§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
I beg to move,That the draft General Practice Finance Corporation (Increase of Borrowing Powers) Order 1978, which was laid before this House on 6th June, be approved.I am presenting this order in conjunction with the Secretary of State for Scotland in exercise of our powers under Section 6(3) of the National Health Service Act 1966. The object of the order is to increase the borrowing powers of the Corporation to £25 million as a top limit.
The National Health Service Act 1966 initially authorised the Corporation to borrow £10 million. This was increased to £18 million with the approval of this House under the General Practice Finance Corporation (Increase of Borrowing Powers) Order 1971. I am now seeking the approval of the House for the further limit.
The order is an indication of the general success of the operations of the Corporation in that it has been able to make a substantial service available to the medical profession over the years, and now the need has come to make more money available.
The General Practice Finance Corporation has its origins in the wide-ranging discussions which took place in 1965 between the British Medical Association and the then Minister of Health, Mr. Kenneth Robinson, about ways of bringing about fundamental improvements in the organisation of general practice in this country. It was common ground at that time between the Government and the representatives of general medical practitioners that doctors were experiencing great and increasing difficulty in raising the capital needed to provide adequate modern surgery premises. We accepted that doctors needed help with the provision of finances and agreed with the profession's proposal that an independent Corporation would be a useful way of providing such assistance.
The 1966 Act received all-party support for the setting up of a General Practice Finance Corporation to make loans available to doctors working in the 852 National Health Service to provide or improve surgery accommodation for their patients. Members will be pleased to know that the Corporation, since it began business in May 1967, has helped more than 5,000 doctors in Great Britain by making nearly 2,500 loans to a total value of more than £20 million. At the end of the last financial year, the Corporation had made firm offers to lend doctors a further £2 million.
The Corporation is an independent body controlled by its members. The members, who include general practitioners, have legal and financial expertise as well as experience of estate management. Nominations for membership of the Corporation are discussed with representatives of the medical profession and appointments are made by my right hon. Friends the Secretaries of State for Social Services and for Scotland.
I would like to take this opportunity of paying tribute to the chairman, Mr. Stebbings, and his predecessor Sir Frederick Hoare, and to members of the Corporation both past and present for all the work they have done in helping doctors provide better surgery accommodation—an aim which will, I am sure, be welcomed in all parts of the House.
The Corporation is continuing to look for new ways in which it can fully discharge its function of assisting doctors who wish to provide new practice premises while at the same time avoiding unnecessary financial risk. The Corporation is, of course, expected to break even, taking one year with another, and this year showed a small operating profit. The staff of the Corporation have given valuable assistance to the members by keeping the operating costs down to below 4 per cent. of loans made. The activities of the Corporation make virtually no charge on the National Health Service Vote.
The Corporation is responsible for its own financial policy and raises finance by issuing stock and by temporary borrowing, both of which are guaranteed under the terms of the 1966 Act by the Treasury. The stock is taken up by the National Debt Commissioners and temporary borrowing takes the form of a bank overdraft, limited to £1½ million, which allows the Corporation some flexibility in choosing the best time for stock 853 issues. Nevertheless, the issue and redemption of stock and the limit of temporary borrowing are and will continue to be subject to the approval of the Secretaries of State and the Treasury.
The Corporation has outstanding stock to the value of £16¼ million. Since May 1967, when it first started making loans, it has issued stock amounting to £19½ million, £3¼ million of which has been redeemed. Within the next few months, further stock issues will be required to meet the demand from doctors for loans. With temporary borrowing of up to £1½ million, the limit under which it has been working has become too restrictive.
I have given the House the essential outlines of the purpose of the order and of the way in which the Corporation works. If necessary, I shall, with permission, reply to any points which are raised.
§ 10.5 p.m.
§ Dr. Gerard Vaughan (Reading, South)
That was an extremely disappointing speech. The Minister has not referred to the important matters which the order will affect. I suppose that that, in a way, may account for the lack of enthusiasm with which he read his speech.
The truth is that on this apparently straightforward and simple order, we should be discussing the conditions in which patients are seen and treated by many family doctors. The order affects whether some general practitioners will be able to see their patients in modern properly equipped surroundings or be forced to continue to see patients in old, uncomfortable and often very unsuitable surgeries. As we all know, from going about the country and hearing what they have to say, doctors are in many cases still seeing patients who wait in long queues in the old familiar cartoon surroundings in dilapidated premises. That is not right.
One cannot have modern surgeries unless one has the money with which to build and equip them, and that money is simply not available to general practitioners, especially young general practitioners, or, when it is, it is on terms which the majority of them cannot afford. Thus, they either have to continue to work in poor surroundings or they have to borrow money to build new surgeries 854 to work on their own, or perhaps go into a group of doctors on conditions which are financially penal. The other course for many of them is to turn to a health centre, with all the drawbacks which they see in such centres.
I agree that the order increases the money available to the General Practice Finance Corporation from £18 million to £25 million, but this is the first increase for seven years and during that time, especially under this Government, the value of money has fallen so disastrously that even the increase which we are now considering does not put the financial position back where it was seven years ago.
Since there is no cost to the National Health Service here, I had hoped that the Minister would seek a larger increase in the amount which the Corporation can raise. Why is there not a greater increase? As he said, this is money which is raised publicly, is then lent, and is later returned.
Not only do we question the amount of money available but we question the use to which the money is put. We consider that it is not as readily available as it ought to be, and that the terms on which it is lent are not sufficiently low. One has only to look at the report of the CorporationߞI must say that we receive these reports very late, and this report is considerably out of date nowߞto find that the interest rates range up to as high as 18 per cent.
Such a rate of interest puts a heavy burden on a doctor, especially a young doctor seeking to set up in life. The result is that many doctors, I understand, are now asked to produce between £30,000 and £40,000 to go into a really modern group practice and buy their share. This is beyond them, or, if they do raise it on the Corporation's terms, particularly if they are young people with a family, they have a financial burden hanging over them which is a disadvantage to the way they carry out their practice.
When I was in the West Country recently, I met several groups of doctors. One of them has the land and it has planning permission, but it does not have the money to set up proper premises 855 and the local authority is trying to persuade this group of doctors to go into a health centre, which they do not wish to do.
I know that health centres are attractive to the philosophy of the Government. They appeal to a tidy bureaucratic mind. It is felt that it is attractive to have the doctor working with the rest of the primary health care team, in the same building. But the same advantages of the primary health care team can be obtained in a proper group practice. There is the advantage that the doctors concerned are able to exercise their skills and professional freedom in a way best suited to the patients in their area. This is important and is something to which the Government pay little regard. In the long run, the way in which doctors work materially affects the standard of care that they are able to offer their patients.
I ask the Minister to think again about the affairs of this Corporation. He says that it has made general progress, but I query that. I think that it has made a small amount of progress, and rather unimaginative progress at that. I ask the Minister to realise that we are discussing effectively the whole pattern of modernising general practice in this country. I ask him to look at the report of the Corporation and at the small number of doctors who have taken up loans from the Corporation. That number is smaller than the number who applied for loans. When the figures are compared, one country with another, it will be seen that there is a small number in this country, a negligible number—sevenߞin Scotland and only two in Wales. Why are there discrepancies between one part of the United Kingdom and another? That is not a satisfactory situation.
Further, there are areas which clearly have a need for financial help but to which no loans have been made. We ask the Government to think a little more about the work of the corporation, to accept that the health centre programme should be drastically reduced and to agree that health centres should be provided only in places where they are suitable, namely, in inner city areas. Health centres ought not to be forced upon 856 groups of doctors who do not want to work in them but who are unable to get premises in any other way.
The Government should develop a proper financial policy for helping general practitioners to modernise their premises and improve their skills. This means allowing the Corporation to raise larger sums than those we are discussing and to make the money much more freely available to general practitioners, particularly the young ones, by offering it at a low rate of interest. On those grounds we are uneasy and dissatisfied with this Statutory Instrument. We think that it shows a lack of imagination, that it is complacent and that it shows that the Government are out of touch with a great deal of what is happening in general practice.
§ 10.14 p.m.
§ Dr. M. S. Miller (East Kilbride)
The hon. Member for Reading, South (Dr. Vaughan) and I have in common the fact that both of us are intensely interested in the family doctor section of medicine, among other things, and believe that there should be a greater emphasis on primary care. Where I do not agree with the hon. Gentleman is in his remarks about health centres. I am not at all satisfied with his dismissal of practice in health centres, which he says has drawbacks.
There is only one drawback for the doctor practising in a health centre and that is that it will probably cost him a little more money than it would if he practised from old premises. For the patient there is only one drawback about the health centre, and that is that it may mean that he will have a little further to travel. Everything else is a plus. It is sad that, 30 years after the beginning of the Health Service, we should be having a debate on the necessity to provide reasonable premises from which the general practitioner can practice. I am sure that I am not giving anything away when I say that the hon. Member for Reading, South and I are old enough to remember the days when doctors practised in premises which were deplorable. I am sorry to say that there are still some places where that description applies.
If the only alternative to the removal from deplorable premises were the building of custom-built surgeries for the GP 857 such as the lion. Gentleman has envisagedߞthe kind of premises which some 25 years ago three of my colleagues and I built in a district in GlasgowߞI would say that he was right in his utter condemnation of the restrictions which my right hon. Friend has implied. Incidentally, I think that the hon. Gentleman is right about the cost today, because those premises in Glasgow cost us about £10,000 25 years ago. But that is not the real alternative.
I contend that the real alternative to premises which are unsuitable for doctors to practise from and for patients to consult them in is the health centre. Contrary to the hon. Gentleman's views, I urge the Minister to push ahead as fast as he can with the building of health centres. I know that there are objections, and I have indicated what I think the two main objections are in each category. But there is no doubt, with all the experience that one can gather from many years of looking at the problem, that it is only in a health centre, with several groups of doctors getting together, that it is possible to provide all the services required for primary care. It is possible to do it only on the basis of four or five groups of doctors getting together, perhaps 20 in all, making the money available not only to have ancillary medical and paramedical staff but also to have social services involved, health visitors and all the adjuncts necessary in practice today.
I know that there are some areas where this is less possible than in others. I do not agree with the hon. Gentleman that health centres should be restricted to inner cities or densely-populated urban areas. I think that they can be erected in parts of the country where the population is not nearly so congested. I know that there might be difficulties, but they can be surmounted.
§ Dr. Vaughan
But does not the hon. Gentleman agree that health centres are far more impersonal, are less easy places in which doctors can see some kinds of patient, that patients are often upset by them, and that there are problems over the confidentiality of the records?
§ Dr. Miller
I could not agree that there are any such constraints. There are disadvantages in health centres, but those are not among them. I do not think that there is any problem over confidentiality 858 or a problem of an impersonal atmosphere. If the hon. Gentleman will come to the Hunter health centre in East Kilbride, I will show him an atmosphere as good as that of any good family hotel. It is an excellent atmosphere, where patients can get a cup of tea and have a chat with their friends. There is no difficulty whatever. Where there are difficulties with health centres is where, for example, a patient has to travel a bit further from home and therefore has to pay a little more for his visit to the doctor.
I think that the custom-built group practice centre still plays a part. Of that I have no doubt at all. But it should not be put against the health centre as the ultimate idea. It should be put against the deplorable, unsatisfactory, and very often insanitary, conditions in which some doctors work. If we looked at it from that point of view, and made sure that any doctor who for whatever reason could not be persuaded to work in a health centreߞI admit that there are some who might not be persuadedߞwas at least persuaded to take part in a group practice centre, and if finance was made available to a few doctors in order to erect a group practice centre, that at least would be a satisfactory compromise.
I again counsel my right hon. Friend not to go too far along the line of making it easier for doctors to opt out of the possibility of health centre practice, because in the immediate and in the long term that is best for the general practice aspect of the medical profession, the ancillary services which go with the GP's and also for the patients themselves.
§ 10.21 p.m.
§ Mr. Robin Hodgson (Walsall, North)
I would not want to argue with the hon. Member for East Kilbride (Dr. Miller), particularly on matters affecting medical practice. But as a layman, the two points which occur to me about a health centreߞto be fair, the hon. Gentleman mentioned one of themߞis that the people in our society who use the medical services the most are mothers with young children and the elderly and the more elderly they are, the more they need to go to the doctor. Yet these are the people who find travelling the most difficult of all. The hon. Gentleman mentioned the problem of travelling, and that is not a difficulty to be skipped over 859 lightly. I believe that it is a very grave difficulty, particularly for an increasing number of very elderly people.
The hon. Gentleman also tends to underestimate the fact that the basic medical relationship in this country is the doctor-patient, a one-on-one, relationship, rather than the patient-group practice of doctors relationship. I would have thought that the concept of an individual patient dealing with an individual doctor was a fairly fundamental part of our medical organisation. However, I take the points which the hon. Gentleman made.
I should like to begin with a plea to the Minister about the explanatory note, This is ground which we have covered before with regard to other Statutory Instruments. The explanatory note on this Instrument states:This Order raises the maximum aggregate amount which may be borrowed by the General Practice Finance Corporation whether by the issue of stock or temporarily to twenty-five million pounds. The amount was previously fixed at eighteen million pounds by S.I. 1971/382.We could have guessed most of that from the title of the Statutory Instrument. Either we should have explanatory notes which tell us something new and novel or we might just as well scrub them. The only interesting thing which we learn from this one is the existence of the previous Instrument, passed in 1971. It might interest more of our colleagues if we had explanatory notes on this and other Statutory Instruments which were more explanatory of the purpose of the Instrument as opposed to merely repeating the title.
The timing of the debate has already been briefly touched on by my hon. Friend the Member for Reading, South (Dr. Vaughan). We are debating this Instrument at the very worst possible time of of the year, because if one looks at the most recent annual report of the GPFC, which covers the year ending 31st March 1977, one will see that it was issued on 5th July 1977. Presumably the statistics for the year ending 31st March 1978 are due out within the course of the next couple of weeks. Indeed, if one looks at the date of the signatories of the assistant secretaries in the Department in London and Scotland, one sees that last year's re- 860 ports were signed on 14th and 15th June. Therefore, there must be one which is just about to emerge. It would have made our deliberations a little more meaningful and helpful, and our comments a little more pertinent, had we been able to hold back this Instrument until we received the report for the year ending 31st March 1978.
The other matter that I wanted to take up concerned the financial management. My hon. Friend referred to the rates of interest being charged. But in respect of this last year for which we have full statistics, the Corporation raised money on three different occasions. It raised £250,000 on each occasion, at 14½ per cent. in May 1976, at 14½ per cent. in July 1976, and at 15¾ per cent. on 11th October 1976. Over the same period it changed the rates of interest that it was charging to 15½ per cent. on 7th May, 16½ per cent. on 13th September, and 18 per cent. on 8th October. That means that on 11th October it raised money in the market place at 15¾ per cent., when only two days earlier it had increased its basic lending rate from 16½ per cent. to 18 per cent. That is a differential of some 2¼ per cent. and, even for a Corporation designed to break even year on year, that seems a quite substantial variation and, as my hon. Friend the Member for Reading, South said, at the highest rate, the interest rates represent a very considerable burden for a young doctor.
In that connection, I was interested to see in Table 6 of appendix B in the annual report that, although the Corporation made a loan of £10,667 at a rate of 18 per cent., in fact no loans had been made. I cannot see how the number of loans can be nil and the sum of £10.667 is being loaned out. That appears to be a minor discrepancy which I hope the Minister will be able to clear up for us.
The other area of interest is the scope of what is available for grant under the scheme. Again, I was interested in the tables in the appendix, which are very full and informative, to see the subheading E "conversion, repairs and improvements", and I wondered what was covered by "improvements". I should have thought that one of the matters on which the hon. Member for East Kilbride and I could agree was that in all modern 861 practices there was a great need for permanent fixtures to ease and help administrationߞfiling equipment of one kind or anotherߞand I wondered whether this kind of improvement qualified for assistance by ways of loans under the provisions of the Corporation. It is most infuriating to patients to have to wait while records are found and collected and to wait in waiting rooms while searches are made and checks are being run on their previous clinical histories. If it were possible to make loans for improvements of this kind, it would be extremely helpful.
The report is less informative about the average life of a loan. We see that there is a total of some £13.4 million in loans outstanding and that repayments are £650,000 in the year in question. One can calculate from that that it is about a 20-year life for a loan. But I shall be interested to know what variation there is in the life of loans that are granted, whether they are all fixed and for the same term or are sufficiently flexible in their terms to enable doctors at various stages of their careers to a take on loans of this kind. A doctor may be 55 years of age and in the last 10 or 15 years of his career. Are the terms of loans sufficiently flexible to allow him to take advantage of the facilities of this scheme?
I underline what was said my my hon. Friend the Member for Reading, South about the variations between different regions, especially between the different countries. My hon. Friend talked about variations in grants. The additional point that I make is to draw attention to the difference between inquiries and applications. In England, about four-fifths of inquiries eventually became applications. In Scotland, less than one-fifth do. I know that the numbers are very different, but about 200 of 250 inquiries become applications in England, but only seven out of 36 do in Scotland. There is a considerable regional discrepency on which we should appreciate the Minister's comments.
It would be helpful in future to produce some statistical averages showing the population in each area in order to get some idea of the number of loans made per doctor population and per patient population. In this way we could see whether there were any discrepancies in the treatment afforded to the different regions of the country.
862 I underline the point made by my hon. Friend the Member for Reading, South. While the scheme is worth while and is helping to develop general practitioner care, which we all agree is very important, it is only a fleabite, and there is room for a great many more imaginative approaches to broaden and bring up to date the ways in which the loans are made. I look forward to hearing the Minister's response to the points that we have made.
§ 10.32 p.m.
§ Mr. Ronald Brown (Hackney, South and Shoreditch)
I want to follow what the hon. Member for Walsall, North (Mr. Hodgson) said, but I do not wish to go too far into the statistical issue. I am more concerned with the human side.
I intervene because the Minister came to my constituency 18 months ago, and tramped around with me in most inclement weather to count the number of general practices in my area and to take the opportunity of looking at them. My right hon. Friend will remember the deplorable premises that he saw. Many of them were deplorableߞwe even saw one with barbed wire outside it. Those premises are still there—and it is 18 months since he looked at them.
I intervene to ask him whether there is any possible chanceߞor dangerߞthat any of this extra £7 million might come to the doctors in my area because they practise in such terrible premises. Will he find out before the end of the debate how much of the previous £18 million came into my area? Then he might ask himself how the doctors spent it on those deplorable premises.
My right hon. Friend came, he saw, he was impressed, and then he went away again. Will anything be done? We are fighting, and rowing and arguing and nothing is happening. If my right hon. Friend thinks that I will sit here and accept this Statutory Instrument unless I get some assurances, he is wrong. I shall call a Division. Eighteen months is long enough to wait. In that lime there has been no action from his Department to put matters right.
I know that things are just as bad as they were 18 months ago. Recently I took a television team around my area. 863 It is exactly as it was before, and we recorded it as such. I find the attitude of the Department extraordinary. There are enough civil servants to have brought forward a plan for some crash action by now to put right the appalling circumstances existing in my area. It is no good going to the Family Practitioner Committee, because that is a complete waste of time.
The Minister should have been able to satisfy himself about the so-called emergency service that runs in my area. The emergency service in my area is the doctor. When the hon. Member for Walsall, North talks about the one-on-one relationship, he should realise that in my area it is on the end of a telephone—802–2066, and anybody comes. I have never heard such rubbish in my life as when he talks about the one-on-one relationship. In my area we do not get it.
§ Mr. Hodgson
That is the ideal. That is what we are aiming forߞnot what we are actually at. The fact that we are not at that situation is one of the reasons that we are dissatisfied with the organisation of the National Health Service at present.
§ Mr. Brown
The hon. Gentleman is wrong. In some areas there is a one-on-one relationship. In Bromley there is a delightful one-on-one relationship, and that is also the case in Blackheath where my right hon. Friend the Minister lives, and in Dulwich. But in Hackney, South and Shoreditch, which my right hon. Friend has visited, it is more comfortable in the local betting shop than it is in the doctor's surgery. There should be telecommunication between the betting shop and the surgery. The betting shop is warmer, nicer and also has music.
My right hon. Friend saw what was happening and I should like him tonight to tell me what he has done about the situation. What proposals is he putting forward to put the matter right? I have had a long-standing row with the area health authority, the Family Practitioner Committee and the whole caboosh. My right hon. Friend also knows that I am rather displeased with the chairman of the regional health authority whom he has just reappointed. To have given that 864 gentleman a knighthood in addition seems to be about as far as one can go to be rude and offensive to a parliamentary colleague.
I shall not vote for this order tonight unless I have from the Minister a categorical undertaking that he will come down to my area and examine these general practitioner conditions and see that some urgent action is taken. I do not want him to institute a long, two-year inquiry. Two days will be enough, and I want to see some action.
Another problem is that my area health authority has a closure syndrome. It takes the view that the National Health Service could be a wonderful service, but the only problem is the patientߞand the authority is trying to get rid of them. If only that were done, one could build a beautiful Health Service. My right hon. Friend has already assisted the authority by closing two hospitals. He has closed one permanently and claims to have saved £1 million. I have not yet seen the rewards that have flowed from that saving. Perhaps I shall soon be asking him to justify where that £1 million went when he closed that hospital against my objection.
My right hon. Friend then changed the use of another hospital, and even that is a disaster. Hackney Hopsital is a disgrace. He knows what an appalling state it is in. What is his Department doing about the matter? He has more civil servants to the square foot than I care to count. Are any of them doing anything apart from looking after their pension rights? It is about time my right hon. Friend understood that areas such as mine should be closely examined and dealt with seriously.
We are dealing with a modest order which, until I heard my right hon. Friend's remarks, I supported. I am sure that this order is an excellent way of going about the matter, but my right hon. Friend must not pretend that there is no problem in my area. I hope he will assure me that he is facing up to the problem in Hackney, South and Shoreditch. He understands the problem, and I want to know what he intends to do about it.
§ 10.38 p.m.
§ Mr. Moyle
We have had an extremely wide-ranging debate on a very 865 limited order. Some of the points seem to have dealt with matters well outside the scope of the order, but I am sure, Mr. Deputy Speaker, in view of your wise supervision of the debate, that that was not the case and that it was merely an aberration on my part that I considered it to be so. I shall try to deal to the best of my ability with the points raised in the debate, although I have not had a great deal of notice of some of them.
I was surprised to hear the hon. Member for Reading South (Dr. Vaughan) attack health centres. Certainly the Government have no intention of reducing the health centre programme. Indeed, we desire to expand the programme as fast as we can persuade general practitioners of the wisdom of practising in them. I stress the word "persuade" because the hon. Gentleman said that health centres should not be forced on general practitioners and we have made no attempt to do so. In fact, we have no powers to do so. A general practitioner is an independent contractor. He is not an employee of the Health Service. He can be part of a group practice, he can practise in his own front room, or he can practise in the ganger's hut to which my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Brown) was referring.
The whole object of area health authorities, if they wish to get GPs into a health centre, must be to persuade them. One of the problems is that after a group of GPs have been persuaded to go into a centre one or two of the leaders of the group may die or retire and different attitudes may develop among the rest. On other occasions, there may be personality clashes so that when the centre is ready for occupation the GPs find it difficult to agree to move in and the centre can stay empty for some time. I mention this problem to convince the hon. Member for Reading, South that there is no compulsion in these matters.
I was surprised when the hon. Gentleman said that health centres should be confined to inner city areas. Some of the best health centres that I have seen were those in rural areas of Northern Ireland which I visited when I was the Minister of State at the Northern Ireland Office. As my hon. Friend the Member for East Kilbride (Dr. Miller) said in his 866 good defence of health centres, there is no reason to believe that they are a technique for solving the general practice problems of inner city areas only.
The hon. Member for Reading, South eventually turned his attention to the order, but it was difficult to follow some of his criticisms because he said that, given the fall in the value of money, the upper limit for borrowing that the Government were seeking would not put the situation back to where it was in 1971.
I do not understand that criticism because until 1971 the Corporation was entitled to borrow up to £18 million without coming to the House for further authorisation. It has substantially used up that power and now wants power to borrow more moneyߞup to £25 million. That is the Corporation's figure. There is no question of offsetting inflation. That is the figure required to allow the Corporation to carry on with its activities. The hon. Gentleman asked why we did not give the Corporation more power; but the power in the order is all the Corporation wants.
In addition, the hon. Gentleman should bear in mind that if we increased the limit the time within which the Corporation would need to come back to the House to account for its activities would be extended still further. There would be less accountability of the Corporation to the House.
I entirely agree with 'what my hon. Friend the Member for East Kilbride said, even when he mentioned one or two weaknesses in the health centre system. There are strengths and weaknesses in everything and, on balance, the Government see health centres as a sound proposition for the development of general practice within the community. They are purpose built and there is nothing to prevent a one-to-one relationship. In most of the centres that I know, the patients are those of a particular doctor. Of course, if there is an emergency the doctor's colleagues can give cover, but that happens in group practices and even in small partnerships.
§ Dr. Vaughan
Will the Minister be discussing the high rates of interest? He should not discuss the total sum without discussing the high rates of interest which will materially alter the amount that is required.
§ Mr. Moyle
I shall deal with that. I admit that the one area in which the Corporation is criticised occasionally by members of the profession relates to the high rates of interest. The hon. Gentleman made a plea that rates of interest should be lower. However, rates of interest are a function of the money market. The Corporation must have regard to that in its interest rate policy and the way in which it charges interest rates. The alternative to interest rates that follow the market are subsidies to hold down the interest rate. Subsidies would lead to increased public expenditure, which I know is the last thing that the hon. Gentleman would want to incur. He will readily see that there is no alternative but to follow the money market.
The Corporation attempts to offset interest rates by borrowing in small amounts when interest rates are low in an attempt to ensure that it can take advantage of a fall in interest rates when that occurs. The hon. Member for Walsall, North (Mr. Hodgson) quoted 18 per cent., but the current rate of interest charged on loans is now down to 13 per cent. as a result of the policy that I have been describing. I think that that answers a number of the questions asked by the hon. Member for Walsall, North.
Broadly speaking, loans are for 20 years at fixed rates of interest, or until such time as the junior member of the partnership reaches the age of 65 years, whichever is the earlier date.
It seems that the relationship of loans made to inquiries received is much more to do with the flow of business than in gaps in demand in any one country in the United Kingdom. Although in the year that the hon. Member for Walsall, North quoted there were 36 inquiries made in Scotland which resulted in only six loans, in the following year ending 31st March 1978 there were eight inquiries and eight loans. That does not signify anything much because in Wales in the same period there were nine inquiries and 10 loans. In England there were 195 inquiries and 212 loans. It seems that it is very much a matter of the flow of business. I shall consider the matter to ascertain whether there is a further explanation.
§ Mr. Hodgson
It is good of the right hon. Gentlemna to produce the figures, but if the debate had taken place at a later stage we would have had the figures ourselves. That underlines the inappropriateness of the debate taking place now. Is the right hon. Gentleman satisfied that the 20-year loan policy has the flexibility to meet the doctors' needs? Is there not an argument for having a more flexible approach?
§ Mr. Moyle
At present the 20-year loan approach must be sufficiently flexible to meet the desires of the profession. No doubt there are doctors who would make suggestions for alterations, but on the whole we do not get any substantial criticism of the operations of the Corporation from the profession other than the level of interest rates, which is a function of the money markets and the general economy.
As for the timing of the debate, the object is not to debate the annual report of the Finance Corporation but to meet the Corporation's desire to increase its borrowing limits. It is knocking hard against the limits that were laid down in the previous order. That is what controls the timing of the debate.
§ Mr. Hodgson
It is all very well for the right hon. Gentleman to say that this is not an inappropriate time for the debate because we are talking only about the extension of the Corporation's borrowing limit. However, this is a question of parliamentary control, which means that we review the Corporation's operations and the effectiveness of its work. We have no figures that are less than 15 months out of date. I do not consider that to be a satisfactory way of reviewing the efficiency of the Corporation before we decide whether to extend its borrowing requirement, as the hon. Member for Hackney, South and Shoreditch (Mr. Brown) has already said.
§ Dr. Vaughan
Does not the right hon. Gentleman accept that he should have 869 made available the figures that are in his possession? He knew that we would wish to discuss the function of the Corporation before authorising an increase of its borrowing limits.
§ Mr. Moyle
I have given the figures for the inquiries received and loans relating to each country in the United Kingdom. I have given that factual information and the amounts borrowed. Therefore, I have attempted to plug the gaps in the knowledge of the House for the purpose of the debate.
My hon. Friend the Member for Hackney, South and Shoreditch is understandably upset about the standard of general practitioner services in his constituency. Indeed, I had an opportunity of seeing for myself when I visited Hackney 18 months ago. There have been certain improvements in the general approach towards inner city areas. My hon. Friend will appreciate that the problem in his constituency is a problem in inner city areas generally. Often the conditions that he finds in his constituency are repeated in other parts of London and in inner city areas in Liverpool, Manchester and other great provincial cities.
Action hs been taken since my visit. The Department is taking a full part in the partnership areas, which have been set up by my right hon. Friend the Secretary of State for the Environment, in developing policies and services to attract back the population. But the problem is intractable and will not be solved quickly.
As a result of my visit to Hackney, I came to the conclusion that the general practitioner services in the area were inadequate and that the social services were under considerable strain. Therefore, one of the first actions was to increase the bed norm for acute beds in the area, because hospitals in that part of London will have to bear a greater strain than was forecast for the general run of the country.
In addition, Barts is using a health centre in Hackney for training its medical students in general practice. That has been a development since my visit. I am talking off the cuff, because I did not have notice that my hon. Friend intended to raise this matter. However, 870 I shall write to him with more precise details of this arrangement. Of course, it means that general practitioner services in Hackney have been strengthened.
There is a fairly vigorous debate within the medical profession and health administration generally on how the problem of general practitioner services in the inner city areas should be solved. One school of thought believes that these services should be directly strengthened. Another school of thought believes that it will be difficult to strengthen these services and that we should develop the services of the hospitals to fill the gaps which general practice seems incapable of fulfilling adequately. That matter has not been resolved. Fairly strong views are held on either side.
I agree that Hackney Hospital is not attractive, but I have every confidence that the nucleus hospital on the site of the Eastern Hospital will be developed and that building will start in the not too distant future.
Obviously, with inadequate general practitioner services in the Hackney area, not only are the deputising services used, but there seems to be a deliberate attempt to try to put as much of the general practitioner services on the deputising services as possible. Since my visit to the area we have engaged in intensive consultations with the medical profession, and a code of practice has now been agreed by the profession, by the Department and by Ministers for application to all general practitioners. I advise my hon. Friend to get hold of a copy of the code of practice and make sure that the general practitioners in his area observe it. If they do not, the matter can be drawn to the attention of the family practitioner committee which is now under a compulsion from its professional association to take disciplinary action against a general practitioner who fails to observe the arrangements for using deputising services as laid down in the code.
Although I agree with my hon. Friend the Member for Hackney, South and Shoreditch that there is a great deal more to be done before a proper general practitioner service can be said to exist in his part of London, there is no doubt that some action has been taken as a result of my visit. Progress has been made 871 towards the solution of the general practitioner problem in inner city areas in general and in his area in some respects. I hope he will on that basis appreciate that there is some good will.
§ Mr. Ronald Brown
I am grateful to my right hon. Friend for identifying these matters for me. Is he aware that he gave me an undertaking when it was agreed to close the hospital in my area that the concomitant of that would be the injection of funds into St. Leonard's Hospital for the improvement of certain departments such as the X-ray department and the outpatients department? Is he further aware that the area health authority is now arguing that since it believes that the hospital has a life of only five years it is not worth spending that money? While he says things in this House in all honesty and sincerity, there is a big difference between what he says and what happens "on site". Will he investigate this matter to ascertain where the communication breaks down? The authority is not planning to spend the money that my right hon. Friend assures me will be spent.
§ Mr. Deputy Speaker (Sir Myer Galpern)
Order. The hon. Member is going rather wide. He knows full well that this matter is entirely outwith the scope of what we are discussing. I have been generous in allowing the Minister to deal with it, but the subject that the hon. Member is raising is more suitable for an Adjournment debate than for question and answer with the Minister during a discussion about an increased loan.
§ Mr. Ronald Brown
On a point of order, Mr. Deputy Speaker. May I enlighten you? This matter is pertinent to the debate. If the general practitioners had proper facilities and were able to use money in this order they could provide adequate accommodation in my constituency. The hospitals would not then have to be used as they are being used. I am urging the Minister to see whether general practitioners can use the money to avoid the problems with the hospitals.
§ Mr. Deputy Speaker
I heard the hon. Member discussing the question of the hospitals and so in in the area. Has the Minister finished?
§ Mr. Moyle
I was about to conclude on the question of St. Leonard's Hospital. In view of your ruling, Mr Deputy Speaker, I had better tell my hon. Friend that I shall look into the matter and leave it at that.
My hon. Friend asked about resources for general practitioners in his area. One can lead a horse to water, but one cannot make him drink. I suspect that a number of the general practitioners we have been discussing this evening and whose premises we inspected 18 months ago do not want to drink. That is the basic problem against the background that they are independent contractors.
§ Question put and agreed to.
That the draft General Practice Finance Corporation (Increase of Borrowing Powers) Order 1978, which was laid before this House on 6th June, be approved.