| Home Page |
Column 1
THEPARLIAMENT ARY DEBA TES
OFFICIAL REPORT
IN THE THIRD SESSION OF THE FIFTY FIRST PARLIAMENT OF THE UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
[WHICH OPENED 27 APRIL 1992]
FORTY FOURTH YEAR OF THE REIGN OF
HER MAJESTY QUEEN ELIZABETH II
SIXTH SERIESVOLUME 258 NINTH VOLUME OF SESSION 1994 95
Column 1
House of CommonsTuesday 18 April 1995
The House met at half-past Two o'clock
PRAYERS
[ Madam Speaker-- in the Chair ]
Oral Answers to Questions
HEALTH
NHS Capital Projects
1. Mr. Dunn: To ask the Secretary of State for Health what was the amount spent on capital projects within the NHS in England since 1979; and if she will make a statement. [17571]
The Secretary of State for Health (Mrs. Virginia Bottomley): At current prices, the total NHS capital investment programme since 1979 stands at more than £22.5 billion. In real terms, the capital spending level today is 70 per cent. above what it was in 1979. Over that entire period, a major capital building project has been completed on average every week.
Mr. Dunn: Does the Secretary of State agree that the Government should take the lead in getting private and public finance to work together in health and in other sectors, as was suggested by the Leader of the Opposition last autumn?
Mrs. Bottomley: I am well aware of the Leader of the Opposition's comments last autumn about getting public and private finance to work together. I am far from clear about the policy of the present Opposition health spokesman and her Labour party team. It seems far from
Column 2
clear whether she agrees with her party leader or whether she dances to the tune of union paymasters. It is clear that private finance is bringing extra opportunities into the NHS so that we can build on the excellent capital programme that already exists.Mr. Kevin Hughes: With the increasing privatisation of the national health service, who will the managers in the NHS ultimately be accountable to--the patients or the shareholders of these companies?
Mrs. Bottomley: The hon. Gentleman knows full well that the NHS is not for profit and is not for sale. The NHS is about progressive improvement in services for patients. More information is available than ever before about the quality and quantity of care that has been provided, to a standard completely unanticipated when the Labour party was in power. The people in the health service deserve credit for that.
Trust Hospitals, Trent
2. Mrs. Angela Knight: To ask the Secretary of State for Health what proportion of NHS hospitals in the Trent region are now run as trusts. [17572]
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): I am delighted to report that all hospitals in the Trenregion are now run as national health service trusts.
Mrs. Knight: Will my hon. Friend therefore join me in congratulating all those in the Trent region, and especially the Southern Derbyshire health authority, which covers my constituency of Erewash, on the excellent job that trust hospitals such as Derbyshire royal infirmary and Derby city general do? Is he aware that the DRI is increasing the number of eye patients that it treats by a further 1,000 this year? Does he therefore find it deplorable, as I do, that a hospital that is doing such an excellent job would have its trust status removed by the
Column 3
right hon. Member for Derby, South (Mrs. Beckett) if she had half a chance, thereby jeopardising health care to her constituents as well as to mine?Mr. Sackville: I agree with my hon. Friend that hospitals have enormously benefited from trust status, as I saw when I recently had the honour of opening a new day case surgery and endoscopy unit at Derbyshire royal infirmary, with the permission of the right hon. Member for Derby, South (Mrs. Beckett). I know that that unit, for example, will allow for 3,500 day cases a year. That will enormously reduce waiting lists and enormously better serve my hon. Friend's constituents.
Mr. Barnes: Is the Minister aware that I have received more complaints from constituents about the operation of trust hospitals since the NHS moved towards that system, and that that has not been helped by some of the other measures that have taken place at the same time, such as GP fundholding, the peculiar interface between community care and hospitalisation, and the development of the rip-off of private nursing homes? Is it little wonder that no one trusts a trust in north-east Derbyshire?
Mr. Sackville: The hon. Gentleman is one of those politicians who treats the health service as somewhere to go and have his photograph taken and to stir up some trouble. The fact is that more patients are satisfied with the NHS, although they see a completely different picture in the press, and the NHS is going from strength to strength with trust status.
Dental Patients
3. Mr. Mudie: To ask the Secretary of State for Health how many NHS dental patients have been deregistered by NHS dentists since July 1992. [17573]
The Minister for Health (Mr. Gerald Malone): A total of 878,156 patients, comprising 867,653 adults and 3,503 children have been deregistered since July 1992. However, adult registrations are up by over 128,000 over a broadly similar period.
Mr. Mudie: The Minister will be aware that the deregistrations arise from a dispute that has been allowed to fester for three years. In view of the fact that the Minister has just told us that nearly 900,000 patients have been deregistered and that 60 per cent. of dentists are taking no new adult NHS patients, is it not about time that the Minister acted--acted other than by press release--or is his real objective the privatisation of dental care?
Mr. Malone: The hon. Gentleman should recognise that in his constituency 58 per cent. of adults are registered for NHS care, which is higher than the national average, as are 61 per cent. of children, which is 4 per cent. above the national average. In Leeds as a whole, there is only one postal district which is not served by NHS dentistry, so there is a comprehensive service in the hon. Gentleman's constituency. The Government are thoroughly committed to ensuring that that continues throughout the rest of the country.
Mrs. Gillan: Does my hon. Friend agree that an important part of dental care is the provision of orthodontics? Is he aware that in my constituency of Chesham and Amersham some parents are experiencing difficulties in finding orthodontists for their children? Can
Column 4
my hon. Friend reassure my constituents by saying that he will place the availability of orthodontists at the top of his list of priorities?Mr. Malone: I cannot give my hon. Friend that unequivocal assurance, but I can tell her that a number of NHS dentists, not orthodontic specialists, can provide certain levels of orthodontic care. If my hon. Friend cares to write to me about the point that she has made, I will look into it and see what improvements can be made.
Mr. Alex Carlile: Will the Minister be kind enough to answer my question head on: how many of the 877,000 deregistered patients to which he referred does he expect to be able to find an NHS dentist in their area within 12 months from today? How many?
Mr. Malone: The hon. and learned Gentleman fails to recognise that, although there are de-registrations on the one hand, there are re- registrations on the other. One of the reasons why we have addressed the question of continuing care payments is that 4.5 million people rolled off dental registers over 12 months and it is important that they are brought back on so that proper care can be provided. The hon. and learned Gentleman's question is absurd, particularly in the terms in which it was asked. NHS dental care is available for everybody in this country where it is clinically essential. If it cannot be provided by an NHS dentist, it will be provided by the community dental service by or a salaried dentist.
Lady Olga Maitland: Does my hon. Friend agree that there are plenty of dentists providing NHS dental treatment in this country and that, in the past two years, the numbers have increased by 533 to a total of nearly 16,000? Is my hon. Friend aware that my son received urgent dental treatment last week and that it was excellent?
Mr. Malone: I was not aware of that last point but I am extremely glad to hear it. My hon. Friend is absolutely right. We do not hear what the Opposition's policy is when they criticise the availability of NHS dentistry, but we have, in fact, heard from their official spokesman in the past few weeks that they will consult Health 2000 and
"be putting the problem to them to seek a solution."
They certainly do not intend to find that solution themselves.
Mrs. Beckett: Surely the Minister must be aware, because the public certainly are, that it is as a consequence of the very low morale in the profession that dentists are leaving the health service in droves and that the General Dental Practitioners Association recently said that the Government's action
"will not stem the tide of dentists leaving the NHS".
As there is no doubt that that is the effect of Government policy, will the Minister tell us whether it is a further example of the Government's gross incompetence or of their deliberate malice and neglect which are undermining the health service?
Mr. Malone: It is the sort of malice and neglect that has resulted in a real terms increase of 53 per cent. in spending on general dental services since 1979 and the sort of malice and neglect that has resulted in more dental practitioners--533 more, as my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) said, providing NHS dentistry. It is absurd for the right hon.
Column 5
Lady to state that NHS dentistry is on the point of collapse or that there is no commitment. Perhaps she should read what her policy is--she is committed merely to"retain as much of the service as possible",
which does not sound to me like a ringing endorsement of NHS dentistry.
Private Nursing Homes
4. Mr. Orme: To ask the Secretary of State for Health what was the total number of residents in private nursing homes in (a) 1979 and (b) 1994. [17574]
5. Ms Janet Anderson: To ask the Secretary of State for Health what was the total number of residents in private nursing homes in 1979 and 1994. [17575]
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): In 1993-94, the total number of occupied beds in private nursing homes was 143,748. It was the first year for which this particular statistic was collected.
Mr. Orme: Is the Minister aware that there is a great deal of anxiety and fear among elderly people because of the closure of local authority premises and the extension of the private sector where proper safeguards have not been developed by the Government? Will he bear in mind the fact that it is his responsibility to stop such closures and to ensure that local authority provision is properly funded?
Mr. Bowis: It would be difficult for local authorities to close the nursing homes to which the question refers as there are none. The question is about private nursing homes, which provide good quality nursing care for those who need it. I should have thought that the right hon. Gentleman would welcome the fact that increasingly people are able to find comfort and privacy and somewhere where they can take their own belongings and receive the care that they need. The increase in the number of nursing homes around the country shows that a great many people have been choosing this form of residential care provision in addition to those who have been placed there by the health service.
Ms Anderson: Is the Minister aware of the deep public concern about the growing number of elderly people who are being forced to sell their homes and use their life savings to pay for residential and nursing care, often of a dubious quality? Does he agree with the Sunday Express that this can be described only as a tax on care? Will he tell us where in the Conservative manifesto at the last election this new tax on the elderly was mentioned?
Mr. Bowis: Perhaps I might remind the hon. Lady that there has been no change in charging policies for people going into residential care. Since 1948, when Aneurin Bevan and Beveridge started the welfare state and the national health service, there has been a division between NHS care, which is free at the point of delivery and paid for by the taxpayer, and the social care that is provided for individuals. Where appropriate, that is topped up, formerly by the income support system and now by community care.
If the hon. Lady does not think that that is the right policy, I suggest that she has a word with Sir Gordon Borrie, who chaired the Labour party's Social Justice Commission and who reminded the country that the
Column 6
Labour party could not afford to ask the taxpayer to pick up the bill. Does she, and do members of Labour's Front Bench, support Sir Gordon Borrie or not? The electorate would like to know.Dame Jill Knight: Is it not the case that any old person who needs care and who does do not have any money will get that care absolutely free? Many of us believe that it is not outrageous to expect an elderly person who has money--often quite a considerable sum--to make some contribution to the cost of their care.
Mr. Bowis: My hon. Friend is right. Nobody who has a low income or is on income support will have to pay towards the cost of care. Those who can afford it are invited to make a contribution to the care. My hon. Friend will recall the continuing care guidance that we issued recently, reminding the NHS that it continues to have responsibility for continuing health care, whether it is provided at a person's home, in a nursing home or in a hospital and that, wherever it is, it will be free.
Dr. Spink: Can my hon. Friend confirm that a very vibrant independent nursing home sector has led to an overall increase in places available to people who need long-term nursing care? Does he deplore the actions of county councils such as Essex, which is not placing people in the independent sector?
Mr. Bowis: My hon. Friend is right. He need look no further than the independent Audit Commission, which made it very clear that although community care as a whole has got off to a very good start around the country, better use could be made of resources if there were better financial controls in social services departments and if, as my hon. Friend says, better use were made of provision in the independent sector of residential and domiciliary care services.
Mr. Hinchliffe: Has not the most obvious consequence of the privatisation of care been the result--I shall start again, Madam Speaker, I am sorry. I am not feeling very well today. Has not the most obvious consequence of the privatisation of care been the wholesale revival of the out-moded institutional model, simply because it is the most lucrative form of care from a business point of view? Once again, by putting ideology before common sense, are not the Government now considering privatising even the inspection of care?
Mr. Bowis: I am sorry to hear that the hon. Gentleman is not feeling well. I hope that he feels better soon.
He is not correct and I am sure that, on reflection, he will consider himself to be incorrect in referring to the privatisation of care. When the national health service contracts with nursing homes for the provision of residential care, it is doing no more than what it does when it contracts with general practitioners. Both are in the private sector. Both are providing services to the NHS which are free to the patient at the point of delivery.
If the hon. Gentleman is really concerned about the care of individuals, I suggest that he looks at this week's Laing and Buisson survey, which reminded the House that the Labour party's policy of a national minimum wage would put up the price of care--
Madam Speaker: Order. I must ask for brisk answers from Ministers. We are making no progress whatever today, our first day back.
Column 7
Mr. Harry Greenway: Does my hon. Friend agree that care in the community ensures that people stay in the community and out of nursing homes as long as they are fit to do so? Is that not the right policy and does it not help people?Mr. Bowis: Yes. One of the purposes and aims of community care is to enable people who wish to do so and are able to do so to remain in their homes, supported by a package of care. All the independent surveys of community care conducted in its early months show that that is precisely what is happening. Innovative packages of care are being provided. Of course, we also need a range of provision in residential care, to which the independent sector can contribute so much.
NHS Senior Managers
6. Mr. Cummings: To ask the Secretary of State for Health what is the average pay of senior managers in the NHS in 1989, 1993 and 1994. [17576]
Mr. Malone: Senior managers are paid at a particular point on a scale which in 1989 went from £12,560 to £39,170 per annum. By 1993 those rates had been increased by 20.8 per cent. and in 1994 by a further 2.2 per cent., making the range £15,490 to £48,340 per annum.
Mr. Cummings: Can the Minister justify to the House why national health service executives are receiving wage rises more than twice the rate of inflation, while nurses are subject to a guaranteed 1 per cent. wage rise, which would give a midwife a rise of 43p a day? Will the Minister for once recognise the value of our nursing staff and ensure that their rises equate to those of senior health service staff?
Mr. Malone: Of course the Government recognise the worth of all clinicians, nurses, midwives and health visitors who work in the health service. They make a fantastic contribution, which has been recognised by the independent review body, the recommendations of which the Government have accepted in full. Trusts are now coming forward with pay proposals, 75 per cent. of which are in the area of 3 per cent. The Government and I fully expect that trend to continue. I hope that, instead of demonstrating, staff will go to their trusts and pick up the offers which are increasingly on the table.
Mr. Sims: Since the national health service owns a large number of properties, spends more than £100 million a day, has the largest labour force in the country and treats thousands of patients, is it not essential that those vast resources are competently and efficiently managed and that those managers are appropriately rewarded? Does my hon. Friend also accept that some of the rather well publicised recent incidents, in respect of which the standard of service in the health service was below what we might reasonably expect, could be ascribed not to structural faults in the NHS, but to management error and shortcomings? Will my hon. Friend ensure that those who are responsible are brought to account?
Mr. Malone: My hon. Friend is right to point out that, in a service as complex as the NHS, delivering increased in-patient activity, day care activity and out-patient activity across the board needs to be properly managed. I
Column 8
remind him that, compared with 12 years ago when 60 per cent. of those who worked within the NHS were involved in direct patient care, the figure is now 66 per cent. That is an increase. On the specific point that my hon. Friend made, I remind him that most health service management is subject to performance-related pay. If performance does not come through and if there are shortcomings, that will be taken into account when determining remuneration.Mr. Nicholas Brown: What estimates does the Minister have of the administrative costs of introducing local pay bargaining into the NHS? To which groups in the NHS does he intend that to apply?
Mr. Malone: As the hon. Gentleman well knows, it is the Government's policy that local pay be introduced for health service clinicians in the long term, and in the short and more immediate term, to nursing staff and midwives. The reason for that is important. It is to give them the benefits of local pay, so that trusts can configure pay and conditions packages appropriately in respect of local conditions. It is far more appropriate that that is done on a local rather than a national basis. A large number of trusts already have in place extremely well developed and refined systems; others will be making across-the-board packages, which they have already been doing. It is in the long-term interests of nursing staff that they pick up the offers which are on the table and ensure that they get fair pay and local pay and conditions.
Mr. Forman: How many of the senior managers referred to in the original question are experienced former nursing and clinical staff? Is it not rather important to recognise that many people are promoted from the wards into managerial positions?
Mr. Malone: My hon. Friend makes an extremely important point. That is one of the strengths of the new NHS. There are far more clinicians and people with qualifications in nursing involved at senior levels in NHS trust management. That is highly significant, and there has been a large amount of reclassification of those who were previously solely involved in clinical duties who are now involved in management as well. That is broadly welcomed by the professions, and I never understand why it is constantly sneered at by the Labour party.
Water-borne Diseases
7. Mr. Dalyell: To ask the Secretary of State for Health what representations she has made to the World Health Organisation about water- borne disease in the valley of the Tigris and Euphrates. [17577]
Mr. Sackville: My right hon. Friend has made no specific representations to the WHO about the water-borne diseases in the valley of the Tigris and Euphrates. However, I would like to make it clear that this country is a large contributor, both financially and in manpower, to World Health Organisation programmes and overseas aid programmes, including those benefiting the people of Iraq.
Mr. Dalyell: Do Ministers accept the horrendous statistic given in the report of Riad el Taher, to which I drew the Minister's attention, that, since the end of the Gulf war, 500,000 infants have died in one way or another from malnutrition and disease? What was the role of the
Column 9
WHO in those circumstances? Do the Government think that, whoever's fault it is, at least it is not the fault of the infants who are in such horrendous conditions?Mr. Sackville: I have the greatest sympathy with the suffering of the people of Iraq, but I must remind the hon. Gentleman that medicine and other humanitarian aid are outside the sanctions that have been applied. Saddam Hussein has yet again turned down another offer of substantial aid in return for limited sales of oil. His record does not suggest that, if there were a total relaxation of the sanctions, the health of his people would benefit. The only thing that would happen would be the rebuilding of his arsenal, which would do nothing for the welfare of his own people or of his neighbours.
Pharmaceutical Exports
8. Mr. Amess: To ask the Secretary of State for Health what was the total level of exports secured in the latest year for which figures are available by pharmaceutical companies based in Britain. [17560]
Mrs. Virginia Bottomley: The latest year for which complete figures are available is 1993, when total pharmaceutical exports from the United Kingdom were £3,685 million. That was an increase of nearly a quarter over the previous year. Provisional figures suggest that pharmaceutical exports continued to rise steadily in 1994.
Mr. Amess: Does my right hon. Friend agree that, when it comes to the pharmaceutical industry, Britain is best? In the light of that, in our own strong industry, together with the international excellence of the research industry in the NHS, does my right hon. Friend agree that we could benefit further from inward investment? In that context, is there anything further that she can add about her recent trade visit to Japan?
Mrs. Bottomley: I support my hon. Friend. The pharmaceutical industry is one of our strongest industries. Britain is a magnet for inward investment, not least because of the strength of our research base; not least because of our comprehensive health service; not least because English is the international language of business; and not least because we have now secured the European Medicines Evaluation Agency.
My recent visit to Japan was extremely productive, not only in further developing Japan as the second largest market for pharmaceutical exports but, above all, for encouraging Japanese inward investment in the pharmaceutical industry here, which I hope soon will be as commonplace as it is in the motor or electrical industries.
Mr. Bayley: Does the Secretary of State agree that the main reason why the British pharmaceutical industry does so well is that the pharmaceutical price regulation scheme guarantees a 20 per cent. return for pharmaceutical companies, which they may invest in research? Will she guarantee that she will reject the siren voices of her Back-Bench colleagues who want free market prices for pharmaceutical products in the United Kingdom, and stick by regulation through the pharmaceutical price regulation scheme?
Mrs. Bottomley: The hon. Gentleman is right to say that the PPRS has served the NHS and the industry well. We have 3.5 per cent. of the world market. We have 5
Column 10
per cent. of the production but 8 per cent. of the research and development. We continue to review the PPRS. The hon. Gentleman will know that we cut prices by 2.5 per cent. on the previous review. Before taking any further steps, we will make sure that we continue to balance the interests of good-value products for the NHS and recognition of an industry which has created jobs, employment and exports for this country.Mr. John Marshall: Does my right hon. Friend agree that one reason that exports rose so markedly in 1993 was that we had adopted a competitive exchange rate? Will she remind our right hon. and learned Friend the Chancellor of the Exchequer that interest rate policy should be designed to ensure that that competitive exchange rate remains, rather than to please the Bundesbank?
Mrs. Bottomley: My hon. Friend will know that I have frequent discussions with the Chancellor on many subjects. I will bear my hon. Friend's suggestion in mind in my next discussion, but I will also remind my right hon. and learned Friend the Chancellor--and, indeed, my right hon. Friend the Foreign Secretary that one reason that Britain is so successful in terms of inward investment is because we have a deregulatory culture and that we have not adopted the social chapter. Therefore, firms that invest here have the advantage of being part of the European Union without all the burdens on industry and employment that are so common elsewhere.
Mental Illness
10. Mr. Jim Cunningham: To ask the Secretary of State for Health if she will make a statement on the Audit Commission's recommendation that access to help for mentally ill people should be available outside office hours. [17562]
Mr. Bowis: The recent Audit Commission report did not make a specific recommendation on the subject. Nevertheless, we encourage health authorities and social services departments to provide access to out-of- hours services.
Mr. Cunningham: That is the Minister's interpretation of the Audit Commission report, but is not the Audit Commission really saying that care in the community, particularly for mentally ill people, is grossly underfunded? Is it not suggesting that the Government, who have boasted about their achievements this afternoon, are following the same policy as California, which is to remove mentally ill people from mental homes and institutions as that saves money? Are not the Government being heartless towards homeless people, who also need after-hours services? What does the Minister plan to do about it? Will the Government put more resources into the scheme?
Mr. Bowis: Had the Audit Commission referred to resources, it would have referred to the £2 billion that is put into the health service year on year. The hon. Gentleman's question is about 24-hour crisis care services. He will know that the Government have issued guidance to encourage the provision of 24-hour crisis services. He will also know that exactly those services are being provided in his own health district. Coventry, which already has a community psychiatric nurse on call and a 24- hour assessment service emergency night care team, is
Column 11
spending £200,000 in the coming year on a more comprehensive crisis service, and has made that its highest priority.Mr. Illsley: Is it not clear that most organisations involved in mental health care have endorsed the call for 24-hour emergency services? The Government say that they are doing all they can to encourage such services and there was cross-party support for a recent private Member's Bill that dealt with the issue of 24-hour emergency services, but could not the Government do more to enable patients to gain access to care when they need it, rather than concentrating on legislation, which deals with compulsory conveyance for treatment? Should not the user benefit?
Mr. Bowis: I do not see that those are in conflict. We want to improve discharge arrangements for patients from hospital, which is the purpose of the Mental Health (Amendment) Bill and the supervised discharge arrangements. We also want to ensure that money is spent on 24-hour care and access to services; that is the purpose of our guidance. We do not issue prescriptive directions from the centre about specific services, but we make it clear that we expect services to have crisis accommodation, crisis assessment and intervention teams, help lines and access to care teams, including the general practitioner and key workers.
Hospital Operations
11. Mr. Cyril D. Townsend: To ask the Secretary of State for Health what percentage of operations carried out in NHS hospitals may be unnecessary. [17563]
Mrs. Virginia Bottomley: The need for an operation for a particular patient is a matter for clinical judgment. Research evidence is leading doctors everywhere to question the frequency of some interventions. The United Kingdom is leading the world in generating that evidence and in helping doctors and patients in the NHS to use it in treatment decisions.
Mr. Townsend: Is some internal NHS study being conducted? Bearing in mind the high speed of medical science, is not detailed national research required? Can my right hon. Friend assure the House that she will not be dilatory in ensuring that, if possible, savings are made in such a crucial area?
Mrs. Bottomley: I can assure my hon. Friend that it is a priority for the NHS that was set out in the planning guidance last year. There is progressive information about clinical effectiveness and outcomes, and a major NHS research programme is under way that supports that work. We work very closely with the professionals to ensure that we take forward understanding about effectiveness, monitor our work and improve practice.
| Next Section
| Home Page |