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Rev. Martin Smyth: The hon. Gentleman mentioned our last debate on the NHS. In that debate, the Minister who was responding gave a figure of £1.56 billion for the NHS, but did not say that £56 million was going to Northern Ireland. The hon. Gentleman has mentioned local negotiations. Our budget has not been given an increase of 3 per cent., but has been cut by 3 per cent. This year, it has been reduced to 1.5 per cent. up front.

Mr. Banks: I thank the hon. Gentleman for telling us what is happening in Northern Ireland. I know that he will forgive me if I plead genuine ignorance of the specific case that he mentioned. I am sorry that my hon. Friend the Under-Secretary of State for Northern Ireland cannot be with us, for the reasons that the hon. Gentleman mentioned earlier. Perhaps we will pick up on that matter later in the debate.

All I can say to the hon. Gentleman is that the flexibility that I have seen in and around my constituency--in the Southport and Formby Community Health Services NHS trust and the Sefton district health authority, which covers three parliamentary constituencies--has been welcomed because it has been effective in giving pay rises to people who deserve them most. With such flexibility, it is important to be able in certain instances to do what is best on a local basis. What is perhaps best in Southport is not necessarily good for Northern Ireland, and vice versa.

I mentioned the background that we have in dealing with in the debate. One further point of substance in relation to improvements in the NHS is the private finance initiative. My right hon. Friend the Secretary of State for Health has in many ways, together with the Secretary of State for Transport, pioneered the PFI. It is no surprise or coincidence that both have been Treasury Ministers. Mixed public and private funding for improvements in the NHS is vital. I need to look only to my constituency to see the enormous benefit of such funding. Approximately £12 million is being used to develop new premises to ensure that one of our older hospitals has the opportunity of closing to provide better facilities on the newer site, which was built after the Government's election to power.

That site should have been built in 1970s, but, when the Labour party had to go cap in hand to the International Monetary Fund and cut the capital hospital building programme by 33 per cent., unfortunately my constituents were not able to have the site when they needed it. The PFI is vital. Its critics are being proved wrong. A combination of public and private sector capital is the way to ensure new build where it is necessary, and improvements in existing facilities.

There is no better proof of increasing satisfaction with NHS services than personal experience. I am sure that I am not alone in the House in experiencing treatment on the NHS, although I freely admit that I take the

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opportunity also of contributing to a private health care scheme. I have had tax relief on those contributions, which have been so opposed by the Opposition parties. I take the opportunity of ensuring that I have choice. I advocate it. That is what we Conservative Members advocate. We have done so, not least in the past, but we continue to do so as we head towards a general election. Choice is vital, but the experience that I was mentioning of hon. Members receiving treatment on the NHS is important.

I recall going to a meeting of the chairman of the NHS trust in my constituency in the early 1990s--I think 1993. I expected the meeting to last some half an hour. I actually left the hospital some seven days later, having spent a week in intensive care. The health care that I received was absolutely outstanding. I had the opportunity not just of remaining in one intensive care ward, but of going to another ward and to two or three different hospitals. I cannot fault the care that I received, and I deprecate people both inside and outside the House who all too frequently criticise unfairly and without good reason the good work by nurses and doctors in the service. We all recognise that there are problems, but too frequently we hear about those few problems and not enough about the success of those who work in the service.

Mr. Simon Hughes: I am glad that the NHS looked after the hon. Gentleman well and brought him back to health. Will he accept, however, that one of the concerns about the health service is that many people who do not want to use the private health sector feel increasingly driven to do so because they cannot be sure that the NHS will be able to do all the things that they need? One of the tests of the NHS's fragility is that there is a consistent increase in people who are opting for private health insurance--it was 11 per cent.; it is now up to 14 per cent. I remember that his previous leader, the noble Lady Thatcher, was happy to have private health insurance, but, when she needed emergency or more acute treatment, she relied on the NHS.

Mr. Banks: I have listened with care to what the hon. Gentleman has said. What I was talking about was choice and I am not going to debate what the noble Baroness did or did not do. I can tell the House my experiences only, and they have been excellent in relation to the NHS.

Mr. Gallie: Surely the words of the hon. Member for Southwark and Bermondsey (Mr. Hughes) underline what my hon. Friend says. He points out the values and the excellence of the NHS. It has been demonstrated that, where someone had the choice between private and NHS, the individual plumped for the NHS. That is surely a great credit to the NHS, and surely backs my hon. Friend's argument.

Mr. Banks: I am grateful to my hon. Friend, who is such an advocate of Ayr; despite what his political opponents say in Scotland, I believe that he will hold his seat.

I should like to make one final local point. May I make a plea to the Minister to take action? The two local health authorities that provide services in and around my constituency have been consulting over a lengthy period on the provision of health care for the future. In some instances, too few patients have been spread over two

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brand new hospitals, if I can put it that way, some five miles apart--one in Ormskirk and one in Southport. South Lancashire district health authority, which covers Skelmersdale and the west Lancashire region, and Sefton district health authority, which covers Bootle to Southport, have been debating whether health care should be provided on one site and, if not, how the split between the two sites should take place.

The major concern has been that the two health authorities, rightly trying to take decisions locally, have not been able to agree. As a result, they commissioned Sir Duncan Nichol, the former chief executive of the health service, to conduct a review. He decided that there should be a hot site and a cold site, and he further concluded that the hot site should be in Southport.

As part of what I can only describe as a deal, a suggestion was made to transfer maternity services from my constituency five miles down the road to Ormskirk. There are concerns about that in relation not just to geography but to where intensive care and accident and emergency services will be located and where, without those facilities, young babies will be born.

I believe now that, after a lengthy period of consultation, South Lancashire health authority has been dragging out taking a decision on the matter because it knows that, in a few weeks' time, there will be a general election. It is vital that a decision is reached, because my constituents are fully aware that, if there were to be a Labour Government, they would ensure that the North West regional health authority intervened to transfer those maternity services away from Southport to Ormskirk.

Every historical precedent suggests that that will happen. There will be nothing for Southport under a Labour Government because, under them, we could not have even the brand new hospital that the regional health authority wanted to build in the 1970s. The only hope to ensure that Sir Duncan Nichol's recommendations are implemented will be for the regional health authority to intervene, and to do soon, before a general election.

I know that my right hon. and learned Friend the Minister of State, Scottish Office, is not involved in this local review of services. It has come not from the Department of Health but from the region and the locality. I want the Minister to press the chairman of the regional health authority to intervene so that a decision can be taken now. Then we can ensure that the Nicol proposals are implemented, so that all the major services are based in Southport. Once the independent review has been implemented, I shall tell my constituents that that review, commissioned by the two health authorities, has gone ahead, that it is expected that maternity services will stay in Southport and that only a Labour Government could change that.

I have no doubt that the interests of my constituents will be best served by the re-election of a Conservative Government.

5.29 pm

Ms Tessa Jowell (Dulwich): We too would like to record our condolences to the hon. Member for North-East Cambridgeshire (Mr. Moss) following his recent sad bereavement.

We welcome the opportunity to debate the immediate priorities for the national health service. I share the view of the hon. Member for Southwark and Bermondsey

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(Mr. Hughes) that we must take every opportunity to provide a view of the real facts of life for staff and patients in accident and emergency departments and GP surgeries up and down the country, as an antidote to the rosy view of the NHS adopted by Richmond house.

I begin, however, by dealing with the priorities outlined in the Liberal Democrat motion. Free eye tests and dental checks are top of that party's wish list. The Labour party recognises the value of eye tests and dental checks as important preventive measures, and we share the concern expressed by the hon. Member for Southwark and Bermondsey that the withdrawal of free tests has had an adverse impact on public health. But restoring free eye tests and checks would not come cheap. The combined cost would be at least £170 million and probably nearer £200 million--roughly the same amount as highly conservative estimates of the hole in the Government's finances for the NHS between now and the end of this financial year.

As the hon. Member for Southwark and Bermondsey knows, the problems of our health authority--Lambeth, Southwark and Lewisham--have led to patients in both our constituencies waiting as long as 18 months to be admitted to hospital, which is longer than patients wait in other parts of the country. The problems have also given rise to what the chief executive of King's College hospital recently denounced as the two-tier health service which he found it impossible to defend to the patients of his hospital.

The acute problems that hospitals have experienced cannot possibly be separated from the pace and scale of the cuts in acute hospital beds in recent years. That is not just our view; it is a view shared by the British Medical Association, which has today published new evidence of the continuing crisis in our hospitals. It has found that Southampton General is "just about coping". In Liverpool, the bed crisis continues. Addenbrooke's in Cambridge is

"in and out of red alert."

Torbay is

"closed to elective admission and running at full capacity",

and in Bristol,

"waiting lists have grown longer".

These problems are inseparable from the fact that a quarter of NHS hospital beds have been lost since the Government's competitive internal market was introduced. Nearly 13,000 beds in all specialties have closed in just five years as a direct result of the Government's doctrinaire obsession with competition. In the battle for patients, hospitals have been forced to cut services to the bone in order to keep costs down.

It is a simple fact that no service, public or private, could withstand such a huge reduction in capacity over such a short time and avoid deterioration in the quality of the service that even the best efforts of staff can provide. Of course we recognise that the needs of the NHS and its patients are changing--that more day surgery is being carried out, for instance; but even so the pace of bed closures has been dangerously fast.

We have in London an example of the damage done to patient care by the pace of change. As long ago as 1994, Dr. Brian Jarman warned that the Tomlinson report, on which the bed closure programme was based, was founded on flawed evidence. Incidentally, it followed the report of the King's Fund, which reviewed the health

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needs of London. Dr. Jarman pointed out that important data relating to the availability of mental health services and of residential and other long-term services for elderly people had been omitted from the calculations.

Even though the Department of Health seems belatedly to have accepted Brian Jarman's analysis, bed closures have continued at an alarming rate. More than 17,500 beds have been closed in North and South Thames over the past five years.

We support the call in the motion for reducing unnecessary bureaucracy by introducing longer-term agreements between health authorities and hospitals. That is what the health service wants; it will provide important stability and savings on bureaucratic costs which can then be redirected to patient care. It was, after all, the Government's doctrinaire obsession with competition that created the explosion of bureaucracy in the NHS at the cost of patient care.

The BMA has calculated that the internal market costs £1.5 billion. In private the Secretary of State seems prepared to accept that. It is significant that his recent White Paper--his credo, as he put it--"A Service with Ambitions", did not make a single reference to the competitive internal market. Indeed, in one part of the country the Secretary of State has even permitted the suspension of that market. In Newcastle, the city's health trusts have returned to a system of collaborative contracting in which competition has been replaced by co-operation and three-year rolling contracts. The move, the trusts explain, is intended to

"avoid the perils of over-competitiveness . . . there is the ever-present danger of trusts becoming too competitive for business at the expense of quality. In other words, trying to do more for less. If this were to continue unchecked, staff would undoubtedly lose confidence in the market system."

When the Minister winds up, perhaps he will assure us that, if the Newcastle project can be shown to have brought benefits by improving local standards of care, the Government will immediately encourage hospitals and health authorities across the country to ditch the absurd competition that is imposing such a burden on the health service and creating such an obstacle to best patient care.

We share the concern expressed in the motion about the effect of local pay bargaining on the NHS. It has embroiled hospitals and staff in drawn-out, often acrimonious negotiations and distracted them from their main priority, which should be improving patient care. The Royal College of Nursing has found that only 196 trusts out of 488 have so far reached agreement on pay for the current financial year.

I offer the House an example of what local pay has meant for one trust this year. The Newcastle City Health NHS trust describes how it has been engaged in a long-running dispute with staff over local pay. The chief executive has spent between 80 and 90 hours on negotiations; his deputy has spent 100 hours, and a human resources manager, 200 hours. On top of that, 80 other managers have spent about 20 hours each on the subject. That amounts to a total of 2,000 managerial hours. Given that a further 1,000 hours were lost on the day of a strike, almost 3,000 hours--which could have been spent on more productive work--have been lost to pay negotiations. That is why we support the call to scrap

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local pay bargaining. It is another example of how the Government have allowed NHS bureaucracy to spiral out of control.

We welcome today's debate, and we support many of the calls that have been made. However, we are sceptical of the remedies suggested by the Liberal Democrats and of how those would be paid for.

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