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Madam Speaker, about the use of the Crown portcullis and the royal arms, and also at a copy that someone sent me of the paper that the hon. Member for Liverpool, Mossley Hill (Mr. Alton) has apparently been sending out in Liverpool.

Mr. D. N. Campbell-Savours (Workington) : What does it say ?

Mr. Newton : Perhaps it would be unfair for me to answer, in the hon. Gentleman's absence. I have to say, however, that if I had sent the paper out I would find it very difficult to defend.

Mr. John Garrett (Norwich, South) : If the Minister for open government continues to refuse to allow a Select Committee to carry out a direct survey of the opinions of civil servants, will the Leader of the House arrange a debate so that that Minister can be called to account for his actions ? Will he also make a statement next week on the accountability of Ministers to Select Committees ?

Mr. Newton : I will certainly consider the latter point, although I am not entirely sure what the hon. Gentleman has in mind. As for the first part of his question, which concerned attitude surveys, the position is clear : civil servants must not take part in surveys or research projects in their official capacities, even unattributably, if they deal with attitudes or opinions on political matters or matters of policy. As I understand it, there is nothing particularly new about that.

Mr. Harry Greenway (Ealing, North) : May we have a debate next week on nursery education, with particular application to the Conservative- controlled borough of Ealing, to examine the provision by the present council of 400 more nursery places than its Labour predecessor, with more on the way ? There are also proposals for more places in Northolt, where much is needed.

Mr. Newton : With the required degree of ingenuity and your permission, Madam Speaker, my hon. Friend may be able to make those points in the debate on the Education Bill on Tuesday 3 May. Whether or not that proves to be possible, I am glad that my hon. Friend has had the opportunity to draw attention to the undoubted merits of Ealing borough council in that respect.

Mr. Bruce Grocott (The Wrekin) : May we have a debate on procedure and will the Leader of House, with his responsibility to all hon. Members, lead that debate ? Many Conservative Members--they are either new hon. Members or they take rather longer than average to learn things--respond when my right hon. and learned Friend the Leader of the Opposition stands up by saying, "Answer, answer, answer." We can understand their confusion, but could it be explained to them that it is the Prime Minister's job to answer questions and the Leader of the Opposition's job to ask them ? While those positions will be changed in the not-too-distant future, should not Conservative Members be instructed in the basics until that time ?

Mr. Newton : This is a bit of an old chestnut from the hon. Gentleman. I hope that he understands that the reaction of my right hon. and hon. Friends stems from what I regard as their understandable frustration at the difficulty in getting Opposition Front-Bench Members to answer any real questions anywhere in the country.

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Mr. Anthony Coombs (Wyre Forest) : Has my right hon. Friend had an opportunity to study early-day motion 1057 ?

[ That this House commends the commitment and dedication of the personnel in the Obscene Publications Branch at New Scotland Yard ; recognises their unique national role and expertise in investigating child pornography and paedophile rings ; notes the ever-growing complexity and volume of computer pornography with which the branch deals ; and calls upon the Home Secretary to ensure that the Commissioner abandons any plan to close the Obscene Publications Branch and that this specialist squad is assured a continuing and strengthened place in the Metropolitan Police on the conclusion of the current restructuring review. ]

The motion deals with the scourge of child pornography and expresses concern at recent reports that the obscene publications branch of the Metropolitan police might be disbanded or dispersed. While I recognise that the Metropolitan police Commissioner must do as he fit with his own force, may we have a statement next week to reassure the House that, whatever the future of the obscene publications branch is, police action against that vile trade will go on unabated ?

Mr. Newton : I am not sure that we would need a debate to establish that. I thought that my right hon. and learned Friend the Home Secretary made it extremely clear during our recent proceedings on the Criminal Justice and Public Order Bill and, indeed, I made the point during business questions last week, that any adjustment of the police arrangements will be certainly intended to improve, rather than to diminish, police efforts in that area.

Mr. Terry Lewis (Worsley) : May we have an early debate on the funding of the Commonwealth War Graves Commission, which would give hon. Members an opportunity to argue with Ministers about the grotesque cut in funding for this year against a background of the £85 million being spent on tarting up the Foreign and Commonwealth Office ?

Mr. Newton : Perhaps the right course for me would be to bring the hon. Gentleman's question to the attention of my right hon. Friends.

Mr. Alan Duncan (Rutland and Melton) : Has my right hon. Friend received a request for the use of an Opposition Supply day to debate the Labour party's proposals to abolish the assisted places scheme ? Given that any such proposal would destroy the hopes and aspirations of tens of thousands of children from less well-off families, is not it important that we should have the opportunity to debate it ?

Mr. Newton : Unhappily, the chances of getting the Opposition to take a Supply day to do that must be rather slim. My hon. Friend, with a little ingenuity, might squeeze that matter into Tuesday's debate on the Education Bill.

Mr. Andrew Faulds (Warley, East) : Would the right hon. Gentleman listen to, and respond to, the many requests to discuss a number of issues relevant to foreign affairs, including the urgent need for the House to debate, discuss and tear to pieces the Foreign Affairs Select Committee's report on relations with China which is full of inadequacies and inaccuracies, and which must be discussed before much more damage is done to our relations with that very great country ?

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Mr. Newton : The hon. Gentleman adverted to that latter point last week, and I made some suitably cautious comments at the time. I always listen to the requests that are made, but I accept that I am not always able to respond as people would wish. I genuinely will look at what the hon. Gentleman has said.

Mr. Gyles Brandreth (City of Chester) : Could my right hon. Friend find time for a debate on the national health service beyond London, particularly in relation to early-day motion 1037 ?

[ That this House views with contempt the renewed attempts by the Labour Party to spread needless anxiety amongst patients by repeating unfounded scare stories about the National Health Service, and considers this latest attempt, led by the Right honourable Lady, the Deputy Leader of the Labour Party, to be particularly loathsome as it is designed to frighten older people into believing that they will no longer receive the treatment they need ; welcomes the fact that, in both the cases used by the Right honourable Lady for Derby South, alternative packages of care were available but notes with regret that she has neither withdrawn her disgraceful allegations or had the decency to apologise to any older people who may initially have believed her ; further notes that the NHS reforms continue to bring important improvements to patient care particularly for older people ; and welcomes the Government's commitment to the NHS by providing ever increasing resources for a service that will continue to be available on the basis of clinical need regardless of the ability to pay. ]

We could then explore how the NHS reforms have now delivered 116 patients being dealt with this year for every 100 patients dealt with before the reforms were introduced.

Mr. Newton : I acknowledge that those points may not be as widely known as we should like and I am grateful to my hon. Friend for seeking further opportunities to make them known. Should he catch your eye, Madam Speaker, they may be in order during today's debate.

Mr. Paul Flynn (Newport, West) : When may we have a debate on the admission yesterday by the Secretary of State for Social Security that at least 2 million people in Britain will have lost out by taking out personal pensions ?

Mr. Bernard Jenkin (Colchester, North) : He did not say that.

Mr. Flynn : They were bribed and conned by the Government, who introduced those pensions and robbed the national insurance scheme of £3 billion by persuading people to take out personal pensions that will leave them in poverty in their old age. May we debate especially the personal involvement in that legislation of the Prime Minister and the Leader of the House ? Would the Leader of the House find his role in that matter difficult to defend ?

Mr. Newton : No, I would not, especially given the many millions of people who have clearly benefited from, and appreciate, the opportunities provided by the development of personal pensions. The hon. Gentleman is becoming a rival to a previous Front-Bench spokesman on that issue, the hon. Member for Oldham, West (Mr. Meacher), whose persistent overstatement undermined the case that he sought to make.

Mr. John Austin-Walker (Woolwich) : Will the Lord President reconsider his earlier statement on the position in

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Southwark, in the light of information that the matter has come to light as a result of investigations by that council, which were notified to the Home Office in December ? Will he arrange for the Home Secretary to explain to the House why it took him five months and until a week before the local elections before taking any action ?

Mr. Newton : I am certainly grateful for that further intelligence. I am glad to say that I do not have to follow, in day-to-day detail, the affairs of the London borough of Southwark, but I shall draw that point, along with the earlier ones, to my right hon. and learned Friend's attention.

Dr. John Reid (Motherwell, North) : Although I welcome an early debate on the Army--while we still have one--would it not be a good idea to discuss specifically those who work in the defence industry ? For instance, is the Leader of the House aware that, this morning, the workers at ROF Chorley presented a petition with more than 20,000 signatures ? That symbolises not only the concern of workers in the defence industry throughout the country but their disgust at the fact that the Government have no plans to assist people who always came to the country's assistance in an emergency. May we have an early debate so that the Government can abandon their non-intervention policy and pursue a policy of helpful defence diversification ?

Mr. Newton : The hon. Gentleman's suggestions about the Government's attitude to that matter would not bear the weight that he seeks to give them. The Government are always anxious to be as helpful as they can to people trying to cope with the effects of change. They have done much to build up the country's manufacturing base in various ways.

Mr. Nick Ainger (Pembroke) : May I draw the attention of the Leader of the House to early-day motion 1111 ?

[ That this House is appalled that the Pembrokeshire National Health Service Trust is making 55 staff redundant immediately and that a further 45 staff may face the sack in the near future ; notes that the management has told the honourable Member for Pembroke that these redundancies are a direct result of the Welsh Office refusing to fund a 2.9 per cent. pay rise rightly awarded to nurses, midwives and doctors and that these support-job losses will ultimately have a detrimental effect on the quality of patient care in Pembrokeshire, contradicting the statement made by the Secretary of State for Wales on Monday 25th April that there would be no impact on patient care ; and therefore calls on the Secretary of State to ensure the House is not misled and to fund the 2.9 per cent. pay rise throughout Wales to prevent mass redundancies throughout the NHS in Wales and to prevent any deterioration in the standard of care received by patients.] It deals with the proposed 100 redundancies at the Pembrokeshire national health service trust. There is a contradiction between what the management of the NHS trust says will be the impact on patient care and what the Secretary of State told me in answer to an oral question on Monday. May we have a debate not just about the Pembrokeshire NHS trust and its impact on patient care but about the position throughout Wales and the fact that the Welsh Office has not funded the 2.9 per cent. pay rise that was rightly awarded to nurses, doctors and midwives ?

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Mr. Newton : In accepting fully the recommendations of the pay review body, the Government have always looked to the national health service to fund those pay increases through improvements in efficiency and productivity so that the extra money announced for the NHS as a whole can go directly into patient services. The reductions in staffing levels are a matter for the trust, and the trust's priority remains to sustain high- quality patient services.

Mr. Peter L. Pike (Burnley) : Recognising the loss incurred by thousands of pensioners in the former Belling pension fund as a result of the fraud committed by the former Belling directors, will the Leader of the House urge the Secretary of State to tell the House that his Department will give maximum assistance to such pensioners to minimise their loss, resolve the problem and ensure that such frauds can never be repeated ?

Mr. Newton : The hon. Gentleman knows of the action that my right hon. Friend the Secretary of State took to assist Maxwell pensioners, especially in the early stages before so much was done to recover the money. He also commissioned the Goode report, which he is now examining with a view to bringing forward proposals. I do not think that my right hon. Friend can be accused of anything other than having taken the problems seriously.

Points of Order

Mr. David Trimble (Upper Bann) : On a point of order, Madam Speaker. I wish to return to a familiar problem in relation to Northern Ireland questions. As you know, security in Northern Ireland is probably the most important issue for the people of Northern Ireland, especially as there have been eight murders in the past week. Unfortunately, due to the order and run of questions today, no hon. Members on this Bench--we represent the largest party in Northern Ireland--had the opportunity to comment on the situation.

It is particularly unfortunate as certain parties in Northern Ireland allege that there is a selective condemnation of events, and silence from this Bench will be seen by them as a lack of concern for some of those atrocious murders. Might it be possible to look yet again at the way in which questions are selected to ensure that Northern Ireland Members are given a fair opportunity ?

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Madam Speaker : Hon. Members on the hon. Gentleman's Bench might like to table substantive questions on the issue that he has just raised. Looking at the Order Paper, I see that five Members on his Bench were called on the first seven questions.

Mr. Max Madden (Bradford, West) : On a point of order, Madam Speaker. I wish to ask you for your advice. You will have heard a few moments ago the Leader of the House refer to a paper that has apparently been issued by the hon. Member for Liverpool, Mossley Hill (Mr. Alton). The Leader of the House went on to criticise that document severely. Would it be in order for me to table a question to the Leader of the House in his capacity as Lord President of the Council asking him to place a copy of the document in the Library so that all hon. Members can form a judgment on its content ?

Madam Speaker : If the hon. Gentleman wants procedural advice he should not ask the Chair. If he wants to table a parliamentary question, he can seek the advice of the Table Office.

Mr. Peter L. Pike (Burnley) : On a point of order, Madam Speaker. I raise this point of order merely to ensure that no mistake occurs in the Official Report in relation to the question that I asked a few moments ago of the Leader of the House. I was not referring to the Maxwell pension fund, but to Belling--a quite different matter.

Mr. Newton : Further to that point of order, Madam Speaker. I apologise to the hon. Gentleman if I misheard and misunderstood the case to which he referred, and then responded according to that misunderstanding. I will ensure that my right hon. Friend the Secretary of State sees the comments of the hon. Gentleman and responds to them.

Ms Liz Lynne (Rochdale) : On a point of order, Madam Speaker. Is it in order for an hon. Member to be named without being previously informed-- I refer to my hon. Friend the Member for Liverpool, Mossley Hill (Mr. Alton) ?

Madam Speaker : When there is an opportunity, it is customary and courteous to inform the hon. Member to whom reference is to be made. As the House knows, I deprecate references to hon. Members if they have not been notified and the reference to them is intended.

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Opposition Day

[11th Allotted Day]


National Health Service (London)

Madam Speaker : I have selected the amendment in the name of the Prime Minister.

4.13 pm

Mr. Frank Dobson (Holborn and St. Pancras) : I beg to move, That this House condemns the policies of Her Majesty's Government which are undermining the capacity of London's health service to care properly for all patients both from London and outside, to provide satisfactory training opportunities for doctors and nurses, to secure reasonable working conditions and job prospects for staff or to make adequate provision for research into improved care for patients and the promotion of good health.

Mr. Richard Tracey (Surbiton) : On a point of order, Madam Speaker. We are about to embark on a debate on the health of Londoners--a matter of great complexity--on an Opposition motion. How is it, then, that today's debate is to be led by the Opposition spokesman on transport ? Surely that is an affront, and deeply offensive to Londoners.

Madam Speaker : As the hon. Gentleman is fully aware, that is not a matter for me, but it is an issue which could be raised in the debate.

Mr. Dobson : I start by declaring an interest. My family and I use our local hospitals. Our three children were born at the Middlesex hospital. They have since received accident and emergency treatment and in- patient treatment at University College hospital. One has received treatment at Great Ormond Street hospital. My wife has had both minor and major operations at the Elizabeth Garrett Anderson hospital, and I have been treated for minor injuries at both the Middlesex and UCH hospitals.

We have been fortunate in the care provided by our general practitioner at the Covent Garden medical centre, by health visitors and by the schools health service. We have been well served by the national health service in our area, and we want to see the same standard of service continue for everyone.

All is not well with the health service in London--not even Ministers can deny that. Never since the establishment of the national health service have Londoners been so concerned about what is happening to their health service, and they are right to be concerned.

The ambulance service is not working.

Mr. Simon Burns (Chelmsford) : Will the hon. Gentleman give way ?

Mr. Dobson : I will give way, but I should warn hon. Members opposite that, on the last occasion that I opened an Opposition day debate about health, every Tory who intervened during my speech, bar one, lost his seat in the subsequent election.

Mr. Burns : I am extremely grateful to the hon. Gentleman for that warning. The day the Labour party wins my seat is the day that pigs fly.

Will the hon. Gentleman consider for one moment that, given the increase in spending on the health service, his

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party may be partly to blame for Londoners' concerns about health, because his party spends day after day maliciously running down the tremendous work of nurses and doctors and improved medical care in London ?

Mr. Dobson : All I can say is that if the hon. Gentleman thinks that our campaigning and propaganda is so effective that we alone have managed to stir up Londoners, I hope that we are equally successful in every other sphere.

The ambulance service in London is not working properly. Hospital beds are being closed and whole hospitals are threatened with closure. Newly built wards are being kept empty and staff have been told to hold back on operations so as not to exceed their budgets. Doctors and nurses are made redundant, while hospital waiting lists are the longest ever recorded.

Scarcely a day goes by without reports--which appear frequently in the Evening Standard --of patients turned away from hospital, of people who cannot get out-patient appointments, of sick patients left waiting on trolleys all night because beds cannot be found, of elderly patients lost in a hospital, and of the ambulance service in chaos because its computerised command system does not work. Health Ministers have a range of responses to these problems : "It didn't happen," "It's all scaremongering," or "It did happen and we are very concerned, but it's someone else's fault and we'll set up an inquiry."

Mr. Gyles Brandreth (City of Chester) : Will the hon. Gentleman give way ?

Mr. Dobson : I will continue for a moment.

Only a few days before the total collapse of the London ambulance service's computer system, Health Ministers were telling the House that the problem was a behavioural matter with the staff rather than a technical matter with the computer. They said that an inquiry would serve no purpose. Five days later, the system collapsed and they had to set up an inquiry.

Never once have Ministers accepted any responsibility for what has happened to the health system. They have never once said that they got it wrong and that they are sorry. They pretend to a day-to-day infallibility which the Pope does not claim. Worse than that, they say that London is getting more than its fair share of health service resources, and that they will have to be cut.

Mr. Iain Duncan Smith (Chingford) : Will the hon. Gentleman give way ?

Mr. Dobson : I will make a little progress first, if the hon. Gentleman does not mind--he should bear in mind my warning. We must not blame the Secretary of State for the situation. The crisis in London's health service is a product of policies supported by the whole Cabinet. The Secretary of State has inherited policies originally introduced by the present Chancellor of the Exchequer. She has been left to pursue her search and destroy operation against London's hospitals--an operation which is the inevitable consequence of unleashing market forces inside the national health service at the same time as restricting the funds made available to would-be purchasers in the market. She has also had to try to reconcile the long-term strategic health care needs of Londoners with the--inevitably short-term--operations of that market.

I offer the House an example from my constituency. University College hospital and the Middlesex hospital are

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to be merged--that is quite right--and so are their medical schools. The total number of hospital beds in my area has been halved in the past dozen years, from over 2,000 to just over 1,000. This is a costly process and, until it has been completed and things settle down, costs inevitably will remain high.

The Secretary of State has said that, for strategic reasons, because its location offers such ease of access from all directions, the UCH accident and emergency department must be kept. The undergraduate medical school is rated the best in the country. The Government's specialty and research reviews give UCH top ratings, so anyone might reasonably expect the hospital to be safe.

The hospital is not safe, however, because the underfunded local health authority says that, to save money, it will have to send its patients for cheaper treatment further afield--in clear breach of the promises made by the right hon. and learned Member for Rushcliffe (Mr. Clarke) in 1990 about the right of GPs and patients to choose where the latter are treated, and about patients not being forced to travel further for treatment.

Several hon. Members rose

Mr. Dobson : I give way to the hon. Member for Chingford (Mr. Duncan Smith), who I believe represents a London seat.

Mr. Duncan Smith : Perhaps the hon. Gentleman could get us off on the right track, first by telling the House how much is spent per patient in London, and secondly, if Labour ever came to power, how much more per head would be spent.

Mr. Dobson : If the hon. Gentleman bides his time, he will hear some comparative figures for hospital spending in London and elsewhere.

The Government claim that London is over-provided with hospitals, so they propose more bed closures and hospital closures in London on top of those that they have forced through already. They say that this will not harm patients : that they are improving primary care instead. Let us examine those claims.

Does London get more funding than it is entitled to ? The answer is no--not if we make allowance not just for the size of London's population but for the health needs of the population served by London's health services. For a start, London provides services--often the most expensive--for large numbers of patients from outside the capital. About 120,000 patients a year --10 per cent. of all patients treated in London district hospitals, and almost a third of those treated by special health authorities--come to London.

London has nearly 7 million people, 15 per cent. of the population of England. It has 1.1 million pensioners and about 1 million people who are poor enough to qualify for income support or family credit. In recent times, London's unemployment rate has been higher than the national average. Indeed, inner London has double the national average unemployment rate, twice as many one-parent families and three times as much overcrowding and poor housing.

Inner London's mortality rate is 25 per cent. above the English average. Three quarters of all AIDS cases are to be found in the Thames region, most of them in London. Almost the same figure applies for reported HIV infections. About one third of all drug addicts notified to

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the police are in London, and there are more than twice as many of them, per million people, as there are in the rest of the country. Mr. Ian Taylor (Esher) rose

Mr. Dobson : I am trying to answer the question I have been asked. Last year, the Secretary of State said :

"We spend some 20 per cent. more per head in London than elsewhere."

That is not true, if London is compared with other big cities, and in the case of family health services it is just not true at all. Average spending per patient on family health services in England is £132 a year ; in London, it is only £124.

Comparing total health spending per head in London with spending in other big cities, London, on £584 per person, comes after Manchester, on £791, Newcastle on £649 and Liverpool on £629. Those figures must be right ; they were provided in an answer by the Minister who is replying to the debate. But that is not the whole story. Almost everything is more expensive to provide in London because of land prices, rents and London weighting of pay. For example, policing in London is the sole responsibility of the Home Secretary ; he is the police authority for London. London, with 15 per cent. of the population of England, gets 29 per cent. of the total spent on policing the whole of England. If the cost of the NHS in London in terms of land prices, rents and London weighting were similar to that of the Metropolitan police, the NHS in London could expect almost one third of the national total ; but it does not get it.

Present figures suggest that London's share has fallen below 17 per cent. Today, the King's Fund, which has taken a hand in helping along the Government's rundown of health services in London, said that London merits a larger, not a smaller, share of the national cake. It suggests the sum of around £200 million.

Several hon. Members rose

Mr. Ian Taylor : On a point of order, Mr. Deputy Speaker. Would it not be in order, when some of us who seek to intervene have constituents in and around London, for the hon. Gentleman to give way so that we can get some common sense to him ?

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : The hon. Gentleman knows full well that it is not a point of order for me, but a matter for the hon. Gentleman who is speaking.

Several hon. Members rose

Mr. Deputy Speaker : Order.

Mr. Dobson : Since they came to power, the Government have relentlessly based their policies on the belief that London is overprovided. In 1979, there were 31,376 acute hospital beds in London. Today, there are just 17,181--a drop of 45 per cent. It is a truly gigantic reduction, yet Ministers claim this has not harmed patient care. That is difficult to reconcile with the fact that, over the same period, the waiting list for London hospitals has increased from 104,000 to 165,000, despite various administrative efforts to stop people getting on the waiting lists, and various administrative culls for those already on them.

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More than 75 hospitals in London have already closed ; 16 or 19 more are threatened, including Guy's and Bart's, University College hospital, Middlesex hospital, the Elizabeth Garrett Anderson hospital for women, Hammersmith hospital, Charing Cross hospital, Edgware general hospital, Barnet general hospital, Oldchurch, Queen Mary's Roehampton, Dulwich and Hither Green. I do not have time to name them all, not even the others in my constituency.

Mr. John Marshall (Hendon, South) : On a point of order, Mr. Deputy Speaker. Is it in order for an hon. Member to suggest that a hospital is to be closed when it has been made quite clear that that hospital will not be closed ?

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