The Right Honourable Robert William Brian McConnell, having been created Baron McConnell, of Lisburn in the County of Antrim, for life -Was, in his robes, introduced between the Lord Grey of Naunton and the Lord Cooke of Islandreagh.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, we do not know the reasons why there is an increase in emergency admissions. Studies looking at the causes are under way and more detailed information will be available later in the year.
Baroness Jay of Paddington: My Lords, I thank the Minister for that reply. Is she considering the report by the National Association of Health Authorities and Trusts? Is she aware that that report has already suggested that it may be part of the operation of the internal market which is leading to the very rapid rise in emergency admissions? For example, are GP fund-holders bypassing routine admissions in order to get fast-track admissions and taking the emergency route? Does she agree that once patients are in hospital, managers are under such financial pressure to improve what is called their patient throughput that they are discharging people too early and they are re-admitted as emergencies?
Baroness Cumberlege: My Lords, there is no firm evidence about that at all. That is why we are running the research studies, five of which are due to take place. We shall be working with all the associations, including the joint consultative committee and the Confederation of Royal Medical Colleges as well as the Trust Federation and the national association.
Baroness Jay of Paddington: My Lords, if no one else wishes to intervene, perhaps I may press the Minister a little further on this point. If she does not yet accept the findings of the National Association of Health Authorities and Trusts, does she accept the findings of the clinical advisory group of the Department of Health, which also suggests that the commercial pressures of the
Baroness Cumberlege: My Lords, I have already said to the noble Baroness that there is no firm evidence. That is why we are running the research projects. We want to find out the reasons. There are a number of commentators who put forward suppositions, such as an increase in asthma cases. At the moment there is no definition of an emergency case. We shall also be looking at that. Overall, it is quite interesting that GP referral rates to A&E departments vary between three and fourfold. We shall be considering all those conundrums.
Lord McColl of Dulwich: My Lords, does my noble friend agree that the complication rate for those patients who are treated on a day-case basis is exactly half the complication rate for those who stay in hospital longer than one day?
Baroness Cumberlege: My Lords, the pattern of medicine is changing very fast indeed. Increasingly operations are being carried out on a day-case basis, rather than have the patients admitted to hospital.
Lord Carr of Hadley: My Lords, does my noble friend agree that whatever may be the reasons for the increase, it is not necessarily a bad thing? Does she further agree that it may indicate a greater flexibility in responses from the service?
Baroness Cumberlege: My Lords, I mentioned the GP referral rate. I believe that as waiting times are slashed and people wait less time to be admitted, GPs clearly feel that it is worth while to send patients to hospital to be investigated and sometimes admitted.
Baroness Robson of Kiddington: My Lords, will the Minister agree to look at another reason for the increase in emergency admissions? Could it have something to do with the lack of community care that exists in some parts of our country, so that elderly people become emergency admissions when that normally would not have been the case?
Baroness Cumberlege: My Lords, we do not have evidence on that matter. That is why we are running the five pilot schemes. It is interesting that not only has the number of emergency admissions increased but so have the referral rates to the London Ambulance Service and ambulance services around the country. The increase in their calls was 8.5 per cent. last year alone. There is something rather strange going on and we need to find out why.
Lord Rea: My Lords, will the noble Baroness accept the logic of the situation? Will she accept that there has been a great increase in the turnover in London hospitals, with a diminution in the number of beds? That has meant a much shorter stay for each patient. Is she aware that many people may well have been discharged
Baroness Cumberlege: My Lords, we do not agree with that supposition at all. In fact, we know that the number of patients being treated is increasing. There always seems to be some kind of correlation between the number of patients treated and the number of patients admitted through accident and emergency departments. We intend to find out the reasons why.
The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Henley): My Lords, the information is not available. Repairs to all buildings have been liable to the standard rate of VAT since 1973. The VAT paid on all repairs is charged by registered builders, who periodically declare to Customs and Excise the total VAT charged by them to all their customers without further analysis.
Lord Boyd-Carpenter: My Lords, while thanking my noble friend for that not particularly informative reply, perhaps I may disclose an interest. I am the churchwarden of a beautiful church in the country now under repair. Is my noble friend aware that the amount raised by VAT on this kind of work is trifling in proportion to the national revenue, but harsh in its operation on those who are desperately trying to raise money to repair and keep beautiful buildings in good order? Is there not an overwhelming case for waiving VAT on this kind of transaction altogether?
Lord Henley: My Lords, I do not believe that there is an overwhelming case, as my noble friend Lord Mackay made clear on another occasion when he repeated that my right honourable friend had made clear that he has no plans for a reduced rate of VAT on anything other than domestic fuel and power. However, we see considerable scope for providing support for historic churches or other heritage buildings. Government funding for the repair of English historic buildings is channelled through English Heritage and this year English Heritage will receive over £105 million in government grants from the taxpayer. Of that, English
Lord Bruce of Donington: My Lords, is the Minister aware that under the European Community's sixth directive the Government have powers if they wish to use them? In the same way that lotteries and gaming institutions are exempt from VAT, it is open to the Minister to order that the tax on church repairs be stopped, if he wishes to do so. Does the Minister want to do so or not?
Lord Henley: My Lords, under the Sixth VAT Directive, to which the noble Lord referred, my right honourable friend has powers, under the list of suppliers of goods and services which may be subject to reduced rates of VAT, to apply a reduced rate of not less than 5 per cent. on specific items. That includes supply, construction, renovation and alteration of housing. It would not go as far as a reduced rate on churches because they do not come under the heading of housing or, for that matter, housing provided as part of the social policy. If we wanted to amend that list of suppliers in the Sixth VAT Directive at Annex 2, we would have to go to ECOFIN and unanimity would be required.
Lord Jenkins of Hillhead: My Lords, does the Minister recognise that this is a remarkable interchange, in that the noble Lord, Lord Bruce of Donington, does not blame the European Community for the position? Does not that show the strength of the case which has occurred to some of us for a long time past that one can, without paying VAT, build the ugliest building it is possible to design but one cannot repair the most beautiful building without paying it?
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