Departmental Achievements (Hansard, 3 March 1987)

§ Mr. Fowler

We have continued to develop services for patients in the Health Service. Spending on the National Health Service in England alone is up about 26 per cent. in real terms since 1978–79. There are almost one million more in-patient cases, about 3¼ million more out-patient attendances, and over ⅓ million more day cases being dealt with each year. The Health Service is now treating more than twice as many people suffering from renal failure. It is performing more kidney and other transplants, more hip operations and more cataract operations.

Health authorities in England have made substantial progress in obtaining improved value for money in recent years. They have achieved cash-releasing cost improvements worth over £240 million in the last two financial years and plan further cash savings of some £150 million in 1986–87. These resources are devoted to patient care. A further £130 million is expected to be freed this year from sales of land which the NHS does not need.

Over 170 health building schemes, each worth over £1 million, have been started and completed since 1979. Over 400 more schemes, worth nearly £3 billion are currently being planned, designed, or built. Over 100 of them will be finished during the next three years.

At the end of last year we announced that we were establishing a special fund to deal with the transitional problems of resources allocation in those regions which get less than national average growth—principally the four Thames regions. Thirty million pounds over two years will help those regions to continue to improve the overall quality and balance of their services to different groups of patients and different areas within each region. A second special fund, with £50 million over two years, is being used to reduce excessive waiting lists and times. Health authorities have already shown their commitment to tackling this problem, and the fund will help them to make further progress, including reducing the time it takes to get to see a consulant in hospital as well as the time it takes to have an operation. The money will finance over 350 different projects throughout the country in the first year and will mean that health authorities will be able to treat an extra 100,000 patients from their in-patient waiting lists over the coming year.

The Government take very seriously the potential threat of an AIDS epidemic. In response we have undertaken the most comprehensive public education 577W campaign there has been in this country. We have agreed proposals for a specially financed programme of directed research put forward by the Medical Research Council and we have provided additional funds for patient care. We shall continue to give priority to all aspects of this issue, to keep in close touch with other Governments and to take whatever further public health measures are necessary.

Following the report of the committee of inquiry into an outbreak of food poisoning at Stanley Royd hospital in 1984 (Cmnd. 9716) we have reviewed the immunity of NHS hospitals under food legislation. We decided that further safeguards were needed to ensure satisfactory standards of food hygiene in the NHS and that it would be right to remove Crown immunity in this field. The opportunity afforded by the NHS (Amendment) Bill was taken to apply food legislation to health authority premises. In recognition of concern expressed in Parliament during the passage of the Bill we also agreed to extend its provisions to remove the Crown immunity of health authorities in respect of the Health and Safety at Work etc. Act 1974.

In the primary care field there are 3,000 more general practitioners and 2,400 more dentists. There are 6,800 more community nurses. General practitioners average list sizes have fallen from over 2,300 to 2,068.

Major reviews in both the primary care and community nursing fields began in 1986. The primary care review—the first since the NHS was established—is intended to raise standards of care still further and to ensure that the service is fully responsive to the public's needs.

In the social services field there have been increases in places in training centres and community homes for mentally handicapped people. There are more home help staff, and more social work staff. There are more places in day centres for elderly people, and many more places in residential and nursing homes. The sum of £16.3 million has been set aside under the care in the community initiative for pilot projects. In addition, £10.2 million has been available under the helping the community to care initiative to help volunteers, families and others to care for people who require support. In a separate initiative over £11 million has been made available to promote care in the community for children coming out of mental handicap hospitals, and £6 million for a series of mental illness development projects to improve the care given to mentally ill people in the community. Since 1983, health authorities have also been able to guarantee continuing annual payments to local authorities and voluntary organisations for the care of people moving into the community from long-stay hospital accommodation. This has given considerable impetus to joint planning and the implementation of the community care policy.

In the social security field, too, expenditure has never been at a higher level, both in cash and real terms. Expenditure in the current financial year is expected to be in the region of £44 billion—about one third of total Government spending. We have protected and increased the real value of nearly all the major social security benefits. Examples of real terms increases since 1979 include supplementary benefit rates (up by about 6 per cent.), prescribed amounts for family income supplement (by a minimum of 13 per cent.), retirement pensions (by several percentage points) and mobility allowance (by about 12 per cent.). The severe disablement allowance has 578W been introduced (and the household duties test abolished) and invalid care allowance has been extended to married women.

There has also been a far-reaching review of the social security system. The Social Security Act 1986 will target help more effectively on those who need help most, make the system easier to understand, widen choice in pension provision and put pensions on a sound basis for the future, tackle the worst effects of the poverty and unemployment traps and create a soundly based system that the country can afford. Twice as many low income working families with children will get extra help under family credit and income support will direct help to groups such as disabled people, lone parents, families with children and pensioners.

We have significantly improved the position of people in occupational pension schemes, and have given everyone in work new pension options The 1985 Social Security Act gives people the right to more information about their schemes and to a transfer value if they leave; it also protects the pension rights of early leavers. Last year's Act will give everyone in work the choice between a contracted-out personal pension and staying in his employer's pension scheme or fully in the state scheme.