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House of Commons

Tuesday 23 March 1993

The House met at half-past Two o'clock

PRAYERS

[Madam Speaker-- in the Chair ]

PRIVATE BUSINESS

Dawat-e-Hadiyah (England) Bill

Pwllheli Harbour (Amendment) Bill

Considered ; to be read the Third time.

Oral Answers to Questions

HEALTH

Community Care

1. Mr. Matthew Banks : To ask the Secretary of State for Health how she intends to promote the interests of the users of community care services.

The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : At the very heart of our community care reforms lies the principlethat all decisions about services must reflect the individual needs and wishes of users of the services and of anyone who helps to care for them.

Mr. Banks : Does my hon. Friend agree that one of the most important aspects of the community care reforms is that they put the user and carer at the centre of services rather than the periphery? Under the old system, far too often needs were dictated by the local authority and trade unions. Will my hon. Friend give an assurance that he will take steps to ensure that Labour-run local authorities that have the task of making decisions do so in the interests of users and not in the interests of the local authorities themselves and trade unions?

Mr. Yeo : Extensive precautions have been taken to minimise the risk that any local authority, however doctrinaire or incompetent, can undermine the reforms. We are requiring 85 per cent. of the money being transferred from the Department of Social Security to be spent in the independent sector--on buying from voluntary and private organisations--to ensure that the local authority does not spend it on empire building. We will monitor changes as they take place and we are determined that the best safeguard that anyone can have against users' wishes being ignored is for more Conservative-controlled councils to be elected on 6 May.

Mr. Hinchliffe : What action will the Minister take to promote the interests of those users of residential care who are to lose their £45 per week residential allowance as a direct result of Government policy? If such people go into hospital or go on holiday and are away from their home for more than six days they may lose their place in the

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home. Will the Minister act to convince users and carers that 1 April is more than just an attempt to reduce the Government's income support expenditure? He can do so by listening to demands for advocacy arrangements, assessment appeals, reassessments and reviews. Is not the Government's total lack of real commitment to change quite obvious from the fact that they discourage the recording of unmet need, which is surely the first port of call for improving community care and genuine reforms?

Mr. Yeo : I am not sure which of the hon. Gentleman's five questions displays the greatest ignorance of the changes that we are about to make. There is no question of any financial saving being achieved in the short term by the policies, as all the money that would have been spent by the Department of Social Security on the higher rates of income support has been transferred to local authorities. In addition, we have added a further £140 million to ensure that they can carry out the assessments. It will be for the local authorities to make the necessary contractual arrangements with residential homes to ensure that the position of people who enter hospital for short periods is protected. We have resourced the authorities to do the job and I have every confidence that the vast majority of Conservative councils will grasp their responsibilities enthusiastically and deliver a high standard of care which meets individual needs.

There is no confusion about unmet need. Decisions are based on an objective assessment of an individual's need. It is a matter for the authority if, for the purposes of planning its services in the longer term, it wishes to keep some record of needs which it would be desirable to meet but which it is not necessary to meet immediately.

Mr. Butterfill : Will my hon. Friend advise Opposition Members to visit Dorset, and Bournemouth in particular, where they can see in action an outstanding example of community care--an example that can serve for the whole of the rest of the nation? That has been achieved by a Conservative- controlled county council which is wholly free of debt, unlike councils controlled by the Labour party.

Mr. Yeo : My hon. Friend is so persuasive that I have had a word with the Secretary of State and she has agreed to pay a visit to Bournemouth on Friday. I am grateful to him for drawing attention to the financial position of Dorset county council. Across the country, expenditure on social services has risen by two thirds in real terms since 1979. In the past three years the standard spending assessment for personal social services has risen by one fifth in real terms. On top of all that, we are transferring a further £565 million to local authorities in England to deliver this new reform.

Treatment (Delay)

2. Mrs. Fyfe : To ask the Secretary of State for Health what steps are being taken to ensure that no patients with urgent conditions are having their treatment delayed due to the early completion of contracts.

The Secretary of State for Health (Mrs. Virginia Bottomley) : Emergency cases are treated immediately and urgent cases are treated as soon as possible according to clinical need. In a letter to the chairman of the Joint Consultants Committee on 23 February, I made it clear that, whatever the particular social circumstances, there

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can be no question of patients requiring urgent investigation or treatment having it delayed because they come forward towards the end of the financial year. We have issued further guidance to the NHS on managing activity and change, and the JCC has supported that guidance.

Mrs. Fyfe : Does the Secretary of State find it satisfactory that hospitals scrabbling around for money to keep going until the end of the financial year get GP fund holders to give them patients while GPs who are not fund holders but have more seriously ill patients have to wait longer? Will she advise the Secretary of State for Scotland to learn from this fiasco in England and not to impose it on Scotland?

Mrs. Bottomley : I find it extremely satisfactory that we have the fewest ever patients waiting more than one year. I find it extremely satisfactory that from 1 April no one will wait more than 18 months for a hip, knee or cataract operation. I find it exceedingly satisfactory that the trusts have gone ahead and dealt with more patients. In the first nine months of the year, 325,000 more patients were treated than in the year before. Certainly we need to match activity and resourcess. The agreement with the JCC on GP fund holders makes it clear that patients will be treated without disadvantage to other NHS patients.

Mr. Lidington : Is my right hon. Friend aware that at Stoke Mandeville hospital, which has had financial problems in the past year, staff have managed to cut waiting lists and waiting times and to increase the number of patients treated by more than 2,000 ? Is that not a tribute to the efforts of all the staff, and will not the service that they provide be improved still further when the £29 million capital spending planned for Stoke Mandeville comes into operation ?

Mrs. Bottomley : My hon. Friend is exactly right, and I can confirm his figures. Stoke Mandeville has made excellent progress. As with other hospitals, and as it has ever been in the NHS, activity and resources must be managed through the year, but Stoke Mandeville, like so many other hospitals, is treating more patients to a higher standard and cutting waiting times. The staff are to be warmly congratulated. Once again, the NHS reforms have shown that they result in better and more patient care.

Ms Lynne : Will the Secretary of State give an assurance that the fiasco of the past few months, with beds closing throughout the country and urgent cases not being treated, will not be repeated at the end of the next financial year ?

Mrs. Bottomley : I can inform the hon. Lady that we have established a working party with the profession, and I quote Stanley Simmons, chairman of the Conference of Medical Royal Colleges : "the Conference of Medical Royal Colleges is encouraged to work constructively with the Management Executive to address those issues that have emerged and to that end expect to make positive recommendations in the coming months".

We want to be sure that work is under way between management and clinicians to ensure that activity is better balanced. I am sure that the hon. Lady would be the first to pay tribute to the fact that more patients are being treated and waiting times have been coming down. It is just a question of ensuring that the contracts are better adapted throughout the year.

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Dame Elaine Kellett-Bowman : Will my right hon. Friend join me in congratulating the Lancaster Acute Hospital Trust on achieving 2.5 per cent. above target and 25 per cent. above target with day cases? Thanks to the Lancaster health authority putting in more money, no urgent or emergency patients are waiting and it is still increasing its patient load.

Mrs. Bottomley : Once again, my hon. Friend has it exactly right. More money is going in ; £100 million a day being spent on the NHS. What is important is not only the money going in, but the organisation and the output of the resources. There is no doubt that NHS trusts are delivering better, higher quality care. Patients are being treated and waiting times are coming right down.

Dental Checks

3. Mr. Chisholm : To ask the Secretary of State for Health how many dental checks were carried out on non-exempt patients in (a) 1991-92 and (b) 1988-89.

The Minister for Health (Dr. Brian Mawhinney) : From the information available, it is not possible to differentiate between those dental examinations provided to exempt and non-exempt patients.

The total number of dental examinations carried out in 1991-92 in England and Wales was 20.9 million, and in 1988-89 it was 22 million.

Mr. Chisholm : What impact does the Minister expect the imposition of 80 per cent. dental charges and the lack of NHS dentists to have on the number of people coming forward for dental checks? What are the health and financial implications of people not seeking dental treatment because they are deterred by the 80 per cent. charge until they need emergency treatment?

Dr. Mawhinney : The hon. Gentleman will be encouraged to know, as I am, that in the six months during which the regrettable attitude taken by some dentists in the NHS has been progressing, the number of adult patients registered in England has increased by 600,000, contrary to the perception that many people have. We remain of the view--as I believe the Labour party does, although it will not say so--that those patients who are capable of making a contribution towards the cost of their dental treatment should do so.

Mr. Simon Coombs : How many dentists are now being employed directly by family health services authorities?

Dr. Mawhinney : As my hon. Friend rightly implies, the FHSAs have the ability to employ salaried dentists. [ Hon. Members :-- "How many?"] The last time I saw the figure, which was about 10 days ago, it was something over 60. If the figure has moved significantly since then, I will write to my hon. Friend.

Mr. McCartney : I thought that the Minister was coming to the Dispatch Box to apologise for the imposition of the 80 per cent. charges. During 1991-92, 1 million nursing mothers and pregnant women used dental services. Sir Kenneth Bloomfield, a personal friend of the Minister of State, is recommending the withdrawal of free dental services for that group of women. Will the Minister give a categorical assurance that, after the Bloomfield report, those women will retain their right to free dental

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treatment and that he will not impose on them the 80 per cent. charge, which in effect is an 80p in the pound health tax?

Dr. Mawhinney : I can tell the hon. Gentleman that I have already started to consult on the Bloomfield report, just as we promised that we would. If he would like to come to give me the views of the Labour party, I should be more than happy to hear him, as indeed I was when I consulted the Labour party on the Tomlinson report. We have not yet made any decisions ; when we do, we will let the hon. Gentleman know.

GP Fund Holders

4. Mr. Hunter : To ask the Secretary of State for Health what is the number of general practitioner fund holders in the Wessex health region.

Dr. Mawhinney : There are 32 fund holders in Wessex at present and a further 23 are preparing to join on 1 April.

Mr. Hunter : Can my hon. Friend confirm that there will soon be 11 fund-holding practices in and around Basingstoke, serving 65 per cent. of the population? Is that not further evidence that the argument has been won and that doctors and patients increasingly realise that the health service is better when general practitioners become fund holders?

Dr. Mawhinney : My hon. Friend is absolutely right, and I have no doubt that he has contributed to the thinking in Basingstoke and in the area which has resulted in that marvellous record of GP fund holders. In so doing, my hon. Friend will have acted in the best interests of his constituents, because there is no doubt that the patients of GP fund holders receive better services and appreciate those services more than used to be the case.

Mr. Gareth Wardell : Has the Minister received any representations from GP fund holders to the effect that they increasingly find themselves under pressure from patients who want to know where they will be referred, to choose their surgeon and to know--

Madam Speaker : Order. The hon. Gentleman must relate his question to the Wessex health region. He has not yet used the word Wessex.

Mr. Wardell : Thank you, Madam Speaker, for that advice. Has the Minister received any representations from Wessex GP fund holders to the effect that they are under increasing pressure from patients demanding certain pills and certain surgeons to carry out certain operations? What protection will the Minister offer to those GP fund holders when that pressure in Wessex arises?

Dr. Mawhinney : Doctor magazine carried out an extensive survey of patients of GP fund holders, including those in Wessex, and found that 70 per cent. of them had experienced a decrease in waiting times, 60 per cent. had experienced improved services, including follow-up appointments, and more than 50 per cent. of fund holders were providing additional services, such as physiotherapy and consultant clinics in surgeries. Given those results and that reflection of patient satisfaction, and given that

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extension of GP fund holder services in Wessex and around the country, it would be surprising if those patients were complaining.

Mr. David Martin : Is my hon. Friend aware that, despite the Labour party's continued opposition to this excellent reform, experience in Portsmouth of fund holding is similar to that of my hon. Friend the Member for Basingstoke (Mr. Hunter)? Will the minimum size of practices eligible to become fund holders be reduced so that fund holding can be enjoyed by practices with lists of fewer than the present minimum of 7,500?

Dr. Mawhinney : I entirely endorse what my hon. Friend says about his part of the country. The size of qualifying fund-holding practices will be reduced on 1 April and we are looking for further ways to make it possible for practices with fewer patients to combine in various ways so that the benefits of fund holding can be made as widely available as possible.

Benzodiazepines

5. Mr. Win Griffiths : To ask the Secretary of State for Health if she will establish an independent committee of inquiry into the effects of the benzodiazepine group of drugs.

Mr. Yeo : I have no plans to do so. The Committee on Safety of Medicines is an independent advisory group which has reviewed the safety of benzodiazepines. To reduce the problem of dependence, it recommended restrictions on their use. The committee continues to monitor the situation.

Mr. Griffiths : As problems existed more than 10 years ago, is it not a pity that the committee did not report much earlier? As the Legal Aid Board is likely to deprive more than 6,000 people of cases against companies such as Roche, would it not be a good thing and a matter of Christian charity for the Minister to undertake an inquiry so that people such as my constituent Mrs. Molly Jones, who has had her life shattered by the use of such drugs, can gain some compensation without incurring huge legal fees in pursuing companies such as Roche?

Mr. Yeo : Questions about legal aid are for my hon. Friend the Member for Solihull (Mr. Taylor), the Parliamentary Secretary, Lord Chancellor's Department, who answers for the Lord Chancellor in the House. The number of benzodiazepine prescriptions dispensed has fallen by 40 per cent. since 1979, so I think that the change in prescribing practice does go back to the period to which the hon. Gentleman refers. Detailed guidance on prescribing is given in the British National Formulary, which is a major reference source for drugs and is issued free to all doctors. I think that it is clear that we have responded to the concerns expressed by the hon. Gentleman.

Ms Primarolo : The Minister will acknowledge that the dangers of dependency on benzodiazepines are well known. The request for the inquiry is based on the understanding that the drug has been licensed for a long time and has caused immense agony and problems in the lives of many people, especially women.

Will the Minister consider taking a number of steps further to control the prescribing of this drug? First, will

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he request that GPs be required to hand- write the prescription script so that it is drawn to their attention? Many people are given repeat prescriptions when they should not be. Secondly, will he ensure that the time is limited to 10 days, which is the recommended period for the safety of these medicines? Thirdly, will the Government consider banning the capsules which are so dangerous and are so misused, particularly by young people, in the abuse of drugs?

Mr. Yeo : The Advisory Council on the Misuse of Drugs has proposed that some benzodiazepines should be rescheduled, which would give a stricter regime and would involve the hand-writing of prescriptions. That will be considered. The question of the period over which these drugs should be used is also subject to guidance given to all doctors. It is now generally regarded as best practice to confine the period of use to a relatively short time. The guidance is not confined to the British National Formulary. In the mental illness key area handbook, which was published earlier this year following the identification of mental illness as a key area under the White Paper "The Health of the Nation", suggestions have been made that family health services authorities should discuss with general practitioners local targets for reducing benzodiazepine prescriptions.

NHS Trusts

6. Mr. Luff : To ask the Secretary of State for Health how many NHS trusts are due to start in the west midlands region in April ; and if she will make a statement.

Dr. Mawhinney : From 1 April, 15 units will become operational as national health service trusts in the West Midlands regional health authority. This will bring the total number of trusts in the region to 25.

Mr. Luff : I thank my hon. Friend for that answer. I invite him to welcome the application from Worcester royal infirmary and my local ambulance service for trust status from April 1994. Does he agree that this will result in a significant improvement in the quality of health care for my constituents? Bearing in mind that trust hospitals in the West Midlands region have increased the number of patients treated by some 5 per cent. compared with a little over 3 per cent. for the region as a whole, does he agree that it is time that the Labour party applied the test set by the hon. Member for Livingston (Mr. Cook)--that trusts should be judged by the number of patients they treat--and admitted that the Opposition got it wrong and we got it right?

Dr. Mawhinney : My hon. Friend is absolutely right in all the points that he makes, particularly the last one. I have no doubt that his constituents will benefit from the fact that Worcester royal infirmary has applied for fourth-wave trust status. I know that he will be pleased, as I was, to learn that the West Midlands regional health authority has agreed a capital scheme for his district general hospital in Worcester, that it will not be affected by the capital moratorium and that work on it will start soon.

Mr. Burden : As the Government are now encouraging extra national health trusts in the west midlands, will the Minister comment on the assurances given by the former chair of West Midlands regional health authority--described by the Secretary of State as someone who has

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made an outstanding contribution to the health service--who said that no further trusts in the Birmingham area would be supported until a major hospital rebuilding programme was nearing completion because trusts were incompatible with strategic planning? What has changed? Is it the strategic planning which has gone out of the window or is it the hospital rebuilding programme? Or is it just another broken Tory promise?

Dr. Mawhinney : No, it is just another example of the incapability of the Labour party to put the patient first. In terms of the number of patients treated, waiting time figures and the quality of service offered to patients, all the evidence shows that trusts are delivering the quality of service that patients want. From this April, they will become the normal mode of delivering health care in this country. We know that the Opposition do not like that, but patients do.

Treatments (Mersey Region)

7. Mr. Brandreth : To ask the Secretary of State for Health how many patients were treated in the Mersey region in the last year for which figures are available and the previous year.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : The figures are 397,000 in 1990-91 and 425,000 in 1991-92 : a rise of 7 per cent. over the year.

Mr. Brandreth : I thank my hon. Friend for that encouraging information. Is he aware that the Mersey region has been the most successful region in the country at implementing the health reforms, with more trusts, more fund holders and lower waiting lists ? Will he join me in congratulating the staff at the Countess of Chester hospital on the service that they deliver to patients and on the fact that they achieve trust status next week ?

Mr. Sackville : I will certainly join my hon. Friend in that. In the sea of municipal despair that characterised the major city of the region during much of the decade, Mersey regional health authority stood out like a beacon of hope and humanity. They are all to be congratulated on what has been achieved in the region.

Mrs. Dunwoody : Is the Minister therefore delighted that the trust that was set up in Crewe, which will be forced into an arrangement with Macclesfield against the wishes of the local people, is in the process of sacking large numbers of nurses ? Is that his idea of good health care ? I assure him that it does not impress the patients.

Mr. Sackville : I cannot see why the hon. Lady should object about the merger with Macclesfield. In any case, there is no way in which that should lead to a diminution in the employment of nurses.

NHS Trusts

8. Sir Roger Moate : To ask the Secretary of State for Health if she will make a statement on progress in establishing hospital trusts.

10. Mr. Skinner : To ask the Secretary of State for Health what, at the latest available date, was the total number of NHS trusts.

Mrs. Virginia Bottomley : The number of fully operational national health service trusts is 156. This will

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increase to 293 from 1 April 1993. It is clear that trusts are the management model of service provision for the future. With each successive wave, enthusiasm and support are increasing.

Sir Roger Moate : Does my right hon. Friend recall the almost hysterical opposition of the Labour party to NHS trusts? Will she contrast that with the widespread welcome and growing enthusiasm for what is proving to be the most successful form of devolved management and local responsibility? Is not the concept so successful that very soon most hospitals will be managed in that way and very soon we will have the support even of the hon. Member for Bolsover (Mr. Skinner)? It will not be long before the Liberal party claims that it thought of the idea first.

Mrs. Bottomley : To use the words of my hon. Friend the Member for Worcester (Mr. Luff), "They got it wrong and we got it right." National health service trusts are here to stay. They are good for patients and for staff. It must be said that throughout the country NHS trusts are treating more patients to a better standard and are reducing waiting times. I will wait and see whether we will convince the hon. Member for Bolsover (Mr. Skinner) at this stage.

Mr. Skinner : Will the Minister confirm that the first wave of hospital trusts cost the British taxpayer £1.17 billion just to set them up ; that it cost a further £800 million for the second wave and another £1 billion for the third wave, making £3 billion in all which has been taken from taxpayers' pockets just to set the trusts up? The Government are now calling on pensioners to pay more VAT. If those trusts are so good, why do not Tory Members use them? Why do not the majority of Cabinet members use them? Is not it remarkable that the Government have double standards--trusts for people out there, but they will not touch them with a barge pole? That is why I will be voting to take them back into the national health service where they belong.

Mrs. Bottomley : I am very surprised to hear the hon. Gentleman's comments. Having been to a great many NHS trust hospitals and used the services of those trusts, I do not know for whom he is speaking. As ever, he has turned down the opportunity to tell the House what is happening at his local hospital, which will become a trust on 1 April. Like all other members of the Labour party, he always takes the opportunity to denigrate the achievements of the national health service, rather than sing its praises. Let me tell my hon. Friends that the Chesterfield and North Derbyshire royal hospital treated an extra 2,700 patients this year. That hospital, which is to become a trust on 1 April, will have no patients waiting for 18 months and very few waiting for more than 12 months. The hon. Gentleman's constituents who use it benefit from an ever-higher standard of health care. When it becomes a trust, it will, like others, go from strength to strength.

Dame Jill Knight : Has my right hon. Friend yet been able to persuade, cajole or charm the hon. Member for Sheffield, Brightside (Mr. Blunkett) to say whether a Labour Government would abolish trusts? Does she think that the hon. Gentleman's reluctance to speak--

Madam Speaker : Order. As the hon. Lady is aware, the Secretary of State has no responsibility for the attitude of

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any other hon. Member. Her responsibility is for the policy of her Department. Will the hon. Lady please rephrase her question?

Dame Jill Knight : Will my right hon. Friend ensure the safety of hospital trusts, whoever may be in charge of them in the future? The citizens of Birmingham, where trusts are becoming very popular, are determined that we should hold to this policy, as it is undoubtedly the best means of serving patients.

Mrs. Bottomley : It is almost a year since the general election, yet the Labour party still has a policy-free zone in respect of the health service and NHS trusts. Perhaps on 1 April, when a further 138 trusts are established, the Opposition will declare that they have been April fools and will see the light. I refer Labour Members to remarks of the previous Labour spokesman on health, the hon. Member for Livingston (Mr. Cook), who, two years ago, challenged the Secretary of State for Health

"to measure the success of those trusts that opted out by the simple test of whether they do more or less work on NHS patients."--[ Official Report, 17 April 1991 ; Vol. 189, c. 457.]

They have done more work. It is time for Labour Members to think about the present and the future and leave their antediluvian attitudes behind.

Dr. Reid : Apart from devotion to the Conservative party, what are the criteria for appointment to the board of a hospital trust? I put this question because in my area of Lanarkshire there is slight confusion over the announcement that the latest member of the board of Bellshill maternity hospital is a part-time vet. What particular expertise and qualifications will a part-time veterinary surgeon bring to the maternity services of Lanarkshire?

Mrs. Bottomley : We are greatly indebted to all the public-spirited men and women who have served as chairmen and non-executives. The NHS is a major employer--the largest employing organisation--and it needs good management skills. Board members come from a range of backgrounds. But I understand the difficulty of the Labour party. Whereas Conservative Members appreciate the service of those who bring skills from the private sector, the employment spokesman of the Labour party, the hon. Member for Holborn and St. Pancras (Mr. Dobson), has said of company directors :

"We are envious of their wealth. These people are stinking, lousy, thieving, incompetent scum."

If that is the Labour party's attitude to people who serve in the NHS, I well understand why the nation has no confidence in the party.

Patient Treatments

9. Mr. Day : To ask the Secretary of State for Health how many patients were treated in the north-western region in the last year for which figures are available and in the previous year.

Mr. Sackville : The figures are 711,000 in 1990-91 and 751,000 in 1991-92, a rise of 6 per cent. This is a remarkable achievement on which I congratulate all those responsible in the north-western region.

Mr. Day : Will my hon. Friend make it clear to the House that the number of patients treated in the north-west is greater than ever before? Will he also take

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particular note of the fact that in my health authority we have seen the number of patients waiting for 18 months reduced by over three quarters in the past year? Will he, therefore, congratulate those who work in my health authority? Is not it time that the Labour party stopped running down the national health service? In his response, will my hon. Friend point out to the hon. Member for Bolsover (Mr. Skinner) that many Conservative Members rely totally on the NHS for their health care and are proud to do so?

Mr. Sackville : I certainly agree. There are many problems that we need to overcome in running the NHS as successfully as we do and 269 of them are sitting opposite us. We hear moaning and groaning and sniping and griping, but never any congratulations on the achievements of those who work in the national health service.

Mr. Eastham : Is not it time for Ministers to take off the blinkers when quoting some of the figures that they have this afternoon? In Booth Hall children's hospital in my constituency, waiting lists increase monthly. Only last month I exchanged correspondence regarding a doctor who complained that although a child had been referred to the hospital in January 1992, the earliest time that could be promised for surgery was May 1993. Are we saying that this is a success story? If the Minister disagrees with me, let us jump on the train now and check these facts out today.

Mr. Sackville : Let me remind the hon. Gentleman that no one in the region is waiting two years for treatment. A falling number is waiting for one year and we hope to complete the guarantee of 18 months for all hip, knee and cataract opertions. If he will write to me, I will investigate the particular case that he mentioned.

Mr. Nicholas Winterton : While I entirely endorse all the views expressed by my hon. Friend the Member for Cheadle (Mr. Day), does my hon. Friend accept that more of the patients in my Macclesfield health authority area are treated in the North-Western regional health authority than are dealt with in the Crewe health authority? Will my hon. Friend therefore oppose the merger of the Macclesfield health authority with the Crewe health authority, a merger which is strongly opposed by the local authorities concerned, a majority of the hon. Members concerned and the community health council? Is there democracy in the health service today or is there not?

Mr. Sackville : Those health authorities that have merged into larger purchasers have found greater efficiencies from doing so and are in a better position to purchase for the needs of the local population.

Hospitals (Charges)

11. Mr. McAvoy : To ask the Secretary of State for Health what plans she has to introduce charges for NHS hospital patients.

Mrs. Virginia Bottomley : There are no such plans.

Mr. McAvoy : The Secretary of State must be well aware that her Government briefed the media earlier this month that they were considering the introduction of charges such as those mentioned in my question. What assurance can the Secretary of State give the House that NHS charges for hospital patients will not be introduced? Or

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will that promise go the same way as the Prime Minister's promise not to introduce value added tax on domestic fuel?

Mrs. Bottomley : That is rich coming from the Labour party, which never comes clean on anything. No one yet knows where the Labour party stands on prescription charges. No one knows where it stands on sight charges. I have made the position quite clear. When it comes to manifestos, we remember that the Labour party said in its 1974 manifesto that it would cut spending on the health service, cut nurses' pay and cut doctors' pay. We have made our commitment to the health service clear. More patients now benefit from free prescriptions. The health service will continue to remain available to all, regardless of ability to pay.

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