National Health Service

HC Deb 11 January 1999 vol 323 cc35-54 4.21 pm

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

I should like to make a statement on how the national health service is coping with the recent sharp rise in the number of people falling ill.

First, on behalf of everybody in the country, I want to thank all the people working in the health service and local social services for the huge effort they have been putting in to ensure that everybody gets the treatment and care that is needed. They have done all that because there has been a surge in the numbers of people going to see their doctor, and an even bigger surge in the number of people calling ambulances and helplines and going to hospital. The sharp increase in the level of illness is confirmed by the increase in the number of people dying, which in some parts of the country has meant that families trying to arrange funerals face long delays.

The figures put together by the Public Health Laboratory Service from returns made by the Royal College of General Practitioners show that the present outbreak of flu and flu-like illnesses seems likely to be on the same scale as that which occurred in the winters of 1994 and 1996, although the figure may go higher. The figures reflect the increased number of people with flu-like symptoms who go to see their local GP. Until now, flu and flu-like illnesses have been worst in the west midlands and the north, but there have been sharp peaks elsewhere.

The demand for ambulance and hospital services has shown a much larger increase, with daily ambulance journeys almost doubling in some places. Both the Merseyside and the Greater Manchester ambulance services saw the demand for ambulances shoot up to more than 1,000 journeys a day, compared with an average of 500 to 600. For the London ambulance service, this new year was the busiest on record with more than 4,700 journeys, compared with a daily average of 3,000.

There have also been some tragic fatalities due to meningitis. I extend my sympathy to the families concerned. Parents are right to visit their family doctor to seek advice if they have concerns. In November, the chief medical officer advised general practitioners to refer suspected cases of meningitis promptly to hospital, and he will renew that advice.

The national health service is better prepared than ever before to cope with those illnesses, and in most places hospitals have coped well with the pressures that they face. In August, I asked the NHS to prepare itself, to strengthen emergency and ambulance services, to make best use of the beds available, to improve discharge arrangements and to prevent unnecessary admissions to hospital in the first place. It has done so. Almost 2,200 schemes are under way nationally, backed by the £159 million announced by my right hon. Friend the Chancellor in the pre-Budget statement. Those include £750,000 to improve intensive and high-dependency care in London; £200,000 for one-stop clinics in Walsall; £175,000 for better home treatment and care in Leeds; £140,000 for a community-based phlebotomy service in Gloucestershire; and £45,000 to help prevent fractures among the elderly in Kent.

In August, we also announced that GPs could this winter, for the first time, offer flu vaccinations to all their patients over 75, rather than confine vaccinations to particularly vulnerable groups. As a result, a third of a million extra doses have been given this year compared with last, and vaccine remains available.

We are tackling particular pressure points. Over the past week, those parts of the NHS that are suffering particular problems which could be helped by extra cash have been told that they can draw on the £50 million contingency fund, which is there for that purpose. In some places that will mean more high-dependency beds being provided to relieve pressure on intensive care beds.

The position today is that 35 adult intensive care beds are free and available for use. The situation seems to be easing, but it could get worse again if icy weather were to lead to a lot of falls, particularly among the elderly. The NHS cannot be complacent. It is not, and I am not.

I will not pretend that the NHS everywhere has coped as well as the public are entitled to expect. Such an increase in illness will always cause difficulties, but those difficulties have been made worse because of the serious underlying problems that we inherited. We inherited a rundown NHS with serious staff shortages. Many buildings are out of date, much equipment is old and unreliable, methods of working are not making best use of new technology—particularly information technology—and there are not enough staffed beds. The Government are getting a grip on the short-term consequences of those problems and are also laying longer-term foundations to build a modern and dependable NHS. Much of that work is already under way.

One of the causes of the shortage of nurses is the cuts that the previous Government deliberately made in the number of nurses going into training, which fell from 15,000 a year at the time of the 1992 general election to fewer than 13,000 when they left office, having fallen at one point to 11,700. If they had not made those cuts, there could have been an extra 11,000 nurses available to the NHS today. It takes three years to train a nurse, so the country is paying a heavy price for those years of Tory neglect.

This year, 15,500 nurse training places will be available and 2,500 more people are already in training compared with when we took over. As I have said before, we must also reform the system of nurse education and training, which the previous Government introduced in the 1980s. It has achieved some of its objectives, but its emphasis on the academic element has put off some potential recruits.

Many nurses, when they qualify, think that they lack the practical skills necessary on a ward. The transfer of responsibility to the education sector from the health service has broken the old links between individual hospitals and nurses in training, to the disadvantage of both. Many nurses and nurse managers recognise the need for change, so I hope to carry the profession with us—but reform there must be.

The previous Government refused, right up to the end, to recognise that there was a shortage of nurses. This Government recognise that reality and therefore training extra nurses is a major objective. We spelt that out in our evidence to the pay review body. This year, we also made it clear that the pay review body should give special attention to the pay of nurses in the lower grades. Like the nurses, we want reform of the present rigid grading structure and better career development prospects so that those vital staff have a modern, fair and flexible system for pay and promotion. I repeat my hope that the independent pay review body will propose a settlement that is fair to nurses and midwives and which the Government will be able to implement in full.

We are also addressing the concerns of qualified nurses who have left the NHS. We want to attract them back, not only with better pay, but with family friendly shift patterns and a better and safer working environment. If we are to retain existing staff, recruit new staff and persuade former staff to return, we must provide them all with the modern buildings, plant and equipment that they need. We have already embarked on the biggest hospital building programme in the history of the NHS, and there is more to come. High priorities for more small-scale investment include the replacement of outdated and unreliable equipment.

Last September, the Prime Minister announced that the national lottery new opportunities fund would help to provide new and better equipment for the detection and treatment of cancer. He also announced that, from April, we would be investing £30 million to renew 25 per cent. of accident and emergency departments to make them better and safer for both patients and staff. Ambulance services will be given new control systems, new vehicles and new equipment. All those will help the NHS to cope better with winter pressures.

New methods of working will also help. We launched three pilot schemes in Newcastle, Preston and Milton Keynes to test NHS Direct, a nurse-led 24-hour helpline. The schemes have been a great success: providing advice and reassurance round the clock, they have been very popular with patients, and have had a positive impact in helping them to look after themselves and reducing unnecessary calls on other services. Over Christmas and the new year, NHS Direct pilots took almost double their usual number of calls—itself an indication of the upsurge in illness. After receiving advice from the nurse to whom they spoke, about half the patients with flu symptoms were able to look after themselves. That shows how the NHS is delivering new and better services, and it is being extended to the rest of the country.

With the special investment of £44 million that we have provided, NHS Direct has already been extended to the west midlands, where it took more than 1,150 calls in its first week of operation. By April this year, it will cover more than 20 million people in the west country, Manchester, south London, west London, Essex, Nottinghamshire and other places: over 40 per cent. of the population. That will provide a new and better service for patients and at the same time help people to avoid resorting unnecessarily to GPs, the 999 service or their local hospitals.

Finally, there is the question of beds. Under the last Government, the number of acute beds was reduced by 40,000 and the number of general beds by a further 23,000. In September I announced a review of beds in the health service—of the number of beds involved, the sort of beds and where they should be. Preliminary work for the review suggests, not surprisingly, that the health service needs more beds. Our extra investment in the NHS over the next three years will ensure that we can respond rapidly when we have the final report.

Then there is the question of intensive care and high-dependency beds. Soon after taking office, on the advice of the specialists in children's intensive care, I authorised a shift of extra funds from the paperwork of GP fundholding to children's intensive care, and the concentration of the service in regional and sub-regional centres, with special arrangements for retrieval of very sick children by specially trained and specially equipped staff. As a result of the additional investment, the service can now provide up to 300 children's intensive care beds, very specialist new-born babies' beds and high-dependency beds. The new system has been working well, but recently there was an unacceptable delay in dispatching an ambulance from Nottingham to Rotherham. In the light of that experience, I have insisted that each children's intensive care unit, with its local ambulance service, must review its arrangements to ensure that it is possible to stabilise and transfer very sick children safely and promptly.

Intensive and high-dependency care beds are vital to the treatment of many people who have had operations, as well as accident and emergency cases. They demand huge resources. Intensive care is not just a matter of a bed and some specialist equipment. To care properly for one patient for one day in intensive care can require the services of around six specialist nurses as well as specialist intensive care doctors, anaesthetists and others.

Previously, the overall level and availability of intensive and high-dependency care has not had the attention that it deserves. That is why the Audit Commission is co-operating with the national health service and the Intensive Care Society to carry out a detailed study of the operation of intensive and high-dependency care in the NHS. I hope that that will provide a sound basis on which to plan for better services. I am also reviewing the role of the emergency bed service and of the national intensive care bed register. None of that is a criticism of the people working in those services—more than anyone else, they want the system to be modernised.

It has always been a source of pride in our country that, when difficulties crop up, people rally round to help and they have certainly done so on this occasion. I thank them all. In particular, I thank Dr. Ian Bogle, chairman of the British Medical Association, for his repeated advice to the public that normally healthy adults should use services in a considerate and responsible way.

From next April, for the first time in 20 years the NHS will operate on a budget entirely set by a Labour Government. It will benefit from the first stage of our £21 billion extra investment. In the meantime, I know that people realise that, when so many people suddenly fall sick, as they have in some places recently, it is inevitable that treatment and care cannot be as prompt as at other times. I want to ensure that we provide the people who work in the NHS with sufficient tools and resources to ensure that the impact is much less in future.

Over the past few weeks, nurses, doctors, midwives, health visitors, cleaners, kitchen staff, managers, porters, ambulance staff, laboratory scientists, therapists, pharmacists, telephonists, clerical, administrative and maintenance staff and social services staff have all performed wonders on our behalf when their own ranks have been severely depleted by the same illnesses that are affecting the rest of us. Many of them have kept on working while "under the weather" themselves. Many have returned early from leave to help their colleagues. Others have cancelled leave that they planned to take. I thank them all. They have done us proud.

Miss Ann Widdecombe (Maidstone and The Weald)

Although I join the Secretary of State in his tribute to the many workers in the health service for the way in which they have coped with the emergency, I feel that my first question must be: what is new in the statement? What in the statement is going to make the slightest bit of difference to those who are now lying on trolleys, in fear and pain, waiting for treatment? The second question is: does he really think, with his complacent statement, that he is on the same planet as those people waiting for treatment?

Does the Secretary of State now agree, with the benefit of hindsight, with what I told him as early as last September—that money for winter pressures in our health service is far too little and too late when it is issued in November? Would it not be simple common sense to allow our hospitals to know how much they will receive much earlier in the year, so that they can plan exactly how the money will be spent?

Is it not the case, as the British Medical Association has been saying along with us, that the obsession of the Labour Government with their so-called early pledge on health service waiting lists has made the current crisis in our health service far worse than it need have been and distorted clinical priorities away from patient priorities? Will the Secretary of State tell the House how many hospitals were continuing to admit routine waiting-list cases while patients were lying in pain on trolleys in corridors, with many forced to seek the help of relatives and friends to provide basic nursing care?

The Secretary of State has, understandably, been telling patients not to use accident and emergency services unless it really is an emergency, but at the same time doctors have been telling worried parents not to take any chances if they suspect that their children may have even the earliest symptoms of meningitis. Is not there a breakdown of communication in the Department of Health?

Does the Secretary of State recall that in January 1996 the right hon. Member for Camberwell and Peckham (Ms Harman) and, indeed, the now Prime Minister, promised the public that a Labour Government would immediately set up a trolley task force? What has happened to that task force? Is it stuck on a waiting list along with some of the Government's other early pledges? It is no good the right hon. Gentleman telling us that he has set up an inquiry into beds, when what he promised was an inquiry into the excessive use of trolleys.

Will the Secretary of State confirm that he has cut nurse training by 3 per cent. from the levels that the Conservative Government had planned for 1997–98? He made much in his statement of what he suggested were our reductions. Will he own up to having cut 3 per cent. from our planned levels in his first year in post? His belated attempts last week to wriggle out of the blame for the crisis in our health service will impress nobody in the light of that cut.

How is the Secretary of State's wish list of nursing recruitment intended to be met? Will he acknowledge the use that is even now being made of the private sector, and deduce from that that it is time to break down the ideological barriers that he continually sets up between the public and private sectors?

The Secretary of State mentioned 35 intensive beds. Where are they? Are intensive beds available in every region, or is there a concentration in particular regions? Why, in the national priorities guidance that he issued last year, is nurse recruitment not listed as a priority? Will he now, at last, abandon his ludicrous concentration on raw numbers on waiting lists in favour of waiting times, which are a far more accurate measure of whether people are getting a satisfactory service from the NHS?

I welcome the Secretary of State's good will on pay for nurses, but can he assure hard-pressed health authorities that he will make the additional money available and not expect it to come from patient care? Will he admit that it is time for a slightly more mature debate on the health service? [Interruption.] I am pleased that Labour Members are agreeing with that at last.

Does the Secretary of State agree that the problems in the health service have been there since its inception and that the extreme, and welcome, expansion of the health service, and the excess of demand over supply, have bothered every Government from Bevan's time onwards? Will he admit that the magic wands that he promised—or, to be fair, because he was not then a health spokesman, that the then Opposition promised—before the general election were not to be found?

Has not the time come for the Secretary of State to be more humble in his approach, when the nation knows that, although he went to the country with the slogan, "14 days to save the NHS", for the past 14 days he and his policies have flayed the NHS?

Mr. Dobson

I welcome the right hon. Lady's characteristic humility and lack of assertiveness. She asked what was new. I have presented the up-to-date facts, including the ones that she cited. I have given the House and, to the extent that our debate is covered, the people, the true and up-to-date position. That is something new, because, with Parliament not sitting, we did not have the opportunity to do that before.

The right hon. Lady seems to think that, because of the massive effort that people in the national health service put in to reduce waiting lists by 150,000 between April and November, they are somehow rendered incapable of dealing with emergencies and urgent cases in December. If the Opposition think that, they are barking up the wrong tree.

The right hon. Member for Maidstone and The Weald (Miss Widdecombe) has asked me effectively to ban all treatment of waiting list cases. However, as she is constantly ranting on, there are large numbers of people on the waiting list who have serious and life-threatening conditions. We have made it clear, as we always do, that it is up to clinicians to judge who should have priority, including, in some circumstances, who should have priority for intensive care beds.

The right hon. Lady asked about meningitis. Those who are offering advice on meningitis to the public have a dilemma. As I explained, the chief medical officer has advised general practitioners to rush children to hospital if they have any concerns or suspicions that those children may have meningitis. Conversely, the chairman of the BMA—on behalf of the profession generally, not on my behalf—has said that healthy adults, who generally are not as susceptible as children to meningitis, should think twice before seeking treatment. I do not think that there is any difficulty with that advice. It is certainly not a matter of the Department of Health speaking with two voices. Moreover, it is a silly, stupid, petty and party political point to suggest that the Department is speaking with two voices.

The right hon. Lady suggested that there was something wrong with being concerned about trolleys. When we were elected to office, we discovered that the previous Government had, quite rightly, established an emergency services action team, the function of which is to examine emergency services, to try to sort out emergency services and to plan for the future—which is what we have done.

I have never ruled out the possibility of relying on the private sector to provide additional help if units within the national health service cannot provide it. About a month ago, the right hon. Lady was denouncing me for not allowing such private sector involvement; now, she is denouncing me for allowing it. It would be better if she tried to introduce a little consistency into her argument.

In a factual question, the right hon. Lady asked whether intensive care beds are available in every region. The answer is yes—or the answer was yes when the service provided me with the information. It is quite possible that, in one or another region, there will be a sudden burst of people coming into accident and emergency and the available beds will be occupied. However, I was informed that every region has some intensive care beds. I might add that, once we started examining the matter of intensive care beds, we discovered that the previous Tory Government had never known how many intensive care beds there were in the United Kingdom. We shall therefore take no criticism on the matter from Conservative Members.

The right hon. Lady produced a document entitled "Ten Measures to Help the National Health Service". However, none of the measures dealt with paying nurses, who never got a mention in the document. When she suggests that paying health service staff can be done only at the expense of patient care, she causes great offence to those who work in the national health service, as those who are paid in the national health service are those who are providing patient care.

The right hon. Lady talks about the national health service as if it faced some unique problems. All I can say is that every country in the developed world is concerned about the future of its health care system, and that all the Ministers from abroad whom I meet tell me that they are rather envious of our system because it is a lot more efficient and cost-effective than their commercial, semi-commercial and insurance-based systems, all of which spend a fortune on paperwork. Our national health service—except under the previous Government's ridiculous internal market—does not spend a fortune on paperwork.

The Tory party had better make up its mind about emergency planning for the winter. The right hon. Lady is suggesting now that we should have acted sooner on the matter. Why was it that, when we made all our plans last winter, they were described in an official Tory press release as a public relations stunt?

Mr. Kevin Barron (Rother Valley)

The nation will be grateful for my right hon. Friend's statement. Given the years of neglect of the NHS, especially in nurse training, I am glad that we may now look forward to a future with more nurses looking after patients in the national health service. Does my right hon. Friend agree that, over Christmas, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) appeared to be more obsessed with opening up the private sector for NHS patients than with sorting out the problems of the NHS that the Tories neglected for decades?

Mr. Dobson

I certainly accept the points that my hon. Friend makes. We must try to ensure that the additional resources, in the various forms that I have described, are in place in the future. We must also try to make additional provision this winter for those areas that are suffering particular problems. That is what I authorised last week and those areas that can benefit from an immediate cash injection will get it, but many can not.

Mr. Simon Hughes (Southwark, North and Bermondsey)

First, the Liberal Democrats join in the tribute to all those who work for the health service in both winter and summer. The Royal College of General Practitioners and the Public Health Laboratory Service have confirmed that there is no flu epidemic and that, although the numbers suffering from flu and flu-like illnesses have risen, they are not exceptional for a winter in Britain. In November, the Secretary of State said that unless we had exceptionally bad weather or a flu epidemic the NHS could face the winter with confidence. Just last week, the Secretary of State said that the NHS is in crisis. What changed in a month?

Secondly, I have to agree with the right hon. Member for Maidstone and The Weald (Miss Widdecombe) and others who have said clearly to the Secretary of State for months now—as the Liberal Democrats have said for years—that the obsession with reducing waiting lists is a folly and should be replaced by concentration on reducing waiting times and improving the quality of treatment. Will the right hon. Gentleman now give up that Government obsession of last year and replace it with better targets for this year? Can he assure us that no one has waited on a trolley for a bed because that bed has been kept for someone from the waiting list initiative instead of for emergency admissions?

Finally, the Secretary of State tried to put much of the blame on to the Conservative administration of the health service, which certainly under-resourced it. With hindsight, does he agree that a Labour Government who came to power in May 1997, but did not commit additional resources to the health service until July 1998–14 months later—should share responsibility for the under-resourcing of the health service this winter? If winter announcements are made in November, four weeks before winter begins, anyone can see that they may be too late to be effective in a winter such as the one we are having. In December, the Minister for Public Health said that there is no rationing in the health service, but that does not appear to be true unless the Secretary of State can guarantee to the House that everybody who needs a bed will get one at the moment they need it.

Mr. Dobson

First, I do not believe that anyone has any great faith in the scientific accuracy of the Public Health Laboratory Service epidemic figures, including the people who assemble them—[Interruption.] For the purposes of this discussion, I am prepared to accept them, but if the definition had not been changed two years ago we would now be suffering what used to be called a moderate epidemic. We are not yet suffering a huge epidemic of the sort that happens about once a decade. We have confidence in the national health service and its capacity to cope, because in most parts of the country it has coped very well.

Secondly, we have brought down not only waiting lists but waiting times. During the period in which waiting lists have come down, the average time that people waited for treatment has also fallen, as has the number of people waiting more than 12 months for treatment. Unlike the Tories, we are not content with keeping only our own promises; we have kept some of theirs, too. During all the time the Tories had a target of having no one wait for 18 months, they failed to deliver on it in a single month. We have delivered it, and we are reducing waiting times.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) seemed to suggest that the extra money that we provided for the NHS somehow did not come in until July last year. He should cast his mind back a little. We found money for winter pressures for the previous winter. From 1 April, we found £1.7 million extra for the health service, and we have found another £250 million on top of that. In case the hon. Gentleman has forgotten his election promises, let me remind him that that is roughly three times as much as his party promised to spend on the NHS.

Mr. David Hinchliffe (Wakefield)

I join my right hon. Friend's tribute to those who work in the national health service, and I particularly welcome his reference to those who work in social services. What was new both this year and last was that the Government brought about much closer working relationships with social services, which, despite all the difficulties of recent weeks, have substantially improved their ability to care for people in their own homes on discharge from hospital. Have the Government had an opportunity to evaluate fully the impact of the winter pressures initiative either last year or so far during the current winter?

May I tell my right hon. Friend of my concerns about West Yorkshire, where there have been specific difficulties and pressures? I pay particular tribute to those who work in the area, but the difficulties relate to some primary care services that patients have been unable to access. I recognise that general practitioners work extremely hard and have every right to their Christmas holidays. However, people have presented themselves to accident and emergency units in several cases because they have been unable to receive advice from GPs. Given the NHS Bill that will come before the House soon on the abolition of competition between GPs, might we consider future arrangements for GP practices to work together over holiday periods to provide back-up provision that would prevent people from presenting themselves unnecessarily at hospitals?

Mr. Dobson

My hon. Friend raises some important points. I do not have all the detailed figures for every part of the country, but I can illustrate the extra sums going into providing care for people outside hospitals by mentioning the money that has gone to the West Kent health authority, which serves the area represented by the right hon. Member for Maidstone and The Weald. That authority received £1.1 million for extra packages of home care, and a further £500,000 for further nursing home beds. I trust that those sums are working just as well this year as they did last year, when the right hon. Lady's party described them as a public relations stunt.

My hon. Friend referred to primary care services. In some parts of the country it appears that when general practitioners took holidays around Christmas and new year—not unreasonably; they are just like everyone else—there was a build-up of people seeking treatment. To be fair to GPs, many who realised that that was happening re-opened their surgeries. We must consider that problem carefully for next year. People go on about the millennium bug, but the millennium humans are even more important, and we shall have to make special arrangements to make sure that the NHS can cope with the extraordinary holiday period that we can expect next Christmas and new year.

Mrs. Virginia Bottomley (South-West Surrey)

I have heard a bit of window dressing today, and quite a bit of sensible evolution. Even more, I experienced a familiar flavour during the statement. What the Secretary of State did not have to contend with was demonstrating junior doctors. I dare say that the modest improvement to the hours of junior doctors is one of the issues that has led to the other difficulties that the health service is experiencing. Ever was it thus.

I urge the Secretary of State to reflect on two serious comments. I welcome his commitment to reconsider how Project 2000 is working in practice. Saying that nursing should be a graduate profession had much merit, particularly for nurses in the community and specialist nurses. However, it may have discouraged some and resulted in disappointment for others who think that they are pursuing academic training for what is ultimately a practical task. Will he consider carefully nurses' education for the necessary tasks?

Will the Secretary of State look again at the resistance to flexible and local pay? Insisting on monolithic pay scales for the tasks that nurses do is extraordinarily unrealistic. Nursing problems in Newcastle are not the same as the acute recruitment problems in Surrey and parts of the south-east. Being so resistant to flexible pay was an error.

Lastly, I urge on the right hon. Gentleman a spirit of realism. Many hon. Members have made this point. The despair in the health service is hard to explain, but I think that too many people believed the rhetoric of new Labour that all the problems would be over and that there would be a massive input of resources when, in fact, it is back to the day-to-day task of trying to meet people's infinite wishes when all the service can do is meet their health needs.

Mr. Dobson

The right hon. Lady made one sensible point and one daft one. She is right to say that we need to review nurse education and training, not because we want to shift away from the improvements and achievements that have resulted from some aspects of Project 2000, but because its disadvantages are beginning to outweigh its advantages. I want a system that keeps the advantages and dispenses with the disadvantages. I want to discuss that with those responsible for nurse training and for representing nurses, and with the NHS as an employer, so that we get it right this time.

On local pay, the most popular thing that I ever said to the Royal College of Nursing was that we would get rid of the daft system of topping up the last bit of pay by local bargaining. It drove everyone mad and gave no one any worthwhile money.

Mr. Barry Jones (Alyn and Deeside)

May I say to my right hon. Friend, to his face and bluntly, that his stewardship has been very good and that he should not be fazed by attacks from Her Majesty's Opposition, who had 18 years to put right the many problems in our still great national health service? Will he give more detail of the new money that he and his ministerial colleagues have put into our health service since he took office? Will he and my right hon. Friend the Secretary of State for Wales visit my constituency and the Deeside community hospital, Dobshill hospital and Penyffordd hospital to see the wonderful contribution of nurses in my constituency?

Mr. Dobson

I hope that my hon. Friend will not take offence, but I try my very best to get out of my office at least once a week to visit parts of the health service, and at the end of this week I am supposed to go to Swansea. I do not think that I will make two visits to Wales in one week, but I will bear it in mind, as I am sure will my right hon. Friend the Secretary of State for Wales. I share my hon. Friend's view that most people are reasonable folk and realise that all the things that were done wrong over 18 years cannot be put right in 18 months.

Mr. Julian Brazier (Canterbury)

The Secretary of State telephoned me two days before Christmas to tell me that the number of beds at Kent and Canterbury hospital was to be halved and the accident and emergency unit run down. The unit was so busy that last week it even had a bed in one of the bathrooms. I was grateful for his courtesy in telephoning me, but words cannot describe the dismay felt by my constituents and many beyond the boundaries of my constituency. Can the Secretary of State tell me whether the pledge that his right hon. Friend the Minister for Public Health gave me in her answer to my Adjournment debate still stands: that no bed will be removed until it is clear that provision exists to cope with the need that exists?

Secondly, can he tell me what steps he will take to ensure that the whole of east Kent, in particular Canterbury, Whitstable and the small villages, which suffer from the worst congestion problems anywhere in the British isles, will have a proper 24-hour accident and emergency service?

Mr. Dobson

As I told the hon. Gentleman, who, to be fair, has campaigned vigorously for the Kent and Canterbury hospital, I have considered the services to be provided in that area, and have received advice from innumerable people and representations from even more. I think that I can at least claim credit for insisting on some substantial changes from the original proposals put forward by the people whom the Tory party appointed to run the health service in Kent. I have ensured special consultant back-up for the A and E service and that consultants are available for other specialist services in the area. I also gave the undertaking that I would keep a close eye on what was happening to bed numbers during the process of change to ensure that it did not go badly. If it looks as though things are going wrong, I am prepared to step in and ensure that the bed reduction does not proceed as quickly, or as far, as presently agreed, let alone according to the huge changes that were originally proposed.

Mr. Dennis Skinner (Bolsover)

Does my right hon. Friend agree that decisions on health service expenditure and where the money goes are much more important than other statements that we hear from time to time in the House? His ability to spend £1.7 million, set against the prospect of spending more than £20 billion, suggests that this humble, old-fashioned Labour stalwart may be able to do a much better job than those handcuff experts on the Tory Benches and the Liberal Democrats, who believe that we can solve all the problems of the NHS by raising an extra penny on tax. Does he understand that we will shortly reach the defining moment of what is to happen to that money? If he wants more nurses, will he give an assurance that he will pay them—and other NHS workers—a lot more money? He will be measured by that and prospects for a future Labour Government will be much rosier if he manages to resolve that problem, so that we have more, better-equipped and better-paid nurses, and if he ensures that, unlike last time, they are given all the money in one fell swoop.

Mr. Dobson

My good and hon. Friend knows as well as I do that, compared with the £1.7 million that I mentioned, we will be finding more than £3 billion extra for the health service next year—an increase of 5.7 per cent., added to an increase for the health service in the country as a whole of £21 billion in the next three years. What is more, we have announced that as a three-year arrangement so that people in the NHS can do what they have always demanded, which is to plan for a longer period rather than living from hand to mouth from one year to another. I can assure my hon. Friend that I sincerely hope, as I have said on innumerable occasions, that the independent pay review body will bear in mind the evidence that we have given about affordability, the evidence that it has taken from the nurses and our evidence to suggest that it should pay particular attention to the pay of the lowest-paid nurses to make going into nursing more attractive, and will come up with an affordable settlement, which the Government will be able to implement in full.

Mr. Damian Green (Ashford)

The Secretary of State will be as alarmed as I am at news of the steady trickle of nurses in hospitals in east Kent who, over the past couple of weeks, in despair at his stewardship of the national health service, have resigned to become agency nurses. They will not be impressed by his attempt to lay the blame on anyone but himself, nor, I suspect, by the sneering tone that he adopted about the East Kent health authority in his reply to my hon. Friend the Member for Canterbury (Mr. Brazier), given that only two weeks ago he wrote to my hon. Friend congratulating him on the authority's work on hospital reorganisation.

We have heard the pious hopes of the Secretary of State. Will he tell us what he is doing now to staunch the flow of nurses resigning from the national health service? That flow is increasing and is likely to increase as long as he maintains his complacent attitude.

Mr. Dobson

That question takes the biscuit, given the hon. Gentleman's party's record. There are 140,000 qualified nurses, trained at public expense, who are no longer in the national health service. The vast bulk of those nurses did not leave over the past fortnight in east Kent; they left over the past 18 years while the Tories were in government, treating them badly and running them down.

National health service staff constantly raise with me the matter of their being subjected to assaults and abuse. When I talked to a senior member of, admittedly in that case, the medical profession about the matter, he told me that they had given up talking to Tory Ministers about the problem, because they were told that nothing could be done about it and that that was the sort of society in which we now lived. The Government do not accept that; we are determined to change things. [Interruption.] That was what the man told me and I shall take his word for it.

We have taken a great deal of action and if Conservative Members do not believe me, let me point out that, not long ago, under the previous Government, someone in the east end was assaulted in a hospital—that person's place of work—and although the person who carried out the assault was successfully prosecuted, if the management had had their way and if there had not been a great row about the matter, they would have disciplined and sacked the person who was the subject of the assault for fighting back. That is the standard of concern that the Tories offered nurses when they were in power.

Ann Keen (Brentford and Isleworth)

I, too, welcome the statement from my right hon. Friend, as will all health workers. They are more than satisfied with his stewardship of the national health service. He is an extremely popular Secretary of State, who is not afraid to go into Marks and Spencer at any time of the day to do his shopping.

One result of the Tomlinson report was the large reduction in the number of beds in London. However, not only was the number of beds reduced, but the role of nurses was reduced by the report. The nature of nurses' work means that they must have good memories and all those nurses whom we want to return to nursing have good memories. Will my right hon. Friend assure me that he will do everything in his power to convince them that family friendly policies are in place, and that shift patterns will not be subject to diktat, as they were under the previous Government? Nurses were told to like it or lump it; they lumped it and they walked. We have much convincing to do to bring those nurses back, but I believe that with the current team we shall do so.

Regarding nurse education, we need highly qualified and highly skilled nurses to nurse in today's complex health care system. Under the previous Government, we in nurse education were evicted off hospital sites overnight and moved into higher education. Will my right hon. Friend seriously consider bringing some of that education back into hospitals, now that we once again have a national health service, not a business of trusts?

Mr. Dobson

I thank my hon. Friend for making those points. In relation to nurse education, one of the most harmful things, certainly in London and some of the other big conurbations, is that because nurse training ceased to be the responsibility of the national health service, the hospitals disposed of huge amounts of accommodation designed for nurses. One of the reasons why it is especially difficult to recruit and retain junior nurses in London and other big conurbations is the absence of anywhere for them to live that is reasonably secure and close to the hospital, and that they can afford. That is one of the reasons why I have opened talks with the Housing Corporation to find out whether we can start to make special arrangements for nurses so that we can once again provide nurse accommodation. That problem was one of the products of shifting nurse education out of the health service and almost exclusively into the education system.

Dr. Julian Lewis (New Forest, East)

The Secretary of State has referred to long memories. Does not he recall that under the previous Labour Government, nurses' pay fell by 3 per cent. and that during the 18 years of Conservative Government, it rose by 70 per cent.? Does not he understand that people are becoming exasperated with him boasting again and again to the House about distributing millions here and billions there, while they open their papers and discover that he is admitting that the health service is in crisis? Does not that reveal that the Government's actions smack more of creative accountancy than caring services?

Mr. Dobson

No.

Several hon. Members

rose—

Madam Speaker

Order. That was a very good and brisk reply from the Secretary of State. I was about to remind the House that the statement has now been running for almost an hour. I want to be able to call every hon. Member who wants to speak, but I can achieve that only with the co-operation of the House. I do not want long statements; I want direct questions and good answers like that just given by the Secretary of State.

Mr. Robin Corbett (Birmingham, Erdington)

The extra money that my right hon. Friend has made available for improved co-operation between Birmingham health authority and the social services department of Birmingham city council is delivering the goods. It means that people who do not need to go into hospital can safely be kept at home and those who no longer need to be in hospital can safely be returned home. Will he provide more such funds?

Mr. Dobson

Yes.

Mr. Peter Viggers (Gosport)

Does the Secretary of State accept that the recent crisis impacted as seriously in the Portsmouth area as anywhere else? Local management at Queen Alexandra hospital in Cosham and St. Mary's hospital in Portsmouth appealed to family and friends to come in to help to feed and wash patients. Is the right hon. Gentleman aware that Queen Alexandra hospital has a waiting list of 11,000?

In those circumstances, how can the Government possibly contemplate the closure of the only tri-service military hospital at Royal hospital Haslar in my constituency, where 110,000 patients are treated each year and 27,000 patients are treated in accident and emergency? Will the Secretary of State agree that his Department and the Ministry of Defence will receive an urgent deputation with representations from Gosport expressing deep concern about the proposed closure and will discuss the way ahead?

Mr. Dobson

At the time of the announcement, I said that I wanted to ensure that any change was not to the disadvantage of the national health service and the people that it serves in Portsmouth, and I shall stick to that.

Mr. Bill O'Brien (Normanton)

I welcome my right hon. Friend's statement, which demonstrates beyond any shadow of a doubt that the health service is safe in his hands. I welcome the distribution of the resources that he has outlined today.

In October, the Secretary of State assured me that the consultation procedure in the Wakefield health authority area would be in his charge and that he would call for a report. Will he urgently consider speeding up that consultation, which must be meaningful? I make that plea having received a letter from a constituent who advises me that when his wife took ill on Boxing day, no GP was available and they went to the hospital and had to wait two hours to see a doctor. His wife was admitted five hours later. The consultation process in Wakefield should be speeded up so that we can resolve the problems referred to me by my constituent. Will my right hon. Friend act urgently on those issues?

Mr. Dobson

I shall certainly examine, yet again, the state of consultation on services in the area.

Dr. Evan Harris (Oxford, West and Abingdon)

I was relieved to hear the Secretary of State draw back from seeking to blame influenza for the problems. It was ludicrous of him to seek to hide his bulky embarrassment behind a tiny virus. However, does he accept that front-line staff were affected by influenza and that it might be reasonable to vaccinate them through a decent occupational health service in the NHS? Why was that not done, and will he consider doing it in future?

Does the right hon. Gentleman further accept that the staff shortage was made worse by his decision last year to stage the nurses' pay award and that he is now reaping the whirlwind? It takes six years to train a medical student so, as the British Medical Association has today asked, will he reconsider his "short-sighted decision" to stage the vital increase in the number of medical students over seven years, and instead stage it over a shorter, more realistic period?

Mr. Dobson

First, I understand that the hon. Gentleman is a doctor, but there appears to be some theological disputation about the value or otherwise of giving flu jabs to usually healthy adults. Broadly speaking, I favour the idea, but I am told that many studies suggest that it is a waste of time and money and that it does not offer much protection. However, I am prepared to consider it, if I can be convinced that it is worth while.

I have forgotten the hon. Gentleman's second point.

Dr. Harris

Doctors' training.

Mr. Dobson

Oh yes. We have agreed to implement the Campbell report which recommended—let us not underestimate this—a 20 per cent. increase in the number of doctors in training from 5,000 to 6,000. We are going ahead with it, but the increase needs to be staged. One cannot establish a new medical school overnight. They are rather expensive items—I assume the hon. Gentleman knows that if he went to one. Nor can one simply expand medical schools because they need additional staff, and those staff might be taken away from treating patients. The change has to be planned and carried out carefully, and it is.

Mr. Harry Cohen (Leyton and Wanstead)

I congratulate my right hon. Friend on his statement and I welcome his acknowledgement of nursing shortages. Will he confirm that there are also serious and growing shortages among midwives? Does he agree that proper pay is important if we are to attract and retain nurses and midwives? Did he see the article by Will Hutton in The Observer yesterday, which pointed out that in the past decade, pay for nurses and midwives slumped from 85 per cent. to 76 per cent. of average earnings? Is not it time for a substantial above-inflation increase in pay for nurses and midwives?

Mr. Dobson

As I have said, I certainly want an increase that is fair to nurses and midwives and which is affordable. That is the necessary combination, and I should like that to be the case this year and in future. I also want the changes in grading and career structure which, I understand, the nursing and midwifery professions want, too. The two have to go together.

Mr. Graham Brady (Altrincham and Sale, West)

Will the Secretary of State give the House his latest estimate of the increased number of pensioners now entirely dependent on the NHS following his Government's decision to withdraw tax relief for pensioners with private medical insurance?

Mr. Dobson

No, and in this respect I am exactly like the Government who provided the pensioners with the tax relief—they made no estimate before they gave it, and we have made no estimate in taking it away.

Mrs. Linda Gilroy (Plymouth, Sutton)

First, I welcome my right hon. Friend's statement. I, too, congratulate people nationwide, but will he join me in congratulating especially the people at Plymouth Derriford hospital, which last week treated more emergency patients than it has ever done before and is currently admitting the equivalent of more than one ward of patients a day? That certainly deserves acknowledgement.

Secondly, I do not know whether it has been brought to my right hon. Friend's attention, but there was another outbreak of meningitis at the weekend, and two young people are currently in the Plymouth Derriford hospital. The parents of the 1,000 children at the local Coombe Dean school must be very worried. In view of the rather confusing information given by the Opposition, will my right hon. Friend put it on record once again that young and vulnerable people should have no hesitation about going to hospital or to their general practitioner for treatment?

Mr. Dobson

It is certainly the case that, in November, the chief medical officer issued advice to all GPs, saying that they should take meningitis very seriously and refer children in particular to hospital if they suspected that they might have it. I would certainly be very happy to congratulate the people at Derriford hospital, and no doubt all over the west country.

My hon. Friend's area will be among those that will benefit from the next stage of the extension of NHS Direct, which will be useful in Plymouth, but may be much more useful in the expansive rural areas of Devon and Cornwall, where getting to treatment or getting treatment to come to the patient is quite difficult. There is a lot of evidence that NHS Direct means that reassurance and advice can be given over a telephone line, to the infinite benefit of patients who are a long way away.

Mr. Eric Pickles (Brentwood and Ongar)

Part of my Christmas recess was taken up in visiting a grievously ill friend in Oldchurch hospital. I saw there some very high-standard nursing, much of it delivered by agency nurses; but I also saw beds in corridors, and I also saw care being given in a dingy, decaying and appalling building. On my way to Oldchurch I passed Harold Wood hospital, whose accident and emergency unit was cancelled due to a decision of the Secretary of State. We were promised that we would get a new accident and emergency unit in Oldchurch hospital. That promise has not been realised; it continues to slip, so my constituents must continue to receive treatment in a substandard hospital. Will the right hon. Gentleman now give a commitment to release money, so that he can make good his promise?

Mr. Dobson

If Oldchurch hospital is substandard, it did not become substandard in the past 18 months; it has been substandard for a long time. That was one of the reasons why Sir Leslie Turnberg and his colleagues who participated in the Turnberg review of health care in London decided that a new hospital was necessary. We have given priority to the development of plans for that hospital, and I hope that, when they emerge, we shall be able to approve them and deliver to that area a first-rate hospital—something which has been lacking for a long time because of the previous Government's indecision.

Ms Ann Coffey (Stockport)

It seems that the Conservative party is suffering from collective amnesia. Will my right hon. Friend remind the House that it took the death of a child under the previous Conservative Government to initiate an inquiry into failing paediatric services in Greater Manchester? The present Government have put extra money into paediatric care, which has meant a new high-dependency unit and an extra theatre at the Royal Manchester children's hospital, which means that children's lives which otherwise might be at risk are now being saved—and those are not my words, but those of a consultant who works in the hospital. Is not that something to be proud of?

Mr. Dobson

Talking of pride, my hon. Friend should be very proud of the part that she played in the campaign that brought that development about.

Dr. Peter Brand (Isle of Wight)

I did a clinical surgery in my practice on Boxing day and worked for the GP emergency services on the bank holiday. I can assure the Secretary of State that I have worked over Christmas for more than 25 years, and that there certainly was not an unusual outbreak of unusual disease this year. As he illustrated, in three of the past five years we had a higher incidence of flu than we have now.

However, I agree with the Secretary of State that we have a crisis in the NHS, and that crisis is there because there is absolutely no flexibility in the secondary services. Ninety per cent. bed occupancy may look good to accountants, but it certainly is not useful if one is looking out for the patients. Will the Secretary of State either define what the NHS is for, so that it restricts its activity, or fund it properly?

Mr. Dobson

First, I pay tribute to the hon. and learned Gentleman. I know that only lawyers are called learned in the House, but I believe that doctors are learned as well, so I shall call him learned. I thank him for the service that, as he said, he has provided over Christmas for a very long time.

The intervening water may slightly isolate and protect the Isle of Wight and its population, but there have certainly been huge increases in illness in some localities, including in the south and east of this country.

It would take a long time to describe what the NHS is for, but by and large, it is to provide top-quality care for people who need it, when they need it, paid for by us all.

Dr. Howard Stoate (Dartford)

I phoned my local hospital in Dartford this morning to find out how it was faring. I was told that, apart from one exceptionally bad day last week, it is doing extremely well, and that that one bad day was made considerably easier by the winter pressures money, which has allowed it to draft in home care teams from social services in order that people may go home much sooner. Does my right hon. Friend agree that it is illogical for Conservative Members to criticise us for our waiting lists initiative? When we took office, record waiting lists were rising by record levels. That represents record numbers of patients suffering record pain and anguish. My right hon. Friend surely agrees that that is entirely what the NHS is there for.

Mr. Dobson

I must admit that I am rather surprised at the extent to which the Tory party—and, apparently, the Liberal Democrats now—seems to think that exceedingly lengthy waiting lists are perfectly acceptable. We do not, and we are doing something about it. Those working hard in the Dartford hospital may be inspired by the thought that, under this Government, they are getting a new hospital building, and that building work has progressed rapidly. I hope that they will be able to make use of it fairly soon.

Mr. Tony Baldry (Banbury)

The Secretary of State talked of pressure points. Is he aware that, as a consequence of this year's local government settlement, Oxfordshire county council will have to make substantial reductions in its social services budget, which are bound to lead to an increase in bed blocking?

Would not it be better if the independent pay review body told the Government what pay was needed to enable the recruitment and retention of sufficient nurses, and the Treasury found sufficient funds to meet that requirement, rather than the Treasury telling the independent pay review body what was affordable?

Mr. Dobson

The sinner who is saved is always welcome, I suppose.

Mr. Simon Hughes

Collectively as well as personally.

Mr. Dobson

I am not sure whether the hon. Member for Banbury (Mr. Baldry) is speaking collectively. The independent pay review body is supposed to come up with a sufficiently attractive settlement to keep nurses in the profession, attract new people into it and encourage those who have left to return, as well as bearing in mind affordability. We made that clear by changing its terms of reference. In the past, the body has been leaned on by Governments. We have made its terms of reference quite clear; that was accepted by everybody. We think that the situation is more straightforward. Clearly, if a settlement were not affordable, it would not be any good to anybody.

Mr. John Austin (Erith and Thamesmead)

Conservative Members have referred to beds and trolleys in corridors. Is the Secretary of State aware that such instances are known universally throughout the NHS as Bottomley wards, as a result of the one fifth cut in acute and general beds under the stewardship of the right hon. Member for South-West Surrey (Mrs. Bottomley), and the reduction, year on year, in nurses training places?

I welcome my right hon. Friend's recognition of the problems in recruitment and retention of nurses. Will he consider particularly not just the issue of nurses, but other professions allied to medicine and the need to tackle low pay in them? Will he ask the pay review body to look specifically at the use of discretionary awards and their discriminatory effect on gender and race in the NHS?

Mr. Dobson

It is too late for me to ask the review body to do anything other than deliver its final report to myself and the Prime Minister. However, I have taken what I think can be described only as fairly serious and strenuous steps to try to reduce discrimination on the ground of gender and the quite disgraceful discrimination to which many black and Asian people have been subjected in the NHS. I am phenomenally proud of the health service, but its record on that score is quite deplorable. We are determined to change that, and we are changing it.

Miss Anne McIntosh (Vale of York)

The Secretary of State is on record as saying that only non-urgent operations will be cancelled. Can he explain that to my constituents living in the northern part of the Vale of York, where operations for serious heart conditions, some of which are life-threatening, have been cancelled over the next six weeks? The official reason given by South Cleveland general hospital is that the only consultant heart surgeon there is going off on study leave for up to five or six weeks. Does the Secretary of State agree that such behaviour is totally unacceptable, and will he intervene to ensure that constituents who are expecting operations over that period will be treated?

Mr. Dobson

All I can say on the specific case is that I shall look into it. I have some sympathy with the hon. Lady's point, but she should later address the same question to the right hon. Member for Maidstone and The Weald who, as I understand it, was asking earlier that all work on waiting list cases should be brought to an end.

Mr. Simon Burns (West Chelmsford)

Will the right hon. Gentleman answer the question that he dodged and weaved around during the debate on the Queen's Speech? Given that parliamentary answers and the national health service executive in Leeds have supplied the figures, how can the right hon. Gentleman claim that he has fulfilled his promise on waiting lists with respect to the people served by the Mid-Essex hospital trust, when on 31 March 1997, 104 people had been waiting 12 months or more for hospital treatment, and the November figures show that 1,194 people had been waiting 12 months or more? In every month of his stewardship of the NHS, those figures have gone up.

Mr. Dobson

The figures may have gone up there, but they have not gone up everywhere. They have been coming down over the past six months.