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Dr. Mawhinney : I am grateful to the hon. Lady for giving way once again, because I am genuinely trying to understand what it is she has suggested. She answered my question by telling us a little bit about hypothecation. That was fascinating, but it did not answer my question.

Is the hon. Lady suggesting that money should be taken from other spending programmes to pay for the health service? The money raised through taxation on alcohol and tobacco is already spent. She cannot spend it twice. Is she announcing to the country that after increasing tax to fund education, she would increase it still further to fund the health service?

Ms Lynne : I am grateful for that further intervention. My party is looking at hypothecation. I am not making a commitment that the Liberal Democrats would raise taxes after the next general election. I want the merits of hypothecation of taxes to be subject to public consultation. I want to go out and talk to the public about whether that is the best way forward. Our policy is markedly different from that of the Government, who brought in their reforms without consulting enough. Hypothecation could be the way forward and it is up to the Minister to examine all its implications carefully instead of trying to make a party political issue.

The British public must be given the opportunity to participate in the key decisions about the future, as well as being given the chance to hold to account those who made mistakes in the past.

I welcome the Secretary of State's announcement to consider having a debate in the House, for which I asked, on the new and possible treatment and use of eggs from dead foetuses for in vitro fertilisation. I am grateful to the right hon. Lady and I hope that she will honour that commitment.

5.53 pm

Mr. Ray Whitney (Wycombe) : I am afraid that the hon. Member for Rochdale (Ms Lynne) followed Opposition Members, as the Liberals usually do, by offering the usual carping, negative criticism of the health service. I congratulate her, however, because, in clear distinction from the Labour party, she at least provided one or two elements of possible Liberal Democratic policy. I do not believe that they bear too much scrutiny. The hon. Lady said, "We are looking at hypothecation," which is a pretty good example of how the Liberals approach policy making. I wish that she had offered a more concrete definition of her party's policy.


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Everyone should join Conservative Members in applauding the idea that decisions on health should be taken locally. That was the thrust of the health reforms and it is one reason why they are working so well. The Liberal Democrats' proposition that such decisions should be made on the basis of elected local agencies, which would, however, be funded centrally, fills me with the deepest misgiving. The problems faced by all central Governments over the funding of local authorities would be a picnic compared with the battles and feuding that would arise over health authorities being elected locally but funded centrally, whether that funding was derived from hypothecated additional taxation or additional income tax. I hope that the Liberal Democrats will continue to explore such ideas, but will offer the nation a more informed analysis of their potential, because I genuinely believe that it is right that such ideas should be considered. That is why it was so sad to witness the performance of the hon. Member for Sheffield, Brightside (Mr. Blunkett) and that of other Opposition Members, because, as usual, they offered no positive thinking on policy.

One of the great tragedies of the Opposition is that they fail to understand that the provision of truly adequate health services for the 1990s is an international challenge facing all modern societies. These days, the aspirations of people, the challenges and costs of modern developments in medicine require the solution of terrifically difficult problems. Germany, France, the United States and other countries face that difficulty and they have all produced different solutions.

I believe that the British solution, as it is developing, is one of which we should be proud. Our solution is not perfect, but we will make no progress as a nation if the continued examination of this crucial subject is bedevilled by the mean-minded, ill-informed, pettifogging attitude adopted by the Labour party.

When the hon. Member for Brightside, the Labour party spokesman on health, can offer as the subject of his major speech nothing but a reference to the restaurant at which my right hon. Friend the Secretary of State for Health dines, it is a pure and appalling reflection on the paucity and poverty of what passes for thinking on the Opposition Benches. Such behaviour by the Labour party is traditional and it makes me somewhat hot under the collar. The hon. Member for Brightside talked about the NHS and said, "We created it." Is the hon. Gentleman suggesting that "we", the Labour party, created the NHS? Does he know nothing about history? Has he any idea of the thought and work undertaken by others towards the creation of the NHS during the 1920s, 1930s and 1940s? He is totally ignorant. He obviously has no idea of the efforts made by all parties towards its creation. It started with the Liberal party and Lloyd George, and the idea was carried forward by Neville Chamberlain. The White Paper that provided the fundamental basis for the NHS was introduced by Henry Willink, the Conservative Minister for health in the wartime coalition Government. The irony is that the only significant change made by Mr. Aneurin Bevan was to go against the declared policy of the Labour party for locally based and controlled health units and opt for a nationalised hospital service. It is the nationalised hospital service which has caused so many problems over the 40 years. [Laughter]

What is the hon. Member for Bristol, South (Ms Primarolo) laughing about? Does she think that there were


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no problems when Baroness Castle was Secretary of State and Lord Owen was Minister responsible for Health? There were huge problems, which is why we have had to find a way forward and why the health service reforms are providing an excellent solution to that challenge.

Ms Dawn Primarolo (Bristol, South) indicated dissent.

Mr. Whitney : The hon. Lady shakes her head. She probably was not born at the time, but Herbert Morrison pointed that out to Aneurin Bevan, who won the argument in Cabinet but lost it in the succeeding 40 years.

Mr. Dennis Turner (Wolverhampton, South-East) : Although that is interesting and I am grateful for the history lesson, I am not sure whether I accept the hon. Gentleman's interpretation of the historic events that led to the creation of the national health service. We are all concerned about the national health service and should be thankful for every person who is treated in our hospitals. Last week, the Wolverhampton Express and Star announced :

"Hospital Waiting Lists Are Soaring".

It said that 1,800 extra people were on the waiting list and that more than 6,000 were waiting. In the west midlands, more than 100,000 people were waiting for treatment. Is that success in the health service?

Mr. Deputy Speaker : Order. That was a very lengthy intervention.

Mr. Whitney : I clearly made a mistake. I could give the hon. Gentleman several answers, but shall give him a brief one. Since 1988, the average waiting time for treatment has fallen from nine to five months. I invite the hon. Gentleman to write to me and tell me what waiting times were in Wolverhampton in 1977 or 1978 during the last Labour Government, when the national health service was plagued by strikes.

I am glad that the hon. Gentleman accepts the history lecture and I hope that he passes it on to his colleagues in the Labour party. I hope that next time they have a debate on the national health service, they will not just say, as the hon. Member for Sheffield, Brightside said, "We shall clarify our own policies in our own good time." That good time is up. The nation demands to know what the Labour party has to offer.

The Conservative party knows that it has to offer the huge improvements which my right hon. Friend the Secretary of State for Health has outlined. The nation knows that we are now treating a million more patients than last year, and 3 million more than when we came into office. The nation knows that waiting times are reduced, there are tens of thousands more nurses and thousands more doctors, and their pay has risen by some 40 per cent. in real terms. We are proud of that record. The nation cannot be proud of a political party that claims, on bogus grounds, that it is its health service, but has no contribution to make to its continued development.

6.3 pm

Mr. Terry Davis (Birmingham, Hodge Hill) : The hon. Member for Wycombe (Mr. Whitney) tried to suggest that the Labour party had claimed that there were no problems before the Conservative Government were elected. That is nonsense.


Column 1080

Mr. Whitney : I said nothing of the sort.

Mr. Davis : Oh yes, he did. Of course, there were problems before the Conservative Government were elected and problems still exist in the national health service. The charge against this Government is that they have made the problems worse.

That charge is contained in the motion. I was interested to note that, in his peroration, the hon. Member for Wycombe never referred to the motion. I shall debate the motion before the House. As I was coming to the House today I wondered how the Secretary of State for Health could oppose a motion that deplores the lack of accountability, growth in bureaucracy, and waste of resources in the national health service, all at the expense of patient care. After all, in the past year the Public Accounts Committee has produced two major reports on how resources have been wasted in the national health service. Both reports drew attention to the lack of accountability in the health service and pointed out that bureaucracy in the health service has failed the people of this country.The Committee says that all that has been done at the expense of patient care.

The West Midlands regional health authority has wasted millions of pounds. The regional health authority admits that it wasted at least £10 million. We have had a report on the Wessex regional health authority, which wasted tens of millions of pounds. The regional health authority and national health service management executive admit that it wasted at least £20 million. Today, the Secretary of State for Health said that the books were no longer closed and no longer examined behind closed doors. That is simply untrue. The books are examined behind closed doors by the district audit service, whose reports are kept secret.

If someone writes to the district auditor and asks about the reports, he or she is referred to the regional health authority. If one then asks, "But how can I ask the regional health authority for the report if I do not know what was reported on?", he simply says that that is a good question. One cannot ask for a report unless one knows that it exists. If one knows that it exists and asks the regional health authority about it, one is most unlikely to get a copy of it because the books are examined behind closed doors and kept secret.

The internal report on the West Midlands regional health authority, known as the Carver report, explained how procedures had been flouted and regulations ignored and how people had wasted money. It was kept secret until someone in the regional health authority leaked it to a journalist on the Wolverhampton Express and Star. Only once it had been leaked and had come into the possession of hon. Members and referred to the Comptroller and Auditor General could the National Audit Office mount an investigation.

We should not depend on leaks. Reports should be put before us so that we can make up our minds on the basis of facts. I am not surprised that the Secretary of State has left the Chamber, having refused to allow me to intervene in her speech. She knows that what she said was totally misleading--I choose my words carefully to stay in order.

The West Midlands regional health authority was described by the chief executive of the National Health Service Management Executive as "a shambles". That is


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the truth about the national health service 15 years after the Government were first elected. The Public Accounts Committee said that officers' behaviour

"fell well short of the standards of conduct expected from public officials".

It said that not only were there

"serious failings at all levels of management"

in the West Midlands regional health authority, but a

"serious failure by Members of the regional health authority and in particular the chairman, in their duty to ensure the accountability of regional management".

The report on Wessex said, most revealingly, that the auditors had sent their reports to the national health service management executive before the issue ever came to the Public Accounts Committee and before the National Audit Office was put on to it by people like my hon. Friend the Member for Southampton, Itchen (Mr. Denham). The auditors did not stop there, but sent the reports to the Secretary of State--not once but over several years. And nothing happened. That is where we come to the whole point of accountability.

When Sir Duncan Nichol, chief executive of the national health service management executive, came before the Public Accounts Committee, he had to say that he had no authority. I am not sure what he was the executive of, but he was called the chief executive and he had to say that he had no authority--it was a matter for the Secretary of State.

We are entitled to ask what the Secretary of State did. The answer can be given in one word--nothing. She did nothing about the fact that those appointed, particularly the chairman of the Wessex regional health authority, Sir Robin Buchanan, were personally responsible for that region's failures. Tens of millions of pounds were wasted at the expense of the care of those living in the region.

Mr. Nicholas Winterton : As the hon. Gentleman will know, I have taken a great interest in the health service over many years. Did the hon. Gentleman tell the House the truth when he said that Sir Duncan Nichol said that he had no authority over that matter? My understanding of the National Health Service Management Executive was that it administered the service on behalf of the Department of Health. If Sir Duncan Nichol has no authority, what is the point of the executive?

Mr. Davis : The hon. Gentleman might well ask. I can assure him that I have given an accurate summary of the statements of Sir Duncan and his predecessor. If the hon. Gentleman wishes to come with me after the debate, we can sit in the Library together and go through, not one or two, but several sittings of the Public Accounts Committee. He will then see that such statements were made, not only by one but by a succession of accounting officers from the health service management executive.

When the chairman of the West Midlands regional health authority eventually resigned, he received a letter of praise from the Secretary of State for Health and a golden handshake worth several thousands of pounds. I suppose that we should consider ourselves lucky because the chairman of Wessex regional health authority was promoted. If someone wastes more--tens of millions of pounds--he is promoted to a better job. That is the truth about accountability and the lack of accountability in the health service under this Government.

All this waste is at the expense of patient care. I shall give an example from the west midlands. A hospital in Birmingham that serves my constituency used to be called


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the East Birmingham hospital. When it opted out and became a trust it changed its name to Birmingham Heartlands hospital--it is known locally by my constituents as the "Heartless" hospital. In October there was a series of newspaper reports about people attending the accident and emergency unit and having to lie on trolleys all night. Another group of people had to wait on trolleys the following night, and the same thing happened the night after that. Patients had to be resuscitated in corridors because there were trolleys in the resuscitation room. Patients had to urinate into bottles in front of other people in corridors.

Staff were almost driven to breakdowns in the accident and emergency unit because there were not enough beds for patients to be admitted. Those who could not be admitted were not attending the unit unnecessarily. They had been taken there by ambulance and examined by doctors who had decided that they should be admitted. But there were not enough beds.

My hon. Friends and I went to see the chairman of the district health authority to discover what he was doing as a purchaser. I did not agree with the Government's changes and voted against them, but the system was implemented. When we met the so-called purchaser to discover what he was doing to purchase an adequate accident and emergency service on our behalf, he told us that he could not obtain answers to his questions.

The chairman said that inherent in the Government's organisation was an adversarial--his word--relationship between his health authority and the trust hospital. That was said by a man appointed chairman of a district health authority by the Government. He has since been appointed as a chairman of a trust elsewhere. He also said that the position was aggravated by personality, but I do not want to become involved in personalities in the House. The adversarial relationship between hospitals and health authorities lies at the root of the problem.

Dr. Tony Wright (Cannock and Burntwood) : Does not my hon. Friend's illustration reveal the heart of the problem--that nobody is responsible for anything any more? We write to purchasers, providers and Ministers, but they all say, "It's not us, guv, it's somebody else." I have a letter from a Minister to back up my hon. Friend's argument. Mid-Staffordshire health authority lost £3 million in the market system last year. I asked the Minister to assure me that there would be no impact on patient care. I received a letter from him assuring me that patient care would not be affected, but this week the authority has closed four wards. It seems that nobody is responsible for that.

Mr. Davis : My hon. Friend is right : nobody accepts

responsibility--it is always the fault of someone else in the national health service, particularly those who sit on the boards of health authorities.

One would have expected something to have been done about the lack of beds in Heartlands hospital last October. In the intervening three months there have been several circulars, meetings and discussions with Ministers, and the Secretary of State for Health has popped in and out of Birmingham. However, after she had made her visit, the problem recurred.


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A fortnight ago the Birmingham Evening Mail featured a patient who had lain on a trolley for 21 hours. He was admitted at 5 o'clock and was not found a bed until 2 pm the next day.

My hon. Friends and I had a meeting with a junior Minister in the Department of Health. He seemed to know all about it and to be well briefed until we asked how many people had suffered the same experience and whether it was a lone incident. We asked whether that man was the only victim of what the Minister described as a sudden surge in emergency admissions. The Minister said no. He said that the man was one of 22 patients who had spent all night on trolleys at the same hospital where, three months earlier, patients had had to suffer the same experience for three nights in succession.

Let us examine the figures of the so-called sudden surge. We were unable to obtain good figures. The junior Minister gave one set of figures and the chairman of the hospital trust gave a different one--the two sets could not be reconciled. The junior Minister said that he would reconcile the figures, but we are still waiting for clarification. After we had talked to doctors, it was clear to us that there has been a steady upward trend in emergency admissions, not merely for one year on year, but year after year. That was true, not only in east Birmingham, but throughout Birmingham.

Those running the health service failed to predict what was an obvious trend. They actually thought that there might be fewer admissions this year than last. They had no explanation for reaching that bizarre conclusion, impossible hypothesis and incredible assumption--they failed and simply did not provide enough beds. That lack of beds existed even without the closure of the Birmingham General hospital, which has led to many more patients being admitted to the Heartlands hospital. Those running the health service did not even take that fact properly into account.

The problem does not stop with patients lying on trolleys instead of beds. Patients are taken out of bed and sent to other hospitals. They are discharged too early. Doctors making their rounds during the night may have to decide that, even though the consultant responsible for the patient stated that he was not ready to be discharged, the patient must be discharged because a patient who is in a worse condition is lying on a trolley.

Other patients do not receive operations as a result of the Secretary of State's gimmicks and gestures. Every hon. Member could recite from letters, cite examples and talk about families at their advice bureaux who have been unable to get the operations that they need. For me, the problem was crystallised in a letter written by a consultant at the Heartlands hospital in reply to a protest about the delay in an operation. The consultant wrote back stating : "There is no doubt in my mind that he requires the operation to correct his nose Unfortunately I am only too well aware of the non- medical urgent priorities of many of our cases on our far too long waiting list. Nevertheless at this time the major incentive for surgery appears to be a management decision"--

not a medical decision, appraisal or assessment

"to remove all those who have been waiting more than one year for their operation regardless of priority and this has upset our general ability to bring forward cases".

That policy is being implemented in hospitals in order to achieve the Secretary of State's target whereby nobody has to wait for more than a year. It means that people who


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need urgent operations are not having them. It is a scandal that people who should have operations--people whose noses bleed every night--cannot get an operation. The priority is decided by management, so that even those who are not so seriously ill will not have to wait for more than 12 months. Of course, we do not want people to wait for more than 12 months, which is a scandalously long time, but the waiting time should be reduced for everyone, not at the expense of the most urgent cases.

One might think that after what I have described--my hon. Friends from Birmingham could give similar accounts--everybody would realise that the fact that there are not enough beds lies at the root of the problem. It is not the staff or the doctors ; it is the beds that people who should go into hospital, or must stay in hospital, cannot have because so many beds and wards have been closed.

We are told that things take less time now and that people do not spend so long in hospital. So putting to one side the mistakes that have occurred in the past 15 years, against the background of a crisis, what does the West Midlands regional health authority want to do in Birmingham? It wants to reduce the number of beds not by 10, 20 or 100, but by 1,500. It proposes 300 fewer beds in the very hospital where people have been left on trolleys all night. The fact is that the regional health authority does not know how many beds are needed.

Today I have managed to get hold of another report by the district audit service. Perhaps my hon. Friends have not yet seen it. The district auditor wrote :

"hospital management in the west midlands have not determined the numbers of acute medical beds required for their contractual work load".

So much for all that business about purchasers and providers. The purchasers place contracts, but the providers do not work out how many beds they need, so people are lying on trolleys.

The Secretary of State praised the efforts of the staff in the national health service. At least we can agree on that, but the staff working in the national health service deserve our credit and our sympathy as they combat and struggle with the consequences of Government policies and the incompetence and waste of resources by Government appointees. It is not surprising that almost every day staff from local hospitals phone my local office to tell us what is happening there. They will not come forward ; they are frightened because they know what will happen--they will lose their jobs ; and, as 15 to 18 per cent. of the local people are already unemployed, they cannot stand up for themselves and we have to explain it for them.

The Secretary of State ignored the terms of the motion because she ignores the facts and does not live in the real world. She has lost the respect of the staff in the national health service and the confidence of all the patients.

6.21 pm

Dame Jill Knight (Birmingham, Edgbaston) : That was good knockabout stuff, but now we come to some facts instead of flying off on extraordinary tacks. Listening to the speech of the hon. Member for Birmingham, Hodge Hill (Mr. Davies), one would think that nobody was ever treated in the health service or went on anything else but trolleys and never went into beds.

Whether the hon. Gentleman likes it nor not, and I suspect he does not, there has never been so much careful treatment of sick people in the west midlands and the rest of the country as there is today. People are being operated


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on with infinitely more complicated techniques and treated with very much newer and cleverer treatments than ever before. They are being treated with drugs which were invented only a few years ago. The hon. Gentleman and the Opposition should recognise that there is a great deal for which to be thankful in the way in which our health service is treating and curing people who, only a few years ago, would have died.

My right hon. Friend the Secretary of State made it absolutely clear that she deplored people lying on trolleys and was anxious to deal with the shortages as soon as she possibly could.

Never before has so much money been spent on the health service--more than £100 million a day. It is interesting that while Opposition Members are happy to object, to fulminate and frighten people into fits, they will never say how much more money they want spent on the health service, nor where they would get it. No one has done more to tackle waste in the health service than my right hon. Friend and one of her predecessors, my right hon. and learned Friend the Chancellor of the Exchequer.

Previously, money was shovelled in increasing amounts into the ever-open maw of the NHS. No one knew how much was wasted because no one knew what anything cost. No one was ever able to assess one hospital's running costs against another's, or one doctor's practice against the one up the road to see if one was managed more sensibly and cutting out waste rather better than the other. No one ever questioned whether any drug costing less might be just as effective as one costing more, or whether wards, operating theatres or kitchens could be run better.

Mainly because it is essential that all the billions of pounds of taxpayers' money spent on the health service should go to patient care and not be wasted, the Government set about changing all that. However, the Opposition fought us long and hard on every single reform that we tried to make to ensure that waste was stopped. That is why they have a brass neck, a bare-faced cheek and a confounded nerve to table the motion on the Order Paper today. A great deal has been done which Labour would never have had the guts to do. My right hon. Friend would probably be the first to agree that there is still some way to go. In fairness, eliminating all the faults in the biggest business in Europe takes a bit of doing. May I suggest to my right hon. Friend that the first essential is accurate information. On that narrow point, I agree with the hon. Member for Hodge Hill. The proposed closure of the Royal Orthopaedic hospital in Birmingham, known locally as the Woodlands, is a case in point. I and others were given wrong and misleading information to support the closure decision. We were told that the hospital was losing £250,000 a year. Now there has been a Peat Marwick report. I am surprised that the hon. Gentleman, who said that he could never get any official reports from the auditors, had not heard of it.

Mr. Terry Davis : I made it very clear, as the hon. lady will see when she reads my speech in Hansard tomorrow, that I was referring to the district auditor's report. Peat Marwick is not the district auditor.


Column 1086

Dame Jill Knight : The hon. Gentleman, in dealing with audits and costs, never mentioned the most important audit report that Peat Marwick produced as a respected and independent auditor.

Mr. Richard Burden (Birmingham, Northfield) : Will the hon. Lady give way?

Dame Jill Knight : The hon. Gentleman must make his own speech. I am trying to be quick for the sake of other hon. Members. I am anxious to inform the House and to say in front of my right hon. Friend that it was a very great shock to some of us that the information that we were given about the amount of money that the hospital was losing was not correct. Far from losing £250,000 pounds per annum, Peat Marwick says that it is making a profit of £680,000 per annum.

We were told that the supply of patients was drying up. Now we learn that there are waiting lists for that hospital. We were told that the layout of the Woodlands was too old fashioned and difficult to run. If that is so, why are so many doctors and surgeons virtually unanimous that the Woodlands should stay open and are campaigning hard to that end? We were told that the doctors and consultants did not object to a move. They most certainly did.

It is crucial that the information on which we make our decisions should be accurate and right ; if it is not, we shall not reach the right decision.

I believe that the hospital should stay open and that is certainly the overwhelming view of the people of Birmingham right across the political spectrum. There is unanimous agreement in the council. We now have a reprieve while the matter is considered again. I shall make two points to my right hon. Friend on it. First, please give us accurate and unbiased information. If there is a cost in the continuation of that hospital--it has been suggested that there is--please tell us what it is and what the option is. We can then decide whether we should pay that cost, whether it be with greater waiting lists elsewhere or with pure money.

Secondly, please can we reach a decision quickly? The Woodlands is peopled with highly expert staff. It has an international reputation. It is not surprising that all those people are under strong pressure to go elsewhere. They are saying to themselves, "Well, if the hospital is not going to be there, perhaps I should accept the request to go elsewhere." It is important not only that a right decision is made but that it is made soon, because we are losing staff through uncertainty.

The motion mentions bureaucracy. I know how open my right hon. Friend is to argument and persuasion, but there is some truth in the fact that bureaucracy exists. Some of it could be struck off. A doctor constituent of mine wrote to complain about a communication from the family health services authority. He says :

"We have just received the enclosed communication from the Birmingham FHSA. The amount of work it will entail for our staff if one follows it to its logical conclusion which includes half-day absences for courses etc. is really quite pathetic and I wonder whether there is anything you can do to try and help us reduce this flood of bureaucratic waste".

I have the form here and it is indeed complicated. It would undoubtedly take a busy doctor a long time to fill it out. I gather from my constituent that it is new. Will my right hon. Friend be kind enough to investigate the complaint, because doctors do not have time to fill out forms that are not necessary?


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I shall now deal with a concern that Birmingham FHSA has with the medical practices committee, which controls the distribution of general practitioners. The FHSAs are responsible for the smooth running of GP services in their area. The MPC is supposed to take the advice of the FHSAs, but it does not. I tell my right hon. Friend, with no pleasure, that there are too many running battles going on between the FHSAs and MPCs. Those battles waste time, impair efficiency and affect patient care.

Last summer, a GP in Birmingham, after two years of consistent inefficiencies, was disallowed from practising. That followed his suspension by the General Medical Council. On four occasions over two years, his conduct was officially deplored. On one occasion he was warned ; on two others, £500 was withheld from his pay and he was suspended. On the last occasion, he was fined £1,000 and suspended again.

The FHSA wanted the GP out. Who can be surprised at that? It explained its need and responsibility to get proper care for the patients on its list. But the MPC did not agree. Oh dear me, no. It said that there would be eight months' suspension and told him that he would automatically be returned to the medical list after suspension, although the FHSA gave strong and unequivocal advice that the doctor could not or would not provide proper patient care and that it could not carry out its duty to give patients that proper care with that doctor still in place. For eight long months, there were no proper services, except temporary, for all the patients on his list. That matter is now resolved, but I have details of no fewer than five other cases where the advice of the FHSA has been ignored and overridden by the MPC. Will my right hon. Friend kindly look at that, because it needs to be checked?

Finally, I wish to voice my concern yet again about a system that keeps a consultant or hospital doctor in suspended animation for months, or even years, on full pay if he is under accusation of improper or negligent conduct. I would like to know what has been done to speed up the business of resolving that matter. I know of one case where a consultant was sent home. He did nothing for two and a half years, but was paid his full salary throughout that time. At the end he was found to be innocent, but it was a great waste of money. Of course I am not saying that he should be cut off from all his money when the case is not proven, but we need to speed up the arrangements formally made because it is a great cost to the country and a great strain on the doctor concerned.

My right hon. Friend has done much to improve the health service. She has fought successfully to get record sums from the Treasury. Even now, we hear that more will be allocated. She has tackled waste and inefficiency. She has stood up with courage and grace to the despicable attacks made by the Opposition and she has never shirked awkward decisions. How the Opposition would love to have a Virginia Bottomley on their side. It is not because she has done little, but that she has done so much and proved time and again that she is dedicated to constant improvement of the health services that I draw those matters to her attention and ask her to bring her considerable talents to bear on solving those problems.


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6.36 pm

Mrs. Alice Mahon (Halifax) : I welcome the debate on accountability, because somebody should certainly be held accountable for what is happening to the national health service. In spite of some of the rhetoric from the Government Benches, every day, in every part of the country, there is an acute bed crisis. Every day, people in pain, anxious, worried and afraid telephone some hospital early in the morning to find out whether there is a bed available. Increasingly, there is not, because one in three beds has been lost since 1979. Every day we read of sick people spending hours on hospital trolleys and mattresses, as my hon. Friend the Member for Islington, North (Mr. Corbyn) outlined earlier this week. We heard also from my hon. Friend the Member for Workington (Mr. Campbell-Savours), who has experience as a patient at Bart's hospital.

The Secretary of State says that she deplores the situation and wants to do something about it. She should be thoroughly ashamed of herself, because her so-called reforms have helped to bring it about. Every day we are bombarded with slick propaganda from the Department of health and the Government telling us that closing wards and hospitals will make the NHS deliver a better service. Fewer beds, but more patients treated, they claim.

A closer inspection suggests that the apparent increase in the treatment of patients has far more to do with the introduction of the internal market and the increasing numbers of managers and administrators, who have the duty and the time to fiddle the figures and ensure that the statistics match what the Government want them to match. Before the internal market, putting a price on everybody's head was not a priority ; treating the patients was.

We should keep saying again and again and outlining one or two of the tricks that the Government get up to, because finished consultant episodes mean that the same people can be counted if they change consultants two or three times. It is only one person, but he or she has been counted three times. The revolving door policy introduced in the 1980s, whereby elderly patients enter hospital for a fortnight and go out for a fortnight, means that the same people are counted over and over again on admission. I do not argue for elderly people to be kept in hospital any longer than is necessary.

The position regarding Government-appointed heads of trusts becomes worse the more that we read. A recent survey conducted by Incomes Data Services, a respectable industrial research body, said that the pay of trust chief executives had escalated sharply. It also found that, in stark contrast to the openness of the trusts, information on that was limited in detail and difficult to acquire. If such people are still working for the NHS, why cannot we be told what they are paying themselves? IDS concludes that public sector accountability appears to be diminishing. That is an understatement.

The Government refuse to keep statistics on the number of nurses and health workers who are disappearing as the army of administrators grows.


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