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House of Commons

Tuesday 25 January 1994

The House met at half-past Two o'clock


[Madam Speaker-- in the Chair ]

Oral Answers to Questions


Community Care Grant

1. Mr. Parry : To ask the Secretary of State for Health what steps she has taken to monitor the adequacy of the special transitional community care grant during the current financial year ; and if she will make a statement.

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis) : We have in place a wide-ranging and continuing programme ofmonitoring.

Mr. Parry : Does the Minister recognise the problems that have arisen because of the ill-thought-out formula used to calculate community care grants in the first year? Will he look at the suggestion contained in the Select Committee on Health's report for a contingency fund to help those authorities that have lost badly in the current financial year?

Mr. Bowis : I can assure the hon. Gentleman that the settlement for community care was one of the most generous that we have made for public sector spending this year. It is noticeable that not only was the total more than was expected, but it included in particular £20 million extra this year for respite and day care, and another £30 million for next year.

The hon. Gentleman would do well to recall that this year the community care special transitional grant for Liverpool has increased on that of last year. He should take back to Liverpool the message that what we look for from the authority is efficient use of resources and efficiency savings. If it stopped putting people into council-owned homes, at twice the cost of the price of care in the private and voluntary sectors, the hon. Gentleman would have a good message for the people of Liverpool.

Mrs. Roe : Will my hon. Friend confirm that all the independent monitoring of the community care reforms shows that they have got off to a good start in their first year? Does that not show that although others have long supported that policy in theory, it is this Government who are putting it into practice and making it work?

Mr. Bowis : Yes, my hon. Friend is absolutely right. All the independent, impartial evidence on the monitoring of community care, which has been in place since 1 April, shows that the start has been encouraging. That is the word

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used by the social services inspectorate and the Audit Commission, and it is the message of the Association of Directors of Social Services.

It is an encouraging start, because a partnership is being built up not just between national and local government but between local government and the health authorities and the voluntary and private sectors. After all, social services did ask to be given the challenge of implementing community care. We gave them the opportunity to meet that challenge, and we now expect them to deliver.

Mr. Hinchliffe : Has the Minister had the opportunity to study the details of a written answer that he gave me on 14 December, which showed that, according to the Government's own assessment of individual local authority need, numerous local authorities have lost millions of pounds during the operation of the current year's special transitional grant? Sheffield has lost more than £2 million, my own authority has lost £1 million and London boroughs have lost nearly £25 million. Does the hon. Gentleman recognise that the Government need to compensate those local authorities for the problems they face as a result of the bizarre formula the Government use to calculate the grant?

Will the Minister listen to the demand by my hon. Friend the Member for Liverpool, Riverside (Mr. Parry), that a contingency fund should be established to help those councils, as suggested by the Select Committee on Health? Will he further reflect on the fact that numerous authorities are encountering difficulties in developing genuine community care because of the Government's continued insistence on their spending 85 per cent. of grant in the so-called independent sector?

Mr. Bowis : The hon. Gentleman may have noticed that the messages that we have received in the first year of the distribution mechanism have been brought into play, and we have transferred towards the standard spending assessment. The reasons for that are partly that there was a faster than expected shift of some 10 per cent. towards domiciliary care and partly that, to some extent, this year's SSA changes go to meet the balance.

I wish that the hon. Gentleman would bear in mind the fact that we are talking about a budget in the first year of £565 million. That will go up to £1.2 billion in the coming year, to £1.8 billion the following year and to £2.2 billion in the year after that. There is no way in which the Government could be said to be selling community care short. We want to see a partnership, and we want to make sure that local authorities that might have other things in mind, encourage, permit and facilitate the independent sector, and that the voluntary and private providers to play their part, too.

Social Work Council

2. Mr. Riddick : To ask the Secretary of State for Health what changes she intends to make to the Central Council for Education and Training in Social Work.

The Secretary of State for Health (Mrs. Virginia Bottomley) : Under its recently appointed chairman, Jeffrey Greenwood, the CCETSW is undergoing substantial reform, both in its internal management structure and in the education and training for social workers for which it is responsible. The underlying

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intention of these changes is to ensure that social workers are equipped for the difficult job that they do with knowledge, practical skills and common sense.

Mr. Riddick : Will my hon. Friend confirm that the reform will extend to the CCETSW document, which states :

"CCETSW believes that racism is endemic in the values, attitudes and structures of British society"?

Is my right hon. Friend aware of the job advertisement for a lecturer in social work at the then Leeds polytechnic, which sought someone with a commitment to "anti-oppressive practice"? Is it not that sort of left-wing, politically correct nonsense that makes some people believe that social workers do not live in the real world?

Mrs. Bottomley : There can be no place in the training of social workers for politically correct notions, for the domination of ideology and textbook theories over practical skills for children. Social workers have an important job to do, and their decisions should not be informed by fashionable theories, but by sensible, time-honoured principles and values.

Ms Jowell : As a former social worker, does the Secretary of State not recognise the complex job they do on behalf of society with people whose lives are often marked by discrimination on grounds of race or disability? Does she not recognise the importance of social workers being properly trained to meet those challenges?

Mrs. Bottomley : As a qualified social worker, I have all the more reason to feel impatient at the way in which good social workers have their work contaminated by some of the more ludicrous theories and extreme ideas. There is no place for playgroups that ban Christmas, or for parents being turned down for fostering or adoption simply because they are the wrong age or have not had sufficiently acute experience of racism.

There are too many examples of that, and training is the way forward. Over 90 per cent. of social workers are now qualified, whereas, in the mid- 1970s, about 34 per cent. were qualified. It is vital that the substantial sums spent on social work training are spent delivering people who have to undertake precisely the complex and difficult tasks that the hon. Lady describes.

Mr. Rowe : Does my right hon. Friend accept that the job of training social workers might be made easier if it were easier to discern who is and who is not properly so described? What progress is being made towards establishing a social work council?

Mrs. Bottomley : There is a debate about the establishment of a social work council. So far, it is not entirely clear whether selection to the council should be based on qualification or simply on occupation. That needs to be carefully studied before further progress can be made.

Withington Hospital

3. Mr. Bradley : To ask the Secretary of State for Health when she last met the chairman of South Manchester health authority to discuss the future of Withington Hospital.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : No such discussions have taken place

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Mr. Bradley : Is the Minister aware of the chronic shortage of hospital beds in Manchester? General practitioners find it increasingly difficult to get their patients into hospital. A local GP in Withington had to ring 999 to get my constituent, who had a suspected heart attack, into hospital, having failed to find a bed at Manchester royal infirmary, Wythenshawe hospital and Withington hospital. In the light of that appalling situation, will the Minister reject proposals to close Withington as a district general hospital with a loss of another 300 beds in Manchester, and undertake a complete review of the real hospital needs of the people of Withington and Manchester?

Mr. Sackville : I am certainly aware of the pressure on emergency admissions in recent months, but that does not change the overall underlying picture in Manchester. The population is declining, there are enormous advances in day care, with a dramatic effect on bed use, and many facilities and excellent hospitals, such as that in Bolton where I come from, are being built outside Manchester. All that will affect the demand for beds in the future. In several years' time, there will be over-capacity of acute beds in Manchester, despite overspending according to capitation. That needs to be addressed : hence the proposals to rationalise services between Wythenshawe and Withington.

Mr. McCartney : The Minister's reply is one of the most complacent I have heard about closures. There are 97,000 people on waiting lists in the north-west, hundreds of beds in Manchester have been taken out of the system, children have been refused access to intensive care units, patients are being bussed as far away as Blackpool, and some patients have died before treatment could be given. When will the Minister make a commitment to meet the Members of Parliament for Greater Manchester about the crisis in health care in the area?

Mr. Sackville : My door is open to the hon. Gentleman at any time, and he knows it. Given his obsession with beds, he must be aware that the numbers of beds has gone down in recent years, but, despite that, activity has gone up. That is a trend he cannot deny, and one which will continue.

Accident and Emergency Admissions

4. Ms Estelle Morris : To ask the Secretary of State for Health what representations she has received from the West Midlands regional health authority about the increase in accident and emergency admissions in the last 12 months.

Mr. Sackville : No representations have been received on that specific topic.

Ms Morris : Is the Minister aware that the West Midlands regional health authority has just announced plans to close 1,500 beds in the city of Birmingham? Given the massive increase in accident and emergency admissions over the past few months, and the effect of that in terms of patients having to lie for up to 21 hours on trolleys in corridors and the constant and regular cancellation of elective surgery, does the Minister agree that further bed closures will exacerbate the situation? What action will the Minister take to stop the planned bed closures going ahead?

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Mr. Sackville : If I may correct the hon. Lady, the report said that, over a period of years, between 1,000 and 1,500 acute beds may be surplus to requirements, depending on an increase in day surgery and various other factors, as she well knows. She also knows that, thanks to the establishment of an emergency bed co-ordinator for Birmingham, there are very many fewer incidents involving difficulties with emergency admissions.

She will also know that, only last week, the chief executive of the national health service circulated all the hospitals and health authorities with a document stating their responsibility to make flexible arrangements, so that, when there is a sudden increase in emergency admissions--for example, when there is an outbreak of influenza--the hosptials can cope.

Mr. Fabricant : Will my hon. Friend confirm that £404,000 in extra funding has been made available to the Birmingham Heartlands hospital for accident and emergency use? Is he further aware that, only the weekend before last, I had the privilege of opening a new wing in the Lichfield Victoria hospital?

Mr. Sackville : I am aware of a great many excellent developments in the health service.

Mr. Terry Davis : Is it not a fact that, although the number of emergency admissions in Birmingham has gone up year after year for several years, the health service, managers in Birmingham base their plans for this year on the totally unreasonable assumption that there will be a reduction in the number of emergency admissions? When will the Minister do something about health service managers who behave in such a totally irrational way?

Mr. Sackville : The House well knows that, in many parts of the country, there has been an unprecedented increase in emergency admissions during the past few months. Hospital managers must make their arrangements against that background. The hon. Gentleman and I have discussed the Heartlands hospital more than once. The emergency bed co-ordinator in Birmingham has been able to make dispositions so that there has not been a serious alert more than perhaps twice in recent months. That is against the underlying background of a rapid increase in emergency admissions. The hon. Gentleman should congratulate that hospital.

Family Doctors' Lists

5. Mr. Evennett : To ask the Secretary of State for Health what was the average number of patients on each family doctor's list (a) in 1979 and (b) in the latest year for which figures are available.

Mrs. Virginia Bottomley : At 1 October 1979, the average number of patients on family doctors' lists in England was 2,286 ; the figure for 1 April 1993 is 1,915, a reduction of 16 per cent.

Mr. Evennett : I thank my right hon. Friend for those excellent figures. Does she agree that the family doctor service is the backbone of our national health system? Will she confirm that today there are more GPs, they are better paid, there are more practice nurses and there is far more effective treatment? Will she join me in urging the Labour

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party to look at the family doctor system to see how it is working so effectively for the benefit of all the patients in the national health system?

Mrs. Bottomley : Indeed. My hon. Friend rightly identifies the family doctor service as the basic building block of our NHS. One of its distinguishing features is as gatekeeper to the NHS. The average person goes to his or her GP five times a year. That is why it is important that there are an extra 4,759 GPs. That is why it is so important that the number of practice nurses has increased by 819 per cent. since the Government came to power, and that family doctor service spending has increased by 151 per cent. Those are substantial figures, resulting in very much better care for patients.

Ms Primarolo : Has the Secretary of State had time to study the parliamentary answer she gave me about the decline in the number of GPs in London over the past three years? Does she share my surprise and anger that that should have occurred at a time when GP services in London are under such massive stress and demand? Does she agree that the increased use of accident and emergency units is partly a by-product of that decline, and immediately agree to investigate the reports from those departments that 8 to 14 per cent. of patients attending accident and emergency units are not registered with a GP in London?

Mrs. Bottomley : I am beginning to see a glimmer of hope that the hon. Lady might be supporting "Making London Better" and the strategy that we set out. It is precisely that distortion of resources in London, which has gone back over many years, that means that urgent action is necessary. There have been far more older GPs in London. There have been far more single-handed practitioners in London. Although, over the past 10 years, there has been a substantial improvement in GP services in London, there is still room for manoeuvre. That is why we are spending an extra £43 million in primary care in London this year, investing it in more than 100 primary care initiatives.

Mr. Oppenheim : Will my right hon. Friend cast her mind back to when the GPs' contract was being introduced? At that time, were not the sick and the vulnerable unnecessarily frightened by a campaign that stated that GPs' lists would dramatically increase and that doctors would not have enough time to look after their patients? As that scare campaign has proved totally untrue, how seriously can we take any pronouncements on the NHS from the Labour party, which was prepared to use the sick and the vulnerable as pawns and puppets in its own sick political campaign?

Mrs. Bottomley : My hon. Friend rightly identifies the Labour party's history of making scaremongering statements, having no policy and denying the results, which have been extremely impressive. For example, the latest immunisation figures, part of the new GP contract, show that 95 per cent. of children are now being immunised against diphtheria, compared with 80 per cent. when the Labour party was in power ; 93 per cent. for measles compared with 51 per cent. when the Labour party was in power, and 93 per cent. of whooping cough compared with 35 per cent. when the Labour party was in power. Those are the results of the changes, quite apart

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from the introduction of deprivation payments which mean that GPs in the most deprived inner-city areas receive additional resources.

Social Care

6. Mr. Austin-Walker : To ask the Secretary of State for Health when she expects to carry out a review of regulation and inspection in social care.

Mr. Bowis : As part of the Government's deregulation initiative, we are already looking at a number of areas of regulation in social services. There will be a review of the independence and effectiveness of inspection next year.

Mr. Austin-Walker : The Government recognise the need to protect individuals through registration and inspection in some forms of social care, but does the Minister share my concern that no such protection is afforded to those people receiving domiciliary care in their own homes? Does he recognise that an increasing number of people will receive domiciliary care, and that that is increasingly being provided by private organisations and agencies? Will the Minister now give detailed consideration to the Licensing of Domiciliary Care Agencies Bill which was introduced in the other place by my noble Friend Lord Ashley and previously in this House by my hon. Friend the Member for Wakefield (Mr. Hinchliffe)?

Mr. Bowis : I am glad to hear the hon. Gentleman acknowledge that domiciliary day services should increasingly be provided by the voluntary and private sectors, and I share his view that we must do whatever we can to ensure that high standards are maintained. The question is how quickly we can find and monitor the evidence of good practice that is necessary in order to set out a proper programme of high standards.

The Department has issued guidelines and advice to independent sector firms that might be considering setting up domiciliary day services which we shall follow up. In the meantime, as my noble Friend Baroness Cumberlege said in the other place, local authorities that provide such services have an absolute right and duty to define within the terms of the contracts the standards of service that they expect to be provided. That is the first step. The second step is to continue to monitor such services, and the third step is to keep an open mind, as I shall do, on whether further protection will be needed in future.

Mr. Wilshire : Whatever my hon. Friend decides on the general issues of inspection, will he set up a special inspection of Surrey county council's social services department. [Hon. Members :-- "Reading."] Is he aware of his inspectorate's report on six child deaths in Surrey which apparently arose from child abuse? [Hon. Members :-- "Reading."] Is he further aware of the non-accidental injuries and severe brain damage caused to my constituent, Thomas Harris, at the hands of a registered child minder? In the light of the judge's criticisms last Thursday of the county council's team adviser, whom he described-- [Hon. Members :-- "Reading."]

I know that I am reading Madam Speaker. I wish to quote the judge's comments correctly.

Madam Speaker : If the hon. Gentleman knows that he is reading, he must know that he is out of order.

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Mr. Wilshire : In the light of the judge's criticism of the team adviser, who he described as showing "bumbling inactivity" ; in view of his criticism of the case conference which, he said, "chose to ignore the risks" ; and in view of the general approach, which the judge described as showing a "lack of urgency", does not my hon. Friend consider that an immediate inspection of Surrey county council is required?

Mr. Bowis : I am sorry that Opposition Members reacted as they did to this case. The House and the nation will have watched with horror the effects of that small child's injuries as we saw him crawling around his living room. The first thing that the House should do is to send its sympathy to that child and his mother and to wish them well for the future.

Secondly, whenever instances of this kind occur, of course there should be investigations and inquiries, and I am glad to hear that Surrey county council has instituted an internal inquiry and has also brought in the area child protection committee to ensure that there is an independent element in that investigation.

We will always keep the quality of inspection and social services under review, regardless of the area concerned. It should be pointed out that all the cases mentioned by my hon. Friend occurred before implementation under the Children Act 1989 of the circular about shaking, in particular, which we distributed to all county council social services departments, as they regulated child minders. I hope and pray that the case to which my hon. Friend referred is never repeated.

Mrs. Mahon : Why does not the Secretary of State set up a statutory register for domiciliary workers in the private sector? Surely the Minister is aware that the elderly and the sick are very vulnerable in their own homes. Common sense dictates that, if tragedies are to be avoided, there should be a formal register.

Mr. Bowis : As I have said, we are keeping an open mind on the question of monitoring local services in the domiciliary sector. We will continue to consider the standards of good practice that we should be setting and disseminating throughout the country. There is nothing to stop local social services departments from setting their own standards and discussing them with the voluntary and private sectors. I hope that all social services departments are not simply consulting the independent sector but involving it in the provision of services. That will enable us to agree standards, to set up local registers of approved firms and-- through contracts and, ultimately, by whatever means prove necessary--to secure the national standards that we want.

Waiting Lists

7. Mr. Hunter : To ask the Secretary of State for Health what has been the change in the number of NHS patients waiting (a) over one year and (b) over two years since March 1991 ; and if she will make a statement.

Mrs. Virginia Bottomley : The number of patients waiting over one year for hospital treatment has fallen by 58 per cent. since March 1991-- from 169,761 to 71,022. There were more than 51,000 patients waiting over two years in March 1991 ; two-year "waiters" have now all but been eliminated.

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Mr. Hunter : Does my right hon. Friend agree that waiting lists reflect the ever-growing demand for services, that what matters to the waiting patient is how long he or she must wait, not how many other people are on the list, and that her answer shows that the health reforms-- especially those involving the internal market--are having a positive impact on waiting lists?

Mrs. Bottomley : Indeed. Waiting lists are almost inherent in a health service that is free at the point of use. The number of people on the list as a percentage of those who are treated has remained fairly steady for the past 20 years. What matters to an individual patient, however, is how long he or she must wait. In that regard, our achievements have been dramatic, enabling everyone to benefit from the NHS reforms. Those reforms will continue and develop, and patients will benefit further.

Mr. Skinner : Will the Secretary of State give us the complete waiting list figures, not just those relating to one year or two years? If doctors and nurses are doing such a wonderful job--which they are--will the Secretary of State give a guarantee that she will tell the Treasury that the pay review recommendations for doctors and nurses should be met in full? If they are not met in full, will she resign?

Mrs. Bottomley : Doctors and nurses are, indeed, doing a magnificent job in reducing waiting times. Before the reforms, the average waiting time was about nine months ; now, it is about five months, and there will be further improvements. Doctors and nurses should note what the Government have already achieved. Doctors' pay has increased by 34 per cent., while nurses' pay has increased by 52 per cent. That contrasts sharply with Labour's record.

The review bodies have undertaken their work in the normal way this year, and the Government will consider their recommendations in the normal way.

Mr. Day : Does my right hon. Friend agree that the way to reduce waiting lists is to increase the number of patients who are treated? That is precisely what has happened when trust hospitals have worked in conjunction with fundholding general practices. Is it not strange that the Opposition wish to abolish the most successful part of the NHS? Far from abolishing trusts and GP fundholders, should we not extend the benefits of those institutions throughout the health service?

Mrs. Bottomley : Most certainly we should. GP fundholders have been able to innovate and to pioneer new forms of treatment, and all family doctors are benefiting from their new procedures. The trusts are going from strength to strength and I shall shortly announce the full number of the fourth wave, which will be the largest wave yet. That is the programme of reform that we have set in hand. During the 1980s, there was a 2.5 per cent. increase in the number of patients treated, but, since the reforms have been in place, the figure has risen to an average of 5 per cent. When the Labour Government were in power, they were struggling along at annual rates of 1 per cent.

Mrs. Dunwoody : Is the Secretary of State aware that in my area we are sick to death of the con trick, of being told that the Government have dealt with the waiting lists while at the same time cutting the money allowed for the running of the general hospital? The Government have cut

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£3 million from the budget of a district general hospital while pretending that they have dealt with the waiting list--it is an insult to the community's intelligence.

Mrs. Bottomley : The hon. Lady comes from a part of the country which has seen a magnificent achievement in terms of the quality and quantity of patient treatment and it reflects the sharp contrast to the attitude of the hon. Member for Manchester, Withington (Mr. Bradley), who asked the first question about social services in that part of the world. If other public services were run with the skill of the health service in that area, there would be many improvements. Progress is being made in the number of in-patients and out-patients treated, but there is more to do.

Mr. John Marshall : Will my right hon. Friend pay tribute to the work of the Royal Free hospital trust, which serves many patients in my constituency? Since it became a trust hospital, it has substantially reduced waiting lists and increased the number of patients that it serves. Should not that be commended instead of criticised, as it often is by the Opposition?

Mrs. Bottomley : The Royal Free is an excellent example of the opportunities to be had in becoming a trust hospital. It was one of the first wave. As we move to the fourth wave, we hope that ever-greater numbers of hospitals will develop the same skills. Last year, trust hospitals increased the number of patients treated by an average of 5.3 per cent., whereas other hospitals increased the number by 4.3 per cent.

Ms Lynne : Following the Government's continual claims that more patients than ever are being treated, will the Secretary of State explain why waiting lists are higher than ever? Could it be because the Government count finished consultant episodes instead of patients treated?

Mrs. Bottomley : The Liberal Democrats seek to undermine the figures produced by the national health service in any way that they can. The figures are an accurate reflection of the work undertaken by the service. There was one change when we moved from the Korner figures to finished consultant episodes, but since then the proportions have remained steady and stable. The hon. Lady is seeking any excuse not to pay tribute not only to the managers who have established the reforms but to the doctors and nurses who are reducing the time that patients have to wait.

Mr. Streeter : I welcome the excellent figures that my right hon. Friend gave at the beginning of her reply. None the less, does she agree that the people of Devon and Cornwall would have to wait an even shorter time for their operations if some of the resources currently locked away in the London specialist hospitals were released for the benefit of the country as a whole? When will the unfair imbalance cease?

Mrs. Bottomley : My hon. Friend will know that we are seeking an end to the imbalance which has bedevilled the national health service for many decades. We spend 20 per cent. of the money on 15 per cent. of the people, but we have to proceed with care and full consultation. We must consider not only the questions of service but the important elements of research and education. I hope soon to be able to make further announcements which will ensure a more

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balanced health service and ensure that London releases resources to other parts of the country which are supporting London to the tune of £100 million this year.

Mr. Blunkett : Is it a fact that the number of people on waiting lists has risen by a third since the Government took office, while the number of beds available has dropped by a third, that the number of people waiting for more than a year rose by 25 per cent. in the first half of this financial year and that those waiting for the first crucial out-patient appointment to see a consultant are not counted at all?

Is the right hon. Lady aware that in the Mersey region, about which the fact is paraded that no one waits for more than a year, the Royal Liverpool hospital had just sent out a notice, saying that the waiting list for out- patient appointments for the spinal clinic now exceeds 18 months? Are not there lies, damned lies and Department of Health statistics?

Mrs. Bottomley : It is hard for the Labour party to speak of waiting lists, as every Labour Government have left office, with longer waiting lists than when they took office. I recommend that the hon. Gentleman study the Audit Commission report on the use of beds, which suggests that if all did as well as the top 25 per cent., the health service could do with fewer beds than we have now. We have to ensure that we make balanced progress.

Once again, Labour Members seek to pour scorn on the Mersey region. They may be interested to know that not only has Mersey tackled the subject of all its one-year waiters but it is now setting a target time of six months maximum for out-patient appointments and hopes to ensure that 90 per cent. of out-patients are seen within three months. It is such a shame that the Labour party cannot listen and watch and observe those regions that have made outstanding progress. Together, we should seek to apply those lessons to other parts of the country that are not yet doing so well.

Trust Hospitals

8. Mr. Amess : To ask the Secretary of State for Health what steps she has taken to ensure that overall NHS trust hospitals are able to continue the greatly increased equipment expenditure of recent years.

The Minister for Health (Dr. Brian Mawhinney) : Trusts now have freedom to spend more than a third of the capital allocated to them according to their own capital investment priorities and we are increasing that amount year by year. Many trusts choose to make equipment a priority and that policy makes more money available for that purpose.

Mr. Amess : Is my right hon. Friend aware that since Basildon hospital achieved trust status, 7 per cent. more patients have been treated and expenditure has been reduced by 7 per cent? Is he further aware that more than £425,000 has been spent on new medical equipment, including £200,000 on a new gamma camera? That is an improvement of 100 per cent. on what the hospital did before it became a trust. Finally, will my right hon. Friend vigorously continue to defend our wonderful national health service against the scurrilous attacks from socialist Opposition Members?

Dr. Mawhinney : No one could have put it better than my hon. Friend. His commitment to his constituents, which

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is well known, also extends to health. Indeed, the trust has done even better in terms of capital equipment. In the year before it became a trust, the hospital was spending only £150,000 ; now, as my hon. Friend says, it is spending £425,000. The most important thing, however, is the increase in the number of patients treated. That is what Conservative Members consider the national health service to be about. Unfortunately, that view is not shared by the Opposition.

Mr. Flynn : Does the Minister realise that high spending does not always mean good value? Of the 60 different hip replacement implants that are available to the health service, the ones that are most expensive are often the least reliable, requiring new operations. Has the Minister noticed that in Sweden 5,000 Christiansen hips were put into people and none of them lasted four years? In Britain, we are spending huge sums without a proper examination of the quality of the replacements that are put in. Will the Minister require and ensure that there is a system properly to evaluate the reliability of hips that are put into patients?

Dr. Mawhinney : The first part of the hon. Gentleman's question was certainly right. Every year, we observe Labour-controlled authorities throughout the country spending lots of money and getting poor value for it. The Government have done more to improve the quality of care in the health service than any of our predecessors, and we shall continue to pursue that end.

Mr. Jenkin : Is my right hon. Friend aware that since the Essex Rivers healthcare trust gained trust status on 1 April 1992 it has substantially expanded its facilities, with a new day surgery centre and a new ward, and that it has further plans for expansion? Will my hon. Friend take the opportunity to pay tribute to the hardworking staff of the hospital and will he give an undertaking that North Essex health authority will continue to benefit from the increase in its share of resources, which is rightly due to it under the capitation funding system, so as to enable that expansion to continue?

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