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Mr. Blunkett : I am interested not in cutting the wages of the lowest paid, but in improving the quality of care to the patient and getting people off trolleys and into beds. Today, in its campaign to improve our health service, has provided excellent information, as has the Evening Standard on what is happening in London, the Manchester Evening News in Manchester and the Sheffield Star in my area, and newspapers throughout the country, and the exposure of waste by the Daily Mirror.

All that information is available for people to see. What is more, people also know who benefits from spending and from the health service, not merely those who are placed in positions with which I have already dealt this afternoon. Of the top five beneficiaries who benefit from health service spending, two of them give money to the Tory party : A. A. H. Holdings plc and Glaxo. They will benefit from our money. The hon. Member for City of Chester should not start lecturing about where the money goes or who benefits from it, because some of us could give chapter and verse about how some people have been benefiting greatly from the thrust towards privatisation in the health service.

Mr. Nigel Evans (Ribble Valley) : Will the hon. Gentleman give way?

Mr. Blunkett : I shall not give way.

We know what is happening. The Secretary of State for Wales revealed it all. There is jargon where previously there was common sense, and over- management where previously people committed themselves to service. Episodes of care have replaced counting patients. Activity levels are fiddled by counting those who come back from theatre not only to a different ward but to a different bed, and by double-counting people who have been discharged too quickly and are readmitted for the care that they should have had in the first place. Provider units have replaced hospitals and community services.

I was asked what we would do. We would repay the confidence of the British electorate by treating them with respect and dignity, to restore common sense to our health


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service. We would not adopt the "Yes, Minister" approach in which the Secretary of State has been engaged, with private gain at public expense, which is what we have had during the past 15 years. Each year, £85 million goes in tax relief alone for those who are retired and cannot obtain services in the NHS. Insurers provide the facilities that the NHS should provide as a matter of right. That is the truth of the matter.

Again and again, we have raised the incompetence, corruption and nepotism in the Wessex and the West Midlands regional health authorities, or the sell-off of the estates facilities in the South West Thames regional health authority, which reaped one man alone a profit of £900,000. It is no wonder that the British people rally to our support in our fight to cut bureaucracy and to increase investment in the care of patients.

In the year ahead, the British people will see the Secretary of State's capital budget cut by £73 million and there has been a 4 per cent. reduction in the proportion of the health service budget spent on the mental health service, despite the declared commitment to that service, and they will hear the Secretary of State repeating platitudes. No wonder the word "ecology" springs to mind. Recycling the same statistics and verbiage is no substitute for a policy. Our principles are clear. We want a comprehensive NHS, not a fragmented, destroyed and undermined service, and equal access for everyone at time of need, not GP fundholding undermining that key principle on which we stand. We want a health service that is publicly funded and publicly provided, not an easy killing for the private sector--what Aneurin Bevan described rather graphically as sucking at the teats of the state. We want public accountability where we currently have nepotism, and a free service at the time of need, not charges and private insurance.

That is why I was so interested in the interview

The Minister for Health (Dr. Brian Mawhinney) : For the purpose of clarification, has the hon. Gentleman just announced that the Labour party will abolish charges if it is ever re-elected to government?

Mr. Blunkett : I did not know that the Government were committed to charges for treatment at the time of need. Last year, the Secretary of State went out of her way to say that she was against charging people at the time of need. The Chief Secretary did not. He made it clear that he was in favour of extending all charges--charges for what he calls hotels in the hospital service ; charges for meals ; charges for what is now known as recuperation, for nursing when one comes out of theatre--which will soon be known as convalescence and charged for. The Secretary of State boldly stepped in to contradict her right hon. Friend, saying that, for the time being, there would be no charges for treatment. And Conservative Members have the cheek to ask me whether we would charge patients for treatment!

I can think of no better way in which to sum up the Secretary of State's dilemma than quoting from a recent interview that she gave The Spectator.

Mr. Garnier : Will the hon. Gentleman give way?

Mr. Blunkett : No, I will not. I have already given way a number of times, to the detriment of the flow of my attack on the incompetent handling of the health service.

In that interview, the Secretary of State said :


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"We are like ducks going round in a fairground, and people shoot at you all the time as you go round. In the end, they get you, and the great thing is to know what you will be doing the next weekend." I know where the Secretary of State will be going. I know where she will find herself when the people of Britain have the opportunity to make a judgment on the Government's stewardship of the NHS-- on the way in which they have used resources, the way in which they have undermined the heritage that they received, the way in which they have increased the amount of waste and bureaucracy in the service and the way in which they have undermined accountability. That is why we have moved the motion, and why we have every confidence that people of good will, who are committed to the NHS, will reject the Government amendment.

4.36 pm

The Secretary of State for Health (Mrs. Virginia Bottomley) : I beg to move, to leave out from House' to the end of the Question and to add instead thereof :

welcomes the improvement in the efficiency of the National Health Service which has resulted in a substantial increase in the number of patients treated, a reduction in long waiting times for hospital treatment and improvements in the quality of patient care ; considers that these improvements show that the health reforms are working and that accountability has been strengthened by the clarification of responsibilities under those reforms ; and looks forward to further benefits for patients resulting from proposals announced by the Secretary of State for Health to minimise the costs of administration through the proposed abolition of regional health authorities and streamlining of management.'.

We have just heard a catalogue of vituperation, personal abuse, innuendo and unsubstantiated smears. Once again, the one thing that we have not heard is a policy : this is a policy-free zone, as it has been before.

Mrs. Jacqui Lait (Hastings and Rye) : I listened carefully to what was said by the hon. Member for Sheffield, Brightside (Mr. Blunkett). I fear that I must disagree with my right hon. Friend : according to her, the hon. Gentleman said nothing about policy, but I picked up two ideas--albeit meagre--from what he said. The first is that, if Labour ran the health service, there would be centralised control of information ; the second is that there would be public

accountability. Does my right hon. Friend agree that that public accountability would lead to a trebling of a number of committees in the health service? That is what happened in Sheffield when the hon. Gentleman led the council.

Mrs. Bottomley : Yes, indeed. My hon. Friend is entirely right. As I was saying, we have again been confronted with a policy-free zone, empty of substance. As always, the hon. Member for Sheffield, Brightside (Mr. Blunkett) condemned and talked down the national health service, rather than pay tribute to the dedicated staff who work in it, providing ever higher quality care.

Ministers give an account of their stewardship of the health service every month at Question Time, and in Adjournment debates and statements. Even when they give their account of developments to the press, the hon. Member for Brightside complains that there are too many press interviews and press notices--simply because, yet again, they highlight the bankruptcy of his own position. He asks a good many questions. During a recent period,


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Opposition spokesmen asked 1,400 questions, at a cost of £144,000 : they cost £97 a go. However, I am grateful to the hon. Gentleman.

Mr. Andrew Faulds (Warley, East) : On a point of order, Mr. Deputy Speaker. Is it not rather inadvisable of this young woman--she supposedly is a Minister--to question the right of hon. Members to table questions, regardless of cost, when she is the most incompetent Minister in an incompetent Government?

Mrs. Bottomley : I was going to suggest to the hon. Member for Brightside that requests for me to list NHS expenditure, in the latest year for which figures are available, on surgical dressings and bandages, broken down into the country of manufacture, were not particularly necessary to the careful stewardship of the national health service, bearing in mind the fact that each question happens to cost £97.

A year ago, we charged the hon. Member for Brightside to explain his policies but we are still waiting. Would he abolish NHS trusts? We heard an interesting intervention from the hon. Member for Stoke-on-Trent, North (Ms Walley) who seemed particularly distressed at the prospect of her trust being dismantled. Would the Labour party dismantle the health reforms or does it accept that they are here to stay? We have waited a year but printing machines have failed to roll. The questions are still unanswered ; the policy zone is still deserted.

The answer to the question, "What is Labour's health policy?" is that Labour's health policy is due out next month. As far as I can tell, that has been the position since the general election and it was certainly the position when last month the hon. Member for Brightside gave a short interview about his policies. However, next month has arrived and the hon. Gentleman is still silent. He is the man ana man, always putting off until tomorrow what he should be doing today.

Mr. George Stevenson (Stoke-on-Trent, South) : On the subject of NHS trusts, does the Secretary of State understand that the split between purchaser and provider is widening and that patients are falling into the gap that is being created? For example, a 90-year-old constituent of mine, who was taken to a trust hospital for a head injury, complained of rib pains, was sent home without an examination and was later found to have broken ribs. That occurred because the hospital needed more beds. Is that the sort of policy that the right hon. Lady promotes? Is that the sort of service that people deserve?

Mrs. Bottomley : There are few thinkers who do not believe that the distinction between the task of assessing health need and purchasing health care and the task of providing for patients is better separated. They are different jobs and separation provides the opportunity to develop a strategic framework to improve the health of the nation. The health reforms, which will ensure that money is not used merely to prop up institutions but has a strategic purpose, are of profound importance.

It is a source of great regret that the Opposition are not interested in debating or willing to debate in detail the complexities of making the system even better. Had they been interested, I should have referred the hon. Gentleman to, for example, the speech by Sir Duncan Nichol, the chief


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executive of the NHS, in which he talks about the importance of purchasers and providers working together and to repeated statements by Ministers to the effect that it is important that there is a spirit of trust and co-operation between the districts and the general practitioners and between the hospitals and the clinicians who work in them. Out of that new system comes an opportunity to develop a health service that meets the health care needs of his and all of our constituents much more effectively.

The sadness of the Opposition, who are dominated by the trade union movement, is that they talk constantly of the reactionary, the fossilised and vested interest but they have no interest in patients or in progress.

Mr. Rowe : Is not it true that in the man ana republic that the hon. Member for Sheffield, Brightside (Mr. Blunkett) wishes to establish we would return to a provider-driven service? Is it not perfectly clear that one of the enormous advantages of the purchaser-provider split is that it has rendered the accounting transparent? That, in turn, has made it much harder for people to get away with a range of little abuses that have crept in, such as the use of NHS equipment in private practice. Is not that a clear example of value for money?

Mr. Deputy Speaker : Order. Interventions are supposed to be short but the two that we have just heard have been rather lengthy. If that continues, the many hon. Members who want to catch my eye will be disappointed.

Mrs. Bottomley : I shall try to resist inteventions for a while but, Mr. Deputy Speaker, you will appreciate that I have a great commitment to the changes that we are setting in hand and my hon. Friend the Member for Mid-Kent (Mr. Rowe) raised precisely the sort of point which proves that we are becoming ever more effective in improving the quality and quantity of care that we are able to deliver.

Mr. Thomas Graham (Renfrew, West and Inverclyde) rose-- Mr. D. N. Campbell- Savours (Workington) rose--

Mrs. Bottomley : I hope that the hon. Gentlemen will bear with me. It is my way to give way but I fear--

Mr. Campbell-Savours : rose--

Mr. Deputy Speaker : Order. It is fairly obvious that the Secretary of State is not giving way.

Mrs. Bottomley : Of course there are times when things do not go as they are intended. There are times when patients are treated unacceptably but, of the 8 million in-patients treated, the vast majority express great satisfaction with the care that they receive. When things do go wrong, it is right for us to take action. One such example is the case of the lady mentioned by the hon. Member for Stoke-on-Trent, South (Mr. Stevenson) who had to wait an unacceptable length of time on a trolley in an accident and emergency department where an £8 million investment programme is under way to extend it. It was, nevertheless, an unacceptable state of affairs which is why I have today written to health authorities to ensure that they have the proper A and E arrangements in place, that they have provision for a service that is subject to unpredictability, that they have the spare capacity and that patients are always treated with dignity and courtesy.


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Mr. Campbell-Savours rose --

Mrs. Bottomley : I cannot give way as I need to make further progress.

The hon. Member for Brightside refers with scorn and abuse to all those who spend their time working in the health service. He speaks vindictively of those he describes as

"non-caring, non-patient--orientated"--[ Official Report, 21 October 1993 ; Vol. 230, c. 400.]

meaning the white collar workers in the NHS. It is not good enough for him then to say that he has in his sights only the senior executives or some group that he associates with the reforms. It is important to make it clear that general and senior managers account for only 3 per cent. of the NHS wage bill and 2 per cent. of the work force. They are tiny figures.

The figures that the hon. Member for Brightside frequently quotes as a damning indictment of NHS bureaucracy include, for example, the medical secretaries who provide the invaluable back-up to doctors, freeing them to spend more time with patients. Is the hon. Gentleman, in his abuse of managers in the service, saying that medical records should not be filed or patients' notes typed? Is he saying that such people are "non-caring, non- patient orientated?" He should apologise for his remarks which belittle and insult the hard-working members of the NHS. As ever, his comments show the bankruptcy of his arguments.

Mr. Blunkett : Statistics provided by the right hon. Lady's Department show that senior management costs have risen from £25 million to £494 million and that last year trusts spent £24 million on cars compared with £5 million the year before. Where do medical secretaries feature in those statistics ?

Mrs. Bottomley : The hon. Gentleman is adding apples and pears ; he is not comparing like with like. There has been an increase in the number of managers, in large measure because of the reclassification of a great number of senior nurses. The fact remains that whereas, 10 years ago, 60 per cent. of our staff were involved in direct patient care, the figure has increased to 65 per cent.

Our record is commended around the world. We concentrate on meeting patients' needs and we do so effectively. The question that the hon. Gentleman should ask is, what is the added value from the management input in the health service ? The answer is the delivery of extra patient care, falling waiting times and improved quality, which is so important.

Mr. Graham : Will the right hon. Lady give way ?

Mrs. Bottomley : I shall give way for the last time and then I must make headway.

Mr. Graham : I am delighted that the Minister has agreed to give way.

The citizens charter, which promised our constituents that they would be treated or get an appointment in a certain period, is absolutely horrifically not working in my constituency. One of my constituents has been waiting five months for an appointment with a urologist. I have been told by a local doctor that it will be more than 19 weeks before they can get an appointment to meet a urology consultant. Is that the type of health service that we are running for our constituents ?


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Mrs. Bottomley : The House must be aware that before the health reforms more than 200,000 people were waiting for more than a year and many people were waiting for more than two years. We have seen a plummeting in the long waiters and a substantial reduction, in the year, of more than one year waiters. There has been progress in the health service and transparency for patients because the patients charter explains to patients precisely to what they are entitled. That is because of the greater transparency, the better organisation and the commitment by the Government to the NHS.

My hon. Friends on the Conservative Benches will remember the Cook test, named after the hon. Member for Livingston (Mr. Cook), who radically challenged us to measure the success of trusts by the simple test of whether they do more or less work for patients. Now that those trusts are indisputably doing more work for patients, the hon. Member for Livingston conveniently finds himself with new duties, but the hon. Member for Brightside is left to wriggle and squirm his way out of that hole. That is why he will count the number of beds, bandages or of press notices-- anything but patients. The hon. Member will not recognise that it is the patients who count.

The hon. Member for Brightside forgot to mention in his speech that the NHS hospitals are on course to treat 8 million patients this year. That is 1 million more than in the year before the reforms, but it is 3 million more than it was when the Labour party was in power. [Interruption.]

Mr. Deputy Speaker : Order. The Secretary of State has made it very clear that she will not give way.

Mrs. Bottomley : The hon. Gentleman forgot to mention that trusts have increased their patient activity even faster than other hospitals. He forgot to mention that for every 100 patients treated in hospital before the reforms 116 are treated today, and next year it will be 120. He forgot to mention the rapid increase in day surgery and childhood immunisation and in the quality of care. The hon. Member for Brightside spoke about waiting lists. He forgot to mention the 51,000 patients who, before the reforms, were waiting more than two years ; there are none today. He never gives credit. He certainly did not mention that before the reforms the average wait was nine months ; that has now decreased to five months. Ten years ago, only one in eight patients were able to have a hospital operation and go home the same day. That is now one in four. That is what our policies are achieving. The Labour party cannot bear to hear the accurate statistics of the achievements of the national health service because the figures highlight even more clearly its abject failure to come up with a policy. [Interruption.]

Mr. Deputy Speaker : Order. It is fairly obvious that the Secretary of State is not giving way at this stage.

Mr. Graham : On a point of order. Mr. Deputy Speaker. I thought that debates were an opportunity to give Back Benchers a chance to question the Minister. It is difficult for us to do a good job if we cannot get a chance to do so.

Mr. Deputy Speaker : The Secretary of State is responsible for her own speech and whether she gives way.

Mrs. Bottomley : I think that I have given way as much as, or probably more than, the hon. Member for Brightside. Opposition Members do not wish to have an informed


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debate. They seem to wish to make a great noise because they want to obscure the achievements of the national health service.

Mr. Mark Wolfson (Sevenoaks) : I am most grateful to my right hon. Friend. She is making a robust defence of the strategic changes in the health service and I commend her fully for that. May I say, however, that there is concern among many general practitioners in my part of the country about the quantity of statistics--which she recently mentioned--which they have to provide. At this stage they do not receive enough information about the usefulness of those figures. I hope that she will regard that as a constructive contribution to the debate, in contrast to the attacks that she has received from Opposition Members.

Mrs. Bottomley : That is an extremely constructive contribution because it highlights one of the dilemmas or complexities that confront us. We have to be accountable for the work that is undertaken by general practitioners ; we have to ensure that there is a comprehensive health service ; we have to have control, not only of the financial aspects, but of the quality of clinical care. Every time that a form is filled in, however, there is a distraction. That is time that general practitioners would rather spend with their patients. I hope that we shall find more simplified ways of satisfying the proper interests of general practitioners as well as, rightly and properly, the need for accountability and the stewardship of the national health service.

Mr. Campbell-Savours rose --

Mrs. Bottomley : I think it would be fair to say that I have given way to Labour Members twice as many times as I have to Conservative Members. I do not wish to fall out with my hon. Friends and, therefore, for fear of getting into difficulty with them, I must demonstrate some sense of balance and order in the number of occasions on which I give way. When I have given way to an equal number of Conservative Members I will try to give way to Opposition Members once again.

You will appreciate, Mr. Deputy Speaker, with the substantial advances that I have identified, that the Labour party--

Mr. Home Robertson : On a point of order, Mr. Deputy Speaker. Will you start a waiting list for Members who want to intervene in the debate?

Mrs. Bottomley : I suggest that Labour Members put their name down on the waiting list for a Labour party policy on health because if ever there was a case of, "If in doubt, shout", it is the Labour party. It has no policy. The nerve of asking for a debate which simply gives my hon. Friends the opportunity to expose the Labour party's policy-free zone defies all description. We had thought last week that the antics of Labour Members were a result of their deciding at the last possible moment that they could not brave a debate, and were a way for them to pull the plug on it. Be that as it may, all day today the hon. Gentleman will have to put up with my hon. Friends asking time and again, "Where is the policy?" That will not deflect me from continuing to give an account and an explanation of those important changes.

We take the view that the way in which resources are managed is of crucial importance to delivering quality and


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cost-effective patient care, but we also accept that the resources are important. That is why, this year, we have more than met our manifesto commitment. NHS spending is already at record levels and it will increase next year by a further £1.6 billion-- equivalent to an extra £83 for every household.

I notice that last week in the British Medical Journal the hon. Member for Brightside said that he hoped that the Labour party would make a specific commitment on NHS funding. I hope so too, after the consultation. We are sick and tired of being told that the health service is underfunded, by a party which refuses time and again to say by how much health spending should increase.

Last month, however--Labour Members may wish to listen to this--the hon. Gentleman said that a Labour Government would aim to take Britain into something called "the 7 per cent. club", by which he meant the group of nations who spend at least 7 per cent. of gross domestic product on health services. Is he aware that the policy would cost the British taxpayer an extra £6 billion? Will he confirm whether that is now Labour's firm commitment? Will he confirm whether he has the express permission of the shadow Chancellor to make that commitment?

While the hon. Member for Dumfermline, East (Mr. Brown) is telling the British taxpayers, "Honest, guv, we've gone straight," the hon. Member for Brightside wants to pick £6 billion out of their pockets. Perhaps the hon. Gentleman wishes to confirm the status of his commitment to spending an extra £6 billion on health. Would he like to intervene?

Mr. Campbell-Savours rose--

Mrs. Maria Fyfe (Glasgow, Maryhill) rose--

Mrs. Bottomley : It seems that the hon. Member for Brightside does not wish to substantiate the claim that he made last month. No doubt my hon. Friends, and their constituents, will be extremely worried about that aspect of Labour party policy.

The truth is that in government Labour cuts spending and in opposition it cuts commitments. The Government have done neither. We have cut out waste and improved efficiency. Since we came into office the number of patients treated in hospitals has increased nearly three times as fast as spending, even when that is adjusted for inflation. In the 1980s the number of patients treated in hospital grew on average by 2.5 per cent. a year.

Mr. Graham : The health of the nation is deteriorating.

Mrs. Bottomley : I must respond to that off-side intervention. The hon. Gentleman says that the health of the nation is deteriorating, but he may like to know that over the past 10 years the number of people who die below the age of 65 has fallen by one fifth, the number of babies who die in their first year has fallen by two fifths, and average life expectancy has increased by two years. I regard that as a substantial improvement in the health of the nation. Mr. Campbell-Savours rose --

Mrs. Bottomley : I am seeking--

Mr. Home Robertson rose --

Mr. Deputy Speaker : It is fairly obvious that the Secretary of State is not giving way.


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Mrs. Bottomley : Labour Members may wish even less to hear what I have to say next. In the 1980s the number of patients treated in hospitals grew on average by 2.5 per cent. a year ; in the 1990s, since the reforms, that number has been growing by 5 per cent. a year, and even faster in the trusts. Under the Labour Government activity grew by little more than 1 per cent. a year. The improvements are essential if the health service is to keep pace with the demands on it. That is why, as well as maintaining our spending commitments, we shall continue to demand tough efficiency improvements from the health service.

Mr. Hughes (Doncaster, North) rose --

Mrs. Bottomley : It is not how much one spends, but what one does with it.

Mr. Hughes : Will the Secretary of State give way, on spending commitments ?

Mrs. Bottomley : I have no need to give way on spending commitments. A Government who have given an extra £1.6 billion this year do not need to give further explanations of spending commitments.

For the coming year we have set a target of 2.25 per cent. for efficiency gains, which will release an extra £450 million to spend on patient care. It is no coincidence that those dramatic improvements in the number of patients treated have taken place as the Government deliberately strengthened NHS managers. Leaders of the profession agree.

Christine Hancock, for example, recognises that that process was needed, and indeed overdue. Sir Roy Griffiths, whose management reports in the mid- 1980s were so important, said that if Florence Nightingale were carrying her lamp through the corridors of the NHS then, she would almost certainly be searching for the people in charge. In the unmanaged shambles that we inherited from the Labour party it was impossible to reduce costs because nobody knew what costs were. Better management has meant that we have been able to cut waste by improving services and service delivery.

Take, for example, the supplies authority--

Mr. Campbell-Savours rose --

Mr. Brian Sedgemore (Hackney, South and Shoreditch) : Give way, give way.

Mrs. Bottomley : Last year and this year the NHS supplies authority has saved £84 million. In addition it has just negotiated a deal with British Telecom to save several million pounds through its contracts. Better management has cut energy consumption. The hon. Member for Brightside pours scorn on the "A to Z of Quality", but the idea has brought forward practical initiatives throughout the health service, and people are taking those achievements forward. The hon. Gentleman is pouring scorn on the efforts of nearly 3,000 NHS staff who have submitted their ideas for individual cases to be selected. Mr. Campbell-Savours rose --


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