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House of Commons
Tuesday 7 December 1993
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker-- in the Chair ]
PRIVATE BUSINESS
British Waterways Bill
[Lords]
Motion made, and Question proposed,
That the Promoters of the British Waterways Bill [Lords] may, notwithstanding anything in the Standing Orders or practice of this House, proceed with the Bill in the present Session and the Petition for the Bill shall be deemed to have been deposited and all Standing Orders applicable thereto shall be deemed to have been complied with ;
That, if the Bill is brought from the Lords in the present Session, the Agent for the Bill shall deposit in the Private Bill Office a declaration signed by him, stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the last Session ;
That as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been so deposited, has been laid upon the Table of the House, the Bill shall be deemed to have been read for the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;
That all Petitioners relating to the Bill presented in the last Session which stand referred to the Committee on the Bill, together with any minutes of evidence taken before the Committee on the Bill, shall stand referred to the Committee on the Bill in the present session ;
That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the last Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;
That, in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against Bill)" were omitted ;
That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the last Session.-- [The Chairman of Ways and Means.]
Oral Answers to Questions
HEALTH
Intensive Care Baby Cots
1. Mr. David Young : To ask the Secretary of State for Health if she will provide resources for the immediate purchase of two additional intensive care baby cots in Bolton ; and what account she takes of infant mortality levels in allocating funds.
The Minister for Health (Dr. Brian Mawhinney) : The director of public health of Bolton health authority has recommended upgrading and extending the intensive care provision for very sick babies. The health authority is acting on the recommendations and is in discussion with
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other local health service organisations to see how best to meet the need for access to two additional intensive care cots.Mr. Young : May I press the Minister further? He will be aware that Bolton has double the national infant mortality rate, and that that trend is increasing. He will also be aware that we in Bolton have 50 per cent. below the recommended number of intensive care beds, and have had for some considerable time. When will those two additional beds be in operation? Babies are currently being transported as far as Liverpool and Leeds, which has been a contributory factor in the death rate. I hope that, at Christmas time, the Government are not going to play Herod.
Dr. Mawhinney : The figures I have for infant mortality in Bolton-- as opposed to the figures for England and Wales--do not show a doubling, although I agree that the figures are higher than the national average. I hope that the hon. Gentleman will have been encouraged by my initial reply. The discussions about identifying the two extra intensive care cots which the director of public health said were necessary are being conducted urgently, because everyone understands that those cots need to be provided.
Mr. Thurnham : In view of the links between low birthweight babies and maternal smoking, will my hon. Friend look into the way in which cigarette advertisers have been targeting Bolton? Is that not in breach of the voluntary code?
Dr. Mawhinney : I am aware of my hon. Friend's concerns on those issues because he has related them before to me and to the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville). My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) is right to point out that the director of public health identified low- weight babies, smoking and teenage pregnancies as three issues on which the concerns in Bolton were different from those in the rest of the country. Consideration of those and other points is proceeding.
Dental Service
2. Mr. Wigley : To ask the Secretary of State for Health what assessment she has made of the adequacy of the level of dental service provision within the NHS ; and if she will make a statement.
Dr. Mawhinney : We are committed to an effective and accessible national health service dental service. There are now more general dental practitioners and more registered patients in England than ever before.
Mr. Wigley : None the less, is the Minister aware that in many areas the dental services provided by the NHS have collapsed as a direct result of the contract that the Government have mishandled so badly? In my constituency--I accept that it is not in England--not a single NHS dentist is taking on new cases in the Dwyfor district. People are having to travel up to 50 miles to find NHS treatment. Is not that a disgrace? When will the Government honour their pledge that the NHS is safe in their hands?
Dr. Mawhinney : The hon. Gentleman's initial statement was wrong. No family health services authority
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in England is unable to find dental health on the NHS for those patients who want it. I am aware of the problems in the hon. Gentleman's constituency because I have seen the correspondence that he has exchanged with my right hon. Friends the Secretaries of State for Wales and for Health.I am pleased to see that the hon. Gentleman's local health authority has now received permission to appoint four salaried dentists. I am also pleased that two extra community dentists have been appointed. In addition to the other measures taken locally, those appointments will go some way to meeting the problems that the hon. Gentleman has identified.
Mr. Hicks : Despite what my hon. Friend has said, is he aware that in rural areas, not least south-east Cornwall, there is certainly a fragility in the framework and structure of provision of our dental services? There is unease, which must be corrected so that the service can regain public confidence.
Dr. Mawhinney : I am aware of my hon. Friend's point, not least because he has made it to me several times, as have other hon. Friends from Cornwall. They will know that salaried dentists arrangements have been made in Cornwall. They will also know of the establishment of the peripatetic dental service. I put what my hon. Friend has said in the wider context of an increased number of dentists taking national health service patients--an all-time high--and of an increase of 1.6 million net in the number of patients registered for NHS treatment since 1 July last year, taking the amount now to almost 29 million.
Mr. Hinchliffe : Is not the Minister being unbelievably complacent on this serious issue? Will he treat the issue with the seriousness that it deserves-- [Laughter.] --a seriousness with which it is obviously not addressed by Conservative Members? Will he tell us why there has been such a lengthy delay in the publication of the Government's oral health strategy, which we were promised a considerable time ago?
What steps are being taken to deal with the health implications of the deregistration of more than half a million dental patients, including many children, in England? What steps is the Minister taking to deal with the concern expressed by both Conservative and Opposition Members about the fact that dental care is rapidly becoming a complete shambles, directly and entirely as a result of deliberate Government policy?
Dr. Mawhinney : What nonsense. A net increase of 1.6 million patients registered for NHS treatment, an all-time high number of dentists delivering NHS treatment and more courses of adult treatment do not add up to a national health service that is coming apart at the seams. The service is being supplemented by 87 salaried dentists and an expansion of the community dental service.
On the hon. Gentleman's first point, we have consulted widely. We have consulted areas that have never before been asked for opinions, such as the local dental committees. We have also taken careful note of the Health Select Committee's report which came out in the summer. The consultation would have been made far easier if the dentists had had any concerted idea of the future that they would like. The Government will produce their report shortly.
Mr. David Nicholson : May I reinforce the concerns expressed by my hon. Friend the Member for Cornwall,
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South-East (Mr. Hicks)? The matter to which he referred does not affect only rural areas ; it is causing considerable problems to my constituents in Taunton itself. Is there not effectively an industrial dispute in the dental service which is causing inconvenience to my constituents? Will my hon. Friend therefore bring forward the Government's conclusions on the Bloomfield report as soon as possible? Numbers of dentists as well as patients are waiting to know what will happen to the dental service.Dr. Mawhinney : I assure my hon. Friend that we will bring forward the proposals as quickly as we can, precisely for the reasons that he has outlined. I know that my hon. Friend shares my desire that we should spend enough time on the proposals to make them as effective as possible when we bring them forward.
Asthma
3. Mr. Eastham : To ask the Secretary of State for Health what measures her Department is taking to improve the treatment for asthma.
The Parliamentary under Secretary of State for Health (Mr. John Bowis) : The chronic disease management programme was introduced in July this year. So far, 90 per cent. of general practitioners have been approved to run an organised programme of care of patients with asthma.
Mr. Eastham : Is the Minister aware that the public feel that not enough urgency is given to the desperate condition of asthma, the incidence of which is growing at a terrific rate? Some 3 million people already suffer from asthma and admissions into children's hospitals have doubled during the past 10 years. It is now costing the nation almost £1 billion. The Government cannot expect to leave the voluntary organisations to care for those suffering from this complaint. The Government have to do far more about the problem of asthma.
Mr. Bowis : That is precisely why we have introduced the programme for general practitioners. It is a tribute to them that 90 per cent. of general practitioners have already accepted the challenge. I am pleased to note that the hon. Gentleman's health authority, North Manchester, has added to this by having an open admissions policy for people with severe attacks. That can only be good for the programme as a whole. We are concerned about the subject, we have taken notice and we have taken action. It is up to everybody--health authorities, general practitioners, the voluntary sector and the Government--to take steps to ensure that the disease is kept under control.
Mr. Alan Howarth : What plans does my hon. Friend have to respond to the call from the Asthma Training Centre, which my right hon. Friend the Secretary of State for Health recently visited in my constituency, for a national standard of training for health professionals, with accredited courses leading to formal qualification? Will my hon. Friend also act jointly with the Department for Education to make sure that schools have a proper policy on asthma, including the training of designated teachers?
Mr. Bowis : I will certainly talk to my right hon. and hon. Friends in the Department for Education. My hon. Friend is right : we are looking at the whole question of training. He is aware that, in addition to the English
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national board's course for nurses in respiratory diseases, we have a specific diploma course, run by the Asthma Training Centre, which brings people up to speed. My hon. Friend recognises that in the CDM--chronic disease management--programme one of the requirements is that doctors qualifying for that payment have trained staff who can fulfil their duties.Prescription Charges
5. Mr. Skinner : To ask the Secretary of State for Health what are the latest figures for the price of prescription charges ; and what were the comparable figures for 1979.
The Secretary of State for Health (Mrs. Virginia Bottomley) : The figures are £4.25 and 49p respectively.
Mr. Skinner : Is not the truth of the matter that the Government have revelled in sadistically attacking the sick and disabled by increasing prescription charges by more than 2,000 per cent? In those same years, the Government have also lined the pockets of the rich with £30 billion. It is not the sick and disabled who have brought the country to its knees but this rotten, lousy, evil Government. They should be made to pay the price--not the sick.
Mrs. Virginia Bottomley : I am afraid that there was cant as well as rant in that question. When the Labour party was in power, three items out of five were charged for ; now more are free. Under our stewardship, the NHS has gained an extra £1.6 billion. The Labour party has failed to say what it would do about charges. The proceeds from charges more than pay the health costs of the hon. Gentleman's constituents ; they pay them twice over each year. It is a practical commitment to an ever-improving health service, backed by the necessary resources.
Dame Jill Knight : Does my right hon. Friend agree that the one out of five persons who pay for their prescriptions are still getting a very good bargain--paying £4.25 for a prescription when the average cost is between £10 and £11?
Mrs. Bottomley : As ever, my hon. Friend makes an extremely good point. As she knows, one out of five now pay. When Labour was in power, two out of five paid. Pensioners, children and others on low incomes do not pay prescription charges, which are a contribution from those who can afford to pay towards a health service that provides for all.
Mr. Blunkett : Apart from the fact that more than 50 per cent. of prescriptions now cost less than £4.25, perhaps the Secretary of State can confirm that, as part of the Budget settlement, prescription charges are likely to rise, probably to a staggering £5 in the early new year, and that pregnant women and nursing mothers will lose their exemption from those charges?
Does the right hon. Lady agree that the amount of £53 million contrasts sharply with the £70 million which, it has been revealed, has been spent on cars for senior NHS management and staff? That expenditure has risen from £5 million to £24 million for those employed in trusts alone. Is that not a scandalous waste of vital resources that should be devoted to patient care?
Mrs. Bottomley : I hope that the House will note the predictions of the hon. Gentleman, because, once again,
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they will be shown to be absolutely false. We will announce the prescription arrangements in due course, but the House should note what the hon. Gentleman has predicted. Only recently, he said that the health service needed an extra £435 million. We have announced an extra £1.6 billion for it. The hon. Gentleman's predictions are always wrong and always full of doom and gloom. The House, however, is still waiting for any policies on the NHS from the hon. Gentleman.With regard to cars for NHS staff, the hon. Gentleman has, once again, done some selective editing, because he did not take into account community nurses, doctors and all those who need transport to deliver health care in the community. No one expects a true reflection of the facts from the hon. Gentleman, but some of us are still awaiting a policy from him.
Mr. Whittingdale : Is my right hon. Friend aware that whereas 82 per cent. of prescriptions are exempt from charges in this country, the figures for Germany and France are 30 per cent. and just 4 per cent. respectively? Does she agree that, by any measure, our record in this area is extremely generous?
Mrs. Bottomley : My hon. Friend is exactly right. We have a health service which is the envy of the world. I have been able to establish that few countries impose fewer charges in their health service than we do.
Winter Deaths
6. Mr. Jim Cunningham : To ask the Secretary of State for Health what assessment she has made of the number of excess winter deaths for England and Wales in 1992.
Mr. Bowis : The figure is 34,845.
Mr. Cunningham : Given the inadequate 50p compensation package on fuel bills, and given that the imposition of VAT will mean that the fuel bill of the average household, particularly those of pensioners, will rise by 89p, does the Minister agree that many more people, including old-age pensioners and those below pensionable age, will find themselves pushing up the figures for winter deaths?
Mr. Bowis : The hon. Gentleman should put the figure of 34,000 in its proper context, because it is out of a total of 558,000 deaths. All the research shows that there is no link between excess winter deaths and poverty, age or anything else. Perhaps the hon. Gentleman was trying, in an oblique way, to thank my right hon. and learned Friend the Chancellor for his package, which will provide £1.5 billion for supportive fuel measures.
Perhaps the hon. Gentleman would also like to reiterate his thanks, which i am sure he meant to give, for the achievements gained under the "keep warm, keep well" campaign, cold weather payments--I do not recall that the Labour party introduced such payments when it was in power--and home insulation grants. All that proves that it is possible to keep warmer under this Government than it was under the Labour Government.
Sir Donald Thompson : Is that estimate of winter deaths more or less than the number of those who were frightened to death by the propaganda of the Opposition?
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Mr. Bowis : My hon. Friend is quite right to point that out. It is also worth noting that, of those winter deaths, hypothermia accounted for just 362. That information should be judged alongside the fact that, in the next 20 years, it is expected that 50 per cent. more people will live past the age of 85, and that, in the past 10 years, there has been a 20 per cent. fall in under-65 deaths. I am sure that my hon. Friend will agree that, given those facts, life is not just better under the Conservatives-- it is longer.
Ms Lynne : Is the Minister aware that there has been a considerable increase in winter deaths due to influenza over the past two to three months compared with the same time last year? The figures come from the Office of Population Censuses and Surveys. What action will the Government take to make up for the shortfall of influenza vaccine, to prevent any more deaths from influenza?
Mr. Bowis : I can confirm the hon. Lady's point that influenza has been a factor in the excess deaths this year. That is always the case when there are bouts of influenza, as one might expect, in the winter months. I can also confirm that there is no shortage of influenza vaccine. As of today, the supplies are completely up to date, and the expectation is that all future demand this winter can be met.
Mr. Elletson : Is my hon. Friend aware that one of my constituents, a pensioner, died last week from hypothermia? Does he agree that, although his death was tragic and avoidable, it was nothing whatever to do with the extension of VAT to fuel? [Interruption.] It has nothing whatever to do with the extension of VAT to fuel, because it has not yet been extended to fuel. Will my hon. Friend take this opportunity to congratulate the Chancellor on the many measures in his Budget that will help to keep pensioners warm next winter?
Mr. Bowis : I will pass on my hon. Friend's thanks. He is quite right. Nobody could conceivably have died as a result of VAT on fuel when it has not yet been imposed on fuel. When it is, individuals will be protected by the package of measures to which my hon. Friend and I have referred.
It is also true that we have seen a steady falling in the level of people dying from hypothermia to the very small figures that we have today. That is in no small part a tribute to the Government and all those involved in the voluntary sector in the "keep warm, keep well" campaign, which has now been running for seven years, and which this year has a commitment of £500,000 towards giving that message, and that support and comfort, to the elderly.
Ms Primarolo : Is the Minister aware of the research by Professor Khaw at Cambridge university, which has established a clear link between the increase in winter deaths, in winter, obviously, and fuel poverty? [Laughter.] Well, we are told that 34,845 additional deaths in the winter months are linked to fuel poverty. Is he further aware that Dr. Boardman at Oxford university has calculated that, even after the inadequate compensation of VAT on fuel, at least a further 2,500 people will die?
Does the Minister not feel a responsibility for those deaths? What will he do to ensure that the necessary health prevention is undertaken, and proper compensation given for VAT on fuel to prevent those premature deaths?
Mr. Bowis : The compensation has been given. "The Health of the Nation" and the health strategy of the
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Government are ensuring that old people are regularly checked by their GPs. If the hon. Lady wants to trade research, I suggest that she reads all of it, because the research that I have seen shows that there is no connection between the points that she has made. There are all sorts of reasons for the excess winter rate of deaths. Some of them are to do with the fact that we have reduced the specific summer reasons for deaths. There are many other elements, such as the natural conditions of a particular country, including humidity, day and night temperatures, even wind speeds. If the hon. Lady wants to help the elderly best, she can join me in advising them to avoid having one room much hotter than another, because a change of temperature can affect circulation, and that is an avoidable factor.London Health Services
7. Sir Michael Neubert : To ask the Secretary of State for Health what are the main criteria for her policy for the location of accident and emergency, neurosciences and oncology services in the Greater London region.
Mrs. Virginia Bottomley : No accident and emergency department will be closed in London, or anywhere else, unless and until it can be shown that proper alternative facilities exist which will secure patient safety and provide quality patient care. As for the specialist services to which my hon. Friend refers, the Government are seeking to reduce the current duplication and fragmentation in London and create a number of world-class centres for treatment, teaching and research.
Sir Michael Neubert : Is my right hon. Friend aware that Oldchurch hospital in my constituency, which is easily accessible to an area with an above-average incidence of illness and deprivation, has served the health needs of the people of Romford and around it to their satisfaction for generations? Is she further aware that there is massive public demand for that hospital to continue as a fully functional district general hospital, and that repeated attempts to remove vital services--the latest being accident and emergency services in respect of which four alarming cases within a month have revealed that patients can expect to wait up to four to six hours in casualty before treatment--are greatly resented and are being actively resisted?
Mrs. Bottomley : I am well aware that my hon. Friend is a great champion not only of his local health service but of Oldchurch hospital in particular. Throughout the country, we must face change in the delivery of health care if we are to have cost-effective improvements that take forward the pioneering medicine that is so important to the citizens of the United Kingdom.
I have looked at the figures for my hon. Friend's area. An extra 1, 100 patients were treated last year. A £6.1 million building programme is in place, involving a new theatre, maternity and paediatric block at the local Harold Wood hospital. The area is also doing extremely well under the patients charter--a written constitution of what local people can expect from their health service. My hon. Friend's health authority will be bringing forward further plans. Above all, it must take forward quality improvements for local people.
Ms Abbott : On the question of oncology services, the Secretary of State suggests that there is duplication and
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excess provision. My constituent, Dr. Spitzer, wrote to me a few days ago about a patient of his whom he sent to the oncology department at Bart's. The consultant recommended that that patient be admitted immediately because his cancer was so far advanced. He was sent home because of a shortage of beds and he died that evening. When will the Secretary of State concede that people are dying because of her policies in London and that more people will die if those policies are pushed through?Mrs. Bottomley : Only yesterday, the chief executive of the NHS produced his annual report which showed that an extra 1.3 million patients had been treated since the introduction of the reforms. Clearly, when anything goes wrong, it is essential to investigate and learn any lessons. But the average cancer service in London, as the independent review of services in London showed, sees about half the number of patients seen elsewhere. The health service has to be cost effective in the delivery of care. I have explained to the House how we have produced an extra £1.6 billion, and there is an extra £70 million for the hon. Lady's region next year. At the same time, however, we have to find the most efficient way of delivering that care.
Mr. Carrington : Has my right hon. Friend considered the need for a major trauma centre in west London? Does she agree that the ideal location for such a centre would be the Charing Cross hospital, which has magnificent specialty services and is ideally located, with easy access from Heathrow and central London?
Mrs. Bottomley : I well understand my hon. Friend's commitment to his own hospital, which serves his constituents so well. It is the case-- independent experts and those in the medical profession are agreed--that the duplication and institutional costs in London are excessive. If we are to take forward the 100 projects in primary care and to have more balanced health provision in London, we must face change. I hope that we shall be able to bring the uncertainty to an end before long and I will certainly note the points that my hon. Friend makes.
Mr. Blunkett : Will the Secretary of State comment on the front page of the London Evening Standard, which has a headline about 5, 000 fewer nurses and triple the number of men in grey suits? Will she bear in mind the Tomlinson report and the work of the London implementation group ; the separate and contradictory proposals for closure and rationalisation under the specialty reviews ; and the fact that the internal market is threatening a completely separate set of hospitals such as University College hospital? Given all that, is it not time that the Secretary of State came clean on her proposals for the future of London's health service and made a statement to the House to end the demoralisation and despair among staff and patients in our capital city?
Mrs. Bottomley : I am sure that the hon. Gentleman must be aware that a great number of former nurses have been redesignated as managers because they held senior positions of responsibility. The same applies to Project 2000 nurses. We have now been able to extend Project 2000 throughout the country so that all nurses training are designated as students rather than nurses. Only six weeks ago, I was announcing the abolition of the regions and the
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substantial slimming down of the layers of authority, and what did the hon. Gentleman say? He complained about redundancies. The hon. Gentleman simply cannot have it both ways. We want a slim, lean, effective service that has the maximum number of people providing hands-on care. That is our whole commitment in London, where change is necessary. I believe that that should unite us and we shall bring the uncertainty to an end before long.Mr. Harry Gl she consider whether extra funding can be provided to meet the enormous pressure on Ealing compared with other hospitals in London?
Mrs. Bottomley : In London in particular, the use of accident and emergency services and its relationship with primary care and GP services is a central factor. My hon. Friend will be aware that 100 primary care projects are under way within the London area in the year ahead. I shall look at the particular factors my hon. Friend describes, and I have some good news for him. The allocations to his region that I am announcing today will include an extra £61 million for next year. That will mean that his region has a total spending of £1.3 billion.
Preventive Health
8. Ms Quin : To ask the Secretary of State for Health when she next plans to meet her EC counterparts to discuss preventive health.
Mrs. Virginia Bottomley : The next meeting of the EC Health Council takes place on 13 December. I have this week written to my EC counterparts to inform them of the health prevention measures which my right hon. and learned Friend's excellent Budget contains.
Ms Quin : Does the Secretary of State agree with the findings in her own Department's report that a ban on tobacco advertising could reduce cigarette smoking by up to 9 per cent. and also save 10,000 lives a year in Britain? In view of this, will she be supporting a ban on tobacco advertising at the EC Council meeting on 13 December?
Mrs. Bottomley : What I am saying clearly to my fellow Ministers, and what my hon. Friend the Minister for Health will be saying at the EC Health Council, is that Britain has had a more substantial fall in the amount of smoking than any other country in the EC except the Netherlands. It is not my view that a statutory ban on tobacco advertising is an appropriate way of achieving change. We know that for every 10 per cent. increase in price there is a 3 to 6 per cent. fall in consumption. When the Labour party was in power, the price of cigarettes went up by about 1 per cent. It has gone up by about 67 per cent. since we have been in power. We believe in achieving results, not pursuing gimmicks.
Mrs. Roe : Will my right hon. Friend join me in congratulating the Chancellor of the Exchequer both on increasing the price of a packet of cigarettes by a further 11p in the Budget last week and on committing the Government to a real-terms increase in tobacco taxation in each successive Budget? Will my right hon. Friend be encouraging her EC counterparts to press their Finance Ministers to take similar action?
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Mrs. Bottomley : I will most certainly be doing precisely that. I am grateful to my hon. Friend. It seems ironic that those who seem most keen to ban the advertising of cigarettes seem to be those who have their own nationalised industries. I would only ask my hon. Friends to compare the price of cigarettes here with that in Spain, for example, where they sell for 51p a packet. We have a tight package of measures, not only increasing the penalties on those selling cigarettes to under-16s, but having the largest warnings on cigarette packets of any country in the EC. We are meeting our targets for adults and pregnant women ; it is the children of smoking parents who cause most concern and we will renew our activities to ensure that they also help us to meet the targets that we set out in "The Health of the Nation".
Chemists, Leicestershire
9. Mr. Janner : To ask the Secretary of State for Health what plans she has to help the small chemists in Leicestershire.
Mr. Bowis : The Government have helped small pharmacies by extending the essential small pharmacy scheme and by protecting the income of small pharmacies during the transition to the new arrangements.
Mr. Janner : Is the Minister aware of the great concern felt by small pharmacies in Leicestershire about the fact that they may be forced to close as a result of the Government's new remuneration policy? Does he accept that it is vital for sick people to have local chemists available to them and, if so, will he please review the remuneration policy, especially with regard to the provision of the more expensive drugs?
Mr. Bowis : Well, I am surprised. I thought that the hon. and learned Gentleman was going to say thank you. He wrote to us last July on behalf of small pharmacists in Leicestershire asking us to take account of the fact that the 2,000-prescription threshold for new payments for professional services was too high. We listened, we consulted and we reduced the figure to 1,500. We also recognised the need to safeguard low- volume pharmacies. We recognised their concern about the scheme's requirement of a distance of 2 km from the nearest pharmacy. Again, we listened, we consulted and reduced the distance to 1 km. After all that, I should have thought that the hon. and learned Gentleman could say thank you twice.
Mr. Duncan : In answering the concerns of the hon. and learned Member for Leicestershire, West (Mr. Janner), will my hon. Friend confirm that a substantial proportion of the extra money going to the NHS announced last week will go to the Trent region which includes Leicestershire? If my hon. Friend has the figures, perhaps he would enlighten the House by letting us know what they are.
Mr. Bowis : I am advised that the figure is £94 million extra.
Ms Glenda Jackson : Why should small pharmacists in my constituency thank the Minister, in the light of the fact that the 1,500 threshold means that up to 13 per cent. of small pharmacies may close--
Madam Speaker : Order. Will the hon. Lady please relate her question to Leicestershire?
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Ms Jackson : Does the Minister agree that the experience of small pharmacies in Leicestershire is reflected nationwide? Does he further agree that the service provided by small pharmacists, when, upon occasion, prescriptions are delivered to house-bound and elderly pensioners, is something for which they should be remunerated?
Mr. Bowis : I am glad that the hon. Lady has realised that the distance between Leicestershire and London is a little more than 1 km. Nevertheless, she will recognise that the important point is that small pharmacists are being helped by these measures. The 1,500 prescriptions a month means an income of £30,000 and there is also the income from cosmetics and toiletries. However, we acknowledge the difficulty that some people might face, particularly in rural areas, of getting to more distant pharmacies and that is why we have introduced this very welcome scheme. I hope that small pharmacists, who may have a particular geographical reason for helping their local communities, may find it easier to survive and prosper.
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