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Mr. Freeman : Information on average costs per operating hour is being provided by health authorities for the first time for the 1987-88 financial year and this will be

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published this summer. Our preliminary view is that such costs will be lower than the £450 per hour estimated by the National Audit Office.

Mr. Shepherd : Does my hon. Friend agree that that information is vital to enable managements to plan their operating theatre utilisation? Does he also agree that if that information was coupled with an enhanced roll-over provision for finance from one year to the next, there could be substantially better theatre planning, which would mean a reduction in waiting lists and in the costs of operations? I urge my hon. Friend to press for an improvement in the roll-over provision.

Mr. Freeman : I can hold out no hope to my hon. Friend that we will change the percentage--the ability to carry forward up to half a per cent. of the combined revenue and capital limits. I agree that there is scope for improved planning. We need better financial and management information systems and clinicians in the Health Service need to become more involved in the management of resources, including operating theatre usage.

Mr. Alton : When considering the costs involved in carrying out kidney transplants, will the Minister consider the allegation that, in the private sector, two Turkish men were paid £2,000 to provide their kidneys for transplant? What action is his Department taking to outlaw such procedures?

Mr. Freeman : The Government have made it plain that commercial trade in vital organs is absolutely abhorrent and unacceptable. I have asked Bloomsbury health authority to investigate the allegations.

Mr. Soames : My hon. Friend will have to provide information not only about costs, but waiting lists. Will he ensure that information about the excellent practices of efficient theatres is disseminated throughout the country so that those authorities that lag behind can bring themselves up to scratch?

Mr. Freeman : Yes, we shall ensure that that is done. The waiting list initiative, which will be worth £31 million in the next financial year, is likely to result in increased treatment for more than 100,000 in- patients.

Mr. Rooker : When the figures are available, will the Minister ensure that there is a health warning attached to them explaining how they are affected by operating sessions being stood down and patients being telephoned on the morning that they are due to go into hospital and being told that they cannot have their operations? By how much will such incidents affect the figures that the Minister will produce?

Mr. Freeman : About 10 per cent. of all operating theatre sessions are planned and then cancelled for a variety of reasons. The hon. Gentleman is right to draw attention to the fact that there could be better planning by health authorities, surgeons and consultants in the use of operating theatres.

Mr. Conway : Is my hon. Friend aware that the operating theatre costs at the eye, ear and throat hospital in Shrewsbury would be greatly increased if the pre-med and recovery areas were not situated in corridors? It is time that the regional health authority was sacked or made to act on this disgraceful matter.

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Mr. Freeman : That is a matter for the local health authority concerned. However I assure my hon. Friend that I will pursue his point.

Mr. Galbraith : I welcome the Minister to the Dispatch Box for the first time at Health questions. Does he agree that the most important factor of an operation is not its cost but its outcome as to mortality or morbidity? In the light of the review, what are the Government's plans for collecting information on mortality and morbidity and what considerations are they giving to making that information available, and in particular to whom?

Mr. Freeman : The hon. Gentleman must await the National Health Service review for some detailed proposals. However, it is certainly the Department's policy to collect up-to-date statistics and I shall ensure that they are more regularly available to the House.

Hospital Waiting Lists

10. Mr. Patnick : To ask the Secretary of State for Health what the in-patient waiting list figures were for the Trent regional health authority in March 1988, 1987 and 1979.

Mr. Freeman : There were 54,900 patients on the in-patient waiting list in Trent region at March 1988. That is a 5 per cent. reduction over March 1987 when the list stood at 57,700, and 25 per cent. lower than the 72,900 patients on the list at March 1979.

Mr. Patnick : Is it not a fact that Trent regional hospital has treated more out-patients and that with extra funding even more patients will be treated? Does that not give the lie to the scare stories put about by the Opposition?

Mr. Freeman : Between 1978 and 1986 the number of in-patients treated in the National Health Service increased by 19 per cent., and in my hon. Friend's own region the increase was even more impressive as there was a 28 per cent. increase in the rate of in-patient treatment.

Mr. Janner : Is the Minister aware that the waiting lists in the Trent region remain disgracefully high? My constituent, Mr. George Brown, aged 82, who is tortured with pain so that he can scarcely sleep, has been told that he can see an orthopaedic surgeon in October, 10 months after his doctor recommended that he should see a surgeon with a view to treatment and surgery? Will the Minister please take steps to deal with that case and with other similar patients waiting in agony in my constituency.

Mr. Freeman : The hon. and learned Gentleman must take the matter up with his local health authority, but I am sure that he will welcome the initiatives that the Government have taken over the past few years and for the forthcoming year. There has been a waiting list initiative of £25 million per annum in the past, and £31 million is being provided next year to treat more than 100,000 in-patients more quickly than otherwise would have been possible.

Mr. Brandon-Bravo : I am sure that my hon. Friend will agree that the resolution of the waiting list problem in Trent and in Nottingham owes as much to the RAWP formula as it does to the special initiatives that I know

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my hon. Friend has taken. Therefore can I say yes please to his special initiatives and to the continuation of the RAWP formula which will help my district and my area?

Mr. Freeman : I am grateful to my hon. Friend. He will welcome the fact that my right hon. and learned Friend the Secretary of State has recently announced increases in allocations to health authority regions of about 2.5 per cent. per annum in real terms for next year. These are additional resources which will go a long way to help not only with waiting lists but with improvement in patient care.

Scientists and Technicians

11. Mr. Andrew Smith : To ask the Secretary of State for Health what proposals he has to improve retention and recruitment of scientists and technicians in the National Health Service.

Mr. Mellor : I understand that the management sides of the appropriate Whitley councils are investigating the nature and scale of reported problems. It is for the management and staff sides of the Whitley councils to consider what, if any, further action should be taken.

Mr. Smith : Is that reply not hopelessly complacent in view of the acute shortage of scientists in Oxford and elsewhere in the National Health Service, the vital nature of the work that they do and the fact that they are paid 40 per cent. less on average than scientists outside the service? Is it not scandalous that even now the very management side to which the Minister refers is threatening to withdraw the miserable 5.5 per cent. pay offer that was made for the as yet unresolved negotiations which were supposed to be settled last April? What is the Minister doing through the management side to tackle this matter, which puts patient care at risk?

Mr. Mellor : It is extraordinary that the hon. Gentleman commends the Whitley council system--the opposition on the council prevents any reform of the system--but then invites Ministers to move in and push the system aside. I am bound to point out to the hon. Gentleman that, whatever he may say about this, that, or the other problem affecting scientists in the National Health Service, the number of scientists in the service has gone up by 57 per cent. since 1979.



Q1. Mr. Campbell-Savours : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister (Mrs. Margaret Thatcher) : This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House I shall be having further meetings later today.

Mr. Campbell-Savours : Has the Prime Minister noted the comments of her hon. Friend the Member for Thanet, South (Mr. Aitken) who last week said that MI5, after the general election of 1979, fingered six Conservative Members of Parliament as unsuitable for office? Will the Prime Minister confirm that she received a report on each

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of those Members? Will she also confirm that each of those Members has been blacklisted for ministerial appointment? Does she not believe that all those Members have a right to know what charges were made against them so that they can clear their names?

The Prime Minister : I noted the comments of my hon. Friend. The hon. Gentleman the Member for Workington will not be surprised at my reply- -indeed he could almost have dictated it as he studied his question. I follow the rules of my predecessors : I do not comment on security matters.

Q2. Mr. Page : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Page : As my right hon. Friend is in overall charge of policy and in charge of the policy review committees, can she assure the House that the members of those committees, and particularly the Ministers, enthusiastically and regularly attend those meetings? I ask because in the latest edition of the Tribune it is said that due to lack of interest, due to lack of attendance, seven national policy committees have been cancelled by the Labour party. The Prime Minister rose --

Mr. Speaker : Order. I trust that the question was about Ministers, not about the Opposition.

The Prime Minister : As regards my responsibilities, I confirm that my colleagues, right hon. and hon., regularly and punctually attend all committees, and are skilful, forceful and effective in their comments and in the implementation of policy following such meetings.

Mr. Wigley : Is the Prime Minister aware that, recently, thousands of pensioners who last year received a mediocre--a small--increase, over and above their basic pension entitlement, which was due to a heating allowance or some such payment, have been told not to expect any increase in their pension from next April? How would the Prime Minister and her husband like to live on a pension of £55 a week with no increase?

The Prime Minister : The hon. Gentleman knows that all the special sums allocated to heating allowances for particular people were lumped together and distributed among those entitled to income support so that they received it regularly. That was done with the approval of the House. The hon. Gentleman also knows that the upratings for pensions in the future have been announced. Unlike the Labour party's figures, they follow precisely the RPI figure, and there was no fiddling with the RPI figure.

Mr. Favell : Is the Prime Minister aware that many people are deeply opposed to the Griffiths proposals that town halls should devise care packages for the elderly and handicapped? What about the family, the family doctor and the district nurse?

The Prime Minister : We shall consider precisely what to propose to the House on the Griffiths report but that will not be before the National Health Service review has been completed.

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Mr. Kinnock : Will the Prime Minister confirm that her Government take a bigger share in taxation from the incomes of the majority of families and earners than any Government in history?

The Prime Minister : The overall burden of taxation is falling. It is true that there was a time under the previous Labour Government when the burden was less than it is now. That was because they borrowed so much-- [Interruption.] Indeed, borrowing went up to 9 per cent. of GDP because they had neither the skill nor the guts to cover their expenditure by taxation. They left the debts for us to repay.

Mr. Kinnock : Why cannot the Prime Minister give an honest answer to an honest question? Does the Prime Minister recall saying that the share of the nation's income taken by the state must be steadily reduced? Can she tell us why, under her Government, it has been increased to a higher level than under any previous Government, Conservative or Labour?

The Prime Minister : The right hon. Gentleman's Government borrowing requirement rose to 9 per cent. of GDP which--in terms of today's money-- meant that they were borrowing the equivalent of £40 billion a year. We are now having to tax to repay the debt that they created. They always leave debts saddled around the necks of their children.

Sir John Stokes : My right hon. Friend the Prime Minister will know that I am not one of those who constantly asks for more spending of taxpayers' money. However, did she hear the recent remarks of my noble Friend Lord Blake about the dire straits of our historical records and great manuscripts that are in danger of being permanently damaged unless more funds are made available to look after them properly?

The Prime Minister : My hon. Friend will know that this Government set up the English Heritage foundation and gave it substantial finance to ensure that there was sufficient money available to keep those objects that are particularly valuable. There are also other Government agencies that protect and look after our heritage. I am sure that Lord Charteris will look into these matters.

Q3. Mr. Ronnie Campbell : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Campbell : What advice does the Prime Minister have for young families and couples who face mortgage increases of £50 and £60 a month? Has she the same advice as the Chancellor, who said that people in those categories must make cuts elsewhere?

The Prime Minister : Quite obviously, those people--particularly those who very recently purchased houses and, therefore, did so at the top end of the market--are having particular difficulty with mortgage increases. That does not alter the fact that we must put the reduction of inflation at the top of the list, and we have to do that through interest rates. Those who purchased their houses before that time, have enjoyed a considerable increase in

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capital. Indeed, as the hon. Gentleman knows, often those who lend money to others to purchase houses do not do as well as those who buy the houses.

Q4. Mr. Jack : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Jack : Will my right hon. Friend accept my congratulations for the support which she is giving to the world ozone conference? Does she agree that the destruction each year of an area equivalent to Great Britain of Brazilian rain forest highlights another major threat to the world? Will she outline to the House the measures that the Government intend to take to alleviate the problem?

The Prime Minister : My hon. Friend knows that the second part of the world ozone conference is being held in London on 7 March when we hope to cut the emissions of chlorofluorocarbons by 85 per cent. from what they were. We have already reached our target of cutting them by 50 per cent. We think that we should go further. The other matter which he mentioned has more to do with carbon dioxide, or the greenhouse effect. The cutting down of tropical forests on the present scale is having an adverse effect. The overseas aid Department, under my hon. Friend the Member for Bath (Mr. Patten), takes into account the willingness of countries to keep their tropical forests when giving aid to them.

Dr. Cunningham : Since when?

The Prime Minister : If the right hon. Gentleman had been listening to what I said before--of course, he was not here--he would have known that this is not a new policy. It indicates the great significance which we attach to the keeping of tropical rain forests.

Mr. Sean Hughes : Does the Prime Minister share the view expressed earlier by the Secretary of State for Defence that no responsible British Government should rule out the possibility of having to fight, and presumably win, a conventional war in Europe?

The Prime Minister : I am not quite certain what my right hon. Friend said but we both hold precisely the same view-- [Laughter.] That could have been better put, could it not? I am not certain whether the hon. Gentleman's report of what my right hon. Friend said is correct ; indeed, I doubt it. Let me make it clear ; conventional weapons, however strong, have not been enough to prevent war from starting. That is the lesson of history. Conventional weapons alone have not been enough to prevent the start of world war. We believe strongly that it is vital to have a nuclear deterrent. It is that which has kept the peace in the last 40 years.

Q5. Mr. Andrew Mitchell : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Mitchell : Given that health care has been, is and will continue to be provided on the basis of need and not on the basis of ability to pay, does my right hon. Friend agree that the Pavlovian reaction of distress from the

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Opposition Benches is completely synthetic in view of the fact that the review is designed to inject added efficiency to ensure that resources for patient care go further?

The Prime Minister : Certainly the Health Service will continue to be available as now on the basis of those who need health care getting it at the time when they need it. One point of the review is to get better value for money from the enormous extra resources in money, nurses and doctors which are being put into the service. The National Health Service is steadily increasing its efficiency. We now treat 1 million more in- patients and 2.5 million more out-patients a year than 10 years ago. That is a considerable achievement.

Q6. Mr. Tony Banks : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Banks : Did the Prime Minister see "Panorama" last night, which showed the Salvation Army handing out stale bread on council estates in Scotland? When will the Prime Minister come out from that bullet-proof Daimler of hers and start visiting some social security offices and council estates up and down the country to see the stale bread society that she is creating for millions of people?

The Prime Minister : Nonsense. The hon. Gentleman is quite aware, and dislikes it intensely, that the level of spending on social security exceeds anything that was available under his Government. I must say to the hon. Gentleman that I thought his comment was a great insult to the Salvation Army.

Mr. Wilshire : Following the inauguration of a new American President last Friday, will my right hon. Friend find the time to convey to former President Reagan the thanks of the House for his great contribution to world peace and to NATO? Will she also find the time to express to President Bush the best wishes of the House for his term of office?

The Prime Minister : Immediately before he left office I expressed our great thanks, and our appreciation to President Reagan for all that he has done for sure defence and for extending freedom the world over. On the day of his inauguration, I expressed our congratulations and best wishes to President Bush, and assured him that we would continue to be a true and faithful ally in defence of freedom.

Q7. Mr. Tom Clarke : To ask the Prime Minister if she will list her official engagements for Tuesday 24 January.

The Prime Minister : I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Clarke : If the economy is as strong as the Prime Minister has been saying, why do sections 1, 2, 3, 7 and 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986 remain unimplemented, despite being given Royal Assent more than two and a half years ago?

The Prime Minister : I had the impression that two sections had come into effect and that we were ready to implement the third when we have secured agreement from local authorities. In the meantime, may I point out that,

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because the economy is strong, we have been able to spend about 90 per cent. more in real terms on the disabled than any previous Government.

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That European Community Documents Nos. 4126/88 and 7396/88, relating to machine safety, be referred to a Standing Committee on European Community Documents.-- [Mr. Sackville.]

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