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Mr. Michael Morris : Is my right hon. and learned Friend aware that perhaps we could learn a lesson from the United States, where peer review organisations examine about one in four operations and determine whether it was necessary in the first place, at what cost it was done and how successful it was? Such detail is more likely to result in patient satisfaction than some overall national body.
Mr. Clarke : I do not envisage a national body taking over the detailed operation of local services. I envisage a national body that will be available as a source of advice if people encounter local difficulties. I agree with my hon. Friend that we require what I call systematic quality control, which is usually described as audit control. We are drawing on American experience, but the royal colleges and the Government would like an even better system introduced in all branches of the National Health Service.
Dr. Kim Howells : On the monitoring of the health of any community, will not the Secretary of State admit that family practitioner committees are extremely worried about the lack of morbidity statistics in terms of their ability to play a constructive role--if that is not a contradiction in terms--in how the NHS reforms are now being applied?
Mr. Clarke : We have morbidity statistics. I have not had representations from English medical practitioner committees about the inadequacy of the statistics, but I shall certainly make inquiries to see whether the federation believes that it is a problem or whether there is a particular problem in Wales.
Mr. Hanley : Bearing in mind the substantial increase in the number of GPs and the fact that our population is static, will my hon. Friend explain why some doctors believe that service to patients will reduce because list sizes will increase?
Mrs. Bottomley : I am quite unable to explain it. As my hon. Friend rightly says, the population remains static. There are more GPs joining the lists each year and we have seen lists come below 2,000 for the first time. That is a major achievement and it leads to better patient care.
Mr. Freeman : Local authorities are primarily responsible for providing day services for mentally handicapped people. The recent social services inspectorate report, "Inspection of Day Services for People with a Mental Handicap", suggested a number of ways in which day services could be improved within existing resources.
Mr. O'Brien : Because of the haste to close mental handicap hospitals and discharge mentally handicapped people, because of the problems facing local authorities--with restrictions on financing and the fact that the money allowed to them is not ring-fenced and there is no guarantee that there will be a sufficient increase to allow for inflation-- and because every pound spent above the level of assessment set by the Government under the poll tax arrangements for services for the mentally handi-capped means a £4 increase in the poll tax, when does the Minister intend to do something to provide real services for the mentally handicapped?
Mr. Freeman : There is no rush to close mental handicap hospitals. The closure programme and the discharge of patients back into the community from mental handicap hospitals is relatively slow. As for the transfer of resources from the Health Service to local authorities for patients discharged, we are looking at the future of joint finance--of finance passing from the Department of Health to the Department of the Environment- -and we shall bring to the House in due course our proposals for ensuring adequate funding for such patients.
The Prime Minister (Mrs. Margaret Thatcher) : This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.
Mr. Smith : Does the Prime Minister accept responsibility for the chaos and confusion at the heart of Government over the poll tax? Does not she owe it to the House and the people before they vote on Thursday to give a straight answer to a straight question? What, precisely, is she going to do about the poll tax?
The Prime Minister : Had the hon. Gentleman read the Official Report of the debate we had on that subject last week, he would have known the answer. We are looking to see whether any adjustments need to be made to the community charge for next year. Some of those were
Column 893indicated in the debate, and there is no surprise about it. When one goes from a rate tax to a community charge, adjustments will, of course, need to be made, and we are looking to see which ones need to be made for next year-- [Interruption.] If there is any confusion or any high rates, that is in the minds of Labour local authorities. High community charges are due to local Labour councils. Most councils have got out their charges with the rebates and the traditional relief included in them.
Mr. Wood : Does my right hon. Friend agree that it would be wrong for a local authority to cave in to threats of a politically motivated strike, particularly to secure the reinstatement of a leading member of Class War who hailed the Trafalgar square rioters as heroes?
The Prime Minister : Yes, I agree with my hon. Friend. I understand that Hackney suspended a person who hailed the Trafalgar square rioters as heroes, that the National and Local Government Officers Association threatened to go on strike and that Hackney then caved in. That tells us a lot about the people whom Hackney employs, a lot about NALGO and a lot about what life would be like under Labour.
The Prime Minister : When we have a statement to make we shall make it-- [Interruption.] --and it will be far more detailed and thorough than any statement we hear from the right hon. Gentleman about roof tax.
"The community charge will be very popular?"--[ Official Report, 22 March 1990 ; Vol. 169, c. 1231.]
Does she still believe that, and if she does, why is she sending her Ministers off in every direction, desperately searching for an escape route from the poll tax?
The Prime Minister : --and a far fairer charge than the alternative roof tax. I notice that when the right hon. Gentleman gave an interview to The Independent on 21 April, it stated that Mr. Kinnock-- [Interruption.]
"Mr. Kinnock then gave a strong indication of his own thinking. He said the tax base for rates was imputed rents and that's one thing we can take into account now and bung into the computer.' " Does not he know the old computer saying, "Garbage in, garbage out"?
Column 894--that the poll tax will never be fair? It cannot be amended ; it must be got rid of, even if that means that the Prime Minister goes down with her own flagship.
The Prime Minister : Cannot the right hon. Gentleman understand that domestic rates have been abolished ; that they were a most unfair tax ; and that the enemy is not the community charge, but the high-spending Labour councils?
Miss Emma Nicholson : Does my right hon. Friend agree that as only 19 million people paid the rates and 36 million people will now pay towards community services, the community charge is already infinitely fairer for over half the adult population?
The Prime Minister : Yes, my hon. Friend is correct. I noticed that in a recent poll over 70 per cent. of people thought that everyone should make some contribution to local authority spending. That is precisely what the community charge does, with more generous rebates than have ever been given before and with generous rebates for transitional relief. It is a much fairer tax than either the rates or the roof tax.
Dr. Owen : Is banding of the poll tax one of the adjustments that the Prime Minister has in mind, so that people can pay on the basis of their ability to pay, or is the Prime Minister opposed to that in principle? Or are there practical arguments, in which case perhaps she will enumerate them to us?
The Prime Minister : Those who cannot afford to pay get generous community charge rebates--far more generous than ever before. Some 9 million people will benefit from them. Those who have a sharp difference between the old rates and the community charge are eligible for transitional relief. That applies to some 7 million people. The people who do not get sufficient transitional relief live in the areas of high- spending labour councils, which care nought for their citizens but are more anxious to dig their hands deeply into their citizens' pockets. People who are better off pay far more to local services because the taxpayer is the greatest contributor to local authority spending. The top 10 per cent. of income earners pay 40 per cent. of the income tax yield and therefore pay more for local services than the people in the bottom 10 per cent.
Dame Peggy Fenner : During her busy day, will my right hon. Friend spare a moment to commend Medway city council on setting the lowest community charge in Kent? Will she list the five local authorities that have the worst education record, the largest number of empty council houses and the highest rent arrears?
Column 895The Prime Minister : I gladly pay tribute to the eficient Conservative authority in Medway.
With regard to my hon. Friend's question about the five worst education authorities and so on, I am sure that the House is avidly waiting to hear my reply. The five councils with the worst education results are Knowsley-- [ Hon. Members :-- "Labour."] ; Waltham Forest--[ Hon. Members :- - "Labour."] ; Barking--[ Hon. Members :-- "Labour."] ; Newham-- [ Hon. Members :-- "Labour."] ; and Sandwell--[ Hon. Members :-- "Labour."].
The five authorities which have most empty council houses are Manchester-- [ Hon. Members :-- "Labour."] ; Liverpool--[ Hon. Members :-- "Labour."] ; Sheffield--[ Hon. Members :-- "Labour."] ; Salford- -[ Hon. Members :-- "Labour."] ; and Birmingham--[ Hon. Members : -- "Labour."]. Between them, those Labour-controlled authorities have more than 20, 000 empty houses.
The five authorities with the highest rent arrears are Southwark-- [Hon. Members :-- "Labour."] ; Lambeth-- [Hon. Members :-- "Labour."] ; Liverpool-- [Hon. Members :-- "Labour."] ; Brent-- [Hon. Members :-- "Labour."] ; and Islington-- [Hon. Members :-- "Labour."]. Between them, those authorities are owed £86 million in uncollected rents.
Mr. Cummings : Is the Prime Minister aware of the many thousands of people in the United Kingdom who have been discriminated against because of a hostile interpretation of rules governing concessionary television licences for the elderly and the disabled? Although they live in identical circumstances, because of the regulations they are being denied what is rightfully theirs. In the twilight of the Prime Minister's premiership, will she now find it within her heart to instruct her Ministers to give to retired people that which is equal and just?
Column 896the regulations is a matter for the Department concerned and I am sure that if people are entitled to receive a concessionary licence they will do so.
Mr. Harry Greenway : Is my right hon. Friend aware that 6,000 people in Ealing have been sent bills for the full community charge, regardless of their rebate applications? Some of those people are pensioners and students who are entitled to pay only one fifth--£87--but instead are being required to pay £435 by Ealing's Labour council, which will not process their rebate applications until after the local elections next Thursday. Is not that another wicked Labour con trick?
The Prime Minister : I agree with my hon. Friend. Most local authorities have been thoughtful enough of their residents to deduct the community charge relief and the transitional relief from the bills, so that they do not raise needless fears. That is naturally good administration. If there are any who have not done it, it is bad administration and demonstrates sheer lack of consideration for their own citizens.
Mr. Canavan : Does the Prime Minister recall those heady days when she described the poll tax as her flagship? Now that Thursday's election torpedo is fast approaching, despite the captain's apparent order to change course, does she recall the fate of another flagship, the Belgrano?
As regards the community charge in Scotland, where it has operated for a considerable time, far more councils are now either holding the charge or reducing it. Accountability in Scotland is at last beginning to work, as this year councils know that they cannot blame increases on anyone but themselves.
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