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Oral Answers To Questions

Volume 75: debated on Tuesday 12 March 1985

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Social Services

Severe Weather Payments

1.

asked the Secretary of State for Social Services if he will estimate how much has been spent up to the latest available date in the current financial year on exceptionally severe weather payments.

The Parliamentary Under-Secretary of State for Health and Social Security
(Mr. Ray Whitney)

The information requested is not available centrally, and could be obtained only at disproportionate cost. When the period during which payments can be made is over, local offices will be asked to make a return so that the total number of payments made this winter and the cost can be worked out.

Now that the cold weather is, we hope, behind us again, does the Minister admit that the criteria for triggering the payments have been utterly discredited? Does he agree that, in future, any such payments should be based on temperature conditions that are the same throughout the country? Is not the idea that the Scots and others should be denied help with their heating bills because they are either hardier or thriftier nonsense?

I do not agree that the system has been discredited. Certainly, the operation of the system, which is undoubtedly complex, is being examined. The hon. Gentleman, like a number of his hon. Friends, continues to confuse the operation of this system — which is designed to give budget help in exceptional circumstances —with the quite different question of a cold climate allowance. As Governments of both complexions have understood it, it is generally considered that the arguments in favour of one national benefit scale are stronger.

Is the Minister aware that although the payments recently made south of the border were entirely commendable, great offence was felt in Scotland at missing out, because the temperatures there are usually lower? Will he ensure that, in future, payment of cold climate allowance—such as that contained in a Bill to be proposed by my hon. Friend the Member for Dundee, East (Mr. Wilson), and the principle of which has been contained in other Bills proposed by other hon. Members —is considered by the Department?

Again, the right hon. Gentleman is confusing two separate issues. The criteria for exceptionally severe weather payments are very clear, objective, laid down and are available to the right hon. Gentleman if he consults the Library. The argument for a cold climate allowance has been very carefully considered during our social security reviews and has consistently been rejected by Governments of all complexions.

Is my hon. Friend aware that many poor pensioners prefer to remain cold rather than get into debt? Will he ensure that before next winter there is in operation a fair and sensible scheme that will ensure that every pensioner is at least able to keep one room at a temperature of not less than 70 deg F?

I repeat that the operation of the system for exceptionally severe weather conditions is under careful examination. I remind my hon. Friend that the major support for heating comes from our supplementary benefit rates, which we have maintained at levels above the rise in the cost of living. I also remind my hon. Friend that the Government are now spending £400 million a year on basic heating additions. This figure is £140 million higher than the amount spent by the Labour Government. I would also point out to him that the level of heating payments is kept significantly ahead of the rise in the cost of energy prices.

Twice in my hearing the Minister has said that the severe weather payments system is under review. Will he give the House a guarantee that the review will be completed and a decision taken so that the same nonsense does not occur next winter?

Does my hon. Friend recognise that our weather has an extraordinary propensity to change from day to day? This system must be extraordinarily expensive to administer. It is about time we called it a day. It is plain daft.

I can only assure the House that the system is under review. It has operated for only two years. Every system that has sought to deal with the matter has run into similar problems. I also remind my hon. Friend that the major help for heating, as with other household additions, comes from our supplementary benefit and other social security programmes. It is important not to get this small addition out of perspective.

Is not this bureaucratic obstacle course of a benefit a monumental farce when pensioners often have to wait weeks or months for the payment, and even then sometimes receive only a footling 50p? When will the Government take some real action, such as restoring the £1 cut in heating allowances which they stole from pensioners last November, building up the home insulation programme which they are now running down and scrapping these absurd severe weather payments in favour of a special fuel payment of £5 a week throughout the period from October to March?

I remind the hon. Gentleman that the action taken by the Government lies in the fact that, for example, our heating additions payments of £400 million a year are £140 million a year more than they were when the hon. Gentleman graced the Government Benches. I also remind him that this Government have kept all the supplementary benefit rates higher than the cost of living.

Doctors And Dentists

2.

asked the Secretary of State for Social Services how many doctors and dentists undertook National Health Service work at the most recent count; and what was the comparable figure in 1979.

The most recent figures (September 1984) are of 67,300 doctors and 17,200 dentists in the National Health Service in England. Comparable figures for 1979 were 61,600 and 15,300. Growth is 9 per cent. in the number of doctors in the National Health Service, and 12 per cent. in the number of dentists, over the last five years.

Does my right hon. Friend agree that these figures provide further evidence of an improvement in the National Health Service since this Government came to office and that they make nonsense of the remarks by the Opposition about cuts in the National Health Service?

I agree entirely with my hon. Friend. The figures established that this Government are devoting more resources to the National Health Service, that they are employing more doctors and dentists and, above all, that they are providing more services for patients.

Is the Secretary of State concerned about the fact that consultants regularly appear in court to give evidence during the time that they are employed by the National Health Service and that they pocket fees from the National Health Service and also very substantial fees for giving medical evidence? Does the Secretary of State agree that this is a potential abuse? Will he therefore look into it? Does the Secretary of State agree that if money could be saved in this way there would be less need for the Secretary of State to come to the House, as he did yesterday, and announce an increase in prescription charges?

I shall look at any evidence that the hon. Gentleman can provide, although I hope that he will not persist in making generalised accusations against the medical profession.

Will my right hon. Friend preserve the freedom of doctors and dentists to help private practice evolve with the Health Service and to stop the accusation of cheating levelled at them by the Opposition?

Yes. Action will clearly be taken on any abuses which are brought to my attention or which my statutory auditors find. That general and dental practitioners should have a right to private practice is clear and is the Government's policy.

How many people who need dental treatment are failing to turn to the NHS for that treatment because of its high cost, currently £15 for a couple of fillings, going up to £17.50? Many families must now be in need of dental care but are not receiving it from the system.

The hon. Lady should look at the figures. In 1979–80 there were 27 million courses of treatment and today there are 31 million courses of treatment. In other words, the courses of treatment are increasing, not falling.

Lone-Parent Families

3.

asked the Secretary of State for Social Security if he has estimated the increase in demand on personal social services which is caused by the increase in the number of lone-parent families.

The Parliamentary Under-Secretary of State for Health and Social Services
(Mr. John Patten)

The Government's plans for expenditure on local authority services take account of pressures on the personal social services, including the effects of increasing numbers of lone-parent families. For individual local authorities the grant related expenditure assessments are calculated using the latest available estimates of numbers of lone-parent families.

Does the Minister accept the view of the National Council for One Parent Families that the GREA levels do not reflect the real needs of one-parent families? What extra help will he provide for those 13 inner London boroughs which have the highest proportion of one-parent families in Britain? In particular, what extra help will he give to Hackney, which, in order to get down to the GREA levels for the under-fives, would have to reduce expenditure by 43 per cent?

I recognise the particular problems of Hackney, which, I understand, has the highest proportion of lone parents of any London borough or any other part of the country. I appreciate the hon. Gentleman's concern for it, but he must ask himself why other London boroughs with almost as high a number of lone-parent families, such as Hammersmith and Fulham, manage well without rate capping and his authority cannot.

In assessing the extra needs of lone-parent families, will my hon. Friend examine the other benefits given to them, particularly milk tokens, which are subject to considerable abuse. Will he consider altering that system? A monetary payment might be the right answer to tokens abuse.

We shall certainly be looking at that in the course of my right hon. Friend's social security review. My hon. Friend referred to other sums and benefits available to lone parents. Let me point out that, for example, benefit for one-parent families has gone up by 112 per cent. since the Government took office, well ahead of the rate of inflation.

Does the Minister not recognise that it is not only the increasing number of lone parents that increases demands on social services, but the increasing number of unemployed and the very old? If so, why are the Government using rate capping and other rate penalties to reduce spending to inadequate levels as set by the grant related expenditure assessment? Do they not want provision to be by businesses to those who can afford it, while those who cannot afford it will have to rely on charities or, worse still, have no service?

Local authorities throughout Britain have increased their expenditure on personal social services by some 18 per cent. in the past five years. They must set their own priorities. The hon. Lady could better spend her time pointing out good practice to boroughs, such as her own, which sometimes have rather bad practice.

Board And Lodgings Allowance

5.

asked the Secretary of State for Social Services how many representations he has received concerning the proposals to place a limit on the board and lodgings allowance.

We have received a large number of representations about the proposals directly, and the Social Security Advisory Committee has received over 500.

Is the Minister aware of the disastrous effect that that change would have on organisations such as the Oldham single homeless project, which has now been operating successfully for seven years in Oldham? Is he aware that it would split families in the same way as the old means test did 50 years ago? It would also affect the young unemployed, who, even if they did get on their bikes, would be unable to find work outside their local area.

I see no reason why it should have the effects that the hon. Gentleman has described. I hope the House will agree that it is no service whatever to young people to give them undue encouragement to come to the big cities and then to trap them on benefit rates which mean that they cannot possibly afford to take work.

Will my hon. Friend confirm that since 1979–80 the cost of board and lodgings allowance has risen by some 900 per cent? What will be the estimated cost in 1985–86 after the changes, and how does that compare with 1979–80?

At the moment I cannot give my hon. Friend an estimate for 1985–86. However, between December 1982 and the estimate for December 1984, the total of those payments, including residential care, has risen from £205 million to £570 million. No responsible Government could allow that rate of increase to continue.

Why has the Minister decided to make this change when he refuses to contemplate any of the sensible suggestions for improvements to other benefits and allowances, which have been put forward by hon. Members on both sides of the House, on the basis that a full-scale review of social security policies is taking place? Why has the hon. Gentleman gone ahead with this change when he refuses to show the same willingness to make sensible adaptations elsewhere?

We have made the change for the reasons that I have already made clear. We are doing no service to many of those who gain from the increase in benefit, and the increase is proceeding at a rate that makes it more difficult to do what we would wish to do for those in genuine need.

Is the Minister aware that one of the groups to suffer most from this cut in the board and lodgings allowance will be the men who are kicked out of their homes as a result of his proposal to close 21 DHSS resettlement units? Is it not dogmatic privatisation of the worst kind when it is directed against people who, in addition to being homeless, have severe psychiatric problems? Do the Government not care that many of those men will not receive proper care in the community, and will die sleeping rough?

The hon. Gentleman has an absolutely relentless tendency to go completely over the top with any argument that he adopts. He referred to the resettlement units, but he should bear in mind that a significant number of those establishments are found in old-fashioned, decrepit, old RAF camps on the outskirts of our big cities.

I accept that not all of them are in that situation, but our declared purpose is to ensure that current resources are used to provide what we regard as more effective services to meet the needs of those people.

Mentally Ill People

6.

asked the Secretary of State for Social Services if he has received any representations concerning the level of local authority support for the mentally ill.

Yes, Sir, I have received representations from several hon. Members and others since my right hon. Friend answered a similar question from the hon. Gentleman last October. The Social Services Committee has also produced its report on community care which bears on this matter.

Does the Minister agree that, at the very time when it is his policy to discharge people from mental illness hospitals into the community, there is an additional obligation on local authorities to provide adequate care? Will he condemn the decision by Wandsworth council to cease funding the Bolingbroke day centre for the mentally ill, which means that some of the most vulnerable people in our community will be thrown onto the streets?

Local authorities are the junior partners in the movement of the mentally ill into the community, because money can be moved with patients into the community. Year on year we are providing better standards of community care, with increased numbers of day hospital places, increased numbers of day centres and, perhaps best of all, a substantial increase in — nay, doubling of — the number of psychiatric community nurses.

I am grateful for my hon. Friend's assurance that provision in the community for the mentally ill is not entirely a matter for the local authorities, and that health authorities also have a very major role to play. Will my hon. Friend take steps to ensure that mental illness hospitals are not closed before adequate provision is made in the community for those displaced, and that a flexible system of bridging finance is introduced, on the ground that the receipts from the sale of hospitals can be several years delayed from the initial capital provision required for the community facilities?

These closures of large hospitals are proceeding rather more slowly than many of us might like, because careful discussions have to take place between local authorities and local health authorities. Sometimes the root of the problem has been found to be not lack of finance, but lack of really good joint planning.

Will the Minister promise to investigate the special difficulties faced by the Salford health authority and the Salford city council regarding the discharge of patients from Prestwich hospital?

My right hon. and learned Friend the Minister for Health recently considered the problems of the Salford health authority.

Will my hon. Friend accept that if a policy of caring for the mentally ill in the community is to work, the mentally ill must be absorbed into the community at a rate with which the community can cope? Bearing that in mind, will he stress to local authorities that they must consider the extent to which people can be absorbed into their particular community, instead of, in some cases, issuing planning permission at random for a particular area because the houses there happen to be acceptable?

Planning permission is obviously an important part of the matter, and I know that there can be emotive issues, as there are in my hon. Friend's constituency. At the root of getting the relatively small number of the remaining mentally ill into the community, whom we judge can go into the community—there are about 5,000 — is not only money, but good joint planning between the health and local authorities to ensure that those people are well and properly placed.

Although I appreciate what the Minister said about the transfer of resources with patients from health authorities to the local government sector and voluntary bodies, will he accept that local authorities are anxious about the continuation of funds for places after the deaths of the patients with whom those funds come? I noted the comments from both sides of the House about the need to be sensible about the problem. Will he take them on board and examine ways to encourage local authorities to accept their responsibilities in that regard?

There are long-term issues to be considered. For the life of a patient, funds are transferred on a named basis with a particular patient.

Is my hon. Friend aware that the Select Committee on Social Services, which recently reported on community care, expressed deep anxiety about the ready availability of rhetoric and principle and in some cases the considerable lack of action and practice? Will he comment on its recommendation that the Department's social work service has an important role to play in the setting and maintenance of standards throughout the country, possibly through an inspectorate?

My hon. Friend talks about the readiness of rhetoric, and I listened carefully to what she said about that point. We welcome the report of the Select Committee on Social Services, on which my hon. Friend gives such distinguished and painstaking service. The report has 101 recommendations, and we shall respond in detail to each recommendation, including the reference to rhetoric which my hon. Friend mentioned.

Is the Minister aware that many of the local authorities which want to do more to provide community care for the mentally ill now say that they are in a Catch-22 situation? In seeking to observe the Government's rate laws, they find it increasingly difficult to discharge their mandatory duty to the mentally ill and others under the Chronically Sick and Disabled Persons Act 1970. What are DHSS Ministers doing to persuade Treasury and Environment Ministers of the need to ensure that adequate funds are available for the full implementation of that Act?

Bad authorities which cannot run good social services departments should look at the best practice of good social services departments, which are run predominantly by Conservative-controlled local authorities.

Limited List Prescribing

7.

asked the Secretary of State for Social Services what representations he has received since he announced his revised limited list about a possible appeal mechanism for the prescribing of non-listed medicines.

13.

asked the Secretary of State for Social Services how many representations he has received concerning the revised final version of his limited list of drugs available on the National Health Service.

We have received 123 letters commenting on the selected list which I announced on 21 February. Ninety-five have been from doctors or patients, of which 11 have been about a mechanism which would enable drugs not available at NHS expense to be prescribed in particular circumstances.

As the Minister has conceded that his first attempt at a limited list was unsatisfactory, why is he so self-confident as to believe that his second attempt is absolutely perfect and foresees every possible clinical need, given that some doctors believe that even with the new list they will be unable to prescribe appropriate pain killers for some cancer sufferers? Does he recognise that he may greatly reduce the opposition to the limited list if he provides a mechanism through which special cases could be dealt with and had it in operation as soon as the list comes into operation?

I hear what the hon. Gentleman says. The expert committee that looked at the list of drugs believed unanimously that the selected list would meet all clinical requirements. The vast majority of concern has now been met. Nevertheless, if the profession wishes to propose some appeal mechanism I am ready to discuss it with the profession. That will mean that the profession will have to come and see me and talk about it.

Is my right hon. Friend aware that many Conservative Members who strongly support his proposals nevertheless believe that it would be in the interests of patients to have an appeals procedure, whereby drugs that are not on the list but are later proven to be essential can be made available? Has he received any communication from the British Medical Association—a minority of whose members have behaved callously towards elderly and sick patients—as to whether it will assist in the appeals procedure?

We have received independent advice from about 2,000 general practitoners, but regrettably the British Medical Association has said that until the House debates the subject next Monday it will not take part in talks. I regret that, but I hope that after Monday's debate the BMA will come to see me and my right hon. and learned Friend the Minister for Health as quickly as possible.

Does the Secretary of State agree that the Government's handling of this has been ham-handed, to say the least, and that anxiety among the sick, especially the elderly sick, could have been avoided had the matter been handled differently? Is it not clear that he must do something immediately to remove people's anxiety over whether they will continue to be provided with drugs that have been successful?

I do not accept what the hon. Gentleman says. We have always made it clear that we would consult on our proposals and that the original list was provisional. The result of consultation is the extended list. The vast majority of the public and of the medical profession accept that the list is now good.

Does my right hon. Friend agree that, although restricting the variety of prescriptions may be necessary, restricting the quantity of drugs prescribed is vital? Will he require doctors to limit prescriptions to 28 days' supply at a time, which would be cheaper, safer and less wasteful?

I am not sure that I can require them to do that. An advantage of the debate that we have had is that there is now much more concern about prescribing habits, and I hope to be able to follow that with further advice from the Department. In principle, I have great sympathy with my hon. Friend's point.

Does the Minister realise that we have received a heavier postbag on this issue than on almost anything else, which is the real reason why so many Tories are standing up? Does he realise that every week there is a new and developing onslaught on the NHS, which causes more and more people to worry about what the Government will do? Is this the creeping privatisation of the Health Service by 1,000 cuts, of which this cut is a major part?

The hon. Gentleman is being more than usually absurd. He must recognise that we are trying to raise money for the NHS. However, it does not surprise me that he comes to such a conclusion. He and the Labour party want more spending on the Health Service but have not thought about how that money will be raised.

Although I welcome the tone of my right hon. Friend's answers this afternoon, especially the feeler that he put out to the medical profession, does he accept that if he met doctors' concern about an appeals procedure in cases where doctors genuinely believe that certain drugs must go to their patients he would do much to defuse all reasonable opposition?

Indeed, and that is why I said that my door is open to listen to representations on that. I am sympathetic to the principle, but it is reasonable to say that if the BMA wants talks it must come to me and discuss the matter.

What consultations is the Secretary of State having with his opposite numbers at the Department of Trade and Industry, who commissioned a working paper from the pharmaceutical industry on extending patent life, which would be a way of moving towards generic substitution and thereby forgoing the shambles which this limited list has caused?

The hon. Gentleman's description of the position is not remotely fair or accurate, and I should be sorry if he took that view into the Division Lobby. Clearly, I am consulting my right hon. Friend the Secretary of State for Trade and Industry, but, as the hon. Gentleman will know, I am the sponsor of the pharmaceutical industry, which has made it clear that, despite the controversy over the limited list, it wants the DHSS to continue as a sponsoring Department.

Will my right hon. Friend say what representations he has made to the ABPI? Does he agree that its newspaper campaign has not only been misleading, but has caused quite unnecessary concern, particularly to elderly people?

I think that the campaign of the ABPI —and I would say that at times the ABPI has not been speaking for some of the excellent companies in the industry — on occasions has been disgraceful and hypocritical. It must be pointed out that its latest proposal, in which it suggests that old people will be affected, goes ill with its suggestion that exemption should be removed as one of the ways of making money.

Will the Secretary of State tell the House how much of the cost of his estimated saving of £75 million will be borne by pensioners? If he cannot give the House a figure, will he say why not? Surely he does not intend to take some free medicines away from pensioners without knowing first how many will be affected and how much money they will lose?

I do not think that our proposals will affect the pensioners. What we expect this to do is to cut the drugs bill by £75 million immediately. We have always recognised that consultation would mean less saving. The aim is to look for further ways of getting better value for the drugs bill.

Will my right hon. Friend confirm that the savings made under the limited list system will redound to the benefit of the National Health Service and not simply to the benefit of the Treasury?

Yes, that is the whole point of the proposal. The money saved will go to health care. The Opposition have been consistent in pressing me to make economies in the drugs bill. The difference is that the Government are doing something about it. The fact is, as my hon. Friend the Member for Banbury (Mr. Baldry) says, that the proceeds from that will go into health care.

Care In The Community

8.

asked the Secretary of State for Social Services if he will make a statement about proposed developments in relation to care in the community.

We shall continue to encourage the development of services which enable people in need of care to live as normal a life as their condition allows.

I think that the overwhelming majority of people would acknowledge that as the correct policy in principle, but, will the Minister recognise the widespread anxiety among local authorities about the level of funding for community care? What guarantees can the Minister give that an appropriate and satisfactory level of funding will be made available to local authorities?

I am grateful to the hon. Gentleman for agreeing with the policy in principle. I can assure him that some very good things are now being achieved in practice by way of placing patients in more suitable care. Local authority social services spending has gone up by 18 per cent. on average ahead of inflation while the Government have been in office. As my hon. Friend was saying, as long as local authorities pay attention to getting the best value for that money, we believe that they can make perfectly adequate provision for this policy.

Are we not in danger of being overhasty over the closure of some hospitals, such as Balderton hospital in my constituency, and Saxondale hospital in his? Can he give the House an assurance that these hospitals will not be closed until firm placings are available for those who will be affected?

As my hon. Friend mentions Saxondale hospital in my constituency, I can tell him that I well remember that being mooted for closure by the right hon. Member for South Down (Mr. Powell) when he was Minister for Health. I am glad to say that we now have a definite date for closure. I agree with my hon. Friend that no closure of any hospital should take place unless and until there is proper provision for better care for the patients. The health authorities concerned are planning to provide just that.

Why should there be under-funded care in the community when there are perfectly good hospitals for the mentally handicapped available, such as the Dovenby hospital, in Cumbria, in my constituency? Is the Minister aware that the future of that hospital is being threatened only because of the backlog of repairs? Why does the Minister not cough up the money and make sure that the people in that hospital who wish to stay are not forced out into the community to save the Government money?

Many of our mentally handicapped patients would do better and have a better quality of life in good, smaller facilities than they will by being locked away in older hospitals. That is the aim of the policy. I understand the reluctance of many of the patients, which is shared by their families, to emerge from a hospital in which they have lived for a long time. However, only recently I met a man released from a hospital in which he had lived for 44 years, spending most of that time mute and violent, who is now enjoying a reasonable quality of life in a small home in Eastbourne.

Does my right hon. and learned Friend agree that there is a shortage of accommodation for the single homeless? In those circumstances, and in view of what the Minister of State said in answering an earlier question, will he reconsider the closure of resettlement units? The one in Newbury is a modern building, the costs of which compare favourably with private accommodation. As it has not been asked by the DHSS to trim its costs, why is it being closed?

I assure my hon. Friend that we shall ensure that our policy towards resettlement units does not conflict with our care in the community policy. As my hon. Friend the Minister for Social Security said, we are seeking to make better use of the resources and, in most cases, to make improved provision.

Is the Minister aware that many mentally disabled people are being pushed out of hospital, that health authorities then divest themselves of responsibility, that local authorities refuse to accept responsibility and that the mentally ill are thereby left in a no man's land, with appalling consequences for them? Is he aware that the only answer is for him to guarantee a community place for every mentally ill person who leaves hospital?

I agree that we must ensure that such incidents do not occur and that, when they occur, they do not happen again. It is essential to make a proper assessment of any provision for each patient. We have lifted many restrictions which applied to health authorities and which previously stopped them from providing funds to enable local authorities to make more provision. We are satisfied that, with good joint planning and the good planning of resources, the policy can go forward successfully.

Will my right hon. and learned Friend accept that many people are thoroughly in favour of the thrust of the new policy—

—but that there is a need to reassure some patients who are being moved out of old-fashioned hospitals and into the community that they will have the care in the community to which they have become used?

I am grateful to my hon. Friend for those remarks, though, as my hon. Friend the Member for Macclesfield (Mr. Winterton) pointed out, it is not a new policy in principle. It is, however, being handled with more care and pace than has been the case in the past, and we must reassure people with understandable fears that proper provision will be made for patients.

As the Government are prepared to give 100 per cent. disregard from rate capping for all council spending on civil defence, why cannot the right hon. and learned Gentleman persuade his fellow Ministers to give 100 per cent. disregard for all spending under joint finance for care in the community? Does he appreciate that the increased spending on the social services which he has praised is attributable largely to the actions of councils which are now being penalised by the Government by rate capping?

We have just eased the rules on the disregarding of joint finance expenditure and put joint finance in line with the urban programme. I assure the hon. Lady that some councils—such as authorities in Exeter and Devon, which are not remotely threatened by rate capping because they provide good services without breaching the Government's guidelines — are making spectacular progress.

Aids

9.

asked the Secretary of State for Social Services what recent representations he has received concerning his guidance about the precautions to be taken concerning acquired immune deficiency syndrome.

15.

asked the Secretary of State for Social Services whether he is satisfied that reasonable safeguards have now been taken to protect hospital staff from infection by the acquired immune deficiency syndrome virus.

I am satisfied that the precautionary measures recently recommended by the advisory committee on dangerous pathogens in its interim guidelines on AIDS for clinical and laboratory staff are adequate. Indeed, in the view of some experienced clinicians, they are too stringent. The interim guidelines were issued on 16 January by Health Ministers and the Health and Safety Commission. We have so far received only a small number of inquiries and comments, mostly relating to the interpretation of wording or specific points of detail. We are learning more about the disease as time goes on and the guidelines will be reviewed in 12 months' time.

Is the right hon. and learned Gentleman aware of the concern of the National Union of Public Employees on behalf of its members employed in the National Health Service, such as nurses, ancillary staff and ambulance personnel? Is he also aware of the concern that has been expressed on behalf of other public servants such as police officers, prison warders and firemen? Will he provide clearer guidelines for those people and make a statement to allay the fears that exist among the general public on this issue, so as to avoid any question of panic arising? Is he further aware of the concern of hon. Members, as shown by the fact that early-day motion 374, tabled by me, has been signed by 103 hon. Members?

The guidelines are clear and should be reassuring. I assure the hon. Gentleman that, for example, in the United States, where there have been 8,000 cases of AIDS, there has not been one case of a hospital or laboratory employee contracting the disease as a result of his or her work.

Wrightington Hospital, Lancashire (Children's Ward)

10.

asked the Secretary of State for Social Services if revised proposals have yet been received regarding the children's ward at Wrightington hospital, Lancashire.

Is my hon. Friend aware that this matter has gone on for too long? Can he give any indication when the matter will be resolved, because local people are becoming increasingly concerned about the delay in saving this very important ward?

Elderly Persons

11.

asked the Secretary of State for Social Services what is the latest average weekly subsidy per head paid by his Department for the care of the elderly in private residential and nursing homes for the elderly.

Our records do not identify separately payments made to the elderly in homes for the elderly. However, the most recent provisional figures indicate that in December 1983 the average weekly payment of supplementary pension—which is paid to people over pension age—in residential care and nursing homes was £75·25.

Will the Minister recognise the concern at the large growth in private nursing homes, and will he ensure that adequate resources are given to local authorities to inspect and control these homes? Will he also ensure that local authorities have adequate capital and revenue resources to provide sufficient sheltered and residential accommodation for all our people who should have this provided by local authorities?

The hon. Gentleman will know that we are anxious to have a proper balance of provision as between all the providers and that we have recently taken new steps to improve the registration and inspection of homes. I am sure that he will agree with that.

Prime Minister

Engagements

Q1.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

This morning I had meetings with ministerial colleagues and others. After my duties in the House, I shall be leaving to attend the funeral of the late President Chernenko.

Has the right hon. Lady's attention been drawn to the point raised in the House yesterday about the outrageous remarks of the chairman of the National Coal Board, Mr. Ian MacGregor? Does she think that he is really up to the job when he is capable of saying that the miners—according to the Sunday Telegraph

"are now discovering the price of insubordination and insurrection.—And boy, are we going to make it stick!"
What kind of a clown have we in that job? Will the right hon. Lady consider sacking him and thus help to promote peace in the coalfields?

I have every confidence in Mr. MacGregor, the chairman of the National Coal Board.

Is my right hon. Friend aware that determined action by the Conservative councillors on the Greater London council has resulted in a saving on the rates of 3p in the pound for each of the London boroughs? Does she agree this is a very significant saving for London ratepayers?

Yes. I think that the determined action of this Government, coupled with the determined action of Conservative councillors on the GLC, has been of great benefit to the ratepayers of London.

Q2.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

I refer the hon. Gentleman to the reply that I gave a few moments ago.

Could the right hon. Lady find time today, or very soon, to reflect upon the position of those communities, some of them in my own constituency, where scarcely any teenagers are in normal employment? Does she not even begin to understand the consequences of such a situation, and may we at least have an assurance that Government economic policy will not be maintained until our societies are utterly corroded?

As the hon. Gentleman is aware, we have done a great deal, and we hope to continue to do more, under the youth training scheme, the technical education initiative in schools and many of the computer centres to enable young people to get better skills to enable them eventually to get better jobs.

When my right hon. Friend goes to Moscow tomorrow, will she make plain to the Soviet people the strong feelings, which I am sure are shared by many of us, that, with the sadness of the death of their leader, we also have high expectations because Mr. Gorbachev, on his visit to this country, opened the doors of peace and friendship, which has given hope to the people of this country that the interests and aspirations of the people of the world can be met and that we can live in peace together?

I think that that will be the wish of everyone when we go to the funeral in Moscow. I think that we may take heart from the fact that the negotiations, which were due to begin in Geneva, have begun, and we all wish that they end successfully in agreement.

May I first agree with every word of that last reply? Today and tomorrow, will the Prime Minister take the opportunity, when she meets representatives of our Western allies in Moscow, to discuss with them the star wars initiative?

I am grateful for that reply. Will the right hon. Lady be reflecting to them the view expressed today by her predecessor, her right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath), that star wars would be decoupling, destabilising and a diversion of resources? Since that is so obviously true, why must the right hon. Lady still trail along toadying behind the Americans? Why does she not do what a real friend would do and tell them they are wrong, honestly?

I believe that the United States is right to do research. It would be very difficult to get an agreement on research only, because there is no way of verifying what research is going on. When it comes to deployment and testing, that is already covered by the antiballistic missile agreement, and that is why I would expect it to be dealt with in that way.

Is my right hon. Friend aware that her trip to Moscow should certainly not lead to the decoupling of the West from its allies, as has just been suggested, but she should try to persuade the Russians to negotiate sensibly and then get the peace and disarmament that we are all looking for?

Yes, I think that it has been the unity and strength of the West that has brought the Soviet Union back to the negotiating table at Geneva.

While the Prime Minister is in Moscow, will she make it clear that not only does she welcome the restart of the Geneva talks today, but that she is willing to make a contribution to them by indicating in principle that the Polaris deterrent should be counted in in East-West negotiations?

No, I do not believe that either our own independent deterrent or the French independent nuclear deterrent should be counted in. Ours amounts to only some 3 per cent. of the Soviet intercontinental ballistic missiles. When that is brought down enormously — very substantially indeed — the situation might be changed, and we might be prepared to consider a different course.

In all the euphoria over the new Soviet leader and his charming wife, does my right hon. Friend agree that the most welcome sign of a change of attitude would be a halt to the genocide that is still going on in Afghanistan?

That would be very welcome indeed. I am reminded, as my hon. Friend suggests, that this year is the 10th anniversary of the Helsinki accord. Doubtless that is a matter for us to reflect about and take action upon.

Q3.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Will the Prime Minister justify to the House how the Government can cut the real value of the heating allowance to old and disabled people and the housing capital investment programme on the one hand, but allow the cost of Trident to treble on the other hand? Is the right hon. Lady proud of the fact that to millions of our fellow countrymen and women she has become the personification of all that is unjust in our society?

The heating allowance has not been cut. It has gone up greatly, ahead of anything that the last Labour Government had and is far ahead of any increase in fuel costs. The cost of Trident will be paid at the time when it falls to be due. We do not know precisely what the dollar-pound exchange rate will be at that time.

When my right hon. Friend meets Mr. Gorbachev tomorrow or the day after, will she please ask him about the foreign policy that he wishes to implement, knowing that he may well reign over the Soviet Union for the next 20 years? Will my right hon. Friend ask him to ensure, sooner rather than later, that the Soviet Union withdraws Soviet troops from Afghanistan, dismantles the SS20s and adheres to the Helsinki final act? That is the only way to ensure peace and prosperity for all mankind.

I think that my hon. Friend has encapsulated the point and I cannot improve on the excellence of his question.

Q4.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Will the Prime Minister repeat the exact words that she used during the 1979 general election campaign when she said that she had no intention of raising prescription charges? Will she tell the House by what percentage they have gone up since 1979?

Yes, sir. I have the transcript of the press conference here with me. Word for word I shall say exactly what the hon. Gentleman asked me:

"I doubt very much whether any responsible Government could say that over a period of five years, regardless of what happened to the value of money, they would not put up prescription charges. I doubt whether they could."

Q5.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

Further to the question of my hon. Friend the Member for Uxbridge (Mr. Shersby), as Ken Livngstone recommended to the GLC the setting of a rate within the legal limit, and as he now appears to be in some difficulty about his nomination in Brent, East, will my right hon. Friennd commend him to those concerned for his new-found respect for the rule of law?

I am very pleased that in spite of all the political posturing a legal rate has been set. I am doubly pleased that it has been so, despite the advice of the Labour party conference, which we all saw on television last autumn. I hope that other rate-capped authorities will follow the example and set a legal rate.

Does the Prime Minister share my regret that Cardinal O'Fiaich's remarks in Boston and the speech by Bishop Duffy in London appeared to support the IRA's demand for British withdrawal from Northern Ireland? Would it not be much better if these gentleman were to take the Pope's advice and concentrate on saving souls?

The troops are in Northern Ireland to protect the fundamental rights of the people. I believe they do their task excellently and we would wish to congratulate them upon it.

Q6.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

Will my right hon. Friend urge those teachers who are taking selective strike action to go back to work and stop the damage to our children, including some in my constituency of Surbiton? Does she share an interest with me in hearing the attitude of Opposition Members to the action taken by some teachers?

I make it clear again that I deplore the action of those teachers who, to pursue a pay claim for themselves, will harm the interests of the children in their care. That is the view taken by most parents and by most people. I applaud the action of the teachers who will not go on strike but who are bearing a particularly heavy burden because some of their colleagues have done so.

Has the Prime Minister's attention been drawn to a report on the front page of The Times today concerning the killing of 34 Lebanese villagers in an Israeli attack, which has been described as inhumanly ferocious? Does the Prime Minister know that there is a motion of censure before the Security Council at this moment on behalf of the Lebanon, which the United States intends to veto? Can the Prime Minister tell the House what her instructions are to the British representative? Will we, this time, exercise political and moral independence of the United States?

We deplore the appalling violence in south Lebanon and Beirut. It underlines the need for an early and complete Israeli withdrawal, co-ordinated as far as possible with the Lebanese authorities. Retaliation and counter-retaliation will solve nothing and will only add to the tragic suffering of civilians. We do not say how we shall vote while the motion is still being considered and the debate continues.

Q7.

asked the Prime Minister if she will list her official engagements for Tuesday 12 March.

Is my right hon. Friend aware that Basildon district council managed to set a rate within the limit placed upon it by the House, without cuts in services? Is she further aware that, without that limit, the ratepayers of Basildon would have had to pay double the rate increase?

I congratulate Basildon on its action. It is clearly taking the view that we have urged on many councils, that we need to get better value for money out of existing moneys rather than increase them.

When the Prime Minister sees President Gorbachev, will she tell him that there are many of us on both sides of the House who have been extremely critical of Soviet policies in the past but who nevertheless remember that it is nearly 40 years since we fought together and won the war against the Nazis? We shall also be commemorating 40 years since the liberation of the concentration camps, and we hope he will, in his regime, usher in a renewed era of goodwill based upon the final act of the Helsinki agreement.

I am grateful to the hon. and learned Member for his message. He will be aware that I also hope that the Helsinki final accord will one day be implemented fully. The 10th year since it was signed is as good a time as any other.

On a point of order, arising out of questions, Mr. Speaker. I seek your guidance because I fear that the Prime Minister inadvertently, in her reply to my hon. Friend the Member for Newham, North-West (Mr. Banks)—

Order. I shall hear the point of order, but I can already sense that it is an extension of Question Time.

The right hon. Lady may have inadvertently misled the House about an election pledge that she gave on prescription charges in the Health Service in 1979.

Order. There is a perfect opportunity to debate this matter later on. This is not a matter for Question Time.