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Mr. Simon Hughes: One never knows.

Mr. Banks: The hon. Member for Caithness and Sutherland drew attention to the fact that the Secretary of State is not present. In his opening remarks, the hon. Member for Southwark and Bermondsey said that this morning he had visited health service premises in his constituency with his right hon. Friend the Member for Yeovil.

Mr. Hughes: The hon. Gentleman is almost right. My right hon. Friend and I had a visit from nurses: the meeting took place in this building, and not in NHS premises.

Mr. Banks: I am grateful to the hon. Gentleman for clarifying that point. It is even more disappointing that his

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right hon. Friend has not bothered to turn up for a debate initiated by his party. Either this is an important subject for the Liberal Democrats or it is not.

Dame Elaine Kellett-Bowman (Lancaster): The debate may be of interest to the three Liberal Democrat Members who are present, but it is clearly of no interest to the rest of them.

Mr. Banks: With the greatest respect to the hon. Member for Cheltenham (Mr. Jones), he stayed for about 20 minutes and did not even hear the end of the opening speech by his hon. Friend the Member for Southwark and Bermondsey.

It was suggested that I will have difficulties at the next election, but I suspect that there will be a number of Conservative gains from the Liberal Democrats.

I shall return to the substance of the debate, Madam Deputy Speaker, because I do not want to incur your wrath or get a little too overheated about the impending general election.

Although I did not catch the fact that the meeting with nurses took place in the House, I listened attentively to the substance of the remarks of the hon. Member for Southwark and Bermondsey. He is clearly not a budding Treasury Minister. He should take care when advocating the hypothecation of taxes, because we could end up with a problem if we had to find money to spend on provisions that were not particularly popular.

Although the motion does not refer to nurses' pay and whether it should be negotiated locally, I have read the hon. Gentleman's previous speeches in which he has referred to that, not least in the debate on 20 November. [Interruption.] He is waving the Order Paper at me. I am grateful to him for pointing that out.

I think that the hon. Gentleman is wrong. His point about the independence of pay negotiating bodies is important, but he cannot have it both ways. We either have an independent body whose recommendations we accept, or we do not. The independent body that looks after nurses' pay has recommended that it should not fall below a ceiling of a 2 per cent. rise. However, there is no reason why nurses cannot be paid more than 2 per cent. either across the board in a geographical area or in specific cases on a local basis, depending on the trust.

It is important to have local flexibility in pay negotiations. In an area that is looked after a particular NHS trust, greater flexibility may allow management to reward nurses with an increase of rather more than the 2 per cent. suggested by the independent body. We should not be too rigid. What matters is the local provision of care within the national health service.

I agree with the hon. Gentleman about contracts. I have some sympathy with the view that too much time is spent negotiating contracts. I am not suggesting that every contract that an NHS trust puts out to tender should be a rigid three-year one. We should seek ways to extend, in appropriate circumstances, the one-year contracts that take up so much time to renew each year. That is bound to free management time, so that the management can ensure that the provision of health care is improved in each trust hospital.

I regret that insufficient reference was made to the additional £25 million. That is a constructive criticism by the Minister of State. Insufficient credit has been given to

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the £25 million additional resources from what I call an emergency contingency fund to deal with some of the winter problems, which have resulted in a marginal rise in waiting lists. I appreciate the action taken by the Department of Health.

I am fairly familiar with the £25 million split. That money will help to deal with bed blocking problems, which have certainly affected my local hospital in Southport. It will ensure that the local health authority has the resources to put more money into care in the community in local authority and private nursing homes, and it will free hospital beds so that people can be treated more quickly.

I pay particular tribute to my hon. Friends in the Department, who have ensured that additional contingency funds have been used to deal with problems in community mental health services.

I believe that a non-partisan approach to some health issues is possible. In this debate, Conservative Members may come closer to achieving that with the Liberal Democrats than with Labour. After all, as the hon. Member for Southwark and Bermondsey pointed out, the Labour party has not in any way met the commitment made by my right hon. Friend the Prime Minister and the Government to year-on-year-on-year increases over and above inflation. That commitment was first made in 1992, and has been met. Have we heard such a commitment from Labour? We have not: the silence has been deafening. I look forward to hearing from the hon. Member for Dulwich (Ms Jowell) later in the debate.

I strongly agree with some of the other comments made by the hon. Member for Southwark and Bermondsey. I particularly agree with what he said in the NHS debate of 20 November:

I hope that those mistakes and tragedies will be kept to the absolute minimum, and eradicated where possible, but we should all recognise that, because so many more patients are being treated in the NHS than were treated in the 1970s--as a result of the Government's policies--the odd mistake will inevitably be made. It would be frivolous to suggest otherwise.

Nevertheless, I agree with what the hon. Member for Southwark and Bermondsey said in that debate. It took place only a few weeks ago, and nothing has changed since then. I have no doubt that the commitment given by the Prime Minister in Bournemouth last year--which is, of course, Government policy--is one of the many promises that we have kept in the present Parliament and will keep in the next.

Mr. Simon Hughes: I am trying to establish what areas of agreement there are between us. Does the hon. Gentleman accept that it would not be a bad thing--I am trying not to trap him into saying anything that might push him too far--if the question of statistics, to which nurses' pay is relevant, were dealt with by an independent body? The Minister suggested the Audit Commission; I have suggested the King's Fund. All the matters pertaining to the hon. Gentleman's constituents--the number of beds,

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whether there are too many or too few, whether they are under pressure and whether there are enough hospital places--could then be evaluated independently, before the political debate about which hospitals should be built and which should be closed. That, of course, will ultimately be a political decision.

Mr. Banks: I am afraid that I cannot agree with the hon. Gentleman on that, for two reasons. In fact, I am sure that there are others, but I shall mention two.

First, the Audit Commission is there to ensure that we receive value for money. I do not think that its task is to do what the hon. Gentleman has suggested, although in certain circumstances I retain an open mind. Secondly, I believe that such a suggestion impugns the integrity of the civil service. Over the years, it has been suggested that the civil service has become a little too close to the present Government, but anyone who talks to Ministers privately will be told that that is certainly not the case. Civil servants do an excellent job; no doubt they have their own private views, but they behave very professionally. I do not agree with the hon. Gentleman that the statistics that he receives from the Government--which are compiled by civil servants--are in any need of disinfecting.

Today's debate takes place against a background of record spending on the NHS. Spending has risen by some 74 per cent. in real terms since 1979. For every man, woman and child in the United Kingdom, we are now spending about £724, compared--in real terms--to some £444 in 1978-79. That is a significant difference. The problems of this winter have led to a special cash boost of £25 million. Some of that has been used to deal with bed blocking, and has certainly helped my constituency; £4 million of it has been spent on extra intensive care and high-dependency beds, and £5 million has been used to improve mental health services, which have also been affected by winter problems.

There are more doctors and nurses than there were in the 1970s. Since then, the number of nurses and midwives has risen by some 55,000. The number of doctors and dentists has risen by 22,500. For every manager in the NHS, there are some 77 employees directly involved in patient care.

I have mentioned the Prime Minister's commitment to year-on-year-on-year real increases in the next Parliament. I remember that, when he first came up with the idea of the citizens charter, one or two foolish people laughed at the suggestion; but what a difference the charter has made. It has enabled the public to know precisely what level of service they ought to expect, and how it should improve year on year. It has established benchmarks, and if those benchmarks are not met, action is taken.

I very much hope that the Labour party will match that guarantee. I thought that the hon. Member for Dulwich was going to intervene and give me such a pledge, but she is only shuffling her papers. I do not think that we should be surprised by the Prime Minister's commitment, because he gave the same pledge in 1992, and has adhered to it. It is, however, staggering to note that there is to be a further increase of some £1.6 billion in NHS spending next year, which means a 3 per cent. real-terms increase in hospital and community health services. In 1995, the NHS share of gross domestic product was about 5.8 per cent.; in 1978-79, it was about 4.7 per cent.

I have mentioned nurses' pay, and the importance of having the flexibility of local negotiation on a trust-by-trust, hospital-by-hospital basis. Nurses' pay has

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risen from about £68 a week in 1979 to some £311 a week in 1995: that is a real increase, over and above inflation, of around 70 per cent. I believe that locally negotiated pay is the way forward. We have seen great benefits from it in my constituency, and I was heartened to learn that the independent body had made it clear that there should be an increase of no less than 2 per cent.

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