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Mr. Simon Hughes: I wonder whether the right hon. Gentleman's experience leads him to the conclusion that, however much one might devolve management, the only person publicly accountable by election for the health service in this country is the Secretary of State, so it is the Secretary of State who ultimately must ensure that, when the health service is needed, for example to respond to emergencies, the services are provided--the buck stops there, not with the local management.
Sir Norman Fowler: The buck ultimately does stop with the Secretary of State. As someone who was Secretary of State for six years, which I believe is longer than most, I bear the scars of the buck stopping with the Secretary of State.
Mr. Ronnie Campbell: You can see them.
Sir Norman Fowler: Indeed you can.
I agree with the hon. Member for Southwark and Bermondsey (Mr. Hughes) that the buck stops with the Secretary of State, but, before general managers were introduced, we had the totally unsatisfactory position in which, all too often, no one was in charge at the health authority level or the hospital level. That is not the way to run anything, let alone a health service as important as ours.
I predict with certainty that, if by some mischance there were a Labour Government, they would not abolish general managers. Labour Members have opposed them, but they would continue with them, because no serious figure inside or outside the health service wants us to return to the old system.
It is not only in the past or the future that the words of members of the Labour party do not match their actions. The Secretary of State was at the Good Hope hospital when it was announced that more beds were being made available. However--this really is an argument for the hon. Member for Peckham--a couple of miles away,in another part of Sutton Coldfield, the Labour-controlled Birmingham city council is closing altogether a 40-bedded, purpose-built residential home for old people, the Frances Withers home. It is transferring to other accommodation, if it can, residents aged, on average, in their late 80s and 90s.
The read-across from that is quite clear. Elderly people account for more than 40 per cent. of the cost of the national health service. If the council takes such facilities out of operation, we all know what will happen--sooner or later, the strain will be taken by the national health service.
I am not the only one who opposes that policy. It is opposed by the residents, it is opposed by the relations of the residents, and, perhaps most vociferously of all, it is opposed by the trade union Unison on behalf of the staff.
Why is the home being closed? Birmingham city council has a budget of about £1.2 billion. It spends almost £190 million on social services, yet it cannot find a small cost to keep that home open. It has wasted millions of pounds--there is no doubt about that--on maladministration in the housing benefit system. It is unable to find the modest resources necessary to keep open a purpose-built home, built only 20 years ago, with good single rooms for residents, an exceptionally quiet and safe position, and an excellent sheltered garden, which is in every respect an excellent place for elderly people.
I find the arguments for that policy extraordinary. The council says that, together, Sutton Coldfield and Erdington constituencies have the second greatest provision of residential accommodation in the city of Birmingham, and that has become an argument for closing down the home. The council cites the cost of refurbishing the home, yet--I toured the home myself again last Friday--there is considerable doubt whether any refurbishment is required.
The television cameras and the media have camped outside Good Hope hospital, and I make no complaint of that. I have, as the Secretary of State knows, been outspoken on behalf of my local hospital. I hope that the same television cameras will portray what is happening in the Frances Withers home. I hope that they will portray a home being broken up. I hope--
Mr. Connarty:
Will the right hon. Gentleman give way?
Sir Norman Fowler:
I will not give way, as I am just ending.
I hope that the cameras will portray how old people are being transferred from one part of the city to another, often far from their relations. I hope that they will portray the way in which a purpose-built home is being vacated. Let no one ever forget that that policy is being instituted and carried out by a Labour-controlled council.
So the hon. Member for Peckham--
Sir Norman Fowler:
I will not give way.
If the hon. Member for Peckham wanted to interrupt me, she might have remained in the Chamber. I regret very much that she has not done so.
Mr. Simon Hughes (Southwark and Bermondsey):
The first two speeches in the debate today have shed much heat but very little light on the subject. The hon. Member for Peckham (Ms Harman) moved the Opposition motion on the national health service. It contains some good ideas, including the suggestion that each health authority should nominate a person to identify bed shortages, that there should be a regular report on bed numbers, and that national guidelines should be introduced to clarify who pays for continuing care. The motion is strong, according to the hon. Lady's own diagnosis, but we know that we seek a diagnosis only in the hope that we shall receive a prescription, and the hon. Lady certainly offered very little in that regard.
The Opposition have many questions to answer. For example, the hon. Lady referred to the difficulty that people have securing dental treatment, but she did not tell us whether Labour is committed to restoring free dental checks. The hon. Lady and her colleagues regularly refer to the difficulties facing opticians, but she did not announce that the Labour party is committed to providing free eye tests. The Opposition complain every year when prescription charges increase, but they never confirm that they would freeze or reduce those charges.
The Secretary of State is correct when he says that we do not know whether the Opposition are for or against fundholding, the private finance initiative or increased money for the health service. Until Labour Members answer those questions, there will be no prescription--which is always more difficult to provide than a diagnosis.
The Secretary of State conceded that the health service has experienced some problems recently. He conceded that the demands on the health service have increased during the winter months, but he did not tell us whether the health service is coping with that demand, and he certainly did not tell us how he will ensure that it copes
in the future. The Government amendment congratulates NHS staff on their hard work and dedication. The staff are certainly working hard, but I intend to cite some facts which show that they are not very happy about their status or about the work they are asked to perform.
The number of practitioners has increased in some areas, but decreased in others. In some areas, there is a dearth of people who are ready and willing to do the necessary work. The Government's figures show that their commitment to a year-on-year increase in real resources--we have debated the subject twice in this place in the past few months--will be barely attainable in future years.
The health service needs to develop three fundamentals in order to secure its future. It needs a working structure which will hold the health service together; it needs adequate funding to do the job; and it must be run effectively in order to improve staff morale. Although we do not need many further significant administrative changes within the health service, many areas that are clearly unsatisfactory could be vastly improved without uprooting or disrupting the service as a whole.
For example, from April we shall have regional outposts and regional civil servants, but no regional health authorities. The Liberal Democrats have long argued against separate regional health authorities. We believe that elected regional representatives should operate the strategy that determines the health service at a regional level. At a local level, the health authorities are appointed by the Secretary of State. That is not a democratic process, and my party has now agreed that health commissioning should be carried out by local government, in the same way as it carries out the commissioning and practice of social services.
Change is necessary in order to democratise the health service. I make it clear to the Minister that that does not mean any alteration in the purchaser-provider split; nor does it signal an end to fundholding. We believe that everyone should be a stakeholder in the fundholding and a partner who is able to buy the service--
Mr. Charles Hendry (High Peak):
Barmy.
Mr. Hughes:
It is not barmy, and it is not a new idea. It has been advocated for a long time by eminent people on both sides of the House, and by others such asJ. K. Galbraith.
Having improved the structure of the NHS, we must then address the question of funding. Whatever the complex causes may be, the perception on the ground is that the funding and resource needs of the health service cannot be met only by the redistribution of resources within the service. It is not sufficient to cut the high salaries and the perks of managers, although that should be done. It is not sufficient simply to reduce the number of managers and put more staff on the front line, although that must occur also. The health service has a more fundamental need, as has been evidenced in the past few weeks by a shortage of doctors, nurses and support staff.
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