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Oral Answers To Questions

Volume 181: debated on Tuesday 20 November 1990

The text on this page has been created from Hansard archive content, it may contain typographical errors.


Children Act


To ask the Secretary of State for Health what progress he is making in the implementation of the Children Act 1989.

Our major programme of regulations, guidance and training continues to make good progress. We hope to launch the bulk of the guidance early in the new year.

Will my hon. Friend tell the House a little more about her Department's plans for the Act's training support programme?

I am able to announce a substantial increase in the amount of money for training in social services generally. The training programme for the implementation of the Children Act is making good headway. I am pleased to be able to inform my hon. Friend that we are arranging training through the National Children's Bureau for those involved in the national health service. The first training event took place in East Anglia only last week. I hope that it will soon be available to NHS workers in my hon. Friend's constituency.

I am always glad to hear from the Minister that there are training programmes. However, as £3,000 million of Government money is to be used to offset the effects of the poll tax, can she assure the House that sufficient resources will be available fully to implement the Children Act in October 1991?

I can give the hon. Gentleman that assurance. There has been a very good settlement for local authority personal social services this year which amounts to a 23·4 per cent. increase on last year's standard spending assessment. In addition, the training resources are ring-fenced. They go out in the form of specific grants for child care and for the implementation of the Children Act. We shall implement the Children Act in 327 days' time.

Is my hon. Friend aware that I heard with some concern from a group of my constituents that the consultation documents sent out by her Department on the running of day nurseries were received in Cleveland only on the day that they were due to be responded to? Will my hon. Friend look into that and, if necessary, extend the time?

I shall certainly look carefully at my hon. Friend's point. Only last month I attended a seminar in Newcastle at which local authorities, voluntary organisations and the private sector discussed precisely that guidance—that they should have inspected provision for child minders in play groups within three months and for day nurseries within six months. New guidance is important. We are funding the National Children's Bureau to produce material on that part of the Act. I certainly assure my hon. Friend that I shall look into the matter as it affects his part of the country.

Elderly (Day Care)


To ask the Secretary of State for Health if he will publish the number of day care places per 1,000 of the elderly and very elderly population, by individual local authorities.

This information was published last July. A copy was placed in the Library.

In view of that almost inadequate reply, will the Minister examine the responses from Labour-controlled county and shire councils and those from Tory-controlled county and shire councils? He will find that Labour-controlled county councils provide a far better service for the elderly. Does he understand that the Royal College of Nursing has expressed concern about inadequate transport arrangements and respite care, as well as the inadequacy of provision for those who live in rural areas?

I did not give every figure, because the hon. Gentleman asked for a figure for every local authority in England and Wales which would have taken some time to read to the House. He asked whether I am aware of the development of the service. He may know that the total number of day care places has risen by nearly 30 per cent. in 12 years and that the resources available to the Northumberland social services departments has risen by 55 per cent. in real terms in 12 years. The way that those resources are used is a matter for social services departments.

Does my hon. Friend agree that the most important thing is to ensure that old people can get about rather than be in day care? Is my hon. Friend aware that, unfortunately, elderly people in south Devon are hobbling about because the chiropody service has been cut and fewer sessions are available? Will my hon. Friend have a word with the chairman of the area health authority and say that before it cuts services at the sharp end, it should have a look at its own bureaucracy?

My hon. Friend is right to highlight the importance of chiropody services. They constitute an important part of proper community care. The exact prioritisation in an area is a matter for the health authority.

Does the Minister accept that as a result of the Government's postponement of their community care programme the number of day care places in the community may be declining? Is he aware that in Birkenhead, for example, the Vincent Harkness day care centre will be closing? What message would the Minister like me to take home to my constituents who may have only one choice—going into residential care—as a result of the Government's postponement of their plans?

I have already said that we recognise the importance of day care places and welcome the fact that over the past 12 years there has been an increase of 30 per cent. in their availability. They are a vital part of any proper community care policy. I do not accept that the phased introduction of community care need have a direct impact on the availability of places or on the way in which social services departments continue to use resources already at their disposal.



To ask the Secretary of State for Health by what percentage the cost of transferring neurosciences from Shooter's Hill to Denmark Hill has risen since the decision was taken; and what proportion of the South East Thames regional annual capital budget this represents.

Nineteen per cent, Sir. The costs are borne over a period of time and not solely by the regional health authority.

Would I be right in saying that the capital budget for South East Thames is between £50 million and £60 million and that the cost of moving neurosciences four miles is between £50 million and £60 million? There are already six or seven neuroscience units in the inner London area and people in my constituency and further out would prefer to have services available to them. Will my hon. Friend confirm that, or shall I take up this matter with the chairman of South East Thames regional health authority before going to independent auditors?

My hon. Friend should take up any discontent with the chairman of the regional health authority. He should be aware that the reasoning for the concentration of neurosciences on the Maudsley site was that it was a more efficient use of clinical resources and involved lower cost. I suspect that neither of those considerations will have changed.

Hospital Beds


To ask the Secretary of State for Health what steps he is taking to avert the closure of hospital beds throughout the United Kingdom.

It is for health authorities to determine the mix of health provision—including the number of hospital beds—which best meets the needs of their local population using the increased resources which the Government have made available to them. Next year will see the largest-ever increase in NHS funding, enabling the health service to continue to treat more people and expand its services.

The Secretary of State is no doubt aware of the recent report of the National Association of Health Authorities and Trusts which forecast some 3,500 bed closures between now and next April. He is probably also aware that all hospital consultants in Sheffield have been told not to prescribe on to general practitioners' budgets in order to save money. Is not it a fact that the Government are passing the buck to health authorities, which are no longer accountable, and are blaming them for the cuts when the Government are simply not providing adequate funding for health authorities to carry out their duties?

No, Sir, I do not accept that. As the figures show, the number of people treated goes on increasing from year to year. As the hon. Gentleman knows, the number of day care surgery cases has doubled since 1979 for medical reasons. That is largely why the beds continue to close.

May I congratulate my right hon. Friend on being appointed to his new position? When considering bed and ward closures, does he recognise that many of us believe that what is important is the treatment of patients, not furniture? Will he assure the House that when wards close and beds are moved, patients who need care will be taken care of elsewhere?

I am grateful for my hon. Friend's welcome. The figures support what she says. The national health service, thanks to its employees, who do so well for us, continues to treat more patients every year, including in my hon. Friend's area.

Does not the Secretary of State realise that the report of the National Association of Health Authorities and Trusts, and the survey carried out by The Independent the day before, showed clearly that, in anticipation of next year's managerial structural changes, health authorities were being forced to close beds? It is quite false for him to say that the key indicator is the number of patients being treated, because all too often health authorities have moved patients from hospital care, sooner than normal, back into the community. Many of them have had to be re-admitted because they did not have sufficient hospital convalescence following surgical treatment. Should not we examine that figure, rather than the platitudes that the Secretary of State is offering?

I read the surveys with care. It is worth noting that the report of the National Association of Health Authorities and Trusts to which the hon. Gentleman referred showed, by any inflation indicator, a real increase in resources available for the health service this year. That contradicts what Opposition Members have often said. The medical advice is against the hon. Gentleman. Before we took office the trend was already to keep people in hospital for less time. That is medically right.

I join in welcoming my right hon. Friend to his new position and express my pleasure that having me as his Parliamentary Private Secretary did not impede his career for too long—or at least I did not damage him as much as I did some of my other right hon. Friends. The reality of bed closures is often the opposite of that suggested by the hon. Member for Barnsley, Central (Mr. Illsley). Beds have been closed in my health district and much public distress has been expressed as a result. But those bed closures are being announced now to achieve required budget savings by next April. The main reason is not a shortage of funds from the Department of Health but the inadequacies of the management of individual health districts. More health districts should address themselves to the subject.

I am grateful for my hon. Friend's kind words. It is true that he has lost one or two Secretaries of State along the way, but he and I had a better relationship. What he says is perfectly true. It would be wrong for well-managed areas—Barnsley health district is managing well within its resources and has closed no beds for financial reasons—to be made to transfer resources to areas that may have tackled their problems with less resolution.

May I congratulate the Secretary of State on his appointment to the Cabinet and share the hope that he will still be in it after 6.30 pm? While he is still with us, will he try to face the realities? Has no one told him that some hospitals will not carry out any routine surgery for the rest of the financial year? Has no one told him that the NAHAT survey found that only 2 per cent. of closures were planned rationalisations and that 98 per cent. were emergency closures to balance the books in time for next April's changes? As those changes are doing so much harm to the national health service, why does not he take the opportunity of this interregnum to put back the lid on changes which came in with the present Prime Minister and should go with her?

I am grateful for the hon. Gentleman's welcome, although I am not so grateful for the fact that he is playing the old gramophone record which he has been playing for the past two or three years and will continue to play for the next two or three years from the position that he now occupies. Every year the health service goes on treating more people. I shall not deny that in some places in the health service beds are being closed for financial reasons, but it would be wrong for us to say that those who are trying to achieve their planned budget spending should not be encouraged to do so, because that is the basis of a well-managed service.

I warmly welcome my right hon. Friend to his new job and I know that he will be a great success. Does he accept that the best way to prevent bed closures is for the money to travel with the patient—which I hope will happen from next April? Does my right hon. Friend accept that he will have to take some tough decisions, particularly in the Thames region where the capital programmes have collapsed? My right hon. Friend must understand that constituencies such as mine, which has the worst waiting lists in the country and where children's wards are being closed, must be assisted if the excellent reforms that will come on stream next year are to mean anything.

My hon. Friend is right. The reforms will help to take the money to where the patients are and will help to reward hospitals that are successful and treat many patients. The present system works in exactly the opposite direction. I am well aware—this is the first thing of which anyone holding my office would be aware—that there is, as usual, a special London problem which has not been sorted out for decades. We shall have to sort it out before too long.

Health Service Funding


To ask the Secretary of State for Health what steps he is taking to ensure that adequate resources are available to meet the need for (a) health service provision and (b) community care as a result of demographic changes.

We shall increase resources for the national health service in the United Kingdom by £3·2 billion in 1991–92. At the same time, the standard spending figure for local authorities' personal social services will rise by 23 per cent.

Does the hon. Lady recognise that Ministers are continually playing the old record which was left behind by the Secretary of State's predecessor? Since 1982, inflation in the health service has been 49·9 per cent., compared with a less than 35 per cent. increase in the retail prices index. Do the Government recognise that the health service is treading water where it is not drowning, that demographic changes and the increasing numbers of elderly people are flooding over our services and that it is not enough to mouth platitudes? Resources are needed if community care is to be more than merely moving people out of institutions and if it is to mean providing adequate services for carers and those who are cared for in the community. Can we have the resources so that the job can be done?

This is the largest ever increase in resources for the national health service—a cash increase of one third over the past three years. I recall that when the Labour party was last in power, long ago, the total cost of the health service was £8 billion. There has been an extra £8 billion in the past three years alone. As for demographic factors, over the past 10 years the number of elderly people has increased by 8·4 per cent. Hon. Gentlemen might like to know that over that period the number of geriatric in-patients increased by 75 per cent.

Order. There is an air of excitement this afternoon which I fail to understand.

I am grateful for the reception by the House, but I am not on the ballot paper upstairs——

Does my hon. Friend agree that it is unacceptable for 50 beds to be closed in a relatively new, modern district general hospital in Macclesfield when there are surgeons and consultants waiting to carry out treatment and operations, theatres available for those operations and waiting lists of people wanting operations? The Mersey regional health authority has allocated insufficient resources to Macclesfield, given the growing number of elderly people and the growing population of the area.

The enemy of the health service is waste. It is a waste not to have people fully using the skills that they have been trained to deploy. It is a major challenge to health authorities to live within their resources. We take great pride in the substantial increase in resources that we have provided for the health service, but we do not underestimate the financial and management skills that health authorities need to deploy so that they do not let their work outstrip the resources to meet that work. We need further improvements in that area.

The Minister will agree that the demographic changes make a difficult situation far worse, so it is more important than ever to look at the way in which resources are moved about. How is it possible that Exeter health authority seems to have lost £60 million, which was released by the sale of two psychiatric hospitals at Digby and at Exminster, not £1 of which has gone into community care for the mentally ill? How is it possible that the Midland nerve hospital has closed a psychiatric ward with a staff of 15 who have been replaced by only three staff working in the community? Where have all those resources gone? Local people cannot find the information and they have been told that it is not available locally. We presume, therefore, that the information is available centrally. Can we be told?

I welcome the hon. Gentleman to his new role. He will know that there is concern about the extent to which provision for the mentally ill has kept up with our wishes and expectations. That is why my hon. Friend the Parliamentary Under-Secretary of State has responsibility for the specific grant for the mentally ill which will commence next April. Next year, £30 million will be spent by local authorities, with the agreement of health authorities, to ensure that there is close collaboration in the provision of services for the mentally ill. Over the past 10 years, there has been almost a doubling in the number of places in homes for the mentally ill. We believe that there is scope for further provision by social services to ensure that they do as well with the mentally ill as, in many cases, they have with the mentally handicapped.



To ask the Secretary of State for Health what is the number of in-patients being treated by the national health service at the present time; and how many were treated in 1979.

Almost 7·5 million in-patient cases were treated in 1989–90 compared with just over 6 million in 1979. That is a rise of almost 25 per cent.

I thank my hon. Friend for that answer because it nails the nonsensical assertion from some Opposition Members, and from my hon. Friend the Member for Macclesfield (Mr. Winterton), about cuts in the health service. It shows that there has been a dramatic increase in the health service provided to the people of the United Kingdom. Will my hon. Friend also nail that lie, for the benefit of my constituents, by telling me the figures for Scunthorpe health authority?

My hon. Friend is exactly right. The figures demonstrate that the national health service is growing each year that the Government are in power. I am pleased to be able to tell my hon. Friend that the number of patients treated in his constituency has risen at a compound rate of 5 per cent. per annum.

Does the Minister accept that although there has been an increase in the number of in-patients treated, there may have been an even greater demand? Are those in need of in-patient treatment receiving the treatment that they need or are they being turfed out of hospitals before they are ready and being directed towards private health care provision in a way which they would not have been in 1979?

In 1979, the in-patient waiting lists was 5 per cent. higher than it is now. It simply is not true to say that the shorter time in a hospital bed is a reflection of the fact that peope are being pushed out into the community. It is a reflection of the refinement of medical practice and of less traumatic medicine which means higher-quality patient care.

Is not it a fact that the improvement in medical techniques to which my hon. Friend referred means that many treatments that involved in-patient care in 1979 can now be achieved through out-patient care? Are not the out-patient figures even more relevant to the arguments on this point and on the whole question of hospital beds?

My hon. Friend is precisely right. There is also an interim category of day cases—people who would previously have had to stay in hospital, in many cases for several days, and in some cases for several weeks. They are now treated as day cases. The number of day cases treated by the national health service has more than doubled since 1979.

Dental Treatment


To ask the Secretary of State for Health what action is being taken by his Department to ensure that all areas have access to national health service dental treatment.

The Department operates a scheme offering financial incentives to dentists to set up in shortage areas.

Will the Minister guarantee the people of the north-east of England a dental service within the health service or are we seeing another way of privatising the dental service?

Is my hon. Friend aware that many dentists are wrestling with their consciences while considering whether they should go for more private practice than NHS practice? My dentist is one of those who finds himself in that predicament. There must be more inducement for dentists to stay with the NHS than there has been previously. They are very inclined to go private.

I read the same newspaper articles as my hon. Friend and I am obviously concerned by them. We have a choice between believing the Daily Mirror or the British Dental Association. The BDA has stated:

"the public should have no difficulty in finding an NHS dentist in any part of the country."
That surely is the important assurance that I gave the hon. Member for Blyth Valley (Mr. Campbell).

Will my hon. Friend take it from me that in the north-east of England there is an adequate supply of dentists, and excellent dentists? The thing that is putting off dentists at present is the amount of paperwork that they are having to complete in accordance with their new contracts. Will my hon. Friend consider that? The system needs streamlining urgently.

I entirely agree with my hon. Friend that we should always be reviewing the paperwork and bureaucratic requirements of the NHS to ensure that they are at the minimum. We must ensure also that there is a sufficient flow of information to allow management to discharge its tasks effectively.

Is the Minister aware that the terms of the new dental contract make it increasingly uneconomic to practice NHS dentistry in London and that the majority of dentists in London and the south-east voted against the contract for that reason? My constituents are finding increasingly that their dentists are moving over to entirely private work. Is the Minister further aware that many dentists and many other members of the public feel that the Government are trying to introduce the privatisation of the dental service through the back door?

I repeat not my words but those of the BDA, which stated that

"the public should have no difficulty in finding an NHS dentist in any part of the country."
The hon. Lady is an unlikely exponent of the point of view that £30,000 a year is not a decent living wage.

Hospital Trusts


To ask the Secretary of State for Health if he will visit those hospitals in Liverpool which have made proposals for hospital trust status in order to obtain at first hand the views of the staff.

I have no immediate plans to visit the hospitals in Liverpool that have applied for trust status.

How can a Government who claim to believe in democracy ignore the wishes of the Liverpool people, as shown in a recent survey carried out by the Liverpool community health council? It revealed that 88 per cent. of staff in hospitals in Liverpool and over 92 per cent. of the public in Liverpool find the concept of opted-out hospitals entirely alien to their idea of a health service. Might not the Prime Minister, if that is what the right hon. Lady remains after 6.30 pm, try out her new-found belief in referendums by going to the people of Liverpool and carrying out a referendum in that city, where no councillors and no Members of Parliament believe in the Government's extreme right-wing doctrines?

It would be absurd to have referenda on management changes within the NHS. It is not surprising that the hon. Gentleman and his colleagues have managed to scare many people in Liverpool, as others have scared people elsewhere. For example, the hon. Member for Peckham (Ms. Harman), who I think is an Opposition Front-Bench spokesman, issued a press handout about hospitals opting out of the NHS. No hospitals are opting out of the NHS.

Given the misunderstandings that many have about opting out or trust status, is not there a need for the Secretary of State to go to places such as Liverpool to explain his plans? Many are fearful that if the Liverpool royal hospital in my constituency or the Alder Hey children's hospital, which has an international reputation, were in some way to be separated from the NHS, they would not be available to ordinary people and would not provide them with the care that they have always provided in the past. If there is a misunderstanding, why does not the Secretary of State come to Liverpool to explain in person the proposals to those who will be affected by them?

There are 66 applications for trust status and we must approve them or not approve them shortly. It would not be practicable for me to visit all those hospitals before I have to take those decisions. It is important that the hon. Member for Liverpool, Mossley Hill (Mr. Alton) accepts, as I hope that the hon. Member for Liverpool, West Derby (Mr. Wareing) accepts, that it is his duty to get rid of the nonsense that has been spread around. I am sure that the hon. Member for Mossley Hill, who is an independent-minded man, will help us to do that.

General Practitioners


To ask the Secretary of State for Health what is the average number of patients and income of general practitioners in England and Wales; and if he will make a statement.

On 1 October 1989, the latest date for which information is available, the average number of patients on a GP's list in England and Wales was 1,962—14 per cent. fewer than in 1979. The intended average net income for GPs is currently £33,280 and will rise to £34,680 from 1 January 1991.

Will my right hon. Friend confirm that since the introduction of the new contract and over the past few years, GPs have had fewer patients on their lists and will therefore have more time to treat them? Will he also confirm that as a consequence of the new contract, GPs' incomes will increase, so in no way can it be said that their standard of living has been eroded?

I can confirm what my hon. Friend says. I remind the House that many statements were made about the effect of the new GP contract and a lot of words will have to be eaten, particularly by Opposition Front-Bench Members. The figures already coming through show dramatic rises, for example, in the immunisation of children, which I do not think would have been achieved without the contract, which is already working well.

How many applications have there been from general practices in England and Wales for budget-holding status? How many of them came from rural areas? When will the Secretary of State make an announcement about those that he will approve?

The number is about 350, with a similar number, or rather more, expressing interest for the future. I cannot give the hon. Gentleman the breakdown between rural and urban now, but I shall write to him about that.


To ask the Secretary of State for Health what has been the effect of the new general practitioner contract on the amount of time spent in consultation with patients.


To ask the Secretary of State for Health what recent representations he has received about the new contract for general practitioners.

A recent survey published in the medical press suggested that 54 per cent. of GPs have spent more time in patient contact since the introduction of the GPs' new contract. In recent months there has been a dramatic reduction in the volume of correspondence received on the GP contract.

When the new contract was negotiated, doctors expressed much concern about targets for cervical cytology and immunisation. Does my hon. Friend have figures to show the percentage and number of doctors who are achieving those targets? Has the number of home visits undertaken by doctors personally rather than through agency services increased since the new contract was agreed?

My hon. Friend rightly highlights the misleading and mischievous statements that were made at the time. The hon. Member for Livingston (Mr. Cook) said:

"The targets … for screening for cervical cancer—are so heroic, so far beyond the present figure for most practices, that there is a danger that many doctors will simply give up trying."—[Official Report, 25 July 1989; Vol. 157, c. 960.]
That shows, as ever, that the Opposition think so little of people and are the doom-mongers and gloom merchants.

I shall give my hon. Friend the figures that he requested: 54 per cent. of GPs are already hitting the higher target for cytology—the majority are hitting the higher target. A further 35 per cent. are hitting the lower target as well and that is very encouraging. A similar story applies to immunisation. The remuneration on home visits, whereby if a GP carries out his own home visit at night, he receives about £45, but if he uses a deputising service, he receives £15, has meant that GPs are more willing to undertake their own home visits.

Does my hon. Friend agree that one of the likely reasons for the reduction in correspondence on this subject is that the contract is now a great deal more popular and more widely accepted, not only among GPs but among patients, than it was when it was first proposed? Is not one of the reasons for that that patients have more information about the services that are available to them than they have ever had before? [Interruption.]

On a point of order, Mr. Speaker. Could we have some quiet? There is a lot of last-minute canvassing on Conservative Benches. These are important Health questions.

I have to say that the noise comes from the hon. Member's side of the House as well—[Interruption.] However, I thank the hon. Member for drawing his point of order to my attention. It gives me the opportunity to say that we should listen to Health questions in silence.

The GP contract is a great success, partly because it has been backed by resources. In the part of the world of my hon. Friend the Member for Richmond, Yorks (Mr. Hague), there has been a 20 per cent. increase in practice staff over the past year and a 65 per cent. increase in practice nurses. He will know that in his part of the country the average GP list size has come down from 2,000 to 1,700. Certainly, his point is important. The GP contract means that more information is made available through practice leaflets and the local directory of services. Patients are better informed. They are treated like partners by the GPs. It is a success for the GPs and a success for the patients.

The Minister mentioned cervical cancer a moment ago. Is she aware that the research unit at Hammersmith hospital, which is looking into breast cancer, now faces closure because of the inability to get £150,000 a year to continue its work, when her Department spent £147,000 on hospitality last year? Will not she say that it is a most inappropriate use and misallocation of resources and that she will keep the Hammersmith breast cancer unit open?

Clearly, as the first country in the European Community with a national call and recall system both for cervical cytology and for breast cancer, we are determined to reduce the number of avoidable deaths by cancer, particularly cancers affecting women. We have not had an application from the Hammersmith unit. We have been in touch with it to see whether there is any way in which we can assist.

Child Abuse


To ask the Secretary of State for Health what steps he is taking to protect children from abuse and neglect.

We are deeply concerned about all incidents of child abuse and attach a high priority to tackling it. Legislation that clarifies and simplifies the existing child care law is on the statute book. It will be implemented in October 1991.

Does my hon. Friend accept that child abuse is a problem which causes appalling conflicts between local authorities and families—conflicts which are often insoluble? Does she accept the need for up-to-date practice guidance to help with those problems?

My hon. Friend hits exactly the point about child abuse. The new Children Act 1989 ensures that there is proper, paramount consideration of the needs of the child and also recognition of the responsibilities of parents and the role of local authorities. Our guidance document, "Working Together", which was produced after the Cleveland report, clarifies and provides advice for the various agencies in their co-operation together. We shall be updating it in the new year and, in particular, drawing attention to the need to recognise the role, responsibilities and rights of parents.

Will the Minister please look again at the possibility of the establishment of a national centre for research into the abuse of children and sexual abuse, in particular—[Interruption]—so that perpetrators and victims can be examined in great depth?

On a point of order, Mr. Speaker. I cannot hear because of the noise.

Will the Minister look at that question, which I first raised with the Prime Minister two years ago, so that, for a small amount of money, we can ensure that real progress is made on that important issue?

I shall certainly give high priority to the development of services for those who have been abused and, indeed, for abusers. A major training programme is under way. We work in collaboration with a great number of voluntary organisations, for example, the National Society for the Prevention of Cruelty to Children, the National Children's Bureau, the National Children's Home and many others. Only recently we identified an additional sum, particularly for the development of services for those who have been the victims of sexual abuse and for the perpetrators of abuse.

Does my hon. Friend agree that a lot of heartache has been caused to parents, because some of the guidelines contained in "Working Together" are still not being observed either by local authorities or by the professional organisations representing some of the professionals involved in case conferences? When she reviews "Working Together", will she ensure that the new guidance is strictly observed by local authorities and professional organisations?

Yes, that is correct. Those involved in child abuse cases should give paramount consideration to the welfare of the child. Many children's lives were lost some years ago because the workers were so busy working with the parents that they almost forgot to focus on the child. The pendulum has now swung the other way and there is concern that parents' interests are not being properly regarded. I can most certainly give my hon. Friend the assurance that the new issue of "Working Together" will properly identify the on-going responsibility of parents.

Residential Care


To ask the Secretary of State for Health what steps he is taking to ensure that persons in residential care are enabled to have individual rooms if they so desire.

That is a matter for local authorities. To assist local authorities, we have issued guidance that makes it clear that residents should have the choice of single rooms wherever that is preferred and practicable.

Is the Minister aware that thousands of residents in care homes have to share a room and that in some cases there are four or five people to a room? How would she like to have to share a room in her old age with four or five other people? What is she going to do about it? Is she aware of the two major reports that have been published, the Wagner report and the Home Life report, which both state that it is highly desirable that elderly people should have individual rooms? Is she further aware of the representations that have been made by organisations such as the Royal College of Nursing, which said that in old age, residents of such homes need choice, dignity and to be cared for properly? What will the Minister do about all this?

It is my intention and hope to share my room with one person in my old age, but perhaps with no more. We are intent on improving standards in residential care homes. We have a training initiative to improve the quality of care. New inspection units were established by local authorities this April and it will be important that local authorities meet the standards that they have been setting for the private sector for many years. Our community care plans should ensure that proper support is provided in the community as well as residential support being provided, where appropriate, for those who need it.

Prime Minister


Questions to the Prime Minister—[HON. MEMBERS: "Hear, hear".]—Order. No. 1, Mr. McAvoy.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

The Lord President of the Council and Leader of the House of Commons
(Mr. John MacGregor)

Mr. Speaker —[Interruption.]

I have been asked to reply.

My right hon. Friend the Prime Minister is attending the conference on security and co-operation in Europe, in Paris.

Does the Leader of the House accept that with the Tory party split from top to bottom in an orgy of bitterness, animosity and hatred, it is proving that it is patently unfit to govern? Bearing in mind the present Prime Minister's new-found enthusiasm for referendums, will the Leader of the House urge him to resign and call the only referendum that matters—a general election—to give the people an opportunity to elect a Labour Prime Minister?

We have just had the debate on the Address and the legislative programme in which the Government secured a very large majority of 108. That is a firm rebuttal of the hon. Gentleman's point. We have a full and important legislative programme and we shall be getting on with it, as the House wants us to do. I do not know why the hon. Gentleman raised that point, because when the general election comes and the focus turns to his leader and the Labour party's policies, I have no doubt that the Conservative party will have a fourth considerable victory.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Can my right hon. Friend confirm that the excellent European arms reduction treaty could not have been achieved under the weak, indecisive and divided policies advocated by the Opposition? Can he further confirm that the defence of the realm remains a key objective of the Government and that the aerospace workers in Lancashire will have a full part to play in that?

My hon. Friend is absolutely right in what he says. It was because the Government—under the leadership of my right hon. Friend the Prime Minister—and other Governments in the west were resolute about defence and maintained an effective nuclear deterrent that the Soviet Union realised that it could not win militarily. When a Soviet leader arose with the courage and vision of Mr. Gorbachev, my right hon. Friend the Prime Minister was the first to recognise that and to encourage him in the process of reform and disarmament, which was so triumphantly sealed yesterday. That treaty is of major significance for the future of Europe. My hon. Friend is also right to stress the role of British Aerospace. I am sure that it will continue to have an important role.

I can tell hon. Members exactly what my right hon. Friend is doing—he is enjoying the undivided support of his party.

Will the Leader of the House accept our congratulations on the Government's refusal to provide £10 million to fund the city technology college in the Prime Minister's borough? When shall we have a statement on the Government's general climbdown on CTCs?

There is no climbdown on city technology colleges. We have a clear programme—15 have been either announced or are well in the pipeline. What is more, the CTCs already in existence are proving not only extremely effective in raising standards in inner-urban areas, but extremely popular with parents. They all have very large waiting lists.

If there is no general climbdown on CTCs, what significance should we read into the Prime Minister having been picked out for special punishment in that particular? Is not it true that the Government's policy is in shambles in yet another area and that the country now faces all the problems of a lame duck Prime Minister leading a lame duck Government?

That was a shambles of an attack. Our CTC policy is continuing and the CTCs are proving very popular. As the former Secretary of State for Education and Science, I recently announced consultations on a new CTC—which I believe will be very good—in the Bristol area. In each case, we must consider the obtaining of sufficient funds from sponsors and the matching of sponsors with sites in appropriate inner-urban areas. It is not true that the CTC programme is crumbling.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Has my right hon. Friend noticed the absence of the Leader of the Opposition? Could he possibly be attending any summit meeting and, if so, would he be advocating his policies of 1983 or his policies of 1990?

Not the least of the achievements of my right hon. Friend the Prime Minister is that the Opposition have changed so many of their policies—for example, on Europe, on the economy and in many other respects. That is a clear sign of the Government's success with our policies during recent years.

I know that the Leader of the House must be worried about matters other than Question Time, but will he address himself to the position from which he was recently removed, that of Secretary of State for Education and Science? Does he realise that the CTCs, which were mentioned by my right hon. Friend the Member for Birmingham, Sparkbrook (Mr. Hattersley), together with the assisted places scheme, are costing more than the £500 million that he recently wrung from the Treasury? Does he accept that both those schemes are an insult to British education? Only a few parents are lucky enough to feel able to support them, while the remainder of education suffers from the siphoning off of public money into private education.

For a start, the hon. Gentleman's figures are completely wrong. The two programmes to which he referred cost a good deal less than £500 million. I know that he will have noticed the proposals in the autumn statement to increase spending on education next year by more than £3,000 million. That is a clear sign of the priority that we give to education. The CTC programme and the assisted places programme are two of the many means by which we are raising standards and extending parental choice.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Does my right hon. Friend agree that the Government's policy towards Europe has been vindicated by the success of the conference on security and co-operation in Europe, held in Paris? Does he further agree that the direction of future policy must lead to greater co-operation across the entire continent of Europe rather than to a retreat into a tight economic unit covering less than half of it?

I very much agree with my hon. Friend. As my right hon. Friend the Prime Minister said in Paris yesterday

"We would hope to see east and central European countries join the Council of Europe. And in the slightly longer term we would also hope to see them join the European Community when they are ready and want to do so".
My hon. Friend is also right to talk about a wider, open Europe. As a former Minister of Agriculture, Fisheries and Food, I believe that the lead that my right hon. Friend gave—[Interruption.] I was pleased to play my part in the reform of the common agricultural policy. The lead that my right hon. Friend gave in trying to get a united European position on the GATT Uruguay round has been most important.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Is the Lord President of the Council aware that my hon. Friend the Member for Bolsover (Mr. Skinner) was outside Committee Room 12 this morning at 10 o'clock when he conducted a most authoritative exit poll of a certain contest? Among the first—[Interruption.]

Order. The hon. Gentleman may well have been there, but the hon. Member for Coventry, South-East (Mr. Nellist) should relate his question to Government responsibilities.

Among the first 200 Tory MPs who emerged, 200 admitted to voting for the Prime Minister and 200 admitted to voting for the right hon. Member for Henley (Mr. Heseltine). With all the duplicity and general savagery of the past few days, does the Lord President agree that it would be better to follow the advice of my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy) and call a general election? Instead of 350 Tory Members of Parliament deciding a political talent contest, 40 million people could pass verdict on the past 11 years of Thatcherism.

I have already dealt with the general election point. The hon. Gentleman has highlighted the fact that, as ever, the hon. Member for Bolsover (Mr. Skinner) not only gets his facts and dates wrong, but has an extremely vivid imagination.

We shall see.

I am grateful to the hon. Member for Coventry, South-East (Mr. Nellist), as he has reminded me that I have still to vote, which I hope to do in about five minutes.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Does my right hon. Friend agree that the fact that in excess of 7 million people have already registered to buy electricity shares demonstrates the continuing and overwhelming public interest in popular capitalism, as espoused by the Conservative party alone under the leadership of my right hon. Friend the Prime Minister? Does he also agree that today's 11 million popular capitalists have everything to fear from the return of an expropriating Labour party?

I agree with my hon. Friend. There is no doubt that one of the many successes of the past 11 years of Conservative rule has been the wider spread not only of share ownership but of property ownership. It has been clear for many years that the wider spread of ownership is not a concept in which the Opposition believe.

Following the earlier remarks of the Leader of the House about Labour party policy, may I ask whether he is aware that at the weekend the Prime Minister accused the right hon. Member for Henley (Mr. Heseltine) of pursuing Labour party policy? Could that be why the right hon. Gentleman is so much further ahead in public opinion than the right hon. Lady?

That was a reference—[Interruption.] If one reads what the Prime Minister said one sees that it was a reference to one or two aspects of economic policy in relation to intervention in industry. If one examines the totality of our policies on the economy, one sees that my right hon. Friend the Member for Henley (Mr. Heseltine) in his remarks was totally in support of the Prime Minister and that in a wide range of other policies there is a great deal of unity on Conservative Benches and a great deal of opposition to the policies being pursued by the Labour party.


To ask the Prime Minister if she will list her official engagements for Tuesday 20 November.

I have been asked to reply.

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

Does the Leader of the House agree that one of the many achievements of the Prime Minister has been to set up the Audit Commission? Does he further agree that it is extraordinary that the Opposition want to abolish it simply because it is exposing massive waste and inefficiency in town halls, with over £1·3 billion of savings already identified?

I wish that I could agree with my hon. Friend that it was extraordinary behaviour on the part of the Labour party. Sadly, it is all too typical, and I was horrified by the reputed remarks of the hon. Member for Sheffield, Brightside (Mr. Blunkett), that the Audit Commission's

"unhelpful undermining of local authority initiatives undoubtedly mean its days are numbered".
The Audit Commission has shown how local authority services can be improved, with the charge payer being saved about £1·3 billion, and has shown how waiting lists in hospitals can be cut by a third at no extra cost. So Labour's action over the Audit Commission carries this single message for charge payers and taxpayers everywhere, "It has money to burn—yours."