HC Deb 20 February 1989 vol 147 cc702-3
10. Mr. Livsey

To ask the Secretary of State for Wales if he will make a statement on the National Health Service review as it affects Wales

11. Mr. Raffan

To ask the Secretary of State for Wales if he will make a statement on the Government's National Health Service review, "Working for Patients", as it caters for the distinctive health care needs and circumstances in Wales.

Mr. Peter Walker

The conclusions of my review of the National Health Service in Wales are included in the White Paper "Working for Patients", Cm. 555. I am confident that by increasing the responsibility and accountability of those working in the service, by increasing patient choice, and by ensuring appropriate rewards for those who deliver results, my proposals will lead to even better patient care for the people of Wales.

Mr. Livsey

Does the Secretary of State agree that there is great concern in rural Wales that the opt-out proposals in the review are totally unsuitable to that area and that the general practitioner services mentioned in the review are not properly structured to deliver the sort of services that should be provided in mid-Wales?

Will the nurses' pay review in Wales be fully funded by the Government?

Mr. Walker

I can understand the hon. Gentleman expressing his concern about the opting-out of hospitals in rural Wales, having looked at some of the press comments on the proposals. When the hon. Gentleman sees the working papers he will discover that no hospital will be able to ask for trust status unless it agrees to carry out the whole range of services that must be undertaken in that area. Thereafter, it will be the responsibility of the Welsh Office to monitor those hospitals to ensure that they carry out all those services. I promise the hon. Gentleman that no trust hospitals will be created without those hospitals first agreeing to the totality of their obligations and without their being monitored thereafter to see that they fulfil those obligations.

I agree with the hon. Gentleman that GP practices throughout Wales differ from one locality to another and that the considerations for the rural areas are wholly different.

Announcements will be made about the nurses' pay award, but I assure the hon. Gentleman that public and Government expenditure will be considerably increased throughout the Principality as a result of that award.

Mr. Raffan

As the review referred to a much higher incidence of heart disease, strokes and most forms of cancer in Wales compared to the rest of the United Kingdom, will my right hon. Friend assure the House that the Health Promotion Authority for Wales will have a much higher profile than it has had and a budget to match? Will my right hon. Friend confirm that the authority's detailed proposals will be published before the summer, and will those proposals include advertising campaigns on tobacco and alcohol abuse, which account for more than 100,000 deaths a year in the United Kingdom?

Mr. Walker

I share my hon. Friend's concern and that is why in the Welsh section of the White Paper I strongly stressed the importance of health promotion and the preventive side of health in Wales, which have an enormous contribution to make. At the moment I am examining a large number of detailed proposals that have been put to me. We have a meeting within the next couple of weeks to discuss those proposals and I assure my hon. Friend that we will publish the details as quickly as possible.

Mr. Michael

In the light of the White Paper, what importance should the public in Wales now place on the 10-year plans being prepared by health authorities and considered by his Department? Will the right hon. Gentleman exempt Wales from the opting-out schemes, which could make those plans meaningless?

Mr. Walker

No. The hon. Gentleman must give more careful thought to the detail of what he describes as the "opting-out schemes". Those schemes do not represent opting out, as hospitals will remain within the National Health Service. By opting out one decides to delegate some of the managerial decisions to a lower level. If that can be done with improved efficiency with the whole range of services continuing to be carried out, there is no reason why the Secretary of State for Wales should not give approval to such a scheme. Thereafter, however, the Secretary of State and the Welsh Office will have the duty to monitor such a scheme. Such schemes should be judged on their merits and improved efficiency and they should mean that, in total, the hospitals still carry out all the functions required in the district.