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5.35 pm

Mr. Gareth R. Thomas (Harrow, West): In the 18 months before the general election last May, my constituents had seen two thirds of their accident and emergency departments shut. All four local NHS trusts were in severe financial difficulty, staff morale was at a low ebb and, not surprisingly, local waiting lists were at record levels and set to rise further. In the years after the Tory reforms, the NHS had degenerated into a bureaucratic health market, kept going mainly by the commitment of NHS staff. It had become a patchwork of businesses competing with each other, dependent for their funding and for their very existence on their success in winning orders and making money.

On Second Reading of the National Health Service and Community Care Bill, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) declared that the reforms would

How right she was, but the truth is that that era is one that my constituents are delighted to have seen consigned to history. The right hon. Lady also claimed that the reforms would turn the NHS into

    "the thriving, expanding concern that it should be."--[Official Report, 11 December 1989; Vol. 163, c. 722.]

She was entirely wrong on that point. The reality of the NHS at the time of the general election was one of rising waiting lists and record sums being spent on administration. The Conservative NHS reforms that she endorsed so enthusiastically turned access to health care into a lottery. People living in the same borough--even in the same street--were confronted with widely differing patterns of care and waiting times for operations. My constituents suffered particularly in respect of ophthalmology, as waiting times for the patients of GP fundholders were up to two and a half times shorter than those for patients of non-fundholding GPs.

The financial position inherited by the Labour Government was appalling: 59 out of 100 health authorities ended the last financial year under the Conservative Government in deficit, as did 128 NHS trusts. At the same time, huge sums were being wasted on bureaucracy and administration as, from 1989-90, annual spending on managerial and administrative staff almost doubled, from £1.2 billion to £2.3 billion. Indeed, in one year, spending on managers soared by 17 per cent.,

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while spending on nurses rose by only 1 per cent. Those who were Ministers in the Conservative Government should admit that they took their eye off the ball. The Audit Commission found that senior management costs in some trusts were more than double those in others, for no comparable reason. Estimates put GP fundholding costs at £80,000 per practice per year, totalling more than£200 million spent each year administering fundholding--money that could, and should, have been put into patient care.

I can think of no other area of government that so encapsulates the way in which the Conservatives let down the people of this country, or that so epitomises the mismanagement and incompetence that riddled the previous Government. It is a story of Tory failure to embarrass and shame even the most senior figures in the party.

The predecessor of the right hon. Member for Maidstone and The Weald, the hon. Member for Stratford-on-Avon (Mr. Maples), said only recently:

That policy was decisively rejected by the electorate. The hon. Member for Rutland and Melton (Mr. Duncan) owned up in his book to some embarrassment about

    "the excessive cost in managerial overheads of GP fundholding".

Perhaps, when he sums up the debate, he will tell us whether that remark will be in the paperback version.

I congratulate my hon. Friends on the Front Bench because, in contrast to the record of failure and mismanagement of the Conservative party, they have begun to tackle the deep-seated problems that the Conservatives bequeathed us. The NHS White Paper and the public health Green Paper hold out the prospect of a health service that truly works in co-operation to provide high-quality health care. Doctors, nurses and their management are genuinely beginning to put together a new health service, and are working much more closely with partners in local authorities and the voluntary sector.

In that context, the extra money allocated for the waiting lists initiative is extremely welcome. The extra 3,000 beds to treat patients, which the initiative will fund, are in stark contrast to the record of bed closures under the Conservative Government, as my right hon. Friend the Secretary of State said. I particularly welcome the 450 extra beds in London. My health authority is to receive an extra £3 million, over and above what the Government have already allocated to it. Some £1 million of that will be used to reduce waiting lists at Northwick Park hospital by an estimated 1,200 patients.

Mount Vernon hospital, which is located in the constituency of the hon. Member for Ruislip-Northwood (Mr. Wilkinson) but serves my constituents, suffered considerable speculation about its future under the previous Government, which was exacerbated when its accident and emergency department was closed. The extra 15 beds that will open at Mount Vernon and the £250,000 from Brent and Harrow health authority's allocation from the waiting lists initiative will offer confirmation of Mount Vernon's continuing viability and reassure my constituents, who felt let down by the previous Government's failure to stop cuts at that hospital.

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I also welcome the plans to establish in my constituency a three-way partnership between Northwick Park, which is the district general hospital, Harrow and Hillingdon Healthcare NHS trust, which is the local community services trust, and Harrow social services to increase community nursing. In the first instance, that will facilitate discharges from hospital and, secondly, it will help to keep out of hospital people who would, perhaps, have been bed blockers, and who can be more appropriately cared for in their home. Reforms in the White and Green Papers will continue to promote that spirit of partnership.

Health improvement plans and the new duty to work in partnership with other care agencies will be essential in cementing effective joint working between local authority departments and health care agencies to continue to tackle waiting list reductions. I hope that Ministers will ensure the speedy dissemination of the lessons to be learned from the way in which health action zones and the pilots under the National Health Service (Primary Care) Act 1997 are working so that all patients can benefit.

The Government are tackling the waiting list problem. More beds are being provided; more wards are being opened; more staff are being recruited and more theatre time is becoming available. The Government should be congratulated on fulfilling their first waiting list promise, made last November, that by the end of last March nobody would be waiting more than 18 months for treatment. That target has been achieved by the work of health authorities and trusts, which is now being stepped up through the work of the waiting lists action team and the appointment of the chief executive of Leicester royal infirmary to reinforce the national drive to slash NHS waiting lists. The Government will fulfil our pledges to cut waiting lists.

It would be worth hearing from the Conservative party what exactly their policy is on the national health service. What actions and reforms would the party of the right hon. Member for Maidstone and The Weald and the hon. Member for Rutland and Melton implement if, God forbid, it were still in power? Do Conservative Members still cling to a belief in the discredited reforms that they so enthusiastically backed nine years ago, which produced a health service weighed down by bureaucracy? Do they support our reforms, but feel a little shy about owning up to that, or do they have something else in mind for the national health service?

I ask that question because, on 13 June in The Daily Telegraph, the right hon. Member for Maidstone and The Weald described the NHS as needing not just a little tinkering, but a radical overhaul. It would be worth while if Conservatives clarified what they mean by a radical overhaul. Do they mean, for example, that the national health service should be privatised? I am sorry that the right hon. Member for Charnwood (Mr. Dorrell) is no longer in his place, because I remember only too well his proposal to privatise many of the social care agencies. It would be interesting to know whether the Conservative party continues to support that proposal. Had that been implemented, it would have been disastrous for partnerships between social care agencies and the health service to reduce waiting lists.

The hon. Member for Stratford-on-Avon wrote in 1994, when he was working in Conservative central office, that it would be best for the Conservative party if there were absolutely no publicity about the national health service.

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I suspect that, if he were still working in Tory central office, he would be arguing that it would be better for the Conservative party if no publicity were given to the national health service for the next 10 years.

5.45 pm

Mr. John Horam (Orpington): The famous NHS waiting list pledge, on which the hon. Member for Harrow, West (Mr. Thomas) and other Labour Members were elected, was quintessentially new Labour in that it was superficially impressive, would not cost very much and would make almost no difference even if it were implemented.

As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who has just left the Chamber, said, it was a pretty thin pledge in the first place. I am sorry that I am agreeing with him--perhaps he is uncomfortable with that when his party is so close to the Labour party. The pledge was almost as thin as the hon. Gentleman's famous pledge to do something about the NHS by putting another 6p on a packet of cigarettes, which was the Liberal Democrats' funding suggestion at the general election.

From an ordinary person's perspective, a waiting list reduction of 100,000 is significant, but if we consider the total waiting list--of 1.3 million--it is not. It is even less significant if we remember that the pledge was to increase the number of patients treated, which is roughly 9 million in any year. That is a thin pledge.

The £100 million of savings on bureaucracy, which the Labour party pledged would pay for more patients to be treated and reduce waiting times, was equally thin. Again, to an ordinary person £100 million sounds like a lot, but it stands against the £40 billion spent on the NHS in England, Scotland and Wales in any one year. It is a meagre amount to achieve an insignificant objective, and it has made very little difference.

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