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House of Commons
Tuesday 20 February 1990
The House met at half-past Two o'clock
PRAYERS
[Mr. Speaker-- in the Chair ]
PRIVATE BUSINESS
Greater Manchester (Light Rapid Transit System) Bill
[Lords]
Happisburgh Lighthouse Bill
[Lords]
Read a Second time, and committed.
Oral Answers to Questions
HEALTH
Waiting Lists
1. Mr. Blunkett : To ask the Secretary of State for Health what progress has been made in reducing waiting lists in the past 12 months.
The Secretary of State for Health (Mr. Kenneth Clarke) : The £31 million waiting list fund for 1989-90 will enable around 100,000 extra in-patients and day cases and 90,000 out-patients to be treated from the waiting lists by the end of March 1990. We have sent a management team into the 22 districts with the longest waiting lists, and as a result waiting lists in those districts have reduced by 12 per cent. and the number of patients waiting over a year by 17 per cent., with further reductions planned. Nationally, provisional figures for September 1989 suggest that waiting lists, in particular the numbers waiting over a year, have fallen since March 1989.
Mr. Blunkett : Does the Secretary of State think that, in the interests of open government, it would be sensible for the Government to collect statistics nationally on out-patients awaiting appointments? In audiology, there is often an 18-month or two-year waiting list. Does he agree that the BBC statistics collected recently, which show that massive cuts would have to be made in a third of health authorities if spending is not increased, would be made worse if the true national statistics for waiting lists were available? Those statistics would show what people are experiencing rather than the propaganda put out by the right hon. and learned Gentleman's Department.
Mr. Clarke : We keep collecting more statistics on waiting lists and we collect accurate information, which we disseminate. Recently, for example, we added figures on the waiting lists for day-patient treatment, as that treatment now represents a much bigger proportion of work.
The BBC survey to which the hon. Gentleman referred showed no results of the type that he described or anything
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like that. The statistics show that some districts are having difficulty keeping within their cash limits this year, but all districts are not only spending much more money than in previous years, but treating more patients and expanding their services.Mr. David Howell : My right hon. and learned Friend has shown considerable determination in tackling the waiting list problem. Does he agree that at least part of the problem is caused by short-term budget cuts that must be made in certain hospitals? Is he aware that in my local hospital, the Royal Surrey county hospital, short-term budget cuts have had to be made because no funding is available for the large number of patients who come to that hospital from other districts? Is not it a crazy system that prevents excellent hospitals, such as the Royal Surrey, from providing the patient care of which they are capable, as they cannot get the money, because, apparently, the accounting system does not allow them to do so?
Mr. Clarke : It has always been a habit within the National Health Service for some authorities to expand their services rapidly for about 10 months of the year and then, towards the end of the financial year, to start to make short-term changes to try to keep within their cash limits. That demonstrates the failure of the present system to enable people to plan steady expansion of services in line with the steady growth of funds. I agree with my right hon. Friend that, in future, districts will be much more able to match their funds to the growth of patients. Districts that take in many patients from outside because of the quality of their services will find that the necessary funds come with those patients.
Ms. Primarolo : Does the Secretary of State accept that the money given to cut the waiting lists represents a blunt instrument? Many district authorities are concerned about the way in which they must allocate their budgets. Yesterday Bristol and Weston district health authority expressed its great concern about how the waiting list money was allocated, as it means that that authority cannot take into consideration pain and suffering or target lists of pain and suffering that may exceed 12 months in the next few months. Will the right hon. and learned Gentleman review that criterion with a view to being much more sensitive about distributing that money?
Mr. Clarke : Our waiting list initiative will be overtaken by our White Paper reforms when they are brought into practice. They will have the beneficial effect that I have just described to my right hon. Friend the Member for Guildford (Mr. Howell). In admitting patients, all hospitals take account of the gravity of the case, and the pain and suffering involved. We have to remember that more than half the patients in the National Health Service go for treatment and do not have to wait at all. Of those who go on to waiting lists, about half go into hospital within five weeks. It is not just a queue. People are admitted according to their clinical priority. Where there are serious problems, pain and suffering, we must not alarm people by making them think that waiting lists get in the way.
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Private Health
2. Mr. Lee : To ask the Secretary of State for Health what powers his Department has in the monitoring of private hospital medical charges and private medical insurance premiums.
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : None. However, health care providers and insurers operatein a competitive market, which helps to control their fees and subscriptions.
Mr. Lee : With the number of people covered by private medical insurance now approaching 10 per cent. of the population, increasing public concern about the level and variation of charges, continually escalating premiums and the fact that the Government now have a direct vested interest because of tax relief for the elderly, will my hon. Friend consider appointing a private sector health commissioner to police this sector and investigate complaints?
Mr. Freeman : The latest figure is that 12 per cent. of the population is covered by private insurance. Some 15 per cent. of elective surgery is performed in private hospitals. It is not the Government's responsibility to control those costs. I share my hon. Friend's concern, but it is for the patient, when he or she takes out an insurance policy to read the small print and be aware of what the charges may be for elective surgery in the private sector.
Mr. Robin Cook : If the Minister will not monitor the excessive charges of private hospitals, will he at least condemn them? Does he agree that it is an outrage that BUPA, the British United Provident Association, should have charged £168 for a cotton swab and £983 for a drug that cost £13? How does that happen in a competitive market? Now that we know, thanks to the National Audit Office, that the NHS can do most operations at half the cost of private hospitals, would not the Minister get better value for his money by putting public money into public hospitals rather than by paying for tax relief on inefficient, private ones?
Mr. Freeman : I think that the hon. Gentleman is misinformed about the National Audit Office report. If he reads it carefully, he will see that the NAO reported that, for the £50 million that the National Health Service spent in private hospitals on long-term contracts for 30,000 patients, it got "good value for money".
Mr. Nicholas Bennett : On several occasions I have asked the Department of Health for comparative figures on the costs of NHS operations, only to be told that the information is not collected centrally. Is it not about time that we did so, to find out why there are such vast differences in the cost of the same operations in different health districts?
Mr. Freeman : Through the introduction of the new performance indicators, we have the first year's results for 1987-88, and will shortly have the 1988-89 figures. They will enable my hon. Friend and other National Health Service patients to compare the performance of districts and hospitals, one with the other.
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Speech Therapists
3. Mr. Menzies Campbell : To ask the Secretary of State for Health if he will make a statement on the salary levels for speech therapists.
The Minister for Health (Mrs. Virginia Bottomley) : Agreement has been reached on speech therapists' pay for the period April 1989 to September 1990 and the new pay rates have been promulgated today. The settlement gives across-the-board increases in pay of 9 per cent. over an 18-month period.
Mr. Campbell : Does the Minister appreciate the extent of the crisis of morale among speech therapists working in the National Health Service? Why are they so poorly paid in relation to, for example, physiotherapists or occupational therapists? Does not their poor level of pay justify their feeling that the contribution that they make to the National Health Service is undervalued? What studies have the Government carried out to satisfy themselves that the low pay does not have an adverse effect on recruitment?
Mrs. Bottomley : Speech therapists are most certainly valued within the National Health Service. Under the new arrangements, their starting pay will be £9,487 ranging up to £22,087. The Department of Health NHS management advisory group is collecting information about recruitment and retention, and we shall look at it.
Mr. Devlin : I welcome the fact that speech therapists' pay has increased by 19 per cent. in real terms since 1979, but does not the fact that theirs is an all-graduate profession and the fact that they can so easily enter other areas of activity mean that they should be rewarded far more generously if their numbers are to be maintained and expanded?
Mrs. Bottomley : I assure my hon. Friend that there has been a considerable expansion in the number of speech therapists over the past 10 years. There are about 80 per cent. more speech therapists than there were 10 years ago. Their new starting pay level makes them more comparable with others in the Health Service and, more importantly, in the private health sector as well. But pay is not the only factor in recruitment and retention. The first report of the Select Committee on Social Services suggested a number of other areas where their needs could appropriately be met within the Health Service.
Mr. Tom Clarke : Does the Minister agree that there will be insufficient speech therapists to achieve what the Government say are their community care objectives and that, because of the starting salary, many young people are denied the right to enter a worthwhile and rewarding profession?
Mrs. Bottomley : I agree with the hon. Gentleman about the importance of speech therapists to the provision of care in the community, but I remind him that there has been an 80 per cent. increase in their number. Speech therapists' starting salary has increased by 46.2 per cent., from £3,800 in 1979 to £9,400. The comparable increase in starting salary when the Labour party was in power was a mere 12 per cent.
Mr. Rowe : I agree that those are encouraging figures, but does my hon. Friend agree that it might be better for
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speech therapists if they left the Whitley council and, taking advantage of the new arrangements for community care and the Health Service, seriously considered setting themselves up as independent, non-profit making trusts to tender their services to all the contractors who might wish to buy them?Mrs. Bottomley : My hon. Friend is a long-term champion of speech therapists. I am meeting members of the College of Speech Therapists next week to discuss their concerns about future arrangements. Under the new regime, it is intended that they should continue to be able to receive patients on the basis of self-referral. The new salary structure will be an improvement and an enhancement, but they will want to discuss many other ways in which they can deploy their services under a future regime.
National Health Service and Community Care Bill
4. Mr. James Lamond : To ask the Secretary of State for Health how much has been spent so far by his Department, by district health authorities and family practitioner committees to prepare for the implementation of the National Health Service and Community Care Bill.
Mr. Kenneth Clarke : So far in 1989-90 expenditure on review-related initiatives in the NHS as a whole stand at just over £80 million.
Mr. Lamond : How is it that the Government can cheerfully find £85 million to set up a monstrous bureaucracy of accountants and clerks who will be busy pushing accounts and receipts across a table to one another, but cannot find one tenth of that to help to overcome the tremendous hardship that people are suffering as a result of the ambulance workers' dispute?
Mr. Clarke : I am sorry that one year after we produced the White Paper entitled, "Working for Patients", the hon. Gentleman has not yet found time to read it. If he did so, he would realise that it has nothing to do with employing large numbers of accountants and clerks. The expenditure that has so far been incurred, includes, for example, expenditure on 100 extra consultants to tackle the waiting lists, on introducing quality control of clinical services, known as medical audit, and on pilot projects to introduce a new system of contracts to be entered into between district health authorities and hospitals. That £80 million has to be set against expenditure on the Health Service as a whole of £29,000 million next year and the £5,000 million increase in two years alone that we are proposing for the NHS.
Mr. Sims : Will my right hon. and learned Friend consider spending more money on ensuring that the general public are acquainted with the Bill's proposals and philosophy, and thus counteract some of the misleading information that has been given by certain professional bodies and by the Labour party?
Mr. Clarke : The White Paper is still available. It is written with clarity and there are explanatory leaflets to accompany it. There are strict rules governing the use of taxpayers' money for publicity and advertising. I have never been able to match the advertising budgets of the people who spent so much money last year on disseminating misleading versions of the reforms.
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Nevertheless, my experience of the Health Service tells me that the climate of opinion is changing rapidly among all groups of staff within the NHS, and I am sure that that will rapidly communicate itself to the general public.Mrs. Wise : Why did not the Secretary of State answer the question, which relates to expenditure
"to prepare for the implementation of the Natioal Health Service and Community Care Bill"?
Why does not the right hon. and learned Gentleman want the House to know the exact figure? Why does he prefer to muddle it up with expenditure on consultants? How can it be lawful to spend any money on implementing a measure that has not yet received the approval of the House?
Mr. Clarke : I answered the original question with precision and accuracy-- [Hon. Members :-- "Oh."] The question relates to the Health Service review, and the introduction of, for example, clinical audit is extremely important. As to the Bill itself, those aspects of it that require statutory changes will not be implemented until the Bill is passed. If I were to interpret the question as narrowly as the hon. Lady suggests, I should have to answer, "Nothing." I described the money that has been spent on the National Health Service review--on desirable things, not on the idiotic things that publicity earlier this year implied lay behind the White Paper.
NHS Pay Disputes
5. Mr. Hague : To ask the Secretary of State for Health whether pay disputes involving any group of National Health Service workers have been to arbitration since 1974.
Mr. Hague : I welcome today's talks on the ambulance dispute, but does not my right hon. and learned Friend agree that his answer exposes the double standard of Opposition spokesmen and union leaders in calling for it to be referred to arbitration, while never referring any dispute to arbitration when Labour was in office? Will my right hon. and learned Friend take this opportunity to point out that referring one claim to arbitration would be very unfair to the majority of Health Service workers, who settled their claims without recourse to industrial action?
Mr. Clarke : I agree with my hon. Friend that it would be unfair to other workers, and an impossible way of running the Health Service, if groups of people only had to go on strike long enough to win their way to arbitration. I do not believe that the people who demanded arbitration ever seriously expected that it would be resorted to. Nor do I imagine that the Labour party, in supporting them, ever expected that either--Labour never went to arbitration in similar circumstances. We are all glad to hear of the talks today. The management has always made it clear that it is prepared to re-enter talks to resolve the dispute on the basis that it described--and talks have started today on that basis. I trust that every right hon. and hon. Member hopes that those talks will succeed and that the dispute will be resolved.
Mr. Strang : I hope, as the Secretary of State does, that the talks will succeed. I put it to the right hon. and learned Gentleman that, judging from his utterances earlier in the dispute, the best contribution that he can make throughout the talks at the Advisory, Conciliation and
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Arbitration Service is to keep his mouth firmly shut on the respective merits of the management and trade union claims.Mr. Clarke : My remarks throughout the dispute have been consistent- -
Mr. Tony Banks : Yes--consistently bad.
Mr. Clarke : In attempts to inflame the dispute remarks were attributed to me that I trust those who attributed them will not repeat.
The Government and the Health Service management have made it clear that they are anxious to see talks resumed, and the basis on which they could resume has also been clear for some weeks. I am glad that common sense has dawned and that talks have restarted.
Mr. Bowis : Does not my right hon. and learned Friend agree that, rather than invoking arbitration, the concept of pendulum pay bargaining may be worth considering? That may be a way of meeting the public demand that disputes in which health, life and safety are put at risk should not be part of our industrial relations system.
Mr. Clarke : I am keenly in favour of pendulum arbitration in small manufacturing companies, and so on--linked usually with single-union deals and no-strike agreements. The ambulance dispute involves so many issues that it is unlikely that those elements could play a part--and the unions with which we are dealing would never enter into a no-strike agreement of the sort that some companies have entered into with unions.
Mr. Robin Cook : Does the Secretary of State accept that the whole House will welcome the fact that his Department has now begun talks with ambulance staff, and the whole country will want those talks to continue until they succeed? In the light of his own repeated refusal to intervene to find a solution, on the ground that management must be free to manage, will he assure the House that management is now free to negotiate and, in particular, that if management wishes to include arbitration or a pay mechanism in the solution, he will not invervene to prevent that?
Mr. Clarke : As I said in my earlier answer, not only did no Labour Secretary of State ever refer such a dispute to arbitration, but no Labour Secretary of State ever intervened in the way that the hon. Gentleman has been urging me to throughout the dispute. If he took the office of Secretary of State for Health, to which he aspires, and then decided that if a strike went on for long enough he would intervene to tell managers to pay the claim, I can only say that he would be a disastrous holder of that office, from the point of view of the National Health Service.
Mr. Hayes : Does my right hon. and learned Friend agree that the best possible way to facilitate a speedy and honourable end to the dispute is not to make party political comments-- [Interruption.]
Mr. Hayes : Such comments inflame the situation and a sensible silence by Ministers, officials, Opposition spokesmen and everyone else involved will lead to a quicker end to the dispute.
Mr. Clarke : Of course, advice from my hon. Friend the Member for Harlow (Mr. Hayes) about the need to keep
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silent on these grave matters is welcome, and I shall certainly take note of it. On the earlier part of his question, negotiations today are being carried on by the chief executive on behalf of the National Health Service executive, and they will ultimately no doubt move on to the Whitley council. Those concerned are free to negotiate there, and that is where the dispute should be resolved. It is the desire of many hon. Members to bring in a party political and a Government context and to keep attributing to me every aspect of the dispute that gives rise to the feeling that has been described.Dental Charges
6. Mr. John P. Smith : To ask the Secretary of State for Health if he will make a statement on the effects of the introduction of charging for dental inspections.
8. Mr. Rees : To ask the Secretary of State for Health if he will make a statement on the effects of the introduction of charging for dental inspections.
Mr. Freeman : The number of dental examinations in the September quarter of 1989, the latest available statistics, at approximately 7.4 million, represented a reduction from the year previously, at approximately 7.9 million. With a few more quarters' statistics, the underlying trend will become clearer. The annual number of dental examinations has gone up gradually in recent years, and we expect this long-term trend to continue.
Mr. Smith : In the light of that answer, can the Minister explain how, as a result of a survey among all dentists carried out in my constituency, the Vale of Glamorgan, it was shown that dental inspections have decreased by up to 20 per cent? The time lag between inspections has now gone beyond the recommended level and it is particularly worrying that 18-year-olds are not having inspections, but merely waiting until they need treatment. When asked to comment, dentists said that the dental health of the nation is suffering and that it will get worse. Will the hon. Gentleman comment on that?
Mr. Freeman : It is important to appreciate that the charge for examinations under the National Health Service is £3.45, which represents 75 per cent. of the cost. No one disputes that examinations appear to have decreased immediately after the introduction of charges, but we believe strongly that the long-term trend of an increase in examinations will shortly reassert itself.
Mr. Rees : It is no use for the Minister to hope for the long-term trend to reassert itself. This is an important element of preventive medicine, and in all areas the number of inspections is falling. It is a serious matter. What will the Government do about it?
Mr. Freeman : Some 50 per cent. of all patients who have National Health Service examinations are exempt from the charges. We believe that the long-term trend will reassert itself. The right hon. Gentleman may say that that is a hope and an expectation, but we firmly believe that the upward trend will continue.
Miss Emma Nicholson : Does my hon. Friend agree that people over 18 have a good cognisance of the value of preventive medicine, having received free medical care until school-leaving age, and that asking them to make a
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modest contribution to the cost of dental inspection in no way undermines our ability to keep their health high on our list of priorities?Mr. Freeman : I am grateful to my hon. Friend. The money raised through charges goes back into the Health Service and, indeed, helps to improve the quality of dental care.
Mr. John Greenway : Does my hon. Friend agree that the best way to benefit dental patients is to make further progress on the new dental practitioners' contract, which will improve the relationship between patients and their dentists? Many members of the dental profession support it, but others have grave doubts. It would greatly assist those charged with the responsibility of persuading their colleagues to accept the new contract if my hon. Friend could tell the House--not now, but very soon-- that the Government have no plans to increase dental charges.
Mr. Freeman : I cannot give my hon. Friend that commitment--he would not expect me to be so specific--but I can say that we have received some very positive encouragement from the profession. We shall not know the final outcome for another six months, but we are very encouraged by the response so far.
Mr. Kennedy : Will the Minister provide evidence to back up his assertion that, to use his own words, the long-term trend will reassert itself in the form of an increase in the number and proportion of people undertaking dental examinations? Does not the current plain evidence suggest that the present charging structures need to be reversed, and that the current trend is making nonsense of the emphasis on preventive medicine?
Mr. Freeman : I have cited the statistics as fairly as I can. There was a reduction of 6 or 7 per cent. in two comparable quarters. It is not surprising that some deferment of examinations and some reduction in the number of patients going for treatment should follow the introduction of charges, but we hope that the long-term trend will indeed reassert itself when the 50 per cent. of people who have to pay charges appreciate that the treatment is good value for money.
Community Care
7. Mr. Thurnham : To ask the Secretary of State for Health what representations he has received about community care for the profoundly mentally handicapped in the north-west ; and if he will make a statement.
Mr. Freeman : We have received a number of representations. The Government are actively encouraging the development of a range of well co- ordinated health and social services for mentally handicapped people and their families.
Mr. Thurnham : Will my hon. Friend ask the chairman of the North West regional health authority to see for himself the superior quality of care provided by voluntary homes such as Brookvale in Bury, South--and provided at half the cost of that provided by Bolton's crisis-ridden neighbourhood network homes?
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Mr. Freeman : Yes, I will ask the chairman to do that, and I am sure that he will visit Brookvale. I hope to be in Bolton myself in May, and to join my hon. Friend in visiting some of the hospitals in his constituency.
Mr. Eastham : While we are discussing seriously handicapped people in the north-west, may I draw to the Minister's attention the case of Cranage Hall? Many Manchester Members have received correspondence expressing grave concern about possible closure from people who do not know what they will then do about their handicapped children.
Mr. Freeman : I am not familiar with that case, but if the hon. Gentleman cares to write to me I will give him a full response. Some 800 hospital patients in the north-west have been resettled in the community, with proper funding from the health authorities. That is a very creditable record.
Mr. Sumberg : I join my hon. Friend the Member for Bolton, North- East (Mr. Thurnham) in saluting the work of Brookvale and its excellent staff in my constituency. Is my hon. Friend the Minister aware that it is a fine example of co-operation between public funding and private giving? He is welcome to come and see some of the work being done there.
Mr. Freeman : I am grateful to my hon. Friend. There are many examples of both the private sector and the charitable sector co-operating with district health authorities and local authorities in providing services for the mentally handicapped.
Mr. Alfred Morris : Is the Minister aware of the presentation by Barnardo's to Members of Parliament last week about the daunting problems of mentally handicapped young people in the north-west and elsewhere? Is he aware of the protests by parents that their children, after their school years, often go from school to scrap heap, and that they are increasingly denied speech therapy even during their school years? Will he meet representatives of Barnardo's as a matter of urgency to hear at first hand their plea for immediate action?
Mr. Dickens : I thank my hon. Friend for the additional resources that the Department of Health has given to the north-west, in response to representations from all north-west Members of Parliament of all parties, but will he be sure not to approve the closure of any mental hospital in the north-west until he is fully satisfied that adequate alternatives have been developed? That is most important.
Mr. Freeman : I give my hon. Friend that categorical assurance. I thank him for referring to the increase in cash resources for the north- west--of 7.21 per cent.--which should permit a real development of services.
Family Planning
9. Mr. Meale : To ask the Secretary of State for Health if he will make a statement about the future of the family planning services.
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Mrs. Virginia Bottomley : The Government continue to regard family planning as an important preventive service which contributes to maternal and child health and to the stability of family life.Mr. Meale : The Minister is aware that there are more than 1,800 family planning clinics in Britain, but is she also aware that, because of the new capital charges, many district health authorities may be encouraged to sell those premises rather than pay the price of retaining them?
Mrs. Bottomley : I do not accept the hon. Gentleman's comments. The fact is that a growing number of individuals are choosing to go to their general practitioners rather than to family planning clinics. I understand that the seven places that provide family planning services in the hon. Gentleman's own district health authority, amounting to a total of 58 sessions, are quite secure.
Mr. Key : My hon. Friend has a long record of interest in the matter. Will she confirm that the district health authorities, as well as the family practitioner services, have a role to play in family planning and that that is not unconnected with the worrying upward trend in teenage abortions?
Mrs. Bottomley : In our guidance to the health authorities we make it clear that we see a role for them in providing family planning clinics, particularly for the young. We are sponsoring three research projects--in Hackney, Milton Keynes and south Sefton--to find out how services could better be provided for young people.
Ms. Harman : Does the Minister not realise that, because of cash limits, one quarter of all health authorities are cutting their family planning services and that some, such as Chichester, Cambridge and Trafford, are closing all their family planning clinics? Will she promise to carry out a review because otherwise there will be an increase in unplanned pregnancies?
Mrs. Bottomley : Once again, the Opposition are showing their preference for places rather than patients. The evidence clearly shows that patients have increased their use of family doctors by 37 per cent. in the past 10 years and that they have reduced their use of family planning clinics. General practitioners could not provide family planning services at all in the National Health Service until 1976. The evidence is clear that skills have been built up, that training has improved and that patients are demonstrating that they would rather go to their general practitioner to discuss these subjects than to a clinic--in the order of 2 : 1.
Sir Fergus Montgomery : Is my hon. Friend aware that no decision will be reached about Trafford's family planning services until next month, so the assertion by the hon. Member for Peckham (Ms. Harman) was wrong? The hope is that the family planning services in Trafford will continue as usual.
Mrs. Bottomley : If agreement cannot be reached locally about a substantial change of health premises use, the matter comes to Ministers. I assure my hon. Friend that no case has come to Ministers for decision. It is for the district health authorities to ensure adequate provision in the light of local circumstances and the proper use of resources.
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