House of Commons Hansard Debates for 31 Jan 1995

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hon. Friend the Member for Doncaster, North (Mr. Hughes) drew attention--that of people waiting to go on waiting lists- -was not a problem. Suddenly, however, a standard has been set in the patients charter, which suggests that the Secretary of State was perhaps being less than forthright with us in the past.

The Prime Minister's local hospital is this month turning patients away because of a bed crisis. People are having to be sent 70 miles away, and the hospital has twice closed its doors to all admissions, once for a full 24 hours. A three-year-old girl in urgent need of treatment for asthma was turned away from St. Thomas's before Christmas and eventually had to be taken to Addenbrooke's in Cambridge.

In another incident, a war veteran had to wait at King's. After he had waited several hours in casualty, his family asked whether a private bed was available, and one was found within 50 minutes. There has since been a dispute, as it seems that the family had apparently misunderstood that they might be asked to pay, but of course the hospital did not intend them to pay, at least once the press got on the case.

The Hull Royal infirmary has recently had difficulties with staffing, and asked that patients with minor injuries should, if possible, care for their own injuries rather than go to the accident and emergency department.

A leaked report from the King's Fund draws attention to a range of problems, such as lack of privacy, inadequate early pain relief and the lack of information given to patients waiting for beds. It says that Government policy should have been based on well-researched facts rather than "anecdotal evidence" before accepting the Tomlinson committee's hypothesis about London. It continues:

"It might have been possible to predict the current increase in patients waiting long periods on trolleys in London's A and E departments as the level of hospital resources in the capital continues its ever-downward spiral."

Earlier this week, a report was published by the--

Mr. Patrick McLoughlin (West Derbyshire): Will the right hon. Lady give way?

Mrs. Beckett: No, I really must get on.

A report to the Secretary of State was published by the Clinical Standards Advisory Group about the problems caused by people having to wait for treatment in accident and emergency departments. We discovered that, although that report was published this January, it was sent to the Secretary of State last January. The Secretary of State has been sitting on it for a year, until--presumably--she could come up with some proposal for a trolley standard for her new patients charter.

The report says-- [Interruption.] I do not know if Conservative Members think that that is funny. I certainly do not think that it is funny at all. The report says that NHS market changes--the changes that the Government have made to the structure of the health service--are causing hospitals to concentrate on non-urgent work, on which their income depends, at the expense of work to treat accidents and emergencies. The report also says that, in hospitals where people have to wait the longest times to be treated in accident and emergency units, the highest rates of death in those accident and emergency units occur.

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My final quote from the press in this section of my speech is of the right hon. Member for Brent, North (Sir R. Boyson), who said to the Evening Standard :

"Every week I fight to get people into hospital within the year."

Perhaps some of his hon. Friends should have a word with the right hon. Gentleman.

In considering the evidence of problems in the health service and how widespread those problems are, I shall refer to the Casualty Watch results of 30 January. Under that procedure, people go into different casualty departments and ask people what is happening, why they are there and how long they have been waiting.

In Queen Mary's, someone with heart failure was being seen and was to be admitted, but had already been waiting for almost two and a half hours. In Bromley, someone of 81 years of age with pneumonia was awaiting treatment for three and a half hours. In King's hospital, someone who had collapsed with hypothermia was waiting for more than three and a half hours. Also in Bromley, someone of 77 who had had a heart attack was awaiting a bed for almost four hours. In King's again, someone who had diarrhoea and vomiting had to wait for almost four hours for a bed. Also, someone of 95 years old who had infectious diarrhoea was waiting almost four hours for a bed. There is a whole string of such cases. They are all a snapshot of what is happening in our national health service accident and emergency units in one day. The worst cases included those in Chase Farm, where someone of 78 with diarrhoea and bed sores had been waiting for almost seven hours, and someone with gastritis, who had previously arrived at 4 o'clock in the morning and who reappeared at 10 o'clock in the morning, had been waiting for seven hours. Someone in Newham of 75 years old had heart failure and had been waiting for eight hours to be admitted. That is the health service in which the Conservative party says its reforms have solved all the problems, and that there is no need for the Secretary of State to continue to address them.

I turn now to the testimony of the staff.

The Minister for Health (Mr. Gerald Malone): What a sad catalogue.

Mrs. Beckett: Yes, it is a sad catalogue, but it is the state to which the Government have reduced our national health service. The very least that the Government can do, when patients in that service are waiting seven hours to be admitted--elderly patients, people who fought in the war and who were in this country during the war--and the very least that the Minister can do is listen for 40 minutes to what his Government have done.

The chairman of the BMA--

Several hon. Members rose --

Mrs. Beckett: I am more interested in the testimony of the staff of the health service at the moment than that of Conservative Members. The chairman of the BMA, Dr. Macara, said:

"There is despair in the air today . . . despair about the mood of alienation and demoralisation in the NHS."

He talked about the Government's changes being

"to serve a perverse philosophy of winners and losers."

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There also is the testimony of Dr. Lee- Potter, a self-described lifelong Tory voter, but perhaps not for much longer. He says that the Government's changes in the health service are dogma driven, and that the Government may claim that what they are doing is not privatisation, but it

"is the next best thing."

He hopes that people will recognise that, if someone such as he is saying how disastrous the changes are, matters really must be bad. Five professors, world-renowned experts in molecular genetics, resigned from the health service in the summer. Four more are considering their positions. They talk about Government policy forcing them

"to engage in a competitive destructive conflict"

and how the Government's changes have

"poisoned the environment between research groups who should be collaborating with one another and instead are being forced into competition."

In a letter to The Guardian on 28 January, the professor of diabetic medicine at the Royal Hallamshire hospital in Sheffield said that people

"should realise that they are sitting on a medico-legal time bomb . . . The image created is of an improved modern NHS . . . The reality is stress and dangerous practices relating to the pressures and it has become worse in the past year".

He went on to say:

"Five years ago our wonderful NHS was reasonable but had some problems. Now reason has gone out of the window and problems dominate."

Earlier this week, Charles Clarke, a distinguished neurologist, said:

"As a neurologist I can no longer offer effective emergency care at either hospital in the trust to the district general hospital I serve . . . in the last six days I have been unable to admit six out of seven patients I regarded as emergencies".

He talks about there being fewer beds available in future. There is also the testimony of London's leading cancer experts, who are finding it increasingly difficult in the market-based NHS to obtain permission to undertake trials and to become involved in research, because that is not the priority of those who control the purse strings.

I shall finish by quoting an anonymous contribution from a junior hospital doctor who wrote--again--to The Guardian . It is sad, is it not, but people will write to and read that newspaper, much though Ministers dislike it and much though they object? He or she said: "I work as a junior hospital doctor in a typical district general hospital. Over the last 18 months I have seen the hospital spiral into crisis."

That person talks about patients waiting in casualty for up to 10 hours before being transferred to an outlying ward, and calls the patients charter a sick joke. He or she finishes by saying: "Patients are already suffering unnecessarily, and some have died . . . The situation continues to deteriorate and soon the NHS will have sunk altogether."

[Interruption.] One hears just about barely sotto voce comments from Conservative Members about how awful and terrible it is to quote all those newspapers.

In our previous debate, the Minister of State accused me of simply talking from the point of view of what the Labour party thought about the health service. He

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demanded evidence. He asked for testimony as to whether there were any problems in the health service. I am giving him testimony in spades. I assure the Minister of State and the Secretary of State that there are shovelfuls more where that came from. All of it is the real experience of patients and doctors of the problems in today's health service, under the Government and resulting from the changes that they have made.

Mr. Richard Tracey (Surbiton): Will the right hon. Lady give way?

Mrs. Beckett: I will give way shortly. [Interruption.] How dare the Under-Secretary of State for Wales? It is not a lazy speech to quote extensively from the experience of patients and doctors. It requires great work, study and collaboration. The hon. Gentleman hates and resents it because I have given him the authentic voice and experience of patients, the authentic voice and experience of the medical profession, of the nursing profession and of everybody else. The Government's stupidity and insensitivity will ultimately bring them down.

Mr. Tracey: The right hon. Lady has read us rather a lot of press cuttings, and I accept that she thinks that those are making her case. Will she comment on the latest edition of "Social Trends", which reports that our population is healthier now than it is has ever been? Presumably that also includes the time of Labour Governments.

Mrs. Beckett: Factually, what the hon. Gentleman says is extremely questionable. There is a sharp disparity in health standards across the population. Those at the bottom of the heap in terms of income, housing and all the other policy factors which impinge upon health care are certainly doing very much worse under the Government; again, there is a great deal of testimony to that.

The Minister will be delighted to hear that I shall now quote from the Government's own document. I presume that he will not object to that. I have given evidence and testimony as to the state of the health service and the opinions of staff, and I want now to turn to the Government's purpose, which I believe is clear.

The Government are intent on ensuring that the NHS will no longer be national. They are intent on fragmenting the service and--through a failure to plan, destructive competition and profound demoralisation within the service--they are intent that the NHS shall no longer play a major role in maintaining the nation's health. Finally, by starving the NHS of resources, the Government are intent on transforming the public service into a private market.

Ministers openly advocate the privatisation and commercialisation of the NHS. The Government's own document--the NHS executive's document called "Managing The New NHS"--states that their capital investment manual

"makes it clear that private finance alternatives should be viewed as a standard option . . . Approval will not be given to business cases unless there is a clear demonstration that private finance alternatives have been adequately tested."

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): We have waited 32 minutes to hear a single word of policy from the right hon. Lady on behalf of her party. This is the big moment for which

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we have all been waiting. She mentioned that resources had been starved. Is she confirming the pledge made by her predecessor, the hon. Member for Sheffield, Brightside (Mr. Blunkett), that Labour would increase spending on the NHS by £6 billion?

Mrs. Beckett: Nobody has ever said that. The Minister is perfectly well aware of that, although the Secretary of State continues to pretend that it has been said. We have always said that, on coming into office, we would examine the state of the NHS, see what money was available, where it was being used and whether it was being used as it should be--

Mr. Bowis rose --

Mrs. Beckett: The Minister need not get up, as I will not give way to him again. We would see whether the money was being used properly for patient care. We would also, of course, have to assess the state of the economy and what could be afforded.

I must say that, in my day--in terms of the years of experience in the House which the Minister has had--it was usually left to Back Benchers to put the kind of point which the Minister has just raised. The Minister is obviously under-worked at the Department. I do not intend to be diverted further, but I might say to the Minister that the length of time which I have taken for my speech has been primarily due to my giving way to interventions from Conservative Members.

Mr. McLoughlin: Will the right hon. Lady give way?

Mrs. Beckett: No, as the hon. Gentleman will only make the same point.

Ministers are now openly advocating the privatisation and commercialisation of the NHS. The Government have already fragmented the service into almost 500 individual businesses competing for the profits to be made from sickness and disease.

I am asked frequently--I am sure that the Secretary of State will ask again today--why the NHS, or parts of it, should not be privatised. There is a tendency for those of us who believe in a public health service to think that that question need not even be addressed, as it is too self-evident. However, after the week that we have just had in the NHS, we should spell it out again. I shall do so briefly.

The national health service should not have been privatised, for the same reasons that British Gas should not have privatised--because a privatised service skimps on public service. Privatised services enrich executives with barrowloads of cash, and it is only about a week since we heard the figures for the huge salary increases that some of them are being paid. While such services enrich executives with cash, they threaten to cut services to the elderly and the blind.

Privatised services do less, and their public relations people make it sound like more. In a privatised service, money talks; where money is absent, and in consequence there is silence, the sick, the poor, the frail and the dying wait on trolleys in corridors, in long queues in waiting rooms, or in the frightening isolation of their homes. At the Conservative party conference, the Prime Minister said that, while he lived and breathed, the national health service would not be privatised. He is, I

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suppose, living and breathing, but yet again he is being, at best, economical with the truth, because the evidence shows that the health service is being privatised.

The National Association of Health Authorities and Trusts issued an "Update" leaflet headed "Private Finance and the NHS", in which it talks about a "mixed economy" in the health service, and says that that would

"also allow for the increased participation of the private sector through the development of joint ventures."

It concludes that

"control of the joint venture must be in the hands of the private sector partner".

The Secretary of State has said:

"Private finance should be the rule and not the exception." In a recent survey carried out by the Health and Social Service Journal , health service managers express their concern and say that they are unhappy about the process of market testing being driven by the Government because they fear that it is

"so time consuming that any benefit gained would be offset by the costs . . . In addition, scarce resources might well be diverted into unprofitable procedures for the sake of quasi-political dogma." Yet the Government have spent almost £1 million market-testing NHS services. They have tended to talk as if market testing were unimportant--merely for catering, or whatever, although people may have a different view about whether that is important or not. A recent parliamentary answer to me by the Under- Secretary of State for Health clearly revealed that we have moved way beyond ancillary or support services, and that the Government have market- tested no fewer than 30 clinical and clinical support services in England during that time--services that range from anaesthetics to nuclear medicine, ophthalmology, pharmacy, and radiology, and take in a range of other core NHS clinical services on the way.

The private insurance industry is identifying those opportunities and trying to move into those fields. A conference organised by a string of private insurance companies was held in early December. They say--

Mr. Jacques Arnold: Name them.

Mrs. Beckett: Certainly. They are Norwich Union Healthcare, Friends Provident, Employers Reassurance, Guardian Health, Private Patients Plan and a whole string of other involved and interested parties. In the brochure to encourage people to attend the conference, they highlight a statement that they clearly believe will draw people there:

"As the UK population becomes increasingly receptive to the concept of private healthcare insurance . . . every player must ensure that their business strategy will increase both profit and market share."

In the lectures listed, someone was to speak on

"which methods are most effective when convincing traditional NHS clients to take private insurance cover".

My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett), as the shadow Health Minister, was to address the conference, and was supposed to speak on

"how far are the Labour party willing to reverse the privatisation of the healthcare industry"--

a privatisation that the Government say is not taking place.

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For helpful illumination, let us turn yet again to Mr. Roy Lilley, the chairman of the Homewood trust, in whose opinion the Secretary of State places such value and whom she is so keen to defend. Mr. Lilley wrote a long article about privatisation. He said:

"Could we--or should we--`privatise' the NHS? . . . The question is more likely to be whether you could get away with it.

Technically, privatising the NHS would be easy. Trusts are tailormade for the job."

He goes on to say:

"So let us not pretend the NHS cannot be privatised, because it can--with a minimum of upheaval."

That is because of the structures which the Government have put in place, and which they keep telling us we may not disturb. But what does it matter, because, as Mr. Lilley says in his closing paragraph:

"after all, the NHS is only a concept".

The NHS is a concept of such huge value to the British people that the Government have consistently denied the real effect and direction of their policy. But it does not stop there.

BUPA proposes to offer people lifelong disability cover policies in the near future. The reason BUPA is thinking of making that offer and moving into new areas is because it believes that the Government will reduce the disability living allowance next year, making private insurance against disability more attractive.

Whether BUPA's insight into what the Government have in mind is to do with the fact that a past chief executive of the NHS executive is now on its board, I am sure the Secretary of State can tell us. But it is interesting that what it sees as a further cut in the welfare state may be designed to create a market for private insurers.

Mrs. Audrey Wise (Preston): Along with that creeping, or perhaps galloping, privatisation and greater reliance on companies such as BUPA, has my right hon. Friend noticed the increased reliance on charitable fund- raising? She may have seen in the Nursing Times and Nursing Mirror recently a spirited debate among nurses about whether they should spend their time fund-raising or caring for patients. Surely everyone in the House should want them to care for patients, not rattle tins on the street.

Mrs. Beckett: My hon. Friend is entirely right. It is particularly alarming that they must spend time doing so when staffing levels and service in the NHS are already under so much pressure.

At the Chelsea and Westminster hospital, there is an example of a national health service ward being converted into a luxury private ward. In another case in Epsom, a ward previously closed to NHS patients because the hospital could not afford to run it then reopened to the private sector. All that is an on-going process. We are already seeing it in mainstream health care; we now see it in disability.

I was recently contacted by someone working in medical market research, who told me that insurance companies have undertaken, on the street and no doubt in the home, research to test the market for privatised general practice. People are being invited to comment on various packages of general practice which they might find

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attractive: a relatively straightforward core general practice service for a monthly fixed fee of £20; a more widespread service including physiotherapy and dentistry for a higher fee; paying a further fee for a full range of treatment, including hospital care; and so on. All that would be for a fully privately run and operated general practice service, rather than a public sector service. The National Association of Health Authorities and Trusts pointed out that the only way to get privately financed primary health care centres built in inner London would be to allow private health providers to both build and operate them. So we are seeing a steady encroachment of the private sector into the national health service, which is why we say that the existence of that service is being put at risk.

I draw a parallel to the attention of the House. In the early 1980s, the Government began to squeeze funds for all the services that local authorities provided, just at a time when demography and changes in national health service care were producing increased demand for residential and nursing care for growing numbers of elderly people. They began to squeeze local authority funding and places. They began to allow-- indeed, to encourage--public funds to be used to subsidise the purchase of places in the private sector to fill the gap because the public sector could no longer provide enough places for the perceived and evident need. As the bills began to grow, the Government began to rein in that level of public support, but continued a steady process of attrition--squeezing, cutting and discouraging extra alternative local authority facilities from being provided, even though the need continued to grow.

Now, we have reached the point where those in private sector residential and nursing care receive allowances that are withheld from those in local authority homes--who face a financial penalty. Local authorities are forced to spend by far the greatest bulk of the money that they have available for community care in the private sector. Increasingly, there is little or no availability of community care in the local authority sector. There is simply private sector care--the local authority is restricted to providing inspection of that care. In effect, community care is being and has been privatised.

Ms Ann Coffey (Stockport): Would my right hon. Friend be interested to know that my local authority of Stockport plans to charge elderly people for community care provided through the public or private sector that comes to more than £350 a week--incidentally, the price of a place in a private home? I am sure that my right hon. Friend knows that £350 a week does not provide much community care. That policy will drive people into private sector residential care, when the object of the Government's policy is to keep them in community care. Does my right hon. Friend agree that it is simply a way of local authorities trying to recoup money that they are having to spend on private nursing homes because they cannot provide community care?

Mrs. Beckett: My hon. Friend makes an interesting point. It is an example of how the process is developing still further.

The end result of the steady process of attrition that has taken place over 12 years is that people are being moved out of the shelter of the welfare state. They no longer have access to public places; they have access to limited public

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