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House of Commons

Tuesday 14 July 1992

The House met at half-past Two o'clock


[Madam Speaker-- in the Chair ]


Summer Time

The Vice-Chamberlain of the Household-- reported to the House, That its Address of 9 July relating to Summer Time had been presented to Her Majesty and that Her Majesty had been pleased to receive the same very graciously and to give the following Answer :

I have received your Address praying that the Summer Time Order 1992 be made in the form of the draft laid before your House. I will comply with your request.


London Regional Transport (Penalty Fares) Bill

Order for consideration of Lords amendments read.

To be considered tomorrow.

Greater Manchester (Light Rapid Transit System) (No.

4) Bill-- [Lords.]

London Docklands Railway (Lewisham, etc.) (No.

2) Bill--

Prices's Patent Candle Company Limited Bill

[Lords] Orders for Third Reading read.

To be read the Third time tomorrow.

River Humber (Upper Pyewipe Outfall) Bill

[Lords] Order for consideration, as amended, read.

To be considered tomorrow.

Llanelli Borough Council (River Lliedi) Bill

[Lords] Order for Second Reading read.

To be read a Second time tomorrow.

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Oral Answers to Questions


NHS Trusts

1. Mr. Alan W. Williams : To ask the Secretary of State for Health what restrictions exist on the number of pay beds in hospital trusts.

The Minister for Health (Dr. Brian Mawhinney) : It is a statutory requirement that private practice in national health service trust hospitals does not significantly interfere with the performance, by the trust, of its obligations under NHS contracts or imposed by order. The actual number of private patient beds that may be made available at any one time is for local determination.

Mr. Williams : As trust hospitals are not required by law to make contracts with the NHS, and as private insurance companies are seeking a greater use of trust hospitals to reduce their premiums, is there not a danger that the number of private beds in those hospitals will dramatically increase without anyone being consulted? If the Government want us to believe that the NHS is safe in their hands, why do they not make the 10 per cent. limit for private beds that applies to health authority-managed hospitals apply also to trust hospitals?

Dr. Mawhinney : The hon. Gentleman's fears are unfounded, not least because the local population is protected by the purchasers who are responsible for purchasing health care on their behalf.

Ms. Harman : Is it not the case that the more hospital trusts such as Guy's hospital in London concentrate on private patients, the longer NHS patients like the Slennet family, whose case was reported recently in the newspapers, have to wait? The longer NHS patients must wait, the more they are forced to go private. To protect NHS services and justify the Minister's claims that trust hospitals are not about privatisation, will he impose a strict and specific limit on the proportion of private work that NHS trusts can do?

Dr. Mawhinney : The hon. Lady should be aware, better than most, that common waiting lists for urgent or seriously ill patients exist in all hospitals and that those arrangements were agreed with the medical profession. She should be aware also that there is a statutory requirement that private practice in hospital trusts must not interfere, to a significant extent, with performance under NHS contracts. The hon. Lady is trying to scare patients unnecessarily.

2. Mr. Kirkwood : To ask the Secretary of State for Health whether special considerations can be applied to health units or organisations wishing to seek trust status in very rural areas ; and if she will make a statement.

Dr. Mawhinney : No. Each application for trust status is measured against four main criteria : that the establishment of the trust will give clear benefits and improved quality of service to patients ; that management has the necessary skills and capacity to operate independently ;

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that senior professional staff, particularly consultants, are involved in the management of the unit ; and that the trust will be financially viable.

Mr. Kirkwood : But is there not a case for giving special consideration to small health board, district and regional health authority areas providing health care in disparate rural communities and, where they are performing well already, leaving well alone? In particular, what guidance is being given to those authorities in rural areas on the purchaser's ability to keep in touch with local communities so that they can deliver the kind of services that those communities seek?

Dr. Mawhinney : That is a perfectly fair question. I assure the hon. Gentleman that all purchasers have the responsibility to assess health needs and the preferences of the local population. That is true in both rural and urban areas. Given the distance that some patients may have to travel, purchasers in rural areas need to have particular regard to accessibility of services. Let me encourage the hon. Gentleman by giving him one example : a purchasing project in North Yorkshire, not far from the hon. Gentleman's constituency, covering about four and a half former districts, has developed 25 natural communities around which it has planned the sort of health care that the hon. Gentleman seeks.

Dame Jill Knight : Does my hon. Friend agree that when trust status is conferred on a hospital, the local people virtually run the hospital themselves and they, after all, know best?

Dr. Mawhinney : As is so frequently the case, my hon. Friend is exactly right.

Mrs. Dunwoody : Then how would the Minister explain the situation that has arisen in my area, which has a large rural contingent, where one fund-holding general practitioner can distort the provision of health care by demanding that the practice's patients go ahead of those of every non- fund-holding general practitioner?

Dr. Mawhinney : I have to say to the hon. Lady what I said to her last time, which is that I am not prepared to accept her interpretation of events. If the health authority has such a problem, it is perfectly free to get in touch with me.

3. Mr. David Martin : To ask the Secretary of State for Health how many hospitals have now achieved trust status.

14. Mr. David Shaw : To ask the Secretary of State for Health if she will make a statement on the national health service trust programme.

The Secretary of State for Health (Mrs. Virginia Bottomley) : A total of 156 national health service trusts are currently operational and 151 applications have been received from hospitals and other units to become operational from April 1993 in the third wave of NHS trusts.

Mr. Martin : Is my right hon. Friend aware that the result of the general election, particularly in Portsmouth, has led directly to applications for trust status there? As the British Medical Association has withdrawn its misguided opposition to that sensible policy, is it not high

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time that the Labour party and the Liberal Democrats followed suit and stopped misrepresenting it as privatisation?

Mrs. Bottomley : My hon. Friend is exactly right. Since the election, a great many people have said that the future lies in NHS trusts, which provide a better form of management. I was delighted to hear that the BMA chairman said :

"The reforms exist. Our task must be to ensure that, for the sake of our patients, we do everything we can to make them work." I visited the hospital where he works, which has become a trust, and was most impressed with its progress. I know that hospitals in my hon. Friend's constituency are applying for trust status in the next wave, with the warm support of the clinicians. I hope that the Labour party will be able to adopt a similar approach.

Mr. David Shaw : Can my right hon. Friend confirm that trust hospitals result in reduced waiting lists, an improved number of patient treatments and an improved quality of service? Therefore it is not surprising that Dover and Deal hospitals are applying for trust status to deliver to my constituents an even further improved quality of service.

Mrs. Bottomley : Trusts are cutting their waiting lists, improving the quality of service and increasing the number of patients treated. They are also a good place for the staff to work. There are overwhelming reasons for devolving the management of health care to the level nearest to that at which decisions on clinical work are undertaken. NHS trusts are the model for the future and provide important new freedoms. They are better for staff and for patients.

Mr. Robert Ainsworth : The Secretary of State will be aware that among the 151 third wave applications, there is one jointly made by the two Coventry hospitals, which want to become a single trust. Is she aware of fears that that will result in the closure of the Coventry and Warwickshire hospital and of the refusal by the management at either site to give any assurances? Will she ensure that there is full consideration and that the assurances sought are given before trust status is approved?

Mrs. Bottomley : I give the hon. Gentleman a clear assurance that the most important criterion for agreeing trust status is better service for patients. A trust must certainly be financially viable and there must be good management--under which clinicians and managers work closely together. The criterion for the future is improved services to patients and that is the basis on which decisions will be made.

Mrs. Bridget Prentice : Does the Secretary of State agree that the Guy's and Lewisham Trust is so strapped for cash that it is moving more and more towards private medicine? What reassurances can she give Lewisham families that they will not be forced into private health care, as was the Slennet family in my constituency so that they could have their child treated in a hospital?

Mrs. Bottomley : I have no time for the politics of envy, in which criteria for the success of the health service are judged against the work of the private sector. Frankly, that is immaterial. I want ever-greater improvements to the national health service. I ask the hon. Lady to re- examine

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the situation at Guy's, which is paying its low-paid workers an extra £6 a week, is tackling junior hospital doctors' hours a year ahead of schedule, has made excellent inroads into waiting times and is treating more patients. Improved patient care, not the criterion of redundancies, should measure the national health service's success.

Mrs. Roe : Does my right hon. Friend recall a survey undertaken among trust patients at the beginning of this year, which showed that seven times as many thought that services had improved as a result of trust status as those who noted a decline? Does she agree that such noticeable gains should be spread further and wider throughout the health service?

Mrs. Bottomley : How much I welcome my hon. Friend's remarks ; as ever, she hits the nail exactly on the head. We ought to consider the effect of trust status on patients and others who use the service. An independent survey published earlier this year showed that 96 per cent. of patients were very satisfied or quite satisfied with the quality of service that they received from NHS trusts.

Personal Social Services

4. Mr. Stevenson : To ask the Secretary of State for Health when she last met the Association of Metropolitan Authorities to discuss its concerns regarding the personal social services.

The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : My hon. Friend the Minister for Health and I met representatives othe local authority associations, including the Association of Metropolitan Authorities, on 1 July.

Mr. Stevenson : Will the Minister acknowledge the continuing concern that is felt in Stoke-on-Trent and elsewhere about the Government's intentions for the funding of community care? What progress has been made in the Government's discussions with the AMA on the principle of ring- fencing community care resources? Given that these are the last health questions before the recess, will the Minister state clearly when an announcement will be made about the transfer of resources for social security purposes, and not allow human community care to be sacrificed on the altar of council tax, as it has been under the poll tax?

Mr. Yeo : The Government have made it clear on several occasions-- and I gladly do so again--that community care policy will be fairly resourced and that local authorities will be given adequate money to implement it. I understand the hon. Gentleman's concern about ring-fencing. Staffordshire county council's record is a prime example of why ring- fencing might be needed. Throughout the 1980s, social services spending in Staffordshire was consistently below the level indicated by the Government's grant-related expenditure assessment. In the eight years from 1982 to 1990, its cumulative underspend was almost £50 million. Any shortage of resources in Staffordshire is nothing to do with the Government, who provide adequate and generous resources, but has everything to do with the county council's decisions.

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Mr. Rowe : When my hon. Friend met representatives of the AMA, did he discuss the crucial importance of increasing opportunities for volunteers in the personal social services? There is no doubt that volunteering not only provides a remarkable service but prevents the many volunteers who have a valuable and important task to perform from becoming a charge on the personal social services themselves.

Mr. Yeo : My hon. Friend is quite right. Indeed, he is a well-known expert in the field. We want to encourage all local authorities to maximise opportunities for volunteers which are useful to the volunteers themselves and to those whom they seek to serve. We are very concerned about the attitude of a few Labour-controlled local authorities, which are obstinately reluctant to increase usage of the independent sector.

Mr. Rooker : In view of today's devastating report from the Policy Studies Institute, which shows the total collapse of the Government's inner -city policies over the past 13 years, will the Minister join me in congratulating social workers on their work in inner-city areas? They sometimes enter unlit blocks of flats in dangerous circumstances to try to settle disputes of which they know nothing beyond what they have been told in a telephone call, and sometimes emerge with injuries. It is they, not Members of Parliament, who are on the front line.

Mr. Yeo : I gladly pay tribute to a number of local authority employees who work in inner-city areas. Their major handicap is the fact that too many inner-city local authorities are controlled by the loony left.

NHS (Expenditure)

5. Mr. Day : To ask the Secretary of State for Health how the proportion of the national income which is spent on the national health service has changed since 1979, and over the periods (a) 1974 to 1979 and (b) 1970 to 1974.

Mrs. Virginia Bottomley : The share of gross domestic product spent on the national health service from all sources has increased from 4.7 per cent. in 1978-79 to an estimated 5.8 per cent. this year--a rise of more than 1 per cent. Figures for the earlier period are not available on the same basis, but show a similar 1 per cent. increase in the share of GDP spent on the health service between 1970 and 1974. Between 1974 and 1979, however, health spending as a proportion of GDP rose by only 0.3 per cent.

Mr. Day : Will my right hon. Friend accept my congratulations--and, I believe, those of the whole House--on that record of achievement under Conservative control? Such a record was never matched or even dreamt of by the so-called friends of the NHS on the Opposition Benches.

Does my right hon. Friend agree that performance in the NHS can be measured not only by the amount that is spent but by the return in terms of health benefit? Does she feel that her recent White Paper will help to produce further achievements?

Mrs. Bottomley : I thank my hon. Friend for his comments. Indeed, the purpose of our latest White Paper, "Health of the Nation", is precisely to maximise the health gain that is achievable for the nation. Inevitably, any Secretary of State must achieve best value for money, but

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real health gains can be achieved through concentration on disease prevention and health promotion as well as on the delivery of services. We are in the business of health as well as health care.

Mr. Robin Cook : Before the Secretary of State disappears in a puff of complacency about her expenditure, may I invite her to report on her income? Will she admit that, since 1979, the rate of increase in charges to patients has been double the rate of increase in spending ; that the increase in prescription charges has been eight times the rate of inflation ; that pay bed charges have risen tenfold ; and that, on top of that, any dental patient who seeks treatment must pay three times more--provided, of course, that he or she can find a dentist to provide treatment? If the Government really want us to believe that they are committed to the NHS, will they stop turning it into a pay-as-you-go service?

Mrs. Bottomley : Charges have been part of the NHS since its early days. We must ensure that we maximise its ability to provide high-quality services. We have never provided such good dental care ; we have never immunised so many children ; life expectancy has improved over the past 12 years. On a number of criteria, health has been improving through the achievement of good value for money. I worked in the health service when the Labour party was in power. Then, it was not a case of putting cash before care ; it was a case of cash-free, care-free national health service. Expenditure was cut in real terms.

Patients, Barnet

6. Mr. John Marshall : To ask the Secretary of State for Health how many hospital patients were treated in the Barnet health authority in 1991- 92.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I understand from locally provided figures that Barnet health authority purchased in-patient and day care treatment for 39, 814 patients in the year 1991-92. This represents an overall increase of 3.4 per cent. over the previous year.

Mr. Marshall : Will my hon. Friend join me in thanking the staff, nurses and doctors who made that record achievement possible? Will he also note that one of the hospitals that made that achievement possible was the Royal Free trust hospital which, in its first year as a trust, treated 6 per cent. more patients and cut waiting lists substantially? Is my hon. Friend aware that the hospital waiting lists in Barnet are much better than those laid down in the guidelines in the citizens charter?

Mr. Sackville : I certainly join my hon. Friend in that. I remind him that on 1 May no one was waiting for more than two years for in-patient treatment in Barnet health authority, that the number of patients waiting between one and two years was down by 66 per cent. and that the health authority's aim by December 1992 is to reduce the maximum waiting time to nine months for general surgery and several other specialties.

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Health Education Budget

7. Mr. Foulkes : To ask the Secretary of State for Health what is her budget for health education for 1992-93 ; and what is the change since 1991-92 in real terms.

Dr. Mawhinney : We have provided £33.9 million for the health education authority in 1992-93, a real increase of 5.2 per cent. on the previous year. This is more than matched by health education of literally incalculable value throughout the national health service, sustained by the successive real increases in funding provided by the Government.

Mr. Foulkes : Is not that a paltry sum compared with the £72 million spent by the tobacco industry each year on recruiting new customers to take the place of those whom it kills off? Will the Government reconsider the question of an advertising ban and ensure that shopkeepers who sell cigarettes to children are prosecuted?

Dr. Mawhinney : The hon. Gentleman must focus his mind on the ends and not the means to the ends. The ends are that cigarette consumption in this country has decreased substantially over the past few years. The targets that we set in the White Paper suggest that tobacco consumption will drop even further in the years ahead. We have made that commitment. The means to achieve that end will be reviewed constantly, to ensure that it is achieved. I am surprised that the hon. Gentleman does not know that the Children and Young Persons (Protection From Tobacco) Act 1991 addresses precisely the concern that he expressed.

Mr. Sims : Does my hon. Friend recall that at the time of the scares about salmonella and listeria there was criticism of his Department for lack of action and of any sense of urgency, yet when he issues a White Paper pointing out to people the need to pay particular attention to sensible drinking and a balanced diet and to cease smoking, he and our right hon. Friend the Secretary of State for Health are accused of interfering and nannying? Will he ensure that adequate resources are made available so that although people remain free to make their own choices in these matters, they can make informed choices?

Dr. Mawhinney : My hon. Friend is absolutely right. The Government have a responsibility to set before the public information on which they may wish to draw in making individual decisions about individual lifestyles. We are not in the business of nannying. However, we are in the business of discharging our responsibilities to put before people the sort of information that we believe they need and which would give them, if they were to follow it, a better quality of life.

Mr. Robin Cook : Does the Minister recognise that the end that the tobacco industry hopes to achieve by advertising is to encourage people to take up smoking? Why does he not adopt, as one of his means, the banning of tobacco advertising? Is not the real reason to be found in Rothmans' annual report, out this month, which shows that Rothmans gave £100,000 to the Tory party in this election year? Can we really expect the Tory party to take on the tobacco barons so long as they are taking their money?

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Dr. Mawhinney : If they were the ends of the tobacco companies, measured against the fall in the consumption of tobacco in the past few years, they have not met those ends--on the contrary. The Government will meet the ends that they have set out by way of targets in the White Paper. It is a matter of great sadness that on his last appearance at the Dispatch Box--almost certainly, dealing with these matters--the hon. Gentleman will not commit the Labour party to achieving the same ends, which will benefit the health of the whole nation.

Education Nursing Service

8. Mr. Nicholas Winterton : To ask the Secretary of State for Health if she will make a statement on the education nursing service under the health service reforms.

Mr. Sackville : My right hon. Friend the Secretary of State has just written congratulating the profession on the centenary of the education nursing service. In "The Health of the Nation" White Paper we emphasise how important the establishment of healthy lifestyles in childhood is to health promotion. School nurses have much to contribute here-- [Interruption.]

Madam Speaker : Order. I hope that hon. Members on the Opposition Benches below the Gangway will allow us to hear what the Minister has to say.

Mr. Sackville : School nurses have much to contribute here and we will be monitoring their vital involvement in the implementation of our health strategy.

Mr. Winterton : May I advise my hon. Friend that, despite what he may hear, I shall be taking an increased interest in health matters. Having just told the House how important the education nursing services are to education and to the health service, will he tell us who will pay for the vital services under the new provider-purchaser system--the Department for Education or the Department of Health?

Mr. Sackville : May I have the honour of congratulating my hon. Friend on his years of service on the Select Committee on Health? I look forward to his many further contributions.

I stress the importance of the education nursing service. It is up to health authorities to provide adequate cover for the monitoring of school children's health. We must accept that the number of school nurses has remained constant against a background of massive extra GP provision as well as special child surveillance clinics, and the fact that the overall health of children has markedly improved in recent years.


9. Mr. Knox : To ask the Secretary of State for Health how many patients were treated in national health service hospitals in the most recent year for which figures are available ; and what were the comparable figures for 1978.

Mrs. Virginia Bottomley : A record 8.8 million patients were treated as in-patients and day cases in 1990-91 compared with 6.5 million in 1978. That represented a 34 per cent. increase.

Mr. Knox : Does my right hon. Friend agree that the figures provide strong evidence of the improvement and

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expansion of the national health service since the Government came into office? Will she confirm that the increase in the number of patients treated has been faster since the national health service reforms were introduced?

Mrs. Bottomley : Indeed, I can confirm that. I have already made it clear that the rate of increase in the number of patients treated has doubled since the Government came to power, as opposed to when the Opposition were in power. There has been an increase of something like 7 per cent. since the introduction of the NHS reforms. There can be no doubt that, on any test, the NHS reforms have resulted in improvements to the quality of health care.

Mrs. Golding : Is the Minister aware of the unacceptable delays occurring yet again at the Birmingham children's hospital? Is she aware that Andrew Brown, a 10-year-old boy in my constituency, has been waiting more than a year for serious open heart surgery? Having been told to prepare himself to go into hospital tomorrow for surgery, he received a message yesterday that he could no longer go in. Two days' notice was given of the cancellation. His parents are distraught as they have been preparing him for weeks. When will we learn to treat our children properly? When will we do something about the Birmingham children's hospital?

Mrs. Bottomley : The hon. Lady illustrates exactly why it is so important for us to tackle waiting times, and why the achievements of the last year, with the number of those waiting more than a year falling by one third, are so important. All the cases are individual cases like the one to which the hon. Lady refers. That is why the achievement of reducing those waiting more than two years from 51,000 to under 2,000 has been so important. With regard to the individual case that the hon. Lady mentioned, I shall make inquiries myself on her behalf. She has mentioned one case : we are anxious to ensure that all NHS patients are seen as swiftly as possible, and we have made real progress in achieving that.

Heart Campaign

10. Mr. Thurnham : To ask the Secretary of State for Health what representations she has had about the Look After Your Heart campaign.

Dr. Mawhinney : The Look After Your Heart campaign, jointly funded by the Department of Health and the Health Education Authority, is one of the largest and most comprehensive coronary heart disease prevention programmes in the world. It includes a wide range of preventive activity. I am not aware of representations on a large scale on any particular aspect of the programme.

Mr. Thurnham : Does my hon. Friend agree that we should use our heads to look after our hearts? Will the congratulate Bolton health authority on its pioneering initiative to promote the sale of fresh fruit and vegetables through cut-price co-ops. Should not others follow that example?

Dr. Mawhinney : I am sure that my hon. Friend is absolutely right. I have heard about the project not only from him but from my hon. Friend the Under-Secretary of State, and I am happy to commend those who have taken that important initiative.

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Patients Charter

11. Mr. Cummings : To ask the Secretary of State for Health if she will make a statement on the progress being made within the national health service to put the patients charter into practice.

Mr. Sackville : The national health service has made substantial progress in implementing the patients charter, which came into effect on 1 April.

NHS staff at all levels have given the patients charter a warm welcome. Their response and commitment to providing a high-quality health service as embodied by the patients charter is to be applauded.

Mr. Cummings : Does the Minister really believe what he has just told the House? If so, how does he square his remarks with the case of the 19-year-old youth in my area who has had his operation cancelled four times since March, on the last occasion at three hours' notice? Will he now admit to the House that his charter is a con trick and a sham?

Mr. Sackville : The more I hear Opposition Members trying to denigrate the patients charter, the more confident I am that we are very much on the right track. In the case of operations that are cancelled-- often unavoidably, as a result of emergencies and so on--we have given specific guidance in the patients charter to the effect that all such operations should be given priority wherever possible.

Mr. Anthony Coombs : Does my hon. Friend agree that GPs themselves will play an important role in pursuing the patients charter? Is he aware that, in my constituency, no less than 78 per cent. of the population will be dealt with by GP fund holders by the end of this year? Is not that an example of the way that doctors are taking advantage of the Government's health reforms to provide better services for their patients?

Mr. Sackville : I agree with my hon. Friend. GP fund holding gives an opportunity to respond directly to patients' needs.

Ms. Lynne : The first right in the patients charter is the right to health care based on clinical need, regardless of ability to pay. Given that there are only 55 salaried dentists in the country, will the Minister explain how the Government can meet their obligation if there is a mass exodus of dentists from the NHS?

Mr. Sackville : I should like to make two points. First, family health services authorities have a responsibility to provide an NHS dentist to anyone in their area who needs one. Secondly, I remind the hon. Lady of the fundamental review announced in the past two days, which will ensure that we shall not arrive at this situation with dentists again.

Miss Emma Nicholson : I recognise the excellence of the patients charter, but does the Minister agree that patients and their families have an obligation to ensure that public money is well spent and that many operations are delayed because patients do not turn up--either to an appointment or for the operation itself.

Mr. Sackville : We have made it very clear through the patients charter that we believe that it is a two-way street : the patients have responsibilities as well as the health service. The public can do many things to improve health.

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