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Mr. Malone: The hon. Gentleman should ask all those involved, who have declared their determination to remain fundholders, whether they wish to remain committed to the general fundholding principle. The answer is that they do.

I shall now address some of the specific issues raised in the debate.

The right hon. Member for Derby, South alleged that the pathology services at Lister hospital were being privatised. The point is that those services were properly market-tested and bidders included an in-house team and another NHS trust as well as a private contractor. When there is proper market testing, as in this case, it is good for the health care of the whole community that the bid which will deliver the best health care for the best value for money should be the one accepted.

I cannot understand the continued refusal by the Labour party to acknowledge that there is nothing wrong with introducing the private sector when it can provide certain services more competitively. What really counts is that NHS patients can be treated at a time nearer their choosing and be given a better service. I am surprised that the right hon. Lady should still be sunk in the old Labour party ideology.

My hon. Friend the Member for Broxbourne (Mrs. Roe) touched on accountability. There are three threads of accountability running through the service; it is important to note that these things never existed before. The first is the code of conduct, which lays down explicit standards of conduct that are expected of NHS boards. It introduces new measures to help boards fulfil their responsibilities for effective stewardship and financial control-- [Interruption.] Thank goodness the hon. Member for Makerfield (Mr. McCartney) seems to have relinquished his former post. From a sedentary position, he calls this a sleaze charter, even though Sir Adrian Cadbury has commended

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the code. The hon. Gentleman should think again before making such ill-considered remarks.The code reaffirms the public service values of openness, probity and accountability--they are all extremely important.

The code of practice on openness clearly states that the NHS will provide information unless there are good reasons for not doing so; the reasons are then defined. The code ensures that the public have access to the information that they want and need.

As for appointments, new procedures will open the system to far more scrutiny and provide greater transparency than ever before. We intend to reach people from a far wider range of backgrounds. Everyone is eligible to apply. As my right hon. Friend the Secretary of State said, if the Labour party will encourage its supporters to apply for these posts, perhaps even more of them will apply and be appointed. [ Laughter. ] I am surprised that the hon. Member for Newcastle upon Tyne, East should mock. It is important that people of all parties be represented on trusts and boards. They should all be allowed to make their public contribution, and I am astonished that the hon. Gentleman should make light of that.

All will be interviewed by panels against agreed criteria. There is no suggestion that there should be any cronyism about it. I welcome what my hon. Friend the Member for Broxbourne had to say about that. Standards of accountability throughout the service are far higher now than ever before.

Mr. David Jamieson (Plymouth, Devonport): While the Minister is on the subject of accountability, he will be aware of the case of Plymouth hospitals trust and Sister Pat Cooksley, who served 17 years as a sister in Derriford hospital and was highly regarded by patients, professionals and workers alike. She objected to a lowering of standards on her ward and was sacked on the slightest pretext. I am sure the Minister will be pleased to know that she has been reinstated by the hospital trust. Does he agree that such outrages would not happen if the trusts were more accountable to local communities?

Mr. Malone: The hon. Gentleman totally misrepresents the facts. The lady has been reinstated and retrained-- [Interruption.] The hon. Gentleman is quite wrong, and if he takes the trouble to find out the facts, he will learn that he is wrong.

The hon. Member for Roxburgh and Berwickshire asked whether any trust applications had been turned down after consultation. I think that he feared that only lip service was paid to such a principle. A number of applications were turned down after consultation. Surrey Heartlands hospital and Manchester children's hospital both had earlier applications for trust status rejected. I hope that that reassures the hon. Gentleman. [Interruption.] I have given two examples and I do not wish to occupy the rest of the time that is available to me in giving all the examples that are available. The hon. Gentleman also spoke about a place that I know, Drumlanrig. As he knows, it provides respite care in the Borders region. There is already considerable capacity for respite care in the area and the health board sees no case for a new purpose-built facility.

I should like to deal with the two points raised by the hon. Member for City of Durham (Mr. Steinberg). I happily reiterate my offer of a meeting with him at the earliest possible opportunity to discuss the matter that is of great

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constituency interest to him. I hope we can arrange that as quickly as possible. The hon. Gentleman spoke about the use of low-grade auxiliaries in place of nurses. The modern health service needs a skill mix that perhaps it did not have in the past. Boundaries are breaking down between professions--for example, between consultants and general practitioners. Consultants often practise minor surgery in the premises of GPs, and that has never happened before. There is a similar situation in secondary care. The hon. Gentleman will find when he enters an accident and emergency unit that the first person to greet him is a qualified nurse instead of someone who clerks patients in rather than assesses them. The breakdown of those boundaries ensures that the nursing profession in particular is able to exercise its professional skills at higher levels rather than carrying out mundane tasks. That is extremely important.

My hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes) highlighted culture changes in the health service. He was right to say that Labour would ignore anything that gets better and would oppose any attempt to introduce an assessment of cost in the health service. But cost is important if one is to improve the quality of patient care while being careful about the spending of public money. I completely fail to understand how Labour can continue to ignore that. Opposition Members seem to be stuck in old arguments that have no place in a modern health service.

The hon. Member for Dulwich (Ms Jowell) criticised the number of cancelled operations and said that she had experience of such cancellations in her constituency. Since 1 April 1994, national standards on cancelled operations have improved substantially. Patients must now be admitted for treatment after only one cancellation on the day of admission. The original standard was two cancellations. I cannot comment specifically on the case that she mentioned, but it seems to have grossly exceeded the previous standard. As I say, a higher standard has been set and we view most seriously any failure to implement such standards.

The hon. Member for Sunderland, North (Mr. Etherington) spoke about Sunderland City hospitals trust. I was rather astonished that he did not mention a 377-bed ward block that was recently opened by the Princess Royal. We can also point to a new dedicated two-theatre day case unit, which opened in March. There is good news in the constituencies and I wish that Opposition Members would sometimes mention that rather than indulging in dirges that give only half the picture. In the hon. Gentleman's constituency, there has been a 6.5 per cent. increase in in-patient and day cases over the past three years, and there are 25 per cent. more consultants than there were in 1988.

I worry that the only response from the Opposition is that those are mere statistics. I was on the "Today" programme on one of the few mornings that my right hon. Friend the Secretary of State was not. I was told by someone representing the opposite case, "That is all very well for you to say, Mr. Malone. These are simply facts and figures. What do they mean?" Let me say to the hon. Member for Sunderland, North and all other hon. Members who do not think that the facts and figures about improved health care mean very much, that they mean a tremendous amount. In particular, I am delighted to

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announce that in his constituency no one has been waiting for more than 12 months. I hope that he will recognise that point. My hon. Friend the Member for Great Yarmouth (Mr. Carttiss) made an interesting speech. I returned to the Chamber to hear the second half and I understand that the first half was as interesting as the second. He raised a number of genuine concerns and I should particularly like to address one of them. He was concerned that chairmen and non-executive members appointed to health authorities should be local and locally known. I do not think for one second that the home address of a potential non-executive member is absolutely crucial to whether he should serve on a trust or a board. A whole range of factors is quite properly taken into account. They include local links with the area and any local work or business connections that the person has had in the area.

Our prime concern is, and will continue to be, to ensure that the NHS benefits from the best possible leadership from the best possible pool of talent. On that point, we believe that best practice should be followed. Best practice is often to advertise. I have said before that we wish to extend that to all posts. It is very important indeed that there is a pool of talent available to occupy such important public positions. We can move forward from the best practice which is already in place in my own area-- the South and West region--and which I hope can be spread throughout the country.

The debate was not terribly surprising for Conservative Members. We heard the same old arguments from the new team. I am interested to see that on their first outing they do not appear to be allowed out on their own. They are flanked by their predecessors, presumably to ensure that they get the line right. The hon. Member for Makerfield has made a longer and more comprehensive speech from a sedentary position than many who have spoken from the Front Bench this evening.

We were told to expect that on this first outing of the new model Labour party on an Opposition day debate we should be hearing new things. I thought that the new model Labour party was in favour of a mixed economy-- but not for health. The new model Labour party is not interested in beggar- my-neighbour policies which ensure that no additional funds from the private sector are to be available for additional health care over and above public spending. Labour is interested only in hiding behind slogans; there is no substance to any of its policies. However, I will move on to the substance of one or two of the policies that we heard.

We hear simply slogans. I suppose that there will be one for the health service. I should not be surprised to learn that it was, "Tough on illness, tough on the causes of illness," and when it came to spending, "Fair spending, not high spending." The veneer has been stripped away in the debate this evening. At bottom, we know that the Labour party is precisely the same Labour party that it has always been, the same Labour party which defends public sector interests and the trade union interests in the health service; it is not in the least bit interested in making any progress.

The right hon. Member for Derby, South gave an interesting message on health policy. Labour's one declared policy is to strip pensioners of their tax benefit for private health care. It is the first time that on a first outing a Labour party spokesman has made a direct attack on pensioners as a specific aspect of policy.

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The whole point of the debate, according to the right hon. Lady, is that the health service is shrouded in secrecy, that we are afraid to disclose details of those who serve on boards and that it is all a great dark secret and a conspiracy. Let me refer to her own constituency. I have here what she would consider to be a secret document, which means that nothing is available to her and that she can obtain no information about who serves on trusts. The secret document is the Derby Evening Telegraph . There it is--the new team,

"The team you can trust".

I can tell the right hon. Lady that there is no such secrecy. Everything is above board and right. The best talent is recruited to run our health service. It is a health service of which we are proud and when it comes to the team that can be trusted, it is not that team over there; it is this team over here.

Question put, That the original words stand part of the Question: --

The House divided: Ayes 263, Noes 297.

Division No. 313] [10.00 pm


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Abbott, Ms Diane

Adams, Mrs Irene

Ainger, Nick

Ainsworth, Robert (Cov'try NE)

Allen, Graham

Alton, David

Anderson, Donald (Swansea E)

Anderson, Ms Janet

Armstrong, Hilary

Ashton, Joe

Austin-Walker, John

Banks, Tony (Newham NW)

Barnes, Harry

Barron, Kevin

Battle, John

Bayley, Hugh

Beckett, Rt Hon Margaret

Beith, Rt Hon A. J.

Bell, Stuart

Benn, Rt Hon Tony

Bennett, Andrew F.

Benton, Joe

Bermingham, Gerald

Berry, Roger

Betts, Clive

Blair, Tony

Blunkett, David

Boateng, Paul

Boyes, Roland

Bradley, Keith

Bray, Dr Jeremy

Brown, Gordon (Dunfermline E)

Brown, N. (N'c'tle upon Tyne E)

Burden, Richard

Byers, Stephen

Caborn, Richard

Callaghan, Jim

Campbell, Menzies (Fife NE)

Campbell, Mrs Anne (C'bridge)

Campbell, Ronnie (Blyth V)

Canavan, Dennis

Cann, Jamie

Carlile, Alexander (Montgomry)

Chidgey, David

Chisholm, Malcolm

Church, Judith

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Clapham, Michael

Clark, Dr David (South Shields)

Clarke, Eric (Midlothian)

Clarke, Tom (Monklands W)

Clelland, David

Clwyd, Mrs Ann

Coffey, Ann

Cohen, Harry

Connarty, Michael

Cook, Frank (Stockton N)

Corbett, Robin

Corbyn, Jeremy

Cousins, Jim

Cox, Tom

Cummings, John

Cunliffe, Lawrence

Cunningham, Jim (Covy SE)

Cunningham, Rt Hon Dr John

Dalyell, Tam

Darling, Alistair

Davidson, Ian

Davies, Bryan (Oldham C'tral)

Davies, Ron (Caerphilly)

Davies, Rt Hon Denzil (Llanelli)

Davis, Terry (B'ham, H'dge H'l)

Denham, John

Dewar, Donald

Dixon, Don

Donohoe, Brian H.

Dowd, Jim

Dunnachie, Jimmy

Dunwoody, Mrs Gwyneth

Eagle, Ms Angela

Eastham, Ken

Enright, Derek

Etherington, Bill

Evans, John (St Helens N)

Fatchett, Derek

Field, Frank (Birkenhead)

Fisher, Mark

Flynn, Paul

Foster, Don (Bath)

Foster, Rt Hon Derek

Foulkes, George

Fraser, John

Fyfe, Maria

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