NHS (Waiting Lists)

HC Deb 18 March 1998 vol 308 cc1290-304 3.31 pm

The Secretary of State for Health (Mr. Frank Dobson)

Madam Speaker, yesterday's Budget has, rightly, been well received. It confirmed new Labour's reputation for economic competence. It was a Budget for enterprise, a Budget for work and a Budget for families, and it was a Budget for our national health service.

The £500 million the Chancellor announced yesterday takes to £2 billion the extra money that the Government have put into the health service in the 10 months we have been in power. That £2 billion in ten months is about £5 million extra for the health service for every single day of the coming year. That is more than the Tories ever planned, and even more than the Liberals promised.

I intend to put that money to very good use. At the general election, we promised to save the national health service and to modernise it. We have kept that promise, as we keep all our promises. We have saved the national health service; we are modernising it. We are doing that in partnership with the million people who work in the health service. We have asked them to work in new and better ways, and we have matched that by extra funds.

When we took over, waiting lists had been rising since 1995, and record numbers of patients were waiting for treatment. I made it clear that the first priority for the NHS was to ensure that the health service avoided a winter crisis. I asked the people working in the health service to make contingency plans, to break down the Berlin wall between hospitals and community and social services, and to make sure that emergency and urgent cases were treated promptly.

NHS and social services staff responded magnificently. The Government provided an extra £300 million, and, with the help of the 1,500 special schemes introduced this winter, the NHS has treated record numbers of emergency cases and record numbers of people off the waiting lists.

As top priority was given to emergencies, waiting lists have grown despite all the hard work of the staff. I set that priority, and the health service met that priority—I congratulate it on doing so. That effort was not simply a one-off for the winter, however; it was a long-term investment for the future. It has put in place new partnerships between general practitioners, hospitals and social services to tackle long-standing problems, which had denied some people high-quality treatment at home or in the community. Those new partnerships will endure.

Now we shall build on those partnerships. We shall bring the same combination of investment and modernisation to bear down on waiting lists. Today, I can spell out that our top priority for the coming year is to reduce waiting lists, using the extra £500 million that my right hon. Friend the Chancellor announced in his Budget yesterday. That £500 million comes on top of the extra £1.2 billion for the NHS next year that had already been announced.

Of that extra money, £417 million will be invested in the health service in England. Three hundred and twenty million pounds of that will go directly into cutting waiting lists; it will be invested in more operations, more surgical and medical sessions, more doctors, more nurses, and more flexible seven-day working. It should result in the biggest increase in the number of operations in the history of the NHS and the biggest ever cut in waiting lists. The money will be earmarked and targeted to deliver what patients most want—shorter waiting lists.

Each health authority and trust will have to play its part, and each will be set a challenging individual target. The waiting lists action team will step up its advice and support, and performance will be closely monitored in every part of the country. Best practice will be identified and spread, and everywhere standards will be driven up. There will be rewards for those who hit their targets and sanctions for those who do not. The chief executive of the NHS, Alan Langlands, will oversee performance in meeting those targets; he will regularly report to me personally.

The rest of the extra money will also be invested in cutting waiting lists. The flow of operations will be maintained by building on the success of the new ways of working that were pioneered this winter, and through better primary, community and mental health services. We shall also start to modernise the waiting list system, which is archaic. Some of the extra money will be spent on pioneering new streamlined appointment systems so that day case patients can book the date that suits them for an operation. Again, we shall manage the new investment closely to ensure that our objectives are delivered.

I said last year that the waiting lists were like a supertanker—it would take time to slow them down, longer to bring them to a stop, and even longer to turn them around. Waiting lists are still growing, but, as our measures bite, we shall halt the rise, and, by the second half of the year, they will be coming down. Through targeted investment, good management and innovative change, we shall do better than the Tories ever did. In the 18 years of Conservative government, the number of people on waiting lists rose by more than 400,000. In the next 12 months of a Labour Government, the numbers will fall, and will continue to fall.

By April next year, I expect hospital waiting lists in England to be shorter than the 1.16 million record level that we inherited from the previous Government. That is the target. Delivering that target will be a significant stepping stone towards fulfilling our pledge to reduce, in this Parliament, waiting lists by 100,000 from the level that we inherited.

The target is ambitious, but I am confident that, provided we do not encounter a dreadful winter or major epidemic, we can meet it. [HON. MEMBERS: "Ah."] Fools opposite apparently think that the system could cope with a major epidemic; perhaps they think that we could cope with the arrival of an asteroid. I am confident that the target can be met, because our ambition to cut waiting lists is shared by the people who do the work in the health service, as well as by the people who need operations.

The Budget was a defining moment, because it showed clearly what new Labour means: enterprise, efficiency and fairness going together. The Government's sound management of the economy has enabled us to find more money for our priorities, and in particular for health. As a result, there can be extra investment.

I am determined to ensure that patients and taxpayers get full value for that investment. That will require modemisation and reform, and I know that the staff of the NHS will match our commitment with their own. It was a new Labour Budget for a new health service, delivering on our promises to the people at the general election.

Mr. John Maples (Stratford-on-Avon)

In the general election campaign, the Labour party made a specific promise: to reduce waiting lists by 100,000. The Secretary of State talks a lot about ambitious targets and supertankers, but I wonder whether the electorate would have been so impressed if they had known that it was a five-year promise. Somehow, reducing waiting lists by 20,000 a year does not sound quite so impressive. Even he should be able to turn a supertanker round in less than five years.

Since the general election, far from falling by 100,000, waiting lists have risen by 100,000, and they have almost certainly continued to rise this winter, and will probably do so this summer. Labour made another promise, intimately connected with waiting lists: to spend more money than us, every year. Our spending plans were criticised in the most exaggerated and emotional terms and denounced as inadequate. Has Labour done better? No, it has not. [Interruption.]

Labour Members do not like this figure, but, for 18 years under the Conservatives, the national health service budget increased by an average of 3.1 per cent. a year over and above inflation. Under Labour, the increase for last year and next year will average 1.8 per cent.

Yesterday, the Chancellor said that there would be £500 million more for health, but the Red Book details show that the increase is only £420 million for England, of which only £340 million is being spent on the NHS. Why is England getting only 84 per cent. of the money, when it got 90 per cent. of the winter emergency money? According to the Red Book, which many members of the Government have clearly not read, England is getting £420 million out of the £500 million. What is the other £80 million—the difference between the £420 million allocated to the Department and the £340 million for the NHS—to be spent on?

Will the Secretary of State confirm that hidden away in the Red Book was an increase in the estimate of inflation for next year; that the estimate of the gross domestic product deflator was raised from 2.75 per cent. to 3 per cent.; and that that will reduce real spending in the NHS by £90 million? When that is taken into account, the £500 million becomes not £420 million or £340 million but £250 million extra in real terms for the NHS in England.

The Secretary of State says that he intends to spend £320 million on reducing waiting lists, and that he will get us back to where he started in two years' time. What an achievement: he will have turned his supertanker 360 deg, and gone absolutely nowhere in two years. Will he go a little further and promise the House that his pledge to reduce waiting lists by 100,000 from the figure that he inherited will have been fulfilled by May 1999?

Can the Secretary of State confirm that the national health service budget increased in real terms by only 1.27 per cent. in 1997–98; that, even with the extra £500 million announced yesterday, the increase in real terms will be only 2.3 per cent. in 1998–99; that the average real-terms increase between 1979 and 1997 was 3.1 per cent.; and that, if the NHS budget had continued to be increased at the same rate under Labour as it was under the Conservatives, the NHS would have an additional £940 million to spend next year?

The Secretary of State has been all over the media, congratulating himself on the extra £500 million, which now turns out to be £250 million. We should like to know what happened to the £2 billion that was being trailed across the Sunday newspapers a couple of weekends ago. That really would have made a difference, and that is what the Secretary of State wanted, but he failed in his negotiations with the Chancellor. That was new Labour 1, old Labour 0.

Far from crowing about his success, the Secretary of State should be apologising for his failure. Since the election, waiting lists have gone up 100,000 and the cash has gone down by £940 million. Is that what he means by saving the NHS—with longer waiting lists and less money?

Mr. Dobson

It is clear from that response that I need to keep the figures simple, because the hon. Gentleman finds them difficult to understand. Since we got in, we have found £2 billion more than the Tories provided for in the Budget for the current year and that for next year. That is £2 billion more than they intended to spend in their last Red Book.

That money is not unreal money or discounted money, but will go on real operations, carried out by real doctors, in real operating theatres, helped by real nurses and other people, and it will treat real patients. That is why it has been welcomed by representatives of doctors, nurses, NHS managers and the unions representing other people who work in the health service.

There is no point in the shadow Secretary of State comparing chalk with cheese. I am comparing what we are providing in this year's and next year's Budgets with what was provided by the previous Tory Chancellor of the Exchequer in his last Budget. When we take those into consideration, we find that there is £2 billion more than the Tories ever intended. I might add, for good measure, that there is £1 billion more than the Liberals promised.

Audrey Wise (Preston)

Does my right hon. Friend agree that the full use of operating theatres, which at present stand empty for some part of the week in many parts of the country, would mean that we could use the capital resources of the NHS as well as the professional skills of surgeons and others far more effectively? Has he noticed that, in the days of the Tory Government, when waiting list reductions took place at all, they took place as a result of making people wait to go on the waiting lists? I congratulate my right hon. Friend on a far more straightforward approach to the problem.

Mr. Dobson

I certainly agree with much of what my hon. Friend says. Clearly there will have to be a lot more operations in operating theatres in the coming year. From my discussions with representatives of the people who have to do that work—no one in this House will do it: it will be the people in the hospitals—I am convinced that they are ready, willing and keen to do it. We have now found the money to enable them to do it.

We have to get away from the ludicrous situation that has prevailed, admittedly for years, in the health service, in which theatre crews—surgeons, anaesthetists, nurses and others working in the operating theatre—have had to stand down for the last six weeks or two months of the financial year because their health authority could not afford to pay the small additional amount to look after patients after they had been operated on. We have to get away from that nonsense, and we are going to get away from it.

Dr. Evan Harris (Oxford, West and Abingdon)

The Liberal Democrats welcome this overdue action on the crisis in waiting lists, and we welcome the overdue and tiny extra spending on community care, but does the Secretary of State accept that, if he followed the costed Liberal Democrat alternative Budget, there would be much more than the £1.7 billion available to spend on those problems next year—in fact, double that? He says that he will modernise waiting lists—that is the new euphemism, modernise—but does that mean that he will change the goal posts?

Can the right hon. Gentleman assure me that all operations will still be offered in the NHS next year that are offered now? Can he assure us that in-patient waiters will be tackled, that this will not just be a blitz on day case waiters, and that hips will be done as well as toenails? Will long waiters be tackled—people waiting over a year, whose number has tripled to over 68,000 since May?

Given the recruitment crisis among doctors, nurses and physios—a recruitment crisis not helped by staging their pay award—where will all the extra doctors and nurses and professions allied to medicine come from to do all these extra operations?

Mr. Dobson

The motto of the Liberal Democrats appears to be: think of a number, put it in their election manifesto, and double it when they lose. At the general election, they said that they wanted £540 million a year extra for the health service. We have put £2 billion into the health service over the first two years, which is roughly double what they advocated. It is difficult for them to criticise us for spending twice as much as they would have, had they by some freak of fate won the general election, which they did not.

I confirm that we intend to reduce the in-patient waiting list. We are making a special effort to ensure that the 18-month waiters list is eliminated by the end of this year. As we progress in getting the waiting list down, waiting times should come down as well. It will be a long, hard struggle for the people working in the national health service, but they asked for the extra money. Representatives of the British Medical Association, the Royal College of Nursing and health service managers have welcomed the money. I do not understand why Opposition Members appear to be the only people who do not.

Mr. David Hinchliffe (Wakefield)

I warmly welcome today's announcement, and congratulate my right hon. Friend on the manner in which he has won huge additional resources for the NHS, which will directly affect many of the problems that the Government have inherited from the Conservatives.

I urge my right hon. Friend, in using the money, to build on the obvious success of the winter beds initiative to establish closer working relationships between the national health service and social services, and to tackle the problems of the Berlin wall to which he referred. The issue is directly related to bed blocking. Will he also consider the problems facing local authority social services departments, many of which are making significant cuts in their budgets? Does he recognise that there is a partnership between local authorities and the NHS, and that local authorities should be enabled to their play their part in resolving these difficult problems?

Mr. Dobson

My hon. Friend, who does such a good job chairing the Health Select Committee and has devoted a substantial part of his parliamentary life to promoting the interests of the NHS and social services, is right to say that we need to draw on the good experience of the way the NHS, social services departments and certain voluntary bodies used the extra £300 million for the winter.

I may be letting out some terrible secret, but it was easier to convince some of my colleagues of the ability of the NHS to respond and to put money to good and immediate use when I could point to the immense success of the initiatives taken in the winter. They are a credit to everyone concerned. More than 1,500 new schemes were introduced, and I asked for reports on them all.

I asked for honest reports, because, if they were put together quickly, it is likely that, out of 1,500, one or two may have turned out to be a total frost. If we are going to learn from one another, we need to learn from the things that work well and the things that go badly. It is on the basis of our experience of the brilliant efforts of the NHS and social services with the money for the winter that I am confident that we can have equal success with targeted funds to tackle the waiting list problem.

Mr. Tom King (Bridgwater)

Is the right hon. Gentleman aware that, while it may seem a clever debating point here to quote Conservative years two and three as though they were likely to be the expenditure levels in the NHS, every year the Conservative Chancellor for the year in question substantially increased health expenditure, which led to the 3 per cent. increase in real terms in health expenditure quoted by my hon. Friend the Member for Stratford-on-Avon (Mr. Maples)? Is he aware that this year is clearly the most difficult that my local Taunton and Somerset NHS trust has ever faced, and that the trust is likely to be in deficit? I do not see the sums announced in the Budget as likely to make a significant difference to that situation.

Mr. Dobson

The right hon. Gentleman obviously knows better than the people representing nurses and doctors, but he certainly does not know too much about his own Government's spending plans, because we are talking not about years two and three, but about years one and two—the year we are in now started off as a Tory year. There was a Tory Government at the beginning of this financial year, so we are not comparing oddities or theories; we are comparing the amount of money that the Tory Government allocated for this year—we started the year with that and did the allocations for the health service on that basis.

I fully accept that a great number of health authorities and trusts are in severe financial trouble, as they were under the previous Government. When we took over, 60-odd of the 100 health authorities were in debt, as were 120-odd of the 400-odd trusts, so that is no novelty. We have reduced that debt by reintroducing financial rigour into the health service, at the same time as people are doing more work.

Mr. Dale Campbell-Savours (Workington)

I warmly welcome the statement, for which we have all called over a long period. However, I have a problem in west Cumberland that has to be resolved, which is that loose talk by consultants in Carlisle Hospitals NHS trust about the configuration of services in Cumbria is totally undermining morale in West Cumberland hospital. That has to stop. Is my right hon. Friend prepared to look into those matters on my behalf? We are very worried indeed.

Mr. Dobson

My hon. Friend raises an important point. When there is any question of reorganisation of the health service, everyone finds it disturbing, but it behoves everyone involved to try to adopt a reasonably moderate tone in what they say about such matters.

Mr. Bernard Jenkin (North Essex)

Like you used to in opposition?

Mr. Dobson

Let me tell the hon. Gentleman—

Madam Speaker

Order. I shall tell the hon. Gentleman something: he will not be called for his question if he shouts from the Back Benches. He is a Front-Bench spokesman.

Mr. Dobson

I can say that I have probably taken a more rational attitude to hospital change in my constituency than any other Member of the House of Commons. I have been in favour of amalgamating two great teaching hospitals and of amalgamating into those two great teaching hospitals a large number of other small hospitals in the area. Not many Tory Members of Parliament can say that.

Sir Geoffrey Johnson Smith (Wealden)

Is the right hon. Gentleman aware that one of the reasons why waiting lists have increased is that some health authorities and trusts have been advised, and in some cases instructed, not to send patients out of area or even to private hospitals—some of them non-profit—which can carry out the surgical or other treatment to a standard equal to that offered by the NHS, and in some cases at less cost?

Mr. Dobson

Generally speaking, if someone is sent for an operation in the private sector, it is not at less cost. Some people running loss leaders may manage it, but generally speaking operations are more expensive in the private sector. However, the restrictions on where health authorities can send patients were part of the system we inherited, and we are getting rid of them because, like the hon. Gentleman, I think that they are stupid.

Mr. Kevin Barron (Rother Valley)

Will my right hon. Friend tell us how quickly patients currently on waiting lists are likely to see action as a result of the new investment in the national health service?

Mr. Dobson

The people who run the health service will know that money is available. We are telling them that they can start making the necessary plans, and, from 1 April, incurring the necessary expenditure in the knowledge that the money is coming. As soon as 1 April arrives, people who would not be treated but for the extra £500 million that the Chancellor has found will begin to be treated. Additional people will be treated.

Mr. Nicholas Winterton (Macclesfield)

Medical treatment and medical care should not be the battleground of party politics. Does the Secretary of State agree that advances in medical skills and technology mean that, year by year, additional burdens are inevitably placed upon the national health service? The East Cheshire NHS trust in my constituency benefited from the winter beds initiative. If the money that the Secretary of State is spending in an attempt to reduce waiting lists achieves that objective, I am prepared to say from this side of the House that I at least will be eternally grateful, as will my constituents.

Mr. Dobson

Yet again, I thank the hon. Gentleman, who, in days gone by, was a distinguished Chair of the Health Select Committee and member of the Social Services Select Committee. He has always spoken up for the national health service.

I recognise the hon. Member's point entirely: technological changes and pharmaceutical improvements offer a challenge to the national health service. However, I would like to change morale within the service.

From the point of view of patients and clinicians, the new technology is wonderful and brilliant. It means that people who could not be treated in the past may now receive treatment. Those who could be treated in only an inferior manner and were offered palliative care can now receive treatment to cure their condition. We must change the whole approach, so that the national health service feels confident enough, and is sufficiently well funded, to look to and welcome change, and to deploy it in the best interests of patients.

Judy Mallaber (Amber Valley)

I hope that hon. Members on both sides of the House will offer warm congratulations to the Secretary of State on securing the additional money. Will my right hon. Friend ensure that at least some of the extra £500 million will be used to introduce new and better ways of managing NHS waiting lists?

Mr. Dobson

Yes, indeed. I like to keep statements short, so I referred only briefly to our intention to move away from the archaic manner in which waiting lists are put together and managed. The treatment of patient data and information is a scandalous disgrace. The national health service is the only major institution in the country that stores basic data on fairly scrappy bits of paper that have a tendency to get lost. We must introduce much better information technology, for the benefit of all.

Mr. Crispin Blunt (Reigate)

Is the Secretary of State aware that, at the time of the general election, the Labour party displayed in my constituency a poster promising shorter waiting lists? I have asked my local hospital about the length of waiting lists in each specialty area of treatment available to my constituents. What poster may I expect to see if the right hon. Gentleman fails to deliver shorter waiting lists by the next general election?

Mr. Dobson

We will not fail to deliver. I would be interested to learn whether the hon. Gentleman displayed a poster in his constituency at the last general election saying that waiting lists would rise under a Conservative Government—because that was inevitable.

Mr. Dennis Skinner (Bolsover)

Does my right hon. Friend agree that it would be much easier to reduce waiting lists if we could start to change more dramatically the dodgy system that we inherited from the Tories in respect of the NHS? I do not think that my right hon. Friend has an easy task—it is probably the biggest nut to crack in government. Did he hear the Chancellor of the Exchequer refer to the extra £500 million that will go into the contingency fund? Will my right hon. Friend keep an eye on that money? He needed some of it last winter, and I think he might need it again this year.

Mr. Dobson

I understand the point that my hon. Friend makes. I am not evading his question if I say that everyone working in the health service shares my view and wants the comprehensive spending review to produce a new approach to funding of the NHS, so that the NHS will know for the next three years what resources it will get, and will be able to plan properly and deal with them. I am reasonably confident that the comprehensive spending review will enable us to do that, to the infinite benefit of the people who work in the health service and, even more so, of the people they look after.

Rev. Martin Smyth (Belfast, South)

I welcome the statement. I read in the papers in Northern Ireland this morning that £13 million is going there. We welcome that, but unfortunately we cannot question the Minister on how it will be spent.

I underscore the point made by the hon. Member for Wakefield (Mr. Hinchliffe): much bed blocking is due to the fact that social services cannot take people into residential accommodation. Does the Secretary of State agree that the problem does not arise just at the end of the financial year, and that purchasing authorities do not pace themselves properly earlier in the year so that people can be operated on, instead of money being held back lest emergencies develop?

Is it not important that the attitudes of managers and administrators should be changed? Often people get a letter when they are on their way to work, on the morning that they are required to present themselves for an operation. That is a waste of health authority time.

Mr. Dobson

I take on board the points that the hon. Gentleman makes. In Northern Ireland, the national health service and social services have worked closely together, which was extremely helpful last winter. I was privileged not long ago to hand over the nursing innovation of the year award jointly to people in the NHS and social services in Northern Ireland, which I am sure was well deserved. Northern Ireland was also well represented among those who did not quite make the final.

Mr. Peter L. Pike (Burnley)

I congratulate my right hon. Friend on the good news that he announced this afternoon. He will know that one of the waiting lists consists of people suffering from multiple sclerosis, who are considered suitable for treatment with beta-interferon, but who cannot receive it. Will some of those people be able to benefit from the additional money that is being made available?

Mr. Dobson

It may be so, but the decision will have to be taken by the clinicians involved. There are disputes among doctors as to the effectiveness of beta-interferon for substantial groups of patients.

One of the points that I am making to the pharmaceutical industry as it introduces more and better ways of treating people is that it must do its part of the job of identifying patients suffering from degenerative diseases who will benefit from a particular new drug. Often the drug will benefit only 17, 23 or 30 per cent. of patients, and we cannot allow false hopes to be raised in the remaining patients or in doctors. We must have a clearer, more sensible system, so that people are not misled into believing that something that has been discovered will cure them, when it will not.

Mr. Andrew Lansley (South Cambridgeshire)

I am sure that the Secretary of State is right to say that nurses, doctors and representatives of health trusts will welcome additional resources, not least because they know that the increase in health resources this year and next is below that which is necessary to maintain services and to respond to demography and technology change.

Will the right hon. Gentleman explain why, if the additional resources arise from an underspend in this financial year, they are not being made available to the NHS in this financial year, rather than being carried forward and being made available in the next financial year? Will the additional resources for winter pressures and the additional £500 million of which the Secretary of State speaks be consolidated into the NHS baseline expenditure for negotiation with the Chancellor of the Exchequer and the Chief Secretary for 1999–2000 and beyond?

Mr. Dobson

The hon. Gentleman has clearly consolidated the £300 million into his figures. The fact that we found the £300 million reduces the apparent increase for next year, as he knows, and he has drawn upon that.

On general funding, I know, the hon. Gentleman knows, and everybody in the country knows, that the national health service does not have at its disposal all the resources it needs. That is why we are having a comprehensive review of spending by the Department of Health and all other Government Departments—so that we can change the priorities and ensure that, in future, the national health service has sufficient sustainable funds to be able to do its job properly, which I assume all of us want.

Ms Karen Buck (Regent's Park and Kensington, North)

Will my right hon. Friend join me in paying tribute to the magnificent work done by national health service staff during the past winter, particularly in the hospitals that serve my constituency—St. Mary and St. Charles? Does he agree that the £500 million that he has announced this afternoon will lift pressure from health service staff by giving them the tools to do the job?

Mr. Dobson

It will indeed lift the pressure on health service staff, but they are applying further pressures on themselves, because the nursing and medical professions are more dedicated to improving the quality of performance, to measuring outcomes and to having evidence-based medicine for the benefit of patients than they have ever been. It is our job to encourage and sustain them in that, and the £500 million will go a long way down that road.

Mr. Edward Davey (Kingston and Surbiton)

Earlier this afternoon, in answer to my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), the Secretary of State said that, by the end of this year, waiting lists will have been cut so that no one will have been waiting for 18 months or more for an operation or treatment. Does he recall that, on Thursday 19 February this year, his Department issued a press release in his name, which said: by the end of March nobody should be waiting over 18 months for treatment. When is it? Is it March this year or December this year?

Mr. Dobson

It would be a bit of a respite for all of us if it was December this year. The hon. Gentleman should know—allowing for the fact that he is a Liberal—that, generally speaking, financial matters and figures in the health service are calculated on the basis of financial years, which end on 31 March.

Dr. Howard Stoate (Dartford)

Does my right hon. Friend agree that one of the most important features of his proposals is that money will now be tied to outcomes? How will he ensure that it is put to best possible use, so that people in my constituency and elsewhere will see genuine improvements in their services?

Mr. Dobson

As I said in my statement, there will be incentives to ensure that people spend the money where it is intended, and sanctions for those who do not.

Mr. Andrew Tyrie (Chichester)

Will the Secretary of State answer at least one of the concerns raised by my hon. Friend the Member for Stratford-on-Avon (Mr. Maples)? In 1998–99, how much of the £500 million is accounted for by the increase in the GDP deflator from 2.75 per cent. to 3 per cent., set out in the Red Book on page 108?

Mr. Dobson

If the hon. Gentleman wants to talk about the GDP deflator, he should know that one does not set it against the £500 million extra; it should be set against the £36 billion or £37 billion that the health service will be getting as a whole. I emphasise yet again that, whatever he may say about Red Books, Green Books, or any other books for that matter, the fact is that the people working in the health service, who will have to do the work, who deal with the operations, welcome this money, because it is an extra £500 million that will be spent on real nurses, real doctors and real operations.

Ms Julia Drown (South Swindon)

This extra much-needed money for the health service will be welcomed by my constituents, just as the winter pressures money made a real difference to Swindon patients this year, and made the winter much better than it was last year. Will my right hon. Friend encourage trusts and the waiting list task force to take into account suggestions from patients and front-line staff, so that together we can get the best ideas about how services can be provided more efficiently and effectively, and thereby help to reduce the waiting lists?

Mr. Dobson

I entirely agree with my hon. Friend—that is what we are trying to do.

Mr. Tony Baldry (Banbury)

May I return to the point made by the Chairman of the Select Committee? Will any of the money go to local authority social services? If it does not, it will be difficult for Oxfordshire county council to play its part in moving patients on from hospital, and beds will inevitably be blocked. We all welcome extra money for the NHS, but defeating waiting lists will be difficult unless social services can play their part.

Mr. Dobson

The success of the winter initiative was that social services and the national health service co-operated to a greater extent than ever before, and most of it will remain in place. I said in my statement, albeit briefly, that some of the money will go on community services—I thought that I had made that clear. We have ring-fenced the additional money that is going to social services for community care for the coming year, and one of the conditions is that some of it must be spent on improving arrangements between social services and the NHS. I think that we are doing what the hon. Gentleman wants us to do.

Mr. John Gunnell (Morley and Rothwell)

May I thank my right hon. Friend for his statement and for being explicit about the Liberal Democrats' election manifesto promise of £540 million per year for the NHS? Will he say what he would have been able to do had he been limited to the Liberal Democrats' spending promise, because that would give the lie to the bleating we heard on this subject from the leader of the Liberal Democrats yesterday?

Mr. Dobson

I agree with my hon. Friend. Every Member of Parliament is supposed to be a person of honour, so I would expect every elected Liberal Democrat to say that they do not want funds over and above the £540 million that they asked for to be spent in their areas, and generously to allow the money to be spent in other areas.

Mr. Nick St. Aubyn (Guildford)

Is the Secretary of State aware of the latest research, which shows that, because of the withdrawal of tax relief on health insurance premiums, an additional £60 will have to be spent on operations in the current financial year? According to his party's calculations, that is equivalent to 60,000 operations. Does he accept—as we warned him—that cancelling tax relief on health insurance premiums has led directly to significant increases in hospital waiting lists?

Mr. Dobson

It is difficult to reconcile what the hon. Gentleman says with the insurance industry's announcement that the measure has not made a blind bit of difference, and that people are still paying their premiums. I cannot work out what to take notice of.

Dr. Brian Iddon (Bolton, South-East)

Partly as a result of the closure of Bolton royal infirmary, which is now a speculative building site; partly as a result of the lack of 24-hour accident and emergency provision at Leigh infirmary; and partly because admissions are brought in from a wide area because new facilities at the Royal Bolton hospital are adjacent to the M61, accident and emergency work at the hospital has increased by 20 per cent. Will my right hon. Friend please bear in mind the fact that Wigan and Bolton health authority must address that problem urgently? I am pleased by yesterday's announcement.

Mr. Dobson

We shall certainly bear that fact in mind, because we do not want local people in any area to suffer as a result of changes in the health service. We want them to benefit, so we shall consider the points made by my hon. Friend.

Mr. John Greenway (Ryedale)

Will the Secretary of State tell us more about how the money will be distributed around the country? He knows that waiting lists grow for different reasons in different areas, and can increase because of lack of provision, or because one health trust is not as efficient as another. Rural North Yorkshire, with which he is familiar, has problems, although waiting lists are not as bad as in other parts of the country.

Does the right hon. Gentleman agree that people would be a little happier about the announcement if they were able to cheer because some of the money was coming to them? Can he assure people in North Yorkshire that the pattern of money going from rural areas to inner cities will not predominate in relation to this money?

Mr. Dobson

Let me make two points. First, about 90 per cent. of the money will be allocated according to the usual formula, so that every area gets some; but a certain amount will be held back to deal with crises or to encourage those who need a bit of encouragement. Secondly, as one who represents an inner-city seat within about a quarter of a mile of the House, I can tell the hon. Gentleman that my health authority received one of the 20 smallest allocations in the country. The area that the hon. Gentleman represents received a good deal more in percentage terms—and I know that his hon. Friends like percentages.

Mr. Tom Levitt (High Peak)

I know that my right hon. Friend is a great believer in long-term planning, so I feel I must alert him to a problem that he may face before the end of the life of the current Parliament. What will happen to all the new doctors and nurses who will be recruited, when no significant waiting lists are left to be reduced?

Mr. Dobson

If—as I hope—we hit the target, there will sadly still be more than 1 million people waiting for treatment. I hope that those doctors and nurses will remain in the employ of the national health service, reducing the figure much further.

People sometimes suggest that waiting lists are not important. Some of the academics who write about health care seem to think that, but we can usually assume that they are not waiting for operations. Many people waiting for operations are in pain, and their lives and subsequent health may be endangered. I also think that long waiting lists damage the reputation of the health service in a way that practically nothing else does. They are dreary and apparently disorganised, and it looks as though our system—the most efficient in the developed world—is not doing its job properly. That is why it is important to reduce waiting lists.

Mr. Jenkin

After all the irresponsible hype and propaganda that was conducted by the right hon. Gentleman's party in opposition, cannot the British people be forgiven for expecting increased resources for the health service under his party in government, to match, at the very least, what the Conservatives gave year on year on year?

Can I communicate to the right hon. Gentleman the real despair in Essex Rivers Healthcare MHS trust, which is having to close small hospitals around north Essex because it is experiencing the tightest financial circumstances in my memory, if not the tightest for the last 10 or 20 years? Will the right hon. Gentleman re-examine the formula for allocating resources across the health districts, which he has manipulated to favour the inner cities rather than the shires? The same has happened with local government.

Mr. Dobson

Let me make it clear that we changed the formula to reflect need, and added an element to allow for the problems of ambulance services in rural areas. If there has been any fixing of the allocation since we came to office, it has been in favour of rural areas. That is why many people in inner cities are not very happy with the present position, and want it to be re-examined. I must tell the hon. Gentleman that we clearly do need to re-examine the system when areas as deprived as the east end are not getting their fair share.

Mr. Neil Gerrard (Walthamstow)

My right hon. Friend will know from his recent visit of the serious concern about the way in which Redbridge and Waltham Forest health authority is managing its waiting lists and its budgets, and about the cuts that it is making in community services. Does he agree that waiting for treatment for mental health problems in the community matters just as much as waiting for an operation in hospital? Will some of the £500 million go into community services? Will my right hon. Friend ensure that whole-service trusts dealing with community services as well as hospitals do not fiddle their hospital waiting lists by cutting community services?

Mr. Dobson

I can confirm that my hon. Friend's health authority will receive its normal allocation, and that money will go into mental health care. On occasion, people suffering from severe mental episodes turn up at hospitals and have to be admitted to wards where they not only occupy beds but make life intolerable for others, which is bad for them and bad for everyone else. We are trying to deal with that important problem.