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10.15 am

Dr. George Turner (North-West Norfolk): Most of us will go back to our constituencies with a lot of good news to relate; the Chancellor's spending review has made sure of that. As we look to what it will mean locally to health and education and in terms of addressing the problems of crime, many of us will be in good heart that it is time to deliver.

However, I thought that it was important to be here today to raise the concerns of one group from my constituency--the large number of pensioners. I understand the technicalities of the spending review, which addressed departmental budgets and not the totality of Government expenditure, the rest of which is addressed in the Budget. However, pensioners do not understand that, although the Chancellor went out of his way to make it clear that he would be doing more work over the summer and would make announcements in the autumn.

The Government must bear in mind the disappointment there has been among many pensioners, despite the good start that the Government have made in addressing the problems that they inherited. My pensioners entirely recognise the roots of the problems. The very fact that for so many years, their campaign has been to restore the link between pensions and earnings--taken away at the outset of the Tories' period in power--shows that they know who was to blame for the problems that they face and the poverty that many have had to endure for far too long.

I represent a wide range of income groups among pensioners. My constituency is an attractive part of the country; the north Norfolk coast has a unique appeal. It is a designated area of natural beauty and protection, and has many sites of special scientific interest. It is an attractive area to live in, and many come there to retire. Some are well off, and many did very well under the last Government. A fairly typical figure nationally is that one in three saw their incomes rise more than those in work during those years.

To their credit, a fair number of those joined in the campaigning for others. Some are well known; Moss Evans comes to mind. In his retirement, he has been among the leaders in my area in the campaign for poorer pensioners. Certainly, at least a third are impoverished. Many pensioners retire to park homes. They have modest capital and have bought cheap homes for their retirement, in some cases having sold a house elsewhere, in the hope that they might use some of the capital to see them

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through their latter years. They are among those who have been thrifty in the past, with an eye to the future. They have a little capital and believe that, as the Government reverse the economic position of so many others in the nation, they deserve help and recognition for what they had to endure for 18 years.

In the middle group are many pensioners who worked for the state. I have very active branches of Post Office and British Telecommunications pensioners. They are typical of a group of people who have modest pensions from various sources. They are not rich and they have not had an easy time.

The Government have done much to address the needs of the poorest pensioners in my constituency. Many thousands have benefited from the minimum income guarantee. It is widely appreciated that the Government have done much good for pensioners across the board. The introduction of and the large increase in the winter fuel allowance were greatly welcomed. There was a huge response to the reintroduction of free eye tests. In Norfolk, there was a 90 per cent. increase in the uptake of national health eye tests--a dramatic increase which suggests that many pensioners had been suffering from poor eyesight, following the imposition of charges by the previous Government.

All these forms of assistance have been welcomed, but when pensioners hear announcements such as those that have been made over the past week or two concerning the future of the health service, education, the police and other public services, they feel that more needs to be done for them. That is the message that I bring to the House.

If I am to do my job of representing pensioners, I must pass on what they tell me. They tell me that what they want, and what they have been arguing for for many years, is the restoration of the link. I have explained to them that Government policy has been more targeted than that, but pensioners do not want to hear that message. However, reasonable folk that they are, they have sat down with me and discussed alternatives and priorities for which local pensioners groups seek support.

I have some extremely active groups--the King's Lynn and District pensioners group, the Post Office and BT groups to which I referred, and the North-West Norfolk pensioners group. I have many meetings and exchanges of correspondence with them. Among the most assiduous campaigners is Mr. Roland Worth, who is involved in at least two of those organisations, and Mr. and Mrs. Martin, from the King's Lynn and District group.

It is clear that pensioners understand the need to help those in most need first, but when the Chancellor introduces his proposals for the pensioners credit, they want it to be targeted not only at the poorest, but at those who, through their own thrift or because of their modest pensions, are only a little better off than those who have been helped so far.

I hope that, during the lifetime of this Parliament, we deliver on the promise that we made at the last election that we would ensure that pensioners shared in the economic prosperity that the Government brought the nation. We must therefore make sure that the scale of the help is in proportion to the benefits that we deliver to other parts of the economy. Pensioners must be seen to receive their fair share of the benefits.

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There remains a concern among many pensioners that more should be done for older pensioners. In answers to written questions, I have been told that a £5 increase in the basic pension at age 75 would cost £700 million net, and that a £10 increase at 80 would cost £700 million. Those are large sums of money, but not in comparison with the sums that have been discussed in the House in recent weeks.

Despite the extra help that we have given through the free television licence, many of my constituents would welcome some cash as well, especially as that age group includes not only some of the poorest pensioners, but, I suspect, a larger proportion of those who fail to take up their entitlement under the minimum income guarantee. There is a good case for targeting older pensioners.

I hope that the Chancellor will bear in mind a further factor. I believe that the Government have a healthy lifetime ahead, and I am confident of the outcome of the next election, but it would be a foolish parliamentarian who did not want to make sure that pensioners' well-being did not depend on which party happened to be in government.

At the first opportunity, the previous Conservative Government undid what the preceding Labour Government had started to do a relatively short time before to safeguard the interests of pensioners. We must ensure that the measures that we introduce are protected, as far as that is feasible, against future changes in political control. There must therefore be as wide a consensus as possible on the ways in which we act to help the pensioner population. That must be tightly tied into law, so that it will not be easy for a future Government of a different hue to change it.

We must ensure that the changes that we have introduced in the pension regime for those in work will survive and be difficult to overturn. We must also ensure that when, as I hope, pensioners receive a boost this autumn, the Conservatives would find it politically difficult, if not impossible, to undo it if they gained power in the future. I hope that my hon. Friend the Parliamentary Secretary will assure me today that work is going ahead at full speed in Whitehall to make sure that the announcement this autumn will meet the needs of the many pensioners for whom I speak.

10.28 am

Mr. John Horam (Orpington): I wish to raise a topic that, at present, is of concern only to my constituents and the residents of the borough of Bromley, but which, in due course, will concern all hon. Members--that is, the proposed merging of health authorities throughout the country. I refer specifically to the proposed merger of the Bromley health authority with the neighbouring Bexley and Greenwich health authority. The consultation on the proposed merger has been launched and will be concluded before Parliament returns in October, which is the reason why I raise the issue before the recess.

The proposed merger in my area is a guinea pig, or a stalking horse, to allow the Government to work out the consequences for a merged authority, before rolling out a programme of mergers across the country. It is intended that the merger will take place in April 2001, to be followed by a series of mergers, possibly a year later.

The proposed mergers are necessitated by a change in the role of the health authorities following the creation of primary care groups, and in particular, primary care trusts,

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which are taking more of the burden of allocating the moneys that they receive from the Government. Therefore, there is a reduced role for the health authority. Obviously, that has been a matter of controversy between the two major parties. We thought that it was not sensible to make a further bureaucratic change. We supported the old system. Bromley health authority was happily contiguous with the Bromley local authority, and, therefore, there was a good relationship between the two. Beneath that level there were GPs and fundholding GPs.

The Government, however, have made the change, and I do not wish to argue about that now. I do not wish to contest the principle behind merging health authorities in the way that the Government intend to do. If they merge them properly and sensibly, there may be savings in bureaucracy. However, I am concerned--I know that my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) and my hon. Friend the Member for Beckenham (Mrs. Lait) are also worried--about the effect on the funding of health care in Bromley as a consequence of the proposed measures. It seems to us that the effect will be unequivocally bad. No doubt the Minister is delighted that my right hon. Friend is not present to make the point in his inimitable way.

That follows from what is called the pace-of-change policy, which has been put forward by the Department of Health. At present, every health authority receives a target allocation that is based on its needs. For historic reasons, some health authorities have an allocation above their target. Some allocations are lower and some are equal. If there is an historic allocation above an authority's target, it will receive less than it otherwise would, so that ultimately there is convergence on target allocations. Bromley is on its target whereas Bexley and Greenwich is above it. Therefore, Bexley and Greenwich receives less each year than Bromley.

A combined health authority would come into the above target category. It would then receive less than the two separate authorities. The Library has calculated that this year, for example, Bromley and Bexley and Greenwich combined would receive £700,000 less than the two separate authorities would receive. Bromley health authority more or less concurs with that figure. It says that there would be a difference of £800,000. That will not happen only this year. As the pace-of-change policy will be unrolled over several years, millions of pounds will be lost to the funding of health care in the area that I represent.

The point was made clearly--perhaps more succinctly than I am making it--in an article in The Health Service Journal. It says:

That is the problem. In addition, the Bromley health authority has underspent over the past two or three years by a total of £3.7 million. Underspending on health may amaze some of our constituents, but underspending is a common problem throughout government. It affects

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health as much as anything else. We should all be concerned about the famine-and-feast approach to public spending that the Government have adopted. It is quite difficult suddenly to step up spending, even when funds are available. For all sorts of reasons relating to contractual obligations, it is sometimes not possible to spend the money in the appropriate period.

For whatever reason, the Bromley health authority has accumulated funds. It seems to me, and to those who are in charge of these matters locally, that the region is, in effect, using these funds as a sanction to persuade the health authority to go along with the plans. In other words, they are saying, "You cannot spend this money, even though it is your money, unless you agree to our plans for the health authority." When the merger takes place, there will suddenly be an announcement of an extra £3.7 million for Bromley. That will be its own money, which it should have had anyway. That seems to be a rather dubious way of proceeding.

There is no doubt that the money is urgently needed in Bromley. For example, the accident and emergency department has come under much criticism recently. We could spend money now, and certainly over the next 12 months, on improving conditions in that area. Despite the heroic efforts of staff, there are long trolley waits and other great difficulties. That is another problem which I should like the Government to consider.

In considering the merger of health authorities, there is the problem of the deficit that is attached to any particular hospital or NHS trust. Bromley has been cautious and does not have a deficit. It has hardly ever had one. However, neighbouring hospitals--for example, Queen Mary's and Greenwich health care trusts--have had deficits and in some instances still do. There is concern in Bromley, which has been careful, that money will suddenly be taken away from it and poured into dealing with the deficits of neighbouring hospitals. That could easily happen if there were no rule to prevent it.

I have no quarrel with the principle behind merging and, in a broad sense, I wish it well, but I seek an assurance that, following the consultation that will take place, Bromley will not be financially disadvantaged by any merger that takes place. If that assurance can be given, many of us would wish the merger to proceed. Until the assurance is given, my colleagues and I will be opposing the merger.

It is in the Government's interests that the matter is handled sensitively and well. As I have said, it is effectively a blueprint for other mergers that will be unrolled throughout the country. If the merger between Bromley and Bexley and Greenwich goes wrong, suspicions will be aroused among Members who are concerned about health funding in the areas that they represent.

While I am on my feet, may I raise another matter? As we all know, palliative care has come about because of huge voluntary efforts by many people throughout the country. The charitable work that has gone into the hospice care movement cannot be praised too much. I know from my own experience that South Bromley Hospice Care has been excellent in raising money over the years. Many people have made a huge effort, for which they should be praised. As it happens, little money comes to hospice care facilities from government.

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Only 21 per cent. of the money that comes to South Bromley Hospice Care comes from government. The rest comes from charitable fundraising.

As we all know, the demand for hospice care facilities and palliative facilities is rising almost exponentially. We know that hospices help to some extent to take the burden off local hospitals by providing for facilities to enable people to remain at home and receive appropriate care. Those are people who otherwise might have to go into hospital. It is a vital but underfunded part of the health care system.

However, South Bromley Hospice Care, like other such organisations, has run into charitable fatigue, as it were. Along with other good causes, it has had difficulties and funding problems. As a result, it has had to lay off staff and cut its provision of facilities. That has had a repercussive effect on the local hospital. There is a plan, which originates from the health authority, to increase funding from 21 to 50 per cent. over a five-year period. However, in the short term, there has been no help. I have corresponded about that with the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper). She recognises the problem because, in recent letter to me, she said:

A more comprehensive strategy certainly needed, but so is more immediate help for hospice care. In my case, South Bromley Hospice Care, which has laboured with great success, now finds itself in difficulty for those obvious reasons.

St. Christopher's--a well-known hospice care organisation--has benefited from Government help. It is ironic that it has received help, given that it had a much deeper crisis, involving much more money, whereas the hospice in my area has not. Obviously, I wish St. Christopher's well and do not want to cavil about its help, but those who have laboured hard and been successful should not be penalised because of those who have not done quite so well. The NHS report, which we received yesterday, states:

I hope that the Government will take that on board in relation to South Bromley Hospice Care.

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