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Oral Answers To Questions

Volume 281: debated on Tuesday 16 July 1996

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Nhs Nurses (Recruitment)


To ask the Secretary of State for Health what efforts his Department is making to recruit nurses to the NHS. [35782]


To ask the Secretary of State for Health what recent representations he has received regarding the supply of nursing students. [35783]

My Department continues to promote a range of initiatives designed to attract suitable, high-calibre recruits to the nursing profession.

The Secretary of State must recognise that there is a severe shortage of nurses. Does he recall that, in 1983, 37,000 nurses qualified? His Department predicts that in 1997–98, only 9,000 nurses are likely to qualify. Is that not a disgrace, given the pressure that it puts on nurses in the national health service? Why did he not take notice of the Royal College of Nursing's recommendation two years ago when it warned him of the shortage?

First, what I take notice of on the question whether there is a shortage of nurses is the independent review body, which examined the matter and published its report earlier this year, together with the finding that there was not a generalised shortage of nursing staff in the NHS, although there are localised shortages of nurses with particular skills. The figures that the hon. Gentleman quoted are wrong. It is not true that 35,000, or even 37,000, nurses qualified each year in the 1980s. The figure for nurses going into basic training in the 1980s oscillated around 15,000 a year—a figure to which we are returning in the commissions that we are planning for this year.

Does the Minister acknowledge that the drop in nursing student numbers, combined with increased demand, has caused nursing shortages? Is there any evidence that the 14 per cent. increase in commissioning of training places will be sufficient to meet future demand for nurses?

I hoped that the Labour party would welcome last year's 8 per cent. increase in the number of nurses going into basic training. This year, there is a further 14 per cent. increase in the number of basic training commissions. That takes us back, as I told the hon. Member for Wansbeck (Mr. Thompson), to roughly the same level of new commissions for basic nurse training as existed in the 1980s. Since then, there has been a dramatic improvement in nurse training because of the introduction of Project 2000, which has led to a reduction in the number of training nurses who drop out of training because they find it unsatisfactory.

Is my right hon. Friend satisfied that NHS hospitals can provide not only refresher courses but sufficiently flexible terms and conditions for nurses to encourage the return to the NHS of qualified nurses who may have left to start families and who are now able and willing to give more time to nursing?

My hon. Friend is on to a very important point. If we are to ensure that we have the skilled people we need to deliver modern health care, we must of course have a proper level of training, but we must also ensure that NHS trusts are good employers. My hon. Friend suggests some important ways in which we can ensure that we have a well-motivated, fully trained work force. The moves that the Government are making on more locally determined terms for nurses' employment are an important enabling step down the road that he rightly points out.

Does my right hon. Friend welcome the number of nurses who are now working in GP practices that are going in for primary care—a move that takes the strain off hospitals?

Yes, I can certainly join my hon. Friend in welcoming the huge growth in primary care nursing over the past 10 years. The number of practice nurses working in primary care 10 years ago was just under 2,000, but it is now 9,000. That is a fourfold increase in the nursing profession's commitment to primary care, which—as my hon. Friend rightly points out—is an important part of the health service.

Whatever the recruitment figures may have been last year, does the Secretary of State admit that, this year, there has been a triple blow to the morale of nurses in the health service? First, there was an independent recommendation on nurses' pay, to which the Government responded by giving nurses a pay rise below the rate of inflation. Secondly, huge amounts of time and money have been taken out of the health service by negotiating settlements on a local level. Out of 500 trusts, fewer than 200 have yet made offers. Thirdly, last week, although the Government recommended restraint to the House, they recommended that hon. Members vote a pay rise for themselves that is greater than the rise that they recommended for nurses. Nurses' morale is going down daily. What will the Secretary of State do to recover it—or is he absolutely oblivious to the problem?

The hon. Gentleman is wrong on every one of the points that he made. The Nurses and Midwives Pay Review Body made a specific recommendation, which the Government accepted in full and are implementing. It is not true to say that the Government have introduced a nurses' pay settlement that is below the rate of inflation. The Government have accepted the recommendation of the independent review body that there should be locally determined pay for nurses, with a 2 per cent. floor to ensure that every nurse gets a basic minimum increase.

Does my right hon. Friend recall the days of that nurse of all nurses, the matron? Will he advocate the return of the matron to hospitals when it is possible and appropriate?

My hon. Friend is right to point out the importance of professional leadership in the nursing profession, and the matron is one element that, in some trusts, has been found to be a means of achieving it. The most direct answer to the questions of my hon. Friend and of the hon. Member for Southwark and Bermondsey (Mr. Hughes) is to remind them and the House that, since 1979, nurses' pay has risen by more than 70 per cent. in real terms. That reflects both the commitment to nursing that my hon. Friend seeks and the commitment to proper pay for which the hon. Member for Southwark and Bermondsey argues.

Will the Secretary of State now accept that a real crisis is facing nursing in Britain? Will he explain to the House why nurses' morale has slumped, why nurse recruitment has collapsed and why the Government are still spending more new money on bureaucracy than they are on nurses? Will he also tell the House why uncertainty in the workplace is driving more NHS nurses away from providing valuable services? Today, will he announce that he will launch a national recruitment campaign to tackle the problem? Will he initiate talks with the Royal College of Nursing and nursing unions about the immediate crisis? Will he stop squandering the most precious asset of the NHS—its human resources? Nurses deserve better from the Government, and surely they should be getting some action from the Secretary of State.

The hon. Gentleman has to square his rhetoric with reality. He talks about declining recruitment in nursing. In 1994–95, the figure for recruitment into nurse training was 11,400 commissions; this year, there are 14,300 commissions. I defy the hon. Gentleman to square an increase from 11,400 to 14,300 with his rhetoric about declining recruitment. His rhetoric is nonsense, and the hon. Gentleman knows it.

Health Authorities (Market Testing)


To ask the Secretary of State for Health if he will make a statement on market testing by health authorities. [35784]

Market testing by trusts has proved very successful in generating savings for the national health service. Approximately £1 billion has been saved since it started. Health authorities are increasingly using the same techniques, although the available alternative would normally be an NHS trust.

Can my hon. Friend confirm that South Humber health authority intends to submit the ambulance service to market testing? While I accept and acknowledge that savings can be made, will he confirm that the health authority has no preferred option until the Humberside ambulance service has had an opportunity to ensure that its service is tested so that the benefits so far obtained can be acknowledged by the health authority?

I can confirm that there is no preferred option. I am concerned to ensure that, in such instances, there is absolutely fair play. I have gone into those and other instances carefully. Accusations of unfair play are usually made on behalf of the bidder, not the existing provider. I assure my hon. Friend that the regional office will ensure that there is fair play in the case that he mentioned.

Does the Minister recognise that a consequence of market testing at Hillingdon hospital in west London is that 54 cleaners, some of whom have worked there for 30 years, have been dismissed by the Pall Mall Services Group for refusing to take a pay cut of £35 a week? Does he not think that market testing is responsible for poverty wages for loyal workers within the national health service? Should not those 54 cleaners be reinstated on national health service conditions and repaid for the whole period for which they have been out of work because of the Pall Mall group's determination to make profits at the expense of loyal workers in the NHS?

On the contrary, the Pall Mall group, which adequately resources all the services that it provides, gives the workers in question rates that are above the nearest comparator—Heathrow. In the circumstances, they are well paid for the work that they do. In addition, they all received a lump sum to do away with the work restraints that they were putting on the service.

Will my hon. Friend confirm that the money saved through market testing is in addition to the extra money that the Government have made available for the health service? Will he also confirm that the Opposition have pledged not a penny of additional money for the health service?

My hon. Friend makes a fair point. The £1 billion that has been saved since 1983 as a result of successful market testing, which has not only saved money but improved quality in many cases, should be set against the paltry £100 million which the Opposition allege that they could save and thereby transform the health service. They should make it plain what we would lose through that "efficiency" if ever there were a Labour Government, not what they would hope to gain.

Nhs Administrative Costs


To ask the Secretary of State for Health when he last met the chairmen of health authorities to discuss administrative costs. [35785]


To ask the Secretary of State for Health what proposals he has to reduce bureaucracy in the NHS. [35787]


To ask the Secretary of State for Health if he will make a statement about administrative costs in the NHS. [35795]

Our programme to streamline NHS management will release £300 million for patient care over the two years ending next March.

Does the Secretary of State accept that the internal market has proved to be a bureaucratic nightmare, which the British Medical Association estimates costs £1.7 billion a year? Will he confirm that, since the baseline of 1989, 20,000 new managers have been put in post at the cost of 50,000 nurses? Is he aware that the cost of that additional bureaucracy to the people of Hemsworth is £2.6 million? The people of Hems worth want not pen pushers but nurses and better clinical care.

Both the statistics that the hon. Gentleman quotes, although much beloved of Labour Front-Bench Members, are simply wrong. First, the hon. Gentleman says that there are 20,000 new senior managers. As the hon. Member for Peckham (Ms Harman) knows well, even if the hon. Gentleman does not, that is a new classification, which was introduced in the mid-1980s. If Labour Members really believe that there was no senior manager in the health service before 1985, they are in a tiny minority. It is clearly absurd. The 20,000 new senior managers is a nonsense statistic, and the hon. Lady knows it. Secondly, the only way in which the hon. Lady can concoct the statistic of 50,000 fewer nurses is by including trainees in 1984 and excluding them in 1994. If one takes honest figures over those 10 years, the figure is not 50,000 fewer, but 20,000 more nurses.

Given what the Secretary of State has said, why does he think that the BMA and others are so strongly critical of the spiralling costs of administration and transaction? Can he share with me the anger that my constituents feel when they see patient services such as urology services under threat in the local hospital, and when valued local facilities are in danger of being transferred to less convenient neighbouring hospitals? What does he have to say to my constituents about that?

I have two things to say to the hon. Lady and her constituents about administrative costs in the health service. First, those costs have grown because, as the hon Lady's predecessor—the right hon. Member for Derby, South (Mrs. Beckett)—acknowledged, the traditional NHS was undermanaged. Secondly, let us consider how much they have grown. The numbers of administration and clerical staff in the health service have increased by 22 per cent. in 10 years. To put that in perspective, the numbers of medical and dental staff in the health service are up by 21 per cent.—almost the same percentage in the same period. The numbers of professional and technical staff of the health service have increased in the same period by 28 per cent. During that period of growth of investment in management, there has been a 41 per cent. increase in patient treatments in the health service. That is the context that the hon. Lady should point out to her constituents.

When will the Secretary of State recognise that the NHS is now suffering from the disease of bureaucracy, and that its complications include waste and secrecy? For instance, in Gwent, a lady manager's employment was terminated and she received £35,000 in compensation, but a few days later she was re-engaged, at a salary of £39,000 per annum. Surely such money would be better spent on more, and better-paid, nurses and on re-opening the wards that have been closed in recent years?

The problem that the Labour party faces in talking about management and administration costs in the health service is that Labour Members voted against £100 million of administrative savings in the health service when they opposed the abolition of regional health authorities. The hon. Member for Peckham has offered the population a recantation for a mistaken vote on the regional health authorities. She recognises that Labour Members made a mistake in not taking that £100 million and she is now on the verge of apologising to the electorate for their failure to take a £100 million saving that was available.

The Government are well ahead of the hon. Member for Peckham. Not only have we taken that £100 million, but we have put in place clear plans to deliver an additional £200 million—£300 million of administrative savings. The hon. Lady offers a paltry £100 million, which she opposed when the opportunity presented itself.

Has my right hon. Friend received any representations from Labour Front Benchers regarding his 5 per cent. cut in NHS administration costs, which are already amounting to about £140 million? Does he know whether the Labour party thinks that this is too much, too little or just right?

When I announced £140 million extra saving through tight controls on bureaucracy in the health service, as my hon. Friend rightly says, Labour Members dismissed it as too little. Nine months later, they presented a programme designed to deliver not £140 million, but £100 million.

Will my right hon. Friend join me in condemning the incessant attacks on national health service managers? Does he agree that the national health service was undermanaged for many years and that managers are now delivering a more efficient, cost-effective and better health service?

I entirely agree with my hon. Friend. Earlier, I quoted figures that show that there has been an increase in the number of medical, dental and nursing staff in the national health service, and that there has also been an increase in the number of administrative support staff. As a result, patient treatment is growing faster than any of the statistics.

Does my right hon. Friend agree that, in the right circumstances, the best way to save taxpayers' money and to ensure that it goes to patient care is to amalgamate trusts? Can we expect an early and quick decision on the amalgamation of the trusts on the Isle of Wight? We are all in favour of it and we want to see it get under way as soon as possible.

I will not make an announcement from the Dispatch Box this afternoon in relation to my hon. Friend's request. However, I say to my hon. Friend and to trusts that are contemplating merger proposals that there are very few administrative savings available to trusts that merge that are not available to the same trusts if they choose to organise their affairs differently while remaining separate. What I look for in proposals to reorganise patient care is improved patient care, not simply changed bureaucratic arrangements.

Will the Secretary of State admit that even though he promises to cut back on the £1.5 billion in extra bureaucracy, he cannot unless he scraps the system that is creating it: the internal market? Is it not cynical of him to demand fewer managers while promoting a system that requires more managers? Will he admit that the right way to ensure minimum bureaucracy is to scrap the annual contracts, scrap the extra-contractual referrals and the protocol compliance, scrap the hundreds of thousands of invoices every year and scrap the national health service internal market?

On behalf of the hon. Lady's many friends on the Government Benches, I wish her well in her campaign for re-election to the shadow Cabinet. I extend the sympathy of every Government Member to the hon. Lady because of the predicament in which she finds herself. She would dearly love to be able to offer more money to the health service but her Presbyterian colleague, the shadow Chancellor, will not let her do that. He has left her making bricks without straw.

The hon. Lady referred to management costs. One day, she says that £1.5 billion can be saved in management costs, and then I point out that that is more than half the total that we spend; the next day, she cuts the figure to one fifteenth and £1.5 billion suddenly becomes £100 million. The inconvenience with £100 million is that it is one third of the amount that the Government are already committed to save.

Notwithstanding the huge reductions in administrative costs brought about by the abolition of the regional health authorities, will my right hon. Friend confirm that increased administrative costs elsewhere in the NHS have led to better management and to more patient treatments? Will he look at how much further the clerical and paperwork undertaken by hospital doctors can be cut, even if it means employing more administrative staff?

My hon. Friend has raised an important point that is easily overlooked. I have emphasised that there has been a 21 per cent. increase in the number of medical and dental staff in the NHS over the past 10 years. If we do not provide administrative support to those doctors and dentists, they end up doing it themselves instead of delivering patient services. My hon. Friend is quite right: if we want an efficient use of the resources available to the health service, we have to provide administrative support staff as well as professional staff.

Doctors (Recruitment)


To ask the Secretary of State for Health when he last met chairmen of health trusts to discuss the impact of levels of health expenditure on the future supply of doctors from universities.[35786]

I have frequent meetings with chairmen of national health service trusts to discuss a range of issues, including how best to utilise the £459 million that trusts receive in recognition of the additional costs of teaching undergraduate medical and dental students.

Does the Minister agree that the Government's university funding cuts are having a severe effect on medical schools and, therefore, a direct impact on patient care? Is it not just plain folly for the Government to think that they can continue to cut medical school funding without ensuring that there will be a severe shortage of doctors in the future in the national health service?

The conclusion that the hon. Lady reaches is quite wrong. She recognises a point that was made by the House of Lords Select Committee on Science and Technology in its report last year. The Government responded to the report by asking the Committee of Vice-Chancellors and Principals for its view. That is why we set up the Richards review, which will report in due course. It will look at issues such as work load pressures, recruitment difficulties and future NHS support for new posts. The Government's continuing medical education policy aims to build upon the number of existing students. That is why we have announced an increase of 500 students before 2000, in order to build on our excellent record of creating more hospital doctors and more doctors per specialty than ever before.

Can my hon. Friend confirm that 22,500 more general practitioners and dentists are working in the health service now than in 1979? Is that not a clear result of the Government's unique commitment to extra funding for that purpose?

My hon. Friend is right, and that applies to all doctors and to all specialties across the health service. It illustrates the fact that the Government are prepared to back with action our commitment to invest in the national health service—unlike the Labour party, which refuses to put a precise figure on its projected investment in the NHS on a year-on-year basis.

Purchasing Costs


To ask the Secretary of State for Health what monitoring he is currently undertaking of purchasing costs. [35788]

Our continuing aim is to improve care for patients and to shorten waiting times, while minimising costs. Following our latest scrutiny, we plan to reduce administration costs by £40 million—money that can be freed for wider national health service investment.

I make no apologies for returning to the effects of the common market—the internal market—and the impact that it is having in Salford in my constituency. As a consequence, we need more nurses and doctors and more patient care. We do not need the cuts that are now taking place in the national health service as a result of the internal market. What will the Minister do about that?

I think that the right hon. Gentleman perhaps returned inadvertently to a feud of yesteryear within his party which might be reflected in present discussions about the health service and how to take matters forward.

I point out to the right hon. Gentleman that, while Opposition Front Benchers talk in absurd terms about £15 billion one day and £100 million the next, the Government have been getting on with pruning bureaucracy where possible. For example, the efficiency scrutiny, "Seeing the Wood, Sparing the Trees", which deals precisely with the purchasing mechanism, will release £40 million for patient care. I thought that the right hon. Gentleman might welcome that.

Will my hon. Friend confirm that fundholding practitioners, which are important in purchasing services and treatment, are able to carry over funds from year to year? If that is so, can my hon. Friend explain why trust hospitals and trusts, such as the East Cheshire NHS trust, are not also able to carry over funds from one year to another in order to take account of exceptional circumstances that occur from time to time? That would surely encourage efficiency and enable trusts to meet exceptional costs without difficulty.

My hon. Friend, as an expert in such matters, will know that there are controls on both. If GP fundholders manage to make savings in any given year, they are able to adjust—together with the health authority—the plans to purchase additional care for patients. We expect hospital trusts to manage their budgets in a sensible way and, if there are differences from year to year, we expect them to manage that over time.

Cumberland Infirmary


To ask the Secretary of State for Health if he will make a statement on the proposed private finance initiative scheme for the Cumberland infirmary in Carlisle. [35789]

The scheme is progressing well. A preferred bidder has been identified and the full business case is expected to be submitted soon.

I thank the Minister for that answer. Does he realise that, when I spoke to the chief executive some three weeks ago, he talked of reducing the number of beds in the new hospital to 450? Since then, pressure has been applied by Cumbria county council, medical consultants and me and, fortunately, that figure has increased to 474—the minimum number necessary. Will the Minister clarify whether any of those beds will be private beds? Will he clarify also the funding of that scheme? It was anticipated originally that the single site would create savings of £1.2 million, but the latest estimate is that there will be a deficit of £500,000. Will that money come from the Government, or will it come directly out of patient care?

Let me correct the hon. Gentleman's original point about the number of beds. Two years ago, when the hospital was publicly funded, there were approximately 470, as there are now. There has been no change since then.

As for the hon. Gentleman's point about funding, the health authority and the trust are currently looking into precisely that issue.

If the PFI system were scrapped, would that not put at risk not only the Cumberland infirmary project in Carlisle but the Darenth Park proposal in my area? Would that risk not arise directly from the scrapping of the system, which is supported by the hon. Member for Peckham (Ms Harman)—who does not propose, and is not being allowed to propose, putting in money from the taxpayer?

Absolutely. Many schemes all over the country, of which the Carlisle scheme is one, had to wait for nearly 30 years. They got nowhere with traditional funding. Now we are making progress everywhere. I must tell my hon. Friends that some hospitals would not be built if the Labour party's hostility to the private finance initiative were maintained. The PFI is our only hope when it comes to building some hospitals.

Is not the PFI in Carlisle in the same sorry state—the same mess—as it is everywhere else in the country? Have not Ministers been travelling up and down the country making promises, and, as they have in Carlisle, building up expectations on which they know that they cannot deliver? Is it not surprising that even the Prime Minister has been reported as saying that he is particularly anxious about health, no major PFI hospital deals having yet been signed?

Will the Minister now apologise to the House, and to the people of Carlisle and elsewhere, for the 17 per cent. cut in next year's national health service capital programme? Will he tell patients and clinicians in Carlisle, who have been waiting for years, when they will have a new hospital, and when the Government will put their PFI house in order?

The hon. Gentleman huffs and puffs a great deal, as he does at every Question Time when this subject arises. In fact, the PFI is proceeding extremely well. It is bringing the prospect of new hospitals, or hospital facilities, to places where such provision could not be envisaged under traditional procedures. One factor which stands in the way of that is the Labour party's old-fashioned attitude, which cannot conceive of the existence of new, radical measures to deal with the problem. The hon. Gentleman ought to realise that he is backing a loser.

Would my hon. Friend care to comment on the paradox that, while the deputy leader of the Labour party claims to have invented the PFI, Labour Back Benchers spend their time criticising it?



To ask the Secretary of State for Health what steps he is taking to reduce the incidence of tuberculosis. [35790]

The United Kingdom has an excellent record on tuberculosis control, and we are determined that that should remain the case. Most recently, we have published two reports from the interdepartmental working group on tuberculosis, "The Control of Tuberculosis at Local Level" and "Tuberculosis and Homeless People".

May I ask a question of which I have given notice to the Minister's private office? In what year did the Department of Health first learn of the likely medical consequences—tuberculosis, and other illnesses—of the alleged nuclear incident at Aldermaston in 1958?

One never quite knows where the spirit of Linlithgow is going to land. I am grateful to the hon. Gentleman for giving me notice that he would be stretching the question a little.

The clinical condition of tuberculosis is brought about by exposure to bacterial infection. As I am sure the hon. Gentleman knows, it is not related to exposure to radiation.

The Committee on Medical Aspects of Radiation in the Environment—COMARE—has considered allegations of an increased incidence of childhood cancer around a number of nuclear establishments. Its third report did not include Royal Air Force sites at Greenham Common. In that report, COMARE recommended that a nationwide study of the geographical distribution of the incidence of childhood cancer should be undertaken. The study is under way and COMARE will consider all new data that are available in assessing whether there is an association between local levels of contamination and the incidence of cancer.

Is my hon. Friend aware of the incidence of antibiotics becoming immune in the treatment of tuberculosis? If so, is there not a case for advising the medical profession to reserve stronger-acting antibiotics for the serious diseases rather than prescribing them on a more prophylactic basis for less serious diseases?

We have had groups examining these matters. We are aware of drug-resistant TB, and I am happy to say that it is at low levels in the United Kingdom. That does not mean that such TB is resistant to all drugs. It is resistant to some, however, and therefore is more complex to treat. An expert working group has been established to examine these matters and to bring forward recommendations.

Read Codes


To ask the Secretary of State for Health if he will publish his assessment of the rate of progress to be made in implementing Read codes in clinical settings in the NHS by 1 January (a) 1997, (b)1998 and (c) 1999. [35791]

I thank the Minister for his answer. In addition to the widespread concerns about the implementation of Read codes, will he confirm that his Department wrote to Dr. Read's private company, CAMS, last month stating, and I quote—[Horn. MEMBERS: "No."]—that there was a deliberate attempt—

Order. The hon. Gentleman knows that there is no quoting during Question Time. Please paraphrase.

Will the Minister confirm that his Department wrote to Computer Aided Medical Supplies—Dr. Read's private company, which is getting a nice little earner out of the NHS—to say that there was a deliberate attempt to deceive the Department of Health's auditors? Does the Minister agree that the time has come to re-examine the relationship between the NHS's centre for coding and classification, which is run by Dr. Read, and CAMS, the company owned by Dr. Read? Should we now consider renaming CAMS as SCAM, as it is making not simply money but illegal money out of the NHS?

As the hon. Gentleman knows, the National Audit Office is conducting a preliminary investigation into the arrangements between CAMS and the national health service precisely to examine value-for-money questions and questions of probity. We should wait until that report is clear to decide how we should proceed.



To ask the Secretary of State for Health what is his estimate of the current number of insulin-dependent diabetics and non-insulin-dependent diabetics in the United Kingdom. [35792]

The health survey for England 1994 estimated that the prevalence of diabetics was approximately 2.4 per cent. Studies suggest that 80 per cent. of people with diabetes are non-insulin dependent.

Is the Minister aware that the number of new cases of diabetes is rising each year and that the estimated cost to the national health service is between £1.4 billion and £1.8 billion a year? Does the hon. Gentleman agree that more resources targeted directly at finding the causes, ameliorating and eventually curing diabetes would be a wonderful investment for the NHS, and would in the end prevent much human misery as well as save much public cash?

I agree that diabetes is treated extremely seriously by the NHS. We need to combine treatment, care, prevention and cure where possible, and research is a party to all that. The fact that we have the sub-group of the clinical outcomes group examining the purchaser guidance that should be developed, based on the St. Vincent's task force recommendations, should be of some comfort to the hon. Gentleman. The report is expected at about the end of the year. In addition, both the Medical Research Council and the Department of Health have made about £5 million available for major research projects. That, too, is the way forward.

Does my hon. Friend agree that the chronic disease management programme has been very successful in improving standards of care for people suffering from diabetes?

If I heard my hon. Friend correctly, he said that the chronic disease management programme was playing an important part in that, and I am happy to say that more than 90 per cent. of general practitioners now run this programme for diabetes, which, of course, enables them to keep a register in their surgeries, to see their patients once a year and to check, in particular, the eyes and feet, as recommended by St. Vincent's.

Nhs Trusts (Cost Improvement Programmes)


To ask the Secretary of State for Health when he last met chief executives of health trusts to discuss the current cost improvement programmes. [35793]

The regional offices of the NHS executive consider the plans of each trust on my behalf, including efficiency gains negotiated with them.

When the Secretary of State next meets Mr. Keith Parsons, the part-time chief executive of Royal Liverpool and Broadgreen University Hospitals NHS trust, will he ask him to explain to the people of Liverpool how he is able to charter an airplane to bring him from a medical conference in Edinburgh to attend the last board meeting of the trust, and then to take him back again, while he is seeking to close four wards in Broadgreen hospital in my constituency, two of which are proving impossible to close because of so-called "over-activity"—in other words, too many orthopaedic geriatric patients who desperately need the services that those wards provide?

What I will do if I meet this gentleman is congratulate him on the fact that his hospital was the first hospital in the NHS to declare that it had no people on its waiting list waiting for more than 12 months. We might have heard that from the hon. Lady when commenting on the affairs of her constituency.

Prime Minister



To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35812]

This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Today marks the launch of the Gun Control Network by the families of the victims of Hungerford and Dunblane. Will the Prime Minister acknowledge the strength of the case against the private ownership of handguns? Will he accept that such a measure to ban them would receive the support of the overwhelming majority of the British people?

I am, of course, aware of the strength of feeling on this issue and of the recent petition calling for strengthened control over firearms. As the hon. Lady knows, the Government have been careful to consult the Opposition parties on this issue from the outset, and I am delighted that, thus far, we have received their firm support for the way in which we are proceeding. Since 1979, we have strengthened firearms controls. As soon as we receive the report from Lord Cullen, we will consider it with great care. I am happy to reiterate to the House that, in the event it is needed, we have preserved a legislative slot to take any action that is required.


To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35813]

In the light of the great news that Lite-On and LG are bringing thousands of new jobs to Scotland and Wales, does my right hon. Friend agree that breaking up the United Kingdom, creating an extra tier of regional government, surrounding it all in bureaucracy and making the Scots pay more tax is likely to scare away potential new investors? Is this not new Labour being new danger?

I am delighted to welcome these substantial new investments to Scotland and Wales. They are the latest of a large number of inward investments that we have seen not only in Scotland and Wales but in other parts of the United Kingdom. I certainly hope that we shall get more. They are coming here predominantly because of the economic environment—[interruption]—because this country is an economic success story—[Interruption.] The hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) is chuntering in the back row. He seems to forget that they have been coming here for 15 years under Conservative policies, because we have created a combination of lower inflation, lower taxes and lower costs. That is attractive not just to companies in this country but to world investors seeking the right country in which to place their money. I am delighted that they place it here. It would be a tragedy if policies were followed that would prevent them from doing so in future.

Does the Prime Minister recall promising the country at the previous general election that he would balance the budget? How does he square that with today's further disastrous borrowing figures which show that, leaving aside privatisation moneys, the Government's overdraft this year is running at a higher level than at the same time last year?

If the right hon. Gentleman would look carefully at today's borrowing figures, he would see that they are entirely consistent with the economic forecast and that they confirm the excellent state of the economy—sustainable growth, low inflation and falling Government borrowing. As for comparatives, since 1979, average borrowing as a proportion of gross domestic product has been just under one half as much as under the previous Labour Government.

Perhaps the Prime Minister will just confirm that this Conservative Government have received more in North sea oil revenues and from privatising the nation's assets than the borrowing requirement under the last Labour Government. That is what his Government have had. Is it not also a fact that, under his prime ministership, the public debt has doubled? Will he confirm this statistic and answer this question directly: is it not the case that, as a result of his Government's borrowing policies, every family in this country now pays £1,000 a year in tax, not for better services in respect of health, education and law and order but just to service the debt that he has created? Is that right or is it wrong?

The right hon. Gentleman is completely misleading the House. He knows what resources have been spent in recent years. I will tell him where they have gone—they have gone on health, education, defence and public services. The right hon. Gentleman is the man who says that he wants to keep taxes down, yet he wants to put public expenditure up. The reality is that, whereas he may play games in opposition, we have to deal with the realities of producing a successful economy, as we have done in recent years and as we will do in the years to come.

Not a single one of those figures did the Prime Minister dispute—£1,000 a year in tax just to service the debt. Let me tell the Prime Minister that, if he wants to have a better balance in public spending, why not tackle the problems of long-term unemployment which have put up the bills for people in this country? Is it not the truth—[Interruption.] That is the party that has spent on welfare and unemployment but lowered spending on investment for the country's future. Will the Prime Minister confirm that, if an ordinary member of the public had run an overdraft as large as this, he would have been told that his time was up and his home should be repossessed? Is that not the fate so richly deserved by this Government and this Prime Minister?

Dear, oh dear. If the right hon. Gentleman wants to talk about success in dealing with unemployment, perhaps he would care to acknowledge that we have the lowest rate of unemployment of any significant nation in western Europe; that unemployment has been falling for three years, which it has not been doing anywhere else; that every single Labour Government we have ever been cursed with have increased unemployment dramatically; that he has policies that would increase the costs of employers, which would create unemployment; and that one of his unions is asking for a minimum wage of £6.03 an hour, which would cost an enormous amount in unemployment.

While the right hon. Gentleman is concerned about economic performance, let me mention the things that he neglected to mention: the lowest level of inflation for 50 years; the lowest mortgage rates for 30 years—[HON. MEMBERS: "More."]—four years of falling unemployment and increasing employment—[HON. MEMBERS: "More."]—the lowest rate of basic tax for 50 years—[HON. MEMBERS: "More."]—disposable income rising way above inflation—[HON. MEMBERS: "More."]—No. 1 in Europe for investment—[HON. MEMBERS: "More."]—in the interests of other questioners, I shall stop there, but there is far more to the success of the Government's policies.


To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35814]

Does my right hon. Friend agree that no responsible Prime Minister would weaken Britain's veto in Europe by giving Brussels more powers to determine matters that should be voted on and discussed in the House? Does not new Labour wish to surrender Britain's veto in Europe? Does not new, phoney Labour mean new, real danger for residents in Basildon, Southend and the whole country?

My hon. Friend should not suggest that the dangers from those policies are in only Basildon and Southend. They are in every constituency around the land. He is quite right.

The Government are not prepared to see our veto eroded, as the Labour party apparently is. On issues of national and constitutional significance, any Government should be prepared to protect British interests, if necessary by using the veto and saying no. I regret that the Opposition are committed to undermining the veto. If they say that they are never going to be isolated in Europe, what they are saying is that they would never use the veto whether it was in this country's interests or not. They would follow the line determined by our European partners. That is their policy out of their own mouths, and upon that let them be judged.

But Britain's national debt has doubled since the Prime Minister took office. Britain's annual debt has doubled against what the Prime Minister said that it would be two years ago. Is the Prime Minister prepared to confirm the words of his own Chancellor of the Exchequer in spring this year when he said that, when public borrowing was around £30 billion a year, tax cuts were irresponsible?

As to the Budget, the right hon. Gentleman will have to wait and see. It is some months away. We will deal prudently, as we have always done, with that aspect.

I seem to remember the right hon. Gentleman's party supporting the largest public borrowing that we have ever seen at any stage in this country. Under this Government, the economy has gone from strength to strength to strength. If the right hon. Gentleman is concerned about public borrowing, as I am, I invite him and the leader of the Labour party to support the Government in the public expenditure decisions that we will have to take in the forthcoming public expenditure round. We will judge by their words whether they support the decisions that we will take in the public spending round. If they support restraint, it will be the first time that they have done so.

In view of the industrial relations unrest in the Post Office, will my right hon. Friend give consideration not merely to the suspension of the monopoly but to the application of a law of contract to all parties in the Post Office?

I thoroughly agree with my hon. Friend about the likely dangers of a Post Office strike. As he knows, my right hon. Friend the President of the Board of Trade is giving consideration to suspension of the monopoly and I shall certainly consider my hon. Friend's further point.


To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35815]

The Prime Minister will be aware that last year's tax revenue fell short by a staggering £7 billion. Likewise, last year's public sector borrowing requirement was £10 billion greater than forecast 16 months previously. Does he agree that, if a managing director in the private sector made such an overestimate of a company's income and plunged it into such huge debt, he would be sacked? What is the Prime Minister going to do about it?

The hon. Gentleman knows very well the degrees of difficulty in determining tax revenue. Of course, his way of determining tax revenue would be to support his leader in increasing taxes, with the large range of extra taxes that the Labour party is already planning. He might as well admit it.


To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35816]

In considering the very sad events in Ulster and welcoming the deployment of extra troops there, I should like to ask whether my right hon. Friend agrees that the overwhelming priority must be the restoration of security, which must involve whatever resources and legal powers the security forces require.

Self-evidently, the overwhelming need is to restore normal law and order to the Province so that problems are solved by dialogue and not by violence and confrontation. We must continue to do whatever we can to ensure that the bomb in Enniskillen—whoever turns out to be responsible for it—does not relaunch the cycle of violence that has so scarred life in Northern Ireland in recent years. I particularly welcome the restraint that has been shown by loyalist groups and I very much hope that they will continue to show that restraint in future. The security forces have our full support. They will continue to have our full support in the Province and in the rest of the United Kingdom.


To ask the Prime Minister if he will list his official engagements for Tuesday 16 July. [35817]

Given that 21 Conservative Back Benchers have signed an early-day motion expressing serious concern about the sale of Ministry of Defence homes and that one of them described it as a half-baked scheme, deeply upsetting to service families, how do the Prime Minister and the Government justify the sale and the £900 million a year rent bill to the British public?

The hon. Lady is mistaken in what she says and in her judgment. The service chiefs support the sale. They have recognised and said publicly that it will raise £1.5 billion in public revenue. The Labour party has said a great deal about public borrowing. Will they vote against the £1.5 billion that the sale will bring into the public revenue and cut borrowing, or will it be another occasion when the leader of the Labour party says one thing and votes in a quite different way?