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7.54 pm
Mr. David Evans (Welwyn Hatfield): We all know that the Labour party is quite capable of believing its own fairytales; its decision to debate the national health service shows its inability to tell the difference between fantasy and reality. To set the scene, we should take a trip down memory lane--after all, it is the only way in which we can measure Labour's achievements in government. The 1974 Labour party manifesto promised:
- "A Labour Government will expand the national health service".
- "In the present economic climate the Government could do little more than provide for the increasing number of old people, leaving a small margin for improvements in methods of treatment".
The economy as a whole reflects the state of the health service. Who will forget the 83 per cent. higher rate of tax, the 26.9 per cent. inflation rate or the Chancellor of the day turning around on his way to Heathrow and being told that the International Monetary Fund was running our economy? In 1978, Dr. James Cameron, the chairman of the British Medical Association, described how
In her confessions, the former Secretary of State for Health, Baroness Castle, described her attack on pay beds during the winter of discontent as an "essential political sweetener" for the trade unions. The Labour party is still committed to tossing political sweeteners to trade unions. In return, the unions toss financial sweeteners to the Labour party. We know that 176 Labour Members are sponsored by unions. As the TGWU boss said, "No say, no pay."
New Labour says that it intends to turn the clock back to the bad old days of the savage 1970s. As if that were not bad enough, it intends to strip health care professionals--administrators, doctors and GPs--of their power and put it in the hands of its new regional assemblies. What a recipe for disaster. Once again, the comrades will cut care. Their motto is, "Strikes first, patients last." Yet again the Labour party refuses to listen to the views of the professionals. Instead, it plays politics with the health service.
If Labour had its way, the national health service as we know it would be destroyed. Decision making would be stripped from health care professionals and given to pompous, political shop stewards, who would tear the service apart as a result of regional, industrial and political battles.
The lot opposite should turn the clock right back and try to understand Nye Bevan's intentions for the NHS. In 1946, he said:
We have referred to the total disaster that was created last time Labour had power, and control of the health service and the lives of others. Let us consider what has happened since those dark days. It is an incredible story. Take GP fundholding. If all applications to join the scheme from April 1997 proceed, a further 3 million patients, and a total of 58 per cent. of the population, will be covered by GP fundholding. Since 1991, 15,000 general practitioners have joined the scheme, which is more than half of all GPs. In east Hertfordshire, which includes Welwyn Hatfield, fundholding covers 78 per cent. of the population, which is 20 per cent. more than the national average.
We are now spending on the national health service £80,000 every minute of the day. We are spending£724 a year for every man, woman and child. Total spending this year will be £42.6 billion. Spending on the national health service has increased in real terms in every year of Conservative government since 1979. The service treats 80 per cent. more acute patients than it did 17 years
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Now we come to the heart of the matter. The number of doctors in England increased from 56,000 in 1978-79 to 81,000 in 1995. The number of nurses and midwives has increased by 55,000 since 1979. Nurses' pay has increased from £68 a week in 1979 to £311 a week in 1995, which is an increase of 70 per cent. in real terms. The number of dentists has gone up from 11,919 in 1978 to 18,668 in 1996. Infant mortality per 1,000 live births has gone down from 13.2 to 6.1. Under Labour, it went down from 16.3 to 13.2. Even more impressive is the fact that over 3 million more treatments were carried out in 1995-96 than in 1979, and over 1 million more than in 1991. In all, 10.5 million treatments are carried out each year.
Mr. Brian Sedgemore (Hackney, South and Shoreditch):
In the spirit of the age--which has clearly bypassed the hon. Member for Welwyn Hatfield (Mr. Evans)--I shall eschew ideology and party political point scoring and, instead, talk about health care in east London.
A few weeks ago, the Royal Hospitals NHS trust launched a £300 million private finance initiative scheme for a new hospital at Whitechapel, which is to be built and run by the preferred bidder, the Health Management Group. The press launch took place in a blaze of self-congratulatory publicity, but what was not revealed was the apprehension of clinicians, consultants and junior hospital doctors. Their apprehension was set out in a letter dated 9 October 1996 to Dr. Duncan Empey, the medical director of the Royal Hospitals trust. It was signed by David MacLean, the chairman of the Royal London hospital medical council, Larry Baker, the chairman of St. Bartholomew's medical council and Mr. P. Magee, the chairman of the London chest hospital medical council.
The letter refers to the £300 million scheme. It states:
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There is also considerable concern about the financial implications of the private finance initiative schemes that were referred to earlier, and particular concern about the financial end-loading of such schemes. It would seem that, in years to come, that could cause havoc to the revenue flows of the area health authority, and to the making of all its decisions. It might have to decide whether to support the PFI scheme down the years, or to stop spending money on hospital care in a variety of other local hospitals.
I am a member of the Treasury Committee. We have done some research into PFI end-loading, but I believe that more is needed. Let me make two suggestions. First, I hope that the National Audit Office will look into the matter. I know that John Bourne, who is in charge of the NAO, would like to issue guidelines on the potential dangers of the end-loading that will occur in future years. Although the NAO does not currently look into schemes that have not been completed, in order to issue guidelines it would have to do so, because there are not enough PFI schemes around. I hope that the Royal Hospitals NHS trust scheme, which is easily the biggest PFI scheme in the NHS, is be one of those that John Bourne will examine.
Secondly, the Health Committee should look at the revenue implications of PFI schemes and the dangers imposed on end-loading by the revenue flows. That must be examined in the context of the health management group in the scheme that I have mentioned asking for a rate of return no lower than 17 per cent.
As I have said, the Royal Hospitals NHS trust scheme is very big, and I feel that it is proceeding with undue haste. I believe that it is being driven by political imperatives rather than by serious medical considerations. The health management group might pause to consider that there could be a change of government early next year, and that the new Government might take a very different view of a PFI scheme that proposes, for example, to close St. Bartholomew's hospital. I see that one of its great alumni, the hon. Member for Wimbledon (Dr. Goodson-Wickes) is present; I hope that he will catch your eye, Mr. Deputy Speaker.
The health management group might like to consider that the children of my right hon. Friend the Member for Sedgefield (Mr. Blair), the leader of the Labour party, were born at St. Bartholomew's. It might also like to consider that the constituents of the next Secretary of State for Health, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith)--who is also present--actually use the hospital. Not only are there powerful logical, financial and medical reasons for the health management group to go a bit easy, unless it wants to wreck its own scheme and its own financial future; there are powerful emotional forces backing the retention of St. Bartholomew's as part of any PFI that eventually sees the light of day.
Another point, which relates partly to the PFI scheme, concerns the future of paediatric care in east London. We have been told that there is no crisis, but there is certainly
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Professor Lilleyman, however, has made an even more bizarre proposal. The professor, who has a privately financed chair at St. Bartholomew's, has proposed taking the whole unit--its facilities and patients--to Guy's hospital, south of the river. He made that proposal without the consent of the hospital for which he works. May I ask the Minister whether it is lawful for a professor with a privately financed chair to take an entire unit and its patients to another hospital without the permission of the Royal Hospitals NHS trust? I understand that Guy's is quite prepared to pinch that world-famous unit for reasons of prestige.
Even the Royal Hospitals NHS trust does not like the idea. I have spoken to its chief executive, Gerry Green, who has made it clear that if Professor Lilleyman does try to scoot off down the river with the unit, he will go without facilities, without money and, in fact, without his clothes. I understand that he has said that the professor will go in his underpants and nothing else.
It is the legality aspect that I find bizarre, as, I am sure, will every Member of Parliament. I want to ask the Minister about the future of paediatric care, without scoring any political points and without attacking the trust. I hope that he will give us a guarantee that if the Queen Elizabeth hospital, whose closure was announced three years ago, does close within the next year or so--it was originally intended to continue into the year 2000--alternative facilities will be made available before it shuts. If it does, three things will be needed.
"The national health service is sick in Britain. It is inadequate and impersonal. It is losing the confidence of the medical profession and the public".
The 1978 Royal College of Nursing congress at Harrogate talked about
"a crisis of manpower, finance and morale in the service".
The national health service went on strike in 1978-79, led by the Confederation of Health Service Employees and the National Union of Public Employees. Telephonists were on strike and clinical staff manned public telephone boxes to get calls into the hospitals. Clean linen was not allowed through picket lines and foul linen was destroyed because the unions would not allow it to be taken from the hospitals to be cleaned. Meals were provided by volunteers and cleaning was non-existent.
Even when we wanted to bury our loved ones--who might have died outside Kingston hospital--we could not do so, because the Transport and General Workers Union would not let the gravediggers dig the graves. We had to keep our loved ones in our living rooms until the gravediggers went back off strike.
"I believe that democracy exists in the active participation in administration and policy. Therefore, I believe that it is a wise thing to give the doctors full participation in the administration of their own professions."
Given that statement, if Nye Bevan were still a Member of Parliament today, and he reflected on the Conservative reforms and Labour's plans, I am pretty certain that he would vote for the Government amendment at the end of the debate.
"We have heard from a large number of consultants, all of whom have been concerned that the space allocation in the new hospital for their relevant departments is smaller than they enjoy at present, and would certainly be inadequate for the planned patient flows. We were all originally promised that in the move to a single site the facilities would be equal to or better than those currently enjoyed, but this does not appear to obtain in plans from either consortium. This has caused a considerable degree of concern, and we feel that the future of the hospital as both an Accident and Emergency centre for the local population, and as a national and international centre of excellence, would be severely compromised under the available plans."
The letter continues:
"We are deeply concerned that if the issues of quality and quantity are not met, while in the short-term the Medical School and Hospital may appear to prosper, in the long-term recruitment will inevitably suffer and the quality of medical care, research and education will decline."
In my view, it takes a peculiarly incompetent Government and hospital trust to spend £300 million on a project and make things worse rather than better.
"The financial position of the Children's Services Directorate at 31 July 1996 . . . shows a worsening overspend of £660,418, with a predicted year end out-turn of £1.366 million overspent . . . Senior management in The Royal Hospitals NHS Trust have made it abundantly clear that radical action has to be taken now to address this situation."
The overspend has knock-on effects on paediatric care at both St. Bartholomew's hospital and Queen Elizabeth hospital for children. Everyone knows that St. Bartholomew's has a world-renowned paediatric cancer service. Following the scare document produced by the Royal Hospitals NHS trust, two proposals have been made so far. The document itself suggests shutting that world-famous paediatric cancer service--which would cause a public outcry--and transferring it to Queen Elizabeth hospital for children by 31 March next year. I do not believe that that will happen; I think that there will be second thoughts.
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