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House of Commons
Tuesday 23 May 1989
The House met at half-past Two o'clock
PRAYERS
[Mr. Speaker-- in the Chair ]
PRIVATE BUSINESS
Midland Metro Bill
Read the Third time, and passed.
Associated British Ports (Hull) Bill
Isle of Wight Bill
Tyne and Wear Passenger Transport Bill
Considered ; to be read the Third time.
Oral Answers to Questions
HEALTH
Wheelchairs and Artificial Limbs
1. Mr. Ashley : To ask the Secretary of State for Health what plans he has to improve the provision of wheelchairs and artificial limbs.
The Minister of State, Department of Health (Mr. David Mellor) : The Disablement Services Authority was established for this purpose. Its first annual report was published in 1988, detailing the improvements made in the service to date. A copy of the report is available in the Library. The annual report for 1989 is being prepared and will be published in August.
I am sure that the authority will be happy to answer any particular questions that the right hon. Gentleman may have.
Mr. Ashley : I am grateful for that full reply. Will the Minister exercise his influence to ensure that every disabled person who acquires an artificial limb or a wheelchair receives an appropriate one soon, that outdoor power wheelchairs are soon made available, and that the funds of the Disablement Services Authority are increased to enable it to provide these?
Mr. Mellor : I and my hon. Friend the Minister responsible for the disabled are in regular contact with Lord Holderness. It is certainly our commitment that everyone who needs a wheelchair or artificial limb should have one. Work is going forward, as the right hon. Gentleman knows, on the indoor-outdoor occupant-controlled powered wheelchair, and we hope that it will be possible to set up studies of its effectiveness in actual use. We are also keen to develop an active-user wheelchair for younger and more active disabled people.
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Mr. Thurnham : Will my hon. and learned Friend support the appeal by Professor McColl to doctors who prescribe wheelchairs, to the effect that millions of pounds could be saved on wheelchairs that are hardly ever used or are not returned when they are no longer required? That money could be used to upgrade heavily used wheelchairs.
Mr. Mellor : To my mind, that is a useful additional point to that made earlier by the right hon. Member for Stoke-on-Trent, South (Mr. Ashley). Just as it is our commitment that everyone who needs an artificial limb or wheelchair should have one, we believe that it is a waste of resources if people who do not need wheelchairs or artificial limbs are prescribed them. We need sensible prescribing which meets the needs of disabled people. Otherwise, as Professor McColl has pointed out, limbs and wheelchairs are stored and never used.
Mr. Wigley : Does the Minister accept that there has not been rapid enough progress in recent years in making available to people in need of them special wheelchairs which are suitable for their circumstances? So far, there has been a general approach and a standard wheelchair which has failed to meet the needs of many people. Although we are waiting the outcome of studies, is it not possible to be more flexible and responsive to individual needs?
Mr. Mellor : I sympathise very much with what the hon. Gentleman says, in that I certainly believe--I hope that I conveyed the flavour of this point in my initial answer--that wheelchairs need to be more tailored to individual needs. That is why we are keen on the active-user wheelchair and keen that the studies on the indoor-outdoor occupant-controlled powered wheelchair should go ahead. It is also why I had a most useful meeting with Lord Holderness the other day. I know that the Disablement Services Authority is keen to make progress, too.
Mr. Alfred Morris : Is it not now extremely urgent for the Minister to press the Disablement Services Authority for a commitment to provide outdoor powered wheelchairs and to supply the resources? Has he read the article in the British Medical Journal by Dr. Graham Mulley which shows that only one in four hospital wheelchairs is safe and in good order, with the result that patients suffer pressure sores, fatigue, falls, shin injuries, chafed heels, penetrating foot injuries and lacerations? Does the Minister agree that that is deeply disgraceful, and what action has he taken since the article was written?
Mr. Mellor : The action that we have taken, as the right hon. Member knows, preceded the article in the two respects that he mentioned. First, on the indoor-outdoor powered wheelchairs, he will know that the Disablement Services Authority started a 12-month pilot study in January, and I hope that that will proceed successfully. The right hon. Gentleman will also know that the report in 1986 by the McColl committee, which was established by the Government, first drew attention to the large number of inadequacies in wheelchair repair arrangements. The wheelchair repair service was open to competitive tendering in 1988-89. Some 79 contracts have been awarded, and we intend to ensure that the service is much improved. We certainly do not mind articles pointing out its deficiencies as that is a spur to further achievements and improvements.
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Cervical Cancer Screening
2. Dr. Twinn : To ask the Secretary of State for Health whether any improvements have been made to the time in which results of cervical cancer screening are issued as a result of the use of private sector laboratories.
Mr. Mellor : I am pleased to say there has been a further improvement in the time taken by National Health Service laboratories to report on cervical smears. More than 85 per cent. are currently meeting our target time of one month. This is due partly to the use of private laboratories. Other measures taken have included employment of additional staff, overtime working and use of other NHS laboratories.
Dr. Twinn : I am grateful for that encouraging answer. Does not this successful co-operation between the private sector and the NHS have wider implications?
Mr. Mellor : Yes. I am sure that such a partnership will be useful in a whole range of NHS activities. Fortunately, examples of co-operation between district health authorities and the private sector over a whole range of NHS activities are legion.
Dame Jill Knight : Will my hon. and learned Friend ensure that his Department loses no opportunity for co-operation with the private service in any way, as this often cuts worrying waiting time for patients after tests, and leads to much better treatment?
Mr. Mellor : I entirely agree with my hon. Friend. We have the highest hopes for our extremely complex cervical cancer screening programme, but obviously much of that is set at naught if there are long waiting times. I am glad to say that while in December 1988, in 43 districts results were taking more than four weeks to come through, by the end of March 1989 the number was down to 25. I hope that by improvements in NHS laboratories and, where appropriate, use of private laboratories we shall be able to reduce that figure still further.
Working for Patients"
3. Mr. Hardy : To ask the Secretary of State for Health what is the total number of representations received by his Department since the publication of "Working for Patients" which express criticism or anxiety in regard to present Government health policies.
The Secretary of State for Health (Mr. Kenneth Clarke) : So far, I have received more than 5,500 representations on the White Paper, "Working for Patients". Many ask questions, many support all or some of the proposals, and some refer only to specific aspects. It is not possible to distinguish the letters in the way that the hon. Member suggests.
Mr. Hardy : Does the Minister expect to receive more letters, not just about resources and the apparent commitment to destabilise the service but in response to yesterday's announcement, which seems to reveal an assumption that a captain of industry is very much in a part-time position, while nurses are so busy caring, in a way that the Government do not reveal, that they cannot be spared to serve on the policy decisions board of the NHS?
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Mr. Clarke : The people who will be given much more local responsibility for managing and delivering the service will be encouraged to see that we are able to recruit to the policy board the services of some high-powered and successful people with experience of large organisations. We also have an important job of nursing management to do. That is why there is a director of nursing on the management executive who is charged with that part of the management responsibility that has to be done from the centre.
Sir Geoffrey Finsberg : In the correspondence that my right hon. and learned Friend is receiving, is he getting the sort of letters that many of us are getting from elderly patients who are being scared by the British Medical Association, through their doctors, with the most vicious lies and propaganda? What does he intend to do to make the BMA realise that it has a duty not to scare patients?
Mr. Clarke : I have written to every general practitioner pointing out that the leaflets that they were distributing were inaccurate and untrue. I hope that many have withdrawn them as a result, but I cannot approach every GP who uses the tactics described by my hon. Friend. It is grotesquely unfair to make such claims to elderly and vulnerable patients in pursuit of some perceived interest. Now that we have settled the GP contract, I hope that there will be much less of that, and much more of the sensible discussion that I have made it perfectly clear that I am open to having with the BMA.
Mr. Fearn : Can the Minister confirm that among those representations and anxieties, many members of the nursing profession have written pointing out that no one from their profession has been elected to the board that he has announced? Why did he not make a statement to the House about that board? Also, what representations has he received from medical secretaries who are having a tough time at the moment?
Mr. Clarke : I have not yet received many letters from nurses about the make-up of the policy board. As their general secretary has written to me, I shall no doubt be receiving some more, but they will be given the same explanation--that the policy board is not a representative committee. [Interruption.] Looking back, I believe that it was an extremely bad tradition of the Health Service that everything had to be subjected to a committee consisting of one doctor, one nurse, one administrator and one treasurer, so that prolonged multi-disciplinary deliberations took place before, in most cases, no decisions were reached. The policy board is charged with the overall strategy for the service. On the executive charged with the management responsibilities it is essential to have a director of nursing, and we have such a director.
Mr. Andrew Mitchell : Will my right hon. and learned Friend commend the approach taken by the general manager of the Queen's medical centre in Nottingham, who said that his hospital was extremely interested in becoming an NHS trust hospital so long as that was in the interests of the patients whom it served? Is not that a constructive approach to the White Paper and one which contrasts substantially with the general approach taken by the BMA?
Mr. Clarke : I agree entirely, and I believe that the decision has been supported by the majority of the medical
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staff at the Queen's medical centre. I take that as an expression of interest because potentially the proposal could benefit patients. I agree with the general manager that after a great deal more discussion, which has to take place, the decision as to whether the hospital becomes self-governing will depend on whether that is in the interests of the patients, the hospital and the staff.Mr. Turner : Has the Secretary of State seen the open letter published in the Wolverhampton Express and Star last week from more than 50 per cent. of Wolverhampton consultants, saying that they could not now guarantee the inhabitants of Wolverhampton a comprehensive health service due to lack of resources and threatened ward closures? What has the Secretary of State to say about that parlous affair?
Mr. Clarke : I am afraid that in all branches of politics and public life it is easier to get people to sign round robins and petitions than to give serious views and discussion. I cannot think that the majority of Wolverhampton consultants believe such nonsense.
Mr. Clarke : There is nothing in the White Paper to justify making such alarmist allegations to the population of Wolverhampton.
Mr. Hayes : Does my right hon. and learned Friend agree that it is time for the hyperbole and scaremongering by the BMA to stop because it is very confusing for patients and adds nothing to the debate? As a conciliatory gesture, is my right hon. and learned Friend prepared to meet the BMA without any preconditions whatever just to talk about the proposals which will help patient care?
Mr. Clarke : When the BMA announced last week that it wished to meet me for discussions, I announced my readiness to have such discussions. The precondition has to be that we all agree on the aim of improving the National Health Service. I look forward to the BMA putting forward positive ideas for improving the National Health Service. I am still waiting for a date to be arranged for the discussions. It is a great pity that after announcing its wish to talk about the proposals, the BMA has now started publishing whole-page newspaper advertisements containing a great list of blatant untruths, which I do not think for one moment that the BMA believes but which are designed merely to frighten patients in the hope that that will somehow strengthen the BMA's bargaining power in discussions with me.
Mr. Robin Cook : What representations did the Secretary of State receive to the effect that what the Health Service needed was three industrialists all clutching their private medical cover? Is he aware that the chief contribution of Sir Graham Day and Bob Scholey to the public sector has been in closing large chunks of it and privatising what was left? Is that why they have been chosen to run the Health Service? How could the Secretary of State find places for four business men on the health policy board but no room for even one nurse? Have not those who know how to care for patients got at least as much to offer the Health Service as those who know only how to read a balance sheet and close a factory?
Mr. Clarke : It is a serious criticism of the hon. Gentleman that he reminds me so much of his hon. Friend
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the Member for Oldham, West (Mr. Meacher) reacting to the Griffiths report on general management in the Health Service four or five years ago. The hon. Gentleman talked a lot of nonsense about supermarkets and how the proposals were not suitable, but the hon. Member for Livingston (Mr. Cook) knows that he would not wish to reverse the great management improvements introduced by Sir Roy Griffiths from Sainsbury's. He knows that a giant organisation requires people able to cope with providing leadership and guidance for managers who will be charged with such great responsibility in the service. The hon. Gentleman should not resort to such populist nonsense when his own proposals are simply that every health authority should be dominated by local councillors and trade unionists, who I suppose he imagines will bring a dynamic new improvement to the way in which care is delivered.Mrs. Maureen Hicks : Would my right hon. and learned Friend like to hazard a guess as to how many of the innocent patients who are writing to us as a result of being lobbied by rather unprofessional and unscrupulous doctors-- [Interruption.] --have any comprehension of the true nature of our reforms? Rather than feeding patients a diet of misinformation, would not doctors be better advised to tell them the true facts and acknowledge the Government's responsibility in overhauling a National Health Service system which was creaking under the strains and demands placed on it?
Mr. Clarke : I have had the same experience as my hon. Friend. There is one village in my constituency from which I keep receiving letters, mainly from worried and elderly people, beginning "I agree with my doctor that" and then giving some nonsense description of the White Paper. I am having to write to reassure those people. That is in contrast with the large meetings that I have had in the past week--there were two in Yorkshire and one last night in
Winchester--which were attended by many general practitioners and where there was much criticism, I concede, but much constructive discussion as well. It is ridiculous that when we agree with the profession that we want to make a better National Health Service for our patients, some GPs have to resort to the low-level propaganda from which my hon. Friend and I have suffered.
Nurses (Regrading Appeals)
4. Mr. Vaz : To ask the Secretary of State for Health if he will make a statement on the nurses regrading appeals in the Leicestershire health district.
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : The grading appeals are being dealt with under a long- standing agreement between the management and staff sides of the general Whitley council on procedures for settling differences over NHS employees' conditions of service. Detailed arrangements for operating the agreement are for local decision.
Mr. Vaz : Does the Minister agree with the statement made by the director of personnel of the Leicestershire health authority that the appeal procedures are a major distraction from the work of the National Health Service? Does he also agree that in processing the 1, 500 appeals that have been made it will take up to two years--until mid-1991--to clear the backlog, which will be a substantial
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hardship for those who have appealed? Why does he not just allow those appeals and enable the nurses to get the salaries that they so obviously deserve?Mr. Freeman : More than 500,000 posts in the National Health Service were subject to regrading last year. Some nurses have appealed, and those appeals are progressing at local level under a procedure agreed with the trade unions. The vast majority of nurses are satisfied with their new grading and pay last year went up by an average of 18 per cent. as a result.
Mr. Tredinnick : Is it not a fact that whereas under the last Labour Government nurses' pay was actually cut, under the Conservative Administration it has increased by 44 per cent., including a rise of 25 per cent. in the past two years?
Mr. Freeman : I am grateful to my hon. Friend. The statistics show that in the five years to 1979 nurses' pay went down in real terms by 21 per cent.
British Medical Association
5. Mr. Robert G. Hughes : To ask the Secretary of State for Health what matters were discussed at the last meeting with the chairman of the British Medical Association.
9. Mr. Hind : To ask the Secretary of State for Health when he last met representatives of the British Medical Association ; and what matters were discussed.
Mr. Kenneth Clarke : I last met the chairman of the BMA formally on 22 February when I discussed with him the remuneration of hospital doctors. I have since then met the general medical services committee's negotiators on 4 May to discuss the remuneration of GPs under the new GP contract.
Mr. Hughes : Will my right hon. and learned Friend discuss the current advertising campaign with the chairman of the BMA and point out that there are so many inaccuracies in it that it is difficult to believe that those responsible for it have even bothered to read the White Paper? Will he seek a further meeting so that he can present a copy of the White Paper to the chairman, together with one for the chairman's advertisers, so that they can reprint the adverts but this time tell the truth?
Mr. Clarke : I was astonished that just three days after the BMA said that it wanted to see me and to have discussions, those advertisements were produced. I was equally astonished that the chairman of the BMA has kept saying that he entirely shares the Government's aims as set out in the preface to the White Paper, and that he and most of his colleagues believe that there is a great deal of good in the White Paper and want us to experiment with and pilot the rest, but followed that with advertisements containing not one word about those positive sentiments and a lot of totally untrue allegations which are simply designed to alarm elderly and chronically sick patients. I should like the BMA to stick to its more constructive proposals and to have a formal word with me about the White Paper for the first time since I presented it to the BMA.
Mr. Hind : How can the BMA, the doctors' trade union, describe the NHS as,
"underfunded, undermined and under threat",
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when the Government have increased spending on the NHS since 1979 from £8 billion to £26 billion, which includes a substantial rise in doctors' pay? Does my right hon. and learned Friend agree that the advertising campaign is misleading and that it is ovepriced, overwrought and certainly over the top?Mr. Clarke : I do not criticise the BMA for using advertising agencies appropriately, but I advise it not to leave the text entirely to the copywriters. It is best to give instructions to the agency about what one wishes to say that is positive and then to make sure that the text is written by someone who has read and understood the proposals. The BMA has not followed either rule. My hon. Friend's slogan in certainly as effective as that of the BMA.
We all agree that the NHS needs more money, although the Government have increased spending on it by 40 per cent. in real terms since we came to power. That money will have the best effect for the patient if it is spent more sensibly and by a better-run Health Service. I am still waiting to hear what positive ideas the BMA might have for improving the running of the Health Service.
Mr. Campbell-Savours : Are not GPs in Kent up in arms over the Secretary of State's proposals-- [Hon. Members :-- "Where?"] In Kent. Is opting out a solution to the problems of the people of Sevenoaks, who face the closure of Emily Jackson house and the rundown of acute services at Sevenoaks hospital? What about the League of Friends at Sevenoaks, which raised £100,000 for acute service support facilities but finds that that money has been wasted? What about the Tory Members from Kent who bleat to their constituents about what they are doing in Westminster but vote with the Government on all these stupid proposals about budget cuts?
Mr. Clarke : The hon. Gentleman's new guise as a man of Kent is intriguing but I suggest that he should do a little more homework on the county before he launches into local politics there in competition with my hon. Friends.
Expressions of interest in self-governing hospitals will come to me and my Department only at the end of this month. They are expressions of interest by doctors, managers and those involved in the hospitals who can see the potential of our proposals to improve the service in their area and give them a greater ability to control what happens in Sevenoaks or wherever. The hon. Gentleman will have to wait and see whether that is pursued in Sevenoaks. Those who are interested will enter into a process of discussion with us so that we can ensure that any hospitals which become self- governing will raise the quality of service for the people whom they serve.
Mr. Duffy : What will be the Secretary of State's response to the BMA representatives who voiced the concern of their colleagues, notably in Sheffield, that patients most in need of care, such as the chronically sick and the elderly, stand to be penalised through budgetary considerations arising out of his new proposals?
Mr. Clarke : People in Sheffield are still complaining about the contract. Frankly, they would be well advised to take the advice of their negotiators who are commending a package that is fair to doctors and will pave the way for a big improvement in the quality of the family doctor service in this country. The hon. Gentleman's comments on the elderly and chronically sick are the opposite to the truth. There is a greater variety in the quality and range of
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service provided for the elderly and chronically sick than there is for most other people. The introduction of the new systems of clinical audit and charging district health authorities with the responsibility to use their money to most effect for the services that local residents need most will have the effect of raising the overall quality of care for the elderly and chronically sick. The scares about them are part of the background to the dispute over the new contract for GPs, which I hope is now resolved.Miss Widdecombe : Does my right hon. and learned Friend agree that, bearing in mind the assessment of Kent by the hon. Member for Workington (Mr. Campbell-Savours), the hon. Gentleman would be better advised to spend his time looking after his own constituency in Cumbria? Does my right hon. and learned Friend agree further that all doctors in Kent have had the opportunity to consult their patients and that many of them have expressed approval of the new plans, and that, where there is interest in self- governing hospitals, it is because they believe that it will be in the interests of the provision of better service for the people of Kent?
Mr. Clarke : I am sure that the attempt by the hon. Member for Workington (Mr. Campbell-Savours) to be a latter-day Wat Tyler and raise the population of Kent will be highly unsuccessful. My hon. Friend is quite right to say that many people are interested in the proposals. Among them are medical staff and others in Kent. Kent has a tradition of being an extremely go-ahead county in the forefront of many reforms in medical care and social services. Many people in Kent will be eager to see the opportunities that our White Paper gives them for improving their ability to deliver good quality services.
Mr. Robin Cook : When the Secretary of State next meets BMA representatives, will he answer their frequent questions about when he will respond to the Griffiths report on community care? Is he aware of the stark contrast between pushing through his proposals, which are opposed by everybody in the medical profession, and the year that he has taken sitting on the Griffiths report, which is supported by the health profession? Did he note the inquest last week into the death of Beverley Lewis who, blind from rubella, starved to death in the community? How many more scandals must there be before the right hon. and learned Gentleman recognises that a growing number of elderly and handicapped people in the community need better community care, and need it urgently?
Mr. Clarke : For 10 years we have been giving priority to the needs of elderly, mentally ill and mentally handicapped people. There has been the most enormous development in community services both in the National Health Service and local authorities over that time. As far as I can recall, the Labour party did nothing in that respect. We set up the Griffiths committee and we are now considering its extremely detailed proposals. I tell the BMA, as I tell everybody else, that we will report soon with our conclusions. It is an important and extremely complex problem, and we must determine how best to take forward the continuing development of good quality community services in this country.
Mr. Maples : When my right hon. and learned Friend next meets the chairman of the BMA, will he draw his attention to the enormous variations in unit costs
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throughout the NHS, which are clearly shown by the Department of Health's own performance indicators? Will he point out that they clearly show how much room for improved performance there is in the NHS and that the proposals for an internal market are designed to achieve that improvement?Mr. Clarke : I certainly will. I hope that my hon. Friend will agree that high costs do not always mean the best quality of care and that it is possible to achieve extremely good quality at a reasonable cost and thereby extend the service that we give to patients. In an internal market we will ensure that far more is known than ever before about high quality care, what the variations in cost are and why, and then place doctors and managers in a much better position to make sensible decisions about how to maximise good quality care for their patients.
Working for Patients"
6. Mr. Allen : To ask the Secretary of State for Health if he will pay a visit to the Glasgow, Central constituency in the next few weeks to meet local doctors in order to discuss the White Paper "Working for Patients".
Mr. Kenneth Clarke : I have no plans to do so at present.
Mr. Allen : That is a disappointing answer. Scottish Members of Parliament and, above all, my hon. Friend the Member for the Vale of Glamorgan (Mr. Smith) will be particularly disappointed. As the Secretary of State is not to go to Glasgow, will he get in touch with and make representations to the Secretary of State for Scotland and ask him to ensure that the two dermatology wards at the royal infirmary in the Glasgow, Central constituency are kept open, as he plans to close both wards on Friday?
Mr. Clarke : First, I regard the Vale of Glamorgan as having been won in part by a campaign of untruths about the Health Service report. The local general practitioners, then in dispute about their contracts, persuaded some people that there was a threat that the Health Service was going to be privatised, or something of the kind. I accept that that influenced the result. In my experience, such campaigns cannot run for very long. I do not believe that they will run again in Glasgow, Central now that matters have already moved on a great deal since the last election. I advise the electors of Glasgow to beware of people from Nottingham who suddenly take an interest in dermatology in Glasgow for party political reasons.
Mr. Bill Walker : Will my right hon. and learned Friend bear in mind that if he reconsidered his decision to visit Glasgow, Central, he would be welcome in my constituency of Tayside, North to meet my GPs and discuss the changes proposed in the White Paper, particularly because the money will follow the patients? Cottage hospitals and other popular hospitals in Scotland can be kept open by the doctors directing the patients to them.
Mr. Clarke : I am grateful for my hon. Friend's invitation. I have held three meetings in Scotland on the National Health Service White Paper and I found an extremely interesting reaction. My right hon. and learned Friend the Secretary of State for Scotland and the Parliamentary Under- Secretary of State for Scotland, my hon. Friend the Member for Stirling (Mr. Forsyth), are
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responsible for delivering health care in Scotland. I know that they are pointing out to their colleagues in the Health Service the great potential advantages that our reforms open up for them.Dr. Reid : I should like to express my deep, heartfelt and sincere regret at the fact that the Secretary of State is not to visit Glasgow, Central. If he does visit, I hope that he will be just as effective from everyone's point of view as he was in the Vale of Glamorgan.
If the Secretary of State goes to Glasgow, Central, would he care to take a 50p bus trip up the road to Motherwell to meet doctors from the health improvement service campaign for Lanarkshire? Will he have the guts to tell them to their faces what he and his colleagues have called them today, unscrupulous liars who are misleading the population, or will he recant and accept that they are non-political and fair minded people who welcome one or two of his proposals, but who conclude that in general the proposals will be the beginning of the end of the NHS? When he is in Glasgow, Central and Lanarkshire, will he explain why everyone in Britain with an interest in the Health Service is a liar and out of step, except him?
Mr. Clarke : I am always glad to visit Glasgow, and I did so often in my previous job, because it is one of the most successful examples of urban regeneration in the country in its inner-city area. It has benefited considerably from the revival of the British economy and the Government's enterprise in restoring life and prosperity to the city centre.
The hon. Gentleman said that the doctors conceded that there was a great deal to welcome in the White Paper. They came out with some slogan or other which the hon. Gentleman repeated. I must point out to the doctors that their advertisements are patently untrue. When I meet individual doctors in Motherwell or elsewhere, I find that they avoid the question when I try to get them to justify the statements put out in the name of their association. That is no way to campaign on a serious subject like the National Health Service. I welcome constructive discussion with doctors from Motherwell or anywhere else.
Mr. Yeo : Is my right hon. and learned Friend aware that there are many elderly and other vulnerable people in Glasgow, Central who are caused unnecessary distress by unfounded suggestions that the Government intend to privatise the Health Service? Does he agree that Opposition Members who try to fan such deliberate untruths are unscrupulously and uncaringly exploiting those vulnerable people for their own sordid political advantage?
Mr. Clarke : I do not think that it will work to their advantage as they believe it will. I agree with my hon. Friend that that is what they are doing at the moment. However, I cannot see how they will defend the Vale of Glamorgan when they must face a situation where there has been no privatisation, where a great deal more control and influence has been placed in the hands of local doctors in relation to local services and where the situation is plainly improving for patients. As we are getting on well with the implementation, I remain confident that that will be the position by the time we reach the next general election.
Mrs. Margaret Ewing : Returning to the original point about the dermatology units at Glasgow royal infirmary,
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will the Secretary of State reconsider his decision not to speak to the Parliamentary Under-Secretary of State for Scotland because this is a vital issue? Does he realise that dermatology units have been quite separate from other wards in Scotland for more than three decades and that apparently none of the consultants involved have had discussions with Greater Glasgow health board on the matter? Would it not make more sense to await the outcome of the strategic review which was planned in 1984?Mr. Clarke : I shall draw the attention of my right hon. and learned Friend the Secretary of State for Scotland and the Under-Secretary of State for Scotland to the representations that have been made on this important subject today, particularly when they come from an hon. Member who comes from north of the border and somewhat nearer to Glasgow than the hon. Member for Nottingham, North (Mr. Allen) who previously raised the matter. This is not a matter for me, but it is a serious matter which my hon. Friend the Under-Secretary of State for Scotland will be considering seriously.
Women Doctors
7. Mr. Sayeed : To ask the Secretary of State for Health how the new general practitioners contract will affect women doctors.
11. Mr. Latham : To ask the Secretary of State for Health whether he will make a statement on the response by general practitioners to the new contract announced to the House on 5 May.
Mr. Mellor : Women doctors are an asset to partnerships because a number of patients prefer to see a woman doctor. Our proposals for formalising part-time working and job-sharing arrangements will help women doctors seeking a reduced commitment--for example, because of family responsibilities. Women general practitioners will also benefit from retention of partnership average list sizes for calculating entitlement to basic practice allowance and the reduced threshold for full basic practice allowance from 1,500 patients previously proposed to 1,200.
On the overall contract, the negotiators undertook, as part of the agreement between us on the major outstanding issues, to commend the new contract to the annual conference of local medical committees on 21 and 22 June.
Mr. Sayeed : I am grateful for that helpful answer, but does my hon. and learned Friend accept that despite the BMA's propaganda, which was designed to mislead and frighten patients, the general practitioners' contract will formalise part-time working arrangements for lady doctors, help with job sharing and ease conditions for locum assistance?
Mr. Mellor : Yes, the contract will do all those things.
Mr. Latham : Is my hon. and learned Friend aware that those of us who were unhappy about the first proposal for the contract warmly welcome the flexibility that Ministers showed in putting forward the revised proposals which have now been accepted by the BMA negotiators? Is he further aware that those of us who pressed for changes now expect the BMA collectively to settle on the matter?
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Mr. Mellor : I endorse what my hon. Friend says. We listened to what was said about the draft contract, including representations from hon. Members who had met their general practitioners. We listened and changes were made on both sides. This is a fair deal and I trust that the local medical committees will endorse it.
Mr. Morgan : Does the Minister agree that, although the new proposals are slightly superior to the unbelievably crass original proposals, the typical woman doctor who joins a general practice now has a list size of about 350, on which the change from 1,500 to 1,200 will have no bearing? Does he further agree that, although averaging will now be allowed, women doctors will probably not be allowed to become partners, and, since 50 per cent. of those now leaving medical schools are women, they will hit a brick wall and will become only employees, not partners, in general practice?
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