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House of Commons

Tuesday 26 October 1993

The House met at half-past Two o'clock

PRAYERS

[ Madam Speaker-- in the Chair ]

PRIVATE BUSINESS

Standing Orders (Private Business)

Ordered,

That the Amendments to Standing Orders relating Private Business set out in the Schedule be made.

Schedule

Standing Order 27

line 14, leave out in duplicate'.

line 18, leave out in duplicate'.

line 64, leave out paragraph (5).

Standing Order 39.

line 10, leave out Energy' and insert National Heritage'. Standing Order 191

line 9, leave out community charge' and insert council tax'.-- [The Chairman of Ways and Means.]

British Railways (No. 4) Bill

Motion made, and Question proposed,

That the Promoters of the British Railways (No. 4) Bill shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ;

That, on the fifth day on which the House sits in the next Session, the Bill shall be presented to the House ;

That there shall be deposited with the Bill a declaration signed by the Agents for the Bill, stating that the Bill is the same, in every respect, as the Bill at the last stage of its proceedings in this House in the present Session ;

That the Bill shall be laid upon the Table of the House by one of the Clerks in the Private Bill Office on the next meeting of the House after the day on which the Bill has been presented and, when so laid, shall be read the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;

That since no Petitions remain against the Bill no Petitioners shall be heard before any committee on the Bill save those who complain of any amendment as proposed in the filled up Bill or of any matter which arises during the progress of the Bill before the Committee ;

That no further fees shall be charged in respect of any proceedings on the Bill in respect of which fees have already been incurred during the present Session ;

That these Orders by Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

British Waterways Bill [Lords]

Motion made, and Question proposed.

That the Promoters of the British Waterways Bill [Lords] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the


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close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ;

That, if the Bill is brought from the Lords in the next Session, the Agent for the Bill shall deposit in the Private Bill Office a declaration signed by him, stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the present Session ;

That, as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been so deposited, has been laid upon the Table of the House, the Bill shall be read the first and second time and committed (and shall be recorded in the Journal of the House as having been so read and committed) ;

That all Petitions relating to the Bill presented in the present Session which stand referred to the Committee on the Bill, together with any minutes of evidence taken before the Committee on the Bill, shall stand referred to the Committee on the Bill in the next Session ;

That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

That, in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against Bill)" were omitted ;

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

Croydon Tramlink Bill

[Lords]

Motion made, and Question proposed,

That the Promoters of the Croydon Tramlink Bill [Lords] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ; That, if the Bill is brought from the Lords in the next Session, the Agent for the Bill shall deposit in the Private Bill Office a declaration signed by him, stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the present Session ;

That, as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been so deposited, has been laid upon the Table of the House, the Bill shall be read the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;

That all Petitions relating to the Bill presented in the present Session which stand referred to the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session ; That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

That, in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against Bill)" were omitted ;

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

Letchworth Garden City Heritage Foundation Bill

Motion made, and Question proposed,

That the Promoters of the Letchworth Garden City Heritage Foundation Bill shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day


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before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ;

That on the fifth day on which the House sits in the next Session the Bill shall be presented to the House ;

That there shall be deposited with the Bill a declaration signed by the Agents for the Bill, stating that the Bill is the same, in every respect, as the Bill at the last stage of its proceedings in this House in the present Session ;

That the Bill shall be laid upon the Table of the House by one of the Clerks in the Private Bill Office on the next meeting of the House after the day on which the Bill has been presented and, when so laid, shall be read the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;

That all Petitions relating to the Bill presented in the present Session which stand referred to the Committee on the Bill, together with any minutes of evidence taken before the Committee on the Bill, shall stand referred to the Committee on the Bill in the next Session ;

That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 1226 relating to Private Business ;

That in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against the Bill)" were omitted ;

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

London Local Authorities Bill [Lords]

Motion made, and Question proposed,

That the Promoters of the London Local Authorities Bill [Lords] shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ; That, if the Bill is brought from the Lords in the next Session, the Agent for the Bill shall deposit in the Private Bill Office a declaration signed by him, stating that the Bill is the same, in every respect, as the Bill which was brought from the Lords in the present Session ;

That, as soon as a certificate by one of the Clerks in the Private Bill Office, that such a declaration has been so deposited, has been laid upon the Table of the House, the Bill shall be read the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;

That all Petitions relating to the Bill presented in the present Session which stand referred to the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session ;


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That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within the present Session or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

That, in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against Bill)" were omitted :

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.

London Underground (Green Park) Bill

Motion made, and Question proposed,

That the Promoters of the London Underground (Green Park) Bill shall have leave to suspend proceedings thereon in order to proceed with the Bill, if they think fit, in the next Session of Parliament, provided that the Agents for the Bill give notice to the Clerks in the Private Bill Office not later than the day before the close of the present Session of their intention to suspend further proceedings and that all Fees due on the Bill up to that date be paid ; That on the fifth day on which the House sits in the next Session the Bill shall be presented to the House ;

That there shall be deposited with the Bill a declaration signed by the Agents for the Bill, stating that the Bill is the same, in every respect, as the Bill at the last stage of its proceedings in this House in the present Session ;

That the Bill shall be laid upon the Table of the House by one of the Clerks in the Private Bill Office on the next meeting of the House after the day on which the Bill has been presented and, when so laid, shall be read the first and second time and committed (and shall be recorded in the Journal of this House as having been so read and committed) ;

That all Petitions relating to the Bill presented in Session 1991-92 or the present Session which stand referred to the Committee on the Bill, together with any minutes of evidence taken before the Committee on the Bill, shall stand referred to the Committee on the Bill in the next Session ;

That no Petitioners shall be heard before the Committee on the Bill, unless their Petition has been presented within the time limited within Session 1991-92 or deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business ;

That in relation to the Bill, Standing Order 127 relating to Private Business shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against Bill)" were omitted ;

That no further Fees shall be charged in respect of any proceedings on the Bill in respect of which Fees have already been incurred during the present Session ;

That these Orders be Standing Orders of the House.-- [The Chairman of Ways and Means.]

Hon. Members : Object.


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Oral Answers to Questions

HEALTH

Regional Health Authorities

1. Mr. Jim Marshall : To ask the Secretary of State for Health if she will make a statement about the future size, number and role of regional health authorities.

The Secretary of State for Health (Mrs. Virginia Bottomley) : I announced to the House last week my intention to abolish the 14 statutory regional health authorities. In advance of the necessary legislation, I propose to reduce the number of RHAs from 14 to eight by next April. These changes will help improve the management of the health service, reduce administration and overhead costs and support the continued drive towards a decentralised health service.

Mr. Marshall : When I tabled the question, I hardly expected it to be the catalyst for the change announced by the Secretary of State last week. Will the right hon. Lady tell the House how many jobs will be lost and how many extra doctors are likely to work in the national health service as a consequence of the changes? She will recognise that the regional health authorities had as part of their responsibilities the encouragement of regional centres of excellence. Will she tell the House who or what will take over that responsibility?

Mrs. Bottomley : I am pleased that the hon. Gentleman should be a catalyst for change. We welcome a sinner who repents--even at a late stage- -to the changes which we are introducing in the NHS. The hon. Gentleman makes some good points about the importance of safeguarding specialist centres. The management executive outposts will be working to ensure that there is a strategic role to safeguard precisely the units to which the hon. Gentleman refers.

It is not possible to make a precise estimate of the numbers of jobs that are involved. We have stated previously that the number of staff in management outposts should be reduced from 570 to 200, and we expect a reduction in the number of regions from 14 to eight over the next few months. We have to work with the NHS to make sure that the necessary tasks are performed. No one wants needless duplication or unnecessary layers of bureaucracy. At the same time, NHS management is an important function which will continue in a new and slimlined style.

Mrs. Roe : Will my right hon. Friend tell the House who will decide on the allocation of resources to the districts once the regional health authorities have been abolished?

Mrs. Bottomley : The regional director of the management executive will of course be involved in the allocation of resources to the districts, but in line with policies that have been laid down and approved by Ministers.

Mr. McCartney : In the Secretary of State's statement to the House last week, she avoided giving any details of


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the future arrangements for the development of community health councils. Will she now tell the House what those arrangements will be?

Will the right hon. Lady take some time out of her busy day's shopping at Marks and Spencer to comment on a community health council's report in south London on the continuing abuse of elderly people in accident and emergency units? In some units in south London, elderly people are lying for between 15 and 29 hours because no beds have been opened. Is not that a result of the disastrous cuts that have been caused by the Government's budgetary policies?

Mrs. Bottomley : The hon. Gentleman makes two different points. With regard to his latter point about accident and emergency centres, he will know that the patients charter has set explicit targets for the time that it should take for people to be treated. Special issues concern the development of primary care in London so that all elderly people can have the services to which they are entitled.

GP Fund Holding

2. Sir Roger Moate : To ask the Secretary of State for Health what further plans she has to spread the benefits of fund holding to other practices.

Mrs. Virginia Bottomley : The GP fund-holding scheme has empowered family doctors to improve services for patients. We wish to see more fund holding and more fund holders and we are pursuing several arrangements, such as consortia, to fulfil our manifesto commitment to extending the benefits of fund holding to all GPs.

Sir Roger Moate : Does my right hon. Friend agree that GP fund holding is proving to be one of the great success stories of the health service? Does she agree that the best way to nail the lie that there is a two-tier service, so often put about by the Opposition, is to extend GP fund holding and the benefits thereof to all practices, including the smaller ones, as soon as possible? Will she confirm her support for consortium arrangements and the multi-fund applications that she is now receiving?

Mrs. Bottomley : My hon. Friend is exactly right. We want to extend the benefits of fund holding to all GPs. We welcome the number of groups that are forming consortia. Of the 800 fund-holding practices that are coming forward for next April, about 350 are precisely for those smaller schemes. We are looking particularly to see further development in London, where the energising effect of GP fund holding on primary care in general could play an important part.

Ms Lynne : Can the Secretary of State tell the House how she intends to fund the initiative that she announced last week whereby non-GP fund holders' patients will receive urgent treatment within six weeks? I welcome the announcement. I believe that it means that the Secretary of State has accepted that she created a two-tier health service. How does she intend to fund it?

Mrs. Bottomley : Fifty per cent. of cases are now seen within five weeks. We must make sure that those are the most urgent cases. All emergency cases are, of course, seen immediately. It is clear that GP fund holding is leading to improvements in primary care generally. GPs are funded


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on a comparable basis for their patients. Any new fund holders who join the scheme will have their budgets arranged on the basis of their referral patterns this year. There is no two-tier system. We are seeing a levelling up.

Mr. Sims : Will my right hon. Friend take steps to contact directly non-fund-holding GPs who may have some doubts and acquaint them with the facts about the advantages of fund holding? That would offset some of the misleading impressions given until recently by the British Medical Association and which continue to be given by those who seem more interested in making party political points than in pointing out the benefits to patients.

Mrs. Bottomley : My hon. Friend has it exactly right. There is no more effective advocate for GP fund holding than the fund holders themselves. GP fund holding is all about empowering the general practitioners. The GP is the most effective advocate on behalf of the patient. A party such as ours, the priorities of which are dominated by the interests of patients, not providers, wishes to see that further advanced. I strongly urge the Labour party to speak to many of its supporters who are active, innovative and energetic GP fund holders. They are showing the way to others.

Mr. Robert Ainsworth : Is the Secretary of State aware of the blatant abuse of the two-tier system in the Coventry and Warwickshire area, and of the consequences of it on the Walsgrave hospital trust? The hospital has refused to operate a two-tier service. The nearby George Eliot hospital offers to fund holders' patients half the waiting time that it offers to health authority patients. As a result, the George Eliot hospital is undermining the Walsgrave hospital trust and is in danger of causing redundancies in the trust. Surely the Secretary of State is aware of this. The blatant introduction of a two-tier service and abuse of the service are causing redundancies within the system that would otherwise be unnecessary.

Mrs. Bottomley : All hospitals are maintaining their patients charter standards. We are seeing a steady downward pressure on waiting times for all patients. The average was previously nine months. It is now down to five months. There has been a 20 per cent. fall in the number waiting more than a year in the past year alone. I repeat that fund holders are funded fairly and comparably. We want all GPs to come forward and have the benefits of fund holding. It is a voluntary scheme. I commend to the hon. Gentleman the comments of Professor Howard Glenister from the London School of Economics. He said :

"GP fund holding shifts the balance of power away from hospitals towards GPs and primary care. It replaces a top-down model of the NHS resource allocation with a bottom-up model driven by GPs acting as purchasers on behalf of patients."

I commend Professor Glenister's work to the hon. Gentleman.

Dame Elaine Kellett-Bowman : My right hon. Friend will recall that she was good enough to waive the requirement that there should be 7, 000 patients for one practice in the southern end of my constituency, when it had already recruited every man, woman and child in its area. That practice is now going from strength to strength. It has extended its buildings and is an example to all others in the area. Will she help fund-holding practices to extend now to the north end of my constituency?


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Mrs. Bottomley : I thank my hon. Friend. Those general practitioners with practice sizes that did not reach the 7, 000-patient limit are bringing to bear pressure that they should be able to join the scheme. That is why we so welcome the consortia that are developing, which make it possible to push through the preferences of general practitioners in the delivery of care for patients.

Ms Primarolo : When will the Secretary of State accept the evidence that a two-tier system is being created by GP fund holders? The joint consultants committee has handed her a document which demonstrates that 70 per cent. of hospitals are fast-tracking GP fund holder patients. When will she act on that information? When will she make it impossible for GP fund holders to make profits for themselves instead of spending the money in the national health service where it is needed? When will she finally agree to prevent the payment of a £35,000 management fee to every GP fund holder to be spent on bureaucracy and instead give it to practice nurses, who are desperately needed in our community?

Mrs. Bottomley : When a hospital has completed the contract that it has agreed with the district health authority to meet its patients' targets and to ensure that it improves the quality and quantity of care, if it has spare capacity it can give it to another health authority or to a GP fund holder. The hon. Lady should ask why the GP fund holders have been able to use comparable amounts of money so much more effectively. Let us learn from that. Let us level up and have good value for money, rather than look for the lowest common denominator.

The hon. Lady resists no opportunity to take a swipe at any managers in the health service. The management allowance for GP fund holders is enabling resources to be used more effectively ; it is about 2 per cent. of the cost. There have been benefits of about 4 per cent. These are ploughed into better patient care. They do not go into the GPs' pockets. They go to physiotherapists, chiropodists and--exactly what the hon. Lady wants--more practice nurses.

Accident and Emergency Units

3. Mr. French : To ask the Secretary of State for Health in how many hospital accident and emergency units medical staff are routinely made available to assess the seriousness of each case immediately on arrival.


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