House of Commons Hansard Debates for 31 Jan 1995

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sniping from the Opposition Benches. The Opposition do not have to seek best value for money from this year's £33 billion budget for England and Wales, and they do not understand the responsibility involved.

Ten years ago, the pursuit of value for money from any part of the national health service was somewhat less than fashionable. The suggestion to doctors at that time that it was a laudable aim to derive best value for every pound that was spent on health care was likely to bring forth the lofty response, "You worry about the cost while I get on with the healing."

The resources debate then was about the absolute level of the money voted to the national health service rather than the deployment of that budget, whether at a national or a local level. Much has changed since that time and, politics notwithstanding, the change has been in the interest of the patient. While my speech is mainly about value for money in primary care, many improvements in the deployment of resources have occurred throughout the hospital and community services sector as well.

Awareness of the need for the NHS to provide value for money is growing, and will continue to develop. In 1992-93, the national health service budget for England and Wales was more than £30 billion, of which approximately one quarter--£7.3 billion, which was the entire health service budget in 1978-79 when the Labour party was last responsible for the national health service--was spent on primary health services. The four main service areas were ophthalmic, pharmaceutical, dental and general medical services.

The cost of pharmaceutical services, at more than half £7.3 billion, dwarfs even the cost of 27,000 registered general practitioners' salaries and their practice allowances. About 10 per cent. of national health service expenditure is spent on drugs prescribed by GPs, who typically write 1.5 million prescriptions daily. It is little wonder that such emphasis has been put on rational prescribing in the search for value for money in primary care. I must declare an interest in the subject, which is on the Register of Members' Interests, as I advise a pharmaceutical company, Pfizer Ltd., in Kent.

Three major initiatives have motivated improvements in the services provided by GPs: the National Health Service and Community Care Act 1990, the general practice contract and the patients charter. The recent reforms have flowed from the NHS and Community Care Act, including GP fundholding, which is now in its fourth year and will undergo major extensions from April.

As my right hon. Friend reminded us, in November 1994, the National Audit Office published a report on the first two years of fundholding. The report concluded that fundholders reported that they had achieved a wide range of benefits for their patients, including reduced waiting times for non-urgent hospital admissions and first out-patient appointments, a more responsive service in diagnostic test results and discharges from hospitals, and the provision of additional services in their practice premises such as advanced equipment and consultant out-patient clinics.

Fundholders have become more aware of the need for rational prescribing, and they have curbed the growth of their drugs expenditure compared with non-fundholders. Although initial budget setting was hampered by lack of good historic data, from 1993-94 the NHS executive has required regions to develop benchmarks based on average

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treatment and prescribing levels, to help set budgets. That should prevent the sizeable underspends and overspends of the first two years.

Early experience showed that GP fundholders were three times more likely to underspend than to overspend their budgets. Although some large windfall underspends were repaid to regions for distribution, in 1992-93, underspend of £28.3 million was retained to be spent by fundholders, to the benefit of their patients. Fundholders have drawn up objectives, and some consulted not only health authority purchasers but their patients on how their practices might be improved. I wonder whether anyone can remember that happening before the 1990 Act was implemented.

All general practitioners are independent contractors to the NHS. Fundholders are accountable to regional health authorities for how they use their funds. It follows that regions and family health service authorities must monitor fundholder performance, not just for financial competence and probity--I will say more about that later--but for the quality of service offered.

The National Audit Office report made a number of recommendations, which I will summarise. The NHS management executive should extend the benefits of GP purchasing involvement to all patients. It should use benchmarks rather than historic figures to set budgets and consider introducing fund management plans for all fundholders, to provide a basis for agreeing objectives and monitoring performance. Regional health authorities are urged to manage underspend by fundholders more effectively, and, where windfall underspends occur, to negotiate voluntary return.

District health authorities are urged to set indicative budgets for non- fundholders on a comparable basis to budgets set for fundholders, and fundholders must be able to demonstrate the likely cost and benefit for patients of their plans to utilise fund savings. It is clear that the NAO report is broadly favourable to the fundholding concept, and applauds the value for money achieved during the scheme's first two years. That is just as well, for the Government propose dramatically to extend the scheme from April this year, when there will be a three-layer fundholding scheme. Small practices will have community fundholding that will not involve the purchase of acute hospital treatment. Standard fundholding will be extended and available to practices with just 5, 000 patients, compared with 7,000 now. A total purchasing pilot scheme will allow GPs in a locality to purchase all hospital and community health services for their patients, including accident and emergency services.

The NAO report called for the extension of the benefits of GP purchasing involvement to all patients. The 1995 extension should enable progress to be made towards that goal. It will be even more important that fundholders keep and submit proper accounts of their activities and that the new health authorities will need to monitor those accounts carefully on a value-for- money basis as well as for strictly accounting purposes. Expertise in auditing that sizeable operation must be developed speedily, and any malpractices rooted out. I will return to that point.

The patients charter, in conjunction with the new GP contract, has given patients the right to expect a number of services not previously available. They include check-ups

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when a patient is first registered, a regular check-up for the elderly every year at the surgery or at home, and check-ups every three years for other patients.

Mr. Thomas Graham (Renfrew, West and Inverclyde): Is the hon. Gentleman aware that, in parts of Strathclyde, a printed sticky label is used to say, "Sorry--we can't meet the nine-week target in the patients charter"? Some folks wait 19, 20 or 25 weeks to meet consultants and surgeons. The patients charter is certainly not working in Scotland.

Mr. Couchman: With respect, I was talking about the expectations from the patients charter in respect of GP services rather than hospital services. I must allow my hon. Friend the Under-Secretary of State for Health to answer the hon. Gentleman's question when he winds up.

Mr. Graham: I was trying to make the point that GPs are having to apologise to their patients because they cannot arrange appointments with consultants and others for long periods.

Mr. Couchman: I am sorry that I gave way again, because I do not think that added to the hon. Gentleman's first intervention. My hon. Friend the Minister will answer for the patients charter in the round, in Scotland as well.

As a result of the GP contract and patients' expectations, many practices have extended their provision for immunisation, well person clinics, specialist clinics for chronic diseases such as diabetes and asthma, and minor surgery--as well as for alcohol and drug misuse. The best practices now offer substantially better value for money than before the new contract, and are being rewarded appropriately. I mentioned that the pharmaceutical bill accounts for half the primary care bill of £7.3 billion, and it would be impossible to refer to value for money in primary care without expanding on that aspect. There has been a tendency to rely on driving down the cost of each prescription to contain the burgeoning NHS drugs bill. It is a cliche to say that cheap is not always best, but to emphasise that maxim, I will quote the words of my right hon. Friend the Secretary of State in Committee on the National Health Service and Community Care Bill, speaking then as Minister of State:

"Sometimes the best prescribing is restrained prescribing of high-cost items. Low-cost prescribing is not necessarily the right way. There are some new drugs which, if applied at the right time, can achieve the best results. It is simplistic to think that prescribing is anything other than a subtle, complex and frequently changing subject."--[ Official Report, Standing Committee E , 1 February 1990; c. 641.]

Those wise words prompt a number of questions, but I do not want to overstay my welcome. The Audit Commission report "Prescription for Improvement", published last year, offers a comprehensive analysis of factors that make the case for rational prescribing, and thereby counters the pressures that my hon. Friend the Member for Broxbourne (Mrs. Roe) mentioned, of demographic change, treatment in the community, continuing pharmaceutical development and the impact of GP contracts in spurring screening--which identifies more disease in more patients, who obviously then demand treatment.

The speech of the right hon. Member for Derby, South (Mrs. Beckett) was one of her least impressive offerings at the Dispatch Box. It was a litany of newspaper cuttings, and I was at pains to discern much of Labour's policy.

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The right hon. Lady mentioned waiting lists, and I declare an interest. I and my family are national health service patients and always have been. We do not pay private health insurance. The only treatment for which we pay is dentistry, because NHS dentists are difficult to come by in my part of the world. [Hon. Members:-- "Oh."] I have written to my right hon. Friend the Secretary of State on many occasions about the provision of NHS dental treatment, because I am as unhappy as hon. Members in other parts of the House about that matter.

I would defend to the limit people who have private health insurance. Having paid their taxes and national insurance, they have a right to contribute to such insurance. They do so in the expectation that, if they need a non-urgent procedure performed, they will be able to have that done more quickly than if they were to rely on the NHS.

Mr. Graham: That is terrible.

Mr. Couchman: The hon. Gentleman says that that is terrible, but I am quite prepared to defend the right to do that, even though I do not choose that option. People who do save the NHS a great deal of money. What I am less happy about is the apparent manipulation of waiting lists by some consultants, to their own advantage. I went home from here last Thursday evening and watched the video of a Channel 4 programme in the "Dispatches" series, called "Serving Two Masters". It related the findings of Dr. John Yates, a senior manager in the health service until two or three years ago, when he became a full-time academic researcher. His project on health service waiting lists left me profoundly disturbed. He says that 96 per cent. of private patients see a consultant within a month, but only 9 per cent. of NHS patients do. That is worrying. He also asked a number of pertinent questions: was it just coincidence that consultants working in specialties with the longest waiting lists have the highest private sector earnings? He asked whether private sector operating concentrates on conditions which, in the NHS, have the longest waiting times for treatment.

Dr. Yates gave some disturbing facts about cardiac surgery in London, and about orthopaedic and ophthalmic consultants throughout the country, particularly in Birmingham, where he was doing most of his work.

I think that Ministers need to pay some attention to Dr. Yates's findings. The time has come to take the Duncan Nicol line of one private practice session a week being the right amount for any consultant who is full time, or the part-time equivalent of ten elevenths. I know that that will not be popular with some consultants, but it is right to keep them to their contracts with the NHS.

Mr. Hayes: Does my hon. Friend therefore agree with the Minister of State, who has suggested that the way round some of these undoubted abuses is to begin more local pay bargaining?

Mr. Couchman: I am not sure that that is as effective a mechanism as where the contract is placed. Most consultants' contracts are still with the regional health authorities. That has been a problem since I was chairman of a district health authority; for it is very difficult for a DHA, now a trust, to call to order consultants who appear

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to be kicking over the traces. There have always been consultants with split responsibilities--three sessions here, four there, two in another district. They were always in the other place.

The time has come for my right hon. Friend the Secretary of State to grasp the nettle and to place contracts at the point where consultants are employed--with the trusts, if they serve trust hospitals.

My right hon. Friend must deal with the problem of waiting lists, because she must give confidence to national health service patients that they are not losing out to abuses by consultants whose probity and integrity, I fear, are falling short of the highest standards expected under their contracts with the NHS.

7.13 pm

Mrs. Alice Mahon (Halifax): I am pleased to have been called to speak. It is worth repeating what the debate is about: the threat to the existence of the national health service resulting from Government policies.

I thought that my right hon. Friend the Member for Derby, South (Mrs. Beckett) made a brilliant speech in which she analysed the Government's intentions with devastating accuracy. The sedentary insults that were hurled at her--there have been more since--only went to prove that her speech hit home.

I shall use my time to allow the patients who have written to me to speak to the House through me about their recent complaints. Under this Government and Secretary of State for Health there is always a yawning gap between the slick image of an improved modern health service and the real world.

The reality for patients can be very different from the Secretary of State's version. The description of a Bottomley ward in The Daily Telegraph --trolleys in the corridors with patients lying on them--says a lot more about the NHS than anything the Secretary of State said today.

In my constituency trust's area, as with every other trust in the country, we are inundated with glossy brochures full of propaganda, but I tend to read more closely the letters that I receive from patients and former patients. In October, for instance, I had a letter from a patient who was attending the oncology clinic at the Royal Halifax infirmary. Hers is a very different story from the one in the glossy brochures. I will not give the House her name, but it has gone to the Secretary of State. She writes:

"Words are inadequate to try and attempt to praise the care and commitment of Dr. Howard Close",

the consultant in charge of the cancer unit.

"My own experience has shown that on Thursdays in Halifax he attends to in- patients, new patients and out-patients from late morning until who knows what time in the early evening . . . He is a man of tremendous warmth and gives each patient the time and individual attention each one so badly needs. As a cancer patient one feels at one with Dr. Close in a trusting relationship . . . The nurses too are equally committed, working in archaic conditions, supporting Dr. Close in this busy, demanding clinic."

Whenever we bring patients' complaints to the attention of the Secretary of State, she sounds off about how we criticise staff and doctors. But I share this patient's admiration for the team working in that clinic.

The patient goes on to describe her concerns about the clinic: "The clinic and its surroundings are small, cramped and cheerless. It is far too small to cater for the number attending at any one time. At a rough count there may be seating for 25 to 30 people. The seats

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are the plastic bucket type, very uncomfortable especially for sick people . . . The seats are placed close together so that it is impossible to read because of sheer space. We just sit. It is a silent clinic, broken only by the nurses calling out the names of people to be weighed; whilst we just sit and listen. At times very sick people are brought into the clinic in wheel chairs to wait. It is a very pathetic sight for ill people to wait at this clinic with little or no privacy for anyone. There is nowhere for a patient to have a drink and the waiting time can be anything from two and a half to four hours . . . I have been an in-patient at the Cookridge hospital when undergoing chemotherapy for 10 months last year and have never experienced the sadness and desolation in the atmosphere one feels in the Halifax out-patient clinic."

I took up this emotional complaint with the chief executive of the trust. I will not bore the House with the reply, except to say that she agreed that Dr. Close and his staff were excellent, caring employees, and agreed about the condition of the clinic, but went on to say:

"Unfortunately, I am not able at this point to guarantee that we will be able to make this funding available."

She was of course referring to funding for improvements to the clinic. This same hospital has £500,000 in trust in the form of donations and bequests from grateful patients' relatives and fund raisers--yet nothing has been done about the clinic. It really is a desolate and desperate place. Calderdale health trust is behaving in exactly the same hard-hearted way as many other trusts all over the country. It especially behaves in that way on early discharge. Primary care and community care in Calderdale is the same as in many other places; it simply means passing the buck, and Calderdale health trust is doing that as well.

I attended recently a forum for Halifax and Calder Valley pensioners, to discuss with the trust one of the so-called "consultation exercises" that it carries out from time to time to put into yet another glossy brochure-- some more propaganda. Elderly people gave their testaments and the trust gave a written report afterwards of the answers. I shall read out a couple of questions on early discharge, because it is symptomatic of what is happening in the country.

One relative of an 84-year-old widower spoke of the widower being discharged from hospital, only to be readmitted shortly afterwards owing to a lack of nutrition. When discharged again, he was provided--to make it easier for him--with a chemical toilet, but no chemicals to enable him to use it. Although he was readmitted with nutrition problems--malnutrition, no doubt--he was told that he was not eligible for "meals on wheels". There was no answer to that complaint for the Halifax pensioners who raised the matter on his behalf. When patients brought up the issue of what will happen when the purpose-built Northowram hospital, for elderly and psychiatric patients, closes, which it will--it is a new hospital, not an outdated Victorian unit--they were told, "If we have all the services on one site, it will save on running costs." I could go on about some of the thoughtless responses--heart-breaking in some cases--when the pensioners asked genuine questions about what would happen to them in the future.

In Halifax, hospital wards are closed almost monthly. Yet patients are crammed like battery hens in old, outdated wards, and men and women are nursed side by side in some of those wards. No matter what the objection to mixed wards, the trust--the people who are giving us all the choice--simply tells us that mixed wards will continue to be the norm in Calderdale. On a recent visit

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to see a patient, I witnessed a severely brain-damaged lady expose herself to a very embarrassed male patient, and some loving and caring patients walked in and caught her doing that. That simply is not good enough today.

Other women, who had suffered strokes or heart attacks, were mixed in with all kinds of patients, cramped together like battery hens. Some of those people were waiting to go into the hospital for rehabilitation. The hospital is about to be closed. It is a disgrace. We are told that we can lose 300 beds without it harming patient care. It is already harming patient care, very badly.

Mrs. Wise: It occurs to me that my hon Friend's points have some relevance to the statement that was made by the Secretary of State--that more patients are being cared for. I am thinking particularly of a friend of mine in the north-east whose mother was discharged, in the circumstances that my hon. Friend described, although clearly extremely ill. She had to be readmitted within a day and died two days later. That, of course, would count in the statistics as two hospital episodes. It would show up as patients. No wonder more people appear to be treated. It is directly linked with premature discharge.

Mrs. Mahon: My hon. Friend makes a very clear and telling point, and what she says is the truth.

Mixed wards are not generally liked. I received a letter only yesterday from the Townswomen's Guilds, which has been complaining against mixed wards for more than 10 years. It told me:

"Our members are very concerned about many health issues and have recently expressed their dismay and dislike of mixed sex wards in British hospitals . . .

Townswomen have personal experience of staying in mixed wards and have written to me with their stories detailing their discomfort and upset when they found themselves in this situation. Many of those writing to me expressed concern that the extra stress of mixed wards could hinder rather than help the healing process."

It goes on to talk about the lack of dignity and the embarrassment experienced by many in such wards. That is the experience that I get as a Member of Parliament, but my trust does not listen to me. I simply get brushed off with, "Oh, well, we only seem to get complaints from you." That is simply not true.

I know that the Secretary of State said that, in future, she will ensure that people are told whether they are to go on to a mixed ward, before they are admitted to hospital. But will they have to wait longer if they object? It is serious, indeed.

Mr. Bowis: The hon. Lady makes an important point about mixed wards. It is something that we take seriously and I hope, therefore, that she will welcome what has been incorporated in the new and updated patients charter. It puts the pressure on--not just her pressure but that of the NHS as a whole--calling for people to be given that option where available and to be given information so that if no place is available on a single-sex ward, there may be an option to wait a week or two until one is available. We are with her on that.

Mrs. Mahon: Or six months, perhaps. The Calderdale trust is taking no notice of that advice. It is advice and the very nature of the advice means that trusts can ignore it if they want. I shall wait to see whether any more teeth is given to the suggestion that the Minister makes.

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I deal now with the excellent document "Serving Two Masters" by Dr. John Yates, an eminent health service manager, as has been said. He exposes not only what is happening with some of the consultants but the Government's claims on waiting lists. He says:

"There is now a queue of over one million people waiting for an operation. For years, the length of this queue has been used as a measure of waiting time. Although the length of the waiting list does not necessarily predict the length of wait, most people see a relationship between the two. The NHS, politicians and the press watch the statistics of waiting lists quite carefully, but rarely admit that they have only examined half of the problem: there is another, sometimes longer, wait just to get on the waiting list. The waiting time for an out-patient appointment to see the surgeon is not information that the NHS gathers systematically, nor does it publish national statistics about it."

As we heard from my hon. Friends the Members for Doncaster, North (Mr. Hughes) and for Wrexham (Dr. Marek), who is not in the Chamber at the moment, there are not three waiting lists but four. We should investigate that further. Also on waiting lists, my hon. Friend the Member for Preston (Mrs. Wise) made the point very well about counting twice, and the radical statistics group makes the same point. That is relevant, because at the moment, it is meaningless jargon at best and at its worst it is simply lies. It bears no relationship to the reality and to people's everyday experiences. There really is an image-reality gap.

The reality is that of Lewis Braun, an 18-year-old teenager from Wilmslow, about whom we all read a couple of weeks ago, who suffered horrific burns but was driven 60 miles, in agony, after being turned away from the Christie hospital--his nearest hospital--because there was no intensive care bed. Then there is the reality of Roberta Gierardo, who died of a brain haemorrhage on new year's eve after an eight-hour wait in casualty at the North Middlesex hospital while staff spent the night scouring London and the home counties for an intensive care bed. I wrote to the Secretary of State shortly after that incident was reported because someone in London had contacted me, but she has still not replied to my letter.

I want to talk about the reality of the NHS today where the elderly, sick and psychiatrically ill are denied a bed simply because they have grown too old or because it has been decided that they can be cared for in the community when, in reality, there is often no community to care. The new draft guidance on long-term care, which clearly departs from the founding principles of the NHS of care from the cradle to the grave, will not solve any of the problems put to me by my constituents or provide an answer when they ask me whether they will have a bed when they become sick and old.

As I shall continue to say in the House at every opportunity, the elderly and the long-term sick are being betrayed daily by the Government. Elderly people are not animals to be dumped by a system that they brought into being and for which they paid. The members of the Halifax Pensioners Association, which has complained to me of that betrayal, are the best in the world and most of them are the product of two world wars in the span of a single lifetime. They deserve better. Too often, their reality is that of an 84-year-old constituent of mine whose

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case is detailed in a letter written to me by his son, which I received just this week, and which I intend to read again. It says: "Last Wednesday my 84 year old father"--

the letter gives his name, but I shall not repeat it--

"entered the `Calderdale Health Care', I still prefer the Royal Halifax Infirmary, for an operation on Thursday. He was told that he would be in until Monday"--

23 January--

"yesterday"--

three days earlier than the date on which he had been told he would be discharged--

"when I rang to find out his condition I was told he was being discharged. I rang my parents to find out how he felt, my father is one of the countless millions who never complains and feels grateful for any help he receives, said he felt `wobbly' and that while he had been waiting for my severely arthritic mother to find someone to give her a lift to the hospital to pick my father up, he had urinated into three pairs of pyjamas . . . Is this another example of Virginia Bottomley's brave new world? If so, I am thoroughly disgusted. All his working life my father has worked and paid his tax for treatment like this. I cannot let the British public know of this disgusting example of the new NHS but you can and I hope this will help you to do so."

I have also forwarded that sad letter to the Secretary of State. We hear all the statistics being churned out, but we should look at the reality for elderly people. I wonder if the Secretary of State would describe that letter as a "jewel to be treasured". It is a sad indictment of the Government and how they have let down the NHS. As I said earlier, people are not animals who must be corralled into the private sector where they are means- tested down to the last pound by smart accountants acting as zoo keepers. They are the people who gave us the NHS and they should not be left to the mercy of community care that scarcely exists because councils have been squeezed and squeezed since 1979. When the Government talk about community care, they mean secondary care where people are dumped out of the NHS.

Mr. Simon Burns (Chelmsford): Rubbish.

Mrs. Mahon: Elderly people are increasingly dumped out of the NHS. It is the Government who are rubbish, not the elderly people who complain to me.

The Secretary of State refused to give way to me and my hon. Friend the Member for Dulwich (Ms Jowell) about psychiatric beds in London because she has been grilled by the Select Committee and knows well that she has no answers for every expert and professional who told her that there were not enough acute beds for psychiatric patients in London. Yet she refused to stop closing them.

The fight is on to save the NHS and to end the market fascism that seeks to destroy it. That is a well-chosen description of what is happening. I want the Government to go and go quickly, but for the sake of the NHS I should like the Secretary of State to go a lot faster.

7.34 pm

Mr. David Evans (Welwyn Hatfield): I am proud of our NHS. It has developed and flourished under successive Conservative Governments who have invested additional funds in real terms in the service each and every year since 1979. That commitment has resulted in an even greater proportion of gross national product being directed towards health--from 4.7 per cent. in 1979, the legacy left us by the Labour party, to 6.1 per cent. currently.

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The Secretary of State has already announced a further large injection of funds for the forthcoming year. For the year 1993-94, a massive £37,000 million was invested to provide a comprehensive and efficient health service which is still the envy of the world and which is available to every man, woman and child in Britain irrespective of age, race, colour or creed.

Why is the NHS the envy of the world? Why do health professionals visit from Europe and America to find out how we provide such good value for money in health care? The answer is simple. It is because of the health service reforms introduced by the Government in 1991. As a result of those reforms, the country now benefits from more health facilities and ever- increasing quality. But that cannot be taken for granted, nor would it continue under a Labour Government. I am sorry to say that I have heard a load of rubbish being spoken about the NHS this afternoon by the lot opposite--scare stories, slurs, misrepresentations and stretching the truth to the limit. That has been a deliberate ploy, instigated by that lot over there in a feeble attempt to obscure what most people see as a clear-cut issue. The health service is a perfect reflection of the state of the two main political parties in Britain. On the Conservative Benches, we have a party which sees the need to alter and adapt policies and institutions to the needs of a changing environment. The Conservative party is the true party of change and has been rewarded for its progressive approach with four successive election victories. The Labour party, however, is politically and financially handcuffed to the policies of the past and, as a result, has stagnated. The Labour party fears change and thus, following the principle of Darwin's theory recorded in "On the Origin of Species", is doomed to extinction.

It might be useful if I put a couple of things into perspective. The NHS became operational on 5 July 1948. At that time, electricity generation was the task of the British electricity authority, the forerunner of the now defunct central electricity generating board. British Rail, established only a year earlier, was investigating technologies to replace the steam locomotive.

In the 1990s, 50 years later, the electricity industry has been privatised and British Rail is in the process of restructuring and reorganising. In 1991, the Government introduced their NHS reforms. Demographic changes, new social aspirations and advances in medical science all contributed to the need for a new service culture. Conservative reforms centred on a set of simple and sensible principles. First, we believe that the national health service should put patients first. Our reforms transformed the NHS, ending the boom-bust mentality of the old provider-led system. In those days, hospitals worked flat out; all their beds were available for the first two thirds of each year, but they then had to cope with bed closures because the money had run out. That resulted in the indiscriminate cancellation of urgent as well as routine operations. We have now created a purchaser-led system, in which the purchaser identifies needs and responds to the requirements of the local population. Purchasers arrange contracts to ensure that hospitals and community units know what services, and how many services, will be required of them, so that they can plan the delivery of those services with optimum staff and bed numbers. The process

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encompasses the principles of local decision making, partnership and efficiency. Efficient hospitals will receive more funds to cope with the increased number of patients whom they serve: the funds follow the patient.

The success of those reforms speaks for itself. First, the number of patients treated in hospital has increased from 7 million in 1991-92 to 8 million in 1993-94. Secondly, more than 800 hospital building schemes, each worth more than £1 million, have been completed since 1980, and nearly 300 are in the pipeline. Thirdly, waiting times have decreased dramatically: 50 per cent. of patients are seen immediately, 30 per cent. of the rest are seen within two weeks, 75 per cent. of patients are seen within three months and 98 per cent. are seen within a year.

Fourthly, spending on the NHS has increased by 66 per cent. in real terms since 1979. Over 1995-96, the Government will again increase their NHS spending--to £37,000 million, an increase of £1,300 million on the year before. Fifthly, between 1979 and 1992 the number of nurses and midwives increased by 25,000, and the number of medical and dental staff by nearly 10,000. Sixthly, since 1979 nurses' average earnings have increased by 65 per cent. in real terms, and doctors' pay by 35 per cent.

Seventhly, for the first time we have published hospital performance targets. Eighthly, we have established the patients charter, which has had an enormous impact in raising standards and improving efficiency. Ninthly, the proof of the pudding is in the eating: following the Government's 1991 reforms, 419 NHS trusts are now in operation. There are also 8,000 fundholding GPs, accounting for more than 50 per cent. of all eligible practices and more than 35 per cent. of the population.

The success of the Government's reforms is reflected in the excellent Queen Elizabeth II hospital in my constituency. Since the hospital was given trust status in 1991, the number of in-patient and day-case operations has increased by 28 per cent. The average waiting time has dropped to just three months, which is well below the national average, and the trust has introduced a number of new developments and schemes amounting to £13 million in total capital expenditure.

That lot over there are a cynical mob. I have watched them shake their heads while I have merely presented the facts. If they cannot accept the truth from me, perhaps they will listen to the people. In a survey conducted in June 1994, nine out of 10 patients who had attended hospital during the previous year found the service very good, good or average. That hardly tallies with the tales of gloom and disaster that we hear from Opposition Members.

Perhaps it would be a good idea to take a trip down memory lane and remind ourselves exactly what happened under the last Labour Government--as opposed to what has been said in more recent statements. Labour's political interference in the Government's health reforms can be traced back to 1990, when the poisoned dwarf, the hon. Member for Livingston (Mr. Cook), who was then Labour's health spokesman--

Mr. Nicholas Brown: On a point of order, Mr. Deputy Speaker. Is it in order to describe an hon. Member as a poisoned dwarf?

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): I did not catch what the hon. Member for Welwyn Hatfield

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(Mr. Evans) actually said, but if he used the phrase "poisoned dwarf" I invite him to think again, and withdraw it.

Mr. Evans: I withdraw it unreservedly.

The hon. Member for Livingston, who at that time was Labour's health spokesman, threatened NHS managers who were working on the implementation of the Government's health reforms. Issuing a blatant threat, the hon. Member for Livingston told them to "go slow", because all the reforms would be reversed by the next Labour Government. The Health Service Journal condemned the outrageous interference of the hon. Member for Livingston, saying:

"The threat was barely veiled: everyone judged to have appeared to be enthusiastic about the White Paper need not expect to have their contract renewed by a Labour Health Secretary."

The journal went on to describe the hon. Gentleman's actions as "outrageous interference in NHS management and flagrant intimidation of NHS managers."

So much for democracy.

The right hon. Member for Sedgefield (Mr. Blair)--balding Bambi-- Mr. Nicholas Brown rose --

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