|Previous Section||Home Page|
Mr. Kenneth Clarke : When district health authorities place contracts, they will be expected to give effect to the referral patterns which local GPs want. They will need to consult closely with their GPs, therefore, in order to agree a range of contracts which make best use of their resources to secure the best services for their residents. As a result, local GPs will be much more closely involved in planning health care for their patients than at present. GPs will also have their freedom to refer increased, because for the first time they will be able to refer patients for NHS treatment in private hospitals. DHAs will be much better placed to take advantage of GPs' knowledge of their patients' needs.
GP practice budget holders will of course have their freedom to refer increased because they will be able to negotiate their own preferred pattern of referral with hospitals and units using the taxpayers money at their disposal.
Mr. Mellor : We are pleased to be able to say that good progress is being made on the implementation of our proposals for the Health Service. Consultation is taking place with a great many interested parties, including those
Column 659representing medical opinion, and we are working with NHS managers to ensure smooth implementation. Progress includes :
receipt of 178 expressions of interest in self-governance from hospitals and other NHS services ;
publication of an initial guide on self-governing hospitals which has provided much more information about how self governing hospitals will operate ;
the establishment of the new NHS management executive and the NHS policy board ;
a major initiative to improve the quality of service is now under way ;
publication of a further working paper on the capital charging system ;
the first 56 hospitals are now in the process of installing new information systems ;
shortlisting for 90 FPC general manager posts is virtually complete and a number of appointments have already been made.
medical audit systems are being developed at a cost of £2 million this year ; and
bids for the 100 extra consultant posts promised in the White Paper are due at the end of July.
Mr. Mellor : Since the White Paper "Working for Patients" was published, a number of working papers have been issued and these contain some further detail about training and education. The working paper, "Self- Governing Hospitals--An Initial Guide", advises that a consultation paper on training and education will be issued shortly, which will deal fully with these important issues.
Mr. Mellor : Provisional figures show that at 30 September 1988 there were 404,000 whole-time equivalent nursing and midwifery staff (including agency staff) in the National Health Service in England. The comparable figure for September 1979 is 358,000 whole-time equivalents.
Mr. Kenneth Clarke : I met Mr. Michael Wilson and his negotiating team from the General Medical Services Committee yesterday. The Government are proceeding with the preparation of the necessary amendments to regulations and to the GPs' statement of fees and allowances. Subject to Parliament's approval, the reforms to the GPs' contract will be introduced on 1 April 1990.
33. Mr. Henderson : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
57. Mr. Redmond : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
85. Mr. John Hughes : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
88. Mr. Caborn : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
Mr. Kenneth Clarke : I have no plans at present to meet the chairman of the British Medical Association on this subject, but I met the chairman of the General Medical Services Committee and his negotiating team on 24 July.
Mr. Mellor : The new contract will for the first time introduce a fee for GPs providing health promotion clinics. It will also require GPs to offer health check-ups to patients newly registering with them, and patients who have not seen their GP for three years.
89. Mr. Jacques Arnold : To ask the Secretary of State for Health to what extent general practitioners will be able to carry out minor surgery under the terms of the new general practitioners' contract.
Column 661minor surgery services to patients. This will encourage the provision of minor surgery by GPs and relieve the pressure on out-patient departments.
Mr. Mellor : The new contract will for the first time introduce a fee for GPs who provide child health surveillance services to children on their lists, according to programmes agreed by the district health authority. There will also be new incentives to encourage GPs to help achieve high levels of coverage for childhood immunisations. District health authorities will continue to be responsible for monitoring health care services for young children, and GPs will be required to keep them fully informed of the services they provide. DHAs will work in close co- operation with family practitioner committees.
Mr. Mellor : By introducing new payments linked to the achievement of specified levels of coverage for childhood immunisation and cervical cytology, the new contract will offer GPs a powerful incentive to help raise coverage among their patients.
Mr. Mellor : The new contract will help improve services in deprived areas. Changes to their remuneration system will encourage GPs to practise in areas of deprivation by recognising the special circumstances involved. In future family practitioner committees will be able to target funds for premises improvements and practice team expansion to improve services in these areas. The greater emphasis in the new contract on preventive care will mean that patients in deprived areas will benefit as GPs seek to improve the levels of protection against childhood diseases and cancer of the cervix.
Mr. Mellor : The new contract will lead to improved services to elderly people. As a result of changes to their terms of service and remuneration system GPs will have a powerful incentive to strive to provide them with the best possible care. There will be a significantly increased capitation free for patients over the age of 75, and in return for this GPs will be expected to offer annually a thorough health assessment, including a home visit if the patient wishes.
Mr. Mellor : The new contract forms an important part of our policy of encouraging health promotion and the prevention of ill-health. General practitioners' terms of service will make clear their role in these areas, and there will be new payments encouraging the provision of health promotion clinics, check-ups for newly registered patients and the achievement of high levels of coverage for cervical cancer screening and childhood immunisations.
Mr. Mellor : The hours during which a night visit fee may be claimed will be extended and a higher fee introduced for GPs who make their own visits or who arrange visits in a small rota of no more than 10 doctors. This will reward those doctors who ensure continuity of care to their patients during out-of-hours periods.
Mr. Mellor : During 1988-89 the Government made an additional £1.3 million available to health authorities to distribute as a contribution to the costs incurred by voluntary hospices due to the nurses' pay award. It also made a grant of £400,000 to Help the Hospices for distribution to local projects in short-term financial difficulty. In addition, the Government provided separate funding for the AIDS hospices at the Mildmay hospital and London Lighthouse, £256,000 and £208,000 respectively. The bulk of NHS support for hospices comes from local health authorities, which are best placed to judge how the contribution of voluntary bodies can be integrated with the other services for which they are responsible.
Mr. Mellor : The results of this survey were published yesterday in an Office of Population Censuses and Surveys report entitled "Smoking among secondary school children in England in 1988" [ISBN 0 11 691267 7]. Copies have been placed in the Library.
Column 663The results of the survey show that the decline in teenage smoking revealed by the 1986 survey has been confirmed, and there is evidence of a further decline in 1988. The prevalence of regular smoking among teenagers aged 11-15 is estimated at 7 per cent. for boys and 9 per cent. for girls. This is well below the level of 13 per cent. for both boys and girls seen in 1984. The results of this survey will be of great value in helping to determine the precise strategy to be used in the new teenage smoking campaign announced by the Prime Minister in January. This should encourage health workers, teachers and parents to continue their worthwhile efforts to persuade young people not to take up this dangerous habit.
Mr. Mellor : We understand that the management side of the Scientific and Professional Staffs Council has set up a working party to investigate the recruitment and retention of scientists in the NHS and is currently considering its findings.
Mr. Mellor : The Government are committed to reducing further the onerous hours of some junior hospital doctors. There are two current initiatives. That launched in June 1988 aims to minimise the number of doctors with average weekly hours of duty in excess of 84. Interim reports from health authorities in January showed
Column 664progress had been made but more needed to be done. The second initiative was launched earlier this month and involves studies to see whether the Government's long-term aim of 72 hours duty a week can be achieved within existing constraints. Final reports on both initiatives are due in October.
Figures, for England only, as at 30 September |1979 |1987 -------------------------------------------- Hospital medical staff |41,736|46,394
Mr. Mellor : The Department has no plans to introduce any kind of no -fault compensation scheme for medical practitioners. We consider that the basis for seeking compensation for injuries alleged to have been suffered as a result of medical negligence should continue to be through litigation in the courts.
38. Mr. Latham : To ask the Secretary of State for Health whether he will make a statement on his latest discussions with the British Medical Association regarding the White Paper, "Working for Patients."
Mr. Kenneth Clarke : I last met the British Medical Association on 15 June when we talked about the Government's proposals for the Health Service. Although the BMA expressed opposition to some of the proposals, they continued to support a number of our planned reforms including medical audit, the principle of money following the patient, the extension of resource management and the greater involvement of doctors in management. Both sides expressed their unconditional support to the underlying principles of the Health Service.
64. Mr. Dykes : To ask the Secretary of State for Health if he is now able to give an assessment of the current relations between his Department and the doctors within the British Medical Association membership.
Mr. Kenneth Clarke : Although I very much regret the hostile and unconstructive stance that the BMA as an association has taken towards our plans for the Health Service, I know that there is strong support for the principles on which our reforms for the Health Service are based and for many of our individual proposals among doctors in the hospital service and in general practice.
29. Mr. Madden : To ask the Secretary of State for Health how public opinion is to be tested in Bradford over proposals for local hospitals to become self-governing trusts ; and if he will make a statement.
84. Mr. Tony Lloyd : To ask the Secretary of State for Health what guidance he is issuing to health authority on arrangements for public consultation where groups have expressed an interest in pursuing the opting out of individual hospitals.
32. Mr. Andrew Bowden : To ask the Secretary of State for Health what steps he is taking to ensure that health authorities adopt the hospital discharge practices outlined in circular HC (89) 5, "Discharge of Patients from Hospital".
Mr. Freeman : Circular HC(89)5 states that, in the light of the guidance held in the circular, district and special health authorities should report on action taken to their regional health authority or, in the case of special health authorities, to the Department by 31 March 1990.
Mr Mellor : Yes, recent discussions have covered hospital services in Birmingham, for which the region has made proposals for reorganisation which are currently the subject of preliminary local consultation.
Mr. Mellor : Provision of wheelchairs is a matter for the district health authority concerned and the hon. Member may care to contact the chairman of Leicestershire health authority for the information that he seeks.