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Mr. Mellor : Our proposals will produce a better quality of care for all NHS patients, including elderly and chronically sick people. We intend to bring all services up to the standard of the very best and to make certain that taxpayers' money is used to best effect from the patient's point of view. The proposals reflect our strong commitment to the principles on which the NHS was founded and will ensure that it is more than ready to face the rapidly changing and rising demands upon it as medical science progresses and the average age of the population rises.
65. Mr. Michael : To ask the Secretary of State for Health what steps he has taken to (a) sponsor adequate research and (b) undertake pilot projects to an adequate level on the likely effects of the White Paper proposals on the effectiveness of the National Health Service.
Column 424are quite satisfied that the NHS needs reform on the lines proposed to improve its management and to improve the service to patients.
Mr. Mellor : Before self-governing status is granted to a hospital the initial arrangements for provision of core services will have to be approved by my right hon. and learned Friend the Secretary of State. Thereafter self-governing hospitals will be expected to continue to provide these services subject to review at the request of either the hospital or the DHA concerned or, in the event of disagreement, the Secretary of State's further approval.
Mr. Kenneth Clarke : On the 4 May I reached agreement with the negotiators of the General Medical Services Committee on all the major outstanding issues in the new contract. The negotiators undertook to commend this agreement to the annual conference of local medical committee representatives on 21 June. This conference voted to reject the agreement reached by the negotiators, and there will be a ballot of all GPs in the country.
I am disappointed that the conference has rejected the contract which its own leadership commended to it. The contract negotiations were long and hard--over 100 hours of discussion spread over more than a year. The resulting agreement was hard fought and I made a number of important concessions which I would not have made but for my desire to reach an agreement if possible. Both sides agreed on the need for a new contract which rewarded good performance. I believe this contract does meet that need and I see no sensible basis upon which negotiations could be reopened. My task is to raise the quality of primary health care within the NHS and, in order to pursue that, I aim to have in place by 1990 a contract which rewards doctors who provide the highest standards of care for their patients and encourages the rest to match the performance of the best. Recent research by York university's centre for health economics has demonstrated the wide range of quality of service to patients provided in different parts of the country under the old contract. I shall be laying regulations before Parliament later this year to bring a new contract into effect by 1990.
Ms. Harman : To ask the Secretary of State for Health if he will give an estimate of what percentage of a district health authority's budget would be for contractual referrals for hospital care and what percentage would be for extra-contractual referrals under his White Paper.
Mr. Mellor : District health authorities will make provision, within their budgets, for the possibility of referrals which were not foreseen when they placed their contracts. The size of this contingency fund will be a matter for them. However, in deciding the pattern of contracts DHAs will be required to take account of the views of all local GPs and place contracts to secure the referral patterns which local GPs wish to see in place unless there are compelling reasons for not doing so. In this way the need for a contingency fund will be minimised.
Mr. Mellor : Applications to participate in the practice budget scheme will be made to, and approved by, regional health authorities. It is too early to estimate the likely numbers which will be in operation from 1 April 1991, but there have been an encouraging number of preliminary inquiries.
Mr. Kirkwood : To ask the Secretary of State for Health if he will make a statement on the effects of his White Paper "Working for Patients", especially relating to self-governing hospitals, on supra-regional services including poisons units.
A working party is currently considering the implications of this for these services. The NHS management executive will discuss with regional health authorities the detailed application to specialist services of the new funding arrangements proposed. It is, however, too early to say how individual units will be affected.
Mr. Kirkwood : To ask the Secretary of State for Health if, under his plans for capital valuation of self-governing hospitals, he will offset the cost of any backlog on building or equipment maintenance against the capital valuation.
Mr. Freeman : The valuation of the property occupied by self- governing hospitals will be on the basis of open market value for existing use. This valuation takes account of the age and condition of the buildings.
Mr. Kirkwood : To ask the Secretary of State for Health what mechanism and estimate of cost exists for separating the cost of treatment from research and training in order that self-governing teaching hospitals have the necessary information to operate effectively.
Mr. Mellor : We have developed a method for estimating the excess service costs arising from teaching and research at hospitals where at least 5 per cent. of student teaching is undertaken. This is used in the calculation of the service increment for teaching (SIFT). Regions and districts as appropriate to local circumstances will contract with hospitals (including self-governing hospitals) to provide service facilities for teaching in return for SIFT payments.
Mr. Kirkwood : To ask the Secretary of State for Health (1) whether he plans to introduce a system of cross charging for accident and emergency work under his proposals for self-governing hospitals where a hospital is situated near a major travel point or in a major commuter area ;
(2) whether, in those inner-city areas where patients are more likely to use accident and emergency services rather than a general practitioner, he has any plans either to allow a hospital to curtail such services or to cross charge a general practitioner or family practitioner committee for costs incurred.
Column 426with the health authority in whose district they are located. District health authorities will be responsible for securing sufficient accident and emergency services in their district irrespective of the place of residence for all patients who are present. There is no intention that family practitioner committees or GPs should be charged.
Mr. Kirkwood : To ask the Secretary of State for Health whether he will postpone his plans to introduce general practitioners' budgets if all hospitals are not operating the necessary management and accounting systems needed to work out the nature of various contracts by April 1991.
Mr. Kirkwood : To ask the Secretary of State for Health whether the capital valuation of a self-governing hospital or unit is to be based on a value for present use or on the current market value of the site.
Mr. Kirkwood : To ask the Secretary of State for Health whether, if a hospital offers an integrated hospital and community midwifery service, he will ensure that the service continues if the hospital has opted out.
Where maternity services are designated by a district health authority as "core services" my right hon. and learned Friend the Secretary of State will approve the initial arrangements for provision of such services on establishment of a self-governing hospital. The detailed arrangements will be set out in contracts between the hospital and health authority. Subsequent changes in provision will have to be either by agreement between the district health authority and self-governing hospital or have my right hon. and learned Friend the Secretary of State's approval.
(2) whether emergency and outpatient facilities will be provided at all self-governing hospitals.
Mr. Mellor [holding answer 21 June 1989] : We are prepared to consider all hospitals and a variety of other units as potentially eligible for self-governing status. Comprehensive core services or particular services need not necessarily be provided by each one.
Mr. Kenneth Clarke : I last met the British Medical Association on 14 June and it confirmed that it shared the aims of the Government to create a better National Health Service, as set out in the foreword to the White Paper.
Column 427The BMA also confirmed that it agrees on the desirability of introducing better financial control, and quality control in the form of medical audit in the service. It also agreed on the need to make money follow the patient, and to make patient service the prime objective of the service.
It did not, however, agree with some of the major proposals in the White Paper such as self-governing hospitals, about which many people in the NHS have expressed interest. These proposals are crucial to delivering the better service which both I and the BMA want. It did not put forward any new proposals of its own to achieve those aims. It did agree to further discussions.
I intend to reform the NHS to make it more able to provide an improved service to patients. I made it clear to the BMA that I would welcome a constructive contribution from it to that process of reform whenever it felt able to make one.
45. Dame Jill Knight : To ask the Secretary of State for Health when he last met the British Medical Association representatives to discuss the Health Service review ; and if he will make a statement.
Mr. Freeman : Responsibility for the control of headlice infection among pupils rests with the individual health authorities through the school health service. It is for them to determine the policy for dealing with this problem in the light of local circumstances.
Mr. Freeman : The Government have introduced a range of measures designed to reduce the risk of food contamination and, with industry, are continuing to consider what further action is necessary. Both primary and secondary legislation are under review. We recently announced the intention to consult on changes in the food hygiene regulations, and the Government are presently considering the results of consultation on a wide-ranging review of the Food Act.
Column 428The Committee on the Microbiological Safety of Food has commenced work under the chairmanship of Sir Mark Richmond.
Meanwhile we shall continue to act promptly to contain outbreaks of food poisoning which occur, and I refer the hon. Member to the statement my right hon. and learned Friend the Secretary of State made on 13 June, at columns 703-9.
26. Mr. Colvin : To ask the Secretary of State for Health whether he will review the grading structure for qualified nurses who became student midwives prior to 1 April 1988 ; and if he will make a statement.
28. Mr. Riddick : To ask the Secretary of State for Health what has been the average annual expenditure on capital programmes in the area covered by the Yorkshire regional health authority between 1979 and 1989 ; what was the equivalent annual figure for the years between 1974 and 1979 ; and if he will make a statement.
Average annual total capital expenditure Period |£000 (Cash) -------------------------------------------------------- 1974-75 to 1978-79 (5 years) |22,837 1979-80 to 1987-88<1> (9 years) |54,508 <1> Latest year available.
The average figure for the later period represents an increase in real terms (measured at 1987-88 prices) of almost 10 per cent. on that for the earlier period.
Mr. Mellor : Together with the Health Education Authority, the Department launched the "Look After Your Heart" campaign in April 1987 as an ongoing initiative to combat the high level of coronary heart disease. This initiative aims to increase awareness about the risk of heart disease and how it may be avoided, and to provide practical help to people in making the necessary changes to their lifestyle. It is doing this through publicity campaigns and special promotions, provision of detailed advice about smoking, nutrition and exercise, and funding of local initiatives. It has developed a very successful workplace element. These activities are currently being expanded, and other areas of work, such as with primary health care and in schools, are being developed.
Much other work is also going on. The Government are taking specific action to discourage smoking, which is a key factor in causing heart disease, and excessive consumption of alcohol. The Standing Medical Advisory Committee has been asked to look at the cost-effectiveness
Column 429of cholesterol screening in relation to the prevention of coronary heart disease. Under changes to general practitioners' terms of service, they will be required to offer patients regular check-ups, including measurement of blood pressure. We believe that this important development will provide an opportunity for GPs to give personal advice to patients, particularly those most at risk of heart disease, about steps they can take to lessen this risk.
35. Mr. Dykes : To ask the Secretary of State for Health what recent representations he has received from all sources concerning the possible transfer to self-governing status of the Northwich Park hospital and the Royal National orthopaedic hospital in the Harrow district health authority area.
Mr. Mellor : Expressions of interest in self-governing status have been received from both Northwick Park hospital and the Royal National orthopaedic hospital. My right hon. and learned Friend the Secretary of State has received a number of representations on the latter. Should this interest, in either case, proceed to an application, I can assure my hon. Friend that all the main interests--including staff and the local community --will have an opportunity to express their views when detailed proposals have been worked out.
37. Mr. Madel : To ask the Secretary of State for Health what information he has as to the average amount of time per week that general practitioners now spend seeing patients ; and if he will make a statement.
Mr. Mellor : The available information is taken from the general medical practitioners workload survey carried out in 1985-86 by the Health Departments and the British Medical Association. it shows that in an average working week GPs spend 26 hours seeing patients. This comprises 18 hours in surgery, six hours in home visits and two hours in clinics.
Mr. Mellor : The role of the NHS policy board is to advise my right hon. and learned Friend the Secretary of State on the formulation of policy for and the strategic oversight of the NHS. It sets objectives for the NHS management executive and monitors their achievement.
Mr. Mellor : We have established two programmes to screen women regularly for cervical and breast cancers. Most of the cervical smears performed each year are taken by general practitioners. Breast cancer screening is organised by regional health authorities and is carried out in specifically equipped centres.
I refer the hon. Member to my reply to the hon. Member for Glasgow, Maryhill (Mrs. Fyfe), on 14 June, at columns 429-30 for information about those breast screening centres in England which are operational and to my reply to my hon. Friend the Member for Eastwood (Mr. Stewart), on 19 June, at column 35, for information about screening in health care.
Information on screening in the other parts of the United Kingdom is the responsibility of my right hon. Friends the Secretaries of State for Wales and Northern Ireland and my right hon. and learned Friend the Secretary of State for Scotland.
64. Ms. Richardson : To ask the Secretary of State for Health whether he has issued guidelines to National Health Service hospitals on (a) the information they provide on breast cancer screening and (b) levying charges for breast cancer screening.
Mr. Mellor : The Health Education Authority has produced a leaflet which can accompany a woman's invitation letter to explain what happens at a breast screening centre. Additional material has been produced to inform staff involved in health education and primary care about the screening programme. A general information leaflet on breast screening is also due to be published shortly. The guidance to health authorities concerning the provision of breast cancer screening referred to in the reply my hon. Friend the Parliamentary Under-Secretary of State for Health gave to the hon. Member on 21 February, at columns 606-7, drew attention to the role the Health Education Authority would play in supporting health authorities' education programmes for women.
Guidance issued to health authorities in March on income generation HN(89)9 states that the Department should be consulted where proposals for income generation clearly involve national policy, "for example breast and cervical cancer screening".
Column 431account of the many representations and views we have received. We hope to be able to announce our proposals shortly.
Mr. Mellor : We allocated £30 million from the central waiting list fund in 1988-89 as part of the Government's drive to reduce hospital waiting lists and times. This money enabled over 117,000 additional in- patients and day cases and over 92,000 extra out-patients to be treated from the waiting lists.
Self governing trusts will not opt out but will remain fully within the NHS.
If an application is made for QMC Nottingham to become self-governing, Trent regional health authority will ensure that all those with an interest have the opportunity of expressing their views but a ballot will not be required. My right hon. and learned Friend the Secretary of State will consider any responses alongside the application.
57. Mr. Hardy : To ask the Secretary of State for Health if he will take steps to ensure that the salaries of medical scientists employed within the National Health Service are sufficient to ensure that there are no critical shortages of such staff.
Mr. Mellor : The pay of non-medical scientists is a matter for negotiation between the management side of the Scientific and Professional Staff Council and the staff side representing scientists employed in the NHS. Negotiations are continuing on the staff side pay claim for 1989/90. The pay of medically qualified staff is decided after taking into account recommendations of the doctors and dentists review body.
England-Average list size |Number --------------------------------- 1 October 1979 |2,286 1 October 1987 |<1>2,020 <1>Latest available figure.
71. Mr. Hardy : To ask the Secretary of State for Health how many appeals have been submitted in regard to salary grading by members of the nursing profession ; and what are the numbers that have yet to be determined.
Mr. Kirkwood : To ask the Secretary of State for Health (1) where nurse education is organised across more than one hospital, what are the implications for such education where one hospital opts out ; (2) whether the budget for nurse education currently with the district health authority will devolve to a hospital which opts out which is currently operating or partly operating a school of nursing.