Lords ] Order for Second Reading read .
To be read a Second time on Thursday 22 February .
1. Mr. Patrick Thompson : To ask the Secretary of State for Health how the money available to councils for spending on personal social services has changed over the years 1990-91 to 1994-95 ; and if she will make a statement.
Mr. Thompson : Does my hon. Friend agree that under this Government no area of local government activity is more generously funded than the social services, particularly community care ? Bearing in mind the lamentable performance of some Labour authorities, will he ensure that they behave more responsibly and sensibly ? In particular, will he apply that scrutiny now to Norfolk county council ?
Mr. Bowis : My hon. Friend is right. The figures reflect the priority that the Government place on policies for the elderly, the disabled, children and those with mental health problems, and he will have noticed the increase this year. He is also right to note the need to keep a sharp watch on councils run by the Labour and Liberal parties. The figures for this year show that Norfolk's funds for social services will increase from £72 million to £86 million. If he looks around, as I have looked around, at examples of Labour authorities running social services, he will see not only the reckless record on spending in so many areas but the appalling record on delivery. Sadly, he has only to look, as I recently have, at Labour's record in authorities such as Islington and Nottingham to see that children are at risk as a result.
Column 132it not also necessary to look at other facilities that social services have to deliver, such as meals on wheels, home helps and particularly home adaptation for the elderly ? Will he ensure that, as well as the direct programme, local authorities have the resources to carry out those services as well ?
Mr. Bowis : The hon. Gentleman is absolutely right to say that the resources for social services as a whole do not just come from the community care special transitional grant. That grant has been good news, but if he looks at the overall resources for social services, which fund all those domiciliary and day centre provisions, he will notice that over the last four years social services provision has risen from £3.6 billion to £6.4 billion. That is a Government putting their money where their policies are.
Mr. Sims : Is not community care in most parts of the country working well, particularly where there is co-operation with the private and voluntary sector so that care packages can be put together that are suited to their recipients ? Is my hon. Friend satisfied that all authorities are making as much use of the private and voluntary sector as they can ?
Mr. Bowis : My hon. Friend is right to say that in the delivery of community care we look to good-quality provision from all sectors, including the private and voluntary sector. He asked the direct question whether I am satisfied that all authorities are ensuring that those sectors can contribute as they should. The straight answer is no. Too many obstacles are being placed in the path of good-quality private and voluntary sector provision by the dogma of Labour and Liberal authorities. We support the provision of the independent sector for reasons not of dogma but of better-quality care for people in need.
Mr. Hinchliffe : Going back to the question, does the Minister accept that there are important differences between standard spending assessments and actual levels of spending ? Will he confirm the figures produced by the House of Commons Library, which show that reductions in Government support for local authority funding for social services since 1979 have cost social services departments £6.2 billion--money which was desperately needed to implement 14 new Acts of Parliament that increased the responsibilities of local authority social services ? If the Government have been so generous, why did they actively encourage local authorities to introduce charges for day care, home care and a whole range of services for vulnerable elderly and disabled people--services which were previously free ?
Mr. Bowis : I do not think that within that tirade we heard a word of thanks from the hon. Gentleman for the figures for Wakefield increasing from £29 million to £40 million. That is the pattern within the overall increase from £3.6 billion to £6.4 billion for social services this year. The hon. Gentleman now needs to remember and recall, for the benefit and education of the ranks behind him, that not only are we giving money to social services, but we expect in return good use of those resources. If local authorities do not use resources effectively, they cannot deliver as good-quality services as we expect.
Column 133per cent. increase in social services funding in the preceding three years ? Will he take the opportunity to salute those in the national health service and in social services at ground level who are making care in the community work within the generous resources that are being made available ?
Mr. Bowis : My hon. Friend is absolutely right. Cheshire is receiving an increase this year from £84 million to £97 million. He is right to praise those on the ground and in the field who, day by day, are providing good-quality services. If he wants a contrast, I invite him to join me on the Clapham omnibus that goes through my constituency eastward to Lambeth where he will see the Labour party in action with a record of decay, dereliction and scandal. That is the opposite of what we want.
2. Mr. Connarty : To ask the Secretary of State for Health what advice she has given to health authorities and trusts on how to raise funds to finance pay increases ; and if she will make a statement.
The Secretary of State for Health (Mrs. Virginia Bottomley) : The £1.6 billion additional resources in 1994-95 announced in the unified Budget includes sufficient to allow for pay increases, provided that they are broadly in line with efficiency improvements.
Mr. Connarty : I thank the Minister for that reply. Does she not realise that there is some absurdity in the estimate of £450 million in efficiency savings and a pay award which will cost £418 million ? Is it not true that, particularly with inflation, there will be very little left for increased services ? Would it not be better to scrap the wasteful market model and put the £1 billion savings into patient care ?
Mrs. Bottomley : This year, an extra £1,600 million is going into the national health service. Those are enormous sums of money together with the efficiency improvements that have been progressively made possible with the reforms. We are treating more patients more effectively. That is better for staff and better for patients.
Mr. Rowe : My right hon. Friend will be well aware that the trusts vary tremendously in quality and in the skill with which they manage their budgets. Will she give an assurance that, as her policy develops, she will find a way of rewarding those trusts that have made a good show and make it easier for them to meet the ever-increasing efficiency targets ? There will come a time when the best run trusts will find it difficult to make the efficiency savings that she keeps demanding.
Mrs. Bottomley : The best-run trusts are progressively moving towards devolved pay arrangements. One of the great freedoms of the trusts is that they can manage their own pay. We welcome review body reports which recognise that this a transitional year. They heralded the move towards devolved pay. I well understand that it will not be to the liking of Labour Front-Bench Members, sponsored as they are to a man by the health unions.
Column 134savings to meet the 4 per cent. increase in activity levels promised, and if the NHS has to find the same amount of money to implement the proposals for pay increases by efficiency savings, which of the two pledges--the increase in activity or the refusal to acknowledge that there will be major cuts--does the Secretary of State accept this afternoon ?
Mrs. Bottomley : The hon. Gentleman, having so singularly failed to convince the shadow Chancellor of his spending commitments in the document that the Labour party has recently produced, has failed to recognise that I was able to persuade our Chancellor that the national health service needed an extra £1,600 million this year. With that extra money and the efficiency savings that are now possible, I am confident that we can not only pay the staff fairly but increase patient care.
Mr. Dickens : Would my right hon. Friend concede that the £1.6 billion extra that has been found this year for the health service represents £83 per household, which brings a total of £1,565 per household into the NHS ? Why do we need to play politics at Question Time when the facts speak for themselves ?
Mrs. Bottomley : As ever, my hon. Friend has it. He will agree with me that it is not only the input into the NHS, but what we do with that money. There are still a large number of areas in which we can improve the efficiency of the NHS, including the Audit Commission, whether through skill mix, the use of beds, or prescribing. With a generous settlement for the health service this year, our task now is to use it efficiently and effectively for patients.
Mr. Cousins : Is the Minister not concerned about the creeping privatisation of more than 1,000 jobs in Newcastle, where prescriptions are processed more cheaply, more accurately and with more fairness than in any equivalent organisation, using the second largest computer installation in Europe to produce the best public health information based on prescriptions anywhere in the world ? Is he not concerned about British public administration at its British best ? Will he come and look at it in Newcastle and stop meddling ?
Dr. Mawhinney : It is not creeping privatisation. It is a market testing programme to ensure-- [Interruption.] I am interested that hon. Members on the Opposition Front Bench do not know the difference. The market testing programme is to ensure that the taxpayer, patients and the NHS get the best value for the considerable sums of taxpayers' money that are being expended.
Dr. Mawhinney : I think that that moves slightly outside the scope of the question, but, as we are already doing what my hon. Friend requests, I am able to give him that assurance with some satisfaction.
Dr. Mawhinney : Figures on adult smoking prevalence in England are taken from the general household survey, which is conducted every two years. In the four years to 1992, adult smoking prevalence fell by 3 per cent. to 28 per cent. of the population.
Mr. Coombs : While I welcome my right hon. Friend's explanation of the downward trend in the general level of smoking in the population, I must point out to him that there is currently a worrying upward trend in the number of young girls in this country smoking. Bearing in mind the risks of smoking to women during pregnancy, what other measures can he introduce--apart from increases in taxation, which I welcome, and which are in stark contrast with the policy of the last Labour Government--to try to counter that extremely damaging trend ?
Dr. Mawhinney : My hon. Friend is right to draw attention to the damaging effects that smoking can have on pregnant women and also on the children born from those pregnancies. In addition to the information that we have recently made available to all hon. Members, he will be interested to know that in the 11 to 15 age group those children whose parents do not smoke have already met our "Health of the Nation" target for the end of 1994. The problem is associated with children whose parents smoke, and they are not responding as we would wish. That underlines the serious messages coming from Conservative Members about the attitude and behaviour of parents on the behaviour of their children.
Mr. McCartney : Since the beginning of Question Time, four of our fellow citizens have died of tobacco-related cancers. When will the Secretary of State and the Minister commit themselves to supporting the Tobacco Advertising Bill presented by my hon. Friend the Member for Rother Valley (Mr. Barron), getting the tobacco industry off the Government's back and saving the lives of the 300 babies a year who are killed by passive smoking, the 300 citizens a day who die because of the tobacco industry and the 110,000 people a year who are killed unnecessarily by the industry's activities ? When will the Government support the nation, and end the industry's campaign to recruit new smokers each and every day because tobacco is killing its own customers ?
Dr. Mawhinney : I must say that the hon. Gentleman put the case better on Second Reading of the Tobacco Advertising Bill. The truth is that both Government and Opposition are committed to reducing tobacco consumption, and the Bill's passage will proceed in the normal way.
The House may find one piece of information encouraging. If the other 10 European Union countries--apart from the Netherlands, which has a slightly better record of tobacco reduction over the past 20 years--had behaved as we have over that period, between 25 million
Column 136and 30 million smokers would not now be smoking, and more than 5 million people who have died prematurely in those countries would not have died if they had followed our lead.
Mr. David Atkinson : Now that coroners can cite smoking as the cause of death, has the Department considered including the statistics in Government health warnings on tobacco products and in advertisements ?
Mrs. Bottomley : The hon. Gentleman should talk to his party's health spokesman. I thought that his difficulty lay in the Tippexing out of the price on the recently published policy document, which was described by The Times as "cosmetic surgery".
I have no difficulty with my right hon. and learned Friend the Chancellor. As my hon. Friend the Member for Littleborough and Saddleworth (Mr. Dickens) said in such a distinguished fashion, my right hon. and learned Friend has made an extra £1,600 million available for the national health service--an extra £83 per household. Let me inform the hon. Member for Makerfield (Mr. McCartney) that, since the beginning of Question Time, we have spent an extra £1.5 million on the health service.
Mr. Ashby : Does my right hon. Friend understand that the health service trusts are really asking for a large degree of freedom from the findings of the review bodies, so that they can reward those who have worked better and thus make overall savings for their hospitals ?
Mrs. Bottomley : I entirely agree. We want to devolve pay as far as possible ; we want to make good progress in that regard this year. The review bodies' reports commend such action, and we are looking for results from the trusts, which know that they can achieve better efficiency by adopting a more flexible approach to their staff.
Mr. Wigley : Will the Secretary of State urgently review the pay agreements with dentists, in view of the rate at which they are leaving the national health service ? Is she aware that, in the whole of my constituency and half the neighbouring constituency, only one dentist is now taking on NHS patients ? When that dentist was approached yesterday, the earliest appointment that he could give was in July. Is the right hon. Lady aware that the emergency peripatetic dental service provides only one dentist for 105,000 patients in the area ? The NHS has broken down here. Will the Secretary of State please do something about it ?
Mrs. Bottomley : Dentists have received a 3 per cent. increase in their fees under the review body's recommendations. More money will go into dentistry than ever before. The hon. Gentleman is right, however, and that is why we have already commissioned the Bloomfield report on the remuneration of dentists. We want a system that is fairer to dentists, to the taxpayer and to patients. I hope that we shall be able to make more announcements on that subject before long.
6. Mr. Duncan : To ask the Secretary of State for Health how many practice nurses are employed by general practitioners ; and what was the number prior to the introduction of the general practitioner contract.
Mr. Duncan : I think that hon. Members on both sides of the House would welcome any improvement in primary health care that results from an increase in the number of practice nurses-- [Interruption.] Has my hon. Friend-- [Interruption.]
Mr. Duncan : Has my hon. Friend had an opportunity to read a recent Labour party policy document, which claims that the Labour party wants an improvement in primary health care ? How does he reconcile that with the Labour party's wish to abolish fundholding, when fundholding practices are exactly the practices in which the improvement in primary care is taking place ?
Mr. Bowis : My hon. Friend is right on both counts. He is right to point out the genuine support that practice nurses are able to give our GPs in helping them to meet immunisation targets, to carry out minor surgery, to take part in our asthma and diabetes programmes, and so on.
As for the second part of my hon. Friend's question, I shall not be held to account for Labour's policy. Labour will be held to account for its policy and it will have to account to the taxpayer for the cost of its policy. As my hon. Friend rightly says, Labour would destroy what is good and send us a bill for £6 billion for the privilege. That is 4p on income tax for starters.
Mr. Enright : Will the Minister stop indulging in petty party politics, which ill suits him, and answer the question ? Is it not nonsense that in the present situation a fundholding practice in Yorkshire can go to down to Dorset to hire a practice nurse, use the same nurse and cut her pay afterwards ?
Mr. Bowis : I am glad to know that that is not a party political point. I remind the hon. Gentleman that when the Labour party was in office in 1979-- [Interruption.] The hon. Gentleman does not want the answer to the question. At that time, we had 888 practice nurses. We now have 9,680 practice nurses. The hon. Gentleman is a schoolmaster ; even in the classics department, that would work out as an increase of 900 per cent. That is quality, and that is progress for fundholders and all GPs.
Mr. Hayes : My hon. Friend said a moment ago that the Labour party would be accountable for its policies. In the next few moments, will he try to find out what those policies are, apart from the abolition
Ms. Primarolo : Is the Minister aware, before he congratulates himself, that the number of managers in general practice has increased by 34 per cent. since the introduction of the 1990 GP contract ? Is he also aware of the low morale and frustration among GPs as a result of the increasing demands on their time for bureaucratic, time-wasting work ? Today's survey--I am sure he is aware of its publication--shows a 9.4 per cent. increase in GP fundholders' work. When will the Government act to review immediately the GP contract and fundholders, stop wasting patients' money on bureaucracy and spend it on the patient instead, which is what we intend to do ?
Mr. Bowis : If 90 per cent. of GPs are now involved in the chronic disease management programme, if 76 per cent. are involved in minor surgery and if 86 per cent. are reaching their higher child immunisation targets, I think that we can say that GP targets are doing very nicely, thank you, without the hon. Lady's criticism. If she went into the average GP's surgery, she would meet many people who support GPs and who would resent her attack on that support. For her to dismiss all GPs as "managers", using that as a derogatory term, is ludicrous. She should remember that, in supporting GPs, we are supporting primary care and that we are doing so to the tune of a £504 million a year increase on the £206 million that we spent four years ago. Again, that is progress and, again, the hon. Lady does not like it.
Mr. Oppenheim : How does that information square with what was being said when the GP contract was introduced ? Did not the doctors' trade union --the British Medical Association--and the Opposition try to frighten the sick and vulnerable by telling them that the GP contract would increase doctors' lists and reduce the number of practice nurses ? As that has clearly not happened, how seriously can we take any pronouncements by the Opposition about the NHS when they are prepared to try to frighten the sick and vulnerable so unnecessarily ?
Mr. Bowis : My hon. Friend is right. Doctors had their concerns when the contract came into force, but we understood their concerns and listened to, and took account of, them. Doctors are now pleased, I think, that the contract is in place. It is helping them to see more patients every day of their working lives. The doctors have moved on, but the Labour party has not.
Mrs. Kennedy : Given that the group is to investigate inequalities in cancer treatment across the United Kingdom, does the Secretary of State agree that the development of an independent cancer treatment centre in north Wales, which will be too small to sustain the number of staff with the required skill and experience, will result in the long term in a worse service for the people of Merseyside ?
Mrs. Bottomley : The hon. Lady will know that her regional health authority in Mersey, for which the Department has an extremely high regard, is giving priority to research and treatment for cancer of which, I understand, there is a high prevalence in her constituency. I know that she will be reassured to learn that discussions are under way between officials from Mersey regional health authority and those from Wales.
Mrs. Roe : Does not fighting cancer depend crucially on early detection ? Therefore, were not the Government getting their priorities right when they ensured that Britain was the first country in the European Community to establish national breast and cervical cancer screening programmes based on a computerised call and recall system ? Is not it also a success of Government policy that the GP contract, which was opposed by the Labour party, is ensuring that there is a greater uptake for cervical screening due to the provision of incentive payments ?
Mrs. Bottomley : Indeed, cancer is one of the key aspects of "The Health of the Nation" strategy and one in which we are determined to make further progress by the turn of the century. My hon. Friend rightly commends the GP contract, characterised by the Opposition as "too heroic" for the targets to be met. In 1990, 66 per cent. of GPs met the higher cervical cancer target : the figure is now 83 per cent., with 97 per cent. of GPs receiving target payments. I commend the GPs, but I also commend the new GP contract.
Ms Lynne : Is the Secretary of State aware that a staggering every 30 minutes, one woman dies from breast cancer in this country and that that is the highest rate in the world ? Does she accept that more resources will have to be found to ensure that every woman with breast cancer sees a specialist and that we establish a national standard of care to prevent any more unnecessary deaths ?
Mrs. Bottomley : I share the hon. Lady's concern about breast cancer, which causes 16,000 or more deaths every year. Seven per cent. of national health service spending goes on cancer services. The breast cancer screening programme has been a formidable success, with 70 per cent. of women now taking up the invitation to be screened, but I should like the other 30 per cent. also to take up that invitation.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : The forecast expenditure by the United Leeds Teaching Hospitals national health service trust for the current year is £165 million.
Mr. Battle : The Minister will know of the recent health ombudsman's report, which says that Leeds general infirmary failed in its duty to a 55- year-old neurological patient who was discharged against his family's interest into private nursing care. What steps has the Minister taken to ensure that there are no other patients in Leeds or elsewhere in private nursing care who ought to be properly and fully cared for by the national health service ? Is not that appalling episode a classic example of the privatisation of the NHS, for which patients and their families are paying too high a price ?
Mr. Sackville : We have made it clear that we acknowledge that that was a rare but unacceptable case in which procedures were not properly followed. We have made clear to all health authorities and trusts the proper discharge arrangements that should be followed.
Sir Donald Thompson : My hon. Friend will remember the debt that I owe to the national health service and to the Leeds general infirmary and its superb services, which are also available to my constituents. Will he ensure that the specialist services available in the United Leeds hospital trust are available over as wide a range as possible ?
Mr. Sackville : We all rejoice in my hon. Friend's recovery. I remind him that I have visited the trust three times. I went to announce the new £70 million hospital for the Leeds general infirmary in 1992, and I went twice last year. I turned the sod, as they say in Yorkshire, for the new Chapel Allerton hospital, and then attended the topping-out ceremony only a few weeks later. On none of those happy occasions did I see the hon. Member for Leeds, West (Mr. Battle) or any of his colleagues. Why ? Because they were all skulking in some National Union of Public Employees office, planning new attacks on the NHS and all those who work in it.
Mr. Sackville : I understand that Sunderland health authority's five -year plans propose that acute services in Sunderland should eventually be concentrated on the Sunderland district general hospital site.
Mr. Mullin : Is the Minister aware of a report by Professor Keri Davies recommending that the number of beds in Sunderland be reduced from the present 1,600 to 800 or 900 ? Is he aware that the health authority members were asked to approve that report without being shown it, that it has not been made available to the community health council and that I, the local Member of Parliament, cannot obtain a copy ? What confidence can the people of
Column 141Sunderland have that the changes in their health service will be properly managed when the health authority behaves in such a way ? What assurance can the Minister give them that any changes made will be properly discussed in public ?
Mr. Sackville : The hon. Gentleman should know that the actual level of staffed beds is 1,150, so the numbers that he gave for the reduction are inaccurate. He should also know that Sunderland has the lowest waiting times anywhere in the northern region. It is not surprising that, with the growth of day surgery and the new day surgery unit on the district general hospital site, in-patient times will fall, and there will be a lower demand for beds. The hon. Gentleman must realise that if there are two or three hospitals and it is clear from projections of bed demand that at some time in the future we shall be able to treat all the patients better and more effectively in one hospital, it is necessary to take action. If we did not, we should be asking the national health service to spend money on buildings rather than on patients. That is no way to run a health service.
Dr. Mawhinney : My right hon. Friend the Secretary of State for Health visited the Lambeth community centre on 5 February 1993. Any increase in services at the centre is dependent on local health authorities and fundholders.
Ms Hoey : I hope that the Minister will take the time to visit that unique centre in Lambeth, which serves local people extremely well and is highly needed and valued in the area. Will he a commitment to expanding the services so that a second community care centre can be opened in the Brixton area, with a special remit for work with sickle-cell anaemia, a disease of which there is a large preponderance of sufferers in my constituency ?
Dr. Mawhinney : I am grateful to the hon. Lady. She will be pleased to know that some time ago I told my private office that I should like to try to fit in a visit to the Lambeth centre during the year, diary permitting, because I, too, want to see the excellent work conducted at that centre. She will know that, with the London implementation group and the primary health forum, we are considering a variety of ways in which to deliver increased primary health care and one of those is developing other centres.
Madam Speaker : Order. I am sure that the hon. Gentleman is going to remain within order. I remind him that the question is specifically about Lambeth community care centre and I do not think that there are bushes outside that building.