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A constituent who contacted me earlier this year had his hernia operation cancelled five times. He was suffering increasing pain. The explanation that he was offered by King's went as follows:

"Mr. D. was placed on the waiting list on the 9th of November 1993 and was first offered a date in December for his operation which unfortunately had to be cancelled as did two subsequent admissions planned for early February 1994 due to the extreme pressure on beds caused by very high numbers of emergency admissions and continuing problems caused by beds occupied by patients awaiting assessment by social services unable to be discharged."

As the proportion of emergency admissions increases and the proportion of elective admissions decreases, hospitals need more beds to deal with the fluctuation in demand that is an inevitable part of handling pressures arising from emergencies.

In south-east London, bed occupancy regularly runs at between 96 and 98 per cent. That places an intolerable burden on the hospitals, which is evidenced by long trolley waits and the cancellation of patients' operations. By general consent, 85 per cent. bed occupancy is regarded as a manageable target.

Such a situation completely disrupts clinical priorities. Increasingly, patients will be referred as emergencies, because that is felt by GPs and patients alike to be the only sure way of getting into hospital, even if it involves the prospect of a long wait in casualty. It means that elective patients will wait longer, as evidenced by the figures provided to me by my local health authority.

The prospect is that there will be two routes whereby patients will be treated electively. They will be treated if they hit the 18-month wait that requires them to be admitted by the patients charter, or if they suffer from a condition that can be treated by day surgery, which is cheap and offers high-volume turnover. Patients are therefore confronted by the absurdity that their bunions may be treated--because they can be operated on on a day surgery basis--but they may have little prospect of getting their hysterectomy done on an elective basis until they become an emergency, or until they have waited for 18 months.

Long waits are tackled only at the expense of patients who have waited for a shorter time. That is a complete abandonment of the principle that patients should be treated according to their clinical need. It is not even as if the hospitals do not have the capacity to treat the patients. The problem arises only because their capacity is determined artificially by the purchasers and the contracts that they negotiate, not by the length of the waiting lists or the number of patients who need to be treated.

Even where it is shown that hospitals could produce another 10 to 12 per cent. in activity, which would make a substantial inroad into increasing the number of patients treated and therefore taken off the waiting list, and even though the hospitals have the capacity, they are prevented from treating those patients, even where they could do so at marginal cost. So a hospital that is "over-performing" by, for example, 10 per cent., but overspending by a fifth of that--which is increased productivity even by the Government's standard--is forced into the madness of closing wards to reduce expenditure instead of opening them to deal effectively with the increased demand. Why? The answer is, because the purchasers have no more money.


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Such is the public apprehension and fear that nothing is now safe from the Government's arbitrary hand, that the Government have succeeded in turning "save our" into the two most potent words in the nation's political vocabulary.

Guy's, just the other side of the Thames, is a world-class hospital and pivotal local hospital, yet for the past eight months it has been blighted by the prospect of its accident and emergency department and acute services being stripped away. Philip Harris House, with its state-of-the-art facilities, is confronted by the prospect of never opening for the purposes for which £140 million of public and charitable money was raised. Dulwich hospital, a much-loved local hospital used by my constituents, is threatened with closure at the same time as people wait on trolleys at King's along the road because there are no beds to which to admit them.

This debate is yet another opportunity to ask Ministers to listen; to ask them to venture out of their world of fantasy to accept the reality that confronts patients and staff every day.

Let me finish with an especially brutal piece of reality, which recently came to me in a letter from another GP who serves many of my constituents. He said:

"I was in H.M. Forces when the National Health Service commenced and could not wait for demobilisation to join, I wished to be part of this brave new world. Sadly, in August"--

this year--

"I was glad to leave the National Health Service disillusioned and demoralised at what the present Government has done to my dream." 7.58 pm

Mr. Andrew Rowe (Mid-Kent): I am somewhat between a rock and a hard place. If I do not make it absolutely clear that I am married to a non- executive director of a health trust I shall rightly be castigated for having concealed that material fact from the House. If I make that fact clear, I shall be given hell when I get home because my wife--who has spent most of her professional career working in the national health service, who currently holds a senior position in the Centre for International Child Health, who has made her way in the health service entirely due to her own efforts and who has earned a considerable reputation therein--will tell me that I have no business dragging her name into a debate on the health service as though she were some sort of appendage of mine.

My wife is a non-executive director who obtained her position entirely on her own merits in a trust that has behaved in an exemplary way, which should be widespread throughout the nation. The trust advertised for non- executive directors and had a thoroughly open selection procedure as a result. That is the right way to proceed and I hope that it will become a widespread practice. As trusts become established, the public interest in them grows and popular support for them grows. We can expect good people to apply for positions on trusts.

As always, I listened with great attention and care to the hon. Member for Dulwich (Ms Jowell), who made an eloquent and telling appeal for her constituents. Her speech suffered from only one weakness in that it had no historical perception. I used to live in the constituency


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that the hon. Lady currently graces. I vividly remember that a number of people whom I knew, including my daughter, went to local hospitals and found them in considerable difficulties--one of them was not particularly clean--which meant that visiting them was not a happy experience.

The idea that financial constraints leading to the closure of beds or wards is a new phenomenon resulting from the reforms is a joke. Of course it is true that, in a health service the size of ours, which has growing difficulties for a variety of reasons--the instability of family life, the growing violence on the streets, the enormous increase in the use of drugs- -inner city areas come under immense pressure. Far from blaming the shortcomings on the reforms, we should realise that the reforms present the only way of meeting the vastly difficult challenges that have not been satisfactorily met under the old system.

Ms Jowell: I have to correct the hon. Gentleman. Both King's College hospital and Dulwich hospital have beds that are closed only because the purchasers do not have the money to fund their being open.

Mr. Rowe: I understand that perfectly. I am saying that that phenomenon is not a direct consequence of the reforms, but existed long before the reforms. The demands on the national health service have always outstripped supply and always will. At some stage, some form of rationing, however it is done, has to be introduced. One method that used to be used across the nation was to close wards and make doctors and others useless. If that still happens in some parts of the country, I very much regret it, but it has diminished considerably and is not nearly as common in my part of the country as it used to be, largely as a result of the reforms.

I approve of the reforms for many well-rehearsed reasons. They have enormously increased the transparency of the costings. We have a much clearer idea of where the costs lie in the national health service. It is not enough emotionally to suggest that because we know where the costs lie we are somehow uncaring. In the old days, because one did not know where the costs lay, it was a matter of pot luck whether a health authority spent money on one thing or another. At least now it is possible to make rational decisions about the likely demand for services and to go for as good a deal for the national health service as possible.

I approve of the reforms and believe that we have a much tighter management as a result. I can give one small but telling example. Before the reforms were introduced, beds tended to belong to a specialty. If there were empty beds in one part of a hospital, there was a complicated system of negotiations about whether some other specialty could use those beds. It is now accepted that the beds belong to the trust and, as a consequence, there is much better and more effective use of them. In the trusts that I know well, there is infinitely greater co-operation between the various clinical directorates than there was under the old system, where many consultants were prima donnas for whom bed ownership was one of their status symbols.

In many parts of the country--certainly in my constituency--there is now better co-operation between the social services and the trusts. The hon. Member for Dulwich may have an added problem because her local social services are not adequately managed and have not forged the


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sort of links with the hospitals that make it easy for patients to move satisfactorily from hospital into community care.

Ms Jowell: The hon. Gentleman is well versed in the working of the community care reforms, so he will understand the particular problems that the London borough of Southwark has in two respects. First, it has among the smallest proportion of long-stay beds for elderly people, whether in the private or voluntary sector, of any authority in the country. Secondly, the Government's stricture that 85 per cent. of special transitional grant be spent in the independent sector discriminates heavily against inner city authorities such as mine, which has virtually no private domiciliary provision. People stay in hospital simply because there is not adequate support for them when they go home.

Mr. Rowe: I accept what the hon. Lady says about her constituency. I wonder whether some of the difficulty of obtaining private sector provision within the local authority stems from the endemic hostility to the private sector that characterises boroughs such as hers. One aspect that is not a direct consequence of the reforms but has enormously helped the reforms in Kent, has been the evolution of doctors' co-operatives such as Meddoc and Maiddoc for the provision of out-of-hours service. That has not only enormously improved the provision of out-of-hours service, with tremendous public acceptability, but has meant that GPs have become accustomed to working together. In my part of the world we are seeing some exciting developments as a direct consequence of the GPs' growing confidence and trust in one another.

The hon. Member for Wolverhampton, North-East (Mr. Purchase), who is not in his place now, but has been here for most of the debate, spoke in Question Time about nurses being forced to undertake medical procedures that were putting them under stress. I have no doubt that that is a stressful business for some nurses, but for many more nurses it provides an opportunity to put into practice their professional skills at a level from which they were hitherto barred due to the unwillingness of the medical profession to trust them. The upgrading of the nurses' job and the growing trust in their capacity to do a range of tasks frees doctors to do other things that only they can do.

I believe that the royal colleges should accept this sort of development and should have much more confidence in a more flexible approach to new ways of guaranteeing quality. Sometimes in the past, their ways have been too rigid. For instance, the ratio between the number of consultants and the number of those in grades below consultant needs to be reviewed. Trusts could often make much better use of their facilities if we did away with a rigidly handed down formula for that ratio. A flexible formula would help the reforms to drive forward.

In a smaller and perhaps less significant way, the NHS reforms have been vindicated by the sharp falling off in the number of complaints about the NHS which I, as a constituency Member, receive. Complaints against GPs in Kent have remained remarkably static, although there has been a slight increase this year. I believe that the trusts have responded much more swiftly and effectively to patient complaints than did their predecessors.

One of the troubles with our parliamentary system is the built-in need for the Opposition to see the glass as half empty and for the Government to see it as half full.


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In the complicated, difficult and challenging environment of the NHS, the Opposition should be much more generous about what is going well and we, perhaps, should be even tougher on what is going wrong. I am encouraged to discover that the proportion of staff delivering direct care rose from 60 per cent. in 1981 to 66 per cent. this year. The right hon. Member for Derby, South (Mrs. Beckett) went on and on about the number of managers in the service, but she failed to say whether clinical directors are to be regarded as managers, or whether nurses who have taken on the management of their peers are to be regarded as managers. I think that practice managers in general practices often take a tremendous load off doctors, leaving the latter free to do what they want to. I do not therefore regard such management statistics as either valuable or threatening.

As for Doctor Macara's anxiety, it is interesting to note that although Bevan, the architect of the NHS in legislative form, felt that he had been held over a barrel by the consultants, at this moment it happens to suit the Labour party to take up that same vested interest and support it to the hilt whenever it wants to complain about how the reforms are working.

An Opposition Member--I forget which one--made a great song and dance about some of his patients having to travel 14 miles. I have spent most of my time in Parliament pressing for the reform of NHS hospitals in London, because constituents of mine, far from having to travel 14 miles, need to go as far as 55 miles for care because of the gross over-provision in London of many services that could easily be delivered locally. Thanks to the reforms, we are at last getting a better deal for Kent than ever before.

On the whole, I think that fundholding is good for patients. There has been a remarkable diversification and generous provision of a variety of services for patients. This has been good for GPs, who have suddenly discovered that they really have a say in the purchase of health care--but I urge the Minister to be careful. It is a worrying fact that the number of GP trainees in Kent has fallen and that, from being top choice, the job of GP has moved well down the ladder. That is partly because of the general upheaval in the service, but it may also have something to do with how fundholding is perceived. We need to take a careful look at that.

We need also to take care lest some of those who are considered for fundholding in the next wave prove not to be up to the standards required to run their own show that we would expect. It would be a grave disservice to the fundholding initiative if, in our enthusiasm for spreading what has been widely accepted by the first wave, we find ourselves rushing into the next wave too quickly.

I have one final anxiety about fundholding. I get the impression that the Government have been slightly surprised by the enormous popularity of fundholding and the drive to increase the number of fundholders. The consequences for trusts and for purchasing authorities have not been completely thought through. Some of my local trusts have been operating extremely well with relatively slim budgetary surpluses. Just as a roll-on roll-off ferry does not need much side-slip to go over, if one of the big co-operatives of fundholders suddenly decided to take its services elsewhere, that could cause quite a severe list in the ferry, or trust.


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I am whole-heartedly behind the national health service reforms and I am entirely in favour of fundholding, but I hope that the Minister can reassure me that he will watch carefully to see that well-managed and effective trusts are not suddenly blown off course by a shift in GP fundholding purchasing.

8.17 pm

Mr. Bill Etherington (Sunderland, North): I am pleased to be able to take part in this debate, especially after the long recess. I feel rather sad and a little angry about the somewhat sanctimonious contribution by the Secretary of State today. In many ways, it was not worthy of such an important subject.

Several speakers in the debate have shown great expertise. We have heard from GPs and from people with backgrounds in nursing and social services. I do not pretend to have that sort of expertise. What I can do, however, is to bring some of the concerns expressed by my constituents to this Chamber.

Of all the subjects that are causing concern at the moment, the plight, or fate, of the NHS is uppermost in most people's minds in my constituency. My constituency and the adjoining one, Easington--I see my hon. Friend the Member for Easington (Mr. Cummings) in his place--were classified in a study carried out not long ago as two of the five worst areas in Britain for long-term illness. Taking 100 as an average, the Easington area was allocated 191.24 and the Sunderland area 154.61. That is the paramount factor in people's perceptions of the sort of service that they are getting. It may not seem too bad when bed cuts are prophesied for areas where standards of health and of living are reasonably high. But that is not the case in Sunderland or anywhere in the north-east.

We all know that the regional health authorities and hospital trusts have become much more oriented towards public relations exercises than they are towards service to the public. That is most noticeable in my part of the world. There is a plethora of glossy magazines, and rather poor stories are gilded as much as possible, but the health authorities and the trusts are signally failing to persuade the public that what is proposed is for their benefit. People's suspicions have reached great heights in the north-east. Fairly recently a petition carrying 11,000 signatures of people opposing the regional health authority's proposals was presented to Sunderland health authority. That petition speaks for itself. The signatures were obtained not by people going from door to door but by people standing in a marketplace on a Saturday, talking to people at random and explaining the situation.

Following consultation, there was a public meeting on 29 September. I had the good fortune--or the misfortune, depending on how it is viewed--to attend that meeting, and I was rather sad to learn that, in essence, the public consultation exercise had been a total sham. The House may be interested to know the sort of people who supported Sunderland health authority's proposal to do away with 200 hospital beds. It was supported by Sunderland university, which is a quango; by the Cumbria ambulance trust, another quango; by the Freeman hospital at Newcastle, which is also a quango; by Priority health care, Wearside, which is one of its customers; by South Tyneside health care trust, a quango; by City hospitals trust,


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Sunderland, another customer; by Durham health commission; by Easington joint commissioning board, which is another quango; and by the South of Tyne health commission, which is yet another quango. All the other bodies that were consulted objected to the proposal, but no one has taken the slightest notice of them. As the business plan was being proposed at the meeting of Sunderland health authority on 29 September--I call it a business plan because that is what the health authority calls it, with no mention of patients--the general practitioners' representative, Dr. Pam Wortley, said that GPs were concerned that if the 200 beds were phased out, there would be no practical alternative but to improve primary health care facilities. One of the rather worrying factors mentioned by Dr. Wortley was that many more GPs would be needed to deal with the increased need for primary health care. In principle, that is excellent--no one would dispute that--but in Sunderland recently there were 30 vacancies for GPs and only 14 were filled. Many members of the public who attended the meeting were shocked by what Dr. Wortley said.

The basis of public disquiet is that there do not seem to be any good alternative proposals. Prime Minister Herbert Henry Asquith used the immortal term, "Wait and see", and that is what Sunderland health authority is telling Sunderland's citizens. That is not good enough and it is unacceptable.

All sections of the public were vehemently opposed to the authority's proposals, but the impression is that bodies of people, whether they form hospital trusts, regional health authorities or local commissions, have been appointed to carry out the instructions of the appointer. That is what it is all about and it does not matter what political party the appointees belong to or how admirable or knowledgeable they are: they are placed there to do as they are told.

In the north-east, the various quangos are staffed by a pool of interchangeable people, some of whom sit on more than one quango. Someone can be a member of a hospital trust and of a regional TEC or a member of Tyne and Wear development corporation and the chairman of a hospital trust. The Secretary of State spoke about Islington dinner parties. I do not know about those, but I know a clique when I see one, and that is what this business is all about. People recognise that and they find it totally unacceptable. Political ramifications have nothing to do with it: I am talking about people who congregate to form a clique that is undemocratic and answerable to no one in the locality. Generally, they are fairly well paid for their services. I agree that the idea of public service is admirable, but in this case such service is also paid for, and that sweetens things a little.

Mr. John Cummings (Easington): I am grateful to my hon. Friend for giving way because it is difficult to take part in a debate while carrying out the duties of a Whip. My hon. Friend mentioned Easington joint commissioning board. Perhaps I could relate an incident that occurred some months ago, and which has not yet been resolved. An infirm lady of 77 was discharged from Ryhope general hospital into the community. Twice a week, she has to take a taxi costing £2 to a private residential home, where she pays £3 for a bath. She is then turned out into the street and has to take a £2 taxi ride back to her home. The matter has been raised with the joint commissioning board


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but we are no further forward. Of course the board has established working parties between itself and social services--

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. I am feeling fairly tolerant, but the hon. Gentleman is going on a bit. Interventions are supposed to be brief.

Mr. Cummings: Those are the problems that we encounter when dealing with quangos, joint commissioning boards and other bureaucrats who take no notice whatever of elected representatives.

Mr. Etherington: I appreciate the intervention of my hon. Friend the Member for Easington because people in his constituency make full use of the facilities in Sunderland that I have mentioned. I am pleased that you exercised tolerance, Mr. Deputy Speaker, although I have no doubt that it will shorten my speaking time. The story told by my hon. Friend is but one of many gruesome tales. People perceive what is happening because of the bureaucrats, the great and the good, who are appointed by the Secretary of State for Health.

I should like to read a short extract from a letter by Dr. R. N. Ford, the chairman of Sunderland local medical committee. He is almost a model of moderation and his letter was published in the Sunderland Echo on 7 October. That letter states:

"I can assure you that local GPs have been very active indeed. We decided to pursue a policy of quiet but firm diplomacy in our negotiations with Sunderland Health Commission and the Sunderland Hospitals Trust management in the hope that this would prove to be in the best interest of the patients under our care.

Unfortunately, we now believe that this has been unsuccessful, and our views have gone essentially unheeded . . . now we have the issue of bed closures looming.

For your information, GPs are overwhelmingly opposed to the business plan proposed by City Hospitals, and in particular to the savage cuts in bed numbers."

For the benefit of Conservative Members, I should say that Dr. Ford is not some unreconstructed Marxist but a general practitioner in a responsible position looking after other GPs and the interests of patients whom they serve.

I know that time is short and that two of my hon. Friends wish to speak, but I should draw attention to one important factor that came to light recently. When the local hospital trusts were trying to point out how little they spent on bureaucracy, they cited two figures that made it appear that very little was being spent on management and administration. However, one can work out from the numbers employed that it costs £24,000 to employ a member of the nursing staff, with all the services that such staff provide, and £38,000 for the provision of one member of staff in management. That throws a different light on matters.

We have a contrived market which hides the fact that Britain does not spend enough on health care. We spend far less than many of our European Union competitors and about half what is spent in the United States. Of course, if money is well spent, what matters is not always how much is available but how the sum is used, and, by and large, the national health service has been successful. No one would suggest that we should never look for improvements, but we should not do so by contriving an artificial market, by creating more management jobs and well-paid jobs in hospital trusts and by setting up a bureaucratic unaccountable quango.


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Having followed developments in Sunderland fairly carefully, I have reached the conclusion that hospital trusts are behaving like asset strippers by closing down premises and moving everything into one unit. Sunderland general hospital has tremendous parking problems. There are many complaints from people who live locally who cannot get into their homes during hospital visiting hours. That has not been helped by the fact that the quango has decided to charge people who visit the hospital for the pleasure of using the car park. Yet the trust is considering extending the premises and putting more hospitals on the same site. That makes no sense whatever and is causing public disquiet among those who live in the area and those who have the misfortune to travel there by motor car. The reason given for charging for parking was to improve security. That has not been successful. My hon. Friend the Member for Jarrow (Mr. Dixon) was told today that his wife's car has been stolen from the car park where security is costing so much money.

We are dealing with a business where patient care is very much secondary.

Mr. Chris Mullin (Sunderland, South): Before my hon. Friend leaves the subject, does he agree that one of the main concerns about the radical changes taking place in Sunderland hospitals stems from a feeling that there are not the facilities at the general hospital to deal with the greatly increased demand and also that there are not the facilities or resources to provide the community care that will be necessary if those extremely radical plans are carried out?

Mr. Etherington: I agree with my hon. Friend the Member for Sunderland, South (Mr. Mullin), who has been very active on the subject, as have other neighbouring Members. I can do no better than to quote to my hon. Friend what Councillor Louise Bramfitt, who is chair of the social services committee of Sunderland city council, said recently. She asked whether the money to be saved from the bed closures would be handed over to the social services department. We all know the answer to that: probably most of the money will find its way back to the Treasury. That is also causing concern.

I will finish off with one personal matter. Recently, an old uncle of mine who is 84 years old had the misfortune to be knocked over. He was taken to Sunderland general hospital, where both the treatment he was given and the way in which I was received when I visited him in casualty were absolutely superb. I can pay no greater tribute than to say that no person on earth does a better job than someone who looks after the health of others and protects their lives. It was magnificent.

I was not so pleased when it was time for my uncle to come out. I did the reasonable and civilised thing and offered to take him home. The sister on the ward was only too pleased to accept my offer, but I still had to pay to park to save the trust a little bit of money. That was deplorable and should not be tolerated in civilised society. There are many poor people in Sunderland as there is high unemployment. People have enough problems paying for transport to visit their loved ones in hospital without the added burden of having to pay for parking. If the Secretary of State has any heart at all, she will take some action. I hope that she will.

When the Minister meets my hon. Friend the Member for City of Durham (Mr. Steinberg), who happens to be my constituency Member, I hope that he will also meet


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me, along with my hon. Friends the Members for Sunderland, South, for Easington, for Houghton and Washington (Mr. Boyes) and for Jarrow, and everyone else who is concerned about the abysmal situation in Sunderland.

8.34 pm

Mr. Michael Carttiss (Great Yarmouth): I was intending to make a fairly gentle contribution to this important debate, but I am emboldened by my hon. Friend the Member for Mid-Kent (Mr. Rowe), who said that we should be tougher about what has gone wrong. My hon. Friends the Under-Secretary of State and the Chief Whip know that last November, at the beginning of this parliamentary year, I advised them both that I could not support the Government in any health service debate for the rest of this Parliament, and I shall explain why later on in my observations.

Tonight, I have no hesitation in coming to the Chamber not only to support the Government's amendment, but actually to speak in its favour. I do so though I have much sympathy with some of the comments that I have heard from Opposition Members, particularly the hon. Member for City of Durham (Mr. Steinberg), who is not here momentarily and who allowed me to interrupt his speech.

I cannot comment on what the hon. Member for Sunderland, North (Mr. Etherington) said about Sunderland, but I certainly share some of his concern about the method of appointment to the hospital trusts and the cliques to which he referred in Sunderland. I am sure that Sunderland is not alone in that experience.

The one feature of the debate that causes me to run fast and furious into the Government Lobby tonight is the reference in the motion tabled by the right hon. Gentleman the Leader of the Opposition and his right hon. and hon. Friends, which talks of "public alarm at the creeping privatisation of the National Health Service".

I would not like it to be thought by anyone who cares to read or listen to what I say that, by being silent in this debate and keeping out of the Government Lobby, as I have in every health service debate since last November for reasons that I shall explain later, I could in any way be associated with the claim by the Opposition that there is any such thing as a "creeping privatisation" of the national health service.

My right hon. Friend the Prime Minister, in his speech at the Conservative party conference, explained and reiterated his commitment to the national health service, which he explained at the party conference and throughout television, as it was reported widely on the various channels in the late news.

Speaking from personal experience, my right hon. Friend the Prime Minister said:

"Believing, as I do, that the greatest nightmare for millions is that one day they might be old, sick, poor, and uncared for, is it really likely that I would take away from people the security of mind that was such a comfort to my own parents? I can tell you--not while I live and breathe".

I am pleased to echo and quote the words of my right hon. Friend the Prime Minister in once again nailing the lie that is promoted up and down the land and has been repeated here. I believe that Opposition Members who sometimes repeat it genuinely believe it. Most of them are


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not making speeches for the sake of party politics. I believe that the vast majority of Opposition Members who have spoken in this and other debates are committed to the health service.

They believe that the Government have a hidden agenda. I reject that assertion, even though I understand that some of them sincerely believe it. Of course, others know that it is not true; they make their comments for party political reasons after they have posted their cheques to some private health care scheme or paid their subscriptions to their unions, which in turn take out private health care for their members.

My right hon. Friend the Prime Minister was speaking from his personal experience and that of his elderly parents. If my mother were alive today, she would be up in the Gallery thinking, "How on earth did I breed someone who is mixing it with all these people? Why doesn't he get himself a decent job?" Of course, my mother is not there. She was not there when I made my maiden speech in 1983. She was not there when, at the age of five, I went to Filby village primary school. She died of tuberculosis in Norwich when I was three years old, before the national health service existed.

I lost my mother when I was three without ever really knowing her, because in those days tuberculosis was a deadly disease. I was taken away from her and brought up by my grandfather because they were afraid that I would catch tuberculosis, which was an horrendous disease. Of course, if someone had money he did not die--in fact, he did not catch it. [ An hon. Member:-- "It is the same."] It is not the same.

I am convinced that, if my mother had caught tuberculosis in her late 30s-- by which time there was a national health service--rather than in her late 20s, she would have been treated and she would be here today. I apologise to hon. Members for wearying them with a personal story, which does not require any sympathy. I state it merely as a similar experience to that of my right hon. Friend the Prime Minister. It explains my commitment, which I believe is shared by the vast majority of Conservatives, to a national health service free at the point of delivery.

Many of the reforms that my right hon. Friend the Secretary of State and her team have introduced have been to the benefit of patients. My hon. Friend the Member for Wimbledon (Dr.

Goodson-Wickes) concluded his speech by saying, "I speak as a doctor, and I speak as a politician." I speak as a patient and as someone whose uncles and aunts--brothers and sisters of my late mother--have benefited from the national health service. I speak as someone who would not dream on principle of taking out a private health care scheme. I do not believe in them, but equally I do not believe that we should stop them.

I believe in a society in which those who, rather than buying a new car, want to take out additional personal health care insurance, are encouraged to do so. That happens with Labour Members as well as Conservatives. However, that is not for me. My national health service hospital is good enough for me, it is good enough for my constituents, and it is doing a great job.

I recently had a letter from a constituent in which he voiced his concern about the Government moving towards privatisation of the NHS. There is a fear throughout the country that we have that agenda. He was concerned because he had read an advertisement for a private health care scheme that said, "Don't wait in the queue. Avoid


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long waiting lists." He interpreted that as meaning that private health care patients were taking a higher place on the waiting list at our local hospital, with the result that he was having to wait longer.

In fact, the James Paget hospital, which serves the Great Yarmouth, Waveney and Mid-Norfolk constituencies, has just six private beds. It is a large hospital, which my hon. Friend the Under-Secretary has visited at least twice during the past three years. He knows that it is a great hospital. Those six private beds are not available to the NHS, but they do not keep NHS patients out of hospital. Instead, they bring a profit of £250,000 to my constituents who use NHS facilities at that hospital.

I wish that we made more of the fact that private health care is something for those who want it. We should not say that, because many of us cannot afford it, no one should have it. Those six beds bring in a profit of £250,000--

Mr. Bayley: Can the hon. Gentleman tell us how much it costs to treat patients in those private beds? I ask that because the Government are unable to give figures for the cost of treating NHS patients. How can the hon. Gentleman tell whether that £250,000 is a profit or a loss when set against costs?

Mr. Carttiss: I cannot answer the hon. Gentleman's question now, but I will find out the answer and let him know, because it is an interesting point.

I am quoting the figure given in a letter from the chief executive of the James Paget hospital. He specifically refers to £250,000 in the hospital's budget that is profit from the use of private facilities at the hospital. That sum is then reinvested in direct patient care services. He writes:

"This is another way of saying that if we did not have that sum then the services at the James Paget Hospital would have to be cut by that same amount."

Marrying the private and public sectors is a recipe for success, which I believe is to the advantage of everybody. That is certainly true in my constituency, as can be seen from that example. However, in supporting that, hon. Members should not assume that the Government are intent on privatising the NHS, as the Opposition's motion suggests.

I said earlier that I had some sympathy with the comments of the hon. Member for City of Durham. I also picked up one or two points made by the hon. Member for Sunderland, North about hospital trusts. I welcome the Government's statement that they will continue to appoint the best possible people to trusts. There is a great deal of nonsense about whether they are Conservative or Labour. There must be some political balance, but the important factor is to get the right people.

I was sure--the hon. Member for City of Durham more or less admitted it-- that the hon. Gentleman had a good relationship with the two Conservatives on his local ambulance trust. He acknowledged that they were very good. I have a good relationship with the Labour members of my local hospital trust, who do a good job.

The local Labour party opposed setting up the trust, but, the next thing I knew, the wife of the chairman of the British Medical Association's local branch--a Labour councillor and a former nurse--was one of the first people


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in the Labour party to accept an appointment to the trust. We welcome one sinner who is converted rather than 99 already on our side.


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