The Vice-Chairman of the Household-- reported Her Majesty's Answer to the Address, as follows:
I have received your Addresses praying that the Double Taxation Relief (Taxes on Income) (Azerbaijan) Order 1994, the Double Taxation Relief (Taxes on Income) (Malta) Order 1994, the Double Taxation Relief (Taxes on Income) (Republic of Ireland) Order 1994 and the Double Taxation Relief (Taxes on Income) (Spain) Order 1994 be made in the form of the drafts laid before your House.
I will comply with your request.
The Secretary of State for Health (Mrs. Virginia Bottomley): The national health service reforms provide a stable and enduring structure to the health service which will enable it to respond flexibly to the changing needs of patients. I am pleased that good progress is being made in Committee on the Health Authorities Bill. We are completing the unfinished business of the reforms, streamlining management and cutting bureaucracy.
The House will also know that I have issued today new guidance on NHS appointments. Those appointed to NHS organisations overwhelmingly give outstanding service. The guidance, based on current best practice, will ensure that appointments continue to be made on merit and that the process is open and fair and commands the confidence of the public and staff.
Mr. Mackinlay: How did the reorganised national health service respond to the flexible and changing needs of Mark Dwan? Will the Secretary of State tell us why she had to see the Lord Chancellor and what was discussed?
Mrs. Bottomley: There is great pressure on medium-secure beds. When the Labour party was in power, the Glancy report recommended medium-secure beds. By 1979, there were none. There are now 700, together with almost 1,000 other medium-secure beds. We are spending £47 million to produce an extra 600
Column 780next year. I shall be taking steps to make sure that the court authorities are aware of the way of making contact with those most directly responsible for the provision and arrangement of medium -secure beds.
Dame Elaine Kellett-Bowman: My right hon. colleague will be aware that one of the parts of the national health service being reorganised is the blood transfusion service. She may be aware that a petition on this matter was presented to her office this morning. Unfortunately, she was too busy to receive it. She may nevertheless be aware that we have a quite outstanding blood transfusion centre in Lancaster and it would be criminal folly to abolish it.
Mrs. Bottomley: I much regret that it was not possible to meet my hon. Friend, who is a great champion of the service. She will understand that, with the publication of new guidance on appointments to health authorities and trusts, it has been an extremely busy morning. There is, however, a distinction between improvement and management of the service and, of course, development of improved services for patients and making sure that blood donors have the best possible service. As she will know, the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville), has been closely involved in these matters and he and I will look carefully at my hon. Friend's recommendations.
Mr. Kirkwood: Will the Secretary of State expand a little on the statement that was made earlier about the procedures being set out for the establishment of appointments to NHS organisations? Does she accept that some of us are disappointed that she has not accepted the advice of the National Association of Health Authorities and Trusts that there should be an independent element in that procedure? From my reading of the statement, I believe that there is no such element. Why has she set her face against that?
Mrs. Bottomley: I hope that the hon. Gentleman will look at the guidance very carefully. Essentially, it puts into one manual best practice as it has been organised throughout the health service for some time.
We want to advertise widely for people to come forward to ensure that there is proper scrutiny of the names by non-executives who have a range of skills. We need people who understand how the health service works and who are involved in either a health authority or a trust to do that. They may bring outside expertise from the private or public sectors--for example, as a lecturer or a vicar--in vetting those names.
Regions may also wish to add the names of total outsiders. However, on balance, we believe that it is best for the names to be scrutinised by people who are involved in health service delivery. We want excellent people to help us to do the work. The hon. Gentleman will know that in his party Baroness Thomas and many others who are appointed on merit do excellent work within the health service.
Column 781council, on her recent appointment as a non- executive director and in wishing her a long and successful time in that position?
Mrs. Bottomley: I certainly will congratulate my hon. Friend's colleague. People from all political parties as well as those with no political affiliations serve on health authorities and trusts. We want people with ability and commitment who share a vision of having the best health service in the world. Overwhelmingly, those who serve on health authorities and trusts work to achieve that goal. However, we need greater openness and public understanding of the work involved to encourage more people to come forward.
Mr. Hinchliffe: In the mad scramble to establish a market in health, what consideration has been given to the implications for other services, such as child protection? Will the Secretary of State accept that it is astonishing that the recent consultation document on general practitioner fundholding made no reference to the importance of GP fundholders liaising with local social service departments and with area child protection committees? Does she accept that the increasing practice of GP fundholders purchasing crucial services, such as health visiting provision, from outside their areas is completely undermining--as she, with her background, should know better than anyone else--child protection collaboration at a local level and that it may cost lives?
Mrs. Bottomley: Of course the hon. Gentleman is right: collaboration between agencies is fundamental to service delivery in many areas, including child protection. However, I dispute the hon. Gentleman's knee- jerk attack on the market system. I can only quote Chris Ham who says:
"The old system of planning by decibels, in which those running hospital services exerted most influence, has been replaced by an arrangement in which health authorities and GPs are in a much better position to shape the direction of the service development". The hon. Gentleman may also consult either The Lancet or the recent edition of the Fabian Review which condemn the Labour party's lack of vision in this area.
2. Mr. Harry Greenway: To ask the Secretary of State for Health how many people in the London area are estimated to be registered with (a) two general practitioners and (b) more than two general practitioners; at what cost to public funds; and if she will make a statement.
The Minister for Health (Mr. Gerald Malone): The problem is being tackled at a local level by individual family health services authorities and the information is not available centrally. Dual registration affects the distribution of general practitioners' remuneration but not the overall cost.
Mr. Greenway: Will my hon. Friend confirm that we meet in the high court of Parliament and that Parliament can handle questions to Ministers about beds, GPs and anything else? What is being done to improve the administration of the health service to ensure that
Column 782people do not appear on more than one GP list? It is a waste of taxpayers' money which could be better spent elsewhere in the health service.
Mr. Malone: My hon. Friend is quite right: dual registration causes damage. It causes difficulties in assessing local health needs, and that is why we must work to solve the problem. It also means that some general practitioners receive funding, over and above that of their counterparts, which they do not deserve. However, I assure my hon. Friend that that does not increase the sum of global public expenditure. In my hon. Friend's own area of Ealing, Hammersmith and Hounslow, a list inflation team has been established to complete a number of important checks, which will, I hope, move towards the elimination of that problem.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): By 1997-98, the total annual savings solely from the abolition of regional health authorities are expected to be in excess of £100 million.
Mr. Garnier: Will my hon. Friend confirm that the number of patients waiting for more than a year has fallen by 4,200 in the last quarter and that no patients in the region are waiting longer than 18 months? Will he assure me that any savings that he makes from the abolition of the region will be reinvested in increasing the standard and speed of patient care?
Mr. Sackville: Yes. I congratulate Trent region on its many achievements, which will be further augmented by its share of the £100 million a year that will be saved from the abolition of the regions. Why the Labour party should wish to oppose the abolition of the regions and take that money away from patient care, heaven alone knows.
Mr. Redmond: The Minister must be aware that, since the reorganisations introduced by the Government in 1979, administration has increased enormously. No one believes that the £100 million will be put into health care to reduce the waiting list. Why does not he get back to the good old days, when 3.5 per cent. of staff in areas such as Doncaster were administrative staff? That is the service that people want to have, not quangos on quangos.
Mr. Sackville: On the good old days, I can tell the hon. Gentleman only that we are treating many more patients than we did in those days; people are living longer; infant mortality is lower; and waiting times are smaller. Let him choose which he prefers.
Column 783White Paper designates asthma as a strong contender for key area status. Further consideration would be necessary before national targets could be set.
Dr. Howells: What further information does the Minister need than the continuing rising incidence of asthma, and its links with atmospheric pollution from vehicles, factories, and so on? Why will he not take notice of the excellent example set by the Welsh Office, which has set achievable targets for the reduction of asthma, included as a key area in "The Health of the Nation"? Let us start to cure children and others who are suffering from that dreadful illness.
Mr. Bowis: We, too, take that matter very seriously. Of course, we are interested in what our Welsh colleagues are aiming at and are able to achieve. The hon. Gentleman will be aware that we have a major research programme into asthma. Causes are unknown; triggers are known. We want to see which triggers can be tackled, and whether we can find causes. The hon. Gentleman will know that, during 1994, we invested some £5 million in new research, and some 14 projects are under way. As and when they come to fruition, we will, perhaps, be in a better position to set realisable targets. In the meantime, of course, our GPs are working to great effect in helping sufferers from asthma to manage their illness.
Sir Peter Emery: Does my hon. Friend not realise that five people a day die from asthma and that it is the one major disease to which reference should be made in "The Health of the Nation"? If it can be done in Wales, for goodness sake we should be able to do it in England.
Mr. Bowis: My right hon. Friend puts a strong case. It is something which, as we have said, has been identified as a potential key area. But there are criteria for our health of the nation key targets: first, the fact that it is a major cause of preventable death and avoidable ill health that is certainly met; secondly, which effective interventions are possible --that is partially met; and thirdly, that it is possible to set targets.
What I am saying to my right hon. Friend is, not yet, but we are doing the research to see how it can best be moved forward. In the meantime, I reiterate that much of the work, as the National Asthma Campaign has said, is within schools, within GPs' practices, and the work there is excellent. Some 90 per cent. of GPs are signed up to the chronic disease management programme.
Mr. Bowis: If the hon. Gentleman has read the latest edition of Doctor , he will have noted that a number of doctors have identified different asthma triggers, ranging from housing to harvesting and from smoking to factory dust. All those elements can cause asthma, and in all those contexts prevention is possible. Individuals can change their life styles, doctors can help asthma sufferers to manage their condition and school nurses can play an enormous part in helping children to cope, and helping teachers to help children to cope.
Mr. Sims: Is my hon. Friend aware that the report's publication and the Government's acceptance of all its recommendations have been warmly welcomed? He will know that one woman in four is affected by the complaint. Is he aware that a survey carried out by the National Osteoporosis Society suggests that only one tenth of sufferers are receiving treatment?
As part of the process of professional and public education that the report recommends, will my hon. Friend ensure that its contents are drawn to the attention of health authorities--particularly the comment that it is desirable for all women at risk to have access to bone densitometry equipment?
Mr. Sackville: My noble Friend wrote to the chairmen of all health bodies at the time of the report's publication, bringing it to their attention and making the specific point about bone densitometry.
Mr. Page: I thank my hon. Friend for that reply. Although we should all like accident and emergency services at the bottom of our gardens, would it not be better for the health of the nation to have specialised centres run by teams with the facilities and expertise to provide such services, backed up by paramedic teams who can deliver people in a stabilised condition as soon as possible? Small localised services could deal with the walking wounded, as has been suggested in south-west Hertfordshire.
Mr. Malone: My hon. Friend is right in principle. There are a number of facilities that can meet such needs. The introduction of minor injuries clinics has provided a helpful source of immediate treatment; the experimental trauma centre in Stoke-on-Trent, which is being assessed, deals with major trauma; and accident and emergency services now have more paramedics who can stabilise people at the scene. All those developments in accident and emergency care should be evaluated, and should inform long- term decisions.
Mrs. Jane Kennedy: The Minister should be aware that the relocation of the accident and emergency unit at Broadgreen hospital in my constituency has been speeded up because hospitals have been unable to recruit enough senior house officers. What does the Minister propose to do to assist hospitals in such circumstances? Changes in the training of doctors are
Column 785making available senior house officers scarcer, and the reduction in junior doctors' hours--welcome though it is-- has been carried out in a way that has caused a crisis in accident and emergency units throughout the country.
Mr. Malone: The hon. Lady is right to point to stories that have appeared about shortages of junior doctors in accident and emergency units. There are several reasons for that. It partly reflects the normal change in the February turnaround of contracts. That is not unusual or unknown, and can be addressed in a number of ways. For example, management can adopt a more flexible approach to the way in which accident and emergency units are run. It is also important for specialist surgeons in hospital teams to contribute fully. The Government have made an effective contribution by increasing the number of accident and emergency specialists considerably since 1988: accident and emergency is now the largest growing hospital specialty in the country.
Mr. Congdon: I accept the need for and the benefits of large A and E departments, but does my hon. Friend agree that it is vital that A and E departments, especially those in London, should stay open 24 hours a day and should not close their doors temporarily, thereby putting pressure on other A and E departments?
Mr. Malone: My hon. Friend is right. It is important that the widest range of facilities is available, especially across London. I counsel him, however, to consider what is termed a closure. For example, I read in a report this morning that ambulances had temporarily not been going to Homerton hospital. However, I noticed that the A and E department there was still open to treat patients for something as serious as, for example, stabbing. I counsel him, therefore, to consider carefully the definitions in these matters.
Mr. Illsley: Should not the proximity of A and E departments to blood transfusion centres be one of the factors to be taken into account in the relocation of those departments? The Minister will be aware of the petition that was delivered to his Department this morning. It contained 500,000 signatures calling for the reversal of the policy to close five blood transfusion centres. Today, of all days, should not he join the Have a Heart campaign, reverse that policy and consider better and more constructive ways of improving the blood transfusion service?
Mr. Malone: The hon. Gentleman is rather ingenious at getting a bite at a different cherry under this question. Of course, all matters in relation to the provision of the blood transfusion service are extremely important. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), who has responsibility for these matters, takes great care to consider all the arguments.
Dr. Twinn: Is my hon. Friend aware that great concern exists in north London about the future of A and E provision, especially at North Middlesex and Chase Farm hospitals? Will he give those of us in north London an undertaking that no decision will be taken until neighbouring purchasers are made to co-operate over A and E provision, not just in north London but
Column 786throughout Hertfordshire and Essex? Grave concern exists that we will find ourselves with no A and E provision because of competing authorities.
Mr. Malone: I am pleased to have the opportunity to reiterate to my hon. Friend the undertaking that my predecessor, my right hon. Friend the Member for Peterborough (Dr. Mawhinney), gave to the House. It states that, where there is a reconfiguration of A and E services, similar, if not better, facilities should be and must be in place.
7. Mr. Mullin: To ask the Secretary of State for Health what representations she has received from Dr. John Yates regarding his study of consultants' waiting lists; what action she has taken; and if she will make a statement.
Mrs. Virginia Bottomley: I am aware of receiving no recent representations, although I am familiar with Dr. Yates's work of old. The action that we have taken is to establish national health service trusts, which are now in a far more effective position to ensure that all NHS consultants fulfil their obligations to the health service. As for waiting lists, I commend to the hon. Gentleman the new quarterly figures published today, which show waiting times continuing to come down and excellent progress towards our new patients charter target of a maximum 18-month wait.
Mr. Mullin: Is not the state of affairs disclosed by Dr. Yates's work scandalous? Why is the Secretary of State's Department so reluctant to face up to the issue of consultants who maintain dual waiting lists? Would not the best way to dispose of the corruption that surrounds dual waiting lists which are maintained by some consultants be to make them choose between working full time for the national health service and working full time privately?
Mrs. Bottomley: The hon. Gentleman shows how divided his party is. His party leader says that he thinks that the new Labour party should be a model of collaboration between the public and private sectors, but the Labour party's vindictive loathing of the private sector is almost the only area of agreement in its non-existent health policy. Our commitment and our achievement have been to manage NHS consultants very much better, and to agree job plans, ensuring that the NHS comes first and that improvements are made in the service. The west midlands, where John Yates works, is now a model to be followed, promising a nine-month guarantee in relation to treating patients. Let us not have a vendetta against the private sector; let us manage NHS consultants to have the best possible NHS.
Mrs. Roe: Does my right hon. Friend agree that the most effective way of ensuring that NHS consultants fulfil their obligations to the NHS is through strong local management? Is that not precisely what trusts are achieving? Does she further agree that local pay for consultants will offer an even stronger way of ensuring that the service is a good one?
Column 787necessary in a modern health service. Instead of denigrating the private sector and NHS managers, the Labour party should consider in more practical terms how we can maximise the ability of all members of our team so that they provide the best possible service. The move towards local pay, heralded last week in the review body reports--which I am pleased that we were able to accept in full--will ensure even greater effectiveness in enabling people to maximise their contribution to the NHS.
Mr. Malone: This information is not held centrally. However, a total of £109,436,000 was made available by the Department of Health to regional health authorities towards the consultation costs, start-up costs and conveyancing costs incurred by units applying for trust status during the period 1991-94.
Ms Corston: It is interesting that the Minister has not taken this opportunity to confirm figures released by his Department in December which show that the cost of setting up the trusts in England alone was £103 million. That must be added to the £1 billion wasted over the past five years on providing extra administration and bureaucracy. Is it not true that all that money could have been spent on treating every one of the 1,071,000 people currently on waiting lists?
Mr. Malone: I must refute entirely what the hon. Lady says. This is a worthwhile investment in bringing about a substantial change in a structure which now delivers more health care than ever before. Reforming institutions so that they spend properly and sensibly is no different from building another unit to treat people. The truth is that trust hospitals have been a huge success. There are now 419 across the country and nearly every unit will be a trust after the fifth wave has gone through. Although the right hon. Member for Derby, South (Mrs. Beckett) continues to refer to trusts as some kind of abomination, it is remarkable that there is no sign that the Labour party intends to do anything to reverse the process.
Dame Jill Knight: Is it not true that since hospitals became trusts far more people have been treated with more complicated operations and treatment so that any cost involved is money well spent? Is my hon. Friend aware of the concern being expressed by patients about the Labour party's threat to get rid of trusts, which would inevitably reduce the opportunities for treatment?
Mr. Malone: My hon. Friend is right. It is intriguing that, although the right hon. Member for Derby, South refers to trusts as abominations, she does not intend to do anything about them. I heard the sedentary remark made by the hon. Member for Bolsover (Mr. Skinner) who, according to "Breakfast with Frost", clearly has more than one finger in the pie of Labour party policy. He said that there is a hidden agenda, so perhaps the right hon. Lady is about to find out. Trusts have outperformed all other
Column 788hospitals in increasing the number of patients treated; as a result, we are now treating 122 patients for every 100 treated in 1990.
Mrs. Beckett: Is the Minister aware that this is only one example of the widespread concern about whether costs in the health service changes are accurately assessed and, much more to the point, about whether the money is being properly directed, whether we are talking about the establishment, merger or even closure of trusts? Is he aware, for example, of the great concern felt in London about the proposals to close Bart's hospital, the consultation period for which is shortly to come to an end? The Minister said a moment ago that the money spent was a worthwhile investment in substantial changes. Does he not recognise that most people see this as just another example of public money being used to turn a good public service into an expensive private business in which the people at the top rake it in, the people at the bottom are exploited and the taxpayer pays more and gets less?
Mr. Malone: The public who are now spending less time on waiting lists and passing through trust hospitals in greater volumes than ever before have reason to be grateful for these investments. I should also point out to the right hon. Lady that the scale of costs of starting up trusts is relatively small. For example, the cost of setting up the Homerton hospital trust was some £215,000 over quite a lengthy period and covering quite a number of functions which would probably have been undertaken over time by the previous hospital. It is a pretty small amount and an extremely good investment, and there is improved health care to show for it across the nation.
9. Sir Anthony Grant: To ask the Secretary of State for Health what is her policy in respect of the location of (a) nurses' residences and (b) the mentally ill, with particular reference to (i) Addenbrookes hospital and (ii) Fulbourn hospital in Cambridgeshire.
Sir Anthony Grant: Is my hon. Friend aware that the proposed move of acute psychiatric cases from Fulbourn hospital to Addenbrookes is opposed on environmental and medical grounds by patients, by those who care for the patients and by nurses, and it is also opposed by the staff at Addenbrookes, who believe that it will cause serious disruption which will affect patients and the public? Will he therefore please urge serious reconsideration of the matter?
Mr. Bowis: I am grateful to my hon. Friend for drawing the matter to our attention. I understand that, in fact, it is proposed to transfer three wards. It is, of course, for the trust to judge. I also understand that the community health council has agreed the move. However, my hon. Friend is quite right: it is important that patients, carers and staff--and, indeed, Members of Parliament--are consulted wherever possible and their views taken into account. I will certainly draw my hon. Friend's comments to the attention of the trust. At the same time, I hope that he will join me in applauding the trust for its work in
Column 789mental health in hospitals and in the community and, indeed, for the work that it is doing to improve security for its residential staff.
10. 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.
Mrs. Virginia Bottomley: There were 10.1 million episodes of care carried out in NHS hospitals in 1993-94. In 1978, the equivalent figure, calculated on a comparable basis, was 6.5 million. That is an increase of 55 per cent. I invite the House to congratulate NHS staff on that achievement.
Sir David Knox: Does my right hon. Friend agree that those figures provide clear evidence of the improvement of the national health service under the present Government? Will she confirm that the North Staffordshire hospital trust has made a significant contribution to that improvement?
Mrs. Bottomley: My hon. Friend is absolutely right. Every time patients are asked their views of the NHS, they report extremely favourably. Indeed, a substantial increase in those who reported favourably on the NHS was found when it was measured last. As my hon. Friend rightly says, his local trust has played a magnificent part. I was just looking at its figures. There has been a three and a half times increase, for example, in day surgery and a huge range of quality improvements. The trust provides an excellent service for local people in what I know is an area of considerable need.
Ms Eagle: As the Secretary of State has asked us all to pay tribute to the staff of hospitals, which we gladly do, will she explain why the Wirral hospital trust is currently attempting to introduce something called a generic support worker so that domestics will be expected to conduct administration and clerical work, help clinical procedures and clean the wards, all for £3.50 per hour?
Mrs. Bottomley: The challenge for the health service is to ensure that all those who work in it are able to look flexibly at their activities so as to ensure that we get the maximum possible quality and quantity of patient care. The hon. Lady will know that last week we were able to support in full the recommendations of the review body for a fair reward for NHS staff, who have seen their pay increase, I am pleased to say, more over the past six years than it has for people in the private sector.
Column 790to which trusts and health authorities are taking advantage of the facilities and expertise of the private health care sector to treat NHS patients, as is happening at the Oaks hospital in Colchester? Does he agree that that leads to a more efficient use of resources and benefits not only patients, but the NHS as a whole?
Mr. Sackville: The private sector often gives very good value for money. Where that occurs, it would be quite immoral not to take advantage. If we followed the Labour party's advice and refused to do that for ideological reasons, only patients would suffer.
Mr. Bellingham: Will my hon. Friend the Minister find time today to consider the private Sandringham hospital which is located adjacent to the local NHS trust hospital in my constituency? Is my hon. Friend aware that the Sandringham hospital is paying a substantial rent to the NHS trust as well as sharing key medical facilities? Is that not an example of the need for a partnership between the public and private sectors? Will my hon. Friend educate his opposite number and explain that the partnership means saving money for the NHS, treating more patients and getting money at the sharp end?
Mr. Sackville: There are many examples of good co-operation and I am glad to add the Sandringham hospital to that list. We certainly encourage health authorities and trusts to find whatever ways they can to take full advantage of the expertise that the private sector has to offer.