Considered; to be read the Third time.
The Minister for Health (Mr. Gerald Malone): The Government's aim is to ensure that the national health service continues to benefit from the appointment of the best possible people with a wide range of skills to serve as chairmen and non-executive directors of health authorities and trusts.
Mr. Milburn: Is the Minister aware that the system for appointing people to serve on health authorities and trusts is now widely discredited? Will he agree with the following three simple steps to open up the health appointment system? First, will he publish a full list of those nominated; secondly, will he make clear the selection criteria that Ministers use; and, thirdly, will he itemise, as for magistrates, the party political affiliations of those chosen to serve? Or does the Minister continue to believe that jobs for the boys and jobs for the girls are more important than public accountability in the national health service?
Mr. Malone: The system has certainly been extremely unfairly impugned by the hon. Gentleman and members of his party. The system is open and accountable. Measures are being put in hand to advertise the non- executive posts more widely to attract a wider range of people, with all the business skills and talents and other necessary skills in the community. If the hon. Gentleman wishes to improve matters, perhaps he will submit to the Nolan committee the disgraceful letter from Labour's national executive committee that instructs members of the Labour party who serve in non-executive capacities to report back to Walworth road. That is where the problem lies.
Mr. Devlin: Will my hon. Friend congratulate some of the well-known Labour supporters in the north of England, such as Brian Hanson, who serve on national health service trusts and do quite a good job and who disagree with the contentions of the hon. Member for Darlington (Mr. Milburn) on the health service but
Column 566agree with the British Medical Association, which says that it is not the time for further major organisational upheaval?
Mr. Malone: Yes, I endorse my hon. Friend's comments. In fact, I would go further and say that the vast majority of all those, from whichever party, who serve in non-executive capacities do a first-class job. They are taking the health service forward and deserve the greatest congratulation on the voluntary service that they provide.
The Secretary of State for Health (Mrs. Virginia Bottomley): Major legislative changes were made in 1980, 1984 and 1990, as a result of which 2.5 million more patients are treated in hospital every year and the number of coronary bypass and cataract operations has more than doubled. The number of patients waiting more than a year for treatment is a quarter of the size that it was. I promise the House even more improvements following the publication of our new patients charter tomorrow.
Mr. Mackinlay: Have not Tory Governments reorganised the management structure of the health service on at least nine occasions since 1979? Is not it like painting the Forth bridge, except that the painting of that is normally completed before it is started again? Will the Secretary of State reflect on the enormous cost to the public purse of those bogus reorganisations, which have sapped morale, lost expertise and meant that people who are dedicated to the national health service have not been able to care for patients?
Mrs. Bottomley: The hon. Gentleman should address his remarks to his own spokesman, or possibly to his party leader. We are not entirely sure how health policy is approved in his party; perhaps Richard Rosser, the transport worker who chairs the hon. Gentleman's policy committee, approves it. Our changes have much improved the efficiency of the service and have increased the quantity and quality of care. It is the hon. Gentleman's party that is threatening upheaval and turmoil and to undo all the good achieved by health service workers in recent years.
Mrs. Roe: Will my right hon. Friend confirm that the Government believe that the process of national health service reorganisation is now drawing to a close and that it will be her priority to create stability, under which staff can realise the full potential of the new system? Is that not in stark contrast with Labour's proposals, which threaten to tear the NHS up by its roots, thus inflicting massive damage on staff and patients? Does that not show in whose hands the NHS is really safe?
Mrs. Bottomley: I entirely endorse my hon. Friend's points. Health service staff have worked hard to achieve a quality of care that is now being observed by independent commentators and around the world. The recent Organisation for Economic Co-operation and
Column 567Development report was an independent commentary on the success of our reforms. The Labour party, however, is trying to appease its left wing to buy out clause IV and to give the health service to the unions at a cost of £1 billion, which will do nothing for patients. The Labour party will not get away with that and the Socialist Health Association is already condemning it for its cynical approach.
Mr. Rooker: Will the Secretary of State explain how the constant reorganisations have helped my constituent, 88-year-old Frances Grew, who, on Sunday afternoon went into Good Hope hospital in Sutton Coldfield, waited five hours for a bed and, at 9 pm, was admitted to the maternity ward, where she remains today? How have we reached such a sorry state where an 88-year-old lady has to be admitted to a maternity ward to obtain treatment?
Mrs. Bottomley: Of course there will be times when things go wrong, and they should be investigated, but Labour's approach is always scaremongering, divisiveness and appeasing the unions. The hon. Gentleman failed to say that, in the west midlands in the past five years, the number of hours for which junior doctors are contracted has fallen by 20 hours, that five years ago there were 8,000 people on the two-year waiting list and that west midlands will meet the nine-month target by next year. Health achievements in the west midlands in the past five years are truly remarkable, but they all stand in jeopardy because of the policies of the Labour party.
3. Mr. Bellingham: To ask the Secretary of State for Health what proportion of general practitioners met their targets for immunisation and cancer screening (a) on the introduction of the general practitioner contract and (b) on the latest date for which figures are available; and if she will make a statement.
Mr. Malone: In 1990, 89 per cent. of general practitioners met targets for childhood immunisation and 86 per cent. for cancer screening. By April 1993, this had increased to 96 per cent. meeting childhood immunisation targets and 98 per cent. meeting cancer screening targets. This is an excellent achievement by family doctors, who are leading the way in improving the health of their patients.
Mr. Bellingham: Does my hon. Friend the Minister agree that those figures are a tribute to the GP contract? Will he join me in congratulating doctors in west Norfolk who, under the contract, are delivering a superb service to their patients? As Labour voted against the contract, is it not time Labour gave doctors an apology?
Mr. Malone: When Labour Members are apologising, perhaps they will point out the fact that, in my hon. Friend's constituency, 100 per cent. of GPs are reaching the higher targets for childhood immunisation and cancer screening. That is an amazing achievement, particularly as we were told by the Labour party and the general medical services committee when we embarked on this exercise that it would be impossible to achieve. The exercise has exceeded all expectations.
Column 568being prescribed, will they consider the submission from the victims of Septrin support group, which claims that 100 people have been killed by that drug and that thousands of others have suffered side effects? Will the Government make a sensible investigation into Septrin, or are they entirely in the control and pockets of the pharmaceutical industry?
Mr. Malone: No, the hon. Gentleman is, first, off the point and, secondly, entirely wrong. The consistent evaluation of drugs and their efficacy is not directly a day-to-day responsibility of Ministers. I am not congratulating myself or my ministerial colleagues on achieving those immunisation targets but recording my thanks and congratulations to practitioners and others involved in the service on those excellent results and on completing a measles vaccination campaign in record time over the winter period.
4. Mr. Nigel Griffiths: To ask the Secretary of State for Health when she last met representatives of the Association of County Councils to discuss the funding of community care; and if she will make a statement.
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): I meet representatives of the Association of County Councilformally and informally on a variety of occasions, the last occasion having been last Monday. We discuss a variety of matters relating to English social services on such occasions.
Mr. Griffiths: Why does not the Minister listen to Lady Farrington, who chairs the association and who presented a list of 20 areas, from Bedfordshire to Wiltshire, that are chronically underfunded for community care? Does he not realise that the murder of Georgina Robinson showed what a failure community care has been and that it is time not for the new mental health Bill that the Minister promises but for a new Minister, a new Secretary of State and a new Government?
Mr. Bowis: I welcome the hon. and Scottish Member to questions about English health, but I shall not be able to do so for much longer if his party has its way. I certainly listen to the ACC. I also listen to the Audit Commission when it tells me that community care has got off to a good start, that some authorities have got into a financial muddle because of inadequate financial control and that others are playing politics with community care, spending money on administration, refusing to use the independent sector and then reducing services to people in need.
Sir George Gardiner: Will my hon. Friend comment on the situation in Surrey county council--a hung council--which appears to have run out of funds to support social services for the remainder of this year?
"This must seem a strange letter to receive."
I endorse that comment. In its letter to councillors, it confesses that everyone took their eye off the budget ball, but, in the end, there were no excuses for Surrey social services.
Column 569I recall that, last year, Surrey social services received £93 million. For community and social services this year, the figure is £108 million. We have announced £121 million for next year, 17 per cent. extra this year, and another 11 per cent. next year. It is beyond my understanding how a county could get into such a muddle when it knew the figures for the current year in December 1993.
Mr. Hinchliffe: From his contacts with local authorities and discussions about community care, is the Minister aware of the extent to which councils are increasingly being asked to take on community care people who should be in hospital? Is he aware of unconscious people who are on drips being referred to councils for community care? Is he aware of people who are in a coma being referred to councils for community care? Is not the root of the crisis in community care the operation of the Government's market in health?
Mr. Bowis: I am aware that, this year, we are putting £4.6 billion into community care. I am aware that, for the coming year, as we have already announced, the allocation will be more than £5.1 billion. The hon. Gentleman will be aware that we have issued draft guidance and will shortly issue full guidance on continuing care, which will reinforce the message to the NHS that it has a responsibility for continuing medical and health care for people in need. I look forward to hearing the hon. Gentleman's policies and those of the right hon. Member for Derby, South (Mrs. Beckett) on community care and on continuing care--whether they agree with the views of the Commission on Social Justice, whether they have not yet made up their minds, or whether they are still waiting for Alastair Campbell to tell them.
Mr. Sims: Is not the hon. Member for Edinburgh, South (Mr. Griffiths) confusing two different matters? Care in the community for the mentally ill has been running for a number of years. It is showing some shortcomings, as in some places provision in the community is not adequate, but there is also evidence that clinicians are releasing into the community some mentally ill patients with a history of violence who should not be released. The community care policy, which has been running only a relatively short time, gives local authorities responsibility for the elderly, children and the disabled. That policy has been generously funded and it is working well in most parts of the country, but some local authorities are financially incompetent.
Mr. Bowis: My hon. Friend is right on both counts. The amount of resources for mental health is not being criticised, although the use of the Mental Health Act 1983 is criticised on occasions. Implementation of the Government's widely welcomed and accepted policy is sometimes inadequate. That was the message of the Blom-Cooper inquiry, which called for a tightening of the Mental Health Act with regard to severely mentally ill people. That is precisely why, before too long, we shall introduce a Bill to implement supervised discharge.
Mrs. Virginia Bottomley: "Working for Patients" has been a great success. Some 96 per cent. of NHS hospitals are now trusts, more than half of all eligible practices are now fundholding and, most important, the quality and quantity of patient care continue to improve.
Mrs. Mahon: Five years after the grossly misnamed "Working for Patients" document, we have the longest-ever waiting lists and the obscenity of people dying because there are no intensive care beds and services for the mentally ill are dangerously underprovided. Will the right hon. Lady make a brief statement on the document and its consequences, perhaps saying, "The Government got it wrong and my team and I resign"?
Mrs. Bottomley: The hon. Lady will know that the length of time that people wait has just about halved, that every day we treat 3,000 more patients than we did at the time of "Working for Patients" and that the quality and quantity of care have improved. We have increased the number of hip operations by 24 per cent., of cataract operations by 44 per cent. and of cardiac operations by 66 per cent. Those are dramatic improvements in the health service.
When considering how to spend the extra £1.3 billion that we are putting into the NHS this year, health authorities will want to be sure that they have the balance right between intensive care, mental health services and reducing waiting times. They are pleased to have Conservatives in government as we provide extra resources for the health service--unlike the Labour party, which cut expenditure on the health service in real terms.
Mr. Patrick Thompson: As "Working for Patients" has led directly to reduced bureaucracy and improved care for patients, especially in my constituency of Norwich, North, will my right hon. Friend join me in welcoming today's announcement in Norwich of approval for the outline business plan for the new district general hospital? It is good news. Way back in the past, there was a history of delay and endless prevarication. Under the new reforms, we now have approval, so will my right hon. Friend ensure that we get the new hospital as quickly as possible?
Mrs. Bottomley: Most certainly; I can do just that. Because we have been determined to improve the efficiency and effectiveness of the health service, it is possible for patients to have a dividend. There can be a massive capital programme with a new project starting every eight days. That is what the Conservative party delivers. All that the Labour party delivers is the wish list of the trade unions, at a price of £1 billion, achieving nothing for patients and nothing for the NHS. It is just trying to keep the left wing happy. Of course, the greatest waiting list scandal in the NHS is the waiting list for a Labour party policy on the health service.
Mrs. Virginia Bottomley: "The Health of the Nation" continues to enjoy the enthusiastic support of the clinical professions within the national health service and of outside bodies such as the World Health Organisation. Where latest information is available, it shows that for 19 out of the 23 targets we are moving in the right direction.
Dr. Wright: Does the right hon. Lady agree that the growing inequality in health between the deprived and the affluent parts of this country is making a nonsense of many of the key targets of "The Health of the Nation"? In particular, does she accept that the appalling rise in suicide rates among young men in deprived areas, which is an indictment of us all, is a direct result of the lack of jobs and the lack of hope? When will the Government understand that we can build a decent health service only if we build a decent society first?
Mrs. Bottomley: May I respond to the hon. Gentleman's comments about the increase in suicide? It is true that suicides have increased in virtually all comparable countries. More people take their own lives than are killed on roads. Our figures are about the average for similar countries. That is why it is such an important target in "The Health of the Nation" strategy. The hon. Gentleman is entirely misguided in that he does not recognise that the changed funding arrangements for the health service, and the distinction between purchasers and providers, mean that we can better focus on many of the difficulties that some areas face. I find it extraordinary that he supports a party that opposed the GP contract, which introduced for the first time deprivation payments for GPs in poorer regions. Perinatal and mortality rates have improved for all income groups and all social classes.
Mr. Streeter: Does my right hon. Friend believe it to be in the interests of patients for NHS hospitals to be put under the control of local Labour councillors and Labour party hacks--as the Labour party proposes--which even Bevan would not have contemplated?
Mrs. Bottomley: My hon. Friend is right. Of course the battle that Herbert Morrison and Nye Bevan fought in 1948 is the debate now being fought in the Labour party. That shows its forward-thinking approach to health policies. It turns the clock back not to 1979, but to 1948 and it reopens the battle of that time. We must have a health service that is responsive to patients, that works with GPs and that focuses on health outcomes. The Government are achieving that, which is why we are delivering results that have exceeded even our own expectations at the time of the first patients charter.
Mr. Alex Carlile: Does the right hon. Lady agree that ensuring that men are as aware of health risks and health needs as women is a legitimate objective of an NHS strategy? Has she noted the alarming rate of deaths caused by prostatic cancer, which exceeds the rate of deaths by cervical cancer? Does she agree that the time has come to
Column 572ask GPs to screen their male patients, as many screen their female patients, so that men's health can be greatly improved?
Mrs. Bottomley: I am pleased that the hon. and learned Gentleman implicitly recognises the success of the cancer screening programmes. Cervical and breast cancer screening programmes have been extremely effective, with many women being screened. They build on the investment in primary care and show the importance in GP services of having, when possible, effective screening processes at primary care level. We shall consider the hon. and learned Gentleman's proposition carefully.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): The number of acute patients admitted to hospital between 1991, the year before the first trusts were established, and 1994 increased by 18 per cent. That represents an additional 3,000 patients treated each day.
Sir Peter Fry: I thank my hon. Friend for that reply. Will he confirm that in the Oxford-Anglian region, my own region, some 25 per cent. more patients have been treated by trusts and that some 50 per cent. more day cases have been treated? Does he, like me, find it difficult to understand why the Labour party wishes to sweep away trusts and thus deny the benefits of their success to our constituents?
Mr. Sackville: I agree with my hon. Friend. I congratulate his region on its exceptional performance. I agree that, under the sort of shower that the Labour party would bring to the health service, there is no way in which the number of patients treated could increase.
Mr. Pike: If the figures are so good, why do so many people find it necessary to pay for their first appointment to see a consultant, in the knowledge that, if they do not do so, they will have to wait months?
Mr. Sackville: Waiting times have come down. All districts are obliged to publish the length of the waiting list of each consultant for out-patient appointments. Waiting times for both in-patient and out-patient appointments are coming down. I should have thought that the Labour party would congratulate the NHS on that.
Dame Jill Knight: Does my hon. Friend agree that not only the figures should be noted? The fact is that more patients have been treated with infinitely more complicated and expensive operations, treatments and drugs than ever before in our history and that thousands of people are alive today who would have died from their condition even five or 10 years ago.
Mrs. Beckett: Does the Minister recognise that the figures that he gives are largely meaningless as they include so many elements of double counting because they count treatments and not patients? If the Minister really wants to look at patient episodes in that way, is he
Column 573aware of the substantial increase in the number of private patients treated in national health service hospitals? Does he recognise that most British people think that NHS patients should have priority in NHS hospitals?
Mr. Sackville: I am aware that the right hon. Lady is only just learning her job. She accuses us of double counting. The figures are now collected on the basis of finished consultant episodes because that is the best way to measure NHS activity. The difference between that figure and the old way of counting based on deaths and discharges is about 3 per cent. and all comparative figures reflect that.
8. Sir David Knox: To ask the Secretary of State for Health what percentage of gross domestic product was spent on the national health service in the most recent year for which figures are available; and what was the percentage in 1978.
Mr. Malone: Yes, I agree with my hon. Friend. Not only that--they underpin the fact that there is increased activity and not merely increased spending. It is the improvement in patient health care that really counts for people in this country.
Ms Jowell: In view of the proportion of gross domestic product spent on the national health service and the importance of securing proper value for money for patients, does the Minister for Health accept that more rigorous monitoring is needed of the way in which NHS consultants who also undertake private practice divide their time between their NHS responsibilities and their private patients?
Mr. Malone: I am delighted that the hon. Lady now seems to support the Government's policy for ensuring that the management of clinicians should be devolved to a local level so that all these matters can be examined. I welcome her to this side. I had hoped that an Opposition Front- Bench Member might stand up and say what a Labour Government would spend as a proportion of gross domestic product, but on the vital matter raised by my hon. Friend the Member for Staffordshire, Moorlands (Sir D. Knox) there is yet again a resounding silence from the Opposition Front Bench.
Mr. Nicholas Winterton: I warmly welcome the figures, which clearly show the Government's commitment to the national health service. Does my hon. Friend accept that some high-tech sophisticated operations cannot be carried out in hospitals within the national health service in the United Kingdom? I draw my hon. Friend's attention to the case of Miss Alicia McCluckie in my constituency, who needed to go to New York for an operation to remove a brain tumour. Will my hon. Friend introduce a system to provide people in this country with a procedure whereby they can bring pressure to bear on
Column 574the authorities to provide facilities for operations abroad when such treatment is not available in the United Kingdom?
Mr. Malone: e people come to Britain to take advantage of medical services here than travel abroad. However, it is true that some procedures are available abroad which have not been clinically proven in this country.
Mr. Nicholas Brown: In 1978, Britain spent 8 per cent. less than the Organisation for Economic Co-operation and Development average on public health care. By 1991, the position had changed to 12 per cent. below the OECD average. Before I answer the Minister's questions, perhaps he will tell the House why the relative position has regressed under Conservative Government.
Mr. Malone: The hon. Gentleman said, "Before I answer the Minister's questions," but he is clearly not going to do so. Perhaps we shall get a commitment once the answer has been cleared, although I had thought that the hon. Gentleman was one of the Front-Bench spokesmen cleared to speak for his party.
On the OECD league tables, the hon. Gentleman is forgetting entirely that one is not comparing health systems that are the same. Some bring in expenditure from social services while others have an entirely different structure. He should study the OECD
recommendations, which state that the British health care system is probably the most effective in the European Union and, more importantly, that we allocate funds throughout the country in a far fairer, more flexible and more sophisticated way than any other health service in Europe in order to meet deprivation and need.
Mr. Hayes: Does my hon. Friend agree that the most civilised part of Essex--Harlow--is delighted with the increased spending on the health service? We are delighted with our new NHS trust, our new computerised axial tomography scanner and our new magnetic resonance imaging scanner, and also with the £10 million spent by the Government on our accident and emergency facilities.
Mr. Malone: I had always thought that my hon. Friend was the most sophisticated and delightful part of Essex, but that opinion is perhaps not shared across the Floor of the House. I thoroughly agree with him. I was in Essex last week, opening a community health trust centre in Purfleet, which shows how excellent health care is in that county and how it is improving.
Column 575continuing care? It cannot be right for an elderly person in one part of the country to have to pay for health care which is free in another part of the country. How does the Minister intend to ensure that health authorities fulfil their financial obligations under the National Health Service Act 1977 and that the elderly have equal access to NHS care, irrespective of where they live?
Mr. Bowis: The answer lies partly in the continued generous funding for the national health service under this Government--£32 billion for England this year--partly in the fact that about 40 per cent. of spending on hospital and community health services goes on the 16 per cent. of people who are 65 and over and partly in the guidance that we are issuing to the health service to ensure that it continues to keep responsibility for the continuing health needs of the elderly and that it reviews, and if necessary re-provides, provision in that area. The hon. Lady must not ask me to take the place of the doctors, who ultimately decide the clinical needs of patients.
Mr. Garnier: If my hon. Friend wants to assess the provision of national health service care, would he like to visit the Coventry Road and St. Luke's hospitals in Market Harborough? Were he to do so, he would find fine examples of the success of the Government's policies and the good sense, management and operation of the Fosse health trust.
Mr. Bowis: I am sure that that is the case and that if I visited those hospitals I would see precisely what my hon. Friend describes--good quality care for people, irrespective of age, provided by the national health service within hospitals and the community.
10. Ms Eagle: To ask the Secretary of State for Health what extra level of financing has been agreed by her Department for an advertising campaign by the National Blood Authority to encourage blood donation.
Mr. Sackville: National publicity to retain and recruit donors for the national blood service is funded by the Department of Health--in 1993- 94, to the extent of £1.6 million. The budget for 1994-95 is £1.2 million. Smaller-scale local publicity is generally funded and organised by the National Blood Authority.
Ms Eagle: Does the Minister not realise that recent changes, which have threatened blood transfusion centres with closure, and the evidence that the National Blood Authority is selling blood products, are fatally undermining the contract with donors who freely give their blood? Does he not realise that a Government who believe in putting a price on everything, while knowing the value of nothing and flogging off everything that cannot be nailed down, will ruin our national blood service?
Mr. Sackville: The only thing which might have undermined blood donation has been the disgraceful campaign by the hon. Lady and her colleagues to frighten donors, but it has failed to do so. Blood stocks are now at about 15,000 units, and it is a tribute to our loyal donors that they have ignored the rubbish that they have heard from the hon. Lady and her colleagues.
Column 576not have the opportunity that they currently enjoy to donate their blood at travelling units because of changes to the regional centres. Will he assure the House that, despite changes that may be made to regional centres, people will still be able to enjoy the benefits of attending those mobile units?
Mr. Sackville: Only a tiny proportion of blood collection takes place at those centres. The reorganisation is taking place because there is too much capacity in processing and testing. The savings that can be made will be available to improve donor support and recruitment of donors. I give that assurance to my hon. Friend.
Mr. Illsley: Does the Minister accept that there is a crisis within the national blood service? He has just quoted a figure of 15, 000 units of blood. At yesterday's date--16 January--blood stock levels were 11,939 units, which is below both the figure that he quoted and the service's target figure of 20,000 units. The public are now unwilling to donate blood because the reorganisation proposals are unpopular and because of the increasing commercialisation of the national blood service. Will the Minister now reverse those reorganisation proposals?
Mr. Sackville: The latest figure happens to be 14,500 units. For the hon. Gentleman to talk about a crisis in the national blood service is highly irresponsible, as it is designed to frighten donors. Of all that has been said by the Opposition, that is the most disgraceful. It has nothing to do with the NHS but is about making political points.