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House of Commons
Tuesday 20 June 1995
The House met at half-past Two o'clock
PRAYERS
[ Madam Speaker-- in the Chair ]
Oral Answers to Questions
HEALTH
Acute Admissions, Leicestershire
1. Mr. Robathan: To ask the Secretary of State for Health what steps her Department is taking to ensure that there are sufficient hospital beds for acute admissions in Leicestershire. [27711]
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): It is for the local health authorities, working with local trusts and other providers, to plan for the right number of beds and other services to meet the identified needs of the local population.
Mr. Robathan: Although I appreciate that it is not the direct responsibility of his Department, my hon. Friend will know that there has been grave concern in Leicestershire about the number of acute and emergency beds available. There have been some publicised incidents in which people have been kept waiting for some time on trolleys in Leicestershire hospitals. I am aware of the good work of the bed bureau in Leicestershire, but will he assure me and the people of Leicestershire that sufficient beds will be made available for their needs in the near future?
Mr. Bowis: The specific question is rightly directed to Leicestershire. My hon. Friend rightly praised the bed bureau for its work; it had a remarkably good success rate right the way through 1994, including the winter months, but, during a couple of months this spring, a problem was caused by extra demand and staff sickness. That has been tackled, and the good news for Leicestershire is that, for 1995-96, the cash allocation goes up by 5.4 per cent. We can therefore look forward to ever-improving services for the people of that county.
Mrs. Beckett: Does the Minister not recognise that, despite the Department's recent conversion to evidence-based policy making, in all too many parts of the country, as in Leicestershire, beds are being closed at a rate that seems to anticipate changes in the delivery of health care rather than to follow in their footsteps, despite lack of evidence, and without evaluation of effects and monitoring of what is happening? As a result, in many parts of the country, including Leicestershire, too many patients are chasing too few beds, and it is his Department's responsibility.
Mr. Bowis: The right hon. Lady has widened this somewhat from Leicestershire. If one widened it still further and considered comparisons round the world, one
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would find that the trend here in in-patient beds per thousand is on the same graph as it is in the United States of America, Italy and many other countries of Europe, including Ireland.The important thing is that, in 1993-94, 8.2 million episodes were carried out. The average wait, which in 1988 was more than nine months, has gone down to under five months. The number of day cases has gone up by 66 per cent. In counties such as Leicestershire, there are improvements day by day, to which the right hon. Lady failed to give a moment's regard, much less a moment's praise.
Let me refer the right hon. Lady to the rapid access chest pain assessment service at Glenfield general hospital, enabling general practitioner referrals on the same day for many people. She should pay tribute to progress, and not find nit-picking criticisms based on somewhere that has nothing to do with Leicestershire.
Mr. Garnier: My hon. Friend will know from his days as a Conservative party agent in Leicestershire of the good work of the national health service in that county. Will he take the opportunity in the near future to return to Leicestershire to consider the work of LOROS--the Leicestershire Organisation for the Relief of Suffering--which has an excellent hospice in the constituency of the hon. and learned Member for Leicester, West (Mr. Janner), which is doing sterling work but which is 50 per cent. funded by the NHS and 50 per cent. funded by voluntary subscription? Will my hon. Friend ensure that the health service continues to donate 50 per cent. of funding to that most wonderful hospice?
Mr. Bowis: I am always pleased to be invited to return to my former county of Leicestershire. When I am next there, I shall try to make time to visit the hospice to which my hon. and learned Friend rightly pays tribute. He also pays tribute to the fact that, under this Government, the hospice movement has really taken off. The funding for hospices, the work in palliative care and our recent guidance on continuing care where palliative care is concerned show that that sector has an excellent future while the Government are in power.
Regional Variations
2. Ms Janet Anderson: To ask the Secretary of State for Health what action her Department is taking to reduce cross-regional variations in health. [27712]
6. Mr. Bayley: To ask the Secretary of State forHealth what new initiatives she intends to take to reduce regional and social class variations in the health of the population. [27716]
The Secretary of State for Health (Mrs. Virginia Bottomley): We are tackling variations in health by working to improve health across the whole population, by allocating funding according to need, and by ensuring that health authorities are able to assess the needs of their local population and target spending accordingly.
Ms Anderson: Can the Secretary of State explain why the death rate from cervical cancer in the Burnley, Pendle and Rossendale area is 60 per cent. higher than the national average, and more than twice the rate in her constituency of Surrey, South-West?
Mrs. Bottomley: Before giving a substantive reply to the hon. Lady, I should like briefly to pay tribute to the
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late Lord Ennals, who held my present office for several years. I knew him personally since my childhood, and he was a great campaigner and a great enthusiast, especially on mental health issues, so it seems appropriate to mention his contribution to the House today, when we are to discuss the Mental Health (Patients in the Community) Bill.In answer to the hon. Lady, the key question is why her party resisted the GP contract that introduced additional encouragement for screening for cervical cancer. Our strategies have directed help to where it is most needed, and developed practical policies that have achieved change, so that the hon. Lady now has in her constituency not only a cervical screening programme but an effective breast screening programme. Difficulties involving variations in health outcome exist in this country, as in every country. The difference between the Labour party and ourselves is that we have practical policies for addressing and reducing those inequalities.
Mr. Bayley: Does the Secretary of State agree with the British Medical Association that the wealth gap and the health gap are both widening--in its words, as
"the direct, if unintentional, result of policy choices" by the Government? When will the Government change those policies, which have led, for instance, to the scandal that, in Gateshead, infants are 12 times more likely to die in their first year of life than are infants in the Prime Minister's constituency of Huntingdon?
Mrs. Bottomley: I agree with the BMA that our "The Health of the Nation" strategy is one of the most important initiatives that we have developed in recent years. It has been commended by the World Health Organisation and the Organisation for Economic Co-operation and Development, and as a result of it we can now bring the different Departments together to tackle the task of improving health. In the same way, we expect local health alliances to form, so that the health authorities and the local authorities can develop practical policies to deliver change. Over the past 10 years, infant mortality rates have fallen from 11 to 6.5 per thousand, and life expectancy at birth has increased from 71.8 to 73.8 years. Those figures have improved, and infant mortality has fallen, for all social groups and in all regions.
Dame Jill Knight: Does my right hon. Friend agree that the biggest and most important link between poverty and ill health is poor housing, and that much--indeed, the overwhelming bulk--of poor housing is administered by local government? If so, how often do she and her colleagues discuss health and housing matters with the Minister for Local Government, Housing and Urban Regeneration?
Mrs. Bottomley: As ever, my hon. Friend has hit the issue precisely. The Labour party talks about equality, but delivers a shambles. It has no practical policies for delivering any of its objectives. We have recently been subjected to the news that it plans a great act of vandalism against precisely the strategic changes in the health service that have enabled us to identify areas of difficulty and to take forward practical policies.
My hon. Friend is absolutely right about the link between housing and health, as she is about many other factors. My hon. Friend the Under- Secretary of State and
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I frequently meet Housing Ministers to discuss practical ways in which to take policies forward. People would be better served by Labour local authorities who took their stewardship more seriously, and, instead of talking the rhetoric of improving quality, took practical action, as the Conservative party has.Sir Anthony Grant: When considering cross-regional variations, will my right hon. Friend bear in mind the fact that hospitals such as Addenbrooke's and Papworth are centres of excellence equal to any London hospital, and that they happen to be in one of the fastest growing areas of the country, whereas London is the slowest growing area? On that basis, is she aware that her policy on hospitals is absolutely bang right?
Mrs. Bottomley: I thank my hon. Friend. He is one of a number of extremely distinguished and eminent opinion formers who take the view that the change in London was long overdue, and that, if there has been a problem in London, it has been the inadequate primary care services. That is why our decision, for example, to introduce deprivation payments for GPs in poorer areas, which means that they can get up to £30,000 more, is the right way forward--the practical action to deliver the necessary change.
Mr. Nicholas Brown: I thank the Secretary of State for her tribute to Lord Ennals, which is, of course, both appreciated and echoed by the Opposition.
On the substance of the question, can I ask the Secretary of State whether, in spite of all the evidence to the contrary, it is still her view that the Government should continue to deny the link between poverty and health inequalities?
Mrs. Bottomley: As ever, the Labour party is simplistic in its analysis. Of course income is a factor, and so are heredity, education, housing and unemployment; but our party supports a wealth-creating, job- creating economy, which means that we have below-average, falling unemployment--1,000 fewer on the unemployment registers every day. I suggest that those in the Labour party who are genuinely concerned about the wealth and well-being of the people of this country should applaud a Government who have so singularly successfully improved the standing of our nation and the employment prospects of our people and, in practical terms, substantially improved the health service.
Mrs. Roe: Does my right hon. Friend agree that the health needs of deprived populations are best met by developing the community health services provided by GPs and their teams? Will she confirm that that will remain at the heart of the new NHS?
Mrs. Bottomley: Undoubtedly, the development of and improvements in primary care have been among the most important changes in recent years. That is the first priority in the guidance that we have issued to the service this year.
I think that those who believe in primary care are perplexed that among the many acts of vandalism being prepared by the Labour party is the undermining or destruction of GP fundholding, which has so singularly led to successes and changes in primary care. It should pay more attention to how it can build on the successes, and, above all, make sure that the substantial extra
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resources going to local authorities for community care are properly spent and wisely used in the interests of the most vulnerable in the community.Hospital Trusts
3. Mr. Denham: To ask the Secretary of State for Health how many hospital trusts have entered into contractual agreements with health purchasers which set different maximum waiting times for the same clinical procedures. [27713]
The Minister for Health (Mr. Gerald Malone): Under the new patients charter, we have recently introduced a new, 18-month guaranteed maximum wait for in-patient and day case treatment and a first ever standard for wait to first out-patient consultation; all patients should be seen within 26 weeks of being referred by their general practitioner with nine out of 10 being seen within 13 weeks. These are, of course, maximum waiting times and we encourage purchasers to agree contracts which improve on these times for their patients when possible.
Mr. Denham: What does the Minister have to say to my constituents in Southampton who in the past year have had to wait twice as long for cardiac operations at Southampton general hospital as patients from Bournemouth who use the same hospital for the same treatment with the same surgeon? Indeed, what does the Minister have to say to his own constituents who had to wait three times as long as patients from Bournemouth for treatment in Southampton general hospital? Is it not the case that the internal market is forcing hospitals to enter into contracts in which where people live is more important than how ill they are in respect of how fast they are treated?
Mr. Malone: I remind the hon. Gentleman that tougher targets of that sort apply only to non-urgent cases. All treatment is provided within the terms of the 1991 agreement between the Government and clinicians, which clearly indicates that no trust should offer a contract to one purchaser that would disadvantage another. Emergencies should be seen at once and there should be common waiting lists for cases that cannot be seen immediately.
The hon. Gentleman wants to deny better treatment when it is possible under the new system. He could always ask those in his constituency who have waited for more than a year for treatment at Southampton hospital whether they think bringing waiting times down is an improvement for them. He will find it hard to do so, because, under the present system, nobody has been waiting for more than a year at the hospital in his constituency.
Mr. Barry Field: Why did my hon. Friend not tell the hon. Member for Southampton, Itchen (Mr. Denham) about the Isle of Wight hospital trust, which moved its cardiac contract from Southampton, because the service was so awful, to King Edward VII hospital at Midhurst, where we now get a fantastic service? The surgeon concerned made a hell of a row publicly, because he preferred playing golf to getting on and doing the operations.
Mr. Malone: I am sure that my hon. Friend, who always speaks vigorously on behalf of his constituents, will lose no time in reminding them that, under the policies that the right hon. Member for Derby, South (Mrs. Beckett) is preparing, which have been leaked, taking such action would not be possible. The reforms that we have put in place for the new NHS bring better
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treatment for more people, more flexibility and decisions closer to the patient. Those are precisely the things that the Labour party is trying to destroy.Ms Jowell: Does the Minister accept that variations in consultant practice may be another reason for different waiting times? Does he consider it acceptable that some consultant surgeons on maximum part-time contracts with the national health service should work three or four half- days a week in the private sector? Has he examined the evidence prepared by his own adviser, John Yates, on this? What action does he propose to take to ensure that consultant surgeon time, paid for by the national health service, is spent treating national health service patients?
Mr. Malone: It is, of course, the Government's policy to pursue over the long term local pay and contracts for the medical profession, which, if I have understood correctly, the Labour party is dead against. I remind the hon. Lady that there are already job plans which have to be agreed between trusts and consultants. A consultant's primary duty is, of course, to his or her NHS contract; that is clearly recognised and understood. The Government, however, very much welcome the fact that any additional work that a consultant may wish to do in the private sector can be done, as long as the balance is right. The Labour party, which continues to carp on about the issue, has brought forward no evidence that the balance is not right in any particular case.
Funding
4. Mr. Robert Ainsworth: To ask the Secretary of State for Health what plans she has to ensure equality of funding between district health authorities. [27714]
Mr. Malone: We remain committed to the principle of weighted capitation as being the fairest way in which to achieve equality of funding for health authorities.
Mr. Ainsworth: Despite covering the area with the second highest level of deprivation in the region, Coventry Health receives the lowest level of funding. Why is there not yet a time scale for addressing that issue? How on earth do those facts stack with what Ministers continually say about applying money where it is needed? Is it not the case that the Conservatives are loth to remove money from more affluent areas where the needs are not as great? That is the real issue.
Mr. Malone: Certainly not. If the hon. Gentleman looked at his own figures, he would see that, during the past year, Coventry Health moved from minus 3.5 per cent. below target to minus 2.2 per cent. That involved a cash increase of £7 million being spent within the hon. Gentleman's health authority.
A number of points have to be borne in mind. As one moves towards targets, it is extremely important not to destabilise arrangements that are already in place. If the hon. Gentleman is suggesting that the health service across the country should be destabilised in terms of funding--his right hon. and hon. Friends intend to destabilise it by ripping up the structure that has been put in place--he will find that that opinion is not very popular.
Mr. Wilshire: Does my hon. Friend accept that the over-provision of service in central London results in underfunding in places such as my constituency? Will he
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accept the advice of my NHS managers, my consultants, and my GPs, and stand firm on the Department's proposal to rationalise services in central London?Mr. Malone: I can certainly assure my hon. Friend of that point. I reiterate that the whole purpose of weighted capitation payments is to ensure that there is fairness not just between London and the rest of the country, but across the rest of the country as a whole.
Mr. Janner: When looking at funding, will the Minister be kind enough to remember the representations made to him just now by his hon. Friend the Member for Blaby (Mr. Robathan), who pointed out the grave concern of people in the Trent area in general, and in Leicestershire in particular, about the difficulty of getting hospital beds at all? A number of people have been dying before they manage to get into hospital or because of delays, an example being my constituent, Mrs. Lillian Wilkinson.
As yesterday marked 25 years of my service to my constituency, will the Minister be good enough to have a special look at the problems of the city of Leicester and its hospitals? Will he try to do what his hon. Friend the Member for Blaby asked him to do, and what Leicestershire Members of all parties wish him to do, which is to bring some hope and help to people in the area?
Mr. Malone: I congratulate the hon. and learned Gentleman on 25 years of representing his constituents, of which I was unaware. The sounds of rejoicing had not quite reached my ears at Westminster, but I am sure that, locally, they are loud indeed.
Allocating resources fairly across the country is the principal objective of policy, but we also have mechanisms whereby local purchasers, be they health authorities or GP fundholders, can ensure that there is proper provision by directing funds at a local level and causing investment to take place. That is exactly what is happening across the health service, and it would be destroyed by the policies of the right hon. and learned Gentleman's party.
Regional Health Authorities
5. Mr. David Shaw: To ask the Secretary of State for Health how much money she estimates will be saved from the abolition of regional health authorities. [27715]
Mrs. Virginia Bottomley: By 1997-98, total annual savings from the abolition of regional health authorities are expected to be around £100 million. Those substantial savings will be retained by the national health service and reinvested in patient care.
Mr. Shaw: Will my right hon. Friend confirm that that £100 million would be lost if Labour were ever to implement its policies on the reforms of the national health service? Is it not true that the reforms in the NHS to date have helped my constituents immensely? Are not more in- patient and out-patient cases being treated, and are there not seven new consultants in the South-East Kent health trust?
Mrs. Bottomley: My hon. Friend is correct in saying that the Labour party proposals would simply increase levels of bureaucracy, with no possible benefit to patients. My hon. Friend has seen the way in which improvements
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have taken place in his constituency, as they have throughout the country, with extra consultants, falling waiting times and improved services. The Labour party simply offers promises to its trade unions, and nothing for patients.Mrs. Mahon: Will the Secretary of State ensure that some of that money is earmarked for the Halifax district hospital? We have been waiting for it to be built for 20 years. Will she also stop the Calderdale trust from closing down the purpose-built Northowram hospital until the new hospital is built? Can she give a date on which construction will start?
Mrs. Bottomley: I know that the hon. Lady will greatly appreciate the fact that, on average, the Government have been able to open one £1 million capital project every week that we have been in office. There has been an unprecedented sustained programme of investment in the national health service. She will understand that changing medicine and changing therapeutic styles inevitably mean a changing structure in the health service in this country, as it is changing in every country in the world. Only the Labour party, with its luddite habits and its resistance to change, would pay the price of failing to give patients the best possible health care. We will continue to make progress as soon as we can.
Mr. Rowe: Will my right hon. Friend take courage from the success of this first assault on the multi-level bureaucracy of the national health service? As the NHS trusts grow in confidence and competence, will she assure the House that she will give them more freedom and less overweening bureaucracy from the top?
Mrs. Bottomley: I can indeed give that assurance. The freedoms of NHS trusts are part of the reason why they have been able to develop more responsive and better quality care for their patients, and not least why they have been able to design the pay structures of staff who work within them. The Labour party's research expenses are funded by Unison, yet Unison is demanding a payback on those research costs by requiring the Labour party only ever to take forward policies that would increase bureaucracy and undermine benefits for patients. We are keeping a book. Every commitment made by the Labour party reduces service and increases costs. Only the union paymasters benefit.
Mr. Alex Carlile: Bearing in mind the fact that GPs are now working an average of 62 hours a week, will the Minister consider committing some of the savings of which she has spoken to the six essential points which need to be met to solve the GPs' out-of-hours problem? In particular, and before the GPs meet tomorrow, will she consider telling them that she is prepared to use some of those savings to deal with the issues of valuing work load, valuing the work done by GPs, and the patient education needed to reduce out-of-hours calls?
Mrs. Bottomley: In my view, there are many areas for discussion with GPs. A work programme which looked at the work load of GPs was submitted to the review body, and it revealed that, although their work had increased by about 2 per cent., pay had increased by about 8 per cent. in the years considered. We have not only met the review body recommendations in full, but have agreed to a number of mechanisms to help GPs share the load of out -of-hours cover.
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In addition, we have put on the table £45 million to help with the development of co-operatives. We want a constructive outcome, and we believe that there are many areas for discussion with GPs, which I hope will continue--not least their fair comments about encouraging the public to use their services responsibly and not to call them out inappropriately.Capital Project Schemes
7. Dr. Spink: To ask the Secretary of State for Health how many capital project schemes costing over £1 million are currently under construction; and how many are in the pipeline. [27717]
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): There are a 112 building schemes in progress with a construction cost of over £1 million, with a further 75 in the pipeline.
Dr. Spink: Does my hon. Friend recall the media criticism of the decision to close the 400-bed unit at Rochford, even though it was based in an old workhouse and could not serve patients' needs effectively? Will he join me in welcoming the new 400-bed unit at Southend trust hospital? It has replaced that old workhouse unit and will serve many more patients, and serve them much better than the old unit. Will he fight the perverse antediluvian tendencies of the Opposition, who seek to resist all sound change we want to make in order to invest in the future of our national health service?
Mr. Sackville: I certainly agree with my hon. Friend that his constituents will receive better health services in modern surroundings at the Southend hospital. The Opposition's constant carping and criticism of any closure is always accompanied by the construction of excellent new facilities elsewhere.
Mr. Betts: How many of the projects are now stuck in the private finance initiative assessment process? What is the average delay while projects are subject to that assessment? Is it true that those delays were responsible for a £200 million underspend in the national health service capital budget in the previous financial year?
Mr. Sackville: The PFI will be a better way of procuring hospitals quicker and more cheaply by using all the skills of the private sector in tandem with those of the NHS.
Hospital Projects
8. Sir Roger Moate: To ask the Secretary of Statefor Health if she will make a statement about capital expenditure on hospital projects in Medway andSwale. [27718]
Mr. Sackville: Some £70 million is being invested in hospital projects in Medway and Swale. I am sure that my hon. Friend will agree that this represents a substantial investment in the health care of his constituents.
Sir Roger Moate: Is my hon. Friend aware that people in north Kent and north Kent Members of Parliament have been battling for years to get that type of investment in our local health service? It is marvellous news that the Government are delivering the next phase of the Medway hospital; that the Sittingbourne hospital is under construction; and that the construction of Sheppey hospital is due to start this year.
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Is that not further evidence that the health service under the Government is being sustained and improved as one of the best health services in the world? Would it not make a change for those on the Opposition Benches to welcome such good news instead of adopting a constant carping, critical and negative approach, which undermines confidence in our health service?Mr. Sackville: Those developments at Medway, Sittingbourne and Sheppey represent a huge number of projects--600 in the past 15 years--and they represent a constant upward trend in the hospital capital programme over that time. In fact, last year, that programme reached a record of £1.8 billion. Although I would be the last person to try to make political capital out of that, I must point out to the House that the late 70s was the only time when that trend was reversed, when the so-called Treasury team of the Labour Government drove this country to the moneylenders, and their first instinct was to slash the hospital capital programme. That is some commitment to health from a Government of which the right hon. Member for Derby, South (Mrs. Beckett) was a member.
St. Bartholomew's Hospital
9. Mrs. Gorman: To ask the Secretary of State for Health what proposals she has to allow St. Bartholomew's to continue as a private hospital. [27719]
Mr. Malone: Local health authorities and trusts are discussing the possibility of continuing health care at the St. Bartholomew's site with the Corporation of London. In addition, my right hon. Friend has asked Sir Ronald Grierson to chair a task force to look at practical options for the future use of the Smithfield site. The outcome of that work is awaited.
Mrs. Gorman: Does my hon. Friend agree that Bart's is to the medical world what Harrods is to retailing in the private sector--that is to say, it is a famous institution which can attract masses of spending to London from abroad? The tens of thousands of alumni of that hospital who are practising abroad would send their clients to a well-known public service hospital if it were not for the prejudice which the Opposition have about pay beds, which has prevented many hospitals from developing what could be a lucrative income to supplement their national health service work. Is it not a great shame that we are not doing more to encourage money that is spent in private hospitals to be spent in that area of the public sector?
Mr. Malone: My hon. Friend will be pleased to hear me confirm that it is the Government's intention to promote and to try to ensure a mixed economy for health, as that is important. My hon. Friend makes her point forcibly, but the reputation of any trust depends on its clinical excellence. The purpose of the change and consolidation at the trust to which we are referring is to promote clinical excellence. I am sure that Bart's reputation will be maintained and that the alumni will take good note of that.
Mrs. Beckett: Is the Minister aware that Bart's received more nominations from the public for a charter mark award than any other institution? Does he think that that might be due to the fact that, in all its history, Bart's has never had private beds and has never treated private patients? Is it not typical of the direction of health care under this Government, and the ultimate comment and
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obscenity of their policy, that Conservative Members should be advocating the closure of Bart's as an NHS hospital and its opening--after 900 years--as a private institution to treat just a few people?Mr. Malone: I am glad to see that--probably uniquely among Labour's Front-Bench team--the right hon. Lady's 1970s prejudices are entirely undiminished. Bart's received no nomination from the right hon. Lady when she was asked in a recent interview whether her party's policy would be to save Bart's. All we got was equivocation, and no firm answer. She is in no position to make any suggestion about the future of Bart's.
Sir Patrick Cormack: Reverting to the point made by my hon. Friend the Member for Billericay (Mrs. Gorman), if the Al Fayeds buy Bart's, can they have British citizenship?
Mr. Malone: I am sure that they would seek my hon. Friend's advice.
Brinnington Health Centre
10. Mr. Bennett: To ask the Secretary of State for Health what progress is being made in funding an extension to the Brinnington health centre. [27720]
Mr. Sackville: The proposal to develop Brinnington health centre as a primary care resource centre is due for discussion at the North West regional health authority's July meeting. If approved, it will receive the go-ahead at that time.
Mr. Bennett: Will the Minister urge North West region to give sympathetic consideration to the proposals since there have been repeated reports during the past six or seven years about the ill health suffered by many people in Brinnington? The most useful thing that could be done is to make sure that those people have a health centre large enough to enable them to have such facilities as a pain clinic to improve the treatment that they are now receiving.
Mr. Sackville: Yes. This appears to be a worthwhile scheme which offers a great variety of services. Since the hon. Gentleman tabled his question he will have received a letter from the Stockport health commission, in which it mentions that the response to date to the information given to the region has been favourable. I hope very much that the scheme will go ahead, and that it will join another nine modern health centres in the north west, including four at a cost of £6.5 million in various deprived areas around Manchester.
Residential Accommodation
11. Mr. Clapham: To ask the Secretary of State for Health what assessment she has made of the implications of removing from local authorities the duty to provide residential accommodation for the elderly; and if she will make a statement. [27721]
Mr. Bowis: There is no such duty. Under the National Assistance Act 1948 the duty is to arrange to provide. Our purpose is to clarify that local authorities may arrange to provide residential care either directly or through contracts with other providers. This matches current practice.
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Mr. Clapham: I hear what the Minister says, but is that not contrary to the policy that has been set down in previous White Papers, which suggested that care for the elderly should be based on a mixed economy? Is he aware that in Barnsley, one third of all households contain at least one person who is either elderly or disabled and who requires care? Some 12 per cent. of the adult population of Barnsley are informal carers. If the changes are implemented, will the Minister ensure that resources are made available to deprived areas like Barnsley so that adequate care in the community can be provided?Mr. Bowis: It is a matter for Barnsley to organise the very real resources that it has obtained from the taxpayer to meet those needs. If our proposals are accepted, no one will compel anyone to do anything; we will just make things possible.
I think that perhaps Barnsley needs some guidance in view of what the Act requires and what a recent judgment suggested might be required. Barnsley provides no residential care for expectant and nursing mothers, for the physically disabled or for the mentally ill. I do not question that, but I think that it might help Barnsley to have the system clarified.
Mr. Sims: Can my hon. Friend confirm that, when an elderly person is assessed as being best cared for in a residential home, it remains the responsibility of the local authority to ensure that that person is suitably placed? Does he agree that elderly people's needs vary greatly and that the private voluntary sector is able to offer a far wider range of accommodation at a more reasonable cost than local authorities have ever been able to provide?
Mr. Bowis: Yes. My hon. Friend is quite right: as local authorities have looked for better quality at a better cost when placing people in residential care, increasingly they have looked to the independent sector. It is also true that individuals who are placed in residential care are choosing that sector as they begin to realise their rights under the statutory direction on choice. The only organisation that stands in the way of that choice is the Labour party, and sometimes the Liberal party, in the local town halls.
Mr. Hinchliffe: In view of the fact that elderly people from the Minister's constituency were in the High Court last month defending their residential accommodation and that elderly and disabled people were in the High Court again last week defending their care services, what steps are the Government taking to address the serious difficulties currently facing vast numbers of users and carers? The Minister's own figures show that, since the care changes, one third of local authorities have been forced to cut home care, half have cut meals on wheels and more people are now entering institutional care. Is it any wonder that there is a total lack of public confidence in the Government's care policies?
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