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House of Commons

Tuesday 20 March 1990

The House met at half-past Two o'clock

PRAYERS

[Mr. Speaker-- in the Chair ]

Oral Answers to Questions

HEALTH

Prescribing Costs

1. Mr. Carttiss : To ask the Secretary of State for Health how prescribing costs under the proposed National Health Service changes will be monitored.

The Secretary of State for Health (Mr. Kenneth Clarke) : Under the indicative drug budget scheme, practices will be able to monitor their own expenditure on drugs by means of a simple monthly statement from the Prescription Pricing Authority.

Mr. Carttiss : I thank my right hon. and learned Friend for his reply. Has he seen the circular letter sent to local medical committees by the hon. Member for Peckham (Ms. Harman), repeating the Opposition claim that drug budgets will be cash limited? As the hon. Lady declines to recognise the repeated assurances that that is not so, will my right hon. and learned Friend take this opportunity to reiterate that drug budgets will not be cash limited, and that no patient will go without necessary drugs?

Mr. Clarke : We demonstrate repeatedly to the British Medical Association and to the hon. Member for Peckham (Ms. Harman) that indicative drug budgets will not be cash limited and that every doctor will be free to prescribe whatever drugs a patient needs for his or her condition. The hon. Lady continues not to produce any evidence for her contrary assertion, but she keeps making it. Therefore, I intend to write to all local medical committees yet again, refuting her suggestion and giving reasons, if I can persuade the British Medical Association to give me the addresses of the local medical committees to which she wrote.

Ms. Harman : Will the Secretary of State please investigate the case of David Whitton, a former chairman of the Royal Free hospital kidney patients association, who had to change his general practitioner because his GP would not prescribe for him cyclosporin, an expensive drug which he needs to keep his transplant in place? Will the Secretary of State acknowledge that cash-starved hospitals are passing on to GPs expensive drug costs? How will patients get the drugs that they need when GPs' drugs budgets are capped under the National Health Service and Community Care Bill?

Mr. Clarke : I shall look into that case, as I look into all the cases that the hon. Lady refers to me. So far, not one

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of the cases that I have looked into has justified the particular assertion that she made on the Floor of the House. Certainly, I disapprove of the attempt by some hospitals to shift the prescription of drugs for which their consultants are responsible on to GPs. A GP has no budgetary reason for refusing to dispense a drug, but some of them are quite correct in insisting that they will not prescribe drugs when a consultant continues to be responsible for the patient. I shall look into that case and see whether it gives rise to some cause to intervene.

Mr. Brandon-Bravo : Does my right hon. and learned Friend agree that no practice or doctor objects to the monitoring that is suggested? Does not he deplore the conduct of Opposition politicians and, sadly, unprofessionally, some doctors who are still frightening the life out of elderly and disabled people by telling them that the drug budget will stop them having the drugs that they need? Will he nail that lie once and for all?

Mr. Clarke : I agree with my hon. Friend. Most doctors already prescribe responsibly. The vast majority welcome the introduction of the information system known as PACT--prescribing analyses and cost--which tells them what they are spending now, and most will welcome the opportunity to monitor their own drug spending. I have already refuted the ridiculous allegation that patients might not get the drugs that they need, on grounds of expense. I continue to insist that in a minority of practices there is a sensible case for tackling avoidable and unnecessary costs in prescribing--perhaps they are dispensing drugs that are not needed by the patient, or expensive drugs when cheaper ones are available. The savings made by extending good prescribing practice will be ploughed back into the National Health Service to help improve services.

Cervical Cancer Screening

2. Mr. Norman Hogg : To ask the Secretary of State for Health if he will make a statement on cervical cancer screening.

The Minister for Health (Mrs. Virginia Bottomley) : The cervical screening programme forms an important part of our strategy to promote women's health. Between 1978 and 1988 deaths from cervical cancer in England and Wales fell by 10 per cent. to under 2,000 women per year and the death rate per million women aged 20 to 74 years fell by 16 per cent.

Mr. Hogg : Is the Minister aware that about 90 per cent. of the 2, 000 deaths that occur each year could be avoided by a proper and effective screening service? What positive steps is she taking to ensure that her Department is providing an effective screening service? What improvements are there in uptake, and what is the hon. Lady doing to ensure that women at risk are aware of the services that are available?

Mrs. Bottomley : I entirely endorse the hon. Gentleman's point about the importance of the cancer screening programme. Regular screening can prevent deaths. We were the first country in Europe to introduce a national call and recall scheme for cancer screening. Great headway has been made with the scheme, but we are determined to improve on delays or difficulties in its implementation. Great successes have been achieved

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already and under the new contract we expect general practitioners to achieve targets, to ensure that they are proactive in encouraging women to realise the importance of health promotion and of having the test.

Mrs. Maureen Hicks : I have some of the most conscientious doctors in my constituency, but is my hon. Friend aware of the concern among many doctors, particularly in deprived areas, about encouraging people to come forward, to help them reach their targets? What should my message be to doctors who fear that there will be no incentive if they do not reach their targets?

Mrs. Bottomley : I hope that my hon. Friend will make it clear to those general practitioners that the payment for screening is part of the capitation fee. The intention of the target is to encourage doctors to go out of their way to help those who might not have realised the importance of screening tests. The lower target of 50 per cent. is achievable by most ; the 80 per cent. target will be more of a challenge, but often health needs are highest in precisely the areas where there is a challenge.

NHS Trusts

3. Miss Hoey : To ask the Secretary of State for Health what representations he has received on the staff ballot in the West Lambeth health authority on the establishment of a self-governing trust.

Mr. Kenneth Clarke : I have received two letters on the matter, including one from the hon. Member.

Miss Hoey : As the Secretary of State's attempts to use cuts to persuade hospitals to opt out were repudiated by 80 per cent. of the staff at St. Thomas's voting against opting out last week, will he take immediate steps to reverse the underfunding of West Lambeth health authority? Is he aware that next week it will be taking decisions to cut another 160 beds, to cut out-patient services and to cut the number of people who can use the accident service? Is he further aware of the strong feeling on the matter, and will he assure the House that St. Thomas's will be taken off the list of hospitals that can opt out--[ Hon. Members :-- "Too long."]--and ensure that it is not allowed to wither away from being a fine hospital?

Mr. Speaker : Order. I ask for single questions, or our proceedings will be delayed.

Mr. Clarke : That question started on a rather extraordinary premise, and I am afraid that the end of it was almost inaudible. There is no question of cuts in West Lambeth health authority. Its funding increased by 7 per cent. in real terms this year and it is treating the planned number of patients. Most people attribute its difficulties to financial mismanagement. Indeed, I have seen letters from the hon. Lady complaining about the position in West Lambeth, in which she mentioned financial mismanagement, which no doubt is why she welcomes the fact that the regional health authority has asked John Barnes to study it. No one has made an application for self-governing status, but there will be full public consultation if St. Thomas's makes such an application. We shall then consider the proposals for patient services and for better financial management.

Mr. Bowis : We have the highest regard for people working in the Health Service, but does my right hon. and

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learned Friend agree that the purpose of hospitals is to benefit patients, not staff? Does my right hon. and learned Friend agree that where a hospital trust is established, it will be because the flexibility and autonomy of such a trust will be in the interests of patients?

Mr. Clarke : I agree with my hon. Friend. Only one judgment should be made on an application for NHS trust status--whether the application is in the interests of the hospital unit, particularly the interests of the patients and the population whom it serves. Staff views are extremely relevant and cannot be disregarded, but the proper way to test those views is to consult staff and the general public when there is a formal proposition. The ballots that are being held about propositions that are not yet forthcoming are somewhat pointless.

Mr. Robin Cook : Why does not the Secretary of State admit that he cannot sell the idea that their hospitals should go it alone? Is not he aware that it is not just West Lambeth, but there have now been dozens of ballots of staff and of patients, and that he has not won a single one? Is he aware that the average "No" vote across the London hospitals is 89 per cent? Is it not time that he paused to reflect that it is just possible that nine out of 10 people who work in the Health Service are right and that it is just possible that he might be wrong? Why, therefore, does he not now--[ Hon. Members :-- "Ask a question."] I am asking a question. If hon. Members will wait, I shall ask the question and I should prefer it if the Secretary of State would answer. Is it not time that the Secretary of State dropped his deeply unpopular proposal to make hospitals opt out, which the next Labour Government will reverse?

Mr. Clarke : The hon. Gentleman is a bit stuck to find anything to say about National Health Service policy as he has no policy of his own and he is rather repeating his comments last week about our policies at great length. The fact is that we do not yet have any propositions for self- governing hospitals and NHS trusts. When we accept firm applications, we shall have proper public consultations, setting out the pros and cons for patient services, for staff interests and for everything else. There have been places where the staff have voted in favour of being interested in self-governing status, but sensible judgments can be made only after proper public consultation on a serious proposition. For the hon. Gentleman to run ballots or to start saying that he will repeal all my

proposals--because after two years he still cannot think of any of his own- -is not, at this stage, to make a sensible contribution to events.

Mr. Speaker : I again appeal to the House to ask single questions. We then get briefer answers and proceed with greater speed down the Order Paper.

Voluntary Groups

4. Mr. Knapman : To ask the Secretary of State for Health what assistance is being given to voluntary groups working with under-fives.

Mrs. Virginia Bottomley : The Department provides grant aid of about £1 million a year to national voluntary organisations that are active in the under-fives area. This year, we have given a further £425,000 to seven national organisations that have distributed small grants to local

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projects providing services to pre-school children and their families. We have also launched the £2 million new under-fives initiative to test out various new policy ideas.

Mr. Knapman : I am obliged to my hon. Friend for her reply and for her consistent encouragement of pre-school play groups and the carers for under-fives. Has she any intention of introducing inspection charges or registration fees for those groups?

Mrs. Bottomley : The Pre-School Playgroups Association receives the largest amount of support from my Department. It is receiving more than £500,000 this year. Under the Children Act 1989, it is necessary for the 17,000 pre-school playgroups to register. We have made it clear that the charges will be modest and we hope that they will be no more than £10.

Mr. Andrew F. Bennett : What discussions are Health Ministers having with Education Ministers and the Chancellor of the Exchequer to try to ensure that there is provision across the board for under-fives, so that parents have a choice between playgroups, nursery schools or classes, day nurseries and workplace nurseries and can use what is most appropriate for their family needs and for their children?

Mrs. Bottomley : I welcome the hon. Gentleman's commitment to a mixed economy of care for the under-fives, which is precisely the Government's policy. Ninety-one per cent. of three and four-year-olds in this country attend some education or day care provision and this country is among the leaders in the European Community. We shall seek to encourage a range of providers to meet the needs and expectations of those children and their parents.

Cot Deaths

5. Mr. Hayes : To ask the Secretary of State for Health when he expects the results of the research into a possible link between fire retardant materials and cot death syndrome to be available ; and if he will make a statement.

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : On 9 March, the Department's chief medical officer, Sir Donald Acheson, announced that he had asked a group of independent experts to investigate a claim that the emission of toxic gases from fungal growth on some cot mattresses is a cause of sudden infant death. He has asked the group to report as soon as possible and will make public its findings.

Mr. Hayes : Will my hon. Friend tell the House what advice he gave to parents during the inquiry? Does he agree that if there was a lesson to be learnt in his Department from listeriosis, it is that the public must be warned at the earliest opportunity of any risk to their health or, of course, that of their children?

Mr. Freeman : I agree with my hon. Friend. There is a sad number of cases--some 1,500--of sudden infant deaths each year. The advice of the chief medical officer, issued on 9 March, was clear : keep young babies warm but not overheated ; give children good ventilation in their rooms and keep bedding fresh and clean.

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Rev. Martin Smyth : Have not scientists in the Department of Trade and Industry already issued warnings on this issue? Why has the Department of Health been slower in bringing forward such advice?

Mr. Freeman : I am not sure that I can agree with the hon. Gentleman. I understand that the laboratory of the Government chemist could neither prove nor disprove the conclusions of the independent consultant chemist. That is why the chief medical officer has set up an independent and fresh team to review the evidence and advise urgently.

Marriage Registrations

6. Mrs. Currie : To ask the Secretary of State for Health what representations he has received about his plans to bring forward legislation to reform the law affecting the registration of marriages.

Mr. Freeman : There has been a widespread welcome for the proposals in the White Paper, "Registration : Proposals for Change", which was published at the end of January. There is particular public support for the introduction of greater choice over where a civil marriage may take place.

Mrs. Currie : Given that the discrimination against marriage was removed by the previous Chancellor in his Budget two years ago and given that all of us--married and single--expect great things of his successor this afternoon, would my hon. Friend like to tell me when people will be able to get married in a hotel, on a hillside or in some other place of their choice?

Mr. Freeman : I am sure that, while paying tribute to my hon. Friend for introducing the Green Paper over a year ago when she held my present position, the House will agree that civil marriage is a serious ceremony. I can tell the House that the Secretary of State will seek to introduce a Bill during this Parliament.

Mr. Key : I congratulate my hon. Friend and his ministerial colleagues on an excellent White Paper. Will he consider placing a duty on local authorities to encourage the collection, storage and accessibility of public records, particularly medical records, which will become essential for epidemiological research in the future?

Mr. Freeman : I shall certainly pursue my hon. Friend's suggestion. It is proposed in the White Paper that all records of births, marriages and deaths that are more than 75 years old should be available for research and open to all members of the public.

NHS Unions

7. Mr. Skinner : To ask the Secretary of State for Health what recent discussions he has had with National Health Service trades union representatives ; and if he will make a statement.

Mr. Kenneth Clarke : Ministers in my Department have frequent meetings with NHS trade union representatives on a variety of subjects. There were four such meetings last month and I personally met the TUC health services committee on three occasions last year.

Mr. Skinner : Why does not the Secretary of State for Health go to Mid-Staffordshire and speak to Health Service union representatives there? Why does not he

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explain to them how he manages to combine cutting the National Health Service and opting out? Why does not he explain to ambulance workers up there in Mid-Staffordshire why he is prepared to offer them only 6.5 per cent., when company bosses got 28 per cent. last year?

Mr. Clarke : My hon. Friend the Minister for Health went to Staffordshire yesterday and tells me that she had an excellent reception. As far as I am aware--and despite the efforts of the hon. Member for Livingston (Mr. Cook), no doubt--health is not a seriously controversial issue in Staffordshire, because the record of advance, in terms of the money spent, the patients treated and the new hospital building already achieved and proposed, has been outstanding. The idea that we can have a serious political argument on the basis that everything that is wrong with the Health Service is the result of underfunding, when we have increased spending on the Health Service by 20 per cent. in cash terms in two years, is nonsensical, and I am told that it has no appeal whatever to the electors of Staffordshire.

Mr. John Greenway : When my right hon. and learned Friend next meets the representatives of the Health Service unions, will he point out to them that there are more people working in the Health Service than ever before and that they are being paid more than ever before? That is a record which the Labour party never could and never will sustain.

Mr. Clarke : The Labour party achieved that record only for some groups of staff who had a habit of going on strike to achieve a higher pay claim. The Labour party reduced in real terms pay of nurses throughout its last six years in office and penalised all those who showed the most dedication to their patients. We have a much better record than our predecessors, in terms of the number of staff employed, their remuneration and making better use of their services to the best advantage of the patients.

Mr. Tom Clarke : When the Secretary of State next meets the unions in the Health Service, such as the Confederation of Health Service Employees, the National Union of Public Employees, the National and Local Government Officers' Association and the GMB, will he accept that their views on community care are highly progressive? As a token of accepting their views, will he ensure some ring-fencing or earmarking of the limited resources that are made available for those purposes?

Mr. Clarke : First, most of the representatives of those trade unions warmly welcome my statement of Government policy on care in the community. Their members are actively looking forward to working with us on that. Secondly, I do not believe that is a correct approach to any part of local government spending to start "ring-fencing", as the hon. Gentleman puts it, by specific grants--set sums of money for set parts of the budget. We are placing confidence in local government to discharge its full responsibilities for choosing priorities within the social service budgets, for making use of the extra funds that we shall give local authorities on quite a scale and for making its own judgment on how to make best use of community charge revenue.

Mr. Jessel : Will my right hon. and learned Friend tell the trade union representatives the excellent news that since the introduction of the waiting list money, in the past

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year the waiting list for orthopaedic operations at West Middlesex hospital has dropped from 899 to 557, which is a drop of 38 per cent., while there has also been a drop of 45 per cent. in the waiting list for ear, nose and throat operations?

Mr. Clarke : I congratulate Hounslow and Spelthorne on what it has achieved, by a combination of the money that we have given it through the waiting list initiative, and good management, and by studying the causes of the long waiting lists in the first place, which were by no means all financial. I am told that one of its best achievements is that the number of people waiting for an operation for more than one year has dropped by 50 per cent. in the past 12 months. That is a considerable achievement by that health authority for the benefit of all its patients.

NHS Chief Executive

8. Mr. Andrew Smith : To ask the Secretary of State for Health when he next plans to meet the chief executive of the National Health Service ; and what matters will be discussed.

Mr. Kenneth Clarke : Mr. Duncan Nichol has responsibility, with his management executive colleagues, for the operation and management of the National Health Service and the delivery of the objectives set for health authorities in line with Government policies and resources. I therefore keep in constant and regular touch with Mr. Nichol over a wide range of issues and usually meet him several times a week.

Mr. Smith : Will the Secretary of State ask Mr. Nichol to review urgently and sympathetically the capital funding problems facing Oxford region, specifically to enable it to proceed with the much-needed replacement of shockingly sub-standard mental illness wards at Littlemore hospital? Will he consider favourably the loan application that he has received for much-needed facilities for severely disturbed elderly people at Littlemore hospital? Is it not time that mental health received the capital investment that it deserves?

Mr. Clarke : Oxford region has an excellent record of capital investment. I agree with the hon. Gentleman that it is important that it is sustained. At the moment, we are having to consider the position in the light of the drop in the anticipated level of land sales, which has been helping to boost that programme, but I assure the hon. Gentleman that Duncan Nichol and myself will keep a close eye on that. I remind him that, for the first time, this year we have introduced a capital loan scheme. One of its first objects is to enable regions to make progress in building new facilities for mentally ill paitents, so that better facilities can replace the older mental hospitals without having to wait for their closure and sale first. I am sure that Oxford region is considering the possibility of making use of that.

Mr. Nicholas Winterton : When he next meets Mr. Nichol, will my right hon. and learned Friend ask him why, when so much additional money is being allocated to the Health Service, so many cottage hospitals are closing and why, when the Health Service is selling so much land in the Macclesfield health authority area, so little goes to Macclesfield and our hospitals and facilities are consistently being closed?

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Mr. Clarke : It is the duty of Health Service managers at every level to make the most effective use of the resources at their command. Obviously, we sometimes have difficult arguments about whether a community hospital should be replaced by a facility elsewhere. I wish that, nationally and locally, people would concentrate more on the number of patients being treated and on the work being done by the Health Service, both of which have increased dramatically since we came to office. The number of in-patients being treated each year is 1.25 million greater than when we took over. That is the best measure of what is happening, both nationally and in Macclesfield.

As to land sales, I encourage management so to arrange things that most of any money raised from sales remains at local level. In that way, local management is given the incentive in making disposals. No doubt, Duncan Nichol will have a look at the particular dispute between Macclesfield and its region, which appears to lie behind the question.

Community Care

9. Mr. Alton : To ask the Secretary of State for Health if he will make a statement on the progress of care in the community as it applies to patients with mental illness.

Mr. Freeman : The Government have set out their proposals in the White Paper, "Caring for People". Key elements are the introduction of the care programme approach, and the specific grant to help increase the social care available for people with a mental illness, which we hope to introduce from April 1991.

Mr. Alton : Has the Minister had a chance to consider the tragic case outlined to him in a letter from me and the right hon. Member for Manchester, Wythenshawe (Mr. Morris), acting as trustees of the charity Crisis, which acts for homeless people? Does he agree that that case illustrates the real problem of discharging people with mental problems into the community? Does he accept that this policy can too easily become dumping in the community, which is in the interests neither of the patient nor of the community?

Mr. Freeman : I shall be replying to the hon. Gentleman on the specific case that he and the right hon. Member for Manchester, Wythenshawe (Mr. Morris) raised. The whole House will agree that in the past some patients have been dumped from mental illness hospitals. There is no question about that. That is why we are pursuing a number of initiatives, including this year a specific initiative aimed at the mentally ill homeless in central London--to be followed in 1991-92, I hope, by a wider national initiative. The situation is scandalous, and I agree with the hon. Gentleman that we must take firm action.

Mr. Simon Coombs : Can my hon. Friend confirm that often the best and most apporopriate quality of care for mentally ill people and mentally handicapped people is provided within the community? To that end, will he promote the citizens' advocacy schemes, which have been growing up on a voluntary basis around the country, notably in my constituency, whereby mentally handi-capped people are provided with a friend, advocate and mediator with outside bodies enabling them to establish themselves more easily in the community?

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Mr. Freeman : I am grateful to my hon. Friend. I am sure that the whole House agrees with him that caring for people with mental illness or handicap to the maximum possible extent in the community is a humane and civilised policy, but there are limitations. As to advocacy I agree that it has a place, particularly for the mentally handicapped and I am grateful for my hon. Friend's support.

Mr. Frank Field : Do the Government accept that not just a few but thousands upon thousands of patients have been dumped into the community and are literally homeless? Does the Minister accept that the measures that the Government have announced, though welcome, in no way meet the crisis faced by this group? When will the Government announce the provision of adequate resources to house those who are homeless?

Mr. Freeman : I do not disagree with the hon. Gentleman's analysis. We are trying, first of all, to correct the discharge policy, and the hon. Gentleman will know of the very firm steps that we have taken. For instance, we have indicated that we shall not permit a mental hospital to close until we are satisfied that there is proper provision for those moving into the community. As regards those who are already in the community--the homeless with a history of mental illness--I agree that in Greater London the number is probably up to 3,000. That is why we shall bring to the House shortly concrete proposals to help to address this problem.

Nurses (Pay and Conditions)

11. Mr. Mans : To ask the Secretary of State for Health what changes have been made in the pay and conditions of nurses since 1978-79.

Mr. Clarke : The pay of nursing staff has increased over and above inflation by an average of 43 per cent. in real terms since 1979.

Mr. Mans : Does my right hon. and learned Friend agree that in addition to the increases in nurses' pay there are many more nurses working in the National Health Service? Does not this show clearly that Opposition claims that the Government do not care about the NHS are totally false?

Mr. Clarke : I agree with my hon. Friend. We have greatly increased the number of nurses, we have hugely increased their pay, we have improved their training and, through the grading system, we have given them a better career structure. This has been one of the Government's main contributions to making the National Health Service an even finer British institution than it was when we took over.

Mr. Cousins : What action does the Secretary of State propose to take to assist the 650 nurses in Newcastle who are still waiting for their grading appeals to be heard two years after the gradings were first awarded?

Mr. Clarke : I told the trade unions that that sort of delay was inevitable. I deeply regret the fact that they did not act on my suggestion that the appeal system should be improved when we introduced the new grading structure. The unions and I were wholly agreed on the desirability of the new grading structure. I cannot understand why they insisted on sticking to an appeal procedure which is

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incapable of sorting out all the individual grievances in a reasonable time. I should like to see a change in the structure to one that could sensibly handle the workload.

Mr. Dickens : I have been in two hospitals in the north-west recently as a National Health Service patient. Is my right hon. and learned Friend pleased to hear that the nursing profession in our hospitals is in extremely good shape, that morale is high and that the nurses are working as hard as ever and are worth every penny?

Mr. Clarke : I trust that my hon. Friend is in good shape as well. He appears to be in extremely good shape. I am grateful to him for his supplementary question. Nine out of 10 patients have nothing but admiration for the clinical and nursing standards achieved by the NHS. Our reforms and the additional money that we are pouring into the NHS are intended to give more power to the elbow of all those doctors and nurses who contribute so much to all those, including my hon. Friend, who need their help.

Mr. Robin Cook : Does the Secretary of State recall that the parliamentary answer to a question that I tabled showed that for eight years under the Government the number of nurses has increased by 9 per cent. compared with 14 per cent. in five years under the Labour Government? Do not those figures show which party is really committed to the Health Service? Do not they confirm that under the present Government the annual rate of increase in the number of nurses has fallen to a third of the level achieved under Labour, and to only one seventh after the reduction in nurses' hours? Do not those figures show clearly why so many hospitals now cannot cope?

Mr. Clarke : Between 1974 and 1979, the take-home pay of nurses fell by 21 per cent. in real terms. The Government have introduced an independent review body to advise us on nurses' pay and we have given them a 9 per cent. award this year. We have reduced their working week, improved their training and raised their pay on average by 43 per cent. in real terms. It is absurd for the hon. Gentleman to make such pathetic claims in respect of the Labour Government's record which was a shameful one in relation to the nursing profession.

Mr. Bill Walker : Does my right hon. and learned Friend agree that the figures that he has given show clearly that the Labour party is the party of cheap labour? It increased the number of nurses but reduced their pay whereas we have increased their pay and improved quality. The Royal College of Nursing recognises that.

Mr. Clarke : I agree with my hon. Friend. We have increased the number of nurses in the NHS, and it is plain that we shall continue to do so. By comparing records-- [Interruption.] --the public should be able to make a judgment about the real concern and commitment shown by the Conservative party to the Health Service compared with that of our opponents-- [Interruption.]

Mr. Speaker : Order. I ask the House to settle down. Too much private conversation is taking place.

Hospices

12. Mr. Malcolm Bruce : To ask the Secretary of State for Health if he will make a further statement on funding for the hospice movement.

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Mrs. Virginia Bottomley : We have now issued guidelines to health authorities on the distribution of the additional £8 million that we have allocated for 1990-91 to enable them to contribute more to the voluntary hospice movement. These measures underline our commitment to the hospice movement. We very much value the standard of care that it has developed and the comfort that it has brought to the dying and their families.

Mr. Bruce : I thank the Minister for her reply. Given that 60 per cent. of all terminally ill patients are still treated in NHS general wards, that there is clearly a growing demand for hospice care and that some hospices are finding difficulty meeting their obligations, will the hon. Lady undertake to keep the situation closely under review and to increase the allocation of funds if the need arises, as many hospice organisations are saying that it will?

Mrs. Bottomley : There is a great deal of work within the National Health Service providing care for the terminally ill and the dying. Our contribution was intended particularly to give assistance to the voluntary hospice movement, which has done excellent and pioneering work in providing comfort and dignity for the dying. Certainly we hope to move towards a fairer partnership between the public support for the dying and the voluntary hospice movement.

Mr. Hannam : Will my hon. Friend confirm that some 36 new hospices are now being planned by the NHS and the voluntary sector, including one in my constituency on a site provided by the local health authority? Is not that a welcome sign of the improving co-ordination between the NHS and the voluntary sector?

Mrs. Bottomley : It is very important that the NHS and the voluntary sector plan together. That is why the £8 million is being distributed through the health authorities, to encourage better planning and the provision of dignity and proper care for the terminally ill.

Mr. Alfred Morris : Why is the matched giving for hospitals in Scotland, pound for pound of charitable funding, not available elsewhere? When will it be available in England and Wales? Is the Minister aware that more hospices could then give more help to more people at home for whom there is no residential accommodation available and that more could be done to help bereaved families, not least bereaved children?

Mrs. Bottomley : I fully endorse the points made by the right hon. Gentleman about the importance of the hospice movement, for the bereaved family and children as much as for the patients themselves. I am pleased to have been able to announce the 70 per cent. increase in public funds for hospices this year and we have made it clear that we hope that health authorities will move towards an equal partnership with the voluntary hospice movement.

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