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House of Commons

Tuesday 20 November 1990

The House met at half-past Two o'clock

PRAYERS

[Mr. Speaker-- in the Chair ]

PRIVATE BUSINESS

Adelphi Estate Bill

London Docklands Railway Bill

Considered ; to be read the Third time.

Heathrow Express Railway Bill

[Lords]

Order for Second Reading read.

To be read a Second time on Thursday.

Oral Answers to Questions

HEALTH

Children Act

1. Mr. David Porter : To ask the Secretary of State for Health what progress he is making in the implementation of the Children Act 1989.

The Minister for Health (Mrs. Virginia Bottomley) : Our major programme of regulations, guidance and training continues to make good progress. We hope to launch the bulk of the guidance early in the new year.

Mr. Porter : Will my hon. Friend tell the House a little more about her Department's plans for the Act's training support programme?

Mrs. Bottomley : I am able to announce a substantial increase in the amount of money for training in social services generally. The training programme for the implementation of the Children Act is making good headway. I am pleased to be able to inform my hon. Friend that we are arranging training through the National Children's Bureau for those involved in the national health service. The first training event took place in East Anglia only last week. I hope that it will soon be available to NHS workers in my hon. Friend's constituency.

Mr. Bell : I am always glad to hear from the Minister that there are training programmes. However, as £3,000 million of Government money is to be used to offset the effects of the poll tax, can she assure the House that sufficient resources will be available fully to implement the Children Act in October 1991?

Mrs. Bottomley : I can give the hon. Gentleman that assurance. There has been a very good settlement for local authority personal social services this year which amounts to a 23.4 per cent. increase on last year's standard spending assessment. In addition, the training resources are


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ring-fenced. They go out in the form of specific grants for child care and for the implementation of the Children Act. We shall implement the Children Act in 327 days' time.

Mr. Devlin : Is my hon. Friend aware that I heard with some concern from a group of my constituents that the consultation documents sent out by her Department on the running of day nurseries were received in Cleveland only on the day that they were due to be responded to? Will my hon. Friend look into that and, if necessary, extend the time?

Mrs. Bottomley : I shall certainly look carefully at my hon. Friend's point. Only last month I attended a seminar in Newcastle at which local authorities, voluntary organisations and the private sector discussed precisely that guidance--that they should have inspected provision for child minders in play groups within three months and for day nurseries within six months. New guidance is important. We are funding the National Children's Bureau to produce material on that part of the Act. I certainly assure my hon. Friend that I shall look into the matter as it affects his part of the country.

Elderly (Day Care)

2. Mr. Jack Thompson : To ask the Secretary of State for Health if he will publish the number of day care places per 1,000 of the elderly and very elderly population, by individual local authorities.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : This information was published last July. A copy was placed in the Library.

Mr. Thompson : In view of that almost inadequate reply, will the Minister examine the responses from Labour-controlled county and shire councils and those from Tory-controlled county and shire councils? He will find that Labour-controlled county councils provide a far better service for the elderly. Does he understand that the Royal College of Nursing has expressed concern about inadequate transport arrangements and respite care, as well as the inadequacy of provision for those who live in rural areas?

Mr. Dorrell : I did not give every figure, because the hon. Gentleman asked for a figure for every local authority in England and Wales which would have taken some time to read to the House. He asked whether I am aware of the development of the service. He may know that the total number of day care places has risen by nearly 30 per cent. in 12 years and that the resources available to the Northumberland social services departments has risen by 55 per cent. in real terms in 12 years. The way that those resources are used is a matter for social services departments.

Mr. Steen : Does my hon. Friend agree that the most important thing is to ensure that old people can get about rather than be in day care? Is my hon. Friend aware that, unfortunately, elderly people in south Devon are hobbling about because the chiropody service has been cut and fewer sessions are available? Will my hon. Friend have a word with the chairman of the area health authority and say that before it cuts services at the sharp end, it should have a look at its own bureaucracy?


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Mr. Dorrell : My hon. Friend is right to highlight the importance of chiropody services. They constitute an important part of proper community care. The exact prioritisation in an area is a matter for the health authority.

Mr. Frank Field : Does the Minister accept that as a result of the Government's postponement of their community care programme the number of day care places in the community may be declining? Is he aware that in Birkenhead, for example, the Vincent Harkness day care centre will be closing? What message would the Minister like me to take home to my constituents who may have only one choice--going into residential care--as a result of the Government's postponement of their plans?

Mr. Dorrell : I have already said that we recognise the importance of day care places and welcome the fact that over the past 12 years there has been an increase of 30 per cent. in their availability. They are a vital part of any proper community care policy. I do not accept that the phased introduction of community care need have a direct impact on the availability of places or on the way in which social services departments continue to use resources already at their disposal.

Neurosciences

3. Mr. Peter Bottomley : To ask the Secretary of State for Health by what percentage the cost of transferring neurosciences from Shooter's Hill to Denmark Hill has risen since the decision was taken ; and what proportion of the South East Thames regional annual capital budget this represents.

Mr. Dorrell : Nineteen per cent, Sir. The costs are borne over a period of time and not solely by the regional health authority.

Mr. Bottomley : Would I be right in saying that the capital budget for South East Thames is between £50 million and £60 million and that the cost of moving neurosciences four miles is between £50 million and £60 million? There are already six or seven neuroscience units in the inner London area and people in my constituency and further out would prefer to have services available to them. Will my hon. Friend confirm that, or shall I take up this matter with the chairman of South East Thames regional health authority before going to independent auditors?

Mr. Dorrell : My hon. Friend should take up any discontent with the chairman of the regional health authority. He should be aware that the reasoning for the concentration of neurosciences on the Maudsley site was that it was a more efficient use of clinical resources and involved lower cost. I suspect that neither of those considerations will have changed.

Hospital Beds

4. Mr. Illsley : To ask the Secretary of State for Health what steps he is taking to avert the closure of hospital beds throughout the United Kingdom.

The Secretary of State for Health (Mr. William Waldegrave) : It is for health authorities to determine the mix of health

provision--including the number of hospital beds--which best meets the needs of their local population


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using the increased resources which the Government have made available to them. Next year will see the largest-ever increase in NHS funding, enabling the health service to continue to treat more people and expand its services.

Mr. Illsley : The Secretary of State is no doubt aware of the recent report of the National Association of Health Authorities and Trusts which forecast some 3,500 bed closures between now and next April. He is probably also aware that all hospital consultants in Sheffield have been told not to prescribe on to general practitioners' budgets in order to save money. Is not it a fact that the Government are passing the buck to health authorities, which are no longer accountable, and are blaming them for the cuts when the Government are simply not providing adequate funding for health authorities to carry out their duties?

Mr. Waldegrave : No, Sir, I do not accept that. As the figures show, the number of people treated goes on increasing from year to year. As the hon. Gentleman knows, the number of day care surgery cases has doubled since 1979 for medical reasons. That is largely why the beds continue to close.

Dame Jill Knight : May I congratulate my right hon. Friend on being appointed to his new position? When considering bed and ward closures, does he recognise that many of us believe that what is important is the treatment of patients, not furniture? Will he assure the House that when wards close and beds are moved, patients who need care will be taken care of elsewhere?

Mr. Waldegrave : I am grateful for my hon. Friend's welcome. The figures support what she says. The national health service, thanks to its employees, who do so well for us, continues to treat more patients every year, including in my hon. Friend's area.

Mr. Kennedy : Does not the Secretary of State realise that the report of the National Association of Health Authorities and Trusts, and the survey carried out by The Independent the day before, showed clearly that, in anticipation of next year's managerial structural changes, health authorities were being forced to close beds? It is quite false for him to say that the key indicator is the number of patients being treated, because all too often health authorities have moved patients from hospital care, sooner than normal, back into the community. Many of them have had to be re -admitted because they did not have sufficient hospital convalescence following surgical treatment. Should not we examine that figure, rather than the platitudes that the Secretary of State is offering?

Mr. Waldegrave : I read the surveys with care. It is worth noting that the report of the National Association of Health Authorities and Trusts to which the hon. Gentleman referred showed, by any inflation indicator, a real increase in resources available for the health service this year. That contradicts what Opposition Members have often said. The medical advice is against the hon. Gentleman. Before we took office the trend was already to keep people in hospital for less time. That is medically right.

Mr. Norris : I join in welcoming my right hon. Friend to his new position and express my pleasure that having me as his Parliamentary Private Secretary did not impede his career for too long--or at least I did not damage him as much as I did some of my other right hon. Friends. The


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reality of bed closures is often the opposite of that suggested by the hon. Member for Barnsley, Central (Mr. Illsley). Beds have been closed in my health district and much public distress has been expressed as a result. But those bed closures are being announced now to achieve required budget savings by next April. The main reason is not a shortage of funds from the Department of Health but the inadequacies of the management of individual health districts. More health districts should address themselves to the subject.

Mr. Waldegrave : I am grateful for my hon. Friend's kind words. It is true that he has lost one or two Secretaries of State along the way, but he and I had a better relationship. What he says is perfectly true. It would be wrong for well-managed areas--Barnsley health district is managing well within its resources and has closed no beds for financial reasons--to be made to transfer resources to areas that may have tackled their problems with less resolution.

Mr. Robin Cook : May I congratulate the Secretary of State on his appointment to the Cabinet and share the hope that he will still be in it after 6.30 pm? While he is still with us, will he try to face the realities? Has no one told him that some hospitals will not carry out any routine surgery for the rest of the financial year? Has no one told him that the NAHAT survey found that only 2 per cent. of closures were planned rationalisations and that 98 per cent. were emergency closures to balance the books in time for next April's changes? As those changes are doing so much harm to the national health service, why does not he take the opportunity of this interregnum to put back the lid on changes which came in with the present Prime Minister and should go with her?

Mr. Waldegrave : I am grateful for the hon. Gentleman's welcome, although I am not so grateful for the fact that he is playing the old gramophone record which he has been playing for the past two or three years and will continue to play for the next two or three years from the position that he now occupies. Every year the health service goes on treating more people. I shall not deny that in some places in the health service beds are being closed for financial reasons, but it would be wrong for us to say that those who are trying to achieve their planned budget spending should not be encouraged to do so, because that is the basis of a well-managed service.

Mr. Hayes : I warmly welcome my right hon. Friend to his new job and I know that he will be a great success. Does he accept that the best way to prevent bed closures is for the money to travel with the patient--which I hope will happen from next April? Does my right hon. Friend accept that he will have to take some tough decisions, particularly in the Thames region where the capital programmes have collapsed? My right hon. Friend must understand that constituencies such as mine, which has the worst waiting lists in the country and where children's wards are being closed, must be assisted if the excellent reforms that will come on stream next year are to mean anything.

Mr. Waldegrave : My hon. Friend is right. The reforms will help to take the money to where the patients are and will help to reward hospitals that are successful and treat many patients. The present system works in exactly the opposite direction. I am well aware--this is the first thing of which anyone holding my office would be aware--that


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there is, as usual, a special London problem which has not been sorted out for decades. We shall have to sort it out before too long.

Health Service Funding

5. Mr. Michael : To ask the Secretary of State for Health what steps he is taking to ensure that adequate resources are available to meet the need for (a) health service provision and (b) community care as a result of demographic changes.

Mrs. Virginia Bottomley : We shall increase resources for the national health service in the United Kingdom by £3.2 billion in 1991- 92. At the same time, the standard spending figure for local authorities' personal social services will rise by 23 per cent.

Mr. Michael : Does the hon. Lady recognise that Ministers are continually playing the old record which was left behind by the Secretary of State's predecessor? Since 1982, inflation in the health service has been 49.9 per cent., compared with a less than 35 per cent. increase in the retail prices index. Do the Government recognise that the health service is treading water where it is not drowning, that demographic changes and the increasing numbers of elderly people are flooding over our services and that it is not enough to mouth platitudes? Resources are needed if community care is to be more than merely moving people out of institutions and if it is to mean providing adequate services for carers and those who are cared for in the community. Can we have the resources so that the job can be done?

Mrs. Bottomley : This is the largest ever increase in resources for the national health service--a cash increase of one third over the past three years. I recall that when the Labour party was last in power, long ago, the total cost of the health service was £8 billion. There has been an extra £8 billion in the past three years alone. As for demographic factors, over the past 10 years the number of elderly people has increased by 8.4 per cent. Hon. Gentlemen might like to know that over that period the number of geriatric in-patients increased by 75 per cent.

Mr. Nicholas Winterton rose-- [Interruption.]

Mr. Speaker : Order. There is an air of excitement this afternoon which I fail to understand.

Mr. Winterton : I am grateful for the reception by the House, but I am not on the ballot paper upstairs--

Mr. Speaker : Order. The hon. Member is on the ballot paper here.

Mr. Winterton : Does my hon. Friend agree that it is unacceptable for 50 beds to be closed in a relatively new, modern district general hospital in Macclesfield when there are surgeons and consultants waiting to carry out treatment and operations, theatres available for those operations and waiting lists of people wanting operations? The Mersey regional health authority has allocated insufficient resources to Macclesfield, given the growing number of elderly people and the growing population of the area.

Mrs. Bottomley : The enemy of the health service is waste. It is a waste not to have people fully using the skills that they have been trained to deploy. It is a major


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challenge to health authorities to live within their resources. We take great pride in the substantial increase in resources that we have provided for the health service, but we do not underestimate the financial and management skills that health authorities need to deploy so that they do not let their work outstrip the resources to meet that work. We need further improvements in that area.

Mr. Rooker : The Minister will agree that the demographic changes make a difficult situation far worse, so it is more important than ever to look at the way in which resources are moved about. How is it possible that Exeter health authority seems to have lost £60 million, which was released by the sale of two psychiatric hospitals at Digby and at Exminster, not £1 of which has gone into community care for the mentally ill? How is it possible that the Midland nerve hospital has closed a psychiatric ward with a staff of 15 who have been replaced by only three staff working in the community? Where have all those resources gone? Local people cannot find the information and they have been told that it is not available locally. We presume, therefore, that the information is available centrally. Can we be told?

Mrs. Bottomley : I welcome the hon. Gentleman to his new role. He will know that there is concern about the extent to which provision for the mentally ill has kept up with our wishes and expectations. That is why my hon. Friend the Parliamentary Under-Secretary of State has responsibility for the specific grant for the mentally ill which will commence next April. Next year, £30 million will be spent by local authorities, with the agreement of health authorities, to ensure that there is close collaboration in the provision of services for the mentally ill. Over the past 10 years, there has been almost a doubling in the number of places in homes for the mentally ill. We believe that there is scope for further provision by social services to ensure that they do as well with the mentally ill as, in many cases, they have with the mentally handicapped.

In-patients

6. Mr. David Davis : To ask the Secretary of State for Health what is the number of in-patients being treated by the national health service at the present time ; and how many were treated in 1979.

Mr. Dorrell : Almost 7.5 million in-patient cases were treated in 1989-90 compared with just over 6 million in 1979. That is a rise of almost 25 per cent.

Mr. Davis : I thank my hon. Friend for that answer because it nails the nonsensical assertion from some Opposition Members, and from my hon. Friend the Member for Macclesfield (Mr. Winterton), about cuts in the health service. It shows that there has been a dramatic increase in the health service provided to the people of the United Kingdom. Will my hon. Friend also nail that lie, for the benefit of my constituents, by telling me the figures for Scunthorpe health authority?

Mr. Dorrell : My hon. Friend is exactly right. The figures demonstrate that the national health service is growing each year that the Government are in power. I am


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pleased to be able to tell my hon. Friend that the number of patients treated in his constituency has risen at a compound rate of 5 per cent. per annum.

Mr. Wigley : Does the Minister accept that although there has been an increase in the number of in-patients treated, there may have been an even greater demand? Are those in need of in-patient treatment receiving the treatment that they need or are they being turfed out of hospitals before they are ready and being directed towards private health care provision in a way which they would not have been in 1979?

Mr. Dorrell : In 1979, the in-patient waiting lists was 5 per cent. higher than it is now. It simply is not true to say that the shorter time in a hospital bed is a reflection of the fact that peope are being pushed out into the community. It is a reflection of the refinement of medical practice and of less traumatic medicine which means higher-quality patient care.

Mr. Sims : Is not it a fact that the improvement in medical techniques to which my hon. Friend referred means that many treatments that involved in-patient care in 1979 can now be achieved through out-patient care? Are not the out-patient figures even more relevant to the arguments on this point and on the whole question of hospital beds?

Mr. Dorrell : My hon. Friend is precisely right. There is also an interim category of day cases--people who would previously have had to stay in hospital, in many cases for several days, and in some cases for several weeks. They are now treated as day cases. The number of day cases treated by the national health service has more than doubled since 1979.

Dental Treatment

7. Mr. Ronnie Campbell : To ask the Secretary of State for Health what action is being taken by his Department to ensure that all areas have access to national health service dental treatment.

Mr. Dorrell : The Department operates a scheme offering financial incentives to dentists to set up in shortage areas.

Mr. Campbell : Will the Minister guarantee the people of the north- east of England a dental service within the health service or are we seeing another way of privatising the dental service?

Mr. Dorrell : Yes, Sir and no, Sir.

Mr. Hill : Is my hon. Friend aware that many dentists are wrestling with their consciences while considering whether they should go for more private practice than NHS practice? My dentist is one of those who finds himself in that predicament. There must be more inducement for dentists to stay with the NHS than there has been previously. They are very inclined to go private.

Mr. Dorrell : I read the same newspaper articles as my hon. Friend and I am obviously concerned by them. We have a choice between believing the Daily Mirror or the British Dental Association. The BDA has stated :

"the public should have no difficulty in finding an NHS dentist in any part of the country."


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That surely is the important assurance that I gave the hon. Member for Blyth Valley (Mr. Campbell).

Mr. Holt : Will my hon. Friend take it from me that in the north- east of England there is an adequate supply of dentists, and excellent dentists? The thing that is putting off dentists at present is the amount of paperwork that they are having to complete in accordance with their new contracts. Will my hon. Friend consider that? The system needs streamlining urgently.

Mr. Dorrell : I entirely agree with my hon. Friend that we should always be reviewing the paperwork and bureaucratic requirements of the NHS to ensure that they are at the minimum. We must ensure also that there is a sufficient flow of information to allow management to discharge its tasks effectively.

Ms. Abbott : Is the Minister aware that the terms of the new dental contract make it increasingly uneconomic to practice NHS dentistry in London and that the majority of dentists in London and the south-east voted against the contract for that reason? My constituents are finding increasingly that their dentists are moving over to entirely private work. Is the Minister further aware that many dentists and many other members of the public feel that the Government are trying to introduce the privatisation of the dental service through the back door?

Mr. Dorrell : I repeat not my words but those of the BDA, which stated that

"the public should have no difficulty in finding an NHS dentist in any part of the country."

The hon. Lady is an unlikely exponent of the point of view that £30,000 a year is not a decent living wage.

Hospital Trusts

8. Mr. Wareing : To ask the Secretary of State for Health if he will visit those hospitals in Liverpool which have made proposals for hospital trust status in order to obtain at first hand the views of the staff.

Mr. Waldegrave : I have no immediate plans to visit the hospitals in Liverpool that have applied for trust status.

Mr. Wareing : How can a Government who claim to believe in democracy ignore the wishes of the Liverpool people, as shown in a recent survey carried out by the Liverpool community health council? It revealed that 88 per cent. of staff in hospitals in Liverpool and over 92 per cent. of the public in Liverpool find the concept of opted-out hospitals entirely alien to their idea of a health service. Might not the Prime Minister, if that is what the right hon. Lady remains after 6.30 pm, try out her new-found belief in referendums by going to the people of Liverpool and carrying out a referendum in that city, where no councillors and no Members of Parliament believe in the Government's extreme right-wing doctrines?

Mr. Waldegrave : It would be absurd to have referenda on management changes within the NHS. It is not surprising that the hon. Gentleman and his colleagues have managed to scare many people in Liverpool, as others have scared people elsewhere. For example, the hon. Member for Peckham (Ms. Harman), who I think is an Opposition Front-Bench spokesman, issued a press handout about hospitals opting out of the NHS. No hospitals are opting out of the NHS.


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Mr. Alton : Given the misunderstandings that many have about opting out or trust status, is not there a need for the Secretary of State to go to places such as Liverpool to explain his plans? Many are fearful that if the Liverpool royal hospital in my constituency or the Alder Hey children's hospital, which has an international reputation, were in some way to be separated from the NHS, they would not be available to ordinary people and would not provide them with the care that they have always provided in the past. If there is a misunderstanding, why does not the Secretary of State come to Liverpool to explain in person the proposals to those who will be affected by them?

Mr. Waldegrave : There are 66 applications for trust status and we must approve them or not approve them shortly. It would not be practicable for me to visit all those hospitals before I have to take those decisions. It is important that the hon. Member for Liverpool, Mossley Hill (Mr. Alton) accepts, as I hope that the hon. Member for Liverpool, West Derby (Mr. Wareing) accepts, that it is his duty to get rid of the nonsense that has been spread around. I am sure that the hon. Member for Mossley Hill, who is an independent-minded man, will help us to do that.

General Practitioners

9. Mr. Hind : To ask the Secretary of State for Health what is the average number of patients and income of general practitioners in England and Wales ; and if he will make a statement.

Mr. Waldegrave : On 1 October 1989, the latest date for which information is available, the average number of patients on a GP's list in England and Wales was 1,962--14 per cent. fewer than in 1979. The intended average net income for GPs is currently £33,280 and will rise to £34,680 from 1 January 1991.

Mr. Hind : Will my right hon. Friend confirm that since the introduction of the new contract and over the past few years, GPs have had fewer patients on their lists and will therefore have more time to treat them? Will he also confirm that as a consequence of the new contract, GPs' incomes will increase, so in no way can it be said that their standard of living has been eroded?

Mr. Waldegrave : I can confirm what my hon. Friend says. I remind the House that many statements were made about the effect of the new GP contract and a lot of words will have to be eaten, particularly by Opposition Front-Bench Members. The figures already coming through show dramatic rises, for example, in the immunisation of children, which I do not think would have been achieved without the contract, which is already working well.

Mr. Kirkwood : How many applications have there been from general practices in England and Wales for budget-holding status? How many of them came from rural areas? When will the Secretary of State make an announcement about those that he will approve?

Mr. Waldegrave : The number is about 350, with a similar number, or rather more, expressing interest for the


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future. I cannot give the hon. Gentleman the breakdown between rural and urban now, but I shall write to him about that.

11. Mr. Couchman : To ask the Secretary of State for Health what has been the effect of the new general practitioner contract on the amount of time spent in consultation with patients.

18. Mr. Hague : To ask the Secretary of State for Health what recent representations he has received about the new contract for general practitioners.

Mrs. Virginia Bottomley : A recent survey published in the medical press suggested that 54 per cent. of GPs have spent more time in patient contact since the introduction of the GPs' new contract. In recent months there has been a dramatic reduction in the volume of correspondence received on the GP contract.

Mr. Couchman : When the new contract was negotiated, doctors expressed much concern about targets for cervical cytology and immunisation. Does my hon. Friend have figures to show the percentage and number of doctors who are achieving those targets? Has the number of home visits undertaken by doctors personally rather than through agency services increased since the new contract was agreed?

Mrs. Bottomley : My hon. Friend rightly highlights the misleading and mischievous statements that were made at the time. The hon. Member for Livingston (Mr. Cook) said :

"The targets for screening for cervical cancer--are so heroic, so far beyond the present figure for most practices, that there is a danger that many doctors will simply give up trying."--[ Official Report, 25 July 1989 ; Vol. 157, c. 960.]

That shows, as ever, that the Opposition think so little of people and are the doom-mongers and gloom merchants.

I shall give my hon. Friend the figures that he requested : 54 per cent. of GPs are already hitting the higher target for cytology--the majority are hitting the higher target. A further 35 per cent. are hitting the lower target as well and that is very encouraging. A similar story applies to immunisation. The remuneration on home visits, whereby if a GP carries out his own home visit at night, he receives about £45, but if he uses a deputising service, he receives £15, has meant that GPs are more willing to undertake their own home visits.


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