House of Commons Hansard Debates for 16 Jul 1991

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House of Commons

Tuesday 16 July 1991

The House met at half-past Two o'clock

PRAYERS

[Mr. Speaker-- in the Chair ]

PRIVATE BUSINESS

Brighton Marine Palace and Pier Bill

[Lords] Queen's consent, on behalf of the Crown, signified.

Read the Third time, and passed, without amendment.

London Underground (Safety Measures) Bill

[Lords] Order for Third Reading read.

To be read the Third time tomorrow.

Llanelli Borough Council (Burry Port Harbour) Bill

[Lords] Motion made,

That the Promoters of the Llanelli Borough Council (Burry Port Harbour) Bill [Lords] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office of their intention to suspend further proceedings not later than the day before the close of the present Session and that all Fees due on the Bill up to that date be paid ;

That, if the Bill is brought from the Lords in the next Session, the Agents for the Bill shall deposit in the Private Bill Office a declaration signed by them stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the present Session ;

That, as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been so deposited, has been laid upon the Table of the House, the Bill shall be deemed to have been read the first and shall be ordered to be read a second time ; That the Petitions against the Bill presented in the present Session which stand referred to the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session ; That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

That, in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words under Standing Order 126 (Reference to committee of petitions against Bill)' were omitted ;

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

Greater Manchester (Light Rapid Transit System) (No. 4) Bill

[Lords]

Ordered,

That the Promoters of the Greater Manchester (Light Rapid Transit System) (No. 4) Bill [Lords] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office no later than the day before the close of the

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present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ; Ordered,

That, if that Bill is brought from the Lords in the next Session, the Agents for the Bill shall deposit in the Private Bill Office a declaration signed by them stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the present Session ;

Ordered,

That the Petitions relating to the Bill presented in the present Session which stand referred to the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session ; Ordered,

That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

Ordered,

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.--[ The Chairman of Ways and Means.]

Message to the Lords to acquaint them therewith.

Commercial and Private Bank Bill [ Lords ]

Ordered,

That the Promoters of the Commercial and Private Bank Bill [ Lords ] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office of their intention to suspend further proceedings not later than the day before the close of the present Session and that all Fees due on the Bill up to that date be paid ; Ordered,

Ordered,

That, as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been deposited, has been laid upon the Table of the House, the Bill shall be deemed to have been read the first and shall be ordered to be read a second time ; Ordered,

That, no Petitions against the Bill having been presented within the time limited within the present Session, no Petitioners shall be heard before any committee on the Bill save those who complain of any amendment as proposed in the filled up Bill or of any matter which arises during the progress of the Bill before the Committee ; Ordered,

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Order of the House.-- [The Chairman of Ways and Means.]

Message to the Lords to acquaint them therewith.

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British Railways Bill

Ordered,

That the Promoters of the British Railways Bill shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ;

Ordered,

That on the fifth day on which the House sits in the next Session the Bill shall be presented to the House ;

Ordered,

That there shall be deposited with the Bill a declaration signed by the Agents for the Bill, stating that the Bill is the same, in every respect, as the Bill at the last stage of its proceedings in this House in the present Session ;

Ordered,

That the Bill shall be laid upon the Table of the House by one of the Clerks in the Private Bill Office on the next meeting of the House after the day on which the Bill has been presented and, when so laid, shall be read the first and second time (and shall be recorded in the Journal of this House as having been so read) and, having been amended by the Committee in the present Session, shall be ordered to lie upon the Table ;- - [The Chairman of Ways and Means.]

To be communicated to the Lords, and their concurrence desired thereto.

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Oral Answers to Questions

HEALTH

NHS Reforms

1. Mr. Bradley : To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms.

2. Mr. Sims : To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms ; and if he will make a statement.

12. Mr. Atkinson : To ask the Secretary of State for Health when he next plans to meet leaders of the British Medical Association to discuss changes in the national health service.

The Secretary of State for Health (Mr. William Waldegrave) : I last met representatives of the British Medical Association on 9 July. We had useful talks on several topics related to the reform programme.

Mr. Bradley : I am sure that the Secretary of State is aware that the BMA is concerned about the policy of opt-out for hospitals and I know that he is also aware of the consultations taking place between Withington and Wythenshawe hospitals about the rationalisation of services, especially the closure of the maternity unit. Now that Wythenshawe hospital has expressed an interest in opting out, the management of Withington hospital may now wish to retain all its services, including the maternity unit. Will the Secretary of State give the assurance today that the maternity unit at Withington can remain open until decisions have been taken about whether Wythenshawe can opt out?

Mr. Waldegrave : As the hon. Gentleman knows, there is no question of opting out. There has been a first expression of interest in establishing a national health service trust for one of those hospitals. As the hon. Gentleman knows--I believe that he recently met the Under- Secretary of State, my hon. Friend the Member for Loughborough (Mr. Dorrell) to discuss the matter--we are considering that reorganisation, as we are statutorily required to do, on its merits and quite separate from the issue of approving any NHS trusts in due course.

Mr. Sims : Is not one of the most important aspects of the reforms the emphasis that is placed on health promotion, by encouraging people to eat and drink sensibly, warning them of the dangers of tobacco products and providing doctors with incentives to provide health checks, immunisation and screening? Is it not a fact that the British Medical Association and all doctors fully support those changes?

Mr. Waldegrave : My hon. Friend is right. The British Medical Journal contained a generous leader by Mr. John Ashton, head of the department of public health at the university of Liverpool welcoming the steps that the Government have taken in publishing "The Health of the Nation". There has been widespread welcome for the publication of the report of the Committee on Medical Aspects of Food and for the tougher action that we are

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taking on cigarette labelling. Together with the general practitioners' contract and its emphasis on preventive medicine, those steps allow the Government to claim that we are the first Government to take forward those matters with such vigour.

Mr. Atkinson : Does my right hon. Friend agree that an increasing number of GP members of the BMA are seeking to pass on the undoubted benefits of his reforms to their patients by becoming fund-holders and will he now end the patient list limitation so that an increasing number of doctors can become fund-holders if that is their wish?

Mr. Waldegrave : My hon. Friend is right. GP fund-holders are bringing forward many innovative new ideas for the better treatment of their patients, which are already being picked up by the district health authorities for the general benefit. Many GPs are pressing me to lower the list size qualification. We are running some experiments and pilot schemes on that, which I hope will be successful.

Rev. Martin Smyth : I welcome the innovative movements, but has the BMA suggested that it needs more GP trainers and trainees? In drawing up the junior doctors' contract, has any consideration been given to increasing the number of medical students?

Mr. Waldegrave : Yesterday evening I met the regional deans, including the dean from Northern Ireland, to discuss these matters. Although in general they welcome the new structure, which protects their budget, we discussed real issues about the total number of doctors needed. That is why yesterday I announced the establishment of a new committee chaired by Professor Colin Campbell to examine and measure objectively the total need for doctors in the years ahead.

Mr. Rowe : Does my right hon. Friend agree that some of the anxiety expressed by Opposition Members about national health service reforms is caused by their astonishment that the Government have listened so carefully and effectively to what GPs and many others have been saying for many years? For example, in Kent, where the number of practice nurses has trebled in the past three years, general practitioners are finding increasingly that the NHS reforms provide them with a tremendous opportunity to improve and innovate.

Mr. Waldegrave : There is absolutely no question but that the improvements which have been made in general practice and community medicine in the past 10 years have in many cases transformed the services available to patients. Patients know that and welcome it warmly, as they have done in my hon. Friend's constituency.

Mr. Robin Cook : If the Secretary of State is so anxious to listen to the views of GPs, which of the BMA's conference resolutions will he be most anxious to discuss when he next meets that body? Will it be the one that records the BMA's view that the reforms of the health service mean that the NHS is not safe in his hands? Or will it be the one that expressed concern at the rapid deterioration of the NHS? Or would the Secretary of State rather meet the 600 consultants who paid for a page in The Observer warning that as a result of the changes there are now serious restrictions on patients' choice? If the Secretary of State prefers the views of patients, will he meet the community health councils, whose conference a week

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ago resolved that contracting could not remedy underfunding? Is not the reality that the Government are not interested in anyone's opinion but their own and will not listen to anyone but themselves?

Mr. Waldegrave : I shall address that part of the BMA motion that said that it sought

"constructive dialogue with the Government rather than confrontation."

Of course, that is what we shall seek.

I am surprised to see the hon. Member for Livingston (Mr. Cook) engage in such debate. He recently visited Walton. It was a rather unsuccessful visit during which he involved himself in the affairs of the Fazakerley hospital with the result that one of the consultants said :

"These electioneering politicians make me sick. They won't talk about the expansion at Fazakerley The Fazakerley option was what the clinicians wanted. It is clearly the best way to deliver health care on one site."

That was followed up by the hospital doctor who said :

"It is ironic that Labour, which criticises the Government for not listening to the views of doctors on its health reforms, is now itself choosing to ignore medical opinion."

A little quiet from the hon. Gentleman would be in order.

Mr. Nicholas Winterton : I warmly congratulate my right hon. Friend on the new constructive dialogue which has been established between his Department and the BMA. Will the new committee that has been set up merely discuss the health service and the reforms, or could it be extremely constructive and seek to monitor and evaluate the effects of the reforms in the national health service? If the latter is the case, I should be grateful if my right hon. Friend could confirm it to the House this afternoon.

Mr. Waldegrave : I think that my hon. Friend is referring to the joint work that we intend to do on GP fundholding, in particular with the general medical services committee. I assure my hon. Friend that that will be a continuing assessment and that we shall listen to recommendations which come out of that work.

Cervical Smears

3. Mrs. Margaret Ewing : To ask the Secretary of State for Health how many health authorities have now met the targets set for the time scale of results of cervical smears to be relayed to general practitioners and patients.

The Minster for Health (Mrs. Virginia Bottomley) : Health authority laboratories must aim to return the results of cervical smear tests within one month to the doctor who took them. Latest figures show that 173 district health authorities--that is 93 per cent.--were meeting the target.

Mrs. Ewing : The Minister will appreciate that that is an improvement on the previous statistics. Does she recall that on 21 February she said that one third of the laboratories were not meeting that target and that there was a waiting list of about 7.5 weeks for the processing of tests? What is the waiting time in areas where the target is not being met?

Mrs. Bottomley : Thirteen districts are not meeting the target, the longest wait, at the latest date, being 13 weeks. The vast majority have waits of much less than that. The particular case is being closely investigated, but there has been a substantial improvement. Last July, about two thirds of districts were meeting the target. Now, 93 per

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cent. of them are. Perhaps even more important, nine out of 10 GPs are obtaining their target payments for making sure that they take cervical smears in the first place. This is real health promotion and disease prevention.

Mr. Marlow : Health Ministers are rightly introducing initiatives to deal with the health care of women, but half the population, by and large, is made up of men. What health care initiatives does my hon. Friend intend to put forward to look after us?

Mrs. Bottomley : I have every sympathy with my hon. Friend and I shall enter into urgent discussions with him to see what further steps we can take to improve the health care of men. Women not only make up the majority of the population ; they make up the overwhelming majority of those who work in the NHS, and for the most part, they are the decision makers and communicators in their families about health. I agree, however, that we must give further concern to the health care of men, whose life expectancy is not, I regret, as great as that of women.

NHS Capital Expenditure

4. Mr. Roger King : To ask the Secretary of State for Health what was the level of capital expenditure in the national health service in 1978 -79 ; and what is the figure for 1991-92.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : NHS capital expenditure is planned to be £1.9 billion in 1991-92 compared with £0.4 billion in 1978-79, an increase in real terms of 68 per cent.

Mr. King : I thank my hon. Friend for those excellent figures. He will have laid emphasis on the fact that in 1979 the last Labour Government --to balance their financial books, at the behest of the International Monetary Fund--cut and cut again capital expenditure in the NHS. Those cuts impeded the development of the service in the Birmingham area, which under the present Government is launching the "Building a Healthy Birmingham" campaign, along with hundreds of millions of pounds of investment. Does my hon. Friend agree that only under a Conservative Government is that possible?

Mr. Dorrell : The track record squares absolutely with my hon. Friend's version. Between 1974 and 1979 the Labour party cut the NHS capital programme by 16 per cent. in real terms, compared with the increase of 68 per cent. that I have just announced. My hon. Friend will be pleased to hear that in Birmingham we currently have in progress a programme costing £15.9 million at the Queen Elizabeth hospital, £23.4 million at the East Birmingham hospital, £5.6 million at the Good Hope hospital, and £2.5 million at the Dudley Road hospital. That represents a total of schemes in progress of £47.4 million, without taking account of the £310 million which we are committed to spend on the "Building a Healthy Birmingham" programme.

Mr. Ashley : Before the Minister and other members of the Government try to score too many party political points in relation to figures such as those, may I ask him to find time to read the letter in The Independent today, which is an account by a patient in a leading London

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hospital casualty department which is filthy, hot and overcrowded? Is the Minister aware that that is the reality facing many patients in Britain today?

Mr. Dorrell : The question that that patient or anyone else wishing to compare the records of the parties on capital expenditure must ask is which of the rival management teams available offers the best prospect of solving the problem--a team which, when it last had the opportunity, cut capital expenditure by 16 per cent., or a team which, since 1979, has seen capital expenditure increase by 68 per cent.

NHS Trusts

5. Mr. Jessel : To ask the Secretary of State for Health how many hospitals applied for and were granted trust status in the first wave ; and how many have expressed interest in possible inclusion in the second and third waves.

Mr. Waldegrave : A total of 66 hospitals and other units applied for trust status in the first wave, of which 57 were established as trusts on 1 April this year ; 130 expressions of interest were received for inclusion in the second wave, and 107 applications have been submitted. We also expect five or six first-wave candidates which were not established to resubmit their applications. We have not yet asked for formal expressions of interest in the third wave.

Mr. Jessel : Can my right hon. Friend confirm that, of the four district general hospitals that serve Twickenham, Kingston already has trust status, Ashford has applied for it in the second wave, and West Middlesex and Queen Mary's Roehampton, hospitals intend to apply for it in the third stage? Does he agree that that great enthusiasm for trust status is despite the efforts of Labour politicians to intimidate those national health service staff who might wish to be involved?

Mr. Waldegrave : The fact that so many hospitals are applying for trust status shows that the staff involved have not been intimidated. We had to make the hon. Member for Livingston (Mr. Cook) back down from his threats before the House on one occasion. I am delighted to say that, as my hon. Friend already knows, Kingston hospital NHS trust has already reduced the number of long waiters from 2,000 to 400 and the new building will be open this year, and the other applications are coming forward. In the case of Ashford, trust status was strongly supported by more than 80 per cent. of the consultants.

Mr. Battle : Does the Secretary of State agree that it would be better to sort out what is happening with the first wave before considering another wave? Where trust status has been granted, as in the case of Leeds general infirmary, the impact has been the loss of 10 beds in Cookridge cancer hospital and eight night staff being told on 14 June, without any prior notification, that their jobs were to go. Is not that what is happening?

Mr. Waldegrave : No. The trust hospitals are matching good management to problems which have often existed for many years, and we are seeing quicker and better solutions to those problems for the benefit of patients. I should have thought that the hon. Gentleman would welcome that.

Mr. Wiggin : Weston-super-Mare general hospital was fortunate enough to achieve trust status in the first round,

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the trust is working extremely well and I can reasonably claim that the people of that excellent town are receiving better health care than ever before, but will my right hon. Friend discourage the regional health authority from seeking to remove some of the peripheral hospitals such as Burnham-on-Sea and Axbridge simply in the interests of tidy bureaucracy?

Mr. Waldegrave : As my hon. Friend would expect, being a relatively near neighbour I am well aware of the issue and I shall look at it closely. I am also aware that the trust is doing extremely well and bringing new benefits to patients every week.

Mr. Robin Cook : The Secretary of State will be aware that one of the hospitals included in the figures that he has announced for the second wave is King's College hospital in Camberwell. Since the changes in April, that hospital has been on red alert and closed to routine cases. Before the Secretary of State considers that hospital for a trust, will he reconsider the three invitations to visit the hospital that he has refused? Would it not be better for the Secretary of State to visit that hospital in financial crisis rather than spend time tomorrow only half a mile away from it at the Dulwich picture gallery, where he is opening an exhibition of portraits of old Etonians?

Mr. Waldegrave : That is a very heavyweight contribution. The hon. Gentleman is going to a meeting at King's College hospital tomorrow, and the leaflets advertising his presence contain untruths. I hope that he will take the opportunity to dissociate himself from those leaflets, which say :

"King's College hospital to opt out of the national health service."

The hon. Gentleman knows that that is a lie. He has backed down on the point before and I hope that he will do so again now. The hon. Gentleman recently made another unsuccessful visit, to Oldham hospital, to campaign against the consultants who wished the hospital to be a trust. He said then that a Labour Government would pour money into the NHS-- [Interruption.] Oh yes, he did--I have the quote with me. A local newspaper reported the hon. Gentleman as saying :

"A Labour Government would pour money into the NHS."

On a recent visit to the British Medical Association, the hon. Gentleman said that additional expenditure of £6 billion was not out of the ball park, but when he was asked on "Panorama" where the money would come from, he said :

"These are questions that you will have to address to John Smith, who is my colleague"--

there may be some doubt about that--

"who handles the Exchequer questions."

May we have answers from the Member who is responsible for those matters?

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