[Lords] Order for Second Reading read.
To be read a Second time tomorrow.
[Lords] Read a Second time, and committed.
1. Mr. Burden : To ask the Secretary of State for Health what meetings she or officials from her Department have had with Sir James Ackers or other officials of West Midlands regional health authority in respect of the deficit faced by South Birmingham health authority.
The Parliamentary-Under Secretary of State for Health (Mr. Tom Sackville) : Officials from my Department have held a number of meetings with the West Midlands regional health authority to discuss this matter.
Mr. Burden : Is the Minister aware that news of the multi-million pound cash crisis facing South Birmingham health authority started to filter out at the end of February this year, but was hushed up until after the general election? Is he also aware that the report into the causes of the crisis has still not been published, but the people of Birmingham are faced with proposals to close hospitals such as the Royal Orthopaedic hospital, the Accident hospital and several others? Will the Minister intervene to ensure that the report into the causes of the crisis is made public straight away? Will he further intervene to ensure that all options are considered before decisions are taken and that the people of south Birmingham will not be forced to suffer hospital closures as a result of financial mismanagement or Government underfunding, or both?
Mr. Sackville : As the hon. Gentleman knows, as soon as the problem came to light, a report into its causes was commissioned from KPMG Peat, Marwick, McLintock. Extra money was allocated to the district to ensure continuity of service and also that all bills were being paid on time. Extra money is to be allocated over the next three years to ensure that the proposed action plan will come into effect smoothly and cause no disruption to service.
Column 760The hon. Gentleman also knows that the report is a technical report to the region, which will have to decide whether and when it will be published.
Dame Jill Knight : Is my hon. Friend aware that his denial of the allegation of any hushing up will be warmly welcomed by those in the west midlands who know the true facts? Is he also aware that the hon. Member for Birmingham, Northfield (Mr. Burden) is mixing up two totally different issues? The first is the need to balance the books when there is underspending and the second is the BHB--Building a Healthy Birmingham plan --which is connected with the hospital closures that the hon. Gentleman mentioned. The two have nothing to do with each other.
Mr. Sackville : I am grateful to my hon. Friend. When Opposition Members see any change in the health service, they attack it. In the current case we are dealing with a £500 million capital investment plan to provide better and more modern hospital facilities for Opposition Members' constituents. That is what they are attacking.
The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : We have no plans to change the existing statutory arrangements. InEngland and Wales health authorities remain responsible for registration and inspection of independent nursing homes and local authorities for registration and inspection of care homes.
Mr. McAllion : Has the Minister read the recent report by the Royal College of Nursing, which reveals that the placement of elderly people in residential care has little or nothing to do with the level of care required or with the wishes of the old people themselves, and everything to do with keeping costs down and a lack of adequate available accommodation? The RCN also warned that the National Health Service and Community Care Act 1990, due to come into force next year, will do nothing to change a situation that it describes as a scandal waiting to happen. The Minister has been warned by those who should know. What does he intend to do about it?
Mr. Yeo : I wholly reject the second conclusion that the hon. Gentleman cited from the RCN report. We are confident that when the new arrangements come into effect next year, the process of assessment that everyone will undergo will ensure that an individually tailored care package appropriate to their needs will be available. Some people may be able to stay at home, some may go into residential homes and some may go into nursing homes. Whatever the appropriate solution is, it will be found.
Mr. Paice : My hon. Friend will be aware that monitoring homes costs money. Is he aware that county council authorities that have a relatively small number of private homes but a large number of social services departments find that they are penalised under the standard spending assessment arrangements? Cambridgeshire is a particular example. Will my hon. Friend undertake to consider that and to talk to my right
Column 761hon. and learned Friend the Secretary of State for the Environment about the composition of the SSA as it relates to care homes?
Mr. Yeo : Decisions about SSAs are taken by my right hon. and learned Friend the Secretary of State for the Environment, but my hon. Friend the Minister for Health is a Cambridgeshire Member and will take a close interest in the Cambridgeshire SSA for personal social services expenditure.
The Minister for Health (Dr. Brian Mawhinney) : We set out the timetable for implementing our community care reforms in 1990. Many of them have already been achieved. We are on course to achieve the remainder by April 1993.
Mr. Griffiths : How does the Minister reconcile that with the statement by the Institute of Health Services Management that the Government have inadequately planned and inadequately funded community care? Social services departments are being starved of the £134 million that they need for community care this year. How does the hon. Gentleman expect tens of thousands of carers to meet the needs of disabled relatives when the Government are doing so little?
Dr. Mawhinney : The Government are doing a considerable amount-- indeed, we have just had the second round of reports from local authorities, and those reports show that the authorities are making steady progress towards implementing the arrangements that must be in place.
Mr. Sims : Will my hon. Friend confirm that it is his intention that the private sector should play an important role in community care? As he studies the community care plans submitted by local authorities, will he satisfy himself that the private sector has been involved in the preparation of those plans and that it will be involved in their implementation?
Dr. Mawhinney : My hon. Friend is right to point out the importance that we attach to giving people a clear choice in the homes to which they go. I also believe that the public generally attach some importance to having that choice. I assure my hon. Friend that, as we continue to progress towards the implementation of this important reform, we shall certainly bear in mind the point that he has made and will want to try to ensure that local authorities relate not only to the independent sector of provision but to health authorities, and GPs, because it is in the interests of everyone--primarily of users and their carers--that there should be a seamless robe as between the various statutory organisations.
Ms. Lynne : Does the Minister accept that, without adequate resources for community care, there will be a disaster in April? May we have a commitment today that those resources will be provided and that they will be ring-fenced?
Dr. Mawhinney : We have already made it clear a number of times that we shall ensure that the policy is adequately resourced, and I make the point to the hon. Lady again today. I understand her concern, but I hope that she will not be too keen to use words such as "disaster". This is an important policy, especially to people in the community who need opportunities for assessment. Many of them want to remain in their own homes, but thus far have not had the option to do so. We are not talking about disasters waiting to happen ; we are committing all our efforts, with local authorities, to ensuring that the policy will be a real success.
Mrs. Currie : Is the Minister aware that there continues to be considerable concern about community care for mentally handicapped people? Will he take an interest in the activities of VOICE, an organisation set up by my constituents Mr. and Mrs. Boniface to campaign for better recruitment, training and monitoring of staff in small homes for the mentally handicapped following the recent tragic indecent assault on their daughter Nicole?
Mr. Robin Cook : Will the Minister acknowledge that last month's survey by the Directorate of Social Services found wild variations in standards? Is he aware that among the 20 authorities with the worst records in the provision of home helps were Suffolk, represented by the Under- Secretary, the hon. Member for Suffolk, South (Mr. Yeo), Cambridgeshire, represented by himself, and, at the very bottom of the table, Surrey, represented by the Secretary of State? Would not it ease their joint embarrassment if Ministers were now to accept the advice of everyone else involved in community care that any extra money should be ring fenced so that those councils must spend it on raising their poor standards?
Dr. Mawhinney : I do not accept for one moment that the reports which we have just received show that there are "wild variations". Of the 108 local authorities that have reported, all bar one have their assessment plans in place. We shall work with them to develop those plans so that when they are managed with adequate resources we shall have a community care proposal and policy which will be welcomed by users and carers alike. I very much hope that before he leaves his present position--should that turn out to be the case--the hon. Gentleman will throw his weight behind the policy to try, as far as possible, to remove from it any partisan elements for the benefit of the frail and elderly in our community.
Column 763The Secretary of State for Health (Mrs. Virginia Bottomley) : Considerable progress has been made by the national health service in implementing the patients charter which came into effect on 1 April. The public and NHS staff have given the patients charter a warm welcome. The NHS has achieved significant success in putting the patients charter into effect. The efforts of the NHS in responding to and implementing the charter should be recognised.
Dr. Goodson-Wickes : Does my right hon. Friend agree that the excellence of the care available under the national health service has for far too long been blighted by scant regard for patients' ordinary comfort and convenience, especially in the administration of out-patients departments and investigations? Does not the introduction of the patients charter signal the end of off-hand, inefficient and uncaring bureaucracy?
Mrs. Bottomley : All agree that the clinical care provided by the national health service has almost invariably been outstanding, but there are times when patients have not felt that they were treated with the courtesy and concern that they would have wished. The provision of information, arrangements for making a complaint and a discussion about their care are all part of making a health service which is truly patient sensitive and patient centred. The NHS has taken the patients charter initiative to its heart and is now providing high-quality services across the country.
Ms. Glenda Jackson : Does the Secretary of State agree that the patients charter is virtually worthless if patients and staff in the nation's hospitals can be subject to violent and, in the case of one of my constituents, mortal attack by intruders? Does she further agree that an independent inquiry into funding and staffing levels for hospital security is long overdue, and will she take the necessary steps to set in train such an inquiry?
Mrs. Bottomley : Certainly, the case in the hon. Lady's constituency in which someone was fatally attacked on the third floor while using a telephone was appalling and outrageous. New guidance has been given for hospital security. Hospitals have a difficult balance to strike between being places to which visitors, families and staff can have easy access but at the same time places from which perpetrators of foul crimes can be removed. I understand that inquiries under way at the hospital in question have shown that there was adequate security. Of course, any further lessons will and must be learnt, and we must ensure that the guidance is properly applied throughout the service.
Mr. John Marshall : Will my right hon. Friend pay tribute to the work of trust hospitals in helping to carry out the objectives of the patients charter? Is she aware that the Royal Free trust hospital, which has already been mentioned this afternoon, has been responsible for treating many more patients since it became a trust hospital? Should not that be welcomed instead of being criticised by Opposition Members?
Mrs. Bottomley : My hon. Friend will be well aware of the habit very quickly acquired by Labour Members of being able to refer to hospitals in their constituencies only by talking about the adverse aspects and the problems that emerge. Conservative Members are very much more ready
Column 764to identify the positive aspects and the work being taken forward, especially in NHS trust hospitals, to deliver the spirit of the patients charter.
Ms. Harman : The Secretary of State will be aware that the patients charter made very specific promises to patients. One of those promises was that no patient would have to wait for NHS treatment for more than two years. In the first month of the operation of the patients charter, 1,999 people have been waiting for more than two years.
Another promise made by the patients charter was that nobody would have to wait for an ambulance for more than 14 minutes in an urban area. Is the Secretary of State aware that in London in the first month of the operation of the patients charter, 10,000 people had to wait for more than 14 minutes for their accident and emergency ambulances to arrive? What does she say to all those to whom the Government made promises in the charters and for whom those promises are now broken?
Mrs. Bottomley : The hon. Lady will be aware that we were deeply disappointed by the small increase in the number waiting for more than two years. The figure amounts to fewer than one patient per hospital throughout the country. The matter must be kept in proportion. Whereas there were 51,000 waiting for more than two years a year ago, the figure is now down to under 2,000.
Once again, the hon. Lady has taken no trouble to investigate what is happening in a hospital in her constituency. I understand that at King's College hospital, there has been a dramatic increase in the number of patients waiting for less than 30 minutes. The figure for those waiting for less than 30 minutes was 30 per cent. a year ago ; it is now 60 per cent. and rising. Better patient information is produced and more is planned. There are improvements in the accident and emergency department ; there are improvements in the out-patients' department ; there are improvements in the numbers of patients whose appointments are not being cancelled. There are further projects to improve the intensive therapy facilities-- [Interruption.]
Mrs. Bottomley : There has been a great investment in new ambulances, in trained staff and in the communications service which is being modernised. Like the hon. Lady, I hope that the London ambulance service will continue to improve its standards and the care available to patients.
Mrs. Virginia Bottomley : We are committed to an NHS dental service for the whole country. The Government have built up NHS dentistry ; there are 27 per cent. more dentists than in 1979, and more than 7 million more courses of adult dental treatment are carried out every
Column 765year. In most parts of the country, NHS dental treatment is readily available. Where there are difficulties, family health services authorities may make use of long-standing arrangements to employ salaried dentists. As part of our determination to safeguard access to NHS dentistry, my Department wrote yesterday to all FHSAs reminding them of this option.
Mr. Hain : Surely the Secretary of State must accept that by increasing charges to patients and cutting fees to dentists, she is effectively privatising dental care, especially as many people cannot find an NHS dentist in their area. Instead of playing Mary Poppins, she has become the Cruella de Vil of the national health service.
Mrs. Bottomley : The hon. Gentleman should look again at the facts. Our proposals would result in a reduction in the charges to patients. I hope that the hon. Gentleman is aware that dentists on average should earn £35,800. It is proposed that they should keep a further £5,000 on top of that. More than £40,000 is a good salary from any professional standpoint. In addition, it is proposed that there should be an 11.6 per cent. increase in expenses. That is a good salary which should certainly safeguard NHS dental services.
Mrs. Mahon : Are not the Government increasingly pushing dentistry into the private sector through their policies? Is the right hon. Lady aware that one third of children have not been registered with a National Health Service dentist during the first six months of the new contract? What is she going to do about it? Is she not failing British children?
Mrs. Bottomley : On the contrary, there are 27 per cent. more dentists than in 1979 ; almost 30 million people have signed up for continuing care ; and, there are about 7 million more adult courses of treatment than in 1979. The NHS dental service is effective. I hope that we can get over the present fee situation and work with dentists for a fundamental review of the way in which they are remunerated.
Mr. Nicholas Winterton : I recognise dentists' vital role within our national health service, but will my right hon. Friend tell the House that, were dentists allowed to keep the total remuneration that they receive, it would set a sad and dangerous precedent for other vital groups of NHS workers, not least doctors, nurses and paramedics? In an endeavour to bring the unfortunate dispute to an end, is she prepared to discuss with representatives of the dental profession their right to pick and choose their patients?
Mrs. Bottomley : I am grateful to my hon. Friend for making a number of important points. Certainly, the increase in dentists' income recommended by the review body, at 8.5 per cent., was much higher than that recommended for nurses or doctors. I have to consider not only the interests of dentists, but those of patients and other NHS workers. I hope that the dentists will find their way through the present difficulties. Given present figures, a 23 per cent. fee reduction would be required to deliver that income of £38, 500. We are proposing a 7 per cent. fee reduction only, which is sensible and fair. My hon. Friend made other points about the way in which dentists work, which are rightly and properly matters for the
Column 766fundamental review. The Minister and I shall certainly be happy to see all interests concerned with the dentists on that review.
Mr. Sweeney : Does my right hon. Friend agree that the British Dental Association's withdrawal from the dental rates study group is an act of folly? Whatever the disagreements between the Government and the profession about fees, surely it is better for dentists to be fully represented in all negotiations over fees. If they disagree about the figures, is not the DRSG the correct way to discuss it-- [Interruption.]
Mrs. Bottomley : I agree with my hon. Friend, to the extent that the public will be confused if dentists fail to attend the dental rates study group with the independent chairman, because that is the setting in which detailed figures should be discussed and examined. For example, I have heard dentists refer to their expenses, but on each of the last three occasions that that issue was debated it turned out that they had been over rather than underestimated. This year an 11.6 per cent. increase in expenses is proposed. The profession should get back to the dental rates study group to discuss the details.
Mr. Robin Cook : Will the Secretary of State admit that the current dispute stems from the contract imposed by the Government only two years ago against the wishes of most dentists? If Ministers got their sums wrong then, why should dentists and their patients have to pay the price now? May I warn the Secretary of State that if, as a result of this dispute, more of our constituents are told by their dentists that they will have to go private, we shall not just hold her responsible for privatising the dental service but will suspect that the Government want such a privatised dental service?
Mrs. Bottomley : I do not agree with the hon. Gentleman that the dispute results from the new contract. It is the result of the long- standing method by which we have remunerated dentists, which dates back nearly 40 years. It is time that we reviewed that system of remuneration, which is what the chairman of the review body suggested. We want to make progress on that review as soon as the dispute is settled. Of course, I am concerned about the needs of national health service patients. That is why I have reminded family health services authorities of their power to take on salaried dentists to safeguard the national health dental service. I hope that dentists will think long and hard before turning their backs on an average income, with expenses, of £88,000.
Column 767Mr. Sackville : The Department has had nearly 900,000 requests for copies of the patients charter.
Mr. Coombs : Does my hon. Friend agree that the patients charter not only gives rights to potential patients, but demands responsibilities from them? To that end, is he aware of the contents of the national fitness survey issued yesterday by the Health Education Authority, which not only showed that between seven and eight people out of every 10 in this country do not do enough exercise to keep themselves healthy, but that 80 per cent. of the population think that they are fit when they are not, including the parliamentary football team, as it displayed at lunch time? What action will the Government take to ensure that people understand the message, which is so important for good preventive health care?
Mr. Sackville : My hon. Friend clearly appears before us at the peak of physical fitness. However, having seen the results of the Lords and Commons tug-of-war match yesterday, I am afraid that I cannot apply that comment more generally. My hon. Friend is right to refer to the national fitness survey because it underlines the fact that the patients charter is a two-way street. It confers right on patients, but it also confers duties on them to try to keep themselves fit and healthy. We shall be making that message exceedingly clear.
Dr. Lynne Jones : In view of the Secretary of State's comments to a local paper in Birmingham that patient care must come first, does the Minister share my concern at the letter sent by the South Birmingham health authority to general practitioners telling them not to refer patients for psychological services? Is it not time that the full details of the financial crisis in South Birmingham were published so that the people of Birmingham can see the full effects of those financial difficulties on patient care?
Mr. Sackville : We have made it clear that we intend to take positive action to ensure no disruption in services as a result of the financial problems of the South Birmingham health authority. We have already commissioned a report and we have allocated extra funds to ensure that there is continuity of services.
Mr. Hayes : Does my hon. Friend agree that all those people who continually moan about the patients charter and national health service trusts should go and see them for themselves? They would find enthusiastic staff at all levels, more patients being treated and more money being spent on patient care. Will the Minister please give us more good news about the health service, because there is a hell of a lot of good news that we do not hear about?
Mr. Miller : As one who has tested the services of the national health service recently in an attempt to obtain peak fitness, I suppose that I could make some remarks about the local health district, but I shall refrain from doing so. In the context of the patients charter, what success has been obtained in reducing waiting lists in neurology in the Mersey region? Will the Minister investigate what is going on and do something urgently about it?
Mr. Rowe : Does my hon. Friend agree that it would be a lot easier to keep fit if one did not have to spend so much time answering letters from one's constituents? Does he further agree that the substantial postbags that all hon. Members receive contain a large number of letters from constituents quoting the patients charter and using it as a yardstick against which to measure local services, the charter having had a salutary effect right through the health service and being taken into account by every decision-maker in the NHS?
Mr. Sackville : I echo my hon. Friend's comments. The patients charter has not only provided a target for staff to strive for in the NHS but has informed patients of their rights, and that has had a salutary effect.
Dr. Mawhinney : One hundred and fifty one applications have so far been received from hospitals and other units in England to become operational from April 1993. That is higher than the number of applications in the first or second waves and is a tangible demonstration that staff and managers in the NHS are behind the Government's reforms.
Mrs. Ewing : Given the rise in the number of applications, does the Minister accept that one of the greatest concerns expressed by NHS employees appears to be the determination of trusts to write into their employees' contracts a gagging clause which prevents them from speaking out against or challenging bad practice? Given that a consultation process on the issue is in place, does the Minister accept that every NHS employee should have a legally protected right, preferably through independent channels, to speak out as appropriate to ensure the best level of practice, irrespective of the system?
Dr. Mawhinney : I am glad that the hon. Lady recognises the increasing popularity of trusts. She will be interested to know that about a third of NHS hospital and community health service capacity is now managed by trusts. From next April, that will become about two thirds.
The hon. Lady rightly points out that this is an important issue. My right hon. Friend the Secretary of State and I have taken it seriously and have made it clear that consultations are to take place with a view to issuing guidance. I hope that the hon. Lady will accept that that is a serious and considered response on a subject which has caused a certain amount of anxiety to a number of people, not least to the Royal College of Nursing.
Mr. Marland : Having reluctantly accepted our policy on the sale of council houses, our policy for moderate taxation and, more recently, our education reforms, how long will it be before the Labour party also endorses our policy on NHS reforms?
Column 769increasingly commanding support among patients and staff of the NHS. The change in attitude that my hon. Friend predicts, and which I agree will come, will be driven by Opposition Members' constituents.
Mrs. Dunwoody : Is the Minister aware that his last comments were totally and utterly inaccurate? Is he further aware that if he represented an area such as mine, where a trust is already in severe financial difficulty--and where many elderly people are deeply concerned because of an application for a second trust to turn all the elderly and geriatric services into a trust--he would know that his moves are distorting the provision of health care, upsetting the staff, putting many jobs at risk and in general leading to a definite downgrading of health care throughout the NHS?
Dr. Mawhinney : No, I do not accept a word of what the hon. Lady has said because it does not accord with the facts and it certainly does not accord with the popularity of the policies. It is clear that the hon. Lady will be among the last Opposition Members prepared to shed their ideological prejudices.
Mr. Gale : My hon. Friend will be aware of the fact that Thanet district hospital has submitted an excellent application for trust status to enable it to attain full district hospital status and provide the 24 accident and emergency services and other acute services that my constituents require. Will my hon. Friend assure my hon. Friend the Member for Thanet, South (Mr. Aitken) and me that that trust status will be granted as soon as possible?
Dr. Mawhinney : I assure my hon. Friend that, after the consultation process has been followed through--as, statutorily, it must be--my right hon. Friend the Secretary of State and I will give serious consideration to the application.
Mr. Yeo : We are looking to health, as well as local authorities, further to develop respite care services as part of the implementation of the White Paper, "Caring for People". We recognise the contribution which such services can make to providing practical support for carers.
Mr. Byers : Has the Minister had an opportunity yet to consider the recent survey carried out by the Carers National Association? Is he aware of the main findings of that survey, which are that no less than 20 per cent. of carers had no break for even a day from their caring responsibilities and that no less than two thirds of carers suffered ill health in discharging their caring obligations? In the light of those disturbing findings, will the Government take urgent steps to provide comprehensive respite care within the national health service, or is the Minister content to continue present Government policies which are clearly based on cynical exploitation of the compassion of those who care for others?
Column 770People", first, to promote the development of respite services and, secondly, to ensure that the service providers make practical support for carers a high priority. Respite care is available in hospitals, nursing homes and people's own homes through better domiciliary services. The number of short-stay residents in care homes is double the 1979 level.
Sir John Hannam : Will my hon. Friend confirm that the benefits given to carers have risen from some £4 million in the last year of the Labour Government in 1978 to more than £213 million this year? Is that not evidence of the importance that the Government place on the role of carers in the forthcoming programme for care in the community?
Mr. Yeo : My hon. Friend, who is known for his expertise in the matter, is absolutely right. That level is likely to continue rising. It shows, in a practical way, exactly how the Government are determined to give carers the support that they need.
Mr. Bradley : I invite the Minister--or, preferably, the Secretary of State--to visit my constituency to see at first hand the high-quality alternative provision by Manchester city council. The elderly persons' resource centre, known as the Minehead centre, is a model which should be replicated throughout the country. It provides services for people in their homes and in the centre, co-ordinated by social services and the health authority. Since its opening, there has been a dramatic reduction in the number of elderly people seeking residential care in its catchment area. If the Government would make capital money available to local authorities, such centres could be opened throughout the country. Will the Minister visit the centre to see for himself what can be achieved by proper local authority provision?