1. Mr. Jacques Arnold : To ask the Secretary of State for Health how many local authorities have already produced community care plans and assessment procedures for an individual's needs for community care services.
The Minister for Health (Mrs. Virginia Bottomley) : All local authorities are required to produce plans for care in the community by April next year and to establish assessment procedures for community care services by April 1993. Many authorities have already moved ahead.
Mr. Arnold : Has my hon. Friend noted that Kent county council was ready to implement its community care arrangements on 1 April this year and has introduced a series of arrangements that will give a far better service to its customers? Can my hon. Friend comment on the considerable increase in resources being put into social services by Kent?
Mrs. Bottomley : Kent has been one of the front runners in the development of care in the community and its care management is a model to many. I visited Kent last year to discuss its work. I can confirm the increase in resources. Its spending on personal social services has risen from £24.4 million in 1978-79 to £99.1 million in 1990-91--a real -terms increase of 61 per cent.
Mr. Ashley : Is the Minister aware that it is necessary to take into account the views of disabled people if community care is to be effective, yet the Government have acknowledged that they are dropping the advocacy parts of the Disabled Persons (Services, Consultation and Representation) Act 1986 and sections 1, 2 and 3? That is damaging to community care and to disabled people.
Mrs. Bottomley : The Disabled Persons (Services, Consultation and Representation) Act predates the care in the community policies. Local authorities are already hard pressed to maintain the timetable for full implementation, but giving proper attention to the user of the service and the carer is a fundamental principle of care in the community. We have made it clear that we will review the formal implementation of those sections once care in the community is properly established.
Column 146packages? We are dealing with the most vulnerable groups in our society--the mentally ill, the mentally handicapped and the elderly. Will my hon. Friend look at the developments that are taking place in Macclesfield? I refer particularly to Hollins park, which is a progressive partnership between the health authority and community health services. That is a private organisation dealing with the provision of beds in a nursing home for the elderly mentally infirm. Could not that be translated to many other areas?
Mrs. Bottomley : I thank my hon. Friend, who has always been a champion of, and a great expert in, these matters. There are many examples throughout Britain of innovative practical schemes offering support to the frail and vulnerable. I was in my hon. Friend's part of the world only recently to see a pioneering scheme combining district nurses and day care workers from the social services to offer a practical alternative to residential care. I shall certainly look more carefully at the details of the scheme that my hon. Friend outlined.
Mr. Rooker : Does the Minister accept that if the plans are to serve the needs of the individual, they will have to involve the voluntary sector? Is the hon. Lady aware of a recent survey of the voluntary sector in which almost half of the respondents said that they had no involvement or an unsatisfactory level of involvement in the planning of community care services? On what date did she issue a letter or a circular to the local authorities making it clear that if those plans are to work they must involve the voluntary sector?
Mrs. Bottomley : The voluntary sector has pioneered many excellent services that are particularly responsive to the needs of users and carers. Only two weeks ago, we announced funding of £25,000 for the National Council for Voluntary Organisations to help voluntary organisations prepare for the contracting procedures. We have regular meetings with the National Council for Voluntary Organisations and many others and we shall certainly be asking whether it has any further concerns at our next meeting, next month. We have made it clear throughout that we in the Conservative party believe in a mixed economy of care using the voluntary and private sectors. We are not committed to the monolithic provision of services by local authorities.
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : The standards of service which national health service providers, including trusts, are expected to meet are defined in their contracts with purchasing health authorities.
Mr. Cryer : Will the Minister confirm that the sad story of the Bradford trust so far includes a freeze on the recruitment of nurses, which has meant that newly qualified nurses have been sacked and that wards 5 and 6 of Bierley Hall hospital have been closed or will be closed despite a refurbishment of £100,000? That scandalous waste of resources also includes the closure of the baby unit at St. Lukes. Does the Minister recall that during the
Column 147Gulf war, the Secretary of State said that as much money as necessary would be made available for the casualties of that war? Why does he not provide money for the casualties of the NHS trusts and ensure that patient care is improved, rather than squandering it on anti-democratic, anti-NHS trusts such as that in Bradford?
Mr. Dorrell : The hon. Gentleman asks for more money and I am pleased to confirm that the Bradford trust has been granted the largest external financing limit of any trust in the NHS. The capital allocation to the Bradford trust will provide for the completion of phase 1(a) at a cost of £23 million in 1993, the completion of phase 1(b) at a cost of £30 million in 1997 and the completion of that entire project, costing a further £11 million, before the end of the decade. In addition, a £44 million redevelopment programme for the Bradford royal infirmary has been planned. All that is equivalent to nearly £110 million capital investment in Bradford's hospitals in this decade. I should have hoped that the hon. Gentleman would welcome that.
Mr. Dickens : Is not it a fact that, since 1 April, 57 hospitals and other units, including those in Bradford, have become NHS trusts? Quality of service and patient care is on the agenda. How can that show that we are in the wrong direction? I am grateful that Oldham and Rochdale have elected for NHS trust status.
Mr. Dorrell : My hon. Friend is right. The trusts present the opportunity for the management and the staff of units to use the resources available to them to the best possible advantage of the patient. The Labour party uses the rhetoric of the opportunity society, but it uses every occasion to deny those seeking such opportunities the means to take advantage of them.
Mr. Madden : Why have all the Government's promises about the benefits of the NHS trust in Bradford gone so sour? The reality is that, this year, there have been cuts of £5 million and swingeing cuts have been planned for the next two years with a deterioration in the quality of patient care. Why are the Government not injecting the necessary funding now to avoid those cuts taking place? Why are they not defending the NHS in Bradford?
Mr. Dorrell : The hon. Gentleman seems unable to welcome the investment of £108 million in the capital provision for health in his constituency in this decade, but perhaps he will find it easier to welcome the fact that waiting lists in his constituency have been cut by 8 per cent. in the latest year for which figures are available and that the total number of people who have been waiting for more than a year has been cut by 37 per cent.
Mrs. Virginia Bottomley : I understand that the main health authorities served by Northwick Park hospital have all placed contracts specifying that those waiting longest should receive priority for treatment.
Mr. Dykes : Although this is obviously a matter for the hospital management and the regional health authority, will my hon. Friend's Department look into this matter and keep an eye on things, because the sombre reality is that, other than those needing acute emergency operations or planned treatment, no one was admitted in the first quarter of the year to Northwick Park hospital? That situation is extremely unsatisfactory. Will my hon. Friend discuss with the hospital and the RHA the possibility of a timed admission system such as that which has already been introduced by the South Western regional health authority?
Mrs. Bottomley : I hope that my hon. Friend will find that the clear priority of tackling long waiting lists throughout the NHS translates into action on behalf of his constituents. Under the new contracting arrangements, it is possible to specify waiting times as one of the quality conditions. I understand that that is precisely what is happening in the hospital to which my hon. Friend referred. North West Thames health authority has made it clear that no patient should have to wait longer than two years for treatment. That will apply to patients who do not have clear clinical priority. My hon. Friend mentioned South Western regional health authority moving to timed admissions instead of waiting lists. We hope that many other local health authorities will follow that example.
4. Mr. Eastham : To ask the Secretary of State for Health how many fund-holding general practitioners have not yet completed their contract negotiations in order to implement the provisions of the National Health Service and Community Care Act 1990.
The Secretary of State for Health (Mr. William Waldegrave) : Fund- holding general practitioners are free to make contracts for the hospital services covered by the fund in the way that they judge best for their patients. The indications are that most fund holders have placed contracts in advance for the greater part of the hospital services necessary for their patients and will arrange other contracts on an individual basis as their patients need them.
Mr. Eastham : But are not some general practitioners in a state of chaos, with hundreds of contracts still not completed? That can be put down to the hospitals that are not in a position to carry out adequate pricing and do not have the necessary additional staff or computer facilities, with consequent further delays for people waiting to go into hospital.
Mr. Waldegrave : The answer is no, Sir. In the hon. Gentleman's region, about 90 per cent. of the contracts have been placed in advance. It is sensible to have 10 per cent. to follow patients who cannot be predicted in advance.
Mr. Michael Morris : Is my right hon. Friend aware that in evidence recently given to the Public Accounts Committee, Mr. Nichol, the chief executive of the national health service management executive, stated that budget holding, research and the success of the project should not be carried out from the centre but that it should be left to each region to undertake its own analysis? Is not that an absurd way to proceed? Whatever the merits or demerits,
Column 149we need an assessment that is objective and will be accepted by all parties. If it is left to each region, it will be useless.
Mr. Waldegrave : No, I think that the regional arms of the NHS are the right people to deal with that. My hon. Friends regularly, and rightly, press me to stop Whitehall's tendency to centralisation. It is those hon. Members with whom I have most sympathy.
Mrs. Mahon : Where contracts have been completed, will the Minister comment on the case of the woman who was referred to Guy's hospital for sterilisation, but then found that her authority would not pay for it although her GP had referred her? Will that be a regular occurrence? Will the Minister say where patient choice comes in, if the GP decides where operations are carried out?
Mr. Waldegrave : That case did not involve GP fund holders, but I am happy to comment on it. The hon. Lady has not followed the story through. It transpired that the district involved had for many years not provided sterilisation of that kind. The present system has brought and will rightly bring that into the open, which enables my hon. Friend the Minister of State to remind the district that in such matters there is a central guideline that that service should be available throughout the kingdom.
Mr. Andrew Mitchell : Are not GP fund-holding practices a successful and valuable attempt to spread choice and opportunity not only to patients, but to the doctors who administer the services? Does my right hon. Friend see any evidence of a desire to spread choice and opportunity for either patients or doctors in the rehashed Labour policy unveiled by the Labour party this morning?
Mr. Waldegrave : I strongly agree with my hon. Friend. An increasing number, although I think that they are a minority, of the GPs who supported the Opposition now take my hon. Friend's view. For example, Dr. David Thome , who used to appear in party political broadcasts on behalf of the Labour party, has now become a GP fund holder and strongly supports the scheme. In the rather weasel words of today's policy document--I am happy to say that the Opposition have watered it down a little more--we are told :
"We would expect a progressive withdrawal".
"Expect" is a good word. If expectations are confounded--as they will be--I hope that the Opposition will endorse the scheme as strongly as my hon. Friend does.
Ms. Harman : The Secretary of State said that 10 per cent. should be set aside to make it possible for patients to get treatment outside contracts placed by districts or GPs. Is he aware that no district health authority has set aside 10 per cent., that most have set aside only 2 per cent. to provide for extracontractual referrals and that some have provided only 1 per cent. or even less? How does the right hon. Gentleman propose to guarantee choice for patients through a system under which so much of the money is tied up in contracts and so little set aside for extracontractual referrals?
Mr. Waldegrave : I am afraid that the hon. Lady could not have been listening to our discussions. We were talking about GP fund-holders, in respect of whom the much smaller sum involved probably makes it reasonable- -in
Column 150the view of most GPs--for the proportion to be larger than is necessary at district level. That is the answer to the hon. Lady's question.
Mr. Waldegrave : Some of the most exciting developments in the national health service are occurring in primary health care. On top of the achievements already being secured through the new contracts for GPs and dentists, there are new opportunities for building on the excellent examples of team-working between GPs, nurses and other health care professionals and to achieve closer working with the hospital services. The aim is to improve the range of high-quality, cost-effective services provided to patients in the primary care setting.
Mr. Davies : Have not the Government's new contracts for GPs in the national health service brought about an unprecedented and dramatic increase in the number of child immunisations and in the amount of cervical screening, mammography and other preventive procedures being delivered in the NHS? Is not it a fact that some of the Opposition Members present in the House opposed the new contract all along and have still not had the grace to admit how wrong they were?
Mr. Waldegrave : My hon. Friend is perfectly right. The contract has produced, and is producing, major benefits for patients and it seems to me uncharacteristically ungracious of the hon. Member for Livingston (Mr. Cook) not to acknowledge that, on this point at least, he was wrong.
Mr. Hardy : Does the Secretary of State accept that, in that part of the national health service and in all others, the assessment of financial performance is increasingly viewed as more important than the successful treatment of patients? Does he also accept that, unless that changes, we shall see the inexorable rise of the accountant, who will be regarded as far more important to the NHS than those in the medically related professions?
Mr. Waldegrave : I strongly refute that. It is irresponsible to say that it is not part of the duty of those of us charged with spending public funds to ensure that they are spent for the best benefit of patients or others for whose benefit the funds were designated by Parliament. In its extraordinary rehashed document, published today, the Labour party has gone a step further. It does not care for a health care market but wants a medical market, so it is coming along nicely.
Column 151Mr. Ground : Does my right hon. Friend agree that threats to the career prospects of national health service managers who recommend trust status for their hospitals represent an unacceptable threat to the independence of those managers and should be condemned whenever they are made? Does my right hon. Friend have an example of such threats in the form of a letter written to the manager of the Walsgrave hospital in Coventry by two Labour Members?
Mr. Waldegrave : I am sorry to say that such a letter was written. I am happy to say that, when I drew it to the attention of the Leader of the Opposition, he immediately repudiated the views of the two Coventry Members concerned. The hon. Member for Livingston (Mr. Cook) has, however, made similar threats himself. He owes the House an endorsement of the repudiation of the views of the hon. Members concerned and the withdrawal of his own threats, made last year, about the renewal of contracts after an election.
Mr. Nellist : If the Secretary of State wishes to make light of the matter, let me tell him that this is just one example of how deep anger already runs in Coventry among thousands of people who are not prepared to allow the hospital to be taken, over their heads, on the first step towards privatisation and got rid of. It is a publicly funded hospital, to provide whose equipment not a single family in Coventry has not bought a raffle ticket in the past 10 years. If the concept of dismissal worries the Secretary of State so much, may I make him on offer? I will withdraw that word, and instead suggest to my hon. Friends on the Front Bench that, after the general election, we require everyone who runs a hospital in Britain to stand for election, so that the staff, the patients and the people of Coventry can sack him instead.
Mr. Waldegrave : The idea of elected brain surgeons is engaging. I do not take the matter at all lightly ; nor does the Leader of the Opposition, who, on the same day that I wrote to him, replied : "I regard all such threats to be as meaningless as they are objectionable."
Let me draw the attention of the hon. Member for Livingston to his own threat, when he warned managers that they should remember that their contracts would not be up for renewal until after the next general election.
Mr. Hayes : Never mind what the hon. Member for Coventry, South-East (Mr. Nellist) says, although his threats are bad enough. It is a different matter when the Opposition health spokesman threatens not to renew the contracts of managers who assist the Government's proposals.
Does my right hon. Friend agree with an editorial in the Health Service Journal, which is not exactly a hotbed of high Toryism? Let me paraphrase it--
"This is outrageous interference in NHS management".
Column 152Mr. Speaker : Order. That sounds like a quotation to me.
Mr. Waldegrave : The bellowing from below the Gangway represents the only support that the hon. Member for Coventry, South-East (Mr. Nellist) is receiving from his own side ; he has been repudiated by his leaders. It is evidence of the weakness of Opposition Members' position. This is a serious matter. To threaten any public servants in such a way is no part of our traditions and should be repudiated by the House.
Mr. Waldegrave : Yes. There is no reason why such a hospital should not make an application for trust status. It would be considered alongside all the other applications, according to the published criteria, but hospitals have a perfect right to seek such status.
Mr. John Greenway : Would not it be helpful if patients in any district hospital could be asked a question about the future of that hospital, free from the political interference by the Labour party and its attempts to dissuade them by perpetrating myths about my right hon. Friend's reforms? No hospital is being asked to opt out of the NHS. What is on the agenda is the prospect of more local control and accountability in the health service for the better delivery of patient care.
Mr. Waldegrave : My hon. Friend is entirely right. A general practitioner was quoted in The Guardian --not usually a supporter of my party--as saying that the current anger of people in the streets was directed at those who had scared them with stories about what the reforms meant, all of which have now turned out to be false.
Mr. Cook : There was nothing nasty about the repudiation and I fully associate myself with it. I am also delighted to take this opportunity to reassure all national health service managers that there will be no problem over renewing the contracts of those managers who serve the next Labour Government as loyally as they have served this Government.
However, the Secretary of State's claims about the accountability of these trusts would be more credible had he not stuffed their boards with people who know little about the national health service and who represent no one in the local community. How does he justify the fact that he has appointed a majority of business men to those trusts and that the largest business interest is property development? Although managers will be safe from action by us after the next election, does the Secretary of State accept that we shall replace those people who were appointed as members of trust boards and health authorities with people who live in the area, who use the health service and who are committed to restoring it as a public service?
Column 153Mr. Waldegrave : I think I hear the hon. Gentleman repudiating his own words, which it is right that he should do. He threatened managers' contracts. The hon. Gentleman shakes his head, but he knows that he said that. It was reported at the time--[ Hon. Members :-- "What is wrong with that?"]--His hon. Friends ask what is wrong with that. That is the voice of the true Labour party. The hon. Gentleman also criticises the appointment of people with business experience to hospital management boards. This great public service can well use the experience of managers of other large organisations in order to deploy most effectively the skills of NHS professionals.
Mrs. Virginia Bottomley : No, Sir. We do not expect regional health authorities to submit formal proposals-- [Interruption.] --for amalgamation of health authorities unless extensive local consultations-- [Interruption.]
Mrs. Bottomley : No, Sir. We do not expect regional health authorities to submit formal proposals for amalgamation of health authorities unless extensive local consultations have shown that the proposals command broad local support.
Mr. Speller : When my hon. Friend considers the needs of the south- west, particularly those in the county of Devon, will she bear in mind the fact that it has four area health authorities, that by and large people in the county of Devon think of themselves as Devonians and that it may be logical to consider replacing the four authorities with one?
Mrs. Bottomley : I am grateful to my hon. Friend for that suggestion. Another advantage would be to have coterminosity with social services departments. That, with the implementation of community care, might make a great deal of sense. Ministers, however, will be influenced by the extent to which such proposals command local support and by the extent to which they are seen as improving health care and services to local residents.
Mrs. Virginia Bottomley : "Look after your Heart" is a major national programme launched in 1987 to reduce death and illness in England from coronary heart disease. All right hon. and hon. Members with English constituencies have received copies of the programme's strategy for 1990 to 1995.
Mr. Coombs : Is my hon. Friend aware of the fact that in England we cut the level of circulatory disease by 24 per cent. between 1980 and 1988, compared with the World Health Organisation's target of 15 per cent. for the year 2000? Has my hon. Friend seen the new World Health
Column 154Organisation paper on heart disease relating to diet and nutrition and does she believe that its recommendations will be included in the strategy for the next five years?
Mrs. Bottomley : My hon. Friend is right to cite the great reduction in coronary heart disease during the 1980s. Ministers are pleased, but are by no means satisfied. My hon. Friend knows that renewal of the "Look after your Heart" campaign envisages a further 25 per cent. reduction in heart disease by the end of the century.
Mr. Loyden : Is the Minister aware that the objections made by the community health council reflect the opinion of patients, staff and the wider public in Liverpool and throughout the region about the proposals to close St. Paul's eye hospital? As a patient there for nine years suffering from glaucoma, I suggest that I know more about the hospital than does the Minister or those placed in areas such as Liverpool to carry out Tory policy in the health service. Will the Minister reflect on the Government's attitude that patient care is of prime importance and take into account as soon as possible the views of patients and community health councils on the proposed closure of St. Paul's hospital?
Mr. Dorrell : We certainly agree with the hon. Gentleman that patient care is the principal concern. The hon. Gentleman will know that the proposal is currently with my right hon. Friend the Secretary of State, who has not yet taken a decision. Of course, my right hon. Friend will take account of the views of Liverpool Central and Southern CHC. He will also take account of the views of Liverpool Eastern CHC, which has not objected to the proposal. He will also take it into account that the effect of the proposal would be to move the majority of ophthalmic provision in the city of Liverpool out of a small and very old hospital into a modern hospital that was opened in 1978. That factor must be taken into account in assessing the issue which the hon. Gentleman rightly places at the top of the agenda--the quality of patient care.
Mr. Alton : Does the Minister accept that it is precisely because St. Paul's is a small hospital which has served the needs of the people of Liverpool for many generations that the people are so hostile to the idea of its being absorbed into a large hospital, the Royal in my constituency? Will he reconsider the reply that he gave on 12 March when he declined to see a delegation from the CHC led by the rector of Liverpool parish? Will he now see that delegation and consider especially the provision of ophthalmic beds for children in the heart of the community?
Mr. Dorrell : Liverpool Eastern CHC took up the question of the provision of ophthalmic beds for children and was satisified by the assurances that it received from the district health authority. I have already given an
Column 155undertaking that we shall, of course, look at all sides of the argument before reaching a decision, but, in assessing the merits of the argument that it is a small hospital, much loved by the local community, we must also remember the clinical benefits that come from a broader base of clinical expertise within the same hospital. Those are balancing arguments and their merits still have to be assessed.
Mr. John Marshall : Is my hon. Friend aware that in the draft Budget produced by the right hon. and learned Member for Monklands, East (Mr. Smith) there is no provision to increase expenditure on the health service? Does not that suggest that the Opposition's concern over the closure of the hosptial is synthetic indignation which the Labour party is unable to fund?
Mr. Dorrell : My hon. Friend is absolutely right that, as we consider the provision in Liverpool, Bradford and every other locality in the country, we must test the claims of the Opposition that they would be able to do better against their inability to extract from the dour Scotsman from Glasgow the promise to spend any more money on the health service.
Mr. Waldegrave : We do not routinely collect this information centrally, since ward and bed numbers are not a good indicator of levels of service in the national health service. However, the hon. Member will be glad to know that since 1979 there has been a 25 per cent. increase in the number of patients treated by the national health service.
Mr. Wray : Will the Minister explain why there are 50,000 people on the waiting list in Wales and 800,000 in other parts of England? Will he also explain under what legislation, since the Tory National Health Service and Community Care Act 1990, Medway health authority is trying to enter into a package deal with a centre hopitalie re in France? Does the Minister agree with that package deal?
Mr. Waldegrave : I am not sure that waiting lists are the strongest line for the hon. Gentleman to pursue, as the numbers on those lists increased by 48 per cent. under Labour, whereas they have declined under the Conservatives. The Medway deal that the hon. Gentleman mentioned has been discussed in the House. If it is within the law--we shall have to check whether it is within the vires of the local health authority--and it is in the best interests of patients, I shall have no reason to interfere with it.
Mr. Rowe : How many wards have been closed as a result of the introduction of non-invasive surgical techniques, day-care operations and the decanting of large numbers of patients into much more satisfactory care in the community? Does my right hon. Friend agree that it is in the spirit of the European Community that if Medway health authority can secure a better deal for its patients by using European facilities, it is all to its credit that it should do so?
Column 156has been an enormous increase in day surgery, as knowledge of its proper use has increased. In most other advanced countries, such as France and Germany, there has been a similar increase in the number of patients treated, alongside a drop in the total number of beds.
Mr. Battle : Is the Minister aware that in Bradford and Leeds some wards and beds are still being held for Gulf crisis casualties? What extra steps will his Department take to ensure that clearance of the backlog of operations resulting from the Gulf crisis is speeded up?
Mr. Waldegrave : I am astonished at what the hon. Gentleman says. It certainly should not be so and I shall have the position investigated urgently. The hon. Gentleman knows as well as I do that in practice the Gulf crisis had almost no impact--indeed, no impact at all--on the national health service. That being the case, there should be no excuses of the kind that the hon. Gentleman has mentioned. As I said, I shall have the matter looked into.