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Lord McIntosh of Haringey: My Lords, I am grateful to my noble friend for his first question. In answer to his second question, the search for savings will include fundholding general practice. There are certainly savings which can be made. In the first place, savings will be gained from having a common waiting list based on clinical need rather than where a patient comes from. Secondly, management allowances to fundholding GPs amount to £150 million per year. Much of that work, for example on patient invoices, will be taken over by our locality commissioning groups. We shall therefore seek significant savings in management allowances.

Lord Molloy: My Lords, will my noble friend consider the possibility of discussing this important subject with representatives of the NHS staff associations?

Lord McIntosh of Haringey: My Lords, the National Health Service Efficiency Task Force which has been set up consists of employees of the National Health Service; in other words, it comprises professionals not politicians. I am quite sure that it is holding discussions with the National Health Service staff associations and unions.

The Countess of Mar: My Lords, will the new arrangements involve getting rid of the system of extra-contractual referrals, which has been contentious?

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In many cases bureaucrats have interfered with clinical decisions made by doctors as to where a patient should be treated.

Lord McIntosh of Haringey: My Lords, that question concerns administration rather than savings and it is somewhat wide of the Question on the Order Paper. However, as I said, common waiting lists operating on the basis of clinical need rather than where patients come from will also affect where patients are sent for treatment.

Earl Howe: My Lords, following what the Minister said about the internal market within the NHS, can he say a little more about which elements of the internal market the Government intend to dispense with and whether they intend to abolish or retain the purchaser/provider split?

Lord McIntosh of Haringey: My Lords, we are at an early stage of the first year of the review which is being carried out by the National Health Service Efficiency Task Force but already we have identified a considerable number of savings. For example, £20 million has been saved by deferring the eighth wave of GP fundholding. As regards the wider issue of the purchaser/provider split, as the noble Earl knows we are preparing a White Paper on all of these issues and that will certainly be an important element of that.

Earl Russell: My Lords, does the treatment of the millennium bug in the NHS computer system count as bureaucracy within the meaning of this Question? Will the Minister confirm that he will not attempt to pay for the treatment of that bug by making savings elsewhere in the NHS?

Lord McIntosh of Haringey: My Lords, a number of estimates are circulating about the cost of management in the National Health Service. The department reckons that the figure is about £1.7 billion and the National Health Service Consultants' Association reckons it is about £1.5 billion. Inevitably, part of those management costs arises from processes which are essential for patient care. Effective information technology systems--I stress the word "effective" in view of some of the disasters that have occurred--clearly must be considered as contributing to patient care.

Lord Campbell of Alloway: My Lords, does the noble Lord accept that nurses serve in the front line and that any benefits that are achieved might involve their receiving some recompense for their services?

Lord McIntosh of Haringey: My Lords, I am the first to acknowledge that nurses are in the front line of patient care. It is true that the reclassification of some nurses into managerial posts, reflecting the proportion of their duties spent on managerial tasks, is one of the

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problems that we have inherited. We would like to see nurses spending as much of their time as possible on patient care rather than filling in forms.

Lord Avebury: My Lords, further to the final part of the Minister's reply, is he aware that every time a patient attends hospital he or she is asked the same questions repetitively; for example, his or her name and address, or whether he or she suffers from diabetes or epilepsy? Is it not within the resources of the National Health Service to have a database of patients who regularly attend so that these time-wasting questions can be dispensed with?

Lord McIntosh of Haringey: My Lords, that is a very sensible question, but one which I am not qualified to answer. I believe it relates to the question from the noble Earl, Lord Russell, who stressed the importance of effective information technology systems.

Nuclear Materials: Carriage by Air

3.40 p.m.

Lord Beaumont of Whitley asked Her Majesty's Government:

    Whether extremely radioactive material is transported by the RAF by air from Brize Norton to the United States and what steps have been taken to protect the public in the event of a crash occurring over land.

Lord Hoyle: My Lords, the Ministry of Defence does transport special nuclear materials by air to the United States under the provisions of the 1958 UK/US agreement for co-operation on the uses of atomic energy for mutual defence purposes. Special and stringent safety arrangements exist for the transportation of this material, and well-rehearsed contingency plans would be activated in the unlikely event of an accident over land.

Lord Beaumont of Whitley: My Lords, I thank the Minister for that Answer. Is it true that the material concerned is carried in containers able to withstand a crash of 30 feet at 30 miles per hour, whereas the aeroplanes fly at over 30,000 feet and at over 500 miles per hour? Is the Minister certain that the packaging and arrangements for transporting this material conform to realistic safety standards?

Lord Hoyle: My Lords, the material is carried in specialised containers. The noble Lord is right: the containers are designed and tested against accidental environments; they are tested against specifications laid down by the International Atomic Energy Authority.

The noble Lord asked whether I believe the containers are safe. Such flights have taken place for over 40 years. We have never had a transportation accident that has posed any radiation hazard to the public during the whole of that time. We maintain a nuclear accident response capability and forces who are prepared and well trained to respond to any defence nuclear accident.

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They work with the local authorities concerned. In addition, exercises routinely take place. I assure the noble Lord that there is no complacency in relation to this matter.

Lord Jenkins of Putney: My Lords, does my noble friend agree that this particular flight is a small matter compared with the constant over-flying of highly dangerous radioactive material brought to the United Kingdom from many other countries for reprocessing purposes? I have discovered that there is a feeling that unnecessary over-flying of populated areas takes place. Will my noble friend look into the matter to see whether the fears that I have come across for many years are justified? Does he agree that if over-flying of populated areas by planes carrying dangerous cargoes can be avoided it should be avoided?

Lord Hoyle: My Lords, I agree with my noble friend. Both in relation to the special nuclear materials I outlined and in relation to flights carrying nuclear waste for civil purposes, we stipulate the avoidance of population centres wherever possible. The stringent safety arrangements that I outlined for special nuclear materials apply equally to the loads to which my noble friend referred.

The Single Currency

3.45 p.m.

The Earl of Northesk asked Her Majesty's Government:

    Whether they will clarify their policy towards the single European currency.

Lord McIntosh of Haringey: My Lords, I am tempted to refer the noble Earl to the answer given to the same question asked by the noble Lord, Lord Mackay of Ardbrecknish, yesterday afternoon. However, the Chancellor of the Exchequer will make a Statement in the House of Commons, when it reconvenes, setting out the Government's position on the single currency and UK membership in 1999.

The Earl of Northesk: My Lords, I thank the noble Lord for a rather unedifying reply. Given the confusion in recent weeks do the Government now endorse the view expressed from within their own ranks that, in terms of presentation of policy in the media, "You have to be economical with the truth sometimes"?

Lord McIntosh of Haringey: My Lords, if the noble Earl is quoting from the noble Lord, Lord Armstrong of Ilminster, I can only say that that was some time ago. I advise the noble Earl to concentrate on what the Chancellor actually said rather than on press speculation.

Baroness Williams of Crosby: My Lords, will the Minister recognise that considerable damage has been done to the very worthy aspiration of this Government

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to play a leading role in Europe? Will the noble Lord assure us that the Chancellor of the Exchequer, when he addresses the matter in another place next week, will indicate how he intends to deal with the issues of the probable premium on interest rates and the exposure of the pound to speculative pressures that are bound to flow from a decision to delay entry?

Finally, will the noble Lord assure the House that the Chancellor will make absolutely plain the standing of the statement so widely circulated that there is no possibility of the Government considering entering monetary union before the end of this Parliament-- a statement which I hope can be attributed to spin doctors and not to the Government?

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