House of Commons Hansard Debates for 3 Dec 1991

Mr. Dorrell : Yes, competitive tendering is based on the simple proposition that health service managers are trained to manage health care institutions, not laundries or cleaning forces. It is surely better to use skilled laundry and cleaning managers to manage those services and to rely on

Column 136

the skills of health care managers to manage the essential core activity of the health service--the provision of health care.

NHS Trusts

8. Sir Patrick Duffy : To ask the Secretary of State for Health what representations he has received in connection with applications for national health service trust status from within the Sheffield health authority.

Mrs. Virginia Bottomley : Trent regional health authority received a wide variety of responses to the consultation exercise for the Sheffield applications which the Secretary of State took fully into account when making his decisions to grant NHS trust status.

Sir Patrick Duffy : Is the Minister aware that now that clear decisions have been taken on trust status, anxiety in Sheffield relates to the likely impact of the Chancellor's autumn statement on the health authority's financial position next year and in the long term, and particularly the need for greater per capita funding given the number of elderly people and the levels of health inequality and social deprivation in Sheffield, particularly in Attercliffe?

Mrs. Bottomley : I am pleased to hear from the hon. Gentleman that there is no more concern about trust status. There has been most impressive progress in Sheffield. I commend the annual report from the health authority chief executive, which shows that Sheffield is a centre of excellence for health. The hon. Gentleman need not look only to the health authority chief executive ; he can ask the patients. A recent survey by Sheffield university showed that 95 per cent. of patients surveyed were either satisfied or very satisfied with the service that they were receiving at the Northern General hospital trust--an impressive result.

The hon. Gentleman particularly asked about weighted capitation. He will know that the health service has an excellent settlement this year, with an additional £2.2 billion for the regions--an increase of 8.9 per cent., or 4.2 per cent. in real terms. Weighted capitation is expected to be a more equitable system of distribution, taking account of the young and the elderly. The precise allocation of resources within the region is a matter for the hon. Gentleman's regional health authority chairman, but I know that he will have confidence in the excellent work taking place in Sheffield, particularly in the light of its new health strategy.

Mr. Roger King : Will my hon. Friend suggest that hospitals in the Sheffield health authority area considering trust status should visit the Walsall trust hospital in the west midlands, where they will discover that in the first three months of this year 1,100 more patients were treated than in the year before--a 13 per cent. increase? Is not that evidence that hospital trusts work?

Mrs. Bottomley : If the citizens of Sheffield needed to go to Walsall, I am sure that they would do so, but they need look only to their own trust to see the remarkable progress already made. It has six more consultants, a new computerised axial tomography scanner, new plastic surgery beds and an additional surgical ward. I am delighted that in Walsall, as in the other trusts around the country, more patients are being treated more effectively and morale is good. The trusts are a great success.

Column 137

Local Authority Social Services

9. Mr. Lofthouse : To ask the Secretary of State for Health if he will make a statement on the provision of local authority social services under the Chronically Sick and Disabled Persons Act 1970.

Mrs. Virginia Bottomley : Local authorities provide a range of social services under section 2 of the Act, including assistance in the home, meals, equipment and adaptations, telephones, holidays and recreational facilities.

Mr. Lofthouse : Why are the Government preventing local authorities from providing adequate services for the chronically sick and disabled? Is the Minister aware that if the Wakefield district council social services department had to stick to its standard spending assessment it would have to save a further £3 million this year on services for the chronically sick and disabled? Is she further aware that, like myself, each weekend many hon. Members meet many chronically sick and disabled constituents who are not receiving adequate services to enable them to lead a reasonable and respectable life? What do the Government intend to do about that?

Mrs. Bottomley : I am pleased to be able to report to the hon. Gentleman that we have just had the first results of the monitoring arrangements for the implementation of community care and we are impressed with the practical schemes already being advanced to ensure that the frail and vulnerable, and particularly the chronically sick and disabled, receive the support that they need. The hon. Gentleman will want to know that during the past two years personal social services standard spending will have increased by nearly 33 per cent.--19 per cent. in real terms--which is more than adequate to allow for demography and renewed pressures on local authorities.

Mr. Thurnham : Does my hon. Friend agree that voluntary groups and private providers can efficiently deliver services for the disabled? Will she instruct local authorities not to use all the extra funds for their own union-dominated monopoly services, so beloved by the Opposition?

Mrs. Bottomley : There is little doubt that the work undertaken by the voluntary sector, and often by the independent sector, is of an extremely high quality. It is vital that local authority social services departments do not use the additional resources for a job creation scheme for their own staff. They are required to identify the best way of helping the frail and vulnerable and in many cases that will be by using the voluntary or the independent sector.

Mr. Wigley : Does the Minister accept that those vitally important services that she described depend not only on her own Department, but on the Department of Social Services, on the Department of the Environment in respect of local government, on the Scottish Office and on the Welsh Office? Given the importance of those services from 1993, in the context of care in the community, will the Minister undertake an in-depth review to ensure adequate budgets for those services to ensure that there is no shortfall thereafter?

Mrs. Bottomley : I greatly respect the hon. Gentleman's comments. If the individual is to receive a seamless service,

Column 138

effective co-operation at local level is essential to ensure that the frail and vulnerable receive help from suitable services and health authorities, with the assistance of housing authorities. We in central Government are taking strenuous steps to make sure that we work effectively ; similarly, it is vital that local and health authorities, together with general practitioners, make sure that they are ready for April 1993.

Dame Elaine Kellett-Bowman : Does my hon. Friend the Minister agree that while Britain has the highest proportion of health costs funded by the public purse, the British public have shown their confidence in it by the fact that only 13 per cent. of them choose private treatment, compared with 25 per cent. in France, and 28 per cent. in Germany? [Interruption.] Will Opposition Members kindly keep quiet?

Mrs. Bottomley : Once again, my hon. Friend identifies a vital point about public confidence in our national health service, which stems from the Government's investment in and support for it. My hon. Friend need ask only one question. If she or any of her friends become unwell anywhere else in the world, what would they do? They would make their way back home as fast as they could to receive the benefits of national health service treatment.

Mr. Alfred Morris : How many disabled people, after being assessed for services under the Chronically Sick and Disabled Persons Act 1979, are now on waiting lists for the help that they need? At the latest date for which the Minister has figures, how many local authorities had reduced or removed services in cases where there was no diminution of need? How does the Minister react to the case, of which I have informed her right hon. Friend the Secretary of State, in which home help provision was withdrawn from an elderly couple, both of whom are severely and progressively disabled?

Mrs. Bottomley : The right hon. Gentleman will be aware that there has been a steady and substantial increase in resources for all kinds of community care--be it day places for the mentally ill or for those with learning disabilities, or increased resources for home help. The right hon. Gentleman identified the way in which some home help services have been moving towards home care services. We are looking at that, but to suggest that there has been other than a clear and steady increase in available services would be a travesty of the truth.

NHS Expenditure

10. Mr. Day : To ask the Secretary of State for Health by how much spending on the national health service (a) in England and (b) in the United Kingdom will increase in 1992-93.

Mr. Waldegrave : Total NHS spending is forecast to increase by £2.2 billion in England and by £2.8 billion in the United Kingdom next year. That means that, throughout the United Kingdom, the national health service will be spending roughly £100 million per day.

Mr. Day : Is my right hon. Friend aware that the shadow Chancellor said recently that to repair what he unjustifiably called the Government's neglect of the national health service would require an extra £2 billion in this year's autumn statement? Given that an extra £2.8

Column 139

billion was found, has my right hon. Friend the Secretary of State received an apology from the right hon. and learned Member for Monklands, East (Mr. Smith), or have any of Labour's Front-Bench spokesmen for health offered to withdraw that allegation?

Mr. Waldegrave : I wrote a number of letters to Labour's spokesman on such matters, asking him to clarify Labour's spending pledges. Some months later, he is still working on the reply, but doubtless I shall receive it sooner or later. Labour's spending pledges are in an equal muddle to its policy position, which was described, in two separate New Statesman and Society articles last week and this week as being meaningless.

Mr. Eastham : Is the not Secretary of State continuously presenting a distorted view when he tries to convince the House that the Government are spending more on the national health service? Is it not a fact that with 560,000 people reaching the age of 65 this year and the elderly accounting for a larger proportion of the population, national health service provision is proportionately poorer, not better?

Mr. Waldegrave : The hon. Gentleman is wrong. His difficulty is that his party has nothing to tell him about what it would spend if it were returned to power, which it will not be. That lack of leadership makes it difficult for him to do other than cavil at our figures. I sympathise with him.

Competitive Tendering

11. Mr. John Marshall : To ask the Secretary of State for Health what is the latest estimate of the savings from competitive tendering in the national health service.

Mr. Dorrell : Total annual savings from competitive tendering of NHS ancillary services in the United Kingdom now amount to £156 million.

Mr. Marshall : Does my hon. Friend agree that the abolition of competitive tendering and the introduction of a national minimum wage would rob the NHS of hundreds of millions of pounds and would lead to the closure of hospitals and the cancellation of operations? Would not such a course of action be as successful as the racing tips of the hon. Member for Livingston (Mr. Cook)?

Mr. Dorrell : My hon. Friend is absolutely right. The Labour party is not committed to any specific increase in health service expenditure, but it is committed to a specific cut in the proportion of NHS expenditure used for patient care. My hon. Friend correctly identifies that, and the hon. Member for Livingston (Mr. Cook) will have a difficult task explaining it to patients who would not be treated if his policies were implemented.

PRIME MINISTER

Engagements

Q1. Mr. Carrington : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister (Mr. John Major) : This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Column 140

Mr. Carrington : Is my right hon. Friend aware that in my constituency Labour-controlled Hammersmith and Fulham council keeps many of its council houses and flats empty? Does he agree that the most effective action that could be taken to end homelessness would be if Labour- controlled London councils brought back into use the many thousands of empty homes under their control?

The Prime Minister : My hon. Friend makes a valid point and I share his concern about homelessness. For that reason, we are spending more than £100 million over the next three years to provide accommodation for young single people. The Government's initiatives on rough sleeping are having a marked effect on the problem in London.

Mr. Hattersley : Is the Prime Minister aware that doctors working in the health service have said today that his promise to cut waiting lists to two years can be achieved only if desperately ill patients sacrifice their beds to less serious cases who have waited longer ? Is he prepared to sanction such manipulation of waiting lists ?

The Prime Minister : I have not seen that comment by doctors, but I assure the right hon. Gentleman that that is not the situation. Long waiting lists are falling fast. Since March 1990, the number of patients waiting more than two years has come down by 47 per cent.--a substantial reduction--and the number waiting longer than one year has reduced by a quarter.

Mr. Hattersley : During the day, doctors from Nottingham University hospital and Chase Farm hospital Enfield have said that they can meet the target only if seriously ill patients are sacrificed. Is the Prime Minister prepared to abandon the target or the seriously ill patients ?

The Prime Minister : There is no question of abandoning the seriously ill patients. For that reason, we have expanded expenditure on the health service, increased the number of medical staff and introduced initiatives to cut waiting lists. All those are practical methods, all of them are working, and all of them are delivering better health care and will deliver faster health care.

Mr. Hattersley : The Prime Minister's wilful refusal to answer a specific question demonstrates the underlying truth of the Government's health service policy : they are interested in public relations, not patient care. No wonder the people of this country know that the health service is not safe in their hands.

The Prime Minister : The right hon. Gentleman is talking nonsense on stilts, and he knows it.

Mr. McAllion : Is the Prime Minister aware of the survey published yesterday by the housing charity, Shelter, which revealed that on every working day in Scotland last year 84 children became homeless because the Government had failed to invest enough in decent, affordable rented housing ? Is he not ashamed that so many children have been thrown on to the streets of Scotland while he has been Prime Minister ? Will he now do something about it by calling a general election and making way for a Labour Government committed to ridding this country of the Tory scourge of homelessness ?

The Prime Minister : The hon. Gentleman would do well to recall that the policies of so many Labour

Column 141

authorities leaving properties empty and voids untreated which significantly adds to the level of homelessness ; until those Labour authorities operate properly with their housing resources, they will not make inroads into the housing problem.

Several Hon. Members rose--

Mr. Speaker : Order. I inadvertently called two hon. Members from the same side.

Q2. Mr. Franks : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Franks : Will the Prime Minister state clearly and concisely that, irrespective of the place or the audience or the day of the week, he has but one policy for the fourth Trident submarine--to build it, equip it and send it to sea armed for the nation's defence? Will he find time to read recent Official Reports of debates and questions in the House where he will find "We will build a boat", "We won't build a boat" and "We will build a boat but it will have no weapons", all of which is official Labour party policy?

The Prime Minister : I am happy to confirm the Government's commitment to Trident, as so frequently set out in this House. As my hon. Friend makes clear, there is no comparable commitment from the Opposition, whose polices on defence vary from day to day.

Q4. Mr. Cran : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Cran : Is my right hon. Friend aware that a senior Japanese industrialist has made it clear that if the European Community adopts the social action programme it will be committing industrial suicide? That being so, will my right hon. Friend give the House a commitment that he will not give way on that in the discussions next week? Does he also agree that the European Community should be an evolutionary community, not a revolutionary one?

The Prime Minister : My hon. Friend is right to say that we live in an increasingly competitive environment and that much in the social action programme would damage that competitiveness within the European Community-- to the interests of the Japanese, the United States and our other competitors. I confirm to my hon. Friend that I am not prepared to see our competitiveness lost in that manner.

Mr. Wallace : I congratulate the Prime Minister on the fact that at long last common sense prevailed and he was prepared to meet the Dalai Lama of Tibet. Can he give any indication of whether at that meeting he expressed the British Government's support for the United Nations human rights sub-commission report in relation to the expressions of concern about the violations of human rights in Tibet, and what proposals did he make to help the many thousands who have been refugees from Tibet in the past 30 years?

Column 142

The Prime Minister : The substantive part of my discussion with the Dalai Lama was specifically concerned with human rights--most notably, though not exclusively, in Tibet. We discussed the present situation and the representations that we had made to the People's Republic of China, and I reaffirmed the fact that I would continue to make such representations.

Q4. Mr. Peter Bottomley : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Bottomley : As this is "Youth and Parliament" day, led by the British Youth Council, would my right hon. Friend recognise the importance of investing in the young, overcoming unnecessary disadvantages such as handicap, and giving them the opportunity to contribute fully to a better future for the country?

The Prime Minister : I agree with my hon. Friend. Perhaps the most striking expression of the changed opportunities for young people is the increasing number now going into higher education. In 1979 it was one in eight--today it is one in four, and in the future, under the plans now projected, it will be an even higher percentage.

Mr. Vaz : Will the Prime Minister reflect on the continued hardship and anxiety facing depositors, creditors and former members of staff of the Bank of Credit and Commerce International? Will he join me today in thanking the Sheikh of Abu Dhabi for his recent proposals which form part of the crucial negotiations that are taking place? Will he for the first time publicly endorse those negotiations and wish them well? Will he ensure that his Ministers are actively involved in getting the best possible settlement for those who have suffered and who are the real victims of this awful tragedy?

The Prime Minister : We have repeatedly made it clear that we wish depositors to get back as much of their money as possible. I am pleased with the improvements evident from the negotiations that have taken place. As the hon. Gentleman will know, the recent adjournment is to allow the provisional liquidator to formalise details of the compensation package that he has been negotiating with the Government of Abu Dhabi. That is proceeding and I welcome it. I hope that it will reach a satisfactory conclusion and remove the substantial problem that it has laid over the lives of so many former customers of that bank.

Q5. Mr. Speller : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the answer that I gave some moments ago.

Mr. Speller : On our way to the single market, is it not time to give a healthy nudge to the metrication programme so as to enable our manufacturers and exporters to compete more fairly with our continental rivals?

The Prime Minister : As my hon. Friend knows, there will be a similar system by the end of 1994, which I believe will bring substantial advantages for industry.

Column 143

Mr. Enright : Will the Prime Minister explain what attitude he intends to take at Maastricht to co-operation on development issues, and what practical result that will have?

The Prime Minister : We are content to develop on a co-operative basis a whole range of policies. Where we often have great difficulty with Community proposals is when co-operation is replaced not by agreement but by majority voting on issues of concern to us.

Q6. Mr. Evennett : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Evennett : Will my right hon. Friend join me in congratulating the Secretary of State for Education and Science on devising tests for seven-year-olds which go back to the basics of reading, writing and arithmetic? Will he further commend the Secretary of State for pushing on with the tests, despite the opposition of the National Union of Teachers, the Labour party and the Liberal Democrats? The parents of this country will welcome those tests most warmly.

The Prime Minister : I believe that my hon. Friend is right. We are concerned primarily about the quality of education and for that reason I very much welcome the tests. Testing is a crucial part of ensuring that we know what quality of education our young people are achieving, so that if a satisfactory level is not reached, appropriate action can be taken.

Mr. James Lamond : Is the Prime Minister fully aware of the importance for many industries in this country, including the textile industry, of a successful outcome of the GATT negotiations? Is he aware that the negotiations have been going on for five years, that we must have a replacement for the multi-fibre arrangement that will enable our textiles to penetrate the markets of countries which do not allow any textiles in and those with tariffs of 200 per cent., and that even the United States has a tariff of 36 per cent. on British wool cloth? Unless those tariffs are diminished our textile industry will have a tough time, and more jobs will be lost.

The Prime Minister : I share the hon. Gentleman's view of the importance of GATT and of all aspects of the negotiations. In recent weeks, I have had the opportunity of discussing the matter not only in the United States but with a number of colleagues in the European Community. It is clear that both sides will have to make concessions to reach a satisfactory GATT conclusion. It is to be hoped that that will happen before the end of the year.

Column 144

Q7. Mr. Harry Greenway : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Greenway : Bearing in mind Britain's good marine conservation record, will my right hon. Friend join some of us in the Whale and Dolphin Conservation Society, with a view to saving thousands of whales and dolphins from drift nets, from so-called scientific whaling and from industrial pollution? I have a form here, it will cost my right hon. Friend £5 or £10 to join, and I invite him to do so.

The Prime Minister : My hon. Friend makes me an irresistible offer. I have much sympathy with the aims that he set out. The Government have taken a strong lead in international forums to restrict the use of drift nets and to increase the safeguards for whales.

Mrs. Margaret Ewing : In the context of the Prime Minister's duties in the House, will he advise us whether he will stay to listen to the statement by the Secretary of State for Scotland? Is the Prime Minister aware that the allocation of trust status to hospitals in Scotland is against the general and political will of the people there? Will he therefore spell out what he decides is democracy in Scotland? It seems that the Secretary of State for Scotland is to ride roughshod over the views of elected members at district, regional and parliamentary level.

The Prime Minister : I shall not be present for the statement because I have a series of meetings with hon. Members immediately after Question Time.

Q8. Mr. Ian Bruce : To ask the Prime Minister if he will list his official engagements for Tuesday 3 December.

The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Bruce : Does my right hon. Friend agree that many people who choose to work more than 48 hours per week, and who thereby earn overtime and give greater security to their families, would be most upset if an edict from Brussels took the right to work such overtime away from them, especially as hon. Members would be excluded from the rules, as would the bureaucrats in Europe and all managers and executives?

The Prime Minister : I agree with my hon. Friend on that point. It goes wider than just the position of individuals, important though that is. It also covers the competitiveness of British industry and commerce, a point to which I referred some moments ago. If we were to have to suffer all the rigours of the directive to which my hon. Friend refers, it would cost employers substantial sums--billions of pounds--in the next year.

Next Section (Debates)

Home Page