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Mr. John Gunnell (Morley and Leeds, South): What new money goes with these proposals? It is all very well for the Secretary of State to tell us that he will legislate as soon as possible, but what new money, not in the health service already, will accompany the proposals, which clearly depend upon adequate resources?
Mr. Dorrell: I have not come to make an announcement about money this afternoon; I have come to make an announcement about proposals for legislative change. But if the Government's record is anything to go by, it will be a lot more than £100 million.
Mr. Richard Burden (Birmingham, Northfield): The announcement has some welcome aspects, but initiatives in primary care are unlikely to be effective if they are grafted on to a system of contracting that encourages short-term thinking when already too many community services do not know what they are doing from one year to the next. Will the Secretary of State review the time scales of contracts so that we have proper commissioning rather than short-term fixing year on year?
With regard to money, may I press the right hon. Gentleman on one specific issue? Appendix A refers to money for the pilots being ring-fenced. Is that new money and, whether or not it is, how much will be ring-fenced?
Mr. Dorrell:
It is not new money and does not need to be new money, because we are talking about the delivery of primary care services to existing patients with existing practitioners. We are talking about ring-fencing the existing pool system for the remuneration of doctors and dentists so that the individual doctor and dentist does not have his remuneration undermined or distorted by the development of the pilots. That is what ring-fencing means in that context.
The hon. Gentleman repeats the assertion that the Government are in favour of short-term annual contracts. We have said repeatedly, and I said it again in May this year when I published some material on improving the efficiency of NHS bureaucracy, that I am in favour of a medium-term perspective in the contracts. I certainly am not in favour of an artificial requirement that every contract should be placed for one year. That never has been the Government's policy, however often it is asserted from the Opposition Benches that it is.
Mr. William O'Brien (Normanton):
What advice does the Secretary of State have for GPs who are concerned
Mr. Dorrell:
I have repeatedly made it clear, and it is being delivered by the NHS, that we need to deliver acute hospital beds for those who are acutely mentally ill, just as we need to deliver acute hospital beds for those who are acutely physically ill. I am not in favour of continuing to provide many long-stay isolated mental illness beds in traditional mental illness hospitals when better models of care are available which provide proper support in the community, nursing home support for people who need nursing homes and a range of other facilities, but, where people need acute mental illness beds, those are being provided, often in acute mental illness units that have been the result of the investment boom of which the Prime Minister spoke when answering questions earlier.
Mr. Ronnie Campbell (Blyth Valley):
The Secretary of State has said that he praised fundholders, but in our region we have evidence of fundholders refusing to put old people on their practice lists. In fact, they are not even refusing them. They are throwing them off the list and other doctors who are not fundholders are having to pick them up. That is not good enough, and will the Secretary of State do something about it?
Mr. Dorrell:
If the hon. Gentleman made that accusation with a name attached to it outside the House, it would be a serious charge of professional misconduct.
Mr. Campbell:
I will bring the case to the Secretary of State.
Mr. Dorrell:
The hon. Gentleman should indeed bring the case to me, because, if he does so, he will find it referred to the General Medical Council for unethical conduct.
Dame Elaine Kellett-Bowman (Lancaster):
Is my right hon. Friend aware that my local district general hospital, the Lancaster royal infirmary, will shortly be the first hospital to incorporate a dedicated blood transfusion service? Will he consider doing us the honour of opening it?
Mr. Dorrell:
I should be delighted to respond to an invitation that my hon. Friend presses on me and I hope that it will be possible to fit it into my schedule.
Madam Speaker:
That was not referred to in the statement that I heard.
Mr. Nick Ainger (Pembroke):
Will the Secretary of State take the opportunity to apologise to the hundreds of thousands, if not millions, of people in Britain who are deprived of primary dental care? In my constituency, a small group in the town of Milford Haven have had to band together and hire a mini-van to transport themselves 30 miles to a dentist who will treat them. That is not uncommon throughout rural Wales. Will the Secretary of State give us an assurance that his measures in the White Paper will deal with that major problem--in one constituency in north Wales, there is no NHS dentist at
Mr. Dorrell:
My hon. Friend the Member for Macclesfield says that he already has a salaried dentist in his constituency. The hon. Member for Pembroke (Mr. Ainger) asks that we return to the position of 10 or perhaps 17 years ago. He would like to return to the position 17 years ago in NHS dentistry. That would mean a reduction of roughly one third in the number of NHS courses of dental treatment delivered.
Mr. Dorrell:
It is no good the hon. Gentleman shaking his head. Adult courses of dentistry received and paid for in NHS terms have risen from 17 million in 1979 to just short of 25 million in 1995. That is an increase in NHS dentistry activity of 46 per cent. It is an inconvenient fact, given the sort of assertions that the hon. Gentleman likes to make. I would not argue--I do not argue--that there are no problems in NHS dentistry. That is why we are introducing the proposals to make the system more flexible, but the hon. Gentleman should not assert that NHS dentistry is in retreat--
Mr. Dorrell:
It is no good saying that it is. I have quoted the facts to the hon. Gentleman. The facts are that there were 17 million courses of treatment in the time that he referred to as a golden age and that there are 25 million courses of treatment now.
Mr. John Battle (Leeds, West):
I do not know where the Secretary of State gets his facts, but many of my constituents cannot get an NHS dentist because the NHS dentists have pulled out and gone private. How will the White Paper help those constituents? Is not this word "choice", which Ministers utter, an increasingly empty word that means the Hobson's choice of going without because, in practice, NHS dentistry has been privatised?
Mr. Dorrell:
The hon. Gentleman is wrong. I have shown clearly that it is not true to say that NHS dentistry is being privatised. I acknowledge that there are problems with the provision of NHS dentistry, which is why we have introduced these proposals to make the regime under which NHS dentistry is provided more flexible and to allow health authorities to target resources on areas where there is a problem with access.
Earlier this year, my hon. Friend the Minister for Health announced changes in the remuneration of dentists under the present contractual arrangements. Resources will be targeted specifically on dental services for children to ensure that that provision receives priority. We are responding to problems of access to NHS dentistry as they arise. My hon. Friend the Member for Macclesfield referred to another example of how that is being done.
Neither of the assertions of the hon. Member for Leeds, West (Mr. Battle) is true. It is not true to say that NHS dentistry is a service in retreat. It is true to say that there are some problems, but we are dealing with them.
Madam Speaker:
I have a statement to make on a matter of privilege. The hon. Member for Ellesmere Port and Neston (Mr. Miller) has written to me about information that came to light during the parliamentary recess alleging that, in 1994, improper pressure was brought to bear on the Select Committee on Members' Interests. I am satisfied that the matter should have the precedence accorded to matters of privilege. The hon. Member is thus entitled to table a motion for consideration by the House as its first business tomorrow at 3.30 pm.
4.24 pm
4.25 pm
Mr. Harry Cohen (Leyton): I beg to move,
- That leave be given to bring in a Bill to reduce the numbers of children taught in classes in schools.
Why is the Bill needed? According to official figures, 40 per cent. of primary school age children in England are being taught in classes of more than 30, and the percentage is worsening. In January 1995, 1.6 million primary school children were in classes of more than 30, which is a 7 per cent. increase on the previous year and a 24 per cent. increase since 1991. The number of classes with more than 40 children has risen even faster--27 per cent. in the year to January 1995--to 18,000. The Chartered Institute of Public Finance and Accountancy says:
There are 400,000 secondary school pupils in classes of more than 30. Class sizes are rising in that sector too. Since the mid-1980s, secondary schools have lost more than one in five of their mathematics and English teachers. The Observer of 1 Sept this year noted that despite the fact that the school age population is set to rise this year by 100,000, the Department for Education and Employment plans to recruit only 85 more teachers. Each year since 1992, the intake of new primary school teachers has fallen. There is a shortfall of 2,000 teachers in the secondary sector if the Government's own targets are to be met, so there is a looming crisis in mathematics, science and English teaching.
The Department for Education and Employment continues to claim that there is no teacher shortage and refuses to acknowledge the effect of class sizes on children's attainment. Meanwhile, more than one third of 14-year-olds are not mastering basic mathematics, English or science, and one in six adults has severe difficulty with literacy and numeracy.
The evidence shows the advantage of smaller class sizes. Despite the Government's refusal to sponsor detailed research studies, several such studies have been undertaken which clearly show that the smaller the class size the better the performance of pupils. STAR, the student-teacher ratio project in Tennessee, found that
Studies show that schoolchildren taught in smaller classes were still benefiting at the age of 12. Mortimore and Blatchford state that, in direct contradiction to Ministers' pronouncements that class sizes are unimportant, it can justifiably be said that it is incorrect to state that there is no proven connection between class size and attainment.
Ofsted's report, "Class Size and the Quality of Education", in November last year said:
The National Commission on Education's report, "Learning to Succeed", said that, within five years, no primary school child should be in a class of more than 30. The National Confederation of Parent-Teacher Associations supports a class size limit of 30. Private schools have pupil-teacher ratios of 10:6. They clearly regard low class sizes as important. There is much evidence to support the need for low class sizes.
What would be the cost of my proposal? Based on the recent survey by the National Foundation for Educational Research, 6,000 more teachers would be needed to cover 39,385 classes. That would cost £156 million. The assisted places scheme will cost £161 million by 1998. By phasing that scheme out over five years, all class sizes could be reduced to a maximum of 30 in the same period. To quote the slogan of the Tory party conference, that would mean opportunity for all. Alternatively, the cost could be met by reducing wasteful spending in other Ministries.
Ofsted has suggested that reducing class sizes would cost an enormous sum--more than £500 million. It included in its calculation large extra transport costs and additional accommodation requirements. Such costs have not been incurred as class sizes have risen, so why should they be taken into account when numbers fall to earlier class size ratios? Ofsted's figures are a crude and unsubstantiated guesstimate. They are much less worked out than those of the National Foundation for Educational Research, which stands by its calculations.
There has been virtually no detailed research in the past decade into relevant class sizes in secondary schools. Most studies have concentrated on primary teaching. Although I acknowledge that that sector is vital for imparting learning skills, smaller class sizes would also benefit secondary school pupils. There is a widespread assumption of failure; that many in the secondary sector are already lost to education. That assumption should not be accepted. There are fewer large classes in secondary schools than there are in primary schools, so the cost of achieving the 30 limit in the secondary sector would be low. Education strategies concentrate on early schooling
and better training after leaving school. Ensuring low class sizes would fill the gap by improving learning in secondary schools, too.
I turn to the Labour party's commitment. While the Government are letting class sizes rise inexorably, claiming that it does not matter, the Labour party is pledging as a manifesto commitment to bring class sizes down to 30 for five, six and seven-year-olds. That commitment is important and most welcome, but I consider it too cautious. It would not cover all primary or any secondary school pupils. Like my Labour party colleagues, I want to take forward the debate on better education. Much of the brouhaha over teaching methods is a smokescreen. That is not to say that such methods are unimportant--they are. However, they are also a cover-up for cost reduction. They are used to avoid consideration of the consequences of rising class sizes.
"average class sizes in primary schools are rapidly increasing."
Primary class sizes in England are now among the least favourable in OECD countries, and the gap is getting wider.
"pupils in small classes consistently out performed pupils in larger classes"
and that
"children from deprived backgrounds benefited the most from learning in this environment."
Mortimore and Blatchford concluded that smaller classes led to greater progress in reading and mathematics for eight-year-olds. They said that the results of smaller classes were "impressive and consistent". There appears to be particular advantage for pupils from ethnic minorities. In addition, the benefits are long-lasting.
"small class sizes are of benefit in the early years of primary education."
It added:
"pupils with special needs frequently make greater progress when they are taught in smaller classes."
Ofsted maintained that teaching methods were more important for attainment than class sizes, but Maurice Galton, writing in the Educational Review in the summer, made clear that the two are linked. He said:
"Challenging high levels of interaction, involving in particular challenging questioning and feedback, are crucial determinants of pupil progress."
High levels of interaction can be best achieved in smaller classes.
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