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Dame Elaine Kellett-Bowman : In the review of the National Health Service, from which my constituents will benefit substantially when money follows the patient, will my right hon. and learned Friend bear in mind that in my constituency we have many elderly people and two very old mental deficiency hospitals for which more funds are required? Will he please see that enough money is pushed into the north-west so that we can have a generous allocation for those services?

Mr. Clarke : In my opinion all parts of the National Health Service will benefit from the new system because we will be matching resources more closely to the delivery of expanding services in the manner that my hon. Friend rightly described as money following the patient. Lancaster will benefit particularly because at the moment it draws in many patients from outside its district boundaries for which no adequate financial provision is made under our present arrangements. It will be important to distribute money to the district health authorities which will have to make decisions about where to put the money in order to get the service that they require in a way that reflects the make-up of the population, demographic trends and so on of each district. They should certainly bear in mind the age structure in Lancaster to which my hon. Friend refers.

Community Care

12. Mr. Nigel Griffiths : To ask the Secretary of State for Health if he intends to ensure that standards of assessment for community care services are of a national minimum quality.

Mrs. Virginia Bottomley : Local authorities will be responsible for carrying out assessment, in collaboration with medical, nursing and other interests. Further information on the procedures will be contained in our White Paper on community care, to be published shortly.


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Mr. Griffiths : The Minister told the House on 17 October that the Government were committed to advocacy for the disabled, so why have they delayed shamefully the implementation of sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1987? The Minister referred to local authorities, so why have the Government postponed meeting local authorities to discuss these matters, which are so critical to disabled people?

Mrs. Bottomley : The proposals in the White Paper will be a milestone in the provision of care for those who need to be cared for in the community. They will offer the opportunity of assessment and appropriate care rather than the perverse incentives that have taken place in the past. The provisions of the Disabled Persons Act will be reviewed in the light of the proposals once they have been announced.

Mr. Soames : Is my hon. Friend aware that now that so many beds are provided in the private sector for the care of the elderly, the generally held view is that there is not sufficient liaison between the private and public sectors for the care of the elderly? Is my hon. Friend satisfied, within the context of the report, that everything possible is being done to obtain that important information?

Mrs. Bottomley : My hon. Friend addresses a key point. What matters to the elderly is that provision is available and there is a choice of provision. Our proposals for care in the community will allow for an equal playing field, which will in turn allow choice, variety and proper inspection. No more will either the public or the private sectors be disadvantaged.

Mr. Tom Clarke : Is the Minister aware that Sense, the organisation of and for blind-deaf persons has issued a clear statement in which it says that the tragic case of Beverley Lewis might not have taken place had the appropriate sections of the Disabled Persons Act been implemented? Will the Government accept that they have on the statute book the opportunity to prevent such dreadful cases from taking place, and will they make sure that this Act is implemented with all possible speed? Will the Minister also resume negotiations with the local authorities?

Mrs. Bottomley : The hon. Gentleman will know as well as I do of the danger of springing to too many conclusions on one tragic and appalling case. We are looking carefully at this case and will learn lessons as appropiate. I draw to the hon. Gentleman's attention the provision, recently announced by my hon. Friend the Under-Secretary, of further services and attention to the needs of the mentally ill.

Prescriptions

13. Mr. Knapman : To ask the Secretary of State for Health what percentage of National Health Service prescriptions are free of charge ; and what is the comparable figure for 1979.

Mrs. Virginia Bottomley : In 1988, 77.5 per cent. of prescriptions dispensed by pharmacies were dispensed free of charge. This compares with 60.9 per cent. in 1979.


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Mr. Knapman : Is it not basic common sense that the one person in four who can readily afford to make such contributions should do so, thereby further expanding NHS services?

Mrs. Bottomley : Yes. The prescription charge is relatively modest and it is appropriate that the one in four who can reasonably pay should do so. The Government's responsibility is to put patients first--to ensure that resources are used effectively and efficiently--and the fact that there has been such a significant increase in the number of prescriptions given free of charge is a demonstration of the Government's commitment to patients.

Mr. Robin Cook : By what percentage have eye tests dropped since they stopped being free of charge? Will the Minister confirm that, on present trends, we are on course for 3 million fewer eye tests this year?

Last year, the Secretary of State told the House that he did not believe the optometrists when they warned that charges would deter people from having eye tests. Given the stark evidence of the dramatic drop in the number of eye tests, do Ministers believe that now?

Mrs. Bottomley : I will take no sermons from the hon. Gentleman about the provision of care. We intend to review the take-up of eye tests but it was, after all, the hon. Gentleman's party, when in office, which cut capital spending, nurses' pay and the NHS budget. This Government have increased nurses' pay, and allowed record spending on the Health Service, which has led to an extra 25,000 patients a week being treated. We have a record to be proud of.

Mr. John Marshall : Will my hon. Friend confirm that 92 per cent. of the cost of drugs is paid by the taxpayer? Does that and the wide variation in drugs prescribed by doctors not underline the case for indicative drug budgets?

Mrs. Bottomley : My hon. Friend has made his point well and I endorse it.

Finance

14. Mr. Win Griffiths : To ask the Secretary of State for Health if he has any plans to reassess the way in which the financial needs of the National Health Service are determined each year.

Mrs. Virginia Bottomley : No. The Government will continue to assess the financial needs of the NHS within the context of the annual public expenditure round.

Mr. Griffiths : Does the Minister admit that talking about additional expenditure on the Health Service beyond the retail prices index is meaningless when costs within the Health Service rise ahead of the RPI, and the number of old people who need treatment means there is additional need for expenditure? Will the Minister take that into account during the next public expenditure review?

Mrs. Bottomley : It is not meaningless for the 70,000 extra nurses who have been employed by this Government. It is not meaningless for the 14,000 extra doctors who have been taken on. It is not meaningless for the nurses who


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have received a 45 per cent. increase in pay and it is not meaningless for the £4 billion hospital building programme.

PRIME MINISTER

Engagements

Q1. Mr. Cohen : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

The Prime Minister (Mrs. Margaret Thatcher) : This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today, then I shall depart for the United States of America to address the United Nations General Assembly.

Mr. Cohen : Has the Prime Minister seen the statement by the chairman of the Police Federation, Alan Eastwood, in which he said that the police do not have the necessary paramedical expertise to man ambulances? The same is true of the Army. Why are the Government putting lives at risk by treating ambulance men and women as the latest enemy within? Have the Government put them on low pay because they think that saving lives is cheap?

The Prime Minister : I think that the hon. Gentleman is correct in his underlying assumption that it would be far better if the ambulance men were to carry out their normal duties, bearing in mind the fact that most other people in the Health Service settled for 6.5 per cent., and that the London ambulance men have been offered well over 9 per cent., backdated to April. That is why it would be better if the ambulance men were all at their posts dealing with emergency services and with the nine out of 10 patients who are non-emergency but need to be conveyed to hospital.

Mr. Onslow : Does my right hon. Friend agree that elections in Britain are fought on issues of principle and policies, which must rule out an Opposition that have neither?

The Prime Minister : Yes. My hon. Friend is absolutely correct. I agree that the Opposition drop principles and policies when it is expedient, but this Government stick to both. It is that sticking to principles and policies, and passing out as many powers and responsibilities as possible--and enterprise--to people, that have enabled us to create more wealth than ever before, to spread it more widely than ever before and to have a higher standard of social services than ever before.

Mr. Kinnock : When the Prime Minister was asked why the Chancellor resigned, why did she not tell the truth?

The Prime Minister : If my right hon. Friend had wanted to resign on a point of policy, I could have understood that. Policy is a matter for Ministers. I find it totally incomprehensible that someone who has held the office of Chancellor with high standing for six years should want to resign over personality-- [Interruption.]

Mr. Speaker : Order.

The Prime Minister : Over personality, with such suddenness and haste.


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Mr. Kinnock : The Prime Minister appears to be the only person left in the country who does not understand why the right hon. Member for Blaby (Mr. Lawson), the ex-Chancellor of the Exchequer, resigned. Is it not the truth that the right hon. Gentleman said to the Prime Minister, "Either the adviser goes by the end of the year or I go now"? Why cannot she admit that truth?

The Prime Minister : Policy is a matter for Ministers, advice is not. I tried to persuade my right hon. Friend not to go but it was quite clear that he was determined to go, and go that day.

Mrs. Ann Winterton : Will my right hon. Friend take steps to ensure that the 1982 principles agreed by the United Nations Security Council, which stand part of resolution 435, are honoured and upheld in Namibia following the elections in that country which began today?

The Prime Minister : I know that my hon. Friend takes a special interest in these matters and that she is aware that resolution 435 lays down that there should be elections to a constitutional convention. She will be aware also that if the winning party gains only a simple majority, the matter remains for the United Nations representative. It it gains 66 per cent., the winning party can draft the constitutional convention. We do not know what will happen. I have absolute faith in Mr. Ahtisaari", the United Nations special representative, who will decide on all the evidence whether the elections have been free and fair. That is a matter for him, and only him, to decide. We put our whole trust and confidence in him in making the correct decision.

Q2. Mr. Jack Thompson : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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

Mr. Thompson : Is the Prime Minister aware of the widespread anger and consternation in mining areas that has been expressed by miners and private mine owners about the importation of foreign, subsidised, slave- labour coal? Is she aware also that British mines have increased their productivity by 90 per cent. and profit by 30 per cent? Is not this a case for buying British?

The Prime Minister : The hon. Gentleman will be aware of the enormous sums of investment that have been put into the mining industry during the lifetime of the Government--about £2 million for every working day over the past 10 years. That should enable the mining industry to be highly competitive and, therefore, to compete with other coal which could otherwise come in, which would be subject to transport costs. I hope that the industry will be competitive, but we cannot long continue in Britain having people who, when they go shopping themselves, expect to have the benefit of competition and when they produce themselves to expect to have the benefit of protection.

Mr. Lord : Does my right hon. Friend agree that haemophiliacs who have been accidentally infected with the AIDS virus have a unique case both for the sympathy of the nation and the full support of the House? Will she today instruct those who have the managing of these


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affairs to have done with their legal wrangling and allow these people the compensation and the peace of mind that they surely deserve?

The Prime Minister : I have a good deal of sympathy with what my hon. Friend says. He will know that a considerable sum has been given to a trust that has been set up for the benefit of these people. It is very similar to trusts which have been set up in other countries. My hon. Friend will be aware, as his supplementary question suggested, that there is a legal case pending. I think that we must wait for the result of that. In the meantime, I make the point that the trust provides about the same amount as has been available to these people, who have suffered so much, in other countries.

Mr. Kennedy : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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

Mr. Kennedy : Does the Prime Minister feel that her diminishing credibility in the office of Prime Minister would be somewhat salvaged were she to follow yesterday's advice which was offered her by her dear friend Sir Edward du Cann, who suggested that a leadership challenge would clear the air? In the event of such a development, does the right hon. Lady think that her position would be unassailable?

The Prime Minister : The comment from behind me was that a party that cannot decide its own name is hardly in a position to criticise anyone.

Mr. John Marshall : Will my right hon. Friend join me in congratulating the London borough of Barnet on the fact, admitted in The Sunday Times, that the best exam results were obtained in that borough? Does she agree that it is no coincidence that the best school exam results come from Conservative boroughs and the worst from Labour boroughs?

The Prime Minister : Yes, I gladly join my hon. Friend in congratulating Barnet. We both represent constituencies in the borough of Barnet. Its educational results are quite the best and it has some good Members of Parliament too.

Q4. Mr. Clelland : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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

Mr. Clelland : Does the Prime Minister recall telling the nation on television just a week ago, that she did not know why the Chancellor had resigned? Can she explain why someone whom she described as, "Brilliant, brilliant, brilliant", was unable to explain clearly to her that he would have stayed if Alan Walters had gone?

The Prime Minister : The hon. Gentleman must have prepared his question carefully before he heard my previous reply. I have nothing further to add.

Q5. Mr. David Porter : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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


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Mr. Porter : Will my right hon. Friend tell the House what fresh steps she can take to protect and promote Britain's interests with a fair and even-handed allocation and enforcement of quotas, restrictions, rules and regulations within the EC?

The Prime Minister : As my hon. Friend knows, we scrutinise draft directives carefully. Frequently, they are perhaps not best suited to the conditions in this country. Directives are also scrutinised by the House. I entirely agree with him that we must watch them extremely carefully, and, bearing in mind that he comes from a fishing area, that we must be careful that the fishing quotas are not undermined by the Community.

Miss Hoey : What advice would the Prime Minister give to a young person sleeping on the streets in my constituency tonight who cannot get a home because he cannot get a job and cannot get a job because he cannot get a home?

The Prime Minister : The hon. Lady will be aware that a great deal of extra money has been allocated to homelessness, particularly to building through the Housing Corporation--some £815 million this year. She will also be aware that there are now 100,000 more vacancies on youth training schemes than people taking them up, that income support is available for young people and that housing benefit is available to 16 and 17-year-olds in great need at the same rate at which it is paid to older applicants. A great deal has been done and I am sure that she will bear in mind all those matters when she takes up cases.

Q6. Mr. Hannam : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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

Mr. Hannam : Tomorrow, when my right hon. Friend speaks on the environment at the United Nations, will she point out that the most effective way of protecting the environment is through energy efficiency, in which Britain has a superb record,--having achieved a 33 per cent. reduction in carbon dioxide emissions from electricity generation--and that our level of energy efficiency is twice the average for countries in the European Community?

The Prime Minister : Yes. My hon. Friend has delivered Britain's excellent record on energy efficiency. It is very good, indeed it is better than that of many of our competitors. He will also be aware that since 1973 we have increased output by about 26 per cent. That was achieved with a reduction in energy usage of 4 per cent. That is a good record which augurs well for the future. It is extremely important for the environment that we continue to be a keen and active supporter of greater energy efficiency.

Q7. Mr. Eadie : To ask the Prime Minister if she will list her official engagements for Tuesday 7 November.

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

Mr. Eadie : As many people are wondering whether the Government team in office this week will be the Government team in office next week, I wish to ask the Prime Minister an easy question. Does she feel entirely


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happy when her Foreign Secretary--[ Hon. Members :-- "Which one?"] Yes, which one? Does she feel entirely happy when he goes to the United Nations? Does she feel wholly happy that he will be sitting next to a representative of the Pol Pot regime?


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The Prime Minister : On the hon. Gentleman's point about changes, I have the impression that the Opposition Front Bench has changed recently and that there are now rather more CND people on it than there were before.


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