Our policy is to encourage the provision of chiropody in the most cost-effective manner. It is for each district health authority to decide to what extent it should make use of directly employed chiropodists as opposed to private chiropodists on a contractual or sessional basis.
Does my right hon. and learned Friend agree that the decision by certain health authorities, including south Bedfordshire, to reduce the number of private chiropodists in service is against Conservative policy of encouraging the private sector? Is he convinced that this will save money and will he give an assurance that no authority will be allowed to make such a change without close monitoring by him or by the Department?
I have not gone into the full details in relation to south Bedfordshire, and I have seen no evidence to justify intervening, but if money can be saved which can then be spent on the rest of the community health service as a result of reducing the proportion of chiropodists employed on a contractual basis it may be entirely consistent with our policy. It can be very expensive to pay items of service fees to chiropodists on a contractual basis, and in some circumstances a better service can be provided by employing more in-house staff.
Will the right hon. and learned Gentleman advise district health authorities that when private contractors are employed there should be a differential scale as between those who are state qualified and registered and those who are not, just as a state registered nurse has a different rate of pay from that of a state enrolled nurse?
The National Health Service uses only state registered chiropodists, whether in-house or on a contractual or sessional basis. I should like to see more use of foot care assistants for the less serious work, as that would help to provide a more cost-effective service and to extend the range of service provided for patients.
Will my right hon. and learned Friend confirm that neither he nor the health authorities have policies which discriminate against the employment of privately trained chiropodists and that he will not introduce discriminatory policies such as a tightly drawn registration system?
I fear that the Health Service is already restricted to state registered chiropodists as a result of regulations passed in the late 1970s. I am aware of the dispute between different branches of the profession and about the type of training given to state registered chiropodists and others, but at present I see no case for intervening in Health Service arrangements, which have been running for some years.
Is the right hon. and learned Gentleman aware that about 2,000 of the existing 5,000 chiropodists are likely to retire in the next few years and that if we do not put more money and effort into a massive increase in the training of chiropodists we shall not have even the limited number that we now have?
Steps are in hand that may lead to the opening of two new skill schools, and the number of chiropodists in training continues to rise. We are also encouraging National Health Service chiropody by accepting the review body's recommendation on the pay of chiropodists in service so that some of the more senior will receive up to 16 per cent. increases in pay by the end of this financial year.