Column 1T H E
P A R L I A M E N T A R Y D E B A T E S
IN THE FIRST SESSION OF THE FIFTY-FIRST PARLIAMENT OF THE UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
[WHICH OPENED 27 APRIL 1992]
FORTY-SECOND YEAR OF THE REIGN OF
HER MAJESTY QUEEN ELIZABETH II
SIXTH SERIES VOLUME 224
EIGHTEENTH VOLUME OF SESSION 1992-93
House of Commons
The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : Our new community care arrangements came into operation in all parts of the country on 1 April. It is now for local health and social services authorities to make full use of the enormous opportunities that those arrangements present. Our monitoring showed that authorities in Somerset were well prepared to take advantage of those opportunities for the benefit of both users and carers.
Mr. Robinson : Does my hon. Friend agree that Somerset was one of the best prepared counties in its plans for implementation of the community care programme? Would he also agree that that is a good reason to re-elect the Conservative-controlled authority on Thursday?
Mr. Yeo : My hon. Friend has put his finger right on the point. As we would expect, the excellent Conservative-controlled Somerset county council is taking its new and substantial responsibilities extremely seriously. Only by re-electing that Conservative council can we hope to preserve user choice, continue to raise standards and, above all, get the best value for money out of the enormous increase in resources that the Government have given Somerset--a 22 per cent. real increase over the past three years in the personal social services standard spending assessment and, on top of that, a special grant of £5.8 million for comunity care.
Mrs. Dunwoody : Is the Minister aware that, far from benefiting from care in the community, the shire counties are already discovering very directly that there are real problems? Is he also aware that some private firms are charging £25 a head for information about private homes? Is that what he means when he speaks about endeavouring to improve patient care?
Mr. Yeo : I am certainly aware that some councils, such as the Labour-controlled Derbyshire county council, are failing to co-operate with the independent sector, refusing to consult with independent providers of community care because of their dogmatic insistence that these services can be delivered only by a public sector monopoly. The Government will not tolerate that from shire counties or anywhere else, and Labour-controlled councils that are continuing to cling to out-of date dogma must heed this warning now.
Mr. Yeo : As I said earlier, our new community care arrangements came into force on 1 April in all parts of the country. They present substantial new opportunities for local health and social services authorities. Our monitoring of preparations in Kent showed that Kent
Column 3county council was one of the best prepared of all authorities to take full advantage of those opportunities for the benefit of users and carers.
Mr. Arnold : Is my hon. Friend aware that in Kent care managers have been in place for three years and that Conservative-controlled Kent county council has developed an excellent database in co-ordination with the general practitioners to ensure that individual packages for the people who need care are properly in place? Is this not an example of what Conservative-controlled Kent county council has done, and should not that example be followed throughout the country?
Mr. Yeo : I am glad to say that my hon. Friend has also put his finger right on the point. I gladly join him in paying tribute to the superb policies of Conservative-controlled Kent county council under its excellent chairman of social services and her fine team of supporting officers.
My hon. Friend mentions one of the many fields in which Kent county council is leading the way. There is one more--that council's co-operation with the independent sector. Kent county council is funding Age Concern to take over the running of many of its elderly persons' day centres. Such co-operation between Kent county council and the voluntary sector clearly gives the lie to Opposition assertions that the Government's insistence that the bulk of the special transitional grant must be spent buying services from the independent sector-- [Interruption.]
Let me conclude by saying that that co-operation between the voluntary sector in Kent and the county council gives the lie to Opposition claims that the Government's insistence that the bulk of the special grant must be spent purchasing services from the independent sector perpetuates the residential model. It clearly does not.
Mr. Hinchliffe : Bearing in mind the fact that, under the Government's bizarre system for distributing community care funding, Kent receives money that should have gone to other areas, notably the London area, because the funding is sent where people have gone to in the past rather than where they come from, does the Minister feel that Kent will be in a position to improve its performance in providing home care, given that, according to the Chartered Institute of Public Finance and Accountancy league table, it is 28 out of 32 in terms of county councils, with Labour Derbyshire county council coming top?
Does it not say something about the financial crisis facing local authorities in the implementation of the community care changes that Kent, with all its financial advantages, has to make savings of around £2 million in the current financial year ?
Mr. Yeo : So far from making savings in the current financial year, apart from a proper insistence on efficiency, Kent was recognised, even by The Guardian on 30 March, as one of the councils that were substantially increasing expenditure on personal social services--as one would
Column 4expect, because Kent received an increase of 7 per cent. this year in its personal social services standard spending assessment. The hon. Gentleman speaks of a bizarre distribution method. We are recognising need by our distribution formula. That is the purpose of the policy--to allow authorities to respond to needs. That is why the inner -London boroughs receive almost three times the money per head of population that the shire counties receive.
Mr. Wolfson : While I welcome my hon. Friend's positive comments about Kent, may I ask him to keep a particularly close eye, as the policy develops, on two sectors ? The first is the development of care for the mentally ill, and the second is the services being offered by rehabilitation centres for alcoholics and drug offenders, which have been used to drawing clients from all over the country but which, under the new system, may find that more difficult ?
Mr. Yeo : My hon. Friend has already mentioned to me privately his concern with facilities for the mentally ill. I look forward to visiting his constituency soon to open a new resource provided by the independent sector in the shape of MIND. As to the provision of services for drug and alcohol abusers, my hon. Friend will be aware that we have set up special monitoring arrangements to examine closely the effects of our new policies during the first three months on the providers of those services and the access that those who need them should continue to have.
A number of county councils, including Conservative-controlled Hampshire and Surrey, have set up ring-fenced allocations from within their special transitional grant to ensure that specialist services for alcoholics and drug abusers continue to be fully utilised. In the case of Hampshire, I know that the sum that has been allocated is greater than the sum that would have been available had we gone ahead with the original intention to ring-fence money at the national level.
3. Mrs. Jane Kennedy : To ask the Secretary of State for Health if she will make it her policy to introduce a guarantee of employment for all nurses satisfactorily completing their nurse training in 1993.
The Secretary of State for Health (Mrs. Virginia Bottomley) : Regional health authorities and local employers manage the recruitment of qualified nurses and are already seeking ways to provide each newly qualified nurse and midwife with at least a period of employment.
Mrs. Kennedy : Does the Secretary of State accept that it costs at least £36,000 a year for every student nurse in training for three years, and that it is a monumental waste of resources to have such nurses leave the profession either to find other work or to join the dole queue? Will she accept two simple proposals that might help nurses to find work-- the introduction of careers counselling for student nurses and the development of a national database for nursing vacancies?
Mrs. Bottomley : I accept the hon. Lady's comments on how expensive it is to train nurses. We need extremely competent nurses for the health service of today and tomorrow, and that is why we have invested £321 million
Column 5on Project 2000--£114 million this year. I am pleased to say that five out of six nurses gain employment immediately upon qualifying, and all regions are exploring various ways of taking the matter further. They could well follow the example of Mersey in this area, as in so many others, which has ensured that the number of nurses being trained meets the requirements of the health service. That is a matter for the regions to explore, using the many means at their disposal.
Mr. Dickens : Will my right hon. Friend concede that British nurses are the best trained in the world and that when they are trained they are the hardest working, most dedicated workers that one could ever see? As today's high-tech training of nurses far exceeds that in the days of Florence Nightingale, will my right hon. Friend try to ensure that regional health authorities gauge more carefully their labour requirements for the years ahead so that we do not train these wonderful people only for them to find that they have no jobs at the end?
Mrs. Bottomley : As ever, my hon. Friend has it exactly right. British nurses are among the best in the world. During my recent visit to Russia, for example, I was particularly pleased to see much British nursing expertise being put to good effect. But it is because we believe in nurses that we have treated them so well, increasing their pay by 50 per cent.-- unlike the Opposition, who cut it by 3 per cent.--and introducing the new independent pay review body, the new clinical grading system and Project 2000. My hon. Friend has it right. All regions should do as well as Mersey and ensure that they balance their training input with the number of jobs.
Mr. McCartney : Is it not a disgrace that the Secretary of State gave no commitment to the House today to guarantee a job for every student leaving nursing college in the next financial year? In Leeds, there is 70 per cent. unemployment among student nurses leaving college, in Birmingham, there are 200 applicants for every three nursing jobs and 50 per cent. of student nurses cannot find a placement at the end of their training. Yet the Government have wasted £86 million on incompatible computer software for GP fund holders. That is equivalent to 6,880 new nursing jobs. Is it not time that the Government got their priorities right and spent money on nurses who have completed their training?
Mrs. Bottomley : Is it not typical of the Labour party that it always tries to find the cloud over the silver lining? Nurses now stay in the health service for an average of 14 years compared with an average of seven years previously. Turnover has fallen to about 10 per cent. and as low as 3 per cent. in some places. That is because nurses know that they have a worthwhile future in the health service and will continue to do so. Of course I regret those few trained nurses for whom there is no immediate employment ; that is why regions are working hard to try to find ways to try to prevent that. But nobody should think other than that nurses have an extremely worthwhile career in the health service, as set out in the chief nursing officer's vision for the future only last week.
Column 6Project 2000, improved clinical grading schemes and improved training and education, the likes of which were not seen when Labour was in office?
Mrs. Bottomley : How right my hon. Friend is. Nurses will look back at those days when not only the capital programme of the health service was cut, but nurses' pay was cut in real terms--a disgraceful record. As my hon. Friend so rightly says, we have introduced all the key elements that nurses so wanted. "The Health of the Nation", the patients charter and the health service reforms all rely on committed, well-qualified nurses. I am pleased that that is the case in this country.
4. Mr. Corbett : To ask the Secretary of State for Health what steps have been taken to ensure that family health services authorities will be able to purchase general dental services in the most cost effective manner.
The Minister for Health (Dr. Brian Mawhinney) : Family health services authorities do not at present purchase general dental services. Giving them that role is one of the many options identified in Sir Kenneth Bloomfield's report, on which we are currently consulting interested groups.
Mr. Corbett : Is the Minister able to tell the House that he has rejected Sir Kenneth Bloomfield's recommendations on withdrawing dental services from 1 million nursing mothers and pregnant women? Does he understand that dental treatment delayed or avoided will cost more in the end and will damage the nation's teeth?
Dr. Mawhinney : I understand that Sir Kenneth produced a comprehensive report and one that has been widely welcomed and appreciated. We are committed to consulting on it, and those consultations are going ahead and producing ideas from a variety of interested groups on how we should best move forward. I should have thought that the hon. Gentleman would welcome that. When we are in a position to let him have decisions we shall make them available to the House.
Mr. John Marshall : Can my hon. Friend tell the House whether there were more or fewer national health service dentistry through-patients in the first six months of this year? Can he also tell the House how many NHS dentists there are today compared with 1978?
Dr. Mawhinney : I am happy to be able to tell my hon. Friend that 28 per cent. more dentists are operating in the health service today--the precise figure is 17,871. I am also happy to be able to tell him that, since 1978, there has been an increase of about 8 million courses of adult treatment per year. He will also be encouraged to know that, since 1 July, 640,000 more patients have registered for NHS dental treatment. Those are all records of which the Conservative side of the House can be justly proud.
Dr. Mawhinney : It is for regional health authorities to keep allocation formulae for allocating to districts under review. The Department is reviewing the formula for allocating to regions, and will give guidance to regional health authorities on any lessons learned from the national review which might profitably be applied in the regions' district formulae.
Ms Short : The Minister will know that the formula used nationally rightly gives a higher weight to the number of elderly people in an area, because they are heavier users of the health service. As a consequence, areas such as mine in west Birmingham--a poor community, where people on average live less long--lose money for the health service, and that has been recognised locally as some adjustments have been made.
I should like an undertaking that, until the Minister can get the formula right, my area and others like it--I think that there are six in the country--will not lose any money because of the defect in his formula.
Dr. Mawhinney : I understand the hon. Lady's argument, and also that west Birmingham is considerably over the capitation formula arrangements. In my answer to her question, I sought to encourage her that we are considering more direct measures for NHS care and treatment, as part of our response to the 1991 census and our review of the formulae that we apply to make money available to regional health authorities.
A better basis may emerge from our review--rather than simply issues based on social deprivation--which we might be able to commend to regions for consideration. As the hon. Lady knows, however, decisions on capitation allocations are ultimately matters for the regions.
Mrs. Roe : Does my hon. Friend agree that, although the level of health spending and how the money is distributed are clearly important, one should judge the success of the health service by the number of patients treated and the quality of service provided? Has my hon. Friend seen the recent Labour party publication which claims to provide an overview of the health services but which hardly mentions patients in its general obervations? Does not that show that the Opposition have got their priorities all wrong?
Dr. Mawhinney : As always my hon. Friend is exactly right. I searched almost in vain for a mention of the word "patient" in the latest Labour party document. I found the Labour party view that the health service was about £40 billion underfunded. Now we all know that Labour wants to add 26p to the basic rate of tax to fund the NHS. We do not know how much the Liberal Democrats would like to add to the basic rate. They also always claim that more money should be spent--but they do not have the guts of the Labour party to say how much.
Dr. Lynne Jones : Will the Minister compensate the people of the west midlands for the £10 million wasted as a result of incompetence, if not corruption, on the part of those whom the Government put in charge of that health authority's affairs?
Dr. Mawhinney : No doubt the hon. Lady was pleased to learn that this year, West Midlands regional health authority received £1.855 billion to spend on health care delivery in the region, which was an increase of more than 2.9 per cent. in cash or 1 per cent. in real terms.
Column 8The hon. Lady made a serious point. She knows that the Government take the matter seriously. Recently, I visited Birmingham to make sure that all the lessons that needed to be learned from recent events in the west midlands have been learnt and that appropriate steps have been taken to ensure that they do not occur again. I was encouraged not only by the actions taken by Sir Donald Wilson as the authority's new chairman but by the new mood of confidence and determination pervading the authority, which will ensure that the people of Birmingham and of the west midlands receive the best possible health care, which they deserve.
Mrs. Virginia Bottomley : Oxford region is an excellent example of the growing success of the trust movement. From 1 April, 15 units--nearly two thirds of all those in the region--achieved trust status.
Sir Anthony Durant : Will my right hon. Friend confirm that, thanks to the excellent work of NHS trusts, including the Royal Berkshire hospital and Battle hospital--which cover my constituency and the neighbouring constituency of Newbury--the 18-month waiting list for cataract, hip and knee operations has been eliminated? That is thanks also to the policies promoted in our manifesto.
Is my right hon. Friend aware that my wife and I attended Royal Berkshire hospital following an accident at Christmas? My wife underwent a serious operation on her shoulder. We received that treatment as national health service patients-- [Interruption.] I hope that the hon. Member for Bolsover (Mr. Skinner) realises that. As NHS patients, we received an excellent service.
Mrs. Bottomley : I confirm my hon. Friend's comments about the Oxford region and about Newbury in particular. Not only in Oxford but throughout the country, no patient is waiting longer than 18 months for a hip replacement or cataract operation. At the end of last month, only eight patients were waiting for a knee replacement. We have passed another milestone in our sustained and increasingly successful drive to reduce long waiting times. We have honoured a key pledge in our manifesto and in the patients charter.
I must tell my hon. Friend that he has sold the residents of Newbury short. At the West Berkshire priority care NHS trust, which I visited last week, no patient is waiting longer than 15 months. That is a substantial achievement. I am delighted that the care received by my hon. Friend and his wife at the Royal Berkshire trust was of such high quality. A recent patient survey in Newbury showed that well over 90 per cent. of patients were very satisfied with the health care that they receive.
Mr. Skinner : If the NHS satisfies the hon. Member for Reading, West (Sir A. Durant) and one or two others in the Tory party, why does not the Secretary of State tell every member of the Tory Cabinet to use the NHS?
Column 9responsibility to ensure that the NHS continues to improve and to treat patients to an ever higher standard. The dramatic reductions in waiting times are a great achievement, as are the new immunisation figures that I was able to announce over the weekend. Nye Bevan would be cheering in his grave.
7. Mr. Roger Evans : To ask the Secretary of State for Health what assessment has been made of the interest of family doctors in the general practitioner fund-holding initiative ; and how this has changed since April 1991.
Dr. Mawhinney : A total of 6,000 general practitioners in 1,200 practices are now fund holders. The number of practices in the scheme is now four times as many as in April 1991 and one in four of the population is benefiting from having a fund-holding GP.
Mr. Evans : Does my hon. Friend agree that this is a further piece of good news and that the extension of GP fund-holding, promised in the Conservative election manifesto, is one of the best ways of improving patient care and making the health service more responsive to people's needs?
Dr. Mawhinney : However, it is of great benefit and encouragement to patients. I can tell my hon. Friend that we are looking for ways to extend GP fund holding even more widely, particularly for those practices which by themselves cannot meet the 7,000 practice list requirement.
Ms Lynne : Has the Minister looked into the possibility of setting up locality fund-holding practices, which will help us to get away fromt the two-tier system where fund holders' patients often jump the queue?
Dr. Mawhinney : That is nonsense. As I made clear in Chester the other day, the hon. Lady is going to have to come to terms with the fact that from now on we have shared purchasing in the health service. If the reforms are about providing the most
patient-sensitive treatment and care possible, GPs are in a maximal position to determine what is good for their patients. Their role in purchasing is central to the reformed NHS and not only will we not back away from it, as the hon. Lady wants, but we will seek to advance it.
Mr. Sims : Is not one of the most positive aspects of GP fund holding the arrangement whereby consultants can attend at GPs' surgeries, which must be for the benefit of patients? Is my hon. Friend aware that there is some concern among consultants in dermatology, whose numbers are small and who are worried that they may spend too much time travelling, which is not the best use of an important but limited resource?
Dr. Mawhinney : My hon. Friend is absolutely right. Recent surveys have shown that 70 per cent. of fund holders report reductions in waiting times, more than 60 per cent. report improved services for follow-up appointments and over 50 per cent. report increased
Column 10consultant services in their surgeries. I visited a fund-holding surgery on Saturday and was able to see physiotherapy being delivered to a patient, which was clearly to the benefit of the patient. I note the other point that my hon. Friend has mentioned.
Mr. Blunkett : Will the Minister confirm that he has direct responsibility for the implementation of the Government's proposals for health care in London and that on 16 February the Secretary of State, in her statement to the House and in public pronouncements, gave the impression to the world that new money was to be invested in primary health care and GP practices in London? Will he now confirm that that was grossly misleading--that there is to be no new money and that the money that is to be applied is being taken from other vital health care investment, in London and the rest of the English regions?
Dr. Mawhinney : I think that is probably as good a response to the hon. Gentleman's question as I can think of. The hon. Gentleman knows-- although he may not understand--that we have made a real increase in the NHS budget this year. That real increase has been distributed down the normal channels through which money flows from the centre to health care delivery, and it is that real increase which is helping to fund the resources in London. If it were not for this Government, the extra resources would not be made available to improve primary and community health care services in London : that is certainly the tenor of Labour party policy. I am sure that the people of London are very pleased that the Labour party is in opposition and that we are in government.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : Three hundred and twenty-nine general practitioners in 83 practices are now fund holders in the north-west. That means that nearly one in five of all those living in the north-west now benefits from being registered with a fund-holding practice.
Sir Fergus Montgomery : Does my hon. Friend agree that there must be considerable satisfaction about the increase in the number of fund holders in the north-west region? For the benefit of the whingers on the Opposition Benches, can my hon. Friend list some of the benefits that patients in the north-west will get from fund holding?
Mr. Sackville : I am glad to do so. They will get greater flexibility and an entirely new attitude from general practitioners to the management of their practices. Fund holding will transfer much of the power from hospitals to general practitioners and their patients. May I say, as a fellow north-west MP, that I am sorry that the figure iices but to the political nonsense that is talked by the Labour party, which represents GP fund holding as being everything that it is not. It is a further example of how the Labour party does not give a fig about patients, only about scoring its own miserable political points.
Mr. Bryan Davies : How will GP fund holders and, even more so, those doctors who stay fully loyal to the NHS provide an adequate service for their patients if trusts such as the Royal Oldham trust place increasing emphasis in their business plans on private practice?
Mr. Sackville : The suggestion that fund-holding GPs are disloyal to the NHS is outrageous. They are some of the finest GP practices in the country and will be joined by many more, including many single-handed and small practices which are taking advantage of agency arrangements. As for the hon. Gentleman's question about trusts placing increasing emphasis on private practice, surveys show that referral patterns by GP fund holders have remained the same as those of non-fund holders. They have referred fewer rather than more patients to private practice.
Mrs. Virginia Bottomley : At 1 October 1979, the average number of patients on family doctors' lists in England was 2,286 ; the provisional figure for 1 October 1992 is 1,922, representing a reduction of 16 per cent.
Mr. Wells : As a member of another family that is entirely dependent on the NHS, may I congratulate my right hon. Friend on that reduction ? Does not it mean that every GP can spend more time with his patients and can concentrate on preventive medicine, such as the child immunisation programme ?
Mrs. Bottomley : My hon. Friend is exactly right. The family doctor service is the basic building block of the NHS. It has a central role in educating the family over the lifetime of that family. My hon. Friend, like so many others, has great confidence in the changes that are taking place. We have almost eradicated a great number of childhood diseases as a result of the success of GP contracts. The Labour party, as ever, resists change and it resisted the GP contract. The success of GPs, health visitors and practice nurses has saved hundreds of thousands of hospital admissions and the lives of tens of thousands of children--once again, a great success.
Mr. Madden : What safeguards exist to ensure that people who are wholly unqualified are not allowed to practise as family doctors ? Has the Secretary of State agreed to establish an independent inquiry into how Mohammed Saaed could practise as a general practitioner in Bradford for nearly 30 years, although he was wholly unqualified and despite an avalanche of complaints against him over that time ? Will there be an independent inquiry into that disgraceful affair ?
Mrs. Bottomley : I well understand the hon. Gentleman's deep concern about that particular matter. It is essential that when general practitioners are appointed, their qualifications are properly scrutinised. I am prepared to discuss the matter with the professional bodies involved to ensure that all possible steps are taken to avoid such an occurrence happening again. As the hon. Gentleman will