HC Deb 21 March 1989 vol 149 cc561-4W
18. Mr. Wilshire

To ask the Secretary of State for Health what provision he is making under the proposals in the White Paper "Working for Patients" for circumstances where a general practitioner overspends on his or her drug budget.

Mr. Kenneth Clarke

FPCs will discuss with practices concerned any significant divergence from planned spending. Where there is a reasonable explanation for the variation the FPC will be expected to accept and accommodate it within its overall budget. If no satisfactory explanation for apparent overspending can be found the FPC will discuss with the practice what remedial action is necessary. Under no circumstances will any practice ever be required to withhold necessary medicine from a patient.

19. Mr. Hannam

To ask the Secretary of State for Health what are the implications of the proposals contained in the White Paper "Working for Patients" for the aims of his policy of care in the community; and if he will make a statement.

Mr. Kenneth Clarke

Our policy aims in the community care field remain unaltered—to promote the development of community services so that people can return to, or remain in the community and live independently wherever this is best for them. We are currently giving active consideration to the future organisation and management of community care following Sir Roy Griffiths' report and will ensure that our conclusions are consistent with our proposals in "Working for Patients".

22. Mr. Leigh

To ask the Secretary of State for Health what further responses he has received to the recent White Paper on the future of the National Health Service, "Working for Patients."

Mr. Kenneth Clarke

I refer my hon. Friend to my reply to my hon. Friends the Members for Harrow, East (Mr. Dykes) and for Hendon, South (Mr. Marshall) earlier today.

32. Mr. Wallace

To ask the Secretary of State for Health what provision is to be made for the proper recruitment and training of staff and the additional cost for establishing the information technology and accountancy needed to implement the proposals contained in the White Paper "Working for Patients".

Mr. Kenneth Clarke

It will be the responsibility of health authorities to decide what additional manpower they will need. There will be an even greater need for management training and development of staff. The Health Service Executive together with the NHSTA will be working closely with the service on these activities which still need to be improved further in the NHS quite apart from the implications of the White Paper.

36. Mr. Andrew Bowden

To ask the Secretary of State for Health if it is intended that long-stay hospital care for elderly people will be included in the essential core services to be provided by National Health Service hospital trusts under proposals in the White Paper "Working for Patients".

Mr. Kenneth Clarke

"Core services" is not intended to be a description of essential services but of those services of any kind which must be provided locally. In other words, as was made clear in the White Paper, core services will include all those hospital and community-based services which need to be provided on a local basis on grounds of practicability. But where patients may wish to choose the location of their treatment, districts will—under the new arrangements—be able to buy services in a more flexible way. Some long-stay care for elderly people might fall into either category. It will be for each district to consider, in the light of local circumstances, what its core services should be. It will be the responsibility of every district health authority to ensure that its population has access to a comprehensive range of services.

37. Mr. Grocott

To ask the Secretary of State for Health how many representations he has received from organisations representing Health Service workers or patients supporting the proposals in his White Paper "Working for Patients".

Mr. Kenneth Clarke

As yet, we have received only a few such representations.

44. Mr. Gerald Howarth

To ask the Secretary of State for Health what provision he is making for doctors who choose to operate a practice budget, as proposed in the White Paper "Working for Patients" to treat patients where their budget is overspent.

Mr. Kenneth Clarke

Budget-holding practices will be expected to stay within the agreed budget. But treatment must be available to patients and no circumstances will ever arise in which a practice is required to withhold necessary treatment or medicine from any patient. Practices will be permitted to overspend in any one year by up to 5 per cent. of budget, on the basis that a corresponding reduction is made in the budget for the following year. Where overspend is due to genuine clinical needs or the changed circumstances of the practice, the practice would opt for a budgetary review. If a practice consistently overspends by more than 5 per cent. the sanction will be that it may lose the right to have a budget.

45. Mr. Hind

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

Mr. Kenneth Clarke

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. General practitioners will be able to improve the service they offer their patients by applying for their own budgets. Patients will be able to choose their general practitioners on the basis of the services they offer. We intend to raise the performance of all hospitals and general practitioners to that of the best. The reformed Health Service will offer a better quality of service and better value for money.

46. Mr. Yeo

To ask the Secretary of State for Health what recent representations he has received regarding his White Paper "Working for Patients".

Mr. Kenneth Clarke

I refer my hon. Friend to my reply to my hon. Friend the Member for Hendon, South (Mr. Marshall) earlier today.

49. Mr. Ieuan Wyn Jones

To ask the Secretary of State for Health what recent representations he has received from general practitioners on the documents "Promoting Better Health" and "Working for Patients".

Mr. Kenneth Clarke

I have recently received a considerable number of representations from individual GPs and their representative organisations on the documents "Promoting Better Health" and "Working for Patients". These have been in person, in writing and through the helpline set up to answer GPs' queries arising from the document "General Practice in the NHS—A New Contract" which set out in more detail our plans for the family doctor service.

62. Mr. Franks

To ask the Secretary of State for Health what are the implications of the proposals in his White Paper, "Working for Patients", for waiting lists.

Mr. Kenneth Clarke

Our proposals in the White Paper "Working for Patients" are designed to ensure that all parts of the Health Service offer the best possible service to patients. The better value for money obtained under the new system will in itself ensure an increase in levels of patient care and reduce pressure on waiting lists. To reduce waiting times for non-urgent treatment, the Government are to introduce a scheme under which 100 extra consultants can be appointed over the next three years. We are also changing the funding system used by the Health Service to make sure that patients can receive treatment in hospitals where waiting lists are shortest if they wish.

69. Mr. Hayes

To ask the Secretary of State for Health what representations he has received from the British Medical Association on "Working for Patients"; and if he will make a statement.

Mr. Kenneth Clarke

I have yet to receive a formal response from the British Medical Association to the White Paper proposals.

Mr. Teddy Taylor

To ask the Secretary of State for Health if he has given consideration to introducing the White Paper reforms initially on a pilot basis in areas of the United Kingdom; and if he will make a statement.

Mr. Kenneth Clarke

We gave very thorough consideration to the proposals contained in the White Paper "Working for Patients" during the year in which we carried out a detailed review of the Health Service. I am quite satisfied that the NHS needs reform on the lines proposed to improve its management and to improve the service to patients. Postponing full implementation would lead to uncertainty and anxiety in the Health Service without producing the benefits for patients and staff that will flow from the early introduction of the planned reforms.