House of Commons Hansard Debates for 3 Jul 1995

Mr. Fabricant: I was not referring to the Chair, Mr. Deputy Speaker, or indeed to the right hon. Member for Derby, South. I certainly would not point at the right hon. Lady.

Mr. Deputy Speaker: When the hon. Gentleman says "you", he is addressing the Chair.

Mr. Fabricant: As always, Mr. Deputy Speaker, you are right. I bow to your superior experience. I ask your forgiveness as merely a new boy and unaccustomed as I am to public speaking.

The fact remains that real Labour--old Labour, the old socialists, the Gosplans and central planners of this world--has no central plan. Its members simply carp, criticise and come up with slogans. When asked to come up with targets, they answer, "We have no targets. We can provide no targets."

The Government do provide a truly national health service in that the national health service should always be available free of charge to people who need it. Under this Government, it will always be nationally funded, but, whether it is the Soviet Union, which determined that central planning did not work, IBM, or any company in this country that knows that centralised planning never works--

Mr. Bayley: Will the hon. Gentleman give way?

Mr. Fabricant: I will give way to the hon. Gentleman. I was just about to conclude my speech and I know that he will be upsetting his Front- Bench team, but I am happy to give way to him.

Mr. Bayley: The hon. Gentleman says that he is against massive bureaucracies, but does he not agree that, as part of Conservative reforms, two further tiers of bureaucracy have been introduced between the Department of Health and the national health service--the NHS management executive and, beneath it, the regional offices of that executive--and that both tiers are accountable upwards to the Secretary of State for Health rather than outwards and

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downwards to the service, which was the case with the old regional health authorities? Two layers of bureaucracy have been introduced to replace one.

Mr. Fabricant: The hon. Gentleman has studied his brief, is well aware of the facts and has stated correctly that those tiers exist, but he has failed to observe that the number of staff in those bureaucracies has been reduced fivefold. There must always be some overall control of matters such as epidemiology, which, incidentally, no Labour Member has--

Mr. Bayley: Health planning.

Mr. Fabricant: Does the hon. Gentleman wish to intervene?

Mr. Deputy Speaker: Order. We should be getting on with the debate.

Mr. Fabricant: I thought that the hon. Member for York was trying to say something. The whole point of the reforms, as the hon. Gentleman obviously knows from his own experience in York, where I know there are many fundholders, is that local fundholders can direct where patients should go and, for the first time, perform operations that they were previously unable to perform.

I remind the House that every doctor gets two degrees, not one. Any doctor who graduates in England or Wales gets a degree in medicine and a degree in surgery--he becomes a Bachelor of Medicine and a Bachelor of Surgery. That enables him to perform minor surgery in his local trusts. The hon. Gentleman will know that the reforms in York and those that my right hon. Friend the Secretary of State has made in channelling money northwards away from London enable his patients to be directed to local hospitals, which are run now by local people. That is local accountability. That is not centralism. That is a framework in which the NHS has clearly demonstrated that it can reduce the number of people on waiting lists and that the number of patients treated can be increased considerably.

The hon. Member for York and his right hon. Friend the Member for Derby, South have come up with no proposals as to what they would do in office. All that they come up with is slogans. Here we have had it--the authentic voice of socialism: plus c a change, plus c'est la me me chose.

5.43 pm

Mr. Kevin Hughes (Doncaster, North): In the short time since my election to this Chamber--three years--I have heard some nauseating nonsense from Conservative Members, but that takes the biscuit. It is appropriate that we are having this debate today, which has again been initiated by the Labour party. In my three years here, I do not believe that the Government have initiated one debate on the national health service. It was appropriate to hold the debate today because it allowed the Secretary of State for Health to give her swan song--and what a swashbuckling attempt it was. I am sure that by the end of the week she will be looking for a new post.

The debate is especially appropriate following the publication last week of Labour's policy document "Rebuilding the National Health Service", which was ably launched by my right hon. Friend the Member for Derby,

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South (Mrs. Beckett). The Secretary of State said that Labour would turn back the clock and return to a command-style national health service. Her criticisms were tongue in cheek and were levelled without foundation. Labour's plans will improve the service that the NHS can give patients, and secure the NHS as a public service for generations to come.

The founding principles of the NHS have been utterly undermined by the Government's policies. Their reforms have introduced competition into the NHS. They have sabotaged the principle of treatment on the basis of clinical need and instead have introduced finance as the main factor that determines whether people receive care.

The NHS was set up to ensure that payment would no longer be a condition of treatment, but the Government have reversed that. They have turned those principles upside down. The internal market has created a system of competing health businesses, each vying with each other for its own niche of the market. That has caused inflexibility, duplication and waste. It has also led to a secrecy and a lack of accountability that has been damaging the service overall, as well as the interests of patients.

The ideology that the Conservatives have imposed on the NHS is totally at odds with its purpose. A collective, co-operative approach is needed to maximise efficiency. What is needed now is a commonsense approach to the NHS to rid the system of the commercialisation, fragmentation and privatisation that the internal market has caused. Labour will maintain managers' ability to manage at local and regional level to secure the most appropriate services for patients in their region. Services will be properly planned. Duplication and waste will not be tolerated under Labour. Patients must be treated, first and foremost, according to clinical need, but the Government's reforms have perverted that principle. Patients of fundholders may receive quicker treatment than some people whose care is paid for by the health authority, especially if its contract is nearing its end, as happens at the end of every financial year. We have heard stories-- and we have checked them out and know them to be true--that, come the end of the financial year hospitals are told by general practitioner fundholders, as they are by different health authorities, not to carry out operations because they are running out of money. Charges for eye and dental check-ups were introduced and charges for prescriptions have spiralled over the 16 years of this Government. We know that one result is that people have been discouraged from taking eye tests. The number of tests fell dramatically when charges were introduced. We also know that NHS dentistry has been sabotaged by the Government's policies. In May 1995, the General Dental Practitioners Association reported that, since 1990, the proportion of dentistry carried out in the NHS had fallen by one third. I know from experience in my constituency of Doncaster, North that dentists have written to patients, saying that they will not treat any more NHS patients and offering them private cover.

Patients are being told that they can wait months to see a consultant, or choose to pay £50 to see the same person privately the following week if they can stump up the money: for some people, that is some choice. With 1 million people on waiting lists, there is a real temptation for people to take that option, but, of course, not everyone can afford to, and the Government know that.

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Time after time, Government policy has undermined equal access to treatment and treatment based on clinical need, with the least well-off in our society the worst affected. Today, the British Medical Association chairman asked a question: where stands equity when the cash lottery dictates priority to patients with lesser need? At the same time as the market is skewing equal access, lower-income groups continue to suffer more ill health than the rest of society. With economic inequality on the increase, inequalities in health have become more marked.

There is evidence that the service in deprived areas is lower than in other parts of the country, but the Government refuse to take account of deprivation through changes to the funding formula. As bureaucracy has spiralled, health care has suffered. Nationally, about 12 per cent. of the health budget is spent on administration. In Doncaster, administration costs increased by 48 per cent. following the introduction of the internal market, rising to £6 million. Management costs have spiralled even higher.

The Government deny any problems. It is clear that Health Ministers do not read the newspapers and do not listen to either their Back Benchers or Labour Members. Patients are being flown miles across the country to find beds. People are waiting for hours on trolleys because there is no proper space for them in local hospitals. In Doncaster, a number of patients have been farmed out to other hospitals because no beds have been available.

Those are real problems affecting real people, but the Government's response has been non-existent. Instead, they just get on with the job of upsetting health service staff by offering the nurses a pay award of just 1 per cent., by ending national pay, by lumbering them with more administration, by undervaluing their contribution and by failing to listen to their concerns. One trust in Doncaster has not paid the full 3 per cent. award--only 2.5 per cent., with a 0.5 per cent. top-up for this year. That means that in years to come nurses will be 0.5 per cent. worse off. With inflation currently at 3.4 per cent., that is little more than an insult to the people who run our NHS.

Labour recognises that patients and staff are people, not units on a production line. They must all be treated with respect and their views listened to. The Government are failing to do that. The long-running dispute with dentists, the imposition of local pay and the dispute over out -of-hours work by general practitioners proves that. Patients need a voice too, and Labour will tackle the secrecy that the internal market has created, ensuring that both patients and staff have a say in their NHS. Labour will bolster the community health councils as advocates for patients.

In "Rebuilding the National Health Service", Labour has comprehensively set out its vision for the national health service. It is a practical, effective recipe for improvement--a way of removing the worst excesses of the internal market and bringing some sanity back into the NHS--

Mr. Fabricant: Will the hon. Gentleman give way?

Mr. Hughes: No, many of my hon. Friends are waiting to speak and we are running out of time.

The Government say that the NHS is safe in their hands, but for those who have had to wait months for operations, for those whose operations have been cancelled--14,500 people in the first three months of this

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year alone--and for those denied services while others jump the queue, Labour has a more impressive agenda to offer. We will dispense with the policies that have left some unfortunate people with a second-rate service; we will introduce a system that can provide a service second to none, which is fair in its distribution of services and effective at meeting the demands of those in need.

We have our agenda for change. The Government will not accept the need for change. The Government must go--and given the current shambles on the Conservative Benches that will be sooner rather than later.

5.53 pm

Lady Olga Maitland (Sutton and Cheam): The hon. Member for Doncaster, North (Mr. Hughes) made one true statement--that patients need a voice. How right he is, and that voice is coming from the Government. It has been passionately expressed by my right hon. Friend the Secretary of State for Health. I can think of no other person who has gone to greater lengths or shown greater commitment to giving patients a voice.

The Labour motion is a complete rag-bag of ideas. It focuses more on "growing alarm" than on any real care and concern, for the patient. Bearing in mind the fact that the Opposition tabled the motion, if they have so much care and concern, why are not their Benches full of Labour Members? Where are they? Their so-called concern for the patient is hypocrisy.

The Government have worked hard for years to get a good deal for patients. Indeed, the evidence of that is clear in the Government's amendment, which points out that

"over one million more patients are treated in hospital every year and waiting times have fallen to the lowest on record".

Why was the right hon. Member for Derby, South (Mrs. Beckett) incapable of paying tribute to those remarkable achievements? Why is she blind to progress? It strikes me that the Labour party is attempting to politicise the health service, rather than focus on patients.

We kept hearing emotive words from the right hon. Lady, such as privatisation is an ogre and the private finance initiative is a dirty phrase. I can tell Labour Members that the PFI will give the NHS a boost and broaden its imagination in a way that has never happened before. I draw the attention of the House to an innovative programme that has been proposed in my constituency for a new Sutton medical campus, which will have the latest in technology and services for patients. How is that to be carried through successfully to the next century? It is by consulting and working with a private finance initiative. I have no doubt that patients throughout the south-west London area will benefit enormously.

Another thought occurred to me when I was listening to the right hon. Lady. Among all her incoherence, she gave me the feeling that she had to alter the NHS just for the sake of it. I maintain, "If it ain't broke, don't mend it." Indeed, what is remarkable is that the NHS is providing a better service than ever before. The greatest evidence of that is that people are now living healthier lives and for much longer because of preventive care-- [Interruption.] That does not happen by accident; it is a result of excellent treatment.

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Mr. Alex Carlile: Is the hon. Lady satisfied with a situation in which poor people live, on average, eight years less than affluent people?

Lady Olga Maitland: The whole point is that everybody has a different life style. If people choose an unhealthy life style, it is difficult to impose better habits on them.

Mr. Carlile: They are poor people.

Lady Olga Maitland: Yes, but does the hon. and learned Gentleman accept that the NHS helps everybody in the community, irrespective of income? With better preventive care than ever before, everyone in the community is leading a healthier life-- [Interruption.] If people choose to smoke cigarettes, that is their choice--

Mr. Carlile: So it is down to fags and chips then.

Lady Olga Maitland: If people choose to eat an unhealthy diet, that is their choice. We can offer them the opportunity of a healthier life. There is no evidence that people on low incomes need necessarily live shorter lives. The hon. and learned Gentleman's comment was bogus.

Let us look at the broader picture in the health service today. It is remarkable that the health service is spending £110 million a day on patient care. Sadly, that message does not always get across. When talking to people in the street, I find that the responses are curiously paradoxical. I ask somebody, "How are you getting on?" They might say, "I am getting on very well, thank you." I ask, "Have you recently had any health treatment?" They say, "Oh, yes; I received wonderful service. My operation was carried out promptly, the doctors were dedicated, the nurses were marvellous and I am home, fit and well." I ask, "Why, therefore, are you and so many other people worried and fearful for the future of the health service?" The answer comes back over and over again, "It is what Labour says on television, what Labour says in the media, what Labour says through its politicians."

There has been a very dangerous and irresponsible misinformation campaign. The Labour party is playing on people's fears; it is playing on the fears of elderly people, of young people, of young mothers. That is utterly wrong. Instead, we need to consider their experiences.

In my constituency, the successful St. Helier NHS trust is treating more people every year. Operations are performed more promptly, waiting times are shorter and more out-patients are treated. The Royal Marsden hospital is also in our community. It has an excellent reputation throughout the world for the service that it provides and it is backed by the Institute of Cancer Research, whose research is second to none. More people are screened earlier for cancer, they are treated earlier and their survival rate has vastly improved. No longer do they suffer the fears that they had before.

With modern technology and medical science, GPs are finding that the whole picture has changed. The concept of day surgery has changed the face of modern medicine. We no longer need the same number of acute beds. Day surgery has meant that people recover more quickly at home. They are back on their feet and back to work more quickly. Modern medicine with modern management has made all that possible. Waiting times have been a curse in the past, and it is interesting to note that, before our reforms, more than 200,000 people were waiting more than a year for hospital

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treatment. Today, the figure stands at only 31,600--the lowest since 1948. Indeed, over the past six years, the average waiting time has been cut in half. Half of all patients are seen right away --on the spot. The GP rings up, the appointment is made, the patient is seen; half the remainder are seen within five weeks. Nearly 75 per cent. are seen within three months and 98 per cent. are seen within a year. That leaves a tiny percentage of patients who have to wait for more than a year- -the least urgent cases. Enormous progress is being made in our health service.

Those improvements have been noted. A British social attitudes survey published in November 1994 showed that more people were satisfied than not. A survey conducted for the National Association of Health Authorities and Trusts in 1994 showed that nine out of 10 patients who attended hospital in 1993 found the NHS very good, good or average and that three out of four found the service very good or good. That is a tremendous improvement on the past.

I shall turn briefly to the success of GP fundholding practices. I know that the Labour party is absolutely committed to sweeping away the independence of GP fundholders. Its deadly campaign against the independence of GP practices is very similar to what it tried to do to grant-maintained schools. It hates anybody or any authority having the ability to think and manage for themselves. It wants to drag people willy- nilly back under its centralised control and management--politicised management at that. Meddlesome Labour Members cannot let go and cannot stop interfering with other people's lives. Even Labour party advisers have recognised the dangers of the interventionism that it advocates. Professor Julian Le Grand, founder of the Socialist Philosophy group, has described the health service as "the biggest success story" and noted that GP fundholding is "now widely thought to be at the cutting edge of the reforms". Professor Brian Abel-Smith, vice-president of the Fabian Society, co-authored a recent article which said:

"There is now overwhelming evidence that fund-holders are able to get a better deal for their patients from hospitals . . . Fund-holding represents a major transfer of power from specialists to GPs".

The success of fundholding has also been highlighted and praised by the Organisation for Economic Co-operation and Development, the National Audit Office, the King's Fund Research Institute and a four-year independent evaluation into GP fundholding in Scotland carried out by Professor John Howie and his team at Edinburgh university.

Why should the patient believe that the Labour party holds out any hope for progress or improvement? As an NHS patient, like anybody else in my constituency, I fear the Labour party's doctrinarian ideology. I fear the fact that Labour wants to bring politics into clinicians' decision making, undermining their work. I fear that patients will be faced with the gobbledegook of the Labour party. When the Labour party talks of comprehensive health care agreements, it means interference and meddling.

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The Labour party will try to destroy incentives for hospitals to improve health care. I cannot see how that will benefit the patient.

Mr. Bayley: Will the hon. Lady give way?

Lady Olga Maitland: I am sorry, but I shall continue with my speech because I know that other hon. Members want to speak. At least one Labour Member wants to speak after me--at least I hope that he does; otherwise, it would show the paucity of Labour representation in this debate.

The Labour party is committed to abolishing compulsory competitive tendering, which will divert £100 million from patient care. I cannot see how that would benefit the individual. It is also going to persist with the minimum wage, which will cost the NHS £500 million. How will that help the patient? Surely we should concentrate all available resources on the patient himself.

The patient now faces a nightmare scenario. If this country ever decides to go down a socialist route, the patient will find that he comes second to confused, left-wing ideologies. I believe firmly that when patients look to their own interests, they will realise that there is only one way forward-- the Conservative way.

6.9 pm

Mr. John Gunnell (Morley and Leeds, South): It is always a pleasure to follow the hon. Member for Sutton and Cheam (Lady Olga Maitland). When she looks at the Conservative central office brief, she should study the articles from which she takes her selective quotations. If she looks at the article by Brian Abel-Smith, to which she referred, she will find that there are references to some of the shortcomings of the fundholding system. Indeed, the article concludes that the Labour party should consider putting substantial extra funds into services in poorer areas. The hon. Lady was asked earlier about the health of poorer people, but she completely ignored the question. There are grave inequities in health care in our present system and it is important that they are corrected.

The hon. Member for Sutton and Cheam was wrong in some of the factual points she made. A constituent wrote to me recently saying that following a first appointment, she was told that she would be on a 78-week waiting list. Her back condition meant that she could not carry on with her work, so she was forced to seek private assistance; she could not wait 78 weeks to get back to work. Another case concerns an 84-year-old lady who required an urgent bladder operation. Her sons were able to pay for her to have the operation and did so. They did not, however, take her off the waiting list because they were interested to find out just how long it would take for her to have the operation under the NHS. It was two years later that she was told that she could have the operation for which her sons had paid two years previously. That 84-year-old would have had an inordinate wait which she should not have had to suffer. There are real concerns which the hon. Member for Sutton and Cheam simply ignores because she sees the NHS through rose-coloured spectacles. Perhaps Sutton and Cheam is very different from the areas that other hon. Members on both sides represent.

The Secretary of State was a little petulant in her opening speech. I am sure that she has seen the Labour party paper, "Rebuilding the National Health Service", to which my hon. Friend the Member for Doncaster, North

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(Mr. Hughes) referred. She must have been able to see that it was a constructive paper. It was also obvious that the hon. Member for Mid-Staffordshire (Mr. Fabricant) had not read the paper because most of what he said about it was completely wrong.

The Secretary of State and the Minister of State no doubt expected a wrecking paper. They find, however, a paper that is constructive in its approach to the NHS. It makes it clear that the reforms already in place will evolve. Some practices will be jettisoned because they cannot conform to the principles that we espouse for the health service. On the whole, however, the reforms will evolve to meet our principles and without any worsening of patient care or of the service given by GPs. It is obvious that our proposals will be welcomed by patients, by health professionals and by health authorities. Under the present system, health authorities could find themselves in conflict. The reforms recently introduced would reduce the significance of the health authorities and reduce their health promotion and health purchasing roles. I am convinced that the reforms that we will put in place and the transformation that we will bring will benefit the health service and the British public. It is clear that our first principle is that of a national health service. We do not believe in a service that is an oligarchy, as suggested by the hon. Member for Mid- Staffordshire, in which all power is centralised. We believe in a service in which regional power and local power exist. We clearly state that we intend to ensure that at the local level, the people who operate the health authorities have a degree of local accountability and that accountability becomes a much more important word. Through the changes that we shall make, we shall reduce the inequities in the service and restore the accountability of the service. We shall make our changes on the basis of the minimum disruption to patient care.

The hon. Member for Sutton and Cheam also suggested that the wording of the motion was inappropriate at almost every point. The motion is clearly worded to show that we have a choice between an increasingly privatised service and a service that returns to being a truly public service. It is important that we consider that point now, when the level of privatisation in the health service is about to increase considerably, if the Conservatives remain in power. In the early years of the reforms of the health service, the Government did not find it easy to progress privatisation. The market that they set up was not a real but a bogus or quasi-market. Both purchasers and providers depended on public finance. Although in their roles as purchasers and providers they entered into contracts and although money was transferred on the basis of episodes of patient care, the money was almost always public money which was transferred from one body to another. The market was often self-consciously not a market in terms of the normal market mechanisms that the Conservative party espouses.

As members of Leeds Health Care--the Leeds health authority--we were given strict instructions when the authority was set up about the two major hospitals in Leeds. Whatever prices we arrived at through the contracting procedures--one of the hospitals appeared for most purposes to be more expensive than the other--it was regarded as important that each of the hospitals

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remained viable and in existence. I entirely supported that view. Leeds clearly needs both the Leeds general infirmary and St. James's University hospital. A current review of Leeds health services will, I hope, start from the basis that each hospital is needed. I understood, therefore, why the market mechanism was not a normal market mechanism, but one in which there were priorities other than simply accepting the lowest tender.

It has been difficult for the Conservatives to progress their privatisation proposals as they wish. There is abhorrence in this country at the idea of making money out of people's ailments. There are other societies where that is not the case. Having lived in the United States for eight years, I am well aware that one can enter a completely different system in which one can feel vulnerable. I felt vulnerable when I took children to the United States, as one child developed pneumonia--a condition not covered by insurance. He had experienced that condition in the year before going to America. In those circumstances, one recognises the great strength of the NHS. Despite what the hon Member for Mid-Staffordshire asserted, the NHS is now not free at the point of delivery. There are charges to pay at many different points of delivery, as the hon. Gentleman and other hon. Members well know. Nevertheless, the NHS provides a level of support that is absent in what one might call the more traditional financial market in health care. The Government have been slow to develop the private market in health care in the NHS.

The debate comes at a critical point, because it is clear that a number of initiatives are progressing apace. One specific area that has been developing since the introduction of the Community Care (Residential Accommodation) Act 1992 is the provision of private nursing care. We are aware that many hospitals seem to have a mechanism whereby people move rapidly from hospital care to private care.

Highlighted in The Independent recently was the work of Michael Fallon, a former Member of the House who lost his seat to my hon. Friend the Member for Darlington (Mr. Milburn). Mr. Fallon, who made it clear that he was developing "Quality Care", a private nursing home group, was a member of the Government's deregulation task force and an adviser on the private finance initiative.

Mr. Fallon suggested that it was important to take the initiative forward, and he looked forward to a time when companies which are at present operating nursing care will be allowed to run entire hospitals, including the employment of doctors and nurses, on behalf of NHS trusts. The private finance initiative is currently concerned with the various ways in which money can be made through the NHS. I do not think that the NHS has yet created any individual millionaires through the initiative, but that is seen to be a possibility for the future.

The Opposition have never taken the view that there are no appropriate ways in which the public and private sectors could work together, but there remains a suspicion of the direct involvement of the private sector in making profits out of health care.

Two other aspects have been highlighted recently. One is the increasing use of NHS facilities--in particular hospital facilities--to assist private patients. An article in the same edition of The Independent referred to the Royal Surrey county hospital at Guildford, which will be well known to the Secretary of State, and talked about its

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provision of facilities for private patients. The article stated that those covered by private care--some 11 per cent. of the population--accounted for one in five of all those on the waiting lists for surgery. The facilities are being made available to the private sector because the income is extremely important to the trust, and the article made it clear just how important.

It is clear that there is preferential treatment as far as the receipt of surgery is concerned, which suggests that we have not a two-tier but a three-tier system. Those in the private sector have the best care, with those who are being treated by GP fundholders next on the list. The patients being treated by non-fundholders are at a lower stage.

Dr. John Yates has made a study of consultants and the incomes that they are receiving from private sector consultancies. He is concerned about the level of that private sector work in comparison with their public sector work. There will be a big increase in the level of privatisation in the service if the present Government remain in control, and that could well be to the loss of many people who rely on the health service in all circumstances.

It is important that people see that the Labour party's proposals in our recent document are constructive. In relation to GPs, we are proposing not to sweep away fundholding but to introduce a system of local commissioning on a wider scale so that the choice which is available currently to fundholders becomes available to non-fundholders too. I have seen examples in Leeds where operations were denied to non-fundholders because the contract was used up, and people wanting certain types of surgery have had to wait until the next financial year.

It is important that there is equality at GP level and that all GPs have similar access to hospitals and to hospital care. Far from being rigid, the pronouncements in our document make it clear that there will be many different forms of local commissioning and that we will encourage experimentation in that commissioning.

Our proposals are extremely constructive on trusts. The Secretary of State referred to trusts and their record of producing patient episodes, but what is not clear is the gain that trusts receive from being the owners of the hospital and from having a property management role. Our paper refers to hospitals, which makes a difference from most of the papers that we see nowadays. It is right that those hospitals are clearly publicly and communally owned, and not owned by individual trusts.

Lady Olga Maitland: Is the hon. Gentleman advocating political involvement in health trusts, and that councillors should take decisions over the heads of clinicians? All the evidence that the Labour party has given suggests exactly that. I cannot see how a patient would in any way benefit from such a system.

Mr. Gunnell: The hon. Lady ought to read the paper, and she will see that that is not the case. Of course, there may be a role for some members of a council. We have suggested, for example, that it may be constructive for the chair of a social services committee to be a member of the health authority. I was the chairman of a social services committee in Leeds and a member of the health authority, and it was possible to assist in getting those two bodies to work together. But we are not suggesting that all the people involved should be elected members. There should be a valid local reason for such a person to be a member

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of a health authority. We are not suggesting that they should all be elected members, but it is important to have some link with the local authority. Nor are we suggesting a lack of involvement on the part of professionals in the health service. Indeed, our proposals make it clear that there will be a wider role for them and that consultation with them will be an important factor in decision making.

The health service is at a crucial stage. A change of control is vital for the future of the service and, therefore, I very much look forward to the time when my right hon. Friend the Member for Derby, South (Mrs. Beckett) takes charge.

6.30 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East): This debate has certainly drawn out the philosophical differences between the two political parties. The Opposition believe in a national health service based on the public service ethos, and the Conservatives believe in fragmented private markets.

As our motion makes clear, it is our fear that the public service ethos that underpins the NHS is being eroded. My hon. Friend the Member for Doncaster, North (Mr. Hughes) said that a doctor's first duty is to the patient--a point of view that is unexceptional on the Opposition side of the House. Mr. Roy Lilley, a leading Conservative thinker on such matters, and a man who is regarded as being in the vanguard of the Secretary of State's reforms, said recently that a doctor's first duty should be not to his patients, but to the employer. Every patient should carefully note that point of view, which comes from the Conservative side of the House.

The public service ethos of the national health service is undermined by the Conservative party's trusts. They are inserting gagging clauses in staff contracts, bringing a cult of Stalinism into the NHS, and preventing clinicians from speaking out. Recently, the Conservatives had the nerve to accuse us of wanting a

command-and-control national health service, but it is they, not the Opposition, who have just renationalised functions that used to be carried out at the regional level of the NHS, but which are now being taken in- house, under the Secretary of State's direct control. On the ground of commercial confidentiality, the Secretary of State is allowing national health service trusts--apparently still publicly owned--secrecy over their affairs. Commercial confidentiality in a public service--those two concepts do not sit happily together. The Nolan committee expressed concern at the appointment procedures used for the boards of NHS quangos. The chairman of the British Medical Association said today that the national health service is "not so much an internal market as an infernal bazaar, in which considerations of cost reign supreme, whilst concerns for value and values are relegated to second place."

Those concerns are echoed by the clergy. Last year, the Bishop of Birmingham described the reforms as

"distressing, unchristian and morally wrong."

This year, the Bishop of Ripon denounced the internal market, and pointed out that it leads to a "lack of patient choice".

The Government defend what they have done on the ground that it has brought about efficiency savings that have benefited patients. We can see that they have brought about a substantial increase in NHS bureaucracy. It is

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harder to demonstrate that that has been to the benefit of patients. Until the reforms were introduced, administrative spending in Britain's health service was among the lowest in the world. At the moment, for every £10 spent in the health service, £1 is spent on administration. In 1989-90, it was £1 in every £20. That is a substantial increase.

The administrative costs of GP fundholding average £80,000 per practice, and trusts have spent around £117 million on conveyancing and image building. Every trust was given a one-off payment of £300, 000 towards set-up costs.

Increasing bureaucracy has made patient admissions to hospital more complicated. It is a time-consuming paper-chase, and it was condemned in an article in the journal of the Institute of Economic Affairs, in June--a right-wing institute and not one associated with the Labour party. It described the red-tape nightmare in today's national health service thus:

"The very act of getting a patient on to a waiting list and then admitted has become a bureaucratic obstacle course for clinicians. The patient's postcode must be matched to their DHA. The GP must be identified in case they are fundholding. The procedure must be checked to see if it is chargeable to the GP or the DHA. The contract must be scrutinised to ensure it covers the proper operation . . . Sending the patient for admission requires many more hurdles to clear. An audit of one unit's admission process found 24 different steps were now required before the patient could be sent for." The institute concludes:

"It is difficult to reconcile this with the White Paper's assertion that the `reforms will make it easier for consultants and their colleagues to get on with the job of treating patients'." That quotation is from a right- wing institute, not the Labour party.

Recently, the Select Committee on Health studied the London ambulance service to find out how well the Secretary of State's reforms were doing. I attempted to intervene on the Secretary of State, but she did not let me, and it will be pretty clear why when I read this passage from the report. That all-party Committee, which commands great authority in this place, had this to say about Ministers:

"We do not think that Ministers can be absolved of blame for the sorry record of the LAS. Ministers represent the final link in the chain of accountability. Had the political will existed at Ministerial level, the problems of the LAS might have been effectively addressed years ago. We are heartened by recent assurances that the political will does now exist."

We will wait and see what that turns out to mean in practice. The Government's reforms have been accompanied by cost cutting on patient care. The recent scandal over the National Blood Authority purchasing cheap blood bags, which have turned out to be defective, has caused widespread public concern, as well it might. Running parallel--this might almost stand as a vignette for the entire NHS--to that scandal, which has relied so much on public good will to help sort it out, there has been a change in the structure of the key management of the service.

Where previously one director and a small staff would do, there are now 23 key managers, including 11 regional chief executives, some of whom are paid more than £100,000 per year, as well as getting a nice new leased car. The public look at the bloated management and the failing service, and draw their own conclusions.

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