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House of Commons

Tuesday 5 July 1994

The House met at half-past Two o'clock


[ Madam Speaker-- -- in the Chair ]


London Underground (Green Park) Bill

Lords amendments agreed to .

University of London Bill

Read the Third time, and passed .

Crossrail Bill

Motion made ,

That the Crossrail Bill be recommitted to the former Committee. That it be an Instruction to the Committee to reconsider its decision on the preamble of the Bill as reported by it to the House.--[ Mr. Lidington ]

Hon. Members : Object.

Mr. Harry Greenway (Ealing, North) : On a point of order, Madam Speaker.

Madam Speaker : Order. Points of order come after questions. Otherwise, the hon. Gentleman is using up the time for questions.

Mr. Greenway : It is on this.

Madam Speaker : After questions in the usual manner, please.

Oral Answers to Questions


Clinical Waste Incineration --

1. Mr. Shersby : To ask the Secretary of State for Health if she will make it her policy to encourage hospitals within the NHS to make arrangements for the incineration of their clinical waste in such a way as to avoid pollution of the environment in residential areas.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : It is the Government's policy to ensure that all national health service hospitals comply with the requirements of the Environmental Protection Act 1990.

Mr. Shersby : Is my hon. Friend aware of the environmental and occupational risks that can be caused by the disposal of clinical waste by incinerators such as the one at Hillingdon hospital in my constituency ? Is he aware of the report published by the British Medical Association only last week on 30 June ? Will he consider the

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desirability of earmarking resources for a national network of incinerators to dispose of clinical waste well away from residential areas ?

Mr. Sackville : We shall be studying that report with interest, as we do all the utterances of the BMA. In particular, I am fully aware of my hon. Friend's consistent representations on behalf of his constituents about the hospital incinerator. However, he must remember the advantages of on-site clinical waste incineration and must take that into account in any other environmental


Elective Operations --

2. Sir Paul Beresford : To ask the Secretary of State for Health what proportion of elective operations are now carried out on a day care basis ; and what was the comparable figure 10 years ago.

The Secretary of State for Health (Mrs. Virginia Bottomley) : The number of day cases in the general acute sector has already doubled since 1988-89, the earliest year for which figures are available. In 1993-94, the proportion of elective admissions treated as day cases reached 48 per cent.

Sir Paul Beresford : This type of day care facility is being used as a specialty by many of the high-quality private health clinics and hospitals in Britain. Is there any trend to encourage health authorities to use those services, which are cost effective, to ease their workload ?

Mrs. Bottomley : Where such services provide good value, the health authority is certainly free to establish a contract with an independent provider. The key is that day care provides good value for money. However, my hon. Friend will know that his local hospital, the Mayday trust, did the fifth best in the country in terms of cataract extraction : 90 per cent. of its cases are dealt with on a day basis. The hospital received four stars for cataract operations, four stars for arthroscopy, four stars for laparoscopy and three stars for hernia repair. My hon. Friend has a great deal to be proud of in the Mayday trust.

Ms Lynne : Is the Secretary of State aware that no one will believe the assurances that she gives on day surgery or any other aspect of the health service ? If it is all sweetness and light in the health service, can she tell us why the British Medical Association, the Royal College of Nursing and a majority of other medical bodies, and now the Bishop of Birmingham, say that the health reforms are not working ? They surely cannot be on their own in that. Will the Secretary of State answer that point ?

Mrs. Bottomley : Change is always difficult, but it has to be grasped if we are to protect a remarkable achievement. Today, the anniversary of its founding, the national health service is providing treatment available to all on the basis of clinical need. That means embracing new technology, taking difficult decisions and resisting the temptation to scaremonger rather than lead people forward.

Sir Anthony Durant : Following my right hon. Friend's comments on day surgery and cataracts, will she congratulate the unit at Royal Berkshire Trust hospital, which she visited last Friday and which has had great success in day surgery ? Will she congratulate the nurses and doctors on the success of that unit ?

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Mrs. Bottomley : Most certainly I will. I will also report to the House the comments from the patients whom I met when visiting the unit. They said that they were appalled by the scaremongering which suggested, for example, that patients over the age of 65 would not be treated by the NHS. Those patients, many of them well into their 60s and 70s, gave an account of the quality of the care that they received : they went in in the morning and returned home in the evening. Although that hospital got one star in the league tables, it is already achieving 45 per cent. of its cataract operations on a day basis because, since those tables were compiled, it has seen the future and invested in a day unit particularly to deliver day cataract surgery.

Mr. McCartney : First, I congratulate the Secretary of State and the Minister of State on attending their last Health Question Time, as I understand that, like so many acute beds in the NHS, they are about to be closed down and shuffled out of the Department of Health.

Last week, the Secretary of State said that she was giving stars to star performers in her league tables. Why, then, is Manchester's Withington hospital--which achieved 100 per cent. ratings in casualty, in ear, nose and throat, ophthalmology, urology, gynaecology, oral, neurology and general surgery--not being congratulated but being given notice to quit ? When such a wonderful hospital is receiving five-star ratings from the right hon. Lady, why is she allowing the regional health authority and the Department to close it down ?

Mrs. Bottomley : If the hon. Gentleman has difficulty believing me, he may like to consult The Guardian , which reported that last week's league tables represented a milestone in the NHS and that the Opposition had made fools of themselves in their attitude towards those league tables.

Perhaps I may quote to the hon. Gentleman the following comments :

"Within the next 20 years, new technology, minimally invasive surgery and new diagnostic and treatment facilities will transform the delivery of health care in the developed world."

Those are not my words ; they come straight out of the Labour party's own policy document.

Dr. Goodson-Wickes : Does my right hon. Friend agree that the agreeable benefits derived by patients from day care surgery are well supplemented by the Government's initiative on community care, which must be for the good of patients and their families ?

Mrs. Bottomley : My hon. Friend is exactly right. Day surgery must be developed in context. The dramatic investment in primary care and the resources committed to community care ensure that those discharged from hospitals are properly supported at home. The idea that we should be in the business of trying to retain hospital beds as our prime preoccupation rather than increasing the number of patients treated conveniently is only the rhetoric espoused by the Opposition parties. We believe in patients, not furniture.

Residential Care and Nursing Homes --

3. Mr. Pickthall : To ask the Secretary of State for Health if she will make a statement on the proposed review of registration and inspection of residential care and nursing homes.

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The Parliamentary Under-Secretary of State for Health (Mr. John Bowis) : We expect shortly to issue for consultation a draft circulaon improving the regulation of residential care and nursing homes.

Mr. Pickthall : What does the Minister intend to do about the rising incidence of professional misconduct and even abuse in residential care and nursing homes, as highlighted in the United Kingdom Central Council report ? How does he intend to provide enough registration and inspection officers to ensure that the affairs of those homes are properly conducted and that the elderly residents are secure ?

Mr. Bowis : The hon. Gentleman referred to the UKCC report. When the report was published, I said that a single case of abuse was a betrayal of nursing trust and I stand by that. I hope that the hon. Gentleman will accept that the rise in the number of cases investigated from 15 to 28, 27 and 35 in the past four years must be judged in the context of the fact that the number of residents in nursing homes has gone up by tens of thousands. In that context, I shall be talking to the Royal College of Nursing about ways of enabling nurses to spot problems, as well as with the associations of matrons and managers about improving supervision and with the National Association of Health Authorities and Trusts, NAHAT, to discuss training and inspection. In that way, we shall ensure as far as we possibly can that people will be safe and secure in their residential nursing homes. I hope that the hon. Gentleman will do nothing to alarm people unnecessarily, because in the vast majority of cases loving care is given.

Mr. Harry Greenway : Does my hon. Friend share my concern at the recent case of a lady who was apparently severely scalded, a fact which was discovered only by accident ? Is that the tip of an iceberg ? If so, is it possible to have a proper inspection system at all times and on every aspect of care in nursing homes, because that is what is needed ?

Mr. Bowis : The case to which my hon. Friend refers occurred, I think, at a residential care home rather than a nursing home, and so is a matter for inspection by the social services. That particular case is also the subject of a police investigation, and I would not wish to comment on it.

My hon. Friend is right to say that we must maintain a secure and effective programme of inspection by social services departments of residential care homes in the private, voluntary and public sectors to ensure the safety and well-being of the people in those homes.

Mr. Hinchliffe : Has the Minister had an opportunity to study the report on a recent survey conducted by the charity Counsel and Care, which shows that the Government are seriously mistaken in believing that registration and inspection are regarded by private homes as burdens ? Has he studied the recent letter sent to his Department by the relatives association which speaks of the anger and concern of relatives at the possible reduction of inspections ? Does he now accept that applying the political gimmick of deregulation to the care of vulnerable people is totally inappropriate and wrong ?

Mr. Bowis : I hope that the hon. Gentleman accepts that the only circular that has been sent from my Department summarises the points that have been put to the

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Department as a result of the consultation period. I hope that he will also accept that the Government have not spent the past decade putting into place regulations to support and safeguard vulnerable people to see them swept aside now. We are carefully considering the system of regulation and inspection to see whether it can be streamlined and simplified, and duplication avoided, so that the care in those homes can be devoted more effectively to the residents, and not in the interests of any form of bureaucracy.

Capital Equipment --

4. Mr. David Shaw : To ask the Secretary of State for Health if she will make a statement on new patient-treating capital equipment installed in hospitals in the past five years.

Mr. Sackville : In recent years, there has been a rapid rise in the use of non-invasive and minimal invasive techniques which has involved the acquisition of much high-tech medical equipment.

Mr. Shaw : Is my hon. Friend aware that in east Kent we now have available in our hospitals a new £1.25 million linear accelerator and a new computer tomographic scanner ? Is he further aware that more patients are being treated by the new magnetic resonance imaging scanner, and that we are looking forward to tomorrow's visit by the Secretary of State formally to open the scanner ?

Mr. Sackville : All that equipment has led to new techniques, with shorter hospital stays and better recovery. My hon. Friend's area has an enviable record, and about £1 billion worth of such equipment is now being acquired each year throughout the country.

Mr. Ashton : Is the Minister aware that it is not much use having all that magnificent equipment if anyone can walk in and fiddle with it, as has happened at Bassetlaw hospital's intensive care unit on 16 occasions ? The Secretary of State has said that that has nothing to do with her, because the hospital is run by a trust. Three days ago at Nottingham, somebody walked into a hospital and walked off with a four-hour-old baby, who has not yet been found. Will the Secretary of State again say that it has nothing to do with her because it is all down to the trust ? Will there be investigations into the way in which hospitals are run, or are five stars just awarded ad lib ?

Mr. Sackville : We are very aware that security needs to be much higher on the agenda of each hospital, but we cannot dictate what level of security to impose on each hospital. Hospitals are open places where people expect to visit their friends and relations, and each hospital must find a balance.

Dr. Liam Fox : Has my hon. Friend had a chance to assess the amount of new equipment opened and the number of new patients treated in the Birmingham area ? Has he had a further chance to assess whether those have any link whatever with falling church attendance and church closures in the area ?

Mr. Sackville : The bishop and I had some exchanges at a distance over the weekend. That is probably sufficient.

Mr. Blunkett : Does the junior Minister agree that if the Secretary of State opens something tomorrow, there is a

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fair chance that it will be closed within the next six months ? Will he take this opportunity to whisper in the right hon Lady's shell-like ear that her credibility and future prospects could be enhanced today, on the 46th anniversary of the founding of the national health service, if the £150 million spent at Philip Harris house and the £44 million donated in charitable giving were put to good use and saved by the right hon. Lady announcing today that she will save Guy's from her closure plan ?

Mr. Sackville : I remind the hon. Gentleman that right through two severe recessions in the 1980s and 1990s we saw a constant rise in the hospital building programme--in sharp contrast with an earlier Government who, faced with a little local trouble in 1976 as a result of their own financial incompetence, reacted by slashing the NHS capital budget.

Mr. Oppenheim : As to capital equipment, does my hon. Friend agree that a caring and a more business-like approach in the NHS are not mutually exclusive, but mutually interdependent ? Fine words and hand wringing do not treat more patients, but using necessarily finite resources does. Conservative Members, together with hundreds of thousands of people working in the NHS, can be justifiably proud of the enormous increase in NHS services since we came to power in 1979.

Mr. Sackville : I agree absolutely with my hon. Friend. Nothing could be more un-Christian than running the health service in such a way as to produce longer waiting lists and less patient care.

Pay Beds --

5. Mrs. Anne Campbell : To ask the Secretary of State for Health what assessment she has made of the effect of pay beds in the national health service on the principle that treatment is determined by clinical need rather than ability to pay ; and if she will make a statement.

Mrs. Virginia Bottomley : Pay beds have existed since the NHS was founded 46 years ago. They have no impact at all on the principle that NHS patients are treated according to clinical need rather than ability to pay. Any private work that a consultant does is additional to his or her NHS duties and is carried out in his or her own time.

Mrs. Campbell : Nevertheless, will the right hon. Lady investigate whether pay beds or private referrals at Addenbrooke's hospital are responsible for one of my constituents, Megan Thompson, being told that she must wait until 1999 to see an orthopaedic consultant ?

Mrs. Bottomley : Once again, that is a typical example of scaremongering from the hon. Lady. If she had made the investigations that I have made, she would know that the other orthopaedic surgeons at Addenbrooke's have waiting lists within 18 months. The hon. Lady referred to a particularly popular orthopaedic consultant, who has a longer waiting list. It is a question of freedom of choice for patients : if they insist on seeing a particular consultant, they must wait longer, but they can have an appointment with another within the 18 months.

Mrs. Roe : Does my right hon. Friend agree that pay beds provide an extremely valuable source of extra income for the NHS, but that the Labour party clearly does not

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appreciate that ? Does that not clearly show that despite the soft-focus imaging that the Labour party is undertaking at the moment, it does not permit freedom of choice ?

Mrs. Bottomley : My hon. Friend has it exactly right. I am concerned about the dispute in the Labour party. I notice from early-day motion 1436 that the hon. Members for Bristol, South (Ms Primarolo) and for Cambridge (Mrs. Campbell) both support putting an end to NHS pay beds. Is that the political sweetener for the unions about which Barbara Castle used to speak ?

Ms Primarolo : Is the Secretary of State aware that the number of private patients treated in the national health service has risen by 10 per cent. since she introduced the internal market ? The NHS is subsidising private patients while health service patients are waiting longer for treatment. Will the right hon. Lady agree to establish the full cost of providing private health care, including the training of doctors and staff time in hospitals ? Will she also ensure that private patients cannot queue -jump those in greater need ?

Mrs. Bottomley : Pay beds bring in £157 million for the NHS-- the equivalent of 41,000 hip replacement operations. There are clear rules. There may be no queue-jumping for priority or urgent operations, and the private sector may not disadvantage the NHS. It so happens that most people signed up to private health insurance in the winter of 1979-80 and in 1980- 81. As ever, the private sector recruiting sergeant was Labour's stewardship of the NHS and the winter of discontent.

Mr. Patrick Thompson : Bearing in mind the relationship between private medical care and the national health service, and the fact that we are now celebrating 46 years of the health service, does my right hon. Friend recall the attitude of the British Medical Association on the formation of the health service, and will she therefore take with a pinch of salt the sort of nonsense that we are currently hearing ?

Mrs. Bottomley : The current BMA conference is the fifth that I have experienced since I have been at the Department of Health. The script varies little from year to year. The doctors' trade union has a job to do, which it has done since 1948. I am pleased that behind the rhetoric there is a great deal of practical progress, such as reducing junior doctors' hours, improving out-of-hours arrangements for general practitioners and progress in other areas. The BMA is not talking about dismantling the reforms, but only about reforming them. That is progress indeed.

Continuing Care --

6. Mr. Gunnell : To ask the Secretary of State for Health what measures she intends to take to clarify health authorities' responsibilities for continuing care.

Mr. Bowis : We shall shortly be issuing, for comment, clarification on the guidance to health authorities on their long-term health care responsibilities.

Mr. Gunnell : How many of the 50,000 beds that the Secretary of State plans to empty are currently filled by continuing care patients ? How can health authorities follow the rulings of the health commissioner on the Leeds

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case if patients cannot afford private beds and cannot find public beds because the Secretary of State has disposed of the furniture ?

Mr. Bowis : It is for health authorities to plan and provide the beds that they need. The hon. Gentleman misses the point that the Leeds case on which the commissioner made his judgment pre-dated community care and the discharge agreements that every local authority has to have in place with its local health authority. It is not for politicians to decide when a patient should remain in a bed ; that is a matter for doctors. When they have decided that a patient no longer needs a bed, the discharge arrangements are put in place. Until the needs of the patient have been assessed and arrangements to meet them are in place, the patient should not be discharged from hospital.

Mr. Sims : Is it right that a patient who no longer needs hospital treatment and is capable of being cared for in a different setting can insist on remaining in hospital and, at his own wish or under pressure from relatives, is legally entitled to occupy a much needed bed ? Is the balance between rights and responsibilities accurate here ?

Mr. Bowis : My hon. Friend makes a fair point. I shall not prejudge the guidance clarification that we are about to issue, but I assure him that we have looked carefully at the issue that he raises so as to ensure that we provide for patients who need hospital beds and do not give patients the right to have beds when they no longer have a clinical need for them.

Mr. Simpson : I am sure that the Secretary of State is aware of the nightmare abduction from Queen's medical centre last week of Abbie Humphries, who was taken from her parents' arms. Will the Minister take this opportunity to offer support and sympathy to Roger and Karen, her parents, at this terrible time, and will he congratulate Queen's medical centre staff who, within five minutes of the abduction, were on the main roads outside stopping buses and questioning passengers ? Will the Minister resist pressure for premature endorsement of the idea that infant tagging would have prevented that abduction rather than made the response time longer ? Will he support calls from the police who say that members of the public must know the woman who took baby Abbie and that if they have even a fragment of information that can help to solve this crime they should contact the police so that Abbie can be returned safely and quickly to her parents ?

Mr. Bowis : The hon. Gentleman makes his point eloquently. I am sure that we all share the anguish of the parents of little Abbie. Our prayers are with those who are hunting for her, with her family and with her ; our pleas are with the person who took her to return her to her family. I am sure that every maternity hospital and every maternity unit up and down the country is examining its security arrangements very carefully, to ensure that babies are safe in their care.

General Practitioner Fundholders --

7. Mr. Anthony Coombs : To ask the Secretary of State for Health what are the latest figures for the proportion of patients in the United Kingdom treated by general practitioner fundholders.

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The Minister for Health (Dr. Brian Mawhinney) : There are now more than 2,000 general practitioner fundholding practices in England covering just over 35 per cent. of the population, with more practices preparing to join next April.

Mr. Coombs : Given the irresponsible scaremongering of the British Medical Association before the introduction of GP fundholding--it said that drugs would run out and that pensioners would go untreated--is not it highly significant that no fewer than 85 per cent. of my constituents are treated by GP fundholders, and are receiving a far higher standard of service as a result ? Is not that evidence that the comments of Dr. Sandy Macara, the head of the doctors' trade union, should be treated with the contempt that they deserve ?

Dr. Mawhinney : Both the BMA and the Opposition got the issue wrong, and both are now edging towards an admission of that. I am not in the least surprised that 85 per cent. of my hon. Friend's constituents are happy with the GP services that they are receiving.

Mr. Austin-Walker : The Minister will know that at the beginning of the last financial year millions of pounds were held in health authority bank accounts, representing the surplus or underspend on GP fundholders' budgets, at a time when hospitals and beds were closing because health authorities did not have sufficient funds. Would not it have been better for the money to be spent on treating patients ? What steps will the Minister take to monitor such expenditure ?

Dr. Mawhinney : That is exactly what the money is to be spent on : it is to be spent to benefit patients, as I suspect the hon. Gentleman knows. Only last week, I announced that we were reviewing the extent of the services on which the money might be spent to benefit patients, and that I would make an announcement about that question in the autumn.

Mr. Duncan Smith : Is my right hon. Friend aware that yesterday I attended the opening of Handsworth medical centre in my constituency, which was financed by money from central Government under the London implementation zone programme ? Is he aware that, as a GP fundholding practice, the centre now has 14,000 satisfied patients ? Does not he agree that that is a good way of demonstrating to the BMA and the Bishop of Birmingham that they should stop making political capital out of such matters, and start backing us ?

Dr. Mawhinney : My hon. Friend has made two important points. The first is that, increasingly, the development of primary care is much more focused on what the GP feels able to do for his or her patients. The second --which flows from that--is that at the heart of the reforms was an understanding that if decisions were made as close to the patient as possible, they were more likely to be correct. That is fully borne out by what is now happening in GP fundholding practices throughout the country.

NHS Authorities (Appointments) --

8. Mr. Milburn : To ask the Secretary of State for Health what changes she is proposing to the system of appointments to NHS authorities.

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Mrs. Virginia Bottomley : The system of appointing chairmen to NHS authorities is largely unchanged, and has been supported by successive Governments. We are introducing further improvements to make the system more standardised and open to support our objective of attracting people of the highest quality on to health authorities and trusts.

Mr. Milburn : Is the Secretary of State aware that the appointments that she has made to both health authorities and trust boards have made them less and less representative of the communities that they are supposed to serve ? When will she abandon the process of making such appointments in secret, behind closed doors, so that credibility can be restored to a system that has lost all public confidence--or does she believe that jobs for the boys and jobs for the girls are more important than public accountability in the national health service ?

Mrs. Bottomley : Publicof a court. No one thought that that was a political appointment ; it was made after careful vetting. The same applies to health authority appointments.

Unless the hon. Gentleman is trying to reopen the argument between Herbert Morrison and Nye Bevan, which was put to bed 46 years ago, I suggest that he ensure that members of his party no longer put the frighteners on Labour people who wish to serve on trusts and health authorities, to make certain that we have good people from all political parties serving the interests of the public.

Mr. Hayes : Does my right hon. Friend agree that the appointment of wicked Tories such as Rabbi Julia Neuberger and the former Labour Member of Parliament, Helene Hayman as chairmen of trusts shows that the hon. Gentleman is talking nonsense ?

Mrs. Bottomley : My hon. Friend is right. If the Labour party wishes to hark back, I do not think that the health service benefited from the appointment of the disqualified Lambeth councillors to the local health authority, or from that of the three prospective parliamentary candidates by Greenwich Labour party to its local health authority.

Mr. Ieuan Wyn Jones : Does not the Minister accept that there would be far more confidence in the system that she propounds if there were much more local discussion about the kind of appointments that should be made, rather than the process appearing to take place behind closed doors ? Openness should be part of the right hon. Lady's policy.

Mrs. Bottomley : I agree with the hon. Gentleman. That is why, based on best practice, we are ensuring that in every region there is a process of open advertisement and nominations, including self-nominations, are encouraged. I hope that the hon. Gentleman and other hon. Members will look for people with the skill, expertise and commitment to help us to take forward the extremely important NHS reforms.

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NHS Hospital Treatments --

9. Sir David Knox : To ask the Secretary of State for Health how many patients were treated in national health service hospitals in the most recent year for which figures are available ; and what were the comparable figures for 1978.

Mr. Sackville : There were 9.6 million finished consultant episodes in 1992-93, compared with 6.5 million in 1978--an increase of 47 per cent.

Sir David Knox : Does my hon. Friend agree that those figures provide strong evidence of the improvement in the health service since the Government came to power ? Will he confirm that the increase in the number of patients treated has been faster since the NHS reforms were introduced ?

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