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Baroness Jeger: My Lords, this is the first time that I have felt happy to be so old. When one is talking about the National Health Service one needs to look through

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a telescope and remember what healthcare was like before the NHS was set up. We have the right year for our 50th anniversary but we do not have the date quite right. The appointed day was 5th July 1948. So I hope we shall have another party, even if we do not have another debate, on 5th July 1998.

The noble Lord, Lord Jenkin, referred to keeping politics out of the NHS. I am so ancient that I can tell him that the NHS was born in politics. I know that my noble friend Lord Bruce of Donington--another old chap like me--will remember the battles that took place to get that legislation through. What could have been more political than the Third Reading debate in the other place--216 in favour and 113 against? I am glad that things have become more sensible but we should not forget--we are allowed to reminisce a little on anniversary days--that it was a long and difficult fight. Five Labour MPs in that parliament were doctors--my husband was one. They were expelled from the BMA on the ground that they had voted for socialised medicine. They had refused to put up notices in their waiting rooms urging patients to express their disapproval of the proposals which were before the House.

My husband was very much in the background, but he was very close to Aneurin Bevan. Sometimes Nye would come to us in the evening and say, "I have had five royal colleges on to me today and the society of this and the committee of that". He would then ask us, "Come on, tell us what your day has been like at the coal face?". The "coal face" was a very poor part of Shoreditch with very modest premises. It was very near the London Hospital where my husband had trained. He deliberately chose to use what training and gifts he had to work in what was a very deprived area. Therefore, when one looks back I hope that we put some marks on the credit side.

One of the things that impressed me most was the number of patients who came to see us and to whom he had to say, "Why did you not come before? Why did you not bring the baby months ago?". People would say that because they had not got any money they hoped that the illness would get better. As the noble Baroness said earlier, that was a fact of life in those areas.

I wish briefly to put on record some of the factors on the credit side that should go into any sensible person's ledger. I think of the reduction in the number of illnesses that used to be fatal. For instance, there was polio. There were many infectious diseases for which the National Health Service provided the necessary injections. The numbers of those illnesses have been drastically reduced. I know that one must give some credit to the engineers who built the sewers for the fall in the number of infectious diseases. That was all part of the raising of standards.

One of the changes that I see is that patients are now coming earlier because of better education and understanding of their prospects. In addition, they do not get a bill at the end of the consultation. It is those patients who come to the doctor earlier, but I regret that the National Health Service is coming in later. One of the disasters of the present situation is the waiting lists.

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They are one of the most expensive elements in the NHS. With my limited experience, I do not know of any operation or treatment which becomes cheaper the longer the patient has to wait for it.

We hear of people needing surgery being told to wait 18 months or even two years. I do not know how much money that saves, but I do know that on the other side of the ledger is the cost of such patients being unable to work. They need social security services, which are not always widely available in some areas. They seek housing benefit, statutory sick pay and help for bringing up their children. Older people now need much more support at home. I wish that we could bring these two bits of arithmetic together and find out whether there is any real saving in postponement with long waiting lists. I want to know what these waiting lists cost. So many of them are unnecessary because the facilities are available.

When I first came to the other place there were 13 hospitals in my constituency of Holborn and St. Pancras. I am very glad that my old colleague on St. Pancras council is now the Secretary of State for Health. He has given such a good start to our revision of the situation for London hospitals. I am very glad that we are discussing hospitals in London. The trouble is, however, that the Tomlinson report thought that London hospitals were exclusively for Londoners. Nothing could be further from the truth. I often used to visit those hospitals. I did not find many of my constituents there so I certainly was not going to the hospitals canvassing for votes.

There were the teaching hospitals such as Great Ormond Street, the University College Hospital and the Hospital for Nervous Diseases, as it used to be called, in Queen's Square. It was like an international party. Not only were there patients from all over the country, but from all over the world. There were not only patients, but students and nurses from all over the world were training so that they could go back to their own countries and take their gifts and accomplishments where they were most needed.

I never took much notice of the Tomlinson report because it got it all wrong as regards the proportion of the population to hospital beds. That committee had the nerve to write that the Royal Marsden hospital was "isolated and vulnerable". There are some Members of your Lordships' House who have reason to have better opinions of the Royal Marsden hospital. How did the word "vulnerable" come into the report? I decided that that hospital was only "vulnerable" to money-pinching governments who thought that it cost too much--as if anything could cost too much in that direction.

I was very glad that the Prime Minister and Frank Dobson visited the Chelsea & Westminster hospital on 18th December. The Prime Minister was told by the head of surgery about his anxieties. The orthopaedic department had been told that it worked too hard and too well. It was doing 10 expensive operations a week. It was asked to reduce that number to three. The surgeon said, "What would you feel like if you had to tell patients who had been waiting for weeks and weeks that they had to wait more than a year?". In fact, a letter

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went out from that hospital telling patients that there was no hope of receiving surgery in 1998 and that it was not possible to give them a date for the following year.

What is saved by a half-empty theatre? Consultants are paid full-time. There are marvellous theatre nurses and sisters. They were told to cut down on the work. It is not a question of wanting productivity in the health service. That has happened at several hospitals which I know only too well. The staff are paid so there is no saving there. The patient goes home. The GP has to get in touch and perhaps the district nurse or the community nurse, or whatever they are called, and the home help are called in.

Baroness Gardner of Parkes: My Lords, perhaps I may remind the noble Baroness that when the figure 10 appears on the clock, we have finished our time.

Baroness Jeger: My Lords, I was just finishing. I want the arithmetic sorted out. It is absolutely criminal. We know how to help people. For example, we know that a day cataract operation can save someone from going blind, but we tell old people of 80 years of age that they will have to wait two years for the operation.

4.59 p.m.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for giving the House this opportunity of paying tribute to 50 years of the National Health Service. I congratulate the noble Lord on his excellent speech. The debate gives me the opportunity to say how delighted many people throughout the country will be at the wonderful news about St. Bartholomew's Hospital--875 years of healthcare should make it a unique historic listed monument which should have a preservation order put on it for ever. It was given to the people of London for their health needs and has always had an outstanding reputation.

The Minister knows my enthusiasm for specialist centres of excellence. I hope that in time St. Bartholomew's will inspire brilliant doctors and scientists to find much-needed advances in cancer cures. I am thinking today of a loved wife of one of our estate staff in Yorkshire, who is the young mother of three children, the youngest being five years-old. She has fought cancer for three years and has been admitted to the local hospital, may be for the last time. I was very pleased to hear the happier story from the noble Baroness, Lady Pitkeathley. Cancer is claiming too many lives. I am thankful that the Government are trying to put that dreaded condition high on the health agenda.

May I ask the Minister whether the HIV/AIDS unit will remain at Bart's? A vaccine for AIDS is becoming a global priority and if there is to be cancer research at Bart's, it seems that the research for an AIDS vaccine could be developed in such a centre. May I also ask whether there is to be a five-day casualty centre for the City of London? So many people come into the City to work. What will happen when someone puts an arm through a glass door or has chest pains?

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A few days ago at the Chelsea & Westminster Hospital a surgeon told me that many of the operating sessions had been cut by about 15 per cent. That seemed to be causing frustration when the hospital staff are there, but the health authorities cannot afford to buy the operations. Is not that a waste of resources? How are waiting lists to be cut if that sort of thing is happening?

National Health Service facilities up and down the country differ a great deal. Better communication at all levels is needed, most of all with patients and their relatives and with hospitals and the community. There may be fragmentation between different trusts.

Some weeks ago, my husband, whom some of your Lordships will not know is a Member of this House, developed emboli in his lungs while in hospital. An appointment was made for him to go to another hospital 16 miles away to have an isotope investigation. The appointment was for 2 p.m. At 4 p.m. the ambulance had still not come. The ambulance has its own trust. Can your Lordships imagine what it is like to be waiting?

Last Friday I was invited to visit the Glaxo Department of Dermatology in South Cleveland Hospital in Middlesbrough. It is an integrated out-patient and in-patient unit. It is an excellent unit, serving a catchment population of approaching 900,000 people. I was most impressed by the dedicated staff and up-to-date equipment, but I should like to bring to the notice of the Government and your Lordships some of the concerns of that unit, because no doubt they can be echoed throughout the country. There is a need to improve general practitioners' understanding of skin diseases. There are difficulties in persuading purchasers to fund extended roles for nursing staff. Hospital drug budgets are inappropriately low for all skin needs. There is also a need to extend the drug tariff to include 10-metre lengths of Tubifast bandaging for eczema and four-layer bandaging for venous ulcers to allow the shift of patients into the community. There would be a saving of hospital and patients' time if that could be done nearer home. I should be grateful if the Minister could look into that and write to me about it.

During the last War, in the 1940s, Dr. Ludwig Guttman, a neurologist who had come to Oxford from Germany before the War to escape Nazi Germany, was asked to start the first spinal unit at Stoke Mandeville Hospital. Many paraplegics (due to spinal injuries) were expected. Service personnel were treated at the unit with Army nurses and Dr. Guttman. It was in 1948 when the NHS was born that civilian paraplegics were admitted to that unit and it became world famous for its pioneering treatment. Other units throughout the UK and the world were developed from it.

Patient associations help to promote the needs of their members. I founded the Spinal Injuries Association with colleagues 24 years ago. Before the National Health Service, paraplegics had a disastrous time being treated in general hospitals, generally dying of sepsis through pressure sores or urinary tract infections. The Spinal Injuries Association knows that spinal injuries need specialised care in spinal units. Sometimes in emergencies spinal patients go to general hospitals. There have been some serious cases of hospitals not

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following the recognised procedures; for example, patients who cannot evacuate their own bowels are refused help for that vital act of life. Why cannot the staff ask the patients and, if they are too ill, ring a spinal unit for advice? Also, as the Minister will know because I have written to her, patients have died because they could not be transported to their spinal unit when very ill. If it is to be a patient-led health service, I hope that the Minister will help patients to get the correct treatment in the correct hospital and whatever their condition requires. We do not want to return to the bad old days before the National Health Service.

At the same time as the spinal units were being developed, so were the lifesaving antibiotics. We became reliant on them. Now, with over-use and wrong use, they are becoming resistant to many bacterial infections.

There is nothing more important than good health. I hope that the Government will do all they can to prevent illness and the spread of infections. Health education needs to be promoted at all levels. The National Health Service is an insurance policy for everyone. With the quick turnover of very sick patients in hospitals, the immense pressure on the service should be recognised.

I have served on a community health council, a health region and a family health services authority. I have seen many successes and many problems over the years. With the ever-increasing expectations of society, the National Health Service needs a great deal of ongoing support from both government and all communities throughout the country.

5.9 p.m.

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