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9.3 pm
Mr. Piers Merchant (Beckenham): There is often a tendency in the House to generalise to such an extent that the conclusions are almost worthless. Conversely, individual cases are sometimes dealt with so specifically that extrapolation to policy is virtually meaningless.
The hon. Member for Islington, South and Finsbury (Mr. Smith), to whom I listened with great interest, as I always do, is a past master at those two dubious arts. Today he surpassed even his usual ability in that respect. I was astonished at his nerve in citing a handful of sad and undoubtedly unacceptable cases and giving the impression that those illustrated the norm, which they palpably do not.
The hon. Gentleman seems to luxuriate in the idea of crisis. He has a fantasy that the national health service has reached such a point of crisis that it is about to collapse, which is plainly untrue. When he is unable to establish that theory, he insinuates that there is a cover-up and he cannot get all the facts. The only cover-up is the Labour party's policies--or lack of policies--on health.
The hon. Gentleman's speeches in the House are usually of a high standard, but today he rambled, probably because he saw lurking behind him the figures of his
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The first was about saving money. The hon. Gentleman claimed that he would be able to save £100 million by cutting bureaucracy. The House needs to know precisely how he will do that. One hundred million pounds is paltry, compared with what my right hon. Friend the Secretary of State has already saved recently in bureaucratic costs: £300 million--three times that. How does the hon. Gentleman square that claim with the supposed policy of his party to restore the regional level of NHS bureaucracy? The regional level was cut out by this Government, saving precisely £100 million.
The hon. Gentleman's second policy seemed to be to do away with the internal market, yet he seems to defend the purchaser-provider split. That is a strange semantic exercise. I fail to see how he will do away with the market but keep the mechanism of the internal market. He owes the House a detailed explanation of how that will operate, what the cost will be and what disruption will be caused to the NHS by another apparently large reorganisation.
We also need to know what the impact of Labour's policy, whatever it may be, will be on the PFI. I listened with considerable interest to the remarks of the hon. Member for City of Durham (Mr. Steinberg) on that, because he described a situation surprisingly similar to that in my constituency, but moving in an entirely different direction.
Will the hon. Member for Islington, South and Finsbury stop all the PFI schemes? How will he explain that to the people in the towns and cities throughout the country who are expecting hospitals to be built because PFI schemes are virtually in place? How will he justify robbing them of their hospitals?
What will the Labour party do about GP fundholding? How will it explain its intentions to the thousands of people who are benefiting because they are on the lists of GP fundholding practices? What will the hon. Gentleman say to them? What is his policy on GP fundholding? What he says in the Chamber contradicts what he toldThe Guardian on 1 November, when he seemed to advance some powerful and rather impressive arguments in favour of GP fundholders.
Dr. Hendron:
I am in medical practice and have some experience of such matters. Some fundholders and their patients do very well, but is the hon. Gentleman aware that many non-fundholders who want to become fundholders are now not accepted? Government funding in the north of Ireland has not been ring-fenced for patients of non-fundholders. That is a serious problem--I do not know whether the hon. Gentleman has encountered it.
Mr. Merchant:
I am grateful for that information. I am not an expert on Northern Ireland and I was not aware of the situation there. Thousands of my constituents benefit from belonging to GP fundholder practices and I welcome a change in the law that would, I hope, extend the scope of GP fundholding and make it more easily available to other GPs. I hope that that opportunity will be extended to Northern Ireland also.
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The Labour party's final policy admission concerns the fundamental question of funding the NHS. I will not labour the point--which has been made effectively in the debate not only by Conservative Members but by the Liberal Democrat spokesman, the hon. Member for Southwark and Bermondsey (Mr. Hughes)--but, if the Labour party is to convince people that it has a credible policy for the health service, it must have a credible policy for funding the health service. That is completely lacking from its policy agenda. The Government have pledged to ensure that funding for the health service increases in real terms every year for the next five years. That is a powerful, and I think very welcome, pledge to the people of this country.
The remainder of my remarks shall concentrate on some local topics affecting my constituents which also illustrate important elements of national policy. I think that we can measure the worth of a policy most effectively by gauging how it affects individuals in a particular area. We should not use single examples or make national generalisations, but look at the impact of policy within a constituency or a health authority area.
My constituents consistently raise three issues with me. The first is waiting lists. That is a good-news story as far as the health service is concerned. Waiting lists are potentially the source of greatest concern to the ordinary person. Therefore, their reduction must be a priority and, when that is achieved, it is a triumph. That is precisely what has happened in my constituency. In the year end at March 1996, not one of my constituents waited for more than 12 months for medical treatment. That is a dramatic improvement on the record of the previous 10 years. I am assured that the results will be just as good this year, give or take a handful of people--we are seven over at present and we were seven under a few weeks ago. I am sure that the yearly average will show a wait of no more than 12 months. I think that that is real and welcome progress.
The results in my constituency match the national figures that have been cited: a reduction since 1987 from 200,000 people waiting 12 months or more for treatment to only 15,000. That is a marked policy achievement that reflects the Government's commitment in that area. Our record funding for the health service of £43 billion and the extra £1.6 billion that will be spent next year are reflected at a local level. I pay tribute to Mark Rees, the chief executive of Bromley hospital, for ensuring that funding is well used at local level. Nationally, 75 per cent. of all patients are treated within three months, which is another excellent achievement.
The second issue is accident and emergency services. It is a difficult area and I do not disguise the fact that the service is not running perfectly in the Bromley area. However, to speak of a crisis or of collapse would be completely to distort reality. The period over Christmas and new year is always difficult owing to a surge in the number of accident and emergency cases. Local staff are working extremely hard to handle the increased work load and they are succeeding admirably. Although there are some unacceptable cases of people waiting too longfor treatment--they receive emergency treatment immediately, but must sometimes wait in A and E until beds become available--there is no question of the system collapsing or of the A and E unit being closed. That is because of the forward planning that was done. Bromley hospital has created a new observation ward, into which it could channel some admissions for observation before moving them on to hospital beds when needed.
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It is important, too, to appreciate why there is a difficulty in that area. It is all very well hon. Members giving examples of problems that have emerged, but unless the reason is understood, little can be done to tackle them. The reason in Bromley is complex and long term and could not be solved overnight. For historical reasons, we have four different hospitals, serving a population of around 250,000, whereas ideally we would have only one.
Because we have four small hospitals, when A and E patients come in, they then have to be observed and stabilised, and, if it is decided to admit them, many have to be transferred to another hospital in the borough. There is no other way of handling the situation, because the hospital with the A and E department is not large enough and cannot be expanded. There is no room; it is right in the centre of the town. Therefore, they have to be moved elsewhere, which brings me to my third and final point.
There is a crying need--it is the only solution to this and a number of other local health problems--for a new acute general hospital. That would solve the problem of transfers and create a much more efficient system. There would not be the complex process of managing beds, wards and specialities in different locations. Patients would not have to be moved around, transported from hospital to hospital. There would be no need for diagnostic transfers. All those problems could be solved with a new acute general hospital. That is a PFI operation.
I return to the speech of the hon. Member for City of Durham. Bromley has been in a similar situation, in that, originally, 20 years ago, the need for a new acute hospital was realised. In 1992, there was a problem with planning over the then chosen site. We have now passed the planning stage, the preferred bidder stage and the interim business plan stage. We are now finalising the final business plan. All that has been achieved in a remarkably swift period, which shows that the PFI can work.
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