HC Deb 09 November 1998 vol 319 cc33-46

4.9 pm

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

This time last year, the Government announced that we had been able to find an extra £300 million to help the national health service to cope with winter pressures. Staff and managers had worked up proposals for all sorts of local schemes to help avoid a winter crisis. The extra money made it possible for them to do what they had planned—and it was a brilliant success. Some £80 million went on the general practitioner drugs bill, but the rest financed almost 1,500 local schemes ranging from grants for extra meals on wheels in Nottinghamshire, to a special respiratory services team in Cheshire to prevent unnecessary admissions, to a joint health authority/local authority rapid response service for elderly people in Bury and Rochdale.

This year, the NHS, local social services departments and the voluntary sector are better prepared for effective joint working than ever before. As a result of conditions that I placed on the special transitional grant, councils are already investing more in order to help prevent people who do not need hospital care from being left in hospital, or people who do not need institutional social care from being placed in residential or nursing homes. This winter, for the first time, we are making flu vaccine available free to everyone over 75, as well as to the usual at-risk groups and key workers.

Last Tuesday, the Chancellor of the Exchequer announced that we would find a further £250 million to help the national health service and social services to cope this coming winter. The English share of that total is £209 million, and I can announce today that the first £159 million will be allocated to health authorities in line with the general allocations to the NHS. The money can be spent only on special arrangements to deal with emergencies, on avoiding people becoming emergency cases in the first place and on enabling patients to get back to their own beds as soon as they can safely do so. The schemes will involve long-term arrangements to improve the speed and quality of treatment and care not just this winter, but for the future. This money will go on arrangements that must stand the test of time.

The remaining £50 million will be held back and used to deal with particular local difficulties and bottlenecks. The regional offices of the NHS and the social services inspectorate have already identified a number of places where there are hold-ups in providing safe discharges from acute hospital beds, particularly for frail elderly patients. The new money will be released to fund schemes that can demonstrate that the money will be well spent. It will not be used to bail out poor performance.

Last year, we had inherited the longest and fastest rising waiting lists in the history of the NHS; so, when we provided extra funds for last winter, I acknowledged that I was asking the national health service to concentrate on winter pressures and I took responsibility—personal responsibility—in advance if waiting lists continued to rise. Rise they did, but they are not rising any more. They fell in May, in June, July and August, and today I can announce to the House that, in September, waiting lists fell by another 29,000. That is the largest monthly fall yet recorded, and it means that hospital waiting lists have fallen by 99,000 since they reached their peak in April.

That is because, providing they have the necessary resources, the dedicated people who work in the health service can deliver the treatment and care that the people of our country want. That is what they showed last winter when they made such good use of the extra £300 million the Government provided, and that is what the million people working in the health service are doing now with the extra £500 million that the Government provided this year to bring down the waiting lists.

The extra £250 million for this winter and the extra £500 million for waiting lists was on top of the additional £1,200 million that the Chancellor had already provided for the NHS in his first Budget, so the extra investment that the Labour Government have put into the national health service this year amounts to almost £2,000 million—£2 billion—more than the Tory Government planned to spend.

And what good use the NHS is making of the extra funds. In the first six months of this year, it treated 195,000 more waiting list cases than in the first six months of last year. It also treated 52,000 more emergency cases. It has therefore treated almost a quarter of a million more people—waiting list cases and emergencies. Not only are waiting lists coming down, but waiting times are improving. Since June 1998, the number of people waiting more than a year has fallen by 9,000–13 per cent. Yet again, today's figures show that no one was waiting more than 18 months for treatment. During the same six-month period, the number of out-patients treated has also risen, by 67,000.

Unless the weather is exceptionally harsh, or there is a major 'flu epidemic, the NHS can face this winter with confidence. That is because the NHS is better organised than before, and now has extra funds for both waiting lists and emergencies. That is because the Government are keeping their promise to modernise and reform the NHS. That, in turn, is possible because of the Chancellor of the Exchequer's prudent control of public spending. That has made it possible to provide extra money for the NHS while keeping overall public spending within the limits that we promised and at the same time reducing Government borrowing from the profligate levels that we inherited from the previous Government.

Those careful policies will continue. That is why the Government have been able to find an extra £21 billion for investment in the NHS over the coming three years—the biggest boost that the health service has ever received. That is why today I can say to the NHS that the extra money available next year will include £320 million extra for waiting lists alone. This is no time for complacency.

That is how we keep our promise to bring waiting lists 100,000 below the level that we inherited. Just as important, we shall modernise the NHS by investing in new hospitals, new plant and equipment. We have started the biggest hospital building programme in the history of the health service. New hospitals are already being built for Gravesham and Dartford, Norfolk and Norwich, Carlisle, Calderdale, Durham, South Manchester, Sheffield, High Wycombe, Amersham, and Greenwich, and 21 more are planned. We owe it to the excellent staff of the health service to provide them with buildings, plant and equipment that match their excellence.

As part of the modernisation, which will improve the way in which the NHS deals with both emergency and waiting list cases, we are introducing NHS Direct, a 24-hour nurse-led helpline, which will cover 20 million people by the end of next year. Next year, we are investing in the modernisation of as many as one quarter of all accident and emergency departments. The NHS is starting to make the change to booked admissions, which will allow people to make hospital appointments that suit them. We are starting to invest £1 billion in an information technology system, which will be good for patients and help staff do their jobs more quickly, better and more easily.

As the Prime Minister announced in October, we have decided that the national lottery new opportunities fund should contribute to our new drive against cancer, with tens of millions of pounds extra for new linear accelerators, breast screening equipment, scanners and hospices. Replacing old machines that break down with state-of-the-art equipment will be good for patients and staff, ending delays, cancellations, frustrations and uncertainties—better for dealing with waiting lists and emergency cases.

The extra £250 million investment for the winter, on top of the extra £1,700 million that we have already committed, should help the NHS ensure that it copes with emergencies and delivers on cutting waiting lists. I congratulate the staff on what they have achieved, and look forward to their making even better use of the extra funds this winter and in the next three years. That will be possible only because this Government give top priority to the health service, and stick to their promises.

Miss Ann Widdecombe (Maidstone and The Weald)

Although the Opposition welcome any measures to reduce the impact of the winter crisis, I should be grateful if the Secretary of State would provide clarification on a number of points.

Last year, an extra £300 million was put into the winter crisis. Can the Secretary of State explain his rationale in making less available this year, when we are unlikely to be so fortunate as to have so mild a winter for two years running?

Has the right hon. Gentleman made an assessment of the number of extra nurses that will be necessary, and can he say where they will come from?

What impact will attention to the winter crisis have on the waiting lists? As a result of action last year, the Secretary of State had to make a somewhat embarrassing apology for a sharp rise in the lists. He excused that on the grounds of attending to the winter crisis. Given that he is putting in less money this year, what is his assessment of the impact of any winter crisis on the lists?

In the context of the lists, and in order to enable the House to have the fullest possible picture of any such impact, when will the Secretary of State fulfil his promise to publish the waiting lists for the waiting lists? Will he assure the House that the falls in the lists that he is announcing represent patients actually treated? Will he confirm the Prime Minister's statement that patients are not being removed from waiting list statistics without receiving the treatment for which they were put on the lists? How would he or the Prime Minister explain the removal from the monthly returns of patients in Bradford, who were put on a supplementary list but had not yet been treated?

The right hon. Gentleman has made a virtue of announcing to the House today a fall in the waiting lists. Most of us will already have learnt about it from the morning media.

Will the money given to social services from the allocation be wholly additional to the rate support grant settlement, or will it result in adjustments?

Will the Secretary of State give the House a guarantee that no dogmatic barriers will be raised to the appropriate use of the private sector in relieving the winter crisis? Can he confirm that the private sector has already played a significant role in reducing the number of long-term waiters?

Are not the measures announced today a little late? Last year, preparations for coping with the winter crisis had already commenced by September.

In his statement, the Secretary of State made a recycled announcement that he had increased spending on the NHS by £21 billion. Does he agree that, calculated on that basis, he would have had to produce at least £19 billion just to keep pace with our average year-on-year real increases and with inflation, but that, from that extra money, he must do what we did not have to do: he must fund the minimum wage, the working time directive, measures to counteract the millennium bug, and the setting up of primary care groups? Will he confirm that, far from being unprecedented, as he implied, his increase in spending is less than our increases in spending between 1991 and 1994?

We notice the right hon. Gentleman's U-turn on lottery funding. Did not his party in opposition argue against the use of lottery money for expenditure traditionally funded from general taxation? He did not dissociate himself from that argument at the time, as I remember; presumably he is dissociating himself from it now.

Will the Secretary of State confirm that waiting lists are still higher than those that he inherited from us? How many of the hospitals that he proudly listed today are private finance initiative projects for which negotiations were well advanced under the previous Government? Finally, is he aware that, according to opinion poll after opinion poll, the general public are dissatisfied with the way in which this Government are delivering their promises on the NHS? After today's complacent recycling of old and manipulated statistics, is he surprised?

Mr. Dobson

No, I am not surprised at all about what the right hon. Lady has been saying. It is clear that she prepared her response before she had received a copy of my statement.

Miss Widdecombe

No. Most of it was done after we got it; it is the right hon. Gentleman's sums which are wrong.

Mr. Dobson

If that is the position, the right hon. Lady needs to improve her mental arithmetic. Last year we found £300 million, £80 million of which we acknowledged was going on the general practitioners' drugs bill. This year we are finding £250 million, none of which is going on the GPs' drugs bill. All of it is going on the identified schemes that I have talked about, so that is an increase. It is a decrease to the Tories, but it is an increase to everybody else. What is the impact on waiting lists? I made it clear last year—I have never tried to shuffle out of responsibility for anything that I have done in my life—that there would be money available only to avoid a winter crisis, and that no extra money would be available to help reduce waiting lists, because the feckless ruinous Government who had preceded us had not provided that money. This year, we have provided £1.2 billion in the Budget, and an additional £500 million for waiting lists. We are now providing £250 million, which is earmarked for the winter. That is the best part of £2 billion more than the previous Government intended to spend.

The number of people who are being treated is increasing. I should point out to those who think that we are great statistical fiddlers like the Tory party that the new measure of the number of people treated in the health service counts fewer people than did its predecessor, because we are saying that we shall count people who have a spell in hospital. Under the previous system, with the previous Government, if somebody was seen by three different consultants in hospital, that counted as being treated three times. We have got away from that stupidity, as well.

The right hon. Lady raised the question of the ridiculous article in The Express on Sundaythe Sunday before last about Bradford. She seems to think that, if someone has a broken arm and has a metal plate or pin put into it, he or she should be regarded as having to wait 12 or 18 months for treatment before the doctor who has inserted it decides that it is safe to remove it. Such people have never been included in waiting lists. It is as daft as suggesting that a woman who discovers today that she is pregnant should be on a waiting list for nine months in the figures that the Tories have come up with.

Information in the news media this morning was published by the Government statistical service, because it has to take responsibility for the figures. Every penny of the money to which I have referred will be additional to the funds that social services departments have already received. As for the £21 billion, the average increase in spending on the national health service over the next three years will be at least 4.7 per cent. Under the Tories, it averaged 3.1 per cent., and only if they included the last year of the previous Labour Government.

We are having to put money into dealing with the millennium bug. It would not have been a bad idea if the Tories had noticed that the year 2000 was approaching before they left office in 1997. There are not many fixed points in this world but the onset of the year 2000 was fairly clearly predictable. Yes, we shall put lottery money into dealing with cancer. I am sure that most people prefer that to giving even more money to the Churchill family.

Yes, some of the hospital schemes are private finance initiatives. They are going ahead only because we sorted out the shambles that we inherited from the previous Government. Again, the feckless, ruin of a Government whom we succeeded left us in the position in which we needed to change the law to enable PFIs to go ahead, which was why even the Opposition nodded through the first Bill that passed through this Parliament.

Mr. Paddy Tipping (Sherwood)

People who work in the health service will praise the provision of this extra £250 million. Will my right hon. Friend accept the good wishes of the chairman and chief executive of Nottingham health authority, whom I met last Friday and who spoke warmly about the extra money for the winter and for waiting list reductions? When he allocates the extra £21 billion, will he ensure that health authorities such as Nottingham, that are presently underfunded against capitation, are set a target, so that there can be fairness across the country?

Mr. Dobson

I thank my hon. Friend for his thanks. We are trying to establish an allocation system that is fair to everyone. Increasing resources by £21 billion makes it easier to be fair. In the first part of the allocation of the extra winter resources, Trent region will get more than £16 million. If it does as it did last year, I am sure that it will make very good use of those extra resources.

Mr. Simon Hughes (Southwark, North and Bermondsey)

Liberal Democrats welcome any reduction in waiting times for treatment by the national health service, and any increase in resources given by the Government. I join the Secretary of State in paying the greatest tribute to those who work in the NHS. Since the Government came to office, has there been any increase in the number of people working for the health service? Have vacancies been filled? Have the people who have left come back? Are the numbers employed going up?

Why is it that, after seeing their doctor, people are being told—as in this letter from South Devon Healthcare to a woman awaiting treatment—that they cannot be put on the waiting list, and are being put on a pending list? They will not go on the waiting list until later, so they are not being counted in the figures for the time being.

When will we have the figures, as the right hon. Member for Maidstone and The Weald (Miss Widdecombe) requested, for the waiting times between seeing the doctor and being treated by the specialist? I refer to the total waiting time, rather than the second half of the waiting time.

Is it the summit of the Government's ambition that, two years after they came to office, the waiting lists and waiting times are still the same as they were when they inherited them from the Tories, and that, at the end of the Parliament, there will be only one in 11 people fewer on the waiting list than there were at the beginning of their five-year term?

Mr. Dobson

That is not the summit of our ambition. The summit of our ambition is to have a national health service that does everything that the people of this country want it to do, and does it as cost-effectively as it does now. We want a health service that is much more proactive: we want it to identify each year the people who need a hip joint replacement, rather than insist, as it has for years, that they walk around limping, lame and in pain before anyone does anything about it. We want to modernise the NHS, and we must get rid of the waiting lists before we can do that. We want a national health service that has smart buildings and brilliant, up-to-date equipment, and matches the excellence of the staff.

As for the number of staff, there are more in some categories and fewer in others. I am sure that the balance will be away from people working in offices and towards people doing things directly for patients. The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) referred to a pending list. If he can identify where there is such a thing as a pending list, I will put a stop to it.

Mr. Hughes

rose—

Mr. Dobson

If he is saying that people must wait to attend out-patients, and that is what he calls a pending list, that list has been pending since before 1948.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

For 18 years, the Conservatives consistently sought not only to undermine and destroy the organisation of the national health service, but often to do so in the guise of efficiency? They made changes that were supposed to be for the benefit of patients. My right hon. Friend's announcement shows that he is the first Secretary of State who is really committed to the interests of the people of this country.

Will my right hon. Friend please take account of the fact that, although these initiatives are important, others need to be considered at the same time? Will he keep a close eye on the provision of nurses, so that district general hospitals such as the one in my constituency, that have been forced to close some wards owing to lack of adequate staff, will not face that problem in the coming winter?

Mr. Dobson

I thank my hon. Friend for her compliments. Everyone likes compliments, and I hope that we will be able to conduct our side of running the health service in such a way that she will be able to congratulate us on being able to train and recruit the nurses we need. We have difficulties, and roughly 140,000 trained nurses—people who are qualified to nurse—are not in nursing. In case anyone on the Opposition Benches starts glorying in that, those people have not all gone out of the health service since we got into government. The vast bulk left over a long period.

Nursing has been made far less attractive. I believe that some aspects of Project 2000 turned away from nursing a group of young people who might otherwise have been attracted to it. I also believe that such things as getting rid of nurses' homes have been harmful to the recruitment and retention of nurses, especially in the big conurbations. Pay has certainly been a deterrent, and we hope that we can do something about that.

Mr. Christopher Chope (Christchurch)

If everything is as rosy as the Secretary of State would like us to believe, will he guarantee that no patient in the NHS will suffer as a result of the millennium bug?

Mr. Dobson

Only an idiot would do that. Whatever else I am, I am not going to do that.

Mr. Dennis Skinner (Bolsover)

Is my right hon. Friend aware that, over the past 18 months, it has been a pleasure to hear him deliver statements in the Chamber? We do not shiver and shudder, and think, "What the hell is he going to say?" Generally, he has come along to tell us that he is trying to repair the crisis in the national health service that the Labour Government inherited.

It is fanciful that, last week, those on the Tory Front Bench were saying that we are spending too much money. Of course, last week was all about the economy. This week, the Tory Front Bencher who was dancing on the stage at the Tory party conference tells my right hon. Friend that he is not spending enough money. We can manage without that kind of hypocrisy, and the hypocrisy of Liberal Democrat Members, who wanted to spend only an extra penny on the national health service.

May I make a suggestion to my right hon. Friend? He has already referred—

Dr. Evan Harris (Oxford, West and Abingdon)

What about the private finance initiative?

Mr. Skinner

That has upset him, hasn't it?

My right hon. Friend has said that he will have something decent to say about pay. Make no mistake this time: the nurses must get a better-than-the-cost-of-living increase, and it must be paid at one fell swoop.

Mr. Dobson

I listened carefully to my hon. Friend, and I thank him for his welcome for what I have been saying up to now. I hope that he will be able to welcome all future statements that I make, including ones about the pay of people in the national health service.

My hon. Friend is right. As I heard it, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) said that she welcomed these measures. I am not sure whether she does or does not welcome spending £21 billion extra on the national health service; she seems to, but I do not know whether she has ever cleared that with the shadow Chancellor, whoever he may be at any particular time. As for the Liberal party, as I have said before, it is about the only party that has turned the words "I want to spend a penny" into a political slogan.

Mr. Edward Leigh (Gainsborough)

A recent study has shown that, as well as cutting waiting lists, a small hospital such as Gainsborough is capable of delivering minor surgery more cheaply than a district general hospital such as Lincoln. I would not expect the Secretary of State to comment on that instance, but will he articulate a general principle—which would be helpful in the Lincolnshire context, where minor surgery has been taken from smaller to larger hospitals—that he wants to encourage surgery to be kept close to the people?

Mr. Dobson

I agree with the hon. Gentleman on trying to ensure that the service is nearest to the people who need it—but it must be top-quality and safe. From time to time, people who are better qualified than I to adjudicate on such matters will decide that a certain service needs to be of a particular size before it is completely safe and sound for local people. I have sympathy with the wish to retain as many local hospitals as can be reconciled with that requirement, especially as changes in information technology over the next few years will—probably—make it more possible to deliver top-quality services closer to people's homes.

At the moment, we face a dilemma: pressure—sometimes, there is a reasonable reason—to close a hospital or reduce its capacity. I want to avoid that as much as possible, so that, in five years' time, we do not find ourselves wishing that we had not taken such action. Pressures remain; on occasion, major specialisations will have to be in major specialist centres—including cancer and cardiac treatment. Fairly recently, we introduced a large regional concentration of children's intensive care, because it makes sense to do so. Such concentration is better for the children who need such care than trying to spread it about, resulting in places without necessary expertise. In that, like everything else in this world, there are gains and losses. We live in a world of dilemmas.

Mr. Bill O'Brien (Normanton)

May I express my appreciation of my right hon. Friend's allocation of additional money, especially to social services? Social services in my area are some of the least financed under the standard spending assessment. The suggested increase will therefore be most welcome to Wakefield district council.

Will my right hon. Friend take note of consultation in Wakefield on the question of new hospital provision? Although my right hon. Friend the Minister of State has helped to try to explain the situation to people in Wakefield every time that we have requested him to do so, we must have assurances from the Secretary of State that the consultation will be meaningful, and that the result will benefit all people in the Wakefield health authority area. Any assistance that my right hon. Friend can give will be appreciated.

Mr. Dobson

The allocation that I have announced today will mean that the Northern and Yorkshire regions will get about £21 million extra for the winter. I hope that that will help my hon. Friend's area as well as any other. As he knows, I recently met people from the Wakefield area. I have said that I want Wakefield health authority to prepare a statement that spells out all the facts, check the impact of any such facts, and reach an agreed position with surrounding health authorities. Once I have such a statement, my hon. Friend and all others who represent Wakefield and the neighbouring areas that might be affected by what is proposed in Wakefield will be supplied with it. At the moment, the consultation does not seem to be carrying much conviction with many people in the area.

Mr. Desmond Swayne (New Forest, West)

Will the right hon. Gentleman confirm that the sort of initiatives on the treatment of cancer that he has described would normally in the past have been paid for out of taxation?

Fiona Mactaggart (Slough)

They would not have been paid for at all—that is the problem.

Mr. Dobson

Exactly; my hon. Friend gives a plain answer. We are finding an extra £21 billion over the next three years for the health service. Our ambitions to improve cancer identification, treatment and care run beyond even the £21 billion. We shall therefore be receiving money from the national lottery to augment the provision, and to provide what would otherwise have not been provided. If the Tories want to oppose that, and say that the priority should be to put money in the pockets of the Churchill family rather than towards treating cancer, it is entirely up to them.

Mr. Peter L. Pike (Burnley)

Will my right hon. Friend confirm that public opinion showed long ago that people wanted resources from the lottery to be used to speed up research into cancer? Additional resources are needed in that area. The public want and fully support the idea. Will he also confirm that East Lancashire health authority, representatives of which he met on Friday, welcomes the fact that the Government are consistently making good news announcements on the health service, enabling it to plan ahead and not keep having to take steps backwards?

Mr. Dobson

I can certainly confirm that, although I should add that we are proposing that lottery funds go not just to cancer research but to cancer identification, cancer screening, cancer prevention and cancer treatment, and to people who are dying from cancer in hospices. We are spreading the funds more widely than some have previously suggested. We are announcing good news, but with the money East Lancashire health authority is providing not just good but better treatment and care. That is what people entered the health service to do, and that is why they are glad that we are facilitating it.

Mr. Robert Walter (North Dorset)

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) posed a long list of questions, one of which the Secretary of State failed to answer. What portion of the £159 million that will be made available immediately will be spent by social services departments? What conditions will be placed on that money? He has reassured the House that the money announced will have no effect on this year's revenue support grant. What deal has he done with the Treasury on offsetting it against next year's local government settlement?

Mr. Dobson

It will not affect next year's local government settlement, because it has to be spent this year. I do not know at this moment what proportion of the £209 million will ultimately be spent by social services departments, because we have not yet seen all the schemes that will be financed. The conditions will be quite straightforward: any of the money that is spent by local authorities will have to be addressed to provision such as that in, say, Bury and Rochdale, where an emergency services team, which is financed jointly by the health authority and local authorities, provides the elderly with immediate attention and help when they are telephoned by a GP, community services or a hospital.

There is no suggestion that any of last year's money, other than that spent on the GP drugs budget, was used for anything other than such purposes. The record of social services and the NHS making good use of the money last year reflected immense credit on all those concerned. The delivery that they made with that amount of money proved immeasurably useful to me in my discussions with the Chancellor of the Exchequer and the Prime Minister on the comprehensive spending review, money for waiting lists and extra money for the winter.

Mr. Andrew Reed (Loughborough)

I welcome the Secretary of State's statement. From my rough calculations, it means an additional £4.5 million for Leicestershire health authority, which I am sure even the hon. Member for Rutland and Melton (Mr. Duncan) would graciously welcome.

My right hon. Friend referred in his statement to the allocation being in line with general allocations to the NHS. Does he recognise that Leicestershire is one of the areas below its weighted capitation fee? It is also one of the most efficient and effective. Will he describe for my constituents in Loughborough and Leicestershire how the additional money will be allocated to make up the difference in weighted capitation, recognising the efficiency and effectiveness of delivery so far?

Mr. Dobson

The money for the winter will be allocated in line with this year's allocation priorities, so it is fairly easy for people to predict, if they know what percentage of the total they usually get. As I have said, the Trent region will receive a little more than £16 million to share among various authorities in the area. We shall very shortly be announcing the major part of the allocation of funds for next year out of the very large rise in spending on the NHS that has been agreed. I hope that my hon. Friend will be duly pleased with the money that flows into Leicestershire.

Dr. Harris

The extra money is welcome, but does the Secretary of State accept that it would have been more easily and efficiently spent and planned for had it been announced at the outset, rather than following a constant drip feed? After all—in relation to the Secretary of State's remarks to the Conservative spokesman, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), about the millennium problem—winter follows autumn as surely as the year 2000 will follow 1999. In Oxfordshire, it would have been easier not to make redundant social services staff, who can now be reappointed with the authority's share of the funding.

On the Secretary of State's desk lies a proposal from Oxfordshire health authority to close community hospitals in Oxfordshire, including Abingdon. I know that he cannot deal with that specific matter today, and I look forward to meeting him. However, does he accept that a useful way of spending the £50 million reserve would be to ensure that community hospital beds are kept open to avoid the bottlenecking and logjamming we see in acute hospitals, as efficient community hospitals with near 100 per cent. occupancy—such as in Oxfordshire—are threatened with closure?

Mr. Dobson

The hon. Gentleman understates the capacity of the national health service to do a good job. In his area—and with about similar notice last year as this year — the health authority opened new high-dependency units at a cost of £300,000, put in place community rehabilitation and care teams which reduced admissions and readmissions, and had a mental health intensive support team for people at home—all of which were funded out of the money that was announced in November. The authority managed to do that, and I am confident that it can do so again. The hon. Gentleman should not belittle the capacity of the NHS and local social services to respond promptly when money is made available.

As for the small hospitals in Oxfordshire, I cannot say today what my decision will be about the future of any or all of them. However, the money is intended to help with winter pressures. If a penny of it is spent on anything else, I will want to know the reason why—even in Oxfordshire.

Fiona Mactaggart

I know that the announcement will be very welcome in my constituency, where I recently had a meeting with the management of Wexham park hospital. Those in management have shown themselves to be able to spend such money efficiently in the past, and they are looking forward to the refurbishment of the accident and emergency unit in the spring.

My right hon. Friend the Secretary of State referred to the Conservative party as feckless. The people of Slough feel very bitter that they face a series of cuts in public health services, health visitors and other provision, to pay off the debts run up by Berkshire health authority under the Conservatives, who consistently underfunded our region. We are grateful for the winter help money, but is there anything that my right hon. Friend can do to make sure that Berkshire health authority does not make the people of Slough suffer today for the bad management of yesterday?

Mr. Dobson

When the people of Berkshire and my hon. Friend hear our announcements for allocations for next year, I hope that they will not feel that they must run to make any precipitate decisions on immediate issues. It is worth repeating that the majority of health authorities and trusts—certainly the majority of health authorities—were deeply in debt when we took over from the previous Government: the famous people who claimed to be careful with public money. They were so careful that they were not even paying the NHS's bills.

Mr. Graham Brady (Altrincham and Sale, West)

The Secretary of State has consistently avoided answering questions about ways in which the health service waiting list figures are being manipulated downwards. Perhaps I could bring him back to a specific issue. Is he aware of the widespread and increasing practice of pre-admitting patients, whereby, when the admission is entered on a computer—sometimes six weeks before treatment—the patient is removed from the waiting list? In many cases, treatment may not ultimately take place.

Mr. Dobson

That is not being done on any central instructions from me.

Miss Widdecombe

"It's not me, guv."

Mr. Dobson

No, it is not me, guv. If the hon. Gentleman wants to make a useful point—and if he wants something done about the matter—he should send me details, and I will attend to it. However, if he is just getting up and blathering, like his Front-Bench colleagues, he will not get very far.

Ms Joan Walley (Stoke-on-Trent, North)

The people of the west midlands—and north Staffordshire in particular—will welcome the extra money to deal with winter pressures. However, may I draw to my right hon. Friend's attention an issue raised with him by Members of Parliament from north Staffordshire—our concern about the way in which the health authority is mothballing long-stay beds for the frail and elderly? We do need to modernise and change, but does he agree that we must look carefully at safeguarding those beds—at least in the short term—until alternatives are in place? Will he help us to ensure that we have the facilities we need, including long-stay beds, for the frail and elderly?

Mr. Dobson

My hon. Friend, who was at the Labour party conference, will know that I was able to say at the conference that we are having a thorough-going review of the availability of beds. It has long been the conventional wisdom in the NHS that the number of beds available has no impact on the provision of care. That always seemed to most people to be contrary to common sense.

When I observed that the NHS opened 700 to 800 extra beds to cope with last winter's pressures—and that it had stopped the closure of 1,000 intended bed closures and was reopening about 2,000 beds to help get waiting lists down—it seemed to me that practice within the NHS last winter was getting closer to confirming common sense than it was to confirming conventional wisdom. That is why I am having a thorough-going review, not just of the number, but of the sort, of beds. There is a relationship between acute beds, long-stay beds and mental health beds which we need to get right. In some parts of the country, it is clearly wrong at present.

Mr. John Bercow (Buckingham)

Notwithstanding the Secretary of State's statement this afternoon, will he confirm that the number of people waiting for more than 12 months for treatment has more than doubled, from 31,000 to 63,000, since his Government took office?

Mr. Dobson

It certainly did, and it is coming down again—by 9,000 since June. [Interruption.] If Opposition Members want to answer the questions as well as ask them, I will let them get on with it.

Mr. John Wilkinson (Ruislip-Northwood)

The Secretary of State spoke of extra funding for special cases and emergencies, as well as for cancer treatment, through the lottery fund. Can I bring to his attention the fact that there are few emergencies more dire than severe burns cases, that the burns and plastics unit at Mount Vernon hospital in my constituency has treated recently some high-profile burns cases—brought in from Luton and Littlehampton in two instances—and that the unit works alongside and complements a cancer centre of international reputation?

Can the Secretary of State give my constituents—and those of other local members, such as his hon. Friend the Member for Harrow, West (Mr. Thomas)—an assurance that the excellent burns and plastics unit will be built up, rather than run down?

Mr. Dobson

The hon. Gentleman knows that that matter is out for consultation. I am not responsible for the proposals health authorities make—I am responsible only for the decisions I take if their proposals come to me. I will bear in mind the hon. Gentleman's point, because it must be said that I do not always agree with what the people proposing changes suggest.

Mr. Adrian Sanders (Torbay)

Will the Secretary of State look at the matter referred to by my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes)? I have two constituents who have received letters from their health authority—from the secretaries of consultants—saying that they cannot yet be put on a waiting list, and have therefore been put on a pending list. That suggests to me that the demand for services clearly outstrips the ability of the health service to supply them. I hope that some of the extra money will be directed to tackling that problem.

Mr. Dobson

I am confident that the extra money for the winter and for tackling waiting lists will mean that the NHS can deal with substantially more patients this winter—from now to the end of the financial year—than it has been able to do in the past. If hon. Members have any information about pending lists, they should send it to me so that I can deal with it. I give them a hint: if they write to me as "Frank Dobson MP" at the House of Commons, the letter will not get lost in the machine. I receive about 50,000 letters a year, and I will give priority to letters from Members of Parliament.