House of Commons Hansard Debates for 22 Nov 1994

Mr. Joseph Ashton (Bassetlaw): If I can catch your eye later, Mr. Deputy Speaker, I shall say a few words about the investigations that are taking place. There is, however, something that I would rather say in private to the Secretary of State. Would it be in order for me to have a private meeting with the right hon. Lady later this week, when we could discuss the matter?

Mrs. Bottomley: I am more than happy to arrange such a meeting. I well understand the hon. Gentleman's profound concern about the issue.

The Gracious Speech carries forward the Government's programme of enlightened social reform. In the NHS, our programme has led to a service that is more responsive to the needs of patients. It is more flexible and it is

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responding better to the challenges that it faces. By being more efficient, it is a far better servant of both patients and the taxpayer.

Through four successive Parliaments, the Government have supported the NHS, as we have supported the welfare state. There has been extra funding, extra staff and better results. Over 3,000 more patients are treated every day, there are shorter waits and there are great improvements in the quality and range of care.

In the 1980s, despite significant extra spending, public satisfaction with the health service fell. That trend has now been reversed. Even the right hon. Member for Derby, South acknowledged that the British social attitudes survey, published last week, shows that, since 1990, satisfaction with how the health service is being run has risen. Dissatisfaction has fallen. Those patients who use the NHS, as hon. Members know only too well, as opposed to those who wish to write it down, are overwhelmingly satisfied with the service that they receive. As the benefits of the health reforms become ever more clear, that trend will be sustained and increased.

The speech of the right hon. Member for Derby, South was a sign of a bankrupt Opposition. Wherever the Opposition look--the economy, health, education and social security--they know that the Government have acted courageously and responsibly to safeguard the best interests of the country and its people. They know also that only by appearing to adopt our policies or adapt our principles would they ever have even the faintest hope of success with the voters. There is one unanswerable question that faces the Opposition: if they were wrong for so long, as they now admit, why on earth should anybody trust them now? They have nothing to offer the health service, and they have nothing to offer the country. After the next general election, once again, they will have nothing to show for ditching their principles. It is not enough to swear allegiance to the NHS and then to bury one's head in the sand.

A great public service such as the NHS must evolve. It must adapt to meeting changing needs, changing expectations and changing capabilities. Governments must face and not fudge the difficult decisions that have to be made. Our policies address the challenges that lie ahead. The new health service is better able than ever before to maintain and enhance the comprehensive, high-quality service that the public deserve and patients expect. The measures in the Gracious Speech will help us to make a great service even greater.

4.56 pm

Mr. Ashton (Bassetlaw): I hope that the House will forgive me if I concentrate on an aspect of the national health service that has become of great importance--security in our hospitals, especially the Bassetlaw hospital and the seven other hospitals that have been mentioned. At the end of January, it was reported that there had been 16 incidents in the new Bassetlaw hospital--it was built only a few years ago. It appeared that someone had tampered with the high-tech equipment in the intensive care unit. After a check was made of the work rotas, a nurse who had been on duty on all the relevant occasions was suspended.

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In the ensuing nine months, the police interviewed 500 members of staff and patients. They have now widened the inquiry, and 1,870 interviews have taken place, spreading over eight other hospitals, involving a further 57 incidents. No one has yet been charged and no one has been interviewed as a suspect. That is despite 20 detectives spending well over nine months on investigations. The investigations have spread to Nottingham city hospital; Sheffield Northern general; the Gloucestershire royal; Bristol Southmead; St. George's, Tooting; the Radcliffe infirmary, Oxford; and the Middlesex Central hospital. Bassetlaw hospital is run by a trust. I suppose that it is no different from, or any worse or better than, any other modern hospital. In the intensive care unit there has been a 12 per cent. death rate, which is the national average in such units; there is no sign that deaths at the intensive care unit at Bassetlaw have been any different from anywhere else. Two patients died during the period when the hospital authorities say that tampering took place. Following investigations, the 16 incidents that were reported have grown to 30.

It is alleged that tampering has taken place mainly with the settings on life-saving ventilators and intravenous pumps--in other words, the settings have been altered. Sometimes relatives were left alone with patients. It is obviously extremely worrying if they think that they might be accused of tampering with equipment. Admission to the unit was by digital code security, the details of which were not generally known. I understand that that is the practice in all the other hospitals.

On Monday, I met the hospital trust chairman, Mrs. Valerie Dickenson, and the chief executive, Mr. Munro Donald, following allegations and revelations in The Independent on Sunday by Mr. Jonathan Foster, who has a long history of specialising in health service issues and, in particular, Beverley Allitt issues. He revealed that further widespread investigations were taking place. When I met the hospital trust chairman, I was told that the nurse who had been suspended had been recruited in the normal way from the Northern general hospital in Sheffield, which is 12 or 13 miles away. She had answered an advertisement. Her boy friend had come to work in Bassetlaw and she wanted to move to Worksop. She was obviously cross- examined. Her qualifications were bound to be in order and there was no reason to think that there was anything untoward about the appointment.

The nurse in question applied for promotion and passed her examinations. There had been no problems before and I understand that there is nothing to show that anything was untoward at the seven other hospitals or places at which she worked. I am not accusing her or anyone else at the hospital of being involved in the incidents. However, 30 incidents took place at the Bassetlaw hospital and 57 incidents took place at another eight hospitals. That is very worrying for my constituents, for patients and for the town in general.

I have not revealed the names of any of the constituents who have complained. However, Mr. Steven Shaw of Workshop, whose mother Muriel died after many months in intensive care, spoke to The Daily Mirror . If the House will forgive me, I want to quote what he said in that paper:

"Detectives have interviewed everyone connected with my mum. They wanted to know if any of us had seen anything suspicious going on around her--if we had seen anyone tampering with

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equipment. The inquiry has been going on so long now that we all want to know when the agony will end. It has been very upsetting waiting all these months without knowing what was going on. In many ways, it would be easier to bear if we were given the worst news. But the police say it could be next year before they can tell us anything definite. With all these other incidents, there are obviously going to be a lot more devastated families like us."

The situation is extraordinary. After all these months, and after 1,800 interviews and hundreds of statements, no one has been charged. The police have told me that no one has been questioned along the lines that that person was a suspect.

A cloud has been hanging over the hospital for nine months and the inquiry does not seem to be getting any further. There have also been a series of worrying incidents in the Trent region. Again, I do not allocate blame or say that those incidents are connected. However, we must remember the Beverley Allitt affair. She is now in Rampton in my constituency. Indeed, she was treated at the Bassetlaw hospital after mutilating herself during the trial.

Beverley Allitt was accused of killing four children and of attacking nine others over a period of 58 days. She was given 13 life sentences and is now in Rampton. The usual checks were carried out on her stability before she was employed at Grantham hospital. Earlier this year, the new-born baby Abbie Humphries was kidnapped from a Nottingham hospital. That baby was missing for 15 days before she was found. Those are worrying aspects of security in our hospitals. The Secretary of State referred to the report of Sir Cecil Clothier, who led the inquiry into the Beverley Allitt affair. Sir Cecil Clothier, a former ombudsman, said:

"It takes only two minutes alone with a helpless patient to kill or injure."

He made 11 recommendations. The Secretary of State says that she has sent them to the health authorities and to the trusts and asked--I do not know whether she ordered--that they be implemented. I am not trying to be political, but the trusts virtually run themselves as they choose. They may be satisfied that such things could not happen in those trusts, but they might happen.

This is all rather like the problem with our football stadiums. People thought that the Hillsborough disaster could not happen and people could not be killed in that way, but ultimately it did. Action then had to be taken to improve football stadiums. A similar thing happened to the ferry when its doors were open and in respect of the King's Cross fire.

The security aspect of our hospitals is unbelievable. What has been done about Sir Cecil Clothier's recommendations on the screening of staff, camera surveillance inside hospitals, controlled admission for visitors and curfews on visiting times? Some of our hospitals are like King's Cross station: anyone can walk in or out of them whenever he or she likes. That is very worrying.

Staff in any inner-city accident and emergency department will be aware of the drunks who roll in at 10 pm on a Saturday night. Some of them just come in to get warm and have a cup of tea. However, nurses and doctors sometimes have to endure horrendous situations. Those drunks do not walk into nightclubs, because there are bouncers on the doors to keep them out. There are no bouncers at a hospital on a Saturday night.

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This sort of thing is happening regularly. We have security in our town halls and in the Houses of Parliament. People cannot simply walk into the BBC or into a police station. I was in a London hospital in August. It seemed to me that half the neighbourhood took a short cut through that hospital. I do not want to mention the hospital by name, because the medical treatment was absolutely superb. The doctors and nurses worked wonders under impossible conditions. However, there were four lines of beds, 18 of which were occupied out of 24. There was a mixture of men and women in the ward. There was one bathroom, three toilets and horrendous traffic noise. Any weirdo could take a short cut through the hospital from one street to the next instead of walking around. There were no controls. People had to be wheeled into the street on trolleys to get to the operating theatres.

All hospitals are different. Some were built when Strangeways prison was built and, in many ways, their architecture is no better than that of the prison. However, others are very good. Many have no locks on internal doors and there is no one on the main door to stop people coming in. Visitors at the hospital to which I have referred rolled in at 11 pm looking as though they had come straight from the pub. The trusts are doing exactly what they like.

The problem with Bassetlaw is not the first case of trouble in health service hospitals. In 1990, two surgeons were knifed to death in Pindarfields general hospital in Wakefield. The man who did it is also in Rampton in my constituency. In 1991, a man was stabbed at Rake Lane general hospital in North Shields while he was in intensive care. In 1992, a patient was shot dead while talking on the phone at the Royal Free hospital. In 1994, three babies were abducted from hospitals in Bath, London and Nottingham.

Some trusts have said that they will electronically tag babies. Why only some and not all? When that question is asked, the first answer is, "But we will want more money." The Secretary of State said that more money is being made available and it is up to the trusts to manage their own resources. However, with regard to this problem, we no longer have a national health service. We have local health services which are spending their money and operating their hospitals as they think fit.

When a Beverley Allitt comes along or a baby is abducted, there is tremendous uproar in the media and there is tremendous news interest. Twenty detectives have been working on the case at Bassetlaw hospital for nine months. I do not know what that is doing to the crime figures in the rest of the county, but it cannot be doing them any good.

Morale in Bassetlaw hospital is very low, patients and patients' relatives are afraid, and the situation is getting worse after nine months. There seems to be no end to the inquiry. The police say that medical inquiries take a very long time. People have to be cross-examined and their memories become confused as time passes. The police must also consult experts. The problem is very difficult. There must be a public inquiry into what has happened in Bassetlaw and what is happening to security in general. We have specific rules about dangerous drugs in hospitals. However, there do not seem to be any rules about dangerous people. They can come and go as they like. To stop allegations being made, we have rules whereby a male GP is not supposed to examine a female patient without another woman being present. However, in the

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case of the problem at Bassetlaw, allegations ran throughout a hospital. False allegations were made about people at the beginning of the inquiry which have not helped the police and have not improved the situation. I hope that, sooner or later, there will be an arrest or that eventually there will be a public inquiry. Such incidents are happening far too often in far too many hospitals to far too many people.

Patients have the right to believe that, when they go into hospital, they will be not only treated but protected. Highly technical equipment can be fiddled with as soon as a nurse turns her back. Nurses cannot watch everything all the time. Anyone can wander in and say, "We'll have a bit of fun and alter this machine." Suspicion then falls on other patients, on relatives and on nurses. None of this is doing the health of the nation any good.

I shall have more to say to the Secretary of State when we meet later. I hope that she will now set up not just the sort of inquiry held under Sir Cecil Clothier into the Beverley Allitt case, but a general inquiry into hospital security and whether we need national rules and regulations on visiting and the conduct of patients. 5.10 pm

Mr. James Hill (Southampton, Test): It is a pleasure to speak in this debate, because health is of such importance to all of us. My wife had a major accident on the motorway on Thursday. The car was completely wrecked and she had to be freed from it. An ambulance came from the Royal South Hants hospital within 10 minutes. After being kept in hospital for three hours, she was released, so it was a happy ending. I hope that that shows the Opposition that the national health service has tremendous back- up facilities, for which we will all be grateful at some time in our lives.

The hospitals in Southampton all have trust status and they are doing very nicely. There are no major grumbles. Figures that I obtained today show that in Hampshire the total money for social services and community care has risen from £148 million in 1993-94 to £173 million in 1994-95 --an increase of 16.9 per cent. That is a very good increase, but the Opposition never mention such things. I am disappointed with Labour Members. Sometimes, they can be outspoken in the Chamber and give credit where credit is due, but not as often as in Committee where they back many of the initiatives taken by my right hon. Friend the Secretary of State.

What is the point politically of deriding the national health service? That does nothing other than depress those working in the service, and the patients waiting to go into hospital get a bad impression. I have been in the House a long time, but I have had few letters from patients in Southampton hospitals criticising them. The security of babies has been mentioned. There was a problem with the maternity unit of the Princess of Wales hospital when babies were given to the wrong parents. It was a rather nasty little episode, but I think that the problem has been solved completely by using armlets for identification.

Surely the emphasis of today's debate should be one of congratulation to my right hon. Friend. I have read nothing that proves that it is not sensible for us to increase the number of patients treated--to 8 million for the first

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time ever, according to the NHS annual report. That is 8 million in a population of 55 million-- [Interruption.] Already, the barrackers are jumping in and denigrating the system. The hon. Member for Glasgow, Garscadden (Mr. Dewar) is a shadow Minister dealing with the NHS nationally, yet he sits there denigrating it. That must stop. We have the best health service in the world and no one should forget that, whether he lives in Scotland, Wales, Northern Ireland or England.

The facts must be stated once in a while. We must look on the good side and not carp, especially on the late-night television shows where politicians get around the table and tear things to pieces. The numbers on the waiting list have fallen quickly--by more than 3,000 in one year. That is admirable. Had the Opposition been able to achieve that, they would be wearing funny hats and carrying balloons; because we have achieved it, they treat it with disdain. General practitioners, consultants and those at the sharp end of the NHS do not like being constantly denigrated. They do not like the fact that they work an incredible number of hours, sometimes in cramped accommodation, while some politicians do nothing but sit here criticising them.

Any grumble that I might have is not about the health service, but about the social and welfare service. I am especially anxious that the Child Support Agency should be investigated intensely. I have some cases from my constituency advice service of unfortunate individuals who have become tied up in the system. One case involves a police officer who has served for 23 years-- [Interruption.] Do Labour Members want to denigrate that chap's suffering as well? [Interruption.] Mr. Deputy Speaker, will you protect me from these denigrators? That is all they are; they are not here for the debate. As I said, the case involves someone with 23 years' police service. He was married for 17 years and has three children. He left home with the clothes he stood up in and the family's second car. He gave his ex-wife the house, the contents and the main car, and she had custody of the children. He continued to pay the mortgage for a further year. He paid for the divorce and ran up an overdraft. He paid for clothes and holidays for the children, in addition to paying maintenance. He remarried and has a second family. He was just starting to get back on his feet financially when in December 1993 the CSA stepped in and then in June 1994 assessed that he should pay three times the amount of maintenance that he was paying.

As a police officer, if that man goes into debt, he will be in danger of losing his job and pension. The chief constable has told him that he is not eligible for financial help, as it is a domestic matter. His second wife-- this may be greeted with a certain amount of glib humour by Labour Members- -has now walked out on him. That is the result of a less than flexible approach by the CSA.

The second case involves a lady with two teenage children who was divorced in 1987. She was awarded £16 a week for the son and £12 for the daughter. In January 1993, the court awarded an increase to £20 a week for each child. Now we get to the nitty-gritty. In May 1993, she received forms from the CSA. She explained that she had just had a maintenance increase, but was told that if she did not fill out the forms family credit would be stopped.

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In July 1994, the CSA awarded my constituent £17.62 a week, to be split between both children. The lady said:

"One final point, if the CSA had not reduced my weekly maintenance so drastically I would not have needed family credit next year, now I shall need the support for the next three years until my daughter completes her `A' level exams."

As a compassionate, deep-thinking Parliament, we must admit that the matter requires further investigation.

We know that we cannot have a perfect society. We cannot give everything to everyone who wants it. Nevertheless, once in a while one has to come to an abrupt halt and say that the matter has to be dealt with. It must be investigated in the light of one of the political aspects that we invariably fail to consider: the public relations side of a severe policy. We must make sure that the public know exactly what Parliament is trying to do.

The difficulty in the House is that we have opposing political views. I sympathise with my right hon. Friend the Secretary of State because the Opposition are not always co-operative. They do not always work with her. They look ahead to two or three years hence when they think that they will get the wheel and drive us right over the cliff. We need more co-operation, certainly on social services and welfare matters, and on hospital trusts. So many trusts are doing well and they will do even better if they see that we are one team here in the House. I wish my right hon. Friend the Secretary of State every success in the future.

5.21 pm

Mr. Alex Carlile (Montgomery): I am sure that everyone in the House will join me in giving our best wishes to the wife of the hon. Member for Southampton, Test (Mr. Hill) in her recovery from her unfortunate accident. The hon. Gentleman gave a good illustration of the quality of the people who work for the national health service, particularly those who have to deal with accidents and emergencies. I start on a positive note by welcoming the commitment in the Gracious Speech to a Bill to introduce new procedures to enable the General Medical Council to deal with those doctors whose professional performance is found to be deficient. I must declare my interest. It has been referred to already. I have been a lay member of the GMC for five years. With me on that council has been the hon. Member for Chislehurst (Mr. Sims), and we have been joined recently by the hon. Member for Gower (Mr. Wardell) from the Labour party.

The hon. Member for Chislehurst and I have come to admire the GMC, although neither of us joined with admiration particularly in mind. The GMC is sometimes criticised, although usually, I fear, from a position of ignorance. The GMC can do only what statute permits it to do. That is something which the newspapers and, as a result, the public rarely understand. It is fortunate, therefore, that the GMC appears to be a beneficiary of the Post Office debacle. It has earned a small but important slot in this year's legislative programme. The council has pressed for change for two to three years. At present it can deal only with what is called serious professional misconduct--a term the meaning of which has been restricted over time by judicial interpretations in the Judicial Committee of the Privy Council. It can also deal with doctors who are so sick that the health committee of the GMC is enabled to interfere with their registration.

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Under the presidency of Sir Robert Kilpatrick, the GMC has sought to modernise the way in which it is run, not only by increasing the lay membership of the council and examining its procedures but by introducing what has been called, as a working definition, "performance review". This is not, as was suggested in one Health Department press release, a lesser offence than serious professional misconduct. It is much broader than that.

The GMC wishes, and is now to be allowed, to deal with doctors whose performance falls below acceptable standards. The aim of the council is universal good doctoring. With that extra shot in our locker, the council of which I am proud to be a member will be able to deal with bad doctoring. There is more to it than merely widening the remit of the GMC. The causes of bad doctoring are complex. It can be based on overwork, cultural misunderstandings, poor mutual support systems in the profession or sometimes poor support systems from family health services authorities. I suggest to the Secretary of State that some more research is needed into the reasons why doctors run into difficulties.

Another interest that I should declare is the unpaid position of parliamentary adviser to the Overseas Doctors Association of Great Britain. One of the matters that troubles me greatly is the disproportionately high number of overseas qualified doctors who find themselves facing the professional conduct committee of the GMC. It is perhaps time for the Secretary of State to consider funding some research into why that occurs. I know that it worries the Overseas Doctors Association of Great Britain as much as anyone else. The Secretary of State mentioned medical schools in her speech. They, too, are a direct responsibility of the GMC. It has responsibility for the accreditation and quality control of medical education. There is some anxiety about the future of the medical schools and medical education under the new management structures. I hope that the management structures that replace the regional health authorities and those at other levels of the health service will properly reflect the important role of the universities. It is vital that they are involved in appropriate ways at various levels of the restructured NHS management to achieve joint planning in the disposition of staff and the provision of patient services. We have excellent medical schools in Britain. They must not be disadvantaged by management changes.

The Secretary of State made a passing reference to whether patients were cheering. In that context, I should like to make some remarks about fundholding general practices. I do not think that patients care very much- -I do not think that they cheer or otherwise--about whether their general practitioners are fundholders, save when they find that they are disadvantaged by fund holding. I ask the Government to respect the views of GPs who conscientiously do not wish to become fundholders.

It is recognised that in certain circumstances fundholding practices may gain advantages, but there is a perception, which is justified occasionally by evidence, that those advantages may be unfair. There is also some evidence that in a few fundholding practices--I do not wish to blacken them all with a sweeping statement--

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those whom one might describe as expensive patients are not welcome. It is logical that to try to drive all GPs into fundholding is a kamikaze policy for the Government.

The Minister for Health (Mr. Gerald Malone): Will the hon. and learned Gentleman give way?

Mr. Carlile: If I may just finish the sentence. If all GPs become fundholders, the advantages which are available to the few fundholders will no longer be available to any of them. They will all face the chaos which, in some areas, they all faced before.

Mr. Malone: It is not the benefits being available to fundholders that matter: it is the fact that benefits should be available for patients. There is no question either of departing from the voluntary principle of fundholding. Of course the Government would like as many GPs as possible to take advantage of the system, but I assure the hon. and learned Gentleman that there will be no compulsion.

Mr. Carlile: That assurance is welcome as far as it goes, but I urge the Minister to look at the success of some non-fundholding commissioning groups. He should look at what is happening in Nottingham, where 200 doctors have become involved in a non-fundholding commissioning group which has had at least as much success as fundholders--and probably more--in securing better services for their patients. I accept that the discipline may have arisen from the introduction of fundholding--I do not deny it for a moment--but I would ask the Minister to take an objective look at the idea, and possibly to accept that in some places it is not wise to urge fundholding when a better alternative may be available.

Another aspect of general practice that patients are not cheering is on- call services performed by locums. Much better quality control is needed to ensure that locum doctors working at night, especially for GPs, are fit to do the job they do--and have the equipment to do it. There is evidence--I heard it repeatedly in my five years on the professional conduct committee of the GMC--to suggest that some locum services are extremely slipshod in their management and in the way doctors are engaged to carry out the work.

I urge the Secretary of State and the Minister to the view that we are approaching the time when we must recognise that extra skills are required for a doctor doing locum work. He does not have the advantage of knowing the patient, or of knowing the aetiology of the patient's illness; he does not have the advantage of the patient's records. He needs a better history and quicker and more perceptive skills. He needs special training, in short, to be a locum doctor. I suggest that the best night-call services are carried out not by the commercially-run services, but by GP co- operatives. I ask the Government to look closely at ways in which co- operatives can be encouraged to take more of these services--

Mr. Malone rose --

Mr. Carlile: It looks as though I am on a winner tonight.

Mr. Malone: I am always glad to point out to the hon. and learned Gentleman the fact that he is supporting a

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Government policy. He will be well aware that measures are in hand to try to encourage co-operative practices for night cover. I hope that he will join us in persuading the medical profession of their acceptability. We need to make progress quickly, and his support would be extremely valuable.

Mr. Carlile: I seem to be on a lucky streak, so I will give that support wholeheartedly.

I should like next to discuss hospital locums. I was a member of the GMC's professional conduct committee when Dr. Gaud, the doctor who operated on patients knowing that he had hepatitis B, was erased from the medical register. It would not be right to comment on that hearing, but I would like to comment on the issue. In that case, a surgeon was able to obtain employment in hospital after hospital because his references were not pursued. It is common practice, when locum consultants and assistant consultants are taken on, for their references to be taken as read. It should not be so. I invite the Government to take urgent steps to ensure that there is a foolproof and fraud-proof system to guarantee that references are always pursued.

Furthermore, there is evidence that some senior consultants are sometimes all too ready to give a favourable reference without possessing the material to justify one--perhaps even occasionally to get rid of a colleague whom they no longer want around. Those are hard words to say, but I believe them to be true. I ask the Health Department to treat this as an issue requiring serious attention. We cannot afford another Dr. Gaud.

I turn next briefly to pay for medical and paramedical staff at all levels. The right hon. Member for Derby, South (Mrs. Beckett) commented on performance-related pay, its definition and its nature, and on whether it is to be individually performance-related or local pay. At the moment that is causing a real worry for all staff. They have no confidence--and I feel none--that a fair system of performance-related or local pay can be devised.

In my constituency, the Powys NHS health care trust has declared its intention to switch to local pay. That has engendered the worst possible morale among staff. It is not right to impose on the NHS a system of pay led by business needs instead of deciding priorities according to patients' needs. There is a danger that rural areas will start to lose medical and nursing staff because of the threat of local pay. It undermines the whole principle of the doctors and dentists review body, which considers pay objectively and nationally.

While on the subject of dentists, I should add that the Secretary of State was plain wrong. She should go and find out what is happening around the country. NHS dentistry for adults is not available in vast areas of rural Wales. In the county of Gwynedd, the situation has become so bad in the past week that no NHS dentist is now available for new adult patients. In my constituency, for distances of 30 miles or more, it can be impossible to find an NHS dentist. The situation has become critical; even if someone finds an NHS dentist--save for a genuine emergency--he has to wait months for treatment.

In other areas of the country, things are different. I understand that in parts of London it is easy to obtain a consultation with a good NHS dentist, but it is not sufficient to use London or urban statistics to distort what is happening in other parts of the country.

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I shall end with a few comments on community care. It will never be the jewel in the crown of this or any other Government unless it is properly resourced. Local authorities' standard spending assessments bring huge variations in the money available to the authorities, and in many areas that is leading to increased rationing of care. The elderly, the disabled and their carers can be the losers. Local authorities have worked hard to make a reality of community care, and the idea that some local authorities are trying to wreck the system is a calumny which cannot be demonstrated to be true anywhere. The increased help given to local authorities was warmly welcomed by members of the public, but it has led to increased demand. The Government unfortunately failed to estimate correctly the element of unmet need. They consistently state how much money has been directed to social services departments, omitting to say where it has come from. By making that omission they perpetuate the myth that it is new money. It is not. It is a reallocation of social security payments to people who previously could have opted for residential care with no assessment of their needs. The Government had no accurate figure for the extra costs required before introducing the policy. The suspicion is that they know no better now. By transferring a fixed sum to local government, however, the Government are successfully capping the spending that is going into community care.

The Government further added to the problems of local authorities by restricting the use of the money transferred from the DSS, so that 85 per cent. of it must be spent on the private sector. The argument for that, apparently, was that it was private sector finance. It was not. It was public money paid in from public taxes. Indeed, that whole area has been so mismanaged by the Government for so many years that £2.5 billion of public money was poured into the private sector without any regard to proper assessment of the individuals, or any attempt at strategic planning.

The Government must recognise two things about community care. First, they must recognise that there are acute funding problems, which have been mentioned already and which largely arose because the Government changed the rules; and secondly, that community care, certainly in rural areas, often means anything but care in one's own community. For many people, it means being shunted off into a community far away from one's life and times, from one's friends and relatives. That is not acceptable.

There are a multitude of other issues that one could raise in this part of the debate on the Gracious Speech, and we shall certainly have a lively debate during the Session on issues relating to health and social services. I hope that the Clydesdale hospital will not remain as the memorial of the Session--an incident led by dogma rather than by considerations of quality and value. Knowing the price of everything and the value of nothing is no basis for improving the nation's health. I hope that, by the end of the Session, we will, by some co-operation--I hope that there will be a large measure of that--have succeeded in improving the nation's health and the way in which the nation is cared for. But I believe that a change of attitude by the Government is needed if that is to be achieved. 5.41 pm

Mr. David Atkinson (Bournemouth, East): I begin by expressing my appreciation and that of my constituents to my right hon. Friend the Secretary of State for Health for

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taking time out during her very busy Conservative party conference week in Bournemouth last month to visit the Royal Bournemouth general hospital in my constituency. I know that she was suitably impressed by its undoubted success and performance in treating my patients and those of my hon. Friend the Member for Bournemouth, West (Mr. Butterfill), but I wonder whether she was informed that it was originally scheduled to be built in 1977, but, like so many hospitals, was a casualty of the Labour Government cuts at that time. There was also a reduction in nurses' pay, to which my right hon. Friend referred. It took the restoration of Conservative Government prosperity for that hospital to be built, for the benefit of our constituents.

I shall make four points, two of which relate to the theme of today's debate. I want to reflect the concerns expressed to me at a public meeting on law and order which I held in my constituency last Saturday afternoon. Apart from when party conferences are in town, there are simply not enough police patrolling our streets during the day--some 20 or 30, I am told--and their resources are fully stretched during the night. Those are the police's words, not mine. They do not want to see more clubs opening in Bournemouth, because they could not cope. That situation threatens to hold Bournemouth back as a successful resort.

Of course, I welcome the new freedom that is now given to chief constables to increase manpower without Home Office approval, but there can be no more police without more money. So I hope that my right hon. and learned Friend the Chancellor of the Exchequer will announce a substantial increase in resources for police manpower in his Budget statement next week and that some of that will come Dorset's way.

I particularly welcome the proposed legislation in the Gracious Speech to make it easier to return those who are mentally ill to hospital, for which I have called for some time in my capacity as the honorary parliamentary consultant to the National Schizophrenia Fellowship, with the hon. Member for Birmingham, Selly Oak (Dr. Jones). I commend my right hon. Friend the Secretary of State for Health on the initiatives that she has already taken in mental health during the past three years--more than the previous 300 years put together. I hope that she will consult widely on what she is proposing.

I strongly urge that the new legislation be subject to the same Special Standing Committee procedure that the Mental Health (Amendment) Act 1983 underwent. It is a process that is sadly underused, inviting as it does interested parties to come before a Standing Committee, just as they are invited to come before a Select Committee. I may be one of the few Members left to have served on the Special Standing Committee that considered that Bill. I hope very much to be able to do so again.

I welcome the reforms that I expect will be announced by my right hon. Friend the Secretary of State for Social Security, to soften the impact of the Child Support Agency on absent fathers who have handed their houses over to their ex-wives in clean break settlements. I also hope that the travel-to-work costs of absent fathers and those incurred by children visiting the father, or by the father visiting the children, will be taken into account when assessing his payments. That is only fair and just. I look forward to learning from my right hon. Friend just how he will reconcile those changes while maintaining the whole point of the CSA, which is to ensure that parents accept the

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financial responsibility for their children, and not the taxpayer, many of whom might be much worse off than the parents.

I shall conclude on a foreign affairs issue, which I could not refer to in the debate last Thursday, because I was in Azerbaijan. The House will be aware of the six-year conflict over Nagorno-Karabakh. The Armenian people have been seeking independence from Azerbaijan, which has resulted in some 40,000 dead, more than 100,000 wounded and maimed and well over 1 million people displaced. I have now seen--

Mr. Deputy Speaker: Order. I am not sure whether the hon. Gentleman will refer to the health service or the pension policy in Azerbaijan and relate it to the Gracious Speech, but I hope that if he is minded to do so he will link it in.

Mr. Atkinson: I will, of course, be referring to the humanitarian support, including the health services that the refugees desperately need at the present time. I understood, however, that in the debate on the Gracious Speech, one is allowed to stray a little from the theme of the day --

Mr. Deputy Speaker: Order. The hon. Gentleman must know that we have an amendment before us. Had he spoken yesterday, he would have been entirely in order, but today he would not be in order to stray wide.

Mr. Atkinson: Thank you, Mr. Deputy Speaker. I will, of course, refer to health issues in what I propose to say.

I have seen the refugee camps in Armenia and Azerbaijan, and it is clear that, without further substantial and immediate help, many of those refugees will die during the coming winter, particularly those living in very insubstantial tents. They need the benefit of medical aid and other supporting health services through the United Nations, to whom I pay tribute for the considerable amount--

Mr. Robert Hughes (Aberdeen, North): On a point of order, Mr. Deputy Speaker. I have always understood that, following the Gracious Speech, we would debate what was in it. The fact that an amendment has been tabled surely cannot restrict Members in what they wish to debate.

Mr. Deputy Speaker: The hon. Gentleman is a senior Member. He will recognise that the question is on the amendment before us, which the Labour party, of which he is a member, tabled. That is the question before the House. Therefore, today's debate, until 10 o'clock, is about the national health service and pensions policy, as related to the amendment tabled.

Mr. Robert Hughes indicated dissent .

Mr. Deputy Speaker: The hon. Gentleman may shake his head, but those have been the rules of the House for the 20 years that I have been here.

Mr. Atkinson rose --

Mr. Deputy Speaker: Order. I appeal to the hon. Gentleman to return to the specific issue that the House is debating.

Mr. Atkinson: It is clear that I have strayed beyond the parameters that you have allowed, Mr. Deputy

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Speaker. Let me end my speech, however, by referring to the Queen's Speech as it relates to the situation that I mentioned. I welcome the statement that the Government will seek to enhance the role of the Conference on Security and Co-operation in Europe in conflict prevention and the resolution at the Budapest summit in December, and look forward to its contribution to a successful outcome of the dispute over Karabakh.

5.50 pm

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