House of Commons Hansard Debates for 20 Jan 1994

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

Mrs. Mahon : No, I will not. I am aware that many hon. Members want to speak, so I shall try to be brief.

Matters get worse. This morning, the Select Committee on Health, in its examination of the drugs budget, heard from witnesses, not for the first time, about the advisory

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committee on national health service drugs- -yet another Government quango. That particular quango is overseeing and advising on the limited list. We do not know its terms of reference ; nor, it seems, does anyone else. Witnesses tell us that its terms of reference have changed from a scientific to a cost basis.

It was put to us that the committee is high-handed and secretive. It is obviously not transparent. We do not know whether the committee holds a statutory position, nor from where its advice comes or to whom it is accountable. The limited list system and the committee are so unaccountable that no one on the Select Committee or giving evidence to it knows how it works. This morning, a representative of the National Association of Health Authorities and Trusts claimed complete ignorance, so we are entitled to ask a question or two about that.

Our national health service, based upon equity and being free at the point of use, is disintegrating before our eyes.

Mr. Garnier : Will the hon. Lady give way on that point?

Mrs. Mahon : I am sorry, no. The hon. Gentleman can make his own speech.

According to a survey by the BMA, 42 per cent. of acute units in England give priority to the GP fundholding practices. Hospital waiting lists stand at over 1 million. We daily read of cuts, closures, queue jumping and sometimes, tragically, avoidable deaths. All the time, the huge unaccountable monster of a market-led NHS gobbles up precious resources.

My hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) gave an excellent expose of what has been happening in the West Midlands and Wessex health authorities and the Government-appointed business men who have made such a mess and wasted so much money. The sleaze encouraged and permitted by the Government is a disgrace. My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) referred to the increase in administrative costs. I wish that the Secretary of State had attempted to reply to some of the serious points that he made. When so much money is going on administration and being taken away from nurses, most people would accept that it is the patients, nurses and health workers who lose. In this brave new world of markets and managers, nursing and midwifery staff have decreased by 5.4 per cent.

Our ambulance service, once the pride and envy of the world, has also suffered. Since 1987, there has been a massive cut in staffing levels and the funding of the service has fallen by 10 per cent. in real terms. The Minister likes to talk in real terms. In 1992-93, 30 per cent. of England's ambulance services failed to meet minimum response times. In west Yorkshire, only 55 per cent. of responses were within eight minutes. In Halifax recently a young man tragically died. Because of cuts in the number of crews, a crew from another town had to come and the time that that took was unacceptable. The new NHS executive management headquarters in Leeds cost £55 million, about the same amount that it would have cost to build the new hospital for which Halifax has been waiting since 1978. Last year, our trust submitted a plan for a new hospital at a cost of £50 million which was turned down by the Government. After meeting in secret, it has now submitted another plan costing

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£35 million, thus hoping to save the Government £15 million in capital expenditure. That will mean the closure of two hospitals--the Royal Halifax infirmary and the Northowram hospital which caters for elderly and mentally ill patients. If that plan is accepted, the service to my constituents will be drastically reduced.

Calderdale has already seen its service much reduced. Due to overspending, infertility and cosmetic surgery are to be curtailed. Mixed wards have been introduced. I receive many letters of complaint about that, mainly from women who do not want to be on a mixed ward. Mixed wards have been introduced simply because managements have closed other wards. Women tell me that they feel at their lowest in hospital and are embarrassed to be on a mixed ward. They do not want them. But all the Government-appointed trust management says is that no one complains to it. They certainly complain to me and I would not want it.

The referral of non-GP fundholding patients from outside hospitals in Calderdale has been stopped and there has been an increasing use of short- term contracts. Staff have experienced insecurity, some of them working in casualty on short-term contracts. How does that relate to a Government who profess to care for nurses? In addition, we have seen the closure of one of our intensive care beds because of a £55,000 overspend. If the hon. Member for City of Chester (Mr. Brandreth) would donate just one quarter of the public money that he has had, we could reopen that bed and perhaps save someone's life. The management of the trust is Government appointed and it is difficult to obtain any real information from it. The chief executive of the Calderdale health care trust wrote to me on 3 December in reply to a letter from me about the closure of the Arthur and Ada children's ward saying that the trust had no plans to close it. Such a statement was a disgrace from a public figure because a few weeks later she announced the closure of the whole hospital, not just the children's ward.

The new development plan for Calderdale is shortly to be put out for so- called consultation. The last consultations concerned whether we wanted trust status and just about everybody in the town said no. But a handful of people, appointed by the Government, decided to go ahead. Therefore, consultations in Calderdale and, I think, everywhere else, should be taken with a pinch of salt.

This week I received a letter from Calderdale and Kirklees local dental committee showing the cuts and how the figures are fiddled. Cuts in services are going on apace. The letter complains that the new purchasing authority, the West Yorkshire health authority, proposes to treat only the most severe orthodontic cases in hospital and to send the rest back to general practitioners. The health authority exists to provide services to my constituents, but in this case it is clear that it is under pressure from the NHS Management Executive to cut waiting lists. It accepts that it is under that pressure.

There is a shortage of orthodontists : the Select Committee was recently told in a report on dental services that the service in the United Kingdom was inadequate. That need will not go away. A group of patients in Calderdale are to be disfranchised just so that waiting lists can be shortened. Sadly, most of the patients involved will be children.

The letter states :

"As in any medical or dental treatment, the most severe cases are the rarest and those children that fall into Grade 3 (moderate)

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will be that group most referred for consultant treatment. The majority of these patients are children and it is probably that the treatment of these children is beyond the skill of most dentists." The children concerned will disappear from the waiting list ; they will go into the black hole into which the Government pour any statistics that cause them difficulty. Another service will be lost--but the waiting list will be shortened. It is all done by fiddling the figures.

The hon. Member for Birmingham, Edgbaston (Dame J. Knight) threw out the taunt that we wanted a Virginia Bottomley in our party. That is the last thing that we want--and, moreover, the last thing that the country wants is another Virginia Bottomley, or any more of the current one. I say that in the name of patients who, tomorrow morning, will be telephoning to ask for beds that are not there, or on a waiting list that is there.

6.51 pm

Mr. John Whittingdale (Colchester, South and Maldon) : Although I agree with nothing else that the hon. Member for Halifax (Mrs. Mahon) said in her speech, I join her in welcoming the debate. I believe that the issue of how to obtain the best possible management in the national health service is very important, and I am glad that the Opposition have given us the chance to discuss it. I regret, however, that Opposition Members who have spoken so far have chosen not to focus on that issue, or to set out any alternative policies. Instead, the hon. Member for Sheffield, Brightside (Mr. Blunkett) treated us to a tirade of personal abuse, smear and innuendo, directed at those who work in the management of the health service and, in particular, at my right hon. Friend the Secretary of State. Although I have not been in the House for very long, I suspect that I shall have to wait some time before I hear such an outrageous speech again.

In contrast, I want to concentrate on the issue of NHS management. The NHS is one of the biggest employers in the world. About 800,000 people work for it--more than the total number working in the armed services, the police, the Post Office and British Telecom combined. This year, the NHS will spend £37 billion of taxpayers' money. Let me put that into proportion : the NHS budget is larger than the gross domestic product of New Zealand, Ireland, Egypt or Portugal. If we are to obtain the maximum value from that enormous sum, an organisation of such size, complexity and scope must clearly have good management.

The Opposition have given the impression today that NHS managers are simply unnecessary bureaucrats--that anyone who is not a doctor, a nurse or an ancillary is a worthless drain on resources. They seem to think that the sole concern of NHS managers is to obtain new offices and limousines : throughout the debate, they have delighted in denigrating the efforts of administrators.

It must be said that the Opposition are not alone in that regard. Every Saturday evening, those who watch "Casualty"--I do, regularly ; it is my wife's favourite programme--will note that the villain is the hospital manager. In every episode, he tells the medical team that they cannot afford to employ any more nurses, that they must close a few more beds or that they must lose a couple

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more wards. The latest development is that the manager is to leave the hospital to work for the ultimate horror, a tobacco company.

Mr. Garnier : May I bring my hon. Friend back to the realms of real life, rather than the fiction presented by television? If he visits Leicestershire, he will see NHS trusts working side by side with non-trust systems. The three major acute NHS trust hospitals in Leicester are the Glenfield, the Leiester Royal infirmary and the Leicester general hospital. In those hospitals, and in the Fosse trust, my hon. Friend will see more patients being treated, shorter waiting lists, more medical staff doing more medical work, greater efficiency and better use of public money to provide the best possible service for NHS patients. Notwithstanding the picture painted by Opposition Members, the Leicestershire system deserves much praise.

Mr. Whittingdale : I entirely agree with my hon. Friend : the reality is very different. The position that he has described is duplicated throughout the country.

The truth is that NHS managers are as essential to the provision of health care as consultant surgeons. The introduction of proper management has not wasted money ; it has saved money. According to one estimate, about £1.5 billion has been secured in efficiency savings since the reforms have installed proper management. The Government's record in providing more resources for the NHS is second to none. Every year the increase in expenditure on the service has risen by more than that in almost every other area of Government spending. That record has allowed us to treat more patients each year, and to ensure that our standard of health care is among the best in the world.

However, it is no good simply increasing the budget every year if the way in which the money is spent is not properly controlled. The search for greater efficiency and value for money is also essential if we are to obtain the maximum amount of patient care. That requires first-class, experienced managers--and securing them means paying the proper rate for the job.

It also requires a clear, streamlined management structure. The original structure of the NHS was a recipe for chaos. Area health authorities, regional health authorities and health districts all competed with each other ; the result was confusion, bureaucracy and a lack of accountability. In 1980, area health authorities were abolished, which removed one unnecessary tier of bureaucracy. The abolition of regional health authorities will remove another : it will give more power to the districts, which are closer to the people whom they serve, and it should also result in savings in administrative costs which can be ploughed back into patient care. I hope that that will also mean that NHS resources can in future be distributed on a fairer and more equitable basis. I know that my right hon. Friend the Secretary of State is familiar with Essex Members' complaints about the way in which we have been penalised, year after year, by the weighted capitation formula used by North East Thames regional health authority. Indeed, we have suffered a double penalty.

The formula for allocating resources between regions works on the basis of capitation weighted on the basis of age and relative mortality ; it does not take account of socio-economic factors such as housing conditions. The formula used within the North East Thames region to

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distribute resources between districts has an additional weighting to benefit poorer areas. As a result, the region receives no more money because it covers some of the poorest London boroughs ; but districts outside London lose as the regional distribution is skewed away from them.

North Essex--which covers my constituency--consistently receives less than its fair share. In 1991-92, for instance, revenue expenditure per head in North East Essex and Mid Essex was £317, compared with £345 in East Suffolk, a district which is identical to North Essex in almost every respect but which has the good fortune to fall within the East Anglia region. In view of the abolition of the regional health authorities, perhaps my right hon. Friend could introduce a single national formula for the allocation of resources to remove the unfairness.

When the regional health authorities are abolished, power and responsibility will rest with the districts. My constituency was previously covered by two district health authorities--the North-East Essex and the Mid-Essex health authorities. They have recently merged with a third authority to form a new single authority--the North Essex district authority. It has a budget of £277 million of which management costs are £3.4 million, or only 1.2 per cent. That is an extremely good record and one which compares well with private sector organisations.

The merger of the three authorities has not only strengthened the district's ability to obtain value for money in its purchasing but has produced a recurrent saving of £100,000. As a result of my right hon. Friend's recent announcement, it will have a further opportunity to merge with the family health service authority. It must make sense to have a single body locally which is responsible for the provision of every element of patient care. I welcome the discussions now taking place between the district health authority and the FHSA on the establishment of a single authority.

Strong and clear management is needed not only at district level and in the purchasing of health care ; it is equally important in provision in hospitals. One of the great benefits of the NHS reforms has been that they have revealed the degree of inefficiency and waste which was endemic throughout the NHS. Prior to the reforms, it was often considered wrong even to think about the cost of treatments or, indeed, the cost of any element of the NHS. As a result, no effort was made to identify possible savings. Staff who faced the choice of using different procedures usually had no idea which might be the more expensive and which might be cheaper but just as effective. That has changed since the reforms.

Cost awareness is now widespread and practitioners have the information that allows them to take account of cost, not as the determing factor in deciding on a treatment but as a relevant consideration. At the same time, the requirement to assign costs to different procedures in different hospitals has shown enormous differentials in costs and, as a result, purchasers are now able to shop around and managers can compare costs and identify best practice. They are now able to obtain more value for money, which means that more resources are releaased and returned to patient care.

Strong management will keep down costs and ensure that more resources are devoted to patient care, but strong management is not enough to maximise efficiency. If anything has been proven in the past 14 years, it is that the greatest spur to efficiency is competition. Compulsory competitive tendering has already led to enormous savings

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in the delivery of health care. Competitive tendering of laundry and portering services has already resulted in an estimated saving of £136 million. Other non-core activities could also benefit from private sector disciplines or CCT.

I cite just one example. Since the NHS Supplies Authority was established in 1991, it has brought together more than 70 separate local supply organisations. As a result, more than £60 million in purchasing costs has already been saved, but the scope for larger savings is considerable.

If the authority were able to take advantage of information technology, it could service every hospital in the country from a single warehouse connected to the hospitals by electronic data interchange. Companies such as Sainsbury, Unipart and National Freight operate complex delivery systems every day. The transfer of the Supplies Authority to the private sector would allow it access to necessary investment capital that it needs to set up such a system and the savings would allow more money to be put back into patient care.

It is not only in non-health activities that competition is providing greater efficiency and value for money. The NHS reforms have created an internal market that allows health purchasers a proper choice for the first time. General practitioners and district health authorities--

Mr. Turner : The hon. Gentleman believes that the health service reforms are wonderful, but my hon. Friend the Member for Wolverhampton, North-East (Mr. Purchase), who is sitting below the Gangway, has informed me that in Wolverhampton tonight dead people are lying in hospital beds because of the disappearance of the night portering service. Is that the image of the national health service in Britain in 1994? Dead people are not being taken from their beds until the following morning because of the failure to provide a portering service.

Mr. Whittingdale : I cannot answer for the service in Wolverhampton, but I accept that the NHS is not perfect and that we still need to make improvements. The Opposition, however, will not accept that more patients are being treated every year and that things are getting better. If the Opposition would recognise that, we might have a more constructive debate.

As I was saying, general practitioners and district health authorities are now able to seek competition between providers and are therefore able to obtain faster and cheaper treatment for their patients. The line between public and private care is now being blurred and NHS trust hospitals are trying to attract extra resources by providing private treatment. Purchasers are turning to private hospitals as well as to NHS hospitals.

Mr. Rhodri Morgan (Cardiff, West) : Wonderful.

Mr. Whittingdale : It is wonderful, and I shall explain why. GP fundholders have been quick to take advantage of the freedom that they have as budget holders. One GP fundholder in my constituency has contracted with the local private hospital rather than the NHS trust hospital, with the result that 90 per cent. of his surgical referrals are carried out by the private sector. In so doing, he has largely eliminated waiting lists, his patients are now treated in single rooms in comfortable surroundings and the cost to his budget and, therefore, to the NHS is less than if he had contracted with the local trust hospital.

The NHS reforms have not--

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Sir Harold Walker (Doncaster, North) : I have listened carefully to the hon. Gentleman. Will he give me a little advice on how to reply to a constituent who wrote to me yesterday? An elderly lady who is going progressively blind because of cataracts has been told that she will have to wait 62 weeks for an appointment for the consultant even to examine her. Will the hon. Gentleman tell me how I might best advise my constituent?

Mr. Whittingdale : I would advise the right hon. Gentleman to tell his constituent that waiting lists are declining and that the number of cataract operations being performed is increasing.

Mr. Hayes : Perhaps I might suggest that the constituent of the right hon. Member for Doncaster, Central (Sir H. Walker) uses the national health service hotline, which is a very effective means of dealing with the problem.

Mr. Whittingdale : I am grateful to my hon. Friend, and I am sure that the right hon. Gentleman will pass on that advice to his constituent.

The NHS reforms have not led to increased bureaucracy and waste as the Opposition motion claims. They have, in fact, done precisely the reverse. They have improved efficiency and they are enabling more patients to be treated. I hope that my right hon. Friend the Secretary of State will build on the reforms by encouraging more competition in the provision of health care and thus allow us to treat even more patients in future.

Mr. Deputy Speaker (Mr. Michael Morris) : Madam Speaker has stated that between 7 pm and 9 pm speeches shall be restricted to 10 minutes.

7.9 pm

Ms Tessa Jowell (Dulwich) : There are two views of the condition of the national health service--the Secretary of State's and everyone else's. The Secretary of State seeks to assure us that all is well and, indeed, improving. Another reality is played out day and night in the casualty units of London's hospitals. Since before Christmas, I have made regular evening visits to a number of casualty departments in London to see at first hand the impact of bed closures and the internal market on Londoners' health service.

I shall at this point make a special mention of King's, which is the hospital that achieved notoriety this week and on a number of previous occasions because of the long waits on trolleys that patients have to endure before being admitted to the hospital. It is not unusual, but it is probably worse at King's than anywhere else in London. The reasons are obvious.

King's has closed 120 beds in the past two years. Is it, therefore, surprising that the hospital finds itself, night after night, without beds to which to admit sick patients? The only alternative is to leave them lined up on trolleys that touch one another, in the casualty department.

Mr. Ian McCartney (Makerfield) : I hope that my hon. Friend will mention the Higgins inquiry report, which the Secretary of State promised to implement in full as a matter of urgency, into the accident and emergency service at King's, where people were lying for up to 24 hours and some people died before treatment was given to them. If the Higgins inquiry report was to be implemented it meant that an absolute commitment, and a fast track commitment, had been made to providing new resources. Is my hon. Friend saying that that promise is not being kept?

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Ms Jowell : As the Secretary of State said earlier, building work is under way for a new accident and emergency department. Indeed, late last night I saw the new X-ray facilities at the hospital. However, it is pointless to tell sick people tonight that in two years' time there will be an accident and emergency department, which will mean that they do not have to wait on trolleys. The Conservative party patently refuses to understand that sense of desperate urgency.

The crisis in our hospitals in London has been brought about by two factors. The first factor is the steady closure of beds during the past five years--inner London has lost about 14,000 beds--and the second is the impact of the internal market. The market now means that hospitals have to live by the rules of competition. "Contractual viability", in new NHS- speak, means 100 per cent. bed occupancy. Anything less will put prices up and therefore threaten the market competitiveness of the hospital.

That also means that there is no slack to deal with the inevitable peaks and troughs in demand that are part of being a national health service hospital. While hospitals may be operating at the limits of the capacity that the contracts that their purchasers have paid for, they are all operating with closed beds, so they are in fact operating at below real capacity and only at the capacity which is specified by the market, not by the needs of patients on the waiting lists.

It is interesting to note the way in which the private sector, which the Government constantly hold up as a desirable role model for our national health service, has such a remarkable and unfair advantage over the national health service. There are important differences.

First, the private sector does not have to deal with emergencies, so all admissions are planned admissions. In contrast, almost every national health service hospital in London admits about 60 per cent. of patients through the accident and emergency department. They are unplanned, unpredictable, unquantifiable admissions--quite unlike the situation in the private sector.

The second difference between the national health service and the private sector is that the private sector responds only to demand. Therefore, if patient demand requires that operating theatres be fully used and consultants kept fully occupied operating, that is what they do. They are not bound by the absurdities of the internal market, which mean that a national health service which is desperately needed to operate at full capacity is prevented from doing so by Government edict through the internal market. As one health manager said to me recently, it is now

"dog eat dog in the national health service".

Consultants admit their elective patients needlessly early, simply to stop anyone else getting into the bed. As a result, patients who need to be admitted through the casualty department have to wait on trolleys because there are no beds available for them.

Some hospitals manage somehow. They put up camp beds. When a bed becomes free during the night it is only because another patient has died. The staff then work to "get the bed cold" in order to take a trolley patient up from the casualty department. However, the patient who is being admitted has to be admitted to the ward wherever the vacancy is. That is why elderly men are admitted to gynae wards and women with gynae complaints are admitted to wards where all the other patients are elderly men. As one

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member of staff said to me, when one has to operate under that type of pressure the quality of care goes out of the window.

Let us dwell for a moment on the fact that the patients charter says that only after someone's operation has been cancelled twice is guaranteed admission within a month. The mayhem that the market has created in our hospitals means that that is regarded now as an acceptable standard.

We heard a lot from the Secretary of State about the way in which waiting times have decreased. What has happened, however, is that people are now treated on the basis of the length of time that they have been on the waiting list only, not on the basis of clinical need.

As a doctor told me a couple of days ago, if someone with an ingrowing toenail has been on the waiting list for 18 months, he will be taken into hospital because the patients charter requires it. However, a woman who needs a hysterectomy, who has been bleeding and in discomfort for many months, and has been on the waiting list for five months, is likely to have to wait 18 months before she is admitted. That type of perversity, that absurdity, is played out day by day in our national health service hospitals.

Is the Minister aware of the Norton scale? If he is not aware of the Norton scale, which was posted up in an accident and emergency department that I visited last night, let me tell him the way in which the administration of that new nursing protocol is described : "Due to increased waiting times in accident and emergency, it is essential that we assess our patients' risks of developing pressure sores."

That is a nursing protocol to ensure that people--often elderly people--who wait for hours on trolleys are monitored, because of the likelihood of their developing pressure sores and dehydration. It is now a fact of life that elderly people who are kept waiting in casualty departments arrive on the wards, when they are eventually admitted, in a worse state than when they arrived at the hospital. There has also been a sharp increase in the numbers of people attending accident and emergency departments and, more disturbingly, in the numbers of people who are not registered with a general practitioner.

7.19 pm

Dr. Charles Goodson-Wickes (Wimbledon) : It will be 50 years ago next month that a Conservative Minister in the wartime coalition published the first Bill promoting the national health service. My hon. Friend the Member for Wycombe (Mr. Whitney) rightly gave credit to Liberals such as Lloyd George and Beveridge, and to the Labour party for actually enacting the legislation, but every party in the House can take credit for the basis of the NHS.

Having listened to some of the Opposition's arguments tonight, I feel that they still fit the descriptions such as "the halt, the sick and the maimed" that we find in the Third Reading debate on the Act that established the national health service. I sometimes wonder whether the Opposition parties can really cope with the advances of the past 50 years.

The strength of the national health service has been much trumpeted over the years, but, not surprisingly, the weaknesses became ever more obvious. By the early 1980s, it was obvious to everybody that its management was inadequate. The Griffiths report began to tackle those problems. However, it was not until the Government under Lady Thatcher published the White Paper, "Working for

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Patients", that the most radical changes were proposed. What a culture shock they were, and what emotions they aroused.

According to the Labour party, hospitals would opt out of the national health service, general practitioners would collapse under the administrative burdens of running their practices, and patients would suffer further as the whole system ground to a halt. Now, three years on, we can see the great success story of those Conservative reforms. The internal market works, based on the logical concept of separating health needs from the delivery of health care. Nobody pretends that there were no teething problems--you, Mr. Deputy Speaker, are in an especially good position to judge that. We all remember the irate meetings and the clamour riding on the back of the threat of change.

Having been trained in the national health service and having worked in it for much of my life, I have some insight into the fears. How were doctors expected to manage budgets when they had spent their entire professional lives ordering investigations and prescribing drugs with no knowledge of the costs involved, let alone any concept of accountability? Yet, surprisingly quickly, the first tentative steps towards fundholding became a rush. Now about 25 per cent. of the population are covered by fundholding GPs.

The story of national health service trusts is similar. The various waves almost had to be held back, as hospitals--their number is now almost 400-- clamoured to regain some of the independence that they had lost over the years when they were kept down by arrogant and stifling bureaucracies. Doctors, nurses, ancillary staff and administrators have risen to the challenge. Suddenly, the national health service was competing with the independent hospital sector for contracts. I declare an interest as a director of two private health care companies operating in this country, one British and one German. They cannot relish the process of NHS reform, but they now have an added stimulus to give choice and value for money.

I welcome the competition. The private sector will survive only if it offers a better service than the reinvigorated national health service. That is what Conservative competition is all about. I can live with that. It gives better treatment for patients, and that is the most satisfactory outcome of all. It so happens that neither I nor my family have private health insurance. We have all been in-patients in the NHS over the past few years and we all have a vested interest in it--and we have all had the most excellent treatment.

We see a great success story, but all we hear from the Opposition parties is negative vilification, with no acknowledgement of the progress that the Government have made. Even if the Labour party does not recognise the achievements of my right hon. Friend the Secretary of State, perhaps Labour Members should listen to Professor Le Grand of the Socialist Philosophy Group, who said that fundholding was "perhaps the biggest success story".

As my right hon. Friend told the House earlier, Professor Le Grand emphasised that

"few who work in the NHS would want to go back to the old pre-reform system."

The Labour party sees efficiency as some sort of inhumane capitalist mechanism rather than as a means to deliver the best possible resources for the care of the only person who matters in the exercise, the patient.

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I am ashamed to say that only two weeks ago my own trade union, the British Medical Association, published pleas for pilot projects. We have heard that expression before. "Pilot projects" were among the concepts advanced by the Labour party at the general election, and it said that the election would be the test of health care delivery in this country. We know the result of that election, and we know that pilot schemes have been translated into the real thing over the past three years, and that patients have benefited thereby.

In anticipation of today's debate, the hon. Member for Sheffield, Brightside (Mr. Blunkett) announced that 10,000 beds had been lost in one year. That statement is an index of the hon. Gentleman's crass ignorance as a health spokesman. Has he never heard of day surgery? Does he not realise that day surgery does not require beds, and that stays in national health service beds are getting shorter and shorter? Does he not realise that more and more patients are being treated in out-patient departments, and that fundholders now treat more patients in their own surgeries, so we need fewer beds? The Opposition keep pushing the argument about people being left in corridors, and so on. That is not a medical problem ; it is a management problem. We accept it as such and it will be sorted out as such.

Dame Jill Knight : Will my hon. Friend give way?

Dr. Goodson-Wickes : No, I regret that my speech is time-limited. Let me educate the Labour party. In 1991-92, 36 per cent. of elective surgery was done on a day basis. That percentage has now risen to 45 per cent., and the Royal College of Surgeons has a target of 50 per cent. for the near future. Sadly, the hon. Member for Brightside seems to have no idea of the effects of community care on the need for beds.

Dr. Joe Hendron (Belfast, West) : Will the hon. Gentleman give way?

Dr. Goodson-Wickes : I cannot, I fear.

Community care has introduced a whole new and humane system that gives the lie to the accusation that the Government are centralist. It has produced the most major change in influence from central to local government, and the greatest increase in local responsiveness that we have seen for many years. That is another reason why fewer beds are needed in our hospitals.

My constituency is served by three excellent national health service trust hospitals, and I have reports from regular visits there. One of them, St. George's Healthcare, has reduced its running costs by almost £10 million, through a combination of removing overheads including direct management costs, improving clinical efficiency and income generation. There has been a vigorous competitive tendering programme, and the trust even generates its own electricity--I welcome that. At night, it sells electricity to the London electricity board, thus generating savings of about £900,000 per year. Who would have thought that that would be an outcome of Conservative policies? And how agreeable it is.

The St. Helier national health service trust has treated more patients every year within the patients charter guidelines, within its financial budget and within the

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