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Regional Health Authorities

6. Mr. Garnier: To ask the Secretary of State for Health what estimates have been made of the savings resulting from the abolition of the regional health authorities. [27986]

Mr. Dorrell: Total annual savings from the abolition of regional health authorities are expected to be about £100 million. A further £50 million has also been saved by the creation of single health authorities at local level. These substantial savings will be retained by the NHS and reinvested in patient care.

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Mr. Garnier: Can my hon. Friend confirm that, with the abolition of the Trent regional health authority, patients in Leicestershire will benefit from a huge additional amount of money to be spent directly on patient care? Can he also confirm that, nationally, with other savings, we are now looking at an additional input of about £2 billion a year being spent directly on patient care?

Mr. Dorrell: My hon. and learned Friend is certainly right to say that there has been huge growth from a variety of different sources, which are delivering an expansion of patient care. The figure associated with increased administrative efficiency is £300 million in total, coming from regional health authorities, the reorganisation of district health authorities and the more efficient discharge of administrative functions within trusts. That is £300 million--a 1 per cent. increase in the total resources available for patient care--through more efficient administration.

Mr. Milburn: Will the Secretary of State confirm that, despite the abolition of the regional health authorities, the NHS bureaucracy bill increased by 6 per cent. in the past year alone? Will he also admit that the Government's market in health care has landed the NHS with an extra bureaucracy bill of £1,500 million every year--public money that should be invested in front-line patient services? Before he gets carried away, will he explain how 20,000 more managers and 50,000 fewer nurses add up to an NHS in which patients come first?

Mr. Dorrell: Constant repetition of wrong statistics does not make them right. As the hon. Gentleman very well knows, those statistics do not present anything like a fair representation of what has happened. The question that the Labour party has to answer is whether it believes--as did the predecessor of the hon. Member for Peckham (Ms Harman)--that the traditional health service was undermanaged, or whether it wants to go back to the health service as it was in the early 1980s. If it wants to go back to that, it will find no constituency for the administrative upheaval that will be involved. As the hon. Gentleman knows, the reality is that we are now committed to reducing the spend on administration to increase the spend on patient care. That is the commitment that the Government are in the process of delivering.

Mental Health Care (Isle of Wight)

8. Mr. Barry Field: To ask the Secretary of State for Health if he will make a statement about funding for mental health care on the Isle of Wight. [27988]

Mr. Bowis: In addition to the £7.2 million budget for mental health planned by the Isle of Wight health authority, I am pleased that we have been able to award a £305,000 grant from the mental health challenge fund.

Mr. Field: I am pleased to learn that the Isle of Wight has been so successful in obtaining funds from the mental health challenge fund. Is the Minister aware that the money will be used to extend the partnership with the island's social services as well as for a 24-hour crisis intervention team, which is badly needed on the island?

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May I thank him on behalf not only of myself but of everyone involved in mental health care on the island for listening to my representations on these difficult issues. Is he pleased to know that on Friday I had a tooth extracted on the national health service? It has brought me great relief and it gave my dentist great satisfaction. Is it not a fact that the Conservatives have cared for the NHS for more than 30 years--a record that far exceeds that of any other party in the nation?

Mr. Bowis: Yes. I am sure that if my hon. Friend puts his tooth under his pillow he will get a bit more, too. I thank my hon. Friend for his thanks. He has been a persistent and persuasive advocate on behalf of the island. He arranged a useful and constructive meeting with his health and social services authorities. The funding has enabled us to see an extension of the 24-hour staffed accommodation on the island and the establishment of the 24-hour crisis intervention team. I was also pleased to be able to allocate an extra £1.9 million to the health authority to enable it to cope with its merger period.

Accident and Emergency Units

9. Mr. Simpson: To ask the Secretary of State for Health what national guidelines exist for hospital accident and emergency units on the standard tests to be undertaken in relation to young women in severe abdominal pain when brought to a hospital; and if he will make a statement. [27989]

Mr. Malone: The management of any particular patient is a matter for the judgment of the clinicians involved. There are no national guidelines for such cases, but many hospitals have local protocols based on best clinical practice and taking account of local circumstances. I expect clinical judgment to be informed by the regular reports issued by the confidential inquiry into maternal deaths.

Mr. Simpson: I ask this question having just come through the traumatic experience of going to the local hospital with a family member who was left requiring almost emergency surgery, following the failure to carry out basic tests in the accident and emergency unit. Is the Minister aware that in the discussions that followed the clinical staff of the hospital said that the Government's failure to provide guidelines about basic tests which could and should be provided had left a huge loophole in the quality of emergency services on offer in hospitals around the country? Poor financial structuring renders reliance on professional judgment open to the fact that there are not enough professionally qualified staff in A and E units to ensure that people are not left unnecessarily in life-threatening circumstances.

Mr. Malone: I do not accept that from the hon. Gentleman. I know of his experience in the matter. That is why I have looked particularly carefully into what advice is given to those who exercise clinical judgment. It is for everyone who exercises clinical judgment in any situation in a hospital, be it in an accident and emergency unit or otherwise, to make him or herself aware of the advice. That is why we have the confidential inquiry which reports every three years into maternal deaths. It specifically recommends that when any young woman

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presents problems of this kind, all steps should be taken to diagnose whether a pregnancy or ectopic pregnancy is involved.

The confidential inquiry is set to report again in the coming months and I understand that it will take that guidance further. I hope that that might give the hon. Gentleman some reassurance.

Sir Sydney Chapman: It is the opinion of the Royal College of Surgeons that one in four deaths in accident and emergency departments is avoidable. Does my hon. Friend agree that the most effective way in which the Government could respond to that appalling statistic is, at least in large urban areas, to recognise the advances that have been made in medical technology and concentrate more A and E resources in fewer hospitals? That would provide greater consultant and doctor cover. Could not the disadvantage to some of having to travel further be met by putting paramedics on every blue light ambulance?

Mr. Malone: I am sure my that hon. Friend will welcome the fact that, especially in the London ambulance service, increased use is being made of paramedics both in ambulances and on motor cycles. I take his point that we must provide the best possible accident and emergency service for everyone. It is for clinicians to guide how that can best be offered in the circumstances. I am sure that my hon. Friend welcomes the great increase in the number of accident and emergency specialist consultants.

NHS Income

10. Mr. Foulkes: To ask the Secretary of State for Health what is the percentage of NHS income received from (a) private sources, (b) taxation, (c) prescription charges and (d) other sources in 1995. [27990]

Mr. Dorrell: The percentage of national health service income in 1994-95 from the sources listed by the hon. Gentleman was: from private sources, 1.4 per cent.; from taxation and national insurance contributions, 96.8 per cent.; from prescription charges, 0.9 per cent.; and from other sources, 0.9 per cent.

Mr. Foulkes: That is exactly the reply that I expected. Does the Secretary of State agree that that shows the creeping privatisation of the NHS?

Mr. Dorrell: The strategy of the hon. Member for Peckham (Ms Harman) has obviously been kept secret from the hon. Gentleman. My answer shows no such thing. It shows that the national health service continues under this Government to be a tax-funded health service, providing health care on the basis of people's clinical need and without regard to their ability to pay.

Mr. Thomason: Will my right hon. Friend confirm that it was the Labour party that introduced legislation to increase charges on prescriptions and that the proportion of public funding for the NHS has remained constant for the past decade?

Mr. Dorrell: Yes. My hon. Friend is right. The commitment to the national health service as a system to

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provide health care to those who need it on the basis of their clinical need is shared across the House. What is contrary to the public interest, and what makes me angry, is that that consensus is being undermined by the Opposition.

Mr. Bryan Davies: Everyone knows that the increases in prescription and dental charges have been excessive over the past 17 years. What is behind that? Is it the Government's belief that people who can afford to pay value their health more?

Mr. Dorrell: Everyone is aware that the charges were introduced under legislation passed by a Labour Government and that 85 per cent. of NHS prescriptions are dispensed without a charge. The charge is made on those who are in a position to pay.


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