which she had made the first phone call- -presumably to try to find out what is going on in the service. However, she failed to tell us that the help line closes at 5 o'clock. We have tried several times to get through, in the hope of obtaining some of the information that we cannot obtain from the Government, only to be held in a queue or requested to leave a recorded message which would be dealt with in due course. I hope that we do not have to wait until April when the new contracts start.The Secretary of State said that a health service should be based on principles, but she went on to qualify that, saying as long as those principles stick to the budget. That is the politics of the balance sheet, not clinical priority.
The Secretary of State announced that £2 million would be given to pump prime pacesetter projects. I wondered whether that had anything to do with heart surgery ; then I realised that it did not. She said that the object was to reduce waiting list times by setting new benchmarks. Perhaps she will explain to the House how pacing treatment, spreading it over a longer time, will lead to a reduction in the waiting lists. Presumably people will have to wait longer before they are reached.
The Secretary of State then announced something that she has already told us about.
Mrs. Virginia Bottomley : The sort of schemes to be funded are those at Walsall and Horsham which ensure that people can have their cataracts treated more swiftly and that people coming forward for breast cancer checks will be seen within 48 hours--innovative schemes, different ways of doing things, which others across the health service can emulate.
Ms. Primarolo : It is a shame that the Secretary of State could not have told us that in her speech and that she did not make it clear that the scheme was not about pacing treatment but about access. The Secretary of State also announced for the second time the £2 billion to be used for capital projects within the NHS. She went on to say that that was to be provided by the sale of land and property. First, that is not new money, because it was in the autumn statement and, secondly, it is money which is funded by closure programmes, and the right hon. Lady cannot be sure that it will be available. The Secretary of State referred to the huge investment that has been undertaken by the Government, and derided Opposition Members for the performance of past Labour Governments. She went on to talk about primary care. In 1981, the Acheson report identified the fact that 15 per cent. of GP premises in London were below the national average in that respect. Extensive and good proposals were made for the expansion of primary care. Hardly any of those were implemented, but linked to that was a bed closure programme. That, no doubt, sounds familiar to my hon. Friends.
A total of 5,000 beds were closed to pay for the increased primary care, but, by 1992, when we received the Tomlinson report, we found that the situation in London had deteriorated rather than improving : now 46 per cent. of GP premises are below the national standard. That decline in primary care has been presided over by a Government who claimed that they were providing more money.
Mr. Willetts : Will the hon. Lady give way?
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Ms. Primarolo : I hope that the hon. Gentleman will appreciate that Conservative Members have spoken at length, and that I have given up some of my time to ensure that my hon. Friends could speak and to allow time for the Minister. Every time hon. Members interrupt me, thus reducing my time, I shorten the Minister's time. Does the hon. Gentleman want to incur the Minister's wrath?
I hope that the Minister will take the opportunity to repudiate paragraph 12.25 of the Bloomfield report on dentistry, which states :
"In considering priorities for exemption from payment, there must be doubts about the category of pregnant women/nursing mothers." Will the Minister state categorically that there will be no reduction in that exemption? Will he also refer to the new blacklist that is to be introduced, and give the House a categorical undertaking that no contraceptives will be removed from the list? The Government told us that the national health service stumbled from crisis to crisis, and that we needed to accept the implementation of their reforms ; the crises would then disappear.
Mr. Miller : We have heard a good deal about choice from Conservative Members. Would my hon. Friend like to comment on the board of the Countess of Chester hospital, in the Mersey region? There are four Conservative activists on the board--including Lord Wade of Chorlton--a failed Tory party treasurer and cheese maker. Would my hon. Friend care to contrast them with my constituent, a YTS trainee who suffers from a life- threatening disease and who--because of the "choice" offered by the Government--cannot get free prescriptions on the national health service?
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