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Mr. St. Aubyn: Will the Minister consider the suggestion that, if he is going to draw on 100,000 volunteers without endorsing the concept of overseas volunteering, he might draw into his programme those who would derive greater benefit from overseas projects and jeopardise the viability of some of the valuable projects that they would otherwise have undertaken?

Dr. Howells: I could not agree more, and I shall certainly take that important point into consideration. I am determined to ensure that we do not jeopardise organisations that plan properly and offer volunteers who go overseas real training, valuable experience and education.

We are fully aware of the valuable work done by volunteers working abroad. I agree entirely that voluntary work overseas offers young people opportunities for personal development. I can give the hon. Gentleman the undertaking that the Government are sympathetic to the idea of encouraging volunteering overseas, and that we are considering how that might be recognised within the millennium volunteers programme. My officials recently met key organisations involved in volunteering overseas, and agreed to consult them further. A final decision on

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recognising volunteering overseas as part of the millennium volunteers initiative will be made when the consultation process is complete.

Voluntary work can be challenging for the individual concerned--that is part of the reward--but I accept that working overseas has its own particular challenges and difficulties. I have therefore listened carefully to the hon. Gentleman's comments about the activities of certain organisations, and I hope that, at some stage, he will see fit to name those organisations, either in the House or outside. I was shocked by some of the figures he quoted--everyone should be concerned about the examples he gave of eight staff arranging 800 placements a year, each costing £2,000, with inadequate guarantees about the conditions awaiting the volunteers; and of the 70 organisations offering gap year experience entirely unregulated.

The hon. Member for Ashford will be relieved to hear that we do not believe that the Government should act as big brother, and try to regulate every single activity. That would impose a straitjacket in an area in which organisations need to be flexible in providing volunteering opportunities. The way forward lies in a voluntary code of self-regulation for organisations involved in arranging gap year projects, but that has to be a genuine exercise in drawing up a code that has some teeth and that can be effective when organisations step out of line. I am conscious of the fact that, occasionally, gap year arrangements do not work smoothly, so organisations need to ensure that adequate controls are in place.

Most students who take a year off have a rewarding experience. As the hon. Member for Guildford made clear, Guildford and many other universities and institutions of higher education appreciate the beneficial effects of the gap year.

There is now a Central Bureau for Educational Visits and Exchanges, which receives a grant of £5 million. It facilitates gap year placements and produces an advice booklet that covers health and safety issues. I give an undertaking that the hon. Gentleman's suggestion that departmental guidelines should be issued will be given careful consideration, especially in relation to our deliberations on extending the millennium volunteers programme to overseas placements. I shall ask the appropriate officials from my Department to meet the main voluntary organisations to discuss the question of guidelines.

Therefore, I hope that the hon. Gentleman will accept that we have achieved some progress. I cannot give him a parallel or simile for last night's match, as he wanted. I am afraid that, as a rugby fan, I have not yet got over the 96:13 defeat of some of my constituents by South Africa. I hope that he will take that as an answer.

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National Health Service (50th Anniversary)

10.59 am

Mr. Llew Smith (Blaenau Gwent): Some anniversaries, like birthdays, are best forgotten, but others cry out for recognition because of their relevance to present-day society. Fifty years on, the national health service is one such example. As a Labour Member of Parliament and one who has the privilege of representing a constituency that in many ways gave birth to that service, I believe that that legislation was the finest piece of socialist legislation this century and created the jewel in our crown. We should never forget that the service was created when we had just gone through another world war and this country was just about bankrupt.

There is a certain irony here in that, 50 years on, we are still not only debating what form the national health service should take but, in the rich country that we are today, whether we can afford the sort of service that my predecessor Nye Bevan envisaged. When he spoke on Second Reading of the National Health Service Bill on 30 April 1946, he outlined his vision of a health service, saying:

As we were reminded, it was to be a national health service in which the rich and the poor were to be treated alike, where poverty was not a disadvantage and wealth not an advantage.

I was reminded of that many years ago when Professor Richard Titmus recalled a visit to a London hospital for the treatment of cancer. He was being treated at the same time and the same place by the same doctor for the very same reason as a young West Indian lad. Titmus observed that what determined who would be treated first each day had everything to do with the vagaries of London's traffic and nothing to do with the amount of money that they had in their pockets.

How different that philosophy and that of the early pioneers of the NHS is from what happened during those awful 18 years of Tory government. We all remember the then Prime Minister, now Baroness Thatcher, proclaiming to the world that the national health service

when in reality she was transforming the service to one that someone described as geared to meet the young, the rich and the healthy, ignoring the poor, the old and the chronically sick.

Obviously, I am pleased that the Government are making considerable efforts to reverse that trend and rectify those wrongs. Additional investment in the service is one of the many ways in which they are doing so. However, Nye also recognised that good health did not depend merely on the health service. He was the first to draw comparisons and to state that, to have good health,

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one also needed a good standard of living--therefore, if one wanted to tackle bad health, one had to tackle poverty. That was also recognised many years later with the publication of the Black report, which explained

    "inequality in health can only be understood in relation to poverty and poor working conditions."

That is still obvious in my constituency, the birthplace of the national health service, which unfortunately is either at or near the top of the league tables for heart and respiratory diseases, cancers, mental health problems, long-term sickness, disabilities and rates of infant mortality, standardised mortality and low birth weight babies. No one will be surprised, if one accepts the link between poverty and bad health, that my constituency is in one of the poorest local authority areas in Wales. We have the highest unemployment in Wales and some of the lowest income levels in the United Kingdom. We also have inadequate housing. If all those and many other factors are brought together, one gets the sort of deprivation that we experience every day.

Neither this debate nor the 50th anniversary celebrations should be an exercise in nostalgia. I suspect that Nye would treat such an exercise with disdain and that he would want us to learn from those 50 years how we can build on his achievements and those of others. Nye would also be honest enough to see the need to point out where successive Governments have been going and are going wrong in their attempts to tackle bad health.

Once again, I shall give an example from my local authority, which is one of the smallest and poorest in Wales. In the past three years, successive Governments with their cuts have made the local authority make resulting cuts of approximately £14 million. One cannot have such cuts in a poor local authority area without adversely affecting the service provided and the health and standard of living of people in the community.

Local authorities like mine also lose out in other ways. For example, many of our health clinics have poor resources and many of the valley constituencies, including mine, also lose out because they find it difficult to attract doctors to set up practices. In my constituency, that situation has been exacerbated by the actions of the local area health authority. For example, a doctor retired in Cwm, Ebbw Vale, which has serious health problems, as do other parts of the constituency. Instead of the health authority replacing that doctor with another, it decided to transfer his work load to another local general practitioner. Obviously, that was not good enough and did not respond effectively to the problems of our community. Much to their credit, the local people raised their voices in protest and, as a result, the health authority was forced to reverse its plans. It then promised us another full-time permanent doctor, but we are still awaiting the replacement a number of years later and we still have only a part-time, temporary doctor.

The Government are not only aware of the link between bad health and deprivation, but are trying to do something about it and, for me, the most important legislation during this Parliament must be the introduction of a minimum wage. However, the effectiveness of such a wage in combating poverty will obviously depend on the level at which it is set. I accept the arguments put forward by many individuals and trade unions, including those representing health service workers, that, if the wage is to be effective, it should be set at £4.60 per hour.

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My next question concerns the possible privatisationof the health service. Successive Governments have proposed or enacted legislation to privatise different public services. Indeed, they seemed to want to copy the United States of America, for example, and how it runs such services.

Many years ago, I read a book on health care in the United States, which mentioned that the chair of Kentucky Fried Chicken had decided to resign his position to head the new Hospital Corporation of America because, as he said:

I do not know how many hon. Members have tasted Kentucky Fried Chicken but, if they have, they will be justifiably concerned that the quality of the product will be what we could expect if the health service is privatised. To allow such an organisation to be involved in the health service would be as nonsensical as to allow McDonald's, for example, to be involved in the organisation of education zones.

I know that the usual response to those who warn about the privatisation of the health service is to say that it will never happen, but the reality is different--one has only to think of the private finance initiative, for example. It is good to see the Secretary of State for Wales here today. He was sponsored for many years by the National Union of Public Employees, and then by Unison, as it became. Unison described the PFI as creeping privatisation, and I agree with that sentiment. It referred to Labour's announcement of major acute hospital PFI schemes, and reminded us that

Responsibility for running services is being handed to the private sector in return for private finance. That, as Unison argues, is creeping privatisation, which will, in the long term, be very expensive for the NHS.

If Government spokespersons are not willing to accept the opinions of so great a union as Unison, I am sure that they will want seriously to consider the words of my right hon. Friend the Secretary of State for Social Security, whom we all respect. In 1996, as a shadow health spokesperson, she said to a Unison conference:

I agree with what she said then, just as I agree with Unison now.

If Nye had wanted a health service to be provided by private companies, he would not have created the national health service. He inherited a patchwork of voluntary, local authority and private hospitals, from which he created a national health service free at the point of use--a service for people, not for profit. If he had wanted a national health insurance system, he would have created one. Nye believed that it was vital that the NHS should be provided by the public sector--the PFI undermines that vision.

As we celebrate the 50th anniversary of the foundation of the NHS, the Welsh Office has published a consultative document proposing a trust to cover the whole of Gwent.

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I believe that that will damage the service in the northern part of Gwent. I want Gwent to have two trusts, but that is not my opinion alone--it is also the opinion of the Blaenau Gwent borough council, Monmouthshire county council, the community councils in the area, the Nevill Hall trust, the community health councils in north Gwent, many voluntary organisations and thousands of people who have signed a petition.

If the Minister is unwilling to listen to those bodies, perhaps he will listen to the 166 general practitioners who have gone public in their opposition to the Welsh Office's one-trust proposal. When I raised the issue some months back, only 50 GPs opposed the proposal; now, 166 GPs oppose it, and that number is increasing every day. Those people should not be ignored. I know that the Welsh Office will say that Gwent health authority supports the scheme, but, in fact, the health authority expressed only a marginal preference for that option. All the main players--for want of better description--have come out in opposition to the Welsh Office proposal.

I am aware that one of the reasons why the Under-Secretary of State for Wales, my hon. Friend the Member for Bridgend (Mr. Griffiths), opposes the two-trust option for Gwent is that he does not want to break up local authority areas. However, in giving trust status to Cynon Valley and Merthyr as part of the North Glamorgan trust, he accepted the need to break up the Rhondda Cynon Taff local authority area. We in my constituency do not object to that proposal--indeed, we applaud the Minister's wisdom--but we argue that he should apply the same reasoning to our community. He may argue that Cynon Valley and Merthyr already had their own trust, but that does not detract from the fact that he is willing to break up local authority areas.

It is proposed that there will be 15 trusts in Wales to serve 2.9 million people--each trust will, on average, serve just under 200,000 people. However, a single trust for Gwent would cover some 550,000 people, although even that is a considerable underestimate, as it does not take into account the catchment areas in Powys and, indeed, parts of Herefordshire.

On 30 March, my hon. Friend the Member for Bridgend perceptively conceded that the trust, if approved, would be very large. In the consultation document, he said:

He could also have said that it would employ a massive bureaucracy of 10,000 people and that it would probably cover an area of some 300 square miles. He seemed to be of the opinion that, for Gwent, big is beautiful. However, for some reason, he decided to reject that philosophy for his constituency. Indeed, the trust that he has set up to cover his constituency and the two neighbouring constituencies will serve a population of only 270,000. I wonder why that is. If we accept the logic of the view that big is beautiful--that trusts to serve 550,000 people are acceptable--Swansea should be added to the trust that will cover those three constituencies, as such a trust would be similar in size to the one that is proposed for Gwent. We in my area and in the area of my hon. Friend the Member for Monmouth (Mr. Edwards) do not argue that the trust serving Bridgend, Port Talbot and Neath should be merged with the one serving Swansea. All we are saying is that that is the logic of the Minister's position.

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We want a trust in north Gwent that can concentrate on the health problems that I have outlined. We do not want a single trust covering the whole of Gwent, under which we would be lost, as we have been lost in the past. The present health funding formula does not take into account the number of people who need long-term care, so areas such as Blaenau Gwent are discriminated against because of their poverty and serious health problems. That is hardly a socialist principle, but it is the reality.

To deal with the winter bed crisis, north Gwent received only 22.5p per patient, whereas the south of the county received £3.47. A year or two ago, it was decided that the provisions for mental health in Gwent should be reorganised. The person appointed to carry that out admitted at a public meeting that he knew nothing about the area. He did not bother to consult the patients, their families and friends, nurses, doctors, local authorities, community councils, trade unions, Members of Parliament or the community health council. That is how we in Gwent have been treated, and we do not want history to repeat itself.

The Minister says that there will be a phased replacement of existing technology and information systems. How long will that take and what will it cost? He says that the existing management responsibilities will be retained until April 1999 and that key responsibilities will be identified as soon as possible. Tell that to a demoralised staff, who are facing yet another major upheaval.

The Minister tells us that locally delivered services will continue to be provided in north Gwent, but he does not say whether they will be the existing services or whether they will be enhanced or reduced. Of course local services will be provided locally: they would not be local services otherwise. What guarantee do my constituents have that they will not have to travel 30 miles to a hospital for treatment or to visit friends or family?

I warn my colleagues in other parts of Gwent that, if high-quality clinical and surgical services are transferred to south Gwent, day-to-day routine operations could be transferred to the north. That would not only affect morale and recruitment in the north but would mean that patients and visitors from Newport would have to travel to Abergavenny.

There are no real health arguments for the one-trust option, and even the possible savings seem to have been watered down. The Government's penny-pinching attitude does them no credit in a country that is now so rich and that was so desperately poor when the national health service was created 50 years ago.

We are told that this is a consultation exercise. We hope that it is; if it is, the Minister will find out that virtually all the community is opposed to the proposals. If it is consultation, and not merely another public relations stunt, the Minister will have the courage to alter the proposals from one trust for Gwent to two. If he fails to do that, we shall all know that it was consultation in name only, and our communities will lose out once again.

We hope that the legacy of the Government will not be one of damaging the national health service that Nye and others had the imagination and courage to create. Future generations would not forgive us for that. Let us build on the positive aspects of the Government's work in the national health service and ensure that, this time at least, justice is done for the people in our communities.

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