Below is the text of the maiden speech made by Francis Maude in the House of Commons on 27th October 1983.
I cannot hope to match the rhetoric of the hon. Member for Bradford, West (Mr. Madden), who spoke with great passion. I am grateful to you, Mr. Deputy Speaker, for giving me the opportunity in this debate to make my maiden speech. I am not quite the last of the new intake of Members to get off the mark, though the list of those who have not done so is gradually diminishing.
My constituency is more recreated than new. It has been absent from the political map of Great Britain for about 98 years. It disappeared under the hand of the Boundary Commission of 1885. I would be delighted to follow the convention of paying tribute to my predecessors from that time, but, even in the healthy climes of Warwickshire, North, I have not been able to find anyone who remembers them.
Warwickshire, North was created from two previous parliamentary seats—the old seat of Meriden and the old seat of Nuneaton. It has been used to a high standard of parliamentary representation. The old seat of Meriden was one of the most marginal seats in Britain and changed sides politically at each election. It had a series of talented and hard-working Members of Parliament, including my hon. Friend the Member for Ashford (Mr. Speed), my hon. Friend the Member for the new seat of Meriden (Mr. Mills) and, between them, Mr. John Tomlinson, who was my Labour opponent in June. All three of them served their constituencies and the House with distinction. They worked for their constituents most conscientiously and all are remembered in Warwickshire, North with gratitude and affection.
The Member who represented the old Nuneaton constituency, from which I have the town of Bedworth, was Mr. Les Huckfield, who I believe worked hard for his constituents wherever they were. I am sure that he will make his involuntary absence from the House a temporary one.
It is customary to talk about one’s constituency and I find it a pleasure to do so. It is in the area of the west midlands which is precariously balanced between but excluding Birmingham, Coventry, Nuneaton and Tamworth. It contains a wide range of activities and occupations. There is an example of virtually everything except, I think, deep-sea fishing. There are four flourishing coalmines with industrious and extremely realistic work forces. There are many square miles of extremely efficiently husbanded farmland. There is a multitude of small, specialised and innovative engineering firms, about whose interests I shall have much to say on other occasions. It contains a number of towns and villages which are expanding and which are providing housing for people working in Birmingham and Coventry. All in all, it is a demanding, stimulating and delightful constituency which I am proud to represent.
The Health Service is increasingly perceived not to be short of resources. There is a mismatch between needs and resources. This explains the apparent paradox that there are too many acute hospital beds while there are still long but, I am glad to say, decreasing waiting lists. There are thousands of beds in acute hospitals that are not being used by those who need acute medicinal care.
About 20 years ago provision was made for people not in need of acute care in cottage hospitals, which we now have to call community hospitals. Nursing care was provided with overall medical supervision from general practitioners. In our wisdom, we chose to get rid of them, but they had many advantages. I believe that in future we shall have to look towards that sort of provision if we are to match needs to resources. The cottage hospitals were cheap to run and they were local. That was especially important in rural areas where people wanted to visit elderly relatives in hospital. The fact that they were close to the areas that they served was an enormous advantage. They were small and because of that they were efficient and cheap to run.
The problem is to decide how we shall pay for that sort of hospital. We must look to much more effective management of resources within the Health Service. There are many parts of the service which are overmanned and it is folly to ignore that unfortunate fact. These areas are not overmanned only by ancillary workers. In some parts of the service there is an over-provision of medical resources and, as I have said, we must match resources to needs.
There is a massive inertia built into the present NHS management structure. I served for a short period as a member of a district health authority shortly after the reorganisation of the NHS. It took an extraordinarily long time for any changes to be made. I believe that the fault lay with the system of consensus management which arose in the early 1970s. No one person carried final responsibility for what actually happened. Members of the district management team took it in turns to act as chairman of the team, and that meant that the system had inefficiency built deep into its structure. I am delighted that the Griffiths report recommends the appointment of chief executives and general managers, who will carry the can for the units that they run. This is an essential step if we are to get inefficiency out of the system.
Many part-time members of district health authorities do a good job, but even those with a will to do so have difficulty in rooting out inefficiency. They do not have the time to do so and in many instances management is incapable of providing the information on which they need to act. It came as no surprise to some of us that in the recent review a number of authorities were unable to provide figures and information on the number of people that they employed. If anyone in the private sector tried to run a business in that way, he would not be around for long. It is astonishing that such a situation was allowed to continue for so long. It is a source of delight to me—and it should be to the entire House—that dramatic and radical action is being taken to improve the level of efficiency of management.
There exists an attitude which has fossilised the way in which we view the National Health Service. The idea seems to be propounded by Opposition Members that it is uncaring and uncompassionate even to contemplate the possibility that the Health Service is working at less than full efficiency. It is as though, in allocating money to the Health Service, one puts a label on it saying “NHS”, and then one cannot follow where it goes. One cannot find out how it is spent. One assumes that because it goes to the Health Service it is automatically going to a good cause. One does not improve the Health Service just by pumping in money to make the statistics look better. The Health Service exists to provide a service to patients, and we must make sure that the money goes where it is needed.
It is therefore folly, when a private contractor can provide an ancillary service better than the direct labour force, to set one’s face against it. The right hon. Member for Islwyn (Mr. Kinnock) made a number of points in his passionate speech about the way in which private contractors can operate. One cannot guarantee that a private contractor will provide a perfect service, any more than one can guarantee that a direct labour force will provide an adequate and efficient service. The difference is that if a private contractor falls down on the job it is possible to replace him immediately. As the privatisation of ancillary services develops, there will be an increasingly large number of firms which are able to take on the work at short notice. There will be competition and efficiency in those important services.
Discussions about the National Health Service have been surrounded for some years by a cloud of muddle and cant. Now we have to tackle the real problem, not so much of shortage of resources as of making sure that the resources we have go where they are needed. That is the challenge for the future, and it is a challenge that the House must face.