House of Commons Hansard Debates for 31 Jan 1995

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funds--they have no choice but to be in a private sector place. Individuals and their families have to provide the funds to meet the costs of private sector places. It is a process of privatisation by stealth.

The existence of the national health service is being threatened. We are seeing not only a decline in standards and damage being done by Government structural changes, but a steady and deliberate process--a parallel process --of attrition of publicly funded health care.

Ministers are already talking about being neutral in their approach to public and private sector provision, which is exactly what they said about community care. Already, as I told the hon. Member for Lancaster, the number of national health service beds is falling, at the same time as the number of beds in the private sector is increasing. As a result, the number of people treated in the private sector is rising because there is no choice--there is nowhere else for them to be treated.

A conference--"Strategic Market Testing--Clinical and Clinical Support Services"--was held by a range of private sector interests. In the blurb telling people why they should attend the conference, the organisers state:

"New government guidelines on Market Testing of clinical and clinical support services are due to be published next year and there is increasing speculation that it may become a compulsory procedure for pathology services."

We are seeing exactly the same process--a neutral approach to the public or private sector, increased use of the private sector because the public sector is squeezed, then use of the private sector starts to become compulsory. All that is happening despite the fact that, on the waiting list initiatives--

Dame Elaine Kellett-Bowman: Will the right hon. Lady give way?

Mrs. Beckett: No, I am sorry, but I have almost finished. I would have given way earlier, but not now.

We are seeing the steady attrition of the public sector and the steady growth of the private sector irrespective of the cost involved. Take the Government's waiting list initiative as an example. There is no question but that, on average, it costs more to treat patients in the private sector than in the public sector, yet the Government continue to insist on private sector treatment. There is no doubt that private health insurance can cause continuing problems. Lord Lawson, a former Chancellor of the Exchequer, refers to private health insurance in his book:

"There are in practice only two ways in which health care can be financed. One is by the taxpayer, and the other through the individual taking out an insurance policy"--

that is the course to which the Government are seeking to drive the British public--

"The latter method, which is the basis of the US system, inevitably results in a massive further escalation in the cost of health care".

It is not a question of value for money; it is dogma-driven policy, which was identified by Dr. Lee Potter and which has so disillusioned people like him. Speaking earlier this year, Dr. Macara said-- [Hon. Members:-- "What is Labour's policy?"] I will tell Government Members what the Labour party's policy is. Our policy is to recreate a public health service which is national in its scope and equal in its access.

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[Interruption.] Does the hon. Gentleman wish to intervene, or is he simply bellowing from a sitting position in a rather ill-mannered way?

Mr. Peter Butler (Milton Keynes, North-East): I am grateful to the right hon. Lady. I did not intend to intervene, but as she insists, I will do so. She has spoken very eloquently for 50 minutes, but she has not even hinted at a Labour policy. All she is giving us now is a description of the Opposition's aims. Do they not have a single policy? It is not too much to ask: just one policy to go on with.

Mrs. Beckett: I can only commend previous debates on the subject to the hon. Gentleman. We have made it very plain that we remain committed, not just in theory but in practice, to the provision of a public health service which is national in scope and which gives access to people across the country on the basis of clinical need and not on the basis of ability to pay. We are concerned that that objective is being put at risk by the Government.

We have also identified three elements in the Government's health reforms which we believe are directed specifically towards privatising the health service. Those elements are: market testing, the use of the internal market and the introduction of competition; the introduction of individual trusts, tailor-made, as Mr. Lilley said, to be moved to the private sector as individual health businesses; and the introduction of general practitioner fundholding, which has created a two-tier system. We have made it clear that those structures must be replaced, and that we are consulting on how that can be best achieved.

I know that Government Members do not like consultation--frankly, I do not think they know what it means. In a previous debate on the Health Authorities Bill, the hon. Member for Hereford (Mr. Shepherd) drew attention to what the Government consider to be consultation. In referring to the consultation process on the changes that the Government are at present pushing through, he said:

"I am not entirely sure who has been consulted . . . myself and my hon. Friend . . . had a meeting with the health authority chairman . . . It was certainly not a consultation . . . I understand that the chairmen of the health authorities were not consulted. The general managers . . . were summoned . . . and told what was to be the case".

He went on:

"What will be the value of so-called consultation if, as I perceive, decisions have already been made and written on tablets of stone"?--[ Official Report , 12 December 1994; Vol. 251, c. 659.] I assure the hon. Member for Milton Keynes, North-East (Mr. Butler) that we shall publish some proposals in the early summer. When it comes to a question of detail, I commend to those hon. Members who are not fortunate enough to serve on it the proceedings of the Committee considering the Health Authorities Bill. They will discover that the Government are pushing through legislation to finalise quite sweeping changes in the structure of the national health service without the faintest idea of their impact.

What will happen to the contracts of junior hospital doctors? The Government say that they might be held at regional level, but nobody really knows. The Government have not decided what will happen to nurse education. What will happen to community health councils? The Government say that that is under consideration. The

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Government are pushing through legislation without settling those details. Why on earth do Government Members expect me to give them details of our proposals which will take effect in two years? If the hon. Gentleman can tell me today how many hospitals will be in the national health service in two years, he knows more than the Department of Health does today. If he can tell me how many accident and emergency units there will be, he knows more than Ministers do today. They do not know the answers to those questions.

Mr. McLoughlin rose --

Mrs. Beckett: I will not give way, because I am almost at the end of my speech, and have given way frequently.

Recently, Dr. Macara said that he was concerned about the existence of almost a plot--although those were not his words--against the national health service. He stated:

"I am categorical about this. I did not want to believe it for a long time, but I now have every reason to believe it is deliberate policy on the part of a number of senior people".

He believes that there is

"a political agenda to break up the NHS."

I drew parallels with the process of attrition and privatisation by stealth in community care. I quote finally from the document "Managing the NHS", published by the Office of Health Economics and written by William Laing, who is a well-known commentator on the role of the private sector in the NHS:

"The relatively streamlined administrative model for community care may prove to be the model towards which the NHS internal market evolves in the future, if the NHS follows the path of community care, in the sense of contracting out the bulk of services to independent providers, the principal function of the NHS Management Executive, or any successor organisation, may change to one of monitoring quality through inspection and registration."

That is exactly what happened in community care.

Our task today and in the months ahead is to ensure that the British people realise the real threat to the national health service's existence; lead the resistance to privatisation and, as we did with the Post Office, prevent privatisation if we can; and work to restore to the British people that which the Government's folly and incompetence has put at risk--the health service, whose worth the people of Britain know and, knowing it, value. The Government's continued existence places in jeopardy the continued existence of the national health service. They must go if the health service is to survive.

4.41 pm

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:

"congratulates National Health Service staff in hospitals and in the community for providing ever more and better care for patients with 122 patients being treated for every 100 four years ago; welcomes the health reforms which have provided a coherent structure to enable them to do so; recognises the challenges faced by the National Health Service resulting from medical advance, the ageing of the population and rising public expectations and believes that the new National Health Service is better placed than ever to meet these challenges; welcomes the 68 per cent. real terms increase in National Health Service spending since 1978-79 and the Government's manifesto commitment to further real terms increases; and condemns Her Majesty's Opposition for its ill-thought-out

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commitment to abolish the reforms, an act which would inflict chaos and confusion on the health service, deprive patients of the benefits of National Health Service Trusts and general practitioner fundholding and prevent the health service from responding to the changing needs of the public."

I am almost at a loss to know where to start. It is clear that the right hon. Member for Derby, South (Mrs. Beckett) and her colleagues have got rid of their policy groups and instead have taken on a selective cuttings service. The right hon. Lady covered a great number of newspapers, and started to read conference agendas as the substance of her speech. My hon. Friends were waiting to hear anything that resembled policy or approached a practical way forward.

If one is to deliver a comprehensive service available to all, young and old, regardless of ability to pay, in the face of medical advances and rising expectations, great pressure will be placed on the service. That is why it is important to devise a framework of coherent policies that address those issues. I urge the right hon. Lady to consult independent commentators, the Organisation for Economic Co-operation and Development, and the London School of Economics--which I visited last week--about the significance of the changes that we have been putting in hand.

Changes in scrutiny and balance, and in the outcomes that the health service is now delivering, are being followed by health care experts throughout the world. As ever, we heard endless smears and innuendos about privatisation. It is hard to understand whether the right hon. Lady dislikes someone ever paying for something or private sector involvement in any provision. In our party, if the private sector can deliver a service of higher quality and good value, we have no vendetta against it. Of course, we are not sponsored by health unions. We do not have one hand tied behind our back, knowing that whatever we say about patients, it is jobs for the boys and girls that must come first. That is not our problem.

It is well understood that the greatest recruiting sergeant ever for private health care was the industrial dispute in the final days of the last Labour Government. If one wants to drive people into the private sector, the most powerful argument is to have shop stewards on the hospital gate deciding whether someone is an urgent case and volunteers manning the kitchens.

The right hon. Member for Derby, South may be interested to know that there has been a decline in the number of people taking out private health care insurance in recent years. That is an interesting reflection on public confidence that the NHS is delivering a quality of care in which they could never have confidence in the past. That reflects the effectiveness of our reforms.

Mrs. Beckett: Does not it strike the Secretary of State that the recession is having an impact on the ability of people to afford private health insurance premiums--let alone loss of employment?

Mrs. Bottomley: The right hon. Lady totally fails to address the point that there is growing public confidence in the care that they receive from their health service locally. Nothing that we heard from the right hon. Lady takes the debate forward.

Mr. James Couchman (Gillingham): The right hon. Member for Derby, South (Mrs. Beckett) was reluctant to quote from cuttings reflecting the state of the health

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service in the winter of 1978-79. Does my right hon. Friend remember the years 1974 to 1976, when the then Secretary of State, Mrs. Barbara Castle, was confronted by simultaneous industrial disputes with every staff group in the NHS--a feat never equalled before or since?

Mrs. Bottomley: My hon. Friend may, like me, have watched last weekend's television programme about Barbara Castle. It provided a reminder that, ironically, the people who always have the greatest problems with health unions are Labour Secretaries of State for Health, because expectations are so high. It is a case of post-dated cheques--"Why are we paying for sponsorship?" As COHSE told the Nolan committee today, why is it giving £5,000 a year to Opposition health team researchers if, at the end of the day, it does not want something for that money?

The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards): It pays £15,000

Mrs. Bottomley: My hon. Friend reminds me that the sum involved is £15,000 a year, not £5,000--and, as far as I know, that is only COHSE's contribution.

Mr. McLoughlin: The right hon. Member for Derby, South (Mrs. Beckett) referred to several press cuttings, many of which related to London. Will my right hon. Friend confirm that there has been a redirection of resources in London, so that facilities in other parts of the country may at long last enjoy a fairer distribution of resources? They include two hospitals in Derby, which have been almost totally rebuilt--the Derby royal infirmary and Derby city hospital, where the right hon. Member for Derby, South opened new facilities just a few weeks ago.

Mrs. Bottomley: I am grateful to my hon. Friend for making that point. Our health service, like every health service in the world, is undergoing change. That change includes investing in the community and trying to put more into mental health services. That change requires leadership, courage and commitment to health care principles. If on every occasion, on every decision, Labour goes for the short-term headline and populist gesture, it will never again be worthy of the stewardship of the health service. Labour is the party of protest, not of progress or responsibility. It backs every campaign against closure and supports every pay dispute, because it can never face the difficult decisions involved in taking responsibility.

Mr. D. N. Campbell-Savours (Workington): I ask the Secretary of State for an honest and straight answer to this question, because I need her reply for my evidence to the Nolan committee, to which the right hon. Lady referred.

Does the right hon. Lady ever meet lobbying companies on matters relating to health? Does she ever meet manufacturers of health products to discuss procurement issues? If she does--these activities may be perfectly legitimate--is she prepared to reveal when those meetings took place and what issues were discussed at them, if I table parliamentary questions? Is she prepared to be open with the House about these matters?

Mrs. Bottomley: As Health Secretary I am overrun by lobbying groups every day of the week. Last week I spent three hours at a dinner at the Royal College of Nursing.

Mr. Campbell-Savours: Answer the question.

Mrs. Bottomley: The hon. Gentleman seeks to draw a distinction between people who produce a product that

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they wish to sell to the health service and the interests of the people who work in the service. I have also met representatives of the Manufacturing, Science and Finance union, of COHSE and of the health unions. Certainly, one aspect of my job is to be involved in promoting some of our most successful industries. I have had lengthy meetings with representatives of the pharmaceutical industry, because I was determined that London should win the Medicines Evaluation Agency. The pharmaceutical industry is one of Europe's, and Britain's, most successful industries. The new agency in London will act as a magnet for further inward investment.

As a member of the Government involved in spending an enormous amount of taxpayers' money, I certainly have an interest in being part of a wealth- creating economy which creates jobs for people and wealth for the taxpayer- -and delivers ever-higher standards of health care. I am sad that the hon. Gentleman has so little interest in wealth creation. The Labour party's inability to generate wealth meant that the Labour Government, as my hon. Friend the Member for Gillingham (Mr. Couchman) reminded us, had to cut nurses' and doctors' pay and instigate the first ever real terms cut in the health service.

Mr. Campbell-Savours: On a point of order, Mr. Deputy Speaker. I have just had a very long answer to a simple question. Will the right hon. Lady answer my parliamentary questions about meetings?

Mr. Deputy Speaker (Mr. Michael Morris): First, the hon. Gentleman did not ask a simple question: he asked a long one. Secondly, I am not in the least responsible either for the question or for the answer.

Mrs. Bottomley: I would not dream of giving the hon. Gentleman details of every meeting I have had. I can only say that the holder of my office is continually bombarded by campaigns and initiatives on all fronts. My job is to discriminate between issues and to make sure that patients benefit as a result.

Mr. Alex Carlile: May I throw the right hon. Lady a lifeline? She had reached the point in her speech dealing with mental health, and had just said something about more resources for it. Why, if more resources are being poured into mental health, do psychiatrists in London--virtually to a person--complain that they do not have enough resources or beds, and that they are having to send dozens of patients out of London, away from their families and communities, for treatment?

Mrs. Bottomley: The hon. and learned Gentleman will know that I am extremely sympathetic to his point. London has had a great duplication and concentration of specialty services. We have 14 cardiac centres and 13 cancer services. Because of the fixed overhead cost of all those centres, I do not think that we have given mental health services the priority that we should have given them. As the hon. and learned Gentleman will be aware, it is not just a matter of health service contributions. It is also a matter of making sure that local authorities play their full part and collaborate. We have made it clear that we want a greater focus on mental health services in London. The changes involve that greater focus. It is not just a question of resources: it is a question of better organisation and targeting. That is why the Bill that we hope to introduce on supervised discharge is so important,

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to make sure that we target the most severely mentally ill and that supervision registers are set up to maintain contact.

Mr. Carlile: Come on.

Mrs. Bottomley: The hon. and learned Gentleman is letting down a good case. If he reads the report on the Clunis inquiry, he will see that hundreds of professional hours were devoted to Christopher Clunis without proper co-ordination or management. We must adopt a more assertive, pro- active approach--an approach that Louis Blom-Cooper has come round to advancing. I have been taking it for some time.

Sir Michael Grylls (Surrey, North-West): On the general standing of the national health service, for which my right hon. Friend is responsible to the country, is she aware that in a survey of 30,000 homes undertaken in my constituency, asking people who had used the NHS what they thought of it, 87 per cent. said that they were satisfied or very satisfied? Surely that is hard evidence, not just tittle-tattle from bits of newspapers.

Mrs. Bottomley: My hon. Friend has rightly identified the real issue. Time and again, when patients are asked what they think of the service they have received, that is precisely the degree of support that they give the NHS. Nobody hearing the disgraceful speech by the right hon. Member for Derby, South would think it a fair reflection of how the health service is experienced by our constituents around the country.

If I may, I should like to tell the House a story. Like many right hon. and hon. Friends, I recently spent a week by the seaside at the excellent Conservative party conference in Bournemouth. During my time there it was a pleasure to visit a smart new hospital with a new A and E department, and with a cancer service that has a recently installed linear accelerator. I also toured its new hospice; and learnt that the hospital had introduced the new arrangements for junior doctors' hours and brought down the maximum waiting time for any care to five months.

At my request, I met privately six of the hospital's junior staff--two doctors, two nurses and two managers. I found them in very good spirits: realistic about the tough job that they have to do, and enthusiastic about the tasks ahead. Indeed, the hospital was a model of what the NHS should be --a model followed by hospitals in many of my hon. Friends' constituencies. It was well run and well equipped. There was a good sense of teamwork. The hospital provides high-quality clinical care in comfortable surroundings.

Just before leaving, I remembered that the hospital also employed a well- known consultant who had in the past been critical of the Government's policies. I tracked him down to his lair and put to him the point that there seemed to be a startling difference between how he portrayed the NHS and what I had found and heard in his hospital. "Oh no," he replied,

"when I speak out I'm talking generally. This is an excellent hospital."

I am sure that the House will want to know that the consultant's name was Jeremy Lee-Potter.

My story illustrates an important point about the health debate. Today we heard a great deal from the right hon. Member for Derby, South about how the service is

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supposed to be on its last legs. That is simply not borne out by the experience of hospitals such as the one in Poole which I have just described. I am sure that my hon. Friends will readily confirm that it is not borne out in their constituencies either.

What the right hon. Lady said is not borne out by the massive expansion of modern family doctor services, new cottage hospitals, as it were, where patients receive locally more and better services than ever before. It is not reflected in the health of the nation either. Life expectancy is increasing for old and young alike. Infant mortality is falling in every region and every social group. Our capacity to prevent disease through immunisation and screening is also better than ever. Only today, I am pleased to say, we have announced our commitment to bone scans for women at high risk of osteoporosis.

Of course, it is against the Labour party's trade union rules--literally, I suppose--to mention any of that. It denigrates the NHS and denies the achievements of staff. Its big idea is to exploit every mishap, every unfortunate incident, for its own short-term political advantage. Constantly, it plays politics with the lives of the vulnerable and the weak. But the public do not like it and will not wear it. It was not such a laughing matter at the previous general election when the Labour party found itself out on its "Jennifer's ear", and it still has not learnt its lesson. The people want progress in the NHS, not protest from the Labour party.

Dame Elaine Kellett-Bowman: My right hon. Friend referred to the family doctor service. The right hon. Member for Derby, South (Mrs. Beckett) denigrated trusts and fundholders. She wonders why people want them. In my city, by the end of next year, every doctor will be a fundholder. That would not be the case if the patients did not want it and did not flock to the doctors who are fundholders.

Mrs. Bottomley: Once again, my hon. Friend has the point exactly. I believe that in the right hon. Lady's constituency 75 per cent. of patients are covered by GP fundholders. What is the merit in destroying a system that has so much empowered GPs--a system that has enabled them to get more choice, to pay more attention to detail and give greater care to their patients than any previous system? My hon. Friend goes to the heart of the issue.

We welcome the debate. We welcome the opportunity that it provides for our hon. Friends to reveal the contradictions between the real health service and the twisted picture presented by the Labour party. I welcome the chance to spell out the strong future for the NHS under our stewardship. There is more to do.

I welcome the opportunity to describe some of the challenges ahead and our policies for meeting them. We relish the chance to expose the disastrous and destructive policies threatened by the Opposition and the NHS nightmare that they would bring about. Unlike their motion, our amendment congratulates NHS staff. We recognise their achievements: more patients treated than ever before; falling waiting times; and dramatic cuts in the hours worked by junior doctors. There is massive investment in new technology and research.

Advances are taking place in our NHS, at the leading edge of medicine: in cystic fibrosis; the genetics of breast cancer; the ability now to create an artificial heart; and in many other areas. All that is taking place in the NHS today to serve patients for today and tomorrow. Teams of

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dedicated doctors, nurses--and managers--are working together to provide the very best that they can. Those achievements command the confidence and the support of those who use the service. The closer people are to the NHS, the more they like it.

Mr. Ronnie Campbell (Blyth Valley): I thank the Secretary of State for giving way.

I do not know whether the Secretary of State has ever been to Northumberland and to Wansbeck general hospital, which is part of Cheviot and Wansbeck NHS trust, but last year, only one month after becoming a trust, it was nearly £2 million in debt. Later, when cuts were made in the hospital, two mothers lost their babies at birth and are now suing the hospital. That is the state of affairs in Northumberland and I would ask the Minister to come up and visit the hospital.

Mrs. Bottomley: It is disgraceful to suggest that those tragic episodes had anything to do with these issues. [Interruption.] I listened quietly while the hon. Gentleman asked his question. The least that he can do, having worked so hard to get me to address his question, is to listen to the answer.

The hospital to which the hon. Gentleman referred received five stars in 11 categories in the league tables, such is the quality of care that it now delivers to patients. Its financial control, however, has not been of the standard that we would wish.

Today, the holder of my office can speak with confidence about the NHS, because the financial control is better than ever it was. When the Labour party was in power, this was the time of year of sudden closures, of running out of money, and of shambles in the health service as people were unable to meet their financial commitments through the year. [Interruption.] I have already explained that the financial control was not all that we would have wished it to be, but the point is that it is a hospital that is delivering a quality of care for patients that matters.

I noticed that the Labour party sneered when I described that. It is interesting that it sneers at the league tables, because most people think that the length of time that one waits in out-patients and in accident and emergency departments, and the length of time that one waits for an appointment, matters. Time and again, that is the issue about which patients will complain in our NHS if one asks them. That is why the patients charter has been such a dramatic success.

My hon. Friends will remember when we launched the first patients charter three and a half years ago. They will remember that the best that we could do then was to offer a two-year maximum wait, and that 50,000 people were waiting longer than two years for treatment. Within only three and a half years, the wait has decreased, not to two years, but to 18 months.

Mr. Lewis: Will the Secretary of State give way on that point?

Mrs. Bottomley: It is my intention now to make headway with my speech. I do not intend to give way further, having given way an excessive amount. If I do, I shall be rebuked by my hon. Friends, who feel very strongly about the changes in the health service. [Interruption.] I think that I have made myself clear.

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The patients charter, which we launched only two and a half weeks ago, shows that not only have we got rid of the two- year waiters, and not only are 18-month guarantees being successfully delivered for hips, knees and cataract operations, but we can now deliver an 18-month guarantee for all care. More than that, we can move into the important area of out-patients. Nine out of 10 are being seen within three months. Nobody is waiting more than six months.

[Interruption.]

Mr. Deputy Speaker: Order. The hon. Gentleman heard the Secretary of State say that she was not giving way.

Mrs. Bottomley: What is even more disgraceful is the way in which the Labour party, when the health service really has delivered improvements, as it has on the patients charter, says that it does not like the figures and that it is suspicious of the statistics. It must understand that, if one is running one of the largest national services, having authoritative figures is absolutely vital. It will be pleased to know that the Audit Commission helped us to validate the figures on the league tables. We want to measure improvements, to compare and contrast. That is precisely what an internal market is all about. It is interesting that the Labour party sneers and jeers about league tables on the achievements of staff. If Opposition Members visited the hospitals concerned, they would see the sense of achievement among nurses, doctors, managers and others who have delivered a quality of care that matters to their patients. I am pleased to tell the House that patients are not as cynical as the Labour party. They welcome the charter. They want us to go even further. We listen to them and respond. They want us to do better on the waiting times. I have set that out. They want action on mixed-sex wards. They want more information and more choice. The new charter meets their aspirations and will meet their needs. It will continue our drive to lever up standards in every part of the service. Once again, the right hon. Member for Derby, South made some rather sneering comments about complaints; certainly the expression that complaints should be "jewels to be treasured" is a phrase used by Brian Edwards, the regional general manager in the west midlands, who has led many of the changes in the patients charter and delivered quite remarkably.

The contrast between the sneering and the public's perception of reality is interesting. Last week, a television programme, "Pulse", made some pretty sharp comments about the health service. It offered a user's guide to the NHS which people could send for. I simply read from the Channel 4 user's guide to the health service--what was said in the book as opposed to the film:

"There has been a lot of effort to encourage hospitals and GPs to raise their standards. Patients are being offered information--once very hard to obtain--about the standards of service they can expect. More than that, they are actually being encouraged to comment and complain if the service does not meet their needs."

That is the new culture that we have been establishing in the NHS. That is the new culture that our constituents and patients appreciate.

The charter makes the NHS more accountable to those whom it serves. The league tables, interestingly much sneered at by the Opposition, provide information so that people can make comparisons and look for further improvements. The Opposition, as we have seen today,

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