1. Mr. Churchill : To ask the Secretary of State for Health what was the average capital expenditure within Trafford area health authority at constant prices (a) in the period 1974-79 and (b) 1979-1991.
The Minister for Health (Mrs. Virginia Bottomley) : Using 1990-91 prices, average capital spending between 1974-75 and 1978-79 was £2, 526,000 a year. Between 1979-80 and 1990-91 spending was £3,083,000--a real increase of 22 per cent.
Mr. Churchill : I thank my hon. Friend for that reply. Is not it clear from those figures and from many others that it takes a Conservative Government to deliver the goods to NHS patients and that all the Opposition have to offer are promises which more often than not prove false? Will my hon. Friend congratulate Trafford area health authority and everyone involved in the hospitals there on the excellent job that they are doing and especially on the way in which they have brought down waiting lists?
Mrs. Bottomley : I certainly endorse my hon. Friend's remarks. All that the Labour party offers is promises and rhetoric ; we have delivered an improved health service. My hon. Friend will know in his part of the world of the £2 million new maternity unit, the £2 million mental illness unit and the £4 million geriatric and physio unit--all practical achievements. As my hon. Friend rightly pointed out, no patient in his area waits for more than two years and there has been a dramatic fall in the number of those who have to wait a year. That, too, is a practical achievement in the health service. It is high time that the Opposition gave recognition to all in the service who have achieved these excellent results.
Mr. Skinner : When I hear Tory Members speaking about the health service, in Trafford or anywhere else, I am bound to come to the conclusion that they are after family jobs. Why does not the Minister condemn the appointments of spouses of Tory Members and of Members of the House of Lords who pick up more than £5,000 a year for doing a day's work? It is time this scandal was put to an end.
Column 312Labour Member of Parliament and in the Cabinet. His wife was the chairman of a health authority and she performed that job excellently for many years. I urge the hon. Gentleman to go to Friern hospital. The reason why I feel so strongly about the care of the mentally ill is because of all that my aunt, Peggy Jay, taught me. No one ever cast smears at her on account of her excellent achievements. Those whom we have appointed were chosen on their merits and because of their strong and unequivocal commitment to our national health service.
Sir Fergus Montgomery : Is my hon. Friend aware that she has just scored a marvellous bull's eye? Does she agree that the Trafford figures show a dramatic fall in waiting lists and that that is a tribute to the efficient way in which the health authority has managed its operating theatres? Does not it also prove, as my hon. Friend the Member for Davyhulme (Mr. Churchill) said, that the Conservative Government are spending more on the health service and does not it nail the falsehoods repeatedly advanced by the Opposition? We have to go back a little way to remember that in 1976 they presided over the most savage cuts ever imposed on the national health service.
Mrs. Bottomley : The only time spending on the national health service has been cut was when the Labour party was in power. My hon. Friend is right that management as well as money is what counts. The achievements of his health authority are remarkable. It has one of the lowest rates of cancelled operations in the country. It is organising the service, delivering high-quality care and using manpower and finance to the best possible effect.
2. Mr. Matthew Taylor : To ask the Secretary of State for Health if he will reconsider making a Government contribution to the costs of the Cornwall air ambulance in view of its contribution to meeting the target for emergency ambulance call-out times.
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : No, Sir. It is for the local management of the service todetermine the most effective deployment of resources to meet performance targets.
Mr. Taylor : The Minister will know that those targets can be met only by the air ambulance in my area. Without that ambulance the target set out in the patients charter would not be achievable. Will the patients charter be guaranteed by public funds or is it to depend in future on private charity?
Mr. Dorrell : The patients charter sets out standards which ambulance services are expected to match. It is for the chief ambulance officer of each area ambulance service to decide how best to match those standards. The hon. Gentleman should note that although the Cornish air ambulance makes a valaable contribution in the county, it has not produced a measured improvement in response times for ambulances in Cornwall.
Sir Gerrard Neale : May I ask my hon. Friend nevertheless to keep in touch with the health authority in Cornwall? The county is 100 miles long and my constituency is the most sparsely populated area of Cornwall. Many of my constituents live 50 miles from the
Column 313nearest district general hospital. I urge my hon. Friend to keep in close touch to make sure that response times are up to the charter.
Mr. Dorrell : We shall certainly keep in close touch with the Cornish ambulance service and, of course, with every other ambulance service to ensure that they match response times and put to good use our investment in the ambulance service. That investment has provided defibrillators for more than 2,300 front-line ambulances across the country and carries through the commitment to provide a trained paramedic on each front-line ambulance by 1996. Those improvements in the ambulance service will apply in Cornwall as they apply in the rest of the country.
The Secretary of State for Health (Mr. William Waldegrave) : For the future, my hon. Friend will have to await the autumn statement by my right hon. Friend the Chancellor of the Exchequer which I understand will be made tomorrow.
Since 1979 we have increased capital spending on average by 4.3 per cent. per year. Labour when in office cut it by an average of 6.7 per cent. per year.
Mr. Thurnham : Is my right hon. Friend aware that that means that since 1979 there has been a two thirds increase in capital spending compared with a cut of one third when Labour was in power? Is he aware that the North Western regional health authority has a record capital spending programme for next year of more than £100 million and that it includes Bolton's new hospital?
Mr. Waldegrave : Those dramatic figures are correct. Labour's record on capital spending was lamentable. It was about a one third cut in real terms in capital spending in Labour's last period in office. The North Western regional health authority has a magnificent capital programme for new projects beginning next year and at the head of that programme is Bolton general hospital. That will cost about £37 million in bricks and mortar and another £10 million for equipment. There are also major new projects at Chorley and South Ribble, Lancaster, Central Manchester, Salford, Tameside and Glossop. As I say, the total is about £100 million for next year.
Ms. Hoey : As the Secretary of State is aware, Westminster hospital is due to close and the accident and emergency department is to move to St. Thomas's hospital. Will the right hon. Gentleman give a commitment that capital will be made available in time for the accident and emergency unit to be completed and ready to receive patients when Westminster hospital closes?
Mr. Waldegrave : As the hon. Lady knows, the commitment to the new Westminster hospital on the old St. Stephen's site is one of the biggest of all the projects in the national health service. The change will need careful management to ensure that the major gains for patients that will come from it are properly realised. I shall look into the specific matter that the hon. Lady raised.
Mr. Beaumont-Dark : Does my right hon. Friend agree that those figures sit ill with the, I am sure honourable, argument of the Opposition that we are trying to close the health service? How can we be spending two thirds more on capital equipment? My right hon. Friend must be wrong when he says that we are spending 4.3 per cent. more in real terms on the health service than when we came to office. The Opposition tell half-truths because Labour is the only party which when in office cut national health expenditure.
Mr. Waldegrave : The previous Labour Government started off with their normal irresponsible pledges which produced enormous inflation and catastrophic cuts to all public service capital programmes. Nowhere did those cuts hit harder than in the health service. Many of those who are now on the Opposition Front Bench were deeply ashamed of that at the time and remain deeply ashamed of it. They are right to be so ashamed.
Mr. Waldegrave : There is increasing independent evidence that the first trusts are proving that bringing management back into the hospitals is already bringing benefits to patients and staff. Waiting times are coming down in most places and staff report improved management and job satisfaction.
Mr. Kennedy : When the Secretary of State made his recent announcement in the House of the second wave of trust applications and approved in principle applications for the four London teaching hospitals he said that, in the interim, until the review was completed, they would benefit from the advantages that could flow from greater local hospital management devolution. If that is a benefit short of trust status, why is it necessary to force through trust status while encouraging local hospital management and in so doing to bring the assets, the buildings and the personnel out of local health service management? Why is that superior simply to having better efficiency through greater local management?
Mr. Waldegrave : It is not difficult to explain. Some of the benefits of devolved management can be achieved without full trust status, but, for local management, one of the major gains of full trust status is full control of capital. That is one reason why hospitals seek it. I hope that the hon. Gentleman is clear on that matter.
Mr. Anthony Coombs : Does my right hon. Friend agree that it is significant that the two major hospitals in Kidderminster district health authority have increased the number of in-patients treated over the past eight years by 14 per cent? The health authority, one of the 30 most efficient in the country, is consulting on third-wave trust status because it believes that it can give a better service to patients and local people on that basis. Does not that contrast with the recent comment by the general secretary of the Institute of Health Service Managers on the Labour party's plans for the health service? She said that they were an unworkable mess.
Mr. Waldegrave : I agree with my hon. Friend. Labour's role in all this is somewhat disreputable. I draw the attention of my hon. Friend to the recent threats issued by the Labour party candidate in Orkney and Shetland, who said that, by doing this,
"it could certainly be argued by an incoming Labour Administration that you had contributed to your own redundancy."
As my hon. Friend pointed out, Labour played a disreputable role in relation to trusts. When I drew the attention of the Leader of the Opposition to a previous threat of this kind, made by the hon. Member for Coventry, South-East (Mr. Nellist), the right hon. Gentleman withdrew it at once. I hope that the Opposition chief spokesman on health matters will withdraw this similar threat today.
Mr. Corbyn : Will the Secretary of State think for a moment about the effects of NHS trusts on the low-paid hospital staff, who are just as essential as medical staff in the running of the hospital? I am thinking of domestics, porters and maintenance staff, who are grossly underpaid and who are suffering badly as a result of administration of hospital trusts and the attempts to break away from the national negotiating machinery.
Mr. Waldegrave : I would strongly argue that the national negotiating machinery has, over the years, delivered low pay to such people. The increased flexibility of NHS trusts will allow them to pay more where the local markets can afford it and I predict that this will increase the pay of the lower-paid staff in such hospitals. That is why, to the embarrassment of the Labour party, some of the local branches of those unions are beginning to support trusts.
Mr. Oppenheim : When it comes to Opposition claims about NHS trusts, should not we bear in mind that, two years ago, the hon. Member for Livingston (Mr. Cook) was telling everyone that general practitioner contracts would result in less time being spent with patients? That turned out to be untrue, so why should we now believe these spurious scares about NHS trusts leading to privatisation? Is not the truth of the matter that the hon. Gentleman is interested only in using his spurious scares to frighten the sick and the vulnerable for his own party ends?
Mr. Waldegrave : The scares that the Labour party tried to run on these matters have rebounded on it. I remind the hon. Member for Livingston (Mr. Cook)--he seems not to wish to rise on these matters--that the letter from the Labour party candidate to the trust applicant reads :
"Were you to do this"--
continue with the trust--
"in the face of so much opposition, it could certainly be argued by an incoming Labour Administration that you had contributed to your own redundancy."
When I drew the attention of the Leader of the Opposition to previous threats of that sort, he wrote as follows :
"Of course I can confirm that there will be absolutely no action of this kind."
The hon. Member for Livingston must respond to these scares. Indeed, they are worse than scares, they are threats.
Ms. Harman : Will the Secretary of State confirm--[ Hon. Members- - : "Answer!"] If Conservative Members paid attention to the issue they would know that my hon. Friend the Member for Livingston (Mr. Cook) repudiated the threat last week.
Column 316Will the right hon. Gentleman confirm that the majority of first-wave trusts face serious financial problems? How much will he spend to bail out the first-wave trusts so that they do not end the first financial year in deficit?
The hon. Member for Peckham (Ms. Harman) is completely wrong on the facts. If she wishes to attach herself to the scare, I am delighted. As I have said, she will find that she is completely wrong.
Mr. Pawsey : I am grateful to my hon. Friend for that helpful and cheering response. Clearly it is good news for the people of Rugby and especially for patients attending St. Cross hospital. It represents a fine effort by the management and workers of the hospital. Does my hon. Friend agree that the way forward is signposted to other improvements in the health service? Will he therefore redouble his efforts to promote NHS trusts while ignoring the ill-founded criticism of Opposition Members, who are prepared to argue more for party dogma than for patient care?
Mr. Dorrell : My hon. Friend is absolutely right. He chose a good day to raise the matter, because only yesterday the hospital opened a new out-patients department. The hospital's track record on waiting lists bears comparison with any in the country, with the number of those waiting for more than two years for in-patient treatment having decreased since June 1990 from 137 to 18. Since the trust has been established we have seen the appointment of new paediatricians, the introduction of new laser technology, a commitment to new surgeons in the general surgery and accident and emergency departments and the continued development of improved accident and emergency facilities in the hospital.
Mr. Waldegrave : The patients charter demonstrates our commitment to providing high-quality services within the NHS which are responsive to people's views and needs. It has been widely welcomed, for example, by the Consumers Association, which said that "it is a golden opportunity to put patients first."
Mr. Gregory : Will my right hon. Friend confirm that this is the first time that any Government have introduced a genuine patients charter of rights? Secondly, does he agree that the quickest way to ensure longer waiting lists,
Column 317unreasonable behaviour and hospitals again being run by unions rather than by consultants is for power to be given to the Labour party?
Mr. Waldegrave : That is correct. The structure of open agreements between district health authorities and hospitals gives us, for the first time, a clear way of setting standards, monitoring them and enforcing them. That is a great gain from the reforms. The first step to patient responsiveness is encapsulated in the patients charter.
Mr. Ashton : Did not the patients charter cost £2 million to publicise and launch and was it not £2 million worth of Conservative propaganda? Have not we heard planted questions this afternoon that have contained carefully worked-out statistic after statistic? It has been a public relations exercise for this week's by-elections. We are in the run- up to a general election and every figure that the Secretary of State has produced today has been carefully worked out and planted among Conservative Back-Bench Members as a publicity stunt, just like the patients charter.
Mr. Waldegrave : The hon. Gentleman fails to understand the importance of the patients charter, as he fails to understand the reforms. It is vital that we get across the fact that under the reforms in the NHS we can now set proper standards of care throughout the country. It is vital that, in the agreements reached next year, we set out what is to be done nationally and locally. That is inherent in the reforms. It is right that every household should know its rights under the NHS.
The whole operation on the patients charter--the printing and so on--has cost about £2 million. That expenditure is well worth while if it gets across to people the facts about what their rights really are.
Mr. Cormack : As the right hon. Member for Islwyn (Mr. Kinnock) and his Front-Bench team are so singularly ill-informed, why does not my right hon. Friend invite them to the Department for a teach-in, when they could be given the true facts and figures? Let them then spread all these lies.
Mr. Waldegrave : We have been trying to brief some Labour Members, especially the London Members. Some of them have been invited again and again to meet the London ambulance service for a briefing other than that which they get from the trade union. They refused to come.
Mr. Alton : Following the disclosure during the past 24 hours of the outbreak of legionnaire's disease at two Liverpool hospitals, does the right hon. Gentleman accept that an essential part of a patients charter should be the right to know when such outbreaks have occurred? Can he explain why that information was concealed for some weeks in one case? Does he accept that another element of the patients charter in this day and age should be that hospitals are constructed in a way that shows that we have learnt the lessons of the past? Equipment should not be installed if it is likely to give rise to legionnaire's disease.
Mr. Waldegrave : I agree that one benefit of the patients charter and, indeed, of the reforms will be the greater availability of information. I am sure that the hon. Gentleman will want to be very careful not to scare people unecessarily. In the first incident, it still has not been shown that the infection derived from inside the hospital. All the necessary investigative and follow-up actions were taken and as soon as the problem was known local general
Column 318practitioners were informed. I have considered the matter and I shall continue to do so, but I do not believe that there has been any dereliction of duty in this important matter. I am sure that the hon. Gentleman, who is a responsible Member of Parliament, would not want to mislead people in this matter.
Dame Jill Knight : Is my right hon. Friend aware that the West Midlands regional health authority has just issued a special paper welcoming the patients charter and agreeing to do everything possible to turn rights into realities? Will he add one more right to the patients charter--that of peace and quiet for sick people in hospital? Is he aware that there is a growing practice of allowing unlimited numbers of people, for unlimited hours, to visit patients in wards? That is not conducive to recovery and nor is the practice of children running up and down wards for hours on end. I hope that my right hon. Friend will add that right to his patients charter.
Mr. Waldegrave : I welcome the steps taken by the West Midlands regional health authority. The issues to which my hon. Friend referred are just those where the health service needs to do a little better on listening to patients' needs. We often receive letters about relatively minor matters that can easily be put right after discussion with patients. I am sure that the hospital that my hon. Friend has in mind will wish to take account of her comments.
Mr. Robin Cook : Can the Secretary of State explain why the words "patient choice" do not appear in his patients charter? Is it because he knows that his new contract system has reduced patient choice? What does his patients charter offer to the thousands of patients who, through the College of Health helpline, have chosen a hospital with a shorter waiting list, but cannot get into that hospital because their health authorities will not pay for them to be treated there? What does the patients charter offer to the woman in Wandsworth who last month found that she could not have her second child in the hospital that she chose for her first child because her health authority has no contract with that hospital? Why should the House take seriously any patients charter that does not give back to those patients the right to choose their hospital--a right that they had until the Government took it away?
Mr. Waldegrave : The hon. Gentleman is wrong. Under the old system-- the system to which the modern Labour party characteristically wishes to return--there was the freedom of the right to refer to any hospital and that right remains. However, that sort of reference was nugatory because the money did not follow the patient. We are moving towards a system where a choice will be made and that choice will become reality because the money will follow the patient and so enable that patient to be treated. That is what the hon. Gentleman still has not grasped.
On the matter of choice, the patients charter draws attention to new freedoms and the ease with which people can change their general practitioners, which is a fundamental improvement in freedom. I am sorry that the hon. Gentleman still does not understand that the whole drive behind the reforms is to back the general practitioner's decision with money so that choice becomes reality.
Mrs. Virginia Bottomley : I regret that it is not possible separately to identify the money devoted to the range of conditions associated with the menopause from the £225 million spent on medical research last year. However, my hon. Friend will be aware of the current work which includes a review of screening techniques for post-menopausal osteoporosis and an economic evaluation of the benefits of hormone replacement therapy.
Mrs. Gorman : I thank my hon. Friend for her reply. I understand that the Government are spending somewhat less than £500,000 in that area. Is my hon. Friend aware of the proceedings of the international menopause conference which point out that the number of deaths of women in the post-50 age group from heart attack and particularly stroke is twice as great as the number dying from osteoporosis and 10 times as great as the number of deaths from breast cancer? Does not that mean that we should be putting a great deal more money into such research or is it to remain the Cinderella of medicine for ever?
Mrs. Bottomley : My hon. Friend identifies why it is difficult separately to identify the sums of money. As she says, associated conditions are heart attacks, strokes and cancer. About £1.5 billion is spent on health research each year. Our new research strategy ensures that we get the best possible value from that and, above all, apply the lessons. However, I can give my hon. Friend the undertaking that as long as she remains in the House such research will not be the Cinderella of the health service. There are a great number of excellent projects. Should my hon. Friend happen to be in the Cleveland area, I strongly urge her to go to the South Cleveland hospital to see the excellent work being undertaken there with a bone densitometer.
Mr. Cousins : Is not the Minister aware that it has been known for some time that four times as many women as men suffer the chronic pain that comes from the loss of movement in and the fracture of hip joints?
Mr. Cousins : You, Mr. Speaker, betray the ignorance of men if you do not understand the relevance of my question. The research has been done for some time and the results have been known for some time, yet still the Government do nothing.
Mrs. Bottomley : I am pleased that there has been a threefold increase in, for example, HRT prescriptions during the past 10 years. We fund to the tune of £1.9 million about 40 voluntary organisations which help spread the message about the importance of HRT and the prevention of osteoporosis. Our recent leaflet on women's health, which has been a remarkable success, also provides information. However, the hon. Gentleman is right. When the research has been evaluated and the screening survey has been completed we will be able to make even further progress in ensuring that the health service is dedicated to prevention as well as cure.
Mr. Barnes : Has the income generation unit given advice to trust hospitals and health authorities on the building of private wings? Was such advice given to the Chesterfield and North Derbyshire Royal hospital? What is the difference between building private wings and privatisation?
Mr. Dorrell : During its existence the income generation union gave a wide range of advice to NHS units. For the expenditure of little more than £250,000 per year we have been able to generate extra funds to support and improve patient care within the NHS rising from £9 million in 1988-89 to £50 million last year. Part of those resources were raised from the sale of NHS facilities for the treatment of private patients. I cannot understand why some Opposition Members--we do not know whether this is the official Opposition Front-Bench policy--appear to believe that profits from private medicine must be preserved for private companies and not made available to the NHS to improve care for NHS patients.
Mr. John Greenway : Is my hon. Friend aware that with the help and advice of the income generation unit, a business man in my constituency has successfully installed private telephones in hospitals in the north-east, paid for by advertising? The only loser from that practice is British Telecom. Some of the profits made from BT telephones in hospitals, which Labour Members appear to think are excessive, can be recouped by the hospital and used to benefit patients.
Mr. Dorrell : My hon. Friend is absolutely right. Not only does that initiative produce a wider range of services to benefit patients and extra resources for the health service but an improved range of hospital facilities, so that services previously available only to private patients in private hospitals are increasingly available to all patients in NHS hospitals.
Mr. Rooker : Was the income generation unit responsible for the policy adopted by New Cross hospital in Wolverhampton and the Mayday hospital in Croydon, whereby bedridden patients must hire a television for a minimum of three days at a cost of £1.95 a day--which is about twice the rate charged by high street television rental companies? Is it not scandalous that ministerial offices and the House have televisions provided by the taxpayer, yet bedridden patients who want to watch television to help them to relax must pay?
Mr. Dorrell : Hospital managers are responsible for providing such services, not any unit of the Department of Health. If the result of the income generation approach is that more resources are released to treat more patients and provide additional resources for their medical care, it does not seem that anyone should have to apologise for that policy.
Mrs. Virginia Bottomley : The Children Act 1989 incorporates most private and public law relating to children. It sets out clearly principles for their care and upbringing, and is in effect a charter for children.
Mrs. Bottomley : The Act was implemented with an unprecedented level of co-operation and collaboration between central and local government and I pay a warm tribute to all those who helped with the delivery of guidance and the legislation's careful framing. The Lord Chancellor's Department and social services departments were involved in the training of 140,000 social service staff last year, when the social service standard spending assessment increased more than at any time over the past 15 years.
Mr. Tom Clarke : Is the Minister aware that the Act cannot be fully effective unless the provision of child psychiatric services is improved? Does she acknowledge the concern that exists about that aspect and can she explain what action the Government intend to take?
Mrs. Bottomley : There will be an announcement in the relatively near future about the results of the review that we are conducting into arrangements for child psychiatric services. I announced such a review at a conference that I addressed the other day. The traditional pattern of child guidance services is not always adhered to and we must ensure proper integration in hospitals and the community. There has been a substantial increase in the number of child psychiatrists, a great increase in clinical psychologists and an increase in child psychiatric nurses. We must ensure that all staff with considerable expertise work to best effect in collaborating not only with the health services but with social and education services.
10. Mr. Arbuthnot : To ask the Secretary of State for Health what new hospital facilities are available to the residents of Wanstead and Woodford ; and if he will make a statement about the funding of further phases of building at Whipps Cross hospital.
Mr. Dorrell : Phase 1 of the redevelopment of Whipps Cross hospital cost £18 million. It includes a new out-patient department, four operating theatres, a hydrotherapy pool, a new pharmacy, improved sterilisation facilities and three new wards.
The Forest Healthcare trust is committed to start phase 2 of the redevelopment of the hospital in the next financial year. This will include a dedicated day surgery unit, further expansion of out-patient facilities and two more new wards. In addition, the capital loans fund is financing the development of new facilities for physiotherapy, occupational therapy and other day services for people with a learning disability.