Previous Section Home Page

Mr. Sebastian Coe (Falmouth and Camborne): I am pleased to be able to contribute to what has been a wide-ranging debate. Although I intend to speak about health, I should like first to compliment the hon. Member for Birkenhead (Mr. Field)--not in his seat now--on a speech of substance. It is a great pleasure to watch the faces of the hon. Gentleman's colleagues as he trespasses with such furtive guile into subjects that have remained no-go areas for his party for so many years.

I begin with a remark that runs the risk of sounding trite, but it is a truism all the same to say that the economic and cultural strength of a country, particularly this country, lies in its people: they are its greatest asset. Their health and well-being are at the centre of any discussion on health.

We know this from the stark reality of third world poverty. We know it from the pockets of deprivation in the United Kingdom, which are matched by equally challenging medical difficulties, in densely populated

Column 534

inner cities or in peripheral rural areas. We know it, too, from World Health Organisation statistics, and from the figures of similar agencies.

On no issue more than health does the House have a great responsibility to enter into responsible and dignified debate, and we have had such a debate this evening. It is a prerequisite of such debate that we avoid the anecdotal trail at all costs--the tabloid slogan that panders to scare stories of dubious origin, and even more dubious academic or scientific rigour.

The media have a major responsibility to fulfil. I would have liked to ask the editor of "Panorama", after the programme a few weeks ago that examined health care for the elderly, whether he would have slept as easily after the programme if he had known of the concern expressed to me only some hours later by a constituent about to receive treatment at the Treliske hospital in Truro. The hospital serves many of my constituents very well. He had got in touch with my office in a blind panic. After watching the programme, he feared that he would turn up at the hospital the following day only to be turned away. He thought that everyone over the age of 65 was suddenly going to be refused hospital treatment. His fears were, of course, unfounded.

The hon. Member for Belfast, South (Rev. Martin Smyth)--I am sorry to see that he is not in his place--spoke with erudition and with his long- standing concern about cot deaths. I am very pleased to have been given a son seven weeks ago. During my maiden speech, it was my great pleasure and privilege to thank the staff at Epsom general hospital for the safe birth of my daughter. Tonight, it is a great pleasure to thank them for the safe delivery of my son.

A few days ago in Cornwall, my wife and I switched on with great interest to watch "The Cook Report" on cot deaths and the problems surrounding some of the fire-retarding agents that have supposedly contributed to them. While we should never turn our backs on new information--scientific rigour is all about scrutiny and monitoring--we should also be careful about engendering unnecessary panic. Forty thousand people rang up ITV straight after the programme, and I for one wonder whether the programme makers took great pleasure in the glee with which they were able to announce that fact. Those people were extremely frightened.

I must also question the editorial judgment of any programme that decided to leave in the crass, ludicrous advice to parents of young children that, if they believed their mattresses comprised any of these substances, they should wrap them up in polythene. I am pleased that the Department of Health and the Chief Medical Officer managed to put the lid on that one quite quickly.

Hard evaluation, nationally, locally and at the point of delivery, often tells a story very different from that portrayed by selective editing. The constituent I mentioned, who was so unnecessarily frightened, went on to receive the right treatment. It was successful, and he is recovering. But he is not alone. He is one of the 7.4 per cent. more people who have been treated at Treliske in the past year, and had he needed out-patient treatment, he would have been one of 8.3 per cent. more people going through the system. He is using a hospital that serves the medical needs of my constituents extremely well.

The hospital has just invested £1.4 million in a new dermatology unit, creating 14 more bed spaces and freeing resources in Falmouth community hospital. The hospital

Column 535

has a new public health laboratory-- £3.6 million worth of facilities, opened in April and incorporating some of the most modern clinical microbiology provision to be found anywhere in the country. It has a county-wide coronary angiography service. That means that many of my constituents will not now have to travel to London for treatment--a total saving to London hospitals of some 400 patients a year. Patients now enjoy the reassurance of being treated locally in familiar surroundings, with staff whom they know and with families close at hand. That enhanced service for my constituents, and the other services that will be created locally, are all part of the reordering of priorities from the centre, which have given new life to many of our regions.

If the London reforms mean that none of my constituents has to make a 520- mile round journey to London for treatment, I welcome them with open arms. For my constituents, the importance of health care delivered through community provision is, of course, all-important. They see new and expanding health centres, more practice nurses and well-funded care in the community, which, in Cornwall, is bedding down remarkably well. They see general practitioners who provide a standard of care and commitment that is unrivalled and who strive for continual improvement and, more often than not, achieve it. My constituents are now part of practices that have more control over local hospitals. Gone are the days of the conversations that I once had with a local GP who, when confronted by one of his patients who had been booked in for a 2.30 appointment at a local hospital, but who was not seen until 6 o'clock, went to see the hospital administrator, who looked askance at him and said, "Well, of course, we book everybody in at 2.30."

There are new initiatives in health centres. Only last Friday in my constituency, I opened Link Line, a computer service that now operates from the Poole health centre, allowing information to be collated and disseminated among my constituents--all in support of care in the community. Health education and, more importantly, health promotion must be central to any national health strategy. There is more evidence in GPs' surgeries than ever before of real developments.

We still have much to do. As we go about our duties in this place over the next week, some 450 people will die from coronary heart disease. As we go about our duties in this place next year, some 40 million days will be lost to that disease. The sadness behind those statistics, behind the tragedies, is that so many of the deaths are preventable--not all of them, but so many. Recent figures highlighted our concerns about the number of women who smoke and who remain resistant to health campaigns. It is certainly no coincidence that coronary heart disease now claims more women than ever before. We have much to do to remove the embarrassment factor from health promotion--the kind of embarrassment that seems to be behind the inordinately high incidence of prostate cancer, which goes undiagnosed and treated for so long, and which claims so many men. Some of the major developments in health promotion have been in female diseases: advances in breast screening, cervical cancer screening, not to mention the major step forward in our immunisation programmes.

Column 536

The right hon. Member for Derby, South (Mrs. Beckett) in part grudgingly accepted, then dismissed, the statistical significance of the recent British social attitudes survey. I must say that I find it more than statistically significant.

Let me return to the anecdotal evidence. I can count on the fingers of both hands the number of letters that I have received from constituents complaining about health services, GPs or hospitals over the course of this year. That is not to say that problems do not exist, but when constituents write, it is often not about a direct experience, but in response to a newspaper article or television programme that may have been badly researched. Very rarely are they from people who have suffered bad patient care.

The British social attitudes survey supports that. Nearly three quarters of those with recent experience of in-patient care are satisfied with that service, as compared with 56 per cent. of those without recent experience.

When the Government tackled the reforms, it was to an institution, a management dynamic that had remained inviolate from any reform for nearly 40 years. There are few institutions in this country about which one could say the same. The national health service still remains the biggest single employer in Europe, at one time employing more people than the Red Army. There was a management sclerosis. It is uncomfortable in some quarters to say that, but it was the case. Few things, if any, were costed--from bandages to serious operations. The answer, of course, is that organisational change and the pattern of the new relationships that emerge within that change cannot be transformed over night or by the single flourish of the legislative pen. It has taken time, and it will take time, but it is gratifying that the British social attitudes survey is now identifying that transition and the very real advances made on behalf of the British people.

8.6 pm

Ms Tessa Jowell (Dulwich): I am pleased to be able to contribute to the debate and I would particularly like to address the proposals contained in the Queen's Speech that will give effect to changes in the law in relation to the community care that is provided to people suffering from serious mental disorder.

I shall draw on my own experience as for 13 years I was assistant director of MIND and, for five years, I was a member of the Mental Health Act Commission, which was a statutory body charged specifically with supervising the needs of people who are seriously mentally ill. It is important to place on record that the legislative proposal arrived in the Queen's Speech belatedly and only as a result of its successful battle for space after the proposal to privatise the Post Office was dropped. It is not a mark of great Government commitment to solving the problems of community care for people suffering from serious mental illness.

The first issue that we must deal with is the number of people who will be, or potentially be, affected by the proposals. The estimates based on research vary enormously from 300,000 to the more tightly defined estimate: that people who are seriously mentally ill are about 1 per cent. of the 1 per cent. of the population who suffer from schizophrenia--between about 2,500 and 4,000. When the Minister replies, I hope that he will be able to shed some light on the size of the group that the proposals are expected to cover.

Column 537

I am sure that I do not need to remind the House of the background to the new proposals and the public concern about recent tragic cases that has given rise to a crisis in public confidence about the effectiveness of community care. Why do things go wrong? None of the people who committed dreadful acts of violence, which, in some cases, resulted in murder, was unknown to the services. They had all at some time been in touch with the services. Characteristically, that group of people rarely commits an offence without talking to somebody beforehand about their intention.

Those dreadful tragedies occur because the system fails the victim and the patient. Too often, they occur after a culmination of events--after several cards have been posted through the door, saying, "Sorry you weren't in, and I missed you." When the community psychiatric nurse, the social worker or whoever is charged with responsibility fails to make contact, dreadful consequences follow. In the past two years, there has been more debate about the crisis of confidence in community care for mentally ill people in the leader columns of newspapers, in pubs and on buses taking people to work than on the Floor of the House. We should not forget that, for every murder and every failure in community care, there are a hundred successes which are quickly obliterated. We now need to rebuild public confidence in a tattered policy.

What is causing the crisis in community care? The picture is complex. That there are many causes rather than just one has been the consistent theme of reports during the past 12 months. It has been expertly documented by the Mental Health Foundation and, more recently, by the Audit Commission, whose authoritative report was dismissed by the Government in an appalling and disgraceful way. They accused the report's authors of being unbalanced; I think that when any of us reads an Audit Commission report that is truly unbalanced, we look out of the window to see pigs flying past.

The crisis in care in the community relates not to the intention or the policy, but to the realisation of intention and policy. There is now ample evidence and experience to show what needs to be done to build effective, valued and co-ordinated services and guarantee high levels of professional performance. Living in the community, with a range of support services and practical assistance, is a viable alternative for all but a handful of patients who, for periods of time, need secure hospital treatment: indeed, it is the consistently preferred option for those needing such services.

For the policy to work, however, the needs of those whose lives will be shaped by it must be acknowledged and respected. Both the Mental Health Foundation and the Audit Commission argued that the approach to the development of community care services should be led by the needs of patients. They described the essential framework as including an appropriate place to live, an adequate income, a useful daytime occupation, access to help and support on a 24-hour basis and the opportunity to be consulted about the range of support available.

It should be remembered that--as many survivors of mental illness will say- -mental illness is a career. Too often, planning and support are provided in relation to a

Column 538

single episode as though it were a discrete event rather than, as is sadly the case, likely to be one of a series in the individual's adult life.

Although we know so much about what makes community care work--have, indeed, known so much for 30 years, since the long-stay mental hospitals were first run down--we now have a geographical lottery. In only a handful of regions is there anything approaching a comprehensive mental health service capable of providing the support that patients need. What a scandal it would be if a cure for breast cancer were known, but available only to those living in, say, the Wirral or Edinburgh. Precisely that position exists in relation to the long-term care and support of mentally ill people. We know what is needed, but the Government have failed to provide it on a consistent and national basis.

Sixty-six per cent. of resources spent on mental health services are still tied up in the mental hospitals which treat 10 per cent. of those who suffer from mental illness. That means that, in the community, 90 per cent. of mentally ill people benefit from only a third of the mental health budget--an imbalance that desperately needs to be corrected.

The Secretary of State has said that reforms to mental health law have caused the

"pendulum to swing too far".

Interpreting such generalities is always difficult, but the Secretary of State appears to have claimed that patients' freedoms and civil liberties are now respected more than the need for those freedoms and liberties to be restricted or removed in the interests of the patients, or of society.

The changes in the law are primarily designed to adjust the swinging pendulum, and to reassert power and control over the way in which patients choose to live and behave; they are not intended to create any new legal regime whereby patients can be assured of the service that they need and to which they should be entitled. In words that the Secretary of State has been heard to use, "patients must take their medicine".

That is how the Secretary of State's legislative proposals will be regarded by those who fear being subject to the new powers, and by professionals who strive to win more--and more versatile--resources for their clients, only to find themselves being made legally responsible for supervising patients within services that are unable to meet even minimal levels of need.

Last year, I served on the health committee inquiry that examined in detail the case for additional legal powers, and broadly rejected the proposals that the Secretary of State is now presenting. We did so because we felt that a more fundamental review of the Mental Health Act 1983 was needed, and that piecemeal reform was misconceived; in our view, extensive legal powers were already available but insufficiently used, or insufficiently effective. I still believe that to be the case, but I firmly believe that the time has come for the House to debate proposals of a different nature which would legally oblige health and social services authorities to provide those in need with a minimum level of service. Unless Parliament requires such action, I do not envisage the Government, or those with local responsibility, ever taking seriously their duties to those who suffer from serious mental illness.

In the report of its 1993 review of mental health law, which recommended the creation of a new supervised discharge power, Department of Health officials stated:

Column 539

"it must be recognised that the use of the power implies a reciprocal obligation on the statutory services to provide the support the patient needs".

Any approach that does not make obligations explicit, easily enforceable and adequately funded will be both unjust and ineffective. I fear that the Government's measure promises to be both.

8.17 pm

Mr. Mark Robinson (Somerton and Frome): I warmly welcome various aspects of the Gracious Speech, but I intend to concentrate on social security and health.

The Gracious Speech heralds a constructive legislative programme, containing measures that will be important to many people. It is a pity that the absence of ideas in the Labour party should present such a stark contrast. I could not help noticing that on seven occasions the right hon. Member for Sedgefield (Mr. Blair) failed to provide answers to what were, after all, very direct questions. The success of the programme that has been announced will depend on the Government continuing their policies for a sound economy. Only through those policies can the programme be financed. They have resulted in the lowering of inflation, a steady fall in unemployment levels and--in succeeding months--the fastest-growing economy in Europe. Efforts to promote enterprise and improve economic performance must therefore remain at the heart of Government policy.

The Government must build on the work that they have done already to reduce the budget deficit, even at the expense of short-term popularity. I hope that the forthcoming Budget to be delivered by my right hon. and learned Friend the Chancellor of Exchequer will reflect that.

As the honorary president of Frome Mencap, I welcome the Government's decision to introduce a Bill to tackle discrimination against disabled people. I have always believed that this task should be undertaken by Government, especially in view of the costs involved, and not left to a private Member's Bill. I wish legislation had been introduced earlier, but I am delighted to see it now.

We must not overlook the fact that the Government approach this subject with a considerable record of support for disabled people. Spending on benefits for the long-term sick and disabled has increased by more than 200 per cent. since 1978-79, rising to the present level of £17 billion. The new legislation must help disabled people in their struggle to achieve independence and secure even greater recognition of the successful contribution that disabled people make to life in the community.

I visit many community activities for disabled people in my constituency, and I never fail to be impressed by the dedication and achievements of the participants and by the carers who help disabled people so much. If I have a plea this evening it is that we do not forget the carers; that we do not forget to care for the carers. After all, respite makes a better carer. By encouraging and helping carers to look after disabled people, we ensure that they are able to do a better job.

Attitudes to disabled people have changed beyond all recognition over the past 30 years. That is reflected by the speeches that are made again and again on both sides of the House. I pay tribute to those members of the all -party group on disablement--the hon. Member for Kingswood (Mr. Berry), my hon. Friend the Member for Exeter (Sir

Column 540

J. Hannam) and all the others, including Lord Ashley from the other place--who have done so much to raise the level of recognition of, and interest and concern for, disabled people.

That is why I believe that, when it is enacted, the importance of the legislation will be recognised. I am sure that it will work effectively. However, we must remember that we cannot achieve everything at once. It is by working hard, effectively and consistently for disabled people that we have secured vast achievements over past years. Fifteen years ago, people would not have believed that we could have come as far as we have today. That is not to say that we have gone as far as we can; we have not. We have much work to do and there is great enthusiasm in the community to undertake that work.

I visited the Bath and West show in my constituency this summer, where I attended a disabled persons games. This was not a special activity, heralded with special fanfare; it was a normal and natural activity which has gone on for a number of years. That is the way in which I believe that disabled persons want to carry out their activities: they do not want them to be seen as something special, or something to be gawked at, but as natural a part of community life as a hospital open day or whatever.

I now turn to the issue of unemployment or, more importantly, the need to get people back into employment. Many people come to my advice centres to complain about the inflexibility of the benefits system. People often say that they have sons or daughters who want to get back into employment but who are finding it extremely difficult. That is why I welcome the job seeker's allowance initiative. It is very difficult to enact change in the benefits system, because whenever an attempt is made some pressure group will scream that it will disadvantage X or Y. It does not matter which party enacts the legislation, that is the automatic reaction--particularly as the negative points tend to be highlighted in the media whilst the positive ones are left, rather conveniently, to one side. It is only at a later date when one sees that the legislation is working and that people are benefiting from it that the press realise the success of the measures which the Government have already undertaken. I see the job seeker's allowance as building on such success by introducing the concept of incentive, which is what the back-to-work bonus will be all about.

I endorse wholeheartedly the remarks by my hon. Friend the Member for Falmouth and Camborne (Mr. Coe) in recounting experiences from his constituency. Not only is the national health service working well currently, but it is improving all the time. The Labour party does not like to acknowledge that fact for obvious political reasons, but it is borne out by monthly published statistics.

The long hospital waiting lists are reducing, and we need to see that. When I was first elected as the Member for Somerton and Frome in 1992, there was a long-running campaign for 24 hour ambulance cover. I was astonished that there was no such cover in Frome when it should have been provided. So I went straight to the Wessex regional health authority and I would not take no for an answer. Within nine months, that necessary service was implemented and since that time I have received no further complaints about ambulance cover. That is a good local example of an improvement in the national health service.

Column 541

Similarly, there were almost outraged demands for a comprehensive breast-screening service in the Frome area. Those involved in the campaign seemed to assume almost automatically that the Government would not make this service available. Equally speedily, the problem was resolved--another local example of improvement in the national health service.

I have seen great improvements in the quality of health care provided. I pay tribute to the local hospital trusts, which operate from Yeovil, Taunton and Bath, for the work that they have done to secure that improvement. Waiting lists in my constituency have come down substantially and the number of complaints in my mail bag is also coming down.

I meet people all the time who have returned from some sort of hospital treatment. They often express surprise at the quality of treatment that they have received. When I ask why they are surprised, they say that it is because of all the negative reporting about the national health service that they have seen in the newspapers. They say also that it is because of the negative comments that they hear from the House of Commons. Those comments come not from Conservative Members but from Labour Members. The Liberal Democrats are not free of blame on that score.

The most vociferous complaints about the NHS often come from people who have not been near a hospital for 10 years, and base their views simply on what they have read in the newspapers. I will not talk for London or Birmingham, but we often hear about the problems facing people in rural communities.

My constituency is wide-ranging and covers many rural communities. The people living in those communities are being extremely well-served and well looked after by the NHS. If they do complain, those complaints are taken up and dealt with extremely swiftly and the problems are sorted out. It is a sad fact that nine tenths of those problems are due to bureaucratic mismanagement, which, once it is looked at by senior managers, can be sorted out quickly and easily.

The improvements that have been brought about by my right hon. Friend the Secretary of State's insistence on supporting and developing the hospital trust concept and the success of many of the fundholding practices has brought about a need to refine and reduce administrative structures. That is why I am glad that a Bill will be introduced to abolish the eight regional health authorities. I would not say that it is overdue, but the time has now come. The regional offices that will replace them will employ just over 1,000 people, compared with nearly 4,000 managers and their support staff employed in the 14 regions two years ago. Time and again, constituents come to me to complain about excess management in the NHS. We are tackling that problem.

We can never do away with management, particularly in a service that is complex and which has strongly entrenched professional organisations. However, we can improve that management. We can streamline it and ensure that it works effectively. By breaking management down to individual hospitals through the hospital trust system, we have managed to bring about a far better performance and, with it, thank goodness, substantial reductions in waiting times.

Column 542

John Yeats has done a great deal of research into this subject, and he has said time and again that it is the time that people have to wait that matters, not necessarily the numbers waiting. People are prepared to wait a reasonable time for non-urgent surgery. People should not have to wait at all for urgent surgery. I am sometimes disappointed when I find constituents who are being treated as non-urgent even though their condition has worsened but their general practitioner has not reported that change to the local hospital. Once it is reported, treatment is effected quickly.

There is a great deal to encourage me in the Queen's Speech. I should like to mention briefly the reform of agricultural tenancy law.

Madam Deputy Speaker (Dame Janet Fookes): Order. The hon. Gentleman must not mention that even briefly. It does not fall within the terms of the amendment.

Mr. Robinson: I understand that, but it is enormously welcome to farming interests in my constituency.

8.34 pm

Mr. Alan Milburn (Darlington): John Maples's advice to Ministers to batten down the hatches on NHS matters clearly came too late for the Gracious Speech. The Government will live to regret that. The NHS management changes outlined in the Queen's Speech will bring yet further health trouble to a Government who are drowning in a mess of their own making.

In October last year, the Secretary of State for Health first told the House of her plans to reform the management of the NHS in England. Her intentions were radical. She said:

"These changes will slim down NHS management. They will make it simpler and sharper . . . They will save money on administration to spend on patients, and they will uphold and strengthen

accountability. They will continue the process of

decentralisation".--[ Official Report , 21 October 1993; Vol.230, c.400.]

How could anyone disagree with those aims? The claims will be judged when detailed proposals are laid before the House, but they also have to be judged against what has gone before. There, the Government's record betrays their rhetoric.

To date, the Government's assault on NHS red tape has turned out to be a damp squib. Even that inveterate self-declared campaigner against bureaucracy in the Welsh NHS, the Secretary of State for Wales, has failed to come up with the goods. Since he declared war on bureaucracy in the Welsh NHS in autumn last year the number of health service managers there has not fallen but has increased. The same is true in England, where the latest Department of Health figures show that in the year to September 1993 managerial numbers increased once again, this time by 13 per cent. That is despite a blatant attempt by Ministers to massage the figures. So much for the Secretary of State's claim about slimming down NHS management. It is not slimmer or leaner and it certainly is not fitter, but it is fatter. What about the other side of the equation? What about saving money to spend on patients? The evidence is equally graphic. An extra £1.5 billion has been spent on managerial salaries since the advent of the market in the NHS. There are bumper salaries for a few but a pay squeeze for the many. This year there are 17,500 fewer nurses on England's hospital wards than there were last

Column 543

year. Increasing the number of managers and cutting back on nurses is hardly the priority for a national health service where 1 million patients are currently waiting for hospital treatment.

The Secretary of State for Health now says that she has learnt all the lessons. She says that the abolition of the regional health authorities will put matters right by launching a new assault on bureaucracy. Her Department's figures give the game away. They show that she has the wrong target in her sights if she wants to make an effective job of tackling NHS red tape. The abolition of the regions will do nothing to tackle the 7,500 extra managers outside the regional health authorities who have been recruited to implement the Government's market changes. The boom in health bureaucracy has taken place not at regional health authority level but at hospital level as a new contract culture has taken over inside the national health service.

The abolition of regional health authorities will achieve at least some of the Government's objectives. It will undermine health service planning and further undermine local accountability in the national health service. The light touch that the Secretary of State commends as a virtue of NHS management executive outposts is irrelevant in a region such as mine, where the incidence of ill health and health inequalities call not for a light touch but for strong Government intervention. Those health inequalities and the health problems that characterise the north also call for in-depth knowledge of the region so that resources can be targeted where they can be most effective. The merger of Northern regional health authority with Yorkshire regional health authority will make for a more centralised, out- of-touch service and a less accountable NHS. The future of health care will be the preserve of people without any stake in the regions. Policy, however, will mirror the sort of confusion that exists at more local level.

There is no disputing the merits of the proposal to merge family health services authorities with district health authorities, which makes sense, but greater coterminosity is being compromised by other Government policies, most notably by the free market approach to health authority mergers, by the advent of health commissions, which are even further distanced from local communities, and by allowing the local government review to happen without reference to institutional change in the NHS.

In my own area, for example, the Local Government Commission is likely to recommend in a few weeks' time the welcome restoration of self-government to Darlington. Henceforth, the town will run its own social and housing services, but the devolution of local government powers from County Durham to Darlington is being accompanied by the centralisation of health powers from Darlington to County Durham. The forced merger of Darlington health authority has resulted in the purchase of health care being undertaken by a county-wide commission. Inevitably, the already yawning gap between social services and health services, so apparent in community care, will become a chasm as decision-making structures become ever more distant from one another.

It is a classic case of one set of Ministers not knowing what the other set is up to. The dog's breakfast that results can only compromise patient care. Nor is that a problem peculiar to my area. Across the country, a laissez-faire

Column 544

approach to health authority mergers has given rise to a patchwork quilt of purchasers. There is no direction from the centre, no overview and no planning. Instead, the market and the whims of local health managers are deciding the future shape of the NHS. There is one bonus, of course, for the Conservatives in this hands-off approach: a further distancing of NHS decision making from the local communities that the health service is supposed to serve. That makes it easier for centrally determined free market thinking to be imposed on the NHS in all parts of the country.

That policy is aided and abetted by a secretive and closed health appointments system. Not surprisingly, that system puts the friends, supporters and even the relatives of members of the Conservative party into key positions, both in NHS trusts and in health authorities. To date, the public have footed a £40 million salary bill for turning NHS trusts into a lucrative job centre for redundant Conservatives.

Ministers could have used the Queen's Speech to make the minimum changes necessary to restore credibility to that discredited system. They could have used the speech to ensure that the lists of people nominated to serve on a health authority or an NHS trust are published. They could have insisted that the selection procedure and the criteria be made transparent. Finally, they could have insisted that, as is the case for people wishing to serve on magistrates benches, the party political affiliations of individuals be declared.

Ministers' refusal to accept those changes clearly shows that they believe that jobs for the boys and for the girls are more important than public accountability in the NHS. They are unscrupulously using the current appointments system to further Conservative interests in the NHS.

I remind Ministers that the health service is not their plaything. It is certainly not the plaything of those people appointed by Ministers. It belongs to the people as a whole. It is a public service and it should be properly and publicly accountable. In place of the chaos and inefficiency of the Government's health care market, we need an NHS that is free, fair, open, accountable, well planned and properly managed. I am afraid that that sort of vision for the NHS will have to await a future Queen's Speech from a future Government.

8.45 pm

Mr. Robert Hughes (Aberdeen, North): There is much that I should have liked to debate with the Secretary of State for Health. Unfortunately, time does not permit that. I shall say, however, that she constantly says at the Dispatch Box that the previous Labour Government cut nurses' pay. I am afraid that she is misinformed. She should look back at the records. It was the Labour Government who set up the Hallsbury committee on nurses' and midwives' pay, and it was of great benefit to the nursing profession, in terms of both their pay and their status. I hope, therefore, that the Secretary of State will consider the facts.

The Aberdeen Royal Infirmary NHS trust in Aberdeen was the flagship of the Government's trust proposals and campaign in Scotland. It was trumpeted as one of the best trusts that would be available. All sorts of tributes were paid to it. What has happened? Waiting times have lengthened and the number of patients on waiting lists has increased to the extent that something has had to be done about it.

Column 545

For some reason or other, the new trust, a flagship of the NHS trust system, has run into rough water. It is in choppy seas. Grampian health board, the purchaser, has had to do something about it. Today, it announced a new £500,000 plan to cut waiting lists. The result is that some services that are to be additionally provided will go to NHS trust hospitals. Some people, however, will have to travel from Aberdeen to Elgin, some 50 miles away, to have their operations.

Even worse, some 50 urological operations and 100 plastic surgery operations will be bought from local private hospitals. I fear that that is what the future holds. As the health service runs into difficulty, services will be bought from private hospitals, which is creeping privatisation. Of course, Ministers will say, "Do you want patients to wait longer and to suffer? Is it not better that services are bought from private hospitals?" It is all very well saying that, but a deliberate attempt is being made to run down the health service.

Grampian health board even went to the extent of trying to purchase about 100 operations from Health Care International hospital in Clydebank. Only seven people from Aberdeen wanted to be treated there. They did not want anything to do with that hospital. That sort of thing brings the health service into disrepute.

Mr. George Kynoch (Kincardine and Deeside): Will the hon. Gentleman give way?

Mr. Hughes: I am sorry, but I have sat in the Chamber all day and I shall not give way to hon. Members who have just entered the Chamber--at this point.

Mr. Milburn: Generous to a fault.

Mr. Hughes: I am generous to a fault, but I do not want to be diverted.

Community care has been at the core of the Government's national health service reforms. I think that all hon. Members agree that the right principle is behind the community care policy. No one would wish any long- stay patient to remain in hospital any longer than necessary. We would much prefer that such patients received community care. The problem is that for many people what is supposed to be community care is not community care at all.

In Grampian, there are some very good examples of small units for former patients of mental hospitals. They are well supported and are a tribute to the community care system, but they are not a cheap option as they can be even more expensive than in-patient care. However, what so many elderly people are offered under community care is simply a transfer from institutionalised public care to institutionalised private care. What lies behind that is one of the most damaging things that the Government have done, which is to abandon the duty to care. That is fatal for the health service and for the patients it serves.

We are witnessing a cynical exercise by the Government to transfer people from hospitals into the private sector to save the public purse. They wish people to pay and to enable private nursing homes to make a killing. Some months ago, I had a very interesting conversation--that is a polite term for the exchange--with the owner of a private nursing home. At any rate, he was more open than the Government. He said that the first

Column 546

method of dealing with the elderly who were in need of nursing care was private hospitals, and that the NHS should be the last resort. He complained that too many social workers were interfering with his ability to choose who he wanted to accept in his private nursing home. When I asked him how he chose, he admitted that his test for admission was not whether his nursing home could provide adequate care or whether particular patients were the most needy, but whether they could pay.

I asked the owner what would happen if he accepted someone, but it turned out that his home could not provide the proper care. He replied that that would be someone else's problem and that the patient would simply go back to the NHS. The notion that the NHS is to be a sort of slum where people go only when there is nothing else available is what I find most offensive about the Conservatives' treatment of it. The NHS should be about excellence, and its first priority should be to ensure that people get the care that they need.

I deal now with an issue of particular importance to Aberdeen, which is the future of Woodlands hospital. It is not, in fact, in my constituency but in that of the hon. Member for Kincardine and Deeside (Mr. Kynoch), to whom I might give way if he seeks to intervene again. However, many of the patients are, in a sense, my constituents, and certainly their parents are.

The patients at Woodlands are very vulnerable and require specialist medical care and attention. In its business plan, Grampian Healthcare NHS trust proposed that the hospital should be closed and its patients transferred to a unit on the site of the Royal Cornhill hospital. From the beginning, this issue has been handled extremely insensitively, to put it mildly. The manner in which it has been handled exposes a major flaw in the purchaser-provider split. Patients have been almost bandied about between purchaser and provider as though they did not count. I am sure that that was not the intention, but that is what has happened.

The unit that was to be opened at the Royal Cornhill site was to be a refurbished and extended former acute psychiatric unit for severely mentally ill patients. It was feared--indeed, this was mentioned in the trust's own documents--that the distinction between mental handicap and mental illness would be at best blurred or at worst extinguished.

There has been the three-month statutory consultation period about the closure, but Grampian health board--the purchaser--has confirmed the closure of Woodlands hospital and the transfer of patients to the new Royal Cornhill site. However, it is proposing a new-build hospital costing £3.5 million, which is £1.6 million more than the earlier cost.

Many of my colleagues might ask, where is the problem? They might jump at the chance to have in their constituency a new-build hospital costing £3.5 million. I do not reject the proposal out of hand--it must be examined seriously--but the recommendation raises as many questions as it seeks to answer.

Grampian Healthcare trust--the provider--has made it abundantly clear that it does not have the necessary money, so where is the capital to come from? There has been great controversy about the problems of selling the current Woodlands site, but why is it not possible to refurbish and upgrade the current hospital buildings,

Next Section

  Home Page