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Mr. Whitney : The hon. Lady has made frequent mention of the number of consultants who are complaining about the health service. Can she name a year since 1948 in which consultants have not complained about the state of the NHS?

Dr. Jones : Consultants have never spoken out as they are speaking out nowadays. That is my experience in Birmingham : they have never been willing to speak out in that way.

A lady who came to my surgery on Friday had been in daily pain, needing an operation. The consultant said that she could have the operation in January ; there is no waiting list. She has been told, however, that because she lives in south Birmingham she cannot have the operation, because there is no money. A patient about to be discharged from a mental hospital in south Birmingham was told that she would be given counselling sessions and would be able to come in once a week for day care. When it was realised that she lived in south Birmingham, however, she was told that she could not receive that service.

Surgeons tell me that elective surgery is virtually being cancelled in Birmingham. Because of the closure of one of our local maternity hospitals, women are being forced to go out of the district, because the remaining maternity hospital cannot cope with the demand. The situation is ridiculous : patients cannot be given the treatment they need, although there are consultants willing to undertake the work. I heard last week that, in the Birmingham maternity hospital--which has an intensive care unit for babies- -demand is so great that nurses are rushed off their feet, because they are admitting more premature babies in need of intensive care than can be dealt with by their facilities. They are packing them in because they want to make a profit. That is a consequence of the market : we are measuring the success of hospital units according to whether they make a profit rather than the quality of service that they provide.

The internal market is not working in south Birmingham. I urge the Minister of State and the Secretary of State to take their own medicine and listen to the people who experience what is happening every day. Will they please accept our invitation to talk to local Members of Parliament, local consultants, local nurses and the local people?

I am confident that, with proper planning to get us over our current problems which are due to inadequate planning in the past and a lack of capital investment, south Birmingham could have good and efficient services on a reasonable budget. At the moment, however, the health authority is being asked to make impossible savings which are decimating patient care in my constituency and in other parts of the South Birmingham health authority area.

9.15 pm

Mr. David Congdon (Croydon, North-East) : A few moments ago, a Labour Member accused the Conservatives of being obsessed with an ideology for the national health service--wanting to make it a commercial market and eventually privatising it. I utterly reject that charge, but I plead guilty to being obsessed with ensuring that the NHS provides the most efficient and cost-effective patient care possible. I also plead guilty to being obsessed with wanting to root out waste in the NHS. It was

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interesting that virtually all Labour Members criticised the NHS for this and that, but they did not offer one constructive proposal to root out waste.

Listening to Labour Members, one would have thought that they had a magic method of improving efficiency in the NHS and that the experiences of other large organisations could be dismissed. Many large public sector organisations have a record of inefficiency. One need only remember the old nationalised industries--thank God there are very few left--or consider many sectors of local government, especially Labour-controlled authorities, to know the meaning of inefficiency. It is difficult for a large organisation which is spending £100 million a day to ensure that it gets the maximum value for each £1 spent and to remember that every £1 spent badly is £1 less for patient care.

The key test is whether we have now organised the national health service in such a way as to provide greater efficiency and improved patient care. It has been announced--rightly so--that the size and scale of the regional health authorities is to be reduced, and that is to be welcomed. The changes have inevitably led to a reduction in the number of staff employed by the district health authorities because many of their functions have been taken over by the trusts. It is true that the DHAs are spending very little in carrying out the purchasing function, but it is a key function.

There is a split between the purchaser and the provider, ensuring that there is an important distinction between those who decide what the health care needs are and those who meet them. That is also leading to improved efficiency. I believe that fundholding GPs are the key to the future. They are able to determine what they wish to buy without an intervening layer of bureaucracy, but we heard little about that from Labour Members. It is also clear that the way in which the purchasing authorities place their contracts is also leading to better value for money.

Perhaps most important of all are the measures that lead to efficiency. I do not have time to list them all, but we know that more patients are being treated than ever before. That cannot be ducked by Opposition Members.

We know that the measures in terms of indices of efficiency are improving in the national health service. There have been productivity gains of about 32 per cent. during approximately the past 10 years. There have been productivity gains of 1.9 per cent. last year and 2 per cent. this year. The NHS is a success story and we are determined to ensure that it continues.

To listen to Opposition Members, one would have thought that there was no need to have managers in the health service who monitor what happens. We know that the performance of individual hospitals varies greatly ; length of patient stay varies considerably ; the amount of use of operating theatres varies widely up and down the country. The challenges for the health authorities--it has not changed for many years--is to ensure that the standards of performance of the worst areas come up to the standards of the best, because there are such wide differences. We must aim for that.

The health service in London was also mentioned. Some difficult problems need to be resolved. We know that the number of beds in London needs to be reduced. My plea to Ministers is to control the pace of change in London, because we cannot afford to reduce the number of

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beds too quickly. We have to ensure that the number is reduced in line with other changes, especially in primary care, in London. The motion that we are debating is a sham. The Opposition are not interested in the efficiency of the health service. We have heard little about what they would do to improve it. They wish to have a large, monolithic organisation, with the producer interests put first. We wish to ensure that the interests of the patients are paramount. That is why it is important to continue with the reforms that are leading to improved efficiency and--perhaps more important--improved patient care.

9.21 pm

Mrs. Jane Kennedy (Liverpool, Broadgreen) : Like the hon. Member for Cheadle (Mr. Day), I am associated with Unison as a sponsored Member and I have been a member of the National Union of Public Employees since 1979. I will not accept instruction from the hon. Member for Falmouth and Camborne (Mr. Coe) on how to represent Unison members. I fought the proponents of permanent revolution in my party and I will fight the idea of permanent revolution in the NHS with every breath left in my body.

I wish, however, to give the Minister the opportunity to take action that will halt the waste of £9 million of capital investment and at least £4 million of revenue costs per year--a waste of resources which, I believe, will have a direct and detrimental effect on the care of cancer patients in my constituency and which has not yet happened. There is an opportunity for the Minister to do something specific that will halt waste in the health service. The Secretary of State said that it was crucial that the management of resources for the NHS should be effective. I agree with her, but a proposal is being considered by the NHS directorate of the Welsh Office to develop a cancer treatment centre at Glan Clwyd hospital in Bodelwyddan, north Wales.

The Welsh Office believes that Wales should be self-sufficient in the provision of services to its people. That has reached the point where services that are provided to Wales from England are to be substituted by provision in the Principality, irrespective of the financial illogicality of it or of the impact on the quality of service that will be offered in return.

The north-west of England and north Wales are well served by the two cancer treatment centres at Christie's in Manchester and Clatterbridge on the Wirral in Merseyside. Christie's, marginally larger than Clatterbridge, draws its patients from east Cheshire, Greater Manchester and Lancashire. Clatterbridge patients come from Merseyside, west Cheshire and north Wales- -specifically Gwynedd and Clwyd.

The patients travelling from north Wales for diagnosis and radiotherapy have long distances to travel and usually stay overnight or are admitted as in-patients to Clatterbridge. I can understand how that must add anxiety to an already stressful and worrying time for patients and their families. However, the current proposal from the Welsh Office to develop an independent radiotherapy service at Bodelwyddan does not make financial sense, will not improve the quality of service provided and flies in the face of recent concerns about the non-uniformity of the quality of cancer treatment throughout the United Kingdom as a whole.

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According to a Touche Ross report for the Welsh Office, estimates of the capital costs involved vary from £11.7 million to £12.9 million, depending on which site is chosen. Revenue costs would add a further £4 million per annum. The maximum number of patients forecast for the unit is 1,700 per year, and the expected number is 1,400 per year. That could never be enough to allow a centre of excellence to develop, and even those numbers could be achieved only if the health authorities of Gwynedd and Clywd committed the vast majority of their patients to the new centre, which would remove all choice from patients and their GPs.

Furthermore, I understand that Glan Clwyd hospital, the most likely site, has asked that the cancer centre's funding should be ring-fenced and underwritten by the Welsh Office. Otherwise, failure of the proposed unit could wreck the financial viability of the Glan Clwyd trust and damage the services on offer there. Such an open-ended financial commitment to the north Wales centre would inevitably be a drain on funds for the treatment of patients in England, and my constituents in Broadgreen would suffer because of the limitations that would be placed on the development of new treatment at Clatterbridge.

The Clatterbridge centre for oncology cares for about 6,000 patients a year, nearly 900 of whom come from north Wales. Its size has allowed it to develop a unique combination of people and equipment. Its neutron accelerator is used in the treatment of eye tumours, and that requires the support of specialist staff, who produce facial masks to hold the patients still while the treatment takes place. It is inconceivable that such treatment would be available at Bodelwyddan, so some patients would still have to travel to the larger centres of Clatterbridge and Christie's.

However, if Clatterbridge lost the 900 patients from north Wales, how would its own financial viability be affected? Obviously unit costs would increase. How long would it be before the case was made by the people whom we have come to know as "the purchasers" that we could not afford three cancer treatment centres in such close proximity? As the Welsh Office would be so financially committed to the unit in north Wales, the future of Clatterbridge would inevitably be called into question.

The Clatterbridge centre for oncology has submitted its own proposals to the Welsh Office. I know that the Minister has been involved in that process, and I hope that he will respond at the end of the debate to what I have said.

The Clatterbridge proposals would improve the treatment of patients throughout the region. The centre would like to develop network cancer treatment facilities throughout its present catchment area, including north Wales. That could involve potential for the installation of linear accelerators at Bodelwyddan. Alternatively, it could involve developing facilities at each of the three general hospitals that serve the area. Being part of the Clatterbridge management unit would allow for provision of the high-quality skills and treatment that we need to standardise throughout cancer care. The capital cost involved would be as little as £2.4 million, depending on which option was adopted. Clatterbridge is developing for all its patients a system of delivering chemotherapy through local clinics, bringing

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the treatment to the patients in Southport, St. Helens, Walton and Warrington. North Wales should be allowed to benefit from that system, too.

At a time when the Government's chief medical officer is leading an initiative to improve cancer treatment across Britain through the standardisation of excellence, it seems a great shame that the Welsh Office should be poised to spend millions of pounds on a venture that will not only almost certainly fail to deliver quality in north Wales, but may also wreck the centre of excellence at Clatterbridge. I should be grateful if the Minister could find time to respond to that specific example of bureaucratic nonsense. However, if he cannot manage to do so in the short time that I know he has available, will he respond more fully later?

In the last minute of my speech, I shall deal with some of the nonsense being perpetrated by Conservative Members. When Unison-sponsored Opposition Members speak up and describe the chaos that they see around them in the health service, which has been caused by the introduction of the internal market, Conservative Members say that we are attacking the Unison members working in hospitals throughout the country. But it is nurses who are Unison members who have told me that, in Alder Hey hospital, they can no longer perform the role of key nurse, because they never know from one day to the next which ward they will be working on. They are redirected, as soon as they enter the hospital, to the ward with the fewest staff on duty that day.

Unison members are unable to carry out the professional role that they came into the service to provide. They feel bitter and tell me so. I wonder what they say to Conservative Members. I wonder whether Conservative Members have held surgeries or have opened their mail bags, because after the messages that I have received, not only from those who work in the health service and Unison members, but from members of the public who have written to tell me about operation cancellations, Conservative Members must have been living in a different world.

9.29 pm

Ms Dawn Primarolo (Bristol, South) : Again, the debate on health has been in Opposition time. The Government claim to have had such wonderful sucess in the service, but they reflect and decide not to debate health in their own time.

In the debate, we have considered accountability, efficiency, bureaucracy, waste and the fundamental difficulties with the reforms. The Labour party is trying to make it clear to the Government that a system that is driven by cost, in which everybody knows the price of everything, affects the quality of care. It is true that staff nurses now know the cost of everything, and that perhaps they did not know before. We all know that canisters to warm blood before transfusions cost £60. However, what happens as a result is that they do not use those facilities.

We know that purchasing authorities use different specifications, which means different services are being purchased across the country, with the inevitable consequence of the undermining of the national health service. We know that commercialisation and privatisation mean a defensive, closed, secret system in which trusts, in order to compete, spend more time worrying about their balance sheets and what their neighbours are doing than

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about the care of their patients. We know that competition is leading to duplication, where every authority thinks that it should have all the equipment and where planning is diminishing. Opposition Members have detailed at length the waste, the bureaucracy, the waiting lists, the problems with GP fundholding and the two-tier system, and they have demonstrated how private gain is at public expense.

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

Ms Primarolo : Conservative Members know that I have 15 minutes only. The Secretary of State took 50 minutes. I shall try to make some progress through my speech if Conservative Members will allow and I shall give way if time permits.

My hon. Friend the Member for Don Valley (Mr. Redmond) said that we ought to go "back to basics"--back to the basics of justness and fairness. Conservative Members spent their time saying how wonderful the reforms were everywhere, except in their constituencies, where their hospitals were having problems and they thought that perhaps it was a hiccup in the system. We have heard about bed crises, cheating on figures, and ways in which to squeeze treatment out of the system.

My hon. Friend the Member for Lewisham, West (Mr. Dowd) rightly pointed out that Tories claimed that they supported the NHS, have always supported it and were joint partners with the Labour party. I refer them to the vote in the House of Commons on 30 April 1946, when their Government voted against the creation of the national health service by 359 votes to 142.

As the hon. Member for Macclesfield (Mr. Winterton) pointed out, fundholding means that GPs have independence. That is one of the fundamental difficulties with the system. There is a conflict between the district health authorities and the GP fundholder. GP fundholders are not monitored or directed, do not have to ensure that they are buying the services correctly and are pulling in the opposite direction to the district health authority's purchasing strategy. In the middle, the hospitals, the patients and the workers are suffering. That is the problem with the system.

In January 1990, the then Secretary of State for Health said : "Next year we propose to reform the NHS : the coming winter will end the last year of an entirely unreformed service. The winter of next year will not be dominated by cancelled operations, closed wards and cuts in services".-- [ Official Report, 11 January 1990 ; Vol. 164, c. 1124.]

Where is the truth in that statement? It appears at column 1124 of the Official Report, for those who are interested in the facts. For three years, we have constantly pointed out that the internal market reforms would mean the destruction of the national health service based on the principles of equity, universal access and comprehensiveness of service. Three years later, we have the cancelled operations, closed wards and cuts in services that the reforms have introduced. We have a two-tier health service, which is nothing to be proud of. A health service is emerging in which, if one chooses private care or one's GP is a fundholder, one is treated quicker than someone who goes to a non-fundholder--and massive waste, bureaucracy and a lack of planning pervade.

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By contrast, the Government continually mislead the public about the crisis in the national health service. For example, a letter that was circulated in one of our hospitals states :

"Theatre cancellation programme.

I am writing to inform you that the cancellation programme for January and February of 1994 has been delayed. The reason is the expected reduction in the workload to counteract the overachievement of contracts in some specialities. I apologise for the delay" in implementing the cancellation programme

"and hope we will be able to finalise the programme shortly." That is the stupidity and chaos of the present system.

The Government and their flagship authorities tell us that they are getting waiting lists down. An article in The Independent of 5 January 1994 states :

"Mersey has become the first regional health authority in England to have no patient on the NHS waiting lists for more than a year." We telephoned some GPs in Merseyside to find out what is going on. A letter circulated in January states :

"The waiting lists for out-patient appointments for the spine clinic is now in excess of 18 months."--

wait for it--

"The total appointment booking facility on the hospital computer system is only 18 months, therefore the computer facility is exhausted. All appointments will be allocated when appointments are available."

Yet the Government, through their good news unit, are encouraging the idea that there are no waiting lists of more than one year. That is not true.

Another patient received a letter in October 1993, advising the date of the first appointment--Thursday 5 January 1995. That is what is going on in the national health service under the Government. The Government say that the health service needs more competition, but what has competition meant so far? We are now three years into the internal market and what do we have? We have a system in which money talks. If one's doctor happens to be a fundholder, one has more chance of being treated quickly.

It used to be that hospitals ran out of money and took only emergencies towards the end of the financial year. That is now happening at the start of the financial year. I have been told that some cash-strapped hospitals are desperate and are asking their consultants to seek out friends who might be fundholders. What does the Secretary of State have to say about that? She says that they are discovering more quickly that they cannot meet their commitments because they are more vigilant. They discover at the end of the year instead of at the beginning. Presumably that is what all the bureaucrats are doing.

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

Ms Primarolo : I have only 15 minutes.

The reforms have been about bringing the health service to the brink of privatisation. The interplay of the internal market, recent national policy changes and the activities of the private sector mean that the boundary between public and private health care is being blurred, so that soon--the Government hope--we will not be able to identify the boundary at all.

The number of people in Britain with private health care has grown. One out of nine people are now covered by private insurance, and GP fundholders have a financial incentive to encourage their patients to take insurance.

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

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Ms Primarolo : No.

National health service income from private patients has soared by more than 30 per cent. in the first year of the reforms. Almost a quarter of the charges were accounted for by the first 57 hospitals. Of course, such hospitals are not taking private patients because they have exhausted their waiting lists. When they have no one to treat, they sit round idly waiting for the next patient to walk through the door. They turn to the private sector for work because the public sector cannot afford to pay for more patients to be treated. Waiting lists grow while the Government starve the NHS of money.

The National Health Service Management Executive actively encourages the investment of private capital in joint ventures in the NHS. In April this year, the Government relaxed the rules authorising capital spending, and the NHS Management executive is holding up schemes such as kidney dialysis, magnetic resonance imaging, staff accommodation, clinical waste incineration and patient hotels as examples of successful private investment. Naturally, the trusts and the private sector are delighted and are developing more joint ventures with enthusiasm.

Mrs. Bottomley : Excellent.

Ms Primarolo : The Secretary of State says "excellent". I am glad that she agrees with our analysis of the Government's interest in privatisation.

Mrs. Bottomley : Will the hon. Lady give way?

Ms Primarolo : Madam Deputy Speaker-- [Interruption.]

Madam Deputy Speaker (Dame Janet Fookes) : The House knows that if the speaker who has the floor does not choose to give way, other hon. Members must resume their seats.

Ms. Primarolo : The Secretary of State had 50 minutes. I do not have all that time and I am required to sum up the debate. The Government say that they are treating more patients. When I asked them how many patients were being treated in 1991 and 1992 by trusts, shadow trusts and directly held units, I was told in a written answer on 8 February 1993 that they did not collect the information and did not know. Dr. Ian Bogle, the chairman of the general medical services committee, describes the Government as undertaking a national cover-up, having a lack of honesty and living in Alice in Wonderland's world. I could not agree with him more. We want to develop a national health service on the basis on which it was established and which the people of this country demand to see maintained--a high- quality public service that is paid for from central taxation and free at the point of delivery for all who need treatment. There will be no self- governing trusts or GP fundholders operating as private businesses in our national health service. There will be no need for gagging clauses restricting health workers from speaking out on the ground of commercial confidentiality. We will provide a public health service, rather than an ill health service. Instead of creating poverty, unemployment and a health crisis, and then leaving the NHS to pick up the tab for poor health, we will promote health through co-ordinated action against poverty and inequality. We will

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consult on the way to shape a national health service around those principles, and about how a Labour Government will fund that underfunding.

The British Medical Association said :

"The council endorses the view that prioritising treatment on the basis of a purchaser's ability to fund that treatment, rather than on the basis of an objective assessment of relative clinical needs, infringes the ethical principle of equity and should be vigorously opposed."

We oppose the Government's privatisation of the NHS. We oppose their reforms, but not because we do not believe that the NHS needs improving and needs changing. It is a dynamic service which deals with people and needs to respond to people's needs. We believe that the Government's vision of the health service will not provide for the NHS. Therefore, we will continue to oppose their attempts--they have tried to do it since 1946--to destroy our NHS.

9.45 pm

The Minister for Health (Dr. Brian Mawhinney) : The hon. Member for Bristol, South (Ms Primarolo) pointed out that neither she nor I had much time to respond to today's debate, so I will take my lead from her.

I cannot ignore the speech by the hon. Member for Sheffield, Brightside (Mr. Blunkett). He pointed out that this was the first debate on the subject for a year, and that the Opposition had called it. After today's experience, I suspect that it will be a long time before the Opposition call another such debate. Indeed, so riveting was it for the Labour party that all of 34 Labour Members sat behind him as he delivered his scathing, vulgar and abusive attack on the Secretary of State.

The hon. Gentleman was unable to give, or to respond to questions and enunciate, any scintilla of Labour party policy. I thought for one moment that the hon. Member for Bristol, South had broken from cover and said something to do with policy. However, it was so ringed around with conditional clauses that I could see that she was entirely on a par with the hon. Member for Brightside.

He did say something, however, and I was interested that my hon. Friend the Member for Harlow (Mr. Hayes) picked up on it, as I did. This was the only policy that we have had from the Labour party tonight, and I want my hon. Friends to listen carefully. The hon. Gentleman said, "Our policies will have something to do with treating patients." I see that as being a big vote-getter around the country. My right hon. Friend the Secretary of State pointed out that that will be next month, or the month after, or the month after that. I want to pick up on the comments of two hon. Gentleman who contributed to the debate. My hon. Friend the Member for Macclesfield (Mr. Winterton) encouraged us to listen to constructive criticism. We do that, but we are not interested in the mindless and ideologically based criticism that we have heard from the Opposition tonight. We are interested in constructive criticism. We recognise that, in a venture as large as the national health service, there are always ways to produce improvements, and we are always open to listen to constructive comments.

I heard what my hon. Friend said about community care. That it is a successful policy and helps frail elderly people enormously is agreed. It also helps people with mental illness, and I know that my hon. Friend is committed to them. I heard what he said about nurses and, while I have always resisted the temptation to encourage

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colleagues to read speeches which I have made in the past, perhaps he will take the time to look at a speech I gave at the Royal College of Nursing congress in May 1993. He will find that I reflected exactly and in some greater detail the very point that he made earlier about the importance of creating space for nurses to care as a part of the professional discharge of their duties.

I would like to thank the hon. Member for Belfast, South (Rev. Martin Smyth) for his kind personal comments. My hon. Friend the Member for Broxbourne (Mrs. Roe) and my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) both recognised that it was important to increase funds to the NHS year on year, as we have done. My right hon. Friend pointed out that another £1.6 billion will go into the NHS during the next financial year. My hon. Friends pointed out that the way to maximise patient benefit from those resources was to improve management.

I was reminded of a comment made to me by a health authority chairman some time ago. He said that, when he was appointed four years ago, he inquired in his first week in office what the cost was for a hip replacement operation. Today, he says that he knows not only the cost of that operation, but the cost and quality of it in every single hospital in the area. He now knows that there is a sixfold difference in those costs. He is now able to manage the system in a manner that enables a better service to be presented to patients. My hon. Friend the Member for Chislehurst (Mr. Sims) also referred to that point.

The Labour motion expresses some concern about patient care. I know that the hon. Member for Brightside is extremely interested in beds. He issued a press statement--I read them all--on that matter on 10 January. I must admit that his press officer did not do an awfully good job, but, with reference to beds, that statement read : "The NHS is slowly being whittled away"

I looked up the figures on the percentage reduction in the number of in- patient beds between 1979 to 1989. I discovered that, in this country, there has been a reduction of just more than 20 per cent. Spain, Greece, Portugal and the United States were in the 15 to 25 per cent. reduction band. The hon. Gentleman will be interested to know that even bigger reductions were made in Italy, Denmark and Ireland. Reductions were also made in Germany, France and the Netherlands.

The hon. Member for Brightside is probably incapable of getting his mind around those figures, but people outside the House will want to know why the number of beds available for health care is being reduced not only in this country but in every developed country in the world, except Belgium--I do not know why that is so. Let me give the hon. Gentleman the answer.

During the 1980s, the average length of stay in hospital was reduced from 10 days to six and a half days. In 1982, the average stay in hospital for someone receiving treatment for cataracts was eight days ; today it is under three days, and many are treated as day patients. In the late 1970s, a person with a peptic ulcer would spend at least a week in hospital. Today, many patients do not go to hospital, because they are simply treated with drugs. The hon. Member for Brightside does not understand, will not understand and is incapable of understanding that, if the health system becomes more efficient, two things happen : more patients get treated and there is less demand for the hospital beds in which to treat them.

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The hon. Gentleman will be interested to know that I visited the Enfield Community Care NHS trust on Monday. Members of the trust told me--I did not ask for or know the facts they simply gave them to me--that it is now treating nearly 20 per cent. more acute elderly in-patients, and that treatment costs have been reduced by 40 per cent. in the past three years. The average length of stay in the hospital has been halved. It has fewer acute beds and more doctors and nurses per acute patient. Those facts reflect what is happening in the health service throughout the country.

Instead of thanking the senior managers or the administrative staff of that trust for the job that they are doing, perhaps I should have said something in keeping with the speech by the hon. Member for Darlington (Mr. Milburn). Perhaps I should have said, "Ward clerks, the Labour party thinks that you are a waste of space. Medical secretaries, the Labour party wants you out. Wage clerks, the Labour party wants you on the dole. District nurses, no cars, the Labour party wants you on your bikes GPs on night calls, walk."

That is the sort of nonsense that flows from the ill-informed attacks by the Labour party on the management of the NHS, month in and month out. Do members of Unison think that they are being denigrated by Opposition spokesmen? Of course they do, because that is precisely what the Opposition have done in the debate. I should like to draw the attention of the hon. Member for Brightside to the North West Anglia hospital trust in Peterborough. It runs the best hospital-at-home scheme in the country. I am told that this year it will treat 635 patients, 435 of whom will be discharged early from hospital as a consequence of the scheme and another 160 who would otherwise have gone into hospital but can be treated at home.

May I give another example for the edification of the hon. Member for Brightside? Based on the national average, the length of stay in an acute hospital for hip replacement surgery is 15 days. In Peterborough it is six days in hospital and six days at home. The hospital-at-home scheme has reduced costs per case by 20 per cent., the length of stay in acute hospitals by 60 per cent., and the total length of the care episode by 20 per cent. We on this side of the House welcome that. It is good patient care and more patient care, but it makes no difference to the Opposition.

Under the last Labour Government, the number of patients treated increased by 1 per cent. a year. During the 1980s under this Government, the number increased by more than 2 per cent. a year. Since reforms were introduced in 1990, the number has increased by more than 5 per cent. a year-- [Interruption.] I understand that Labour Members do not like that.

Let me help the Opposition to understand it in a different way. That 1 per cent. a year under Labour represented 57,000 extra patients a year, whereas the 5 per cent. increase in the number of patients treated since the reforms represents 417,000 extra patients treated every year.

Let me put it another way for the Labour party. If I were to fill Wembley stadium on Monday night, Tuesday night, Wednesday night and Thursday night, and put more people in it on Friday night than ever watch Sheffield Wednesday or Sheffield United, all of them together would represent

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the increase in the number of patients treated under this Government each year compared with the annual increase in the number treated under the last Labour Government.

Let me put it another way. Had we not changed the system that we inherited from the Labour party in 1979, more than 2,600,000 patients who received treatment would not have been treated. That number would fill Wembley stadium every night for a month. Those facts give a new meaning to that well known song, "We're on our way to Wembley." This debate has illustrated, like no amount of Labour press releases could, the difference between each side of the House. The Labour party has no policies, whereas we have a co-ordinated patient-focused policy that is producing more patient care. They have a fixation with beds ; we have a fixation with patients. They have a fixation with hospitals ; we have a fixation with patient care. I call on my hon. Friends to recognise that, in every football ground in the country, people are singing our praises because they realise that we are on our way to Wembley in terms of the number of patients that we have treated. I urge my hon. Friends to throw out the Opposition motion and support the Government's policy. Question put, That the original words stand part of the Question :--

The House divided : Ayes 265, Noes 311.

Division No. 85] [10 pm


Abbott, Ms Diane

Adams, Mrs Irene

Ainger, Nick

Ainsworth, Robert (Cov'try NE)

Allen, Graham

Alton, David

Anderson, Donald (Swansea E)

Anderson, Ms Janet (Ros'dale)

Armstrong, Hilary

Ashton, Joe

Austin-Walker, John

Banks, Tony (Newham NW)

Barnes, Harry

Battle, John

Bayley, Hugh

Beckett, Rt Hon Margaret

Bell, Stuart

Benn, Rt Hon Tony

Bennett, Andrew F.

Benton, Joe

Bermingham, Gerald

Berry, Dr. Roger

Betts, Clive

Blair, Tony

Blunkett, David

Boateng, Paul

Boyes, Roland

Bradley, Keith

Bray, Dr Jeremy

Brown, Gordon (Dunfermline E)

Brown, N. (N'c'tle upon Tyne E)

Bruce, Malcolm (Gordon)

Burden, Richard

Byers, Stephen

Caborn, Richard

Callaghan, Jim

Campbell, Mrs Anne (C'bridge)

Campbell, Menzies (Fife NE)

Campbell, Ronnie (Blyth V)

Campbell-Savours, D. N.

Canavan, Dennis

Cann, Jamie

Chisholm, Malcolm

Clapham, Michael

Clarke, Eric (Midlothian)

Clarke, Tom (Monklands W)

Clelland, David

Clwyd, Mrs Ann

Coffey, Ann

Cohen, Harry

Connarty, Michael

Cook, Frank (Stockton N)

Corbett, Robin

Corbyn, Jeremy

Cousins, Jim

Cox, Tom

Cryer, Bob

Cummings, John

Cunliffe, Lawrence

Cunningham, Jim (Covy SE)

Cunningham, Rt Hon Dr John

Darling, Alistair

Davidson, Ian

Davies, Bryan (Oldham C'tral)

Davies, Rt Hon Denzil (Llanelli)

Davies, Ron (Caerphilly)

Davis, Terry (B'ham, H'dge H'l)

Denham, John

Dewar, Donald

Dixon, Don

Dobson, Frank

Donohoe, Brian H.

Dowd, Jim

Dunnachie, Jimmy

Dunwoody, Mrs Gwyneth

Eagle, Ms Angela

Eastham, Ken

Enright, Derek

Etherington, Bill

Evans, John (St Helens N)

Ewing, Mrs Margaret

Fatchett, Derek

Faulds, Andrew

Field, Frank (Birkenhead)

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