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Mr. Nicholas Bennett : Given that there are wide differences in cost between different hospitals for the same operation, and that waiting lists vary so greatly, has my right hon. and learned Friend received from the BMA --or, indeed, from the Labour party--any suggestion as to how this matter might be dealt with? Is not the Labour party's only vision of the future of the NHS one that is safe for COHSE and NUPE?

Mr. Clarke : My hon. Friend touches on one of the important problems in the National Health Service, and given that there are these apparently inexplicable differences in performance from place to place, it must be a worthwhile objective to so organise the Health Service that we raise standards everywhere to the high level achieved in some places now. I have most certainly received no proposals from the Labour party on that or on any other subject relating to the review. I look forward to receiving constructive proposals from the BMA which address the main point of how to raise standards everywhere for the benefit of patients.

Mr. Robin Cook : Has the Secretary of State read his own White paper? Is he not aware that it is dripping with commitments to privatisation? Will he put the record straight and confirm that GPs with practice budgets will be expected to use NHS money to buy private treatment? Will he confirm that opt-out hospitals will be expected to use NHS facilities to bid for private patients? Will he further confirm that today's Finance Bill contains a cash subsidy to private medicine? Does it not speak volumes for this Government's lack of commitment to a public Health Service that the very first proposal from the White Paper to be brought before the House is a straight cash hand-out to private medicine?

Mr. Clarke : The right hon. Gentleman has impaled himself on a hook by making such an allegation about privatisation, and he can find no factual basis in the White Paper or anywhere else to justify it. What he is describing are proposals which ensure that patients and GPs have the maximum choice to use National Health Service money to get the best quality service where they can find it, and provided as quickly as possible. That cannot be described as privatisation. It is using the taxpayers' money to the best advantage of the patient, and it is absurd to claim that we should exclude doctors and patients from high-quality

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operations provided quickly because we are using excess private sector capacity at a low cost. That is an enhancement of the service and no kind of privatisation at all.

Mr. Robert B. Jones : My right hon. and learned Friend's answer will be regarded as what it is--clear and the truth. Would it not have been better if the BMA had kept to the truth instead of launching an outrageous campaign to frighten little old ladies and other poor pensioners?

Mr. Clarke : I certainly would welcome it if the BMA withdrew its untruthful leaflet and substituted one which tried to make constructive proposals on the contract. I certainly hope that all doctors will forbear from making untruthful allegations to elderly and vulnerable patients, so causing them needless alarm. The contract seeks to enhance services to elderly people and I trust that doctors will acknowledge that and seek to build on it.

Mentally Handicapped and Mentally Ill People

11. Mr. Ashley : To ask the Secretary of State for Health what representations he has received regarding the numbers of mentally ill and mentally handicapped people who, after being discharged from hospital, subsequently became homeless.

Mr. Freeman : We have received representations from voluntary bodies and individuals about the level of support available to patients discharged from hospital, some of these expressing concern that such patients risk becoming homeless.

Mr. Ashley : Has the Minister read the report "Slipping through the Net" by the National Schizophrenia Fellowship? Is he aware that it is a terrible condemnation of the Government that schizophrenics and other mentally ill and mentally handicapped people are so deprived of community care that they end up on the streets, in prisons or in coffins? Does he accept that the only answer is first, to stop closing the hospitals and secondly, to provide adequate resources for these very desperate people?

Mr. Freeman : I have read the report that the right hon. Gentleman cites and I can make it quite plain that no mental illness hospital should or will close unless there are adequate facilities in the community for the care of those who have been discharged from hospital, or have not been in hospital. Next week, we shall be issuing guidelines to district health authorities as to how they are to put in place by 1991 adequate community care facilities for the mentally ill.

Mr. Nicholas Winterton : In associating myself entirely with the remarks of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) I must tell my hon. Friend that his remarks are totally untrue. Many mentally ill or mentally handicapped people are homeless or in prison because psychiatric hospitals and hospitals for the mentally handicapped have been closed prematurely without adequate accommodation and trained personnel in the community to look after them. Will he ensure that no further psychiatric hospitals close?

Mr. Freeman : Perhaps my hon. Friend did not catch what I said in reply to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley). I repeat that we

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endorse the policy which has been in place for 30 years of moving those who are mentally ill from the large, isolated Victorian asylums to proper facilities in the community. I agree with my hon. Friend that the challenge is to provide proper community care facilities.



Q1. Mr. Callaghan : To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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. Callaghan : Is the Prime Minister aware that the Select Committee on the Environment recently produced a report about the disposal of toxic waste and that the chairman said that only God knows what time bomb we are sitting on because of fears that toxic chemicals will get into our water supply? Is she further aware that the Select Committee unanimously condemned the Department of the Environment for its lack of leadership and control? In view of the Prime Minister's statement that the present Secretary of State for the Environment is the best there has ever been, how does she reconcile those two views? Who is telling the truth?

The Prime Minister : I speak from my recollection of reading that full report, but if the hon. Gentleman looks at the list of action taken, he will find that action by the Government goes back to 1983. Our action in regard to beaches goes back to 1979. The Labour party did nothing about the beaches directive for four years and we had to take immediate action. As I have pointed out, there will be another major Bill to implement the consultation that we have had this year.

Mr. Dickens : Does the Prime Minister agree that our doctors are the custodians of the nation's health but that by the same token, they are also procurement officers on behalf of the taxpayer and the National Health Service, collectively placing orders worth millions of pounds every day? If we are to have a cost-effective and efficient Health Service, we have to make provision for an aging population. Is it not therefore a pity that we are subjected to the politics of fear, envy and myth which, in one word, is Socialism?

The Prime Minister : I am very glad to see my hon. Friend back, clearly absolutely recovered. In addition to what he has said, for every £1 that was spent on the Health Service in 1979, £3 is spent today, on more doctors, more nurses, more and better hospitals and very much better care of which he has probably been a recent beneficiary.

Mr. Kinnock : When two thirds of the people of West Germany are against the modernisation of short-range nuclear weapons, are not the German Government absolutely right to act on their view?

The Prime Minister : Short-range nuclear weapons are part of the NATO strategy. NATO strategy is being discussed and NATO strategy cannot be determined by any one country.

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Mr. Kinnock : When we are told that the Warsaw pact has a 16 : 1 advantage in short-range nuclear weapons, does it not make sense for Britain and for NATO to gain the most by negotiating their verifiable removal?

The Prime Minister : I thoroughly agreed on that point with an early -day motion which appeared on the Order Paper on 9 February 1989 congratulating

"the Socialist Prime Minister of France on his statement ... that conventional and nuclear weapons are jointly necessary for the security of Europe', that despite some initial signs of an unquestionable desire for disarmament in the Soviet camp, we are still far from seeing the reasonable sufficiency or the defensive posture that they claim', and that we must avoid having disarmament become a smokescreen for denuclearisation.' "

That was tabled by a Labour Member.

Mr. Kinnock : I am glad to hear the Prime Minister quoting a Socialist President. I quote to her a Conservative Chancellor. Does she agree that there should be

" early negotiations on short-range nuclear weapons based on the goal announced by the Alliance in Reykjavik in 1987 and in Brussels in 1988 to achieve equal numbers at lower levels' and negotiations on nuclear artillery with the aim of achieving equal ceilings at levels that are drastically reduced' "

That is the view of Chancellor Kohl.

The Prime Minister : I do not think that the right hon. Gentleman could have heard my first answer to him-- [Interruption.] The strategy that we are discussing is the strategy of NATO, which has protected peace for 40 years. It is the strategy which the right hon. Gentleman does not accept and which he wishes to throw away. The strategy on which he is engaged is to get the denuclearisation of Europe and to have no safety left in defence in NATO for this country.

Sir Geoffrey Johnson Smith : Is my right hon. Friend aware that there are many parliamentarians both here and on the continent of Europe who share her deep concern about the West German Government proposal to start talks on short-range nuclear weapons with the Warsaw pact countries unilaterally in advance of reductions in chemical weapons and conventional forces?

The Prime Minister : I agree with my hon. Friend. NATO has played a vital role in maintaining Germany's freedom, which started the day the second world war ended, and I do not believe that the German Government want to put NATO at risk.

Q2. Mr. Illsley : To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Mr. Illsley : In view of the fact that in February of this year the south Yorkshire police instructed Barnsley football club to admit 2, 000 spectators to an FA cup match at one minute before the kick-off without payment and without tickets, will the Prime Minister now consider delaying the Football Spectators Bill until after Lord Justice Taylor reports or, even better, withdraw it altogether as such police action clearly makes that Bill unworkable?

The Prime Minister : I answered some questions from this Dispatch Box last week pointing out that there had been nearly 300 deaths in the post-war period from crush and hooliganism in football, that unless we had a Bill we

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should be unable to take any action contained in the measure apart from the national membership scheme and that I believed that, against that number of deaths, for the House to wash its hands of such a Bill would be negligent in the extreme.

Mr. Nicholas Baker : Does my right hon. Friend agree that anyone of reputable character--a public company, a national newspaper or a child playing in the street--on finding documents or property lost, stolen or fallen off the back of a lorry, would, as their first action, seek to return it to its rightful owner?

Mr. Tony Banks : Not in my constituency.

Mr. Baker : Should not all thieves be treated equally before the law?

The Prime Minister : What my hon. Friend says is correct and most people would agree.

Mr. Ashdown : What is the limit, if any, below which the Prime Minister would not be prepared to let child benefit be cut?

The Prime Minister : Our policy on child benefit has been set out. We increased child benefit to the poorest families, which gave them far more help than they would have had if there had been an across-the-board increase. I am happy to say that that policy was endorsed by a majority of 100 yesterday evening.

Mr. Patrick Thompson : Bearing in mind that we are this month marking the 40th anniversary of NATO, will my right hon. Friend take the opportunity to discuss with her colleagues at the Department of the Environment the recent decision by Norwich city council to throw out an exhibition which was installed to mark the 40th anniversary of NATO? Does she agree that that Labour-controlled council has pointed up the Opposition's confusion on defence matters?

The Prime Minister : My hon. Friend makes his point effectively. NATO has kept the peace in Europe for over 40 years. We are firmly behind NATO's strategy--which is a mix of conventional and nuclear weapons--as, I believe, are the United States and the overwhelming majority of NATO members. Anything that undermines NATO would be highly damaging to the defence of liberty.

Q4. Mr. Pawsey : To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Mr. Pawsey : Does my right hon. Friend agree that one of the principal achievements her three Administrations has been the way in which the trade unions have been firmly brought under the rule of law? Would she care to say what the effect would be on the economy and on employment of a return to the secondary picketing advocated by Opposition Members?

The Prime Minister : The effect would be utterly devastating. We would go back to secondary strikes, in which there was no dispute between the employer and the employee and we would see again some of the massive strikes that we had in Labour's last period of office, during

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which about 13 million days a year were lost through strikes--a situation that would not have been encountered under a Tory Government.

Q7. Mr. Tim Smith : To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Mr. Smith : Does my right hon. Friend agree that some doctors have behaved in a most irresponsible and non-professional nammer in their treatment of elderly and vulnerable patients-- [Interruption.]

Mr. Speaker : Order.

Mr. Smith : The doctors have frightened their elderly and vulnerable patients about the effect of the National Health Service review. Will my right hon. Friend emphasise to the British Medical Association--the doctors' trade union--before its conference on Thursday, that it should stop using patients as a political battering ram and should instead sit down to discuss the proposals with the Department of Health?

The Prime Minister : Yes, I wholly agree with my hon. Friend. My right hon. and learned Friend the Secretary of State for Health answered the doctors effectively in some of the letters which he sent in reply to them. There are more doctors with more resources than ever before in the Health Service and the objective of the National Health Service White Paper is to give better health care, to give greater choice and to produce greater satisfaction and rewards for those who work in the NHS and who successfully respond to local needs. The changes proposed in remuneration before the White Paper are planned to distribute the same amount of money to doctors, but by way of distributing more to those who have a bigger case load than to those who have a smaller case load. That seems eminently just.

8. Mr. Tony Banks : To ask the Prime Minister if she will list her official engagements for Tuesday 25 April.

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

Mr. Banks : Is the Prime Minister aware that there is an important Roman site in Upper Thames street near St. Paul's cathedral, which is the site of the palace of Julius Agricola, a former governor of London?

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Mr. Speaker : Order. The question must have to do with the Prime Minister's responsibilities.

Mr. Banks : The site is threatened by office development and there are difficulties with English Heritage and the developers about compensation that might be paid if the development is kept in abeyance while archaeological inspection continues. Will the Prime Minister please look at the matter urgently because the site is of great significance not only to London but to the nation?

The Prime Minister : I am aware of the site and of its importance. I am sure that the hon. Gentleman will be in touch with the Department of the Environment, under which English Heritage comes. If it comes to a final decision on planning, that would be for my right hon. Friend the Secretary of State for the Environment to determine.

Mr. Frank Field : Is the Prime Minister aware that the first compensation payments will shortly be paid from the Hillsborough disaster fund? Is she also aware that the poorest families may-- [Interruption.]

Mr. Speaker : Order.

Mr. Field : Is the Prime Minister aware that the first payments will shortly be paid from the Hillsborough disaster fund? Is she also aware that the poorest families may, as a result of gaining help from that fund, lose their entitlement to social security payments? As I cannot believe that the nation contributed generously to that fund so that the Treasury would be the net beneficiary, and because I do not believe that the Treasury would wish to be the net beneficiary, will the right hon. Lady undertake to review the disregard rules so that the poorest families can gain help from that fund and keep their social security payments?

The Prime Minister : First, I am not sure what the status of the Hillsborough disaster fund will be. As the hon. Gentleman will be aware, other funds have chosen to have charitable status, but I am not sure what decision has been made about the Hillsborough fund and that will affect the way in which the payments are made. Secondly, as the hon. Gentleman knows, other disaster funds have had charitable status and they must have worked out a reasonable way forward on this matter. I do not think that we can change the rules and regulations, but I shall look to see how similar funds have worked.

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