HC Deb 27 June 1989 vol 155 cc419-26W
17. Mr. Amos

To ask the Secretary of State for Health if he will make a statement on the future provision of resources for teaching and training of doctors under the proposals in the White Paper, "Working for Patients."

Mr. Kenneth Clarke

In the White Paper we emphasised the Government's continuing commitment to maintaining the quality of medical education. We recognised that hospitals in which teaching and research take place incur higher costs as a result, and said that we had decided to accept that the service increment for teaching—(SIFT)—should be enhanced. More recently, I announced in a written reply to my hon. Friend the Member for Staffordshire, Moorlands (Mr. Knox) on 6 June that we have agreed to improve means for the distribution of SIFT. We have also stressed the importance we continue to attach to the postgraduate training of doctors, and our intention is that hospitals should not be placed at an unfair disadvantage or advantage in the distribution of resources by undertaking such training.

18. Mr. Anthony Coombs

To ask the Secretary of State for Health if he will make a statement on the intended effects of the increased capitation element in the new general practitioners' contract for patient care.

Mr. Mellor

By increasing the proportion of general practitioners' income which comes from capitation payments we will be encouraging greater competition in the family doctor service. This will ensure a better service for patients by giving GPs a greater incentive to provide the best possible range and quality of service to all patients.

20. Dr. Michael Clark

To ask the Secretary of State for Health how patient care will be affected by the proposals to allow large general practitioner practices to hold their own budgets.

32. Mr. Waller

To ask the Secretary of State for Health what are the implications for patient care of the proposals for general practitioners' practices to operate their own budgets.

Mr. Mellor

The introduction of practice budgets, in common with our other proposals for the National Health Service, will lead to even higher standards of service and better quality of care for patients. General practitioners who choose to have budgets will for the first time hold the purse-strings to finance the treatment of their patients which falls within the scope of the budget. This will mean that hospitals will become more responsive to the needs of GPs and their patients. Practice budget holders will also be able to transfer funds between the different elements of the budget which will provide them with greater flexibility in meeting the individual needs of their patients. Greater freedom in managing their own budgets will enhance the clinical freedom of the doctors involved.

22. Dr. Twinn

To ask the Secretary of State for Health how the proposals in the White Paper "Working for Patients" on medical audit will affect patient care.

Mr. Mellor

The objectives of developing a comprehensive system of medical audit as proposed in the White Paper is to enhance the overall quality of care given to patients in the National Health Service.

23. Mrs. Gillian Shephard

To ask the Secretary of State for Health what are the intended effects of the changes in composition of the family practitioner committees proposed in the White Paper "Working for Patients".

Mr. Mellor

I refer my hon. Friend to the reply given to my hon. Friend the Member for Gillingham (Mr. Couchman) on 23 May 1989, at columns482–83.

25. Mr. Sumberg

To ask the Secretary of State for Health how many requests for information he has now received from hospitals inquiring about the possibility of obtaining self-governing status.

Mr. Kenneth Clarke

People or groups interested in self-governing status have been advised to direct inquiries in the first instance to their regional health authority. RHAs have so far notified my Department of a total of 179 expressions of interest, including a number of units which feature more than one hospital.

27. Mr. Gill

To ask the Secretary of State for Health how the proposals to allow hospitals to become self-governing National Health Service hospitals will affect patient care.

70. Mr. Hannam

To ask the Secretary of State for Health if he will explain the effects of the proposals to allow hospitals to become self-governing.

Mr. Mellor

Self-governing hospitals will remain firmly within the NHS and there will be safeguards to ensure that essential local services continue to be provided locally. But they will have far more freedom to take their own decisions on the matters which affect them most without detailed supervision from above. This will give patients more choice, produce a better quality service and encourage other hospitals to do even better in order to compete.

29. Mr. Hayes

To ask the Secretary of State for Health what will be the benefits for patient care of the indicative drug budgets proposed in the National Health Service White Paper.

48. Mrs. Maureen Hicks

To ask the Secretary of State for Health how much account has been taken under the proposals for prescribing budgets of the needs of patients in receipt of drugs on a long-term basis.

66. Mr. French

To ask the Secretary of State for Health how patient care will be affected by the proposals in the White Paper "Working for Patients", for indicative drug budgets.

Mr. Mellor

Indicative prescribing budgets will provide a further incentive to general practitioners to examine their prescribing patterns critically and in particular to avoid excessive and unncessary prescribing. This is very much in the best interests of patients and more economical prescribing will release money for other forms of patient care in the NHS,. We have made it clear that the amount allocated to a practice for its indicative prescribing budget will take into account the presence on the practice's list of patients, such as the elderly or chronically sick, who need drugs on a longer-term basis. All patients will always get the drugs they need.

30. Mr. Livsey

To ask the Secretary of State for Health what percentage of consultants' contract hours he expects to be devoted to administrative work as a result of the proposals in the White Paper on the National Health Service.

Mr. Mellor

We are not making any estimate of the time consultants will spend in administrative work, but we expect—and would wish to see—consultants taking an increasing management role, as "Working for Patients" makes clear, through the devolution of managerial responsibility, the extension of resource management, and the establishment of self-governing hospitals.

36. Mr. Raffan

To ask the Secretary of State for Health what representations he has received concerning the proposals contained in the White Paper "Working for Patients", relating to medical audits.

Mr. Mellor

The proposal to develop a comprehensive system of medical audit in the NHS has been widely welcomed and the medical profession supports the concept of audit and consider it a central part of the doctor's obligation to his patient.

38. Mr. Conway

To ask the Secretary of State for Health whether he has received any expressions of interest from general practitioners' practices about operating their own practice budgets.

Mr. Mellor

Although we have not yet asked GPs to register formally their interest in becoming budget holders, we are encouraged by the level of interest from eligible practices.

39. Mr. McLoughlin

To ask the Secretary of State for Health what effect the proposals in the National Health Service White Paper will have on the distance that patients will have to travel for treatment.

Mr. Mellor

Surveys suggest that many people are willing to travel for better and quicker treatment. In setting contracts for services district health authorities will take full account of the wishes of patients and there will be no question of patients being expected to travel unreasonable distances.

43. Mr. Flannery

To ask the Secretary of State for Health what are the conditions which have to be fulfilled before the authorities in a National Health Service hospital apply to be self governing; and if he will make a statement.

Mr. Mellor

The main criteria were set out in the White Paper "Working for Patients" and working paper (1) "Self-governing Hospitals". Further details are given in the document "Self Governing Hospitals: An Initial Guide" published last week and copies are available in the Library.

44. Mr. Gregory

To ask the Secretary of State for Health how the additional £40 million to assist with the implementation of the National Health Service reforms will be allocated.

49. Mr. Franks

To ask the Secretary of State for Health if he will give further details of the recently announced extra £40 million for the implementation of the health service reforms.

Mr. Mellor

I refer my hon. Friends to my reply to the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) on 26 June, at columns315–16.

46. Mr. Rooker

To ask the Secretary of State for Health what is the cost to the latest date of the promotion and information relating to his White Paper "Working for Patients".

Mr. Kenneth Clarke

I am introducing into the NHS a system of regular direct communications with the staff which I believe is necessary for any large organisation and certainly for one which employs over 1 million people. It is misleading to compare this with public advertising or political promotion campaigns of the kind being conducted by the BMA and other interest groups. The cost of the communications exercise to inform the staff and management of the NHS about the White Paper proposals is approximately £1.25 million.

Estimated expenditure on the next stage of information for NHS staff about self-governing hospitals will be some £750,000.

The only expenditure on material aimed at the public included in these sums is the cost of:

  1. (a) a leaflet for the public on the White Paper proposals, costing £117,000;
  2. (b) a further leaflet to be made available to the general public on request in the local areas of units which have expressed an interest in becoming self governing, costing £13,000.

47. Mr. David Davis

To ask the Secretary of State for Health whether he has any plans to privatise self-governing hospitals.

Mr. Mellor

No.

50. Mr. Michael Brown

To ask the Secretary of State for Health how patients' choice will be affected by the proposals in the White Paper "Working for Patients".

56. Mr. Burt

To ask the Secretary of State for Health if he will make a further statement on the implications for patient choice of the proposals in the White Paper "Working for Patients."

Mr. Mellor

A fundamental aim of the White Paper proposals is to make the Health Service more responsive to the needs of patients. We will stimulate better services to patients by encouraging suitable hospitals to apply for self-governing status, by delegating responsibility to local level and by allowing money for patients' treatment to cross administrative borders. GPs will be able to improve the service they offer their patients by applying for their own budgets. Patients will be able to choose their GPs on the basis of the services they offer. We intend to raise the performance of all hospitals and GPs to that of the best. The reformed Health Service will offer a better quality of service and better value for money.

52. Mr. Macdonald

To ask the Secretary of State for Health what further representations he has received in respect of his proposals to cash-limit general practitioners' budgets.

Mr. Mellor

I refer the hon. Member to the reply I gave earlier today to the hon. Member for Oxford, East (Mr. Smith).

53. Mr. Latham

To ask the Secretary of State for Health whether he will make a statement on the outcome of his consultations to date on the White Paper "Working for Patients".

Mr. Kenneth Clarke

Consultations are continuing and have been useful. In particular, I have held many meetings with members of the medical profession and have established that, despite some remaining important disagreements, there is a substantial area of agreement.

There is almost universal agreement with the aims of the White Paper to produce a better NHS for patients giving medical treatment free at the point of delivery regardless of means and financed largely as now out of general taxation.

I also judge that the great majority of doctors accept the need for a framework of quality control, in the form of medical audit; the distribution of resources in a way which ensures that "money follows the patient"; and improved systems of financial management using modern information technology. The BMA has told me in meetings that it accepts these three proposals but it has fundamental disagreements with the details of our proposed reforms to implement them. Unfortunately, it and the great majority of doctors have no alternative proposals of their own. The BMA has been discouraging its members from putting constructive alternative proposals to me.

58. Mr. Carttiss

To ask the Secretary of State for Health how the proposals in the White Paper "Working for Patients" will affect general practitioners' freedom to refer patients for treatment.

Mr. Kenneth Clarke

The new arrangements will enable general practitioners to play a more direct part in deciding which hospitals will provide services for their patients. GP practice budget holders will be able to refer patients to hospitals which provide the best care and shortest waiting times irrespective of administrative boundaries. Those practitioners who do not hold budgets will be consulted extensively before DHAs place contracts with hospitals based on GPs' wishes and there will be provision for GPs to make extra-contractual referrals.

61. Mr. Norris

To ask the Secretary of State for Health how patients will be affected by the proposals in the White Paper," Working for Patients"; and if he will make a further statement.

68. Mr. Irvine

To ask the Secretary of State for Health if he will make a statement on the intended effects on patient care of the proposals in the White Paper, "Working for Patients".

Mr. Mellor

Our proposals will produce a better quality of care for all NHS patients, including elderly and chronically sick people. We intend to bring all services up to the standard of the very best and to make certain that taxpayers' money is used to best effect from the patient's point of view. The proposals reflect our strong commitment to the principles on which the NHS was founded and will ensure that it is more than ready to face the rapidly changing and rising demands upon it as medical science progresses and the average age of the population rises.

65. Mr. Michael

To ask the Secretary of State for Health what steps he has taken to(a) sponsor adequate research and (b) undertake pilot projects to an adequate level on the likely effects of the White Paper proposals on the effectiveness of the National Health Service.

Mr. Mellor

Many of our proposals are evolutionary in nature and we will learn from the experience gained. We are quite satisfied that the NHS needs reform on the lines proposed to improve its management and to improve the service to patients.

69. Mr. Key

To ask the Secretary of State for Health whether he proposes that self-governing hospitals will be required to retain core services.

Mr. Mellor

Before self-governing status is granted to a hospital the initial arrangements for provision of core services will have to be approved by my right hon. and learned Friend the Secretary of State. Thereafter self-governing hospitals will be expected to continue to provide these services subject to review at the request of either the hospital or the DHA concerned or, in the event of disagreement, the Secretary of State's further approval.

Mr. Malcolm Bruce

To ask the Secretary of State for Health if he will make a statement on the current situation with regard to the new contract for general practitioners.

Mr. Kenneth Clarke

On the 4 May I reached agreement with the negotiators of the General Medical Services Committee on all the major outstanding issues in the new contract. The negotiators undertook to commend this agreement to the annual conference of local medical committee representatives on 21 June. This conference voted to reject the agreement reached by the negotiators, and there will be a ballot of all GPs in the country.

I am disappointed that the conference has rejected the contract which its own leadership commended to it. The contract negotiations were long and hard—over 100 hours of discussion spread over more than a year. The resulting agreement was hard fought and I made a number of important concessions which I would not have made but for my desire to reach an agreement if possible. Both sides agreed on the need for a new contract which rewarded good performance. I believe this contract does meet that need and I see no sensible basis upon which negotiations could be reopened. My task is to raise the quality of primary health care within the NHS and, in order to pursue that, I aim to have in place by 1990 a contract which rewards doctors who provide the highest standards of care for their patients and encourages the rest to match the performance of the best.

Recent research by York university's centre for health economics has demonstrated the wide range of quality of service to patients provided in different parts of the country under the old contract. I shall be laying regulations before Parliament later this year to bring a new contract into effect by 1990.

Ms. Harman

To ask the Secretary of State for Health if he will give an estimate of what percentage of a district health authority's budget would be for contractual referrals for hospital care and what percentage would be for extra-contractual referrals under his White Paper.

Mr. Mellor

District health authorities will make provision, within their budgets, for the possibility of referrals which were not foreseen when they placed their contracts. The size of this contingency fund will be a matter for them. However, in deciding the pattern of contracts DHAs will be required to take account of the views of all local GPs and place contracts to secure the referral patterns which local GPs wish to see in place unless there are compelling reasons for not doing so. In this way the need for a contingency fund will be minimised.

Mr. Kirkwood

To ask the Secretary of State for Health how many general practitioners budget holders practices he intends to approve to begin operating in 1991.

Mr. Mellor

Applications to participate in the practice budget scheme will be made to, and approved by, regional health authorities. It is too early to estimate the likely numbers which will be in operation from 1 April 1991, but there have been an encouraging number of preliminary inquiries.

Mr. Kirkwood

To ask the Secretary of State for Health if he will make a statement on the effects of his White Paper "Working for Patients", especially relating to self-governing hospitals, on supra-regional services including poisons units.

Mr. Mellor

The NHS review White Paper has stated thatsome central funding will he necessary for the development of supra-regional services".

A working party is currently considering the implications of this for these services. The NHS management executive will discuss with regional health authorities the detailed application to specialist services of the new funding arrangements proposed. It is, however, too early to say how individual units will be affected.

Mr. Kirkwood

To ask the Secretary of State for Health if, under his plans for capital valuation of self-governing hospitals, he will offset the cost of any backlog on building or equipment maintenance against the capital valuation.

Mr. Freeman

The valuation of the property occupied by self-governing hospitals will he on the basis of open market value for existing use. This valuation takes account of the age and condition of the buildings.

Mr. Kirkwood

To ask the Secretary of State for Health what mechanism and estimate of cost exists for separating the cost of treatment from research and training in order that self-governing teaching hospitals have the necessary information to operate effectively.

Mr. Mellor

We have developed a method for estimating the excess service costs arising from teaching and research at hospitals where at least 5 per cent. of student teaching is undertaken. This is used in the calculation of the service increment for teaching (SIFT). Regions and districts as appropriate to local circumstances will contract with hospitals (including self-governing hospitals) to provide service facilities for teaching in return for SIFT payments.

Mr. Kirkwood

To ask the Secretary of State for Health (1) whether he plans to introduce a system of cross charging for accident and emergency work under his proposals for self-governing hospitals where a hospital is situated near a major travel point or in a major commuter area;

(2) whether, in those inner-city areas where patients are more likely to use accident and emergency services rather than a general practitioner, he has any plans either to allow a hospital to curtail such services or to cross charge a general practitioner or family practitioner committee for costs incurred.

Mr. Mellor

All hospitals which provide accident and emergency treatment will do so under a block contract with the health authority in whose district they are located. District health authorities will be responsible for securing sufficient accident and emergency services in their district irrespective of the place of residence for all patients who are present. There is no intention that family practitioner committees or GPs should be charged.

Mr. Kirkwood

To ask the Secretary of State for Health whether he will postpone his plans to introduce general practitioners' budgets if all hospitals are not operating the necessary management and accounting systems needed to work out the nature of various contracts by April 1991.

Mr. Mellor

We are quite sure that district health authorities and GP practice budget holders will be able to manage the contractual process by April 1991.

Mr. Kirkwood

To ask the Secretary of State for Health whether the capital valuation of a self-governing hospital or unit is to be based on a value for present use or on the current market value of the site.

Mr. Freeman

The valuation of the property occupied by self-governing hospitals will be on the basis of open market value for existing use.

Mr. Kirkwood

To ask the Secretary of State for Health whether, if a hospital offers an integrated hospital and community midwifery service, he will ensure that the service continues if the hospital has opted out.

Mr. Mellor

Self-governing hospitals will not opt out but will remain fully within the NHS. The NHS will continue to provide integrated hospital and community services.

Where maternity services are designated by a district health authority as "core services" my right hon. and learned Friend the Secretary of State will approve the initial arrangements for provision of such services on establishment of a self-governing hospital. The detailed arrangements will be set out in contracts between the hospital and health authority. Subsequent changes in provision will have to be either by agreement between the district health authority and self-governing hospital or have my right hon. and learned Friend the Secretary of State's approval.

Mr. Kirkwood

To ask the Secretary of State for Health (1) whether comprehensive care services will be provided at all self-governing hospitals;

(2) whether emergency and outpatient facilities will be provided at all self-governing hospitals.

Mr. Mellor

[holding answer 21 June 1989]: We are prepared to consider all hospitals and a variety of other units as potentially eligible for self-governing status. Comprehensive core services or particular services need not necessarily be provided by each one.