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Volume 202: debated on Tuesday 21 January 1992

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Sunderland General Hospital


To ask the Secretary of State for Health how many beds were available at the intensive care unit at Sunderland general hospital in (a) December 1990 and (b) December 1991.

Five beds were available at the intensive care unit throughout both of the months named.

Is the hon. Gentleman aware that, for most of last year, only four of the seven beds in the Sunderland intensive care unit were operating, that five are now operating, although there is a staff shortage, and that the future of the fifth bed is not clear? Is he aware also that during that time scale many seriously ill patients had to be turned away and had to go to other hospitals and that patients using the unit had to be taken out of it prematurely so that others more seriously ill could take their place? How does that square with the repeated claim that the national health service is safe in Tory hands?

It is true that, on occasions last year, there were staff shortages in the intensive care unit at the hospital. The health authority has made it clear that it is initiating an inquiry to establish the levels of staffing and back-up staffing that are necessary to ensure that there are no shortages. I am advised that there were no serious repercussions for any patient at Sunderland general hospital last year.

Is my hon. Friend aware that Sunderland general hospital will receive an investment of £19 million this year, of which £11 million is to be spent on a new acute ward block? That is part of Northern regional health authority's largest-ever capital investment, and it has been brought about by the Government.

My hon. Friend is right to draw attention to the local example in Sunderland of the greatest-ever capital investment programme taking place in the national health service. The hon. Member for Sunderland, South (Mr. Mullin) might have mentioned that the local health authority has committed itself to eliminating all waiting lists of more than 12 months by the end of this calendar year.

Hiv Infection


To ask the Secretary of State for Health if he will make provisions comparable to those made to haemophiliacs to non-haemophiliacs infected with HIV as a result of national health service blood or tissue transfers.

We have every sympathy with the plight of those infected with HIV as a result of NHS blood or tissue transfer. However, we have not been persuaded that it would be right to extend the special provision which has been made for the infected haemophiliacs.

How can the Minister justify the Government's callous attitude towards those who become HIV positive as a result of national health service treatment? Surely she accepts that the Government were right to provide compensation for haemophiliacs who became infected through contaminated blood factor 8. Surely she must appreciate that there is no logical or moral case for making a distinction between haemophiliacs and non-haemophiliacs in this respect. That is the view of the Haemophilia Society and of the vast majority of hon. Members on both sides of the House. Will the Government think again on this matter?

Frankly, I find it extremely difficult to make judgments about any of the 5,451 AIDS sufferers, let alone the 16,828 HIV sufferers. As the hon. Gentleman of all people will know, we must ensure that we have effective, first-rate services for all those suffering from HIV or AIDS. We took the view that the haemophiliacs were a special case: they were doubly disadvantaged because of their hereditary condition and the onset of HIV, which compounded their problems.

May I press my hon. Friend on this matter? Does she agree that haemophiliacs and others who are given contaminated blood transfusions receive them from the national health service? Does she agree also that we are talking of not one or two people but tens of people? There are more than 1,000 haemophiliacs and nearly 100 others who received contaminated blood transfusions. These major disasters are compounded by the fact that those people believed that the NHS would make them better.

How can my hon. Friend argue that compensation should be given to haemophiliacs because, sadly, they suffered a congenital disease and that a sick person who required a blood transfusion was in a different category? The result is the same—great suffering for the individual and great suffering for his or her family, probably the onset of AIDS and, ultimately, death. In those terms alone, have not the Government and the NHS a moral obligation to do something about the matter?

With respect to my hon. Friend, I do not believe that it is ever possible to cut a hard-and-fast line. Any case in which a patient suffers a medical accident is a great tragedy. However, the House debated no-fault compensation and, like the royal commission involved, took the view that it could not be justified. We made a difficult decision, and provided a generous settlement for haemophiliacs. Although my hon. Friend makes persuasive and powerful arguments, I cannot accept that they are convincing reasons for moving the line.

The Minister will be aware from her files that two of the 62 cases are my constituents. Does she accept that it is impossible to explain to them why patients who are haemophiliacs are eligible for compensation but they are not—even though my constituents have the same condition, life expectancy and financial pressures? It is impossible to do that because there is no logic to that argument. If it is difficult to defend where the line is drawn, it may be that the line is drawn in the wrong place and that it should be drawn instead so that it includes all those who were infected because of NHS treatment—not just some.

As the House knows, Labour has no difficulty making pledges that would result in untold expenditure. The hon. Gentleman argues for no-fault compensation. Where it can be established that there has been negligence, of course compensation is payable. It is the job of the national health service to provide health care and treatment and to continue developing that treatment. I cannot convince myself or the House that the hon. Gentleman's argument is right or persuasive. I remind the hon. Member for Livingston (Mr. Cook) that, this year, £200 million will be earmarked especially for those suffering from HIV or AIDS.

Ec Health Treatment


To ask the Secretary of State for Health if he will introduce proposals whereby national health service patients could be referred to receive treatment in the EC.

Under current European Community regulations, individual patients may be referred elsewhere in the Community for treatment in certain specified circumstances, with the prior authorisation of the Department.

Is my hon. Friend aware that some of our European partners, with a very high standard of health care, are offering to perform operations for which there is a demand in this country—such as hip replacement—at competitive prices? One health authority is already negotiating with a French hospital, but it is under the impression that it may not yet make use of that facility. Does my hon. Friend agree that such an arrangement would not only broaden the health services already made available to patients but achieve financial savings that could be ploughed back into the provision of other services?

I urge my hon. Friend to examine more carefully the health arrangements in many European Community countries, because Britain is one of the few in which a patient may visit a general practitioner and receive hospital treatment free of charge. That is rare in the rest of the Community. Patients in France are expected to pay 20 per cent. and patients in Belgium up to 25 per cent. of the costs. My hon. Friend should again examine the relative costings. The figures that she gave referred to comparisons with the private sector, not the national health service. I want to ensure that we build on the success of the first six months of NHS reforms so that no one will want to go anywhere but to his or her most immediately available hospital to receive NHS treatment.

Will the Minister make the point that, rather than look for treatment to be provided elsewhere in Europe, the Government should provide hospitals in this country? For the past 10 years, my constituency has been promised a hospital, but no progress has been made.

I much regret that such a new Member of Parliament should have picked up the churlish habits of other Labour Members. The hon. Gentleman's constituency includes the South Cleveland NHS trust hospital, which is a first-rate, second-wave trust. As the report produced last week by my right hon. Friend the Secretary of State made clear, patients are getting a first-rate service from NHS hospitals and ever-improving treatment from the hospitals.

The problem is not just that frequently patients in other European countries have to pay for their treatment. They often receive a far lower standard of care than patients in this country. Is not it a fact that doctors and nurses in France were on strike recently, and that in Italy patients have to ask relatives to bring in food because none is provided by the hospitals? Relatives often have to provide non-medical care as well, and patients have to bring in their own blankets and bed linen. Will my hon. Friend note that I, for one, want to receive the superior care that our patients receive?

My hon. Friend is absolutely right. I seem to remember being told that the latest policy is to turn water cannon on the nurses; that does not strike me as the most helpful approach.

We do indeed have one of the best health services in the European Community, and my hon. Friend is right to emphasise its strengths. The report that my right hon. Friend the Secretary of State produced last week revealed that this year we are due to treat an extra 250,000 patients; we are cutting the number of long "waiters", and creating a service that is responsive to patient needs. Those are all reasons for us to have pride in our health service, rather than denigrating the achievements of all our public-spirited NHS staff.

Mentally Ill People


To ask the Secretary of State for Health what recent assessment he has made of the adequacy of community care provision for people with serious mental illness.

I am today publishing an assessment of the case for hospital hostels for people with serious mental illness. In recent years, we have established the capital loans fund and introduced the mental illness specific grant. My right hon. Friend recently announced that the mental illness specific grant is to be increased by 50 per cent. in the coming year, and he is today announcing that we are doubling the size of the homeless mentally ill programme in London. This programme together provides over £100 million of new money for mental illness services in this country.

There could be no more tragically eloquent testimony to the fact that the Government's community care policies have failed than the sight of mentally ill people spilling on to the streets every moment. Although it comes late, I welcome the comment by the Secretary of State for the Environment that that sight is an affront to society.

May I point out, however, that it is not only for the convenience of passing citizens that mentally ill people should be cleared from the streets? What is required is adequate special accommodation, along with the necessary health facilities. Will the Minister give a commitment that there will be no further discharges of patients from long-term hospitals until places have been found for mentally ill patients? Will he also give an assurance—

Will the Minister give an assurance that mentally ill patients who were ejected before the Government's U-turn will be given a rightful place in society?

The hon. Gentleman is wrong in almost every particular. First, he is wrong to assume that the policy to which he refers is espoused only by the Government: until now, there has been a bipartisan commitment to ensuring that mentally ill people receive care and facilities that are properly attuned to their needs.

Secondly, the hon. Gentleman asked for a change of policy that would ensure that, before people were discharged from long-stay hospitals, proper provision was made for them in the community. That does not require a change of policy; it is the Government's policy. It is our policy that no one should be discharged from long-stay hospitals without the existence of a care programme that defines that person's needs—and, furthermore, naming an individual key worker who will be responsible for ensuring that the person receives the care that he requires.

The fact is that the hon. Gentleman cannot support his assertions on the basis of the available evidence.

Order. I remind the House that multiple questions lead to multiple answers and take up time.

I warmly welcome my hon. Friend's announcement. Does he accept, however, that—sadly—many of those who are sleeping rough in our cities and elsewhere have indeed been discharged from psychiatric hospitals and have slipped through the care package net? Hundreds more are in our prisons, which are the wrong place for such people. Will my hon. Friend ensure that there is a proper care package, properly drawn up, for every mentally ill patient who is discharged from a psychiatric hospital before such patients are discharged? If that cannot be achieved, will he ensure that psychiatric hospitals do not close until the necessary arrangements can be made?

I am grateful to my hon. Friend for his support for the document that we are publishing today on hospital hostels. I agree with him that they have an important role to play in a fully integrated service for mentally ill people, but the House would mislead itself if it believed that those mentally ill people who find themselves on the streets are drawn from those patients who have been discharged from long-term care in hospitals. The great majority of homeless people who are mentally ill have never been in our hospitals. We need to ensure that the management of community care is improved to meet the needs of those who are discharged from hospitals and, more particularly, of those who have never been long-stay patients in our hospitals for the mentally ill.

I welcome without qualification the Minister's statement and confirm that there is a bipartisan approach to this policy. However, we want that policy to be activated and managed. That is the difference between us. We do not want to stand idly by and do nothing. The Minister's announcement—which again I welcome without qualification—comes six years after the Audit Commission's report on care in the community, which in paragraph 28 highlighted the fact that then, six years ago, there were 37,000 fewer mentally ill and mentally handicapped patients than there were 10 years ago but that nobody knew where those who had been discharged were because nobody had done anything to find out what had happened to them. For six years, the Government have not taken a blind bit of notice of the Audit Commission's report. They have allowed their care in the community policy for ex-mental patients to amount to no more than people drifting within a community of hostels, in which one finds people who have fallen through the safety net and ended up homeless on the streets.

I find myself left wondering, if £100 million of new money is standing idly by, how much an action programme is going to cost the Labour party and when we shall see it properly costed.

Orthopaedic Treatments


To ask the Secretary of State for Health by what factor (a) hip replacements and (b) all orthopaedic procedures have increased since 1979.

The latest figures for 1990–91 show the number of hip replacements up by 54 per cent. from 28,788 to 44,477. Latest information on all orthopaedic procedures from the hospital episode statistics is for 1989–90 and shows an increase of 18 per cent. from 554,000 to 656,000.

Does my right hon Friend agree that the figures confirm the tremendous advances that have been made in health care since the Conservatives came to power? Does he agree that that is evidenced by the recent successful survey of the national health service? Does my right hon. Friend agree also that the last Labour Government introduced such swingeing real cuts in the health service that, if they were returned to power, it would represent a real threat to those who require advanced orthopaedic treatment?

My hon. Friend is right. That is reflected in the fact that there are now about 100,000 more orthopaedic operations than there were in 1979. The hon. Member for Livingston (Mr. Cook) recently said to the House, rather chillingly, that if Labour were re-elected it would treat the national health service as it did last time. As Mr. Charles Webster, the national health service historian, recently told "Newsnight", that meant a splurge of spending at the beginning that was followed by the most desperate and dangerous cuts ever in the history of the national health service.

Is my right hon. Friend aware that an enormous number of people in Herefordshire are very grateful for the spectacular increase in knee and hip replacements that has taken place in that health authority's area during the past 10 years? It is an astonishingly successful programme. However, with a higher age structure, compared with the national average, demand continues to outstrip supply. In view of my right hon. Friend's waiting lists initiative, will he take special cognisance of that point and balance the distribution of that resource to reflect the age structure?

My hon. Friend knows that one of the changes that we are introducing is much fairer funding of health authorities throughout the land to reflect, among other things, the age structure. It is the duty of health authorities to meet the needs of local people by putting the money where it best serves those local needs.

Eye Treatments


To ask the Secretary of State for Health what plans he has for reducing waiting times in respect of eye treatments; and if he will make a statement.

We are taking vigorous action to reduce waiting times for hospital treatment in all specialties.

Is my hon. Friend aware that, for many years within the referral area of the Plymouth eye infirmary, people have had to wait excessively long periods not only for an initial eye examination but for subsequent treatment? Will my hon. Friend tell us what action is being taken to improve the position in respect of new staff and new facilities and any benefits that might be derived from the new contractual arrangements?

My hon. Friend is right to say that the ophthalmology specialty in Plymouth hospital has had excessive waiting lists. I am pleased to be able to tell my hon. Friend that the new structures and management priorities of the health service led the health authority to appoint a new ophthalmology consultant last week to provide extra sessions to work through the waiting list. The contracting system to which my hon. Friend referred has made it possible for the health authority to provide extra capacity for the specialty at Exeter hospital which will ensure that the waiting list can be worked off much more quickly than would otherwise be possible. My hon. Friend's constituency experience demonstrates clearly the higher priority now attached to reducing waiting times and the management system that is necessary to deliver that objective.

Is the Minister aware that the new cataract centre at Manchester royal eye hospital is dependent upon private patients to pay the £2 million loan for its refurbishment? Does he agree that that will lead to preferential treatment for private patients and creeping privatisation? Why on earth is his Department so scared of answering questions on this subject?

That question is not for the Government; it is for the hon. Gentleman and his party to explain to his constituents why it is in the interests of the patients of Manchester to remove private patients from NHS hospitals, to deny the NHS revenue that private patients bring and to deny benefits to NHS patients in general.

Does my hon. Friend agree that, whether the Opposition like it or not, waiting lists are going down? Will my hon. Friend pay tribute to the doctors, nurses and administrators who have made the reforms, the fundholders and the NHS trusts a success? Will my hon. Friend ask the Opposition whether they will continue to embark upon their policy of abolishing those trusts? If they do not give an answer, will my hon. Friend take the Leader of the Opposition out for an Italian meal?

My hon. Friend is right to draw attention to the deafening silence of the Labour party when last week we announced success in reducing long waits for NHS treatment. The House may be interested to know that, because we were seeking to look at the effect of NHS management reforms over the first six months, we did not draw attention to the fact that the number of people who have been waiting for more than one year on in-patient lists is 37 per cent. down on what it was when we took office in 1979.

Infant Mortality


To ask the Secretary of State for Health if he will state the infant mortality rate for each of the last 10 years.

The rate of infant mortality per 1,000 live births in England and Wales has fallen from 11.1 in 1981 to 7.9 in 1990. The complete figures for the past 10 years will be published in the Official Report.

Although those figures are welcome, is the Minister aware that we do not compare well with our European colleagues and that our declining infant mortality rate is not as good as many of their rates? Also, there are big differences between social classes and regions in this country in terms of the opportunities for children to survive. Does the Minister consider it fair that, if a child is born in East Anglia, it has a far better chance of survival than if it is born in Yorkshire or in my region, where we recently lost five intensive care cots? Is not it right that all children should have access to the latest technology, irrespective of where they live or the poverty of their parents?

I do not think that it is right for the hon. Lady to knock the national health service in that way. In fact, Britain's figures are rather good. Some in Europe are better than ours, but we are better than some others and very much better than the United States. She will also want to welcome the fact given in answer to the hon. Member for Peckham (Ms. Harman) that the percentage improvement among the poorest groups—what the sociologists call groups 4 and 5—has been greater than that among the higher groups, so the gap is therefore narrowing. That is very welcome.

I recently referred the subject of access to neo-natal facilities to the Clinical Standards Advisory Group, and we recently set up a confidential inquiry into stillbirths and deaths in infancy. We are making steady progress, of which the country should be proud. We should also be proud of the NHS's achievement in that respect.

Is my right hon. Friend aware of the improvements made in Shropshire, especially by the maternity unit of the Royal Shrewsbury hospital, where two thirds of the Conway brood were born? Is he aware that that progress has been made not merely because of the skill of the consultants and of the nursing staff but because of the way they work together as a team? Therefore, will he ensure that the district health authority does not break up that team in order to move it to Telford to try to keep an under-used district general hospital busy?

I believe that steady progress is being made, as my hon. Friend says. I am grateful to the hon. Member for Eccles (Miss Lestor) for having tabled the question, which otherwise the Opposition might have accused me of having planted.

Following is the information:

Infant mortality rates per 1,000 live births: 1981–1990 England and Wales




Gp Budget Holders


To ask the Secretary of State for Health if he will make a statement on the progress of budget-holding general practitioner practices.

The Government's introduction of general practitioner fundholding has been a clear success, a fact confirmed in the independent academic research undertaken by Professor Glennerster of the London school of economics reported today by the King's Fund.

To allow the advantages of fund holding to be enjoyed by more patients and doctors, I am pleased to announce that we are lowering the list size eligibility criterion from 9,000 patients to 7,000 patients for practices entering the scheme from April 1993.

My right hon. Friend's announcement is to be welcomed by GPs who welcome the principle of managing their own funds. It helps the NHS and its patients. Is not it now time that the hon. Member for Peckham (Ms. Harman) apologised to the House for saying that GPs were not interested in fund holding?

It is true that the hon. Lady said in column 687 a couple of years back on 15 March 1990—[Interruption.]—that there was "no support among GPs"—[Interruption.]

She said that that was the position of all general practitioners of fund-holding practices. [Interruption.] Hon. Members opposite must get used to the idea that I shall read out what their Front-Bench spokesmen have said about fund holding. The hon. Member for Livingston (Mr. Cook) associated himself with the sentence:

"I'll be surprised if budget holding does not collapse in the first year."—[Official Report, 13 March 1991; Vol. 187, c. 946.]
He should have the grace to admit that he was wrong and the grace to clear up the muddle that has existed in his ranks since his colleague the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) recently announced that he was going to abolish fund holding. I could not get a straight answer from the hon. Member for Livingston about this. I think that the House needs to know whether he will abolish fund holding in the teeth of opposition from virtually every GP and from the British Medical Association.

Will not the fact that the percentage of GPs who hold their own budgets still remains a very small fraction of the total number of GPs—even after today's announcement—linked to the nature of the block contract system of an internal market, inevitably mean that, if we are to avoid a two-tier health service in terms of patient referrals, either all GPs must hold their own budgets or none should be budget holders? The present two-tier structure is leading to a two-tier treatment of health.

Like those on the Opposition Front Bench, the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) is out of date. Professor Glennerster and others looked at the allegations and found no evidence of a two-tier structure emerging. Professor Glennerster said that it was clear that the benefits won by GP fund holders were swiftly being transferred to the patients of other GPs, which is what we said would happen. I think that the hon. Member, who belongs to a party that is supposed to believe in devolution, might occasionally support a practical piece of devolution.

Will my right hon. Friend accept that GPs were encouraged to introduce computerisation partly by an offer of Government funds to refund the cost of that process and, in districts such as the Wessex health authority, those funds have not been fully forthcoming? Will he agree to allow a carry-over into next year to ensure that those GPs who have introduced computerisation will be compensated by the Government, in accordance with the Government undertaking?

I have been to a large number of conferences and met many general practitioners, including many from my hon. Friend's district. I have found no such systematic problems, but if there are specific difficulties in some practices, those involved should discuss them with their regional health authority.

Why does the Minister continue to misrepresent the views of doctors? Is he aware that the chair of the local British Medical Association branch in Calderdale recently publicly rebuked local Tories who were saying that GPs wanted to become fund holders? Dr. Whittaker had to say that no doctors in Calderdale had applied to become fund holders in either the second or third wave. Is it not about time that the Minister started to represent doctors' views properly?

I am tempted to quote Oliver Cromwell and to ask whether the hon. Lady could conceive of the possibility that she might be wrong. I am making the extension because of the pressure from general practitioners who have asked me to extend the list size. People are queuing up to join the voluntary scheme.

Is my right hon. Friend aware that the fund-holding system has been a spectacular success—so much so that many of the more trendy, intellectual GPs who were initially sceptical of it now welcome it more and more with open arms? Will my right hon. Friend look again at some of the procedures for recording, note taking and keeping records, as some GPs say that the system is a little too cumbersome and bureaucratic?

I am very sympathetic to comments like that. The scheme will obviously be a permanent and beneficial part of health care in this country but is, I am sure, susceptible to improvement and further development, which I shall promote. My hon. Friend correctly records the honesty of many general practitioners, some of whom were sceptical. At his press conference this morning, Professor Glennerster said that, when he started his investigation, he was sceptical, but that he was converted by the evidence of his own eyes, and what he had seen and heard. I only wish that the Labour party had the same openness of mind.

If the Secretary of State does not believe that GP fund holding produces two-tier waiting lists, how can he explain the position in Manchester, where patients of fund holders are given eye treatment in a private wing, while patients of other GPs wait 13 months for an appointment? If that is not queue-jumping, what does the Secretary of State call it? How can he explain the position in Surrey and in St. Albans, where consultants are being placed under pressure by managers to give priority to GP fund holders because they bring extra money? If the Secretary of State does not recognise that as an example of two-tier lists, what will he recognise as such?

I shall answer the Secretary of State's question. [HON. MEMBERS: "Ah."] I welcome the fact that the Secretary of State is getting in practice and asking the questions to which I give the answers at Question Time, as it is a situation to which he shall have to become accustomed. The next Labour Government will end GP fund holding, because we shall not tolerate a two-tier list system in which the length of time a patient waits depends on the size of the GP's budget. There is a phrase for that policy—double standards. The Labour party will clear it out of the NHS.

I offer the hon. Member for Livingston (Mr. Cook) my heartfelt thanks for giving what is almost the first straight answer that I have ever extracted from him. I believe that he has, in a single word, delivered to us the votes of the majority of general practitioners in the country, for which I am most grateful. I urge him to study the remarks of Professor Glennerster, who knows rather more about this matter than he does and has laid the two-tier rumours to rest once and for all.

Nurse Prescribing


To ask the Secretary of State for Health what progress is being made towards permitting nurse prescribing.

My hon. Friend the Member for Chiselhurst (Mr. Sims) has introduced a private Member's Bill to allow nurse prescribing. It has the Government's full support.

I thank my hon. Friend. As, only a few months ago, she very charmingly killed a similar measure that I had introduced I doubly welcome her support now. Does she now accept that allowing nurses to write prescriptions against a limited range of medical products is a liberalising measure that peels back one layer of the onion skin in the bureaucracy of health care? Would she care to tell the House the costs and benefits of this measure, which will be welcomed so much by doctors, nurses and, of course, patients?

The House and, indeed, the nursing profession are indebted to my hon. Friend, who pioneered this measure in the House. I am very pleased that our hon. Friend the Member for Chislehurst (Mr. Sims) is now able to take it forward. We did indeed commission a cost-benefit analysis by Touche Ross. That has been published today, and there is a copy in the Library. It shows that the cost is likely to be about 15 million a year, but the benefits will be improved patient care and a greater ability on the part of community nurses to use their professional skills to the full.

East Cumbria Health Authority


To ask the Secretary of State for Health when he last met the chairman of the Northern regional health authority to discuss the financial budget of East Cumbria district health authority.

I have not discussed East Cumbria's budget with the chairman of the Northern regional health authority. Establishing the budgets of district health authorities is a task delegated to the regional health authority.

Will the Minister discuss with the regional chairman the formula base that is used for the distribution of money to the districts? Is he happy with the fact that one of the deprivation factors that he has used relates to car ownership? Does he realise that, in rural areas such as East Cumbria, many low-paid people need cars because public transport does not exist? Last year this formula robbed East Cumbria and my constituents of many thousands of pounds. Does not the Minister agree that it will be a travesty if the same formula is used this year and my constituents are therefore robbed of much more money that is needed for health in the area?

Some of my hon. Friends will be grateful to the hon. Gentleman for his advocacy of the rural cause. He raises a subject that he has discussed with me. I have told him that I agree that the way in which the region originally proposed to use car ownership raises some questions that have not yet been answered. That is why the Department has written to the Northern region saying in effect, "We hope you will take account of our reservations in the next year's allocations, either in the formula or in tempering the pace of change where you have yet to satisfy yourselves and us that the adjustment you propose is entirely reliable."

When my hon. Friend meets the chairman of the East Cumbria authority, will he congratulate him warmly on the fact that having, since 1982–83, secured a budget increase, after inflation, of almost 15 per cent. and an increase in front-line staff of about 28 per cent., he has succeeded in securing a yearly increase of 42 per cent. in the number of in-patients and an increase of 152 per cent. in the number of out-patients? That is a very remarkable achievement.

My hon. Friend has drawn attention to the very distinguished record of that health authority. He might have drawn attention also to the fact that the health service is planning to spend £36 million on a very substantial capital scheme at the Cumberland infirmary. The health service in East Cumbria is developing fast, to the benefit of all patients—my right hon. Friend's constituents and those of the hon. Member for Carlisle (Mr. Martlew).

Healthy Eating


To ask the Secretary of State for Health how much is spent by his Department on advice to the public in respect of healthy eating.

During the current financial year, some £2.7 million will be spent by the Department and the Health Education Authority on healthy eating advice.

Is it not time that the Government diverted rather more of their enormous advertising budget into advocating the eating of vegetables to promote health? After all, the Minister is surrounded by a large number of them on the Conservative Benches. If she were interested in such a campaign, she could perhaps use as the model for it our own dear Speaker, whose radiant health and youthfulness make him the perfect epitome of a diet based on vegetarianism.

The hon. Gentleman's advice should be warmly taken by members of his own party. May I suggest that he directs that advice to those who think that the right way forward is a £500 roadside snack at the Savoy to raise party funds? It may also be helpful to those who dine at Italian restaurants and seem to suffer from Luigi's syndrome.

Is it part of the Government's duty to advise us all on what we should eat? Is my hon. Friend aware that I have lived for a number of years without any such advice, and I cannot believe that it is really necessary?

My hon. Friend's view is worth having. On the whole, the advice is in favour of a balanced and sensible diet, and I think that the public wants facts and not fads. Mrs. Heal: Why will not the Minister introduce nutritional guidelines for school meals to ensure that the school meals service plays a vital role in child nutrition, as recommended in the Black report a decade ago?

We have had the excellent report of the Committee on Medical Aspects of Food Policy, which has been extremely helpful. A great deal of work is being carried out by the Health Education Authority, the Department of Health and the Ministry of Agriculture, Fisheries and Food to ensure that people have simple and effective information about healthy eating, and a great deal is being done on school meals, with the particular help of the wife of our own Secretary of State.