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1.23 pm
Mr. Nigel Spearing (Newham, South): In the closing part of his speech, the hon. Member for Hendon, South (Mr. Marshall) mentioned circumstances that may or may not be widespread. I, too, have occasionally encountered such cases. In some instances, asylum has not been granted, and people have returned to a certain country that I will not name. The Foreign Office can give me no guarantee that they have not subsequently been killed.
I agree with the hon. Gentleman that this is an important matter. It is so important that I hope that he will join me and his hon. Friend the Member for South Staffordshire (Sir P. Cormack) in the atmosphere that was introduced by the Prime Minister in an intervention on my right hon. Friend the Member for Sedgefield (Mr. Blair) on Wednesday that this matter should go to a Special Standing Committee or through a special Committee procedure. Without that, this important matter cannot be dealt with in the way that it should.
The hon. Member for Hendon, South spoke about a person going to hospital and not caring less who owned it when he was placed on the operating table. Of course that would be true at the time, but even the constituents of Hendon, South would not be too content if, for example, Barnet hospital, which we have heard about in the debate, or Edgware hospital, if it is saved, were paying rent for a building or land to some private company that had to make a profit. I think that we can leave the matter there.
I had an exchange with the hon. Member for Southwark and Bermondsey (Mr. Hughes) about the increased involvement of the private sector in health care. The hon. Gentleman and I spoke about the Gracious Speech and
the proposed legislation. The hon. Gentleman was a bit trusting because he and the Minister, who I am glad to see in his place, said that I was wrong. I hope that in replying for the Opposition, my hon. Friend the Member for Monklands, West (Mr. Clarke) will mention that some sections in the legislation make it quite clear that the Government have in mind that "particular groups of people" may be paid by a local authority to purchase health care in the community. If that is done, the grant can be lower because another part of the document states that account may be taken of financial circumstances.
If the person concerned has the means to supplement the amount, perhaps to a higher sum to be paid to a private provider, there will be every inducement for him to do that. There might be an inducement for some of his relatives or friends to help with that supplement, especially if the service is more immediate than that which could be provided by the local authority, whose expenditure is capped. There is every reason to suppose that there will be an inducement not only for the payment to be made by the local authority following local demand, but also for an increase in private providers, and that means an increase in private contractors in the health service providing that community care. Perhaps the Minister or the Secretary of State for Social Services, who has just entered the Chamber and is in consultation with his hon. Friend, will deny that possibility. I shall win either way because if the hon. Member for Southwark and Bermondsey and the Minister are right I shall be pleased. However, if I am right some people will get a nasty surprise.
I now turn to the wider issue of health service funding and how it is organised. I mentioned the basic principles in an intervention on the Secretary of State and later in an intervention on the hon. Member for Finchley (Mr. Booth). Appropriately enough, I made those interventions when we were debating contracts and competitive tendering. Quite clearly there is a problem about the amount to be spent on the NHS but we understand that, as a proportion of GNP, the figure is about half that of the United States of America. As the Secretary of State said in opening the debate, we spend the money very efficiently. So what is the problem? The problem of course is priorities. In The Guardian today, under the headline "Rationing in Third of NHS", an article makes accusations about what is coming up. The Secretary of State for Social Security may say that it is newspaper tittle-tattle, but he owes the House and public an explanation or a refutation, if he can make one, of that article. He will of course have been shown it by his officials and he may take the opportunity of refuting it, if he can.
Baroness Thatcher, the former right hon. Member for Finchley, in her famous White Paper, "Working for Patients", specifically introduced an element of commercial competition in the health service. At the time, I was most disturbed. I said that we were introducing care as a commodity. That is why I asked the Secretary of State for Health whether he believed that care was a negotiable and commercial commodity. If everyone, including the media, reads the record or if they were listening or watching, they will find that he did not answer the question. Once one introduces that element, one is in dire trouble.
At the time--I make no apologies for it--I issued a public challenge to any London Conservative Member to debate with me whether such a matter was against
Christian principle. I was not saying that it was against Christian faith: that is another matter. Many people agree with Christian principles, even if they do not agree with Christian faith and they have every right to do so. The point is, however, how can one estimate the amount of care that a person will need? One cannot do it like an enterprising firm in my constituency called Clutch King. It has all the clutches of every motor car and it will give a person a contract. One can estimate that, but when an elderly person goes into hospital, perhaps for a relatively simple operation, how much extra care can one estimate?
One cannot do so. We therefore have that provider-purchaser relationship.
To keep in business, to prevent itself from becoming bankrupt and to prevent imposing changes in employment conditions on its staff, who are full of good will--I disregard the argument about whether it would be legal to change those conditions, although I understand that, under subcontracting, it will be--a hospital will be at financial risk. Is it Guy's hospital that has gone bankrupt?
What sort of a health service is it if health service workers know that their enterprise--at ward level, in the dispensary or in relation to a specialist service--is likely to be wiped out because of such competition? We suspect that that has happened in respect of the blood transfusion service. The Brentwood service, which serves hospitals in north-east London and Essex, will be wiped out. Did that happen for any reason other than the introduction of those inappropriate principles in the health service? That has not yet been sufficiently understood in the country or in the Government.
A third of the beds in the East London and City health authority are to be dispersed, abandoned and reduced-- 24 of them in a proposed transfer from St. Andrew's hospital in Bow to extensions at Newham General hospital. How can that be given the bed shortages that my hon. Friend the Member for Peckham (Ms Harman) mentioned? We know that the problem applies across London. How can that be? It seems mad. In addition, notifiable diseases and people's ages and demands are going up.
I know that all sorts of technique exists. We are told that technique projections speed treatment up, that people are going in and out of hospital quicker because of, for example, key-hole surgery, which is right, but let us always keep a surplus of beds and ensure that they are not required. That would be the right way to proceed, but commercial forces come into play and force the closure of beds.
The borough of Newham, which is the size of Derby, Nottingham or Leicester, has no secure accommodation. It is difficult to get people to certify when things go wrong. The pressures on people in east London are tremendous, so people go berserk and all sorts of things happen. My hon. Friend the Member for Woolwich (Mr. Austin-Walker) mentioned people who are a danger to others and themselves. A terrible murder was committed in Stratford.
I gave notice to the Secretary of State for Health, who is no longer here, that I would mention the law relating to the release from psychiatric hospitals of people who had been transferred from prison. My researches show that the law is defective in that matter. People leave psychiatric hospital when they have served their sentence and I can find no proper procedure whereby a definitive
decision is taken about signing them out. I hope that the Minister can point to the relevant chapter and verse in the law, because I cannot find it. I cannot accept the findings of the Woodley panel in relation to that double murder, when one of my constituents murdered another because a person who should not have been in the community had been discharged.
St. Bartholomew's hospital, which is one of the greatest hospitals in the world, has been dispersed. How does that conserve our Christian tradition of a medical service, particularly as it serves people in a large built-up area?
What will happen to a taxi driver who lives in Newham if he has a heart attack in that area in the future? Those pursuing that policy must answer that question.
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