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Mr. Gallie: Will the hon. Gentleman give way?

Mr. Kennedy: No, I am sorry. I only have a few minutes to speak, and I must move on.

The Labour party is not in a position to give a commitment on the system of charges to which we drew specific attention during the debate. That has been made clear from the strictures placed by the shadow Chancellor on Labour's overall tax and spending proposals. We need

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not look with much hope in that direction if we want to see significant improvements in both the administration and the funding of the NHS.

Turning specifically to charges, there is no doubt, from the surveys and analyses that our party has carried out across the country as to the severe disincentive effect that the current system of check-up charges is having, that it is not just turning people away, but runs against what is supposed to be the central thrust--agreed by all parties--of health care policy, which is in the direction of prevention and promotion.

One cannot have effective preventive and promotional health strategies when, for example, people are making savings on multiple prescriptions when issued by a doctor, when people are not undertaking the entire range of dental treatment recommended by their dental surgeon, and when serious medical conditions--very serious, in some cases--are going unchecked, or are not being picked up in time, as a result of people not resorting to optical tests when they should.

I carried out a survey in my constituency, and I was genuinely surprised by the results. Local opticians were asked how many times in the past year they had detected any of the following conditions. [Interruption.] Please let it be noted for the record that Conservative Members are laughing. The opticians discovered these conditions: brain tumours, on six occasions; cataracts, 718; diabetes, 49; glaucoma, 253; detached retina, 12; multiple sclerosis, two. These conditions are slipping through the net on some occasions at GP level, but--thank goodness--thanks to the technology available to opticians, they can be detected when people go in for a perfectly routine eye test. If more people are being turned away from eye tests, more of these serious medical conditions will not be picked up, and the Government must directly address that.

In respect of general practice, it was alarming to discover the number of doctors--this is a reflection of what is happening nationally--who were contemplating early retirement because of the sheer pressure of the paperwork, the bureaucracy and the demands that have been loaded on to them as a result of the changes that have taken place to their status and to general practice as a whole. The Government will be making a severe long-term error if they do not pay attention to the warnings that are coming from general practitioners, and to the fact that more and more GPs are choosing at an early age to vote with their feet. That is creating long-term difficulties in terms of health care as a whole.

We must look at the question of the annual year-on-year contract negotiations, and hon. Members will be able to provide many examples from their areas, where, because of the protracted length and complexity of the negotiations between the health authorities and individual NHS trusts and the amount of management time devoted to them, all too often the negotiations spill well into the financial year, with the contracts still not signed. Therefore, short-term ward closures and service downgrading must take place.

The Minister of State should consider whether we can have a more flexible rollover system to extend the negotiating period from one to three years, and whether we can allow the managers on both sides greater flexibility than the somewhat artificial constraints represented by the need for the annual renewal of contracts, as they presently stand.

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This has been a useful opportunity to set out our priorities for the NHS on behalf of the Liberal Democrats, and to explore the priorities and the scale of the commitment from other directions. If the voters are looking for a real choice in terms of the funding and future of the health service, it is between the maintenance of the status quo--under whichever of the two major parties might be in power after the election--and a genuinely funded and costed improvement. Only the Liberal Democrats will be arguing unequivocally and honestly for the latter at the election.

6.46 pm

The Minister of State, Scottish Office (Lord James Douglas-Hamilton): We have heard some constructive speeches in the debate. The hon. Member for Caithness and Sutherland (Mr. Maclennan) referred to Raigmore as a centre of excellence and, having visited it, I endorse that view. Our whole purpose is to ensure that the NHS is engaged in the pursuit of excellence. I also wish to associate the rest of the House with the expression of sympathy from the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) towards my hon. Friend the Under-Secretary of State for Northern Ireland following his recent bereavement.

The fact that Scottish National party Members and Labour Back Benchers have not attended the bulk of the debate in no way diminishes the seriousness and validity of the points raised by the hon. Member for North Antrim (Rev. Ian Paisley). He will know that my right hon. Friend the Minister of State, Northern Ireland Office made it clear on 10 December that he was delighted to confirm the investment at Lodge road, Coleraine and the long-standing commitment to replace it. He added that the facilities there, together with the new Antrim hospital, will provide the whole of the north-east of the Province with the most up-to-date acute services available, and that represents an investment of almost £100 million during this decade.

The hon. Member for North Antrim asked when we expected the project to be completed, and the current estimate is that it should be completed towards the end of 2000. He also referred to the McKenna review, and my right hon. Friend the Minister of State, Northern Ireland Office has consulted widely on the recommendations put to him by the project steering group. He is considering all aspects of the matter and is hoping to announce his decisions in the near future.

The hon. Member for Caithness and Sutherland referred to pressures on rural doctors. I entirely agree with him that rural GPs face particular pressures, and that is why we have schemes such as the inducement practices in the more remote areas of Scotland. The needs of particular practices are best considered locally. Highland health board is well aware of the importance of maintaining a comprehensive and well-motivated network of GPs in the area. I also accept that it is important that GPs are able to take part in audit and to contribute their views. It is particularly difficult, of course, for those who are in practices on their own and we are conscious of the need to deal with that problem.

The hon. Member for Caithness and Sutherland mentioned the proposed closure of Migdale hospital. Every closure proposal requires ministerial approval and

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I assure the hon. Gentleman that the matter will be considered with the utmost care. At this stage, the health board is consulting. The hon. Gentleman also mentioned the shortage of orthopaedic surgeons at Raigmore. I am glad to be able to confirm that there is now a full complement, and he will be pleased that I can also confirm that the hospital is rapidly eliminating the backlog of operations that had built up.

I can tell the hon. Member for Ross, Cromarty and Skye that we have been able to make a further £2 million available in the current year to Highland health board, under the bridging finance scheme for community care developers. Also, the health board and the Highlands community trust have recently submitted proposals for a new acute psychiatric unit and new continuing care and rehabilitation facilities at Craig Dunain hospital. The preference of the board and the trust is to locate those facilities on the site of the existing Craig Phadrig hospital in Inverness.

The trust will be exploring the scope for proceeding with the projects under the private finance initiative. We look forward to learning what conclusions are reached. It is in everyone's interests that the outdated facilities there are replaced at the earliest opportunity, but we shall want to be satisfied that firm plans are properly in place to provide new facilities that fully reflect the needs of patients, before agreeing that the hospital should close.

Mr. Gallie: Does my right hon. and learned Friend get the impression from the comments of the spokesmen for both the Opposition parties that they are obsessed with buildings and beds? Conservative Members are concerned about patients. We want waiting lists to drop and treatment to be improved. We want new techniques to be adopted. Is not that Conservative policy?

Lord James Douglas-Hamilton: Our policy is driven by the needs of patients. That is our top priority and we shall ensure that that happens. I can make one obvious point in response to my hon. Friend. There has been a demand for an increase in day surgery, and we have increased the amount of day surgery enormously. That is to the benefit of families and, above all, patients themselves. It is a shift in the pattern of care that is in accordance with patients' needs.

We are supporting some key themes throughout Britain. The time that people have to wait under the health service is steadily reducing. In Scotland, the number of patients who had to wait a year for in-patient treatment dropped steadily from 1,745 in March 1994 to only 126 last month. In England, the average wait reduced from nine months to around four months between 1990 and 1995. That is undoubtedly progress. The NHS continues to treat an increasing number of people year on year, not only efficiently, but producing good outcomes in terms of curing illness and improving health.

Wherever I go--whether to Raigmore, which is next to the constituency of the hon. Member for Caithness and Sutherland, or to hospitals throughout Scotland--I invariably find patients saying that the care and dedication with which they are looked after are admirable. We are determined to maintain services free at the point of delivery.

On resources, we have fully honoured our manifesto commitment to increase health spending in real terms. Planned Government spending on the NHS is more than

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70 per cent. higher in real terms than in 1978-79. Current NHS spending will grow by £1.75 billion in 1997-98--a substantial real-terms increase. In the United Kingdom as a whole, the NHS will spend more than £116 million every day in 1996-97. During my remarks, well over £1 million will have been spent--in fact, the sum will be more than £1.5 million. For the United Kingdom as a whole, spending is £724 for every man, woman or child in 1996-97, compared with £444 in 1978-79 at constant prices. That is, without question, a record of commitment.

I can confirm to the hon. Member for Belfast, South (Rev. Martin Smyth), who is temporarily absent from the Chamber, that we have now been able to make an additional £3.5 million allocation to boards in Northern Ireland in 1996-97, to help alleviate the resources problems arising from emergency admission levels, high-cost blood products and elective activity pressures.

The hon. Member for Dulwich (Ms Jowell) mentioned winter pressures. All parts of the NHS have experienced additional pressure this winter. They always do, and I pay tribute to the hard work of all involved to cope with the peak in emergency admissions. It is right that trusts should constantly keep the way in which they provide acute services under review. With increased numbers of day cases and of non-invasive surgery, the number of patients treated can be increased.

The review of acute services planning assumptions that my right hon. Friend the Secretary of State for Scotland commissioned last year came to the conclusion that it would be counter-productive to prevent acute hospitals from making changes to the acute services that they provide, including the number of beds, in response to changing needs. The same arguments apply to England and Wales. We encourage all health authorities and trusts to plan carefully to cope with the level of admissions that they are likely to face. We believe that the national health service is performing well.

My hon. Friend the Member for Southport (Mr. Banks) mentioned various hospitals in his constituency. Despite comprehensive consultation, the proposed plans remain contentious. They envisage the closure of the Christiana Hartley maternity hospital in Southport--maternity services would be centred on Ormskirk. The Sefton and South Lancashire health authorities are considering the responses to the proposals and all views will be taken into account. As Ministers may be asked to take a final decision, I cannot comment further at this time, but the views that my hon. Friend expressed tonight will be kept in mind.

Remarkable advances have been made in the national health service. The example that I found particularly moving was when I visited the hospital in Kilmarnock where cochlear implantations are performed. There have been more than 100 operations, and persons who experienced profound deafness--both young and old--were given hearing for the first time. I was able to talk to the patients, whose quality of life had been improved enormously. It is not merely the profoundly deaf who have benefited. Thirty years ago, there were no hip replacements, and keyhole surgery has advanced by leaps and bounds.

I should make it clear to the hon. Member for Ross, Cromarty and Skye that one advance that we look forward to is telemedicine--when his constituents go to a health centre, they might be able to speak to a specialist several hundred miles away, who will give them the best possible advice, followed by the necessary treatment where appropriate.

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The use of scanners has enabled much quicker and more effective diagnosis and treatment. Heart transplant units are performing effectively and well, as are the liver transplant units that have come into existence throughout Britain. We are developing cancer services steadily and ensuring that there are specialist cancer centres, where expertise and skills can be concentrated and patients assured that they will get the best possible treatment. Similarly, we are ensuring that specialist palliative care is developed throughout Britain. We support the extension of palliative care for conditions other than cancer, and its introduction as soon as possible after diagnosis.

We are determined to ensure that our health service becomes the best in the world. We want to make certain that, when GP fundholders have remarkable pioneering innovations, those should be spread throughout the national health service. We want better access, responsiveness, information and continuing care, and more emphasis on prevention.

The NHS has an overall record of success, with more patients treated, shorter waiting times and improved treatments. We are determined that it should be the best in the world.

Question put, That the original words stand part of the Question:--

The House divided: Ayes 44, Noes 309.

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