House of Commons Hansard Debates for 22 Nov 1994

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figure should be the main and perhaps even the sole source--will have been strongly reminded of the Home Secretary's attempt to draft Lord Lieutenants into service to nominate the chairs of police authorities, one of the more ludicrous examples of the Government's striving to escape from the consequences of the richly deserved electoral hammering that they took at local level when the lies that they had told to win the general election had been exposed. In the light of that great deceit, and of the lesser, almost daily examples of the Government's economy with the truth, we shall look in the legislation not only for clear, categorical assurances but for practical measures to ensure that there is no loss of hard information enabling the public to test their own experience and the wealth of anecdotal information available against published evidence.

Let us take waiting lists, for example. In common with most health service staff and the general public, we regard them today as fiddled figures; but at least some figures used to be centrally collected and readily available. In Wales, I understand, that has not been the case to anything like the same degree, the reason being the different structure of the service there. NHS administrators in Wales are civil servants, responsible to, and with a duty of official secrecy to, the Welsh Office. Consequently, what information is supplied is supplied when it suits the Secretary of State rather than when it is first available and might be most useful to those judging the worth of Ministers' statements.

Under the legislation proposed, English regional staff, too, will be civil servants, owing a duty of official secrecy to that fine exemplar of open government, the Secretary of State, whose press office was charged with keeping news away from the public even before she had the benefit of Mr. Maples' wise advice.

We shall want to look very carefully at the legislation, as will my Welsh and Scottish colleagues. In view of the existing organisational differences, they have asked me to seek guidance from the Secretary of State about whether there will be, as we assume, separate legislation for them.

We shall also want to give much thought and scrutiny to the Government's proposals for supervision orders for the small number of patients whose violent behaviour makes them a danger to the public. That is a proposal about which, as the Secretary of State will know, those in the field are expressing considerable anxiety.

Our concern will be not just for the specific proposals in the legislation, but for the background against which they will be implemented. For example, the Opposition are very conscious that the Ritchie report, which was issued following the tragic death of Jonathan Zito, contained 2l pages of recommendations, of which supervision orders was only one. His widow, Jayne, is on record as describing such orders as "a cosmetic response to a critical situation"--inadequate without more far- reaching change.

Recently, both the Audit Commission and the Mental Health Foundation published serious and weighty studies which suggest greater difficulties with implementing care in the community than the Government seem ready to acknowledge.

I give the Secretary of State fair warning: while we will look constructively at whatever proposals the Government make, we shall expect and demand evidence that, outside

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the legislation itself, the Government are taking action to address the issues. We will not be party to any process which seems destined primarily to create scapegoats to take the rap for the Secretary of State.

The fear that that may be the outcome of the legislation is fuelled by the record and approach of the Tory party in the past 15 years. One of the Government's first acts on obtaining office was to bury the Black report, which highlighted the consequences of poverty and deprivation. Ever since, they have sought to ignore and deny not only the steady increase in poverty and deprivation to which their economic failure has led, but its inexorable consequences for mental and physical health: the knock-on effects and the costs, especially to the health service itself.

A few days ago the Government signalled that nothing has changed when, having commissioned from York university research to assist in finding a better measure of health need to guide the distribution of health money, they decided to avoid taking too much notice of it until after the next election because, inconveniently, it suggested that less money may be needed in the kinds of leafy suburbs represented by the Secretary of State.

We want to see the greatest measure of public money going to where there is the greatest need. We want to see it used sensibly for investment and not wasted as it was on Health Care International, the Wessex health authority and in the west midlands. We want the available resources to be used in the front line for patient care. I again quote Lynda Lee-Potter:

"When we're sick, frightened and in pain . . . We want to believe that the most important thing in any hospital is not its bank account, but its commitment."

The Government and the Secretary of State believe that patients, like the unemployed and pensioners, have to learn to stand on their own. For 15 years, the Government have been telling people to stand alone when, increasingly, it means that people live in insecurity and fear. For example, the Government have encouraged people to take out costly health insurance which is needed only because the Government have put in jeopardy the quality and security of the national health service.

We in the Labour party believe that everyone's self-interest is inextricably intertwined with the common interest, and that the national health service is the greatest expression of that common interest and of the spirit of community that this country has ever known--community not just as an aspiration, but as a living and breathing daily experience.

That is why the NHS is not just valued by the British people; it is loved. That is why, contrary to the notions of Professor Caines, Labour will rebuild a public health service and run it in the common interest.

4.14 pm

The Secretary of State for Health (Mrs. Virginia Bottomley): The Gracious Speech has shown that important social reform will be at the heart of the agenda for the new parliamentary Session. I welcome the measures that it contains to improve the working of the economy, because it is wealth that makes welfare possible. I shall address in a moment some of the prejudiced, short-sighted and blinkered comments that we

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heard from the right hon. Member for Derby, South (Mrs. Beckett). I want to start with some of the most important issues.

The Labour party is disqualified from ever again being trusted with our national health service. Perhaps the most serious reason for that is that its current policies and its history in office show that they would destroy our economy. Listening to the radio yesterday, we heard the serialisation of the diaries of the right hon. Member for Chesterfield (Mr. Benn). We were all reminded again of the time when volunteers had to man the hospital kitchens, when the economy suffered under the right hon. Gentleman and his colleagues, and when the NHS suffered bitterly. Unlike the right hon. Member for Derby, South, I was at that time working with the national health service, and I remember that only too clearly.

Mrs. Barbara Roche (Hornsey and Wood Green) rose --

Mrs. Bottomley: At that time, the right hon. Lady was one of the culprits. She sat on the Government Benches during that time. She was a Member of the grim reaper Government who cut doctors' pay, cut nurses' pay and cut real terms spending for the only time in NHS history. I am grateful to my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) for pointing that out once again to the House. Before the right hon. Lady lectures us, let us look at the disgraceful record of the Government of which she was a Member. The background to the Gracious Speech this year is very different. We have an economic climate that is as favourable for long- term growth as it has been for decades.

Mrs. Roche rose --

Mrs. Bottomley: Inflation is firmly under control, unemployment is falling and exports are surging. We have been able to make Britain, in the words of the President of the European Commission, a paradise for inward investment. We have been able to do that not least because we have rejected the social chapter, which the Labour party would foist upon us. The Government's programme for this Session will help us to build on those prospects. That is good news for the country and good news for the national health service. The longer the faces on the Opposition Benches grow, the louder patients should cheer. Thanks to our health reforms, we are better placed than ever to maintain a comprehensive service, available to all, at a cost that our economy can afford. I notice that the right hon. Member for Derby, South is happy to recite a vision of what might be achieved in the health service, but that she is totally devoid of any mechanisms by which the Labour party would deliver that objective. As a result of the reforms, we now have the potential to achieve more and more. Last week, I was invited to address the conference of the Organisation for Economic Co- operation and Development on health care reform. The OECD experts have looked at the United Kingdom health reforms, and they like what they see. Their report highlighted a series of positive results stemming from the reforms.

Mrs. Roche: Does the Secretary of State agree with the vice-chairman of the Tory party, who advised his party

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that the only way in which it could deal with the Government's record on the health service was to have a total news blackout?

Mrs. Bottomley: I would certainly like a blackout of the endless denigrating comments from the Labour party.

It is bizarre. I am keeping a check on how long it is before the right hon. Member for Derby, South gives a single word of credit to the people who work in the health service in Derby. We had no mention last time of the £48 million programme in Derby and we had no mention this time. I am just waiting until all those thousands of people who work in and serve the national health service in her constituency get any recognition. What matters is that we continue to deliver the results.

Mrs. Beckett: I am sorry that the Secretary ofState is so at fault. She has clearly forgotten that, during our previous debate only a few days ago, I opened my speech by praising the staff of the national health service.

Mrs. Bottomley: The right hon. Lady made no recognition of the achievement of that team and of how the service has seized the opportunity of the reforms to reduce waiting times and to improve the quality and the quantity of patient care.

It is an example of the way in which the Labour party behaves that it does not hesitate to denigrate, for example, the work of Roy Lilley, but I wonder how many Labour Members have visited the Homewood Trust, which is a Rolls-Royce service for patients. That is the Rolls-Royce that I mind about.

The trust cares for some of the most severely-- [Interruption.] It is interesting that the Labour party derides and jeers a trust providing care for some of the most severely mentally ill patients. When the right hon. Member for Derby, South was busy as a trade union official, my life's work involved trying to improve services for those patients. If I thought then that there would be the quality of service-- [Interruption.]

The hon. Member for Wakefield (Mr. Hinchliffe) is right. He has long been a champion of the cause. I invite him to visit the Homeward Trust and to see for himself the quality of care and the commitment of staff to that group of patients. He, as much as I, has long wanted to ensure that they are given the recognition and respect that they deserve. Before jumping to vituperation and personal attack, the Labour Members should visit and see with their own eyes some of the quality care that is being provided.

Rather than dwelling further on the gossip and on the pasting together of press cuttings of the Labour party, I should like to return to the comments of international experts, such as those at the Organisation for Economic Co -operation and Development, which I was invited to address last week. Its report highlighted a series of positive results stemming from the reforms. They include the improved performance of hospitals, especially trusts, the success of GP fundholders and the doubling in the number of day cases, greatly contributing to increased efficiency.

Health care systems around the world face similar challenges. Changes are driven by medical advance, rising expectation and demographic pressures. Our response is widely regarded as well judged. Other countries that have long respected the national health service are looking to

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us as pioneers of health service reform. The World Health Organisation, for example, described our "Health of the Nation" strategy as a model for other countries to follow.

It is still this Government who are coming up with the ideas. It is still the Labour party that has none of the answers. It does not even know the questions that it should be asking. The right hon. Member for Derby, South tells us that, for the third time of asking, the Labour party is consulting on what its policy should be. It is difficult for Conservative Members to hear that with a straight face. I have faced three Opposition health spokesman. All of them were looking for a policy and searching for the questions and the answers, without delivering anything which could have given any assurance to the people of this country.

Five years ago, the Gracious Speech unveiled the historic Bill to reform the NHS. Responding for the Opposition, the hon. Member for Livingston (Mr. Cook) offered his usual rash of predictions--or should I say, his rash predictions? He said that the Bill would spell the end of the Conservative Government, and that not a Tory Member of Parliament would be left between here and Aberdeen if we dared implement the Bill. My hon. Friend the Member for Aberdeen, South (Mr. Robertson), who so ably seconded the Gracious Speech and who won his seat from Labour in 1992, might beg to differ.

The Conservative Government are still here, returned for the fourth time, with more votes than any other party in history. Our reforms are still here, and they are here to stay. Even the local hospital in the constituency of the hon. Member for Livingston went off to become a trust, and the hon. Member went off to another job.

Mrs. Jane Kennedy (Liverpool, Broadgreen): I am grateful to the Secretary of State for giving way, as I know that many other hon. Members wish to intervene.

She is talking about reform of the national health service, but will she consider for a moment the change for change's sake that has been forced on the National Blood Authority, whose staff are highly skilled and provide an excellent service to the people who rely on it? Will she recognise that the donors who contribute to the service are deeply worried about the proposal to close five centres? When will we be told about the outcome of the consultation process?

Mrs. Bottomley: If ever we needed proof of the jeopardy in which people would be placed if the Labour party were to form the Government again, that intervention is it. The hon. Lady speaks, understandably, on behalf of the unions involved in the delivery of that service. Our health service, like that of every country, needs to change. Change is necessary, and we are rationalising the 14 processing centres to release resources for mobile units. I look to the courage of the people who are prepared to say that change is necessary because patients will benefit.

I pay the warmest possible tribute to the millions of people who regularly give blood to the national health service. The gift relationship established in our blood transfusion service, which is one of the best in the world, is remarkable, valuable and precious, but that does not mean that we should not rationalise the centres where the

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processing is undertaken if we can streamline the service, thus releasing more resources for mobile units and for parts of the health service where there is pressing demand.

Dame Elaine Kellett-Bowman (Lancaster): Is my right hon. Friend aware that the chairman of the National Blood Authority came to Lancaster last Monday and spent the whole day there from 8 am? He spoke to all the staff and the anti-D donors and made it clear that there was no way on earth that he would imperil the donation of blood from the anti-D donors or others. His object was to make it easier to give blood, not more difficult. He also said that blood was a valuable commodity, and that, as it was given freely, it was up to us to look after it as best we can. I am sure that he will do that.

Mrs. Bottomley: I thank my hon. Friend for putting the case fully and fairly.

I was talking about history and the hon. Member for Livingston. His great hot tip was that the general election would be a referendum on the NHS. A number of hon. Members have raised the question of public opinion and perceptions. The hon. Gentleman later kept pretty quiet about the fact that he had said that the general election would be a referendum on the NHS. It was a good thing for the health service that he lost.

Dismantling the reforms, as the hon. Gentleman promised then and as the right hon. Member for Derby, South is promising again today, would mean chaos, upheaval and disillusion in the service. Incredibly, the right hon. Lady seems to have learnt nothing, as she is still pledging to reverse the reforms. She said that she would abolish trusts, that fundholders would go and that she would bring back the old command and control bureaucracy that encased the health service in cement.

She would be foolish to try it, and she must know it. In fact, I do not think that she believes for a moment that it would happen. It is a posture, an empty gesture that impresses no one--except, of course, her old friends the unions which sponsor the Labour party's health Front-Bench spokesmen.

I was wondering whether the right hon. Lady would have learnt from her predecessor's awkward predicament. He spent two years dithering about how to respond to the reforms and their growing success in dealing with patients. Like the right hon. Member for Sedgefield (Mr. Blair), he would not say yes and he would not say no. Finally, however, he got off the fence and decided that he was against them. Two weeks later, he was sacked. He is not making the same mistake twice. As the House will know, he made a spectacular and humiliating U-turn in Labour education policy. My advice to the right hon. Lady is to follow his example, to hoist the white flag now on health and decide to support the reforms, before she too gets shunted off.

Mr. Dafydd Wigley (Caernarfon): I am sorry to intervene in this private Punch and Judy show, but the Secretary of State mentioned the comprehensive health service available to all. Is she aware that, not only in my constituency but in many other areas, it is no longer possible for someone to get dental service on the NHS if he or she is seeking it for the first time? More and more dental practitioners are telling even the patients on their lists that, unless they pay a monthly subscription, the

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service will no longer be available. When will the right hon. Lady make the NHS dental service available again to everyone in need?

Mrs. Bottomley: I beg to differ. Our weekly figures make it clear that dental services are available. But if the hon. Gentleman wants me to investigate the situation in his constituency, I shall be more than happy to do so. Although the number of dentists and the amount of dental care have increased, more children are registered and there is an unprecedented level of dental cover, we accept, as the House will know, that it is time to re-examine the system under which dentists are employed and remunerated, and the structure of the service. That is why we commissioned the Bloomfield report, to which we are now considering the responses. We want a service that is fairer to patients, to dentists and to the taxpayer.

My task is certainly to set out the achievements of the health service, but where issues need reconsidering with the profession, with patients and with the public, we should openly say so, and take forward that process of debate.

I notice that the right hon. Member for Derby, South has been singularly quiet on the subject of health care since her appointment. That is no surprise, because she was silent on the subject before that, too. The debates ahead on the Health Authorities Bill will afford her an opportunity to make her position and that of her party clear, and to admit before it is too late that the Labour party is wrong about the health reforms, as it has admitted that it was wrong about almost everything else.

We welcome the opportunity that the Queen's Speech provides to take three Bills through Parliament this Session, because we wish to speak at great length about the achievements and the further developments in the health service. My hon. Friends look forward to being in Committee, where they will miss no opportunity further to explain and to set out the achievements of the health service, and the way in which our reforms have made it possible to do even better for patients.

The Bill will complete the unfinished business of the reforms. It will abolish regional health authorities, and build on the decentralised system of decision making now largely in place. In place of the existing arrangements, it will create single health authorities, better able to champion patients' needs. It will ensure that we have a streamlined system of management, able to balance local flexibility with greater strategic direction on core issues. Regional health authorities have served us well, but now that, rightly, decisions are taken closer to patients, they are no longer needed. A redundant layer of management can be removed, and the Bill will secure that.

The right hon. Lady identified several areas, and I agree that it will be important to make it clear how medical education, training, research, communicable diseases and the other factors that she mentioned will be dealt with. Only yesterday, I saw the Committee of Vice-Chancellors and Principals to discuss some of the issues involved concerning education and research.

In sweeping away the regions, we shall be able to save substantial sums on administration, and we shall invest that money in even more and better patient care. I challenge the Opposition to support the Bill, and I hope they will. If they resisted it, that would confirm what we have long suspected, so I welcome the right hon. Lady's comments. However, we believe that the Opposition are

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still the disciples of old-style central planning, the friends of the command and control bureaucracy that we have consigned to history, and the true champions of bureaucracy and bureaucrats.

Mr. D. N. Campbell-Savours (Workington): I understand from the health authority in West Cumbria that it is £1.5 million short. An argument has broken out among the general public about how that shortfall should be funded. Many of the people who come to me say that they are prepared to pay higher taxes to ensure that they have a proper health service in West Cumbria. What does the right hon. Lady say to them?

Mrs. Bottomley: I say to the hon. Member for Workington (Mr. Campbell-Savours) that his constituents should appreciate the fact that they have a Government who are able to invest progressive extra resources in the national health service--£1.6 billion this year--and a Government who can afford to make a commitment of real-terms increases in resources. As I set out at the beginning of my speech, the Labour party, which the hon. Gentleman supports, was lamentably unable to deliver. Whatever its promises, it cannot deliver and it ultimately betrays the public, the patients and NHS staff.

Mr. Thurnham: A moment ago, my right hon. Friend talked about blood donors. I do not know whether, like me, she has been over to the Treasury to one of its blood-letting sessions. Is not that as good a place as any to reflect on how much greater value for money she is achieving in the national health service? Is not the latest national health service report as good an example as any of all the points where we are getting much better value for money and much greater efficiency in the national health service, under my right hon. Friend's direction?

Mrs. Bottomley: The point made by my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) is certainly right. I find the association between blood-letting and the Treasury too close for comfort. When I give blood, I go elsewhere because I do not feel totally relaxed in that environment.

I noticed that in responding to the Gracious Speech, the Leader of the Opposition, as the right hon. Member for Derby, South (Mrs. Beckett) did today, made a number of mean-spirited and frankly disgraceful attacks on NHS managers. Labour claims to be in favour of efficient management, yet it always attacks the very people in the system who have brought it about. The right hon. Member for Sedgefield (Mr. Blair) then quoted the usual inflated figures about increases in the number of managers. He failed to mention the 18,000 extra qualified nurses, the 8,000 extra hospital doctors and dentists and the 3,000 extra general practitioners. The right hon. Member for Derby, South may look at the figures for nurses. I commend her to look at the project 2000 nurses and at the dramatic increase in practice nurses. She will then want to look again at her figures. What the Leader of the Opposition did not, of course, mention was that NHS management accounts for less than 3 per cent. of staff while front-line doctors and nurses account for almost two thirds. I know of no health service in the world that can better those figures and all the members of the team deserve congratulations for their work for the health service. The Labour party seeks to set doctor against manager, nurse against executive and

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clinician against clerk. A well-run health service needs them all and if the Labour party knew anything about running a modern health service, it would admit that.

Frankly, I resent the Labour party's insinuating comments that the information provided by the Department of Health and by the NHS is made up of factoids, and is dubious and somehow not to be trusted. Last week, the national health service, the biggest organisation in the country and one of the most significant health services anywhere in the world, published the NHS annual report. It documents the achievements of our staff and it is a tribute to them and their work.

I remind the House of some of the highlights. The number of patients treated rose to more than 8 million for the first time ever. That is thanks to the work of NHS staff. It is a rate of increase in one year twice the annual average increase in the 1980s and, as my hon. Friends will want to know, five times the miserable figure achieved under Labour. The annual report showed that there were significant reductions in junior hospital doctors' hours and that there was improved training for nurses. There were more and better immunisation services for children, breast and cervical cancer screening programmes, community nursing, services for mentally ill people and much, much more. Those are the achievements of health service staff and they do not wish their achievements constantly to be belittled by the Labour party.

Lady Olga Maitland: I am grateful for my right hon. Friend's catalogue. Does not she also agree that the Labour party would choke rather than admit that this Conservative Government have launched one £1 million national health service project every eight days?

Mrs. Bottomley: Once again, my hon. Friend is right. Is it not interesting that all the Labour party can do is jeer and sneer? Most people think that a million-pound project every eight days is something from which the patients would benefit and about which patients would be glad to hear.

On waiting times, which have traditionally been the great problem of our national health service, I am pleased to inform the House of further excellent figures published today. There has been a small, welcome reduction in the overall list size, but, more significantly for patients, because this is what really matters to them, we have made even further dramatic progress on cutting waiting times. In the past year alone, there has been a fall of nearly 10,000 in the number of patients waiting more than a year for treatment. That is a dramatic achievement--10,000 fewer patients waiting more than a year now compared with a year ago. The figure now stands at 62, 000--still too many, but less than one third of what it was before the reforms. Half of all patients do not wait at all, but for those who do, our policies have virtually halved the average waiting time. By extending and improving the patients charter guarantees, we will drive that figure down further still and provide an even greater dividend for patients.

Several hon. Members rose --

Mrs. Bottomley: We are building a national health service fit for the 21st century. Increasingly, we want to focus on the quality of care. We need to home in on, and wherever possible improve, clinical outcomes. As

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technology advances and medicine evolves, we must ensure that patients reap the full benefits of a state of the art health service.

I am pleased to be able to announce today that the Government will set aside an extra £40 million next year especially to support research and teaching in the NHS, which will bring to £530 million the earmarked funds dedicated for this purpose. The decision underlines the Government's commitment to research and teaching in the national health service. It will support the health service in training tomorrow's doctors, and allow work to be accelerated in the NHS research and development programme on innovative and evidence-based health care.

The NHS R and D strategy has made impressive and often unsung progress. Its continued evolution is essential for the NHS to take full advantage of the advances in science and technology. Research is crucial for identifying those methods in health care which will lead to better ways in which to promote health, prevent illness and treat patients more quickly and effectively. I look forward to the opportunity of working with the profession to enhance further the NHS's national and international reputation for teaching and research--again, an area about which we hear very little from the Labour party.

Mr. Kevin Barron (Rother Valley): If we are to have the confidence that the right hon. Lady wants us to have in her and the health service, will the right hon. Lady tell the House what she thinks about a report on the front page of The Guardian , which states that a letter leaked from the Ian Greer Associates office names the principal Member of Parliament involved in lobbying Ministers and individuals of the House against the tightening of the voluntary code for tobacco advertising as her own Parliamentary Private Secretary?

Mrs. Bottomley: Certainly my Parliamentary Private Secretary has no recollection of such a matter at all. Much more to the point is the fact that any holder of my office who is not used to energetic lobbying by people from all persuasions and interests would be unable to do the job. If anybody wanted to take lessons in lobbying, for all the respect, indeed, affection that I have for them, there would few better advisors on the arts of lobbying than the British Medical Association and the Royal College of Nursing themselves.

Talking of the BMA and its colleagues, the recent meeting of the medical profession on core values in medicine was, I believe, a landmark. It showed that the Government and the profession share a commitment to the same objective--to a modern, dynamic health service based on knowledge, informed by research and focused on outcomes for patients, to a health service of the future and for the future. In the same way, I am pleased to be working with the medical profession in taking forward our proposed Medical Act (Amendment) Bill. The public rightly have confidence in the vast majority of our doctors, but there is regrettably also a very small number of doctors whose performance is deficient. The General Medical Council, the doctors' regulatory body, wants to improve the procedures which they have for dealing with that minority. There may be some, for example, who need further training before they can be allowed to continue to

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practice. This Bill will provide those necessary powers, and the Government are glad to be able to support the GMC in that matter. My hon. Friend the Under-Secretary of State and Opposition Members have long made that point, and I am pleased that we are able to take it forward at this stage. I also welcome the support of the right hon. Member for Derby, South and of the hon. and learned Member for Montgomery (Mr. Carlile) on behalf of his party. I hope that that support will translate into practical action which will facilitate the passage of the Bill through the House.

I want to speak now about the important Mental Health Bill also announced in the Gracious Speech. The principle of caring for mentally ill people, where proper and possible in the community, is long-standing and supported on both sides of the House. The national health service now spends more than £2 billion on services for mentally ill people. More and more of that money is being spent in the community. There are now better services for the vast majority of mentally ill people than ever before--four times as many psychiatric nurses, four times as much residential provision, twice the number of day centre places. However, the right hon. Lady and many of my hon. Friends know of areas in which we have not yet delivered the comprehensive standard of care that we want for all patients, and we are determined to take that work forward.

We have, for example, a £45 million capital programme to increase the number of medium-secure psychiatric beds. It has long been a concern of mine, as members of the Select Committee and others will be aware, that, while care in the community generally works well for the majority, a small group of the most vulnerable patients do not always get the support they need. There have been a number of well-publicised cases which have brought the issue into sharp perspective. The national health service needs to do more to make services for that group a greater priority. It is beginning to happen.

For years, in the cities in particular, the large acute hospitals commanded most of the money available. Our Bill introduces stronger powers for looking after the most severely mentally ill people in the community. The new power of supervised discharge will build on our programme of action to strengthen care in the community. We have already introduced tougher and clearer guidance on the discharge of patients from hospitals. Four out of five health authorities now have in place supervision registers.

Supervised discharge will apply to those patients who have been detained in hospital and who, on discharge, need special support in the community. A patient subject to supervised discharge will be required to abide by the terms of the care plan drawn up by the clinical team when he or she leaves hospital. Failure to comply would lead to an immediate review and the possibility of compulsory readmission to hospital under the Mental Health Act.

That, too, is a measure which I hope should command support on both sides of the House. It will significantly tighten care in the community. It will provide added

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protection for the public and for patients themselves, and it will reinforce confidence in the policy of care in the community itself. Several hon. Members rose --

Mr. Archy Kirkwood (Roxburgh and Berwickshire): I am sure that the House will welcome what the Secretary of State has said about mental health. I know that she has a personal commitment-- [Interruption.]

Mr. Deputy Speaker (Mr. Michael Morris): Order. I appreciate that the hon. Gentleman is asking a question, but I would be most grateful if other hon. Ladies and hon. Gentlemen would keep their peace so that we may hear that question.

Mr. Kirkwood: We all welcome what the Secretary of State has told the House. We all accept the need for filling some of the gaps to which she has referred. Does she not accept, too, that, in community care more generally, some of the transitional arrangements are producing some difficulties, which I do not believe are caused by lack of good management in local authorities? If those local authorities which are suffering some shortfalls in transitional arrangements demonstrate to her that it is not bad management which is causing that shortfall, would she consider addressing some of the financial gaps which are emerging?

Mrs. Bottomley: When I became Secretary of State, a number of hospitals and health authorities came to see me in the ninth month of the year and said that they were greatly surprised to discover that the year had 12 months, not nine, that it came as a great shock and that they were running out of money. I said then, and I say now, to local authorities that, when people take on a position of responsibility, it is their job to act as good stewards for the extra resources that they have available. It is essential that they realise that they must plan that resource through the year.

Some of my hon. Friends may want to know the sums of money going to some of the local authorities which have been making the most noise. The Isle of Wight, for example, has received a 2 per cent. increase this year in its personal social services--almost £2 million more.

Mr. Campbell-Savours: Liberals.

Mrs. Bottomley: Liberals, as the hon. Gentlemen says.

Gloucestershire, for example, has a 10 per cent. increase--an extra £5 million. Devon has a 13 per cent. increase in personal social services moneys--an extra £14.6 million. Local authorities have an extra £1.2 billion for community care. It is a policy which local authorities fought hard to secure, as it were, from the Government. They were determined that they would act as good stewards. They worked closely with us in the implementation of the policy. They must now demonstrate that the trust that was placed in them was well founded. It is irresponsible to indulge in scaremongering tactics in respect of some of the most frail and vulnerable in the land when this year there are resource increases to which no other Department in local government is looking, even remotely.

Mr. Alan Howarth (Stratford-on-Avon): On the issue of good stewardship, and on another aspect of care in the community, did my right hon. Friend note the report

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yesterday, published jointly by the Policy Studies Institute and the British Council of Organisations of Disabled People, which showed that, in terms of cost-effectiveness--indeed, by a factor of about one third--and of quality of life and dignity in independent living, there is a clear advantage in allowing disabled people to manage their own budgets for domestic and personal care rather than having services provided for them?

My right hon. Friend has expressed her relish for reform, and she made some encouraging remarks recently to the conference of the Association of Directors of Social Services. Will she confirm that it is the Government's intention to amend the National Assistance Act 1948 during the Session to allow individuals to make their own arrangements?

Mrs. Bottomley: My hon. Friend has been a long-standing champion of that cause, as the House knows well. I began being somewhat sceptical and cautious, feeling that local authorities might not be able to be trusted to take on the responsibility. I have been assured that, on the contrary, they are able stewards. I must confess my concern about the signs that we have been seeing this year that the authorities might be playing at the sort of games that we have seen in other areas. They will need to demonstrate that they can be trusted to manage a budget through the year without holding to ransom the most frail and vulnerable.

I am not able to say more on the issue that my hon. Friend the Member for Stratford-on-Avon (Mr. Howarth) has raised, but I shall continue to reflect on his persuasive comments before I am able to make final announcements.

Before completing my speech, I wish to comment on the police investigations at Bassetlaw hospital and at other hospitals. It is clear that they involve serious matters. The police have our full support in the inquiries that they are pursuing. The House will understand that I am constrained in what I can say in advance of the investigations coming to a conclusion. I have made it clear, however, that I expect the NHS to co-operate fully, and I am sure that it is. All seven hospitals involved have given a helpline number for any past patients, or their relatives, who are worried. Inevitably our minds all go back to the appalling crimes committed by Beverley Allitt. As I recently stated in a written answer, all recommendations contained in Sir Cecil Clothier's important report have been or are being acted upon. If there are further lessons to be learnt from the Bassetlaw case, I give the House an assurance that action will be taken as soon as they become apparent.

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