The Parliamentary Under-Secretary of State for Health (Mr. John Horam): On 31 March 1996, there were 5,231 patients awaiting kidney transplants. On 31 December 1990, the figure was 3,668 and on 31 December 1985, it was 3,443. Improvements in medicine and surgery have allowed many more people to receive renal dialysis and so be added to the transplant list.
Ms Hodge: I am intrigued by that answer because the figures seem somewhat at variance with those that were given to me by the National Kidney Federation. It has expressed some concern that the number of those waiting for kidney transplants has increased by 50 per cent. over that time frame whereas--[Interruption.]
Ms Hodge: Does the Minister agree with the concern that has been expressed by the National Kidney Federation that the number of people waiting for kidney transplants between those years has increased by 50 per cent. whereas the number of transplants that has been executed is 30 per cent? That is a huge indictment of the national health service. Does he wish to comment on two important matters that were raised by the National Kidney Federation, first that--[Interruption.]
Madam Speaker: Order. Hon Members must get accustomed to the fact that questions must be brisk and to the point. I have said from time to time that we are not proceeding down the Order Paper properly because of long questions and long answers. I appeal to all Members for short, sharp, brisk questions. That is the way to do it.
Mr. Horam: I shall certainly keep my wind-up short. I am surprised that the hon. Lady mentioned the National Kidney Federation because I saw its representatives only a few weeks ago and they expressed satisfaction with progress although, obviously, they would like to see quicker progress. I hope that the hon. Lady will join me in welcoming this week the president of Rotary International, Dr Keith Barnard-Jones, who hopes to put another 7 million people on the donor register. That will be the best action that can be taken to help the people about whom the hon. Lady is concerned.
Mr. Nigel Evans: I welcome the fact that the number of people receiving dialysis since 1983 has doubled. I also welcome the Government's 1994 initiative on placing the donor organ register on computer. I and other hon. Members pressed for that. Does he think that there is some disappointment at the fact that there are only 3 million people on that register? Will he look at other initiatives in addition to the one that he has just announced to try to entice more people who used to fill in and carry cards to put themselves on the organ registration computer scheme?
Mr. Horam: I welcome my hon. Friend's long-standing interest in this matter. We are also advertising on television to get more donors and in my hon. Friend's area, the north-west of England, there is a particular experiment in the hospitals that is designed to get more donors.
Mr. McLeish: Despite the Minister's characteristic complacency, does he accept and acknowledge that the treatment of kidney failure in England and Wales is facing a real crisis, with damaging consequences for patients, that, every year, 1,000 people are dying because of their failure to receive kidney dialysis machine treatment, and that the differences between regions in terms of treatment are grotesque and totally unacceptable? Will he not say that the market is distorting patient priorities? The Government must act to put an end to that scandal.
Mr. Horam: I reject emphatically all the hon. Gentleman's allegations. The renal review was welcomed by the National Kidney Federation, which was mentioned by the hon. Member for Barking (Ms Hodge), and which has expressed considerable satisfaction with the position. Of course, it wants to go faster, but we have not only published the renal review, but put in place further guidelines to health authorities, which will tackle the problem. I agree with the hon. Gentleman about one thing: there are disparities between the regions. The guidelines will help to tackle those.
The Minister for Health (Mr. Gerald Malone): We fund several sources of information for general practitioners on drug treatments, consulting a wide range of professional and other bodies as appropriate. GPs are, of course, free to choose which drugs to prescribe for their patients, in the light of the information available to them.
Dr. Goodson-Wickes: My hon. Friend will remember the understandable disquiet expressed by GPs about the limited list, which was subsequently, and rightly, replaced by, and expanded to, a selected list. The pilot study being done on a computer-aided scheme known as Prodigy is also causing concern. Will he give an absolute assurance that this is a flexible system that will ensure that economic considerations do not override the most important consideration: the patient's clinical needs?
Mr. Malone: I am happy to confirm that. That is exactly the purpose of the project: to enable general practitioners to prescribe more effectively for their patients. The system is based on 600 guidelines, which are based on already published information from, for example, the British National Formulary, so I can give him that undertaking. We will, of course, see how the project proceeds. As he knows, it will be thoroughly evaluated.
Mr. Simon Hughes: If the Government believe in taking action on the basis only of the best scientific advice, why, last October, did they issue vague advice to every GP about certain third-generation oral contraceptives--with the result that about 200,000 women stopped taking the pill and about 3,000 women had abortions--when it is clear that there was no new scientific evidence that there was a danger, when the European regulatory body ruled last month that there was no new scientific advice and when there has been no other support for that Government action? Will the Minister apologise for an appalling piece of advice and confirm that no action will be taken against any of the drugs in terms of regulating differently?
Mr. Malone: I disagree with the hon. Gentleman profoundly. The best possible scientific advice was made available to the medical community at the first available opportunity, which it has the right to expect from a Government and a Government organisation. The hon. Gentleman need not shake his head because he has had detailed replies to what I think must be between 200 and 300 written parliamentary questions that he has tabled on this matter. Every morning, as I do the 30 or 40 more that he has tabled from some inspired source, he is seldom absent from my mind.
Dame Jill Knight: Have not the Government's fundholding schemes given GPs great freedom to treat their patients in the way in which they wish? Is my hon. Friend aware of many GPs' extensive concern that the Labour party proposes to get rid of the scheme?
Mr. Malone: Especially in relation to the ability to prescribe and to retain any savings that are made in prescription budgets, my hon. Friend is right. At present, 53 per cent. of the population in England are covered by GP fundholders. It would be appalling if that system were abolished, as the Labour party is promising.
Ms Harman: Will the Minister admit that approved prescribing practice was one of the many unsubstantiated claims that he has made for GP fundholding? Will he take this opportunity, before the Audit Commission report next week, to admit that he has made wildly exaggerated claims about fundholding? Does he understand that all general practitioners, fundholders and non-fundholders, want to work on the basis of partnership, not division and co-operation, and not cut-throat competition? That means replacing fundholding with Labour's system of GP commissioning.
Mr. Malone: When it comes to shooting from the hip about documents that have not been published, we do not need any lessons from the hon. Member for Peckham (Ms Harman) do we, Madam Speaker? I thought that her public accusations yesterday about fundholding and a primary care-led NHS were a disgrace. They were totally unsubstantiated. Unlike the hon. Lady, I do not intend to break a confidence about a report that we have received. That is extraordinary, coming from a party that has changed its policy on fundholding so many times, from outright abolition under the hon. Lady's predecessor to a half-way house from her initially. Now, in The Times today, I see that the Labour party is not even going to bring its policy to abolish fundholding to the House, but will do it by some covert means as yet undescribed because, if it were ever to form a Government, it would not have the courage to bring to the House a measure to abolish something that has the support of 51 per cent. of general practitioners in England.
Mr. Congdon: I welcome the fact that generic prescribing has doubled over the past 10 years. Does my hon. Friend agree that it represents good value for the taxpayer and good care for the patient? Following the question asked by my hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes), can my hon. Friend confirm that, whether GPs use Prodigy or any other computer-based software, steps will be taken to ensure that they are given the widest possible choice of drugs from which to select?
Mr. Malone: My hon. Friend is right. The Prodigy system is not designed to limit GPs' ability to prescribe. I fully support the move to generic prescribing. It is excellent and should be encouraged. I can tell my hon. Friend that the Prodigy scheme, which gives clinical guidelines to doctors, is also capable of being amended by them in the light of what they think will be best for their patients.