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House of Commons

Tuesday 1 February 2000

The House met at half-past Two o'clock


[Madam Speaker in the Chair]


Baxi Partnership Limited Trusts Bill [Lords]

Read the Third time, and passed, without amendment.

Greenham and Crookham Commons Bill

Order for Second Reading read.

To be read a Second time on Tuesday 8 February.

Mersey Tunnels Bill

Order for Second Reading read.

To be read a Second time on Thursday.

Oral Answers to Questions


The Secretary of State was asked--

Nursing Homes

1. Mr. Michael Colvin (Romsey): What is his estimate of the percentages of costs of the nursing element in nursing homes paid by (a) the national health service, (b) local authority social services departments and (c) patients. [106238]

The Minister of State, Department of Health (Mr. John Hutton): About 147,000 people are resident in nursing homes in England. About 9 per cent. are funded by the national health service, about 49 per cent. wholly or partly by local authorities, about 17 per cent. have their care funded from state benefits and about 25 per cent. pay for their own care.

Mr. Colvin: I thank the Minister for his helpful reply. However, as we all know from our constituency casework, once it has been decided that a resident patient is entitled to state aid, the patient tends to become caught in crossfire between the NHS and local authority social services departments over who should pay how much of the nursing element. To avoid all that haggling, should we not lay down in statute what the breakdown should be? Will the Minister consider that?

Mr. Hutton: My right hon. Friend the Secretary of State set out the Government's position in December, and explained that we intended to respond more fully to the royal commission's recommendations. In March, we will

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organise a seminar involving all the key organisations and individuals who have a view, so that they can discuss with the Department issues involving the definition of nursing care in this context.

I agree with the hon. Gentleman--as, I think, do all right hon. and hon. Members--that the present system of funding long-term residential care is not acceptable or fair; but it is only reasonable for me to point out to him and his colleagues that they created the system.

NHS (Pay)

2. Mr. Ernie Ross (Dundee, West): What steps he is taking to reform the pay system in the NHS. [106239]

The Secretary of State for Health (Mr. Alan Milburn): We are negotiating with the NHS trade unions on a new pay system for the health service. In the meantime, we have offered non-review body staff an innovative three-year pay package, and we are implementing the recommendations from the doctors' and dentists' review body and the nurses' review body in full.

Mr. Ross: Does my right hon. Friend agree that the joint statement published by the health departments, management, the unions and NHS staff-side organisations offers a way forward for the NHS after at least 18 years of attack from the last Government? Does he further agree, however, that the real tests of the proposals are whether they are an improvement on what we have now, whether they are easy to understand, whether they are easy to implement, whether they are fair to all staff groups and whether they deliver a genuinely improved service to patients?

Does my hon. Friend also agree that the proposals give all who are concerned with the health service an opportunity to move forward in a true spirit of partnership?

Mr. Milburn: I certainly agree with my hon. Friend's sentiments. He is right in saying that too many of the employment and, indeed, pay structures of the NHS date back to its inception in 1948. Today's world is very different: different requirements are placed on the health service, and on NHS staff. It is important for us to combine fairness with flexibility in the way in which we employ doctors, nurses and other health care professionals, and that is precisely what our negotiations for a new pay system are designed to achieve.

Mr. Nick Harvey (North Devon): Given last week's report on NHS laboratories, which revealed that 60 per cent. were using unqualified staff, and given yesterday's news that two leukaemia patients in Wales had received each other's test results, what steps is the Secretary of State taking to address the problems and to reassure patients? Will he ensure that biomedical scientists are given a substantial pay increase, and bring them and all other professional and technical staff in the NHS under the remit of the review body? If he does that, will he address the fact that such staff have fallen 30 per cent.

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behind the recommendations of the review body since it was formed, and will he submit evaluations to bring them up to a sensible level at the outset?

Mr. Milburn: As the hon. Gentleman knows, part of the negotiation on the new pay system is designed to reconfigure the coverage of review bodies. Some have argued, I think reasonably, that the groups covered by the two review bodies do not necessarily reflect the fact that team working is now crucial to a modern national health service. We are considering that, and are negotiating with the NHS trade unions to establish a common position. I think it far better to achieve results through partnership and agreement.

Extra money has been targeted at groups of staff such as medical laboratory scientific officers and cytology screeners who are not covered by the review bodies, where there was evidence of recruitment problems leading to a deterioration in services to patients. The high offers made to those staff for 1999-2000 still stand.

Mr. Phil Sawford (Kettering): Is my right hon. Friend aware that, partly owing to the recent pay settlement in the NHS, the Northamptonshire health authority currently projects a deficit of £8.7 million for next year? I know that Northamptonshire has received a great deal more money, but the chair of the health authority is due to retire in April, and the chief executive will shortly move to another post. We face the prospect in Northamptonshire of having no chief executive, no chair and no money. Will my right hon. Friend look into that serious matter, which is of great concern to my constituents?

Mr. Milburn: I do not know about the position as regards the chair of Northamptonshire health authority, or, indeed, the chief executive. Clearly, those are matters that we will have to address. On the question of there being no money, I am slightly surprised by my hon. Friend's view as Northamptonshire health authority and other health authorities have received a substantial growth in the amount of money that they will have for the next financial year, compared with the current financial year.

Mrs. Caroline Spelman (Meriden): Does the Secretary of State accept that not only is the 3.6 per cent. increase in nurses' pay well below average wage increases of 4.6 per cent. in the economy as a whole, but that the Government's failure to fund it fully amounts to giving with one hand and taking with the other?

Mr. Milburn: I do not agree with that view. That view will come as a great surprise to nurses and doctors in the NHS, who, year after year, suffered from their pay being staged, rather than being paid in full.

Mr. Gordon Prentice (Pendle): May I ask a question about the pay of dentists? Why is it that the review body that reported a couple of weeks ago found it impossible to compute the average earnings of dentists who are employed wholly or mainly on NHS work because, it said, the necessary information was not forthcoming from my right hon. Friend's Department, or from the British Dental Association? Will he give me an assurance that next year,

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when we get the next report from the pay review bodies, it will be possible for them to compute the average earnings of NHS dentists?

Mr. Milburn: We do have some figures available, as I think my hon. Friend is aware. He takes a great interest in dentists' salaries. We have some figures about the average earnings of dentists who have a reasonable commitment to the NHS. Those figures are widely available. As he is also aware, this year the Doctors and Dentists Remuneration Review Body recommended that we pay a further £20 million to dentists who have demonstrated a real commitment to the NHS. We will, of course, discuss with the profession how best to achieve that.

Cleft Lip and Palate Units

3. Mr. Robert Syms (Poole): If he will make a statement on the implementation of the review of cleft lip and palate units. [106240]

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): Designated centres have so far been identified in three regions and discussions are continuing to identify the remaining centres.

Mr. Syms: Today, there has been a luncheon for charter mark winners, one of which is the Poole cleft lip and palate unit. As the Minister wrote to me just before Christmas:

Apart from the inconvenient fact that the Government are trying to close the unit, does she not understand the real concern about the clinical standards advisory group proposals, and the concern that there seems to be no clear guidance about what is happening on implementation? If she cannot give me an answer today, will she please write to me and tell me when decisions will be made?

Ms Stuart: Charter mark awards are made in recognition of public services. Discussions on the reconfiguration of Poole's provisions for cleft lip and palate are about clinical decisions. I have said that three areas have been identified for Poole and the whole of the south-east, including London. The four health authorities are still forming a stakeholder group. Reports are expected at the end of February, but it is important to recognise that although, nationally, some 865 newly born children need such surgery, in Dorset health authority alone, only 10 will need it. All the recommendations from CSAG say that, to deliver the best service, surgeons should deal with about 30 cases a year.

Mr. Tony Clarke (Northampton, South): My hon. Friend will be pleased to know that, although we might not have a chief executive or chair of the health authority, we have an excellent consultant in our cleft lip and palate unit at Northampton general hospital, but will she expand her answer to include the future for those that carry out the Delaire technique, such as Bill Smith, who works at the hospital? Parents are concerned that, with the forthcoming changes, that pioneering technique--which concentrates on natural growth and surgery rather than

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plastic surgery--could be phased out. Will she give some hope to those parents that the Government will continue to allow the Delaire technique, and that, where it is being practised, it will continue to flourish?

Ms Stuart: Different orthodontic and cleft palate surgeons use different techniques. Once the overall national reconfiguration system has been implemented, the posts will be advertised, and it will then be a matter of which types of surgeon are able to provide continuity. No decisions have been made on which techniques will be continued, but the decisions will be based on clinical considerations and on what is best for the treatment of those children.

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