House of Commons Hansard Debates for 7 Nov 1989

Self-governing Hospitals

17. Dr. Goodson-Wickes : To ask the Secretary of State for Health what steps he is taking to ensure that patients are aware that the proposed self-governing hospitals will not be opting-out of the National Health Service.

Mrs. Virginia Bottomley : The Government have made it quite clear, in published documents on the NHS review proposals, and in statements to the House and in public, that NHS trusts will remain firmly within the NHS. We shall continue to take every opportunity to explain our proposals and to dispel any misconceptions.

The Chief Executive of the NHS Management Executive has recently announced (18 October) a new initiative to improve communications and stimulate a better understanding of the Government's proposals amongst NHS staff. This will help to ensure that the people who have direct contact with patients have the necessary information to explain the implications of the NHS review proposals to them.

62. Mr. Watts : To ask the Secretary of State for Health which services will have to be retained by National Health Service self-governing hospitals.

Mrs. Virginia Bottomley : It will be for district health authorities to determine, in the light of local circumstances, what services are required to meet the health care needs of their resident popultion and to secure provision of those services through contracts. As part of this process, health authorities will identify those services which must be provided locally. Where a unit which applies for NHS trust status is the only sensible option for providing such services my right hon. and learned Friend the Secretary of State will approve arrangements for their continued

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provision on establishment of the NHS trust. Any later changes will be subject to my right hon. and learned Friend's further approval if they cannot be agreed locally.

67. Mr. Shersby : To ask the Secretary of State for Health how many National Health Service hospitals have now indicated their interest in self -governance.

Mr. Kenneth Clarke : I have received 186 expressions of interest in NHS trust status. Some are for non-hospital facilities and others include more than one hospital.

73. Mr. McAllion : To ask the Secretary of State for Health what progress towards establishing self-governing hospitals he expects to achieve by 1992.

Mr. Kenneth Clarke : I refer the hon. Member to my reply to my hon. Friend the member for Maidstone (Miss Widdecombe) on 3 November. Apart from the units which are preparing applications for NHS trust status in 1991, others will prepare applications to become trusts later. I expect to receive applications in about 18 months time from hospitals and units wishing to become self-governing NHS trusts from April 1992.

75. Mrs. Rosie Barnes : To ask the Secretary of State for Health what steps his Department has taken to develop the necessary commissioning expertise within district health authorities so that they will be in a position to purchase services from self-governing hospital trusts from April 1991 ; and whether his Department has any plans to revise this implementation date.

Mrs. Virginia Bottomley : On 2 November, Duncan Nichol, the chief executive of the NHS management executive announced a major programme of work to support DHAs in adopting their new role. The project will draw on the results of local initiatives in 11 districts and ensure that the lessons learned are shared quickly across the service. We have no plans to change the timetable for implementing the White Paper reforms.

90. Mr. Sumberg : To ask the Secretary of State for Health how many requests for information he has received from hospitals interested in acquiring self-governing status.

Mrs. Virginia Bottomley : A total of 186 expressions of interest in acquiring NHS trust status have been received. Some of these are for non- hospital facilities and others include more than one hospital.

Mr. Canavan : To ask the Secretary of State for Health which managers of hospitals for mentally handicapped people have expressed an interest in opting out under the arrangements outlined in the Government White Paper.

Mrs. Virginia Bottomley : Eleven units for mentally handicapped people have expressed interest in NHS trust status. A number of other expressions of interest in NHS trust status, for whole district services and for community services, also include units for mentally handicapped patients. There is, of course, no question of any hospital "opting-out" of the NHS.

Mr. Graham Allen : To ask the Secretary of State for Health what was the result of the recent ballot of staff of Queen's medical centre on opting-out.

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Mrs. Virginia Bottomley : I understand that a ballot relating to the expression of interest in NHS trust status from the University hospital in Nottingham was held at the request of Nottingham Trades Council, the results of which are a matter for the trades council. There is, of course, no question of any hospital "opting-out" of the NHS.

Cottage Hospitals

19. Mr. Wigley : To ask the Secretary of State for Health what is his policy on the promotion and support of cottage hospitals under the proposed new funding arrangements for the National Health Service.

Mrs. Virginia Bottomley : Small hospitals can have a valuable role to play in providing a range of services if that is what is needed locally. Under our proposals district health authorities will have responsibiity for ensuring provision of a comprehensive range of services for their resident population. They will be able to take full account of services offered by cottage hospitals in deciding where to place contracts.

Practice Budgets

20. Mr. Robert G. Hughes : To ask the Secretary of State for Health whether he has received any expressions of interest from general practitioners' practices about operating their own practice budgets, as proposed in the White Paper "Working for Patients".

Mr. Kenneth Clarke : Although we have not yet asked GPs to indicate formally their interest in being directly funded as practice budget holders, the level of interest shown by eligible practices has been encouraging.

National Health Service Expenditure

21. Mr. Knox : To ask the Secretary of State for Health what percentage of the gross domestic product was spent on the National Health Service in the most recent year for which figures are available, and what was the percentage in 1978.

Mrs. Virginia Bottomley : In 1988, 5.2 per cent. of the United Kingdom's gross domestic product was spent on the National Health Service compared with 4.9 per cent. in 1978.

25. Mr. Tim Smith : To ask the Secretary of State for Health how much his Department expects to spend on the National Health Service in 1990 -91.

Mr. Freeman : Planned expenditure for 1990-91 for the National Health Service in England currently stands at £22.1 billion. At this time of the year we are awaiting the Chancellor's Autumn Statement ; I cannot, of course, anticipate its contents.

66. Mr. Teddy Taylor : To ask the Secretary of State for Health what has been the total increase or decrease in real terms, taking inflation into account, in Health Service spending in England and Wales over the past 10 years ; and if he will make a statement.

Mr. Freeman : In the past 10 years, since 1979-80, gross expenditure on the National Health Service in England and Wales has increased by 38 per cent. in real terms. Over the period since 1978-79 real terms expenditure has increased by 40 per cent.

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East Anglia Regional Health Authority

22. Mr. Patrick Thompson : To ask the Secretary of State for Health when he last met the chairman of the East Anglia regional health authority, and what matters were discussed.

Mr. Freeman : My right hon. and learned Friend the Secretary of State last met the chairman on 20 September at one of the bi-monthly meetings with regional health authority chairmen. He discussed various matters of common interest.

44. Mr. Paice : To ask the Secretary of State for Health what additional funding he anticipates will come to the East Anglia regional health authority as a result of the new allocation formula announced in the White Paper.

Mr. Kenneth Clarke : Actual allocations for 1990-91 have yet to be decided and are dependent on the outcome of this year's public expenditure survey. Under the new formula, which will be more sensitive to population growth, East Anglia's share of the resources available nationally will increase and continue to increase as the region's share of population increases.

Pendle Community Hospital

23. Mr. Lee : To ask the Secretary of State for Health if he will make a statement on the progress of the Pendle community hospital.

Mr. Freeman : The Pendle community hospital is a £6 million development in community hospital care which will open in September 1991. It will provide 24 beds which general practitioners can use for treating patients suffering from a range of medical conditions not requiring the full services available at the district general hospital. In addition to this, so that day cases will benefit from ready access to physiotherapy and occupational therapy, an acute outpatients department will have extensive clinical facilities in medical, surgical and paediatric services. There will also be 45 beds for the elderly who need medical treatment and rehabilitation care.

Community Care

24. Mr. Hannam : To ask the Secretary of State for Health how he plans to increase the participation of disabled people in the planning of their own community care services.

47. Rev. Martin Smyth : To ask the Secretary of State for Health if he will make a statement about his plans for ensuring that disabled people are fully consulted when their community care needs are assessed.

48. Miss Emma Nicholson : To ask the Secretary of State for Health how he plans to promote choice for the individual disabled person or carer in the new arrangements for community care services.

Mrs. Virginia Bottomley : I refer my hon. Friends and the hon. Member to the statement which my right hon. and learned Friend made to the House on 12 July announcing our main proposals for the future organisation of community care. In that statement my right hon. and learned Friend outlined arrangements designed to widen choice to individuals in need of community care and

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provide more appropriate services closer to their wishes and needs. Our forthcoming White Paper will set out in detail how we intend to achieve these aims.

72. Mr. Alfred Morris : To ask the Secretary of State for Health what plans he has to increase and encourage advocacy opportunities for disabled people with regard to community care provision.

85. Mr. Tom Clarke : To ask the Secretary of State for Health how he plans to put support for the principle of advocacy into practice in future arrangements for community care services.

Mr. Freeman : I assume that the right hon. and hon. Members have in mind the provisions of sections 1 and 2 of the Disabled Persons (Services, Consultation and Representation) Act 1986, which deal with the appointment and rights of authorised representatives of disabled persons in connection with local authority welfare services. We have already implemented six key sections of this Act, but we have always made it clear that further implementation would depend on the availability of the necessary resources. With section 1 there is the additional complication that implementation would require detailed procedures to be set out in regulations. We hope to begin consultations soon with the local authority associations about the costs of implementing these sections, together with section 3, and with those associations and other interested bodies about the appointment procedures which would be set out in regulations under section 1.

Post-abortion Syndrome

26. Mr. Alton : To ask the Secretary of State for Health when the 1976 study of post-abortion syndrome, commissioned from the Royal College of General Practitioners, will be published.

Mrs. Virginia Bottomley : This is a major United Kingdom study of the short and long-term sequelae of abortion. Since it began in 1976 papers have been published covering induced abortions and their early sequelae ; the outcome of pregnancy following induced abortion ; and the sequelae of induced abortion. I understand that completion of the analysis of the large amount of data collected by the researchers is taking much longer than expected. They hope to be in a position to produce a final report in the middle of next year.

Health Authority Chairmen

28. Mr. Battle : To ask the Secretary of State for Health if his Department will draw up a code of conduct to ensure that the private business interests of chairmen of health authorities are kept clearly separate from their public responsibilities.

Mrs. Virginia Bottomley : The statutory position is already quite clear. Under regulation 14(1) of the National Health Service (Regional and District Health Authorities : Membership and Procedure) Regulations (SI 1983 No. 315) a chairman of a health authority is required to declare any pecuniary interest, direct or otherwise, in any contract or other matter which is the subject of consideration by the health authority. He may not then take part in any consideration or discussion of the contract (or matter) or vote on any question in respect of it.

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Kidney Unit, Leicester

29. Mr. Vaz : To ask the Secretary of State for Health whether he will make available additional resources to the Leicestershire health authority to enable it to fully open the kidney unit at the general hospital.

Mr. Freeman : I understand Trent regional health authority has agreed with Leicestershire health authority to open three new beds in the renal unit at Leicester general hospital at a cost of £90,000 per annum. The beds are available now and I understand the health authority plans to have the necessary staff in post by 20 November. The health authorities hope to open a further three beds next year, bringing the unit to its full complement a year earlier than originally planned.

NHS (Accountancy and Auditing)

30. Mr. Ralph Howell : To ask the Secretary of State for Health if he will make a statement on the effectiveness of the accountancy and auditing systems operating within the National Health Service.

Mr. Freeman : The statutory auditors regularly review the effectiveness of the well-documented accountancy and audit arrangements in the NHS, and the annual report of the director of NHS audit sets out their findings. For 1987-88, the auditors found material errors leading to qualification of their certificate in respect of five health authorities of the 334 audited ; the audits of the 1988-89 accounts have not yet all been finalised.

Dentists

31. Mr. Geraint Howells : To ask the Secretary of State for Health if he anticipates there being any increase in demand for dentists ; and if he will make a statement.

Mr. Kenneth Clarke : No. Dental health is steadily improving in this country and the nature of dental services is changing. Dental manpower reviews undertaken in 1983 and 1987 in conjunction with the profession recommended reductions in the overall undergraduate intake to United Kingdom dental schools in order to slow down the rate of increase in the numbers of dentists. The next review of dental manpower will take place next year and will report during 1991.

General Practitioner Contract

32. Mr. Kirkwood : To ask the Secretary of State for Health what further discussions he proposes with the British Medical Association before he implements the new general practitioner contract.

Mr. Kenneth Clarke : I have no plans for further discussions with the British Medical Association on the subject of the GPs' new contract before that contract is introduced. My officials are still consulting them on technical and drafting details of the new statement of fees and allowances.

50. Mr. Amos : To ask the Secretary of State for Health if he will make a statement on the allocation of travelling time for general practitioners in rural areas under the new contract obligation of 26 hours patient contact time.

Mrs. Virginia Bottomley : It is accepted that the 26-hour requirement in the revised terms of service for general

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practitioners includes travelling time when GPs make home visits. There is no specific element within the 26 hours which is allocated to travelling time because GPs in some rural areas will need more travelling time for home visits than those in urban areas.

82. Mr. Ian Bruce To ask the Secretary of State for Health if he will give a progress report on the implementation of the general practitioners' new contract.

Mrs. Virginia Bottomley : The NHS (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989 were laid on 16 October and certain parts come into operation today. The revised statement of fees and allowances will be sent to all GPs later this month with a copy of their revised terms of service. FPCs will shortly receive a circular of guidance on the management of the GP's new contract. These arrangements will enable GPs and FPCs to make detailed plans for the full implementation of the new contract from 1 April next year.

Working for Patients"

33. Mr. Nellist : To ask the Secretary of State for Health what representations he has recently received concerning the effect on women of the proposals contained in the White Paper "Working for Patients"; and if he will make a statement.

Mrs. Virginia Bottomley : We have received a small number of representations. Our proposals will benefit women, as all patients, by bringing all parts of the NHS closer to the standards already achieved by the best.

38. Mr. William Powell : To ask the Secretary of State for Health how patients will be affected by the proposals in the White Paper "Working for Patients."

Mr. Kenneth Clarke : The point of all our proposals is to produce a better NHS providing the type and standard of service a patient has a right to expect throughout the country. Hospitals will have more freedom to manage their own affairs and so will be able to respond better and quicker to individual patients and their GPs. District health authorities for their part will in future be able to concentrate on identifying the health needs of the populations they serve and then making sure that they receive a comprehensive range of high quality services. They will be able to use contracts to specify the quality of services to be provided. Extra funding will go directly to hospitals which can best provide the services needed. This means that the hospitals to which most patients want to go will be funded accordingly.

Clinical audit will make sure that there is systematic quality control of treatments throughout the Health Service with, for the first time, all doctors looking critically at what they and their colleagues are doing so that they can improve their effectiveness and outcomes. Patients will have shorter waiting times and better appointment systems ; 100 more consultants will be appointed in addition to the existing year-by-year growth in numbers. The new GP contract will result in improved services and some large GP practices will be able to seek to make more effective use of NHS funds for their patients.

The effect of all these, and the other proposals in the White Paper, will be to make the NHS more consumer conscious and better able to provide a high quality service.

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42. Mr. Latham : To ask the Secretary of State for Health whether he will make a statement on his discussions with the British Medical Association regarding the White Paper "Working for Patients."

Mr. Kenneth Clarke : I had a useful meeting with the British Medical Association on 18 October. We both took away ideas for further consideration. I am always ready to enter into constructive discussions with the BMA about how best to implement the proposals in the White Paper.

49. Mr. Bellingham : To ask the Secretary of State for Health if he will make it his policy to ensure that the proposals in the National Health Service White Paper will not mean that patients will be compelled to travel long distances for treatment.

Mrs. Virginia Bottomley : No patient will be made to travel long distances for treatment against their will. Surveys have shown that a majority of patients are willing to travel to get earlier or better treatment. When doctors refer patients to hospital they will take the circumstances and wishes of patients fully into account.

51. Mr. Devlin : To ask the Secretary of State for Health if he will outline further improvements that patients can expect to result from the implementation of the White Paper "Working for Patients".

Mrs. Virginia Bottomley : There are a number of detailed proposals in the White Paper, "Working for Patients", which will lead to substantial improvement for patients when implemented. These include ensuring that patients are given reliable appointment times, better waiting and counselling facilities, much fuller information about the services available and about their own care and quicker notification of diagnostic test results. We are asking everyone working in the Health Service to recognise the importance of the individual patient. In future it will be easier to choose and, if necessary, change GP.

55. Mr. Roy Hughes : To ask the Secretary of State for Health what consultations he proposes to have with the British Medical Association, the Royal College of Nursing, the Confederation of Health Service Employees, the National Union of Public Employees and the National and Local Government Officers Association concerning the Government's White Paper "Working for Patients".

Mr. Kenneth Clarke : My fellow Ministers and I have had several meetings with representatives of all the trade unions mentioned about how best to implement the reforms set out in the White Paper.

57. Mr. David Nicholson : To ask the Secretary of State for Health if he will make a statement on progress towards implementing the proposals in the National Health Service White Paper.

Mr. Kenneth Clarke : We are making good progress in putting into action the changes outlined in the White Paper "Working for Patients". I am confident that the NHS will be ready to implement the basic elements of the new and better systems of matching growth and resources with expansion of patient services by April 1991 if Parliament approves the necessary legislation. We have made £82 million available to finance progress towards implementation this year.

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We have issued detailed guidance on many subjects including the new contracting system for all district health authority hospitals and community units and on education and training for non-medical staff. We have recently launched a project to support district health authorities in detailed work on developing the key role which DHA's will have under the new system of identifying and obtaining the best pattern of services which will most effectively meet all the health needs of the populations they serve.

We have received more than 180 expressions of interest from potential NHS hospital trusts ; 79 of them are proceeding towards being in the first wave of applicants for self-governing status within the NHS in April 1991 and I expect many more to be ready for later waves of applicants in future years.

We are spending more than £1 million on the development of self-audit systems by the medical profession and a £4.5 million scheme has been launched to develop information technology skills. Demonstration projects, aimed at improving the quality of care and service to patients, have been announced for five out-patient departments. The principles of general management are being introduced into the family practitioner committee system. Good progress is also being made in relation to medical education and research. As I explained in a speech on 10 July, since sent to all hospital doctors, I intend to take powers to ensure, for instance, the continuation of high standards of undergraduate, postgraduate and continuing medical education and research in all NHS hospitals. I will also ensure that postgraduate training posts are provided in NHS hospital trusts in accordance with the national objectives set out in "Achieving a Balance". Medical education and research will be further enhanced by the proposed increased in the service increment for teaching (SIFT) to meet 100 per cent. of the median excess costs of teaching hospitals. This will be distributed by regions in consultation with medical schools.

60. Mr. Moss : To ask the Secretary of State for Health if he will make a statement on the aims of the proposals affecting family practitioner committees in the White Paper "Working for Patients".

Mr. Kenneth Clarke : The proposals in the White Paper which directly affect family practitioner committees are designed to equip each committee to take on the major tasks of implementing in 1990 new contracts of service for medical and dental practitioners ; of helping to introduce the reforms proposed in the White Paper "Working for Patients" which affect family doctors ; and generally to manage and develop effectively all the primary health care services for which they are responsible in the light of the Government's proposals in the White Paper "Promoting Better Health".

76. Mr. Carttiss : To ask the Secretary of State for Health if he will make a statement on the implications for patient choice of the proposals in the White Paper "Working for Patients".

83. Mr. Gerald Bowden : To ask the Secretary of State for Health how patients' choice will be affected by the proposals in the White Paper "Working for Patients".

Mrs. Virginia Bottomley : Our proposals will help to ensure that patients are given reliable appointment times,

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better waiting and counselling facilities, much fuller information about the services available and about their own care and quicker notification of diagnostic test results. We are asking everyone working in the Health Service to recognise the importance of the individual patient.

Social Workers

34. Mr. Hinchliffe : To ask the Secretary of State for Health what action he is taking to deal with the national shortage of qualified social workers.

Mr. Freeman : I refer the hon. Members to the reply given by my hon. and learned Friend to him on 19 June at columns 37-8.

Hospital Building Schemes

36. Mr. Sims : To ask the Secretary of State for Health what steps he has taken to encourage health authorities to take advantage of unconventional financing hospital building schemes as envisaged in paragraph 9 : 14 of "Working for Patients" ; how many such schemes have been proposed to, and approved by, him ; and if he will make a statement.

Mr. Freeman : As stated in the White Paper "Working for Patients" the Government welcome any proposals which make imaginative use of the private sector's skills, including financing, which can result in the more cost-effective and quicker development of new and existing services. The key factor, however, is to ensure that best value for money is achieved through the use of such finance, and the Department has recently issued guidance to health authorities on the procedures to be followed where private sector finance is involved.

It is for health authorities to demonstrate the best value for money can be achieved through the use of private sector finance. To date I have received only one substantive case, for a district general hospital development at Bromley, in which use of private sector finance may be cost effective. Approval has therefore been given for the authority to proceed to the first stage of a competitive tendering exercise to establish the relative costs of this approach before final approval can be given.

Speech Therapy

37. Mr Squire : To ask the Secretary of State for Health if he has received representations about the level of speech therapy provision in the North-East London regional health authority.

Mrs. Virginia Bottomley : We have received no such representations recently.

Student Nurses

39. Mr. Andrew Smith : To ask the Secretary of State for Health what financial support he intends to make available for student nurses' living costs.

Mr. Freeman : Levels of student nurse salaries and bursaries were announced respectively by my right hon. Friend the Prime Minister on 16 February at columns 302-3, and my right hon. and learned Friend the Secretary of State for Health on 16 June at column 556 .

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Community Nursing

40. Mr. Nicholas Brown : To ask the Secretary of State for Health what future community nursing services have in light of plans for community services.

Mrs. Virginia Bottomley : Community nursing staff will have a crucial role to play in our proposed new arrangements for community care. Community nursing services will continue to be planned and provided by health authorites.

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