Sitting of 3 November 1995

Preamble
The House met at half-past Nine o'clock
PRAYERS
[MADAM SPEAKER in the Chair]
PRAYERS

  National Health Service (Fundholding)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Conway.]
  9.34 am
  The Minister for Health (Mr. Gerald Malone): I am pleased to have this opportunity to debate such an important topic. The House will find it interesting to have an opportunity to explore how far statements made by former Opposition spokesmen on fundholding now reflect the views of the current team or, indeed, the views of the people they represent. General practitioner fundholding is one of those issues that appear to divide Opposition Members. It certainly has in the past and it will be interesting to discover whether it will today. Perhaps we shall be given a clearer view of their proposals for the future of primary care and, perhaps, some final acknowledgement of the important role that fundholders have already played in reshaping local health services to benefit patients. I will return to that subject later.
  First, I want to make clear what the Government are doing in the primary care sector and fundholding in particular. It is widely recognised that the NHS is in a constant state of change and development. That is not surprising and there are a number of reasons for that. Medical technology, public expectations and other pressures all require the NHS constantly to change and adapt. The same is true of all other health care systems. We need only to look around the world to realise that many countries are not coping with the pressures, whereas in this country the NHS, as it is shaped by Government policies, is coping. The conclusions that I draw from those international trends is that the United Kingdom is out in front, while other countries are following our lead.
  The Government's overriding aim in that process of change is to ensure that the quality of NHS care we have tomorrow is better than we have today. I want to set out the four key aims for the NHS. First, we want to make services high quality and effective, focusing on the care of individuals as well as improving the health of the population, as set out in "The Health of the Nation". I hope that the House will recognise, as I am sure the public recognise, that "The Health of the Nation" strategy is an extremely important development, leading the NHS away from simply coping with problems to positively developing the health of the nation and moving more towards prevention than we have ever previously been able to do.
  Secondly, we aim to give patients the right services in the right way. It is not just about improving the quality and range of clinical services and developing the patients charter, but about ensuring that services are accessible to
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  people. The NHS must be at the heart of every local community. Patients must be confident that the organisation of services reflects what they want and need, rather than what others think they should have.
  At the core of the reforms is the point about putting patients' care first. The changes that have occurred and the move from the acute to the primary sector ensure that treatment is taking place in an appropriate setting, as near to the patient as possible. Under the old NHS patients were pushed around the system; under the NHS as we envisage it today, patients will find services much closer to where they live.
  Thirdly, we want services to fit together in a seamless way, with no gaps or overlaps and with strong links between all parts of the NHS. Many people with varying degrees of expertise work within the service. Now, the consultant cannot work in splendid isolation from the community midwife; nor can the GP from the social worker. Only through partnership among professionals can we the secure highest quality of care for patients. What underpins that aim is the principle that when the patient is being treated, he should not notice when he is moving from one element of care to another. Care for the patient should be seamless.
  Lastly—and I make no bones about this point—we must give patients as much as we can from the money available. I am always astonished by the Labour party constantly saying in debates that getting value for money and putting the mechanisms in place to achieve that are almost unimportant. The taxpayer is now putting record levels of money into the health service, yet the Opposition think that unimportant.
  The truth of the matter is that that money is not only for the men in grey suits—the accountants and financial directors or, indeed, the Treasury—but embraces those in white coats who are now far more involved in managing the NHS than ever before. Benefits can also be obtained through improvements in clinical effectiveness and audit. That is part of the process that has been under way since 1990 to ensure that the NHS is accountable in detail to Parliament and the public. In essence, it means ensuring that decisions are made at the right level by those in the right place who have the right information.
  I wonder whether Opposition Members would disagree with any of that. I would be surprised if they could. They say that they share our objectives, but, when the mechanisms are put in place and we debate them, they say that the mechanisms are wrong. If they sign up to those objectives, it is all the more amazing that they can continue their opposition to fundholding. I cannot think of a better example than fundholding that meets all the four aims necessary to improve the NHS.
  I now cite examples of the ways in which fundholders deliver the key principles. First, they make services responsive to the needs of patients and they make them more accessible. There are examples of that happening all over the country, as I see when I visit GP practices, fundholding and non-fundholding. For example, in Buckinghamshire, the patients of Dr. Maisey and his partners no longer have to attend the local district general hospital for radiology or out-patient services.
  Patients at a practice in Ealing now have access to a range of complementary medicine at the practice, which is increasingly what patients want. Under fundholding, if patients think it desirable and doctors think it a clinically

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  appropriate way to deliver treatment, that is what happens. Before fundholding was introduced, those patients had to go into hospital for orthopaedic, rheumatic or physiotherapy treatment. Patients agree that life is much better when fundholders can use their discretion and ensure that care is delivered closer to the patients.
  One of the arguments constantly used by the Opposition is that in fundholding we have created a two-tier health service. Yes, we do have a two-tier NHS—the NHS that we had in 1989 and the NHS that we have now in 1995. Let me give the House an illustration of the difference. Under the old NHS, the number of people waiting more than 12 months was 223,311. This year, the figure is 32,194. The average waiting time under the old NHS for in-patient or day case admission was 9.3 months, whereas the average time now is four months. Under the old NHS, there were 38,900 hospital doctors; there are now 44,600. There were 3,051 medical school places available; there are now 3,315.
  The Opposition say that we have cut the national health service and that we, as a Government, have not been decent custodians of it, but the opposite is true. The service has become far more effective and is now a top-tier NHS. That is what the Opposition would dismantle.
  Mr. David Hinchliffe: I am interested in the Minister's comments about the two-tier system which he denies that fundholding has created. I should like an answer to the questions that I have been asking him and the Secretary of State for some time. If there is not a two-tier system, why are my constituents, who are waiting for treatment at Pinderfields hospital in Wakefield, being asked whether they belong to a fundholding practice or not? Why is it that patients from fundholding practices needing certain specialist treatment can get it while patients from non-fundholding practices cannot?
  Mr. Malone: I am glad that the hon. Gentleman has given me the opportunity to deal with that point. As he well knows, when we set out to introduce fundholding, there was agreement with consultants and the medical profession as a whole as to how we would view priorities. Every emergency is treated as a priority and the treatment is similar. Where fundholding bites is in the purchasing of marginal care in hospitals where there is spare capacity for fundholding patients. Of course, when people present to have certain needs addressed, the question to which the hon. Gentleman referred will be asked because it has to be determined whether there is a contract with the fundholder for that particular service.
  What amazes me about the Opposition's comments about there being a two-tier system is that they imply that everyone across the country was treated in the same way under the old NHS. I said that in 1989 there were 223,311 people waiting for treatment, but they did not all wait the same length of time. That time varied from region to region, and waiting lists still vary from region to region. It is absurd that the Opposition denigrate the fact that we have been making progress. They wish to denigrate the fact that using fundholding in a different way from a health authority to purchase margins of health care is providing better treatment for patients.
  The Labour party is, as it has always been, the party of levelling down. It does not ask why health authorities are not purchasing their health care in the same innovative
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  way as fundholders so that patients benefit. The purpose of fundholding is to create a leading edge by which others will inform themselves of best practice. It also creates targets to which others may aspire.
  Mr. Bernard Jenkin: Do not Labour's complaints about fundholding fail to make it clear that fundholding is advantageous to patients? Does my hon. Friend recall the time when there used to be a multi-tier health service across the country? The treatment that one received and how long one had to wait for it was a lottery, depending on where one lived. Does he remember that the two-tier system of 1979 meant that, if one could persuade the picket line to let one through, one was treated, but, if one could not cross the picket line, one went without treatment?
  Mr. Malone: My hon. Friend is absolutely right. It is important for patients and the country as a whole that we demolish the two-tier argument. The Opposition use it to suggest that it is unusual that waiting times vary across the country, but that has always been the case.
  Mr. Hinchliffe: At the same hospital?
  Mr. Malone: When there were 223,000 people waiting for treatment, there were of course different waiting lists at the same hospital, but then people had to buy care to move up the waiting list. Now, the NHS treats people within an average of four months rather than nine months. That is the system that we have developed.
  Mr. David Congdon: Does my hon. Friend agree that, as the evidence shows that GP fundholders get no more funding per patient on their list than equivalent non-fundholders, the reality is that fundholders use their purchasing power far better than the bureaucracies of the health authorities? Is not the challenge for health authorities to bring their use of purchasing power to the level of that of fundholders?
  Mr. Malone: My hon. Friend is right. If that were the question asked by the Opposition, I might have some sympathy with them. I was coming to the point raised by my hon. Friend. Fundholding is about making services more coherent and providing stronger links between the primary and secondary care sectors and within the primary care team. It is these fundamental changes that have delivered the margins with which fundholders are able to buy additional care for their patients.
  There is an example of that in Manchester which shows how fundholding can help a practice focus on how to be better organised, involving the whole primary health care team. Doctors there have greatly improved the practice for patients by reducing non-attendance and improving immunisation services. The practice will not stop there, and that is one of the characteristics of fundholding. The doctors and professionals concerned are keen to move the boundaries ever further forward and they are looking to develop a wide range of in-house services not previously available.
  But that is only part of the story. Fundholding is not just about improving services. Our strategy under the "Health of the Nation" White Paper is central to the aim that I set out earlier of improving the health of the population as well as delivering first-class health care. GPs are ideally placed to make a major contribution to that. Their dual role of needs assessment and direct patient care puts them at the leading edge to achieve genuine health gain.

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  For example, there are new and novel solutions to meet problems being faced by the community. In County Durham, Dr. Derek Brown has developed a scheme called "Positive Parenting" to help parents of children under five move safely through concerns that they may have over their children's health, be they speech difficulties or sleeping.
  In such ways, GPs are using the flexibilities of the fundholding scheme to seek improvements in the health of the population. Who better than fundholders can demonstrate how doctors, directly involved in managing resources, can secure not only better care for their patients but better value for money for that care?
  Mr. Stephen Timms rose—
  Mr. Malone: I will give way in a moment.
  The point about managing resources is absolutely crucial. On fundholding, the Labour party has been slippery. It has moved towards the principle and said that the principle is all right. Now I understand its policy to be—it may change yet again today—that, sure, it thinks that it is fine to be a fundholder, but it will not let the medical profession get their hands on the funds. That is the most patronising, absurd attitude towards the medical profession that I can think of. The use of the funds, and the responsibility that that brings, has transformed much of primary care in our country.
  Mr. Timms: In view of what the Minister is saying about fundholding, will he clarify whether it is the Government's intention that all general practitioners should become fundholders, and, if so, in what period does he envisage that taking place?
  Mr. Malone: If GPs wished to become fundholders, I would very much welcome it. But it will not be compulsory. The Government's policy has not changed. [Laughter.] The Labour party's health spokesman, the hon. Member for Fife, Central (Mr. McLeish), may laugh, but when we introduced fundholding, I remember Labour Members' tales of how it would never happen in practice because doctors would not like it. Yet now more than 50 per cent. of the population of England and Wales are served by fundholders. Not only do the doctors like it, the patients like it as well.
  I see the process rolling forward, not by compulsion, but in an entirely voluntary way. The Government are not forcing them. It is peer group pressure. When one doctor sees what is happening in a fundholder's surgery and the improvements that the fundholding practice is able to bring to bear on patient care, there is a "me too" principle—[Interruption.] There is a "me too" principle of being able to do better for the patients.
  Mr. Michael Stephen: Does my hon. Friend remember that, when we introduced fundholding, the Labour party predicted that doctors would be going bankrupt all over the country? Has that scare story been realised?.
  Mr. Malone: No, it has not, but it is useful for my hon. Friend to remind us of what the Labour party was saying about fundholding. We shall contrast with some interest what it was saying, and what we recollect of it, with what—perhaps—it will say about it today.
  I should like to look at some other examples. In Glossop, there is the development of a homeward bound unit for people with learning disabilities, which has
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  provided an ideal link between leaving a long-stay institution and moving into the local community. Not only does it provide a better, more integrated service, but that unit saves the NHS more than £500,000 a year in in-patient costs.
  I use that specific example of a saving which can now be spent on patient care to take head on the other argument against fundholding that the Labour party uses: that it absorbs far too much in management costs and that it is an inefficient use of funds. I find that a rather surprising argument. We are for ever seeing the rather lugubrious face of the shadow Chancellor of the Exchequer popping up on television saying that the problem with the Government is that they are not prepared to invest; that they look at short-termism and are not investing in services.
  Well, proper management in fundholding is such an investment. Let us get the amount of it in context. The amount that has been invested in fundholding management is 0.1 per cent. of the total NHS budget. That investment is well worth while. The House should consider what just one fundholder can achieve. If one fundholder saves £500,000 for the NHS, which can be deployed in further patient care, just think of what is happening across the country.
  Doctors who are directly involved in managing those resources at the grass roots are getting better value. Overall, sfundholders have achieved efficiency savings of more than 3.5 per cent. a year in return for increased management expenses. Not only have they achieved it once, but have done so every year since the scheme began to operate.
  Ms Margaret Hodge rose—
  Mr. Malone: I shall give way in a moment.
  The savings have been achieved by releasing the innovation and ideas in primary care on better ways in which to deliver services.
  Ms Hodge: Two questions arise. We are not talking about additional administrative costs as a proportion of the total NHS budget, but as a proportion of what was previously spent on GPs. By how much has that increased? Will the Minister reply to the point raised by the hon. Member for Croydon, North-East (Mr. Congdon)? Do not GP fundholders receive additional moneys ostensibly to cover those administrative costs? Are they not better off than GPs who are not fundholders?
  Mr. Malone: The hon. Lady persists in refusing to recognise the point which I happily concede: of course fundholders get extra money for administration. I point to the fact that not only is that a good use of public money—an investment, as the shadow Chancellor of the Exchequer would no doubt tell us if he were making this speech. Such investment has produced greater efficiency in health care and has delivered a net benefit of about 2 per cent. Those funds can then be devoted to patient care and would otherwise have been lost.
  So I make no apology for saying that good management in fundholding is right. Investment must be at the proper level. As long as it continues to drive more efficiency and better patient care, it is a proper deployment of public funds.
  The illustration that I have given the House of how freedoms have worked is just a portion of what has been happening across the country. GPs are now able to

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  manage NHS resources to improve the care for their patients—the freedoms and services that the Labour party wants to end; taking away from patients the improvements that they have seen and enjoyed. Only the Labour party would wish to make services worse for patients. Indeed, what it probably means is that it would be satisfied if the worst in the land was the criterion on which every service should be administered.
  That is the implication of the Labour party's argument about two-tierism. If it thinks that those who are doing better are doing unfairly by their patients, the clear corollary must be that, to introduce fairness into the system, everybody must proceed at the pace of the worst. That is not an agenda that this House or the public would accept, and it is certainly not an agenda that the 50 per cent. of the population think is realistic for the way forward.
  I should like to move to the important role of new health authorities in supporting primary care. It is a key feature—
  Mr. Henry McLeish rose—
  Mr. Malone: I will give way in—
  Mr. McLeish: It is on the previous point.
  Mr. Malone: In that case, I shall give way.
  Mr. McLeish: The Minister has talked ostensibly about the 50 per cent. of GPs and the population covered by fundholding. I expect that a fair chunk of his speech will be given over to the other innovations and activities of non-GP fundholding practices throughout the country.
  Mr. Malone: I will certainly be dealing with joint commissioning in due course. May I say that I am delighted to see that the number of GP fundholders in the hon. Gentleman's constituency is rising. That is indeed good news for the people in Fife. There seems to be a remarkable connection, because when the right hon. Member for Derby, South (Mrs. Beckett) was Opposition spokesperson on health, fundholding in her constituency rose to 87 per cent. It is not yet quite at that level in the hon. Gentleman's constituency—it is about 30 per cent.—but we all hope for progress. Similarly, we look for great strides to be made in Peckham in increasing fundholding.
  The role of health authorities will be extremely important as we bring together district health authorities and family health service authorities to make a coherent whole. We must continue to develop our service with the new health authorities so that they have the confidence to deliver the services patients need. Fundholders do not lack confidence. We have seen their confidence to try out new ideas, to extend influence and to seize opportunities. That work must be supported by the new health authorities, which will be able to look at the needs of the population locally and more directly.
  Not everybody is at the leading edge or sees the world in that way. With the new health authorities in place, we need to translate the enthusiasm of some into the willing commitment of all; that will be the most important task of the new authorities. For the first time in England, we shall have single authorities looking strategically at the whole range of primary, secondary and community services in their areas. They will be able to assist in the
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  process of meeting the four aims: making services high quality and effective; giving patients the right services in the right way; ensuring services fit together; and getting as much as we can from the money available.
  We have now set an agenda related to primary care for the authorities to follow; those on the ground now need to see, feel and believe in the benefits. I expect the new health authorities to work with all GPs and primary health care teams and to involve them in the process of delivering a primary care-led service. GP fundholders are at the forefront of the changes and health authorities must tap into their enthusiasm, their innovative ideas and their ability to get improvements in the care provided to all patients.
  I am slightly surprised that the hon. Member for Fife, Central and the rest of the Labour party seem to think that joint commissioning is a great innovation; it became possible only under our health service reforms. It has happened to some extent on a voluntary basis, in different ways, and I welcome that. But joint commissioning is not a policy that has been rolled out in a comprehensive way, as fundholding has been. It is not a policy under which one can measure the benefits across the country as one can do with fundholding. Of course, I welcome the fact that the new health authorities will have a duty to consult all GPs about the commissioning of services.
  The joint commissioning policy misses the fact that, under fundholding, it is the individual doctor who decides what is best for patient care. Commissioning is, perhaps, a bit of a revamp of the old system under which committees decided these things. Representatives of doctors were involved and the Labour party would probably like councillors to be involved as well. That is the way in which Labour wants to take the policy forward. They will not concede the important principle that what has driven forward the reforms and has made everyone try to catch up with the fundholders is the idea that the funds follow the patient and are secure in the hands of the GP fundholder.
  I recognise that not all GPs will be fundholders; not everyone wishes to be one. However, a clear majority now do and they must be supported. Fundholding should be developed comprehensively so that we can take it forward even beyond the existing successes.
  I find it extraordinary that the Opposition are pushing the supposed merits of GP commissioning over fundholding. We have always had some locality purchasing in GP commissioning, but the fundholding model devolves purchasing power from health authorities to GPs to provide greater sensitivity to patients at a grass-roots, practice-by-practice level and ensures that decisions best reflect the needs of individual patients and the local community.
  The information that we get from those who participate in joint commissioning exercises is welcome and many of them have innovative ideas. However, joint commissioning is not evenly spread across the country. Giving power to the individual doctor is at the core of our policy and it clearly works. I believe that the Opposition finally recognise that fact.
  Only a few weeks ago, the right hon. Member for Derby, South finally acknowledged the beneficial developments made by fundholders. She said at a conference:
  "We want genuinely to pay tribute to the role that you as fundholders have played in kick starting and developing innovative practice in both primary care and the acute sector. None of it has gone unnoticed and all of it is valued and is worthwhile."

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  Although those words may have been used to placate the fundholding conference she was addressing, the second half of the policy was missing: "We value you, but we are going to take your power of choice away by depriving you of your budgets." If the right hon. Lady had been entirely honest, she would have given that message. She went further and said that Labour proposed to keep the flexibilities introduced by this Government. Is this a signal of yet another change in Labour's position? We shall wait and see what the hon. Member for Fife, Central has to say.
  We were told at first that Labour would end the fundholding scheme within the first 100 days of a Labour Administration. Then we were told—the hon. Member for Newcastle upon Tyne, East (Mr. Brown) developed this policy in a sub-fugue:
  "It is our intention to phase out fundholding over a period which may be as long as three years."
  As fundholding rolled out and became more popular, the Labour party began, inevitably, to roll back from the argument and we heard that it was "individual practice fundholding" which would be phased out. I am not sure what that means, but I suppose that it sounds more comfortable than closing fundholding practices.
  What further changes can we now expect? The truth is that the Labour party has now waved the white flag in terms of the rest of the improvements that the Government have brought to the health service. I suggest to the hon. Member for Fife, Central that Labour should complete the surrender and use this opportunity to make a fresh start, to move forward and to accept fundholding as it is. Such a step would be welcomed by doctors and patients.
  The only changes that I am interested in making now involve looking at how we can spread the benefits further. Fundholding is and remains the Government's preferred option for involving GPs in purchasing. It is obvious that most GPs agree, as more than half are expected to have chosen that option by next April.
  I turn now to the new opportunities for fundholding. The community option, which has been a great success for those who have taken it up, will take root soon. The community option gives GPs control of their immediate practice environment: the budget for their staff; community nursing services; the prescribing budget and direct access to diagnostic tests for their patients. All our expectations have been surpassed. More practices have chosen to enter community fundholding than entered the first wave of the scheme in 1991. There will be about 1,000 GPs in the community scheme alone.
  Standard fundholding is not standing still either. It has been changed and developed, and it has been made simpler and more coherent. From next April, it will cover virtually all elective surgery and out-patient services. The changes to the scope of the scheme should resolve many of the bureaucratic problems reported by trusts which were caused by their not knowing which services were in the scheme and which were not.
  The argument against the point that there is too much bureaucracy is simply this. We are happy to cut bureaucracy where we can do so. The White Paper "Putting Patients First" and the work that followed showed that we could relieve the burden of bureaucracy on GPs enormously. I am always happy to entertain suggestions about how we can do that. Under standard fundholding, everything will be included except emergency and urgent work, and the very rare and most expensive treatments.
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  In all, more than 3,000 GPs in more than 1,200 practices have applied to be fundholders from next April. That will mean that about 14,000 GPs, more than half of all the GPs in England, will have chosen to be fundholders. Between them, they serve more than half the population. I am confident that a similar story is emerging in Scotland, in Wales and in Northern Ireland. These are major developments, yet the Labour party would seek to put them in reverse.
  I shall now say a word or two about total purchasing. From next April, GPs working at the 51 pilot total purchasing sites will have started purchasing all services for their patients. I have been especially impressed when I have visited the total purchasing pilots and seen all the work that is being done.
  In Bromsgrove, GPs have employed nurses to visit patients admitted as emergencies. That has helped both the GPs and the health authority to understand better why some patients remain in hospital longer than others. It has also helped to ensure that patients are discharged appropriately into the community, and that the primary and community services are ready and available to receive those patients.
  Other innovative work has been done there in bringing community midwifery forward. By ensuring that private nursing homes can be used to deliver respite care for their patients, GPs have helped to resolve many of the problems that the hospital had with beds being inappropriately used. Likewise, GPs in Runcorn have contracted for the secondment of midwives from provider units to their practice, to set up team midwifery and thus bring services far closer to patients.
  All those projects are demonstrating how GPs involved in the direct total purchasing of care for their patients can help to introduce a radical culture change within a health authority. Under the old system, although there were committees that presided over all such matters, they probably gave more lip service than real attention to the needs of patients.
  It was said that GPs were involved in purchasing under the old procedures, but if that was so, why is a system such as total purchasing, in which GPs have control, suddenly producing demonstrably better innovative services that under the old schemes were never thought possible?
  That is a culture change of the most extraordinary and innovative sort. We seek to spread such culture across all health authorities, and when the new health authorities are up and running on 1 April next year we expect the new chairmen and chief executives to rank it among their top priorities.
  The development of a primary care led NHS throughout the country means improving the links between primary and secondary care, and increasing the influence that GPs and their teams exercise over those services. It means giving GPs real power to influence the way in which services can best be shaped to benefit patients. It is about trusting GPs to listen to and reflect the wishes of the patients whom they see daily, rather than paying lip service to their good work and then depriving them of the means of carrying it out, as the Labour party wants to do.
  That means real power, with real responsibilities and real money, not notional power, notional budgets and notional accountability. Only the Labour party would wish to

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  reintroduce the endless committees, the centralised bureaucracy and the abrogation of decision making that was rife in the health service that we inherited in 1979.
  What are Labour's plans for GPs and the primary health care led service that we want? What is its policy for primary care? What are Labour spokesmen saying when they tell GPs that they want to end fundholding? The truth is that they have no policies for primary care and no plans to use GPs' skills and abilities. Their message is a simple one: "Let's turn the clock back. GPs, go straight back into the box that you used to occupy. Stop fighting for what is best for your patients." In effect, Labour says, "Trust us, we know what's best; the old committees know what's best. We recognise that you GPs happen to have been developing services in a way that nobody could have anticipated—but too bad, we want you to stop, and we want to go back to the bad old ways."
  I suspect that one reason why the Labour party is so determined to scrap fundholding is that it could not think of a way to rename it, as it has renamed the rest of the NHS. It will be interesting for my hon. Friends to hear how Labour has redefined the health service and its language, because the definitions are strange and marginal.
  With some of the jargon words, Labour has made some really fundamental progress. What is now commonly known among professionals as the internal market, or the purchaser-provider split, Labour has heroically decided to rename; it is now called the "planner-provider split". What a difference that will make. Trusts will be changed fundamentally from their roots up; they will be called "local hospital services"—although I understand that trusts will not change their signs or letterheads.
  Instead of the vile marketplace, which uses such disgustingly hard-edged words as "contracts", there would be "health care agreements". Labour strategists' problem is that they cannot find another word for fundholding, so it rather looks as though they are obliged to scrap it.
  The difference between our parties is clear. GP fundholding and the move towards a primary health care led NHS have brought improvements in the provision of care, made services more accessible and provided a means by which GPs and their primary health care teams can have real power and responsibility, and can change the pattern of local health services to meet the individual needs of their patients.
  I take the opportunity now to thank all those who have been involved in the pioneering of fundholder practices, including the health care professionals that GPs have brought into their practices, for the work that my colleagues and I—and, if they were honest and admitted it, Labour Members—see when we visit fundholders all over the country. The success of fundholding has exceeded the Government's expectations, and the people involved should be thanked for that.
  Our policy is about levelling up; Labour's policy is about levelling down. Our policy is about giving doctors control over funds for patient care; Labour's is to patronise them and take that real power away. We have built an NHS that will meet the challenges of the 21st century, and today we have an excellent opportunity to debate the policies of the Labour party, which seems determined to destroy it.
  10.15 am
  Mr. Henry McLeish: I am pleased that the Government have selected fundholding to debate today.
  Mr. Keith Mans: Delighted.
  Mr. McLeish: We shall wait and see the delight develop in the next few minutes.
  It is important to accept the fact that a primary care-led health service is what Labour wants and supports. There is no distinction between us and the Government there. GPs' role in that process is, of course, vital, but it is also important that we register our support for and applaud the work of every person who works in the NHS. Far too often in the House we have a knockabout over issues, principles or structures, but we in Britain are fortunate in having some of the most dedicated and skilled personnel working in all aspects of the health service. [HoN. MEMBERS: "Hear, hear."] That, at least, is a point that unites the House at this early stage in my speech.
  It is important to talk about the political context of the Government's approach to health care. I do not want to destroy the morale of Conservative Members, but I hope that most of them have read The Daily Telegraph this morning. Probably because the Government do not listen, do not evaluate and do not care much what ordinary people think, the Conservatives are now 40 points behind in The Daily Telegraph poll.
  I am quite happy for the Conservatives to plummet to historical new depths of unpopularity, but there must be a link between the unpopular policies for which the Government are famed, and electoral support. It is instructive that Tory party strategists in Smith square want to bury the issue of health. It is a weak issue for the Government. [HoN. MEMBERS: "Why are we here, then?"] That is what I want to find out. It is important to know, because it may represent a change of tactic by the Government. They are 40 points behind in the opinion polls, but now they think that health may be a winner. Is that right?
  Mr. Malone: I am delighted that the hon. Gentleman has given way to me. The sort of news that we do not want to hear about the health service is the false news peddled by the Labour party. That is what John Maples, my successor as deputy chairman of the Conservative party, was talking about. Conservatives want to hear the truth about the new NHS that is delivering proper health care. On that issue we can be strong.
  I had hoped that the arrival of a new health team on the Labour Front Bench would stop the peddling of untruths about the health service. However, the first instance arose at Question Time earlier this week, when the hon. Member for Peckham (Ms Harman), in order to make a clear political point, made the accusation that people in Winchester—my constituency—were having to wait more than 18 months for admission to hospital for orthopaedic surgery. After Question Time, I checked and found that that was simply untrue. I have written to the hon. Lady to ask her to withdraw her allegations, but I have yet to receive a reply. We do not want to hear untruths about the health service. We want to hear about what is happening.
  Mr. McLeish: I am delighted that the Government are to engage in discussions on the NHS in the run-up to the general election. If they do so, I am convinced that the Opposition's 40-point lead will be increased.

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  The Government do not like certain concepts being discussed in their presence—for example, the two-tier health service that they have dismissed in relation to fundholding. In The Independent on 19 October, the new Secretary of State for Health said:
  "fundholding certainly empowers the GPs in a way that makes it easier for them to improve services available to their patients."
  If that is not a comment about a two-tier health service, what is? [Interruption.] The Minister may mumble, but even the Secretary of State has acknowledged that GP fundholders who receive preferential contributions will inevitably and instinctively use them for the benefit of patients. That is not the issue, however. The issue is whether this country should have a two-tier health service.
  Mr. Malone: The clear implication of the hon. Gentleman's argument on two-tierism is that all GPs should become fundholders and share the same benefits. That would get rid of the problem by levelling up, and not levelling down as the hon. Gentleman wants.
  Mr. McLeish: I am happy to engage in discussions on levelling up, and the Opposition will give more detail on that in our commissioning proposals. But the Government cannot wriggle off the hook. The Secretary of State for Health acknowledges that the current system empowers GP fundholders to get a better service than non-fundholders.
  It was instructive that the Minister did not spend more time in his speech on other activities in primary care, despite the fact that I asked him to do so. He did make a grudging and passing reference to those involved in commissioning, but we should not have a particularised view on what is good for primary health care. It is evident that the Government are obsessed with GP fundholding virtually to the exclusion of anything else that is happening in primary health care, especially in the multiplicity of commissioning options.
  Mr. Mans: Does the hon. Gentleman agree that the present system also empowers health authorities—as well as GP fundholders—to get a better deal for their patients?
  Mr. McLeish: That is a fair point, and I shall discuss that issue in detail shortly.
  Mr. Jenkin: May I remind the hon. Gentleman that he welcomed the opportunity of having this debate, the proposed subject for which is
  "Fundholding in a primary care-led National Health Service"?
  The hon. Gentleman can hardly blame my hon. Friend the Minister for discussing fundholding when it is the subject for debate.
  Is the hon. Gentleman proposing that the fundholders' advantages should be spread to all other fundholders, or that those advantages should be removed? Will he address that point?
  Mr. McLeish: Conservative Members are rightly anticipating what I shall be saying in a minute, but I give the hon. Gentleman an assurance that he can intervene again if I do not return to that point.
  A two-tier health service is a prominent part of the Government's agenda, as is private health care. In The Observer on Sunday 6 August, the Secretary of State for Health—who has been making soothing noises about the NHS—confirmed that he has private health care as a "safety net", and added:
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  "My commitment as Health Secretary is to ensure that the service provided by the NHS is sufficiently good".
  That is an admission that we may be on the verge of a safety net service under the NHS.
  Mr. Malone indicated dissent.
  Mr. McLeish: The Minister shakes his head, but we are used to that. The Government simply do not like the suggestion that their agenda is very different from the agenda of the British people, and, I believe, from the agenda of most GP fundholders, about whom the Minister waxed so eloquent today.
  The Government are obsessed with GP fundholding to the exclusion of all else. An interesting letter appeared in The Guardian on 12 July, with the Minister being the subject of the discourse. The letter suggested not only that the Minister was obsessed with fundholding, but that he was making sure that his managers clocked up enough GP fundholders in the system so that they could get their bonuses and satisfy the Government's political objectives.
  Mr. Malone: No.
  Mr. McLeish: The Minister disagrees from a sedentary position, and I am willing to leave the matter there.
  The Government will not come clean on their true intentions for the future of the NHS in the next century. Despite all the Government's concerns about primary health care, we have no doubt that, first, we have a two-tier health service and the Government are willing to continue to develop it; secondly, the Government are preoccupied with private health care as their first priority and the safety net NHS as their second priority; and thirdly, the Government will use every endeavour—above and below the table—to ensure that their political targets for fundholding are achieved.
  Mr. Malone: I wish to put the Government's commitments firmly on record again. We are committed to the NHS as a tax-funded service that is free at the point of delivery. We are also committed to developing that service in the best way possible, something that the hon. Gentleman does not seem keen to do.
  To suggest that there is some sort of private agenda is bizarre. The hon. Gentleman may like to ask some of the trade unions about private patient care, as they deliver private care as a benefit to some of their members. By talking about hidden agendas, the Labour party is getting into a bizarre world. I understand that the right hon. Member for Derby, South (Mrs. Beckett) recently became so excited about hidden agendas that she accused me of a having a hidden agenda of abolishing fundholding after the next election. However, I am glad that the right hon. Lady thought that I would be at this Dispatch Box after the next election.
  Mr. McLeish: I have no vision at all of the Minister being at that Dispatch Box after the next election. Whether that cheers him up is up to him.
  The Labour party is looking at primary health care and at the contributions made by GP fundholders and those involved in commissioning projects throughout the country. As politicians, we must build on the best. As politicians, we should want a service that provides for all patients and all doctors and in which exists the pluralism that the Government often talk about but never want to discuss in detail.

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  We must address the many issues that the Government will not tackle, two of which are the equity of access to primary health care and the equity of funding. Labour's approach is based upon and will be informed by a vigorous debate about equity of access and equity of funding. The Government's greatest weakness on that matter is to assume that because between 40 per cent. and 50 per cent. of fundholders are providing a preferential service, they can simply forget about the 60 per cent. who are involved in other types of health care.
  Mr. Mans: The hon. Gentleman has made an important point about equity of access. Does he agree that equity of access inevitably allows someone to have something only if everybody else has it at the same time? Does not that effectively mean that there will be a levelling down to the lowest common denominator, not a levelling up?
  Mr. McLeish: I do not want to narrow expectations or narrow horizons. Why do Conservative Members always refer to levelling down?
  Mr. Jenkin: Because of the Opposition's policies.
  Mr. McLeish: That is a matter of debate.
  The Opposition are talking about levelling up and building on the best that is currently available. To finish this part of my speech, I wish to raise a matter with the Minister. In Britain, we are seeing the Government putting in the building blocks for the privatisation of the NHS.
  Mr. Malone: No.
  Mr. McLeish: The Minister disagrees, but trusts and fundholding are the building blocks for future discussions on privatisation. That is in sharp contrast to the Opposition, who believe that we should be boosting a blueprint for the renewal of the NHS. I hope that those outside the House will understand that there is a fundamental divide between the Labour party and the Government on the future direction of the NHS. We say that the Government are not seeking to develop any part of the NHS for patient benefit. Instead, they have a long-term strategy to dismantle and disaggregate what has been built up over many years.
  The Minister talked about fundholding and my constituency. Earlier this year my wife died suddenly. My GP practice is fundholding. There is an excellent bunch of doctors doing an excellent job. My wife's GP suggested that because she could not get a scan, she should go to hospital in Edinburgh. He said that as he was part of a fundholding practice, that could be delivered. I had no problem with that and neither did my wife. She was at the front end of an extremely serious illness.
  My wife had a scan. When she went for it, she was completely healthy. Two weeks and five days later she died. I appreciated fully this year the benefits that GPs provide and the benefits that my GP practice was providing. But whether it was a fundholding practice or anything else, it was all too late for my wife. I appreciated the qualities and the benefits that the practice delivered. With great respect to the Minister, I do not need lectures from him. My passion and compassion are focused on trying to ensure that the very service that my wife received is received by all.
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  Why should the service that my wife enjoyed not be available to and on offer by every other GP practice in my constituency? My approach to the health and primary care service is that we should build on the best. My wife and I had the best. She had the best in hospital. In her case, however, it was not enough. It is often useful that during our knockabouts in this place there is informed comment that is based on personal experience. I hope that the Minister accepts the spirit in which that comment is made.
  Much has been said already about GP fundholding, but there are 95 groups and nearly 7,700 GPs serving 14 million patients by means of various forms of commissioning. We must take on board the problems, the issues and the innovations that come to light each day. The Labour party's approach is to build on the best of fundholding and commissioning. We are not saying to GPs in fundholding practices that important rights and important benefits for patients as well as important responsibilities for GPs should be discarded. Instead, we must focus on how best we can take things forward by combining the best of commissioning and of fundholding in a primary health care system.
  I am sure that we, the Government and the Opposition will disagree on what the future should hold. The Conservative party should accept, however, that there is an alternative approach.
  First, the benefits that have flowed to patients from both fundholding and commissioning should be recognised as constituting the important issue. Secondly, we, the Labour party, acknowledge the freedoms of GPs. It is their skills, commitment and dedication to the health service that motivate the entire system and produce improvements. That understanding must be acknowledged and embraced in any new programme. Thirdly, we must tackle unresolved problems. Fourthly, we must find a way forward that combines the two essential principles that fired the debate on 26 April 1948 in this place, which preceded the setting up of the NHS. Those principles were equity of access and of funding. Those core principles are applicable to the entire health service and to its continuation into the next century.
  We, the Opposition, are putting forward a series of propositions. First, we say that the first priority of a Labour Government will be to develop commissioning proposals. We believe that they will prove attractive to all GPs. Secondly, GP fundholders will be absorbed into a new framework. Thirdly, GP fundholding will be eventually replaced by a new commissioning framework. Fourthly, we shall consult in detail with GPs about a realistic timetable for commissioning. That policy provides something that the Government's approach does not, and that is an opportunity for all GPs, whether fundholders or not, to participate in a system that ensures by means of a levelling-up process that the perceived benefits and freedoms of fundholding are available to everyone.
  Mr. Malone: The crucial question is who will control the funds.
  Mr. McLeish: With commissioning goes a number of other considerations that the Government sometimes ignore. First, we need collaboration among health authorities. It is—[Interruption.] The Minister has turned away from me. I have obviously satisfied him by fully meeting his question. I shall continue, however, for the record.

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  We are talking about commissioning, collaboration and partnership. The Government may not like those words, but it is obvious that those three approaches will be essential if we are to tackle some of the unresolved issues.
  Mr. Jenkin: The hon. Gentleman has confirmed that in his commissioning framework he will remove the crucial advantage that fundholders have, which is exclusive control of the funds that they are allocated. The system in which he obviously passionately believes, bearing in mind what he has told the House, must embody fundholding control. Would it not be better for the hon. Gentleman to accept that we should be trying to extend that crucial control to all GPs rather than removing it and reducing what GPs can do for their patients?
  Mr. McLeish: I fundamentally disagree with both the premise of the hon. Gentleman's argument and the conclusion at which he has arrived. If we are to have a detailed dialogue about the process that will enable us to have a commissioning framework, we must consider budgetary implications. It is important to recognise that the Government argue that all the benefits that have flowed from GP fundholding stem from budgetary control. In future, however, we must examine budgetary implications. We do not want to lose anything in the commissioning process that is of benefit to the patient and the doctor, and of benefit to the system generally. We propose to build on the best and to remove some of the excesses.
  We, the Opposition, are confident that our policy will be a commonsense way forward. That will be the basis on which dialogue will take place. A recent speech by the Secretary of State for Health suggested that he is beginning to see things differently. When speaking to the Conservative political centre summer school in Cambridge, he said:
  "There is no single blue print, nor has the government ever suggested that there should be. The important commitment is that there should be a determination to see the continued development of the family health services."
  We agree.
  The right hon. Gentleman talked about no preconceptions and no closed minds. We agree. We agree also that there should be no rejection of ideas because they were not invented by us. Instead, as he said, there should be
  "a clear commitment to strengthening and developing the role of the family doctor."
  I do not think that I have said anything with which the Secretary of State could disagree. If his speech at Cambridge signalled a change in the substance of the Government's policy, I welcome it. If it signalled merely a change of style, the right hon. Gentleman has much further to go before he arrives at where the Opposition are.
  Let us take up the issues that were not mentioned by the Minister, which to me are inextricably linked to the future of primary health care, whether it is a GP fundholding system or the system that we are advocating. We have already trawled the issue of equity, so I shall not discuss it in great detail. I am willing to accept that comments in the press by Ministers agree with my view that a two-tier mentality is developing. The Government may say that that should act as a push to go on to something else. We argue that at no stage should there be a two-tier system where people who live in one street get the benefits of a service, but people who live in another do not.
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  We need to ensure that Britain is not divided into GP fundholders versus the rest or divided on the basis of geography. The analysis of the location of fundholding practices shows that they are to be found in some areas, but not in others. There is a geographical bias. There is also the question, upon which I do not want to dwell, of the sorts of patients whom fundholding practices may want to have or avoid.
  The second issue that we need to consider is equity of funding. There is not equity of funding. That is a fact. Fundholding practices get better financial contributions than do other practices. Nobody is arguing against that. We need not dwell on the matter. If I were a GP and did not want to be a fundholder but wanted to do the best that I could for my patients, I would think badly of a situation that heavily discriminated against me and in favour GP fundholders. There is no logic or fairness in that system.
  Mr. Mans: The hon. Gentleman says that there is no dispute, but what about the comments of Professor Glennester in his study of fundholding practices? He says that it is difficult to support the contention that, nationally, GP fundholders were systematically overfunded compared with what a national formula would have given them in the early years of the scheme.
  Mr. McLeish: A trawl of his further comments would show that the professor simply does not know, because one of the key weaknesses of the Government's effort has been that there has been no proper evaluation of what has been happening.
  Mr. Malone: Will the hon. Gentleman give way?
  Mr. McLeish: The Minister should wait until I raise that issue. If he thinks that some objective evaluation has been done, he must be the only one in the medical community who does.
  The third issue is that of equality of opportunity for GPs to participate not only in what the Government would call purchasing of care but in dealing with providers. There is still dialogue in each area about what is provided, but it is clear that the GP fundholding model sets up difficulties for and barriers between the purchasers and providers of care.
  Mr. Malone: Let me deal with evaluation. The hon. Gentleman says that nobody knows of any evaluation. He may not have heard of the National Audit Office report on fundholding, which went into the matter in some detail. It states:
  "The direct involvement of general practitioners in health care purchasing has led to improvements in the services provided for their patients and made fundholders more aware of the cost implications of their spending decisions."
  It went on to recommend to the NHS executive board that it
  "should endeavour to ensure that the benefits of general practitioner involvement in purchasing, as demonstrated through the introduction of fundholding, are extended to all patients."
  If the hon. Gentleman were prepared to travel in that direction, I could find more common ground with him.
  Mr. McLeish: The Minister has opened up a hornets' nest because I am going to deal in a big way with the reports of the Health Select Committee, the National Audit Office and the Public Accounts Committee. They make some pretty damning statements on the lack of information upon which proper evaluation can be based.

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  The fourth issue that I want to stress is the strategic input of the health authorities. It is crucial in any primary health care system that the health authority and the providers are involved in the care that is being provided and in the purchasing of treatment. In the public interest and in the interest of value for money for taxpayers, it is ludicrous that long-term contractual obligations can be severely undermined by a system of GP fundholding that often operates in isolation from wider concerns such as spot contracts.
  Mr. Malone indicated dissent.
  Mr. McLeish: The Minister shakes his head, but the fact is that, where GP fundholders exist, there are major problems in that respect. It is one of the problems about which the Government are, again, blinkered.
  The GPs have budgets; let them purchase care with spot contracts if they wish; but with such a myriad of contractual relationships developing, what about the providers? In Health questions this week, one of the Minister's hon. Friends, the hon. Member for Salisbury (Mr. Key), raised the question of the destabilisation of hospitals.
  We should be interested not only in GPs being able to commission or purchase care but in the quality of providers. A primary health care system cannot work effectively when hospitals are destabilised to the extent that they can run out of cash and, more importantly, have no long-term future because they are not part of the particular privilege that has been given to GP fundholders.
  Mr. Malone: I am sorry to disappoint the hon. Gentleman, but before he extends that argument too far, he should take into account some simple facts. For example, there is the accountability framework that has been published, ensuring that GP fundholders must take into account the implications of the possible service dislocation to which the hon. Gentleman referred. That includes the lodging and approval by the health authority of practice plans.
  If there is going to be dislocation for a provider—the precise point that the hon. Gentleman was dealing with—practices have to give due notice, so that the provider unit at the hospital can adjust accordingly. The very points that the hon. Gentleman is illustrating are dealt with in the accountability framework in the fullest possible way.
  Mr. McLeish: That does not square with the question of the hon. Member for Salisbury on 31 October.
  Mr. Malone: My hon. Friend was wrong.
  Mr. McLeish: Does that mean that anyone who criticises the Government has to be wrong? The question of the hon. Member for Salisbury stated:
  "However, will he now look at a problem that has arisen and advise my national health service trust? Where that trust literally runs out of money, it is beyond doubt and political banter that patients suffer because non-fundholders cannot have equal access to the national health service trust."—[Official Report, 31 October 1995; Vol. 265, c. 90.]
  That was a Conservative Member. The Minister can accuse us of being politically prejudiced and a bit biased, but that was one of his hon. Friends. The Minister cannot continue to rubbish the comments of his colleagues and
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  dismiss key issues about the strategic input of health authorities in the development of primary health care. Of course, that problem leads to another issue.
  The Government always come to the Dispatch Box and lecture everyone on value for money. The Government have a problem, because value for money is often equated with least cost, but value for money is entirely different. The increased bureaucracy involved in certain aspects of primary health care surrounding GP fundholding means that a lot of money is being tied up in pushing paper.
  Does the Minister accept the logic of the Secretary of State for Health who, after his Government have created an explosion of management, wants to cut it back? What are the Government doing to ensure that investment in management in GP fundholding is not done at the expense of patients? If, throughout the country, every GP fundholder has a budget, where is the accountability and the value for money?
  Mr. Malone: In the framework.
  Mr. McLeish: The Minister says that it is in the framework, but, in a sense, it is getting further and further away from real accountability and moving more and more towards the market model. The Minister is not unhappy with that, because that is his agenda. We are unhappy with that, because it means that taxpayers' money may not be spent to the best advantage.
  There is also the matter of the long-term future stability of GP fundholders themselves. The Minister may want to answer this question: if every GP practice is a fundholder, how will they be funded? At present, the GP fundholders' budgets come from the health authorities' overall funding. There is currently an obvious discrimination in favour of fundholding practices, but if all practices were fundholders, would the Government plough in huge sums?
  Mr. Malone: That is ridiculous.
  Mr. McLeish: The Minister says that that is ridiculous. I wait with some anticipation for him to return to the Dispatch Box. Is there to be more money if preferential treatment is to be given or will money be taken away from GP fundholders and spread, levelling down, to use a phrase, to the non-GP fundholders?
  Mr. Malone: There is no magic in this. Extra funds are given to GP fundholders because they exercise an additional management function that non-fundholders do not exercise. Non-fundholders have that function exercised by health authorities. If everybody were to become a fundholder, it does not take a flash of genius to understand that the function at present exercised by a health authority would then be replaced by the function at fundholder level. That is precisely what would happen.
  Mr. McLeish: That has illuminated an issue for us: bureaucrats will simply be shifted out of health authorities into GP fundholding practices.
  Mr. Jenkin: What a predictable comment.
  Mr. McLeish: It is predictable, but predictable comments often make sense, especially given what the Minister said. He knows, and GP fundholders will appreciate it in the long term, that the financial stability of GP fundholders will ultimately not be what it is now.
  Ms Hodge: If bureaucracy were transferred from one health authority to a large number of GP fundholders,

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  would not that inevitably lead to an increase in the amount of resources spent on bureaucracy at the expense of patient care?
  Mr. McLeish: That, too, was a predictable comment, but it was brilliantly penetrating in terms of the issue at stake and of what the Minister just said.
  Mr. David Rendel: Is it not also true that, if bureaucracy is transferred from a health authority to the doctors concerned, GPs who have been heavily trained at great expense to the public to become doctors will then be used as bureaucrats?
  Mr. McLeish: That, too, is a valid point. The deep disquiet within the health service is all about the financial nexus being pushed between patient and doctor. That is another example of what could happen in the future.
  Mr. Jenkin: May I just thank the Opposition for expounding the Stalinist theory of public administration?
  Mr. McLeish: That comment does not even rise to predictability, and I shall not waste the House's time in answering it.
  Earlier, the Minister focused on one of the issues that we want to raise, when he made one of those comments that the Government liberally make about the benefits of GP fundholding. It is widely appreciated that benefits have flowed to patients, and it is clear that freedoms have been enjoyed by doctors. But whereas the Minister talks about objective evaluation, the same Audit Commission report that he quoted earlier says in its preface:
  "There is a dearth of factual information about the scheme which has grown and changed at a very great rate. It has not been evaluated systematically and, although there are a small number of published studies, most tend to be based on comparatively small samples and have relied on fundholders' own assessments of their achievements."
  The Lancet of 28 October said:
  "Our knowledge about fundholding is rudimentary. Many important questions remain unanswered."
  It then goes on to say:
  "Even the scant results we do have must be interpreted cautiously."
  The question that we must pose is: on what basis do the Government make extravagant claims about the benefits of GP fundholding? The Minister has been energetic enough to rise to intervene in past exchanges, but I suspect that the Government have no interest in properly evaluating this exercise. Regardless of whether patient care is improving, the political benefits from the exercise are overwhelming. In the run-up to an election, it would be daft for the Government to evaluate what is happening objectively, in a scientific or non-scientific way.
  Although the issue concerns the public purse, because the Government have invested much time and money in this development, they are now acting irresponsibly. They will not initiate research with a sensible methodology, which would give the House and the country a proper basis on which to evaluate the claims that have been made.
  Mr. Congdon: I have listened carefully to the points that the hon. Gentleman makes. Earlier, he said that we have a two-tier service. That implies that fundholders are doing their purchasing better, so if the hon. Gentleman wants an audit of fundholders as he described, the searchlight should be on the poor purchasing of health authorities.
  Mr. McLeish: That point carries no weight because, in a sense, privileges conveyed financially allow GP
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  fundholders to exercise purchasing rights on behalf of patients. It is self-evident. The issue is not about fundholders and non-fundholders exercising different skills in terms of quality of care, which would be a different debate.
  The Government cannot continue to parade those benefits before the country unless and until they have information on which that is based. They can do so in a political knockabout debate, but I hope that the National Audit Office and the Public Accounts Committee will soon examine why nearly 8 per cent. of the health service budget—£2.8 billion—is tied up in an experiment that has not yet been evaluated.
  As a fellow Scot, the Minister may like to say why he took a much more cautious approach in Scotland, where he piloted projects that could be evaluated. If pilots have been carried out in Scotland, why are they not good enough for England? The Government are behaving irresponsibly and the Minister is silent because he knows that he does not have the information to make such ludicrous statements about achievements.
  How can we have a partisan embrace of GP fundholding to the total exclusion of the other 50 per cent. of the country? I have already mentioned the figures. Are we to pretend that the treatment given to 40 million patients is of no significance to the Government? Are we to believe that 7,730 GPs are operating outwith Government approval because they have not yet had the guts to buy into GP fundholding? Or are we to believe that the 95 commissioning groups throughout the country are not doing a good job?
  Does not that illustrate why the Government are so fundamentally unpopular? They hook into a certain obsession and relegate anyone who dares criticise it or does not come forward to be involved. The Minister cannot continue to conduct business in such a sensitive and vital area as primary health care with such a dogmatic attitude. Although I asked him, in his contribution, to discuss GP commissioning in its variety of forms, I had no response.
  If one wants to build on the best, one must see what is happening in the various exercises throughout the country. Naturally, the Minister wanted to discuss GP achievements. Why, then, does not he go to north Cumbria and look at the alliance there, where group-negotiated funds for open-access exercise electro-cardiograms for all GPs have transformed access to cardiology for all patients? Why does not he look at the Blackpool, Wyre and Flyde GP advisory group's surgery-based dietetic service? There are lists and lists of good news stories.
  Mr. Malone rose—
  Mr. McLeish: The Minister may now want to rescue his position, but he has simply ignored a huge swathe of innovation, activity and excellent things happening in the health service.
  Mr. Malone: That was a bad example for the hon. Gentleman to choose. He may understand that, when party conferences are held in Blackpool, Ministers sometimes feel constrained to remove themselves from the winter gardens. I visited the commissioning practice of which he speaks and spoke to its members for an hour about what they do. I found that, although they have an innovative

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  practice, they had had the utmost difficulty in getting the local health authority to agree to it, because they did not have purchasing power. They also came up with a list of proposals so that they could be given expensive management costs to carry out joint commissioning. That undermines the hon. Gentleman's point about it being a cheaper option.
  Mr. McLeish: That contribution does not take away the fact that the Government are simply not interested in what is happening outwith GP fundholding.
  I do not want to go on and on with other examples. It is a question of balance. Given that the Government are 40 points behind in an opinion poll conducted by a paper widely read by themselves, is it not time that they listened to those who do not embrace or applaud some of what they are doing in government? After 16 years, they simply do not care. That is the conclusion that you must reach, Mr. Deputy Speaker, after hearing the Minister's responses.
  The Government have given no answers on a range of issues that are important for the future of primary health care, which is not developed in a vacuum. They include access, funding, the strategic importance of health authorities, equal access by GPs to providers in terms of dictating quality, and evaluation and objectivity in making claims. All those issues have been neglected. One cannot have a system of GP fundholding or GP commissioning that ignores in large measure the implications of those issues.
  Worryingly, at a time when the Government have been partisan and particular, they continue to want to ignore some of the issues that I mentioned. I hope that, specifically, the Government will now initiate, arising from the debate, a series of far-reaching studies into GP fundholding and some of the other innovations that are taking place throughout the country.
  We started the debate by saying that there was a fundamental distinction between what we, Labour, wanted to achieve in health care and what the Conservative Government wanted to achieve. Considering the Government's strategy logically, one recognises the classic signs of a process that was recently imposed on the railways, and is now being imposed on the health service—fragmentation, contractorisation and commercialisation. If the nation gave the Conservatives a fifth term, they would move to privatisation.
  Mr. Piers Merchant: Absolute nonsense. We do not want privatisation. It is not a possibility.
  Mr. McLeish: To use a phrase much quoted this morning, the hon. Gentleman's response is very predictable. The Government are very uncomfortable when one says something that they want to keep hidden. Is not that true? It is true. As far as I am concerned, the partisan approach that they have adopted this morning to primary health care merely reinforces our belief that the Government do not care about the national health service but do care about that four-step process towards the marketplace.
  Mr. Jenkin: It is evident that the hon. Gentleman and the Labour party do not want to campaign on the issue of what we have achieved in the health service. They want to campaign on what they pretend that we might do in future, which they know to be untrue.
  Mr. McLeish: I have heard much better interventions from the hon. Gentleman. Perhaps, because I am reaching the end of my speech, Conservative Members are reaching the end of their concentration. I do not believe that that comment required a response.
  The exclusivity of the Government's approach will be evident to all who witness the debate. However, the Government are failing to tackle other problems, which we cannot go into today. Morale in the primary health care service is not good. There are major problems with recruitment and work loads and problems with early discharges and emergency admissions.
  We are in the ludicrous position, which affects the Minister's constituency among others, where nearly £100 million of surpluses from GP fundholders is sitting in the health authorities' bank. I cannot believe that we have a million people on waiting lists and we have £100 million sitting there. The Minister should take seriously the issue of whether that will be ploughed back over four years into GP fundholding. Or is it the Government's tactic to dip into that bank budget and spend it on reducing waiting lists? People will find extraordinary that conflict between a million people on waiting lists and £100 million stored in a bank and not being used. It is a scandal.
  We shall be in government within 18 months. We now have an important task to speak to GPs and to consider the new era that will open up for them. We shall start doing so early in the new year. I am confident that the policies being proposed by Labour will mean one national health service, a policy for all patients and a policy for all doctors. We shall reduce that partisanship, that particularisation of GP fundholding, by building on the best and taking the whole system forward.
  Ms Hodge: On a point of order, Mr. Deputy Speaker. Have you heard whether the hon. Member for Dover (Mr. Shaw) is intending to make a personal statement on the Government's decision not to privatise the harbour at Dover, especially because he appears to be the only person in Dover who supports such a privatisation?
  Mr. Deputy Speaker (Sir Geoffrey Lofthouse): I have no such information whatever, and it is not a matter for the Chair.
  11.4 am
  Mr. David Congdon: I listened carefully to the speech of the hon. Member for Fife, Central (Mr. McLeish). Initially, he tried to make a thoughtful speech and I believed that he would avoid the temptation to engage in party political banter. However, my hopes were not fulfilled, especially near the end of his speech, when we had the usual canard that the Conservative party, which has invested so much in the national health service and been responsible for its stewardship during most of its time since 1948, has a hidden agenda of privatisation.
  If there is a hidden agenda, it must be well hidden. If the Government were intent on privatising the health service, why have they invested 22 per cent. extra in real terms in the national health service since 1990—an enormous sum? Many commentators say that not even a Labour Government would have had the ability to deliver such an excellent amount of extra resources to the NHS. That canard should be dismissed for what it is. It does not help the debate. We also had the usual canard about

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  morale being bad. Someone said recently that morale has always been bad in the national health service. I do not accept that it is any worse now than it has ever been.
  First, I should like to place the debate in context. Debates about the NHS have usually been about hospitals and there have been four or five debates in the past year or so about the health service in London. One of the reasons why debates have tended to focus on hospitals is that that is the glamorous side of the NHS, where doctors carry out high-tech interventions and receive much publicity when they do a heart and lung transplants and the like. As a result, the opportunity to debate the importance of primary care is lost.
  Undoubtedly, primary care is becoming much more important because of the changes in secondary care—changes in the way that hospitals work. There is much less invasive surgery and much more day surgery. There is much more surgery which does not involve surgeons having to open up a person to find what is wrong, discover that there is nothing wrong and stitch them up again, having done a great deal of damage in the process. They are now able to find out what is wrong without doing that.
  That leads to much shorter stays in hospital. It also leads to people who have had operations being discharged much earlier, which places more pressure on primary care services. That is why primary care services have rightly been forced to change, and will have to change much more during the next decade and as we enter the next century.
  We are also witnessing the proper implementation of community care, which is leading to much more long-term care in the community, which also places pressure on those primary care services. However, significant changes to the configuration of hospitals, especially in London, have provided the opportunity for £85 million to be invested in primary care developments in London. Many have been in the north of the borough of Croydon. I am privileged to represent one of the constituencies in Croydon. There has been significant investment in GP surgeries in the north of our borough, providing much better care and facilities for the people of Croydon than in the past.
  I note that yesterday a further £35 million was announced for various initiatives to help single-practice GPs in London. I am sure that other London Members will join me in welcoming the Government's initiative in that respect.
  Mr. Malone: Does it not shoot down the Opposition's case that the Government are interested only in developing fundholding practices when, as recently as yesterday, I made that announcement, which means that single-handed practitioners, most of whom are not fundholders in London, will receive the benefit of flexibility payments to improve services for their patients, too? On equity, of course we are sensitive about allowing other services to develop where possible.
  Mr. Congdon: My hon. Friend is absolutely right. I should say at this point, in case I create a different impression later, that I am primarily interested in primary care services delivered by GPs and their staff. I do not care whether they are fundholders or non-fundholders, but I do care that they should have the opportunity to deliver the best possible care for their patients. I happen to believe—in my view the evidence is strong—that when one gives the budget to GPs they are better able to decide where the money should be spent.
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  We should put the issue of GPs in context. I mentioned the extra pressure that GPs are under. There have been changes in the way that they work. There has been a significant growth in the number of GPs since we came to power in 1979. The numbers have risen from 21,000 to 26,000—an increase of 22 per cent. Doctors often say that they have a heavy work load, and I do not dispute that. But their list sizes have decreased from 2,300 to 1,900—a drop of 16 per cent.
  Perhaps the most incredible change is in the number of practice staff. How many of us remember when we used to go to our GP and were lucky to find anyone else on the premises? The number of GP practice staff has risen from 20,000 to 54,000, which means that we can receive many more treatments at our GP surgeries without having to go to the local hospital for tests. That is why a primary care-led NHS is so exciting.
  According to a recent MORI poll, nine tenths of patients are satisfied with the services provided by their GPs. GPs have always been the gatekeepers to other health services: they decide whether a patient should go to the hospital for a test or to see a consultant for further investigation. But until the reforms that introduced fundholding, GPs were gatekeepers with little power to exercise on behalf of their patients. They used to have to try to negotiate with consultants at the hospital, and it was a matter of which consultants they knew best, and perhaps even whether they went to the same golf club. That was not a transparent system of negotiating health care on behalf of patients.
  Mr. Malone: The relationship between GPs and consultants can perhaps be encapsulated in a remark that I heard from a GP fundholder in London recently. He said that, five years ago, he used to send a Christmas card to a hospital consultant, but now the consultant sends him one.
  Mr. Congdon: I congratulate my hon. Friend on that remark—he must be telepathic and is perhaps in the wrong occupation, as that was my next point. There has been a significant change in the relationship between GPs and consultants which has fundamentally changed the balance of power in the health service for the good of GPs and, more importantly, for the good of their patients. GPs now negotiate on behalf of their patients; they are not negotiating on their own behalf to protect or spend their budget. They use the power that their budgets give them to negotiate on behalf of their patients to obtain the best possible care for them.
  The evidence is clear: GPs are able to negotiate better care for their patients. They have also been able to negotiate to ensure that more treatments are carried out in their surgeries. There are cases of GP fundholders negotiating with consultants and persuading them to come to their surgeries to carry out a clinic. What better way is there to run a health service?
  It was alleged that GP fundholders would spend far less on drugs because they had control of the budget. The hon. Member for Fife, Central did not refer to the Select Committee on Health in his speech, but it carried out an investigation into the drugs budget. GP fundholders spend less per capita on drugs than non-fundholder GPs. More interestingly, the average value of the prescriptions that they give is higher than for non-fundholders. Significantly, they issue fewer prescriptions. The inference to be drawn must be that they prescribe more effectively.

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  Many doubts have been expressed and there have been many debates on the effectiveness of GP fundholders, as we heard some from the hon. Member for Fife, Central today. One source that has not always been a friend of the Conservative Government—the King's Fund—has acknowledged GP fundholding as one of the major successes of the health service reforms. We should give weight to its views.
  The evidence is that fundholders manage to buy care far more effectively than health authorities. The question for Opposition Members to ask is why. There is no evidence that fundholders have been given more money for patient care than non-fundholders, but because they are much closer to their patients they manage their budgets more effectively. In many respects, that is not surprising. We all believe that we manage our financial affairs much better than the Government do on behalf of taxpayers. Large organisations do not necessarily manage budgets and other matters better than at local level. The challenge now is to put pressure on health authorities to exercise their purchasing power more effectively and to bring themselves up to the standard achieved by fundholders.
  I wish to deal head on with the question of a two-tier service. Before fundholding was introduced, the charge from the Labour party was that it would lead to a two-tier service—but not the two-tier service that the Labour party describes today. The Labour party's idea of a two-tier service was that GP fundholders would have a pot of gold, which they would be so determined not to spend that they would deny services to their patients. The net effect would be that fundholder patients would receive poorer quality patient care than non-fundholder patients.
  Mr. Rendel: The hon. Gentleman has just told us proudly that GP fundholders make fewer prescriptions for their patients than other GPs. He used that argument to show that they were more efficient. He now tells us that it is not true that fundholders provide less for their patients, and that they in fact provide better care. I cannot see how the two arguments fit together.
  Mr. Congdon: I am sorry that the hon. Gentleman cannot understand the subtleties of the important point that I am making. Fundholders are given the same pot of gold as the health authority on a per capita basis; the important question is what they do with that money. Health authorities spend the money on behalf of GPs; fundholders spend it on their own. Fundholders spend less money on drugs than non-fundholders. They undoubtedly spend more money on some things than non-fundholders, and less on others. The net result is that there will be differences in the care provided.
  It is my contention, and that of many others, that fundholders buy care more effectively. As a result, fundholders' patients are sometimes seen earlier than those of non-fundholders. That does not mean that there is a two-tier service, but that the fundholders buy a different pattern of care. The question that the hon. Member for Newbury (Mr. Rendel) must ask is what the health authorities are spending the money on and why they are not achieving the same success as fundholders.
  The Opposition cannot have it both ways. If they say that there is a two-tier service, the logic of their argument must be—I make no apology for repeating it—that all GPs
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  should be encouraged to become fundholders. The argument involving a two-tier service—if it is valid—would then disappear. There would still be differences within the service, because different GP fundholder practices would buy different patterns of care to meet their patients' needs.
  The important question is whether we level up or down. Conservatives believe that, by introducing fundholders, we have improved standards, and we want all GPs' standards to be levelled up to the standard of the best. Opposition Members believe that there is a two-tier service and that the only way to achieve the end that they desire is to level down. I am sure that hon. Members will join me in rejecting that.
  I am pleased that fundholding is spreading at a fast rate. Some 41 per cent. of GPs are now in fundholding practices and next year the figure is likely to be more than 50 per cent. To date, the figures in my borough have been disappointing, but I am pleased to learn that many practices are to become fundholders from next April. I am confident that they will reap the benefits of fundholding.
  I have never been particularly wedded to one standard model. I accept that the needs of one group of GPs can differ from those of another. I therefore welcome the fact that we now have three possible varieties of fundholding: community fundholding for small practices which do not have the ability to buy a wide range of services; standard fundholding, which is being extended to include most elective surgery, out-patient services and specialist nursing services and—perhaps the most exciting development—total fundholding, where fundholders are responsible for buying all care.
  I understand that emergency services are also included. There is a need to ensure that there are no gaps in the loop. There have been allegations that fundholders could have an incentive to delay treatment so that patients present themselves at accident and emergency units. There is no evidence to support that, but one solution is to give fundholders total responsibility for all aspects of their patients' care.
  In developing and extending fundholding, we need carefully to examine transaction costs in the NHS. In that context, I welcome the publication in June by the NHS executive of the efficiency scrutiny into bureaucracy in general practice. I hope that all the proposals in that document are implemented. I shall mention one or two that are particularly important.
  The implementation of the new NHS number is crucial in terms of being allocating costs back to fundholding and non-fundholding practices. That must go ahead quickly. The report states on page 14 of the summary:
  "On present plans the software specification for standard fundholding does not cater for electronic data interchange.".
  I urge my hon. Friend to address that aspect, as it could play a key part in reducing the volume of paperwork which flows between fundholders and providers.
  There is also a proposal to implement an NHS-wide clearing system from April 1996. At present, there is a big invoicing process between providers and fundholders. Unfortunately, on current plans, fundholders will not be included from April 1996. Will my hon. Friend address that, as it is important to reduce the need for paperwork going backwards and forwards in this age of modern

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  technology. I could raise other points, but I simply urge my hon. Friend to ensure that the recommendations in that report are dealt with properly.
  Let me turn briefly to Labour's so-called joint commissioning. I listened carefully in order to understand exactly what that would involve, and I have to confess that I am none the wiser. I know that it will not be real fundholding because the GPs will not have funds, so what is the difference between what the Labour party is proposing and what exists today for non-fundholders?
  Health authorities are empowered and cajoled to engage GPs and GP fundholders in dialogue about what should he in their purchasing plans. There are collaborative plans, but how much say do GPs have in that process and how much say would they have in the joint commissioning process? Professor Howard Glennester says:
  "Many GPs that have participated in that sort of activity get very frustrated by it … they are asked their views and then nothing happens and it just causes frustration and irritation."
  In other words, there is consultation and collaboration and then the bureaucrats in the health authority do what they thought of in the first place. That is why the proposal for joint commissioning is no more than a half-baked idea.
  Another alternative that the Labour party thought up, but did not mention this morning, is shadow budgets. I am not sure what a shadow budget is. Presumably GPs would not actually have the money, but there would be a notional account and if they were lucky the right amounts might be credited or debited. We would need more details before we could consider such half-baked proposals.
  Labour's arguments for joint commissioning do not stand up. There have been a variety of allegations about what is wrong with fundholding and mention has been made of two-tier services here and there, but when the allegations have been investigated, most of them have been proved false.
  In future, of course, the links between doctors—fundholders and non-fundholders—and health authorities have to be very good and clear, but when I listened to the speech of the hon. Member for Fife, Central I was struck by the fact that he was living in a time warp. He implied that fundholders were given a pot of gold and could do exactly what they liked with it regardless of the strategy of the health authority and the needs of the locality.
  The reality is quite different. My hon. Friend the Minister referred to the framework document, which sets out the role of the health authority. The health authority has to assess the health needs of the population in its area. It has to prepare a strategy in line with the overall objectives of the national health service. It then has to purchase care for GPs who are not fundholders in line with that strategy. It also has to ensure that the plans of fundholders are in line with that strategy.
  It is not a matter of GP fundholders getting together on a rainy afternoon to cobble together some plan that threatens their local general hospital and suddenly implementing it without anyone knowing about it. If they wish to make significant changes to their purchasing plans, they have to submit them six months in advance to the health authority which has a clear and direct role in the strategy, albeit that it does not purchase health care directly for fundholders. Opposition Members too often neglect that point.
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  I am firmly convinced that fundholding is the right way ahead for the health service. At last it has put the money close to the patient. Ideally, the money should be in the hands of the patient, but that is not realistic. Fundholding is a good second best and is achieving excellent results. I hope that we can build on those results because the system is so responsive to patient needs.
  If all GPs cannot become fundholders—there will be problems in that respect, for reasons that we all understand—or at least community fundholders, we must find ways of giving a surrogate power to the residue of GPs unable to participate fully in the scheme. I want all GPs to benefit from the advantages of GP fundholding. I certainly do not want to turn back the clock, as advocated by the Labour party.
  11.28 am
  Mr. David Hinchliffe: I am grateful for the opportunity to participate in the important debate this morning. I begin by commenting on the excellent speech by my hon. Friend the Member for Fife, Central (Mr. McLeish) from the Opposition Front Bench. It was his debut at the Dispatch Box, and he made a commendable speech that clarified Labour's position on GP fundholding while totally exposing the Government's current position. All hon. Members will agree that my hon. Friend courageously raised certain points that were drawn from personal experiences.
  One reason why I decided to return to the Back Benches is that, over the past three years or more, I have felt somewhat inhibited in raising detailed concerns about specific developments in my constituency in debates on the health service. When I was at the Dispatch Box, the last thing Back Benchers wanted to hear was detailed concerns from a Front-Bench spokesman about his own constituency.
  As the Minister is well aware, I want to spend some time today on the detailed implications of GP fundholding for my constituents in Wakefield.—[Interruption.] If the hon. Member for Croydon, North-East (Mr. Congdon) cares to listen, he will hear evidence that clearly shows that some people are deeply concerned that fundholding has created a two-tier system. I shall not only give examples, I shall name names. I can show Conservative Members letters that I have received—I have already shown the Minister some—that demonstrate clearly the effects of a two-tier system on my constituents.
  Mr. Congdon: I am happy to accept the hon. Gentleman's examples in the spirit that they are given. If what he says is true, is not that evidence of the health authority not exercising its purchasing function as well as GP fundholders exercise it?
  Mr. Hinchliffe: If the health authority was here, I think it would say that we should be examining the money available to fundholders compared with that available to non-fundholders and the health authority. The hon. Gentleman points a finger at the health authority, but it was set up by the Government, and its chairman was appointed by the Government. They cannot blame the very people whom they put in place. It is the system that is wrong, as I shall show throughout my speech.
  Mr. Malone: Before the hon. Gentleman does that, we must be clear that the implication in what he has already

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  said, and in what the hon. Member for Fife, Central said, is that there is some huge disparity in funding for patient care. I want to put the basis of funding for patient care clearly on the record. Fundholders get a fair share of NHS resources, which is calculated by the historic use of services that their patients made of them before they became fundholders, and which is now modified by movement to a local capitation benchmark. It is a fair allocation system.
  I hope that the hon. Gentleman will distinguish between the funds that are allocated fairly for patient care, which fundholders manage, and the funds allocated to carry out the management function of fundholders. It is clear from what Labour Members have said so far that the two points are being thoroughly confused.
  Mr. Hinchliffe: I shall give way to the Minister later if he will put on his thinking cap and find a reason for underspent resources within fundholding practices in Sheffield, while non-fundholding practices are unable directly to obtain health care purchased by the health authority in exactly the same specialisms in the same hospital. The two-tier system is not just between different areas: it is within the same district general hospital.
  Before going into detail about local issues, I want to make one or two broader points of relevance to the debate and to reinforce the eloquent comments of my hon. Friend the Member for Fife, Central, who outlined the Labour party's belief in primary care. I have been very closely involved with the health service at local level over many years. I worked in local authority social services and therefore dealt with GPs and hospitals on a day-by-day basis. In fact, at one point I was practice based with a GP, so I worked very closely with a primary care team.
  I recall a time before 1974 when I worked in the same building as district nurses, health visitors and midwives. The model that operated then, especially in respect of collaboration with child protection services and community care, was fundamentally better than the present model. That much better system was scrapped by a Conservative Government in the early 1970s. The Minister talks about looking forward to this or that development. I look back on the many positive elements that existed some time ago, which his party wrecked in the 1970s.
  For many years, the power in the NHS has been primarily in the hands of hospital consultants. I do not think that there is any difference between me and Conservative Members on that point. I accept that moves have been made to enhance the power and status of general practitioners. That is simple common sense; anybody wanting to develop an effective primary care system would do that. I also accept that fundholding has enhanced the powers of certain GPs. Indeed, I have personal friends who are fundholding GPs. I also know some local GPs who became fundholders not because they believed in the system, but because they saw it as a way to obtain more money and to queue-jump their patients—something that many people find unacceptable. I do not blame them for fighting for their patients; I blame a system that has created two-tier health care.
  I accept that effective general practice is fundamental to a properly run health service. As has been said, it is the linchpin, and has been from the word go. However, we
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  have never facilitated general practice in a way that would allow it to play that crucial pivotal role, so obviously I welcome any moves in that direction. My party recognises the need increasingly to examine ways to improve primary care because that is fundamental to improving the health of the nation.
  I served on the 1990 Standing Committee that considered the National Health Service and Community Care Bill. I privately felt that we had failed to understand that fundholding was potentially a greater threat to the central principles of the NHS than the purchaser-provider split and trust status. I felt strongly that the Government were taking a huge leap in the dark by introducing fundholding without any attempt at a pilot scheme, any sort of experimentation or any evaluation of different models. Instead, they went straight in at the deep end. Now, unfortunately, in my area and other areas, including the Minister's constituency, we are having to pick up the pieces of the Government's failure to consider the possible results of fundholding.
  We could all describe personal and practical experiences. My hon. Friend the Member for Fife, Central mentioned a few. The hon. Member for Croydon, North-East referred to equal funding. The Minister, when he intervened, made it clear that a great deal of money is thrown at GPs to encourage them to become fundholders. Many of them have spent lavishly on their premises—money that some might argue could have been better spent on patient care. We could argue all day about equality of funding, but the simple question is whether the system for allocating funds is the best use of scarce public resources. I am not the only one to ask that question.
  Mr. Malone: Before the hon. Gentleman goes too far in denigrating doctors and the way in which they spend any savings, I want him to understand that the savings that. fundholders make have to be audited and schemes upon which they spend any savings must be approved. The hon. Gentleman referred to improvements in surgery premises. Surely he should welcome those improvements, which often mean that other health professionals can be included in new premises, thereby giving standards of patient care that are not available in the old-fashioned, clapped-out premises that are being replaced.
  Mr. Hinchliffe: If the Minister cares to visit God's own county of Yorkshire, I will take him to a city not far from where I live, where there are some very innovative uses of fundholding money. One practice—the hon. Gentleman probably realises that I am talking about Sheffield—set up a private hospital and referred patients from its practice to its hospital. The doctors were making a large amount of money.
  I am sure that the Minister will accept that, in many areas, an objective analysis of fundholding has raised serious questions. I am not denigrating fundholding GPs who have genuinely attempted to improve their service at practice level. I do not suggest that all fundholders are necessarily bad. As I said, I know a number of fundholders and, as a shadow Minister, I recently addressed the Yorkshire fundholding group. We had a very interesting dialogue. The group understood where I and my party were coming from and some of our reservations about a system that creates the anomalies that I shall describe in a moment.
  Ms Judith Church: Like my hon. Friend, I represent an area in which there is great inequality in

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  health care. I have met local fundholding and non-fundholding GPs to discuss the effect of fundholding on inequality. Do GPs in my hon. Friend's area think that fundholding is doing anything to reduce inequality? In Dagenham, they think that it serves merely to widen inequality in health care.
  Mr. Hinchliffe: I shall outline in a moment exactly what non-fundholding GPs think that fundholding has done. They think that it has increased the inequality that already exists. I shall illustrate my point with reference not to my views but to those of GPs who have set out in their own words what they think about the current position.
  I have listened many times to Conservative Members saying that the market will resolve any problem. With the National Health Service and Community Care Act 1990, we introduced the market into primary care. The idea that competing, thrusting GPs would fight on behalf of their patients, and that practice would fight against practice, to get what is best for their patients is absolute nonsense.
  As the Minister knows, right from the word go fundholder cartels were established. The Wakefield metropolitan district fundholders immediately appointed someone to work on their behalf and block contract purchase. Straight away, there was a complete monopoly of purchasing. I heard in Committee and in the Second Reading debate on the 1990 Act that the competitive, thrusting market would somehow enhance patients' rights and their access to treatment, but from the start we saw the establishment of block collaborative purchasing by fundholders. That happened not only in my area but across the country. Block purchasing is worth examining in its own right, because it has implications for the planning of health care.
  Mr. Malone: The hon. Gentleman mentioned what is happening in his area. In fact, 81 per cent. of the population there are now covered by fundholding practices. A large fundholding project has resulted in savings of £820,000 to be spent on patient care. Those uncaring fundholders have also returned to the health authority £217,000 worth of savings for general spending. I should have thought that the hon. Gentleman's own area is an ideal example of the benefits that fundholding has provided.
  Mr. Hinchliffe: The Minister used the term "uncaring fundholders". That is his term, not mine. I hope that he will be as happy to intervene when I have spelt out my concerns about what is happening in Wakefield. I have already raised my concerns with him and the Secretary of State, and did so with him again this morning. I am getting a little impatient because I am not getting answers to questions that are directly relevant to the meat of this debate.
  Before I go into detail about my locality, I shall make one or two further points on the wider issues that need to be examined. I have mentioned the collective purchasing by fundholders. Important questions need to be asked about what collective, collaborative block purchasing means for local health planning.
  Mr. Stephen: Will the hon. Gentleman give way?
  Mr. Hinchliffe: With respect, I have taken a number of interventions and still have some very important points to make.
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  I believe that local health planning is being wholly undermined by the collective purchasing power of fundholders. It is a simple fact that their collective purchasing power increasingly renders the planning role of local health authorities redundant. Fundholders have the power to shift contracts and, effectively, to close hospitals. They have the power to close key local services. To whom are they accountable?
  Health authorities and trusts at least have a token accountability. If one looks through one's local newspaper, one might, if one is lucky, find a notice stating that the local trust or health authority is having a public meeting. Usually, only about three people turn up, because few know about it or know what the trust or health authority does these days. However, there are at least token meetings.
  Who can influence the decisions of fundholding blocks? Where is the public accountability? Where can my constituents go to ask why fundholders have decided to shift a contract from hospital A to hospital B, with the resulting implications for services at hospital A? Such issues are fundamental to our belief in a national health service that offers people equality of treatment. Frankly, that framework has gone by the board. The Government did not think through these issues, which are increasingly coming home to roost in areas such as mine. People who can spend millions of pounds are completely unaccountable to the public. How can my constituents influence fundholding practices?
  Mr. Malone: Before the hon. Gentleman accuses me of not rising to deal with that point, I should point out that I shall deal in great detail with the accountability framework and what it implies when I wind up the debate.
  Mr. Hinchliffe: The hon. Member for Croydon, North-East mentioned the tie-in between general practice and community care, which is an important point. I had Front-Bench responsibility for community care policy and travelled around the country, talking to many people about the implications of fundholding on community care, child protection and the services that work alongside general practice.
  I hear worrying tales from people working in mental health who are responsible for implementing the new supervised discharge order. They say that it is nonsensical that local GPs are bringing in community psychiatric nurses from outside the area who are not involved in the local collaboration process. GPs are also purchasing health visitors and midwives, people directly involved with the nitty-gritty of child protection. Those people have no relationship with local social services.
  That undermines completely collaboration on key issues such as child protection. I fear that, before very long, when something has gone badly wrong, we shall be hearing of yet another inquiry into child abuse. I predict that one issue that will arise from that will be the fact that fundholders are buying services from outside their immediate area and that that undermines proper local collaboration.
  Mr. Merchant: The hon. Gentleman referred to the buying-in of services by GP fundholding practices. Surely GPs take decisions in the interests of their patients. He betrays a lack of faith in GPs if he believes that they cannot make the best choice for their patients in these circumstances.
  Mr. Hinchliffe: I have a great deal of faith in GPs. The essence of what I am saying is that I want them to he

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  given more power. General practice has a crucial role to play, but we need to think through the consequences of fundholding for community care and personal social services.
  I am told by community psychiatric nurses that fundholders do not understand their role. One CPN told me recently that it was sad that, instead of being brought in to deal with seriously mentally ill people, CPNs were being asked to deal with those described as the worried well, people who have various neuroses of a not very serious nature and do not need the skills that CPNs have. The Government have not even started thinking about such problems.
  I focus now on an issue that I mentioned in an intervention on the Minister and which has been bandied across the Chamber—the two-tier system created by fundholding. My fundamental objection to fundholding is that it completely undermines what I felt was a cross-party belief in the equity principle of the national health service, which has been there right through from the 1940s: the belief that if people pay into a system, they have a right to expect equal access to that system and that they can get the same treatment as others in an area. That has been blown out of the window by general practice fundholding.
  Mr. Mans: Does the hon. Gentleman believe that that equity principle applied in practice during the past two periods in which there was a Labour Government? Was there equal access across the country to medical facilities, as was suggested in 1948 when the NHS was founded?
  Mr. Hinchliffe: One of the issues that we have had to address right through from the very brave decision of the Labour Government in the 1940s has been that of equity across the country. Of course I concede that there is different access in different parts of the country. I understand that. Indeed, Government after Government have had to address such issues. We had the Resource Allocation Working Group. Now there is the reverse of RAWG, whereby inner-city areas in the north of England have been robbed of funding to shunt it to the opulent south of England where there is less pressure on the health service.
  I travel around the country and see many people. I accept the fact that there have always been differences, and successive Governments have attempted in their own ways to address them. But there have not in my experience been differences in the same hospital between patients living in the same community, served by that hospital. That scenario has arisen, and I shall spell out in some detail how it applies in Wakefield. The equity issue has been raised with me by my constituents who want to know why they are denied treatment that their next-door neighbours can get on the basis of which practice they happen to be registered with.
  Over considerable time, anecdotal evidence of the two-tier system operating in my constituency—it depends on the status of a person's GP—has been given to me. In July, a constituent came to see me. All the constituents whom I am about to identify have given me their permission to mention their names and their circumstances. If the Minister wants, I will show him the correspondence in each case—it is with me today—which spells out their feelings in their words.
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  In my surgery in July, I saw a Mrs. Doreen Armitage, who lives in Alverthorpe, Wakefield. She is a 65-year-old widow who, along with her late husband, spent many hours raising thousands of pounds for Pinderfields hospital from charity work. Some time ago, that lady was injured in a road accident. She broke her neck and fractured her femur and, as a consequence, needs a hip operation. She was told after an X-ray at Pinderfields hospital on 15 December 1994 that her operation would take place between four and six weeks later and that she would be "admitted on a phone call". That was later amended to four to six months and, later still, her daughter was told that the operation would be at the end of June or in July.
  Mrs. Armitage rang the hospital again in mid-July and was told that the operation would definitely take place in August. That was amended again because—she was quite clearly told this—her GP was not a fundholder. She was told that the operation would take place in December at the earliest. That lady is in acute pain to the extent that she cannot function on her own and has had to leave her home in Wakefield to live with her daughter in Scunthorpe.
  In September, I had a letter from a Mrs. Mary Parkin of Thornes, Wakefield. This lady is a 79-year old widow and happens to be the mother of somebody who was in the same class as me at school. I have known her for many years. She is of my parents' generation. She is awaiting a hip operation in pain and discomfort. She is also a patient of a non-fundholding GP. After writing to the chief executive of the Pinderfields hospital trust, she received a letter from the chief executive dated 15 September, which said:
  "Pinderfields is in negotiation with Wakefield Healthcare over the funding of operations from non-funding GPs in Wakefield. Problems have arisen in recent months as the hospital has carried out all the operations it has been contracted for".
  That is no real comfort to Mrs. Parkin, who is in great pain.
  In October, I was contacted on behalf of a constituent, Mr. Robert English, who lives in Eastmoor, Wakefield. He is a 54-year-old man who has been suffering from a painful hip condition for more than a year. It was initially diagnosed as arthritis, and because of his concern, he ended up, as so many people have to nowadays, paying privately to see a consultant, who diagnosed a fractured hip.
  That man has been in considerable pain while waiting for the operation that he requires. When he rang the secretary of the hospital consultant concerned, he was asked whether he was the patient of a fundholding GP.
  This week, I was contacted on behalf of a Mr. David Garlick, a 77-year-old man who lives in Wakefield. He has been treated since 1991 for a painful hip condition. His GP told him in 1991 that he required a hip replacement operation. His consultant told him in December last year that he was on the waiting list, and that an operation would be carried out before May 1995. He was told in July that the operation would go ahead in August. In late August, Mr. Garlick was told that the operation could not go ahead until after Christmas due to a shortage of funds. His GP is not a fundholder.
  Mr. Reynolds, from Flanshaw, Wakefield, was a miner for 28 years and after that worked as a hospital worker. He is suffering from osteoarthritis of the hip. He was referred to hospital in October 1994. He was seen by the consultant after that referral on 19 April 1995, told that a hip replacement operation was needed and that he would

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  have to wait two months. He is still waiting. He has been told by his own GP that the delay is because his general practice is non-fundholding.
  Mr. Stephen: Will the hon. Gentleman give way?
  Mr. Hinchliffe: If the hon. Gentleman would let me finish my point, I will give way later.
  I would like to finish the point by giving my opinions. This morning I received a copy of a letter sent on 31 October by the Wakefield non-fundholding practices, representing the various surgeries in Alverthorpe, Chapelthorpe, Church street in Ossett, and Grove and Kirkgate in Wakefield. Most of them are in my constituency and represent 36,370 patients—most of whom live in my constituency—including, by the way, myself, my wife and my children, because we are very happy with the service provided by our non-fundholding general practice.
  The letter sent to the chief executive of Wakefield health authority is quite lengthy and asks a number of important questions. It makes the following point:
  "We understand that our patients who are already on Waiting Lists will not receive Elective Surgery in ANY speciality, because the budget has been spent. We also understand that the Budget was £2 million less than the last financial year.
  We are very concerned that our patients are not receiving the same standard of care from Pinderfields Hospital Trust as patient from Fund-holding Practices."
  The letter goes on to ask eight questions, and I shall mention one. It said:
  "We have been led to believe that the Fund-holding Practices are financed to the same level as the Non-Fund-holding Practices. If this is so, why have the Fund-holders not run out of money?"
  I have raised the matter with the Secretary of State in writing. I have a letter sent to me by the Minister on 16 October, in which he says—he probably has a copy of it with him which he might be able to fish out—that he was sorry to learn that my constituent, Mrs. Armitage, the first one who came to my notice, has been asked to wait. He said that he understands that, in relation to the case, Wakefield Healthcare issued a statement confirming its policies to treat patients according to clinical priorities and that that is in line with national policy. He mentions joint guidance and also says that the statement
  "refers to additional funding, which I understand amounts to £800,000 for Wakefield, made available to reduce the length of time which people have to wait."
  I welcome that additional funding; I am not grumbling about that. I am asking why some people can get treated and some cannot; that seems fundamentally wrong.
  The Minister writes:
  "I understand also that in mid-September the Wakefield Fundholders' Group, which represents a number of local GP fundholders, wrote to Pinderfields Hospital NHS Trust reaffirming that treatment should be given to their patients and others on the basis of clinical need."
  I am not arguing that the fundholders in Wakefield want a two-tier system; I do not believe that they think it acceptable that some people are winners and some are losers, any more than I do. I do not blame the fundholders; I blame the system, and the Minister will have to respond to that point.
  The Minister writes:
  "I hope this information helps to reassure you that both Wakefield Health Authority and GP fundholders in the Wakefield area aim to ensure equitable treatment for all patients based on clinical need and clinical priority."
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  What the Minister does not do is answer the central question. We have a two-tier system; the Minister knows it, and I know it. The Minister will not answer my question.
  Mr. Malone: The hon. Gentleman has had a 20-minute backswing before coming to this point in his argument. I checked the record of the letters I received about these cases. I received one letter that related to the case of Mrs. Armitage; the hon. Gentleman has quoted the reply. I have learnt from experience never to comment without the fullest information on cases such as those which the hon. Gentleman has quoted to the House today. On a previous occasion, I was told of somebody who had not been able to get an operation because it had been cancelled. I discovered that the patient had pushed off to Greece and that that was why the operation had been cancelled. One has to have a care when looking at these issues.
  If the hon. Gentleman writes to me about all the cases that he has raised on the Floor of the House today, I shall happily look at them and ensure that the actions taken have accorded with Government policy. In general terms, I ask him this. Is he saying that none of these patients has been treated on the basis of clinical priority? Is he saying that none of these patients has been treated within the terms of the patients charter? What does he have to say on those two general points?
  Mr. Hinchliffe: In a moment or two, I shall tell the Minister exactly what I am saying. What I want from him is an answer to the central question. He has dodged the point. In my letter, I asked him to explain why fundholders' patients could get access to treatment whereas people such as Mrs. Armitage and the others could not. Those people are being denied treatment and that is the issue.
  The Minister was here on Tuesday when I raised the specific points with the Secretary of State. Why should people be asked, when they ring a hospital, whether they are the patients of fundholders or non-fundholders? What difference should that make? They are ringing a hospital about their needs. Why should their status make a difference to their treatment? It clearly does, and we can prove that it does.
  Mr. Stephen rose—
  Mr. Hinchliffe: The answer given by the Secretary of State—
  Mr. Stephen: On a point of order, Mr. Deputy Speaker. Is the hon. Gentleman refusing to give way to me on the ground that I am not a fundholding Member of Parliament—
  Mr. Deputy Speaker: Order. When the hon. Gentleman rose to his feet, he knew full well that what he was about to say was not a point of order. It is for the hon. Member for Wakefield (Mr. Hinchliffe) to decide whether he gives way, and the hon. Gentleman knows it.
  Mr. Hinchliffe: I have not been exactly ungenerous in giving way. I am making a point, and I think that the hon. Member for Shoreham (Mr. Stephen) understands that.
  I am losing my patience with the Government on this issue, because they will not give me an answer to my question. I do not know how much further I need to take the matter. I spelled out my question to the Secretary of

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  State on Tuesday and I spelled it out to the Minister this morning. The answers I get are not a response to my question.
  I want to know why we have a two-tier system and what the Government intend to do about it. Quite simply, the answer is fundholding and the Minister knows it. The problems are a direct, logical consequence of the system that he and his colleagues have introduced. We have an internal market, with winners and losers. The people who come to me are the losers. Incidentally, they would love to be able to go to Greece, but most of them could not walk to the taxi to get there. I can give all the case files to the Minister this morning. I hope that he will then give me an answer.
  On Tuesday, the Secretary of State said that the Government had a commitment to treatment on the "basis of clinical need". That sounds very nice, but that commitment does not seem to apply in my constituency. Why have fundholders' patients been treated in the orthopaedic department at Pinderfields hospital when non-fundholders' patients have not been? If that is not a result of a two-tier system, what is the reason?
  If the Minister does not believe what I am saying, will he look at the operating list at Pinderfields hospital? Will he check who the patients' GPs are? Will he tell me how many of those treated recently came from non-fundholding practices? I should be interested to know. I know for a fact that the money has run out for non-fundholders' patients. They cannot be treated because there is no money to pay for treatment. The money is not there. We see the two-tier system that we have predicted in all its glory. How sad it is that people have to suffer to prove the point.
  We have been told that there is no district health authority funding for orthopaedic operations. I am aware of an underspend in certain fundholding practices in our locality. That is our money—taxpayers' money, as the Government would say—and not the GP fundholders' money. Why could that money not be used to fund people like Mrs. Armitage, Mrs. Parkin and Mr. Garlick? If we have a logical system and if there is equity, the money should be used to obtain patient care, instead of being stuck in GPs' bank balances.
  My constituents want answers from the Minister. I do not blame the Pinderfields hospital trust; it can treat only the patients it is paid to treat. I do not blame Wakefield Healthcare trust because I know that it has fought for and obtained more money to address the orthopaedic problem. I learned late last night that Mr. Garlick has received a letter asking him to go into hospital because it now has more money. Mr. Garlick, however, is a victim of the two-tier system; he has been waiting since 1991 and he should have had his operation a long time ago. As a non-fundholder's patient, he has been cast aside like the others. There are probably many more cases of which I am not aware.
  I do not blame Wakefield Healthcare. I blame the Government for introducing a system that creates two tiers, winners and losers, and a fast track and a slow track. The Minister may blame my hon. Friend the Member for Peckham (Ms Harman) for raising what has happened in his constituency. My hon. Friend simply repeated what was in the national press. I read the articles with interest
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  and thought that the Minister might sympathise with my situation in Wakefield. Let us get back to addressing the real issues of equity.
  I was impressed when my hon. Friend the Member for Fife, Central described models that would enhance the role of GPs and the role of primary care. We do not have to create a two-tier, fast track and slow track system to achieve those ends.
  12.7 pm
  Mr. Keith Mans: I am pleased to speak in this health debate. It is the first time that I have had the privilege of speaking in a health debate for more than five years. The hon. Member for Wakefield (Mr. Hinchliffe) will not agree with many of my remarks, although we do have one thing in common. We have both recently returned to the Back Benches, which allows us to speak our minds in our different ways.
  During my five years in the Department of Health as a parliamentary private secretary, I saw the latter stages of the planning of the reforms, the initiation of the reforms and their subsequent progress. I was also involved in evaluating the results of the reforms. My hon. Friend the Minister set out clearly the advantages, in terms of the number of patients treated, that the reforms had allowed—over and above the extra resources, in real terms, that have been provided by the Government since 1990.
  I make that point because we must bear it in mind when we are discussing fundholding or any other issue involving the NHS as we see it today, Over the past five years, there has been an increase in real terms in the number of patients treated in the health service, at least part of which can be explained only by the fact that the service is running more efficiently as a result of the reforms.
  There has also been a dramatic decrease in waiting times. Yes, the overall waiting list as such may have increased, but all that that shows is greater demands on the NHS. Many of the people on the list are waiting only a matter of days or weeks, or in a few cases months. What is important is the fact that we have brought the total waiting time down for people who require hospital treatment.
  That applies to patients both of fundholding and of non-fundholding practices throughout the country. I would like there to be more evaluation so that we could see, on a health authority by health authority basis, how much better the health service is now than it was five years ago. The Minister knows that I pressed that point several times when I was a parliamentary private secretary.
  I should like to see exactly what is happening now in my area, Fylde, compared with what was happening five years ago. If we had more such information, we could draw comparisons between different parts of the country so that we could see where things were right, and where we had the right procedures.
  Ms Church: I know that the hon. Gentleman has a background in health and in management, and I support his request for proper information and evaluation, especially as between fundholding and non-fundholding GPs, the service that they provide for their patients and the contribution that they make to reducing inequalities. Can the hon. Gentleman explain how the Government can

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  make claims about GP fundholders and improvements in the health service, when they have carried out no studies? Indeed, as my hon. Friend the Member for Fife, Central (Mr. McLeish) said earlier, the Audit Commission report greatly regretted that no proper systematic studies had been carried out. What is the point of making claims when there is nothing to base them on?
  Mr. Mans: The hon. Lady makes a good point in terms of the amount of information that should be made available at district level. But I also disagree with her, in that there is already a fair amount of information available at national level, in the figures published by the Department of Health. Those show that, at a macro-level, there has undoubtedly been an increase in the number of patients treated over and above the extra resources made available to the NHS since 1990 and before.
  Where the hon. Lady and I might agree is—
  Ms Hodge: Will the hon. Gentleman give way?
  Mr. Mans: May I finish my first answer?
  I believe that, as we get further into the reforms, we should have more detailed information at district authority level, so that we can see which authorities are doing things more efficiently and treating more patients satisfactorily, and where lessons can be learned across the country.
  Ms Hodge: The point about the statistics kept is that they relate to patients treated in hospitals. They have nothing to do with the efficacy and efficiency of GP fundholders in providing services for their patients, especially in comparison with non-GP fundholders.
  Mr. Mans: If the hon. Lady will bear with me, I shall deal more specifically with fundholders and non-fundholders later. I was trying to make the overall point that I would like more detailed information to be available at district level across the board, as is available at national level, so that we could see what I believe to be true, and what the apocryphal evidence in my constituency supports—that people are being treated more quickly and are more satisfied with the health service now than they were a few years ago.
  What partly explains the extra number of patients being treated is the fact that our reforms have empowered people throughout the NHS to make decisions for patients and to take responsibility for those decisions. Decisions can no longer be blamed on someone else in a location remote from where patients are treated. Trusts are responsible locally, and health authorities are more responsible too, because they have the resources in their budgets. GP fundholders are also responsible, because they too have funds.
  As for the so-called two-tier system, the image offered by the Labour party is that before the reforms there was a single-tier system. Everybody who has used the health service knows perfectly well that that was never the case. We had what one could depict as a multi-tier, opaque system. People did not know whether they were waiting longer than other people down the road or in the next county. They did not know what was going on at all.
  Waiting time may have depended on who one's GP was, and who he trained with, or whether he knew a particular consultant in a certain part of the country to
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  whom he could refer one. The idea that the reforms have created a tiered system of health treatment that did not exist before is utter rubbish.
  Mr. Timms: The tone of Conservative Members' comments on the two-tier system now seems different from what we have heard in the past. Does the hon. Gentleman accept that there is now a two-tier system in general practice?
  Mr. Mans: If the hon. Gentleman will bear with me a little longer, I am trying to explain what I believe the position to be today. I am pleased that Opposition Members agree that we did not have equality of access or a single-tier system before the reforms, but an opaque system, in which nobody even knew whether they were waiting longer or shorter times, or when they would get treatment.
  I shall now give what many people might describe as a petty example of how the GP fundholding principle is improving health care. It is petty in that it does not involve health care. Right at the beginning of the reforms, a story was repeated many times; I do not know how true it is, although I suspect that there is an element of truth in it.
  Apparently, a fundholding practice negotiated a contract with its local hospital stipulating that any of its patients who had to wait more than 20 minutes to be seen by a consultant had to be given a cup of tea. That is precisely what happened. I do not know exactly how it happened, but I imagine a lady going down the line of people waiting to see the consultant and asking, "Are you from Dr. Smith's practice?" Those who were, got the tea, and those who were not did not. [Interruption.] Opposition Members may laugh, but there is a serious point here.
  What happened next? There was an outcry and the hospital simply said, "That GP fundholding practice asked for that, so we gave it to them. The health authority has only to ask for the same and it will get it too." As a result, I have no doubt that in that hospital everybody gets a cup of tea.
  Opposition Members may think that that is a ridiculous story, but that "silly little example"—it could be depicted as such—shows that, as a result of fundholding, there was a levelling-up process. That point has been more seriously and authoritatively put by Professor Glennester, in the book that I cited in an earlier intervention:
  "To argue for the abolition of fund-holding on this ground [two-tier service] is … perverse. It is akin to the philosophical paradox that equality in human needs can best be achieved by starving everyone. Equality is best pursued by seeking to maximise opportunities, not to minimise them—levelling up not down".
  To me, 'that is the main argument in favour of keeping fundholding practices. The examples that the hon. Member for Wakefield gave a few minutes ago, concerning many of his constituents who, he submits, were denied treatment, give the wrong impression, because the hon. Gentleman assumes that they were denied treatment simply because of the existence of fundholders. They were not. Without fundholders, there would not be that so-called "spare cash" in the budgets that the hon. Gentleman mentioned and those patients would not have been treated any sooner. The existence of fundholders makes no difference to the time it takes to treat patients of non-fundholding GPs.
  Ms Church: There are a number of points on which I am in agreement with the hon. Gentleman. The Opposition support a levelling-up process, but where is the evidence of that levelling up? No study has been done

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  on whether fundholding is making any contribution to reducing inequalities in the health service. Are the Government ashamed to carry out a study? Do the Government not believe that a study would prove that the system is so good?
  Mr. Mans: I shall not dwell on that point, although I do agree with the hon. Lady up to a point. I know that some studies have been done, and I hope that others will follow to prove my point.
  Mr. Malone: I am grateful to my hon. Friend for allowing me in a sense to intervene on the intervention of the hon. Member for Dagenham (Ms Church). I say to him and to her that I shall be dealing with the issue of evaluation thoroughly in my winding-up speech. I take my hon. Friend's point, but I am sure that he agrees that the formation of unified health authorities as from 1 April next year gives us an opportunity to look at how the reforms are operating on a district level.
  Mr. Mans: I am pleased that my hon. Friend will deal with that matter in his winding-up speech. There is a fair amount of information on the success of fundholders.
  It is worth making the point that, in 1990, the Labour party was convinced that fundholders would fail. The hon. Member for Peckham (Ms Harman) predicted that the patients of fundholders would suffer because of the limits on fundholders' budgets. Labour cannot have it both ways. It criticised the initiative in the first place because it said that fundholders' patients would suffer. It is now criticising the system because fundholders are clearly succeeding. Labour is now arguing that people who are not the patients of fundholders are suffering as a result of that success. I have stated that that is not true, because there has been a levelling-up process.
  Opposition Members have suggested that health commissions were the way forward. That is interesting, as those locally initiated health commissions—which I commend—have been set up as a result of the spur that they received from GP fundholders. A group of doctors have got together in my area, and my hon. Friend the Minister went to see them when he was up at the party conference. That group would never have got together had it not been for the fact that GP fundholders existed.
  We constantly hear from the Labour party—we have heard many more examples this morning—examples of patients who have not been treated because they were not members of GP fundholding practices. Labour suggests that that is the fault of the GP fundholders, but it must address its remarks to the local health authorities. Labour must ask the authorities how they cannot stretch what are effectively the same resources as far as GP fundholding practices do.
  The fact that GP fundholders have money left at the end of the financial year—and certainly two thirds of the way through the year—is an example of how resources can be used efficiently. Health authorities can learn from the experience of fundholders, and can treat more of their patients the following year within their budget.
  Mr. McLeish: The hon. Gentleman is making a thoughtful speech. I wish to tackle the issue of evaluation, although I know that the Minister has stated that he will deal with it when he winds up. The much-quoted Howard Glennester
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  submitted a paper to a market research seminar in March 1995, which looked at the impact of GP fundholding from various points of view. On equity, Professor Glennester said that the data were of such poor quality that he could not make a judgment. On efficiency, he said that the details were unknown, while there was not enough information to judge the effect on the quality of care.
  Mr. Malone: So why is the hon. Gentleman making a judgment?
  Mr. McLeish: The Minister asks why I am making a judgment in that case. Extravagant claims are being made—not by the hon. Member for Wyre (Mr. Mans), but by Ministers—about the benefits of GP fundholding. Why do the Government not set up proper evaluation techniques with proper methodologies to look at both GP fundholding and non-fundholding? What do the Government have to hide? I am sorry that my comments are addressed not to the hon. Member for Wyre, but to the Minister.
  Mr. Mans: The hon. Gentleman must wait for my hon. Friend the Minister to answer his questions at the end of the debate. I have been surprised at the tone of some of the interventions, because an Opposition Member—it may have been the hon. Member for Fife, Central (Mr. McLeish)—said earlier that we must "build upon the best". Implicit in that is the belief that the patients of fundholders seem to be getting a better service. Is the hon. Gentleman assuming that some of the best techniques available are being pioneered by GP fundholders?
  Mr. McLeish: Building on the best implies that we can have best practice in developments in non-GP fundholding, as well as in fundholding. We are looking for a level playing field. Building on the best should not mean the particularisation of the benefits flowing from GP fundholding to the exclusion of the other 50 per cent. of patients who are served by some form of health authority, GP-commissioning framework.
  Mr. Mans: I agree with that point, as we must obviously build upon the best—wherever it is. It is clear from Opposition Members' remarks that GP fundholding is working in the sense that the patients of those fundholders seem to be getting treatment sooner than other patients. That shows that some of the best practice is available in GP fundholders' practices as a result of them holding their own budgets. That is the key to the discussion.
  If we take away GP fundholders' empowerment and their ability to make decisions and live with the financial implications, we shall reduce the amount of innovation and we shall find that the best practice is levelled down on the altar of equality of access. As a result, fewer patients will be treated in an attempt to make certain that there is more equality of access for those who are not the patients of fundholding practices.
  We have dwelt long enough on that point; I shall make a couple of other points before I finish. We hear a great deal from Labour about the amounts spent on administration. As far as I can understand, the Opposition want to spend more money on evaluating the results of the reforms. In no way can that money be directly related to patient care—an argument normally put forward by Opposition Members when money is spent on information technology or computers.

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  I believe that good use is made of NHS money. Services are moved forward. For example, information technology is used dramatically more nowadays than five years ago. It is surely odd that many Labour Members decry that use of NHS money, yet suggest that we should use IT increasingly in schools and elsewhere. If we are to have a modern health service, we must embrace IT. We must employ people to collect all the data that Labour Members want to ensure that the health service is more efficient.
  Labour Members cannot have it both ways. If they accept, as the hon. Member for Dagenham (Ms Church) is by nodding her head, that that is not possible, I hope that she and others will not complain in future about the moneys that have not been spent on patient care.
  Ms Church: We are not concerned if money is spent on proper and systematic research into the effect of the huge changes that were introduced in one fell swoop throughout England without pilot studies being undertaken. Of course there should have been—[Interruption.] I would ask the Minister and other Conservative Members to allow me to continue. It is—[Interruption.]—
  Madam Deputy Speaker (Dame Janet Fookes): Order. There is a recurrence of seated commentaries and interventions. From whichever side of the Chamber they come, I deprecate them.
  Ms Church: The changes to which I was referring were introduced by the Government throughout England without any pilot studies being undertaken. There was no proper opportunity to monitor the progress of the changes, to ensure that the system would work and would meet the Government's objectives. The Government's approach was not scientific and was managerially wrong. Indeed, it was incompetent.
  Now, in the run-up to the general election, the Government have decided that they want to spend some money to ensure that it is "proved" that their system has worked. Of course, we—
  Madam Deputy Speaker: Order. The hon. Lady's intervention is much too long.
  Mr. Mans: I shall try to answer some of the questions that the hon. Lady posed. First, as I understand it, there were pilot studies of GP fundholding. Secondly, as I understand it—[Interruption.] I hope that the hon. Lady will listen to the answer or answers that I am trying to give her. As I have said, there were pilot studies of GP fundholding before the scheme was introduced. I think that I am right in saying that a fair amount of evidence was compiled before the purchaser-provider split and trusts were introduced in 1991.
  It could be argued that GP fundholding was introduced voluntarily and thus was an evolutionary process. Only a practice that felt that it could cope with the burden of fundholding was allowed to go ahead. Experiments took place that built on what had gone before. As a result, we have a system that is being reformed as it proceeds. I believe that it is highly successful.
  Fundholders have been much more successful than was anticipated. I have been surprised by the innovations and new ideas that have flowed from the ability of doctors to decide that they want to do something on behalf of their patients and then to act because they have the necessary
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  financial resources. Labour Members tell doctors that they want them to have new ideas, but at the same time they say, "You won't have any money to implement them." They want to give authority to others, to those who are further away from the problems that GPs are trying to overcome and less knowledgeable about them.
  Much has been said about bureaucrats, managers and administrators in the health service. We spend too much time studying inputs, and more time should be spent examining the number of patients treated. There has been an awful lot of comment in the Chamber about having too many administrators and bureaucrats. It is right that we should ensure that there are not people in the health service who carry out work that is not absolutely necessary. However, we should not cut arbitrarily the number of administrators or bureaucrats; we have to relate such cuts to the effect that they would have on the number of patients treated.
  I am not desperately worried about the ratio of doctors and nurses to other people working in the health service. What is important is that, whatever the ratio in a particular area may be, it maximises the amount of patient care that is possible.
  Mr. Rendel: The hon. Gentleman may have failed to recognise that the Secretary of State announced in Blackpool just such an arbitrary cut in bureaucrats.
  Mr. Mans: The hon. Gentleman does me a disservice. I most certainly heard what my right hon. Friend the Secretary of State said. The Secretary of State made the specific point that he wanted that cut to increase the number of patients treated. My point is that we should not consider administrators in isolation and say that the fact that their numbers happen to have gone up at a certain time demonstrates how inefficiently the health service is operating.
  To take one example, many GP practices, fundholding and non-fundholding, have practice managers. I strongly advocate that as a good move. The number of administrators will have increased as a result of that move, but the number of patients being properly treated will probably have gone up as well, because GPs will be able to devote more time to treating patients and less to filling in forms.
  In conclusion, I strongly believe that we already have a fair amount of information available at national level to show that the reforms over the past five years have been very successful. More patients have been treated and that cannot be explained only by the extra resources that the Government have put into the health service.
  We have to embrace information technology and ensure that medical advances are used increasingly to make certain that we get the maximum benefit from the money provided by the taxpayer for the health service. That process will happen increasingly in the primary rather than secondary care part of the system. The driving force behind innovation and the use of new technology and techniques has been the GP fundholding initiative. I want it to be developed further. I am certain that that points the right way for the health service.
  12.37 pm
  Mr. David Rendel: I am grateful for the opportunity to speak in this important debate. I have a personal interest, in that my wife is a GP in a practice in Newbury. The House will not be surprised to hear that I

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  am a strong supporter of the pre-eminent place of primary health care in the health service in looking after the health of the nation. There are several reasons for that.
  First, prevention is surely better than cure. Primary care is the main arena for preventive medicine. Secondly, and this is a connected point, it is a national health service—I stress the word "health", because we should never forget that that is what it is all about. Primary health care gives the best opportunity to work towards good health promotion.
  Thirdly, it is primary care, on the whole, in which patients have the greatest say. Most patients find it easier to talk to their GP than to a hospital specialist, who may talk in a strange and idiosyncratic language and find it more difficult than a GP would to explain to patients the details of what is involved.
  Cynics will ask about the Government's real aim in supporting the pre-eminence of primary care in the health service. There is no question that many people would answer that the Government are after cost-cutting yet again. People cannot be blamed for assuming that that is the Government's main aim when one considers what has happened over such issues as care in the community. We have all accepted that care in the community is the right way to go, but we have seen what has happened as it has been introduced.
  Although care in the community may be the right policy, it does not work unless it is backed by the right funds. In exactly the same way, making primary care the pre-eminent part of the health service may be the right policy, but it will not and cannot work unless it is supported by the best resources.
  Mr. Malone: On care in the community, does the hon. Gentleman agree that, while funds are important, implementing proper practice is also important? In some authorities where the care programme approach has been implemented it works successfully, but in others where it has not been implemented it does not. Although funds are important, they are not the sole explanation of why the policy works well in some areas but not in others.
  Mr. Rendel: I should have thought that implementation of the policy would depend heavily on the amount of resources allocated to it, so the two issues interact closely.
  In practice, if we move more resources into primary health care, we may save some hospital costs. The danger, however, is that we would do so at the cost of greatly increasing GP work loads if there is no corresponding increase in funds for primary care. Moreover, if we move more effort into the primary care sector, that will lead in some cases to greater need being identified. That is another reason why, if we are to go down that route, we shall need greater resources to manage the greater needs that are then identified. How does that fit in with the Government's hospital closure programme?
  Let us examine in more detail how the Government want to move extra resources into primary care. They want to base the move almost entirely on fundholding. I hope that the rest of this debate will not concentrate on fundholding, as it has until now, and that some hon. Members will concentrate instead on primary care.
  I do not deny for a moment that fundholding can bring some benefits. In particular, it has tended to teach some GPs about the importance of taking care with regard to drug
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  costs. It is not a question of prescribing less—that would be the wrong way to look at the matter, although that point has been made by some Conservative Members—but of prescribing, where possible, alternative but equally effective drugs which may cost less. That important change has sometimes been brought about by fundholding.
  However, that change could have taken place without the introduction of fundholding. Had GPs gone about matters in the right way, and had more pressure been put on them to bring down their prescription costs, that change could have been made without fundholding. Fundholding has, however, pointed the way for some GPs, even non-fundholders, to bring down their drug costs.
  Fundholding can help to bring some services closer to patients. Cases have been well advertised in which physiotherapy services, for instance, have been brought into the GPs' surgeries and thus brought closer to the patients who need them.
  There are, however, several disadvantages to fundholding and it is important to mention those as well as the advantages if we are to have a clear picture of what is happening.
  A constituent of mine had the misfortune, some years ago, to be involved in a car accident in Wales. He hurt his back severely and was out of work as a result of the pain. He was sent to various different hospitals until at last he found a specialist who could deal with his problem. That specialist cured the pain, and my constituent was able to return to work. He then moved into my constituency and, several years later, the pain recurred. Once again, he had to leave his job, at a considerable cost to the community as a whole.
  He was by that time with a fundholding practice in my constituency, and he visited his GP and asked to be referred back to the one specialist who he knew had been able to treat the problem in the past. The specialist being in Wales, however, that fundholding GP did not have a contract with him and refused to send the patient back to him. He tried all sorts of other specialists with whom he did have contracts; none of them worked, but he insisted to the patient that those specialists were every bit as good as the man that he had seen in Wales. No doubt that was true, in general terms, but they did not work for that patient.
  Those of us who know anything about medicine realise that the psychological effects of visiting a doctor whom one trusts and who one believes can bring about a cure are often extremely important. Only when, after a series of letters from me, the GP was in effect forced to allow the patient to be referred back to the man whom he had seen originally, was the man cured of his pain once again and enabled to return to work, with all the savings that that implied for the taxpayer. That is an example of a way in which fundholding certainly does not work.
  I agree with the hon. Member for Newham, North-East (Mr. Timms), who intervened earlier, that there has been an interesting change in the Government's line as to whether fundholding implies a two-tier system. When the Minister was questioned about that earlier, although he attempted to deny it, in practice what he said was not a denial of the idea that there is now a two-tier system. He admitted that, in effect, a two-tier system had been introduced deliberately, but said that it was only in the marginal aspects of medicine and not in the centre.

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  The Minister went further, saying that there was now and always had been a two-tier system, in that, in different regions, patients receive different levels of service. It is true that that always has been the case, and it is one of the scandals of the health service that that has not been corrected in the past. It should be corrected now, but fundholding does not help the problem.
  There is undoubtedly unequal funding of fundholding practices and non-fundholding practices, perhaps especially in information technology equipment. Two years ago, the British Medical Association made proposals to the NHS executive to introduce equity and high standards of computerisation. The executive said that it would respond, but for two years it has failed to do so. Will the Minister tell us today what his response is to that initiative? He must surely want to respond that there will be a levelling up of funds for IT equipment for non-fundholding practices.
  Far from being popular with GPs, in practice fundholding is very unpopular, even with most fundholders. It is nonsense to say, that because people take on fundholding duties, it follows that they must like it and prefer it to the old system. As a result of all the extra administration involved, most of the fundholders object to it. I say that from personal experience, because, as I am married to a GP, my wife and I know a great many GPs from both fundholding and non-fundholding practices.
  As was briefly mentioned, fundholding has undoubtedly brought about a major increase in emergency admissions—by fundholders because in many cases it is a way of getting their patients treated without it coming off their budgets, and by non-fundholders because it is often the only way they can ensure that their patients are treated. Whatever may have been said by Conservative Members, the evidence clearly shows that the huge increase in emergency admissions must mean that people are either being held back until they are emergencies or going into hospital as emergencies when previously they would not have been counted as such.
  There are alternative ways of obtaining the advantages of fundholding. That is what is wrong with the present move towards greater fundholding. Locality purchasing, joint commissioning or whatever one likes to call it, would unquestionably bring about much of the increased command that GPs have over the way in which their funds are used without involving them in the extra administrative burden that they so much abhor.
  Locality purchasing is to fundholding what the local management of schools is to the grant-maintained system. It is wrong that the Government refuse to encourage locality purchasing. They are perfectly happy about the local management of schools, and I wish that they would do more to encourage locality purchasing. Do they not do so because the equity of funding combined with locality purchasing would lead not to fundholding being abolished but to its withering on the vine? They do not seem to like that idea. It is unnecessary to make fundholding the basis for a new emphasis on primary care in the NHS. Is it now possible, as I would like, for primary care to take on that expanded role?
  There is a huge danger in the desperately low morale of the GP service. We have been told today that morale is no lower than it has ever been. That shows how out of touch some hon. Members are. I have been familiar with the health service scene since I first met my wife in 1969, and I have never seen morale in the health service so low as it is now, particularly among GPs.
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  There are many signs: recruitment is desperately difficult, especially in many inner cities, the number of applicants per post is falling and some jobs often have to be re-advertised, perhaps more than once. A recent report showed that, in Yorkshire, 78 out of 300 training posts remain empty. In Wales, the figure is 40 out of 80, and in the west of Scotland there are now 27 posts lying empty. In Yorkshire in 1989, there were 30 applicants per vacancy; by 1992, the figure had dropped to just five.
  Another sign is the number of GPs who now take early retirement. It is difficult to find a GP who retires later than the earliest moment at which his or her practice agreement allows that to happen. That never used to be true; GPs used to continue into their 70s or even 80s. That was not necessarily a good idea, but it was possible and some GPs were keen to do it. One could not find a GP now who wanted to continue in practice for longer than was absolutely necessary.
  What are the reasons for the low morale? Patients are becoming more knowledgeable, which is a good thing, and are therefore becoming more demanding. There is nothing wrong with that, but the GPs' work load is increasing as a result. There are more elderly patients and, as we all know, the elderly are not only ill more often, but their illnesses are often more severe. Patients are discharged from hospital earlier and return to their GP's care at a time when they would previously have remained in hospital.
  We must never forget that doctors are not in the job for the money. They do not enter GP work or primary care for the money, but because they want a job which allows them to express their care for other people in the community. As has been, there is a culture change in the NHS, but that change is not welcome to the GPs or to any of the medical staff. They are uncertain about their future and about whether the NHS will survive in anything like its present form. They work desperately long hours.
  This important point is not contradicted by list sizes, which have been reduced. As each patient requires more than before, the overall level of work has increased. A survey of west country GPs, which was discussed in the House recently, showed that more than half of them are working more than 64 hours per week and many are working more than 80 hours per week—70 per cent. of them thought that the hours they work are putting their patients at risk. There can be no doubt of that risk when doctors are on duty all through the night and possibly through the next day as well.
  Long hours are caused not least by an increase in administration, form-filling and budgeting. In Blackpool, the Secretary of State made a great proclamation that was welcomed widely by his audience. He said that he was cutting the number of forms to be filled in by GPs by 15 million per year. That sounds marvellous until one realises that it means merely that each year each GP will be filling in one form fewer per three patients—a minimal drop in work load.
  Finally, there is the huge burden on GPs of the present complaints system. It is cumbersome and lengthy, and leaves GPs in uncertainty for long periods and it is hugely stressful. I have known GPs having to drop out of work for a while because of stress caused by the complaints system. It would be much better for patients and doctors if we could introduce once and for all a no-fault compensation system. The only people who might suffer are the lawyers, who would no longer get the work involved in taking lengthy medical cases through the courts year after year.

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  In principle, it is right to increase our reliance on primary care, but I have deep concerns about how the Government have chosen to do it. First, they should have resolved the huge problems currently facing primary care, which find their expression in the appallingly low morale of most GPs but which arise from the hugely increased work load for which GPs have been given no increased resources to enable them to cope. Secondly, the Government should not have chosen to rely on the deeply flawed fundholding ideology. Whatever benefits it may have brought, it has undoubtedly led to a divisive two-tier system while destroying the trust between doctor and patient which is such a crucial part of the healing process.
  As usual, the Government have succeeded in so mismanaging what started as a good idea that they have lost its entire value. When that happens with something as precious to Britain as our national health service, it is not just a shame—it is a tragedy.
  12.56 pm
  Mr. Roger Sims: I preface my remarks by expressing a welcome to the hon. Member for Fife, Central (Mr. McLeish), albeit in his absence, on his Front-Bench debut. We listened with interest to what he had to say, and the whole House listened with particular sympathy to his account of his personal experience of the health service earlier this year. It cannot have been easy for him to discuss that matter in public. He said that all his constituents should be entitled to the best possible service, and, of course, we all share that wish.
  We shall study carefully what the hon. Gentleman said about Labour party policy on fundholding. He made several references to the desirability of common ground, which clearly we would all like to feel that we occupy, but it seems to me that he and his party still do not understand the philosophy behind GP fundholding and certainly he does not understand how it works in practice. I was a little surprised by his criticism of my hon. Friend the Minister for what he described as a partisan approach. If anybody, having started on what appeared to be common ground, finished by being very partisan, it was the hon. Member for Fife, Central.
  The subject of our debate is
  "Fundholding in a primary care-led National Health Service".
  Of course, the NHS is and always has been essentially primary care-led, but it is becoming even more so. Not only is the general practitioner the so-called gatekeeper to services, but increasingly GPs are actually giving treatments which in the past would have been given in hospitals. If they do not actually give the treatment, they may provide accommodation within the practice premises for visiting consultants or, in the case of my own GP, from time to time caravans with specialist facilities have been parked outside for the benefit of patients.
  Just as services are coming down the line from the centre to the individual GP, so should finance. Currently, the Department of Health makes grants to regions, which in turn pass money to districts. A district has a global picture of what is required in its area, and so can judge how resources can best be used. As general practitioners have even better knowledge of patients' needs, it is sensible that, if they so wish, they should hold the purse strings. That is surely what fundholding is all about.
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  We have heard, and will no doubt continue to hear, the inevitable comments about a two-tier service. My hon. Friend the Member for Croydon, North-East (Mr. Congdon) dealt with some of them in his speech. It is evident that, if resources are limited and contracts are made between providers and purchasers, in some circumstances a health authority contract for routine and straightforward operations may be exhausted and patients may have to wait until the next financial year, while GP fundholders may have organised their finances on a different basis and be able to continue to make that provision for their patients. That is bound to happen from time to time, and it would be hard to avoid it.
  However, it is possible that the reverse may also be true. GP fundholders may have exhausted their contracts and therefore find themselves unable to arrange routine operations, while non-fundholding doctors, still being directly funded by the health authority, may not have exhausted their contracts and may be able to continue to arrange routine operations. It could be two-tier in both directions.
  In fact, there is not much substance to the argument about a two-tier service, because the NHS has actually always been multi-tier. Provision has always depended on the part of the country in which one lives, one's doctor, the local hospital, the differing lengths of waiting lists, and so on. The claim about a two-tier service simply does not stand up.
  Mr. Rendel: Can the hon. Gentleman give us examples of fundholding practices that have run out of money while the local health authority has had the money to continue to provide routine operations?
  Mr. Sims: I cannot provide examples off the top of my head. I have certainly heard of such examples, but I accept that they are few, probably because GP fundholders know the needs of their patients and thus are better able to organise their finances than health authorities are generally able to do. In the past, everything was haphazard; now fundholders can arrange access to services according to pain and the severity of illness. It is no longer a matter of just adding a name to a waiting list.
  Fundholding facilitates the co-ordination of services in the interests of patients rather than consultants; it brings together the budgets for primary, secondary and community care; it makes GPs and consultants aware of costs; it increases the range of services available to patients; it ensures the decentralisation of control and decision-making, and GPs can purchase the best service for their patients.
  Whatever the Opposition may say, the fact is that fundholding is working. It is not perfect, because it is still at a relatively early stage, but a number of surveys have proved that it is successful. Several references have been made to lack of research, so I draw hon. Members' attention to an interesting document issued by the Institute of Health Services Management, written by Mr. Donald W. Light and entitled, "The future of fundholding". Mr. Light is an American, who brings an objective view to fundholding.
  I advise hon. Members to read the document, which examines fundholding, warts and all. It mentions some of the shortcomings, but states that the advantages enormously outweigh them. We surely need to consider how fundholding is working and proceed with it rather than going back to where we were before, as the Opposition seem inclined to do.

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  My hon. Friend the Minister said that the scene is still changing, and my right hon. Friend the Secretary of State has said that fundholding as it is at present is not to be the only model. One way forward is the introduction of the three levels of fundholding. The first is the standard level, and it is proposed to reduce the list size necessary to qualify as a fundholding practice. The second is community fundholding, whereby a more limited range of services would be available for fundholders with smaller lists. There is no doubt that that idea is attracting GPs in my constituency who have hitherto been hesitant about becoming fundholders. The third level involves fundholders who are already well into the process and may wish to take advantage of the proposal for total purchasing. The reaction to the pilot scheme suggests that that is likely to be successful.
  Of course there are still variations in the extent to which fundholding has been taken up in different parts of the country, and there is concern about suggestions of tension, if not competition, between health authorities and fundholders. That should not and need not be the case.
  I was also rather worried to hear what the hon. Member for Wakefield (Mr. Hinchliffe) was telling us about non-fundholders who reached the stage where they found it necessary to write a joint letter to the health authority. That seems to show a regrettable lack of co-operation, co-ordination and communication between the non-fundholding doctors and the health authority. I am not sure where the fault lies.
  I should like to draw the House's attention to what is happening in Bromley, where a number of general practitioners—fundholding and non-fundholding—have been appointed to the health authority as clinical commissioning directors. Perhaps the House will allow me to quote from the document to which I referred and which states how that works—or rather, how it is intended to work as it is still in its early stages. It states:
  "The Bromley experiment, called Clinical Commissioning to indicate that creative purchasing will be done for everyone in the Bromley area, consists of appointing GPs (including fundholders) from sub-areas called 'locality patches,' as clinical commissioning directors. They will be paid for a session a week at BMA consultant rates to serve on a clinical commissioning board. They will go through a training programme, learn about overall commissioning and then decide how best to commission services and allocate funds. They will present the views of their part of the GP community and interact with them through a network of peer groups to learn their priorities, and to inform them about deliberation. At the moment, the scope is hospital and community health services, but general medical services could be and may be added. The aim of the Board is to reach consensus about decisions, but the Chief Executive has ultimate responsibility and thus makes final decisions."
  The advantage of clinical commissioning is that it puts GPs, fundholders or otherwise, at the very heart of commissioning and gives them a say in the decisions. It means that they can work together, instead of being in conflict. Indeed, Claire Perry, the chief executive of Bromley health authority, said:
  "GPs are the best group to do overall commissioning because they have the best feel for local residents and can communicate best with consultants."
  There are clear benefits from clinical commissioning, especially for patients. Clinical commissioning gives GPs more involvement, which means better quality services for the patients and better use of NHS resources. It is an opportunity for GPs to involve themselves in a new role which brings them right to the heart of the commissioning
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  process. It also shares power—that is part of the object of the operation. Bromley health authority wants a real partnership with GPs and wants to actively involve them. It is an effective model, because it mobilises practice-based evidence to help us tackle the issues of service effectiveness and providers.
  It seems that clinical commissioning is a logical development from fundholding. Indeed, it is likely, as more GPs become involved in it, that those who are not already fundholders may be attracted to fundholding status.
  I welcome this debate as an opportunity to demonstrate the advantages of fundholding, to discuss how it can develop, and also—perhaps—to educate the Labour party in the developments. The right hon. Member for Derby, South (Mrs. Beckett), in one of her last statements as the shadow Secretary of State for Health, said that she recognised the advances that fundholding has brought to many patients. Surely we all do, and we all want all our constituents to benefit from those advances. That, at least, is common ground.
  1.10 pm
  Ms Margaret Hodge: I want first to deal with some general points, and then turn specifically to the position in my constituency.
  A number of Conservative Members have made the point that the reforms in relation to general practitioners with the introduction of fundholding were something to do with levelling up. It is strange to hear that Conservative Members and the Government are in any way interested in levelling up the health service. Their record is all one of levelling it down and of a lack of confidence and trust in their ability to run a national health service.
  More importantly, we do not, as the hon. Member for Wyre (Mr. Mans) suggested, level up by institutionalising inequality. All of us want to level up and improve the quality of health care in this nation, but we must do that hand in hand with ensuring equality of access. One of the strongest criticisms that Labour Members make of the introduction of GP fundholding is that it has institutionalised yet further inequality by bringing about a two-tier system.
  We have been told that there has always been inequality; that we have always had a two-tier system. Indeed, there have always been inequalities in health care, but the purpose and role of any responsible Government must be to tackle those inequalities and disparities of access, not, by a deliberate act of Government policy, to further it and deliberately to strengthen it. The role of a responsible Government must be to introduce policies that lessen the differences, not heighten them. Labour Members' second general criticism of the Government is that they are heightening the differences through the way in which they have introduced the reform.
  I am all for introducing and strengthening the role of general practitioners in commissioning health care—of course it makes sense. Our attack is on the way in which that has been done: partly to the exclusion of other interested parties in the commissioning process, but especially by introducing a two-tier service which disadvantages far too many people in Britain today.
  Mr. Merchant: Is the hon. Lady saying, therefore, that, if all GP practices became fundholders, she would be happy?
  Ms Hodge: I am saying that I would like us to revise, as we propose, the way in which we commission health

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  care, so that we involve not only GPs, but others who work in the primary care service—health visitors, midwives, district nurses and local authorities, which have a role in care in the community. I would like a system that strengthens that involvement in the purchase of health care. I do not believe that the way forward is through the current structure of GP fundholding; there are other mechanisms.
  As part of the general thrust of our argument about primary care and GP fundholders, I make this point. I have with me some research that was carried out by York university on the allocation of resources. If the Government want to bring equity into the system, they must deal with the allocation of resources. The most recent research by York university on the North Thames region shows that the gainers have been areas that have the least need for additional health resources. North Essex has gained almost £23 million in capitation. At the bottom of the table, the East London and the City health authority and my authority have lost more than £23 million in health resources. If we want equity and equality of access to health care, we must shift resources to the areas that have the highest levels of deprivation. That is not what the Government are doing. Their policy institutionalises and increases inequality.
  Mr. Malone: Is the hon. Lady suggesting that the formula for allocating resources for patients on an equitable basis, which has been informed by the York study and which has been refined so that it makes the allocation more responsive to local need, is defective compared with her ex-cathedra statements? She is embarking on dangerous ground if she pitches out the formula, which we have refined for some time and which, until now, has been common ground. If she wants her simple observations to replace it, we are in for an interesting time.
  Ms Hodge: I simply make the observation that if, under the formula, a district with one of the sickest populations loses a further £14 million, it would appear to be common sense further to refine that formula. I hope that when the Minister looks at the statistics, he will take a similar view.
  I am enormously concerned about the health service in general in Barking, and especially about GP services. I shall examine GP fundholding services in terms of what they are doing for GP primary care services in my constituency. I have said in previous health debates that I believe that east London is one of the areas whose health needs, and therefore health services, have been ignored for too long, even in the context of the health needs of the capital.
  People in east London do not shout as loudly as those in other parts in London, as has been shown by the appalling closure proposals for Bart's and Guy's. In east London, we have lost an enormous number of hospitals. There is no longer a hospital in my constituency; there is no hospital in the borough. Many of my constituents have to travel 10 to 12 miles to attend a hospital. Public transport facilities are poor, and most people are too poor to afford a taxi. Almost half of my constituents—40 per cent.—have no access to a car. In the context of that absurd hospital closure programme, which clearly did not take into account the health needs of the people in my
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  constituency, it is critical that there should be good access to high-quality primary care facilities if those people are to enjoy equality of access to a national health service.
  Yet in my constituency the premises of many practices are of very poor quality. The quality of the practitioners themselves is often worrying, too, and, as the chair of the FHSA has said to me several times, the authority's ability to recruit high-quality practitioners is limited.
  The people who live in Barking are the most in need, yet in my part of east London they are the ones furthest from a hospital. In my constituency I have the highest concentration of children under five, the highest concentration of the homeless and the highest concentration of elderly people, yet we are the furthest from a hospital.
  Despite the distance from a hospital, we have a problem with poor primary health care. The statistics produced for "The Health of the Nation" are worse for Barking than elsewhere. For example, the instance of coronary heart disease is way above the national average, as is the rate of conception among under-16s. The rate of accidents to girls under 15 is three times the national average.
  With that background, what are our primary health care facilities? The most recent data give a shocking picture: 81 per cent. of the premises that are supposed to provide the facilities that can no longer be provided by hospitals were classified as poor. Not one surgery in Barking was classified in the best category. In other parts of London where there are areas of deprivation—Lambeth, Lewisham or Southwark, for example—50 per cent. of surgeries were classified as poor. Yet in Barking the figure was 81 per cent.
  Who are the GPs in Barking? There is a strong concentration of single-person practices, and many of the GPs are elderly. One in five is likely to retire in the next few years, and the FHSA will have an enormous task to replace them. When it advertises for GPs, the response rate is extremely poor.
  Our premises are poor, we have an elderly cohort of GPs, and we have more GPs dealing with patient lists above the national average. The average patient list in my constituency is 2,175 per GP, and more than one in four practices in Barking have patient lists of more than 2,500. Those are large lists for single-person practices working in poor premises. Only 8 per cent. of GPs in England work in practices with patient lists of more than 2,500.
  Other aspects of the profile of general practitioners in Barking are worrying, too. We have fewer women doctors than the national average. The number of support staff working in primary care is lower than the national average. One in 10 of the GPs in Barking has no practice nurse. There are hardly any training facilities in my constituency, and many of the GPs working there have to go as far as Basildon for their in-service training. In the entire district health authority and FHSA area, we would need as many as 30 additional GPs simply to reach the national average in relation to the ratio of patients per GP.
  In that context, individual fundholding is irrelevant to the needs of my constituency. More money going towards administration costs does not help. I understand from the answer to a question by my hon. Friend the Member for Darlington (Mr. Milburn) that the public subsidy towards management and computer costs in the NHS works out at £201.1 million. I would rather that that money was spent

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  on recruiting more quality GPs for my constituency and improving the premises in which they have to operate to enable them to provide a better service to my constituents. I want money to go to premises, training and providing incentive payments to attract high-calibre GPs to east London. That money could be spent on the support staff necessary to provide a high-quality primary health care service in east London.
  I wish to draw the attention of the House to some cases from my constituency. As a relatively new Member of the House, I have been astonished to note the number of people coming to my surgery each week with valid complaints about the quality of health care that they have received. What has shocked me is that, in barely a year as a Member of Parliament, I have had four cases in which people have died and in which, on the face of it, the death could have been avoided had there been an effective health service operating in my part of London. Two of the cases relate to the quality of service provided by GPs.
  One case involved a young girl in her early 20s who had pains in her left leg. She visited her GP, and was referred to a hospital where she was placed on a waiting list for an arthroscopy. While she was waiting for that appointment, the pain became worse and she returned to her GP, who had no further advice for her.
  On Christmas eve last year, the GP visited her home, and her father recalls that the consultation lasted for about one and a half minutes. The GP did not examine her knee, but did prescribe some mild painkillers. Her condition got worse during the Christmas and new year period, and her father tried to get the GP—a sole practitioner—to visit. He would not, and her father was unable to get an urgent appointment with a GP. On 24 January this year, the young girl collapsed and became unconscious. Her father rang the GP, who could not send a doctor. Soon after, Maria died in her father's arms.
  Obviously, the family are pursuing the case through the appropriate processes, but I hope that there will be an inquest into my constituent's death. Maria was taking a pill that we have since learnt is one likely to cause a blood clot. It seems to me as a lay person that, with better-quality care from her GP, her death could have been avoided. I am deeply concerned that the Government's policies are not raising the quality of primary health care. Instead, they are motivated by Conservative dogma that the only way to improve anything is to try to introduce a phoney market.
  The other case to which I draw the attention of the House involved a young man—he was 32—who had a wife and children. He first fell ill in May 1994. His GP prescribed antibiotics. Later in 1994, he was given more medicine because he had a stomach upset. He continued to feel ill and went to see his GP, who told him to see a psychiatrist. He managed eventually to see a specialist at King George's hospital. Within two days, he was diagnosed as having cancer. He died within days. That tragic episode is being investigated by the relevant committee. It demonstrates to me that there was poor practice at the first port of call for anyone who is in need of help from the health service.
  The family health services authority in my constituency is doing its best to tackle what I consider to be inadequate primary health care facilities in the area. It is trying to work with the Government's irrelevant policies. I commend the authority because I think that it works
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  imaginatively with the reforms. It is not in the business of establishing a GP market. Instead, it is using and manipulating fundholding and producing an example of how we can strengthen the capacity of GPs.
  The FHSA has set up a multi-fund that brings together 34 GPs in 22 practices. It has probably added to the number of fundholders in the Minister's statistics. The authority does not think that fundholding is a good thing, but it is using the system to improve the capacity of GPs in my constituency and to provide them with direct support.
  Thirteen of the 34 GPs represent single-handed practices and seven double-handed practices. The FHSA has found a way of collectivising commissioning within my patch. It is not a way of creating greater division, nor is it a way of introducing the market. Through the collective strength that is supported by the FHSA, we shall improve somewhat the quality of patient care.
  It was absurd that Barking hospital was closed when my constituency was represented by the late Jo Richardson. She fought the closure vigorously. It is a scandalous story of a building, much of which was put up in the 1970s but some in the mid-1980s, and most of which is now empty.
  A physiotherapy clinic was located there and the multi-fund GP fundholders have used that physiotherapy clinic to good advantage. The physiotherapy clinic was funded, in the complex health world in which we now live, by Redbridge Healthcare NHS trust, which runs King George hospital. The trust does not want the clinic. It has no interest in the well-being of people in Barking; it is concerned with people who live in Redbridge. The trust wanted to close the clinic and has given notice that it intends to do so.
  However, now another health authority—Barking and Havering—through its purchasing and the GPs, through fundholding, will ensure that another lot of people are imported to retain the facility. X-ray equipment is going to be removed to one hospital from Barking hospital, while X-ray equipment is imported from another hospital to Barking hospital. How that makes sense, or demonstrates an effective and efficient use of resources, I am left to wonder. However, because the GP fundholders worked collectively—rather than individually—in a multi-fund concept, we have managed to retain a facility that is of benefit to my constituents.
  The truth is that GP fundholding is not the answer for the people of Barking. It is typical of much of the Government's policy on the public services that if they cannot manage something efficiently they cop out and pass the buck to somebody else. The really difficult but important task is getting to grips with managing our resources more effectively so that we can improve the quality of the health service that we offer to all, not just to some.
  My part of east London has been badly served by the Government's health reforms. Too many hospitals have closed; too little money has been invested in primary health care; and too little attention has been given to the real problems that face primary health care services in our part of London. We must improve the facilities; ensure that we provide the proper pay and incentives to attract high-calibre GPs to work in the poor areas of an urban capital such as London; and ensure that there are sufficient resources for the support services.

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  I will end with this story. I spend a lot of time in my constituency, which has many old people, going around the luncheon clubs that are provided by the local authority. I talk to those old people about the health service, which is clearly of huge concern to them as they reach the age where they will require the services of a high-quality health service.
  I was shocked the other week to be in a luncheon club where we discussing the imminent closure of the accident and emergency unit at Oldchurch hospital. One woman told me, "I have given up. I don't bother any longer to go and see either my doctor or the hospital because it is too far away and I can't get there." I do not know what that will mean for that woman, but I know that if—when—there is a change of Government and we take control of the Department of Health and try to reinstate a truly national health service, we will ensure that the real problems facing real people in ordinary communities are tackled and stop the absurdity of dogma dominating how we run our health service.
  1.39 pm
  Mr. Piers Merchant: We have heard a great deal today from Opposition Members about equality of access and equity, but that issue is not the preserve of the Opposition. I believe in it just as strongly as Opposition Members do. I listened to the examples given by the hon. Member for Barking (Ms Hodge) and I sympathise with her and her constituents in wanting the best possible care at primary and other levels of the health service. The question is: how will that be brought about? I make no apology for saying that I believe strongly in the concept of GP fundholding. By extending that system by one mechanism or another to all GPs, we shall achieve exactly what the hon. Lady wishes.
  There is an innate contradiction in the position adopted by many Opposition Members. They talk about a two-tier system, which implies that GP fundholders can offer their patients a better service—that may be true, and I believe that it is—yet when they are given an opportunity to extend that better form of treatment and administration to the whole sector, they back away and say that they want something else. I am a little uncertain about exactly what they want. They seem to accept that GPs should play a greater role in determining administrative matters at that level and in decision making, but they seem to want it by putting GPs on committees where they will spend their time arguing about decisions rather than doing what they should do, which is looking after patients. I hope to illustrate in a moment exactly how GP fundholding enables GPs to do that.
  At the risk of sickening my hon. Friend the Minister, I refer to a GP practice in my constituency to which I referred earlier this week in Health questions, because it is a good example of how the system works. It is a long-established GP fundholding surgery, which has had time to settle in and develop exactly what the system can develop.
  Since its establishment, Elm House surgery has been able to develop incredibly the service that it offers to its patients. I have been round the surgery a number of times and have seen it develop. It now offers an operating theatre for minor operations; its own purpose-built out
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  patients consultancy room; its own nursing staff; and full administrative support. But GPs do not spend their time writing out records or calculating finances; they have been further freed to look after their patients. Nevertheless, because the decisions and administration take place on their premises, they can exercise an overview of them at all times, and can control and determine the direction in which their practice develops.
  What really matters, however, is what the patients think. The patients are my constituents and I know many of them well. I have talked to them about the change in GP services that that fundholding practice has brought about, and they are absolutely delighted. They think that it is wonderful. Members of the public can be excused for not appreciating, understanding or knowing the intricacies of many aspects of the health reforms. After all, the average member of the public could be excused for not really understanding or being interested in the concept of providing and purchasing, with which we are well acquainted and which has achieved a great deal. They want good medical care from hospitals, but are not particularly bothered about how it comes about.
  GP fundholding practices, however, are different because members of the public understand the concept and appreciate it. When they go to their GPs in those practices, they see that they are being offered a much wider range of services, which they really appreciate. Above all, people can often avoid joining a waiting list to go to the strange environment of a hospital, and can thus avoid the tensions and stresses that many people feel when they go to hospital for the first time or on a rare occasion. All that can be obviated, in many cases, because the GPs are now able to provide a service on the premises, under the supervision of the familiar face of the GP.
  Ask any member of the public whom they prefer to visit if they have a medical problem. It is their GP, the person they know and have personal contact with—not a remote consultant, not a person in a hospital that they may never have visited before. All that can be provided by a fundholder.
  That additional facility to see a consultant, if necessary, on the premises, is good, not only for the patient, but for the consultant and the GP. If a patient visits the consultant on the GP's premises and there is a problem, or the consultant wants further information or wants to tell the GP something, what does he do? He need not start some administrative process to write a letter, go to a hospital secretariat and go through all the complications of the administration. He simply goes up the stairs or along the corridor, knocks on the door and speaks to the GP who is sitting there. It is direct personal communication and contact—what medicine was originally about. We have gone back to a fundamental that is a very good fundamental.
  Those are the significant benefits that patients receive from fundholding practices, and that is why those practices are so popular. They can blend in the operations there with some of the modern developments in medicine, such as day care surgery and evidence-based medicine. All those benefits of innovation, new technology and so on can blend in efficiently and effectively with GP fundholding practices.
  In many areas, fundholders have expanded greatly the services that they provide. I shall not detain the House by listing all those services, but I can mention some. In

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  addition to the procedures and minor operations that I mentioned, often fundholding practices can buy expensive heart and other equipment to monitor patients, to carry out diagnostic work, and to carry out glaucoma testing, even endoscopy, and in some cases X-ray services. All those can be provided on the premises.
  I therefore believe that GP fundholding is a tremendous innovation. First, it is, above all, patient-driven. It depends on what is best for the patient and frees GPs to concentrate on the clinical side, but leaves them with administrative power. Secondly, it is driven by clinicians, not managers; by GPs, not remote administrators. Thirdly, it is driven by the clinicians who are closest to the patient—GPs—so it is primary-driven, and it is a devolvement of power, a decentralisation, down to local level.
  Not only is GP fundholding achieving tremendous developments in fundholding practices, but it has a knock-on effect elsewhere because other GPs who are not fundholders see what can be done, and copy. It strengthens GP practices tremendously by providing a more comprehensive system of primary care and it is entirely possible for fundholding practices to work, as they do, in conjunction with local authorities and voluntary organisations—which the hon. Member for Barking suggested was important. I agree, and fundholders can do and are doing that.
  GP fundholding also achieves improvements in hospitals because of the influence that GP fundholders have, not only as GPs, but as people who hold cash. The benefits are extremely wide.
  Anxiety has been expressed that GPs who are not fundholders do not benefit. In my health area of Bromley, the health authority, Bromley Health, responding to the growth of popularity of fundholding, has felt obliged to tackle the problem of other GPs. That is quite right; there is no reason why that should not happen. I commend the authority for it. As a result, it has involved GPs in a system of commissioning throughout the area. I am keen that that should not in any sense erode or replace fundholding but, running alongside it, it shows the impact that fundholding has on the rest of the sector and that it innovates, generates ideas and forces new thinking, all to patients' benefit.
  I am concerned about the spread of fundholding, which is uneven. The figures for the South Thames area on 1 April 1995 show that, in the Bromley health district, only 18 per cent. of the population is covered by fundholding, compared with 41 per cent. across the region. I am keen for that imbalance to be redressed. It is already being redressed to an extent, as the number of applications this year has greatly increased, and, from 1 April next year, the level will be much higher. I believe that, in the Bromley area, the figure will approach 40 per cent. In my constituency the figure will rise to about one third, which is an improvement, but still below the national average. I am keen that my constituents should not lose through being left behind. I urge my hon. Friend the Minister to help to solve the problem and to find ways of encouraging GPs who have felt inhibited from becoming fundholders to achieve that end.
  The principal reason for the low percentage rate in my area is probably the large number of single practitioners. My constituency shares an historic problem with that of the hon. Member for Barking in that my constituency contains areas that are less well off than other parts. The less well-off districts tend, for historical reasons, to have single practitioners. I should like to see encouragement
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  for the development of multi-funds, where single practitioners can get together, become fundholders and, perhaps, use common premises. My hon. Friend the Minister has visited Beckenham hospital in my constituency. It offers GPs, acting together as multi-fundholders, an ideal base in which to locate some of the enhanced practices that I described earlier. I should like that policy to be encouraged.
  The benefits of fundholding are overwhelming. I do not want a two-tier system; I want everyone to benefit from the advantages that have flowed from fundholding. I predict that the Labour party will recognise the benefits of that policy. As with so many other policies, it is only a matter of time before the Labour party becomes convinced that the initiative is successful, exciting and, above all, popular. It will then perform one of its now characteristic 180-degree ' turns and, instead of condemning the policy, support it. I hope that the Labour party does that—I believe that it will, for the simple reason that the policy works.
  1.52 pm
  Mr. Michael Stephen: I am sure that the House will have been distressed to hear of the deaths of the two constituents mentioned by the hon. Member for Barking (Ms Hodge), but she must realise that the cases involved clinical judgment, or the lack of it, on the part of the doctors involved. Those issues will be investigated, and the hon. Lady has already told the House that the family is pursuing the avenues open to it.
  The transformation of the national health service into a primary care-led service is one of the best of the many excellent reforms introduced by Conservative Governments since 1979. We now have a system that is driven by the requirements of general practitioners—by the requirements of those who are closest to the patients and who best understand their needs.
  Before the reforms, in so far as the national health service was led at all, it was led by the union bosses. Only last week, I spoke to a lady who is now retired, who was a ward sister during the last Labour Government. She said that almost nothing could be done in her hospital without the shop stewards' approval. In those days, morale was at rock bottom. I am amazed that Opposition Members have the nerve to compare morale in the national health service today with the state of morale in those days, particularly in the winter of 1978–79, when cancer patients were ot allowed into hospitals because the gates were being picketed.
  Before we introduced our reforms, many doctors did not know and did not care how much anything cost. Their approach was, "It is our business to heal the sick; it is your problem to worry about the money." That was an irresponsible attitude, because doctors know as well as we do that resources for the national health service are not unlimited, and the service has to be cost-effective.
  There never has been and never will be enough money to meet every need in the health service. It is perverse that the more money we put in, the greater the demand we create. There were no waiting lists for kidney transplants 10 years ago, simply because it was not possible to carry out a kidney transplant. Now that it is possible, there are waiting lists for that and many other wonderful

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  procedures that are now available because of the money that the Conservative Government and their predecessors put into the national health service.
  The Labour party makes a great deal of fuss about the number of administrators employed in the national health service. In the old days, many doctors and nurses were employed in administrative capacities. They appeared on the records as doctors and nurses, not administrators. We have taken the sensible decision that it is better for administration to be carried out by administrators and not by doctors or nurses who may or may not be good at it.
  The patients charter has been a great success and has improved the quality of service to patients. It is the mission statement of the national health service. It makes it clear to those in the service what is expected of them, and it makes it clear to the public what they can expect, but it is not a guarantee that the requirements of the charter will be met tomorrow. It is a long-term objective, a mission statement—something that we must all work towards—and we have made great progress towards meeting the targets set by the patients charter.
  The advantage of a general practitioner-driven system is that GPs are local, convenient and flexible. Consistent with the Conservative party's general approach to devolution wherever possible, we are seeking to devolve real power and responsibility within the national health service to the lowest possible level—to individual GP practices in our constituencies. The Labour party is keen on devolution, but the only devolution to the localities in which it is interested is devolution to local political bosses on local authorities. We do not want that. We want to devolve power to the parents in the schools and to the doctors in the surgeries.
  One example of the effect of devolving power to the GPs was given to me by a GP fundholder, not in my constituency but near it. In the old days, he found it difficult to get an appointment with a particular consultant in the hospital, but now that he is a fundholder, the consultant sends him a Christmas card. That is a classic example of the change in attitude.
  Consultants are more responsive to GPs, as are the hospitals and the administrators who run them. The flexibility that GP fundholding has given our doctors—not the amount of funding—has changed the quality of service that they can offer patients. As my hon. Friend the Minister explained to the House, GP fundholders get no more per capita than any other doctor, although they get a little extra money to pay for the administrative costs that are not being paid centrally and are therefore offset. In addition, they managed to save £64 million in 1993–94 alone, which more than offsets the extra money that they receive for administration. The doctors do not do the administration; they are out with their stethoscopes treating patients. They have administrators and practice managers, whom they sometimes share with other practices.
  In Sussex, 56 per cent. of the population are covered by fundholding practices, and by next April we hope that the figure will have increased to 66 per cent. Fundholding practices have been able to bring to the locality such services as physiotherapy. Patients no longer have to go to the local hospital to see the physiotherapist; the physiotherapist comes to the surgery two days a week. The same applies to chiropody and dermatology services and
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  asthma treatment. In respect of the latter two treatments, consultants visit surgeries and carry out procedures with the GP watching. GPs are learning on the job, and many of them are now carrying out those procedures without having to call on the consultants, and their patients do not have to go to hospital for treatment.
  The fact that so many more treatments can now be carried out at GPs' surgeries means that there are shorter hospital stays, which must be good for everyone. Because of the £64 million that has been saved, GP practices are able to buy expensive endoscopy equipment and obtair. pathology results more quickly. That also benefits non-fundholders in the area.
  Labour Members say that it would be easy for fundholders to close a local hospital by changing their purchasing decisions. As my. hon. Friend the Minister has explained, that can be done only within the accountability framework. Anyway, why would GPs want to close a good local hospital that was providing a good service to their patients? Surely they would want to close a hospital only if it was not good and they wanted to transfer their patients to a hospital where they would receive proper treatment. The signal being sent out by doctors exercising their freedom sharpens up hospital administrators and consultants, and forces them to provide a better service.
  Doctors are now able to challenge hospital practices. Previously, they would have been listened to politely and then shown the door. Administrators no longer do that because they cannot afford not to listen to GP fundholders. In an area near mine, two hospitals providing parallel orthopaedic services, and therefore effectively competing with each other, were told by local GP fundholders, "That is not the right way to proceed. You must amalgamate and provide us with a greater range of options for our patients." In the old days, the hospitals would have said, "That is all very interesting," and then done nothing about it. Now, they have to do—and, indeed, have done—something about it.
  All those benefits could have occurred in the old days under Labour, but they did not—just as British Steel could have made a profit, but never did, and British Airways could have been the best airline in the world, but never was until a Conservative Government privatised it and put responsibility where it would do some good. The Labour party said that the doctors could not cope with the administration involved in fundholding, and that they would all go bankrupt. It is one of Labour's scare stories that has not come true, and its reputation as a clairvoyant has received a nasty dent.
  Remarks have been made about paperwork. No one wants paperwork in the health service, but sometimes it is necessary. I have spoken to doctors about the reports on prescribing that they have to complete. They think that they are very useful. They look at the reports four times a year and ask why one practice is prescribing more of a certain drug than the practice next door. Sometimes there is a good reason for that, sometimes there is not; but at least it focuses their minds. That shows that sometimes the paperwork is necessary and that the doctors want it.
  To talk as if there was no paperwork prior to fundholding can hardly be reality. Doctors were always scribbling notes to consultants and filling in forms about their patients. Paperwork is nothing new. However, the Government have focused on the problems associated

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  with form-filling and are reducing the number of forms by 15 million in the first tranche. I hope that they will then reduce the number even further.
  This is a transitional period, with some practices being fundholding and others non-fundholding. Therefore, there is bound to be a difference in the quality of service being provided by the two groups. That is not to say that the quality of service will always be better when delivered by fundholders than by non-fundholders—sometimes it will be one, sometimes the other. The way to obtain the benefits that undoubtedly come with GP fundholding is to extend the system to all GPs. It is wrong to say that, just because, at the moment, we cannot all benefit, no one should benefit—that is absolute nonsense. It is what the Labour party says about the education system. It is absolute nonsense.
  The Labour party says that joint commissioning is a great idea and that it is the way to proceed. It sounds very good, but it simply amounts to GPs having their say and nothing further being done. That is not the case when GPs have the money under their control.
  Of course, the Labour party consistently rubbished everything that has been shown to work. For example, it rubbished the idea of the purchaser-provider split, but now accepts that it is the right way to run the health service. It rubbished the idea of NHS trusts, but now accepts that it is an extremely good idea.
  What does the Labour party say about fundholding? On 13 September, the right hon. Member for Derby, South (Mrs. Beckett) said, "We oppose GP fundholding," but on 17 October—the same year—she said:
  "We understand and welcome the advances that fundholding has brought to many patients."
  Mr. Hinchliffe: Read the full speech.
  Mr. Stephen: I am surprised that the hon. Gentleman has the nerve to try to intervene, given the lack of courtesy that he showed me during his speech.
  In a 1992 paper, which was rather strangely entitled "Restoring the Nation's Health", the Liberal Democrats said:
  "There is no case for GP fundholding".
  Since 1992, they have changed their minds, which, of course, they are entitled to do and frequently do. In 1994, they said:
  "GP fundholding does seem to have brought benefits. By holding a part of the hospital service's budget, GPs are now able to demand a better deal for their patients, resulting in a turnaround time for tests being vastly improved and services becoming more personal."
  That is the Liberals for you.
  It is amazing that the Labour party should claim that we have destroyed the national health service. It is even more amazing that anyone believes it. Indeed, it is a sad reflection on the mood of the press and the broadcast media. An old lady who spends 10 minutes on a trolley makes the front page of our local newspapers, whereas all the wonderful things that are done in the health service every day of the year go completely unnoticed in the local papers, and certainly never reach local television.
  I am very angry about that, because the Conservative party has put an enormous amount of money into the health service—more than 50 per cent. more in real terms than the Labour party—yet Labour has the effrontery to say that we are destroying the NHS, and the media have
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  the effrontery to assist it to mislead the public. It is perhaps a very good example of the notion that if a lie is big enough and told often enough, people believe it. I sincerely hope that when the general election comes, people will not believe it, because to hand control of the national health service to the Labour party would be an appalling tragedy.
  Madam Deputy Speaker: Before I call either of the Front Bench representatives, I remind them that they will need the leave of the House to speak again.
  2.7 pm
  Mr. McLeish: With the leave of the House, I shall speak again briefly.
  I am pleased to follow that rather spirited, but simplistic, contribution made by the hon. Member for Shoreham (Mr. Stephen) in defence of what the Government are doing to the NHS. I should not wish you to get me wrong, Madam Deputy Speaker; I am happy for tea to be provided for patients who have to wait, and I am also partial to receiving a Christmas card from my GP.
  In essence, the hon. Gentleman was saying that the NHS is a bit like British Airways and British Steel—it is simply a matter of introducing market techniques and privatising a major service, and all will be well. I am not even sure that the hon. Gentleman believes that, but he was nevertheless keen to say it.
  What was extraordinary was that the hon. Member for Shoreham should blame the messenger. He said, in effect, that there was nothing wrong with the message. Why are the Conservatives 40 percentage points behind Labour in the opinion poll in The Sunday Telegraph? It must be because of the press and the Labour party. We do not mind him blaming us or the press, but there should be no slight on the judgment of the people who have shown, in opinion poll after opinion poll, that the Government's health policies are not wanted.
  Our approach has been to build on the best, which is a common-sense point of view. In few, if any, of the contributions made by Conservative Members did we hear anything about the innovations or good ideas coming from non-fundholders. Why? It is hard to escape the conclusion that that particularised approach basically means that the Government have closed their minds to any option other than GP funding.
  Even if—and we have conceded it—benefits flow from GP funding and non-GP funding, why are the Government not simply saying to 50 per cent. of patients and 50 per cent. of GPs, "You are part of our future"? Some distress is being created because the Government will not accept the fact that, outwith GP fundholding, much good work is being done. Labour Members have established that point.
  The second point that we have established today is that there is a two-tier system. Lurking behind the comments of most Conservative Members was an acceptance of that. Of course, they wanted it to be removed by the expansion of GP fundholding, but there was a tacit—in fact, more of a direct-acceptance that two-tier funding and two-tier accessing exist. That breaches the fundamental principles on which the NHS was based.
  It is interesting to note and worth putting on the record that in the debate on Second Reading on 30 April 1946, when the national health service was being established,

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  172 Conservatives voted against the setting up of the NHS in the form that was being devised. It seems that, almost 50 years on—I do not want us to be discussing old Labour/new Labour—it would be useful for Conservative Members to go to the Library and read that debate. They may notice some particularly germane comments—
  Mr. Congdon: I was not born then.
  Mr. McLeish: Nor was I. Nevertheless, I am sure that Conservative Members can read.
  I shall dwell briefly on two issues that have not been given sufficient attention. One concerns morale and recruitment in primary care services. Conservative Members will be aware of the report prepared by the British Medical Association, published in September 1995, on those issues. One paragraph about recruitment says:
  "The Health Department is aware that there is a recruitment problem but so far it has failed to define its parameters."
  I am sure that that is a euphemism for saying that the Department of Health has done very little about it.
  It continues:
  "It needs to be persuaded that action is urgently needed to tackle the causes of the decline in recruitment. We are probably facing a serious long term manpower crisis."
  Those are the words of the BMA—not the Labour party or the organs of the so-called supporters of the Labour press. It is important that the Minister should address his comments to that point.
  On morale, page 8 of the report says:
  "GPs have also been angered by the continual denial of `two-tierism' in the NHS".
  Obviously, after today's debate, the BMA will know that the Government have caved in on that point. The report continues:
  "it has become apparent that non-clinical considerations are determining where and when patients are treated."
  It is quite clear that, although the Government might not own up to questions about access and funding, other organisations, which know a great deal more about the health service than the Government, are doing so. That is encouraging, because it informs the debate, but a little depressing in relation to the lack of comment from the Government Front-Bench team.
  The other issue which has not received attention is how the debate is taken forward. I quoted earlier some of the Secretary of State's more soothing comments about the fact that there is no one model. It is interesting that, given the fact that enthusiasm was lacking for the first two or three waves of GP fundholding, the Government are involved in a little experimenting themselves. In addition to standard fundholding, we have community fundholding, multi-funds and total fundholding.
  Part of our argument is about the development of a concept. I would like the Minister also to address his comments to why, indeed, there is community fundholding and why there is multi-funding. Does that not illustrate the point that we are making, that what we need is to take the best out of the two systems that are operating and ensure, based on the principles of equity of access
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  and funding, that we have the best primary health care system possible? If the Minister reflects on that, he will see the merit of what we have said.
  The Government will be uncomfortable about my next point. The bigger agenda item is whether they can show the nation that they genuinely want the type of national health service that Labour wants to be developed into the next century. The public see through the step-by-step approach. We have seen fragmentation, contractualisation and commercialisation. A fifth term in power for this Government will mean privatisation of the service. I hope that the Minister will reassure me that that will not happen. More important, I hope that he will address himself to the fact that we still do not have a primary health care system that has equity of funding and equity of access at its core.
  2.15 pm
  Mr. Malone: By leave of the House, Madam Deputy Speaker. I hardly need to give a reassurance. I intervened in the opening speech by the hon. Member for Fife, Central (Mr. McLeish) to give precisely that reassurance about the Government's commitment to the NHS. I happily give it again: we are committed to a taxation-based system which will be free at the point of delivery. I do not know how we can make it clearer.
  Instead of engaging in the issues of the debate and the qualities of GP fundholding, the Opposition, astonishingly, attempted to obscure the issue by suggesting that there was a hidden agenda. We have had a clear agenda for the health service, which we have rolled out since 1990 when the new health service took shape.
  I thank all my hon. Friends for their contributions. In view of the short time left to me, they will understand if I do not recognise them individually. They will also understand that I have to deal with several important matters of principle which were raised by Opposition Members.
  The hon. Member for Fife, Central tried to open " fresh debate about GP manpower issues and morale in his winding-up speech. I can deal with that simply. We take the issue extremely seriously. Manpower requirements throughout the service are taken seriously by my Department and by the profession, and we address them as a priority. That is why my right hon. Friend the Member for Surrey, South-West (Mrs. Bottomley), the then Secretary of State for Health, announced earlier this year that we would create 500 more student places in medical school, and that is why I referred earlier to the increase in the number of medical students since 1979. Of course we take these matters seriously.
  If there was clear evidence that there was difficulty in GP recruitment, we would be concerned. In practice, when GP posts are advertised, more people apply than there are posts available. The same is true for trainee posts across the country.
  Mr. Rendel indicated dissent.
  Mr. Malone: The hon. Gentleman shakes his head. I assume that he is implying that there is a general difficulty. There is not.
  I want to take head on three points that have emerged from the debate. I found it extraordinary that Labour Members, having set out to say how all the good things

  567
  that GP fundholding had achieved were bad and that it was unfortunate that the good things were not being extended to others in the health service, said that they did not know whether GP fundholding was good or not because there had been no proper evaluation. My hon. Friend the Member for Wyre (Mr. Mans) made a specific point on this, as did the hon. Members for Newbury (Mr. Rendel) and for Dagenham (Ms Church) in a number of interventions.
  There are two sorts of evaluation, of which the first is peer group evaluation. As my hon. Friends rightly pointed out, it was not a question of the Government forcing GPs down the fundholding route. Fundholding is a process that has rolled out through six waves of GP fundholding. As peers have watched what their equivalents have been able to achieve in GP fundholding, many of them, who were often highly sceptical at the outset, have evaluated what is happening and moved forward. There is also much independent research into fundholding; the suggestion that there is none is nonsense.
  A national centre for primary care research and development has now been set up at Manchester university, and it will be an important resource for taking forward primary care research and the associated agenda. I opened the centre this spring, and I was delighted to do so. It will cost £1.5 million per year for a 10-year period to develop a sustained programme of work to explore a range of primary care issues. That will include watching fundholding develop. In addition, £500,000 is being spent on total fundholding evaluation, and that is already under way.
  Other work is taking place at a more local level, and evaluation is being carried out by the National Audit Office. The Public Accounts Committee has already worked on the subject, and no doubt will return to it. It is nonsense for Opposition Members to say that there is no evaluation, and that we are introducing the system to ensure that no one will find out what is happening, and we cannot measure the benefits. There is a comprehensive programme in place.
  Accountability was another issue raised by Opposition Members, especially by the hon. Member for Wakefield (Mr. Hinchliffe). We all sat with bated breath as he announced that he was about to reveal to us why he had left the Front Bench and returned to the Back Benches. I am almost obliged to ask him: is that it? If so, we look forward to his return to the Front Bench as quickly as possible. However, at least the hon. Gentleman has the ability to deliver miserable facts with a cheerful face, which is a great benefit compared with the attitude of many of his hon. Friends.
  The hon. Gentleman asked about accountability. Of course that is fundamental, and it is dealt with in the accountability framework that we debated at length during the passage of the Health Authorities Act 1995. The purpose of the framework is to balance the requirements of public accountability within a centrally funded service, with the need to minimise the administrative work load on general practices and health authorities.
  The policy will be implemented nationally in several ways. Any major shifts in purchasing intentions will have to be published six months in advance, just as health authorities are obliged to publish their intentions. Fundholders will be in the same position. The idea that
  568
  Labour Members put about during the debate, that there will be great changes and dislocations in services across the country, is absolutely untrue.
  Mr. McLeish: That is already happening.
  Mr. Malone: I find it surprising that the hon. Gentleman should say that. The purchasing power that fundholders have at their discretion is inevitably a small proportion of the activity in any provider unit. The point about exercising the power of the budget is that it makes provider units think in a different way. Practices that are not fundholders readily accede that they also benefit. When fundholders get better services, they follow, and the whole system is uplifted.
  As well as the publication of purchasing intentions, an annual practice plan will have to be given to the health authority. Practices will also have to produce a performance report, and review performance regularly with the health authority.
  That illustrates the fact that there will be a firm framework to make GP fundholders truly accountable, as they should be—ultimately to Ministers, who have custody of the policy. The framework will come into effect in the course of next year, and already many of its elements are being put into place. Local workshops involving GPs and others are taking place all over the country to explore all the issues arising from it. It is entirely wrong to suggest to the House that there is no accountability for GP fundholders, yet that was one of the main planks on which the Opposition rested their case.
  Another issue raised was equity. Despite Opposition Members' attempts to suggest that there has been some sort of admission that a two-tier health service exists, that is not the case. I find entirely incomprehensible the persistent misrepresentation by Opposition Members of a self-evident fact about fundholding.
  Let me reiterate the Government's position. Equity in funding comes from the allocation of resources which are given to health authorities. These resources are allocated on an equitable basis to fundholding practices. The fundholders then derive extra value out of the equitable resource and spend it on behalf of their patients. That is what the Opposition cannot stomach.
  Mr. Hinchliffe rose—
  Mr. Rendel rose—
  Mr. Malone: I will not give way, as I have only six minutes in which to conclude.
  The hon. Member for Fife, Central asked about the benefits from joint commissioning, but misrepresented what I said. I clearly remember saying that there are benefits, but they are sporadic and cannot be relied upon, as they are spread across the country.
  The hon. Gentleman referred to those involved in joint commissioning, and cited the practice at Blackpool. But such people find it very difficult to persuade the health authorities to go along with the plans they put forward. The reason for that—this is at the centre of this debate—is that those people do not exercise purchasing power.

  569
  Joint commissioning groups can be talking shops with GPs, but they will make no progress if they do not exercise their financial muscle.
  Mr. Hinchliffe: Will the Minister give way?
  Mr. Malone: I will not give way to the hon. Gentleman.
  Mr. Hinchliffe: On a point of order, Madam Deputy Speaker. I assumed that, in winding up the debate, the Minister would respond to the points that have been made. I have made serious allegations about health care in my constituency—
  Madam Deputy Speaker: Order. That is not a point of order for the Chair. If the hon. Gentleman who has the Floor does not give way, other hon. Members must resume their seats. That is a well-known and established rule.
  Mr. Malone: I dealt with the hon. Gentleman's point during his speech. I told him that if he submitted all the cases he was talking about to me, they would be examined in full, and he would get a response.
  Mr. Hinchliffe: I want answers.
  Mr. Malone: The hon. Gentleman will get answers, but not from me at this Dispatch Box unless I know all the facts. I shall be happy to respond to the hon. Gentleman on that basis.
  The hon. Member for Barking (Ms Hodge), who has apologised for not being in her place for the winding-up speeches, made some interesting suggestions about the Government's general policy of equity and fairness. She said that her constituents were being done down because there was less cash in Barking.
  Although I did not have the precise details during the hon. Lady's speech, I am pleased to say that I have them now. Barking and Havering is 1.7 per cent. behind the target fixed by our fair allocation process, so—contrary to what the hon. Lady said—resources in her constituency and health authority area are set to increase as it moves towards the target. When one gets suggestions from the Labour party, it pays to treat every single one of them as if it had a health warning.
  I ask the Labour party—which Government introduced deprivation payments for general practice? The present Government did. Which Government introduced the new health authorities which, at a far more local level, will set out the priorities for health care? The present Government did that, and we now have the framework firmly in place.
  Much was made by the Opposition of their belief that there was no wish among professionals to have GP fundholding, but the opposite is the case. It has been a success, as a survey of fundholders by the Association of Fundholding Practitioners has shown.
  Mr. McLeish: Surprise, surprise.
  Mr. Malone: The hon. Gentleman might say that, but he should bear in mind that the vice-chairman of that organisation is Dr. Mike Armstrong, a member of the Labour party. This is not a partisan point, and I would have hoped that the results of the survey would suggest that fundholding has been successful and that patient care has benefited as a result.
  Dr. Mike Armstrong has a warning that the hon. Member for Fife, Central should heed: he has said that, if Labour is to appease fundholders, it will have to offer more than a mere advisory role—that is what the hon. Gentleman has offered today—and will have to concede some budget responsibility.
  At the end of an important debate, we get back to that central point. Improving health care driven by primary carers means that some budget responsibility must follow. We have noted that the hon. Member for Fife, Central was not prepared to concede that point, and GP fundholders and others in the country will have noted that as well.
  It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

  BUSINESS OF THE HOUSE
  Ordered,
  That, at the sitting on Monday 6th November, the Speaker shall:

  (1) put the Questions necessary to dispose of proceedings on the Motions in the name of Mr. Tony Newton relating to Conduct of Members, Employment Agreements, Standards in Public Life (General Recommendations) and Standards and Privileges not later than three hours after the commencement of proceedings on the first such Motion, or Seven o'clock, whichever is the later; and

  (2) put the Questions necessary to dispose of proceedings on the Motion in the names of Mr. Tony Newton and Mr. A. J. Beith relating to the Commissioner for Standards not later than one hour after their commencement; and

  the said Questions shall include the Questions on any amendments to the said Motions which she may have selected and which may then be moved; and the said Motions may be proceeded with, though opposed, after Ten o'clock.—[Mr. Wells.]
  Ordered,
  That, at the sitting on Tuesday 7th November, the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Mr. Tony Newton relating to Select Committees related to Government Departments not later than one and a half hours after their commencement, such Questions including the Questions on any amendments to the Motion which she may have selected which may then be moved; and the said Motion may be proceeded with, though opposed, after Ten o'clock.—[Mr. Wells.]

  SITTINGS OF THE HOUSE
  Ordered,
  That this House do meet on Wednesday 8th November at half-past Nine o'clock.—[Mr. Wells.]

  Badgers
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wells.]
  2.30 pm
  Sir Jim Spicer: We all know that a Friday afternoon Adjournment debate is not well attended, because, by the time it is announced the previous week, most Members have already made their arrangements. Attendance is therefore thin this afternoon. However, I have received letters from 11 of my colleagues telling me that they are as concerned as I am about badgers and bovine tuberculosis.
  I am delighted that you are in the Chair for this debate, Madam Deputy Speaker, as we all know that animal welfare is close to your heart.
  It is time for us all to face facts and to accept that the badger is neither in danger nor endangered. Without doubt, it is the most protected mammal in Europe, especially in the United Kingdom. Badger numbers are increasing dramatically. An exact count has not been taken, but best guesses are that the minimum number of adult badgers is 250,000, with 105,000 cubs being born each year.
  If we make a rough estimate that half of those cubs are killed in the first year of life, we are still left with an explosion in badger numbers. My extremely rough guess is that there will be about 750,000 badgers by the year 2000. That is a frightening prospect. We all know that bovine TB is endemic in badgers and that the spread of the disease is clearly linked to the species, although as yet methods of transmission are poorly understood.
  Most Members are jacks of all trades and masters of none, and I am no expert on badgers and bovine TB. As a result of my concern, however, I have attended two seminars organised by the Ministry of Agriculture, Fisheries and Food; the first was two years ago and the second was last month. I left those seminars—I cannot believe that any other person who attended them did not do likewise—with the certainty that badgers are a cause of bovine TB.
  All too often, people say, "We must preserve every badger, so we must have a vaccine." It is my understanding, however, that we shall not have an effective vaccine before the year 2005, at the earliest, and that it is more likely to be 2010—and then only if enormous resources are made available and there is the closest co-operation with other countries in the meantime.
  We must take action now because of the greatly increased number of herds to have tested positive in the past five years, especially in the south-west. I will give some examples. In Cornwall, there were 38 outbreaks in 1990 and 106 in 1994. In Devon, there were 26 in 1990 and 75 in 1994. Hereford and Worcestershire had one in 1990 and 12 in 1994. That shows that the disease is moving up the west line to the Welsh border. In Wiltshire, there were two cases in 1990 and 21 in 1994. I do not have any figures for Wales, but I know that there is increasing concern there about the spread of tuberculosis in badgers and about bovine tuberculosis.
  My county of Dorset, for some inexplicable reason, has been lucky. It seemed that we were set on an upward curve for three or four years, but suddenly it seems to
  572
  have levelled off. I would want to touch wood if I were to say that that will not change, in view of the vast increase in the number of badgers.
  Each of the figures represents not only a slaughter of cattle but personal tragedy, financial loss and enormous stress for the individual farmers. I will give the House two examples—three, in fact, because I have added another only this afternoon.
  First, there is Robert Bowditch, who is a friend and near neighbour of mine and farms at Netherbury. He writes:
  "Our main problems started in 1988 with eight beef cattle at Brimley Coombe. In 1991, seven cows from Knowle dairy went down and one steer from Brimley. In 1993, two cows from Knowle dairy were taken out. Then last year two steers were taken out from Laverstock. This year we had a clear test, thank goodness."
  Behind those figures lies a story of heartbreak, concern and stress for the farmer. Mr. Bowditch continues:
  "I will now try and explain some of the management and financial problems when a TB outbreak occurs. When you have a TB reactor it is necessary to retest every 60 days until you go clear—therefore no cattle movements. Each time we test 4 men and 2 full days work is required. You can't mix units where a reactor has been found and one that is clear of TB. This becomes a major problem when you need to get in calf heifers from a TB closed area into a TB clean dairy herd!
  If restrictions continue for months, as is often the case, major cash flow problems can occur. You nearly always miss the peak of one trade or another. There is also the constant personal worry when a test is due—one needs to plan stock numbers, sales and finances accordingly to protect yourself if things go wrong.
  The speed of MAFF badger men coming on to reactor farms is very slow which means disease is still being spread. 25 per cent. of badgers caught last time were positive. Also three cows from Knowle had TB lesions in the neck which is frightening."
  Behind that short account lie months of agony and heartbreak for everyone on that farm.
  Another, smaller case involves the Fooks brothers of North Porton. They had TB movement restriction from April to September this year following the identification of four reactors. This prevented bull calf and beef animal sales, and they were not able to buy in any cattle. They are four brothers who farm together. They have 120 cows, and they farm beef, sheep, cereals and maize. This year, they have had an especially difficult time quite apart from the horrendous problem of bovine tuberculosis.
  The problem involves badgers and the maize crop. The brothers planted 30 acres for winter feeding and estimate that one third of that has been a complete loss—destroyed by badgers. Some might say that the brothers should have protected their crops with electric fences. They did, but they did not work. Their wheat crop was also badly affected by badgers moving into ripening wheat and just crushing it down. It is difficult to put a figure on such damage, but the cumulative effect on an individual farm on top of a bovine TB problem must be dreadful.
  There is one other case which has been drawn to my attention. We know that a large number of people believe that there is no clear link between bovine tuberculosis and badgers. After this debate, I am bound to get dozens—hundreds—of letters saying how disgraceful it is that I should make that allegation.
  Another example involves Tyneham in south Dorset. Starting in 1966, that area experienced huge amounts of TB and in the five years between 1966 and 1971, 800 cattle had to be slaughtered. People do not realise the

  573
  slaughter that follows an outbreak of bovine tuberculosis and its effect on people in the farming industry. In 1973 and 1974, badgers were gassed, and in 1976 all the badgers were taken out. Since then, the area has been re-inhabited by badgers and there has not been a single case of TB in the area since the clearance. That is proof positive, and it is borne out by tests that have taken place in the Republic of Ireland.
  Many more tragic cases have occurred all over the south-west, which prompted the National Farmers Union to commission a study into the problems associated with badgers and bovine TB, and the effects of the badger population on the environment and agricultural operations. That excellent paper makes clear the need for better management of the badger population, not only in the interests of farming and animal health but for the long-term welfare of badgers. The foreword to the NFU study spells out the background.
  The study was undertaken following reports of concern among farmers about the link between bovine tuberculosis and badgers in certain areas of the country, particularly the south-west. Although the vast majority of farmers wish to see healthy badgers in reasonable numbers, some are anxious about the increase in numbers and their effect on the natural environment, to the extent that it has a knock-on effect on agricultural operations, including hazards to humans and machinery. More than 90 per cent. of the farmers surveyed felt that badger numbers should be managed where appropriate. While I acknowledge and appreciate the concern of wildlife groups, their desire totally to protect badgers is likely to expose the creatures to an endemic infection with bovine TB.
  The NFU believes that clear, objective thinking is needed, supported by facts, and that solutions must be found—that is the aim of the study. The study makes a number of recommendations, which I know my hon. Friend the Minister and her team will consider carefully. She knows only too well that the farming community wishes to support the Ministry of Agriculture, Fisheries and Food in all sensible measures.
  The report makes it clear that MAFF is in a difficult position, not least because of public ignorance of the facts, and an instinctive desire among the general public and certain hon. Members to regard badgers as a special category and to find any excuse they possibly can for not taking action which we all know in our heart of hearts must be taken. That ignores the massive problems that are created not only for farmers and public health but for the badger population as a whole.
  I cannot stress strongly enough that we are not in the business, as someone said this week, of disposing of the badger population or removing their protection. But where badgers have TB, something must be done, and it must be more than is currently being done. We can all help to get information through to the general public. The president of the NFU should circulate the study paper to Members of Parliament and to all candidates in rural seats, asking them totally to support its recommendations.
  It is not that I have a suspicious mind, but it might be helpful if that support were given to the president of the NFU in writing rather than orally, so that we may avoid point scoring on party lines and be able to work together
  574
  to solve a major problem which can only grow and become more dangerous for all our rural communities in the years ahead.
  As we all know, the vast majority of people are far more attracted to and concerned about badgers than about cattle and the welfare of our agricultural industry. As we are only 15 or 18 months away from a general election, it is only natural that people should try to hold back from committing themselves to a course which they know to be right. Anyone who attended the seminar so kindly arranged by my hon. Friend the Minister the other day, where all the evidence was given by people who were experts in their field, who tried not to bamboozle or persuade us into a course of action but to deal with facts, will have been left with no doubt that there is a clear link, and it is somewhat disreputable for anyone to back off afterwards from any commitment to more positive action.
  I hope that the Minister—and the NFU—will continue to urge all of us to take whatever action is necessary in the coming months to ensure that the present awful trend is reversed. If we do not, and if we go on for another five years at the current rate, our dairy herds will be decimated and there will be not 250,000 but more than 1 million badgers and the large number infected might then become a cause of genuine concern to every person in the country.
  2.44 pm
  The Minister for Food (Mrs. Angela Browning): I am grateful to my hon. Friend the Member for Dorset, West (Sir J. Spicer) for initiating this debate on a subject in which I know he takes a strong interest.
  Although it is obvious from the figures that the disease has increased in recent years, it has stabilised, and fewer new cases were reported in south-west England to the end of September 1995 than in the same period in 1994.
  Sir Jim Spicer: I apologise for intervening so early, but might there be a direct link between the drought this year and that fall-off in numbers? We know that most people would expect, and do believe, that the disease is transmitted through urine on grass.
  Mrs. Browning: My hon. Friend is right to mention that. During our studies of that matter, especially in the south-west, we shall try to take account of all factors, including my hon. Friend's suggestion, when considering the overall trend in those figures. I was simply describing the position as we consider it to be this year.
  It is incorrect to say, as some people have, that the disease is out of control and that there is a continuing acceleration in new cases.
  However, I am worried about the impact of the disease, which is why I have started a series of informal consultations to explain the range of action that we are taking and to help us consider whether there is anything more that we can do. That began with a seminar, which my hon. Friend mentioned, for Members of the House with a specific constituency interest in the disease. I followed that up with a meeting with the National Farmers Union, which has presented me with the very useful document that my hon. Friend mentioned, setting out its ideas on the problem, which I am now studying.
  We are trying to bring together everyone who is genuinely interested in the subject to discover whether any further measures may he taken to make us more effective in the way in which we tackle the problem that my hon. Friend rightly brings to the Floor of the House.

  575
  As a Member of Parliament representing a constituency in the south-west, I am aware of the serious problems that confront many farmers when they have outbreaks of disease. However, there is public anxiety in many quarters about the Ministry policy of trapping and killing a protected species, the badger.
  I make two important arguments. First, there is clear scientific consensus that the badger plays an important role in transmitting tuberculosis to cattle. That is the opinion of scientists in the United Kingdom and in the Irish Republic who have studied the issue. In places in England and in Ireland where badger clearance operations were undertaken, there is a marked decrease in TB in cattle. My right hon. Friend rightly identified that in his part of the country.
  Despite suggestions to the contrary in the media, many of our critics who are active scientists in that field accept that badgers can infect cattle. What they criticise is the effectiveness of our current control policies to break that link.
  I must tell hon. Members of the House who have associated themselves with the opinion that badgers are innocent victims of cattle TB that science is not on their side. I am sorry that there is no representative of the Labour party or the Liberal Democratic party in the Chamber. Labour Members have put their names and signatures to early-day motions that do not recognise the science of the subject. Liberal Democratic Members of Parliament in the south-west have rightly felt it necessary to bring that subject to the House of Commons, but then have gone away and tried to sit on the fence—neither fish nor fowl—not saying what future action they prefer or even acknowledging the science as we have presented it.
  The second important point that I should like to make clear, and which my hon. Friend also mentioned, is that we do not have a policy of killing badgers. We have a policy of removing the source of infection of bovine tuberculosis, which is a very serious disease of cattle, and indeed of people, although the general population is not now at risk from bovine TB, because of milk pasteurisation and meat inspection. The Government cannot ignore the problem; we must take action to eliminate infection in cattle, and in some cases, particularly in the south-west, that cannot be done unless the related source of infection in badgers is tackled.
  We hear a great deal about the killing of badgers, and I regret that it is necessary, but to put the matter in perspective, I should say that, last year in Great Britain, we killed 2,773 cattle because of TB. My hon. Friend mentioned Tyneham, where cattle had to be slaughtered in large numbers. The figure of 2,773 cattle compares with the killing of 1,683 badgers—considerably fewer. The interesting statistic for those who may think that the badger is an endangered species—it is not—is that, over the same period, considerably more badgers will have been killed in road accidents in Britain, out of a total population estimated at around 250,000. We estimate that about one quarter of the British badger population resides in south-west England, and we recognise that important regional aspect.
  Badger control operations are undertaken only after an exhaustive epidemiological investigation by a veterinarian has implicated badgers in the breakdown. In areas where there is no recent history of badger-related TB, no action is taken against badgers unless it is specifically sanctioned
  576
  by an independent sub-committee of the consultative panel on badgers and bovine tuberculosis, which considers the evidence in each case before reaching a decision.
  We do not take action against badgers lightly, but only where there is a clear link. I have made that point at some length, because I believe that the stringency of the examination before any action is taken against badgers is not always well understood. Equally, it is not always well understood just how devastating the impact of a TB breakdown on a farm can be. My hon. Friend mentioned several cases in Dorset that have been drawn to his attention and, as a west country Member of Parliament, I have seen at first hand just how serious the problem can be.
  I am not talking simply about loss of profit and economics: I am talking about families being subjected to severe and sustained stress over a long period, particularly when the herd breaks down for a second, third or even fourth time.
  I bow to no one in my desire to protect and respect wildlife, but I wish that those who are concerned about the taking of badgers were also concerned about the anguish—I make no apologies for using that word—of the farming families who are hit by the disease. I would find it difficult to walk away from the problem, as those who would support a cessation of badger control seem prepared to do.
  I made it clear at the beginning of my speech that I was in the middle of a consultation period. I do not want to pre-empt that consultation by making any firm commitments today, but we did introduce, on a trial basis in 1994, a new policy based on the use of a serological test—the "live test"—for TB in badgers which was developed following a recommendation of Professor Dunnet's report in 1986. That test allows us to identify setts in which badgers test positive for tuberculosis; thereafter, we kill the badgers from those setts only.
  In the trial using that test, we are extending the badger control area beyond the farm with the disease breakdown to the neighbouring area, to include the whole territory used by the particular social group of badgers involved. We are assessing the impact of that wider programme against the current policy which is based on the trapping of badgers only on the breakdown farm. It was made clear at the seminar for hon. Members in 1993, which was organised by my predecessor, my hon. Friend the Member for Crawley (Mr. Soames), that it would be a five-year trial.
  The new policy was introduced in the winter of 1994 after a number of pilot projects earlier that year. Therefore, we are only in the early stages of the trial. I have to put it on record that I entirely reject the suggestions from some hon. Members, especially the hon. Member for North Cornwall (Mr. Tyler), that the new strategy has already failed. I am sorry that the hon. Gentleman is not here today, as he has expressed an interest in the subject. However, his response to what is being done was extremely negative, and certainly did not move in any way towards finding a solution to the problem. His statement showed only a complete lack of

  577
  understanding of the issues. In Cornwall in particular, it is a matter of extreme concern to the farmers affected.
  While the trial is in progress, we are continuing to apply the old interim strategy on farms outside the trial area or not eligible for the trial where there is a badger-related outbreak.
  The long-term solution to the TB problem may lie in the development of a vaccine for badgers. My hon. Friend was quite correct to say that, although we are conducting a great deal of research into the matter, we are a long way from finding a solution.
  Obviously, in respect of a wild animal species, it is not simply a matter of finding a vaccine that works; one has also to consider the method of delivery in the wild and make sure that one targets the right species so that something beneficial to one species in the wild will not be harmful to another. Developing such a vaccine will necessarily be rather a long haul, but we
  578
  are putting resources into research and we are working hard to find a vaccine capable of being delivered in the field. That may take some 10 or 15 years.
  We are consulting. We are concerned about the effect on the farming community whose herds have a breakdown of bovine tuberculosis. I intend to listen carefully to all interested parties. I hope that I shall have the support of all hon. Members who have personally experienced in their constituencies the devastation that the problem can cause.
  As my hon. Friend rightly pointed out, we are all used to the cut and thrust of party political debate in the Chamber, but there are some issues—and I believe that this is one—where we need to address the science and find practical solutions to a difficult problem. I hope that all parties will unite in their support of what we are doing to seek a solution, to help the farming community and address a difficult problem.
  Question put and agreed to.
  Adjourned accordingly at three minutes to Three o'clock.

ENVIRONMENT

  Planning Policy Guidance
  Mr. Chris Davies
  To ask the Secretary of State for the Environment when the revised guidance paper No. 6 will be published. [40684]

  Level of debt for each local authority in Greater Manchester

  £ million

  At 31 March 1991

  At 31 March 1992

  At 31 March 1993

  At 31 March 1994

  At 31 March 1995

  Bolton

  215

  216

  146

  152

  157

  Bury

  117

  115

  82

  80

  87

  Manchester

  1,275

  1,382

  1,326

  1,277

  1,173

  Oldham

  274

  274

  242

  242

  258

  Rochdale

  248

  278

  212

  204

  209

  Salford

  450

  467

  403

  376

  425

  Stockport

  165

  156

  116

  104

  123

  Tameside

  248

  262

  186

  183

  188

  Trafford

  113

  109

  81

  82

  89

  Wigan

  276

  278

  250

  237

  244

  Greater Manchester

  3,381

  3,538

  3,045

  2,937

  2,953

  1. The amounts include long-term borrowing undertaken in accordance with approvals issued under local authority capital finance legislation, and also temporary debt (less than one-year) to cover cash flow shortages.

  2. Outstanding amounts for longer term borrowing are not collected regularly. There have been three surveys—in 1991, 1993 and 1994. Figures for 1992 and 1995 have been estimated using data on flows of longer term borrowing collected quarterly.

  3. Part of the decrease in debt between 1992 and 1993 can be attributed to the commutation of the PWLB debt which took place in October 1992.

  Trust Councils
  Mr. Jim Cunningham
  To ask the Secretary of State for the Environment what proposals he has to introduce trust councils into local authority management. [41013]

  Sir Paul Beresford
  We have no plans for a trust councils initiative.

  English Nature
  Ms Ruddock
  To ask the Secretary of State for the Environment which members of the council of English Nature have management agreements with English Nature; and where. [41475]

  Mr. Clappison
  None of them.

DEFENCE

  Laser Weapons
  Mr. Cohen
  To ask the Secretary of State for Defence how many laser weapons that(a) have the potential to blind enemy troops and (b) the potential to disrupt their eyesight temporarily are possessed by the United Kingdom forces; and what development plans his Department has in this area.
  476
  Sir Paul Beresford
  There have now been over 500 responses to the draft revised planning policy guidance note on town centres and retail developments. These are now being considered carefully. I hope to publish the final version on PPG6 early next year.

  Local Government Debt, Manchester
  Mr. Thurnham
  To ask the Secretary of State for the Environment what is the current level of debt for each local authority in Greater Manchester; what was the figure for each year since 1988–89; and what are the equivalent figures for the whole of the Greater Manchester metropolitan area. [41099]

  Sir Paul Beresford
  The information from 1991 to 1995 is as follows:

  Mr. Arbuthnot
  I have nothing to add to the information contained in the letter from my noble Friend the Under-Secretary of State for Defence to the hon. Member dated 17 August 1995, a copy of which I have placed in the Library of the House.

  Ministerial Transport
  Dr. Lynne Jones
  To ask the Secretary of State for Defence what has been the cost of ministerial transport in each of the past five years; what allowance has been paid to Ministers who use their own vehicles; and what has been the cost in each of the past five years. [40737]

  Mr. Arbuthnot
  I shall write to the hon. Member.

  Salaries
  Mr. Malcolm Bruce
  To ask the Secretary of State for Defence what was the(a) lowest and (b) highest full-time salary paid to any employee in his (i) Department, (ii) agencies and (iii) non-departmental public bodies in (1) 1994–95 and (2) 1995–96. [40865]

  Mr. Arbuthnot
  [holding answer 1 November 1995]: It is the Government's normal policy to publish civil servants' salaries in bands. Accordingly, the lowest full-time civilian salaries in the Department, agencies and NDPBs fell within the band:

  477

  1994–95: Less than £5,000

  1995–96: Less than £5,000

  The highest full-time civilian salary in the Department fell within the band:

  1994–95: £95,000—£99,999

  1995–96: £95,000—£99,999

  The highest full-time civilian salary in agencies fell within the band:

  1994–95: £145,000—£149,999

  1995–96: £145,000—£149,999

  The highest full-time civilian salary in NDPBs fell within the band:

  1994–95: £85,000—£89,999

  1995–96: £85,000—£89,999

  The highest military salary fell within the band:

  1994–95: £115,000—£119,999

  1995–96: £ 120,000—£124,999

  and the lowest military salary fell within the band:

  1994–95:
  £5,000—£9,999

  1995–96:
  £5,000—£9,999

  Annual Remuneration
  Mr. Malcolm Bruce
  To ask the Secretary of State for Defence how many individuals in(a) his Department, (b) agencies and (c) non-departmental public bodies received annual remuneration including benefits in kind exceeding (i) 100,000, (ii) 200,000 and (iii) 300,000 in each year since 1985–86. [40864]

  Mr. Arbuthnot
  [holding answer 1 November 1995]: Those who received annual remuneration above the sums specified, excluding pension benefits, in the years in question were:

  (i) Exceeding £100,000

  Department

  Agencies

  NDPBs

  Military

  1985–86 to

  1990–91

  0

  0

  0

  0

  1991–92

  0

  1

  0

  1

  1992–93

  0

  1

  0

  2

  1993–94

  0

  1

  0

  2

  1994–95

  0

  1

  0

  2

  (ii) and (iii)—no staff in the Department, agencies, NDPBs or the armed forces received remuneration in excess of £200,000 in the years in question.

  Other than pension contributions, benefits in kind are not normally paid to staff in the Department, agencies and NDPBs. As members of the principal civil service pensions scheme or armed forces pensions scheme, staff receive benefits in accordance with the rules which have been deposited in the Library of the House.

PRIME MINISTER

  Opposition Parties (Civil Service)
  Mr. Alfred Morris
  To ask the Prime Minister what are the conventions whereby civil service Departments take steps to consult the Opposition about their policies towards the end of a Parliament; and when such steps are 478
  planned to be taken before the end of the current Parliament. [40883]

  The Prime Minister
  The convention has been that, by authority of the Prime Minister, towards the end of a Parliament or when a general election has been called, Opposition parties may arrange, with the authority of their party leaders and through the head of the civil service, contacts with senior civil servants. These arrangements are designed to allow briefing on factual questions on departmental organisational changes which Opposition parties have in mind or which may result from Opposition party policies. Any exchanges would be confidential. Following the last general election, I told the leader of the Opposition that I would be content to authorise confidential exchanges between senior civil servants and Opposition spokesmen from January 1996.

  Copex Arms Exhibition
  Mrs. Clwyd
  To ask the Prime Minister what(a) financial and (b) other assistance is given by Her Majesty's Government to the Copex arms exhibition. [40094]

  The Prime Minister
  [holding answer 27 November 1995]: I refer the hon. Member to the answer given yesterday by my right hon. Friend the President of the Board Trade.

  Duke of Windsor (Papers)
  Mr. Mackinlay
  To ask the Prime Minister, pursuant to his answer of 26 October,Official Report, column 747, how many other documents relating to the conduct of the Duke of Windsor during world war two are held by Her Majesty's Government. [40678]

  The Prime Minister
  [holding answer 2 November 1995]: British official papers in question have been released to the Public Record Office with the exception of a few items, which will be re-reviewed under the open government initiative and released at the appropriate time.

  Lockerbie
  Mr. Dalyell
  To ask the Prime Minister what recent representations Her Majesty's Government have received from the Arab League in relation to Libyan sanctions and Lockerbie. [39290]

  The Prime Minister
  [holding answer 2 November 1995]: None.

FOREIGN AND COMMONWEALTH AFFAIRS

  Temporary and Part-time Staff
  Mr. Ian McCartney
  To ask the Secretary of State for Foreign and Commonwealth Affairs how many staff are currently employed in his Department and in related agencies on(a) temporary or casual employment contracts and (b) part-time employment contracts, given as an actual figure and as a proportion of the total work force; and what were the corresponding figures for five years ago. [41123]
  479
  Mr. Hanley
  Breakdowns by Department and executive agency for 1 April 1995 of the number of permanent staff, the number of casual staff—normally those engaged for a period of up to 12 months, but exceptionally up to two years—and of the number of part-time staff are presented in the civil service staff in post summary table for 1 April 1995, a copy of which is in the Library of the House. Estimates on a comparable basis for 1 April 1990 have also been placed in the Library of the House.

  Hong Kong Overseas Public Servants
  Mr. Gallie
  To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on Hong Kong overseas public servants. [41764]

  Mr. Hanley
  We plan to introduce legislation as soon as time allows. Copies of a draft Hong Kong (Overseas Public Servants) Bill are being made available in the Libraries of both Houses.

  Foreign Affairs Council
  Mr. Congdon
  To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on the outcome of the Foreign Affairs Council on 30 October. [41696]

  Mr. David Davis
  The A points listed in document 11057/95, which will be deposited in the Library of the House as soon as it is available, were adopted unanimously.

  The Council took note of resolutions in documents 9914/95 (PE-RE 61) and 10679/95 (PR-RE 67). A copy of these documents will be deposited in the Library of the House as soon as they are available.

  An Association Council with Turkey took place. The Council decided on the implementation of the EU/Turkey Customs Union agreement.

  The presidency noted Latvia's application to join the EU, lodged in Madrid on 27 October. The Council agreed on a formal acknowledgment referring to the procedure laid down in article 0 of the treaty.

  The Council reached agreement on participation in the Euro-Mediterranean conference at Barcelona on 27 November.

  The Council discussed a draft association agreement with Morocco. A special Foreign Affairs Council is to be convened on 10 November with the aim of reaching final agreement, preceded by discussion in the Committee of Permanent Representatives.

  The Commission presented a communication on strengthening EU-Mexico agreement. This was remitted to COREPER for further discussion.

  The Commission presented a draft Council decision for conclusion of the EU/Mercosur inter-regional framework agreement, which was remitted to COREPER.

  The presidency reported on the Troika visit to the middle east. The head of the EU electoral unit reported on preparations for election monitoring. The Commission's communication on relations with the Palestinians was remitted to COREPER for detailed examination.
  480
  The Council discussed the setting up of the World Trade Organisation appellate body.

  The Council discussed EU/US relations in preparation for the EU/US summit on 3 December.

  The Council adopted a policy paper on former Yugoslavia, covering civilian aspects of implementation of an eventual peace settlement. The Council reaffirmed its support for the EU Mostar administrator's continuing efforts to unify the city.

LORD CHANCELLOR'S DEPARTMENT

  Official Solicitor
  Mr. David Nicholson
  To ask the Parliamentary Secretary, Lord Chancellor's Department when the present Official Solicitor commenced his appointment; by what mechanism the appointment is(a) made and (b) terminated; and what is the official address of the post. [40702]

  Mr. John M. Taylor
  The present Official Solicitor commenced his appointment on 1 August 1993, following an open competition. The appointment is statutory and is made by the Lord Chancellor under section 90 of the Supreme Court Act 1981. Under the provisions of the 1981 Act, as amended by the Courts and Legal Services Act 1990, the postholder has tenure until the completed year of service in which he or she attains the age of 62. In addition, the 1981 Act provides that the Lord Chancellor may remove the appointee from office on account of misbehaviour or on account of inability to perform the duties of the office. The official address of the post is:

  The Official Solicitor to the Supreme Court

  Official Solicitor's Department

  81 Chancery Lane

  London WC2 1DD

  Acts of Parliament
  Mr. Gordon Prentice
  To ask the Parliamentary Secretary, Lord Chancellor's Department if he will list those Acts of Parliament since 1979 which have not been brought into force either fully or in part. [40481]

  Mr. John M. Taylor
  On the basis of information available up to 27 October 1995, the following are the Public General Acts of Parliament since 1979, which, as at 1 November 1995, have not been brought into force either fully or in part:

  Antarctic Minerals Act 1989 (c.21)

  Smoke Detectors Act 1991 (c.37)

  Osteopaths Act 1993 (c.21)

  Road Traffic (Driving Instruction by Disabled Persons) Act 1993 (c.31)

  Civil Evidence (family Mediation) (Scotland) Act 1995 (c.6)

  Home Energy Conservation Act 1995 (c.10)

  Road Traffic (New Drivers) Act 1995 (c.13)

  Land Registers (Scotland) Act 1995 (c.14)

  Geneva Conventions (Amendment) Act 1995 (c.27)

  Landlord and Tenant (Covenants) Act 1995 (c.30)

  481
  The following Acts are not yet in force but are due to come into force fully or in part on fixed dates in 1996:

  Motor Cycle Noise Act 1987 (c.34)

  Carers (Recognition and Services) Act 1995 (c.12)

  Merchant Shipping Act 1995 (c.21)

  Shipping and Trading Interests (Protection) Act 1995 (c.22)

  Goods Vehicles (Licensing of Operators) Act 1995 (c.23)

OVERSEAS DEVELOPMENT ADMINISTRATION

  Afghanistan
  Mr. Duncan
  To ask the Secretary of State for Foreign and Commonwealth Affairs what further assistance he proposes to give to Afghanistan, in light of recent developments in that country and following the new inter-agency consolidated appeal from the United Nations. [41959]

  Mr. Hanley
  Following a detailed review of aid to Afghanistan by an ODA-led mission earlier this summer and in light of the UN appeal launched in October, my right hon. and noble Friend the Minister for Overseas Development has approved a package of further assistance amounting to £3.5 million, which will be provided through a number of UN agencies, as well as the International Red Cross and some UK-based non governmental organisations.

HEALTH

  Retirement Ages
  Mr. Alex Carlile
  To ask the Secretary of State for Health what was the average retirement age of national health service employees, per professional group, in each of the last five years for which figures are available; and if he will make a statement. [40437]

  Mr. Sackville
  Responsibility for this matter has been delegated to the NHS Pensions Agency under its chief executive, Mr. A. F. Cowan. I have asked him to reply to the hon. and learned Member.

  Letter from A. F. Cowan to Mr. Alex Carlile, dated 3 November 1995:

  The Secretary of State for Health has asked me to reply to your recent Parliamentary Question as it falls within my area of responsibility.

  1992–93

  1993–94

  1994–95

  Region

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  Northern and Yorkshire

  596

  1.9

  1,023

  7.2

  1,236

  16.9

  Trent

  312

  1.5

  740

  3.0

  1,045

  7.2

  Anglia and Oxford

  363

  1.8

  722

  5.0

  1,067

  10.4

  North Thames

  349

  1.7

  705

  3.6

  894

  7.2

  482
  Data is held centrally on the average age at retirement for the members of the NHS Pension Scheme in England and Wales over the period 1 April 1989 to 31 March 1994, split by broad professional groups. A more detailed breakdown by year of retirement is only available at disproportionate cost. The first table shows the average age at retirement in normal health excluding redundancies; the second table shows the average age on retirement in ill-health only.

  Average age on normal retirement 1989–1994, excluding redundancies

  Professional group

  Male

  Female

  Administrative staff and hospital medical staff (excluding female nurses)

  64

  62

  Mental health officer (non manual)

  60

  60

  Manual workers (excluding MHO's)

  64

  61

  Mental health officer (manual)

  56

  60

  Medical Practitioner

  63

  63

  Dental Practitioner

  63

  63

  Female nurse, physiotherapist, midwife or health visitor

  —

  60

  Average age on ill-health retirement only

  Professional Group

  Male

  Female

  Administrative staff and hospital medical staff (excluding female nurses)

  51

  51

  Mental health officer (non manual)

  49

  49

  Manual workers (excluding MHO's)

  53

  52

  Mental health officer (manual)

  50

  50

  Medical Practitioner

  54

  52

  Dental Practitioner

  51

  49

  Female Nurse, Physiotherapist, midwife, health visitor

  —

  50

  GP Fundholding
  Ms Jowell
  To ask the Secretary of State for Health what was the amount of money being held on behalf of fundholders at regional level by region for(a) 1992–93, (b) 1993–94 and (c) 1994–95. [36797]

  Mr. Malone
  The information requested is shown in the table. By 1994–95 there were 8,889 general practitioner fundholders covering 34 per cent. of the population, with budgets totalling £2.8 billion. Savings available for spending totalling £84 million—equivalent to 3 per cent. of 1994–95 budgets.

  In any one year, a large proportion of the retained savings will date from the previous year and will not therefore be available for use until the final audit of fundholders' accounts has been completed. Savings may be retained for up to four years to be used for the benefit of patients of the practice.
  483

  1992–93

  1993–94

  1994–95

  Region

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  Number of GP fundholders

  Net cumulative savings available for spending (£ million)

  South Thames

  387

  2.3

  749

  3.5

  1,345

  8.6

  South and West

  442

  1.3

  755

  4.5

  1,103

  9.1

  West Midlands

  322

  2.5

  687

  5.7

  1,098

  14.7

  North West

  388

  1.8

  759

  4.3

  1,101

  10.2

  England

  3,159

  14.8

  6,140

  36.7

  8,889

  84.4

  Source:

  Regional offices.

  Notes:

  Savings spent in previous years or voluntarily returned to health authorities during the audit process are not included in the figures.

  Grants
  Mr. Chris Smith
  To ask the Secretary of State for Health for what grant-giving funds his Department is responsible, requiring a private sector contribution, where the use of national lottery funds is not allowed to count towards that private sector portion. [38601]

  Mr. Bowls
  I refer the hon. Member to the reply given by my hon. Friend the Minister of State, Department of National Heritage on 31 October,Official Report, columns 186–87.

  NHS Trusts
  Mr. Redmond
  To ask the Secretary of State for Health if he will list, for each NHS trust in the Trent region, those(a) chairmen and (b) non-executive directors who currently reside outside the boundaries of the district health authority in which that trust is situated. [38975]

  Mr. Malone
  For the latest information I refer the hon. Member to the replies I gave to the hon. Member for Sherwood (Mr. Tipping) and the hon. Member for Sheffield, Brightside (Mr. Blunkett) on 2 November 1994,Official Report, columns 1231–32. This information is not routinely collected. In order to provide the answers given on 2 November 1994, a special exercise was conduced. To update this information would mean repeating that exercise and incurring a disproportionate cost of approximately £7,000.

  Mr. Redmond
  To ask the Secretary of State for Health (1) if he will make it his policy to collate centrally the names of NHS trust chief executives who resign, or whose contracts are terminated together with the name of the trust involved and the amounts paid for loss of office; and if he will make a statement; [39545]

  (2) if he will make it his policy to hold centrally records on how many employees of NHS trusts have been (a) dismissed, (b) made redundant, (c) given early retirement and (d) had their contracts revoked with compensation in

  Hospital medical staff by grade for cancer specialties in England at 30 September each year

  Numbers

  1989

  1990

  1991

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  All staff

  100

  520

  30

  100

  530

  40

  120

  550

  50

  Consultant

  30

  210

  10

  40

  210

  20

  50

  220

  20

  Staff grade1

  —

  —

  —

  —

  0

  —

  —

  10

  —

  Associate specialist

  —

  10

  —

  —

  10

  —

  0

  10

  —

  484
  excess of (i) the NHS redundancy provision, (ii) £100,000 gross and (iii) £250,000 gross; and if he will make a statement. [39543]

  Mr. Malone
  No.

  Royal Hallamshire Hospital
  Mr. Redmond
  To ask the Secretary of State for Health what current research the Royal Hallamshire hospital, Sheffield is carrying out for his Department; and what research it has carried out during the last 12 months. [39568]

  Mr. Malone
  I refer the hon. Member to the reply I gave him on 30 October,Official Report, columns 35–37.

  Prescription Drugs
  Mr. Barron
  To ask the Secretary of State for Health (1) if he will list the 50 most expensive and 50 least expensive prescription drugs available in the NHS; what is the cost of each to the NHS; and how many prescriptions for each have been issued during the last 12 months for which records are available; [40698]

  (2) what was the cost to the National Health Service of each of the 50 most commonly prescribed drugs for the latest available 12-month period; and how many prescriptions for each drug were issued. [40697]

  Mr. Malone
  The information requested cannot be supplied as it contains data which are confidential.

  Cancer Specialists
  Mr. Barron
  To ask the Secretary of State for Health how many full-time cancer specialists are working in the NHS; in what specialties; and what were the corresponding numbers in each of the last five years. [40699]

  Mr. Malone
  The available information is shown in the table by grade for cancer specialties in England at 30 September each year.
  485

  Hospital medical staff by grade for cancer specialties in England at 30 September each year

  Numbers

  1989

  1990

  1991

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Senior registrar

  10

  60

  0

  10

  70

  0

  20

  70

  10

  Registrar

  10

  80

  0

  10

  80

  0

  20

  80

  0

  Senior house officer

  20

  100

  10

  20

  100

  10

  20

  100

  10

  House officer

  0

  20

  —

  0

  10

  —

  0

  10

  —

  Other staff

  —

  —

  —

  —

  —

  —

  —

  —

  —

  Hospital practitioner

  —

  10

  —

  0

  10

  0

  0

  10

  0

  Clinical assistant

  20

  50

  10

  20

  50

  10

  20

  60

  10

  Numbers

  1992

  1993

  1994

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  All staff

  160

  530

  80

  170

  520

  100

  190

  560

  130

  Consultant

  50

  220

  20

  60

  230

  30

  80

  250

  40

  Staff grade1

  —

  10

  0

  0

  20

  0

  0

  20

  0

  Associate specialist

  —

  10

  —

  —

  10

  —

  —

  10

  —

  Senior registrar

  20

  50

  10

  30

  50

  20

  30

  50

  20

  Registrar

  30

  80

  10

  20

  70

  10

  20

  80

  20

  Senior house officer

  30

  100

  10

  30

  100

  10

  20

  100

  10

  House officer

  10

  10

  —

  10

  10

  —

  0

  10

  —

  Other staff

  —

  —

  —

  —

  —

  —

  —

  —

  —

  Hospital practitioner

  0

  10

  0

  0

  0

  0

  0

  0

  0

  Clinical assistant

  20

  50

  20

  30

  40

  30

  30

  40

  30

  1 Staff grade is a new grade from 1989. — signifies a zero value.

  O = signifies a number between '0' and '5'.

  All figures are rounded to nearest '10'.

  Whole time equivalents

  1989

  1990

  1991

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  All staff

  70

  450

  20

  70

  460

  30

  80

  480

  30

  Consultant

  20

  190

  10

  20

  190

  10

  30

  200

  10

  Staff grade1

  —

  —

  —

  —

  0

  —

  —

  10

  —

  Associate specialist

  —

  10

  —

  —

  10

  —

  0

  10

  —

  Senior registrar

  10

  50

  0

  10

  60

  0

  20

  60

  0

  Registrar

  10

  80

  0

  10

  80

  0

  10

  80

  0

  Senior house officer

  20

  100

  0

  20

  100

  10

  20

  100

  10

  House officer

  0

  20

  —

  0

  10

  —

  0

  10

  —

  Other staff

  —

  —

  —

  —

  —

  —

  —

  —

  —

  Hospital practitioner

  —

  0

  —

  0

  0

  0

  0

  0

  0

  Clinical assistant

  0

  10

  0

  0

  10

  0

  0

  10

  0

  Whole time equivalents

  1992

  1993

  1994

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  Medical oncology

  Clinical oncology

  Palliative medicine

  All staff

  120

  460

  60

  120

  450

  70

  140

  490

  80

  Consultant

  30

  200

  20

  40

  200

  20

  60

  220

  30

  Staff grade1

  —

  10

  0

  0

  10

  0

  0

  10

  0

  Associate specialist

  —

  10

  —

  —

  10

  —

  —

  10

  —

  Senior registrar

  20

  50

  10

  20

  50

  20

  30

  50

  20

  Registrar

  20

  80

  10

  10

  70

  10

  20

  80

  10

  Senior house officer

  30

  100

  10

  30

  100

  10

  20

  100

  10

  House officer

  10

  10

  —

  10

  10

  —

  0

  10

  —

  Other staff

  —

  —

  —

  —

  —

  —

  —

  —

  —

  Hospital practitioner

  0

  0

  0

  0

  0

  0

  0

  0

  0

  Clinical assistant

  10

  10

  0

  10

  10

  10

  10

  10

  10

  1 Staff grade is a new grade from 1989. — signifies a zero value.

  O = signifies a number between '0' and '5'.

  All figures are rounded to nearest '10'.

  486

  Psychiatric Patients
  Mr. Kevin Hughes
  To ask the Secretary of State for Health (1) how many new beds have become available for psychiatric patients in NHS hospitals in 1995 and in each year since 1979; [41107]

  (2) how many psychiatric patients have been moved from hospitals that have been closed down to alternative NHS hospitals in 1995 and in each year since 1979; [41105]

  (3) how many psychiatric patients have moved from hospitals that have closed down to private psychiatric hospitals in 1995 and in each year since 1979. [41104]

  Mr. Bowis
  This information is not available centrally.

  Mr. Hughes
  To ask the Secretary of State for Health what is the current number of beds in private psychiatric hospitals; and what is was in each year since 1979. [41106]

  Mr. Bowis
  Information on the current number of beds in private hospitals in 1993–94 designated for mental illness and people with learning disabilities is published in "Private hospitals, homes and clinics registered under section 23 of the Registered Homes Act 1984", copies of which are available in the Library.

  Prior to 1993–94, the data did not differentiate between hospitals/clinics and nursing homes.

  Ballon Angioplasty
  Mr. Redmond
  To ask the Secretary of State for Health if his Department has participated in the research carried out by Dr. Julian Gunn, Professor David Cumberland and Professor David Crossman in respect of patients suffering from angina after receiving balloon angioplasty; and if he will make a statement. [40952]

  Mr. Malone
  I refer the hon. Member to the reply I gave him on 30 October,Official Report, columns 35–37.

  Ecstasy
  Mr. Redmond
  To ask the Secretary of State for Health (1) what research his Department has commissioned to discover whether the drug Ecstasy is demethylenated by human cytochrome P.4502D6 (CYP 2D6); and if he will make a statement; [41004]

  (2) what research his Department has commissioned to discover whether the drug Ecstasy is a substitute for human CYP 2D6; and if he will make a statement. [41005]

  Mr. Malone
  I refer the hon. Member to the reply I gave him on 30 October,Official Report, columns 35–37.

  Residential Care Homes
  Mr. Butcher
  To ask the Secretary of State for Health what assessment he has made of the extent to which the conditions imposed on private residential homes and nursing homes in Coventry are within the scope of legal requirements or his Department's guidelines. [40897]

  Mr. Bowis
  Responsibility for the regulation of private residential care homes and nursing homes lies with the local authority and health authority respectively. It is for them to ensure that homes comply with statutory requirements and to develop local standards for 488
  registration. Guidance issued recently to authorities promotes sensible, pragmatic and consistent approaches in setting standards.

  Individual Treatments
  Mr. Spearing
  To ask the Secretary of State for Health what representations he has received concerning his intention to remove grommets from the list of approved treatments; and what reasons were given for their removal. [41110]

  Mr. Malone
  No list of approved treatments exists. Health authorities and general practitioner fundholders are responsible for assessing the needs of the people they serve and deciding what treatments and services are required to meet those needs, within the framework of national priorities. Decisions about individual treatments are a matter for the individual clinician together with the patient, based on an assessment of clinical need, and taking account of available evidence of effectiveness.

  Laryngectomies and Tracheotomies
  Mr. Jim Cunningham
  To ask the Secretary of State for Health if he will create a body that is able to answer questions and concerns from people who have undergone laryngectomies and tracheotomies. [39679]

  Mr. Sackville
  Surgeons and other professional staff in hospital ear, nose and throat departments are available to answer questions and address the concerns of patients undergoing this treatment. The National Association of Laryngectomy Clubs also provides advice and has branches attached to a number of hospitals which specialise in laryngectomies.

  NHS Administration Costs
  Ms Harman
  To ask the Secretary of State for Health what is the change in administration costs in the NHS since 1989–90; and how he intends to achieve the 5 per cent. cut in health authority spending on administration he announced on 11 October. [41516]

  Mr. Malone
  The table sets out health authority administration expenditure from 1989–90 to 1993–94, the latest year available. I expect the national health service executive regional offices to agree with individual authorities figures for the cost of running the authority for 1996–97 which will, in aggregate, deliver the 5 per cent. cash savings my right hon. Friend the Secretary of State announced on 11 October 1995.

  Health authority administration expenditure 1989–90 to 1993–94

  £ million

  1989–90

  691

  1990–91

  871

  1991–92

  786

  1992–93

  900

  1993–94

  1,069

  Source:

  Summarised annual accounts of regional health authorities, district health authorities, special health authorities for the London postgraduate hospitals and family health services authorities/family practitioner committees.

  Notes:

  1. The figures represent the total revenue expenditure on pay and accommodation costs of staff of all disciplines and their support staff employed at headquarters levels.
  489
  2. RHA, DHA and SHA costs are reported in the accounts as "Authority administration and purchasing expenses". This includes capital charges from 1991–92. FHSA/FPC administration costs are those reported in the accounts as revenue administration costs and represent that part of the total expenditure which is not medical, dental, ophthalmic or pharmaceutical.

  3. Changes in the years in the roles and responsibilities of family practitioner committees, which became family health services authorities in 1990, RHAs and DHAs, which started to transfer provider functions to NHS trusts in 1991–92, together with changes in accounting policies, particularly the inclusion of capital charges in health authorities' administration and purchasing expenditure, mean that the figures are not comparable.

  Employment of Children
  Mr. Ian McCartney
  To ask the Secretary of State for Health, further to his announcement' of 30 October Official Report column 42–43 regarding changes in child employment law, if he will publish details of the representations he has received recommending that the limit on children's work of two hours on a Sunday be increased to between five and eight hours; and if he will list the organisations and their papers submitted in support of this proposed change to the Children and Young Persons Act 1933, as amended. [41388]

  Mr. Bowis
  The consultation I announced on 30 October is intended to provide us with the views of others on what in our view would be a sensible change to the current law.

  Public Health Link
  Ms Harman
  To ask the Secretary of State for Health by what procedure general practitioners will be notified in the case of immediate category of notification procedure on the public health link system being activated. [41512]

  Mr. Sackville
  Following consultation with the profession, the chief medical officer wrote to all doctors on 24 February 1994 setting out the new arrangements for communications with the profession (PL CMO(94)3). Where there is a need to send information very quickly to doctors, the public health link system is activated. The message is transmitted electronically to district directors of public health who have the responsibility for forwarding it, with the minimum of delay, to the relevant health professionals. Every district has set up its own locally determined mechanisms for cascading the information. For example, some general practitioners would receive the information electronically via a local e-mail system, others by fax, others by courier, and in some instances the message could be conveyed by a telephone call.

  Ms Harman
  To ask the Secretary of State for Health what assessment he has made of whether the public health link system of communications which uses the EPINET system will operate satisfactorily if the immediate category of notification procedure needs to be activated. [41511]

  Mr. Sackville
  The public health link system was set up in February 1994, following consultation with the profession and in response to a recognised need to get important urgent information to doctors. The system was first tested on 6 July 1994 when a test message was sent to district directors of public health to cascade to all doctors. This test message enabled districts to assess their local arrangements.
  490
  Since then the cascade system has been activated a further seven times, for example to provide information about Ebola virus and plague. The system has generally been welcomed and has worked well, though it is recognised that it is very difficult for each district to get information to each and every doctor within a few hours. Each use of the cascade has provided a valuable opportunity to assess and revise the local and central arrangements for cascading information. A list of the cascade messages, and chief medical officer letters and updates, is included in the annual report "On the State of the Public Health", copies of which are available in the Library.

  Ms Harman
  To ask the Secretary of State for Health whom he intends to consult in his review of the public health link procedure for notifying general practitioners that he announced in his statement to the House of 23 October,Official Report, columns 701–10, when he expects to conclude the review; and if he will publish the results. [41513]

  Mr. Sackville
  The review of arrangements for communicating urgent information to all doctors has already started. The results of the review will be discussed with the profession. We shall ensure that the conclusions from that review will be acted upon.

  Dental Services
  Ms Harman
  To ask the Secretary of State for Health if he will list by family health services authority the number of people registered with NHS dentists in England in(a) December 1993, (b) July 1994, (c) December 1994 and (d) July 1995. [41514]

  Mr. Malone
  This information will be placed in the Library.

  Waiting Times
  Ms Harman
  To ask the Secretary of State for Health if he will make a statement regarding the waiting times for patients of general practitioner fundholders and the patients of general practitioners who are not fundholders in the North and Mid-Hampshire health commission area. [41515]

  Mr. Malone
  This information is not available centrally.

WALES

  Ministerial Transport
  Dr. Lynne Jones
  To ask the Secretary of State for Wales what has been the cost of ministerial transport in each of the past five years; what allowance has been paid to Ministers who use their own vehicles; and what has been the cost in each of the past five years. [40749]

  Mr. Hague
  The information is not readily available in respect of all transport and could be provided only at disproportionate cost. The cost of ministerial use of the official car service, a significant element of ministerial travel arrangements, over the five years is as follows:

  1990–91: £144,209

  1991–92:£158,535

  491

  1992–93:£170,062

  1993–94: £174,069

  1994–95:£176,452

  Ministers who use their own vehicles are paid normal civil service rates. The cost in 1994–95 was £1,020 and in 1995–96 to date, £915. The cost of the previous three years is not readily available.

  Council House Sales
  Mr. Win Griffiths
  To ask the Secretary of State for Wales he will list by local housing authority,(a) the amount each authority has used from the sale of council houses since April 1981 to pay off its debts, (b) the amount each authority currently has on deposit from the sale of council houses and (c) the amount saved in interest payments on debts in the case of (a) and the amount received in interest in the case of (b). [40689]

  Mr. Gwilym Jones
  The available information is given in the following tables.

  £000

  Authority

  Usable receipts from the sale of council houses available at 31 March 1995

  Outstanding loan debt as at 31 March 1995

  Alyn and Deeside

  521

  35,067

  Colwyn

  569

  27,763

  Delyn

  0

  32,279

  Glyndwr

  456

  11,980

  Rhuddlan

  397

  27,743

  Wrexham Maelor

  992

  74,603

  Carmarthen

  776

  35,755

  Ceredigion

  1,170

  21,618

  Dinefwr

  608

  28,115

  Llanelli

  0

  47,698

  Preseli Pembrokeshire

  2,597

  41,828

  South Pembrokeshire

  1,209

  21,090

  Blaenau Gwent

  2,199

  103,856

  Islwyn

  390

  50,848

  Monmouth

  3,585

  45,849

  Newport

  7,642

  122,004

  Torfaen

  2,660

  83,132

  Aberconwy

  247

  20,265

  Arfon

  0

  29,695

  Dwyfor

  303

  15,939

  Meirionnydd

  0

  10,635

  Ynys Mon

  246

  53,675

  Cynon Valley

  0

  52,914

  Merthyr Tydfil

  345

  64,194

  Ogwr

  633

  74,913

  Rhondda

  0

  87,253

  Rhymney Valley

  0

  71,738

  Taff Ely

  532

  41,957

  Brecknock

  1,188

  31,614

  Montgomeryshire

  689

  23,199

  Radnorshire

  399

  13,239

  Cardiff

  7,053

  183,971

  Vale of Glamorgan

  6,702

  60,004

  Port Talbot

  0

  40,166

  Lliw Valley

  0

  39,742

  Neath

  0

  39,981

  Swansea

  242

  135,631

  Clwyd

  n/a

  145,656

  Dyfed

  n/a

  118,889

  Gwent

  n/a

  171,914

  Gwynedd

  n/a

  80,160

  Mid Glamorgan

  n/a

  134,775

  Powys

  n/a

  57,412

  492

  £000

  Authority

  Usable receipts from the sale of council houses available at 31 March 1995

  Outstanding loan debt as at 31 March 1995

  South Glamorgan

  n/a

  171,374

  West Glamorgan

  n/a

  170,118

  Dyfed /Powys Police Authority

  n/a

  4,377

  Gwent Police Authority

  n/a

  4,050

  North Wales Police Authority

  n/a

  3,179

  South Wales Police Authority

  n/a

  11,306

  Total Districts

  44,350

  1,901,954

  Total Counties

  n/a

  1,050,298

  Total Police Authorities

  n/a

  22,912

  Total Wales

  44,350

  2,975,164

  Source:

  Local authority returns.

  Failure to use sale proceeds to redeem existing debt would have resulted in correspondingly higher outstanding loan debt and correspondingly increased interest charges paid by council taxpayers in Wales.

  European Regional Development Fund
  Mr. Morgan
  To ask the Secretary of State for Wales if he will make a statement on the technical meeting between his officials and those of the regional development directorate of the European Commission in relation to the supply of information material to the Welsh Office reduced grant in aid to the Welsh Development Agency and the additionality principle. [37814]

  Mr. Hague
  [holding answer 19 October 1995]: I am pleased to say that the Commission has now accepted that European structural funds are properly spent in Wales and has released all previously blocked resources. Agreement has also been reached on improving the presentation of European regional development fund support made to the WDA and other public bodies in Wales.

  Veterinary Services
  Mr. Alex Carlile
  To ask the Secretary of State for Wales if he will make a statement on the availability of Welsh Office veterinary services in mid Wales. [39808]

  Mr. Hague
  The Government's veterinary field service provides veterinary services throughout Great Britain. VFS officers are employed by the Ministry of Agriculture, Fisheries and Food, but on a wide range of subjects, state veterinary service officers working in Wales do so on my behalf, in view of my responsibilities for matters such as farm animal health, welfare and meat hygiene.

  A review of the VFS earlier this year recommended an improved and streamlined management structure, and the Government announced on 4 May a number of changes to the VFS. In future there will be fewer, larger VFS divisions, altering from four to three in Wales. The future VFS divisional offices in Wales will be located at Cardiff, Carmarthen and Caernarfon. The present VFS divisional office at Llandrindod Wells will remain as an area office, as will the current area office at Ruthin. The number of front-line veterinary and technical staff will stay the same.

  Assisted Places Scheme
  Mr. Alex Carlile
  To ask the Secretary of State for Wales what is the cost of the assisted places scheme in Wales for each of the last three years for which figures are available. [40466]

  Mr. Hague
  Expenditure in Wales on the assisted places scheme for each of the financial years 1992–93 to 1994–95 was £2,457,230, £2,621,261 and £2,771,504 respectively.

  Primary School Pupils
  Mr. Alex Carlile
  To ask the Secretary of State for Wales how many primary school pupils were taught in classes of more than 30 pupils, in total and as a percentage of all pupils, in each local authority in(a) January 1994 and (b) January 1995. [40429]

  Mr. Hague
  On the basis of provisional January 1995 schools census figures, there were some 67,800 pupils in ordinary classes of more than 30 in maintained primary schools in Wales in January 1994 and approximately 72,500 in January 1995; these pupils represented 26.5 per cent. of all pupils in ordinary classes in January 1994 and 28.0 per cent. in January 1995.

  Information on the basis of individual local authorities is not currently available.

  Mr. Alex Carlile
  To ask the Secretary of State for Wales what is the average annual cost of educating a primary school pupil in a class of 30 pupils. [40430]

  Mr. Hague
  The information requested is not available centrally.

TRADE AND INDUSTRY

  AGCO-Massey Ferguson Merger
  Mr. Jim Cunningham
  To ask the President of the Board of Trade what discussions he or his officials have had regarding the AGCO takeover of certain Massey Ferguson operations in Coventry; and what notification he has received of expected job losses. [41284]

  Mr. Jonathan Evans
  None. In the first instance, it is for the Director General of Fair Trading to consider and advise my right hon. Friend the President of the Board of Trade on all qualifying mergers under the Fair Trading Act 1973. That advice would take into account all relevant factors.

  Investment (United States)
  Sir Irvine Patnick
  To ask the President of the Board of Trade what initiatives he has taken to attract United Kingdom firms to invest in the United States of America; and if he will make a statement. [40576]

  Mr. Nelson
  United Kingdom companies have a long history of investing in the United States. It is the most popular destination for direct investment overseas and the United Kingdom is the largest foreign investor in the United States.

  My Department encourages British companies to consider the investment option in drawing up strategies for doing business with American companies. As one
  494
  element of the "North America Now" trade promotion campaign we have a programme of help for United Kingdom companies seeking strategic partners in north America.

  Annual Remuneration
  Mr. Malcolm Bruce
  To ask the President of the Board of Trade if he will estimate the number of individuals in his(a) Department, (b) agencies and (c) non-departmental public bodies whose annual remuneration including benefits in kind exceeded (i) £100,000, (ii) £200,000, (iii) £300,000 in (1) 1985–86, (2) 1990–91, (3) 1992–93, (4) 1994–95 and (5) 1995–96. [40815]

  Mr. Jonathan Evans
  [holding answer 1 November 1995]: Other than pension contributions, benefits in kind are not normally paid to staff in the department, agencies and NDPBs. No individual—in the Department, its agencies or its NDPBs has received remuneration, excluding pension benefits, above £100,000 in any of the years specified.

  Salaries
  Mr. Malcolm Bruce
  To ask the President of the Board of Trade what was the(a) lowest and (b) highest full-time salary paid to any employee in his (i) Department, (ii) agencies and (iii) non-departmental public bodies in (1) 1994–95 and (2) 1995–96. [40816]

  Mr. Jonathan Evans
  [holding answer 1 November 1995]: It is the Government's normal policy to publish civil servants' salaries in bands. Accordingly, the lowest full-time salary in all three organisations fell within the band:

  1994–95: £4,000-£8,999

  1995–96: £4,000-£8,999

  The highest full-time salary relating to civil servants in agencies fell within the bands:

  1994–95: £65,000-£69,999

  1995–96: £70,000-£74,999

  and in the Department:

  1994–95: £95,000-£99,999

  1995–96: £95,000-£99,999

  The highest full-time salary relating to non-civil servants in NDPB's fell within the band:

  1994–95: £95,000-£99,999

  1995–96: £95,000-£99,999

  New Parliamentary Building
  Mr. Spellar
  To ask the Chairman of the Accommodation and Works Committee, pursuant to his answer of 23 October,Official Report, column 460, what percentage of existing contracts have gone to British firms; when he expects the award of the cladding contract to be announced; and how many (a) UK cladding firms and (b) other firms have been invited to tender for the cladding contract. [40682]

  Mr. Ray Powell
  Many of the companies which are invited to tender for the new parliamentary building contracts are multi-national in either their ownership or their operations, or both. Consequently it is not possible to provide a precise answer about the use of "British firms".
  495
  Of the three major contracts let to date, two went to a British-based company. Numerous smaller contracts have been awarded for work which has been carried out almost entirely in the UK although the companies may not have been UK owned.

  The tender list for the fenestration units reflected the fact that the cladding industry tends to be dominated by continental European companies. Initially, five companies were invited to tender at least two of which have a significant UK presence. Negotiations are still underway to determine which of the offers is the most competitive in terms of both time and cost. An announcement is not expected this year.

  SCOTLAND

    Waverley Court, Paisley
    Mr. McMaster
    To ask the Secretary of State for Scotland what is his best estimate of the total cost to the public purse of keeping Waverley court at Foxbar in Paisley empty for six years following a decision by Scottish Homes to dispose of it to the private sector; what were the costs in terms of(a) lost rental income, (b) resettlement allowances, (c) decoration payments, (d) removal expenses, (e) furniture storage expenses, (f) other rehousing payments and costs, (g) staff time in developing the package, (h) staff time in consultation with individual tenants or groups of tenants, (i) staff time in briefing, consulting, guiding and instructing outside bodies, (j) staff time in working with potential developers, (k) loss of rental income for the whole period, (l) all consultancy fees relating to the building during the whole period and (m) other costs; what will be the cost of demolishing the building and clearing the site; what action he intends to take to ensure such events cannot occur again; and if he will make a statement. [39188]

    Mr. Raymond S. Robertson
    The information requested is a matter for Scottish Homes and I have asked its chairman, Sir James Mellon, to write to the hon. Member.

    Mr. McMaster
    To ask the Secretary of State for Scotland (1) if he will seek a meeting with the chairman of Scottish Homes to discuss the cost to the public purse of its decision to evacuate Waverley court at Foxbar in Paisley six years ago; if he will instruct an investigation into the circumstances which caused Scottish Homes to seek disposal of the building to the private sector without first checking that private sector financiers were willing to lend or enter into mortgages on the property or its component parts; if he will instruct the board of Scottish Homes to instruct disciplinary investigations arising from the performance of its officials in this episode; and if he will launch a full-scale investigation into the loss of public funds; [39189]

    (2) if he will launch a public inquiry into the possible misuse of public funds, maladministration and negligence of Scottish Homes in relation to Waverley court at Foxbar in Paisley. [39173]
    496
    Mr. Robertson
    My right hon. Friend is aware of the corrrespondence between the hon. Member and the chairman of Scottish Homes and has no plans to initiate any inquiry into the matter.

    Ministerial Visits
    Mr. McMaster
    To ask the Secretary of State for Scotland if he will list visits made by him and each of his Ministers since they were appointed to the Scottish Office, and if he will make a statement. [39207]

    Mr. Michael Forsyth
    Since taking up my present appointment I have made one visit overseas. This was to the Fisheries Council in Luxembourg on 26 October. Details of visits undertaken by other Scottish Office Ministers are given in the table.

    Date

    Location

    Lord James Douglas-Hamilton

    15 September to 19 September 1995

    Helsinki

    8 October to 10 October 1995

    Stockholm

    Mr. Raymond Robertson MP

    17 October 1995

    Brussels

    Mr. George Kynoch MP

    26 August to 31 August 1995

    Taiwan

    24 October to 29 October 1995

    USA

    Earl of Lindsay

    3 October 1995

    Cologne

    30 October to 2 November 1995

    Washington

    Special Educational Needs
    Mr. Home Robertson
    To ask the Secretary of State for Scotland what grants or other financial assistance have been awarded by the Scottish Office, in the financial year 1995–96, to organisations representing children with specific speech or language disorders; and what assistance has been given to organisations representing children with other physical disadvantages. [40170]

    Mr. Raymond S. Robertson
    A range of organisations represent children with special educational needs, including children with physical disadvantages and also speech and language disorders. Funding has been given by the Scottish Office to the following organisations in this area in the current financial year.

    Organisation

    Amount £

    Children in Scotland

    170,000

    Disability Scotland

    275,592

    en ABLE

    25,755

    Epilepsy Association of Scotland

    3,500

    Family Fund

    2,270,600

    Royal National Institute for Deaf People

    30,000

    Royal National Institute for the Blind

    27,000

    Scottish Association for the Deaf

    7,993

    Sense Scotland

    47,083

    Scottish Council for Spastics

    24,000

    Spinal Injuries Scotland

    15,372

    497
    Mr. Home Robertson
    To ask the Secretary of State for Scotland which of the organisations listed as useful contacts in the Scottish Office parents' guide to special educational needs(a) provide a helpline to families on record of needs, (b) provide written guidance or advice to supplement the official literature on record of needs arrangements and procedures and (c) provide support or speak for parents of children at record of needs meetings or appeals. [40169]

    Mr. Robertson
    The 27 organisations listed in the parents' guide to special educational needs provide a variety of advice and assistance to parents of children and young persons with special educational needs. Detailed information on the services offered by each of the organisations listed is not held centrally; however, their telephone numbers are listed.

    Organisation

    Telephone numbers

    Association for all Speech Impaired Children

    0171-236 3632

    0171-236 6487

    Barnardo's

    0131-334 9893

    British Red Cross Society

    0141-332 9591

    Catholic Education Commission

    0141-943 0494

    Children in Scotland1

    0131-228 8484

    Church of Scotland

    0131-225 5722

    Disability Scotland

    0131-229 8632

    Dyslexia Institute

    0141-334 4549

    Epilepsy Association of Scotland

    0141-427 4911

    ENABLE2

    0141-226 4541

    Linking Education and Disability (LEAD)

    0131-339 5408

    National Deaf Children's Society

    0171-229 9272

    National Federation of Blind of the UK

    01924-291313

    Royal Institute for the Blind

    0171-388 1266

    Royal National Institute for the Deaf

    0171-387 8033

    Royal National Institute for the Blind

    0131-225 6242

    Royal National Institute for the Deaf

    0141-332 0343

    Scottish Association for the Deaf

    0131-556 8137

    Scottish Consumer Council

    0141-226 5261

    Scottish Council for Spastics

    0131-337 9876

    Scottish Dyslexia Association

    01786-446650

    Scottish Downs Syndrome Association

    0131-313 4225

    Scottish National Federation for the Welfare of the Blind

    01463-233663

    Scottish Society for Autistic Children

    0131-557 0474

    Scottish Spina Bifida Association

    0131-332 0743

    SENSE IN SCOTLAND

    0141-221 7577

    Spinal Injuries Scotland3

    0141-440 0960

    1 Formerly Scottish Child and Family Alliance.

    2 Formerly Scottish Society for the Mentally Handicapped.

    3 Formerly Scottish Spinal Cord Injury Association.

    Mr. Home Robertson
    To ask the Secretary of State for Scotland what grants or other financial assistance have been awarded by the Scottish Office, in the financial year 1995–96, to organisations currently listed in the Scottish Office parents' guide to special educational needs to enable them to equip themselves with the necessary information to offer appropriate advice or guidance to parents. [40173]

    Mr. Robertson
    Of the organisations listed in the current edition of a parents' guide to special educational needs, those shown have received funding from the Scottish Office in the current financial year. It is not possible to say what proportion of the funding shown is used by the organisations for provisions of advice or guidance to parents of children with special educational needs. Detailed information on that aspect is a matter for the individual organisation concerned.498

    Organisation

    Amount (£)

    Children in Scotland

    170,000

    Disability Scotland

    275,592

    enABLE

    25,755

    Epilepsy Association of Scotland

    3,500

    Royal National Institute for Deaf People

    30,000

    Royal National Institute for the Blind

    27,000

    Scottish Association for the Deaf

    7,993

    Scottish Consumer Council

    20,500

    Sense Scotland

    47,083

    Scottish Council for Spastics

    24,000

    Spinal Injuries Scotland

    15,372

    New Homes
    Mr. Chisholm
    To ask the Secretary of State for Scotland how many new homes have been started by(a) local authorities and (b) housing associations in each year since 1974; and what is his estimate of the likely number of starts in 1995–96 and 1996–97. [39929]

    Mr. Raymond S. Robertson
    I refer the hon. Member to the answer I gave to the hon. Member for Greenwich (Mr. Raynsford) on 24 October,Official Report, column 510.

    Beaufort Dyke
    Mr. Foulkes
    To ask the Secretary of State for Scotland if he will make a statement on the full nature and extent of the independent marine survey of the Beaufort dyke area announced by his Department on 24 October with particular reference to(a) sonary soundings, (b) investigation by divers, (c) other physical checks and (d) video investigations; if he will undertake to publish the report in full; and if he will make a statement. [40221]

    Mr. Raymond S. Robertson
    [holding answer 30 October 1995]: The Under-Secretary with responsibility for industry—my hon. Friend the Member for Kincardine and Deeside (Mr. Kynoch)—told the House on 24 October, that the routine monitoring survey, planned for next spring by the Department's marine laboratory, Aberdeen to determine the effect on the marine environment of the munitions dump sites in the Beaufort dyke area, would be brought forward to mid-November this year. In view of the Government's concern for public safety over the arrival of large quantities of phosphorus canisters on the foreshore of the Clyde estuary and surrounding islands, the survey has been extended in an attempt to identify their source and whether they were disturbed by recent pipeline trenching operations in the area. The fisheries research vessel Clupea will undertake the survey in mid-November. The work will comprise:

    analysis of sea bed sediment samples and a trawl survey to confirm that there has been no environmental contamination resulting from munitions dumping;

    exploratory under-water television studies and side-scan sonar investigations to confirm the distribution of any dumped munitions;

    analysis of commercially exploited fish and shellfish species to ascertain the presence of contaminants that may be related to dumping activity;

    The survey will not include investigation by divers.

    The results of the survey will be published when available.
    499

    Forestry Commission
    Mrs. Ewing
    To ask the Secretary of State for Scotland how many people are employed by the Forestry Commission on(a) a part-time and (b) a full-time basis in (i) Scotland, (ii) England, (iii) Wales and (iv) Northern Ireland. [40670]

    Mr. Kynoch
    [holding answer 1 November 1995]: The number of people employed by the Forestry Commission is:

    Country

    Part-time employees

    Full-time employees

    Scotland

    166

    1,859

    England

    161

    1,315

    Wales

    45

    474

    These figures do not include contractors working in Forestry Commission forests.

    The Forestry Commission does not operate in Northern Ireland.

    Mrs. Ewing
    To ask the Secretary of State for Scotland how much land(a) in acres and (b) in percentage terms is owned by the Forestry Commission in (i) Scotland (ii) England (iii) Wales and (iv) Northern Ireland. [40671]

    Mr. Kynoch
    [holding answer 1 November 1995]: The information is as follows:

    Country

    Forestry Commission land (acres)

    Percentage of total land in each country

    England

    660,000

    2.1

    Scotland

    1,700,000

    8.9

    Wales

    331,000

    6.5

    The Forestry Commission does not manage land in Northern Ireland.

  NORTHERN IRELAND

    Higher Education
    Mr. Llwyd
    To ask the Secretary of State for Northern Ireland what was the proportion of young people from Northern Ireland entering higher education in(a) 1993–94 and (b) 1994–95; and if he will make a statement. [29023]

    Mr. Ancram
    The proportion of young people from Northern Ireland entering higher education was 36.4 in 1993–94 and 37.2—provisional—in 1994–95.

    Fold Housing Association
    Mr. Robert McCartney
    To ask the Secretary of State for Northern Ireland to what extend the figure in the Department of the Environment approved rules of 15 per cent. to 20 per cent. of tenants in the Fold Housing Association being actively able to help its fellow tenants is being met; and what assessment he had made of the adequacy of the target figure. [40559]
    500
    Mr. Moss
    Information on Fold Housing Association's target balance between active and less active tenants in sheltered housing is not collated or monitored by the Department. The need for such a balance is currently being considered in a review of the social housing needs of older people which is jointly being carried out by the Northern Ireland Housing Executive and the Northern Ireland Federation of Housing Associations. It is hoped that the report will be produced before the end of this year. I will arrange for copies to be forwarded to the hon. and learned Member and placed in the Library.

    Tuition Fees (Grants)
    Mr. Robert McCartney
    To ask the Secretary of State for Northern Ireland (1) how many students from Northern Ireland have their tuition fees paid while attending educational institutions in the Irish Republic; [40560]

    (2) what are the estimated savings to the Northern Ireland budget from the 1996–97 academic year onwards arising from students from Northern Ireland at public sector educational institutions in the Irish Republic no longer being required to have their tuition fees paid by education and library boards in Northern Ireland; and how many students in the last year have been paid grants in respect of their applications meeting the eligibility requirement of United Kingdom residence and schooling in the Irish Republic during the last three years. [40561]

    Mr. Ancram
    In the 1994–95 academic year tuition fees were paid for 1,622 students from Northern Ireland attending education institutions in the republic of Ireland. Final figures are not available for the current academic year.

    The savings referred to are estimated at £1.7 million in the 1996–97 financial year and at £2 million in both the 1997–98 and 1998–99 financial year.

    Some 583, 891 and 1,370 Northern Ireland students attending institutions of higher education in the Republic of Ireland were in receipt of maintenance grant in the last three academic years.

    Graduates
    Mr. Robert McCartney
    To ask the Secretary of State for Northern Ireland what was(a) the number of Northern Ireland graduates, (b) the number and proportion of graduates recruited in the Northern Ireland civil service, (c) the number of recruits overall, (d) the number and proportion of the total who were graduates and were taken on in jobs where a degree was an eligibility requirement, (e) the number and proportion of recruits to the general and administrative grades where a degree was a requirement and (f) the number of graduates recruited to grades where a degree was not an eligibility requirement in each of the last three years. [40562]

    Sir John Wheeler
    The number of Northern Ireland graduates for 1992–93 and 1993–94, and the number of recruits overall and details of graduates recruited to permanent non-industrial posts in the Northern Ireland civil service for 1992–93, 1993–94 and 1994–95 are set out in the following table:
    501

    1992–93

    Per cent.

    1993–94

    Per cent.

    1994–95

    Per cent.

    (a) Number of NI graduates1

    3,843

    —

    4,220

    —

    n/a

    —

    (b) Number and proportion of graduates recruited to NI Civil Service

    277

    7.2

    102

    2.4

    99

    n/a

    (c) Number of recruits overall to NI Civil Service2

    1,554

    —

    633

    —

    540

    —

    (d) Number and proportion of recruits where degree required

    132

    47.6

    36

    35.3

    40

    40.4

    (e) Number and proportion of recruits to general and administrative grades where degree required

    6

    2.2

    6

    5.9

    1

    1.0

    (f) Number of graduates recruited where degree not required

    142

    —

    66

    —

    54

    —

    1 Northern Ireland domiciled graduates from Northern Ireland universities. Figures not yet available for 1994–95.

    2 Non-industrial permanent recruits. Includes recruits who obtained a degree since appointment.

    Community Alarms
    Mr. Clifford Forsythe
    To ask the Secretary of State for Northern Ireland what consultation he had with health and social services boards or trusts prior to issuing guidance to social security offices which led to applicants requiring community alarms being refused community care grants to purchase them; and when he intends to rectify the situation. [41474]

    Mr. Moss
    Responsibility for the subject in question has been delegated to the Social Security Agency under its chief executive, Mr. Alec Wylie. I have asked him to arrange for a reply to be given.

    Letter from Alec Wylie to Mr. Clifford Forsythe, dated 3 November 1995:

    I have been asked to reply to your recent question on the provision of Community Care Grants for Community Alarm Systems.

    I should first of all assure you that there has been no recent change in policy regarding the provision of grants from the Social Fund for Community Alarm systems. The position is that the Health and Social Service Boards/Trusts (HSSB/Ts) are responsible for the provision of a wide range of services under the government's community care policies. This provision can include community alarm systems, but it is a matter for the individual Boards to decide what resources should be made available from their overall budget for any particular form of help.

    Social Fund Community Care Grants complement these provisions and a person who is getting Income Support may be entitled to a grant for the purchase of a Community Alarm System. In considering awards, Social Fund Officers must look carefully at all the circumstances of each individual case including the possibility that help may be available from another source such as the HSSB/Ts. Thus the need for close liaison between the Social Security Agency and the local social services departments.

    Internal procedural guidance on this subject was issued earlier in the year but unfortunately some offices did not interpret this correctly and applicants were wrongly advised to contact the HSSB/Ts for help. Steps have already been taken to ensure that all applications for Community Care Grants for community alarms are handled correctly. In addition, offices have been asked to identify and review those cases which were incorrectly handled.

    I hope this helps explain the position for you.

    Bankruptcy Petitions
    Mrs. Roche
    To ask the Secretary of State for Northern Ireland how many petitions for bankruptcy have been begun by his Department for businesses with under 500 employees in each of the last five years. [40514]

    Sir John Wheeler
    [holding answer 1 November 1995]: Responsibility for the subject in question has been delegated to the Rate Collection Agency under its chief executive, Mr. D. W. Gallagher. I have asked him to arrange for a reply to be given.
    502
    Letter from D. W. Gallagher to Mrs. Barbara Roche, dated 2 November 1995:

    You asked the Secretary of State how many Petitions for Bankruptcy have begun by his Department for businesses with under 500 employees in each of the last five years.

    The numbers of Petitions for Bankruptcy and Winding-Up actions begun by the Rate Collection Agency for businesses with under 500 employees in each of the last five years is as follows:

    1991–92: 27

    1992–93: 147

    1993–94: 92

    1994–95: 94

    1995–96: 60

    I hope you find this information helpful.

  TREASURY

    Unemployment
    Mr. Jim Cunningham
    To ask the Chancellor of the Exchequer what was the level of unemployment among 16 to 24-year-olds from ethnic minority backgrounds in each year since 1992–93. [39677]

    Mrs. Angela Knight
    Estimates from the labour force survey are shown in the table.

    ILO unemployed persons aged 16 to 24 from ethnic minority groups Great Britain

    Spring

    Number

    1992

    76,000

    1993

    77,000

    1994

    74,000

    1995

    76,000

    Mr. Jim Cunningham
    To ask the Chancellor of the Exchequer what was the level of unemployment among 16 to 24-year-olds in each year since 1992–93. [39676]

    Mrs. Knight
    [holding answer 2 November 1995]: Claimant unemployment by age, for the months of January, April, July and October, and ILO unemployment by age, for the quarters spring, summer, autumn and winter, can be obtained from the NOMIS database accessed by the House of Commons Library.

    Bank of Credit and Commerce International
    Mr. Vax
    To ask the Chancellor of the Exchequer if he will make a statement about the progress of litigation between the liquidators of BCCI and the Bank of England. [41332]
    503
    Mrs. Knight
    The matter is before the court and it is not possible to comment further in these circumstances.

    Mr. Vaz
    To ask the Chancellor of the Exchequer when he next intends to meet the Governor of the Bank of England to discuss the liquidation of BCCI and the issue of the liquidators' writ against the Bank of England. [41333]

    Mrs. Knight
    My right hon. and learned Friend the Chancellor and the Governor meet regularly to discuss a range of issues.

    Tax Evasion
    Mr. Milburn
    To ask the Chancellor of the Exchequer how many full-time equivalent staff were employed by the Inland Revenue on tax evasion investigations and at what cost in each of the last five years. [37923]

    Mr. Jack
    Approximate numbers of staff units—full-time equivalent staff—and their cost, are as follows:

    Staff units

    Cost £m

    1990–91

    3,200

    103

    1991–92

    3,400

    115

    1992–93

    3,500

    124

    1993–94

    3,800

    137

    1994–95

    4,400

    166

    The figures for 1994–95 cannot be compiled on a basis exactly comparable with earlier years, owing to a change in the way these figures are maintained. Unlike previous years, they include details of staff employed on all employer compliance work.

    Pension Schemes
    Mr. Nigel Griffiths
    To ask the Chancellor of the Exchequer what is the average contribution to personal or occupational pension schemes by employees(a) under 40 years old, (b) between 40 and 50 years old and (c) over 50 years old, expressing the figures both in cash terms and as a percentage of gross income. [39092]

    Mr. Jack
    Latest provisional information for 1995–96 is as follows:

    As a perentage of

    Age

    Average contribution to a personal or occupational pension scheme £

    Gross income

    Income from employment

    Under 40

    800

    4.5

    4.5

    Between 40 and 50

    1,100

    5.0

    5.5

    Over 50

    1,200

    5.5

    6.5

    Public Appointments
    Mr. Redmond
    To ask the Chancellor of the Exchequer (1) if he will list the public appointments for which his Department is responsible in the county of 504
    South Yorkshire, indicating in each case the duration of the appointment, the date when a new appointment is due, and the salary; [39431]

    (2) if he will list all the non-departmental public bodies to which his office makes appointments in the county of South Yorkshire, with the total annual budget of each body and the number of appointments made or renewed for each body in each of the last four years. [39468]

    Mrs. Angela Knight
    The Chancellor's Departments and agencies make no appointments to non-departmental public bodies in the county of South Yorkshire.

    Temporary and Part-time Staff
    Mr. Ian McCartney
    To ask the Chancellor of the Exchequer how many staff are currently employed in his Department and in related agencies on(a) temporary or casual employment contracts and (b) part-time employment contracts, given as an actual figure and as a proportion of the total work force; and what were the corresponding figures for five years ago. [41111]

    Mrs. Angela Knight
    Breakdowns by Department and executive agency for 1 April 1995 of the number of permanent staff, the number of casual staff—normally those engaged for a period of up to 12 months, but exceptionally up to two years—and of the number of part-time staff are presented in the civil service staff in post summary table for 1 April 1995, a copy of which is in the Library of the House. Estimates on a comparable basis for 1 April 1990 have also been placed in the Library of the House.

    Child Benefit
    Mr. Peter Bottomley
    To ask the Chancellor of the Exchequer if he will estimate the number of employment changes each year to parents of children eligible to child benefit. [41139]

    Mrs. Angela Knight
    The latest available estimates from the labour force survey show that in spring 1994 there were 9.3 million parents in Great Britain who were eligible to claim child benefit—with a child aged zero to 15 or 18 or under full-time education. Among those in this group who were in employment in both spring 1993 and spring 1994, 757,000 changed their employment at least once during the intervening period.

    Regional Expenditure
    Mr. Ron Davies
    To ask the Chancellor of the Exchequer if he will provide a breakdown for the current financial year for each standard planning region in England, for expenditure on(a) agriculture, fisheries, food and forestry, (b) trade, industry, energy and employment, (c) road and transport, (d) housing, (e) other environmental services, (f) law, order and protection services, (g) education, (h) national heritage, (i) health and personal social services and (j) social security. [41050]

    Mr. Waldegrave
    No information is currently available on expenditure in 1995–96 attributed to each English standard planning region. An annual exercise to collect regional figures for general Government expenditure for one outturn year only is carried out annually. A functional breakdown of regional expenditure
    505
    will be given for financial year 1993–94 in the statistical supplement to the "Financial Statement and Budget Report", which will be published in March 1996.

    Michael Allcock
    Mr. Byers
    To ask the Chancellor of the Exchequer if Ministers have signed public interest immunity certificates in the case of Inland Revenue v. Michael Allcock. [38195]

    Mr. Jack
    [holding answer 24 October 1995]: No Treasury Minister has signed public interest immunity certificates in connection with the prosecution of the Inland Revenue employee, Michael Allcock, which is being conducted by the Crown Prosecution Service.

    Capital Allowances
    Mr. Bayley
    To ask the Chancellor of the Exchequer if he will give the cost of tax relief in the latest available year for capital allowances to businesses with gross profits of(a) £1 million, (b) £2 million, (c) £3 million, (d) £4 million, (e) £5 million and (f) £10 million. [40770]

    Mr. Jack
    [holding answer 31 October 1995]: The latest estimates for 1995–96 are:

    £ million

    Business with gross profits (lower limit)

    Cost of Tax relief for capital allowances

    10

    3,500

    1

    500

    2

    500

    3

    300

    4

    300

    5

    1,100

    10

    9,000

    Total

    15,200

    1 Includes businesses with current year losses.

    Economic and Finance Council
    Ms Quin
    To ask the Chancellor of the Exchequer if he will make a statement on the outcome of the EU ECOFIN Council of 23 October. [40114]

    Mr. Kenneth Clarke
    [holding answer 1 November 1995]: I represented the United Kingdom at the Economic and Finance Council of the European Union in Luxembourg on 23 October.

    The Council welcomed Finland's convergence programme.

    The Council agreed, in principle, that a single, short report on employment prepared by representatives of the Economic Policy Committee, the Commission and the Social Affairs Council be submitted to the Madrid European Council.

    The Council considered a communication from the Commission on the approximation of excise duty rates, in which all that is proposed is further detailed consultation.

    The Council discussed the loan guarantee fund and specifically the level of the guarantee from the Community budget for European investment banks
    506
    external lending. Most member states agreed that the level of the guarantee should be reduced from 100 per cent. to 75 per cent. It was decided that further work was required on the conditions of the guarantee.

    The Council mandated the Committee of Perparent Representatives and the financial questions working group to continue work on a Commission proposal for a directive on a carbon/energy tax, providing a framework for those member states wishing to levy such a tax.

    There were discussions with the Finance and Economic Ministers of the central and east European countries on banking and financial issues.

    National Lottery
    Mr. Malcolm Bruce
    To ask the Chancellor of the Exchequer (1) if it is his policy to review the 12 per cent. tax rate set in relation to expenditure on the national lottery; and if he will make a statement; [40831]

    (2) what assessment he has made of the effect on the annual total tax yield as a consequence of the establishment and tax treatment of the national lottery; if he will publish his Departments assessment; and if he will make a statement. [40826]

    Mr. Heathcoat-Amory
    [holding answer 1 November 1995]: The then Chancellor, the right hon. Member for Kingston upon Thames (Mr. Lamont), said in his Budget statement on 16 March 1993, Official Report column 192:
    "I have taken into account the level of tax on other forms of gambling and the extent to which spending is likely to be diverted from other taxed activities. Much, of course, will depend on how the lottery develops and I shall keep the position under review, but for the first year of its operation, I propose that national lottery tickets should be taxed at a rate of 12 per cent.

    My right hon. and learned Friend the Chancellor has kept the position under review, but I cannot anticipate his Budget statement.

    Pay Review Bodies
    Mr. Andrew Smith
    To ask the Chancellor of the Exchequer when(a) the recommendations of the pay review bodies and (b) the Government's conclusions on the pay review bodies will be published. [40732]

    Mr. Waldegrave
    [holding answer 2 November 1995]: We expect to publish the pay review body reports by early February as usual, and to give the Government's response at the same time.

  AGRICULTURE, FISHERIES AND FOOD

    Fisheries Council
    Ms Quin
    To ask the Minister of Agriculture, Fisheries and Food if he will make a statement on the outcome of the EU Fisheries Council of 26 October. [40116]

    Mr. Baldry
    [holding answer 1 November 1995]: I refer the hon. Member to the reply given to the hon. Member for Medway (Dame P. Fenner) on 31 October, Official Report, columns 213–14.

    Late Payment (Small Businesses)
    Mrs. Roche
    To ask the Minister of Agriculture, Fisheries and Food how often his Department and each agency within it has failed to pay invoices due to small businesses within 30 days in each of the last five years. [40535]

    Mr. Boswell
    [holding answer 1 November 1995]: The information is not available in the format requested. From 1991 to 1994 prompt payment performance was measured by a manual sampling process, not restricted to small businesses. This sampling established MAFF's overall payment performance including payments to farm businesses, many of which will be small businesses, as:

    1990–91: not recorded

    1991–92: 77 per cent.

    1992–93: 85 per cent.

    1993–94: 85 per cent.

    1994–95: n/a—see below

    During 1994 MAFF was in the process of installing a computerised payments system and as a result consistent, statistically valid data on prompt payment performance could not be collected. Data emerging from the new system indicate 85.41 per cent. of all payments made by MAFF in the first quarter of 1995–96 were made by the due date. Strategies are in place to provide more refined data from 1 April 1996, including performance on payments to small business; and to use these data to secure further improvements in MAFF's prompt payment record.

    Responsibility for this matter is delegated to agencies, and I have asked the chief executives to reply direct.

    Letter from Johnston McNeill to Mrs. Barbara Roche, dated 3 November 1995:

    As Chief Executive of the Meat Hygiene Service (MHS), your question regarding payment of invoices has been passed to me for reply with regard to this Executive Agency. As you may know, the MHS was established on 1 April this year. Therefore, we do not have sufficient data to provide you with an answer, such information would be collated after a full year of operation. [40535]

    I can advise you, however, that the MHS is committed to payment of all invoices within timescales agreed with our suppliers. We have procedures in place to monitor payments to ensure that this is adhered to. In particular, we pay careful attention to the payment of our veterinary contractors. We have 176 practices supplying the majority of our veterinary services in meat plants. It is important to us that we maintain good working relations with these practices, many of which are small firms. We realise that one of the best ways of doing this is through prompt payment of their bills and ensure that this is done.

    Letter from T. W. A. Little to Mrs. Barbara Roche, dated 3 November 1995:

    The Minister has asked me to reply to your question on the timing of invoice payments to small businesses. [40535]

    Over the last five years, the policy of the Veterinary Laboratories Agency (known as the Central Veterinary Laboratory until 30 September 1995) has been to pay all invoices within 30 days. Where we know that we are dealing with a small business, we aim to pay within 5 to 10 days. We are not aware of any failures to apply this policy although, clearly, in cases of disputes with suppliers, settlement will tend to take a little longer.
    508
    Letter from Professor P. I. Stanley to Mrs. Barbara Roche, dated 3 November 1995:

    You asked the Minister of Agriculture, Fisheries and Food about the number of times his Department and Agencies have failed to pay invoices due to small businesses within 30 days in each of the last five years. The Central Science Laboratory (CSL) became a MAFF executive agency in April 1992 and the Minister has asked me to reply to you in respect of the period since then, as this is an operational matter for which I am responsible. [40535]

    When CSL invoices are paid no differentiation is made between the size of businesses and so, the information is not available in the form you have requested. However since 1993 the Agency has measured overall prompt payment performance by manual sampling of supplier invoices. This sampling indicates that the percentage of invoices paid within 30 days of the invoice date has been as follows:

    1993/94:80%

    1994/95:90%

    1995/96:86%

    Letter from G. K. Bruce to Mrs. Barbara Roche, dated 3 November 1995:

    The Minister of Agriculture, Fisheries and Food has asked me to reply, in respect of the Pesticides Safety Directorate (PSD), to your question about payment of invoices to small businesses. [40535]

    The Pesticides Safety Directorate was established as an Agency on 1 April 1993. We continue to rely on the Ministry of Agriculture, Fisheries and Food to effect our payments and up to the time of our relocation to York in October 1994 it was not possible to identify our payment processing performance separately from that of our core Department. Since our relocation we have put in place a system to monitor performance on a sample basis. Our records show that so far during 1995/96, 98% of all valid invoices and 100% of invoices to small businesses have been paid within 30 days of receipt.

    Letter from Phillip Needham to Mrs. Barbara Roche, dated 3 November 1995:

    The Minister of Agriculture has asked me to reply to your Parliamentary Question (Number 1953) in which you asked how often each Agency has failed to pay invoices due to small businesses within 30 days for the last five years. [40535]

    ADAS was formed as a Next Steps Agency in 1992. In our Report and Accounts 1994/95 (which is lodged in the library of the House of Commons), we state that it is our policy to pay suppliers against invoice within agreed trading terms.

    Unfortunately, we could not extract the information you require without disproportionate costs to this agency.

    Letter from Dr. J. M. Rutter, to Mrs. Barbara Roche, dated 3 November 1995:

    The Minister has asked me to reply to your question about the time taken by the Veterinary Medicines Directorate (VMD) to pay invoices due to small businesses, as this is an operational matter for which I am responsible.

    In arranging payment of invoices, we make no distinction between those due to small or large businesses, but aim to pay them all within 30 days or the terms of the invoice if less. Since the VMD was established as a Next Steps Agency in April 1990, payment of invoices has been carried out by the Ministry of Agriculture, Fisheries and Food on our behalf. Information on core MAFF payment performance contained in the reply to your question from the Minister, therefore also embraces that for the VMD.

  HOME DEPARTMENT

    Doncaster Prison
    Mr. Redmond
    To ask the Secretary of State for the Home Department how many prisoners have been
    509
    relocated to Doncaster because of disturbances at other establishments since Doncaster prison was opened; what was their grade; and if he will make a statement. [40950]

    Miss Widdecombe
    Responsibility for this matter has been delegated to the temporary Director General of the Prison Service, who has been asked to arrange for a reply to be given.

    Letter from Richard Tilt to Mr. Martin Redmond, dated 3 November 1995:

    The Home Secretary has asked me to reply to your recent Question about the number of prisoners who have been relocated to Doncaster because of disturbances at other establishments since Doncaster prison was opened; their grade, and if he will make a statement.

    Doncaster prison received a number of convicted prisoners from Everthorpe prison after a disturbance there on 2/3 January 1995. Doncaster has also received other individual prisoners involved in disturbances at other prisons, but these figures are not recorded locally or at Prison Service headquarters.

    Clacton Police Station
    Mr. Redmond
    To ask the Secretary of State for the Home Department if his Department was notified by Essex police force that a time capsule was being buried beneath Clacton police station on 23 August; what was the cost of the operation; what was placed in the capsules; and if he will make a statement. [40951]

    Mr. Maclean
    Neither I nor my Department would expect to be notified about such a local matter. I understand that the capsule, which cost £50, was buried in the foundations of the new police station now being constructed in Clacton at no additional cost to the building project. It contains some 29 items among which are a photograph album of the old station, handcuffs, fingerprinting kit, custody record and a book of comments by serving staff. Although the decision is an entirely local one, it seems to me an entirely suitable and inexpensive way of preserving for posterity the hard work and endeavours of these local police officers who serve their community so well.

    Asylum applications of nationals of Sri Lanka, Nigeria and Algeria, January to September 1995

    Sri Lanka

    Nigeria

    Algeria

    Total asylum applications

    1,510

    4,550

    1,409

    Applied in-country of which:

    those with leave to remain

    7 per cent.

    14 per cent.

    12 per cent.

    out-of-time applications

    4 per cent.

    20 per cent.

    8 per cent.

    illegal entrants and means of entry unknown

    38 per cent.

    47 per cent.

    68 per cent.

    Applied at port of entry

    51 per cent.

    19 per cent.

    12 per cent.

    Female Prison Escapees
    Mr. George Howarth
    To ask the Secretary of State for the Home Department how many female prisoners have(a) escaped from an establishment, (b) escaped from an escort, (c) attempted to escape from an establishment, (d) attempted to escape from an escort, (e) absconded from an establishment and (f) absconded from an escort, in each of the last three years. [40640]

    Boot Camps
    Mr. George Howarth
    To ask the Secretary of State for the Home Department if he will make a statement on the planned regimes for the proposed boot camps. [40639]

    Miss Widdecombe
    On 18 September, my right hon. and learned Friend announced details of the new high intensity training regime to be introduced next June at Thorn Cross young offender institution. The regime will have discipline and hard work as its foundation and the emphasis will be on personal responsibility underlined throughout by very strict standards of behaviour. A typical day will begin at 6 am sharp with drill followed by an intensive schedule of training, education, work and other physical activity. The day will end with lights out at 10 pm.

    Discussions are taking place between officials from the Prison Service and Ministry of Defence about the possibility of establishing a young offender institution at the military corrective training centre at Colchester.

    Asylum Seekers
    Mr. David Nicholson
    To ask the Secretary of State for the Home Department (1) what estimates he has made of the proportion of asylum seekers originating from(a) Sri Lanka and (b) Nigeria who reached the United Kingdom via a last point of departure in the European continent in each of the last five years; and if he will make a statement on the practice of interrupted travel to the final destination; [40708]

    (2) what proportion of applications for asylum from nationals of (a) Sri Lanka, (b) Nigeria and (c) Algeria are made by persons already resident in the United Kingdom as visitors, tourists and students; and if he will make a statement. [40707]

    Mr. Kirkhope
    The number of applications made by nationals of Sri Lanka, Nigeria and Algeria and the percentages of when the application was made is given in the table.

    Information on the number of applications for asylum from people who reached the United Kingdom via another European country is not separately identifiable.

    Miss Widdecombe
    Responsibility for this matter has been delegated to the temporary Director General of the Prison Service, who has been asked to arrange for a reply to be given.

    Letter from Richard Tilt to Mr. George Howarth, dated 3 November 1995:

    The Home Secretary has asked me to reply to your recent Question asking how many female prisoners have (a) escaped from

    511
    an establishment; (b) escaped from an escort; (c) attempted to escape from an establishment; (d) attempted to escape from an escort; (e) absconded from an establishment; and (f) absconded from an escort, in each of the last three years.

    Escapes from establishment

    Escapes from escort1

    Attempted escape from escort

    Attempted escape from escort

    Abscond from establishment

    1 April 1992-31 March 1993

    6

    9

    —

    4

    126

    1 April 1993-31 March 1994

    1

    8

    —

    2

    126

    1 April 1994-31 March 1995

    5

    6

    2

    6

    174

    1 April 1995-30 September 1995

    —

    2

    —

    1

    54

    1 Includes escapes from the court escort service which would have beer, the responsibility of the police service in previous years (1 in 1993).

    1. Figures for escapes from escort exclude recaptures within 15 minutes provided that no further offence has been committed.

    2. Figures for attempted escapes and attempted escapes from escort include those recaptured within 15 minutes where no further offence was committed.

    Prison Officers
    Mr. George Howarth
    To ask the Secretary of State for the Home Department what are the total numbers of(a) prison officers, (b) senior officers, (c) principal officers and (d) prisoner custody officers, in the Prison Service; if he will list the number and percentage of each grade who are identified as of ethnic minority origin; and if he will make a statement. [40455]

    Miss Widdecombe
    Responsibility for this matter has been delegated to the temporary Director General of the Prison Service, who has been asked to arrange for a reply to be given.

    Letter from Richard Tilt to Mr. George Howarth, dated 3 November 1995:

    The Home Secretary has asked me to reply to your recent Question about the number of staff in the prison officer grades and equivalents in the Prison Service and the number of those who are of ethnic minority origin.

    The information for 3 October 1995 is given in the following table.

    Grade

    Total number

    Number from ethnic minorities

    Per cent of total

    Prison Officer

    19,539

    476

    2.4

    Senior Officer

    3,531

    43

    1.2

    Principal Officer

    1,332

    8

    0.6

    On the same date there were 728 prisoner custody officers at contractually managed prisons, of whom 23 (3.16%) were from ethnic minorities.

    DNA Samples
    Mr. Beith
    To ask the Secretary of State for the Home Department how many of the 11,000 DNA samples referred to in his speech of 12 October and held by the national centre were taken from(a) persons suspected of crime, (b) persons subsequently convicted of crime and (c) other persons; how many of these persons have been notified that their samples continue to be held; and for how long they will be held. [39957]

    Mr. Maclean
    A precise breakdown of the samples held on the national DNA database on 12 October is not available.

    The database currently contains approximately 11,200 profiles from samples taken from individuals under the Police and Criminal Evidence Act 1984, as amended, and approximately 600 profiles from crime scene samples.
    512
    The information is given in the attached table. There are no absconds from escort—only escapes.

    Profiles derived from samples taken from people who are not suspected of crime but who volunteer to participate in mass screenings are not held on the database.

    On the retention of samples, I refer the right hon. Member to the reply given in his question on 31 October, Official Report, column 166.

    Grants
    Mr. Chris Smith
    To ask the Secretary of State for the Home Department for what grant-giving funds his Department is responsible, requiring a private sector contribution, where the use of national lottery funds is not allowed to count towards that private sector portion. [38602]

    Mr. Kirkhope
    I refer the hon. Member to the reply given by the Minister of State, Department of National Heritage on 31 October,Official Report, columns 186–87.

    African National Congress Office (Bombing)
    Mr. Hain
    To ask the Secretary of State for the Home Department, pursuant to his answer of Thursday 22 June, Official Report, column 471, if he will give a progress report on the investigation into the bombing of the London office of the ANC in 1982; and he will place a copy of the report, when complete, in the Library. [41133]

    Mr. Howard
    I understand that, as part of this continuing investigation, officers from the Metropolitan police service hope to travel to South Africa this month to interview several people, after which they would submit a further report to the Crown Prosecution Service. Such reports cannot be made public for legal reasons, but the police will write to the hon. Member on conclusion of the investigation.

    Football Clubs (Police Charges)
    Mr. Tony Banks
    To ask the Secretary of State for the Home Department (1) for what reasons football clubs in different parts of the country are charged different hourly rates for police officers of comparable rank; [41177]

    (2) what was the hourly rate charged to (a) Manchester United FC and (b) Chelsea FC for the presence of (i) a chief superintendent, (ii) a superintendent, (iii) a chief inspector, (iv) an inspector, (v) a police sergeant, and (vi) a police constable; and if he will give the reasons for the differences between (a) and (b). [41205]
    513
    Mr. Maclean
    [holding answer 2 November 1995]: The Police Act 1964 gives discretion over charging for police special services to the local police authority. Home Office guidance, based on Audit Commission recommendations, is that charges should be set at the level which will enable full cost recovery to be achieved. We would therefore expect charges to vary where the force incurs higher costs, for example in paying London weighting and London allowance or in paying rest-day rates to officers who are deployed on overtime.

    The charges currently payable by Manchester United FC and by Chelsea FC are set out in the table:

    Rank

    Hourly charge payable1

    By Manchester United FC to Greater Manchester Police2 £

    By Chelsea FC to the Metropolitan Police £

    Constable

    29.91

    28.63

    Sergeant

    35.17

    34.75

    Inspector

    43.34

    43.88

    Chief Inspector

    46.96

    47.25

    Superintendent

    58.36

    53.50

    Chief Superintendent

    63.33

    57.50

    1Charges (exclusive of VAT) as at 1 September 1995. Rates may vary on public holidays or if the force is given reduced notice that the match is to be played.

    2Greater Manchester police have recently revised their estimates of the full cost of their special services. Better estimates of central overheads (together with the recent police pay rises) have resulted in a 20 per cent, increase in charging rates.

  TRANSPORT

    Marine Safety Agency
    Mr. Allen
    To ask the Secretary of State for Transport what the Marine Safety Agency's budget has been over the last five years; what it is for 1996–97 and if he will make a statement. [40305]

    Mr. Norris
    The Marine Safety Agency was established on 1 April 1994 and the gross budgets for the first two years of operation are as follows:

    1994–95: £31.7 million

    1995–96: £30.8 million

    The budget for 1996–97 has not yet been settled.

    Flags of Convenience
    Mr. Allen
    To ask the Secretary of State for Transport if he will make a statement on the trends in the use of flags of convenience. [40366]

    Mr. Norris
    Shipowners are free to choose the flag under which their ships operate and will be influenced in their choice by a number of factors. Internationally, there has been a trend over the last 25 years for greater use of open registers. We are aiming to improve the competitive position of British shipping and to make the use of the Red Ensign more attractive through a range of positive measures outlined to the House by the then Secretary of State on 21 April 1994,Official Report, columns 1077–78. However, while flag states may legitimately seek to encourage ships onto their registers, we do not
    514
    believe that it is acceptable for shipowners to register ships with flag states which do not have the capability of supervising the safety of their ships, or which do not do so effectively.

    The Government are determined to take a strong line against substandard shipping whatever flag it flies. Accordingly, the Marine Safety Agency inspects 30 per cent. of foreign ships visiting UK ports and also publishes monthly lists of those ships which are detained. We also fully support work in the International Maritime Organisation to improve compliance with international conventions.

    Ministerial Transport
    Dr. Lynne Jones
    To ask the Secretary of State for Transport what has been the cost of ministerial transport in each of the past five years; what allowance has been paid to ministers who use their own vehicles; and what has been the cost in each of the past five years. [40743]

    Mr. Norris
    The cost of ministerial transport in each of the past five years has been:

    1995–96: £125,000 (First 6 months of current financial year)

    1994–95: £288,000

    1993–94: £286,000

    1992–93: £280,000

    1991–92:£219,000

    1990–91: £186,000

    Motor mileage allowance has been paid to Ministers who use their own vehicles. The cost in the current and previous two financial years is as follows. Information before that is not available.

    1995–96: None to date

    1994–95: £43.26

    1993–94: £56.12

    Transport Policies and Programmes
    Mr. Allen
    To ask the Secretary of State for Transport what is his policy on allowing unspent TPP to be carried over into the next financial year. [41003]

    Mr. Norris
    Under the TPP system, the Department of Transport makes capital allocations for local transport infrastructure by means of transport supplementary grant, grant under section 56 of the Transport Act 1968, annual capital guideline, and supplementary credit approval. The allocation of TSG in the annual local transport settlement is adjusted to take account of the amount underspent in past years. As section 56 grant is paid in arrears, the question of unspent resources does not arise. ACG is a borrowing approval that can be used on any local authority service. It is not recoverable and authorities have wide discretion over its use. SCA is allocated for a specific financial year. Local authorities are required to surrender the unused portion of their allocation.

    Sites of Special Scientific Interest
    Mr. Allen
    To ask the Secretary of State for Transport what measures are taken by his Department to ensure that sites of special scientific interest are not damaged by road development. [40990]
    515
    Mr. Watts
    This is an operational matter for the Highways Agency. I have asked the chief executive to write to the hon. Member.

    Letter from Lawrie Haynes to Mr. Graham Allen, dated 3 November 1995:

    As you know, the Minister for Railways and Roads, Mr. John Watts, has asked me to reply to your Parliamentary Question asking the Secretary of State for Transport, what measures are taken by his Department to ensure that Sites of Special Scientific Interest are not damaged by road development.

    My Department has a long standing policy of keeping trunk roads away from protected areas such as Sites for Special Scientific Interest (SSSIs), so far as is reasonable possible. When it is not possible to avoid such areas, every effort is taken on minimise landtake from the affected site and, where possible, measures are provided to reduce adverse effects.

    Bus Stop Information Displays
    Mr. Allen
    To ask the Secretary of State for Transport if he will list the experiments known to his Department on bus stop information displays using satellite links; and what his Department is doing to promote them. [40999]

    Mr. Norris
    My Department is aware of experiments using satellite-based systems in Birmingham, Ipswich and Nottingham. Passenger information systems sponsored by local authorities are eligible for funding through the transport policies and programme system.

    Departmental Expenditure
    Mr. Allen
    To ask the Secretary of State for Transport if he will list for each of the last five years the budget for his departmental expenditure and the percentage of gross domestic product spent on transport. [40994]

    Mr. Norris
    The information required on departmental expenditure can be found in the relevant "Financial Statement and Budget Report".

    Gross domestic product is a measure of output while much transport expenditure is intermediate. Total transport expenditure is thus not calculated as a component of GDP. However, a separate exercise has estimated total expenditure on transport including intermediate expenditure. The estimated expenditures expressed as a percentage of GDP, at market prices, for 1990 to 1994, are as follows:

    1990: 18 Per cent.

    1991: 17 Per cent.

    1992: 18 Per cent.

    1993: 18 Per cent.

    1994: 17 Per cent.

    Spending Decisions
    Mr. Allen
    To ask the Secretary of State for Transport (1) what proposals he has to devolve spending decisions on transport to(a) local authorities and (b) regions; [41008]

    (2) what transport decisions are taken at regional level rather than at central or local government levels. [40982]

    Mr. Norris
    We take full account of advice from the Government offices for the regions on transport decisions relevant to them, for example on the allocation of 516
    transport resources for capital investment by local authorities. There are no plans further to devolve decisions to the regional offices.

    Local authorities have a wide range of transport powers and responsibilities. They are responsible for taking their own decisions on transport spending priorities within the total resources available to them.

    Rail Charges
    Mr. Allen
    To ask the Secretary of State for Transport what rights of appeal exist when a rolling stock company or Railtrack imposes large increases on rail operators. [41002]

    Mr. Watts
    Initial leases for vehicle fleets, agreed between the passenger rolling stock companies and the train operators, are in place and are at a fixed price. Renewals will be negotiated between the parties in a competitive market.

    Access contracts between Railtrack and train operators are approved by the Rail Regulator. The operators can appeal to the regulator if they consider that the charges proposed by Railtrack are unreasonable.

    Motor Cycles
    Mr. Cann
    To ask the Secretary of State for Transport what is the policy of Her Majesty's Government in respect of the Barton/Metten compromise agreed between motor cyclists' representatives and the European Parliament, at the Council of Ministers meeting in November relating to the European multi-directive COM (93) 449-COD 470 of 30 November 1993. [41224]

    Mr. Norris
    We expect to be considering the amendments to the motor cycle multi-directive proposed by the European Parliament at the November Council of Ministers.

    The Government have made clear their view that anti-tampering measures should be required only for mopeds and learner motor cycles. The Government consider that the noise and emission standards contained in the draft directive generally represent the appropriate levels for all categories of mopeds and motor cycles.

    Passenger Transport Executives
    Mr. Allen
    To ask the Secretary of State for Transport which are the five largest cities in the United Kingdom without a passenger transport executive. [41330]

    Mr. Norris
    Measured by population, the five largest cities in the United Kingdom without a passenger transport executive are Edinburgh, Bristol, Cardiff, Belfast and Leicester.

    Buses
    Mr. Gordon Prentice
    To ask the Secretary of State for Transport what estimate he has made of the average age of the bus fleet operated by(a) private bus companies and (b) municipal undertakings. [41283]
    517
    Mr. Norris
    The records held by the Driver and Vehicle Licensing Agency show that, at the end of 1994, public service vehicles in the bus taxation class having nine or more seats had an average age of just under 10 years. The split of the average age of the fleet between private bus companies and municipal undertakings is not readily available.

    M66 Manchester Outer Ring Road
    Mr. Chris Davies
    To ask the Secretary of State for Transport when tenders will be let for construction of the main carriageway of the M66 Manchester Outer Ring Road; and what is the reason for the delay. [39987]

    Mr. Watts
    [holding reply 30 October 1995]: There has been no unexpected delay. I hope to be in a position to award a contract for the first part of the remaining main carriageway, (Contract 1) around the turn of the year. Tenders for the second part (Contract 3) are yet to be sought.

  EDUCATION AND EMPLOYMENT

    National Vocational Qualifications
    Mr. Mills
    To ask the Secretary of State for Education and Employment how many pupils qualified for NVQs in(a) retail, (b) manufacturing, (c) the car industry, (d) fast fit cars, (e) golf, (f) restaurants, (g) travel agents, (h) tailoring, and (i) equine activities in each of the last five years. [38795]

    Mr. Paice
    Data are not available in the form requested. The following table shows the number of full national vocational qualification certificates, including expired NVQs, awarded in each of NCVQs framework areas up to the end of 1994.

    Table 1: Numbers of full NVO certifications: awards by framework area

    prior to 1991

    1991

    1992

    1993

    1994

    Total awards (000s)

    57

    110

    152

    201

    238

    Tending animals and plants

    1—

    1

    3

    5

    9

    Extracting/providing natural resources

    0

    1—

    1

    2

    3

    Constructing

    5

    2

    10

    23

    28

    Engineering

    1

    3

    7

    15

    25

    Manufacturing

    1

    3

    5

    7

    8

    Providing goods and services

    20

    33

    36

    48

    58

    Health, social and protective services

    6

    21

    7

    12

    18

    Providing business services

    24

    47

    83

    89

    87

    Communicating

    0

    1—

    1—

    1—

    1—

    Developing/extending knowledge/skill

    0

    0

    1—

    1—

    1—

    Source:

    NCVQ.

    Note:

    1Less than 500.
    518
    Mr. Mills
    To ask the Secretary for State for Education and Employment what is the percentage of the relevant age group in each EU country which has passed a national vocational qualification type qualification in each of the past five years. [38797]

    Mr. Paice
    The total number of national vocational qualifications awarded in the UK between their launch and the end of 1994 is about 758,000 according to figures supplied by NCVQ. Data are not available on the number of individuals gaining such awards; nor are data available in a comparable form for other EU member countries.

    Total NVQs awarded in the United Kingdom to 31 December 1990: 58,294; total awarded in 1991: 111,235; total awarded in 1992: 152,114; total awarded in 1993: 202,426; and total awarded in 1994: 239,780.

    Barnsley and Doncaster Training and Enterprise Council
    Mr. Redmond
    To ask the Secretary of State for Education and Employment what was the reason given by Barnsley and Doncaster TEC for making an operating loss for the financial year 1993–94, and if she will make a statement. [38631]

    Mr. Paice
    The information relating to the operating surplus/deficit made by Barnsley and Doncaster training and enterprise council is available in the TEC's annual report for 1993–94. A copy of this report is held in the Library.

    Mr. Redmond
    To ask the Secretary of State for Education and Employment, how many(a) adults and (b) young people on average participated in the Barnsley and Doncaster TEC training scheme in each month in the past two years; and if she will indicate the average percentage of those who gained qualifications. [38981]

    Mr. Paice
    The number participating in youth training and training for work in the Barnsley and Doncaster Training Enterprise Council area are given in the following table. The table also includes information on those gaining qualifications.

    Barnsley and Doncaster TEC

    1993–94

    1994–95

    Youth Training

    Average number in-training

    4,040

    3,710

    Percentage of leavers gaining a qualification or credit towards one:

    52 per cent.

    (January-December 1994) 53 per cent.

    Training for Work

    Average number in-training Percentage of leavers gaining

    3,460

    3,130

    Percentage of leavers gaining a qualification or credit towards one:

    39 per cent.

    (January-December 1994) 45 per cent.

    Source:

    TEC management information returns, YT and TFW national follow-up surveys.
    519
    Mr. Redmond
    To ask the Secretary of State for Education and Employment to what extent Barnsley and Doncaster TEC is involved in(a) the open learning credits initiative and (b) the skill choice initiatives; what achievements have been made under the programme; what yearly funding it has received to date; and when the initiative will end. [39011]

    Mr. Paice
    Barnsley and Doncaster training and enterprise council did not take part in either the open learning credits pilots or the skill choice initiative.

    The open learning credits pilots were run in 1993–94 to trial the use of open learning for unemployed people. There were 14 pilots involving 17 TECs and two local enterprise councils. Total funding for the pilots was £2.97 million. The purpose of the pilots was to trial the use of open learning for unemployed people. The pilots were fully evaluated and identified a number of benefits including choice, flexibility, high levels of client satisfaction and the opportunity to target particular client groups.

    Skill choice was a two-year initiative run in 1993–94 and 1994–95. There were 14 TECs and three local enterprise companies involved and total expenditure was £19. 5 million. The aim of the initiative was to help individuals, mainly those in employment, to purchase the vocational guidance and assessment services of their choice. The total number of individuals helped over two years was 250,000, and employers participating in the initiative reported significant economic benefits.

    Evaluation reports for both programmes have been placed in the Library.

    Mr. Redmond
    To ask the Secretary of State for Education and Employment what discussions she has had with her colleagues in increasing the funding of Barnsley and Doncaster TEC. [38982]

    Mr. Paice
    There are no plans to increase the allocation of funds to Barnsley and Doncaster training and enterprise council in the current financial year. However, the TEC along with others, may benefit from additional resources available through funds already committed for national/regional competitions between TECs. These include performance-related funding, skills challenge and the achievement of additional qualifications through youth training.

    Mr. Redmond
    To ask the Secretary of State for Education and Employment what plans she has to extend or amalgamate the boundaries of the Barnsley and Doncaster TEC, and if she will make a statement. [39048]

    Mr. Paice
    I am not aware of any plans to extend or amalgamate the boundaries of Barnsley and Doncaster training and enterprise council. It is for TECs themselves to propose any structural change.

    Mr. Redmond
    To ask the Secretary of State for Education and Employment if Barnsley and Doncaster TEC uses adult training credits within its training for work provision; and if she will make a statement. [39451]

    Mr. Paice
    The information requested is operational information on the Barnsley and Doncaster training and enterprise council and the question would be best addressed to the TEC to answer.
    520
    Mr. Redmond
    To ask the Secretary of State for Education and Employment what is the estimated number of people who have found permanent work during the last 12 months as a result of training at the Barnsley and Doncaster TEC. [39453]

    Mr. Paice
    In 1994, 43 per cent. of those leaving training for work from Barnsley and Doncaster training and enterprise council were in a job six months after leaving. In the same period, 50 per cent. of youth training leavers were in a job.

    As the information comes from surveys, it is possible to give only percentages not actual numbers.

    School Buildings
    Mr. Spearing
    To ask the Secretary of State for Education and Employment, pursuant to her answer of 19 October concerning amendments to the regulations to school buildings, which of the bodies she lists favoured removal of any regulatory standard; which provisions she now proposes to remove and when; and by what means she announced her own views. [39319]

    Mrs. Gillan
    The Department issued a consultation letter on 14 August 1995. Responses were requested by 18 October 1995 and are now being analysed. We will, of course, give careful consideration to respondents' views before making any decisions on the final shape of the regulations.

    Nursery Education
    Mr. Blunkett
    To ask the Secretary of State for Education and Employment what was the number and percentage of(a) three-year-olds and (b) four-year-olds in local education authority maintained pre-school provision in each authority, at the latest date for which figures are available. [39118]

    Mr. Robin Squire
    Information on pupils aged three and four in maintained nursery schools and nursery classes in each local education authority in England in January 1995 is shown in the following table. The Department does not publish information on participation rates of individual age cohorts by local education authority.

    Pupils aged three and four in maintained nursery schools and nursery classes in maintained primary schools in each local education authority in England—January 1995 (provisional)

    Pupils (age at 31 August 1994)

    3three

    2four

    Percentage of population aged three and four at 31 December 1994

    Camden

    845

    4

    25

    Greenwich

    2,229

    746

    48

    Hackney

    1,898

    11

    35

    Hammersmith and Fulham

    1,069

    271

    46

    Islington

    1,473

    80

    37

    Kensington and Chelsea

    603

    153

    27

    Lambeth

    1,603

    490

    31

    Lewisham

    1,869

    612

    37

    Southwark

    2,323

    91

    42

    Tower Hamlets

    2,456

    267

    58

    Wandsworth

    2,056

    54

    35

    Westminster

    801

    187

    31

    521

    Pupils aged three and four in maintained nursery schools and nursery classes in maintained primary schools in each local education authority in England—January 1995 (provisional)

    Pupils (age at 31 Augustl994)

    3three

    2four

    Percentage of population aged three and four at 31 December 1994

    Barking and Dagenham

    2,046

    6

    46

    Barnet

    2,024

    44

    32

    Bexley

    1,413

    6

    23

    Brent

    2,459

    17

    37

    Bromley

    162

    2

    2

    Croydon

    1,999

    12

    21

    Ealing

    3,143

    7

    46

    Enfield

    1,620

    3

    22

    Haringey

    2,354

    50

    44

    Harrow

    1,006

    3

    18

    Havering

    464

    3

    9

    Hillingdon

    1,430

    1,923

    49

    Hounslow

    2,362

    0

    40

    Kingston upon Thames

    1,028

    14

    35

    Merton

    1,860

    387

    55

    Newham

    2,925

    1,206

    52

    Redbridge

    970

    310

    20

    Richmond upon Thames

    653

    1

    18

    Sutton

    816

    1,147

    41

    Waltham Forest

    1,738

    899

    39

    Birmingham

    10,471

    17

    34

    Coventry

    1,910

    0

    24

    Dudley

    2,626

    11

    37

    Sandwell

    3,844

    136

    54

    Solihull

    1,877

    3

    36

    Walsall

    3,505

    2

    59

    Wolverhampton

    3,175

    6

    54

    Knowsley

    2,336

    23

    62

    Liverpool

    4,941

    4

    46

    St. Helens

    1,489

    3

    35

    Sefton

    2,290

    5

    36

    Wirral

    2,156

    1

    26

    Bolton

    2,703

    3

    41

    Bury

    1,448

    0

    30

    Manchester

    5,116

    1,764

    54

    Oldham

    2,455

    3

    37

    Rochdale

    2,074

    10

    33

    Salford

    2,922

    22

    53

    Stockport

    1,972

    3

    27

    Tameside

    2,377

    1

    39

    Trafford

    2,056

    30

    43

    Wigan

    2,050

    4

    25

    Barnsley

    1,975

    869

    48

    Doncaster

    3,647

    1

    44

    Rotherham

    2,176

    1,110

    46

    Sheffield

    3,888

    1,473

    42

    Bradford

    5,142

    634

    44

    Calderdale

    1,945

    1

    36

    Kirklees

    3,985

    31

    40

    Leeds

    7,147

    549

    47

    Wakefield

    3,389

    976

    54

    Gateshead

    1,675

    2

    36

    Newcastle upon Tyne

    2,761

    7

    39

    North Tyneside

    2,306

    0

    55

    South Tyneside

    1,971

    3

    53

    Sunderland

    3,300

    1

    42

    Avon

    4,844

    52

    21

    Bedfordshire

    3,010

    2,003

    32

    Berkshire

    3,043

    3,721

    32

    Buckinghamshire

    1,785

    1,201

    16

    Cambridge

    2,174

    8

    12

    Cheshire

    4,528

    75

    21

    522

    Pupils aged three and four in maintained nursery schools and nursery classes in maintained primary schools in each local education authority in England—January 1995 (provisional)

    Pupils (age at 31 August1994)

    3three

    2four

    Percentage of population aged three and four at 31 December 1994

    Cleveland

    7,179

    5

    60

    Cornwall3

    1,393

    175

    15

    Cumbria

    2,971

    40

    25

    Derbyshire

    6,515

    2,168

    38

    Devon

    1,998

    855

    12

    Dorset

    726

    0

    5

    Durham

    6,356

    29

    46

    East Sussex

    1,424

    54

    10

    Essex

    1,604

    981

    7

    Gloucestershire

    27

    0

    0

    Hampshire

    1,750

    67

    5

    Hereford and Worcester

    868

    770

    9

    Hertfordshire

    6,734

    2,673

    34

    Humberside

    6,343

    2,308

    38

    Isle of Wight

    150

    3

    7

    Kent

    1,853

    43

    5

    Lancashire

    7,235

    24

    21

    Leicestershire

    3,119

    1,913

    21

    Lincolnshire

    1,917

    33

    14

    Norfolk

    1,119

    119

    7

    North Yorkshire

    3,096

    489

    22

    Northamptonshire

    3,024

    4

    18

    Northumberland

    2,411

    7

    41

    Nottinghamshire

    7,807

    4,995

    50

    Oxfordshire

    1,668

    1,521

    19

    Shropshire

    1,332

    669

    18

    Somerset

    521

    2

    5

    Staffordshire

    6,602

    94

    25

    Suffolk

    1,650

    1,422

    17

    Surrey

    2,423

    345

    12

    Warwickshire

    2,109

    4

    17

    West Sussex

    828

    308

    7

    Wiltshire

    397

    158

    4

    England3 4

    277,376

    46,064

    27

    1 Includes pupils who became four years of age by 1 January 1995.2

    Excludes pupils who became five years of age by 1 January 1995.

    3 Includes Isles of Scilly.

    4 Includes Corporation of London.

    Funding, Dorset
    Mr. David Atkinson
    To ask the Secretary of State for Education and Employment what has been the(a) increase in Government funding on education in Dorset and (b) the inflation rate since (i) 1979 and (ii) 1990; and if she will make a statement. [38973]

    Mr. Robin Squire
    The information is not available in the form in which it has been requested. I shall write to the hon. Member and place a copy in the Library.

    Teachers' Pay
    Mr. Blunkett
    To ask the Secretary of State for Education and Employment what was the average point on the teachers' pay scale at which teachers were appointed in(a) primary schools and (b) secondary schools, for each year since 1988. [39115]
    523
    Mr. Robin Squire
    The points on the qualified teachers' pay scale at which new entrant classroom teachers were typically appointed in England for the financial years 1988–89 and 1993–94 are shown in the following table:

    Typical scale or spine point1 2 to which new entrants were appointed in:

    Financial Year

    Primary schools

    Secondary schools

    Point

    Value £

    Point

    Value £

    1988–89

    4

    8,859

    4

    8,859

    1989–90

    4

    9,390

    4

    9,390

    1990–91

    4

    10,503

    4

    10,503

    1991–92

    3

    11,502

    4

    12,051

    1992–93

    3

    12,366

    3

    12,366

    1993–943

    2

    12,633

    2

    12,633

    1 At least 50 per cent, of new appointees are placed either on or below this point.

    2 In the academic years 1988–89 to 1990–91 teachers, other than head teachers and deputies, were paid on an 11 point incremental main scale. From 1 December 1991 the main scale was shortened to 10 points. From 1 September 1993 the Government introduced a new common 18-point pay spine for classroom teachers. In the academic years 1988–89, 1989–90 and 1990–91 the point of entry for a teacher with a good honours degree was point 4; and ordinary degree was point 2; a non-graduate was point l.The point of entry in 1991–92 and 1992–93 for a teacher with a good honours degree was point 3; others were point 1. The point of entry in 1993–94 for a teacher with a good honours degree was point 2; others were point 0. For each of the years shown further discretionary points could be gained for various reasons, eg recruitment and retention.

    3 Data for 1993–94 are estimated.

    Public Appointments
    Mr. Redmond
    To ask the Secretary of State for Education and Employment if she will list all the non-departmental public bodies to which her Department makes appointments in the county of South Yorkshire, indicating the total annual budget and the number of appointments made or renewed for each body in each of the last four years. [39422]

    Mr. Robin Squire
    The Secretary of State for Education and Employment makes appointments to:

    (a) The Committee for the Employment of People with Disabilities (Sheffield and Rotherham)

    (b) The Committee for the Employment of People with Disabilities (Wakefield, Barnsley and Doncaster)
    CEPDs do not hold budgets. Their functions are financed by the Employment Service out of regionally held budgets.
    The press committees were constituted in April 1994 and will run for three years. Each committee consists of a chairman and up to 13 members.

    (c) The Further Education Funding Council regional committee (Yorkshire and Humberside)
    The FEFC regional committee has no separate budgets. Its functions are financed from the FEFC's central budget.
    The committee consists of 11 members and a chairman. The current chairman was appointed in April 1993 and the 11 members in October 1993.

    Temporary Teachers
    Mr. Redmond
    To ask the Secretary of State for Education and Employment if she will make it her policy to collate centrally the number of temporary teachers paid on a daily rate who are employed by each(a) college and (b) university in England for longer than 26 weeks during each year; and if she will make a statement. [39506]

    Mr. Robin Squire
    My right hon. Friend has no plans to collate such information.

    Nursery Education Vouchers
    Sir Thomas Arnold
    To ask the Secretary of State for Education and Employment what response she has had from the Metropolitan borough of Stockport about taking up the voucher scheme for nursery education. [39609]

    Mr. Paice
    The Metropolitan borough of Stockport has responded to the consultation papers which cover elements of the nursery education voucher scheme. The council has resolved not to participate in phase 1 of the scheme.

    Local Education Authority Administration
    Mr. Spring
    To ask the Secretary of State for Education and Employment what is the level of administrative or overheads expenditure per pupil in the local education authorities in(a) Suffolk, (b) Cambridgeshire and (c) Norfolk for the last three years
    available. [39615]

    Mr. Robin Squire
    The table shows, at 1994–95 prices, the gross costs per pupils of expenditure on central administration recorded by(a) Suffolk, (b) Cambridgeshire and (c) Norfolk education authorities for 1991–92, 1992–93 and 1993–94, the latest year for which figures are available. These figures have not been adjusted for any changes of function. The figures may not be comparable between LEAs of differing local accounting practices.

    Central administrative gross expenditure per pupil (pre-primary/primary, secondary and special 1994–95) prices

    LEA

    1991–92 £

    1992–93 £

    1993–94 £

    Suffolk

    160

    169

    100

    Cambridgeshire

    145

    124

    128

    Norfolk

    94

    142

    86

    England

    146

    160

    138

    Free School Meals
    Mr. Gordon Prentice
    To ask the Secretary of State for Education and Employment how many assisted pupils qualified for free school meals for the most recent years for which figures are available. [40484]

    Mrs. Gillan
    The information requested is shown in the table and relates to the last three academic years and to England only.
    525

    Assisted places scheme

    Academic year

    Numbers of assisted pupils qualified for free school meals

    1992–93

    3,002

    1993–94

    3,521

    1994–95

    3,867

    Assisted Places Scheme
    Mr. Gordon Prentice
    To ask the Secretary of State for Education and Employment what is the total amount paid under the assisted places scheme for(a) uniform grant, (b) school travel grant and (c) travel grant for visiting universities for the most recent years for which figures are available. [40483]

    Mrs. Gillan
    The information requested is given in the following table and relates to participating schools' expenditure in the last three academic years in England only. Figures for travel grant to enable assisted pupils visit universities for the purpose of interviews are not collected separately: they are subsumed in the total for school travel grants.

    Assisted places scheme

    £000

    Total cost of

    Academic year

    uniform grants

    travel grants

    1992–93

    813

    1,639

    1993–94

    869

    1,878

    1994–95

    940

    2,123

    School Governors
    Sir Irvine Patnick
    To ask the Secretary of State for Education and Employment what progress has been made in encouraging parents to become school governors, and if she will make a statement. [40573]

    Mr. Robin Squire
    The governing bodies of all maintained schools must include parents governors, elected by the parents of pupils at the school, as one means of giving parents power to influence the nature and quality of the education their children receive. It is increasingly recognised that governors, including parent governors, play a key part in deciding the conduct and development of their school. The available evidence suggests that most schools are able to find sufficient parent and other governors to serve. The Government are grateful for the time, effort and commitment which governors devote, and we will continue to encourage parents and other members of the local community to undertake this demanding but rewarding task.

    Employment Service Client Advisers
    Mr. Jim Cunningham
    To ask the Secretary of State for Education and Employment if performance-related management of client advisers in the Employment Service is related to the number of unemployed within the area of their work. [39673]

    Mr. Forth
    Responsibility for the subject of the question has been delegated to the Employment Service Agency under its chief executive. I have asked him to arrange for a reply to be given.
    526
    Letter from D. J. Litton to Mr. Jim Cunningham, dated 3 November 1995:

    The Secretary of State has asked me, in the absence of the Chief Executive, to reply to your question about the performance management of client advisers in the Employment Service (ES).

    It may help if I briefly outline the performance management system which operates in the ES. Effective performance management is vital if we are to achieve our business objectives as set out in the Annual Performance Agreement between the Secretary of State and the ES. Agreement and achievement of performance and development objectives for everyone in the ES, including client advisers, plays a critical part in our performance management arrangements and the achievement of these business objectives.

    Client advisers, like all other people in the ES, need to understand what they are required to achieve throughout the year. Performance targets and standards are set and used to ensure that our business objectives are met, value for money is delivered and individuals are properly rewarded for their performance.

    Each client adviser:

    has key responsibilities and operational objectives based on the Agency's and the individual Jobcentre's operational plans. These operational plans are derived from the Annual Performance Agreement and take account of the number of unemployed people nationally and within the locality;

    agrees with their line manager how their performance is to be measured;

    agrees personal development objectives where necessary to sustain and enhance their performance; and

    has regular reviews with their line manager to assess achievement against operational and developmental objectives. During these reviews external factors, notably changes in their local labour market will be taken into account.

    I hope this is helpful and assures you that the performance management of our advisers is part of a comprehensive system which takes into account all the factors that are likely to be relevant.

    Jobseeker's Allowance
    Mr. Jim Cunningham
    To ask the Secretary of State for Education and Employment in what circumstances unemployed volunteers claiming the jobseeker's allowance are able to continue their voluntary employment; and what benefits they will be entitled to between ending voluntary work and starting paid employment. [39681]

    Mr. Forth
    Claimants will be able to undertake voluntary work while in receipt of a jobseeker's allowance as long as they are actively seeking work and available for work at 48 hours' notice. If they decide to stop undertaking voluntary work, they will have to be immediately available for work; in other respects, their benefit entitlement will not be affected. On starting paid employment of more than 16 hours a week, they may be eligible for a range of in-work benefits, depending on their individual circumstances.

    Area Cost Adjustments
    Mrs. Ann Winterton
    To ask the Secretary of State for Education and Employment if she will list the level of area cost adjustment expressed as a percentage add on to the primary and secondary standard spending assessments that receive area cost adjustment, the value of the London weighting as a percentage of average teacher and pay, and the amounts of any other qualifiable costs taken into account in determining the area cost adjustment in each authority that receives area cost adjustment. [38171]
    527
    Mr. Robin Squire
    [holding answer 20 October 1995]: The information requested on the level of the area cost adjustment is set out in the "Local Government Finance Report (England) 1995–96", a copy of which has been placed in the Library.

    Some care must be taken in drawing conclusions about the area cost adjustment using information on teachers' salaries and London weightings.

    All the employment groups relevant to the local authority labour market for education have to be taken into account—not just teachers—since the area cost adjustment has to take off non-teaching costs, which account for about a third of education labour costs.

  SOCIAL SECURITY

    Chronic Bronchitis and Emphysema
    Mr. Redmond
    To ask the Secretary of State for Social Security how many applications his Department's Benefits Agency offices in the Doncaster and Mexborough area have received during the last 12 months in respect of chronic bronchitis and emphysema; of those how many have(a) been accepted on first application, (b) been refused, (c) gone to appeal and (d) been accepted following an appeal; and what were the figures for the previous 12 months. [39439]

    Mr. Roger Evans
    The administration of industrial injuries disablement benefit is a matter for Mr. Peter

    Table 1: September 1993-October 1994

    Successful

    Failed (reason)

    Area

    Claims

    20 year rule

    20 year rule

    Lung test1

    CAT 1 PNEUMOCO NIOSIS

    South Yorkshire and Humberside

    6,521

    773

    171

    6,551

    3,957

    1 These figures were collected by the disability benefits centre at Leeds. Leeds DBC also dealt with other areas so the figures do not equate exactly.

    Table 2: October 1994-September 1995

    Area

    Claims

    Successful

    Failed (all reasons)

    Doncaster

    92

    16

    112

    Rother and Dearne

    141

    21

    187

    Note:

    Tables include claims received but not decided within the period.

    Source:

    100 per cent. count, figures are subject to amendment.

    Benefits Agencies, South Yorkshire
    Mr. Redmond
    To ask the Secretary of State for Social Security if he will list each Benefits Agency office in South Yorkshire indicating(a) the number of employees and (b) the number of claimants receiving benefit through these offices; and how many each office had paid out by way of (i) crisis loans and (ii) community care grants under the social fund in each of the last four years. [39443]
    528
    Mathison, the chief executive of the Benefits Agency. He will write to the hon. Member with such information as is available.

    Letter from Peter Mathison to Mr. Martin Redmond, dated 2 November 1995:

    The Secretary of State for Social Security has asked me to reply to your recent Parliamentary Question about how many applications the Benefits Agency offices in the Doncaster and Mexborough area have received during the last 12 months in respect of chronic bronchitis and emphysema; of those how many have (a) been accepted on first application, (b) been refused, (c) gone to appeal and (d) been accepted following an appeal; and what were the figures for the previous 12 months.

    Not all the information requested is available. This is because figures for the number of claims made for chronic bronchitis and emphysema, also known as PD D12, since the end of the initial twelve month take-on period have been collected separately and in a slightly different format. The take-on period lasted from September 1993 to October 1994.

    It is also not possible to provide specific information about the number of appeals against decisions on PD D12 claims as these are not kept separate from other prescribed diseases.

    The available information is shown in the enclosed tables. The information in the first three columns of Table 1 was collected at Area Directorate level. The information in columns four and five was collected at the Disability Benefit Centre (DBC) at Leeds. Table 1 covers the South Yorkshire and Humberside areas which include Doncaster and Mexborough.

    From 3 October 1994, the number of claims for PD D12 has been recorded at District Office level. The offices at Doncaster East and Doncaster West form the Doncaster District. Mexborough, Rotherham, Goldthorpe and Wath-on-Dearne offices form the Rother and Dearne District. Table 2 shows the information for those two Districts.

    I hope this reply is helpful.

    Mr. Roger Evans
    The administration of the social fund is a matter for Mr. Peter Mathison, the chief executive of the Benefits Agency. He will write to the hon. Member with such information as is available.

    Letter from Peter Mathison to Mr. Martin Redmond, dated 2 November 1995:

    The Secretary of State for Social Security has asked me to reply to your recent Parliamentary Question asking for a list of the Benefit Agency offices in South Yorkshire indicating (a) the number of employees and (b) the number of claimants receiving benefit through these offices; and how many each office had paid by way of (i) Crisis Loans and (ii) Community Care Grants under the Social Fund in each of the last four years.

    With the formation of the Benefits Agency in April 1991, offices were grouped into Districts and figures for each branch office cannot be given separately. Annex A - C gives information for each District in South Yorkshire.

    The latest available data for the number of employees in South Yorkshire is provided at Annex A at District level.

    Annex B gives the latest available number of customers receiving benefits as at 30 September 1995 and the latest available figures for Income Support as at 31 August 1995. You should note that a customer may receive more than one of the benefits listed.
    529
    The number of customers in each office that had been paid a Crisis Loan or a Community Care Grant during the last four years is not available. This is because information on the Social Fund is not kept by customer but by applications made to the Fund. Annex C provides details of the number of successful applications.

    I hope you find this reply helpful.

    Annex A: The number of employees in each district in South Yorkshire

    As at 30 September 1995

    District

    Employees

    Rother and Dcarne

    389

    Sheffield East

    340

    Sheffield West

    292

    Barnsley

    234

    Doncaster

    306

    Annex B: Customers in receipt by benefit type in each district in South Yorkshire

    As at 30 September 1995

    District

    Incapacity benefit

    Maternity benefit

    Severe disablement benefit

    Rother and Dearne

    18,588

    42

    2,716

    Sheffield East

    9,444

    58

    1,799

    Sheffield West

    10,155

    81

    1,539

    Barnsley

    14,469

    62

    1,409

    Doncaster

    15,323

    68

    2,070

    Customers in receipt of income support in each district in South Yorkshire

    As at 31 August 1995

    District

    Income support

    Rother and Dearne

    38,686

    Sheffield East

    36,037

    Sheffield West

    33,261

    Barnsley

    22,451

    Doncaster

    30,718

    Annex C: Number of CL and CCG Awards made by each district in south Yorkshire from April 1991 to March 1995

    District

    CCG Awards

    CL Awards

    1991–92:

    Rother and Dearne

    2,950

    2,704

    Sheffield East

    3,102

    7,295

    Sheffield West

    2,345

    5,886

    Barnsley

    2,009

    2,243

    Doncaster

    1,818

    3,456

    1992–93

    Rother and Dearne

    3,167

    2,902

    Sheffield East

    3,244

    7,494

    Sheffield West

    2,473

    6,176

    Barnsley

    2,080

    2,489

    Doncaster

    1,511

    3,810

    1993–94

    Rother and Dearne

    3,153

    2,839

    Sheffield East

    3,243

    7,723

    Sheffield West

    2,273

    5,912

    Barnsley

    2,211

    1,818

    Doncaster

    1,784

    4,144

    1994–95

    Rother and Dearne

    1,746

    1,841

    Sheffield East

    1,560

    4,064

    Sheffield West

    970

    3,396

    530

    Annex C: Number of CL and CCG Awards made by each district in south Yorkshire from April 1991 to March 1995

    District

    CCG Awards

    CL Awards

    Barnsley

    1,157

    1,135

    Doncaster

    888

    2,118

    Mr. Redmond
    To ask the Secretary of State for Social Security if he will list by location each of his Department's benefit agencies(a) districts and (b) directorates that cover the postcode areas of (i) Doncaster and (ii) Mexborough; and if he will indicate in his answer the postcodes concerned. [39558]

    Mr. Evans
    This is a matter for Peter Mathison, the chief executive of the Benefits Agency. He will write to the hon. Member with such information as is available.

    Letter from Peter Mathison to Mr. Martin Redmond, dated 2 November 1995:

    The Secretary of State for Social Security has asked me to reply to your recent Parliamentary Question concerning the postcodes covered by the Benefit Agency's districts and directorates in Doncaster and Mexborough.

    The enclosed Appendix A lists the names and addresses of the offices in Doncaster and Mexborough and the postcodes they cover. This should, however, only be used as a general guide because local offices are not organised by postcode but on a geographical basis. In some instances postcode areas are covered by more than one District.

    I hope you find this reply helpful.

    Appendix A

    Postcodes areas covered by the Doncaster East, Doncaster West and Mexborough offices. To be used as a guide only:

    Doncaster East Benefit office,

    St Peters House, Princes Street, Doncaster,

    DN1 3NY

    Postcodes DN1

    Postcodes DN2

    Postcodes DN3

    Postcodes DN4

    Postcodes DN5

    Postcodes DN7

    Postcodes DN8

    Postcodes DN9 (Part)

    Postcodes DN10 (Part)

    Postcodes DN14 (Part)

    Doncaster West District office,

    Castle House,

    Princegate,

    Doncaster,

    DN1 3XT

    Postcodes DN1

    Postcodes DN2

    Postcodes DN4

    Postcodes DN5

    Postcodes DN6

    Postcodes DN11

    Postcodes DN12

    Postcodes DN14 (Part)

    531

    Postcodes S66 (Part)

    Postcodes WF8 (Part)

    Mexborough Benefit office,

    Crown Buildings,

    Adwick Road,

    Mexborough,

    S64 OBD

    Postcodes DN5

    Postcodes DN12

    Postcodes S63

    Postcodes S64

    Child Support Agency
    Ms Lynne
    To ask the Secretary of State for Social Security how much of the maintenance claimed as new maintenance by the Child Support Agency would have been due under pre-CSA agreements. [40315]

    Mr. Andrew Mitchell
    The administration of the Child Support Agency is a matter for the chief executive, Miss Ann Chant. She will write to the hon. Member.

    Letter from Miss Ann Chant to Ms Liz Lynne, dated 2 November 1995:

    I am replying to your Parliamentary Question to the Secretary of State for Social Security about child maintenance.

    Between launch in April 1993, and August 1995, as a direct result of Child Support assessments, the Agency has collected or arranged maintenance totalling £300m. It is not possible to say how much of this maintenance would have been due under pre-CSA agreements.

    Ms Lynne
    To ask the Secretary of State for Social Security how much of the Child Support Agency's outstanding debt is attributable to type A interim assessments. [40318]

    Mr. Mitchell
    The administration of the Child Support Agency is a matter for the chief executive, Miss Ann Chant. She will write to the hon. Member.

    Letter from Miss Ann Chant to Ms Liz Lynne, dated 2 November 1995:

    I am replying to your Parliamentary Question to the Secretary of State for Social Security about how much of the Child Support Agency's outstanding debt is attributable to Category A interim maintenance assessments (IMAs).

    Of a total outstanding debt of £700m at the end of August 1995, it is estimated that £456m was the result of IMAs.

    It is not possible to further break down the £456m debt by category of IMA, but the vast majority of this debt can be attributed to category A IMAs. This is because the other types of IMAs (Category B, C and D) are used in circumstances where the absent parent is most likely to be cooperating with the Agency.

    Since 18 April 1995, IMAs have been converted to full maintenance assessments (FMAs) from the effective date of the assessment, as soon as the absent parent provides sufficient information for this to be done. FMAs are generally much lower than IMAs and it follows that much of the IMA debt is provisional.

    Ms Lynne
    To ask the Secretary of State for Social Security if he will provide a breakdown of the child 532
    maintenance assessments issued to absent parents who have previously paid no maintenance including nil and minimum assessments. [40319]

    Mr. Mitchell
    The administration of the Child Support Agency is a matter for the chief executive, Miss Ann Chant. She will write to the hon. Member.

    Letter from Miss Ann Chant to Ms Liz Lynne, dated 2 November 1995:

    I am replying to your Parliamentary Question to the Secretary of State for Social Security requesting a breakdown of child maintenance assessments. This information is available for parents with care receiving Income Support.

    Whilst it is not possible to provide a breakdown relating to absent parents, an estimated figure for parents with care is available and is set out in the table attached. This is produced based on five percent samples of Income Support and Child Support Agency cases, taken in February 1993 and August 1995 respectively.

    Most of the cases included in these samples will be Income Support taken on in the first year of the Agency, when it was estimated that around 50 per cent of those cases taken on were not already receiving maintenance. This proportion has increased to an estimated 77 per cent. since April 1994. We would expect the percentage assessed who were not previously receiving maintenance (38.95%) to increase in future samples as Income Support data for 1994 and 1995 becomes available.

    I hope this is helpful.

    Maintenance assessed at August 1995 for parents with care who received no maintenance whilst on Income Support in February 1993

    Number of cases (000s)

    As a percentage of the 333,500 cases assessed at August 1995 who were in receipt of Income Support in 1993

    (a) £0 to £2.35

    60

    17.97

    (b) £2.36 to £4.99

    1

    0.30

    (c) £5 to £9.99

    2

    0.60

    (d) £10 to £19.99

    4

    1.20

    (e) £20 to £29.99

    5

    1.50

    (f) £30 to £39.99

    6

    1.80

    (g) £40 to £49.99

    7

    2.10

    (h) £50 to £59.99

    8

    2.40

    (i) £60 to £69.99

    4

    1.20

    (j) £70 to £79.99

    3

    0.90

    (k) £80 or more

    29

    8.69

    Total

    129

    38.95

    Note:

    The table may include some instances where maintenance was paid to the DSS in respect of the claimant and/or dependant(s) at February 1993 and some cases where there was no entitlement to maintenance at February 1993.

    Number of cases include interim and full maintenance assessments.

    Bank of Credit and Commerce International
    Mr. Vaz
    To ask the Secretary of State for Social Security what has been the total amount of moneys paid by his Department to the liquidators of BCC1, Touche Ross, in respect of staff mortgage interest payments for each year since 1991 and for each month since 1 January 1995. [41287]

    Mr. Andrew Mitchell
    The information is not available.

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