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Mrs. Bottomley : The hon. Lady will know that the success of community care depends on an effective relationship between social service departments and regional health authorities. At present, we ask them to report to us every six months--and more often--to make certain that the work is under way.
District health authorities have been involved for 20 or 30 years in community care for people with learning disabilities, the mentally ill and elderly patients. The question of resources for social service departments arises regularly in the yearly local authority spending round, and we have made it clear that community care will be fairly funded.
Health Promotion
9. Mr. Quentin Davies : To ask the Secretary of State for Health to what extent family doctors are improving health promotion.
Dr. Mawhinney : Significant progress has been made since the introduction of the GPs' new contract. In particular, there are now more GPs holding health promotion clinics, immunisation uptake is rising and more women are being screened for cervical cancer.
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Mr. Davies : Do not the new targets in the GPs' contract relating to child immunisation, regular health checks, cervical cytology, mammography and other diagnostic procedures represent a revolutionary advance in the practice of preventive health care?
Dr. Mawhinney : My hon. Friend is absolutely right. This is a new, innovative and very important development in the preventive work of general practitioners. In the context of prevention and health promotion, I am sure that my hon. Friend and the rest of the House will be pleased to know that in 1990, for the first time in the United Kingdom, no child died from acute measles.
Mr. George Howarth : Has the Minister any proposals to involve GPs in trying preventive measures to stop the spread of anorexia nervosa--which is very worrying, especially in view of its effect on young women? The problem needs to be tackled and it seems to me that GPs are the obvious starting point.
Dr. Mawhinney : I share the hon. Gentleman's concern about the disease, which is indeed very worrying and, as he knows, can sometimes be fatal. I am sure that he is right to point out that the initial contact between patient and general practitioner is significant--it may even be crucial in some cases--and I will bear his comments in mind.
Immunisation
10. Mr. Brazier : To ask the Secretary of State for Health what proportion of children are now immunised against (a) whooping cough and (b) measles ; and what was the proportion in 1978.
Mr. Yeo : By February 1992, 89 per cent. of children aged two had been immunised against whooping cough and 91 per cent. against measles. This is a big improvement since 1978, when only 31 per cent. were immunised against whooping cough and 48 per cent. against measles.
Mr. Brazier : Does my hon. Friend agree that those welcome figures have been caused partly by the new GP contract, which has had a very good effect on the level of immunisation in the past couple of years? As the Minister for Health has just pointed out, we have managed to achieve a year with no deaths from measles. Is not that yet another sign that the new contract is bearing fruit?
Mr. Yeo : My hon. Friend is quite right. The GPs, like everyone else involved in the programme, are owed a great debt of gratitude. The figures show how successful the contract was ; they also show how utterly wrong the hon. Member for Livingston (Mr. Cook) was in 1989, when he described the target set for general practices as "heroic far beyond the present figure for most practices".--[ Official Report, 25 July 1989 ; Vol. 157, c. 910.]
As usual, the hon. Gentleman underestimated what the national health service can achieve with Conservative policies, under Conservative leadership and with the backing that the present Government give the health service.
Charitable Fund Raising
11. Mr. Enright : To ask the Secretary of State for Health if she will make a statement about charitable fund raising for national health service services.
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Dr. Mawhinney : We value the charitable contributions that people make to the health service through their voluntary efforts.
Mr. Enright : Is the Minister aware that a considerable number of hospital managers have declared that they are dependent on charity for their services? It must be true--it was in The Daily Telegraph. Is the Minister also aware that the Charity Commissioners have consistently stated --and I quote--
Madam Speaker : Order. I am sure that the hon. Gentleman is not reading from any speech. [Interruption.] Hear me out, please. If the hon. Gentleman is quoting, that is not permissible. Will he please paraphrase?
Mr. Enright : Is the Minister further aware that the Charity Commissioners have consistently stated that moneys raised through charity cannot be used for statutory purposes in the health service? How does he square that circle?
Dr. Mawhinney : There is no circle to square. The health service is better funded now than ever before. As the hon. Gentleman quoted to me, I will paraphrase to him. A pressure group suggested recently that total charitable funding amounted to £370 million. I do not know whether that is right, but if it is, it represents £1 for every £92 of taxpayers' money going towards the health of the nation. I am surprised that the hon. Gentleman should adopt such a mean attitude to the voluntary activities of the many people who want to put something back into a health service that they value.
Mr. Nicholas Winterton : While warmly welcoming the large sum of money raised from charitable sources for the national health service, can my hon. Friend assure the House that any such moneys that are raised either in districts or in regions will not be offset by reductions in money and resources from the Department of Health that would otherwise be made available for services or equipment to improve health care in this country?
Dr. Mawhinney : My hon. Friend has a good point and I am happy to give that categorical assurance. In fact, I would go further. Whatever money is raised by charitable activities is neither known nor taken into account by the Department when it comes to deciding how much taxpayers' money should be invested in the health service.
Ms. Lynne : Is the Minister aware of the tragic case of four-year- old Laura Davies, who is desperately in need of a bowel and kidney transplant which is not available in this country? The Manchester Evening News has mounted a campaign which we all welcome, but can the Minister say whether national health service money will be made available for that life- saving operation in the United States?
Dr. Mawhinney : I am aware of the case and I understand that discussions are proceeding to try to find a way to address that issue.
Mr. Couchman : Does my hon. Friend agree that for very many years people have enjoyed raising charitable funds for the health service because it gives them a sense of being involved in their own health care? Is not that
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wholly to be applauded, particularly as it frequently leads to the provision of capital equipment, the revenue consequences of which the NHS is then happy to take on?Dr. Mawhinney : My hon. Friend is absolutely right. People wish to make contributions to the health service for a variety of reasons--some out of gratitude for the service that they or their families have received, others out of humanitarian concern, others out of Christian compassion, and for many other reasons. Only the most mean-spirited Opposition Members find that objectionable.
Mr. Robin Cook : Is the Minister aware that the charities report to which he referred concluded that the growth in NHS charities under the Government has been five fold? Does not that trouble him in the slightest? Has he no worries when the collecting can goes round for intensive care cots? Has he no concern that services for mental health and geriatrics, which are not charitable money spinners, might be left further behind? In his first month as Minister for Health will he remember the warning of the first Minister for Health that warm gushes of self-indulgence are not a reliable source of funding for a public health service?
Dr. Mawhinney : I will tell the hon. Gentleman what I shall remember. I shall remember a 56 per cent. real increase in spending on the NHS under this Government as against a 17 per cent. decrease under the last Labour Government. I shall remember a capital increase of 76 per cent. under this Government against a 29 per cent. decrease under the last Labour Government. I hope very much that the hon. Gentleman will come out of character and not be one of those mean-spirited people who want to stop those who wish to make a contribution over and above that of the taxpayer from doing so.
Hospital Waiting Lists
12. Mr. Shersby : To ask the Secretary of State for Health what has been the change in the last year in the number of patients waiting over two years for hospital treatment.
Mrs. Virginia Bottomley : I am today publishing provisional waiting time figures for the year to 31 March 1992. They are available in the Library. I have arranged
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for the figures to be printed in the Official Report. In the past year the number of patients waiting over two years for hospital treatment fell 97 per cent. That is a remarkable achievement of which the NHS can rightly be proud.Mr. Shersby : Is my right hon. Friend aware that the whole House will have been pleased to hear those figures? Will she tell the House what progress has been made in reducing the waiting lists in my district health authority of Hillingdon?
Mrs. Bottomley : I can give my hon. Friend that information. In his health authority, remarkable progress has been made. There are no two-year waiters. The total list has come down by 27 per cent. per year. The list for one to two-year waiters has gone down by 18 per cent. and the list for under one-year waiters has gone down by 9 per cent. My hon. Friend has a district health authority in a region which has done similarly well. In the past year it has dealt with more than 5,200 of the over two-year waiters and reduced the one to two-year waiters and the under one-year waiters. That is a practical demonstration of our commitment to a better health service which meets patients' needs.
Miss Lestor : May I remind the Secretary of State that my constituent, Laura Davies--to whom the hon. Member for Rochdale (Ms. Lynne) has already referred, without consultation with me--does not have two years or two months to wait for funding for her operation in America? I have written two letters to the right hon. Lady in the past two weeks asking what financial help is forthcoming in addition to the efforts being made in my constituency and around to raise money. Will the right hon. Lady tell me why she has not replied?
Mrs. Bottomley : The hon. Lady will shortly receive a reply from me. I am having discussions with the regional health authority chairman and the chief medical officer. I regret the way in which individual cases become the subject of discussion in this place, because it is an intrusion on the personal difficulties and sadness of the families involved. I am well aware of the detail of the case, the complexity of the treatment that the patient needs and the treatment that she has already had in this country. I am having discussions to see what more can be done to assist her.
Following is the information :
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Provisional<1> waiting time figures year ending 31 March 1992
In-Patients and day cases combined
March 1992-and percentage change since March 1991
Region Under 1 year: 1 to 2 years: Over 2 years: Total
|Number |Per cent.|Number |Per cent.|Number |Per cent.|Number |Per cent.
|change |change |change |change
------------------------------------------------------------------------------------------------------------
Northern |53,292 |12.5 |3,992 |-15.2 |1 |-99.9 |57,285 |7.0
Yorkshire |63,196 |5.1 |6,422 |-23.9 |16 |-99.5 |69,634 |-2.9
Trent |76,229 |9.8 |9,281 |0.4 |4 |-99.7 |85,514 |6.9
East Anglian |36,326 |-0.7 |4,688 |-29.8 |41 |-98.8 |41,055 |-12.2
North West Thames |46,565 |-2.7 |9,160 |-11.6 |2 |-100.0 |55,727 |-12.1
North East Thames |68,723 |6.1 |8,687 |-29.0 |748 |-88.7 |78,158 |-6.6
South East Thames |68,005 |8.7 |8,170 |-23.5 |96 |-98.5 |76,271 |-4.4
South West Thames |44,038 |6.6 |2,323 |-66.5 |0 |-100.0 |46,361 |-7.8
Wessex |52,299 |6.4 |4,076 |-39.3 |0 |-100.0 |56,375 |-4.5
Oxford |40,353 |6.9 |5,848 |-15.1 |0 |-100.0 |46,201 |-2.9
South Western |62,916 |7.0 |2,766 |-72.7 |10 |-99.8 |65,692 |-10.4
West Midlands |84,392 |5.4 |5,452 |-53.8 |158 |-97.2 |90,002 |-7.8
Mersey |49,653 |14.2 |428 |-85.0 |0 |N/A |50,081 |8.1
North Western |77,020 |10.9 |6,772 |-30.5 |3 |-99.9 |83,795 |0.3
|---- |-- |--- |--- |--- |--- |---- |---
All Regions |823,007 |7.1 |78,065 |-33.5 |1,079 |-97,9 |902,151 |-3.7
SHAs |11,504 |15.7 |1,431 |0.0 |521 |-35.0 |13,456 |10.6
|---- |-- |--- |--- |--- |--- |---- |---
Total |834,511 |7.2 |79,496 |-33.1 |1,600 |-96.9 |915,607 |-3.5
<1>Based on provisional figures obtained from regions.
NHS Reforms
13. Mr. Sims : To ask the Secretary of State for Health what criteria her Department uses in assessing the success of the implementation of the national health service reforms.
Mrs. Virginia Bottomley : We measure the success of our health policies by the benefits that they are delivering to patients in terms of the improvement to the quality of service, reduction in waiting times, patient satisfaction and the overall improvement in the health of the nation.
Mr. Sims : Does my right hon. Friend consider that the fall in waiting times and the increase in the number of patients treated should be warmly welcomed? Has she noticed the change in the attitude of doctors and nurses towards the reforms in view of their demonstrable success? Does she think that it is about time that the Labour party changed its attitude?
Mrs. Bottomley : I heartily agree with the sentiments expressed by my hon. Friend. We have had a great deal of change in the health service recently. The results of those changes are already clear for all to see. I hope that the nurses and medical professionals will all work with us to ensure that we can build on those services. Since being made Labour's health spokesman, the hon. Member for Livingston (Mr. Cook) has constantly made allegations about a hidden agenda, but he has been unable to prepare an agenda for himself. As the Health Service Journal commented only last week,
"Defeat has left the Opposition flat-footed and its health policies irrelevant."
It is time to build for the future and to build on the achievements in the service.
Mr. Flynn : An important part of the health reforms is health promotion. Can the Minister explain why Imperial Tobacco gave 2,000 poster sites to the Conservative party in the election campaign? Does not that show why the Government are in the pockets of the tobacco industry? Or will the right hon. Lady disprove that by moving a motion to support the European ban on tobacco advertising?
Mrs. Bottomley : We have seen another example of the way in which the Labour party constantly pursues vindictive vendettas. I have made the position quite clear. The fall in smoking in Britain has been greater than in any other country apart from the Netherlands. We have an effective system under the voluntary agreement. We do not support the subsidy for growing tobacco. We have maintained the price of tobacco and we do not have a nationalised tobacco industry. We should be judged on the result--a dramatic fall in smoking, which will continue--and not by the vindictive gimmick{ of the Labour party.
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PRIME MINISTER
Earth Summit
Q1. Mr. Simon Hughes : To ask the Prime Minister what are the specific objectives of Her Majesty's Government at the Earth summit.
The Prime Minister (Mr. John Major) : The Government's specific objectives for the Earth summit are signature of global conventiofs on climate change and biodiversity ; a statement of principles on forests ; a short "Rio declaration" of environment and development principles ; a comprehensive action plan ; and reinforcement of international institutions dealing with environment and development.
Mr. Hughes : As that was the Prime Minister's first parliamentary answer, will he make it his No. 1 priority this Session to tackle the global environmental crisis? Is he aware that the secret documents that we have seen contain proposals which amount to a watering down of the tough energy-saving commitment and replace specific targets with vague promises, and are to be put to the European Commission tomorrow? Will the Prime Minister ensure that, at the Earth summit and thereafter, tackling the global crisis will be his priority and that of his colleagues on the world stage?
The Prime Minister : This is an important conference--an important prioritq--and there is a great deal to be done. The political will is there, not just in this country but in countries around the world. It appears that the attendance at the Rio summit will be very high--and very high at Heads of Government level. I must emphasise that what is agreed at the conference is only the beginning of the work that needs to be done. Some people might set their expectations too high. There is bound to be a limited amount of success at Rio. There will be a good deal to be done subsequently in this country, in the European Community, and beyond.
Mr. Lester : If my right hon. Friend gets a chance to watch television, I am sure that in the past two or three days, and certainly this month, he has noticed the beginning of the one world '92 campaign, linking 66 nations' broadcasters throughout Europe as well as the general public in preliminary matters to the Rio conference. On 30 May, it will culminate in a day of action throughout Europe and the tree of life, for which I am sure he has signed his pledge. Will he support all the work that is being done to involve the public in this issue because, however much we feel that it is important, without general public support we shall never get anywhere?
The Prime Minister : I agree with my hon. Friend. It needs a commitment by Governments, by which I mean Governments across the world. Little will be gained if
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some contribute while many others do not. A great deal of commitment by individuals will also be necessary. This may be one of the areas of policy where it is often the individual driving the Government, rather than the reverse, in terms of commitment to the environment. I have little doubt that individuals in this country and beyond will commit themselves to these environmental and desirable aims.Engagements
Q2. Mr. Janner : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : 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.
Mr. Janner : Will the right hon. Gentleman please tell the House the extent to which, in his own opinion, the Parliament of the United Kingdom should surrender sovereignty in the interests of European unity and what role he considers that a British monarch should play in influencing policy and opinion within the European Community?
The Prime Minister : Influencing policy and opinion in the European Community at a political level is a matter for the politicians. That has been a long-established tradition and it remains the position. The position of the sovereignty of this House is a matter which we have discussed on many occasions. The sovereignty of this House is not a matter that is up for grabs--that is perfectly clear. What we have said is that there are areas where we can pool decision making in the general interests of the whole of Europe and in those circumstances it is right to pool decision making, but perhaps one of the most essential parts of the Maastricht agreement was the agreement on subsidiarity--that things must be done on a national level when they can best be done at a national level.
Sir Anthony Grant : While recognising that miscarriages of justice are bound to take place from time to time and must be rectified, will my right hon. Friend confirm that there will be no weakening in the attitude of the Government, of the police or of the courts in the relentless battle against terrorism?
The Prime Minister : I am certainly happy to give my hon. Friend that assurance. Terrorism is one of the most wicked and evil problems faced by this Government and by Governments across the world. There will be no weakening in our determination to fight terrorism and no weakening in our determination to work with our European partners at a European level to fight terrorism.
Mr. Kinnock : As the Prime Minister rightly says that he wants to sweep away the cobwebs of secrecy, is that a principle that he will be applying to the financing of the Conservative party?
The Prime Minister : The financing of the Conservative party is not a matter for the right hon. Gentleman.
Q3. Mr. Tony Banks : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : I refer the hon. Gentleman to the reply that I gave some moments ago.
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Mr. Banks : What representations has the Prime Minister made to President Bush to get the pilots of the A10 tank busters to submit themselves to the inquiry into the deaths of the nine service men killed by the so-called
Madam Speaker : Order. The matter with which the hon. Gentleman is dealing is sub judice. If he can rephrase his question, I will certainly hear him.
Mr. Banks : The Prime Minister will recall in principle terms that President Bush gave assurances to the parents of the service men who were killed that the pilots would come over here for examination. Will he tell us what representations he has made to ensure that President Bush carries out those assurances?
The Prime Minister : As I believe the House has been told on previous occasions, my right hon. Friend the Secretary of State for Defence will be drawing the families' letters to the attention of Mr. Cheney, the United States Defence Secretary.
Mrs. Peacock : Now that my right hon. Friend has been returned to Downing street for a further five-year term, may I invite him--when he is planning his visits--to visit my constituency of Batley and Spen in Yorkshire where he will find much manufacturing prospering as it has been investing during the recession? He would be made most welcome on such a visit.
The Prime Minister : I am grateful to my hon. Friend for her invitation and it is certainly one which I shall hope to take up during the course of this Parliament. I share her view about the prospects for manufacturing industry and, in particular, for the new areas of manufacturing which have flourished so much in recent years and which are so often overlooked when people talk about manufacturing in the generality.
Q4. Mr. Dunnachie : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : I refer the hon. Gentleman to the reply that I gave some moments ago.
Mr. Dunnachie : What pressure has the Prime Minister put on President Bush in relation to the British soldiers who were massacred in the friendly fire incident and to fulfil the promise to their relatives? Will he tell them why nothing has been done in that respect? What does he intend to do in the future to bring that sorry state of affairs to an end?
The Prime Minister : I responded to that point a few moments ago, as the hon. Gentleman and the House heard. The hon. Gentleman will be aware that United States officials have discussed the handling of the evidence with the coroner, who has made it clear that he accepted the United States decision not to provide witnesses. That matter has been raised at the highest level with the American Government and Defence Secretary.
Q5. Mr. Gill : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.
Mr. Gill : As the first Conservative Member whose name appears on the Order Paper for the first Prime
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Minister's Question Time of the new Parliament, may I convey the congratulations of all Conservative Members to my right hon. Friend the Prime Minister on leading our party to its unprecedented fourth election victory? Does my right hon. Friend not agree that his strongly anti-federalist stance was instrumental in securing that general election victory? In view of today's press reports, will he reassure the House that British sovereignty is not "insignificant"?The Prime Minister : I am grateful to my hon. Friend. As I said a few moments ago, decisions need to be taken as close to the citizen as possible. That was the principle of subsidiarity that we fought for and obtained in the negotiations at Maastricht. Where the nature of a problem requires a European response, we believe that it should have a European response. That was the balance that we struck, and I believe that it was the right balance.
Mr. Wigley : The Prime Minister has again emphasised the importance of the subsidiarity concept that decisions should be taken as close as possible to the people. How will that be applied to the people of Scotland, Wales and Northern Ireland, or is it a principle which starts in Brussels and ends in London?
The Prime Minister : The hon. Gentleman knows that we are one United Kingdom and the Government are determined that we shall remain one United Kingdom.
Q6. Mr. Quentin Davies : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.
Mr. Davies : Is my right hon. Friend aware of the enormous sense of pleasure, relief and hope in the future generated by our victory at the election under his leadership? [Interruption.] There are obviously some sour grapes on the Opposition side. Does my right hon. Friend agree that after another five years of Conservative Government, instead of this country's performance being measured by how fast we are catching up with Germany, for the first time in 100 years we shall be a model for others in respect of economic performance, enlightened administration of public services, and social peace and cohesion?
The Prime Minister : I am grateful to my hon. Friend and I agree with him. We very much want wealth and welfare to go hand in hand, and I believe that the fear of the election of a Labour Government had been holding that back. Since polling day we have seen a dramatic
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change in the confidence of the markets and individuals. Share values have risen by about a seventh, sterling is up, and interest rates have been cut by a further per cent., bringing us almost level with German rates for the first time in a quarter of a century. That is good news for British industry, for British investment and, over time, very good news for British employment prospects.Mr. Cryer : As the Prime Minister is so complacent about British manufacturing industry and claims that there is much good news about, will he assure the House that he is not prepared in the GATT negotiations to sacrifice the textile industry to gain advantages on behalf of the farmers who have supported the Conservative party? Will he give an unqualified guarantee that he will fight to keep jobs in the British textile industry, as many thousands of jobs have been lost in the past years of Conservative rule? We want to keep that industry going in Bradford and elsewhere. Will he give that guarantee?
The Prime Minister : What I have never understood in the hon. Gentleman's remarks about manufacturing is why he and his colleagues are always so keen to assume that British manufacturing industry is failing, doing unwell and needs special assistance and special subsidies to survive. The reality is that the United Kingdom share of world trade in manufactures rose in 1991 for the third successive year. Right across the country we have seen growth in areas of manufacturing industry which did not show signs of growth in earlier years.
Q7. Sir Thomas Arnold : To ask the Prime Minister if he will list his official engagements for Tuesday 12 May.
The Prime Minister : I refer my hon. Friend to the reply that I gave some moments ago.
Sir Thomas Arnold : Does my right hon. Friend agree that the recent actions of Ofgas and Oftel to reduce prices still further show that the community charge has real teeth when it comes to protecting the interests of the consumer?
The Prime Minister : The work of Ofgas and Oftel goes right to the heart of the citizens charter. The principles of those two regulatory bodies are important and the citizens charter underlines our commitment to put the consumer first. The regulators have achieved significant price cuts. British Telecom's prices have been cut by 27 per cent. in real terms, British Gas has cut domestic prices and standing charges, and the regulator is demanding more cuts. The impact of the citizens charter will continue to put the citizen in the forefront of people's minds when state prices are determined.
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