HC Deb 19 February 1991 vol 186 cc83-5W
Mr. Pawsey

To ask the Secretary of State for Health if he will make a statement on the principal achievements of his Department since June 1987.

Mr. Waldegrave

The principal achievement since June 1987 has been the enactment of the reforms of the health service set out in the National Health Service and Community Care Act 1990. The reforms build on the fundamental principles of the national health service and on the achievements of the last 40 years, to secure the best possible use of the record level of resources now available for health care and to give patients, wherever they live in the United Kingdom, better health care and greater choice of services. Improved organisation and management of the national health service through clearer definition of responsibility between those purchasing health services in line with the needs of their local population and those providing and managing those services will be key elements.

The national health service has made a positive response and welcomed the greater devolution and delegation of responsibility. Fifty-seven hospital trusts have already been announced and will come into effect from next April along with a substantial number of general practitioner fund holders. Considerable interest has been expressed by others wishing to follow in subsequent waves. These changes mean putting quality and responsiveness to the patient at the top of the agenda.

Since 1987, and throughout their period of office, the Government have remained firmly committed to the national health service as a service free to all regardless of means and funded primarily from central taxation. Gross United Kingdom spending has increased from £21.8 billion in 1987–88 to a level of planned expenditure of £32.6 billion in 1991–92. United Kingdom per capita expenditure on the health service will have risen from £383 in 1987–88 to £567.

The numbers of patients receiving treatment has continued to rise each year. Targets set in 1986 for cataracts and bone marrow transplants have been met and the target for hip replacements is close to being achieved. There has been a 23 per cent. increase in the total number of heart and lung transplants and a 72 per cent. increase in the number of liver transplants.

Besides the increases in the number of direct care staff, doctors and nurses are better paid. The Government have responded positively to the recommendations made by the respective independent review bodies. Last December, broad agreement was reached with the medical profession to reduce to 72 hours per week the long hours worked by junior hospital doctors in hard-pressed posts.

The NHS and Community Care Act 1990, also provides the framework for the development of domiciliary day and respite services to enable people to live in their own homes wherever feasible and sensible. This programme will have a phased introduction to avoid overburdening the agencies involved.

Since 1987, the Government have placed particular emphasis on the importance of health promotion and disease prevention. In 1990, immunisation and vaccination targets were set under the terms of the new contract for GPs. These have already led to improvements, particularly in the inner city areas where rates were generally low. Since 1988 all English health authorities have had a computerised call and recall system for cervical cancer screening. All women aged between 20 and 64 are expected to be brought into the programme by 1993. The first nationwide breast cancer screening programme in the European Community has been established, and important initiatives have been taken on teenage smoking, alcohol misuse, drug misuse, diet, food safety and coronary heart disease. In January 1988, the world summit of Ministers of Health was held in London, to look at programmes for combating the spread of AIDS. More than £10 million has been made available annually to health authorities and voluntary organisations to continue this work. Further progress has been made towards the WHO European region's 38 "Health For All" targets with many of those relating to health trends, lifestyles and healthy environment having been achieved. With the support of the leading health professions, the Government expect to produce a consultative document in the early part of 1991, which will form the first stages of a health strategy for England and provide the means for measuring improved health outcomes.

Other developments since June 1987 include the improved approach to child care practice under the Children Act 1989. Close working between magistrates courts, the higher courts and local authorities with the need for understanding new court processes will be important factors. The Human Fertilisation and Embryology Act 1990 addresses the complex legal and ethical issues surrounding embryos and embryo research.