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Social Services

Volume 35: debated on Tuesday 18 January 1983

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The Grove Maternity Hospital, Barton-On-Sea


asked the Secretary of State for Social Services if he will make a statement on the future of the Grove maternity hospital Barton-on-Sea.

In March 1981, after considering the case put forward for the closure of the Grove maternity hospital, my predecessor decided that the hospital should remain open and be given the opportunity to develop. The Southampton and South-West Hampshire health authority is now carrying out a review of the situation on the Grove's future, but no conclusion has yet been reached.

I thank my hon. and learned Friend for his reply and apologise for continuing to press the case for the Grove hospital. However, is he satisfied that the health authority has done what it was told to do by his predecessor with regard to investment and use of facilities? With regard to the future of the Grove, can he confirm that there is no question that he will become involved until those obligations have been clearly carried out?

I am aware of my hon. Friend's interest in this subject, and he has brought a deputation to see me about the matter. At the moment the health authority is reviewing the future and considering the case, but has reached no conclusions. I will not be involved unless for some reason the authority again decides to propose closure. Before anything was put to me, I should need to be satisfied that the spirit of my predecessor's original decision had been complied with in every way.

What would be the effect on the maternity unit at the Southampton general hospital of keeping the Grove open?

Those are matters that should be left to the health authority. I rely on its judgment in looking at maternity services in the area as a whole, which is what it is doing now. I hope that it will be able to draw up a clear future programme for maternity services that will meet all the queries of my hon. Friend the Member for Christchurch and Lymington (Mr. Adley) and the hon. Member for Southampton, Itchen (Mr. Mitchell).

Kidney Complaints (West Midlands)


asked the Secretary of State for Social Services what representations he has received about the lack of treatment for sufferers of kidney complaints in the west midlands; and if he will make a statement.

I have received a total of 19 representations, of which 11 have been from hon. Members.

Is it not deplorable that purely because of the lack of resources many people in the west midlands and elsewhere will die from kidney disease this year, although there are tried and tested methods of treatment? Will the Minister consider the suggestion that I have made on a number of occasions, that a computer bank system for kidney donors would greatly increase the efficiency of the system?

I accept that one reason for the deficiencies is the unfortunate shortage of donor kidneys. A television programme two years ago did a great deal of damage by reducing the public and medical response to the demand for kidneys. We examine all possible ways to increase supplies of donors. We recently put a new kidney donor card into all provisional driving licences, and we are looking at other ways.

I replied yesterday on the hon. Member's particular point. We look at every suggestion with interest, but there are practical problems with computer donor banks that have to be resolved to make sure that they provide the best value for money in tackling the problem.

Has the Minister considered the possibility of contracting-in for donors of live organs, by computer?

This is a highly controversial and difficult problem, with people holding a wide variety of views about the position of relatives of donors, if a tragic death occurs. We are looking at several propositions and we are actively encouraging as many people as possible to carry donor cards, as this greatly facilitates the taking of kidneys after a tragedy. It has also been suggested that we introduce kidney donor co-ordinators to assist doctors in providing the necessary organs. All the ideas are looked at, but the hon. Member's proposal is controversial.

One-Parent Benefit


asked the Secretary of State for Social Services what percentage of those entitled to receive one-parent benefit are receiving it.

Our latest estimate is that one-parent benefit is being paid to about 70 per cent. of those who stand to gain by claiming the benefit.

Does my hon. Friend agree that, while the figure represents an improvement over the position last year, it is still rather disappointing? Does he propose to take any further steps to try to raise the figure?

I would not wholly agree that the figure is as disappointing as my hon. Friend implies. It represents an increase from only about 60 per cent. when the Government took office. That is a substantial achievement. We are considering further steps to try to increase take-up still further.

I welcome the improvement. Has the Department received any information from the 1981 census that helps to establish that there are more single parents and therefore a genuine need for a continuing review of the uptake?

It is interesting that preliminary findings for 1981 from the Office of Population Censuses and Surveys show that the number of one-parent families may be slightly lower than that on which we based our take-up estimate. In that case the take-up estimate would rise, but I cannot be absolutely certain at the moment.

Given the relatively low level of benefit available to single parents, will the hon. Gentleman make representations to his right hon. and learned Friend the Chancellor of the Exchequer for tax concessions to be made available to single parents who have to hire child minders?

This matter has been discussed in the House on a number of occasions. I have no doubt that my right hon. and learned Friend the Chancellor will register the fact that the point has been raised again.

The Minister says that he is not disappointed because take-up has increased by 10 per cent. Does he realise that £25 million remains unclaimed by people among whom there are a higher proportion of those on the poverty line? Is he not convinced that further efforts to increase the take-up are desirable?

I have explained that we are considering a further effort. I should like to see the £25 million taken up. However, I do not wish the House to under-estimate the achievement in getting the figure up from 60 per cent. to 70 per cent. This is recognised, I am happy to say, by the National Council for One Parent Families.

Greenfield Report (Prescribing)


asked the Secretary of State for Social Services if he will now publish the Greenfield report on effective prescribing.

Is the Secretary of State aware that what is required now is action? Is he not aware that even the pharmaceutical industry concedes that at least £50 million would be saved by implementing this report, which was produced for him last February? Is he aware that it would also help to stop the soap powder style promotion of drugs, which all hon. Members saw documented so well on the "Panorama" programme last night? Will the right hon. Gentleman, having published the report, act upon it to make these savings rather than seek to increase the prescription charge by lop, which would not be necessary if he made this change?

Not all hon. Members have the leisure of the hon. Gentleman to watch television. His supplementary question would have been more appropriate if the Government were not publishing the report. That is what he asks and that is what I am doing. I would therefore have expected him to welcome it.

Does the Secretary of State realise that every Minister since 1950 has urged the use of the British National Formulary or the British Pharmacopoeia in general prescribing? Will he not bring forward legislation to allow clinical freedom for doctors to refuse substitutes but to ignore the brand name percentage that applies at present?

The first stage is to publish the report. The committee specifically did not examine the contribution that the pharmaceutical industry makes either to the discovery and development of new medicines or to the economy generally. I shall want to hold consultations before considering further action.

Is it not clear that the majority of the thousands of drugs used every year in this country are me-too drugs, that they are not the result of original research and development? Will the right hon. Gentleman, when he publishes the report, consult not only the pharmaceutical companies but the medical profession, which knows of the contribution that could be made to the National Health Service?

We shall consult the medical profession as well as the pharmaceutical industry. I hope that the hon. Lady will agree with me that it is important to consult the pharmaceutical industry, which is responsible for net exports worth about £570 million. The industry also employs 70,000 people. That is important. I accept what the hon. Lady says about the medical profession being consulted.

Will the Secretary of State ask, at the same time, why there is such a disparity between the prices of the same drugs in this country and on the Continent?

As the hon. Lady must know, we have a pharmaceutical price regulation scheme which was accepted by the previous Government, as was the promotional cost scheme. We are prepared to look at these matters.

Community Nurses (Cars)


asked the Secretary of State for Social Services whether he intends to provide cars for community nurses who need them to visit their patients, as recommended in the Acheson report on primary care.

The Under-Secretary of State for Health and Social Security
(Mr. Geoffrey Finsberg)

This is one of a number of recommendations in the Acheson report about the living and working conditions of community nurses. There is already provision in a national agreement of the general Whitley council for the allocation of Crown cars to staff who need them for their work. Only the health authority locally is in a position to assess the need for cars to be allocated and how effective this would be in aiding the recruitment and retention of nursing staff. The alternative is the payment of mileage allowances to staff using their own cars.

Is the Minister aware that it is precisely the difficulties of that system that are highlighted in the Acheson report? Is he aware that the report shows that London community nurses are at a disadvantage over transport compared with nurses in what are characteristically described in the report as country areas? Does the hon. Gentleman agree that there should be a national levelling-up of provision, primarily in the interests of patients?

The hon. Gentleman must realise that this is part of the series of recommendations in the Acheson report. We are still considering the action that is necessary. We announced some time ago an additional sum of money for particular purposes. The hon. Gentleman must also realise that there is virtually no pressure from staff for the provision of Crown cars. Most staff prefer to use their own cars because of the contribution towards standing costs within the mileage allowances.

As the Minister has referred to the feelings of staff, does he appreciate that there is a widespread sense of injustice over the need for community nurses or health visitors to provide their own cars to do their job? If he is not willing to provide money for community nurses and health visitors to have cars provided by their employers, will he talk to his right hon. and hon. Friends in the Treasury about the injustice of taxing the mileage allowances?

I shall convey the hon. Gentleman's remarks to my right hon. and learned Friend the Chancellor of the Exchequer.

Ealing-Hammersmith Hounslow Family Practitioner Committee


asked the Secretary of State for Social Services, pursuant to the answer of the Minister of State, Official Report, 30 November, c. 135, whether an official of his Department telephoned the administrator of Ealing-Hammersmith Houslow family practitioner committee during the past six months and inquired about the political affiliations of some members of the family practitioner committee.

I now find that such inquiries were in fact made in connection with letters which my hon. Friend the Member for Hampstead (Mr. Finsberg) wished to send to members of this and other committees. The inquiries concerned only those committee members who are also members of local authorities. I have investigated the matter and I can assure the hon. Member that there was no motive for the inquiry other than to assist my hon. Friend in adopting a personal approach in his letters to the members concerned.

That seems to be a denial of what was stated previously. It seems that there may be some chance of the Minister coming clean to the House this afternoon. Will he explain what possible justification exists for making inquiries about the political affiliations of members of these committees? Is it not a disgrace?

My previous reply said that I was not aware of these approaches and that I had not authorised any. That remains the case. It is also true of my hon. Friend the Member for Hampstead. My hon. Friend wished to write to members of five FPCs about a problem with which he is dealing over offices at Wembley. An official decided that it would be helpful in writing personal letters if he knew the political affiliations of the elected local councillors of the FPCs.

Rather than look up the political affiliations of these councillors, which is publicly available in a book, the official decided to ring up the office and inquire about the political affiliations. Once Ministers discovered that, the inquiries were, of course, ended.

Can we all know what their political affiliations were? As the Minister has the information, will he publish it in the Official Report?

The Greater London council already fulfils that service for us. One can buy a document which gives London election results together with the political affiliations of every councillor, including those who serve on FPCs. Our official decided to engage in the cost of a telephone call rather than pay £7 to the Greater London council. Either method is open to the hon. Gentleman and anyone else.

What was the difference in the text of the letters that made it necessary for the official to know which letter to send to which councillor?

At that stage my hon. friend had not sent any of the letters. The intention was that he could vary his manner of address according to their party, if he so wished. Each Minister and each Member of Parliament follows his own practice. In correspondence I refer to more of my hon. Friends as "Yours ever" than I do to my opponents. It is entirely up to my hon. Friend what form of address he adopts.

Death Grant


asked the Secretary of State for Social Services if he will now make a statement of the future of the death grant.

We have not yet completed our consideration of the future of the death grant following public response to the consultative document. I shall make a statement as soon as this is complete.

Is it not already clear that all the proposals in the Government's consultative document are unacceptable to pensioners' organisations? Will the Government press ahead and provide a decent increase in the death grant so that old people need no longer live in fear of being unable to afford a decent burial?

It is also perfectly clear that the resources do not exist to pay a substantially increased death grant to rich and poor alike. If I had that kind of money available, I should use it for other priorities.

Will my hon. Friend look at the problem of funeral expenses facing widows whose husbands are on long-term sickness benefit for a considerable time and then die? It causes great difficulty and hardship, and the policy in this regard seems to be confused.

It had been our intention, as a result of the consultative document, to redirect resources to the area of greatest need. Unfortunately, we did not receive sufficient public support for that approach. Therefore, we have to reconsider the matter.

Does the Minister recall saying on 31 March that he looked forward to

"a quick and favourable response to … the consultative document".—[Official Report, 30 March 1982; Vol. 21, c. 175.]
Was not the response predominantly unfavourable? Does not the fact that we have not yet had any proposals suggest that the Government have decided to drop the means-testing of the death grant this side of the general election?

Fifty five per cent. of those who replied were not in favour of any of the proposals in the consultative document. All the same, a number of people replied in favour of one or other of the options. It is regrettable that we do not have public support to put resources where they are really needed and, because we do not have that support, we are having to consider the matter de novo.

Is not my hon. Friend confusing public support with the expression of opinion from a sizeable number of people who could have been expected in the first place to take the line that they did? Has not the time come for the Government to grasp the nettle and pay a sizeably increased death grant to those who need it? Is it not clear that this is a case where selective use of the public social services is highly desirable?

It can equally be said that because only 630 responses were received to the consultative document there is not a great deal of public interest in the matter anyway. That is perfectly arguable, when one considers the millions of people who are affected by this matter. Of course the Government have to come to a conclusion, and I hope that it will be possible to make an announcement in the not-too-distant future.

How many of the 630 responses were from representative bodies that represent many more than one individual response?

Some were from representative bodies on both sides. For example, the ex-service organisations very much supported the proposals. I do not want to give the hon. Gentleman an accurate figure, but I shall certainly give it to him in writing, if that is what he wishes.

Tobacco Advertising


asked the Secretary of State for Social Services whether he is satisfied that the code of practice for tobacco advertising makes adequate provision for advertisements contained in magazines given away free.

Is the Minister aware that High Life magazine, the in-flight magazine of British Airways, carries cigarette advertising with no Government health warning? Even if the company can dodge the Government code of practice, because of certain terms in the code, does it not have a moral responsibility, as one of our big national organisations, to ensure that that advertising carries health warnings? Will the Minister make sure that health warnings are included in future?

The answer to the latter part of the hon. Gentleman's question is "No". The present arrangements for the Advertising Standards Authority and the new voluntary agreement specifically are not meant for magazines such as the one that the hon. Gentleman mentioned. Such publications are designed basically for passengers who are not in this country. The advertisements are aimed basically at duty-free sales. Exactly like our predecessors, we do not intend to move on this matter.

Does my hon. Friend agree that the limit of bullying the tobacco industry had just about been reached, and that if Government pressure continues to be applied to the tobacco industry there is a real risk of the industry reaching virtual extinction, with the loss of many thousands of jobs at home and abroad?

In replying to my hon. Friend, I must make clear the appalling dangers that people run if they smoke. I think that that is accepted on all sides. The voluntary agreement that we were able to negotiate on this occasion is a substantial improvement on those that went before, and, in my opinion, the co-operation that we receive from the industry shows that it understands its responsibilities very well.

Has the Minister seen the grim figures published by ASH last week, which show that because of smoking 8,213 Scots will die and that a further 15,774 Scots will be admitted to hospital during the current year? In view of those grim figures, does the Minister accept that the time has come to do something more effective to discourage this expensive form of suicide?

The hon. Gentleman should not assume that a ban on advertising will reduce the amount of smoking. Finland, which banned smoking advertising in 1977, now finds that cigarette consumption is rising, whereas here it is declining.

Will my hon. Friend explain one thing? I accept that many things that human beings do to themselves are not very good for them, but why is it necessary to take these steps for cigarettes, when apparently it is not necessary for drinking alcohol or sniffing glue?

The difference is that there is a danger in smoking cigarettes, however few one smokes. There is no danger in sensible drinking.

National Health Service (Pay)


asked the Secretary of State for Social Services what recent discussions he has had concerning the creation of a pay review body for the National Health Service; and if he will make a statement.


asked the Secretary of State for Social Services what recent discussions he has had with the Health Service unions concerning the pay dispute; and if he will make a statement.


asked the Secretary of State for Social Services whether he proposes any early meeting with the health services committee of the Trades Union Congress to discuss health workers' pay.

Following the ballot of the Royal College of Nursing and the decision by the TUC health services committee to resume negotiations on the basis of the two-year settlement offered by the Government, agreements covering the period to 31 March 1984 have now been concluded in most of the NHS Whitley councils.

Settlements for the remaining staff groups are expected to be agreed in the very near future. Normal working has now been resumed throughout the Health Service. Consultations will begin shortly on the establishment of the new review body for nurses, midwives and professions allied to medicine. I hope that discussions with representatives of other Health Service staff will begin shortly to consider new arrangements for determining their pay in the longer term.

When will the Secretary of State announce the setting up of a body to cover staff other than the nurses of whom he spoke and those associated with them? Will that body contain a structure that will enable the management and trade unions to establish acceptable pay and conditions for those very deserving staff?

I do not envisage a body such as the review body to be set up for the other staff groups. However, I envisage the start of discussions with the Health Service unions as soon as possible in an effort to get new and better arrangements for the longer term.

Is the Secretary of State aware that 3 million working days were lost, compared with the 600,000 that were lost during the winter of discontent, as a direct result of his inability to settle the dispute sooner? What responsibility does he accept for the increased waiting lists?

I entirely reject what the hon. Gentleman says. We have achieved a fair settlement and not the surrender over which the previous Government presided. My regret is that industrial action continued for so long when a settlement was available much earlier. If the hon. Gentleman is trying to ascribe responsibility, I suggest that he considers the responsibility of the Labour Opposition, who at no stage condemned industrial action in the Health Service.

Will my right hon. Friend be careful to ensure that the new body does not turn into another Clegg commission? In comparing salaries, will he ensure that it is remembered that in the public service there is very great security compared with that in the private sector, where there are risks and strains and often redundancies?

Yes, but I think that my hon. Friend will agree that the nurses' review body recognises the special position of nurses and other professional groups which do not take industrial action. It is right to recognise their position and that is what the review body is intended to do.

The review body may not be independent enough, because it will take account, presumably, of the views of Conservative Ministers in fixing wage rates. Are we to learn that there will be a split between SENs and SRNs? Is the right hon. Gentleman seriously suggesting that he should even offer other parts of the profession terms inferior to those offered by a review body?

It has been made clear to the review body that we are consulting on how many and on what groups will be contained within its considerations. It has been clear from the beginning that there will be no question of the review body covering, for example, ancillary workers, administrative workers and clerical workers. We have made our position clear.

The giving of evidence to the review body will be like giving evidence to the doctors and dentists review body. The Government will give evidence to the review body and the review body will consider it.

Has my right hon. Friend any information about the other strike—in social security offices, which recently terminated in Birmingham and in the Oxford area?

I am not sure whether my hon. Friend's supplementary question stems from the main question. However, she will be aware that the strike to which she has referred has come to an end, which I welcome.

Why has the right hon. Gentleman arbitrarily excluded entire sections of the NHS? That is not sensible and it can lead only to even more aggravation.

The hon. Lady is being ridiculous. She has never advocated a review body for the whole of the Health Service. I have made it clear from the beginning that the review body recognises the special position of nurses, who do not take industrial action and who have never—certainly not under the previous Government—had any satisfactory system of determining pay. There is a background in the general labour market against which comparisons can be made with ancillary and administration staff and others. I think that the hon. Lady has a dud point.

Supplementary Benefit (Application Form)


asked the Secretary of State for Social Services what recent representations he has received regarding the size and complexity of the new form for application for social security benefit.

About a dozen representations from local authorities, bodies providing advice services or representing workers, and individuals, were made in the six weeks prior to the form's introduction on 6 December 1982. The hon. Gentleman has, of course, followed up the representations that he made at that time.

Does the Minister not realise that far more representations are coming to individual Members of Parliament than the number to which he has referred? Is this not the result of the form-filling that is required? I think that the form contains 104 questions. This is a deterrent, because many of those who are called upon to answer the questions set out in the form are already depressed by the position in which they find themselves. Does the Minister accept that this position, and the new form, are the result of the Government's economic policies, which are driving hundreds of thousands into over-crowded DHSS offices? Due to the overcrowding, the staff have to give claimants a form to complete so that they will leave the offices instead of remaining in them. Is this not the fact?

No. Our purpose in introducing the form was to try to improve rather than damage the administration of the social security system, not least to ensure that the unemployed who claim supplementary benefit do have to go to two offices instead of one. The form helps also in rural areas, where there were particular difficulties. The number of questions is related to the information that is required—whether on a form or by interview—to assess a claim for supplementary benefit.

Will the Minister say whether, at this early date, any special problems have arisen from one of the very last questions on the form, which asks the recipient whether he or she is a registered blind person? Is that the sort of question that should be left until the end of such a form, or the sort of question that should be on the form in the first place?

The form makes it clear that anyone who experiences difficulties, including blind persons and those who have language problems, will find help available from the staff at the offices. I am not aware that any problems have shown up in the monitoring exercise. If they do, we shall change the form.

I really want to ask a supplementary question to the next question, Mr. Speaker.

Retirement Age


asked the Secretary of State for Social Services if he will take steps to introduce retirement for men at the age of 60 years; and if he will make a statement.

In its report on the age of retirement the Social Services Committee has put forward proposals for phased transition over 10 years towards a scheme of flexible retirement between age 60 and 65 for both men and women. I am currently examining these proposals and the Government response will be published shortly.

Is the Minister aware that if the Government have any serious intention of reducing the massive unemployment totals they will do so not only by reflating the economy, which is important, but by progressing towards a shorter working week and a shorter working life? If the Government can find £2 billion to spend on the Falklands for 1,500 people—some say £3 billion—and if they can spend £10 billion on Trident, why cannot they spend a few billion pounds to achieve retirement at 60 for men, so that many of the youngsters who want a job will be given one?

A change in the state pension age must be regarded as a long-term change for which a great deal of preparation must be made. It is not one that can be fixed only in accordance with short-term economic considerations. The Government have extended the job release scheme because they consider it to be a more cost-effective way of reducing unemployment. We have also ensured that the long-term rate of supplementary benefit is now available to men of over 60 who were on low incomes and who have been unemployed for a year or more.

Will my hon. Friend accept that I thoroughly agree with his long-term aim of flexible retirement for both men and women? Will he agree also that it is crucial that we keep in step with our colleagues in the other European countries so that we are not caught at a competitive disadvantage?

Clearly that is a factor that will have to be taken into account. However, my hon. Friend will realise that I cannot anticipate the formal response that the Government will make to the Committee in due course.

General Practitioner Statistics (London)


asked the Secretary of State for Social Services what proportion of people living in London are not registered with a general practitioner.

This information is not routinely available. A recent survey by the Office of Population Censuses and Surveys suggests that 5 per cent. of people living in inner London are not registered with a general medical practitioner under the National Health Service.

Is it not the case that in London a larger proportion of people are not registered with a doctor than in other parts of the country? Is this not due to the reasons that are given in the Acheson report, which suggest that in London doctors are older, that premises are less satisfactory and that there are more single practices? Does the Minister think that some action should be taken to implement this section of the Acheson report?

I remind the hon. Gentleman that Professor Acheson's study group took the view that a non-registration rate of 5 per cent. or less could be regarded as insignificant. The survey that I have quoted shows that no special remedial action is needed.

In view of the disproportionate number of elderly doctors in the inner city areas and the number of doctors who want semi-retirement by having shorter lists, will the Minister restore the encouragements previously in existence for setting up new health centres?

I am prepared to consider that matter, but the hon. Gentleman ought to know that of the 35 medical practice areas in inner London, 34 are classified as being well or adequately doctored, so the problem is, at worst, patchy.

Treatment Methods And Centres Of Excellence


asked the Secretary of State for Social Services what consideration is given to the central funding of new methods of treatment and of regional centres of excellence.

New methods of treatment are normally funded by individual health authorities from the funds made available each year to them. Where a service involves substantial expenditure and is of national interest, arrangements may exceptionally be made for central funding.

I thank my hon. and learned Friend for his reply. May I ask about the new method of kidney treatment that is being developed in Birmingham, which has fallen on the charge of the finances of the district health authority, which is unable to sustain it, and, similarly, about the centre for neurosurgery at Smethwick, which has suffered with regard to grants for the same reason, compared with Sheffield, for example?

The need for renal treatment is widespread and must be handled on a regional basis. The West Midlands regional health authority is giving high priority to its renal services. It has been financing a new transplant unit at Stoke and new dialysis services at Coventry, for example. It has had to put a cash limit on a service in Birmingham, but overall the region is spending more money than before on renal services and is treating more patients. It intends to continue to do so. The future of the new unit at Sandwell will be looked at by the region in the first place, which is now consulting on its regional services. If it comes to us with a proposition, we shall look at it with interest.

Is it not disgraceful that patients are denied the benefits of the new treatment developed at the centres of excellence simply because central funding is not available and those centres cannot afford the cost themselves? Can the Minister help?

As I have just explained, central and regional funding for those services has been expanded rapidly. Some £2 million a year more is being spent in the west midlands on renal services than was the case three or four years ago. There has been restraint on one centre providing one form of treatment in Birmingham, which was outstripping its budget by far, but the general picture in the region is that more money is being spent on services and more patients are being treated. I am assured by the region that it is setting itself higher targets.

While the Minister is considering the funding of those centres of excellence, may I draw to his attention the fact that in Manchester we have numerous hospitals of excellence, such as Christie's, and those dealing with plastic and neurosurgery? Is he aware that a burden is being placed on the social workers of the city and that while 93 per cent. of patients attending Christie's cancer hospital are from outside Manchester, Manchester ratepayers have paid £1½ million to support the social workers?

When it comes to funding the hospital service, which is the responsibility of the Government, we compensate health authorities for the cost of treating patients who come from outside their district and immediate locality. With regard to funds for the service as a whole, the latest public spending round produced an extra £80 million on top of previously published plans for the Health Service, which will allow for real growth in services next year.

My right hon. Friend the Secretary of State will shortly make an announcement about the distribution of that extra money to each and every health authority.

Overseas Visitors (Hospital Treatment)


asked the Secretary of State for Social Services what has been the cost of administering charges for hospital treatment of overseas visitors since 1 October.

Is the Minister aware that first impressions suggest that the Opposition's predictions are proving correct and the new system is wasting the efforts of hospital staff and administrators, adding to the administrative costs, confusing and inconveniencing patients and adding hardly anything in terms of increased revenue? How soon will the Minister conduct a review to see whether that is correct? If that is correct, will he give a pledge here and now that he will withdraw the new system?

The scheme has been operating for only three months. It would be silly to come to firm conclusions now. There is absolutely no evidence of extra staff being taken on. I have no reason to doubt the original findings of the working party, which concluded, before the setting up of the scheme, that the administrative costs would be minimal.

Is it not both common sense and good business practice to ensure that the cost of administering charges is less than the revenue collected? What is the Minister afraid of?

The Minister is not afraid of anything. If the hon. Gentleman wants to swap common sense, the general principle that we are applying is this. When we go to the United States or Japan, we have to pay charges and we have to insure. The Government say that there is no reason why visitors who come from the United States to this country should not also have to pay charges.