HC Deb 10 January 2000 vol 342 cc21-33 3.31 pm
The Secretary of State for Health (Mr. Alan Milburn)

With permission, Madam Speaker, I would like to make a statement on the outbreak of influenza that is gripping the country and the impact that it is having on NHS services.

As the House will be aware, the past few weeks have seen a particular strain of influenza—Sydney A—affecting thousands of people in all parts of the country. According to the Public Health Laboratory Service, which monitors the incidence of flu, it has been rising in all regions over recent weeks. The worst-affected regions to date have been the north and central. Nationally in early December, the numbers of people consulting their GP for the first time with flu-like symptoms stood at 40 per 100,000 of population. Today, I can tell the House that the latest provisional figure has more than quadrupled to 197 per 100,000.

The chief medical officer, Professor Liam Donaldson, has advised me that the official figures reflect only the people who have consulted their doctor and undoubtedly understate the true size of the outbreak. That is because heavy usage of the new service, NHS Direct, and the number of patients going to the pharmacist mean that many patients will not show up on the conventional GP-based tracking system.

The previous highest levels of influenza since monitoring began were in 1968–69 and 1989–90. The CMO believes that the present epidemic will not reach those levels, but he considers that there are people missing from official statistics, because instead of consulting their GP, they have used alternative routes of advice. That means that unless present levels of influenza activity peak very soon, we could be heading for the worst epidemic in the past decade.

That certainly chimes with most people's experiences. There can hardly be a family in the land that has not been affected by the flu. Everybody knows somebody who has had it. People also know that it is particularly severe in its effects. Professor Brian Duerden, deputy director of the PHLS, says that it is a more prolonged illness, at 10 to 12 days before people start to feel better rather than four or five. The epidemic is also having a particular impact on elderly people, some of whom have developed serious complications such as bronchitis and pneumonia. In addition to influenza, other viruses such as respiratory syncytial virus—RSV—are contributing to acute respiratory illness. I am advised that RSV illness is at its peak at present. Emergency admissions to hospital have increased as a result: there have been more than 200,000 such admissions to hospitals in the past three weeks alone, and there has been an increase of almost 30 per cent. in the past two months. The evidence that we are receiving from hospitals is that the patients who are being admitted are more ill than normal and are staying longer than normal.

The serious flu outbreak has placed additional strain on local health services in many parts of the country. In the past three weeks, the number of people attending hospital accident and emergency departments has risen to more than 600,000. There have been 250,000 calls to ambulance services—an increase of almost one third on last year—and a similar number of calls to NHS Direct over the past three weeks, many flu-related. According to Professor Mike Pringle, chairman of the Royal College of General Practitioners, over the millennium, GP co-operatives had 50 per cent. more calls than last year, mainly owing to the flu.

Those figures clearly demonstrate that the flu outbreak has put real pressure on NHS services—there is no doubt about that. Equally, the evidence suggests that the NHS is dealing with those pressures. All acute hospitals throughout the country have remained open throughout the winter period. Of course, both GP surgeries and hospitals have been extremely busy.

The highest priority is being given to patients who are the most seriously ill. As is usual, and as had been planned, most hospitals have undertaken little routine elective surgery over the past few weeks so as to be able to concentrate their efforts on emergency cases. The number of emergency admissions remained unusually high last week because of the flu outbreak, and many hospitals that had planned to start surgery today have decided to delay until the immediate emergency pressures subside. Hospital managers and clinicians will judge how best to balance their work load in the light of local experience over the next few weeks.

That approach represents a sensible deployment of NHS staff and resources, allowing the health service to cope with the surge in emergency demand that the flu outbreak has brought. Thanks to the staff who run critical care services, they, too, are coping with the demands being placed on them, despite the fact that intensive care is under real pressure. About half the patients being admitted to intensive care have flu or flu-like illnesses, sometimes resulting in pneumonia and—less commonly—in septicaemia, leading to multiple organ failure.

This year, the Government have provided a record number of intensive care and high-dependency beds. We have worked closely with the Intensive Care Society to plan critical care facilities in hospitals. Patients who need acute and critical care are being looked after. There has been an increase of 100 critical care beds this year and, in the face of exceptional demand, staff and facilities are being used flexibly to ensure that patients receive the care that they need. Staff are doing an excellent job in difficult circumstances.

The number of beds available fluctuates by the hour, but I can tell the House that, as of mid-morning today, there were 22 beds available. However, local surges in demand arising as the flu moves around the country will continue to place particular pressures on critical care facilities. Where appropriate, local NHS hospitals have made arrangements with local independent hospitals for critical care. If transfers between intensive care units are required as a last resort, the chief executives of NHS trusts have been asked to ensure that the arrangements run smoothly and that clinical staff are given as much support as possible.

The influenza outbreak has put great pressure on the NHS, but the NHS is coping. As the chairman of the British Medical Association, Dr. Ian Bogle, said earlier today: all parts of the NHS have been put under pressure but doctors and nurses are coping well from GP services to intensive care. The incidence of new cases of flu is uneven but wherever it is occurring it is a particularly nasty strain. Thanks to the high level of planning across the country we are coping". Of course the NHS is under severe pressure. Winter is always the busiest time of year for the national health service; in addition, this winter, the NHS and social services have had to deal with the special pressures brought by the extended millennium period.

That is why planning for this winter began earlier than ever. Local winter planning groups were established in April last year in every part of England to co-ordinate the planning and provision of health and social services over the winter and millennium period. Each group includes health authorities, social services, NHS trusts, primary care groups, out-of-hours and deputising services, NHS Direct, police and fire services, community health councils, other local authority departments, and, of course, the voluntary and private sector.

Each local group submitted its plans for dealing with winter pressures by the end of September 1999. They were followed by visits from the Department of Health's millennium executive team to ensure the robustness of the plans. We have extended the capacity of local health services to deal with winter pressures. Extra beds have been provided, and over the millennium period, for example, 45 per cent. more ambulance staff than the year before were on duty.

Winter planning has also included a major public information campaign. Its aim has been to encourage the public to use the most appropriate service for their needs—the local pharmacy and NHS Direct or, indeed, self-care—as a complement to GP or hospital services. The campaign was backed by the BMA, the Royal College of Nursing and the Patients Association, among others. All the evidence that we have received to date suggests that the public have responded positively to the campaign by recognising that health services should be used appropriately and responsibly.

The campaign was also supported by a large increase in flu vaccinations made available to the public through family doctors. Flu vaccine can never eradicate flu, but it can help to provide further protection for vulnerable groups. This winter, 8.6 million doses of influenza vaccine were made available: 1 million up on last year. We do not as yet have uptake levels for flu vaccine this year, but we will review them when they become available. In the meantime, I have asked the chief medical officer to consider ways of enhancing uptake in future. Increased use of computerised call-up systems is one possibility.

Over the past few weeks, the NHS has risen to the challenges that it has faced. That is not to say that services are not stretched: they are. We owe an enormous debt of gratitude to NHS and social services staff for making sure that services have been there for people when they need them. I hope that the House will want to join me in thanking them for their efforts over Christmas, the millennium and now into the new year.

Health service staff have done a magnificent job and I know that the whole country is grateful to them. They are up against a serious flu outbreak, but I have every confidence that they will go on delivering care for patients where and when they need it.

Dr. Liam Fox (Woodspring)

I am grateful to the Secretary of State for his statement and for giving us a copy in advance. It is long on complacency and short on detail and substance. Many people will have voted new Labour because of the Prime Minister's promises about the health services. How hollow those promises sound now. Those voters must feel betrayed.

I am happy to join the Secretary of State in praising health service staff. I have been one of the health service staff who had to deal with flu outbreaks in the past. However, first-class staff work in an increasingly second-class service, thanks to second-class Ministers.

We may have a flu epidemic—it is hard to get decent information from the Government about what constitutes an epidemic. When considering statistics, there is no truth or untruth with this Government: simply convenience and inconvenience. People in this country are asking how, in the world's fifth biggest economy at the beginning of the 21st century, an illness as predictable, cyclical and common as flu can cause the system to break apart at the seams.

The Secretary of State admits that no elective work has been done in the past week. If the health service had been doing its normal work, it would have fallen apart completely. What faith can we have, in view of the Secretary of State's attitude? When we see sick patients left to die in waiting rooms, waiting in car parks to be seen or stored in converted operating theatres, and when the Secretary of State can say something as complacent as, "The NHS is coping tremendously well," we wonder whether the only isolation unit in this country that is operating is the one that he keeps himself in so that he cannot see the complete picture. NHS staff are coping tremendously well, but they are being badly let down by those who run the service.

The Secretary of State has to answer several points today. Too many beds, especially non-acute and respite care beds, have been lost. How many beds have been lost in the health service since Labour came to power? How many extra beds does he estimate will be needed in the coming months if there is a proper flu epidemic? There are too few intensive care beds. I was warned by a consultant six weeks ago that that represented an impending crisis. Ministers presumably got the same information. What did they do? What plans have been made in the past two months for extra intensive care beds; and what measures were they putting in place, knowing that this was coming? It is also true that the Government's obsession with their waiting list initiative has left the service overstretched and with too little spare capacity to deal with any crisis, including this one.

The Government's dogmatic hatred of the private sector instinctively leads them away from co-operation. Only last week, the Secretary of State was saying that NHS patients would not be treated in the private sector. Now he tells us that they will. Their dogma is put ahead of patients' interests. Will he tell us clearly now whether he will guarantee that no trust will be penalised this month for failing to meet its waiting list targets because of action that it may take to deal with the flu epidemic?

More importantly, in the longer term, will the Government look at a better immunisation programme—[Interruption.] The Secretary of State seems to think that funny. Will they look at a better immunisation programme for the over-75s to make sure that the sort of deadly morbidity of this year is not repeated? What specific measures will the Government take? If they suggest a good immunisation programme, we shall support them.

Will the Secretary of State also please review the decision not to make Relenza available on prescription? That false economy, with the huge cost to British industry—an estimated £6 billion to £8 billion, compared with the £100 million for Relenza—shows what a shabby mechanism the National Institute for Clinical Excellence could be: people can improve their chance of survival by buying Relenza if they can afford it, but cannot get it if they are old or needy. That is the reality of Labour's health policy.

There are three truths that we have to accept: we no longer have the best health care system in the world, the health service cannot do everything—we must not pretend that it can—and the NHS on its own, as currently funded, cannot provide the health care that we need and deserve in this country at the beginning of the 21st century. We need a Government who take a full assessment of the failings of the NHS, who are willing to recognise the reality of the situation that we are in, who will avoid the complacency that we have heard today, and who will increase the total resources across the board for health care in this country.

The Government are failing patients, but worse, they are betraying the trust that the people of this country put in them.

Mr. Milburn

I welcome the hon. Member for Woodspring (Dr. Fox) back from his holidays. Indeed, I welcome him back to the country, which, in his absence, has seen the staff of the national health service coping with a very serious flu outbreak.

Let me deal with the issues that the hon. Gentleman raised one by one. As far as cuts in the number of beds are concerned, if I were he, I would be extremely wary of getting into that territory. Let us not forget that the Conservative Government, during their last 10 years in office alone, managed to cut 40,000 hospital beds—but the Conservatives now have the temerity to complain that there are not enough hospital beds in the NHS.

The hon. Gentleman asked about intensive care. If he had listened to the statement—indeed, if he had read it, as I made it available to him in advance—he would know that we listened carefully to what intensive care doctors and nurses were saying to us. They said that, on the evidence of last year, we needed additional intensive care and high dependency beds. We have provided them: an extra 100 critical care beds were made available to the NHS last year and I am pleased that we did that, given this serious outbreak of flu.

As for the use of private sector beds, I have never said that the national health service would not co-operate with the private sector when it is appropriate to do so. There is nothing to prevent local NHS hospitals from using capacity in the independent sector locally. Some have done so, especially in hard-pressed areas such as London.

Making ideological points cannot mask the facts. It is overwhelmingly the case that the national health service has better intensive care facilities than the private sector, for the simple reason that NHS hospitals are able to provide 24-hour medical cover. Private sector hospitals are not usually able to do that. That is why, this winter, the national health service has taken requests from private sector hospitals to admit private sector patients to NHS critical care facilities. We shall of course continue to do that when it is appropriate. Some estimates show that up to 1,000 patients a year are shifted by private hospitals into NHS intensive care units precisely because the private sector has not been able to cope with the complications that have arisen.

On the issue of Relenza, I do not know where the hon. Member for Woodspring takes his advice from—presumably from the marketing departments of pharmaceutical companies. We take our advice from expert clinicians. The National Institute for Clinical Excellence, which is staffed by a dozen professors of medicine, gave us clear advice that Relenza was not right on clinical effectiveness grounds. However, NICE is working with the drugs company to see whether Relenza could be made available in the future. [Hon. Members: "Ah!"] There is nothing new in that. I know that the sheep are baaing early this year, but that was made clear when we made the announcement on Relenza.

What is depressing about the hon. Gentleman's response to my statement is that it is so predictable. I know that it suits Conservative Members to talk down the incidence of flu in order to talk up the problems in the national health service, but the truth is that the Conservative party is out of kilter with the British people on this issue. The public—each and every family in the land—know that the national health service is dealing and coping with a serious outbreak of flu. While the staff of the national health service are busy coping, the best that the Conservatives can do is to carry on carping.

Mr. Kevin Barron (Rother Valley)

Does my right hon. Friend agree that the attack on the National Institute for Clinical Excellence is an attack on some of the most eminent clinicians in the health service? The ideology coming from the Opposition Front-Bench spokesman shows that he should take some sound advice.

How many people were immunised against flu last year to try to prevent their being affected? If expenditure had remained as it was under the previous Government, how many, if any, of the extra 100 critical beds would have been available in the national health service to cope with this problem?

Mr. Milburn

I am grateful to my hon. Friend. As he rightly says, Conservative Members are always urging the Government to take difficult decisions to prioritise health services but, when we take those difficult decisions, they criticise them.

As I explained, we have increased the doses of vaccination available through GPs' surgeries. We do not yet have the figures on uptake rates, but we shall review them when we get them. We know that we probably need to do more to encourage uptake, and I have asked the chief medical officer to report to me on the best way of doing that in the future.

My hon. Friend is on to a very good point about the funding of the national health service. The Conservatives claim that there are not enough hospital beds and there is insufficient funding for the NHS. The Conservative party is the very party that, when we announced our record cash injection into the national health service, described the extra funding as reckless, mad and irresponsible.

Mr. Matthew Taylor (Truro and St. Austell)

The Secretary of State was right to thank NHS staff for trying to cope with the current problems, but he came to the Dispatch Box to suggest that all was well, and those staff know that all is not well. Patients, especially those who have been carted around the country in search of beds, know that all is not well; and those who are in the areas where there are no beds for sufferers are very much aware that all is not well.

The Secretary of State likes to speak of critical care beds. Will he clarify the position relating to funded intensive care beds? In September, he conducted a survey to establish the numbers of both intensive care and high dependency beds, and he has put those figures together. What is the number of intensive care beds? The Intensive Care Society, to which we spoke today, did not know the answer, and feared that the number of funded beds might have fallen.

The fact is that the overall difficulty experienced by the NHS results from a lack of flexibility. It lacks the resources to cope with a peak demand of this sort, even at its current level, which has not yet exceeded that of last year: the graph is still the same. Is it not a fact that, so far, the NHS has not turned the corner, following 18 years of misrule by the Conservative party—years that the hon. Member for Woodspring (Dr. Fox) tried so conveniently to forget?

Having moved from the Treasury to the Department of Health, does the Secretary of State now regret his former team's decision to introduce a lp cut in income tax while the NHS was still clearly underfunded, and was still experiencing the difficulties of the Conservative years?

Mr. Milburn

Let me issue a small health warning to the hon. Gentleman. Before quoting figures relating to money, he should consult his own party's manifesto for the last general election, which makes interesting reading. The Liberal Democrats promised an injection of an extra £500 million a year for the NHS—a pittance by comparison with the extra money that the present Government have invested in it.

The hon. Gentleman made a more serious and substantive point about the number of intensive care beds. He was right to say that the last Government did not even know how many such beds were available in our hospitals. That is why we instituted a census to establish the number; the results will be published shortly. The extra 100 critical care beds are a mixture of intensive care and high dependency beds. As I speak, we have approximately 1,570 intensive care beds and 800 high dependency beds.

Ms Ann Coffey (Stockport)

Last Friday, I visited Stepping Hill, my local hospital. I am pleased to say that, despite a record number of emergency referrals to casualty over the past two weeks, there were no unacceptably long trolley waits and no ambulances stacked outside, and beds and treatment were available to all who needed them. That visit was in marked contrast to my visit to the same hospital at Christmas in 1997, when there were a record number of trolley waits, stacked ambulances and a lack of beds throughout the region. Of course, the Conservative party was in power at the time. [Hon. Members: "No!"] It all seems such a long time ago.

One reason why the problem has been managed so much better this Christmas is the fact that there has been much better planning, along with co-operation with general practices and community services and a great deal of commitment on the part of staff at the hospital. Will my right hon. Friend join me in congratulating those staff on managing this Christmas crisis?

Several hon. Members


Madam Speaker

Order. I should like to remind the House that it is question time, not statement time, so will Members please put questions to the Secretary of State, not compliments?

Mr. Milburn

With regard to the recollections of my hon. Friend the Member for Stockport (Ms Coffey), time certainly flies when you are enjoying yourself, Madam Speaker. What she says about the position this year is right. It is borne out by what many senior clinicians and managers have been telling us—that the NHS is better prepared and planned than ever before. I have been particularly pleased to see a high level of co-operation in many areas, including her own, between the NHS and social services. Not too long ago, the NHS and social services viewed each other as enemies on opposite sides of the fence. It is heartening that, on the ground, they now co-operate. That can only be to the benefit of patients.

Mr. Paul Keetch (Hereford)

The Secretary of State will know about the tragic death last week of my constituent Mr. Harold Smith of Ross-on-Wye, who died in a bed in Bridgend after being moved from Herefordshire because no intensive care beds were available. I am sure that the whole House will join me in sending condolences. The internal investigation is under way, but can the Secretary of State tell the House whether the flu crisis caused the lack of beds in Herefordshire which caused Mr. Smith to be moved?

Herefordshire has gained one more intensive care bed since the Government came to power, but what will the effect be on the new hospital that is being built in Hereford—the number of beds will be cut from around 400 to just 250 by 2005? Will the Secretary of State assure the House that that number will be sufficient to deal with any influenza crisis? Will he assure me that he will review the position to ensure that such a tragedy does not happen again?

Mr. Milburn

May I give the hon. Gentleman that assurance and pass on my condolences to the family of Mr. Smith? As the hon. Gentleman rightly said, an internal inquiry is taking place. That is due to report shortly. I do not want to pre-empt it, but I understand that human error is the most likely cause of the tragedy.

The hon. Gentleman is right to say that we have provided extra hospital intensive care facilities since we came to office. I know that he lobbied extremely assiduously and successfully for a new hospital, which is being built through the private finance initiative. It might help him to know that we are making available additional capacity for up to two extra intensive treatment or high dependency beds. In preparation for the new hospital, further ITU nurse training will be undertaken during the next financial year.

Mr. Dale Campbell-Savours (Workington)

The people should know that influenza injections work. I have had one each year for the past three years and I have not had flu for three years. It is the same for people throughout the country who have had the injections. However, a problem arises with some groups of people: they fear the needle. The injection is painless; it is a couple of pin pricks. That may seem of little importance to Members, but to people outside who face the prospect of injection, it is important. They should feel absolutely reassured.

Mr. Milburn

I am grateful to my hon. Friend for that sensible advice. It is good advice. We and the chief medical officer continue to encourage people, particularly the vulnerable and those in at-risk groups such as the elderly, even now to go to their family doctor and to be vaccinated against the flu. It is not too late; and it is a sensible action. I hope that many elderly people and others at risk, such as those with chest and respiratory problems, will consider doing so.

Mr. Roger Gale (North Thanet)

I visited the Queen Elizabeth the Queen Mother hospital, Margate this morning. I found it heaving with patients, with admissions being accommodated in day care beds because every other bed was full. I join the Secretary of State in paying tribute to staff there and at the Queen Victoria Memorial hospital, Herne Bay, who are doing their best to cope. They tell me that one of the problems that they face is a lack of staff not only through long-term staff shortages, but through sickness too. We have heard much about the flu vaccine. How many people in the NHS—not just medical staff but ancillary staff—have been offered and have taken up the vaccine?

Mr. Milburn

I join the hon. Gentleman in paying tribute to the staff at his local hospital. As I said in my statement, we acknowledge that the NHS, particularly in the acute sector, is extremely busy and that staff are doing a quite remarkable job. I cannot give the hon. Gentleman the actual numbers on staff flu vaccination, but I can tell him that, this year, for the first time, we made flu vaccination available to NHS staff. Although that was a sensible precaution, it has not proved to be successful in every case, and there have been quite high levels of staff sickness. Nevertheless—although not every NHS staff member decided to heed the advice of my hon. Friend the Member for Workington (Mr. Campbell-Savours)—I have no doubt that staff vaccination has had an impact.

Hon. Members will know that the current flu bug is particularly nasty; that it affects NHS staff just as it affects everyone else; and that not only hospitals, but schools and businesses across the country are being affected by it. Nevertheless, the views expressed by the hon. Member for North Thanet (Mr. Gale) were sensible, and we shall seek to learn lessons from this year, and to determine whether, next year, we can vaccinate even more NHS staff members against the flu.

Dr. Tony Wright (Cannock Chase)

Is it not depressing that there are people around who find it impossible to talk about any issue at all without turning it into a political game? When even an influenza epidemic has to become a political football, is it surprising that the people who engage in such games are not household names even in their own households?

Will the Secretary of State clarify one matter? I speak from self-interest—like my hon. Friend the Member for Workington (Mr. Campbell-Savours), as a recipient of the flu jab—and am not clear whether the strain of flu that I was immunised against is the strain that is sweeping the land. Is it, or is it not?

Mr. Milburn


Mr. John Townend (East Yorkshire)

In view of what the Secretary of State said about the need for immunisation, what would he say to Mrs. Wheddon, of Watton, in my constituency, who rang me this afternoon and said that, today, on the media, she had heard a health service spokesman say that people should go to be vaccinated? She rang up her local surgery and was told that—although she suffers from emphysema—no vaccine was available, and that they thought that there was a shortage of it across the country.

Subsequently, I rang my general practitioner, in Yorkshire, and asked whether—as the Secretary of State recommends—I could have a flu vaccination, but was told that he had no flu vaccine. I pointed out that the other surgery had said that there was a national shortage of flu vaccine, and asked whether that was the case. I was told, "We are going to get some more, but only a very limited quantity, and we will put you on a waiting list."

Does the Secretary of State agree that the current situation demonstrates that the Government were completely unprepared for a flu epidemic, and that spin will not solve Mrs. Wheddon's problem?

Mr. Milburn

Tediously predictable, as usual.

Mr. John Bercow (Buckingham)

Could anyone be tediously predictable as not usual?

Mr. Milburn

That is a very good point. It is good to see that the hon. Gentlemen has—perhaps; we shall see—recovered from his Christmas break.

I should be very glad to investigate local problems with the availability of flu vaccination. As far as I am aware, however, there is no local shortage of vaccine. Indeed, although the accusation made by Opposition spokesmen has been that we have not made flu vaccine available, we have in fact been providing it to family doctors. I see the hon. Member for East Yorkshire (Mr. Townend) nodding.

I remind the hon. Gentleman that, last year, the current Government became the first one to make available flu vaccination to all members of vulnerable groups, such as over-75s. We reversed the previous position, as that was the sensible course of action to take. We shall, of course, learn from this year, and we shall improve on it. However, it is simply not the case that people generally have not been receiving a flu vaccination if they need one.

Fiona Mactaggart (Slough)

My local hospital, Wexham Park, like that of other hon. Members, is admitting twice as many people as it usually does. It is coping because doctors and nurses are working very hard indeed, for which I pay tribute to them.

Two issues arise. First, many hospital registrars are facing examinations, on which they are working very hard, and hospital management will have to provide them with study time to cope with that pressure. Is any action being taken centrally to help local hospital trusts address that issue?

Secondly, some of the cancelled elective surgery was cancer surgery. Some local people are scared because we are not meeting the swift times that we have introduced for cancer surgery. As the crisis diminishes, will my right hon. Friend encourage hospital trusts to make those operations a high priority? Some people who have had to have their time changed for inevitable managerial reasons will need to be dealt with urgently when it becomes possible.

Mr. Milburn

I shall give my hon. Friend and her constituents that assurance. We have continually reiterated that treatment on the national health service should be according to clinical urgency as well as clinical need. That has always been the position. Of course hospitals are hard pressed at the moment. Some are having to cancel routine elective surgery. As the pressures diminish, I expect the national health service and local hospitals to get back on track and start to treat patients according to the urgency of their conditions. That is the appropriate thing to do, and it is what the national health service has been doing.

Dr. Evan Harris (Oxford, West and Abingdon)

Does the Secretary of State accept that, to justify his assertion that the figures of the Royal College of General Practitioners for a flu epidemic—which show a typical year, not an atypical year—are wrong, the Government need to publish data from NHS Direct or elsewhere? If not, he runs the danger of the chief medical officer appearing to be a political football—a subject just referred to by the hon. Member for Cannock Chase (Dr. Wright).

I worked in my local casualty department over the millennium. Does the Secretary of State accept that NHS staff want more money for the health service? They recognise that the disease afflicting the NHS is a contagious one caught by the Government from the Tories. It involves their spending pre-election war chests on tax bribes rather than on NHS services. Does he accept that to blame a microbe for the problems of the NHS, when the real problem is years of underfunding which the Government have continued, does a disservice to the people working in the health service?

Mr. Milburn

No, I do not accept that. The Government are giving the NHS a record cash injection. I should have thought that the hon. Gentleman would welcome that. As the economy grows, the national health service can grow. I am determined to ensure sustained and sustainable increases in funding for the NHS, not just this year, next year and the following year, but in the years after.

The hon. Gentleman's first point was a decent and substantive one. We are into a new ball game. The chief medical officer is looking again at the advice that we have received from the PHLS, because we have listened carefully to clinicians and managers, who have told us over the past three or four weeks that the official figures dramatically understated the range of demand in hospital accident and emergency departments and in GP surgeries. The evidence on the number of people who have been to the pharmacist and bought cold and flu remedies from major outlets such as Boots the Chemist, as well as those phoning NHS Direct, shows that many people have heeded the chief medical officer's sensible advice that the best way to deal with the flu is to take care and stay at home.

Dr. Howard Stoate (Dartford)

I spent part of my millennium break helping to treat the flu epidemic and vaccinate those at risk. My local health trust in Dartford and Gravesham has coped very well. It has increased the number of intensive care beds by 50 per cent. to cope with the difficulty. One of the trust's main problems has been a shortage of highly trained specialist nurses to manage those beds. When does my right hon. Friend predict that the Government's new nurse recruitment and training programme will start to roll out such highly qualified and dedicated nurses into our wards and intensive care units, so that we no longer encounter critical problems every year caused by a lack of nurses?

Mr. Milburn

As my hon. Friend knows, we aim to recruit up to an extra 15,000 nurses to the national health service over the next few years. We are making good progress on that. So far, around 4,000 nurses have returned to the national health service or returned to training as a result of the recruitment campaign initiated by my predecessor, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). That is beginning to take effect.

More optimistically for the longer term, I can tell my hon. Friend that the number of applications this year for nurse training courses in colleges is double the previous year's. That is a good sign. We know that there are problems with particular specialties which have come about as a direct consequence of the fact that the previous Government cut not only the number of nurses, but—even more short-sightedly—the number of nurses in training. We are beginning to make up that lost ground. It will take time, but we are seeing nurses come back to the NHS.

Mr. David Prior (North Norfolk)

Does the Secretary of State have the honesty and the courage to admit that, compared with other developed countries, the resources in this country made available to the health service, private and public, are massively underfunded?

Mr. Milburn

As I told the hon. Member for Oxford, West and Abingdon (Dr. Harris), I want to see sustained increases in investment in the NHS—this year, next year and in the years that follow. By the end of this Parliament, for the first time ever, spending on the NHS will have risen to more than 6 per cent. of gross domestic product.

Mrs. Eileen Gordon (Romford)

I am a great supporter of NHS Direct—I could be accused of using it as a political football—which was introduced by the Labour Government. Is my right hon. Friend as pleased as I am by the valuable contribution that it has made during the influenza outbreak? Will he issue statistics on how many calls to NHS Direct concern flu-related symptoms? Is there any way of estimating how many of those people chose NHS Direct rather than presenting themselves to GPs or accident and emergency departments, which would have added to the stresses and strains?

Mr. Milburn

My hon. Friend is right. NHS Direct, described by the Tory party as a gimmick, has proved its worth and its mettle over the millennium period. It has taken almost 250,000 calls, many of which have been related directly to flu. Early evidence suggests that NHS Direct is referring about one third of those who ring up to more appropriate and less intensive forms of care than they envisaged when they made the phone call. In other words, people who might have expected to turn up at their GP's surgery, to call the family doctor out of hours, or to turn up at the local casualty department are instead looking after themselves and their families at home where that is the safe thing to do. NHS Direct is a real success story, not least because it is helping patients to get the most appropriate level of care and treatment that they need.

Mrs. Virginia Bottomley (South-West Surrey)

The Government have been in power for 130 weeks, and the Secretary of State has five Ministers. In that time, no Minister has visited any of the eight constituencies within the West Surrey health authority area. Is that because the authority has lost 111 beds, nurse vacancies are over 300 and accident and emergency trolley waits are the longest in the country? I join the right hon. Gentleman's praise for NHS staff, but does he intend to come and tell those staff that things can only get better, as they have seen a sharp deterioration in the years since his party came to power?

Mr. Milburn

The right hon. Lady takes an active interest in her local health service—particularly the local hospitals—and she has been to see me to express some of her concerns. The question of why no Minister has visited the area is one that I will try to put right for her and for the hon. Member for Guildford (Mr. St. Aubyn), if she would find that helpful. She should recall that the reasons we have some of the problems in West Surrey are precisely the appalling deficits that the health authority built up when she, I think, was Secretary of State for Health.