House of Commons
Tuesday 18 June 1996
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
PRIVATE BUSINESS
Allied Irish Banks Bill
Read the Third time, and passed.
Oral Answers to Questions
HEALTH
Travel Vaccines
1. Mr. Canavan: To ask the Secretary of State for Health if he will ensure that travel vaccines continue to be made available on the NHS. [31694]
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): Yes.
Mr. Canavan: Is the Minister aware that last year alone 39 million British people made overseas visits, 16 per cent. of them to areas with a high risk of infection? Will he resist any suggestions that vaccination should cease to be available on the NHS? If he does not, many people may not get vaccinated, which would lead to an increase in the number of infected travellers returning to Britain, thereby increasing costs to the national health service and having a detrimental effect on many people's health.
Mr. Bowis: The hon. Gentleman makes a fair case for the economic health of the nation that enables so many people to travel abroad, and a good point about travellers needing to take precautions. Just as they need to take out travel insurance, they should consider their health protection. I hope that they will read the "Health Information for Overseas Travel" booklet produced by the Government. The position of successive Governments has been that immunisations are free for travellers where there is considered to be a real risk to public health if a disease is brought back to the United Kingdom. That remains the case. I am happy to join him in resisting any change to that.
Mr. Fabricant: Before my hon. Friend is overcome by generosity, will he bear in mind that many business travellers have their vaccinations paid for by their companies? It is difficult to have sympathy with people who go on exotic holidays to Australia and Thailand who say that they cannot afford to pay for their vaccinations.
Mr. Bowis: My hon. Friend makes a fair point. That is why there is a balance in the system whereby vaccinations for diseases that would not be a threat to the remainder of the population if someone were to bring them back from abroad are the responsibility of the individual. As he said, they may be paid for by a company, but the cost is small compared with the overall cost of travel abroad, certainly to the remote places that he mentioned. Where there is a potential public health risk, it is right that the NHS system should be able to provide the service through doctors or clinics.
Purchasing Contracts
2. Mr. Touhig: To ask the Secretary of State for Health when he last met the chairmen of NHS trusts to discuss the administrative costs of purchasing contracts. [31695]
7. Mr. Bennett: To ask the Secretary of State for Health what representations he has received about administrative costs in the NHS. [31700]
The Secretary of State for Health (Mr. Stephen Dorrell): I meet NHS trust chairmen regularly. The Government are committed both to the effective management of the NHS and to the reduction of unnecessary bureaucracy.
Mr. Touhig: While I recognise that an extra £1.4 billion was put into the national health service in 1993-94, every penny of it went on administrative costs. Is that obsession with bureaucracy, as opposed to front-line services, the reason why three quarters of NHS trusts have yet to make a local pay offer to nurses four months after Ministers pledged action on the matter? Is that another broken Tory promise?
Mr. Dorrell: The Opposition's concern about bureaucracy would be a great deal more convincing if they had not voted against the abolition of the regional health authorities, which was the biggest single element in the £300 million programme for shifting resources out of unnecessary bureaucracy into front-line patient services.
The Government have made it clear that nurses' pay arrangements are a matter for local agreement between employers and local nurses groups, against the guarantee of a minimum increase of 2 per cent. on a national basis.
Mr. Bennett:
Will the Secretary of State now confirm that there are 20,000 extra NHS managers and 50,000 fewer nurses as a result of the Government's programme? Is that by design on the part of the Government or by accident?
Mr. Dorrell:
The hon. Gentleman persists in deliberately misreading figures, despite repeated explanations of what the figures he quotes mean. He might do well to remember the words of the previous shadow health spokesman, who said:
Sir Sydney Chapman:
Does my right hon. Friend agree that administrative costs in the health service should be kept in proportion? Does he further agree that, if increased administrative costs result in more medically qualified people undertaking less administrative work, and in the more effective targeting of the ever-increasing funding of our national health service for the benefit of patients, they are justified.
Mr. Dorrell:
My hon. Friend is on a very important point. He underlines the interest that every taxpayer and every patient of the NHS has in its efficient management. The question that should be asked of the Opposition Front-Bench team, particularly of the hon. Member for Darlington (Mr. Milburn) in the light of press reports at the weekend, is why the Labour party wishes to disfranchise 6.5 million people who take out private health insurance and prevent them ever playing any part in the management of NHS trusts and health authorities.
Mr. Thomason:
Can my right hon. Friend confirm that the proportion of NHS staff who are involved in the direct care of patients has increased in the past decade?
Mr. Dorrell:
My hon. Friend is on to an important point. We have increased commitment to front-line services, delivering more treatment to more patients than ever before in the history of the NHS. The Labour party is more concerned with dogma. [Interruption.] The hon. Member for Darlington says that I should not believe everything that I read in the newspapers. Perhaps he would like to deny the story in the weekend newspapers, since it appeared in quotation marks, attributed to him.
Ms Harman:
Can the right hon. Gentleman confirm that the bill for bureaucracy for his NHS internal market is an extra £1.5 billion every year? Is he aware that, because of the market, St. Thomas's and Guy's hospitals now have to send out 57,000 invoices every year? How can he justify children being turned away from intensive care and their parents being told, "Sorry, there is no bed"? How can he justify patients waiting for hours on trollies? How can he justify patients being told at the last minute, "Sorry, we are cancelling your operation"? How can he justify any of that while he squanders precious NHS resources on red tape to run the market?
Mr. Dorrell:
Rather than uttering these repetitive soundbites, the hon. Lady might do better to explain to the NHS and to the public what she means when she says that she will abolish the internal market. Her policy document is clear. She retains the purchaser system. She retains the principle that purchasers should be free to place their contracts where their patients' advantage lies. How will she do that while delivering the commitment that she professes to abolish an internal market?
Mr. Congdon:
Does my right hon. Friend agree that one of the benefits of the internal market is that it has enabled health authorities to focus on the real issues of health need and effectiveness of health care? Does he agree that it is nonsense for people to pretend that the NHS can be managed without managers, and managed on a system based on ignorance? Have not the changes led to real improvements in the quality of health care given to the people of this country?
Mr. Dorrell:
My hon. Friend is right. The interest of every patient and every taxpayer is that the health service should be efficiently managed and that health resources should be targeted at real health need. That is the purpose of NHS management. The hon. Member for Peckham (Ms Harman) professes to mean that, but consistently commits herself to undermining the structure that makes it possible.
3. Mr. Purchase:
To ask the Secretary of State for Health when he last met representatives of local authorities to discuss the provision of care to the elderly people living in the community. [31696]
Mr. Bowis:
I meet them on a wide range of formal and informal occasions and discuss with them an equally wide range of issues.
Mr. Purchase:
Is the Minister aware of the considerable confusion that exists in local authorities and in other agencies, such as Age Concern and widows' associations, and the tremendous anxiety that many older people now feel about their future and about the Government's plans, which seem to be aimed at further commercialising and privatising the health services that older people have a right to rely on, having paid for them all their working lives?
Mr. Bowis:
In that case, I am sure that, if the hon. Gentleman has discerned this concern, he will reassure those people by pointing out that 40 per cent. of NHS health care spending is spent on people over 65, despite the fact that they are only 16 per cent. of the population. I am sure that he will also have reassured them by pointing out that the present Government have enabled social services departments to spend £5.7 billion on their community care needs.
I am sure that the hon. Gentleman will have noticed--although he does not appear to wish to notice it at this moment--the considerable increase in contact hours for people receiving care in their own home, up 42 per cent. in the past three years. Those are measures of success and care, and show that the Government do care about the future of the increasing numbers of elderly people in this nation--people who can rely on our policies, although, when it comes to the Opposition's policies, they will have to wait for a royal commission.
Dame Jill Knight:
Does my hon. Friend agree that one of the most important things that helps elderly people living in their own homes is the home help service? Is he aware that many local authority social services departments now state that doing the shopping should be top priority for home helps, but that the people they help need a reasonably clean home, whereas neighbours and relatives will often do the shopping? Can he do something about that?
Mr. Bowis:
My hon. Friend is right to suggest that local authorities, which are responsible for arranging social care when that is needed, should listen carefully to the users of those services and their families to discover what type of services they should be purchasing on their behalf. I believe that the Community Care (Direct
"I don't think it's really in question any more that the NHS has been under-managed in the past."
That is why the Government strengthened NHS management and why the NHS is now delivering more patient care to higher quality more efficiently than it has ever done before.
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