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Mr. Dorrell: The hon. Gentleman ought to be better informed about what his hon. Friends are up to, because, according to The Times today, the shadow Treasury Minister, the hon. Member for Edinburgh, Central(Mr. Darling)
- "is currently meeting City lawyers and seems to be whispering reassuring words"
about the private finance initiative. The conclusion drawn by the people in receipt of those whispers is:
Mr. McLeish:
The Secretary of State raises an important issue, and must deal with it. He ought to deal with the Stonehaven issue. The right hon. Gentleman goes about England saying, "No clinical services: read my lips." In Scotland, the Secretary of State has sold off virtually everything in that state hospital to the private sector. Will policy in England be contrary to that in Scotland, or is Scotland being tested in respect of the NHS as it was with the poll tax?
The Government do not like our attack on waste. There are also £100 million of GP fundholder surpluses lying unused. A recent article in the Observer suggested that NHS suppliers may be taking £400 million from the health service. It is vital that the Public Accounts Committee takes on board the workings of the internal market in the NHS. There is no accountability or no cost-benefit analysis by the Department of Health. The cost to the taxpayer and benefits to patients must be high up on such an appraisal.
I urge the Minister for Health, when he winds up, to embrace and endorse that idea, to get to the bottom of whether the internal market is working, and--more importantly--in whose interest it is working. We need to know what is happening and where the money is going. It is a Government issue of massive waste in the NHS. The Government lecture us about where cash will be found for this or that. If one considers the £1.1 billion spent on bureaucracy, one sees that there is a significant difference between ourselves and Government Members. We believe in front-line care and in doctors and nurses. We do not believe in adding further to bureaucracy.
When the Minister winds up, I would like him to answer this simple question: are the Government happy for £1.1 billion cash to be used merely to police the internal market?
Mr. Dorrell:
One question, after 17 minutes.
Mr. McLeish:
The Secretary of State says that, but the fact remains that we provided time for the hon. Member for South Suffolk (Mr. Yeo), who had not been in the Chamber for most of the debate, but who informed the Chair of his wish to speak.
The Government do not like to be confronted with the waste argument. The Government's case is flimsy. Their arguments, "It is nothing to do with us" or "Blame it on the trusts", will not stand up. They are spending more and more money, but creating more and more waste.
The Government pretend that bed closures are all about care in the community and continuing care. The Government simply cannot match bed closures with what is happening in care in the community. That defence will not wash with the public.
The Minister for Health (Mr. Gerald Malone):
I will not exactly follow the stream of consciousness of thehon. Member for Fife, Central (Mr. McLeish) with respect to the health service, but I will deal with a number of the foundation stones with which the Opposition thought they would underpin their argument today--and there were precious few of those.
I do not know why the Opposition called this debate. If it was to underpin morale on their Back Benches, they clearly have not succeeded, because no one bothered to turn up to listen.
We have heard another debate predicated on a false assertion supported by an exaggeration that the health service is in a state of collapse. The Government admit that the health service is under tension, that it is delivering more health care than ever before, that its staff are working extremely hard, and that problems must be addressed. My right hon. Friend the Secretary of State quite clearly said in his speech that the problems need to be addressed. However, we do not accept the grotesque image of the national health service, of those who work in it and of the way they feel about it that has been painted by Labour Members.
Labour Members relied on a number of arguments, which I shall deal with individually. They referred to recruitment. They said that the NHS was now denuded of front-line staff, and that there simply are not enough people to provide a service. I shall cite some figures for the hon. Member for Peckham (Ms Harman) that might change her mind, although she is not interested in evidence; she prefers assertion. I shall refer to some medical manpower numbers.
Between 1984 and 1994, the number of general medical practitioners increased from 23,640 to 26,567--a12.38 per cent. increase. The hon. Lady would no doubt
argue, on the basis of assertion, that they have a far harder task. Those figures are accompanied by a decrease in the average list size from 2,089 to 1,900.
When the Opposition refer to nursing figures, they always ignore--this is perhaps one of the most unforgivable ways in which they try to bend the figures--all the changes and transfers between nursing staff, the context in which they used to work and how they work now. One reason why fewer nurses work in hospitals is that 60 per cent. of the activity is to be found in day case surgery, where fewer of them are needed. There has been a great transfer across the service and the way in which nurses work. I refer to the number of GP practice staff.
Ms Harman:
From the private sector.
Mr. Malone:
The hon. Lady says, "From the private sector." I do not want to talk about the private sector;I want to talk about the NHS.
In 1984, there were 25,994 GP practice staff, and now there are 51,833--an increase of 99.4 per cent. The number of nurses included in GP practice staff has increased from 1,924 to 9,099--an increase of372.92 per cent.
These staff increases have occurred in a service that the Labour party says is being denuded of people at the front line. Where is there more of a front line than in primary care? Whose policies have ensured that these talents are now being devoted to primary care, which was not the case in the past? Since 1979, the number of nurses has increased by some 55,000. Labour Members choose to ignore--
Mr. Malone:
I may give way to the hon. Gentleman in a moment, but I do not have much time in which to speak, because he squeezed me out. I shall anticipate what the hon. Gentleman was going to say.
Usually, Labour Members selectively quote figures and ignore what has happened in agency nursing and bank contracts. I was delighted that today, for the first time, they acknowledged the existence of such agency and bank nurses. Their failure to take those figures into account has resulted in the lower figures to which they have referred.
The Labour party has also said that there are not enough nurses in training. This year, there are 14,920 in training, and next year there will be 17,080--they are all decided by training commissions across the country--an increase of 14.4 per cent.
Mr. McLeish:
In 1989, there were 62,100 training nurses in the health service, and in 1994, including the learners and Project 2000, there were 32,000--a decrease of 19,000. Will the Minister accept those figures as correct?
Mr. Malone:
My right hon. Friend explained why that was so: the wastage rate has decreased by 50 per cent. Of course there will be fewer people in training if more are staying in the service. I should have thought that the hon. Gentleman would welcome the fact that retention rates were up, and that more people were finishing their training and working in the NHS rather than leaving it.
The other point of strength that Labour Members always think they have is what is happening to senior house officers, and we heard that argument again in the debate today. I advise hon. Members that SHO strength is extremely good. My right hon. Friend and I were both concerned about what happened in accident and emergency departments on 1 February last year, and we undertook to monitor the situation.
I am pleased to tell the House--although the Labour party will not welcome it--that SHO strength in the regions monitored to date now totals 945, and there are now59 vacancies--only 6.3 per cent. Most trusts, when consulted, find that because of an agreement the Government have reached with the profession they are able to fill those posts with staff grade doctors. That has destroyed yet another myth that the Labour party has peddled.
Labour Members claimed that there is low morale in the NHS. I am astonished that they ignored--in fact, they considered it a matter of ridicule--what we have done about junior doctors' hours. I remember when that was the test of whether the Government would be successful in raising the morale of those who work in the hospital sector. The targets that the Government have reached are remarkable, as is acknowledged by junior doctors.
There is 99 per cent. compliance with the target to eliminate hard-pressed, on-call posts contracted for more than 72 hours a week. I inform hon. Members that93 per cent. of the 27,994 junior doctors complied with the end of 1996 targets. That is a tremendous achievement, for which we have fought hard and in which we have invested a tremendous amount of money. It goes hand in hand with the creation of the specialist registrar grade which came into effect on 1 January, enabling junior doctors, when they get to the more senior posts, to spend more time in training than in providing service commitment.
Labour Members' solution was a five-point plan. Conservative Members agreed with four of the points--they were all apple pie and motherhood. [Interruption.] We agree with the concept of fair pay. We established the independent review body that delivers fair pay on an annual basis, unlike the Labour party, which chose to cut it. Unfortunately, the fifth point appears to have been lost--doubtless we will learn about that in due course.
The hon. Member for Peckham would not be drawn on the most important question. If she were serious about introducing a policy to improve the NHS if she were ever in government, she would say how much money would be provided. I ask her that question again--perhaps, during the debate, she has been able to have a word with the Member for Dunfermline, East (Mr. Brown) to find out the position of the Labour party in this regard.
Will she now give the House a commitment that she would at least imitate what this Government has done since 1979 with respect to increasing expenditure on the health service? Well, as the whole House can see, the hon. Lady sits firmly in her place--unable, as the health spokesman of her party, to give such a commitment. And this is a debate in which she has claimed that morale in the health service is at an all-time low.
The Opposition have been found out; the arguments they have put to the House this afternoon about the health service have amounted to no more than the usual innuendo and denigration of a service that provides
excellent care for the whole population. The hon. Lady's argument has been demolished. The country will recognise that, and the House will recognise it, too.
Question put, That the original words stand part of the Question:--
"There may be a certain amount of rebadging, but the essentials would remain the same."
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