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Mr. Forman: I also saw the "Panorama" programme, which I found interesting. Does the hon. Gentleman recall the powerful point it made about the great advantage to patients from the constant provision of new facilities and new hospitals for the health service, as has happened over the past 18 or 20 years or longer? That requires older facilities to be closed down, but it is important that continuity of provision should be maintained.

Mr. Gunnell: The programme suggested that potential savings had not been made, because of reluctance to close down some facilities that had passed their useful life and that did not have the skilled staff to deal with emergencies for which they were supposed to cater.

I agree with the hon. Gentleman, but the fundamental argument of the programme was that the Government were allowing health authorities to run up large debts in order to keep the health service afloat and maintain the impression of stability until the general election. The hon. Gentleman may not agree with that, but I am sure he will agree that that was the main thesis of the programme. The Government must answer the charge.

I hope that we would all agree that deficiencies exist in the NHS. As a result of closures, there is undoubtedly a shortage of beds. The British Medical Association, which is clearly not popular with the hon. Member for Wycombe (Sir R. Whitney), says that the reduction in bed numbers is a key reason for the current NHS crisis.

The Conservatives have cut almost one in four beds since the internal market was introduced. In the North and Yorkshire area, which is my area, there has been an incredible 33 per cent. drop in geriatric beds, a 25 per cent. drop in maternity beds and a 19 per cent. drop in general and acute beds since 1989-90--a 27 per cent. drop overall. We must accept that those figures are accurate and based on a count by the BMA.

In a recent report on the state of the health service, Leeds general infirmary was highlighted by the BMA for bed closures due to lack of money. The infirmary closed 40 beds because it was the focus of criticism last year about the number of patients on trolleys. I drew attention to two relatives from south Leeds who had died as a result of being left too long on trolleys.

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I accept that an attempt was made to increase the number of intensive care beds. That attempt was partially successful: we have not had quite the same level of crisis this winter, but that has been achieved at the expense of ordinary services. Those 40 beds and others were cut, resulting in the postponement of operations and delays in admission.

I have been invited to visit a hospital in the next week or two to meet one of the consultants and hear why people must wait so long to see him. The crisis in the NHS is fundamentally a beds crisis. The BMA has warned that, unless the chronic underfunding is tackled, an "emergency-only service" will characterise the NHS in the winter months ahead. Routine surgery, treatment and investigations are already being cancelled or slowed down.

The Sunday Telegraph, which I would not usually expect to support the Labour party's position, recently reported an accident and emergency official who described the entire hospital service as being

"stretched beyond its capacity to cope."

Even the Minister must accept that the health service is under great strain because of a shortage of hospital beds.

I shall not rehearse the argument about intensive care beds. However, the Secretary of State must examine the position in Leeds and in the North and Yorkshire region, as I do not believe that that region has received the number of paediatric intensive care beds that he specifically promised in his statement. That is why I asked him about the situation in that area.

The right hon. Gentleman accepted in correspondence with me that the paediatric intensive care unit at Leeds General infirmary is the most highly skilled facility in the region. It is logical to expand the best unit, but the facility at Leeds General infirmary occupies an enclosed space, and it would have to be relocated within the hospital in order to accommodate more than one additional bed.

We are told that an extra bed has been added to the unit, but the facility is unchanged from when I visited it a year ago. It has space for five beds, and, at a time of real crisis, it can expand to six. That extra bed is shoved in at the expense of the space available to the other beds. It is all very well for the Secretary of State to claim that the unit now has an additional bed, but that bed was always available when needed. The difference is that, previously, it was not counted as an official paediatric intensive care bed, and now it is. I believe that the Secretary of State has failed to fulfil his promise to the North and Yorkshire region, and I shall be interested to hear his comments on the matter.

A shortage of capital funds in the Budget has also caused problems. The Chancellor has revealed a 16 per cent. cut in capital spending, in the expectation that the private finance initiative will make up the difference. The matter was raised previously in debate.

I think that the Government should come clean about the PFI's achievements in terms of completed projects. When I asked the Secretary of State about it, he said that 43 PFI projects had been signed, which were worth a total of £317 million. When I asked how many of those projects had progressed to building work on a hospital site, he said that 32 such projects had been completed.

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I can only assume that he meant that the signing had been completed in 32 cases and that the projects were ready to go ahead.

I ask the Minister of State: how many projects are under way? I am interested not only in signed contracts but in bricks and mortar. Can those whom the new facilities are intended to serve see something happening? I do not know of a single instance where construction is under way.

It is all very well to assume in the Budget that the PFI will make up a shortfall in expenditure--I hope that the private sector ventures will prove successful and that the projects will go ahead, because the NHS needs them--but we must be sure that the projects have progressed beyond the mere signing of pieces of paper. Parliament enacted the National Health Service (Residual Liabilities) Bill last year to enable the contracts to be signed, and now I want to know what progress has been made. Is the private sector confident about those contracts?

Mr. Steinberg: I asked the same question of the Library, and I was told that no PFI project has begun, and not one brick has been laid on any site. Where the Secretary of State gets his 32 starts from is anyone's guess--in fact, I suspect that he was misleading the House.

Mr. Gunnell: I thank my hon. Friend for his intervention.

Mr. Deputy Speaker (Sir Geoffrey Lofthouse): Order. Do I understand that the hon. Member for City of Durham (Mr. Steinberg) is accusing the Secretary of State of misleading the House? If so, I think that he may want to withdraw that remark.

Mr. Steinberg: I did so inadvertently, Mr. Deputy Speaker, and I obviously apologise to the House. However, when information from the Library states that not one brick has been laid on site and the Secretary of State says that 32 projects have been completed, someone somewhere is supplying the wrong information.

Mr. Deputy Speaker: Do I understand that the hon. Gentleman has withdrawn the remark?

Mr. Steinberg: Yes.

Mr. Gunnell: Thank you, Mr. Deputy Speaker. I do not think that the Secretary of State tried to mislead the House. When I asked about completions under the PFI, I think that he thought that I was referring to contracts rather than buildings. Like my hon. Friend, I understand that the projects have yielded no concrete results.

Mr. Steinberg: According to the Library, the schemes' commencement dates have not been announced.

Mr. Gunnell: I must move on rapidly.

Mr. Malone: Perhaps I can assist the hon. Gentleman. I cannot allow the intervention of the hon. Member for City of Durham (Mr. Steinberg) to stand. I shall deal with the matter in some detail in my winding-up speech, but I rise now merely to state that I celebrated the completion

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of a PFI scheme involving the internal refurbishment of part of a London hospital about six to eight months ago. The scheme was valued at some £5 million to £6 million.

Mr. Steinberg: What a load of cobblers!

Mr. Malone: The hon. Gentleman may mock--I am sure that those at the hospital will note his comments--but I can vouch for the fact that the PFI principle is delivering within the NHS.

Mr. Gunnell: I thank the Minister for his comments, and I accept that he has seen that project completed. However, I am sure that he does not intend to imply that the Secretary of State meant that 32 such projects have been completed.

I believe that the shortage of capital in the NHS--I hope that my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) has noted it--is causing real concern within the service. There is also clear dissatisfaction with the purchasing system.

On Sunday, the Minister of State responded to claims that 20 per cent. of expenditure on purchasing in the NHS is unnecessary. A group claimed that £8 billion of the £40 billion spent on purchasing in the NHS could be saved. The group did not substantiate its case, and I think that we would need more information if we were to pursue that line. However, it is important to examine the way in which money is spent.

I have written to the Department about the concerns expressed by a company in my constituency--I think that it is the only firm in England that manufactures operating theatre lights--as a result of its experiences of trying to win contracts in the national health service.

As a member of the Select Committee on Public Service, I am a little concerned about the meeting that we had with the Audit Commission. We talked to the Audit Commission. The freedom it has when it examines local government, whereby it can examine almost anything that local government is doing, is not available to it in the national health service. It is not able to investigate hospitals.

I hope that the Minister and my hon. Friends on the Front Bench will consider the use of the Audit Commission in the NHS. If the commission were not restricted in what it can do in individual hospitals and trusts, we might get some useful information from it. Certainly, if purchasing does not, as was alleged, ensure value for money, I would expect the Audit Commission to be able to make a positive contribution. I hope that the Minister will consider that.

My hon. Friend the Member for Islington, South and Finsbury made a point about which we feel very strongly: if so little information is held centrally, as the Department of Health is willing to reveal to us in answers to parliamentary questions, it is no wonder that some of the decisions that are taken are not the best decisions for the service. I am amazed at the number of times we are simply told that the information is not held centrally, even when my hon. Friend the Member for Bolsover (Mr. Skinner) asked how many hospital closures there had been.

Let me give examples of matters that are important for an understanding of the workings of the health service. I have been looking at the Mental Health Act 1983 and the

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way in which electro-convulsive therapy treatments are given--I have a constituent who is concerned about this--and particularly the way in which they are often given without specific consent. I attempted to find out, through the Department of Health, the extent to which such treatments take place, but was told that the information was not held centrally.

I tried to find out what information the Department collected centrally to determine the performance of the health service in relation to its "Health of the Nation" targets on strokes. It told me that, although it holds a certain amount of information concerning mortality, it was not able to tell me much about the people who experienced strokes and went into hospital, and what treatment was effective in preserving them, perhaps for a later stroke but perhaps for very much longer than that.

If that information is not held centrally, what is? How do Ministers get the information they need to make policy decisions? The health service is now so fragmented that it must be difficult even for Ministers if the Department of Health is not able to give factual data about the state of the nation's health--and, indeed, how far we have progressed towards meeting the "Health of the Nation" targets.

After the general election, a change will come about that will be extremely helpful to the service. In the first instance, in office will be people who always use and rely on the service. That is very important. It makes a difference. The attitude of someone who is able to contract out of the health service and pay for his or her private health care is very different.

I lived in the United States for eight years, where I had to pay for my own health care. The health care that I received there was very good, but that was because I was able to pay for it. We do not want different standards of care according to people's ability to pay. There will be a positive effect from the presence in office of people who recognise that, in times of emergency, they have only the health service on which to rely.

We have within the health service an enormously committed work force. The Government say that we run down those who work in the health service, but that is not true. We have very strong praise for those who work in it. Often, the conditions under which they work do not help their morale. I am thinking, for example, of those who work on temporary contracts. A little while ago, my wife had an operation in the Huddersfield royal infirmary. The treatment that she received was extremely good. I have nothing but praise for those who carried out the service.

Some of the staff on temporary contracts explained their position. They did not know whether, in the next financial year, they would have a contract. The morale of people who work in the health service is affected by such matters. If they cannot live their normal lives because they are uncertain whether they will have a permanent job, that makes it more difficult for them to show commitment to the service. In this instance, however, I found that the people concerned showed extremely good care, and I saw their commitment to the service.

Under a Labour Administration, there would be ways of working to correct the low morale in the service. There would be much greater participation. On local commissioning, we are concerned that more people take part in decision making. I believe that real savings can be

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made by reducing bureaucracy. One area where a Labour Government could make savings is the enormous bureaucracy within the service on billing those who receive treatment outside their areas. It is possible to make the savings that we have spoken about without detriment to the service.

We should make use of the services of the Audit Commission to ensure that purchasing is carried out on a value-for-money basis. The Minister was accused on Sunday, by the person with whom he was debating, of wanting to remove from the NHS the very people who are making good decisions. It is important that we have advice, so that any changes we make in the service do not affect patient care.

Tonight's debate has highlighted deficiencies in the service. The Government are unusually complacent about the service for which they are responsible. It has proved to be less than safe in their hands, and I feel confident that the election of a Labour Government will be welcomed throughout the health service. The Government will have to explain why, in every survey, the public believe firmly that the health service will be safer in Labour's hands. It is because they know that it is a service on which we ourselves will rely in emergencies. We believe that the health service is essential for the health and well-being of the nation.

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