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Rev. Martin Smyth (Belfast, South): On a visit to New Zealand, the Select Committee on Health, met a medical manager who told us that when a hospital was allowed to have more than 400 beds, it ceased to be properly managed. I wonder whether in thinking about beds, we miss the real issue—that we are not getting suitable management to use what we have properly.

Mr. Redwood: That is a valuable point; our system is over-administered and undermanaged. As described by my right hon. Friend the Member for South–West Norfolk, it has layers upon layers; an increasing number of trusts and committees preside over that massive expenditure and absorb a lot of money.

What do we get? We do not get more operations; we get more glossy brochures. We do not get more nurses and doctors where we want them; we get more assistants, administrators, advisers and other consultants. We get more accountants and so-called financial control, but we do not seem to get the health care that we require.

There was a certain poetic justice in hearing on the radio only this morning that the curse of the cuts has at last caught up with the Labour Government. I remember all those regular occasions when Conservative Ministers were invited into studios to be pilloried on that basis. Having announced hundreds of millions or billions of pounds of extra money, they were told that it represented a cut, because it was bespoke and people in the service for which it was destined always wanted more. Of course they did; that is the nature of the political and administrative bargaining process.

As Labour spokesmen stoked up those issues in those days, it was apt to hear on the radio this morning no less a figure than the Secretary of State for Health clutching his billions and saying, "Haven't I done well?" but having to face a letter from a senior chief executive in the south-east health region. The letter was sent to all the chief executives of the hospitals in that part of the world. It said that they were in a dire financial situation and had immediately to make cuts of £60 million in the last two months of this year in order to live within what the Minister has described as very generous budgets.

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The letter went on helpfully to state that that would involve making very difficult decisions and damaging the clinical and medical services to the people in each of the areas concerned and in respect of each hospital and trust.

The Secretary of State said that £60 million was rather a small sum, as that part of the country was getting £6 billion, and that anyone should be able to manage things better in order not to need the £60 million that the chief executive thought to be missing. The right hon. Gentleman is probably right, but the problem is that his chosen chief executive, who is responsible for finding the £60 million, could not do so. She said that it was impossible and that she could find it only by damaging medical and clinical services. The Secretary of State should be a little more humble. He should either decide that he has got the wrong person running that great big chunk of the health service—if it is so easy to find the £60 million, he must find the person who can get it without doing any damage—or accept that there is a problem and that these sums are not enough and he is at least £60 million light in that particular part of the world, and probably light in other parts of the world as well, as we will discover.

When the national health service was launched in 1947, before most of us here were born, I imagine that its establishment was a great relief for many people who had voted Labour, or indeed had voted Conservative and were wedded to a similar type of scheme. It was a bipartisan view that people should be taken away from fear of the doctor's bill and that there should be much more state involvement. It was the question whether the hospitals should be nationalised that caused the dispute between the main parties. None the less, a bipartisan church had been working on the issue, as had Labour people. I can understand why. It must have been great. When the health service was set up, people on low incomes were offered a much higher standard of health care than they could previously have aspired to in terms of the voluntary arrangements and charging that predated the national health service.

I often wonder what would have happened if, at the same time as launching the health service, or instead of doing so, Labour had said, "It is terrible that a lot of people are not rich enough to have a holiday, so we will set up a national holiday service." One can see how attractive such a proposal would be. Everybody would have a week's free holiday in a resort of their choice.

Mr. Lilley: Not in the resort of their choice.

Mr. Redwood: My right hon. Friend is ahead of me. First, they would have been offered the resort of their choice, just as they were offered the health care of their choice. However, if the then Government had introduced such a service and nationalised the buses and railways to get people to their destinations, we would now be sitting around debating why it cost so much to run the service and asking why I had been told that I must go to Skegness when I wanted my two weeks in Bournemouth. We would be asking why, although I said that I wanted to go on holiday in August, I was told that I had to go in February in two years' time, because there was a long waiting list. If somebody had then told me, "By the way, when you get there, you'll have to share a hostel dormitory with lots

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of other men, although I hasten to add that you'll be given your own bed," I would by that stage have decided that I had grown out of the national holiday service and that the lack of choice and the frustrations were not very good.

Labour Members have been kind enough to giggle a little about that prospect, but I ask them to think about why we have not modernised the offering of the national health service as we should have done. Is it right that people should now be told that they have to go into mixed or even single-sex dormitory wards? Why is there not a choice of separate rooms or better partitions? Is it right that patients are offered a fairly standard table d'hôte menu? Could there not be more imagination in the range of meals and eating times?

Is it right that there are so few additional services available even for those patients who would like to pay a little to enjoy different services while they are in hospital? Why cannot patients rent digital multi-choice televisions and computer systems to play with while they are trying to recover from an operation? Why cannot they have a range of services available at their bedside or, even better, in their room, to cheer them up? We are not thinking creatively enough about what people would like or about how we could use the money that people would freely choose to spend while still enjoying the benefit of the fundamental pledge to give them a roof over their head, the operation that they need and the nursing care that they receive in hospital.

I know that the Health Secretary has said that he will consider such matters, and I hope that he does. I hope that he will also consider how private finance can be jazzed up and made to work a little better. There are too many cases of private finance delaying necessary developments and of a failure properly to transfer risk, which is part of the purpose of having a private finance initiative. Why does the Secretary of State not decide that it would be a good idea to alleviate the bed crisis by allowing private enterprise to build blocks of rooms on or adjacent to the sites of leading hospitals where that is physically possible, as it must be in many cases? People could then choose to rent the room of their choice while receiving free NHS care. Would that not build a proper bridge between the NHS and the private sector and help to create capacity, which is clearly lacking at the moment?

We could then concentrate more NHS money on clinical and medical care, hiring more nurses and doctors, because we would not need as many ancillary staff if part of the hotel functions were paid for by patients choosing to spend their own money. Pay beds used to be anathema to Labour, but there are still some left. They would now be seen as a public-private partnership. I am happy to use that language because that is the sort of PPP that we need generously to expand so that we can give people more choice, modernise the service, bring in more money and provide more care and treatment.

I still have too many constituents who cannot get the treatment that they need for the simple reason that there are not enough beds in the local hospital and there are not enough nurses and doctors to service the number of beds that we need. Those problems can be solved. The Government always say that there are not enough nurses and doctors because they inherited a situation in which there were not enough nurses and doctors. It takes three years to train a nurse. If the Government were very worried about the number of trained nurses in the country,

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all they had to do in their first or second year was to increase training, and by now they would have had as many nurses as they wanted.

As my right hon. Friend the Member for Hitchin and Harpenden has said, there are many trained nurses throughout the country who choose not to work as nurses, either in the NHS or at all. The Government ought to address that because it shows that there is something wrong with the terms and conditions of employment in our hospitals. If the Government have so much money and the problem is one of pay, the solution is simple—to put up pay to a level that people find acceptable.

I hope that the Government will listen to their colleague the hon. Member for Reading, West, if not to me, on the issue of pay differentiation. The hon. Gentleman is right to say that it would be fair to give nurses throughout the country a fairly equal standard of living rather than to pay them all the same amount. If they are paid the same, nurses in Reading and London will have a pretty miserable quality of life, while those in cheaper parts of the country will do a bit better, and that would not be terribly fair. The Government ought to consider how they can find a better solution to the pay problem, particularly in depressed parts of the country.

If the problem is morale, as I fear in some cases it is, and working conditions, the great bevy of managers that the Government have brought into the NHS ought to be able to tackle it. If they cannot, the Government must sort out the management. I fear that the management is too cumbersome and complex; there are too many people in the chain of command, and health service managers often take a very defensive approach. It is much easier to have another consultation, hold another committee meeting or send out another glossy brochure than to make somebody responsible for something and try to make something happen as a result.

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