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Durham was among the bottom six of 16 districts, with a spend of less than £15 million in 1989; only £2.5 million extra was spent between 1982 and 1989. In contrast, Newcastle district health authority was allowed to spend nearly £59 million in 1989, £9 million extra being spent between 1982 and 1989.

Even if we add the capital expenditure of North-West Durham district health authority--which is now part of the new Durham authority, and which was bottom of the table with a total spend of only £3.8 million in 1989, with virtually no increase since 1982--it is clear that both authorities have been allowed very little capital expenditure over the years.

Until a few weeks ago, it seemed that at last--after seven years--the hospital was ready to be built. Detailed business plans were drawn up and it was a case of looking to the Government for the capital expenditure. However, the Government have dashed hopes that funds for the proposed North Durham hospital would be approved by the end of the year. They are now insisting that a private sector bid for planning, building and running all but the core medical services must be included with the business plan. That is completely contrary to what the authorities had already been told; the decision, which is now expected to delay the bid for over a year, has ruined the plans for the hospital and delayed them even further.

The business plan had been prepared at a cost of about £500,000. It had forecast the start of building work by 1996, with patients being admitted by 1999. Not only have the plans been delayed, however; they have been forced down the road to privatisation. The hospital managers of North Durham acute hospital trust hoped to receive the plans for go-ahead this year and hoped that the first phase, costing approximately £44 million --building next to the existing hospital--would start even before 1996. For the hospital authorities now to be told that their plans have been dashed, and that a new financing system is to be introduced, is a scandal and a disgrace, and has set the hospital back further.

Not only has the new hospital been delayed; all the money spent on plans-- including the business plan--has been a complete waste. For the Government to insist that private money builds a hospital is nothing more than privatisation of that hospital, and privatisation of the health service in Durham. Whichever way we look at it, if the private sector builds the hospital the private sector will expect to profit from it after it is built. That means that the private sector will run the hospital, and that therefore the hospital will run on a basis of profit rather than health care.

If the hospital is not making a profit in certain areas, its owners will insist that the managers drop the service concerned and dictate where profitable services may be found. That could lead to a cut in non- profitable services, such as care for the elderly, and to decisions on medical care being taken not by doctors and consultants but by property developers and business men. If that is not privatisation, I do not know what is.

So much for the Prime Minister's statement at the Tory party conference that the national health service would never be privatised while he lived and breathed. The proposed new North Durham district hospital is being used as a guinea pig for new financing arrangements, and my constituents will have to suffer--now and later. I ask the Minister to meet me, along with other hon. Members, in

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the Durham area, to discuss the new proposals; I should be grateful if he would give me some indication of his response this evening.

Mr. Malone: I should be delighted.

Mr. Steinberg: The speed of the Minister's response has taken my breath away, but I am glad that he has acceded to my request. Under the new regional structure, the NHS executive's new regional offices will be responsible for purchasers and providers of primary and secondary care. The executive, with its single structure of regional offices--each with no more than 135 staff--will take on responsibility for all policy development in relation to the NHS. At local level, health authorities will evaluate health care needs. Major objectives will be delivered through corporate contracts between health authorities and the NHS executive.

Trusts are primarily accountable to purchasers for the delivery of care through NHS contracts. They will be held to account by the provider arm of the NHS executive regional offices for meeting their statutory financial duties: in other words, there will no longer be any democratic accountability in local health care provision. There will be limited direct monitoring by regional offices of certain non-financial aspects of trusts' performance which cannot be pursued through NHS contracts, including national policy initiatives such as Opportunity 2000 and junior doctors' hours.

Once regional health authorities are abolished, all appointments to district health authorities, family health services authorities, new health authorities and trusts will be formally made by the Secretary of State. Far from localising decisions, we will see a considerable move of power to the centre and political domination by the Secretary of State.

With the abolition of RHAs, the emphasis will shift from a regional picture to the performance of individual health authorities and trusts which are unaccountable. National health service executive headquarters will establish an accountability framework for the NHS to be set out in a statement of responsibilities and

accountabilities. Chief executives of health authorities and trusts are to be designated as accountable officers who will be accountable to Parliament for the use of all funds in their charge. Purchasers will provide information to those interested in their activities, including Members of Parliament, the public and the press. By any stretch of the imagination, that cannot be a democratic or acceptable system of accountability.

Undoubtedly, a hospital trust has the financial interest of the hospital ahead of the health needs of patients and the pay and conditions of staff. There is already a trend towards low-paid, casual work and job insecurity. The cost-cutting measures of the market depress pay levels and by that means providers can offer cheaper services to purchasers through being more competitive. The rosy picture of staff morale in Durham hospitals painted by the Secretary of State is not familiar to me. Recently, we saw the regional health authority attempt to buy off nurses in a grading dispute. The health authority offered a blanket £700 to each claimant in exchange for dropping the claim. It is nothing more than a cash-oriented scam. Many of the nurses waited years for a fair hearing

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at a grading appeal to recognise their additional responsibilities. In today's health service, there appears to be little scope for fairness. The health authority did its sums and pressed nurses to drop their claims in an unprincipled attempt to cut its losses. The nurses were given a deadline to accept the offer and were advised that refusal could result in a two-year wait for their grading appeal to be heard. Many nurses accepted the cash offered rather than face a further delay. Almost 2,000 of the nurses had already been waiting for five years.

That action is further evidence of the abandonment of long-established public service traditions in favour of the "money talks" philosophy that we see in the health service under this Government.

One of the first staff-related decisions made by the acute hospital trust in Durham was to replace skilled staff with cheaper and fewer staff. Staff are being treated as disposable units and are being used to make savings by reducing wage costs and job security. Auxiliaries, ward clerks and ward aids were replaced by what are called team assistants. The team assistants are to be recruited from jobcentres and are not required to have any previous experience in the health service. They will receive in-house training, but the complete training course lasts only 11 months or even less for successful students.

The new post will be more qualified than an auxiliary but less qualified than an enrolled nurse and most post holders will have no previous experience in the health service. The new post holders will not be offered Whitley council employment and service conditions. Their conditions will be imposed upon them. For example, they will have only seven weeks holiday a year, including time off for sickness. Any further absences after seven weeks will mean a loss of pay. Given the nature of the work and the stress involved, that is an erosion of the rights that they have enjoyed for years. I do not see that as progress through reforms.

A further erosion of their rights is that the 37-hour working week will be stretched to six days instead of five. Although that means shorter shifts, it means that an extra working day will be imposed for the same money. There is to be an overall pay decrease and special duty payments have been scrapped for night and weekend work. There will be no pay structure except at the whim of management with increments being awarded on merit. A bribe will be offered to the present work force with a one-off payment if they sign away their Whitley conditions.

A system of internal rotation has been introduced where nurses who previously worked only night shifts must now work day duty and vice versa. That is all at the whim of the sister in charge of the ward. To make matters worse, nurses who did two complete night shifts are now being forced to do five nights with four hour shifts, finishing at one o'clock in the morning. That means that nurses have to return home alone in the early hours of the morning. That is unsafe and has been forced upon them. The nurses who gave me this information pleaded with me not to reveal my source because they believed that they would be sacked.

At a meeting, the chairman of the hospital trust indicated that workers' rights were important. However, it seems that the new system is being imposed without real negotiation and will be implemented regardless of trade union opinion. The guarantees given to me seem worthless. I wonder whether the guarantee that he gave about

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not sacking anybody who spoke to me rings true. I would not dare take a chance and reveal any source of my information.

Secrecy surrounds the appointment of board members to the newly formed health trusts in county Durham. I was notified of the trust membership of the community health service, acute hospitals unit and the ambulance service. I was not objecting to individual appointments, but I inquired about the process of selection. I was particularly interested in the full list of nominations that had been received for trust membership so that I would be able to judge the criteria upon which the successful board members had been appointed. I was astounded to be told by the management of each service that the list of nominations was privileged information and could not be released. That is disgraceful.

Those boards will run the vast majority of health services for the people of Durham, yet I am told that secrecy surrounds who was considered and how the appointments were made. That contrasts dreadfully with local government, where councillors are selected by the people and all nominations are open to public scrutiny. The chair of the ambulance trust in Durham is a very nice lady. I have met her and I got on very well with her. However, she is a failed Tory candidate for local government. How and on what grounds was she appointed? What are her qualifications? We do not know because they will not tell us. Her qualification is that she is a supporter of the Tory party and she was appointed on that basis. That is scandalous. In my constituency, there has not been a single Tory elected to the district council, which consists of 49 councillors, or to Durham county council. However, two of the ambulance trust members are Tory party members. That is a slap in the face for the people of Durham, who consistently vote against Tory representation. They do not want the Tories, but they are lumbered with them.

Mr. Michael Carttiss (Great Yarmouth): Is the hon. Gentleman suggesting that in an area where one party is dominant, such as in Durham and in some parts of the country where, until recently, the Conservative party might have been dominant, nobody with a different political affiliation should be appointed to hospital trusts or any other body responsible for the health service? Is he saying that because the people in Durham are silly enough to vote Labour, no Conservative should be appointed there, even though some people in Durham do vote Conservative?

Mr. Steinberg: The people who vote Conservative in Durham could probably be counted on one hand. I am saying that it seems strange that in an area that predominantly votes Labour, two Tories are placed on the board of the ambulance trust and one is made its chairperson. I am not against those individuals. In fact, I get on well with them. One was the leader of the Tories in Durham. My point is that when I asked for information about how and why those people had been elected, I was told basically to mind my own business. I can assume only that they were appointed because they were Tories. I would have been satisfied if I had received an explanation of why they had been appointed or if I had been given their credentials for serving on boards. The system as it stands,

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however, is non-democratic and unaccountable and, therefore, it must change. It is perceived that the appointments of those people are a political favour. I am sure that Conservative Members cannot be happy with such a position.

Mr. Rowe: I have a lot of sympathy for what the hon. Gentleman says. There is great deal to be said for being entirely open about trust appointments. In the early stages of the trusts, there is bound to be a presupposition that people who approve of trusts rather than those who do not will be appointed.

Mr. Steinberg: That is a fair point. I was asked by the chairman of the regional health authority whether I would be prepared to propose nominees for the trust board. I duly nominated a number of Labour party members who would like to serve on trust boards. That was the last that I heard of the matter. No reason was given as to why they were not picked or why the Tories were. That must lead to suspicion.

Mr. Duncan Smith : May I press the hon. Gentleman on this point? He said that he nominated a number of Labour party people. When he nominated them, did it occur to him whether those people would do an efficient job?

Mr. Steinberg: I assure the hon. Gentleman that one of the members who I nominated was the former vice-chairman of the district health authority. He had been removed by the Secretary of State when the new district health authority was set up.

Mr. Bayley: Purged is the word.

Mr. Steinberg: Sorry, he had been purged. I nominated someone with a tremendous amount of experience.

My relationship with the trusts is excellent. I work well with them, but they are not accountable. We do not know why the appointees were chosen and we do not know what their qualifications are for holding their positions. That is an unhealthy state of affairs. It can be put right only by a more accountable system in which trust members are elected by the people whom they serve. They should not chosen by the Secretary of State for Health purely on the basis of the political party that they support--in this case, the Tory party. I do not wish my views to be taken as a personal slur on any trust appointees, but I believe, as a matter of principle, that greater public accountability is needed in this process.

Patients do not have the freedom to attend a hospital of their choice. General practitioners cannot refer them to the consultant of their choice. I should like to give an example of an appalling problem that occurred in my constituency. A 70-year-old lady had a heart attack and she had to bussed to the next county to receive emergency treatment. When she became ill at midnight, she was attended by what I call a night-shift doctor from the GP's practice who was unable to obtain her admission to the local hospital. It refused her admission because it did not have a bed for an old lady who was having a heart attack.

Her husband's wish to accompany her to an accessible hospital led to an inquiry in the next county, but that was also refused. Eventually, the ambulance took her to a different hospital in the county unaccompanied by her husband. Ambulancemen told the old gentleman that if he went with his wife at 1 o'clock in the morning, they could not get him back home. He had to wait at home while his

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wife was shipped off to the end of the county. That is an outrageous and intolerable position. An elderly man was left grief stricken while his wife was shipped off to the other end of the county.

Unfortunately, that is likely to be regular occurrence now that the hospital has been granted trust status. That is the sort of health care that the reforms have brought. Durham's hospitals should care for the people of Durham. The Government have wasted millions of pounds on expensive management studies and bureaucratic procedures in the health service, yet they have got the basic things wrong. Why should elderly people be treated like second-class citizens? Things are going from bad to worse.

There is little distinction between private and national health care. No patient can be accepted by a trust hospital unless someone pays the bill. We are assured that the health service will not be privatised, but few people believe it.

7.24 pm

Dr. Charles Goodson-Wickes (Wimbledon): Durham is a long way from my constituency, but I note that my hon. Friend the Minister, whom I welcome to his new post, has already acknowledged the points that have been raised and shown his willingness, and that of his colleagues, to listen to them. That is the new listening national health service, if I can call it that.

A distinguished medical colleague said to me recently that "treating patients is a great deal easier than running the national health service."

As a physician, I acknowledge the difficulties addressed by my right hon. Friend the Secretary of State for Health.

When I became a medical student 30 years ago, I could not possibly have imagined the nature and pace of change, either professionally or administratively, especially in the past few years, but changes there had to be. For far too long, the NHS thought itself immune from challenge. Indeed, any challenge precipitated the wheeling out of Nye Bevan and was portrayed emotionally as a betrayal of the ethos of those people who set up the NHS.

Those of us who worked in the NHS knew otherwise. Paternalism, from consultants downwards, had too often turned into a patronising attitude. Patients were led to believe that they should be grateful to be treated at all. Often, scant attention was paid to the timing of their appointments and admissions and they were often treated less well as people than one would expect. If that sounds over-critical, I should balance it by saying that those same patients received some of the best medical, nursing and ancillary treatment in the world. The publication of the White Paper "Working for Patients" was the watershed. New thinking had to be applied to a service which, as everyone had come to recognise, was subject to unlimited demands and that, paradoxically, increased in line with further medical and surgical sophistication.

As new treatments became available, waiting lists inevitably increased. General practitioners felt frustrated and hospitals were overstretched. Hospitals often found themselves in the wrong place because of demographic

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movements and changes in catchment areas. Rationalisation, particularly in London, was long overdue. Therefore, the Government, introduced new concepts, initially perhaps rather tentatively, which soon gathered a momentum of their own.

The achievements are worth restating. NHS trusts forced the introduction of proper management techniques and accountability. No longer were investigations ordered without regard to cost and usefulness. No longer were waste and poor stock-keeping tolerated. Attention was at last paid to the cost of stays in hospitals, which was linked appropriately to the development of day surgery, a theme that I have developed in the House before. Lastly, compulsory competitive tendering, introduced by the Government, promoted efficiency and ensured that the maximum resources were available for patient treatment.

GP fundholders were another great innovation. I remember attending highly charged meetings in my constituency with GPs who were apprehensive about having to manage their own affairs and about making use of the purchaser- provider split in the internal market. I understood their concerns and you, Mr. Deputy Speaker, would also have understood them. Like them, I had grown up in the NHS, of which it really was true to say that doctors tended to know the value of everything and the cost of nothing. They certainly knew the value of all sorts of human and scientific factors but few of us knew the cost of anything, whether of a day's stay in hospital, of drugs that we prescribed, of dressings that were applied by staff or of investigations for which we daily wrote forms.

Hon. Members know that the waves of NHS trust applications gathered a momentum of their own. I welcome the announcement of my right hon. Friend the Secretary of State for Health at the party conference that, in response to demand, the threshold for GP fundholders would be lowered to 5,000 patients on a list. Those changes truly represent market forces at work as doctors and, more importantly, patients see the benefits of the reforms. I can speak personally of those benefits because I and all four members of my family have been in-patients under the NHS at Bart's hospital during the Government's term of office.

Who did nothing but carp and criticise? The Labour party and, I am ashamed to say, my union, the British Medical Association. The classic socialist arguments were trotted out. The changes were described as creating a two- tier service as though all those benefiting from fundholding practices should be deprived simply because if everyone cannot benefit, no one should benefit. I suspect that that type of egalitarian thinking will survive in the Labour party long after any cosmetic surgery has been carried out on clause IV. The hon. Member for Newcastle upon Tyne, East (Mr. Brown) appears to be nodding in agreement.

Mr. Nicholas Brown: Our argument is that everyone should be treated the same.

Dr. Goodson-Wickes: That is our aspiration as well. The hon. Member was obviously not listening to what I said. The Labour party has always maintained that one

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cannot have a two-tier service during a transition that provides a one-tier levelling up. Over the years, socialism, on the contrary, has persistently been all about levelling down.

Mr. Tom Clarke: I must say that what the hon. Gentleman said did not sound like that to me. When he talked earlier about the difference between value and price, which was more important to him?

Dr. Goodson-Wickes: I know that the hon. Gentleman was listening attentively, so he will know that I was talking about human values as opposed to financial costs.

It is interesting to consider the attitude of the BMA in this saga. On Saturday 6 August, the British Medical Journal published a leader entitled:

"Where now for the NHS reforms?"

I suppose that as the BMA is producing its own magazine, it is not at the mercy of anyone else and its staff can write the sub-headings to any articles. The sub-heading to that leader was:

"Making them up as they go along."

If that sub-heading does not make that leader a political tract at first sight, I wonder what it does. The article stated:

"For many managers and professionals in the NHS, this has meant a period of learning by doing in which the importance of GP fundholding, NHS trusts, and similar initiatives have been discovered in the process of making the reforms work. Where these changes will take the NHS is unclear even (or perhaps especially) to those at the heart of government . . . To this extent, the changes introduced by Working for Patients are out of control, with developments being driven from the bottom up not from the top down.

And yet. Despite the overwhelming evidence of confusion and inconsistency at the centre of the NHS, there are those who argue that the reforms are guided by a master plan".

That is a load of gobbledegook, unworthy of the usual stringent editing of the BMJ. The BMA cannot have it both ways--it cannot criticise reforms instigated from the bottom up while, on the other hand, accusing the Secretary of State by implication of imposing some master plan from above.

The article in the BMJ asked

"What should be done? Firstly, Ministers should assess the founding principles of the NHS for their relevance today." I do not know how good the right hon. Member for Derby, South (Mrs. Beckett) is at her history, but I did a bit of research and found out that one of the main criticisms levelled by the Labour party has been directed at the Government's theme of money following the patient. I challenge any of the health intellectuals on the Opposition Benches to give me the provenance of that phrase. I am met with a lot of blank faces, so let me educate those hon. Members. That phrase came straight from Nye Bevan, who, when speaking about local hospitals, said:

"the endowment of that local hospital follows the patient"--[ Official Report , 26 July 1946; Vol.426, c.470.]

I recommend that phrase to the Opposition and I hope that the concept of money following the patient will no longer be criticised as a Conservative philosophy.

Mr. Bayley: When Nye Bevan was speaking, the money did follow the patient because the doctor could refer the patient to any hospital. The funding that that hospital received depended on the number of patients that it had. Now, of course, money does not follow the patient. The doctor sets a contract with various providers and the

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patient cannot exercise choice by going to whichever hospital he believes is the best--that is the nature of the internal market.

Dr. Goodson-Wickes: The hon. Member is obviously not an expert because he knows nothing about extra-contractual referrals. We have heard cries from the Opposition about creeping privatisation and commercialisation, despite the categorical assurances of my right hon. Friend the Prime Minister that the Government have no intention of privatising the NHS.

My health interests are registered in the Register of Members' Interests, about which we have to be so careful nowadays, and I am proud to be associated with a public company that is working closely with local authorities to deliver an excellent standard of community care. It allows patients to be treated with dignity in the best possible environment. I also greatly welcome the fact that the company is competing not only with other companies but with in-house services.

The new-look Labour party may admit to synergy between the public and private sectors in the NHS, as it does in other sectors. I challenge the Opposition to come clean. What do they really believe about co-operation between the private and public sectors? I do not know whether the right hon. Member for Derby, South believes that there is a place for the private sector in the NHS. However, I recently found out that her predecessor, now disposed of, the hon. Member for Sheffield, Brightside (Mr. Blunkett) did not seem to have any qualms about such co-operation. Dental Practice reported that, last year, the hon. Member opened a dental practice called Shiregreen, in Sheffield, within the largest public housing scheme in Europe. The magazine described how a private patient suite and private office were located on the first floor of that practice. I hope that when the right hon. Member for Derby, South replies to the debate she will clarify her party's views on such co-operation.

Mrs. Beckett: I opened the debate; I will not be winding it up.

Dr. Goodson-Wickes: Perhaps she will clarify her party's views in due course.

What I find most frustrating in any debate on the NHS--we have all heard the interminable debates that have gone on--is the lack of good news that is described as such. In my constituency I have several good examples of such news. The St. Helier NHS trust, together with St. George's Hospital trust and the Kingston Hospital NHS trust, is responsible for the care of my constituents. It is an extremely successful trust and it is proposing possible new plans under the private sector finance initiative to transform the delivery of health care in south-west London. That is excellent news in itself and it may involve other hospitals, but it would be wrong of me to mention those in other hon. Members' constituencies.

Atkinson Morley's hospital in my constituency is recognised as a centre of excellence throughout the world and it is quite possible that it may find its eventual home within the new set-up pioneered by the St. Helier hospital trust. I commend that trust for the work that it is doing on that project.

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Nelson hospital in my constituency is a small, old-fashioned hospital which is held in enormous affection by my constituents. Its obituary notice has been written prematurely many times. At last, there is a proposal before the local council for that hospital to benefit from an entirely new build. I submit that there could hardly be a better index of faith in its future.

The new plans incorporate increasing the number of out-patient consulting rooms from seven to 10 and the number of places for day treatment for the elderly from 20 to 30, and doubling the operating theatres from one to two. Moreover, my constituents will benefit from locally available physiotherapy, occupational therapy and x-ray facilities.

Mr. MacShane: I can cite examples in Rotherham of an increasing number of beds and positive work accomplished in the NHS. What concerns me and should concern the Minister of State who will wind up, as he is a former journalist and Scottish editor of The Sunday Times , is the fact that when consultants, physicians and nursing staff in Rotherham district general hospital tell me things and I say that we shall discuss them publicly, they say that we cannot. That is a gagging of discussion inside the NHS by a Government who talk about decentralisation and improving information flow but who will not allow the people who know about those matters to express their views in the public domain. I am happy to represent the staff of Rotherham hospital, but I should prefer the Government to lift the gagging and allow consultants, doctors and nurses to speak for themselves in public debate.

Dr. Goodson-Wickes: I cannot speak for the hon. Gentleman's constituency of Rotherham. I can simply say that once the plans servicing my constituency are worked out, they will go to full and very public consultation. I imagine that that pattern is reproduced elsewhere.

A recent MORI poll shows that doctors are the most trusted profession. At the other end of the table, politicians are the least trusted. I believe that politicians are now on a par with journalists and, in the light of recent events, I am not certain whether the position at the bottom of the table has changed. Those of us who are both physicians and politicians must be somewhat schizophrenic. Speaking as a doctor and a politician, I welcome the reforms, knowing them to be for the benefit of the only person who matters in all our deliberations--the patient.

7.41 pm

Ms Tessa Jowell (Dulwich): I, too, am pleased to take part in this debate and should like to record my interest as an adviser to the Royal College of Nursing. Like the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who spoke earlier, I am a member of its parliamentary panel.

Such is the collapse of public confidence in the Government's management of the health service that every week my constituents come to my advice services or write to me to express their fear and fury about what is happening. The Secretary of State prefers press conferences to Parliament and a mantra of statistics and jargonese that causes bewilderment to even the most hardened bureaucrat or journalist. Recently, when she appeared before the Health

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Select Committee and was challenged about where support came from for her health reforms, she conceded that some members of the public may be "counter intuitive" to the changes. However, she went on to say that trust chairmen were always telling her how wonderful the NHS reforms were. Too right, as she appointed them and rescued many of them from oblivion after a general election defeat.

It is because the NHS now seems to be run by a deadly combination of the Secretary of State's fantasy and a new breed of bureaucrat that patients and the public--that means all of us--are so alarmed. If public confidence in the national health service is as high as Conservative Members would have us believe, why has there been such a sharp increase in the number of people taking out private health insurance?

Another major aspect of our debate today is the increase in bureaucracy. My hon. Friend the Member for Newham, North-East (Mr. Timms) has already referred to CELFACS. A constituent of mine recently sent me a list of vacancies within the corporate services for CELFACS. Anybody who believes that the patient is still at the heart of our national health service should take a look at the 31 job descriptions, which include the assistant director of financial management; the assistant director of financial services; the financial accountant; the finance manager; the contracting systems and development accountant; the debtors' cash management accountant; the assistant management accountant; the public relations manager; and the press and public relations assistant. CELFACS has advertised 31 jobs, not one of which refers to patients in its job description.

Mr. Malone: That is a pretty stupid point to make. Advertisements for jobs for clinicians appear in another source called the British Medical Journal . If the hon. Lady is talking about over-management in the service, does she accept the fact that only 2.6 per cent. of those employed in the service are in management? That is a pretty small figure for a service that runs at a rate of £32 billion a year.

Ms Jowell: Given that the Health Ministers claim the NHS to have the patient at its heart, the fact that City and East London Family and Community Health Services has produced 31 job descriptions, none of which refers to patients, makes my point.

I recently received a letter from a local GP practice that serves many of my constituents. It said:

"On Monday evening the 10th of October 1994 at about 6.00 p.m. one GP trying to get an emergency admission for an elderly patient was told by the Registrar on call that there were no available beds at King's or Dulwich and that some eighteen patients were currently waiting on trolleys. Our patient was admitted to a ward at Dulwich at 5.00 a.m. on Tuesday the 11th of October. This practice of holding people for hours on trolleys in A&E seems to be commonplace and acceptable to the hospital but we do not believe that ill, elderly or vulnerable or distressed people should ever be treated in this manner."

Another reality that the Government systematically avoid is the well- documented crisis facing London's mental health services. During the summer, we heard from the Royal College of Psychiatrists that bed occupancy is running at a staggering 130 per cent. I pay tribute to the excellent work of the Mental Health Foundation in systematically analysing and providing data on the scale of

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the crisis facing the mental health services in London, with which all my hon. Friends who represent London constituencies deal daily. A constituent of mine who is a mental health worker wrote to me recently:

"The bed situation in London is terrible. Our patients are frequently referred to private hospitals where they are known as outliers'. I understand that the bed in the private sector costs £500 a night which is more expensive than an NHS bed and the NHS has to pay for the bed.

However, all our patients who go to these hospitals complain that the care they receive is poor. Their medication needs are just about met but they are excluded from group and occupational activities and the staffing ratios are poorer than in the NHS. More importantly they are patients we know well who have been treated by a team they do not know and over whom we"--

the people who know them--

"have no control."

In south-east London, more than 43 per cent. of spending on medium secure beds is now in the private sector. Often, beds are more than 100 miles away, making a mockery of community-based care. A private bed costs between £80,000 and £87,000 a year and a national health service bed in a medium secure unit about £70,000 a year, but with a much wider range of support services. The situation in south-east London is critical, with four times the national average number of people suffering from serious mental illness.

I shall happily give way if the Minister will now give an undertaking that the bid by the Southwark, Lambeth and Lewisham health commission for an additional 45 medium secure beds for south-east London will be funded when the bid is considered by South Thames regional health authority. I see that he is not rising to his feet to give the people of south-east London that assurance. For those who doubt the oppressive hand of bureaucracy, I shall quote the words of a local general practitioner:

"In the inner city most of us do not have the premises to promote the Government Policy, and where the premises are available the time factor is still a problem. We are having to spend more and more of our time in form- filling and every week we are bombarded with new forms and charters.

Instead of treating patients we are subjected to magazines from Health Authorities and Hospitals who are fighting for our custom with pretty pictures of their staff. All this bureaucracy costs money, but obviously the patient . . . is the least person to be considered." Waiting lists for treatment are lengthening. If I take again the example of my area, that covered by the Lambeth, Southwark and Lewisham health authority, as the number of available beds decreased between 1991-92 and the present by nearly 400, so waiting lists increased by 1,700, with an especially marked increase in the number of patients waiting up to one year.

That illustrates another piece of illogicality in the Government's policy about which they have chosen to do nothing--the problem created by the substantial increase in the number of emergency admissions. It is a national problem, which is biting especially hard in London, where hospitals are reporting as much as a 17 per cent. increase in emergency admissions.

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