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Mrs. Marion Roe (Broxbourne): I am grateful for the opportunity to speak in today's important debate. We live in a country with a health service which is the envy of the world, where care is universally available and provided economically, where standards are improving and waiting times are falling, as measured by every available parameter.

Yet Opposition Members do nothing but criticise and demean, destroying morale in the service and damaging the confidence of the public. Today, we are seeing a new tactic, calculated insidiously to undermine the jewel in the crown of world health care: criticism of the innovative ways in which the health service is seeking further to increase the funding available for patient care, and criticism about accountability and management and its costs.

My right hon. Friend the Secretary of State has already clearly explained in national terms the misrepresentations in the Labour party's assertions, but I should like to explore and answer those issues using a local example.

My constituents use the services of East Hertfordshire NHS trust, a second wave whole-district trust which, since its creation in April 1992, has offered high-quality care


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economically and efficiently. It has innovatively developed its facilities, and has expanded the capital available to it by partnership with the independent sector.

For example, the trust required a magnetic resonance imaging scanner, the latest technology for visualising internal body structures. A partnership was established with a private company, and a new unit was built in the grounds of the Queen Elizabeth II hospital. Scans are now rapidly available to health service patients more cheaply than the trust could otherwise have obtained them. The company involved is contracted to provide the latest upgrades in equipment at no cost to the trust, and the trust receives a share of the proceeds of the work that is undertaken. For health service patients, therefore, the huge benefits of rapid access are obvious, while for the trust there is the availability of a major clinical resource that it would not otherwise have. That is not the creeping privatisation which the right hon. Member for Derby, South (Mrs. Beckett) presages, but a valuable symbiotic relationship for mutual benefit and better patient care.

Opposition Members should never forget that the health service exists to provide care for the people of Britain, not to act as a sounding board for those who would use alarmist statements for political ends.

The Opposition parties claim that, in some way, the trusts and general practitioner fundholders are not accountable. Such an accusation is entirely without foundation. The trusts and fundholders are accountable, both to the populations they serve and to the principles of ethical activity that govern all business behaviour.

Mr. Gerry Steinberg (City of Durham): How?

Mrs. Roe: I shall explain.

Trusts are monitored by regional health authorities, and their activities are examined in great detail by both internal and external auditors. The chairman and non-executive directors of the trusts, who are local residents, monitor executive activities and decisions. Trusts must publish an annual report, and the public have access to the senior management teams at a statutory, publicised annual public meeting, where they can question the report and ask about any other issues of interest and concern.

Mr. Steinberg: If, at one of the meetings, the general public, after seeing the information, decide that they do not like the membership of the trust or the way in which the trust is being worked, can they get rid of the members of the trust?

Mrs. Roe: I fear that the hon. Gentleman has never attended one of those meetings. The people who attend them in my area find that they get satisfactory answers, and that the queries they raise are investigated. Furthermore, patients who have any cause for anxiety can write directly to the chief executive of the trust, who has the responsibility for investigating and personally responding to any complaints or worries.

As for fundholders, they are accountable to their family health services authority and to the regional health authority, they undergo statutory regular examination of their financial activities by auditors and, most importantly, they are accountable to their patients with whom they work all day and every day.

Such public sector accountability is comprehensive and effective, and compares favourably with the accountability, for example, of many trade union organisations,


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which work furtively, espousing individual rights on the one hand while stoically maintaining secret block voting and decision-making on the other.

In addition, the trusts and health authorities work within the codes of conduct expected of the most ethical businesses. Public organisations must be open and accountable, and everything they do must stand the test of public scrutiny.

The Government recognised that requirement and are to be congratulated on their vision and determination to introduce the principles of Cadbury into the medical services. The code of conduct and accountability, which was published last spring, defined the information for the annual report, outlined the decisions to be taken at board level, reviewed the mechanism for financial and performance reporting, and introduced a declaration and register of interests. For the Opposition to declare that there is anything less than openness and full accountability within the health service is to fail to understand the high and ethical standards demanded of and received from the trusts, the fundholders and the health authorities. A business with a £37 billion turnover needs effective management. My right hon. Friend the Secretary of State has already informed the House how that has been achieved nationally and how the Labour party propaganda has been used in an attempt to disseminate misinformation about management costs.

I am in accord with the former shadow spokesman for health, the hon. Member for Sheffield, Brightside (Mr. Blunkett), when he stated in the Health Service Journal earlier this year: "Managers--at whatever level--are not the enemy but the lubricant of the service".

They administer and deliver the service economically and more effectively than anywhere else in the world.

Again, I can cite the East Hertfordshire NHS trust used by my constituents. Its team of senior managers account for only 2 per cent. of the pay bill. Using the much broader definition of "management" as described by the Audit Commission, the trust has recently been examined and found to have total management costs of 5.9 per cent.

That figure--among the lowest in the North Thames region--compares with an average figure of between 7 and 8 per cent. for trusts and, using the same criteria, an average figure of about 14 per cent. for an industry with an equivalent turnover. Therefore, since the introduction of the reforms, there has been a doubling of the increase in the number of patients treated in the secondary care sector, in the face of management costs about half that of industry. Surely that is a truly remarkable success story.

Our excellent health service is not in decline, not over-managed, not unaccountable, not subject to insidious privatisation; it is developing, expanding, introducing innovative and exciting ideas, and working with the independent sector to expand further the facilities available for the population.

It is doing all that in an open and accountable way, with management costs that are modest by any standard and on which there is continued pressure for reductions to ensure that an ever greater proportion of national health service funding goes into clinical care. There is no public


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alarm about the health service, just a genuine belief among the overwhelming majority of the population that the care they are receiving is continuing to improve.

To fail to consider the care and treatment of patients and to use tactics designed to alarm and confuse is a cheap trick by the Labour party. Let Opposition Members whinge and whine, bereft of genuine cause for criticism or complaint. For me, the health service is a source of great pride; for my constituents, a service which is ever better; and for the country, a universal provider of care that is second to none.

6.22 pm

Mr. Archy Kirkwood (Roxburgh and Berwickshire): I do not think that the hon. Member for Broxbourne (Mrs. Roe) is right in her assessment of the changes in the national health service. However, I do not think that she is wholly wrong, either. She was right to say that some benefits have resulted from the administrative changes over the past few years. She was certainly right to say that the issue is not the involvement of the private sector, provided that the treatment for the patient is free at the point of delivery. That is the important factor. Nor is it bad to separate the purchasing and providing provisions. That is a sensible change which can be built upon.

The hon. Lady takes a keen interest in those matters and does a sterling job in her role on the Select Committee on Health. However, I am sure that, in the quietness of her own thoughts, she would accept that the implementation of some of the changes could be improved--and, in some cases, improved significantly. The Government were wrong to try to achieve their targets within the time scale that they set themselves. The computerisation programme and the introduction of new technology, which I support, were done at a speed that anyone with an understanding of the implementation of some of the systems knows was wholly unrealistic. Because of that, some of the aspects of implementation have been more chaotic than they should have been. The Government should have made greater use of a system of pilot schemes. Different parts of the country could have tried different things in different ways.

I hope that I carry the hon. Lady with me in saying that not every part of the country is necessarily always best served by trusts. Some elements of the centralised system have a coherence that the local delivery of services through trusts may not yet have. The jury is still very much out on that. If the hon. Lady is to be confident in her assertion that the new system is serving the interests of local people best, local people should have been given an opportunity to say whether they wanted to try it.

I am not aware of any of the consultation processes, which are part of the statutory legislation, ever succeeding in persuading a trust applicant that it was wrong. I know that from my local experience-- [Interruption.] The Minister may want to put me right on that when he replies. If there has been a public consultation on whether a trust should be implemented, which then showed that that trust was not wanted by the local community, which then resulted in the trust application being abandoned, I should be pleased to hear about it. I am not aware of the consultation process resulting in such an outcome.


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I know that the Minister takes a keen interest in the Borders because he is always visiting his weekend cottage in God's own country in Roxburghshire. He is very welcome when he comes.

Mr. Tom Clarke: The Minister did not make the same mistake as the hon. Member for Harwich (Mr. Sproat).

Mr. Kirkwood: I shall not be tempted down that road.

The Minister knows that the Borders health board is going through a process of public consultation on whether there should be twin trusts to provide health care in south-east Scotland. I have to tell the hon. Member for Broxbourne--her writ on the Select Committee does not run north of the border--that there is widespread fear that the implementation of twin trusts would not improve local health care. We have a very high quality of health care, mainly because of the standard of care produced by the professionals who work in the service. The health council carried out widespread consultation and there was a unanimous view that local people did not want any change.

The hon. Lady is a fair person. The health council is an objective body with no Labour party axe to grind. If the result of its consultation is that local people want their local health provision left alone, surely she accepts that it should be left alone. If a case cannot be made and if the public cannot be carried, they are entitled to keep the existing system and not have it replaced by the trust system. Otherwise, she would be sentencing every part of the country, whether it likes it or not, to the implementation of the new machinery. That would be wrong.

The Government may well have a case on the provision of trusts and they may, in certain circumstances, improve health care--that might be true in inner-city centres--but I am not convinced that they are necessarily good for every part of the country. The local people should be allowed to have their say on that.

The hon. Lady's investigations as part of the Select Committee are important in these matters. She will know that there is at least a question mark over the state of morale among nurses, doctors and health care professionals generally. The pace at which the reforms were implemented may have been responsible for some of that. I do not have a Labour party axe to grind-- [Interruption.] The hon. Member for Monklands, West (Mr. Clarke) will have to wait for a long time before I do. I do not have any ideological hang-ups, but I believe that there are considerable concerns among health care professionals and that their morale is low.

The Government's attempt to measure procedures, episodes and treatments by volume is a mistake. Of course, it is an important indicator, which must be taken into account, but the quality of outcome is also an essential part of the process of trying to evaluate whether the system is working. We tend to forget that aspect. We have just been trading statistics about the number of staff in place and the number of patients treated. I accept that there have been signal improvements in some areas, particularly waiting lists, which were far too long to start with.

The argument about private versus public is sterile. We are spending far too much time looking at the mechanism when we should be spending more time looking at the quality of health care and the way in which it is being delivered. The debate is obsessed with structures.


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My final point to the hon. Lady for consideration in a quiet moment is that she is wrong to say that power has been devolved from central command all the way down to patients. Power has been devolved down the line and is now in the hands of providers, but they are not necessarily the same as patients. We have a long way to go to persuade people that, just because there is more empowerment at the level of provider, we can be confident that that meets with the accords, wishes and needs of local people. I am sure that outside the confrontational atmosphere of the Chamber, the hon. Lady will acknowledge that there is some truth in some of the things that I have said in response to her interesting speech.

I declare an interest. I am a member of the Royal College of Nursing panel and have been for a number of years. It is one of the more fulfilling aspects of my work in this place. I get to meet real people who work at the front line of the NHS, a contact from which I benefit. I am also grateful for the expertise and briefings from which members of the panel from both sides of the House benefit. The Royal College of Nursing rightly identifies the future of long-term care for older people as being one of the issues that comes into the category, or could come into the category--I know that such loose language annoys Ministers--of creeping privatisation. There is much confusion at present about who should pay for continuing care for the elderly. We all know that in recent years there has been a dramatic reduction in the number of NHS continuing care beds and, as a result, a rapid growth in private nursing homes.

There has been an absence of any sensible, coherent and orchestrated debate at the hands of the Government. That is a dereliction of duty. I do not run away from the fact that tough decisions have to be made. They may involve getting the community at large to face up to family responsibilities more rigorously than happens at the moment. Those are not easy questions, but the Government have introduced the changes by stealth. That is not in the interests of arriving at a national consensus on how to cope with such matters.

The Government are sloughing off responsibility and increasingly local authorities are expected to take responsibility for continuing care. As a direct result, more patients previously funded by the NHS are now to be means-tested and needs-assessed before they have any guarantee of continuing care.

The lack of clarity in the past few months about who should fund continuing care is causing much anxiety, particularly for elderly and disabled people and their relatives. Those anxieties were fuelled by the draft guidance that was published in August 1994 by the Department. It proposes that local authorities and health authorities should, between them, decide which elderly people are eligible for state-funded continuing care and which are not. That is an abdication of responsibility.

The Government should give a much clearer steer on what they expect to happen in such circumstances and what the future will bring. The RCN's particular worry is that continuing care, if it consists of anything, consists of intensive nursing. It is right to say that that should be the clear responsibility of the NHS. The draft guidance, in describing the elements of continuing care, talks about the NHS focusing only on medical needs in future. It fails to acknowledge the crucial contribution of nursing to the continuing care process. The Minister may not have time


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to deal with that question tonight, but I hope that he will address it seriously. It is a legitimate question, which is not being properly tackled.

I welcome the right hon. Member for Derby, South (Mrs. Beckett) to her new position. The health portfolio can in no way be described as middle- ranking. Health is a crucial issue and the right hon. Lady is an experienced parliamentarian. I have enjoyed doing business with her in the past and I look forward to continuing that relationship in future. The Secretary of State was a bit churlish in her welcome to the right hon. Lady, but that is a matter for her.

The right hon. Lady made some important points about the need for more accountability in trusts. I was interested in the experience of the hon. Member for Broxbourne, who has for some time had a trust in her constituency, an experience which I do not share. Leaving aside the party political arguments which are valid and will continue, urgent efforts need to be made to satisfy the public that there is genuine accountability in some of those bodies.

There is a wider concern. There are ways in which the need for accountability could be addressed by creating more user groups and voluntary organisations and in which the independent sector could take a more direct interest in trusts. More than anything else, greater accountability could and should be achieved by making trust meetings more accessible. They should always be held in public. I cannot for the life of me understand why health boards, trusts and so on are allowed to meet in private. That is a dereliction of duty on their part and an abdication of democracy.

Annual reports and annual meetings are valuable and welcome, but the trusts should make far more effort to achieve a much more open style of management. It is up to them. Unless the Minister tells me that they are precluded in some way from adopting an open style of management, they have the power to do so. They have a responsibility not just to feed information up and to be accountable to the Secretary of State but to reach out and contact the public whom they seek to serve. People with more direct experience of trusts in the constituency can put me right if I am wrong, but I see no evidence of that.

The right hon. Member for Derby, South referred to the increase in bureaucracy. To a certain extent, that is inevitable. If there are purchasers and providers, there are now two sets of management where previously there was one, so there must be an increase in management. The right hon. Lady contrasted the 2 per cent. drop between 1992 and 1993 in the number of nurses and midwives with the 13 per cent. increase in senior managers during the same period.

I was disappointed that the Government did not do more to encourage health care professionals to go into those management roles. If more doctors and senior nurses had gone into trusts as managers, many of the public fears that we are now experiencing and with which we are having to cope would have been substantially allayed. Bureaucracy is a matter which should be addressed.

I fear that the climate of fear, to which reference has been made, is creeping into the national health service in a way that I would never previously have thought possible. Members of staff are beginning to say that they would like to come to my public meetings and say what they


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think, but they have their jobs to consider. Such a suggestion would have been strange, foreign and unheard of 10 years ago. However, such people now fear for their jobs and that is a bad thing. Finally, I make a plea to the Minister, who I am glad to see is making assiduous notes. I am also pleased to see his colleague, the Under- Secretary of State for Scotland, the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton). I have a completely lunatic situation in my constituency. Recently, the Borders health board entered into an arrangement with a bona fide, non-profit-making partnership to run a nursing home, using an NHS hospital at Drumlanrig in Hawick that looked after old people. The Minister knows what I am talking about. The board signed a contract with the non-profit-making organisation to deliver residential care in that NHS hospital, which, apart from a couple of acute beds, was denied to the health service.

As part of that contract, the organisation undertook to build a 36-bed residential unit costing millions of pounds. It was to be a state-of-the- art and most welcome addition to the town's residential care needs. The week that it opened, the health board announced that it was beginning consultations on a number of options, the preferred one being to turn that residential home into a community hospital. However one explains the management processes, from St. Andrew's house to the health board and local care in Hawick, that development makes no sense. The town has waited years for that brand new home, providing 36 places and state-of-the-art care, yet the week that facility opened, the health board said that it wanted to turn the home into a cottage hospital.

The Minister of State has not been in his job long, but I know that he has close connections with health care professionals and meets them most weekends, if he gets home at weekends these days. One does not need to be an expert to know the difference between a cottage hospital and a residential home. It is scandalous to suggest such a proposal, and that a town the size of Hawick, with 18,000 souls in the immediate vicinity, should be denied a custom-built primary care cottage hospital for the future. If Ministers are to be believed, primary care is the aspect that will be enhanced and developed in future. To provide a town the size of Hawick with a cobbled-together arrangement, with a residential unit being converted the week that it is opened, makes no sense.

I hope that Ministers from the Scottish Office--and I note that the Under- Secretary of State for Scotland is taking an interest--will investigate that matter and can give an assurance that the Borders health board will be given the opportunity, facilities and capital consents that it may require to ensure that Hawick will have both the residential care unit and the cottage hospital that it needs in the years ahead.

6.42 pm

Mr. Edward Garnier (Harborough): The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) made a thoughtful speech, and I will take up his point about guidance relating to long-stay patients. I had a similar problem in my constituency.

Leicester has seen the closing of the Carlton Hayes and the Towers long- stay mental hospitals. Members of the Carlton Hayes action group visited my surgery to express


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their concern about the future for long-stay elderly patients and about the Department's so-called guidance. Their fears were allayed because the health authority's chief executive displayed sensitivity, met patients and their families, and was able to interpret the rules in a way that neither offended the patients' long-term hopes nor breached the guidance, to reach a compromise that was entirely within the rules.

The hon. Member for Roxburgh and Berwickshire said that there should be openness and contact between health authority managers and patients and their relatives. That point was well made, and was well satisfied in the case that I cited. I commend to my hon. Friend the Minister the sensible handling of that problem by the chief executive of Leicestershire's health authority. That problem was solved thanks to sensitive and sensible behaviour by all parties. I am grateful to the Government for providing rules that allow for flexibility. It is the duty of all who comment on the Government's behaviour and reforms to consider what has been achieved rather than to put up Aunt Sallies. I will outline some of the good developments that have occurred over the past few years thanks to the reforms. National health trusts treat 3,000 more patients every day than before the reforms were introduced. Since April 1991, the number of hospital in-patients has risen by 1.3 million a year, and out-patient attendances have increased by 2.1 million. The population of Leicester is about 650,000, which gives some idea of the scale of the increase in in- patients.

Since the reforms, the number of people waiting for hospital treatment longer than one year has fallen from 170,000 to fewer than 65,000, and the average waiting time has been cut by half. A survey by the National Association of Health Authorities and Trusts in June showed that nine out of 10 patients who had attended hospital the previous year had found the service very good, good or average, and three out of four had found it to be very good or good.

I conducted a similar survey in m\y own constituency, by having questionnaires delivered to every household--and I have approximately 79,500 electors. There was a large number of replies, and the proportion of respondents saying that they were pleased with the performance of the NHS was even higher than nine out of 10. I hope that it is accepted by the House that patients are happy with the conduct of the health service. Members of the public and others nationally and internationally have also commented favourably. My right hon. Friend the Secretary of State referred to the comments of the Organisation for Economic Co-operation and Development. I will quote a short passage from page 65 of its July report:

"The command and control system of the NHS lacked flexibility, incentives for efficiency, financial information (and hence accountability) and choice of providers of secondary care . . . Consultants with lifetime positions in hospitals had little incentive to run a service more effectively. There was little incentive to use buildings economically as they had always been paid for by the Government . . . reliable per unit capital costs were generally absent."

It added that

"the reforms opened up possibilities to overcome some of the weaknesses of the old NHS"

and highlighted the improvements introduced by NHS trusts and GP fundholders, who

"do seem to have done a better job of purchasing than district health authorities."


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It reported also that

"recent national attitude surveys suggest some increase in satisfaction with the way in which the NHS is run, both among recent users of the service and among the population as a whole". That is confirmed by my local survey.

My right hon. Friend mentioned also the remarks of the founder of the Socialist Philosophy Group, Professor Le Grand, who made this clear:

"Central planning was not a conspicuous success in the old health service; decentralised sources of information close to local needs, like GP fund- holders, may provide a better base for long-term decisions than a centralised planning agency."

I could not agree more. Professor Le Grand thinks also that "many, perhaps most" health policy analysts believe that the reforms have been a success. That view was attributed to him by The Times on 6 April.

I suggest that the general picture is one of satisfaction and approval of the way in which the national health service reforms are delivering care to patients. The Government spend huge sums of money on the national health service on the taxpayers' behalf--£100 million a day. That is why a strong management is required to improve efficiency and services for patients. Some £1.5 billion in cumulative efficiency savings has been realised since the mid-1980s, when the Government began strengthening NHS management.

The Government have taken tough action and will continue, I trust, to eliminate unnecessary administrative duplication and waste in the national health service. I trust that before very long we shall see the abolition of regional health authorities and the merger of many district and family health services authorities. I am pleased to note that already the number of regions has fallen from 14 to eight, and when eight regional offices replace the regions, they will employ a total of 1,080 people, as compared with the 3,900 employed in 14 regions two years ago. In the past two years, the number of district health authorities has been reduced by 70 to 111. That has meant that administrative savings at regional and district level have released a total of £34 million to date. That money, instead of being spent on teacups, trolleys and filing cabinets, can be spent on direct patient care.

Earlier this month, my right hon. Friend announced that NHS trusts will publish in their annual reports how much they spend on management. To enable the public to see and compare those figures, they will be published alongside NHS performance tables.

A further improvement is that general and senior managers now account for only 2.6 of the NHS work force and 3 per cent. of the wages bill. The vast proportion of the NHS wages budget now goes on staff who provide care directly to patients. For your information, Mr. Deputy Speaker, the proportion of NHS staff who provide care directly to patients has increased from 60 per cent. in 1981 to almost 66 per cent. now.

One further improvement is that, earlier in the year, the Government published codes of conduct and accountability for NHS boards and other members, covering such areas as remuneration and declaration of interest. All trusts and health authorities have been requested to incorporate those matters in their standing orders. The whole flavour of the national health service reforms and the whole purpose behind them is to increase the priority of the patient as opposed to the providers of the service. We now have 419 NHS trusts in operation and there are good examples of those trusts in my own


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area of Leicester. We have the Leicester Royal Infirmary trust, the Leicester General Hospital trust and the Glenfield trust. The three major acute hospitals are now all under trust management. Furthermore, the Fosse trust covers the community hospitals and many of the GP practices. The system is working and it is seen to be working, but the ultimate test of the success of the new arrangements is whether they have increased the quality and the quantity of patient care. I would suggest that that is precisely what they have done. Since April 1991, when the trusts began, the number of hospital in-patients has risen by 1.3 million a year and the number of out-patient attendances by 2.1 million-- figures which I mentioned at the start of my remarks. In daily terms, that means that 3,000 more patients are treated every day. If that is not a benefit of the reforms, I do not know what is. Since April 1991, the number of patients waiting over one year for hospital treatment has more than halved, to under 65,000. That means that, since March 1988, the average waiting time for all patients has been cut by half--to 4.6 months in March 1994. Waits of more than two years have been all but eliminated, as I am sure my hon. Friend the Minister will be able to confirm later. No one now has to wait for longer than 18 months for a hip or knee replacement or a cataract operation and 80 per cent. of patients are seen within 30 minutes of their appointment time, as set out in the patients charter. I can confirm that national figure from my visits to my local major hospitals, where one can see that the waiting times have been vastly reduced in the past few years. One can now go to hospital and expect to be seen at the time at which one is booked in to be seen--and that is under a national health system, not a private BUPA system.

At the party conference earlier this month, my right hon. Friend announced that a new expanded patients charter will offer an even greater dividend for patients, with a new national standard for out-patient appointments and a maximum 18-month waiting time for every operation. Already, half the total number of patients are seen immediately; half the remainder are seen within five weeks; almost 75 per cent. are seen within three months; and 98 per cent. are seen within a year.

Those improvements are a direct consequence of the Government's reforms. They flow from the reforms because the new system involves the devolution of decision-making power to local level: they give doctors and NHS managers living in the community the freedom to innovate and to improve patient services. The whole system is driven by the district health authorities and the GPs at local level--those who control the money that the trusts receive. They are developing ways in which to respond more closely than ever to the needs and wishes of the communities that they serve. The GP fundholding initiative in particular has involved a devolution of power to those closest to the patients.

Mr. Iain Duncan Smith (Chingford): Does my hon. Friend agree that often when criticisms are made--and there may be some legitimate criticisms of some of the changes--it is also said that everything was perfect in the past? For example, people say that access to information was excellent and that identifying who was responsible for what was very easy, when in fact quite the reverse was true? In many senses, breaking everything down and


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devolving it has made it much easier to identify who is responsible for the treatment and--now that the accounts are published--where the money is flowing. Does not my hon. Friend agree that that has been a massive improvement?

Mr. Garnier: Yes, I do agree, and I am most grateful to my hon. Friend for that intervention. The responses to my survey in my constituency underline the point that my hon. Friend has just made. I wish also to commend the Government for providing better accountability in the national health service. That subject has been mentioned also by Labour Members, who have complained that that is not the case. I beg to differ from them and will seek to persuade the House that there is better accountability. The NHS reforms have already led to significant strengthening of the accountability of the health service to the patients whom it serves. That is the whole point of the national health service. It is there for the patients. It is not a job provider; it is a patient carer.

The patients charter sets out in black and white the rights enjoyed by patients and the means of redress when things go wrong. The split between the providers of health care and the health care commissioners, to whom hospitals are accountable and whose role it is to promote the interests of patients, means that the service is now largely patient driven. Again, I have seen that in my constituency. I see it at my advice surgeries, where people thank me--quite unnecessarily, because I have not done anything--for the good work of the national health service in our local hospitals. [Hon. Members:-- "Come on."] Hon. Members may scoff, but that is a fact. I am not in the business of misleading the House. Constituents of mine have come into my surgery time after time to commend the work of the national health service. It is fair to say that even the Opposition nowadays agree--the hon. Member for Roxburgh and Berwickshire certainly agrees--that there is a case to be made for, and even a case for accepting, the need for a split between purchasers and providers of care.

Hospitals are now much more accountable for the use of taxpayers' money through their contracts with health authorities and GP fundholders. Under the old system, few hospitals knew what individual treatments cost, as my hon. Friend the Member for Chingford (Mr. Duncan Smith) has just pointed out. Few felt the need to know because they were not held properly accountable. Most people simply did not know how to find out information; there was a great black wall of bureaucracy which they could not penetrate.

Mr. Turner: Talking of bureaucracy, the hon. Gentleman will have heard this week of the record pay-out in respect of a very serious accident that happened to a young man in Wolverhampton. Some £2 million of compensation has had to be paid or is to be paid. It has taken 14 years of bureaucracy for that case to be heard and settled. Is that the accountability in the health service and the lack of bureaucracy about which the hon. Gentleman is telling us? It has taken 14 long years--a scandal--for that case to be heard and dealt with. Where is the justice, accountability or lack of bureaucracy in that case?

Mr. Garnier: With respect, I think that the hon. Gentleman must be taking part in a different debate. What is more, 11 of the 13 years to which he referred--or however many it was--were pre-reform. But I digress: I will


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not be diverted by the hon. Gentleman. I have no doubt that, if he has a sensible point to make, he will try to catch your eye in due course, Mr. Deputy Speaker.

I see that the hon. Gentleman is now leaving the Chamber. No, he has returned, and is approaching the Front Bench. I am delighted that his intervention has led to instant promotion; I trust that he will go further.

Decision making has been devolved to levels much closer to the patient, particularly--as I suggested a moment ago--to GPs, through fundholding. As I was saying before I was interrupted, those making the decisions are better able to assess patients' needs. More information is available to patients and the public than ever before, enabling them to make more important decisions.

The Government's NHS reforms allow the Government and NHS managers to listen to the needs of the public. They have listened to those needs, as is clear from the example that I gave the hon. Member for Roxburgh and Berwickshire. I have no doubt that Ministers have that at the forefront of their minds. I am much fortified by the assurance given by my right hon. Friend the Prime Minister at the Conservative party conference that the national health service was safe for as long as he was alive and breathing: he is a young man, and I wish him a long stay in office.

I am certain that, when the time comes, the national health service will be available to me in my old age. I trust that the Minister will continue his good work, and ensure that the public still have the confidence in the NHS that my constituents have shown--as I have no doubt they will.

7.1 pm

Mr. Gerry Steinberg (City of Durham): The gigantic programme of change brought about by the health service reforms will have implications for nearly every patient and member of staff. In Durham, the merger of the district health authorities, the abolition of the regional health authority and the plans for a new district general hospital represent an era of change unprecedented since the formation of the national health service.

I am delighted that there is to be a new hospital in the city of Durham, and that the new regional office will be sited there as well: that will create many welcome jobs. But what is going on behind the scenes of these changes? Will these major developments enhance the range and quality of hospital services locally available to the people of Durham?

The changes are market led, not customer led. The internal market is rapidly reshaping the health service, fundamentally changing the nature and quality of services and undermining the ideals that underpin the NHS--that health care is available to all, that money does not buy better or quicker treatment and that patients are treated locally if that is what suits them best.

Let me refer specifically to the proposed new Durham hospital. I hope that the Minister will take careful note of what I am going to say. I am disgusted and outraged by the latest decision on how the hospital is to be funded.

Soon after I was first elected to Parliament in 1987, plans for a new district general hospital were discussed--although the hospital had been proposed even earlier. Capital expenditure in Durham district health authority had been miserly over the years in comparison with that of other district health authorities in the region. For example,


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