The following Members took and subscribed the Oath, or made and subscribed the Affirmation required by law :
Robert Parry, esquire, Liverpool, Riverside.Julian Michael Gordon Critchley, esquire, Aldershot.
(No. 2) Bill--
Orders for Second Reading read.
To be read a Second time on Thursday.
For Session 1991-92 of--
(1) the total number of Questions to Ministers or other Members which stood on the Order Paper, distinguishing those set down for oral, written priority and written answer respectively, the number of days upon which replies to Questions for oral answer were given in the House ; and the total number of Questions for oral answer to which such answers were given in the House ;
(2) the total number of Notices of Motions given for an early day ;
(3) the number of Members ordered to withdraw from the House under Standing Order No. 42 (Disorderly conduct), showing separately the orders given in the House and those given in Committee ; and the Members suspended from the service of the House under Standing Order No. 43 (Order in debate) or otherwise, distinguishing whether the offence was committed in the House or in Committee, the period of such suspension, the number of occasions on which more than one Member was so suspended having jointly disregarded the authority of the Chair, and the number of occasions on which the attention of the House was called to the need for recourse to force to compel obedience to the Speaker's direction ; and
(4) the number of public petitions presented to the House, distinguishing separately those brought to the Table at the times specified by Standing Order No. 133 (Time and manner of presenting petitions).-- [The First Deputy Chairman of Ways and Means.]
Closure of Debate and Allocation of Time Return ordered, Respecting- (a) applications of Standing Order No. 35 (Closure of debate) during Session 1991-92 (1) in the House and in Committee of the whole House, under the following heads: 1 |2 |3 |4 ----------------------------------------------------------------------------------------------------------------------------- Date when |Question before |Whether in |Whether assent Closure claimed, |House or |House or |given to Motion and by whom |Committee |Committee |or withheld by |when claimed |the Chair and (2) in the Standing Committees under the following heads: 1 |2 |3 |4 Date when |Question before |Whether assent |Assent withheld because, Closure claimed, |Committee when |given to Motion |in the opinion of the and by whom |claimed |or withheld by |Chair, a decision would |the Chair |shortly be arrived at |without that Motion and (b) applications of Standing Order No. 28 (powers of Chair to propose question) during Session 1991-92: (1) in the House and in Committee of the whole House, under the following heads: 1 |2 |3 |4 Date when |Whether in |Whether claimed |Whether assent Closure claimed, |House or |in respect of |given to Motion and by whom |Committee |Motion or |or withheld by |Amendment |by the chair and (2) in the Standing Committees under the following heads: 1 |2 |3 |4 Date when |Whether claimed |Whether assent |Result of Motion, Closure claimed, |in respect of |given to Motion |and, if a Division, and by whom |Motion or |or withheld |Numbers for |Amendment |by the Chair |and against and (c) the number of Bills in respect of which allocation of time orders distinguishing where appropriate orders supplementary to a previous order) were made under Standing Order No. 81 (Allocation of time to Bills), showing in respect of each Bill-- (i) the number of sittings allotted to the consideration of the Bill in Standing Committee by any report of a Business Sub-Committee under Standing Order No. 103 (Business sub-committees) agreed to by the Standing Committee, and the number of sittings of the Standing Committee pursuant thereto; and (ii) the number of days or portions of days allotted by the allocation of time order and any supplementary order to the consideration of the Bill at any stage in the House or in committee, together with the number of days upon which proceedings were so taken in the House or in committee.--[The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of-- (A) the numbers of Instruments subject to the different forms of parliamentary procedure and those for which no parliamentary procedure is prescribed by statute (1) laid before the House ; and (2) considered by the Joint Committee and Select Committee on Statutory Instruments respectively pursuant to their orders of reference, setting out the grounds on which Instruments may be drawn to the special attention of the House under Standing Order No. 124 (Statutory Instruments (Joint Committee)) and specifying the number of Instruments so reported under each of these grounds ; and (B) the numbers of Instruments considered by a Standing Committee on Statutory Instruments, &c., and by the House respectively, showing the number where the Question on the proceedings relating thereto was put forthwith under paragraph (5) of the Standing Order No. 101 (Standing Committees on Statutory Instruments, &c.).-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of--
(1) the number of Private Bills, Bills for the confirmation of Orders under the Private Legislation Procedure (Scotland) Act 1936, and Bills for confirming Provisional Orders introduced into this House, and brought from the House of Lords, and of Acts passed, specifying also the dates of the House's consideration of the several stages of such Bills ;
(2) all Private Bills, Hybrid Bills and Bills for confirming Provisional Orders which were reported on by Committees on Opposed Bills or by Committees nominated by the House or partly by the House and partly by the Committee of Selection, together with the names of the selected Members who served on each Committee ; the first and also the last day of the sitting of each Committee ; the number of days on which each Committee sat ; the number of days on which each selected Member served ; the number of days occupied by each Bill in Committee ; the Bills of which the Preambles were reported to have been proved ; the Bills of which the Preambles were reported to have been not proved ; and in the case of Bills for confirming Provisional Orders, whether the Provisional Order ought or ought not to be confirmed ;
(3) all Private Bills and Bills for confirming Provisional Orders which were referred by the Committee of Selection to the Committee on Unopposed Bills, together with the names of the Members who served on the Committee ; the number of days on which the Committee sat ; and the number of days on which each Member attended ;
(4) the number of Bills to confirm Orders under the Private Legislation Procedure (Scotland) Act 1936, distinguishing those proceeded with under section 7 and under section 9 respectively ; specifying, in the case of Bills proceeded with under section 9 against which petitions were deposited, whether a motion was made to refer the Bill to a Joint Committee, and if so, whether such motion was agreed to, withdrawn, negatived or otherwise disposed of ; and stating for each Joint Committee to which a Bill was referred the names of the Members of this House nominated thereto, the first and last day of the Committee's sitting, the number of days on which each Joint Committee sat for the consideration of the Bill referred to it, the number of days on which each Member of the Committee served, and whether the Committee reported that the Order ought or ought not be confirmed ;
(5) the number of Private Bills, Hybrid Bills, Bills for the confirmation of Orders under the Private Legislation Procedure (Scotland) Act 1936, and Bills for confirming Provisional Orders withdrawn or not proceeded with by the parties, those Bills being specified which were referred to Committees and dropped during the sittings of the Committee ; and
(6) the membership, work costs and staff of the Court of Referees and the Standing Orders Committee.-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of the number of Public Bills (other than Bills to confirm Provisional Orders and Bills to confirm Orders under the Private Legislation Procedure (Scotland) Act 1936) distinguishing Government from other Bills, introduced into this House, or brought from the House of Lords, showing--
(1) the number which received the Royal Assent ; and
(2) the number which did not receive the Royal Assent, indicating those which were introduced into but not passed by this House, those passed by this House but not by the House of Lords, those passed by the House of Lords but not by this House, those passed by both Houses but Amendments not agreed to ; and distinguishing the stages at which such Bills were dropped, postponed or rejected in either House of Parliament, or the stages which such Bills had reached by the time of Prorogation.-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of the days on which the House sat ; stating for each day the day of the month and day of the week, the hour of the meeting, and the hour of the adjournment ; the total numbers of hours occupied in the sittings of the House ; and the average time ; showing the number of hours on which the House sat each day and the number of hours after the time appointed for the interruption of business ; and specifying, for each principal type of business before the House, how much time was spent thereon, distinguishing from the total the time spent after the hour appointed for the interruption of business.-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of--
(1) the number of Special Procedure Orders presented, the number withdrawn ; the number annulled ; the number against which Petitions or copies of Petitions were desposited ; the number of Petitions of General Objection and for Amendment respectively considered by the Chairmen ; the number of such petitions certified by the Chairmen as proper to be received and the number certified by them as being Petitions of General Objection and for Amendment respectively ; the number referred to a Joint Committee of both Houses ; the number reported with Amendments by a Joint Committee, and the number in relation to which a Joint Committee reported that the Order be not approved and be amended respectively ; and the number of Bills introduced for the confirmation of Special Procedure Orders ; and (2) Special Procedure Orders which were referred to a Joint Committee, together with the names of the Commons Members who served on each Committee ; the number of days on which each Committee sat ; and the number of days on which each such Member attended.-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of--
(1) the total number and the names of all Members (including and distinguishing Chairmen) who have been appointed to serve on one or more Standing Committees showing with regard to each of such Members, the number of sittings to which he was summoned and at which he was present ;
(2) the number of Bills, Estimates, Matters and other items referred to Standing Committees pursuant to Standing Order No. 101 (Standing Committees on Statutory Instruments, &c.), or Standing Order No. 102 (European Standing Committees), considered by all and by each of the Standing Committees, the number of sitttings of each Committee and the titles of all Bills, Estimates, Matters and other items as above considered by a Committee, distinguishing where a Bill was a Government Bill or was brought from the House of Lords, and showing in the case of each Bill, Estimate, Matter and other item, the particular Committee by which it was considered, the number of sittings at which it was considered
Column 479(including, in the case of the Scottish Grand Committee, the number of Meetings held in Edinburgh pursuant to a motion made under paragraph 3 of Standing Order No. 94 (Scottish Grand Committee)) and the number of Members present at each of those sittings ; and (3) the membership, work, costs and staff of the Chairmen's Panel.-- [The First Deputy Chairman of Ways and Means.]
for Session 1991-92 of statistics relating to the membership, work, costs and staff of Select Committees (other than the Standing Orders Committee).- - [The First Deputy Chairman of Ways and Means.]
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : No. As the hon. Lady will be aware, the residents of Haringey receive accident and emergency services from excellent local hospitals.
Mrs. Roche : Is the Minister aware that the two local hospitals, Whittington and North Middlesex, are extremely overstretched and in a financial crisis and that a consultant at North Middlesex hospital estimates that if it were to keep to its contracts for paediatric care it would have to turn away 600 sick children seeking admission from accident and emergency treatment? Does that not make a sham of the pledge in the Gracious Speech to improve the quality of the national health service?
Mr. Sackville : No. There is no question of any patients being turned away from either hospital. I suggest to the hon. Lady that she might like to take a step back from her party's usual policy of denigration from a distance, visit the accident and emergency units and let me know of her impressions.
Mr. Evennett : Will my hon. Friend confirm that the Government are determined to improve health services for the whole of Greater London and to ensure that the needs of London are matched by the resources to improve health care for everyone in the capital?
Mr. Sackville : I thank my hon. Friend for those observations. No residents of Haringey are more than 3 miles from one of the accident and emergency units. There is no reason why they should not have an excellent service.
Mr. Bernie Grant : North Middlesex hospital might be three miles from south Tottenham where my constituents live, but on a Saturday afternoon, especially when Spurs are playing, the High road becomes virtually a war zone, which means that my constituents are not able to get to the hospital. What will the Minister do about that?
Mr. Sackville : I am aware of various complaints that the hon. Gentleman has made about North Middlesex hospital. As far as I know, none of the complaints that the Department has received has involved football matches. There is at least one complaint, however, on which I intend to receive a report.
The Secretary of State for Health (Mrs. Virginia Bottomley) : At 1 October 1979, there were 3,261 women general medical practitioners ; the number had risen to 6,430 at 1 October 1991. This represents an increase of 97.2 per cent.
Column 481Mr. Hargreaves : Does my right hon. Friend believe that those figures suggest an answer to those general practitioners who were concerned that changes to their funding arrangements would inevitably lead to a reduction in the number of female general practitioners?
Mrs. Bottomley : It certainly is a clear answer. The general practitioner contract made it clear for the first time that there could be part-time general practitioners, which was a help for women. We improved the locum arrangements for those wanting to go on maternity leave. There has been a substantial increase in the number of women GPs and we want to see the same increase in the number of women consultants. In our targets for the Opportunity 2000 programme we make it clear that we are determined to see progress for nurses, women doctors and members of health authorities and trusts. We want to see the development of women's careers throughout the service.
Mr. Connarty : Is the Minister aware that Professor Donald Campbell, who chaired the review, expressed concern about the inadequate location of emergency facilities, emergency operating theatres, intensive care units and high dependency units? Is he aware also that concern was expressed about the lack of adequate staffing in some of those units? I know that the Government's policy for Scottish health is dealt with by the Scottish Office, but the Government's general policy obviously impinges on my constituency. For example, is the Minister aware that nurses at Falkirk royal infirmary are expressing concern that the high dependency unit is not staffed adequately to be an intensive care unit? Does the Minister plan to do anything about the report in the near future?
Dr. Mawhinney : I am sure that the hon. Gentleman will be encouraged to know that the inquiry found that the standards of surgical and anaesthetic care were high and that the overall trends demonstrated considerable improvements since earlier reports. As for the hon. Gentleman's constituency, he will know that that is a matter for my noble Friend the Under-Secretary of State.
I point out to my hon. Friend that the report of the confidential inquiry into perioperative deaths shows that there are far too many intensive care units in small hospitals across the country and calls for their concentration into bigger trauma and stress units in centres of population. Does not that throw up some interesting conclusions for the large number of hon. Members on both sides of the House who frequently argue for the continuation of their own small cottage hospitals?
Dr. Mawhinney : I thank my hon. Friend for his kind remarks. He will be encouraged to know that there are nearly 2,500 available beds in intensive care units in England and more than 300 about to open. We want to improve the provision of intensive care if possible, and proposals from the College of Anaesthetists are being considered.
Ms. Harman : I congratulate the hon. Gentleman on his appointment as Minister. Will he, however, demonstrate a little more concern and a little less complacency about a report which states that there are needless deaths after surgery because of the shortage of consultants and the lack of intensive care units? Perhaps, instead of telling us that everything is perfectly all right and running smoothly, the hon. Gentleman will act on the findings of the report and deal with the shgrtage of consultants and the lack of intensive care units.
Dr. Mawhinney : I am grateful for the hon. Lady's kind remarks, soured ever so slightly by the rest of her question. Ministers are not complacent. I have already told the hon. Lady of the number of intensive care beds and the fact that more are to be opened. She also asked about the number of consultants. She might more properly have mentioned the extra 100 consultants in acute specialties whose posts were created following publication of the White Paper "Working for Patients". I did not hear her mention, either, the 350 new consultants' posts that have been agreed as part of the new deal for junior doctors.
Dr. Maw`inney : Regional health authorities are responsible for revenue allocations to health districts. Every regional health authority was given a real increase of at least 3.5 per cent. for 1992-93, allowing a margin for all regions to bring underfunded districts closer to their weighted capitation share.
Mr. Channon : Is my hon. Friend aware that for many years Southend has been in this position, that there has been some modest extra help$ which is welcome and which has provided extra benefits for residents of Southend, but that the process must go on? Will he make it his policy while he holds his portfolio to ensure that money follows the patient, so that those who treat most patients are given adequate money to do so?
Dr. Mawhinney : Yes. I know of my right hon. Friend's continuing concern about this matter. I am grateful that he recognises that North East Thames region went out of its way to be helpful to Southend, which started the year at about 10 per cent. below average and, as a result of the extra money provided to it in this financial year, is now less than 5 per cent. below average. I am glad that my right hon. Friend welcomes that, and I can assure him that the process will continue. I hope that it will even reach a conclusion in the next financial year.
Mrs. Mahon : Will the Minister comment on underfunding in intensive care units over the past five years, and on the report by Paddy Ross, the eminent surgeon who resigned from the Tory party because of
Column 483underfunding and the Government's reforms? I will pass his letter on to the Minister. He states that a woman died in the Royal Hampshire hospital, possibly because of underfunding in the intensive care unit. Will the Minister make up that funding and stop tragedies like that happening again?
Dr. Mawhinney : I will be happy to receive the letter if the hon. Lady cares to send it to me. Her question must be viewed in the context of record spending in the health service this year, including in the Halifax area. Against that background I find her comments rather hard to understand.
Mrs. Virginia Bottomley : Almost 1,200 responses were received from organisations and associations ; a further 900 replies were received from individuals. That demonstrates the very great interest in the initiative to improve health, which is high on the Government's agenda and to which I attach the highest importance.
Mr. Steen : I welcome the excellent Green Paper, particularly as it points out the need to reduce smoking in all age groups. Bearing in mind that some 60 per cent. of patients in hospitals are there because of some smoking or smoking-related disease, does my right hon. Friend agree that we should ban smoking in public places or at least cordon off an area so that smokers can enjoy smoking without infecting all those who do not enjoy it?
Mrs. Bottomley : I thank my hon. Friend for his generous remark about the Green Paper, the credit for which is entirely due to my predecessor, the Chancellor of the Duchy of Lancaster. For the first time, we have a strategy to prevent ill-health as well as to treat it, and that is a significant achievement. My hon. Friend has long been a champion of the anti-smoking cause. Great progress is being made in banning smoking from many public places. As my hon. Friend will know, we prefer the voluntary approach, but there are times when legislation is required. We are now seeing the removal of smoking from various forms of public transport, from many public places and from Government offices, and we shall continue to maintain the momentum.
Mr. Eastham : May I impress upon the Secretary of State the need to give greater thought to dental care, especially for young children? Would not it be a good idea to include the sugar content on soft drink labels on such as Coca Cola, which I understand contains about seven spoonfuls of sugar and is detrimental to children's teeth? Will the right hon. Lady do something about that?
Mrs. Bottomley : I am able to report that our record on children's dental health is impressive, but I appreciate the hon. Gentleman's thinking, which is exactly the thinking behind the health strategy. We want to think widely about labelling and how we can improve health and prevent disease. In addition to thinking in terms of health services, the effective provision of information is exactly the way forward.
Mr. Jessel : Does my right hon. Friend recognise that back pain causes massive absenteeism, distress and waste and that the problem is increasing by 13 per cent. a year? Does she agree that the National Back Pain Association deserves positive support and encouragement?
Mrs. Bottomley : Having just welcomed my constituent, my hon. Friend the Member for Aldershot (Mr. Critchley), to the House, I am well aware of the difficulties caused by back pain. My hon. Friend the Member for Twickenham (Mr. Jessel) is right. Back pain is a significant cause of disability and disease, not least among health service staff, and it is one of the matters that we are considering. The Health and Safety Executive is bringing forward guidelines through the Health Service Advisory Committee. The organisation to which my hon. Friend referred clearly has an important part to play in promoting awareness and understanding.
Mr. Robin Cook : I add my congratulations to the Secretary of State on her promotion. I also congratulate her on presiding over a team which contains the largest number of Ministers in the history of the NHS, which may seem odd since they administer the fewest hospitals in the history of the NHS. Can the Secretary of State confirm that since the Green Paper was published she has received a report from her own officials that an advertising ban would cut tobacco consumption and, therefore, cancer? Why, then, does she not drop Britain's objection to a European advertising ban? It surely is not because Imperial Tobacco provided the Conservative party with 2,000 poster sites during the election and on this issue the health of the Conservative party comes before the health of the nation.
Mrs. Bottomley : I thank the hon. Gentleman for his welcome, but he never seems to change. He always has a cynical reaction. He always concentrates on means, not ends. In the same way as he comments on the number of hospitals and not on the quality of patient care, he is always addressing the wrong issue. We are determined to achieve a further fall in tobacco smoking in Britain. We have one of the most powerful records of any country in the EC. It is interesting that many of those countries which support a ban on tobacco advertising have their own nationalised tobacco industries and all of them except one have cheap cigarettes. We believe in fighting smoking by means of price and advertising and we do not support the subsidy on tobacco growing through the common agricultural policy. We will achieve the ends. I am fed up with the hon. Gentleman constantly looking at the means and not the ends.
Column 485from their general practitioners. Does my hon. Friend think that there has been a great change in the past few years?
Mr. Sackville : It is not surprising that there is general satisfaction with primary care. The number of practice staff has nearly doubled over the past 10 years, as has the number of services that practices offer.
7. Dr. Strang : To ask the Secretary of State for Health what steps she is taking to ensure that health authorities are spending appropriately money allocated for HIV and AIDS ; and if she will make a statement.
The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : Health authority use of earmarked funds for AIDS-related services is monitored through the reports required under the AIDS (Control) Act 1987. From this year, we have also introduced a requirement for regions to submit to the Department forward spending plans, which will be checked against quarterly monitoring reports.
Dr. Strang : Does the Minister agree that it is more important than ever that health authorities allocate adequate resources to help to prevent the spread of AIDS and to provide care and treatment to those who are HIV positive or who have AIDS? The House welcomes the Minister's confirmation that quarterly monitoring is now supplementing the annual reports made under the AIDS (Control) Act 1987. May we take it that the Government are determined to ensure effective ring fencing of the money required for those purposes?
Mr. Yeo : I acknowledge the hon. Gentleman's close interest in that subject over the years and confirm that the Government are determined to ensure, through the quarterly monitoring reports, which are operating for the first time in the current year, that the substantial resources allocated to AIDS-related services are used for the intended purposes. Those resources amount to more than £180 million in the current year, which is a rise of more than one third over last year, and contribute to expenditure of more than £650 million since 1987.
Mrs. Virginia Bottomley : We have no current plans to change the role of regional health authorities, although we will be examining their role as we continue to implement our reforms to improve the health service.
Mr. Bayley : It is odd that the Secretary of State makes no mention of the newly created regional outposts of the NHS management executive, which are assuming powers in relation to opted-out hospitals that were previously the province of regional health authorities. Unlike those authorities, regional outposts do not meet in public or have members who are accountable to the public, and they were not established by statute. Will the Secretary of State describe the role of the new regional outposts, explain what will be left for regional health authorities to do, and state whether there will be a statutory basis for the
Column 486outposts--or will they be part of a secret, centralised, east European-style command economy for the national health service?
Mrs. Bottomley : The six regional outposts will essentially monitor the financial effectiveness of NHS trusts and report back to the management executive. The role of the regions will remain as it is--that of central authorities seeing through the priorities established by Ministers and the management executive. This year, regions are charged with ensuring further progress with the patients charter, which is a central element in our health programme, seeing through the further implementation of community care and enhancing the health of the nation. They work by monitoring and, with the family health services and district health authorities, strengthen the purchasing power which, as the hon. Gentleman will be aware, is the key to securing the quality improvements that are so important to the nation's health.
Mr. Dunn : Does my right hon. Friend agree that regional health authorities are too vast, bureaucratic and remote, and that the sooner we move to a system of direct funding for the capital works of district health authorities, the better the service will be run?
Mrs. Bottomley : My hon. Friend will be reassured to learn that the number of staff working in regional health authorities has fallen in recent years. The authorities have a function--to form a link between the management executive and Ministers, and the district health authorities-- and it is important for the task that they are undertaking to benefit the districts and to be properly understood. I shall bear my hon. Friend's comments in mind.
Ms. Armstrong : Is the Secretary of State aware that many regional health authorities are not releasing sufficient funds to get community care up and running? How does she intend to ensure that local authorities have enough resources from the regions to be able to put community care into operation?