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doctor-patient relationship, as the cash considerations threaten to displace medical considerations? As a result, patients will increasingly fear that the cost of their treatment rather than the medical need for their treatment will take priority. Will this not damage the most valuable part of the NHS?

Mr. Mellor : The hon. Gentleman builds a house on sand because his basic premises are completely wrong. First, in terms of large practices, anyone who chooses to have a practice budget will choose to do so because he believes that he can operate effectively within it. That is quite different from an imposed cash limit. Secondly, if the hon. Gentleman really thinks that an indicative drug budget is the same as a cash limit, he is being misleading. He should know that an indicative budget is a way to show general practitioners where their prescribing practices place them compared with others. I am happy to repeat that once again. Every patient will get the drugs that he needs, and that is a pledge.

Mr. McCrindle : In view of the predictable opposition to indicative drug budgeting by the pharmaceutical companies, will my hon. and learned Friend the Minister take this opportunity to restate what he sees as the benefits to patient care of the Government's proposals?

Mr. Mellor : It will be in the interests of patients who really need drugs, particularly expensive drugs, and there should be proper control of budgets to allow us in future to pay for the drugs that patients need. I know of no other enterprise for which £2,000 million of expenditure would be treated on the basis that those who sign the prescription forms can do anything they like. There is no threat to patients because doctors are being put under some pressure to prescribe generically instead of prescribing branded drugs which are twice as expensive. If we are to find the elbow room to afford the wonder drugs of the future, we must be sensible about not paying excessively for less than wonderful drugs which are merely branded instead of generic.

11. Mr. Tony Lloyd : To ask the Secretary of State for Health if he will make a statement on reaction in the North Western regional health authority to his recent White Paper.

Mr. Mellor : Reaction from the authority has been most positive. Members of the authority had an opportunity to consider the Government's White Paper "Working For Patients" at a seminar arranged in the region on 17 April. Since then the authority has forwarded to the Department expressions of interest in self-governing status from eight hospitals and one community unit, and in doing so they drew attention to the need, which we fully accept, to protect medical education and research.

Mr. Lloyd : Will the Minister take into account the fact that of the eight hospitals in the north-west region, four of them--Christies, Manchester royal infirmary, St. Mary's and the royal eye hospital--are not simply district-based services, but provide regional specialties? Does the Minister recognise that the medical professionals, the ordinary people in the street and the whole of public opinion in the north-west is hostile or suspicious of the Government's proposals? Why will the Government not

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agree to some form of consultation, or even ballots, outside the districts directly affected? The proposals affect the whole of the north-west region.

Mr. Mellor : With respect to the hon. Gentleman, it is not true to say that all the groups to which he referred are opposed to the expressions of interest in self-governing status. I can show that there is substantial support already for self-governing status in those hospitals that have expressed an interest.

Regional specialties will continue to be provided and we are aware of the need to ensure that regional specialties are protected. There will also be ample opportunity for people to make their views known before the Secretary of State has to take any decision on self-governing status. Indeed, an expression of interest is not the same as a formal application and none of those hospitals have been invited to, or have made, formal applications.

Mr. Hind : My hon. and learned Friend will have noticed in the response of the North Western regional health authority to the White Paper "Working for Patients" three expressions of interest to form National Health Service hospital trusts. In Wrightington hospital in the West Lancashire district health authority 95 per cent. of the patients come from all over the region and from the rest of the country. Does my hon. and learned Friend accept that his proposal for money following the patient is ideal for that hospital as it will provide better care and more independence for the doctors at that hospital?

Mr. Mellor : I entirely agree with my hon. Friend and I am glad that he referred to Wrightington hospital. The senior medical staff at Wrightington have been the driving force behind the expression of interest from that hospital for, I suspect, precisely the reasons that my hon. Friend has given.

Tuberculosis Vaccinations

13. Mrs. Dunwoody : To ask the Secretary of State for Health when it was decided to discontinue the routine vaccination of pre-school children against tuberculosis.

Mr. Freeman : Pre-school children are not routinely vaccinated against tuberculosis. The BCG vaccine is currently recommended for children generally at aged 13 and for infants born to immigrants from developing countries, or where there is a family history of the disease. It is only the school vaccination programme at aged 13 that has had to be postponed due to a temporary shortage of the BCG vaccine.

Mrs. Dunwoody : Is the Minister aware that preventive health care works only when it is in use and that this programme is tremendously important particularly for immigrant families which suffer from active tuberculosis? Does he agree that it is quite likely that the disease will again become the real difficulty that it used to be in my youth unless the programme is reinstated as rapidly as possible? Is what is happening now a demonstration of how much the Government care about preventive health care?

Mr. Freeman : I agree with the hon. Lady about the importance of preventive health care. Vaccination of the priority groups is continuing ; it has not been stopped. Britain now has some 4,000 cases of tuberculosis a year

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compared with some 40,000 in 1948. That is still too many and I agree with the hon. Lady about the importance of that programme for the immigrant population.


14. Mr. Andrew F. Bennett : To ask the Secretary of State for Health what is the total number of midwives currently working in the National Health Service.

Mr. Mellor : At 30 September 1987, 19,320 whole-time equivalent midwives were employed in the National Health Service in England.

Mr. Bennett : Will the Minister explain to the House why morale among midwives working in hospitals is so low, why the numbers leaving the profession are steadily increasing and why recruitment is proving so difficult?

Mr. Mellor : I do not accept the premise of the hon. Gentleman's question. There are 20 per cent. more midwives today than there were a decade ago and never have midwives been better paid than they are now. In the past 12 months their pay has increased on average by some 20 per cent. There is absolutely no reason for midwives' morale to be anything other than high.



Q1. Mr. Wood : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

The Lord President of the Council and Leader of the House of Commons (Mr. John Wakeham) : I have been asked to reply My right hon. Friend the Prime Minister is attending the European Council meeting in Madrid.

Mr. Wood : I thank my right hon. Friend for that reply. Bearing in mind the continuing importance of a sound defence policy, is my right hon. Friend not relieved that the Government can rely on friends who believe in nuclear deterrence rather than nuclear disarmers such as Mr. Ron Todd?

Mr. Wakeham : Yes, I agree. However much the Opposition try to hide it, with their present defence policy they could not sign up to NATO's excellent comprehensive concept which my right hon. Friend the Prime Minister and the 15 other NATO leaders agreed last month.

Mr. Hattersley : What is the Government's revised forecast for the annual deficit on current account?

Mr. Wakeham : It is not my job to give revised forecasts at the Dispatch Box at this time. It is also unwise to draw conclusions from one month's figures. The May current account figure of £1.3 billion is the lowest monthly figure since last September and the signs that import growth has been slowing down in recent months suggest that the tightening of monetary policy may be starting to influence recorded trade.

Mr. Hattersley : What sort of an economic policy is it that rejoices, as the right hon. Gentleman has just rejoiced, at the worst balance of payments figure--worst except for eight previous months in our history--a forecast for the current year which would be infinitely worse than the

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Treasury predicted at Budget time, and a balance of payments which produces interest rates which continue to impose intolerable burdens on home owners? What sort of an achievement is that and what sort of a triumph is it that the Leader of the House boasts about?

Mr. Wakeham : The right hon. Gentleman is so fond of working out his supplementary questions that he does not listen to the answers. I started my answer by saying that it is unwise to draw conclusions from one month's figures, and that is not boasting about figures. The Government's policies, which have successfully brought down inflation in the past, will do so again.

Mr. Teddy Taylor : Will the Leader of the House have time in his busy day to send a message of congratulation to my right hon. Friend the Prime Minister for fighting so hard for common sense and stopping Britain being sucked into the kind of bureaucratic Socialist nonsenses that we had at the time of George Brown and Harold Wilson's national plan?

Mr. Wakeham : I shall certainly do as my hon. Friend asks. My right hon. Friend the Prime Minister will be making a statement to the House when she returns, but things look pretty good to me.

Q2. Ms. Abbott : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer the hon. Lady to the reply that I gave some moments ago.

Ms. Abbott : When will the Government meet the very real grievances and concerns of people throughout the country, and particularly of general practitioners, about the Government's proposals for the Health Service?

Mr. Wakeham : My right hon. and learned Friend the Secretary of State for Health is negotiating--as would have been apparent to any right hon. or hon. Member present in the Chamber for health questions--to reach a satisfactory solution over doctors' contracts. I have no doubt that satisfactory arrangements will ultimately be made.

Q3. Sir William Clark : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Sir William Clark : Will my right hon. Friend join me in welcoming the fact that since 1983 employment in this country has increased by nearly 3 million and is running at an all-time record high? Does he agree that that economic achievement and success has been made possible only because of sound financial policy, encouragement and enterprise that the Government have persistently pursued?

Mr. Wakeham : Yes. More people are in work than ever before. Between 1983 and 1987 as many new jobs were created in this country as in the whole of the rest of the European Community put together. Over the past decade, self-employment has risen by more than 1 million as people have responded to Government policies of deregulation and of encouraging enterprise and initiative. A 1 million fall in unemployment since the last general

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election was achieved in less than the two years that Labour claimed their reckless policies of high spending and phoney jobs would take to produce the same result.

Mr. Winnick : Now that the Prime Minister is out of the country, will the Leader of the House say whether Cabinet Ministers are haunted by the date of 13 July 1962--the night of the long knives--when seven members of the then Cabinet were sacked by Harold Macmillan? If this is the right hon. Gentleman's last appearance in the House deputising for the Prime Minister, may I express my regret that he has served under a leader who blames everyone but herself for failures and wish him every success for the future--with or without redundancy money?

Mr. Wakeham : The hon. Gentleman has more experience of losing elections than I have. In my judgment he must get ready to lose a few more.

Q4. Mrs. Gorman : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Mrs. Gorman : Does my right hon. Friend, and through him my right hon. Friend the Prime Minister, agree that a necessary precondition of our joining the European monetary system is the abolition of exchange controls by the other member nations, which is something that we did with great success in 1979?

Mr. Wakeham : I agree with my hon. Friend that it is highly desirable that all our European partners should follow our lead in abolishing exchange controls. As to the outcome of the Madrid summit, my hon. Friend should await the statement by my right hon. Friend the Prime Minister on her return.

Sir Russell Johnston : As it is now clear, and has been remarked upon by the Treasury Select Committee, that the Government signed the Single European Act without believing in it, can the right hon. Gentleman give an assurance that his right hon. Friend the Prime Minister is not about the same sort of business in Madrid?

Mr. Wakeham : I am not responsible for Select Committee reports, except for that which the House approved the other day. However, I give the hon. Gentleman a categorical undertaking that my right hon. Friend the Prime Minister would not sign a communique with which she did not agree.

Q5. Mr. Watts : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Watts : Will my right hon. Friend, in support of the action taken by my hon. Friend the Member for Windsor and Maidenhead (Dr. Glyn), find time to discuss with our right hon. Friend the Home Secretary the alarming reports of an acid house party in Berkshire at the weekend and to consider with him whether adequate powers exist in current legislation to deal with such menaces or whether fresh legislation is required to protect young people from being ensnared in the vicious circle of drug abuse?

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Mr. Wakeham : I agree with my hon. Friend that press reports of drug taking at the events at White Waltham are deeply disturbing. A police investigation is in progress. The Home Secretary has asked the police for a full report. The wider implications will be considered when the report has been received. The police already have tough powers to tackle the misuse of drugs and the menace of drug dealing. They have powers to trace, freeze and confiscate the assets of those involved in the evil trade of drug trafficking.

Mr. Skinner : Will the Leader of the House remind the SLD--

Hon. Members : Who?

Mr. Speaker : Order. The hon. Gentleman is very experienced. He cannot ask the Leader of the House to undertake anything for which he is not responsible.

Mr. Skinner : The Leader of the House is responsible, Mr. Speaker, in his capacity as Leader of the House, if the Short money is being paid to parties that have a specific name. [Interruption.] Will he therefore recall the correspondence that we had last year when that party was in the throes of changing its name? He ought kindly to remind it that it got the Short money under one name and that if it intends to change its name again it had better be careful or it will lose the lot.

Mr. Wakeham : On this particular issue, I think that the Members of the party who sit behind the hon. Gentleman had better take notice of him, because he is one of the greatest living experts on this matter. I treasure very much the letter that he wrote to me in his own fair hand some time ago setting out the whole position.

Q6. Mr. Oppenheim : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Oppenheim : Bearing in mind the Government's economic policies, will my right hon. Friend consider recent comments that nationalisation is no solution to social ills and that free markets are the best way to signal the desires of consumers and to encourage innovation? Those remarks were made by Willy Brandt, the president of the Socialist International, to which the British Labour party still subscribes.

Mr. Wakeham : I agree that nationalisation is no answer to anything. The Labour party purports to be a convert to the market and to a partnership between Government and industry, but its notion of a partnership is like the walrus and the oysters.

Q7. Mr. Fraser : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Fraser : Will the Leader of the House obtain immediate instructions from the Prime Minister to withdraw amendments in the other place that would give

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privatised water companies immunity from prosecution and allow untreated sewage to be released into our rivers? The fact the Prime Minister feeds us that stuff, with authority, about the economy is no reason for releasing it into our rivers.

Mr. Wakeham : The House will have an opportunity to consider the Bill which is now in another place when it returns here. I have no intention of taking the hon. Gentleman's advice. When the Bill returns here we shall be able to debate any changes that are made in the other place. I believe that our record is better than that of virtually any other country in the European community.

Dr. Glyn rose --

Hon. Members : Hear, hear.

Mr. Speaker : Order.

Dr. Glyn : Contrary to suggestions, I missed the party by half an hour. I have impressed on the Home Secretary that it is necessary to tighten the law that relates to these sort of events which are held on private property with the consent of the owner. At the moment there is only one sanction--a £1,000 fine. The amount of money that was made on that occasion was enormous with 11,000 present at up to £40 a ticket. No provision whatsoever had been made for proper hygiene, but the police had no power to intervene because the party was held on private property.

Mr. Wakeham : I am grateful-- [Interruption.]

Mr. Speaker : Order. Interruptions take up a lot of time.

Mr. Wakeham : I am grateful to my hon. Friend for what he just said and I know that the Home Secretary will be interested in hearing his views on the matter. As I said, my right hon. Friend has called for a report, and he will consider the issues involved after that.

Q10. Mr. Loyden : To ask the Prime Minister if she will list her official engagements for Tuesday 27 June.

Mr. Wakeham : I have been asked to reply.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Loyden : Will the Leader of the House reconsider his previous answer relating to the subject of unemployment? Is he aware that, despite the figures that he gave, hardcore unemployment in this country remains virtually unchanged and that only by massaging and fiddling the figures are the Government able to paint a picture which suggests that the whole problem of unemployment is now off the agenda? Is he aware that unemployment is still causing great hardship among families, who consider that such steps as the Government have taken represent a policy of complete disregard?

Mr. Wakeham : That supplementary question is just not a reasonable analysis of the situation. The Government's policies have created a great many jobs in Britain. Of course there are still problems, but we shall tackle them vigorously with the policies that have been so successfully pursued over the last 10 years.

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