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Oral Answers To Questions

Volume 114: debated on Tuesday 7 April 1987

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Social Services>

Nhs (Costs)

1.

asked the Secretary of State for Social Services what was the per capita cost of the National Health Service throughout the United Kingdom in 1986; and what it was in real terms in 1978–79.

6.

asked the Secretary of State for Social Services what percentage of the gross domestic product was spent on the National Health Services in the most recent year for which figures are available; and what the percentage was in 1978.

Between 1978 and 1985 the proportion of the United Kingdom gross domestic product spent on health care rose from 5·2 to 6·0 per cent. Over the same period, health spending increased from £301 to £384 per head at 1986–87 prices.

Is not this 26 per cent. increase per person throughout this country one of the most accurate indicators of health provision, suggesting vastly improved services and better health care for all? How does this increase compare with other Western countries?

I entirely agree with my hon. Friend. The real growth in total health spending per head in the United Kingdom between 1978 and 1983 was about 21 per cent. and according to OECD data—1983 is the latest comparison that we have—that growth rate was higher than in any other Western industrialised country, with the exception of the United States.

Does my right hon. Friend agree that these figures provide an interesting reflection on the priorities of Conservative and Labour Governments?

Indeed. The base figure that I am quoting in the figures is the base figure that we inherited from the Labour Government. If we want to go back to cuts in the NHS, we must go back to the last Labour Government and their cuts in the hospital building programme.

Is the Minister aware that when similar claims were made in Scotland yesterday the genteel members of the Royal College of Nursing howled the Minister down? Nobody in the country, not least the 1986 Select Committee report on expenditure in the social services, believes a word of the boasts that the right hon. Gentleman continually makes about the Health Service. Is he aware that if we take into account the index used by the NHS with regard to pay and prices, and take account of demographic and technological changes we see that there has been a decrease in real expenditure on the Health Service between 1979 and today?

What the hon. Gentleman said is typically absurd. Quite apart from the figures on finance, which he has entirely wrong, the real figures on health care, showing the number of patients treated, have shown a real—

Well, surely the hon. Gentleman is most interested in health care, in treating patients and in providing for better health care. That is what the Government are providing through the Health Service.

I remind the hon. Gentleman that since 1979 nurses' pay has increased by 23 per cent. in real terms, and that contrasts with the fall of 21 per cent. under the last Labour Government.

The Secretary of State should come clean with the House and confirm that the United Kingdom spends a lower proportion of its gross domestic product on the Health Service than any European Community country, apart from Greece an d Portugal.

Does he accept that the logic of the argument that he and his colleagues adduced yesterday—that if one increases the total cake everybody gets a bigger share—is that we should increase the total expenditure on the Health Service as a proportion of GDP? That is the answer to the health inequalities from which Britain is devastatingly suffering. In that way, we would remove some of the horrendous inequalities that his Government were embarrassed to admit only a week ago.

I do not accept for one moment that there are horrendous inequalities, and the report that the hon. Gentleman is holding is no objective indication that there are. The policy of the reallocation of resources and the resource allocation working party has meant a redistribution of resources to those areas which were deprived of them under the last Labour Government, supported by the hon. Gentleman's party.

Would not that excellent record on increased health expenditure mean even more in terms of better health care if steps were taken to control the escalating cost of pharmaceuticals on the NHS? Are not some doctors still wasteful in their prescribing habits, and will my right hon. Friend take steps to encourage them to prescribe generically where possible?

We adivse doctors on good dispensing and good practice, but I am sure my hon. Friend recognises that the selected list introduced by the Government has meant a saving to the NHS of about £75 million. That policy has been entirely vindicated, despite all the opposition from the Opposition.

If the nurses are doing so well under the Government, why did 30,000 qualified nurses and 6,000 nurses in training leave the NHS last year?

That must be put against the total nursing strength of about 380,000. It is relevant to consider the proportion. The hon. Gentleman must explain why the nursing profession had to wait for this Government to introduce an independent pay review body, which it was never given by the last Labour Government, whose record on nurses' pay was a disgrace.

May we have briefer supplementary questions, which will lead to briefer answers?

Hospital Beds

2.

asked the Secretary of State for Social Services if he will state his policy relating to the provision of hospital beds for convalescent patients within the National Health Service.

The level and extent of provision of beds for convalescence is a matter for individual health authorities.

Will my hon. Friend bear in mind that the limited number of hospitals providing special convalescent facilities for patients supply a demand existing over a much bigger area than a regional or district health authority? The Grove convalescent hospital in my constituency receives patients from all over the north of England. Therefore, is it right that a regional or district health authority should be able to make a decision to end such facilities, regardless of the broader or national dimension, which certainly exists?

My hon. Friend will be aware that the proposals to which he refers are being formulated and there would have to be widespread consultation before any decision was made. Should there be objections from the relevant quarters, they would come to Ministers to determine and, in that event, we would take account of factors such as that which my hon. Friend mentioned.

If there is a change in the provision of convalescent beds, will the Minister seriously take into account the importance of applying rehabilitation techniques within those convalescent places? Will he make sure that there is adequate back-up from the paramedical professions?

It must be borne in mind that there has been a substantial drop in the number of convalescent beds in Britain because of changing practices, and the modern approach to rehabilitation may well entail a different way of dealing with patients after they leave hospital, which is not something that I would wish to discourage.

Is my hon. Friend aware that at the West Middlesex university hospital some 96 beds are taken up by people who, in the opinion of Hounslow and Spelthorne district health authority, need neither medical nor nursing care? As those beds are needed for other people who need treatment, will my hon. Friend see what can be done?

I shall certainly look at my hon. Friend's point. He will be aware that health authorities can consider a variety of options in such circumstances, including making contractual arrangements with private or voluntary residential or nursing homes.

Does the Minister accept that there are three options when there are insufficient beds in the National Health Service? One is that patients stay on too long, with the result that their beds are not available for those in greater need of them. The second is that they should be released into the community, but there are not enough resources and care in the community. Thirdly, that they may be forced into private facilities, as the Minister suggested a moment ago. Are not those three options unsatisfactory?

I respect the hon. Gentleman's views, but that was a wild series of generalisations. The position differs from area to area, but the general thrust has been to build up community care resources in a way that affects the issue of convalescent beds.

Unemployed Persons (Mortgage Interest Payments)

3.

asked the Secretary of State for Social Services how many people he expects will lose by the changes in the payments of mortgage interest for the unemployed; and if he will make a statement.

Our latest estimates suggest that just over 70,000 claimants will be affected at any one time by the recent changes in supplementary benefit payments for mortgage interest for new claimants under 60.

Is it not typical of the Government that they first put people's homes at risk by cutting the mortgage interest rate relief by half in the first 16 weeks, and then tell people to take out insurance policies against that happening to them when they become redundant? The Government then have the gall to send out a circular to say that they will take at least part of that money away from such people if they take out those policies.

We are not putting people's homes at risk, and there is no evidence to that effect. If the hon. Gentleman reads the remarks of the Building Societies Association he will see that it made that point clearly. There is no reason to suppose that people will lose their homes because of the change.

Does my hon. Friend agree that people who voluntarily take on the responsibility of home ownership, and who stand to gain enormously from the benefits of that ownership are reasonably obliged to accept all that it entails? They should make provision for themselves and not necessarily look to the state as the first resort in times of difficulty.

That is a fair and valid point. Even from the first day of unemployment 50 per cent. of mortgage interest remains payable through the social security system, and the full amount is payable after 16 weeks.

Is it not extraordinary for the hon. Member for Mid-Worcestershire (Mr. Forth) to congratulate the Minister, as he was one of those who during our debate sang the praises of mortgage protection policies? Is it not outrageous for the Minister to defend the policy in those terms when he well knows that if people have taken out insurance policies, which in any case are not very good value for money, the Government will take the money from them, as my hon. Friend the Member for Rother Valley (Mr. Barron) said. What sort of way to proceed is that?

My hon. Friend the Member for Mid-Worcestershire (Mr. Forth) is being entirely consistent in his remarks today and in those that he made on an earlier occasion. We still have the most generous system of assistance with mortgage payments of any country in Europe.

Epilepsy

4.

asked the Secretary of State for Social Services if he will make a statement about attendance allowance to people suffering from epilepsy.

Attendance allowance is available to people suffering from epilepsy who fulfil certain conditions for attention or continual supervision. These matters are adjudicated by the attendance allowance board or a doctor delegated on its behalf. The interpretation of the "continual supervision" criterion has been affected by the Court of Appeal judgment in the case of Mrs. Dorothy Moran. The attendance allowance board is preparing revised guidelines on this matter for use by its delegated doctors.

I thank the Minister for that reply. Will he now answer the question in simple English, so that disabled people can understand? Will the Government now dispute the success of Mrs. Moran by going to the House of Lords, even though the Court of Appeal refused her permission to do so? Will the Minister extend his congratulations to my constituent, Mrs. Moran, for scoring her success? Is it not uncharacteristically ungenerous of the Minister not to extend his congratulations to the two lawyers—Mr. Nicholas Warren and Mr. Richard Drabble—who, on this and many other occasions, have advanced the Government's policy that everyone should remain within the law, including the Government?

On the second part of the hon. Gentleman's question, I am not quite sure of the current score between Mr. Drabble and the Government.

Perhaps there is cause for congratulations on both sides. As regards the appeal, about which the hon. Gentleman asked his substantive question, we do not propose to appeal against the judgment.

Will my hon. Friend look into the circumstances whereby epilepsy can be caused by the defecation of dogs in public areas? When he has done so, will he support his hon. Friend in the Home Office in taking action to clean up our parks and other areas, which are disease ridden at the moment?

I admire my hon. Friend's ingenuity. I am not sure whether his supplementary question is related to the attendance allowance, but I shall ensure that Home Office Minister's are aware of his concern.

Is my hon. Friend aware of the difficulties that arise for parents of children below the age of two years who are not entitled to claim attendance allowance, while a parent who is fostering a child who is severely handicapped and disabled is entitled to claim the allowance? Does he agree that this is an unfair discrimination?

I am grateful to my hon. Friend for raising that matter, which I am examining.

Southend General Hospital

7.

asked the Secretary of State for Social Services how many letters he has now received from the general public on the proposal by the North East Thames regional health authority to close the radiotherapy unit at Southend general hospital; and if he will make a statement.

The Parliamentary Under-Secretary of State for Health ans Social Security
(Mrs. Edwina Currie)

We have received 15 letters which have been referred by hon. Members, together with about 1,100 letters direct from members of the public. If Ministers are required to make a decision on the proposal, we shall take into account all the representations that have been received.

Does this flood of letters not show the serious concern that a regional health authority, which claims to be short of money, is planning to spend £4 million on closing a modern and efficient unit and to build an entirely new one 30 miles away, when there is no guarantee that it will attract as many patients as the Southend unit? Will my hon. Friend seek to remove the damaging uncertainty among staff and patients by trying to persuade the authority to abandon this silly empire building?

My hon. Friend is right to suggest that the proposals involve an increase in expenditure, but not a cut in services. We expect that we shall receive rather more representations in the near future, as my right hon. Friend the Secretary of State has agreed to receive a petition that bears more than 90,000 signatures.

Is the Minister aware that the regional health authority's plan to close the unit at Southend will mean many of my constituents, including those who are suffering and ill, having to travel much longer and more difficult journeys to receive treatment? On that ground, will the hon. Lady discourage the authority from putting into effect the absurd plan of closing the much appreciated radiotherapy unit at Southend?

The hon. Lady will be aware that the proposal involves only the radiotherapy unit. Other forms of cancer diagnosis and treatment will continue as at present and I have no doubt that they will continue to command the confidence of local people. The problem is how best to organise high-tech services, which are expensive and which need to be concentrated if we are to provide a good service.

Without commenting on the case that is being made by Southend, and before my hon. Friend becomes over-impressed by the public relations campaign and the petition to which she has referred, will she take note that other of her hon. Friends who represent Essex constituencies applaud the regional health authority's decision to construct a pupose-built cancer unit at the Harold Wood hospital? Will she take on board the fact that on this occasion, if on no other, the voice of Southend is not necessarily the voice of Essex?

I am grateful to my hon. Friend, who I am sure speaks very much for his constituents, as does my hon. Friend the Member for Southend, East (Mr. Taylor). His comments serve to demonstrate the heat that is in this kitchen.

I am sure my hon. Friend appreciates that she will require the judgment and wisdom of Solomon to resolve this problem. Those of my constituents who are cancer patients presently travel to north Middlesex, to a hospital that is under threat of closure. The choice appears to be between Harold Wood and Southend. My concern, and that of my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle), is that our constituents who are suffering from cancer will have to travel an inordinate distance—a journey that will be uncomfortable and unpleasant—to attend the Southend unit. We find that intolerable.

My hon. Friend will remember that during the debate on cancer on 13 February I said that we would attempt to get a more up-to-date view on the extent to which stress and travelling problems have an effect on the treatment of patients who are suffering from cancer, and that commitment stands.

When will Ministers recognise that instead of dealing with each piecemeal proposition from each of the four Thames regions for the reorganisation of cancer treatment it would be better if Ministers got the four regions together, knocked their heads together and got them to produce a comprehensive plan for the treatment of cancer covering the arrangements in an area containing 13,25 million people?

The hon. Gentleman is keen on telling local health authorities what to do, and we have made careful note of his views on that sort of centralisation. However, it is no good doing all that unless the money is available—[HON. MEMBERS: "Ah!"] I recall that whereas the North East Thames regional health authority is now receiving a total of over £1 billion in revenue, under the Labour Government, supported by the hon. Gentleman, the total was only £407 million, barely 40 per cent. of what it now receives. The result is that we can now seriously discuss improving the quality of cancer therapy for all the patients concerned in the region, whereas under the hon. Gentleman's Government they did not have a chance.

My hon. Friend will know that my constituency is in the Southend health authority area. She will also know that the North East Thames regional health authority proposes to reduce its number of cancer treatment units from nine to six. Is she aware that the population of south-east Essex is one quarter of the population of the North East Thames regional health authority? Therefore, is it not eminently reasonable that at least one cancer treatment unit should be in south-east Essex?

My hon. Friend adds some sensible comments to the discussion. If the community health councils in the neighbourhood continue to object to the regional health authority's proposals, those proposals will come to Ministers for a decision. We do not expect that to happen before the end of this year and we will take into account all the representations made to us.

Aids

8.

asked the Secretary of State for Social Services if he will make a further statement on Government measures to combat AIDS.

Action to combat the threat of AIDS continues to be one of our highest priorities. The latest research on our public education campaign shows an exceptionally high level of public awareness of how the AIDS virus is transmitted and how to avoid infection. We are continuing to develop the campaign. In addition, we have provided increased resources for research, counselling and care, and last month I convened two conferences : on predictions of the spread of HIV infection and on community care for people with AIDS.

I congratulate my right hon. Friend on the success of his public education campaign. If the number of AIDS victims being suggested as likely to arise in the next few years is reached, is he satisfied that there will be enough hospices?

That is one of the areas in which we are planning increased provision. We will need not only more hospices but more hostel accommodation and more community care. All told, we need more community care involving not just the Health Service but the voluntary services and the social services as well.

Why are there no proper AIDS counselling facilities available in Birmingham, to haemophiliacs identified as carrying the virus?

We are providing resources in Birmingham but if there is a specific area of need I shall certainly look at that and seek to remedy it.

Bearing in mind the extremely serious implications of AIDS, what steps does my right hon. Friend have in mind to deal with the hard Left Militant Labour councils which actively promote homosexuality among children? Is it not ridiculous—[Interruption.]

I did not go to a public school.

Is it not ridiculous that large sums of public money should be spent on proselytising and encouraging homosexuality in schools while other sums of Government money should be spent in trying to stop the spread of AIDS?

I do not believe that anyone would support or encourage homosexuality among young children, and I believe that that view is shared on both sides of the House.

What budget has the Secretary of State allocated to research on AIDS? What proportion will this be of the entire health budget? What research projects are being carried out internationally into this disease?

We have just announced a £14·5 million directed research compaign, organised by the Medical Research Council, which I believe is one of the most exciting and potentially most succesful campaigns. In addition, research campaigns are being organised in other parts of the world, notably in the United States and in European countries.

Is not the only way to contain this killer disease, for which there is no known cure, and for which there is unlikely to be a cure for at least 10 years, to have widespread public screening of those at risk, so that those groups among which the disease is spreading can be ascertained and identified, and also so that the people who are carrying this deadly virus can be identified and treated?

The argument on compulsory public screening, which is what I think that my hon. Friend is suggesting, means that one has to ask the next question, which is what one does with that information. Does one then advocate a policy of isolation? It is all very well talking about treatment, but, as my hon. Friend has said, treatment is not possible at the moment. We are looking at aspects of testing, although not at compulsory screening. There is now a consensus that public education is the No. 1 priority for a disease for which there is neither a vaccine nor a cure. I hope that my hon. Friend will support that also.

Will the Secretary of State acknowledge that while the Government have given a commitment on publicity and research, they have given no commitment on future clinical care, which is far and away the most costly item in the AIDS budget? Will he confirm the projection of the DHSS on the spread of AIDS, which suggests clinical care costs of about £90 million within the next two years? How will this be met? Will the Secretary of State confirm that health authorities' existing expenditure on AIDS is now funded centrally only to the extent of about one quarter, so that, already, large funds are having to be diverted from other essential health care? Is this not yet another sign of the gross underfunding of the NHS?

The hon. Gentleman must grow up a little in some of the points that he is putting. As even he knows, we do not fund centrally individual programmes throughout the NHS. That is not the way that we have done it, nor the way that he, when he was in government, did it. I do not know where he gets the forecast of £90 million. We recognise the duty that is on us to provide resources so that people can be treated with decency and compassion. I hope that he will support us on that.

What advice will my right hon. Friend be giving to dentists in the NHS on the treatment of patients who are antibody positive? Will he be going along with the recommendation made in some parts of the country that such patients should be treated within specialised facilities, or will he continue to recommend treatment as part of the normal service?

As my hon. Friend knows, precautions are already being taken. I hope that we shall be issuing fresh guidance shortly.

Income Support

9.

asked the Secretary of State for Social Services whether he intends to include in the rates of income support to be proposed a sum to compensate for any rate contribution demanded from those on income support; and if he will make a statement.

The illustrative figures published in the technical annex to our White Paper "Reform of Social Security" (Cmnd. 9691) make no assumption about increasing the income support rates to compensate specifically for an average minimum contribution. Final decisions about the level of income support rates have not yet been taken, but the hon. Gentleman may be reassured to know that the illustrative figures showed that the majority of people on income support would not experience any reduction in disposable income overall.

Has the Minister noticed that the recent report of the Social Security Advisory Committee suggested that the proposal, which will make the poorest pay 20 per cent. of their rates, will cause real hardship, and that any switch to a community charge would make the scheme unworkable? Will he therefore scrap the proposition?

I am afraid that I cannot take the action that the hon. Gentleman proposes. As he will know, when spouses and non-householders are taken into account, in many authorities more than half the adult population do not pay for half the services that they enjoy. That cannot be right.

Will not the income support scheme, which has been the result of intensive and widespread negotiation, be designed to ensure that adequate resources are available to everyone to maintain a decent and reasonable living standard? Against that background, is it not unthinkable that a rise in costs should not be matched by a rise in means?

The first part of my hon. Friend's point is entirely accurate. However, the essence is that the illustrative figures set out in the White Paper alone show that the majority of people on income support would not experience a reduction in disposable income overall.

Surely that is quite wrong. During the proceedings of the Abolition of Domestic Rates (elc.) (Scotland) Bill it was admitted that those in receipt of supplementary benefit—presumably going on to income support—would still have to pay 20 per cent. of a rate bill for which they are not now liable. When will the Government make a decision on that? It is under social security legislation.

The illustrative figures set out in the technical annex take account of the 20 per cent. rate contribution.

Does my hon. Friend think that, when the new system comes into operation, more or fewer people will receive state support?

A whole series of different intangibles must be fed into the equation. I should be unwise if I were drawn into giving a specific answer.

Will the Minister clarify the point at which the interface is reached between rate contribution and income support? Is he saying that his Department and the Scottish Office are at one?

How can the Minister justify the statement that he has just made, that the illustrative figures in the White Paper show that no one will lose? Clearly, an increased rate charge of 20 per cent. is intended, and the illustrative figures for the unemployed show no increase m income. The facts do not bear out the Minister's answer.

I fear that the hon. Lady, uncharacteristically, is wrong. The facts do bear it out. The illustrative figures published with the White Paper clearly show that the majority of people on income support will not suffer any loss in disposable income.

Social Fund

10.

asked the Secretary of State for Social Services how many representations he has received about draft guidelines on the social fund; and if he will make a statement.

11.

asked the Secretary of State for Social Services whether he expects the majority of payments from the social fund to be made as grants or as loans; and if he will make a statement.

12.

asked the Secretary of State for Social Services if the guidelines on the social fund will include an indication of cash limits to be imposed; and if he will make a statement.

Draft directions and guidance for staff on the operation of the social fund from April 1988 were issued to interested organisations, for comment or for information, on 25 March. Comments were requested by 26 May, and to date no representations have yet been received. Decisions on the size of the social fund, its division between grants and loans and its allocation to local offices will be announced nearer the introduction of the second phase of the social fund in April 1988.

The draft guidelines published last week explicitly suggest that no help will be available for those paying fuel bills. Does that mean that the Government, despite all their boasting throughout last winter, intend to abolish the severe weather payments scheme in April 1988 without replacing it with another scheme?

We have repeatedly said that we will keep under review the exceptionally severe weather payments. We shall reach our decisions at the conclusion of this winter.

The draft guidelines suggest that grants will be made only to those coming out of community care. Will the Minister confirm that that means that any pensioner who applies to the social fund for help will receive only a loan? If that is so, pensioners will be very aggrieved and will feel discriminated against.

That is not necessarily the case. There will be circumstances in which community care payments will be desirable. We have sought to set those out in the draft guidelines. The purpose of issuing the guidelines in draft form is to take account of representations, including those that may be made by the hon. Lady or by any other hon. Member.

Do not the draft guidelines and the new social fund rule out not only grants but budgeting loans for such items as expenses to cover starting up in a new job or the returnable deposit that is needed to obtain accommodation? Is that not a false economy? Have not the restrictions been included only to make sure that the social fund is strictly cash limited?

The social fund is replacing a whole series of regulatory entitlements that have not worked adequately. I suggest that the hon. Gentleman should carefully re-read the draft guidelines, because he may then find that he has just misrepresented them.

Will the Minister confirm that, because of the obvious elasticity of demand, any payments from the social fund relating to maternity or death grants will not be cash limited?

Is the Minister aware that in order to win a narrow vote in another place the departmental Minister there stated explicitly that there would he no formal cash limits on the social fund when it is introduced, yet the draft guidelines that were issued a week ago state that there will be a budget? Will the Minister describe the difference between a budget and cash limits? Will he also confirm the ministerial hints that this budget will involve a cut of about £75 million for some of the most vulnerable families in society, and that forcing them to repay loans out of future supplementary benefit payments will drive them deeper into poverty and debt?

The cash limit applies to the fund generally. The individual budgets apply to local offices. The hon. Gentleman was, frankly, inaccurate about much of what he had to say on the other matters.

X-Ray Service

13.

asked the Secretary of State for Social Services if he has any plans to meet the Society of Radiographers to discuss the future needs of the X-ray service within the National Health Service.

I am sure that the Minister will be aware of the concern of the Society of Radiographers that it was not consulted before the Forrest report on screening for breast cancer was published. Is he aware that the society thinks that 600 additional radiographers are needed to cope with the additional work load? Is he also aware that last October the Society of Radiographers said that its school was 34 per cent. below the numbers needed to meet the demand? What do the Government intend to do to ensure that the Society of Radiographers is able to train sufficient radiographers to enable the breast screening programme to go ahead?

The hon. Lady has asked quite a number of questions. The advice that has been given to me, based on the Forrest report, is that only about 200 additional radiographers will be needed for the programme in the next three years. To answer the main thrust of the hon. Lady's question, the Department of Health and Social Security, the regional scientific officers of the National Health Service and the College of Radiographers have made a joint submission to the manpower planning advisory group for a study of radiography manpower to be completed in time for the 1988 student intake.

Supplementary Benefit

14.

asked the Secretary of State for Social Services if he will give the number of supplementary benefit claimants in the Leeds, West constituency for the current year and for 1979.

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

In February this year, some 27,000 claimants were receiving supplementary benefit from the two local offices which serve the Leeds, West constituency. The equivalent number for February 1979 was 20,000, but the figures are not strictly comparable because the boundaries have changed.

Does the Minister accept that the figures are also not strictly comparable because of the basis on which supplementary benefit is awarded? Is the Minister not concerned that there should be such a level of deprivation in our inner cities, which has such a debilitating effect on a small section of the population, which is forced to live at subsistence level and which appears to have been given no hope by this Government?

The hon. Gentleman ought to recognise that the real value of supplementary benefit has risen by 6 per cent. since 1979.

Appeals Tribunals

15.

asked the Secretary of State for Social Services if he has any plans to meet the chairman of the Social Security Commission to discuss the future of appeals tribunals.

Officials maintain continuing discussions with the office of the president of social security appeal tribunals and medical appeal tribunals. I have no immediate plans to meet His Honour Judge Byrt, the president.

Can the Minister give an assurance that the Government intend to maintain the appeals system in the benefits system? Will he take account of the fact that there appears to be some pettifogging bureaucracy that is discouraging people from attending appeals tribunals on the side of the appellants? Will he give a further assurance that he will investigate matters of this sort and see that those friends and other people who attend on behalf of appellants are encouraged, not discouraged?

I can certainly give the assurance that we shall continue the appeals system. It works well. Those claimants who seek to appeal are encouraged to bring people with them. I should make it clear that it is our policy to pay expenses for a friend or witness who comes to a tribunal except where he or she is a paid member of an organisation and is attending in that capacity.

Prime Minister

Engagements

Ql.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April 1987.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today. This evening I am attending a dinner to mark the 30th anniversary of the Institute of Economic Affairs.

Is my right hon. Friend aware that, in the light of the many achievements of the present Government, not least low inflation, rising productivity and growing world respect, morale on the Conservative Benches is extremely high at present? Will my right hon. Friend assert today that the decision on the date of the next general election is hers and hers alone and does not depend on media hype, pressure or speculation?

I agree with my hon. Friend's assessment that the economic position and economic prospects are good. I am glad to give her the assurance that the date of the next general election will be decided not in Fleet street but in Downing street.

When the president of the Royal College of Nursing warns that if pay and conditions are not improved the service will crack, will the Prime Minister give the nurses their well-earned due, or will she give them the same patronising, self-satisfied response as was given by her Minister at the RCN congress yesterday?)

It was this Government who set up a nurses' pay review body. IC was this Government who last year accepted the increase of 7·8 per cent. recommended by the pay review body. It was staged. Nurses' pay as a result of that award was one third higher in real terms than in 1979, even before the last July increase. Under the present pay scales a ward sister on the maximum of the scale is £2,700 a year better off than if pay had simply been indexed since 1979. Our record on nurses' pay is very good indeed, and the right hon. Gentleman's Government could not hold a candle to it.

If conditions are as wonderful as the Prime Minister describes, why, does she think, did that most dignified of professions barrack her ministerial mouthpiece yesterday? If the nurses do not believe the Prime Minister, why should anyone else? As far as the pay review is concerned, since the Prime Minister failed to honour the recommendations last year and the year before, will she now give me, the nurses and the whole country an undertaking that she will honour the recommendations of this year's review in full, pay the increase in full, date it from 1 April and not evade, dodge or give short change as she has done in the last two years?

Perhaps the right hon. Gentleman does not recall that under Labour nurses received pay increases of less than the rate of inflation for three years in succession. Our record on nurses' pay and on the reduction in working hours—because the number of nurses has increased by 60,000 and their working week cut by two and a half hours with no drop in pay—is excellent. We have not yet received the pay review body awards. They will be considered carefully when we get them.

Recalling my right hon. Friend's recent visit to the Soviet Union, may I ask whether she agrees that the Soviets, perhaps better than any other nation, can-understand the terrible carnage that conventional warfare can wreak? Thus, is it not misguided for people in this country to concentrate on nuclear disarmament, especially one-sided nuclear disarmament? Would it not be a better and nobler ideal to seek mutual confidence, leading to real security in Europe and elsewhere?

I agree with my hon. Friend. When we are discussing disarmament matters, we have to consider nuclear, conventional and chemical weapons. If we are to get the reduction of weapons that we seek consistent with the defence of this country and its continued security, we must look for increasing trust and confidence. For that, we shall have to see how the Soviet Union honours its treaty on the Helsinki accord and what it does over Afghanistan.

Will the Prime Minister instruct the Secretary of State for Education and Science to bring forward immediately positive proposals for the restoration of teachers' negotiating rights and a timetable to go with them? Will she recognise that if she fails to do that the teachers' dispute, which we deplore, will get more acrimonious?

No, Mr. Speaker. The right hon. Gentleman is well aware of our position. We have granted a considerable increase in teachers' pay. Recruitment of teachers, particularly in physics and mathematics, is going up. The arrangements that we have made in the meantime for teachers' pay negotiations are temporary until we reach a permanent settlement.

Will my right hon. Friend take time during the course of her busy day to comment on the fact that total National Health Service spending is 300 per cent. of what it was in 1979? How does she reconcile that with what some people call "cuts"?

The National Health Service has many more resources under this Government than it had under the Labour Government. Those resources are found not by Governments but by the people who pay taxes—income tax and value added tax. Taxpayers pay well over twice what they did when we came to power. Any increase has to be met from their pockets. There is no other way.

Q2.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April.

What does the Prime Minister propose to do about the fact that one in four jobs for trained nursing staff in London is now vacant?

The National Health Service Management Board has commissioned a report to look at particular problems over the recruitment of nurses in London. The study team expects to report by late spring and the board will then consider what action may be required. So that is already being considered.

Q3.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April.

Has my right hon. Friend had time to read recent reports of brutality towards young soldiers in training? Will she confirm that those reports represent a deviation from the high standards expected and usually achieved in the British Army? Will she confirm that brutal NCOs and the officers who turn a blind eye to their acitivities will be rooted out and transferred to areas away from recruit training?

I agree with my hon. Friend that bullying will not and must not be tolerated in the Army or elsewhere in the armed forces. Reports that junior soldiers have been bullied are being thoroughly investigated, and if the allegations are substantiated firm disciplinary action will be taken against offenders.

Will the Prime Minister accept that, though the teachers are involved in a struggle with the Government, I want to ask her a question about nurses? Does she realise that 30,000 are leaving the nursing profession each year. Although all of us need nurses—and very often urgently—they are being treated to howling abuse from her party. They are struggling as best they can for all of us, and they are being treated obscenely. Does the Prime Minister not realise that the nurses are struggling to stay in their profession and to help the rest of us?

This Government's record on pay to the nursing profession, on reduction of hours in the working week for nurses, and on the increased number of nurses in the National Health Service is better than that of any other Government in the whole history of the NHS. As I indicated earlier, on present-day scales, before any proposals are put before us for new scales, a ward sister on the maximum of the scale would be £2,700 a year better off then if pay had simply been indexed by the RPI since 1979. That is a good record. It is no wonder that there are now 60,000 more nurses in the Health Service than there were eight years ago.

Q4.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April.

Will my right hon. Friend accept that in March this year new car sales were up by 8 per cent. over last year and new car imports were down 5 per cent.? Is this not a clear indication that, under Conservative leadership, our economy is increasingly product-competitive and far more prosperous?

Yes, I agree with my hon. Friend. It is very good news that car manufacturers here—whether Austin Rover or Jaguar or the multinational car manufacturers—are increasing their sales to the home market. It is part of the recovery of manufacturing industry, which is now doing very well under the policies that are being pursued by this Government.

Q5.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April.

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

Is the Prime Minister not even slightly embarrassed by the greed and avarice that the sell-off of state-owned industries at well below their market value seems to have incited in some people? Will she explain to the House why it is that these matters were discovered by the Labour research department and not by the Government's own watchdog?

I have nothing to say about any particular case, and I am surprised that the hon. Gentleman expects a reply on a particular case. Privatisation has led to millions of employees having shares that they would never have been able to have. There are now up to 8 million shareholders. That, of course, means nothing to the Labour party except bad news, because it leads to independence and personal prosperity, both of which are death to its policy.

Will my right hon. Friend find time today to carry out a review of the unfair Japanese domination of the once again postponed financing arrangements for the Channel tunnel? Is my right hon. Friend aware that in Eurotunnel's prospectus, for every one British bank involved in the financing, seven Japanese banks have signed up? In order to avoid these unfair 7: 1 ratios and the creation of a Franco-Japanese Channel tunnel, will my right hon. Friend intervene to insist on proper national investment quotas and limits?

I am not certain whether my hon. Friend wants a Eurotunnel to be built. I want a Eurotunnel to be built and I think, therefore, that I will interpret his question as inviting more British banks and British institutions to apply to finance a very exciting project.

Q6.

asked the Prime Minister if she will list her official engagements for Tuesday 7 April.

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

Will the Prime Minister tell the House what action the Government are taking to check the statistical validity of their recent claim that one in five people in this country own shares?

The Treasury's record on professional statistics is extremely good. I am not quite sure whose statistics the hon. Gentleman is questioning. If he writes to me and lets me know, we will see what we can do.