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The debate is welcome, because it gives us a chance to debate the fundamentals of the NHS. The speech of the hon. Member for Woodspring (Dr. Fox) makes it clear that the Conservatives now prefer the American model of bargain basement public provision, with everybody else paying for their treatment. In the long run, that would inevitably lead to a decline in the national health service and, therefore, a diminution in the opportunities for good quality health care for those who cannot afford to buy privately. It is essential that we continue to adhere to the principle of a national health service that is universally available and free at the point of use.
Not mentioned much during the debate are inequalities in illness and ill health. The outgoing 1974-79 Labour Government commissioned Sir Douglas Black to produce a report on inequalities in health care treatment and in health and life expectancy. It was suppressed by the incoming Conservative Government and later emerged as a Penguin book, which sold extremely well. It is to the credit of the current Government that they have taken an interest in and adopted many initiatives designed to tackle the problems of ill health in our poorer communities.
Like my right hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), I represent an inner-city constituency. Our constituencies, compared with the rest of the country, have the dubious distinction of having higher infant mortality and shorter life expectancy, and a much greater incidence of mental illness and of notifiable diseases. In addition, to take up the remarks of the hon. Member for Broxbourne (Mrs. Roe), we have the highest incidence of suicide in the country. There are many reasons for those tragedies, including a combination of poor housing, unemployment, stress, living in complicated inner-city communities and social exclusion. I have always been fascinated by the reports of the medical officer of health for my district, because they reveal a direct link between ill health and poverty.
We obviously welcome any improvement in the health service, but it is important that that links in with the enthusiasm of ordinary people who are participating in trying to reduce smoking and improve fitness, travel- to-work areas, safety and school safety especially. There are many issues that need to be considered.
I hope that the health action zones will continue for some time. I hope also that in the examination of community health and future structures and configurations, the Minister will think extremely carefully about the size of the areas proposed, and especially the size of those proposed for mental health trusts.
I and my colleagues with constituencies in Camden and Islington represent an area with serious and acute problems, very different from the problems faced in suburban London, outer London or the rural hinterland surrounding London. If we have good working relationships developing between community groups, the local authority, the health authority, hospitals and many voluntary organisations, it is essential that we do not break them apart.
I hope that the Minister will thoroughly consider these issues before approving any reorganisation that could end up being detrimental to the interests of people in the poorest parts of inner London. It could lead in some instances to a flow of resources out of inner London. I am sure that my hon. Friend understands my argument because he must be well aware of the issues that have arisen.
The Government's amendment rightly refers to the need to continue the hospital building programme and expand it. That is something that we all welcome. Anyone who represents an area that has inadequate hospital provision will be well aware of the problems. The incoming Labour Government inherited a backlog of maintenance alone of more than £2.5 billion. A great deal has to be done in terms of capital programmes within the NHS.
The use of private finance initiatives in the funding of the future expansion of the health service has a number of effects, and not all of them are particularly good. I hope that the Minister will take that remark in the spirit in which it is intended. A trilogy of articles has been put
I ask the Minister to take seriously the concerns that many people have expressed about PFI and the long-term costs. I have an inadequate hospital in my constituency, as do many other Members. It needs rebuilding, expanding and new units, and all that goes with that. However, PFI can be regarded as a form of candyfloss. A shiny new building is provided quickly with PFI, but the long-term costs are extremely great.
The experience of PFI in many parts of the country has been that long-term costs for the local hospital and for the NHS itself have been considerable. For example, the fees charged on construction costs are much higher under PFI than they would be if the hospital were funded and built directly by public finance through the Department of Health, as I believe it should be. Also, when PFI hospitals are constructed, they tend to be somewhat smaller than existing hospitals. Research has borne out the fact that there tends to be a reduction in the number of beds in total because of the use of PFI.
I am glad that we have a sense of joined-up thinking, but it worries me that the use of the PFI in the Government's expansion programme will cost more in the long run. It is cheaper for central Government to borrow money for hospital building than to use the PFI--which gives rise to a democratic deficit as some control is lost over the building, running and management of hospitals. Many of us are deeply concerned and will continue pursuing that argument.
Mrs. Virginia Bottomley (South-West Surrey): I apologise profusely to the House for not being present for the opening speeches. I was attending a key governors meeting for the London Institute. The noble Lord Puttnam and I were equally late back for our parliamentary engagements. I shall read the Minister's comments with care.
The Economist Intelligence Unit's magnificent documents about health care, the King's Fund history of the NHS and Chris Ham's account of the past 10 years of change in the NHS show that the previous Government introduced many ways of making health care more efficient, effective and patient focused. The last Administration's patients charter, "The Health of the Nation" and mental health strategy--with almost the same targets as now--were first vilified but were then rebranded and incorporated into the present's Government's strategy.
The 1948 NHS model had a great many advantages and held its own on health outcomes; changes during the years of Conservative government brought a boost of efficiency gains--but that model is not good enough today. The UK is falling in all the international league tables. It is crazy for Labour, with its huge majority, to cling to reactionary policies that disappoint many people in the NHS. The worse the situation gets, the louder the Government's rhetoric.
My right hon. and hon. Friends are seeking to help the Government to be more constructive, responsible and realistic. In every debate on the NHS, Labour Members claim that the service has never before been so wonderful. My colleagues are telling the Government, who listen to no one, that the situation is not good enough.
I speak with great emotion about my constituency, because I have one in nine people now waiting more than a year for treatment. The number trebled after the election. In the Prime Minister's constituency, the figure is only one in 50. I understand why he might think that everything is all right, Jack, but it is not all right in my part of the world. One in nine people are waiting more than a year, even after all the Government's efforts to increase the waiting list to be on the waiting list, and the rise in the out-patient waiting list.
Week after week I deal with cases that are unacceptable. Many hon. Members despise the private sector, but I defy them not to ask people, as I have never previously done, whether they have private cover. I cannot tell them that I can do anything for them, because the situation is so bad. There is a crisis in the acute hospitals. What is the health authority doing?
I am delighted that the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), is winding up. I ask him to help me again, as he did before. Two years ago, in a debate, I told him that after months--indeed, years--of discussion and decision about Farnham hospital, a plan had been agreed for 42 beds for a day hospital and for stroke rehabilitation. That had been agreed by both trusts--it is a complex area on the fringe of two health authorities.
The plan was presented to local people as a good way through. I had worked hard to lower expectations to the minimum. Since then, according to Government rhetoric, there are too few beds, there should be intermediate beds, there is masses more money, and people have never been so lucky in their lives.
The health authority has now come up with proposals under which there would be no beds in Farnham and no beds in Haslemere, which is the town in Surrey with the highest elderly population. The health authority proposal comes at a time when there have never been more examples of inadequate care. In three cases at least--I say this particularly to the hon. Member for Dartford (Dr. Stoate), with whom I often discuss such matters--if the people involved had been treated in the private sector, I would have advised the family to sue, because in all three cases, the people lost their lives.
Under the new proposals, £900,000 is to be taken out of the mental health budget in the Waverley area, and--surprise, surprise--£100,000 is to come out of the community nursing budget. The reason behind all that is that it is a costly area. There are 300 nurse vacancies because nurses do not get London weighting.
The changes introduced by the Government have meant more top-slicing. There are ministerial back-pockets for health action zones, accident and emergency departments and all sorts of other modernisation projects, but such projects do not come to areas like mine because the basic population is healthy. It may be healthy, but it is enormously needy and demand is high. It is wrong for a poor person in my area to have a worse service than a poor person in the constituency of the hon. Member for Islington, North.
Why should one in nine people in my area wait more than a year, when only one in 50 has to wait more than a year in the Prime Minister's constituency? In his area, for every man, woman and child, £115 more is spent on health care every year. I support programmes for additional health visitors and midwives, and prevention programmes, but the gap has become too great. Not only have the Government top-sliced more, but they have squeezed the formula to make it even harder for people in wealthy areas, and they have raided the social services budget and taken away the specific grant.