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Mr. Bayley: Let her speak for herself.

Mr. Carttiss: That lady did not have to accept the appointment if she was so solidly opposed to the trust. I am trying to make the point that it is good that there are Labour members serving on the trust. She was selected by the other trust members not because she was a Labour councillor, not because her husband was chairman of the local BMA branch, but because she was identified as a young woman who could contribute to the hospital trust. I welcome that. I wish that we heard more speeches from the Opposition of the kind made by the hon. Member for City of Durham, who paid tribute to the fact that some people were doing a good job, and that his objection was to the way in which they were appointed rather than to who they were. That is an objection which I share.

The Department of Health is drawing up new guidelines with a view to implementing them across all regions next year. The system will be transparent and the procedures clear to potential candidates for membership of NHS trusts. It will be accessible to people from a wide range of backgrounds. I understand that there will be advertisements at regional and local level to allow access to vacancies. I hope that the hon. Member for York (Mr. Bayley) will pursue that point further.

There is much to be done about NHS trusts. A man has just been appointed to the Anglian Harbours NHS trust in Great Yarmouth and Waveney, replacing the Tory chairman, who was a county councillor. That is an example of the Government dispensing with the services of a first-class Tory councillor and producing someone from goodness knows where. No one in Yarmouth and Waveney, including the two Members of Parliament, has ever heard of him. I was sent his name and asked for my comments. I said that I did not know him, and therefore did not think that he was suitable, and asked what was wrong with the existing chairman.

The chairman of the Anglia and Oxford regional health authority--we have a huge region looking after my constituency, based in Oxford--decided that that man was the right one for the job. He may well be, but that is not good enough for me. [Interruption.] I see the Whip indicating something, but I will ignore him, because I have not made the point that I came here to make. That is that, having dispensed with the nonsense in the Opposition's motion about creeping privatisation, which brings me back on side with the Government tonight, I come now to another phrase with which I do have some sympathy--lack of accountability.

Everyone in Great Yarmouth and Waveney was consulted about the proposal to merge half the Great Yarmouth and Waveney health authority with the Norwich health authority in order to complete the new purchasing body. Waveney, which had been united with Yarmouth as one health authority or grouped hospital administration unit ever since the NHS was set up, was taken away from the Great Yarmouth and Waveney health authority, and placed with Suffolk health authority. That was interpreted locally as meaning that hospital services for people in Lowestoft, represented by my hon. Friend the Member for Waveney (Mr. Porter), would have to go to Ipswich. That was never a reality.


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Repeated reassurances on that point were given, but 90 per cent. of the bodies and people consulted last year came down in favour of the Yarmouth and Waveney health district continuing. As a secondary fallback position, those people were prepared to accept, as part of the general reorganisation of district health services, the merger with Norwich.

In October, I brought to the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville) a deputation of doctors and clinicians and other people, to present the virtually unanimous view that merger was okay, but that there should be no separation. My hon. Friend rejected that. On 8 December, in an Adjournment debate, we repeated our claim.

On 3 March 1994, with my hon. Friend the Member for Waveney, I brought another deputation from Great Yarmouth and Waveney, and pleaded with my hon. Friend the Under-Secretary to reconsider his decision. One reason for that decision had been the need to relate the health service purchasers to the providers of social services. The argument was that the boundaries of the health authorities had to be related to the social service providers, Suffolk and Norfolk county councils.

I told my hon. Friend that the Local Government Commission was coming to Norfolk and Suffolk to review the future of local government, and that there was a strong possibility that it would recommend the merger of the Great Yarmouth borough council and the Waveney district council as a single -tier authority and a social services provider. We asked the Government to wait for the Local Government Commission's report and the response to it.

In July, the Local Government Commission recommended five unitary authorities in Norfolk, one of which was to be the Great Yarmouth and Waveney authority, crossing the county boundary. There we had the possibility, if the Local Government Commission's original recommendation was accepted, of a new social services provider, knocking on the head one of the arguments that my hon. Friend the Under-Secretary had advanced for separating the two. That is the sort of nonsense that gets the Government a bad name and which underlines the lack of accountability of the decision makers.

If the population, the chambers of commerce and the district bodies had been split half and half in favour of the Minister's proposals, or even 40 per cent. in favour and 60 per cent. against, my hon. Friend could have said that the 60 per cent. were people who did not know what they were talking about. But in Waveney and Yarmouth the decision was almost unanimous, that the authority should continue to be one district, albeit merged with Norwich. My hon. Friend rejected that.

Where is the public accountability in that? Where is the public accountability in the appointments that my hon. Friend has made to the East Norfolk health commission? Where is the public accountability in sacking the first-class chairman of the Anglian Harbours NHS trust, who happens to be a Conservative county councillor, and replacing her with someone who is completely unknown?

I fear the same debacle that we had when a complete unknown was appointed to be chairman of the James Paget hospital trust. He was a man resident in the constituency of the Parliamentary Secretary to the Treasury, my right hon. Friend the Member for Mid-Norfolk (Mr.


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Ryder). No one in Yarmouth or Waveney knew him. What did he do? He gathered together all his friends, none of whom lived in Great Yarmouth or Waveney and only about two of whom had any connection with the catchment area of the health service provision at the James Paget hospital.

Within a few weeks, the then Minister for Health, who is now my right hon. Friend the Secretary of State for Transport, wanted to sack him. Eventually, happily, the man resigned, in much the same voluntary way as my hon. Friend the Member for Tatton (Mr. Hamilton) did today.

We are getting more accountability, but not enough. Therefore, I welcome the statement made my right hon. Friend the Prime Minister this afternoon about examining all these matters. Why on earth is there such a fuss about a published list? My right hon. Friend stood at the Dispatch Box and announced half a dozen members of the Labour party. Opposition Members asked how we know that they are Labour members. The answer is obvious.

Why not have a full list? What is so secret about the people who sit on quangos? I do not take the view that they should be elected, or that they ought to be in local authority service. After all, the Crossman reforms, which the Conservative party implemented, established area health authorities based on counties, and district bodies within them--which took from the county council of which I was a member responsibility for all sorts of health matters that were previously the remit of elected councillors.

I do not need any lectures from Opposition Members on elected bodies, because the Labour party's Richard Crossman was the father of previous health service reforms that took some health service responsibilities from local authorities.

Nevertheless, I hope that my hon. Friend the Minister will devise a more effective and transparent method of appointing people to health service trusts, with chairmen and existing trust members having some involvement-- rather than waft a name out of a hat and telling me, "We've taken note of your comments but we will appoint this man willy-nilly."

Let there be public consultation. If 90 per cent. of the local population, doctors and others working in the service are against a regional health authority proposal and Members of Parliament, irrespective of their party, urge my hon. Friend the Minister not to abandon his plans but to leave them for a year--to see what the Local Government Commission produces before making a decision--and he still ignores us, he will have to unscramble everything again if a Great Yarmouth and Waveney social services provider emerges from the current review.

I want to continue speaking, but other hon. Members wish to contribute--and my Whips are nodding me down because they do not like anything that remotely resembles the truth. The real test of friendship and loyalty is to tell one's friends when one knows that they have gone wrong. On this particular issue, my hon. Friends know that they have gone wrong--but I will be happy to enter the Government Lobby, knowing that Opposition Members are more wrong than we are. 9.1 pm

Mr. Tom Clarke (Monklands, West): I do not regret having been in the House since 2.30 pm this afternoon so


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that I could make the point that both the motion in the names of my right hon. and hon. Friends and the Government amendment refer to patient care and the needs of patients. I do not see how we can accomplish those objectives if we do not, before the end of the debate, address ourselves to the enormous problems of care in the community, which are staring us in the face, and which did not invite even one word from the Secretary of State for Health.

Many years ago, we were told by the National Audit Office that community care was in a state of chaos. That led the former Prime Minister, Lady Thatcher, to establish the Griffiths committee, which confirmed that view and reported that the one option that was not tenable was to do nothing. Not only are the Government saying nothing, as we have seen today, but they are doing nothing--and that is entirely unacceptable.

To throw community care to market forces, which seems to be the Government's approach, is to destroy the concept of community care, is absolutely repugnant and is a great disservice to the people of our country. It is not as though the Government lack information. The letters that right hon. and hon. Members receive from constituents and representations made at surgeries show grave concern. Individual, family and community experience is something that the House cannot ignore.

Recently, I received a letter about the morale of consultants at Monklands district hospital, which serves my constituency. Having listened carefully to the Minister's reply this afternoon to my hon. Friend the Member for Wallasey (Ms Eagle) and to the excellent speech of my hon. Friend the Member for City of Durham (Mr. Steinberg), I am reluctant to reveal the names of those who wrote to me. They are enormously respected in my community-- [Interruption.] Much more so than the Minister of State, who interrupts from a sedentary position. I should be happy to give way if the Minister wishes to challenge my evidence. The evidence is that consultants in Monklands district hospital, in common with their colleagues in district hospitals all over the country, are experiencing a decline in their morale and greater and greater demands, which they are unable to meet. They reject utterly the Government's approach to performance-related pay and it being imposed on them while those increasing demands continue. I say to the Government--

Mr. Malone rose --

Mr. Clarke: I shall give way to the Minister in a second because, given the late hour, I want to go on to deal with the issue of care in the community. The Government may ignore the points that are being made in this debate, but the British people will not.

Mr. Malone: If the consultants in the hon. Gentleman's constituency are against any form of local pay arrangements that perhaps allow different levels of pay to be introduced, can he confirm that they are also against the merit awards system, which consultants elsewhere in Britain seem to back?

Mr. Clarke: I said very clearly that the consultants in the Monklands district hospital, which serves my constituency, are overwhelmingly opposed to performance-related pay. If the Minister, in his reply, can tell us how one can relate performance-related pay to accident and emergency units, or to the time that consultants in psychiatric units have to give to their patients, and one can make some


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kind of division between them and other departments, I would be very interested to hear his view. But I must tell the Minister that there is not a consultant in the country who would believe a word that he would say.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) has established a very distinguished tradition in the House of bringing to the Floor of the House and to its Committees the realities of what is happening outside. The Royal College of Psychiatrists has twice warned the Government about care in the community. I am delighted to see the Secretary of State for Health-- she no doubt came in when she saw my name on the annunciator and realised that it was not the Chancellor of the Exchequer who was speaking--so that I may repeat that the Royal College of Psychiatrists has warned twice that the present system of community care simply is not working.

Let us look at the evidence, not only that of our mailbags and what we see in our communities, but of the fact that, in three years, there have been 34 murders by patients who have been involved in psychiatric care in the preceding 12 months. We know of cases, such as that of Jonathan Zito--

Mrs. Virginia Bottomley rose --

Mr. Clarke: Would the hon. Lady wait for a second, as I would like to finish the point? There have been cases such as that of Jonathan Zito, who was a musician in the London underground. Those circumstances were followed by a report by Jean Ritchie QC, in which we saw that Jonathan Zito's death--it could have been avoided--clearly took place because proper assessment of the person who had killed him had not been acted on and that tragedy occurred.

Mrs. Bottomley: Does the hon. Gentleman agree that it is important not to inflame unduly anxiety about care in the community? The Royal College of Psychiatrists has not in any way suggested that there has been an increase in the number of homicides proportionately from severely mentally ill people. Every homicide is serious in itself, but there is no suggestion that there is an increasing trend. Does he agree that the Ritchie inquiry about Zito suggested that we needed better co-ordination and a more assertive approach to the supervision of mentally ill people in the community? That is exactly what the supervision registers and the guidance on discharge from hospital are doing and that is precisely the intention of supervised discharge, which we hope to introduce at a later date.

Mr. Clarke: I agree entirely that the recommendations of the Ritchie report ought to be taken seriously. However, I must say bluntly to the hon. Lady that I see no comparison between those recommendations and the policy that she is pursuing. I want to continue to cite other cases because the right hon. Lady appears at the Dispatch Box, and on the "Today" programme, I think, every second morning--almost as often as the God squad--and the tragedy is that she does not relate what she is saying to the real world. We have case after case in our constituencies such as, for example, that of Ben Silcock and Tony Sarumi, who found themselves in the lions' cage at London zoo clearly because assessments were being made and nobody was acting on them. As I did the Secretary of State the courtesy of listening to her intervention, she might just listen to a word or two of the remainder of my speech.


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I am appalled by the Government's complacency, which is personified by the Secretary of State and made even worse by the Minister. In September, the Government--not the Opposition-- appointed a mental health task force, and received its report. The task force said that services in London were overstretched, and that vulnerable patients were being discharged.

In a leader entitled "Care Beyond the Cages", The Guardian said: "The problem is not confined to London. Every major conurbation is facing the same challenge: Manchester, Birmingham, Liverpool, Glasgow."

We all know that to be true. Even The Sunday Telegraph --which does not rush in to support the Labour party or the trade unions that the Secretary of State derided, ignoring the fact that hundreds of thousands of their members are keeping the NHS afloat at this very hour--said, in a moving account of the story of Mary Batchelor and Graham, her schizophrenic son:

"There is a big gap between what the Government says is happening and what they see is happening."

That is what this debate ought to be about.

Earlier, I asked the Secretary of State a clear question. I asked her to tell us the number of people who are mentally ill and in prison in England and Wales. She said that she did not know. I am very glad that my hon. Friend the Member for Lewisham, Deptford (Ms Ruddock) takes her duties more seriously: she does know, because she put a question to the Government which was answered on 18 October. The answer stated that 19.2 per cent. of the sentenced population had some form of psychiatric disorder.

What does that mean? It tells us what is happening in Britain today--in England and Wales, that is; it ignores the problems that we are having in Scotland. I welcome the presence of the Under-Secretary of State for Scotland, the hon. Member for Edinburgh, West (Lord James Douglas- Hamilton), who is much more civilised than those whose company he currently keeps. I say to Ministers that for the Secretary of State to ignore the fact that 6,800 mentally ill people are in prison because the courts simply cannot find anywhere else to put them is an absolute disgrace, which cannot be excused even by her Mary Poppins-style sweetness and light on the "Today" programme. The current position contrasts starkly with promises given during health debates. I recall the Secretary of State's contribution to some of those debates, as a junior Minister. What was said when we debated the National Health and Community Care Act 1990, and even when we debated the Children Act 1989, and the glossy documents produced by the Government could not be more different from what we are seeing now. There was, for instance, the crucial issue of assessment, followed by the provision of services; the Secretary of State does not seem to have taken that on board.

There is no excuse. The Secretary of State will recall being visited in Richmond house by some of my hon. Friends, and members of another place who are interested in these matters. I went along with Brian Rix--now Lord Rix- -Lord Ashley, my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and the hon. Member for Exeter (Sir J. Hannam), to support the Disabled Persons (Services, Consultation and Representation) Act 1986. As the right hon. Lady will recall, we argued


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then that the legislation that the Government were producing was no substitute for sections 1 and 2 of that Act, which meant that there would be real representation, and that the patient of the advocate concerned would have a say in what happened to him. We have heard nothing of that theme from a single Conservative Member today. The Government talk about voluntaryism, but ignore the views of the voluntary organisations. As recently as yesterday, Enable, which was recently called the Scottish Society for the Mentally Handicapped, and Scope, which was until recently the Spastics Society, reinforced strongly the arguments that still hold for the implementation of sections 1 and 2 of the 1986 Act. I will explain why. In spite of the slogans that we have heard from the Government, there are those who are committed to the rights of citizens regardless of whether a charter exists. Why are not patients having a say? Why is there no real advocacy? In the limited time available, I shall relate one important story about advocacy.

When I was involved with many others in trying to get the 1986 Act on to the statute book, I visited one of the most excellent community care projects in Glasgow. I met two ladies who had once worked in the shipyards but who had spent 15 or 20 years in a hospital which was described as a hospital for the mentally ill. By that time, they were living in nice flats with privacy when they wanted it but support when they needed it. When I asked them what difference they saw between the hospital in which they had spent many years--I concede that it was a Victorian building--and where they were living now, one of the ladies said, "They dinnae gie ye jags." To interpret that for the benefit of non-Scottish Members, it means that they were not given injections. People are entitled to know what medication they are being given. People or their advocates are entitled to know what is happening and why. Yet, time after time, the Government give the impression that they support the principle while they do not provide the resources necessary to put those principles in operation. Following the Government's legislation, the balance of NHS and community care has shifted away from institutional care. We have seen closure after closure. However, we have not seen provision within the community of the support that is necessary if community care is to work. Some 85 per cent. of people with learning difficulties are living in the community and increasing numbers of elderly parents are looking after younger people with learning difficulties.

What of assessments? I plead with the Minister to take on board not just my view but the view of the Carers National Association, which has already told us that, although assessments are taking place, there is no action in response to the needs that are being assessed. We find young people with learning difficulties leaving school at 19 and being placed beside much older people. We find local authorities trying to deal with discharged patients and councils, which are themselves under financial seige, are cutting back on facilities such as day care services and respite care and having to introduce charges which are repugnant to them.

We are seeing a mockery of care in the community and joint planning. It will not be helped in Scotland by the fact that when the local authority boundaries are introduced in January 1996 they will not even be coterminous with the boundaries of local authorities. That is unacceptable.


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When Griffiths was asked to report and to respond to the views of the National Audit Office, he confirmed that care in the community was in chaos. That tells us something. This is a problem about people, families, communities and individuals. I want to conclude by quoting not statistics but the moving views of Jonathan Zito's widow, Jayne, in that excellent television documentary that we saw a few months ago. She talked about the death on the London underground of her husband, a musician. She talked with courage, conviction and compassion. She was not bitter. She was not negative. All she asked for was better community provision, and that is all we ask for. 9.19 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East): It is a great pleasure to follow the moving speech of my hon. Friend the Member for Monklands, West (Mr. Clarke), who brings an enormous amount of expertise and experience to this important debate.

At the beginning of the debate, my right hon. Friend the Member for Derby, South (Mrs. Beckett) said that the national health service had a special place in the nation's affections. The enduring twin achievements of the post-war Labour Government are the provision of universal education and the provision of universal health care. All institutions change over time, responding to changing needs, demography, technological advancement and even economic factors. If that were all that was happening to the NHS, the Conservative party would be able to mount some sort of defence in this debate, but that is not all that is happening.

As my hon. Friend the Member for City of Durham (Mr. Steinberg) said, the driving engine of Conservative party health service reform is political philosophy, not practical experience, common sense or even managerial efficiency. The imposition of a blinkered ideology that is wrong anyway on an organisation like the NHS is bound to lead to nothing but harm. Worse, when theory comes to practice, that ideology sinks into a quagmire of, at best, expediency and, at worst, corruption. Replacing a flawed and old- fashioned framework with a more fundamentally flawed one makes the delivery of the service difficult, unworkable in places and increasingly unfair.

A legitimate case exists for devolved responsibility and accountability. Public resources are not infinite. They have to be managed and prioritised. That is not what Conservative health care reform is about. Under the previous Prime Minister, the Conservative party had clear objectives. She had a clear vision of the future of the NHS. She was the avowed enemy of public expenditure, yet her Conservative party authorised substantial extra expenditure on NHS managers, administrators and accountants.

To use the Government's own figures and taking the period 1988 to 1993, the number of people employed in nursing and midwifery fell by 4.2 per cent. Over the same period, the number of people employed as general or senior managers has risen by 1538.3 per cent., a substantial increase. The Conservative party will say two things about those figures: first, that some of the figures are the result of reclassification; and, secondly, that the health


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service was undermanaged anyway and there was a case for appointing more managers. Both arguments have some substance.

Mr. Malone: I am grateful to the hon. Gentleman for giving way. I should not like his argument to be incomplete. He is making two important points, but there is a third: Project 2000 nurses are no longer included in the figures and there are a substantial number of them. I hope that I am helping to bolster his argument.

Mr. Brown: That goes to prove that one can be too generous in wind- up speeches. I said that reclassification accounted for part of the figure involved in this argument. Only 45 per cent. of the total, however, can be accounted for by reclassification. The transition has taken place over four years yet, last year, the number of managers employed in the NHS increased by 13.5 per cent. The Government are still at it.

The reforms are not driven by managerial efficiency alone. The Secretary of State for Health boasted about cutting bureaucracy, but the 1538.3 per cent. increase in bureaucrats is hardly evidence of that. The real purpose of the purchaser-provider split is to put a price tag on individual transactions. If the state is paying the bill, surely there is less need to have everything individually priced. But of course the original objective of the Conservative party was to alter the structure so that payment by state entitlement could sit alongside payment by private medical insurance or even by direct private purchase. Why should the British citizen want to purchase medical care privately if he is entitled to provision free at the point of need? The answer can only be because private provision will be made better than the state's; will be given more quickly; or, worst of all, will be the only method of getting treatment because the state will no longer provide it. In summary, that is what the Conservatives are trying to do to the NHS.

On BBC radio, in one of her frequent and much-loved appearances, the Secretary of State-- [Hon. Members:-- "What?"] Well, I enjoy waking up to the Secretary of State on the "Today" programme--frankly, I think myself lucky that that is where she is. On 24 August 1994, the Secretary of State said that she had "no views" about whether service should be delivered by the public or the private sector. She is supposed to be in charge of it, but she has no views about the delivery of services. I must tell the House that the author of the NHS reforms, Mark Thatcher's mother, had views. According to her, it should be private, so that she could, as she famously said, have what she wanted, when she wanted it. Other patients would like the same. That right hon. Lady told us that the health service, like the Saudi arms contract, was supposed to be safe in her hands.

Is the NHS safe in the Government's hands? Not according to the Public Accounts Committee, which has produced an important report on the proper conduct of public business. The NHS features prominently in that report. We learn from the PAC that the director of regionally managed services of the West Midlands regional health authority left on redundancy terms, after five years' service with the authority, and was given an immediate pension of £6,462 a year and lump sums totalling £81,837. Some might think that that is all well and fine, but the PAC report goes on to say:

"The Authority and the NHS Management Executive told us that he should have been dismissed not made redundant."


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Wessex regional health authority managed to waste £20 million of public money in attempting to implement its regional information systems plan, which it abandoned in 1990. The PAC reports uncompromisingly that the money should have been spent on health care for sick people.

It also levelled other criticisms at West Midlands regional health authority.

Mr. Tony Worthington (Clydebank and Milngavie): May I suggest that the PAC should also investigate Health Care International at Clydebank? Up to £40 million of public money has been given to a private international hospital, but. within three months of being opened by the Secretary of State for Scotland, it faces financial collapse. It was funded to provide for overseas patients. I tabled a parliamentary question to find out how many overseas patients it has, but, I was told that information about non-NHS patients is commercially confidential to the company. We put £40 million into that hospital; it promised not to deal with British patients, but just last week 100 patients were moved from Birmingham to Clydebank. Should not that--

Mr. Deputy Speaker: Order. That was a very long intervention.

Mr. Brown: Nevertheless, it was a very important one. My hon. Friend is quite right that that deplorable scandal should be investigated by the PAC. The Secretary of State for Scotland opened the hospital in June and said that it was an important investment opportunity, which would provide 1,800 jobs. So far, the hospital has employed 400 people, but it has had a maximum occupancy of just 20 patients. That is scandalous and represents a substantial waste of public money. It looks as though the Government will waste more public money digging themselves out of a privatised nightmare that they have created for themselves. That is precisely the sort of thing that the PAC would denounce.

Mr. Malone: Will the hon. Gentleman give way?

Mr. Brown: The Minister has not yet been denounced by the PAC, but he is no doubt anticipating it. Of course I shall give way.

Mr. Malone: I am grateful to the hon. Gentleman for giving me an opportunity to clear up this matter now. First, it was £30 million that was invested under the aegis of Locate in Scotland. [Interruption.] It is important to have put those £10 million more accurately into the argument. Secondly, this is not a health service budget commitment but a commitment by Locate in Scotland, designed specifically to attract jobs to Scotland. When I represented another constituency in a different capacity, Scottish Labour Members were keen to ensure that they devoted a maximum amount of money to projects that would attract jobs.

Mr. Brown: In her opening speech, the Secretary of State tried to gloss over that whole appalling affair as if it were attracting inward investment into Scotland. The Minister of State says that the Government have wasted only £30 million so far and the figure of £40 million is what they are planning to waste to get them out of it. If


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he thinks that that acquits him of the charges that we are making, his view is unlikely to find a hearing from an impartial audience.

Mr. Burden: Will my hon. Friend comment on my concern that the Minister suddenly seems to know a great deal about this issue whereas, in answer to a parliamentary question that I tabled last week about the cost to the NHS of transferring patients from Birmingham to Glasgow, the Under- Secretary of State answered that that was a local matter and that I should contact Mr. Brian Baker, chairman of the West Midlands health authority. Does my hon. Friend believe that it is acceptable for Ministers to say one minute that they have no knowledge and the next that they have such knowledge? Should not they know how much the national health service is wasting in that way?

Mr. Brown: My hon. Friend has clearly caught the Minister out, as the investigatory authorities will no doubt do in due course. The Public Accounts Committee has been hard at work in the Department of Health. On Wessex regional health authority, for example, it says:

"the Authority acknowledged that a fundamental conflict between their interests and those of Wessex Integrated Systems Limited arose when the Authority appointed a Director of that company, with whom the Regional Health Authority had a contract to supply computer services, to act as Regional Information Systems Manager." It goes on to point out:

"The Authority also allowed a secondee from IBM to advise them on the purchase, without competition, of"

-- guess what?--

"an IBM computer for £3.3 million, at a time when it could have been purchased for £0.5 million to £1 million less."

The Conservatives tell us that their new structures prevent such things from happening. It is perfectly clear from evidence produced by the PAC that that is not so.

Let us look at some of the other absurdities. The number of administrative staff in general practice has risen dramatically, yet it has not eased the burden on GPs. Since 1989, GPs are doing a third more administrative work, despite--or perhaps because of--a 40 per cent. growth in administrative staff. Interestingly, Oxford Research shows that GPs who are fundholders cost four times as much as other GPs for health authorities to administer.

My hon. Friend the Member for Dulwich (Ms Jowell) spoke about front-line services for community care and other reasons. The money is going on administration, not on front-line services. Adminstrative costs at the Department of Health have risen by 108 per cent. since 1987. The hospitality budget for the Department of Health has risen by 74 per cent., and that is only between 1990-91 and 1992-93. I am concerned not about whether it is spent or underspent but about the fact that it has risen by 74 per cent. in one financial year. The South-East Thames region managed to beat even that. The administrative costs in its family health service rose by 403 per cent. between 1989-90 and 1992-93. It is a gruesome fact that, this year, 143 health service trusts managed to spend £37 million between them on logos and image-building. The national health service management executive has managed to spend £620,000 of taxpayers' money on writing and distributing pamphlets to other health service managers.


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To pay for all that, prescription charges have increased 16 times since the Conservatives came to power. Dental charges will, apparently, increase from 80 per cent. to 100 per cent., further undermining the provision of dentistry in the national health service.

My hon. Friend the Member for Newham, North-East (Mr. Timms), in an excellent contribution, asked what is wrong with "front line first" as an objective for the health service? If the Government care about front-line services for the Ministry of Defence, why not have front-line services for the Department of Health as well? However, I must not give the impression that all is doom and gloom, because it is not. According to an Income Data Studies survey in November 1993, the remuneration--I know that the whole House will be reassured to hear it--of chief executives has "escalated rapidly". In one year, the average increase was 8.9 per cent. and the largest pay increase has been at the Guy's and Lewisham NHS trust, where the chief executive received a 33 per cent. pay increase.

Halton health authority in Cheshire paid £228,000 to relocate its new district general manager, and the House will be reassured to learn that only half those payments were deemed to be unlawful by the district auditor. The House will also be relieved to learn that the North Cheshire health authority is trying to recover some of the money. The National Audit Office told us last September that more than £3 million had been wasted in potentially unlawful pay-offs and removal expenses.

The Department of Health has spent more than £1 million on sending national health managers on image-building courses, which it calls "executive coaching".

I know that the House will be interested to learn of the excellent expenditure of public resources at Quarry house, the new management executive headquarters at Leeds. It cost £55 million; it has a swimming pool; it has a £30,000 gym and a £15,000 hand-woven rug, which, I am reliably assured, is not an executive toupee but a £15, 000 rug. Thirty thousand pounds a year is being paid on first-class rail tickets between London and Leeds, yet the former Department of Health offices in Elephant and Castle are being kept empty at a cumulative cost of £5 million per year between 1991 and 1997. My hon. Friend the Member for Monklands, West said that the patients did not get the jags. It may be true in the Secretary of State's health service that the patients do not get the Jags, but the chief administrators certainly do--or at least a decent Ford. The amount spent on company cars by the national health service has increased to about £70 million in 1992-93. It is an increase of 31 per cent. on the previous year. The amount spent by trusts on cars, as opposed to patients, has increased by nearly £19 million-- from £5.3 million to £24 million.

Those are substantial sums of money. There may be some defence for some of the expenditure, but that is a startlingly dramatic increase.

I must draw my remarks to a close, because I shall no doubt want to intervene on the speech of the Minister, as he has intervened on mine. He will ask what the Labour party would do. Oh--the Government are silent. The Labour party believes in the ethos of public service, based on respect for professionalism, admiration for ethics, even a belief in altruism. We need to renew the methods by which public service is delivered. Management systems


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must emphasise management, not simply administration. We shall expect managers to take responsibility in the public interest, for the public interest.

Good people can make a bad system work after a fashion. As Conservative health bosses are showing, ill-motivated people can wreck the most carefully structured institution.

I conclude by echoing my hon. Friend the Member for Sunderland, North (Mr. Etherington). The national health service should not be about markets, purchasers or providers. It is an institution rooted in an earlier, less complex, more innocent, age. It is about collectivism. It is a socialist creation, and a socialist institution to the core of its being. The Labour party built it; it is our creation. We intend to keep it safe and we intend to keep it safe in our hands.

9.39 pm

The Minister for Health (Mr. Gerald Malone): I am grateful to enter the debate at this stage when we are suddenly hearing that the great, new- look modern Labour party is going to go back to the start of the health service in the 1940s to instruct us on how it should be run in the 1990s and beyond. Of course, the health service is about a public ethos; of course, it is a health service that is in the nation's custody. Those aspects were all underpinned by my right hon. Friend the Prime Minister at our recent party conference in Bournemouth. The national health service is not about the sort of collectivist activity to which the hon. Member for Newcastle upon Tyne, East (Mr. Brown) referred. He made an astonishing admission about his agenda and that of his right hon. Friend the Member for Derby, South (Mrs. Beckett) for the future of the health service. Although the Labour party may have been responsible for setting up the health service in the late 1940s, it has been under the custody of a Conservative Government for far longer than it has been in the hands of a Labour Government. In the hands of a Conservative Government, it has prospered, new practices have been introduced to make it more efficient and more patient care is being delivered. More importantly--this was conceded by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood)--many of the reforms are widely accepted. I understand that the hon. Member for Roxburgh and Berwickshire differs from the Government on some of them.

Many of the reforms are accepted, not just by the hon. Member for Roxburgh and Berwickshire, but throughout the country and the medical profession, as being essential and desirable. They are clearly accepted in the constituency of the right hon. Member for Derby, South, where 79 per cent. of residents are covered by GP fundholders. The right hon. Lady made an astonishing pledge--one of the only new policies that she revealed to the House today--when she declared that she would say to that 79 per cent. of people, "I am going to abolish fundholding." That is one of the right hon. Lady's declared policies.

Mr. Nicholas Brown: If the reforms are widely accepted by the medical profession, as the Minister says, I should draw his attention to the publication, "Senior Doctor", which contains an exclusive survey of consultants and describes the national health service as being on


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the "verge of collapse". That does not sound like the sort of acquiescence that the Minister was describing to the House.

Mr. Malone: That is yet another exclusive survey that probably relates to a tiny minority of the people involved. We are used to exclusive surveys of a selected 200 or 300 people done by organisations such as the British Medical Association which clearly have an interest in the result. Across the House, the

purchaser-provider relationship is accepted as a sensible principle in the provision of care in the health service. It was resisted root and branch by the Opposition when it was first introduced. I had better warn the hon. Member for Newcastle upon Tyne, East that GP fundholding is widely accepted in the community and regarded as something of great importance by all those who have taken it up. They see that it is not only a challenge, but a method of delivering far better patient care than has ever been delivered before.

Mr. Burden: Will the Minister comment on the case of Sandwell Healthplan--an independent consortium of GP fundholders--which has gone bust? It rented its premises from the chair of the Sandwell family health services authority--for £19,000 in one case and £35,000 in another. That has been the subject of an internal audit report. Does the Minister think that that is a good advertisement for fundholding?


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