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Mr. William O'Brien (Normanton): My hon. Friend and I share the same health authority area, and Pinderfields hospital, to which he referred, is in my constituency. Today, we had a meeting to consider the merger between the two trusts. I am sure that my hon. Friend will agree that we must ensure that the services and resources that are needed for the Wakefield area are made available now that there is to be one trust. The deficit of both hospitals and the area health authority, and the surpluses that apply to the GP fundholders, should be merged so that we have unity of provision in both primary and acute care in the Wakefield area. That is the point that my hon. Friend is making. It is significant and important, and I hope that the Minister will take note.
Mr. Trickett: I thank my hon. Friend for making some telling points about the position in our area.
We live in a complex geographical area with a large number of small townships and village communities spread over a large area. At the moment, health services are provided at both ends of the district. We fear that, because of the cutting process in our area and the downward pressure on finances, as a result of the formula and aggregate expenditure on the health service throughout the nation, we shall end up with a single hospital. Just one hospital in any part of our district cannot serve the whole of our community because of the geographical character of the district, its infrastructure and transport services. We therefore resisted the proposal to unify the health service management, because we believe that the next step is unification of the hospitals and the closure of one or other of them.
Mr. David Congdon (Croydon, North-East):
I welcome this further opportunity to debate the health service because there is no doubt that the public regard it as the jewel in the crown of public services. The NHS has a good tradition, since its foundation in 1948, of meeting the rising expectations of the public and the demands placed on it.
Why do I say that the health service is a success story? The success is not entirely due to the NHS, but a large part is. Life expectancy has risen--even over the past 18 years, it has increased by a further two years--and, even more important, infant mortality has been halved, but one would not get that impression as a result of listening to some hon. Members' speeches. I argue strongly that the NHS has been and will continue to be a success story.
The NHS has been a success story because of the dedication of its staff and the resources that have been committed to it. Resources have risen by 3 per cent. a year since 1979, in sharp contrast to the period of the last Labour
Government, 1974 to 1979. We now spend £43 billion a year on the NHS--£80,000 a minute or £31 million during this debate.
The sums are large in anybody's language and the key is to ensure that they are well and properly spent. I remind anybody who does not believe that that is the issue of what, as long ago as 1953, the Guillebaud committee stated:
As my hon. Friend the Member for Chipping Barnet (Sir S. Chapman) properly reminded the House, health expenditure has risen from 4.7 per cent. of gross domestic product in 1979 to 5.8 per cent. of GDP in 1995-96. That is a significant increase.
Another reason why the public regard the NHS as crucial is that it is there when it is needed. They know that if they are ill, if an emergency occurs, or if they are in an accident, they will receive the best possible care. Even more crucially, the NHS is free at the point of use. If people are knocked down, or have a stroke or heart attack, they know that they will be cared for and will not be presented with a bill afterwards.
It is not and never has been the Conservative party's intention to privatise the NHS. One of the most depressing parts of debates on the NHS for a long time is the continuing attempt--particularly just before a general election, for some reason--to allege that there is a hidden plan to privatise it. If there is--I know that there is not--it has been pretty well hidden for the past 18 years, and especially during the past five years when we have significantly increased NHS expenditure.
The Opposition's motion alleges that
Mr. Couchman:
Does my hon. Friend remember the mismanagement of the health service in 1978-79? Does he remember the Labour Government, propped up by the Liberal party, abrogating their responsibility to trade union shop stewards?
Mr. Congdon:
Yes I do. People were being turned away from hospitals by pickets, who were determining
Having said that the NHS provides an excellent service and is safe in our hands, I recognise that it faces great pressures. That is one reason why the Secretary of State allocated an extra £100 million to deal with bed blocking and for intensive care facilities. Why does the NHS experience great pressure? The answer is obvious: advances in medical science have led to cures that were not available 10 or 15 years ago. More people have heart transplants or bypass operations now. That is a great success.
Demographic change has put great pressure on the NHS. The number of people aged 85 and over increased by nearly 50 per cent. between 1986 and 1996. The NHS dealt very well with the enormous extra pressure that that put on it. We all know that, as people get older, they use more health care. The hon. Member for Hemsworth (Mr. Trickett) mentioned the funding formula, but it is designed to take into account the fact that the elderly put more demands on the health service.
The Secretary of State's document, "The NHS--A Service with Ambitions," which was published recently, made it clear that we are over the period of greatest growth in the number of over-85s. Over the next decade--1996 to 2006--the increase will be only 12 per cent. Just in case hon. Members think the percentages confusing, in absolute terms there was a 300,000 increase in the number of over-85s in the decade just finished, and the increase will be 110,000 in the coming decade. That is an important point. I would argue categorically that the NHS can and will cope with the demands that will be placed on it over the next decade and further into the future.
Not enough research has been done on this, but there has been a significant increase in the number of emergency admissions. A number of reasons are given, but there is no firm conclusion. At my local district general hospital, the Mayday Healthcare NHS trust, during December, there was an 18 per cent. increase in the number of emergency admissions. That is a lot to cope with. Despite the planning in many hospitals to bring forward elective surgery, which we heard about earlier, it is difficult to cope with demand.
My hon. Friend the Member for Chipping Barnet talked about the number of patients being treated, which has gone up greatly. I draw the House's attention to some figures about specific operations. Compared with 1990-91, there has been a 70 per cent. increase in the number of heart bypass operations, to 22,000. The number of cataract operations has increased by 54 per cent., to 152,000. Hip replacements are up 26 per cent., to 62,000.
All that has been achieved because extra resources have been devoted to the health service, but perhaps as significant is the fact that it has been achieved with a significant decrease in the number of beds. We have not had to increase the number of beds to cater for more people, because the average length of stay has decreased by 60 per cent. since 1970. As we know, a large number of operations--up to 60 or 70 per cent. in many hospitals--are now carried out as day surgery. That is why more people can be treated in a reduced number of beds.
Mr. Simon Hughes:
The hon. Gentleman is, as always, making a thoughtful speech. He knows the subject well,
"If the test of adequacy were that the Service should be able to meet every demand which is justifiable on medical grounds, then the Service is clearly inadequate now, and very considerable additional expenditure would be required to make it so . . . In the absence of an objective and obtainable standard of adequacy"--
in other words, what does "adequacy" actually mean?--
"the aim must be to provide the best Service possible within the limits of the available resources".
The resources devoted, rightly and properly, to the NHS have been increased every year--by 75 per cent. in real term since 1979--and, whenever the general election comes, the next Conservative Government are firmly committed to increasing that funding every year in real terms.
"the National Health Service is not safe in this Government's hands."
I would argue categorically that, looking at the record, it is clearly safe in this Government's hands; but looking at the contrasting record of Labour-controlled local authorities on community care, which is an important part of the NHS, it is certainly not safe in Labour's hands.
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