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Oral Answers To Questions

Volume 173: debated on Tuesday 5 June 1990

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Cancelled Operations


To ask the Secretary of State for Health what is the maximum and minimum number of operating theatre sessions cancelled by district health authorities last year.

Four districts reported no cancelled scheduled operating theatre sessions in 1988–89 and one reported just over 2,000 cancelled sessions.

I congratulate my hon. Friend on his appointment. Does he agree that the figures that he has just given show yet again that there are enormous discrepancies in the performances of different health authorities? Does he further agree that if only the less efficient could improve their performance, they could deliver far more health care for the same amount of money?

I am grateful to my hon. Friend for his good wishes. He made a good point. Both the National Audit Office and the Public Accounts Committee have pointed out the enormous discrepancy within health districts in the efficient use of operating theatres. The Bevan report shows that across the country the average utilisation is 70 per cent. If that were raised to 90 per cent., there would be a saving to the National Health Service of £100 million. The reforms that we intend to introduce next April will help to achieve that.

What steps are being taken to increase the average utilisation figure? Would improved information technology help, especially when patients do not turn up or when notes are not available to the surgeon carrying out the operation?

Improved technology certainly has a part to play and our response to the Bevan report recognises that. We are currently consulting on the lessons to be learnt from that report and we expect to issue guidance soon.

Was not there a recent case of an ophthalmic surgeon working in the Health Service carrying out more operations in one month than another ophthalmic surgeon carried out in six months? Do not NHS patients have the right to expect unanimity of good service, wherever they may live? Is not that the most important reason for the review of the NHS?

During my three and a half weeks in the job, that specific case has not been drawn to my attention. However, the principle espoused by my hon. Friend is right. We are introducing reforms next April to try to achieve that unanimity of service throughout the country.

Community Care


To ask the Secretary of State for Health if he will make a statement on earmarked grants to local authorities for the purpose of community care.


To ask the Secretary of State for Health if he will make a statement on earmarked grants to local authorities for the purpose of community care.

Local authorities are responsible for determining the use of the resources on matters for which they have policy responsibility and for which they are accountable. The House welcomed the Government's decision to make community care the prime responsibility of local government, and earmarked grants would be inconsistent with that decision.

I am sorry to hear the Secretary of State's response, although I am not surprised by it. Is he aware of the anxiety throughout social services departments that there will not be sufficient grant to meet the demand for community care? Is he further aware of the London Research Centre report, published in April, which suggested that there would be a shortfall of £100 million rising to £500 million by 1994? Will he consider specific grants to meet such shortfalls, should they arise?

We have always made it clear that local authorities need, and will receive, adequate resources to carry out their new responsibilities. Those resources will be decided during the public expenditure round. It is rather premature to produce reports, from any source, about the inadequacy of resources before we have even decided what those resources will be.

One difficulty with earmarked grants is that it is impossible to separate that area of expenditure from what is already being spent on care in the community, which in large part is already a local authority responsibility. remind the hon. Gentleman that while the Government have been in power total spending on care in the community has risen by 68 per cent. in real terms—that is more than half as much again as was being spent when we took office and before we introduced our popular arrangements.

On 6 December the former junior Minister made a speech of glowing support for community care when he addressed the annual general meeting of the National Schizophrenia Fellowship. Is not it a cruel deception of such bodies that there is a distinction between the Government's aims and the methods that they use? Does the right hon. and learned Gentleman accept that earmarked grants should be available to areas such as north Derbyshire so that they can meet the provisions referred to in Government statements?

My junior Ministers move on to greater things so rapidly that I am not sure whether the hon. Gentleman is referring to a speech made by my hon. and learned Friend the Minister of State, Home Office or my hon. Friend the Minister for Public Transport, but if he was addressing the National Schizophrenia Fellowship I have no doubt that the reference was, above all, to the specific grant that we have made it clear that we shall be introducing to encourage community care for mentally ill people. A specific grant for that area is important because in the past it has not been given high enough priority by local authorities. Therefore, money aimed specifically at mental illness will be allocated to local authorities when they produce plans that are satisfactory to the health authorities.

Will my right hon. and learned Friend comfirm that, whether earmarked or not, grants given to local authorities from next April will represent the sums that hitherto would have been paid in social security benefits? Is he yet able to give the formula by which the figures will be calculated or an estimate of the sum involved? I am sure that he appreciates the difficulties of local authorities in making their plans from next April without knowing what resources will be available to them.

We are firmly committed to transferring from the Department of Social Security vote to our vote and to local government the sum of money that would have been spent by the Department of Social Security under the old policy of making provision through income support for people in residential care. We also have to make a calculation for growth and a calculation of what is available for this year, and we shall do that when we make the decision on the revenue support grant for local government. I appreciate the difficulties for local government in having to make plans when final decisions have not been reached on exactly how much will be available next year, but that is inescapable in the system of annual financial planning that we have always had. It is true of the whole range of government, under this Government or any other, that we have to wait for the autumn spending round before we know exactly how much we have for the next year. Neither the Treasury and Civil Service Committee nor anybody else has yet come up with a better way of doing it.

Has my right hon. and learned Friend had a chance to consider the sad and moving story that appeared in the Nottingham Evening Post last Friday about Colin Jago, a schizophrenia sufferer, who slipped so tragically through the community care net? Will he have a look at that story to see whether any lessons can be learnt for our policy on care in the community?

I agree that the story of Colin Jago is tragic. It shows what a dreadful way of life he led as a result of suffering from schizophrenia. I shall ask the chairman of the district health authority to let me have a report on his case to see whether there are any lessons to be learnt.

That is sheer hypocrisy. The Secretary of State is allowing the mental illness unit for adolescents to close.

Before the hon. Gentleman stoops any further to try to make party political points out of a tragic individual case—

People must make their own judgment about where hypocrisy lies in the matter, and loud-mouthed barracking does not help.

I should point out to my hon. Friend the Member for Gedling (Mr. Mitchell) that Colin Jago was examined and interviewed by a doctor at Mapperley hospital, who decided that it was not necessary to admit him to hospital for treatment. However, we must discover the full facts to see whether there are any lessons to be learnt from Mr. Jago's sad death.

Will the Secretary of State acknowledge that Sir Roy Griffiths recommended an earmarked grant, that the local authorities, including the Conservative ones, want an earmarked grant, and that now the other place has voted for it? Even flagship Wandsworth has made representations to the Secretary of State supporting the case for a ring-fenced grant. Why does he disagree with everybody else if it is not that he is afraid that an earmarked grant will make it only too plain that he cannot come up with the cash that the councils need to make care in the community work?

Because good government depends on clear responsibility and accountability, and I have not been persuaded that it is right to give responsibility for this matter to local government and then for the House or any Government to try to keep to themselves part of the responsibility for determining the level of resources. No one in Wandsworth or anywhere else would want the Government to determine the total level of resources available. There is also a practical problem with an earmarked grant. I do not understand how it is proposed to distinguish the earmarked grant, made with whatever new money we might make available, from all the moneys already being spent on care in the community by local government, which already provides home helps, meals on wheels, and so on. I do not believe that it is practicable and nor, for the reasons that I have given, am I persuaded that it is desirable.

Social Workers


To ask the Secretary of State for Health what steps he is taking to assist in the recruitment of local authority social workers.

It is for local authorities themselves, as employers, to take whatever steps are appropriate to recruit the staff whom they need.

Did the Minister hear the Prime Minister praising the work of child helplines the other day, when she said that we must make sure that enough telephones are provided and that sufficient volunteers are available to man them? Is not it a little hypocritical of the Prime Minister to make that remark when the Central Council for Education and Training in Social Work states that an extra 800 social workers need to be trained each year to maintain the present level of services?

My right hon. Friend the Prime Minister was praising the work of Childline, which uses volunteers and provides an excellent service. We pay £300,000 towards the cost of that service. The CCETSW has responsibility for training, and we have substantially increased its funding. There are significantly more people—about 4·5 per cent. more—joining the profession each year than leaving it. Of course, we continue to have discussions with employers and with the CCETSW to ensure that there is an adequate supply of social workers to undertake important tasks, in addition to the volunteers to whom the hon. Gentleman referred.

Does my hon. Friend agree that social services recruits not only need university degrees or to be armed with diplomas in humanities but should be streetwise? Would not it be a good idea to recruit mothers whose children have grown up—and perhaps even younger grandmothers—because such women have raised families, are streetwise, and are not as green as grass?

I entirely support my hon. Friend. In my view, streetwise grandmothers are precisely the people who should be undertaking work with young families. The work that we do in training social workers ensures broad entry. It is not the case that it is only 18 or 19-year-old undergraduates whom we want to attract. We seek to recruit also the mature woman who has experience. I shall certainly bear in mind my hon. Friend's words when I next meet those responsible.

Health Care, Nottingham


To ask the Secretary of State for Health when he next plans to visit Strelley health centre, Nottingham to discuss standards of health care.

Is the Minister aware that there is great concern at Strelley and other health centres about the Government's policy on preventive medicine? Is he further aware that 2·5 million fewer people have received free eye tests than in the previous year? Eye tests can detect serious illnesses such as cancer and kidney disease, and other conditions. Will the Minister admit at the Dispatch Box, on his first day in the job, that it was a terrible mistake to charge people for eye tests that were previously free?

No, I am unaware of any of those things. The hon. Gentleman will have an opportunity to represent his arguments in tomorrow's debate. I have not the slightest doubt that my hon. Friend the Minister for Health, who is replying to that debate, will be able to knock the hon. Gentleman out of the water.

My hon. Friend the Member for Loughborough (Mr. Dorrell) is almost the local Member of Parliament concerned, and I am sure that he agrees that his constituents and mine receive excellent service under the National Health Service provision in the city of Nottingham. Does my hon. Friend the Minister agree that health centres are growing not only in number but in excellence? I ask him to join in paying tribute to the chairman of the district health authority, Mr. David White, and to all those involved in Health Service provision in the city of Nottingham.

I join my hon. Friend in congratulating Mr. White. As he said, my constituents also benefit from the considerable improvement in health care made over the past few years in Nottingham. The city has two major general hospitals, and has seen a 9·2 per cent. increase in direct care staff in the Health Service over the past five years. It has also seen a 22 per cent. increase in in-patient cases and a 22 per cent. fall in the average general practitioners' list. That is an enormous improvement in health care in Nottingham, from which my constituents, among others, benefit.

Community Health Councils


To ask the Secretary of State for Health if he will make a statement on the future of community health councils.

Has the Minister read the leaked letter—published in the National Union of Public Employees journal recently—from the Secretary of State for Social Security, which showed that the answer given to the House is not as accurate as suggested? The letter states that it is the Government's intention to do away with the right of community health councils to complain about such things as hospitals opting out. If that is the case, will the Minister admit it, and if it is not, will he officially deny it? Consumers of health care are getting sick of their democratic rights being taken away.

I am afraid that I am not an avid reader of the NUPE journal, but I can confirm that no change is envisaged for the role of the community health council when a district health authority proposes the closure of a hospital.

I welcome the reassurance that my hen. Friend has given, but will he reflect on the fact that while community health councils can be a useful sound-board for local opinion on the health services that are provided, it is the membership of the health authority that has executive control over local allocation of resources? A key issue in future is to try to ensure that the range of authority members and their responsiveness to local opinion is such that they can bring influence to bear and reflect public opinion in the provision of health services.

My hon. Friend is right to say that the changes that will be introduced next April are intended to emphasise the executive nature of health authorities. That leaves an important role for the community health councils. In many ways it will be an enhanced role after April. It creates the opportunity for them to become more concerned with the development of the service in the area for which they are responsible.

Will the Minister publish for the relevant community health council any draft business plan that has been submitted to his Department or any draft application for self-governing trust status? Will he also publish for the relevant community health council a copy of his Department's response to any such draft papers, to ensure that the council is effectively able to represent local opinion when a hospital in its area is deciding whether to opt out?

I shall not undertake to publish draft business plans, but I give the undertaking, which my right hon. and learned Friend has given many times, that the community health councils will be fully consulted on any proposal to establish a self-governing trust.

Will community health councils be able to do much that Members of Parliament who are active in their constituencies cannot do? Given that circumstance, does my hon. Friend think that if the councils did not exist at this time tomorrow, they would be missed, or that they are much loved?

My hon. Friend is an active Member of Parliament. If everyone was as active as him, he might have a point. Community health councils have a significant part to play in the future of the Health Service, by representing proper concerns when major changes are envisaged and as a consultee in the future development of the Health Service. I hope that in future the councils, in the same way as other bodies are concerned with health issues, will be more interested in output by the Health Service than in input.

Nhs Trusts


To ask the Secretary of State for Health what information he has on how many ballots have been held in hospitals which are considering opting out; and whether any of these have shown a majority in favour of such a course of action.


To ask the Secretary of State for Health what evidence he has of the views of National Health Service staff or patients on the formation of self-governing trusts.

No Government have ever thought it sensible for changes in management of NHS services to be subject to ballots. Applications for NHS trust status will not be invited until Parliament has approved the necessary legislation. Staff and members of the public will then have an opportunity to express their views on individual proposals before any decisions are taken. I prefer the usual process of consultation rather than public referendum on such complicated and specialist issues.

A total of 195 units have so far expressed an interest in NHS trust status, with some 80 stating that they may seek trust status in 1991. That demonstrates the keen interest with which senior NHS staff, including members of the medical and nursing profession, view the prospect of establishing NHS trusts.

In the light of that response, will the Secretary of State tell us the definition of the electorate when such decisions are reached? Surely all categories of staff and existing, past and potential patients must be involved in the decisions as well as the community health councils, which have already been referred to. Has he established any criteria on which he will say no?

Of course, the staff of the National Health Service are a key part of it. They deliver the service and we depend on their dedication. However, we have never operated any type of worker control and the public have an interest in those matters as well. The founding of the National Health Service was not made subject to local ballots and I can recall no change in the 40 years since then that has been made in that way. We shall have a full process of consultation and I will refuse applications unless I am satisfied from all the information that comes in from the consultation that, if granted, a particular application will lead to a better quality of service for patients in that hospital and better value for money for all those interested in the National Health Service.

Is the Secretary of State aware that in ballots held across the country, huge majorities have been returned that are opposed to hospitals opting out of the National Health Service? Is he further aware that almost every organisation connected with the National Health Service—the Health Service trade unions, the community health councils, Health Service charities and voluntary organisations—is equally opposed to hospitals being allowed to opt out of the National Health Service? As the Health Service belongs to the people, why does not the Minister let the people decide by ensuring that there are ballots in every area affected before any hospital is allowed to opt out of the Health Service?

I am against any hospital opting out of the National Health Service. If people go round asking daft questions, they get daft answers, which is not a very positive contribution to running a better National Health Service. We shall have a full process of public consultation on what local people are proposing in the places that go ahead with an application for NHS trust status. The Labour party is bereft of any serious contributions. Instead of putting forward its own ideas on how we might go back to more local discretion and control in running the Health Service, it leaves the whole matter to the ridiculous local ballots being run by councils, unions and other people.

Will my right hon. and learned Friend admit to the House that the drive for NHS self-governing status comes from his Department through the chairmen of the regions and the chairmen of the districts, all of whom are party political appointments? Will he state genuinely to the House that if it is the view of local people, and especially if it is the view of consultants, doctors, nurses and paramedics working in a hospital, that they do not wish to go for self-governing status, he will refuse that application?

I do not only not admit, but I strongly deny my hon. Friend's allegation and his ridiculous travesty of our appointment process—[Interruption.]

If the appointments were party political, I should have complaints from the Opposition about them. The applications for self-governing status are coming from people concerned with the hospitals and units themselves. It is rather absurd that when, in effect, we go back to a system very similar to the old hospital management boards, which gives back far more local control at the sharp end of delivery over how the Service is run, we are opposed in this way. I well remember the Labour party fiercely fighting the establishment of the district health authorities and the regional health authorities, which it now says should run the Service. Eighteen years ago, the Labour party argued vehemently that it was wrong to take away local control of hospitals. I have undergone a conversion in those 18 years and I am inclined to think that the Labour party was right. The trouble is that the Labour party just opposes any change at any moment.

On a point of order, Mr. Speaker. I asked a question and the Minister did not——

Order. That is not a point of order. If the hon. Gentleman were asking to raise the matter on the Adjournment, that would be different.

On a calmer note, does my right hon. and learned Friend agree that if there is a proposal for a management area change and then the idea of a self-governing trust, it could cause extra delays, and that, if there is an erosion of services and facilities, as at the Royal National Orthopaedic hospital, there is a danger of that hospital's future being severely threatened? Will my right hon. and learned Friend pay attention to that and say what he intends to do about it and when our colleague the Minister for Health will visit the hospital?

I have visited that hospital and I certainly recommend my hon. Friend the Minister for Health to visit it if she has the opportunity. I understand the need to resolve some of the uncertainties surrounding the future of the Royal National Orthopaedic hospital. I shall certainly ensure, and I am sure that my hon. Friend the Minister of Health will too, that nothing connected with NHS reforms causes further delay or creates fresh difficulties for all those who work in that excellent hospital.

Does not the Secretary of State recognise that he could sidestep all questions on local ballots if he would simply agree to a timetable that first put the proposals to the general electorate so that electors who had no opportunity to comment in the last election will have an opportunity to vote on them in the next one? I warn the Secretary of State that, if he persists in bulldozing through the proposals for opt-out without giving local people any voice, the next Labour Government will take back all those hospitals into local health authority control.

I have had a look at the draft manifesto that the Labour party prepared for the next election. It seems to be so vague on management issues that I came to the view that it was voting to make no changes in particular to whatever it inherited if and when it got back into power. I am absolutely astonished that the hon. Gentleman is now committing himself to making no changes to the way in which the National Health Service is run, without submitting any proposals that he might have for local ballots in the future. If we ever had a Labour Government, it might reduce the dangers of dangerous action, but I do not think that a Labour Government would adopt such a foolish process.

Does my right hon. and learned Friend accept that a growing number of senior doctors, nurses and paramedics in the two district health authorities in my area are growing increasingly excited at the thought that they may have an opportunity to shorten the administrative hierarchy that constantly second-guesses their judgments, frequently to their detriment?

I am interested to hear what my hon. Friend says. I know that quite a lot of those who are interested in NHS trust status are, among other things, looking forward to being free of the day-to-day control of their district, region or other parts of the system. There certainly is widespread enthusiasm. I disapprove of all the ballots, whatever the electorate is. It is a selective way of looking at the interests of everybody who has a common interest in the NHS—it does not belong to the staff. So far, five of the ballots among consultants have been in favour and seven have been against. I hope that everybody will wait until they have a proper application and then go through a sensible process of consultation, making whatever representations they want. That will enable me to make a better-informed judgment in the end, which is in the interests of the Health Service and its patients.

Dental Checks


To ask the Secretary of State for Health if he will now remove the charge on dental checks.


To ask the Secretary of State for Health if he will now remove the charge on dental checks.

I see no reason to do so. It is right that adults who can afford to do so should make a contribution to this part of their dental care.

Are not dental checks an important part of preventive medicine? Has the Secretary of State noticed that independent research shows that the number of dental checks is falling? Although that may save money, is not it bad for the health of Government policy?

I think that dental checks are important, which is why I think that those who can afford to do so will willingly pay £3·45 for a dental check. The right hon. Gentleman is aware that 40 per cent. of the population is exempt from any charge. I know of no evidence of a sustained decline in the number of dental checks. Indeed, over any lengthy period, there has been a steady increase in the number of dental checks and in the total number of dental treatments in the National Health Service.

Will my right hon. and learned Friend encourage the dental practice board to make available treatment under the EC 18 certificate? I understand that recently the board was denied all knowledge of it and that therefore some patients have been paying for their treatment.

I am not aware of those problems. I am grateful to my hon. Friend for drawing them to my attention. I shall take up the matter with the dental health board and let my hon. Friend have a written response to her question.

Further to the answer to the right hon. Member for Morley and Leeds, South (Mr. Rees), the right hon. and learned Gentleman cannot have been talking to dentists, because all the dental surgeons to whom I have spoken over the past few months have said clearly that only people in two income categories can afford a full, prolonged and comprehensive system of dental care—those on full state benefits who do not have to pay and those in an income category such that they can afford to pay—and that the bulk of people, who fall somewhere between the two, are cutting their dental treatment because of the cost. How can the Secretary of State deduce from that that there is no downturn in preventive medicine?

Of course, similar representations are made to me by dentists whenever dental charges are raised generally, in line with the longstanding policy of this Government and of previous Labour Governments. However, it is clear that over any sustained period there has been a steady increase in the number of dental treatments given under the National Health Service. Over a lengthy period I expect to see a continued and satisfactory level of dental check-ups. I do not believe that for the 60 per cent. of the population who are asked to pay, £3·45 is a deterrent charge for a perfectly reasonable part of any individual's preventive medicine—[Interruption.]

Order. I appeal to hon. Members to listen to the questions and not to conduct private conversations, which is disruptive.

Is not it true that the new dental contract will, for the first time, pay dentists a fee for the regular patients on their list, without requiring any contribution from the patients? Although it is understandable that dentists feel some concern about the details, does my right hon. and learned Friend agree that a positive vote from dentists in the forthcoming ballot on the new contract would be a vote for prevention and would provide a much-needed shift in emphasis towards better dental health?

Yes, I agree. The new contract will enable dentists to offer patients all-round continuing care, including emergency cover, treatment plans, better information and the replacement, free of charge, of certain restorations that fail within 12 months, and so on. I have agreed the new contract with the dentists' representatives and they are commending it to their members. I very much hope that the dentists will vote in favour of the new contract, which represents a substantial improvement in our dental services, for which many dentists have been pressing for many years.

How can the right hon. and learned Gentleman tell the House that there is no evidence of a decline when the Minister for Health told the House in February that there had been a slight dip and when in May his Department reported a reduction of 700,000 cases, thus bucking the upward trend throughout Europe? Does the Secretary of State accept that he has got his figures wrong and will he go back and do his homework—[Interruption.]

Order. I am sorry to interrupt the hon. Gentleman, but will hon. Members, especially those below the Gangway, desist from conducting private conversations, which are very disruptive?

Does the Secretary of State accept that he has plainly got his figures—and his policies—wrong?

There was a dip, but I referred to long-term trends. There is always a dip—I have no doubt that this was the case when the Labour Government were in power—when charges are increased for any part of NHS services. However, over the years, the dips are not sustained. I repeat that I do not believe that £3·45 is a deterrent charge for the 60 per cent. of the population who are liable to pay the charge, and nor do I believe that any evidence will be forthcoming to demonstrate that it is.

Cottage Hospitals


To ask the Secretary of State for Health what policy changes his Department has instituted during the last six months with regard to cottage hospitals; and if he will make a statement.

There has been no change in the position. It is for health authorities to determine the pattern of services in their own locality.

Is the Minister aware of the comments by the Secretary of State on 10 October when he said that the Government's new funding arrangements would ensure that

"popular cottage hospitals will thrive"?
As there are now six small cottage hospitals under the axe for closure in my county, will the hon. Gentleman confirm whether that is because a different policy is being pursued in Wales or because there has been a change of policy in the Department of Health, which means that such hospitals in England are in as much danger as are those in Wales?

No, Sir. There has been no change of policy. The same policy is pursued in Wales and England. The policy is to allow greater delegation of decision-making to local level. Where there is a genuine and sustained local demand for a community hospital, that will be seen in the purchasing decisions taken from next April onwards.

Does my hon. Friend agree that the cottage hospital provides a signal service in rural areas, especially where travelling distances are great? Does he recognise that there is a feeling in the southern part of my constituency that Herefordshire district health authority is being frustrated in its attempt to redevelop Ross cottage hospital into a community hospital by a less than fully co-operative attitude on the part of West Midlands regional health authority? Will he be careful that any advice that he gives to the regional health authorities reflects the wish to sustain the viability and independence of the health authority to provide what it deems to be appropriate for an area and that no element of discouragement floats in?

One great virtue of our reforms is that we shall be rather less heavy handed than we may have been in the past in the type of advice that we offer from the centre to a district health authority. I believe that as a result there will be greater diversity of local decisions and of health care available and the manner in which it is provided. We hope that that will lead to improved standards and more uniformity in the quality of health care, which in the end is what the patient is interested in.

Has the Minister considered the possibility of setting up a royal commission to look into cottage hospitals with a view to safeguarding their future? He could put in charge a man who is desperate for a job—he sits below the Gangway—and who is the last leader of the SDP. He has done a good job for the Tory party over the years and the Minister could repay him the compliment.

The right hon. Member for Plymouth, Devonport (Dr. Owen) will be grateful to the hon. Gentleman for his concern about his future well-being.

Doctors (Recruitment)


To ask the Secretary of State for Health what plans he has to meet members of the medical practices committee to discuss the recruitment of doctors.


To ask the Secretary of State for Health how many general practitioners there are now in the National Health Service.

The Department holds regular meetings with the chairman of the medical practices committee. We are not aware of problems with regard to the recruitment of doctors. At 1 October 1988 there were 25,322 unrestricted principals in England. That is 4,000 more than in 1979.

Does my hon. Friend agree that not inconsiderable delays can occur between the practice obtaining approval to recruit a general practitioner and the recruitment taking place and that that is to the clear detriment of the local community? Therefore, when she next meets the chairman of the medical practices committee, will she ask him to introduce a more rigorous monitoring system that will ensure that appointments are made in under a year and that if a practice does not intend to take advantage of it, the opportunity to have a new doctor is given to another practice?

I am aware of my hon. Friend's concern about the matter, particularly the case which arose in his constituency. Time is needed to advertise and to interview prospective candidates and, of course, for new appointees to give notice. Certainly, I shall examine closely the point made and raise it with the relevant committee the next time I meet it.

I thank my hon. Friend for her reply and I welcome the increased number of GPs, which shows the Government's commitment to the NHS. Will she confirm that GP list sizes have dropped dramatically in the past couple of years? Does she agree that the GP now has more time to deal with the individual patient, which is in the interest of the GP, the patient and the NHS?

My hon. Friend is absolutely right. For the first time, the GP list size has fallen below 2,000. That is a major achievement. Not only do we have smaller list sizes, but the GP has at his disposal a much larger practice team. There has been 70 per cent. increase in the number of ancillary staff in the practice. That all means better care for patients.

How many general practitioners will run their own budgets next year? Is there any truth in the rumour in the press last weekend that the software will not be available for GPs to run their budgets?

The whole proposal to have budget holders is going well, and about 400 practices have expressed an interest. Clearly, they will not be finally approved until we are confident that they can undertake the responsibilities. A practice budget will provide general practitioners with more autonomy and control. GPs are willing to join the scheme and we welcome the steps forward. We are making good progress with the software and we are confident that it will be possible fully to implement the proposals.

Community Care


To ask the Secretary of State for Health when he next expects to meet the Association of Directors of Social Services to discuss community care.

I hold regular formal and informal meetings with the ADSS, but there is no fixed date for the next meeting.

When the Minister meets the directors of social services will she agree to provide the additional necessary funds, as promised in the report of Sir Roy Griffiths, to maintain services to the elderly, the mentally ill and other people in need? Will she consider funding the additional social workers that will be necessary to meet the demand for social work? Will she also consider the suggestion of creating a Minister of Community Care?

Indeed, but when I meet the ADSS, which is frequently, as I made clear, I shall speak again about the vast sums already spent on community care—about £3·5 billion—as well as about the importance of new policies and ensuring that those resources are spent effectively and well in the interests of the individuals concerned. We have made it clear that adequate resources will be available and we are working openly and in close consultation with the ADSS on that popular policy.

Prime Minister



To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

This morning I presided at a meeting of the Cabinet and 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 hope to have an audience of Her Majesty the Queen.

As this is World Environment Day, may I congratulate my right hon. Friend on the United Nations award to her? Is not it a fact that my right hon. Friend's recent decision to limit CO2 emissions in 2005 to the present levels will represent about a 30 per cent. reduction in CO2 emissions from the projected levels? Surely this will mean substantial sacrifices on the part of energy consumers.

I am grateful to my hon. Friend. Of course, I welcome the award as a recognition of the lead that the Government have taken on environmental matters. We have put forward a target time of 2005 so that we can get down the CO2 emissions during that year to where they are this year. That is a realistic target and one which I think will become a world consensus. I am very glad that the chairman of the Intergovernmental Panel on Climate Change has endorsed that as a realistic target and believes that in 15 years' time we shall have better science on which to make further decisions.

Does the Prime Minister appreciate that she spoke for the whole country recently when she said that the poll tax had been a huge mistake?

The right hon. Gentleman is mistaken—I never said any such thing. I am very sorry to disappoint him, but he should not believe everything he reads in the newspapers.

I am sad that the reports that there was some common sense breaking out in Downing street have been slightly exaggerated. Is the Prime Minister aware that the costs of administering poll tax are huge? Is she aware that there is chaos in many areas about the collection of the poll tax? Does she appreciate that poll tax capping will inflict crippling losses, especially on children's education? When all those things are true, is not it obvious that the only thing wrong with her saying that the poll tax is a huge mistake is that it was a gross understatement?

The right hon. Gentleman never conditions his supplementary questions to my previous replies; perhaps that is beyond his capacity to think on his feet. With regard to the collection of the community charge, the right hon. Gentleman and his advisers will be aware that we accelerated the taxpayer's contribution, the revenue support grant, to local authorities so that they got virtually three months' grant in place of the two months that they otherwise would have got. That gives them a considerable advantage in cash terms so that if they put it on deposit they have a good extra amount to tide them over any difficulties.

Perhaps the right hon. Lady will condition herself to the reality that all over the country, under Conservative and Labour councils, people are saying, "This poll tax is costing us much more than the rates ever did. Where is the sense, prudence and fairness in that?" Is not it clear that such a tax is doomed, as it deserves to be, along with the Government who invented it?

I understand that the right hon. Gentleman feels strongly about the community charge, especially as he lives in Ealing, where, having had a Labour council, there is a very high community charge. But who is the right hon. Gentleman to talk? We looked at the Labour party's document, having heard Labour's director of campaigns and communications promise on 4 April that the next major policy statement by the Labour party would be on 23 and 24 May. We were told:

"In that will be contained our fully worked out alternative to the poll tax."
What did we see when we got that document? We found a list of principles followed by the statement:
"The practical means by which we achieve these aims and principles are set out in a background paper."
There is no background paper. The Labour party does not have a clue.

Is my right hon. Friend aware of the astonishment and dismay of right hon. and hon. Members on both sides of the House at the decision of the unelected Chamber on the War Crimes Bill? Will she bear it in mind that Australia, Canada and the United States, three countries with legal systems not dissimilar to ours and which do not take second place to us in regard to human rights, legislated on this long ago? Will she weigh very carefully in coming to any decision on this grave matter the words in the conclusion of the Hetherington-Chalmers report that to take no action against such monstrous crimes—[HON. MEMBERS: "Reading."] I am quoting——

will taint the United Kingdom with the slur of becoming a haven for war criminals? Is not it clear that the only moral conclusion to be reached is that the Bill must be introduced in another Session?

Of course I recognise the extremely strong feelings, because of the hideous nature of the crimes. We shall be considering carefully the implications of the result of the debate in another place and how best to proceed, bearing in mind the size of the majority in this House on a free vote. It may be that the House itself will wish to discuss the matter, in which case I am sure that that will be pursued through my right hon. and learned Friend the Lord President.


To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

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

Is the right hon. Lady aware that her Government are presiding over record levels of homelessness, high mortgage costs, high rent increases and the complete collapse of the private rented sector? What does she intend to do about that?

The Government are also presiding over a record number of homes. The hon. Gentleman will be aware that considerable proposals have been made and money allocated to reduce homelessness. It was recently announced that £250 million would be devoted to it, with considerable increases in the money being made available in the coming two years, from £985 million to £1,700 million, to the Housing Corporation and housing associations to build more houses suitable for those and other people.


To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

My right hon. Friend will be aware of the success of inward investment in Britain. She has no doubt noted that 41 per cent. of American investment and 38 per cent. of Japanese investment in Europe comes to Britain. Does she agree that if the Labour party put the unions back in the saddle, overtaxed everyone and increased public expenditure that new investment would end and Britain would become the sick man of Europe, as it was in 1979?

I agree with my hon. Friend that a record amount of inward investment in the Community comes to this country from the United States, Japan and other countries. Part of the reason for that is the kind of free enterprise economy that we run and our excellent record on enterprise, production and manufacturing investment. All those things would go if the Labour party ever put into practice its policy document, which goes back to the failed policies of the past.

Does the Prime Minister agree with the very sensible views of Hans-Dietrich Genscher, the West German Foreign Minister, who said that NATO will have to change and evolve to become the keystone of a new pan-European defence structure if the long-term stability and security of Europe is to be maintained?

They are not new or sudden. I shall be speaking to a meeting of NATO Foreign Ministers at Turnberry on Thursday and there will also be a NATO summit in this country in June-July to do just that.

Does my right hon. Friend agree that although it would be inappropriate for the Government to respond to the illegal action of France in banning British beef imports by a similar illegal action of our own, it is perfectly reasonable for British consumers to use their purchasing power to boycott French goods, inluding the appalling French Golden Delicious apples?

I understand my hon. Friend's strong feelings, but I must tell him that the Commission has been extremely good and quick in its action. It is quite illegal to ban exports from this country to Germany or France and the Commission is taking action. The special veterinary committee of the Community has agreed that Britain has taken all action possible and that British beef is safe.


To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

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

Does the Prime Minister agree that at a time of low morale in the teaching profession and teacher shortages it is a tragedy that Barnsley metropolitan borough council is having to sack teachers and close its music teaching centre, thereby depriving local children of tuition in music, simply as a result of her Government's arbitrary and artificial poll tax capping?

That is not the cause, and it is absolute nonsense for the hon. Gentleman to say that. Local authorities such as mine whose education record is unbeaten have managed to do it with a low community charge. They manage things very well with the co-operation of their teaching staff and exhibit excellent local authority management.


To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

Will my right hon. Friend note that I had British beef for lunch? [Interruption.]

Will she convey the congratulations of my farmers to the EEC Commission on its prompt action on the illegal ban imposed by certain EEC countries which is based on pure commercial interests? Will she confirm that all the independent scientific and medical evidence shows that it is perfectly safe to eat British beef? Does she agree that the decision by Northumberland county council to ban beef, which was withdrawn within two days, was an utter disgrace?

I thank my hon. Friend for his meaty question. I entirely agree that the Commission has acted quickly, in response to the ban, which it regards as illegal. I agree that the special committee of veterinary experts attached to the Community has approved of everything that we have done in taking every possible measure in pursuit of the recommendations of the Southwood and Tyrrell committees and that British beef is safe. I also agree that those who have banned British beef have done so more to protect their farmers than for anything else. I will gladly pass on my hon. Friend's remarks.


To ask the Prime Minister if she will list her official engagements for Tuesday 5 June.

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

I thank the Prime Minister for her reply. I hope that she enjoys the rest of her day and that she has a pleasant night's sleep in a warm bed. Is she aware that this is National Housing Week? What will she do for those of my constituents who do not even have a home to go to tonight?

I shall tell the hon. Gentleman precisely what has been done. I understand that just over 1,000 people sometimes sleep out rough in London. Some of them have other problems such as being mentally retarded, or have genuine problems and are genuine social cases. Others are not. During the lifetime of the Government, a great many hostel places have been built. There are now more than 21,000 hostel places in London, including some 3,000 emergency places and direct access beds. We have already just allocated another—[Interruption.]

They do not like to hear the facts, Mr. Speaker. Some £250 million will be spent over the next two years to provide nearly 15,000 extra lettings. The new housing association hostels will be allocated another £100 million, all to help with the problem of the homeless. There are far more council flats empty in London than there are people homeless on London streets.