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Column 635methodology behind the allocation of the budget. It also says that, as we move to capitation funding for GP fundholding, it will be more possible to make tight comparisons. There is overwhelming evidence of the benefits of GP fundholding in independent report after independent report. It is also evidenced by the number of people who are seeking to become GP fundholders, and recent Government announcements have made that even more possible.
Mr. Tim Smith (Beaconsfield): Is it not extraordinary that the Opposition will not accept the National Audit Office's genuinely objective and independent assessment of the situation? It has completely vindicated the decision to establish fundholders, as well as making the more general point about pushing down decision making in the health service as far as possible.
Mrs. Bottomley: I thank my hon. Friend for his comments. Characteristically, the Labour party has a lowest common denominator approach to everything. Labour Members dislike excellence and innovation. They think that any change must be a change for the worse, and that is a tragedy. GP fundholding has been commended by the Organisation for Economic Co-operation and Development report, by Professor Glennerster's report, and now by the National Audit Office. Labour Members are deaf and blinkered; bad news is the only news they favour.
The Government have achieved the objectives which we set out in the National Health Service and Community Care Act 1990. Trusts are here to stay, and fundholders are leading the drive towards our goal of a primary care-led health service. The power to take decisions has been put in the hands of those closest to patients.
But in one vital respect, we want to go further than was envisaged in our original reforms. The principle purpose of the Bill is the abolition of regional health authorities. The RHAs played a necessary role in the old NHS. That fact has been recognised by many of my colleagues, not least by the late Lord Joseph, to whom I pay a very warm tribute. He was a most distinguished predecessor in this office and a major contributor to the well-being of this country. In the first stages of the reforms, regional health authorities assisted the successful development of trusts, of fundholders and of district health authorities in their new purchasing role. I express my appreciation, and that of other Ministers, of the work of regional chairmen over the years. I am pleased to say that they will have a continuing and important role as regional members of the policy board.
The successful devolution of responsibility to local level inevitably meant that the role of RHAs would reduce. To put it slightly more bluntly: they were the last bastion of the old command and control system from which we have now escaped. By abolishing RHAs, the Government will sweep away an unnecessary tier of NHS management. The Bill is part of our concerted move to streamline management, to eliminate unnecessary duplication and bureaucracy, and to save money on administration which we can then spend on patients. We estimate that the savings from the Bill will total £150 million every year in England, and at least £3 million a year in Wales -- substantial savings, which will result in even better patient care. Those savings will result from the abolition of RHAs and from bringing together
Column 636and halving the number of DHAS and family health services authorities. In Wales, 17 health authorities will be reduced to five. A further £50 million will be saved from reductions in the size of the Department of Health. We are determined to ensure that we set an example from the centre, and we expect streamlining to take place throughout the service.
Mr. Kevin Hughes (Doncaster, North): If the Secretary of State's Government are leading the fight against bureaucracy and are streamlining management, why has bureaucracy in Doncaster increased by 48 per cent since the changes were introduced? Spending on bureaucracy has increased from £4 million to £6 million--and that is only in Doncaster. Where is the Secretary of State's streamlining there?
Mrs. Bottomley: A less than worthy characteristic of the Labour party is its knee-jerk attacks on NHS managers at every possible opportunity. People who go into NHS management are committed to the national health service and to the improvement of service provision to patients.
The Government's achievements have included strengthening management in NHS trusts and health authorities; ensuring that there is better financial control, so that health authorities do not run out of money nine months into the year; and, above all, managing waiting lists so that progress can be made on waiting times. The hon. Member for Doncaster, North should realise that, because of the Government's reforms, his region has received a further £139 million this year for the benefit of patients. Those are the achievements that really matter.
In line with our manifesto commitments, substantial efficiency savings, amounting to £200 million, will be spent to improve the quality of services further. Thanks in part to this Bill, we will be able to make even further cuts in hospital waiting times.
Mr. Alex Carlile (Montgomery): On the question of NHS administrators, does the Secretary of State agree or disagree with the views expressed on that subject by her hon. Friend the Under-Secretary of State for Wales?
Mrs. Bottomley: I certainly agree with the Under-Secretary of State for Wales, my hon. Friend the Member for Clwyd, North-West (Mr. Richards), who makes a very important contribution to the decision-making process. It is a great asset to have a colleague in the territorial Departments who takes a close and detailed interest in the matter, and I am delighted to see that he is in the Chamber today.
Mr. Robert Banks (Harrogate): I am especially glad that my right hon. Friend has paid tribute to the work of employees in the regional health authorities. Will she, however, give full recognition to the talent, expertise and knowledge of the work force during the reorganisation? In particular, will she consider carefully before moving the headquarters from Harrogate, which has one of the best possible offices? If the headquarters was retained, the pool of expertise could continue its valuable work in the enlarged area.
Mrs. Bottomley: I know what a great champion of that cause my hon. Friend is. I have visited the headquarters to which he refers, and his local trust hospital. I have seen some excellent mental health project developments there. Detailed consideration is, of course, given before final
Column 637decisions are made. The region under consideration is large, so it is important to have the headquarters somewhere that is accessible not only for the area my hon. Friend represents, but for those in the north and the east of the region.
Several hon. Members rose --
Mrs. Bottomley: I will not give way now, because many hon. Members may be fortunate enough to catch your eye later, Mr. Deputy Speaker. In short, the changes will ensure that we have a local service which is locally accountable to health authorities and trusts providing the service, and not the great command-and-control, hierarchical, bureaucratic service of the past. It is because of that change that the service is so much more flexible and so much more responsive to local circumstances than it would be with a command-and-control system.
It is not a coincidence, of course, that Labour Members belong to the party that produced that great document, the national plan, in 1965. That is how Labour Members would like to run the health service. They would like one document in the centre--
Mrs. Bottomley: No. The hon. Gentleman will be able to address the House on his Stalinist ideas at great length later. He will understand that I must now make progress-- [Interruption.] I will not be tempted on the matter now.
The Opposition's amendment refers to cancer services. Thanks in part to the Bill, we shall be able to make further progress on that front as well. We shall build on the excellent cervical and breast screening programme that we established. I again place on record my commitment to take forward the principles set out in the report on cancer by the chief medical officer's expert advisory group. I want to see them sensibly implemented throughout the service. Facing changes, as we do in the Bill, will enable us to do precisely that. This is the difference between the Government and the Opposition. Labour's policies are in turmoil, and its policies threaten turmoil for the national health service. We have introduced this sensible measure, which will improve the management of the NHS, improve its efficiency and improve services for patients. Let no one be in any doubt that, if the Opposition vote against the Bill tonight, they will be voting for bureaucracy and inefficiency, and voting to put patients last.
I turn now to the detailed provisions of the Bill. It is essentially a straightforward measure, with one major provision in clause 1, which will abolish regional health authorities. It will also remove the existing district and family health services authorities and replace them with a single body--the health authority.
It is a further measure of the success of the reforms that the merger of DHAs and FHSAs now seems an obvious and inevitable step. Many DHAs and FHSAs already work in an integrated way under a single chief executive.
Column 638Those joint health commissions eagerly await formal merger and other authorities are not far behind. It has become clear that the whole NHS will be ready for this change by 1 April 1996. We have decided, therefore, to establish all the new health authorities on the same date. That will make it absolutely clear where we stand and where the future lies.
As all hon. Members are probably aware from their constituency mail, many people outside the health service cannot tell the difference between DHAs, FHSAs and RHAs. I am pleased to tell them that they will not have to bother in future. From 1 April 1996, there will be just one health authority at local level, and the system will be simple, clear and accessible. The new merged authorities with their wide span of responsibility will have real influence at local level.
Mrs. Bottomley: I am delighted that the hon. Gentleman is prepared to offer advice to the Government on these matters. I know that he will vigorously support the legislation when it is in Committee. My hon. Friend the Minister for Health has noted the hon. Gentleman's enthusiastic support; he may be able to help to move some of the amendments.
The local authorities will have real influence and a vital role. They will be the single authority responsible for ensuring that the entire health needs of their populations are met. For the first time, their job will to be to ensure that the hospital, the community and the family doctor services are planned together in a coherent and co-ordinated way. I expect the new health authorities to work especially closely with the family doctors in their areas--fundholders and non-fundholders alike.
General practitioners, as my hon. Friends are well aware, have always had a crucial role as the gatekeepers of the national health service. Their position is a hallmark of our health service and is recognised, at home and abroad, as one of its great strengths. Our reforms have, rightly, enhanced the role of family doctors. We have given them new powers and new authority to shape services according to the needs of patients. The Bill will build on that.
The Bill will ensure that family doctors are even more at the heart of the new NHS. The new health authorities will be better placed to support GPs in the move towards more primary care-led health care, and they will ensure that family doctors, as the National Audit Office report again suggested, are fully involved in the crucial task of purchasing secondary care.
Schedule 1 makes the consequential changes required to reallocate functions. The new health authorities will bring together responsibility for both primary and secondary care-- [Hon. Members:-- "And dentists."] Indeed, as hon. Members say, dentists will also be included. As a result, the new authorities will be able to take on some of the roles previously carried out at regional level. We shall be able, for example, to pass down to local level functions such as purchasing specialist services, public health, midwifery supervision and some aspects of education and training. Where tasks need a wider perspective than a single health authority, several will be able to work together, supported as necessary by regional offices. I know that this is a point of concern to many of
Column 639my hon. Friends. The new system will retain the necessary overview to ensure that the health service continues to deliver its objectives efficiently, effectively and coherently.
We have today published a guide to the operation of the new system, which sets out some of the issues in more detail. It builds on good practice and experience so far. Among other things, it describes the role of the new regional offices. The proper implementation of key national policies, such as our objectives in "The Health of the Nation", the reduction of junior doctors' hours, teaching and research, and the development of regional and supra-regional specialty services, requires strategic direction. The NHS executive, operating through its regional offices, will discharge that role. It will support the development of local policies and, where necessary, ensure effective co-operation across service, education and research.
Mr. Hugh Bayley (York): The Secretary of State referred to the Yorkshire regional health authority office in Harrogate. Will she undertake to publish the full and detailed option appraisal on whether the new regional offices should be based in Harrogate, York or Durham, so that hon. Members within the new region can express opinions on the merits of each case and so that the public can be consulted? Or does she intend that the new decentralised health service should deny the public the opportunity to express views on the health service? Will decisions simply be taken behind closed doors in the NHS executive?
Mrs. Bottomley: I regret having given way to the hon. Gentleman. It is the case that decisions about the delivery of services are open to public consultation, and the papers are made available. For decisions about the organisation of NHS staff and people in the Department of Health, that is not the process followed. Our duty is to ensure that the taxpayer's money is used as effectively and efficiently as possible for patient services.
I regret giving way to the hon. Member for York (Mr. Bayley). I thought that he might have something interesting to say about the role of the regional office and that vital aspect of delivering a local service but also managing to pursue a number of national priorities. We believe that we have got that balance right in this important Bill--through detailed consultations and consideration within the service.
Mr. D. N. Campbell-Savours (Workington) rose --
Mrs. Bottomley: I have lost patience. I was so disappointed with the comments of the hon. Member for York that I am not prepared to give way. I am afraid that my patience has withered away. I shall try to be more forgiving in due course, but now I have lost patience.
What matters is to establish a more effective, streamlined management, so that the executive can better fulfil its role. That will ensure that we continue to deliver national policies by getting the best out of the local flexibilities that are at the heart of the new NHS.
Column 640The regional offices will not be RHAs by another name, however. They will be considerably smaller, and totally different in outlook. Two years ago, the regions employed around 3,900 staff. Today they employ 2,600. The new regional offices will employ no more than 1,100, which is less than a third of that original size.
Their work will focus on the key functions that have to be exercised at regional level. There will be no unnecessary duplication of functions between the regions and the centre, or between the regions and NHS trusts and health authorities. The executive will give proper strategic management to ensure accountability of health authorities, fundholders and trusts. The simplified structure means that information and advice can flow more freely between the NHS executive and local level. There will be a clear line of accountability from the NHS in the field through to Ministers. The new system will further promote freedoms at a local level. It recognises the importance of innovation and will nurture it. We utterly reject the Labour party's model of a health service--rigid, monolithic and crawling along at the pace of the slowest. We believe in the rest learning from the best and in levelling up, not levelling down. That is the culture that the Bill will reinforce.
I do not need to take the House through the functions in schedule 1 in detail, as most of them are straightforward consequential amendments, but I must highlight two areas, not least because they are of direct relevance to the Labour party's amendments. They are the role of professionals and the future of education and research. On the latter, we are committed to maintaining and improving the essential partnership between the universities and the NHS. I have already had productive discussions with the Committee of Vice-Chancellors and Principals, and we will monitor progress carefully during and after the reorganisation.
Dame Elaine Kellett-Bowman: I trust that my right hon. Friend is not referring only to universities, as there is a very good Project 2000 in St. Martin's college in my constituency, which is not a university, although it is as good as most, or better.
Mrs. Bottomley: Again, my hon. Friend has the right of it. She will know that that revolution in the training of nurses is one of the changes since the introduction of the reforms. The Project 2000 course is now available throughout the country. As my hon. Friend rightly says, we are leading in that area. The courses are especially good for training nurses to work in the community as well as in a hospital setting. I thank my hon. Friend for drawing that fact to the attention of the House.
As I think that my hon. Friend the Member for Lancaster (Dame E. Kellet- Bowman) will agree, the training of doctors and dentists has certain special aspects--the long training, the rotations and the links with research. Because of the importance of maintaining those contacts, I asked the eight regional policy board members to take special responsibility there.
Some of the changes that the Bill introduces are to enable consortia of health authorities and trusts to work more closely together in informing the purchasing of education and training over time and, in due course, taking on some purchasing themselves. That will no doubt apply to the college to which my hon. Friend referred. That change will take place within a national framework, which will be carefully overseen by the NHS executive.
Column 641Similarly, because medical research in this country is, frankly, outstanding--some of our centres receive commendations from around the world--it is important that we have the right balance between local and national input. Many of my hon. Friends will be aware of the important work undertaken by Professor Michael Peckham, the first ever director of research and development for the NHS.
I was recently able to underline the Government's commitment to teaching and research by announcing an additional £40 million support in the coming year. In passing, it is only possible to make such announcements for the health service because the Government are taking such good care of the economy that we have such sums to invest.
Following the publication of the detailed document "R&D in the New NHS" and of the important Culyer report, we have been holding discussions with the research and academic communities, with a view to introducing a new single stream of funding for NHS research. I am pleased that, so far, that has been welcomed. I shall be able to make more announcements shortly.
Finally, when we make regulations on the membership of the new health authorities, we will require them, where they have a medical or dental school in their area, to have a university member on the board. In doing so, we shall continue the present arrangements, which recognise how vital is the partnership between universities, medical schools and the NHS.
On health authority membership, when our changes created district health authorities, with their new and distinct role, we paid special attention to who should sit on their boards. Frankly, I regret the fact that so many of the non-executive members have had to face the vituperation of the Opposition, who constantly denigrate their contribution, regardless of the way in which appointments to health authorities were made by the Labour party when it was in power, and of the arbitrary way in which 32 health authority chairmen were dismissed at one stroke by a former Labour Secretary of State for Health because he did not like their political colour.
More important than the non-executive appointments, however, we brought in executives for the first time. It was absurd that, under the old system, the agenda was often dominated by overtly political interests, such as the prospective local Labour party candidates in Greenwich who sat on the board of the health authority, while those who had to do the work had to sit on the sidelines. In the new health authorities, we propose that the executive members will include a director of public health. The Labour party's
amendment--characteristically missing the point--mentions regional public health directors.
Of course, the new local health authorities should be the focus of action in a decentralised system. The public health function should properly reside there, closer to the public whose health is the key issue. That is why, in an important advance on the old system, we will establish for the first time as a statutory requirement an executive director of public health at the local level.
Health authorities will continue to be unified boards, bringing together executive and non-executive members working towards a common purpose. It is important that
Column 642they comprise the best people locally to give them the balance of skills that they need. People should be selected for the personal qualities they bring to the boards, and not to represent sectional interests. As the House will know, we are opening up our appointments procedures so that both health authorities and trusts have access to an even wider range of skills and experience.
I have asked the right hon. Member for Derby, South before to take her embargo off the trusts and to encourage people to serve on them, instead of putting them in the appalling position in which, if they serve on trusts, they are apparently supposed to be working for her to bring them to an end.
Mrs. Bottomley: I am to some extent reassured by the right hon. Lady's comments, but members of her party have been worried about taking on such appointments, when approached to do so by Ministers, because of their fears of offending the party they support. If that happens again, I shall refer the details to the right hon. Lady. The Bill will build on the practice that we have already established with district health authorities, so that the new boards have the best people to help them to discharge their vital role. We expect that a growing number of both health authority and trust members will have backgrounds in nursing, medicine or any other relevant profession, and we are already seeing examples of that. The hon. Member for Wakefield (Mr. Hinchliffe) and I served on the Standing Committee on the National Health Service and Community Care Act a long time ago-- [Interruption.] We were all young then. The hon. Gentleman, and my hon. Friends who served on the Committee, will be aware that the president of the Royal College of Physicians at that time was Dame Margaret Turner-Warwick. I am pleased to report to the House that she has for some time contributed her considerable talent as chairman of the Royal Devon and Exeter trust.
I am delighted to be able to announce today that the then chairman of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, Dame Audrey Emerton, is now to take up her post as chairman of the Brighton hospitals trust. I think that that is very good news indeed.
Sitting on boards is not the only way for professionals to be involved, nor is it sufficient. I commend to the House the views of Professor Cyril Chantler, who is principal of the United Medical and Dental Schools of Guy's and St Thomas's, and is a policy board member. He described the old medical advisory committees as "functioning as a sort of Greek chorus, commenting on what was going on the stage but not taking part in the play."
He says that doctors need to contribute to
"the strategic and operational management of the service, in hospital, in the community and in practice, and in the commissioning role at district and central level, rather than doctors simply seeing themselves as there to give advice."
I strongly agree, although I would extend the analysis to nurses, dentists, pharmacists and the full range of health professionals. As Professor Chantler suggests, the existing professional advisory structure is not firmly integrated into the work of regional and district health authorities. It
Column 643is peripheral, and that is why we will not be incorporating it into the new structure. We want professional advice to be integral in the new structure, and we want professional advice to become professional involvement. We require the new health authorities to promote a constructive partnership between health professionals and managers, as many of the best DHAs and family health service authorities are doing.
Teamwork is vital to the NHS, and I have been at great pains to point that out during my tour of the regions during the past six months. The Bill will make teamwork easier by removing some of the organisational boundaries, and enabling us to build on the considerable progress which has been made during the past four years.
The House will want me to address the question of accountability. There will be a full and accountable partnership between health authorities and the public on whose behalf they act. The Bill marks an important boost for accountability by cementing the devolution of decision-making to local level. The closer to patients that decisions are taken the more accountable the service will be to them. Health authorities are beginning to work much harder at explaining to the public what they do, and asking how they could do better. I believe that they could be doing better still, and I shall insist that they do so. In the new structure, the public will have access to a single body which will be responsible for securing health care for them. The new authorities must work even more closely with the public-- consulting, communicating and involving them in key decisions.
Mr. Campbell-Savours: As a Member who is sponsored by Unison--the union pays me personally nothing, in case the Secretary of State wishes to misrepresent that fact--may I press her on the question raised by my hon. Friend the Member for York (Mr. Bayley) about a very important issue for the northern region? Why cannot we, and the health service workers and administrators throughout the region, have access to the appraisal documents which were produced in conjunction with departmental officials upon which the decision to move the regional headquarters has been taken?
Is it not significant that, when the hon. Member for Harrogate (Mr. Banks) intervened, he did not ask that pertinent question? He asked a safe question, which he knew the Secretary of State could answer.
Mrs. Bottomley: My hon. Friend may wish to raise that point in his own speech. I have made the position clear. There is a requirement for consultation when there is a proposal to change services for patients. As many hon. Members will know, that consultation can be extremely lengthy and often delays necessary change, but it is important in terms of changing services for patients. Ministers have a duty to make sure that taxpayers' money is effectively used, and the streamlining outlined in the changes will result in better patient care. The hon. Member for Workington (Mr. Campbell-Savours) will know that another £139 million will go to his region in the year ahead. The changes will mean that we can do even more.
I was talking about the important role of the new health authorities in making sure that they involve local people in decisions. Authorities must consult and encourage local visibility. We are making much more information about the organisation of the service available to the public than
Column 644ever before through annual reports, public meetings and the important NHS performance tables. None of that information was ever made available to the public when the Labour party was in power. That is the accountability that matters to patients--information which enables them, or their advocates, the GPs, to exercise informed choices. We shall back all that up through clear lines of accountability between the NHS at local level and Ministers. Those lines will be reinforced by such measures as our codes of conduct of accountability and openness.
Let me briefly mention clause 3 and schedule 2, which provide for the transition to the new structure. Clause 3 gives health authorities wide powers to work together, so that, by l April 1996, they can be completely ready for merger. We are taking steps to manage the process effectively to minimise any disruption to services. The significant degree of joint working which is already in place will help, and some of my hon. Friends have referred to that. Schedule 2 provides for the effective reallocation of the staff, property, rights and liabilities of the authorities which are being abolished. We will do all we can to minimise the distress to health authority staff. I take the points made by my hon. Friend the Member for Harrogate and by the hon. Member for Workington-- [Interruption.] The hon. Member for Workington, having made his intervention, is no longer interested. He talks about being interested in staff, but when I talk about minimising the disruption to staff, he cannot even be bothered to listen. [Interruption.]
Mrs. Beckett: Is it not rather bad parliamentary manners for the Secretary of State to chide my hon. Friend for not listening when the hon. Member for Harrogate--to whom she referred--is not even in the Chamber?
Mrs. Bottomley: The hon. Member for Workington was talking through my speech. That is a great discourtesy, particularly when the hon. Gentleman protests his interest in health service staff. But that will not surprise any of my hon. Friends at all, and I only regret giving way to the hon. Gentleman.
Mrs. Bottomley: My hon. Friend did not intervene during my speech. The hon. Gentleman persistently made attempts to intervene, and he has proceeded to have his own conversation while I am discussing what we are doing for health service staff. I shall move on, as clearly we will have some fascinating speeches from Opposition Members, and certainly my hon. Friends are longing to get in.
I began by setting out the background to the Bill, and the enormous progress which has been made in a short time in implementing the health reforms. What is truly remarkable is that, throughout the period of substantial organisational change, the NHS has not only maintained its services to patients, but improved and enhanced them. For every 100 patients treated in 1990-91--the last year before the reforms--118 were treated in 1993-94. [Interruption.] I find it extraordinary that Opposition Members cannot be bothered to listen to the staggering achievements of Health Service staff during the process of transition. I suppose--as ever--that the news is so
Column 645good they cannot bear it. In 1994, we expect the number of patients treated to rise to 122 for every 100 treated before the reforms. Whereas, before the reforms, 170,000 patients were waiting for more than one year, today that figure is just 60,000, and it is coming down. The figures which have been published only today show that, in the past five years, the number of hip replacement operations has risen by nearly one quarter, the number of cataract operations by 44 per cent., and the number of heart operations by 65 per cent. Those are impressive figures, and they mean an improved quality of life for many thousands of people.
While the implementation of the reforms has been a substantial management success, the changes should only ever be seen as a means to an end, and not an end in themselves. The real challenge lies in realising the full potential of the new NHS at a time when it must respond to profound changes in clinical practice, the aging of the population and the rising expectations of patients. Those changes have been recognised not least by the medical profession in its recent welcome statement on core values.
The measures contained in the Bill will draw our organisational changes to a successful conclusion. They are based on our experience so far, and on evolving practice. They reflect widespread consideration and discussion within the service and beyond. They provide the basis for a period of stability and constructive partnership. They will streamline and improve management; cut bureaucracy and costs; and ensure that even more power and responsibility is passed down to where it belongs--to those closest to the interests of patients.
The independent evidence that our reforms are working is mounting up. The OECD, the Audit Commission, the National Audit Office, the British social attitudes survey, and independent experts of all persuasions and none, say that the Government are getting it right. The Bill is important and timely, and a good one. It confirms our commitment to a comprehensive, high-quality health service, which responds to the needs of patients and is true to its founding principles. It puts in place the final building block to create the first-class health service we need, fit for the 21st century. I commend the Bill to the House.
Mrs. Margaret Beckett (Derby, South): I beg to move, To leave out from `That' to the end of the Question, and to add instead thereof: "this House declines to give a second reading to the Health Authorities Bill; notes widespread concern over future provision of cancer screening services, the independence of regional public health directors and the delivery of medical education for doctors; fears that claims for reduced bureaucracy and savings to public funds will prove ill-founded; and believes that far from completing the NHS reforms the Bill fails to address the problems of hospital closures, waiting lists over one million, commercialisation of trusts, a two tier service with general practitioner fundholding and the fragmentation of a National Health Service into hundreds of health businesses."
I salute the extraordinary efforts of the staff of the national health service to maintain the level of that service in the face of the Government's enthusiasm for the anarchy of the internal market, the fragmentation of the service and the commercialisation of health provision. I
Column 646make that point deliberately at the outset of my speech because I have observed from previous debates that if the Opposition do not mention what a wonderful job the staff of the NHS are doing the Secretary of State accuses us of attacking them and not appreciating their work in the public service.
Let it be clearly on record that the Labour party believes that the ancillary workers, nurses, dentists, physiotherapists, dieticians, cleaners, radiographers, radiologists, doctors, anaesthetists, consultants, clerical workers, managers and physicists--to name but some of the categories of staff--are unstinting in their loyalty to the health service and to the notion of public service.
Let our admiration for the level of patient care that is still provided in the health service be clearly and explicitly on the record. And let it be accompanied by an equally explicit and clear statement that it is, remains and always will be our view that the NHS is a public service which should not be--and by the Labour party never will be--regarded as a business.
It should not be necessary to detain the House by making such relatively simple statements about our support either for staff or for patients. I do so only because the Secretary of State has developed a rather tedious habit: if the Opposition fail to mention the staff of the health service, the right hon. Lady accuses us of attacking them and not appreciating their work. Yet if we mention them, she accuses us of being in the pockets of the trade unions. That is scarcely a sophisticated debating technique, and it has become deeply boring; as we are discussing a new Bill, I urge the right hon. Lady to turn over a new leaf and just drop it.