asked the Secretary of State for Social Services whether he has now reconsidered his letter of 22 August to the chairman of the North-West Thames regional health authority on the subject of consultation on closures as promised by his hon. Friend the Minister for Health on 13 November; and, if so, whether he will confirm that that letter was meant to apply to very short-term closures of small sub-units.

Temporary closure should not be a way of avoiding consultation. When a substantial temporary closure has to be made without prior consultation, the authority is still expected to consult afterwards if there is any danger of the closure becoming lasting.

Is the Minister aware that while he has been making conciliatory noises on the question of consultation about closures, the Secretary of State has been adopting a hard line on the matter? Will the hon. Gentleman do his best to ensure that his view prevails?

I am not aware that there is any difference of view between my right hon. Friend and myself.

The Minister will be aware that in my constituency a hospital in perfect condition, with 230 beds, has been closed without consultation. That closure has caused great hardship and pain. Will the Minister state what consultations took place? Will he also define "temporary"?

In a few cases the authorities—I am not saying that that is one of them—may have misunderstood the position initially. For that reason we issued clarification guidance.

The Government have been compounding confusion in this matter. First, the Secretary of State issued a letter of guidance which was supposed not to change the position. It could have fooled hon. Members. Then the Minister made statements which are more acceptable, but which the community health councils consider to be different from those of his right hon. Friend. The Minister is now issuing further guidance which may confuse matters. Why does not the Minister state firmly that the practices of previous Ministers should be followed? My right hon. Friend the Member for Bermondsey (Mr. Mellish) and his constituents will then know where they stand.

Order. My request for brief supplementary questions. applied to Front Bench as well as to Back-Bench speakers.

I do not accept the lengthy allegations of the right hon. Gentleman. Much of the chaos could have been avoided had there been clearer guidelines from the previous Government.

asked the Secretary of State for Social Services how many mentally handicapped persons in each of the Rotherham, Doncaster and Barnsley area health authority areas would require residential accommodation if they were not being cared for by their elderly parents; and if he will make a statement on his policy regarding the provision of accommodation when these parents can no longer look after their children.

The figures requested are not held centrally. The hon. Member may wish to ask the area health authorities concerned what information they hold. We believe that it is often best for mentally handicapped people to live at home and it is therefore our aim to ensure that support is provided to families with a mentally handicapped member to enable them to cope for as long as possible. Satisfactory residential or hospital accommodation, appropriate to their needs, should be provided for those mentally handicapped people no longer able to live at home.

A report issued by the Rotherham area health authority states that there are approximately 400 mentally handicapped adults in that area. That means that there are thousands of parents in the country who are disturbed about what will happen to their sons and daughters when there is no parental care. What will the Government do about that? The cuts in expenditure on the Health Service will mean that there will be no help for these children when their parents die.

I am aware of the CHC report to which the hon. Gentleman referred. The report is now being considered by the Rotherham area health authority. In Doncaster and Rotherham there are no urgent cases awaiting long-term care. There is only one patient in Barnsley urgently awaiting admission for long-term care.

The Minister says that the area health authority should provide residential accommodation for mentally handicapped persons whose parents can no longer care for them. Has he taken into account the need to provide them with the necessary resources to do so? Will not that be more difficult in the light of the Government's policy on public expenditure?

No. Building of new hospital units for 96 adults and 24 children is due to start in Barnsley next year. The Doncaster and Rotherham AHAs already provide a comprehensive service for mentally handicapped people in their areas.

On a point of order, Mr. Speaker. In view of the unsatisfactory nature of that reply, I beg to give notice that I shall seek to raise the matter on the Adjournment at the earliest opportunity.

asked the Secretary of State for Social Services when he will implement his proposals for the administrative streamlining of the Health Service; and if the plans will include the abolition of Derbyshire area health authority.

asked the Secretary of State for Social Services if he will make a statement about the progress of his consultations on changes to the administrative structure of the National Health Service.

We have today published our proposals to streamline the structure and management of the National Health Service in England and Wales in a consultative paper entitled "Patients First". It would not be appropriate for me at this stage to speculate about the future of specific area health authorities.

May we have an assurance that the Government will use an axe, rather than tweezers, on those health authorities that prefer to close hospitals than to cut their own waste and inefficiency? Is it not true that under proper management there wouldbe more than enough cash to provide better facilities for patients in need?

We believe that the closer that management decisions are taken to the point of patient care the more likely it is that patients' interests will predominate. Our proposals are designed to strengthen management at the local hospital level and to bring health authorities closer to the people.

I welcome my right hon. Friend's announcement, but is he aware that there is considerable feeling that the Health Service is over-weighted in administration and that those who work with those who suffer in our society are becoming increasingly separated, in terms of experience and salary, from those who take the decisions? Is my right hon. Friend aware that urgencyis necessary in order to save the morale of the NHS?

I entirely accept what my hon. Friend says. If he reads the consultative document he will see that our proposals are designed to deal with precisely those problems.

We note that the Secretary of State is to attempt to put right the disastrous reorganisation carried out by the present Secretary of State for Industry. Can the right hon. Gentleman tell us whether the House will be able to debate the consultative document and the Royal Commission report before the Second Reading of the Health Services Bill?

The question of debates is a matter for my right hon. Friend the Chancellor of the Duchy of Lancaster. On the right hon. Gentleman's substantive question, a great deal of benefit flowed from the unification of the primary care, community and hospital services, which was one of the principal objectives of the 1974 reform. However, there is now common consent that the Service has an over-elaborate structure and planning system and that decisions are taken too far away from the point of patient care. We have published today proposals to put that right.

Will my right hon. Friend take into account, when considering streamlining the NHS, the growing number of recent reports about ancillary workers who are apparently overpaid, under worked and not pulling their weight within the NHS? If the reports are true, is not the position that they reveal grossly unfair on the majority of workers in the NHS, medical and others, who are doing a good job? Will my right hon. Friend tell us what action he proposes to take in light of those reports?

I too have read the reports, and I regard them as disturbing. However, they are no great surprise. The primary need—and this is the central point in the document published today—is to strengthen management at the local level—and by that I mean in the hospital and the community. I stress "management" because I agree with what was said to me a few months ago by a wise hospital head porter who remarked "The trouble with the Health Service is that there is too much administration and not enough management".

I agree with what was said by my right hon. Friend the Member for Salford, West (Mr. Orme).Will the Secretary of State admit that there is something rather cheeky about a paper entitled "Patients First" being produced by a Government who have just put up prescription charges to 70p and have squeezed the NHS of money for patients more than any previous Government?

If I wanted lessons on how to manage the NHS, I am not sure that I would go to the right hon. Gentleman. He knows that even 70p, which will apply from next April, is no bigger a proportion of the cost of a prescription than was the 20p charge when it was introduced in 1971. We are doing no more than keeping the charge level with the rising costs of prescriptions.

Will the right hon. Gentleman ensure that in the local units to which he referred the trade unions that organise doctors, technicians and nurses are represented?

No. We are putting forward the proposal that we should not follow up the suggestion of, I think, Mrs. Barbara Castle that there should be automatic representation of staff interests on health authorities. It is noteworthy that in the five years since she made that proposal, during which time a Labour Government were in power, no one succeeded in even bringing forward for consultation a procedure under which that proposal could be implemented. Our view is that staff interests are more properly taken account of in proper joint consultation procedures. We lay great emphasis on that.

asked the Secretary of State for Social Services whether he has received representations from local authority directors of social services about their budget for 1980–81.

Yes, Sir.

Is the Secretary of State aware that the majority of directors of social services are appalled at his insistence that the recipients of social services—the elderly and the sick—have to pay a disproportionate share of the cost of the tax cuts that the Government have given to the wealthy? When will the right hon. Gentleman standup in the Cabinet and fight for the poorest sections of the community?

Perhaps I may commend to the hon. Gentleman and those on behalf of whom he has asked his question an article in Social Work Today at the end of October by a young residential social worker, Mr. Keith White. He says:

"it is deplorable to argue that the social services are being run as efficiently and economically as possible and that therefore nothing can be streamlined. This is naïve and untrue. There are glaring examples of inefficient administration and delivery of the social services."

Will the Secretary of State admit that his disgraceful decision to abolish the Personal Social Services Council was taken because the council was ably pointing out the detrimental effects of the cuts in social services? From whom will the Government get advice on social services—and they are badly in need of advice—now that they have decided to abolish the body set up by the present Secretary of State for Industry?

The impression that I have formed in the past six months is that the Government are not short of advice on the personal social services. We have to see whether we are getting that advice in the most efficient and effective way and without undue overlapping. The Personal Social Services Council has had a number of years of experience and I have concluded that we can probably get advice through other, professional, channels as effectively, and perhaps more effectively. If a body has not proved itself to be essential, I do not believe that the public ought to go on paying for it.

Is the Secretary of State aware that the British Association of Social Workers, of which Social Work Today is the journal, is launching a massive campaign against the Government's cuts in social services? I am a member of the association, which is horrified that many elderly people will probably die this winter who would have stayed alive if the Government had not come to power.

I commend to the hon. Gentleman a further proposition put by Mr. White in his article:

"In the wake of the social work strikes and the emotional harm they inflicted on clients, doesn't the present demand for compassion on the part of others have that hint of hypocrisy?"

I am sure that in issuing the directive to the directors of social services my right hon. Friend had in mind that the problem is that these departments are heavily over laden with administrative personnel. Will he state that the action of the Government in asking for cuts in the social services is principally directed towards administrative personnel and not at the elderly and the sick?

My hon. Friend will know that in paragraph 38 of the White Paper we said that the Government expected that savings would, as far as possible, be made by further increases in efficiency. I hope that both elected members and professional heads of departments are doing their utmost to achieve that.

asked the Secretary of State for Social Services what is the estimated take-up rate of those entitled to free welfare milk and prescriptions and if he will undertake publicity campaigns to improve this take-up rate.

I estimate that for most categories of beneficiary the take-up is 95 per cent. or above. For those entitled to claim on grounds of income the take-up has always been small and now stands at about 4 per cent. The Government already publicise the benefits in a variety of ways and the question of any further publicity would have to be considered in the light of other work and the resources available.

Is the Minister aware that the take-up of free welfare milk was only about 1·8 per cent. in 1977? As these figures will no longer be worked out, according to the Secretary of State, we shall never know what the trend is. That means that about 600,000 families are being deprived of what they should receive in order to maintain family nutriments for proper subsistence. What will the Minister do about this deplorable situation?

The hon. Lady does not have her facts quite right.

Yes she has.

The take-up of welfare milk is not 1·8 per cent. overall.

Yes it is.

It is 96 per cent. for supplementary benefit recipients, 98 per cent. for family income supplement recipients, and 100 per cent. for handicapped children not registered at school. The 4 per cent. applies only to those claiming on low-income grants. Nothing said by my right hon. Friend yesterday affects their position.

Is it not a fact that the situation with regard to prescriptions is disturbing? There is a great shortfall in the number of people taking up their entitlement to free prescriptions. Does not this draw attention to the recommendations of the Royal Commission that all charges in the National Health Service, including prescription charges, should be abolished forthwith?

No, Sir. Information is available on every prescription form about exemption from charges. Posters giving this information are available in doctors' surgeries, health clinics, chemists, hospitals and local DHSS and family practitioner offices, and it is also made known on leaflets that are available from post offices, DHSS offices, and family practitioner committees.

Is the Minister aware that the cuts in school meals, transport and housing, the increases in electricity charges, and now welfare foods, are aimed at large families where the husband is working? These cuts are being made by a Government who talk about incentives for people at work. What does the Minister say about that?

I repeat that nothing that my right hon. Friend announced yesterday about free welfare milk affects anyone entitled to free milk on the ground of low income.

asked the Secretary of State for Social Services if he will give extra financial help to retirement pensioners in view of the substantial increase in the cost of a television licence.

My right hon. Friend has no proposals to make a special payment for this purpose. But the recent increase in the cost of television licences will be reflected in the general index of retail prices and, to that extent, it will be taken into account with other price increases when the rates of retirement pension are next reviewed.

Is the Minister aware that, particularly at Christmas, countless thousands of old-age pensioners will regard themselves as the victims of a cruel deception? The Minister's Department is giving them £10 with one hand, and his right hon. Friend the Home Secretary is taking it back with another. What kind of Christmas gift is that for old-age pensioners?

No, Sir. I think that there was an attempt at cruel deception by the Labour Party when it promised pensioners free television licences, without saying where the money would come from.

Will my right hon. Friend consider what is a sore point, namely that some pensioners pay the full rate for a TV licence while others, living almost next door, do not pay a licence fee at all? This is an anomaly. Will my right hon. Friend look into it?

I assume that my hon. Friend is talking about old persons' homes, for which a small licence fee was introduced in 1969 not as a welfare concession but to correct an anomaly in the licensing of those homes.

I suggest to the right hon. Gentleman that he is the last person to talk about deception. Will he accept that if we are to wait until there is a further uprating of pensions nearly a year will pass between the recent announcement of the increase in the television licence fee and the Government's taking action to uprate pensions?

It is in the nature of pension upratings that between one uprating and the next 12 months later, the cost of living will increase. That is why the fight against inflation is our most important fight, on behalf of pensioners as well as the rest of the community.

asked the Secretary of State for Social Services if he will give his estimate of the cost of making the maternity grant non-contributory.

With the grant at its present level the additional gross cost would be £1½ million a year. This would be offset by an estimated £300,000 paid out by the Supplementary Benefits Commission in lieu of the grant.

As the grant at present goes to everybody except those who need it most, will the Government consider making the maternity grant non-contributory at the earliest possible moment?

As I said in the House on 23 November, the Government are giving the proposal careful consideration, and an announcement will be made when that consideration is completed.

Is the hon. Lady aware that the perinatal mortality rate in then on-contributory group is five times that in class 1? Does she realise that any delay will mean that five times the number of babies born in that group will either be born either dead or with a severe handicap?

The hon. Gentleman is right to point out that there is a problem here. However, we are in danger of creating too strong a link between the level of the grant and the perinatal mortality figures. Probably the more important figures are those that relate to the biological effects of deprivation and poor nutrition in early childhood and the effects of smoking and poor housing in adult life.

Are the Secretary of State and his Ministers aware that in my constituency an officer of the Department is alleged to have said that the Government are seriously considering abolishing certain benefits, and that the maternity grant is one of them?

The House knows that many claims are made by certain people for their own reasons in various constituencies. If the hon. Gentleman will let me know what this claim is, I shall look into it.

asked the Secretary of State for Social Services if he will permit certification of pneumoconiosis for disability pension purposes by two general practitioners.

No, Sir. The diagnosis of pneumoconiosis requires special skill in the reading of radiographs and interpreting the results of clinical examination and lung function tests which pneumoconiosis medical panel doctors have acquired, together with specialist knowledge of the disease in all its forms, through dealing with thousands of cases every year. General practitioners do not have this special training or experience in industrial chest diseases.

Does the right hon. Gentleman realise that in the mining valleys of Wales there is deep distress that the pneumoconiosis medical tribunals are turning down many more applicants than before? About 70 per cent. are rejected, compared with 30 per cent. previously. Will the right hon. Gentleman take seriously what was put to him by the deputation that came to see him? Will he review the matter and take a more sympathetic attitude to those suffering from pneumoconiosis?

I listened carefully to the deputation, but my confidence in the professional ability and integrity of the doctors who serve on the panels is not shaken in any way. Fewer claims are now succeeding because safety precautions have improved in coal mining and other industries which involve a risk of dust disease. Fewer miners are therefore contracting the disease. I should have thought that that would be welcome news to us all.

If the diagnosis of pneumoconiosis requires specialist skill and knowledge, as the Minister claims, why are some panels staffed by junior doctors, some of whom need refresher courses in chest medicine? Why do no people with full-time consultant status serve on the panels? Will the Minister accept the suggestion that there should be one doctor and one full-time consultant on each panel?

No, Sir, I shall not. Ever since the industrial injuries scheme was founded in 1948 claims for benefit for industrial accidents or industrial diseases have been decided by properly appointed adjudicating panels. That system has stood the test of time. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) does not come up to his usual standards when he makes attacks against professional people, who give good service to the community and who are not in a position to answer him back.

Has any advance been made in the diagnosis of asbestosis during the life of the patient? Is my right hon. Friend aware that this disease is as debilitating as pneumoconiosis and that it is difficult to diagnose until after death?

I need notice of that question. If my hon. Friend tables another question or writes to me on the matter I shall answer him.

asked the Secretary of State for Social Services what was the increase in the number of people dependent on supplementary benefit between December 1973 and December 1978.

No direct comparison of the statistics is possible because of a change in the method of estimation, but the number of claimants and their dependants went up by about 700,000.

Does my hon. Friend agree that those figures, together with other means-tested benefit figures, lend support to the immortal words of the former hon. Member for Birmingham, Selly Oak Mr. Litterick, when earlier this summer he said that the present Government have a long way to go before their contribution to the sum total of human misery equals the last Labour Government's contribution?

Yes, Sir.

Given that deplorable increase in the number of people who are dependent on supplementary benefit, why are the Government in their White Paper on reforming supplementary benefit procedures planning to cut benefits to 1,750,000 people? Is that the Government's way of reducing the number of people receiving supplementary benefit?

The hon. Gentleman knows that the 1,750,000 people to whom he referred are mainly single people, who will lose between 25p and 40p at the time of an upgrading in order to bring national insurance benefits and supplementary benefits into line. If we are to achieve a simplification of our social security system we must at some stage, as the previous Government well know, align national insurance and supplementary benefits.

Do not the figures indicate that when the Labour Party continues to inveigh against the evils of selective benefits under the social security system they are guilty of humbug, or worse?

Nobody can provide the perfect answer to these grave problems. I notice a great difference between what was said by Labour Members when they were in government and the line that they now take.

In the light of the swingeing reductions in public expenditure and rampant monetarism, can the Minister say what the increase in the number of people drawing supplementary benefit will be between December 1979 and December 1980?

I cannot speculate on unknown figures. Inevitably, some people will have no entitlement to unemployment benefit and may therefore have to claim supplementary benefit. I am not able to speculate, and it would be wrong to mislead the House by so doing.

asked the Secretary of State for Social Services what was the estimated increase in the number of people awaiting admission to hospitals between 1974 and 1979.

On 31 December 1974, a total of 517,424 people were awaiting admission to National Health Service hospitals in England, compared with 752,422 on 31 March 1979, the latest date for which figures are available. That is an increase of 234, 998.

Does my hon. Friend agree that the figures are an appalling indictment of the National Health Service when presided over by the Labour Party? Do not the figures compare unfavourably with those of our European partners? Can my hon. Friend offer hope that the waiting lists will be diminished, as they were when we were last in government?

Yes. I believe that we shall reduce waiting lists. Britain is the only country in Western Europe where almost half of the hospitals were closed for almost two months to all but emergency admissions. Last winter added 125,000 to the waiting lists.

Is not the really shocking indictment the closure of hospitals, either temporarily or permanently, that is occurring under this Government? How much will that increase the waiting lists for admission in the coming year? Will the Minister come to Derbyshire and talk to the authorities there, because they are having to close seven hospitals this year alone?

Under the previous Administration about 280 hospitals were closed or approved for closure. On 31 March this year proposals for the closure of a further 31 hospitals were made and proposals for the closure of 2,363 beds were in the pipeline.

In order to put the matter into perspective, will my hon. Friend say how many beds are involved and how many urgent cases there are on the waiting lists?

It is difficult to give exact figures of the numbers of beds involved. Across the country over 3,500 beds, in brand-new hospitals, have been opened so far this year. Over 1,000 more beds are scheduled for the next three months.

How can the Minister succeed in tackling the waiting list problem when his right hon. Friend the Secretary of State states clearly to the world at large that he would rather spend more money on defence than on the Health Service?

We are not sitting idly by allowing waiting lists to become worse, as the previous Government did. Only this morning we produced a consultation paper on reorganising management in the National Health Service which we believe will contribute to that end. Last week we issued a clear guide to health authorities and staff so that they know exactly how they stand during an industrial dispute. We have achieved more in a few months than the previous Government did in four years.

asked the Secretary of State for Social Services whether he is satisfied with the level of assistance for disabled children to enable their parents to meet the extra cost of clothing and footwear.

Assistance can be provided in appropriate cases under the supplementary benefits scheme. Mobility allowance and attendance allowance are also available to handicapped children who satisfy the criteria for those benefits. Moreover, the family fund may be able to help families of very severely disabled children and voluntary organisations may assist in particular cases. I have every sympathy with the parents of disabled children, but, as I have already made clear, we cannot consider any further assistance to them in the present economic climate.

What possible justification is there for refusing assistance to my constituents whose daughter has to wear shoes of different sizes? Is the Minister aware that the parents have to spend about £20 every six weeks for two pair of shoes in order to provide one pair of shoes that will fit the child's feet? Why should these parents be penalised financially because their daughter is disabled?

I wrote to the hon. Gentleman about the case of his constituents. They are not on supplementary benefit. Therefore, they have to buy their children's shoes, just as any other parents do. As for the problem of children with a disability which means that they have different sized feet, I was able to send the hon. Gentleman a list prepared by the Disabled Living Foundation of suppliers and retailers who provide odd-sized shoes either for adults or children. I hope that that was helpful.

Can my right hon. Friend assure the House that equal help will be given to those who go to what used to be known as grammar schools, as opposed to any other form of educational establishment?

Yes, Sir.

Is the Minister aware of the tragic case of 9-year-old Stuart Charles Whitehouse, whose family lost an award of £100,000 for damages in the Appeal Court last week? Is he aware of the statement by Mr. Justice Lawton, that cases of medical mishap should be looked after by the community and not subjected to the hazards of litigation? How do the Minister and the Government respond to that urgent appeal, having regard to the report of the Pearson Commission and to the precedent of the vaccine damage payments scheme?

That question contained a number of supplementaries, none of which arose from the original question. However, the tragic case that was recently decided in the High Court underlines the fact that society has not found a satisfactory way of dealing with such cases. They ought not to depend, ultimately, on fine points of law as they have done over past generations.

asked the Secretary of State for Social Services how many hospital beds have been closed in each hospital region over the past month; and how many more closures are contemplated.

A total of 381 beds were permanently closed during November. At 30 September 1979 proposals for closures involving 2,153 beds were under formal consultation. I am circulating in the Official Report figures by region for both categories.

Will the hon. Gentleman tell us by how much these figures will accelerate over the next 12 months? Can he go even further and say whether there is any prospect of this trend being reversed during the course of the disastrous period of existence of the present Government, with their disregard for the enormous benefits that the country has had from the National Health Service since its inception?

If I have followed the hon. Gentleman's question accurately, I refer him to the answer I gave a moment ago. Only this morning we introduced the consultation paper on the reorganisation of the Health Service, which will substantially help in the administration, management and costs of that Service.

Does my hon. Friend recognise that the main reason for the closure of beds was the total failure of the previous Administration to prevent disruptive action in the National Health Service? Does he also recognise that there will be overwhelming support in the country for the proposal produced by my right hon. Friend to ensure that this does not happen again?

Yes, I agree entirely. I should also point out that the appalling and contemptible picketing of Charing Cross hospital increased the urgent waiting list from 213 to 564 patients. That is dreadful.

How many National Health Service units have been closed by the St. Helens and Knowsley area health authority, what is the cause of the closures and what will the hon. Gentleman do about it?

I understand that consultation is taking place on this. It is something that I should be glad to look into and let the hon. Gentleman know the result.

asked the Secretary of State for Socal Services whether he has any plans to reorganise the operation of the child benefit scheme.

asked the Secretary of State for Social Services if he is satisfied that his Department's computer centre in Washington, Co. Durham is now working satisfactorily; and if he will make a statement.

Most of the arrears of work at the child benefit centre caused by industrial action have now been cleared. We are, nevertheless, continuing to examine ways of improving the system.

Can my hon. Friend tell us how many people who should be receiving child benefit are not receiving it, for administrative reasons?

At this moment I cannot give my hon. Friend an exact figure. However, anyone who is entitled to child benefit and whose payment is held up by the continuance of the ban on overtime at the child benefit centre should go to his local office, where there are special arrangements for paying those who are in urgent need of that money.

Will the hon. Lady tell the House whether, in pursuit of improving the operation of the child benefit scheme, it is the Government's intention to undertake an uprating of child benefit in April? Is she aware that if an affirmative answer is not given now it will be too late to operate the improvement?

The right hon. Gentleman knows, from previous exchanges in the House, that I amnot at present in a position to give him an answer to that question. He knows full well that the increase of £1 last April, followed in November by our special increase in the level of support for children in one-parent families, where the parent is unable to work or has no earnings, and for working lone parents is the most that the country could afford at present. As we are required to do, we shall undertake a further review in the coming months.