Mr. Thurnham : After the success of the pilot schemes in Manchester and Newcastle, will my hon. Friend make sure that sufficient funds are available to maintain national progress? Will he see what can be done to reduce the very high costs of powered wheelchairs?
Mr. Dorrell : As my hon. Friend knows, it was always the intention that the services that are currently run by the Disablement Services Authority should be transferred to health authorities with effect from April this year. We have set in place arrangements that will ring-fence the funding that is currently granted to the Disablement Services Authority for two years, to ensure that, in the immediate aftermath of the transfer, the real level of provision will be maintained.
Mr. Frank Field : Does the Minister think it fair that some of the most disabled people in Birkenhead are those who are least likely to get a powered wheelchair? If he does not think that that is fair, what will he do about it?
Mr. Dorrell : What we are doing about it is that, from April, the local health authority will have the resources available to make a properly prioritised decision about the way in which those resources should be used. It will be for the hon. Gentleman to take up that matter with his local health authority to ensure that the people who need such services have them provided.
Mr. Atkinson : Will my hon. Friend take advantage of this opportunity to pay tribute to the work of the various associations for the disabled and the St. John Ambulance brigade, whose work makes the lives of those who rely on wheelchairs much more normal?
Column 144to health. It is right also to take this opportunity to draw attention to the valuable work that has been done by the Disablement Services Authority, which was set up by my right hon. Friend the Prime Minister when he held a different brief. It has made a substantial improvement in the efficiency with which resources are used to the benefit of the patients who use such services.
Mr. Alfred Morris : Is not it the general view, after the pilot experiments in Manchester and Newcastle, that the Government's offer of £1 million in response to the DSA's request for £10 million is woefully inadequate? After all, we are talking here about independent living for people who would otherwise have to rely on much more expensive institutional care. Will powered wheelchairs be available for casualties from the Gulf if, ultimately, they can be of help?
Mr. Dorrell : The decision on the provision of a powered wheelchair for an individual patient will be for health authorities and clinicians. From April, the £112 million budget for disablement services--the provision of wheelchairs and of artificial limbs--will be transferred to local health authorities so that they can use the resources in a way that reflects local priorities. That seems to be the most effective way of ensuring that resources are well used.
2. Mr. Teddy Taylor : To ask the Secretary of State for Health what guidance he is giving to regional health authorities about the time scale to be adopted in transferring the funding of districts to the capitation system ; and if he will make a statement.
The Secretary of State for Health (Mr. William Waldegrave) : All regional health authorities have submitted details of their proposals for achieving funding based on weighted capitation at district level. We are analysing the method and pace of change proposed by the regions and will be formulating a national policy and timetable shortly.
Mr. Taylor : As authorities such as Southend, which has traditionally been woefully underfunded, were looking forward to the new Government proposals that would give them a fairer deal, is my right hon. Friend aware of the serious concern, first, that there might be an unduly extended time scale for change and, secondly, and more important, that the regional health authorities can adjust the figures as they see fit to make allowances for what they assess as deprivation? Bearing in mind the fact that regional health authorities are not subject to any democratic control, will my right hon. Friend see to it personally that they do not undermine his excellent plans?
Mr. Waldegrave : I am aware of the anxiety in Southend because my hon. Friend has made his concerns clear to us. There are two aspects of the matter. First, it is fair to say that the potential gains for Southend, which will come through in the end, must be set against the disruption to the losers in the process. It is fair to take a little longer so that the disruption is tolerable. Secondly, I can set my hon. Friend's mind at rest that all the formulae produced by the regions will have to come to my Department for approval and I shall ensure that they are fair.
Column 145Mr. Ashley : Is the Secretary of State aware that he should not be too tolerant with the regional health authorities? I endorse what was said a moment ago. If the Secretary of State does not insist on the authorities allocating resources on a weighted capitation basis, underprivileged areas such as north Staffordshire will not receive the money to which they are entitled. Will the Secretary of State press them strongly?
Mr. Waldegrave : I can give the right hon. Gentleman the same assurance as I gave earlier. The plans put forward by the regions will be carefully scrutinised in the Department to make sure that they are consistent and sensible.
Mr. Hayes : While warmly welcoming the minimum 10 per cent. cash increase, which should make it a great deal easier to introduce weighted capitation at district level, may I ask my right hon. Friend to take into account poor beleaguered Essex, which year after year has suffered cash shortages in the national health service? Will my right hon. Friend do what he can to support our new regional chairman, who is very able and supportive? Mr. Waldegrave : I strongly endorse what my hon. Friend said about the regional chairman, who is strengthening management throughout his area. I take my hon. Friend's point. He understands why I have slowed down by, I hope, no more than a year the move to full weighted capitation at the regional level so that there is not too much disruption in the process.
3. Mr. Strang : To ask the Secretary of State for Health what steps he has taken to ensure that the best medical facilities in this country are available when needed to treat Gulf war coalition casualties ; and if he will make a statement.
10. Mr. Lofthouse : To ask the Secretary of State for Health what representations he has received with regard to the additional resourcing requirements of hospitals likely to be caring for possible casualties of the Gulf war.
Mr. Strang : Has the Secretary of State heard the Prime Minister's warning that Saddam Hussein might soon resort to the use of chemical weapons? Does he agree with the views of medical experts that in the worst- case scenario, our burns and plastic surgery units might be overwhelmed with thousands of casualties? Is he satisfied that health authorities are taking all immediate steps to increase the number of staff available in such units, as it is likely that staff, rather than equipment and buildings, will limit the number of people who can be treated quickly?
Mr. Waldegrave : Yes, Sir. I am satisfied that the health service is well prepared. The remarks to which the hon. Gentleman may be referring were originally made by Professor McGrouther, a great man in plastic surgery. I am happy to say that last week he said that he was quite satisfied that the health service is fully prepared.
Mr. Lofthouse : Will the Secretary of State give an assurance to the House that no patients will be turned away from hospitals before any Gulf casualties arrive in Britain? If it has to happen, will he ensure that national health service patients share the sacrifice equally with private patients in national health service beds?
Mr. Waldegrave : We do not believe that it will be necessary for patients to be turned away from hospitals or for wards to be emptied at present. It is worth remembering that if the worst comes to the worst and there are many casualties, there will be a considerable warning time before patients begin to arrive in national health service hospitals.
Mr. Michael Morris : Is my right hon. Friend aware that I have checked with Northampton district health authority and in particular Northampton general hospital and that I have only the utmost praise for the preparations that have been undertaken? May I say a particular thank you to the Department of Health?
Mr. Waldegrave : I am grateful to my hon. Friend. I join him in saying that the Gulf crisis shows the health service once again at its very best. The speedy co-operation that has been exercised between the different levels--region, centre, district and hospital--is exemplary.
Rev. Martin Smyth : While accepting the Secretary of State's assurance about the immediate care of casualties, may I ask about their long-term care? Will they be left to depend on local charities or will adequate provision be made for them in their communities?
Mr. Waldegrave : The hon. Gentleman makes a fair point. The Ministry of Defence and the forces have considerable expertise in the matter. My hon. Friend the Minister for Health will be answering a question later today about the role of the social services in this.
Mr. Allason : Did my right hon. Friend see the televised broadcast on behalf of the Soldiers', Sailors' and Airmen's Families Association during the weekend and does he agree that the point might be misinterpreted? Will he confirm that there is plenty of room for rehabilitation and recuperation for any Gulf casualties and that the private sector will not have to contribute places?
Mr. Robin Cook : In view of the Secretary of State's welcome assurance to my hon. Friend the Member for Pontefract and Castleford (Mr. Lofthouse) that it should not be necessary for hospitals to turn away patients now, may I invite him to comment on a letter that I have seen that was sent to a woman in her 80s advising her that many operations have been cancelled at the hospital in question because beds are already closed for Gulf casualties? Does he agree that it would be wrong if elderly patients were to become early casualties of the Gulf war? Will he urge
Column 147health authorities to meet the new emergency not by closing even more beds but by bringing back into service some of the 27,000 that have been closed under Conservative rule?
Mr. Waldegrave : If the hon. Gentleman had been interested in receiving a serious reply to a serious question, he would have been courteous enough to raise the matter with me earlier. If he will send me the letter, I will give him a proper reply.
Mr. Sims : Although the treatment of Gulf casualties may mean the postponement of non-urgent operations, may we be assured that there will be no diminution in the ability of the NHS to respond to civil emergencies such as multiple car crashes or the recent Cannon street train crash?
Mr. Waldegrave : My hon. Friend's point is entirely fair. I have been assured by the chief executive of the health service that it will be able to maintain its emergency cover for civil emergencies. It is worth remembering that compared with the scale of activities of the NHS, which treats about 8.5 million cases a year, even the worst-case scenarios about which the commentators have been telling us should be relatively well within its capacity.
Manchester/Trafford area following the opting-out decision by central Manchester hospitals.
Mr. Lloyd : Is the Minister prepared to put on record in this place what his colleague in another place told me in a letter : that when the new children's hospital is built in central Manchester--on the same site as the now to be opted-out hospital--it will itself be considered for opting out? Is he aware that in the north-west region we already have about double the national child mortality rate and that in central Manchester we have triple the rate? Is the Minister aware that the people of the region do not want opting out, which is irrelevant to their needs, but the resources to make sure that our children do not die?
Mr. Dorrell : No hospital has opted out of the NHS and we shall not entertain a proposal from any NHS hospital to opt out of the NHS. NHS hospitals are not for sale. The change that we are introducing is designed to give more power to the local management teams of hospitals to use the resources devoted to those hospitals to the best advantage of the patients.
Mr. Knox : Will my hon. Friend explain why Christie hospital in Manchester has refused to supply the drug interleukin to my constituent Mrs. Kendrick, even though it had been prescribed by Dr. Thatcher of that hospital? Does this have anything to do with the reorganisation of hospitals in Manchester?
Mr. Dorrell : It has nothing to do with the reorganisation of hospitals. There has been some discussion of the subject in the press today and I make three simple points about it : interleukin does not have a product licence in this country or in the United States ; one manufacturer of the drug has decided not to proceed with
Column 148clinical trials because of doubts over its efficacy, and the decision not to use the drug in Christie hospital was taken by the drug and therapeutics committee of that hospital before Christmas, nine of the 12 members of that committee being medical people.
Mr. Robin Cook : In view of the Minister's reference to the minute of the 12 consultants, may I remind him that it clearly specified that the consultants decided that there was general support for interleukin, but that the treatment could not be used within existing funds? Is not it clear from the very committee from which he quotes that its decision not to proceed with a drug that had been used in that hospital for four years, regardless of whether it had a licence, was due to the deficit at Christie hospital? Three years ago, even this Government met hospital deficits with extra funds, not extra cuts. Does not the Minister appreciate that the response to the case shows that the public would much rather that the Christie hospital deficit was cleared by the taxpayer than by not treating Mrs. Kendrick?
Mr. Dorrell : Is the hon. Gentleman inviting the House to put his clinical opinion ahead of that of the Committee on Safety of Medicines or the Food and Drug Administration? The use of that drug in Christie hospital was part of a clinical trial and the hospital's drug and therapeutics committee decided that there were greater priorities for the use of the resources available to the hospital. The Labour party is as explicit as the Government in proposing that the only way to run a publicly funded free national health service is on the basis of there being a limit to the resources available to fund it.
The Minister for Health (Mrs. Virginia Bottomley) : In 1989, the death rate per 10,000 population in England from acute myocardial infarction was 1.03 for men and 0.13 for women under the age of 50 and 68.81 for men and 45.88 for women over the age of 50.
Mrs. Gorman : I thank my hon. Friend for her reply. She is saying that young women hardly ever have heart attacks or strokes, whereas the number of women over 50 who suffer those conditions is rapidly catching up with the number of men. They are the largest single cause of death for women in that older age group. Is my hon. Friend aware of the research work carried out at King's College hospital showing that hormone replacement therapy is a way to protect women from such an early death? Will she state the amount of money currently spent in the health service on making hormone replacement therapy available to women in that older age group?
Mrs. Bottomley : It would be difficult to be in this place with my hon. Friend without having a passing acquaintance with the subject of hormone replacement therapy and the work undertaken at King's College hospital. She has identified the important contribution that the treatment can make. We spend £29.5 million in the health service on hormone replacement therapy and the number of prescriptions has tripled over the past 10 years. Although there is evidence of the contribution of HRT in
Column 149preventing cardiovascular disease, it is not conclusive. My hon. Friend must bear with us while further research is undertaken to assess the effects of HRT on those with osteoporosis and cardiovascular disease.
Mr. Rooker : Will the Minister comment on the stark contrast highlighted by the Public Accounts Committee's report on coronary heart disease? In this country we spend £10 million on prevention and £500 million on the treatment of the biggest killer, which kills 3, 000 people a week. That stark contrast in expenditure shows that the Government need to respond to the need for prevention.
Since the Public Accounts Committee reported, what has the Department of Health done about monitoring the training of ambulance crews so that they can deal with the matter? The Minister must know that half the people who die from heart disease die in the first two hours. When the Department of Health gave evidence to the Public Accounts Committee, the Department was not monitoring the extra training being given to ambulance crews in that vital sector.
Mrs. Bottomley : I appreciate the hon. Gentleman's recognition that prevention is better than cure. I hope that he will join us in carrying forward our strategies and priorities for health. Certainly, the prevention of heart disease--whether through the GPs' contract, the "Look after your Heart" campaign or environmental and lifestyle factors, especially smoking- -is crucial. The hon. Gentleman will know that treatment is also costly. The number of heart transplants has risen from three to 295 in 10 years and the number of coronary artery bypass grafts has risen from 3,100 to almost 13,000.
As for the training of ambulance crews, a great deal of work is being done to ensure that they are properly qualified and that defibrillators are available in ambulances.
Mr. Hind : Does my right hon. Friend agree that the essence of the internal market in the NHS is choice and that if it is to succeed, more general practitioners must be encouraged to take up budget holding and more hospitals, such as Wrightington on the edge of my constituency, must be encouraged to become national health trusts?
Mr. Waldegrave : The benefits of both systems are becoming increasingly understood. Both systems are voluntary, but tremendous benefits are available to patients from the GP fund-holding scheme--a matter which I hope that Opposition Members will consider in due course, because it would be paradoxical if that aspect, which is aimed at giving help to patients and those most directly representative of them, should run into opposition from the Labour party.
Column 150shows the problem of fixed budgets? In a written answer to me the Department of Health said that that drug could be used on a named patient. The drug and therapeutics committee said that the drug was not being prescribed not because it did not agree with it in principle but because
"this could not be achieved within existing funding."
That drug has not been allowed to Mrs. Kendrick and 50 others because the budget is overspent. Will the Secretary of State please review the position and ensure that life-saving drugs are available to all patients if they are about to die?
Mr. Waldegrave : My hon. Friend the Under-Secretary of State has dealt with the matter once. I repeat that the truth of the matter is that the drug and therapeutics committee of that hospital took an entirely sensible view that against the background of doubts about the drug-- [Interruption.] The hon. Gentleman will find that at the time the meeting took place the committee believed that the drug had a product licence whereas in fact it did not. Other, more expensive drugs are still being prescribed in the hospital.
One doctor breaking ranks with his colleagues like that and taking an individual case is exactly the wrong way to make decisions about such matters and puts patients in a difficult position. We must stand on the clinical decisions of the committees in the hospitals. They have always had difficult decisions to make about alternative treatments. I am sure that the doctors in that hospital took the right decision, which was not to spend a large sum of money on a drug of doubtful efficacy.
Mr. Nicholas Winterton : My right hon. Friend will be aware that the Select Committee on Health will be carefully monitoring the effects of the NHS reforms. If he and his colleagues wish to remain closely in touch with what is happening at the grass roots, will he accept an invitation from Cumberland house, the largest general practice in my constituency, which has opted for budget-holding status, to discuss what it sees as the advantages and some of the expected problems of budget holding?
Mr. Waldegrave : I visited my hon. Friend's constituency not very long ago, and very pleasant it was, too. I will try to fit another into my programme. I also visited two proposed budget-holding practices in East Anglia and south London, and I was very impressed by the enthusiasm shown at both. They will rapidly offer patients significant benefits.
Mrs. Virginia Bottomley : We support the principle of nurse prescribing. The advisory group report on nurse prescribing and comments received during the consultation period identified a number of issues that require further work, which we are urgently carrying forward.
Column 151acknowledge the suspicion that the Government are using delaying tactics by establishing independent cost benefit analysis of some of the problems that the consultation process reveals? When will we know the terms of reference of that analysis, and may we have an assurance that if it suggests that additional costs will be incurred because people who do not currently receive prescriptions will do so in future, that will not be a deciding factor in vetoing the scheme's introduction?
Mrs. Bottomley : I hope to disabuse the hon. Gentleman of such suspicions. The cost benefit analysis is important, and we hope to announce the details shortly. We will certainly make all the information available. However, there are other issues to be considered--such as deciding the precise formula, training, and the relationship between nurse and general practitioner prescribing. It is a complex matter, but the concept has strong support and we shall carry forward that work.
Mr. John Greenway : Is my hon. Friend aware that many practice nurses would welcome a limited prescribing arrangement? With proper training and a sensible list of drugs, it should be possible for nurses to relieve their practitioners of regular prescribing, thus releasing them for other work. When that bright initiative is in place, will the nurses be encouraged to prescribe generically, as is done in hospitals?
Mrs. Bottomley : My hon. Friend makes a strong case for nurse prescribing, as did my hon. Friend the Member for Kensington (Mr. Fishburn), when he introduced his ten-minute Bill last week. Such an arrangement would help not only practice nurses but health visitors and district nurses. Many argue that they, too, could helpfully prescribe a limited range of items. With the greater emphasis being placed on community care, those other categories could certainly play a fuller part. I give my hon. Friend the assurance that he seeks. We are carrying forward that work and we want to see nurses play their part in prescribing.
Mr. Cousins : Will the Secretary of State ensure that before all the management board members dwindle away to take up high-paid jobs in self- governing hospitals, they do something about the plight of low-paid NHS workers? I refer particularly to blood transfusion workers in the northern region, who have waited two and a half years for a pay regrading under the guidelines issues by the management board. Everyone is praising those workers, rightly, at this time--but will the Secretary of State ensure that they get properly paid as well?
Column 152there are too many low-paid people in the health service. In the negotiations on ancillary pay, we should try to shift attention towards the lowest-paid.
Mr. Porter : Although the Royal College of Nursing has expressed concern that the speed of funding does not match the desire to implement Project 2000 as soon as possible, will my hon. Friend confirm that when it is in place throughout the country, its training provisions will make nursing a most attractive profession for the future?
Mrs. Bottomley : I can certainly give my hon. Friend that assurance. The East Suffolk, Great Yarmouth and Waveney nursing school in my hon. Friend's constituency was among those that received approval in the first wave. By the end of next year, half the nurses training will be in Project 2000 courses, by which time we shall have spent £109 million. That is a rapid rate of progress and, while I understand the desire to implement the scheme even faster, we are content with the speed at which Project 2000 courses--which lay the foundation for the professional nurses of the future --are introduced.
Dr. Kim Howells : Is the Minister aware that, laudable though the aims of Project 2000 are, some area health authorities are strapped for cash and are finding it difficult to identify proper campus sites for training nurses?Mid Glamorgan is a classic example. It is being forced to consider closing down the excellent rehabilitation centre at Talygarn to house nurses.
Mrs. Bottomley : My right hon. Friend recently announced our plans to carry forward the work on the Peat Marwick McLintock report on nurse education and its management, and also the work of working paper No. 10. We understand that there needs to be proper organisation of nurse training within the regions. I cannot comment on the hon. Gentleman's area, but can say only that, within the English health authorities, good headway has been made in introducing Project 2000 and we are certainly considering nurse education in a broader context as we look to the future.
Mrs. Virginia Bottomley : On 9 January I announced the allocation of an additional £16.96 million to health authorities in England for 1991 -92 to enable authorities to increase the support that they give to hospice organisations. Last year that figure was £8 million.
Mr. Bowis : Does my hon. Friend agree that her figures confirm the Government's support for the increasing role that the voluntary hospice movement is playing, alongside the national health service? Will she continue to monitor
Column 153the costs of that movement, not least when it has to face unexpected costs such as national pay awards, and also when it loses money as a result of decisions taken by local Department of Social Security offices not to recognise voluntary contributions by patients to the running of those hospices?
Mrs. Bottomley : My hon. Friend speaks with authority about hospices, as the Trinity hospice provides a service for many of his constituents. Questions of income support are for my right hon. Friend the Secretary of State for Social Security--it is not the case that the higher rate is paid for those for whom no charge is made. I understand that his hospice received in the order of £443,000 last year from the health authority and from money made available by central Government. That was a 25 per cent. increase on the help that it received the year before.
Mr. Spearing : Can the Minister confirm that this welcome increase in grants to the hospice movement is partly based on the fact that it covers a wide spectrum of the public potential, and partly because it provides a unique service between hospice and home? Will she also confirm that, due to effects of the hospice upon the statutory service, any additional expenditure saves money elsewhere?
Mrs. Bottomley : I have no doubt that any additional money is providing good value by ensuring a quality service. All of us would want to pay tribute to the voluntary hospice movement and the work that it has undertaken in pioneering a quality service for the dying. The hon. Gentleman is right to identify not only those in hospice beds, but the excellent work achieved by hospices at home. With the rapid expansion in the voluntary hospice movement, it is important to integrate planning, consideration and provision between the voluntary hospice movement and national health service provision. We are proceeding with work to ensure that the two develop in tandem and in a spirit of co-operation.
Mr. Donald Thompson : Is my hon. Friend aware that the voluntary hospice movement is most welcome in all parts of every constituency and that this further help from the Government will be welcomed by the movement?
Mrs. Bottomley : I thank my hon. Friend for endorsing the warm tribute that all of us would want to pay to the hospice movement. The number of hospice beds has doubled in the past 10 years. As well as providing additional funding this year, we have decided to establish a research project into standards of palliative care and have also asked the Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory Committee to report back on the organisation of hospice care.
12. Mr. Duffy : To ask the Secretary of State for Health when he next expects to meet the chairman of the Trent regional health authority to discuss the hospital bed situation in the Sheffield health authority.