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Sir Teddy Taylor (Southend, East): Is not it grotesquely unfair for the Opposition repeatedly to attack my wife for being appointed to a trust when she has spent all her life working in the health service and did a great deal of service for no payment in the Southend health authority and whom I met when I was taken to Westminster hospital as one of her patients? Is the right hon. Lady aware of anything inadequate about her qualifications for chairing a trust? Is she aware of anything inadequate in the record of the Southend community care trust? Is not it dirty and unfair to mention my wife's name repeatedly when she has had no job other than working in the health service as a fully qualified person?

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Mrs. Beckett: I am not attacking the hon. Gentleman's wife as an individual or her expertise. I did not know her background, but now I do. I named her because she is one of a string of known Conservative party members and supporters appointed to boards. It is an indication of the way in which the structure of the health service is being packed with people who, whatever their other expertise and experience, are Conservative party supporters. The hon. Member for Southend, East must be well aware that the vast majority of them have no experience in the health service.

The Minister for Health (Mr. Gerald Malone): Will the right hon. Lady give way?

Mrs. Beckett: No, I have not finished.

There would be nothing wrong with people such as the hon. Gentleman's wife having a place on these trusts were they balanced by people of similar experience from right across the community. There would be nothing wrong if people who had that knowledge, expertise and understanding were much more widely represented on the boards. If the hon. Gentleman's wife has any sort of medical or health service background, she is one of a tiny percentage-- between 4 and 6 per cent. We are attacking not the individuals but the nature and overall composition of the boards and the Secretary of State's decisions about the people she puts on them.

Mr. Malone: The right hon. Lady cannot have her argument two ways. She refers consistently to the wives of hon. Members and then concedes that they are perfectly well qualified to serve on boards. Will she undertake to the House that she will stop referring to them in the future? That would be the decent thing to do.

Mrs. Beckett: The Minister is missing the point, no doubt deliberately. My point is not that these are people with or without expertise in the health service. My point is that the only people appointed to serve on these boards have a known political allegiance or have no knowledge or understanding of the health service.

Mr. Malone: The only people?

Mrs. Beckett: Not the only people but the vast bulk of them. There is a tiny number of people of a different political persuasion. There is a sprinkling of Liberal Democrats and a slightly larger sprinkling of members whose political orientation is towards the Labour party. The Minister knows perfectly well that what we are saying is true. He knows, too, that this information has had to be dragged out of the Government inch by squealing inch. He knows that the boards are packed with people who can be relied upon to do the Secretary of State's bidding. If the Government have so little to hide why have not they been prepared to publish these lists until we dragged the information out of them?

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Sir Teddy Taylor rose --

Mrs. Beckett: With respect to the hon. Gentleman, I want to go on to a different point. I have sympathy for him, but he has made his point.

Sir Teddy Taylor rose --

Madam Deputy Speaker (Dame Janet Fookes): Order. If the right hon. Lady is not giving way, the hon. Gentleman must resume his seat.

Mrs. Beckett: I would give way to the hon. Gentleman if I had not already done so.

As my hon. Friend the Member for Darlington (Mr. Milburn) has revealed in a survey, almost £20 million a year is being spent by the national health service on payments for these chairmen and non-executive directors of trusts. This morning on the "Today" programme the Secretary of State was sniffy about our concern over these issues. If I recall correctly she said that they were receiving "insubstantial sums". Well, I recognise that for people in the position of some of the directors involved, the sums they receive--£15,000 or £20,000 for the chairman of a trust--may not be regarded as substantial. I remind the Secretary of State that although a non-executive director on a trust can hope to earn £12 an hour for an eight-hour week working for that trust, a nurse on the middle range of pay can expect to earn £5.79 an hour for a long 40-hour week. Although it is claimed that everything about the appointments has been open and above board, we all recognise that that is not the case. If declarations of interest were made initially, they were certainly unpublished and had to be dragged out of the Government by my hon. Friends who preceded me in this post. Now that they are being published, we see how little experience of and contact with the NHS some board members have had and we are starting to see some more direct conflicts of interest. The chair of Trent regional health authority, which covers the area that I represent, is a board member of a company called Takare plc, the business of which is nursing homes. Therefore, it has a direct financial interest in reducing the role of the national health service.

My predecessor wrote to the Secretary of State, who was too busy to reply. One of her junior Ministers replied, shrugging off the concern. The Minister offered not his own view about whether there was a conflict of interest but said that Mr. Ackroyd believes that "there is very little risk of any conflict of interest arising between his position as Chairman of Trent Regional Health Authority and as a Director of Takare".

He would say that, wouldn't he? I have heard that before. In that context, the Government's announcement that they will finally respond to demands from the Opposition and set up some sort of independent body to review and monitor standards in public life is welcome, but it remains too little, too late. It is not clear to me that it will address, or that there are other steps to address, the questions that I put to the Secretary of State this morning. We want to hear from her whether the Government propose to establish a central register of quangos so that we know of all the bodies that exist. We want to know whether the Government propose to establish a register of the names of every board member of each quango and the qualifications of those members for board membership. We want to know whether the Government intend that the same

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standards as apply to surcharge and other safeguards in local government will apply to quangos, because, even more than local government, these bodies are involved in the use of public money and it is right that they should be dealt with in the same way. The Secretary of State sometimes seems to imply that because, by the standards of those involved, the money is so slight, it does not matter that it goes overwhelmingly to people involved with the Conservative party. Although she tries to pretend that there is no real problem, the Government have already made some changes in the way that the matter is handled by insisting that interests are declared. Today, it appears that perhaps they are making more. The concern that is reflected in those changes is felt much more widely outside the ranks of the Government than they sometimes recognise. The Conservative leader of Wandsworth council, in putting forward a proposal opposing the closure of Queen Mary's hospital in Roehampton said that

"health care decisions are too important to be left to unelected quangos."

I did not think that I would ever agree with the Conservative leader of Wandsworth council. Clearly, today is a first.

Apart from the accountability of public money, we are concerned about its use. We want to see the money used in the front line to provide the maximum and best possible patient care. Under the Government's waiting list initiative, trusts are being encouraged to use the private sector even though the cost of treating patients there is, on average, £1,552, which is more than five times the cost in the NHS. For a high level of psychiatric care the national health service cost is on average £46,000 a year whereas, according to the National Schizophrenia Fellowship, some private hospitals are charging £70,000 or £80,000 a year for similar care.

Of course, those are rough and ready approximations. However, there seem to be some strange exceptions to the pattern. For example, the Health Care International hospital in Clydebank has received £40 million of public money, which has doubled from an initial estimate of £20 million, and that was enough, to treat patients from beyond these shores and, it was claimed at the time, create 4,000 jobs into the bargain. That project, however, has employed only 400 people. I understand that, far from treating patients from overseas, as was intended, the hospital is treating patients from Birmingham and Manchester on a cut-price deal basis. I shall refrain from wondering whether the geographical origin of someone in Clydebank is a matter of concern. What really worries Opposition Members is the widespread rumour that such sums of public money have already been spent on a hospital that everyone in the locality concerned with health care said was an unnecessary investment and that the Government are coming under pressure to put in further public money to rescue a collapsed private sector initiative.

The Secretary of State keeps telling us how open, honest and transparent the Government are in their NHS policy, so I am sure that it is an aberration that the eight

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questions tabled by my hon. Friend the Member for Glasgow, Maryhill (Mrs. Fyfe) came back to her yesterday without a substantive reply on what is happening in relation to the hospital or the Government's intentions.

Mr. Dennis Turner (Wolverhampton, South-East): The Secretary of State is not listening.

Mrs. Beckett: I am sure that she does not wish to take heed of the question that I am directly putting to her. I hope that she will tell us that the Government have no intention of putting further public money into a purse that has already had far too much of it. The Secretary of State says that she has declared war on bureaucracy. It is obviously serious because she has taken on thousands of bureaucrats to help her fight it. There has been a 57 per cent. increase in the number of practice managers, but the number of general practitioners has decreased. The number of health managers has tripled, so we have a huge standing army of non-medical staff being paid large sums of money to think up new ways of saving money. I can provide the Secretary of State with one new way of saving money without any difficulty. The Government should abolish tax relief on private health insurance. If they did that, £85 million could be available at a stroke. That would go a long way to restoring free eye and dental checks, which would be of far greater value to most of the British public.

In 1989, there were 4,540 managers in England, whereas in 1993 there were 20,000. Manager numbers are rising by 13 per cent. a year, but the number of nurses is falling by 1 per cent. a year. Department of Health expenditure on management consultants totalled £20 million in the days before this permanent revolution, but it was £66 million in the last reported year of 1993. It is being suggested that the cost of local pay bargaining that is under consideration could run to an extra £40 million in new bureaucracy. The Secretary of State's permanent revolution has led to an explosion of bureaucracy and waste, which is associated most directly with trust management and with GP fundholding.

I see the Secretary of State, presiding as she does over this permanent revolution, as the Madame Mao of the health service. She attacks the authority of medical staff. She banishes or sacks people who disagree with her. Parliament and the public have to seek information through a system of Chinese whispers. She turns for support to the now highly politicised managers of the health service--a group of involuntary Red Guards who are obliged blindly to follow the dogma of the internal market. Increasingly paranoid, she and her Ministers treat the medical profession as conspirators and as harbingers of counter-revolutionary values, rejecting their advice and tossing aside their experience and judgment.

Despite what the Secretary of State said at health questions, it is known that gagging clauses are widespread in contracts issued by health service trusts and that people who dare to speak out risk disciplinary action. Evidence has been found of telephone bugging. All hon. Members hope that that was an exception. As Dr. Brian Boughton, a senior consultant of the South Birmingham health authority has observed, there is now a climate of fear among staff in the health service and especially among those staff who are critical of the effects of Government policy on patients. In a rather sinister phrase, he told The Birmingham Post that

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"these people are being removed from the scene."

That was certainly the experience of Ian Mahady, the clinical director of obstetrics at Burnley general hospital. He is a highly respected and experienced senior consultant who happens to be critical of the Government's reforms. He was sacked and asked to clear his desk within three hours.

The proposal for performance-related, locally determined pay is another step in the permanent revolution, which, against this background, can be guaranteed only further to weaken morale. We hear that Ministers have had to put those plans on ice because the national health service trusts announced that they were not ready for the move. It is clear yet again, and particularly clear if that was the reaction of the trusts, that the proposal has been bandied about without thought or consideration, let alone debate.

The chairman of the Federation of National Health Service Trusts, Rodney Walker, has said that managers are confused and uncertain and that

"it is one thing for Government to set the agenda and say there you are then, but it is a quite another to embark individually from scratch on such a profound course."

That was yet another criticism from someone who was trying to make the Secretary of State's changes work and an example of what is happening in practice.

Perhaps the most succinct critique of the Secretary of State's role came from the Daily Express , normally a slavish supporter of the Government. An editorial written during the Conservative party conference deplored the brutality with which the Secretary of State was destroying our health service. It stated:

"We don't want our centres of excellence, our Guy's and Bart's hospitals, chopped up and sown together again under some new name which satisfied the demands of Virginia's managers on tightening up resources . . . Imagine the uproar if she were to become Education Secretary and decide to do away with Oxford and Cambridge." [Interruption.]

No heckling please.

The editorial continues:

"The NHS is not about numbers. It's about people and people don't want managers to decide where and when they are going to have their hip operations. They want doctors and nurses and hospitals near to where they live, where staff are not too tired and overworked to give them the treatment they deserve."

We want the outcome of the debate to be that the Secretary of State and her colleagues stop tinkering with our health service and start listening. They should stop repeating bogus statistics about the number of people treated, like some demented mantra, believing that, if chanted long enough, it will ward off evil reality. The Secretary of State knows that episodes of consultant care are distorted by patients going for an operation from one ward, coming back from it to another and being counted twice. The figures mean nothing and the Secretary of State is aware of that.

Opposition Members ask the Government to start listening to passionate words like those of Dr. Macara of the British Medical Association. The Government must hear these things, but they seem to go in one ear and straight out the other. Speaking about our health service last July, Dr. Macara said:

"There is despair in the air today. There is despair about the mood of alienation and demoralisation in the NHS."

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He goes on to say:

"Co-operation has been supplanted by commercial competition. There is an uncontrolled ill-managed internal market pitting purchaser against provider, fund-holding GP against non-fund holding GP, GP against consultant, junior against senior, hospital against hospital, and all to serve a perverse philosophy of winners and losers . . . Money does not follow the patient"--

the Government's justification for the changes--

"the patient has no choice but to follow the money until it runs out."

Later in his remarks, he says that

"we must all face the facts. Government must acknowledge that their huge national experiment', as the new Chief Executive of the NHS has described it, has failed them and failed the nation." Opposition Members oppose both the commercialisation and the fragmentation of our health service. Since the NHS trusts and GP fundholdings are agencies of fragmentation, we oppose them and wish to see them replaced. Like the British people, we reject the drift towards privatisation and we are appalled at the attitudes that it is already engendering--attitudes such as that revealed in July concerning the business plan for Charing Cross hospital. When that hospital decided to try to poach the leading consultant from the Royal Marsden, Mr. Nicholas Breach, one of the criteria taken into account was that that act would

"assist in destabilising a competitor."

What kind of attitude is that in a health service that is supposed to be providing patient care? I will tell the Secretary of State--it is an attitude fostered by everything that the Government have done by introducing their reforms.

We are engaged in the process that the Government have shirked; a process of thorough and lengthy consultation, which includes representatives of patients and staff at every level. When our consultations are complete, we will come forward with proposals to re-establish a health service that can provide access to treatment on the basis of medical need rather than ability to pay. We will re-establish a health service that is available in every part of Britain because that is what the British people expect of our national health service and what this Government have put at risk. We in the Labour party created the NHS and that is why we can be trusted to modernise it, but only a new Labour Government can give Britain the new health service that it needs.

5.10 pm

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:

notes that since the introduction of the Government's health reforms the number of patients treated has risen, waiting times fallen and quality of care improved; welcomes independent support for the reforms from sources such as OECD; and calls upon Her Majesty's Government to continue policies which uphold the values and ethos of the NHS, further reduce administrative duplication and waste and deliver a flexible service able to respond to the changing needs of patients.'.

I warmly welcome the right hon. Member for Derby, South (Mrs. Beckett) to her new responsibilities. I must say that the literature does not bulge with her previous utterances on health. The best that can be said of her speech today is that she was making up for lost time. The second best thing that can be said is that she has been

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given her new job as an essential political sweetener, as Barbara Castle might have described it, for the trade unions.

True to form, as Opposition Members will soon realise, the right hon. Lady, sponsored by her trade union, spoke at length about staff, but spoke not once about patients. That is always the case with Opposition Members who are sponsored by people who work in the railways or in the health service. Those hon. Members are blinkered to the needs and interests of patients.

Ms Hilary Armstrong (Durham, North-West): Will the right hon. Lady give way?

Mrs. Bottomley: I should like to make some progress, but I shall then happily give way.

I had hoped that today might have proved third time lucky, because as long as I have been at the Department of Health there have been three Labour party spokesmen on health. I kept hoping that the Opposition might offer a policy, but from what we have heard today they are off consulting again. It is a great tragedy, however, that the right hon. Member for Derby, South did not take the opportunity here and now to say that she supports trusts and recognises their work and the fact that they are doing good for patients. It was her predecessor but two, the hon. Member for Livingston (Mr. Cook), who said that he did not believe that trusts would treat more patients. That was the test that he set at that time and they have passed it, because they are treating more patients than the numbers treated under the old system. Let me give the right hon. Lady a small piece of advice: she should take the opportunity to modernise the health service, accept the world in which we live and support the trusts and the work that they are doing.

The right hon. Lady began by challenging the Government's commitment to the NHS. Perhaps I could remind her of some facts. Under the Government, NHS spending has risen from £7 billion to £37 billion, a 64 per cent. increase. That is a remarkable figure. More than that, a new multi-million pound hospital project has been completed, on average, once every eight days.

The right hon. Lady wondered how anyone with any experience of the construction industry could have any part to play in a trust. Let me tell her the answer. Because we have one of the largest capital and building programmes of any organisation, we certainly need people with skill and expertise in the construction industry.

Ms Armstrong: On that specific point, is the right hon. Lady aware that patients and prospective patients in my constituency are now facing the worst of all worlds with the rundown of their hospital at Shotley Bridge? Now her Government have delayed the building of a new hospital, which, in any event, is 14 miles away, because they have said that private companies must make a successful bid to plan, build and manage all but the core services of that new hospital. That will inevitably lead to a delay of at least a year and, in the meantime, the trust has said that services at Shotley Bridge must continue to be wound down. Is that looking after patients and their needs?

Mrs. Bottomley: I regret that I gave way to the hon. Lady at that moment, because I shall address later that precise issue of the private finance initiative and the

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importance of considering that option. It would be better to deal with it at that stage in my speech rather than at this particular moment.

Mr. Keith Mans (Wyre): The hon. Member for Durham, North-West (Ms Armstrong) will have to sit there and wait.

Mrs. Bottomley: Indeed.

I must ask the right hon. Member for Derby, South to consult her sources again because in the past 10 years alone 8,000 more hospital doctors and dentists have been employed as well as 3,000 more general practitioners--a dramatic increase in their number--and 18,000 more qualified nurses. Let me remind her that while her party cut the pay of nurses and doctors, we have paid nurses 65 per cent. more in real terms and doctors 35 per cent. more. We are proud of our record because it contrasts and compares extremely well with that of any other previous Government.

Above all, I remind the right hon. Lady that that investment has been generously repaid by results. Our policies have delivered a handsome dividend of better health, longer life and higher quality care. Since 1979, life expectancy has gone up by more than two years. In the past 10 years, the number of children dying at birth or within the first year of life has fallen by two fifths and the number of people dying under the age of 65 has fallen by one fifth. Those are dramatic achievements.

Mrs. Barbara Roche (Hornsey and Wood Green): Does the right hon. Lady agree that that handsome dividend has been paid just to the private sector? In my local health authority, New River, to date more than £500,000 has been paid to the private sector because there are not enough beds for mental health in-patients in the NHS. As a result, 79 of those patients have been sent far away from their homes. The beneficiaries have been, once again, those in the private sector.

Mrs. Bottomley: What we see from the Opposition is their virulent loathing of the private sector. For all the eau de nil, the modern Labour party style and the Opposition's apparent belief in a mixed economy and working with the private sector, they are obsessed with the ownership of the means of production. That is the only issue that matters. It is the clause IV mentality. It is not a coincidence that Unison sponsored the health debate at the Labour party conference and that Unison voted to support clause IV. It is no coincidence that the right hon. Member for Derby, South is sponsored by a union that wants to retain clause IV. At heart, that is the issue for the Labour party, but the issue that we mind passionately about is benefits for patients. We are proud of all that we have achieved for patients. We are proud that the average waiting time has halved--

Mr. Paul Boateng (Brent, South) rose --

Mrs. Bottomley: I am still replying to the hon. Member for Hornsey and Wood Green (Mrs. Roche), but I would be happy to give way to the hon. Member in a moment.

We are proud of the increase in the number of community psychiatric nurses. We are proud of the improvements in services that are now taking place. Today is a

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good day for the NHS, because new figures from the Government's statistical service show that in the past year alone- -

Mr. Tom Clarke (Monklands, West): Will the right hon. Lady give way?

Mrs. Bottomley: If the hon. Member will allow me to complete my sentence, I shall then give way.

Only today, new figures from the Government's statistical service show that in the past year alone, NHS hospitals treated an extra 455, 000 patients. That is a 4.7 per cent. increase. It is twice the annual average achieved in the 1980s and five times the annual average increase achieved under the Labour Government. It represents a dramatic increase in the quality of care received.

Mr. Tom Clarke: The right hon. Lady touched on community care by referring to the number of psychiatric health visitors. How many persons are in prison in England and Wales, and what advice has she had from the medical units in those prisons?

Mrs. Bottomley: The hon. Gentleman will know that I cannot instantly tell him the number of people in prisons. However, I can tell him very strongly that, for more than two years, I have been saying that we should target resources and care on the severely mentally ill. I have also been saying that we need supervision registers, which are really mental health priority lists, to ensure that, with the great expansion in services for the mentally ill--that is a priority for the Department but also a personal priority--we shall ensure that those resources are focused on the most severely mentally ill. In co-ordinating the improvements and tightening up care in the community wherever possible, it is extremely important to co- operate closely with social services and the Home Office.

Mr. Boateng: On benefits to patients, is the right hon. Lady aware that in the Central Middlesex hospital trust, which is not alone, matters are now so bad that the trust charges patients and nurses for using the car park? The only people exempt from those charges are the managers, who have their own spaces. Is not that typical of the level to which she has now reduced the national health service--a service that cares only about money and managers?

Mrs. Bottomley: When the right hon. Member for Derby, South considers other health services, she will realise that the NHS is remarkable in its lack of charges. We have no charge to go to a GP or to hospital and few charges for prescriptions, and we have £100 million more than when the Labour party was in power. It is sometimes appropriate to charge for car parking, not least because many people use hospital car parks for a great number of purposes. Where that can result in further developments and improvements in health care, it makes a sensible contribution. I cannot confirm the precise arrangements at the hospital mentioned by the hon. Member for Brent, South (Mr. Boateng), but I should be surprised if managers uniquely had free car parking spaces. That would not have my support.

Mr. Rowe: In the long distant mists of time when there was a Labour Government and I was a civil servant working for them in Scotland, there was a hospital called

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Ninewells hospital, Dundee. In the absence of someone on the board who understood construction, it overran its costs by well over three times. When it was opened, all the consultants insisted on having named spaces in the car park. Those were removed after two months because they simply revealed how seldom they were there.

Mrs. Bottomley: My hon. Friend is absolutely right. My excellent Minister of State, who has experience north of the border, well remembers the example that he gives. It makes the precise point about why many of the appointments in the health service help us to develop our skills in sectors where, frankly, we have not always been as good as we should have been. We have first-rate doctors and nurses, but in many other sectors the NHS has not had the quality and calibre of expertise that we should have in an organisation that spends well over £100 million a day.

It may surprise the right hon. Member for Derby, South to know that the Conservative Members judge the NHS not by who is appointed to it but by the results. We take great pride in those results, which have come about following the reforms that we have introduced. We appoint people to health authorities and trusts for their ability to get the job done, whether they are the wife of the my hon. Friend the Member for Southend, East (Sir T. Taylor) or any other member of society. We want to get the job done and to improve the efficiency of the service and the quality of care to make services more responsive to patients' needs. Our excellent non-executives are helping the health service build on its already formidable record of efficiency.

Mr. Richard Burden (Birmingham, Northfield): As the Secretary of State is interested in results, does she consider it an acceptable result of the health service reforms that in Birmingham, at a time when hospital wards are being shut and beds being closed, heart patients are being asked to travel 300 miles to a private hospital in Glasgow, Health Care International? Do not people have the right to be treated in their own communities where their families can visit them?

Mrs. Bottomley: Once again, the hon. Gentleman has singularly failed to identify what really matters to patients, which is how long they wait. Patients want to be treated as soon as possible. Before the reforms, 200,000 patients were waiting for more than a year. That number is now down to 60,000. We said that we would bring an end to the two-year waiters; we did so. We then said that we would bring an end to the 18-month waiters for hip, knee and cataract operations; we have done so. Moreover, we have extended that 18-month guarantee across the board from next year. In the area where the hon. Gentleman lives, the health authority is going for a commitment of a maximum of nine months' waiting. I should have thought that he would pay credit to all those people who are leading the country and delivering a nine-month guarantee for new patients. Those patients are being offered an opportunity to have their heart operations sooner. If they do not want that, they need not do so. If I lived in that area, I would much rather take the opportunity of being treated than linger so that the hon. Gentleman could satisfy some ideological dogma.

Dame Elaine Kellett-Bowman (Lancaster): My constituents like not only a short waiting list but, if possible, a short stay in hospital. That applies particularly to

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women, as long stays in hospital disrupt their domestic arrangements. If they can go to a day hospital, they are absolutely delighted.

Mrs. Bottomley: My hon. Friend is absolutely right. I commend to my hon. Friend and the right hon. Member for Derby, South a recent article in the British Medical Journal about the dramatic change in health care, not just in this country but in every country in the world. The rapid advance of micro-invasive techniques, endoscopy, new scanning techniques and new medical treatments mean that people need not automatically put on their pyjamas when they go into hospital but can be treated on a day basis and return home.

Dame Elaine Kellett-Bowman: As they are in Lancaster.

Mrs. Bottomley: As they are in Lancaster, as my hon. Friend says. However, we must have a service that is forward looking, responsive and flexible--

Mrs. Maria Fyfe (Glasgow, Maryhill): Will the Secretary of State give way?

Mrs. Bottomley: I shall try to make some headway now. I have already given way twice as much as the right hon. Member for Derby, South did, and I shall try to come back to the hon. Lady in a moment.

The NHS is world renowned for its quality of care, teaching and research. That is important and we intend to build on it. We are recognised internationally as having taken a lead in preventive health with "The Health of the Nation" White Paper, which was commended by Sandy Macara at the BMA conference. I was surprised at the element of the speech which the right hon. Member for Derby, South quoted. It seems to have slipped her mind that he said how much he commended "The Health of the Nation" and that we should make progress. He emphasised the importance of doctors in management, and we agree. He emphasised the importance of looking at effectiveness and outcomes, and we agree. He emphasised the importance of looking at health needs, not only health demands, and we agree. We agree on those and many other sectors, and that agreement and working together have characterised our relationship with the professions in recent years.

It is important that we recognise all that has been achieved, but also that we build on it and seek further improvements. Our family doctor service is seen across the world as a model of its kind. That is important and we shall build on it. The NHS is facing a medical and technological revolution that will dwarf the management changes that have taken place. New techniques, new drugs, an aging population and rising expectations all place immense pressure on the service. They will dictate new patterns of care, new challenges and new ways in which we view the health service and its achievements. We need a flexible service, able to respond to those challenges--not clinging on to the past, but moving to the future. We need to liberate the innovators; to release the

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talents from our doctors and nurses, our technicians and scientists. That is the aim of our reforms, and that is the dividend for patients that we have been delivering.

Dr. Lynne Jones (Birmingham, Selly Oak) rose --

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