House of Commons Hansard Debates for 31 Jan 1995

Mr. Eric Illsley (Barnsley, Central): Yes.

Mr. Clappison: The hon. Gentleman said yes. It is a fairly safe bet that if there had been a fall in the number of patients treated since the introduction of reforms, members of Labour's Front Bench would not be saying that that had little to do with Government reforms but would blame it on those reforms. We cannot win. However many more patients are treated, it is said that has nothing to do with Government reforms--even when the rate of increase in NHS activity has improved. We have seen a move from Cook's law to Beckett's law. One could almost say that the move is to Beckett's fork, because I am most reminded of Morton's fork of Henry VII fame. We cannot win, whichever way we go.

Health service reforms are working. For all the sensational stories from Labour, the proof is there in the greater number of patients being treated and shorter waiting lists. The maximum waiting time for my constituents has been reduced not only to the 18 months in the charter but to 12 months, because of the target that the health authority set itself. The average waiting time has reduced from seven months to three months.

I welcome the Government's introduction of a new measure of waiting time in respect of out-patients wishing to see consultants. That is another step forward and further evidence that the patients charter is working. New targets are set all the time and the health service is being driven forward for the benefit of patients.

The challenge for Opposition Members is not to search every hospital for every bed that has been moved or mistake made, but to declare how they would do things better and achieve more. We heard precious little about that in the debate, and nothing about the future of trusts. There was vague talk about accountability. Does that mean that trusts will be left the same but that they will be joined by a few Labour councillors as the magic, miracle ingredient for success? We have already heard the views of the people of Merseyside, and they might have something to say about that. Would they have one of the most successful health authorities in the country if they had the benefit and wisdom of certain Liverpool city councillors, or of the regional councils being imposed on England as a quid pro quo for Labour's mess over Scottish devolution? Labour Members make it up as they go along. They said nothing about policy. At least the right hon. Member for Derby, South did not fall into the same trap as her predecessor, who had outbursts of frankness and candour--for example, when he said that the status quo was not an option in respect of London health reforms. For his pains, he was banished from Labour's Front Bench when that subject was debated.

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I urge my right hon. Friend the Secretary of State to drive forward reforms and to aim at ever-higher standards, to show the commitment of the Conservative party to the national health service.

9.13 pm

Dr. Tony Wright (Cannock and Burntwood): Time is short, so I will be brief. The most interesting and alarming part of the Secretary of State's speech was her assertion that if one wanted to know what is happening in the national health service today, one should go to the London School of Economics--and if one is not satisfied, to the Organisation for Economic Co -operation and Development. That was meant to trump the evidence of people who work in and use the health service. It is a rather strange kind of evidence.

I cite three experiences from my area. The first concerns complaints. Like all Members of Parliament, I am visited from time to time by people who tell me that they want to complain, or they have complained, and they are usually dissatisfied with the outcome. They usually receive a letter from someone with a title such as assistant customer services manager--telling them nothing but reassuring them that everything is basically all right.

Complaints do matter, however. As the Minister said earlier, they should be the jewels in the crown. They are actually more like a kind of buried treasure. We have had an inquiry into the NHS complaints system. Since the Wilson inquiry, we have been given endless promises about the implications of the report and of the Government's proposals. We have it on the authority of the Secretary of State that the present complaints system is

"fragmented, confusing, cumbersome and slow".

Back in May, a report in the British Medical Journal said that "the Health Secretary, Virginia Bottomley, said that she accepts the broad thrust of the report Being Heard ; she has begun a three month consultation period before introducing legislation". The least we expected today in this health debate was that the Government would announce that they had clear plans to reform the unsatisfactory NHS complaints system.

When asked when they intend to take action, the Government always tell us that it is imminent. I happened to discover a document issued just before Christmas by the health service in Scotland. Entitled "The Patients Charter: What Users Think", it says:

"The committee chaired by Professor Wilson to look at NHS complaints procedures has also recently reported its findings and the Government will be making a response to the recommendations in January."

Fortunately for us, this is the last day of January; so I presume that when the Minister rises to reply, he will give us a dramatic announcement--no doubt the cause of muted cheers behind him--about a new start for the jewels in the crown, the complaints about which the Minister spoke earlier. Nothing less will be satisfactory; anything less will be a breach of promise.

A few weeks ago I had occasion to visit the mental health trust in my constituency in Staffordshire. I met the chairman of the trust, a decent gentleman, and asked him how he had become chairman. He said that he had been a timber merchant but had wanted to hand over to the next generation. I said that that was interesting, but asked what it had to do with running an NHS trust. He said,

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"Well, I had a friend who was a consultant. I phoned him up and asked him whether it would be a good idea for me to take the job on. He said it would."

I happened to discover later that this same gentleman is chairman of the local Conservative association. And this is a trust whose consultants have just passed a vote of no confidence in the chief executive, and, by extension, in the board. The health service is being run as a kind of occupational therapy for retired timber merchants with Conservative connections. No wonder it has lost all legitimacy in the community.

Cannot the Government understand that they are eroding the foundations of respect inside the service? This is not our argument: listen to Simon Jenkins, no friend of my party, writing in The Times last week:

"As for the 15,000 health authority posts that had to be filled in 1991, it was the most undignified case of catch-as-catch-can in the history of public patronage. On seeing his list, one health administrator paraphrased Wellington and hoped they would `terrify the consultants as much as they terrify me.'"

This is a scandalous story; little wonder that people have lost faith in the system.

Every so often a piece of paper will come under my constituency office door. One came recently from a nurse--whether a he or a she I do not know. The nurse felt unable to come and speak to me about what was going on in the health service, but nevertheless wanted to communicate with me. What a situation we have reached. Health service employees feel that they have to come covertly in the middle of the night and put pieces of paper under the doors of Members of Parliament to let people know what is going on. Revealingly, when the Government recently issued a document on how NHS staff can take up complaints with the media, they were told to approach their Members of Parliament--in the first instance through their line managers. No wonder the Government were told off by the Select Committee for saying such things. They have since had to back-track.

I do not want to return to how the world was before 1979. There was always an agenda of health service reform. It was about efficiency, quality and accountability. The tragedy is that we have gone down a false road, a cul- de-sac. The Government have managed to grow 10 accountants when there was one before. They have grown 20 managers when there was one before, and have recruited graduates from the Eric Cantona school of public sector management to do it. It is that which is eroding the health service. The agenda remains--of quality, efficiency and accountability. That is the agenda that will have to be taken up by the next Government.

9.20 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East): I congratulate my hon. Friend the Member for Cannock and Burntwood (Dr. Wright) on his vigorous contribution to the debate. Indeed, hon. Members on both sides of the House concentrated their fire on right hon. and hon. Members on the Front Benches. As I understand it, the charge against us from Conservative Members is that we have no policies. I will have something to say about that in a moment.

Our charge against the Government is that they have the wrong policies, and I have something to say about that now. Before doing so, however, I pay tribute to Britain's health care workers, to the medical staff and to the non-medical staff, including the management. The

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workers in the health service are not responsible for Government policy. Indeed, their recent protests have in part inspired today's debate.

The charges against the Government on secondary care are well known and have been well rehearsed in the debate. Since 1979, one in five hospitals have closed; one in three general hospital beds have gone; and one in four acute beds have gone. Since 1987, a third of all NHS psychiatric beds have gone. More than 1 million of our fellow citizens are on hospital waiting lists. Between July and September of last year, more than 10,000 operations were cancelled, either on the day or the day after admission to hospital, and 10 per cent. of those were not readmitted within one month.

In primary health care, GP fundholding has created a divisive two-tier service--patients are fast-tracked from fundholders' practices, disadvantaging the patients of non-fundholders. It has cost more than £100 million in management allowances to put that unfair system into place. Budgetary concerns have been put before the needs of patients. It has undermined, as my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) said, the necessary trust that must exist between a GP and the patient. Worst of all, although the Secretary of State likes to boast about the National Audit Office report as an endorsement, no region has been able to supply it with hard information on the reliable costs of fundholding versus non-fundholding.

The reforms, of which the Government are so proud, have almost ended national health service dentistry. Prescription charges have risen tenfold in real terms since 1979. The provision of community care is disfigured by demarcation disputes between health authorities and social service departments. They are mostly about money as well as responsibilities. The Department of Social Security's rules are rigged against the public sector provision of community care facilities, such as council-owned care facilities. Indeed, the distinction that it draws between the purchaser and provider is wholly consistent with the Conservative party's general approach to the issues.

The Secretary of State and the Minister claim that fundholding is popular, at least with the profession. My hon. Friend the Member for Liverpool, Garston (Mr. Loyden) pointed out that GP fundholding is not popular. Indeed, "Pulse", a professional magazine, conducted a survey of GPs to find out how popular the idea was. The survey shows us that more than 75 per cent. of GPs want fundholding abolished. What is the Government's response to that? General practitioners are saying that they want the fundholding structure abolished. Indeed, just under half of fundholders want it abolished. That is not a ringing endorsement.

My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) spoke about the special problems of London. He is right. My right hon. Friend the Member for Derby, South (Mrs. Beckett) quoted examples not from the previous Labour Government--that was fashionable with Conservative Members--but from last night. I also have the list with me, but time is short, so I shall not read my examples from it, although there are enough of them. Instead, I make the following points.

In London, there is a high prevalence of social deprivation. People there have higher than average levels of ill-health; there is a large transient population and

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higher ground rents and labour costs than in the country as a whole; and it is a centre of excellence for secondary medical care, something of which we should be proud rather than undermine. Yet the Government will not establish a London-wide health authority or a London health care planning strategy. The Government use London-wide arrangements for their internal planning, but they will not put the structure in the public domain.

There is no London-wide review of accident and emergency services, although we have heard of the enormous tensions that there are in the capital. There has been long-term underfunding of London health care and, although it is the nation's capital, London has some of the country's lowest rates of general practitioner registration, putting further strain on the hospital services. Therefore, there is a particular crisis in London which is not being met by the Government.

The Secretary of State claimed that under the previous Labour Government when the financial year came to an end there was fear and terror throughout the NHS as people tried to get the budgets to balance for the year. I can tell her that that has not changed but is still going on now. I have an example from my own region, or regions as we think of them--the north and Yorkshire.

My regional health authority has a financial monitoring report which sets out the position as at 30 November 1994 which David Florry, the director of finance, has sent me. I do not know whether he knows that he has sent it to me, but I have it now and I am sure that he would not mind me sharing it with the House of Commons. At least, in the interests of open government, I shall share it with all the Members of the House of Commons and the public when they read Hansard tomorrow. He says:

"the overall regional forecast is an underdraw against cash limit of some £34m."

That is just for our region. He draws the following conclusion: "Contracting and other pressures are now clearly showing across a number of Authorities with reserves of some £6.0m having been deployed to meet these costs and continuing pressures may lead to deficits being forecast which will need to be funded from non-recurrent sources or working balances. Particular attention will need to be given during the remainder of the year to managing the overall regional resource to that agreed within the NHSE." That is exactly what the Secretary of State complained had happened under the previous Labour Government. We have not moved on far there.

Another issue that has been raised in the debate quite forcefully is the question of the democratic deficit in the NHS--how appointments are made to non-executive posts. Mr. Roy Lilley, a mentor to Ministers on such issues, says:

"Non-executives are like bidets--stylish to have, but no one knows how to use them."

Those words were spoken by a man who clearly from his other actions, misuses his bidet.

The Secretary of State says that politics play no part in appointments to office within the NHS and the Minister of State said the same thing in a written answer to me. However, I have a letter from a retired health care professional who applied to be a non-executive trust

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member having seen the advertisement in the paper. Writing to my right hon. Friend the Member for Derby, South, she says:

"In 1993 I applied for a post advertised locally as a `non-executive Trust Member' of the new Haywards Heath Hospital. On the application form was an actual request for me to supply one's political affiliation. Needless to say, I was not appointed". My hon. Friends, particularly my hon. Friend the Member for Doncaster, North (Mr. Hughes), are right to believe that the Government's protestations of not taking politics into account are not to be taken at face value. It would be remarkably coincidental, if they were able, at random selection, to appoint their own relatives, friends and former supporters to those boards without reference to the rest of the population. What do Conservatives, those who have a responsibility for party management, as opposed to the conduct of ministerial office, think about that? They say this. Mr. Maples--whom I remember from my time in Labour's Treasury team--says: "We can never win on this issue".

I can almost see him shaking his head sadly as he says:

"People perceive the reforms as clumsy and believe what doctors and nurses say about them, which is almost universally hostile". Wide-eyed and innocent! No doubt that was received with a certain amount of pain in the Secretary of State's office.

What is the Government's response? Since 1989, they have spent some £1.1 billion on their market-led reforms; over the same period, the managers' pay bill has increased by 206 per cent., the number of managers has risen dramatically and the number of nurses has fallen almost as dramatically. Sixty per cent. of hospital staff budgets are now spent on non-medical activities. Public-private partnerships for capital projects, which have predominated this year, have been entered into on an uneven basis: profit and certainty of outcome are transferred to the private sector, while the risk is transferred to the public sector.

My hon. Friend the Member for Doncaster, North pointed out that when the Government boast about the number of patients treated, it is important to remember that, when considered for statistical purposes, patients are episodes and not people. The same accounting device is used when the Government boast about waiting lists. In fact, more than 1 million of our fellow citizens are still awaiting hospital care as we speak, and not receiving the treatment that they ought to receive.

My hon. Friend the Member for Strathkelvin and Bearsden spoke of our values and the Government's values. I said that I wanted to set out the Labour party's approach to the national health service, and compare and contrast it as fairly as I could with that of the Government. We in the Labour party believe in a unified service; the Conservative party believes in a fragmented service, and, indeed, takes pride in that. We believe in a public service; the Conservatives praise privatisation. We believe in achieving efficiency within the public sector; the Conservatives believe in a market mechanism, which they argue will achieve economic efficiencies.

We believe in professionals taking responsibility for the service that they provide. The Conservative party believes in management checks, sometimes-- in one instance, at least--pursued to the absurdity of hiring private detectives to follow consultants. We believe in a co-operative model of health care for different professionals to share; the Conservative party believes in, and indeed boasts of, a competitive model. We believe that public representatives

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should represent the public interest, and that if the public interest is to be represented in the laity of health service structures it is best for the public to choose their representatives. The Conservative party believes--if it is to be judged by its actions--that those representatives should be chosen by the Secretary of State, or on her behalf, from the relatives and friends of her ministerial and other parliamentary colleagues.

We believe that hospital services should be in the public sector, and that other provider services should be public sector responsibilities. The Conservative view--I have heard the Secretary of State express it on the radio, and I have heard the Parliamentary Under-Secretary express it in Committee--is that it does not matter whether the provider of the service is in the public or the private sector. I draw a clear distinction there between provider and purchaser.

That is clearly a green light, at least ideologically, for the privatisation of the providers, including trust hospitals. As we have heard today, the trust hospital structure has been set up for privatisation purposes. We believe that general practitioners' first duty is to the patient; Mr. Roy Lilley has said, presumably from a Conservative perspective, that their first duty is to the paymaster and the service. We believe in setting national pay and conditions for a national service, on grounds of fairness and economic efficiency; the Government believe in local pay bargaining, presumably on grounds of unfairness and economic inefficiency. Clear distinctions exist, therefore, between the point of view of the Labour party and that of the governing party. I hope that, in setting out those distinctions, I have given the Conservative Members who asked for it an idea of where the Labour party is going in the consultations and policy review that it is conducting, is drawing to a conclusion, and will have drawn to a conclusion by the time of its conference this year. There will, therefore, be plenty to debate in the run -up to the general election, which, as was helpfully announced from the Conservative Benches, will be in 1997.

Where are the Government going? Back in 1988, Dr. David Green, director of the grandly titled Institute of Economic Affairs health unit, proposed health vouchers as a way of getting around the difficulty with the status of general practitioners--are they purchasers or providers? His idea is to have an age-weighted cash payment to purchase private health care insurance and thus private medical care. In his model, everything except regulation would be run as a private sector function.

For people who think that the voucher idea is a long way off, let me point out that vouchers are already in place to pay for spectacles. Dr. Green was echoed by Mark Bassett from the European Policy Forum. His argument is that every individual should receive a weighted insurance entitlement. It is a similar argument to Dr. Green's. He calls it a "health cheque". For the avoidance of any doubt, he meant cheques, in case people thought that he meant regular medical checks. The purpose of that payment would be to insure for comprehensive ordinary health and social care. He argues that it would create

"an individual cost-awareness that is currently absent.

The commissioners of health services would include private insurers and would be subject to public licensing and oversight. These roles"--

and I think he means those roles alone--

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"would be assigned to the health authorities."

Madsen Pirie of the Adam Smith Institute argues for the creation of health maintenance organisations for the entire population. He argues for competition between different producers of health care, and for subscription-based health care from private or public sources. One final ideologue has a contribution to make--Dr. Ann Robinson, head of the influential Institute of Directors policy unit.

It is important to know that those people play an important part in the thinking of the Conservative party. What they say today, Conservative Ministers say from the Dispatch Box tomorrow, probably because they are paid to do so, which is the allegation that they always make about Labour Members and the unions, so why not throw it back at them?

The head of that influential policy unit says in criticising the Government's trusts:

"They cannot make profits, establish subsidiary companies to trade, nor go to the money markets to borrow money. And they cannot become bankrupt no matter how poorly managed they are."

She is right. We argue that, because of those things, a real market does not exist, and that it would be better to have a unified, publicly owned health service.

Dr. Robinson goes on to argue, and no doubt this is the Conservative party's point of view:

"Running a hospital should be subject to the same disciplines as business. If it becomes insolvent, it should go into receivership or administration and a new management with tighter financial control installed".

That is where the ideologues, who drive the Conservative party and who create its dogma, are trying to take that party.

There are two visions. Ours is of a national public service and the Conservative vision is of a fragmented private health care market. In urging my hon. Friends to vote for the motion standing in the name of my right hon. Friend the Member for Sedgefield (Mr. Blair), I should like to give the last word to Dr. Lee-Potter, an inspiration for the debate, and a man who is frequently chaired-- [Interruption.] I mean cheered. If he had stayed on, he would have been chaired. He is frequently cheered from the Conservative Benches. He says:

"I am sorry to say it but I have given up on this Government. Surely they cannot believe what they are doing is good. If they believe it, then that is another reason not to talk to them . . . If the election were tomorrow I would not like the Conservatives to win."

I agree with him on that. I think that he was speaking for doctors everywhere when he said-- [Interruption.] I am sure that he is. Very well, I shall correct that--he is speaking for doctors everywhere but not for Members on the Tory Benches. He said:

"We are valued less than the managers, boards and authorities put over us, but lions led by donkeys have a habit of eating the donkeys in the end and John Major would do well to remember this." The problem for the Prime Minister is that if things carry on as they are he will be eaten not by the lions but by the donkeys. 9.39 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): Having listened to the hon. Member for Newcastle upon Tyne,East (Mr. Brown), I think that we heard a rather better effort from the hon. Member for Renfrew, West and Inverclyde (Mr. Graham), aided by the hon. Member for Liverpool, Garston (Mr.

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Loyden), in terms of summing up the Labour party's point of view. I suppose that Renfrewshire meeting Welwyn is as good a summing up of the debate as any.

By and large, it has been a good-humoured and sometimes thoughtful debate. We heard a song of pride from the Tory Benches, and occasionally from the Labour Benches--pride in the achievements of our new national health service and in what the men and women who work in it have done. We heard calls for further progress, and rightly so. We have been pressed to remove the occasional example of poor and even bad practice, and that is right, too. However, the calls from the Tory Benches are made in the knowledge that more is achievable because so much has already been achieved.

I shall deal briefly with some of the points that have been raised. We heard a great deal about political appointments, but I must tell the hon. Member for Newcastle upon Tyne, East that I have here pages of appointees, starting with Audrey Callaghan and including Helene Hayman, Baroness Jay, Brian Stoten, Roy Widdowson and Brian Hanson--I wonder whether they would claim to be card-carrying members of the Conservative party.

In their contributions, the right hon. Member for Derby, South (Mrs. Beckett) and others showed that they did not understand the difference between waiting lists and waiting times. What is important is how long one has to wait for treatment, but we are very much aware of the need to do more, which is why we introduced the patients charter, extending a patient's rights to out-patient appointments. Of course, there was no patients charter of any sort when Labour and the Confederation of Health Service Employees were in power. Then, patients waited longer on every list.

Much has been said about beds which are, of course, important--not just the number but the type, the appropriateness of their use, the management of and advances in beds. I recently opened the first London hospital-at-home scheme and I realised how the bed argument should move forward. The Labour party should examine its record on beds.

Reference was made to mental health. Let us look back to Labour's record on medium secure beds. The Glancy report which called for medium secure beds was published in 1974, but how many were there by 1979? The answer is not one. We now have 1,300 secure and interim secure beds and we shall increase the number this year and next. We also heard about the supposed privatisation of the health service. Patients want services commissioned by the NHS, but they do not especially mind the status of the provider as long as the provision is good. That is, after all, what they have been used to all their lives. They have been used to receiving such service from their general practitioners because every GP is an independent contractor to the NHS, and the voluntary sector and private nursing homes have long been doing contract work for the NHS, bringing a great quality of service to people in need. The Labour party's ideological slip is showing across the Chamber, perhaps even as a threat to the independence of GPs.

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If Opposition Members do not want to listen to me, let them listen to Labour's health spokesman in another place, Baroness Jay, who endorsed the market approach to meeting patients' needs and wishes. She said:

"If patients can be persuaded to treat the health service like a service industry they will naturally expect and insist on high standards of personal care in all things, ranging from good food to single-sex accommodation."--[ Official Report, House of Lords , 18 January 1995; Vol. 560, c. 739.]

She went on to applaud the contract culture of the national health service, and I applaud her for doing so and hope that the right hon. Member for Derby, South will have a word with her, too.

We have heard a lot about community care. Again, the ideology of hostility to the independent sector, of not listening to the Audit Commission's message that much better use could be made of the independent sector for the benefit of patients, shines through. It is a partnership that we look for in providing community care. That is why we are proud of the partnership between our health service and our social services. That is why we have committed our support, through specific grants for acquired immune deficiency syndrome, drugs and alcohol and for mental illness, and why we have taken that partnership with the voluntary sector through with section 64 funds. I am pleased tonight to be able to announce that we are extending that support by taking section 64 money over £20 million for the first time.

A good and thoughtful speech was made by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). It was thoughtfully answered by my hon. Friend the Member for Broxbourne (Mrs. Roe) on behalf of the Select Committee on Health. In many ways, her response answered the hon. Gentleman, and it would not be right for me to pre-empt our careful consideration of her Committee's report. We shall certainly consider it well. What she says is entirely in tune with what we believe.

My right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) and the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) referred to St. Bartholomew's. As my right hon. Friend said, the consultation is in process. He asked for special care to be taken over the results of that consultation and, of course, we agree to do that. He asked for the preparedness for emergencies in the City to be looked at carefully. That, too, we will do. He paid tribute to the co-operation since the decision on accident and emergency units. I am grateful for his acknowledgement that good can come from change.

The hon. and learned Member for Montgomery (Mr. Carlile) raised a number of issues, including trolleys. Of course, the patients charter goes some way down that line. He referred also to waiting times for out-patients. I have already referred to the patients charter in that role. He referred to whistle-blowing. I hope that he has read carefully the guidance which we have issued to ensure that staff have a route to use.

The hon. and learned Gentleman referred to psychiatric care. Of course he is right that it should not only be supervised discharge. We never suggested that it was. Sir Louis Blom-Cooper said in his report that that was the missing element in our provision and that is why we have come to the House with that measure. The hon. and learned Gentleman is right and I hope that he will acknowledge that we are right in saying that the care programme approach is central to the care of people in

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the community. Our clinical discharge guidance is central to ensuring that those who need hospital care receive it for as long as they need it and until care in the community is provided. The hon. and learned Gentleman asked the Labour party questions. I did not hear them being answered, but no doubt he will pursue that mini-duet of a debate at another time. He did not mention much about Liberal Democrat policy, as my hon. Friends have said. I understand that. The one Liberal Democrat policy of which I am aware is the proposal to merge health and local government. As the hon. Member who represents a borough right next to the London borough of Lambeth, the thought that my neighbouring friends in Lambeth may have their hospitals run by Lambeth council is a little startling to me. I suspect that that could be copied around the capital.

Mr. Morgan: Lambeth is the hon. Gentleman's local authority.

Mr. Bowis: It is not my local authority. Mine is Wandsworth--a good authority and a good health authority. Authorities are doing their own jobs in their own ways and working and co-operating together. That is not Liberal Democrat policy.

My hon. Friend the Member for Gillingham (Mr. Couchman) made good points about good management of budgets and the need to monitor the fundholding world and to monitor consultants fulfilling their contracts.

The hon. Member for Halifax (Mrs. Mahon) mentioned mixed wards and I replied to her during the debate. She did not like the draft continuing care guidelines. I hope that she likes what she sees in the full guidelines that we shall issue before long.

I shall return to the comments made from the Opposition Front Bench, especially those made by the right hon. Member for Derby, South. We can say tonight, as did Dorothy Parker, that the right hon. Lady ran the whole gamut of her emotions from A to B.

My right hon. and hon. Friends have paid tribute to the NHS and to its year -on-year, day-on-day progress, and their tribute rings true. Why cannot the Opposition bring themselves to salute that progress, too? I do not mean the lip service that they pay to the health service or the genuflection that they make to their Unison bosses; I mean full, whole-hearted, public recognition of the light years of progress that have made since their stewardship of the NHS ended in striking hospital workers, broken promises, broken morale among doctors and nurses, cuts in pay, cuts in health spending and cuts in health investment.

I do not expect Opposition Members to say sorry for their failures in the past. I do not expect them to pay tribute to the Government, who have steered that great service into the waters of success. I want them, just once, to praise the NHS, instead of trying to bury it. If they did that, we would accept their strictures on those rare occasions when someone, somewhere, in one of the biggest enterprises in the world gets something wrong.

When I hear a justified complaint or report, I take it seriously, but I also recall that, each year, there are more than 8 million in-patient treatments, 34 million people receiving out-patient treatments, and 256 million people visiting their GPs. In a year, there are nearly 300 million treatments and visits. That is the context in which the

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small number of errors takes place. Each and every error is one that we try to put right. Each and every single error is portrayed by the Opposition as typical of the NHS. That attitude does more than anything else to undermine the morale of staff who, all over the country, are dedicated to their patients and to the NHS, and it undermines public confidence, too.

We have heard quotations from the Transport house press cuttings service from the right hon. Member for Derby, South. We had many press cuttings and readings from her, but we do not seem to have heard yet from the letter that she received from a man in Manchester. He wrote:

"Dear Mrs. Beckett,

In any large organisation like the National Health Service there are bound to be one or two mistakes . . . When you blow those few mistakes out of all proportion, splash them all over the media you can actually change the perception of the Health Service in the minds of the public. That may be very good for your party and for you personally but what does it do for the morale of the people who actually work in the NHS and the people who have to receive the treatment?"

He went on to give the example of his own excellent treatment in hospital, with the care and attention of people in the service. He said:

"This kind of service does not happen in an organisation that is falling to pieces or where the staff are totally de-motivated, it can only happen where it is well managed, well funded and well run . . . I don't expect to hear this matter raised on the floor of the House because it happens thousands and thousands of times every day and you are not interested in what is working well, only in the very few mistakes people make."

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