Order for consideration read.
To be considered on Thursday 5 December.
Considered ; to be read the Third time tomorrow.
1. Mr. Moss : To ask the Secretary of State for Health what has been the average annual increase in national health service capital spending since 1978-79 ; and what was the average increase between 1973-74 and 1978-79.
The Minister for Health (Mrs. Virginia Bottomley) : National health service capital spending has increased by an average of 4.3 per cent. a year in real terms since 1978-79, compared with an average real terms fall of 6.7 per cent. a year between 1973-74 and 1978-79.
Mr. Moss : I thank my hon. Friend for that reply. Will she confirm that that excellent national news is reflected in my constituency, which is served by three separate district health authorities which have invested more than £54 million in new hospital builds since 1979?
Mrs. Bottomley : Not only can I confirm my hon. Friend's figures, I can go further and tell him that an additional £115 million has been invested by the three health authorities that his patients use in Cambridge, Peterborough, and West Norfolk and Wisbech. That is a real and practical example of investing in the health service for the future and of serving patients.
Mrs. Bottomley : I cannot give the hon. Gentleman that figure at the moment, but it is essential that we use NHS buildings as effectively as we can. Investing in capital does not mean preserving units that are no longer needed. There were 30,000 tuberculosis beds in this country before the
Column 128war, but we do not need TB beds now ; we need day surgery and intensive care facilities, such as those that I opened yesterday when I visited a hospital in the constituency of the hon. Member for Peckham (Ms. Harman). That shows the side of the health service that the hon. Lady is not so keen to talk about--our investment in the future and our effective use of facilities and resources.
The Secretary of State for Health (Mr. William Waldegrave) : There were 752,422 people waiting for in-patient treatment in March 1979 and 692,946 in March 1991--a drop of 8 per cent. However it is the time that patients wait that matters. Latest provisional figures for in-patients and day cases for September 1991 show that in the past six months the number of patients waiting over a year fell by 7 per cent. and the number waiting over two years fell by 16 per cent. This builds on the record reductions achieved last year. Comparisons with 1979 can be made only for in-patients. On that basis the number waiting over 12 months is now 27 per cent. lower than in March 1979. Details have been placed in the Library.
Sir Fergus Montgomery : Does my right hon. Friend agree that those figures clearly show the progress that the Government are making? Will he confirm that in the north-west region the latest figures show a fall of 26 per cent. since last March in the number of patients having to wait more than a year? Are not those figures the best in the whole of England?
Mr. Waldegrave : It gives me pleasure to confirm that my hon. Friend's region has been the winner in the past six months, and that waits of more than one year have been reduced by 26 per cent. while waits of more than two years have been reduced by 37 per cent.
Mr. Gareth Wardell : Will the Secretary of State tell the House how many magnetic resonance imagers are available in England and Wales to provide essential diagnostic information, given that the town of Portland in Oregon has 14?
Dame Jill Knight : I thank my right hon. Friend on behalf of the west midlands, which is also high in the league table. The numbers waiting two years have fallen by some 31 per cent. in my area, and we are most grateful for that.
Mr. Waldegrave : I can confirm that my hon. Friend is right--over two-year waits in the west midlands are down by 31 per cent. and over one- year waits are down by 24 per cent. That shows the real progress that is being made on the waiting lists initiative and towards fulfilling our commitment to get rid of all over two-year waits by next year.
Column 129waiting list figures have not been higher than for every year under Labour? While he is dealing with waiting list figures, will he tell us more about the figures for day patients? Does he admit that the waiting list for day patients has shot up by 50 per cent? Does he also admit that for the first time in the history of the national health service, waiting lists for day patients and in-patients combined have risen above 900,000 people?
Mr. Waldegrave : The hon. Lady persists--I do not think that it is because she does not understand--in making the bogus comparison between in- patient and out-patient waits now and in 1979. I am proud that we have greatly increased the facilities for day-case treatment. That was right. Therefore, there are increasing numbers of people on the waiting lists for such treatment and they are being treated rapidly. I hope that she will welcome that--if she understands it, which I believe she does.
Mr. Brazier : Is not it sad to hear that until yesterday no representations had been made on the patients charter by NUPE and COHSE? Does he agree that it shows that the unions do not represent their ordinary members who, in hospitals such as the Kent and Canterbury hospital in my constituency, strive for every possible improvement in care of the patient?
Mr. Dorrell : My hon. Friend is to be congratulated. It is perhaps not entirely a coincidence that his question was due to be answered today and the representations from the two trade unions arrived in the Department yesterday. We know something about the views of Mr. Bickerstaffe because he gave a substantial interview to the New Statesman and Society recently. He did not mention the patients charter, but he gave us some other insights into his approach to the problems. He was asked :
"What are the likely expectations of your members with Labour in power?"
He answered :
"We hope the national minimum wage--currently £3.40 an hour for 40 hours before stoppages--will rise."
When asked what relationship there was between NUPE and Labour's leadership, Mr. Bickerstaffe said :
"I meet with the leader, with John Smith, Robin Cook, when necessary."
My hon. Friend might like to speculate about who decides when it is necessary.
Mr. Canavan : Will the Minister pay tribute to the distinguished record of COHSE and NUPE in providing excellent standards of patient care over many years? That dates back to long before the Government's so-called patients charter was ever dreamt of. Will the Minister respond positively to COHSE's request for a ministerial meeting to discuss certain aspects of the patients charter?
Mr. Dorrell : I will gladly give credit to the unstinting support that the staff of the national health service give to the principles of the NHS. Without it we could not possibly deliver the high quality of service that we do.
Column 130However, the role of COHSE, the trade union which sponsors the hon. Gentleman, in delivering that quality of care is, at best, marginal.
Mr. Sayeed : Does my hon. Friend agree that it is regrettable that the same unions that stopped the sick from getting to hospital in 1978 and 1979 are showing the same callous disregard--or at least their leaderships are doing so--for the needs of patients? Does he hope that Labour Members of Parliament who are sponsored by COHSE and NUPE will prevail on those unions to put the patients first?
Mr. Dorrell : Yes, I hope that the Labour party is anxious that reference to patients should be one of the priorities of the unions which claim to represent health service staff. In the same interview from which I quoted, Mr. Bickerstaffe went on to repeat the high priority that NUPE attaches to increasing the minimum wage--a proposal which the hon. Member for Livingston (Mr. Cook) has already said would cost the NHS between £400 million and £500 million.
"We would like to have argued"-- [Interruption.]
Mr. Campbell-Savours : The Minister is a hypocrite.
"We would like to have argued for a higher minimum wage, for example, but the party has said no, there are others--pensioners and so on.
Even in that context, Mr. Bickerstaffe does not mention patients.
"to receive health care on the basis of clinical need, regardless of ability to pay"
are being breached daily. The promises made have already been broken. Do not Conservative Members, the Secretary of State and his health team agree with the hon. Member for Birmingham, Edgbaston (Dame J. Knight), who said in a newspaper article that :
"All in all, it was, and is, wrong to breach the principle that a health check within the NHS should be free"?
The question that the Secretary of State must answer is-- [Interruption.]
Mrs. Heal : Conservative Members do not like to be reminded of what is going wrong. The Secretary of State has said that he wants a national health service that is well informed of people's needs and preferences. Does the Minister agree that people need and prefer a free eye test?
Column 131of ability to pay is common ground between both sides of the House. Any charge within the NHS requires a statutory authorisation. There are three important bases for such charges, and two of them were introduced by the Labour party.
4. Mr. Simon Coombs : To ask the Secretary of State for Health how many area health authorities now have (a) part-time and (b) full-time use of helicopters for air ambulance ; and what advice his Department gives to area health authorities on the desirability of these services.
Mr. Dorrell : Several ambulance services now use helicopters. It is the view of the regional ambulance officers' group that further development of air ambulances should await the outcome of the current evaluation of helicopter ambulances.
Mr. Coombs : I am sure that the research being undertaken will show that air ambulances are a useful contributor to paramedical facilities within health authorities. However, will my hon. Friend consider the impact on residents in areas close to the landing pads for helicopters providing such services? Will he also consider the difficulties being experienced by some of my constituents in Swindon, who have a helicopter landing pad only 20 yds away from their back fence? That has been provided because it does not require planning permission. No doubt it is to the benefit of patients, but it is by no means to the benefit of residents.
Mr. Dorrell : My hon. Friend raises an important matter. The local ambulance service in Wiltshire is to be congratulated on the innovative proposal that it has introduced--sharing the cost of a helicopter ambulance between the health authority and the police service. However, when a helicopter lands it can cause a disturbance to local residents. The health authority has recognised that and has sought an alternative and more convenient landing pad. Unfortunately, it did not get approval from the Civil Aviation Authority. I am sure that that issue is not dead and that the health authority will continue to look for more appropriate landing facilities.
Mr. Kennedy : Is the Minister aware of the broad welcome that has been given to the development of such a service in various parts of the country ? Is he further aware of the important contribution that it can make in large and more geographically remote areas, as it allows casualty access to larger regional hospitals in the event of mountaineering or road accident emergencies ?
Will the Minister examine how the system is working at the weekends ? I gather that in some areas, where facilities are usually available from Monday to Friday, the lack of weekend facilities is causing anxiety. That is especially true for travelling, mountaineering and similar accidents, when weekends may be times of maximum need.
Mr. Dorrell : The hon. Gentleman raises an important point. The patients charter sets out clearly the entitlement of a patient and the standard we seek to set for ambulance services. The charter does not specify 14 minutes in urban areas and 19 minutes in rural areas during weekdays ; it sets that standard for seven days a week, 365 days of the
Column 132year. It is the responsibility of the regional ambulance officer to deliver that standard to all the people living in his district.
Mr. Waldegrave : I know that many general practitioners who are not eligible to join the scheme recognise the benefits of fund holding and wish to take part. I hope to be able to open the scheme to more practices soon. At present, small practices may group together to become fund holders.
Mr. Knapman : My right hon. Friend is aware of the clear advantages to patients of fund-holding practices. That is being increasingly recognised, not only by doctors but by the British Medical Association and, possibly, by some Opposition Members. Does he appreciate the keen desire of many small practices to join these excellent schemes?
Mr. Waldegrave : My hon. Friend is right. There is a growing consensus about the success of the scheme, and that runs right across the general practitioners taking part in it. The hon. Member for Livingston (Mr. Cook) is not exactly clear about his policy on these issues. I hope that that unclarity means that he is moving towards us.
Mr. Loyden : Does the Secretary of State agree that there is a danger that the number of patients per doctor might have an effect on the eventual standard of treatment that patients receive? Is he carefully watching the changes that are taking place to ensure that the number of patients per doctor conforms with the ability to supply a good service?
Mr. Waldegrave : Yes, we are assessing the whole fund-holding scheme jointly with the general medical services committee, the relevant committee of the BMA. The hon. Gentleman might recall that one of our successes has been to bring down average list sizes markedly since Labour was in power.
Mr. Wolfson : Does my right hon. Friend agree that general practitioners, whether fund-holders or not, as a result of the new contract --which initially was often bitterly opposed--are now giving patients a much better service than they had in the past?
Mr. Waldegrave : My hon. Friend is right, and that is not just his opinion. A recent independent poll on exactly that matter showed that already, within the first year, a significant number of patients of general practitioners recognised that they were getting better services than a year previously. The level of opposition that existed when my predecessor brought in the contract will be shown by history to have been wildly overstated. It has been a success.
Mr. Rooker : In the context of smaller practices, I wish to raise with the right hon. Gentleman a subsidiary but related issue, that of the single-practice general practitioner. Does he believe that, even with massive commitment and dedication, it will be possible for the
Column 133large number of single-practice GPs in this country to measure up to the demands of the community care programme in 1993?
I cite as an example the urban areas of the city which I partially represent-- [Interruption.] I speak for all of Birmingham when I speak on this issue, and I am trying to raise an important matter in which there may be some common cause. There are 586 GPs in 270 practices, over a third of which are single practices. Even with their dedication and commitment, one must feel concern about their ability to measure up to the infrastructure needed for a viable community care programme.
Mr. Waldegrave : I respect the hon. Gentleman's commitment to those matters, and he is right to point to one of the problems. In recent years there has been a move to much bigger primary care teams, which has generally been welcomed. Many dedicated single-handed practitioners remain, and we must ensure that that option remains so that GPs are free to practise how they wish. One of the strengths of the fund-holding scheme is that general practitioners can group together to use the benefits of the scheme. Therefore, the scheme can provide some of the back-up for single- handed practitioners without their losing the independence that they rightly value.
6. Mr. Ian Bruce : To ask the Secretary of State for Health what is the percentage of gross domestic product spent on the national health service in 1991-92 ; what it will be in 1992-93 ; and what it was in 1978- 79.
Mr. Waldegrave : An estimated 5.6 per cent. of the United Kingdom's gross domestic product will be spent on the NHS this year, rising to 5.7 per cent. next year. In 1978-79, the NHS share of GDP was a full percentage point lower, at 4.7 per cent.
Mr. Bruce : Does my right hon. Friend agree that not only has the Conservative party demonstrated that it is willing to spend a greater proportion of gross national product, but, by continuing to expand our economy, we have surpassed the Labour party bid at the 1987 election--when it said that it would increase spending on the national health service by 3 per cent.--by about a third?
Mr. Waldegrave : It is important to note that if the pledge that the Labour party made at the last election had been carried through, dramatically less money would have been spent on health, for the reasons that my hon. Friend gave. That achievement represents a larger share of a larger national product and the Conservative party can be extremely proud of it.
Mr. Nellist : Has the Secretary of State seen the item in The Independent yesterday about NHS spending on opted-out hospitals? It refers to a paper called "Personnel Policy and Practice", which advises the managers of all opted-out hospitals to sack renegades and subversives. They are defined as all those who do not share the values and goals of opt-outs. At Coventry's Walsgrave hospital, in virtually every ballot that was held, 80 to 90 per cent. of all doctors, nurses and health workers voted against opt-out. If they are all sacked, who will run the health service?
Mr. Waldegrave : The hon. Gentleman actually threatened some of the staff in that hospital for carrying out Government policy. He was forced by the Leader of the Opposition to withdraw that threat, so he should be a little careful. He referred to an old paper that is regularly recycled by one of the unions. It is a little out of date. I direct the hon. Gentleman to the leader on the matter in the same newspaper today.
Mr. Nicholas Winterton : Will my right hon. Friend consider that, although statistics are helpful, the important thing about the health service is the quality of care, and the outcome of the treatments that are given? It is important, especially in my area, to accept that Mersey has achieved dramatic reductions in health service waiting lists, for which Sir Donald Wilson should be given credit in Mersey and Mr. Peter Hayes for the part that he has played in Macclesfield. However, the quality of the service for the amount of money allocated and the outcome of the treatment are critical for the people of this country.
Mr. Waldegrave : I strongly agree with my hon. Friend and I join him in paying tribute to the management of the health service in his part of the country. We are taking on Mr. McKeever from Crewe to help us with new waiting list initiatives in the Mersey region, and we are giving him £2 million to deal with some of the longer lists. We should be most proud that, despite the fact that our health service spends less wastefully than those in some other countries, our figures on, for example, perinatal mortality are better or just as good.
Mr. Salmond : Can the Minister confirm that health boards have been issued with new instructions, both written and by meetings, to be responsive to the needs of private contractors ? Is there any chance of the Government issuing similar instructions to ask health boards to be responsive to the needs of health service workers ? How can a Government who claim to defend the national health service pursue that claim when the hidden agenda behind so many of the changes is to break the morale, commitment and solidarity of people who work in the health service ? How can a Government at war with health service workers claim to be defending the NHS ?
Mr. Dorrell : The hon. Gentleman does not need to rely on my words to rebut every word that he has just said ; he need only read the latest edition of the in-house magazine of the Confederation of Health Service Employees, where it is written :
"The Mid-Glamorgan District Linen Service is efficient because it has no choice. In 1987, the service had to compete for the hospital's laundry contract for the first time and in 1993, it will have to submit another tender."
The article quotes Mr. Jeff Chard, a former COHSE shop steward, as saying :
Column 135"At the moment, I have to use hospital staff like engineers to service the machines and do repairs. But eventually I'll be able to go to anyone I like if he's cheaper I'll have to get Dai Jones the carpenter from down the road instead." He went on
Hon. Members : Boring !
The article continues :
"Competitive tendering was forced on to us and it's put a tremendous pressure on everyone. But it has made us more productive and more of a team --we all have to co-operate and pull together just to keep our heads above water."
Mrs. Currie : Is not the key to good service in the health service, good management? Would not the worst thing that could possibly happen for any of our constituents or patients be for the Labour party to come to power and abolish competitive tendering? That would not only cost a great deal of money, but put power once again into the hands of the National Union of Public Employees and the Confederation of Health Service Employees, which could then decide how hospitals were to be run.
Mr. Dorrell : My hon. Friend is precisely right. The compulsory competitive tendering programme has already saved the health service £630 million in England and £85 million in Scotland--enough to complete 225,000 hip replacements. The repeating saving on an annual basis is £156 million, which is used to increase patient care. It is that figure that the Labour party is committed to cut.
Mr. Robin Cook : Does the Under-Secretary of State ever ask in relation to competitive tendering about the price patients have to pay in poorer food and dirtier hospitals? Does he not know that one in five of private contracts has ended in failure? Is he aware that the National Childbirth Trust recommends that mothers in maternity wards should clean the baths? Is he aware of the concern expressed by the Mental Welfare Commission for Scotland about the poor food supplied by a private contractor in my constituency? Does the right to a clean hospital or decent food figure anywhere in his patients charter, or does cutting costs always come first with the Government?
Mr. Dorrell : Perhaps not surprisingly, the hon. Gentleman's question is a straight paraphrase from publications issued by COHSE and NUPE. The hon. Gentleman must answer this question : how can he argue that it is in patients' interests to move away from a system of competitive tendering and use that money to pay trade union members rather than to pay for extra treatment for patients?
Mr. Gregory : Will my hon. Friend confirm that savings in ancillary services such as catering, cleaning and laundry go to benefit patients directly, not to the paymasters of the Labour party, COHSE and NUPE?