asked the Secretary of State for Social Services whether he has revised his plans for an increase in the number of consultants as a result of the Chancellor of the Exchequer's statement on 7 July.

As my right hon. Friend made clear on 7 July, it will be necessary for health authorities to work to lower manpower targets for 1984, but we remain committed to the policy objective of improving the medical staffing structure, and therefore the quality of medical care, by increasing the ratio of consultants to junior staff.

Is the Minister aware of the considerable strain on consultants operating in hospitals and the tremendous suffering that is caused to certain patients who cannot get access to the treatment and operations that only consultants can provide?

In the four years from 1978 to 1982 the number of consultants has increased by 992, which is an increase of 8·1 per cent. I am not yet aware that as a result of the statement of my right hon. Friend the Chancellor of the Exchequer we have failed to fill a solitary consultant's place. As I said, we are committed to our policies and we shall steadily improve matters.

Will the Minister comment on the distribution of consultants, as well as their numbers, because in the west midlands there is less than one consultant per million people, whereas the Thames region has seven consultants per million people? Does he agree that this crazy maldistribution means that the people in the west midlands are less well cared for, and that this matter requires urgent action by him?

The unfair distribution of resources goes back to the beginning of the National Health Service. However, I agree with the right hon. Gentleman. We continue to redistribute resources—and, therefore, consultant staff—in our allocation of moneys. As a result, we continue to give the west midlands region growth money, and we have told it to continue planning in the expectation of increased resources over the next 10 years.

Does the Minister agree that, as a result of the Chancellor of the Exchequer's statement, about 20,000 NHS staff, including doctors and nurses, will be sacked? Will he confirm the report in the The Sunday Times last weekend that if these cuts are implemented they will cut deeply into the provision for the care of the elderly throughout Britain?

That figure is completely exaggerated. There is no question of 20,000 jobs being lost. We are consulting the regional chairmen about the new manpower targets for 1984. We believe that a more efficient use of manpower, which is our main resource, can be achieved without any adverse effect on patient services.

asked the Secretary of State for Social Services what was the percentage change in the cost of drugs dispensed under the National Health Service in each of the past three years.

asked the Secretary of State for Social Services by how much he expects to reduce the National Health Service drugs bill following the statement by the Chancellor of the Exchequer on 7 July.

asked the Secretary of State for Social Services whether he will immediately reduce the rate for Government non-competitive contracts in the pharmaceutical industry to 17 per cent. or less following the recommendation of the Public Accounts Committee in its tenth report of Session 1982–83.

The cost of NHS drugs dispensed in the three years to 1981–82 increased by approximately 15, 21 and 14 per cent. respectively. Pharmaceutical industry profits from the Health Service are being examined in the current review of the pharmaceutical price regulation scheme. Meanwhile, as one of the measures to contain public expenditure, I have secured the industry's agreement to a reduction of £25 million in the United Kingdom Health Service drugs bill in the current financial year.

Is my right hon. Friend satisfied that the cost of drugs is now tightly under control?

We want to do more with the family practioner service to be completely satisfied about that matter. As I explained to my hon. Friend, the pharmaceutical price regulation scheme is now being examined. We are making progress with it, and we expect to have savings from it.

Is not the £25 million which the Secretary of State mentioned less than the total amount of excess profis made by the drug companies since the right hon. Gentleman became Secretary of State?

No, Sir. The £25 million that we are seeking from the drugs industry is a six-months total. It follows from that that the annual total will be £50 million. If other industries had been asked to make such a contribution no one here would be seriously suggesting that it was an unnecessarily small contribution.

I welcome the Secretary of State's determination to obtain value for money from the pharmaceutical industry, but does he nevertheless recognise that the current arrangements for August and September will cause the main brunt to fall on dispensing chemists, that it will take them six to eight weeks to clear high-price stocks and that, meanwhile, they will be paid at the lower prices?

No, it will not cause the main brunt of the economies to fall upon retail chemists, although it will have some impact on them. We shall be considering that with representatives of the pharmacists and I hope that one of my ministerial team will be meeting them in the next few days.

Is the Minister aware that confidential information given to the Select Committee on Public Accounts about the profits of the drug firms showed a disgraceful state of affairs of, in some cases, more than 100 per cent. profit? Will he take much more robust action against that exploitation of the NHS?

There is no question of exploitation of the NHS. It comes ill from a Labour Member to make such foolish generalisations about an industry which employs about 67,000 people in Britain and makes a contribution to the balance of payments of £600 million.

Will the right hon. Gentleman revise the voluntary price regulation scheme, as the Select Committee has shown it to be a complete shambles? Will he now implement the Greenfield report on generic prescribing? If not, when a company has been holding the Health Service to ransom on a patented drug, will he use his powers under the patent legislation to make a purchase for the Crown?

The pharmaceutical price regulation scheme and the scheme that is now in operation between the Government and the industry were agreed by the Labour Government in 1978. The Government are reviewing that scheme and we shall be reviewing the return on capital, the Greenfield report and promotional expenses. It is this Government who have taken action.

asked the Secretary of State for Social Services whether gross spending on family practitioner services has risen more rapidly than on hospital and community services in the last four years.

Between 1978–79 and 1982–83 spending on the family practitioner services rose by some 7 per cent. more in cash than spending on the hospital and community health services.

Does the Minister have any plans to institiute cash limits on family practitioner committees? If so, by what mechanism will he instigate that? Will the Minister give a categoric assurance that in that event doctors will not be prevented from giving the best possible prescription to patients?

We shall always want to bear the hon. Gentleman's second point in mind. Question No. 6 deals with cash limits, and I must ask the hon. Gentleman to await my reply to that.

asked the Secretary of State for Social Services how much support his Department gives to help voluntary organisations.

In 1982–83 the Department gave grants totalling over £15 million to voluntary organisations through 10 different schemes. I am circulating details in the Official Report. Mr. Rowe: Does my hon. Friend agree that one of the major values of the voluntary sector is to act as a critic of the monopoly public sector? Will he assure the House that in the allocation of grants critical voluntary organisations do not suffer?

I can give my hon. Friend the assurance that he seeks. We welcome constructive criticism as one of the great merits of the voluntary sector in a democratic society, even if it is sometimes uncomfortable for Ministers, of whatever party.

Is the Minister aware that because of the Government's doubling of VAT last year the Spastics Society paid £428,000 in non-recoverable VAT? Is he further aware that, between them, six national charities for the disabled paid over £1 million in VAT? Why do the Government mug the good samaritans in that way? Will the Minister now stand up for the charities and tell the Chancellor to take his hand out of their tills?

The right hon. Gentleman knows very well that those matters have been the subject of extensive consultation and discussion with my right hon. Friend the Chancellor of the Exchequer. I think that he also knows some of the difficulties. He is well aware that the Government, including my right hon. Friend the Chancellor, have taken many steps to assist charities in the past few years.

asked the Secretary of State for Social Services if he will pay an official visit to St. Giles hospital, Camberwell.

I have no plans to do so, but my noble Friend the Under-Secretary of State this morning met a deputation which included the hon. Lady to discuss Camberwell health authority's proposal to transfer inpatient services from St. Giles to St. Francis and Dulwich hospitals.

In view of the threatened closure of services at St. Giles hospital, with the loss to the area of not only vital services but hundreds of jobs, will the Minister accept that the Government's pledge that the Health Service is safe in their hands has a somewhat hollow ring to it? Will he also recognise that people in Peckham feel that the Government are prepared to sacrifice their health in pursuit of the Government's cruel spending cuts?

My answer to the two general points is, no, followed by no. In answer to the specific question on the hospital about which the hon. Lady is rightly concerned and which is a popular local hospital in an area of social deprivation, I cart say that that matter is being considered by my right hon. Friend the Secretary of State. However, the majority of the people from the area go not to that hospital but to others nearby, such as King's college hospital.

Is the Minister aware that the people of Morton in my constituency would join forces with those in Camberwell in complaining about the closure of their hospital? Will the hon. Gentleman give an assurance that now that he has stopped the pharmaceutical industry ripping off the taxpayer and the NHS to the extent that it was doing hitherto, the money will be used to keep open the St. Giles and Morton hospitals?

The hon. Gentleman is uncharacteristically out of touch with his constituency. I understand that the area's community health council has agreed to the closure.

asked the Secretary of State for Social Services whether, in the light of the Chancellor of the Exchequer's statement on 7 July, he has any plans to introduce cash limits on family practitioner services.

The Government have commissioned an independent study by a firm of chartered accountants, Binder Hamlyn, of arrangements for forecasting and controlling expenditure on the family practitioner services. Its remit includes examination of the possibility of introducing a cash limit. We are awaiting its report. Meanwhile no decision has been or will be taken.

Will the Secretary of State tell the House whether the report will take into account the possibility of end-year flexible limits in the family practitioner services? If so, does he agree that that could cause the closure of small surgeries throughout the country?

The Binder Hamlyn study has a wide remit, but I do not think that end-year flexibility will be one of the things at which it will be looking.

Does my right hon. Friend accept that if the report does not recommend cash limits for the family practitioner services there will be a need to find some other way to improve the services' cost effectiveness?

Yes. It is important that, given the expense of the family practitioner services, we seek, as we have sought with the hospital services, to make the most effective use of resources.

Given that the family doctor deals with people who need immediate treatment, will the Secretary of State tell the House what sorts of economies could be made by a family practitioner committee faced with a need to cut spending to keep within its cash limits?

The hon. Gentleman is presupposing that cash limits will be introduced. As I have just made clear, that has not been and will not be decided until we have the Binder Hamlyn report.

asked the Secretary of State for Social Services how he proposes to develop his strategy of improving co-operation between voluntary organisations and statutory services.

Recent legislation guarantees a place for voluntary organisations in joint planning by health and local authorities, where they will play a vital role in particular in our "Care in the Community" proposals. We shall continue to look for new ways to promote this partnership in which voluntary effort complements but does not replace statutory services.

Does my hon. Friend agree that the voluntary sector is particularly good at raising capital funds but that there is much more of a problem with revenue transfers? Therefore, in line with his paper "Care in the Community", will he consider the problem of long-term revenue funding of capital projects such as the Salisbury hospice care trust?

Without commenting on the specific case mentioned by my hon. Friend, which I will gladly look into if he wishes, I should make the point that additional proposals for joint finance, including those in the last Parliament's Health and Social Services and Social Security Adjudications Act 1983, do provide for some improvements in the terms of joint finance and, as I said in my earlier answer, are very much aimed in part at voluntary organisations.

Does the Minister recall the long caller office correspondence that I have been having with him ever since his Department suddenly curtailed the caller office services in the towns of Tranent and Haddington in my constituency? He knows that that has cast a considerably increased burden on to local voluntary organisations such as the citizens advice bureaux. Has he yet thought of a way of paying back the citizens advice bureaux for doing his Department's work?

I think that I have made the point to the hon. Gentleman in correspondence that while the Government provide some central funding, not through my Department but through another, to the National Association of Citizens Advice Bureaux, the funding of local citizens advice bureaux is a matter for local authorities.

Is my hon. Friend aware that if a housing association wishes to provide accommodation for elderly people with wardens on site it can do so with grants from the housing corporation? However, if it wishes to buy accommodation where frail, sick and elderly people may live and have medical attention, it does not qualify for housing corporation grants, and no similar grant is available from his Department. Could not this be considered as an area for more co-operation between the voluntary and the statutory sectors?

I should like to look into the particular point, but I refer again to the Act that I mentioned a moment ago. One of its purposes is to extend the scope for the use of joint finance in connection with housing in relation to care in the community.

Will the Minister concentrate on the problem that arises as between short-term and long-term aid for the voluntary sector? Does he accept that there are immense problems for the voluntary sector in coping with capital assets unless it has a guarantee of funding? Does the Minister accept that there is room for more long-term funding than the Government currently acknowledge?

Those problems are not confined to the voluntary sector. They are also raised with us by local authorities' social services departments. We are taking steps to try to improve the position and obviously we will consider further suggestions if and when they are made.

On this important question of cooperation between the voluntary and statutory sectors, the Minister will have seen the code of practice which the Royal Association for Disability and Rehabilitation is recommending to local authorities in respect of the services they provide under the Chronically Sick and Disabled Persons Act. What is the Government's reaction to that important document?

I was interested to see the document. Indeed, I have written to RADAR to say that I have no doubt that local authorities will wish to consider it in considering how they, the local authorities, excercise their statutory responsibilities.

asked the Secretary of State for Social Services if he will take steps to promote the interests of members of occupational pension schemes.

I shall do whatever I reasonably can to promote the interests of members of occupational pension schemes.

Has my hon. Friend seen the latest attempts of the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley) to re-establish his Left-wing credentials by proposing that pension funds, the savings of millions of people, should be diverted into the Labour party's state investment plans? Does my hon. Friend agree that if such a proposition were ever to be presented to the British electorate the Labour party would get exactly the same verdict as it did at the general election?

I entirely agree with my hon. Friend. Indeed, at the general election that prospectus was put before the British public. The idea that 10 per cent. of pension funds affecting 11·5 million people should go into a national investment bank to be used by the Government was one of the reasons why the Labour party lost the general election. My right hon. Friend the Secretary of State referred to it in a speech at that time.

What progress is being made to ensure that occupational pension schemes do not prevent mobility of labour?

I am grateful to my hon. Friend for raising that point. The issue of early leavers is an important matter. We have called a conference for 14 September with all the interested parties to see whether we can progress on this matter with voluntary action. If that is not possible, however, we shall have to take other action.

Does the Minister agree that one of the essential aspects of an occupational pension scheme is that people can make contributions throughout their working lives? Is it not a crazy system for British pension money to be invested abroad to make products which in turn put people out of work in this country, so making it impossible for them to complete their pension contributions?

I think that the first responsibility of those who are managing pension funds is to maximise the income so that contributors can get a good pension when they retire. I am sure that the public, including the hon. Gentleman's constituents, who are involved in pension funds, would agree with that. The hon. Gentleman referred to people contributing throughout their working lives. We are concerned that pension funds are responsive to those who put their money in. We are considering the responsiveness of the schemes to their clients.

The Minister should know that this has been a problem for many years. Is he aware that the CBI has calculated that more than 90 per cent. of people change their jobs during their lifetime? Does he agree with the CBI's view that a system which subsidises the few by penalising the many cannot last? How many more conferences do the Government intend to hold before that truth is realised and rammed home?

I do not remember the Labour party doing anything about this matter when it was in Government. We have had a report from the Occupational Pensions Board. We have similarly called a conference and, as my right hon. Friend said last year, we would prefer early leavers to be dealt with voluntarily, but if not we will take legislative action. That is something that the Labour party never even talked about.

asked the Secretary of State for Social Services whether he expects the number of whole-time equivalent nurses to fall during the present financial year.

asked the Secretary of State for Social Services how many agency nurses are employed in the National Health Service.

We have told regional health authority chairmen that the NHS should plan to work to lower manpower targets over the year 1983–84, but within those targets we expect to see a shift in the balance of those employed towards those staff engaged in direct patient care, such as nurses.

Will the Minister answer yes or no if he is planning to reduce the number of nurses by 2,000 this year?

The hon. Gentleman has no basis or assumption for that figure.

The answer is no, then, is it?

We are urging health authorities to work to lower manpower targets which will ensure the more efficient use of manpower of all the staff, including nurses. If we make more efficient use of manpower, we can improve the quality of nursing care.

Is the Minister aware of the increasing concern within the National Health Service about the employment of agency nurses? Is not the increasing employment of agency nurses jeopardising the long-term employment of nurses within the Health Service. Will the Minister now say whether he has any proposals to limit the number of agency nurses within the National Health Service?

We have no evidence that an increase in the number of agency nurses employed in the National Health Service is taking place. We can see nothing wrong with employing agency nurses in suitable circumstances to cover emergency or particular situations. It is for each individual health authority to make the best decisions about the type of nursing manpower it needs and the numbers it needs in order to maximise patient care within its available resources.

Is the Minister aware that the nursing school in the central Nottinghamshire health district has had its trainee nurse intake seriously reduced? The Minister knows that the central Nottinghamshire health district sits on his constituency's doorstep. This will mean that fewer nurses will go into the service, with the end result that services will suffer. Is he aware that this is all because of the Government's policy? The Secretary of State must not shake his head. What I have said is true. There has been a serious reduction in Trent region's allocation. I want a straight answer from the Minister.

Without notice, I cannot answer for the decisions of nursing management in central Nottinghamshire, even though it is quite close to my constituency. The proper approach to nurse training is to train the number of nurses in the right place and in the right specialties that good patient care requires. That is the judgment which, I am sure, the managers in central Nottinghamshire are applying, just as we are applying it nationally.

May we have an assurance that there will not be any reduction this year in the number of nurses?

What on earth would be the point of giving an undertaking like that if we can save money by making better use of nurse manpower in one place to release resources for the better care of patients in another? It is absolutely fatuous to approach the planning of an important service such as the NHS by just wedding oneself to job statistics in a particular place at a particular time. We need to get the best value for money we can so as to get the best possible patient care from the resources available.

asked the Secretary of State for Social Services when he expects the maternity services advisory committee to publish its next report.

I understand that the committee hopes that its next report, on care during childbirth, will be ready for publication later this year.

While we await the publication of the next report, will my hon. Friend tell the House what response his Department has received to the last report of the maternity services advisory committee and what steps his Department is taking to monitor the implementation of that report's recommendations by individual health authorities, particularly in the light of the successful Sighthill scheme for ante-natal care in Edinburgh?

About 11,000 copies of this excellent report have been distributed to health authorities, professionals and others in the field. The Department is monitoring carefully the activities of the authorities and the way in which they respond to the checklist of recomendations set out in the report. I know that my hon. Friend joins me in rejoicing in the fact that perinatal mortality has fallen by more than a quarter in this country in the past five years.

asked the Secretary of State for Social Services how many hospital and ward closures he expects in the Yorkshire region over the next three years.

The development of the National Health Service has always involved the closure of old, surplus or unsuitable hospitals and wards from time to time, but I would not normally expect to be directly involved in these issues unless a community health council objected to a district health authority's proposals. I have no such objections from Yorkshire before me at present.

Is the Minister aware that there is widespread anxiety in Yorkshire because in all the regions covered by the Yorkshire regional health authority there are rumours of closures? Will he say whether the statement made the Chancellor on 7 July will lead to further cuts, the closure of wards and hospitals and the loss of jobs in the NHS in the Yorkshire region?

Her Royal Highness the Princess of Wales is today opening the new district general hospital in Grimbsy. The opening of that new hospital will lead to the closure of the old general hospital and the Croft Baker maternity home. I can therefore confirm that the rumours about the closure of those hospitals are well-founded, but I cannot accept that as evidence of a cut in the NHS. If we are to develop the service, we must close old, surplus and redundant hospitals and alter the pattern of service to face patient needs. That process must go on.

Will the Minister make it clear that if the Yorkshire health authority this week postpones a decision about the future of the Thornton View hospital in Bradford, it will incur no criticism from him?

I understand that it is at present consulting on the future of both those hospitals and I am waiting for the health authority's decisions in the light of that consultation. That is the right way of proceeding in these matters. If a health authority thinks that it can provide services better by making a closure, it must check the views of the local people, and if there is disagreement between the health authority and the community health council, it will eventually come to Ministers for approval.

asked the Secretary of State for Social Services if he will take steps to change the rule whereby a general practitioner cannot obtain reimbursement for the costs of employing his wife on his ancillary staff.

No, Sir. Some general practitioners already receive an allowance under the related ancillary staff scheme to help with the cost of employing dependant relatives.

Does my hon. Friend agree that there is still an anomaly here, for example when a GP seeks to employ his wife for clerical work? Does he agree that it would be possible at least to relieve that anomaly without creating sources of possible abuse?

I am glad that my hon. Friend recognises the problem of abuse and that it must be carefully watched. I understand that representatives of the profession will engage in further discussions with my Department on the issue in the near future.

asked the Secretary of State for Social Services if he will seek to ensure that a higher proportion of Health Service resources goes to direct patient care by achieving savings in the cost of support services.

Yes, Sir. This is one of the aims of the Government's policy of competitive tendering.

While recognising that expenditure on the NHS has increased by 17 per cent. in real terms in the past five years, but accepting that demand for resources will be even greater in the future, may I ask my right hon. Friend whether he agrees that if we are to give the maximum support to direct patient care it is essential that we eliminate unnecessary bureaucracy and administration in the service, just as it is important to see that within quality specifications we get the best possible price for the services supporting that direct patient care?

I agree with both those points. As has been made clear, the Government are working to manpower targets, but equally what we shall want to do is to see competitive tendering bringing the support services of the NHS under scrutiny so that we can check the cost of those services, and so that any money saved can go to direct patient care.

Does the Secretary of State accept that there is great danger in the definition of support services as being simply administrative, when it is possible that the support services include the home help services, which are possibly the most economically efficient and valuable of the whole Health Service?

We are talking basically about the NHS, and the services involved in contracting out, which are the domestic services, portering, cleaning and services of that kind. I am sure the hon. Gentleman will agree that if savings can be made in those services and if the money saved can go to direct patient care, his party would support that.

Does my right hon. Friend agree that there is a valid argument for saying that a proportion of any savings made from the privatisation of the support services should be returned to the Treasury to help fund tax reductions for the low-paid?

There is an argument for that, but I am not sure that it is an argument that I would necessarily accept at this stage, because the important thing that we are trying to do is to ensure that the health authorities make sensible economies and savings in their budgets. That money can then go to patient care. That is the sensible way of tackling the problem.

asked the Secretary of State for Social Services how many regional health authorities will have net growth in their revenue budgets following the implementation of the proposal announced by the Chancellor of the Exchequer on 7 July.

Ten, Sir. In the other four regions the impact of the reductions in finance should be offset by more efficient use of existing resources, particularly manpower.

But is not the real truth that there will be a cut in every region? How does the hon. and learned Gentleman square that with the statement of the Prime Minister that the NHS was safe with her, when further cuts are intended, and when she said that there would be an increase in spending of £700 million this year, £800 million next year and £700 million the year after? Is not this deception of the electorate a resigning matter?

The real truth, as I have said, is that there will not be cuts in 10 out of the 14 regions. The real truth also is that the overall resources devoted to the NHS will be as planned; in the case of the hospital services, about the same as last year. The four regions that are suffering some reduction in finance are comparatively over-resourced regions and we must work towards a fair distribution of those resources, not least for the benefit of an under-resourced district health authority such as Warrington, whose cause the hon. Gentleman is usually urging on me.

Is not the real truth that the four regional health authorities covering the London area will be under enormous pressure, with serious consequences for the district health authorities in inner London? How many hospitals does the Minister think will be closed as a result of these proposals?

The four Thames regions have more than their fair share of resources. That is not a fact suddenly discovered by this Government; it was discovered by previous Governments. We therefore have to reallocate resources to give a fairer distribution to the rest of the country. In London there is a surplus of acute beds but a shortage of some other services, particularly community services. Therefore we must reallocate within the Thames regions as well. That process will lead only to the closure of surplus, redundant or unnecessary beds to release resources for other patient care.

Is the Minister aware that it is not long since he was talking about the reallocation of finance to areas such as Newcastle-upon-Tyne because of the enormous problems of that area, yet here we have a £1 million cut being imposed by him so soon after the election?