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The Tomlinson report has brought in its train serious threats to some of the finest centres of medical excellence in the world. People from overseas look aghast that we should even be considering closing centres like Bart's or University College hospital or Guy's or St. Thomas's. They think that we must be several light years out of our skulls, or at least that the Government are.

What else were we told by Tomlinson? We were told that the link between Guy's and Lewisham was now no longer necessary, because Guy's would be linked with St. Thomas's. We were assured by the self-same people who, a couple of years ago, told us that Lewisham had no future other than being linked with Guy's that Lewisham could stand happily on its own and would, in fact, benefit from being a separate trust. I can only suggest that there were either lies three years ago or there are lies now, because both cannot be true.

More embarrassing for those who are currently running the trusts is that the same people were telling us that those two conflicting stories were both true. So now we have a trust in Lewisham and a separate trust at Guy's and St. Thomas's. What Tomlinson came up with for Guy's and St. Thomas's was a merger on a single site. Anybody with any intelligence could see what that means. Either Guy's or St. Thomas's will close, and either over the river or further down at London bridge there will be a single sign saying "Guy's and St. Thomas's hospital". The entire nation is to be asked to believe that that is the continuation of Guy's and St. Thomas's, but it is a mask for closure.

The health authority has been through a metamorphosis. While the trusts were being set up, there was an imbalance--particularly as the flagship was moored so close by. Incidentally, it is now obvious that the flagship trust was sailing under a flag of convenience, which was that of expediency. The authority had to look at another way of matching the producer-provider split. That idea has not just dropped from the heavens. It is not a revolutionary idea--the

producer-provider split in the public services is as old as public service itself.

We are arguing about the way in which it operates and the system under which it operates. The district health authority at Lewisham and North Southwark got together with what was then the authority for Camberwell and West Lambeth and created what was informally known as the south-east London commissioning authority. After due consultation, they decided to formalise a split with the commissioning authority, and we had something called the South East London health authority. That was formed, amazingly, out of the London boroughs of Lambeth, Lewisham and Southwark. Those hon. Members who are still awake will recall that I mentioned the area health authority which was formed in 1978 out of Lambeth, Lewisham and Southwark.

I was just getting used to the South East London health authority, when I got a letter at the end of 1993 from an organisation called the Lambeth, Southwark and Lewisham health commission. This has all happened within a space of a few months. The only people who have benefited from the upheaval in south-east London are public relations consultants who have designed logos and printers who have designed letter headings.

The Lewisham trust, meanwhile, has announced for the fifth time to my certain knowledge phase 2 of the

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development of Lewisham general hospital. This is the fifth time since 1984 that that major step forward has been announced. On the other four occasions, it came to nothing. Let us hope that it is more successful on this occasion.

The chairman of the Lewisham trust resigned after I placed questions on the Order Paper asking what the hell he was doing launching a £100 million carpet company at the same time as he was supposed to be running a hospital. I accept immediately that carpets are important in hospitals, but I would much rather have somebody in charge who knows about health rather than about carpets. I asked questions about what he was doing and he resigned a few months later, I am pleased to say. However, we are left with his legacy. It is clear that the NHS is not safe in the hands of the Government, and not safe in the hands of the Conservative party. The British people know to their cost that it is not the protection of the Tories that the NHS needs, but protection from them.

8.18 pm

Mr. Nicholas Winterton (Macclesfield) : I congratulate the hon. Member for Belfast, West (Dr. Hendron) on his rational speech. He showed that he has a refreshing knowledge of the health service in Northern Ireland. The hon. Gentleman is now accompanied by the hon. Member for Belfast, South (Rev. Martin Smyth), whom I know well. He has served on the Health Committee and its predecessor Committee for many years, and there is no doubt that Northern Ireland is well represented in the debate.

I also congratulate the hon. Member for Belfast, West on what I consider to be a sensible remark. He said that the Government have done a lot of good for the health service and indeed they have. Some of the reforms have been beneficial and should be carried forward. The hon. Gentleman added that the Government are not prepared to listen to criticism. They are not prepared to listen to people who have a point to make. He said that the Government appear to think that any criticism comes from people who do not want to know anything about the reforms that the Government have introduced. He believes that the Government consider that those people are foolish, that they believe in a different philosophy and that therefore they need not be listened to. I think that people should be listened to.

Although I warmly welcome a number of the reforms that the Government have introduced, certain problems have arisen. Unlike the Opposition, I would not abolish fundholding practices, but I would ensure that every practice was a fundholder. That would put all practices on the same footing.

The hon. Member for Bristol, South (Ms Primarolo) will respond for the Opposition and I say to her, as a Conservative and a member of the Government, that I accept that there is a two-tier system. I have had many instances in my own constituency of such a system operating. Patients in a fundholding practice are offered immediate treatment, whereas those in a non-fundholding one are made to wait because the district health authority or the regional health authority has run out of money. The hon. Lady and every other hon. Member could cite similar examples. It is interesting that fundholding practices do not

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appear to run out of money, just district health authorities. I do not have time, unfortunately, to talk about the allocation of resources.

I respect my right hon. Friend the Minister immensely, despite our many differences since his appointment to the Department of Health. Many of the Government reforms are good and should be supported, but my right hon. Friend and his ministerial colleagues, particularly the Secretary of State, should listen to constructive criticism, because everything in the health service is not rosy.

I accept that there is a lack of morale and a sense of uncertainty within the NHS. I say that as a Conservative, so my comments will not be welcome, bearing in mind the theatrical performance from my hon. Friend the Member for Harlow (Mr. Hayes). People wonder whether the Government are committed to the health service, as we know it and as I believe it should be. People are concerned about whether functions are being gradually weaned away to the private, independent sector or charitable sector of the hospital service.

That process has already affected community care and the care of the mentally ill, the mentally handicapped and those who are suffering from aging illnesses. They are no longer looked after in the NHS, but in private nursing homes, private residential homes or charitable, non-profit-making institutions. That is dangerous, because the health service is now dominated by its concern for treatment. It is gradually squeezing out care, but to my mind the provision of such care is a vital part of our NHS. People who work within the service, especially nurses, express that concern to me over and over again.

Macclesfield has a superb district general hospital. I congratulate the regional health authority chairman, Sir Donald Wilson, on the resources that he has allocated to that hospital and the extensions that have been made to it. I also congratulate him on the additional facilities that we have bought, because, I am glad to say, a private hospital went into liquidation. It had been built on health authority property next to the district general hospital and, as a result of its failure, we now have a superb orthopaedic department, at a third of the cost of providing one from scratch.

Nurses are overworked and are under immense pressure. They tell me that they were taught to care, but that they do not have time to care, even for people who are dying. My right hon. Friend has an immense experience of the medical profession and surely he would agree that a person should die with dignity and be offered care, compassion and love. The people who can give them that do not have the time to do so.

The debate is about bureaucracy and administration. Whatever my hon. Friends may say, there is no doubt that the system has created a huge bureaucracy and a huge additional administration. Senior management have increased from 1,000 to 10,000. It is not as though those people are still paid between £35,000 and £40,000 per annum. They now earn between £80,000 and £100,000 and receive big bonuses, cars, perks and various other benefits. They are extremely costly to the health service. Administrative and management personnel have increased from 10,000 to 35,000. My right hon. Friend may justify expenditure on those functions and claim that it is worth while, but a lot of that money should be going to patient care.

It is difficult to cost care. It is quite easy to cost treatment, but my right hon. Friend does not know how

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much care a particular patient will need. If commercialisation is to dominate our hospital service, one of the most valuable assets of our service, the care that is offered to sick people will disappear. That would be extremely sad.

I recently wrote to Sir Donald Wilson, because, although I pay tribute to him for reducing waiting lists and, perhaps, for running the most efficient region in the country--as he, or should I say his public relations department, is wont to say--I can only say that Macclesfield looks rather like a war memorial. Although I have a first-class trust chairman in Mr. Peter Hayes, a first-class board, both non-executive and executive, and first-class staff at the district hospital, what has happened to health facilities in Macclesfield?

The Mary Dendy hospital and the Alderley Edge community cottage hospital have been closed. The Soss Moss hospital is to close. Parkside hospital, one of the finest mental health hospitals in the country, is to close, despite my opposition, which I have voiced throughout the time, nearly 23 years, in which I have represented Macclesfield.

The young persons unit, which treats young people with behavioural problems, has the most outstanding reputation of any such unit. It, too, will be closed because it has a low profile in terms of the service that it provides and therefore it is a low priority on any purchaser's list. At the same time, the district hospital will provide an after-school sex clinic. The authority has got its priorities slightly wrong, because to abolish a unit that is a success story and to duplicate existing facilities in my community is a mistake.

The health authority has also decided to close the Priory unit, which treats those who suffer from alcohol dependence. The carers, the staff and those who use that unit want it to survive, but, oh no, the health authority wants it to close. The authority has informed my trust that it will not purchase any places at the unit and that its patients should be treated in the community.

I have received pleading letters from my constituents whose lives have been saved by the unit, but where is the consultation about which we hear so much? My hon. Friend the Member for Broxbourne (Mrs. Roe), who now chairs the Select Committee on Health, talked about accountability, but where is it? There may be accountability to Ministers and Sir Duncan Nichol, but there is none to the local community which is served by the health service.

The decisions in my area are not even made by the chairman of the district health authority, County Councillor Simon Cussons, but by Sir Donald Wilson, and I give him full credit for his experience. That health authority was merged against the wishes of my local authority, my wishes and those of the community health council. Now, it is not even located in the area that it serves, so how can it offer an acceptable level of accountability?

I urge my right hon. Friend to use the good reforms that we have introduced, but we should implement them in a way that is acceptable to the people of this country, the people who serve in the NHS, and particularly the patient.

8.28 pm

Rev. Martin Smyth (Belfast, South) : I am glad to follow my parliamentary friend and erstwhile colleague on the Select Committee, the hon. Member for Macclesfield (Mr. Winterton), because of his concern in health.

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The hon. Member for Falmouth and Camborne (Mr. Coe) gently chided the hon. Member for Belfast, West (Dr. Hendron) for overdrawing the picture. Unless my knowledge of quotations is completely wrong, he was quoting the director of Booz Allen and Hamilton, speaking in December, when he compared spending £1 directly on patient care and £4 on aspects of indirect care. I had the impression that that had been changing as a result of the Government's reforms, whereas the director was implying that that was still going on. He said : "For every pound spent directly on caring for the patient, £3-£4 is spent on writing things down, scheduling work, and waiting for work to be required."

We must face some of the issues that remain with us. I pay tribute without reserve to the work that has been done over the years through the national health service. I have campaigned for it, but I do not believe that it has been perfect. Indeed, I do not believe that anything that a human puts his hand to is necessarily perfect. We should therefore always strive to improve.

In that context, I pay tribute to the recent honour that the Minister for Health has received. When I raised a question during the paediatric statement, he missed the point that I was making and said that he would refer the matter to the Earl of Arran. I received an acknowledgement that he had done so and, amazingly, I am still waiting for a definitive reply.

Paediatric orthopaedics is an example of the weakness in the national health service. It has a tremendous need to deal with youngsters, and one of the finest provisions in the United Kingdom is provided by Musgrave Park hospital. I knew that the Minister had personal experience of it. I acknowledge that the North British Tours organisation has given another generous donation from private enterprise to fund the work carried out at the hospital's Gait unit. I was amused to receive an oblique reply referring to the orthopaedic surgeon handling the work at the children's hospital.

I cannot understand why the Department continues to write to Members who raise issues detailing facts that the Members already know rather than dealing with the problems that they raise. He told me that Kerr Graham was the surgeon, but he had already written to me to thank me for the interest that I had shown.

I am not knocking at the health service but pleading for continued improvement in it. I understand the views of the hon. Member for Falmouth and Camborne on care because, on Tuesday this week, I was travelling from Belfast with one of Northern Ireland's finest comedians, Frank Carson, who paid tribute to the hon. Gentleman's concern for social care.

The earlier part of this debate seemed, with sound and fury, to signify nothing. We must get beyond a partisan approach so that we can come together to help and improve. Some people constantly seek to defend their own patch. It is interesting to discover that the pharmaceutical industry is adamant that we should not curb drug production because only 10 per cent. of the national health budget is spent on drugs. Yet there is 10 per cent. wastage in the health service, so why take it out on drug manufacturers when what they supply equals the waste ? Nobody will suggest that the waste occurs only in the drugs budget.

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Hon. Members complain that we knock the managers. As I said in Committee earlier today, I put on a blue suit because I was not knocking the men in grey suits. None the less, we need to examine the growth of the managerial approach. Figures that were given to another hon. Member suggest that 36,000 more managers and 27,000 fewer nurses are employed than before the reforms. I appreciate that statistics can be confusing, because those figures refer to the whole United Kingdom from 1989-90 onwards and include nursing auxiliaries and pre-Project 2000 nursing students, whereas the Department of Health figures in the statistical bulletin exclude Northern Ireland and apply only to qualified nurses.

It is, therefore, difficult for hon. Members asking questions in this place if they do not get clear answers. Perhaps some of us are still living in our school days, when we gave a vague answer to try to gain something from the examiner because we did not have the full answer. I suspect that there are still more nurses in patient care, because one must add to the number of nurses involved in the health service those now involved in private residential and nursing home provision.

The fashion of provision on acute sites is one of the issues raised in the London review. It is argued that we should not have specialised, free- standing units, but that they should be on acute hospital sites. I share the concern of the hon. Member for Belfast, West about the suggestion that one of the finest cancer units in the United Kingdom, at Belvoir park on the outskirts of Belfast, serving the whole region, should be on an acute site, whether the City or Royal site. The Minister will agree that the City or Royal sites could not even cope with the parking facilities now available at Belvoir Park. To destroy that wonderful provision because a fad in medicine says that it must be on an acute site would be lunacy. We must challenge some of the thinking in the medical profession for which politicians get the blame when, in fact, the changes have been driven on by advances in medical care and technology. The poor politician must then provide the money and carry the can for those decisions. The public must realise that medical folk have their own agenda.

The hon. Member for Macclesfield referred to community care and the move to private provision. The tragedy is that now, with the new programme--in time, the Government want to try to extend community trusts to the rest of Britain--we are discovering that private residential facilities in Northern Ireland are closing. People are afraid that there will be no provision for the elderly, the mentally infirm and others. We are decanting them and relying on their families, without proper respite provision or back-up in community care.

We must constantly keep alert to those issues, so thatwe maintain the best health service that the world knows.

8.38 pm

Mr. Stephen Day (Cheadle) : First, I declare an interest. I am the parliamentary consultant to the National and Local Government Officers' Association section of Unison, and I am proud so to be. Some of the comments in the debate may be construed by members of that union to be an attack on them. That is unfortunate, because many members of Unison work in the NHS and many members of NALGO work in the administration of that great service.

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It has been said today that, as a Government and as a party, the Conservatives should listen to criticism about the present workings of the national health service. That is right, and that is what the Government do. Only recently, the Secretary of State responded by announcing an initiative issuing new NHS codes for accountability, probity and financial control, for which I applaud her.

The NHS is a vast service, which employs many people, and it would be surprising if there were no instances of genuine distress involving individual patients at specific hospitals. When such stories are related by Opposition Members, they are valid and particularly pertinent to the patients who suffer. But such tales do not tell the other side of the story --the vast number of patients who are treated by the NHS and are well satisfied. I am constantly amazed by the number of people who come to me, either in my surgeries or as I am wandering around the constituency, and say that they have received wonderful service from the NHS. They are often elderly people.

Opposition Members often cite examples of patients who have been kept waiting for what everyone agrees are unacceptably long periods. It is fine if Opposition Members do so to try to improve the service, but they do not. They do so in an attempt to attack the integrity of the Government and the NHS by continually alleging that that is the true picture.

That is why I had some sympathy with the hon. Member for Belfast, South (Rev. Martin Smyth) when he said that in order to deal with the problems we need a consensus. That is necessary if we are genuinely interested in saving the NHS for the future--the task before us. All hon. Members know the pressures on the service. They are shown not just by the individual difficult circumstances already mentioned, but by the massive number of patients successfully treated by the NHS. Success identifies the problems faced by the service, but that aspect has hardly been mentioned in today's debate.

The idea that a service designed to meet the needs of the 1950s could be retained in a fossilised form without change is bizarre. The NHS could not possibly have met the needs of the 1990s in its original form. Even now, the NHS is not perfect. Given the pressures that it is under, I suspect that it never will be. Nobody in the House can deny that the NHS has never been perfect. The problem of patients having to wait too long did not suddenly occur when the reforms were introduced. Indeed, the reforms were an attempt to deal with that problem.

Nobody can promise to eliminate that difficulty, but it does not serve the interests of the House or the subject when hon. Members constantly and only relate the downside of the equation. Even with the shortest of waiting lists, someone will always have to be last on the list. Hon. Members who are constantly on the attack by reminding us of the person who comes last are not helpful. According to them, the NHS cannot win, but it is not good enough merely to say that. The NHS is a great institution. I am proud to say that I rely totally on the NHS for my health provision. I thank God that I have been lucky enough not to have use the services of the NHS except for specific injuries. The NHS has been successful, and more people are living to a greater age. We all welcome that and hope to be part of the problem. In the light of the temperature in here sometimes, I am not sure whether it is the best place to be to become part of that problem for the NHS, but I shall try.

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Parliament and politicians must recognise that to provide for people in old age requires changes. We must constantly fine-tune the system and the changes. If the Opposition criticisms are designed to help that fine tuning, they are valid, but I do not recognise such criticisms in what they have to say.

I cannot remember who it was but, during the debate, an hon. Member related the problems that one of his constituents faced waiting for a cataract operation, and his story proves my point. The number of people waiting for cataract operations originally began to grow--despite the Government's partial success in that sphere--because the NHS was so successful that more people began to live to an age when they suffered cataracts. We must recognise that problem if we want to save the NHS. As someone who uses the NHS, I have faith that the reforms are not a threat to the principles of the NHS, but its salvation.

8.45 pm

Mr. Alan Milburn (Darlington) : I pay tribute to the brave and forthright speech of the hon. Member for Macclesfield (Mr. Winterton). He highlighted what happens when a Government become so obsessed with ideological ends that they put their obsession ahead of a commitment to the most popular of all public services in this country, the national health service. The Government have taken no account of the costs of their policies.

We have heard today that the NHS is in a state of perpetual crisis in all parts of this country. I do not need to repeat the litany of problems already mentioned by my hon. Friends--suffice it to say that the NHS cannot cope with demand because it is so short of supplies. I should have thought that a Government so committed to the ethics of the marketplace would have understood that--the first principles of economics. For any enterprise to succeed, it must be able to meet demand with adequate supply. If one closes one fifth of one's capital assets--hospitals and acute wards--and fails to protect investment--the NHS budget--from the ravages of inflationary costs, one's enterprise will inevitably fail to keep pace with demand. Is that not the homily that we have heard from successive Chancellors of the Exchequer, Prime Ministers and Health Ministers?

Such a scenario is bad enough when it afflicts an individual firm, but when it comes to pass in an institution as vital to the health of our nation as the NHS, the country's alarm bells should start to ring. What is at stake is the health and future of our nation. The NHS is in danger of imploding as a consequence of the combination of underfunding, rock-bottom staff morale, public disquiet and the Conservatives' market changes. The straw that may finally break the camel's back is the boom in bureaucracy of recent years.

We all know that times are hard, that precious resources have to be husbanded and that we cannot do everything that we would wish to do immediately. If we ask members of the public where they want their hard- earned tax revenues to be spent in the NHS, they say that they want more doctors, nurses and midwives and more expenditure on medical equipment. I bet that no one would say that they want more bureaucrats or managers, but that is precisely what we have. In the midst of famine, there is a feast of bureaucracy.

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There is the starkest contrast between the problems that my constituents face as health care providers and people requiring health care and the boom in bureaucracy over recent years. The NHS is becoming more secretive, centralised and top heavy. It is in danger of becoming a service where the daily growth in the number of chiefs is matched only by a fall in the number of indians. The position is now sufficiently clear. The Department of Health's own figures paint the starkest picture. There were 14,000 more managers, 22,000 more administrators and 27,000 fewer nurses in the United Kingdom's national health service between 1989 and 1992. The introduction of the Conservatives' market changes saw a 236 per cent. increase in managers and a 5 per cent reduction in nurses. Ministers have formed an army of bureaucrats which is strangling the NHS with more and more red tape. The internal market is sapping the health of the nation with a booming bureaucratic burden in contrast to Ministers' promises. We were promised a leaner and a fitter national health service where resources would be freed for better patient care. It is not leaner or fitter ; it is fatter with bureaucracy.

Ministers say they are determined to hold down administrative costs. The Secretary of State claimed in her statement to the House last October that the abolition of the regional health authorities "will slim down NHS management".--[ Official Report, 21 October 1993 ; Vol. 230, c. 400.]

She repeated that claim earlier today, but, as the right hon. Lady must know, axing the regional health authorities will do no such thing. They have been sacrificed, not in an effort to cut down bureaucracy, but to stamp out the last vestiges of proper planning in the NHS.

If the proposals go ahead, the distinctive health needs of my region, the north, will be swamped in a larger, less accountable organisation run from the centre by the hand-picked appointees of the Secretary of State for Health.

As for the claim that it will mean fewer managers, who on earth do Ministers think they are kidding? In 1992, out of a total of 710 managerial staff in the national health service of the north, just 88 were directly employed by the regional health authority. The Secretary of State quite simply has the wrong target in her sights if she is serious about reducing NHS bureaucracy. Its growth owes nothing to the planning work of regional health authorities and even less to the redesignation of nurses as managers ; it owes everything to the introduction of a new contract culture at hospital level. That culture has brought with it the paraphernalia and institutional bureaucracy of the marketplace. We have more financial directors, more pieces of paper, more trading in health care, and more PR specialists and management consultants, and they are all looking to make a killing in the new environment. If the Government really want to cut down on bureaucracy, stamp out waste and end the growth in grey suits, they have to end the market experiment in the national health service.

The responsibility for waste and unnecessary red tape lies with Ministers. They have abused public spending. The annual pay bill for managerial staff in the United Kingdom has trebled--an increase of more than £350

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million. In the past year in England alone it has risen by £110 million--an increase of 29 per cent.--while the overall nurses' salary bill has increased by just 5 per cent.

Ministers say that it takes a special person to be a hospital manager and that therefore hospital managers deserve a special reward, but it also takes a special person to be a nurse, a doctor, a porter or somebody working in NHS labs saving lives in our hospitals and communities every day. But what is their reward? A pay squeeze, which damages morale further. It is an insult to NHS staff at the sharp end of health care and it is precisely the double standards we have come to expect from the Government.

That is just the beginning of the story. My hon. Friends have alluded to the growth in corruption within the national health service. I never thought that we would see the day when corruption would become synonymous with the NHS.

In my region we have the Northumbria ambulance service, the jewel in the crown of the NHS trust success story run by a man who happens to be the president of the Tynemouth Conservative association and, I understand, of the Tynemouth boy scouts as well. Mr. Stewart and his friend Mr. Caple have very good track records. There are personalised number plates for NHS ambulances. They pop over to America and buy a new fleet of ambulances

Madam Deputy Speaker (Dame Janet Porter) : Order.

8.56 pm

Mr. Roger Sims (Chislehurst) : The motion alleges lack of accountability within the health service, and I would dispute that. Health authorities and trusts are answerable to local people, including local Members of Parliament. They are answerable to the NHS executive and to Ministers who, in turn, are answerable to us in the House by way of letters, parliamentary questions and debates such as we are having today.

I do not consider the first leg of the motion to be particularly strong. When Opposition Members talk about accountability, what they mean is that they would like to see health authorities elected and turned into party political bodies, to which my response is, God forbid.

The second leg of the motion alleges a growth in bureaucracy. In the sense that there are now people with management responsibilities that did not exist before, that is correct. It is exactly what was needed in the health service--a clear line in management responsibility.

The third leg alleges waste of resources. That is certainly true. There is some waste of resources, but, thanks to the reforms in the health service, we can now identify and deal with them. At least there is now a mechanism in place whereby they can be handled, which was not the case in the past.

I am not going to quote an over-quoted slogan, so I think that we should go back to why and how the structure of the NHS was changed. The House will recall that, in the early 1980s, we were faced with ever-increasing expenditure in the health service without apparent corresponding improvements in the service, and with lengthening waiting lists. As a result, the then prime Minister set up her inquiry and Sir Roy Griffiths was asked to initiate an inquiry into the management of the health service which he concluded was poor. There was waste then, but it could not be identified, because we did not know how much things cost. In those

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days, if one asked at the local hospital or health authority what was the average cost of a gall-bladder operation or a hysterectomy, they literally did not know. How can waste be prevented if one does not know what the costs are? Nor were there clear lines of responsibility. Obviously, resources of cash and staff were not being used as effectively as they could have been, but no mechanism existed to identify where the weakness lay. That was why the reforms were introduced.

The front line of the NHS are the doctors and nurses, who heal and care for patients. Every one of us has benefited from the work they do, but they do not work in isolation. It is easy to scoff at managers and administrators, but without them doctors and nurses simply could not do their work. Any successful industrial or commercial organisation depends on the skills, not only of those who fashion the final product, but of those responsible for managing the premises, for the purchase and supply of materials, and for programming the production process to make the maximum use of facilities within the organisation.

I do not suggest that the NHS is either an industrial or commercial concern, but, in staff employed and the money spent, it is big business. It must be sensible to apply business methods to its administration. Behind those front-line doctors and nurses there are now managers responsible for the premises, for record keeping, for ensuring that drugs and equipment are available when needed, and for effecting a match between operating theatre time, bed occupancy, treatments and patients' needs, thus reducing and, I hope, eliminating, waste.

We now have managers at purchaser level in the health authorities who know the cost of treatments and can allocate resources in the best interests of the local population. By contracts, they can get the best value for the funds that they have available, which are always going to be limited, whatever the ultimate figure. The fact is that the system is working. We are getting more and better treatment for the money spent.

In her opening speech, my right hon. Friend the Secretary of State quoted some national figures. They are reflected locally. In my area, in 1992-93, Bromley health authority purchased homeopathic treatment for 232 out- patients, two day cases and nine in-patients, at a cost of £50,000. In 1993-94, it purchased 320 out-patient appointments, nearly 100 more, for £14,400 as against £50,000 the year before, thus releasing more money for other treatments.

There is a new administrative structure, or, as Opposition Members might like to call it, bureaucracy. But it is working. It is having the effect that it was intended to have. That is not to say that there is not scope for further improvement--of course there is. We look forward to legislation to reduce the number of regional health authorities. It will also enable the merging of health authorities and family health services authorities. That is already happening in Bromley, in all but name, with advantages all round. It means that referral and discharge protocols have been developed to ensure the maximum benefits for patients, and the most effective use of resources. It has enabled the managing of joint budgets to ensure that authorities are able to make the most appropriate and cost-effective arrangements for the treatment of those for whom they are responsible.

Inevitably, there are problems as new systems are implemented. Hospitals may well complete their contracts

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before the end of the financial year, but that demonstrates the need for them to pace themselves and/or to consider whether there are ways of attracting new contracts. All the players are learning by experience in negotiating contracts and in assessing extra contractual referrals that are likely to be needed.

Of course mistakes will be and have been made, and where they are gross-- some examples have been quoted today--that may well be due to sheer incompetence, and appropriate action should be taken against managers who are simply not up to the job.

The organisation and administration of the NHS is not perfect, but at least the Government have had the courage to implement revolutionary changes and have not been afraid to make adjustments and improvements where they are needed. All the Opposition seem able to do is to criticise in a manner that cannot help the morale of those who work in the service, whether as nurses or at management level.

It is not as if the Opposition's criticism is constructive, even though members of the Labour party are actively involved in working in the NHS at many levels. We simply do not know what the Opposition's policies are. Are they in favour of trusts? Would they put the clock back? Are they in favour of fundholding GPs? Yes or no?

Today was the opportunity for the Opposition to tell us what Labour party health policy is, especially since they initiated this debate. Once again they have fluffed it. There has been plenty of criticism but nothing constructive. It is just possible that when the hon. Member for Bristol, South (Ms Primarolo) replies to the debate she will tell us what Labour party policy on health is, but I would not put my money on it.

People will make their own judgments on which party believes that the NHS is a subject for party political point scoring but has no new ideas and which party is wholly committed to the NHS and is constantly working to improve it.

9.6 pm

Dr. Lynne Jones (Birmingham, Selly Oak) : Earlier today we heard a great deal about the large quantities of propaganda material being churned out of the Department of Health. My attention was drawn to a press release dated 6 January with the headline :

"NHS must learn to listen and respond to local voices says Mawhinney".

About the same date, a letter signed by 124 consultants--yes 124 consultants, more than 60 per cent. of the consultants in the south Birmingham acute unit--wrote a letter to the Secretary of State which was a cry for help. They are the local voices. They referred to the problems that they experience day to day and to what was going on in our health authority in south Birmingham--a series of reorganisations, relocations and administrative schemes that have consumed funds and countless working hours and have led to confusion, demoralisation and reduced efficiency. That is what 124 consultants working in south Birmingham said about what was going on in our health service. If they are confused, the people are even more confused. The merger of south and central Birmingham health authorities had been forced through with inadequate preparation by the discredited former chair of the regional health authority, Sir James Ackers, who was appointed by the Government. A new accident hospital was originally

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planned for Birmingham as part of plans for major capital investment. Sir James Ackers said that Birmingham had been starved of investment and he put forward grandiose plans, most of which local people did not want because they concentrated everything on the site of one mega-hospital. That plan was to go ahead and lots of money was to be spent, but, all of a sudden, that money dried up and the plan was shelved.

In the confusion, there were plans to close hospitals to try to save money. The accident hospital was relocated to the general hospital. Now, because we need a new hospital the accident hospital has to move out of the general hospital so that the children's hospital can move into the general hospital. The Royal Orthopaedic hospital that was to move to the general hospital will not now do so, and there are plans to move it to Selly Oak hospital. No wonder people are confused. They wonder what on earth is going on when decisions seem to change from day to day and money which at one time was readily available suddenly dries up.

We know what is happening. Because everyone is moving towards the idea of hospital trusts, new trusts can no longer guarantee that they will have contracts : that means that they cannot plan for the future and cannot make long-term capital investment. That is why Birmingham cannot have a new children's hospital and that is why we cannot have a new trauma unit.

The people of Birmingham have little confidence in the present arrangements. First, they were told that the number of beds in the Queen Elizabeth hospital must be doubled ; then, only a year ago, the chief executive of the acute unit--who has now resigned--said that there was a greater demand for beds in that hospital and in the Selly Oak hospital. Last October, however, the new purchasing plans were published : they envisaged a loss of 236 beds. Only two months later, the regional health authority's plans appeared, stating that nearly 500 beds must go.

When I queried the discrepancies, the regional health authority told me that there was one year's difference in its figures ; a steep decline in numbers was taking place. Now, the people of Birmingham are wondering whether they will have any hospitals left. The Minister talks about listening to local people, but he does not really want to listen to the voices of people in Birmingham, or to the views of those 124 consultants. I note that the Secretary of State did not mention the letter from those consultants when she referred to the various comments that she had received.

In its propaganda newspaper, "Heartbeat", the regional health authority proudly announced last September that beds, wards and even whole hospitals could be closing across the west midlands as patients and general practitioners exercised their new power to withhold custom from unsatisfactory hospitals. Beds, wards and hospitals are closing ; but they are not closing because customers do not want to use them. Waiting lists have lengthened, and every week I hear from my constituents about their difficulties in securing the operations they need.

One consultant recently told a patient, "You are No. 144 on my waiting list of 238. Only very urgent cases--patients with cancer--can get treatment." A group of gynaecologists, frustrated by their inability to take patients from GPs unless they were fundholders, wrote a circular letter to all GPs, letting them know what was going on.

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