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6.31 pm
Mr. Henry McLeish (Fife, Central): I am pleased to reply to the debate. Let me begin with a point on which the whole House will unite. National health service staff do an excellent job year in, year out and over Christmas--a particularly difficult time--they did more than their pay levels would suggest. That reinforces the concern that has been expressed about the recent pay review, particularly by nurses. We should also praise the work of the London hospitals on Friday evening after the terrible outrage in the east end. Members will agree that the staff represent one of the most precious assets of the NHS.
As usual, we have had an interesting debate. According to Conservative Members, there are no problems. They seem to say, "Read my lips: there are no problems with the national health service."
Mr. McLeish:
The Minister says, "No." He will have a chance to tell us about those problems when he replies to the debate. The Government intend to make no concessions to patients, the public or the Opposition.
Mr. Malone:
As far as I can recollect, thehon. Gentleman was listening to the speech by my right
Mr. McLeish:
I listened to Secretary of State, and I did not hear him enumerate the problems, but I await with interest the Minister's reply to the debate.
The Secretary of State was highly selective about pay review quotes. The essence of the debate is morale and motivation in the national health service, but the Secretary of State forgot to mention that, tucked away in the review body report published last week, was the following paragraph:
The Secretary of State joins us at a time when the pay review body has conceded that there are major problems of morale and motivation. Not only did he refuse to acknowledge them, but, by logical definition, he will do nothing about them.
It is important that we put firmly on record what has happened to our national health service. It is indisputable that there are major problems that are recognised by all parties, but not by the Government. Why have we lost 60,000 beds and 50,000 nurses in five years? Ministers may quibble, but those are the Government's own figures.
Ministers should not attack their own Department of Health and their own civil servants. We have 19,000 fewer nurses in training. The Government like to talk about customers, and there are now 20,000 more managers in the national health service. It is ridiculous for the Secretary of State to champion the nurses against the bureaucrats. In the past five years, we have seen front-line care disappear, and a management explosion in the national health service.
This morning, my hon. Friend the Member for Darlington (Mr. Milburn) produced an excellent report highlighting the fact that an additional £1.1 billion has been spent on bureaucracy in the past five years. That represents £6 for every second in the past five years. It is hard to find the right word to describe that, but "scandal" is the first word that comes to my lips. All those factors make it easy to deduce why morale and motivation are major problems in the national health service.
We no longer talk about bed availability; we shall soon be tabling questions about trolley availability. We shall talk not about ward closures, but about corridor closures, and, as I have said, Ministers no longer talk about patients; on a number of occasions, they have described them as "customers". Does that not underline what we have been saying over the past few years--that the Government see the national health service as a business and an internal market, but at the end of the day they do not wish to talk about the patients?
Mr. Ian McCartney (Makerfield):
An example of that occurred in my constituency recently, when a gentlemen
Mr. McLeish:
My hon. Friend strengthens our attack on the Government. We are living in the real world, and the NHS is populated by real patients, with real anxieties and concerns. Why do they never seem to interface with Ministers or Conservative Back Benchers, although they recount their recent visits to hospitals? They do not want to acknowledge that, despite relentlessly pursuing five years of internal reforms, they simply have not got it right. Now, they are squandering the most precious resource of the NHS--the staff, their commitment and their skills.
The debate is about morale, so we have to ask why it is at such a low ebb. The Government believe that everything in the garden is rosy, so why should we have a debate on morale in the national health service?
Mr. Malone:
It is habit-forming.
Mr. McLeish:
The Minister says from a sedentary position that it is habit-forming. We would love to have a debate on the health service every week in Government time. [Interruption.] I hope that the Minister passes that note to the Leader of the House and to the Conservative Chief Whip.
Finally, I shall spell out our case against the Government. The first point that affects morale is that the Secretary of State is keen to tell interviewers that he believes that he should have private health care as a safety net. What does that do for the morale of doctors and nurses? It is not good enough. In recent interviews, he said, "We should try to make it as good as possible, but I still have private health care insurance." His predecessor, now the Secretary of State for National Heritage, may not have many qualities, but she does not have private health care. [Hon. Members: "That is cheap."] It may be cheap, but it is accurate.
In the Observer on 11 February, an advertisement for Norwich Union Health Care Ltd. took advantage of the hypocrisy of the Secretary of State and others, using a quote from the Minister of State and two quotes from the British Medical Journal, all about delays. But of course, the advertisement states:
It adds:
One disgraceful aspect of Government policy is that it is driving people into the private sector.
Mr. McLeish:
I have little enough time left, and I have given way before to the Minister.
The Secretary of State's lead on the private health care issue is only adding to the problem.
As to the pay award, press comments read: "Anger over 2 per cent.", "Outrage at mean awards", "Nurses accuse Tories of contempt for the NHS", "Nurses to fight for rise of 5.6 per cent.", "Fury over NHS pay insult". One would have thought that the Government, faced with a battery
of problems, would have shown some contrition--just a bit of humility and recognition that nurses do a good job and should be rewarded. Not a bit of it. The award and the Government's response was not only insulting but provocative. Perhaps the Government want to provoke, rather than to ease the burden.
The third issue on which our case is based is the health service's future direction. The Government will try to convince everyone that their agenda is not one of privatisation or commercialisation. No one believes them. There are in place the building blocks of further fragmentation, commercialisation and contractualisation over the next year. Ultimately, through the private finance initiative, market testing and other methods, there will be privatisation. That is the challenge for the Government. That is why the public do not believe that the health service is safe in Conservative hands.
Mr. Dorrell
indicated dissent.
Mr. McLeish:
The Secretary of State continues to interrupt, and I am happy that he should--but he must answer a question that he ignored earlier. What is the reason for the money-go-round of the internal market, with its bureaucrats in place? The Government lecture us on waste and fiscal prudence. It is time that official organisations within the House started to examine what the internal market is doing and its consequences.
My hon. Friend the Member for Peckham (Ms Harman) rightly highlighted the problem of recruiting nurses and doctors. The Government simply walk away. For them, the problem does not exist. If a Government are to take the NHS seriously, recruitment is the only strategy to deploy when faced with the criticisms that we are making.
Health service morale is being destroyed by the daily diet of regional and national newspaper reports of tragic incidents of hospitals posting "Full up" signs and patients having to travel across the Pennines. That issue should unite the House, as it threatens to undermine the fabric of a one-nation health service. The Government know the problems, but do not wish to do anything about them.
The Government's first line of defence is, "It has nothing to do with us. We do not collect the information. That information is not centrally held." Only after a recent parliamentary question by one of my hon. Friends are we building up the picture in respect of paediatric intensive care beds. The Government did not have relevant information. The Secretary of State said, "That is nothing to do with me. We only pass the budgets. It is over to the NHS." Thankfully but belatedly, the Government now accept that they have a role to play. The Government's defence is, "Don't ask us"--a hear no evil, see no evil, speak no evil, attitude.
The Government's second line of defence is, "Blame it on the trusts. Blame it on the managers." God forbid, there are a lot of managers around. Can the Government really pass the buck? They cannot. They set the policy. They have relentlessly pursued internal reforms for five years. The trusts are only implementing Government policy, so it seems astonishing that the Government are still blaming trusts. Their answer to every issue raised in the House and elsewhere is, "It must be due to inefficient management." Sixty thousand beds have been lost, but, according to the Government, that is still a management problem.
"As we commented last year, changes in the wider business and labour market environment have affected the morale of employees in a number of sectors. However, the pace of change in the NHS: heavy workloads; significant and sustained pressure on resources; fears about job security; and, we suspect, the course of this year's pay dispute, will all have exacerbated staff anxieties."
"The hospital says you can have a bed straight away."
"When it comes to healthcare, we talk sense."
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