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Mr. Jim Dowd (Lewisham, West): The Minister mentioned the difficulty of comparisons between Great Britain and Northern Ireland. He admitted that there will be cuts in health service provision in Northern Ireland. That stands in stark contrast to his counterparts in the Department of Health, who resolutely refuse to admit to that. Apart from his obvious greater honesty and candour, what is the reason for that distinction?
Mr. Moss: There is a distinction primarily on the basis that we spend far more on health per head of population in Northern Ireland than we do in Great Britain, although spending in Scotland is high. There is a differential of 14 to 15 per cent. in spend per head of population. Northern Ireland obviously has a high cost base that needs addressing in one way or another. In the rest of the United Kingdom, there probably would be 10 district general hospitals per 1.5 million head of population; in Northern Ireland we have 19. I am not saying that we should get rid of nine--I hope that that will not be tomorrow's headline--but we have to look carefully at the number of hospitals and what they do.
There is a higher cost base, which needs to be addressed in the medium term, but short-term measures are difficult. Earlier this evening, attention was drawn to the fact that 3 per cent. cash-releasing savings is different from what has been asked of the health service in England and Wales--and, I believe, in Scotland. I met the boards and trusts, to try to establish a way forward that would help to minimise the effects of cuts in some activities. We selected elective surgery because it would also affect the fundholder budgets that are used to purchase elective surgery.
In the past few years, Northern Ireland has had an excellent record of increasing the throughput of in-patients, out-patients and day surgery. Our waiting lists are extremely low in most activities, and I do not believe that the impact of the cuts will be as draconian or dramatic as people claim. Until I get the full list of contracts, I cannot review the position, but I intend to do so very quickly.
Rev. Martin Smyth:
In respect of the drugs budget, how far has the Department proceeded with the pay review? Is there a disparity in drug prescription in particular areas or by individual doctors? I am not suggesting that we should save money by reducing the
Mr. Moss:
The hon. Gentleman is absolutely right. There is a disparity, and we have statistics on it, but it is a different matter from publishing a list of what individual GP practices prescribe. We have had some considerable success in reducing the drugs budget through our fundholding GP practices. We want non-GP fundholders to try to emulate that success. We shall be launching a campaign in the near future. I have not yet brought all the strands together, but I am looking carefully at the matter, and making inroads into it is a major plank of our policy over the next year. I shall certainly consider any specific suggestions that the hon. Gentleman and his hon. Friends may make to me.
The right hon. Member for Lagan Valley referred to the funding of two schools in his constituency, and I shall certainly convey that information to the Minister of State, my right hon. Friend the Member for Devizes(Mr. Ancram).
I was somewhat surprised that the South-East education and library board, to which the hon. Member for South Down (Mr. McGrady) also referred, had not yet replied to a letter of 5 March. I find that very strange and will certainly take up the matter.
The right hon. Member for Lagan Valley referred to the statement that has been made--he mentioned my right hon. and learned Friend the Chancellor of the Exchequer, but I think that the statement has also been made by my right hon. Friend the Prime Minister and by my right hon. and learned Friend the Secretary of State for Northern Ireland. Certain key services--the health service and education--were particularly mentioned. I can speak this evening only on the health service. The health service has been protected in so far as we have given it a real--terms increase this year.
The hon. Member for Belfast, North (Mr. Walker) also raised health issues. He referred to the capitation formula, on which a moratorium is being conducted at the moment. When he and the hon. Member for Belfast, West(Dr. Hendron) came to see me, I said that the Eastern board had begun a moratorium, and we are looking at that again. It is true that finding a capitation formula that is acceptable to all is extremely difficult. However, we believe that we have built deprivation factors into our formula--for distribution not only to community trusts but to boards. It is difficult to arrive at a formula that meets everyone's approval. I am grateful to the hon. Member for Belfast, North for his comments on the strengthening of the Housing Executive's role, especially in a strategic sense, and I endorse the importance of housing not only to his constituents but to those of every hon. Member in Northern Ireland.
The issue of grants came up at Question Time this afternoon, and I accepted that there had been some delays, especially for disabled people. That is because of the lack of occupational therapists. We are addressing that and hope to bring it into line in the very near future. The amount of money allocated for grants has increased year by year. There has been a £3 million increase--I think--this year to £47 million. The problem of mandatory
repairs grants that were eating into the total budget has been addressed, and we have reduced the maximum amount available to £500. That should make quite a difference.
The hon. Member for South Down raised the sub-programme for agriculture and rural development. It is true that the capital grant elements of that scheme were suspended from 24 March 1995 because, as he noted, commitments to applicants risked outstripping the available financial resources. A decision about reopening the scheme will not be made until an assessment of funds required to finance the applications received has been made. We shall take stock at that time.
The hon. Gentleman also referred to fishing. We agree that the European Union proposals are unacceptable at this juncture. We accept the view that the assessments of over-fishing in the Irish sea are probably wrong. I am sure that my noble Friend Baroness Denton, together with my hon. Friends in the Ministry of Agriculture, Fisheries and Food, will be arguing the British case very strongly in European meetings.
The hon. Member for South Down again mentioned theory test centres. I have written to him and said that we are starting off with--I think--six test centres, but I shall review the position at the half-year point. Essentially, we are trying to keep the costs of the tests down. We have calculated that every extra test centre might cost us £55,000 a year, which would put £1 or £2 on each candidate's test. I heard what he said about £35 for the hire of an educational establishment in Downpatrick. Obviously, I shall have to check that out with the usual sources.
The hon. Member for Belfast, South mentioned the bad publicity about theatre closures at the Royal Victoria hospital. I was pleased to have his support on the fact that at least some such closures happen every year, but are just not publicised. Doctors and nurses have to take a holiday. August is a holiday time in any case, and the number of people admitted to hospital in that month drops dramatically. The information is not new, but I was grateful to the hon. Gentleman for his support of the Government's position. I shall refer the issue of Tyrella school to my right hon. Friend the Minister of State.
The hon. Member for Belfast, South also made a plea for investment in south Belfast. That will be passed on accordingly, but it should be borne in mind that every hon. Member who speaks for Northern Ireland makes a personal plea for his constituency. I am not aware of any problems with Sports Council funding, so I cannot comment this evening, but I shall look into it for him.
The hon. Member for East Londonderry (Mr. Ross) raised the issue of fluoridation. It is true that the four boards have formally requested that I consider introducing fluoridation in Northern Ireland. They are tasked with conducting a thorough and adequate consultation, not only with the public at large but with district councils, and they must take those views into account. It is common knowledge that, if the consultation process has not been as thorough and proper as it should have been, the boards could lay themselves open to judicial review. I have not seen their request, but I shall be looking at it fairly soon. The important thing is that they consult properly in their areas. I have to balance--as indeed they do--the points made for fluoridation against the general thrust of their policy, to look after the health and well-being of their populations.
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