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Mr. David Winnick (Walsall, North): Did my hon. Friend see the article in last night's Evening Standard by its art critic? I strongly doubt whether he is a long-standing Labour supporter, but he wrote about his heart attacks and about the fact that he had to choose private surgery because of the crisis in the national health service. Does not that illustrate yet again how many people in our country feel betrayed by the Government because the national health service is not in a position to help when help is absolutely essential?

Mr. Smith: My hon. Friend makes a valid point. I never want the day to come when people feel that they have to go private because the national health service cannot deliver the care that they expect and to which they are entitled.

Mr. Hugh Bayley (York): Does not that answer illustrate the fact that under Conservative management the number of private beds in the national health service has increased year on year to the point where people are encouraged to go private?

Mr. Smith: My hon. Friend is right. The private content of health provision has more than doubled under the Conservatives; the figure for private treatment is 11 per cent. and rising. I believe from what he has told the press that the Secretary of State for Health has private medical insurance.

In figures presented to the House in an answer to my hon. Friend the Member for Newham, South (Mr. Spearing) a few weeks ago the Government had to admit that health authorities throughout the country will face an overall net deficit of about £120 million by the end of this financial year. What the Government cannot tell us, or at least they say that they cannot tell us, is how much deficit trusts are facing. However, the Health Select Committee has helpfully assisted us by showing that serious deficits are looming for a range of hospital trusts.

The Secretary of State for Health (Mr. Stephen Dorrell): I would not like the hon. Gentleman to develop his argument on the basis of a misunderstanding of the position. Some questions have been tabled about the financial position of trusts. We are preparing answers and intend to publish them. The net figure anticipated for the end of this financial year for the whole trust sector is a surplus of £60 million.

Mr. Smith: That is indeed interesting and new information. If this debate does nothing else, it has been useful in flushing that out. If that is the case, can the Secretary of State explain why the Royal Sussex county hospital has cancelled all dialysis for new patients for the rest of the financial year; why the King's Healthcare NHS trust has increased its waiting times for orthopaedic

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patients to 18 months, even for patients with infected hips; why Merton, Sutton and Wandsworth health authority has decided not to contract for any elective surgery from St. Helier NHS trust and St. George's NHS trust next year; or why no new ear, nose and throat patients are being taken on by the Royal Hospitals NHS trust in London for the remainder of the financial year? If there is such a healthy surplus in our hospitals, why are they withdrawing care and treatment from patients with every week and month that passes?

Mr. Brian David Jenkins (South-East Staffordshire): My local trust took two and a half years to find that it was £1.5 million in debt. The financial regulations and the state of accountability are such that I do not know any trust that can say that it will be in surplus or debt next year because of the way in which they are run. Many of them simply do not know.

Mr. Smith: My hon. Friend is right. Does the £60 million that the Secretary of State told us about take account of the £100 million that the recent decision of Customs and Excise on the repayment of VAT to hospital trusts will cost hospital trusts in the course of the year?

Mr. Dorrell: The hon. Gentleman may have missed the fact that Customs and Excise announced at the end of October that it was giving every trust, health authority and NHS body until the end of November to submit applications for VAT repayments. The story that has been running in the newspapers on that subject is wrong, too.

Mr. Smith: The Secretary of State ignores the fact that that does not apply to money that was paid out in VAT two or three years ago and which has not yet been reclaimed. The fact is that health trusts say that the recent decision by Customs and Excise eases the burden but does not remove it entirely. Whereas previously the burden might have been some £160 million, health trusts estimate that it will be about £100 million after the Government's recent announcement. Clearly, the Secretary of State does not know what is happening.

Mr. Dorrell: I am not sure about that. Will the hon. Gentleman explain how an organisation can assess outstanding VAT so that it can provide the estimate that the hon. Gentleman gave but cannot send it to Customs and Excise to reclaim the tax?

Mr. Smith: That is what the hospital trusts are saying and I place greater credence on what they say than on what the Secretary of State says.

Mr. Nigel Spearing (Newham, South): A few moments ago my hon. Friend asked why the Royal Hospitals NHS trust had to make cuts. Is he aware that yesterday the East London and The City health authority announced cuts in the forthcoming year of £14 million of general treatment--an additional £4 million is to be announced in January, which could mean the closure of St Andrew's hospital, Bow--despite the fact that its capitation from the Secretary of State is about 600,000, yet the doctors' lists are 700,000? If that anomaly were corrected, would not some of those difficulties be removed?

Mr. Smith: My hon. Friend has identified two factors. The first is that the Government often get their figures

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wrong--they have clearly done so in my hon. Friend's case as they do in many others. Secondly, there is an enormous gulf between the reality of what happens--in hospitals, health authorities and health services received by people up and down the country--and what the Government say is happening. There is a serious difference between what the Government say and what is being experienced.

What is the Secretary of State doing about the winter crisis that is affecting east London and hospitals elsewhere in the country? Everyone in the health service knows that there is a serious problem looming. What is the Secretary of State doing about it? Precisely nothing. When he was pressed specifically on that point on television on Sunday he said clearly and firmly that there was no new money available this year to help hospitals through the crisis. He then said, "But it is the expectation of what will happen next year that really matters and makes the difference in the decisions that hospitals and health authorities have to make." What is he saying? Is he saying to health trusts that cannot legally overspend, "Don't worry; overspend if you have to. Get through the winter. Don't alarm the electorate in advance of a general election--help will be coming along in next year's funds"?

I offer the Secretary of State the opportunity of today's debate to spell out precisely what he is saying to health trusts and health authorities around the country. Is there to be money this year or is there only going to be extra money next year--placating this year's crisis with next year's funds? If so, what happens next year? If he uses up next year's money to try to resolve this year's crisis, we shall end up with exactly the same problem next year. Instead of year on year on year of additional funding for the health service--the mantra that the Secretary of State likes to chant--it will be year on year of winter crises in the health service under a Tory Government.

Lady Olga Maitland (Sutton and Cheam): Perhaps the hon. Gentleman will enlighten the House. Instead of criticising the Government on their handling of health policies, which is satisfactory, perhaps the hon. Gentleman will tell the House what his party would do. Would it spend more money on health? If so, would that money be in addition to the pledges already given which would increase taxation by 9p in the pound? We should be told.

Mr. Smith: I am surprised that the hon. Lady does not seem to be worried about what is happening at St. Helier hospital, which I should have thought would have been of concern to her constituents. I am astonished at the hon. Lady who, along with the Secretary of State, says that the Labour party will not spend more money on the health service. Meanwhile, the Chief Secretary to the Treasury and the chairman of the Conservative party publish documents purporting that Labour will spend an extra £1.3 billion on the health service. Can they make up their minds? Do they believe that we will spend more money on the health service, or that we will not? There are two voices coming from the Tory party--sometimes two voices coming from the same person. I am sure that we are about to hear them from the Secretary of State.

Mr. Dorrell: I have been too kind to the hon. Gentleman, because I have always assumed that the

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proposals that were set out this morning by my right hon. Friend the Chief Secretary and which would have the effect of increasing costs in the health service without treating a single extra patient would be paid for out of a Labour extra spend. Is the hon. Gentleman saying that those extra costs would be paid for by the fewer patients who would be treated in Labour's health service?

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